Local security in the idea of sustainable development

Purpose: The aim of the research is to analyse the relationship between the level and sense of security of residents and local sustainable development. Design/Methodology/Approach: The analysis of local security in the context of sustainable development is based on critical analysis of literature and statistical data. In addition, the results of research on the evaluation of the basic elements of the local security system, carried out on a statistically significant sample (4,400 people) of residents of local communities in the Kujawsko-Pomorskie Voivodeship. Additionally, taxonomic analyses were carried out, in which the assessments of the level of security by the communities of the powiats of the above voivodeship were compared. In the further part of the study, a review was made of the correlation of taxonomic measures of local security level with the most important indicators of sustainable development. In the final phase of the study, the ranking of powiats of Kujawsko-Pomorskie voivodeship was constructed according to the integrated measure of development. Findings: Local communities, in conditions of sustainable development, aim at the security (social order) of individuals associated in the local community. The special role of local government in ensuring the principle of sustainable development is proved by the systemic solutions adopted in Poland and legal regulations specifying the competences and tasks of local government units of various levels. Practical Implications: The results are of significant importance to local authorities. They allow for a better design of local development management systems, taking into account the assessment of individual elements of the security system. Originality/Value: The research carried out has primarily proven the usefulness of multidimensional analysis and linear ordering methods for the assessment of the examined issues. Sustainability issues, which by nature are multidimensional problems, should not be assessed through the prism of single indicators or stratetical documents.peer-reviewe

Zapalenie płuc i inne infekcje związane z wentylacją mechaniczną

One of the fundamental elements of therapy in patients hospitalised in the Intensive Care Unit (ICU) is mechanical ventilation (MV). MV enables sufficient gas exchange in patients with severe respiratory insufficiency, thus preserving the proper functioning of organs and systems. However, clinical and experimental studies show that mechanical ventilation may cause severe complications, e.g. lung injury (VALI, VILI), systemic inflammatory response syndrome (SIRS), and, on rare occasions, multiple organ failure (MOF). Mechanical ventilation and especially endotracheal intubation are associated also with higher risk of infectious complications of the respiratory system: ventilator-associated respiratory infection (VARI) and ventilator-associated pneumonia (VAP). The complications of the MV listed above have a significant influence on the length of treatment and also on the increase of the costs of therapy and mortality of patients who stay in an ICU. These negative effects of supported breathing are the reasons for intensive research to find new biological markers of inflammation and lung injury, more sensitive and specific diagnostic instruments, more effective methods of therapy, and programs of prevention. The purpose of this article is the presentation of current knowledge concerning VAP-related infections, to allow pulmonologists and general practitioners to become more familiar with the problem. Basic and the most important data concerning the definition, epidemiology, pathophysiology, microbiology, diagnostics, treatment, and prevention of VAP have been included. Additionally, ventilator-associated tracheobronchitis (VAT) was discussed.Jednym z zasadniczych elementów leczenia pacjentów na oddziale intensywnej terapii (OIT) jest wentylacja mechaniczna. U chorych w stanie zagrożenia życia oddech zastępczy umożliwia uzyskanie wymiany gazowej w stopniu niezbędnym do funkcjonowania narządów i układów. Wyniki badań klinicznych i doświadczalnych wykazały jednak, że wentylacja mechaniczna może powodować groźne dla zdrowia komplikacje jak na przykład: uszkodzenie płuc (VALI, VILI), rozwój zespołu uogólnionej odpowiedzi zapalnej (SIRS), a w skrajnych przypadkach wystąpienie zespołu niewydolności wielonarządowej (MOF). Z wentylacją mechaniczną i konieczną do jej prowadzenia intubacją dotchawiczą związane jest również wyższe ryzyko powikłań infekcyjnych w obrębie układu oddechowego (VARI) i rozwój zapalenia płuc związanego z wentylacją mechaniczną (VAP). Te powikłania respiratoroterapii i intubacji dotchawiczej wywierają istotny wpływ na wydłużenie czasu trwania leczenia, wzrost kosztów terapii i zwiększenie śmiertelności chorych przebywających na OIT. Te niekorzystne efekty oddechu zastępczego przyczyniły się do poszukiwań nowych biologicznych wykładników zapalenia i uszkodzenia płuc, czulszych i bardziej swoistych narzędzi diagnostycznych, skuteczniejszych metod leczenia i programów profilaktycznych. Celem pracy jest przedstawienie istotnego zagadnienia klinicznego, jakim jest VAP, a które może być mało znane w środowisku pulmonologów i internistów. W sposób usystematyzowany opisano w niej podstawowe i najważniejsze informacje dotyczące definicji, epidemiologii, patofizjologii, mikrobiologii, diagnostyki, leczenia i zapobiegania VAP. Tematykę odrespiratorowych infekcji układu oddechowego uzupełniono rozdziałem o zapaleniu tchawicy i oskrzeli związanym z wentylacją mechaniczną (VAT)

Hospitalizacja pacjentów ze schorzeniami nienowotworowymi w hospicjum stacjonarnym — doświadczenia ośrodka w Białymstoku

 Background. Current epidemiological observations indicate an increasing need for palliative care for patients with non-cancer diseases, including end-stage heart failure. One of the forms of palliative care are medical services provided in stationary hospice. The aim of the study was to present the characteristics of patients hospitalized in hospice stationary care, and in particular to determine the proportion of non-cancer patients. Patients and methods. The study consisted in analyzing the annual medical records of patients hospitalized in the stationary hospice and recording information on referrals, diagnoses determining admission to the hospice and time of hospitalization. The obtained data was analyzed with non-parametric tests, assuming p &lt; 0.05 as the level of statistical significance. Results. During the study period, 708 patients were hospitalized in the stationary hospice, significantly more often patients with a diagnosis of a cancer (74%), p &lt; 0.05. Patients diagnosed with cardiology accounted for 12% of the group of non-cancer patients and 2.5% of all hospitalized patients. In the group of cancer patients end-stage heart failure was noticed in 34% cases. In the diagnosis of chronic respiratory failure, 28% of patients had a potential end-stage heart failure cause as a co-morbid diagnosis. The age of patients and their hospitalization time in the stationary hospice did not differ significantly between patients with cancer and non-cancer diseases. Conclusions. The dominant group in palliative care in the stationary hospice are still oncological patients. End-stage heart failure is the primary indication in palliative care and associated diagnosis in patients with cancer and chronic respiratory failure.Wstęp. Aktualne obserwacje epidemiologiczne wskazują na wzrastającą potrzebę prowadzenia zasad opieki paliatywnej wobec pacjentów z schorzeniami inne niż nowotworowe, w tym schyłkową niewydolność serca. Jedną z form prowadzenia opieki paliatywnej są świadczenia medyczne realizowane w ramach Hospicjum Stacjonarnego. Cel. Celem pracy była aktualizacja charakterystyki pacjentów hospitalizowanych w hospicyjnej opiece stacjonarnej, a szczególnie określenie udziału pacjentów nienowotworowych w tym pacjentów z rozpoznaniem schyłkowej choroby kardiologicznej. Metodyka i pacjenci. Badanie polegało na analizie rocznej dokumentacji medycznej pacjentów hospitalizowanych w Hospicjum Stacjonarnym i odnotowaniu informacji dotyczących skierowań, rozpoznań warunkujących przyjęcie do hospicjum oraz czasu hospitalizacji. Uzyskane dane poddano analizie testami nieparametrycznymi, przyjmując p < 0,05 za poziom istotności statystycznej. Wyniki. W badanym okresie hospitalizowano w Hospicjum Stacjonarnym 708 pacjentów, znamiennie częściej pacjentów z rozpoznaniem choroby nowotworowej (74%), p < 0,05. Pacjenci z rozpoznaniem kardiologicznym stanowili 12% grupy pacjentów nienowotworowych i 2,5 % wszystkich hospitalizowanych. W obrębie rozpoznania niewydolności oddechowej 30% pacjentów miało potencjalną przyczynę kardiologiczną jako rozpoznanie współistniejące. Łącznie pacjenci z głównym i współistniejącym rozpoznaniem kardiologicznym stanowili 4% badanej populacji. Wiek chorych i czas ich hospitalizacji w Hospicjum Stacjonarnym nie różnił się znamiennie pomiędzy pacjentami z schorzeniami nowotworowymi i nienowotworowymi. Wnioski. Dominującą grupą korzystającą z opieki paliatywnej w Hospicjum Stacjonarnym są nadal chorzy onkologiczni. Niewydolność serca jest rozpoznaniem głównym kwalifikującym do prowadzenia opieki paliatywnej oraz rozpoznaniem towarzyszącym u pacjentów z chorobą nowotworową i przewlekłą niewydolnością oddechową

Inspiracje i wspomnienia dedykowane pamięci Jerzego Koniecznego

Płk w st. spocz., dr hab. Jerzy Konieczny, prof. Uniwersytetu Opolskiego (13 sierpnia 1950 – 27 lipca 2020) Po ukończeniu chemii na Wydziale Matematyki, Fizyki i Chemii Uniwersytetu Śląskiego w Katowicach i uzyskaniu tytułu magistra (w zakresie chemii) zatrudnił się w Zakładzie Kryminalistyki na Wydziale Prawa i Administracji tegoż Uniwersytetu, na etacie technicznym. W 1979 roku, po uzyskaniu stopnia doktora na Uniwersytecie Wrocławskim (Ekspertyza dokumentów sporządzonych pismem ręcznym na papierach syntetycznych – promotor: doc. dr hab. Zdzisław Kegel), przeszedł na etat adiunkta. W 1990 roku, na podstawie pracy Pojęcie prawdopodobieństwa ze stanowiska procesu karnego i kryminalistyki, uzyskał stopień doktora habilitowanego nauk prawnych na Uniwersytecie Śląskim. W międzyczasie, po odbytych studiach zaocznych na Uniwersytecie Jagiellońskim, uzyskał tytuł magistra prawa. Obok pracy na Uniwersytecie Śląskim, w latach 1988–1989 był kierownikiem Zakładu Kryminalistyki Instytutu Ekspertyz Sądowych w Krakowie. Był jednym ze współzałożycieli Klubu Inteligencji Katolickiej w Katowicach, członkiem „Solidarności”. W sierpniu 1990 roku został szefem delegatury Urzędu Ochrony Państwa w Katowicach, a w 1991 roku zastępcą szefa urzędu. Przez okres, kiedy MSW kierował Antoni Macierewicz, odszedł z urzędu i został podsekretarzem stanu w Kancelarii Prezydenta RP Lecha Wałęsy. W czerwcu 1992 roku został szefem UOP. Z funkcji tej zrezygnował w grudniu 1993 roku. Założył wtedy firmę ochroniarsko-detektywistyczną Konsalnet. W 1995 roku objął na krótko tekę Ministra Spraw Wewnętrznych w gabinecie Józefa Oleksego. W 1997 roku bezskutecznie kandydował do Sejmu. Od tego momentu wycofał się z działalności politycznej, poświęcając swój czas pracy naukowej i biznesowi (wykaz Jego publikacji naukowych znajduje się na stronach 9–17). W tym czasie był również nauczycielem akademickim (profesorem uczelnianym) w Uczelni Łazarskiego w Warszawie, Krakowskiej Akademii im. Andrzeja Frycza Modrzewskiego, a później w Uniwersytecie Opolskim. Zmarł nagle 27 lipca 2020 roku. Jan Widack

Stress hormone response to various anaesthetic techniques during thyreidectomy

BACKGROUND: Thyroidectomy is among the most frequently performed procedures in endocrine surgery. The hormonal response to surgery and anaesthesia depends in part on the anaesthetic techniques used; therefore, we measured serum concentrations of TSH, fT4, and fT3 in patients scheduled for elective thyroidectomy under TIVA or VIMA.METHODS: Seventy-eight adult patients, of both sexes, with non-toxic or hyperthyroid nodular goitre, were divided into groups with regard to the goitre type and the technique of anaesthesia used during thyroid surgery. Serum concentrations of TSH, fT4, and fT3, were measured and the surgical stress was estimated using the E-PASS scale.RESULTS: In the groups examined, the mean serum concentrations of TSH remained unchanged during the period of observation. The initially high fT4 and fT3 concentrations gradually decreased, reaching their lowest level on the fourth day after surgery.CONCUSIONS: Both VIMA and TIVA can be regarded as safe techniques of anaesthesia for thyroidectomy

Zapalenie Płuc i Inne Infekcje Związane z Wentylacją Mechaniczną

One of the fundamental elements of therapy in patients hospitalised in the Intensive Care Unit (ICU) is mechanical ventilation (MV). MV enables sufficient gas exchange in patients with severe respiratory insufficiency, thus preserving the proper functioning of organs and systems. However, clinical and experimental studies show that mechanical ventilation may cause severe complications, e.g. lung injury (VALI, VILI), systemic inflammatory response syndrome (SIRS), and, on rare occasions, multiple organ failure (MOF). Mechanical ventilation and especially endotracheal intubation are associated also with higher risk of infectious complications of the respiratory system: ventilator-associated respiratory infection (VARI) and ventilator-associated pneumonia (VAP). The complications of the MV listed above have a significant influence on the length of treatment and also on the increase of the costs of therapy and mortality of patients who stay in an ICU. These negative effects of supported breathing are the reasons for intensive research to find new biological markers of inflammation and lung injury, more sensitive and specific diagnostic instruments, more effective methods of therapy, and programs of prevention. The purpose of this article is the presentation of current knowledge concerning VAP-related infections, to allow pulmonologists and general practitioners to become more familiar with the problem. Basic and the most important data concerning the definition, epidemiology, pathophysiology, microbiology, diagnostics, treatment, and prevention of VAP have been included. Additionally, ventilator-associated tracheobronchitis (VAT) was discussed

Molecular basics of sepsis developement

Bacterial infections and sepsis remain major causes of morbidity and mortality in intensive care units. The normal host response to infection is a complex process that serves to localise and control the invasion of microbes and to repair injured tissue. Local inflammatory processes are regulated through the production of cytokines by macrophages. In some cases, mediator release exceeds the boundaries of the local environment and results in the development of sepsis. It is well known that the innate immune system plays a crucial role in preventing microbial invasion. The human innate immune system consists of genetically programmed defence mechanisms that are directed against molecular components found only in microorganisms. Understanding the complexity of early response to infection with respect to innate immune response is required for the future development of drugs that will effectively control infectious diseases.Bacterial infections and sepsis remain major causes of morbidity and mortality in intensive care units. The normal host response to infection is a complex process that serves to localise and control the invasion of microbes and to repair injured tissue. Local inflammatory processes are regulated through the production of cytokines by macrophages. In some cases, mediator release exceeds the boundaries of the local environment and results in the development of sepsis. It is well known that the innate immune system plays a crucial role in preventing microbial invasion. The human innate immune system consists of genetically programmed defence mechanisms that are directed against molecular components found only in microorganisms. Understanding the complexity of early response to infection with respect to innate immune response is required for the future development of drugs that will effectively control infectious diseases

Artroplastia total do joelho induz apoptose em linfócitos de sangue periférico e não é evitada por anestesia regional – estudo randomizado

ResumoJustificativa e objetivoDentre as muitas alterações causadas por uma ferida cirúrgica, uma das menos estudadas é a imunossupressão pós‐operatória. Esse fenômeno é uma causa importante das complicações infecciosas relacionadas à cirurgia, como infecção do sítio cirúrgico ou pneumonia nosocomial. Um dos mecanismos que levam à imunossupressão pós‐operatória é a apoptose de células imunológicas. Durante a cirurgia, a anestesia se destina a minimizar as alterações prejudiciais e manter a homeostase perioperatória. O objetivo deste estudo foi avaliar o efeito da técnica anestésica usada para artroplastia total de joelho sobre a apoptose em linfócitos de sangue periférico no pós‐operatório.MétodosTrinta e quatro pacientes submetidos à artroplastia total primária de joelho foram randomicamente designados para dois protocolos de anestesia regional: raquianestesia e bloqueio combinado raqui‐peridural. Onze pacientes submetidos à artroplastia total do joelho sob anestesia geral formaram o grupo controle. Antes da cirurgia, logo após a cirurgia, durante o primeiro dia de pós‐operatório e sete dias após a cirurgia, amostras de sangue venoso foram colhidas e o estado imunológico do paciente foi avaliado com o uso de flow cysts 87 m, juntamente com apoptose de linfócitos com o uso de microscopia de fluorescência.ResultadosApoptose em linfócitos de sangue periférico foi observada imediatamente no pós‐operatório e acompanhada por uma redução do número de células T e B. Não houve diferença significativa no número de linfócitos apoptóticos de acordo com o protocolo anestésico. Alterações no número de células T CD3/8 e no número de linfócitos apoptóticos foram observadas no sétimo dia após a cirurgia.ConclusãoApoptose em linfócitos de sangue periférico é um evento precoce no período pós‐operatório que dura até sete dias e não é afetado pela escolha da técnica anestésica.AbstractBackgroundAmong the many changes caused by a surgical insult one of the least studied is postoperative immunosuppression. This phenomenon is an important cause of infectious complications of surgery such as surgical site infection or hospital acquired pneumonia. One of the mechanisms leading to postoperative immunosuppression is the apoptosis of immunological cells. Anesthesia during surgery is intended to minimize harmful changes and maintain perioperative homeostasis. The aim of the study was evaluation the effect of the anesthetic technique used for total knee replacement on postoperative peripheral blood lymphocyte apoptosis.Methods34 patients undergoing primary total knee replacement were randomly assigned to two regional anesthetic protocols: spinal anesthesia and combined spinal‐epidural anesthesia. 11 patients undergoing total knee replacement under general anesthesia served as control group. Before surgery, immediately after surgery, during first postoperative day and seven days after the surgery venous blood samples were taken and the immunological status of the patient was assessed with the use of flow cysts 87 m, along with lymphocyte apoptosis using fluorescent microscopy.ResultsPeripheral blood lymphocyte apoptosis was seen immediately in the postoperative period and was accompanied by a decrease of the number of T cells and B cells. There were no significant differences in the number of apoptotic lymphocytes according to the anesthetic protocol. Changes in the number of T CD3/8 cells and the number of apoptotic lymphocytes were seen on the seventh day after surgery.ConclusionPeripheral blood lymphocyte apoptosis is an early event in the postoperative period lasts up to seven days and is not affected by the choice of the anesthetic technique

REVISTA BRASILEIRA DE ANESTESIOLOGIA Total knee replacement induces peripheral blood lymphocytes apoptosis and it is not prevented by regional anesthesia ---a randomized study PALAVRAS-CHAVE

Abstract Background: Among the many changes caused by a surgical insult one of the least studied is postoperative immunosuppression. This phenomenon is an important cause of infectious complications of surgery such as surgical site infection or hospital acquired pneumonia. One of the mechanisms leading to postoperative immunosuppression is the apoptosis of immunological cells. Anesthesia during surgery is intended to minimize harmful changes and maintain perioperative homeostasis. The aim of the study was evaluation of the effect of the anesthetic technique used for total knee replacement on postoperative peripheral blood lymphocyte apoptosis. Methods: 34 patients undergoing primary total knee replacement were randomly assigned to two regional anesthetic protocols: spinal anesthesia and combined spinal---epidural anesthesia. 11 patients undergoing total knee replacement under general anesthesia served as control group. Before surgery, immediately after surgery, during first postoperative day and seven days after the surgery venous blood samples were taken and the immunological status of the patient was assessed with the use of flow cytometry, along with lymphocyte apoptosis using fluorescent microscopy. Results: Peripheral blood lymphocyte apoptosis was seen immediately in the postoperative period and was accompanied by a decrease of the number of T cells and B cells. There were no significant differences in the number of apoptotic lymphocytes according to the anesthetic protocol. Changes in the number of T CD3/8 cells and the number of apoptotic lymphocytes were seen on the seventh day after surgery. Conclusion: Peripheral blood lymphocyte apoptosis is an early event in the postoperative period that lasts up to seven days and is not affected by the choice of the anesthetic technique. PALAVRAS-CHAVE Artroplastia total do joelho; Anestesia regional; Anestesia geral; Linfócitos; Apoptose Artroplastia total do joelho induz apoptose em linfócitos de sangue periférico e não é evitada por anestesia regional ---estudo randômico Resumo Justificativa e objetivo: Dentre as muitas alterações causadas por uma ferida cirúrgica, uma das menos estudadas é a imunossupressão pós-operatória. Esse fenômeno é uma causa importante das complicações infecciosas relacionadas á cirurgia, como infecção do sítio cirúrgico ou pneumonia nosocomial. Um dos mecanismos que levam à imunossupressão pós-operatória é a apoptose de células imunológicas. Durante a cirurgia, a anestesia se destina a minimizar as alterações prejudiciais e manter a homeostase perioperatória. O objetivo deste estudo foi avaliar o efeito da técnica anestésica usada para artroplastia total de joelho sobre a apoptose em linfócitos de sangue periférico no pós-operatório. Métodos: 34 pacientes submetidos à artroplastia total primária de joelho foram randomicamente designados para dois protocolos de anestesia regional: raquianestesia e bloqueio combinado raqui-peridural. Onze pacientes submetidos à artroplastia total do joelho sob anestesia geral formaram o grupo controle. Antes da cirurgia, logo após a cirurgia, durante o primeiro dia de pós-operatório e sete dias após a cirurgia, amostras de sangue venoso foram colhidas e o estado imunológico do paciente foi avaliado com o uso de citometria de fluxo, juntamente com apoptose de linfócitos usando microscopia de fluorescência. Resultados: Apoptose em linfócitos de sangue periférico foi observada imediatamente no pós-operatório e acompanhada por uma redução do número de células T e B. Não houve diferença significativa no número de linfócitos apoptóticos de acordo com o protocolo anestésico. Alterações no número de células T CD3/8 e no número de linfócitos apoptóticos foram observadas no sétimo dia após a cirurgia. Conclusão: Apoptose em linfócitos de sangue periférico é um evento precoce no período pós-operatório que dura até sete dias e não é afetado pela escolha da técnica anestésica