Resuscitation of the patient with suspected/confirmed COVID-19 when wearing personal protective equipment: A randomized multicenter crossover simulation trial

Background: The aim of the study was to evaluate various methods of chest compressions in patients with suspected/confirmed SARS-CoV-2 infection conducted by medical students wearing full personal protective equipment (PPE) for aerosol generating procedures (AGP).Methods: This was prospective, randomized, multicenter, single-blinded, crossover simulation trial. Thirty-five medical students after an advanced cardiovascular life support course, which included performing 2-min continuous chest compression scenarios using three methods: (A) manual chest compression (CC), (B) compression with CPRMeter, (C) compression with LifeLine ARM device. During resuscitation they are wearing full personal protective equipment for aerosol generating procedures.Results: The median chest compression depth using manual CC, CPRMeter and LifeLine ARM varied and amounted to 40 (38–45) vs. 45 (40–50) vs. 51 (50–52) mm, respectively (p = 0.002). The median chest compression rate was 109 (IQR; 102–131) compressions per minute (CPM) for manual CC, 107 (105–127) CPM for CPRMeter, and 102 (101–102) CPM for LifeLine ARM (p = 0.027). The percentage of correct chest recoil was the highest for LifeLine ARM — 100% (95–100), 80% (60–90) in CPRMeter group, and the lowest for manual CC — 29% (26–48).Conclusions: According to the results of this simulation trial, automated chest compression devices (ACCD) should be used for chest compression of patients with suspected/confirmed COVID-19. In the absence of ACCD, it seems reasonable to change the cardiopulmonary resuscitation algorithm (in the context of patients with suspected/confirmed COVID-19) by reducing the duration of the cardiopulmonary resuscitation cycle from the current 2-min to 1-min cycles due to a statistically significant reduction in the quality of chest compressions among rescuers wearing PPE AGP

Comparative analysis of the incidence of selected sexually transmitted viral infections in Poland in 2010-2015 : a retrospective cohort study

Sexually transmitted infections (STIs) represent a major cause of morbidity in women and men worldwide. The main aim of this study was to perform a comparative analysis of the incidence of sexually transmitted viral infections in 2010–2015 in Poland, taking into account the administrative division of the country into provinces. This was a retrospective study. The analysed data came from the Centre for Health Information Systems of the Ministry of Health and the National Institute of Public Health-National Research Institute and constituted information from the epidemiological surveillance system in Poland. We collected data on the incidence of the following diseases: genital herpes (HSV), genital warts, human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS). The key groups with the highest risk of infection were young people between 20 and 29 years of age. The reported data on the incidence of genital herpes in Poland (n = 3378; 1.5/100,000) showed a downward trend, which does not coincide with global trends. Genital warts were the most frequent genital infections in Poland (n = 7980; 3.46/100,000), with significant regional variation. Over the analysed period, the situation of newly detected HIV infections seemed to be stable (n = 7144; 3.1/100,000). The incidence of these infections appeared to be highly correlated with urbanisation rates, which was not confirmed in the case of other analysed infections. The worsening epidemic situation with respect to sexually transmitted infections, the inefficiency of the current surveillance system and the reduction in funding for diagnosis and prevention, combined with inadequate legal solutions, make it necessary to undertake new legal and organisational measures aimed at improving the reproductive health in Poland in terms of sexually transmitted infections

Comparative analysis of the incidence of selected sexually transmitted bacterial infections in Poland in 2010-2015 : a retrospective cohort study

Sexually transmitted infections are common infectious diseases. The main aim of this study was to perform a comparative analysis of the incidence of bacterial sexually transmitted infections in 2010–2015 in Poland, taking into account the administrative division of the country into provinces. This was a retrospective study. The analysed data came from the Centre for Health Information Systems of the Ministry of Health and constituted information being the epidemiological surveillance system in Poland. The analysis included data on the incidence of primary and secondary syphilis, gonorrhoea and non-gonococcal urethritis and genital infections. The overall incidence rates were disproportionately lower than European rates and those presented in studies from other countries. Young people, between 20 and 29 years of age, were the key groups at the highest risk of infection. The incidence rate of primary and secondary syphilis was lower in Poland than in Europe or America, but some regions, such as Mazovia and Lodz provinces, were found to have a higher incidence rate than other European rates. The reported incidence of gonorrhoea in Poland was also significantly lower compared with other countries, with a significantly higher number of infections in males than in females, and this was also one of the highest rates in EU countries. During the study period, the number of non-gonococcal genital infections systematically decreased, while in other countries of the European region, the incidence was among the highest of all sexually transmitted infections

Artykuł oryginalnyMały Małopolski Rejestr Ostrego Zatoru Tętnicy Płucnej – przebieg kliniczny

Background: Acute pulmonary embolism (APE) is a life-threatening disease. Mortality in APE still remains very high in spite of progress in diagnostic tools. Mortality rate is about 30% in patients with unrecognised APE. APE is one of the main causes of in-hospital mortality. Aim: To asses management of patients with APE in the Małopolska region. Methods: This registry consists of 205 consecutive patients who were hospitalised in 6 cardiology departments between 1 January 2005 and 30 September 2007, with the mean age of 65.1 ± 15.3 years (124 females and 81 males). Mean hospitalisation duration 14.6 days (1-52 days). Results: During hospitalisation 23 (11.2%) patients died. Complications (death, cardiogenic shock, cardiac arrest, use of catecholamines, respiratory therapy and ventilation) during in-hospital stay were observed in 57 (27.8%) patients. Fifty-three patients were haemodynamically unstable (cardiogenic shock or hypotension). The troponin I or T level was assessed in 147 (71.7%) patients and in 50 (34.0%) was positive. In patients with positive troponin we observed 11 (22.0%) deaths, while in patients with normal troponin T or I level 6 (6.2%) deaths occurred. In patients with normal blood pressure we observed a significant difference in mortality in patients with elevated vs. normal troponin level (14.3 vs. 2.5%, p = 0.02). Thrombolytic therapy was used in 20 (9.8%) patients. In patients treated with thrombolytic therapy 9 (45%) deaths were observed. We divided patients according to the ESC 2008 guidelines risk stratification. The ‘non-high risk’ group consisted of 152 (74.1%) patients, and mortality was 3.9%. The ‘high-risk’ group consisted of 53 (26.8%) patients. The ‘non-high risk’ group was divided into the following subgroups: 1. moderate-high (with 2 risk factors: both RV dysfunction and positive injury markers) mortality – 8.1%; 2. moderate subgroup with one risk factor, mortality – 3.6%; 3. low risk – no risk factors – 0% mortality. Conclusions: 1. In our registry mortality rate in patients with APE was 11%. 2. In about 30% of patients APE was under mask of acute coronary syndrome or syncope, 34% of patients had elevated troponin level, and 30% of patients had complication during hospitalisation. 3. In patients treated with thrombolytics mortality rate was 45%. 4. Reperfusion strategy (trombolysis or embolectomy) in the high risk group was used in only 41% of patients. 5. Elevated troponin level in normotensive patient was associated with 4-fold times higher risk of death. 6. New risk stratification according to the ESC guidelines 2008 correctly predicts prognosis in everyday clinical practise.Wstęp: Ostry zator tętnicy płucnej (OZTP) jest stanem bezpośredniego zagrożenia życia. Prezentowana praca ma charakter rejestru chorych z OZTP. Rejestr pozwala na przedstawienie rzeczywistej praktyki klinicznej. Cel: Analiza postępowania diagnostyczno-leczniczego u chorych z rozpoznaniem zatoru tętnicy płucnej na 5 oddziałach kardiologii w Małopolsce. Metody: Rejestrem objęto kolejnych pacjentów hospitalizowanych od 1 stycznia 2005 r. do 30 września 2007 r. na 5 oddziałach kardiologicznych. Do badania włączono 205 chorych (124 kobiety, 81 mężczyzn) w wieku 17–87 lat (średni wiek 65,1 ± 15,3 roku) z potwierdzonym OZTP. Średni czas trwania hospitalizacji wynosił 14,6 ± 8,7 dnia (1–52 dni). Wyniki: W czasie obserwacji szpitalnej zmarło 23 (11,2%) pacjentów. Pobyt powikłany obserwowano łącznie u 57 (27,8%) chorych (zgon, wstrząs kardiogenny, zatrzymanie krążenia, konieczność stosowania amin katecholowych lub sztucznej wentylacji). Łącznie 53 chorych miało wstrząs kardiogenny lub hipotonię. Stężenie troponiny oznaczono u 147 (71,7%) chorych, a jego podwyższenie stwierdzono u 50 (34%) chorych. W grupie osób z podwyższonym stężeniem troponiny doszło do 11 (22%) zgonów, a w grupie z prawidłowym stężeniem troponiny do 6 (6,2%) zgonów (p = 0,01). U chorych stabilnych hemodynamicznie różnica w śmiertelności pomiędzy podgrupą osób z prawidłowym i podwyższonym stężeniem troponiny (2,5 vs 14,3%) była istotna statystycznie (p = 0,02). Leczenie trombolityczne stosowano u 20 (9,8%) osób, w tym 18 chorych leczono streptokinazą (STK), a 2 chorych tkankowym aktywatorem plazminogenu (tPA). W grupie leczonej trombolitycznie wystąpiło 9 zgonów – śmiertelność 45%. Do grupy wysokiego ryzyka zgonu (high risk) zaliczono 53 (26,8%) chorych, w tej grupie stwierdzono 17 zgonów – śmiertelność 32%. Do grupy niewysokiego ryzyka (non-high risk) zaliczono 152 (74,1%) chorych i w tej grupie stwierdzono 6 zgonów – śmiertelność 3,9%. W grupie niewysokiego ryzyka wyróżniono dodatkowo 3 podgrupy: 1. umiarkowanego-zwiększonego ryzyka (IM2) – 3 zgony, śmiertelność 8,1%; 2. umiarkowanego-mniejszego ryzyka (IM1) – 3 zgony, śmiertelność 3,6%; 3. niskiego ryzyka – bez zgonów, śmiertelność 0%. Wnioski: 1. Śmiertelność w populacji chorych z OZTP wyniosła w niniejszym rejestrze 11%. 2. U 30% chorych OZTP wystąpił pod maską ostrego zespołu wieńcowego lub omdlenia, 34% chorych miało podwyższone stężenie troponiny, 30% miało powikłania w trakcie hospitalizacji. 3. Śmiertelność w grupie chorych leczonych trombolitycznie wyniosła 45%. 4. Leczenie reperfuzyjne (trombolityczne lub chirurgiczne) w grupie wysokiego ryzyka wg aktualnych standardów otrzymało tylko 41% chorych. 5. Podwyższone stężenie troponiny u chorych z prawidłowym ciśnieniem tętniczym wiązało się z 4-krotnie większym ryzykiem zgonu 6. Nowa strategia stratyfikacji ryzyka chorych zagrożonych zgonem w trakcie epizodu OZTP zaproponowana w wytycznych ESC 2008 znakomicie koreluje z codzienną praktyką kliniczną

Resuscitation of the patient with suspected//confirmed COVID-19 when wearing personal protective equipment: A randomized multicenter crossover simulation trial

Background: The aim of the study was to evaluate various methods of chest compressions in patients with suspected/confirmed SARS-CoV-2 infection conducted by medical students wearing full personal protective equipment (PPE) for aerosol generating procedures (AGP). Methods: This was prospective, randomized, multicenter, single-blinded, crossover simulation trial. Thirty-five medical students after an advanced cardiovascular life support course, which included performing 2-min continuous chest compression scenarios using three methods: (A) manual chest compression (CC), (B) compression with CPRMeter, (C) compression with LifeLine ARM device. During resuscitation they are wearing full personal protective equipment for aerosol generating procedures. Results: The median chest compression depth using manual CC, CPRMeter and LifeLine ARM varied and amounted to 40 (38-45) vs. 45 (40-50) vs. 51 (50-52) mm, respectively (p = 0.002). The median chest compression rate was 109 (IQR; 102-131) compressions per minute (CPM) for manual CC, 107 (105-127) CPM for CPRMeter, and 102 (101-102) CPM for LifeLine ARM (p = 0.027). The percentage of correct chest recoil was the highest for LifeLine ARM - 100% (95-100), 80% (60-90) in CPRMeter group, and the lowest for manual CC - 29% (26-48). Conclusions: According to the results of this simulation trial, automated chest compression devices (ACCD) should be used for chest compression of patients with suspected/confirmed COVID-19. In the absence of ACCD, it seems reasonable to change the cardiopulmonary resuscitation algorithm (in the context of patients with suspected/confirmed COVID-19) by reducing the duration of the cardiopulmonary resuscitation cycle from the current 2-min to 1-min cycles due to a statistically significant reduction in the quality of chest compressions among rescuers wearing PPE AGP

Update of EULAR recommendations for the treatment of systemic sclerosis

The aim was to update the 2009 European League against Rheumatism (EULAR) recommendations for the treatment of systemic sclerosis (SSc), with attention to new therapeutic questions. Update of the previous treatment recommendations was performed according to EULAR standard operating procedures. The task force consisted of 32 SSc clinical experts from Europe and the USA, 2 patients nominated by the pan-European patient association for SSc (Federation of European Scleroderma Associations (FESCA)), a clinical epidemiologist and 2 research fellows. All centres from the EULAR Scleroderma Trials and Research (EUSTAR) group were invited to submit and select clinical questions concerning SSc treatment using a Delphi approach. Accordingly, 46 clinical questions addressing 26 different interventions were selected for systematic literature review. The new recommendations were based on the available evidence and developed in a consensus meeting with clinical experts and patients. The procedure resulted in 16 recommendations being developed (instead of 14 in 2009) that address treatment of several SSc-related organ complications: Raynaud's phenomenon (RP), digital ulcers (DUs), pulmonary arterial hypertension (PAH), skin and lung disease, scleroderma renal crisis, and gastrointestinal involvement. Compared with the 2009 recommendations, the 2015 recommendations include phosphodiesterase type 5 (PDE-5) inhibitors for the treatment of SSc-related RP and DUs, riociguat, new aspects for endothelin receptor antagonists, prostacyclin analogues and PDE-5 inhibitors for SSc-related PAH. New recommendations regarding the use of fluoxetine for SSc-related RP and haematopoietic stem cell transplantation for selected patients with rapidly progressing SSc were also added. In addition, several comments regarding other treatments addressed in clinical questions and suggestions for the SSc research agenda were formulated. These updated data-derived and consensus-derived recommendations will help rheumatologists to manage patients with SSc in an evidence-based way. These recommendations also give directions for future clinical research in SSc.status: publishe

Update of EULAR recommendations for the treatment of systemic sclerosis

The aim was to update the 2009 European League against Rheumatism (EULAR) recommendations for the treatment of systemic sclerosis (SSc), with attention to new therapeutic questions. Update of the previous treatment recommendations was performed according to EULAR standard operating procedures. The task force consisted of 32 SSc clinical experts from Europe and the USA, 2 patients nominated by the pan-European patient association for SSc (Federation of European Scleroderma Associations (FESCA)), a clinical epidemiologist and 2 research fellows. All centres from the EULAR Scleroderma Trials and Research (EUSTAR) group were invited to submit and select clinical questions concerning SSc treatment using a Delphi approach. Accordingly, 46 clinical questions addressing 26 different interventions were selected for systematic literature review. The new recommendations were based on the available evidence and developed in a consensus meeting with clinical experts and patients. The procedure resulted in 16 recommendations being developed (instead of 14 in 2009) that address treatment of several SSc-related organ complications: Raynaud's phenomenon (RP), digital ulcers (DUs), pulmonary arterial hypertension (PAH), skin and lung disease, scleroderma renal crisis, and gastrointestinal involvement. Compared with the 2009 recommendations, the 2015 recommendations include phosphodiesterase type 5 (PDE-5) inhibitors for the treatment of SSc-related RP and DUs, riociguat, new aspects for endothelin receptor antagonists, prostacyclin analogues and PDE-5 inhibitors for SSc-related PAH. New recommendations regarding the use of fluoxetine for SSc-related RP and haematopoietic stem cell transplantation for selected patients with rapidly progressing SSc were also added. In addition, several comments regarding other treatments addressed in clinical questions and suggestions for the SSc research agenda were formulated. These updated data-derived and consensus-derived recommendations will help rheumatologists to manage patients with SSc in an evidence-based way. These recommendations also give directions for future clinical research in SSc