Evaluation of selected factors influencing sleep disorders in paramedics during the COVID-19 pandemic.

Introduction: Sleep disorders can develop as a result of exposure to stressors. The outbreak of the COVID-19 pandemic was an additional source of stress for paramedics, due to the fear of the unknown nature of the new pathogen. The main aim of this study was to identify factors influencing the development of sleep disorders among paramedics working during the COVID-19 pandemic. Material and methods: This was a cross-sectional, anonymous, voluntary, online survey conducted on social networks among paramedics working during the COVID-19 pandemic in Poland from 10/11/2020 to 14/01/2021. The survey included 387 participants, the majority of whom were men (72.35%). A proprietary questionnaire and standardized scales were used to identify risk factors: Athens Insomnia Scale (AIS) and Epworth Sleepiness Scale. Results: Among all participants, there were 107 (27.65%) women and 280 (72.35%) men. Significantly higher scores of the analyzed scales were observed in the female gender. Based on the AIS scale, mild sleep disorders were found in 3.6% of women and 2.9% of men. Excessive sleepiness on the Epworth scale was assessed in more than 70% of women and 58.8% of men working in Emergency Medical Teams (EMTs). Conclusions: The main factors influencing the development of sleep disorders were female gender, use of sleep aids and not having a life partner. In contrast, older age and longer job tenure, being married, and having good relationships with family members had a protective effect.

Evaluation of Parameters Affecting the Occurrence of Systemic Inflammatory Response Syndrome in Patients Operated on Due to Kidney Tumors.

The application and prognostic nature of systemic inflammatory reaction syndrome (SIRS) is still being researched, as using SIRS parameters to predict patient status is cheap, efficient, fast, and easy. The study aimed to determine SIRS markers and postoperative complications occurrence in patients undergoing kidney tumor surgery, and to verify if SIRS occurrence depends on age, sex, BMI (body mass index), comorbidities, patients' general condition before the surgery, type of surgery, intraoperative blood loss, or intraoperative ischemia time. Body temperature, heart rate, respiratory rate, and leukocyte count were measured in patients (n = 285) operated on due to a kidney tumor on the first (T0) and third (T3) postoperative day. Univariable and multivariable logistic regression were used to analyze the factors affecting postoperative SIRS and complications occurrence. T0: SIRS developed in patients with higher BMI, >2 ASA points, and more substantial intraoperative blood loss. T3: SIRS developed in obese or overweight patients, with >2 ASA points, significantly higher relative HR change, lower relative body temperature change, respiratory rate, and leukocyte count. BMI values, preoperative general health status, and the amount of intraoperative blood loss in patients undergoing surgery due to a kidney tumor can contribute to SIRS occurrence. Patient's sex, age, tumor size, type of surgery, operated side, and time of intraoperative ischemia do not affect SIRS occurrence.

APELIN IN HEART FAILURE.

Apelin is a biologically active protein encoded by the APLN gene. It was first isolated in 1998 as a ligand for the APJ receptor. It exists in several isoforms differing in polypeptide chain length and biological activity. It is secreted by white adipose tissue, and its expression has been identified in many body tissues, including the cardiovascular system, kidneys, lungs, CNS (especially the hypothalamus, suprachiasmatic and ventricular nuclei), skeletal muscle, mammary glands, adrenal glands, ovaries, stomach, liver cells, placenta, and breast milk. However, the highest concentrations were observed in the endocardium and endothelium of vascular smooth muscle cells. In myocardial tissue, apelin has a positive inotropic effect and exerts an opposing effect to the RAA (renin-angiotensin-aldosterone) system, lowering blood pressure. Therefore, its positive role in early stages of heart failure, in patients with hypertension and ischemic heart disease is emphasized. The synthesis and secretion of apelin by adipocytes makes it possible to classify this peptide as an adipokine. Therefore, its production in adipose tissue is enhanced in obesity. Furthermore, apelin has been shown to increase cellular sensitivity to insulin and improve glucose tolerance in the onset of type 2 diabetes, and therefore appears to play a significant role in the pathogenesis of metabolic disease. An accurate assessment of the importance of apelin in cardiovascular disease requires further studies, which may contribute to the use of apelin in the treatment of heart failure.

A rare case of giant teratocarcinoma of the testis with accumulation of fluid.

Testicular cancer is one of the most curable cancers. However, the course of the disease largely depends on the clinical stage at diagnosis, and there are still cases where the tumor size is large, which makes surgical treatment challenging. A 30-year-old man presented with painless, extremely enlarged scrotum. A CT scan revealed a tumor of the right testis of 21.5 × 15 × 18cm in size. The patient underwent a right orchiectomy and histologic examination revealed teratocarcinoma. Suspicion of hydrocele testis should prompt meticulous differential diagnosis including malignancies. There is a strong need to increase public awareness in terms of symptoms of testicular cancer.

Pre and Postoperative Sexual Dysfunction in Patients with Leriche Syndrome-A Prospective Pilot Study.

Background: Recovery of normal arterial inflow in the lower limbs after Leriche's syndrome surgery does not always improve erection. This study assesses the effects of Leriche syndrome on erectile and ejaculatory dysfunction in patients awaiting surgical treatment and the impact of treatment used on sexual dysfunctions. Methods: 35 men with Leriche syndrome aged 61.3 years (SD = 7.74) were assessed for erectile dysfunction. The patients were classified into three groups: aortofemoral bypass (group 1); stenting of the iliac artery (group 2) and aortobifemoral bypass (group 3). The patients were qualified for surgery based on the TASC II guidelines. Follow-up was done 3 months after treatment. Results: The mean preoperative IIEF-5 score was 14. 69 (+/- 5.30), with better preoperative scores obtained by 54.3% of patients. A total of 51.4% and 48.6% of patients, respectively, reported normal erection enabling satisfactory penetration and normal ejaculation before treatment. After surgical treatment, satisfactory erection was reported by 60% of all surgically treated patients, whereas the presence of ejaculation was reported by only 14.2% of patients. Conclusions: The IIEF-5 score is a tool for careful assessment of vascular erectile dysfunctions, it allows for the evaluation of erectile dysfunctions in relation to atherosclerosis risk factors. The treatment strategy used allowed for slight improvement as evidenced to erection but decreasing normal ejaculation.

HOMOCYSTEINE AND CARDIOVASCULAR DISEASE - A CURRENT REVIEW.

Cardiovascular diseases remain the leading cause of death worldwide for the past 20 years. Of these, ischemic heart disease has the highest mortality rate. In over 98% of cases it is caused by atherosclerosis of the coronary arteries. Homocysteine is an amino acid, containing a sulfhydryl group, which is formed as a result of the metabolism of the amino acids methionine and cysteine, which is supplied with protein-containing foods. A small amount of it is necessary for the proper functioning of the body, however, an increased concentration in blood plasma, which hyperhomocysteinemia, negatively affects blood vessels leading to the development of atherosclerosis and thrombotic com¬plications. The adverse effect on blood vessels results from various mechanisms, such as: excessive activation of Toll-like 4 receptor, activation N-methyl-d-aspartate receptors, increased production of reactive oxygen species, and impairment of nitric oxide synthesis. Elevated levels of reactive oxygen species are associated with increased expression of proinflammatory cytokines such as IL-1ß, IL-6, TNF-α (tumor necrosis tumor necrosis factor), MCP-1 and intracellular adhesion molecule-1. Another factor contributing to hyperhomocysteinemia is mutation of the MTHFR gene, which in normal conditions is responsible for maintaining homocysteine levels within the normal range. People with MTHFR mutation are more prone to develop atherosclerosis and the following complications: myocardial infarction, stroke, thrombotic episodes and coronary artery disease. The aim of this paper is to present evidence supporting the role of homocysteine in the development of many cardiovascular diseases.

Changing patterns of urologic emergency visits and admissions during the COVID-19 pandemic: a retrospective, multicenter, nationwide study.

INTRODUCTION: We aimed to examine the change in the number and severity of visits to the emergency departments (EDs) and subsequent admissions for urgent urologic conditions in the early stage of the coronavirus disease 2019 (COVID-19) pandemic in Poland. MATERIAL AND METHODS: We evaluated data from 13 urologic centers in Poland and compared the number of visits to the EDs and subsequent admissions before and after the advent of COVID-19 in 2020, and before and after the escalating national restrictions. Furthermore, data on types of urologic complaints, crucial laboratory parameters, and post-admission procedures were analyzed. RESULTS: In total 1,696 and 2,187 urologic visits (22.45% decrease) and 387 and 439 urologic urgent admissions (11.85% decrease) were reported in given periods in 2020 and 2019, respectively. The year-over-year difference in daily mean visits was clear (36.1 vs. 46.5; p < 0.001). Declines were seen in all complaints but device malfunction. In 2020 daily mean visits and admissions decreased from 40.9 and 9.6 before lockdowns to 30.9 (p < 0.001) and 6.9 (p = 0.001) after severe restrictions, respectively. There was a trend towards more negative laboratory parameter profiles in 2020, with patients who visited the EDs after severe restrictions having twice as high median levels of C-reactive protein (15.39 vs. 7.84, p = 0.03). CONCLUSIONS: The observed declines in ED visits and admissions were apparent with the significant effect of national lockdowns. Our results indicate that some of the patients requiring urgent medical help did not appear at the ED or came later than they would have done before the pandemic, presenting with more severe complaints.

Solitary Fibrous Tumor of the Retroperitoneal Space.

A solitary fibrous tumor develops from mesenchymal cells as a pleural neoplasm, but it is also occasionally reported in extrapleural sites. Retroperitoneal tumors are a group of neoplasms located between muscles and the fascia of the posterior abdominal wall and the parietal peritoneum. Their cytology differs from that of urinary tract organs or adrenals. This case report presents a rare solitary fibrous tumor incidentally found during an ultrasound examination. A 54-year-old male underwent urgent surgery for a tumor located in the left retroperitoneal space. The histologic examination confirmed a solitary fibrous tumor with a 5% Ki67 proliferation index, a 1 MF/10 HPF mitotic activity, and CD34-positive immunostains. A solitary fibrous tumor is a rare retroperitoneal tumor. Its symptoms and signs might resemble those of the classical triad of renal cell carcinoma, although the tumor's growth phase is typically asymptomatic. Intraoperative diagnosis of a solitary fibrous tumor strongly recommends radical excision.

Analysis of Sexual Disorders in Men with Infrarenal Abdominal Aortic Aneurysm Treated by Stent-Graft or Prosthesis Implantation-A Pilot Study.

Background and objectives: Patients with obstruction or stenosis of the aorta and iliac arteries or with aortic aneurysm, often co-existing with iliac artery aneurysms, suffer from sexual disorders because of insufficient perfusion to the pelvic organs and penis. This is often the cause of visits to a medical doctor's office with reports of a difficult life situation and a problem with the satisfactory completion of sexual intercourse. A low percentage of vascular surgeons or angiologists are prepared to talk about issues related to the hereditary sphere with a patient who qualifies for the treatment of Leriche syndrome or abdominal aortic aneurysm. The aim of this study was to analyze sexual disorders in men with infrarenal abdominal aortic aneurysm treated by stent-graft or prosthesis implantation. Material and methods, Outcomes: 38 patients who completed the IIEF-5 (International Index of Erectile for Men) questionnaire are presented. Initially, 146 qualified for the study after meeting the study inclusion criteria for surgery (Group 1) or for endovascular treatment of abdominal aortic aneurysm (Group 2). Results: In the study, no negative impact of smoking was found; however, over 95% of respondents had been smoking for many years in both groups. Patients who qualified for vascular prosthesis implantation were subject to a more advanced atherosclerotic process involving the aorta and iliac arteries. Patients who qualified for stent-graft implantation were twice as often treated for coronary vessel stenosis. In Group 1, the percentage differences, as shown by questions 1 and 5, were statistically significant (58, i.e., 25%, and 40, i.e., 29%). Conclusions: Education should target medical personnel in terms of conversations with patients, as well as men who are directly affected by this problem, although their partners and families should not be neglected in these activities. The ability to communicate properly allows for an open dialogue on issues that the patient finds difficult, particularly in the field of sexology.

Use of endoscopic lithotripsy technique in the treatment of intestinal neobladder lithiasis performed by means of the VIP method.

We describe a case of minimally invasive endoscopic technique used in the treatment of a large calculus in the intestinal neobladder. The patient had the intestinal bladder created by means of the Vesica Ileale Padovana (VIP) method because of an invasive urothelial carcinoma. The use of the pneumatic lithotripter, inserted through the urethra into the intestinal neobladder, enabled crushing of the calculus and safe evacuation of the resulting small fragments. The endoscopic technique described enabled avoidance of a technically difficult surgical treatment and allowed for rapid return of the patient to complete health. In our opinion this is the best method of treatment.

Modern management of stone disease in patients with a solitary kidney.

Analysing the data available in the literature, contemporary methods of treatment of nephrolithiasis are limited to the methods of minimally invasive percutaneous nephrolithotomy (PCNL) and ureterorenoscopic lithotripsy (URSL), not excluding their use in the presence of developmental abnormalities and kidney impairment only. Minimally invasive methods have become standard procedures. A complement to ineffective URSL and PCNL treatment is extracorporeal shock wave lithotripsy. This is confirmed by 30 years of observation in the only treatment of kidney calculi by Alken launched in 1981 and continued by Jones et al. Before the era of endoscopic procedures (PCNL and URSL) effectively removed the only deposits in the kidney in open operations. Minimally invasive treatments are recommended for patients with localized deposits in the pelvicalyceal system or solitary kidney ureter. They are recognized as safe and effective treatment in a solitary kidney in particular in patients who have already been operated on.

Tumour in horseshoe kidney - different surgical treatment shown in five example cases.

AIM OF THE STUDY: Horseshoe kidney is one of the most common genitourinary system anomalies. The frequency of its occurrence in the whole population is about 0.25%. In the available literature more than 200 cases of such tumour-defect coexistence have been described. Purpose of this study was to present the possibilities of using various methods of surgical treatment of tumors localized in the horseshoe kidney. MATERIAL AND METHODS: In the years 2004-2007 five patients were diagnosed and treated for tumours in horseshoe kidneys. Ultrasonography, computed tomography, urography and nuclear magnetic resonance were applied in the diagnosis. During the treatment both open operations and modern methods of treating tumours with a diameter less than 40 mm (nephron sparing) were used. RESULTS: Renal cell carcinoma (RCC) was confirmed in all the patients. CONCLUSIONS: Our observations confirm the fact that RCC is the most often diagnosed tumour in horseshoe kidneys. The prognostic factors are the same as in the case of tumours of the kidneys without any abnormalities. The diagnosis is based on applying the modern methods of imaging and in the treatment it is possible to apply the modern, non-invasive methods.

[Erectile dysfunction in patients treated for bladder and prostate cancer]. / Zaburzenia erekcji u pacientów leczonych z powodu raka pecherza moczowego i stercza.

The disorders of the erectile dysfunction are well-known complication connected with the operating interventions of abdominal and pelvic surgery. Radical treatment of the malignancy, vascular operations and transurethral resection can lead to the rise of these disorders. The majority of these interventions is carried out at patients in the old age at which the disorders of the erection already existed about the various degree of intensification before treating operating how also the presence of the illnesses of the leaders to their rise or intensification after finishing the treatment (diabetes, arterial hypertension, arteriosclerosis). Patients in the young aged wait not only curing from the malignancy from second side, but also the behaviour of the quality of the life (QOL - quality of life), which the correct erection enabling is one of elements satisfying living together.

[Retrocaval ureter]. / Moczowód przebiegajacy poza zyla glówna dolna.

The ureter which runs behind the main lower vein is the evolutionary fault of the vascular system. It is the result of the disorder of the foetal vein canals developments. The clinical symptoms resulting from this fault are: the pains in the lumbar region, hematuria, the recurrent pyelonephritis, nephrolithiasis and the arterial hypertension. Ultrasonography, tomography and magnetic resonans imaging are used in the diagnosis. The best treatment is the operation leading to the restoration of the ureter anatomic position. Nowadays the laparoscopic minimal invasive methods are used more and more often. In this study we described 3 patients. Each of them underwent the operation to correct the ureter position. The result was the improvement of the clinical condition.

[Multiple primary malignancies of the genitourinary tract--renal cell carcinoma and seminoma testis]. / Mnogie pierwotne nowotwory ukladu moczowo-plciowego--rak jasnokomórkowy i nasieniak jadra.

Multiple primary malignancies are tumors which present a definite picture of malignancy, each must be distinct and the possibility that one is a metastasis of another must be excluded. Authors present rare case of renal cancer associated with testicular cancer.

[Blunt injury of the dystopic kidney]. / Tepy uraz nerki dystopicznej.

The study presents the patient who was diagnosed with a malformation of the right kidney located in the right hip cavity, and also hydronephrosis. The malformation was detected during the diagnosis of the massive haematuria which was caused by the blunt injury of the right hip cavity. The X-ray examination confirmed the presence of the damage of the right dystopic kidney, type I according to AAST. The conservative treatment was sufficient to improve the general condition of the patient. After the check-up examination there was no recommendation for surgical treatment of hydronephrosis.

[Blunt kidney injury--the use of AAST score (American Association for the Surgery of Trauma)--own observations]. / Tepy uraz nerki--przydatnosc skali AAST (American Association for the Surgery of Trauma)--obserwacje wlasne.

Thirty six patients with blunt kidney injury were qualified for the treatment based on the results of present diagnostic methods and AAST (American Association for the Surgery of Trauma) scale. In all of them ultrasonographic exam was performed. It was abnormal in 38.9% of patients. This abnormality was confirmed in intravenous urography in 36.1% patients; 86.1% of them were treated conservatively, while the rest (13.9%) was operated on. For the correct diagnosis and qualification for the treatment, contemporary standards containing a general condition and radiographic examination results were applied.

[Kidney cancer local recurrence after 20 years]. / Miejscowa wznowa raka nerki po 20 latach.

The kidney cancer local recurrence after 20 years is a very rare process. Mostly its course is asymptomatic and it is recognized accidentally during ultrasonography examination. The imaging diagnostics is completed with computer tomography. The operative removal of the tumor, complemented with immunotherapy and radiotherapy, is the approved way of treatment. The presented in this article case of kidney cancer local recurrence after 20 years since nephrectomy caused by malignancy is the first such a distant case described in worldwide literature (according to our knowledge).

Comparison of long-term results of transurethral incision of the prostate with transurethral resection of the prostate, in patients with benign prostatic hypertrophy.

One hundred patients with benign prostatic hypertrophy (BPH) were randomized to transurethral incision (TUIP) or transurethral resection of the prostate (TURP). The average prostate weight before operation was not more than 30.0 g. Indications for the operations were based on the disease history, physical examination, digital rectal examination, laboratory values, and pressure-flow examination. All operations were performed with patients under spinal anesthesia. TUIP was performed with a Collins knife, and TURP was performed with a resectoscope. Follow-up was performed 24 months after the operations. After treatment there were statistically significant daytime and nocturnal reduction in voiding frequencies of 2.9 and 1.7, respectively, after TUIP, and 2.0 and 1.5 after TURP. In both groups, there occurred significantly better maximal flow rate from 7.6 mL/s to 16.9 mL/s in group I and from 6.9 mL/s to 17.6 mL/s in group II. The mean values of linearized passive urethral resistance relation in both groups significantly decreased from 3.6 +/- 0.6 to 1.0 +/- 0.5 after TUIP and from 3.9 +/- 04 to 1.4 +/- 0.5 after TURP. The TUIP procedure is effective and safe for patients with a small number of complications.