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Abstract A situation of emergency involving the whole population introduces changes in the dynamics of the health services that are provided. The magnitude of these shifts should be also linked to the medical speciality within which the health benefits are delivered. The aim of the paper was to identify changes in tendencies in inpatient medical service delivery during the COVID-19 pandemic by medical specialties. On the basis of a database extracted for in-patient treatment received from the public payer, a retrospective analysis was carried out. Comparing the values of the dynamics of the services provided in each medical speciality, the period before the COVID-19 pandemic was collated to the years of the pandemic (2020–2021). In the period before COVID-19, positive patient dynamics were observed in more than half of the specialities. Between 2020 and 2021, virtually all specialties reversed the trend and negative dynamics were recorded. The dynamics in 2021 indicate a process of return to the values from 2015 to 2019. Emergency situation has affected the dynamics of healthcare provision in different specialities to various extent. The most resistant to the negative impulses of the state of emergency were the areas that are strictly organisationally and financially defined (e.g. the group of “therapeutic and drug programmes”).

Abstract Introduction SARS-CoV-2 unsparingly impacts all areas of medicine. Pregnant women are particularly affected by the pandemic and COVID-19 related liver damage seems to be another threat to maternal and fetal health. The aim of this study is to define liver damage profile including bile acids serum levels in COVID-19 pregnant patients and to determine predictors of disease aggravation and poor obstetrics outcomes. Methods This study has been carried out in the Obstetrics and Gynecology Department, at the National Medical Institute in Warsaw, Poland between 01.02.2021 and 01.11.2022 The study cohort comprises 148 pregnant patients with COVID-19 and 102 pregnant controls who has been tested negative for SARS-CoV-2. Results COVID-19 pregnant patients presented liver involvement at admission in 41,9%. Hepatotoxic damage accounted for 27 (19.85%), cholestatic type was diagnosed in 11 (8.09%) and mixed type of liver injury was presented in 19 (13.97%) of patients. Higher serum levels of AST, ALT, GGT, total bilirubin and bile acids as well as mixed type of liver injury at admission were correlated with severe form of an illness. AST and ALT above upper reference limit as well as hepatotoxic type of liver damage predisposed pregnant patients with COVID-19 to poor obstetrics outcomes. Conclusion Hepatic damage in pregnant women with COVID-19 is a common, mild, transaminase-dominant, or mixed type of injury, and often correlates with elevated inflammatory markers. SARS-CoV-2 test should be performed as a part of differential diagnosis in elevated liver function tests. Although bile acids serum levels were commonly elevated they seems to be clinically irrelevant in terms of pregnancy outcomes. Video Abstract

Objectives Secondhand smoke exposure causes serious health problems. Banning smoking in public venues decreases exposure to secondhand smoke. However, the implementation of smoke-free rules in a private setting (including homes) is largely voluntary. This study aimed to assess the prevalence and characteristics of voluntary smoke-free home rules in Poland during the COVID-19 pandemic as well as to identify factors associated with the voluntary implementation of smoking bans at home. Material and Methods This cross-sectional survey was conducted in March 2022 with a nationally representative sample of 1090 individuals aged ≥18 years in Poland. Data were collected using a computerassisted web interviewing (CAWI) technique. The research tool was an original questionnaire developed for the purpose of this study. Results Nationally, 60.6% of individuals had total ban on smoking in home (100% smoke-free home rules), 34.0% had implemented a partial smokefree home rule and 5.4% had not implemented any smoke-free home rules. Over three-quarters of non-smokers (76.8%) and only one-fifth of smokers (20.7%) had adopted a full smoke-free home rule. In multivariate logistic regression analysis, males (OR = 1.65, 95% CI: 1.22–2.22, p < 0.01), non-smokers (OR = 13.78, 95% CI: 9.80–19.38, p < 0.001), respondents who had higher education (OR = 1.57, 95% CI: 1.15–2.14, p < 0.01) as well as those who lived alone (OR = 2.44, 95% CI: 1.52–3.90, p < 0.001) had higher odds of having a 100% smoke-free home rule. Conclusions This study demonstrated the negative impact of the COVID-19 pandemic on the implementation of smoke-free home rules in Poland. Less than two-thirds of the Polish population has adopted a total smoke-free home rule, with significant gaps between smokers and nonsmokers. Information on current voluntary smoke-free rules will be useful for further implementation of the smoke-free law in Poland. Int J Occup Med Environ Health. 2023;36(1):84–95

Introduction In the following study we describe the diagnostic process and further case analysis of a 30-year-old woman admitted with typical COVID-19 symptoms, who subsequently developed additional symptoms suggesting cerebral autosomal dominant arteriopathy with sub-cortical infarcts and leukoencephalopathy (CADASIL). Material and methods Other than the standard diagnostic procedures, whole genome sequencing (WGS) was used, which led to following findings. A new variant of the NOTCH3 gene, which led to CADASIL-like symptoms, was found, and it had been most likely activated by the SARS-CoV-2 infection. This novel variant in NOTCH3 has not been found in existing databases and has never been mentioned in research concerning CADASIL before. Results Furthermore, after subjecting the patient’s close relatives to WGS it was found that no other examined person demonstrated the same genetic mutation. Conclusions It seems therefore that the new variant of NOTCH3 is of de novo origin in the patient’s genome. Additionally, the relatively early onset of CADASIL and the unexpectedly severe COVID-19 infection suggest that the two occurred simultaneously: the infection with SARS-CoV-2 accelerated development of CADASIL symptoms and the unusual variant of the NOTCH3 gene contributed to the more severe course of COVID-19.

Introduction The aim of our study was to assess the potential value of the Comirnaty vaccine (BNT162b2) in Poland. A model was used to estimate patient events, direct medical costs, utilities, and cost-effectiveness for 1 year with and without implementation of the vaccine. Material and methods The Markov model with 1-week cycles was used to estimate patient events, direct medical costs, utilities, and cost-effectiveness for 1 year with and without implementing the Comirnaty vaccine in Poland. The incremental cost per quality-adjusted life-year (QALY) gained vs. no vaccine was calculated for the general population and selected age-groups. All costs are reported in PLN (average exchange rate in 2020: 1 EUR = 4.44 PLN). Results In the base case analysis the incremental cost per QALY gained associated with vaccinating the whole population is 6249 PLN. For individuals aged 60–69 years and > 80 years vaccination is less costly and more effective than no vaccination. The incremental cost per QALY gained when vaccinating individuals aged 40–49 and 30–39 years is 28,135 PLN and 67,823 PLN, respectively. In the general population and in younger subpopulations the incremental cost-effectiveness ratio is most sensitive to the vaccine effectiveness, vaccine price, and SARS-CoV-2 infection rates. Conclusions When prioritization is required due to supply constraints, vaccination of the elderly is justified because it gives the highest number of QALY gained and generates savings for the health care system. Continual updates of the model concerning vaccine real-life effectiveness and epidemic course are required to refine the prioritisation scheme in the future.

Objectives Uniformed services such as police employees are exposed to acute and chronic stressful events at work that may lead to tobacco use. This study aimed to assess the prevalence of cigarette smoking, e-cigarette use and heated tobacco use among police employees in Poland, and to investigate personal characteristics associated with tobacco or e-cigarette use. Material and Methods This cross-sectional study was carried out in June–July 2020 on a randomly selected sample of 8789 police employees from the Mazowieckie Province, Poland. Results Completed questionnaires were obtained from 5082 police employees (79.2% being police officers) with an overall response rate of 57.8%. Smoking ≥100 cigarettes or similar amounts of other tobacco products was declared by 54.6% of the respondents, with significant differences (p < 0.001) between males (56.8%) and females (50.3%). Daily cigarette smoking was declared by 19.5% of the respondents, and 13.4% were occasional cigarette smokers. Daily e-cigarette use was declared by 3.1% of the respondents, and 3.2% were occasional e-cigarette users. Daily heated tobacco use was declared by 2.6% of the respondents, and 2.9% were occasional heated tobacco users. Higher odds of occasional cigarette smoking were observed among men compared to women (OR = 1.254, 95% CI: 1.009–1.558), and among the participants aged 20–29 years (OR = 7.982, 95% CI: 3.066–20.775) or 30–44 years (OR = 3.730, 95% CI: 1.44–9.599) vs. those aged ≥60 years. Higher odds of occasional e-cigarette use were observed among the participants aged 20–29 years (OR = 4.554, 95% CI: 1.213–17.101) vs. those aged 60 years. Police employees with office-based work had lower odds of daily cigarette smoking vs. those with fieldwork (OR = 0.726, 95% CI: 0.55–0.946). Police officers had higher odds of daily heated tobacco use compared to civil workers (OR = 3.362, 95% CI: 1.325–8.534). Conclusions The authors observed a marked proportion of police employees who declared occasional tobacco or e-cigarette use, which may indicate the common social smoking phenomenon in this occupational group. Int J Occup Med Environ Health. 2021;34(5):629–45

Coronavirus disease 2019 (COVID-19) was declared a pandemic and has spread around the globe, unsparingly affecting vulnerable populations. Effective prevention measures for pregnant women, who are particularly affected, include early identification of those patients at risk of developing in-hospital complications, and the continuous improvement of maternal-fetal treatment strategies to ensure the efficient use of health resources. The objective of our retrospective study was to determine which patient biomarkers on hospital admission correlate with disease severity as measured by disease course classification, the need for oxygen supplementation and higher demand for oxygen, the need for mechanical ventilation, intensive care unit admission, and length of hospital stay. Analysis of 52 PCR SARS-CoV-2 positive pregnant women revealed that the median date of hospital admission was the 30th gestational week, with dyspnoea, cough, and fever as the leading symptoms. The presence of diabetes and hypertension predisposed pregnant women to the severe course of illness. Lung involvement shown by CT scans on admission correlated with the greater clinical severity. The main laboratory predictors of disease progression were lymphocytopenia, hypocalcemia, low total cholesterol, low total protein levels, and high serum levels of C-reactive protein, ferritin, interleukin-6, glucose, lactate dehydrogenase, procalcitonin, and troponin I. Further research with a larger cohort of pregnant women is needed to determine the utility of these results for everyday practice.

Objective: This study aimed to investigate the efficacy and safety of convalescent plasma (CP) transfusion in a group of high-risk COVID-19 patients. Methods: This prospective study included 204 patients from a single tertiary-care hospital, hospitalized with COVID-19, of whom 102 were treated with CP administration and standard care (PG) and 102 others who received standard care only (CG). The CG was selected from 336 hospitalized patients using the propensity-score matching (PSM) technique using age, MEWS score, and comorbidities. The primary outcome was mortality rate; secondary outcomes were the requirement of a ventilator, length of ventilator need, length of intensive care unit (ICU) stay, and length of overall hospital confinement. Additionally, parameters predicting death in COVID-19 patients were identified. Results: Findings confirmed a significantly lower mortality rate in the PG versus the CG (13.7% vs. 34.3 %, p = 0.001) and a significant difference in the cumulative incidence of death between the two groups (p

Several COVID-19 convalescents suffer from the post-acute COVID-syndrome (PACS)/long COVID, with symptoms that include fatigue, dyspnea, pulmonary fibrosis, cognitive dysfunctions or even stroke. Given the scale of the worldwide infections, the long-term recovery and the integrative health-care in the nearest future, it is critical to understand the cellular and molecular mechanisms as well as possible predictors of the longitudinal post-COVID-19 responses in convalescent individuals. The immune system and T cell alterations are proposed as drivers of post-acute COVID syndrome. However, despite the number of studies on COVID-19, many of them addressed only the severe convalescents or the short-term responses. Here, we performed longitudinal studies of mild, moderate and severe COVID-19-convalescent patients, at two time points (3 and 6 months from the infection), to assess the dynamics of T cells immune landscape, integrated with patients-reported symptoms. We show that alterations among T cell subsets exhibit different, severity- and time-dependent dynamics, that in severe convalescents result in a polarization towards an exhausted/senescent state of CD4+ and CD8+ T cells and perturbances in CD4+ Tregs. In particular, CD8+ T cells exhibit a high proportion of CD57+ terminal effector cells, together with significant decrease of naïve cell population, augmented granzyme B and IFN-γ production and unresolved inflammation 6 months after infection. Mild convalescents showed increased naïve, and decreased central memory and effector memory CD4+ Treg subsets. Patients from all severity groups can be predisposed to the long COVID symptoms, and fatigue and cognitive dysfunctions are not necessarily related to exhausted/senescent state and T cell dysfunctions, as well as unresolved inflammation that was found only in severe convalescents. In conclusion, the post-COVID-19 functional remodeling of T cells could be seen as a two-step process, leading to distinct convalescent immune states at 6 months after infection. Our data imply that attenuation of the functional polarization together with blocking granzyme B and IFN-γ in CD8+ cells might influence post-COVID alterations in severe convalescents. However, either the search for long COVID predictors or any treatment to prevent PACS and further complications is mandatory in all patients with SARS-CoV-2 infection, and not only in those suffering from severe COVID-19.

Introduction Delivery is a physiological process stimulating the adaptation of the newborn to new conditions of life outside the mother’s body The moment of the baby’s birth and cutting the umbilical cord means the newborn’s violent transition from the uterine environment to the external world, which requires the dynamic process of adaptation connected with numerous physiological states of transient character. The degree of the intensification of the transient states may still be different and cause deviations from the norm, or even transition into pathological states constituting the cause of a prolonged stay in hospital, invasive examinations and longterm treatment. Objectives The aim of the study was a comparative analysis of the intensification of the chosen transient states in the newborns born naturally, and those born through Caesarean section. Material and methods In August-September 2018, 148 women and 148 newborns were qualified to the study. The exclusion criteria were mother’s chronic diseases diagnosed before the pregnancy, delivery before the 37th week, negative blood group of the mother, and the newborn’s Apgar result below 10 points. Results The newborns born naturally were more frequently fed only naturally (N- 55; 67.9%), in comparison to those born through caesarean section (30; 44.7%). The body weight loss expressed in % in relation to the birth body weight in the group SN reached 5.45%, while in group CC – 6.26% (p=0.01275). Conclusions The newborns born naturally were more often fed naturally than those born through caesarean section. The physiological weight loss in the first days was greater in newborns born via caesarean section than those born naturally

Introduction The article describes the process of converting a large multi-specialized hospital into one dedicated to COVID-19 patients, and present established standards of work organization in all the wards and training system of the medical and supporting staff. The several weeks pandemic of the COVID-19 disease has forced the healthcare systems of numerous countries to adjust their resources to the care of the growing number of COVID-19 patients. Managers were presented with the challenge of protecting the healthcare workers from transmission of the disease within medical institutions, and issues concerning the physical and psychological depletion of personnel. Material and methods Based on analyses of the structure and work processes in Central Clinical Hospital (CCH) reconstructive strategic plan was developed. It included: division of existing wards into observation and isolation wards; installing locks; weekly plan for supplying personal protection equipment (PPE); designating new access to the hospital and communication routes; training of medical and supporting staff. The plan was implemented from the first days of conversion of the hospital. Results The wards of the CCH were converted for observation and isolation, and each one was fitted with sanitary locks. There was a big improvement in the supply of PPE for the medical staff. Separation of the ‘dirty’ and ‘clean’ parts of the CCH were attained, and widespread intensive training not only protected personnel against infections, but also diminished unrest which was discernable at the beginning of conversion. Conclusions The transformation efforts will ultimately be appraised at the end of the epidemic, but the data looks encouraging. Two weeks after conversion, the testing of hospital Staff was started and by the end of April, 459 tests were had been conducted, of which only 11 were positive.

Introduction End-stage renal disease (ESRD) is an important complication of diabetes, which is the leading cause of ESRD worldwide The aim of the study was a comparative analysis of all-cause mortality in patients with ESRD with diagnosed diabetes mellitus (DM) and no diagnosed DM. Material and methods Data for the analysis were obtained from the resources of the Polish National Health Fund, and they concerned patients with end-stage renal disease from the entire population of Polish patients in the period from 01.01.2011 to 31.12.2013. In addition, the period from 01.01.2012 to 31.12.2012 was analysed for two subpopulations: diabetic and non-diabetic patients. Results The all-cause mortality in patients with end-stage renal disease in Poland per 100,000 representatives of the general population was 17.7, 15.9, and 12.50 persons in 2011, 2012, and 2013, respectively. The all-cause mortality rates for patients with ESRD and diabetes in Poland in 2012 were more than 15 times higher, for both men and women, than the all-cause mortality rates for non-diabetic patients with ESRD. Mortality in the study group of diabetic men with ESRD amounted to 147.59 ±29.07/100,000 men, whereas in the study group of diabetic women with ESRD it was 105.13 ±26.77/100,000 women. Regarding non-diabetic men with ESRD and non-diabetic women with ESRD, mortality amounted to 9.58 ±6.29/100,000 and 6.87 ±2.27/100,000 men and women, respectively. Conclusions The occurrence of diabetes in patients with ESRD significantly increases the risk of death compared to patients with ESRD without diabetes.

Introduction High amputation of the lower limb not only causes immense physical disability but also the destruction of the patient’s mental state, and helps to shorten life of patients with diabetes. The incidence of amputations in diabetic patients is 10 times higher in comparison to non-diabetic subjects (2.8% vs. 0.29%). The purpose of the study is an analysis of the geographic variability of major non-traumatic lower limb amputation in diabetic and non-diabetic patients in Poland. Material and methods All major non-traumatic lower limb amputations performed for the first time, in particular databetween 1 January 2013 – 31 December 2013, and between 1 January 2014 – December 2014, were identified in the National Health Fund (NHF) database. In the presented study, the patients were grouped in relevant provincial departments of the NHF according to their place of residence, and not according to the hospital where lower limb amputation was performed. Results In 2013 in Poland, 4,727 major non-traumatic lower limb amputation were performed in diabetic patients, and 4,350 in 2014. On the other hand, in non-diabetic patients, 3,469 major non-traumatic lower limb amputations were performed in 2013, and 3149 in 2014. The mean number indicator of major non-traumatic lower limb amputations in diabetic patients in Poland, compared to the average indicator of amputations in patients without diagnosed diabetes in Poland was 19.9-fold in 2013 and 19.4-fold higher in 2014. Conclusions In populations of diabetic patients and individuals without diagnosed diabetes major non-traumatic lower limb amputations are performed over 19-fold more frequently.

Introduction Multiple myeloma is the third most common blood cancer in Europe and accounts for approx. 10–15% of these cancers. The objective of this study was to determine the incidence, prevalence, mortality and survival in multiple myeloma (ICD code: C90.0) patients in Poland in the years 2008–2017. Material and methods The analysis used the data on healthcare services provided to patients with multiple myeloma defined with the ICD-10 (International Statistical Classification of Diseases and Related Health Problems) code C90.0 and reported by healthcare entities to the National Health Fund (NFZ). Results In 2009, the C90.0 incidence per 100,000 inhabitants was 6.4, while in 2017 it was 8.3. The prevalence in the same period increased by 76%, from 13.6/100,000 to 23.9/100,000. The mortality to prevalence ratio gradually decreased from 78% in 2008 to 22.8% in 2017. The 1-year, 3-year and 5-year survival rates in patients with this diagnosis made in the years 2009 and 2013 were 70.5%, 51.5% and 40.2% versus 78.4%, 60.3% and 48.3%, respectively. Conclusions The incidence and prevalence of multiple myeloma and survival rates in Poland were continuously increasing in the studied period. These trends may result from the aging of Polish society, better recognisability of multiple myeloma and/or improved access to increasingly more effective therapies in Poland. The impact of these factors on the epidemiology of multiple myeloma requires further studies.

Introduction Many epidemiological studies show a correlation between the risk of cancer and type 2 diabetes mellitus in various populations. Material and methods The material was obtained from the database of the National Health Fund. This publication presents a comparison of the incidence of new malignancies in rural and urban populations of diabetic patients in Poland based on the database of the National Health Fund for the period between 1.05.2008 and 30.09.2014. Results Comparison of the mean incidence of selected malignancies in diabetic patients in the population analysed indicated significant differences between the incidence rate in the urban and rural populations (p < 0.001). The mean incidence of gastric cancer, colorectal cancer, kidney cancer, brain tumours and leukaemia in both sexes was significantly higher in rural areas compared to urban. The mean incidence of oesophageal cancer and pancreatic cancer in females was significantly higher among in the urban population compared to the rural areas (p 0.05). Conclusions The incidence of gastric cancer, colorectal cancer, laryngeal cancer, lung cancer, testicular cancer, kidney cancer, lung cancer, lymphocytic leukaemia and myeloid leukaemia is higher in diabetic males in rural areas than the incidence in the urban population. The incidence of the malignancies liver cancer, malignant skin melanoma, malignant skin, prostate cancer, urinary bladder cancer and multiple myeloma in male diabetic patients living in urban areas is higher than the incidence in rural areas.

The aim of this study was to compare the estimated blood loss and the frequency of obstetric hemorrhage among pregnant women with and without COVID-19 infection. The study was carried out in the Department of Obstetrics and Gynecology, at the Central Clinical Hospital of the Ministry of the Interior and Administration in Warsaw, Poland. From 15 May 2020 to 26 April 2021, a total of 224 parturients with COVID-19 infection were admitted for labor. The control group consisted of 300 randomly recruited pre-pandemic deliveries that took place between 15 May 2019 and 26 April 2020 at the Department. The primary outcome was the presence of postpartum hemorrhage, defined as an estimated blood loss of ≥500 mL within 24 h after birth or the need to transfuse 2 or more units of packed red blood cells (pRBCs). Secondary outcomes were the difference between hemoglobin and hematocrit levels at 24 h postpartum, the number of pRBCs units transfused, and the need for transperitoneal drainage. After applying the propensity-score-matching procedure for postpartum bleeding risk factors, 325 eligible patients were included in the final analysis, divided into 203 COVID-19 positive and 122 COVID-19 negative prepandemic deliveries. SARS-CoV-2 infected patients were characterized by a longer activated partial thromboplastin time (APTT), a reduced prothrombin time (PT), and lower platelet count at initial presentation. COVID-19 deliveries were found to be associated with a higher frequency of postpartum hemorrhage, an increased estimated blood loss, the more frequent use of peritoneal drainage, and more pRBCs units transfused. During the pandemic, an increased risk of postpartum hemorrhage posed another threat to SARS-CoV-2 infected pregnant women. It is essential to be aware of this when approaching COVID-19 delivery and to implement efficient preventative methods.

Despite development of radiologic imaging, detection and follow-up of neuroendocrine neoplasms (NENs) still pose a diagnostic challenge, due to the heterogeneity of NEN, their relatively long-term growth, and small size of primary tumor. A set of information obtained by using different radiological imaging tools simplifies a choice of the most appropriate treatment method. Moreover, radiological imaging plays an important role in the assessment of metastatic lesions, especially in the liver, as well as, tumor response to treatment. This article reviews the current, broadly in use imaging modalities which are applied to the diagnosis of GEP-NETs, (the most common type of NENs) and put emphasis on the strengths and limitations of each modality.

Background: Most respiratory viruses show pronounced seasonality, but for SARS-CoV-2, this still needs to be documented.Methods: We examined the disease progression of COVID-19 in 6,914 patients admitted to hospitals in Europe and China. In addition, we evaluated progress of disease symptoms in 37,187 individuals reporting symptoms into the COVID Symptom Study application.Findings: Meta-analysis of the mortality risk in seven European hospitals estimated odds ratios per 1-day increase in the admission date to be 0.981 (0.973–0.988, p < 0.001) and per increase in ambient temperature of 1°C to be 0.854 (0.773–0.944, p = 0.007). Statistically significant decreases of comparable magnitude in median hospital stay, probability of transfer to the intensive care unit, and need for mechanical ventilation were also observed in most, but not all hospitals. The analysis of individually reported symptoms of 37,187 individuals in the UK also showed the decrease in symptom duration and disease severity with time.Interpretation: Severity of COVID-19 in Europe decreased significantly between March and May and the seasonality of COVID-19 is the most likely explanation.

Background. Diabetic foot is one of the leading causes of patient disability worldwide. Lower-extremity amputations (LEAs) resulting from this disease massively decrease quality of life, the function of the patient, and incur significant healthcare costs. The aim of this study was to assess trends in the number of amputations, the diagnosis at discharge, and diagnosis-related mortality after LEA procedures in a nationwide population. Methods. Datasets of the National Heath Fund containing information about all services within the public healthcare system in Poland, spanning the years 2010-2019, were analyzed. The source of data regarding mortality was the database of the Polish Ministry of Digital Affairs. Results. Between 2010 and 2019, the annual number of amputations in patients with diabetes increased significantly from 5,049 to 7,759 (p for trend

Introduction The aim of the study was to estimate the overall survival of patients with EGFR mutation-positive non-small-cell lung cancer treated with erlotinib, gefitinib or afatinib. Material and methods Real-world patients who received afatinib, erlotinib or gefitinib between 1 July 2012 and 30 October 2017 were analysed in five subgroups. Results Among 267 patients treated with afatinib financed as the first line of treatment, 76 (28.46%) deaths occurred. Median observation time was 12.8 months (95% CI: 11.2–13.9). Median OS was 22.8 months (95% CI: 19.2–27.1). Among 83 patients who received erlotinib financed exclusively as the second line of treatment the number of deaths was 74 (89.16%). Median observation time was 64.3 months (95% CI: 60.4–64.6). Median OS was 16 months (95% CI: 13.2–22.9). Among 622 patients who received erlotinib financed both as first and second line treatment, there were 400 (64.3%) deaths. Median observation time was 33.3 months (95% CI: 31.2–37.6). Median OS was 17.8 months (95% CI: 16.4–19.7). Among 137 patients who received gefitinib financed only as the first line of treatment, there were 128 (93.4%) deaths. Median observation time was 58.3 months (95% CI: 49.4–62.5). Median OS was 16 months (95% CI: 13.8–19.7). Among 348 patients who received gefitinib financed both as the first and second line of treatment the number of deaths was 208 (59.8%). Median observation time was 23.7 months (95% CI: 20.7–28.7). Median OS was 15.5 months (95% CI: 12.9–17.5). Conclusions Our real-world data regarding OS confirm the benefits found in clinical trials from the use of afatinib, erlotinib or gefitinib. However, the lower overall survival rate of Polish patients compared to similar studies from other research centres suggests the need for deeper investigation of this issue.

Human papillomavirus (HPV) infection is a risk factor for head and neck cancers (HNC). HPV-related head and neck cancers are preventable through vaccination. This study aimed to assess the attitudes towards HPV vaccination among adults in Poland, with particular emphasis on preventing HPV-related HNC, as well as identifying factors associated with a willingness to vaccinate children against HPV. This cross-sectional survey was carried out in November 2021 on a nationwide, representative sample of 1082 adults in Poland. The computer-assisted web interview (CAWI) technique was used. Only 42.5% of respondents were aware that HPV infection is a sexually transmitted disease. Less than one fourth of respondents (23.8%) indicated vaccination as an HPV infection prevention method and 51.9% of respondents correctly indicated HPV vaccine-eligible populations. Only 48.1% of respondents declared positive attitudes towards HPV vaccinations and declared that they would vaccinate their child against HPV. Males (OR: 1.43, 95% CI: 1.11–1.85; p < 0.01), respondents who did not have children (OR: 1.50, 95% CI: 1.04–2.14; p < 0.05), as well as those who had received a higher education (OR: 1.43, 95% CI: 1.11–1.85; p < 0.01), had greater odds of indicating positive attitudes towards HPV vaccinations. This study revealed a low level of public awareness of HPV vaccination as a cancer prevention method in Poland.

Introduction Several studies have suggested, that diabetes is very important factor of the risk of the chronic a renal disease. The paper aims to present a retrospective analysis of incidence of end-stage renal disease in subgroups of patients with and without diabetes in Poland. Material and methods For assessing this problem an electronic search was performed using Polish National Health Fund data base from 01.01.2011 until 31.12.2013 in general population and from 01.01.2012 until 31.12.2012 in 2 populations: with diabetes and without diabetes mellitus. Results The 43.70 % patients with end-stage renal disease was diabetic. The incidence rate in 2012 was: 292.48 ± 90.97 diabetic men / 100,000 diabetic population; 203.10 ± 90.97 diabetic women / 100,000 diabetic population; 23.44 ± 6.34 non-diabetic men / 100,000 non-diabetic population; 17.88 ± 6.33 non-diabetic women / 100,000 non-diabetic population. Conclusions The incidence rate of end-stage renal failure in diabetics was multiple times higher than the incidence rate in non-diabetics. The incidence rate of new ESRD cases in Poland estimated to be 36.17 per 100,000 of general populations in 2011, 35.28% in 2012 and 30.46 per 100,000 of general populations in 2013. In 2012, the incidence rate of new ESRD cases in male diabetics was 292.48 ± 90.97 per 100,000 of diabetes men population, and in women diabetics 203.10 ± 66.06 per 100,000 of diabetes women population. In the same 2012 year, the incidence of new ESRD cases in men non-diabetics was 3.44 ± 6.34 per 100,000 of non-diabetes, and in women non-diabetes 17.58 ± 6.33 per 100,000 of non-diabetes women population.

Introduction Phenol and 1-hydroxypyrene are biological markers of exposure to polycyclic aromatic hydrocarbons (PAH) that have certain negative effects on parenchymal organs such as the human placenta. The literature presents only few reports regarding the effects of elevated PAH levels on the functions of the human placenta. Objective The aim of the work is to assess the effects of elevated PAH levels in excreted urine on the endocrine and metabolic functions of the human placenta obtained from a normal pregnancy. Material and Methods Tissue material from 50 afterbirths from Płock constituted a study group, whereas 50 afterbirths from Kutno constituted a control group. Immunohistochemical reactions with the peroxidase method using LSAB kits (DAKO, Denmark) were performed. The extent and intensity of reactions were analysed. The levels of phenols and 1-hydroxypyrene in the excreted urine of pregnant women (undergoing delivery) were detected using gas chromatography and colorimetry. The statistical analysis used the PQStat v.1.6.2 software; moreover, t-student and chi-square tests were used. Differences were considered to be significant at the significance level of 95% (p

Introduction Systemic sclerosis (SSc) is a rare and potentially severe connective tissue disease, characterized by skin fibrosis and involvement of internal organs. Because of its rarity and heterogeneous clinical presentation, reliable epidemiological studies on SSc have been particularly difficult to carry out. Objectives The purpose of this study was to present SSc epidemiology among hospitalized patients in Poland. Material and Methods The analysis was based on population-based administrative data, taken from a Polish hospital morbidity study carried out by the National Institute of Public Health between January 2008 – December 2012. Results Analyzed data covered 9,049 hospitalization records. The final sample comprised 3,653 patients with first-time hospitalizations for SSc. The average age of the sample was 53 years (SD 16.2; range 0–91 years); 84% of patients were female and 16% male. Based on hospitalization registers, the average SSc incidence was estimated to be 1.9/100,000 per year and peak age of incidence was 55 years. The point prevalence was estimated to be 9.4/100,000 at the end of 2012. SSc was more common in females, with F:M ratio ranging from 6.2:1–4.6:1 depending on the year. Analysis of hospitalization trends revealed that overall numbers of SSc hospitalizations increased, while first-time hospitalizations decreased between 2008–2012. Clusters of higher incidence were observed in more rural regions vs. urban regions. Conclusions Estimated incidence of SSc in Poland was comparable to reported incidence in other European countries. Analysis of demographic factors and reports of clusters of higher incidence may suggest the existence of environmental risk factors for the development of SSc. These observations may require further research

In SARS-CoV-2 patients with severe acute respiratory distress syndrome (ARDS), Veno-Venous Extracorporeal Membrane Oxygenation (V-V ECMO) was shown to provide valuable treatment with reasonable survival in large multi-centre investigations. However, in some patients, conversion to modified ECMO support forms may be needed. In this single-centre retrospective registry, all consecutive patients receiving V-V ECMO between 1 March 2020 to 1 May 2021 were included and analysed. The patient cohort was divided into two groups: those who remained on V-V ECMO and those who required conversion to other modalities. Seventy-eight patients were included, with fourteen cases (18%) requiring conversions to veno-arterial (V-A) or hybrid ECMO. The reasons for the ECMO mode configuration change were inadequate drainage (35.7%), inadequate perfusion (14.3%), myocardial infarction (7.1%), hypovolemic shock (14.3%), cardiogenic shock (14.3%) and septic shock (7.1%). In multivariable analysis, the use of dobutamine (p = 0.007) and a shorter ICU duration (p = 0.047) predicted the conversion. The 30-day mortality was higher in converted patients (log-rank p = 0.029). Overall, only 19 patients (24.4%) survived to discharge or lung transplantation. Adverse events were more common after conversion and included renal, cardiovascular and ECMO-circuit complications. Conversion itself was not associated with mortality in the multivariable analysis. In conclusion, as many as 18% of patients undergoing V-V ECMO for COVID-19 ARDS may require conversion to advanced ECMO support.

Inhibitors of 3-hydroxy-3methylgultaryl-coenzyme A reductase (statins) are one of the main groups of drugs used in preventing and treating cardiovascular diseases worldwide. They are widely available, cheap, and well-tolerated. Based on statins’ pleiotropic properties, including improvement of endothelial dysfunction, antioxidant properties, atherosclerotic plaque stabilization, and inhibition of inflammatory responses, it can be hypothesized that the use of statins, at least as an adjuvant in antiviral therapy, may be justified. All these effects might be especially beneficial in patients with COVID-19, suffering from endothelial dysfunction, microvascular and macrovascular thrombosis, and cytokine storm. Here, we review the recent data regarding the pathophysiology of SARS-CoV-2 activity in host cells, proposed COVID-19 therapy, the pleiotropic activity of statins, and statins in clinical trials in respiratory infections. According to the guidelines of the European and American Cardiac Societies, in patients with cardiovascular disease or high cardiovascular risk with concomitant COVID-19 it is recommended to continue statin treatment. However, the initiation of statin therapy de novo in COVID-19 treatment should only be done as part of a clinical trial.

Cannabis is the most popular illicit drug on the European market. Over 16 million young Europeans have used it at least once in the last few years. The recent trends in the consumption of marihuana differ between countries. Some countries face an increase in the prevalence of cannabis use, including Poland, where the level cannabis use has been systematically increasing since the 1990’s. According to a recent ESPAD study, 19% of Polish adolescents aged 15–16 have used cannabis in the last year. Marihuana is also a leading substance when analyzing the data of seizures and crimes. The recent EMCDDA Annual report on the drug situation in Europe notes the increasing potency in cannabis available on the market. Some countries face an increasing number of emergencies caused by marihuana, which was unlikely to have happened previously. In almost all European countries there is an ongoing discussion about loosening marijuana laws or its complete legalization. There is also ongoing discussion on the use of marihuana in therapy as a medicine. Many scientific studies are being conducted in this field. Some of the results are promising; however, there is no well-designed human trial which would unequivocally confirm that medical cannabis is effective as a medicine, or more effective than other medicines on the market. The problem is that the debate on the medical use of marihuana becomes more ideological and less professional. The medical use of marihuana is strongly supported by organizations lobbying for the legalization of cannabis use. Research on the medical use of cannabis should be continued, as there are some promising results supporting therapy in different medical conditions. However, the use of cannabis as a medicine should be discussed only among professionals. If marihuana is to be used for medical purposes, the fact that it is the most popular illicit drug in Europe is irrelevant.

Poland in the 1980s was a country with the highest incidence of smoking tobacco products in Europe – 42%, therefore it became necessary to take urgent and effective measures to reduce the undoubtedly harmful to health smoking of tobacco products among millions of Poles. These actions over the past 20 years have brought huge success, as witnessed by a significant decline in smoking in Poland to 24% in 2015. One of the important factors affecting the incidence of smoking among men and women all age groups, including children and youths, was the law of 1997 on protection of health against the consequences of tobacco use and tobacco products (Journal of Laws, Item 298, 2015), introducing, among others, a total ban on tobacco advertising. The development of this Act was a milestone for Polish smoke- free policies. Another very important success was the amendment of the said Act, which took place in April 2010. This introduced a number of smoking bans, among others, in hospitals and other medical entities, organizational units within the education system, indoor plants work in means of public passenger transport, public transport stops, playgrounds and premises for catering-entertainment (outside the designated, separate places). With this solution, since 2010 Poland has significantly decreased exposure to tobacco smoke in public places. The largest — more than twice — the decrease in exposure was observed in the premises for catering-entertainment (from 36% to 14%).

to investigate the drug-class-specific changes in the volume and cost of antidiabetic medications in Poland in 2012-2015.This retrospective analysis was conducted based on the National Health Fund database covering an entire Polish population. The volume of antidiabetic medications is reported according to ATC/DDD methodology, costs-in current international dollars, based on purchasing power parity.During a 4-year observational period the number of patients, consumption of antidiabetic drugs and costs increased by 17%, 21% and 20%, respectively. Biguanides are the basic diabetes medication with a 39% market share. The insulin market is still dominated by human insulins, new antidiabetics (incretins, thiazolidinediones) are practically absent. Insulins had the largest share in diabetes medications expenditures (67% in 2015). The increase in antidiabetic medications costs over the analysed period of time was mainly caused by the increased use of insulin analogues.The observed tendencies correspond to the evidence-based HTA recommendations. The reimbursement status, the ratio of cost to clinical outcomes and data on the long-term safety have a deciding impact on how a drug is used.