Search

The development of treatment methods for nicotine dependence has progressed slowly because people with psychiatric disorders are usually excluded from participating in clinical trials. There are several therapeutic options to support smoking cessation, including psychological and pharmacological interventions, which should be offered to smokers with mental disorders. The first step in helping tobacco smokers and nicotine-dependent individuals is the assessment of smoking intensity and confirmation of nicotine dependence. Currently, we have several methods of treating nicotine dependence -- starting from education and psychotherapy, through pharmacotherapy and replacement therapy, and ending up with obtaining gradual progress with the application of harm reduction. Pharmacological treatment options include nicotine replacement therapy, varenicline or bupropion. The effectiveness of such interventions can be improved by providing anti-smoking therapy under psychiatric treatment and promoting harm reduction as an acceptable initial therapeutic goal. The harm reduction strategy is an approach that should be taken into account individually, particularly in the case of individuals unable to stop smoking, patients with limited insight into their illness, patients experiencing an exacerbation of their illness and persistently uncooperative patients. In this paper, recommendations of the Polish Psychiatric Association on the diagnostics and different treatment methods for nicotine dependence in patients with psychiatric disorders are presented. [ABSTRACT FROM AUTHOR]

Smoking and nicotine dependence are still one of the main reasons for a number of serious and life-shortening somatic diseases. At the same time, they are more prevalent in mentally ill individuals than in the general population. This work, which constitutes the first part of recommendations of the Polish Psychiatric Association, presents the scale of the phenomenon in the general population and among people with psychiatric disorders, diagnostic criteria of nicotine dependence and nicotine withdrawal. It discusses the impact of smoking and exposure to cigarette smoke on the development and course of psychiatric disorders as well as on the treatment of psychiatric disorders, including interactions between nicotine and psychotropic medications. Many psychiatric patients can reduce smoking or achieve complete abstinence if they are offered adequate motivation and therapeutic support. Contrary to popular belief, smoking cessation and nicotine dependence treatment do not negatively affect the symptoms of psychiatric disorders; patients' mental conditions can improve following smoking cessation therapy. The best results in terms of maintaining abstinence are achieved with a treatment approach that combines pharmacotherapy with psychotherapeutic intervention integrated into routine psychiatric care. [ABSTRACT FROM AUTHOR]

Copyright of American Journal of Emergency Medicine is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Cardiac complications, including clinically suspected myocarditis, have been described in novel coronavirus disease 2019. Here, we review current data on suspected myocarditis in the course of severe acute respiratory syndrome novel coronavirus-2 (SARS-CoV-2) infection. Hypothetical mechanisms to explain the pathogenesis of troponin release in patients with novel coronavirus disease 2019 include direct virus-induced myocardial injury (ie, viral myocarditis), systemic hyperinflammatory response (ie, cytokine storm), hypoxemia, downregulation of angiotensin-converting enzyme 2, systemic virus-induced endothelialitis, and type 1 and type 2 myocardial infarction. To date, despite the fact that millions of SARS-CoV-2 infections have been diagnosed worldwide, there is no definitive proof that SARS-CoV-2 is a novel cardiotropic virus causing direct cardiomyocyte damage. Diagnosis of viral myocarditis should be based on the molecular assessment of endomyocardial biopsy or autopsy by polymerase chain reaction or in-situ hybridization. Blood, sputum, or nasal and throat swab virology testing are insufficient and do not correlate with the myocardial involvement of a given pathogen. Data from endomyocardial biopsies and autopsies in clinically suspected SARS-CoV-2 myocarditis are scarce. Overall, current clinical epidemiologic data do not support the hypothesis that viral myocarditis is caused by SARS-CoV-2, or that it is common. More endomyocardial biopsy and autopsy data are also needed for a better understanding of pathogenesis of clinically suspected myocarditis in the course of SARS-CoV-2 infection, which may include virus-negative immune-mediated or already established subclinical autoimmune forms, triggered or accelerated by the hyperinflammatory state of severe novel coronavirus disease 2019. [ABSTRACT FROM AUTHOR]

Introduction: Cardiovascular disease is an increasing and leading cause of morbidity and mortality in people living with human immunodeficiency virus (PLHIV) infection. Arterial stiffness is a predictor of endothelial dysfunction in subclinical patients. The aim of this study was to assess which of the laboratory parameters performed during the standard PLHIV medical care visit may be associated with increased arterial stiffness. Material and methods: Thirty HIV-1-infected adult patients (four females and 26 males) were recruited to this study. Endothelial dysfunction and arterial stiffness assessment was performed using the Endo-PAT 2000 device (ITAMAR®). Baseline pressure waveform obtained by peripheral arterial tonometry (PAT) was used to calculate the augmentation index (AI). AI values were corrected for heart rate using an arbitrarily defined reference heart rate of 75 bpm (AI@75). Results: Our analysis included 30 patients. Men comprised 87% (n = 26), 16 patients (53%) were on combined antiretroviral therapy (cART), 11 patients (36.7%) had undetectable HIV viral load, 15 patients (50%) had active or previous hepatitis C virus (HCV) or hepatitis B virus (HBV) co-infection, and 16 patients (53%) smoked cigarettes. In univariate analysis, only total platelet count and effective cART use influenced arterial stiffness in PLHIV. In multivariate analysis, the variables with confirmed statistical significance were low-density lipoprotein (LDL) (p = 0.040; slope estimate = 6.30 per mmol/l of LDL) and platelet (PLT) count (p = 0.003; slope estimate = 0.13 per 109/l of platelet count). Conclusions: We showed that high LDL concentration and high total platelet count may be an independent risk factor of the subclinical atherosclerotic disease in PLHIV. Moreover, we observed a possible negative influence of cART on arterial stiffness. [ABSTRACT FROM AUTHOR]

Objectives This study aimed to investigate the 5-year clinical follow-up of the HYBRID (Hybrid Revascularization for Multivessel Coronary Artery Disease) trial. Background The HYBRID trial, the only randomized study involving thorough analysis of outcome after the 2 procedures, suggested that hybrid coronary revascularization (HCR) is feasible in selected patients with multivessel coronary disease referred for conventional coronary artery bypass grafting (CABG). There are currently no long-term outcome data from randomized trials in this setting. Methods A total of 200 patients with multivessel coronary disease referred for conventional surgical revascularization were randomly assigned to undergo HCR or CABG. The primary endpoint was the occurrence of all-cause mortality at 5 years. Results Nine patients (4 in HCR and 5 in CABG group) were lost to the 5-year follow-up. Finally, 191 patients (94 in HCR and 97 in CABG group) formed the basis of this study. The groups were well balanced in terms of pre-procedural characteristics. All-cause mortality at 5-year follow-up was similar in the 2 groups (6.4% for HCR vs. 9.2% for CABG; p = 0.69). The rates of myocardial infarction (4.3% vs. 7.2%; p = 0.30), repeat revascularization (37.2% vs. 45.4%; p = 0.38), stroke (2.1% vs. 4.1%; p = 0.35), and major adverse cardiac and cerebrovascular events (45.2% vs. 53.4%; p = 0.39) were also similar in the 2 groups. Conclusions HCR has similar 5-year all-cause mortality when compared with conventional coronary bypass grafting (Safety and Efficacy Study of Hybrid Revascularization in Multivessel Coronary Artery Disease; NCT01035567 ) [ABSTRACT FROM AUTHOR]

The International Committee of Medical Journal Editors (ICMJE) provides recommendations to improve the editorial standards and scientific quality of biomedical journals. These recommendations range from uniform technical requirements to more complex and elusive editorial issues including ethical aspects of the scientific process. Recently, registration of clinical trials, conflicts of interest disclosure, and new criteria for authorship -emphasizing the importance of responsibility and accountability-, have been proposed. Last year, a new editorial initiative to foster sharing of clinical trial data was launched. This review discusses this novel initiative with the aim of increasing awareness among readers, investigators, authors and editors belonging to the Editors’ Network of the European Society of Cardiology. [ABSTRACT FROM AUTHOR]

Introduction. Professional drivers of the public transportation are one of the occupational groups exposed to very poor working conditions. Factors such as low physical activity, irregular working hours, poor eating habits and excessive stress at work, have a negative impact on cardiovascular risk and promote the development of diseases of the cardiovascular system. Aim. This study aimed to establish the prevalence of depression and work-related stress in a group of drivers from the RACER (Risk of Adverse Cardiovascular Events among professional dRivers in Poland - development of specific cardiovascular preventive program) study population. Methods. The prospective RACER study includes unselected professional drivers and aims to establish prevalence of cardiovascular risk factors in this group. During the enrolment all subjects were asked to fill in the BDI-II. All drivers were also asked about job-related stress and had their history taken for cardiovascular risk factors. Results. Out of the subjects included into the RACER study drivers employed in the public bus transportation were selected. Analysis covered 292 consecutive drivers of public transportation buses as well as drivers of international coaches (96.6% male, mean age 48.2 ± 10.7 years). Following the BDI-II scoring subjects were categorized according to symptoms. Symptoms of depression were found in 5.8% subjects. There were no differences in populations with and without depression in terms of age and body mass index (p > 0.05). All subjects were asked "Do you find your job stressful?" The answer was affirmative in 205 (70.2%) of drivers. No significant differences were found in the prevalence of depression in drivers who found their job stressful or not, or between the drivers of international coaches and city buses. Conclusions. In professional drivers prevalence of depressive symptoms and work-related stress is relatively high. There are no clinical factors predictive of high risk for depressive disorders development. This along with cardiovascular risk associated with depression is reason for routine, psychological screening of professional drivers. [ABSTRACT FROM AUTHOR]

Introduction and objective. Dyslipidemia is the most common factor leading to ischemic heart disease, which is one of the leading causes of death. The use of statins is the most important preventative measure of ischemic heart disease; however, their efficacy in patients in Poland is still too low. The purpose of this study was to evaluate regional differences in achieving treatment goals in total cholesterol (TC) and LDL cholesterol levels in patients treated with statins on an outpatient basis. Materials and methods. A survey was used to evaluate efficacy of treatment, completed by 49,950 patients in Poland treated with statins in 2008. The territory of Poland was divided into 4 research regions: the Northeast (NE), Northwest (NW), Southeast (SE), and Southwest (SW) regions. Results. The largest group of patients resided in the SW region, the smallest in the SE region. Participants of the study suffered from hypercholesterolemia, on average, for at least a year before completing the study survey. Effective treatment leading to achievement of target TC was observed in less than 10% of the patients. Rate of achievement of target cholesterol levels was highest in the NE region, lowest in the NW region. Cardiologists were more successful in achieving therapeutic goals than GPs. Similar correlations between regions and doctors' specializations were observed for LDL values. Conclusions. Significant differences in the efficacy of treatment with statins were observed among the study group and were evaluated based on achievement of target TC and LDL cholesterol levels. Better results achieved in the NE region may be because the region includes the Masovian province, which is the most economically developed region in Poland. [ABSTRACT FROM AUTHOR]

Copyright of Archives of Cardiovascular Diseases is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objectives The aim of this study was to assess the feasibility of hybrid coronary revascularization (HCR) in patients with multivessel coronary artery disease (MVCAD) referred for standard coronary artery bypass grafting (CABG). Background Conventional CABG is still the treatment of choice in patients with MVCAD. However, the limitations of standard CABG and the unsatisfactory long-term patency of saphenous grafts are commonly known. Methods A total of 200 patients with MVCAD involving the left anterior descending artery (LAD) and a critical (>70%) lesion in at least 1 major epicardial vessel (except the LAD) amenable to both PCI and CABG and referred for conventional surgical revascularization were randomly assigned to undergo HCR or CABG (in a 1:1 ratio). The primary endpoint was the evaluation of the safety of HCR. The feasibility was defined by the percent of patients with a complete HCR procedure and the percent of patients with conversions to standard CABG. The occurrence of major adverse cardiac events such as death, myocardial infarction, stroke, repeated revascularization, and major bleeding within the 12-month period after randomization was also assessed. Results Most of the pre-procedural characteristics were similar in the 2 groups. Of the patients in the hybrid group, 93.9% had complete HCR and 6.1% patients were converted to standard CABG. At 12 months, the rates of death (2.0% vs. 2.9 %, p = NS), myocardial infarction (6.1% vs. 3.9%, p = NS), major bleeding (2% vs. 2%, p = NS), and repeat revascularization (2% vs. 0%, p = NS) were similar in the 2 groups. In both groups, no cerebrovascular incidents were observed. Conclusions HCR is feasible in select patients with MVCAD referred for conventional CABG. (Safety and Efficacy Study of Hybrid Revascularization in Multivessel Coronary Artery Disease [POL-MIDES]; NCT01035567 ). [ABSTRACT FROM AUTHOR]

Background: The objective of this collaborative, multicenter, European effort was to evaluate the outcomes of the convergent procedure for the treatment of persistent and long-standing persistent atrial fibrillation (AF) in consecutive patients at 4 European centers. Methods: Outcomes of consecutive patients, undergoing the convergent procedure at 4 European centers, were evaluated in this study. Epicardial ablation was performed before endocardial ablation. Convergent procedure outcomes were recorded by interrogation of implanted loop recorders or Holter monitors. Rhythm status and required interventions (antiarrhythmic drugs, cardioversions, and repeat ablations) were quantified 6 and 12 months after the procedure. Outcomes, monitoring type, and patient baseline characteristics were analyzed and reported. Results: Seventy-three consecutive patients presenting with persistent AF (30.1%) or long-standing persistent AF (69.9%) underwent the convergent procedure between January 2010 and December 2011. At 6 months, 82% (56/68) were in sinus rhythm. At 12 months, 80% (53/66) were in sinus rhythm; single-procedure maintenance of sinus rhythm without postblanking period interventions was 76% (50/66); 52% (34/66) were in sinus rhythm and not receiving antiarrhythmic drugs. Conclusions: This multicenter European collaborative effort demonstrated that the convergent procedure is a safe and efficacious treatment option for persistent and long-standing persistent AF. [Copyright &y& Elsevier]

Abstract: Familial hypercholesterolemia (FH) affects on average 1 in 500 individuals in European countries, and it is estimated that FH in Poland may affect more than 80,000 people. However, in Poland, only about 20% of the population is estimated to have been diagnosed with FH, of which only a small number receive adequate treatment. FH results in more rapid development of atherosclerosis and is associated with a high risk of cardiovascular events. Atherosclerosis develops beginning in childhood in patients with FH and reaches advanced stages before clinical manifestations develop. Inadequate diagnostics and treatment of FH in Polish children suggests a need for raising the level of awareness and understanding of the condition in both society and among health professionals. These recommendations present the current epidemiological status, guidelines for diagnosing FH in Polish children and adolescents, and effective treatment options. [Copyright &y& Elsevier]