Sex-specific relationships of inflammatory biomarkers with blood pressure in older adults.

Emerging evidence indicates an association between blood pressure and inflammation, yet this relationship remains unclear in older adults, despite the elevated prevalence of hypertension. We investigated the association between blood pressure, high sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6), and white blood cell (WBC) count in a cohort of 3571 older adults aged 65 and above, and 587 middle-aged participants (55-59 years old). In women aged 65 and above, the relationship between inflammatory markers and blood pressure was consistent, with hs-CRP and WBC emerging as predictors of high blood pressure. For hs-CRP, the adjusted odds ratio (OR) was 1.5 (95% CI, 1.07 to 2.10, P = 0.02), and for WBC, the adjusted OR was 1.41 (95% CI, 1.02 to 1.94, P = 0.04), comparing the highest to the lowest quartiles. In men, only the WBC count was significantly associated with an increased OR for high BP (adjusted OR 1.49, 95% CI, 1.09 to 2.02, P = 0.01) across quartiles. Across the entire study population, in a fully adjusted model, all inflammatory markers were modestly associated with blood pressure levels, while the effect of being over 65 years was the most significant predictor of high blood pressure (OR 1.84, 95% CI, 1.50 to 2.25, P < 0.001). The link between key inflammation markers and blood pressure in older adults varies by sex and biomarker type and may differ from the relationship observed in younger individuals. These relationships are likely to be affected by factors linked to age.

Predicting acute kidney injury onset with a random forest algorithm using electronic medical records of COVID-19 patients: the CRACoV-AKI model.

INTRODUCTION: Acute kidney injury (AKI) is a serious and common complication of SARS­CoV­2 infection. Most risk assessment tools for AKI have been developed in the intensive care unit or in elderly populations. As the COVID­19 pandemic is transitioning into an endemic phase, there is an unmet need for prognostic scores tailored to the population of patients hospitalized for this disease. OBJECTIVES: We aimed to develop a robust predictive model for the occurrence of AKI in hospitalized patients with COVID­19. PATIENTS AND METHODS: Electronic medical records of all adult inpatients admitted between March 2020 and January 2022 were extracted from the database of a large, tertiary care center with a reference status in Lesser Poland. We screened 5806 patients with SARS­CoV­2 infection confirmed with a polymerase chain reaction test. After excluding individuals with lacking data on serum creatinine levels and those with a mild disease course (<7 days of inpatient care), a total of 4630 records were considered. Data were randomly split into training (n = 3462) and test (n = 1168) sets. A random forest model was tuned with feature engineering based on expert advice and metrics evaluated in nested cross­validation to reduce bias. RESULTS: Nested cross­validation yielded an area under the curve ranging between 0.793 and 0.807, and an average performance of 0.798. Model explanation techniques from a global perspective suggested that a need for respiratory support, chronic kidney disease, and procalcitonin concentration were among the most important variables in permutation tests. CONCLUSIONS: The CRACoV­AKI model enables AKI risk stratification among hospitalized patients with COVID­19. Machine learning-based tools may thus offer additional decision­making support for specialist providers.

Angiotensin-converting enzyme inhibitors and angiotensin-II-receptor antagonists modulate sodium handling based on endogenous lithium clearance.

BACKGROUND: Numerous studies based on assessment of lithium clearance demonstrated higher sodium reabsorption in renal proximal tubules in individuals with hypertension, overweight, obesity, metabolic syndrome, or diabetes. AIMS: We aimed to assess the influence of angiotensin-converting enzyme inhibitors (ACE-I) or angiotensin-II-receptor antagonists (ARB) treatment on sodium handling. METHODS: In a sample of 351Caucasian subjects without diuretic treatment with prevailing sodium consumption, we studied associations between renal sodium reabsorption in proximal (FPRNa) and distal (FDRNa) tubules assessed by endogenous lithium clearance and daily sodium intake measured by 24-hour excretion of sodium (UNaV), in the context of obesity and long-term treatment with ACE-I or ARB. RESULTS: In the entire study population, we found a strong negative association between FPRNa and ACE-I/ARB treatment (b = -19.5; SE = 4.9; P <0.001). Subjects with FPRNa above the median value showed a significant adverse association between FPRNa and age (b = -0.06; SE = 0.02; P = 0.003), with no association with ACE-I/ARB treatment (P = 0.68). In contrast, in subjects with FPRNa below the median value, we found a strongly significant adverse relationship between FPRNa and ACE-I/ARB treatment (b = -30.4; SE = 8.60; P <0.001), with no association with age (P = 0.32). CONCLUSIONS: ACE-I/ARB long-term treatment modulates FPRNa in the group with lower reabsorption, but not in that with higher than median value for the entire study population.

Serial echocardiographic evaluation of COVID-19 patients without prior history of structural heart disease: a 1-year follow-up CRACoV-HHS study.

Background: It is a well-known fact that COVID-19 affects the cardiovascular system by exacerbating heart failure in patients with preexisting conditions. However, there is a poor insight into the cardiovascular involvement and sequelae in patients without preexisting conditions. The aim of the study is to analyse the influence of COVID-19 on cardiac performance in patients without prior history of structural heart disease. The study is part of the CRACoV project, which includes a prospective design and a 12-month follow-up period. Material and methods: The study included 229 patients hospitalised with a diagnosis of COVID-19 (median age of 59 years, 81 were women). A standard clinical assessment and laboratory tests were performed in all participants. An extended echocardiographic image acquisition was performed at baseline and at a 3-, 6-, and 12-month follow-up. All analyses were performed off-line. A series of echocardiographic parameters was compared using repeated measures or Friedman analysis of variance. Results: In all subjects, the left ventricular (LV) ejection fraction at baseline was preserved [63.0%; Q1:Q3 (60.0-66.0)]. Elevated levels of high-sensitivity cardiac troponin T were detected in 21.3% of the patients, and elevated NT-proBNP levels were detected in 55.8%. At the 1-year follow-up, no significant changes were observed in the LV diameter and volume (LV 48.0 ± 5.2 vs. 47.8 ± 4.8 mm, p = 0.08), while a significant improvement of the parameters in the biventricular strain was observed (LV -19.1 ± 3.3% vs. -19.7 ± 2.5%, p = 0.01, and right ventricular -19.9 ± 4.5% vs. -23.2 ± 4.9%, p = 0.002). In addition, a decrease in the LV wall thickness was also observed (interventricular septum 10.4 ± 1.6 vs. 9.7 ± 2.0 mm, p < 0.001; LV posterior wall 9.8 ± 1.4 vs. 9.1 ± 1.5 mm, p < 0.001). Conclusions: In an acute phase of COVID-19, the elevation of cardiac biomarkers in patients with normal left ventricular ejection fraction is a frequent occurrence; however, it does not translate into clinically significant cardiac dysfunction after 1 year. The serial echocardiographic evaluations conducted in patients without preexisting structural heart disease demonstrate an overall trend towards an improved cardiac function and a reduced myocardial thickening at 1-year follow-up. This suggests that the acute cardiac consequences of COVID-19 are associated with systemic inflammation and haemodynamic stress in patients without preexisting conditions.

Neglect and self-rated health among older adults - a cross-sectional study in Poland.

The aim of this cross-sectional study is to examine if neglect is associated with self-rated health (SRH) and if neglect mediates the association between selected factors and self-rated health, among older men and women. The analyses were based on face-to-face computer-assisted personal interviews conducted with 1632 randomly selected community-dwelling individuals aged 65 years and more from among the general population of Lesser Poland. The regression models' analysis revealed that elder neglect was associated with self-rated health, and the mediation analysis demonstrated that neglect mediates the association between frequency of church attendance and SRH, as well as between marital status (being a widower vs being married) and SRH, among men. These observations can be helpful in better under- standing of the broad context of elder neglect in order to develop instruments for an efficient improvement of older adults' health and quality of life. In addition to this, the study underlines the role of social networks and social engagement as factors which might protect against neglect, and thus improve self- rated health of older people.

Effectiveness and Safety of SARS-CoV-2 Vaccination in HIV-Infected Patients-Real-World Study.

The development of COVID-19 vaccines has been a triumph of biomedical research. However, there are still challenges, including assessment of their immunogenicity in high-risk populations, including PLWH. In the present study, we enrolled 121 PLWH aged >18 years, that were vaccinated against COVID-19 in the Polish National Vaccination Program. Patients filled in questionnaires regarding the side effects of vaccination. Epidemiological, clinical, and laboratory data were collected. The efficacy of COVID-19 vaccines was evaluated with an ELISA that detects IgG antibodies using a recombinant S1 viral protein antigen. The interferon-gamma release assay (IGRA) was applied to quantitate interferon-gamma (IFN-γ) to assess cellular immunity to SARS-CoV-2. In total, 87 patients (71.9%) received mRNA vaccines (BNT162b2-76 (59.5%), mRNA-1273- 11 (9.1%)). A total of 34 patients (28.09%) were vaccinated with vector-based vaccines (ChAdOx Vaxzevria- 20 (16.52%), Ad26.COV2.S- 14 (11.6%)). A total of 95 (78.5%) of all vaccinated patients developed a protective level of IgG antibodies. Only eight PLWH (6.6%) did not develop cellular immune response. There were six patients (4.95%) that did not develop a cellular and humoral response. Analysis of variance proved that the best humoral and cellular response related to the administration of the mRNA-1273 vaccine. COVID-19 vaccines were found to be immunogenic and safe in PLWH. Vaccination with mRNA vaccines were related to better humoral and cellular responses.

Artificial intelligence guided HRCT assessment predicts the severity of COVID-19 pneumonia based on clinical parameters.

BACKGROUND: The purpose of the study was to compare the results of AI (artificial intelligence) analysis of the extent of pulmonary lesions on HRCT (high resolution computed tomography) images in COVID-19 pneumonia, with clinical data including laboratory markers of inflammation, to verify whether AI HRCT assessment can predict the clinical severity of COVID-19 pneumonia. METHODS: The analyzed group consisted of 388 patients with COVID-19 pneumonia, with automatically analyzed HRCT parameters of volume: AIV (absolute inflammation), AGV (absolute ground glass), ACV (absolute consolidation), PIV (percentage inflammation), PGV (percentage ground glass), PCV (percentage consolidation). Clinical data included: age, sex, admission parameters: respiratory rate, oxygen saturation, CRP (C-reactive protein), IL6 (interleukin 6), IG - immature granulocytes, WBC (white blood count), neutrophil count, lymphocyte count, serum ferritin, LDH (lactate dehydrogenase), NIH (National Institute of Health) severity score; parameters of clinical course: in-hospital death, transfer to the ICU (intensive care unit), length of hospital stay. RESULTS: The highest correlation coefficients were found for PGV, PIV, with LDH (respectively 0.65, 0.64); PIV, PGV, with oxygen saturation (respectively - 0.53, -0.52); AIV, AGV, with CRP (respectively 0.48, 0.46); AGV, AIV, with ferritin (respectively 0.46, 0.45). Patients with critical pneumonia had significantly lower oxygen saturation, and higher levels of immune-inflammatory biomarkers on admission. The radiological parameters of lung involvement proved to be strong predictors of transfer to the ICU (in particular, PGV ≥ cut-off point 29% with Odds Ratio (OR): 7.53) and in-hospital death (in particular: AIV ≥ cut-off point 831 cm3 with OR: 4.31). CONCLUSIONS: Automatic analysis of HRCT images by AI may be a valuable method for predicting the severity of COVID-19 pneumonia. The radiological parameters of lung involvement correlate with laboratory markers of inflammation, and are strong predictors of transfer to the ICU and in-hospital death from COVID-19. TRIAL REGISTRATION: National Center for Research and Development CRACoV-HHS project, contract number SZPITALE-JEDNOIMIENNE/18/2020.

Sex-related patient-reported brain fog symptoms in non-hospitalised COVID-19 patients.

INTRODUCTION: Previous studies on the prognostic role of sex in post-COVID-associated brain fog have yielded divergent results. Moreover, limited evidence exists regarding the evolution of brain fog symptoms over time, especially in ambulatory patients and separately for women and men. Therefore, the aim of the current study was to assess brain fog symptoms in nonhospitalised patients with COVID-19, according to their sex. MATERIAL AND METHODS: We created a neuropsychological questionnaire including eight questions on the presence of brain fog symptoms in the following four time periods: before COVID-19, and 0-4, 4-12, and > 12 weeks post-infection. The validity and reliability of the questionnaire were assessed. In this cross-sectional study, questionnaires were filled out anonymously and retrospectively once only by patients or through a survey link posted online. Included were patients ≥ 18 years, with > 3 months since the SARS-CoV-2 infection onset confirmed by RT-PCR from a nasopharyngeal swab. RESULTS: The study included 303 patients (79.53% women, 47.52% medical personnel). Median time between COVID-19 onset and questionnaire completion was 208 (IQR 161-248) days. Women, compared to men, reported a higher prevalence of problems with writing, reading, and counting (< 4 weeks, OR 3.05, 95% CI: 1.38-6.72; 4-12 weeks, OR 2.51, 95% CI: 1.02-6.14; > 12 weeks, OR 3.74, 95% CI: 1.12-12.56) and thoughts communication (< 4 weeks, OR 2.53, 95% CI: 1.41-4.54; 4-12 weeks, OR 3.74, 95% CI: 1.93-7.24; > 12 weeks, OR 2.00, 95% CI: 1.01-3.99). The difference between the two sexes in answering questions in an understandable/unambiguous manner was statistically significant between four and 12 weeks after infection (OR 2.63, 95% CI: 1.36-5.10), while a sex difference in recalling new information was found below 12 weeks (OR 2.54, 95% CI: 1.44-4.48 and OR 2.43, 95% CI: 1.37-4.31 for < 4 and 4-12 weeks, respectively). No sex differences in reporting problems with multitasking, remembering information from the past, determining the current date, or field orientation were noted. CONCLUSIONS: Non-hospitalised women and men retrospectively report a different course of COVID-19-associated brain fog.

Factors associated with mortality in hospitalised, non-severe, older COVID-19 patients - the role of sarcopenia and frailty assessment.

BACKGROUND: COVID-19 has affected older persons the most. The propensity to have severe COVID-19 or die of the infection was especially prevalent among older subjects with multimorbidity, frailty and sarcopenia. The aim of our study was to check which of the simple clinical biomarkers, including the assessment of muscle and frailty, would associate with the survival and the length of hospital stay in older patients with COVID-19. An additional aim was to report the influence of chronic diseases, chronic medication use, and COVID-19 signs and symptoms on the aforementioned outcome measures. METHODS: The CRACoV study was a prospective single-center (University Hospital in Krakow, Krakow, Poland) observational study of clinical outcomes in symptomatic COVID-19 patients that required hospital treatment. We analysed data of persons aged ≥ 65 years. We assessed muscular parameters in accordance with EWGSOP2, frailty with the Rockwood Clinical Frailty Scale. We used the data of the initial and 3-month assessment. Demographic characteristics, past medical history, and baseline laboratory values were gathered as a part of routine care. We calculated sex and age, and additionally number-of-diseases adjusted odds ratios of mortality associated with studied factors and betas of the relation with these factors and the length of hospital stay. RESULTS: The mean (standard deviation, SD) age of 163 participants (44.8% women, 14.8% died) was 71.8 (5.6) years, age range 65-89 years. One score greater SARC-F was associated with 34% (p = 0.003) greater risk of death, and 16.8 h longer hospital stay (p = 0.01). One score greater Rockwood was associated with 86% (p = 0.002) greater risk of death, but was unrelated to the length of hospital stay. Hand grip strength and dynapenia were unrelated to mortality, but dynapenia was related to longer hospital stay. Probable sarcopenia was associated with 441% (p = 0.01) greater risk of death. CONCLUSIONS: In conclusion, the patient assessment with SARC-F and the Rockwood Clinical Frailty Scale may significantly improve the prediction of outcomes in older patients with COVID-19 and by extension might be of use in other acute severe infections. This, however, requires further research to confirm.

New insights on the link between body composition, nutritional status and physical performance in elderly outpatients.

OBJECTIVES: The aim of the study was to assess the relationship between body composition, nutritional status and physical ability in elderly outpatients. METHOD: . In this cross-sectional study, demographic data and medical history were collected from patients aged ≥60 years followed in the Geriatric Outpatient Clinic from October 2010 to February 2014. Body composition was examined using a dual-energy X-ray absorptiometry. Physical performance was assessed by gait speed (GS), Timed Up&Go Test (TUG), Six Minute Walk Test (6MWT). The nutritional status was evaluated using the Mini Nutritional Assessment (MNA) and serum albumin level. RESULTS: Mean age (± SD) of 76 patients (64.47% men) was 71.93 ± 8.88 yrs. The most common diseases were: hypertension (89.47%), coronary heart disease (81.58%) and chronic heart failure (68.4%). In multiple regression analyses, the factors significantly affecting GS were: age (B = - 0.017, p ≤0.0001), good nutritional status (B = 0.038, p <0.01) and percent of lower extremity fat (B = - 0.009, p <0.05). Longer TUG time was associated with poorer nutritional status (B = -0.031, p <0.01), older age (B = 0.01, p <0.01) and a higher number of comorbidities (B = 0.034, p <0.05). 6MWT was influenced negatively by age (B = -3.805, p <0.01) and percent of lower extremity fat (B = -2.474, p <0.05). CONCLUSIONS: Age and nutritional status remain a strong determinant of physical fitness deterioration. Different measures of physical performance are influenced by different elements of body composition - no single element of body composition was found determining the deterioration of all assessed parameters of physical fitness. Identifying the relationship between body composition, nutritional status and physical performance can help elucidate the causes of disability and target preventive measures.

Chemerin as a Potential Marker of Resolution of Inflammation in COVID-19 Infection.

Chemerin is one of the specialized pro-resolving mediators that participate in the early phase of inflammation and contribute to the initiation of the pro-resolving response. There is a paucity of data regarding the time course of chemerin during acute infections. We aimed to evaluate the sequence of inflammatory responses in the acute COVID-19 phase throughout onset and resolution of inflammation. We evaluated changes in selected biomarkers in COVID-19 survivors on the 7-day and 28-day follow up. Chemerin was lower in patients with baseline moderate/severe disease at day 7 compared with asymptomatic patients and individuals with mild illness (7265 [5526−9448] vs. 8730 [6888−11,058] pg/mL; p = 0.03). Only in patients with moderate/severe disease, but not in those with mild symptoms, were chemerin concentrations decreased one week after infection onset compared with baseline (7265 [5526−9448] vs. 8866 [6383−10,690] pg/mL; p < 0.05) with a subsequent increase on the 28-day follow up (9313 [7353−11,033] pg/mL; p < 0.05). Resolution of inflammation in the group of moderate/severe SARS-CoV2 infection was associated with increasing serum concentrations of chemerin, contrary to pro-inflammatory cytokines and adipokines (pentraxin 3, TNFα, resistin, leptin). A similar pattern of angiopoietin-2 dynamics may suggest signs of enhanced vascularization as a consequence of acute SARS-CoV2 infection.

Comparison between COVID­19 outcomes in the first 3 waves of the pandemic: a reference hospital report.

INTRODUCTION: The course of consecutive COVID­19 waves was influenced by medical and organizational factors. OBJECTIVES: We aimed to assess the outcomes of patients hospitalized for COVID­19 during the first 3 waves of the pandemic. PATIENTS AND METHODS: We performed a retrospective analysis of medical records of all COVID­19 patients admitted to the University Hospital in Kraków, Poland, a designated COVID­19 hospital in Malopolska province, between March 1, 2020 and May 31, 2021. The waves were defined as 1, 2, and 3, and covered the periods of March 2020 to July 2020, August 2020 to January 2021, and February 2021 to May 2021, respectively. Patients' characteristics and outcomes for waves 1 through 3 were compared. RESULTS: Data analyses included 5191 patients with COVID­19. We found differences in age (mean [SD], 60.2 [17.3] years vs 62.4 [16.8] years vs 61.9 [16.1] years, respectively, for waves 1, 2, and 3; P = 0.003), sex distribution (proportion of women, 51.4% vs 44.2% vs 43.6%; P = 0.003), as well as concentrations of inflammatory markers and oxygen saturation (the lowest and the highest for wave 1, respectively; P <0.001). Hospital death rates in subsequent waves were 10.4%, 19.8%, and 20.3% (P <0.001). Despite similarities in patients' characteristics, the length of hospital and intensive care unit stay was shorter for wave 3 than for wave 2. The risk factors for in­hospital death were: advanced age, male sex, cardiovascular or chronic kidney disease, higher C­reactive protein level, and hospitalization during the second or third wave. CONCLUSIONS: We identified differences in patients' clinical characteristics and outcomes between consecutive pandemic waves, which probably reflect changes in terms of COVID­19 isolation policy, hospitalization and treatment indications, and treatment strategies.

The Seroprevalence of SARS-CoV-2 Antibodies among HealthCare Workers in University Hospital in Krakow before the Era of Vaccination.

BACKGROUND: Knowledge of occupational health is crucial to the safety of healthcare workers in the pandemic period. The aim of our study was the rating of SARS-CoV-2 seroprevalence in connection with selected demographic, social, and organizational factors, as well as the identification of key elements determining the safety of HCWs and patients of the University Hospital in Krakow. METHODS: This was a non-interventional, uncontrolled, open, single-center, cross-sectional online survey on the preparedness for the COVID-19 epidemic and the seroprevalence of medical and non-medical HCWs and students. Serum specimens from 1221 persons were tested using an immunoassay analyzer based on the ECLIA technique for the anti-SARS-CoV-2 antibodies IgM + IgG. RESULTS: The total seroprevalence was 42.7%. In medical students it was 25.2%, while in physicians it was 43.4% and in nurses/midwives it was 48.1%. Of those who tested positive, 21.5% did not know their serological status. The use of personal protective equipment did not have any significant impact on the result of testing for anti-SARS-CoV-2 antibodies. The risk of developing the disease was not influenced by sex, professional work experience, workplace, or intensity of contact with the patient. Among the studied elements, only care of COVID-19 patients significantly increased the risk. The protective factor was starting work between the waves of the epidemic (June-September 2020). CONCLUSIONS: PPE is only one element of infection prevention and control-without other components, such as hand hygiene, it can be dangerous and contribute to self-infection. It is also very important to test healthcare workers. Not being aware of the COVID-19 status of HCWs poses a threat to other staff members, as well as patients and the family and friends of the infected. Thus, extreme caution should be applied when employing respirators with exhalation valves during the COVID-19 pandemic.

Polypharmacy in Polish Older Adult Population-A Cross-Sectional Study: Results of the PolSenior Project.

Polypharmacy is a challenging issue in geriatrics. The aim of the study was to characterize correlates of polypharmacy in the PolSenior project. The PolSenior project, was a comprehensive survey in a large and longitudinal representative sample of thePolish older population. The project was conducted by the International Institute of Molecular and Cell Biology in Warsaw between 2008 and 2011. All medications consumed during the week preceding the survey were evaluated for each participant (n = 4793, including 2314 females (48.3%)). Thereafter, the percentage of those with polypharmacy (at least 5 medications) and excessive polypharmacy (at least 10 medications) was calculated, and their correlates were determined. The average number of medications used by participants was 5.1 ± 3.6, and was higher in females than in males (5.5 ± 3.5 vs. 4.8 ± 3.5; p < 0.001). Polypharmacy characterized 2650 participants (55.3%) and excessive polypharmacy-532 of them (11.1%). The independent correlates associated withpolypharmacy were: age over 70 years, female sex, higher than primary education, living in an urban area, comorbidities, any hospitalization during past five years, and visiting general practicioners at least yearly. As for correlates with excessive polypharmacy, they were: age 80-84 years, female sex, living in an urban area, diagnosis of at least four chronic diseases, and at least two hospitalizations in the last five years. This study serves as a starting place to understand patient characteristics associated with polypharmacy, excessive polypharmacy, and identify targeted interventions.

What factors influence the long-term survival of nursing home residents with severe disabilities?

B a c k g r o u n d / A i m: Factors influencing the survival of the nursing home population have not yet been clearly defined. The aim of the study was to investigate the impact of nutritional, mental, functional, disease and pharmacological factors on the survival of nursing home residents with severe disabilities. Material and Methods: A retrospective cohort study was conducted with a 9-year follow-up period among nursing home residents with a Barthel score ≤40. The initial assessment included the following scales: Mini Nutritional Assessment Short-Form (MNA-SF), Abbreviated Mental Test Score (AMTS), the Barthel Index, and blood pressure (BP) measurements. Comorbidities, medications and all-cause mortality were extracted from medical records. The analyzed cohort was divided into two groups: Deceased - residents who died ≤3 years and Survivors - those who survived >3 years of observation. R e s u l t s: Survivors (n = 40) and Deceased (n = 48) did not differ significantly in terms of age, sex, systolic and diastolic BP, the Barthel Index, number of diseases and medications used. Survivors had significantly higher scores in MNA-SF (p <0.001) and AMTS (p <0.003) than Deceased. Moreover, Survivors had hypertension significantly more often and took aspirin and ACE inhibitors (p <0.05). The multivariable logistic regression analysis showed that the MNA-SF score significantly affected mortality [OR = 0.62, (95%CI, 0.46-0.84), p <0.001]. C o n c l u s i o n: Higher MNA-SF scores were a factor that significantly affected the survival of nursing home residents, while functional status assessed using the Barthel Index had no effect on survival. MNA-SF was found to be a useful tool for assessing the risk of death in a nursing home.

Association of sulfur content in erythrocytes with cardiovascular parameters and blood pressure.

OBJECTIVE: The study aims at assessing the relationship between blood pressure, heart geometry parameters, and the erythrocyte content of sulfur, potassium, chlorine and phosphorus, in a group of patients with ambulatory systolic and diastolic blood pressure (SBP, DBP) below 140 or 90 mm Hg, respectively, who were otherwise healthy and untreated. METHODS: The study group consisted of 42 adults recruited in a primary care setting. The individuals were healthy, not undergoing any therapy and free from smoking. For each individual, data were obtained on: average 24-hour SBP and DBP, left ventricle geometry, complete blood count, lipids profile, fibrinogen, hs-CRP and the erythrocyte concentration of sulfur (S), potassium (K), chlorine (Cl) and phosphorus (P). RESULTS: Multivariate regression analysis showed statistically significant relationships of diastolic posterior wall thickness (PWTd) and relative wall thickness (RWT) with the concentration ratio of sulfur and potassium (S/K) in erythrocytes: PWTd and RWT increase as the S/K ratio increases. Also, SBP was found to be positively correlated with the S/K ratio. CONCLUSIONS: The increase in sulfur content in RBCs could be an indicator of the downregulation of nitric oxide (NO) erythrocyte bioavailability exerted by endogenously produced hydrogen sulfide (H2S), and, in consequence, a marker of the development of hypertension and/or adverse changes in heart geometry.

Is treated hypertension associated with a lower 1-year mortality among older multimorbid residents of long-term care facilities?

INTRODUCTION: Long-term care facility (LTCF) residents are typically excluded from clinical trials due to multimorbidity, dementia, and frailty, so there are no clear evidence-based rules for treating arterial hypertension in this population. Moreover, the role of hypertension as mortality risk factor in LTCFs has not yet been clearly established. OBJECTIVES: The study aimed to investigate whether treated hypertension is associated with lower mortality among older LTCF residents with multimorbidity. PATIENTS AND METHODS: The study was performed in a group of 168 residents aged ≥ 65 years in three LTCFs. Initial assessment included blood pressure (BP) measurements and selected geriatric scales: MNA-SF, AMTS and ADL. Hypertension, comorbidities, pharmacotherapy, antihypertensive drugs and mortality during one-year follow-up were extracted from the medical records. The data was compared in groups: Survivors and Deceased. RESULTS: Survivors and Deceased revealed similar age, DBP, number of diseases, medications, and antihypertensive drugs. However, Deceased had significantly lower SBP (P <0.05) and presented significantly worse functional, nutritional and cognitive status than Survivors (P <0.001). Hypertension (P <0.001) and antihypertensive therapy (P <0.05) were significantly more frequent among Survivors. Significantly more of the hypertensive-treated than other multimorbid residents survived the follow-up (P <0.001). Logistic regression analysis showed that treated hypertension had a protective effect on mortality [OR = 0.11 (95% CI, 0.03-0.39); P <0.001]. CONCLUSIONS: One-year survival of LTCF residents with treated hypertension was significantly higher than the others. Appropriate antihypertensive therapy may be a protective factor against death in frail nursing home residents, even in short period of time.

CRACoV-HHS: an interdisciplinary project for multi-specialist hospital and non-hospital care for patients with SARS-CoV-2 infection as well hospital staff assessment for infection exposure.

The complex course of the COVID-19 and the distant complications of the SARS-CoV-2 infection still remain an unfaded challenge for modern medicine. The care of patients with the symptomatic course of COVID-19 exceeds the competence of a single specialty, often requiring a multispecialist approach. The CRACoV-HHS (CRAcow in CoVid pandemic - Home, Hospital and Staff) project has been developed by a team of scientists and clinicians with the aim of optimizing medical care at hospital and ambulatory settings and treatment of patients with SARS-CoV-2 infection. The CRACoV project integrates 26 basic and clinical research from multiple medical disciplines, involving different populations infected with SARS-CoV-2 virus and exposed to infection. Between January 2021 and April 2022 we plan to recruit subjects among patients diagnosed and treated in the University Hospital in Cracow, the largest public hospital in Poland, i.e. 1) patients admitted to the hospital due to COVID-19 [main module: 'Hospital']; 2) patients with signs of infection who have been confirmed as having SARS-CoV-2 infection and have been referred to home isolation due to their mild course (module: 'Home isolation'); 3) patients with symptoms of infection and high exposure to SARS- CoV-2 who have a negative RT-PCR test result. In addition, survey in various professional groups of hospital employees, both medical and non-medical, and final-fifth year medical students (module: 'Staff') is planned. The project carries both scientific and practical dimension and is expected to develop a multidisciplinary model of care of COVID-19 patients as well as recommendations for the management of particular groups of patients including: asymptomatic patient or with mild symptoms of COVID-19; symptomatic patients requiring hospitalization due to more severe clinical course of disease and organ complications; patient requiring surgery; patient with diabetes; patient requiring psychological support; patient with undesirable consequences of pharmacological treatment.

Assumptions of the European FRAILTOOLS project and description of the recruitment process for this study in Poland.

A i m: The main purpose of this article is to present the main assumptions of the FRAILTOOLS project and the characteristics of the recruitment process in the Polish part of the study. MATERIAL AND METHODS: The FRAILTOOLS project is a prospective observational study conducted in 5 European countries. The study included people aged 75 and older. Each participating center was required to recruit 388 patients, which corresponded to 97 subjects in each clinical setting by center. Recruitment took place in clinical settings (hospital geriatric acute care, geriatric outpatient clinic, primary health care) and in social conditions (nursing homes). The frailty syndrome was assessed among study participants using 7 different scales. The follow-up period was 18 months. RESULTS: In Poland, 268 elderly subjects took part in the study, which constituted 69.1% of planned recruitment. The majority of participants were acute care patients (108 participants). A high percentage of people successfully recruited for the study was seen in nursing homes (83.5% of predicted number). The lowest recruitment came from primary healthcare (53 participants) and geriatric outpatient clinic (26). About a quarter of recruited participants were lost during follow-up period. The poorest results of control visits were observed among patients from geriatric wards and geriatric outpatient clinic. CONCLUSIONS: The recruitment process for older people in Poland was satisfactory, mainly in hospitalized and institutionalized patients. The worst enrollment result was observed among outpatients. A detailed analysis of enrollment problems among the older Polish population is necessary to determine the optimal recruitment strategy and retain eligible study participants.