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Gawlik R.,Katedra i Klinika Chorob Wewnetrznych
Alergia Astma Immunologia | Year: 2014

Bronchial asthma is a common disease among athletes. Heavy endurance training in different environmental conditions affects respiratory function. The paper presents the current state of knowledge on harmful effects of training environment upon athletes airways. Preventive measures to reduce the exposure are discussed and high-risk disciplines are reported. © Alergia Astma Immunologia 2014.

Wystrychowski G.,Katedra i Klinika Chorob Wewnetrznych
Przegla̧d lekarski | Year: 2012

The U.S. prevalence of obesity increases since the mid-70s of the 20th century. Around that time high-fructose corn syrup (HFCS)--mixture of fructose and glucose was introduced as a sweetener replacing sucrose in the food production. HFCS containing 55% fructose and 42-45% glucose (HFCS55) has dominated the American soft drink industry and HFCS has recently become commonly used in Poland. The coincidence of HFCS introduction and obesity epidemic raised widely publicized suspicions of a causal relationship between the two. As a possible mechanism, a higher content of fructose in the HFCS55, as compared with sucrose was suggested -fructose is known to increase serum uric acid level, induce hepatic lipogenesis and not stimulate postprandial hyperinsulinemia, a main activator of leptin release. Few comparative studies of HFCS and sucrose have largely failed to reveal any different impacts on the metabolic parameters, yet they were mainly short-term. It has been recently shown that obesity is linked with changes in the intenstinal flora. Among the causes of allegedly different effects of sucrose and HFCS on metabolism, their influence on the gut microbiome has not been examined. Some bacterial types do not hydrolyze sucrose which may determine different compositions of gut flora with the use of both sweeteners. Studies involving quantitative analysis of bacterial DNA in the stool, both in animals and in humans, shall shed light on the issue that has recently so much absorbed the U.S. public opinion.

Systemic lupus erythematosus (SLE) is an inflammatory connective tissue disease with an autoimmune background, involving various organs and systems during its course. The most important and characteristic clinical manifestations have been included in the revised diagnostic criteria for the classification of SLE published by the American College of Rheumatology (ACR) in 1987. One of them is oral ulceration which occurs in 50% of SLE patients. Oral ulcers and other gastrointestinal complaints such as dyspepsia, abdominal pain and diarrhea, usually attributed to the side-effects of medications, are among the most frequent symptoms in patients with lupus. We report the case of a 42-year-old female suffering from long-standing lupus with kidney and joint involvement, who developed abdominal pain, diarrhea, edema, and cachexia. Our case illustrates the difficulties encountered when searching for the cause of gastrointestinal symptoms. Attention during diagnosis should be given to rare gastrointestinal manifestations of SLE, such as intestinal pseudo-obstruction (IPO) and protein-losing enteropathy (PLE).

Zdrojewski Z.,Katedra i Klinika Chorob Wewnetrznych
Annales Academiae Medicae Stetinensis | Year: 2011

Lupus nephritis (LN) is one of the most serious manifestations of systemic lupus erythematosus. Renal biopsy remains the gold standard for diagnosis of lupus nephritis. The wide spectrum ofmorphologic, immunohistological, and ultrastructural abnormalities reflects the clinical course, therapy planning, and prognosis as to renal function and patient survival. Conventional clinical parameters, such as creatinine clearance, proteinuria, urine sediment, anti-dsDNA antibodies, and complement levels are not sensitive or specific enough for monitoring disease activity. Thus, novel biomarkers are necessary which could be used for diagnosis, therapeutic monitoring, early detection of exacerbations, and prognosis. This article reviews promising biomarkers, all of which await evaluation in clinical trials. Additionally, current therapeutic options in LN are discussed.

Gomulka K.,Katedra i Klinika Chorob Wewnetrznych | Szczepaniak W.,Katedra i Klinika Chorob Wewnetrznych
Pneumonologia i Alergologia Polska | Year: 2012

Introduction: The aim of this study was to evaluate the frequency of various degrees of depressive disorders in patients diagnosed with bronchial asthma of different degrees of severity. Material and methods: The study involved 120 patients - 80 with bronchial asthma from mild to severe and various prevalence of the disease hospitalized in The Department of Internal Medicine, Geriatrics and Allergology, Medical University in Wroclaw, and 40 patients without chronic lung's disease as the control group. The methods included a structural interview, body examination and spirometry. The psychological status was assessed by Beck Depression Inventory (BDI). Results: The level of negative mood state and depression was positively correlated with severity of bronchial asthma. Also relationship between the level of depression and male-gender was rather strong. Conclusions: It should be noted that the presence of negative mood state and depressive symptoms in patients suffered from bronchial asthma might be the problem in proper compliance and indicate that adequate treatment, when these psychopathological symptoms are diagnosed, should be implemented. It could suggest that depressive disorders are associated with worse asthma control and deterioration in quality of life. © 2012 Via Medica.

Introduction: Chronic obstructive pulmonary disease (COPD) is a fourth cause of death in USA and is expected to be the third cause of death by year 2020. It is believed that some diseases like cardiovascular diseases, osteoporosis, cachexia, anaemia are systemic consequences of COPD. Some data show that the co-morbidities are more frequent in severe COPD patients than in control groups and are associated with the serious health outcomes. It is debated whether extra pulmonary comorbidities or pulmonary complications are the main reason of death in COPD. The aim of the study was to analyze the mortality and comorbidity in COPD patients who died during hospitalization in the Department of Pneumonology and Allergology in WMU from 2004 to 2008. Material and methods: We analyzed 266 records of patients who had diagnosis of COPD and died during hospitalization (179 [67%] M and 87 [33%] F). The mean age at death was 73 ± 8 years (M 73 ± 8 years, F 74 ± 9 years). Results: The most frequent cause of death were: COPD exacerbation (n = 81 [30%], F = 32, M = 49), pneumonia (n = 67 [25%], F = 17, M = 50), lung cancer (n = 50 [19%], F = 18, M = 32), ischemic heart disease (n = 20 [7%], F = 5, M = 15), cardiovascular insufficiency (n = 14 [5%], F = 6, M = 8) and other (n = 34 [14%]). The lung cancer was more frequent cause of death in younger patients (p = 0.002), and pneumonia in older (p = 0.02). In COPD patients the following co-morbidities were diagnosed: chronic heart failure (n = 169), hypertension (n = 103), ischaemic heart disease (n = 102), diabetes mellitus type 2 (n = 55), renal insufficiency (n = 43), hypertrophy of prostate (n = 36), arteriosclerosis obliterans (n = 28), osteoporosis (n = 19), anaemia (n = 14) and others. Conclusions: 1. The most frequent reasons of death were related to respiratory system: COPD exacerbation, pneumonia and lung cancer. 2. The most frequent diseases coexisting with COPD were cardiovascular disease, respiratory insufficiency and diabetes mellitus.

Rheumatosexuology is a medical specialty studying detection, management and prophylaxis of sexual health in patients with rheumatic disorders. Particular aspects of rheumatosexuology include effect of individual rheumatic diseases on sexual health, influence of medication applied in rheumatology on sexual health as well as methods of management of sexual problems in patients with rheumatic diseases. Quality of life of rheumatic patients includes also disturbances of sexual life and this aspect is commonly passed over in everyday practice of rheumatologists. It is important to include sexologic issues in curriculum of education of rheumatologists as well as familiarize sexuologists with selected aspects of rheumatology.

Zdrojewski Z.,Katedra i Klinika Chorob Wewnetrznych
Annales Academiae Medicae Stetinensis | Year: 2010

Amyloidoses represent an inhomogeneous group of diseases characterized by extracellular deposition of amyloid fibrils. AA amyloidosis is a serious life-threatening complication of chronic rheumatic diseases responsible for increased mortality due to organ failure or infection. The main component of amyloid is the serum amyloid A precursor protein (SAA) produced by the liver as an acute phase protein. This article presents the pathogenesis of amyloidosis, which is at the core of our understanding of treatment options. Effective anti-inflammatory therapy of rheumatic diseases is the best way to prevent AA amyloidosis. Early detection of this complication leads to treatment that can effectively retard the course of the disease and may even be accompanied by regression of amyloid deposits. New hope is offered by anti-TNF-alpha antibodies or by eprodisate, which blocks the proamyloidogenic interactions of glycosaminoglycans with SAA.

Chazan R.,Katedra i Klinika Chorob Wewnetrznych
Pneumonologia i Alergologia Polska | Year: 2011

Inhaled bronchodilators such as β 2-agonists and muscarinic antagonists help to prevent and control symptoms in COPD patients, reduce the frequency and severity of exacerbations, improve health status and exercise tolerance and have an acceptable safety profile. For patients with moderate to severe COPD combining bronchodilators from different classes long acting β 2-agonists or long acting muscarinic antagonists (LABA/LAMA) are recommended. Indacaterol with 24 hours duration and fast onset of bronchodilation is the first once daily dosing LABA. Indacaterol used alone or in combination with LAMA may be advantageous through simplification of treatment regimens as well as improvement the efficacy. As COPD progresses and patient has repeated exacerbations triple therapy LABA/LAMA/ICS may be required. The addition of PDE4 inhibitor (roflumilast) to LABA or LAMA in patients with severe COPD, improves lung function and reduces exacerbation frequency. The reduction in exacerbation frequency is similar to that seen in the studies on bronchodilators and inhaled corticosteroids therapy. PDE4 inhibitors have been shown to play a role in severe COPD and they are effective particularly in combination with other pharmacological agents. Based on the results of studies combining different classes of the drugs seems to be an important step towards the goal of optimal control for COPD patients. © 2011 Via Medica.

Hildebrand K.,Katedra i Klinika Chorob Wewnetrznych
Pneumonologia i Alergologia Polska | Year: 2011

Terms exercise-induced asthma (EIA) or exercise-induced bronchoconstriction (EIB) are used to describe transient bronchoconstriction occurring during or immediately after vigorous exercise in some subjects. For the diagnosis of EIB it is necessary to show at least 10% decrease in FEV 1 from baseline following physical exercise. The prevalence of EIB has been reported to be 12-15% in general population, 10-20% in summer olympic athletes, affecting up to 50-70% of winter athletes (particularly ski runners and skaters). There are two key theories explaining EIB: thermal and osmotic. Differential diagnosis of EIB should include chronic cardio-pulmonary diseases, vocal cord dysfunction, hyperventilation syndrome and poor physical fitness or overtraining. According to the ATS guidelines from 1999 for the diagnosis of EIB a standardized exercise on a treadmill or cycle ergometer test with stable environmental conditions regarding temperature and humidity of inhaled air, should be employed. Other laboratory tests assessing bronchial hyperresponsiveness to indirect stimuli including eucapnic voluntary hyperpnea (EVH), mannitol, hypertonic saline, AMP or measurement of exhaled nitric oxide (FE NO) are also successfully used. In the prevention of EIB include both pharmacologic and non-pharmacologic treatment. In patients with poorly controlled asthma intensification of anti-inflammatory treatment can decrease the frequency and severity of EIB. Short and long acting beta 2-agonists, antileukotriene drugs can be used prior to exercise to prevent EIB. © 2011 Via Medica.

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