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IntroductionBurnout was already found to be an important factor in the professional landscape of nephrology prior to the COVID-19 outbreak and is expected to worsen during the pandemic.ObjectivesThe aim of our study was to assess pandemic experiences, perceptions, and burnout among Polish dialysis unit professionals in the COVID-19 period.Participants and methodsA survey, which consisted of a Pandemic Experiences and Perceptions Survey (PEPS) and a Maslach Burnout Inventory was distributed online to Polish dialysis units. The study group comprised 379 participants (215 nurses, 148 physicians, and 16 respondents of other professions).ResultsThe pandemic largely affected or completely dominated the work of dialysis units according to 53.4% and 25.5% of nurses responding to the PEPS, respectively. Among physicians, the prevalence was 55.5% and 15.4% of participants, respectively. Serious or life-threatening risk was perceived by 72.1% and 11.9% of dialysis healthcare professionals, respectively. Furthermore, 74.6% of the study participants stated that their work in a dialysis setting amidst the pandemic was felt to be associated with serious risk for their relatives. Adequate personal protective equipment and information from management decreased burnout among dialysis staff. Burnout was lower in all dimensions among those participants who felt more in control of their exposure to infection, provided by proper training, equipment, and support (p = 0.0004 for emotional exhaustion,p = 0.0007 for depersonalization, andp ConclusionsThe COVID-19 pandemic has largely affected the work in dialysis units. Providing proper training, equipment, and support may decrease burnout among dialysis staff.Graphical abstract

In recent years, the distribution of Dermacentor reticulatus ticks has expanded into new territories in many European countries, including Poland, with increased population densities in areas of their regular occurrence. The spread of D. reticulatus enhances the risk of exposure of domestic animals and their owners to tick-borne diseases. The objective of this study was to assess the prevalence of infection of D. reticulatus ticks feeding on dogs with the pathogens Borrelia burgdorferi sensu lato and Anaplasma phagocytophilum. The study material comprised 152 D. reticulatus ticks collected from dogs in the northeastern part of Lublin Province (eastern Poland). A ready-made AmpliSens® TBEV, B.burgdorferi sl, A.phagocytophilum, E.chaffeensis/E.muris-FRT PCR kit was used for qualitative detection and differentiation of tick-borne infections. The assessment of the degree of infection of the analyzed ticks with the two pathogens revealed that 9.2% (14/152) of the examined ticks were infected with one of the pathogens. No co-infections with the pathogens were detected in any of the ticks. The highest specific percentage of infections (8.6%, 13/152) was associated with A. phagocytophilum. The presence of B. burgdorferi s.l. was detected in only one of the examined ticks (0.7%). The spread of D. reticulatus to new territories and the increase in population density in areas of their regular occurrence implies the need for further studies of the prevalence of pathogens with medical and veterinary importance in order to assess the risk of tick-borne diseases.

Background. The lack of ideal sphericity of the hip joint acetabular bed is a problem encountered by orthopedists during the initial process of learning about hip joint replacement procedures. The aim of the study was analysis of the complications after cementless endoprosthesoplasty, when the primary sphericity was not obtained and the “Screw Cup” acetabulum (Aesculap) was used as a rescue procedure. Material and methods. The inclusion criteria were met only by 39 patients since, due to numerous complications, such implants were no longer used for patients aged 44–90 years and the average time of postoperative observation was 54 months. The patients were operated in a lateral position, from the posterolateral access or minimally invasive posterior access. In order to assess hip joint function after the procedure, the Harris and Hoos Hip Score questionnaires were used. Results. Harris Hip Score revealed 64.3%very good and good results and the obtained mean score was 96 points according to Hoos’s questionnaire. The type of surgical incision, BMI values and the types of dermal sutures had no impact on the functional result, the rate of complications and the incidence of pain in the groin. All the pa­tients who underwent surgical procedures using the minimally invasive access and whose skin sewn using a transdermal continuous suture, assessed their postoperative scars as esthetic. However, the lateral position during the procedure significantly complicated the intraoperative limb length assessment. In consequence, 30% of the opera­ted patients reported different lengths of their lower limbs, which significantly (p = 0,036) reduced the score corresponding to limb functionality, measured using HOOS and Harris Hip Score. The functional values show a significantly negative correlation with age, but not with gender, although men are more at risk of postoperative complications (p = 0,18). Despite the relatively big number of postoperative complications after surgical procedures using the “Screw Cap” acetabular implants, 75% of patients operated using this approach reported no objections to secondary procedures using the same system. Conclusions. Using the Screw Cap” acetabular implants in cases of failure to obtain an ideal sphericity entails the risk of numerous complications and only 60% of the results are good and very good, therefore, the authors of this paper do not recommend this solution.

BACKGROUND Atypical hemolytic uremic syndrome (aHUS) is an ultra-rare disorder characterized by over-activation and dysregulation of the alternative complement pathway. The clinical presentation of the disease comprises thrombocytopenia, microangiopathic hemolytic anemia, and acute kidney injury. In most cases, aHUS is caused by genetic mutations in components of the alternative complement pathway. The risk of graft loss in patients after kidney transplantation with aHUS is dependent on the type of genetic mutation. CASE REPORT We present a case of a 32-year-old patient after a second kidney transplantation with atypical hemolytic uremic syndrome, whose clinical manifestation was triggered by the Shiga toxin-producing E. coli infection. Genetic testing revealed a new mutation (p.I342T) in the gene encoding complement factor B (CFB). Since 2 causative variants for aHUS have been described in the same exon of CFB gene, it might be supposed that the p.I342T variant has similar deleterious effects on CFB function. Despite the implemented treatment, graft function deteriorated and the patient had to return to a hemodialysis program and is currently on a waiting list for a third kidney transplant. The presence of the gene variant with increased susceptibility for aHUS and its recurrence after kidney transplantation makes the patient a good candidate for therapy with complement factor C5 inhibitors during and after the planned kidney transplantation. CONCLUSIONS Our case confirms the importance of genetic testing in patients with any sign of thrombotic microangiopathy. The finding of Shiga toxin-induced HUS with typical clinical course should not limit our vigilance of complement-mediated HUS with high risk of renal failure.

We współczesnej literaturze przedmiotu koncepcje zrównoważonego rozwoju od strony teoretycznej są dość dobrze opracowane, dostrzega się jednak potrzebę zbadania zastosowania tych idei w praktyce. Ważne wydaje się zatem budowanie strategii działań zwłaszcza w odniesieniu do sfery świadomościowej. Kształtowanie społecznej świadomości zrównoważonego rozwoju warunkowane jest kształtowaniem postawy prozdrowotnej dzieci już w młodszym wieku szkolnym. Dlatego celem podjętych badań, których wyniki są przedstawione w artykule, było poznanie poziomu nawyków prozdrowotnych, jaki osiągnęły dzieci w wieku wczesnoszkolnym, jako elementu edukacji sustensywnej. Analiza uzyskanych wyników badań pozwoliła odpowiedzieć na kluczowe pytanie problemowe, w jaki sposób kształtuje się postawa prozdrowotna dzieci w wieku wczesnoszkolnym w kontekście zrównoważonego rozwoju z udziałem oddziaływań rodziców i nauczycieli? Wyniki badań pokazały wysoki poziom nawyków prozdrowotnych dzieci, co w pewnym stopniu wskazuje na potrzebę utrzymania strategii działań edukacji sustensywnej poprzez realizację zadań w aspekcie współdziałania środowiska szkolnego i rodzinnego, a także na potrzebę kontynuacji badań z wymienionego obszaru.

Background Medical simulation is a teaching method, which enables the development of clinical skills by implementing a simulation scenario in a true-to-life environment, but without exposing patients to any risk. So far, there has been no information on the use of high-fidelity simulation in undergraduate clinical nephrology teaching. Aim of this study was to analyze students' opinions and reactions to the simulation module in nephrology. Methods The survey consisting of the Satisfaction with Simulation Experience Scale (SSES) and open-ended question concerning the overall impression of classes was conducted among 103 5th year medical students, who took part in the simulation training in nephrology. SSES consisted of three parts (debriefing, reasoning, education). Statements from the open-ended question were interpreted by means of the Atlas.ti software for qualitative data analysis. Results The overall score for simulation classes was 4.39 ± 0.69 points. Students rated debriefing, reasoning and education at 4.43 ± 0.78, 4.32 ± 0.7 and 4.39 ± 0.73 points, respectively. 87.4% and 84.5% of participants agreed that simulation developed their 'clinical reasoning' and 'decision-making' skills in nephrology, respectively. Thematic analysis revealed that students evaluated the module as 'interesting', 'useful' and 'informative', but they found number of classes significantly insufficient. Students pointed out that due to the small emphasis placed on practical aspects in the existing curriculum e.g. routes of drug administration and conversion of doses, they could not fully benefit from simulation. Conclusion Medical simulation is a valuable constituent of the nephrology course. Putting greater emphasis on practical aspects from the beginning of training may enable students to benefit more from simulation modules.

Objectives: Study determined effects of arterial hypertension and impaired kidney function on acute cold exposure induced changes in peripheral and central aortic blood pressure (BP). Methods: Five-six subjects were divided into 3 groups including 20 hypertensive patients with normal kidney function (AH-non-CKD), 20 patients with hypertension and CKD (AH-CKD) stage 3b–4 and 16 healthy normotensive subjects (C). Baseline BP, central BP, and central pulse pressure, unadjusted augmentation index (AI) and central augmented pressure were assessed by applanation tonometry (SphygmoCor) before entering the room with constant temperature −10°C (°C), after 10 min in the cold room and in same conditions in room temperature. Results: Cold exposure led to significant increase of central aortic, systolic, and diastolic BP in both AH-non-CKD (p < 0.01) and AH-CKD (p < 0.001). The central aortic BP did not change in healthy subjects. The increase of central aortic systolic blood pressure was significantly larger in AH-CKD compared to AH-non-CKD group (p = 0.0002). Increase of aortic central and brachial systolic and diastolic BP was significantly larger in AH-CKD and AH-non-CKD patients than in controls. AI increased and subendocardial viability ratio and heart rate decreased after cold exposure in all groups. Central aortic and brachial rate pressure product increased by approximately 2,300 bpm × mm Hg (p < 0.001) and 1,600 bpm × mm Hg (p < 0.001), respectively, in the AH-CKD group and by 1,000 bpm × mm Hg (p = 0.007) and 500 bpm × mm Hg (p = 0.19) in AH-non-CKD group after cold exposure. Conclusion: Short-term cold exposure induces larger increase of brachial and central aortic BP in patients with arterial hypertension than in healthy subjects. The changes in central aortic pressure are augmented in hypertensive patients with impaired kidney function.

Interest in the problem of the participation of people with disabilities in public, social, professional and, in particular, educational life has increased over the past few years both worldwide and in Poland. The literature on the subject includes numerous publications concerning the education of children and youth with disabilities. This is not surprising since education at the primary as well as secondary school level is obligatory in Poland. It is also a condition for taking up higher education. The functioning of students with disabilities in higher education institutions is not so widely commented on in the literature. According to the data by the Central Statistical Office (GUS), the number of university students with disabilities amounted to 22,988 in 2007, and it increased to 31,613 by 2012. However, there has been a decline in the number of university students with disabilities since 2013. There were 28,940 university students with disabilities in 2013, while only 25,121 strived to receive third-level education in 2016, which constituted 1.86% of the total number of students in Poland. The fact that only 4.6% of people with disabilities had third-level education in 2002 is also worth noting. Since 2006, the number of students with disabilities at Pope John Paul II State School of Higher Education in Biała Podlaska has maintained a relatively permanent level of 50 people, representing 1.7% of the total number of students at the school. The objective of the study was to define the specificity of the functioning of the students with disabilities at Pope John Paul II State School of Higher Education in Biała Podlaska in the context of educational conditions offered to them by the school. The findings show that students with disabilities point to their difficult individual situation rather than to the conditions provided by the university as the source of their difficulties in studying.

BACKGROUND This study is aimed at evaluating the awareness among hunters and foresters concerning the activities undertaken for the prevention of Borrelia burgdorferi infections. MATERIAL AND METHODS The study group included 236 hunters from Poland and 339 foresters from Ukraine. The study was based on an original questionnaire including questions which concerned the applied methods of removing ticks attached to the skin, the kind of preventive measures undertaken to avoid tick bites, the evaluation of knowledge concerning the prevention of tick-borne diseases, as well as the participants' willingness to be educated on this issue. RESULTS Removing a tick with a pair of tweezers by a simple vertical move was more frequently practiced by the hunters (16.5%). Spreading an oily substance over a tick to make it go out on its own was more often applied by the foresters (18.8%). The occurrence of erythema migrans was more frequently reported by the foresters (47.2%). Among the persons declaring no knowledge of the prevention of tick-borne diseases, 77.8% of the hunters and 61.5% of the foresters were willing to gain such knowledge, and 11.1% of the hunters and 21.2% of the foresters did not want any education on this issue. The hunters more often than the foresters applied repellents and checked their body after returning from green areas. CONCLUSIONS Education is needed in certain groups undertaking hobby or vocational activities in forest areas of Poland and Ukraine. It seems reasonable to undertake research on the preferences concerning the choice of repellents among the groups at risk of tick bites. Med Pr. 2020;71(1):59-68.

Ixodes ricinus followed by Dermacentor reticulatus are the most common tick species with medical and veterinary importance in Poland. Ixodes ricinus is widely distributed across Poland, whereas the range of D. reticulatus is limited to the eastern and central parts of the country, with several new foci in the mid-west and west. Concurrently, an increase in the occurrence range of D. reticulatus has been observed. Recent studies indicate its high density in eastern Poland. The aim of the study was to determine the species composition of ticks infesting dogs from the northeastern part of Lublin Province. In a three-year study (2017-2019), 501 tick specimens were collected from 122 dogs in the north-eastern part of Lublin Province (eastern Poland). 174 ticks were removed from 24 pet dogs kept by individual owners and the other 327 were collected from 98 dogs from the animal shelter. Two tick species: D. reticulatus 55.5% (278/501) and I. ricinus 44.5% (223/501) were identified in the group of 501 ticks removed from the dogs. Dogs in the north-eastern part of Lublin Province are exposed to contact with two tick species: I. ricinus and D. reticulatus, with a higher frequency of the latter species. Identification of the species of ticks infesting dogs in an analyzed area and knowledge of pathogens transmitted by ticks facilitates correct differential diagnosis of tick-borne diseases.

BACKGROUND Kidney transplantation (KTx) reverses most abnormalities related to chronic kidney disease (CKD), but sedentary lifestyle persists in most kidney graft recipients. Physical inactivity has been associated with altered adipokine profile and inflammation in CKD. We postulated that increased physical activity achieved through an individually-tailored program can reverse these changes. MATERIAL AND METHODS We included 25 clinically stable KTx recipients at least 12 months after transplantation and with eGFR >30 mL/min and 15 age-matched non-dialysis patients with CKD stage 3. Body composition, pattern of daily physical activity, and serum concentrations of leptin, adiponectin, NT-proBNP, and hsCRP were assessed at baseline. All patients in both groups participated in a 12-week supervised exercise program with short cell phone text reminders. All measurements were repeated after 3 months. RESULTS Active energy expenditure increased significantly during the 3 months in both the KTx and CKD patients, compared with baseline by 47% (p

Background and Aims Iron therapy may induce inflammatory response that may indirectly affect endogenous erythropoietin (EPO) production. We postulated that increased secretion of FGF-23 may provide a link between intravenous iron administration and suppression of endogenous EPO secretion. Evaluation of a short-term effect of intravenous iron sucrose administration on the secretion of endogenous EPO in patients with chronic kidney disease (CKD). Method 35 non-dialysed patients with G3b-5 CKD were included. All patients received 100 mg of intravenous iron infusion (iron (III)-hydroxide sucrose complex) daily for 5 days. Plasma concentration of EPO, iFGF-23, cFGF-23, PTH, bone alkaline phosphatase (BAP), phosphorus (PO4) and calcium (Ca) were measured before and two hours after the first and third iron infusion and at the end of iron therapy. Results EPO concentration at the end of iron treatment was significantly lower compared to 2 h after the first iron infusion (p Conclusion Intravenous iron therapy increases the secretion of FGF-23 and supresses endogenous EPO production but these two effects do not seem to be related.

Background Burnout syndrome in physicians is associated with adverse patient safety events, poorer quality of care and reduced patients’ satisfaction. There has been scarce information on the risk factors of burnout affecting professionals working in the renal care settings. As yet the phenomenon has not been studied in the population of Polish nephrologists therefore a nationwide cross-sectional study was established by the Polish Society of Nephrology to assess the prevalence of the syndrome. Methods The survey, that consisted of the abbreviated Maslach Burnout Inventory, questions about strategies for dealing with burnout symptoms and demographic data, was distributed during two main national meetings that gather nephrologists in Poland. 177 participants filled out the survey – 64% of participants were women, 88% were specialists and 12% - doctors in training. Results 52% of participants demonstrated a high level of depersonalization and almost half of the study group showed high level of emotional exhaustion. Reduced personal accomplishment was more pronounced in doctors working mostly in dialysis units compared to other nephrologists (p = 0.017). 37% of participants reported that they treat some patients as they were impersonal objects and 48% felt emotionally drained from their work. 59% of participants would like to take part in the remedy program. Conclusions Burnout syndrome seems to be an important problem in the population of Polish nephrologists. Doctors working mostly in dialysis settings might be at increased risk of reduced personal accomplishment. The results of the survey may be useful to prepare burnout remedy program.

Pesticides are a major problem not only in the food chain but also when considering the protection of our planet. The use of neonicotinoids has been banned in the EU due to their high toxicity to living organisms, in particular honeybees. The presence of neonicotinoids in natural waters poses a threat to pollinating insects and thus hampers organic production. Pesticide residues in the natural waters of agricultural land are monitored within the framework of promoting sustainable rural development to maintain the safety of human and animal health. Chromatographic analyses of selected neonicotinoid pesticides in water samples from agricultural sites in eastern Poland were performed using high performance liquid chromatography (HPLC), which followed a solid-phase extraction (SPE). The research revealed no evidence of neonicotinoids contamination. Water quality in this region can be a good factor in promoting sustainable development. The obtained results complement the existing knowledge on the impact of neonicotinoids on both the sustainable food chain and the environment. Based on the results obtained, it is possible to conclude that they are not being used in rural area under the study.

Background: Hemophagocytic lymphohistiocytosis (HLH) is a life-threatening disorder of immune regulation. In patients over 60 years of age, HLH associated with hematological malignancies (hM-HLH) is the most prevalent. β-2-Microglobulin (B2M) plays an important role in antigen presentation and immunological regulation. Elevated B2M levels reflect T-cell activation. Objective: The aim of this study was to determine serum B2M concentrations in adults with hM-HLH and to interpret its significance in the context of overall survival (OS). Patients and methods: Serum B2M concentration was determined in 31 adults aged 22–84 years at the time of hM-HLH diagnosis. Lymphoid malignancy was diagnosed in 22 patients and myeloid malignancy in 9 patients. Results: The serum concentration of B2M was elevated in 100% of the examined patients. Mean and median serum B2M concentrations were 5.3 and 4.2 mg/L, respectively (range 2–17 mg/L). We have not found any significant differences in terms of the studied serum B2M concentrations between patients with T/NK-cell lymphomas, B-cell lymphomas, and myeloid malignancies. The outcome of HLH was poor in vast majority of patients with the median OS for the entire group of 46 days. Conclusions: Elevated serum B2M level is a frequent finding at the time of hM-HLH diagnosis in adults. It seems to be a useful indicator of HLH for its early detection and evaluation afterward, as well as for immediate therapeutic intervention. Further prospective studies answering the question whether serum B2M can be used as a prognostic factor in hM-HLH would be of interest.

Global economic forces, political decisions, and natural disasters are only some of the factors that affect contemporary healthcare education. Given the centrality of health in all settings, the future of healthcare education depends on how we overcome these difficult circumstances.Through a series of collaborative activities involving healthcare educators from around the world and their attempts to overcome these difficulties, the authors have developed a conceptual model centered around the people involved, the impact of culture, and organizations and systems.The model can help to frame discussions and develop strategies about how best we, as a community of health professionals and educators, collaborate and share wisdom, experiences and resources to assist colleagues who might be struggling to deliver education. What has clearly emerged from this work is the centrality of leadership and management in effectively challenging and addressing difficult circumstances.Contemporary health professions' education leadership needs to be inclusive, mindful, compassionate and caring; echoing and role-modeling how we expect our students to be with patients and colleagues. This means being willing to confront unacceptable behaviors and speak out and challenge authority when needed. It also requires awareness and understanding of the complex systems in which healthcare education is provided.

Hemophagocytic lymphohistiocytosis (HLH) is an underdiagnosed but life-threatening syndrome of hyperinflammation often occurring in adults with hematological malignancies (hM-HLH). The aim of the study was to describe clinical characteristics, therapy response, and outcome of adults with hM-HLH. The study included 51 adults with hM-HLH aged 23-84 years. Hyperferritinemia ≥500 µg/L was present in 96% of patients. The serum concentration of sIL-2Rα ≥ 2400 U/mL was revealed in 94% of patients. Twenty-three patients (45%) responded to therapy and achieved remission of HLH. The probability of overall survival (OS) at 6, 12, 24, and 60 months after HLH diagnosis were 42, 20, 15, and 15%, respectively. Patients with HLH during chemotherapy showed longer OS (median 124 days) than the patients who had HLH solely attributed to malignancy (median 65 days), but this difference was not statistically significant. Awareness of HLH in lymphoid and myeloid malignancies is crucial for improved survival.

The storage of glucosylceramide in macrophages produces an inflammatory response in Gaucher disease type 1 (GD1) resulting in iron metabolism dysregulation and cytokine release.The study included 16 adults with GD1 aged 20-86years. All but one patient carried at least one allele with the c.1226AG (N370S) mutation in the GBA1 gene. Ferritinemia, iron metabolism profiles including hepcidin, and inflammatory cytokine concentrations were assessed in GD1 patients in Sweden.Hyperferritinemia was present in 81% of patients. There was no correlation between hyperferritinemia and patient's gender, spleen status, or clinical status. Hepcidin was discrepantly low in relation to ferritin levels. TNF-α was moderately increased in 5 of 11 patients; 2 patients with the highest TNF-α concentrations showed mildly elevated IL-6 levels. The concentrations of IL-1β, IL-8, and IL-10 were normal in all patients. Upon treatment, ferritinemia ameliorated but S-ferritin levels did not normalize. The increased TNF-α level however, normalized in all treated patients, reaching the lowest values after 2years of therapy and continued to be stable during the remaining 2years of follow-up.Hyperferritinemia is a frequent finding in GD1 in Sweden. The relatively low hepcidin levels reveal a distorted relationship between hepcidin and ferritin in GD1. Therapy has the potential to not only ameliorate hyperferritinemia but to also normalize the serum TNF-α concentration in GD1.

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Although immunosuppressive drugs have been recognized as leading causes of gastrointestinal symptoms after kidney transplant, other widely used medications such as proton-pump inhibitors recently have been implicated. Our aim was to study the effects of chronic proton-pump inhibitor therapy on gastrointestinal symptoms in clinically stable patients late after kidney transplant.The study comprised 100 kidney transplant recipients (66 men and 34 women, mean age of 49 ± 12 y, mean time after transplant of 56 ± 46 mo). All patients completed the Gastrointestinal Symptoms Rating Scale and the Quality of Life Questionnaire SF-8 surveys.The most commonly reported symptoms included borborygmus (27%), flatulence (23%), abdominal distension (18%), urgent need of defecation (17%), and heartburn, acid reflux, and eructation (13%). Proton-pump inhibitors were chronically used by 50% of patients and sporadically by 33%. Gastrointestinal Symptoms Rating Scale scores were higher in patients who used proton-pump inhibitors (mean score of 7.8 ± 5.5 vs 4.6 ± 3.0; P = .013). Total score of items representing diarrhea in the Gastrointestinal Symptoms Rating Scale (increased passage of stools, loose stools, urgent need of defecation, incomplete evacuation) was higher in patients treated with proton-pump inhibitors than in those not treated (2.3 ± 2.2 vs 1.3 ± 1.9; P = .04).Chronic use of proton-pump inhibitors may increase the prevalence of gastrointestinal symptoms, particularly diarrhea, in patients late after kidney transplant.