Neurological symptoms in hospitalised patients with COVID-19 and their association with in-hospital mortality

Objectives. To evaluate the spectrum of neurological symptoms in patients with COVID-19 during the first 14 days of hospitalisation and its association with in-hospital mortality. Material and methods. We included 200 patients with RT-PCR-confirmed COVID-19 admitted to University Hospital in Krakow, Poland. In 164 patients, a detailed questionnaire concerning neurological symptoms and signs was performed prospectively within 14 days of hospitalisation. In the remaining 36 patients, such questionnaires were completed retrospectively based on daily observations in the Department of Neurology. Results. During hospitalisation, 169 patients (84.5%) experienced neurological symptoms; the most common were: fatigue (62.5%), decreased mood (45.5%), myalgia (43.5%), and muscle weakness (42.5%). Patients who died during hospitalisation compared to the remainder were older (79 [70.5–88.5] vs. 63.5 [51–77] years, p = 0.001), and more often had decreased level of consciousness (50.0% vs. 9.3%, p < 0.001), delirium (33.3% vs. 4.4%, p < 0.001), arterial hypotension (50.0% vs. 19.6%, p = 0.005) or stroke during (18.8% vs. 3.3%, p = 0.026) or before hospitalisation (50.0% vs. 7.1, p < 0.001), whereas those who survived more often suffered from headache (42.1% vs. 0%, p = 0.012) or decreased mood (51.7% vs. 0%, p = 0.003). Conclusions. Most hospitalised patients with COVID-19 experience neurological symptoms. Decreased level of consciousness, delirium, arterial hypotension, and stroke during or before hospitalisation increase the risk of in-hospital mortality

Paradoks palacza

Smoking is one of the most important risk factors leading to the coronary artery disease and acute myocardial infarction. However, numerous studies showed lower mortality rate in smokers hospitalized due to acute coronary syndrome as compared with non-smokers. This phenomenon is called “smoker’s paradox”. The aim of this study was to review current knowledge of this issue. There were discussed the pathophysiological mechanisms underlying coronary artery disease in smokers. It was found that the main reason of the higher survival rate in smoking patients is their different clinical, baseline characteristics. Younger age and lower comorbidity in smokers as compared with non-smokers seem to play important role. There is also different mechanism of acute coronary syndrome in smokers and non-smokers. More often prothrombotic mechanism is observed in smoking patients. After elimination of confounding factors there is no enough evidence supported cigarette smoking as a protective factor in patients after acute myocardial infarction. In conclusion, smoking cessation should remain the most important part of prevention in patients with coronary artery disease.Palenie papierosów jest jednym z głównych czynników ryzyka choroby wieńcowej i zawału serca. Istnieje jednak szereg publikacji, wskazujących na mniejszą śmiertelność wśród palaczy hospitalizowanych z powodu ostrego zespołu wieńcowego w porównaniu do osób niepalących. Zjawisko to określa się jako paradoks palacza (smoker’s paradox). W pracy dokonano przeglądu aktualnego stanu wiedzy na temat tego zjawiska, uwzględniono patofizjologiczne mechanizmy wpływające na przebieg choroby wieńcowej u osób palących papierosy. Główną przyczyną zwiększonej przeżywalności wśród osób palących są różnice w charakterystyce klinicznej tej populacji. Szczególne znaczenie ma tutaj młody wiek oraz mniejsza współchorobowość wśród pacjentów palących. Różnice między grupami obserwuje się również w odniesieniu do mechanizmu zawału serca, wśród palaczy zauważono zwiększone ryzyko incydentów zakrzepowych. Niemniej, po uwzględnieniu wszystkich zmiennych wpływających na występowanie tego zjawiska, nie ma wystarczających dowodów, aby uznać palenie papierosów jako pozytywny czynnik rokowniczy wśród pacjentów po ostrym zespole wieńcowym. W związku z tym rzucenie palenia powinno nadal stanowić element profilaktyki stosowanej wśród pacjentów ze zwiększonym ryzykiem choroby wieńcowej

Anatomic Variations of Renal Arteries as an Important Factor in the Effectiveness of Renal Denervation in Resistant Hypertension

Hypertension remains the leading cause of death worldwide. Despite advances in drug-based treatment, many patients do not achieve target blood pressure. In recent years, there has been an increased interest in invasive hypertension treatment methods. Long-term effects and factors affecting renal denervation effectiveness are still under investigation. Some investigators found that the renal arteries’ morphology is crucial in renal denervation effectiveness. Accessory renal arteries occur in 20–30% of the population and even more frequently in patients with resistant hypertension. Diversity in renal vascularization and innervation may complicate the renal denervation procedure and increase the number of people who will not benefit from treatment. Based on previous studies, it has been shown that the presence of accessory renal arteries, and in particular, the lack of their complete denervation, reduces the procedure’s effectiveness. The following review presents the anatomical assessment of the renal arteries, emphasizing the importance of imaging tests. Examples of imaging and denervation methods to optimize the procedure are presented. The development of new-generation catheters and the advancement in knowledge of renal arteries anatomy may improve the effectiveness of treatment and reduce the number of patients who do not respond to treatment

Revision of dentistry safety guidelines during COVID-19 pandemic

Szerząca się pandemia COVID-19, choroby wywołanej przez SARS-CoV-2, spowodowała diametralne zmiany w funkcjonowaniu placówek ochrony zdrowia, co wpłynęło także w znacznym stopniu na pracę lekarzy dentystów. Ze względu na wysoką zakaźność i przede wszystkim kropelkową drogę przenoszenia się SARS-CoV-2 pacjenci, tak jak personel gabinetów stomatologicznych, są szczególnie narażeni na zakażenie koronawirusem. W celu ograniczenia ryzyka rozprzestrzeniania się COVID-19 wiele towarzystw medycznych wydało rekomendacje na temat postępowania przy udzielaniu świadczeń zdrowotnych w pandemii. Niniejszy artykuł w głównej mierze został opracowany na podstawie zaleceń polskiego Ministerstwa Zdrowia, ponieważ według rekomendacji Światowej Organizacji Zdrowia przestrzeganie lokalnych zaktualizowanych wytycznych jest najistotniejsze. Nie ma możliwości przygotowania jednolitych wskazówek dla wszystkich lekarzy dentystów na świecie, ponieważ pandemia rozwija się w różnych krajach w innym tempie i każde państwo wymaga wytycznych dostosowanych do aktualnej sytuacji epidemiologicznej. Publikację dodatkowo uzupełniono przeglądem piśmiennictwa zagranicznego oraz wytycznymi proponowanymi przez poszczególne towarzystwa stomatologiczne. W artykule przedstawiono rekomendacje dotyczące funkcjonowania gabinetów stomatologicznych, wykonywania procedur stomatologicznych oraz zalecanych środków ochrony osobistej. Podkreślono nadrzędną zasadę, aby w pierwszej kolejności zarówno lekarze, jak i lekarze dentyści dbali o swoje zdrowie po to, żeby pomagać innym. Med. Pr. 2021;72(5):561–568The ongoing pandemic of coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has completely transformed the functioning of health care facilities. These changes have also significantly affected the work of dental health professionals. Due to the high infectivity of the virus and the fact that transmission occurs primarily through respiratory droplets, both dental patients and professionals are particularly exposed to coronavirus infection. In order to reduce the risk of COVID-19 transmission, a number of medical societies have issued recommendations for the provision of health care services during the pandemic. The article is based mainly on the recommendations of the Polish Ministry of Health, since WHO recommendations underline that following updated local guidelines is of highest importance. It is impossible to outline uniform guidelines for all dental specialists in the world, as the pandemic develops at differing rates in different countries and each country requires guidelines adapted to the current local epidemiological situation. The publication features an additional review of foreign literature and guidelines proposed by individual dental societies. The article presents an overview of guidelines related to the functioning of dental offices, dental treatment procedures and recommended personal protective equipment, as well as underlines the overriding principle that both physicians and dental practitioners should first and foremost take care of their own health in order to be able to protect others. Med Pr. 2021;72(5):561–

Experience with optical coherence tomography enhanced by a novel software (Ultreon<SUP>™</SUP> 1.0 Software) - the first one hundred cases

Introduction: Optical coherence tomography (OCT) intravascular imaging including the latest version Ultreon™ 1.0 Software (Abbott Vascular, Santa Clara, CA, USA), not only improve patients prognosis, but also facilitates improved percutaneous coronary intervention (PCI). Objectives: The aim of the study was to compare procedure related decision making, procedural indices, clinical outcomes according to the extent of stent expansion and assess risk factors of underexpansion in patients treated with PCI using OCT. Methods: The study comprised 100 patients, which were divided in groups according to the extent of stent expansion: <90 (29 patients) and ≥90% (71 patients). Comparison of OCT parameters, selected clinical and procedural characteristics was performed between groups. We assessed clinical outcomes during the follow-up: major adverse cardiovascular events and risk factors of stent underexpansion. Results: Patients from the stent underexpansion group were treated more often in the past with percutaneous peripheral interventions (p = 0.02), no other significant differences being noted in general characteristics, procedural characteristics or clinical outcomes comparing both groups. Significant predictors of stent underexpansion assessed by simple linear univariable analysis included: hypercholesterolemia, obstructive bronchial diseases and treatment with inhalators, family history of cardiovascular disease, PCI of other than the left main coronary artery, stent and drug-eluting stent implantation, PCI without drug-eluting balloon, paclitaxel antimitotic agent, greater maximal stent diameter and lower mean Euroscore II value. Univariable logistic regression analysis revealed a correlation between stent underexpansion and greater creatinine serum concentration before [OR: 0.97, 95%CI: 0.95–0.99, p = 0.01)] and after PCI [OR: 0.98, 95%CI: 0.96–0.99, p = 0.02)]. Conclusions: Based on the presented analysis, the degree of stent expansion is not related to the selected procedural, OCT imaging indices and clinical outcomes. Logistic regression analysis confirmed such a relationship for creatinine level