Anthropometric profile of pediatric patients undergoing allogeneic hematopoietic stem cell transplantation: a single center one-year follow-up study

Introduction: Hematopoietic stem cell transplantation (HSCT) is an aggressive form of therapy which leads to malnutri­tion requiring nutritional support. The aim of our study was to evaluate if the growth of children is affected by HSCT and what the relevant factors are. Methods: We analyzed changes in anthropometric measures of 79 pediatric patients who underwent allogeneic HSCT. Nutritional status was assessed based on weight and height measurements collected prior to HSCT and within 12 months post-transplantation. Body weight and height were referred to the age of patients using available z-score calculators. Results: Compared to the first measurement, the weight-for-age and height-for-age z-scores were significantly reduced in all following measurements within a 1-year follow-up. The most severe weight loss occurred on the last day of hospitalization related to HSCT, while the height gain declined progressively after HSCT. The presence of acute graft versus host disease (GvHD) and the use of a total body irradiation-based regimen were found to be risk factors for a severe slowdown of weight gain, while acute GvHD of the gastrointestinal tract, chronic GvHD and the use of parenteral nutri­tion were risk factors for a decline in height gain. Conclusions: Patients treated with allogeneic HSCT demonstrate a reduction in the pace of growth. HSCT recipients complicated by GvHD require prolonged and close weight and height monitorin

The knowledge of Polish primary care physicians about bariatric surgery

Introduction: The general practitioner (GP) can play a key role in this multi-disciplinary team, coordinating care provided by dietitians and surgeons, maximizing the potential benefits of surgery. Therefore, it seems important to verify changes in GPs’ knowledge about surgical treatment of obesity. Aim : To reassess knowledge of obesity surgical treatment among Polish primary care physicians and their willingness to improve it in the future. Material and methods: To assess the knowledge of Polish primary care physicians about surgical treatment of obesity, a prospective study, which included an anonymous online questionnaire, was conducted in the years 2015–2016. Results : Two hundred and six physicians answered the invitation. One hundred and sixty-six (81.8%) respondents were familiar with the indications for bariatric operation. The great majority of respondents, 198 (96.6%), were aware that bariatric surgery is efficient in the treatment of the metabolic syndrome. The study revealed a disproportion between the number of patients who would be potential candidates for bariatric treatment, who are currently under care of participating physicians, and the number of patients who are referred to a bariatric surgeon. Conclusions : Our study demonstrates that nowadays bariatric surgery is a recognized method of treatment, but physicians remain reluctant to refer their patients for surgical treatment of obesity. It was found that there is a large disproportion between the number of patients who are referred to a bariatric surgeon and the number of patients who require this treatment. It may be a result of lack of knowledge in the field of bariatric surgery

Symptoms related to idiopathic environmental intolerance attributed to electromagnetic fields (IEI-EMF) : a questionnaire study

Badanie miało na celu analizę objawów związanych ze zjawiskiem idiopatycznej nietolerancji środowiskowej przypisywanej działaniu pola elektromagnetycznego. Zostało ono przeprowadzone z zastosowaniem metody ankietowej. Objawy zgłaszane przez 408 potencjalnie elektrowrażliwych respondentów zostały przeanalizowane i porównane w odniesieniu do danych demograficznych. Zgłaszane objawy były zwykle niespecyficzne i trudne do obiektywnej oceny, co potwierdza wyniki wcześniej przeprowadzonych badań.The aim of the study was to analyse the symptoms reported by self-reported IEI-EMF subjects with the use of web-based questionnaire. 408 potentially electrosensitive individuals were identified and symptoms reported by them were analysed and compared depending on demographic characteristics. Declared symptoms were usually not specific and difficult for an objective medical assessment, what is in line with results of previous studies

Histidine-Rich Glycoprotein Protects from Systemic Candida Infection

Fungi, such as Candida spp., are commonly found on the skin and at mucosal surfaces. Yet, they rarely cause invasive infections in immunocompetent individuals, an observation reflecting the ability of our innate immune system to control potentially invasive microbes found at biological boundaries. Antimicrobial proteins and peptides are becoming increasingly recognized as important effectors of innate immunity. This is illustrated further by the present investigation, demonstrating a novel antifungal role of histidine-rich glycoprotein (HRG), an abundant and multimodular plasma protein. HRG bound to Candida cells, and induced breaks in the cell walls of the organisms. Correspondingly, HRG preferentially lysed ergosterol-containing liposomes but not cholesterol-containing ones, indicating a specificity for fungal versus other types of eukaryotic membranes. Both antifungal and membrane-rupturing activities of HRG were enhanced at low pH, and mapped to the histidine-rich region of the protein. Ex vivo, HRG-containing plasma as well as fibrin clots exerted antifungal effects. In vivo, Hrg−/− mice were susceptible to infection by C. albicans, in contrast to wild-type mice, which were highly resistant to infection. The results demonstrate a key and previously unknown antifungal role of HRG in innate immunity

The significant impact of age on the clinical outcomes of laparoscopic appendectomy : results from the Polish Laparoscopic Appendectomy multicenter large cohort study

Acute appendicitis (AA) is the most common surgical emergency and can occur at any age. Nearly all of the studies comparing outcomes of appendectomy between younger and older patients set cut-off point at 65 years. In this multicenter observational study, we aimed to compare laparoscopic appendectomy for AA in various groups of patients with particular interest in the elderly and very elderly in comparison to younger adults. Our multicenter observational study of 18 surgical units assessed the outcomes of 4618 laparoscopic appendectomies for AA. Patients were divided in 4 groups according to their age: Group 1- 8 days. Logistic regression models comparing perioperative results of each of the 3 oldest groups compared with the youngest one showed significant differences in odds ratios of symptoms lasting >48hours, presence of complicated appendicitis, perioperative morbidity, conversion rate, prolonged LOS (>8 days). The findings of this study confirm that the outcomes of laparoscopic approach to AA in different age groups are not the same regarding outcomes and the clinical picture. Older patients are at high risk both in the preoperative, intraoperative, and postoperative period. The differences are visible already at the age of 40 years old. Since delayed diagnosis and postponed surgery result in the development of complicated appendicitis, more effort should be placed in improving treatment patterns for the elderly and their clinical outcome

Risk factors for serious morbidity, prolonged length of stay and hospital readmission after laparoscopic appendectomy : results from Pol-LA (Polish Laparoscopic Appendectomy) multicenter large cohort study

Laparoscopic appendectomy (LA) for treatment of acute appendicitis has gained acceptance with its considerable benefits over open appendectomy. LA, however, can involve some adverse outcomes: morbidity, prolonged length of hospital stay (LOS) and hospital readmission. Identification of predictive factors may help to identify and tailor treatment for patients with higher risk of these adverse events. Our aim was to identify risk factors for serious morbidity, prolonged LOS and hospital readmission after LA. A database compiled information of patients admitted for acute appendicitis from eighteen Polish and German surgical centers. It included factors related to the patient characteristics, peri- and postoperative period. Univariate and multivariate logistic regression models were used to identify risk factors for serious perioperative complications, prolonged LOS, and hospital readmissions in acute appendicitis cases. 4618 laparoscopic appendectomy patients were included. First, although several risk factors for serious perioperative complications (C-D III-V) were found in the univariate analysis, in the multivariate model only the presence of intraoperative adverse events (OR 4.09, 95% CI 1.32-12.65, p = 0.014) and complicated appendicitis (OR 3.63, 95% CI 1.74-7.61, p = 0.001) was statistically significant. Second, prolonged LOS was associated with the presence of complicated appendicitis (OR 2.8, 95%CI: 1.53-5.12, p = 0.001), postoperative morbidity (OR 5.01, 95% CI: 2.33-10.75, p < 0.001), conversions (OR 6.48, 95% CI: 3.48-12.08, p < 0.001) and reinterventions after primary procedure (OR 8.79, 95% CI: 3.2-24.14, p < 0.001) in the multivariate model. Third, although several risk factors for hospital readmissions were found in univariate analysis, in the multivariate model only the presence of postoperative complications (OR 10.33, 95% CI: 4.27-25.00), reintervention after primary procedure (OR 5.62, 95% CI: 2.17-14.54), and LA performed by resident (OR 1.96, 95%CI: 1.03-3.70) remained significant. Laparoscopic appendectomy is a safe procedure associated with low rates of complications, prolonged LOS, and readmissions. Risk factors for these adverse events include complicated appendicitis, postoperative morbidity, conversion, and re-intervention after the primary procedure. Any occurrence of these factors during treatment should alert the healthcare team to identify the patients that require more customized treatment to minimize the risk for adverse outcomes