Silesian Medical University of Katowice

Zabrze, Poland

Silesian Medical University of Katowice

Zabrze, Poland

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Morawiec B.,University of Lausanne | Morawiec B.,Silesian Medical University of Katowice | Muller O.,University of Lausanne | Khatchatourov G.,Clinique Cecil | Goy J.-J.,Cantonal Hospital
EuroIntervention | Year: 2016

Background: Coronary artery fistula (CAF) is a very rare clinical finding in itself. Here we report a case of a CAF complicated with myocarditis and discuss the diagnostic and therapeutic challenges. INVESTIGATION: Clinical evaluation, laboratory tests, blood culture, coronary angiogram, cardiac computed tomography (CT), cardiac magnetic resonance (CMR), positron emission tomography (PET) CT scan (PET/CT). DIAGNOSIS: Myocardial infarction in the setting of CAF caused by a possibly infected thrombus migrated downstream to the inferoseptal cavity followed by myocarditis. MANAGEMENT: Medical pre-treatment (dual antiplatelet therapy, antibiotics), surgical treatment (resection of the CAF and coronary artery bypass grafting). © 2016 Europa Digital & Publishing. All rights reserved.


Fendler W.,Medical University of Lódz | Borowiec M.,Medical University of Lódz | Baranowska-Jazwiecka A.,Medical University of Lódz | Szadkowska A.,Medical University of Lódz | And 10 more authors.
Diabetologia | Year: 2012

Aims/hypothesis: The aim of this study was to study dynamic changes in the prevalence of different types of diabetes in paediatric populations in Poland, with a specific focus on monogenic diabetes (MD). Methods: Using epidemiologic data (PolPeDiab Collaboration) and nationwide genetic test results (TEAM Programme), we compared the prevalence of type 1, type 2 and cystic fibrosis-related diabetes (CFRD) and MD. Genetically confirmed MD included MODY, neonatal diabetes and Wolfram and Alström syndromes. The study covered all children aged 0-18 years treated for diabetes between 2005 and 2011 in three regions, inhabited by 23.7% (1,989,988) of Polish children, with a low prevalence of childhood obesity (<5%). Results: The prevalence of type 1 diabetes showed a continuous increase, from 96 to 138/100,000 children. The prevalence of type 2 diabetes and CFRD also increased, from 0.3 to 1.01/100,000 children and from 0.1 to 0.95/100,000 children, respectively. The prevalence of MD was stable at between 4.2 and 4.6/100,000 children, accounting for 3.1-4.2% of children with diabetes, with glucokinase (GCK)-MODY being the most frequent type, amounting to 83% of patients with MD. The percentage of positive test results decreased with the number of referrals, suggesting that children with the highest probability of MD were referred initially, followed by those with a less clear-cut phenotype. The prevalence of neonatal diabetes equalled 1 in 300,000 children. Conclusions/interpretation: The prevalence of MD in a paediatric population with a low prevalence of obesity remains stable and is nearly fivefold higher than that of type 2 diabetes and CFRD, justifying a need for increased access to genetic diagnostic procedures in diabetic children. © 2012 The Author(s).


Zmyslowska A.,Medical University of Lódz | Borowiec M.,Medical University of Lódz | Fendler W.,Medical University of Lódz | Jarosz-Chobot P.,Silesian Medical University of Katowice | And 3 more authors.
Endokrynologia Polska | Year: 2014

Introduction: Wolfram syndrome (WFS) is the most frequent syndromic form of monogenic diabetes coexisting with optic atrophy and many other disorders. The aim of this study was to estimate the prevalence of Wolfram syndrome among children with diabetes in Poland. Material and methods: These calculations were performed among Polish diabetic children, aged 0-18 years, from three administrative regions between January 2005 and December 2011. Epidemiological data was obtained by matching the results from the EURO-WABB-Poland Project and the PolPeDiab Registry. Results: Throughout the study period, we confirmed genetic diagnosis of Wolfram syndrome in 13 patients from Poland. Three patients originated from the studied regions with complete epidemiological data on paediatric diabetes. The total number of patients with diagnosed diabetes in the study equalled 2,568 cases. The prevalence of Wolfram syndrome among Polish children with diabetes is 0.12% (95% Confidence Interval 0.04-0.34%). Conclusions: We estimate that Wolfram syndrome is 26 to 35 times less frequent than monogenic diabetes (MODY and neonatal diabetes) in the Polish paediatric population.


Fendler W.,Medical University of Lódz | Borowiec M.,Medical University of Lódz | Antosik K.,Medical University of Lódz | Szadkowska A.,Medical University of Lódz | And 8 more authors.
Clinical Endocrinology | Year: 2011

Introduction Confirmation of monogenic diabetes caused by glucokinase mutations (GCK-MODY) allows pharmacogenetic intervention in the form of insulin discontinuation. This is especially important among paediatric and young adult populations where GCK-MODY is most prevalent. Methods The study evaluated the utility of lipid parameters in screening for patients with GCK-MODY. Eighty-nine children with type 1 diabetes and 68 with GCK-MODY were screened for triglyceride (TG), total and HDL cholesterol levels. Standardization against a control group of 171 healthy children was applied to eliminate the effect of development. Clinical applicability and cut-off value were evaluated in all available patients with GCK-MODY (n = 148), hepatocyte nuclear factor 1-alpha-MODY (HNF1A MODY) (n = 37) or type 1 diabetes (n = 221). Results Lower lipid parameter values were observed in GCK-MODY than in patients with type 1 diabetes. Standard deviation scores were -0·22 ± 2·24 vs 1·31 ± 2·17 for HDL cholesterol (P < 0·001), -0·16 ± 2·14 vs 0·60 ± 1·77 for total cholesterol (P = 0·03) and -0·57 ± 0·97 vs-0·22 ± 0·97 for TG (P = 0·05). Validation analysis confirmed that HDL cholesterol was the best parameter for GCK-MODY selection [sensitivity 87%, specificity 54%, negative predictive value (NPV) 86%, positive PV 56%]. A threshold HDL concentration of 1·56 mm offered significantly better diagnostic efficiency than total cholesterol (cut-off value 4·51 mm; NPV 80%; PPV 38%; P < 0·001). TG did not offer a meaningful cut-off value. Conclusions HDL cholesterol levels measured in individuals with likely monogenic diabetes may be useful in screening for GCK-MODY and differentiation from T1DM and HNF1A-MODY, regardless of treatment or metabolic control. © 2011 Blackwell Publishing Ltd.


PubMed | Medical University of Gdańsk, Medical University of Lódz and Silesian Medical University of Katowice
Type: Journal Article | Journal: Experimental and clinical endocrinology & diabetes : official journal, German Society of Endocrinology [and] German Diabetes Association | Year: 2014

Mutations in the glucokinase (GCK) gene are associated with altered blood glucose and lipid concentrations. Our aim was to assess the effects on HbA1c and serum lipid levels of single nucleotide polymorphisms (SNPs) in 2 genes encoding proteins that interact with glucokinase: glucose-6-phospatase catalytic subunit 2 (G6PC2) and glucokinase regulatory protein (GCKR).The study group included 129 children with GCK-MODY from the Polish Registry of Monogenic Diabetes and 395 with type 1 diabetes (T1DM), in whom we genotyped 2 SNPs in G6PC2 (rs560887) and GCKR (rs1260326). Lipid concentrations were assessed in fasting serum samples.Total and HDL cholesterol concentrations were significantly lower in the GCK-MODY group than in patients with T1DM (167.532.5mg/dl vs. 174.431.1mg/dl, p=0.0435 and 48.4214.3mg/dl vs. 58.712.7mg/dl, p<0.0001, respectively). No differences in genotype distributions were found except for underrepresentation of GCKR TT homozygotes among GCK-MODY patients (10.9% in GCK-MODY vs. 17.7% in T1DM, p=0.0651). GCKR genotypes showed significant associations with lipid profiles and HbA1c levels, whereas no such associations were noted for G6PC2. After adjustment for confounders, TT homozygotes were shown to have higher total cholesterol and marginally higher LDL cholesterol and triglyceride levels (p=0.0245, p=0.0657 and p=0.0550, respectively). The difference between TT homozygotes and other genotypes was similar in magnitude within the GCK-MODY and T1DM groups. No significant interactions between the type of diabetes and the GCKR or G6PC2 genotype were detected.Individuals who are homozygous TT at rs1260326 of the GCKR gene have higher triglyceride, total and LDL cholesterol levels regardless of the presence of GCK mutations.


PubMed | Prince of Wales Hospital, Silesian Medical University of Katowice and Tuen Mun Hospital
Type: Clinical Trial | Journal: The American journal of emergency medicine | Year: 2015

The objective of the study is to evaluate the role of copeptin in the diagnosis of acute coronary syndrome (ACS) and its role in dual-cardiac marker diagnostic strategy with troponin.A prospective cohort study was carried out from May 2012 to October 2012.The study was conducted at the emergency department (ED) of a public hospital in a cluster of Hong Kong.Patients aged at least 18 years presented with chest pain to ED who have intermediate or high likelihood of ACS were included. All patients had blood taken in the ED for copeptin and troponin I. The adjudicated diagnoses of ACS were made by 2 independent physicians based on the universal definition. Diagnostic characteristics were calculated. Receiver operating characteristic curves were created. Areas under the curves were compared for copeptin, troponin I, and dual-marker strategy with copeptin and troponin I.A total of 637 patients were recruited. Seventy-eight had been diagnosed to be ACS. The negative predictive value of copeptin for ACS was 0.881 (0.849-0.907) compared with troponin I, 0.937 (0.913-0.956). The areas under the receiver operating characteristic curves of copeptin, troponin I, and dual-marker strategy were 0.68, 0.859, and 0.880, respectively.Addition of copeptin to troponin does not have significant improvement of the diagnostic accuracy of ACS in patients presented with chest pain.


Blood and its components are valuable medication that should be administered according to recommendation after consideration of expected benefits and adverse reactions to the patient. The aim of study was to analyze amount and form of blood components or whole blood transfused at gynecological-obstetrical wars of university hospital (UH) or regional hospital (RH). Age of the patients and clinical diagnosis were included into the analysis. Material and methods. Two gynecological-obstetrical wards were investigated. The appropriate data were obtained from the hospital documentation (there was no electronic data system). Amount and form of transfused blood components or whole blood, diagnosis at admission, patient's age and number of the treated patients were collected from the hospital transfusion book. The final clinical diagnosis, age of the patient, and transfusion details were obtained from the patient's medical records. The diagnoses were presented according to the ICD-10 classification. UHpatients (29,759 patients) and 13,540 patients from RH from 1996 to 2002 were investigated. Results. Blood and its components were used for transfusion in 1150 women (3.8%) treated in UH, and in 206 women (1.5%) hospitalized in RH. In years 1996-2002, there were transfused 2746 units of blood and its components, including: 371 units of whole blood (13.5%), 2073 units of red blood cells (75.5%), 281 units of fresh frozen plasma (10.2%) and 21 units of therapeutic platelet concentrate (0.8%) in RH there were transfused 527 units of blood and its components, including: 8 units of whole blood (1.5%), 450 units of red blood cells (85.4%), 63 units of fresh frozen plasma (12%), and 6 units of therapeutic platelet concentrate (1.1%). The age of patients in UH was between 14 and 92 years and in RH between 18 and 79 years. Conclusions. The rate of patients with the same diagnosis in whom the transfusion was made, was higher in University Hospital. There were no differences between the number of transfused blood and its components between the two hospitals. The age of patients who had blood transfusion was higher for the University Hospital. Introduction of payment for blood and its components, resulted in decrease in percentage of the patients receiving transfusion as seen in comparison of the period 1999-2002 and 1996-1998 in both investigated hospital. The PRBC transfusion average rate units, increased in the period 1999-2002, compared to the 1996-1998. Presented method of analysis of use of blood and its components may reveal new aspects of the problem and may be helpful for planning of blood donation.


Siatkowska H.,Silesian Medical University of Katowice | Siatkowska H.,Slaski University Medyczny | Jastrzebski D.,Silesian Medical University of Katowice | Kozielski J.,Silesian Medical University of Katowice
Polski Merkuriusz Lekarski | Year: 2010

Smoking cigarettes is an illness and it constitutes one of the major health risks. Although the consumption of cigarettes has been on the decline since 1990s, the smoking habit is still widespread. According to WHO statistics, Poland is among the countries in which smoking and smoking-related diseases are very common. Material and methods. 1026 patients (83.8% of the patients registered in one of the health care centers in Bytom) were examined and the prevalence of smoking and the relation between chronic tobacco smoking and the clinical symptoms, lung function tests and concurrent diseases were assessed. Results. The study revealed that the majority of the patients examined were either current or former smokers (567 persons, 55.3% study population). 343 persons (33.4%) were current smokers; 200 men (58.3%) and 143 women (41.7%), while former smokers were 224 persons (21.8%): 135 men (60.3%) and 89 women (39.7%). Correlation between smoking habit and dyspnoea, morning cough, sputum production and wheezing was confirmed. It was established that lung function (FEV 1 FEV 1%FVC) decreases with increasing number of pack-years. Moreover, smokers were more likely to develop such diseases as systemic hypertension, coronary disease and COPD. Conclusions. Tobacco smoking is related to such demographic factors as age, sex, education and financial status. Although the Poles' attitude towards tobacco smoking has changed for the better, the smoking habit still remains a significant epidemiological problem, particularly among young women. The incidence of cardiovascular diseases and COPD are statistically significantly related to smoking habit.


Gumkowska O.,Silesian Medical University of Katowice | Kotyla P.J.,Silesian Medical University of Katowice | Kucharz E.J.,Silesian Medical University of Katowice
Polski Merkuriusz Lekarski | Year: 2012

Systemic lupus erythematosus is a connective tissue disease of unknown origin and unpredictable course. At the moment there Is no specific targeted treatment for the disease and corticosteroids are still main therapeutic option. Steroid use, however brings many side effects. Therefore searching for new treatment strategies is at the moment the main challenge for rheumatologists. The potential targets for the treatment include B and T cells co-stimulation molecules and various cytokines. In the paper potential targets for treatment of SLE have been reviewed with the special emphasis to the result of recently finished clinical trials in this indication.


PubMed | Silesian Medical University of Katowice
Type: Journal Article | Journal: Polski merkuriusz lekarski : organ Polskiego Towarzystwa Lekarskiego | Year: 2012

The prevalence of diseases of the cardiovascular system is the cause of their frequent use, and thus, easy availability of drugs acting on the cardiovascular system, including people they do not require. In Poland, annually are taken from 4.5 to 5.5 thousand suicide attempts, about 3.7% of them due to excessive consumption of pharmaceuticals. The aim of this study was to analyze patients who for suicidal attempts ingested drugs acting on the cardiac conduction system, and to study performed diagnostic and therapeutic procedures and obtained results.The study included all hospitalized in the years 1995-2010 in the Department of Anesthesiology and Intensive Care patients after excessive suicidal ingestion of drugs acting on the heart conductive system. The study group comprised a total of 40 patients aged from 15 to 70 years.Suicide attempts in the study group were mostly taken by the lonely people and by the subjects with disturbed adaptation. The patients were unconscious mainly after ingestion of psychotropic drugs. From the 40-person group of patients after suicidal ingestion of drugs affecting the conduction system of heart eight patients (20%) required respirator. It has not been shown that any group of drugs significantly more frequent induced respiratory distress requiring mechanical assistance. Rhythm and conduction disturbances during hospitalization occurred in 15 patients (38%), of which 12 (30%) required temporary endocardial stimulation. The study revealed the longest ventricular stimulation need in patients after consumption of calcium channel blockers. Blood pressure in half of the patients was depressed, and 15 of them (38%) required the use of pressor amines. From the 40-person group 2 people died (one patient after ingestion of 4000 mg of propranolol and the other after eating 6000 mg of verapamil). Patients who died differed from the other patients with in younger age, longer time elapsed since the consumption of drugs to their hospitalization, during admission they had undetectable blood pressure, bradycardia, and decreased serum potassium levels. The remaining 38 patients (95%) were discharged from the Department of Anesthesiology and Intensive Care.Attempts to take his own life with the use of drugs in the cardiac conduction system in the study group were taken by a lonely and adaptive disturbances. The most commonly used preparations for suicide were beta-adrenergic receptors blockers, whereas hemodynamic abnormalities, arrhythmias and conduction disturbances were observed more frequently after the drugs that block calcium channels. In patients with life-saving use in suicide attempts important role in addition to medication dosage plays an elapsed time of their consumption and speed of action taken to remove and prevent absorbtion the poison, as well as close supervision in the intensive care unit.

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