Indirect and Direct 65+ Patient Reporting of Non-Steroidal Anti-Inflammatory Drug-Induced Adverse Drug Reactions as a Source of Information on Polypharmacy and Polypharmacy-Related Risk.

Background and Objectives: Non-steroidal anti-inflammatory drugs (NSAIDs), which have anti-inflammatory and analgesic properties, are commonly used in the treatment of various, particularly frequent, as well as chronic, conditions in older patients. Due to common polypragmasia in these patients and a high risk of adverse drug reactions (ADRs) and drug interactions, pain management poses a therapeutic challenge. This study describes the importance of ADR reports in the identification of polypharmacy and the ensuing interactions. Materials and Methods: Both healthcare professionals (HPs) and non-healthcare professionals (non-HPs) reports collected in the EudraVigilance database of NSAIDs, including most commonly co-reported medications and reported reactions, were analysed and differences between HPs and non-HPs reports were identified. Results: In the analysed period and group, non-HPs reported more reactions but indicated fewer drugs as suspect or concomitant. The outcomes of our analysis indicate more HP engagement and more detailed reports of serious ADRs when compared to non-serious individual case safety reports (ICSRs) by non-HPs, which appeared more detailed. Such reactions as kidney failure and increased risk of bleeding are known adverse reactions to NSAIDs and common symptoms of their interactions, which were described in the available literature. They were much more frequently reported by HPs than by non-HPs. Non-HPs more frequently reported reactions that may have been considered less significant by HPs. Conclusions: The differences between healthcare professionals' (HPs) and non-healthcare professionals' (non-HPs) reports may result from the fact that the reports from patients and their caregivers require a professional medical diagnosis based on symptoms described by the patient or additional diagnostic tests. This means that when appropriately classified, medically verified, and statistically analysed, the data may provide new evidence for the risks of medication use or drug interactions.

Practical Aspects of the Use of Telematic Systems in the Diagnosis of Acute Coronary Syndrome in Poland.

Background and Objectives: The guidelines of the European Society of Cardiology (ESC) recommend the use of telematic methods in the diagnosis of myocardial infarction, allowing for transtelephonic electrocardiography (TTECG) from the emergency scene to centers performing percutaneous coronary interventions (PCI center). It has been proven that such a procedure has a beneficial effect on the survival of patients with ST elevation myocardial infarction (STEMI). Fewer data can be found on the correct use of these methods in everyday clinical practice. The aim of this study was to indicate potential indications and contraindications for the use of the TTECG system, and provide recommendations for proper collaboration between emergency medical systems (EMS) teams and PCI centers. Materials and Methods: The article is a systematic review of cardiological emergencies, with an assessment of indications for the use of the TTECG system. The authors introduced their own grading of the validity of indications for transmission of the TTECG, similar to those used in the official ESC guidelines.: Results:: The authors described individual cardiological emergencies occurring in the practice of EMS, considering specific indications or contraindications for the transmission of the TTECG. The article also discusses individual practical recommendations for proper cooperation between EMS teams and PCI centers in detail. All of the recommendations are compiled in a handy table to facilitate its use in everyday clinical practice. Conclusions: The summary presents a comparison of the realities of the functioning of the telematic support system in Poland in the field of STEMI diagnostics, with the model's recommendations. The necessity of further educating the members of individual teams included in the network dealing with STEMI treatment was indicated, as well as the necessity of introducing legal regulations sanctioning the functioning of telematic systems in modern medicine.

Changes in mortality and years of life lost due to lung cancer in Poland, 2000-2016.

BACKGROUND: The aim of the study was to evaluate trends of mortality and the number of years of life lost due to lung cancer in Poland, in the period 2000-2016. METHODS: The study material was 375,151 death certificates of all inhabitants of Poland who died in the period 2000-2016 due to lung cancer. In order to calculate the number of years of life lost, the authors used indices: SEYLLp (Standard Expected Years of Life Lost per living person), SEYLLd (per deaths), APC (Annual Percentage Change) and AAPC (Average Annual Percentage Change). RESULTS: The standardized death rate (SDR) due to lung cancer decreased in the analyzed period from 74.5 to 68.3 per 100,000 population (AAPC = -0.6%). The most rapid decrease was noted in the years 2008-2011 (APC = -2.2%). With regards to males, SDR decreased from 148.8 to 114.5 (AAPC = -1.7%), whereas in females, it increased from 25.7 to 37.6 (AAPC = 2.3%). The SEYLLp index, calculated per 100,000 inhabitants, increased from 1189.9 in the year 2000 to 1250.5 in the year 2016. The trend and pace of changes fluctuated. In 2000-2008, the SEYLLp index was increasing at a pace of 0.7%. This growth was followed by a decrease at a pace of -1.2%, noted in 2008-2011. After the year 2011, the indices started to grow at an annual pace of 0.4%. AAPC in the whole study period was 0.3%. Increased mortality in females was responsible for the increase in the number of lost years of life. SEYLLp values in this sex group increased from 464.8 in the year 2000 to 774.7 in the year 2016 (APC = 3.3%).With regards to males, SEYLLp values, calculated for 100,000 male population, decreased in the analyzed period from 1961.1 to 1758.3. CONCLUSIONS: Lung cancer still poses a serious epidemiological problem in Poland and the number of years of life lost due to this cause reflects social and economic implications of premature lung cancer-related mortality. There is a great need to educate, particularly women, and show effective ways of quitting smoking.

Trends of mortality due to breast cancer in Poland, 2000-2016.

BACKGROUND: The aim of the study was to assess trends in mortality and the number of lost years of life due to breast cancer in the female population in the years 2000-2016, with consideration given to differences regarding the level of education and place of residence. METHODS: The analysis was based on a database of the Central Statistical Office of Poland, containing information gathered from 92,154 death certificates of all Polish female inhabitants who died in the period 2000-2016 due to breast cancer. The SEYLLp (Standard Expected Years of Life Lost per living person), the SEYLLd (per deaths), the APC (Annual Percentage Change), the AAPC (Average Annual Percentage Change) were calculated to determine years of life lost. RESULTS: The mean age of women who died from breast cancer increased in the study period from 64.7 years to 69.7. The SEYLLp index (per 100,000) increased to 776.8 years in 2016 (AAPC = 0.5%). The most unfavorable changes were observed in the group of women with secondary education. In 2004, the SEYLLp values started to grow at a rate of 2.3% and since 2011, they have been higher than amongst women with elementary education. In the years 2000-2016, the authors observed that SEYLLp was steadily declining (APC = -1.0%) in the group of inhabitants of rural areas, whereas with regards to city dwellers, the SEYLLp index has been increasing since 2004 (APC = 0.5%), which has resulted in increased disproportions regarding the place of residence. CONCLUSIONS: The results of this study showed that breast cancer is becoming a serious epidemiological problem in Poland. There is the need to intensify activities among women at highest risk group and it should be the starting point for making key decision in combating breast cancer.

Territorial differences in years of life lost due to premature mortality in inhabitants of Poland

INTRODUCTION: Reduction of social and territorial differences with regards to health of a population is one of the most crucial global problems of public health. An analysis of years of life lost focuses on social and economic aspects of premature mortality. AIM: The aim of the study is to analyze territorial differences in years of life lost due to premature mortality in inhabitants of various regions of Polan d, according to the most important causes of death, with consideration given to classification categories of ICD-10. METHODS: The study material included a database which contained information gathered from 387,312 death certificates of inhabitants of Poland in 2013. The SEYLLp index (Standard Expected Years of Life Lost per living person) was used to calculate standard expected years of life lost. RESULTS: The absolute number of years of life lost in inhabitants of Poland for the year 2013 was 4,168,256 in males and 2,536,447 in females, which corresponded to 2,237 years per 10,000 males and 1,277 per 10,000 females. Inhabitants of the Lodz Province are characterized with the highest number of years of life lost (2,858 years per 10,000 males and 1,544 per 10,000 females), whereas inhabitants of the Subcarpathian Province are characterized with the lowest number of years of life lost (1,833 years per 10,000 males and 1,039 per 10,000 females). In the male group, the highest SEYLLp values were contributed by: ischemic heart disease (217 years), malignant neoplasms of the trachea, bronchi and lungs (175 years) and cardiac insufficiency (156 years), whereas in the female group, the causes included: cerebral diseases (106 years), cardiac insufficiency (105 years) and ischemic heart disease (103 years) CONCLUSIONS: There are huge territorial differences in Poland with regards to a number of years of life lost. Thus, there is a need to continue studies in order to find an explanation for these differences and gradually eliminate them.

Trends in Mortality Due to Malignant Neoplasms of Female Genital Organs in Poland in the Period 2000-2021-A Population-Based Study.

The aim of this study is to assess mortality trends due to malignant neoplasms of female genital organs (MNFGOs) in Poland between 2000 and 2021. For the purpose of the study, the authors used data on all deaths of Polish female inhabitants due to MNFGO between 2000 and 2021, obtained from the Statistics Poland database. The standardised death rates (SDR), potential years of life lost (PYLL), annual percentage change (APC) and average annual percentage change (AAPC) were calculated. Between the years 2000 and 2021, 138,000 women died due to MNFGOs in Poland. Of this number, 54,975 (39.8%) deaths were caused by ovarian cancer, 37,487 (27.2%) by cervix uteri cancer, and 26,231 (19.0%) by corpus uteri cancer. A decrease in mortality due to cervix uteri cancer (APC = -2.4%, p < 0.05) was the most favourable change that occurred in the period 2000-2021, while the least favourable change was an increase in mortality due to corpus uteri cancer for the period 2005-2019 (APC = 5.0%, p < 0.05). SDRs due to ovarian cancer showed a decreasing trend between 2007 and 2021 (APC = -0.5%, p < 0.05). The standardised PYLL index due to cervical cancer was 167.7 per 100,000 women in 2000 and decreased to 75.0 in 2021 (AAPC = -3.7, p < 0.05). The number of lost years of life due to ovarian cancer decreased from 143.8 in 2000 to 109.5 in 2021 (AAPC = -1.3, p < 0.05). High values of death rates due to MNFGO in Poland, compared to other European countries, show that there is a need to promote preventive programmes and continue to monitor changes in mortality.

Incidence and prevalence of registered hypertension in Poland.

INTRODUCTION: Hypertension is a major factor related to morbidity and mortality in middle- and high­income countries. OBJECTIVES: The aim of the study was to assess the incidence and prevalence of registered hypertension in Poland in the years 2018-2022. PATIENTS AND METHODS: We used the public payer claims database to assess incidence and prevalence of registered hypertension. Definition of hypertension was based on the International Classification of Diseases, 10th Revision codes from I10 to I15. RESULTS: The number of registered hypertension cases during the analyzed period varied from 10.9 to 11 million. The prevalence was 0.5%, 0.5%, 0.5%, 0.4%, and 0.4% (P <0.001) in children (age <18 years) and 34.4%, 34.8%, 34.9%, 35.2%, and 35.2% (P <0.001) among adults in 2018, 2019, 2020, 2021, and 2022, respectively. In 2022, the mean (SD) age of persons with registered hypertension was 66.2 (14.1) years in women and 60.8 (14.8) years in men (P <0.001). The highest incidence of registered hypertension was found in men aged 55-59 years and in women aged 50-54 years. In the population aged up to 54 years, the registered prevalence of hypertension was higher among men, while in older age groups it was higher in women, reaching 94% and 87% in the oldest groups of women and men, respectively. CONCLUSIONS: In 2022, the number of patients with registered hypertension in Poland was close to 11 million, while the prevalence was 35.2% in adults and 0.4% in children. In the population under the age of 55 years, hypertension is more common in men, while women predominate in the older age groups.

Self-rated quality of life of city-dwelling elderly people benefitting from social help: results of a cross-sectional study.

BACKGROUND: The percentage of people aged 65 or older living in Poland is 13.6%, but 17.2% in Lódz. The aim of the study was to identify factors correlating with the self-rated quality of life of elderly inhabitants of cities applying for social help, on the basis of a cross-sectional study. METHODS: The study was conducted in Lódz, a large Polish city, between September 2011 and February 2012 in a group of people applying for help in the Municipal Social Welfare Centre. Four hundred and sixty-six respondents aged 65 or older were included in the study. The tool used in the study was an interview questionnaire. The respondents answered questions on their demographic situation, living conditions, financial, health and social situation. The authors also applied the WHOQOL-BREF Questionnaire, the Activities of Daily Living Scale (ADL) and the Geriatric Depression Scale (GSOD). For statistical purposes, the authors used single- and multiple-factor regression and the Statistica 9.0 Program. The results were presented as an odds ratio (OR) with a 95% confidence interval (CI); the adopted significance level was p < 0.05. The authors applied the Pearson's x(2) test in order to evaluate the structure of the studied group and the subpopulation, who were aged 65 or older and using social help, throughout the city. RESULTS: Logistic regression confirmed that a high quality of life depends on the following variables: university education (OR = 2.31; p<0.05), an income which is sufficient to live (OR = 1.63; p<0.05), no heart palpitations (OR = 2.32; p<0.05), stable blood pressure (OR = 2.32; p<0.05), no headaches (OR = 1.55; p<0.05), no pain in the chest (OR = 1.51; p<0.01), no shortness of breath (OR = 1.51; p<0.01), no tiredness (OR = 2.08; p<0.05), a score on the Geriatric Depression Scale pointing to a lack of suspected depression (OR = 9.88; p<0.001 if the person does not suffer from depression and OR = 6.33; p<0.001 if there is uncertain depression) as well as not using nursing services, a score on the ADL Scale confirming the person's fitness and participation in family gatherings. CONCLUSIONS: A subjective evaluation of the quality of life of the elderly depends on many factors. An identification of these factors might be helpful in implementing steps aimed at improving the quality of life of elderly people who, as a consequence, will need less social help: particularly nursing services.

Changes in mortality of Polish residents in the early and late old age due to main causes of death from 2000 to 2019.

Purpose: The aim of the study was to assess mortality trends in Poland between 2000 and 2019 in the early and late old age population (65-74 years and over 75 years). Methods: The work used data on all deaths of Polish residents aged over 65 years (N = 5,496,970). The analysis included the five most common major groups of causes of death: diseases of the circulatory system, malignant neoplasms, diseases of the respiratory system, diseases of the digestive system and external causes of mortality. The analysis of time trends has been carried out with the use of joinpoint models. The Annual Percentage Change (APC) for each segments of broken lines, the Average Annual Percentage Change (AAPC) for the whole study period (95% CI), and standardized death rates (SDRs) were calculated. Results: The percentage of deaths due to diseases of the circulatory system decreased in all the studied subgroups. Among malignant neoplasms, lung and bronchus cancers accounted for the largest percentage of deaths, for which the SDRs among men decreased, while those among women increased. In the early old age, the SDR value increased from 67.8 to 76.3 (AAPC = 0.6%, p > 0.05), while in the late old age group it increased from 112.1 to 155.2 (AAPC = 1.8%, p < 0.05). Among men, there was an upward trend for prostate cancer (AAPC = 0.4% in the early old age group and AAPC = 0.6% in the late old age group, p > 0.05) and a downward trend for stomach cancer (AAPC -3.2 and -2.7%, respectively, p < 0.05). Stomach cancer also showed a decreasing trend among women (AAPC -3.2 and -3.6%, p < 0.05). SDRs due to influenza and pneumonia were increasing. Increasing trends in mortality due to diseases of the digestive system in women and men in the early old age group have been observed in recent years, due to alcoholic liver disease. Among the external causes of mortality in the late old age group, the most common ones were falls. Conclusions: It is necessary to conduct further research that will allow to diagnose risk and health problems of the elderly subpopulation in order to meet the health burden of the aging society.

The Burden of Suicide Mortality in Poland: A 20-Year Register-Based Study (2000-2019).

Objectives: The aim of the study was to assess mortality trends due to suicide in Poland in the years 2000-2019 with the use of joinpoint regression. Methods: The study analysed all suicide deaths in Poland in the years 2000-2019 (N = 113,355). Age-standardised death rates (SDRs), the annual percentage change (APC) and the average annual percentage change (AAPC) were determined. Results: In the male group, SDR was 29.3 in 2000 and 21.6 in 2019, in the female group, SDR decreased from 5.2 to 3.0. In 2019, the highest SDR values were noted in the group aged between 45 and 64 years. The most common method of suicide was hanging. In 2019, odds ratios (OR) of death due to suicide for age groups 15-24 years vs. 65 years or above were 51.47 among men and 181.89 among women. With regards to primary vs. tertiary education, OR values were 1.08 and 0.25, respectively; for single vs. widowed individuals 8.22 and 12.35; while for rural vs. urban residents 1.60 and 1.15. Conclusion: There is a need to implement educational programmes, primarily designed for young people.

Mortality Trends due to Falls in the Group of People in Early (65-74 Years) and Late (75+) Old Age in Poland in the Years 2000-2020.

The aim of the study was to assess mortality trends due to falls in early (65-74 years) and late (75+) old age groups in Poland in 2000-2020. The study used a database of all deaths due to falls in two age groups. Per 100,000 men in early old age, the crude death rate (CDR) increased from 25.3 in 2000 to 25.9 in 2020. After 2012, a statistically significant decrease was observed (annual percentage change (APC) = -2.3%). Similar trends were noted for standardized death rates (SDR). Among men 75 years and older, the CDR values between the years 2000 and 2005 decreased (APC = -5.9%; p < 0.05), while after 2005, they increased (1.3%; p < 0.05). The SDR value decreased from 160.6 in 2000 to 118.1 in 2020. Among women aged 65-74, the CDRs values between 2000-2020 decreased from 13.9 and 8.2 per 100,000 women. The SDR value decreased from 14.0 to 8.3, respectively (2000-2007: APC = -7.2%; p < 0.05). Among women aged 75+, the CDR value decreased from 151.5 to 111.6 per 100,000 but after 2008, they began to increase (APC = 1.9%; p < 0.05). SDR decreased from 188.9 to 98.0 per 100,000 women. Further research on the mortality in falls is needed in order to implement preventive programs.

Assessment of In-Hospital Mortality and Its Risk Factors in Patients with Myocardial Infarction Considering the Logistical Aspects of the Treatment Process-A Single-Center, Retrospective, Observational Study.

Technological progress, such as the launching of a new generation of drug-coated stents as well as new antiplatelet drugs, has resulted in the treatment of myocardial infarction (MI) becoming much more effective. The aim of this study was to assess in-hospital mortality and to conduct an assessment of risk factors relevant to the in-hospital death of patients with MI. This study was based on an observational hospital registry of patients with MI (ACS GRU registry). For the purpose of the statistical analysis of the risk factors of death, a univariate logistic regression model was applied. In-hospital general mortality amounted to 7.27%. A higher death risk was confirmed in the following cases: (1) serious adverse events (SAEs) that occurred during the procedure; (2) patients transferred from another department of a hospital (OR = 2.647, p = 0.0056); (3) primary percutaneous coronary angioplasty performed on weekdays between 10 p.m. and 8 a.m. (OR = 2.540, p = 0.0146). The influence of workload and operator experience on the risk of death in a patient with MI has not been confirmed. The results of this study indicate the increasing importance of new risk factors for in-hospital death in patients with MI, such as selected logistical aspects of the MI treatment process and individual SAEs.

Do selected lifestyle parameters affect the severity and symptoms of COVID-19 among elderly patients? The retrospective evaluation of individuals from the STOP-COVID registry of the PoLoCOV study.

BACKGROUND: Older individuals tend to include less physical activity in their routine and are more prone to chronic diseases and severe medical complications, making them the most burdened group that is losing years of life due to pandemic-related premature mortality. This research aimed to assess the lifestyle factors that affect the COVID-19 course among patients ≥ 65 years old. METHODS: The study included 568 convalescents (64.1% women and 35.9% men) with persistent clinical symptoms after isolation. The mean age was 70.41 ± 4.64 years (minimum: 65 years; maximum: 89 years). The patients completed the questionnaire during their in-person visit to the medical center. The survey included questions regarding their health status when suffering from COVID-19, basic sociodemographic data, and medical history concerning chronic conditions and lifestyle. RESULTS: Physical inactivity (p < 0.001) and feeling nervous (p = 0.026) increased the risk of having a severe disease course. Coronary artery disease raised both the risk of a severe disease course (p = 0.002) and the number of present symptoms up to 4 weeks (p = 0.039). Sleep disturbances increased the number of symptoms during infection (p = 0.001). The occurrence of any symptoms was also associated with the female sex (p = 0.004). The severity of the course was associated with longer persistent symptoms (p < 0.001) and a greater number of symptoms (p = 0.004); those with a more severe course were also at a greater risk of persistent symptoms for up to 4 weeks (p = 0.006). Senior citizens in the third pandemic wave suffered with more severe disease (p = 0.004), while illness during the fourth (p = 0.001) and fifth (p < 0.001) waves was associated with a lower risk of persistent symptoms for up to 4 weeks. The disease duration was significantly shorter among vaccinated patients (p = 0.042). CONCLUSIONS: Elderly COVID-19 patients should re-think their lifestyle habits to consider a physical activity level that is adjusted to their abilities, in order to decrease the risk of a severe disease course and to further limit both the number and duration of symptoms. The research was carried out in accordance with the Declaration of Helsinki, and approval from the Bioethics Committee of Lodz Regional Medical Chamber to conduct the study was obtained (approval number 0115/2021). The PoLoCOV-Study ClinicalTrials.gov identifier is NCT05018052.

Post-Traumatic Stress Response and Appendicitis in Children-Clinical Usefulness of Selected Biomarkers.

Acute appendicitis is an inflammatory process which is one of the most frequent global causes of surgical interventions in children. The goal of the study was to determine whether acute phase proteins, that is, C-reactive protein (CRP), procalcitonin (PCT) and neutrophil gelatinase-associated lipocalin (NGAL), interleukin 6 (IL-6), transforming growth factor-beta1 (TGF-ß1) and cortisol (HC) play a role in the pathomechanism of post-trauma stress response of the organism and to establish the impact of the applied surgical procedure and/or of inflammation on their concentrations. An additional purpose was to establish the clinical usefulness of the studied biomarkers in the diagnostics of appendicitis. CRP concentrations were quantified via the immunoturbidimetric method, while the levels of IL-6 and PCT were assessed using a bead-based multiplexed immunoassay system in a microplate format (Luminex xMAP technology); NGAL, TGF-ß1 and cortisol concentrations were determined via the enzyme-linked immunosorbent assay (ELISA) technique. All the investigated biomarkers were assayed twice, i.e., immediately before the surgery and 12-24 h after its completion. Significant increases in CRP, IL-6 and PCT concentrations were found in all children subjected to laparoscopic surgeries (p = 0.001, p = 0.006, and p = 0.009, respectively) and open (classic) surgeries (p = 0.001, p = 0.016, and p = 0.044, respectively) compared to the initial concentrations. The patients undergoing classical surgery moreover presented with significant (p = 0.002, and p = 0.022, respectively) increases in NGAL and TGF-ß1 levels after the procedures. In a group of children undergoing laparoscopic surgery, the appendicitis induced an increase in cortisol concentration, whereas in patients undergoing classical surgery the increase in the levels of this biomarker was caused by the type of performed surgical procedure. Simultaneously assaying the levels of CRP, NGAL and IL-6 (p = 0.008, p = 0.022, and p = 0.000, respectively) may prove useful in clinical practice, enabling the diagnosis of appendicitis in paediatric patients reporting to a hospital with abdominal pains, in addition to data from anamnesis and from clinical or ultrasound examination. The performed study confirms the participation of examined biomarkers in the pathomechanism of post-injury stress reaction of the organism to surgical trauma.

Use of 1-MNA to Improve Exercise Tolerance and Fatigue in Patients after COVID-19.

COVID-19 is not only a short-term infection, as patients (pts) recovering from SARS-CoV-2 infection complain of persisting symptoms, which may lead to chronic fatigue syndrome. There is currently no evidence that nutritional supplements can assist in the recovery of pts with chronic fatigue syndrome. 1-Methylnicotinamide (1-MNA) is an endogenic substance that is produced in the liver when nicotinic acid is metabolized. 1-MNA demonstrates anti-inflammatory and anti-thrombotic properties. Therefore, we investigated whether 1-MNA supplements could improve exercise tolerance and decrease fatigue among patients recovering from SARS-CoV-2. METHODS: The study population was composed of 50 pts who had recovered from symptomatic COVID-19. The selected pts were randomized into two groups: Gr 1 (NO-1-MNA)-without supplementation; Gr 2 (1-MNA) with 1-MNA supplementation. At the beginning of the study (Phase 0), in both groups, a 6-minute walk test (6MWT) was carried out and fatigue assessment was performed using the Fatigue Severity Scale (FSS). Both FSS and 6MWT were repeated after 1 month. RESULTS: A significant improvement in the mean distance covered in the 6MWT was noted at follow-up in Gr 1-MNA, compared with Gr NO-1-MNA. We also noted that in Gr 1-MNA, the 6MWT distance was significantly higher after 1 month of supplementation with 1-MNA, compared with the beginning of the study (515.18 m in Phase 0 vs. 557.8 m in Phase 1; p = 0.000034). In Gr 1-MNA, significantly more pts improved their distance in the 6MWT (23 out of 25 pts, equal to 92%), by a mean of 47 m, compared with Gr NO-1-MNA (15 of 25 pts, equal to 60%) (p = 0.0061). After one month, significantly more patients in the group without 1-MNA had severe fatigue (FSS ≥ 4) compared with the group with supplementation (Gr 1-MNA = 5 pts (20%) vs. Gr NO-1-MNA = 14pts (56%); p = 0.008). CONCLUSIONS: 1-MNA supplementation significantly improved physical performance in a 6-min walk test and reduced the percentage of patients with severe fatigue after COVID-19. The comprehensive action of 1-MNA, including anti-inflammatory and anticoagulant effects, may be beneficial for the recovery of patients with persistent symptoms of fatigue and low tolerance to exercise after COVID-19.

Excess mortality in Poland during the first and second wave of the COVID-19 pandemic in 2020.

Purpose: The aim of the study was to analyse excess deaths by major causes of death and associated changes in the mortality pattern of the Polish population in 2020 due to the impact of the COVID-19 pandemic. Methods: The study used data on all deaths in Poland which occurred between 2010 and 2020 (N = 3,912,237). 10-year mortality trends for 2010-2019 were determined. An analysis of time trends has been carried out with joinpoint models and Joinpoint Regression Program. Based on the determined regression models, the number of deaths expected in 2020 and the number of excess deaths due to selected causes were calculated. Results: The crude death rates of all-cause deaths increased from 2000 to 2019 at an average annual rate of 1% (p = 0.0007). The determined regression model revealed that the number of deaths in 2020 should have been 413,318 (95% CI: 411,252 to 415,385). In reality, 477,355 people died in Poland that year. The number of excess deaths was therefore 64,037 (15.5%). According to data from Statistics Poland the number of COVID-19-related deaths was 40,028, the number of non-COVID-19 deaths was 24,009. The largest percentage increase over the expected number of deaths was observed for suicide (12.5%), mental and behavioral disorders (7.2%) and diseases of circulatory system (5.9%). A lower than expected number of deaths was observed for malignant neoplasms (-3.2%) and transport accidents (-0.1%). Conclusion: The difference between expected and observed non-COVID-19 deaths in 2020 indicates a need for further analysis of the causes of excess mortality.

Decreasing Trends in Road Traffic Mortality in Poland: A Twenty-Year Analysis.

The aim of the study was to assess mortality trends due to road traffic accidents in Poland between 1999 and 2018. The study material was a database including 7,582,319 death certificates of all inhabitants of Poland who died in the analyzed period (104,652 people died of transport accidents). Crude deaths rates (CDR), standardized death rates (SDR) and joinpoint models were used. Annual percentage change (APC) for each segment of broken lines and average annual percentage change (AAPC) for the whole study period were calculated. CDR decreased from 19.7 per 100,000 population in 1999 to 9.6 per 100,000 population in 2018; APC was -4.1% (p < 0.05) while SDR decreased from 20.9 to 10.9 per 100,000; APC was -4.1% (p < 0.05). Large differences in traffic accident-related mortality were observed between men and women. An analysis by gender and age shows that the decline in the number of deaths due to traffic accidents has been slowed down in the oldest age group, 65+, in both males and females. There is a need for in-depth analyses aimed at introducing effective preventive solutions in the field of road traffic safety in Poland. Legal regulations should particularly refer to the most endangered groups of road users.

The Importance of Direct Patient Reporting of Adverse Drug Reactions in the Safety Monitoring Process.

All medicinal products authorized in the European Union are subjects of constant drug-safety monitoring processes. It is organized in a pharmacovigilance system that is designed to protect human health and life by the detection, analysis and prevention of adverse drug reactions (ADRs) and other drug-related problems. The main role of the aforementioned system is to collect and analyze adverse drug reaction reports. Legislation introduced several years ago allowed patients, their legal representatives and caregivers to report adverse drug reactions, which caused them to be an additional source of safety data. This paper presents the analysis of EudraVigilance data related to adverse drug reactions provided by patients, their representatives, as well as those obtained from healthcare professionals related to medicines which belong to M01A anti-inflammatory and antirheumatic products, a non-steroid group. The objective of the study was to identify the changes in the number and structure of adverse reaction reporting after the introduction of pharmacovigilance (PV) obligations in EU. A review of scientific literature was also conducted to assess the differences in adverse reactions reported by patients or their representatives and by healthcare professionals. We also identified other factors which, according to literature review, influenced the number of adverse reaction reports provided by patients. Analysis of data collected from the EudraVigilance showed that from 2011 to 2013 the number of reports made by patients and their caregivers increased by approx. 24 percentage points, and then, from 2014, it constituted around 30% of the total of reported reactions every year, so patient reporting is an important part of pharmacovigilance system and a source of drugs' safety information throughout their use in healthcare practice. Additionally, there was no interrelationship between the seriousness of reported adverse reactions and the overall number of patient reports when compared to reports form healthcare professionals.

Respiratory Burst and TNF-α Receptor Expression of Neutrophils after Sepsis and Severe Injury-Induced Inflammation in Children.

Systemic inflammatory response syndrome (SIRS) is defined as the systemic host response to infection or a non-infectious factor. The purpose of this study was to evaluate the involvement of reactive oxygen species (ROS) in severe inflammation and to assess the discrimination strength of the neutrophil BURSTTEST assay regarding its etiology in three groups of patients (sepsis, burns, and bone fractures) who met the SIRS criteria. The neutrophil activation (respiratory burst of granulocytes as well as p55 and p75 tumor necrosis factor (TNF-α) receptor expression) was evaluated twice using flow cytometry, and the results were compared with healthy controls and among SIRS subjects. A decreased oxygen metabolism in neutrophils after E.coli stimulation and increased TNF-α receptor expression were found in septic and burned patients on admission, while ROS production augmented and TNF-α receptor expression diminished with the applied therapy. The significant differences in neutrophil respiratory burst intensity among septic and burned patients and those with sepsis and bone fractures were found (however, there were not any such differences between patients with thermal and mechanical injuries). This study indicates that the neutrophil BURSTTEST evaluation might be a clinically reliable marker for differentiating the SIRS etiology.

[Trends in excess male mortality in the working age population in a region with the highest mortality rates in Poland]. / Trendy nadumieralnosci mezczyzn w wieku produkcyjnym w województwie o najwyzszych wspólczynnikach zgonów w Polsce.

BACKGROUND: The intensity of premature deaths in the Lódz region in 2014 amounted to 40 per 10 000, and was the highest in the country (the average rate for Poland was 32). Excess mortality of men aged <65 continues to be a major medical and social problem. The aim of the study is to analyze time trends of excess male mortality in the working age population in the Lódz region, both in general and due to the most important causes of deaths. MATERIAL AND METHODS: The research material consists of information on 144 589 deaths of the Lódz region inhabitants aged 20-64 in 1999-2014. Crude and standardized mortality rates were calculated, as well as excess male mortality rates both in general and by cause of death. Standardization was carried out using the direct method according to the standard European population. A study of time trends was performed with the use of the joinpoint regression analysis. Average annual percentage rates of changes were estimated. RESULTS: The excess mortality rate of men at the productive age decreased from 2.9 to 2.8 in the Lódz region in 1999-2014. The most important causes of death among men aged 20-64 in 2014 were (rates per 10 000): cardiovascular diseases (19.1), malignant neoplasms (16.6) and external causes of death (12.3). Among women, the most significant were malignant neoplasms (11.1), cardiovascular diseases (5.1) and diseases of the digestive system (2.1). The excess mortality rate of men aged 20-64 in the analyzed period reached the highest values due to external causes of death (5.1-7.3) and cardiovascular diseases (3.0-3.7). The highest rate of the decline in excess male mortality in 1999-2014 was recorded due to malignant neoplasms, on average 1.4% per year (p < 0.05). Meanwhile, the fastest growth concerned external causes of death, on average 1.0% per year (p < 0.05). CONCLUSIONS: Despite the decline in the mortality rates among both sexes, excess male mortality due to external causes of death and cardiovascular diseases increased. Med Pr. 2020;71(3):325-35.