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Background. Pharmaceutical care is currently an increasingly common tool facilitating the optimisation of pharmacology. Implementation of pharmaceutical care in collaboration with healthcare units, especially the Primary Health Care (PHC), will result in higher integration of the medical and pharmaceutical professions, resulting in tangible benefits for the patient. Due to this innovative approach, the scope of healthcare services provided by pharmacists has not been thoroughly researched. Objectives. This research investigates the issue of assessing the scope of the services provided within the framework of pharmaceutical care. The paper presents an original concept created by the Medical and Diagnostical Centre in Siedlice, Poland (MCD). Material and methods. The research methodology started with a literature analysis and systematic review. The second stage was brainstorming based on the current practical experiences of the MDC. The research and literature analysis were carried out in electronic databases to identify published studies on the scope of services provided within the framework of pharmaceutical care. Considering the practical and widely discussed nature of the subject, an Internet search was performed as a supplementary strategy to identify articles. The results were then analysed and brainstormed by the managing staff at the MDC. Results. In the research and analysis process, the authors found, named and stated seven types of pharmaceutical services: medication review, medication consultation, pharmaceutical assistance, prophylaxis diagnosis, intervention/urgent visit, patient digitisation, internal pharmaceutical consultation. The above services together comprise the coordinated pharmaceutical care process over a patient. It has been tested in the MDC and is now in the implementation phase. Conclusions. Identification and reinforcement of the scope of the services provided within the framework of pharmaceutical care may have a crucial influence on the quality and effectiveness of patient care. This care is provided by the pharmacy in close cooperation with the ambulatory medical facilities. [ABSTRACT FROM AUTHOR]

Background. Systemic sclerosis (SSc) is an autoimmune disease characterized by inflammation, progressive vasculopathy, and fibrosis of skin and internal organs. The aim of the study was to evaluate extended inflammatory parameters (EIP) in patients with SSc in comparison to the control group of healthy subjects. Methods. A total of 28 patients with SSc and 29 healthy controls (HCs) were included in the study. The following EIP parameters were analyzed: neutrophil reactive intensity (NEUT‐RI), neutrophil granularity intensity (NEUT‐GI), antibody‐synthesizing lymphocytes (AS‐LYMP), and reactive lymphocytes (RE‐LYMP). Results. Patients with SSc showed significantly higher values of parameters determining neutrophil reactivity and neutrophil granularity when compared to HCs (respectively, 49.16 FI vs. 44.33 FI, p < 0.001, and 152.01 SI vs. 147.51 SI, p < 0.001). Moreover, patients with SSc had higher absolute numbers of RE‐LYMP than HCs (0.69 × 103/µl vs. 0.04 × 103/µl, p < 0.001). Importantly, significant correlations between the RE‐LYMP and either IL‐6 (R = 0.447, p < 0.001) or ESR (R = 0.532, p < 0.001) were found among patients with SSc. Conclusions. Changes in NEUT‐RI, NEUT‐GI, and RE‐LYMP levels positively correlate with inflammation in SSc and, thus, could potentially be used as an additional reliable inflammatory biomarker to assess inflammation in this disease. [ABSTRACT FROM AUTHOR]

Objective: During the COVID-19 pandemic, the screening approach to the diagnosis of gestational diabetes mellitus (GDM) was subject to emergency simplifications. We aimed at assessing the effectiveness of two of these temporary pandemic protocols—namely the Australian and UK, and to examine the insights they gave into the effectiveness of the more standard WHO-outlined GDM diagnosis protocol. Methods: We performed a retrospective analysis of 432 GDM patients attending the outpatient clinic at the University Hospital of Cracow, Poland throughout 2020. Results: When applying the UK criteria, 272 (63.0%) of 432 GDM cases would be missed. Women with missed-GDM by UK criteria were slightly older, had lower BMI, and had lower use of insulin. The frequency of child perinatal complications was lower in the missed GDM group (7.6% vs. 18.9%, p = 0.042) when compared to the non-missed cases group. When applying the Australian criteria, 86 of 432 (19.9%) GDM cases would be missed. Women with missed-GDM by the Australian criteria had lower BMI and less commonly used insulin than the women not missed. There were no differences in the frequency of child and maternal complications. Conclusions: Modifications proposed from the UK and Australia resulted in varying decreases and delays in GDM diagnoses, but with no apparent harm to mothers and offspring. More studies are required to investigate the impact of the simplification of GDM diagnosis on pregnancy outcomes. [ABSTRACT FROM AUTHOR]

Introduction: This retrospective cohort study was performed to compare the outcomes of primary peritoneal drainage (PD) vs. laparotomy (LAP) in patients with intestinal perforation due to necrotising enterocolitis (NEC) or spontaneous intestinal perforation. Additionally, it aims to identify demographic and clinical characteristics of eligible infants. Material and methods: We identified infants hospitalised in the Neonatal Intensive Care Unit of the University Children's Hospital of Kraków between November 2014 and April 2022 and diagnosed with intestinal perforation due to NEC or spontaneous intestinal perforation. These infants underwent surgical intervention with either PD or LAP . The primary outcomes were death, short bowel syndrome (SBS), and combined outcome of death and/or short bowel syndrome. Odds ratios (OR) were calculated for these outcomes. Statistical significance was determined by a p-value < 0.05, with a 95% confidence interval (CI) other than 1.0. Results: The primary outcome of death occurred in 8 (21%) of patients who had PD and in one (5.8%) of patient who had LAP as the initial surgery (OR = 0.23, 95% CI: 0.02-2). Short bowel syndrome occurred in 14 (36.8%) and 6 (35%) babies who had drainage and LAP, respectively (OR = 0.93, 95% CI: 0.28-3.0). Composite outcome of death and/or SBS occurred in 19 (50%) and 7 (41%) babies who had drainage and LAP as the initial surgery, respectively (OR = 0.70, 95% CI: 0.22-2.2). Conclusions: Our findings indicate that the choice of initial surgical procedure does not significantly impact the combined outcome of death and/or short bowel syndrome. Further studies are necessary to assess the impact of initial surgery on survival, intestinal function, and long-term neurodevelopmental outcomes. [ABSTRACT FROM AUTHOR]

Background. Clostridioides difficile infection is the most common diarrheal disease associated with antibiotic use. Treatment includes fidaxomicin, vancomycin, metronidazole, rifaximin, fecal flora transplants, and bezlotoxumab. There are numerous reports of the potential beneficial effects of using probiotics in Clostridioides difficile infection. Objectives. This study aimed to analyze the effects of the use of probiotics on patients with Clostridioides difficile infection who were hospitalized at the University Clinical Hospital in Wroclaw from 2016 to 2018. Material and methods. The study was conducted by analyzing the medical records of patients treated from 2016 to the end of 2018 at the University Clinical Hospital in Wroclaw. We examined the frequency of use of probiotics in Clostridioides difficile infection, differences in the use of probiotics by year of hospitalization, mortality among patients taking probiotics and not receiving this type of treatment, length of hospitalization by probiotic use, and the relationship between the gender of patients and the use of probiotics. Results. 313 patients were enrolled in the study, out of 319 patients total. Almost half of the patients (45.54%) received no probiotic during hospitalization. The most commonly administered probiotics were preparations containing Saccharomyces boulardii, which were received by 24.2% of patients. The use of probiotics did not affect mortality in Clostridioides difficile infection. Patients receiving probiotics were hospitalized longer. There was no significant statistical difference in probiotic use by patient gender. Conclusions. Probiotic use did not reduce the risk of death or shorten the length of hospitalization of patients with Clostridioides difficile infection [ABSTRACT FROM AUTHOR]

Although biomedical research requires cooperation with a large number of donors, its success also depends on the input of healthcare professionals who play a crucial role in promoting biomedical research and influencing an individual's decision to donate one's biospecimens that are left over after a medical procedure. This work was aimed at investigating the correlation between medical and healthcare students' willingness to donate a biospecimen, the type of tissues to be donated, and the type of biomedical research to be conducted. A population survey among medical and healthcare students enrolled at the Poznan University of Medical Sciences was conducted on their attitudes toward the donation of human biological material for research purposes. A total of 1500 students responded and completed the survey. The questionnaire used multiple-choice closed-ended questions designed to explore medical and healthcare students' preferences for sharing particular types of tissues and donating to a particular type of biomedical research. It asked three questions: 1. Which type of tissue would people be willing to donate for research purposes? 2. Which organs would they be willing to donate after death? 3. What type of research would they be willing to donate to? While future healthcare professionals' beliefs regarding certain types of tissues and research can influence their willingness to donate for research purposes, many students tend to think about the body and biomedical research in terms of clusters. Consequently, their willingness to donate certain tissues for a particular type of research can affect their decision to donate other tissues. Our data suggest that cluster thinking with regard to donation can be a predictor of people's readiness to participate in the collection and management of biospecimens. [ABSTRACT FROM AUTHOR]

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Introduction: The authors present the prevalence of refractive errors in premature infants, demonstrating the relationship between refractive development and selected demographic characteristics and the forms of treatment used: diode laser, anti-vascular endothelial growth factor (anti-VEGF) and combination therapy. Material and methods: The study included 56 healthy children without retinopathy of prematurity (ROP) and 63 children with ROP. Ophthalmologic evaluation and diagnosis were performed according to the International Classification of Retinopathy of Prematurity assessed in Ret-Cam 3. Treatment of ROP was carried out according to the guidelines of the Polish Ophthalmological Society using a diode laser (IRIDEX IQ 810) and an anti-VEGF intravitreal preparation (ranibizumab, Lucentis) at a reduced dose of 0.18 mg. Refractive measurements were taken at 7 months of age using a handheld computerized autorefractometer (Retinomax) after 1% tropicamide cycloplegia. Results: A statistically significantly higher prevalence of high myopia (p = 0.019) and low astigmatism (p < 0.001) was observed in the eyes of premature infants with ROP and moderate hyperopia in the group without ROP (p = 0.031) regardless of the treatment used [mean +1.33 spherical diopters (Dsfr.); SD ±3.09 for eyes with ROP vs. mean +2.42 Dsfr.; SD ±2.11 for eyes without ROP]. Birth weight (p = 0.01) and gestational age (p = 0.048) correlated with changes in spherical refraction in children with ROP. There were statistically significant differences in high myopia (p = 0.041), low myopia (p = 0.010) and low hyperopia (p = 0.014) in the group of premature infants treated for ROP depending on the form of therapy. Conclusions: There were statistically significant differences in high myopia (p = 0.041), low myopia (p = 0.010) and low hyperopia (p = 0.014) in the groups of premature infants with ROP and high myopia (p = 0.019) and low astigmatism (p < 0.001) in the groups treated with monotherapy or combined therapy. Birth weight (p = 0.01) and gestational age (p = 0.048) had a significant effect on refractive development in eyes with ROP. [ABSTRACT FROM AUTHOR]

Maintenance of proper oral hygiene by dental plaque elimination is one of the most important factors affecting the healing process in postoperative oral wounds. Propolis is a substance produced by bees. Ethanolic extract of propolis has bactericidal, fungicidal, anti-inflammatory, and antioxidative properties. Moreover, it can scavenge free radicals. The purpose of this paper is to demonstrate the efficacy of a gel containing 3% of ethanolic extract of Brazilian green propolis (EEP-B) when used for maintaining oral hygiene in patients with postoperative oral mucosal wounds. The hygiene was assessed using API, OHI, and SBI followed by microbiological examinations. The patients were divided into two groups. Group 1 consisted of those who used a gel containing EEP-B for oral hygiene, and group 2 consisted of those who used a gel without EEP-B. Although improved oral hygiene was noted in both groups, the improvement was markedly greater in the group using gel containing EEP-B. Summing up the results of microbiological examinations, EEP-B has beneficial effect on mouth microflora in postoperative period. Propolis preparations used for oral hygiene allow eliminating microorganisms of pathogenic character and physiological flora microorganisms considered as being opportunistic, with no harmful influence on physiological microflora in oral ecosystem. [ABSTRACT FROM AUTHOR]

Simple Summary: In the 2012 WHO guidelines for the treatment of chronic pain in children, the recommendation for the use of the weak opioids tramadol and codeine was removed, and in 2017 the indication for the use of these drugs for the treatment of postoperative pain in the paediatric population was also withdrawn. For the treatment of pain associated with cancer treatment, the recommendations of non-opioid analgesics and, in cases of insufficient analgesia, the use of strong opioids remained. Nalbuphine, a weak opioid commonly used in the treatment of perioperative pain in children, can also be used effectively in the treatment of cancer-related pain. Our study is the first to evaluate the quality of analgesia, side effects, and withdrawal syndrome in children receiving nalbuphine for the treatment of cancer pain. The results indicate that nalbuphine is an effective and safe analgesic that is less likely than morphine to cause adverse side effects when used to treat cancer-related pain in children. Contemporary pain management regimens in children do not include the use of the middle step of the analgesic ladder, i.e., weak opioids. The aim of this study was to analyse the comparison of side effects and the therapeutic efficacy of morphine and nalbuphine in pain management in children with cancer. We conducted an observational, prospective study and analysed medical records of patients treated at the Clinic of Paediatric Haematology and Oncology of the University Hospital in Wroclaw (Poland), who developed mucositis during treatment. The efficacy and safety of both drugs were analysed, and the efficacy of pain relief and the incidence of adverse effects characteristic of opioid drugs were compared. The cases of 96 of children treated with opioid drugs nalbuphine or morphine were analysed. Nalbuphine therapy was accompanied by a statistically significantly lower incidence of side effects such as skin pruritus, constipation, and micturition disorders compared to morphine (p < 0.05). After the discontinuation of nalbuphine, signs of withdrawal syndrome were much less frequent than after morphine (p < 0.05). In Conclusion, nalbuphine used as a pain killer in children with oncological disorder is a safe drug. It provides stable analgesia in most children. Compared to morphine, the side effects typical of opioid use are less common, and the incidence decreases over time. [ABSTRACT FROM AUTHOR]

Aim of the study: All over the world people are increasingly turning to dietary supplements, the market for which is growing every year. Unfortunately, still little is known about the use of dietary supplements in paediatric population. The aim of the study was to assess the frequency of use of dietary supplements among children in Lesser Poland Voivodeship and to verify the source of parents' knowledge about dietary supplements. Material and methods: A multiple-purpose survey was conducted anonymously among 229 parents of patients hospitalized in the Department of Paediatrics, University Children's Hospital in Krakow. Each parent answered 41 questions regarding dietary supplements use in his/her hospitalized child throughout the whole child's life. The data was statistically analyzed. Results: 71.4% of parents supply dietary supplements to their children, 57% admitted that they serve it daily. Parents most often give their children a single vitamin or mineral preparation (39.2%). Mostly the choice of a particular preparation was conditioned on the opinion of a physician (68%) or a pharmacist (37%). Families with a high socioeconomic status more often take advice from health professionals regarding their knowledge about supplements. Nearly half of the respondents admit that they do not have sufficient knowledge on the dietary supplements they give to their children. Conclusions: Most parents give or gave dietary supplements to their children. Although a well-balanced diet provides all vitamins and micronutrients that young organisms need, many parents find it necessary to use dietary supplements. It is alarming how many people use alternative sources of information. It is necessary to educate and build awareness among parents that they take an active role and are responsible for their child's health and that they should have reliable knowledge about the preparations they decide to give their child. [ABSTRACT FROM AUTHOR]

Aim of the study: Although the recognition of acute pancreatitis in children has been increasing over the last decades, knowledge this condition is limited. Thus, we aimed to evaluate the aetiology and clinical course of the first episode of acute pancreatitis in children. Material and methods: We retrospectively analysed medical records of patients hospitalized due to the first episode of acute pancreatitis in the Department of Paediatrics and Gastroenterology, Medical University of Lublin, from January 2011 to December 2019. The analysis took into account the age and sex of patients, clinical symptoms, abnormalities in physical examination, past and family history data, and results of laboratory and imaging tests. The review of consecutive hospitalizations of patients from the study group was carried out to assess the number of recurrences of pancreatitis in the analysed period. Results: The study group consisted of 72 patients, including 37 boys and 35 girls. The age of patients ranged from 2 to 18 years, with a median of 12 years. The vast majority (62%) of acute pancreatitis cases were diagnosed in the latter 4 years of the study period. In 43% of patients, acute pancreatitis was of idiopathic origin, followed by infectious (22%), toxic (18%), and biliary (8%) aetiology. The most common initial symptoms included abdominal pain (93%), vomiting (66%), and nausea (28%). In the study period recurrence of acute pancreatitis occurred in one-third of the children. Conclusions: Paediatric acute pancreatitis is an increasing health care issue with various aetiologies. Acute pancreatitis should be considered in every child with acute abdominal pain, vomiting, or nausea. Further studies are needed to determine the risk factors of recurrent acute pancreatitis. [ABSTRACT FROM AUTHOR]

Background. Patients with Chronic Kidney Disease (CK D), with an additional burden of cardiovascular disease, should be monitored, educated and treated through the close cooperation between multidisciplinary nephrology and cardiology teams. One of the elements by which this can be achieved is cardiac rehabilitation programs. Objectives. The aim of this study is to assess the effect of chronic kidney disease on exercise performance within cardiac patients. Material and methods. 92 patients qualified for stationary cardiac rehabilitation took part in a study conducted at the Cardiac Surgery Clinic of the SPSK 2 Pomeranian Medical University in Szczecin. Among them, a group with CK D (n = 24) and without (n = 68) was selected. Statistical analysis was performed on the basis of data from medical records and the results of the 6-minute walk test. Results. Patients with and without CK D improved the results of the 6-minute test. From an average result of 256.21 (± 138.99) at the beginning of the rehabilitation to an average of 385.96 (± 109.09) after that for patients with CK D and from average result of 281.01 (± 110.16) to an average result of 422.29 (± 96.39) for patients without CK D. Conclusions. Cardiac rehabilitation has a positive effect on physical fitness and exercise tolerance both in patients with CK D and without. However, the coexistence of CK D results in less satisfactory results compared to the control group. [ABSTRACT FROM AUTHOR]

Aims and objectives: Analysis of factors determining acceptance of disease and satisfaction with life in patients with peripheral artery disease. Background: Peripheral artery disease is more common in older patients and is associated with increased morbidity and mortality due to cardiovascular diseases and the risk of amputation. The acceptance of disease is one of the most important factors for adjusting to life with a chronic disease. Design: A cross‐sectional survey study. Patients' questionnaires. Method: The participants were patients with peripheral artery disease (N = 72). The study included the use the standardized research tools the Acceptance of Illness Scale (AIS) and the Satisfaction with Life Scale (SWLS). Results: The highest acceptance of disease was observed for patients with higher education, while the lowest was found for patients with the greatest limitation of physical mobility. Conclusions: The education level and physical fitness of patients had significant impact on disease acceptance. [ABSTRACT FROM AUTHOR]

Intravenous lidocaine, a potent local anesthetic with analgesic and anti-inflammatory properties, has been shown to be an effective adjunct that reduces intra- and postoperative opioid consumption and facilitates pain management in adults. While it shows promise for use in the pediatric population, limited evidence is available. Objectives: To determine if general anesthesia with intraoperative intravenous lidocaine infusion versus general anesthesia without intravenous lidocaine infusion in children undergoing laparoscopic appendectomy decreased opioid requirements intra- and postoperatively. Design: A single-center parallel single-masked randomized controlled study. A computer-generated blocked randomization list was used to allocate participants. The study was conducted between March 2019 and January 2020. Setting: Pediatric teaching hospital in Poland. Participants: Seventy-four patients aged between 18 months and 18 years undergoing laparoscopic appendectomy. Seventy-one patients fulfilled the study requirements. Intervention: Intravenous lidocaine bolus of 1.5 mg/kg over 5 min before induction of anesthesia followed by lidocaine infusion at 1.5 mg/kg/h intraoperatively. The infusion was discontinued before the patients' transfer to the postanesthesia care unit (PACU). Primary outcome measure: The primary outcome measure was total nalbuphine requirement in milligrams during the first 24 h after surgery. Secondary outcome measures: The secondary outcome measures were intraoperative fentanyl consumption, intraoperative sevoflurane consumption, time to the first rescue analgesic request, incidence of postoperative nausea and vomiting during the first 24 h after surgery, frequency of side effects of lidocaine. Results: Children (n = 74) aged 5–17 randomly allocated to receive intraoperative lidocaine infusion (n = 37) or no intervention (n = 37). Seventy-one were included in the analysis (35 in the study group and 36 in the control group). There was no difference in the cumulative dose of nalbuphine in the first 24 h after removal of the endotracheal tube between groups [median of 0.1061 (IQR: 0.0962–0.2222) mg/kg in the lidocaine group, compared to the control group median of 0.1325 (IQR: 0.0899–0.22020) mg/kg, p = 0.63]. Intraoperative fentanyl consumption was lower in the lidocaine group [median of 5.091 (IQR: 4.848–5.714) μg/kg] than in the control group [median of 5.969 (IQR: 5.000–6.748), p = 0.03]. Taking into account the additional doses administered based on clinical indications, the reduction in the requirement for fentanyl in the lidocaine group was even greater [median of 0.0 (IQR: 0.0–0.952) vs 0.99 (IQR: 0.0–1.809) μg/kg, p = 0.01]. No difference was observed in the sevoflurane consumption between the two groups [median of 32.5 ml (IQR 25.0–43.0) in the lidocaine group vs median of 35.0 ml (IQR: 23.5–46.0) in the control group, p = 0.56]. The time to first analgesic request in the lidocaine group was prolonged [median of 55 (IQR: 40–110) min in the lidocaine group vs median of 40.5 (IQR: 28–65) min in the control group, p = 0.05]. There was no difference in the frequency of PONV between the two groups (48.57% in the lidocaine group vs 61.11% in the control group, p = 0.29). No lidocaine related incidence of anaphylaxis, systemic toxicity, circulatory disturbances or neurological impairment was reported, during anesthesia or postoperative period. Conclusions: Intraoperative systemic lidocaine administration reduced the intraoperative requirement for opioids in children undergoing laparoscopic appendectomy. This effect was time limited, and hence did not affect opioid consumption in the first 24 h following discontinuation of lidocaine infusion. Trial registration: NCT03886896. [ABSTRACT FROM AUTHOR]

Background: Multiple organ failure and early surgery are associated with high morbimortality after open necrosectomy. Data are mostly derived from historical cohorts with early necrosectomy bereft of step-up treatment algorithm implementation. Thus, mostly circumstantial evidence suggests a better clinical course following mini-invasive surgical and endoscopic necrosectomy. We studied the results of open necrosectomy in a contemporary cohort of patients with complicated pancreatic necrosis treated at a tertiary center. Methods: A retrospective cohort study from a university teaching hospital. Results of 109 consecutive patients treated with open necrosectomy during a 12-year period are reported. Results: The overall 90-day mortality rate was 22.9%. The 90-day mortality rate was 10.6% if necrosectomy could be delayed until 4 weeks from symptom onset and the necrosis had become walled off on preoperative imaging. The risk factors for 90-day mortality were age over 60 years (OR 19.4), pre-existing co-morbidities (OR 16.9), necrosectomy within 4 weeks (OR 6.5), multiple organ failure (OR 12.2), white blood cell count over 23 × 109 (OR 21.4), and deterioration or prolonged organ failure as an indication for necrosectomy (OR 10.4). None or one of these risk factors was present in 52 patients (47.7% of all patients), and these patients had no mortality. Conclusion: Late open necrosectomy for walled-off necrosis has a low mortality risk. Open necrosectomy can be done without mortality in the absence of multiple risk factors for surgery. [ABSTRACT FROM AUTHOR]

The increase in type 1 diabetes mellitus (T1DM) incidence in children is worrying and not yet fully explored. It is suggested that probably air pollution exposure could contribute to the development of T1DM. The aim of the study was to investigate the relationship between the concentration of gaseous pollutants including, nitrogen dioxide (NO2), nitric oxides (NOx), sulphur dioxide (SO2), carbon monoxide (CO), and particulate matter (PM) in the air, and the number of new cases of T1DM in children. The number of new cases of T1DM was obtained from the Clinic of Paediatrics, Diabetology, and Endocrinology, Medical University of Gdańsk. The number of children of 0–18 years old in Pomeranian Voivodeship was acquired from the Statistical Yearbook. The concentrations of PM10 absorbance, NO2, NOx, SO2, and CO were measured at 41 measuring posts, between 1 January 2015 and 31 December 2016. It was detected that the average annual concentration of PM10 was higher than the value acceptable to the WHO. Furthermore, the average 24-hour concentration of PM10 was 92 μg/m3 and was higher compared to the acceptable value of 50 μg/m3 (acc. to EU and WHO). Moreover, the number of new cases of T1DM showed a correlation with the annual average concentration of PM10 (β = 2.396, p < 0.001), SO2 (β = 2.294, p < 0.001), and CO (β = 2.452, p < 0.001). High exposure to gaseous pollutants and particulate matter in ambient air may be one of the factors contributing to the risk of developing T1DM in children. Therefore, it is important to take action to decrease air pollutant emissions in Poland. It is crucial to gradually but consistently eliminate the use of solid fuels, such as coal and wood in households, in favour of natural gas and electricity. The development of new technologies to improve air quality, such as "best available techniques" (BAT) or renewable energy sources (water, wind, and solar generation) is of critical importance as well. [ABSTRACT FROM AUTHOR]

Recently, the diagnostic criteria of preeclampsia have been changed. No studies are available in the literature that analyzed in detail the differences between early-onset preeclampsia (EOP) and late-onset preeclampsia (LOP), taking into account the International Society for the Study of Hypertension in Pregnancy (ISSHP) criteria. Thus, we sought to retrospectively investigate in detail the differences in clinical and laboratory outcomes between EOP and LOP diagnosed according to the ISSHP criteria. A retrospective cohort study was conducted in 214 women with singleton pregnancies and preeclampsia admitted to the Department of Obstetrics and Perinatology of the University Hospital in Kraków, Poland, from 2013 to 2017 (113 (52.8%) women with EOP and 101 (47.2%) women with LOP). Electronic medical records were reviewed for demographics and medical history, laboratory tests, and delivery and neonatal data. Patients with preeclampsia accounted for 1.7% of the women who delivered during the study period. The EOP and LOP groups did not differ in the distribution of risk factors for preeclampsia. The most common risk factor was primiparity, which was observed in 72.0% of cases. Regarding the ISSHP diagnostic criteria, the two groups differed in the incidence of fetal growth restriction (p=0.0009), hemolysis (p=0.0416), and neurological complications (p=00342), which were found more often in the EOP group. In addition, the EOP group had more frequent occurrence of severe cardiorespiratory (p<0.0001) and hematological (p=0.0127) complications, adverse fetoplacental conditions (p<0.0001), and severe fetoplacental complications (p=0.0003). Children born to women with EOP had lower Apgar scores (p<0.001) and higher rates of intraventricular hemorrhage (p<0.0001), respiratory disorders requiring mechanical ventilation (p<0.0001), and early (p=0.0004) and late sepsis (p=0.002). EOP differed from LOP in terms of maternal and perinatal adverse outcomes. The observed higher rates of fetoplacental adverse conditions and severe complications indicate a significant contribution of impaired placentation to the etiopathogenesis of EOP. [ABSTRACT FROM AUTHOR]

Background. The use of over-the-counter (OT C) medications without consulting a doctor has become increasingly common. Objectives. To compare the scale of self-treatment in a population of students of the Medical University of Bialystok in 2012 and 2017. Material and methods. The study included 217 students in 2012 and 220 students in 2017, and used a proprietary questionnaire. Results. A total of 78.8% of students in 2012 and 86.4% in 2017 were familiar with the meaning of the abbreviation OT C. When using an OT C drug for the first time, most students consulted a nurse (66.4%) in 2012, while in 2017, students usually consulted a family member (68.8%). Headache was the main reason for using OT C drugs (89.4% in 2012, and 92.7% in 2017). The use of analgesics (87.1%) and the use of OT C medicines in accordance with the leaflet (47%) predominated in 2012, while vitamin therapy (83.2%) took first place in 2017. When purchasing OT C medications, students usually based their decision on their own experience (63.1% in 2012 and 84.1% in 2017). A total of 35.5% of the students in 2012 and 39.1% in 2017 always read the leaflet. Conclusions. Self-medication was practiced by most students in both years, with lack of time for a medical appointment being the main reason. Over the last 6 months, the students most often used prescription and non-prescription drugs simultaneously. [ABSTRACT FROM AUTHOR]

Background. Long-term care (LTC ) services involve long-lasting continuous supervision, care, nursing, therapy, and rehabilitation of patients who do not qualify for acute medical care. Demand for LTC services is on the rise, because of the aging of society and increasing number of dependent young and middle-aged people. Objectives. The aim of the study was to examine the dysfunction of LTC services in Poland, taking the phenomenon of prolonged hospitalization as an example. Material and methods. We examined data on patients at the University Clinical Hospital in Wroclaw, Poland, who were waiting for transfer from hospital to LTC facilities in the years 2012-2017. The statistical threshold of significance was p < 0.05. Results. There were 1006 cases of hospital stays prolonged by waiting for transfer to LTC facilities; 77% of patients affected were 65 years or older. This age group saw a large increase in the total number of patients transferred from hospital to LTC facilities. Patients 65 years and older made up the majority of patients on transfer waiting lists, but their average waiting time was significantly shorter than that of younger patients (38.7 vs 69.6 days, respectively). Conclusions. The demonstrated forced prolonged hospitalizations, which result from a lack of capacity on the part of LTC facilities to accept patients who have undergone hospital treatment, confirmed the dysfunction of the Polish LTC system. This results in a lack of adequate medical care continuity, increased total costs of medical care, and a shifting of expenses from the LTC facilities to the acute treatment facilities, which are most often hospitals. [ABSTRACT FROM AUTHOR]

Background. The average waiting time for cataract treatment in Poland is 441 days - the longest for any surgical procedures in the country. Objectives. The aim of the study was to examine the availability of surgical cataract treatment among older Polish patients. Material and methods. Using data from 25,970 hospitalizations at the Ophthalmology Ward of the University Clinical Hospital in Wrocław, Poland in years 2012-2017, we analyzed the demographic structure of the patients, the duration of hospital stay, and the average cost; the level of statistical significance was taken to be p < 0.05. Results. Patients 65 years of age or older made up 78% of patients receiving surgical cataract treatment. This treatment required significantly shorter hospitalization time in 2017 than in 2012 (an average of 1.89 vs. 2.19 patient-days, respectively). The average hospital stay length among the older patients was significantly shorter than among younger patients (2.3 vs 3.2 patient-days, respectively) and the average hospitalization cost for patients aged 65 years or older was significantly lower (2105.63 PLN vs 2929.57 PLN , equivalent of 495.44 EUR vs 689.31 EUR , respectively). Conclusions. The duration of the average hospital stay in the ophthalmology ward was shorter, and the average hospitalization cost was lower, for patients aged 65 years or older than for younger patients because older patients mostly undergo modern standardized less-invasive cataract treatment. As more ophthalmological medical staff, infrastructure, and financial assets are available for cataract treatment and have not yet been assigned or spent, Polish hospitals should introduce newer medical technology, process adjustments, and organizational innovations to fully utilize their potential and improve the availability of cataract treatment. [ABSTRACT FROM AUTHOR]

Background. Disorders connected with the musculoskeletal and central nervous system dysfunction are the most significant clinical problem worldwide. Our earlier research has shown that back and spinal disorders and lumbar disc disorders were most frequently diagnosed using MRI scanner at the University Clinical Hospital (UCH) in Olsztyn in years 2011–2015. We have also observed that another two diseases of spinal column, spondylosis and cervical disc disorders, were also very prevalent. The main objective of this work was to analyze the prevalence of spondylosis and cervical disc disorders in the study population diagnosed at UCH in years 2011–2015. Methods. The digital database including patients’ diagnostic and demographic information was generated based on MRI reports from years 2011–2015 and analyzed using SPSS software. Results. Within the study group (n=13298) the most frequently MRI-diagnosed diseases were musculoskeletal group (M00–M99; n=7711; 57,98%) and cervical disc disorders (M50; n=1659; 12,47%) and spondylosis (M47, n=611; 4,59%). More women (67%) than men (33%) were enrolled in the study, and the largest fraction of the study population was in the range of 51–60 years, with about 1/3 of cases of both diseases diagnosed in early age range of 31–40 years. Conclusion. Significant number of patients presenting with either of the spine disorders at the young age of 31–40 years points to the necessity of introducing methods preventing disorders of the vertebral column at younger age, preferably at school age. [ABSTRACT FROM AUTHOR]

A slight decrease in blood testosterone level in men is a physiological state associated with the aging. The aim of our study was to evaluate the occurrence of hormone and metabolic disorders, as well as the immunolocalization and immunoexpression of androgen receptors (AR) and estrogen-alpha receptors (ERa) in the prostates of men with benign prostatic hyperplasia (BPH) and coexisting testosterone deficiency syndrome (TDS).~Introduction~Background~The study involved 150 men, diagnosed with and receiving pharmacological treatment for BPH. Concentrations of glucose, total cholesterol (TCh), high-density lipoproteins (HDL), low-density lipoproteins (LDL), and triglycerides (TG) were determined in blood serum. Serum concentrations of total testosterone (TT), free testosterone (FT), estradiol (E2), luteinizing hormone (LH), insulin (I), sex hormone-binding globulin (SHBG), dehydroepiandrosterone sulfate (DHEAS), and insulin-like growth factor 1 (IGF-1) were measured by ELISA. The number of AR-positive cells and ERa-positive cells were measured in prostate sections of men with BPH.~Material and Methods~Methods~Patients eligible for transurethral resection of the prostate and TDS were significantly more likely to have higher abdominal circumference and higher serum levels of insulin and IGF-1 as well as lower levels of FT and SHBG than control subjects with BPH and no TDS. Quantitative analysis revealed 35.8% AR-positive colum-nar epithelial cells and 24.3% AR-positive stromal cells in prostates of BPH patients with TDS and 30.5% and 23.0%, respectively, in BPH patients without TDS. However, the differences between the study and the control groups were statistically not significant. In prostates of BPH patients with TDS the immunoexpression of ERa was observed in 2.88% of the columnar epithelial cells and 0.39% of stromal cells. In BPH patients without TDS ERa-positive cells were only found in 0.04% of columnar epithelial cells and 0.62% of prostatic stromal cells.~Results~Results~Considering the statistically significantly higher levels of I and IGF-1 and larger abdominal circumference of men with BPH and TT deficiency, it can be supposed that visceral obesity and carbohydrate disorders may contribute to the reduction of testosterone concentration. The results of our study indicate a relationship between TT concentration in the plasma of patients with BPH and the percentage of AR-positive cells in the prostate.~Conclusions~Conclusions [ABSTRACT FROM AUTHOR]

Background: To evaluate in patients with aggressive periodontitis (AgP) the effect of nonsurgical periodontal treatment in conjunction with either additional administration of systemic antibiotics (AB) or application of photodynamic therapy (PDT) on the gingival crevicular fluid (GCF) concentration of matrix metalloproteinases 8 and 9 (MMP-8 and -9). Methods: Thirty-six patients with AgP were included in the study. Patients were randomly assigned to treatment with either scaling and root planing (SRP) followed by systemic administration of AB (e.g. Amoxicillin + Metronidazole) or SRP + PDT. The analysis of MMP-8 and -9 GCF concentrations was performed at baseline and at 3 and 6 months after treatment. Nonparametric U-Mann-Whitney test was used for comparison between groups. Changes from baseline to 3 and 6 months were analyzed with the Friedman's ANOVA test with Kendall's index of consistency. Results: In the AB group, patients showed a statistically significant (p = 0.01) decrease of MMP-8 GCF level at both 3 and 6 months post treatment. In the PDT group, the change of MMP-8 GCF level was not statistically significant. Both groups showed at 3 and 6 months a decrease in MMP-9 levels. However, this change did not reach statistical significance. Conclusions: Within the limits of the present study, it may be suggested that in patients with AgP, nonsurgical periodontal therapy in conjunction with adjunctive systemic administration of amoxicilin and metronidazole is more effective in reducing GCF MMP-8 levels compared to the adjunctive use of PDT. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to evaluate the prevalence of malnutrition in Polish elderly population and analyse its social and economic correlates based on the data from the PolSenior project, the first large-scale study of a representative group of Polish seniors. Design: A cross-sectional population-based study. Setting: All territorial provinces in Poland. Participants: 4482 community-dwelling respondents aged 65 years or above (women: n=2142, age=79.0±8.4 years; men: n=2340, age= 78.3±8.6 years). Measurements: The nutritional status of participants was assessed through the Mini Nutritional Assessment Short Form (the revised MNA-SF). Out of social and economic correlates we evaluated age, sex, level of education, marital status, place of residence, living conditions and economic status. Economic status of the respondents was determined on the basis of questions on how well they could manage their own budgets. Those who could afford only the cheapest food or clothes were considered the group of self-reported poverty. Results: Frequency of malnutrition in the PolSenior population accounted for 7.5% (in 5.0% men and 9.0% women; p<0.001). The risk of malnutrition was present in 38.9% (33.3% men and 42.4% women; p<0.001). In our study female sex, older age, unmarried status, living in a rural area and self-reported poverty were independent correlates of malnutrition. Conclusions: Our data showed high prevalence of malnutrition and the risk of its development among the community-dwelling elderly people in Poland. Screening with MNA-SF should focus in particular on unmarried, poorly educated individuals, in late old age, living in rural areas and self-reporting a poor financial state, especially women. [ABSTRACT FROM AUTHOR]

Wstęp: Zgodnie z wytycznymi Towarzystwa SOSORT, w leczeniu zachowawczym skoliozy idiopatycznej (SI) stosuje się fizjoterapię oraz leczenie gorsetowe, a jego głownym celem jest zapobieganie progresji skrzywienia i poprawa estetyki sylwetki. Celem pracy jest przedstawienie wynikow leczenia zachowawczego 12-letniej dziewczynki z progresywną skoliozą idiopatyczną. Opis przypadku: Diagnostykę fizjoterapeutyczną przeprowadzono po raz pierwszy w marcu 2010 roku z powodu zaobserwowanej przez matkę asymetrii ustawienia łopatek. Pacjentkę skierowano do poradni ortopedycznej w celu dalszej diagnostyki. W badaniu radiologicznym stwierdzono: prawostronne wygięcie kręgosłupa w odcinku piersiowym (Th6-Th11, 30°) oraz lewostronne w odcinku piersiowo-lędźwiowym (Th11-L4, 30°), test Rissera (0). Zalecono leczenie gorsetem Cheneau (23 godz./dobę) oraz intensywną fizjoterapię. Na podstawie wywiadu z rodzicami dziewczynki ustalono, że zalecenia dotyczące noszenia gorsetu i ćwiczeń nie były w domu przestrzegane. Kontrolne zdjęcie rentgenowskie wykonane we wrześniu 2010 roku wykazało progresję prawostronnego skrzywienia w odcinku piersiowym (Th6-Th11, 36°). Zalecono zwiększenie systematyczności noszenia gorsetu i wykonywania ćwiczeń. Zdjęcie rentgenowskie wykonane w czerwcu 2011 roku wykazało zmniejszenie wartości kątowych skrzywienia: Th6-Th11, 18° oraz Th11-L4, 14°. Test Rissera określono na (1). Wystąpienie pierwszej miesiączki odnotowano w listopadzie 2011 roku. Pacjentka kontynuowała leczenie gorsetem i fizjoterapią. We wrześniu 2013 roku wykonano kontrolne zdjęcie rentgenowskie (Th5-Th11, 15°, Th11-L4, 11°). Test Rissera określono na (4). Zalecono zakończenie leczenia gorsetem oraz kontynuację fizjoterapii w celu poprawy estetyki sylwetki. Podsumowanie i wnioski: Leczenie zachowawcze (gorset i fizjoterapia) może prowadzić do zmniejszenia wielkości kątowej skrzywienia u dzieci z progresywną SI. Introduction:According to SOSORT, conservative treatment of idiopathic scoliosis (IS) includes physiotherapy and bracing. The main goal of treatment is to prevent of progression of the curvature as well as improvement the appearance. The aim of the study is to present the results of conservative treatment of girls aged 12 years with progressive idiopathic scoliosis. A case study: The first diagnostic was performed in March 2010 due to asymmetry of scapulas observed by the mother. The girl was referred to an orthopedist for a more detailed diagnostics. The radiographic assessment found: the right-sided curvature in the thoracic (Th6-Th11, 30°) and left-sided in the thoraco-lumbar (Th11-L4, 30°). The Risser sign was determined (0). It was recommended Cheneau brace (23 hours per day) as well as intensive physiotherapy. In the conversation with parents and girl, it was established that they failed to comply the recommendation. The control radiographic exam (September, 2010) revealed the progression of the right thoracic curve (Th6-Th11, 36°). It was recommended more systematic wearing the brace and exercises. The X-ray performed in June 2011 showed decrease of the Cobb angle (Th6-Th11, 18° right and Th11-L4, 14° left). Risser sign value was (1). The menarche occurred in November 2011. The patient continued the treatment with the brace and physiotherapy. In September 2013 performed the control X-ray exam (Th5- Th11, 15°, Th11-L4, 11°). The Risser sign was determined (4).The physician decided by the end of treatment with Chenenau brace and recommended the continuation of physiotherapy to improve the appearance. Summary and conclusion: The conservative treatment (Cheneau brace and physiotherapy) can lead to decrease the Cobb angle in children with IS. [ABSTRACT FROM AUTHOR]

The article discusses the current Indian epidemic of dermatophytosis. Topics include descriptive study conducted among the patients with dermatophytosis attending the dermatology outdoor of a tertiary healthcare center in eastern India; Descriptive statistical analyses were done by SPSS for Windows; and direct microscopic examination.

Background: An unfavorable trend of increasing rates of colorectal cancer has been observed across modern societies. In general, dietary factors are understood to be responsible for up to 70% of the disease's incidence, though there are still many inconsistencies regarding the impact of specific dietary items. Among the dietary minerals, calcium intake may play a crucial role in the prevention. The purpose of this study was to assess the effect of intake of higher levels of dietary calcium on the risk of developing of colorectal cancer, and to evaluate dose dependent effect and to investigate possible effect modification.Methods: A hospital based case-control study of 1556 patients (703 histologically confirmed colon and rectal incident cases and 853 hospital-based controls) was performed between 2000-2012 in Krakow, Poland. The 148-item semi-quantitative Food Frequency Questionnaire to assess dietary habits and level of nutrients intake was used. Data regarding possible covariates was also collected.Results: After adjustment for age, gender, education, consumption of fruits, raw and cooked vegetables, fish, and alcohol, as well as for intake of fiber, vitamin C, dietary iron, lifetime recreational physical activity, BMI, smoking status, and taking mineral supplements, an increase in the consumption of calcium was associated with the decrease of colon cancer risk (OR = 0.93, 95% CI: 0.89-0.98 for every 100 mg Ca/day increase). Subjects consumed >1000 mg/day showed 46% decrease of colon cancer risk (OR = 0.54, 95% CI: 0.35-0.83). The effect of dietary calcium was modified by dietary fiber (p for interaction =0.015). Finally, consistent decrease of colon cancer risk was observed across increasing levels of dietary calcium and fiber intake. These relationships were not proved for rectal cancer.Conclusions: The study confirmed the effect of high doses of dietary calcium against the risk of colon cancer development. This relationship was observed across different levels of dietary fiber, and the beneficial effect of dietary calcium depended on the level of dietary fiber suggesting modification effect of calcium and fiber. Further efforts are needed to confirm this association, and also across higher levels of dietary fiber intake. [ABSTRACT FROM AUTHOR]