Multiorgan Failure and Sepsis in an ICU Patient with Prolidase Enzyme Deficiency-The Specificity of Treatment and Care: A Case Report.

Background and Objectives: Prolidase deficiency (PD) is a rare, life-threatening, genetically determined disease with an incidence of 1-2 cases per 1 million births. The disease inhibits collagen synthesis, which leads to organ and systems failure, including hepato- and splenomegaly, immune disorders, chronic ulcerative wounds, respiratory infections, and pulmonary fibrosis. The complexity of the problems associated with this disease necessitates a comprehensive approach and the involvement of an interdisciplinary team. The objective was to present the treatment and care plan, as well as complications of PD, in a young woman following admission to an intensive care unit (ICU). Materials and Methods: A retrospective observational single-case study. Results: A 26-year-old woman with PD was hospitalized in the ICU for acute respiratory failure. The presence of difficult-to-heal extensive leg ulcers and the patient's immunocompromised condition resulted in the development of sepsis with multiple organ failure (respiratory and circulatory, liver and kidney failure). Complex specialized treatment consisting of wound preparation, limb amputation, the minimization of neuropathic pain, mechanical ventilation, renal replacement therapy, circulatory stabilization, and the prevention of complications of the disease and of therapy were applied. On the 83rd day of hospitalization, the patient expired. Conclusions: Despite the use of complex treatment and care, due to the advanced nature of the disease and the lack of therapies with proven efficacy, treatment was unsuccessful. There is a need for evidence-based research to develop effective treatment guidelines for PD.

A comparative study of paranasal sinus and nasal cavity anatomic variations between the Polish and Turkish Cypriot Population with CBCT.

BACKGROUND: Genetic and environmental factors especially climatic conditions are thought to influence the shape and size of the paranasal sinuses and anatomic variations may create both a diagnostic and therapeutic challenge. However, no study has been published about the climatic adaptation of the paranasal sinus region in different populations. This study aimed to compare the prevalence of anatomical variants in the paranasal sinus and nasal cavity using Cone-Beam Computed Tomography (CBCT) between Polish and Turkish Cypriot populations. METHODS: The material consisted of volumes acquired utilizing Galileos (Sirona, Germany) as well as Newtom 3G (QR Verona, Newtom, Italy) CBCT units. There were examined 356 Polish and 359 Turkish Cypriot patients in whom paranasal sinuses were included in the field of view. Paranasal sinus anatomic variations were assessed in both populations. RESULTS: In the Polish population, the most common anatomic variation was septum deviation followed by the Agger nasi cell and concha bullosa with a prevalence of 87.7%, 83.2%, and 54.8% respectively. For the Turkish Cypriot population, the most common anatomic variation was Agger nasi cell followed by concha bullosa and supraorbital ethmoid cells with a prevalence of 81.6%, 68%, and 57.8% respectively. Many anatomic variations were found to show substantial differences among both populations. Incidence rates of hyperpneumatization of the frontal sinus, septum pneumatization, supraorbital ethmoid cells, concha bullosa, uncinate bulla, and internal carotid artery protrusion into the sphenoid sinus were significantly higher in the Turkish Cypriot group, while the incidence of Haller cell, frontal sinus hypoplasia, maxillary sinus hypoplasia, ethmomaxillary sinus, sphenomaxillary plate, and septum deviation were significantly higher in Polish population. CONCLUSION: According to the Köppen-Geiger world climatic map, the climate is warmer and drier in Turkish Cypriote populations than in the Polish population. These climatic differences influence the paranasal sinus variations between the Turkish Cypriot and Polish populations that must be taken into account by rhinologic surgeons especially when performing frontal and sphenoid sinus surgery.

Pain Assessment with the BPS and CCPOT Behavioral Pain Scales in Mechanically Ventilated Patients Requiring Analgesia and Sedation.

BACKGROUND: Intensive Care Unit (ICU) patients often experience pain, especially during diagnostic, nursing, and therapeutic interventions. Pain assessment using the Behavioral Pain Scale (BPS) and Critical Care Pain Observation Tool (CCPOT) are recommended, but they are difficult to do in patients undergoing deep sedation. This study analyzed the usefulness of the BPS and CCPOT scales in assessing pain among patients with varying degrees of sedation. METHODS: In 81 mechanically ventilated and sedated ICU patients, 1005 measurements were performed using the BPS and CCPOT scales. The study was conducted by 3 trained observers 3 times a day (each measurement at rest, during painful nursing interventions, and after the intervention). The Richmond Agitation-Sedation Scale (RASS), the Simplified Acute Physiology Score (SAPS II), and the Acute Physiology and Chronic Health Evaluation (APACHE II) were also analyzed from medical records as well as information on the length of hospitalization and treatment. RESULTS: It was shown that signs of pain increased significantly (p < 0.001) during interventions in patients on both scales (BPS and CCPOT), and then returned to values close to the resting period. RASS results correlated significantly (p < 0.05) and positively with the results of the BPS and CCPOT. A strong correlation was found between the results of both scales at each stage of the study (R = 0.622-0.907). CONCLUSIONS: Nursing procedures are a source of pain in analgosedated patients. The BPS and CCPOT scales are useful tools for assessing the occurrence of pain in mechanically ventilated patients, including those in deep sedation.

Risk Factors of Eye Complications in Patients Treated in the Intensive Care Unit.

In critically ill patients, normal eye protection mechanisms, such as tear production, blinking, and keeping the eye closed, are impaired. In addition, many other factors related to patients' severe condition and treatment contribute to ocular surface disease. Reducing risk factors and proper eye care can have a significant impact on incidences of eye complications and patient quality of life after discharge from the intensive care unit (ICU). The aim of the study was to determine risk factors for ocular complication, especially those related to nursing care. The study was conducted in the ICU of a university hospital. Methods for estimating and analyzing medical records were used. The patient's evaluation sheet covering 12 categories of risk factors for eye complications was worked out. The study group included 76 patients (34 patients with injuries and 42 without injuries). The Shapiro-Wilk test, the Spearman's rank correlation test, the Mann-Whitney U test and the Friedman's ANOVA test were used. The level of significance was set at α = 0.05. The most important risk factors for eye complications in the study group were: lagophthalmos (p < 0.001), sedation (p < 0.01), use of some cardiological drugs and antibiotics (p < 0.01), mechanical ventilation (p < 0.05), use of an open suctioning system (p < 0.01), presence of injuries (p < 0.01) including craniofacial trauma (p < 0.001), high level of care intensity (p < 0.01), failure to follow eye care protocol (p < 0.001), length of hospitalization at the ICU (p < 0.001), and the frequency of ophthalmological consultations (p < 0.001). There was no correlation between the incidence of these complications and the age and gender of the patients. The exposure of critically ill patients to eye complications was high. It is necessary to disseminate protocols and guidelines for eye care in ICU patients to reduce the risk factors.

Risk Factors of Pneumonia Associated with Mechanical Ventilation.

Background: The hospitalization of patients treated in the intensive care unit (ICU) in 5%-15% of cases is associated with the occurrence of a complication in the form of ventilator-associated pneumonia (VAP). Purpose: Retrospective assessment of risk factors of VAP in patients treated at ICUs in the University Hospital in Krakow. Methods: The research involved the medical documentation of 1872 patients treated at the ICU of the University Hospital in Krakow between 2014 and 2017. The patients were mechanically ventilated for at least 48 h. The obtained data were presented by qualitative and quantitative analysis (%). The qualitative variables were compared using the Chi2 test. Statistically significant was the p < 0.05 value. Results: VAP was demonstrated in 23% of all patients treated in ICU during the analyzed period, and this infection occurred in 13% of men and 10% of women. Pneumonia associated with ventilation was found primarily in patients staying in the ward for over 15 days and subjected to intratracheal intubation (17%). A statistically significant was found between VAP and co-morbidities, e.g., chronic obstructive pulmonary disease, diabetes, alcoholism, obesity, the occurrence of VAP and multi-organ trauma, hemorrhage/hemorrhagic shock, and fractures as the reasons for admitting ICU patients. Conclusions: Patients with comorbidities such as chronic obstructive pulmonary disease, obesity, diabetes, and alcoholism are a high-risk group for VAP. Particular attention should be paid to patients admitted to the ICU with multi-organ trauma, fractures, and hemorrhage/hemorrhagic shock as patients predisposed to VAP. There is a need for further research into risk factors for non-modifiable VAP such as comorbidities and reasons for ICU admission in order to allow closer monitoring of these patients for VAP.

Thermovision analysis of surface body temperature changes after thermal stimulation treatments in healthy men.

PURPOSE: Among thermal stimulation treatments that have a beneficial effect on the human body general application of cold and various forms of massage are mentioned which can be assessed by means of thermovision analysis. The aim of the study was to evaluate changes in the distribution of surface body temperature under the influence of whole-body cryostimulation, classical massage and hot stone massage. MATERIALS AND METHODS: The study was conducted on a group of 40 men aged 20-24 years. They were subjected to a cryostimulation treatment at -120 °C and -140 °C, and to heat-stimulating treatments in the form of massages. Before the treatment, blood pressure and heart rate were measured. Temperature distribution in the 12 areas of the body surface was recorded using a Thermo Vision A20M Thermo Vision Camera with Therma CAM Researcher 2.8 software. RESULTS: Statistically significant differences between cryostimulation treatments in the left upper limb and the back of the trunk were found. After heat-stimulating treatments, a statistically significant increase in temperature after classic massage was observed in the lower limbs, and a similar increase in temperature was noted in the rear of the pectoral girdle and of the trunk after hot stone massage. CONCLUSIONS: The thermovision analysis showed a great variation of body surface temperature depending on the body area. The higher changes in temperature, of up to 20%, were found within the upper and lower extremities in the group treated with cryostimulation. After heat-stimulating treatments, lower temperature differences, of 2-6%, were observed, the largest within the trunk and the lower limbs.

Reprint of "CON4EI: Bovine Corneal Opacity and Permeability (BCOP) test for hazard identification and labelling of eye irritating chemicals".

Assessment of ocular irritation potential is an international regulatory requirement in the safety evaluation of industrial and consumer products. None in vitro ocular irritation assays are capable of fully categorizing chemicals as stand-alone. Therefore, the CEFIC-LRI-AIMT6-VITO CON4EI consortium assessed the reliability of eight in vitro test methods and computational models as well as established a tiered-testing strategy. One of the selected assays was Bovine Corneal Opacity and Permeability (BCOP). In this project, the same corneas were used for measurement of opacity using the OP-KIT, the Laser Light-Based Opacitometer (LLBO) and for histopathological analysis. The results show that the accuracy of the BCOP OP-KIT in identifying Cat 1 chemicals was 73.8% while the accuracy was 86.3% for No Cat chemicals. BCOP OP-KIT false negative results were often related to an in vivo classification driven by conjunctival effects only. For the BCOP LLBO, the accuracy in identifying Cat 1 chemicals was 74.4% versus 88.8% for No Cat chemicals. The BCOP LLBO seems very promising for the identification of No Cat liquids but less so for the identification of solids. Histopathology as an additional endpoint to the BCOP test method does not reduce the false negative rate substantially for in vivo Cat 1 chemicals.

CON4EI: CONsortium for in vitro Eye Irritation testing strategy - EpiOcular™ time-to-toxicity (EpiOcular ET-50) protocols for hazard identification and labelling of eye irritating chemicals.

Assessment of acute eye irritation potential is part of the international regulatory requirements for testing of chemicals. The objective of the CON4EI (CONsortium for in vitro Eye Irritation testing strategy) project was to develop tiered testing strategies for eye irritation assessment for all drivers of classification. A set of 80 reference chemicals (38 liquids and 42 solids) was tested with eight different alternative methods. Here, the results obtained with reconstructed human cornea-like epithelium (RhCE) EpiOcular™ in the EpiOcular time-to-toxicity Tests (Neat and Dilution ET-50 protocols) are presented. The primary aim of this study was to evaluate whether test methods can discriminate chemicals not requiring classification for serious eye damage/eye irritancy (No Category) from chemicals requiring classification and labelling for Category 1 and Category 2. In addition, the predictive capacity in terms of in vivo drivers of classification was investigated. The chemicals were tested in two independent runs by MatTek In Vitro Life Science Laboratories. Results of this study demonstrate very high specificity of both test protocols. With the existing prediction models described in the SOPs, the specificity of the Neat and Dilution method was 87% and 100%, respectively. The Dilution method was able to correctly predicting 66% of GHS Cat 2 chemicals, however, prediction of GHS Cat 1 chemicals was only 47%-55% using the current protocols. In order to achieve optimal prediction for all three classes, a testing strategy was developed which combines the most predictive time-points of both protocols and for tests liquids and solids separately. Using this new testing strategy, the sensitivity for predicting GHS Cat 1 and GHS Cat 2 chemicals was 73% and 64%, respectively and the very high specificity of 97% was maintained. None of the Cat 1 chemicals was underpredicted as GHS No Category. Further combination of the EpiOcular time-to-toxicity protocols with other validated in vitro systems evaluated in this project, should enable significant reduction and even possible replacement of the animal tests for the final assessment of the irritation potential in all of the GHS classes.

CON4EI: Bovine Corneal Opacity and Permeability (BCOP) test for hazard identification and labelling of eye irritating chemicals.

Assessment of ocular irritation potential is an international regulatory requirement in the safety evaluation of industrial and consumer products. None in vitro ocular irritation assays are capable of fully categorizing chemicals as stand-alone. Therefore, the CEFIC-LRI-AIMT6-VITO CON4EI consortium assessed the reliability of eight in vitro test methods and computational models as well as established a tiered-testing strategy. One of the selected assays was Bovine Corneal Opacity and Permeability (BCOP). In this project, the same corneas were used for measurement of opacity using the OP-KIT, the Laser Light-Based Opacitometer (LLBO) and for histopathological analysis. The results show that the accuracy of the BCOP OP-KIT in identifying Cat 1 chemicals was 73.8% while the accuracy was 86.3% for No Cat chemicals. BCOP OP-KIT false negative results were often related to an in vivo classification driven by conjunctival effects only. For the BCOP LLBO, the accuracy in identifying Cat 1 chemicals was 74.4% versus 88.8% for No Cat chemicals. The BCOP LLBO seems very promising for the identification of No Cat liquids but less so for the identification of solids. Histopathology as an additional endpoint to the BCOP test method does not reduce the false negative rate substantially for in vivo Cat 1 chemicals.

Thermovision Analysis Changes of Human Hand Surface Temperature in Cold Pressor Test.

The cold pressor test (CTP) as a diagnostic method of the circulatory system reactivity may be a basis for the qualification for thermal stimulation therapy. The aim of the work was a thermovisual assessment of the reaction to the Hines and Brown cold pressor test. A group of 30 healthy men in the age of 23.5 ± 0.8 years were examined. The average weight of the examinees was 78.4 ± 9.2 kg, their height 180.7 ± 5.9 cms, and BMI 23.9 ± 2.2 kg/m(2). A thermovisual picture of a tested and not tested hand of all the subjects was taken before and after the cold pressor test. Under the influence of cold water the surface temperature of a tested hand has decreased in a statistically significant way by 8.3°C on average, which is 29% of the temperature before the test, whilst the temperature of an untested hand dropped by 0.67°C. The decreases of temperature were not even and there was a statistically significant difference between the dorsal and palmar side of the hand. The correlation between the changes of systolic blood pressure and the hand surface temperature before and after CTP was observed.

Preferred and undesirable products in the dietary habits of women.

BACKGROUND: Proper nutrition, especially for elderly women as well as for women after mastectomy, is one of the basic conditions of maintaining physical health and mental well-being. OBJECTIVES: The comparison of dietary habits of women of various ages and various levels of physical activity. MATERIAL AND METHODS: The investigated group consisted of 90 women: 20 students of the Faculty of Physiotherapy at the Academy of Physical Education in Wroclaw, 25 students of University of the Third Age at the Academy of Physical Education in Wroclaw, 25 visitors of the sanatorium in Jedlina Zdrój, and 20 women after mastectomy. The authors' questionnaire was applied to assess the adherence of the dietary habits of the women in the researched groups to the rules of proper nutrition on the basis of the consumed products. RESULTS: The highest average dietary preferences expressed in questionnaire points were revealed among the students of the University of the Third Age (4.13) and the women after mastectomy (4.10). Lower numbers of questionnaire points were noted among the visitors of the sanatorium (3.78) and the students of the Academy of Physical Education (3.60). CONCLUSIONS: A significant correlation of BMI and the average number of questionnaire points was revealed in the group of women after mastectomy and the students of the University of the Third Age and a clear correlation in the group of students. A significant correlation between the average of questionnaire points and the age of the women was observed in the first two groups. Applying the authors' questionnaire makes it possible to assess conscious application and adherence to the rules of proper nutrition on the basis of preferred and undesirable products consumed.

Transmigration of mandibular canine - case report.

BACKGROUND: Transmigration is a phenomenon of movement of an unerupted tooth in the bone across the midline. This anomaly is not often found. Transmigration is more prevalent in females than in males, and more often encountered in the mandible than maxilla, it affects mostly canines. CASE REPORT: The aim of this study was to present a case report of a mandibular canine transmigration in a patient aged 12. Intraoral examination determined hypodontia of right second premolar and delayed eruption of left second premolar in maxilla, as well as persistent deciduous teeth: right second molar, left canine and second molar. The patient was referred for a Cone-Beam CT examination, which allowed precise visualization of the transmigrating canine as well as ruled out resorption of roots of mandibular incisors. RESULTS: The treatment with a maxillary fixed orthodontic appliance was finished after obtaining a satisfactory result. Proper alignment of the incisors in the anterior-posterior plane and correct midline position were accepted by the patient. Transmigrating canine after consultation with the surgeon was designed to further radiological observation.

Strategies for coping with pain presented by adolescents with hematopoietic malignancies.

INTRODUCTION: Leukaemias and lymphomas are the most common malignant diseases diagnosed among adolescents and they are associated with pain and anxiety. As a result they may affect the way patients accept their disease and determine subjective assessment of quality of life. The objective of this study was to recognise strategies for coping with pain, evaluate the process of accepting the disease and assess quality of life among adolescents diagnosed with hematopoietic malignancies. MATERIAL AND METHODS: The study group comprised 66 patients aged between 14 and 21 and diagnosed with leukaemia or lymphoma. The following measuring tools were used: the Pain Coping Strategies Questionnaire (CSQ), Zung Self-Rating Anxiety Scale (SAS), Acceptance of Illness Scale (AIS), and WHOQOL-BREF for quality of life evaluation. RESULTS: Coping self-statements and praying or hoping were the two most common strategies used by our respondents when coping with pain. In the study group the level of anxiety had no influence on pain control and the ability to reduce it. A statistically significant relation was found between the level of catastrophizing as a method of coping with pain and quality of life in the physical domain. An additional correlation was observed between quality of life in the psychological domain and the level of pain control. CONCLUSIONS: The ability of coping with pain promotes the acceptance of illness and improves patient's quality of life. The age and duration of the disease were factors affecting strategies for coping with pain. A small percentage of respondents who experienced anxiety suggests that further and deeper research is needed in this field.