Prolonged ventilation post cardiac surgery - tips and pitfalls of the prediction game

<p>Abstract</p> <p>Background</p> <p>Few available models aim to identify patients at risk of prolonged ventilation after cardiac surgery. We compared prediction models developed in ICU in two adjacent periods of time, when significant changes were observed both in population characteristics and the perioperative management.</p> <p>Methods</p> <p>We performed a retrospective review of two cohorts of patients in our department in two subsequent time periods (July 2007 - December 2008, n = 2165; January 2009 - July 2010, n = 2192). The study was approved by the Institutional Ethics Committee and the individual patient consent was not required. Patients were divided with regard to ventilation time of more or less than 48 hours. Preoperative and procedure-related variables for prolonged ventilation were identified and multivariate logistic regression analysis was performed separately for each cohort.</p> <p>Results</p> <p>Most recent patients were older, with more co-morbidities, more frequently undergoing off-pump surgery. At the beginning of 2009 we also changed the technique of postoperative ventilation. Percentage of patients with prolonged ventilation decreased from 5.7% to 2.4% (p < 0.0001).Preoperative and procedure-related variables for prolonged ventilation were identified. Prediction models for prolonged ventilation were different for each cohort. Most recent significant predictors were: aortic aneurysm surgery (OR 12.9), emergency surgery (OR 5.3), combined procedures (OR 5.1), valve procedures (OR 3.2), preoperative renal dysfunction (OR 2.9) and preoperative stroke or TIA (OR 2.8).</p> <p>Conclusions</p> <p>Prediction models for postoperative ventilation should be regularly updated, particularly when major changes are noted in patients' demographics and surgical or anaesthetic technique.</p

On data collection time by an electronic nose

We use electronic nose data of odor measurements to build machine learning classification models. The presented analysis focused on determining the optimal time of measurement, leading to the best model performance. We observe that the most valuable information for classification is available in data collected at the beginning of adsorption and the beginning of the desorption phase of measurement. We demonstrated that the usage of complex features extracted from the sensors’ response gives better classification performance than use as features only raw values of sensors’ response, normalized by baseline. We use a group shuffling cross-validation approach for determining the reported models’ average accuracy and standard deviation

The advantages and disadvantages of using a CO2 laser in endoscopic treatment of laryngeal cancer: a literature review

Introduction: The use of a carbon dioxide (CO2) laser combined with a microscope has revolutionized the surgical approach in treating larynx lesions. This method is mainly used in malignant and premalignant lesions in the larynx. The CO2 laser is also commonly used to widen the glottis and in palliative surgery. Aim of study: The purpose of our study was to show advantages and disadvantages of using a CO2 laser in surgery for laryngeal cancer while analyzing available literature. Material and methods: An unsystematic review of Polish and English-language scientific literature was carried out. Electronic databases: SCOPUS, Google Scholar and PubMed were searched using keywords: laser surgery, CO2 laser, laryngeal cancer, larynx. Description of the state of knowledge: CO2 laser microsurgery is characterized by precision and a high safety profile. Low tracheotomy rate, preservation of the closed anatomical area of the neck, makes the operation lightly burdening, shortens the time of hospitalization and recovery. Moreover, it minimizes costs and has a positive impact on the quality of life. The disadvantages of using a CO2 laser mainly relate to transient perioperative and postoperative complications. Disturbances in voice emission clearly have a negative impact on functioning in society. The use of a carbon dioxide laser in the presence of anesthetic gases creates the risk of ignition in the respiratory tract, tissue burns or attachment of the endotracheal tube. Conclusions: The use of a CO2 laser in the treatment of larynx lesions has advantages and disadvantages. The benefits of this technique outweigh the rare complications. Side effects are usually minor and transient but may lead to damage to health. It is worth remembering that only early neoplastic lesions are operated with the CO2 laser, which emphasizes the essence of prevention. Key words: laser surgery; CO2 laser; laryngeal cancer; laryn

Bupropion - an antidepressant drug with broad therapeutic potential

Introduction: Bupropion is currently mainly used as an atypical antidepressant due to its psychotropic effects. In addition, it shows high potential in reducing withdrawal cravings in addicts, which is also used in the treatment of nicotinism. However, studies in recent years have shown that it may also be useful in other conditions.Aim of the study: Our aim was to review the known usage of bupropion in the fields of psychiatry, neurology and internal medicine, and to identify potential directions for further research. Methods and materials: We reviewed the literature available in the PubMed database, using the key words: "bupropion"; "depression"; "smoking cessation"; "obesity"; "ADHD".Results: Bupropion- an antidepressant drug belonging to the group of selective norepinephrine and dopamine reuptake inhibitors. Bupropion is approved by the FDA(Food and Drug Administration) for the treatment of depression, seasonal affective disorder and nicotinism. The literature shows that it is also effective in off-label indications - treatment of antidepressant-induced sexual dysfunction, attention deficit hyperactivity disorder (ADHD), depression in bipolar disorder, obesity, neuropathic pain and cancer-related fatigue syndrome.Conclusion: Due to the specific effects of bupropion, there are many more usage for the drug than the primary indications for which it is usually used. The usage of the drug described in the literature require additional studies on a larger group of patients

Angiotensin Receptor Antagonist-Neprilysin Inhibitor (ARNI) therapy as a new hope in the population of people with heart failure with reduced ejection fraction (HFrEF)

Introduction: Heart failure affects an estimated 23 million people, as many as 50% of whom suffer from a heart failure with reduced ejection fraction (HFrEF), in which the left ventricle ejection fraction is &lt;40% and is accompanied by clinical symptoms. Given the high mortality rate in this group of patients and the continuous suboptimal control of the condition, novel pharmacotherapy regimens are needed to slow the progression of the disease. Preliminary studies report a positive effect of including an angiotensin receptor antagonist and neprilysin inhibitors (ARNIs) in this group of patients. Aim of the study: The aim of the study was to summarize the benefits of ARNI in a group of patients with HFrEF. Methods and materials: This article is based on the literature found in PubMed Database with use of keywords such as “ARNI”, “neprilysin inhibition”, HFrEF”, “heart failure” Results: The benefits of ARNI therapy in patients with HFrEF originate from reversing myocardial remodeling and increasing left ventricular ejection fraction. ARNI therapy is associated with reduced number of hospitalizations and a lower need for intensive treatment. In addition, ARNI use reduces the risk of cardiovascular death and is responsible for lower overall mortality rate compared to pharmacotherapy with angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor antagonists (ARBs). Conclusion: ARNIs in patients with HFrEF have a positive effect on the rate of cardiovascular hospitalization, as well as reducing cardiovascular-related mortality and total mortality. Future research studies should evaluate the predictive factors of response to treatment with this group of drugs using larger groups of patients

Inositol supplementation - known and possible applications

Introduction: Myo-inositol (MYO) and D-chiro-inositol are chemical compounds known to exert an impact on multiple signaling pathways of a human body. Due to its effects on insulin metabolism and ovaries’ hormone activity their use in polycystic ovary syndrome (PCOS) therapies has been highly recommended in the recent literature. In this article we aim to review the known and possible applications of inositol and its derivatives for treatment of various gynecological and endocrine disorders and to indicate possible directions of further investigations. Methods and materials: This article is based on the literature found in PubMed Database from the period of 2016-2022 with use of keywords such as “inositol”; “myoinositol”; “d-chiro-inositol”; “PCOS”; “insulin”. Results: The applications of myoinositol in the treatment of polycystic ovary syndrome (PCOS) are very well known in recent publications. It is reported that MYO supplementation improves the quality of oocytes, regulates the menstrual cycle and ovulation rates. Prevention of gestational diabetes (GDM) amongst the patients with risk factors is likely another use of inositols. Inositol takes part in phospholipase C pathway, thus its depletion may be the cause for hypothyroidism. Inositol inhibits the expression of aromatase, the enzyme which is responsible for the growth of endometrial tissue - it may constitute a targeting point in the treatment of endometriosis. So far, no adverse effects of inositol isomers have been reported. Conclusion: The use of inositol, its isomers and derivatives represents an interesting direction in the development of the treatment of many conditions associated with endocrine disorders. There is a need for further investigations and studies on larger groups of patients to exploit its potential.

Diagnosis and treatment of mental disorders – a review of the scientific literature

Introduction: Unambiguous definition of mental disorders is difficult, mainly because of          the heterogeneity of this group of diseases and the clarity of the line between pathology and normal. The definition proposed by the World Health Organization (WHO) is widely accepted.                   In practice, definitions from the legislation of a country are also important. Aim of the work: The purpose of this study is to discuss the basic issues of diagnosis                    and treatment of mental disorders. Material and method: A method of non-systematic literature review from databases such           as scientific Google Scholar, PubMed, CinalHl, Scopus, Arianta, Web of Science was used. Results and conclusions: In the treatment of mental disorders, I use pharmacological and        non-pharmacological methods. Psychopharmaceuticals are divided into several groups depending on their mechanism of action. Their selection depends mainly on the diagnosed disease entity and tolerance to treatment. The most widely used group of drugs is the group of non-selective serotonin reuptake inhibitors (SSRIs). Non-pharmacological methods include psychotherapy, electroconvulsive therapy, deep brain stimulation, and psychosurgery

How to restore your voice? - rehabilitation methods after laryngectomy

Introduction: The voice is an unique communication tool, characteristic of each person alone. Lacking the ability to communicate through it, can negatively affect mental health. It turns out that voice and speech rehabilitation after surgery is widely used and allows patients to improve their functioning, giving them a chance to live a normal life.Aim of the study: The purpose of the study was to review the knowledge of voice and speech rehabilitation options for patients after laryngectomy and the results of the methods used. The text is intended to educate professionals and patients who are undergoing surgical treatment and experience concerns about their future functioning.Materials and Methods: Scientific articles were reviewed using the PubMed database using the keywords: voice rehabilitation; total laryngectomy; speech disorders.State of the art: Prevalent methods of voice and speech rehabilitation in patients after total laryngectomy include the teaching of esophageal speech, tracheoesophageal speech and the use of an artificial larynx. Of these, esophageal speech appears to be the least effective method. Under certain circumstances, an artificial larynx may be the optimal choice among certain groups of patients. Numerous studies cited prove tracheoesophageal speech to achieve the best results measurable by commonly used indicators. Summary: Total laryngectomy is not a sentence for patients. Effective rehabilitation significantly improves the quality of life and communication. It is difficult to unequivocally indicate which method of voice and speech rehabilitation is most beneficial for patients - the choice should be tailored to the individual and its preferences and chances. In his work, the specialist should seek a compromise between obtaining the best acoustic results and acceptance of the method by the patient

Von Meyenburg complexes in a patient with chronic gastritis - a case report

Introduction: Bile ducts hamartoma (von Meyenburg complexes) is a common but unknown pathology of the liver. It can lead to the widening of the bile ducts. It is usually detected incidentally in asymptomatic patients. There are indications of transformation into bile duct cancer or hepatocellular carcinoma.Aim of the study: The aim of the study is to draw attention to a little known, but common pathology - von Meyenburg complexes and to sensitize medical professionals to the implications it may cause during the diagnostic process.Material and methods: We conducted a case study. The research material was the patient's medical history.Case report: A 60-year-old man came to the Gastrology Clinic due to chronic epigastric pain and tenderness in the navel area. Colonoscopy ruled out pathology in the large intestine. After six months, the pain worsened. The result of the gastroscopy allowed the diagnosis of chronic gastritis, which was probably the cause of the problem. The abdominal ultrasound showed a suspicion of renal cell carcinoma of the right kidney, but the neoplastic process was excluded on the basis of the abdominal computed tomography. In the same study, for the first time, numerous minor hypodense lesions in the liver were detected. The final diagnosis was made on the basis of magnetic resonance cholangiography, where the disseminated, T2 hyperintense cystic areas were described. This suggested a biliary scythe.Conclusions: Despite the asymptomatic occurrence of biliary hamartoma, it is important to remember about the possible transformation into a malignant neoplasm. It should be considered in the differential diagnosis of disseminated liver lesions. Patients should be treated symptomatically