Projekt utworzenia sieci ośrodków diabetologicznych w województwie pomorskim

Wstęp. Cukrzyca stanowi ważny problem zdrowotny i ekonomiczny w Polsce. W województwie pomorskim choruje na nią około 110 tysięcy osób powyżej 18. roku życia. Co czwarty pacjent spośród nich jest nieświadomy posiadania choroby. Szacuje się, że liczba osób chorych na cukrzycę w Polsce i na Pomorzu będzie szybko wzrastać ze względu na coraz większą zapadalność oraz starzenie się społeczeństwa. Głównym celem niniejszego artykułu jest przedstawienie optymalnego dla województwa pomorskiego modelu sieci ośrodków diabetologicznych. Jego głównym założeniem ma być redukcja liczby hospitalizacji chorych z cukrzycą oraz zdecydowana poprawa opieki ambulatoryjnej. Materiał i metody. Oceniono dane dotyczące hospitalizacji osób z rozpoznaną cukrzycą w całym województwie pomorskim, uzyskane z bazy Pomorskiego Oddziału NFZ oraz dane osób hospitalizowanych z powodu cukrzycy w Uniwersyteckim Centrum Klinicznym w Gdańsku (szpitalu dysponującym jedynym oddziałem diabetologicznym w województwie). Następnie odniesiono się do aktualnych zaleceń towarzystw naukowych i wskazano wady obecnego systemu leczenia osób chorujących na cukrzycę. Ostatecznie zapro­ponowano model sieci ośrodków diabetologicznych dla województwa pomorskiego. Wyniki. Wyniki przedstawiono osobno dla opieki szpitalnej i ambulatoryjnej. Zaproponowano sieć 4 szpitali dla opieki całodobowej, zwracając uwagę na potrzeby finansowe, sprzętowe oraz wymagany personel. W opiece ambulatoryjnej zaproponowano szereg rozwiązań, zwłaszcza dotyczących opieki nad osobami młodymi z cukrzycą typu 1, kobietami ciężarnymi oraz pacjentami z zespołem stopy cukrzycowej.Introduction. Diabetes is an important health and economical problem in Poland. Pomorskie Region has a population of about 110.000 adult diabetics. Every fourth of them is unaware of having the disease. It is estimated that the number of people with diabetes in Poland will rapidly increase due to population aging. Aim. The aim of this article is to describe the optimal model of diabetes centers network in Pomorskie to reduce the number of hospitalizations of patients with diabetes and to improve outpatient care. Material and methods. Data of hospital care of diabetics in Pomorskie from National Health Service and from the University Clinical Centre in Gdansk was evaluated and compared to the current guidelines. Then defects of current healthcare on diabetics was indicated. Finally, the model of diabetes centers network in Pomorskie was proposed. Results. Results are presented separately for hospital and outpatient care. The network of four hospitals was proposed depending of the financial needs, required equipment and staff. In outpatient care several solutions was suggested, e.g. healthcare for young people with type 1 diabetes, pregnant women and patients with diabetic foot syndrome

Expression of KIM-1, VEGF and bFGF in the transplanted kidney as predictive factors of kidney allograft function

Introduction: Transplantation is now a common treatment for kidney failure. However, it is associated with numerous complications, among which is rejection. Currently, factors that can predict the function of the transplanted kidney are being sought. This study aimed to investigate whether the expression of KIM-1 (kidney injury molecule-1), VEGF (vascular endothelial growth factor) and bFGF (basic fibroblast growth factor) assessed in the transplanted kidney before transplantation can be a predictive marker of the later function of the transplanted kidney and the occurrence of complications such as delayed graft function (DGF) and acute rejection (AR). Material and methods: The study group included 44 kidney allograft recipients who underwent kidney transplantation. Results: There were no statistically significant correlations between KIM-1, VEGF and bFGF gene expression in transplanted kidney biopsies and the occurrence of DGF and AR. The expression of the bFGF gene correlated significantly with the creatinine levels before and on the first day after transplantation. There were no statistically significant correlations between creatinine levels and expression of the KIM-1 and VEGF genes. There was also no statistically significant correlation between bFGF, KIM-1 and VEGF gene expression in the transplanted kidney and later eGFR and diuresis values. A statistically significant negative correlation was found between bFGF and serum potassium levels before transplantation and up to one month after transplantation. KIM-1 expression correlated significantly negatively with pre-transplant serum potassium levels. VEGF expression correlated significantly negatively with potassium levels 2 and 24 months after transplantation. Conclusions: The present results suggest that the expression of KIM-1, VEGF and bFGF assessed in the transplanted kidney before transplantation is not a significant predictor of the later function of the transplanted kidney. The expression of the bFGF gene correlates with the creatinine levels before and on the first day after transplantation. The expression of KIM-1, VEGF and bFGF may correlate with potassium serum levels

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

Soyfem modulation role in osteogenesis and resorption in women with spine osteoarthrosis in en early menopausal period

Wstęp. Celem pracy była ocena zależności między gęstością mineralną trzonów kręgów lędźwiowych a stężeniami prolaktyny i wydalanych z moczem specyficznych markerów resorpcji kości: pirydynoliny (Pyd), dezoksypirydynoliny (Dpyd), C-terminalnego telopeptydu łańcucha alfa kolagenu typu I (CTx I) i resorpcji chrząstki stawowej C-terminalnego telopeptydu łańcucha alfa kolagenu typu II (CTx II) u kobiet we wczesnym okresie pomenopauzalnym ze zmianami zwyrodnieniowymi kości i stawów. Materiał i metody. Badaniem objęto 65 kobiet w wieku 51,19 &plusmn; 4,18 roku we wczesnym okresie pomenopauzalnym, które w zależności od gęstości mineralnej trzonów kręgów lędźwiowych i stosowanych preparatów podzielono na trzy grupy. Grupę I kontrolną stanowiły kobiety z prawidłową gęstością T-score &#8211;1, grupę II i III kobiety z gęstością mineralną powyżej normy referencyjnej T-score +1. Kobiety z grupy I i II otrzymywały doustnie preparat placebo, a w grupie III podawano preparat terapeutyczny Soyfem przez okres 12 miesięcy. Gęstość mineralną trzonów kręgów lędźwiowych oznaczono tomograficznie, wyrażając wartości w mg/cm3 przed i po 12 miesiącach, natomiast badania biochemiczne - przed i po 3 miesiącach badania. Stężenia hormonów oznaczano metodami radioimmunologicznymi, a markery resorpcji kości metodą ELISA. Wyniki. Stwierdzono, że u kobiet ze zwyrodnieniem kręgosłupa BMD był znamiennie wyższy, a stężenie markerów resorpcji - Pyd, Dpyd i CTx I, wapnia w surowicy i moczu - było znamiennie niższe w porównaniu z wartościami w grupie kontrolnej. U kobiet z grupy III po zastosowaniu Soyfemu znamiennie wzrosły stężenia Pyd, Dpyd, wapnia w surowicy i moczu w porównaniu z wartościami wstępnymi, a stężenia CTx I i CTx II były nieznamiennie wyższe. Również BMD u kobiet z grupy III był znamiennie mniejszy. Zachodzi znamiennie ujemna korelacja między BMD a Pyd, Dpyd oraz brak korelacji między BMD a stężeniami CTx I i Ctx II. Wnioski. 1. Stosowanie preparatu Soyfem u kobiet ze zmianami zwyrodnieniowymi kości i stawów wywiera modulujący wpływ na poprawę zaburzonych procesów resorpcji. 2. Zaburzenia procesów resorpcji u kobiet z osteoartrozą manifestuje się wzrostem gęstości mineralnej kości.Background. The aim of this work was to assess the correlation between the mineral density of lumbar vertebrae and the serum prolactine level and specific resorption bone markers: pirydynolin (Pyd), dezoksypirydynolin (Dpyd), C-terminal telopeptide of type I collagen (CTx I) and specific resorption cartilage markers C-terminal telopeptide, type II collagen (CTx II) in women with lumbar osteoarthrosis in an early postmenopausal period. Material and methods. 65 women, aged 51.19 &plusmn; 4.18 years in an early postmenopausal physiological state were enrolled in the study. The women were divided into three groups of treatment, according to the lumbar vertebrae mineral density results. The control group I was with normal mineral density of lumbar vertebrae (T-score &#8211;1) and the groups: II and III were with increasing mineral density of lumbar vertebrae (T-score +1). The patients in groups I and II took placebo and in the group III were administrated Soyfem for 12 months. The mineral density of lumbar vertebrae was assessed with computed tomography at the beginning and after 12 months of treatment and results were expressed in mg/cm3. Biochemical tests were performed at the beginning and after 3 months of treatment. The radioimmunological method for the determination of serum hormone levels and the Elisa method for the bone resorption markers assessment were used. Results. The BMD were significantly higher and bone resorption makers, Pyd, Dpyd, CTx I and calcium, in serum and urine were significantly lower in women with osteoarthrosis in comparison with the control group. Moreover, serum and urine levels of Pyd, Dpyd, and calcium were significantly higher and the CTx I and CTx II serum levels were insignificantly higher after treatment in comparison with baseline results in the Soyfem administration group III. Also BMD were significantly lower in the group III. The negative correlation between BMD and Pyd, Dpyd and lack of correlation between BMD and CTx I and CTx II serum levels were determined in the study. Conclusions. 1. Soyfem drugs have a positive modulating influence on disturbed resorption process in women with bones and joints osteoarthrosis. 2. Disorders of resorption proces in women with osteoarthrosis manifest increase of bone mineral density