Sinoatrial Wenckebach periodicity as an independent marker for the development of high-degree sinoatrial exit block

Background: The present study of patients with Wenckebach-type second-degree sinoatrial block (W-block) evaluated the probability of the development of a more advanced grade of sinoatrial block. Data on the clinical significance of W-block are limited. It is unknown whether W-block predicts a more advanced grade of sinoatrial block. Methods: Standard ECGs of 412 patients with symptoms that might have been related to cardiac arrhythmias were reviewed for the presence of W-block. In the initial ECG W-block occurred in 29. During the follow-up period of 62 ± 35 months the main end-point was the first episode of type II second-degree sinoatrial block. An additional end-point was the occurrence of a sinus pause greater than 3 s or the development of type II second-degree sinoatrial block. Results: Of the 29 patients with W-block initially, 6 (20.7%) developed higher grade sinoatrial block, and sinoatrial arrhythmic events occurred in 9 (31%). In the 383 patients without W-block subsequent episodes of higher grade sinoatrial block occurred in 14 (3.7%) and sinoatrial arrhythmic events in 28 (7.3%). A multivariate Cox analysis identified W-block as an independent marker for developing type II second-degree sinoatrial block (HR = 3.72, 95% CI 1.39-9.99) and for the occurrence of sinoatrial arrhythmic events (HR 3.01, 95% CI 1.37-6.58). Conclusions: In patients with symptoms that might be caused by cardiac arrhythmias the presence of W-block in a standard ECG indicates a high probability of developing a more advanced grade of sinoatrial block. (Cardiol J 2007; 14: 391-395

Assessment of a gastric arterial network for oesophageal substitute by means of pulse oximetry

Insufficient vascularisation of substitutes in the operative reconstruction of the oesophagus is one of the main causes of the occurrence of anastomotic leaks. In the present study, the blood oxygenation of gastric substitutes for the oesophagus was evaluated before and during the reconstruction. A pulse oximeter was used for the assessment (S & J Medico Teknik AIS, Albertslund, Denmark). Oxygenation in the examined places ranged from 79% to 98%. The values of blood oxygenation in places C1 (fundus of the stomach after the formation of the substitute) and C2 (fundus of the stomach after the formation and stretching of the substitute) were significantly lower than those in analogous places in the stomach before the transformation (C/C1 p < 0.02; C/C2 p < 0.03, Fisher test). There were no correlations between pulse oximetry values observed and the presence of anastomosis leak

Good practices in asynchronous e-learning — a short guideline document for Polish medical teachers — a pilot study

INTRODUCTION: E-learning is gaining popularity also in medical education. It offers students unlimited access to educational materials, helps meet their individual preferences by adapting various learning styles, and is considered to be at least as effective as traditional lectures. However, this can only be true provided that e-learning is of good quality. Short guidelines may be used to familiarise medical teachers with good practices in e-learning, but they should meet the needs of their users, and some areas may require more attention. They should be identified, and medical teachers should be provided with additional resources covering them. This study aimed to develop a short guideline for Polish medical teachers and determine potentially troublesome areas. METHODS: A detailed review of the literature was performed to create a guideline on preparing and conducting e-learning classes. The most important items from it were listed as an evaluation template and pre-tested on a sample of 10 e-learning courses in a search for areas requiring more attention. RESULTS: Half of the courses did not provide students with a syllabus, and none of them clearly defined intended learning outcomes. Also, adult learning concepts were not introduced satisfactorily. Only seven out of 10 courses used activities at all, and they often tested simple knowledge reproduction, were limited to poorly-written test questions, and placed at the end of lessons. CONCLUSIONS: In this pilot study three potentially troublesome areas were identified: defining learning outcomes, application of adult learning theory, and choice of activities. KEY WORDS: e-learning quality, e-learning guidelines, medical teacher

Blok zatokowo-przedsionkowy typu periodyki Wenckebacha jako niezależny wskaźnik prognostyczny wystąpienia wysokiego stopnia zatokowo-przedsionkowego bloku wyjścia

Wstęp: W przedstawianym badaniu, obejmującym pacjentów z blokiem zatokowo-przedsionkowym drugiego stopnia typu periodyki Wenckebacha (dalej: blok Wenckebacha), oceniano prawdopodobieństwo wystąpienia bardziej zaawansowanego bloku zatokowo-przedsionkowego. Dane na temat klinicznego znaczenia bloku Wenckebacha są ograniczone. Nie wiadomo, czy pozwala on przewidywać wystąpienie bardziej zaawansowanego bloku zatokowo-przedsionkowego. Metody: Przeanalizowano występowanie bloku Wenckebacha w standardowych elektrokardiogramach (EKG) u 412 pacjentów z objawami klinicznymi, które mogły być związane z zaburzeniami rytmu serca. Blok Wenckebacha stwierdzono w 29 spośród początkowych EKG. Głównym punktem końcowym ocenianym w czasie obserwacji prowadzonej przez 62 &#177; 35 miesięcy było wystąpienie pierwszego epizodu bloku zatokowo-przedsionkowego drugiego stopnia typu II. Dodatkowym ocenianym punktem końcowym było wystąpienie pauzy zatokowej trwającej dłużej niż 3 s lub bloku zatokowo-przedsionkowego drugiego stopnia typu II. Wyniki: Spośród 29 pacjentów, u których początkowo stwierdzano blok Wenckebacha, wyższego stopnia blok zatokowo-przedsionkowy wystąpił u 6 osób (20,7%), a u 9 chorych (31%) stwierdzono pauzę zatokową lub blok zatokowo-przedsionkowy drugiego stopnia typu II. Wśród 383 pacjentów, u których nie zaobserwowano bloku Wenckebacha w początkowym EKG, wyższego stopnia blok zatokowo-przedsionkowy wystąpił w czasie obserwacji u 14 osób (3,7%), a u 28 pacjentów (7,3%) stwierdzono pauzę zatokową lub blok zatokowo-przedsionkowy drugiego stopnia typu II. W wielozmiennej analizie Coxa blok Wenckebacha był niezależnym wskaźnikiem prognostycznym wystąpienia bloku zatokowo-przedsionkowego drugiego stopnia typu II (HR 3,72; 95% CI 1,39-9,99) oraz pauzy zatokowej lub bloku zatokowo-przedsionkowego drugiego stopnia typu II (HR 3,01; 95% CI 1,37-6,58). Wnioski: U pacjentów z objawami klinicznymi, które mogą wynikać z zaburzeń rytmu serca, obecność bloku Wenckebacha w standardowym EKG wskazuje na duże prawdopodobieństwo wystąpienia bardziej zaawansowanego bloku zatokowo-przedsionkowego. (Folia Cardiologica Excerpta 2007; 2: 598-603)

Polymorphism of VDR gene - the most effective molecular marker of osteoporotic bone fractures risk within postmenopausal women from Wielkopolska region of Poland

Osteoporoza jest ważnym problemem zdrowotnym dzisiejszych czasów. W większości przypadków dotyczy kobiet w okresie pomenopauzalnym. Rozwija się zwykle powoli i początkowo ma bezobjawowy przebieg. Często pierwszym jej objawem i groźnym powikłaniem jest złamanie kości. Skutki tego zdarzenia mogą wpływać negatywnie na jakość życia oraz mogą być przyczyną zwiększonej umieralności tej populacji. Efektywna prewencja i leczenie osteoporozy polega na identyfikacji i ocenie indywidualnego ryzyka złamania kości. Do tego celu można wykorzystać wiele metod diagnostycznych, w tym również metody genetyczne. Celem badania była ocena, które z różnych wariantów genotypu związane są z występowaniem choroby oraz mają wpływ na gęstość mineralną kości. Obserwacji poddano 261 pacjentek z osteoporozą pomenopauzalną. W badaniu ocenie poddano polimorfizmy następujących genów: OPG, VDR, ESR1, TGFB1, COL1A1 oraz BMP2.Znamienność statystyczną pomiędzy wartościami gęstości mineralnej kości a polimorfizmem genu wykazano tylko dla allelu T TaqI genu VDR. W populacji kobiet z osteoporozą pomenopauzalną, zamieszkujących teren Wielkopolski, stwierdzono częstsze występowanie genotypu aa dla ApaI, bb dla Bsm i TT dla Taq genu VDR u pacjentek z większym ryzykiem złamania kości.The major public health problem which will arise is a frequency of osteoporosis. The first manifestations of this disease are often bone fractures. Identification and evaluation of individual bone fracture risk will be the most effective way of solving the problem. Genetic determination of osteoporosis is unquestionable. The aim of this study is to detect which variants of genotypes lead to illness. We investigated 187 patients with osteoporosis (161 women, 26 men) and 19 healthy subjects. Polymorphisms of the following genes were investigated: OPG, VDR, ESR1, TGFB1 COL1A1, and BMP2. The statistically significant relationship between BMD value and T allele of Taq I VDR gene were found. Genotypes: aa, bb, TT of VDR gene occur more frequently in polish osteoporotic population in Wielkopolska region within patients with higher risk of bone fractures

The COVID-19 drive-through point — screening and testing — first in Poland complex centre experience

Introduction: Rapid widespread of the SARS-CoV-2 virus in early 2020 caused global chaos. In the initial period, a lack of knowledge of epidemiology and viral contamination, as well as no availability of either causal treatment or preventive vaccination, resulted in mass testing of symptomatic individuals as the priority for protection. This study aimed to evaluate the effectiveness and safety of the first COVID-19 (coronavirus disease) drive-through testing model in the Greater Poland Region. Material and methods: The authors demonstrate step-by-step the creation and development of the Centre of Medical Simulation Poznan University of Medical Sciences (PUMS) COVID-19 drive-through testing point for 3.5 million inhabitants in the Greater Poland Region during the 1st through 4th coronavirus pandemic waves. For staff education, low and high-fidelity simulation techniques were used. Additionally, the number of tests performed at the swab point and the efficiency of the developed testing model were evaluated and assessed in all pandemic waves. Results: PUMS POST (point of screening and testing) activity lasted 24 months. Improvement of staff skills developed through simulation training increased the median number of 91 patients tested each day (with a median of 25 tests per hour) during the 1st wave to a maximum of 260 patients tested each day (135 tests per hour) during the 4th wave when the new drive-through POST system was employed (p &lt; 0.001). Conclusion: The present study supported the previous preliminary reports that drive-through systems developed during the COVID-19 pandemic proved to be efficient and safe for mass population testing. Moreover, the Medical Simulation Centre confirmed the effectiveness of staff skills improvement

Inhibitors of sodium-glucose transport protein 2: A new multidirectional therapeutic option for heart failure patients

Several mechanisms have been suggested to explain positive cardiovascular effects observed in studies with sodium-glucose co-transporter 2 (SGLT2) inhibitors. The reduction in glucose reabsorption in proximal tubuli induced by SGLT2 inhibitors increases urinary glucose and sodium excretion resulting in increased osmotic diuresis and consequently in decreased plasma volume, followed by reduced preload. In addition, the hemodynamic effects of SGLT2 inhibition were observed in both hyper and euglycemic patients. Due to the complex and multidirectional effects induced by SGLT2 inhibitors, this originally antidiabetic group of drugs has been successfully used to treat patients with heart failure as well as for subjects with chronic kidney disease. Moreover, their therapeutic potential seems to be even broader than the indications studied to date