Andrzej Lewiński

Instytut Centrum Zdrowia Matki Polki, Łódź, Łódź Voivodeship, Poland

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Publications (353)518.26 Total impact

  • J Smyczyńska, R Stawerska, M Hilczer, A Lewiński
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    ABSTRACT: Objective: Growth hormone (GH) deficiency (GHD) has recently been classified as secondary IGF-I deficiency but the significance of IGF-I measurement in diagnosing GHD is still discussed. The aim of the study was to assess the relationships between IGF-I secretion and GH therapy effectiveness in children with GHD. Patients and methods: The analysis comprised 300 children with isolated, non-acquired GHD (GH peak below 10 μg/l) who completed GH therapy and attained final height (FH). In all patients IGF-I concentration was measured before the treatment and IGF-I deficiency was diagnosed if IGF-I SDS for age and sex was below -1.0. The following auxological indices were assessed: patients' height SDS before treatment (H0SDS), FH SDS and improvement of FHSDS vs. H0SDS (ΔHSDS). Results: In the patients with IGF-I deficiency when compared with those with normal IGF-I secretion before treatment, significantly better FH SDS (-1.42±0.90 vs. -1.74±0.86, p=0.004) and ΔHSDS (1.64±1.01 vs. 1.32±1.05, p=0.010) were observed, despite similar H0SDS (- 3.07±0.78 vs. - 3.11±0.77, p=0.63) and GH peak (7.0±3.1 μg/l vs. 6.8±2.1 μg/l, p=0.55). The patients who achieved FH over 10(th) centile had significantly lower IGF-I SDS before treatment than those with FH below 10(th) centile (- 1.59±1.54 vs. - 1.20±1.64, p=0.04), despite similar GH peak (7.0±2.3 μg/l vs. 6.7±3.1 μg/l, p=0.45). The patients with ΔHSDS over the median value had significantly lower IGF-I SDS than those with ΔHSDS below the median value (- 1.59±1.71 vs. - 1.09±1.47, p<0.0001), despite similar GH peak (6.8±2.5 μg/l vs. 7.0±2.7 μg/l, p=0.86). Conclusion: In children with isolated, non-acquired GHD, secondary IGF-I deficiency is an important predictor of better GH therapy effectiveness. © Georg Thieme Verlag KG Stuttgart · New York.
    01/2015;
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    ABSTRACT: introduction and objective. In Poland, the assessment of nocturnal GH secretion has gained the status of screening test; however, this procedure is not included in international recommendations. The aim of the study was to assess the accuracy and predictive value of the test of nocturnal GH secretion as a screening procedure in diagnosing GHD, and to check the adequacy of the cut-off value for GH peak in this test on the level of 10 ng/ml. materials and methods. The analysis comprised the data of 1,000 children with short stature. In all the patients, GH secretion was assessed in a screening test (after falling asleep) and in 2 stimulating tests (reference tests), with simultaneous assessment of IGF-I secretion before stimulating tests. The indices of screening test accuracy, likelihood ratios and predictive values were assessed. The cut-off level of GH peak after falling asleep, ensuring its 95% sensitivity, was calculated in ROC curve analysis. results. Sensitivity of the screening test was 70.4%, while the specificity - 61.2%, positive likelihood ratio - 1.842, negative likelihood ratio - 0.482, positive predictive value - 0.462, negative predictive value - 0.812. The sensitivity of the test of GH secretion after falling asleep is too low with respect to the requirements for screening test. The ROC curve analysis showed 95% sensitivity for the screening test on the level of 19.0 ng/ml; however, with a very low specificity - below 25%, thus making this test completely useless as a screening procedure. conclusions. The obtained results strongly contradict the opinion that the assessment of GH secretion after falling asleep should be a screening test in diagnosing GHD in children with short stature.
    Annals of agricultural and environmental medicine: AAEM 11/2014; 21(4):893-7. · 3.06 Impact Factor
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    ABSTRACT: Iodine, bivalent iron (Fe(2+)), and hydrogen peroxide (H2O2), all significantly affecting the red-ox balance, are required for thyroid hormone synthesis. Intracellular iodine excess (≥10(-3) M) transiently blocks thyroid hormonogenesis (an adaptive mechanism called Wolff-Chaikoff effect). The aim of the study was to evaluate the effects of iodine, used as potassium iodide (KI) or potassium iodate (KIO3), in concentrations corresponding to those typical for Wolff-Chaikoff effect, on the level of oxidative damage to nuclear DNA (nDNA) and mitochondrial DNA (mtDNA) isolated from porcine thyroid under basal conditions and in the presence of Fenton reaction (Fe(2+)+H2O2 → Fe(3+)+(·)OH + OH(-)) substrates.
    European Journal of Nutrition 11/2014; · 3.84 Impact Factor
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    Polskie Archiwum Medycyny Wewnętrznej. 10/2014; 124(10):557.
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    ABSTRACT: Introduction Cohort study evaluated dendritic cells (DCs) subsets in portal and peripheral blood of patients with pancreatic cancer (PC) and chronic pancreatitis (CHP). Material and Methods Myeloid type 1 (mDCs1) and 2 (mDCs2), plasmocytoid (pDCs) and SLAN+ DCs were assessed in PC (n=20) and CHP (n=6) patients. Results Percentage of mDCs1 was significantly lower in PC patients when compared to CHP (0,48±0,26 vs 0,76±0,3; p=0,038) only in portal, but not peripheral blood. Discussion Further studies to assess the functional properties of portal blood DCs and their applicability in anticancervaccination are needed.
    Pancreatology 09/2014; · 2.50 Impact Factor
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    ABSTRACT: Recent reports suggested dendritic cells (DCs) to be important players in the pathogenesis of autoimmune thyroid processes in humans. However, there are virtually no data addressing the influence of thyroid autoaggression-associated disturbances of thyrometabolic conditions on DCs biology. The aim of the study was to evaluate the influence of L-thyroxine supplementation on conventional and plasmacytoid peripheral blood DCs subtypes in patients with hypothyroidism due to Hashimoto's thyroiditis (HT). Eighteen patients with newly diagnosed hypothyroidism due to HT were included into the study. All patients received L-thyroxine treatment with doses adjusted to reach euthyroidism. Peripheral blood DC subtypes structure and immunoregulatory phenotype were analyzed by flow cytometry in the same patient prospectively at two time points: (i) beforeand (ii) 3 months after beginning of L-thyroxine treatment (hypothyroidism vs. euthyroidism, respectively). Percentage of plasmacytoid DCs in peripheral blood mononuclear cells fraction was significantly decreased in the course of L-thyroxine treatment (0.27 ± 0.19 vs. 0.11 ± 0.08; p < 0.05), whereas we did not observe any changes in the number of conventional DCs. However, the phenotypic analysis showed a significant increase of conventional DCs expressing CD86 and CD91 (64.25 ± 21.6% vs. 86.3 ± 11%; p < 0.05 and 30.75 ± 11.66% vs. 44.5 ± 13.3%; p < 0.05; respectively) in euthyroid patients. Standard L-thyroxine supplementation in HT patients exerted significant immunoregulatory effects, associated with quantitative and phenotypic changes of peripheral blood DC subpopulations.
    Folia Histochemica et Cytobiologica 07/2014; 52(2):138-143. · 1.10 Impact Factor
  • Polskie Archiwum Medycyny Wewnetrznej. 07/2014;
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    ABSTRACT: introduction. Lipid peroxidation (LPO) results from oxidative damage to membrane lipids. Whereas LPO rises in normal pregnancy, the effect of gestational diabetes mellitus (GDM) on this process has not been clearly defined. materials and method. Fasting blood concentrations of malondialdehyde+4-hydroxyalkenals (MDA+4-HDA), as LPO index, TNFa soluble receptors (sTNF-R1 and sTNF-R2), and soluble adhesion molecules (sICAM-1, sVCAM-1), were measured in 51 women at 28 weeks of gestation. The women were divided according to the results of 50.0 g glucose challenge test (GCT) and 75.0 g oral glucose tolerance test (OGTT): Controls (n=20), normal responses to both GCT and OGTT; Intermediate Group (IG) (n=15), abnormal GCT but normal OGTT; GDM group (n=16), abnormal both GCT and OGTT. results. Glucose concentrations in women diagnosed with GDM were within the range of impaired glucose tolerance. There were no significant differences in concentrations of either TNF a soluble receptors R1 and R2, or sICAM-1 or sVCAM-1. LPO concentrations [MDA+4-HDA (nmol/mg protein)] were significantly higher in women with GDM than in the other two groups [64.1±24.3 (mean±SD), 39.3±23.1, 47.0±18.1, for GDM, IG and Controls, respectively; p<0.05]. In multivariate analysis, the only significant independent correlation was between LPO level and glucose at 120 minutes of OGTT (rs=0.42; p=0.009). conclusions. Oxidative damage to membrane lipids is increased in GDM and might result directly from hyperglycaemia. Physiological significance of this phenomenon remains to be elucidated.
    Annals of agricultural and environmental medicine: AAEM 06/2014; 21(2):429-434. · 3.06 Impact Factor
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    ABSTRACT: introduction and objective. Taking into consideration the common ontogenic origin of prolactin (Prl) and growth hormone (GH), the Prl circadian pattern was analysed in children with different degrees of GH deficiency (GHD). materials and methods. The analysis comprised 100 short children (31 girls and 69 boys), aged: 10.1±3.51 years. Based on maximal GH secretion (GHmax) during two stimulating tests multiple hormone deficiency (MPHD), severe isolated GHD (SIGHD), partial isolated GHD (PIGHD) or idiopathic short stature (ISS) were diagnosed. Non-inferential chronobiometry (macroscopic analysis) of the circadian Prl rhythm, based on serum Prl measured every 3 hours during 24 hours, was performed. In this analysis, mesor, the area under curve (AUC), peak and trough level, dispersion, mean nocturnal and diurnal concentration, night/day ratio, amplitude and regression index were estimated. results. In the study group, the positive correlations between GHmax and Prl concentrations at 02:00 and at 05:00 were observed, as well as between GHmax and mesor, amplitude, mean nocturnal concentration, night/day ratio and AUC. The nocturnal rise of Prl secretion was blunted in 100% MPHD and 50% SIGHD children, whereas in most children with PIGHD and ISS, the circadian Prl rhythm was normal. conclusions. 1) In short children, the lower the concentration of GH is, the more blunted nocturnal Prl secretion becomes. 2) In the majority of MPHD and SIGHD children (but not PIGHD), the circadian Prl rhythm was disturbed; namely, reduced nocturnal Prl secretion was noticeable.
    Annals of agricultural and environmental medicine: AAEM 06/2014; 21(2):445-449. · 3.06 Impact Factor
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    ABSTRACT: Dendritic cells (DCs), considered as one of the crucial immune regulatory populations, are implicated in the immune pathology of various disorders. Also in the thyroid gland, DCs were shown to be involved in early and chronic phases of various types of autoimmunity - including Hashimoto's thyroiditis and Graves' disease. In thyroid malignant processes, DCs are suggested as an important element of both tumour defence and tumour immune evasion mechanisms. Recent findings emphasize a crucial role of interactions between particular DC subsets and other regulatory cell populations (e.g. FoxP3+ regulatory T cells) in thyroid pathology. Additionally, an increasing attention has been paid to the control of DC function by thyrometabolic conditions. (Folia Histochemica et Cytobiologica 2014, Vol. 52, No. 1, 18-28).
    Folia Histochemica et Cytobiologica 05/2014; 52(1):18-28. · 1.10 Impact Factor
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    ABSTRACT: Introduction. Inadequate calcium intake is a recognized osteoporosis risk factor. The aim of the study was to estimate calcium intake in women in the Łódż population, the influence of calcium intake on bone mineral density (BMD) and fracture incidence, as well as the relationship between calcium intake and age. Material and methods. This cross-sectional investigation is a part of the EPOLOS study (a multicentre, population-based study on osteoporosis risk factors in Poland). In this study, 277 women from the Lodz urban area were involved [aged 20-80 years, not treated for osteoporosis before]. BMD was measured by dual-energy X-ray absorptiometry (DXA) in the lumbar spine and femoral neck. Fractures were self-reported and calcium intake was calculated according to data gathered in a questionnaire. Results. An average daily calcium intake was 797±432 mg. 65.7% of the examined women took less calcium than 1,000 mg/daily. Daily calcium intake decreased with age - from 903 mg between 20-30 years of age, to 624 mg between the ages of 70-80. In women aged 50 and older, the prevalence of low BMD at the lumbar spine (T-score <-1.0) was 31.9%. Patients reported 75 low-trauma fractures. There was a weak negative correlation between age and calcium intake, and no correlation between BMD and calcium intake. Women with fractures were significantly older than women without fractures, had significantly lower BMD, and similar levels of calcium intake. Conclusions. 1) Calcium intake below the recommended dietary intake was found in the majority of examined women. 2) No correlation between calcium intake and BMD, and between calcium intake and fracture incidence may suggest the involvement of factors other than calcium intake in pathogenesis of osteoporosis development. 3) Calcium intake gradually diminished with the age of the women.
    Annals of agricultural and environmental medicine: AAEM 03/2014; 21(1):201-4. · 3.06 Impact Factor
  • Andrzej Lewiński, Arkadiusz Zygmunt
    Annals of agricultural and environmental medicine: AAEM 03/2014; 21(1):1-4. · 3.06 Impact Factor
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    ABSTRACT: Introduction. Deficiency of vitamin D in pregnancy leads to higher incidences of preeclampsia, gestational diabetes, preterm birth, bacterial vaginosis, and also affects the health of the infants. According to Polish recommendations published in 2009, vitamin D supplementation in pregnant women should be provided from the 2nd trimester of pregnancy in daily dose of 800-1000 IU. The aim of the presented study is: 1) to estimate how many pregnant women comply with those recommendations and 2) to determine the 25(OH)D levels in pregnant women. Patients and methods. The study included 88 pregnant women, aged 20-40 years, between 12-35 week of gestation. Vitamin D concentrations [25(OH)D] were measured by a direct electrochemiluminescence immunoassay (Elecsys, Roche). Results. 31 of 88 pregnant women (35.2%) did not use any supplementation. Mean level of 25(OH)D was 28.8±14.8 ng/mL (range from 4.0 - 77.5 ng/mL). Vitamin D deficiency, defined as 25(OH)D concentration below 20 ng/mL, was found in 31.8% of the women (28/88). Insufficiency of vitamin D [25(OH)D concentration between 20-30 ng/mL] was present in 26.1% of the women (23/88). Optimal level of 25(OH)D (over 30 ng/mL) was present in 37/88 (42.0% women). Hence, in 46.2% of women taking vitamin D supplementation, the levels of 25(OH)D were still below 30 ng/mL. Conclusions. Supplementation of vitamin D in the investigated group was inadequate. More than 35% of pregnant women did not take any supplements, while half of the subjects who had declared taking vitamin D, failed to achieve optimal serum 25(OH)D concentration.
    Annals of agricultural and environmental medicine: AAEM 03/2014; 21(1):198-200. · 3.06 Impact Factor
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    ABSTRACT: Apoptosis is a process that affects life span and health. Mice with liver-specific disruption of the growth hormone receptor (GHR) gene (ie, Ghr gene) liver-specific growth hormone receptor knockout [LiGHRKO] mice), as opposed to mice with global deletion of the Ghr gene (GHRKO; Ghr-/-), are characterized by severe hepatic steatosis and lack of improved insulin sensitivity. We have previously shown that levels of proapoptotic factors are decreased in long-lived and insulin-sensitive GHRKO mice. In the current study, expression of specific apoptosis-related genes was assessed in brains, kidneys, and livers of male and female LiGHRKO and wild-type mice using real-time PCR. In the brain, expression of Caspase 3, Caspase 9, Smac/DIABLO, and p53 was decreased in females compared with males. Renal expression of Caspase 3 and Noxa also decreased in female mice. In the liver, no differences were seen between males and females. Also, no significant genotype effects were detected in the examined organs. Lack of significant genotype effect in kidneys contrasts with previous observations in GHRKO mice. Apparently, global GHR deletion induces beneficial changes in apoptotic factors, whereas liver-specific GHR disruption does not. Furthermore, sexual dimorphism may play an important role in regulating apoptosis during liver-specific suppression of the somatotrophic signaling.
    The Journals of Gerontology Series A Biological Sciences and Medical Sciences 02/2014; · 4.31 Impact Factor
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    ABSTRACT: Abstract Macroprolactin may cause elevation of prolactin (PRL) concentrations measured by standard assays. In our study, we assessed the prevalence of pituitary lesions in women with macroprolactinaemia and either oligomenorrhoea or secondary amenorrhoea. Pituitary MRI scans were performed in 61 women aged 31.0 ± 6.7 years (mean ± SD), with raised PRL concentrations due to macroprolactinaemia, detected by 25% polyethylene glycol (PEG) precipitation method (PRL recovery <40%). After PEG precipitation of macroprolactin, free PRL concentrations were still raised in 36 (59%) women. Microadenomas were detected in 10 patients out of 61 (16.4%), with raised free PRL in 9 of these cases, while macroadenomas were detected in 4 out of 61 (6.6%) women, all of whom also had raised free PRL. In case of coexistence of macroprolactinaemia and raised free PRL after PEG precipitation of macroprolactin, the chance of finding of either a micro- or a macroadenoma was 36% (13 cases out of 36). We conclude that hyperprolactinaemia and macroprolactinaemia may coexist in the same patient. Furthermore, if free PRL is raised after PEG precipitation of macroprolactin, then the chance of finding either a pituitary micro- or macroadenoma in women with oligo-/amenorrhoea is over 30%. Therefore pituitary magnetic resonance imaging is mandatory in all such cases.
    Gynecological Endocrinology 02/2014; · 1.14 Impact Factor
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    ABSTRACT: Whereas oxidative reactions occur in all tissues and organs, the thyroid constitutes such an organ, in which oxidative processes are indispensable for physiological functions. In turn, numerous metabolic reactions occurring in the liver create favourable conditions for huge oxidative stress. Melatonin is a well-known antioxidant with protective effects against oxidative damage perfectly documented in many tissues, the thyroid and the liver included. Caffeic acid phenethyl ester (CAPE), a component of honeybee propolis, has been suggested to be also an effective antioxidant. The aim of the study was to evaluate the effects of CAPE on Fenton reaction-induced oxidative damage to membrane lipids (lipid peroxidation, LPO) in porcine thyroid and liver, and to compare the results with protective effects of melatonin.
    Thyroid Research 01/2014; 7:5.
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    ABSTRACT: is usually delayed and is often associated with the development of various complications causing premature mortality. In patients with hypertension, heart failure, diabetes, and arthropathy that is non-specific for age, attention should be paid to the occurrence of somatic signs of acromegaly. As a screening test, insulin-like growth factor-1 (IGF-1) concentration should be assessed. Further diagnostic and treatment procedures are possible in specialised centres. The first-line therapy is selective transsphenoidal adenomectomy. Patients with a good prognosis related to a surgical removal of the pituitary tumour should be referred only to centres experienced in performing this type of procedure, after pharmacological preparation. Other patients, and those who have not recovered after surgical treatment, should be subjected to long-term pharmacotherapy with long-acting somatostatin analogues. In each case, the complications of acromegaly should be followed-up long-term and actively treated. This proposed new recommendation should be helpful for the management of patients with acromegaly. (Endokrynol Pol 2014; 65 (4): 326-331).
    Endokrynologia Polska 01/2014; 65(4):326-31. · 1.21 Impact Factor
  • Andrzej Lewiński, Elżbieta Skowrońska-Jóźwiak
    Annals of agricultural and environmental medicine: AAEM 01/2014; 21(3):455-6. · 3.06 Impact Factor
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    ABSTRACT: An increasing body of evidence has linked diabetes to inflammation. The phosphatidylinositol 3-kinase delta (PI3-K delta), a member of the PI3K class IA family, has been implicated in the regulation of inflammation since it is predominantly expressed in leukocytes. To date, no information has been available on the relationship of leukocyte PI3-K delta with gestational diabetes mellitus (GDM). Therefore, the aim of this study was to investigate changes in leukocyte PIK3CD mRNA expression in GDM women and, in turn, to correlate them with anthropometric and metabolic parameters of patients. Additionally, an association between leukocyte mRNA expression of PIK3CD and Sirtuin 1 (SIRT1) was determined. Blood samples from women with normal glucose tolerance (NGT; n = 43) and GDM (n = 132) at 24-33 weeks of gestation were collected. After isolating leukocytes from the blood, quantitative real time PCR (qRT-PCR) was performed to determine PIK3CD gene expression in these cells. Univariate regression analyses were used to assess an association of leukocyte PIK3CD mRNA level with clinical characteristics of patients as well as with leukocyte SIRT1 mRNA expression. Leukocyte PIK3CD mRNA was increased by 1.98-fold in the GDM v. NGT subjects and inversely correlated with low-density lipoprotein cholesterol (LDL-C) and total cholesterol (TC) in diabetic pregnancy. There were also significant positive correlations of leukocyte PIK3CD mRNA with plasma glucose concentration at 2h of 75 g oral glucose tolerance test (OGTT) and SIRT1 mRNA in the whole study population (both P < 0.05). GDM is accompanied by leukocyte PIK3CD overexpression associated with reduced plasma LDL-C and TC levels, as well as with hyperglycaemia and elevated leukocyte SIRT1 mRNA. (Endokrynol Pol 2014; 65 (1): 17-24).
    Endokrynologia Polska 01/2014; 65(1):17-24. · 1.21 Impact Factor
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    ABSTRACT: In a considerable proportion of patients with childhood-onset growth hormone (GH) deficiency (GHD), a normalisation of GH secretion at the attainment of final height (FH) is observed. The aim of the present study was to assess the incidence of, and to find out the predictors of, persistent and transient GHD, available in the pre-treatment period, in patients with childhood-onset isolated, non-acquired GHD.
    Endokrynologia Polska 01/2014; 65(5):334-41. · 1.21 Impact Factor

Publication Stats

2k Citations
518.26 Total Impact Points

Institutions

  • 2003–2014
    • Instytut Centrum Zdrowia Matki Polki
      Łódź, Łódź Voivodeship, Poland
  • 1999–2013
    • University of Lodz
      Łódź, Łódź Voivodeship, Poland
  • 1984–2013
    • Medical University of Łódź
      Łódź, Łódź Voivodeship, Poland
  • 2012
    • Instytut Medycyny Wsi
      Lyublin, Lublin Voivodeship, Poland
  • 2011
    • Wojskowy Instytut Medycyny Lotniczej
      Warszawa, Masovian Voivodeship, Poland
    • Southern Illinois University School of Medicine
      • Department of Internal Medicine
      Springfield, IL, United States
    • Jagiellonian University
      • Department of Endocrinology
      Kraków, Lesser Poland Voivodeship, Poland
  • 2007–2008
    • Wroclaw Medical University
      • Department and Clinic of Endocrinology, Diabetology and Isotope Therapy
      Wrocław, Lower Silesian Voivodeship, Poland
  • 2004
    • Centrum Medyczne Ksztalcenia Podyplomowego
      Warszawa, Masovian Voivodeship, Poland
  • 1983–2001
    • University of Texas Health Science Center at San Antonio
      • Department of Cellular and Structural Biology
      San Antonio, TX, United States
  • 2000
    • Wojskowy Instytut Medyczny
      Warszawa, Masovian Voivodeship, Poland