Triglicerydes/high-density lipoprotein ratio as a risk factor of post-Covid-19 sinus tachycardia: A retrospective study

Inappropriate sinus tachycardia (IST) is one of the manifestations of the post-COVID-19 syndrome (PCS), which pathogenesis remains largely unknown. This study aimed to identify potential risk factors for IST in individuals with PCS. The 1349 patients with PCS were included into the study. Clinical examination, 24H Holter ECG, 24H ambulatory blood pressure monitoring and biochemical tests were performed 12-16 weeks after the COVID-19 in all participants. IST was found in 69 (3.5%) individuals. In the clinical assessment IST patients were characterized by a higher age (p < 0.001) and lower prevalence of the diagnosed hypertension (p = 0.012), compared to remaining patients. Biochemical testing showed higher serum triglycerides (1.66 vs. 1.31 pmol/L, p = 0.007) and higher prevalence of a low high-density lipoprotein (HDL) cholesterol (24.6% vs. 15.2%, p = 0.035) in the IST group. Subsequently, the triglicerydes (TG)/HDL ratio, an indicator of insulin resistance, was significantly higher in the IST individuals (3.2 vs. 2.4, p = 0.005). 24H monitoring revealed a significantly higher minimum diastolic, maximum systolic and mean arterial blood pressure values in the IST group (p < 0.001 for all), suggesting a high prevalence of undiagnosed hypertension. A multivariate analysis confirmed the predictive value TG/HDL ratio >3 (OR 2.67, p < 0.001) as predictors of IST development. A receiver operating characteristic curve analysis of the relationship between the TG/HDL ratio and the IST risk showed that the predictive cut-off point for this parameter was 2.46 (area under the ROC curve = 0.600, p = 0.004). Based on these findings, one can conclude that insulin resistance seems to be a risk factor of IST, a common component of PCS.

Prevalence and assessment of risk factors among Polish adults with post-COVID-19 syndrome: a 12-month follow-up study

INTRODUCTION

Previous studies have indicated that COVID-19 symptoms may persist for up to 12 months after recovery; however, data on this phenomenon are still limited.

OBJECTIVES

The aim of this study was to assess the prevalence, the most common symptoms, and the risk factors for development of post-COVID syndrome in hospitalized and nonhospitalized patients during a 12-month follow-up after recovery from COVID-19.

PATIENTS AND METHODS

This longitudinal study was based on medical data collected at follow-up visits at 3 and 12 months post-COVID-19. Sociodemographic data, chronic conditions, and the most common clinical symptoms were assessed. A total of 643 patients were enrolled in the final analysis.

RESULTS

A majority of the study group were women (63.1%), and the median age of the entire group was 52 years (interquartile range [IQR] 43-63). After 12 months, a median of 65.7% (IQR, 62.1%-69.6%) of the patients declared the presence of at least 1 clinical symptom of post-COVID syndrome. The most common complaints were asthenia (median, 45.7% [IQR, 41.9%-49.6%]) and neurocognitive symptoms (median, 40% [IQR, 36%-40.1%]). In a multivariable analysis, female sex (odds ratio [OR] 1.49; P = 0.01) and severe COVID-19 course (OR, 3.05; P <0.001) were associated with persistence of clinical symptoms for up to 12 months after recovery.

CONCLUSIONS

After 12 months, persistent symptoms were declared by 65.7% of the patients. The most common symptoms 3 and 12 months after the infection were worse tolerance to exercise, fatigue, palpitations, and memory or concentration problems. Women are at a higher risk of experiencing persistent symptoms, and COVID-19 severity was a predictor of persistent post-COVID-19 symptoms.

Clinical and electrocardiographic correlates of myocardial dysfunction after COVID-19 in nonhospitalised patients in long-term follow-up. Data from the polish long-covid cardiovascular study

Clinical evidence indicates that COVID-19 is a multiorgan disease that significantly impacts the cardiovascular system. However, little is known about the predictors of myocardial dysfunction after SARS-CoV-2 infection. Therefore, this research aimed to evaluate the clinical and electrocardiographic correlates of myocardial dysfunction after SARS-CoV-2 infection in nonhospitalised patients without previously diagnosed cardiovascular disease. This observational study included 448 patients selected from the database of 4142 patients in the Polish Long-Covid Cardiovascular study. All patients underwent a 12-lead electrocardiogram (ECG); 24-h Holter ECG monitoring, 24/7 ambulatory blood pressure monitoring, echocardiography, and cardiac magnetic resonance imaging. According to the results of diagnostic tests, patients were divided into two groups depending on the occurrence of myocardial dysfunction after COVID-19. Group 1-without myocardial dysfunction after COVID-19-consisted of 419 patients, with a mean age of 48.82 (SD ± 11.91), and Group 2 (29 patients)-with myocardial dysfunction after COVID-19, with a mean age of 51.45 (SD ± 12.92). When comparing the analysed groups, there were significantly more men in Group 2 (p = 0.006). QRS (corresponds to the time of ventricular contraction in an electrocardiographic examination) fragmentation (p = 0.031), arrhythmias (atrial fibrillation, supraventricular extrasystole, ventricular extrasystole) (p = 0.008), and male gender (p = 0.007) were independently associated with myocardial dysfunction after COVID-19. The study showed that myocardial damage after COVID-19 affects men more often and is independent of typical clinical factors and the severity of the disease course. The QRS fragmentation and arrhythmias observed in the ECG indicate the possibility of myocardial dysfunction in patients after COVID-19, which may be a valuable marker for physicians.

Do COVID-19 Vaccinations Affect the Most Common Post-COVID Symptoms? Initial Data from the STOP-COVID Register-12-Month Follow-Up

Around the world, various vaccines have been developed to prevent the SARS-CoV-2 virus infection and consequently the COVID-19 disease. However, many patients continue to report persistent symptoms after the acute phase. Since gathering scientific information on long COVID and post-COVID syndrome has become an urgent issue, we decided to investigate them in relation to the vaccination status of patients from the STOP-COVID registry. In this retrospective study, we analyzed data from the medical visit after contraction of COVID-19 and follow-up visits in the 3rd and 12th month after the disease. In total, 801 patients were included in the analysis. The most frequent complaints after 12 months included deterioration of exercise tolerance (37.5%), fatigue (36.3%), and memory/concentration difficulties (36.3%). In total, 119 patients declared that they had been diagnosed with at least one new chronic disease since the end of isolation, and 10.6% required hospitalization. The analysis of individual symptoms revealed that headache (p = 0.001), arthralgia (p = 0.032), and dysregulation of hypertension (p = 0.030) were more common in unvaccinated patients. Considering headache and muscle pain, people vaccinated after the disease manifested these symptoms less frequently. Subsequent research is needed to consider vaccines as a preventive factor for post-COVID syndrome.

Do selected lifestyle parameters affect the severity and symptoms of COVID-19 among elderly patients? The retrospective evaluation of individuals from the STOP-COVID registry of the PoLoCOV study

BACKGROUND

Older individuals tend to include less physical activity in their routine and are more prone to chronic diseases and severe medical complications, making them the most burdened group that is losing years of life due to pandemic-related premature mortality. This research aimed to assess the lifestyle factors that affect the COVID-19 course among patients ≥ 65 years old.

METHODS

The study included 568 convalescents (64.1% women and 35.9% men) with persistent clinical symptoms after isolation. The mean age was 70.41 ± 4.64 years (minimum: 65 years; maximum: 89 years). The patients completed the questionnaire during their in-person visit to the medical center. The survey included questions regarding their health status when suffering from COVID-19, basic sociodemographic data, and medical history concerning chronic conditions and lifestyle.

RESULTS

Physical inactivity (p < 0.001) and feeling nervous (p = 0.026) increased the risk of having a severe disease course. Coronary artery disease raised both the risk of a severe disease course (p = 0.002) and the number of present symptoms up to 4 weeks (p = 0.039). Sleep disturbances increased the number of symptoms during infection (p = 0.001). The occurrence of any symptoms was also associated with the female sex (p = 0.004). The severity of the course was associated with longer persistent symptoms (p < 0.001) and a greater number of symptoms (p = 0.004); those with a more severe course were also at a greater risk of persistent symptoms for up to 4 weeks (p = 0.006). Senior citizens in the third pandemic wave suffered with more severe disease (p = 0.004), while illness during the fourth (p = 0.001) and fifth (p < 0.001) waves was associated with a lower risk of persistent symptoms for up to 4 weeks. The disease duration was significantly shorter among vaccinated patients (p = 0.042).

CONCLUSIONS

Elderly COVID-19 patients should re-think their lifestyle habits to consider a physical activity level that is adjusted to their abilities, in order to decrease the risk of a severe disease course and to further limit both the number and duration of symptoms. The research was carried out in accordance with the Declaration of Helsinki, and approval from the Bioethics Committee of Lodz Regional Medical Chamber to conduct the study was obtained (approval number 0115/2021). The PoLoCOV-Study ClinicalTrials.gov identifier is NCT05018052.

The Impact of Controlled Physical Training with Hydrotherapy on Changes in Swelling and Claudication Distance in Patients with Atherosclerotic Ischemia of the Lower Limbs

BACKGROUND

Patients with peripheral artery disease (PAD) often experience intermittent claudication. It is manifested by pain typically seen in the distal part of the legs during walking, which impairs the ability to walk, limits physical activity and results in lower health-related quality of life. It often leads to chronic ischemic pain, ulceration and even amputation. The aim of the study was to evaluate the effect of controlled physical training and whirlpool massage on changes in circuits, range of motion and distance of claudication in people with atherosclerotic ischemia of the lower limbs.

MATERIAL AND METHODS

The study included 100 patients, males and females aged 39 to 79 years, with peripheral circulation disorders of the lower limbs. The subjects were randomly divided into two groups. Group I (G) was treated with a series of 10 lower-limb whirling massages and took part in individually planned training, including breathing, relaxation and active free lower-limb exercises. Group II-control group (GC) took part only in individually planned training. Prior to the treatment procedures and after their completion, the ranges of movement of the ankle joint and the circumference of the lower limbs were measured and the corridor test (6MWT, six-minute walk test) was performed.

RESULTS

Statistically significant reduction in the circumference of the foot, ankle, calf and thigh in the G group was noticed. Both, in G and in GC group, a statistically significant increase in the range of dorsiflexion of the foot was found in comparison to the period before the procedures (p = 0.010; p = 0.006, respectively). There was also a statistically significant increase in the range of motion of the plantar flexion of the foot after the procedures in G (p = 0.007) and in GC (p = 0.048). Differences in the circumference of the lower limbs and the range of ankle joint movements between the study group and the control group before and after the therapy were not statistically significant. However, there was a statistically significant difference between these groups after the procedures in the 6-min walk test-significantly higher values of 6MWT were recorded in group G (p = 0.003).

CONCLUSIONS

Individually planned training, supplemented with hydrotherapy as thermal therapy, has a beneficial effect on reducing swelling of the lower limbs, increasing the range of foot movements and extending the distance in the 6-min walk test.

Long Term Effectiveness of ESWT in Plantar Fasciitis in Amateur Runners

BACKGROUND

Shock wave therapy is one of the modern methods of treatment used to treat diseases of muscles, tendons, and entheses in orthopedics, as well as in sports medicine. The therapy is increasingly used in the treatment of plantar fasciitis-a disease that is very difficult and burdensome to treat. Where basic conservative treatment for heel spurs fails, the only alternative consists of excision of the bone outgrowth, and shock wave therapy: a modern, minimally invasive, and relatively safe method. The aim of the study was to determine the long-term effectiveness of extracorporeal shock wave therapy in the treatment of painful ailments occurring in the course of plantar fasciitis in amateur runners.

MATERIALS AND METHODS

The study includes a group of 39 men and women, aged 34-64 (mean age 54.05 ± 8.16), suffering from chronic pain in one or both feet, occurring in the course of plantar fasciitis. The patients had to meet five criteria to qualify for the study. The group was divided into two subgroups: those who had not undergone other physiotherapeutic procedures prior to the extracorporeal shock wave therapy (ESWT-alone; 23 people), and those who had received other procedures (ESWT-plus; 16 people). The therapy was performed using extracorporeal shock wave (ESWT). No local anesthesia was used. The effectiveness of the extracorporeal shock wave therapy was evaluated using the visual analogue scale of pain (VAS), Modified Laitinen Pain Index Questionnaire, the AOFAS scale (American Orthopedic Foot and Ankle Society), and a survey questionnaire consisting of 10 questions concerning metrics and subjective assessment of the effects of therapy. The interview was conducted before ESWT, and again five years later.

RESULTS

The use of extracorporeal shock wave therapy reduced the intensity and frequency of pain, and improved daily and recreational activity. Moreover, a reduction in the level of pain sensation on the VAS scale and pain symptoms during walking was demonstrated. More favorable results were obtained in the ESWT-plus group; however, the first effects were observed later than in the ESWT-alone group.

CONCLUSIONS

Extracorporeal shock wave therapy is an effective form of therapy for amateur runners. It reduces pain associated with plantar fasciitis that amateur runners may experience at rest, while walking, and during daily and recreational activity.

Lifestyle, course of COVID-19, and risk of Long-COVID in non-hospitalized patients

INTRODUCTION

The coronavirus disease (COVID) 2019 pandemic remains a great challenge for the healthcare system. The widely reported prolonged signs and symptoms resulting from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection (Long-COVID) require medical care. The aim of the study was to assess factors, including lifestyle variables, related to the course of COVID-19 infection and to assess their impact on prolonged symptoms in non-hospitalized patients with COVID-19.

METHODS

A total of 1,847 (637 men and 1,210 women) non-hospitalized participants of the STOP-COVID registry of the PoLoCOV-Study who, following the COVID-19, underwent check-up examinations at the cardiology outpatient clinic were included in the analysis.

RESULTS

The study participants (median age 51 [41-62] years) were evaluated at 13.4 (8.4-23.6) weeks following the diagnosis of COVID-19. Female sex (odds ratio [OR] 1.46 [95% CI 1.19-1.78]), body mass index (BMI; per 1 kg/m2: 1.02 [1.00-1.04]), hypertension (1.39 [1.07-1.81]), asthma (1.55 [1.06-2.27]), stress or overworking (1.54 [1.25-1.90]), and nightshift work (1.51 [1.06-2.14]) were independently related to the severity of symptoms during acute phase of the COVID-19 infection. The Long-COVID syndrome was independently related to the female sex (1.42 [1.13-1.79]), history of myocardial infarction (2.57 [1.04-6.32]), asthma (1.56 [1.01-2.41]), and severe course of the acute phase of the COVID-19 infection (2.27 [1.82-2.83]).

CONCLUSION

Female sex, BMI, asthma, hypertension, nightshifts, and stress or overworking are significantly related to the severity of the acute phase of the COVID-19 infection, while female sex, asthma, history of myocardial infarction, and the severity of symptoms in the acute phase of COVID-19 are the predictors of Long-COVID in non-hospitalized patients. We did not find an independent relation between Long-COVID and the studied lifestyle factors.

Independent predictors of long-COVID in patients without comorbidities. Data from the Polish long-COVID cardiovascular (PoLoCOV-CVD) study

 

Coronavirus disease 2019 (COVID-19) is a serious respiratory disease that results from infection with a newly discovered coronavirus (SARS-COV-2). Patients recovering from SARS-COV2 infection complain of persisting symptoms which may lead to chronic fatigue syndrome and as well as many other complications. The vast majority of COVID-19 patients remaining in isolation/quarantine, due to the mild course of the disease, do not require hospitalization. There are many studies describing the course and complications of patients hospitalized due to COVID-19. There is little published data on how nonhospitalized patients get sick and what are the early and late complications of SARS-CoV-2 infection. Little is also known about Long-COVID (LC) in patients without comorbidities. Therefore, the aim of our analysis was to assess the predictors of long-lasting symptoms in patients without comorbidities suffering from COVID-19.

Methods

Patients ≥18 years of age diagnosed with COVID-19, were examined after full recovery (resolution of clinical symptoms, minimum 14 days after last symptoms). Patient information, course of the disease with symptoms, post-COVID-19 complaints were collected within 4–8 weeks after the COVID-19 recovery. We followed patients for at least 3 months. Patients were ordered the following tests: 12-lead ECG, 24-hour Holter ECG monitoring, 24-hour Holter blood pressure monitoring, Echocardiographic of the Heart assessment, Biochemical tests: lipid profile, glucose or glycosylated hemoglobin level, D-dimers. In patients with indications, the following were additionally performed: Magnetic resonance imaging of the heart, Computed tomography angiography (CTA) of pulmonary vessels, Angio CT of coronary vessels or other diagnostic tests.

Results

We identified 701 consecutive patients without comorbidities of whom 488 pts completed 3 month follow-up. Comparisons were made between LC group (n=218) and non-LC group (n=270). The demographic and laboratory characteristics of the studied group are presented in Table 1. Patients with severe course of acute phase of COVID-19 developed LC more often (72 vs. 28%, p<0.001). Significant differences regarding sex, weight, height, body mass index were observed. Patients with LC more often presented with dyspnoea, significant fatigue, chest pain, leg muscle pain, headache, arthralgia and chills. No statistically significant difference was observed regarding laboratory tests, 24-hour systolic and diastolic BP and echocardiographic parameters. LC group had higher 24-hour heart rate (77 [72–83] vs. 75 [70–81], p=0.021). Multivariate regression analysis showed that LC patients had higher BMI (odds ratio 1.057, 95% confidence intervals 1.016–1.100) and almost twice as often had a severe course (1.736, 1.071–2.814) and presented with arthralgia in the acute phase (1.901, 1.225–2.950).

Conclusions

Severe course of COVID-19, BMI, and arthralgia are independently related to long-COVID in patients without comorbidities.

Funding Acknowledgement

Type of funding sources: None.

Predictors and clinical consequences of heart damage in CMR in patients after COVID-19

Methods

Out-hospital clinic patients (pts) recovered from COVID-19 were prospectively recruited and underwent cardiac magnetic resonance (CMR) examination with a protocol including: edema, hyperemia, and necrosis or scar-derived from signal intensity assessment in T2-weighted, early gadolinium enhancement (EGE) and late gadolinium enhancement (LGE) CMR images.

Results

A total of 702 patients (mean age 50±12 years, 62% female) were included. The median (IQR) time interval between COVID-19 diagnosis and CMR was 13 (8–22) weeks. In none pts signs of edema, hyperemia and necrosis derived from signal intensity assessment in T2-weighted and early gadolinium enhancement was found. LGE was found in 152 (22%). LGE+ patients had significantly lower left ventricular (LV) ejection fraction (58.5±7.7 vs 61.1±7.9%, p&lt;0.001) and greater LV end-diastolic (117.0±52.2 vs 103,0±36.3 ml, p=0.023) and end-systolic (50.3±28.0 vs 41.0±17.5 ml, p=0.010) volumes when compared with LGE− patients. In the resting electrocardiogram (ECG) fragmented QRS was observed significantly more frequently (46% vs 25%, p&lt;0.001) in LGE+ group, whereas in 24h Holter ECG neither single premature, nor complex ventricular extrasystole burden did not differ between groups (p&gt;0.05). There were observed no differences between symptoms of COVD-19 and comorbidities between LGE+ and LGE− pts. In the multivariable logistic regression analysis: fragmented QRS [OR and 95% CI: 2.85 (1.93–4.21)] and any ST-T segment deviation in resting ECG [OR: 1.93 (1.15–3.25)] were identified as independent predictors of LGE, even after adjustment for comorbidities and COVID-19 symptoms.

Conclusions

1. In patients with fibrosis after COVID-19 reduced left ventricular ejection fraction and greater volume of the heart was found.

2. Fragmented QRS and ST-T abnormalities were independent predictors for LGE in patients after COVID-19.

Funding Acknowledgement

Type of funding sources: None.

Use of 1-MNA to Improve Exercise Tolerance and Fatigue in Patients after COVID-19

COVID-19 is not only a short-term infection, as patients (pts) recovering from SARS-CoV-2 infection complain of persisting symptoms, which may lead to chronic fatigue syndrome. There is currently no evidence that nutritional supplements can assist in the recovery of pts with chronic fatigue syndrome. 1-Methylnicotinamide (1-MNA) is an endogenic substance that is produced in the liver when nicotinic acid is metabolized. 1-MNA demonstrates anti-inflammatory and anti-thrombotic properties. Therefore, we investigated whether 1-MNA supplements could improve exercise tolerance and decrease fatigue among patients recovering from SARS-CoV-2.

METHODS

The study population was composed of 50 pts who had recovered from symptomatic COVID-19. The selected pts were randomized into two groups: Gr 1 (NO-1-MNA)-without supplementation; Gr 2 (1-MNA) with 1-MNA supplementation. At the beginning of the study (Phase 0), in both groups, a 6-minute walk test (6MWT) was carried out and fatigue assessment was performed using the Fatigue Severity Scale (FSS). Both FSS and 6MWT were repeated after 1 month.

RESULTS

A significant improvement in the mean distance covered in the 6MWT was noted at follow-up in Gr 1-MNA, compared with Gr NO-1-MNA. We also noted that in Gr 1-MNA, the 6MWT distance was significantly higher after 1 month of supplementation with 1-MNA, compared with the beginning of the study (515.18 m in Phase 0 vs. 557.8 m in Phase 1; p = 0.000034). In Gr 1-MNA, significantly more pts improved their distance in the 6MWT (23 out of 25 pts, equal to 92%), by a mean of 47 m, compared with Gr NO-1-MNA (15 of 25 pts, equal to 60%) (p = 0.0061). After one month, significantly more patients in the group without 1-MNA had severe fatigue (FSS ≥ 4) compared with the group with supplementation (Gr 1-MNA = 5 pts (20%) vs. Gr NO-1-MNA = 14pts (56%); p = 0.008).

CONCLUSIONS

1-MNA supplementation significantly improved physical performance in a 6-min walk test and reduced the percentage of patients with severe fatigue after COVID-19. The comprehensive action of 1-MNA, including anti-inflammatory and anticoagulant effects, may be beneficial for the recovery of patients with persistent symptoms of fatigue and low tolerance to exercise after COVID-19.

Do the Successive Waves of SARS-CoV-2, Vaccination Status and Place of Infection Influence the Clinical Picture and COVID-19 Severity among Patients with Persistent Clinical Symptoms? The Retrospective Study of Patients from the STOP-COVID Registry of the PoLoCOV-Study

The severity of ailments caused by SARS-CoV-2 varies and the clinical picture has already evolved during the pandemic, complicating diagnostics. In Poland, no study has been performed to assess the clinical picture of patients across the successive pandemic waves. The aim of the study was to present the characteristics of patients who present to medical center because of persistent symptoms after COVID-19, and to study differences between hospitalized/non-hospitalized, vaccinated/non-vaccinated individuals and between different waves in Poland. This is a retrospective study evaluating the clinical presentation of COVID-19 patients from the STOP-COVID registry of the PoLoCOV-Study. This registry includes patients who present to the medical center because of persistent clinical symptoms after the isolation. The patients' data were obtained from individuals who suffered from COVID-19 between September 2020 and December 2021.The patients were divided into groups according to the infection rate increase pattern (II/III/IV pandemic wave), status of vaccination and place of isolation. Regardless of the pandemic wave, the patients' most commonly reported weaknesses were a cough and a headache. The arterial hypertension and hyperlipidemia were the most frequent concomitant chronic conditions. Hospitalized patients more often reported weakness or a cough while home-isolated patients were more likely to have rhinitis or a headache. Patients who completed the vaccination course showed a shorter duration of clinical symptoms and a lower mean number of symptoms. Additionally, vaccinated individuals reported less taste and/or olfactory dysfunction than unvaccinated individuals. To conclude, the persistence of the pandemic has resulted in significant changes observed in the clinical picture. Successive waves caused deterioration in the subjective assessment of the disease severity. A cough seemed to occur more frequently in the later pandemic waves.

Evaluation of frequency of occurrence of cognitive impairment in the course of arterial hypertension in an elderly population

BACKGROUND

Dementia is a very serious problem with regard to geriatric population. In the population over the age of 80 the prevalence of dementia varies by up to 20%. It is very important to answer the question - are arterial hypertension and its duration associated with cognitive performance?

METHODS

One hundred and sixty people were qualified for participation in the study, women and men, diagnosed with arterial hypertension. The patients were divided into two pairs of groups. The first pair was group 1, patients with hypertension over the age of 85 and group 2, patients with hypertension aged 75-85. The second pair was group I, patients with up to 10 years of arterial hypertension and group II, patients with over 10 years of arterial hypertension. In the study, the Mini-Mental State Examination (MMSE) was used. Interpretation of impairment depended on the obtained numerical value.

RESULTS

In the tested group of patients, for individual correlations it was found that age is the independent variable which significantly affects the MMSE score. It was found that the time of duration of arterial hypertension did not have impact on the MMSE.

CONCLUSION

Cognitive functions evaluated through the MMSE were correct for the entire population. The length of the course of arterial hypertension did not have a significant adverse impact on cognitive functions and on the achieved MMSE result. Significant impact of age on the lowering of MMSE results and impairment of cognitive functions was shown.

[The influence of treatments in the field of hydrotherapy and controlled physical training on the temperature of lower limbs in patients with atherosclerotic peripheral vascular disease]

The ever-increasing pace of life, and thus constant stress, poor nutrition and lack of time for physical activity caused the development of many diseases referred to as civilization diseases, i.e., obesity, diabetes, hypertension, metabolic diseases or generalized atherosclerosis. They have a significant impact on the development of pathological changes in all tissues of the human body.

AIM

The aim of the study was to evaluate the effect of vaginal massages and controlled physical training on the temperature of lower limbs in patients with atherosclerotic peripheral vascular disease.

MATERIALS AND METHODS

The study included 50 patients, women and men, aged from 39 to 79 years, with impaired peripheral circulation of the lower limbs. The subjects were randomly divided into two groups, each of 25 patients. In group I, a series of 10 lower limb massage vortex procedures and an individually selected training including breathing, relaxation and active exercises of the lower limbs were used. In Group II, individually selected training was conducted. The temperature of the lower extremities was measured in all the subjects using an infrared multifunction thermometer (IR). The measurements were carried out before the beginning of the rehabilitation program and after its completion.

RESULTS

There was a statistically significant increase of lower limbs' temperature in group I (p <0.001).

CONCLUSIONS

The applied vortex massage treatments significantly influenced the improvement of the lower limbs' warmth. Treatments in the field of hydrotherapy have a beneficial effect in the treatment of patients with chronic lower limb ischemia.

[The influence of hydrotherapy and physical training procedures on selected haemodynamic parameters of the circulatory system in patients with atherosclerotic peripheral vascular disease]

Currently, the most common cause of death among highly developed countries are cardiovascular diseases. In terms of incidence, they take epidemic proportions. The main cause of the development of cardiovascular disease in 90% of cases is atherosclerotic lesions. The most important complications of atherosclerosis in addition to myocardial infarction and stroke include peripheral arterial disease, including arteries of the lower limbs. It is estimated that 3-10% of the general population suffers from atherosclerotic peripheral vascular disease. In people over 70, the number of patients with peripheral vascular disease increases up to 15-20%.

AIM

The aim of the study was to evaluate the influence of vortex massages and physical training on the temperature of lower limbs and selected haemodynamic parameters of the circulatory system in patients with atherosclerotic peripheral vascular disease.

MATERIALS AND METHODS

The study included 50 patients, both sexes, aged from 39 to 79 years, with impaired peripheral circulation of the lower limbs. The subjects were randomly divided into two groups. In group I, a series of 10 lower limb massage vortex procedures and an individually selected training including breathing, relaxation and active exercises of the lower limbs were used. In Group II, individually selected training was conducted. Measurements of blood pressure and heart rate (HR) were carried out before and after the series of treatments. The technique of performing the measurements was consistent with the recommendations of the Polish Society of Arterial Hypertension regarding blood pressure measurements.

RESULTS

After the end of the series of treatments, in group I there was a statistically significant decrease in systolic blood pressure (SBP) and heart rate (HR).

CONCLUSIONS

The applied eddy massage treatments significantly influenced the improvement of the hemodynamic parameters of the cardiovascular system.

[Evaluation of the incidence of stroke in the course of hypertension in elderly patients]

One of the more common chronic diseases is hypertension. After 70 years of age, it is found in over 70% of this population. It causes a number of organ complications that cause death.

AIM

The aim of the study was to evaluate the prevalence of stroke in hypertension in elderly patients.

MATERIALS AND METHODS

The study involved 63 women and 17 men, aged from 75 to 93 years, who were diagnosed with arterial hypertension in accordance with the guidelines of the Polish Society of Hypertension. Patients were divided into two groups. The first pair consisted of a group of 1 hypertensive patients (HA) lasting up to 10 years of age over 85 years and a group of 2 patients with HA lasting up to 10 years at the age of 75-85 years. The second pair is group I - patients with HA over 10 years of age over 85 years and group II - patients with HA lasting over 10 years at the age of 75-85. The test confirming the history of stroke was obtained from medical records.

RESULTS

In the study, no significant differences were found in the incidence of stroke between younger patients and those older than 85 years. In the group of patients treated for more than 10 years due to hypertension, the percentage of patients with diagnosed stroke was slightly higher than in patients treated for shorter periods, however these were not statistically significant differences p <0.43.

CONCLUSIONS

In the study population, the incidence of stroke was not significantly influenced by the age or duration of hypertension.

[Evaluation of selected results of laboratory blood tests in the course of hypertension in elderly patients]

Hypertension is one of the most common chronic diseases. The incidence is estimated at about 30% of the general population, with a clear tendency of increasing the frequency with age.

AIM

The aim of the study was to assess selected results of laboratory blood tests in the course of hypertension in elderly patients.

MATERIALS AND METHODS

The study involved 63 women and 17 men, aged from 75 to 93 years, who were diagnosed with arterial hypertension in accordance with the guidelines of the Polish Society of Hypertension. Patients were divided into two pairs of groups - in terms of the duration of hypertension and the age of the subjects. Blood samples were taken in patients to determine blood counts, glucose, creatinine, total cholesterol, LDL, HDL and triglycerides. In the morphological examination of the blood, the number of leukocytes, erythrocytes and platelets in 1 μl of blood was assessed, as well as the concentration of CRP, ALAT and ASPAT were assessed.

RESULTS

In the study, no significant differences were found between the results of selected biochemical tests and peripheral blood morphology between the analyzed subgroups of patients with respect to age and also depending on the duration of hypertension.

CONCLUSIONS

Both the older age of patients and the duration of hypertension do not significantly affect the results of selected blood laboratory tests in the study population.

[Assessment of the intima and media of carotid arteries in the course of hypertension in the elderly]

According to the position of the European Society of Hypertension in 2009, the thickening of the inner and middle membrane complex of the carotid arteries (I-M CCA), or the finding of atherosclerotic plaques is associated with high cardiovascular risk. The increase in I-M CCA thickness, assessed within the carotid artery, is considered the initial stage of atherosclerosis. According to the concept of parallel development of atherosclerosis in many arterial areas I-M CCA is a recognized marker of the process involving other arteries, such as coronary arteries, kidney or lower limbs.

AIM

The aim of the study was evaluation of the intima and media of carotid arteries - I-M in the course of hypertension in the elderly.

MATERIALS AND METHODS

The study involved 63 women and 17 men, aged from 75 to 93 years, who were diagnosed with arterial hypertension in accordance with the guidelines of the Polish Society of Hypertension. Patients were divided into two groups. The first pair consisted of a group of 1 hypertensive patients (HA) lasting up to 10 years of age over 85 years and a group of 2 patients with HA lasting up to 10 years at the age of 75-85 years. The second pair is group I - patients with HA over 10 years of age over 85 years and group II - patients with HA lasting over 10 years at the age of 75-85. Carotid artery examination was performed using the Aloka SSD-1100 ultrasound machine. The measurements were made within the left and right carotid wall of the common carotid artery in the anterior and lateral-posterior projection. The maximum thickness of the inner and middle membranes was measured in three places within two segments of the common carotid artery.

RESULTS

It was observed that in the group of patients treated longer due to hypertension, the thickness of the intima-media complex is significantly higher than in patients with shorter duration. Moreover, in the examined group of patients in the analysis of individual correlations, life expectancy was influenced, among others, by significantly on the thickness of I-M CCA.

CONCLUSIONS

Both the older age of patients and the longer duration of hypertension caused thickening of the intima-media complex. The duration of hypertension greater than 10 years had a greater impact on the thickness of this complex than the age of the patients.

[Evaluation of renal function in the course of hypertension in the elderly]

Hypertension is one of the most common chronic diseases in Poland. It occurs in all age groups, but most often affects people over 65 years of age. The correct diagnosis of hypertension in older people includes documenting elevated blood pressure values, differentiating disease changes from physiologically related changes to aging, as well as assessing organ related complications. Detection of organ complications is also an important parameter of prognosis assessment.

AIM

The aim of the study was evaluation of renal function in the course of hypertension in the elderly.

MATERIALS AND METHODS

The study involved 63 women and 17 men, aged from 75 to 93 years, who were diagnosed with arterial hypertension in accordance with the guidelines of the Polish Society of Hypertension. Patients were divided into two groups. The first pair consisted of a group of 1 hypertensive patients (HA) lasting up to 10 years of age over 85 years and a group of 2 patients with HA lasting up to 10 years at the age of 75-85 years. The second pair is group I - patients with HA over 10 years of age over 85 years and group II - patients with HA lasting over 10 years at the age of 75-85. The assessment of glomerular filtration was made using the estimated glomerular filtration rate (GFR), which was calculated according to the mathematical formula of MDRD, while the renal resistance index was assessed using spectral Doppler after visualization of the flow in the renal arteries.

RESULTS

The value of glomerular filtration in the examined groups divided by age was 55.1±15 (group 1) and 66.9±16 (group 2). The values of the kidney artery resistance index (depending on age) were in 1 group: 0.61±0.04 vs 0.60±0.05 and in the second group: 0.59±0.06 vs 0.58±0.05. The values of the renal artery resistance index (depending on the duration of HA) were 0.62±0.04 vs 0.61±0.03 (group I) and 0.61±0.04 vs 0.60±0.04 ( group II).

CONCLUSIONS

GFR depends on the duration of hypertension. A relationship was found between the value of the kidney artery resistance index and age. There was no significant relationship between the value of the kidney artery resistance index and duration of hypertension.

Copper influence on bank vole's (Myodes glareolus) sexual behavior

The impact of human activity on the environment has led to a steady increase of the amounts of copper in the ecosystems. This element accumulates in plants and water, potentially exposing rodents to its harmful effects. In industrial districts, a decrease in the density of small rodent populations has been observed. This decline may be caused by many factors, including mortality, decreased fertility, or impaired sexual behavior. The decline in the reproductive abilities of small rodents after copper exposure was demonstrated in our previous work (Miska-Schramm A, Kruczek M, Kapusta J, Ecotoxicology 23:1546-1554, 2014). The aim of the presented research was to determine how copper administered at concentrations similar to those recorded in industrial districts (Cu I-150 mg/kg, Cu II-600 mg/kg, C-control) affects the sexual behavior of small rodents. The model species was the bank vole (Myodes glareolus). The behavior and vocalizations of male-female pairs were recorded during open-field tests: ♂C vs. ♀C; ♂Cu I vs. ♀C; ♂Cu II vs. ♀C while in preference tests, female behavior was assessed in the following combinations: ♀C vs. ♂C & ♂Cu I; ♀C vs. ♂C & ♂Cu II. In the presented work, we show that copper decreased the males' sexual attractiveness. Females showed suppressed preference towards males treated with 600 mg/kg copper. The number of sniffs and a number of approaches towards Cu II males was significantly lower than towards control individuals. Also, in preference test with 150 mg/kg treated animals, total activity was lower towards copper treated animals. At the same time, copper did not influence intra-sexual interactions.

[Echocardiographic evaluation in the course of hypertension in the elderly]

Factor contributing to the high prevalence of hypertension in the elderly is currently observed high survival rate of people diagnosed and treated hypertension, as well as the aging process itself. Detection of systemic complications was considered to be an important element of the diagnosis of hypertension as well as an important parameter of prognosis. Nowadays, echocardiography is the main tool used to assess heart cavities and to diagnose ventricular hypertrophy.

AIM

The aim of the study was echocardiographic evaluation of the heart in the course of hypertension in the elderly.

MATERIALS AND METHODS

80 patients (63 women and 17 men) aged 75 to 93 years (mean age 81±5.3 years) with diagnosed hypertension were enrolled. Patients were divided into two groups because of the duration of hypertension and age. Hypertension was diagnosed based on clinical measurements. All patients underwent echocardiography.

RESULTS

The echocardiographic study showed a significant effect of duration of hypertension on the dimensions of both the left ventricular heart chambers and the thickness of the ventricular septum and the posterior wall.

CONCLUSIONS

Long-term hypertension results in left atrium and right ventricular hypertrophy, diminished left ventricular systolic and diastolic dimensions, and increases ventricular septal thickness in diastole and posterior wall thickness, without affecting the diastolic dimension of the right ventricle.

[Evaluation of selected vascular active factors in patients after myocardial infarction subjected to cardiac rehabilitation]

Atherosclerosis is an inflammatory process that develops in the coronary arteries. Clinically active agents such as proinflammatory interleukins, TNF-α, tissue inhibitors of metalloproteinases (including TIMP-1), and vascular endothelial growth factor (VEGF), are important factors in the development of acute coronary syndromes.

AIM

The aim of the study was to evaluate the effect of cardiac rehabilitation (stage II) on the concentration of selected vascular active factors (IL- 1, IL-6, TIMP-1, VEGF).

MATERIALS AND METHODS

The study involved 24 patients after ACS who underwent complex cardiac rehabilitation (stage II) in the Department of Internal Medicine and Cardiac Rehabilitation at the Medical University of Lodz. The study involved 20 men and 4 women aged 42-78 years (average age 58.75 ± 8.45 years). The ELISA method was used in the vascular endothelial cell assay using readymade sets for determining individual molecules: Human Quantum ELISA Kit (DTM100; R & D Systems, BIOKOM, Poland), Human VEGF Quantikine ELISA Kit (DVE00; R & D Systems, BIOKOM, Poland) Human IL-1 beta / IL-1F2 Quantikine ELISA Kit (DLB50; R & D Systems, BIOKOM, Poland), Human IL-6 Quantikine ELISA Kit (D6050, R & D Systems, BIOKOM, Poland). TIMP-1 concentration is expressed in ng / ml, VEGF in pg / ml, IL-1 in pg / ml, IL-6 pg / ml. The results of the study were analyzed statistically at significance level p <0,05.

RESULTS

There was no significant effect of cardiac rehabilitation on vascular endothelial factors: TIMP-1, VEGF, IL-6. Significant effect of cardiac rehabilitation was observed on the increase of IL-1 concentration (p=0.016).

CONCLUSIONS

The absence of post-cardiac rehabilitation in patients after ACS, significant changes in vascular endothelial activity, confirm the hypothesis that adequate physical effort does not involve changes in blood concentrations and justifies perception of rehabilitation as a safe and risk-free intervention.

[Evaluation of oxidative-reduction markers of blood in patients with acute coronary syndromes (ACS) subjected to cardiac rehabilitation]

Role in the pathogenesis of atherosclerosis play a reactive oxygen species. In the case of disturbance of dynamic balance between their production and antioxidant defense mechanisms comes to undesirable consequences - oxidative stress. Excessive exercise can, among others, disrupting the balance.

AIM

The aim of the study was to evaluate the exponents of the processes of oxidation - reduction of blood in patients with ACS undergoing rehabilitation in a hospital setting.

MATERIALS AND METHODS

The study included 25 patients after ACS STEMI, including 19 men and 6 women, aged 51.5±6.5 years, underwent rehabilitation in the Department of Internal Medicine and Cardiac Rehabilitation, University Hospital im. WAM in Lodz. Blood samples were taken after an initial exercise test (I) and after the final exercise test (IV). Marked: SOD-1, CAT, GPX- in red blood cells, plasma antioxidant activity (TAS) and the concentration of MDA in the red blood cells. Cardiac rehabilitation program included 15 interval training, each lasting 40-45 minutes.

RESULTS

The results were statistically analyzed. For the statistically significant level of p<0.05. No significant effect of cardiac rehabilitation on the activity of GPX, SOD-1, MDA and antioxidant activity of plasma. There was only a significant impact on the rehabilitation of CAT activity (p=0.002).

CONCLUSIONS

Properly conducted cardiac rehabilitation does not disturb the balance of oxidation - reduction of blood in patients with ACS. Exercise should be selected in such a way that this balance is maintained.

Cardiac rehabilitation in patients with ST-segment elevation myocardial infarction: can its failure be predicted?

BACKGROUND

The prognosis in patients after acute coronary syndromes (ACS) is significantly burdened by coexisting anaemia, leukocytosis and low glomerular filtration rate (GFR). Hyperglycaemia in the early stages of ACS is a strong predictor of death and heart failure in non-diabetic subjects. This study aimed to evaluate the effect of hyperglycaemia, anaemia, leukocytosis, thrombocytopaenia and decreased GFR on the risk of the failure of cardiac rehabilitation (phase II at the hospital) in post-ST-segment elevation myocardial infarction (STEMI) patients.

METHODS

The study included 136 post-STEMI patients, 96 men and 40 women, aged 60.1 ± 11.8 years, admitted for cardiac rehabilitation (phase II) to the Department of Internal Medicine and Cardiac Rehabilitation, WAM University Hospital in Lodz, Poland. On admission fasting blood cell count was performed and serum glucose and creatinine level was determined (GFR assessment). The following results were considered abnormal: glucose ⩾ 100 mg/dl, GFR < 60 ml/min/1, 73 m², red blood cells (RBCs) < 4 × 106/μl, white blood cells (WBCs) > 10 × 103/μl; platelets (PLTs) < 150 × 10³/ml. In all patients an exercise test was performed twice, before and after the completion of the second stage of rehabilitation, to assess its effects.

RESULTS

Based on logistic regression analysis and the results of an individual odds ratio (OR) of the tested parameters, their prognostic impact was determined on the risk of failure of cardiac rehabilitation. This risk has been defined on the basis of the patient's inability to tolerate workload increment >5 Watt in spite of the applied program of cardiac rehabilitation. As a result of building a logistic regression model, the most statistically significant risk factors were selected, on the basis of which cardiac rehabilitation failure index was determined. leukocytosis and reduced GFR determined most significantly the risk of failure of cardiac rehabilitation (respectively OR = 6.42 and OR = 3.29, p = 0.007). These parameters were subsequently utilized to construct a rehabilitation failure index.

CONCLUSIONS

Peripheral blood cell count and GFR are important in assessing the prognosis of cardiac rehabilitation effects. leukocytosis and decreased GFR determine to the highest degree the risk of cardiac rehabilitation failure. Cardiac rehabilitation failure index may be useful in classifying patients into an appropriate model of rehabilitation. These findings support our earlier reports.

[The usefulness of the scale before exercise and exercise to identify coronary artery disease by physiotherapists]

Myocardial ischemia can be assessed by ECG at rest or doing the stress test, which also serves to evaluate the results of cardiac rehabilitation.

AIM

The aim of this study was to determine the usefulness of the scale before exercise and exercise to assess the risk of coronary heart disease and recognition by physiotherapists.

MATERIALS AND METHODS

The study included three groups of people: 1. 65 patients with stable coronary heart disease (IHD), including 45 men and 20 women, ranging in age from 33 to 79 years, an average of 60.18 ± 9.43 years who exercise test was positive; 2. 24 patients after myocardial infarction undergoing subsequent rehabilitation, including 20 men and 4 women, aged from 42 to 78 years, an average of 58.75 ± 8.45 years; 3. 70 healthy subjects without ischemic heart disease, including 34 men and 36 women, ranging in age from 24 to 70 years, an average of 56.24 ± 12.33 years. All healthy people and patients were hospitalized in the Department of Internal Medicine and Cardiac Rehabilitation, University Hospital im. WAM in Lodz. The study groups were assessed risk of coronary heart disease based on the result obtained in the scale before exercise and exercise. The results were statistically analyzed using Statistica version 12 (StatSoft, Poland). For the statistically significant level of p<0.05.

RESULTS

Compared to healthy individuals in both the ischemic heart disease (p=0.04) and in the group treated with rehabilitation (p=0.03) results in a scale before stress was significant higher. Compared to healthy individuals, both in the group of ischemic heart disease (p <0.001) and in the group treated with rehabilitation (p<0.001) The results on a scale of exercise were significantly higher.

CONCLUSIONS

The use of scale before exercise to assess the risk of coronary heart disease is useful for physical therapists in their professional practice. There legitimacy of the use of scale exercise for the initial diagnosis of coronary artery disease without knowing the interpretation of the ECG stress test.

The Effect of Aluminum Exposure on Reproductive Ability in the Bank Vole (Myodes glareolus)

Human impact on the environment is steadily increasing the amounts of aluminum in the ecosystems. This element accumulates in plants and water, potentially exposing herbivores to its harmful effect. In heavily polluted sites, a decrease in the density of small rodent populations has been observed. This decline may be caused by many factors, including decreased fertility. The aim of the presented research was to determine how aluminum, administered at concentrations similar to those recorded in industrial districts (Al I = 3 mg/l, Al II = 200 mg/l), affects the reproductive abilities of small rodents. As the indicators of reproductive abilities, body weight, weight of the testes and accessory sex glands of males, and uterus weight of females were estimated. In females, the number of matured follicles (types 6, 7, and 8) was analyzed, while in males, the quantity and quality (matured, viable, swollen, motile, head abnormalities) of epididymal sperm cells were assessed. Moreover, the development of testes, measured by spermatogenic index, was determined. The model species was the bank vole. Our results have proven that aluminum impairs adult individuals' reproductive abilities by decreasing the quality and quantity of sperm cells and by causing morphologically abnormal development of the gonads. However, no difference in male organometric parameters was found, and only in females treated with 3 mg/l Al, the uterus weight was higher than control. No differences were found in the total number of matured follicles. These results suggest that the decline in rodent numbers in industrial districts is due, at least in part, to poorer males' reproductive abilities, resulting from exposure to aluminum contamination.

[The usefulness of complete blood count in predicting cardiac rehabilitation failure in post-NSTEMI patients]

ACS (acute coronary syndrome) NSTEMI is more prevalent than ACS STEMI. Within four years the mortality rate was twice higher in NSTEMI group than in the STEMI group. Studies have demonstrated that cardiac rehabilitation decreases the risk of all-cause mortality as well as the mortality related to cardiovascular events.

AIM

The aim of the study was to evaluate with the use of an index of own design the prognostic value of the complete blood count (CBC) in predicting cardiac rehabilitation failure in post-NSTEMI patients.

MATERIALS AND METHODS

The study comprised 116 post-NSTEMI patients, 81 men and 35 women, aged 64,12±11,29 years, admitted for cardiac rehabilitation to the Department of Internal Medicine and Cardiac Rehabilitation, MU in Lodz. On admission fasting blood cell count was performed, serum glucose and creatinine level was determined (GFR assessment). The following results were considered abnormal: glucose level ≥100 mg/dl, GFR<60 ml/min/1.73m2, RBC < 4x106 μl, WBC > 10x103/μl, PLT < 150x103/μl. Exercise test (cycloergometer) was performed twice in all patients - before and after the completion (4 weeks) of the II phase of the rehabilitation to assess its effects.

RESULTS

Basing on logistic regression analysis and the results of individual odds ratio (OR) of the tested blood parameters, their prognostic impact on the risk of cardiac rehabilitation failure was determined. This risk was defined on the basis of patient's inability to tolerate any workload increment (0 Watt) between the initial and final result of the exercise test despite the applied cardiac rehabilitation program. The most statistically significant risk factors were selected as the result of logistic regression model building on the basis of which cardiac rehabilitation failure index was determined. Anemia and leucocytosis determined most significantly the failure of cardiac rehabilitation (respectively OR=2,77 and OR=2,36; p=0,01). They were used to construct a rehabilitation failure index with the values ranging from 0 to 2, where 0 - corresponds to absence of anemia and leucocytosis, 1 - corresponds to the occurrence of anemia or leucocytosis in post-NSTEMI patients and was associated with 2,65-fold increase of the risk of cardiac rehabilitation failure, 2 - corresponds to simultaneous occurrence of anemia and leucocytosis and was associated with 7,02-fold increase of the risk of cardiac rehabilitation failure.

CONCLUSIONS

Complete blood count is useful in predicting cardiac rehabilitation failure. Anemia and leucocytosis are the most significant determinants of cardiac rehabilitation failure in post-NSTEMI patients. Cardiac rehabilitation failure index can be used for its individual programming. Then optimal rehabilitation effects can be obtained maintaining its safety in post-NSTEMI patients.

[Leukocytosis and decreased glomerular filtration rate increase the risk of cardiac rehabilitation failure in post-STEMI patients]

Recently, in the prognostic assessment of ACS patients attention has been paid to hyperglycemia, leukocytosis, decreased GFR, anemia and thrombocytopenia as they are believed to worsen the prognosis.

AIM

The aim of this study was to evaluate the results of basic laboratory blood tests in predicting the failure of in-hospital cardiac rehabilitation in post-STEMI patients - using an index of own design.

MATERIALS AND METHODS

The study comprised 100 post-STEMI patients, 70 men and 30 women, aged 60,1±10,3 years, admitted for cardiac rehabilitation (phase II) to the Department of Internal Medicine and Cardiac Rehabilitation, WAM University Hospital in Lodz. On admission fasting blood cell count and glucose and creatinine level was determined (for GFR assessment). The following results were considered abnormal: glucose level ≥100 mg/dl, GFR<60 ml/min/ 1,73m2, WBC> 10x103/μl, RBC<4x106/μl, PLT<150x103/μl. Exercise test was performed twice in all patients - before and after the completion of the II phase of cardiac rehabilitation to assess its effects.

RESULTS

Basing on logistic regression analysis and on the results of individual odds ratio (OR) of the tested blood parameters, their prognostic impact on the risk of cardiac rehabilitation failure was determined. This risk was defined on the basis of post-STEMI patients' inability to tolerate any workload increment (0 Watt) between the initial and final result of the exercise test despite the applied cardiac rehabilitation program. This concerned 54 out of 100 post- STEMI patients. Leukocytosis (WBC>10x103/μl) and GFR<60 ml/ min/1,73 m2 determined most significantly the failure of cardiac rehabilitation (respectively: OR=6,65 and OR=3,43; p=0,05). Thus, they were used to construct a cardiac rehabilitation index. The occurrence of leukocytosis or decreased GFR in post-STEMI patients was associated with a 4,5-fold increase of the risk of cardiac rehabilitation failure, whereas simultaneous occurrence of leukocytosis and decreased GFR was associated with over 20-fold increase of this risk.

CONCLUSIONS

The results of peripheral blood laboratory tests are useful in predicting cardiac rehabilitation effects. Leukocytosis and decreased GFR (<60 ml/min/1,73 m2) determine to the highest degree the risk of cardiac rehabilitation failure (phase II) in post-STEMI patients. Cardiac rehabilitation failure index can be useful in developing individualized rehabilitation program for post-STEMI patients.

[The use of controlled physical training in patients with acute coronary syndrome treated with intervention - assessment of effects on biochemical parameters and functional myocardial]

Diseases of the cardiovascular system is one of the most common causes of death among people over 65 years. Due to its course and incidence are a major cause of disability and impaired quality of life for seniors, as well as a serious economic problem in health care. Important role in the prevention of cardiovascular disease plays making systematic physical activity, which is a component of any rehabilitation program. Regular physical training by doing cardio-and vasoprotective has a beneficial effect on cardiovascular status and physical performance in patients with diagnosed coronary heart disease, regardless of age.

AIM

The aim of this study was to evaluate the effect of controlled exercise on selected biochemical parameters and functional myocardial infarction.

MATERIALS AND METHODS

A group of 89 patients were divided into 3 subgroups. In group I (n = 30) was performed 2 weeks cardiac rehabilitation program, in group II (n = 30) 4 weekly. Streamline the program consisted of a series of interval training performed using a bicycle ergometer and general exercise. The remaining group (gr. III, n = 29) participated in individually selected training program. In all subjects before and after the training cycle underwent thoracic impedance plethysmography, also determined the level of plasma natriuretic peptide NT-proBNP and echocardiography and exercise test.

RESULTS

After training, in groups, which carried out a controlled physical training, improvement was observed: exercise capacity of patients respectively in group I (p = 0.0003), group II (p = 0.0001) and group III (p = 0.032), stroke volume SV, cardiac output CO and global myocardial contractility, there was also reduction in the concentration of natriuretic peptide NT-proBNP. Furthermore, the correlation between the results shown pletyzmography parameters and NT-proBNP, SV, CO and EF.

CONCLUSIONS

Regular physical training as part of the cardiac rehabilitation has a beneficial effect on biochemical parameters and functional myocardial infarction in patients with ACS. Size of the observed changes conditioned by the nature and duration of the training.

[Evaluation of changes in the central and peripheral circulatory system under the influence of physical training carried out under the standard procedure of improving patients after acute coronary syndrome]

The observed with age, atherosclerotic changes in vessels and increasing damage to the vascular endothelium, causing an increase in the occurrence of cardiovascular events. An important element in the rehabilitation of patients with coronary artery disease is a physical activity, to complement the pharmacological treatment.

AIM

The aim of the study was to evaluate the influence of a controlled exercise training on changes in central and peripheral circulatory system in patients after acute coronary syndrome.

MATERIALS AND METHODS

Group comprising 92 patients were divided into three subgroups. The rehabilitation period ranged from 2 to 4 weeks. In group I and II performed a series of interval training on a bicycle ergometer supplemented by general conditioning exercises; in the group III training individually tailored program, consisting of breathing exercises, relaxation and small muscle groups. In all groups, before and after the training cycle test was performed impedance plethysmography of the chest, echocardiography, exercise test.

RESULTS

After completing the program, the parameters plethysmography improved in all groups, with the largest changes were observed in the group treated to the longest training: increase PAmpl (pulse wave amplitude) of 16.7% and PSlope (systolic slope) of 17.6%, while decline in the value of CT (crest time) by 5.7% and PT (propagation time) by 6.3%. In groups, which carried out a controlled exercise training have improved as well: exercise capacity of patients, stroke volume SV, cardiac output CO and global myocardial contractility EF. Moreover, a correlation between the results plethysmography parameters and SV, CO and EF.

CONCLUSIONS

Controlled physical training, which comes under the standard procedure rehabilitation of patients after acute coronary syndrome, leads to better blood perfusion in vessels of the legs and improve myocardial functional parameters, thereby affecting the growth of physical capacity of patients.

[Evaluation of the effectiveness of exercise-based controlled physical effort in women with heart failure in the elderly]

Heart failure (HF), especially during old age, significantly influences the decrease in physical fitness, depriving the patient of their independence during everyday life. The positive results of cardiac rehabilitation are one of the most well documented methods of lowering the frequency of hospitalisation and unfavourable prognosis of cardiovascular diseases. Currently complex cardiac rehabilitation is recommended by the American College of Cardiology (ACC) and American heart Association (AHA) as being an important element of treating patients with HF. However these recommendations are poorly executed in the everyday clinical practise, concerning elderly patients.

AIM

The aim of study is the assessment of the efficacy of controlled physical activity in elderly women, in their VII-X decades, with stable cardiac failure, based on exercise training.

MATERIALS AND METHODS

The study included a group of 55 elderly women (mean age 84.73 ± 7.13 tears) with stable heart failure, NYHA II-III. In each patient plasma concentration of B-type natriuretic peptide was measured and a 6 minute walk test (6MWT) was undertaken.

RESULTS

In the study group of patients who underwent a 12 weeks of cardiac rehabilitation (72%) a decrease in level of NT-proBNP was observed after completion of physical training. The mean value decreased by 204.7pg/ml. Cardiac rehabilitation resulted in an improvement of physical fitness capacity in the group that qualified for fitness training, which was observed by an increase in distance covered during the 6MWT, initial distance of 236 (±127)m to a distance of 300.9 (±75.9)m. Furthermore using statistical analysis it was shown that in the group qualified for cardiac rehabilitation, there is a positive correlation between distance covered during the 6MWT and the improvement in clinical symptoms as measured by the NYHA classification, r=0.099, p>0.05.

CONCLUSIONS

Cardiac rehabilitation modified for the individual needs and abilities of the patient is one of the significant elements that make up the complex therapy of elderly women with HF. Systematically undertaken physical activity occupies an important place in the prevention of cardiovascular disorders, by increasing the level of physical fitness, as manifested by the increase in distance covered during the 6MWT and by the change in classification of NYHA to a higher class or by the decrease in plasma concentration of NT-proBNP.

[The impact of cardiac rehabilitation on selected hemodynamic parameters and risk in patients with heart failure]

Due to the aging of the population is an increase in the incidence of heart failure. Progress in the treatment of cardiovascular disease determines the development of cardiac rehabilitation, which in addition to drug therapy, dietary and psychotherapy plays an important role promoting physical activity The aim of this study was to evaluate the impact of cardiac rehabilitation on the process of treatment and prognosis in patients with heart failure.

MATERIAL AND METHODS

The study included 23 women and 46 men, aged 40-74 years (mean age 58.6 ± 8.1 years) with a diagnosis of heart failure, Class I-III NYHA. All were qualified forthe second stage of rehabilitation. The period of stay in the hospital was 2-4 weeks. Patients were divided into 3 groups: group I population of 19 patients (59.2 ± 8.3 years) participated in a 2-week rehabilitation program, group II representing 29 patients (55.3 ± 7.9 years) in 4-week program. In Group III--reference (21 patients, mean age 65.4 ± 8.2), due to the high risk of using individual cardiac rehabilitation program adapted to the patients. All patients underwent submaximal exercise test. In groups I and II to assess the level of physical fitness, a standard Bruce protocol, while in group III, its modified form. Blood pressure and resting heart rate were also studied. To assess the risk of patients the Duke's indicator was used. Systolic function of the left ventricle were evaluated in echocardiography. After a period of 6 months from the end of the second phase of cardiac rehabilitation, 24 patients who agreed were repeated the whole range of clinical trials conducted in the course of rehabilitation.

RESULTS

In the group that received the cardiac rehabilitation based on interval training, after completion of the program, there was a statistically significant increase in EF, while reducing the level of blood pressure and pulse rate. The risk assessment of patients undergoing rehabilitation showed the greatest changes in group II, which after rehabilitation were classified as low risk. After a period of six months from the end of the second stage of rehabilitation analysis of individual parameters showed a further, significant improvement in groups I and II, with the highest rate of change between the studied parameters throughout the study period was observed in group II--subjected to a longer period of rehabilitation.

CONCLUSIONS

The rehabilitation gives the favorable effect on the healing process in patients with heart failure by reducing the risk of patients undergoing systematic training.

Effect of copper exposure on reproductive ability in the bank vole (Myodes glareolus)

The amount of copper in natural ecosystems is steadily increasing, due to human activities. It accumulates in plants, posing a threat to herbivores. In polluted areas the population density of small rodents is observed to be lower. The decline in rodent numbers may be caused by increased mortality or diminished fertility. This study examined the effect of copper on the reproductive activity of the bank vole (Myodes glareolus), a small rodent which during foraging often wanders into fields where it might be exposed to pollution. The animals were treated with solutions of 0, 150 or 600 ppm Cu. After 12 weeks of exposure the quality and quantity of the male's sperm was tested. To assess morphological development we compared the experimental groups for body weight, the weight of the male's testes and accessory sex glands, the female's uterus, and the number of matured ovary follicles in tested females. At both doses, copper administration led to lower sperm count and caused sperm head anomalies. The higher dose compromised sperm tail membrane integrity, viability and motility. No effect of copper on morphological development was observed in males, and only the lower dose increased testes weight. In females the higher dose had a negative effect on morphological development, and the lower dose increased uterus weight. No effect of copper on ovarian follicle number was found. For the first time, the morphology of the most typical ovarian follicles of the bank vole is presented.

Sexual maturation in common vole (Microtus arvalis) males raised under laboratory conditions

The common vole is one ofthe most numerous rodents in Europe and Asia but its reproductive biology is not fully described. It is thought that females reach reproductive abilities at a very young age, however, there is no data concerning male sexual maturation. The aim of the present study was to determine the rate of sexual maturation of males of the common vole. Research was carried out on 4, 6, 8 and 10 week-old animals. Body, testes and accessory sex glands weights were compared to evaluate morphological development. Epididymal sperm quality was assessed by a motility test, sperm tail membrane integrity, viability, maturity and sperm head morphology. Moreover, the number of sperm cells in 1 mm3 of semen was evaluated. The largest body weights were observed in 8 and 10 week-old males, which also possessed the highest relative weights of gonads and accessory sex glands. These groups of males produce about 2 times more gametes than 6 week-old individuals. The highest seamen quality was noted in 8 and 10 week-old males. Based on the obtained results, it is concluded that among the investigated age groups the most appropriate male age for fertile copulation is between 8 and 10 weeks.

[Role of controlled physical activity as a method of therapy in patients with heart failure after invasive treatment of angina pectoris]

Due to the aging of the population is an increase in the incidence of heart failure. According to the current guidelines for conduct in the treatment of cardiovascular diseases, rehabilitation is introduced in the first treatment period. Individually matched to the severity of illness of each patient, increases the quality of life of patients and reduces mortality in this group of patients. The aim of the study was to evaluate the effect of controlled exercise on left ventricular systolic function of heart and change the level of concentration of natriuretic peptide NT-pro-BNP in patients with heart failure after invasive treatment of angina pectoris.

MATERIAL AND METHODS

The study group consisted of 87 patients, men and women aged 35 to 85 years (mean age 65.6 +/- 10.4) with a diagnosis of heart failure. Patients were divided into 3 groups. I group numbering 19 patients (67.3 +/- 7.8) were subjected to two-week cardiac rehabilitation program, representing 46. Group II patients (59.4 +/- 10.9) was qualified for the 4-week program. The basis for rehabilitation of patients accounted for interval training was performed using a bicycle ergometer. Group III--control, representing 22 patients (68.1 +/- 9.2) were excluded from the training groups because of the high risk. Used with them individually tailored program of cardiac rehabilitation. All patients were performed: submaximal exercise test, echocardiography and examined the concentration of NT-pro-BNP (N-terminal pro-B-type natriuretic peptide). After a period of 6 months from the end of the second phase of cardiac rehabilitation in 32 patients who agreed repeated the scope of clinical trials.

RESULTS

In groups where physical training was conducted controlled noticed an improvement in EF and reduction of NT pro-BNP. It was also a significant, negative correlation between the degree of damage to the left ventricle (EF), and the level of NT pro-BNP. After a period of 6 months from the end of the second stage of rehabilitation, the analysis showed a statistically significant further and improve. It was observed that the best results were obtained in the group with the longest period of rehabilitation.

CONCLUSION

Rehabilitation, part of cardiac rehabilitation is an important component of therapy in patients with heart failure. By influencing the improvement actions cardiovascular favorable effect on the clinical course of the disease.

Home bedding modifies ultrasonic vocalization of infant bank voles

Bank vole,Clethrionomys glareolus, pups, similar to many other infant rodents, emit ultrasonic vocalizations when they are removed from the nest and cooled. Infants exposed to bedding from their home cage produced fewer and shorter calls than infants tested without bedding. Sound frequencies were significantly higher in infants exposed to home bedding than in other experimental groups. These results provide evidence that infant bank voles are able to identify the presence of home bedding, probably on the basis of odor. This appears to be the first report of shifts in frequency of pup ultrasonic calls in response to olfactory cues.

Effect of gonadal hormones and sexual experience on vocalizations and behavior of male bank voles (Myodes glareolus)

This study investigated the influence of gonadal hormones and sexual experience on behavior, especially vocalizations, of male bank voles ( Myodes glareolus (Schreber, 1780)) during same-sex encounters in a neutral arena. Interactions within pairs of castrated males, castrated but testosterone-treated males, and sham-operated intact males were studied in the first experiment and within pairs of sexually experienced males and sexually inexperienced males in the second experiment. Castration reduced the number of ultrasonic vocalizations emitted and androgen treatment restored it to levels seen in intact males. Ultrasounds were emitted more frequently during amicable encounters than during aggressive ones, but ultrasonic calling was reduced during interactions between sexually experienced males, possibly because of the high level of aggression seen in such encounters. In contrast, audible sounds were associated with aggressive behavior and were positively affected by social experience, but they were not testosterone dependent. Neither testosterone nor sexual experience appeared to have any effect on the spectral and temporal characteristics of either audible or ultrasonic calls. The results indicate that emission of ultrasounds during same-sex encounters of male bank voles is regulated by hormonal and social factors and seems to be correlated with type of behavior shown.

The influence of phospholipid structure on the interactions with nystatin, a polyene antifungal antibiotic

This work presents the investigations of the interactions between nystatin, a polyene antibiotic, and phospholipids with various head groups (phosphatidylcholine and phosphatidylethanolamine) and acyl chains of different length and saturation degree. The experiments were performed with the Langmuir monolayer technique. Among phosphatidylethanolamines, DMPE, DPPE and DSPE were studied, while phosphatidylcholines were represented by DSPC and DOPC. The influence of the antibiotic on the molecular organization of the phospholipid monolayer was analysed with the compression modulus values, while the strength of nystatin/phospholipid interactions and the stability of the mixed monolayers were examined on the basis of the excess free energy of mixing values. The results obtained proved a high affinity of nystatin towards phospholipids. Nystatin was found to interact more strongly with phosphatidylcholines than with phosphatidylethanolamines. The most negative values of the excess free energy of mixing observed for the antibiotic and DOPC mixtures prove that nystatin favors the phospholipid with two unsaturated acyl chains. The results imply that nystatin/phospholipid interactions compete in the natural membrane with nystatin/sterol interactions, thereby affecting the antifungal activity of nystatin and its toxicity towards mammalian cells.

Ultrasonic calls of bank vole pups isolated and exposed to cold or to nest odor

Bank vole pups produce ultrasounds when isolated from the nest, as other rodents do. The present study was intended to elucidate the possible interaction between the social stress of isolation from the mother and the physical stress of low ambient temperature during the nesting period. Although bank vole pups removed from nests and monitored at nest temperature vocalized at high frequency, the number and duration of signals increased at lower ambient temperature. In the tested voles it appears that exposure to cold was the most important stimulus of vocalization during the preweaning period. This effect can be enhanced by prolonged isolation from the mother, manifested as longer duration of calls. Moreover, vocalization was reduced not only by the odor from the home nest, but also by exposure to bedding of an alien lactating bank vole or even a lactating mouse fed the same diet. This suggests that the olfactory signals affecting the ultrasonic vocalization of bank vole pups probably are a mixture of volatile metabolites related to the physiological status and diet of rodent females. The reported experiments provide convincing evidence that the vocalization of bank vole pups is affected by isolation from the mother, by ambient temperature, and by olfactory signals released by lactating rodent females.

The study on the interaction between phytosterols and phospholipids in model membranes

Sterols are one of the major components of cellular membranes. Although in mammalian membranes cholesterol is a predominant sterol, in the human organism plant sterols (phytosterols) can also be found. Phytosterols, especially if present in concentrations higher than normal (phytosterolemia), may strongly affect membrane properties. In this work, we studied phytosterol-phospholipid interactions in mixed Langmuir monolayers serving as model membranes. Investigated were two phytosterols, beta-sitosterol and stigmasterol and a variety of phospholipids, both phosphatidylethanolamines and phosphatidylcholines. The phospholipids had different polar heads, different length and saturation of their hydrocarbon chains. The interactions between molecules in mixed sterol/phospholipid films were characterized with the mean area per molecule (A(12)) and the excess free energy of mixing (DeltaG(Exc)). The effect of the sterols on the molecular organization of the phospholipid monolayers was analyzed based on the compression modulus values. It was found that the incorporation of the phytosterols into the phospholipid monolayers increased their condensation. The plant sterols revealed higher affinity towards phosphatidylcholines as compared to phosphatidylethanolamines. The phytosterols interacted more strongly with phospholipids possessing longer and saturated chains. Moreover, both the length and the saturation of the phosphatidylcholines influenced the stoichiometry of the most stable complexes. Our results, compared with those presented previously for cholesterol/phospholipid monolayers, allowed us to draw a conclusion that the structure of sterol (cholesterol, beta-sitosterol, stigmasterol) does not affect the stoichiometry of the most stable complexes formed with particular phospholipids, but influences their stability. Namely, the strongest interactions were found for cholesterol/phospholipids mixtures, while the weakest for mixed systems containing stigmasterol.

Ultrasonic responses of CBA pups to the odour of genetically different mice

Abstract

Mouse pups that are separated from the nest and exposed to cold temperature emit ultrasonic calls. These signals are perceived by conspecifics and play an important communicative role in mother-offspring interaction. Newborn mice are able to modify ultrasonic calls in response to different olfactory cues. Three-day-old CBA-strain mouse pups produced fewer sounds in contact with bedding of adult CBA mice than when exposed to genetically unrelated cues of C57BL and DBA adult animals. The pulses were also significantly shorter in the presence of odour of CBA mice than when exposed to another strain. Newborns emitted the shortest signals when in contact with urine of CBA virgin females, but there were no differences in vocalizations in response to odours from intact, castrated, and testosterone-treated castrated CBA males. These results confirm that CBA pups can distinguish the odour of their genotype. The paper also presents the first evidence that CBA pups discriminate the sex of adult animals and that the chemosignals recognized by pups are secreted with urine but are not testosterone-dependent.

Prenatal stress modifies behavior in offspring of bank voles (Clethrionomys glareolus)

The aim of the present study was to investigate the effect of prenatal stress on behavior of adult bank vole males and females. Pregnant females were submitted to stress by short encounters of two females at the same stage of pregnancy, to crowded condition by transfer to a cage with four to five nonpregnant females, or stressed by immobilization. The stressors were applied on Days 13, 14, and 15 of pregnancy. The results indicate that prenatal stress influenced adult offspring behavior tested in the presence of the same sex, as compared to controls. Females and males differ in their reactions to stress. Prenatal stress decreased the nonaggressive behavior of females but males did not change their amicable approaches toward males. In bank vole males, prenatal social or immobilization stress increased aggression, but females made more attacks only after prenatal stressing by immobilization. This indicates that in bank vole females classical stressor involved different mediators from those associated with prenatal social stresses. Our results indicate that prenatal stress in bank voles decreases the social activity of female offspring and increases aggression in male offspring. Social stress applied to females in late pregnancy may increase the number of aggressive males in a population.

Prenatal stress affects the rate of sexual maturation and attractiveness in bank voles

Field studies reveal that bank vole females' mobility and aggression increase during pregnancy. Here we investigated the reaction of pregnant females to social stress evoked by short but frequent meetings with another female at the same stage of pregnancy. The stress neither evoked pregnancy termination nor affected pregnancy duration but had a long-term effect on the reproductive activity of the offspring. Prenatal stress reduced the rate of sexual maturation of voles as estimated at the age of 20 days. Uterine weights of prenatally stressed females and testes weights of prenatally stressed males were significantly lower than in offspring born to nonstressed mothers. Olfactory signals are known to be important in the sexual preferences of bank voles. Adult prenatally stressed females were more attractive to other adult females than were nonstressed animals. For bank vole males, however, prenatal stress decreased the attractiveness of females; adult males selected nonstressed females over stressed partners, by odor. This study shows that prenatal conditions evoked by short but frequent encounters with another pregnant female lead to delayed puberty in females and males, and decrease sexual attractiveness in adult offspring. These two negative effects may significantly limit the reproduction of prenatally stressed offspring.