Device associated -health care associated infections monitoring, prevention and cost assessment at intensive care unit of University Hospital in Poland (2015-2017).

BACKGROUND: Device-associated health care-associated infections (DA-HAIs) in intensive care unit (ICU) patients constitute a major therapeutic issue complicating the regular hospitalisation process and having influence on patients' condition, length of hospitalisation, mortality and therapy cost. METHODS: The study involved all patients treated > 48 h at ICU of the Medical University Teaching Hospital (Poland) from 1.01.2015 to 31.12.2017. The study showed the surveillance and prevention of DA-HAIs on International Nosocomial Infection Control Consortium (INICC) Surveillance Online System (ISOS) 3 online platform according to methodology of the INICC multidimensional approach (IMA). RESULTS: During study period 252 HAIs were found in 1353 (549F/804M) patients and 14,700 patient-days of hospitalisation. The crude infections rate and incidence density of DA-HAIs was 18.69% and 17.49 ± 2.56 /1000 patient-days. Incidence density of ventilator-associated pneumonia (VAP), central line-associated bloodstream infection (CLA-BSI) and catheter-associated urinary tract infection (CA-UTI) per 1000 device-days were 12.63 ± 1.49, 1.83 ± 0.65 and 6.5 ± 1.2, respectively. VAP(137) constituted 54.4% of HAIs, whereas CA-UTI(91) 36%, CLA-BSI(24) 9.6%.The most common pathogens in VAP and CA-UTI was multidrug-resistant (MDR) Acinetobacter baumannii (57 and 31%), and methicillin-resistant Staphylococcus epidermidis (MRSE) in CLA-BSI (45%). MDR Gram negative bacteria (GNB) 159 were responsible for 63.09% of HAIs. The length of hospitalisation of patients with a single DA-HAI at ICU was 21(14-33) days, while without infections it was 6.0 (3-11) days; p = 0.0001. The mortality rates in the hospital-acquired infection group and no infection group were 26.1% vs 26.9%; p = 0.838; OR 0.9633;95% CI (0.6733-1.3782). Extra cost of therapy caused by one ICU acquired HAI was US$ 11,475/Euro 10,035. Hand hygiene standards compliance rate was 64.7%, while VAP, CLA-BSI bundles compliance ranges were 96.2-76.8 and 29-100, respectively. CONCLUSIONS: DA-HAIs was diagnosed at nearly 1/5 of patients. They were more frequent than in European Centre Disease Control report (except for CLA-BSI), more frequent than the USA CDC report, yet less frequent than in limited-resource countries (except for CA-UTI). They prolonged the hospitalisation period at ICU and generated substantial additional costs of treatment with no influence on mortality. The Acinetobacter baumannii MDR infections were the most problematic therapeutic issue. DA-HAIs preventive methods compliance rate needs improvement.

Well-differentiated mucinous uterine adenocarcinoma predominantly diagnosed as adenoma malignum: a case report with an immunohistochemical analysis.

Adenoma malignum (AM), also referred to as "minimal deviation adenocarcinoma", is an extremely uncommon variant of highly-differentiated adenocarcinoma of the uterine cervix. The study presented herein describes a case of uterine AM found out after hysteroscopy. An early-stage, well-differentiated mucinous uterine adenocarcinoma was diagnosed post-operatively. A subsequent immunohistochemical assessment of a panel of antibodies was applied, in order to distinguish between female genital tract malignancies.

[Indications for hospitalization of young girls and adolescent girls--clinical work-up in the selected cases]. / Wskazania ginekologiczne do hospitalizacji dziewczynek i mlodych kobiet--postepowanie w wybranych przypadkach klinicznych.

OBJECTIVE: The aim of the study was to analyze the clinical reasons for hospitalization due to gynecological causes of adolescent girls and young women. METHODS: We reviewed clinical data on reasons for hospitalization, treatment methods, and histopathological diagnosis in adolescent girls and young women hospitalized at the Second Department of Gynecology Medical University of Lublin, between January 2003 and December 2012. Methods of conservative or surgical treatment, as well as their clinical effectiveness, have been discussed. RESULTS: Over the analyzed period of time, we identified 334 patients at the age between 8 and 20 years, which accounted for 1.61% of all hospitalized women during that time. Rating these patients by age, we found the following: 1 patient < 9 years old, 2 patients aged 10-11 years, 38 patients aged 12-14 years, 128 patients aged 15-17 years and 165 patients aged 17-19 years old. The main clinical reasons for hospitalization of adolescents and young women due to gynecological causes were: ovarian cysts (138 cases; 41.3%), menstrual disorders (46 cases; 13.7%), pregnancy complications (35 cases; 10.5%), and congenital Müllerian anomalies (33 cases; 9.9%). The remaining patients (24.6%) were admitted due to suspicion of ovarian cyst (22 cases; 6.6%), cervical erosion (15 cases; 4.5%), juvenile metrorrhagia (15 cases; 4.5%), and vulvar diseases (8 cases; 2.4%). CONCLUSIONS: Adolescent girls and young women are rarely admitted to gynecological departments. Nevertheless, they present a clinical challenge. Proper diagnosis using advanced visualization methods, along with modern pharmacotherapy accounts for the final therapeutic success.

Postmenopausal overactive bladder.

Bladder storage symptoms have a severe impact on many areas as regards the quality of life including health-related, social, psychological and working functions. Pharmacotherapy of lower urinary tract stores (LUTS) has been developed to optimize neural control of the lower urinary tract in pathologic states. The bladder can be overactive or underactive. Overactive bladder (OAB) is highly prevalent and is associated with considerable morbidity, especially in aging population. Therefore, an effective treatment of OAB must result in a meaningful reduction in urinary symptoms. Pharmacotherapy for the OAB must be individualized based on the degree of bother, medication side-effect profile, concomitant comorbidities and current medication regimen. Antimuscarinic agents will continue to represent the current gold standard for the first-line pharmacological management of OAB. Alternatively to antimuscarinic therapy, ß3-adrenergic receptor agonists, due to their efficacy and favorable adverse event profile, are a novel and attractive option of pharmacological treatment of overactive bladder symptoms. A combination of selective antimuscarinic and ß3-adrenergic receptor agonists, agents with the different mechanism of action, gives a new treatment option for the patient with OAB according to its harms profile. A number of putative novel therapeutic agents is under clinical evaluations that may ultimately provide alternative or combination treatment options for OAB in the nearest future.

Expression of matricellular proteins in human uterine leiomyomas and normal myometrium.

Growth of human leiomyomas can probably be initiated as a response to injury, in a way similar to the development of keloids. Among many bioactive molecules, which are implicated in tissue repair, a pivotal role is attributed to matricellular proteins. The aim of the current study was to evaluate the immunohistochemical expression of tenascin-C (TNC), thrombospondin-1 (TSP-1), SPARC/osteonectin and tenascin-X (TNX) in human uterine leiomyomas and normal myometrium. Immunostaining was performed on 33 pairs of paraffin-fixed sections and 9 cell-lines derived from uterine leiomyomas and normal myometrium. Fifteen (45.5%) leiomyomas investigated were positive for TNC, whereas all normal myometrial samples were immunonegative (χ²=19.41; p<0.001). Immunostaining for TSP-1 was observed in 20 (60.6%) uterine fibroids and in 12 (36.4%) control samples (χ²=3.88; p<0.05). The expression of SPARC/osteonectin protein was more frequently found in leiomyomas than in normal myometrium, but this difference was not significant. Apart from one fibroid culture and one myometrial culture, all the others revealed strong TNC immunostaining. Expression of TSP-1 and SPARC/osteonectin was weak to moderate in all established cell-lines. None of the tissues or cell lines investigated showed positive staining for TNX. In conclusion, TSP-1 and TNC are likely to play important roles in the pathogenesis of uterine leiomyomas, presumably affecting cell proliferation and/or extracellular matrix deposition.

[The CHOICE study (Contraceptive Health Research Of Informed Choice Experience)--an educational research program for Polish women planning combined hormonal contraceptives use]. / CHOICE (Contraceptive Health Research of Informed Choice Experience)--edukacyjny program badawczy dla kobiet planujacych stosowanie zlozonej antykoncepcji hormonalnej w Polsce.

OBJECTIVES: The aim of the study was to develop an optimal educational model for contraceptive counseling, to analyze conditions influencing choice of hormonal contraception, to study patients' opinions on present, planned and proposed contraceptive methods and to link these data with socioeconomic and demographic conditions. MATERIALS AND METHODS: One thousand eight hundred fifty women (mean age 26.8 +/- 5.9 yrs) willing to use hormonal contraception were presented with essential information on combined hormonal contraception and asked to fill the anonymous questionnaire investigating factors influencing contraceptive choice and patients' opinion on alternative forms of birth regulation. The study was conducted in selected 185 centers in Poland and was a part of a larger survey (CHOICE) conducted on 11 216 women in Europe and Israel. RESULTS: Majority of the studied women were in stable relationship (85,5%), had higher or incomplete higher education (54.8%) and permanent job (54%). The purpose of the visit was to start/change contraception (64.2%), a routine gynecologic check-up (36.7%) or the need for a prescription for the continued contraceptive medication (18.7%). The most commonly used contraceptive methods were oral contraceptive pills (OCP 38.7%) and condom (24.9%). Majority of women highly valued contraceptive counseling and more than 90% were eager to get familiarized with information leaflets. Before the counseling majority of subjects stated that were convinced to use OCP (52.7%; major advantages named: easy to use, favorable bleeding profile, amelioration of menstrual discomfort, comfortable, discrete) and contraceptive patch (22%; major advantages named: applied once a week, comfortable, simple, low risk for noncompliance, favorable bleeding profile). After the counseling there was an increase in proportion of women interested in contraceptive hormonal ring (by 19%; major advantages named: applied once a month, comfortable, very low risk for noncompliance, high efficacy and positive recommendation from a physician). In 58 women no hormonal contraception was recommended, predominantly due to medical contraindications. CONCLUSIONS: Appropriate patient counseling on all forms of combined hormonal contraception, with special attention paid to benefits and safety issues, suited to women's expectations and education is fundamental for the selection of an optimal birth control method.

[Oral combined hormonal contraception containing nomegestrol acetate and 17beta-oestradiol--the statement of Polish Gynecological Society Experts Group]. / Stanowisko Ekspertów Polskiego Towarzystwa Ginekologicznego. Doustna zlozona antykoncepcja hormonalna oparta na octanie nomegestrolu i 17beta-estradiolu.

Nomegestrol acetate (NOMAC) combined with E2 (Zoely) is a monophasic oral contraceptive (OC) which safety and efficacy was confirmed in a number of level I evidence clinical trials. Zoely is highly effective OC, especially in overweight and obese patients, with good cycle control, safe and well tolerated. NOMAC/E2 combination causes no or minimal weight gain and is characterized by minimal influence on bone mineral density or blood pressure and presence of acne. Moreover lipids profile, carbohydrates metabolism, haemostasis and endocrine glands functioning were not affected. High tolerance and acceptance of NOMAC/E2 combination by women, low adverse event profile, fast recovery of ovarian activity and ovulation is a reasonable treatment tool in everyday practice.

Tape fixation: an important surgical step to improve success rate of anti-incontinence surgery.

PURPOSE: Mid urethral slings are effective surgical treatment for stress urinary incontinence. However, 5% to 20% of patients still experience surgical failure with clinically significant recurrent or persistent stress urinary incontinence. Since a subset of these failures may be caused by improper tape position, we elucidated whether additional paraurethral fixation of a tape to prevent displacement during tensioning could improve the transobturator sling outcome. MATERIALS AND METHODS: The study was done in 463 patients with stress urinary incontinence who were randomly allocated to treatment with a standard transobturator intravaginal monofilament sling procedure (232) or to an intravaginal transobturator monofilament sling with additional 2-point tape fixation (231). Another 2 absorbable sutures parallel to the urethra were added to fix the tape and prevent displacement during tape tensioning. Outcome was assessed by a cough test and a 1-hour pad test at 12 months. RESULTS: Clinical efficacy of the procedure with fixation was significantly higher with 195 women (95.12%) cured or improved compared to the 199 (88.73%) cured or improved with the standard sling (chi-square 5.71, p = 0.0169). There was no increase in intraoperative or postoperative complications. Also, among patients with intrinsic sphincter deficiency we noted a significantly better outcome in the fixation group than in the control group, that is 39 of 41 patients (95.1%) cured or improved vs 31 of 42 (73.8%) (chi-square 10.65, p = 0.0011). CONCLUSIONS: Tape fixation significantly increases the clinical efficacy of the transobturator sling, especially in patients with intrinsic sphincter deficiency.

[Collagen type III biosynthesis by cultured pubocervical fascia fibroblasts surrounding mono and multifilament polypropylene mesh after estrogens and tamoxifen treatment]. / Wplyw estrogenów i tamoksifenu na biosynteze kolagenu typu III przez fibroblasty powiezi lonowo-cewkowej w hodowlach prowadzonych na mono i multifilamentowych siatkach polipropylenowych.

AIM: Surgical procedures using synthetic implants are currently considered as the most efficient therapy for stress urinary incontinence (SUI) and pelvic organ prolapse (POP). Insertion of the tape or mesh causes enhanced collagen synthesis that largely affects the biomechanical property of the implant. This process is significantly modulated by estrogens and improper wound healing and treatment failure may result in hypoestrogenism. The aim of the study was to assess the rate of collagen type II synthesis by pubocervical fascia fibroblasts cultured with polypropylene meshes in the presence of estrogens and tamoxifen. MATERIAL AND METHODS: Fibroblasts were obtained from pubo-cervical fascia sampled from a 52-year-old premenopausal woman who underwent surgical treatment for SUI and cultured with monofilament or multifilament polypropylene meshes in the presence of 17B-estradiol, estriol, daidzein or tamoxifen. The cultures were run for 216 hr and the media were replaced every 72hr N-terminal propeptide of type III procollagen (PIIINP) was used as a marker of collagen type III synthesis. Its concentration in the media was measured by radioimmunoassay Pubocervical fascia fibroblast cultured with monofilament or multifilament meshes are capable of collagen type III synthesis. Following treatment with estradiol or tamoxifen, the highest PIIINP concentrations were observed after 72 hr whereas in case of estriol, daidzein or no treatment after 144hr of culture, regardless of the type of mesh used. RESULTS: Only in cultures containing monofilament mesh and stimulated with estriol the high rate of collagen type III synthesis persisted until the end of the experiment. Paradoxically the highest total production of PIIINP was observed in culture treated with tamoxifen, both for multifilament and monofilament meshes. CONCLUSION: The rate of collagen type III synthesis by pubocervical fascia fibroblast cultured with polypropylene meshes is subjected to modulation by estrogens and antiestrogens.

[The quality of life of patients with overactive bladder after local injections of botulinum toxin A--a preliminary report]. / Jakosc zycia pacjentek z pecherzem nadreaktywnym po zastosowaniu toksyny botulinowej--doniesienie wstepne.

OBJECTIVES: The purpose of this work was to evaluate the quality of life of patients suffering from urge urinary incontinence resistant to anticholinergic therapy treated with intradetrusical injections of 200 U botulinum toxin A. MATERIALS AND METHODS: The study group consisted of 10 female patients who were diagnosed with urge urinary incontinence. Standard King's questionnaire was used for the assessment of the change in the quality of life after treatment. Questionnaires were filled in by all patients before the treatment and during control visits, 3 months after the injection of botulinum toxin A. RESULTS: Statistically significant improvement in the quality of life for the majority of the domains of King's questionnaire (except the evaluation of urinary incontinence impact on the general health condition and social relations) was observed in 7 out of 10 patients subjected to botulinum toxin therapy (p < 0.05). CONCLUSIONS: Based on the results of this study we can conclude that treatment of patients with urge urinary incontinence not responding to classical anticholinergic treatment with botulinum toxin causes a significant improvement in the quality of their life.

[The statement of Polish Gynecological Society experts on oral use of contraceptive 75 microg desogestrel minipill in different clinical cases--state of art in 2008]. / Stanowisko Zespolu Ekspertów Polskiego Towarzystwa Ginekologicznego dotyczace zastosowania antykoncepcyjnej minitabletki gestagennej zawierajacej 75 microg dezogestrelu w wybranych sytuacjach klinicznych--stan wiedzy na 2008 rok.

Recent epidemiologic studies indicate that use of combined oral contraception is associated with a increase in the incidence of cardiovascular disease (venous thromboembolism, pulmonary embolism, myocardial infarction and stroke). The risk of cardiovascular disease is strongly related to estrogen dose, progestogen type and other factors for example thrombogenic mutations and cigarette smoking among female over age 35. The progestogen only contraception is safe alternative to combined hormonal contraception. Progestogen only pill (POP) has different levels of action (local and/or central) which may vary from one drug to another. As for the cardiovascular disease risk, progestogens are not considered to be risk factors. Desogestrel containing POP is advised in the following cases: bad tolerance of exogenous oestrogens; in order to counteract an endogenous hyperoestrogenosis; medical, metabolic or cardiovascular contraindications to estroprogestogen contraception. Lastly, POP should be used as a prime contraception in some particular situations (breast feeding, endometriosis, adenomyosis, cigarette smoking, contraception for older women). These recommendations present the actual system of care in that population of women in Poland.

[NuvaRing-combined contraceptive vaginal ring: state of art in 2008. Expert Board of Polish Gynecological Society]. / Stanawisko zespolu ekspertów Polskiego Towarzystwa Ginekologicznego. Dopochwowy hormonalny system antykoncepcyjny (NuvaRing)-stan wiedzy na 2008 rok.

The development of steroid-releasing vaginal rings over the past three decades is reviewed to illustrate the role of this device as an effective hormonal contraceptive for women. NuvaRing is a combined contraceptive vaginal ring that releases constant low doses of ethinylestradiol and etonogestrel. The soft flexible combined ring is inserted in the vagina for three weeks and removed for seven days to allow withdrawal bleeding with no serious side-effects. Maximum levels of EE and ENG with NuvaRing were 30% and 40%, respectively, of those seen with the COC. Because ENG bioavailability was higher following vaginal administration, the systemic progestogen exposures were comparable with the oral contraceptives. NuvaRing has been shown to be safe and effective, with high levels of user compliance, acceptance and patient satisfaction.

[Treatment of acute and recurrent vulvovaginal candidiasis (VVC/rVVC)--state of art in 2008. Expert Board of Polish Gynecological Society]. / Stanowisko zespolu ekspertów Polskiego Towarzystwa Ginekologicznego w sprawie leczenia ostrego i nawrotwege grzybiczego zapalenia pochwy i sromu--stan wiedzy na 2008 rok.

Vulvovaginal infection is the most common cause of gynecological problems in sexually active women. Few years ago it was not considered as serious disease which may cause major health implications. Currently we are aware that it implies life worsening, temporal indisposition, postoperative complications and even life threatening sepsis in patients hospitalized in Intensive Care Units. Knowledge about pharmacological properties of drugs used in treatment vulvovaginal candidiasis allows for tailoring therapy to each patient. Fluconazole is modern and up to date option for treatment of VVC/rVVC. Short- and long-term therapeutic efficacy of fluconazole was confirmed in numerous high reliability clinical trials. Good tolerance, wide range of single therapeutic dose and high level of patient's acceptance gives the specialist powerful and efficient tool for management of VVC/rVVC.

Changing trends in the surgical treatment of female stress urinary incontinence--twenty two years observation.

OBJECTIVES: The aim of this study was to analyze the changing trends in surgical treatment of female urinary incontinence (UI). MATERIAL AND METHODS: Medical records of all women admitted to II Department of Gynecology from 1985 to 2006 were analyzed in order to find out how the female SUI treatment changed over these years. RESULTS: During analyzed time 36819 patients were hospitalized in our Department and 77.6% (28568) of them were operated because of various indications. The number of SUI surgeries among all hospitalized women steadily rose from 1.93% in 1985 to 10.96% in 2006 reaching maximum in 2005 (13.73%). Clinical effectiveness of SUI surgeries markedly improved from 35% for anterior colporrhaphy to almost 90 % for suburethral slings. CONCLUSIONS: Introduction into clinical practice modern suburethral slings improved clinical efficacy of SUI treatment. The percentage of women admitted and treated surgically because of SUI steadily increased over the last years.

[The prospective comparison of the clinical effectiveness and the complication rate of retropubic (IVS-02) and transobturator (IVS-04) midurethral slings in the treatment of female stress urinary incontinence]. / Prospektywne badanie porównujace efektywnosc kliniczna i czestosc wystepowania powiklan sród- i poopera- cyjnych slingu zalonowego (IVS-02) i slingu przezzaslonowego (IVS-04) zastosowanych w leczeniu wysilkowego nietrzymania moczu u kobiet.

UNLABELLED: The prospective comparison of the clinical effectiveness and the complication rate of retropubic (IVS-02) and transobturator (IVS-04) midurethral slings in the treatment of female stress urinary incontinence. OBJECTIVES: The purpose of this study was the prospective comparison of clinical efficacy and safety of retropubic (IVS-02) and transobturator suburethral tape techniques (IVS-04) in the treatment of female stress urinary incontinence. MATERIAL AND METHODS: From January 2003 to June 2004, 145 patients with uro-dynamically proven stress urinary incontinence underwent surgical treatment (IVS-02 or IVS-04). During pretreatment work-up, all patients had under-gone full clinical and urodynamic evaluation. Patients with mixed, urge incontinence and the advanced urogenital prolapse (POPQ scale > 2) were excluded from the study. RESULTS: Patients clinical characteristics and urodynamic parameters were comparable between the analyzed groups. At one year follow-up, 122 patients (61 in each group) were evaluated in terms of clinical efficacy of the procedure. The total cure (78.7% in IVS-02 vs 70.5% in IVS-04), the improvement (14.7% vs 21.3%) and the failure rates (6.6% vs 8.2%) were similar in both analyzed groups, chi2 = 0.58; (p = 0.75). CONCLUSIONS: The transobturator route for the treatment of stress urinary incontinence appears to be as effective as the retropubic one at one year follow-up. Moreover, the shorter operation time and no need to perform cystoscopy during the surgery make the transoburator route a very attractive alternative to retropubic approach.

Collagen deposition around polypropylene tapes implanted in the rectus fascia of female rats.

OBJECTIVE: Implantation of the mesh induces a foreign-body reaction followed by the development of connective tissue that may alter tape property. The aim of our study was to evaluate the deposition of collagen in the vicinity of monofilament tension-free vaginal tape (TVT; Ethicon Inc., Johnson & Johnson) and multifilament intravaginal slingplasty (IVS; Tyco Healthcare) polypropylene tapes implanted in female rats. METHODS: The samples of the meshes (10 mg each) were implanted in the rectus fascia of 14 Wistar female rats and removed after 42 days. Collagen was extracted with 0.5 M acetic acid and subsequently with pepsin (1 mg/ml in 0.5 M acetic acid). Collagen concentration was measured using Sircol Collagen Assay (Biocolor Ltd.) and normalised for milligrams of tape weight. For histological examination, tape samples were stained with haematoxylin and eosin or with silver for type III collagen. RESULTS: The total amount of collagen extracted did not differ significantly between TVT and IVS samples. For both tapes, extraction with acetic acid yielded a higher amount of collagen (about 70%) than extraction with pepsin. On histological examination, less densely packed bundles of collagen fibres and a slightly more intense inflammatory reaction were observed with TVT compared with IVS mesh. CONCLUSION: The total amount of collagen deposited around the polypropylene mesh implanted in female rats was similar for TVT and IVS meshes, but differences were noted in the arrangement of the collagen fibres and the intensity of the inflammatory reaction.

Clinicoprognostic significance of pRb1 pathway alterations in uterine endometrial adenocarcinoma.

Components of the pRb1 pathway play a pivotal role in regulating the G1/S transition in the cell cycle. This study investigated the association between pRb1-cyclin D1-cdk4-p16INK4A pathway alterations and the clinical and prognostic utility for women affected by primary uterine endometrial adenocarcinoma (EC). The study population consisted of 50 cases of EC patients who were investigated for RB1 and CDKN2A (alias p16INK4A) gene alterations, as well as for the expression pattern of pathway proteins. Altogether, pRb1 pathway alterations were noted in 54% (27 of 50) of ECs, and more frequently in advanced-stage uterine carcinomas (P=0.024, Fisher exact test). Loss of heterozygosity abnormalities in RB1 and CKDN2A coexisted with altered cyclin D1-cdk4 complex immunoreactivity only in 2 patients, both less than 50 years of age. With respect to pRb1 pathway alterations, however, the recurrence rate was not significantly different (P=0.477; log-rank test). Our results suggest that the progression of uterine endometrial adenocarcinoma is generally accompanied by increased frequency of pRb1 pathway alterations. Alterations of the retinoblastoma pathway may not be necessarily associated with the recurrence of EC.