Assessment of Lipid Balance Parameters after Laparoscopic Sleeve Gastrectomy in 1-Year Observation.

Introduction: Currently, the increase in the percentage of obese people observed along with the development of civilization, reaching the level of a global pandemic, has forced a search for methods of effective and permanent obesity treatment. Obesity is a multifactorial disease; it coexists with many disease entities and requires multidisciplinary treatment. Obesity leads to metabolic changes in the form of metabolic syndromes, which include, among others, atherogenic dyslipidemia. The proven relationship between dyslipidemia and cardiovascular risk enforces the need to effectively improve the lipid profile of obese patients. Laparoscopic sleeve gastrectomy is a method of surgical treatment of morbid obesity which improves bariatric and metabolic parameters. The aim of the study was to assess the effectiveness of laparoscopic sleeve gastrectomy (LSG) at improving lipid profile parameters upon a 1-year follow up. Material and Methods: Bariatric parameters of 196 patients who underwent laparoscopic sleeve gastrectomy as well as the lipid profile of total cholesterol (TC), high-density lipoprotein (HDL), low-density lipoprotein (LDL), non-NDL, and triglycerides (TG) in a 1-year observation were analyzed. Results: Improvements in bariatric parameters were observed in patients after LSG. Total cholesterol, low-density lipoprotein (LDL), triglycerides and non-HDL level decreases were observed along with an increase in high-density lipoprotein (HDL) cholesterol levels. Conclusions: Sleeve gastrectomy is an effective method of treating obesity and improving the lipid profile in obese patients.

Epidemiology, management, and survival rate of out-of-hospital cardiac arrest in Upper Silesia, Poland: an Utstein-style report.

INTRODUCTION: Despite the growing number of studies on the epidemiology of out-of-hospital cardiac arrest (OHCA) in Poland, this issue has not been sufficiently studied. Notably, there has been a lack of uniform Utstein-style data reporting. AIM: To evaluate the epidemiology of OHCA, patient characteristics, the laypeople and emergency medical service (EMS) response to cardiac arrest, and outcomes of OHCA patients, based on a prospective registry encompassing a population of 2.7 million Poles. MATERIAL AND METHODS: Consecutive, adult, EMS-treated OHCA cases in 2018 were analyzed. Prehospital data were collected using case report forms by EMS. Information on in-hospital procedures and outcomes was based on data from the public payer of health care services. Multivariable logistic regression analysis was performed to find independent predictors of survival to discharge. RESULTS: A total of 1392 patients were included. Most OHCA occurred at home (74.7%). In 66.8% of OHCA cases, the cardiac arrest was witnessed by bystanders and in another 20.4% by EMS. Laypeople performed cardiopulmonary resuscitation (CPR) in 54.4% of non-EMS-witnessed events, and an automated external defibrillator (AED) was used in 4.6% of patients who received bystander CPR. Finally, 30.7% of all patients were transported to the hospital, and 9.2% survived to hospital discharge. Epinephrine administration, unwitnessed OHCA, longer response time, older age, and initial non-shockable rhythm were independently associated with lower survival to discharge. CONCLUSIONS: The prognosis of OHCA patients in Poland is poor. There is still room for improvement in increasing the prevalence of bystander CPR and AED use before EMS arrival.

Assessment of education effects on patient involvement and bariatric treatment outcome: an observational study.

INTRODUCTION: As a result of the growing number of people with obesity, the popularity of bariatric surgery has been systematically increasing. It has not yet been explored whether individual education of the patient can contribute to long-term success in weight reduction after bariatric treatment. AIM: To implement and compare the effects of different education methods, versus receiving one-time written information in the form of a guidebook, on patient involvement in abiding by lifestyle recommendations after laparoscopic sleeve gastrectomy (LSG) bariatric treatment. MATERIAL AND METHODS: The study included 160 patients with morbid obesity. The education session study participants were 100 patients after sleeve gastrectomy, with whom three education sessions were planned, and who were enrolled in the study. The control group consisted of 60 patients who underwent sleeve gastrectomy, and before discharge from the department, they received one-time written recommendations in the form of a guidebook. RESULTS: We confirmed that the three education sessions we conducted with the study group after LSG had a significant impact on weight loss. The control group, which received only written information, achieved weight loss and abided by the written recommendations, although to a lesser extent than the study group. The differences were evident particularly in motivation to adhere to recommendations and check-ups, which was significantly lower (p < 0.001) after a year of observation in the control group. CONCLUSIONS: This study results should encourage the establishment of education as a permanent element of the LSG procedure.

Operational and Financial Considerations of Using Drones for Medical Support of Mass Events in Poland.

OBJECTIVE: The implementation of drones in the medical security system requires a proper planning of the cooperation of different services, dividing the area into sectors, assessing potential risks, and other factors. This study refers to the cost analysis of using drones in the medical support of mass events. The aim of this research is to analyze the costs of unmanned aerial vehicle (UAV) implementation in the mass event medical support system. METHODS: The description includes purchase and maintenance costs of UAVs. The analysis also involves ways of raising funds for projects related to the UAV sector. Apart from the financial aspect, staff and drone operator training issues are the subjects of this analysis as well. RESULTS: This study is based on a specialist research involving drones and referring to reports on the current situation in Poland and in the world. CONCLUSIONS: The presented funds required for such projects and the way of raising these funds illustrate the range of the project and its requirements. (Disaster Med Public Health Preparedness. 2019;13:527-532).

The assessment of the influence of the method for obtaining hemostasis on the occurrence of postoperative complications after thyroid surgery.

BACKGROUND: The need to obtain successful surgical hemostasis had a significant impact on the development of electrosurgery. Innovative technical solutions necessitate the continuous training of surgeons in the use of more modern technologies. The diversity of solutions is also associated with the need to adapt the methods for obtaining hemostasis to the type of operation. Each time, the introduction of new technologies requires a critical evaluation of the results of surgical treatment. The most important measure of quality in thyroid surgery is the presence of chronic complications, such as the recurrent laryngeal nerve palsy and parathyroid insufficiency. Transient disorders also have a significant impact on the patient's comfort and quality of life. The report is preliminary in nature and it requires further investigation. OBJECTIVES: The aim of the study was to evaluate the effect of three methods for obtaining hemostasis on the occurrence of hypoparathyroidism, recurrent laryngeal nerve palsy, bleeding and the surgical site infection after thyroid surgery. MATERIAL AND METHODS: A retrospective analysis included patients who underwent thyroidectomy (n=654). Three methods of hemostasis were used. The first group (n=339) had blood vessels tied off. In the second (n=192) bipolar electrocoagulation was used and in the third one (n=123) bipolar electrocoagulation with integrated cutting mechanism. RESULTS: The transient hypoparathyroidism was found in 1.4% patients in the first group, 8.3% in the second and 27.6% in the third one. Chronic hypoparathyroidism was found in 0.29% in the first group, 0% in the second group and 2.4% in the third group. Significantly statistical differences were found in the incidence of transient hypoparathyroidism. CONCLUSIONS: Significant statistical differences were found in incidences of transient hypoparthyroidism in the group where bipolar electrosurgery was used.

[Assessment of possible correlations between endogenous androgens and the extent of coronary heart disease and left ventricle function]. / Badanie korelacji stezenia meskich hormonów plciowych ze stanem zaawansowania choroby wiencowej i funkcja lewej komory serca.

In men, androgens and especially testosterone are considered responsible for the much higher rate of coronary artery disease. The male gender is an independent coronary artery disease risk factor. An adverse correlation between endogenous testosterone levels and the extent of coronary atherosclerosis has been demonstrated in just one study. In our study, we investigated the associations between endogenous sex hormone levels and the extent of coronary atherosclerosis, ejection fraction of the left ventricle and coronary heart disease risk factors.

An assessment of correlations between endogenous sex hormone levels and the extensiveness of coronary heart disease and the ejection fraction of the left ventricle in males.

This clinical study investigated the possible associations of male sex hormone with the extensiveness of coronary artery lesions, coronary heart disease risk factors and ejection fraction of the heart. Ninety six Caucasian male subjects were recruited, 76 with positive and 20 with negative coronary angiograms. Early morning, prior to haemodynamic examination all of them had determined levels of total testosterone, free testosterone, free androgen index (FAI), sex hormone-binding globulin (SHBG), oestradiol, luteinizing hormone, follicle-stimulating hormone, plasma lipids, fibrinogen and glucose. The ejection fraction and the extensiveness of coronary lesions of each subject was assessed on the basis of x-ray examination results using Quantitative Coronary Angiography (QCA) and Left Ventricular Analysis (LVA) packages on the TCS Acquisition workstation, Medcon. Men with proven coronary heart disease had significantly lower levels of total testosterone (11.9 vs 21.2 nmol/l), free testosterone (45.53 vs 86.10 pmol/l), free androgen index (36.7 vs 47.3 IU) and oestradiol (109.4 vs 146.4 pmol/l). The level of testosterone was negatively associated with the DUKE Index. The most essential negative correlation was observed between SHBG and atherogenic lipid profile (low high-density lipoprotein, high triglycerides). Ejection fraction was substantially lower in patients (51.85 vs 61.30) (without prior myocardial infarction) with low levels of free-testosterone (23.85 vs. 86.10 pmol/l) and FAI (28.4 vs 47.3 IU). A negative correlation was observed between total testosterone, free testosterone, FAI and blood pressure, especially with diastolic pressure. Men with proven coronary atherosclerosis had lower levels of endogenous androgens than the healthy controls. For the first time in clinical settings it has been demonstrated that low levels of free-testosterone was characteristic for patients with low ejection fraction. Numerous hypothesies for this action can be proposed but all require a proper evaluation process. The main determinant of atherogenic plasma lipid was low levels of SHBG suggesting its main role in developing atheroscerotic lesions.