Hospital In Krakow Research Articles

Social work education in the light of the evaluation of the "Axiological Walk in Kobierzyn"

In the education of social workers, it is particularly important to seek working methods that provide to experience values which define the foundations of professional action. The authors of the article approve the personalistic philosophy as a theoretical basis of educational work, the practice of which is based on the cooperation of academic staff and students, striving for partnership, open dialogue and experiencing personal subjectivity. Nevertheless, the essence of the issue is to search for the content of education, which refers not only to contemporary social issues, but also to their historical conditions and correlates. The context for the article is a reflection on the history of 20th century eugenics, with particular emphasis on the extermination of nearly a quarter of a million people with mental illness and disabilities performed by the German Nazi. It is difficult, without studying the times in which the history derailed, to fully understand the social responsibility of people who are particularly vulnerable and exposed to social non-recognition and damage. The curriculum of social workers’ education at the Institute of Sociology of the Jagiellonian University in Krakow has included the space of the Clinical Hospital in Krakow's Kobierzyn, where, in cooperation with the Institute of Therapy and Social Education - the Association, an educational project under the name of Axiological Walk in Kobierzyn is being implemented. The article is based on reflection on axiological education in the light of evaluation of the aforementioned project.

Comparability of estimated and determined LDL cholesterol in hospitalized children

Introduction: The concentration of LDL cholesterol (LDLC) is the main parameter used in the stratification of risk and the management of atherosclerosis. Aim of study: The aim of this study was to compare the LDLC concentration calculated by the Friedewald (LDLCF ), the Cordova (LDLCC) and the Planelli (LDLCP ) formulas with the LDLC concentration measured by direct metod (LDLCD) with regard to age and sample matrix. Material and Methods: 594 serum samples were collected from children (1 day to 18 years) hospitalized in University Children’s Hospital in Krakow. Concentrations of hemoglobin A1c and/or creatinine were determined. In all serum samples total cholesterol, triglycerides, high-density lipoprotein cholesterol, apolipoprotein B and LDLCD were measured. In addition, the LDLC concentration was estimated. Results: The means of the LDLCF and LDLCC concentrations were significantly lower compared to the mean of the LDLCD in all samples and in samples from children ≥1 years of age (in all cases p<0,0001). Bland-Altman analys is showed, that the values LDLCC were not comparable to the values of LDLCD in samples from all children and regardless of the LDLCD concentration. In samples with HbA1c≥6,0% mean values of differences between estimated LDLC and LDLCD were higher than in samples with HbA1c<6,0%, regardless of the used formula. The mean values of differences between estimated LDLC and LDLCD in samples with creatinine concentrations <74,0 µmol/l and ≥74,0 µmol/l differed significantly regardless of the used formula (in all cases p<0,001). Conclusion: The differences between concentration of determined and estimated LDLC depend on composition of sample matrix and formula which is used in calculations.

The relationship between pre-pregnancy BMI, gestational weight gain and neonatal birth weight: a retrospective cohort study.

Maternal pre-pregnancy body mass index (BMI) and gestational weight gain (GWG) have a meaningful impact on pregnancy and perinatal outcomes. The first aim of the study was to analyze the association between pre-pregnancy BMI and the prevalence of small for gestational age (SGA) and large for gestational age (LGA) outcomes. The second aim was to assess the relation- ship between pre-pregnancy BMI combined with gestational weight gain (GWG) and the prevalence of SGA and LGA measurements. The retrospective cohort study was conducted at Jagiellonian University Hospital in Cracow, Po- land from 2016 to 2017. During this time there were 2,123 deliveries. Patients with chronic diseases, multiple pregnancies, fetal defects and incomplete data were excluded. Finally, 474 cases were enrolled. Patients were divided into BMI groups (underweight, normal, overweight and obese) and into GWG groups (inadequate, adequate, excessive). Relationships between maternal BMI, GWG and newborn weight were examined. There was no statistically significant association between maternal pre-pregnancy BMI and prevalence of SGA measurements. However, underweight women with inadequate GWG showed a higher risk to bear SGA babies (OR 5.2, 95% CI 1.57-17.18). Obese women with adequate GWG had higher risk of bearing LGA newborns (OR 5.48, 95% CI 1.15-26.13). High BMI correlated with excessive GWG (overweight: OR 3.0, 95% CI 1.84-3.87; obese OR 2.45, 95% CI 1.1-5.48). There is a considerable risk of giving birth to a SGA newborn for underweight women with inadequate GWG. There is a statistically significant association between maternal obesity and LGA outcomes. Our study shows that redefining the risks of abnormal neonatal weight considering both pre-pregnancy BMI and gestational weight gain can be useful in providing effective prevention during pregnancy.

ROLA HORTITERAPII I BUKIECIARSTWA W LECZENIU DZIECI I DOROSŁYCH

Hortiterapia i bukieciarstwo skierowane są do wszystkich grupy pacjentów: dzieci, osób starszych, osób z zaburzeniami psychofizycznymi i umysłowymi, ludzi z dysfunkcjami fizycznymi i sensorycznymi, a także osób uzależnionych od narkotyków, alkoholu itp. Hortiterapia może odbywać się w ogrodach przy szpitalach, domach opieki społecznej, domach spokojnej starości, ośrodkach dla osób uzależnionych, a także w terapeutycznych gospodarstwach o profilu rolnym i ogrodniczym. Celem pracy jest przedstawienie wyników licznych badań nad pozytywnym oddziaływaniem roślin na człowieka oraz opisanie przykładów zastosowania ogrodu jako elementu pomocniczego w rehabilitacji. Od lat 30. XX w. wspomniana forma terapii alternatywnej popularna jest w Stanach Zjednoczonych, Australii, Kanadzie, Japonii, Wielkiej Brytanii, Niemczech, Holandii, Belgii i krajach skandynawskich. W Polsce pionierem w stosowaniu ogrodu, jako środka wspomagającego leczenie jest Szpital im. św. Ludwika w Krakowie. Kolor, kształt, zapach, faktura roślin i obiektów małej architektury, dźwięk wody w fontannie, szum wiatru, śpiew ptaków oraz rozmowa z innymi osobami przebywającymi w ogrodzie stymulują narządy zmysłów i uatrakcyjniają rehabilitację. Dotykanie roślin, wdychanie pięknego zapachu oraz wykonywanie czynności ogrodniczych prowadzi do redukcji napięcia psychicznego i stresu. Poprzez wzmocnienie siły mięśni, poprawę koordynacji, równowagi i wytrzymałości fizycznej terapia ogrodowa wspomaga rehabilitację zdrowotną.

Bronchiolitis in children ‒ do we choose wisely?

AimThe aim of our study was to evaluate the adherence to the 2014 American Academy of Pediatrics guidelines for bronchiolitis.Material and methodsThe study measured the utility of diagnostic and therapeutic procedures in children with the first episode of bronchiolitis in their lives hospitalized at the University Children’s Hospital in Krakow, Poland, between September 2014 and March 2015. The results were compared with the achievable benchmarks of care (ABCs) for hospitalized children with bronchiolitis. Hospital performance was measured by five clinical indicators: chest X-ray utilization, viral testing implementation, steroids, antibiotics and bronchodilator prescriptions. Odds ratios (OR) with 95% confidence intervals (95%CI) were calculated for comparisons between hospital performance and ABCs.Results There were 214 children in the study group (56% were boys). Chest X-ray was performed in 95% of the children, while ABCs indicate 32.4% (OR=42; 95%CI [30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58]); viral testing in 67.9% children, whereas ABCs indicate 0.6% (OR=350; 95%CI [155-790]). Steroids were prescribed in 62% of the patients (ABCs=6.4%; OR=24; 95 %CI [18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31]), similarly antibiotics in 62% (ABCs=18.5%; OR=20; 95 %CI [1525]), bronchodilators were administered in 86% patients (ABCs=18.9%; OR=27; 95%CI [21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34]). All the analyzed procedures were used dozens of times more often than suggested by ABCs (the difference is highly statistically significant) ConclusionsOveruse of ineffective procedures and therapies in bronchiolitis remains common, with overuse of chest X-rays, viral testing, prescriptions of bronchodilators, corticosteroids and antibiotics. We should focus our efforts on strategies aimed at decreasing the procedures that have no benefit for children with bronchiolitis.

Clinical profile of patients with systemic autoimmune diseases treated in the intensive care unit who developed diffuse alveolar haemorrhage - an observational retrospective cohort study.

Patients with autoimmune diseases constitute arelatively low percentage of the intensive care unit (ICU) population but their prognosis is particularly poor, partially due to involvement of multiple organs as well as complications related to immunosuppressive treatment. Diffuse alveolar haemorrhage (DAH) is one of the most life-threatening presentations of autoimmune diseases, associated with worse outcomes. The aim of this study is to report about clinical factors associated with DAH in the ICU setting and to assess the survival in 5-year follow-up. This is an observational, retrospective, cohort study performed in the ICU of the University Hospital in Krakow, Poland. We enrolled 21 patients treated for the first time in the ICU due to autoimmune diseases, who developed DAH. Severity of patients' clinical condition was assessed on the first day using APACHE II, APACHE III, SAPS II and SOFA scores. Mortality was assessed during the ICU stay and in 5-year follow-up. The median age of the study population was 53 (18-78) years and 13 (61.9%) of patients were females. The most common diagnoses were granulomatosis with polyangiitis (38.1%), systemic lupus erythematosus (23.8%) and microscopic polyangiitis (14.3%). Most of the patients required mechanical ventilation (85.7%), renal replacement therapy (57.1%) and blood product transfusions (71.4%). Mortality in the ICU was 52.4%, while in both 1-year and 5-year follow-up it was 76.2%. Patients who develop DAH in the course of autoimmune diseases and are treated in the ICU have apoor prognosis and often require advanced therapeutic measures.

Prognostic value of inflammatory markers in acute coronary syndrome in a population with premature cardiovascular disease (RCD code: VIII)

Introduction: Inflammation plays a significant role in the development of atherosclerosis, and inflammatory markers could be used in risk assessment of patients with ischaemic heart disease. The use of such markers could be beneficial in younger patients, since in this group, prevention is more effective than treatment of myocardial infarctions, as long‐term prognoses are often unfavourable. Aim: Our goal was to examine the value of inflammatory biomarkers as an assessment tool for cardiovascular risk in a population with a premature ischaemic heart disease. Materials and Methods: We analysed laboratory test results of 100 consecutive patients hospitalized in the John Paul II Hospital in Krakow, Poland between 2014–2017. Inclusion criteria was cardiovascular disease diagnosed in coronarography under the age of 55 years for women and 45 years for men. We excluded patients with incomplete data and acute infections. The remaining 90 patients were divided into groups based on the reason of admission (myocardial infarction or elective diagnostics). Results: White blood cell count (median of 6.990 × 10 3 per/μl in comparison to 8.535 × 10 3 /μl) and absolute neutrophil count (median of 4060 × 10 3 /μl and 5360 × 10 3 /μl ) were lower in the group admitted for diagnostics. Although inflammatory biomarkers (platelet distribution width, white blood cells) were within normal ranges, we observed higher values (above the medians for studied population) in the group admitted to hospital due to acute coronary syndrome. Conclusion: Inflammatory biomarkers could be useful in the assessment of cardiovascular risk in patients with a premature ischaemic heart disease. Since the measured values of the inflammatory biomarkers were within normal range in the examined population, further studies should be conducted to determine appropriate cut‐off values. JRCD 2019; 4 (2): 37–41.

Comparison of health locus of control in oncological and non-oncological patients.

Aim of the studyThe aim of the study was to investigate whether there are differences in the various dimensions of the health locus of control between oncological and non-oncological patients and to determine whether there is a relationship between the level of health locus of control and the type, duration of disease and gender.Material and methodsThe study was conducted at the Department of Hematology and the 1st Department of Cardiology of the University Hospital in Krakow. 204 patients were enrolled. Our own questionnaire developed for this purpose and the Multidimensional Health Locus of Control scale were used. The US normalization group and the Polish standardization groups of the chronically ill patients were used for comparative analysis.ResultsAnalysis showed significant differences between women and men in the Internal control scale (p < 0.02). The respondents from both groups showed lower scores in the Internal locus of control and much higher scores in the dimension Powerful Others. In the group of oncological patients, a negative correlation was found between the Internal scale of health locus of control and the duration of the disease (p = 0.007). There was a significant difference between oncological and non-oncological patients in the Powerful Others scale (p < 0.004).ConclusionsThe results suggest that oncologically ill patients could be more convinced that others are responsible for their health when compared to non-oncological patients. The longer the disease persists in oncological patients, the weaker is their internal motivation to achieve good treatment results.

Acral melanocytic nevi in the Polish population: prevalence, clinical characteristics and dermoscopic patterns.

IntroductionAcral melanocytic nevi dermoscopic patterns have been well described in several populations. There have been no prospective studies assessing the prevalence, clinical characteristics and dermoscopic patterns of acral nevi in the Polish population.AimTo characterize the prevalence of acral nevi, frequency of dermoscopic patterns, relationships between acral nevi and patients’ characteristics.Material and methodsThis was a prospective study conducted in the Dermatological Outpatient Clinic of the University Hospital in Krakow. Study inclusion criteria: presence of nevi on foot soles and/or palms, Caucasian race, Polish origin, and age ≥ 18 years.ResultsSix hundred and twenty-four acral melanocytic lesions were observed in 287 patients, 174 (60.6%) women and 113 (39.4%) men, mean age 43.5 and 42.8 years, respectively. Four hundred and thirty-four (69.6%) lesions were present on soles, 190 (30.4%) on palms. No acral melanomas were detected. The following dermoscopic patterns were observed: parallel furrow 262 (42%), lattice-like 106 (17%), fibrillar 66 (11%) and other 190 (30%). Patients with acral nevi on the soles or both on the palms and soles had a higher number of atypical nevi on the body (p = 0.011) and a much higher total body nevi count (p = 0.043), when compared to those with acral nevi only on the palms.ConclusionsThe study revealed a higher prevalence of acral nevi in the analysed population. A higher number of acral nevi was associated with a higher number of atypical nevi and higher total body nevi count, the risk factors for melanoma. Because of that it is possible to note that a higher number of acral nevi should increase diagnostic alertness.

Challenging iatrogenic menopause. Oncofertility programme in Poland - a single-centre experience.

IntroductionMenopause is defined as a 12-month period of time when menstruation permanently ceases. In some cases, menopause may be caused by external factors – for example gonadotoxic treatment that irreversibly damages ovarian tissue leading to loss of its hormonal and reproductive function. Oncofertility is a discipline that merges oncology and reproductive medicine, giving patients a chance to experience parenthood after gonadotoxic treatment is finished.Aim of the studyThe purpose of the study is to present the implementation and first outcomes of the Oncofertility Programme in the University Clinic of Endocrinological Gynaecology and Gynaecology, University Hospital in Krakow, Poland.Material and methodsPatients interested in fertility preservation have been consulted in the University Clinic of Endocrinological Gynaecology and Gynaecology in Krakow since April 2016. Preliminary qualification to one of the available methods (embryo cryopreservation, oocyte cryopreservation, ovarian tissue cryopreservation) was conducted. Patients declaring a wish to join the programme were then referred to one of the three infertility treatment centres cooperating with the University Clinic, in order to undergo the chosen procedure.ResultsDuring a period of 24 months, 18 patients were consulted. The youngest consulted patient was 20 years old, the oldest 39. Two years after the first consultation, a telephone survey among consulted patients was carried out to verify whether the patients finally underwent oncofertility procedures, and to ask about their reproductive status.ConclusionsThe problem of fertility issues being inadequately addressed results in low referral rates to oncofertility programmes. Attempts to raise awareness of oncofertility possibilities among oncologists should be undertaken because critically few patients are being referred to oncofertility centres.

Thyroid hormones as potential prognostic factors in sepsis.

Sepsis is a life-threatening organ dysfunction caused by a dysregulated host reaction to infection. There is an upward trend in sepsis prevalence and mortality worldwide. Sepsis causes hypoxia, which reduces the ability of cells to produce ATP. This process is also influenced by thyroid hormones. Some of the previous studies revealed association between the mortality rate in sepsis and thyroid hormone levels. We aimed to evaluate thyroid hormones' predictive value in septic patients. Forty-nine adult patients with sepsis admitted to the Intensive Care Unit of Allergy and Immunology Department at the University Hospital in Krakow, Poland, between 2015 and 2017 were enrolled in the study. Blood samples were obtained from septic patients immediately after establishing the diagnosis, in order to measure free triiodothyronine (fT3), free thyroxine (fT4), and thyroid-stimulating hormone (TSH) levels. The primary endpoint was 30-day survival rate. The secondary endpoint was death anytime during intensive care unit (ICU) stay. Patients who died within 30 days had significantly lower level of fT4 than survivors (9.8 vs. 12.7 pmol L<SUP>-1</SUP>; P = 0.033). There was no statistically significant difference between the groups in TSH and fT3 levels. As for the secondary endpoint, both fT3 (1.6 vs. 1.8 pmol L<SUP>-1</SUP>; P = 0.021) and fT4 (9.8 vs. 12.7 µIU mL<SUP>-1</SUP>; P = 0.019) levels were significantly lower among non-survivors compared to survivors, which was not the case for TSH. Thyroid hormone levels were significantly lower among patients who died during ICU stay. The results of the presented study suggest that fT3 and fT4 levels may be taken into consideration as potential new prognostic factors in sepsis.

Oral manifestations of granulomatosis with polyangiitis - Clinical and radiological assessment

Background/purposeGranulomatosis with polyangiitis (GPA) is a type of primary systemic vasculitis associated with the presence of anti-neutrophil cytoplasmic antibodies (ANCA). GPA mainly affects medium and small vessels and may manifest in different organs, most commonly upper respiratory tract. Oral lesions occur in 6–13% of GPA patients and might be the first symptom observed by the patient. This study presents the evaluation of orofacial manifestations of patients with GPA. Materials and methodsProspective study was conducted between June 2014 and November 2017 in Department of Allergy and Immunology at University Hospital in Krakow. Patients diagnosed with GPA, after medical assessment, were examined including precise dental inspection, bacterial and fungal flora of oral cavity evaluation and Cone Beam Computed Tomography (CBCT) imaging. ResultsNine patients were enrolled in the study. Characteristic for GPA strawberry gingivitis was observed in one patient. Bone destruction and inflammatory lesions in paranasal sinuses was confirmed by CBCT in 55.6% of patients. Fungal infection was revealed in 66.7% of patients. ConclusionThese findings oblige dentists to consult patient with laryngologist or internal medicine physician to establish further diagnostic approach, because early diagnosis of GPA is crucial for implementing appropriate treatment and preventing chronic organ damage.

Epidemiologic characteristics and clinical course of children with acute gastroenteritis hospitalized in the Department of Pediatric Infectious Diseases and Hepatology at John Paul II Hospital in Krakow

Acute gastroenteritis (AGE) is considered one of the most common reasons for hospitalization and the third leading cause of death related to infectious diseases in children. The incidence and prevalence of campylobacteriosis is lower in Poland than in other parts of the European Union. The aim of the study was to investigate the epidemiology and clinical features of AGE in hospitalized children. The study population comprised 462 consecutive patients with AGE, hospitalized in the Department of Pediatric Infectious Diseases and Hepatology at John Paul II Hospital in Krakow during 2016. After admission in the hospital, the patients’ stool samples were collected and tested for viral or bacterial pathogens. The specimens were analyzed using classical cultural methods and qualitative immunochromatographic assays for pathogens screening. The patients’ age, sex, etiological factor, seasonal distribution, hospital length of stay and symptoms of disease were collected retrospectively. The median age of AGE patients was 3.0 years [1.5-5.5]. Eighty percent of all AGE cases occurred in patients under 5 years of age (p<0.001). Rotavirus was the leading cause of AGE and Campylobacter was the most common bacterial pathogen (p=0.001, p=0.05 respectively). The average length of hospital stay was 3.1 ± 1.6 days. The longest hospitalization stays were related to patients with enteropathogenic Escherichia coli and Salmonella (p<0.001 for all). A seasonal pattern was observed for etiological factors of AGE (p<0.001). Fever, diarrhea and pathological stool contaminations occurred more frequently in patients with bacterial AGE (p<0.001 for all). This study showed that routine diagnosis of Campylobacter in all children with AGE is associated with a higher than reported prevalence of campylobacteriosis.

Patients with small-vessel vasculitides have the highest mortality among systemic autoimmune diseases patients treated in intensive care unit: A retrospective study with 5-year follow-up

PurposeSystemic autoimmune diseases are a heterogeneous group of disorders associated with dysfunction of multiple organs and unpredictable course. Complicated management and treatment become even more challenging when patients require critical care. This study aims to compare outcomes of small-vessel vasculitides (SVV) and other systemic autoimmune diseases (SAD) patients admitted to the intensive care unit (ICU). Materials and methodsRetrospective, observational study conducted in the ICU of Allergy and Immunology Department at the University Hospital in Krakow, Poland, between years 2001–2014, with 5-years follow-up and no lost to follow-up patients. Results74 patients with autoimmune diseases were enrolled in the study - 23 with SVV and 51 with SAD. Patients in the SVV group achieved higher scores in APACHE II and III SAPS II and SOFA at ICU admission. The SVV patients required renal replacement techniques, blood products transfusion and immunosuppressive treatment more often. SVV patients had higher ICU mortality (60.9% vs. 35.3%, p = .04), however after discharge from ICU, in long term follow-up (1 year and 5 years) mortality was similar in both studied groups. ConclusionsAmong systemic autoimmune diseases small vessel vasculitides appear to be associated with the highest ICU mortality, higher requirement for advanced procedures and aggressive immunosuppressive therapy.

Relaparotomy following cesarean section – a single center study

IntroductionRelaparotomy is a serious complication of caesarean section. The aim of this study was to investigate its risk factors and postoperative outcome. MethodsWe conducted a retrospective case-control study examining 48 reoperations between January 2013 and June 2017 at the Obstetrics and Perinatology Department, Jagiellonian University Hospital in Cracow, Poland. This is tertiary referral center, in that time 8421 cesarean section were performed. The control group was randomly matched from all CS in a 1 to 2 ratio. The following figures were analyzed: demographic obstetrics data, indication for cesarean section, perioperative data and laboratory results. Patients’ follow up data was evaluated. ResultsThe frequency of relaparotomy was 0.57%. There were no statistically significant differences in indications for primary surgery between the control group and the relaparotomy group. There were only two perioperative factors which increased the risk of relaparotomy: general anesthesia and the duration of operation. Laboratory results were in reference range in both groups, however, in the relaparotomy group, platelets were lower, while APTT and INR were prolonged. The main indication for relaparotomy was bleeding into the peritoneal cavity. Patients with relaparotomy more often required blood transfusion, admission to ICU, as well as longer hospitalization. ConclusionRecognition of risk factors of relaparotomy and proper diligence in hemostasis may decrease its rate.

Analiza zatruć u dzieci i młodzieży hospitalizowanych w Uniwersyteckim Szpitalu Dziecięcym w Krakowie w latach 2009–2012

Wprowadzenie. Zatrucia wśród dzieci i młodzieży, obok urazów i utonięć, są jedną z najczęstszych przyczyn zgonów, stąd stanowią aktualny problem pediatryczny oraz społeczny. Zatrucia, zarówno przypadkowe, jak i zamierzone, są jednym z głównych powodów hospitalizacji dzieci i młodzieży.Cel pracy. Celem pracy była analiza rodzaju i częstości występowania zatruć przypadkowych i zamierzonych w grupie dzieci i młodzieży leczonych w Uniwersyteckim Szpitalu Dziecięcym w Krakowie w latach 2009–2012.Materiał i metody. Badania miały charakter prospektywny. Wykorzystano w nich analizę dokumentacji medycznej, którą stanowiły historie chorób 1120 dzieci leczonych z powodu zatruć w Uniwersyteckim Szpitalu Dziecięcym w Krakowie.Wyniki. Badania wykazały, że zatrucia miały w większości charakter przypadkowy (61%) i dotyczyły głównie dzieci w wieku przedszkolnym. Substancjami toksycznymi były przede wszystkim leki, tlenek węgla oraz alkohol (22%), a drogą wchłaniania głównie przewód pokarmowy (74,6%). Do następstw zatruć rozpoznanych po przyjęciu do szpitala należały najczęściej utrata przytomności oraz urazy głowy (7,2%). Analiza danych wykazała zależność pomiędzy rodzajem zatruć i rodzajem substancji toksycznej a wiekiem, płcią i miejscem zamieszkania badanych (p < 0,0001).Wnioski. Zmniejszenie częstości występowania zatruć wymaga prowadzenia działań edukacyjnych, którymi powinni być objęci zarówno rodzice i opiekunowie, jak również dzieci i młodzież.

Comparison of the usefulness of selected formulas for GFR estimation in patients with diagnosed chronic kidney disease

Introduction: The diagnosis and classification of chronic kidney disease (CKD) are based on the glomerular filtration rate value. The simplest way to evaluate glomerular filtration rate is to estimate it based on serum creatinine concentration using one of many specific mathematical formulas. None of the formulas created for this purpose are perfect. Differences in eGFR values are frequently observed in specific stages of chronic kidney disease by KDIGO classification based on different formulas. Aim: The aim of the study is to compare the eGFR value in patients previously diagnosed with CKD treated in the Outpatient Nephrology Unit of the University Hospital in Krakow using the selected formulas. Material/Methods: The study was performed in a group of 882 patients (392 women, 490 men) aged 65.0 ± 14.8 years. GFR values were estimated using Bjornsson, the abbreviated MDRD, and CKD-EPI formulas. These values were then compared according to chronic kidney disease stage and age groups: above and below 60 years. Results: The mean eGFR value was for Bjornsson formula- 47.2 ± 21.1 ml/min/1.73m2, abbreviated MDRD formula- 38.8 ± 15.2 ml/min/1.73m2, and CKD-EPI formula- 37.7 ± 15.9 ml/min/1.73m2. There was a large concordance in eGFR values obtained using the CKD-EPI and abbreviated MDRD formulas in every stage of chronic kidney disease and in both age groups. The Bjornsson formula significantly increased the number of patients in early stages of CKD, G1 - 33 vs 2 (abbreviated MDRD) and 6 (CKD-EPI), G2- 186 vs 70 (abbreviated MDRD) and 69 (CKD-EPI). Conclusions: CKD-EPI and abbreviated MDRD formulas have a similar usefulness in GFR value estimation in patients with diagnosed chronic kidney disease. Lower eGFR values achieved using abbreviated MDRD formula and CKD-EPI equation in comparison with Bjornsson’s formula may result in an increased number of patients diagnosed with CKD.

The intensity of anxiety, neurotic symptoms and perceived control among patients with neurotic and personality disorders

Aim of the studyThe study aimed to determine the relationship between the intensity of anxiety, neurotic symptoms and perceived control using Bryant’s model - A Four-Factor Model of Perceived Control. The goal of the study was also to describe the structure of perceived control among patients with neurotic and personality disorders.Subject or material and methodsThe study included 49 patients with neurotic disorders, personality disorders or coexistence of neurotic and personality disorders from the Department of Psychotherapy University Hospital in Krakow. Used the following tools: the Symptom Checklist KO “O”, the Neurotic Personality Questionnaire KON-2006, the Polish adaptation of the State-Trait Anxiety Inventory STAI, the Bryant’s Questionnaire of Perceived Control.ResultsThe intensity of neurotic personality and anxiety-trait are significantly negatively associated with most indicators of perceived control.DiscussionIn the literature there are some findings showing association of perceived control with anxiety disorders, depressive disorders and even psychotic states. To date, Rotter’s one-dimensional Scale has been used in most studies (internal versus external Locus of Control). The conducted research enables researchers to broaden the perspective of the perceived control, adding cognitive control and emotional control over positive events as well as aversive one.ConclusionsMost of the various factors of perceived control are related to some extent to the personality structure, which is responsible for occurrence of neurotic disorders, and to some extent to anxiety-trait – an important predictor for neurotic disorders. The results presented are relevant to patients suffer from neurotic symptoms and diagnosed with neurotic disorders and personality disorders according to ICD-10 criteria.

Selected life quality variables of women treated surgically due to intertrochanteric femur fractures in the aspect of nursing and rehabilitation standards

Introduction: The aim of presented study was to evaluate selected quality of life indicators for women treated surgically due to intertrochanteric femur fractures in terms of implementation of physiotherapeutic and nursing standards. Clinical Hospital in Krakow (5WSK) within the period from January 2015 to December 2016. At that time, 145 women with intertrochanteric femur fracture were admitted to the hospital. The age of the patients ranged between 58 and 92 years, with an average of 83.6 years. The following questionnaires and score scales were used to assess the quality of life: Short Pfeiffer Mental Status Questionnaire (SPMSQ), Instrumental Activities of Daily Living (IADL) scale, SF-36 Quality of Life Questionnaire, Barthel scale, HOOS scale, Geriatric Depression Scale (GDS) by Yesavage, the author’s questionnaire on rehabilitation care problems related to urinary tract infections, bed sores, pneumonia, gastrointestinal disorders, gastrointestinal infections and thromboembolic complications as well as survival rate. Results and conclusions: 1. The quality of life of women operated because of intertrochanteric femoral fractures using an intramedullary Gamma nail had deteriorated in both short and long-term observation. 2. Maintenance and individualization of nursing standards and rehabilitation in women treated surgically due to intertrochanteric femoral fractures had a positive effect on the overall process of their treatment. 3.The level of physical activity declared by women operated due to intertrochanteric femur fracture prior to the occurrence of these fractures, has a signifi cant effect on their functional results in short and long-term observation. The higher the level of physical activity of these patients before the fracture, the more favourable was the functional outcome. 4. The level of mood and self-acceptance of the disease in women treated surgically for this fracture had signifi cant impact on the process of their nursing as well as rehabilitation, and on functional status in short and long-term follow-up. The higher the level of mood and self-acceptance of the disease in these women, the better the process of their nursing, rehabilitation and the functional outcome.

Analysis of the effects of the upper limb improvement programme in patients after ischemic stroke treated with botulinum toxin

Introduction: Stroke is not only a medical problem, but also - due to the permanent disability of the injured person - a significant social problem. A significant number of patients after a neurological event develop increased muscle tone. Upper motoneuron damage syndrome promotes pain, stiffness, muscle contracture and weakness, which can potentially delay or prevent success in the rehabilitation process. In the upper limb, the spastic pattern is most often expressed through adduction and internal rotation of the glenohumeral joint, combined with flexion in the elbow, radiocarpal joint and interphalangeal joints. The specificity of spasticity-type increased tension makes rehabilitation of patients suffering from this disorder one of the most difficult tasks of neurological rehabilitation. Aim: The aim of the study was to assess muscle tone and range of motion of the inferior limb in patients after ischemic stroke subjected to 4 cycles of intramuscular injections of a botulinum toxin preparation and subjected to motor rehabilitation. Research Project: Pilot experimental study. Methodology: The study was carried out in the Neurological Unit with Stroke Sub-unit and Sub-Department of Neurological Rehabilitation at John Paul II Specialist Hospital in Krakow in the period from September 2014 to November 2015. The study group consisted of 20 patients after ischemic stroke (13 men, 7 women), age 30 to 72. All patients completed a 4-cycle study, which included injections of the botulinum toxin preparation, combined with a 15-day cycle of individual rehabilitation exercises. Each training session lasted 90 minutes. In order to verify the therapeutic process, active and passive mobility was measured according to the SFTR method and the assessment of muscle tone level was done using the Modified Ashworth Scale. Results: The taken therapeutic actions caused a positive increase in mobility, mostly passive, in the glenohumeral-scapular, elbow and forearm as well as the radiocarpal joints. There was also a slight increase in active mobility of the upper limb joints. In the course of obtaining results, it was shown that the use of botulinum toxin, combined with the rehabilitation exercise programme, significantly reduced pathological muscle tone both within the elbow, radiocarpal joint, and the interphalangeal joints of the hands. Conclusions: The presented results showed that the use of the botulinum toxin combined with medical rehabilitation allows local treatment of spasticity without exposing patients to adverse systemic reactions associated with oral medication. In addition, it has a positive effect on the increase in passive and - to a lesser extent - active range of motion in the joints of the inferior limb.