The use of anticoagulants in chronic kidney disease: Common point of view of cardiologists and nephrologists

In patients diagnosed with chronic kidney disease (CKD), atrial fibrillation (AF) is associated withan increased risk of thromboembolism and stroke. Moreover, patients with CKD — especially those inend-stage renal disease — also present an increased risk of bleeding. Oral anticoagulation is the mosteffective form of thromboprophylaxis in patients with AF and an increased risk of stroke. However, theunderuse of these drugs was observed, mainly due to safety reasons and restricted evidence on efficacy.Much evidence suggests that non-vitamin K-dependent oral anticoagulant agents significantly reducethe risk of stroke, intracranial hemorrhage, and mortality, with lower to similar major bleeding ratescompared with vitamin K antagonists, such as warfarin, in normal renal function subjects. Thus, theyare currently recommended for that group of patients. However, their metabolism is largely dependenton the kidneys for elimination, and current knowledge in this area is limited due to patients witha decreased glomerular filtration rate are usually excluded from clinical trials. The present review articlefocuses on currently available data on oral anticoagulants in patients with moderate to advancedchronic kidney disease and those with end stage renal disease

A patient with the hepatorenal syndrome treated with a liver transplant — case description with duties of the nursing staff

Transplantacja wątroby (LTx) jest leczeniem z wyboru w przypadku zespołu wątrobowo-nerkowego (HRS). Pacjenci oczekujący na przeszczep w stanie zdekompensowanej marskości wątroby z niewydolnością nerek stanowią grupę potencjalnych biorców wysokiego ryzyka rozwoju poważnych powikłań i zgonu w okresie oczekiwania na przeszczep. W pracy przedstawiono przypadek pacjenta z niewydolną marską wątrobą w przebiegu toksycznego jej uszkodzenia, u którego doszło do rozwoju HRS typu I. Chorego zakwalifikowano do pilnego przeszczepu wątroby. W okresie oczekiwania na zabieg poddany był hemodializom. Po transplantacji nastąpiła normalizacja parametrów wątrobowych i nerkowych. W dalszym okresie potransplantacyjnym stężenie kreatyniny obniżyło się do 0,6–1,0 mg/dl. U chorego w okresie oczekiwania na transplantację dominowały problemy wynikające z marskości wątroby oraz niewydolności nerek: żółtaczka, wodobrzusze, obrzęki kończyn dolnych, wyniszczenie, encefalopatia, zaburzenia krzepnięcia, zaburzenia hemodynamiczne, bezmocz. Zadania podejmowane przez personel pielęgniarski zależały od zmieniającego się stanu zdrowia pacjenta i stosowaną terapią mającą na celu utrzymanie go przy życiu i zapewnienie mu opieki do czasu uzyskania przeszczepu.Liver transplantation (LTx) is the first-line treatment for hepatorenal syndrome (HRS). Patients awaiting LTx with decompensated cirrhosis and renal failure are a group of potential recipients with a high risk of developing serious complications and death in the period of expecting for a transplant. The work presents the case of a patient with cirrhosis and a failing liver due to toxic-induced damage; the patient developed HRS type 1. The patient required urgent LTx. During the waiting period s/he undergone haemodialyses. After LTx, there was a normalization in the hepatic and renal parameters. In the ensuing post-transplantation period, the concentration of creatine went down to 0,6–1,0 mg/dl. During waiting for treatment, the patient suffered chiefly from conditions related to cirrhosis and renal failure: jaundice, abdominal dropsy, edema of lower extremity, emaciation, encephalopathy, coagulation disorder, hemodynamic disorder, and anuria. The activities of medical personnel were subject to the patient’s changing condition and employed therapy that was to keep the patient alive and provide safety until the transplantation

Molnupiravir Outpatient Treatment for Adults with COVID-19 in a Real-World Setting—A Single Center Experience

Background: Molnupiravir is approved for the treatment of adult patients with mild to moderate COVID-19. The main goal of the treatment is to reduce hospitalization and mortality rate. This study aimed at the all-cause hospitalization and all-cause death assessment in patients at high risk of severe COVID-19 treated with molnupiravir. Methods: This was a prospective, observational single center study. Non-hospitalized patients with SARS-CoV-2 infection, COVID-19 symptoms with the onset of up to 5 days, and at high risk of severe COVID-19 illness received molnupiravir based on attending physician decisions. Results: In total, 107 patients were enrolled. Adverse events were reported in 28.0% of patients, with nausea and abdominal pain being the most commonly observed. No treatment-emergent AEs resulted in therapy discontinuation. Overall, 15 patients required hospitalization. During the observation, 2.8% (n = 3) of patients subsequently died. All deaths were considered to be related to COVID-19 complications. Age over 65 years, heart failure, and ischemic heart disease showed a significant correlation with the severe course of COVID-19. Conclusion: Molnupiravir may be perceived as an alternative treatment for patients with immunosuppression and advanced chronic kidney disease. Nevertheless, further studies are required to conclusively establish a role for molnupiravir in future COVID-19 treatment recommendations

Development of educational motivation through the youth socio-cultural, environmental and leisure practices

The presents the results of a study of the developmental potential of socio-cultural and leisure practices of youth, used in university education to increase educational adaptation and motivation of students. The relevance of the study lies in the identification of new motivational mechanisms that provide more effective educational adaptation and motivation of young people to obtain vocational education. The relevance of the research is confirmed in the substantive discussion of scientists in the field of transformation of cultural and leisure practices and improving the mechanisms of educational motivation in vocational education. The empirical part of the study of the development of educational motivation through socio-cultural and leisure practices, implemented in the university community, was conducted by a questionnaire survey of 458 people from among the students of the Stavropol Territory. The data was processed using the SPSS Statistics program (version 21). Factor analysis was performed by the method of separation of the main components and by the method of rotation – Varimax with Kaiser Normalization. We present the models of socio-cultural activity that contribute to educational adaptation and increase the motivation of professional self-determination and the formation of future specialists

Translation and validation study of the Polish version of the Brief Hepatitis C Knowledge Scale.

IntroductionChronic hepatitis C (HCV), considered by the World Health Organization as one of the greatest epidemiological health hazards, often with asymptomatic clinical course and one which, due to scanty knowledge, remains a crucial risk factor of serious chronic HCV infection complications. The purpose of this study is to validate the psychometric properties of the Polish version of the validated Brief Hepatitis C Knowledge Scale (BHCKS_PL), developed by Balfour in 2009.MethodsThe study, conducted from May to July 2018, included 246 persons (68,69% females), divided into four subgroups: patients (n = 86), nursing students (n = 74), medical students (n = 28), healthcare workers (nurses and doctors; n = 58). The 19-items questionnaire contained questions designed to assess general knowledge regarding hepatitis C and the transmission risk factors.ResultsAn evaluation by means of multiple comparisons in pairs showed that there were significant differences in the knowledge level between the group of patients and the group of nursing students (Mdn: 14.0 vs 11.0, z = 7.713, PConclusionsThe completed validation suggests good BHCKS_P psychometric characteristics with the internal consistency convergent and known-groups validity. The questionnaire can be used in educational practice. The obtained results of the measurement provide information about the studied person based on the total score

Metabolic Profile of Liver Transplant Recipients and Determinants of their Body Fat Distribution

Obesity and diabetes mellitus epidemics exert a measurable impact on the liver transplant (Ltx) population. This study aimed to investigate the metabolic profile of Ltx recipients and its association with body fat distribution. Adults who underwent de novo elective cadaveric-donor Ltx were eligible. Metabolic syndrome (MS) was diagnosed based on the adapted International Diabetes Federation, the American Heart Association, and the National Heart, Lung, and Blood Institute guidelines. We recruited 100 patients with a mean age of 54 years, of whom 70% were men. Overall, 54% met the criteria for MS, most of which comprised new-onset cases. Excessive fat accumulation in liver donors was found to be associated with an increased metabolic risk in liver recipients. Haemoglobin A1C (OR: 8.962, 95% CI: 2.188–84.545, p = 0.013), ferritin (OR: 1.024, 95% CI: 1.005–1.054, p = 0.038), and de novo hypertriglycaeridemia (OR 27.957, 95% CI: 2.626–752.121, p = 0.014) were found to be independently associated with de novo MS. After a step-wise multivariate analysis, only the anthropometric obesity indices were significantly associated with abdominal fat distribution in Ltx recipients. Metabolic complications were common in liver recipients. Both pre- and post-Ltx factors impacted MS development in liver recipients and determined abdominal fat distribution

Rapid normalization of severe hypercholesterolemia mediated by lipoprotein X after liver transplantation in a patient with cholestasis - a case report

Hypercholesterolemia is a common disorder in adult population, but total cholesterol concentrations beyond 1000 mg/dl occur rarely, and are found in patients with homozygous familial hypercholesterolemia and familial lecithin-cholesterol acyltransferase deficiency, in chronic graft-versus-host disease of the liver, after intravenous infusion of fat emulsion (intralipid), in newborn infants with immature liver function, and in obstructive biliary cholestasis. Cholestasis induces a dramatic increase in plasma cholesterol and the appearance of an abnormal lipoprotein, lipoprotein X (LpX), in the plasma. We report a case of severe hypercholesterolemia mediated by LpX in a patient transplanted for primary biliary cirrhosis (PBC), who was qualified for liver re-transplantation (re-LTx) due to chronic cholestasis. Four months after re-LTx, the cholesterol concentration was normal. The problems in diagnosis and treatment are discussed