The impact of anemia on the course and short-term prognosis in patients with first ever ischemic stroke

Background Anemia is the risk factor for cerebrovascular events. The aim of this study was to evaluate the prevalence of anemia among patients with first-ever stroke and its impact on neurological state in the acute phase of the disease and the degree of disability in short-term follow-up. Patients and methods The prospective study included 107 patients aged 72.81±11.12 with the first-ever stroke. Each patient underwent CT of the head and blood tests, including Hb concentration on the first day of hospitalization. We have analyzed the neurological state on the first day of stroke by NIHSS and the functional status on the 14th day after the onset of stroke by mRankin scale in patients with and without anemia. Patients with anemia were additionally divided according to Hb level (less or over 11g/dl). Results Patients with Hb≤11g/dl significantly more often achieved a score of 4–5 points on mRankin scale on the 14th day of stroke compared to patients with anemia and Hb>11g/dl. Independent predictors of a worse functional status on the 14th day of stroke in patients with anemia include the neurological state on the 1st day and the hemispheric location of stroke; an independent predictor of death was the neurological state on the 1st day of onset. Conclusion Mild anemia did not influence significantly the neurological condition in acute phase of stroke but worsened the functional status in subacute phase of stroke. The neurological state on the first day of stroke and the hemispheric location of cerebral ischemia are independent factors of poor prognosis in patients with anemia in short-term follow-up

Dylematy diagnostyczne u chorych z niedokrwistością. Zespół pustego siodła - opis przypadku

Empty sella syndrome is defined as a group of clinical symptoms developing as a result of herniation of the subarachnoid space within the sella, which is often associated with some degree of flattening of the pituitary gland. It is usually recognized incidentally during brain imaging studies performed for different indications, and in most cases this condition is asymptomatic. However, it may result in impairment of various endocrine glands, for which the pituitary gland produces its crinins. Despite the high incidence of empty sella syndrome (up to about 5% of the population) it is commonly ignored as the cause of various symptoms. We present a case of 55-year-old patient admitted to the department of internal medicine due to anaemia and progressive weakness, with recognized hypothyroidism and adrenal gland insufficiency in the course of empty sella syndrome. (Pol J Endocrinol 2010; 61 (4): 400-403)Zespół pustego siodła definiuje się jako grupę objawów klinicznych rozwijających się w wyniku wpuklania się przestrzeni podpajęczynówkowej do siodła tureckiego, co często powoduje ucisk przysadki. Zespół ten zwykle rozpoznaje się przypadkowo podczas badań obrazowych mózgu przeprowadzonych z różnych wskazań i w większości przypadków nie powoduje on żadnych objawów. Czasami jednak skutkuje on zaburzeniami czynności różnych gruczołów wydzielania wewnętrznego, spowodowanymi upośledzeniem produkcji przez przysadkę hormonów tropowych dla tych gruczołów. Mimo stosunkowo częstego występowania zespołu pustego siodła (u ok. 5% populacji), zwykle nie bierze się go pod uwagę jako możliwej przyczyny różnych symptomów. W niniejszej pracy przedstawiono przypadek 55-letniego pacjenta, przyjętego na oddział chorób wewnętrznych z powodu niedokrwistości i postępującego osłabienia, u którego rozpoznano niedoczynność tarczycy i niewydolność kory nadnerczy w przebiegu zespołu pustego siodła. (Endokrynol Pol 2010; 61 (4): 400-403

Urinary tract infections in patients with diabetes mellitus

Artykuł dotyczy zakażeń układu moczowego (ZUM) jako istotnego problemu u chorych na cukrzycę związanego ze zwiększonym ryzykiem ostrego odmiedniczkowego zapalenia i rozwoju niewydolności nerek. Przedstawiono najważniejsze odrębności dotyczące ZUM w tej grupie chorych - zmiany zachodzące w układzie moczowym w przebiegu cukrzycy, etiologię zakażeń oraz sposób leczenia i postępowania profilaktycznego w przypadku nawrotów ZUM. Autorzy zwracają uwagę, że najistotniejszą różnicą w postępowaniu, w porównaniu z chorymi bez cukrzycy, jest konieczność dłuższego leczenia w/w chorych oraz szczególna dbałość o euglikemię, ponadto wybór antybiotyku i czas jego stosowania musi uwzględniać nie tylko potencjalną szkodliwość dla miąższu nerek, ale również większe prawdopodobieństwo występowania szczepów opornych na chemioterapeutyki.In the present article authors discuss the matter of urinary tract infections (UTIs) as a serious problem in diabetic patients associated with the high risk factor for acute pyelonephritis and progression of renal insufficiency. The article presents the major differences in development of UTIs in diabetes - clinical dysfunctions in urinary tract, etiology, treatment and prophylactic procedures in case of recurrent UTIs. Authors indicate that the most important case in clinical treatment of UTIs in diabetic patients is prolonged antibiotic therapy and maintaining of euglycemia. Moreover, the dose and duration of antibiotic treatment should be adequate to renal insufficiency and probability of occurrence of antibiotic resistant microorganisms

Evaluation of individual absolute fracture risk in obese perimenopausal women

Powszechnie uznaje się, że większa masa ciała wiąże się z większą gęstością mineralną kości oraz zmniejszonym tempem ubytku masy kostnej. Z drugiej strony, pojawiają się prace, w których autorzy donoszą, że nadmiar tkanki tłuszczowej nie wykazuje ochronnego wpływu na ubytek masy kostnej. Ponieważ wyniki dostępnych badań są rozbieżne i nie pozwalają na jednoznaczne wnioskowanie co do wpływu otyłości na tkankę kostną, autorzy pracy zdecydowali się ocenić 10-letnie bezwzględne ryzyko złamania u otyłych kobiet w wieku okołomenopauzalnym. Badaniem objęto grupę 60 otyłych kobiet. Grupę kontrolną stanowiło 15 zdrowych kobiet w porównywalnym wieku. Badanie gęstości mineralnej kości w obrębie szyjki kości udowej oraz odcinka lędźwiowego kręgosłupa wykonano metodą absorpcjometrii podwójnej energii promieniowania rentgenowskiego przy użyciu aparatu Lunar DPXL. Dziesięcioletnie bezwzględne ryzyko złamania obliczono zgodnie z zaleceniami Światowej Organizacji Zdrowia/ Polskiej Fundacji Osteoporozy. Otyłe kobiety charakteryzowały się większą gęstością mineralną kości w obrębie szyjki kości udowej oraz odcinka lędźwiowego kręgosłupa oraz mniejszym10-letnim bezwzględnym ryzykiem złamania w porównaniu z kobietami z prawidłową masą ciała.It is widely known that an elevated body weight correlates with increased bone mass and a lower rate of bone loss. However, some authors have suggested that excessive fat mass may not protect against a decrease in bone mass. As results of recent studies have diverged, and it is still unclear whether or not obesity has a beneficial effect on bone, we decided to evaluate the individual absolute fracture risk in obese perimenopausal women. Sixty obese perimenopausal women were enrolled into the study. The control group consisted of 15 healthy women of comparable age. Dual energy X-ray absorptiometry (DXA) of the lumbar spine and femoral neck to measure bone mineral density (BMD) was performed using the Lunar DPXL apparatus. Absolute 10-year fracture risk was calculated as a multiplication of relative risk, according to the guidelines of the WHO/Polish Foundation of Osteoporosis. Obese women have significantly a higher BMD both of the lumbar spine and the femoral neck and a significantly lower 10-year absolute fracture risk in comparison to healthy controls

The Serum Level of Fibroblast Growth Factor-23 and Calcium-Phosphate Homeostasis in Obese Perimenopausal Women

Plasma FGF-23 concentrations and its relationship with calcium-phosphate homeostasis were evaluated in 48 perimenopausal obese women and in 29 nonobese controls. Serum parathyroid hormone, 25-hydroxyvitamin D3, CTX1, osteocalcin, total calcium, phosphorus, creatinine, and plasma intact FGF-23 concentrations were assessed. DXA of lumbar spine and femoral neck was performed to determine bone mineral density (BMD). Plasma iFGF-23 concentration was significantly higher in obese patients (by 42%) and correlated with age and BMD of proximal femur (R = −0.346; R = 0.285, resp.) but not with markers of bone turnover. However, serum phosphorus level in obese subjects was significantly lower. iFGF-23 concentration correlated significantly with body mass index (R = 0.292) and fat content (R = 0.259) in all study subjects. Moreover, a significant correlation between iFGF-23 and iPTH (R = 0.254) was found. No correlation between serum phosphorus or eGFR and plasma iFGF-23 and between eGFR and serum phosphorus was found. Elevated serum iFGF-23 concentration may partially explain lower phosphorus levels in the obese and seems not to reflect bone turnover

The impacts of the COVID-19 pandemic on indirect costs of mental illness and behavioral disorders in Poland

IntroductionIn various research, the estimation of the disease’s economic burden has been taken into consideration. But given the fact that different settings will have distinguished consequences, determining the economic burden of COVID-19 in the studied environment is of great importance. As a result, this study aimed to show the change in indirect costs of mental health problems due to the COVID-19 pandemic in Poland.Methods and ResultsIndirect costs related to mental health problems were analyzed from the perspective of the Social Insurance Institution in Poland. In 2021, they amounted to about 285.8 billion PLN (Polish currency) [61.1 billion EUR (European currency)], up 6% from the previous year. A large increase in spending on disability benefits was observed for 2019–2021 (+14.7%). Disease groups generating the highest expenditures in the structure of total expenditures on incapacity benefits in 2021 in Poland were mental health problems (16.7% of total expenditures). Expenditures on disability benefits related to mental health problems incurred by Social Security in 2021 amounted to about 7.42 billion PLN [1.6 billion EUR] and were 19.4% higher than in 2019 (before the pandemic). In the 2012–2019 period, there was a significant decrease in expenses related to inpatient rehabilitation (41.3%), while in 2020–2021, these expenses decreased several times as the epidemiological situation related to the COVID pandemic reduced access to such services.DiscussionThis is the first study on the economic burden of COVID-19 indirect costs in Poland. Calculating the economic impact is crucial, particularly when there is a large disease outbreak and countries are severely constrained by financial resources. Doing so could aid in the development of effective social security policies. As shown in this study, the indirect costs of absenteeism expenses due to mental health problems increased significantly during the COVID-19 pandemic. It is necessary to take all possible measures, both in the field of primary and secondary prevention, to prevent disability and exclusion from the labor market of people affected by mental health problems, which is justified by epidemiological data and financial data on the expenses incurred by Social Security for social insurance benefits