Nowości i modyfikacje w Kryteriach Rzymskich IV

Kryteria Rzymskie IV opublikowane w maju 2016 roku stanowią najnowszą aktualizację kryteriów diagnostycznych zaburzeń czynnościowych układu pokarmowego, określanych zgodnie z nową definicją zaburzeniami interakcji jelitowo-mózgowych. Główne zmiany wprowadzone w odniesieniu do poprzednio obowiązujących Kryteriów Rzymskich III obejmują modyfikację terminologii związaną z częściową eliminacją terminu „czynnościowe”, wprowadzenie nowych rozpoznań, zmianę progów częstości występowania objawów uwzględnionych w kryteriach, kategoryzację zaburzeń jelitowych w ramach spektrum objawów, modyfikację kryteriów zespołu jelita nadwrażliwego (IBS) oraz podziału IBS na podtypy, a także rewizję zaburzeń pęcherzyka żółciowego i zwieracza Oddiego. Aktualnie IBS definiowany jest jako nawracający ból brzucha występujący średnio przez co najmniej 1 dzień w tygodniu przez ostatnie 3 miesiące, który spełnia co najmniej 2 z 3 kryteriów: 1) związany jest z defekacją, 2) związany jest ze zmianą częstości wypróżnień, 3) związany jest ze zmianą konsystencji stolca. Cztery nowo wprowadzone rozpoznania to: nadwrażliwość na refluks, zespół niepowściągliwych wymiotów wywołanych kannabinoidami, zaparcie wywołane opioidami oraz zespół jelita narkotycznego, czyli hiperalgezja przewodu pokarmowego wywołana opioidami. Kontrowersje może budzić uwzględnienie w Kryteriach Rzymskich IV zaburzeń wywołanych przez kannabinoidy lub opioidy, pomimo iż wpisują się one w definicję zaburzeń interakcji jelitowo-mózgowych związanych z dysfunkcją na poziomie zarówno centralnego, jak i jelitowego układu nerwowego. W pracy przedstawiono najważniejsze zmiany wprowadzone w Kryteriach Rzymskich IV wraz z ich uzasadnieniem oraz znaczeniem w praktyce klinicznej

Fat embolism syndrome case in woman presenting with a multiple injury following a traffic accident successfully treated using interdisciplinary approach - case report

BACKGROUND: A potential complication of extensive injuries is an episode of fat embolism, also referred to as fat embolism syndrome. The main causes of fat embolism include long bone and pelvic fractures. Symptoms of fat embolism may also develop after elective orthopedic surgery, removal of subcutaneous fat tissue, multiple rib fractures, acute pancreatitis, or parenteral nutrition with fat-containing products.Most of the possible clinical signs are non-specific. The triad of clinical signs including gas exchange disorders in the lungs, central nervous system disorders, and bloody petechiae on the skin makes fat embolism syndrome diagnosis much easier. However, the final diagnosis is based on meeting one large criterion, four small criteria, and one laboratory criterion in accordance with Gurd’s assumptions. METHODS: Manuscript description a case of 44-year-old woman with a multiple injury following a traffic accident. Computed tomography revealed a extensive head injury, numerous fractures of ribs, transverse processes of thoracic vertebrae and right scapula. As a result of the injuries developed full-blown fat embolism syndrome. CONCLUSIONS: This case highlights the importance of appropriate knowledge of the pathomechanism and clinical presentation of fat embolism syndrome and interdisciplinary therapeutic team approach. A quick correct diagnosis is crucial to improve treatment results. Access to laboratory and imaging tests considerably facilitates the diagnostic process, which should be followed by optimal therapeutic management. The lack of a golden standard of treatment necessitates a flexible and interdisciplinary therapeutic approach

VivaSight single-lumen tube as an intubation method. A systematic review and meta-analysis of randomised simulation trials

INTRODUCTION: Endotracheal intubation is one of the basic procedures performed in emergency medicine in patients with respiratory insufficiency, inability to maintain airway patency, or apnoea. Rapid performance of the procedure and implementation of ventilation are among the basic principles of rescue procedures. The primary aim of the present systematic review and meta-analysis was to compare the VivaSight SL tube-mounted camera with a standard endotracheal single-lumen tube and direct laryngoscope for endotracheal intubation based on randomised controlled trials of simulation or cadaver trials. The analysis was based on the hypothesis that the use of videolaryngoscopy based on VivaSight SL tube increases the effectiveness of endotracheal intubation, reducing the risk of ineffectiveness of the first intubation attempt and the risk of adverse events, such as dental compression.  MATERIAL AND METHODS: We searched the MEDLINE, EMBASE, Scopus, Cochrane, and Google Scholar databases for randomised, controlled trials and observational studies from 1985 until October 2019, without language restrictions. Grey literature, clinicaltrials.gov, and reference lists of articles were hand searched. We conducted a meta-analysis with random-effects models to evaluate time to intubation, first-pass success rates, overall success rates, dental compression, and glottic view.  RESULTS: The search located 12 eligible studies. The time of intubation using VivaSight was significantly shorter than that of direct laryngoscopy (MD = –11.29 [–13.10, –9.49], p < 0.001). The efficacy of the first intubation attempt was higher for VivaSight than for DL (96.0% vs. 61.7%; RR = 1.62 [1.40, 1.88], p < 0.001). The meta-analysis showed that the total efficacy of VivaSight intubation compared to direct laryngoscopy was statistically significantly higher (100% vs. 88.9%, RR = 1.11 [1.02, 1.20]; p = 0.02). The glottis visibility assessed as Cormack-Lehane grade I or II was better in VivaSight intubation compared to direct laryngoscopy (100% vs. 90.9%, RR = 1.05 [0.99, 1.12]; p = 0.08).  CONCLUSIONS: Our meta-analysis suggests that the VivaSight SL provided better glottic visualisation and shorter intubation time, with improved success rates during different simulated intubation scenarios

Diagnostic performance of point-of-use ultrasound of resuscitation outcomes: A systematic review and meta-analysis of 3265 patients

Background: Echocardiography in the setting of resuscitation can provide information as to the cause of the cardiac arrest, as well as indicators of futility. This systematic review and meta-analysis were performed to determine the value of point-of-care ultrasonography (PoCUS) in the assessment of survival for adult patients with cardiac arrest. Methods: This meta-analysis was performed in adherence to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, EMBASE, Web of Science, Cochrane have been searched from databases inception until March 2nd 2021. The search was limited to adult patients with cardiac arrest and without publication dates or country restrictions. Papers were chosen if they met the required criteria relating to the sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of this diagnostic technique concerning resuscitation outcomes. Results: This systematic review identified 20 studies. Overall, for survival to hospital discharge, PoCUS was 6.2% sensitivity (95% confidence interval [CI] 4.7% to 8.0%) and 2.1% specific (95% CI 0.8–4.2%). PoCUS sensitivity and specificity for return of spontaneous circulation were 23.8% (95% CI 21.4–26.4%) and 50.7% (95% CI 45.8–55.7%) respectively, and for survival to admission 13.8% (95% CI 12.2–15.5%) and 20.1% (95% CI 16.2–24.3%), respectively. Conclusions: The results do not allow unambiguous recommendation of PoCUS as a predictor of resuscitation outcomes and further studies based on a large number of patients with full standardization of operators, their training and procedures performed were necessary

Jakość pośredniego masażu serca wykonywanego przez ratowników medycznych u niemowląt z zastosowaniem nowej metody uciskania klatki piersiowej: randomizowane badanie krzyżowe z wykorzystaniem fantomów

Background: The aetiology of sudden cardiac arrest in infants is different from that in adults, with respiratory failure, sudden infant death syndrome, and drowning being the primary causes in the former. According to the European Resuscitation Council (ERC) and American Heart Association (AHA) recommendations, the quality of chest compressions (CC) is a key element affecting the effectiveness of cardiopulmonary resuscitation (CPR). The current ERC and AHA guidelines recommend the ‘two-finger technique’ (TFT) or ‘two-thumb encircling hands technique’ (TTHT) for external CCs during infant CPR. Aim: The aim of the randomised crossover manikin trial was to assess the CC quality during simulated resuscitation in infants performed by paramedics. Methods: A prospective, randomised, crossover, single-centre study was conducted between June and August 2016. The study material consisted of 120 fully trained and licensed paramedics (39 females, 32.5%) with a minimum of five years of professional experience (mean 7.5 ± 4.8 years) in emergency medicine (mean age, 30.5 ± 5.5 years). The participants performed CCs using three techniques: TFT (the rescuer compresses the sternum with the tips of two fingers); TTHT; and the ‘new two-thumb technique’ (nTTT). The novel method of CCs in an infant consists of using two thumbs directed at the angle of 90 degrees to the chest while closing the fingers of both hands in a fist. Results: The median CC rate when using the TFT, the TTHT, and nTTT methods varied and amounted to 134 min–1 vs. 126 min–1 vs. 114 min–1, respectively. There was a statistically significant difference in the median CC frequency between TFT and TTHT (p < 0.001), TFT and nTTT (p < 0.001), and between TTHT and nTTT (p < 0.001). The highest percentage of compressions with the frequency recommended by the ERC guidelines (100–120 min–1) was achieved by the study participants only with the nTTT. The median CC depth during the TFT was 28 mm (interquartile range [IQR] 27–30 mm) and was significantly lower than in the static TTHT (40.5 [IQR 39–41] mm; p < 0.001) and nTTT (40 [IQR 39–41] mm; p < 0.001). The percentage of adequate depth CCs was correctly obtained with TTHT and nTTT. The largest proportion of total decompression of the chest was observed with the nTTT technique (96 [IQR 96–98] %), followed by TFT (95.5 [IQR 85.5–99] %) and TTHT (5 [IQR 3–7] %). In all scenarios, the correct placement of the CC point was achieved in more than 90% of cases. Conclusions: Our novel infant CC method provides the highest percentage of CCs with the frequency recommended by the ERC guidelines as compared with standard techniques. It also allows optimal CC depth.  Wstęp: Etiologia nagłego zatrzymania krążenia różni się w przypadku noworodków i niemowląt oraz osób dorosłych, a niewydolność oddechowa, zespół nagłej śmierci niemowląt oraz utonięcie stanowią główne przyczyny zgonu w tej pierwszej grupie pacjentów. Zgodnie z zaleceniami wynikającymi z Wytycznych Europejskiej Rady Resuscytacji (ERC) i Amerykańskiego Towarzystwa Kardiologicznego (AHA) jakość pośredniego masażu serca (CC) jest zasadniczym elementem wpływającym na skuteczność resuscytacji krążeniowo-oddechowej (CPR). W obecnie obowiązujących wytycznych ERC i AHA w przypadku prowadzenia resuscytacji u noworodków i niemowląt zaleca się stosowanie pośredniego masażu serca techniką dwóch palców (TFT) lub techniką dwóch kciuków i dłoni z objęciem klatki piersiowej (TTHT). Cel: Celem niniejszego randomizowanego badania krzyżowego przeprowadzanego na fantomach była ocena jakości pośredniego masażu serca w trakcie symulowanej resuscytacji u niemowląt, prowadzonej przez ratowników medycznych. Metody: Badanie prospektywne, randomizowane, krzyżowe, jednoośrodkowe było przeprowadzone w okresie od czerwca do sierpnia 2016 roku. Materiał badawczy stanowiło 120 czynnych zawodowo ratowników medycznych (39 kobiet, 32,5%) posiadających co najmniej 5-letnie (7,5 ± 4,8 roku) doświadczenie zawodowe w ratownictwie medycznym (średnia wieku 30,5 ± 5,5 roku). Każdy z uczestników prowadził CC, stosując każdą z trzech technik: TFT (ratownik uciska mostek opuszkami dwóch palców), TTHT oraz nową techniką uciskania dwoma kciukami (nTTT). Nowa metoda CC u noworodków i niemowląt polega na uciskaniu dwoma kciukami skierowanymi pod kątem 90 stopni do klatki piersiowej przy jednoczesnym zaciśnięciu palców obu dłoni w pięści. Wyniki: Średnia częstość uciskania klatki piersiowej przy stosowaniu technik TFT, TTHT oraz nTTT różniła się i wynosiła odpowiednio 134 min–1, 126 min–1 i 114 min–1. Stwierdzono istotną statystycznie różnicę w średniej częstości CC między technikami TFT i TTHT (p < 0,001), TFT i nTTT (p < 0,001) oraz TTHT i nTTT (p < 0,001). Najwyższy odsetek uciśnięć klatki piersiowej zgodnych z wytycznymi ERC (100–120 min–1) uczestnicy badania osiągnęli, stosując technikę nTTT. Średnia głębokość CC przy technice TFT wyniosła 28 (odstęp międzykwartylowy [IQR] 27–30 mm) i była istotnie statystycznie niższa niż w grupie TTHT (40,5 [IQR 39–41] mm; p < 0,001) oraz nTTT (40 [IQR 39–41] mm; p < 0,001). Odpowiedni odsetek prawidłowych uciśnięć klatki piersiowej osiągnięto, stosując techniki TTHT i nTTT. Najwyższy odsetek całkowitej dekompresji klatki piersiowej obserwowano przy stosowaniu techniki nTTT (96 [IQR 96–98] %), na dalszych miejscach były technika TFT (95.5 [IQR 85,5–99] %) i TTHT (5 [IQR 3–7] %). We wszystkich scenariuszach prawidłową lokalizację miejsca uciskania klatki piersiowej osiągnięto w ponad 90% przypadków. Wnioski: Zaproponowana nowa metoda uciskania klatki piersiowej u noworodków i niemowląt zapewnia wyższy odsetek uciśnięć klatki piersiowej w zakresie częstości zalecanej w wytycznych ERC w porównaniu z technikami standardowymi. Technika ta zapewnia uzyskanie optymalnej głębokości uciskania klatki piersiowej.

A multicenter survey on toxoplasmosis knowledge among pregnant women in Poland (the TOWER study)

Abstract Background The seroprevalence of Toxoplasma gondii ranges widely in different areas of the world and different populations. Although toxoplasmosis is typically benign and asymptomatic, it induces major complications in immunocompromised individuals and during pregnancy. Prevention of maternal primary infection constitutes the major tool for avoiding congenital T. gondii infections and toxoplasmosis complications. The preventive measures depend on the women’s knowledge about toxoplasmosis. The aim of the study was to assess the knowledge on toxoplasmosis among pregnant women in Poland. Methods The study was conducted between October 2016 and January 2017 in 3 Polish cities. During a visit in a hospital outpatient clinic, pregnant women aged > 16 years fulfilled a previously validated questionnaire. The questions concerned personal data (age, parity, educational level, place of residence), toxoplasmosis knowledge (etiology, routes of transmission, symptoms, sequelae), and sources consulted to collect information. Results Overall, 465 pregnant women participated in the survey; 439 (94.4%) were aware of toxoplasmosis. Toxoplasmosis was perceived as a zoonotic disease by 77.4%, as a parasitic disease by 41.7%, as a disease transmitted through poor hand hygiene by 8.6%, as a childhood illness by 4%, and as a congenital disease by 0.4%. Regarding the transmission route, 84.5% of women pointed at a domestic cat, 46.7% at eating raw or undercooked meat. The total of 84.3% did not know toxoplasmosis symptoms, and 12.0% stated that they did not present the symptoms. In multivariate analysis, younger age (OR, 2.74; 95% CI, 1.67–4.49; p <  0.001), city residence (OR, 13.45; 95% CI, 3.12–57.89; p <  0.003), and higher education level (OR, 6.81; 95% CI, 3.69–12.59; p <  0.001) were significantly associated with better knowledge of toxoplasmosis, and the number of children (OR, 0.32; 95% CI, 0.22–0.48; p <  0.001) – with higher knowledge of the symptoms. Conclusions Among pregnant women in Poland, the basic knowledge on toxoplasmosis is very high (94.4%). Younger age, city residence, higher education level, and the number of children turned out significantly associated with better knowledge of T. gondii and toxoplasmosis symptoms

Determinants of Place of Delivery during the COVID-19 Pandemic—Internet Survey in Polish Pregnant Women

Background and Objectives: COVID-19 is a pandemic disease, and its unpredictable outcome makes it particularly dangerous, especially for pregnant women. One of the decisions they have to make is where they will give birth. This study aimed to determine the factors influencing the choice of place of delivery and the impact of the COVID 19 pandemic on these factors. Materials and Methods: The study was conducted on 517 respondents from Poland. The research methods comprised the authors’ own survey questionnaire distributed via the Internet from 8 to 23 June 2021. The survey was fully anonymous, voluntary, and addressed to women who gave birth during the pandemic or will give birth shortly. Results: A total of 440 (85.1%) respondents were afraid of SARS-CoV-2 infection. The most frequently indicated factors were fear of complications in the newborn, fear of intrauterine fetal death, and congenital disabilities in a newborn. A total of 74 (14.3%) women considered home delivery. The main factors that discouraged the choice of home birth were the lack of professional medical care 73.1% (N = 378), the lack of anesthesia 23.6% (N = 122), and the presence of indications for caesarean section 23.4% (N = 121). The possibility of mother–child isolation caused the greatest fear about hospital delivery. During the COVID-19 pandemic, pregnant women concerned about SARS-CoV-2 infection were more likely to consider home delivery than those without such fears. The most important factors affecting the choice of the place of delivery included the possibility of a partner’s presence, excellent sanitary conditions and optimal distance from the hospital, and the availability of epidural analgesia for delivery. Conclusions: Our study identifies the determinants of place of delivery during the COVID-19 pandemic. The data we obtained can result in the healthcare system considering patients’ needs in case of similar crisis in the future