Barbara Gryglewska

Is blood flow in the middle cerebral artery determined by systemic arterial stiffness

Abstract Background and purpose. The relationship between systemic arterial stiffness and parameters of cerebral circulation is poorly understood. We aimed to assess the relation between pulsatility (PI) and resistance (RI) indexes of the middle cerebral artery (MCA) and aortic pulse wave velocity (PWV) and brachial pulse pressure (PP). Methods. Bilateral transcranial Doppler ultrasound (TCD) examination of the MCAs was performed using the GE Vivid 3 Ultrasound, equipped with a 2.5-MHz probe and PI and RI were calculated. Aortic PWV was obtained with the Complior device (Colson France). Conventional blood pressures were measured at the time of TCD. Data regarding risk-profile constituents, habits and medication use were recorded. Subjects with occlusion or significant stenosis of carotid arteries or MCA, previous or acute stroke, temporary ischaemic attack, bilaterally absent transtemporal sonographic windows, dysrhythmia, haematocrit value <30% or >48% were excluded. Results. Of the 165 included subjects (mean age, 56.70±11.80 years, range 22–86 years), 50.3% were men, 20.9% smokers, 20.7% diabetic and 63.4% hypertensive. PWV correlated to both PI (r=0.45, p<0.001) and RI (r=0.36, p<0.001) of MCA. A similar relation was found for PP and PI (r=0.32, p<0.001) or RI (r=0.30, p<0.001). Age, diabetes and hypertension, but not chronic tobacco smoking, interfered with MCA flow parameters. In multivariate adjusted regression analysis, PP was related to both PI and RI of MCA (p<0.001). In similar models, increased PWV was related to PI (p=0.007), but not RI (p=0.08) of MCA. Conclusions. Increased PI and RI of MCA are closely related to measures of increased aortic stiffness.

Elevated markers of inflammation and endothelial activation and increased counts of intermediate monocytes in adult survivors of childhood acute lymphoblastic leukemia

BACKGROUNDnAdult survivors of childhood malignancy are prone to accelerated atherogenesis and late cardiovascular complications. Plaque formation is initiated by recruitment of monocytes and T-cells into the intima, mediated by adhesion molecules and chemokines expressed by activated endothelial cells.nnnAIMnTo assess markers of inflammatory activity, endothelial activation as well as monocyte heterogeneity in adult survivors of childhood acute lymphoblastic leukemia (ALL) who had been treated with chemotherapy without cranial irradiation.nnnMETHODS AND RESULTSnWe studied 27 (age: 18-28 years) healthy survivors of childhood ALL and 20 controls (age: 20-31 years). Flow cytometry was used to identify monocyte subsets: classical CD14(++)CD16(-), intermediate CD14(++)CD16(+) and nonclassical CD14(+)CD16(++) monocytes which were further characterized by their expression of HLA-DR and β2-integrins CD11b/CD18 and CD11c/CD18. In ALL survivors we found increased levels of pentraxin-3 (median [interquartile range]: 0.63 [0.36-0.94] vs. 0.40 [0.32-0.57] ng/ml; p = 0.03), soluble vascular cell adhesion molecule-1 (687 [597-761] vs. 558 [534-702]ng/ml; p = 0.02), osteoprotegerin (mean ± SD: 5.24 ± 1.00 vs. 4.42 ± 1.34 pmol/l; p = 0.02) and tumor necrosis factor (TNF)-related apoptosis-inducing ligand (107.0 ± 23.6 vs. 89.5 ± 18.9 pg/ml; p = 0.01), whereas C-reactive protein, interleukin 6 and 18, TNF-α, monocyte chemotactic protein-1 and soluble intercellular adhesion molecule-1 were unchanged. Former ALL patients exhibited elevated counts of intermediate monocytes (6.3 ± 4.0 vs. 4.3 ± 1.5% of blood monocytes; p = 0.03). CD11b/CD18 and CD11c/CD18 expression on intermediate monocytes tended to be higher in ALL survivors (1917 ± 993 vs. 1396 ± 673 MFI [median fluorescence intensity]; p = 0.06 and 3883 ± 1445 vs. 3185 ± 645 MFI; p = 0.05, respectively).nnnCONCLUSIONnOur findings suggest chronic inflammatory activation and immune dysregulation in adult survivors of childhood ALL, which can translate into late cardiovascular morbidity.

Age and other risk factors of pneumonia among residents of Polish long-term care facilities.

BACKGROUNDnPneumonia is one of the leading causes of morbidity and mortality in the elderly population. Nursing home-acquired pneumonia (NHAP) is probably the largest health problem in long-term care facilities (LTCFs). It is the second most common infection in LTCFs and frequently requires hospitalization. The aim of this study was to investigate the incidence rate of NHAP among LTCF residents, its microbial etiology, and the frequency of multidrug-resistant microorganisms. Risk factors for NHAP were analyzed.nnnMETHODSnThis was a prospective study conducted on a group of 217 elderly subjects aged ≥65 years, recruited from the inhabitants of LTCFs, with disabled elderly individuals living in the community serving as controls. Continuous surveillance was carried out from December 1, 2009 to November 30, 2010.nnnRESULTSnThe incidence rate of NHAP in the observed population of Polish residents was 0.6/1000 resident-days. Vulnerability to NHAP was due to the poor general condition of residents, expressed by low Barthel index values (relative risk (RR) 1.6), the activities of daily living (ADL) score (RR 1.7), the Katz scale (RR 1.2), and limited physical activity (RR 1.6). Also significant were malnutrition (RR 2.3), the use of a bladder catheter (RR 1.3), dysphagia (RR 1.7), tracheotomy tube (RR 3.1), and gastric feeding tube (RR 3.5). Enterobacteriaceae were the predominant etiological agents of NHAP (56.3%).nnnCONCLUSIONSnThe significance of risk factors for NHAP among residents in LTCFs was confirmed. Unfortunately, we also found that a lack of proper supervision with regard to the microbiology of infections is characteristic of Polish health care and LTCFs. There is an opportunity to improve the medical care of patients with severe disabilities, limit the rise in antimicrobial resistance and the need for hospitalization, and improve the prognosis.

Women with prehypertension in primary care - Risk profile on the basis of selected cardiovascular risk factors.

Abstract Background. Demographic, social and economic trends will serve to increase the importance of women as healthcare consumers. Design. The aim of the study was to assess cardiovascular (CV) risk in the normotensive female patients during single visit to primary care (PC) offices. Methods. Demographic data, history of coronary heart disease (CHD), diabetes (DM), smoking habit and family history of CV diseases were obtained from women who visited general practitioners. Moreover, blood pressure (BP), pulse rate, weight and height used to calculation body mass index (BMI) and waist circumference (WC) were performed. Prehypertension was defined as a systolic BP (SBP) of 120–139 mmHg, and/or a diastolic BP (DBP) of 80–89mmHg. Results. Prehypertension was observed in 21.5% of the whole group of female PC patients. SBP, DBP, BMI and WC revealed significant trends towards increase with age among both prehypertensives (p<0.001) and normotensives (SBP, BMI, WC: p<0.001; DBP: p<0.05) and in the whole group (p<0.001). Nevertheless, heart rate (HR) significantly increased with age only among prehypertensive women (p<0.05). The CV risk of the studied adult women increased progressively with presence of overweight, obesity and visceral obesity. The CV risk of the youngest groups was associated mainly with high prevalence of smoking, and with high prevalence of CHD and DM among the oldest female patients. Conclusions. The prevalence of majority of CV risk factors increase with age among both prehypertensive and normotensive women, which should stimulate PC practitioners to identify and modify them.

The relation between ACE D/I and CYP11B2 C-344T polymorphisms and parameters of arterial stiffness in the context of renal sodium handling

Abstract Background. Sodium overload is related to the development of primary hypertension and its complications. Methods. In 131 (65 female) treated hypertensives (average blood pressure 144/82 mmHg and duration of hypertension 11.7 years), we measured peripheral and central arterial pressures, peripheral (AIxP) and central (AIxC1, AIxC2) augmentation indices, pulse-wave velocity (PWV) and daily urinary sodium excretion, and conducted genetic studies of ACE D/I and CYP11B2 C-344T polymorphisms. Proximal (FELi) and distal (FDRNa) sodium reabsorption measurements were performed using endogenous lithium clearance. Results. We found statistically significant interactions between FELi and ACE D/I polymorphism with respect to AIxC2 (PINT = 0.05) and between FELi and CYP11B2 C-344T polymorphism with respect to AIxC1 (PINT = 0.01), AIxC2 (PINT = 0.04) and AIxP (PINT = 0.01). In the group of ACE I allele carriers compared with DD homozygotes, the AIxC1 (154.1 vs 140.6%; p = 0.02), AIxC2 (33.3 vs 26.9%; p = 0.02) and AIxP (94.6 vs 85.2%; p = 0.01) were higher in the subgroup with FELi below the median value (FELi1), but not in the subgroup with FELi above the median value (FELi2). In the group of CYP11B2 TT homozygotes compared with C allele carriers, we observed higher values of AIxC1 (158.5 vs 146.4%; p = 0.03), AIxC2 (36.0 vs 29.4%; p = 0.01) and AIxP (99.0 vs 88.7%; p = 0.005) in the FELi1 but not the FELi2 subgroup. Conclusions. In the population with assumed high dietary sodium intake and long-standing history of hypertension, the relation between proximal sodium reabsorption and the development of arterial stiffness depends on the genetic context of the selected genetic polymorphisms of the renin—angiotensin—aldosterone system, independent of blood pressure.

Physical performance and inflammatory markers in relation to nutritional status in older subjects

Introduction.– The aim of the study was to assess the correlates of poor nutritional status of elderly subjects. Methods.– Comprehensive geriatric assessment (Mini Mental State Examination (MMSE), Geriatric Depression Scale (GDS), Mini Nutritional Assessment (MNA), Katz’s Index, Lawton scale) was performed in 89 subjects aged 60 years and older. Physical performance was assessed using 6-Minute Walk Test (6MWT), walking speed (V) and handgrip strength. Markers of inflammation: hsCRP, TNFalfa-soluble receptor2 (STNFR2), IL-6, IL-8, IL-18, pentraxin (PTX) and osteoprotegerin (OPG) were measured. Using dual energy Xray absorptiometry (DXA) lean body mass total (LBM) and appendicular (aLM)weremeasured, aLM indexwas calculated: aLMIx= aLM(kg)/height(m2). Results.– Out of 89 patients (mean age 72.8±7,6) MNA<24 had 30.3%. Subjects in good nutritional status and at risk of malnutrition did not differ in age, but had lower MMSE (P=0.025), handgrip strength (14.0±7.9 vs 22.79±10.97kg, P=0.0019), lower hemoglobin (12.82±1.5 vs 14.07±1.5 g/dl, P=0.0006), and albumin level (41.82±3.6 vs 43.48±2.7, P=0.026). Patients with lower MNA had lower LBM (41.51±7.71 vs 48.67±7.24kg, P=0.001), aLM (16.85±3.5 vs 20.68±3.4 kg; P=0.0003) and aLMIx (6.64±0.99vs7.52±0.86kg/m2, P=0.001), and performed worse physical tests: had shorter 6-MWT distance (308.89±7682 vs 362.55±107.5m; P=0.03), lowerV (0.761±0.23 vs 0.935±0.3m/s; P=0.03). MNA<24 was associated with higher OPG (9.851±3.45 vs 8.094±2.5, P=0.013), and STNFR2 (P=0.039). MNA correlated positively with 6MWT (r=0.3, P=0.04), V (r=0.44, P=0.002), handgrip strength (r=0.42, P=0.003), LBM (r=0.29, P=0.04), aLM (r=0.32,P=0.03), aLMIx (r=0.20, P=0.047) and negatively with age (r=–0.33,P=0.02). In multiple regression analysis MNAwas influenced by MMSE positively and negatively by hsCRP, IL-8 and number of diseases. Conclusions.– Risk of malnutrition in elderly was associated with worse physical performance, cognitive impairment, comorbidity, higher osteoprotegerin and inflammatory markers.

Selected mutli-drug-resistance-organisms in selected Polish long-term-care facilities*

Nosocomial infections and antimicrobial resistance (AR) are a very well-known public health problems. Unfortunately, up to now there is no surveillance of AR in Polish long term care facilities (LTCF). The aim of this presentation was to analyze prevalence of selected Multi-Drug-Resistance-Organisms (MDRO) among residents of LTCFs in Krakow, Poland.