Helena Martynowicz

The dependence between urinary mercury concentration and carotid arterial intima-media thickness in workers occupationally exposed to mercury vapour

OBJECTIVES Mechanisms of the mercury effect on arterial vessel walls include increased free radicals generation, decreased nitric oxide synthesis and increased reactivity to vasoconstrictors, leading to accelerated development of atherosclerosis and arterial hypertension. The aim of this study was to evaluate the correlation between urinary mercury (Hg-U) concentration and carotid intima-media thickness (IMT) or intraventricular septum diastolic diameter (IVSDD) to find the best markers of mercury cardiovascular toxicity. MATERIALS AND METHODS The study included 154 workers of a chemical factory using mercury in chlorine production. Urinary mercury concentration was determined by atomic absorption spectrophotometry. Serum lipids were assessed by routine methods using enzymatic assay. Serum total antioxidant status (TAS) was determined by colorimetry. Measurements of IMT and IVSDD were made by ultrasound imaging using MEDISON SA 9900 PRIME system. RESULTS The mean Hg-U concentration was 1.9+/-2.7 microg/g creatinine in women (n = 29) and 5.6+/-12.2 microg/g creatinine in men (n = 125). In the group of non-smokers (n = 102) there was a positive linear correlation between Hg-U concentration and IMT (r = 0.1728; p < 0.05) and a negative dependence between high density cholesterol (HDL-C) and IMT (r = -0.2109; p < 0.01). The negative linear correlation between serum total antioxidant status (TAS) and carotid IMT (r = -0.2142; p < 0.05), and the positive correlation between HDL-C and TAS (r = 0.1953; p < 0.05) were shown to be valid for the total studied group. Serum lipids in women were normal, but in men the mean triglyceride level was higher than normal. CONCLUSIONS The occupational exposure to mercury vapour remains in a relationship with early, asymptomatic carotid atherosclerosis. The dependence between urinary mercury elimination and carotid intima-media thickness is evidenced in non-smoking workers. Defensive anti-atherosclerotic mechanisms in these workers are strongly related with HDL. In smokers, these protective mechanisms are disturbed.

Thrombocytopenia in pregnancy - pathogenesis and diagnostic approach.

Thrombocytopenia (TP) affects 7-10% of pregnant women. It occurs 4 times more frequently in pregnancy than in the non-pregnant women population. Women with thrombocytopenia in pregnancy are a heterogeneous and poorly known group. There are several possible causes of thrombocytopenia in pregnancy. The most common are: gestational thrombocytopenia (GE) (60-75%), preeclampsia (PE) and HELLP (hemolysis, elevated liver enzymes, low platelets) syndrome associated TP (21%), and idiopathic immune thrombocytopenia (ITP) (3-10%). Although thrombocytopenia diagnosed in pregnancy in most cases has a mild course, it has also been reported to be associated with a higher rate of preterm birth and premature detachment of the placenta. Some cases of severe thrombocytopenia with systemic involvement are associated with high risk of serious perinatal complications and require early diagnosis, careful clinical monitoring and medical treatment. The differential diagnosis and proper assessment of clinical risk of TP during pregnancy may be of great concern. The article discusses these issues, focusing on pathophysiology of TP in pregnancy.

The influence of hypertension on daytime sleepiness in obstructive sleep apnea

Daytime sleepiness is a common symptom among hypertensive patients. The aim of this study was to determine subjective sleepiness assessed by Epworth Sleepiness Scale (ESS) and to asses sleep architecture in 304 patients with arterial hypertension. All patients underwent a standardized diagnostic overnight, polysomnography. The control group consisted of 67 normotensives. The hypertensive patients had a decreased sleep efficiency, mean and minimum oxygen saturation levels, and increased apnea/hypopnea index and oxygen desaturation index compared with normotensive patients. The lower ratio of N3 sleep, higher of N2 sleep, and decreased sleep efficiency was observed in hypertensives without obstructive sleep apnea (OSA). In the moderate to severe OSA groups, the total ESS score was significantly lower in hypertensives compared with normotensives. The ESS scores decreased with age in hypertensives, but not in normotensives. The study showed that ESS total score is lower in hypertensives than in normotensives with OSA, making the OSA more difficult to suspect. Thus, the low ESS score in hypertensives should not discourage further evaluation.

Function of respiratory system evaluated using selected spirometry parameters in persons occupationally exposed to lead without evident health problems.

UNLABELLED This study aimed at evaluation of selected spirometric parameters in persons occupationally exposed to lead without evident health problems. The studies were conducted on 69 men occupationally exposed to lead. Occupational exposure to lead was characterized by estimation of blood lead concentration (Pb-B) and blood zinc protoporphyrin concentration (ZnPP). Function of respiratory system was examined using spirometric analysis with evaluation of its basic parameters: forced vital capacity (FVC), forced expiratory volume (in 1s) (FEV1), Tiffeneau index (FEV1%VC) and peak expiratory flow (PEF). In the study group negative linear correlations were documented between Pb-B and FVC, FEV 1 and FEV1%VC. A more pronounced age, higher values of BMI and higher blood lead concentration constituted independent risk factors for reduced FEV1%VC. CONCLUSION Persons occupationally exposed to lead with elevated blood lead concentration and blood zinc protoporphyrin concentration manifested the impaired function of respiratory system, evaluated using parameters of spirometry.

Evaluation of Intensity of Sleep Bruxism in Arterial Hypertension

Sleep bruxism (SB) is a masticatory muscle activity during sleep that is characterized as rhythmic (phasic) or non-rhythmic (tonic). The recent hypothesis on the etiology of SB supports the role of the central and autonomic nervous systems. Therefore, in this study, we aimed to assess the intensity of SB in patients with arterial hypertension. A total of 70 adults participated in this study: 35 patients with hypertension (study group) and 35 normotensive subjects (control group). Data were recorded using home portable cardiorespiratory polygraphy. The bruxism episode index (BEI) in the study group was found to be significantly higher compared to the control group (3.4 ± 3.25 vs. 2.35 ± 2.29, p = 0.04). Hypertension, higher body mass index (BMI), lower values of mean oxygen saturation (SpO2), and a higher percentage of SpO2 < 90% constituted independent risk factors for increased BEI. These results suggest the need for special oral care in hypertensive patients, patients with higher BMI, lower values of SpO2 and a higher percentage of SpO2 < 90%.

The Co-Occurrence of Sexsomnia, Sleep Bruxism and Other Sleep Disorders

Background: Sleep sex also known as sexsomnia or somnambulistic sexual behavior is proposed to be classified as NREM (non-rapid eye movement) parasomnia (as a clinical subtype of disorders of arousal from NREM sleep—primarily confusional arousals or less commonly sleepwalking), but it has also been described in relation to REM (rapid eye movement) parasomnias. Methods: The authors searched the PubMed database to identify relevant publications and present the co-occurrence of sexsomnia and other sleep disorders as a non-systematic review with case series. Results: In the available literature the comorbidity of sexsomnia and other sleep disorders were reported mainly in case reports and less in case series. Sexsomnia was reported both with one and with multiple sleep-related disorders, with NREM parasomnias and obstructive sleep apnea (OSA) being the most commonly reported. Furthermore, the authors enrich the article with new findings concerning two novel cases of sleep bruxism triggering recurrent sexsomnia episodes. Conclusions: Sexsomnia has still not been reported in the literature as often as other parasomnias. The coexistence of sexsomnia and other sleep-related disorders should be more thoroughly examined. This could help both in sexsomnia as well as other sleep-related disorders management.

Parasomnias and obstructive sleep apnea syndrome: in search for a parasomnia evaluating tool appropriate for OSAS screening

Background. Obstructive sleep apnea syndrome (OSAS) is the most common form of sleep-disordered breathing. It is also a known major risk factor of parasomnias. Objectives. To verify if an additional diagnostic tool for parasomnia assessment might be useful in OSAS screening. Additionally, to investigate the possible relations of parameters measured during polygraphy evaluation and the severity/frequency of parasomnia episodes in order to find the pathophysiological background of increased frequency of parasomnias in OSAS cases. Material and methods. Parasomnia evaluation with the Paris Arousal Disorder Severity Scale (PADSS) and OSAS evaluation with polygraphy in a group of 105 adult patients hospitalized for assessment of possible OSAS. Results. According to the polygraphic evaluation, patients were divided into: non-OSAS (n = 19, 18.1%), mild OSAS (n = 31, 29.52%), moderate OSAS (n = 21, 20%) and severe OSAS (n = 34, 32.38%). Based on the recommended cut-off score of 13 points in PADSS, two groups of patients emerged after the parasomnia evaluation: with positive (n = 10) and negative (n = 95) results. PADSS achieved sensitivity of 10.9% and 92% specificity when used for moderate and severe OSAS screening. The positive predictive value (PPV) reached 60%, negative predictive value (NPV) – 48.4%. A statistically significant elongation of the percentage of estimated sleep time below 80% blood oxygen saturation emerged in patients with positive PADSS scores (p = 0,006). Focusing on the parasomnia frequency criterion did not significantly affect the results. Conclusions. Due to low sensitivity, PPV and NPV PADSS cannot be used as a screening tool in possible OSAS assessment. Another tool with higher sensitivity should be developed, also including assessment of other parasomnias and sleep-related movement disorders. Cyclic intermittent hypoxia might be the cause of the higher frequency of arousal disorders in OSAS patients.

Lecithin derived from ω-3 PUFA fortified eggs decreases blood pressure in spontaneously hypertensive rats

Hypertension is the most common risk factor for stroke, coronary heart disease and heart failure, which are the leading causes of death worldwide. Dietary patterns and supplements intakes are becoming important factors in the hypertension. The aim of this study was to estimate the effects of new generation egg yolk phospholipids rich in lecithin (SL) esterified with omega-3 and omega-6 fatty acids on blood pressure in hypertensive rats (SHR). Here we have reported that lecithin (SL) derived from egg yolk lowers blood pressure in pathology of hypertension. The SHR rats treated with SL had significantly lower blood pressure than control group (157/104 vs. 178/121 mmHg; P < 0.05) and down-regulated mesenteric artery over-response to norepinephrine and potassium chloride, giving similar arterial response as for normotensive Wistar Kyoto rats (WKY). Hypertensive rats treated by SL demonstrated significantly lower serum level of inflammatory factors. This work also indicates that SL treatment lowers heart rate and reduces the serum level of oxidative stress marker - nitrotyrosine - by 30–34% in both hypertensive and normotensive animals. Phospholipids with lecithin derived from PUFA fortified eggs may be a valuable dietary supplement in prophylaxis of hypertension and in patients with hypertension, however, this requires further studies on humans.

PS 04-14 THE PHOSPHOLIPID FRACTION OBTAINED FROM EGG YOLK AMELIORATES STRESS-INDUCED HYPERTENSIVE RESPONSE IN SPONTANEOUSLY HYPERTENSIVE RATS

Objective: Hypertension is the most prevalent chronic cardiovascular disease in adults all in western societies. Stress is a common factor associated with cardiovascular morbidity including hypertension. Rise in blood pressure is part of classic reaction to stress. Acute and chronic exposure to stress has been linked to cardiovascular disorders. Associations of chronic stress burden and traumatic stress with cardiovascular disease prevalence and risk factors was observed in clinical trials. Functional foods including foods containing polyunsaturated fatty acids (PUFA) have attracted considerable interest as potential complementary therapies for treatment of cardiovascular diseases including hypertension. Egg yolk, rich in polyunsaturated fatty acids and phospholipids might be a good source of phospholipids and PUFA. The aim of this study was to evaluate the impact of the diet enriched in phospholipid fraction obtained from egg yolk on the blood pressure in spontaneously hypertensive rats exposed to acute stress. Design and Method: Male SHR rats at 7 weeks of age were given supplemented or standard diet for 12 weeks. A model of acute stress with white noise was used. The blood pressure measurements were taken during 40 minutes acute stress exposure and before stress procedure under standard condition for 12 h. The blood pressure was measured using DSI telemetry devices. Results: The mean, systolic and diastolic blood pressure was significantly lower in the SHR fed with enriched diet compared to control. White noise used as an acute stressor evoked significant increase of mean, systolic and diastolic blood pressure in the group fed with standard diet and enriched diet. Increase of blood pressure induced by stressor was significantly less pronounced in rats fed with supplemented diet compared to control. Conclusions: The results of the present study indicate that our phospholipid fraction obtained from egg yolk can decrease stress induced blood pressure rise.

Prevalence of hypertension in Polish population of PURE Poland study

Introduction: Hypertension is the most common risk factor for cardiovascular disease and is a significant predictor of premature death and cardiovascular disability. The aim of this cohort study was to evaluate prevalence of hypertension and cardiovascular risk factors in studied population of Lower Silesia province in Poland. Material and methods: Presented results are a part of PURE project. The study group included 2,044 inhabitants Lower Silesia province. Data collection included clinical history, anthropometric data, blood pressure, and serum glucose. Prevalence, awareness, and treatment of hypertension were evaluated. Results: 60.3% of studied population were hypertensive. Hypertension was more prevalent in studied men (70.63%) than in women (57.24%). Education had a significant impact on prevalence of hypertension and the highest prevalence of hypertension was observed in the least educated group. Hypertension was undiagnosed in 48.5% of studied population. Significantly, more men than women had undiagnosed hypertension (53.4 vs. 44.3). The prevalence of undiagnosed hypertension significantly increased with the education level. Conclusions: The studied group had high prevalence of hypertension (60.3%). Hypertension was less frequent and better diagnosed in studied women than in men. Level of education had significant impact on prevalence and awareness of hypertension.