The national burden of frailty and disproportionate distribution of its components-the predominance of slow gait speed: a 2018-19 face-to-face epidemiologic assessment representative of population of older Poles.

BACKGROUND: The prevalence of frailty and its components may be affected by age, diseases and geriatric deficits. However, the current operational definition of frailty assigns equal weight to the five components of frailty. AIMS: To perform a population-based assessment of physical frailty, its prevalence, and distribution of its components across different age, disease and deficit spectrum. METHODS: From 2018 to 2019, we conducted a face-to-face cross-sectional assessment of a representative sample of older Poles. We obtained data on frailty components, chronic disease burden, and prevalence of particular diseases and geriatric deficits. We calculated weighted population estimates, representative of 8.5 million older Poles, of prevalence of frailty and its components across the disease burden, associated with the particular diseases and the geriatric deficits present. RESULTS: Of 10,635 screened persons ≥ 60 years, 5987 entered the face-to-face assessment. Data of 5410 have been used for the present analysis. Seventy-two percent of the population are burdened with at least one frailty component. The estimated weighted population prevalence (95% CI) of frailty was 15.9% (14.6-17.1%), and of pre-frailty 55.8% (53.3-58.2%). Slow gait speed predominated across disease burden, specific diseases, geriatric deficits and the age spectrum. Overall, the prevalence of slow gait speed was 56.3% (52.7-60.0%), followed by weakness 26.9% (25.4-28.4%), exhaustion 19.2% (17.6-20.8%), low physical activity 16.5% (14.8-18.3%), and weight loss 9.4% (8.4-10.3%). CONCLUSIONS: Slow gait speed predominates among the components of frailty in older Poles. This may affect the component-tailored preventive and therapeutic actions to tackle frailty.

Prevalence and Predictors of Suicidal Ideation in Patients Following Cardiac Surgery.

BACKGROUND: Patient-reported outcomes (PROs) which demand special attention and immediate help are referred to as PROs alert. Suicidal ideation (SI) is one of the PROs alerts which are insufficiently investigated. The aim was to assess the prevalence and risk factors for SI in patients following cardiac surgery. METHODS: A total of 190 patients (mean age: 66.09, SD = 10.19; 57 women) were assessed at three months following cardiac surgery. SI was identified using the Patient Health Qustionnaire-9 (PHQ-9) question. The Hospital Anxiety and Depression Scale-Modified was used to assess anxiety, depression, and irritability. Additionally, self-perceived health improvement and level of hope were assessed using the Likert scale. Dyspnea and chest pain were assessed using a visual analogue scale. RESULTS: SI was observed in 14.7% of participants. Patients experiencing SI had significantly higher levels of depression, anxiety, irritability, dyspnea and chest pain. They perceived the surgery to be less effective and had lower levels of hope. No significant relationships were found regarding age, sex, employment status, myocardial infarction, heart failure, operation mode, type of procedure, extracorporal circulation, hospital stay and postsurgical complications. Logistic regression revealed female sex (B = 2.363), higher anxiety level (B = 0.451) and older age (B = 0.062) to be risk factors for SI. The total variance explained by the model was 46%. CONCLUSIONS: Assessing suicidality and negative emotions with special emphasis on anxiety simultaneously with somatic complaints is vital to address PROs alerts and improve care for patients following cardiac surgery. In-depth evaluation and psychological care are recommended in case of positive screening.

Health status and its socio-economic covariates in the older population in Poland - the assumptions and methods of the nationwide, cross-sectional PolSenior2 survey.

INTRODUCTION: Population ageing constitutes an increasing medical, social, and economic burden worldwide. Optimal senior policy should be based on well-assessed knowledge on the prevalence and control of age-related diseases, multimorbidity, disabilities, and their social determinants. The objective of this paper is to describe the assumptions, methods, and sampling procedures of the PolSenior2 survey, which was aimed at characterising the health status of old and very-old adults in Poland. MATERIAL AND METHODS: The project was conducted in the period 2018-2019 as a cross-sectional survey of a representative sample of people aged 60 years and over. Subjects were selected using three-stage stratified and proportional random sampling in seven equally sized (n = 850) age groups. The study protocol consisted of face-to-face interviews, specific geriatric scales and tests, and anthropometric and blood pressure measurements performed by well-trained nurses at participants homes as well as blood and urine sample laboratory tests. RESULTS: In the Polsenior2 study a group of 5987 subjects underwent the questionnaire parts of the survey, and almost all (n = 5823) agreed to blood or urine sample collection. CONCLUSIONS: In recent decades several studies focused on various aspects of elderly health and life conditions had been carried out in Poland and Central and Eastern Europe. However, none of them is so complex and has covered so many issues as PolSenior2, which is the largest study devoted to the health status of older persons in Poland and one of the largest and the most comprehensive in Europe. The results of the study will help to improve health policy targeted at the elderly population in Poland.

Self-limiting COVID-19-associated Kikuchi-Fujimoto disease with heart involvement: case-based review.

BACKGROUND: The association between COVID-19 infection and the development of autoimmune diseases is currently unknown, but there are already reports presenting induction of different autoantibodies by SARS-CoV-2 infection. Kikuchi-Fuimoto disease (KFD) as a form of histiocytic necrotizing lymphadenitis of unknown origin. OBJECTIVE: Here we present a rare case of KFD with heart involvement after COVID-19 infection. To our best knowledge only a few cases of COVID-19-associated KFD were published so far. Based on presented case, we summarize the clinical course of KFD and its association with autoimmune diseases, as well we discuss the potential causes of perimyocarditis in this case. METHODS: We reviewed the literature regarding cases of "Kikuchi-Fujimoto disease (KFD)" and "COVID-19" and then "KFD" and "heart" or "myocarditis" by searching medical journal databases written in English in PubMed and Google Scholar. RESULTS: Only two cases of KFD after COVID infection have been described so far. CONCLUSION: SARS-CoV-2 infection can also be a new, potential causative agent of developing KFD.

Subjective sleep quality and fatigue assessment in Polish adult patients with primary immunodeficiencies: A pilot study.

Introduction: Primary immunodeficiencies (PIDs) are clinically heterogeneous disorders caused by abnormalities in the immune system. However, PIDs are genetically determined and may occur at any age from early childhood to elderly age. Due to chronic patterns, the risk of malignancy and organ damage in patients with PIDs may affect any aspect of life, including sleep patterns. To our knowledge, the prevalence of insomnia and subjective sleep quality have not been investigated in patients with PIDs. Therefore, this pilot study was conducted to investigate sleep quality, the prevalence of sleep disturbances, and fatigue in adult patients with PIDs in Poland. Methods: All participants were surveyed using the Athens Insomnia Scale, Pittsburgh Sleep Quality Index, Fatigue Severity Scale, and a questionnaire concerning general health and demographic data. We included 92 participants: 48 women (52.2%) and 44 men (47.8%). Results: Participants' mean age was 41.9 ± 13.9 years. The mean sleep duration was 7.0 ± 1.5 hours, and the mean sleep latency was 41.2 ± 53.1 minutes. Additionally, 44.6% of patients (n=41) had symptoms of insomnia and 44.6% (n=42) had poor sleep quality. Less than one-fourth (n=22; 23.9%) of the patients reported the use of sleeping pills; moreover, clinically significant fatigue was reported in 52.2% (n=48). Discussion: Our investigation provides insight into the problem of sleep disturbances in patients with PIDs. Data have demonstrated that sleeping disorders with concomitant fatigue are common in patients with PID. Further studies are needed to determine the determinants of poor sleep quality in this specific group of patients.

Lung Ultrasonography as an Accurate Diagnostic Method for the Diagnosis of Community-Acquired Pneumonia in the Elderly Population.

Community-acquired pneumonia (CAP) is one of the most common causes of both hospitalization and death in elderly patients. The chest x-ray (CXR) is nowadays still the imaging method of choice for patients suspected of having pneumonia. However, the sensitivity of CXR, particularly bedside chest radiography, is relatively low. Chest computed tomography, the procedure of higher precision, cannot be conducted routinely for safety, organizational, and economic reasons. Thus, lung ultrasonography (LUS) could be the most accurate diagnostic tool for CAP in the geriatric population.This prospective observational study involving 191 elderly patients (older than 65 years), hospitalized because of suspicion of pneumonia, aimed at comparing the diagnostic accuracy of LUS and CXR to final clinical diagnosis. During the first hours of hospitalization, both CXR and LUS were conducted. At discharge, pneumonia diagnosis was confirmed in 115 patients (60.2% of the study group). Chest x-ray revealed inflammatory lesions in only 65 patients (34% of the study group, 56.5% of the patients with final pneumonia diagnosis), whereas LUS was positive in 114 patients (59.7% of the study group, 99% of the patients with final pneumonia diagnosis). Sensitivity and specificity of LUS in pneumonia diagnosis were, respectively, 99% and 98.7%, whereas CXR sensitivity and specificity were 56.5% and 100%, respectively. The positive and negative predictive values of LUS were 99% and 98.7%, whereas, for CXR, they were 100% and 60.3%, respectively.Lung ultrasonography proved to be more effective at revealing pulmonary inflammatory lesions as compared with CXR in elderly patients suspected of pneumonia.

Letter to Editor. Thromboembolic complications in psychiatry from the perspective of legal claims - authors response. / List do redakcji. Powiklania zakrzepowo-zatorowe w psychiatrii z perspektywy roszczen prawnych ­ odpowiedz autorów.

no summary.

Palaeoproteomics resolves sloth relationships.

The living tree sloths Choloepus and Bradypus are the only remaining members of Folivora, a major xenarthran radiation that occupied a wide range of habitats in many parts of the western hemisphere during the Cenozoic, including both continents and the West Indies. Ancient DNA evidence has played only a minor role in folivoran systematics, as most sloths lived in places not conducive to genomic preservation. Here we utilize collagen sequence information, both separately and in combination with published mitochondrial DNA evidence, to assess the relationships of tree sloths and their extinct relatives. Results from phylogenetic analysis of these datasets differ substantially from morphology-based concepts: Choloepus groups with Mylodontidae, not Megalonychidae; Bradypus and Megalonyx pair together as megatherioids, while monophyletic Antillean sloths may be sister to all other folivorans. Divergence estimates are consistent with fossil evidence for mid-Cenozoic presence of sloths in the West Indies and an early Miocene radiation in South America.

Risk and prophylaxis of venous thromboembolism in hospitalized psychiatric patients. A review. / Ryzyko i profilaktyka zylnej choroby zakrzepowo-zatorowej u pacjentów hospitalizowanych z powodu zaburzen psychicznych. Przeglad badan.

Venous thromboembolism (VTE) is a frequent dangerous complication occurring during hospital treatment with total annual incidence of 70-200 per 100,000 citizens. Venous thromboembolism includes deep vein thrombosis (DVT) and pulmonary embolism (PE). Pulmonary embolism is responsible for about 10% of hospitalization-related deaths and is the most common avoidable reason for deaths in hospitals. Psychiatric inpatients are particularly vulnerable to an increased risk of VTE due to their limited mobility, the use of restraints, catatonia, communication difficulties, and the use of antipsychotics. Patients with chronic psychiatric conditions like schizophrenia and recurrent affective disorders have significantly higher somatic comorbidity. This population of patients requires specific approach to VTE prophylaxis during hospitalization. This article offers an insight into issues related to thromboembolism, and presents validated diagnostic tools and VTE prophylaxis strategies. The paper includes the review of available research on VTE in patients hospitalized for psychiatric reasons. Considering the scarcity of specific studies in this population we highlight the necessity to follow the available general medical guidelines for psychiatric inpatients.

How do patients and doctors-to-be perceive systemic lupus erythematosus?

The aim of the present study was to assess and compare illness perception of systemic lupus erythematosus (SLE) held by 6th-year medical students and patients suffering from SLE. The study group consisted of 104 students (66 women; 63.5 %), mean age 24.7 (±1), and 64 outpatients with SLE (60 women; 93.7 %). All patients were treated at a university rheumatology outpatient clinic. Mean patients' age was 44.3 years (±12.5). Mean duration of the disease was 11 years (±6.8). The Polish version of Brief Illness Perception Questionnaire (B-IPQ) was used to assess five dimensions of illness perception. The students were asked to complete a modified version of B-IPQ designed to measure health professionals' illness perception. Significant differences were found in all but one B-IPQ scores. The students obtained significantly higher scores than the SLE patients in consequences, identity, concern and emotional response, whereas significantly lower scores in personal control, treatment control and understanding were noted among students. No differences were found in timeline scores. Medical students' perception of SLE is more threatening and more negative than that of patients'. Doctors-to-be perceive SLE as being less controllable, more burdensome and having more consequences than patients do. Additionally, they believe the disease causes more emotional concern. The article discusses possible explanations together with positive and negative aspects of the discrepancies.

Illness perception in Polish patients with chronic diseases: Psychometric properties of the Brief Illness Perception Questionnaire.

The study evaluates the psychometric properties of a Polish translation of the Brief Illness Perception Questionnaire. A total of 276 patients with chronic conditions (58.7% women) completed the Brief Illness Perception Questionnaire and the Hospital Anxiety and Depression Scale. The internal consistency of the Polish Brief Illness Perception Questionnaire measured with Cronbach's alpha was satisfactory (α = 0.74). Structural validity was demonstrated by significant inter-correlations between the Brief Illness Perception Questionnaire components. Discriminant validity was supported by the fact that the Brief Illness Perception Questionnaire enables patients with various conditions to be differentiated. Significant correlations were found between Brief Illness Perception Questionnaire and depression and anxiety levels. The Polish Brief Illness Perception Questionnaire thus evaluated is a reliable and valid tool.

[Macrophage activation syndrome: report on three cases]. / Zespól aktywacji makrofagów--opis trzech przypadków.

The macrophage activation syndrome (MAS) is a rare and potentially fatal disease. This syndrome is founded on congenital or acquired dysfunction of NK cells resulting in secondary activation and proliferation of macrophages with excessive cytokine production and organ infiltration. Causes of acquired MAS include viral infections (chiefly EBV and CMV), malignancies, and autoimmune diseases. The macrophage activation syndrome is usually associated with juvenile idiopathic arthritis and adult-onset Still's disease and rarely with rheumatoid arthritis, systemic lupus erythematosus, dermatomyositis, and systemic sclerosis. Fever, hepatosplenomegaly, lymphadenopathy, and bi- or pancytopenia in peripheral blood represent typical symptoms of MAS. Hyperferritinemia, hypertriglyceridemia, hypertransaminasemia, and hypofibrinogenemia are among the common laboratory findings. The macrophage activation syndrome is a life-threatening condition requiring aggressive therapy due to multiple organ dysfunction. Treatment also includes elimination of the triggering infection and high-dose glucocorticosteroids. Second-line therapy is based on cyclosporin, intravenous immunoglobulins, and etoposide. The present work focuses on diagnostic and therapeutic difficulties in three patients with the macrophage activation syndrome.

[Diabetes and road traffic collisions]. / Cukrzyca a kolizje w ruchu drogowym.

Insulin-treated diabetes influences motor vehicle driving mainly through the possibility to induce hypoglycemia in patients. However, there has never been any consistent evidence to suggest that patients with insulin-treated diabetes cause significantly more accidents than the general population. Diabetes and its complications have very various individual courses in patients, because of that candidates for driver's license should always be qualified individually. Drivers with diabetes complications, especially the elderly, quite often themselves limit driving. The programme facilitating the diagnosis of early hypoglycemic symptoms--Blood Glucose Awareness Training--decreases road traffic collision number.

[Acute intoxication with zaleplon--a case report]. / Ostre zatrucie zaleplonem--opis przypadku.

UNLABELLED: There has been little data in the medical literature about intoxication with a new hypnotic agent zaleplon. The zaleplon, chemically N-[3-(3-cyanopyrazolo[1,5-a]pyrimidin-7-yl)phenyl]-N-ethylacetamid, is a selective agonist of the benzodiazepine omega 1 receptor subtype. The case of a 15-year-old female who eat 60 mg of zaleplon (1.2 mg/kg) because of suicidal attempt was described. At the admission to the hospital the somnolence, blurred speech, slowdown, ataxia, tachycardia and hypokalaemia were observed. The child was treated symptomatically, and discharged from the hospital for further psychologic treatment after 36 hours. CONCLUSIONS: Acute intoxication with zaleplon had mild clinical course. The signs of intoxications were drowsiness, blurred speech, ataxia, tachycardia, dizziness, confusion and vomiting. The described case required only symptomatic treatment.

[Acute intoxication with clonidine--a case report]. / Ostre zatrucie klonidyna--opis przypadku.

The case of a 24-year-old female who ingested 45 tablets of clonidine (Iporel á 0.075 mg) in the total dose of 3,375 mg in suicidal attempt was described. At the admission to the hospital the patient had complained of drowsiness and weakness. She was conscious but somnolent. Minimal blood pressure was 90/50 mmHg. The patient was treated with gastric lavage and crystalloids infusion. During two days of observation the symptoms were rapidly retreated.

[Insulin resistance in type 2 diabetes patients]. / Insulinoopornosc u chorych na cukrzyce typu 2.

Among 1052 type 2 diabetics 11 patients with insulin requirement from 102 to 138 (average 123) i.u. were selected. They were only 1% of the population. Two of them (average age 49,5 years) suffered from diabetes 4 and 6 years, had BMI 26-27 kg/m2 and were free of other metabolic syndrome manifestations. Nine patients (8 women and one man) with average parameters--62 years-old, diabetes duration 15.7 years, BMI 34,7 kg/m2 suffered from metabolic syndrome and its complications such as ischemic heart disease and/or state after stroke. The attempt of treatment 7 patients with metformin (2550 mg/24h) for 3-4 months has not caused significant decrease of daily insulin requirement.

[Recurrence of pheochromocytoma in the second adrenal gland 19 years after adrenalectomy]. / Nawrót pheochromocytoma w drugim nadnerczu po 19 latach od wykonania adrenalektomii.

A case of the patient who underwent by bilateral adrenalectomy at the age of 37 and 56 years due to recurrent pheochromocytoma has been described. The authors stress that follow-up of patients after adrenalectomy is mandatory on lifetime basis.

Cholestasis induced by parabolan successfully treated with the molecular adsorbent recirculating system.

We describe a case of a 21-year-old male bodybuilder who overdosed on Parabolan (trenbolone acetate) because of its anabolic activity. The patient, with no previous medical history, experienced pruritus and yellow discoloration of the skin and sclerae. Basic biochemical laboratory examination revealed signs of cholestasis with a serum bilirubin level of up to 65.5 mg/dl. Because supportive medical treatment was ineffective, the patient was treated with the molecular adsorbent recirculating system (MARS). Five MARS cycles lasting from 8 to 12 hours were performed every second day. The procedure was well tolerated by the patient and resulted in a sustained relief of pruritus. At the 2-month follow-up visit the plasma bilirubin level had decreased to 2 mg/dl.