Biomedical subjects

Ewa Florek

Publications and source records attributed to Ewa Florek.

At least 19 recordsLinked to original sources

PubMed2006

Monitoring of verapamil enantiomers concentration in overdose.

A 52-year-old woman with a history of depression and personality disorders, hypertension, coronary disease and asthma was admitted to the Department of Clinical Toxicology after taking 60 tablets of Staveran (immediate release verapamil), and 4 tablets of acetaminophen. One and a half hours after ingestion her condition was critical. She required endotracheal intubation and artificial respiration. Her heart rate was 75 beats per minute, (bpm) and her blood pressure dropped from 70/50 to 50/00 mmHg. Additionally, drowsiness and headache were observed. On admission, R-(+)- and S-(-)-verapamil serum concentrations were 2252 ng/ml and 810 ng/ ml, respectively. Monitoring of the verapamil serum concentration was carried out over 74 h. Terminal elimination half-lives were 18.7 (21.3) and 17.0 (18.5) hours, respectively, for R-(+)- and S-(-)-verapamil. Monitoring of verapamil enantiomers concentrations in serum indicated a higher concentration of the less active form and slightly faster elimination of the more active enantiomer. The data-support a stereoselective difference between first pass clearance and later systemic clearance of verapamil, when taken in overdose.

Blood Pressure↗

PubMed2006

Disposition of valproic acid in self-poisoned adults.

Acute intoxication with valproic acid is increasingly being observed in clinical practice. In Poland, such intoxication frequently occurs as a result of mixing different drugs or alcohol. We studied the pharmacokinetics of valproic acid in five intoxicated patients. Apart from valproic acid, barbiturates, chlorprotixene, tricyclic antidepressants, tetrahydrocannabinols and alcohol were detected and measured. The absorption of the drug was rapid and the maximum concentration was observed after the period of 3.5-5.6 hr. The lowering of the valproic acid level in plasma was biphasic, with terminal half-life ranging between 8.8-30.9 hr. The calculated apparent volume of distribution was 0.17-0.72 l/kg and could be affected by varied levels of doses as well as time of drug intake (data from interviews of patients) used for calculation and reduction in plasma protein binding at higher concentration of valproic acid. Frequent multiple drug poisonings oblige toxicological laboratories not only to monitor valproic acid concentration in serum, but also to perform the toxicological screenings.

Adolescent↗

PubMed2006

The influence of tobacco smoke and nicotine on antidepressant and memory-improving effects of venlafaxine.

In experimental and clinical studies, central nicotinic systems have been shown to play an important role in cognitive function. Nicotinic acetylcholine receptors also mediate the reinforcing properties of nicotine (NIC) in tobacco products. A variety of studies have shown that acute treatment with NIC or nicotinic agonists can improve working memory function. Moreover, it is known that the monoaminergic system plays an important role in memory function. And there is evidence suggesting that prolonged use of NIC may exert antidepressant action via nicotinic receptors. The purpose of this study was to investigate the interactions between a novel antidepressant, venlafaxine (VEN), a blocker of noradrenaline and 5-hydroxytryptamine reuptake sites, and pure NIC in the context of antidepressant and memory function in tobacco smoke exposed and nonexposed rats. The animals were subjected to Porsolt's test for testing antidepressant activity and their memory function (spatial memory) was evaluated in the Morris Water Maze Test. In tobacco smoke non-exposed and exposed rats both single and chronic administration of VEN (20 mg/kg po) shortened immobility time. NIC (0.2 mg/kg sc) significantly reduced immobility time on the 1st, 7th and 14th test days in both non-exposed and exposed rats. Combined VEN+NIC treatment in tobacco smoke non-exposed rats reduced immobility too. This effect of the combination of drugs was significantly stronger as compared to the effects obtained after individual administration of VEN or NIC. In the group exposed to tobacco smoke, joint administration of VEN+ NIC induced a significant reduction of immobility as compared to the control and NIC groups. In the Morris Water Maze Test single and chronic administration of VEN, lower values of escape latencies and lower numbers of crossed quadrants were noted in both exposed and non-exposed rats, which indicates improved performance. After administering NIC we could observe improvement of spatial memory in both the exposed and non-exposed group. A similar effect of improvement of spatial memory was observed after joint administration of VEN and NIC. The study results support the involvement of nicotinic systems in memory processes in rats. Memory improvement and antidepressant effects following joint administration of VEN and NIC may depend on nicotinic interactions with monoaminergic systems and VEN may represent a new therapeutic approach to smoking cessation.

Animals↗

PubMed2005

The role of laboratory examinations in medical toxicology.

Medical toxicology is a medical subspecialty focusing on the diagnosis, management and prevention of poisoning and other adverse health effects due to medications, occupational and environmental toxins, and biological agents. The medical toxicology laboratories operates an analytical facility for clinical toxicology (intentional or unintentional drug overdose), environmental medicine (occupational and environmental toxicology, workplace drug monitoring), drug of abuse management, therapeutic drug monitoring (TDM) and in some cases forensic toxicology. This article is focus on clinical toxicology, monitoring of drug abused patients and TDM. Still the most popular in medical toxicology is determination of xenobiotics in classic biological materials (blood/plasma, urine) however alternative materials (saliva, hairs) cause increasing attention. Alternative materials has special value in drug of abuse management (evaluation of drug abstinence), when collecting the blood create some problems and urine samples can be adulterated. For screening usually immunology based assays are applied and for some xenobiotics thin-layer chromatography (TLC) method. Conformation and quantitative analysis are carrying on using chromatographic method. In clinical toxicology chemical analysis are performed for diagnostic, therapeutic and some time for legal purposes. If results of toxicological analysis have direct influence on diagnosis or treatment they should be available during 2 hours other determination ought to be performed during 24 or 48 hours. Integral part of toxicological analysis is interpretation of results carried over by well-trained analyst with close co-operation with clinical toxicologist (physician).

Biomarkers↗

PubMed2005

[Effect of exposure to tobacco smoke and selected socioeconomic factors in occurrence of low birth weight].

The aim in this survey was analysis of contribution of exposure to tobacco smoke and selected socioeconomic factors in occurrence of low birth weight. The research was done on the group of 1528 pregnant women. Smoking habit was declared by 18.2% of women and passive exposure to tobacco smoke was stated by 31% of respondents. Significant association between active and passive smoking and socioeconomic status of respondents was observed. Cigarette smoking during pregnancy was the main cause of lower birth weight of newborns. The newborns of actively smoking mothers were lighter of about 332 g according to those ones of mothers who did not smoke and were not exposed to passive smoking, and were lighter than newborns of mothers who were not exposed to passive smoking of about 342 g.

Adult↗

PubMed2005

[Tobacco smoking in patients with hyperthyroidism].

The objective of this study was to determine the impact of cigarette smoking in hyperthyroidism patients. The study group included patients with Graves-Basedow disease (GB): n = 317 (32.9%), patients with Graves' ophthalmopathy (GO): n = 108 (11.2%), patients with toxic nodular goiter (TNG) n = 511 (53%) and 28 (2.9%) patients with toxic adenoma (TA). Evaluation of tabacco smoking and exposure to environmental tobacco smoke (ETS) was performed on the base of questionnaire acording to Fagerström test. The comparison of GO and GB indicate increased tabacco smoking in GO (OR = 0.36; 95%CI: 0.22-0.59). The frequencies of tacacco smoking displayed significantly increased in GB and TNG patients (OR=0.39; 95%CI: 0.28-0.56). Further analys of patients with GO and TA presented statistcal significance in group of smoking and non-smoking (OR=0.26; 95%CI: 0,073-0,95). In other cases we didn't found a significant influence of tobacco smoking on thyroid disease. The effect of smoking was more pronounced in Graves' patients (particulary in the patients with GO) than in other thyroid patients. Smoking among patients with thyroid disease (GO and GB disease) is associated with developing of anxiety and fright, depression and problems with social relations sphere.

Adolescent↗

PubMed2005

[Tobacco smoking in patients with multiple sclerosis--preliminary study].

Muliple sclerosis (MS) is a chronic disorder of autoimmune origin, affecting young people. The aim of our study was to evaluate the tobacco smoking in the patients with MS in the period of beginning the disease. The study included 58 MS patients (31 females, 27 males, mean +/- SD: age 32.15 +/- 6.28) with varying degrees of severity and types of MS (A. RRMS relapsing- remitting MS, B. SPMS - secondary-progressive MS and C. PPMS primary - progressive MS). Smoking status was determined by medical history and Fagerström test. In the examined group 38 (65.51%) persons were tobacco smokers, among them 21 (55.26%) females and 17 (44.74%) males. This preliminary analysis needs further thorough studies, f.e. the urine level of cotinine - as a main marker of tobacco smoking in MS patients.

Adult↗

PubMed2005

[Urinary cotinine in patients with hyperthyroidism].

The aim of our study was an analysis of cotynine, the main nicotine metabolite in the urine among hyperthyroid patients. The study group included 39 females and 4 males. The mean age was 35.59+/-14.22 yrs. (range: 18-73 yrs.; median: 32 yrs) among hyperthyroid patients suffering from: Graves-Basedow disease (GB), Graves' Ophtalmopathy (GO) and toxic nodular goiter (TNG). To evaluate the nicotine smoking intensity and ETS Environmental Tobacco Smoke, the urine analysis of cotynine level were performed. According to the statistical analysis using the Mann-Whitney test, the statistically significant difference between the level of cotynine among smokers suffering from GO and Graves-Basedow disease was revealed (p = 0.03). Similar results were obtained among the GO and TNG (p=0.02) using t-Student test with Welsch correction. To compare, there was no stastistically significant difference between the GB and TNG series (p=0.4). In the group of smoking patients with GO we found out incresed level of urine cotinine than in smoking patients with GB and TNG. We didn't found differences between GB and TNG in depends on an urine analysis of cotynine level.

Adolescent↗

PubMed2005

[Evaluation exposition to polycyclic aromatic hydrocarbons of pregnant women who smoking tobacco].

The aim of the study was to evaluate the exposure of smoking pregnant women (total number 52) to polycyclic aromatic hydrocarbons (PAH) on the base of determination of 1-hydroxypyrene in urine. Standardised survey questionnaire and determination of cotinine in urine estimated the smoking habit. In the case of smoking women the mean concentration of cotinine was 362+/-320 ng/mg creatinine, passive smokers had cotinine concentration 32+/-6 ng/mg creatinine and non smokers below 5 ng/mg creatinine. In the urine of pregnant women, 1-hydroxypyrene a biomarker of PAH exposure was measured. The urine of smokers contained 0.17+/-0.18 micromol/mol creatinine, passive smokers 0.11+/-0.20 pmol/mol creatinine and nonsmokers 0.10+/-0.12 pmol/mol creatinine. The obtained results confirmed the higher risk of exposure to PAH in group of smoking pregnant women, however cigarette smoke are not only one source of these cancerogenic compounds.

Adult↗

PubMed2005

[Are tobacco smoking teachers knowledgeable on their habit?].

Teachers are an important part of anti-tobacco education. The aim of this study was evaluation of the level of tobacco smoking among teachers as well as to check their knowledge on tobacco toxicity. The study group consisted of 745 teachers from whom 671 participated in the study. We found that 32% teachers were smokers and it was a higher level than average for Polish population. Two thirds of responders were smoking from 6 to 20 cigarettes per day. 35% of teachers pointed tobacco smoke tar as risk factor of tobacco-related diseases (e.g. lung cancer). Similar percentage of responders pointed on the correlation between tobacco smoking and osteoporosis. As a conclusion of this study we would like to stress that the knowledge on tobacco-related topics among teachers is insufficient for a proper anti-tobacco education. In the future a repeated courses for teachers on such issues should be prepared.

Adult↗

PubMed2005

Education program about tobacco for medical students.

Tobacco smoking is one of the principal causes of morbidity and mortality in the worldwide. By the year 2030, more than four million people per year worldwide will die of tobacco-related cause. No other consumer product is as dangerous as many people. Tobacco causes more deaths than any other dependence-producing substances, e.g. poor diet, alcohol, bacterial infections, poisoning, firearms, and illicit drugs. The morbidity and the mortality associated with tobacco use is caused by several toxic substances (e.g. nicotine, polynuclear aromatic hydrocarbons, aza-arenes, N-nitrosamines, aromatic amines, acrylonitrile, crotonaldehyde, vinyl chloride, formaldehyde, benzene, inorganic compounds). Tobacco smoking is a major independent risk factor for chronic obstructive pulmonary diseases (COPD), cancer (lung, larynx, pharynx, oesophagus, pancreas, kidney, urinary bladder, nasal cavity, uterine cervix), coronary heart disease (CHD) and reproduction. In 2004 42% of Polish man and 23% Polish women smoked. This publication presents a program that has been designed to educate medical students (fourth or fifth year) about tobacco in University of Medical Sciences. There are two parts in total six hours education. Part I is concerned with the epidemiology of smoking, the toxicology of tobacco smoke, the health effects of tobacco use, the process of smoking cessation, the treatment for smokers, and smoking prevention. Part II (workshops) deals with teaching medical students how to motivate patients to stop smoking. The second part consist of: identifying the smoker, taking a smoking history, evaluation of the level of dependence and assessing the smoker's readiness to stop smoking, motivating smokers to change, and preventing relapse. Both parts (theory and practical sessions), are scheduled to take three hours each.

Humans↗

PubMed2004

Tobacco smoke-dependent changes in cytochrome P450 1A1, 1A2, and 2E1 protein expressions in fetuses, newborns, pregnant rats, and human placenta.

Tobacco smoke (TS) was described as a mixture of numerous cytochrome P450 (P450) substrates, inducers, and inhibitors. These inducers and inhibitors may modify drug clearance and xenobiotic or endogenous metabolism affecting P450s expression. In the present study, the effect of gestation and TS on: (1) cytochrome P450 CYP1A1, CYP1A2, and CYP2E1 protein expressions, and (2) cytochrome P450-linked microsomal enzyme activities, were studied in fetal rat liver, rat, and human placenta and in newborn and adult rat hepatic and extrahepatic tissues. Non-pregnant and pregnant 4-month-old female Wistar rats were exposed to TS (500, 1,000, or 1,500 mg carbon monoxide per m(3) air) in a toxicological chamber for 3 weeks (6 h daily, 5 days weekly). Human placentas were sampled from non-smoking, passive smoking, or active smoking primiparas. The efficacy of exposure was assessed by measuring urine cotinine levels. The TS-dependent inductory effect on the expression of CYP1A1 and 1A2 and related monooxygenase activities, and the inhibitory/inductory effect on CYP2E1 expression in rat tissues were observed. Pregnancy was associated with decreased levels of constitutive CYP1A1 and 2E1 in hepatic and extrahepatic tissues, TS-inducible CYP1A2 expression in the liver, and CYP1A1 expression in lungs and heart, but had no inhibitory effect on TS-inducible CYP1A1 and 2E1 expression, EROD, and P450-cooperated enzyme activities in the liver, kidney, and, in the latter case, in the heart. The presence of TS-induced CYP1A1 protein was confirmed in rat and human placenta and showed in newborn liver and lungs. CYP1A2 and 2E1 proteins were detectable in fetal rat liver. It was concluded that the expression of CYP1A1, 1A2, and 2E1, which metabolize some drugs and activate carcinogens, is controlled by age-, pregnancy-, and tissue-specific regulatory mechanisms in rats. Gestational differences in the regulation of expression of CYP1A subfamily members are not excluded. CYP1A1 and 2E1, but not CYP1A2 inductory mechanisms seem to be functional in fetal liver at day 21 of pregnancy but they appeared to be uninducible under a TS exposure. In TS-exposed pregnant females and fetuses the effects of metabolic activation of CYP1A1 and 1A2 substrates might be reduced because of lower CYP expressions or poor induction, respectively.

Animals↗

PubMed2004

[Use of a questionnaire and biomarkers for evaluation of tobacco smoking in parturient women].

According epidemiological study tobacco smoking is popular addiction around the world. It was estimated, that one third of world population smoking tobacco. The statistical data from 2002 show that in Poland 42% of men and 22% of women smoke tobacco on a daily basis. As many as 60% of non-smokers are exposed to environmental tobacco smoke (ETS). The aim of the study was verification the answer on a standardised survey questionnaire (related to tobacco smoking) by laboratory method--determination of cotinine in urine. In the study participated 244 delivering women. In the tested group 23.8% of surveyed declared smoking during their pregnancy and around 28% of non-smoking women were exposed to passive inhalation of tobacco smoke. More than 15% of women, which declared non smoking has concentration of cotinine higher than 50 ng/mg creatinine (mean 227.3 ng/mg creatinine) what indicated active smoking of cigarettes. From these results we can conclude that as much as 35.6% of women smoking tobacco during pregnancy and is higher than suggested the questionnaire examination.

Adult↗

PubMed2004

Using questionnaire and cotinine concentration in urine for studying the smoking habits and ETS exposure of pregnant women.

The aim of this study was to evaluate the exposure of pregnant women to tobacco smoke on the basis of a standardised survey questionnaire, and determination of cotinine in urine. In the study participated 133 women delivering, checked in at the Obstetric Department of Independent Public Health Care Unit in Srem in 2003. The all women fill in the questionnaire forms referring smoking and exposure to ETS (Environmental Tobacco Smoke). In the tested group 22.6% were smoking during pregnancy. Only 5 pregnant women quit smoking, however around 60% of smokers reduced the number of cigarettes. Near 56% of women were exposed to ETS, mainly during social events. In case of women, who declared smoking the mean concentration of cotinine was 2164 ng/mg of creatinine. Passive smokers had cotinine concentration between 10 and 50 ng/mg of creatinine Cotinine may be used to validate tobacco smoke exposure assessment from surveys.

Adult↗

PubMed2004

[The socio-economic status of women smoking during pregnancy and birth weight of their newborns].

In this survey, socio-economic status of pregnant women smoking during pregnancy and influence of this status on birth weight of their newborn were assessed. The research was done on the group of 1328 pregnant women. Smoking habit was declared by 18.6% of women and passive exposure to tobacco smoke was stated by 30.6% of respondents. Significant association between active and passive smoking and socioeconomic status of respondents was observed. Cigarette smoking during pregnancy was the main cause of lower birth weight of newborns. The newborns of actively smoking mothers were lighter of about 357 g according to those ones of mothers who did not smoke and were not exposed to passive smoking, and were lighter than newborns of mothers who were not exposed to passive smoking of about 330 g. The passive exposure to the tobacco smoke was not significant considering effect on the birth weight.

Adult↗

PubMed2004

[The awareness of health consequences of active and passive smoking and access to information about these consequences in the population of pregnant women].

Despite of significant progress in the area of perinatal care, there have been numerous perinatal complications still existing. The health status of mother and newborn is affected by many factors, namely: socio-economical; medical prior to pregnancy and medical through the pregnancy; dietary customs, substance use, including tobacco smoking; health service quality; and risk factors that may occur through fertilization. The active and passive exposure to tobacco smoke in utero have been linked to numerous gestation and delivery complications, including low birth weight, preterm delivery and low Apgar score. In this survey, the awareness of health consequences of active and passive smoking in the population of pregnant women and access to the information of this consequence was assessed. Among of women smoking through their pregnancies, the only 19.7% got the information from their doctors about harmful effect of active and passive smoking, and 16.5% of respondents declared self-awareness on health effects of exposure to the tobacco smoke.

Attitude to Health↗

PubMed2004

[Smoking among thyroid patients].

UNLABELLED: The effects of cigarette smoking on the thyroid disease (Graves disease, toxic nodular goiter, toxic adenoma) have been studied for years. However, the effect of smoking on thyroid function is still controversial. OBJECTIVES: To determine the impact of cigarette smoking on the development of above-mentioned thyroid disease. PATIENTS METHODS: Study of 405 individuals with different thyroid disease. Information on thyroid disease and smoking habits was gathered by Fagerström questionnaire, and the patients' endocrinologist or general practitioner verified the diagnosis. RESULTS: The effect of smoking was more pronounced in Graves' patients than in other thyroid patients. We found out significant number of patients with toxic nodular goiter. CONCLUSIONS: Smoking is associated with an developing clinically thyroid disease--especially Graves disease. We also suggest the connection between psychological traits and smoking in this group of patients, corresponding with our previous examinations.

Female↗

PubMed2004

[The level of cotinine in urine and placenta of women smoking or exposure to tobacco smoke during pregnancy].

The aim of the studies was evaluation smoking habit by delivering woman using objective method--determination of cotinine in urine and placenta. In the study participated 93 woman delivering in Gynaecological-Obstetric Clinical Hospital of Medical University at Warsaw. Evaluation of tobacco smoking and exposure to ETS performed on the base of questionnaire and level of cotinine in urine. In the group of non smoking woman cotinine was not detected any in urine any in placenta. In the second group (19 patients), woman exposure to ETS concentration of cotinine in urine was 28.9 +/- 14.9 ng/mg of creatinine and only in two placentas was detected a low level of cotinine. In smoking delivering woman the urine concentration was 837.0 +/- 1324.5 ng/mg of creatinine and 21.3 +/- 7.5 ng/g placenta calculated from all results and 67.0 +/- 3.5 ng/g calculated only from positive results. A weak relation between concentration of cotinine in placenta and urine of smoking woman was shown.

Adult↗