Predicting Short- and Long-Term Functional Outcomes Based on Serum S100B Protein Levels in Patients with Ischemic Stroke

BACKGROUND

Ischemic stroke is one of the leading causes of mortality and disability. The neuroimaging methods are the gold standard for diagnostics. Biomarkers of cerebral ischemia are considered to be potentially helpful in the determination of the etiology and prognosis of patients with ischemic stroke.

AIM

This study aimed to investigate the usefulness of serum S100B protein levels as a short- and long-term prognostic factor in patients with ischemic stroke.

STUDY DESIGN AND METHODS

The study group comprised 65 patients with ischemic stroke. S100B protein levels were measured by immunoenzymatic assay. Short-term functional outcome was determined by the NIHSS score on day 1 and the difference in the NIHSS scores between day 1 and day 9 (delta NIHSS). Long-term outcome was assessed by the modified Rankin Scale (MRS) at 3 months after the stroke. At the end of the study, patients were divided into groups based on the NIHSS score on day 9 (0-8 "good" and >8 "poor"), the delta NIHSS ("no improvement" ≤0 and >0 "improvement"), and the MRS ("good" 0-2 and >2 "poor"). Differences in S100B levels between groups were analyzed with the ROC curve to establish the optimal cut-off point for S100B. The odds ratio was calculated to determine the strength of association. Correlations between S100B levels at three time points and these variables were evaluated.

RESULTS

We revealed a statistically significant correlation between S100B levels at each measurement point (<24 h, 24-48 H, 48-72 h) and the NIHSS score on day 9 (R Spearman 0.534, 0.631, and 0.517, respectively) and the MRS score after 3 months (R Spearman 0.620, 0.657, and 0.617, respectively). No statistically significant correlation was found between S100B levels and the delta NIHSS. Analysis of the ROC curve confirmed a high sensitivity and specificity for S100B. The calculated AUC for the NIHSS on day 9 were 90.2%, 95.0%, and 82.2%, respectively, and for the MRS, 83.5%, 83.4%, and 84.0%, respectively. After determining the S100B cut-off, the odds ratio for beneficial effect (NIHSS ≤ 8 at day 9 or MRS 0-2 after 3 months) was determined for each sampling point.

CONCLUSION

S100B is a useful marker for predicting short- and long-term functional outcomes in patients with ischemic stroke.

Heat and cold stress increases the risk of paroxysmal supraventricular tachycardia

Paroxysmal supraventricular tachycardia (PSVT) is a common arrhythmia in adults. Its occurrence depends on the presence of the reentry circuit and the trigger of the paroxysm. Stress, emotional factors, and comorbidities favour the occurrence of such an episode. We hypothesized that the occurrence of PSVT follows extreme thermal episodes. The retrospective analysis was based on the data collected from three hospital emergency departments in Poland (Olsztyn, Radom, and Wroclaw) involving 816 admissions for PSVT in the period of 2016-2021. To test the hypothesis, we applied the Universal Climate Thermal Index (UTCI) to objectively determine exposure to cold or heat stress. The risk (RR) for PSVT increased to 1.37 (p = 0.006) in cold stress and 1.24 (p = 0.05) in heat stress when compared to thermoneutral conditions. The likelihood of PSVT during cold/heat stress is higher in women (RR = 1.59, p< 0.001 and RR = 1.36, p = 0.024, respectively) than in men (RR = 0.64 at p = 0.088 and RR = 0.78, p = 0.083, respectively). The susceptibility for PSVT was even higher in all groups of women after exclusion of perimenopausal group of women, in thermal stress (RR = 1.74, p< 0.001, RR = 1.56, p = 0.029, respectively). Females, particularly at the perimenopausal stage and men irrespective of age were less likely to develop PSVT under thermal stress as compared to thermoneutral conditions. Progress in climate change requires searching for universal methods and tools to monitor relationships between humans and climate. Our paper confirms that the UTCI is the universal tool describing the impact of thermal stress on the human body and its high usefulness in medical researches.

Significance of S100B Protein as a Rapid Diagnostic Tool in Emergency Departments for Traumatic Brain Injury Patients

Traumatic brain injuries (TBIs) are not only the leading cause of death among people below 44 years of age, but also one of the biggest diagnostic challenges in the emergency set up. We believe that the use of serum biomarkers in diagnosis can help to improve patient care in TBI. One of them is the S100B protein, which is currently proposed as a promising diagnostic tool for TBI and its consequences. In our study, we analyzed serum biomarker S100B in 136 patients admitted to the Emergency Department of the Regional Specialist Hospital in Olsztyn. Participants were divided into three groups: patients with head trauma and alcohol intoxication, patients with head trauma with no alcohol intoxication and a control group of patients with no trauma or with injury in locations other than the head. In our study, as compared to the control group, patients with TBI had a significantly higher S100B level (both with and without intoxication). Moreover, in both groups, the mean S100B protein level was significantly higher in patients with pathological changes in CT. According to our study results, the S100B protein is a promising diagnostic tool, and we propose including its evaluation in routine regimens in patients with TBI.

Friedewald formula may be used to calculate non-HDL-C from LDL-C and TG

Background

The Friedewald formula (FF) was originally designed 50 years ago and has been in use to this day despite better methods for estimating LDL cholesterol (LDL-C). Its success was mainly due to its simplicity. Nowadays most laboratories determine or can determine LDL-C by the direct method. The SCORE2 tables, recommended by the European Society of Cardiology, are based on non-HDL cholesterol (non-HDL-C). To calculate its value, one needs to know the values of total cholesterol (TC) and HDL-C. The presented idea is to use the FF to calculate non-HDL-C based on the values of LDL-C and TG instead of TC and HDL-C.

Methods and findings

Based on database of 26,914 laboratory results, covering the complete lipid panel, the error regarding non-HDL-C values calculated in both ways (recommended and proposed) was determined. The average error in the LDL-C value calculated with the FF compared to the LDL-C value measured in the laboratory is 9.77%, while for non-HDL-C the error between the calculated and laboratory-determined value amounts to 8.88%. The proposed transformation of the FF also yields a much lower percentage of error calculations. Both LDL-C and non-HDL-C (calculated) in our material are strongly correlated with LDL-C and non-HDL-C (measured) values of r = 0.965 (p < 0.000) and r = 0.962 (p < 0.000), respectively.

Conclusion

Non-HDL-C may be calculated based on the values of LDL-C and TG (without the need to determine the levels of TC and HDL-C). The proposed calculation may greatly reduce the cost of testing, given the price of a complete lipid profile.

The effect of isocaloric, energy-restrictive, KETOgenic diet on metabolism, inflammation, nutrition deficiencies and oxidative stress in women with overweight and obesity (KETO-MINOX): Study protocol

Obesity is considered one of the biggest health problems of the 21st century, becoming a worldwide epidemic, leading to the development of many diseases and increasing the risk of premature death. The first step in reducing body weight is a calorie-restricted diet. To date, there are many different diet types available, including the ketogenic diet (KD) which is recently gaining a lot of attention. However, all the physiological consequences of KD in the human body are not fully understood. Therefore, this study aims to evaluate the effectiveness of an eight-week, isocaloric, energy-restricted, KD as a weight management solution in women with overweight and obesity compared to a standard, balanced diet with the same calorie content. The primary outcome is to evaluate the effects of a KD on body weight and composition. The secondary outcomes are to evaluate the effect of KD-related weight loss on inflammation, oxidative stress, nutritional status, profiles of metabolites in breath, which informs about the metabolic changes in the body, obesity and diabetes-associated parameters, including a lipid profile, status of adipokines and hormones. Notably, in this trial, the long-term effects and efficiency of the KD will be studied. In summary, the proposed study will fill the gap in knowledge about the effects of KD on inflammation, obesity-associated parameters, nutritional deficiencies, oxidative stress and metabolism in a single study. ClinicalTrail.gov registration number: NCT05652972.

Clinical Characteristics and Predictors of In-Hospital Mortality of Patients Hospitalized with COVID-19 Infection

Background: The identification of parameters that would serve as predictors of prognosis in COVID-19 patients is very important. In this study, we assessed independent factors of in-hospital mortality of COVID-19 patients during the second wave of the pandemic. Material and methods: The study group consisted of patients admitted to two hospitals and diagnosed with COVID-19 between October 2020 and May 2021. Clinical and demographic features, the presence of comorbidities, laboratory parameters, and radiological findings at admission were recorded. The relationship of these parameters with in-hospital mortality was evaluated. Results: A total of 1040 COVID-19 patients (553 men and 487 women) qualified for the study. The in-hospital mortality rate was 26% across all patients. In multiple logistic regression analysis, age ≥ 70 years with OR = 7.8 (95% CI 3.17−19.32), p < 0.001, saturation at admission without oxygen ≤ 87% with OR = 3.6 (95% CI 1.49−8.64), p = 0.004, the presence of typical COVID-19-related lung abnormalities visualized in chest computed tomography ≥40% with OR = 2.5 (95% CI 1.05−6.23), p = 0.037, and a concomitant diagnosis of coronary artery disease with OR = 3.5 (95% CI 1.38−9.10), p = 0.009 were evaluated as independent risk factors for in-hospital mortality. Conclusion: The relationship between clinical and laboratory markers, as well as the advancement of lung involvement by typical COVID-19-related abnormalities in computed tomography of the chest, and mortality is very important for the prognosis of these patients and the determination of treatment strategies during the COVID-19 pandemic.

Universal Climate Thermal Index as a prognostic tool in medical science in the context of climate change: A systematic review

The assessment of the impact of meteorological factors on the epidemiology of various diseases and on human pathophysiology and physiology requires a comprehensive approach and new tools independent of currently occurring climate change. The thermal comfort index, i.e., Universal Climate Thermal Index (UTCI), is gaining more and more recognition from researchers interested in such assessments. This index facilitates the evaluation of the impact of cold stress and heat stress on the human organism and the assessment of the incidence of weather-related diseases. This work aims at identifying those areas of medical science for which the UTCI was applied for scientific research as well as its popularization among clinicians, epidemiologists, and specialists in public health management. This is a systematic review of literature found in Pubmed, Sciencedirect and Web of Science databases from which, consistent with PRISMA guidelines, original papers employing the UTCI in studies related to health, physiological parameters, and epidemiologic applications were extracted. Out of the total number of 367 papers identified in the databases, 33 original works were included in the analysis. The selected publications were analyzed in terms of determining the areas of medical science in which the UTCI was applied. The majority of studies were devoted to the broadly understood mortality, cardiac events, and emergency medicine. A significant disproportion between publications discussing heat stress and those utilizing the UTCI for its assessment was revealed.

Are the levels of uric acid associated with biometeorological conditions?

Hyperuricemia is an independent risk factor for renal and cardiovascular diseases and is closely associated with gout episodes. It is caused, inter alia, by nutritional habits and genetic factors, and also displays seasonal variability conditioned by meteorological factors. The impact of meteorological factors, including both cold and heat stress, on the human physiology is presented based on the Universal Thermal Climate Index (UTCI) - a biometeorological index derived from an analysis of human thermal balance. The aim of our study was to establish whether seasonal variations significantly affect routinely measured urine acid (UA) levels and could eventually support the clinical decision making process, as well as assessing whether UTCI values are correlated with UA levels in blood serum. This work presents a retrospective epidemiological study of data collected in Olsztyn (Poland). Study material comprised 54,536 results of ambulatory tests measuring UA levels, performed during the period 2016-2019. The analysis concerned correlations between UA and the ages of female and male subjects as well as existing biometeorological conditions as represented by UTCI values in an annual cycle. UA levels in females were found to be lower (4.94 ± 1.37 SD) as compared to those of males (6.13 ± 1.43 SD) and demonstrated a strong positive correlation with age. UA values differed significantly (p < 0.05) on days characterized by cold stress and heat stress, for the oldest age group. UA levels were found to differ depending on the season, but these relationships were not statistically significant, except for significantly higher UA levels in females in autumn (p < 0.001). However, there was an evident difference in population UA levels under cold stress conditions (lower) and heat stress conditions (higher) in the elderly. The UTCI is an adequate predictor of population variations in UA levels since it takes into account the variability of local meteorological conditions.

The association between the biometeorological indicators and emergency interventions due to fainting: A retrospective cohort study

The association of fainting with specific situations and circumstances, such as the sight of blood, response to pain, prolonged standing position and fatigue, is well recognized and described in medical literature. Clinical experience also indicates that specific, local physical conditions, such as exposure to heat or remaining in a small, stuffy room may also trigger fainting. This paper verifies the hypothesis concerning the association between atmospheric conditions and the incidence of fainting. This is a retrospective cohort study of data relating to fainting collected in the city of Olsztyn (Poland). In total, 10,449 emergency service interventions in the period 2012-2019 that concluded with the R55 (syncope and collapse) diagnosis according to the ICD 10 were analyzed. The obtained data were matched with meteorological data, including basic parameters (temperature, humidity, atmospheric pressure) and complex parameters, with special attention given to the Universal Thermal Climate Index (UTCI). This index is derived from an analysis of human thermal balance and is particularly useful for describing the organism's response to thermal stress. Statistically significant differences in the occurrences of fainting depending on the season were revealed (more in the summer), but only for women. Among the analyzed meteorological and biometeorological parameters, statistical significance was found for parameters relating to temperature, with the greatest usefulness revealed for the UTCI. Periods with heat stress were more conducive to fainting, whereas the result for the general population was influenced by women in two age groups: 25-45 and 46-60. To our best knowledge, this is the first attempt worldwide to utilize the UTCI as a predictor of fainting. Our results confirmed the applicability of the UTCI as a universal biometeorological tool for the assessment of relationships between atmospheric conditions and the incidence of fainting.

Assessment of the Consultation Rate with General Practitioners in the Initial Phase of the COVID-19 Pandemic

Background: The COVID-19 pandemic affected the functioning of healthcare systems (HSs) in a way that was difficult to foresee earlier. It quickened the introduction of e-medicine, and changed the manner and number of services provided in the open medical setting. Aim: To assess variations in the consultation rate of patients in primary healthcare centers (PHCs) in consecutive months of the pandemic. Method: Data collected from two PHCs located in Olsztyn (Poland) were analyzed retrospectively. Collectively, these two centers provide care for approximately 20,000 inhabitants and perform approximately 100,000 medical services annually. The analysis was based on data covering the period April-July of the years 2010-2020, consisting in total of 337,510 medical services records. Results: A large, statistically significant decrease in the consultation rate (consultation rate understood as the number of individuals seeking consultation in relation to the number of people under care in a given time period) was revealed in each age group in the initial phase of the pandemic. In consecutive months, the approximated consultation rate achieved mean long-term values. Conclusions. The largest reduction in the consultation rate was revealed in the youngest age group, with the smallest occurring in the oldest. In the group of patients older than 65 years of age, the consultation rate after 3 months of the pandemic was the same as before the outbreak. Variations in the consultation rate were independent of the epidemiological situation. During the study, we observed an increased level of the administrative and paperwork activities carried out by PHC physicians.

Relationship between biometeorological factors and the number of hospitalizations due to asthma

The incidence of asthma exacerbation depends on atmospheric conditions, including such meteorological factors as the ambient temperature, relative air humidity or concentration of atmospheric aerosols. An assessment of relations between the frequency of asthma exacerbation and environmental conditions was made according to the meteorological components, the biometeorological index UTCI (Universal Thermal Climate Index), as well as selected air quality parameters, including concentrations of PM₁₀ and PM_2.5. The study was conducted on the basis of a retrospective analysis of medical data collected at the Independent Public Hospital of Tuberculosis and Pulmonary Diseases in Olsztyn (Poland). Our analysis of patient data (from 1 January 2013 until 31 December 2017) showed a significant correlation between the number of asthma exacerbation and the UTCI value. More frequent asthma exacerbations are observed in patients aged over 65 years when air humidity increases. The UTCI values contained within class 5, describing thermoneutral conditions, correspond to an average frequency of asthma exacerbation. A decline in the UTCI value leads to a reduced number of asthma exacerbation, while a rise makes the cases of asthma exacerbations increase.

UTCI as a bio-meteorological tool in the assessment of cold-induced stress as a risk factor for hypertension

BACKGROUND

Hypertension (HT) affects >1/3 of adult populations in developed countries. Several studies reported periodic changes in blood pressure (BP) values depending on atmospheric conditions, and analyzed the impact of outdoor temperature, atmospheric pressure, relative humidity and other meteorological parameters. The Universal Thermal Climate Index (UTCI) is a bio-meteorological index derived from an analysis of human thermal balance that comprehensively describes the impact of meteorological factors, including both cold stress and heat stress and their physiological consequences.

AIM

Our aim was to assess the relationship between UTCI values and the number of consultations for HT within the framework of the healthcare system.

METHODS

This work presents a retrospective epidemiological study of data collected in Olsztyn (Poland), characterized by cold climate type. The analytical material comprised 5578 consultations in emergency departments (EDs) due to HT.

RESULTS

Seasonal differences in the numbers of HT consultations with a significant increase in winter months were noticed, especially as regards women. Under cold stress conditions, the relative risk (RR) related to consultations for HT was 2-fold higher for women as compared to thermoneutral conditions (p < 0.001). For men these differences were also statistically significant, though at a much smaller level (p = 0.03). The increased RR of HT due to cold stress was found among younger and older women contrary to the women at the perimenopausal age.

CONCLUSIONS

Cold stress should be considered as a significant risk factor among patients, particularly women, diagnosed with cardiovascular diseases. The UTCI is an adequate bio-meteorological tool for the assessment of relationships between atmospheric conditions and occurrence of cardiac symptoms.

Applicability of the universal thermal climate index for predicting the outbreaks of respiratory tract infections: a mathematical modeling approach

Respiratory tract infections (RTI) are one of the most frequent reasons for medical consultations. As air temperature decreases, but also in connection with other meteorological parameters, evident seasonal fluctuations in the number of consultations for RTI can be observed. The Universal Thermal Climate Index (UTCI) is a complex meteorological index derived from an analysis of human thermal balance that depends on air temperature, air humidity, and wind speed. Our aims were to check if this index, although never used before for that purpose, is an adequate tool for forecasting seasonal increases in RTI prevalence. This study is a retrospective analysis of patients' consultations with general practitioners in the period of 2012-2015 (453,674 records) recorded in the city of Olsztyn (Poland), which is characterized by a cold climate type (Dfb). The values of air temperature, atmospheric pressure, relative air humidity, wind speed, and UTCI were used for a statistical analysis and a mathematical analysis of curve fitting in order to determine correlations between analyzed meteorological parameters and a number of medical consultations for RTI. Analysis of the number of medical consultations for RTI revealed an evident seasonal pattern in a 4-year observation period, with a strong inverse correlation between the number of patients with RTI and the UTCI. A statistically significant increase in the number of patients with RTI appeared when the UTCI decreased, especially when it reached the classes of strong cold stress and very strong cold stress. In conclusion, the UTCI is a valuable predictive parameter for forecasting seasonal increases in RTI cases. Its decrease may initiate a seasonal increased prevalence. This effect is strongest about the 10th day following a change in the thermal climate conditions and is not continuous. A larger number of consultations for RTI after weekends and holidays (the Monday effect) may blur the results of statistical analyses.

Spirometry testing among the homeless

BACKGROUND

Many literature reports have indicated the fact that the percentage of active smokers among the homeless is high, often several times higher than that of the general population. The homeless are known to have worse spirometric parameters than the general population.

OBJECTIVES

The question of what the principal and exclusive cause of airway obstruction among the homeless is remains unanswered. Verification of the above-mentioned hypothesis is possible by comparing the spirometric parameters in homeless people with those in the general population, based on the data related to subgroups with similar tobacco smoke exposure, which are homogenous in terms of sex, race and age.

MATERIAL AND METHODS

The spirometric parameters in 58 homeless male smokers were compared with those in 55 male smokers living normal lives. Neither group differed in age, duration of smoking or the number of pack-years. All of the subjects were Caucasian.

RESULTS

The mean values of forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC) and FEV1/ FVC, both corrected and expressed as absolute figures, were lower amongst the smoking homeless men than amongst men living normal lives. In 27.59% of the homeless subjests not receiving treatment for lung diseases, airway obstruction was identified.

CONCLUSIONS

Our results suggest that smoking is not the only cause of the worse spirometric parameters found among the homeless.

Mortality among the homeless: Causes and meteorological relationships

Background

The homeless constitute a subpopulation particularly exposed to atmospheric conditions, which, in the temperate climate zone, can result in both cold and heat stress leading to the increased mortality hazard. Environmental conditions have become a significant independent risk factor for mortality from specific causes, including circulatory or respiratory diseases. It is known that this group is particularly prone to some addictions, has a shorter life span, its members often die of different causes than those of the general population and may be especially vulnerable to the influence of weather conditions.

Materials and methods

The retrospective analysis is based on data concerning 615 homeless people, out of which 176 died in the analyzed period (2010–2016). Data for the study was collected in the city of Olsztyn, located in north-east Poland, temperate climatic zone of transitional type. To characterize weather conditions, meteorological data including daily minimum and maximum temperatures and the Universal Thermal Climate Index (UTCI) were used.

Results

The average life span of a homeless person was shorter by about 17.5 years than that recorded for the general population. The average age at death of a homeless male was 56.27 years old (SD 10.38), and 52.00 years old (SD 9.85) of a homeless female. The most frequent causes of death were circulatory system diseases (33.80%). A large number of deaths were attributable to smoking (47.18%), whereas a small number was caused by infectious diseases, while a relatively large proportion of deaths were due to tuberculosis (2.15%). Most deaths occurred in the conditions of cold stress (of different intensity). Deaths caused by hypothermia were thirteen-fold more frequently recorded among the homeless than for the general population. A relative risk of death for a homeless person even in moderate cold stress conditions is higher (RR = 1.84) than in thermoneutral conditions.

Conclusions

Our results indicate excessive mortality among the homeless as well as the weak and rather typical influence of atmospheric conditions on mortality rates in this subpopulation, except for a greater risk of cold related deaths than in the general population. UTCI may serve as a useful tool to predict death risk in this group of people.

Socioeconomic Characteristics, Health Risk Factors and Alcohol Consumption among the Homeless in North-Eastern Part of Poland

BACKGROUND

Homelessness is a form of social pathology, which is for various reasons undesirable and as far as possible limited by efforts such as programmes that assist in transitioning out of homelessness. Because, as time passes, the homeless population undergoes both quantitative and qualitative changes, the process of developing these programmes requires up-to-date information on the extent and profile of this phenomenon that takes into account the characteristics of a given country.

METHODS

A 12-month study of homeless individuals (ETHOS categories 1.1, 2.1 and 3.1) was conducted between December 2013 and November 2014 in Olsztyn, Poland. Demographic, sociological, psychological, and medical data were collected.

RESULTS

The study population comprised 98 homeless individuals. The average homeless individual in our study population was a single (93.88%), most commonly divorced (59.18%), alcohol-dependent (78.57%), smoking (84.69%), middle-aged (54.33 years, SD 9.70) male (92.86%) with a low level of education (10.19 years of completed education, SD 3.09). The individual was most commonly an unemployed person suffering profound privation, living off various types of benefits, and spending a significant proportion of his income on alcohol and cigarettes. The person often resigned from social welfare due to his alcohol dependence. Almost a third of the study population (32.65%) declared that they occasionally went hungry. The principal source of food were meals provided by welfare services (89.80%).

CONCLUSIONS

Our results indicate that the design of the social welfare system for homeless people should always take into account issues related to alcohol dependence, and each homeless person should be evaluated for possible alcohol dependence. Institutionalised material support provided to homeless individuals should be organised in such a way as to minimise the risk of promoting alcohol and nicotine dependence.

Coping Styles and Alcohol Dependence among Homeless People

BACKGROUND AND OBJECTIVES

The ways in which homeless individuals cope with stress may differ from those relied upon by the members of the general population and these differences may either be the result or the cause of their living conditions. The aim of the study was to determine the preferred coping style among the homeless and its relationship with alcohol dependence.

METHODS

The study included 78 homeless individuals and involved the collection of demographic, sociological, psychological and medical data from each participant. Coping styles relied upon when dealing with stressful situations were assessed using a Polish adaptation of the Coping Inventory for Stressful Situations. Alcohol dependence was assessed using the Michigan Alcoholism Screening Test (MAST) and a quantitative analysis of alcohol consumption.

RESULTS

Men accounted for 91.93% of the study population. Nearly 75% of the subjects met the alcohol dependence criterion. Significant relationships were observed between the individual's age, preferred coping style and alcohol consumption level. As an individual's age increased, the use of emotion-oriented coping styles decreased, while an increase in alcohol consumption was associated with a more frequent use of emotion- and avoidance-oriented strategies.

CONCLUSIONS

The findings of this study, similarly to those of many other studies of homeless individuals but investigating other areas (e.g. epidemiology of tuberculosis and traumatic injuries), are an exaggerated representation of associations observed in the general population. The results describe a group of people living on the margins of the society, often suffering from extremely advanced alcoholism, with clear evident psychodegradation. The presence of specific ways of coping with stress related to excessive alcohol consumption in this group of individuals may interfere with active participation in support programmes provided for the homeless and may further exacerbate their problems.

[Was it necessary to modify the classification of chronic kidney disease stages designed by NKF KDOQI? - "Nefrotest" study results]

INTRODUCTION

The introduction of the classification of chronic kidney disease (CKD) by NKF KDOQI guidelines in 2002, including the staging and risk assessment of this disease, was a landmark event. The division of CKD into stages 1-5 turned out to be very useful and sensitive tool in the hands of both scientists and clinical practitioners; it established common nomenclature pertaining to CKD all over the world. This stratification profoundly changed the approach to CKD, transforming it from a somewhat neglected clinical problem to the phenomenon named "the epidemic of CKD". However, after a short period if clinical experience a heated debate was initiated in the literature, indicating the shortcomings of the adopted classification. The most questionable areas included methodological issues as well as dissimilar prognoses for patients depending on the cause of kidney dysfunction, the presence of proteinuria and comorbidities.

AIM

The aim of this study was to evaluate the prevalence of CKD and the risk factors based on NKF KDOQI classification of 2002 in the population of Ostróda administrative district.

MATERIAL AND METHOD

In total 437 individuals (F 277, M 160) aged 52.7±18.0 were examined. The study was conducted in Ostróda among randomly selected inhabitants of Ostróda adminstrative district. Serum creatinine was determined by a modified Jaffe method and eGFR was calculated (MDRD formula) for each individual. The correlations between serum creatinine and eGFR, gender and age were studied. Additionally, 326 of the examined participants were interviewed to establish CKD risk factors: kidney disease in the family, being overweight and/or obese, arterial hypertension, diabetes, smoking, heart attack, stroke.

RESULTS

58.6% of the examined individuals demonstrated abnormal eGFR values (<90 ml/min/l.73 m2), whereas serum creatinine above the laboratory norm was found in 1.3% of patients. Significant CKD risk factors included an increased prevalence of obesity (78.3%), arterial hypertension (38.6%), and smoking (26.8%); 23.9% reported kidney disease in the family.

CONCLUSIONS

Based on our study, it can be concluded that CKD prevalence evaluated according to the classification of 2002 seems to be overestimated, and the main factor contributing to a false CKD diagnosis is a physiological decline in eGFR values with aging. The modification of CKD classification carried out by NKF in 2012 requires further observation and evaluation of its usefulness in daily clinical practice.

Exposure of breastfed infants to quercetin after consumption of a single meal rich in quercetin by their mothers

SCOPE

The exposure to quercetin (Q) has not been studied in breastfed infants whose mothers were consuming a Q-rich diet. The objective of the study was to determine whether plant-origin antioxidant-Q passes from the mother's diet to her milk and to calculate the pharmacokinetic parameters of this phenomenon.

METHODS AND RESULTS

Eleven breastfeeding women were included in this controlled case study. Volunteers followed a Q-restricted diet for 5 consecutive days with the exception of the 3rd day when they received a single meal providing 1 mg of Q per kg of body weight. Urine analysis showed the presence of Q already in the first collected samples after the test (1.5-4 h), which indicated its rapid absorption from the meal. The Cmax = 68 ± 8.44 nmol/L concentration of Q in the milk was calculated for Tmax = 11.89 ± 3.37 h. It was significantly different (p = 0.007) from 40 nmol/L and (p = 0.016) from 42 nmol/L of Q concentration before and 48 h after the test, respectively.

CONCLUSIONS

Q was shown to be a component of human milk at the nmol/L level. Infants breastfed by mothers consuming a diet rich in Q are exposed to a dose of approximately 0.01 mg of Q daily.

Antihypertensive efficacy and tolerability of aliskiren/hydrochlorothiazide (HCT) single-pill combinations in patients who are non-responsive to HCT 25 mg alone

OBJECTIVE

Thiazide diuretics such as hydrochlorothiazide (HCT) are a widely used first-line treatment for hypertension, but most patients will not achieve blood pressure (BP) control with HCT alone and so will require combination therapy. In this study the efficacy, safety and tolerability of a single-pill combination (SPC) of the direct renin inhibitor aliskiren with HCT were investigated in patients non-responsive to HCT 25 mg therapy.

METHODS

In this study, 722 patients with hypertension and an inadequate response to 4 weeks of HCT 25 mg (mean sitting diastolic BP > or =90 and <110 mmHg) were randomized to once-daily, double-blind treatment for 8 weeks with an SPC of aliskiren/HCT 300/25 mg or 150/25 mg, or continued HCT 25 mg monotherapy. Least-squares mean changes in mean sitting systolic/diastolic BP (msSBP/DBP) from double-blind baseline were analyzed for the ITT population at week 8 endpoint.

RESULTS

Aliskiren/HCT 300/25 mg and 150/25 mg SPCs lowered msSBP/DBP from baseline by 16.7/10.7 and 12.9/8.5 mmHg, respectively, both significantly greater reductions than HCT 25 mg alone (7.1/4.8 mmHg; both p < 0.001). Rates of BP control (<140/90 mmHg) were also significantly higher with aliskiren/HCT 300/25 mg (58%) and 150/25 mg (49%) than with HCT (26%; both p < 0.001). Aliskiren/HCT 300/25 mg provided significantly greater msSBP/DBP reductions and rates of BP control than the 150/25 mg SPC dose (all p < 0.05). Aliskiren/HCT SPC treatment showed similar tolerability to HCT alone and a numerically lower incidence of hypokalemia (serum potassium <3.5 mmol/L; aliskiren/HCT, 1.3-2.2%: HCT alone, 3.4%).

CONCLUSION

Aliskiren/HCT SPCs provide clinically significant BP reductions and improved BP control rates in patients who are non-responsive to HCT 25 mg monotherapy. Limitations of the study were the mainly Caucasian patient population and the non-responder design.

Quercetin from shallots (Allium cepa L. var. aggregatum) is more bioavailable than its glucosides

The lipophilic character of quercetin suggests that it can cross enterocyte membranes via simple diffusion. Therefore, it should be more bioavailable than its glucosides, which require preliminary hydrolysis or active transport for absorption. However, the published human studies show that quercetin is less bioavailable than its glucosides. Assuming that low bioavailability of quercetin aglycone provided to humans as a pure substance is the result of its low solubility in the digestive tract, we studied its bioavailability from dietary sources in which quercetin was dispersed in the food matrix. In a randomized crossover study, 9 volunteers took a single dose of either shallot flesh (99.2% quercetin glucosides and 0.8% quercetin aglycone) or dry shallot skin (83.3% quercetin aglycone and 16.7% quercetin glucosides), providing 1.4 mg quercetin per kg of body weight. Blood samples were collected before and after consumption of shallot preparations. Plasma quercetin was measured on HPLC with electrochemical detection after plasma enzymatic treatment. The maximum plasma quercetin concentration of 1.02 +/- 0.13 micromol/L was reached at 2.33 +/- 0.50 h after shallot flesh consumption compared with 3.95 +/- 0.62 micromol/L at 2.78 +/- 0.15 h after dry skin consumption. The area under the concentration-time curve after dry skin consumption was 47.23 +/- 7.53 micromol x h(-1) x L(-1) and was significantly higher than that after shallot flesh intake (22.23 +/- 2.32 micromol x h(-1) x L(-1)). When provided along with dietary sources, quercetin aglycone is more bioavailable than its glucosides in humans. Results point to the food matrix as a key factor.

Incidence and risk factors for pulmonary tuberculosis among the poor in the northern region of Poland

SETTING

The falling trends in pulmonary tuberculosis (PTB) incidence observed in European countries may be due both to an improving epidemiological situation and to a shift of tuberculosis (TB) towards socially important subpopulations; this trend may cause some TB cases to go unnoticed. Identification of such risk groups should be the basis for prevention programmes aimed at containing the spread of the disease.

OBJECTIVE

To evaluate the incidence and risk factors for PTB among the poor.

DESIGN

The study material was based on the data of 7380 people living in poverty, including 243 homeless adults, aged between 18 and 96 years. Potential medical and socio-economic risk factors were evaluated with regard to PTB incidence.

RESULTS

The TB incidence rate in the group studied was estimated at 730 per 100,000 population. The main risk factor was homelessness, with a TB incidence rate in the homeless group of 4290/100,000. According to our data, socio-economic factors correlated much more closely with a final TB diagnosis than subjective disease symptoms.

CONCLUSIONS

Efficient TB control requires prevention programmes aimed at systematic monitoring of the homeless. A population with such a high proportion of TB patients is a dangerous source of TB.

Analysis of selected risk factors of coronary artery disease in a healthy population aged 35-55 years

BACKGROUND

This report comprises an analysis of results of examinations performed as a part of a cardiovascular disease prevention programme funded by the National Health Fund.

AIM

To determine the relationship between body mass index (BMI) and blood pressure, blood glucose and lipid metabolism abnormalities in an ethnically homogeneous population of males and females aged 35 to 55 years with sense of full health without prior diagnosis of cardiovascular disease or diabetes.

METHODS

The study was carried out in the population of a 175,000-resident city during 9 months, involving 1080 subjects (696 females and 384 males) aged 35 to 55 years (mean age - 47.2+/-5.4). The following variables were assessed: systolic and diastolic blood pressure, body weight and height, BMI, fasting blood glucose, total cholesterol, triglycerides and HDL cholesterol levels.

RESULTS

The studied male population had significantly higher blood pressure, blood glucose, total cholesterol, triglycerides and lower HDL cholesterol levels compared to age-matched females. The female population was found to have a more prominent relationship between increased BMI and blood pressure, blood glucose and serum cholesterol levels than males. Significant differences in favour of females regarding systolic blood pressure, blood glucose and serum cholesterol failed to be present in the obese women subgroup (no statistically significant differences were found compared to obese males). In females aged 45 to 55 years, significantly higher body weight, blood pressure as well as blood glucose, cholesterol and triglyceride levels were observed than in younger women (35-45 years old).

CONCLUSIONS

Overweight and obesity are associated with increase of arterial blood pressure, lipid metabolism disturbances and elevation of blood glucose. The relationship between BMI and studied risk factors was influenced by age and gender. Menopause is associated with increasing body weight and unfavourable evolution of studied risk factors.