Poziom wiedzy na temat dysfagii wśród pielęgniarek neurologicznych i internistycznych

Introduction. Dysphagia is defined as swallowing disorders which causes malnourished, aspiration pneumonia andincreased number of deaths. The best method to diagnose dysphagia are screening tests. Due to the tests it is possibleto introduce an accurate therapy and make a team of therapists to participate in. According to the information theknowledge about this kind of dysfunction is important among nurses.Aim. The main goal of my diploma project was to measure the level of knowledge about dysphagia among thenurses from neurological and internal wards.Material and Methods. The scientific method, which has been used to make the research was diagnosis soundingincluding the surveys. Research tool which has been used while the research was especially made and dedicated formy project own questionnaire of surveys.Results. In the research have taken a part 70 nurses in the age over 22 year-old, who are active in their jobs andwork at neurological and internal wards in the hospitals of Gdańsk. The research has proved higher knowledge levelof the nurses working at neurological wards. All the surveyed people showed the knowledge about the definitionof dysphagia as well as about the food which every sick person should consume and avoid.Conclusions. Own research has shown that the garden of respondents does not affect the level of knowledge aboutdysphagia. The age of the respondents shows no relation to the level of nurses’ knowledge about dysphagia. In turn,seniority affect the knowledge of nurses in this area. The greater the seniority, the higher the level of knowledge ofthe topic in the field of dysphagia. Similarly the workplace. Neurological nurses were characterized by a higher levelof knowledge about dysphagia than nurses from internal medicine departments, while the level of knowledge aboutdysphagia does not depend on the education of the nurses surveyed. (JNNN 2021;10(1):10–17)Wstęp. Dysfagia to zaburzenia połykania powodujące niedożywienie, zachłystowe zapalenie płuc oraz zwiększająśmiertelność. W celu szybkiego rozpoznania dysfagii, pomocne są przesiewowe testy do wykrywania zaburzeń połykania.Dzięki nim, można wprowadzić odpowiednią terapię, w której uczestniczy cały zespół terapeutyczny. Dlatego niezwykleważna jest wiedza pielęgniarek na temat zaburzeń połykania.Cel. Celem pracy była ocena poziomu wiedzy na temat dysfagii wśród pielęgniarek oddziałów neurologicznychi wewnętrznych.Materiał i metody. Metodą badawczą, która została wykorzystana do przeprowadzenia badania był sondaż diagnostycznywraz z techniką ankietową. Narzędziem badawczym, jakim się posłużono podczas badania był autorski kwestionariuszankiety.Wyniki. W badaniu wzięło udział 70 pielęgniarek w wieku od 22 roku życia, które czynnie pracują w zawodziew gdańskich szpitalach — oddziałach neurologicznych i wewnętrznych. Badanie wykazało wyższy poziom wiedzywśród pielęgniarek zatrudnionych w oddziałach neurologicznych. Wszystkie badane osoby wykazały wiedzę, dotyczącądefinicji dysfagii oraz pokarmów jakie powinien spożywać pacjent, a czego powinien unikać chory z dysfagią.Wnioski. Badania własne wykazały, że płeć respondentów nie wpływa na poziom wiedzy na temat dysfagii. Wiekosób badanych nie wykazuje związku z poziomem wiedzy pielęgniarek na temat dysfagii. Z kolei staż pracy rzutujena wiedzę pielęgniarek w tym obszarze. Im większy staż pracy, tym wyższy poziom wiedzy badanych w zakresiedysfagii. Podobnie miejsce pracy. Pielęgniarki neurologiczne charakteryzowały się wyższym poziomem wiedzy na tematdysfagii niż pielęgniarki z oddziałów internistycznych. Natomiast poziom wiedzy na temat dysfagii nie zależyod wykształcenia badanych pielęgniarek. (PNN 2021;10(1):10–17

Paradoxical vocal fold movements as a functional cause of laryngeal dyspnoea and hoarseness

Paradoxical vocal fold movements is a complex and heterogenic syndrome. It is a functional disorder manifesting itself as a pathological adduction of vocal folds in the inspiratory and/ or expiratory phase, resulting in airway obstruction and dyspnoea. This pathology may appear as an extreme form of psychosomatization involving otolaryngological organs, leading to dyspnoea and stridor. The paper presents the case of a young woman who was admitted to hospital due to dyspnoea, stridor and hoarseness. The paper presents the clinical picture, diagnostics and therapeutic procedures which were used.Paradoksalne ruchy fałdów głosowych (ang. paradoxical vocal fold movements – PVFM) to kompleksowy, heterogenny zespół objawów o zróżnicowanej etiologii i manifestacji klinicznej. Jest to zaburzenie czynnościowe, które oznacza patologiczne przywiedzenie fałdów głosowych w fazie wdechowej i/lub wydechowej, co skutkuje obturacją dróg oddechowych i dusznością. Jednostka ta może być klinicznie skrajną postacią psychosomatyzacji, w zakresie laryngologicznym prowadzącą do objawów zwężenia głośni. W artykule zaprezentowano przypadek młodej kobiety, która zgłosiła się do szpitala z powodu duszności ze stridorem oraz chrypki. Przedstawiono obraz kliniczny, diagnostykę i postępowanie terapeutyczne

Antibiotic resistance among Escherichia coli urinary isolates and their susceptibility to clove essential oil

Escherichia coli is a Gram-negative, facultatively anaerobic, rod-shaped, coliform bacterium, which is a primary cause of urinary tract infections. Resistance to antibiotics has become a particular problem in recent decades. Consequently, there is an unmet need for new therapeutic options. It has been observed that essential oils have bactericidal effects. The antimicrobial susceptibility testing for Escherichia coli isolates obtained from urine of patients with urinary tract infections was determined via disk diffusion method according to the European Committee on Antimicrobial Susceptibility Testing (EUCAST, 2015). Essential oil from clove – Syzygium aromaticum (L.) Merill et L.M. (Myrtaceae) was analyzed by GC-FID-MS. Minimal Inhibitory Concentration (MIC) and Minimal Bactericidal Concentration (MBC) were detected by using the micro-dilution broth method. Escherichia coli clinical isolates are characterized by high resistance to ampicillin, amoxicillin with clavulanic acid, norfloxacin, trimethoprim/sulfamethoxazole, tetracycline, tobramycin and ticarcillin. Clove oil possesses strong inhibiting and killing properties against E. coli isolates, among them the ones resistant to recommended antibiotics. The results of this study highlight the need for testing the efficacy of new agents to inactivate bacteria in clinical settings

Czy wysoka wartość BMI rzeczywiście dyskwalifikuje chorego z leczenia dializą otrzewnową?

We present the history of 53-years old female with 41.5 BMI, who was treated with peritoneal dialysis due to the lack of regular vascular access to hemodialysis and contraindications to kidney transplantation. We contin­ued peritoneal dialysis for 6 years without any compli­cations resulting from this method of treatment. Introduction of peritoneal dialysis to obese persons is not an easy decision and should be always indi­vidualized. Published data does not specify which renal replacement therapy — hemodialysis or peri­toneal dialysis is superior/better for obese patients. Nowadays obesity is no longer considered as abso­lute contraindication to peritoneal dialysis especially if such is the patient’s will — patient’s preferences should be taken into consideration at all times.We present the history of 53-years old female with 41.5 BMI, who was treated with peritoneal dialysis due to the lack of regular vascular access to hemodialysis and contraindications to kidney transplantation. We contin­ued peritoneal dialysis for 6 years without any compli­cations resulting from this method of treatment. Introduction of peritoneal dialysis to obese persons is not an easy decision and should be always indi­vidualized. Published data does not specify which renal replacement therapy — hemodialysis or peri­toneal dialysis is superior/better for obese patients. Nowadays obesity is no longer considered as abso­lute contraindication to peritoneal dialysis especially if such is the patient’s will — patient’s preferences should be taken into consideration at all times

Lytic DSAs as the qualification criterion for virtual crossmatch test. Benefits and challenges

Pre-formed anti-HLA antibodies against the potential donor antigens (donor-specific antibodies, DSA) are a prevalent risk factor significantly reducing the patient’s chances of receiving a transplant. Pre-transplantation immunization assessments consist mainly of the high-sensitivity anti-HLA fluorescence flow cytometry assays (Luminex). The assays facilitate the determination of the specificity of anti-HLA antibodies within the entire range of the IgG class, including the subclasses of non-lytic antibodies, such as IgG2 and IgG4, which are significantly less harmful to the transplant as compared to lytic antibodies. When the results of anti-HLA IgG assays are taken into account as the only qualification criterion for virtual crossmatching without their lytic potential being determined, the recipient’s chances for transplantation are significantly reduced. In view of the problem of the increasing number of immunized patients, a modification of the virtual crossmatching protocol is proposed so that only recipients with anti-HLA antibodies identified as complement-binding [C1q(+)] DSAs are excluded from the further qualification process. The presence of C1q(−) DSAs would be an indication of increased risk of humoral rejection rather than contraindication for transplantation. The results of transplantations followed by strict monitoring of antibody levels in these patients are promising albeit burdened by increased risk of humoral rejection. This article presents the benefits and challenges related to the introduction of the new algorithm focusing particularly on the interpretation of the C1q status of donor-specific antibodies

Możliwości diagnostyczne oceny ryzyka immunologicznego biorcy nerki przed przeszczepieniem i po jego wykonaniu

Mimo ogromnego postępu, jaki dokonał się w zakresie stosowanych leków immunosupresyjnych, wciąż jedną z przyczyn utraty nerki jest odrzucanie. Szczególnie zagrożeni tym powikłaniem są biorcy zimmunizowani, którzy w większym stopniu niż biorcy niezimmunizowani są narażeni na ryzyko odrzucania humoralnego. Ten typ odrzucania może wystąpić zarówno we wczesnym okresie po transplantacji, jak i być przyczyną utraty nerki z przyczyn immunologicznych w późniejszym okresie. Przekłada się to na znacznie gorsze wyniki transplantacji w tej grupie chorych. Rozwiązania nowoczesnej diagnostyki immunologicznej mogą przynieść istotne korzyści zarówno na etapie doboru do przeszczepu, jak i monitorowania odpowiedzi po transplantacji. W pracy przedstawiono metody pomiaru i oceny immunizacji na podstawie identyfikacji swoistości alloprzeciwciał anty-HLA i ich wykorzystanie na etapie: — poprawy doboru do przeszczepienia — za pomocą obecnych metod możliwe jest określenie u zimmunizowanego biorcy kompletnej grupy „bezpiecznych” antygenów HLA, wobec których nie wykrywa się u niego przeciwciał. Oznaczenie swoistości przeciwciał anty-  -HLA jest też podstawą dla nowej, czulszej i dokładniejszej metody oceny immunizacji, tak zwanej virtual PRA, czyli określeniu częstości prawdopodobieństwa dodatniej próby krzyżowej wobec reprezentatywnej populacji potencjalnych dawców. Precyzyjna identyfikacja swoistości przeciwciał anty-HLA w połączeniu z rozszerzeniem zakresu typowania antygenów HLA u dawców i biorców umożliwia wprowadzenie tak zwanego virtual cross-match, który jest oparty na najlepszym doborze HLA przy jednoczesnym bezwzględnym unikaniu antygenów HLA dawcy, wobec którego biorca posiada przeciwciała;  — monitorowania odpowiedzi humoralnej po przeszczepieniu jako identyfikacja przeciwciał specyficznych dla HLA dawcy, tak zwane donor specific antibody. Ocena immunologiczna przed przeszczepieniem i monitorowanie po przeszczepieniu na podstawie nowoczesnej diagnostyki immunologicznej umożliwia uzyskanie wyników porównywalnych z grupą biorców niezimmunizowanych

Antioxidative assessment of new trans-palladium (II) complexes in head and neck cancer

Background: Head and neck neoplasms stand for 6% of all malignant neoplasms worldwide. Chemotherapy has limited use due to the biological properties of the tumor (in the majority of cases moderately and poorly differentiated squamous cell carcinoma). The fundamental molecule used in treatment is cisplatin and its derivates, that can be associated with fluorouracil. The new chemotherapeutic agents are not in common use during the treatment of head and neck malignancies. However, the use of low molecular weight complexes Pd (II) carries the potential of being more effective in therapy. Material and Methods: Fifty-one patients, 30 men and 21 women (aged 52.9 ± 12.1 years) with head and neck cancer were included in the study. Fifty-one healthy subjects, 31 men and 20 women, (aged 54.1 ± 14.7 years) years formed the control group. Antioxidant enzymes, superoxide dismutase, and catalase activities in erythrocytes were examined. Results: An increased level of antioxidant enzymes was seen in the blood samples from patients with head and neck cancer after incubation with Pd (II) complex. In the group we obtained a statistically significant result p = <0.001. Discussion: That project may contribute to the development of new, more efficient head and neck cancer treatment strategies. In our opinion, the results can be used in the future to develop a valuable prognostic marker of the disease. This is important because the initial phase of cancer is asymptomatic. The search for factors involved in pathogenesis translates into economic benefits and makes therapy more effectiveness through the reduction of treatment expenses

Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

Background: Regular, detailed reporting on population health by underlying cause of death is fundamental for public health decision making. Cause-specific estimates of mortality and the subsequent effects on life expectancy worldwide are valuable metrics to gauge progress in reducing mortality rates. These estimates are particularly important following large-scale mortality spikes, such as the COVID-19 pandemic. When systematically analysed, mortality rates and life expectancy allow comparisons of the consequences of causes of death globally and over time, providing a nuanced understanding of the effect of these causes on global populations. Methods: The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 cause-of-death analysis estimated mortality and years of life lost (YLLs) from 288 causes of death by age-sex-location-year in 204 countries and territories and 811 subnational locations for each year from 1990 until 2021. The analysis used 56 604 data sources, including data from vital registration and verbal autopsy as well as surveys, censuses, surveillance systems, and cancer registries, among others. As with previous GBD rounds, cause-specific death rates for most causes were estimated using the Cause of Death Ensemble model—a modelling tool developed for GBD to assess the out-of-sample predictive validity of different statistical models and covariate permutations and combine those results to produce cause-specific mortality estimates—with alternative strategies adapted to model causes with insufficient data, substantial changes in reporting over the study period, or unusual epidemiology. YLLs were computed as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 1000-draw distribution for each metric. We decomposed life expectancy by cause of death, location, and year to show cause-specific effects on life expectancy from 1990 to 2021. We also used the coefficient of variation and the fraction of population affected by 90% of deaths to highlight concentrations of mortality. Findings are reported in counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2021 include the expansion of under-5-years age group to include four new age groups, enhanced methods to account for stochastic variation of sparse data, and the inclusion of COVID-19 and other pandemic-related mortality—which includes excess mortality associated with the pandemic, excluding COVID-19, lower respiratory infections, measles, malaria, and pertussis. For this analysis, 199 new country-years of vital registration cause-of-death data, 5 country-years of surveillance data, 21 country-years of verbal autopsy data, and 94 country-years of other data types were added to those used in previous GBD rounds. Findings: The leading causes of age-standardised deaths globally were the same in 2019 as they were in 1990; in descending order, these were, ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and lower respiratory infections. In 2021, however, COVID-19 replaced stroke as the second-leading age-standardised cause of death, with 94·0 deaths (95% UI 89·2–100·0) per 100 000 population. The COVID-19 pandemic shifted the rankings of the leading five causes, lowering stroke to the third-leading and chronic obstructive pulmonary disease to the fourth-leading position. In 2021, the highest age-standardised death rates from COVID-19 occurred in sub-Saharan Africa (271·0 deaths [250·1–290·7] per 100 000 population) and Latin America and the Caribbean (195·4 deaths [182·1–211·4] per 100 000 population). The lowest age-standardised death rates from COVID-19 were in the high-income super-region (48·1 deaths [47·4–48·8] per 100 000 population) and southeast Asia, east Asia, and Oceania (23·2 deaths [16·3–37·2] per 100 000 population). Globally, life expectancy steadily improved between 1990 and 2019 for 18 of the 22 investigated causes. Decomposition of global and regional life expectancy showed the positive effect that reductions in deaths from enteric infections, lower respiratory infections, stroke, and neonatal deaths, among others have contributed to improved survival over the study period. However, a net reduction of 1·6 years occurred in global life expectancy between 2019 and 2021, primarily due to increased death rates from COVID-19 and other pandemic-related mortality. Life expectancy was highly variable between super-regions over the study period, with southeast Asia, east Asia, and Oceania gaining 8·3 years (6·7–9·9) overall, while having the smallest reduction in life expectancy due to COVID-19 (0·4 years). The largest reduction in life expectancy due to COVID-19 occurred in Latin America and the Caribbean (3·6 years). Additionally, 53 of the 288 causes of death were highly concentrated in locations with less than 50% of the global population as of 2021, and these causes of death became progressively more concentrated since 1990, when only 44 causes showed this pattern. The concentration phenomenon is discussed heuristically with respect to enteric and lower respiratory infections, malaria, HIV/AIDS, neonatal disorders, tuberculosis, and measles. Interpretation: Long-standing gains in life expectancy and reductions in many of the leading causes of death have been disrupted by the COVID-19 pandemic, the adverse effects of which were spread unevenly among populations. Despite the pandemic, there has been continued progress in combatting several notable causes of death, leading to improved global life expectancy over the study period. Each of the seven GBD super-regions showed an overall improvement from 1990 and 2021, obscuring the negative effect in the years of the pandemic. Additionally, our findings regarding regional variation in causes of death driving increases in life expectancy hold clear policy utility. Analyses of shifting mortality trends reveal that several causes, once widespread globally, are now increasingly concentrated geographically. These changes in mortality concentration, alongside further investigation of changing risks, interventions, and relevant policy, present an important opportunity to deepen our understanding of mortality-reduction strategies. Examining patterns in mortality concentration might reveal areas where successful public health interventions have been implemented. Translating these successes to locations where certain causes of death remain entrenched can inform policies that work to improve life expectancy for people everywhere. Funding: Bill & Melinda Gates Foundation