Aleksander Goch

Genetic determinants of platelet response to clopidogrel

Antiplatelet agents are the mainstay treatment in the prevention and management of atherothrombotic complications. However, a substantial interpatient variability in response to clopidogrel has been reported. Furthermore, patients with coronary artery disease and lesser platelet inhibition in response to clopidogrel are at increased risk for cardiovascular events. Clopidogrel after absorption requires two-step oxidation by the hepatic cytochrome P450 to generate its active metabolite. Polymorphisms of genes encoding the cytochrome enzymes and P-glycoprotein involved in clopidogrel absorption are regarded as major determinants of the interindividual variability in the clopidogrel-induced platelet inhibition. In our review we discuss the prevalence and clinical significance of various alleles of the genes: CYP2C19 and ABCB1 in the setting of coronary artery disease. Allele CYP2C19*2 is associated with excess of ischaemic events including myocardial infarction and stent thrombosis. On the other hand, CYP2C19*17 allele poses a serious threat of bleeding. Data concerning the prognostic value of genetic variant 3435C→T of ABCB1 remain inconclusive.

Intracoronary versus intravenous abciximab administration in STEMI patients: overview of current status and open questions

Abstract Objectives: To perform a systematic review to provide rationale for intracoronary (IC) abciximab administration in patients with ST-segment elevation myocardial infarction (STEMI), to summarize recent studies comparing IC vs. intravenous (IV) abciximab administration in this setting and to define questions that need to be answered in future trials determining the optimal abciximab regimen. Methods: A search covering the period from January 1993 to June 2011 was conducted by two independent investigators using MEDLINE, CENTRAL and Google Scholar databases. Proceedings from the scientific sessions of ACC, AHA, ESC, TCT and EuroPCR were also considered. Results: IC administration allows one to obtain a much higher concentration of abciximab than IV injection at the culprit lesion. Therefore it is hypothesized that IC abciximab administration provides more efficient GP IIb/IIIa receptor inhibition and more pronounced additional dose-dependent antiplatelet, antithrombotic, and anti-inflammatory effects when compared to the IV route. Numerous observational and randomized studies comparing IC vs. IV abciximab in STEMI patients indicated improvement in different surrogate end points (infarct size, obstruction of coronary microcirculation, ST segment resolution, inflammatory mediators and markers of platelet activation) related to IC administration. The evidence supporting clinical benefits associated with IC injection of abciximab comes from one randomized and several non-randomized trials as most of the studies were underpowered to assess clinical outcomes. No difference in bleeding complications was observed between IC and IV regimens. Issues that need to be addressed in future studies include: the use of IC abciximab in combination with thrombectomy, the role of selective delivery systems, and the necessity of a prolonged IV infusion of abciximab after IC bolus administration. Conclusions: An accumulating body of evidence suggests the superiority of IC over IV abciximab administration in STEMI patients. However, further trials are warranted to establish the optimal strategy of abciximab treatment in this setting.

Association of vitamin D status and clinical and radiological outcomes in a treated MS population in Poland

Vitamin D influences the immune system significantly. Previous studies have found that vitamin D deficiency in adolescence can play a significant role in increasing the risk of developing autoimmune diseases including multiple sclerosis. The aim of this study was to investigate the relationship between the vitamin D status in serum and clinical and radiological outcomes in a treated population in Poland.

Treatment of patients with acute coronary syndrome: Recommendations for medical emergency teams: Focus on antiplatelet therapies. Updated experts’ standpoint

A group of Polish experts in cardiology and emergency medicine, encouraged by the European Society of Cardiology (ESC) guidelines, have recently published common recommendations for medical emergency teams regarding the pre-hospital management of patients with acute coronary syndrome. Due to the recent publication of the 2017 ESC guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation and 2017 focused update on dual antiplatelet therapy in coronary artery disease the current panel of experts decided to update the previous standpoint. Moreover, new data coming from studies presented after the previous document was issued were also taken into consideration.

Anti-aggregation therapy in patients with acute coronary syndrome — recommendations for medical emergency teams. Experts’ standpoint

Jacek Kubica, Piotr Adamski, Przemysław Paciorek , Jerzy R. Ładny, Zbigniew Kalarus, Waldemar Banasiak, Wacław Kochman, Jarosław Gorący, Beata Wożakowska-Kapłon, Eliano Pio Navarese, Andrzej Kleinrok, Robert Gil, Maciej Lesiak, Jarosław Drożdż, Aldona Kubica, Krzysztof J. Filipiak, Jarosław Kaźmierczak, Aleksander Goch, Stefan Grajek, Andrzej Basiński, Łukasz Szarpak, Grzegorz Grześk, Piotr Hoffman, Wojciech Wojakowski, Zbigniew Gąsior, Sławomir Dobrzycki, Jolanta M. Siller-Matula, Adam Witkowski, Wiktor Kuliczkowski, Marcin Gruchała, Dariusz Timler, Grzegorz Opolski, Dariusz Dudek, Jacek Legutko, Marzenna Zielińska, Jarosław Wójcik

The impact of pelvic floor muscle training on the myostatin concentration and severity of urinary incontinence in elderly women with stress urinary incontinence – a pilot study

Objective The aim of the study was to assess the myostatin concentration and an improvement in the severity of urinary incontinence (UI) after pelvic floor muscle training (PFMT) in a group of elderly women with stress UI. Methods A total of 74 participants were included in the analysis: 40 participants in the experimental group (EG) and 34 participants in the control group (CG). The EG underwent PFMT, whereas no therapeutic intervention was applied to the CG. Myostatin concentration and UI severity (Revised Urinary Incontinence Scale [RUIS]) were assessed in all women before and after the treatment. Results By comparing the results before and after the treatment, we have been able to demonstrate a statistically significant decrease in myostatin concentration (P<0.0001) and an improvement in the severity of UI (RUIS) (P<0.0001) in the EG. No statistically significant differences in all measured variables were reported before and after the treatment in the CG. A lower myostatin concentration (P=0.0084) and an improvement in the severity of UI (RUIS) (P=0.0008) were observed after the treatment in the EG compared to that in the CG. Conclusion Effective PFMT causes downregulation of myostatin concentration and an improvement in the severity of UI in elderly women with stress UI. Further trials on a larger EG and an assessment of long-term treatment outcomes are required.

Results of hyperbaric oxygenation in chronic wound healing – preliminary findings

Introduction: Improved wound healing decreases the risk of complications, increases the possibilities of further treatment, rehabilitation, and care, and improves the quality of life for the patients. Aim of the research: The aim of this paper is to present the outcomes of a study of chronic wound healing using hyperbaric oxygenation therapy (HBOT). The indirect aim of the study was also to assess correlations, i.e. statistical relationships, between observed changes of pain assessment, wound length, wound width, and transcutaneous oximetry and establish prognostic signs. Material and methods: Inclusion criteria meet the medical records of thirty adult patients with chronic wounds treated with HBOT. Wound length, wound width, and transcutaneous oximetry were measured before and after treatment. The pain was evaluated using the numerical rating scale before and after treatment. Results: The response to HBOT varied from good to excellent. Favourable and statistically significant changes were observed in all measured areas: pain assessment, wound length, wound width, and transcutaneous oximetry. Conclusions: The HBOT in adult patients with chronic wounds is an effective method of treatment. Age above 60 years, sex (male), and lack of obesity, if confirmed by further studies, can be useful prognostic signs. However, there is still little evidence. There is a strong need for more research.

Ocena równowagi statycznej z wykorzystaniem platformy posturograficznej u osób słabowidzacych i niewidomych = Evaluation of static balance with the use of the posturographic platform in poorly visionaries and blind persons

Stability can be examined for many different ways. There are a number of stability tests – Attempt Romberg, test Unterberg, Babinski-Weill test Oran attempt to drift. Another method test the platform posturographic. On the platform, we can evaluate the balance on the basis of shifts the center of gravity of the body. Swing of the anteroposterior and lateral valuate stability and its disorders. During normal quiet standing platform receives the position of center of gravity of the quadrangle refers to its position and support what is should be. The study included 10 people who are blind and visually impaired 13. Among the respondents, the blind were 4 men and 6 women. The age range was 43-70 years old with an average age of 61.3. In the group of visually impaired were 5 men and 8 women. The subjects were aged 41-69 years, with an average age of 59.2. The inclusion criteria were vision problems. Exclusion criteria were problems with balance and dizziness. The control group consisted of 25 people with sight problems, with an average age of 63.9 years. The subjects that participants rehabilitation camps for the blind and visually impaired held at the Centre Intercor Street Powstańców Wielkopolskich 33 in Bydgoszcz. Blind people have a worse balance than the sighted correctly. Visually impaired people maintain the imbalance on a similar level to fully sighted people.