The effectiveness of pollutant removal from municipal wastewater in vertical flow constructed wetlands

The efficiency of pollution removal from municipal sewage in two vertical flow constructed wetlands consisting of gravel filters with surface area 4 x 5 m, depth 60 cm, covered by reedwas evaluated over a period of two years. The flow of wastewater was about 50 mm per day.Wastewater underwent only mechanical treatment before reed bed B, but reed bed A wassupplied with wastewater after biological treatment with activated sludge. Sewage wassampled before and after filtration every IO days. Measurements were made of sewage supplyand discharge, precipitation and wastewater temperatures. The main indicator of efficiencywas the elimination of suspended solids, carbon, nitrogen and phosphorus from thewastewater during filtration. The elimination of the pollution load was 2-25 g per squaremeter per day for the BOD5 and 0--3.5 g per square meter per day for total nitrogen. Rates ofpollution removal were between 2 and 4 times as high in bed Bas in bed A. The rate ofBOD5 removal and the coefficient k for BOD5 were strongly dependent on temperature for reed bedB; less so far for bed A. The difference between summer and winter indicates that the surfacearea of constructed wetland B should be 3 times bigger during winter to obtain the summerrate ofBOD5 pollution removal in the climatic conditions ofNorth Poland (54a° N)

Produkty tytoniowe oparte na podgrzewaniu tytoniu (heat-not-burn) a zdrowie pacjentów — opinia grupy ekspertów

Smoking, especially of cigarettes, is one of the best-recognised and most widely studied risk factors for cardiovascular disease and death. Despite the availability of many methods of counteracting tobacco addiction, their effective- ness is still insufficient. An alternative to smoking cigarettes could be tobacco products based on heating tobacco (‘heat-not-burn’), the use of which may be associated with a lower cardiovascular risk. this article presents a summary of the current state of knowledge and the recommendations of Polish experts regarding the safety of these products.Nikotynizm jest jednym z uznanych i szeroko zbadanych czynników ryzyka chorób układu sercowo-naczyniowego oraz zgonu. Palenie papierosów stanowi również jeden z najistotniej- szych czynników ryzyka zachorowań oraz zgonu z powodu chorób serca i naczyń krwionośnych. Mimo dostępności wielu metod wspomagających leczenie uzależnienia od tytoniu ich skuteczność pozostaje niewystarczająca. Alternatywę dla palenia papierosów mogą stanowić produkty tytoniowe oparte na podgrzewaniu tytoniu, których stosowanie może się łączyć z niższym ryzykiem sercowo-naczyniowym. W niniejszym artykule przedstawiono podsumowanie aktualnego stanu wiedzy i zaleceń polskich ekspertów w zakresie bezpieczeństwa stosowania tych produktów

Innovative medical technologies in the percutaneous treatment of tricuspid regurgitation in Poland

Tricuspid regurgitation (TR) usually develops secondarily to left-sided heart diseases, whereas primary lesions to the valve apparatus is less common. Untreated severe TR has a poor prognosis and surgical treatment, i.e., valve repair or replacement, is the only treatment option with class I recommendation. However, cardiac surgical procedures may be associated with a high risk of complications. Recent advances in percutaneous approaches to managing structural heart diseases, especially mitral valve diseases, have enabled the implementation of this therapeutic strategy in the population of patients with TR. This paper presents data on the clinical efficacy, cost-effectiveness and expected population size for one of these procedures, namely the TriClip TTVr System procedure. Its efficacy was assessed in the TRILUMINATE study involving 85 patients with co-morbidities and at high surgical risk. After 1 year of follow-up, the reduction in the TR grade was reported in 71% of patients. Clinical improvement in New York Heart Association functional class, a 6-minute walk test, and the quality of life were also observed. A published analysis comparing percutaneous treatment modalities with a drug therapy based on data from medical registers was utilized, and propensity score matching was also employed. Percutaneous treatment reduced 1-year mortality and rehospitalisation risk. The economic analysis showed the use of TriClip TTVr System is cost-effective: the cost of an additional quality-adjusted life year ranged from approximately PLN 85,000 to PLN 100,000, which is below the official threshold in Poland. The potential annual number of candidates for this treatment modality in Poland is estimated at 265

Vestibular Schwannoma tumor withdrawal – case report

Vestibular Schwannomas (VS), benign intracranial tumors originating from the vestibulocochlear nerve, whose symptoms usually are hearing loss, tinnitus, and balance dysfunction. Rarely, however, if untreated, these neoplasms can cause significant patient compromise – resulting in facial paralysis, brainstem compression, and even death. Neurosurgical problems are the neuro-vascular structures often surrounding the tumors. The annual incidence of cystic vestibu-lar schwannomas in literature is 19.4%. A 66-year-old woman came to our clinic with serious hearing loss, balance dysfunction and tinnitus in the left ear. Full imaging diagnostic of the head was performed (TK, MRI and angio-MRI) which showed a cystic vestibular Schwannoma n. VIII (CVS). After 12 years of observation we noticed full neurological symptoms withdrawal and significant reduction of the tumor volume.Osłoniaki nerwu przedsionkowo-ślimakowego (n. VIII) to grupa łagodnych nowotworów, zwykle wyrastających z przewodu słuchowego wewnętrznego (PSW) i penetrujących wtórnie do okolicy kąta mostowo-móżdżkowego (KMM). Guzy rosną zazwyczaj powoli, jednak ze względu na otaczające je struktury nerwowo-naczyniowe stanowią duży problem operacyjny w neurochirurgii. W piśmiennictwie częstość występowania osłoniaka z torbielą wynosiła 19,4%. Najczęstszymi objawami są: utrata słuchu, szumy w uszach i zawroty głowy. Kobieta 66-letnia kobieta zgłosiła się z objawami znacznego niedosłuchu ucha lewego, odczuwaniem pisków i trzasków w uchu lewym, zaburzeniami równo-wagi. U chorej wykonano pełną diagnostykę obrazową w postaci tomografii komputerowej (TK) głowy i rezonansu magnetycznego (RM) głowy. Początko-wo wysunięto podejrzenie zmiany w okolicy lewego KMM o charakterze he-mangioblastomy. Angio-MR głowy nie potwierdziło rozpoznania. Wysunięto podejrzenie osłoniaka n. VIII z torbielą. Pacjentka była poddana 12-letniej obserwacji. W tym czasie doszło do całkowitego wycofania się objawów neurologicznych i znacznej regresji guza

Prognostic Impact of Hybrid Comprehensive Telerehabilitation Regarding Diastolic Dysfunction in Patients with Heart Failure with Reduced Ejection Fraction—Subanalysis of the TELEREH-HF Randomized Clinical Trial

Aims: The objective of the study was to evaluate the effects of individually prescribed hybrid comprehensive telerehabilitation (HCTR) implemented at patients’ homes on left ventricular (LV) diastolic function in heart failure (HF) patients. Methods and results: The Telerehabilitation in Heart Failure Patients trial (TELEREH-HF) is a multicenter, prospective, randomized (1:1), open-label, parallel-group, controlled trial involving HF patients assigned either to HCTR involving a remotely monitored home training program in conjunction with usual care (HCTR group) or usual care only (UC group). The patient in the HCTR group underwent a 9-week HCTR program consisting of two stages: an initial stage (1 week) conducted in hospital and the subsequent stage (eight weeks) of home-based HCTR five times weekly. Due to difficulties of proper assessment and differences in the evaluation of diastolic function in patients with atrial fibrillation, we included in our subanalysis only patients with sinus rhythm. Depending on the grade of diastolic dysfunction, patients were assigned to subgroups with mild diastolic (MDD) or severe diastolic dysfunction (SDD), both in HCTR (HCTR-MDD and HCTR-SDD) and UC groups (UC-MDD and UC-SDD). Changes from baseline to 9 weeks in echocardiographic parameters were seen only in A velocities in HCTR-MDD vs. UC-MDD; no significant shifts between groups of different diastolic dysfunction grades were observed after HCTR. All-cause mortality was higher in UC-SDD vs. UC-MDD with no difference between HCTR-SDD and HCTR-MDD. Higher probability of HF hospitalization was observed in HCTR-SDD than HCTR-MDD and in UC-SDD than UC-MDD. No differences in the probability of cardiovascular mortality and hospitalization were found. Conclusions: HCTR did not influence diastolic function in HF patients in a significant manner. The grade of diastolic dysfunction had an impact on mortality only in the UC group and HF hospitalization over a 12–24-month follow-up in HCTR and UC groups

Prognostic Impact of Hybrid Comprehensive Telerehabilitation Regarding Diastolic Dysfunction in Patients with Heart Failure with Reduced Ejection Fraction—Subanalysis of the TELEREH-HF Randomized Clinical Trial

Aims: The objective of the study was to evaluate the effects of individually prescribed hybrid comprehensive telerehabilitation (HCTR) implemented at patients’ homes on left ventricular (LV) diastolic function in heart failure (HF) patients. Methods and results: The Telerehabilitation in Heart Failure Patients trial (TELEREH-HF) is a multicenter, prospective, randomized (1:1), open-label, parallel-group, controlled trial involving HF patients assigned either to HCTR involving a remotely monitored home training program in conjunction with usual care (HCTR group) or usual care only (UC group). The patient in the HCTR group underwent a 9-week HCTR program consisting of two stages: an initial stage (1 week) conducted in hospital and the subsequent stage (eight weeks) of home-based HCTR five times weekly. Due to difficulties of proper assessment and differences in the evaluation of diastolic function in patients with atrial fibrillation, we included in our subanalysis only patients with sinus rhythm. Depending on the grade of diastolic dysfunction, patients were assigned to subgroups with mild diastolic (MDD) or severe diastolic dysfunction (SDD), both in HCTR (HCTR-MDD and HCTR-SDD) and UC groups (UC-MDD and UC-SDD). Changes from baseline to 9 weeks in echocardiographic parameters were seen only in A velocities in HCTR-MDD vs. UC-MDD; no significant shifts between groups of different diastolic dysfunction grades were observed after HCTR. All-cause mortality was higher in UC-SDD vs. UC-MDD with no difference between HCTR-SDD and HCTR-MDD. Higher probability of HF hospitalization was observed in HCTR-SDD than HCTR-MDD and in UC-SDD than UC-MDD. No differences in the probability of cardiovascular mortality and hospitalization were found. Conclusions: HCTR did not influence diastolic function in HF patients in a significant manner. The grade of diastolic dysfunction had an impact on mortality only in the UC group and HF hospitalization over a 12–24-month follow-up in HCTR and UC groups

Neurofibromatosis type II – case report

We present a case report of a 49-year-old female patient with type II neurofi-bromatosis (NF-2), recognized at the age of 34. NF-2 is one of the phakomatoses in which multiple neoplasms of the central nervous system (CNS) occur: neuromas (Schwannomas), meningiomas, ependymomas, pilocytic astrocytomas and other benign neoplasms. NF-2 is an incurable genetic disorder and the only way to treat patients is detailed diagnostic imaging, early recognition and removal CNS tumors. The most important aspect is to recognize and cure Schwannomas of the acoustic nerve in their early stages because it is the only way to prevent hearing loss and to help NF-2 patients to maintain a good quality of life. The main way to treat Schwannomas of the acoustic nerves is their surgical removal.W niniejszej pracy przedstawiono przypadek 49-letniej chorej z nerwiakowłók-niakowatością typu 2 (neurofibromatosis type II – NF-2), rozpoznaną w wieku 34 lat. Omówiono NF-2 jako jedną z fakomatoz, w której występują m.in. mno-gie zmiany nowotworowe ośrodkowego układu nerwowego (OUN), przede wszystkim osłoniaki, jak nerwiaki i schwannoma, ale również oponiaki, wyściół-czaki, glejaki włosowatokomórkowe i inne łagodne nowotwory OUN [1]. Jest to choroba genetycznie uwarunkowana, tym samym nieuleczalna [2], a jedynym sposobem postępowania z chorymi na NF-2 jest dokładna diagnostyka obrazowa, wczesne rozpoznawanie zmian guzowatych OUN i ich usuwanie [3]. Szczególnie ważne jest wczesne rozpoznawanie i leczenie osłoniaków nerwu słuchowego (n. VIII), gdyż tylko wówczas istnieje możliwość zachowania słuchu i w związku z tym zapewnienie komfortu życia chorym z NF-2. Operacyjne usuwanie osłoniaków n. VIII jest zasadniczym sposobem ich leczenia [1]