Professional burnout of doctors in Poland and in the world. Research review

The work of a doctor is one of the most demanding. It requires not only a great deal of knowledge, but also a lot of commitment, responsibility and often devoting one's private life. It is called a prestigious job for a reason. Unfortunately, it is also very absorbing both mentally and physically. Increasing stress leads to emotional exhaustion, and its consequence may be burnout

Anxiety and depression intensity and the quality of life of patients with an implanted pacemaker

Introduction. The consequences of anxiety and depression in various forms affect the course of cardiovascular diseases - including patients with an implanted pacemaker. To improve the quality of care for such patients, it is important to understand the scale of the problem, as well as to determine the impact of the above-mentioned symptoms on the patients' quality of life.Aim of research. The aim of the study was to assess the relationship between the quality of life and the anxiety and depression intensity on patients with implanted pacemakers.Material and methods. The study involved 100 patients hospitalized at the SPSK 4 cardiology clinic in Lublin with an implanted pacemaker. The method of diagnostic survey and research tools were used - the WHOQOL - Bref questionnaire to assess the quality of life and the Hospital Anxiety and Depression Scale (HADS-M). The results of the research are summarized in the statistical analysis.Results. The average score obtained by the respondents on the depression scale was 6.05 points with a standard deviation of 4.47. On the anxiety scale, this result was 7.99 points with a standard deviation of 4.54. The results indicating disorders in both scales concern values higher than or equal to 11 points. On the depression scale they were obtained by 16% of the respondents, while on the anxiety scale 26%. The conducted analyses showed a statistically significant relationship between the level of anxiety and depression and the quality of life of the respondents in all domains. The overall declared quality of life of the respondents and the self-esteem of the health condition were the lower, the higher the anxiety and depression severity coefficient in the study group.Conclusions.1. Most of the studied patients with pacemakers do not have high levels of anxiety and depression. 2. The occurrence of anxiety and depression affects the quality of life of respondents after pacemaker implantation in all domains. 3. Patients with high levels of anxiety and depression have a lower assessment of their quality of life and health

Limits of body composition assessment by bioelectrical impedance analysis (BIA)

Bioelectrical impedance analysis (BIA) is a safe, non-invasive and repeatable method of body composition assessment, based on diversified electrical conduction through the aqueous and fat compartment of the body. The popularity and availability of the BIA study has increased in recent years. The aim of the work is to discuss its limitations, which can be divided into factors affecting the measurement of parameters and contraindications for measurements. The first group includes body structure, obesity and malnutrition, body temperature, intake of fluids and foods, changes in hydration and water and electrolyte balance, physical activity, long-term staying in a supine position, examination procedure and method of placing measuring electrodes. Contraindications include implanted cardiac devices (cardiac pacemaker, implantable cardioverter-defibrillator, resynchronization therapy), metal implants and pregnancy. There is no unambiguous confirmation of the validity of the mentioned contraindications in literature. Knowing the limitations of BIA is important because parts of potential errors can be avoided by properly preparing for the examination and following appropriate procedures during the measurements

Powikłania okołooperacyjne u pacjentek z cukrzycą poddanych zabiegom ginekologicznym

Objectives: The aim of the study was to estimate whether diabetes was an independent risk factor for perioperative complications in patients undergoing gynecologic surgery. Material and methods: The study population consisted of 182 women (diabetics and controls) who underwent elective gynecologic surgery. Each patient without diabetes from the control group and matched for age and body mass index diabetic patient were admitted with the same gynecologic diagnosis, underwent the same gynecologic procedure, were operated on in the same operating room and were hospitalized within the same time interval. The following parameters of the perioperative period were compared between every matched pair of patients (diabetic vs. non-diabetic patient): number and characteristics of intra- and postoperative complications, length of postoperative hospitalization, decrease in hemoglobin level, increase in body temperature, and postoperative use of antibiotics. Results: The study revealed no statistically significant differences between the diabetic patients and pair-matched controls in terms of the examined parameters of the perioperative period. Conclusions: Diabetes was not an independent risk factor for early postoperative complications after gynecologic procedures in the examined population. Good pre-operative glycemic control and strict cooperation of the diabetologist with the surgeon in the perioperative period resulted in reduction of the complication rate to the level typical for non-diabetic patients.  Cel pracy: Celem pracy było ustalenie, czy w badanej grupie pacjentek które zostały poddane zabiegom ginekologicznym, cukrzyca stanowiła niezależny czynnik ryzyka powikłań okołooperacyjnych. Materiał i metody: Badaniami objęto 182 kobiety (grupa badana i kontrolna łącznie) które zostały poddane zabiegom oraz operacjom ginekologicznym w trybie planowym. Każdej pacjentce z cukrzycą przyporządkowano pacjentkę bez cukrzycy: w podobnym wieku, o zbliżonej wartości wskaźnika masy ciała, z tym samym ginekologicznym rozpoznaniem zasadniczym, poddaną takiemu samemu zabiegowi operacyjnemu i na tej samej sali zabiegowej/operacyjnej, co pacjentka z grupy badanej oraz hospitalizowaną w tym samym okresie czasu. Następujące parametry okresu okołooperacyjnego zostały porównane między każdą pacjentką z cukrzycą i przyporządkowaną jej pacjentką bez cukrzycy: liczba i charakter powikłań, czas pooperacyjnej hospitalizacji, spadek stężenia hemoglobiny, wzrostu temperatury ciała, pozabiegowe zastosowanie antybiotyków. Wyniki: Nie wykazano istotnych statystycznie różnic między grupą cukrzycową a grupą kontrolną w zakresie analizowanych parametrów okresu okołooperacyjnego. Wnioski: Cukrzyca nie stanowiła niezależnego czynnika ryzyka wczesnych powikłań okołooperacyjnych po zabiegach ginekologicznych we wszystkich rodzajach zabiegów. Dobre przedoperacyjne wyrównanie cukrzycy, ocena pacjentek z cukrzycą przez lekarza diabetologa oraz ścisła współpraca okołooperacyjna między lekarzem ginekologiem a diabetologiem umożliwia ograniczenie liczby powikłań okołozabiegowych w grupie chorych z cukrzycą poddawanych zabiegom ginekologicznym do poziomu odpowiadającego pacjentkom bez cukrzycy.

Nutritional support in sepsis and septic shock

Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection. Its incidence is increasing worldwide. Sepsis and septic shock are associated with changes in metabolism. So far, research into nutrition and metabolism in sepsis has shown inconsistent results. Inadequate nutrition (both malnutrition and overfeeding) is detrimental for the patient. According to current recommendations, the treatment of choice in patients with sepsis is enteral nutrition, which is associated with many benefits. In the absence of enteral nutrition or the inability to provide the patient's energy requirements, total or partial parenteral nutrition is indicated. ESPEN guideline on clinical nutrition in the intensive care unit recommends for critically ill mechanically ventilated patients to assess energy expenditure by indirect calorimetry - in this case, hypocaloric nutrition is recommended in the early acute phase, and gradual introduction of isocaloric nutrition at a later stage. For critically ill patients, a progressive supply of 1.3 g/kg BW protein equivalents per day is recommended. The amount of carbohydrates should not exceed 5 mg/kg BW/ min. Intravenous lipid emulsions in parenteral nutrition should not exceed 1.5 g lipids/kg BW/day and should be adequate to the patient's tolerance. There is no clear evidence of the effect of supplementation with fish oil, antioxidants and glutamine on the results of treatment in patients with sepsis, none of these substances is indicated for routine use. More research is needed into the metabolism and nutrition of patients with sepsis

Popular co-occurrence of thyroid autoimmune disorders and specific gastrointestinal tract diseases

Introduction: Thyroid gland, despite of its small average size, is a crucial organ of human body. Hormones produced by the thyroid i.e. thyroxine (T4) and triiodothyronine (T3) are necessary for proper functioning the whole organism. Excess or deficiency of these hormones manifest as multiple symptoms of different organs or systems. In this review we focused on special complaints of gastrointestinal tract. Worth to notice is that some thyroid disorders are present in particular gastrointestinal disorders more frequently. Purpose: The aim of this review is to indicate co-occurrence disorders of the thyroid gland, especially autoimmune thyroiditis with disorders of some organs of gastrointestinal tract. State of knowledge: By this time we can enumerate series of thyroid diseases, i.e. hypothyroidism, hyperthyroidism, thyroid nodular goiter, neoplasms or multiple forms of thyroiditis. Generally chronic autoimmune thyroiditis is the most frequent disorders of the gland. That’s the reason why we focused on coexisting this state with gastritis, chronic inflammatory bowel diseases, steatosis of the liver or with neoplasms of gastrointestinal tract. We aim to prove the necessary of constitute diagnosis towards other autoimmune diseases, when the one has bed diagnosed. Thyroid disorders may result in abnormalities of functioning particular organs of the human body. This fact may have an impact on blood tests results – for example elevation of transaminases evaluating function of the liver is often noted in thyroid diseases, what should sensitize clinicians towards performing diagnostics of thyroid function during treatment of liver or intestines or stomach dysfunction. Summary: Diseases of the thyroid gland may coexist with particular diseases of gastrointestinal tract. They may alter the course of these disorders and constitute unfavorable factor of the treatment

Metabolic syndrome - diagnostics, pathophysiology and treatment

Abstract Metabolic syndrome, though it is not a disease included in ICD-10, is a serious epidemiological problem as much as a challenge for medicine and prevention of developed countries. The aim of this work is to discuss, based on literature, the basics of pathophysiology, diagnostic criteria and principles of treatment of the metabolic syndrome. The diagnosis of the metabolic syndrome is based on simple criteria, which include: abdominal circumference, blood pressure and triglycerides, HDL cholesterol and glucose levels. This allows the diagnosis of the metabolic syndrome at the level of primary care. The basis for treatment of the metabolic syndrome is behavioural therapy, sometimes, at non-advanced stage of the disease, it is sufficient. Due to the significant progress in pathophysiology of the metabolic syndrome, it is possible to determine its primary causes and risk factors - obesity and insulin resistance. Both of them belong to the reversible states, which is motivation to detect and treat these conditions before irreversible complications develop

Platelet distribution width (PDW) and platecrit (PCT) as the new biomarkers of the myocardial infarction

Introduction Despite the advancement of medicine in the field of diagnostics and treatment of myocardial infarction, the annual mortality rate exceeds 40%, which is why it is still being strived to develop better and more specific markers of myocardial damage, which would allow for faster diagnosis and thus would improve the prognosis in this group of patients. Objective The objective of the study was to assess the relationship between the platelet with distribution (PDW) and plateletcrit (PCT) and the occurrence of myocardial infarction. Results People who suffered from a heart attack had higher PLT and PCT values than those who did not. Conclusions Author study research has not confirmed the relationship between PDW and PCT and the occurrence of myocardial infarction. Keywords: myocardial infarctio

Quality of life of patients after implantation of a pacemaker

Introduction. According to data from 2017 provided by the National Health Fund, nearly 30,000 pacemakers and 10,000 cardioverter-defibrillators have been implanted in Poland so far. Pacemaker implantation alone results in an improvement in the quality of life in approximately 35% of patients. Interest in the subject of quality of life can be seen in researchers from various fields since the middle of the last century. Despite the passing years, the demand for comprehensive research on the quality of life in the group of patients with an implanted pacemaker does not decrease.Purpose of research. The aim of the study was to assess the quality of life of patients after implantation of a pacemaker.Material and methods. The study included 100 patients after implantation of a pacemaker, treated at the SPSK 4 cardiology ward and outpatient clinic in Lublin from January to May 2020. The diagnostic survey method was used, and the WHOQOL-BREF standardized tool was used to collect the research material. The obtained results were compiled in a statistical analysis.Results. It was shown that 64% of patients with implanted pacemakers rated their quality of life as at least good. The result of the self-assessment of health was lower, 41% of respondents scored above the average criterion. The highest results were observed in the domain of the functioning environment, and the lowest in the physical domain.Conclusions. The quality of life of most subjects with an implanted pacemaker is at least at a good level. Self-assessment of patients' health is lower than the overall assessment of the quality of life. In patients with an implanted pacemaker, the quality of life was rated the lowest in the physical domain, and the highest in the aspect of the functioning environment

Hyponatremia as drug-induced or secondary to endocrine disorder electrolyte abnormality

Introduction: Hyponatremia is one of the most commonly occuring electrolyte disorder. The main clinical symptoms of natrium imbalance are weakness, lost of appetite, headache, nausea with or without vomiting or altered mental status with somnolence or even seizures and death. Purpose: To present a list of drugs pretending to occurrence or natrium serum level reduction and known endocrine disorder causing hyponatremia. Summary: Hyponatremia is very common electrolyte disorder. Changes that may develop in human organism in the presence of this type of dyselectrolytemia, may be extremely dangerous for proper functioning and life of the entity. It’s well known, that hyponatremia may be caused by multiple factors, such as hormonal disturbances, taking special medicines or even excessive physical activity. It may also develop due to popular health conditions, for example congestive heart failure, liver cirrhosis, malignancies, neurological disorders or human-immunodeficiency virus infection1⁠. The huge amount of patients that are hospitalized in Chair and Department of Endocrinology in Lublin has prompted us to right analysis, due to available medical literature - the endocrine causes of hyponatremia. In second part of this review paper we aimed to enumerate drugs, that are able to result in developing hyponatremia