Quality of life in women with endometriosis: a cross-sectional survey.

PURPOSE: The aim of the study was to assess QoL and identify and analyse its determinants in women with endometriosis. METHODS: The study was performed in 2019 in health centres in Lublin (Poland) on 309 women with diagnosed endometriosis. In order to verify which factors affect QoL of the study participants, regression for qualitative variables (CATREG) was used. The applied research instruments included the WHOQOL-BREF quality of life questionnaire, the Acceptance of Illness Scale (AIS), the Laitinen Pain Scale, and a general questionnaire. RESULTS: The overall QoL score of the respondents was 3.30, whereas their overall perceived health score was 2.37. The highest QoL scores were found for the psychological domain 13.33, whereas the lowest QoL were found for the physical domain 11.52. Women with endometriosis have a moderate level of illness acceptance (24.64) and experience daily pain of moderate intensity (5.83). CONCLUSION: Women with endometriosis rate their overall QoL higher than their overall perceived health. Perceived QoL in women with endometriosis is most commonly associated with their acceptance of illness, BMI, negative impact of symptoms on the relationship with the partner, and dyspareunia. To improve these women's lives, care should also respond to the social, emotional, and sexual issues resulting from the illness. Such interventions will contribute to improved comfort and QoL among these women.

[Mycophenolate mofetil (MMF) as the first choice immunosuppressive drug in treatment of steroid-dependent nephrotic syndrome in children]. / Mykofenolan mofetilu (MMF) jako lek immunosupresyjny pierwszego wyboru w leczeniu steroidozaleznego zespolu nerczycowego (SZZN) u dzieci.

Most children diagnosed with nephrotic syndrome show favourable response to corticosteroid therapy, nonetheless 30% of patients have frequent relapses or a steroid-dependent course of disease. Cyclophosphamide, cyclosporin A or MMF are being used in treatment of steroid-dependent nephrotic syndrome in search of a drug with highest long-term effectiveness and least amount of side effects. AIM: The aim of study was to assess of the efficacy of MMF as the first choice immunosuppressive drug in children with nephrotic syndrome after determining a steroid-dependency. MATERIALS AND METHODS: 23 children with steroid-dependent nephrotic syndrome were enrolled in the study. Mean age at disease onset was 3.8 years. Mean disease duration time before introducing MMF was 21.3 months. Mean treatment time with MMF was 23.6 months. Patients previously treated with immunosuppressive drug, except for prednisone were excluded from the study. RESULTS: Per year of treatment with MMF 56,5% of patients had not more than 1 relapse of the disease, 5 patients had more than 1, but less than 2 relapses. After the mean time of 23.6 months MMF treatment was discontinued in 15 patients (62,5%). 11 patients (48%) from that group significantly benefited from treatment in the form of no further relapses, defer of steroid-dependence or the possibility to reduce the dose of corticosteroids to minimal. CONCLUSIONS: MMF has advantage over cyclophosphamide and calcineurin inhibitors in reference to side effect profile, especially glomerular filtration markers, hypertension and frequent drug dependency. Treatment with MMF is effective in maintaining long-term remission and enables the reduction of cumulative steroid dose. Regarding nearly 50% of patients with benefits after MMF treatment and good treatment tolerance, it seems justified to introduce MMF as the first choice immunosuppressive drug in patients with steroiddependent nephrotic syndrome.

Managed Care after Acute Myocardial Infarction (MC-AMI) - Poland's nationwide program of comprehensive post-MI care improves prognosis in 2-year follow-up. A single high-volume center intention-to-treat analysis.

BACKGROUND: Managed Care in Acute Myocardial Infarction (MC-AMI) is a program introduced in Poland aimed at comprehensive, scheduled, and supervised care for AMI patients to improve longterm prognosis. AIMS: Our study aimed to compare 24-month mortality and the incidence of major cardiovascular events (MACE: a composite of death, recurrent MI, and hospitalization for heart failure) in a cohort of AMI patients treated in the MC-AMI era (intention-to-treat analysis) vs. similar population treated before the MC-AMI era. METHODS: We analyzed 2323 consecutive patients with AMI: 1261 patients enrolled in the MC-AMI era (study group) and 1062 patients treated 12 months before the MC-AMI era (control group). In the study group, 57% of patients participated in MC-AMI while 43% of patients remained under standard care. The patients were followed up for 24 months. Mortality and MACE were recorded. RESULTS: Treatment in the MC-AMI era was related to a 30% reduction in all-cause mortality and a 14% reduction of MACE although it was not related to the reduction of hospitalization for heart failure (HF) or AMI in 24 months. The 24-month survival rate was the highest in MC-AMI enrolled patients while patients treated in the MC-AMI era but not enrolled had a similar prognosis to those treated before the MC-AMI era. Multivariable Cox regression analysis revealed the MC-AMI era to be inversely associated with mortality in 24-month follow-up (hazard ratio [HR], 0.49; 95% confidence interval [Cl], 0.38-0.65; P <0.001). CONCLUSIONS: AMI treatment in the MC-AMI era reduces 24-month mortality and MACE. Moreover, AMI treatment in MC-AMI is inversely related to mortality, MACE, and hospitalization for HF. The effect is pronounced in patients enrolled in MC-AMI.

Mechanical Thrombectomy in Acute Ischemic Stroke-The Role of Interventional Cardiologists: A Prospective Single-Center Study.

OBJECTIVES: The aim of this study was to assess the safety and outcomes of mechanical thrombectomy (MT) performed at a stroke center by interventional cardiologists (ICs) compared with other interventionists. The primary endpoint was functional independence of stroke survivors (modified Rankin scale score 0-2) at 3 months. The secondary endpoints included recanalization rate, reduction in stroke severity, and 3-month mortality. BACKGROUND: MT is a validated treatment for large vessel occlusion acute ischemic stroke. Incorporating ICs with their infrastructure into a comprehensive stroke team may increase the accessibility of this therapy. METHODS: In this single-center, prospective study, we included 248 ischemic stroke patients (mean age 68 ± 13 years, 48% women) with confirmed large vessel occlusion. The procedures were performed by ICs (n = 80), vascular surgeons (n = 116), and neuroradiologists (n = 52). RESULTS: Functional independence after 3 months was similar between patients operated by cardiologists and other specialists (modified Rankin scale score 0-2 in 44% vs 55%; P = 0.275). Similarly, the mortality rate at 3 months did not differ (28% vs 31%; P = 0.585). Procedures performed by cardiologists took longer than those performed by other specialists (120 minutes vs 105 minutes; P = 0.020). A percentage of procedures with angiographic success (TICI [Thrombolysis In Cerebral Infarction] grade 2b or 3) was lower when performed by cardiologists (55.7% vs 71.7%; P = 0.013), but the change in stroke severity (National Institutes of Health Stroke Scale score after 24 hours) was similar. CONCLUSIONS: Endovascular treatment in stroke provided by interventional cardiologists in cooperation with noninvasive stroke specialists is noninferior to procedures performed by the other endovascular specialists. Mortality and functional independence after 3 months are similar regardless of an interventionist performing the procedure.

Does gender affect the outcomes of patients in program of managed care for acute myocardial infarction.

BACKGROUND: There is increasing evidence that cardiac rehabilitation and regular follow-ups are associated with reduced mortality and morbidity. A programme of Managed Care for Patients with Acute Myocardial Infarction was developed in Poland (MC-AMI; in Polish, KOS-zawal), based on current scientific evidence. However, there is a lack of data on possible improvement in long-term prognosis among women after acute myocardial infarction. AIMS: To compare the male and female population who participated in MC-AMI, regarding major cardiovascular events, defined as a composite of death, recurrent myocardial infarction, and hospital-ization for heart failure, in a 1-year follow-up. METHODS: A prospective research study from a single cardiology care centre. The study compared 2 groups: women and men who agreed to participate in the MC-AMI programme. RESULTS: A total of 529 patients were included in the study (167 women and 362 men). In the 12-month follow-up, the difference in major cardiovascular events events was not statistically significant for women and men, respectively (11.38% women vs 11.33% men; p = 0.98). Cox multivariate regression analysis of the surveyed population showed that coronary heart disease, diabetes mellitus type II, and previous percutaneous coronary intervention were significantly correlated with the primary endpoint. CONCLUSION: Women participating in the MC-AMI programme did not have a worse prognosis regarding major cardiovascular events, compared with men in a 12-month follow-up. Given the benefits of the MC-AMI programme, the proportion of women participating in the programme should be increased.

Managed Care after Acute Myocardial Infarction (KOS-zawal) reduces major adverse cardiovascular events by 45% in 3-month follow-up - single-center results of Poland's National Health Fund program of comprehensive post-myocardial infarction care.

INTRODUCTION: Despite progress in medical and interventional treatment of acute myocardial infarction (AMI) resulting in low in-hospital mortality, the post-discharge prognosis in MI survivors is still unacceptable. The Managed Care in Acute Myocardial Infarction (MC-AMI, KOS-zawal) is a program introduced by Poland's National Health Fund aiming at comprehensive care for patients with AMI to improve prognosis. It includes acute intervention, complex revascularization, cardiac rehabilitation (CR), scheduled outpatient follow-up, and prevention of sudden cardiac death. The aim of the study was to assess the effect of MC-AMI on major adverse cardiovascular events (MACE) in 3-month follow-up. MATERIAL AND METHODS: In this single-center, retrospective observational study we enrolled 1211 patients, and compared them to 1130 subjects in the control group. After 1 : 1 propensity score matching two groups of 529 subjects each were compared. Cox regression was performed to assess the effect of MC-AMI and other variables on MACE. RESULTS: MC-AMI participation is related to reduced MACE rate by 45% in a 3-month observation. Multivariable Cox regression analysis revealed MC-AMI participation to be inversely associated with the occurrence MACE at 3 months (HR = 0.476, 95% CI: 0.283-0.799, p < 0.005). Also, older age, male sex (HR = 2.0), history of unstable angina (HR = 3.15), peripheral artery disease (HR = 2.17), peri-MI atrial fibrillation (HR = 1.87) and diabetes (HR = 1.5) were significantly associated with MACE. CONCLUSIONS: Participation in MC-AMI - the first comprehensive in-hospital and post-discharge care for AMI patients - improves prognosis and is related to a MACE rate reduction by 45% as soon as in 3 months.

Nanopowders of Yttria-Stabilized Zirconia Doped with Rare Earth Elements as Adsorbents of Humic Acids.

The aim of the investigations was to use, for the first time, zirconia nanopowders stabilized with yttria (YSZ) and rare element oxides (YSZ-Nd, YSZ-Gd) for removal of humic acids (HA) from aqueous solutions. Nanopowders were synthesized by means of hydrothermal crystallization and characterized using scanning electron microscope (SEM) with energy dispersive X-ray spectroscopy (EDX), X-ray diffraction (XRD), Fourier transform infrared (FT-IR) methods and analysis of zeta potential. The adsorption processes analysis was carried out in a series of experiments depending on: initial concentration of humic acids, contact time, pH and mass of the used adsorbent. It was found, that the YSZ-Nd exhibits strong and much higher effectiveness of HA adsorption than YSZ and YSZ-Gd. The HA adsorption rate reached 96.8% for YSZ-Nd dosage of 100 mg, pH 4, and 15 min reaction time and for HA initial concentration equal to 25 mg/L. According to the Langmuir model simulation, the maximum adsorption capacity of HA on YSZ-Nd at pH 4 was calculated to be 2.95 mg/g. Changes in the FT-IR spectra of YSZ-Nd confirmed humic acids' adsorption on the tested nanopowders, by the presence of additional bands representing carboxylic, alcohol, carbonyl and amino groups in humic acid structure. These functional groups could represent humic acids binding on the YSZ, YSZ-Nd or YSZ-Gd surfaces.

Managed Care after Acute Myocardial Infarction (MC-AMI) - a Poland's nationwide program of comprehensive post-MI care - improves prognosis in 12-month follow-up. Preliminary experience from a single high-volume center.

BACKGROUND: Despite progress in the treatment of acute myocardial infarction (AMI), long-term prognosis in MI survivors remains a challenge. The Managed Care in Acute Myocardial Infarction (MC-AMI, KOS-zawal) is the first program of a comprehensive, supervised care for patients with AMI to improve long-term prognosis. It includes acute intervention, complex revascularization, cardiac rehabilitation (CR), outpatient follow-up, and prevention of SCD. Our aim was to assess the relation between participation in MC-AMI and major adverse cardiovascular and cerebrovascular events (MACCE) in 12-month follow-up. METHODS AND RESULTS: In this single-center, retrospective analysis we compared 719 patients participating in MC-AMI and compared them to 1130 subjects in the control group. After propensity score matching, two groups of 529 subjects each were compared. MC-AMI was related with MACCE reduction by 40% in a 12-month observation. Participants of MC-AMI had a higher adherence to cardiac rehabilitation (98 vs. 14%), higher rate of scheduled revascularisation (coronary artery bypass grafting: 9.8% vs. 4.9%, p ≪ 0.001; elective percutaneous coronary intervention: 3.0% vs 2.1%, p ≪ 0.05) and ICD implantation (2.8% vs. 0.6%, p ≪ 0.05) compared to control. Multivariable Cox regression analysis revealed MC-AMI to be inversely associated with the occurrence of MACCE (HR = 0.500, 95% Cl 0.349-0.718, p ≪ 0.001). Besides, older age, diabetes mellitus, hyperlipidemia, prior PAD, previous UA, and lower LVEF were significantly associated with the primary endpoint. CONCLUSIONS: MC-AMI is the first program of comprehensive care for AMI patients. MC-AMI improves prognosis by increasing the rate of patients undergoing CR, complete revascularization and ICD implantation, thus reducing MACCE.

Pharmacological Cardioversion With Antazoline in Atrial Fibrillation: The Results of the CANT Study.

Background Antazoline mesylate represents an antihistamine capable of rapid and safe cardioversion of atrial fibrillation, yet evidence concerning its efficacy in comparison to other medications is insufficient. The study aimed to evaluate the success rate and safety of pharmacological cardioversion of atrial fibrillation with intravenous antazoline ( CANT [Cardioversion With Antazoline Mesylate] study) in the setting of the emergency department. Methods and Results After reviewing 1984 medical records, 450 eligible patients (22.7%) with short-duration atrial fibrillation subject to pharmacological cardioversion were enrolled in a retrospective observational analysis. The choice of antiarrhythmic drug was left to the discretion of the attending physician. The primary end point was successful cardioversion in the emergency department. The safety end point comprised bradycardia <45 bpm, hypotension, syncope, or death. The study population (mean age, 65.5±11.9 years; 52.9% females) was characterized by a median atrial fibrillation episode duration of 10 hours. Antazoline, alone or in combination, was administered in 24.2% (n=109) and 40% (n=180), respectively; amiodarone was administered in 46.7% and propafenone in 9.3%, while ≥2 antiarrhythmic drugs were administered in 19.8% of patients. Antazoline had the highest success rate of pharmacological cardioversion among all drugs (85.3%), which was comparable with propafenone (78.6%; relative risk, 1.09, 95% confidence interval, 0.91-1.30; P=0.317) and higher than amiodarone treatment (66.7%; relative risk, 1.28, 95% confidence interval, 1.13-1.45; P<0.001; number needed to treat, 5.4). The rate of cardioversion with antazoline alone was higher than combined amiodarone and/or propafenone (68.1%; relative risk, 1.25; 95% confidence interval, 1.12-1.40, P=0.0001). No safety end points were reported in the antazoline group, while 5 incidents occurred in the non-antazoline cohort ( P=0.075). Conclusions Antazoline represents an efficacious and safe method of pharmacological cardioversion in a real-life setting.

[Mycophenolate mofetil in treatment of childhood nephrotic syndrome--preliminary report]. / Mykofenolan mofetilu w leczeniu dzieci z zespolem nerczycowym--doniesienie wstepne.

The management of nephrotic syndrome (NS) in children remains a clinical challenge for pediatricians and pediatric nephrologists. Especially, the treatment of patients with steroid-resistant (SR) and steroid-dependent (SD) nephrotic syndrome, because they are at risk for developing complications from prolonged exposure to steroids, CsA and alkylating agents. Mycophenolate mofetil (MMF) is a selective and reversible inhibitor of inosine monophosphate dehydrogenase used above all in transplantology and recently also in patients with nephrotic syndrome. The aim of this study was to tentatively assess the usefulness and the safety of MMF as an immunosuppressive agent in children with steroid-resistant NS, in whom remission was not obtained with previous treatment regimens, and those with steroid-dependent NS, in whom severe adverse reactions were observed in steroid and cyclosporine therapy. The study included 19 children with NS (11 girls, 8 boys) aged 7 to 19.5 years (a mean of 13.5), treated at the Deptartment of Pediatric Nephrology. The duration of disease was from 1 to 16 years (a mean of 9.3). The patients were divided into 3 groups: I--9 children with steroid-dependent NS; II--6 children with steroid-dependent NS and episodes of steroid-resistance; III--4 children with steroid-resistant NS. All patients in groups II and III required multi-drug therapy (prednisone, cyclosporine A, methylprednisolone, chlorambucil, cyclophosphamide) before MMF was introduced. MMF was administered orally: 180-600 mg/m2 body surface/dose, twice daily. The follow-up period lasted for 4 to 16 months (a mean of 7.7). The clinical outcome analysis included decrease or disappearance of proteinuria, clinical improvement and/or possibility of tapering therapy intensity, especially the dosage of steroids and/or CsA. Also, renal function was monitored with serum cystatine C concentration. Particular attention was paid to adverse effects of MMF upon the gastro- intestinal tract and/or opportunistic infections. All medication (apart from MMF) could be discontinued in 4 patients; in 15 cases, prednizone dose was reduced and in 9 cases CsA dose was reduced or discontinued. In group I (SD) steroid treatment could be reduced from a mean prednisone dose of 22.8 to 3.6 mg/m2/48 hours (p=0.018), in groups II and III, in spite of 50 % reduction of a mean prednisone dose, the difference did not reach statistical significance. During MMF therapy Csa treatment could be reduced from a mean CsA dose 4.3 to 2.9 mg/kg/24 hours (p=0.008). Improvement or preservation of stable renal function was observed in all patients--cystatin C levels decreased significantly from a mean 1.35 to 0.96 mg/l (p=0.007). Adverse reaction to MMF (abdominal pain) was observed in 2 patients (nausea, vomiting, diarrhoea in 1, CMV infection in 1). The initial clinical observation of MMF treatment in nephrotic patients shows its best effect in the group of patients with steroid-dependent NS. MMF can safely be used in children with NS. The introduction of MMF allows for reduction of other chronically used medications, especially CsA and steroids.

[Doppler ultrasound as the main diagnostic procedure in renovascular hypertension]. / Zastosowanie badan dopplerowskich w diagnostyce nadcisnienia naczyniowo-nerkowego u dzieci.

Renovascular hypertension (RVH) accounts for 5-25% cases of secondary hypertension in children. It is the second most frequent cause of hypertension (second only to aortic coarctation), potentially treatable, provided that early diagnosis is made and no permanent organic lesions develop. No clinical symptoms are observed in more than 60% children with renovascular hypertension; hypertension itself is diagnosed incidentally, in routine checkups. The patient is often hospitalised only after organic complications. The study aim was to verify the value of Doppler examination in the diagnosis of renovascular hypertension in children. In 2001, four out of 18 patients of the Nephrology Department examined due to hypertension were diagnosed with renovascular hypertension. In three of them, examination demonstrated aneurysmatic widening of renal artery with multiple stenoses, renal artery trunk stenosis, significant stenosis in abdominal aorta and in both renal arteries. In another case, stenosis of an additional renal artery was observed. All diagnoses were made with Doppler ultrasound and confirmed by angiography. Colour and spectral Doppler ultrasound examination is a non-invasive and valuable method of diagnosing hypertension in children.