A multicenter survey on toxoplasmosis knowledge among pregnant women in Poland (the TOWER study).

BACKGROUND: The seroprevalence of Toxoplasma gondii ranges widely in different areas of the world and different populations. Although toxoplasmosis is typically benign and asymptomatic, it induces major complications in immunocompromised individuals and during pregnancy. Prevention of maternal primary infection constitutes the major tool for avoiding congenital T. gondii infections and toxoplasmosis complications. The preventive measures depend on the women's knowledge about toxoplasmosis. The aim of the study was to assess the knowledge on toxoplasmosis among pregnant women in Poland. METHODS: The study was conducted between October 2016 and January 2017 in 3 Polish cities. During a visit in a hospital outpatient clinic, pregnant women aged > 16 years fulfilled a previously validated questionnaire. The questions concerned personal data (age, parity, educational level, place of residence), toxoplasmosis knowledge (etiology, routes of transmission, symptoms, sequelae), and sources consulted to collect information. RESULTS: Overall, 465 pregnant women participated in the survey; 439 (94.4%) were aware of toxoplasmosis. Toxoplasmosis was perceived as a zoonotic disease by 77.4%, as a parasitic disease by 41.7%, as a disease transmitted through poor hand hygiene by 8.6%, as a childhood illness by 4%, and as a congenital disease by 0.4%. Regarding the transmission route, 84.5% of women pointed at a domestic cat, 46.7% at eating raw or undercooked meat. The total of 84.3% did not know toxoplasmosis symptoms, and 12.0% stated that they did not present the symptoms. In multivariate analysis, younger age (OR, 2.74; 95% CI, 1.67-4.49; p <  0.001), city residence (OR, 13.45; 95% CI, 3.12-57.89; p <  0.003), and higher education level (OR, 6.81; 95% CI, 3.69-12.59; p <  0.001) were significantly associated with better knowledge of toxoplasmosis, and the number of children (OR, 0.32; 95% CI, 0.22-0.48; p <  0.001) - with higher knowledge of the symptoms. CONCLUSIONS: Among pregnant women in Poland, the basic knowledge on toxoplasmosis is very high (94.4%). Younger age, city residence, higher education level, and the number of children turned out significantly associated with better knowledge of T. gondii and toxoplasmosis symptoms.

Evaluation of new two-thumb chest compression technique for infant CPR performed by novice physicians. A randomized, crossover, manikin trial.

BACKGROUND: The impact of high-quality chest compressions during CPR for the patients' outcome is undisputed, as it is essential for maintaining vital organ perfusion. The aim of our study is to compare the quality of chest compression (CC) and ventilation among the two current standard techniques with our novel "nTTT" technique in infant CPR. METHODS: In this randomized crossover, manikin trial, participants performed CCs using three techniques in a randomized sequence: standard two finger technique (TFT); standard two thumb technique (TTHT), and the 'new two-thumb technique' (nTTT). The novel method of CCs in an infant consists in using two thumbs directed at the angle of 90° to the chest while closing the fingers of both hands in a fist. RESULTS: Median depth compression using the distinct chest compression techniques varied and amounted to 26 [IQR, 25-28] mm for TFT, and 39 [IQR, 39-39] mm for TTHT as well as for nTTT. Best percentage of fully released compressions were received using TFT (100[100-100] %), then in the case of nTTT (99[98-100] %), and the worst in situation where TTHT (18[14-19] %). was used. The fastest chest compression rate was achieved with TFT (134[IQR, 129-135]/min) and the slowest when using nTTT (109 [IQR, 105-111]/min). CONCLUSIONS: We found that our new nTTT technique's performance, in terms of compression depth, hands-off time, and ventilation quality, is comparable to the current standards. Based on our findings of this initial manikin study, the nTTT technique is superior to TFT in many of parameters that are vital to a quality chest compression during pediatric CPR.

Diagnostic performance of point-of-use ultrasound of resuscitation outcomes: A systematic review and meta-analysis of 3265 patients.

BACKGROUND: Echocardiography in the setting of resuscitation can provide information as to the cause of the cardiac arrest, as well as indicators of futility. This systematic review and meta-analysis were performed to determine the value of point-of-care ultrasonography (PoCUS) in the assessment of survival for adult patients with cardiac arrest. METHODS: This meta-analysis was performed in adherence to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, EMBASE, Web of Science, Cochrane have been searched from databases inception until March 2nd 2021. The search was limited to adult patients with cardiac arrest and without publication dates or country restrictions. Papers were chosen if they met the required criteria relating to the sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of this diagnostic technique concerning resuscitation outcomes. RESULTS: This systematic review identified 20 studies. Overall, for survival to hospital discharge, PoCUS was 6.2% sensitivity (95% confidence interval [CI] 4.7-8.0%) and 2.1% specific (95% CI 0.8-4.2%). PoCUS sensitivity and specificity for return of spontaneous circulation were 23.8% (95% CI 21.4-26.4%) and 50.7% (95% CI 45.8-55.7%) respectively, and for survival to admission 13.8% (95% CI 12.2-15.5%) and 20.1% (95% CI 16.2-24.3%), respectively. CONCLUSIONS: The results do not allow unambiguous recommendation of PoCUS as a predictor of resuscitation outcomes and further studies based on a large number of patients with full standardization of operators, their training and procedures performed were necessary.

Tranexamic Acid for Shoulder Arthroplasty: A Systematic Review and Meta-Analysis.

Tranexamic acid (TXA) is an antifibrinolytic agent that has been shown to decrease blood loss and transfusion rates after knee and hip arthroplasty, however with only limited evidence to support its use in shoulder arthroplasty. Therefore, we performed a systematic review and meta-analysis to evaluate the clinical usefulness of tranexamic acid for shoulder arthroplasty. A thorough literature search was conducted across four electronic databases (PubMed, Cochrane Library, Web of Science, Scopus) from inception through to 1 December 2021. The mean difference (MD), odds ratio (OR) or relative risk (RR) and 95% confidence interval (CI) were used to estimate pooled results from studies. Total of 10 studies comprising of 993 patients met the inclusion criteria and were included in the analysis. Blood volume loss in the TXA and non-TXA group was 0.66 ± 0.52 vs. 0.834 ± 0.592 L (MD= -0.15; 95%CI: -0.23 to -0.07; p < 0.001). Change of hemoglobin levels were 2.2 ± 1.0 for TXA group compared to 2.7 ± 1.1 for non-TXA group (MD= -0.51; 95%CI: -0.57 to -0.44; p < 0.001) and hematocrit change was 6.1 ± 2.7% vs. 7.9 ± 3.1%, respectively; (MD= -1.43; 95%CI: -2.27 to -0.59; p < 0.001). Tranexamic acid use for shoulder arthroplasty reduces blood volume loss during and after surgery and reduces drain output and hematocrit change.

Efficacy and Safety of Tranexamic Acid in Emergency Trauma: A Systematic Review and Meta-Analysis.

In trauma patients, bleeding can lead to coagulopathy, hemorrhagic shock, and multiorgan failure, and therefore is of fundamental significance in regard to early morbidity. We conducted a meta-analysis to evaluate the efficacy and safety of tranexamic acid (TXA) in civil and military settings and its impact on in-hospital mortality (survival to hospital discharge or 30-day survival), intensive care unit and hospital length of stay, incidence of adverse events (myocardial infarct and neurological complications), and volume of blood product transfusion. The systematic review and meta-analysis were conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A systematic review of the literature using PubMed, Scopus, EMBASE, Web of Science, and the Cochrane Central Register and Controlled Trials (CENTRAL) database was conducted from inception to 10 January 2021. In-hospital mortality was reported in 14 studies and was 15.5% for the TXA group as compared with 16.4% for the non-TXA group (OR = 0.81, 95% CI 0.62-1.06, I2 = 83%, p = 0.12). In a civilian TXA application, in-hospital mortality in the TXA and non-TXA groups amounted to 15.0% and 17.1%, respectively (OR = 0.69, 95% CI 0.51-0.93, p = 0.02, I2 = 78%). A subgroup analysis of the randomized control trial (RCT) studies showed a statistically significant reduction in in-hospital mortality in the TXA group (14.3%) as compared with the non-TXA group (15.7%, OR = 0.89, 95% CI 0.83-0.96, p = 0.003, I2 = 0%). To summarize, TXA used in civilian application reduces in-hospital mortality. Application of TXA is beneficial for severely injured patients who undergoing shock and require massive blood transfusions. Patients who undergo treatment with TXA should be monitored for clinical signs of thromboembolism, since TXA is a standalone risk factor of a thromboembolic event and the D-dimers in traumatic patients are almost always elevated.

Assessment of dietary intake of patients with irritable bowel syndrome.

The dietary intake of patients with irritable bowel syndrome was assessed using 24-h dietary recall. The energy value and nutrient contents in the daily food rations were calculated by Nutritionist IV computer program with the Polish database. Differentiations in the Polish RDA coverage for energy and nutrients were observed in the studied group. Fat, saturated fatty acid, phosphorus and also vitamin A, E and C contents were above the RDA in the patients' daily food ration. The majority of IBS individuals did not meet recommendations for carbohydrate intake. Calcium and cooper intake was below the Polish RDA. The insufficient vitamin B2 intake and excessive Fe supply have been shown in the male patients.

Occurrence of dietary risk factors in inflammatory bowel disease: Influence on the nutritional status of patients in clinical remission.

BACKGROUND: Among the complex factors that may favor the occurrence of inflammatory bowel disease (IBD), genetic, immunological and environmental initiators, including nutritional factors, are listed. So far, there have been no previous studies on the type and frequency of dietary risk factors for IBD in Poland and their effect on the nutritional status of patients. OBJECTIVES: The aim of the study was to assess the influence of the frequency and type of dietary risk factors for IBD on the nutritional status of patients with ulcerative colitis (UC) and Crohn's disease (CD). MATERIAL AND METHODS: In the study, the dietary habits and nutritional status of patients were assessed using the cross-check dietary history method and the Mini Nutritional Assessment (MNA) questionnaire. The study group consisted of 162 IBD patients: 61 individuals with CD and 101 with UC. The data was compared to the results of a control group (129 healthy volunteers). RESULTS: The results obtained showed that IBD patients during a period of remission disclosed such dietary risk factors as inadequate consumption of fiber and excessive consumption of red meat and meat products, animal fats, and sugars in comparison to the control group. Only low fiber intake was associated with a worse nutritional status of patients with UC. No consistent influence of the number of IBD dietary risk factors on the nutritional status of patients was found. CONCLUSIONS: The nutritional status of IBD patients in remission was related to the type of dietary risk factors, but did not depend on the number of them.

The quality of a newly developed infant chest compression method applied by paramedics: a randomised crossover manikin trial.

BACKGROUND: The aetiology of sudden cardiac arrest in infants is different from that in adults, with respiratory failure, sudden infant death syndrome, and drowning being the primary causes in the former. According to the European Resuscitation Council (ERC) and American Heart Association (AHA) recommendations, the quality of chest compressions (CC) is a key element affecting the effectiveness of cardiopulmonary resuscitation (CPR). The current ERC and AHA guidelines recommend the 'two-finger technique' (TFT) or 'two-thumb encircling hands technique' (TTHT) for external CCs during infant CPR. AIM: The aim of the randomised crossover manikin trial was to assess the CC quality during simulated resuscitation in infants performed by paramedics. METHODS: A prospective, randomised, crossover, single-centre study was conducted between June and August 2016. The study material consisted of 120 fully trained and licensed paramedics (39 females, 32.5%) with a minimum of five years of professional experience (mean 7.5 ± 4.8 years) in emergency medicine (mean age, 30.5 ± 5.5 years). The participants performed CCs using three techniques: TFT (the rescuer compresses the sternum with the tips of two fingers); TTHT; and the 'new two-thumb technique' (nTTT). The novel method of CCs in an infant consists of using two thumbs directed at the angle of 90 degrees to the chest while closing the fingers of both hands in a fist. RESULTS: The median CC rate when using the TFT, the TTHT, and nTTT methods varied and amounted to 134 min-1 vs. 126 min-1 vs. 114 min-1, respectively. There was a statistically significant difference in the median CC frequency between TFT and TTHT (p < 0.001), TFT and nTTT (p < 0.001), and between TTHT and nTTT (p < 0.001). The highest percentage of compressions with the frequency recommended by the ERC guidelines (100-120 min-1) was achieved by the study participants only with the nTTT. The median CC depth during the TFT was 28 mm (interquartile range [IQR] 27-30 mm) and was significantly lower than in the static TTHT (40.5 [IQR 39-41] mm; p < 0.001) and nTTT (40 [IQR 39-41] mm; p < 0.001). The percentage of adequate depth CCs was correctly obtained with TTHT and nTTT. The largest proportion of total decompression of the chest was observed with the nTTT technique (96 [IQR 96-98] %), followed by TFT (95.5 [IQR 85.5-99] %) and TTHT (5 [IQR 3-7] %). In all scenarios, the correct placement of the CC point was achieved in more than 90% of cases. CONCLUSIONS: Our novel infant CC method provides the highest percentage of CCs with the frequency recommended by the ERC guidelines as compared with standard techniques. It also allows optimal CC depth.