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1.  Obesity risk factors in a representative group of Polish prepubertal children 
Archives of Medical Science : AMS  2013;10(5):880-885.
Introduction
The study aim was to evaluate risk factors of obesity in Polish children aged 7 to 9 years.
Material and methods
A representative group of 2571 children (1268 girls and 1303 boys) was randomly selected according to the European Childhood Obesity Group protocol. Weight and height were measured and body mass index (BMI) was calculated. A questionnaire was completed by the children's parents with respect to behavioural and family-related risk factors of obesity. International Obesity Task Force criteria were used for classification of children's obesity.
Results
Obesity was found in 3.7% of girls and 3.6% of boys. There was a statistically significant association between the prevalence of obesity in girls and their mother's obesity: OR = 5.06 (1.96–13.05), p < 0.001, father's obesity: OR = 5.19 (1.96–13.69), p < 0.001, and both parents’ obesity: OR = 5.43 (1.39–21.29), p = 0.01. Obesity in boys was significantly associated with mother's obesity: OR = 5.6 (2.6–12.02), p < 0.001, father's obesity: OR = 6.21 (2.89–13.37), p < 0.001, and both parents’ obesity: OR = 7.22 (2.44–31.33), p < 0.001. Skipping or irregular eating of breakfast was a risk factor for obesity in girls with OR = 2.71 (1.33–5.51), p = 0.005. Neither family income nor parents’ education level was related to their offspring's obesity. TV watching, physical activity level and eating in fast food places were not significant risk factors for obesity.
Conclusions
Eating breakfast regularly seems to protect girls from obesity development while low physical activity is not a significant obesity risk factor in this age group for either boys or girls. This finding stresses the more important role of healthy diet than physical activity promotion in obesity prevention in prepubertal children.
doi:10.5114/aoms.2013.33328
PMCID: PMC4223122  PMID: 25395938
obesity risk factors; children; parental obesity; physical activity
2.  Increased level of serum prostaglandin-2 in early stage of esophageal squamous cell carcinoma 
Archives of Medical Science : AMS  2013;10(5):956-961.
Introduction
Prostaglandin-2 (PGE-2), one of the products of cyclooxygenase-2 (COX-2) induced catalysis, may play a critical role in the carcinogenesis of esophageal squamous cell carcinoma (ESCC). We investigated the efficacy of using serum PGE-2 concentration as a biomarker for this cancer type.
Material and methods
Prostaglandin-2 levels were analyzed in the serum of 65 ESCC patients and in 47 healthy individuals. The concentrations of cyclooxygenase-2 (COX-2) were measured in tumor tissues and normal tissues obtained from 31 surgically treated ESCC patients.
Results
Serum PGE-2 concentration was significantly higher in ESCC patients than in control patients (p = 0.004), especially in the early stages (I + II) of cancer (p < 0.0001). We observed significant inverse relationships between serum PGE-2 levels and: tumor stage, primary tumor progression, lymph and distant metastasis. The COX-2 concentration was significantly elevated in tumors as compared to normal tissues (p = 0.008). A significant correlation between serum PGE-2 and tumor COX-2 was observed (rho = 0.46, p = 0.009). However, ROC analysis showed that serum PGE-2 may be a weak prognostic factor for ESCC.
Conclusions
Our results suggest that an elevated concentration of serum PGE-2 in the early stages of cancer may possibly be associated with tumor initiation and cancer development in ESCC. The exact role of these findings in early detection of this highly lethal cancer requires further research.
doi:10.5114/aoms.2013.34985
PMCID: PMC4223123  PMID: 25395947
prostaglandin-2; cyclooxygenase-2; squamous cell carcinoma; esophagus
3.  Prognostic role of troponin and natriuretic peptides as biomarkers for deterioration of left ventricular ejection fraction after chemotherapy 
Archives of Medical Science : AMS  2013;10(5):1007-1018.
Cardiotoxicity due to anthracyclines, trastuzumab and other potential cardiotoxic drugs is still a problem of modern chemotherapy. For years researchers have tried to find biological markers that can predict changes in the heart. The most thoroughly tested markers are troponin and natriuretic peptides. Some studies have proven that these markers can indeed be useful. In studies which have shown the predictive role of troponin I the assessment of this marker was performed very frequently. It is not possible to carry out such serial measurements in many centers because of typical 1-day hospital stay times. The predictive role of natriuretic peptides still needs further investigation. This review considers the newest research from recent years.
doi:10.5114/aoms.2013.34987
PMCID: PMC4223124  PMID: 25395954
biological markers; cardiotoxicity; chemotherapy; left ventricular dysfunction
4.  Years of life lost due to malignant neoplasms characterized by the highest mortality rate 
Archives of Medical Science : AMS  2014;10(5):999-1006.
Introduction
The analysis of premature deaths measured with years of life lost between the studied and referential populations helps to emphasize the social and economic aspect of a loss caused by deaths due to malignant neoplasms. The aim of the study was to analyze years of life lost by inhabitants of the Lodz province due to malignant neoplasms.
Material and methods
The study material included a database which contained information gathered from 313,144 death certificates (including 66,899 people who died of malignant neoplasms) of inhabitants of the Lodz province who died between 1999 and 2008. The SEYLLp (Standard Expected Years of Life Lost per living person) method was used to determine years of life lost. Jointpoint models were used to analyze time trends.
Results
In males the diseases which mostly contributed to death were tracheal, bronchial and lung malignant neoplasms (SEYLLp = 170.7) and cancer of the large intestine, rectum and anus (SEYLLp = 47.5). In females the principal diseases were tracheal, bronchial and lung malignant neoplasms (SEYLLp = 61.6), breast cancer (SEYLLp = 60.4) and cancer of the large intestine, rectum and anus (SEYLLp = 42.3). The years of life lost were growing in the period under study.
Conclusions
The number of years lost due to malignant neoplasms in the Lodz province between 1999 and 2008 was growing. The main reasons for deaths in females were tracheal, bronchial and lung malignant neoplasms as well as breast cancer and in males – cancer of the large intestine, rectum and anus as well as prostate cancer.
doi:10.5114/aoms.2013.36237
PMCID: PMC4223125  PMID: 25395953
malignant neoplasms; years of life lost; trends; the Lodz province
5.  A forgotten oat head aspiration in an adult patient 
Archives of Medical Science : AMS  2013;10(5):1066-1067.
doi:10.5114/aoms.2012.30984
PMCID: PMC4223126  PMID: 25395964
6.  Usefulness of patient's history and non-invasive electrocardiographic parameters in prediction of ajmaline test results in patients with suspected Brugada syndrome 
Archives of Medical Science : AMS  2013;10(5):899-912.
Introduction
The aim of the work was to assess the usefulness of patient's history and non-invasive electrocardiographic parameters in the prediction of ajmaline test results in patients with suspected Brugada syndrome.
Material and methods
The study involved a group of 59 patients (37 men) at average age of 31.6 ±12.2 years with suspected concealed form of Brugada syndrome. Pharmacological provocation with intravenous ajmaline administration was performed. The patients were divided into two groups depending on ajmaline test results. Individual and total predictive value for ajmaline test was based on the analysis of medical anamnesis and non-invasive electrocardiographic examination.
Results
The analysis carried out within the work indicated a special predictive value of 2 parameters which constituted the study inclusion criteria – family history of Brugada syndrome (28.6% vs. 3.8%; p = 0.0477) and occurrence of saddleback electrocardiographic changes in ECG curve (42.9% vs. 0.0%; p = 0.0002). Non-invasive electrocardiographic parameters which showed significant predictive value for ajmaline test were as follows: dispersion of QTc interval (prior to the provocation test 54.43 ±24.77 ms vs. 32.70 ±12.98 ms; p = 0.0005 and during daytime activity 46.81 ±27.16 ms vs. 32.07 ±13.19 ms; p = 0.0198), corrected QT intervals, Tpeak-Tend intervals in particular leads, QTpeak intervals, dispersion of Tpeak-Tend interval assessed from precordial leads (V1–V6) (42.86 ±13.80 ms vs. 26.54 ±11.70 ms; p = 0.001) and J-point elevation in V2 and V3 leads.
Conclusions
Both interview and non-invasive electrocardiographic parameters which reflect cardiomyocyte repolarization disorders are of high predictive value in anticipating ajmaline pharmacological provocation results in patients with suspected Brugada syndrome.
doi:10.5114/aoms.2013.36928
PMCID: PMC4223127  PMID: 25395941
Brugada syndrome; non-invasive predictors; ajmaline challenge
7.  Relationship between single nucleotide polymorphisms in the 3’-untranslated region of the vascular endothelial growth factor gene and susceptibility to diabetic peripheral neuropathy in China 
Archives of Medical Science : AMS  2013;10(5):1028-1034.
Introduction
This study is to elucidate the relationship between a 936C/T mutation at the 3’-untranslated region of the human vascular endothelial growth factor (VEGF) gene and diabetic peripheral neuropathy (DPN).
Material and methods
All subjects recruited in this study were divided into DM (diabetes without neuropathy, retinopathy or nephropathy), DPN (diabetes with peripheral neuropathy only) and healthy control groups. The gene polymorphism was determined by polymerase chain reaction-restriction fragment length polymorphism, as well as other clinical methods including serum VEGF by ELISA.
Results
The C allele frequency and CC genotype frequency in the DPN group were higher than those in the NC group and DM group. The T allele frequency and CT+TT genotype (carrying the T allele) frequency in the DPN group were lower than those in the NC group (χ2 = 19.051 and 18.533, both p < 0.001) and DM group (χ2 = 11.117 and 11.156, both p = 0.001). However, there was no statistically significant difference in the three genotype (CC/CT+TT) frequencies and allele (C/T) frequencies between the DM group and the NC group. The multivariate logistic regression analysis showed that the levels of glycated hemoglobin (HbA1c), total cholesterol (TC), low density lipoprotein cholesterol (LDL-C) and plasma VEGF positively correlated with DPN, while the 936C/T gene polymorphism of VEGF negatively correlated with DPN.
Conclusions
Allele 936C of VEGF may serve as a genetic marker susceptible to DPN, while allele 936T may be a protective genetic marker of DPN.
doi:10.5114/aoms.2013.39381
PMCID: PMC4223128  PMID: 25395956
vascular endothelial growth factor; polymorphisms; type 2 diabetes mellitus; diabetic peripheral neuropathy
8.  Chronic cough – assessment of treatment efficacy based on two questionnaires 
Archives of Medical Science : AMS  2014;10(5):962-969.
Introduction
Efficacy of chronic cough treatment is ambiguous. The aim of the study was to analyze chronic cough alleviation after specific treatment and the relationship between cough etiology and treatment efficacy.
Material and methods
A stepwise diagnostic approach was used to diagnose cough etiology in non-smoking adults with chronic cough. In all patients specific treatment was applied. Two different questionnaires – a visual analog scale and a 5-degree scale – were used to assess cough severity before and after 4-6 months of treatment.
Results
A significant correlation between pre-treatment and post-treatment results of both questionnaires was found (Spearman coefficient 0.43, p = 0.0003 and 0.73, p < 0.0001, respectively). Baseline questionnaire analysis revealed no differences in cough severity between patients with different cough causes or multiple cough causes. Although specific treatment resulted in a significant decrease of cough severity in the entire group, only partial improvement was noted. According to the visual analogue scale, a decrease of cough severity by at least 50% was achieved only in 54.4% of patients (37/68). Similarly, satisfactory improvement was noted in only 54.4% (37/68) of patients when using the 5-point scale. There were three sub-groups of patients, in whom no relevant decrease of cough severity was observed despite treatment: patients with 1. three coexisting cough causes, 2. non-asthmatic eosinophilic bronchitis, and 3. chronic idiopathic cough.
Conclusions
Cough severity does not depend on its etiology. Efficacy of chronic cough treatment in non-smoking patients is only moderate.
doi:10.5114/aoms.2014.40642
PMCID: PMC4223129  PMID: 25395948
gastroesophageal reflux; upper airway cough syndrome; nonasthmatic eosinophilic bronchitis; asthma
10.  The incidence of acute myocardial infarction in relation to overweight and obesity: a meta-analysis 
Archives of Medical Science : AMS  2014;10(5):855-862.
Introduction
Epidemiological evidence suggests that overweight and obesity have been associated with acute myocardial infarction (AMI). However, data on this issue are controversial. This study aims to use meta-analysis to determine whether overweight and obesity are related to AMI.
Material and methods
We searched PubMed and Embase databases up to October 23rd, 2013 for related literature. The association of overweight and obesity with AMI was assessed by odd ratio (OR) with 95% confidence interval (CI) as the effect size. Then subgroup analysis was performed according to gender, area and study type.
Results
Five primary studies (one cohort study and four case-control studies) were included in this meta-analysis involving 36 803 participants, 14 883 of whom had an AMI. There was a significant association between overweight and AMI (OR = 1.27, 95% CI: 1.21–1.33, p < 0.001). Similar results revealed a relation between obesity and AMI (OR = 1.22, 95% CI: 1.07–1.40, p = 0.003). Subgroup analysis showed that overweight and obesity were positively associated with AMI risk except for obese subjects in Europe. There was no publication bias (Begg's test p = 0.972, Egger's test p = 0.858).
Conclusions
Both overweight and obesity increased the incidence of AMI, and it is necessary to control weight to prevent AMI. A large number of studies is needed to explore the mechanisms that link overweight and obesity with AMI.
doi:10.5114/aoms.2014.46206
PMCID: PMC4223131  PMID: 25395935
meta-analysis; acute myocardial infarction; overweight; obesity
11.  Prognostic role of SPARC expression in gastric cancer: a meta-analysis 
Archives of Medical Science : AMS  2014;10(5):863-869.
Introduction
Secreted protein acidic and rich in cysteine (SPARC) is involved in regulating cell adhesion, proliferation, migration, and tissue remodeling. We performed a meta-analysis to evaluate the association between SPARC expression and the clinicopathologic features and outcomes of gastric cancer patients.
Material and methods
Publications that assessed the clinical or prognostic significance of SPARC in gastric cancer up to October 2013 were identified. A meta-analysis was performed to clarify the association between SPARC expression and clinical outcomes.
Results
Ten studies, including 1417 cases, met the inclusion criteria. The data were analyzed and the results show that SPARC is not significantly associated with the depth of gastric cancer invasion (odds ratio (OR) = 1.17, 95% confidence interval (CI): 0.60–2.29, Z = 0.47, p = 0.64) or tumor differentiation (OR = 0.59, 95% CI: 0.22–1.58, Z = 1.06, p = 0.29). Moreover, SPARC was not significantly correlated with lymph node metastasis (OR = 0.72, 95% CI: 0.37–1.41, Z = 0.96, p = 0.34). However, SPARC overexpression was highly correlated with reduced overall survival (relative risk (RR) = 1.78, 95% CI: 1.52–2.09, Z = 7.10, p = 0.43).
Conclusions
The SPARC may play an important role in the progression of gastric cancer, and SPARC overexpression is closely correlated with poor patient survival. The SPARC is a potential clinical marker for the survival of gastric cancer patients; however, well-designed prospective studies are needed to confirm these findings.
doi:10.5114/aoms.2014.46207
PMCID: PMC4223132  PMID: 25395936
secreted protein acidic and rich in cysteine; tumor progression; gastric cancer; prognosis
12.  Carotid intima media thickness and low high-density lipoprotein (HDL) in South Asian immigrants: could dysfunctional HDL be the missing link? 
Archives of Medical Science : AMS  2014;10(5):870-879.
Introduction
South Asian immigrants (SAIs) in the US exhibit higher prevalence of coronary artery disease (CAD) and its risk factors compared with other ethnic populations. Conventional CAD risk factors do not explain the excess CAD risk; therefore there is a need to identify other markers that can predict future risk of CAD in high-risk SAIs. The objective of the current study is to assess the presence of sub-clinical CAD using common carotid artery intima-media thickness (CCA-IMT), and its association with metabolic syndrome (MS) and pro-inflammatory/dysfunctional HDL (Dys-HDL).
Material and methods
A community-based study was conducted on 130 first generation SAIs aged 35–65 years. Dys-HDL was determined using the HDL inflammatory index. Analysis was completed using logistic regression and Fisher's exact test.
Results
Sub-clinical CAD using CCA-IMT ≥ 0.8 mm (as a surrogate marker) was seen in 31.46%. Age and gender adjusted CCA-IMT was significantly associated with type 2 diabetes (p = 0.008), hypertension (p = 0.012), high-sensitivity C-reactive protein (p < 0.001) and homocysteine (p = 0.051). Both the presence of MS and Dys-HDL was significantly correlated with CCA-IMT, even after age and gender adjustment. The odds of having Dys-HDL with CCA-IMT were 5 times (95% CI: 1.68, 10.78).
Conclusions
There is a need to explore and understand non-traditional CAD risk factors with a special focus on Dys-HDL, knowing that SAIs have low HDL levels. This information will not only help to stratify high-risk asymptomatic SAI groups, but will also be useful from a disease management point of view.
doi:10.5114/aoms.2014.46208
PMCID: PMC4223133  PMID: 25395937
coronary artery disease; risk factors; common carotid artery intima media thickness; South Asians; dysfunctional high-density lipoprotein
13.  Peripheral blood lymphocyte subsets (CD4+, CD8+ T cells), leptin level and weight loss after laparoscopic greater curvature plication in morbidly obese patients 
Archives of Medical Science : AMS  2014;10(5):886-890.
Introduction
The aim of the study was to detect the effect of laparoscopic greater curvature plication (LGCP) on peripheral blood lymphocyte subsets (helper and cytotoxic T lymphocytes – CD4+ and CD8+ T cells respectively), leptin level and weight loss in morbidly obese patients.
Material and methods
Morbidly obese patients (n = 20, age range: 25–50 years, body mass index (BMI) range: 37–45 kg/m2) who underwent LGCP were enrolled in a prospective study to determine the percentages of their peripheral blood T cells (CD4+ and CD8+) before and 4 months postoperatively using flow cytometry. Also, the level of their leptin before and 4 months postoperatively was established using enzyme-linked immunosorbent assay (ELISA). The data are expressed as the percentage of total lymphocytes ± the standard error of the mean.
Results
A decrease in the BMI and loss of weight (31.20 ±1.2%) were confirmed 4 months postoperatively since BMI was 44.71 ±4.3 (range: 37–45) kg/m2 preoperatively, and decreased to 31.80 ±1.1 (range: 24–33) kg/m2 after surgery. The mean percentage of CD4+ and CD8+ T lymphocytes significantly decreased postoperatively (38.2 ±1.5 before and 29.3 ±2.6 after operation for CD4+, 17.3 ±1.8 preoperatively and 9.5 ±1.7 postoperatively for CD8+, p < 0.05). The mean leptin level was 43.01 ±22.01 preoperatively while postoperatively it was 24.8 ±11.1 (p < 0.05), so the leptin level substantially decreased compared to its preoperative values.
Conclusions
This study found that weight loss after LGCP in morbidly obese patients led to decreases in levels of leptin and circulating immune cells compared to their preoperative values.
doi:10.5114/aoms.2014.46209
PMCID: PMC4223134  PMID: 25395939
bariatric surgery; laparoscopic greater curvature plication; morbid obesity; immunity; leptin
14.  Validation of the Polish version of Diabetes Quality of Life – Brief Clinical Inventory (DQL-BCI) among patients with type 2 diabetes 
Archives of Medical Science : AMS  2014;10(5):891-898.
Introduction
The aim of the study was to develop a Polish version of the Diabetes Quality of Life Brief Clinical Inventory (DQL-BCI) and to perform validating evaluation of selected psychometric aspects.
Material and methods
The translation process was performed in accordance with generally accepted international principles of translation and cultural adaptation of measurement tools. Two hundred and seventy-four subjects with type 2 diabetes completed the Polish version of DQL-BCI, the generic EQ-5D questionnaire and the diabetes-specific DSC-R. The examination provides information about the reliability (internal consistency, test-retest) and the construct validity of the studied tool (the relationship between the DQL-BCI score and EQ-5D and DSC-R scales, as well as selected clinical patient characteristics).
Results
Cronbach's α (internal consistency) for the translated version of DQL-BCI was 0.76. Test-retest Pearson correlation coefficient was 0.96. Spearman's coefficient correlation between DQL-BCI score and EQ-5D index and EQ-VAS were 0.6 (p = 0.0000001) and 0.61 (p = 0.0000001) respectively. The correlation between scores of the examined tool and DSC-R total score was –0.6 (p = 0.0000001). Quality of life was lower among patients with microvascular as well as macrovascular complications and with occurring hypoglycemic episodes.
Conclusions
The result of this study is the Polish scale used to test the quality of life of patients with diabetes, which includes the range of problems faced by patients while maintaining a patient-friendly form. High reliability of the scale and good construct validity qualify the Polish version of DQL-BCI as a reliable tool in both research and individual diagnostics.
doi:10.5114/aoms.2014.46210
PMCID: PMC4223135  PMID: 25395940
quality of life; type 2 diabetes; psychometric evaluation; reliability; validity
15.  In-hospital daily insulin dose predicts long-term adverse outcome in patients with diabetes with ST-elevation myocardial infarction treated with successful primary percutaneous angioplasty 
Archives of Medical Science : AMS  2014;10(5):913-919.
Introduction
Early initiation of reperfusion therapy including primary percutaneous coronary revascularization (PPCI) has been recognized as a crucial factor determining clinical outcomes in the acute phase of myocardial infarction. In unstable patients with type 2 diabetes mellitus (T2D) the clear benefit from PPCI was proven. We aim to evaluate the prognostic value of factors describing glycometabolic state on admission in patients with T2D undergoing PPCI in acute ST-elevation myocardial infarction (STEMI).
Material and methods
Prospective analysis of clinical and laboratory variables (mean daily short acting exogenous insulin dose (DID), admission blood glucose, glycated hemoglobin (HbA1c), microalbuminuria) was performed in 112 consecutive patients with T2D with STEMI who underwent PPCI. Women comprised 58% of the group.
Results
Insulin dosing was targeted to obtain a mean daily glucose level < 7.8 mmol/l. During 12-month follow-up 33 (29.5%) major adverse cardiac events (major adverse cardiac events (MACE) consisting of death, reinfarction, and repeated target vessel revascularization) were reported. Microalbuminuria was present in 68 (60.5%) patients. The mean HbA1c level was 7.9%. In the multivariate logistic regression model only DID > 44 IU remained an independent risk factor for MACE (p = 0.02, OR = 5.2).
Conclusions
In patients with diabetes with STEMI treated with PPCI, simple measurement of DID during hospitalization can add valuable prognostic information about the future risk of MACE.
doi:10.5114/aoms.2014.46211
PMCID: PMC4223136  PMID: 25395942
diabetes; primary percutaneous coronary intervention; daily insulin dose; ST-elevation myocardial infarction
16.  Potential drug-drug interactions in hospitalized patients with chronic heart failure and chronic obstructive pulmonary disease 
Archives of Medical Science : AMS  2014;10(5):920-932.
Introduction
Polypharmacy is common in patients with chronic heart failure (HF) and/or chronic obstructive pulmonary disease (COPD), but little is known about the prevalence and significance of drug-drug interactions (DDIs). This study evaluates DDIs in hospitalized patients.
Material and methods
We retrospectively screened medical charts over a 6-month period for diagnosis of chronic HF and/or COPD. Potential DDIs were evaluated using Lexi-Interact software.
Results
Seven hundred and seventy-eight patients were included in the study (median age 75 years, 61% men). The median number of drugs on admission and discharge was 6 (interquartile range (IQR) 4–9) and 7 (IQR 5–), respectively (p = 0.10). We recorded 6.5 ±5.7 potential DDIs per patient on admission and 7.2 ±5.6 on discharge (p = 0.2). From admission to discharge, type-C and type-X potential DDIs increased (p < 0.05 for both). Type X interactions were rare (< 1%), with the combination of a β-blocker and a β2 agonist being the most common (64%). There were significantly more type-C and type-D potential DDIs in patients with chronic HF as compared to patients with COPD (p < 0.001). Patients with concomitant chronic HF and COPD had more type-C and type-X potential DDIs when compared to those with individual disease (p < 0.005). An aldosterone antagonist and ACE inhibitor/ARB were prescribed to 3% of chronic HF patients with estimated glomerular filtration rate < 30 ml/(min × 1.73 m2).
Conclusions
The DDIs are common in patients with chronic HF and/or COPD, but only a few appear to be of clinical significance. The increase in potential DDIs from admission to discharge may reflect better guideline implementation rather than poor clinical practice.
doi:10.5114/aoms.2014.46212
PMCID: PMC4223137  PMID: 25395943
potential drug-drug interactions; chronic heart failure; chronic obstructive pulmonary disease
17.  The effect of postoperative positive end-expiratory pressure on postoperative bleeding after off-pump coronary artery bypass grafting 
Archives of Medical Science : AMS  2014;10(5):933-940.
Introduction
To compare postoperative prophylactic use of two positive end-expiratory pressure (PEEP) levels in order to prevent postoperative bleeding in patients undergoing off-pump coronary artery bypass grafting (CABG) surgery.
Material and methods
Sixty patients undergoing an elective off-pump CABG operation were included in this prospective, nonrandomized clinical trial. Patients were divided into two groups as receiving either 5 cm H2O (group 1) or 8 cm H2O PEEP (group 2) after the operation until being extubated. Chest tube outputs, use of blood products and other fluids, postoperative hemoglobin levels, accumulation of pleural and pericardial fluid after the removal of chest tubes, and duration of hospital stay were recorded and compared.
Results
Low- and high-pressure PEEP groups did not differ with regard to postoperative chest tube outputs, amounts of transfusions and crystalloid/colloid infusion requirements, or postoperative hemoglobin levels. However, low-pressure PEEP application was associated with significantly higher pleural (92 ±37 ml vs. 69 ±29 ml, p = 0.03) and pericardial fluid (17 ±5 ml vs. 14 ±6 ml, p = 0.04) accumulation. On the other hand, high-pressure PEEP application was associated with significantly longer duration of hospitalization (6.25 ±1.21 days vs. 5.25 ±0.91 days, p = 0.03).
Conclusions
Prophylactic administration of postoperative PEEP levels of 8 cm H2O, although safe, does not seem to reduce chest-tube output or transfusion requirements in off-pump CABG when compared to the lower level of PEEP. Further studies with larger sample sizes are warranted to confirm the benefits and identify ideal levels of PEEP administration in this group of patients.
doi:10.5114/aoms.2014.46213
PMCID: PMC4223138  PMID: 25395944
off-pump coronary artery bypass grafting; positive end-expiratory pressure; bleeding; pleural effusion; pericardial effusion
18.  Caregiving burden and its determinants in Polish caregivers of stroke survivors 
Archives of Medical Science : AMS  2014;10(5):941-950.
Introduction
Despite the growing body of literature on the consequences of providing non-professional care to stroke survivors, the determinants of caregiving burden are still not fully recognized. Identification of significant determinants can facilitate caregiver intervention programs. The aim of this study was to evaluate the level of burden borne by caregivers of stroke patients and to identify the most important determinants of burden at 6 months after hospitalization.
Material and methods
Data were collected from 150 pairs of stroke patients/caregivers. Caregiver burden was assessed on the Caregiver Burden scale (CB). Several characteristics were measured as potential predictors of the burden. Special attention was paid to the caregiver's sense of coherence (SOC) and anxiety. Regression analysis was employed to test the hypothesized relationships between these variables and the burden.
Results
Forty-seven percentage of the caregivers reported a substantial burden (severe or moderate). Caregiver SOC (p < 0.001), anxiety (p < 0.001) and the patients’ functional status (p < 0.001) were the most important predictors of the overall burden and the most consistent predictors of the majority of aspects included in the CB scale. Caregiver health, patient's gender, time spent caregiving and social support were also factors related to the burden. The identified predictors explained 67% of the variance in the overall burden.
Conclusions
Clinicians and other professionals should focus on the coping abilities of caregivers, their emotional state and the level of patients’ dependency, as these are the vital and modifiable factors affecting caregiver burden following stroke.
doi:10.5114/aoms.2014.46214
PMCID: PMC4223139  PMID: 25395945
stroke; family caregiving; stress; coping
19.  The alcohol dehydrogenase isoenzyme alcohol dehydrogenase IV as a candidate marker of Helicobacter pylori infection 
Archives of Medical Science : AMS  2014;10(5):951-955.
Introduction
Helicobacter pylori infection is associated with decreased alcohol dehydrogenase (ADH) activity in the gastric mucosa. The decrease in gastric ADH activity depends on the severity of inflammation and mucosal injury. This damage can be a reason of the release of enzyme from gastric mucosa and leads to the increase of the ADH activity in the sera of patients with H. pylori infection.
Material and methods
Serum samples were taken from 140 patients with H. pylori infection. Total ADH activity was measured by photometric method with p-nitrosodimethylaniline as a substrate and ALDH activity by the fluorometric method with 6-methoxy-2-naphtaldehyde. For the measurement of the activity of class I and II isoenzymes we employed the fluorometric methods, with class-specific fluorogenic substrates. The activity of class III ADH was measured by the photometric method with n-octanol and class IV with m-nitrobenzaldehyde as a substrate.
Results
The activity of ADH IV in the serum of patients with H. pylori infection increased about 42% (7.86 mU/l) in the comparison to the control level (4.52 mU/l). Total activity of ADH was 1105 mU/l in patients group and 682 mU/l in control. The diagnostic sensitivity for ADH IV was 88%, specificity 90%, positive and negative predictive values were 91% and 84% respectively. Area under ROC curve for ADH IV was 0.84.
Conclusions
Helicobacter pylori infection of gastric mucosa is reflected in the serum by significant increase of class IV and total ADH activity. The results suggest a potential role for ADH IV as a marker of H. pylori infection.
doi:10.5114/aoms.2014.46215
PMCID: PMC4223140  PMID: 25395946
alcohol dehydrogenase isoenzymes; Helicobacter pylori infection
20.  Compliance with severe sepsis bundles and its effect on patient outcomes of severe community-acquired pneumonia in a limited resources country 
Archives of Medical Science : AMS  2014;10(5):970-978.
Introduction
Validation of compliance with severe sepsis bundles is still needed. The purpose of this study was to determine compliance and its outcomes in severe community-acquired pneumonia (CAP) patients in a limited resources country.
Material and methods
A prospective cohort study of 212 severe CAP patients was carried out. The implementation programme was organized into two continuous phases. The primary outcomes were compliance and hospital mortality.
Results
Compliance with administration of antibiotics and vasopressors as well as plateau pressure on average < 30 cm H2O was high in both groups. In the bundles group, patients received more serum lactate monitoring (62.3% vs. 11.3%), more blood cultures (47.1% vs. 24.5%), more fluid resuscitation (63.2% vs. 26.4%) and volumes infused (1319.8 ±1107.4 ml vs. 461.9 ±799.3 ml), more inotropic dobutamine and/or packed red blood cells (21.7% vs. 10.0%), more low-dose steroids (56.5% vs. 15.0%), and more glucose control (51.9% vs. 6.6%) compared with such patients in the control group. The rates of total compliance with 6-hour, 24-hour, and 6/24-hour bundles in the prospective period were 47.1%, 51.9%, and 42.5%, respectively. Hospital mortality was reduced from 44.3% to 29.2% (p = 0.023) in the bundles group, and the compliant subgroup had a more than twofold decrease in mortality (17.8% vs. 37.7%, p = 0.003). Serum lactate measured, blood cultures, and fluid resuscitation showed independent relationships with decreased mortality.
Conclusions
Total compliance was relatively low, but the implementation of severe sepsis bundles could clearly reduce mortality from severe CAP.
doi:10.5114/aoms.2014.46216
PMCID: PMC4223141  PMID: 25395949
severe sepsis bundles; severe community-acquired pneumonia; severe sepsis; septic shock; compliance; mortality
21.  The effects of botulinum toxin type A on improvement and dynamic spastic equinus correction in children with cerebral palsy – preliminary results 
Archives of Medical Science : AMS  2014;10(5):979-984.
Introduction
We evaluated the effects of botulinum toxin type A (BTA) with physical therapy on dynamic foot equinus correction and higher motor functional outcome in children with spastic type of cerebral palsy (CP).
Material and methods
Ankle joint active and passive movement, gastrocnemial muscle spasticity levels (Modified Ashworth Scale (MAS)), and higher motor functional status (Gross Motor Function Classification System (GMFCS) and Gross Motor Function Measure (GMFM) (GMFM-D – standing and GMFM-E – walking) were assessed before treatment and 3, 8, 16 weeks and 6 months after BTA administration in 12 children.
Results
There was a significant improvement of active (initial – (–)13.07 ±5.78; 6 months – (–)10.64 ±4.77; p < 0.001) and passive (initial – 4.21 ±2.29; 6 months – 4.71 ±2.16; p < 0.05) ankle joint foot dorsiflexion. GMFM-D and GMFM-E were significantly higher after 3, 8, 16 weeks (p < 0.001) and GMFM-D after 6 months (p < 0.001).
Conclusions
Botulinum toxin type A administration and physical therapy in patients with spastic CP improves the motion range of dynamic foot equinus after 3 weeks and higher motor functional outcome (standing and walking).
doi:10.5114/aoms.2014.46217
PMCID: PMC4223142  PMID: 25395950
cerebral palsy; botulinum toxin; dynamic equines
22.  Effects of preoperative physiotherapy in hip osteoarthritis patients awaiting total hip replacement 
Archives of Medical Science : AMS  2014;10(5):985-991.
Introduction
The World Health Organization (WHO) claimed osteoarthritis as a civilization-related disease. The effectiveness of preoperative physiotherapy among patients suffering hip osteoarthritis (OA) at the end of their conservative treatment is rarely described in the literature. The aim of this study was to assess the quality of life and musculoskeletal health status of patients who received preoperative physiotherapy before total hip replacement (THR) surgery within a year prior to admission for a scheduled THR and those who did not.
Material and methods
Forty-five patients, admitted to the Department of Orthopaedics and Traumatology of Locomotor System for elective total hip replacement surgery, were recruited for this study. The assessment consisted of a detailed interview using various questionnaires: the Harris Hip Score (HHS), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the 36-Item Short Form Health Survey (SF-36), and the Hip disability and Osteoarthritis Outcome Score (HOOS), as well as physical examination. Patients were assigned to groups based on their attendance of preoperative physiotherapy within a year prior to surgery.
Results
Among patients who received preoperative physiotherapy a significant improvement was found for pain, daily functioning, vitality, psychological health, social life, and (active and passive) internal rotation (p < 0.05).
Conclusions
Patients are not routinely referred to physiotherapy within a year before total hip replacement surgery. This study confirmed that pre-operative physiotherapy may have a positive influence on selected musculoskeletal system status indicators and quality of life in hip osteoarthritis patients awaiting surgery.
doi:10.5114/aoms.2014.46218
PMCID: PMC4223143  PMID: 25395951
preoperative physiotherapy; rehabilitation; hip; osteoarthritis; coxarthrosis
23.  Does concomitant meniscectomy affect medium-term outcome of anterior cruciate ligament reconstruction? A preliminary report 
Archives of Medical Science : AMS  2014;10(5):992-998.
Introduction
Anterior cruciate ligament (ACL) injury is often accompanied by injuries of the menisci. In order to restore knee stability, anterior cruciate ligament reconstruction (ACLR) is performed, with meniscus surgery when needed. The purpose of this study was to assess the medium-term outcome of ACLR in subjects with and without concomitant meniscus tear and partial meniscectomy.
Material and methods
We prospectively studied 73 patients after arthroscopically assisted bone-patellar tendon-bone ACLR. Subjects were divided into two subgroups: those who had only ACLR (group A, 54 subjects with mean age 28, (SD 9)) and those who underwent both ACLR and concomitant partial meniscectomy (group B, 19 subjects, mean age 32 [11]). Subjects completed a disease-specific questionnaire, the Knee injury and Osteoarthritis Outcome Score (KOOS), preoperatively and at a minimum follow-up of 1 year.
Results
No differences in mean scores between group A and B were observed either preoperatively or at follow-up. We found a significant change in mean score in the KOOS subscale QoL in group A following ACLR (Δ = 9 points, p = 0.039). Most subjects improved in the KOOS subscales Sports and Recreation and QoL in both group A (59 and 52% respectively) and B (63 and 47% respectively). Eight subjects (15%) from group A and 1 (5%) from group B fulfilled criteria of functional recovery. Criteria of treatment failure were fulfilled in 17 subjects (32%) from A and 4 (21%) from group B.
Conclusions
Patients undergoing ACLR with partial meniscectomy had a similar medium-term outcome compared to individuals with ACL tear alone.
doi:10.5114/aoms.2014.46219
PMCID: PMC4223144  PMID: 25395952
anterior cruciate ligament; outcome; meniscectomy; functional recovery; treatment failure
24.  Tuberculosis and diabetes mellitus – an underappreciated association 
Archives of Medical Science : AMS  2014;10(5):1019-1027.
The current review presents up-to-date knowledge on tuberculosis (TB) in diabetic patients. On the basis of available literature, there is little doubt about the close relationship between these two conditions. Diabetes mellitus in this association may still contribute substantially to the burden of TB and negatively affect control of the latter. Chronic hyperglycemia at least to some extent may alter the clinical manifestation, radiological appearance, treatment outcome and prognosis of TB. Although the pathogenesis is not clear, diabetes may impair both innate and adaptive immune responses to Mycobacterium tuberculosis. Eventually, effective screening and dual management of the diseases have to be addressed both in low- and high-income countries in order to limit the negative effects of the forthcoming global diabetes epidemic.
doi:10.5114/aoms.2014.46220
PMCID: PMC4223145  PMID: 25395955
Mycobacterium tuberculosis; hyperglycemia; epidemic; screening
25.  Lung damage after long-term exposure of adult rats to sodium fluoride 
Archives of Medical Science : AMS  2014;10(5):1035-1040.
Introduction
Fluorides, when taken in amounts exceeding the standard therapeutic dosage, are regarded as toxic substances. Chronic fluorosis causes marked destruction of lung tissues. The study aimed to determine whether the effect of a chronic toxic dose of sodium fluoride on the lung of an adult male albino rat is reversible or irreversible. This was done through light and electron microscopic studies. Morphometric study was also done.
Material and methods
Forty adult male rats were used. The animals were divided into 3 groups: control group; group I (chronic fluorosis group) in which sodium fluoride was given daily for 3 months; and group II (recovery group) in which sodium fluoride was given daily for 3 months and after that the rats survived for another month.
Results
The lung of group I was characterized by presence of blood and lymph congestion. Thickening of alveolar septa was also observed with rupture of septa and widening of the air spaces. The area % of collagen (1.13 ±0.5), septal wall thickness (13.47 ±6.1), and number of macrophages (5 ±2.5) increased in comparison to the control group (p ≤ 0.05). With discontinuation of sodium fluoride (group II), no much improvement was observed.
Conclusions
Chronic fluorosis has many pathological effects on the lung which are irreversible.
doi:10.5114/aoms.2014.46221
PMCID: PMC4223146  PMID: 25395957
chronic fluorosis; lung damage

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