Predictors of In-Hospital Mortality in Surgical Wards: A Multivariable Retrospective Cohort Analysis of 2,800,069 Hospitalizations.

BACKGROUND: Identifying prognostic factors that are predictive of in-hospital mortality for patients in surgical units may help in identifying high-risk patients and developing an approach to reduce mortality. This study analyzed mortality predictors based on outcomes obtained from a national database of adult patients. MATERIALS AND METHODS: This retrospective study design collected data obtained from the National Health Fund in Poland comprised of 2,800,069 hospitalizations of adult patients in surgical wards during one calendar year. Predictors of mortality which were analyzed included: the patient's gender and age, diagnosis-related group category assigned to the hospitalization, length of the hospitalization, hospital type, admission type, and day of admission. RESULTS: The overall mortality rate was 0.8%, and the highest rate was seen in trauma admissions (24.5%). There was an exponential growth in mortality with respect to the patient's age, and male gender was associated with a higher risk of death. Compared to elective admissions, the mortality was 6.9-fold and 15.69-fold greater for urgent and emergency admissions (p < 0.0001), respectively. Weekend or bank holiday admissions were associated with a higher risk of death than working day admissions. The "weekend" effect appears to begin on Friday. The highest mortality was observed in less than 1 day emergency cases and with a hospital stay longer than 61 days in any type of admission. CONCLUSION: Age, male gender, emergency admission, and admission on the weekend or a bank holiday are factors associated with greater mortality in surgical units.

The role of beliefs about the impact of illness on fertility and close relationships for psychopathological symptoms in women treated for hypothyroidism.

OBJECTIVE: As demonstrated in a pilot study, hypothyroidism has a highly stressful impact on some areas of functioning. This study aims to evaluate the connection between illness-related beliefs (IRBs) and the impact of hypothyroidism on fertility and close relationships, which were the strongest stressors, and the level of depressive, anxiety, and anger symptoms. METHODS: Two hundred and thirteen women being treated for hypothyroidism took part in an online survey and completed the modified Hospital Anxiety and Depression Scale, Hypothyroidism Symptoms Severity rating scales, and a measure of IRBs. Other relevant clinical data were also collected. RESULT: Mean levels of thyroid-stimulating hormone indicated that the women were euthyroid. Four groups of participants were identified based on IRBs. The group holding a strong IRB about the negative impact of illness only on close relationships scored significantly higher on depressive symptoms than women in the other groups. The group holding strong IRBs about the negative impact of illness on both close relationships and fertility scored significantly higher on anxiety symptoms than the women in the other groups. Regression analysis showed that IRBs about the negative impact of hypothyroidism predicted anxiety, depressive, and anger symptoms. CONCLUSIONS: Negative IRBs about the impact of illness on fertility and close relationships contribute to increased levels of emotional distress symptoms in women being treated for hypothyroidism.

[Reactive hypoglycemia - an interdisciplinary approach of the disease of XXI Century].

Reactive hypoglycemia is characterized by low blood glucose level in non-diabetic patients. It manifests as a syndrome of adrenergic and neuroglycopenic symptoms in the postprandial period, and their resolution occurs after consuming carbohydrates. The etiology of reactive hypoglycemia is not fully understood. It may occur in patients after gastrointestinal surgery due to too fast gastric emptying. Decreases in postprandial glucose are also observed in people with a pre-diabetes condition in which insulin secretion is disturbed. Hypoglycaemia can also be seen in patients with insulin resistance and hyperinsulinism. The aim of this study was to summarize existing knowledge about reactive hypoglycemia - etiology, diagnostic model and treatment.

In-Hospital Mortality in a 4-Year Cohort Study of 3,093,254 Operations in Seniors.

BACKGROUND: Surgery-related mortality depends on a number of factors including the type of surgical procedure, quality of healthcare, co-morbidities, and age of patient. The objective of the study was to assess the in-hospital mortality in the elderly undergoing surgical treatment. METHODS: This was a national data-based retrospective cohort study. Data were extracted from the National Health Fund, a public organization financing medical procedures in Poland. Adult citizens who underwent 9,344,384 surgical interventions (including 3,093,254 cases in seniors who were above 65 years old) between 2009 and 2012 were included in this study. Overall, surgery type-dependent, age-stratified in-hospital mortality related to surgery was assessed. RESULTS: Overall in-hospital surgery-related mortality rate in seniors was stable (approximately 2 % annually, P for trend = 0.104). It doubled with each successive decade of life (1.2, 2.3, 5.6, and 13 % in 65-74, 75-84, 85-94 and ≥ 95 years old groups, respectively, in 2012). In ≥ 75-year-old mortality exceeded 10 % only after neurological surgeries, in ≥ 85-year-old after neurological, vascular, gastrointestinal, and endocrinological surgeries, and in ≥ 95-year-old also after heart and circulation, bones and muscles, liver, pancreas, and spleen operations. However, even in the oldest individuals it was low after genitourinary, female genital tract, head and neck, and eye surgeries. CONCLUSIONS: The overall rate of in-hospital mortality after surgery, although increasing with age, is rather low up to the ninth decade of life. Whereas some surgeries pose a significant risk, others may be relatively safe even in the oldest subjects.

Comparison of pre-and postoperative medication costs in patients who underwent bariatric surgery - a nationwide data analysis.

Introduction: Bariatric surgery has known health benefits and may lower the medication-related costs. This study aimed to assess the cost of medications prior to and after bariatric surgery in the Polish nationwide registry. Methods: The study included 2,390 adults. The analysis was conducted separately for a 12-month pre-operative period, and a 12-month postoperative period. The total costs of medication and cost per anatomical therapeutic chemical group were assessed and the mean cost per patient in the preoperative and postoperative periods was compared. Results: The study showed a significant increase in the overall medication costs and mean costs of medications per patient in the year after bariatric surgery. This increase was related mainly to low-molecular-weight heparins used in the 1st month after surgery. Alternatively, costs of medication used in the cardiovascular system diseases and anti-infectives decreased significantly. The total costs of hypoglycemic agents were reduced by 46%, antihypertensive medications by 29%, and lipid-lowering drugs by 38. Conclusions: In general, medication costs are higher in the first year after surgery. The increase results from the perioperative use of low-molecular-weight heparins, whereas a significant cost reduction of glucose-, lipid-lowering, antihypertensive, and anti-infective medications was observed.

Influence of quitting smoking on diabetes-related complications: A scoping review with a systematic search strategy.

INTRODUCTION: Smoking in people with diabetes markedly elevates their risk of developing complications and increases the likelihood of cardiovascular mortality. This review is the first to specifically provide evidence-based analysis about the influence of quitting smoking on diabetes-related complications in people with type 2 diabetes. METHOD: The present review was carried out according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Extension for Scoping Reviews. All human clinical studies assessing the effects of stopping smoking cessation on diabetes-related complications were included. PubMed and Embase were screened until January 2024. References of primary studies and principal peer-reviewed scientific journals in the field were manually screened. RESULTS: We identified a total of 1023 studies. Only 26 met the criteria for eligibility. In general quitting smoking is associated with decreased risks of myocardial infarction and ischemic stroke. Regarding microvascular complications, the strongest evidence for the beneficial effects of smoking cessation is observed in diabetic nephropathy. However, the relationship between smoking cessation and retinopathy, neuropathy, diabetic foot complications and diabetic-related erectile dysfunction, is poorly investigated. CONCLUSION: Quitting smoking offers significant advantages in managing diabetes-related complications, significantly lowering the risks of myocardial infarction, ischemic stroke, and diabetic nephropathy. This underscores the importance of cessation. Providing evidence-based information on the benefits of stopping smoking for people with type 2 diabetes who smoke, can bolster smoking cessation efforts in the context of diabetes management.

Behavioral Therapy for People With Diabetes Who Smoke: A Scoping Review.

BACKGROUND: Tobacco smoking exacerbates diabetes-related complications; its prevalence is notwithstanding substantial. Persons with diabetes face a number of barriers and challenges to quitting such as multiple lifestyle restrictions; tailored interventions are required for smoking cessation. OBJECTIVE: To identify research on behavioral interventions for smoking cessation in diabetes. METHODS: Studies had to be randomized controlled trials, quasiexperimental or systematic reviews. The behavioral interventions included were: the 5As, Cognitive-Behavioral Therapy, Motivational Interviewing, Contingency Management, Health Coaching and Counselling, as compared to standard care. The outcomes were self-reported and/or biochemically verified smoking cessation. CINAHL Complete, MEDLINE Complete, the Cochrane databases of systematic reviews and randomized controlled trials, PsychInfo and PubMed Central were searched until July, 2023. Keywords used included diabetes, smoking cessation and each of the behavioral interventions included. RESULTS: 1615 papers were identified. Three studies on the 5As/brief advice, 4 on Motivational Intervention and 1 on counseling were retained. The results on the 5As and Motivational Interviewing were conflicting. More intensive interventions appear to be more successful in achieving smoking cessation in smokers with diabetes. CONCLUSIONS: Future research should focus on the continued development and evaluation of structured smoking cessation interventions based on the 5As, Motivational interviewing and Cognitive Behavioral Therapy.

Cost of Surgical Treatment of Obesity and Its Impact on Healthcare Expense-Nationwide Data from a Polish Registry.

Weight loss surgery is linked to health benefits and may reduce the cost to the public healthcare systems. The aim of this study was to assess the cost and cost-structure in the one-year periods before and after a bariatric surgery in the Polish nationwide registry. The study included 2390 obese adults which underwent surgical treatment for obesity in 2017. The cost structure and the total costs per patient for one year before bariatric surgery, preoperatively, and for one year after surgery were analyzed. The total cost of the postoperative period was about PLN 3 million lower than during the preoperative period. After bariatric surgery, a reduction of approximately 59% in costs associated with hospital treatment was observed. The costs of outpatient specialist services, hospital treatment, psychiatric care, and addiction treatment also significantly decreased. There was a negative correlation between the changes in the cost of treatment of patients undergoing obesity surgery and their age. The health care cost during the period of one year after bariatric surgery is lower than in the year preceding the surgery (a greater cost difference is observed in younger people). This is mainly influenced by the reduction in costs associated with hospital treatment.

Coping profiles, depression, and body image anxiety during the Covid-19 pandemic: Comparative analysis of females with thyroid diseases and a non-clinical sample.

OBJECTIVES: This study aimed to compare profiles of coping among females with thyroid disorders and females from a healthy control group regarding depression levels and body image anxiety. We also wanted to check whether subjectively experienced Covid-19-related psychological distress moderated the above-mentioned association in both groups of participants. METHOD: The study sample comprised 564 females, of which 329 were diagnosed with a thyroid disease and 235 formed the healthy control group. Participants filled out paper-and-pencil or online versions of psychometric questionnaires to assess coping strategies, depression, and body image anxiety. RESULTS: In general, we observed higher depression intensity and a higher level of body image anxiety among females with thyroid diseases than among the healthy control group. Latent profile analysis revealed adaptive vs. maladaptive coping profiles from both study samples. Depression symptoms were significantly higher if coping was maladaptive in both the clinical and control groups. Still, there were no significant differences in body image anxiety between participants with adaptive and maladaptive coping profiles. Covid-19-related distress did not moderate the link between coping profiles, depression, and body image anxiety in either group. CONCLUSION: Greater focus should be placed on the role of body image in females struggling with thyroid diseases. Bodily therapy may help these patients to cope better with co-occurring thyroid diseases and mental disorders, whose relationship is still not fully understood.

Risk Factors for Osteoporosis among Patients with Inflammatory Bowel Disease-Do We Already Know Everything?

INTRODUCTION: There are many known risk factors for osteoporosis (OST) among patients with inflammatory bowel disease (IBD), one of which is physical activity. MATERIAL AND METHODS: The aim of the study is to assess the frequency and risk factors of OST among 232 patients with IBD compared to a group of 199 patients without IBD. The participants underwent dual-energy X-ray absorptiometry, laboratory tests, and completed a questionnaire about their physical activity. RESULTS: It was found that 7.3% of IBD patients suffered from OST. Male gender, ulcerative colitis, extensive inflammation in the intestine, exacerbation of disease, rare physical activity, other forms of physical activity, past fractures, lower levels of osteocalcin, and higher levels of C-terminal telopeptide of type 1 collagen were risk factors for OST. As many as 70.6% of OST patients were rarely physically active. CONCLUSIONS: OST is a common problem in IBD patients. OST risk factors differ significantly between the general population and those with IBD. Modifiable factors can be influenced by patients and by physicians. The key to OST prophylaxis may be regular physical activity, which should be recommended in clinical remission. It may also prove valuable to use markers of bone turnover in diagnostics, which may enable decisions regarding therapy.

Assessing Long-Term Impact of Dietary Interventions on Occurrence of Symptoms Consistent with Hypoglycemia in Patients without Diabetes: A One-Year Follow-Up Study.

Background: A well-balanced nutritional diet pattern has a significant role in the management of diet-related disorders. Currently, there are no specific dietary guidelines to refer to when advising non-diabetic patients with symptoms attributed to hypoglycemia in the postprandial period or patients with confirmed reactive hypoglycemia (RH). The aim of this study was to investigate the impact of the dietary interventions, and their sustained outcome, on the severity of hypoglycemic-like symptoms occurring in non-diabetic patients. Methods: The study group included forty non-diabetic individuals with symptoms consistent with RH. At the baseline, each patient underwent RH diagnosis and complex dietary evaluation. Over a period of six months, each patient had four appointments with a dietitian. Two sessions were focused on a dietary education about low glycemic index diet (LGID) and Mediterranean diet (MD). The said diets were to be followed for a period of three months, with two additional dietary check-ups. Once dietary supervision was completed, patients had no imposed dietary patterns. The final follow-up appointment took place twelve months later and that is when each patient underwent a detailed assessment of their current dietary habits and evaluation of the frequency of symptoms consistent with hypoglycemia. Results: There was a statistically significant reduction in the severity in eight out of the ten analyzed hypoglycemic-like symptoms after the dietary interventions. The most significant change was observed in the following symptoms: hunger (η2 = 0.66), impaired concentration (η2 = 0.61), hand tremor (η2 = 0.55), and fatigue (η2 = 0.51). The outcomes were comparable for both recommended diets, the LGID and the MD. The reduction in hypoglycemic-like symptoms continued after the twelve-month period. The individualized dietary counselling significantly improved the patients' eating habits in comparison to those present prior to intervention in terms of healthy diet index (F(2,78) = 27.30, p < 0.001, η2 = 0.41, 90%CI [0.26; 0.51]) and unhealthy diet index (F(2,78) = 433.39, p < 0.001, η2 = 0.91, 90%CI [0.89; 0.93]). Conclusions: Healthy modifications in dietary habits may improve patient's well-being and reduce the severity of their postprandial symptoms attributed to hypoglycemia. Therefore, dietary intervention focused on appropriate nutritional management combined with follow-up consultations may be a beneficial step towards comprehensive treatment of non-diabetic patients who present with hypoglycemic-like symptoms in the postprandial period.

Impact of stopping smoking on metabolic parameters in diabetes mellitus: A scoping review.

The purpose of this scoping review is to create a single narrative that describes the impact of smoking cessation on metabolic parameters in people with diabetes. It is generally well accepted that smoking enhances the harmful effects of elevated blood glucose levels, accelerating the vascular damage seen in patients with diabetes. Smoking cessation has clear benefits in terms of reducing cardiovascular morbidity and mortality. However, there is less evidence for the impact of smoking cessation on other diabetes-related complications. Studies in people with diabetes have shown improvement as well as temporary deterioration in glycemic control after ceasing smoking. Only a few studies have described the effect of quitting smoking on insulin resistance and lipid parameters, however, their results have been inconclusive. In this situation, healthcare professionals should not assume that cessation of smoking will improve metabolic parameters in patients with diabetes. It seems they should, first of all, emphasize the prevention of weight gain that may be associated with quitting smoking. The lack of data regarding the metabolic effects of smoking and smoking cessation in diabetes is very disappointing and this area needs to be addressed.

Seasonally Dependent Change of the Number of Fractures after 50 Years of Age in Poland-Analysis of Combined Health Care and Climate Datasets.

Aim: The incidence of fractures correlates with many independent and interrelated factors. The aim of the study was to examine trends in fracture incidence and to find possible reasons for changes. Materials and methods: A complete dataset of Polish population aged above 50 from the National Heath Fund­which is a single, state-owned payer for the health service procedures in Poland­covering the years between 2010 and 2015 was analyzed along with climate dataset. Results: The analysis indicated that there was a substantial and statistically significant decrease in the incidence of forearm and hip fractures (p = 0.007 and 0.007, respectively). On the other side, there was a statistically significant increase in incidence of humerus and lumbar fractures (p = 0.002, p < 0.001, respectively). The observed changes (especially decrease in forearm and hip fracture incidence) happened mostly in the cold season and were correlated to mean-temperature changes during the assessed time period. Conclusion: In the analysis based on the dataset obtained from fracture-related database collected in Poland in the years 2010−2015 in the population of patients over 50 years of age, we observed that the changes of fracture incidence during the observation period are associated with and may be dependent on the season (warmer versus colder) and on mean temperature increase during the observation period.

Efficacy and Safety of Varenicline for Smoking Cessation in Patients With Type 2 Diabetes: A Randomized Clinical Trial.

Importance: Evidence of effective smoking cessation interventions in patients with diabetes is limited. The unique behavioral and metabolic characteristics of smokers with type 2 diabetes warrants a randomized clinical trial of the smoking cessation drug varenicline. Objective: To evaluate the efficacy and safety of varenicline in patients with type 2 diabetes with an intention to quit smoking. Design, Setting, and Participants: This multicenter, double-blind, placebo-controlled randomized clinical trial recruited patients from 6 outpatient clinics in 5 hospitals in Catania, Italy. Patients with type 2 diabetes, who were smoking at least 10 cigarettes a day, and who intended to quit smoking were screened for eligibility. Eligible patients were randomized to either varenicline or placebo treatment. The trial consisted of a 12-week treatment phase followed by a 40-week follow-up, nontreatment phase. Intention-to-treat data analysis was performed from December 2020 to April 2021. Interventions: Varenicline, 1 mg, twice daily or matched placebo administered for 12 weeks. Patients in both treatment groups also received smoking cessation counseling. Main Outcomes and Measures: The primary efficacy end point of the study was the continuous abstinence rate (CAR) at weeks 9 to 24. Secondary efficacy end points were the CAR at weeks 9 to 12 and weeks 9 to 52 as well as 7-day point prevalence of abstinence at weeks 12, 24, and 52. Results: A total of 300 patients (mean [SD] age, 57.4 [0.8] years; 117 men [78.0%] in varenicline group and 119 men [79.3%] in placebo group) were randomized to receive varenicline (n = 150) or placebo (n = 150). The CAR at weeks 9 to 24 was significantly higher for the varenicline than placebo group (24.0% vs 6.0%; odds ratio [OR], 4.95; 95% CI, 2.29-10.70; P < .001). The CARs at weeks 9 to 12 (31.3% vs 7.3%; OR, 5.77; 95% CI, 2.85-11.66; P < .001) and weeks 9 to 52 (18.7% vs 5.3%; OR, 4.07; 95% CI, 1.79-9.27; P < .001) as well as the 7-day point prevalence of abstinence at weeks 12, 24, and 52 were also significantly higher for the varenicline vs placebo group. The most frequent adverse events occurring in the varenicline group compared with the placebo group were nausea (41 [27.3%] vs 17 [11.4%]), insomnia (29 [19.4%] vs 19 [12.7%]), abnormal dreams (19 [12.7%] vs 5 [3.4%]), anxiety (17 [11.4%] vs 11 [7.3%]), and irritability (14 [9.4%] vs 8 [5.4%]). Serious adverse events were infrequent in both groups and not treatment-related. Conclusions and Relevance: Results of this trial showed that inclusion of varenicline in a smoking cessation program is efficacious in achieving long-term abstinence without serious adverse events. Varenicline should be routinely used in diabetes education programs to help patients with type 2 diabetes stop smoking. Trial Registration: ClinicalTrials.gov Identifier: NCT01387425.

Metabolic Parameters in Patients with Suspected Reactive Hypoglycemia.

BACKGROUND: It remains unclear whether reactive hypoglycemia (RH) is a disorder caused by improper insulin secretion, result of eating habits that are not nutritionally balanced or whether it is a psychosomatic disorder. The aim of this study was to investigate metabolic parameters in patients admitted to the hospital with suspected RH. METHODS: The study group (SG) included non-diabetic individuals with symptoms consistent with RH. The control group (CG) included individuals without hypoglycemic symptoms and any documented medical history of metabolic disorders. In both groups the following investigations were performed: fasting glucose and insulin levels, Homeostatic Model Assessment for Insulin Resistance (HOMA-IR), 75 g five-hour Oral Glucose Tolerance Test (OGTT) with an assessment of glucose and insulin and lipid profile evaluation. Additionally, Mixed Meal Tolerance Test (MMTT) was performed in SG. Results from OGTT and MMTT were analyzed in line with the non-standardized RH diagnostic criteria. RESULTS: Forty subjects have been enrolled into SG. Twelve (30%) of those patients had hypoglycemic symptoms and glucose level ≤55 mg/dL during five-hour OGTT and have been diagnosed with RH. Ten (25%) subjects manifested hypoglycemic like symptoms without significant glucose decline. Patients with diagnosed RH had statistically significantly lower mean glucose at first (92.1 ± 37.9 mg/dL vs. 126.4 ± 32.5 mg/dL; LSD test: p < 0.001) and second (65.6 ± 19.3 mg/dL vs. 92.6 ± 19.3 mg/dL; LSD test: p < 0.001) hour of OGTT and insulin value (22.7 ± 10.9 lU/mL vs. 43.4 ± 35.0 lU/mL; LSD test: p < 0.001) at second hour of OGTT compared to the patients who did not meet the criteria of RH. Seventeen (43%) subjects from SG reported symptoms suggesting hypoglycemia during MMTT but none of them had glucose value lower than ≤55 mg/dL (68.7 ± 4.7 mg/dL). From the entire lipid profile, only mean total cholesterol value was significantly higher (p = 0.024) in SG in comparison with CG but did not exceed standard reference range. CONCLUSIONS: No metabolic disturbances have been observed in patients with diagnosed reactive hypoglycemia. Hyperinsulinemia has not been associated with glycemic declines in patients with this condition. Occurrence of pseudohypoglicemic symptoms and lower glucose value was more common after ingestion of glucose itself rather than after ingestion of a balanced meal. This could suggest an important role that nutritionally balanced diet may play in maintaining correct glucose and insulin levels in the postprandial period.

The Role of Illness-Related Beliefs in Depressive, Anxiety, and Anger Symptoms: An On-line Survey in Women With Hypothyroidism.

Hypothyroidism may affect 3-8.5% of the population and is a growing global health problem. Objective: The aim of the current study was to assess the relationships between cognitive representations of this illness and the severity of symptoms of depression, anxiety, and anger in women who suffer from hypothyroidism. Methods: The study used a cross-sectional design with on-line recruitment and measurements. A total of 354 women took part in the study and completed the following questionnaires: a 5-point self-rating scale that measures the three major symptoms of hypothyroidism, the Illness-Related Beliefs Questionnaire, the Hospital Anxiety and Depression Scale-Modified (HADS-M), and a clinical and sociodemographic data questionnaire. Results: The study found a relationship between the severity of emotional distress symptoms and illness-related beliefs. These beliefs were correlated with depressive symptoms, anxiety, and anger regardless of age, education, hormone levels or time since the diagnosis. In addition, the results of regression analyses, both hierarchical and stepwise, indicated that beliefs about the disease explained relatively high levels of the outcome variables (about 30% of the variance of depressive and anxiety symptoms and 16% of anger) as measured by HADS-M. Conclusions: Psychological factors seem to play an important role in the development of symptoms of depression, anxiety, and anger in patients with hypothyroidism. Psychosocial interventions targeting personal beliefs about the nature of the disease and its social aspects may be an effective way to reduce emotional distress symptoms.

Amputations of Lower Limb in Subjects with Diabetes Mellitus: Reasons and 30-Day Mortality.

BACKGROUND: Diabetic foot is one of the leading causes of patient disability worldwide. Lower-extremity amputations (LEAs) resulting from this disease massively decrease quality of life, the function of the patient, and incur significant healthcare costs. The aim of this study was to assess trends in the number of amputations, the diagnosis at discharge, and diagnosis-related mortality after LEA procedures in a nationwide population. METHODS: Datasets of the National Heath Fund containing information about all services within the public healthcare system in Poland, spanning the years 2010-2019, were analyzed. The source of data regarding mortality was the database of the Polish Ministry of Digital Affairs. RESULTS: Between 2010 and 2019, the annual number of amputations in patients with diabetes increased significantly from 5,049 to 7,759 (p for trend < 0.000001). However, the number of amputations in patients with diabetes calculated as a number per 100,000 diabetics decreased significantly (p for trend < 0.0005) during this period. Amputations in patients with diabetes accounted for a majority of all amputations; the mean percentage of amputations in patients with diabetes was 68.6% of all amputations (from 61.1% in 2010 to 71.4% in 2019, p for trend < 0.0000001). The most common disease diagnosed at discharge after LEA in diabetic patients was diabetes itself. Vascular pathologies, such as soft-tissue/bone/joint infections and ulcerations, were the next most common. The 30-day mortality rate after LEA was rather high in patients with, as well as without, diabetes (depending on the cause for amputation 3.5-34% and 2.2-28.99%, respectively). CONCLUSIONS: The number of LEA in patients with diabetes in Poland increased substantially between 2010 and 2019 along with an increasing number of diabetics. Vascular pathologies, infections, and ulcerations were the most common causes of LEA. The 30-day mortality rate after amputation was rather high and varied depending on the diagnoses at discharge.

Predictors of Rehospitalization and Mortality in Diabetes-Related Hospital Admissions.

The risk factors of rehospitalization and death post-discharge in diabetes-related hospital admissions are not fully understood. To determine them, a population-based retrospective epidemiological survey was performed on diabetes-related admissions from the Polish national database. Logistic regression models were used, in which the dependent variables were rehospitalization due to diabetes complications and death within 90 days after the index hospitalization. In 2017, there were 74,248 hospitalizations related to diabetes. A total of 11.3% ended with readmission. Risk factors for rehospitalization were as follows: age < 35 years; male sex; prior hospitalization due to acute diabetic complications; weight loss; peripheral artery disease; iron deficiency anemia; kidney failure; alcohol abuse; heart failure; urgent, emergency, or weekend admission; length of hospitalization; and hospitalization in a teaching hospital with an endocrinology/diabetology unit. Furthermore, 7.3% of hospitalizations resulted in death within 90 days following discharge. Risk factors for death were as follows: age; neoplastic disease with/without metastases; weight loss; coagulopathy; alcohol abuse; acute diabetes complications; heart failure; kidney failure; iron deficiency anemia; peripheral artery disease; fluid, electrolytes, and acid-base balance disturbances; urgent or emergency and weekend admission; and length of hospitalization. We concluded that of all investigated factors, only hospitalization within an experienced specialist center may reduce the frequency of the assessed outcomes.

Relationship between age and in-hospital mortality during 15,345,025 non-surgical hospitalizations.

INTRODUCTION: Mortality, whether in or out of hospital, increases with age. However, studies evaluating in-hospital mortality in large populations did not distinguish between surgical and non-surgical causes of death, either in young or in elderly patients. The aim of the study was to assess in-hospital non-surgical mortality in a large group of patients, with a special focus on the elderly. MATERIAL AND METHODS: Data from the database of the Polish National Health Fund (NHF) regarding hospitalizations of adult (≥ 18 years) patients not related to surgical procedures in the years 2009-2013 were used to assess in-hospital mortality. RESULTS: 15,345,025 hospitalizations were assessed. The mean in-hospital non-surgery-related mortality rate was 3.96 ±0.17%, and increased from 3.79% to 4.2% between 2009 and 2013. The mean odds ratio for in-hospital death increased with the age of patients, reaching a 229-fold higher rate in the ≥ 95 years age group as compared to the 18-24 age group. The highest mean mortality was associated with respiratory diseases (6.91 ±0.20%), followed by heart and vascular diseases, nervous system diseases, as well as combined gastrointestinal tract, liver, biliary tract, pancreas and spleen diseases (5.65 ±0.27%, 5.46 ±0.05% and 4.01 ±0.13%, respectively). CONCLUSIONS: The in-hospital non-surgery-related mortality rate was approximately 4%. It significantly increased with age and, regardless of age, was highest in patients suffering from respiratory diseases.

Vitamin D supplementation in adults - guidelines.

Vitamin D is necessary in maintaining appropriate calcium and phosphate homeostasis in the body (classical function) and ensuring appropriate functioning of many tissues, organs and cells, unrelated to mineral economy (non-classical function). Vitamin D deficiency in adults may cause osteomalacia, increase fracture risk in osteoporosis, induce cardiovascular diseases, diabetes type 1 and 2, multiple sclerosis, Lesniowski-Crohn disease, and cancer, including colon, breast, and prostate cancer. Possible causes of vitamin D deficiency in a healthy population include decreased cutaneous synthesis and an inadequate intake of vitamin D, both in food and in supplements. Vitamin D deficiency level (25(OH) D. 〈 20 ng/mL), is fairly widespread, being found in a substantial percentage of healthy subjects around the world, regardless of race, gender and age. Daily vitamin D dose, as determined by the Food and Nutrition Board in 1997, is now rather insufficient, the biggest problem being associated with maximal vitamin D levels (50 µg/day) in actually available food supplements. Nowadays, it is recommended that adults need a minimum of 800-1,000 U/day when their exposure to the sun is inadequate (in Poland from October to April). This dosage should be provided to all subjects who avoid sunlight, as well as to those aged over 65 because of their slower skin synthesis of vitamin D and for its proven anti-fracture and anti-fall effects.