Czynniki warunkujące ocenę psychometryczną pacjentów po protezoplastyce stawu biodrowego

Background. The aim of this study was to investigate the influence of selected factors such as place of residence, education, age, duration of hospitalization and pain intensity before and after hip replacement surgery on the level of acceptance of the illness, on the subjective assessment of the patient’s state of health during surgery and on the level of pain and the ability to manage and reduce pain. Material and methods. The study included 181 patients diagnosed with hip joint degeneration and qualified for total hip replacement hospitalized in the Regional Specialist Hospital in Biała Podlaska, Poland. The study was conducted by means of a diagnostic survey with the use of a set of questionnaires: Acceptance of Illness Scale – AIS, WOMAC Scale, SF-36 Questionnaire, BPCQ Questionnaire. Results. More than half of the respondents (55.2%) were highly accepting of their condition. The level of acceptance was influenced by the place of residence, education, age, the intensity of pain after surgery and functional limitation. The overall assessment of the quality of life in the physical domain was – 62.9 points, with the worst scores for physical functioning and general health. Analysis with the WOMAC questionnaire showed that the majority of the subjects scored below 50 points on the functional limitation scale. All factors, except the level of pain before surgery, influenced the degree of functional limitation. Conclusions. Age, place of residence and education provided opportunities for pain control and the ability to reduce pain was perceived by those with longer hospital stays. Participants from cities had the highest quality of life. Education influenced the quality of life, which decreased with age and higher pain intensity. The better the quality of life, the higher the level of acceptance of illness, and vice versa.Wprowadzenie. Celem niniejszej pracy było zbadanie wpływu wybranych czynników takich jak: miejsce zamieszkania, wykształcenie, wiek, czas hospitalizacji oraz nasilenie bólu przed i po zabiegu operacyjnym protezoplastyki biodra na poziom akceptacji choroby, na subiektywną ocenę stanu zdrowia operowanego pacjenta oraz na poziom bólowy i umiejętność panowania nad bólem i jego obniżeniem. Materiał i metody. Badaniem objętych zostało 181 pacjentów z rozpoznaniem zwyrodnienia stawu biodrowego i zakwalifikowanych do zabiegu operacyjnego całkowitej alloplastyki biodra hospitalizowanych w Wojewódzkim Szpitalu Specjalistycznym w Białej Podlaskiej. Badanie przeprowadzono metodą sondażu diagnostycznego z wykorzystaniem zestawu kwestionariuszy: Skali Akceptacji Choroby – AIS, Skali WOMAC, Kwestionariusza SF-36, Kwestionariusza BPCQ. Wyniki. Stwierdzono, że ponad połowa badanych (55,2%) w wysokim stopniu akceptowała swoje schorzenie. Na poziom akceptacji miały wpływ: miejsce zamieszkania, wykształcenie, wiek, natężenie bólu po zabiegu oraz ograniczenie sprawności funkcjonalnej. Ogólna ocena jakości życia w dziedzinie fizycznej wynosiła – 62,9 pkt., przy czym najgorzej wypadła ocena funkcjonowania fizycznego oraz zdrowia ogólnego. Analiza za pomocą kwestionariusza WOMAC wykazała, że większość badanych, w pomiarze stopnia ograniczenia sprawności funkcjonalnej, uzyskała poniżej 50 pkt. Wszystkie czynniki, poza poziomem bólu przed zabiegiem, wpływały na stopień ograniczenia sprawności. Wnioski. Wiek, miejsce zamieszkania oraz wykształcenie dały możliwości panowania nad bólem, a o możliwości jego zmniejszenia wiedziały osoby dłużej hospitalizowane. Najwyższą jakością życia charakteryzowały się osoby z dużych miast. Wykształcenie wpłynęło na jakość życia, która wraz z wiekiem i wyższym natężeniem bólu spadała. Im lepsza jakość życia, tym wyższy poziom akceptacji choroby i odwrotnie

Marginal zone B-cell lymphoma with multiple extranodal locations in a patient with Sjögren’s syndrome – a diagnostic problem

Sjögren’s syndrome is a chronic autoimmune disease characterized by the presence of lymphocytic infiltrates in exocrine glands, mainly salivary and lacrimal glands, which result in xerophthalmia and xerostomia. About half of the patients develop systemic complications, including lymphoproliferative disorders. We report a case of a 27-year-old woman with a diagnosis of Sjögren’s syndrome and a suspicion of respiratory system involvement in the course of granulomatosis with polyangiitis. Histopathological examination of a skin lesion suggested marginal zone B-cell lymphoma. After pathological and immunohistochemical evaluation of all available previous biopsy samples and the medical documentation the diagnosis of extranodal marginal zone B-cell lymphoma stage IV according to the Ann Arbor classification was rendered. The patient was referred to the Department of Haematology and was treated with R-CVP (cyclophosphamide, vincristine, prednisone, rituximab)

Age-Adjusted D-Dimer Levels May Improve Diagnostic Assessment for Pulmonary Embolism in COVID-19 Patients

Introduction: SARS-CoV-2 infection leads to a hypercoagulable state. The prevalence of pulmonary embolism (PE) seems to be higher in this subgroup of patients. Patients and methods: We combined data from two tertiary referral centers specialized in the management of PE. The aims of this study were as follows: (1) to evaluate the prevalence of PE among a large population of consecutive patients admitted for COVID-19 pneumonia in two centers, (2) to identify a plasma D-dimer threshold that may be useful in PE diagnostic assessment, (3) to characterize the abnormalities associated with PE and mortality in COVID-19 patients. Results: The incidence of symptomatic acute PE was 19.3%. For diagnosing PE in COVID-19 patients, based on ROC curve analysis, we identified a D-dimer concentration/patient’s age ratio of 70, which improved D-dimer diagnostic capacity for PE and led to a reclassification improvement of 14% (NRI 0.14, p = 0.03) when compared to a cut-off level of 1000 ng/mL. Especially in severe COVID-19 lung involvement, D-dimer/age ratio cut-off equal to 70 was characterized by high diagnostic feasibility (sensitivity, specificity, negative predictive value, positive predictive value of 83%, 94%, 96%, and 73%, respectively). Apart from PE status, lung involvement and troponin T concentration were also independent predictors of in-hospital mortality. In the subgroup of PE patients, mortality was comparable with non-PE patients (19/88 (21.5%) vs. 101/368 (27.4%) for non-PE, p = 0.26) and was associated with older age, higher Bova scores, and higher troponin T concentrations. Age was the sole independent predictor for mortality in this subgroup. Conclusions: PE in COVID-19 patients is common, but it may not influence mortality when managed at a specialized center. In suspected PE, age-adjusted D-dimer levels (upper limit of normal obtained from the formula patient’s age × 70) may still be a useful tool to start the diagnostic workup. In COVID-19 patients without PE, older age, more extensive parenchymal involvement, or higher D-dimer levels are factors predicting mortality

The Effect of Manufacture Process on Mechanical Properties and Burning Behavior of Epoxy-Based Hybrid Composites

The production of hybrid layered composites allows comprehensive modification of their properties and adaptation to the final expectations. Different methods, such as hand lay-up, vacuum bagging, and resin infusion were applied to manufacture the hybrid composites. In turn, fabrics used for manufacturing composites were made of glass (G), aramid (A), carbon (C), basalt (B), and flax (F) fibers. Flexural, puncture impact behavior, and cone calorimetry tests were applied to establish the effect of the manufacturing method and the fabrics layout on the mechanical and fire behavior of epoxy-based laminates. The lowest flammability and smoke emission were noted for composites made by vacuum bagging (approximately 40% lower values of total smoke release compared with composites made by the hand lay-up method). It was demonstrated that multi-layer hybrid composites made by vacuum bagging might enhance the fire safety levels and simultaneously maintain high mechanical properties designed for, e.g., the railway and automotive industries