Biomedical subjects

W Smielak-Korombel

Publications and source records attributed to W Smielak-Korombel.

At least 19 recordsLinked to original sources

PubMed2001

[Krakow Program for Secondary Prevention of Ischaemic Heart Disease. Part II. Secondary prevention of ischaemic heart disease during hospitalization].

UNLABELLED: Hospitalization due to ischaemic heart disease provides a possibility to introduce patients education, to initiate non-pharmacological treatment and to assure patient compliance. The aim the study was to assess the frequency of risk factors and the quality of care in the field of secondary prevention in patients hospitalized due to acute coronary syndromes or subjected to myocardial revascularization. METHODS: The study was carried out in cardiac departments of six hospitals serving the area of the city. Consecutive patients (age < or = 70 years; residing in the Cracow province) were identified according to the following clinical diagnoses or procedures: first or recurrent acute myocardial infarction, first or recurrent unstable angina, first coronary artery bypass grafting or first percutaneous coronary intervention. RESULTS: Data of 536 patients (140 women and 396 men; mean age--56.6 +/- 8.4 years; hospitalized from 1.07.1996 to 30.09.1997) were collected from medical records. The rate of blood pressure measurement during the first 24-hours of hospitalization was 88.8%. Total cholesterol, HDL cholesterol, and triglycerides were assessed in 32.8%, 30.2%, and 32.3% of patients respectively during the first 24-hours of hospitalization. The height and weight were found in 54.9% and 85.1% of medical records. Obesity (BMI > or = 30 kg/m2) was found in 20.3% of patients, 36.7% smoked, 56.0% had hypertension, 15.5% diabetes and 79.5% had hyper-cholesterolemia. Medication at discharge was: antiplatelet drugs 86.7%, beta-blockers 66.4%, ACE inhibitors 50.2% and lipid lowering drugs 27.1%. CONCLUSION: There is a need to initiate a comprehensive programme in order to improve quality of care in the field of secondary prevention of ischaemic heart disease.

Adult↗

PubMed2001

[Krakow Program for Secondary Prevention of Ischaemic Heart Disease. Part III. Secondary prevention of ischaemic heart disease after discharge].

UNLABELLED: Even though the majority of actions undertaken within the secondary prevention of ischaemic heart disease should be initiated while the patient is still hospitalized, the maximum benefit (measured as decreased cardiovascular risk) achieved depends mostly on the continuation and modification of these actions in the postdischarge period. There is not much known about the quality of medical care provided for patients after hospitalization due to ischaemic heart disease. The aim of the study was to assess the quality of postdischarge care in the field of secondary prevention of ischaemic heart disease. METHODS: Consecutive patients (age > or = 70 years; residing in the Cracow province) were identified according to the following clinical diagnoses or procedures: acute myocardial infarction, unstable angina, CABG and PCI. Out of 536 patients 418 took part in the control visit 6-18 months after discharge. Risk factors and medication used were assessed. RESULTS: High total cholesterol (> or = 5.2 mmol/l) was found in 65.8% of patients, high blood pressure (> or = 140/90 mmHg) in 46.2%, obesity (BMI > or = 30 kg/m2) in 24.6%, fasting glucose over 6.0 mmol/l in 17.7% and smoking in 16.3%. The frequency of antiplatelet drugs and beta-blockers use decreased whereas that of lipid-lowering drugs increased in the postdischarge period. The highest frequency of use of antiplatelets and lipid-lowering drugs, as well as the best control of hypercholesterolemia was found in the PCI group, whereas the lowest frequency of smoking was found in the CABG group. CONCLUSIONS: Insufficient control of risk factors and the frequency of secondary prevention using drugs was found. There is a need to intensify secondary prevention in patients with ischaemic heart disease in the postdischarge period.

Adrenergic beta-Antagonists↗

PubMed1999

Low-dose glucose-insulin-potassium is ineffective in acute myocardial infarction: results of a randomized multicenter Pol-GIK trial.

We aimed to assess the clinical efficacy of glucose-insulin-potassium (GIK) in acute myocardial infarction. Experimental data provided evidence of the beneficial effects of GIK on ischemic myocardium. The clinical trials, mostly uncontrolled and conducted mainly before the thrombolytic era, were inconclusive due to the small number of patients and discrepancies in protocols. In order to evaluate the efficacy of this intervention, we have performed a prospective multicenter randomized study. The study consisted of 954 patients with acute myocardial infarction (MI) randomized within 24 hours from the onset of symptoms to low-dose GIK (n = 494), which consisted of 1000 mL 10% dextrose, 32-20 U insulin, and 80 mEq K-, or to the control group (n = 460), which was given 1000 mL 0.89% sodium chloride, by intravenous 24-hour infusion at a rate of 42 mL/h. Cardiac mortality and the occurrence of cardiac events at 35 days did not differ between GIK and control-allocated patients (32 (6.5%) vs. 21 (4.6%), respectively; OR 1.45, 95% CI 0.79-2.68, P = 0.20; and 214 (43.3%) vs. 192 (41.7%), OR 1.07, 95% CI 0.82-1.38, P = 0.62). Total mortality at 35 days was significantly higher in the GIK than in the control group (44 (8.9%) vs. 22 (4.8%), respectively, OR 1.95, 95% CI 1.12-3.47, P = 0.01). The excess of non-cardiac deaths in the GIK group may have occurred by chance. Low-dose GIK treatment does not improve the survival and clinical course in acute MI.

Aged↗

PubMed1998

[The role of estrogens in hormonal regulation of lipid metabolism in women].

In the view of lipid metabolism, adipose tissue and liver are the most important tissues for 17-beta-estradiol, the main estrogen in women's body. The lack of estrogens in women after menopause may cause coronary heart disease. It is considered, that 25 to 50% of positive effect of estrogens which are given to postmenopausal women is connected with their action on lipid metabolism. Blood plasma parameters which characterize lipid metabolism return to their physiological values during estrogens therapy. Estrogens are transferred to adipose tissue cells and liver cells by endocrine and paracrine way. They are also produced in these cells from androgens. In adipocytes 17-beta-estradiol can be stored as its esters with long-chain fatty acids. It was proved that estrogens receptors are present in adipocytes and hepatocytes but their density is much lower than in gonads. On the cellular level estrogens regulate mRNA production for particular proteins among which there are proteins involved in lipid metabolism. In adipose tissue 17-beta-estradiol has a direct effect on lipoprotein lipase (LPL) and hormone-sensitive lipase (HSL). In the case of the first enzyme its synthesis is faster, while the synthesis of the latter is slower. On the other hand, indirect action of estrogens on adipose tissue is connected with the stimulation of the releasing of other hormones which increase HSL activity. To this group of hormones there belong catecholamines, growth hormone (GH) and glucagon. In liver 17-beta-estradiol regulates the rate of synthesis of structural apolipoproteins for VLDL and HDL. 17-beta-estradiol reduces the rate of apoB-100 synthesis, while stimulates apoA-I and apoA-II synthesis. HDL fraction containing apoA-I and apoA-II is necessary for chylomicrons and VLDL degradation as well as direct and indirect cholesterol transport to liver. Moreover, in hepatocytes estrogens stimulate the synthesis of apoC-III, while they decrease the synthesis of hepatic lipase (HL). In conclusion, 17-beta-estradiol by regulating lipid metabolism in adipocytes and hepatocytes modulates the concentration of lipid substances in plasma. The lack of 17-beta-estradiol leads likely to various lipid metabolism disorders in women after menopause. Estrogens therapy in these postmenopausal women may result in the improvement of lipid metabolism.

Adipose Tissue↗

PubMed1996

Lack of effect of amiodarone on survival after extensive infarction. Polish Amiodarone Trial.

BACKGROUND: The purpose of this study was to elucidate whether the reduction of mortality with amiodarone after myocardial infarction depended on ejection fraction. METHODS: The data from the Polish Amiodarone Trial were analysed retrospectively. Patients with acute myocardial infarction and contraindications to beta-blockers were randomized on days 5-7 after admission to receive amiodarone (n = 305) or placebo (n = 308). Short and long-term (46 months) mortality were analysed comparing the groups with impaired (ejection fraction < 40%) and preserved (ejection fraction > or = 40%) left ventricular function. A subset of patients (n = 523) with available echocardiograms were subjected to this analysis. RESULTS: Long-term and sudden cardiac mortality were significantly reduced with amiodarone in the group of patients with ejection fraction > or = 40% (amiodarone versus placebo, respectively: 9.1 versus 16.5%, P < 0.05; 3.4 versus 8.2, P < 0.05). No beneficial effect of amiodarone was observed in the group with low ejection fraction (cardiac and sudden cardiac mortality: amiodarone versus placebo, 20.8 versus 19.3% and 7.8 versus 5.7% respectively). One-year mortality also revealed a favourable trend only in amiodarone-allocated patients with ejection fraction > or = 40%. CONCLUSION: Amiodarone decreased long-term and sudden cardiac mortality after myocardial infarction only in patients with preserved left ventricular function. No benefit was observed in patients with decreased ejection fraction.

Amiodarone↗

PubMed1996

[Early exercise test in patients with myocardial infarction after nifedipine administration of prolonged duration].

In 25 patients with transmural myocardial infarction a mean of 16 days after the onset of infarction an exercise stress test was performed 2 hours after the administration of Corinfar Retard. We evaluated ECG, blood pressure, heart rate, echocardiograms and spirographic parameters before and after drug administration. In the majority of patients ST segment depressions were reduced and duration of the exercise test increased or remained unchanged. In 5 patients the magnitude of ST segment depression was markedly decreased and associated with prolonged duration of exercise and substantial patient comfort. In these patients the drug is continued, as its withdrawal resulted in decreased exercise tolerance with accompanying chess discomfort. Corinfar Retard significantly decreased weigh blood pressure, both systolic and diastolic, whereas its effect on low blood pressure was only slight or none. Heart rate was higher before exercise, during and after exercise it did not differ from that measured without the drug. Ejection fraction increased by a mean of 4%; VC and FEV1 increased or remained unchanged. Exercise testing was safe, did not produce and any side effects and seems to be useful in deciding about the choice of drug after myocardial infarction, especially in patients with counterindications to beta blockers.

Adult↗

PubMed1989

[Occurrence of risk factors for atherosclerosis in young women with myocardial infarction].

Occurrence of atherosclerosis risk factors was analyzed in 16 women aged 26-45 with myocardial infarction. The control group consisted of women of the same age and profession. Stated risk factors were in order: hypertension, diabetes mellitus, positive family history, fat metabolism disturbances, stress and cigarette smoking. The most hazardous association was fat metabolism disturbances connected with hypertension, positive family history or hypertension or excess sensibility to stress were also frequently observed. Authors stated three, four, five and even six risk factors together in 64.3% of women after myocardial infarction.

Adult↗

PubMed1986