Hospital In Krakow Research Articles

Impact of Kidney Function on Physiological Assessment of Coronary Circulation.

Diagnosing myocardial ischemia in chronic kidney disease (CKD) patients is crucial since coronary artery disease (CAD) forms the predominant cause of mortality in these patients. Thus, this study aimed to assess the impact of kidney function on the results of coronary circulation physiological assessment. Data were collected from 279 consecutive patients admitted to the Clinical Department of Cardiology and Cardiovascular Interventions at the University Hospital in Krakow. A total of 417 vessels were assessed for fractional flow reserve (FFR) and non-hyperemic resting pressure ratios, such as instantaneous wave-free ratio (iFR) and resting full-cycle ratio (RFR). Patients were categorized into two groups: glomerular filtration rate (GFR)-L (estimated GFR (eGFR) <70 mL/min/1.73 m2) and GFR-H (eGFR ≥70 mL/min/1.73 m2). A total of 118 patients (42.3%) were included in the GFR-L group, while 161 patients (57.7%) were in the GFR-H group. The left anterior descending branch of the left coronary artery (LAD) was the assessed vessel in approximately 60% of procedures, the frequency of which was very similar in both study groups. Focusing solely on LAD assessments, both FFR metrics (continuous and binary) were comparable between the groups. In contrast, for non-LAD vessels, the GFR-H group revealed substantially reduced FFR values, with more vessels displaying significant constriction. Patients in the GFR-H group showed higher instances of FFR+ iFR/RFR- discrepancies than their lower eGFR counterparts. An eGFR of 70 mL/min/1.73 m2 was the optimal cut-off to differentiate patients concerning the mentioned discrepancies. Kidney function influenced the coronary circulation physiological assessment results. Patients with reduced eGFR tended to have negative hyperemic assessments, especially in non-LAD vessels.

Increased incidence of myxedema coma during the COVID-19 pandemic and in the post pandemic era: a single-center case series.

The COVID-19 pandemic was a major challenge for all health care employees, but it was also difficult for patients to gain access to health care services. Myxedema coma (MC) is an extremely rare but potentially fatal endocrine emergency. The aim of the study was to report an increased incidence of life-threatening myxedema coma that occurred in relation to the COVID-19 pandemic. In this paper, we report a cohort of 11 patients with MC who were treated at the University Hospital in Krakow, Poland, in the period from 2015 to 2023. Only 1 case of MC was recorded in the period from 2015 to 2019, and, in the same area, 10 cases of MC were recorded after the start of COVID-19 pandemic until present. Hypothyroidism was diagnosed de novo in 2 (18%) patients; the remaining patients were severely hypothyroid due to therapy non-compliance. Nine patients had primary hypothyroidism, and 2 had central hypothyroidism. Besides longstanding hypothyroidism, an additional precipitating factor for MC was identified in 4 (36%) of the patients. Due to the inaccessibility of parenteral levothyroxine, patients were treated with oral, mostly liquid, form of levothyroxine. The mortality rate in this cohort was 27.2%. In conclusion, the increase of the incidence of MC, which is a life-threatening complication of inadequately treated hypothyroidism, during the COVID-19 pandemic, when resources were limited, and in the post-pandemic era, underlines the importance of adequate communication with patients and of long-term availability of primary care for patients with thyroid disease.

Resilience as a protective factor in the development of post-traumatic stress disorder in patients hospitalised for COVID-19

Introduction and objective: Both the illness itself and hospitalisation due to COVID-19 are potentially traumatic experiences, especially when the course of the disease is severe. Resilience has been identified as a crucial factor in the process of successfully coping with traumatic events and may protect against the development of symptoms of post-traumatic stress disorder. The aim of this study was to determine the role of resilience in the prevention of post-traumatic stress disorder symptoms in patients requiring hospitalisation due to COVID-19. Materials and methods: A total of 138 patients (59 women, 79 men; mean age: 52.34 years; standard deviation, SD = 12.46) hospitalised at the University Hospital in Krakow were included in the study, which was conducted 7–8 months after their COVID-19 diagnosis. The PTSD Checklist for DSM-5 (PCL-5) and the Resilience Measurement Scale (SPP-25) were administered, and stepwise multiple regression analysis was used in the predictive models. Results: A total of 31 participants (22.5%) met the criteria for probable post-traumatic stress disorder symptoms. The study participants were characterised by a moderate level of resilience (5th sten), with women exhibiting lower levels than men. Higher levels of resilience were associated with lower severity of PTSD symptoms. A significant predictor of post-traumatic stress disorder symptoms was “Tolerance for failure and treating life as a challenge”. Conclusions: Resilience has an impact on the severity of symptoms of post-traumatic stress disorder. Specifically, the dimension of “Tolerance” within resilience appears to be an important protective factor against post-traumatic stress disorder symptoms after hospitalisation for COVID-19. Patients hospitalised with severe course of COVID-19 exhibit a moderate level of resilience, with men demonstrating higher resilience levels than women.

Use of antibiotics in the early COVID-19 pandemic in Poland, the Netherlands and Spain, from erraticism to (more) logic

IntroductionIn the Spring of 2020, the world was hit with unparalleled impact by the coronavirus pandemic. Antibiotics were widely used, even without good rationale. The aim of our study was to compare the use of antibiotics in patients with confirmed COVID-19 from three hospitals across Europe (Poland, the Netherlands and Spain) between two subsequent periods in the early days of the pandemic.MethodWe analysed data (antibiotics used and variation in the use of antibiotics, patients, admission and disease-related characteristics) from 300 patients admitted in three hospitals (University Hospital in Cracow, University Medical Center in Utrecht and Vall d’Hebron University Hospital in Barcelona) with confirmed infection of SARS-CoV-2 during Q1 2020 and Q4 2020.ResultsThere was ample variation in terms of patient mix and outcomes across the 3 hospitals. The majority of patients (225 out of 300) in all 3 hospitals received at least 1 antibiotic during the hospitalisation period. A minority of patients (68 out of 300) had their bacterial test results positive during their hospitalisation period. Throughout the 2 study periods, third-generation cephalosporins (ceftriaxone in 170 out of 300 patients) emerged as the most commonly used class of antibiotics. There was an apparent shift towards more rational utilisation of antibiotics, in all three hospitals.ConclusionsOur study shows that during the early stage of COVID-19 pandemic in 2020, antibiotics were frequently used in three European teaching hospitals despite the relatively low incidence of microbiologically confirmed bacterial infections. While in the early days of the COVID-19 pandemic antibiotic prescribing was full of trial and error, we could also confirm a learning curve over time.

Is Antimicrobial Stewardship Policy Effectively Implemented in Polish Hospitals? Results from Antibiotic Consumption Surveillance before and during the COVID-19 Pandemic.

The COVID-19 pandemic posed numerous challenges to public health systems, particularly in antimicrobial stewardship. This study aimed to assess antibiotic consumption before and during the COVID-19 pandemic to evaluate the effectiveness of the implemented antimicrobial stewardship program. This retrospective study was carried out at the University Hospital in Krakow, Poland, between 1 January 2019 and 31 December 2020. A total of 80,639 patients were enrolled. Antibiotic usage was measured as the percentage of patients receiving antibiotics and the number of days of therapy (DOTs). The World Health Organization (WHO) methodology and Anatomical Therapeutic Chemical (ATC) codes and AWaRe classification were utilized. The analyzed ATC antibiotic groups included penicillins (J01CA, J01CE, J01CF, J01CR, excluding piperacillin/tazobactam), piperacillin with tazobactam-beta-lactamase inhibitor (J01CR05), third- and fourth-generation cephalosporins (J01DD, J01DE), carbapenems (J01DH), macrolides (J01FA), fluoroquinolones (J01M), colistin (J01XB01), metronidazole (J01XD01) and others (J01DF, J01DI, J01E, J01G, J01XA, J01A). In the AWaRe classification, Access, Watch and Reserve groups of antibiotics were included. In 2020, 79.2% of COVID-19 patients and 40.1% of non-COVID-19 patients were treated with antibiotics, compared to 28.8% in 2019. Also, in 2020, the antibiotic consumption in non-ICU COVID-19 patients was twice as high as in non-COVID-19 patients: 50.9 vs. 38.5 DOTs/100 patient days (pds). Conversely, in the ICU, antibiotic consumption in COVID-19 patients was 112.1 DOTs/100 pds compared to 248.9 DOTs/100 pds in non-COVID-19 patients. Significant increases were observed in the usage of third- and fourth-generation cephalosporins in 2020. The analysis according to the AWaRe system revealed the highest usage of the Watch group-ranging from 61.9% to 78.7%-and very high usage of the Reserve group-from 5.8% to 11.1%-in non COVID-19 and COVID-19 patients, respectively. Our findings highlight substantial issues with antibiotic use both before and during the COVID-19 pandemic. The results underscore the urgent need for improved antimicrobial stewardship policy implementation.

HGG-36. ASSESSMENT OF CHROMOSOMAL ABERRATIONS IN DIFFUSE ASTROCYTOMAS OF CHILDHOOD USING THE ARRAY COMPARATIVE GENOMIC HYBRIDIZATION (ACGH+SNP) TECHNIQUE – PRELIMINARY STUDY

Abstract BACKGROUND Comprehensive knowledge of the genomic changes underlying cancer is a key basis for diagnosis, prognosis and targeted therapies. With recent advances, the technique of comparative genomic hybridization (aCGH+SNP) facilitates genome-wide screening for genome copy number changes and rapid examination of numerical and structural chromosomal changes, as well as loss of heterozygosity at high resolution down to several tens of kilobases. METHODS The study included 12 patients aged 6 months to 15 years, operated on at the Department of Pediatric Neurosurgery in Krakow due to paediatric-type diffuse gliomas (according to WHO classification 5th Ed). Tumor tissue samples were collected from all included participants as remnants of routine examination. Pangenomic profiling of diffuse astrocytomas was performed with using SurePrint G3 Cancer CGH+SNP Kit 4x180K (Agilent, Santa Clara USA) at the Molecular Genetics Laboratory of the University Children’s Hospital in Krakow. Genomic DNA was extracted automatically from deep-frozen tumor tissue. Descriptive statistics were used to describe the basic characteristics of the data included in the study due to the small number of participants. RESULTS Of the 12 tumors examined by microarray, 5 patients had abnormalities in the form of diffuse high grade gliomas. In 1 patient, only numerical changes in chromosomes were observed, in 1 case only structural chromosomal abnormalities were detected. Combined numerical and structural aberrations were presented in 3 samples. Additionally, we detected 1 case of triploidy and 1 case of loss of heterozygosity. CONCLUSIONS Significant changes were observed in paediatric-type diffuse high-grade gliomas. Interestingly, we detected new undescribed alterations that were not only of a chromosomal nature, but also concerned individual genes. This may constitute the basis for further research aimed at establishing new diagnostic and prognostic markers, as well as effective therapy. A limitation of this study is the small patient sample, and further research is recommended.

Changes in temperament, character and intensity of empathy in adolescents treated in a day care unit - pilot study.

The aim of this pilot study was to compare the level of empathy, temperament and character traits before and after 6 months of treatment in a group of patients staying in a psychiatric day care unit in groups with different (internalising vs. externalising) disorder types. The study was conducted in a group of 44 patients (33 girls and 11 boys), aged 15-20, treated between 2016 and 2021 in the Clinical Day Care Unit of the Department of Adult, Child and Adolescent Psychiatry of the University Hospital in Krakow. 40% of the adolescents had externalising disorders and 60% had internalising disorders. The Davis Empathy Scale and the Cohen Empathy Scale were used in the study, as well as the Cloninger' Temperament and Character Inventory (TCI). Six months of treatment in a day care unit resulted in statistically significant changes in the "Fantasy" scale from the Davis Empathy Scale, in the "Reward dependence", "Self-directedness" and "Self-transcendence" subscales on the Temperament and Character Inventory in the group of adolescents with internalising disorders. In the group of adolescents with externalising disorders, there were changes at the level of statistical trend in the values of the "Fantasy" scale and the "Harm Avoidance" scale of the Temperament and Character Inventory. The obtained results are in line with the available data in terms of differences in temperament and character profiles between types of mental disorders and constellations of traits that are unfavourable for mental health, such as low self-directedness, harm avoidance and reward dependence.

Taste assessment as a part of geriatric nutritional care: Potential implications for clinical practice

IntroductionAging is related to decrease in taste perception. As appetite is considered crucial for maintenance of proper nutritional status of older adults, its decrease during aging raises questions about its relation to gustatory functions and further prevention possibilities. Aim of the studyThe aim was to assess the characteristics and eating behaviors of the patients who reported a self-perceived reduction in taste perception in the context of appetite. Material and methodsThis semi-qualitative study was conducted between November 2021 and March 2022 in the Department of Internal Medicine and Geriatrics of the University Hospital in Krakow. Patients were assessed using an original appetite assessment scale, which allowed for an in-depth interview on areas related to the decline in gustatory function. Additionally, nutritional assessment was performed using Mini Nutritional Assessment and Council on Nutrition Appetite Questionnaire (CNAQ) and anthropometric measurements. ResultsThe most common characteristics of patients with gustatory dysfunction were early satiety, decreased appetite in the three months prior to the study and polypharmacy. A significant difference was observed in the CNAQ scores between the group of patients with and without gustatory dysfunction. ConclusionCareful identification of patients presenting with gustatory dysfunction can provide an important cue for an individualised approach aimed at preventing malnutrition. In our work, we suggest the areas that can be addressed during a nutritional interview to enable the selection of an optimal approach.

Tight versus less tight 1-hour postprandial glycemic target in women with gestational diabetes mellitus - a single-center cohort study.

We aimed to assess the impact of the change of 1-hour postprandial glycemic target from < 6.7 mmol/L (120 mg/dL) to < 7.8 mmol/L (140 mg/dL) on gestational diabetes mellitus (GDM) treatment and pregnancy outcomes. In a retrospective analysis of 1021 GDM patients from the Department of Metabolic Diseases, University Hospital in Cracow, Poland, we compared insulin therapy regimens and pregnancy outcomes between women admitted in 2014-2016 (before the change) and in 2018-2019 (after it). A total of 377 patients were admitted between 2014 and 2016 (TIGHT group) and 644 between 2018 and 2019 (LESS TIGHT group). Women from the LESS TIGHT group were older (32 vs 30 years, p < 0.001) and gained less weight during pregnancy (7.0 vs 9.0 kg, p < 0.001). There was no change in the frequency of any insulin therapy (51.6% vs 56.1%, p = 0.168). In the LESS TIGHT group, the basal insulin-only model was used more frequently (32.5% vs 10.2%, p < 0.001), while the prandial insulin and basal-bolus model less frequently (23.6% vs 42.6% and 21.4% vs 36.7%, p < 0.001, respectively) than in the TIGHT group. There were no differences in the frequency of cesarean sections, preterm births, Hbd of delivery, mean birth weight or prevalence of perinatal complications. Less tight glycemic targets in women with GDM, compared to tighter targets, were associated with less frequent use of prandial insulin, with insulin therapy often limited to basal administration. The change in glycemic targets did not affect the prevalence of adverse pregnancy outcomes, providing evidence supporting new recommendations.

„Nie daję łajbie żadnych szans”. Depresja: choroba czy rozczarowanie?

The subject of depression, often driven by personal experience, has lately become very prominent in the public sphere. Olga Hund's Psy ras drobnych [Dogs of Smaller Breeds] (2018) is a novel about depression, though unlike many European films and novels, it does not blame the condition on the individual – the main character of the story. Her book is memoir of sorts, a series of dramatic scenes from a mental ward of the Kobierzyn Psychiatric Hospital in Cracow. The whole is written, we may assume, to provoke out-rage: it is an accusation of the health care system, yet the blame for the mental condition rather than the wrong therapy, is put squarely on the structures and socio-economic mechanisms of the neoliberal society. The book makes two points. First, the psychiatric hospital by its very nature is a total institution that’s totally indispensable; and second – as seen from the interface of the ‘normal’ people and the mental patients – the social, economic and ideological factors have a significant role in generating suffering and the mental illness itself.

Why do patients refuse hospital meals? Reflections on the nutritionDay Audit at the University Hospital in Krakow.

I n t r o d u c t i o n: Despite increased awareness of malnutrition and improved nutrition-related policies, there are still cases of deterioration of nutritional status during hospitalisation. NutritionDay is an audit organised by the European Society for Clinical Nutrition and Metabolism (ESPEN), the Medical University of Vienna and the Friedrich-Alexander University Erlangen-Nürnberg (FAU) to prevent the onset of malnutrition and to improve hospital policies to deal with this problem. The aim of the study was to analyse the results of the audit with regard to factors that may contribute to the deterioration of a patients' nutritional status in hospital setting. Materials and Methods: This cross-sectional study was performed in a tertiary teaching hospital and was part of an international audit. The questionnaires used were provided by the nutritionDay office, and included information on weight loss, patients' appetite, dietary restrictions, food intake and reasons for food rejection during hospital stay. R e s u l t s: Of the examined patients, 61% reported weight loss prior to the current hospital stay. We identified 25 patients who did not consume a whole portion of their main meal on the day the audit took place. Approximately 17% of the patients' complaints could be resolved within a hospital ward. C o n c l u s i o n s: Hospital patients often eat less than a standard meal portion. Identifying the reasons for meal rejection may be helpful for development of standards for nutritional care in the hospitals.

Personality profiles of candidate patients for surgical treatment of obesity in the context of recommendations for psychological interventions in the pre- and post-operative periods

BackgroundThe aim of the study was to investigate and identify similarities and differences in the severity of personality traits of candi-date patients for surgical treatment of obesity in the context of developing psychological recommendations in the pre- and post-operative period.Participants and procedureThe study included 101 patients (74 females, 27 males) aged between 22 and 64 (M = 40.46, SD = 9.25) undergoing evalua-tion for surgical treatment of obesity at the University Hospital in Krakow. An examination of personality traits with the NEO Personality Inventory-Revised (NEO-PI-R) was conducted. The results presented here are an extract from an ongoing longitudinal study. The data were statistically processed using cluster analysis.ResultsThree clusters of personality traits were identified. The first cluster is characterised by low results in the factor Neuroticism and high results in the factors Extraversion, Openness to experience, Conscientiousness. The second cluster shows high val-ues in the Neuroticism factor and low values in the Extraversion and Conscientiousness factors. Third cluster is character-ised by low results in the factor Neuroticism and Extraversion, and high results in Openness to experience and Conscien-tiousness factors.ConclusionsThe three identified clusters of personality traits of bariatric patients indicate a diversity of patients in terms of personality trait profiles. Due to the characteristics of these profiles and the resulting functioning modes, the first profile has been called ‘action-focused’, the second profile ‘emotion-focused’ and the third profile ‘avoidance-focused’. The results justify the need for an individualised approach in the surgical treatment of obesity. The results presented are of clinical value to the psychologist’s practice in the context of developing treatment-relevant recommendations for psychological interventions in the pre- and postoperative periods. The specific nature of the profiles provides a foundation for recommending, based on the principles of sound clinical practice, psychological interventions conducive to positive treatment outcomes.

Incidence versus treatment outcomes and survival in patients before age 40 with colorectal cancer

&lt;b&gt;&lt;br&gt;Introduction:&lt;/b&gt; Colorectal cancer (CRC) was the third most common cancer and the second cause of cancer deaths worldwide in 2020. Its incidence has increased dramatically in people under 50 years of age (early-onset colorectal cancer; EOCRC).&lt;/br&gt; &lt;b&gt;&lt;br&gt;Aim:&lt;/b&gt; The aim of this study was to compare two age groups of patients with colorectal cancer in terms of stage, prognostic factors, survival and incidence of recurrence.&lt;/br&gt; &lt;b&gt;&lt;br&gt;Materials and methods:&lt;/b&gt; The study group consisted of 588 patients operated on between 1995 and 2005 at the University Hospital in Krakow in the Clinical Department of General, Oncological and Gastroenterological Surgery. A method of retrospective documentation analysis was used. Patients were divided into two age groups: up to forty years of age and between 45 and 65 years of age.&lt;/br&gt; &lt;b&gt;&lt;br&gt;Results:&lt;/b&gt; Up to 40 years of age, stage IV colorectal cancer was diagnosed in 33.3% of patients, while between 45 and 65 years of age, it was diagnosed in 26.1%. Five-year survival differed according to tumour stage. In the two groups analysed, there was a significant difference between the survival curves (P = 0.00000). Also, comparing recurrence times in the paired group excluding cancer-independent deaths revealed a statistically significant difference between the groups (P = 0.006).&lt;/br&gt; &lt;b&gt;&lt;br&gt;Discussion:&lt;/b&gt; The incidence of colorectal cancer has increased worldwide in young people under 50 years of age, and it is therefore recommended that the research presented here be studied, and that prognostic factors be analysed and multicentre prophylactic studies combined with health education of those at risk be encouraged. Cancer occurring in younger patients is characterized by advanced stage at diagnosis and five-year survival is lower and has a poorer prognosis. The availability is very important of early diagnosis to detect pre-cancerous and considered pre-cancerous conditions is important. This involves detecting lesions at a lower stage of the disease.&lt;/br&gt; &lt;b&gt;&lt;br&gt;Conclusions:&lt;/b&gt; The availability of early diagnosis to detect precancerous and considered pre-cancerous conditions is very important. This involves detecting lesions at a lower stage of the disease. Diagnosing colorectal cancer at an early stage and treating the pre-cancerous lesions will improve treatment outcomes, resulting in fewer metastases and longer survival and recurrence times.&lt;/br&gt;

Side effects of treatment with tyrosine kinase inhibitors in patients with chronic myeloid leukemia and the occurrence of anxiety symptoms.

The study aims to check whether individual side effects of treatment with TKIs in patients suffering from CML may contribute to the occurrence of anxiety symptoms. In addition, it was decided to check whether there were any relationships between age, gender, duration of treatment, and the intensity of anxiety, divided by the occurrence of individual side effects. The study involved 91 patients and was conducted at the Hematology Clinic of the University Hospital in Krakow. The following questionnaires were used: created by the author, David Goldberg Questionnaire GHQ-28, and the four-dimensional 4DSQ Questionnaire. The most frequently mentioned side effects of treatment were bone and joint pain, muscle cramps and pain, water retention, and fatigue. The mean duration of the disease was ten years. Our research showed that fatigue, nausea/indigestion, frequent infections, bone and joint pain, abdominal pain, and loss of appetite were the most common side effects of TKI treatment, which resulted in increased anxiety symptoms. The work of doctors, psychologists, and pharmaceutical companies on reducing/alleviating side effects may in the future affect a better quality of life for these patients. Early detection of severe anxiety and taking appropriate steps can prevent the emergence of more significant disorders. In addition, several years of attempts to discontinue treatment with some TKIs (imatinib and nilotinib) in patients who achieve a profound molecular response may improve their mental condition.

Electrocardiography versus Echocardiography in Severe Aortic Stenosis with the Consideration of Coexistent Coronary Artery Disease.

(1) Background: Coexistent coronary artery disease (CAD) might influence the ability of electrocardiogram (ECG) to identify echocardiographic left ventricular hypertrophy (ECHO-LVH) in patients with aortic stenosis (AS). We aimed to assess the relation between ECG-LVH (by the Sokolov-Lyon or Cornell criteria) and ECHO-LVH considering coexistent CAD. (2) Methods: We retrospectively analyzed the medical records of 74 patients (36 males) with severe AS who were hospitalized in the University Hospital in Cracow from 2021 to 2022. (3) Results: ECHO-LVH was present in 49 (66%) patients, whereas 35 (47.3%) patients had ECG-LVH. There was no difference between the rate of ECG-LVH in patients with vs. without ECHO-LVH. Single-vessel and multi-vessel CAD were diagnosed by invasive coronary angiography in 18% and 11% of patients, respectively. The sensitivity of the classical ECG-LVH criteria with regard to ECHO-LVH was low, reaching at best 41% for the Sokolov-Lyon and Cornell criteria. The results were similar and lacked a pattern when considering patients without significant stenosis, with single- and multi-vessel disease separately. Correlations between the left ventricular mass index and ECG-derived parameters were weak and present solely for the Lewis index (r = 0.31), R wave's amplitude >1.1 mV in aVL (r = 0.36), as well as the Cornell (r = 0.32) and Sokolov-Lyon (r = 0.31) voltage criteria (p < 0.01). The presence, location of stenoses, and CAD extent were not associated with the presence of either ECHO-LVH or ECG-LVH, irrespective of individual ECG-LVH criteria. (4) Conclusions: The sensitivity of classical ECG criteria for echocardiographic LVH in severe AS is low, regardless of coexistent CAD or its angiographic extent.

Delirium is not dementia: Delirium Awareness Day-related event at the University Hospital in Krakow.

To present the two-day Delirium Awareness Day-related event held at the University Hospital, Kraków, Poland. Activities included a lecture, a multimedia presentation, meetings with healthcare workers at their respective wards, and distribution of information posters about delirium. Local news outlets were also engaged. We reached out to approximately 300 persons in the hospital itself and several thousand via TV and radio broadcasts. We prompted interdisciplinary discussions about delirium, especially concerning preventive measures. The most common questions were how to alleviate symptoms as soon as possible, with the expectation of straightforward solutions for the non-geriatrician staff. Patient distress and burden on caregivers were important topics brought-up in the discussions. We demonstrated that our educational initiative was feasible and well-accepted among medical staff. Local media helped in building public understanding of delirium. Education about the syndrome should be one of the key societal tasks of geriatricians.

Maternal Vaccination in Pregnancy: An Assessment of Influenza, Pertussis, and COVID-19 Vaccination Rates in Cracow, Poland.

BACKGROUND Maternal vaccination during pregnancy reduces the risk of severe course and complications from infections both for the mother and her child. As information regarding immunization status of pregnant women with recommended vaccines in Poland is scarce, this questionnaire-based study aimed to identify influenza, pertussis (whooping cough), and COVID-19 vaccination in 205 pregnant women in Cracow, Poland, between February and April 2023. Another objective was to assess whether any of the maternal factors might influence women's decision to inoculate during pregnancy. MATERIAL AND METHODS An anonymous and self-reported questionnaire developed specifically for this study was disseminated among postpartum women, who gave birth and were hospitalized at the Department of Obstetrics and Perinatology of the University Hospital in Cracow, Poland, between February and April 2023. Study participants were asked about their basic sociodemographic and obstetric data, as well as their immunization status regarding influenza, pertussis, and COVID-19 during their most recent pregnancy. RESULTS Only 12.2% and 23.4% of study participants received influenza and pertussis vaccinations, respectively, during pregnancy, while 61.5% of pregnant women reported vaccination with at least 2 doses of the mRNA COVID-19 vaccine. Features including type of occupation, place of residence, gravidity, and parity were statistically significant (P.

Risk factors of acute kidney injury during hospitalization in acute ischaemic stroke patients undergoing mechanical thrombectomy.

Acute kidney injury (AKI) seems to worsen the prognosis of acute ischaemic stroke (AIS) patients treated with mechanical thrombectomy (MT). At the same time, the procedure of MT increases AKI risk by iodinated contrast use. Identification of factors predisposing to AKI after MT is important for recognizing vulnerable patients and successful prevention. To identify factors associated with the occurrence of AKI during hospitalization in MT-treated AIS patients. The study included all AIS patients treated with MT in the University Hospital in Krakow from 2019 to 2021. The diagnosis of AKI during hospitalisation was based on serum creatinine concentration levels, according to the Kidney Disease Improving Global Outcomes guidelines. We compared patients with and without AKI in terms of age, sex, comorbidities, stroke course and laboratory test results at admission. We identified factors associated with the occurrence of AKI using univariate logistic regression analysis, with significant variables subsequently added to the multivariate analyses. Among 593 MT-treated AIS patients the incidence of AKI during hospitalisation was 12.6%. AKI development was associated with diabetes, chronic kidney disease, total volume of iodinated contrast obtained during hospitalisation, posterior circulation stroke, lack of intravenous thrombolysis, and laboratory test results at admission: haemoglobin, glucose, urea, potassium, and creatinine. Total contrast volume and urea level were the most important independent risk factors associated with occurrence of AKI. AKI is common in MT-treated AIS patients. There is a need to establish a protocol for decreasing the risk of AKI in AIS patients undergoing MT and, in case it occurs, a procedure for its treatment.

Szpital psychiatryczny – poza granicami miasta i wyobraźni

The research, conducted at the Dr. J. Babinski Clinical Hospital in Krakow - Kobierzyn, investigates how the psychiatric hospital is perceived by city residents. In this paper, the research question is which borders were spotted by the participants. The way of talking about them, creating meanings, was analyzed. The research process consisted of a questionnaire and a walk through the hospital's green area, visiting an exhibition and a group interview, as well as a separate session which included the mapping of the respondents' feelings on the hospital's plan. The implementation of qualitative and action methods served to explore issues familiar from sociological research on social distance toward people with mental illness. Another innovation was to invite the participants to the public park space of the psychiatric hospital and conduct most of the research there. This influenced the way they talked about boundaries and domesticating space. The statements by the participants described the boundaries between the city and the hospital, the frontiers and the borderlands of the hospital as such, the problem of the indistinguishability of the boundary between the hospital and other places and between the sick and the healthy, the internal boundaries of the hospital and the boundary of the disease. These boundaries were both tangible and intangible. Even physical barriers were given metaphorical meaning. The most difficult to overcome were the limits of imagination and illness, according to the respondents. Overcoming the physical boundaries, i.e., visiting the park and the hospital complex, and the exhibition about the process of illness and recovery, in their opinion, resulted in taming the space of the psychiatric hospital.

The Impact of Age on the Physiological Assessment of Borderline Coronary Stenoses.

Background and Objectives: Coronary angiography is the gold standard for diagnosing coronary artery disease (CAD). In the case of borderline changes, patients require further diagnosis through ischemia assessment via one of the recommended methods of invasive evaluation. This study aimed to assess whether clinical factors influence the risk of a positive result in invasive myocardial ischemia assessment and if these potential factors change with the patient's age and the consistency of ischemia assessment. Materials and Methods: Data were collected retrospectively on all consecutive patients hospitalized in the University Hospital in Krakow between 2020 and 2021, on whom physiological assessments of coronary circulation were performed. Patients were divided into two groups: patients aged 60 or younger and patients older than 60. Results: Despite the older patients having more risk factors for CAD, their physiological assessment results of borderline lesions were similar to those of the younger patients. Positive fractional flow reserve (FFR) assessments were obtained from almost 50% of vessels. In the younger patients, cigarette use and type 2 diabetes mellitus increased the risk of a positive FFR result by 3.5 and 2.5 times, respectively. In the older patients, male gender and peripheral vascular disease significantly increased the risk of a positive FFR by 2.5 and 2 times, respectively. Conclusions: Clinical characteristics of patients undergoing physiological assessment of borderline coronary stenosis varied significantly by age. Refining the definition of borderline lesions to include age, gender, and other factors may improve the identification of patients who would benefit from physiological assessment and coronary revascularization.