Evaluation of Health Pattern and Stress Levels among Patients Undergoing Alcohol Addiction Treatment-A Cross Sectional Study.

Alcohol consumption is linked to over 200 diseases and injuries. It is also classified as a risk factor for several types of neoplasms as well as infectious diseases (i.e., HIV and tuberculosis). In 2019, among people aged 25 to 49, alcohol use was the leading risk factor for attributable burden of disease. There are many factors that affect alcohol drinking patterns such as social and economic status, social norms, cultural customs, availability of alcohol, etc. Stress also plays a significant role in the process of developing alcohol addiction. The aim of our study was to examine health patterns and stress levels among patients undergoing alcohol addiction treatment. The study sample consisted of 104 patients who were treated in a hospital ward due to alcohol dependence. Three standardized questionnaire tools were used to measure the sense of coherence and the level of stress among those patients. The main results suggest that the level of perceived stress correlated negatively with all dimensions of sense of coherence and all indicators of health behaviors, however, age was positively correlated with positive mental attitude, proper eating habits, and health behaviors. In conclusion, it is worth noting that developing patterns for positive health behaviors will make it possible to avoid alcohol dependence or reinforce the treatment results if alcohol dependence syndrome occurs.

Normalization of the AIS (Acceptance of Illness Scale) questionnaire and the possibility of its use among cancer patients.

INTRODUCTION AND OBJECTIVE: Cancer triggers many negative emotions in patients which affect the quality of life and low acceptance of the illness. The level of acceptance of illness is related to the level of pain and the degree of compliance with medical recommendations. The aim of the study is evaluation of the use of the Acceptance of Illness Scale (AIS) among people with cancer. MATERIAL AND METHODS: The study involved 1,187 patients (666 women aged 21-96 (M=58.17; SD=12.88) and 521 men aged 22-96 (M=67.12; SD=13.75) diagnosed with malignant cancer under outpatient care of the Maria Sklodowska-Curie Institute - Oncology Center in Warsaw. An acceptance of illness questionnaire developed by B. J. Felton, T. A. Revensson and G. A. Hinrichsen was used. RESULTS: Socio-economic (education, place of residence, income, professional status) and medical (occurrence of metastases, type of treatment used) factors affect the level of acceptance of illness by patients. Stent standards were developed to determine the level of acceptance of illness in the low-average-high categories. CONCLUSIONS: The Acceptance of Illness Scale (AIS) should be used in the case of cancer patients. Assessment of the patient's acceptance of illness, as well as the factors affecting acceptance, will allow for the planning of appropriate treatment and psychotherapeutic support for specific patients, whose level of acceptance of illnes is the lowest.

Pain Control, Acceptance and Adjustment to the Disease among Patients with Ovarian, Endometrial and Breast Cancer in Poland.

BACKGROUND: Breast, ovarian, and endometrial cancer are among the most common causes of morbidity and mortality of women in Poland. In 2016, breast cancer was the most common cause of morbidity and the second leading cause of cancer deaths in women, endometrial cancer was the third most common cause of morbidity and the seventh leading cause of death, and ovarian cancer was the fifth most common cause of morbidity and the fourth leading cause of cancer deaths in women. The aim of the study was to assess the strategy of pain control, acceptance of the cancer and adjustment to life with disease in women with ovarian cancer, endometrial and breast cancer. This study shows how level of pain control, acceptance, and adjustment can differ among patients with the three kinds of cancer and which factors have the most influence on patients' adjustment to the disease. METHODS: The study was carried out with 481 patients diagnosed with ovarian cancer, endometrial and breast cancer. In the study BPCQ, CSQ, AIS and Mini-MAC questionnaires were used. RESULTS: In the BPCQ questionnaire the highest result was acquired in the scope of the impact of doctors (M = 16.45, SD = 4.30), differentiated by cancer location and socio-economic variables. In the CSQ test, the highest result was achieved by praying/hoping, differentiated by cancer location and socio-economic variables. The average AIS acceptance score was M = 27.48 (SD = 7.68). The highest result of the Mini-Mac scale was obtained by patients in the area of fighting spirit (M = 22.94, SD = 3.62), and these results depended on socio-economic and treatment-related variables but were not differentiated by cancer location. CONCLUSIONS: Patients attribute the highest importance in the disease to the influence of physicians, praying/hoping, and fighting spirit. The awareness of the pain management strategies of patients with cancer allows appropriate psychological support to be designed for specific groups of patients.

Granulomatous Lymphocytic Interstitial Lung Disease in a Spectrum of Pediatric Primary Immunodeficiencies.

BACKGROUND: Granulomatous lymphocytic interstitial lung disease (GLILD) has been increasingly recognized in children affected with primary immunodeficiencies (PIDs). In this study, we aimed to better characterize the spectrum of pediatric PIDs coexisting with GLILD including clinical and immunological predictors, thoracic imaging findings, and histopathologic features. METHODS: We respectively reviewed records of six representative cases of children, three of them affected with common variable immunodeficiency (CVID) and three with syndromic immunodeficiencies, in whom a diagnosis of GLILD was established based on clinical, radiological, and histopathologic findings. Clinical and immunological predictors for GLILD were also analyzed in the patients studied. RESULTS: All the children with GLILD had a history of autoimmune phenomena, organ-specific immunopathology, and immune dysregulation. Defective B-cell maturation and deficiency of memory B cells were found in all the children with GLILD. The radiological and histopathological features consistent with the diagnosis of GLILD, granulomatous disease, and lymphoid hyperplasia, were accompanied by chronic airway disease with bronchiectasis in children with CVID and syndromic PIDs. CONCLUSIONS: Our study shows that both CVID and syndromic PIDs may be complicated with GLILD. Further studies are required to understand the predictive value of coexisting autoimmunity and immune dysregulation in the recognition of GLILD in children with PIDs.

Occurrence of adverse events in the activity of hospital wards in the opinions of doctors and nursing management staff.

INTRODUCTION: An adverse event is an incident induced while providing health care services or resulting from it, not related to the natural course of a given disease or health condition, which causes or is likely to cause negative consequences for the patient, including their death, a threat to life, the necessity of hospitalisation or its prolongation, permanent or considerable health detriment; or is a foetal disease, congenital defect or the result of foetal damage. OBJECTIVE: The aim of this analysis is to explore the problem of the occurrence of adverse events from the perspective of doctors and ward nurses who manage wards. MATERIAL AND METHODS: The research on the occurrence of adverse events among doctors and nurses (the management staff) was conducted with the use of a postal survey. RESULTS: It was ascertained that 86.5% of the medical personnel had taken part in an adverse event, of which 20.2% took part in an occurrence associated with pharmacotherapy, 16.2% - in an event related to diagnostics and diagnosis, or an infection - 15.7%. 14.2% of respondents were involved in an occurrence linked to a medical device malfunction, and 14.1% - in an adverse event related to an operation. CONCLUSIONS: The adverse events most often identified in the nursing professional group are occurrences associated with pharmacotherapy, and in the doctors' professional group - occurrences related to diagnostics and diagnosis. The research established that the most frequent reason for not informing patients about the occurrence of an adverse event is fear of their filing a complaint. Medical management staff show high acceptance of an adverse event reporting system as a tool for improving patient safety.

Metastatic and non-metastatic sentinel inguinofemoral lymph nodes in vulvar cancer show an increased lymphangiogenesis.

INTRODUCTION AND OBJECTIVE: Lymph node involvement is a strong predictor of disease recurrence and patient survival in vulvar cancer. The aim of the study was to evaluate the feasibility of sentinel lymph node (SLN) screening, the incidence of skip metastases, and lymph node lymphangiogenesis. MATERIAL AND METHODS: Fifty-five patients participated in this prospective, single centre study. A double SLN screening method was employed using radiocolloid (technetium-99 sulfur colloid) and 1.0% Isosulfan Blue. Immunohistochemistry, using a mouse monoclonal antibody against D2-40, was used to evaluate lymphatic vessel density (LVD). All calculations were performed using STATISTICA software v. 10 (StatSoft, USA, 2011); p < 0.05 was considered significant. RESULTS: Using both methods of SLN detection, 100% accuracy was achieved, and skip metastases were diagnosed in only one woman (1.82%). Peri-tumour median LVD was significantly increased compared with matched intra-tumour samples (p < 0.001), while median LVD was significantly lower in negative, compared with positive SLN, regardless of whether matched non-SLN were negative (p < 0.001) or positive (p = 0.005). Metastatic SLN exhibited significantly higher median LVD compared with matched negative non-SLN (p = 0.015), while no significant difference in median LVD was detected between positive SLN and matched positive non-SLN. However, negative SLN had a significantly higher median LVD compared with matched negative non-SLN (p = 0.012). CONCLUSIONS: SLN detection is a safe and feasible procedure in vulvar cancer. In patients without nodular involvement, SLN, compared with non-SLN, exhibited significantly higher median LVD, which may be an indication of its preparation to host metastases, and thus requires further investigation.

Causes of delays in breast cancer diagnosis in Poland.

Breast cancer is the most common malignant tumor in women. The results of breast cancer treatment to a large extent depend on the time of the primary diagnosis of the disease. AIM: The aim of this study was to determine the most common causes of the delay and the delay time in the diagnosis of breast cancer in Polish women. MATERIALS AND METHODS: The study was performed using a diagnostic survey and analysis of medical documentation from the Subcarpathian Regional Oncology Center, Poland. A total of 231 patients with diagnosed breast cancer were recruited to the study. RESULTS: Delays in diagnosing of breast cancer were found in 83.1% of all the patients. The average time from the first symptom observation by a woman to the first medical consultation was on average 61.7 days. The most common cause of the delay in medical consultation in the examined group was a fear of diagnosing cancer (31.2%). CONCLUSIONS: The examined women require permanent health education in the field of breast cancer and the importance of early diagnosis of the disease for the effectiveness of treatment and prognosis.

Immunoexpression of DNA fragmentation factor 40, DNA fragmentation factor 45, and B-cell lymphoma 2 protein in normal human endometrium and uterine myometrium depends on menstrual cycle phase and menopausal status.

INTRODUCTION: DNA fragmentation factors 40 and 45 (DFF40 and DFF45) are final executors of apoptosis, and B-cell lymphoma 2 (Bcl-2) is a well-recognized apoptosis inhibitor. We aimed to evaluate DFF40, DFF45 and Bcl-2 immunoexpression in the normal human endometrium with respect to the glandular and stromal layer and in uterine myometrium. MATERIAL AND METHODS: DFF40, DFF45, and Bcl-2 expression was assessed via immunohistochemistry in the endometrium and myometrium collected postmenopausally and premenopausally during the proliferative and secretory phases of the menstrual cycle. RESULTS: Compared to the myometrium and stroma, endometrial glands showed the highest DFF40 and DFF45 expression in pre- and postmenopausal specimens. DFF45, but not DFF40, glandular expression dependent on menstrual cycle phase and DFF40 and DFF45 scoring was significantly lower in postmenopausal specimens. Significantly higher Bcl-2 expression was observed in proliferative glandular endometrium compared to secretory and postmenopausal specimens. No cycle- or menopause-dependent changes were reported for stromal or myometrial DFF40, DFF45 or Bcl-2 expression. DFF40, DFF45 and Bcl-2 expression was independent of age, age at menarche and menopause, BMI, menstrual cycle and menses lengths, parity and gravidity. CONCLUSIONS: The study provides important evidence regarding menstrual cycle-dependent changes in the expression of DFF40, DFF45 and Bcl-2 in the normal human endometrium, especially in the glandular layer, and shows that their levels are stable in the normal uterine myometrium.

Endometrial Polyps and Benign Endometrial Hyperplasia Have Increased Prevalence of DNA Fragmentation Factors 40 and 45 (DFF40 and DFF45) Together With the Antiapoptotic B-Cell Lymphoma (Bcl-2) Protein Compared With Normal Human Endometria.

DNA fragmentation factor 40 (DFF40) is a key executor of apoptosis. It localizes to the nucleus together with DNA fragmentation factor 45 (DFF45), which acts as a DFF40 inhibitor and chaperone. B-cell lymphoma (Bcl-2) protein is a proven antiapoptotic factor present in the cytoplasm. In this study, we aimed to investigate DFF40, DFF45, and Bcl-2 immunoexpression in endometrial polyps (EPs) and benign endometrial hyperplasia (BEH) tissue compared with that in normal proliferative endometrium (NPE) and normal secretory endometrium (NSE) as well as normal post menopausal endometrium (NAE). This study used archived samples from 65 and 62 cases of EPs and BEH, respectively. The control group consisted of 52 NPE, 54 NSE, and 54 NAE specimens. Immunohistochemistry was used to detect DFF40, DFF45, and Bcl-2. DFF40, DFF45, and Bcl-2 were more highly expressed in the glandular layer of EPs and BEH compared with the stroma, and this was not influenced by menopausal status. Both glandular and stromal expression of DFF40, DFF45, and Bcl-2 were significantly higher in EPs compared with NPE, NSE, and NAE. Glandular BEH tissue showed significantly higher DFF40, DFF45, and Bcl-2 expression than in NPE, NSE, and NAE. No differences in the glandular expression of DFF40, DFF45, and Bcl-2 were observed between EP and BEH tissues, while Bcl-2 stromal expression in BEH was significantly lower than in EPs. Glandular, menopause-independent DFF40, DFF45, and Bcl-2 overexpression may play an important role in the pathogenesis of EPs and BEH.

Diagnostic significance of serum concentrations of soluble Fas ligand (sFasL) in children with autoimmune thyroid disease.

INTRODUCTION: The aim of the study was to assess serum levels of sFasL as a marker of thyroid dysfunction in children with autoimmune thyroid disease (AITD). DESIGN: The group comprised 45 newly diagnosed children with Hashimoto's thyroiditis and Graves' disease versus euthyroid control group: 11 with hypothyroidism (10 girls and 1 boy, aged 12.2 ± 1.9 years), 19 children with hyperthyroidism (15 girls and 4 boys, aged 12.4 ± 4.9 years) and 15 healthy subjects (7 girls and 8 boys, aged 10.5 ± 4.8 years). METHODS: Thyroid function (TSH, fT4, fT3), autoimmune (ATG, ATPO, TRAb) and anthropometric (weight, height, BMI, BMI-SDS, Cole index) parameters were evaluated. sFasL concentration was measured by ELISA. Nonparametric statistical test and ROC analysis were performed to assess the data. RESULTS: We found no significant differences in serum concentrations of sFasL between boys and girls in the studied groups. Significantly higher sFasL levels (median 0.26 ng/ml) were identified in children with hypothyroidism compared with the control group (median 0.06 ng/ml, p < 0.001) and in comparison to a group of children with hyperthyroidism (median 0.14 ng/ml, p < 0.05). ROC analysis indicates that sFasL effectively discriminated hypothyroid and healthy children (area under the curve/AUC = 0.897; p < 0,001; sensitivity: 100%, specificity: 73.3%), as well as both clinically opposing states: hyperthyroidism and hypothyroidism among themselves (AUC = 0.833; p= 0,003; sensitivity: 94,7%, specificity: 72.7%). CONCLUSIONS: Our work shows that sFasL may be useful marker in the assessment of thyroid dysfunction in children with autoimmune thyroid disease.

[Patient safety in poland according to analysis of medical adverse events].

The paper presents the analysis of rulings from regional commisions on health care malpractice in Poland wiith special attention to patient safety issues. The analysis entails causes, types and consequensence of 469 malpractice claims. In 23,7% of cases the claim was confirmed by commission. The most frequent types of malpractice was body injury. General surgery and othopedis were the major medical specialities when confirmed malpractices took place.

The clinical role of serum concentrations of selected cytokines: IL-1ß, TNF-α and IL-6 in diagnosis of autoimmune thyroid disease (AITD) in children.

Chronic autoimmune thyroiditis (cAIT) leads to hypothyroidism due to T cell-mediated cytotoxicity in most cases. By contrast, Graves' disease (GD) with thyrotropin receptor stimulatory autoantibodies cause hyperthyroidism. Cytokines play a crucial role in modulating immune response in both disorders. The aim of study was to evaluate the concentrations of cytokines: IL-1ß, TNF-α and IL-6 in these two opposite clinical and hormonal thyroid diseases. The study group consisted of 64 children, 44 newly diagnosed, untreated children with cAIT (n = 22; with hypothyroidism) and GD (n = 22; hyperthyroidism), and the control group of 20 healthy children. Cytokine concentrations were evaluated using the ELISA technique. The studied groups of children did not differ significantly in concentrations of IL-6 (p = 0.48) and TNF-α (p = 0.067). In children with hypothyroidism, we found significantly higher concentrations of IL-1ß (median 2.16 pg/ml, IQR 0.87) compared to hyperthyroidism (median 1.39 pg/l, IQR 1.27) (p < 0.01) and the control group (median 1.88 pg/ml, IQR 1.04) (p < 0.05). The results of ROC curve analysis demonstrated the usefulness of IL-1ß (AUC = 0.77, p = 0.003) and TNF-α (AUC = 0.691, p = 0.034) as diagnostic parameters in cAIT which enable discrimination of children with autoimmune thyroid disease from healthy individuals. Concentrations of these markers are increased in autoimmune hypothyroidism. We found no significant sex differences in the tested parameters. In conclusion, IL-1ß and TNF-α may be considered as markers of hypothyroidism, and could efficiently discriminate between healthy and autoimmune hypothyroid children. Significantly higher concentrations of IL-1ß in children with hypothyroidism may be used to distinguish children with cAIT from GD patients.

The role of the immune system and cytokines involved in the pathogenesis of autoimmune thyroid disease (AITD).

Autoimmune thyroid disease (AITD) is the most common organ-specific autoimmune disorder. AITD development occurs due to loss of immune tolerance and reactivity to thyroid autoantigens: thyroid peroxidase (TPO), thyroglobulin (TG) and thyroid stimulating hormone receptor (TSHR). This leads to infiltration of the gland by T cells and B cells that produce antibodies specific for clinical manifestations of hyperthyroidism in Graves' disease (GD) and chronic autoimmune thyroiditis (cAIT). In addition, T cells in Hashimoto's thyroiditis induce apoptosis in thyroid follicular cells, leading ultimately to the destruction of the gland. Cytokines are involved in the pathogenesis of thyroid diseases working in both the immune system and directly targeting the thyroid follicular cells. They are involved in the induction and effector phase of the immune response and inflammation, playing a key role in the pathogenesis of autoimmune thyroid disease. The presence of multiple cytokines has been demonstrated: IL-1alpha, IL-1b, IL-2, IL-4 , IL-6, IL-8, IL-10, IL-12, IL-13, IL-14, TNF-alpha and IFN-gamma within the inflammatory cells and thyroid follicular cells. Finally, cytokines derived from T cells can directly damage thyroid cells, leading to functional disorders and may also stimulate the production of nitric oxide (NO) and prostaglandin (PG), thus increasing the inflammatory response in AITD. Immunological mechanisms involved in the pathogenesis of AITD are strongly related to each other, but differences in the image of cAIT and GD phenotype are possibly due to a different type of immune response observed in these two counteracting clinical thyroid diseases. This article describes the potential role of cytokines and immune mechanisms in the pathogenesis of AITD.