Descriptive Analysis of Trauma Admission Trends before and during the COVID-19 Pandemic.

INTRODUCTION: Traumatic injuries are a significant global health concern, with profound medical and socioeconomic impacts. This study explores the patterns of trauma-related hospitalizations in the Lublin Province of Poland, with a particular focus on the periods before and during the COVID-19 pandemic. AIM OF THE STUDY: The primary aim of this research was to assess the trends in trauma admissions, the average length of hospital stays, and mortality rates associated with different types of injuries, comparing urban and rural settings over two distinct time periods: 2018-2019 and 2020-2021. METHODS: This descriptive study analyzed trauma admission data from 35 hospitals in the Lublin Province, as recorded in the National General Hospital Morbidity Study (NGHMS). Patients were classified based on the International Classification of Diseases Revision 10 (ICD-10) codes. The data were compared for two periods: an 11-week span during the initial COVID-19 lockdown in 2020 and the equivalent period in 2019. RESULTS: The study found a decrease in overall trauma admissions during the pandemic years (11,394 in 2020-2021 compared to 17,773 in 2018-2019). Notably, the average length of hospitalization increased during the pandemic, especially in rural areas (from 3.5 days in 2018-2019 to 5.5 days in 2020-2021 for head injuries). Male patients predominantly suffered from trauma, with a notable rise in female admissions for abdominal injuries during the pandemic. The maximal hospitalization days were higher in rural areas for head and neck injuries during the pandemic. CONCLUSIONS: The study highlights significant disparities in trauma care between urban and rural areas and between the pre-pandemic and pandemic periods. It underscores the need for healthcare systems to adapt to changing circumstances, particularly in rural settings, and calls for targeted strategies to address the specific challenges faced in trauma care during public health crises.

Evaluating Changes in Trauma Epidemiology during the COVID-19 Lockdown: Insights and Implications for Public Health and Disaster Preparedness.

The COVID-19 pandemic demanded changes in healthcare systems worldwide. The lockdown brought about difficulties in healthcare access. However, trauma still required further attention considering its modifications. The presented study aims to investigate the variances in epidemiological patterns of trauma during the lockdown and the previous year, with a view to better understand the modifications in healthcare provision. The authors analyzed data from the first lockdown in 2020 (12 March-30 May) and the same period in 2019 from 35 hospitals in Lublin Province. A total of 10,806 patients in 2019 and 5212 patients in 2020 were included in the research. The uncovered changes adhered to the total admissions and mortality rate, the frequency of injuries in particular body regions, and injury mechanisms. The lockdown period resulted in a reduction in trauma, requiring an altered approach to healthcare provision. Our research indicates that the altered approach facilitated during such periods is essential for delivering tailored help to trauma patients.

Comparing the Healing Abilities of Fluorapatite and Hydroxyapatite Ceramics in Regenerating Bone Tissue: An In Vivo Study.

Some reports in the literature show the advantages of fluoride-containing apatite ceramics over hydroxyapatite (HAP), at least in some aspects. While HAP has been used extensively in the treatment of bone defects, fluoridated apatite has hardly been tested in vivo. In order to verify the biological properties of fluoride-doped apatite and to assess its therapeutic potential, we synthesized fluorapatite (FAP) and applied it as a filling in bone defects of experimental animals (rabbits). The treatment effects were evaluated on extracted bones after 3 and 6 months from implantation using peripheral quantitative computed tomography (pQCT), dual-energy X-ray absorptiometry (DXA), radiography (X-ray) and histological staining. The study proved the integration between FAP and the bone tissue, thus indicating its stimulating effect on new bone formation and mineralization. The results achieved after 3 months of treatment were difficult to interpret unequivocally and suggested the transient delay in FAP integration of bone in comparison with HAP. The reasons for this phenomenon are unclear. Most likely, these differences between FAP and HAP resulted mainly from the different porosities, densities and ionic reactivity of the ceramics, which in our opinion affected their solubility, integration and degree of bone tissue resorption. However, it was shown that 6 months after implantation, similar level of bone defect regeneration was achieved for both FAP and HAP. In this article, we present our hypothesis concerning the basis of this phenomenon.

Use of neural network based on international classification ICD-10 in patients with head and neck injuries in Lublin Province, Poland, between 2006-2018, as a predictive value of the outcomes of injury sustained.

INTRODUCTION AND OBJECTIVE: Head and neck injuries are a heterogeneous group in terms of both clinical course and prognosis. For years, there have been attempts to create an ideal tool to predict the outcomes and severity of injuries. The aim of this study was evaluation of the use of selected artificial intelligence methods for outcome predictions of head and neck injuries. MATERIAL AND METHODS: 6,824 consecutive cases of patients who sustained head and neck injuries, treated in hospitals in the Lublin Province between 2006-2018, whose data was provided by National Institute of Public Health / National Institute of Hygiene, were analyzed retrospectively. Patients were qualified using International Statistical Classification of Diseases and Related Health Problems (10th Revision). The multilayer perceptron (MLP) structure was utilized in numerical studies. Neural network training was achieved with the Broyden-Fletcher-Goldfarb-Shanno (BFGS) method. RESULTS: In the designed network, the highest classification efficiency was obtained for the group of deaths (80.7%). The average value of correct classifications for all analyzed cases was 66%. The most important variable influencing the prognosis of an injured patient was diagnosis (weight 1.929). Gender and age were variables of less significance with weight 1.08 and 1.073, respectively. CONCLUSIONS: Designing a neural network was hindered due to the large amount of cases and linking of a large number of deaths with specific diagnosis (S06). With a predictive value of 80.7% for mortality, ANN can be a promising tool in the future; however, additional variables should be introduced into the algorithm to increase the predictive value of the network. Further studies, including other types of injuries and additional variables, are needed to introduce this method into clinical use.

Analysis of the Effect of Component Ratio Imbalances on Selected Mechanical Properties of Seasoned, Medium Viscosity Bone Cements.

The paper presents the results of experimental strength tests of specimens made of two commercially available bone cements subjected to compression, that is a typical variant of load of this material during use in the human body, after it has been used for implantation of prostheses or supplementation of bone defects. One of the factors analysed in detail was the duration of cement seasoning in Ringer's solution that simulates the aggressive environment of the human body and material degradation caused by it. The study also focused on the parameters of quantitative deviation from the recommended proportions of liquid (MMA monomer, accelerator and stabiliser) and powder (PMMA prepolymer and initiator) components, i.e., unintentional inaccuracy of component proportioning at the stage of cement mass preparation. Statistical analysis has shown the influence of these factors on the decrease in compressive strength of the cements studied, which may be of significant importance in operational practice.

Mortality prediction by 'Life Threat Index' compared to widely used trauma scoring systems.

INTRODUCTION AND OBJECTIVE: Injuries are an extremely important problem in public life and account for up to one-third of deaths in the entire human population. Available trauma scoring systems provide a good estimation of mortality; however, some factors affect their utility in daily practice. Therefore, a new easily applicable in any given country trauma scoring system has been developed and proposed in this study. MATERIAL AND METHODS: A retrospective study of the medical records of 485 patients were evaluated, together with diagnostic performance with regard to mortality, was calculated for the Revised Trauma Score (RTS), Injury Severity Score (ISS), The New Injury Severity Score (NISS), Trauma and Injury Severity Score (TRISS), International Classification based Injury Severity Score (ICISS) and the newly-developed Life Threat Index (LTI). Sensitivity, specificity, accuracy, PPV and NPV were calculated for each scoring system, and overall diagnostic performance was estimated with the use of ROC curves. RESULTS: Apart from RTS, all scoring systems showed similar performance regarding mortality prediction. TRISS and LTI showed the highest sensitivity reaching 0.998 and AUC of 0.89 and 0.87, respectively, which proved its usefulness in predicting mortality. CONCLUSIONS: LTI proved to be one of the most sensitive in comparison with widely-used and recognized trauma scoring systems. Based on LTI methodology, it can be applied in any given country or region, even without a previously developed trauma database.

Evaluation of the Effect of Selected Physiological Fluid Contaminants on the Mechanical Properties of Selected Medium-Viscosity PMMA Bone Cements.

Revision surgeries several years after the implantation of the prosthesis are unfavorable from the patient's point of view as they expose him to additional discomfort, to risk of complications and are expensive. One of the factors responsible for the aseptic loosening of the prosthesis is the gradual degradation of the cement material as a result of working under considerable loads, in an aggressive environment of the human body. Contaminants present in the surgical field may significantly affect the durability of the bone cement and, consequently, of the entire bone-cement-prosthesis system. The paper presents the results of an analysis of selected mechanical properties of two medium-viscosity bone cements DePuy CMW3 Gentamicin and Heraeus Palamed, for the samples contaminated with saline and blood in the range of 1-10%. The results obtained for compressive strength and modulus of elasticity were subjected to statistical analysis, which estimated the nature of changes in these parameters depending on the amount and type of contamination and their statistical significance.

Highly Porous Fluorapatite/ß-1,3-Glucan Composite for Bone Tissue Regeneration: Characterization and In-Vitro Assessment of Biomedical Potential.

A novel fluorapatite/glucan composite ("FAP/glucan") was developed for the treatment of bone defects. Due to the presence of polysaccharide polymer (ß-1,3-glucan), the composite is highly flexible and thus very convenient for surgery. Its physicochemical and microstructural properties were evaluated using scanning electron microscopy (SEM), Fourier transform infrared spectroscopy (FTIR), mercury intrusion, mechanical testing and compared with the reference material, which was a hydroxyapatite/glucan composite ("HAP/glucan") with hydroxyapatite granules (HAP) instead of FAP. It was found that FAP/glucan has a higher density and lower porosity than the reference material. The correlation between the Young's modulus and the compressive strength between the materials is different in a dry and wet state. Bioactivity assessment showed a lower ability to form apatite and lower uptake of apatite-forming ions from the simulated body fluid by FAP/glucan material in comparison to the reference material. Moreover, FAP/glucan was determined to be of optimal fluoride release capacity for osteoblasts growth requirements. The results of cell culture experiments showed that fluoride-containing biomaterial was non-toxic, enhanced the synthesis of osteocalcin and stimulated the adhesion of osteogenic cells.

Social Prestige of the Paramedic Profession.

BACKGROUND: There is a lack of research on social image, prestige, and the position of the paramedic profession in the social structure. The main objective of the study was to determine the place of the paramedic profession in the hierarchy of prestige of professions as viewed by the public. In operationalizing the term 'prestige', we deemed the word 'respect' to best fit the sense of the subjective evaluation of prestige with regard to a profession. MATERIAL AND METHODS: The data comes from cross-sectional survey-based research. The research was carried out on a group of 600 people over 18 years of age. The sample was of a random nature, and the selection of respondents was calculated on the basis of them being representative of the Polish population. RESULTS: The median of respect declared for the paramedic profession, on a scale of 1 to 5, was 4.49, which placed the profession in fourth place in the ranking. The assessment of respect for paramedics among other medical professions placed them in third place, directly after doctors and midwifes. CONCLUSIONS: The profession of paramedic is characterized by high social prestige, locating it at the forefront of the medical profession and other examined professions, but its social position, expressed by objective measures (earnings, structural possibilities, social power), is significantly lower.

Fluorapatite ceramics for bone tissue regeneration: Synthesis, characterization and assessment of biomedical potential.

Calcium phosphates, due to their similarity to the inorganic fraction of mineralized tissues, are of great importance in treatment of bone defects. In order to improve the biological activity of hydroxyapatite (HAP), its fluoride-substituted modification (FAP) was synthesized using the sol-gel method and calcined at three different temperatures in the range of 800-1200 °C. Physicochemical and biological properties were evaluated to indicate which material would support bone regeneration the best. X-ray diffraction (XRD), scanning electron microscopy (SEM) with energy dispersive X-ray spectrometry (EDS), and Fourier transform infrared spectroscopy (FTIR) revealed that fluoride ions were incorporated into the apatite lattice structure. In studies it was found that fluorapatite sintered at the highest temperature had the lowest porosity, no internal pores and the highest density. In vitro ion reactivity assessments showed that during the 28-day immersion of the samples in the simulated body fluid, the uptake of calcium and phosphorus ions was inversely correlated to the calcination temperature. All tested materials were non-toxic since the cytotoxicity MTT assay demonstrated that the viability of preosteoblast cells incubated with sample extracts was high. Fluorapatite sintered at 800 °C was determined to be of optimal porosity and fluoride release capacity and then used in cell proliferation studies. The results showed that it significantly shortened the doubling time and thus enhanced the proliferation of osteogenic cells, as compared to the fluoride solutions and control group. Therefore, this material is proposed for the use in orthopedic applications and bone tissue engineering.

Different regulation of PARP1, PARP2, PARP3 and TRPM2 genes expression in acute myeloid leukemia cells.

BACKGROUND: Acute myeloid leukemia (AML) is a heterogenic lethal disorder characterized by the accumulation of abnormal myeloid progenitor cells in the bone marrow which results in hematopoietic failure. Despite various efforts in detection and treatment, many patients with AML die of this cancer. That is why it is important to develop novel therapeutic options, employing strategic target genes involved in apoptosis and tumor progression. METHODS: The aim of the study was to evaluate PARP1, PARP2, PARP3, and TRPM2 gene expression at mRNA level using qPCR method in the cells of hematopoietic system of the bone marrow in patients with acute myeloid leukemia, bone marrow collected from healthy patients, peripheral blood of healthy individuals, and hematopoietic stem cells from the peripheral blood after mobilization. RESULTS: The results found that the bone marrow cells of the patients with acute myeloid leukemia (AML) show overexpression of PARP1 and PARP2 genes and decreased TRPM2 gene expression. In the hematopoietic stem cells derived from the normal marrow and peripheral blood after mobilization, the opposite situation was observed, i.e. TRPM2 gene showed increased expression while PARP1 and PARP2 gene expression was reduced. We observed positive correlations between PARP1, PARP2, PARP3, and TRPM2 genes expression in the group of mature mononuclear cells derived from the peripheral blood and in the group of bone marrow-derived cells. In AML cells significant correlations were not observed between the expression of the examined genes. In addition, we observed that the reduced expression of TRPM2 and overexpression of PARP1 are associated with a shorter overall survival of patients, indicating the prognostic significance of these genes expression in AML. CONCLUSIONS: Our research suggests that in physiological conditions in the cells of the hematopoietic system there is mutual positive regulation of PARP1, PARP2, PARP3, and TRPM2 genes expression. PARP1, PARP2, and TRPM2 genes at mRNA level deregulate in acute myeloid leukemia cells.

Potential Involvement of BIRC5 in Maintaining Pluripotency and Cell Differentiation of Human Stem Cells.

The BIRC5 gene encodes a survivin protein belonging to class III of inhibitors of apoptosis, IAP. This protein serves a dual role. First, it regulates cell death, and second, it is an important regulator of mitosis progression, although its physiological regulatory function has not been fully understood. Many studies have shown and confirmed that survivin is practically absent in mature tissues in nature, while its overexpression has been reported in many cancerous tissues. There is little information about the significance of BIRC5 expression in normal adult human stem cells. This paper presents the study and analysis of survivin expression at the transcription level using qPCR method, in hematopoietic stem cells from peripheral blood mobilized with a granulocyte growth factor, adherent cells derived from the umbilical cord, and normal bone marrow stem cells. The expression of this gene was also examined in the blood of normal healthy individuals. The results of the analysis have shown that the more mature the cells are, the lower the expression of the BIRC5 gene is. The lowest expression has been found in peripheral blood cells, while the highest in normal bone marrow cells. The more the CD34+ and CD105 cells in the tested material are, the higher the BIRC5 expression is. Stem cells from cell culture show higher BIRC5 expression. The study confirms the involvement of BIRC5 from the IAP family in many physiological processes apart from apoptosis inhibition. The possible effect of BIRC5 on cell proliferation; involvement in cell cycle, cell differentiation, survival, and maintenance of stem cells; and the possible effect of IAP on the antineoplastic properties of mesenchymal stem cells have been demonstrated. Our research suggests that BIRC5 may be responsible for the condition of stem cell pluripotency and its high expression may also be responsible for the dedifferentiation of tumor cells.

Damien de Veuster (1840-1889): A life devoted to lepers.

Father Damien de Veuster, or Saint Damien of Molokai (1840-1889), was one of the pioneers of the holistic approach to care provision for leprosy patients and contributed to the overcoming of the patients' social stigmatization. He devoted his life to the lepers living in America's only leper colony, on the Hawaiian island of Molokai, where people with leprosy were required to live under government-sanctioned medical quarantine. Father Damien gained practical skills in caring for the sick, eagerly learning wound cleansing, bandaging techniques, and drug administration from a nurse. Mahatma Gandhi said that Father Damien's work had inspired his own social campaigns in India.

Behavior of new hydroxyapatite/glucan composite in human serum.

Biomaterials for bone tissue regeneration, including polymer-based composites, are typically evaluated in vitro prior to the clinical trials. However, such composites tested in vivo may behave different due to the specific body conditions. For example, some composites implanted into the tissue acidified due to transient postoperative inflammation may unexpectedly swell which delays the wound healing. Such massive swelling in acidic medium was previously observed for new elastic hydroxyapatite (HAp)/ß-glucan biomaterial. However, in further clinical cases concerning the composite implantation in patients without significant inflammation indicators, no side effects were observed. Therefore, it was reasonable to test the effect of human serum of neutral pH (typical for noninflamed tissues) on the composite parameters, in particular volume changes. Thus, this article shows the characterization of physicochemical parameters of the composite after incubation (5 days) in human serum of neutral pH by means of weight and volume measurement, scanning electron microscopy, X-ray diffraction, Fourier-transform infrared spectroscopy, microcomputed tomography, mercury intrusion, and biochemical techniques. Results showed that human serum collected from healthy people caused no uncontrolled changes in weight and volume, porosity and mechanical properties of the composite. Therefore, this suggests the lack of volume change-related side effects of HAp/glucan composite in bone defects treatment if postoperative inflammation is prevented. © 2018 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 106B: 2653-2664, 2018.

Association between Serum Selenium Concentrations and Levels of Proinflammatory and Profibrotic Cytokines-Interleukin-6 and Growth Differentiation Factor-15, in Patients with Alcoholic Liver Cirrhosis.

According to some authors, serum selenium levels are strongly associated with the severity of liver diseases, including liver cirrhosis. The aim of this study was to determine the relationship between the concentration of selenium and pro-inflammatory and profibrotic cytokines-interleukin-6 (IL-6) and growth differentiation factor 15 (GDF-15) in patients with alcoholic liver cirrhosis. The parameters studied were determined in the serum of 99 patients with alcoholic liver cirrhosis divided based on the severity of disease according to the Child-Turcotte-Pugh criteria. In patients with liver cirrhosis, the serum selenium concentration was statistically lower, whereas serum IL-6 and GDF-15 concentrations were higher than those in the control group. Moreover, the concentration of selenium negatively correlated with the levels of GDF-15 and IL-6. The above results may indicate a role of selenium deficiency in the pathogenesis and progression of alcoholic liver disease.

History of trauma and posttraumatic disorders in literature.

In 1980 a third edition of Diagnostic and Statistical Manual of Mental Disorders (DSM) brought diagnostic criteria for a new diagnosis - posttraumatic stress disorder (PTSD). This disorder is a result of highly intensive stressor and in many cases leads to sever psychiatric distress. Despite relatively recent introduction of PTSD as a new diagnosis, this disorder was excessively described in scientific papers as well as in fiction novels. Analysis of those descriptions across ages allows for the conclusion that character and type of stressors has changed, however, people's reactions to highly intensive stressors are basically similar. First descriptions are found in notes of Egyptian physicians and then in papers of Homer, Herodotus and Plutarch. In consecutive parts of this paper, the authors present history of posttraumatic stress disorder describing contribution of Polish authors - Kepinski and Szymusik. Presented historical perspective of posttraumatic stress disorder allows for better understanding of reasons for introducing PTSD into classifications as well as controversies related to it.

Life hazard ratio--a new scale for assessing the severity of injury in the populational stud.

UNLABELLED: The heterogeneous population of patients affected by trauma is extremely difficult to systematize. This is due to the diversity of mechanisms of injury, the nature and severity of the injury and the population, which relate to injuries, diverse in terms of gender, age, presence of comorbidities that make up the final severity of the injury and a certain degree of danger to life. THE AIM OF THE STUDY: To develop a universal method to assess the severity of injury and loss of life resulting from their consequences, using the parameters available in the Polish administrative databases, a similar diagnostic efficacy as other used scales to assess the severity of damage. MATERIAL AND METHODS: The study analyzed a group of 92,463 patients hospitalized due to injuries sustained as a result of injuries in all hospitals of the Lublin region in 2003-2005. Developed catalogs risk factors, reference to the population of the Lublin province. RESULTS: Developed five models predictive of injury severity scale counterparts, which include different combinations of risk factors associated with the type of injury, age of the patient and the mechanism of injury that have been evaluated for their diagnostic efficacy in differentiating the expected outcomes. Prediction model have the best diagnostic efficacy AUROC 0.9615, SE 0.0025 and 95% CI 0,9565-0,9665, hereinafter referred to as Life Hazard Ratio (LHR), which has a similarly high diagnostic efficacy as the other, examined in the work of the rock assess the severity of damage AUROC 0.9585, SE 0.0368, 95% CI0 0.8849-1. CONCLUSIONS: 1. The proposed method of use of the International Classification ICD-10 allows the use of regional administrative databases to conduct detailed analyzes of population and monitor trends in the epidemiology of injuries. 2. Developed Life Hazard Ratio (LHR)is a universal method for the objective evaluation of the severity of injuries and the associated risk of life-threatening, can also conduct population studies. 3. LHR has a comparable rate of diagnostic efficacy as other commonly used scales assessing the severity of the injury.