Liver Oxidative Status, Serum Lipids Levels after Bariatric Surgery and High-Fat, High-Sugar Diet in Animal Model of Induced Obesity.

Nutritional status is a major determinant of hepatocyte injuries associated with changed metabolism and oxidative stress. This study aimed to determine the relations between oxidative stress, bariatric surgery, and a high-fat/high-sugar (HFS) diet in a diet-induced obesity rat model. Male rats were maintained on a control diet (CD) or high-fat/high-sugar diet (HFS) inducing obesity. After 8 weeks, the animals underwent SHAM (n = 14) or DJOS (n = 14) surgery and the diet was either changed or unchanged. Eight weeks after the surgeries, the activity of superoxide dismutase isoforms (total SOD, MnSOD, and CuZnSOD), catalase (CAT), glutathione peroxidase (GPx), glutathione reductase (GR), and lutathione S-transferase, as well as the thiol groups (-SH) concentration, total antioxidant capacity (TAC), total oxidative stress (TOS) levels, and malondialdehyde (MDA) concentration liver tissue were assessed. The total cholesterol, triglycerides (TG), and high-density lipoprotein (HDL) concentrations were measured in the serum. The total SOD and GPX activities were higher in the SHAM-operated rats than in the DJOS-operated rats. The MnSOD activity was higher in the HFS/HFS than the CD/CD groups. Higher CuZnSOD, GST, GR activities, -SH, and MDA concentrations in the liver, and the triglyceride and cholesterol concentrations in the serum were observed in the SHAM-operated rats than in the DJOS-operated rats. The CAT activity was significantly higher in the HFS-fed rats. Lower TAC and higher TOS values were observed in the SHAM-operated rats. Unhealthy habits after bariatric surgery may be responsible for treatment failure and establishing an obesity condition with increased oxidative stress.

Reversed urban-rural gradient in COVID-19 seroprevalence and related factors in a nationally representative survey, Poland, 29 March to 14 May 2021.

BackgroundWe anticipated that people in rural areas and small towns with lower population density, lower connectivity and jobs less dependent on social interaction will be less exposed to COVID-19. Still, other variables correlated with socioeconomic inequalities may have a greater impact on transmission.AimWe investigated how COVID-19 affected rural and urban communities in Poland, focussing on the most exposed groups and disparities in SARS-CoV-2 transmission.MethodsA random digit dial sample of Polish adults stratified by region and age was drawn from 29 March to 14 May 2021. Serum samples were tested for anti-S1 and anti-N IgG antibodies, and positive results in both assays were considered indicative of past infection. Seroprevalence estimates were weighted to account for non-response. Adjusted odds ratios (AORs) were calculated using multivariable logistic regression.ResultsThere was serological evidence of infection in 32.2% (95% CI: 30.2-34.4) of adults in rural areas/small towns (< 50,000 population) and 26.6% (95% CI: 24.9-28.3) in larger cities. Regional SARS-CoV-2 seroprevalence ranged from 23.4% (95% CI: 18.3-29.5) to 41.0% (95% CI: 33.5-49.0) and was moderately positively correlated (R = 0.588; p = 0.017; n = 16) with the proportion of respondents living in rural areas or small cities. Upon multivariable adjustment, both men (AOR = 1.60; 95% CI: 1.09-2.35) and women (AOR = 2.26; 95% CI: 1.58-3.21) from these areas were more likely to be seropositive than residents of larger cities.ConclusionsWe found an inverse urban-rural gradient of SARS-CoV-2 infections during early stages of the COVID-19 pandemic in Poland and suggest that vulnerabilities of populations living in rural areas need to be addressed.

Corrigendum to "Utilisation Trend of Long-Acting Insulin Analogues including Biosimilars across Europe: Findings and Implications".

[This corrects the article DOI: 10.1155/2021/9996193.].

Rapid antiretroviral treatment start seems as vital and cost-effective strategy in Central and Eastern Europe.

BACKGROUND: It is essential to deliver specialist human immunodeficiency virus (HIV) care with maximum effectiveness, but also minimum time delay. Therefore, we aimed to determine whether rapid linkage to care defined as starting combined antiretroviral therapy (cART) on the day of the first visit at the HIV clinic is a costeffective approach. METHODS: In the analysis, Markov's lifetime model presented in our previous study was implemented. The inputs used in the model were updated in the terms of costs, life expectancy, and patient characteristics. For the analysis we used information from the previous model about the additional costs of treatment and qualityadjusted life years (QALYs) lost in the life horizon for people newly infected with HIV. The number of newly infected persons was estimated based on available data. RESULTS: Input data was available for 344 men having sex with men (MSM) who registered in the HIV specialist care between 2016 and 2017. The estimated QALY loss due to lack of rapid treatment initiation, where the viral load is not (was) taken into account, equals 0·018 (0·022), 0·039 (0·047), 0·131 (0·158) respectively in low, medium and high risk transmission groups. Rapid cART initiation was dominant regardless of the chosen scenarios. CONCLUSIONS: Cost-effectiveness analysis considering the HIV transmission indicates that the rapid initiation of HIV treatment is a cost-effective and potentially cost-saving approach to improve HIV care and reduce HIV transmission in Central and Eastern Europe.

Utilisation Trend of Long-Acting Insulin Analogues including Biosimilars across Europe: Findings and Implications.

BACKGROUND: Diabetes mellitus rates and associated costs continue to rise across Europe enhancing health authority focus on its management. The risk of complications is enhanced by poor glycaemic control, with long-acting insulin analogues developed to reduce hypoglycaemia and improve patient convenience. There are concerns though with their considerably higher costs, but moderated by reductions in complications and associated costs. Biosimilars can help further reduce costs. However, to date, price reductions for biosimilar insulin glargine appear limited. In addition, the originator company has switched promotional efforts to more concentrated patented formulations to reduce the impact of biosimilars. There are also concerns with different devices between the manufacturers. As a result, there is a need to assess current utilisation rates for insulins, especially long-acting insulin analogues and biosimilars, and the rationale for patterns seen, among multiple European countries to provide future direction. Methodology. Health authority databases are examined to assess utilisation and expenditure patterns for insulins, including biosimilar insulin glargine. Explanations for patterns seen were provided by senior-level personnel. RESULTS: Typically increasing use of long-acting insulin analogues across Europe including both Western and Central and Eastern European countries reflects perceived patient benefits despite higher prices. However, activities by the originator company to switch patients to more concentrated insulin glargine coupled with lowering prices towards biosimilars have limited biosimilar uptake, with biosimilars not currently launched in a minority of European countries. A number of activities were identified to address this. Enhancing the attractiveness of the biosimilar insulin market is essential to encourage other biosimilar manufacturers to enter the market as more long-acting insulin analogues lose their patents to benefit all key stakeholder groups. CONCLUSIONS: There are concerns with the availability and use of insulin glargine biosimilars among European countries despite lower costs. This can be addressed.

Sensitivity and specificity of different imaging modalities in diagnosing necrotising enterocolitis in a Polish population of preterm infants: a diagnostic test accuracy study protocol.

INTRODUCTION: Necrotising enterocolitis (NEC) is one of the most serious conditions in newborn infants, affecting up to 10% of very low birth weight (VLBW) infants. Mortality rates can rise as high as 60%.The suspected diagnosis is confirmed with typical findings on abdominal radiography (AR) such as pneumatosis intestinalis (PI), portal vein gas (PVG) and in extreme cases pneumoperitoneum. Abdominal ultrasound (AUS) can depict PI, PVG and pnuemoperitoneum (in some cases ahead of AR), but it also provides other crucial information such as bowel wall viability (thickness or thinning) and free abdominal fluid. These additional findings are helpful in diagnosing and managing NEC. METHODS AND ANALYSIS: The hypothesis being tested is that preforming an AR in patients with clinical symptoms of NEC, but inconclusive/normal AR will enhance detection rates, and expedite treatment in infants born at <32 weeks. Additionally, the time needed to initiate treatment, according to decision made based on AR or AR and AUS will also be compared. The use of AUS together with AR as an add-on test may increase the accuracy of diagnosing NEC and expedite life-saving treatment. We plan to recruit 200 VLBW infants, who are most prone to NEC. It will also be the first multicentre study evaluating the use of AUS as an add-on test, enabling us to recruit a significantly higher number of patients compared with published studies. ETHICS AND DISSEMINATION: The Bioethical Committee of the Medical University of Warsaw has approved the study (KB 130/2017). We plan to submit our findings to international peer-reviewed journals. Abstract will be submitted to local and international conferences. TRIAL REGISTRATION NUMBER: NCT03188380; Protocol version: V.2.08.2019; Pre-results.

International consensus is needed on premedication for non-emergency neonatal intubation after survey found wide-ranging policies and practices in 70 countries.

AIM: This study evaluated whether practitioners from 70 countries used premedication for non-emergency neonatal intubation and identified attitudes and experience regarding the safety, side effects and efficiency of neonatal intubation. METHODS: Invitations to take part in the survey were issued between December 18, 2018 and February 4, 2019 to the users of neonatal-based websites and Facebook groups, members of professional societies and the authors of relevant publications in the last five years. RESULTS: We analysed 718 completed questionnaires from 40 European and 30 non-European countries. Most of the responses were from neonatologists (69.6%) and paediatric or neonatal trainees (10.3%). In units without a protocol (31.6%), more than half of the practitioners (60.4%) chose premedication according to personal preference and 37.0%-11.9% of the overall respondents did not use any drugs for non-emergency intubation. The most frequently reported drug combination was fentanyl, atropine and succinylcholine (6.8%). Most of the practitioners (78.5%) use the same drugs for term and preterm infants. Only 24.8% of the physicians were fully satisfied with their premedication practices. CONCLUSION: Nearly 12% of the respondents did not use premedication for non-emergency neonatal intubation. The wide-ranging policies and practices found among the respondents highlight the need for international consensus guidelines.

Modelling the cost-effectiveness of HIV care shows a clear benefit when transmission risk is considered in the calculations - A message for Central and Eastern Europe.

BACKGROUND: HIV epidemic remains a major global health issue. Data from cost-effectiveness analyses base on CD4+ count and morbidity in patients with symptomatic and asymptomatic HIV infection. The approach adopted in these analyses includes many other factors, previously not investigated. Additionally, we evaluate the impact of sexual HIV transmission due to delayed cART on the cost-effectiveness of care. METHODS: A lifetime Markov model (1-month cycle) was developed to estimate the cost per quality adjusted life years (QALY) for a 1- and 3-year delay in starting cART (as compared to starting immediately at linkage to care) lifetime costs, clinical outcomes and cost-effectiveness. Patients were categorized into having asymptomatic HIV, AIDS, Hodgkin's Lymphoma, and non-AIDS defining condition. Mortality rates and utility values were obtained from published literature. The number of new infected persons was estimated on the basis of sexual orientation, the number of sexual partners per year, the number of sex acts per month, frequency of condom use and use of cART. For the input Test and Keep in Care (TAK) project cohort data were used. Costs of care, cART and potential life-years lost were based on estimated total costs and the difference in expected QALY gained between an HIV-positive and an average person in Polish population. Costs were based on real expenditures of the Ministry of Health, National Health Fund, available studies and experts' opinion. Costs and effects were discounted at rates of 5% and 3.5%, respectively. RESULTS: Input data were available for 141 patients form TAK cohort. The estimated number of new HIV infections in low, medium and high risk transmission groups were 0.28, 0.61, 2.07 with 1 and 0.82, 1.80, 6.11 with a 3-year delay, respectively. This reflected QALY loss due to cART delay of 0.52, 1.13, 3.84 and 2.02, 4.43, 15.03 for a 1- and 3-year delay, respectively. If additional costs of treatment and potential life-years lost due to new HIV infections were not taken into account, initiating cART immediately at linkage to care was not cost-saving irrespective of cART delay. Otherwise, when additional costs and QALY lost due to new HIV infections were included, immediate cART initiation was cost-saving regardless of the chosen scenarios. CONCLUSIONS: If new HIV infections are not taken into account, then starting cART immediately does not dominate comparing to delaying cART. When taking into account HIV transmission in cost-effectiveness analysis, immediate initiation of HIV treatment is a profitable decision from the public payer's perspective.

Cost-effectiveness analysis of treatment of osteoporotic fractures in relation to FRAX algorithm in a sample of Polish population.

BACKGROUND: The increasing incidence of osteoporotic fractures is becoming a growing burden on the health service. Due to the high cost of treatment, these fractures require a broader look at the underlying problem. The aim of the study was to assess the 10-year probability of hip fracture or any other major osteoporotic fracture at which the treatment becomes cost-effective. MATERIAL AND METHODS: This was a retrospective study of a group of 1,024 patients. The cost-effectiveness of pharmacological low-energy fracture prevention was analyzed by means of the medication defined as the reimbursement limit basis in the reimbursement limit group 147.0. (medications used in bone diseases) in July 2013 (Alendrogen 70 mg). 3- and 5-year therapies were analysed. The outcome was compared with the results of FRAX® (of the Polish and British population) in every patient. RESULTS: The model for calculating cost-effectiveness showed that treatment after the age of 50 until the age of 60-65 years is cost-effective at a similar level of 10-year major fracture probability (regardless of treatment duration). After the age of 65, there is a clear decline in the profitability of the therapy. The results indicate that, for the population of women aged >50 years, the treatment is cost-effective when the 10-year major fracture probability equals 5.1% and 6% for a 3- and 5-year therapy, respectively. CONCLUSIONS: 1. The study showed pharmacological treatment to be cost-effective in a large group of patients forming the study population. 2. The analysis also revealed a strong correlation between study results and the specific tool employed to define fracture probability.