Transformation of a large multi-speciality hospital into a dedicated COVID-19 centre during the coronavirus pandemic

Introduction. The article describes the process of converting a large multi-specialized hospital into one dedicated to COVID-19 patients, and present established standards of work organization in all the wards and training system of the medical and supporting staff. The several weeks pandemic of the COVID-19 disease has forced the healthcare systems of numerous countries to adjust their resources to the care of the growing number of COVID-19 patients. Managers were presented with the challenge of protecting the healthcare workers from transmission of the disease within medical institutions, and issues concerning the physical and psychological depletion of personnel. Materials and method. Based on analyses of the structure and work processes in Central Clinical Hospital (CCH) reconstructive strategic plan was developed. It included: division of existing wards into observation and isolation wards; installing locks; weekly plan for supplying personal protection equipment (PPE); designating new access to the hospital and communication routes; training of medical and supporting staff. The plan was implemented from the first days of conversion of the hospital. Results. The wards of the CCH were converted for observation and isolation, and each one was fitted with sanitary locks. There was a big improvement in the supply of PPE for the medical staff. Separation of the ‘dirty’ and ‘clean’ parts of the CCH were attained, and widespread intensive training not only protected personnel against infections, but also diminished unrest which was discernable at the beginning of conversion. Conclusions. The transformation efforts will ultimately be appraised at the end of the epidemic, but the data looks encouraging. Two weeks after conversion, the testing of hospital Staff was started and by the end of April, 459 tests were had been conducted, of which only 11 were positive

Synthesis of Novel Pyrido[1,2-c]pyrimidine Derivatives with 6-Fluoro-3-(4-piperidynyl)-1,2-benzisoxazole Moiety as Potential SSRI and 5-HT1A Receptor Ligands

Two series of novel 4-aryl-2H-pyrido[1,2-c]pyrimidine (6a–i) and 4-aryl-5,6,7,8-tetrahydropyrido[1,2-c]pyrimidine (7a–i) derivatives were synthesized. The chemical structures of the new compounds were confirmed by 1H and 13C NMR spectroscopy and ESI-HRMS spectrometry. The affinities of all compounds for the 5-HT1A receptor and serotonin transporter protein (SERT) were determined by in vitro radioligand binding assays. The test compounds demonstrated very high binding affinities for the 5-HT1A receptor of all derivatives in the series (6a–i and 7a–i) and generally low binding affinities for the SERT protein, with the exception of compounds 6a and 7g. Extended affinity tests for the receptors D2, 5-HT2A, 5-HT6 and 5-HT7 were conducted with regard to selected compounds (6a, 7g, 6d and 7i). All four compounds demonstrated very high affinities for the D2 and 5-HT2A receptors. Compounds 6a and 7g also had high affinities for 5-HT7, while 6d and 7i held moderate affinities for this receptor. Compounds 6a and 7g were also tested in vivo to identify their functional activity profiles with regard to the 5-HT1A receptor, with 6a demonstrating the activity profile of a presynaptic agonist. Metabolic stability tests were also conducted for 6a and 6d

A perspective of the comprehensive and objective assessment of analytical methods including the greenness and functionality criteria : application to the determination of zinc in aqueous samples

The recently proposed concept of White Analytical Chemistry (WAC), referring to the Red-Green-Blue color model, combines ecological aspects (green) with functionality (red and blue criteria), presenting the complete method as “white”. However, it is not easy to carry out an overall quantitative evaluation of the analytical method in line with the WAC idea in an objective manner. This paper outlines the perspective of the future development of such a possibility by attempting to answer selected questions about the evaluation process. Based on the study consisting in the evaluation of selected model methods by a group of 12 independent analysts, it was shown how well individual criteria are assessed, whether the variability of assessments by different people is comparable for each criterion, how large it is, and whether averaging the scores from different researchers can help to choose the best method more objectively

Terapia nadczynności tarczycy jodem promieniotwórczym jest bezpieczna u chorych na chorobę Gravesa i Basedowa z orbitopatią — badanie prospektywne

Introduction: Radioactive iodine (RAI) therapy may induce or worsen orbitopathy (GO) in Graves’ disease (GD). The aim of this study was a prospective assessment of the risk of GO exacerbation in a GD patients cohort submitted to RAI therapy for hyperthyroidism.Material and methods: 208 consecutive GD patients treated with 131I in 2007 were enrolled. The analysis was performed on 156 patients strictly monitored for one year. Glucocorticosteroid (GCS) prophylaxis was administered if GO symptoms or GO history were present, and in cases of tobacco smokers even without GO symptoms. Clinical and biochemical evaluation at one, three, six, and 12 months after therapy was performed in the whole group, then at 24 months in 138 patients.Results: There was no severe GO progression in patients without GO symptoms at the time of RAI treatment. The risk of severe GO worsening for preexisting GO patients (demanding systemic GCS administration) during the 12-month follow-up after RAI therapy was 10%. 12 and 24 months after 131I administration, stable improvement compared to the initial GO status had been achieved in most (98–96%) patients.Conclusions:1. In patients with mild GO, the risk of severe GO worsening after RAI therapy is acceptable, as long as RAI therapy is applied with GCS cover.2. In patients without GO symptoms at the time of RAI therapy but with a history of GO and with subclinical GO diagnosed by MRI only, the risk of severe progression is minimal.3. Distant outcomes of RAI treatment confirmed its safety in GO patients. (Endokrynol Pol 2014; 65 (1): 40–45)Wstęp: Leczenie jodem promieniotwórczym (131I) może indukować lub nasilać objawy orbitopatii u pacjentów z rozpoznaniem choroby Graves-Basedowa (CHGB). Celem pracy była prospektywna ocena ryzyka zaostrzenia orbitopatii w grupie chorych leczonych 131I z powodu nadczynności tarczycy.Materiał i metody: Do badania włączono 208 kolejnych pacjentów z rozpoznaniem CHGB leczonych 131I w 2007. Do analizy włączono 156 chorych ściśle monitorowanych przez rok. Osłona glikokortykoidowa (GCS) była stosowana w przypadku występowania objawów orbitopatii, dodatniego wywiadu w kierunku orbitopatii i u palaczy tytoniu, także bez objawów orbitopatii. Kliniczna i biochemiczna ocena była przeprowadzona w całej grupie 1, 3, 6 i 12 miesięcy po leczeniu 131I i u 138 chorych po 24 miesiącach.Wyniki: Nie obserwowano poważnego zaostrzenia orbitopatii u chorych bez objawów GO w chwili leczenia 131I. Ryzyko istotnej progresji orbitopatii (wymagającej stosowania GKS systemowych) w ciągu 12 miesięcznej obserwacji wynosiło u chorych z wyjściowymi objawami orbitopatii 10%. U większości chorych 12 i 24 miesiące po leczeniu 131I poprawa orbitopatii w porównaniu ze stanem wyjściowym była trwała.Wnioski:1. Ryzyko istotnej progresji objawów po leczeniu 131I u chorych z orbitopatią o umiarkowanym nasileniu jest akceptowalne.2. Ryzyko progresji orbitopatii u chorych bez objawów w chwili leczenia 131I, ale z dodatnim wywiadem w kierunku orbitopatii i z subklinicznymi objawami (obecnymi tylko w badaniu NMR) jest minimalne.3. Odległa ocena potwierdza bezpieczeństwo terapii radiojodem u chorych z orbitopatią. (Endokrynol Pol 2014; 65 (1): 40–45

Predicted and observed in-hospital mortality after left main coronary artery stenting in 204 patients

Background: The purpose of this study was to compare risk predicted using available risk scores and actual outcomes in patients with left main coronary artery disease undergoing percutaneous coronary intervention with stent implantation (PCI LM). Methods: We studied 204 patients treated with elective or emergent coronary angioplasty. We estimated in-hospital mortality using the EuroSCORE, Parsonnet and GRACE risk scores and compared this data with actual in-hospital mortality. Results: There were no deaths among 62 patients undergoing elective PCI LM regardless of the estimated risk. Acute coronary syndrome (ACS) was diagnosed in all 142 patients undergoing emergent PCI LM. Mortality in this group was 24% (34/142). Area under receiver operating characteristic curve (AUC) values for the EuroSCORE, Parsonnet and GRACE risk scores in patients with ACS were 0.812 (p = 0.0001), 0.857 (p = 0.0001), and 0.870 (p = 0.0001), respectively. No statistically significant differences were found when these AUC values for different evaluated risk scores were compared. Overall, the EuroSCORE and Parsonnet risk scores had no discriminative value, as all deaths occurred in the highest risk group. Only the GRACE risk score discriminated risk among intermediate- and high-risk patients with ACS. Conlusions: The EuroSCORE and Parsonnet scoring systems are of no value in predicting periprocedural mortality risk in patients undergoing elective PCI LM. Overall, discriminative ability of the EuroSCORE, Parsonnet, and GRACE risk scores in unselected patients with ACS undergoing emergent PCI LM was good. In this group of patients, the EuroSCORE and Parsonnet scoring systems had no discriminative value in low and moderate risk patients. Only the GRACE risk score discriminated risk among intermediate and high risk patients. (Cardiol J 2008; 15: 268-276

Ocena ryzyka a rzeczywiste wyniki implantacji stentu do pnia lewej tętnicy wieńcowej u 204 chorych w okresie okołozabiegowym

Wstęp: Celem niniejszej pracy było porównanie ryzyka oszacowanego na podstawie powszechnie dostępnych modeli z rzeczywistymi wynikami leczenia chorych ze zwężeniem pnia lewej tętnicy wieńcowej metodą angioplastyki wieńcowej (PCI) z implantacją stentu. Metody: Obserwacji poddano grupę 204 pacjentów zakwalifikowanych do angioplastyki wieńcowej w trybie planowym i natychmiastowym. Oceniano śmiertelność szacowaną na podstawie skal EuroSCORE, Parsonneta, GRACE oraz śmiertelność rzeczywistą w badanej grupie chorych w okresie obserwacji wewnątrzszpitalnej. Wyniki: W badanej populacji nie stwierdzono zgonów wśród 62 osób leczonych w trybie planowym w żadnej z grup ryzyka. U wszystkich 142 chorych poddanych PCI z implantacją stentu w trybie natychmiastowym rozpoznano ostry zespół wieńcowy (ACS). W tej grupie zmarły 34 osoby (24%). Pola powierzchni pod krzywą ROC (AUC) dla skal EuroSCORE, GRACE i Parsonneta w grupie osób z ACS wynosiło odpowiednio: 0,812 (p = 0,0001), 0,857 (p = 0,0001) i 0,870 (p = 0,0001). Porównanie AUC dla analizowanych skal nie wykazało różnic istotnych statystycznie. Skale EuroSCORE i Parsonneta nie miały zdolności dyskryminacji ryzyka chorych (wszystkie zgony wystąpiły w grupie najwyższego ryzyka). Jedynie skala GRACE różnicowała ryzyko chorych z ACS w grupie umiarkowanego i wysokiego ryzyka. Wnioski: Modele oceny ryzyka EuroSCORE i Parsonneta nie mają zastosowania w ocenie okołozabiegowego ryzyka zgonu podczas planowego zabiegu implantacji stentu do pnia lewej tętnicy wieńcowej. Zdolność dyskryminacyjna skal EuroSCORE, GRACE i Parsonneta w niewyselekcjonowanej grupie chorych z ACS poddanych zabiegowi PCI z implantacją stentu była dobra. W tej grupie pacjentów skale EuroSCORE i Parsonneta nie cechowały się zdolnościami różnicowania chorych z niskim i umiarkowanym ryzykiem; jedynie skala GRACE różnicowała pacjentów w grupach ryzyka umiarkowanego i wysokiego