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An important drug used in the treatment of Parkinson's disease is amantadine. We are the first to perform a comprehensive study based on various glycation and oxidation factors, determining the impact of amantadine on protein glycoxidation. Sugars (glucose, fructose, galactose) and aldehydes (glyoxal, methylglyoxal) were used as glycation agents, and chloramine T was used as an oxidant. Glycoxidation biomarkers in albumin treated with amantadine were generally not different from the control group (glycation/oxidation factors), indicating that the drug did not affect oxidation and glycation processes. Molecular docking analysis did not reveal strong binding sites of amantadine on the bovine serum albumin structure. Although amantadine poorly scavenged hydroxyl radical and hydrogen peroxide, it had significantly lower antioxidant and antiglycation effect than all protein oxidation and glycation inhibitors. In some cases, amantadine even demonstrated glycoxidant, proglycation, and prooxidant properties. In summary, amantadine exhibited weak antioxidant properties and a lack of antiglycation activity.

Introduction: Currently, the increase in the percentage of obese people observed along with the development of civilization, reaching the level of a global pandemic, has forced a search for methods of effective and permanent obesity treatment. Obesity is a multifactorial disease; it coexists with many disease entities and requires multidisciplinary treatment. Obesity leads to metabolic changes in the form of metabolic syndromes, which include, among others, atherogenic dyslipidemia. The proven relationship between dyslipidemia and cardiovascular risk enforces the need to effectively improve the lipid profile of obese patients. Laparoscopic sleeve gastrectomy is a method of surgical treatment of morbid obesity which improves bariatric and metabolic parameters. The aim of the study was to assess the effectiveness of laparoscopic sleeve gastrectomy (LSG) at improving lipid profile parameters upon a 1-year follow up. Material and Methods: Bariatric parameters of 196 patients who underwent laparoscopic sleeve gastrectomy as well as the lipid profile of total cholesterol (TC), high-density lipoprotein (HDL), low-density lipoprotein (LDL), non-NDL, and triglycerides (TG) in a 1-year observation were analyzed. Results: Improvements in bariatric parameters were observed in patients after LSG. Total cholesterol, low-density lipoprotein (LDL), triglycerides and non-HDL level decreases were observed along with an increase in high-density lipoprotein (HDL) cholesterol levels. Conclusions: Sleeve gastrectomy is an effective method of treating obesity and improving the lipid profile in obese patients.

Substantial differences in survival after out-of-hospital cardiac arrest (OHCA) have been observed between countries. These might be attributed to the organization of emergency medical service (EMS) systems, including prehospital physician involvement. However, limited data exist on the physician's role in improving survival after OHCA.To compare prehospital and in-hospital outcomes of OHCA patients attended by physician-staffed EMS vs. paramedic-staffed EMS units.Among all patients enrolled in the regional, prospective registry of OHCA in southern Poland, we excluded those aged18 years, with unwitnessed or EMS-witnessed cardiac arrest, without attempted cardiopulmonary resuscitation (CPR), attended by more than one EMS, or with traumatic cardiac arrest. The groups were matched 1:1 using propensity scores for baseline characteristic variables that might influence physician-staffed EMS dispatch.A total of 812 OHCA cases were included in the current analysis. Among them, 351 patients were attended by physician-staffed EMS. There were no differences in baseline characteristics in the propensity-score matched cohort consisting of 351 pairs. The return of spontaneous circulation (ROSC) was more often achieved in the physician-staffed EMS group (42.7% vs. 33.3%; P = 0.01). The prehospital survival rate was also higher in this group (34.1% vs. 19.2%; P0.01). However, there were no significant differences in survival rate to discharge between cases treated by physician-staffed and paramedic-staffed EMS (9.7% vs. 7.0%; P = 0.22).OHCA patients attended by physician-staffed EMS were more likely to have ROSC and survive till hospital admission. However, better prehospital outcomes might not translate into improved in-hospital prognosis in these patients.

Introduction Currently, the increase in the percentage of obese people observed along with the development of civilization, reaching the level of a global pandemic, has forced the search for methods of effective and permanent obesity treatment. Obesity is a multifactorial disease, it coexists with many disease entities and requires multidisciplinary treatment. Obesity leads to metabolic changes in the form of metabolic syndrome, which includes, among others, atherogenic dyslipidemia. The proven relationship between dyslipidemia and cardiovascular risk enforces the need to effectively improve the lipid profile of obese patients. Laparoscopic sleeve gastrectomy is a method of surgical treatment of morbid obesity which improves bariatric and metabolic parameters. The aim of the study was to assess the effectiveness of laparoscopic sleeve gastrectomy (LSG) in improving lipid profile parameters in 1-year follow-up. Material and Methods Bariatric parameters of 196 patients who underwent laparoscopic sleeve gastrectomy as well as lipid profile of total cholesterol (TC), high-density lipoprotein (HDL), low-density lipoprotein (LDL), non-NDL, and triglycerides (TG) in 1-year observation were analyzed. Results Improvements in bariatric parameters were observed in patients after LSG. Total cholesterol, low-density lipoprotein (LDL), triglycerides and non-HDL levels decrease were observed along with the increase of high-density lipoprotein (HDL) cholesterol level. Conclusions Sleeve gastrectomy is an effective method of treating obesity and improving the lipid profile in obese patients.

Aim: To evaluate the level of life satisfaction of patients after an ischemic stroke, as well as to determine the factors that may affect the life satisfaction. Material and methods: The study included 100 subjects (42% women and 58% med) after an ischemic stroke re¬cruited from the Department of Neurology of the Medical University of Bialystok. The research material was collected on the basis of the author’s questionnaire constructed on the basis of research, Satisfaction Life Scale SWLS, Barthel scale. Results: The mean value of the SWLS scale was 23.15 (± 5.19), which is assessed as a high level of life satisfaction, and it was-comparable among women among women and men (23.90± 5.69 and 22.60± 4.77,respectively). The level of satisfaction of life after stroke, in relation to the situation before the disease, decreased in 41% of respondents, did not change in 27% of respondents , while in 8% of participants increased. Conclusions: The level of life satisfaction of people after ischemic stroke was high despite complications and loss of independence experienced to varying degrees. The occurrence of complications is a decisive factor in the deterioration of the mobility of a person after ischemic stroke.

Background: Obtaining vascular access is one of the key procedures performed in patients in emergency settings. Aims: The study was conducted as a meta‑analysis and a systematic review and aimed to address the following question: which intravascular access method should be used in patients with COVID‑19 when wearing full personal protective equipment (PPE)? Methods: We performed a systematic search of PubMed, EMBASE, and CENTRAL databases for randomized controlled trials that compared intravascular access methods used by operators wearing full level C PPE. We evaluated procedure duration and the success rate of intraosseous and peripheral intravenous accesses. Results: Eight randomized controlled trials were included in quantitative synthesis. The use of PPE during intravascular access procedures had an impact on procedure duration in the case of intraosseous access (mean difference [MD], 11.69; 95% CI, 6.47–16.92; P < 0.001), as well as reduced the success rate of intraosseous access by 0.8% and intravenous access by 10.1%. Under PPE conditions, intraosseous access, compared with peripheral intravenous access, offered a shorter procedure time (MD, –41.43; 95% CI, –62.36 to –24.47; P < 0.001). Conclusion: This comprehensive meta‑analysis suggested that the use of PPE significantly extends the duration of intravascular procedures. However, under PPE conditions, operators were able to obtain intraosseous access in a shorter time and with a higher success rate than in the case of intravenous access.

Aim: To assess the trips made by Emergency Medical Teams due to injuries (ICD-10 code: S) completed by Voivodeship Medical Rescue Teams in Katowice in 2018. Material and methods: Analysis of the characteristics of the trips was done based on information contained on “Emergency ambulance travel cards”. Statistical analysis was carried out using the t-Student, ANOVA variance as well as the Tukey post-hoc tests (p

Background: Cardiopulmonary resuscitation with the use of personal protective equipment (PPE) for aerosol generating procedures (AGP) in patients with suspected or confirmed coronavirus disease 2019 (COVID‑19) remains challenging. Aims: The aim of this study was to compare 3 chest compression (CC) methods used by paramedics wearing PPE. Methods: The single‑blinded, multicenter, randomized, crossover simulation study involved 67 paramedics wearing PPE AGP. They performed 2‑minute continuous CCs in an adult with suspected or confirmed COVID‑19 in 3 scenarios: 1) manual CCs; 2) CCs with the TrueCPR feedback device; 3) CCs with the LUCAS 3 mechanical CC device. Results: The depth of CC was more frequently correct when using LUCAS 3 compared with TrueCPR and manual CC (median [IQR] 51 [50–55] mm vs 47 [43–52] mm vs 43 [38–46] mm; P = 0.005). This was also true for the CC rate (median [IQR]102 [100–102] compressions per minute [CPM] vs 105 [98–1114] CPM vs 116 [112–129] CPM; P = 0.027) and chest recoil (median [IQR]100% [98%–100%] vs 83% [60%–92%] vs 39% [25%–50%]; P = 0.001). A detailed analysis of 2‑minute resuscitation with manual CCs showed a decrease in compression depth and full chest recoil after 1 minute of CCs. Conclusion: We demonstrated that during simulated resuscitation with the use of PPE AGP in patients with suspected or confirmed COVID‑19, CC with LUCAS 3 compared with manual CCs as well as the TrueCPR essentially increased the CC quality. In the case of manual CCs by paramedics dressed in PPE AGP, it is advisable to change the person performing resuscitation every minute.

PurposeThe aim of the study was to assess whether a history of dialysis is related to cardiopulmonary resuscitation (CPR) attempts and survival to hospital admission in patients with out-of-hospital cardiac arrest (OHCA).MethodsThe databases of the POL-OHCA registry and of emergency medical calls in the Command Support System of the State of Emergency Medicine (CSS) were searched to identify patients with OHCA and a history of dialysis. A total of 264 dialysis patient with OHCA were found: 126 were dead on arrival of emergency medical services (EMS), and 138 had OHCA with CPR attempts. Data from the POL-OHCA registry for patients with CPR attempts, including age, sex, place of residence, first recorded rhythm, defibrillation during CPR, and priority dispatch codes, were collected and compared between patients with and without dialysis.ResultsCPR attempts by EMS were undertaken in 138 dialyzed patients (52.3%). The analysis of POL-OHCA data revealed no differences in age, sex, place of residence, first recorded rhythm, and priority dispatch codes between patients with and without dialysis. Defibrillation was less frequent in dialysis patients (P = 0.04). A stepwise logistic regression analysis revealed no association between survival to hospital admission and a history of hemodialysis (odds ratio = 1.12; 95% CI 0.74–1.70,P = 0.60).ConclusionsA history of dialysis in patients with OHCA does not affect the rate of CPR attempts by EMS or a short-term outcome in comparison with patients without dialysis. Defibrillation during CPR is less common in patients on dialysis than in those without.

Background: The National Emergency Medical Services Management Support System, a unique information and communication technology system, was developed to reduce the burden of ST-segment elevation myocardial infarction (STEMI) in Poland. According to the European Society of Cardiology guidelines, medical emergency teams (METs) should diagnose STEMI using electrocardiogram (ECG) transmission and apply dual antiplatelet therapy (DAPT) as a pivotal treatment. Aims: This study aimed to analyze MET interventions in patients with STEMI and assess regional differences in the management in Poland. Methods: Using ambulance call reports, we retrospectively analyzed MET interventions due to conditions classified as I21 (acute myocardial infarction; according to the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision), which were performed in Poland between January 1, 2018 and December 31, 2018. Results: In 2018, METs conducted 16 807 interventions classified as I21, which accounted for 0.5% of all MET interventions in Poland in that year. Most interventions were conducted in the Mazovia Province (13.4%; P < 0.001), and the lowest number was reported in the Podlasie Province (2.5%). A 12‑lead ECG was performed during 98.6% of interventions, and ECG transmission in 37.49%: most often in the Mazovia Province (59.62%; P < 0.001), and least often in the Lublin Province (13.8%). In 72.12% of interventions, DAPT was applied: clopidogrel was the P2Y12 inhibitor used in 49.68% of interventions, and ticagrelor in 25.14% (P < 0.001). A P2Y12 inhibitor was most often used in the Wielkopolska Province (98.4%), and least often in the Silesia Province (40.34%). Conclusions: Significant differences in the implementation of the European Society of Cardiology guidelines regarding ECG transmission and DAPT were observed between particular provinces in Poland.

© ALUNA Publishing HouseEmerg Med Serv, 2020; VII, 1: 5-12ORIGINAL ARTICLE5DOI: 10.36740/EmeMS202001101carDIac FUnctIon In PatIents wItH coronarY arterY DIsease PrePareD For coronarY angIograPHYKatarzyna Łagoda1, Regina Sierżantowicz2, Klaudiusz Nadolny4,5, Jerzy Robert Ładny3,4, Hady Razak Hady3Introduction: Cardiovascular diseases are one of the major health issues in the world. One of the factors that adversely affects the cardiovascular system is the acceleration of heart rate.the aim: Assessment of heart rate in patients with coronary heart disease depending on age and gender, as well as determination of patients ability to measure heart rate and to interpret the results.Material and methods: The study included 100 patients, both genders (62% men), aged from 45 to 84 years (67.61 ± 9.22 years) with diagnosed coronary heart disease, directed to coronarography, hospitalized in the Department of Invasive Cardiology of the University Hospital in Białystok. The data has been gathered using own questionnaire (38 questions), NYHA and CCS scale.results: The majority of patients do not know how to measure their heart rate correctly. Subjects with higher education level and under 65 years of age more often declared the knowledge about the correct heart rate value. Only 7.9% of women and 11.3% of men performed heart rate measurements by themselves. Elderly patients less frequently per-formed heart rate measurements (p=0.017) than those under 65 years of age. As many as 84.2% of women and 75.8% of men believed that the value of the heart rate affects their health.conclusions: 1. Lack of patients’ knowledge about the impact of heart rate on the cardiovascular status and lack of self-monitoring may lead to further disease development and deterioration of health. 2. Therapeutic education performed systematically on the subject of heart rate measurement, proper lifestyle and diet are important elements in improving the health of patients with coronary heart disease.

The aim: To assess patients admitted to the Emergency Department requiring hospitalization in whom the presence of alcohol has been stated in laboratory tests. Material and methods: The study was conducted on the basis of medical documentation analysis of 134 patients treated in Emergency Department in whom blood alcohol has been stated. The study included: sociodemographic data, blood alcohol concentration, the reason for hospitalization, the average duration of hospitalization and the patient’s future. Results: Retrospective study was based on medical records of134patients treated in the Emergency Department of the University Hospital in Bialystok from 01/01/2016 to 01/06/2016.The analysis took into account patients whose laboratory tests results showed an alcohol concentration above 0.004 ‰.The most common reason for hospitalization for examined patients was alcohol intoxicationa 26%.For 25% of examined patients, the cause of hospitalization was alcohol addiction syndrome, 19%drug poisoning,13% gastrointestinal bleeding. Almost 20% of patients was hospitalized in the Emergency Department with multiple injuries. Conclusions: The majority of patients hospitalized in Emergency Departments are patients under the influence of alcohol. Such patients are a cause of Emergency Departments overload, which are not efficient due to the number of patients who use the services of EDs instead primary healthcare facilities. Other causes of hospitalization of alcoholic patients are associated with constant exposure to alcohol. Such situation suggests changes in the health care system which would relieve EDs and involve other units of the health care system. The system should focus on education and treatment of patients by non-invasive methods, i.e. psychotherapy or other psychological help.

Introduction As a result of the growing number of people with obesity, the popularity of bariatric surgery has been systematically increasing. It has not yet been explored whether individual education of the patient can contribute to long-term success in weight reduction after bariatric treatment. Aim To implement and compare the effects of different education methods, versus receiving one-time written information in the form of a guidebook, on patient involvement in abiding by lifestyle recommendations after laparoscopic sleeve gastrectomy (LSG) bariatric treatment. Material and methods The study included 160 patients with morbid obesity. The education session study participants were 100 patients after sleeve gastrectomy, with whom three education sessions were planned, and who were enrolled in the study. The control group consisted of 60 patients who underwent sleeve gastrectomy, and before discharge from the department, they received one-time written recommendations in the form of a guidebook. Results We confirmed that the three education sessions we conducted with the study group after LSG had a significant impact on weight loss. The control group, which received only written information, achieved weight loss and abided by the written recommendations, although to a lesser extent than the study group. The differences were evident particularly in motivation to adhere to recommendations and check-ups, which was significantly lower (p < 0.001) after a year of observation in the control group. Conclusions This study results should encourage the establishment of education as a permanent element of the LSG procedure.

Introduction: Despite the progress of medicine and the implementation of the latest treatment methods, the problem of Acute Coronary Syndrome (ACS) and the patients’ knowledge of the factors favoring the emergence of the disease, manifesting symptoms and providing first aid to a person with suspected myocardial infarction are still part of the discussion not only medical but also economic. The aim: Assessment of the state of knowledge of patients after cardiac surgery about acute coronary syndromes. Material and methods: The study evaluated the knowledge of patients after cardiac surgery about acute coronary syndrome. Patients were treated at the Department of Cardiosurgery, University Hospital in Bialystok from January to March 2018. The study involved 60 patients after cardiac surgery, of which 43 were men and 17 were women (aged 37 – 83 years). Own survey consisting of 10 single-choice closed questions and metrics has been used. Results: The respondents’ answers to the questions about risk factors for coronary artery disease were satisfactory due to the fact that as many as 82% of the respondents indicated the proper reasons for the development of acute coronary syndromes. The respondents had difficulties with questions regarding the provision of first aid in the event of ACS symptoms. When asked if they are willing to change their lifestyle to healthier and safer for their organism – 90% of respondents expressed a desire. Conclusions: The basis for forming patient awareness is a good knowledge of factors predisposing to the development of clinical disorders. It is proposed to create expert groups composed of cardiologists, diabetologists, hypertensiologists, psychologists, family doctors, dietitians and other physicians who may adapt the risk assessment to the specificities of individual countries, gender, age and co-morbidities. It has been estimated for reducing mortality that 50% corresponds to good control of the most important risk factors, and the remaining 50% are appropriate pharmacotherapy.

OBJECTIVE: Introduction: The SARS-CoV-2 virus was recognized in December 2019 in China. From that moment it has quickly spread around the whole world. It causes COVID-19 disease manifested by breathlessness, coughing and high temperature. The COVID-19 pandemic has become a great challenge for humanity. The aim: To analyze interventions of emergency medical teams during the SAR-CoV-2 pandemic, and to compare obtained data with the same periods in 2018-2019. PATIENTS AND METHODS: Material and methods: The study retrospectively analyzed interventions of emergency medical teams in the period from 15.03 to 15.05 in 2018 - 2020. 1,479,530 interventions of emergency medical teams were included in the study. The number of interventions, reasons for calls, and diagnoses made by heads of the emergency medical teams during the SARS-CoV-2 pandemic were compared to the same period in 2018-2019. RESULTS: Results: Authors observed the decline in the number of interventions performed by emergency medical teams during the pandemic in relation to earlier years by approximately 25%. The big decline concerned interventions that were the reason for calls to public places, such as "traffic accident" and "collapse". In the case of diagnoses made by the head of the emergency medical team, the diagnoses regarding stroke or sudden cardiac arrest remained at the similar level. Others showed a marked decline. CONCLUSION: Conclusions: Reduced social activity contributed to a reduced number of interventions by emergency medical teams in public places. The societal fear of the unknown also contributed to the decrease in the number of interventions performed by emergency medical teams. People began to avoid contact with other people.

Introduction: The gas composition and acid-base balance of blood play a main role in assessing the patient in critical condition. Estimating the dynamics of acid-base balance, one can judge the severity of pathology and the adequacy of therapeutic measures. The aim: to determine the effect of hemoperfusion on the gas composition and acid-base balance of blood in children with severe forms of peritonitis. Material and methods: The study was performed on the basis of a prospective analysis of acid-base balance of blood and blood gas composition of 30 patients in the early postoperative period with severe forms of peritonitis, who were treated in the Department of anesthesiology and intensive care of the Grodno regional children’s clinical hospital. This study was conducted in accordance with the standards of bioethics, was approved by the ethical Committee of the institution and complies with the principles of the Helsinki Declaration. Results and conclusions: This article describes the methodology of hemoperfusion in children, analyzed the dynamics of changes in the basic parameters of acid-base balance and blood gas composition in the early postoperative period with severe forms of peritonitis during hemoperfusion. The positive dynamics of laboratory data obtained as a result of the study proves the high effectiveness of the use of antiproteinase biospecific hemosorbent. The use of biospecific hemoperfusion as an additional method in the complex therapy of peritonitis gives a real opportunity to improve the results of treatment of this category of patients.

Introduction: Complications associated with intra-hospital infections are an important clinical issue determining the further condition of hospitalized patients. One of the most invasive and of high risk of complications in ICU conditions is the otolaryngological procedure of opening the anterior wall of the trachea, aimed at introducing the tube into the lumen of the respiratory tract, enabling subsequent ventilation. Epidemiological data indicate that in Poland the percentage of patients admitted to the ICU annually, due to respiratory failure, who require the implementation of mechanical ventilation reaches 74%, where 41% is qualified for prolonged ventilation and requires a tracheostomy. The aim: The epidemiological analysis of patients under the care of the Department of Anaesthesiology and Intensive Care of University Hospital in Bialystok. Particular attention was paid to patients who underwent tracheostomy. Material and methods: The study material was collected based on the analysis of the patient’s individual treatment process cards, the results of microbiological tests functioning in the Department of Anaesthesiology and Intensive Therapy of the University Hospital in Bialystok. 115 patients were qualified for the study, including 48 women and 67 men. Results: Retrospective studies were based on medical records of 115 patients treated in the Intensive Care Unit of the Department of Anaesthesiology and Intensive Care, University Hospital in Bialystok in 2017-2018. The analysis involved patients after tracheostomy tube implementation, 48 were women and 67 men. Among the analyzed cases, 53 deaths (46.1%) occurred, and 62 subjects were discharged from the ICU (53.9%). Conclusions: Early tracheostomy significantly improved patients’ prognosis and reduced the risk of death. Cardio-respiratory failure with respiratory arrest may often be associated with the need for prolonged mechanical ventilation applied in patients with the aforementioned disease. Therefore, prevention in the form of early tracheostomy is important.

Introduction: The factors associated with work and the structure of a given organisation can influence on appearing the burnout of its employees. It does most often affect people who do not have an ability to manage stress as well as those who are not provided enough with social support. The aim: The main purpose of the study was to assess the burnout symptoms and satisfaction of personal life of nurse staff over the age of 40. The influence of demographic-occupational factors was evaluated in connection with the occurrence of work burnout. Material and methods: The research included a group of 523 randomly chosen workforce nurses over 40 years old, CBI - Copenhagen Burnout Inventory was used in the research, the assessment of life satisfaction was conducted with the use of SWLS - The Satisfaction with Life Scale. Results: The nurses in a worse material situation feel higher work burnout in almost all researched category. Those who do not achieve satisfaction from work have definitely much higher level of work burnout than those nurses who declare high satisfaction level from their work. The higher work burnout, the less life satisfaction. Conclusions: The level of burnout in the surveyed group can be considered as a moderate one.

Introduction The worldwide outbreak of morbid obesity forced contemporary medicine to adopt a multidisciplinary approach, which led to the description of metabolic syndrome (MS): a disease with self-aggravating components and one of the most important causes of morbidity and mortality. The need for therapeutic methods provoked development of metabolic surgery, which nowadays give possibilities for safe and effective treatment of all MS aspects simultaneously and improves many obesity-related comorbidities. Aim To assess the laparoscopic sleeve gastrectomy (LSG) procedure's efficiency in resolving MS components, treating comorbidities and to analyze the influence on certain biochemical markers in 1-year follow-up. Material and methods The retrospective cohort study of 211 patients after an LSG operation relied on statistical analysis of clinical data collected prospectively in follow-up visits. All applicable guidelines and bioethical recommendations were respected in this study. Results Assessment of bariatric efficiency proved the LSG operation to be effective in inducing significant weight loss and treating obesity. Analysis on the influence on MS components, such as non-insulin dependent diabetes (NIDDM), arterial hypertension (AH) and dyslipidemia, showed substantial improvement in all observed cases of these diseases. In the present study, follow-up also proved a partial remission inducing effect of this bariatric operation in many comorbidities, especially in chronic obstructive pulmonary disease, obstructive sleep apnea, peptic ulcer disease and depression. A desirable reduction in creatinine, C-reactive protein, uric acid, alanine aminotransferase, asparagine aminotransferase, γ-glutamyltransferase serum levels has also been observed during the follow-up. Conclusions The LSG is an effective method of treatment in all areas of metabolic syndrome, provides a significant positive clinical outcome in obesity-related comorbidities and induces desirable changes in inflammatory, kidney and liver related biomarkers.

Background: The aim of the study was to compare the quality of chest compressions (CCs) carried out with and without the use of the TrueCPR device during simulated cardiopulmonary resuscitations conducted by trainee doctors. Methods: The study was a prospective, randomized, cross-over simulation study. The study involved 65 trainee doctors who were tasked with performing a 2-min cycle of uninterrupted CCs under conditions of a simulated cardiopulmonary resuscitation of adults. CC were carried out in two scenarios: with and without TrueCPR chest compression support. Participants did not have experience in the use of CCs prior to this study. Results: The depth of compressions in regard to CC techniques were varied by 45 mm (IQR 43–48) for manual CC and 53 mm (IQR 51–55) for the TrueCPR device (p < 0.001). The incidence of CCs with and without TrueCPR was: 112 (IQR 103–113) vs. 129 (IQR 122–135) compressions (p = 0.002). The degree of complete chest relaxation with the TrueCPR device was 95% (IQR 76–99) and without the device, 33% (IQR 29–38) (p < 0.001). Conclusions: In the simulation study performed, the use of the TrueCPR device resulted in a significant improvement in the quality of CCs in relation to frequency and depth of CCs and correctness of chest relaxation.

The aim of the study was to assess the impact of individual components of the metabolic syndrome on the human body, taking into account their etiology and pathogenesis. This article is analytical analysis of scientific and medical literature basing on aspects of the etiology and pathogenesis of the metabolic syndrome. The key role in the pathogenesis of the metabolic syndrome is played by insulin resistance, which may be a result of lifestyle conditions (low physical activity, overweight or obesity) or genetic background. A certain role in the pathogenesis of the metabolic syndrome is also attributed to disorders of the hypothalamic-pituitary-adrenal axis in the form of increased cortisol control, which may initiate the development of abdominal obesity, insulin resistance, hypertension and dyslipidemia. Aforementioned factors (environmental, hormonal and genetic) lead to excessive fat tissue gathering. The excess of abdominal fat tissue – abdominal obesity – leads to insulin resistance, the concentration of which causes body mass gain. Such mechanism is dangerous for our health and may lead to the occurrence of type 2 diabetes and premature development of atherosclerosis with all its consequences such as atherosclerotic cardiovascular diseases including coronary artery disease.

INTRODUCTION Obesity‑related hypertension is a life threatening medical condition that significantly increases the risk of cardiovascular diseases and premature mortality. Effective treatment of obesity may be achieved by laparoscopic sleeve gastrectomy (LSG). This surgical method contributes not only to sustained weight loss but also to normalization of blood pressure. OBJECTIVES To evaluate the effect of weight loss after LSG on partial or full control of blood pressure. PATIENTS AND METHODS A retrospective analysis of medical and clinical data of 305 patients who had undergone LSG was performed. The bariatric effect of LSG was assessed by calculating percentage of total weight loss (%TWL), percentage of excess weight loss (%EWL), and percentage of excess BMI loss (%EBMIL). Blood pressure status after surgery was categorized as partial or full hypertension resolution. RESULTS A total of 143 patients (46.9%) were diagnosed with hypertension preoperatively with median (IQR) hypertension duration of 7.52 (1.88-13.16) years. Hypertensive patients were older (49 vs 38.5 years) and had higher prevalence of coexisting diseases (type 2 diabetes, dyslipidemia, and obstructive sleep apnea) than patients with normal blood pressure. During 1‑year follow up, 90 patients (63%) used lower doses of antihypertensive medications and 33 patients (23%) discontinued the therapy. Twelve months after the surgery, median (IQR) %TWL in the control group was 32.5% (28.1%-37.7%), while in the hypertensive group, 29.1% (25.9%-33.6%) (P

ObjectiveThe implementation of drones in the medical security system requires a proper planning of the cooperation of different services, dividing the area into sectors, assessing potential risks, and other factors. This study refers to the cost analysis of using drones in the medical support of mass events. The aim of this research is to analyze the costs of unmanned aerial vehicle (UAV) implementation in the mass event medical support system.MethodsThe description includes purchase and maintenance costs of UAVs. The analysis also involves ways of raising funds for projects related to the UAV sector. Apart from the financial aspect, staff and drone operator training issues are the subjects of this analysis as well.ResultsThis study is based on a specialist research involving drones and referring to reports on the current situation in Poland and in the world.ConclusionsThe presented funds required for such projects and the way of raising these funds illustrate the range of the project and its requirements. (Disaster Med Public Health Preparedness. 2019;13:527-532)

Insulin resistance (IR) is a condition of impaired tissue response to insulin. Although there are many methods to diagnose IR, new biomarkers are still being sought for early and noninvasive diagnosis of the disease. Of particular interest in laboratory diagnostics is saliva collected in a stress-free, noninvasive, and straightforward manner. The purpose of the study was to evaluate the diagnostic utility of salivary redox biomarkers in preclinical studies in an animal model. The study was conducted on 20 male Wistar rats divided into two equal groups: a standard diet and a high-fat diet (HFD). In all rats fed the HFD, IR was confirmed by an elevated homeostasis model assessment (HOMA-IR) index. We have shown that IR is responsible for the depletion of the enzymatic (↓superoxide dismutase) and nonenzymatic (↓ascorbic acid, ↓reduced glutathione (GSH)) antioxidant barrier at both the central (serum/plasma) and salivary gland (saliva) levels. In IR rats, we also demonstrated significantly higher concentrations of protein/lipid oxidation (↑protein carbonyls, ↑4-hydroxynoneal (4-HNE)), glycation (↑advanced glycation end products), and nitration (↑3-nitrotyrosine) products in both saliva and blood plasma. Salivary nonenzymatic antioxidants and oxidative stress products generally correlate with their blood levels, while GSH and 4-HNE have the highest correlation coefficient. Salivary GSH and 4-HNE correlate with body weight and BMI and indices of carbohydrate metabolism (glucose, insulin, HOMA-IR) and proinflammatory adipokines (leptin, resistin, TNF-α). These biomarkers differentiate IR from healthy controls with very high sensitivity (100%) and specificity (100%). The high diagnostic utility of salivary GSH and 4-HNE is also confirmed by multivariate regression analysis. Summarizing, saliva can be used to assess the systemic antioxidant status and the intensity of systemic oxidative stress. Salivary GSH and 4-HNE may be potential biomarkers of IR progression. There is a need for human clinical trials to evaluate the diagnostic utility of salivary redox biomarkers in IR conditions.

Valsartan belongs to angiotensin II type 1 (AT1) receptor blockers (ARB) used in cardiovascular diseases like heart failure and hypertension. Except for its AT1-antagonism, another mechanism of drug action has been suggested in recent research. One of the supposed actions refers to the positive impact on redox balance and reducing protein glycation. Our study is aimed at assessing the antiglycooxidant properties of valsartan in an in vitro model of oxidized bovine serum albumin (BSA). Glucose, fructose, ribose, glyoxal (GO), methylglyoxal (MGO), and chloramine T were used as glycation or oxidation agents. Protein oxidation products (total thiols, protein carbonyls (PC), and advanced oxidation protein products (AOPP)), glycooxidation products (tryptophan, kynurenine, N-formylkynurenine, and dityrosine), glycation products (amyloid-β structure, fructosamine, and advanced glycation end products (AGE)), and albumin antioxidant activity (total antioxidant capacity (TAC), DPPH assay, and ferric reducing antioxidant power (FRAP)) were measured in each sample. In the presence of valsartan, concentrations of protein oxidation and glycation products were significantly lower comparing to control. Moreover, albumin antioxidant activity was significantly higher in those samples. The drug’s action was comparable to renowned antiglycation agents and antioxidants, e.g., aminoguanidine, metformin, Trolox, N-acetylcysteine, or alpha-lipoic acid. The conducted experiment proves that valsartan can ameliorate protein glycation and oxidation in vitro in various conditions. Available animal and clinical studies uphold this statement, but further research is needed to confirm it, as reduction of protein oxidation and glycation may prevent cardiovascular disease development.

IMPORTANCE: Remdesivir demonstrated clinical benefit in a placebo-controlled trial in patients with severe coronavirus disease 2019 (COVID-19), but its effect in patients with moderate disease is unknown. OBJECTIVE: To determine the efficacy of 5 or 10 days of remdesivir treatment compared with standard care on clinical status on day 11 after initiation of treatment. DESIGN, SETTING, AND PARTICIPANTS: Randomized, open-label trial of hospitalized patients with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and moderate COVID-19 pneumonia (pulmonary infiltrates and room-air oxygen saturation >94%) enrolled from March 15 through April 18, 2020, at 105 hospitals in the United States, Europe, and Asia. The date of final follow-up was May 20, 2020. INTERVENTIONS: Patients were randomized in a 1:1:1 ratio to receive a 10-day course of remdesivir (n = 197), a 5-day course of remdesivir (n = 199), or standard care (n = 200). Remdesivir was dosed intravenously at 200 mg on day 1 followed by 100 mg/d. MAIN OUTCOMES AND MEASURES: The primary end point was clinical status on day 11 on a 7-point ordinal scale ranging from death (category 1) to discharged (category 7). Differences between remdesivir treatment groups and standard care were calculated using proportional odds models and expressed as odds ratios. An odds ratio greater than 1 indicates difference in clinical status distribution toward category 7 for the remdesivir group vs the standard care group. RESULTS: Among 596 patients who were randomized, 584 began the study and received remdesivir or continued standard care (median age, 57 [interquartile range, 46-66] years; 227 [39%] women; 56% had cardiovascular disease, 42% hypertension, and 40% diabetes), and 533 (91%) completed the trial. Median length of treatment was 5 days for patients in the 5-day remdesivir group and 6 days for patients in the 10-day remdesivir group. On day 11, patients in the 5-day remdesivir group had statistically significantly higher odds of a better clinical status distribution than those receiving standard care (odds ratio, 1.65; 95% CI, 1.09-2.48; P = .02). The clinical status distribution on day 11 between the 10-day remdesivir and standard care groups was not significantly different (P = .18 by Wilcoxon rank sum test). By day 28, 9 patients had died: 2 (1%) in the 5-day remdesivir group, 3 (2%) in the 10-day remdesivir group, and 4 (2%) in the standard care group. Nausea (10% vs 3%), hypokalemia (6% vs 2%), and headache (5% vs 3%) were more frequent among remdesivir-treated patients compared with standard care. CONCLUSIONS AND RELEVANCE: Among patients with moderate COVID-19, those randomized to a 10-day course of remdesivir did not have a statistically significant difference in clinical status compared with standard care at 11 days after initiation of treatment. Patients randomized to a 5-day course of remdesivir had a statistically significant difference in clinical status compared with standard care, but the difference was of uncertain clinical importance. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04292730

Symptoms of hypertension with accompanying complications result in a significant reduction in patients&rsquo, quality of life. Effective conduct of prescribed pharmacotherapy supported by a healthy lifestyle allows to achieve satisfactory effects of treatment, which translates into an improvement in the quality of life of patients. The aim of the work was to determine the quality of life of patients with hypertension and the factors affecting it. The study included 100 people with hypertension, who are patients of the department of internal diseases of the hospital in Hajn&oacute, wka during the period 1.6.2019&ndash, 1.12.2019. The questionnaire survey, the standardized WHO Quality of Life (WHOQOL)-BREF scale and the Barthel scale were the research tools. The probability p &lt, 0.05 was assumed as the level of statistical significance. The study group consisted of subjects between 30&ndash, 89 years old. The majority were men and those living in the city. The average BMI (body mass index) of the subjects was 28.4 kg/m2. The duration of the disease among those surveyed was on average 7 &plusmn, 6.34 years. The highest-rated area of quality of life was the physical field and the lowest social sphere according to the WHOQOL-BREF questionnaire. Patients with hypertension have determined their quality of life at a good or medium level in the physical, psychological, social, and environmental sphere. There are many factors that improve quality of life in all areas. These include following the recommendations on modifiable risk factors.

Background: Appropriate pharmacotherapy during advanced resuscitation procedures may affect the return of spontaneous circulation. Current guidelines on cardiopulmonary resuscitation recommend amiodarone for shock‑refractory cardiac arrest or when lidocaine is not available. Aims: The aim of this study was to systematically analyze the available literature and to conduct a meta‑‑analysis to determine the effect of amiodarone and lidocaine on survival and neurological outcome after shock‑refractory cardiac arrest. Methods: PubMed, Scopus, Embase, Web of Science, and Cochrane Library databases were searched. Two independent reviewers screened randomized and quasi‑randomized controlled trials as well as cohort and cross‑sectional trials evaluating amiodarone or lidocaine for the treatment of adults with cardiac arrest. Results: After screening 682 unique references, 8 were selected for this meta‑analysis. A higher number of cases with return of spontaneous circulation was observed in the amiodarone group compared with the lidocaine group (OR, 1.03; 95% CI, 0.87–1.21; P = 0.75). A similar relationship was observed for survival to hospital discharge (OR, 1.12; 95% CI, 0.92–1.38; P = 0.26), as well as survival with favorable neurological outcome (OR, 1.11; 95% CI, 0.89–1.39; P = 0.35). Conclusions: We found no statistically significant survival benefit of resuscitation with amiodarone compared with lidocaine. Future randomized controlled trials are needed to identify which antiarrhythmic drug should be use in shock‑refractory cardiac arrest.

Background and Objectives: Choosing a pain management strategy is essential for improving recovery after surgery. Effective pain management reduces the stress response, facilitates mobilization, and improves the quality of the postoperative period. The aim of the study was to assess the effectiveness of pain management in patients after surgery. Materials and Methods: The study included 216 patients operated on in the following surgical wards: the Department of Cardiosurgery and the Department of General and Endocrine Surgery. Patients were hospitalized on average for 6 &plusmn, 4.5 days. Patients were randomly selected for the study using a questionnaire technique with a numerical rating scale. Results: Immediately after surgery, pre-emptive analgesia, multimodal analgesia, and analgosedation were used significantly more frequently than other methods (p &lt, 0.001). In the subsequent postoperative days, the method of administering drugs on demand was used most often. Patients with confirmed complications during postoperative wound healing required significantly more frequent use of drugs from Steps 2 and 3 of the World Health Organization (WHO) analgesic ladder compared with patients without complications. Conclusion: The mode of patient admission for surgery significantly affected the level of pain perception. Different pain management methods were used and not every method was effective.

Despite the proven role of oxidative stress in numerous systemic diseases and in the process of aging, little is still known about the salivary redox balance of healthy children, adults, and the elderly. Our study was the first to assess the antioxidant barrier, redox status, and oxidative damage in nonstimulated (NWS) and stimulated (SWS) saliva as well as blood samples of healthy individuals at different ages. We divided 90 generally healthy people into three equally numbered groups based on age: 2–14 (children and adolescents), 25–45 (adults), and 65–85 (elderly people). Antioxidant enzymes (salivary peroxidase (Px), glutathione peroxidase (GPx), catalase (CAT), and superoxide dismutase-1 (SOD)), nonenzymatic antioxidants (reduced glutathione (GSH) and uric acid (UA)), redox status (total antioxidant capacity (TAC), total oxidant status (TOS), and oxidative stress index (OSI)), and oxidative damage products (advanced glycation end products (AGE), advanced oxidation protein products (AOPP), and malondialdehyde (MDA)) were evaluated in NWS and SWS as well as in erythrocyte/plasma samples. We demonstrated that salivary and blood antioxidant defense is most effective in people aged 25–45. In the elderly, we observed a progressive decrease in the efficiency of central antioxidant systems (↓GPx, ↓SOD, ↓GSH, and ↓TAC in erythrocytes and plasma vs. adults) as well as in NWS (↓Px, ↓UA, and ↓TAC vs. adults) and SWS (↓TAC vs. adults). Both local and systemic antioxidant systems were less efficient in children and adolescents than in the group of middle-aged people, which indicates age-related immaturity of antioxidant mechanisms. Oxidative damage to proteins (↑AGE, ↑AOPP) and lipids (↑MDA) was significantly higher in saliva and plasma of elderly people in comparison with adults and children/adolescents. Of all the evaluated biomarkers, only salivary oxidative damage products generally reflected their content in blood plasma. The level of salivary redox biomarkers did not vary based on gender.