Demographic features of type 2 diabetes patients are associated with diabetes control in terms of primary health care

Aim. The aim of this study was to evaluate the association between selected demographic features of type 2 diabetes (T2D) patients and glycemia control expressed as the percentage of glycated hemoglobin (HbA1c) in the period of publishing the first diabetes treatment guidelines for general practitioners (GPs). Material and method. Medical records of 209 patients with type 2 diabetes (84 men and 125 women) aged from 22 to 87 years (mean age 65.8 years) from two general practitioners’ (GPs) practices in 2009 and 2010 were retrospec- tively assessed. Analysis of HbA1c was performed using high performance liquid chromatography (HPLC). Results. In regard to 2010 significantly higher mean percentage of HbA1c was found: in men compared to women (7.9±1.9% vs 7.1±1.1%); in patients <70 years of age compared to ≥70 years of age (7.7±1.8% vs 7.0±0.9%); in the population <70 years of age – in men compared to women (8.2±2.0% vs 7.2±1.3%) and in the group of men <70 years of age compared with ≥70 years of age (8.2±2.0% vs 7.0±1.1%). Among the 66 patients analyzed in both years, lower mean percentage of HbA1c was demonstrated in the group <70 years of age in 2009 compared to 2010 (7.3 ± 1.1% vs 7.8 ± 1.5%). By contrast, regarding 2010 patients <70 years of age had a higher HbA1c than those ≥70 years of age (7.8 ± 1.5% vs 7.1 ± 0.9%). Discussion and conclusions. Demographic features of patients with type 2 diabetes treated in primary care are associated with glycemia control. GPs should take into consideration patients’ demographic characteristics, especially being a younger men, when planning treatment of type 2 diabetes. Read full text »

Effect of Left Ventricular Systolic Dysfunction on Renal Transplantation Outcomes- A Paired Kidney Analysis

Background: Reduced left ventricular ejection fraction (LVEF) is thought to be a rel-ative contraindication for kidney transplantation (KT). It is not clear how to manage congestive heart failure (CHF) due to left ventricular systolic dysfunction in patients with end-stage renal disease (ESRD). Material and Methods: A total of 21 kidney recipients transplanted between 2011 and 2013 who had LVEF <55% were ana-lysed in this retro- spective single-centre study. This group was compared with 21 patients with LVEF ≥ 55% who had received another kidney from the same de-ceased donor. The mean duration of follow-up was 32Ī10 months. Results: Con-cerning post – transplant characteristics there were no significant differences be-tween groups regarding rate of urinary tract infection after transplantation, level of serum creatinine at 12 months post KT, patient survival and subjective opinion of patient about their ability to physical effort at the end of follow up comparing to pre-transplant condition. In the group with reduced EF there were more incidences of delayed graft func- tion(28.8% vs 14.3%, p=0.29)and lower rate of graft survival( 85.7% vs 100%, p=0.23) but the differences did not reach statistical significance. Conclusion: Reduced EF should not exclude patients from consideration for KT, however greater caution is recommended.
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Heat Stroke. Review

The HS is an acquired disease that cla- ims many lives as they pass the hottest stages of each year, taking a record in each country and sometimes increased mortality figures for this entity associated with hot flashes, which are Frequent daily as a result of natural disasters, pollution, sudden climatic changes, etc.
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Is there a limit for expanding criteria of kidney donors? How far can we go?

Introduction: The lack of organs for transplantation has forced the transplant community to expand the pool of donors. Using expanded criteria donor (ECD) organs is one of the strategies. Although there are organs that do not fit into definition of ECD and remains controversial for transplantation. The aim of this paper is to report the criteria of discharging kidney from transplantation.
Material and methods: 704 patients received cadaveric renal transplants between January 1, 2010 and August 31, 2015. In this time 181 kidneys were discharged from the transplantation – 125 kidneys (63 referred potential donors) were disqu- alified before organ procurement and 56 kidneys were rejected from transplantation during organ storage. Data on donors and preservation parameters were collected. Causes of organ refusal were analysed.
Results: The most common causes of kidney rejection from transplantation was poor donor kidney parameters with pro- bability of kidney irreversible injury (84 kidneys – 46,4%) and malignancy or strong suspicion of malignancy in donor body (44 organs – 24,3%). The next causes of kidneys disqualifications were unsatisfactory parameters during machine per- fusion (20 kidneys – 11%) and hepatitis C virus (HCV) or hepatitis B virus (HBV) infection in donor body with no recipients with negative crossmatch (7 kidneys – 3,9%). The less common causes of kidney rejection from transplantation were anatomical abnormalities (6 organs), nephrolithiasis (5 kidneys) and the others less frequent causes.
Conclusion: Careful kidney selection is recommended in cases of expanded criteria donor kidneys in order to diminish factors that can negatively affect graft function and survival.
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Music therapy – history of development (part 2)

The contemporary music therapy is a relatively new scientific and therapeutic field, which has its beginnings in ancient times. Records of music therapy treatment can be found both in the Holy Bible, as well as in old Roman sources, Greek mythology and the Far East writings. Since the introduction of the current term of the music therapy, the very concept of using music for therapeutic purposes has been constantly changing and evolving. Apart from the American and Swedish research, Polish scientist have also contributed to the deve- lopment of the method. The therapeutic effects of music have already been used in pedagogy, psychology, rehabilitation and many other areas. Music finds numerous applications in various branches of medicine due to its influence on the emotional sphere of human life and, in consequence, also on the physiological parameters of the human body. Music therapy can be divided into two categories: receptive and active one. Although in medicine mainly the former is preferred, it is an interesting alternative to the pharmacological treatment, which in itself encounters many limitations. The possibility of using music therapy in reducing the level of anxiety in patients is particularly important in dental practice. The high percentage of patients suffering from dentophobia and a profound impact of the increased anxiety level on the intensification of pain perception may provide sufficient incentive for introducing music therapy as a standard procedure.
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Meckel’s diverticulum resection as a part of Emergency General Surgery – single centre experience in years 2006-2014.

Background: An emergency surgery is a medical procedure that must be performed immediately to solve the patients’ health problem successfully. A delay of this medical procedure could result in a death or a permanent impairment of the health. An emergency surgery can be also defined as a surgery which is required to be performed in case of an acute threat to life of an organ, limb or tissue caused by an external trauma, acute disease process, acute exacerbation of a chronic disease process or complication of a surgical or other interventional procedure. Scott and co-workers [1] analysed 3.1 million of patients admitted to the hospital due to acute indication and they reported that emergency general surgery (EGS) represents 11% of admissions. EGS includes: cute appendicitis, peritonitis, bowel obstruction, acute mesenteric ischemia, gastrointestinal perforation or bleeding, acute cholecystitis, irreducible or incarcerated hernias, injuries after accidents e. g. organ fractures, intentional ingestion of foreign bodies or poisonous substances. Read full text »

A Model-Based Meta-Analysis Evaluating Gender Differences on Blood Flow Responses to Brachial Artery Infusions of Acetylcholine, Albuterol, ATP, Bradykinin, Estradiol, Glyceryl Trinitrate, L-NMMA, Nevibolol, Norepinephrine, Sodium Nitroprusside, Substance P, and Verapamil

Background: Venous occlusion plethysmography (VOP) is a methodology that was originally reported in the literature by A.W. Hewlett and J.G. Van Zwaluwenburg in 1909 [1]. The technique describes an approach to measure blood flow based from factors affecting the forearm vasculature. Since the methodology has been formally presented in the published literature, countless of articles have documented the clinical utility of VOP and is currently the key method for evaluating the physiological responses to various doses of drugs modulating the cardiovascular system. Throughout this time, physicians and scientists evaluating the mechanisms of vasodilation and vasoconstriction have used various compounds to test arterial response based on endothelial dependence (e.g. Acetylcholine or Bradykinin), endothelial independence (e.g. Sodium Nitroprusside or Glyceryl Trinitrate), or other mechanisms like the calcium channel blocking effects of drugs (e.g. Verapamil). Read full text »

Living kidney donor with expanded criteria for qualification – a case report

Background: Nowadays, kidney transplantation is the best way of treatment of end-stage renal failure (1). Results of transplantation of organs procured from living donors are much better in comparison to those from deceased donors (2). Benefits of living donation include not only better graft survival and reduced number of episodes of rejection, but also shorter dialysis time and greater chance for preemptive transplantation (meaning that the recipient remains in pre-dialyses period). Fewer rejection episodes imply the possibility of reducing immunosuppression and therefore, lower incidence of associated complications. Beside the obvious improvement in recipients’ quality of life, the possibility of pre-emptive transplantation significantly reduces the cost of end-stage renal disease treatment in relation to possible avoidance of renal replacement therapy by hemodialysis. In addition, scheduled and controlled character of the procedure improves its safety and reduces the relative length of hospital stay and absence from work due to illness. Read full text »

A Clinical Trial Simulation Evaluating Epinephrine Pharmacokinetics at various Dosing Frequencies during Cardiopulmonary Resuscitation

Background: This article seeks to identify if differences exists in epinephrine blood levels in virtual patients who are administered epinephrine at a dosing interval of either 3-minutes or 5-minutes. According to the most recent, 2015 American Heart Association (AHA) guidelines for cardiopulmonary resuscitation (CPR) epinephrine remains the primary drug of choice during resuscitation with a fixed dose of 1mg for Adult Advanced Cardiovascular Life Support (ACLS) every three to five minutes [1]. Do differences exist in epinephrine kinetics during simulated CPR scenarios in virtual adult patients of varying health backgrounds? This article will used published population pharmacokinetic parameters and dosing simulations will be conducted according to the 2015 AHA adult guidelines. Prior to the pharmacokinetic simulations, this article will review the reported sources of variability influencing epinephrine pharmacokinetics. Read full text »

Recurrent incisional hernia sublay repair with fully reabsorbable monofilament mesh – a case report

Incisional hernia is the most common indication for reoperation after abdominal surgery. Mesh hernioplasty is almost a gold standard of treatment, associated with the low recurrence rate. Study presents a case of usage of a fully reabsorbable mesh for successful sublay hernioplasty in recurrent incisional hernia with a past history of many wound complications.
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