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Background: Non-adherence occurs in various groups of patients, including those with chronic diseases. One strategy to increase adherence among oncological patients is to individualise treatment and expand pharmaceutical care. Pharmaceutical labels that remind patients how they should take their medications are of great importance in this respect. Objective: The main objective of this study was to evaluate medication adherence in oncological patients, and to gather their opinions on the individual medication labelling system as an element of effective treatment. Methods: The study was conducted in 2021 among 82 patients of the oncological department of the Centre of Oncology in Radom. The research tool was a questionnaire consisting of personal data and two parts relating to the patient’s disease and the medication labelling system. Results: Nearly half of the respondents reported that they forget to take medications and how they should take them. These problems increased with the age of the patient and the number of administered medications. Of the respondents, 89% stated that the labels with dosing information are helpful. Over 67% agreed that these labels should be affixed to all medications. Nearly 90% of the respondents believed the labels should be available in all pharmacies. Conclusions: Non-adherence is a common phenomenon among oncological patients. Pharmacists providing a labelling service for medicinal products can play a significant role in reducing this phenomenon.

Przewlekła choroba oskrzelowo-płucna, której postęp spowodowany jest przewlekłymi zakażeniami, stanowi główną przyczynę hospitalizacji i śmierci osób chorych na mukowiscydozę. Wśród bakterii najczęściej powodujących przewlekłe zakażenia wyróżnia się Staphylococcus aureus oraz Pseudomonas aeruginosa. W celu ustalenia statusu mikrobiologicznego konieczne jest systematyczne wykonywanie badań mikrobiologicznych u każdego pacjenta. Umożliwia to wczesne wykrycie zakażenia patogenami wymagającymi eradykacji (np. Pseudomonas aeruginosa, Staphylococcus aureus oporny na metycylinę) i natychmiastowe jej wdrożenie. W przypadku zaostrzenia choroby oskrzelowo-płucnej zawsze konieczne jest rozpoczęcie antybiotykoterapii zgodnie z dostępnym antybiogramem. Ewentualna modyfikacja leczenia może nastąpić po uzyskaniu aktualnego wyniku posiewu i ocenie stanu pacjenta. Zazwyczaj dawki antybiotyków są wyższe niż w populacji ogólnej, a czas leczenia ulega wydłużeniu. Zakażenie prątkami niegruźliczymi jest rzadkim, mogącym doprowadzić do poważnych następstw powikłaniem. Alergiczna aspergiloza oskrzelowo-płucna i inwazyjna aspergiloza płucna stanowią coraz częstszy problem u pacjentów z mukowiscydozą i wymagają specjalistycznego, monitorowanego leczenia. Postępowanie w zakażeniach bakteryjnych i grzybiczych u osób chorych na mukowiscydozę różni się znacząco od postępowania wdrażanego w populacji ogólnej. Lekarz sprawujący opiekę nad pacjentem z mukowiscydozą musi znać podstawowe zasady terapii zakażeń dróg oddechowych, ponieważ ich właściwe zastosowanie w codziennej praktyce wpływa znacząco na długość i jakość życia pacjentów.

Introduction: Spiritual care is needed in a clinical setting to improve the patients’ quality of life. Deep connection with another person and delight with the beauty of nature or art and (in some cases) with God are all transcendental experiences. They may enable patients to ascribe meaning to their life with a chronic illness, find hope and well-being despite burdening symptoms. The opposite situation: lack of inner peace, inability to accept what is happening, feeling disconnected from others is called spiritual distress. Objectives: The aim of this research is to assess spiritual distress and spiritual needs of a group of Polish chronically ill patients and find associations with independent variables in order to provide data for recommendations on spiritual care in Poland. Patients and methods: 204 patients treated at the University Hospital and the Cystic Fibrosis Clinic in Poznan were surveyed in 2017 and 2018 with an original questionnaire. Results: Over half of the patients felt that their illness was life-threatening. A little more than half reported that faith was a resource to cope with suffering. Almost all patients showed signs of spiritual distress, and more than half expressed spiritual needs. The intensity of distress correlated only with the severity of the disease. The most important predictor of having spiritual needs was recognizing faith as a resource. Conclusions: Spiritual needs are associated with personal beliefs; however, spirituality spans beyond the religious context since spiritual distress is unrelated to the level of religious devotion. Therefore, any patient with a severe chronic disease needs basic spiritual care, which includes being treated with compassion.

Introduction: The severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) infection resulted in significant worldwide morbidity and mortality. The aim of our study was to evaluate the results of laboratory tests performed on patients on admission to the hospital between groups of patients requiring and not requiring oxygen supplementation, and to find predictive laboratory indicators for the use of high-flow nasal oxygen therapy (HFNOT)/continuous positive airway pressure (CPAP)/bilevel positive airway pressure (BPAP). Materials and Methods: We retrospectively analysed the data of consecutive patients hospitalised in the Pulmonology Department of the Temporary COVID Hospital in Poznan from February to May 2021. On admission to the department, the patients had a panel of laboratory blood tests. Results: The study group consisted of 207 patients with a mean age of 59.2 ± 15.0 years of whom 179 (72%) were male. During hospitalisation, oxygen supplementation was required by 87% of patients. Patients requiring oxygen supplementation and/or the use of HFNOT/CPAP/BPAP had lower lymphocyte counts and higher levels of urea, C-reactive protein, D-dimer, troponin, glucose, lactate dehydrogenase (LDH) as well as higher white blood cell and neutrophil counts, The parameter that obtained the highest area under curve value in the receiver operator curve analysis for the necessary use of HFNOT/CPAP/BPAP or CPAP/BPAP was LDH activity. Conclusions: Among the basic parameters assessed on admission to the temporary hospital, LDH activity turned out to be the most useful for assessing the need for CPAP/BPAP active oxygen therapy. Other parameters that may be helpful for predicting the need for HFNOT/CPAP/BPAP are serum levels of urea, D-dimer and troponin.

This study aims to investigate whether wearing face masks (filtering facepieces, FFP class 2) with personal protective equipment (FPP2/PPE), while working a 12-h shift in a COVID-19 referral center, affects the blood saturation, heart rate (HR), and well-being of health care providers (HCPs). The study included a group of 37 HCPs. To perform continuous recordings of the SpO2 and heart rate (HR) in real time, we used a Nellcor PM10N (Covidien, Mansfield, MA, USA) portable monitoring system. SpO2, HR, and HCP well-being scales were measured during two 3-h shifts, while HCPs worked during a 12-h period. Additionally, each subject completed a questionnaire concerning their well-being. The difference in the SpO2 level between the 1st and 2nd working shifts while wearing an FFP2/PPE was small, with a median decrease in SpO2 of −1%. The scales of the well-being indicators increased within the shift. They were mainly fatigue and thirst with median scores of 2 out of 6 (range 0–4). We assume that during a 12-h period, a work scheme that consists of a 3-h shift in FFP2/PPE and a 3-h rest period (working without FPP2/PPE) is a reliable and safe solution for HCPs working in specialized COVID-19 referral hospitals.

The MTP Temporary Hospital in Poznań operated within the nationally adopted model of dealing with the COVID-19 epidemic, being one of the largest clinics of this type in the country. It has become an essential element in the fight against the pandemic in the region. The article presents the basic principles and organizational framework for the functioning of this makeshift hospital, which fulfilled its medical and social role thanks to the persistent work of a wide range of competent employees and well-used infrastructure.

The aim of this study was to assess the periodontal status of cystic fibrosis (CF) adult patients and to evaluate whether there is a correlation between the bacterial population of the subgingival biofilm and the health status of the periodontal tissues in this group of adults. The study involved 22 cystic fibrosis adult patients. The periodontal condition was assessed using Plaque Index (PLI), Gingival Index (GI), and Probing Pocket Depth (PPD). The gingival sulcus samples were analyzed by the Real-Time PCR assay (RT-PCR). Majority of patients showed moderate or severe bacterial dental plaque accumulation, but none of them had clinical symptoms of periodontal diseases. RT-PCR showed the presence of periopathogens in 50% of patients. Red complex microorganisms were detected in 9.09%, orange complex in 27.27%, and green complex in 31.82% of the samples analyzed. In cystic fibrosis patients colonized by periopathogens, the periodontal markers were significantly higher in comparison to not colonized by periopathogens patients. Despite the widespread presence of bacterial dental deposits in the cystic fibrosis adult patients examined, none of them has clinical symptoms of periodontal disease; however, the presence of periodontal pathogens in subgingival biofilm may represent a possible risk factor of this disease in the future. An unsatisfactory level of oral hygiene in any patient with cystic fibrosis indicates a need to focus on standards of dental care for such patients. The aim of this study was to assess the periodontal status of cystic fibrosis (CF) adult patients and to evaluate whether there is a correlation between the bacterial population of the subgingival biofilm and the health status of the periodontal tissues in this group of adults. The study involved 22 cystic fibrosis adult patients. The periodontal condition was assessed using Plaque Index (PLI), Gingival Index (GI), and Probing Pocket Depth (PPD). The gingival sulcus samples were analyzed by the Real-Time PCR assay (RT-PCR). Majority of patients showed moderate or severe bacterial dental plaque accumulation, but none of them had clinical symptoms of periodontal diseases. RT-PCR showed the presence of periopathogens in 50% of patients. Red complex microorganisms were detected in 9.09%, orange complex in 27.27%, and green complex in 31.82% of the samples analyzed. In cystic fibrosis patients colonized by periopathogens, the periodontal markers were significantly higher in comparison to not colonized by periopathogens patients. Despite the widespread presence of bacterial dental deposits in the cystic fibrosis adult patients examined, none of them has clinical symptoms of periodontal disease; however, the presence of periodontal pathogens in subgingival biofilm may represent a possible risk factor of this disease in the future. An unsatisfactory level of oral hygiene in any patient with cystic fibrosis indicates a need to focus on standards of dental care for such patients.

There is growing evidence that obstructive sleep apnoea (OSA) influences the hypothalamic–pituitary–gonadal axis (HPG axis) in men. The aim of the study was to assess the association of nesfatin-1 with HPG axis disturbances in OSA. This is a prospective study with consecutive enrolment. It comprises 72 newly diagnosed OSA patients ((AHI: apnoea-hypopnea index) 18 subjects: 5 ≤ AHI

Aim. Increased arterial stiffness is a risk factor for cardiovascular disease (CVD). Adult men with untreated hypertension are at risk of future CVD. The study aimed to compare the effects of a submaximal exercise on the recovery of the two descriptors of arterial pressure waveform, i.e. stiffness index (SI) and reflection index (RI), between men with untreated hypertension (HA) and healthy peers. Material and Methods. The study included 70 Caucasian men with untreated primary HA and 30 normotensive men. Blood pressure, SI and RI were determined by photoplethysmography before and 6 minutes after a submaximal (up to 85% of age-predicted maximal heart rate) exercise on a treadmill. Results. Baseline SI was higher in HA than control men (6.06 [0.66] vs. 6.61 [0.84] m/s; p=0.0019) and remained significantly increased during post-exercise recovery only in HA men (7.59 [1.6] vs. 6.18 [0.85] m/s; p

Background: Primary ciliary dyskinesia (PCD) is a rare, ciliopathic disorder. In many ciliopathies, dental anomalies are observed alongside other symptoms of the disease. To date, there are no published reports concerning the dental developmental problems that are associated with ciliary defects in PCD patients. Methods: Patients suffering from PCD underwent dental clinical examination, which included the assessment of developmental disorders regarding the number and morphological structure of the teeth (size and shape) as well as developmental disorders of mineralised dental tissues. Then, three-dimensional radiographic examination was performed utilising Cone Beam Computed Tomography (CBCT). Results: Four PCD patients, aged 31-54, agreed to enter the study. Dental examinations showed the presence of dental developmental disorders in three of them. Additionally, CBCT showed abnormalities in those patients. Conclusions: 1. The dental phenotype in PCD patients seems to be heterogeneous. Tooth developmental disorders resulting from abnormal odontogenesis may be a symptom of PCD that is concomitant with other developmental abnormalities resulting from malfunctioning primary cilia. 2. Patients with ciliopathies are likely to develop dental developmental defects. Therefore, beginning in early childhood, they should be included in a targeted specialised dental programme to enable early diagnosis and to ensure dedicated preventive and therapeutic measures.

Selectins and their ligands play an important role in atherosclerosis. The role of these adhesion molecules in the pathogenesis of obstructive sleep apnea (OSA) may be of clinical relevance. Therefore, the aim of this study was to assess the serum content of platelet P-selectin (P-SEL) and P-selectin glycoprotein ligand 1 (PSGL-1) in different OSA stages. The study was performed in nondiabetic patients, aged 32–71, in whom OSA was verified by polysomnography. The apnea/hypopnea index (AHI) was used to stratify OSA stages: AHI 30, (OSA-3). There were 16 patients in each group. P-SEL and PSGL-1 were assessed by ELISA kits. There were no appreciable differences in the patients’ glucose or high-specificity C-reactive protein content. We found that P-SEL and PSGL-1 significantly increased from OSA-0 to OSA-3. There were the following positive associations in all OSA patients: P-SEL vs. AHI, PSGL-1 vs. AHI, and P-SEL vs. PSGL-1. In addition, the adhesion molecules are associated with the anthropometric parameters, oxygen saturation, and sleep architecture in the OSA-1 group. We conclude that the adhesion molecules consistently increase in the blood of nondiabetic OSA patients, along with progression of disorder severity.

The COVID-19 pandemic significantly impacted the healthcare system, including dentistry. However, it is not entirely clear whether affected patients’ willingness for regular dental visits and preventive behaviors with regards oral hygiene and diet. This is essential to understanding the potential effects of the COVID-19 pandemic on the acceleration of dental issues in the future. It was aimed at checking the level of dental visit avoidance, self-reported oral health needs, and dietary changes. This cross-sectional questionnaire study conducted in Poland (n = 2574; mean age 44.4 ± 15.6; female 56.3%) assessed nutritional habits and dental care changes during the COVID-19 pandemic. As demonstrated, nearly half of the responders (47.1%) avoided regular dental visits, while only 0.5% used online consultations. Fears related to potential cross-contamination in dental offices dropped from 25% to 11.4% and were associated with increased BMI and age (p < 0.05). Sweet snacking/drinking confirmed 19.1%/33.2% subjects. Self-reported oral health care needs (tooth stain, calculus, gingivitis, loss of fillings) were related to frequent snacking and poor oral hygiene (p < 0.05). The study highlights that pandemic periods are covered by eating and drinking changes combined with inadequate hygiene and dental care impose health complaints in the oral cavity. This can magnify both nutritional and interrelated oral health issues, highlighting the need to implement preventive and mitigation measures.

Introduction: Bronchial artery embolisation (BAE) is one of the methods used in massive and recurring haemoptysis. The aim of the study is to determine the effectiveness and complications of bronchial artery embolisation in recurring haemoptysis. Material and methods: The analysis included 47 embolisation procedures performed on 30 patients treated between 2011 and 2017 in the Department of Respiratory Medicine, Allergology and Pulmonary Oncology due to haemoptysis. The patient’s age ranged between 18 and 71 years, while mean age at the time of BAE was 33.5 years. Patients with tuberculosis constituted 73.33% (n = 22) of the sample and underwent 31 embolisation procedures in total. The remaining part of the sample (n = 8) collectively underwent 16 BAEs. The analysis was conducted by verifying the medical documentation, as well as carrying face-to-face and phone conversations. Results: Immediate control due to the inhibition of bleeding was obtained in 95.75% of cases. Recurrence within 3 days of BAE was reported in 5 patients (10.63%), and 4 re-embolisation procedures were conducted. In 10 patients (33.33%), recurrence was observed during the first year post-BAE, while it was reported in 17 cases during the whole observation period (56.66% of patients). The subjects who underwent re-embolisation demonstrated recurrence-free periods lasting from 2 days to 63 months. In patients with recurrence but no re-embolisation, the shortest and longest haemoptysis-free time was 2 and 35 months, respectively. 11 patients (36.66%) required several embolisation procedures during the whole observation period. Conclusions: BAE is a highly successful procedure in treating haemoptysis. The risk of complications is low.

Aim To determine tissue expression (mRNA, protein) of two types of mucins [mucin 1 (MUC1) and mucin 2 (MUC2)] in patients with colorectal cancer (CRC). Methods Expression of membrane-bound mucin (MUC1) and secretory mucin (MUC2) in CRC (mRNA, protein) were analyzed in tissue material including fragments of tumors obtained from CRC patients (n = 34), and fragments of normal colorectal tissue from the same patients (control). The analysis was conducted using real-time quantitative polymerase chain reaction (RT-qPCR) (transcripts), immunohistochemistry (IHC) (apomucins), and the modern approach for morphometric analysis of IHC reaction (HSV filter software). Results on tissue expression of both mucins (mRNA, protein) were compared to histological alterations in colorectal cancer samples and correlated with selected clinical data in the patients. The statistical analysis was conducted using Statistica PL v. 12.0 software. Results Significantly higher expression of the MUC1 mRNA in the CRC, compared with the control and the borderline correlation of mRNA expression with MUC1 protein levels in colorectal samples was observed. The expression of apomucins concerned cell membranes (MUC1) and cytoplasm (MUC2) and occurred both in control tissues and in most cancerous samples. There were no significant relationships between MUC1 (mRNA, protein) and the clinicopathological data of patients. MUC2 protein expression was significantly lower as compared to the control, while MUC2 mRNA expression was comparable in both groups. The MUC1/MUC2 ratio was significantly higher in CRC tissues than in the control. The higher expression of MUC2 was a feature of mucinous CRC subtypes, and characterized higher histological stage of tumors. Negative correlations have been obtained between MUC2 and the Ki-67 antigen, as well as between MUC2 and p53 protein expressions in CRC. Conclusion A combination of tissue overexpression of MUC1, reduced MUC2 expression, and high ratio of MUC1/MUC2 is a factor of poor prognosis in CRC patients. MUC2 tissue expression allows to differentiate mucinous and nonmucinous CRC subtypes.

Purpose The risk of vitamin E deficiency is of primary concern in cystic fibrosis patients. However, early diagnosis and routine vitamin E supplementation can lead to its normal or even high levels. In the present study, we assessed vitamin E status in a large group of cystic fibrosis patients. Moreover, we also aimed to establish determinants of its body resources in cystic fibrosis patients. Material and methods The study group comprised 211 cystic fibrosis patients aged from 1 month to 48 years. In all of them serum α-tocopherol concentration was analyzed using high-performance liquid chromatography. Results Median vitamin E concentration was 9.9 μg/ml (1st–3rd quartile: 7.5–13.5). Vitamin E deficiency was found in 17 (8.0%) and high levels were documented in 24 (11.4%) participants. Patients with and without vitamin E deficiency did not differ significantly with respect to age, standardized body weight and height, FEV1, albumin concentration and vitamin E supplementation dose. However, vitamin E deficiency appeared more frequently in participants without vitamin E supplementation. Moreover, in multiple linear regression analysis pancreatic insufficiency, severe CFTR gene mutation and vitamin E dose, were potentially defined as determinants of vitamin E concentration. Conclusions Vitamin E deficiency in cystic fibrosis patients is rather rare nowadays. Excessive vitamin E levels seem to be more frequent. Vitamin E status wasn’t documented to be strictly related to clinical determinants. Beyond vitamin E supplementation, exocrine pancreatic function and CFTR gene mutations may have had an impact on the vitamin E body resources in cystic fibrosis patients.

Background Routine administration of vitamin A, recommended in CF patients, can help to prevent its deficiency. However, high vitamin A supplementation may lead to its excessive level and possible toxicity. Therefore, the aim of the present study was to assess the status of vitamin A and the determinants of its body resources in CF patients. Methods In 196 CF patients aged from 4 months to 47 years, the following parameters were analysed: nutritional status (standardized body weight and height, serum albumin concentration) and clinical expression of disease (lung function - spirometry; biochemical markers of liver function - ALT, AST, GGT; respiratory tract colonization by Pseudomonas aeruginosa; diabetes; cirrhosis, non-cirrhotic liver disease; exocrine pancreatic function - fecal elastase-1 concentration; blood clotting - INR and vitamin A supplementation). Results Median vitamin A concentration in the study group was 383.0 ng/ml (1st-3rd quartile: 316.5-457.0). Vitamin A deficiency was found in 32 (16.3%) subjects studied. Vitamin A concentrations above the reference range were observed only in 3 (1.5%) CF patients. CF patients with vitamin A deficiency were significantly older and had lower values of FEV1 compared to CF subjects with normal vitamin A status. Moreover, vitamin A deficiency occurred more frequently in CF patients with diabetes, Pseudomonas aeruginosa colo- nization, worse lung function and in those without vitamin A supplementation. However, in multiple linear regression analyses, none of the independent variables was documented to be important for predicting vita- min A status. Conclusions Vitamin A body resources in CF patients are mostly normal. Moreover, there are no good de- terminants of vitamin A status in these patients. Further studies targeted at exploring potential toxicity and deficiencies of vitamin A in CF patients are needed.

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The obstructive sleep apnea (OSA) is highly associated with various significant cardiovascular outcomes such as resistant hypertension (RAH). Despite this, as of now the relationship between high night-time blood pressure (BP) and left ventricular hypertrophy (LVH) in patients with OSA and RAH is not fully understood. The aim of this study was to assess the influence of the addition of eplerenone to a standard antihypertensive therapy on parameters of 24-h ambulatory blood pressure measurement (ABPM) as well as on the results of echocardiography and polysomnography in patients with OSA and RAH. The patients were randomly assigned to one of the two study groups: the treatment group, receiving 50 mg/d eplerenone orally for 6 months (n = 51) and the control group, remaining on their standard antihypertensive therapy (n = 51). After that period, a significant reduction in the night-time BP parameters in the treatment group including an increased night blood pressure fall from 4.6 to 8.9% was noted. Additionally, the number of non-dipper patients was reduced by 45.1%. The treatment group also revealed a decrease in left ventricular hypertrophy and in the apnea&ndash, hypopnea index (AHI) with a positive correlation being observed between these two parameters. This study is the first to report the improvement of the circadian BP profile and the improvement of the left ventricle geometry in patients with OSA and RAH following the addition of selective mineralocorticoid receptor antagonists to antihypertensive therapy.

Oxidative stress underlies both obstructive sleep apnea (OSA) and atherosclerosis. The aim of the study was to assess the markers of oxidative stress in plasma at different stages of OSA in non-smoking obese Caucasian males aged 41–60, with normal oral glucose tolerance test. All patients were subjected to clinical and polysomnographic examinations. The stage of OSA severity was set according to the following criteria of the apnea-hypopnea index (AHI): AHI 30/h obstructive episodes per hour – severe disease (OSA-3; n = 27). Plasma total antioxidant status (TAS) and thiobarbituric acid-reacting substances (TBARS), reflecting the level of lipid peroxides, were determined spectrophotometrically. We found that TAS decreased and TBARS increased significantly from OSA-0 to OSA-3. We conclude that the oxidative stress markers are conducive to setting the severity of OSA in normoglycemic patients.

Sleep Apnea Syndrome (SAS) becomes an important medical and social problem of contemporary societies. It is burdensome, it can be dangerous to health and even cause of death. The most efficient way to detect this syndrome is polysomnography. It gives good results but it is expensive and not commonly available. Main aim of this study is to present another, easier and cheaper way to detect SAS. Proposed method is based on prediction of sleep state using only oximetry and heart rate. The Artificial Neural Network (ANN) algorithm to predict time series was introduced. These networks were used to detect apneas and hypopneas to support diagnose of SAS and to detect whether patient sleeps or not. All data needed to train and test ANN were collected in sleep laboratory for a group of five considered patients with diagnosed SAS. The presented in this work results show that it is possible to predict apneas during sleep with high rate of accuracy, just with use of information about heart rate and blood oxygen saturation. It means that presented method could be effective to diagnose this disease using only simple device with implemented ANN.

In this paper authors propose a method of sleep analysis based on the algorithm of artificial neural networks. Unlike polysomnography methods, that are used commonly in clinical practice, the described method does not require specialist equipment or a qualified technician to analyze biomedical signals. The results presented in this work show that the properly implemented neural network algorithm can determine incidents during sleep and recognize its phases. Main idea was tested on the base of data collected from sleep laboratory of eight patients. From many signals collected during clinical assessment only two were taken under further consideration: heart rate and blood saturation. As it was shown, these two parameters measured during sleep allows to determine incidents occurring during sleeping and even to recognize actual stage of sleep. It means, that it is possible to use simple device that measures only heart rate and blood saturation to identify sleep apnea syndrome. The method is very effective and can replace the existing ways to recognizing sleep problems especially, when sleep examination of patient is conducted in home conditions.

Mukowiscydoza (CF, cystic fibrosis) jest najczęściej występującą wśród rasy kaukaskiej chorobą genetyczną [...]

Background The oral cavity is an important reservoir of microorganisms and can be a potential source of infection of the respiratory tract in CF patients. The literature on the oral health does not explicitly determine dental problems in these patients. The aim of the study was to systematically review the studies relating to oral status in CF patients. Methods A systematic review of papers published from 1997 to 2018 regarding oral status in CF children and adults, carried out in accordance with the Cochrane Collaboration guidelines. Results The search resulted in 143 studies. Thirteen publications were included in the systematic review. Conclusions 1. Equal or a higher prevalence and more severe enamel defects in permanent dentition in CF patients, compared to healthy people, require a targeted dental care. 2. The presented data show an equal or lesser caries risk in CF patients compared to the control group, but future research should focus on caries prevalence evaluation and assessing the relationship between caries experience and the enamel defects prevalence in CF adults. 3. The available data cannot provide an objective assessment of the possible relationship of periodontal conditions with cystic fibrosis. The literature dealing with these issues is based solely on clinical trials but does not take into account, specialized tests, such as microbial analyses of dental plaque and saliva. 4. There is a need to develop standards of dental care not only for children but also for adults, mainly to reduce the risk of autoinfection in CF patients.

The antioxidant enzyme paraoxonase-1 (PON1) may limit oxidative stress in the development of cardiovascular diseases (CVD) and obstructive sleep apnea (OSA). The aim of the study was to determine PON1 gene L55M polymorphism in OSA-positive and OSA-negative subjects, along with paraoxonase activity of the enzyme (PON1-act). Caucasians aged 25–75, with BMI 19.0–53.0 kg/m2 and no acute or severe chronic disorder underwent polysomnography, and OSA-negative (n = 44) and OSA-positive (n = 57) groups were established. The following parameters were assessed: arterial blood pressure and serum glucose, lipids, C–reactive protein, and homocysteine. Genomic DNA was extracted and amplified, and automatic sequencing was used to confirm the LL, LM, MM genotypes. PON1–act was measured spectrophotometrically using paraoxon as a substrate. We found that frequency of polymorphisms differed significantly between the OSA–negative and OSA–positive patients (p < 0.05). Increased PON1–act was observed in the LL–genotype versus the LM + MM–genotype in the study population (p < 0.05). PON1–act was higher in the OSA–negative compared with OSA–positive patients (p < 0.001); in general and in the subgroups presenting the LL or LM genotype. In addition, there was an inverse relationship between PON1–act and LDL–cholesterol in the entire study population. The OSA–positive group presented an inverse relationship between PON1–act and fasting glucose. We conclude that patients could benefit from the LL genotype related with higher activity of PON1. OSA pathology might decrease the enzyme activity, despite the presence of L allele.

409 Address for correspondence: Tadeusz M. Zielonka, Department and Unit of Family Medicine, Medical University of Warsaw, ul. Banacha 1A, 02−097 Warszawa, Poland, tel./faks: +48 22 3186325, e-mail: tadeusz.zielonka@wum.edu.pl DOI: 10.5603/PiAP.2015.0066 Received: 24.06.2015 Copyright © 2015 PTChP ISSN 0867–7077 Tadeusz M. Zielonka, Szczepan Cofta Department and Unit of Family Medicine, Medical University of Warsaw, Poland Department and Teaching Hospital of Pneumonology, Allergology and Pulmonological Oncology, Karol Marcinkowski Poznan University of Medical Sciences, Poland

The proper care of cystic fibrosis patients extends over their lifetime. More than half of the children with the disease die before adulthood. An important element in the patient’s care is a time of transition from a paediatric to the care of an internist and the patient’s acceptance of this necessity. Transition from paediatric care to an internist should be adequately prepared. It is not only a question of transfer of medical records, but also careful preparation of patients for such transition. The patients expect not only continuity of care but also the Introduction to the management with the disease. The creation of a base for specialist hospital treatment for exacerbation of the disease at the adulthood is an important element in the care of these patients. The problem has been solved in the children group, but is still waiting for solution in adults with cystic fibrosis. It has been proven that care in the centres carried out by a specialized team ensures longer life and better quality of life of these patients. The paper is an overview of these two important elements of care of adults with cystic fibrosis.

Obturacyjny bezdech senny (OSA) jest obecnie uwazany za jedną z najczestszych przyczyn nadciśnienia tetniczego opornego. Związek miedzy OSA i nadciśnieniem tetniczym opornym byl opisywany w wielu badaniach. W przebiegu OSA nadciśnienie tetnicze stwierdza sie u 37–56% chorych, a wśrod pacjentow z nadciśnieniem tetniczym opornym OSA wystepuje az u 70–85%. Do rozwoju nadciśnienia tetniczego opornego u osob z obturacyjnymi zaburzeniami oddychania podczas snu dochodzi prawdopodobnie przez wspoldzialanie kilku mechanizmow. Kluczową role odgrywa hipoksja, ktora doprowadza do aktywacji ukladu wspolczulnego, pobudzenia ukladu RAA, zwiekszonego stresu oksydacyjnego i wzrostu wydzielania endoteliny. Pobudzenie ukladu RAA i związane z tym podwyzszone stezenie angiotensyny II i aldosteronu generuje wzrost oporu naczyniowego, co w konsekwencji zwieksza obciązenie nastepcze serca. Wspolistnienie OSA zmniejsza skutecznośc terapii hipotensyjnej. W celu uzyskania kontroli ciśnienia tetniczego w tej grupie chorych konieczne jest rownoczesne stosowanie kilku lekow hipotensyjnych o zroznicowanym mechanizmie dzialania, w tym leku moczopednego.

The aim of this study was to elucidate body composition, anthropometric indices, and hydration status in obstructive sleep apnea (OSA) patients, taking into account different disease stages, gender, and the possibility of the presence of cachexia. There were 98 OSA patients and 23 control subjects enrolled into the study. All study participants underwent polysomnography examination. Body mass index (BMI), fat mass index (FMI), fat free mass, muscle mass, body cell mass, total body water, and extracellular and intracellular water were evaluated. The neck, abdominal, and waist circumference was measured. We found that overweight and obesity were present in 96% of patients. Cachexia was present in one OSA individual with comorbidities. Apnea-hypopnea index correlated with the neck and waist circumference, and with BMI in OSA patients. All muscle indices and water contents above outlined were significantly higher in severe OSA compared with control subjects. BMI, FMI, neck circumference, and extracellular water were greater in a subset of severe OSA compared with a moderate OSA stage. The female OSA patients had a higher FMI than that present in males at a comparable BMI. We conclude that the most body composition indices differed significantly between severe OSA patients and control subjects. A higher FMI in females at a comparable BMI could be due to a discordance between BMI and FMI. Cachexia occurs rarely in OSA and seems to coexist with comorbidities.

The aim of this study was to elucidate body composition, anthropometric indices, and hydration status in obstructive sleep apnea (OSA) patients, taking into account different disease stages, gender, and the possibility of the presence of cachexia. There were 98 OSA patients and 23 control subjects enrolled into the study. All study participants underwent polysomnography examination. Body mass index (BMI), fat mass index (FMI), fat free mass, muscle mass, body cell mass, total body water, and extracellular and intracellular water were evaluated. The neck, abdominal, and waist circumference was measured. We found that overweight and obesity were present in 96% of patients. Cachexia was present in one OSA individual with comorbidities. Apnea-hypopnea index correlated with the neck and waist circumference, and with BMI in OSA patients. All muscle indices and water contents above outlined were significantly higher in severe OSA compared with control subjects. BMI, FMI, neck circumference, and extracellular water were greater in a subset of severe OSA compared with a moderate OSA stage. The female OSA patients had a higher FMI than that present in males at a comparable BMI. We conclude that the most body composition indices differed significantly between severe OSA patients and control subjects. A higher FMI in females at a comparable BMI could be due to a discordance between BMI and FMI. Cachexia occurs rarely in OSA and seems to coexist with comorbidities.

W pracy przeanalizowano przypadek kobiety w ciąży bliźniaczej powikłanej stanem przedrzucawkowym i zaburzeniami oddychania podczas snu. Pacjentka została przyjęta do szpitala z powodu nadciśnienia tętniczego, białkomoczu oraz narastających obrzęków. Wyniki badań laboratoryjnych ujawniły białkomocz oraz zmniejszenie stężenia białka całkowitego w surowicy krwi. Rozpoznano łagodną postać stanu przedrzucawkowego. Z uwagi na zaobserwowaną nasiloną senność dzienną, głośne chrapanie i przerwy w oddychaniu podczas snu wykonano u pacjentki badanie polisomnograficzne, podczas którego obserwowano liczne epizody bezdechów obturacyjnych i spłyconego oddychania podczas snu. Wartość wskaźnika AHI (apnea-hypopnea index) wynosiła 82.1 z licznymi epizodami desaturacji osiągającymi najniższą wartość 82%. Rozpoznano ciężką postać obturacyjnego bezdechu sennego i włączono leczenie za pomocą protezy powietrznej (CPAP). Zastosowanie CPAP pozwoliło na zmniejszenie wskaźnika AHI do 1.2 oraz lepszą kontrolę ciśnienia tętniczego. Między 33. a 35. tygodniem ciąży pacjentka stosowała CPAP. W 35. tygodniu ciąży z uwagi na wystąpienie objawów zagrożenia życia pierwszego bliźniaka w zapisie kardiotokograficznym ukończono ciążę cięciem cesarskim. Urodziły się dwa noworodki płci męskiej w stanie dobrym. W okresie połogu pacjentka zaprzestała stosowania CPAP. Obserwowano wzrost wskaźnika AHI do 45.3 oraz wzrost wartości ciśnienia tętniczego do najwyższej wartości 180/100 mm Hg. Pacjentka w stanie ogólnym dobrym w 7. dobie połogu została zwolniona do domu z zaleceniami dalszej diagnostyki i leczenia w poradni zaburzeń snu. Podsumowując, należy stwierdzić że, zaburzenia snu wywierają niekorzystny wpływ na zdrowie matki i płodu, na nastrój i jakość życia ciężarnej. Udowodniono, że istnieje wiele zależności między snem a zdrowiem. Zaburzenia snu wraz z zaburzeniami oddychania podczas snu przyczyniają się do rozwoju wielu różnych chorób ogólnych bądź też pogarszają ich przebieg. A choroby te z drugiej strony negatywnie wpływają na jakość snu. Podstawowe znaczenie ma leczenie schorzenia podstawowego, lecz towarzyszące mu zaburzenia snu także wymagają terapii.

Cystic fibrosis (CF) is the most common autosomal recessive disorder in Caucasians [...]

Wstęp: Jedną z metod postępowania w masywnym lub nawracającym krwiopluciu jest embolizacja tętnic oskrzelowych (BAE). Celem pracy było wykazanie skuteczności oraz określenie powikłań zabiegu embolizacji tętnic oskrzelowych u pacjentów z nawracającym krwiopluciem. Materiał i metody: Analizie poddano 47 zabiegów embolizacji u 30 pacjentów przebywających w latach 2011–2017 na oddziale pulmonologii, alergologii i pulmonologii onkologicznej w Poznaniu z powodu krwioplucia. Przedział wiekowy pacjentów: 18–71 lat, średnia wieku podczas BAE: 33.5 roku. Pacjenci z mukowiscydozą stanowili 73.33% (n = 22); wykonano u nich łącznie 31 embolizacji. U pozostałych pacjentów (n = 8) wykonano łącznie 16 embolizacji. Analizy dokonano, przeprowadzając weryfikację dokumentacji medycznej oraz rozmowy bezpośredniej bądź telefonicznej. Wyniki: Natychmiastową kontrolę wynikającą z ustąpienia krwawienia uzyskano po 95.75% embolizacjach. Nawrót krwioplucia w ciągu 3 dni od zabiegu nastąpił po 5 BAE (10.63%), wykonano 4 reembolizacje. W pierwszym roku nawrót wystąpił u 10 pacjentów (33.33%), w czasie całej obserwacji u 17 chorych (56.66%). Wśród pacjentów, którzy mieli wykonane ponowne BAE najkrótszy czas bez krwioplucia to 2 dni, a najdłuższy 63 miesiące. Wśród pacjentów z nawrotem krwawienia, ale bez ponownej embolizacji najkrótszy czas bez krwioplucia wynosi 2 miesiące, najdłuższy 35 miesięcy. Jedenastu pacjentów (36.66%) wymagało wykonania kilku embolizacji na przestrzeni omawianych lat. Wnioski: BAE jest zabiegiem o dużej skuteczności w leczeniu krwioplucia, obarczonym niewielkim ryzykiem powikłań.

The role of pulmonary function monitoring after allogeneic haematopoietic stem cell transplantation and the prognostic significance of detected airflow impairment are discussed by the authors. The purpose of the work is also to clarify the nomenclature and diagnostic criteria of non-infectious pulmonary complications after allotransplant. The incidence and diagnostic criteria of representative conditions, as bronchiolitis obliterans and cryptogenic organizing pneumonia are presented. The significance of radiologic findings, bronchoscopy and lung biopsy in diagnostic strategy is also discussed. We believe that the presented review of the current multidisciplinary knowledge on late non-infectious pulmonary complications in patients after stem cell transplantation may be useful in improving the quality of long-term care of those patients.

Aim of the study: to analyze the oxidase activity of ceruloplasmin (Cp) along with copper concentrations, in the blood of different stage obstructive sleep apnea (osa) patients. Material and methods: sixty normoglycemic males aged 35-65 without any acute or chronic disease were included into the study. eMBla s4000 system was used to establish the apnea/hypopnea index (aHi) and to divide patients into groups: osa1 with aHi 5-15 (n = 20); osa2 with aHi 16-30 (n = 20); osa3 with aHi ≥ 31 (n = 20). the control group (n = 22) had no osa suspicion. fasting plasma lipid profile, serum insulin, plasma ceruloplasmin concentration (Cp-c), serum copper (Cu) concentrations and oxidase activity of plasma ceruloplasmin (cp-oa) by schosinsky’s method were estimated. Results: 1. all three osa groups did not differ in systolic (sBp) and diastolic (DBp) blood pressure and Cp-c. increased Cp-oa was observed in osa-1 and osa-2 groups, although the increased Cu was observed in osa-1, then decreased Cu was found in osa-2 and osa-3. 2. osa-1 patients were found to show positive relationships between Cp-oa and sBp, DBp and Cu, of which sBp correlated independently from others. in osa-2 group, Cp-oa was rather affected by aHi. osa-3 subjects presented positive correlations of sB p&BMi and sBp &aHi with an independent influence of aHi. Conclusions: we suggest some mobilization of plasma Cp activity in early stages of osa. the oxidase activity of plasma ceruloplasmin in normoglycemic osa patients may reflect some compensation for an increased activity of the sympathetic nervous system (elevated blood pressure) until there is severe osa pathology.

INTRODUCTION Obstructive sleep apnea (OSA) is considered to be one of the major causes of resistant arterial hypertension (RAH). Apnea episodes cause hypoxia, which triggers the activation of the renin-angiotensin-aldosterone system. This leads to water retention and swelling in the neck region, exacerbating OSA symptoms. It is assumed that the use of eplerenone may reduce the swelling and thus alleviate the severity of OSA. OBJECTIVES We aimed to prospectively assess the impact of eplerenone on the severity of OSA and arterial stiffness in patients with RAH. PATIENTS AND METHODS The study included 31 patients with RAH and OSA. The exclusion criteria were as follows: secondary hypertension, myocardial infarction, stroke 6 months prior to the study, congestive heart failure, chronic kidney failure, alcohol or drug addiction, and active cancer. In all patients, the following tests were performed: blood pressure (BP) measurement (traditionally and using ambulatory BP measuring [ABPM]), applanation tonometry, polysomnography, and the apnea-hypopnea index (AHI) calculation. The tests were done before and after 3 months of eplerenone therapy. Patients received 50 mg of oral eplerenone daily, along with other hypertensive drugs. RESULTS The mean age of participants was 57.76 ±6.16 years. After 3 months of eplerenone therapy, we observed a significant reduction in the AHI, neck circumference, BP, aortic pulse wave, and arterial wall stiffness. There were significant correlations between the AHI and mean BP measured by ABPM and between the AHI and arterial stiffness parameters. CONCLUSIONS Our results provide evidence for the clinical significance of eplerenone, not only as an antihypertensive medication but also as a drug that may reduce the severity of OSA and arterial stiffness in patients with RAH and OSA.

Objective Onconeuronal antibodies are important diagnostic tool in patients with suspicion of paraneoplastic neurological syndromes (PNS). However, their role in PNS pathophysiology and specificity for particular neurological manifestation remains unclear. The aim of this study was to evaluate onconeuronal and antineuronal antibodies in patients with pulmonary pathologies and suspected for PNS. Materials and methods Twenty one patients with pulmonary pathologies were selected from the database of 525 consecutive patients with suspicion of PNS. Patients' sera were screened for the presence of onconeuronal and antineuronal antibodies by means of indirect immunofluorescence; the presence was confirmed by Western blotting. Clinical data were obtained from medical records, hospital data base, and questionnaire-based direct telephone contact with patients. Results Among 21 patients, aged 54 ± 11, with pulmonary pathologies, the most frequent neurological manifestations were neuropathies. Typical PNS included paraneoplastic cerebellar degeneration (PCD) and limbic encephalitis (LE). We found cases with multiple onconeuronal antibodies (anti-Ri and anti-Yo) and coexisting PNS (PCD/LE). Well-defined onconeuronal antibodies were identified in 23.8% of patients. Among antineuronal antibodies, the most frequent were anti-MAG (23.8%). ROC curves analysis revealed high sensitivity of onconeuronal and antineuronal antibodies for typical PNS and lower for pulmonary malignancies. Conclusions Tests for antibodies are highly sensitive for the diagnosis of typical paraneoplastic neurological syndromes. Anti-myelin and anti-MAG antibodies are associated with non-neoplastic pulmonary diseases. Patients with well-defined onconeuronal antibodies require careful screening and follow-up, because the PNS diagnosis indicates a high probability of an underlying malignancy.

Objective Biomarkers of adipose tissue may affect glucose and lipid metabolism and present pro-inflammatory properties, thus could be involved in the pathobiochemistry of cardiovascular disease (CVD). The coexistence of sleep apnea syndrome (OSA) and metabolic risk factors of CVD is worth explaining. The aim of the study was to compare the serum adipocytokines in subjects with and without OSA, who had all elevated body mass index (BMI). Methods Overweight (BMI: 25.0-29.9 kg/m2) and obese (BMI: 30.0-39.9 kg/m2) OSA-suspected Caucasian males, aged 30-63, with no acute disease or chronic disorder underwent polysomnographic evaluation to select OSA-positive (AHI ≥ 5) and OSA-negative (AHI < 5) subjects. Four subgroups were created of 18 persons each: Over(weight)-OSA-Neg, Over-OSA-Pos, Obese-OSA-Neg, Obese-OSA-Pos. In all subjects, plasma carbohydrate and lipid metabolism parameters, and serum uric acid, resistin and leptin concentrations were determined. Results A decreased resistin level was observed in Over-OSA-Pos vs. Over-OSA-Neg subjects (P = 0.037) as well as in Obese-OSA-Pos vs. Obese-OSA-Neg (P = 0.045). No differences in leptin concentrations were observed. A positive correlation between leptin and BMI was in both overweight subgroups and a negative one between resistin and fasting glucose was in both obese subgroups. Conclusions OSA may decrease the serum resistin level in subjects with excess body mass and also may contribute to glucose metabolism, but has no influence on the leptin level.

W dniu 1 grudnia 2006 roku odbyły się w Poznaniu obchody jubileuszu 60-lecia pulmonologii akademickiej oraz 55-lecia Kliniki Ftyzjopneumonologii Akademii Medycznej [...]

Summary Purpose To assess the effect of repeated palliative treatment with high dose rate brachytherapy in patients with advanced lung cancer. Material and Methods Fifty-six patients, 25.3% of a total of 221 patients treated for lung cancer with HDR brachytherapy were treated twice, using High Dose Rate Brachytherapy. All patients were qualified for repeated brachytherapy due to the recurrence of intrabronchial tumour and acceptable remissions after the first treatment. The survival times were compared with selected clinical data. Correlations between survival times and subjective breathing difficulties were analyzed separately. Results The median survival time in the whole group of patients was 8.9 months. The period of obtaining a positive clinical response was correlated with a longer survival time (log-rank test, p=0.0009, F Cox test, p=0.007). In the multivariate analysis other statistically important prognostic factors were also included: the clinical stage of the primary tumour (F Cox test, p=0.04), and the interval between the first and second treatment (F Cox, p=0.004). None of the analyzed factors (dyspnoea, cough, haemoptysis and pain) had any influence on survival. Conclusion Repeated HDR brachytherapy in advanced lung cancer was an efficient method that in many patients led to regression of symptoms and improvement in life quality.

The paper examines the case of a pregnant woman in a twin pregnancy complicated by pre-eclampsia and sleep disordered breathing. The patient was admitted to hospital with high blood pressure, proteinuria and increasing oedema. Laboratory tests revealed proteinuria and reduced total protein concentration in serum. The patient was diagnosed with mild pre-eclampsia. Due to the observed severe daytime sleepiness of the patient, loud snoring and pauses in breathing during sleep, polysomnography was performed. The test revealed a number of episodes of obstructive apnea and hypopnea. The AHI (apnea-hypopnea index) value was 82.1. A number of episodes of desaturation were observed. The lowest saturation had a value of 82%. When the patient was diagnosed with severe obstructive sleep apnea, treatment with CPAP (continuous positive airway pressure) was introduced. The use of CPAP allowed a reduction of the AHI to 1.2, and the blood pressure value normalised. The patient used CPAP between the 33rd and 35th weeks of gestation. At the 35th week of gestation, caesarean section was performed due to life-threatening symptoms of the first foetus in the CTG-recording. Two male infants were delivered in good condition. During the postpartum period, the patient discontinued the use of CPAP. Following this, an increase in AHI to 45.3 and an increase in blood pressure to a maximum of 180/100mmHg were observed. The patient was discharged from hospital in good general condition on the 7th day postpartum with recommendation for further diagnostic and therapy. The conclusion that may be drawn from the case is that sleep disorders adversely affect the health of the mother and the foetus. Also, the mood and quality of life of the pregnant woman deteriorate. It has been proven that there are many relationships between sleep and health. Sleep disorders and disorders of breathing during sleep contribute to the development of various diseases or they degrade the overall phenomena. A disease, on the other hand, additionally negatively affects the quality of sleep. Therefore, it is essential to treat not only the primary disease, but also the accompanying sleep disorders.

In this study we determined the relationship between the severity of obstructive sleep apnea (OSA) and body mass index (BMI), systolic and diastolic blood pressure (SBP, DBP), and carotid intima-media thickness (cIMT) in 30 hypertensive male patients, aged 30–70, with newly diagnosed OSA (15 with moderate OSA – Group A, and 15 with severe OSA – Group B) and 20 non-OSA hypertensive individuals (Group C). We revealed significant differences in cIMT between Groups B and C (0.9 ± 0.3 vs. 0.6 ± 0.1 mm and 1.0 ± 0.4 vs. 0.6 ± 0.2 mm in the right and left common carotid arteries, respectively; p

Spirometry is a standard lung function test for diagnosis and staging of chronic obstructive pulmonary disease (COPD). Impulse oscillometry (IOS) can be complementary to spirometry, especially in patients at advanced age and with physical or mental disorders who cannot be diagnosed through spirometry. The aim of this study was to compare IOS and spirometry in the assessment of airway obstruction in COPD. The study was conducted in 112 stable COPD patients, including 29 females and 83 males of the mean age of 69 ± 11 years. The oscillometric evaluation included total (R5), peripheral (R5-R20), and negative reactance (X5), which were compared with the predicted forced expiratory volume in 1 s (FEV1%pred). The findings show a significantly negative correlation between FEV1%pred and the R5, R5-R20, and X5. COPD patients had increased R5, R5-R20, and X5. The severity of bronchial obstruction found by impulse oscillometry correlated well the spirometric assessment. IOS is a simple to perform test that may be helpful for functional examination of COPD patients.