Anaphylaxis: the current state of knowledge

Anaphylaxis is a severe, life threatening, generalised or systemic hypersensitivity reaction. In the last decade there has been a significant increase in the frequency of anaphylactic reactions in all age groups and all regions of the world. It is estimated that about 0.3% of the European population experience anaphylaxis at some point in their lives. In connection with the above, this article summarizes current information about anaphylaxis. The following aspects were discussed: definition, epidemiology of disease, pathomechanism, triggers, signs and symptoms, clinical criteria for the diagnosis, treatment and preventive activities

Sudden cardiac arrest accompanied by severe accidental hypothermia - modifications of the standard cardiopulmonary resuscitation procedure

Severe accidental hypothermia is associated with a high mortality rate. This is related to the fact that assessment and treatment may be difficult: the severity of determining the presence of pulse and breathing, the significant sensitivity of the patient to a change in body position, difficulty in the instrumental protection of airways, ease of ventricular fibrillation occurrence and many other risks. A well-prepared medical team, coordinated actions based on current medical guidelines and recommendations, give a chance to save patients even after a few hours of cardiopulmonary resuscitation. Despite the availability of advanced devices for heating and supporting cardiovascular function in patients with cardiac arrest with coexisting hypothermia, basic activities such as isolation and protection against heat loss are critical important rescue tasks necessary for effective treatment of the patient. In connection with the above, this article summarizes current information about sudden cardiac arrest with coexisting hypothermia. The following aspects were discussed: definition, epidemiology, diagnosis and assessment of hypothermia severity and modifications of standard resuscitation algorithm in the case of coexisting hypothermia

Abdominal injuries caused by a horse kick - rescue procedure

Kicking by the horse can cause very serious injuries to the victim. The groups of people particularly vulnerable to such an injury are: veterinarians, farmers, sport riders and stables. The aim of this article is to present the proceedings with the victim, who was kicked by a horse with special attention to abdominal injuries. Injuries caused as a result of horse kick are paradoxically quite frequent. Early call for help, precise gathering of the interview according to the SAMPLE algorithm and patient’s observation in the direction of shock symptoms may later help the ambulance crew and emergency medicine physician in treatment and in faster, targeted diagnostics in the emergency department

Preliminary metrological study of the lumbar vertebral column during the foetal period

The aim of our study was to elaborate a scheme for the development of the particular elements of the lumbar vertebral column in the foetal period based on metrological data analysis. 30 human foetuses between 31 and 183 mm C-R length were examined. The whole vertebral column and lumbar segment length, intervertebral spaces and structural elements of each vertebra were measured. Statistical analysis was carried out of the data obtained. The development of the lumbar vertebral column during the foetal period is ongoing, although not in a proportional way. The percentage participation of the lumbar segment in the length of the whole vertebral column increased from 17.5 to 22%. The most intensive development of the particular elements resulted from the period between 60–170 mm. The intensive transversal growth of each vertebra began after 60 mm while the axial growth began after 110 mm CRL. The percentage participation of a single lumbar vertebra in the length of the whole lumbar segment decreased by approx. 5%. The largest contribution to the ossification centres was made in the areas of neural arches L1. Each structural element and the diameter of each lumbar vertebra is characterised by specific growth dynamics

Thermostability of Freeze‐Dried Plant‐Made VLP‐Based Vaccines

Freeze-drying or lyophilisation is a technique commonly used for pharmaceutical products, in which stability is required to be preserved beyond 4°C temperature. Although lyophilisation is a well‐established method, designing a sustainable process for a new product is still to a large extent subjected to empirical practice and often requires trial and error approach. Moreover, even successful lyophilisation of the product may not assure its good long‐term storage stability, and progressive decrease in activity may still be encountered. In the past decades, numerous studies have been conducted in the area of protein instability and preservation during lyophilisation and long‐term storage. Many critical issues have been identified with regard to physical and chemical instability of proteins in the solid

Geometrical assessment of the foetal lumbar vertebral column - clinical implications

The neural arches, transverse processes, spinous processes, and superior and inferior articular processes of each of the 5 lumbar vertebrae can often be found under the common heading of ‘posterior element’. The aim of our study was to assess the changes in geometry of the posterior elements of the foetal lumbar vertebrae during the foetal period. A total of 50 human foetuses, both female and male, from natural abortions, C-R length ranging from 58 to 220 mm, were examined. The methodology of the research included classical anatomical preparation, detailed measurements of the structural elements of the lumbar vertebrae and statistical analysis. Geometrical reconstruction was subsequently performed. The shape of the posterior elements changed gradually from wide and massive to slender. We observed a descending sequence of these alterations, the first vertebra to change being L1, with L5 the last. The dynamic of the change was at its greatest during the first 4 weeks of the period evaluated. On the basis of our observations we concluded that the geometry of the posterior elements of the lumbar vertebrae undergoes a process of a great transformation during the foetal period, a process which progresses dynamically until the 14th week of intra-uterine development. The associations with micro-angiogenesis, the ossification process and the notion of structural adaptation of the lumbar spine to heightening mechanical stress are also discussed

Coherent production on nuclei and measurements of total cross sections for unstable particles

The Kölbig–Margolis formula is fitted to some explicitly nonperturbative models of diffractive production. It is shown that, in spite of the fact that the standard procedure of fitting the integrated cross sections may give acceptable fits, thus obtained "cross sections of unstable particles", $\sigma_{2}$, grossly disagree with the "true" cross sections known exactly from the models

Monoclonal gammopathy with renal significance

Monoclonal gammopathy of unknown significance (MGUS) is a benign condition that carries a risk of progression to haematological malignancy. It is accepted that MGUS should not be treated until progression to multiple myeloma or another lymphoid malignancy. Recently, growing evidence has started to show that even small monoclonal clones can be responsible for renal impairment. Long-term observation of patients with monoclonal gammopathy and abnormal renal function showed that this condition can significantly affect renal and overall survival. Patients with monoclonal gammopathy with renal impairment have also higher risk of relapse after kidney transplantation. Among patients with monoclonal gammopathy of unknown significance there is a group of defined monoclonal component-related diseases, which includes: light-chain amyloidosis, monoclonal immunoglobulin deposition disease, crystal-storing histiocytosis, cryoglobulinaemias, and some others. They can be diagnosed on the base of clinical features and on histological examination. In patients with monoclonal protein and deposition of fragments or whole particle of monoclonal immunoglobulin with distinct localisation and substructural organisation can be found. The treatment strategy is targeting of B cell clones, which requires administration of chemotherapeutics or other medications that are used for the treatment of lymphoid malignancy or myeloma. The choice of therapeutic agent should take into account the current kidney status. Treatment of renal disease should not differ from other patients with similar conditions not related to monoclonal protein. The expert opinion is that the presence of monoclonal gammapathy is not a contraindication to kidney transplantation.

Knowledge and skills toward capnometry and capnography among Emergency Medical Service providers

Capnometry is an increasingly used element of patient monitoring in emergency medicine, also in pre-hospital area. The increasing availability of compact devices for measuring the end-expiratory concentration of carbon dioxide (EtCO2) offers great opportunities to improve the quality of treatments, as well as giving rescuers feedback on the effectiveness of life-saving procedures. However, the capnometer is just another device and without the proper substantive preparation of the person who uses it, its usefulness will be negligible. Aim of this study, is to assess paramedics knowledge about capnometry and capnography. The study group consisted of 102 paramedics who are actively working in ambulance service, aged 30.5 ± 5.7 years including 7% of women and 93% of men. Results were collected with the author’s questionnaire. Most of participants (91%) confirmed that in their ambulance was available device to measure end-expiratory carbon dioxide (EtCO2). The most commonly available device was capnometry (72%), followed by the capnography (19%). Moreover, the analysis shows that the rescuers who declared participation in the training of monitoring and analysis end-expiratory value of carbon dioxide concentration in the last 12 months obtained significantly higher correct answers than the staff who did not have such training (6.5 ± 2.0 vs. 5.4 ± 1.7). However, only 35% of participants took part in such training in last year. Study shown a lack of knowledge and experience in use of devices to measure end-expiratory carbon dioxide concentration (EtCO2) by Emergency Medical Service providers

Can novice physicians perform a high-quality record of a 12-lead electrocardiographic examination? Preliminary data

High-quality 12-lead electrocardiogram recording is one of the most important elements of the patient's physical examination, not only in the case of chest pain. Carelessness and inaccuracy in the method of placing the electrodes on the patient's body results in poor record quality which may affect the wrong therapeutic decisions and the possibility of exposing the patient of health or even life loss. The aim of the study was to determine the reliability of ECG electrodes placement on the patient’s body by novice physicians. The study group consisted of 53 novice physicians who carry out a postgraduate internship including 58% of female. Results were collected with the use of authorial and anonymous questionnaire where participants marked the correct position of all ECG electrodes. The correct position of the V1 electrode in the fourth right intercostal space was identified by only 19% of the respondents. Additionally, V1 and V2 were often (37.7%) incorrectly placed parasternally in the right and left second intercostal spaces. Only 2% of the study participants knew the correct position of the V3R electrode. Only 23% of participants knew the correct location of V7 lead, 15% location of V8 and 17% of V9 electrode. It is necessary to propagate the correct technique of performing a 12-lead electrocardiogram recording of the heart in group of novice physicians. More detailed and practical training is undoubtedly indicated. Critical review of training and education curricula is therefore recommended