Changes in the scar tissue structure after cesarean section as a result of manual therapy.

BACKGROUND: Available statistical data from 2015 show that 28% of pregnancies in developed countries end in cesarean section (CC). Discomfort associated with the scar after surgery is a common complication. OBJECTIVES: This study aimed to evaluate the changes in the structure of the cesarean scar after the application of a scheme of manual therapy. MATERIAL AND METHODS: The study included 15 women in the treatment group (TG) and 15 in the control group (CG). The scars were evaluated twice at 5-week intervals with the use of quantitative scales: the Vancouver Scar Scale (VSS), the Manchester Scar Scale (MSS) and the Patient and Observer Scar Assessment Scale (POSAS). During each examination, the scar was compared, using the specified criteria, to the physiological skin, i.e., the tissues directly bordering the incision. During therapy, 8 manual techniques were used during a 4-week program consisting of 30-minute sessions 3 times per week. RESULTS: Patients in the TG showed a statistically significant improvement in all of the analyzed characteristics of the scar. A statistically significant difference was also observed between the results obtained during the 2nd examination (after the therapy) in the TG and the CG. CONCLUSIONS: As a result of the therapy, the condition of the scar in the TG significantly improved. Onerous scar-related symptoms were alleviated. The vascularity, hyperpigmentation and distortion of the scar were reduced. The elasticity and pliability of the scar increased, and the height of the scar decreased. The texture, finish and contour of the scar improved. Obtained results suggest that manual therapy of the scar after CC should be a part of the treatment in women during the postpartum period.

Comparison of cognitive functioning of elders with late-life depression and patients with and without a history of depressive episodes: a cross-sectional study.

Nowadays there are numerous studies on the occurrence of cognitive dysfunction in late-life depression (LLD). The role of executive dysfunctions in the psychopathology of depression is particularly emphasized and needs further examination. The aim was to assess cognitive functions and their relation to depressive symptoms in elders with LLD, previously depressed, and patients without the history of depressive episodes. The study consisted of 824 older adults who underwent a neuropsychological evaluation (97 currently depressed, 114 previously depressed and 613 patients without the history of depressive episodes). LLD patients performed poorer in ACE-III and AVLT and poorer in TMT-B than those previously depressed and never depressed. The LLD group also performed significantly poorer than the previously depressed on Digit Span Forward. Results of a multiple regression analysis indicated that performance on measures of executive functioning was associated with depression severity in LLD (ß =.227, P =.024). The results of this study suggest that executive functions are the most impaired in the elderly with LLD. Furthermore, there is a relationship between executive dysfunction and the severity of depression in LLD. Executive dysfunction appears to be the core neurocognitive deficit in LLD.

Giant Intrathoracic Mass in a Young Woman With Acute Kidney Injury.

CASE PRESENTATION: A 35-year-old woman without past medical history sought treatment for fatigue and dry cough of 3 weeks' duration. Basic laboratory tests revealed severe anemia. She had no history of bleeding, hemoptysis, dyspnea, or fever. The patient was admitted for RBC transfusion and more extensive diagnostics.

The utility of fluorescence in situ hybridization (FISH) in determining DNA damage-inducible transcript 3 (DDIT3) amplification in dedifferentiated liposarcomas - an important diagnostic pitfall.

BACKGROUND AND OBJECTIVE: Dedifferentiated liposarcoma (DDLPS) is characterized by non-lipogenic sarcoma fields coexisting with adipocyte-rich well-differentiated areas. Amplification of the 12q13-15 region includes the MDM2 and DDIT3 genes. MDM2 amplification is considered a genetic hallmark of DDLPS, while DDIT3 is typically rearranged in myxoid liposarcoma. Recent studies showed that DDIT3 amplification is associated with myxoid liposarcoma-like (LPS-like) morphology in DDLPS. Our study aimed to evaluate the status of MDM2 and DDIT3 by FISH in DDLPS and correlate it with MLPS-like features. MATERIAL AND METHODS: Six patients with MLPS-like morphology DDLPS were investigated pathologically, immunohistochemically, and genetically. The control groups of patients with classical DDLPS morphology and well-differentiated liposarcoma (WDLPS) were established and molecularly assessed as well. Fluorescence in situ hybridization (FISH) used in routine diagnostics was performed to determine the status of MDM2 and DDIT3 genes. RESULTS: The patient's mean age was 64 (range from 43 to 85 years) with a 5:4 male to female ratio. Tumors were localized retroperitoneally (15) and extra-retroperitoneally (3). All cases demonstrated amplification of the 12q15 region containing MDM2 gene and co-amplification of the 5' DDIT3 FISH Probe representing DDIT3 telomeric tag. However, we did not find the relation of myxoid LPS-like morphology with DDIT3 amplification as previously reported. CONCLUSIONS: The biopsy material from DDLPS with myxoid areas can be misclassified as myxoid liposarcoma. Indeed, according to the histological image, DDIT3 status may be evaluated first. In these cases, we show that the DDIT3 telomeric tag amplification assessed by FISH, is a common, nonspecific feature, which is also found in classical DDLPS and WDLPS. Therefore, we believe that co-amplification of DDIT3 and MDM2 may be considered a spectrum of the 12q13-15 region amplification due to the specification of FISH methodology.

[Clinical and demographic predictors of mild cognitive impairment - cross-sectional study].

OBJECTIVE: Introduction: Cognitive limitations are a serious health and social problem, which concerns elderly people. Effective prevention and treatment of cognitive dysfunction is one of the challenges of modern medicine. There is not enough consistent data in the literature to indicate to indicate the relationship between various clinical and demographic factors with cognitive functioning in different age ranges. The aim: To analyze clinical and demographic predictors of mild cognitive impairment by age group. PATIENTS AND METHODS: Material and methods: The analysis included 817 participants (669 with normal cognitive function and 148 people with MCI). The evaluation of the level of depressive symptoms was measured by the Short Form Geriatric Depression Scale. All participants were screened for cognitive functioning using the Mini-Mental State Examination and Addenbrooke's Cognitive Examination-III. Different cognitive domains were evaluated with different neuropsychological tools: the Rey Auditory Verbal Learning test, Clock Drawing test, Verbal Fluency test, Digit Span Test and Trail Making test. RESULTS: Results: It has been shown that independently associated with MCI ware age (OR = 1.09, 95% CI: 1.05-1.13) and level of education (OR = 0.75, 95% CI: 0.69-0.81). Depending on the age, it turned out that in the younger MCI group, age, education and depression were significant, and the age and level of education were significant in the older MCI group. CONCLUSION: Conclusions: The identification of cognitive dysfunctions is an important element of the diagnostic and therapeutic process.

Profiles of empathic sensitivity in students of the last year of medicine.

Developing the empathic attitude is one of the tasks of medical education as it affects the quality of therapeutic contact in the relationship between the doctor and the participant, conditioning the treatment process. According to Davis's concept, empathy is defined as an affective-cognitive reaction in the context of the other person's experience. AIM: Analysis of profiles of empathic sensitivity in students of medicine. Group: Male and female students of the fifth year of medicine who agreed to participate in an anonymous study (n = 153; M = 57, F = 96; mean age: 23 years). Tools: The Empathetic Sensitivity Scale (EES), which is the Polish tool for Davis's Interpersonal Reactivity Index (IRI) was used. The ESS includes three sub-scales: Empathic Care (EC), Personal Distress (PD) and Adopting Perspective (AP). RESULTS: The raw results were converted into sten scores and for sten scores for all three dimensions of empathetic sensitivity no differences were found between male and female students. Three clusters (1: n = 33%, 2: n = 39%, 3: n = 28%), which differ in terms of each distinguished indicator, were identified. CONCLUSIONS: The first cluster characterizes empathetic people, both in the affective and cognitive spheres, and those dealing well with unpleasant emotions in situations difficult to others. The second cluster characterizes participants with the ability to recognize the needs of others and to take into account their perspectives; the third cluster includes participants with a tendency to focus on own experiences emerging in response to other people's suffering but with the ability to understand a situation and show empathic concern for the other person. The most favourable profile - for a future doctor as well as for his participants - is the first cluster because the doctor, with his empathic sensitivity directed towardsthe other man, can deal with his own unpleasant emotions.

Nutritional therapy complications in children with ultra-short bowel syndrome include growth deficiency but not cholestasis.

AIM: Children with ultra-short bowel syndrome (USBS) have not been extensively studied to date because the condition is rare. The aim of the study was to assess the nutritional status of children with USBS receiving home parenteral nutrition, using citrulline serum concentration and cholestasis. METHODS: We studied 17 patients with USBS, with a median age of 6.6 years and median duration of parenteral nutrition of 6.6 years. The study was carried out at The Children's Memorial Health Institute, Warsaw, from January 2014 to January 2015. RESULTS: The median standard deviation score (SDS) was -1.2 for body mass according to chronological age, -1.72 according to height and -0.59 according to height for age. Patients requiring seven days per week parenteral nutrition had a citrulline concentration below 10 µmol/L. Decreased bone-mineral density was observed in 87% of the patients. Low values of 25-hydroxyvitamin D were found in 53% of the children. None of the patients had elevated conjugated bilirubin levels above 34.2 µmol/L. CONCLUSION: Children with USBS were growth deficient according to their chronological age, with frequent abnormal bone mineralisation and vitamin D deficiency. Children requiring parenteral nutrition seven days a week had citrulline concentrations below 10 µmol/L. Cholestasis was not seen.

An Assessment of the Number of Cariogenic Bacteria in the Saliva of Children with Chemotherapy-Induced Neutropenia.

BACKGROUND: Anticancer therapy entails qualitative and quantitative changes in the physiological bacterial flora of the organism, including the oral microflora. OBJECTIVES: The aim of the study was to assess the number of cariogenic bacteria - Streptococcus mutans and Lactobacillus spp. - in the saliva of children with chemotherapy-induced neutropenia, and the relationship between the dynamics of neutrophils in the blood and the number of cariogenic bacteria in the saliva. MATERIAL AND METHODS: The study included 52 children aged 3-17.5 years, diagnosed with cancer and undergoing antineoplastic treatment. The control group comprised 52 generally healthy children matched for age and gender. Both groups underwent microbiological analysis of the saliva. The Dentocult SM Strip Mutans test (Orion Diagnostica, Espoo, Finland) was used to evaluate the number of Streptococcus mutans colonies in the saliva, while the Dentocult LB test (Orion Diagnostica) was used to assess the number of Lactobacillus spp. bacteria. The statistical analysis was carried out using STATISTICA 10 software (StatSoft Inc., Tulsa, USA). RESULTS: The statistical analysis using Kendall's tau test showed a significant inverse correlation between the number of neutrophils in the blood and the number of the Streptococcus mutans and Lactobacillus spp. colonies in the saliva of the children undergoing anticancer therapy. The highest titres of cariogenic bacteria in the saliva were observed during severe neutropenia, which was frequently observed between day 7 and day 21 of the chemotherapy course. CONCLUSIONS: A significant increase in the number of cariogenic bacteria in the saliva during episodes of chemotherapy-induced neutropenia suggests that the activity of dental caries increases in children undergoing antineoplastic treatment.

Disease associated malnutrition correlates with length of hospital stay in children.

BACKGROUND & AIMS: Previous studies reported a wide range of estimated malnutrition prevalence (6-30%) in paediatric inpatients based on various anthropometric criteria. We performed anthropometry in hospitalised children and assessed the relationship between malnutrition and length of hospital stay (LOS) and complication rates. METHODS: In a prospective multi-centre European study, 2567 patients aged 1 month to 18 years were assessed in 14 centres in 12 countries by standardised anthropometry within the first 24 h after admission. Body mass index (BMI) and height/length <-2 standard deviation scores (SDS, WHO reference) were related to LOS (primary outcome), frequency of gastrointestinal (diarrhoea and vomiting) and infectious complications (antibiotic use), weight change during stay (secondary outcomes) and quality of life. RESULTS: A BMI <-2 SDS was present in 7.0% of the patients at hospital admission (range 4.0-9.3% across countries) with a higher prevalence in infants (10.8%) and toddlers aged 1-2 years (8.3%). A BMI <-2 to ≥-3 SDS (moderate malnutrition) and a BMI <-3 SDS (severe malnutrition) was associated with a 1.3 (CI95: 1.01, 1.55) and 1.6 (CI95: 1.27, 2.10) days longer LOS, respectively (p = 0.04 and p < 0.001). Reduced BMI <-2 SDS was also associated to lower quality of life, and more frequent occurrence of diarrhoea (22% vs 12%, p < 0.001) and vomiting (26% vs 14%, p < 0.001). CONCLUSION: Disease associated malnutrition in hospitalised children in Europe is common and is associated with significantly prolonged LOS and increased complications, with possible major cost implications, and reduced quality of life. This study was registered at clinicaltrials.gov as NCT01132742.