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The objective of this paper was to assess the impact of the COVID-19 pandemic on the mental health of Poles and the availability of psychiatric and psychological support during the pandemic. A prospective, cross-sectional web-based survey design was adopted. It was carried out on a sample of 1080 Polish citizens above 18 years old. The majority of Poles (70%) experienced symptoms of mental disorders during the COVID-19 pandemic. Sleep disturbance (63.79%), anxiety (48.79%), low mood for most of the day (44.63%), sadness, tearfulness (41.29%), and concentration disorders (35.93%) were the mental disorder symptoms reported most often by the survey subjects. To reduce the potential acute and long-lasting effects of the COVID-19 pandemic on mental health, decision-makers of the Polish health system should implement stepped multilevel and multi-target psychological support services.

Background: The SARS-Cov-2 pandemic has had a profound impact on all aspects of life in the global population, causing above other, psychological problems. Aims: The objective of this study was to evaluate the mental health of the Poles during the COVID-19 pandemic. Methods: A prospective, cross-sectional web-based survey design was adopted. The study horizon was from 1 June 2021, to 31 December 2021. An anonymous, standardized questionnaire was disseminated electronically by means of social media among Polish adults. The following tests were performed: Depression, Anxiety, and Stress Scale (DASS-21), and the Insomnia Severity Index (ISI). Results: A total of 1306 individuals completed the survey. Of the participants, 77.79% were female at a mean age of 34.89 ± (14.79), 62.25% had higher education, and 56.43% were employed. The prevalence of depression, anxiety, stress, and sleep disturbances in this sample were as follows: 50.38%, 43.49%, 61.26%, and 44.74%, respectively. Poor self-estimated health status, the presence of comorbidities, and regular use of nicotine significantly increased the risk of any of the analyzed psychiatric symptoms and sleep disorders. The depression level was significantly associated with age, living alone, health status, and the use of nicotine. Moreover, the level of anxiety was significantly associated with age and health status. The level of stress depended on gender, age, health status, use of nicotine, and being vaccinated against SARS-CoV-2. Sleep disturbances depended on age, health status, the presence of comorbidities, and regular use of drugs. Conclusions: The Polish population manifested numerous psychological symptoms during the COVID-19 pandemic. There is a need to afford psychological support to them and ensure their mental health.

Anna Paczkowska,1 Karolina Hoffmann,2 Micha&lstrok; Michalak,3 Wies&lstrok;aw Bryl,2 Dorota Kopciuch,1 Tomasz Zaprutko,1 Piotr Ratajczak,1 El&zdot;bieta Nowakowska,4 Krzysztof Kus1 1Department of Pharmacoeconomics and Social Pharmacy, Poznan University of Medical Sciences, Pozna&nacute;, Poland; 2Department of Internal Diseases, Metabolic Disorders and Arterial Hypertension, Poznan University of Medical Sciences, Pozna&nacute;, Poland; 3Department of Computer Science and Statistics, Poznan University of Medical Sciences, Pozna&nacute;, Poland; 4Department of Pharmacology and Toxicology, Institute of Health Sciences, Collegium Medicum, University of Zielona Gora, Zielona Góra, PolandCorrespondence: Anna PaczkowskaDepartment of Pharmacoeconomics and Social Pharmacy, Poznan University of Medical Sciences, Rokietnicka 7 Street, Pozna&nacute;, 60-806, PolandTel +48 507 975 635Fax +48 618 546 894Email aniapaczkowska@ump.edu.plPurpose: The study aimed to compare the metabolic effects of an intensive dose of metformin alone among non-adherence patients with type 2 diabetes versus in combination with insulin among adherence patients.Methods: The prospective cohort study was carried out on a sample of 140 patients above 18 years old, divided into two groups. The first group (n=70) was recommended metformin monotherapy in an intensive dose of 2– 3 g/day, whereas the second group (n=70) was prescribed metformin (1– 2g/day) in combination with insulin. FPG, HbA1c, BMI, blood pressure, TC, TG, HDL-C, LDL-C, creatinine, and eGFR were measured for each patient at baseline and after a follow-up of 6 months of active treatment.Results: After six months of active treatment using monotherapy with an intensive dose of metformin, only 11.43% of patients achieved the target levels of HBA1c below 7%. In the group of patients treated using a combination of metformin with insulin, after six months of active treatment, 45.72% achieved HBA1c levels below 7% (p< 0.0001). Compared with an intensive dose of metformin alone, the combination of insulin and metformin was associated with improved glycemic control (change of fasting blood glucose: 2.49 mmol/l vs 1.30 mmol/l, p=0.0016). Metformin use alone, as compared with insulin, was associated with a significant increase in HDL-C (+0.03 mmol/l vs − 0.14 mmol/l, p=0.0485). Increased baseline obesity and increased baseline glycemia were the factors related to the likelihood of failing to achieve the target levels for HbA1c.Conclusion: Metformin proved to be more effective in controlling hyperglycemia when combined with insulin therapy. Our study shows how many health benefits loss patients who, despite systematic diabetes education, do not agree to change their treatment in the form of adding a second drug, including insulin.Keywords: type 2 diabetes, non-adherence, metformin, insulin, effectiveness of the treatment

This study aimed to investigate and compare the adherence of patients treated for morbid obesity living in Poland and Germany. Methods: A cross-sectional international multicenter survey design was adopted. The study involved 564 adult subjects treated for morbid obesity at selected healthcare facilities in Germany (210 participants) and Poland (354 participants). A validated, custom-made questionnaire based on the literature related to this issue was used. Results: The degree of adherence was higher, but not statistically significant, among Polish patients (83.82% vs. 78.33%, p = 0.26140). Patient adherence was associated with gender, age, level of education, duration of obesity, number of health professionals involved in obesity treatment, and type of obesity treatment (p < 0.05). A positive correlation was observed in the case of age, level of education, and a growing number of health professionals involved in obesity treatment, whereas a negative correlation was observed in the case of the duration of obesity. Patients who underwent bariatric surgery significantly more often followed medical recommendations regarding lifestyle changes, compared to obese participants treated only conservatively. Adherence in the field of obesity treatment significantly increases the percentage of total weight loss and excess weight loss due to applied obesity treatment among both Polish and German groups (p < 0.001). Both the percentage of total weight loss and that of excess weight loss were significantly higher in the group of adherent patients compared to the nonadherent patients (p < 0.00001). The levels of perceived anxiety, stress, and depression were significantly higher in nonadherent patients in both countries. Conclusions: These findings confirm the role of adherence in the effective and satisfactory treatment of morbid obesity. There is a great need to improve patient adherence to overcome the consequences of the obesity pandemic.

Objectives: The aim of this study was to compare the level of discrimination among patients with obesity living in Poland and Germany. Methods: This was a retrospective cross-sectional international multicenter survey study including 564 adult participants treated for morbid obesity at selected healthcare facilities in Germany (210 patients) and in Poland (354 patients). Discrimination was evaluated using a custom-made questionnaire based on the related literature. Results: The level of obesity discrimination did not differ between German and Polish patients (p = 0.4282). The presence of obesity was reported to be associated to a large or a very large extent with the feeling of social exclusion and discrimination by 46.63% of German participants and 42.09% of Polish ones (p = 0.2934). The mean level of discrimination related to the lack of employment was higher in patients who underwent bariatric surgery or endoscopic method than in those who underwent conservative treatment (for Germany: 2.85 ± 1.31 (median, 3) vs. 2.08 ± 1.31 (median, 1), p = 0.002; for Poland: 2.43 ± 1.15 (median, 2) vs. 1.93 ± 1.15 (median, 1), p = 0.005). The level of discrimination was associated with sex, age, the degree of obesity, and treatment-related weight loss (p < 0.05). Conclusions: Our findings confirm that obesity significantly affects the social and economic well-being of patients. There is a great need to reduce weight stigma and to take measures to alleviate the socioeconomic and psychological burden of obesity.

Introduction Paraoxonase 1 is an enzyme associated with high-density lipoprotein fraction and is considered to present antioxidant activity. Objectives The aim of the study was to assess the arylesterase activity of paraoxonase 1 (PON1) in the serum of patients with hypertension, due to effect of therapy and before treatment. Patients and Methods. The study was conducted in 76 patients with primary hypertension and 28 volunteers for the control group. Hypertensive subjects were assigned to one of three groups: well controlled (n=25), poorly controlled (n=26), and newly diagnosed before therapy (n=25) hypertension. We evaluated metabolic parameters in all participants using routine laboratory methods, as well as arylesterase activity of PON1. Results The four study groups differed with arylesterase activity of PON1 and the highest levels were found in patients with well controlled hypertension and the lowest in newly diagnosed. All patients diagnosed with hypertension presented negative correlations between PON1 and systolic and diastolic blood pressure. Conclusions Effective treatment of hypertension could result in increased PON1 activity, despite unfavorable homocysteine concentrations in blood. Untreated hypertension might decrease activity of PON.

Anna Paczkowska,1 Karolina Hoffmann,2 Jonas Raakow,3 Matthias Pross,4 Rafael Berghaus,4 Micha&lstrok; Michalak,5 Wies&lstrok;aw Bryl,2 Kinga Marzec,1 Dorota Kopciuch,1 Tomasz Zaprutko,1 Piotr Ratajczak,1 El&zdot;bieta Nowakowska,6 Krzysztof Kus1 1Department of Pharmacoeconomics and Social Pharmacy, Poznan University of Medical Sciences, Poznan, Poland; 2Department of Internal Diseases, Metabolic Disorders and Arterial Hypertension, Poznan University of Medical Sciences, Poznan, Poland; 3Department of Surgery, Campus Charité Mitte and Campus Virchow Klinikum, Charité - Universitätsmedizin Berlin, Berlin, 10117, Germany; 4Department of Surgery, DRK Kliniken Berlin, Köpenick, Berlin, 12559, Germany; 5Department of Computer Science and Statistics, Poznan University of Medical Sciences, Poznan, Poland; 6Department of Pharmacology and Toxicology Institute of Health Sciences, Collegium Medicum, University of Zielona Gora, Zielona Góra, PolandCorrespondence: Anna Paczkowska, Department of Pharmacoeconomics and Social Pharmacy, Poznan University of Medical Sciences, Rokietnicka 7 Street, Poznan, 60-806, Poland, Tel +48 507 975 635, Fax +48 618546894, Email aniapaczkowska@ump.edu.plBackground: Recent studies indicate that the treatment of obesity is unsuccessful. The cause of this situation is that patients are not sufficiently educated about therapeutic methods and the health consequences of not treating obesity. Moreover, obesity prevention strategies differ significantly between EU countries.Objective: The primary aim of this study was to examine and compare the level of obesity-related knowledge and illness perception among obese patients from Poland and Germany.Methods: A prospective cross-sectional international multicentre study was conducted. The study included 564 subjects above 18 years old (210 German patients and 354 Polish patients) with obesity. A validated custom-made questionnaire was used to evaluate obesity-related knowledge. Patient illness perception was evaluated using Polish and German language versions of the standardized Brief Illness Perception Questionnaire (B-IPQ).Results: Obese patients from Germany had significantly higher level of obesity-related knowledge than patients from Poland (22.01 ± 4.68 vs 19.17 ± 6.59, p< 0.0001). Obesity-related knowledge was associated with the patient’s education, patient participation in therapeutic educational programs, patient’s perception of the illness, age and the number of healthcare professionals involved in the patient’s treatment process.Conclusion: The level of obesity-related knowledge among both Polish and German patients is unsatisfactory. This study suggests that health education is required to facilitate informed choices and support the use of cognitive approaches educating patients on the health consequences of obesity.Keywords: obesity, patient education, health education, health behaviour, illness perception

During the coronavirus disease 19 (COVID-19) pandemic it has become very important to comply with preventive measures. We aimed to assess compliance with applicable restrictions and to explore the links between the level of compliance and the risk of COVID-19. This cross-sectional study included Polish adults who were asked to complete a validated questionnaire. The study period was from 1 November 2020 to 31 January 2021 and a computer-assisted web interview method was chosen to perform the survey. The study involved 562 women and 539 men. COVID-19 was reported in 11.26% of participants. A good level of compliance with the sanitary restrictions was reported for 38.87% of participants, an average level of compliance for 47.96%, and a low level of compliance for 13.17%. A reduced risk of COVID-19 was associated with the following preventive measures: regular use of protective masks, social and physical distancing in public places, regular use of hand sanitizers with high ethanol content, and the use of disposable gloves in public places. Our survey revealed satisfactory public compliance with the pandemic restrictions. Sanitary and epidemiologic measures to prevent the pandemic were shown to be adequate and effective.

The SARS-CoV-2 virus pandemic has exerted enormous impacts on individuals’ lifestyle, economics and social life. The aim of the study was to assess the impact of the COVID-19 pandemic on health-promoting behaviors of a sample of the Polish population, including dietary supplementation, physical activity, eating habits, and the implementation of preventive vaccinations. Within the scope of a survey, data was collected from 1101 adult respondents residing in Poland (862 women and 239 men). An anonymous questionnaire prepared based on the scientific literature was used as a research tool. The survey was conducted during the second wave of COVID-19 using the CAWI (Computer—Assisted Web Interview) method by disseminating the questionnaire using selected social media. We found that, during the COVID-19 pandemic, the respondents were more likely to maintain healthy eating habits and use dietary supplementation; however, the majority engaged in physical activity less frequently and had a sedentary lifestyle. Most felt no need to undergo preventive influenza vaccinations. The COVID-19 pandemic significantly increased the health awareness of the analyzed group from the Polish population. However, the obtained results are not fully satisfactory; therefore, there is a need to promote a healthy lifestyle and pro-health behaviors as part of social campaigns.

Celiac disease (CD) is widely perceived as a childhood disorder. However, it has been demonstrated that 19–34% of new CD cases are diagnosed in patients over 60 years of age and lack the typical presentation. A 76-year-old female was admitted to the clinic due to a recurrent fever that had lasted over a year accompanied by progressive weakness, weight loss of about 10 kg, dehydration, and malnutrition. The patient had undergone resection of a fragment of the small intestine due to perforation and abscess 13 years previously (at which time no histopathological examinations were performed). During the current hospitalization, despite extensive laboratory, microbiological, and imaging tests, no specific diagnosis was made. Symptomatic treatment and empirical antibiotic therapy were conducted, but the patient died on the twenty-seventh day of hospitalization due to progressive respiratory failure. The autopsy revealed peripheral T-cell lymphoma in the mesentery of the small intestine, uterus, cecum, lung, and mediastinal lymph nodes. Based on the clinical picture, we believe that the lymphoma was induced by long-term, undiagnosed CD. Current knowledge allows us to see age-related differences in the manifestation of celiac disease and to be alert to the possible late-stage complications of the disease. The lack of awareness of how CD’s symptoms vary with age may lead to misdiagnosis and serious consequences of delayed diagnosis, including death.

Objective. The objective of the study was to compare polygraphic parameters and selected laboratory parameters in patients with obstructive sleep apnoea (OSA) who develop various types of left ventricular (LV) geometry. Material and Methods. The research covered 122 patients with obstructive sleep apnoea and coexisting effectively treated systemic hypertension (95 men, 27 women, average age: 54 ± 10.63 ). Overnight polygraphy, echocardiography, carotid artery ultrasonography, and laboratory measurements were performed. The patients were classified into four groups, depending on LV geometry. Group 1 comprised patients with normal LV geometry, group 2 included those with LV concentric remodelling. Group 3 and group 4 were patients with LV hypertrophy, concentric or eccentric, respectively. Results. The most frequent type of LV geometry in the examined population was eccentric hypertrophy (36%). The highest average values of BMI and T-Ch were observed in the group of patients with concentric remodelling (group 2). The most severe respiratory disorders were found in the group of patients developing LV concentric hypertrophy (group 3); however, these differences were not statistically significant in comparison to other groups. Patients with LV eccentric hypertrophy had significantly decreased LV ejection fraction ( p = 0.0008 ). Conclusions. LV eccentric hypertrophy is the most frequent type of LV geometry in OSA patients. Patients with severe sleep-disordered breathing are more likely to develop concentric hypertrophy, while concentric remodelling occurs more frequently among OSA patients with other coexisting conditions, such as obesity or lipid-related disorders.

Introduction: Recent studies show that treatment of arterial hypertension is unsuccessful. This is due to the patients' insufficient knowledge of about the therapeutic methods and the consequences of not treating arterial hypertension. Objectives: The aim of the study was to evaluate the patients' knowledge concerning therapeutic options, prophylaxis, and complications of arterial hypertension. The study also assessed the effect of such knowledge on hypertension treatment adherence and efficacy. Patients and Methods: The survey included 488 patients (250 female and 238 male), aged over 18 years, diagnosed with and treated in outpatient and inpatient settings at selected healthcare institutions in Poland. A custom-made questionnaire, based on references on this subject, was the key tool in the present study. Information about the course of the disease and evaluation of hypertension treatment efficacy was based on the patients' medical records. Results: The study found that 54.7% of the subjects had good knowledge about arterial hypertension, 40.0% had average knowledge, and 5.3% had poor knowledge. The extent of knowledge about the disease was significantly dependent on the level of education and the place of receiving medical care (p< 0.05). Good knowledge was significantly associated with controlled blood pressure, number of antihypertensive drugs used, frequency of hospitalization, as well as with medication adherence, and healthy lifestyle behaviours (p< 0.05). Conclusions: More than half of the patients presented good knowledge but a large group still had poor knowledge, especially patients with a low level of education and with hypertension treated at a general practitioner's clinic. The results of our study clearly show that knowledge about arterial hypertension affects medication adherence and healthy lifestyle behaviours and improves hypertension treatment efficacy.

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Bone metastases are the most frequent cause of cancer-induced bone pain (CIBP). Although palliative radiotherapy and pharmacotherapy conducted according to World Health Organization (WHO) analgesic ladder are the treatment of choice for CIBP reduction, these methods are not always successful, especially with regard to alleviation of incidental pain. Antiresorptive drugs (bisphosphonates) are able to inhibit bone destruction (loss), proliferation of cancer cells and angiogenesis, but their prolonged use may lead to a spectrum of adverse effects. In this paper, types of bone metastases, their complications, as well as diagnostic and therapeutic implications are presented. Moreover, the paper discusses presently used CIBP treatment methods and research directions for future methods, with special focus on bone metastases.

There has been enormous progress in antihypertensive therapy over the last few decades. However, the management of arterial hypertension is still insufficient and more efforts are needed to improve both non-pharmacological and pharmacological treatment of this widely prevalent disease. Renin-angiotensin-aldosterone system (RAAS) inhibition is crucial both for blood pressure (BP) control and for prevention of organ damage or its development in patients with hypertension. Angiotensin-converting enzyme inhibitors and/or sartans block RAAS incompletely. Aliskiren is one of the novel drugs that has been introduced to antihypertensive therapy recently. Up to now no trial has confirmed that aliskiren is efficacious in reducing cardiovascular events. Double RAAS blockade with aliskiren was not always safe. This review article presents the current view on the place of aliskiren in the therapy of arterial hypertension.

INTRODUCTION The aim of this study was to assess the costs associated with mild hypertension (HTN) in Poland and to compare the costs of 3-year ambulatory care for those diagnosed with mild HTN (group A) and those diagnosed with mild HTN and comorbidities (group B). MATERIAL AND METHODS The researchers undertook a retrospective study of a group of 120 patients treated for 3 years (2006-2008) (60%, n = 72 women and 40%, n = 48 men), taking into account the broadest possible social perspective. Medical and non-medical direct costs as well as indirect costs were calculated. RESULTS The total costs of the 3-year pharmacotherapy in group A equalled 49,985.65 EUR, or 833.09 EUR per patient, whereas in group B the costs were twice as high: 105,691.55 EUR in total or 1,761.53 EUR per patient. Indirect costs for group A patients totalled 3,468.80 EUR (578.13 EUR per patient) and 4,579.20 EUR for group B patients (572.40 EUR per patient). Total direct costs (medical and non-medical) and indirect costs for group B patients were much higher, amounting to 130,228.14 EUR and 2,666.55 EUR per patient, which was double the costs in group A, where costs were 74,184.96 EUR and 1,756.73 EUR per patient. CONCLUSIONS The costs of HTN treatment in Poland are very high and are growing, like in other countries. Potential solutions include developing better patientdoctor communication to improve compliance, and increasing the chances of more effective and less expensive therapy by prescribing cheaper generic drugs, limiting polypharmacy and improving availability of novel therapeutic methods.

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 There is an inverse relationship between high‑density lipoprotein cholesterol (HDL-C) levels and the risk of atherosclerosis. OBJECTIVES The aim of the present study was to assess the oxidant-antioxidant balance in elderly people with different concentrations of HDL-C. PATIENTS AND METHODS A total of 541 people aged 60 years or older were examined, of whom 90 individuals with no acute or severe chronic disorders had their waist circumference, body mass index, percentage of body fat, and blood pressure measured. Fasting and 120‑minute glycemia was determined in an oral glucose tolerance test, following which 15 patients with type 2 diabetes were excluded. Fasting plasma levels of lipids, total antioxidant status, and thiobarbituric acid-reacting substances (TBARS), as well ast the activity of erythrocyte superoxide dismutase 1 (SOD‑1) were assessed. Based on HDL-C levels, participants were divided into the high HDL‑C group (≥40.0 mg/dl and ≥50.0 mg/dl for men and women, respectively; n = 50) and the low HDL‑C group (

Introduction: Obesity-related disturbances are considered to be risk factors for cardiovascular disease (CVD). Chromium is shown to improve carbohydrate and lipid metabolism. Conflicting data on effects of chromium supplementation in humans are published. The aim of the study was to assess the concentrations of serum chromium during the 75-g oral glucose tolerance test (OGTT) in obese persons. Material and methods: Fourty-eight centrally obese Caucasians, apparently healthy, using neither special diet nor mineral supplementation, were enrolled in the study. During the OGTT, 0-min and 120-min concentrations of plasma glucose (G 0', G 120'), serum insulin (Ins 0', Ins 120') and chromium (Cr 0', Cr 120') were determined. Plasma lipids, apolipoproteins A and B, and serum uric acid were measured at 0 min only. For parameters assessed during the OGTT, the difference D = ((120' concentration) - (0' concentration)) was calculated. Contr - adictory tendencies of Cr 120' were observed; thus the difference of serum chromium concentrations, DCr = ((Cr 120') - (Cr 0')), was used to establish the positive DCr group with DCr > 0 (PosDCr: n = 24; 9 male/15 female) and the negative DCr group with DCr < 0 (NegDCr: n = 24; 8 male/16 female). Results: The studied groups were comparable as far as their metabolic parameters are concerned, except higher G 120' (p = 0.043) and DG (p = 0.048), and lower Cr 120' (p < 0.000), which were observed in the NegDCr group. The NegDCr persons showed inverse correlations between Cr 0' and systolic and diastolic blood pressure. Conclusions: We suggest that the studied centrally obese persons differed in chromium metabolism. In subjects "consuming" Cr during the OGTT, chromium status may be associated with increased risk for CVD.

Objective: Apelin and its specific receptor, APJ system, seems to be involved in the development of arterial hypertension (HTN). The aim was to estimate plasma apelin concentration in young patients (pts) with primary HTN and to assess the relationship between apelin and selected anthropometric parameters, serum lipids and carotid intima-media thickness (right and left cIMT). Methods: 70 pts (48 males, 22 females) aged 18-33 with newly diagnosed, untreated primary HTN were recruited. There were 15 age- and gender-matched healthy people in the control group. Anthropometric and BP measurements were done. Fasting serum apelin and lipids were evaluated. The cIMT was estimated using ultrasonography. Results: Serum apelin was higher in whole group (but not statistically significant, 98.04 ± 51.82 vs. 79.19 ± 39.51 pg/ml, p >0.05) and in males with HTN (compared to healthy males, 105.86 ± 53.21 vs. 61.42 ± 24.04 pg/ ml, p= 0.04). We observed a statistically significant negative correlation between apelin concentration and left cIMT in normal-weight women (R = -0.74), a negative correlation between triglyceride levels and apelin concentration in overweight subjects (R = -0.49), a negative correlation between apelin concentration and right cIMT (R = -0.99) and a positive correlation between apelin concentration and WHR (R = 0.99) in obese women. Conclusion: In whole examined group with HTN there were no statistically significant differences in serum apelin and no relationships between its concentration and anthropometric parameters, serum lipids or cIMT. However, higher serum apelin concentration in young males with HTN and some statistically significant correlations between serum apelin and analyzed parameters in groups divided by sex and BMI may suggest a possible role of apelin in the development of HTN. Further studies are required to clarify the relationship between apelin, metabolic parameters and the early markers of atherosclerosis in pts with HTN.

BACKGROUND The term "compliance" means the degree to which the patient's behavior, applying medication or certain lifestyle changes, is consistent with arrangements communicated to him by a doctor or other healthcare professional. Literature indicates that the degree of adherence to medical recommendations for hypertensive patients is unsatisfactory, making it the main cause of the low effectiveness of antihypertensive therapy. OBJECTIVES The aim of the study was to assess the compliance of adolescents in the field of pharmacological and non-pharmacological methods of hypertension treatment. MATERIAL AND METHODS The study included 62 patients (20 women, 42 men) diagnosed with hypertension and treated in specialist healthcare facilities. As a research tool, a questionnaire prepared on the basis of recent literature was used. RESULTS The vast majority of respondents (72.7%) declared that they were regularly taking antihypertensive drugs. The proportion of patients regularly taking antihypertensive drugs was higher in patients treated with monotherapy than with polytherapy (48.5% vs. 24.2%). Among the methods of non-pharmacological treatment of hypertension, the most accepted lifestyle change in the study population was smoking cessation (83.8% of respondents) and reduction of salt consumption (64.5% of respondents), and the least acceptable lifestyle change was maintaining proper body weight by eating a low calorie diet (30.6% of respondents). CONCLUSIONS Adolescents with hypertension adhere in varying degrees to medical recommendations related to the hypertension treatment. The available literature indicates that the currently effective way to improve cooperation with the patients is education.

In adolescents, arterial hypertension (AH) is diagnosed much more frequently than previously thought--it affects 3.2% of the population aged 11-18. In Poland, at present, there are no cost analyses of treatment arterial hypertension among adolescents. The aim of the conducted studies was to analyze direct medical and non-medical costs in the time horizon of one calendar year (2010) of AH treatment in adolescents in Poland. A retrospective study from the societal perspective was based on data from 480 patients medical history cards obtained from the archives of the hospital. From this group, according to the criteria for inclusion in the study, a research group was selected consisting of 36 patients aged 16-18 years, with a diagnosed and treated hypertension. Analysis covered direct medical costs (costs of pharmacotherapy, doctors' visits and laboratory tests, hospitalization) and direct non-medical costs (cost of transport to the outpatient clinic). Average annual cost of hypertension treatment per patient was 89.96 Euro. The largest part of the structure of total costs related with hypertension treatment in adolescents in Poland were the costs of medical consultation with lab tests and diagnostic examinations--35.04% and pharmacotherapy costs--32.95%, with hospital stays rating somewhat lower with 19.12%, and the smallest part were the costs of the patient's transportation to the hypertension outpatient clinic--12.89%. Early identification of risk factors of such cardiovascular diseases as hypertension as early as in the developmental age, and their subsequent elimination, should be considered a good investment in the reduction of costs associated with hypertension treatment in adulthood.

Background: Heart rate (HR) is an important risk factor in coronary artery disease (CAD). However, there is little contemporary data on HR and the use of HR-lowering medications, particularly beta-blockers, among patients with stable CAD inroutine clinical practice. Aim: To describe HR in the Polish population of the CLARIFY registry, overall and in relation to beta-blocker use, and to assessthe determinants of HR. Methods and results: CLARIFY is an international, prospective, observational, longitudinal registry of outpatients with stable CAD, defined as either prior myocardial infarction or revascularisation procedure, or evidence of coronary stenosis of at least 50%, orchest pain associated with proven myocardial ischaemia. A total of 33,438 patients from 45 countries in Europe, the Americas, Africa, the Middle East, and Asia/Pacific were enrolled between November 2009 and July 2010. In Poland, 1,004 patients were enrolled between February and June 2010, which was the largest population among countries from Eastern Europe. Most patients were men (72.8%). Mean ± standard deviation age was 62.1 ± 9.1 years. HR determined by pulse was 69.3 ± 9.4 bpm and by electrocardiogram was 68.2 ± 10.6 bpm. Beta-blockers were used in 89.9% of patients. Resting HR ≥ 70 bpm was noted in 49.3% of all patients and in 48.6% of patients on beta-blockers. Resting HR ≥ 70 bpm was significantly more frequent among younger patients, and in those with diabetes, those being treated for arterial hypertension, and who lacked regular physical activity. Patients with HR ≥ 70 bpm at rest had more frequent symptoms of angina and more frequently needed hospitalisation due to heart failure. Conclusions: Despite a very high rate of beta-blocker use, almost 50% of patients with stable CAD had a resting HR ≥ 70 bpm, which was associated with more frequent angina and ischaemia. Further HR lowering is possible in many patients with CAD. Whether or not this will improve symptoms and outcomes is under investigation.

Recently, an increase has been observed in the number of patients suffering from diseases which are the consequence of an anti-health life style; therefore it is necessary to undertake proper actions in this area, including those addressed to hospital staff.1) Comparison of self-reported state of health and life style between hospital staff in Sweden and Poland, and the motivation of these employees to change the to-date life style for one that is more health promoting. 2) Presentation, based on Swedish experiences in the field of health promotion in hospitals, of the possibilities to implement these changes in Polish conditions.The study covered the staff from the following hospitals: 1) hospitals in Östergötland County, Sweden, and 2) the Ludwik Perzyna Regional Polyclinical Hospital in Kalisz, Poland. The studies were conducted in parallel in Sweden and in Poland during the fourth quarter 2010. The research instrument was a questionnaire form.The following measures should be undertaken by the staff of Polish hospitals: an increase in the consumption of fruit and vegetables, physical activity, organization of workshops aimed at the shaping of skills of coping with stress and relieving stress, assistance in reducing body weight and increasing physical activity. Obligatory breaks at work should be introduced for the consumption of meals and intake of beverages, including water, promotion of fluid replacement would reduce fatigue. An obligatory lunchtime would allow each employee to consume a decent meal, and consequently have respite away from one's own work activities. In order to have a well-functioning staff an employer should, in his/her own interest, decrease potential sick absenteeism, provide incentives for motor activity, e.g. by the organization of groups, reduction of weekly working time on behalf of documented physical activity, or financial support for the purchase of tickets for various forms of physical exercises. Promotion of collective exercise, e.g. common nordic walking for 30 min. during lunch, competition in the largest number of steps made. Promotion of healthy nutrition by the preparation of recipes for meals, several exemplary healthy meals in the form of a healthy alternative breakfast. During this event, a basket of fruit is provided, instead of cakes and sweets.1) The life style of the staff of health care facilities is more health promoting in Sweden than in Poland. 2) It is possible to change the life style of employees of health care facilities into one that is more health promoting. Changes in this area have been made in Sweden with a great success; therefore, it is worthwhile implementing in Poland these Swedish experiences which may function also in Polish conditions. 3) The foundations of health promotion in enterprises have been known for a long time; however, considering the fact that the comparative studies show that these foundations are more advanced in Sweden, it is necessary that Polish employers devote more attention to this problem, and become interested in Swedish experiences in this area.

Obstructive sleep apnea (OSA) patients present increased cardiovascular morbidity and mortality. Oxidative stress is involved in OSA and cardiovascular pathology. The aim of the study was to assess oxidative stress markers in the blood of OSA males during oral glucose tolerance test (OGTT). The study involved OSA-suspected obese males (BMI ≥ 25 kg/m2) aged 35–64, with no acute or chronic disorders, appointed for polysomnography to diagnose OSA (AHI ≥ 5). The results of OGTT allowed to select prediabetic (Pre) subjects and normal glucose tolerance (N), excluding newly diagnosed diabetes. Blood was collected at 0 min (fasting) and 120 min of the test. Plasma glucose, total antioxidant status (TAS), thiobarbituric acid-reacting substances (TBARS), and activity of superoxide dismutase-1 (SOD) in erythrocytes, were determined at the two time points and the difference (D) between the 120 and 0 min time points was calculated for either oxidative stress variable (D-TAS, D-SOD and D-TBARS). Fasting serum insulin and lipids also were measured fasting. There were four groups of subjects, each consisting of 22 individuals N-OSA-neg(ative), N-OSA-pos(itive), Pre-OSA-neg and Pre-OSA-pos. The N-OSA-pos and Pre-OSA-pos subjects demonstrated decreased SOD-0 compared with OSA-negative groups. In N-OSA-neg and N-OSA-pos groups, the positive differences D-SOD and D-TAS were observed, while Pre-OSA subjects presented negative differences. In conclusion, prediabetic OSA patients may consume blood antioxidant factors to counter the effects of oxidative stress, more than individuals with normal glucose tolerance.

Background: Heart rate (HR) is an emerging risk factor in coronary artery disease (CAD). However, there is little contemporary data regarding HR and the use of HR-lowering medications, particularly beta-blockers, among patients with stable CAD in routine clinical practice. The goal of the present analysis was to describe HR in such patients, overall and in relation to beta-blocker use, and to describe the determinants of HR.\ud \ud Methods and Findings: CLARIFY is an international, prospective, observational, longitudinal registry of outpatients with stable CAD, defined as prior myocardial infarction or revascularization procedure, evidence of coronary stenosis of >50%, or chest pain associated with proven myocardial ischemia. A total of 33,438 patients from 45 countries in Europe, the Americas, Africa, Middle East, and Asia/Pacific were enrolled between November 2009 and July 2010. Most of the 33,177 patients included in this analysis were men (77.5%). Mean (SD) age was 64.2 (10.5) years, HR by pulse was 68.3 (10.6) bpm, and by electrocardiogram was 67.2 (11.4) bpm. Overall, 44.0% had HR≥70 bpm. Beta-blockers were used in 75.1% of patients and another 14.4% had intolerance or contraindications to beta-blocker therapy. Among 24,910 patients on beta-blockers, 41.1% had HR≥70 bpm. HR≥70 bpm was independently associated with higher prevalence and severity of angina, more frequent evidence of myocardial ischemia, and lack of use of HR-lowering agents.\ud \ud Conclusions: Despite a high rate of use of beta-blockers, stable CAD patients often have resting HR≥70 bpm, which was associated with an overall worse health status, more frequent angina and ischemia. Further HR lowering is possible in many patients with CAD. Whether it will improve symptoms and outcomes is being tested.

Numerous factors and conditions affect the dietary behaviours of the young population. Urban-rural differences may also influence the lifestyle of adolescents, including diet.To describe dietary behaviours of two young populations: living in urban or rural areas in the district of Szamotuły (a city with a population of 19,000 inhabitants).116 adolescents aged 15-17 years were included to this preliminary study and asked to answer questions concerning health and lifestyle.No statistically significant difference was detected in the number of meals eaten daily, and 3 meals a day was the most frequent answer (45.9% in the rural group and 32.7% in the urban group). About 41.0% of rural subjects and 50.9% of urban ones admitted that they ate fresh fruit and vegetables every day. There was no statistically significant difference in the medium consumption frequency of fresh fruit, vegetable, fish, sweets and salty snacks.1. Between rural and urban adolescents no statistically significant differences were observed in dietary behaviours concerning medium number of meals eaten daily, medium frequency of fresh fruit and vegetable consumption, medium monthly frequency of fish consumption, medium weekly frequency of consumption of sweets and salty snacks. 2. More than a half of the young rural dwellers preferred more salty meals in contrast to over 56% of urban youths who preferred less salty meals. Both urban and rural adolescents most often declared that eat sweets and salty snacks daily. 3. There is a great need to change the dietary habits of teenagers, especially in avoiding an over-intake of high fat and high energy products, in order to reduce the rising prevalence of obesity among adolescents.

Chronic intestinal ischemia is a diagnostic problem for the physicians from internal department as well for the surgeons. The clinical manifestation of this disease is not clear and the symptoms are similar to many other disorders. This requires from the physician a wide knowledge and many-sided diagnostic process. The success depends also on the good cooperation between radiologist and vascular surgeon. The authors presents the case of 59-aged patient with occlusion of superior mesenteric artery. After the angioplasty there was a complete relief of ischemic symptoms.

The aim of this study was to assess the influence of trandolapril on blood pressure and ET-1 plasma activity in young patients with essential mild-to-moderate hypertension.19 persons with essential mild-to-moderate hypertension were enrolled into the study: the average age of this group was 17,6 +/- 1,4 years. The blood pressure and serum concentration of ET-1 in plasma were measured before enrolling and after 42 days of trandolapril (2 mg per day) therapy. The concentration of endothelin-1 was measured using RIA method.In the studied group, after trandolapril therapy SBP was reduced from 142.6 +/- 9,7 mmHg to 129.3 +/- 8,4 mmHg (p0,003), DBP from 85.7 +/- 6,9 mmHg to 79.8 +/- 8,6 mmHg (p0,01). The average serum concentration of endothelin-1 was: before therapy 9,33 +/- 1,9 fmol/ml and after therapy 8,96 +/- 2,2 fmol/ml (non-significant).1. Young hypertensives treated with trandolapril (ACEI) showed significant decrease of SBP and DBP 2. 6-weeks trandolapril therapy was associated with the reduction of serum concentration of ET-1, but without statistical significance.

Overexpression of chemokine receptors might contribute to the initiation of atherosclerosis, due to promotion of monocyte migration to the subendothelial space which is considered as an initiating mechanism in the natural history of atherosclerosis. The CCR5 receptor is one of the chemokine receptors present on peripheral T lymphocytes, monocytes and macrophages.The aim of the study was to determine the expression of CCR5 receptor on peripheral blood mononuclear cells (PBMC) in patients with type 2 diabetes.14 patients with type 2 diabetes and 6 healthy subjects as a control were included to the study. We evaluated the density of the CCR5 receptor on peripheral blood mononuclear cells by flow cytometric analysis by use of LSR Cytofluorograf System (Becton Dickinson Co.).There was significantly higher density of the CCR5 receptor on PMBC in diabetic subjects when compared to the controls.(1) Patients with type 2 diabetes present overexpression of the CCR5 receptor on peripheral blood mononuclear cells. (2). Overexpression of the CCR5 receptor should be considered as a factor that promotes the development of atherosclerosis in diabetic patients.

Metabolic syndrome occurs in about 25% of the adult population in industrialised countries. The pathogenesis of this syndrome is associated with insulin resistance. There are growing evidence that proteins produced in adipose tissue can play a role in development of insulin resistance. One of them is adiponectin (APM1), that circulates in human plasma at high level (5-30 microg/ml). A reduction in APM1 expression is closely associated with insulin resistance in animal models and in studies in humans. APM1 correlates with typical features of metabolic syndrome: BMI, WHR, total cholesterol, HDL, LDL and triglyceride levels, glucose, insulin, degree of insulin resistance in hyperinsulinemic-euglycemic clamp, blood pressure, hyperuricemia. There are some hypotheses that in the future therapy with APM1 may play a role in reversing insulin resistance in many disorders.

Endothelin (ET) is the strongest endogenic substance causing vasoconstriction. The aim of this study was to assess the influence of ACEI therapy on serum concentration of ET-1 plasma activity in young patients with essential mild-to-moderate hypertension.19 persons with essential mild-to-moderate hypertension were enrolled into study (14 male and 5 female). The average age of this group was 17.6+/-1.4 years. The patients were untreated or there was a 7 day wash out period. The blood pressure and serum concentration of ET-1 plasma were measured before enrolling and after 6 weeks of trandolapril (2 mg per day) therapy. The concentration of endothelin-1 was measured using RIA methods.In analyzed group there was a significant both SBP and DBP lowering after the ACEI therapy. SBP was reduced from 142.6+/-9.7 to 129.3+/-8.4 mmHg (p0.003), DBP from 85.7+/-6.9 to 79.8+/-8.6 mmHg (p0.01). The average serum concentration of endothelin-1 was: before treatment 9.33+/-1.9 fmol/ml and after therapy 8.96+/-2.2 fmol/ml.The treatment with ACEI drug (trandolapil) induced the significant decrease of SBP and DBP in young hypertensives. 6-weeks trandolapril therapy was associated with the reduction of serum concentration of ET-1, but not statistically significant.

It has been proved that effectiveness of monotherapy in mild hypertension is about 50%; in the other half of patients the dose of previously used drug should be increased or combined therapy should be recommended. THE AIM OF THE STUDY was to compare treatment with angiotensin convertase enzyme inhibitor--ACE-I (enalapril 10 mg bid--group 1) to therapy with ACE-I combined with calcium antagonist (enalapril 5 mg bid + nitrendipine 20 mg qd--group 2).In a prospective, open, randomised crossover study we assessed 44 hypertensive subjects (17 women, 27 men), aged 35-69 years (mean age 48.6 years) with poorly controlled hypertension treated with enalapril 5 mg twice daily. Mean initial systolic blood pressure was 150.8or = 9.9 mmHg, diastolic 94.7 +/- 5.3 mmHg respectively. The influence of the treatment regimen on the quality of life (QoL) was estimated by a questionnaire.The effectiveness of both used procedures did not differ statistically--in both groups mean blood pressure reduction was similar (14/8 mmHg in 4 weeks), also percentage of patients with well controlled hypertension (about 50%) did not differ significantly. In the group with changes regimen from monotherapy to combined therapy the improvement of systolic blood pressure was found to be statistically significant (p0.05); in the case of combined therapy replaced with monotherapy such an improvement was not observed. In the subgroup with the isolated systolic hypertension combined therapy was considerably more effective. The improvement of QoL was noted in both groups, mainly in the initial phase of the study.In mild hypertension ACE-I and calcium antagonist combination is effective in blood pressure reduction and in the improvement of the quality of life. Nitrendipine in a dose 20 mg in an once daily regimen is a potent and safe hypotensive agent, particularly in isolated systolic hypertension.