Association of Higher Rates of Type 2 Diabetes (T2DM) Complications with Psychological and Demographic Variables: Results of a Cross-Sectional Study.

Introduction: The aim of this study was to assess the relationship between the occurrence and number of T2DM complications with sociodemographic (age, sex, habitation, education), clinical (duration of diabetes, HbA1c (%), BMI) and psychological (well-being, sense of influence on the diabetes course, coping styles) variables. Methods: A total of 2574 adult patients were assessed using The Sense of Influence on the Diabetes Course Scale, WHO-5 Well-Being Index, and the Brief Method of Evaluating Coping with Disease. Hierarchical Regression Analysis was conducted with number of complications as the dependent variable and three sets of variables entered in sequential steps: (a) sociodemographic; (b) clinical and (c) psychological factors. Logistic regression analysis was used to examine the association of these variables with diabetes complications' occurrence. Results: A higher number of complications and higher odds ratios of occurrence of complications were associated with sociodemographic and clinical variables, poor well-being, low perception of influence on the diabetes course, and an emotion-oriented coping style. The logistic regression indicated that participants with HbA1c >7% (in comparison with HbA1c ≤ 7%) and with high risk of depression (in comparison with no risk of depression) had respectively 68% and 86% higher odds of developing complications. Discussion: The number of complications has weak but statistically significant relations with psychological and clinical factors. Conclusion: The results support the rationale of including the psychosocial factors in the context of diabetes management.

Relations of Well-Being, Coping Styles, Perception of Self-Influence on the Diabetes Course and Sociodemographic Characteristics with HbA1c and BMI Among People with Advanced Type 2 Diabetes Mellitus.

PURPOSE: Assessment of the relationship between psychological and sociodemographic factors with the levels of glycated hemoglobin (HbA1c) and Body Mass Index (BMI) among people with advanced type 2 diabetes mellitus (T2DM). PATIENTS AND METHODS: A total of 2574 persons, among them 1381 (53.7%) women, with type 2 diabetes, during the period of switching from biphasic mixtures of human insulin to insulin analogues. The age of participants ranged from 22 to 94 years (M = 63.5; SD = 9.58), and their treatment period was in the time frame from 2 years to 43 years (M = 10.2; SD = 6.1). Participants filled out a Scale for Perception of Self-Influence on the Diabetes Course, Well-Being Index WHO-5, two questions from the Brief Method of Evaluating Coping with a Disease. RESULTS: Statistically significant correlations were found between the HbA1c levels and (1) disease duration (rs=0.067; p < 0.001); (2) number of complications (rs = 0.191, p < 0.001) (3) the perception of self-influence on the diabetes course (rs=- 0.16; p < 0.001); (4) well-being (risk of depression) (rs=- 0.10; p < 0.001). The regression analysis showed that 7% of HbA1c variability is explained by age, a perception of self-influence on the diabetes course, the number of complications, place of residence, education, BMI. The most important findings concerning BMI were found in regression analysis, which indicated a week relationship between BMI and a number of complications, perception of self-influence on the diabetes course and coping styles (3% of the resultes' variability). The group at high risk of depression had the highest levels of HbA1c. CONCLUSION: Sociodemographic and psychological factors show weak but statistically significant relationships with the current levels of HbA1c and BMI.

PAID-PL-The Polish Version of the Problem Areas in Diabetes Scale: Perfect Reliability and a One-Factor Structure.

PURPOSE: The aim of this study was to assess the structure and validate the Polish version of the Problem Areas in Diabetes (PAID) scale, as the current translations of the original English version significantly vary in their psychometric properties. PATIENTS AND METHODS: Two hundred and sixteen consecutive Polish outpatients were invited to participate in this international cross-sectional study on depression in diabetes. The research was based on the demographic and clinical characteristics of the study population, including the level of glycated hemoglobin (HbA1c) and scores obtained in the Polish versions of the following questionnaires: PAID, World Health Organization-Five Well-Being Index (WHO-5), Patient Health Questionnaire 9 (PHQ-9). The psychiatric diagnosis was conducted with the use of Mini-International Neuropsychiatric Interview (M.I.N.I.). RESULTS: Exploratory factor analyses yielded a 1-factor structure that included all 20 items. The internal consistency of the Polish version of PAID was high (Cronbach α = 0.97). There were significant positive correlation between PAID and PHQ-9 and a negative correlation between PAID and WHO-5. We also observed a negative association between PAID scores and age and a positive correlation between PAID and HbA1c levels. Patients with depression reported significantly higher PAID scores as compared with those without depressive symptoms. CONCLUSION: The Polish version of PAID has a one-factor structure and is a reliable, valid outcome measure for Polish outpatients with type 2 diabetes and it may constitute a useful instrument for screening for psychologic issues in diabetic patients during their appointments at the diabetes clinic.

Two-stage revision arthroplasty in the treatment of periprosthetic hip infections with severe bone loss: Results from 182 cases.

The optimum treatment for periprosthetic joint infection (PJI) of the hip with substantial bone defects remains controversial. A retrospective assessment was performed for 182 patients treated for PJI with a two-stage protocol from 2005 to 2015. Implant removal and debridement were followed by Girdlestone arthroplasty or spacer implantation. The results of the Girdlestone and spacer groups were compared. There were 71 cases that received spacers, and 111 Girdlestone procedures were performed. After the first stage, 26.37% of cultures were negative, and among patients with a detected pathogen, methicillin-sensitive Staphylococcus aureus was the most common organism (41.79%). Acetabular and femoral bone defects, according to the Paprosky classification, were more severe in the Girdlestone group (P<0.05). During the follow-up (mean, 5.95 years), the overall incidence of complications was 21.42%. The mean Harris hip score was significantly lower in the Girdlestone group (68.39 vs 77.79; P<0.0001). The infection recurrence rate reached 8.79%. Despite satisfactory infection control, the number of complications and poor functional outcomes associated with resection arthroplasty indicate the necessity for development of different approaches for patients with advanced bone loss.

Cut-off points for Polish-language versions of depression screening tools among patients with Type 2 diabetes.

AIMS: Screening tools can help improve the detection of depression in patients with diabetes, yet the psychometric properties of most translations of scales, which are originally published in English, have not been assessed. Thus we studied the screening performance of widely used depression measures. METHOD: We applied the cut-off points of the English-language versions of the Beck Depression Inventory (BDI); Hospital Anxiety and Depression Scale (HADS); Depression in Diabetes Self-Rating Scale (DDS-RS); Brief Self-Rating Scale of Depression and Anxiety (BS-RSDA); and Problematic Areas in Diabetes Survey (PAID), all of which were used to assess diabetes-specific distress in a sample of 101 patients with Type 2 diabetes. The Mini International Neuropsychiatric Interview and the Hamilton Depression Rating Scale (HDRS) were used to diagnose depression. RESULTS: When the English cut-off points were used, the tools had varied values of both sensitivity and specificity. When the best cut-off points were used, all measures had either very good or good sensitivity. Taking into account their length, the HADS and the BS-RSDA seem to be the best among the screening tools. CONCLUSIONS: Effective initial diagnosis of depression in patients with diabetes during a routine medical visit requires the use of screening tools that have adequate cut-off points. The analyses presented in this article show that screening tools should be validated and the cut-off points that are used should be population-specific.

An analysis of complex, life-threatening infectious complications of hip and knee joint arthroplasty based on departmental data.

BACKGROUND: The growing popularity of arthroplasty results in an increase in the number of infectious complications. The clinical course of inflammation, silent initial symptoms of the disease and non-medical factors, such as poor public awareness and difficulty in finding specialist care, lead patients to postpone the decision about surgical intervention. This results in a state of imminent threat to health or life by endangering other organs of the body. The purpose of this study was to analyze extreme cases of vital organ damage due to infections following hip and knee replacement procedures. MATERIAL AND METHODS: Retrospective analysis of selected cases of life-threatening infectious complications resulting in vital organ damage (urinary tract, large vessels, cardiorespiratory system, etc.) treated at the Department of Orthopedics at the Center of Postgraduate Medical Education (CPME) over the past 12 years. RESULTS: Establishment of an early diagnosis, and above all, confirmation of periprosthetic infection are extremely important. This allows for a biologically reasonable, early and radical management with the best possible treatment options and prevents the risk of life-threatening complications. CONCLUSIONS: Universal access to antibiotics, suppression rather than treatment of infections, silent and unusual course of septic joint loosening and the lack of sufficient awareness of the problem among physicians, contribute to the reoccurrence of such cases and cause significant treatment challenge. They require management at multidisciplinary centers specializing in such cases and rarely end successfully.

[Two-stage revision procedure for septic complicated endoprosthesis of the hip]. / Dwuetapowa replantacja stawu biodrowego w leczeniu powiklan zapalnych endoplastyki.

Total hip arthroplasty is commonly used way for treatment of degenerative changes of a hip joint. Continuous progress of medicine enables use of more and more modern implants, that are supposed to provide to patients comfortable and painless motility. Nevertheless, with increasing number of implanted endoprostheses, rising numer of loosened impants is observed. Proper laboratory dignostics and postoperative proceedings as well as systematic follow up with standard X-ray scans allow for early recognition of loosened prostheses and implementation of surgical procedure. In the article two-stage method for treatment of septic loosened primary total hip arthroplasties applied in CMKP Orthopedic Clinic in Otwock, Poland as well as results of treatment of selected cases are presented.

[Conduct and tactics of infections after hip arthroplasty]. / Taktyka postepowania w zakazeniach stawu biodrowego po endoplastykach.

The number of arthroplasty surgeries is growing globally, bringing about an increase in the absolute number of infected complications. No precise statistics of complications are available in Poland. The present paper discusses the main causes of infected complications of hip arthroplasty. The object is to present both pre-surgery prophylaxis and the treatment of an infected complication adjacent to the endoprosthesis. Infections are commonly divided after Coventry and Fitzgerald. The most common pathogens in infected endoprostheses include Staphylococcus aureus and Staphylococcus epidermidis, while the treatment of infections with the Gram-negative flora poses many problems. Discussed within treatment of infected complications of hip arthroplasty has been one- and two-stage surgical treatment with temporary implants--"spacers"--combines with prolonged antibiotic therapy. Important within the post-surgery treatment is prolonged monitoring of the infective agents (CRP and SR).

[Modular short-stem prosthesis in total hip arthroplasty--preliminary report]. / Modularny, krótki trzpien w endoprotezoplastyce stawu biodrowego--doniesienie wstepne.

Total hip arthroplasty has become one of the most succesful procedure in orthopaedic surgery. More and more active, young patients undergo primary hip replacement. Bone stock preservation is crucial when performing THR in this group of patients. The short stem design allows a methaphyseal intratrochanteric multipoint, strong primary fixation which is very important for this group of patients. The goal is to save bone stock for the revision operation. This study presents early results of Metha short stems prosthesis. Between April 2006-December 2007, 58 short stem (Metha) were implanted. The Harris Hip Score improved from a mean 64.3 before to 89.7 at follow-up. The Metha stem may not be indicated for every hip diseases. There were only two fractures of femur without any further problems. Despite the short follow-up, Metha prosthesis already represent a valuable alternative for younger patients.

Strength of proximal humeral fraction fixation employing implants of various types--a study of porcine bones.

In this study, the authors assess the strength of proximal humerus fracture fixation using different methods. The strength, while pulling out the chosen single Kirschner wires implanted in porcine bone, has been examined. Tests concerning the strength of fixation with different types of implants have been carried out on prepared models. We observed the maximum strength of the bone-single wire coupling for Kirschner wires of a 2.5 mm diameter with 100 mm thread where mean was 2396 N (SD 345). The mean strength of the 4 wires fracture fixation for Kirschner wires of a 2.5 mm diameter with 100 mm thread was 736 N (SD 229) and was similar to Kirschner wires of a 2.5 mm diameter with 10 mm thread where mean was 709 N (SD 191).

Charcot's arthropathy of the hip joints: a late manifestation of tabes dorsalis successfully treated by total joint arthroplasty. report of 2 cases.

This article describes 2 cases of Charcot's arthropathy of the hip joints successfully treated with cemented total hip arthroplasty. Follow-up at 10 and 9.5 years confirmed the success of the treatment. This article also includes a review of current publications on the topic.

Minimally invasive total hip arthroplasty--our clinical experience.

BACKGROUND: Minimally invasive prosthetic hip surgery (MIS) attempts to minimise the extent of the operation. The aim of the study was to describe minimally invasive hip surgery and to present early clinical experience of the authors. MATERIAL AND METHODS: 41 minimally invasive hip replacements through a posterior approach were carried out at the Orthopaedic Department of the Postgraduate Medical Education Centre in Otwock between 2004 and 2006. 29 of those patients were included into the study, of whom 23 presented for follow-up. A control group consisted of 29 randomly selected patients operated on using the classical method. Patients qualified for MIS had a BMI below 30 and a structurally normal hip joint with a good range of motion. RESULTS: Early results were subjected to a statistical analysis of 20 parameters. CONCLUSION: 1. The analysis showed that statistically significant baseline differences between MIS and traditionally treated patients included only BMI scores, structure of the hip joint and range of motion. 2. Implantation of a hip endoprosthesis in a MIS procedure does not differ from the traditional operation utilising a posterior access except for skin incision length.

[Neer classification of the proximal humerus fractures based on our own material]. / Klasyfikacja zlaman blizszego konica kosci ramiennej wedlug Neera w materiale wlasnym.

INTRODUCTION: About 4-5% of all fractures are localised to the proximal end of the humerus. During the last 30 years a two-time increase has been observed. The cause was ageing of population and a higher incidence of fractures. Treatment improved owing to proper classification based on radiological diagnostics. OBJECTIVE: The principles of diagnostic and classification were presented on the basis of the literature and analysis of the clinical material. MATERIAL: We analysed the ways of the diagnosis and classification of the proximal humerus fractures in 166 patients treated in Traumatologic and Orthopaedics Department of the Bielanski Hospital in Warsaw and in Orthopaedics Department of the Medical Postgraduate Medical Education Centre in Otwock during years 1988-2004. RESULTS: The classification suggested in 1970 by Neer has firmly established the way of treatment, is easy to remember, and regarded as the most popular and acceptable practice. It is based on dislocation one or more of the four bone fragments: shaft, head with articular surface, greater and lesser tuberosity of the humerus. Proper assessment of the type of fracture requires precise identification of these elements on radiograms. Correct assessment of dislocations of bone fragments and the way of dislocations is essential matter because specificity of the blood supply that improves heeling of the fracture and efficiency of the affected limb in the future. SUMMARY: It was found that conventional plain radiograms made in AP and Y exposures were sufficient for recognition the type of fracture. When diagnosis was questionable examination had to be broadened by axillar exposure and CT performed in the stated sequence.

Diagnostic of the proximal humerus fractures.

About 4-5% of all fractures are localised to the proximal end of the humerus. During the last 30 years a two-time increase has been observed. The cause was ageing of population and a higher incidence of fractures. Treatment improved owing to proper classification based on radiological diagnosis. The principles of diagnosis was presented on the basis of the literature and analysis of the clinical material. Proper assessment of the type of fracture requires precise identification the anatomical elements of shoulder joint on radiograms. At first radiological diagnosis came down to performing AP and trasnsthoracic exposures. The latter was often unclear and that is why diagnosis has been completed with axial exposures in the axillar projection. Next Y exposure has been put into effect, which was later replaced by trasnsthoracic exposure. In individual cases CT and MRI were performed. It was found that conventional plain radiograms made in AP and Y exposures were sufficient for recognition the type of fracture. When diagnosis was questionable examination had to be broadened by axillar exposure and CT performed in the stated sequence.

Evaluation of various methods treatment of proximal humerus fractures.

Background. Most of the proximal humerus fractures are osteoporotic and concern elderly patients. In the literature long-term results of treatment of proximal humerus fractures are poor or fair. Objective. The objective of the paper was to present various methods of treatment - conservative and surgical. Material and method. A group of 138 fractures of proximal humerus fractures treated during years 1988-1999 was analysed. 84 (63%) fractures were followed up for a period ranging from 18 months to 10 years. Results were estimated by Neer's criteria. Results. The worst results in conservative treatment were obtained when Desault plaster cast was used (47% poor and fair); the best when sling was used (75% very good and good). Among the surgical methods the best results were observed thanks to fixation with threaded Kirschner wires (86% very good and good); the worst when screw or plate and screw fixation was used (60% poor). Conclusions. 1. For two- and three-part fractures with dislocation in which proper heeling augurs well, the right method of fixation is stabilisation with threaded Kirschner wires. 2. Treatment to be chosen for fractures without dislocation is the sling and early rehabilitation (1-2 weeks after trauma), whereas treatment in Desault plaster cast should be regarded as a mistake. 3. In elderly patients with four-part fractures, haemiarthroplasty as a primary operation should be considered.