Impact of modality of anesthesia on major amputation surgery

Critical limb ischemia remains a therapeutic challenge and, despite best efforts from the surgical and interventional team, some of these patients will require major amputation. Despite advances in anaesthesia, surgical technique and critical care, there remains a significant 30-day mortality in this group. Recent quality improvement frameworks have sought to improve outcomes and we present our experience with general and regional anaesthesia in this cohort of patients

Historia rozwoju dermatologii i wenerologii na Podkarpaciu

Historia dermatologii i wenerologii na Podkarpaciu sięga XIX wieku. Dzięki wielkiemu poświęceniu i zaangażowaniu personelu medycznego możliwe było utworzenie pierwszych ośrodków dermatologicznych i wenerologicznych, niosących pomoc chorym ze schorzeniami skórnymi i chorobami przenoszonymi drogą płciową. Ciągłe starania i ciężka praca zaowocowały poprawieniem jakości i zwiększeniem dostępu pacjentów do świadczeń zdrowotnych. Obecnie na Podkarpaciu funkcjonuje sześć oddziałów dermatologicznych, a ponadto są tu liczne poradnie dermatologiczne, wyposażone w sprzęt pozwalający na diagnostykę oraz leczenie schorzeń dermatologicznych i poprawę komfortu życia chorych. W niniejszym artykule przedstawiono historię i rozwój wybranych oddziałów i poradni dermatologicznych na terenie Podkarpacia

The development and validation of a scoring tool to predict the operative duration of elective laparoscopic cholecystectomy

Background: The ability to accurately predict operative duration has the potential to optimise theatre efficiency and utilisation, thus reducing costs and increasing staff and patient satisfaction. With laparoscopic cholecystectomy being one of the most commonly performed procedures worldwide, a tool to predict operative duration could be extremely beneficial to healthcare organisations. Methods: Data collected from the CholeS study on patients undergoing cholecystectomy in UK and Irish hospitals between 04/2014 and 05/2014 were used to study operative duration. A multivariable binary logistic regression model was produced in order to identify significant independent predictors of long (> 90 min) operations. The resulting model was converted to a risk score, which was subsequently validated on second cohort of patients using ROC curves. Results: After exclusions, data were available for 7227 patients in the derivation (CholeS) cohort. The median operative duration was 60 min (interquartile range 45–85), with 17.7% of operations lasting longer than 90 min. Ten factors were found to be significant independent predictors of operative durations > 90 min, including ASA, age, previous surgical admissions, BMI, gallbladder wall thickness and CBD diameter. A risk score was then produced from these factors, and applied to a cohort of 2405 patients from a tertiary centre for external validation. This returned an area under the ROC curve of 0.708 (SE = 0.013, p  90 min increasing more than eightfold from 5.1 to 41.8% in the extremes of the score. Conclusion: The scoring tool produced in this study was found to be significantly predictive of long operative durations on validation in an external cohort. As such, the tool may have the potential to enable organisations to better organise theatre lists and deliver greater efficiencies in care

Sexual Dysfunction in Women and Men with Psoriasis: A Cross-Sectional Questionnaire-Based Study

Background and objectives: Psoriasis can lead to feelings of stigmatization, hinder social functioning, and impair quality of life. Psoriasis can also affect sexual activity, but there is still little research on this topic. The present study investigated whether and to what extent psoriasis, its severity, location and extent of skin lesions affect sexual dysfunction. Materials and Methods: A total of 45 women and 64 men aged 18 to 73 years hospitalized for psoriasis exacerbations were included in the study. Psoriasis severity, as assessed by the Psoriasis Area and Severity Index (PASI), ranged from 0.2 to 65 points (mean: 17.0 ± 14.9 points). After collecting demographic and clinical data, each subject was asked to complete the Dermatology Life Quality Index, the 11-item Sexual Life Questionnaire and the International Index of Erectile Function (only men). Results: Our study found that more than 90% of the patients surveyed felt at least a slight unattractiveness due to psoriasis. In approximately 80% of the subjects, the skin lesions at least occasionally affected their sex life, and more than 50% at least sometimes avoided sexual contact. The location of psoriasis, particularly in the genital area (p = 0.01), on the face (p = 0.03) and hands (p = 0.05), also had a significant impact on the level of sexual problems. Psoriasis has a significant impact on the quality of life (QoL), and a deterioration in QoL was strongly correlated with sexual dysfunction (r = 0.6, p < 0.001), PASI scores (r = 0.36, p < 0.001), self-assessment of psoriasis severity and location of psoriatic lesions. Conclusions: Psoriasis leads to various limitations, especially in the sphere of sexual life. Patients with psoriasis feel stigmatized, have lowered self-esteem and consequently experience significant sexual problems. Awareness of the co-occurring psychological aspect of psoriasis and the routine use of validated scales in dermatology practice should contribute to the rapid identification of patients with sexual dysfunction

Original articlePrimary coronary intervention in diabetic octogenarians with acute ST elevation myocardial infarction

Background: Diabetic patients with acute coronary syndrome (ACS) have higher mortality risk than non-diabetic patients. No data are available on long-term results of interventional treatment of ACS in diabetic patients aged ł80 years. Aim: To compare the effects of primary angioplasty (pPCI) on short- and long-term outcome in diabetic patients ≥80 years with ST-elevation myocardial infarction (STEMI) compared to those without diabetes mellitus (DM) of similar age. Methods: In 63 consecutive patients (22% with diabetes mellitus) aged 80-93 years (mean 83±3) with ST elevation ACS (ACS-STE) coronary angiography was performed. Severity of coronary atherosclerosis, effects of pPCI, one-day mortality, in-hospital mortality and one-year mortality were studied. Results: Severity of coronary atherosclerosis measured by angiographic Gensini score and author’s own score was similar in diabetic and non-diabetic patients (23.25±9.6 vs. 20.6±10.2; NS, and 9.1±6.0 vs. 8.1±5.4; NS, respectively). In 78.6% of diabetic subjects and in 69.4% of those without DM, pPCI was performed. Successful pPCI, defined as TIMI 3 flow and residual infarct related stenosisWstęp: Wyniki badań wskazują, że chorzy z ostrymi zespołami wieńcowymi (ACS) z towarzyszącą cukrzycą mają wyższe ryzyko wstrząsu kardiogennego, nawrotu niedokrwienia pomimo skutecznej reperfuzji, zgonu oraz innych powikłań w porównaniu z chorymi bez cukrzycy. Metodą z wyboru leczenia ACS z przetrwałym uniesieniem odcinka ST (ACS-STE) jest pierwotna przezskórna angioplastyka wieńcowa (pPCI). Współczesne standardy postępowania w ACS powstały jednak na podstawie wyników badań z randomizacją, przeprowadzonych w grupie chorych w średnim wiek

Brassinosteroid leaf unrolling QTL mapping in durum wheat

Brassinosteroids are a newly reported class of plant growth phytohormones found in plants throughout the plant kingdom. Functioning at very low concentrations, they play an essential role in improving biomass yield and stress tolerance. There are no reports in the literature of the genetic variability of responsiveness of brassinosteroids in wheat; most studies on brassinosteroids have focused on the physiological effects of exogenous addition of brassinosteroids. Our aim was to study the genetic variation in the responsiveness of a doubled haploid durum wheat population to three brassinosteroid concentrations using the leaf unrolling test, which is a simple bioassay to test brassinosteroid activity. An F1-derived doubled haploid population of 77 individuals from the cross Strongfield/Blackbird was used to construct a genetic map of 427 molecular marker loci. The leaf unrolling test was performed on the parents and doubled haploid genotypes of the population using 0.2, 2 and 20 nM brassinosteroid concentrations. The results indicated significant differences in leaf unrolling between the two parents, doubled haploid genotypes, treatments and genotype-by-treatment combinations. Transgressive segregation beyond Strongfield of leaf unrolling was observed for all concentrations, with the strongest response at 20 nM. Putative quantitative trait loci were revealed in the intervals Xgwm2-Xbarc45 on chromosome 3A and Xwmc643a-Xwmc625a on chromosome 3B. Additional quantitative trait loci were associated with markers Xwmc48a, Xwmc511, Xwmc89a and Xgwmc692 on chromosome 4B, and Xwmc17 on chromosome 7A. This work should enhance the understanding of the relationship between stress tolerance and productivity, and responsiveness to brassinosteroids

Molecular epidemiology of giardiasis from a veterinary perspective

A total of eight Giardia species are accepted. These include: Giardia duodenalis (syn. Giardia intestinalis and Giardia lamblia), which infects humans and animals, Giardia agilis, Giardia ardeae, Giardia psittaci, Giardia muris, Giardia microti, Giardia peramelis and G. cricetidarum, which infect non-human hosts including amphibians, birds, rodents and marsupials. Giardia duodenalis is a species complex consisting of eight assemblages (A-H), with assemblages A and B the dominant assemblages in humans. Molecular studies to date on the zoonotic potential of Giardia in animals are problematic and are hampered by lack of concordance between loci. Livestock (cattle, sheep, goats and pigs) are predominantly infected with G. duodenalis assemblage E, which has recently been shown to be zoonotic, followed by assemblage A. In cats and dogs, assemblages A, B, C, D and F are commonly reported but relatively few studies have conducted molecular typing of humans and their pets and the results are contradictory with some studies support zoonotic transmission but the majority of studies suggesting separate transmission cycles. Giardia also infects a broad range of wildlife hosts and although much less well studied, host-adapted species as well as G. duodenalis assemblages (A-H) have been identified. Fish and other aquatic wildlife represent a source of infection for humans with Giardia via water contamination and/or consumption of undercooked fish and interestingly, assemblage B and A predominated in the two molecular studies conducted to date. Our current knowledge of the transmission dynamics of Giardia is still poor and the development of more discriminatory typing tools such as whole genome sequencing (WGS) of Giardia isolates is therefore essential