Pain Assessment in Patients Undergoing Maggot Debridement Therapy in the Process of Local Treatment of Chronic Wounds.

(1) Background: Developing and implementing strategies for local wound care focused on improving the quality of life related to health status and reducing treatment costs for this patient group poses a challenge to contemporary healthcare systems. The utilization of Maggot Debridement Therapy (MDT) is one potential form of local therapy for preparing wounds for the healing process. The debridement of the wound bed with medical maggots is highly precise, and the defensins produced by the larvae eliminate bacteria and stimulate tissue regeneration. However, the presence of larvae in the wound may lead to the occurrence of pain symptoms. The aim of the study was to assess the intensity of pain during larval therapy in patients with chronic wounds treated in outpatient settings. (2) Patients and Methods: The study employed a diagnostic survey and estimation; the tool consisted of a research protocol comprising three parts (questionnaires). Inclusion criteria for the study were voluntary consent to participate (completion of the MDT acceptance questionnaire), chronic wounds of vascular etiology or pressure injuries, full-thickness skin or deep tissue damage, and pain intensity not exceeding four on the NRS (Numerical Rating Scale: 0-no pain, 10-the most severe pain) at the time of the study. Patient observation during the 3-day treatment was conducted by a wound care clinic nurse, assessing pain intensity once every 24 h during the larval dressing changes. (3) Results: Out of 348 individuals who qualified for MDT during the study period, 215 individuals participated in the study: 94 women (43.7%) and 121 men (56.3%). The age of the participants ranged from 28 to 97 years (mean 69.87 ± 12.95). Each participant experienced mild pain (2.26 ± 1.60 on the NRS) on the day of qualification for the study. An increase in pain intensity, according to subjective assessments, was reported by 29.3% of participants (n = 63). On the third day of MDT therapy, an increase in pain intensity was observed, reaching a mean value of 4.79 ± 2.12 (p < 0.0001). Participants with pressure injuries showed the lowest pain intensity, which increased in consecutive days for all types of wounds. Additionally, the increase in pain intensity in patients with vascular etiology wounds was greater compared to patients with pressure injuries (p < 0.001). (4) Conclusions: Local wound therapy with Lucilia sericata larvae increases pain intensity in the consecutive days of treatment. The wound area and the time since its occurrence may determine pain symptoms.

Variables Associated with Attitudes toward Biodebridement Using Lucilia sericata Larvae in a Group of Nurses.

Despite numerous studies and recommendations, the acceptance of treatments involving medicinal maggots in many clinics has been slow. Several factors may account for this, including the gender of nurses administering the treatment, their level of work experience, and their perceived level of personal stress. The aim of the study was to assess the impact of selected variables (gender, work experience, stress level) on the readiness of nurses to administer maggot debridement therapy (MDT), which is a form of biodebridement. The study population was a cohort of 290 wound care nurses providing specialist care for patients with chronic wounds. It was assumed that the identified variables may determine the implementation of larval therapy in everyday professional practice. A subsample of 35 men and 35 women was further analyzed to determine if gender, work experience, and/or personal stress levels were correlated with attitudes towards the utilization of maggots in biodebridement. Assessment tools included the Perceived Stress Scale (PSS-10) and the MDT 10 Perception Assessment Questionnaire, a protocol by which the subject ranked six wound photographs in order of repulsiveness and responded to questions regarding demographic variables, which include education and work experience. The visual perception of pictures of a wound with larvae is indirectly an indicator of the attitude towards larval therapy. Selection of the photograph with maggots on the wound as the most repulsive image was associated with a personal appraisal of not being ready to implement maggot therapy (chi-square = 8.430, p = 0.015). Low work experience (chi-square = 14.039, df = 4, p = 0.007), and low readiness for MDT (chi-square = 8.430, df = 2, p = 0.015) were also associated with unpreparedness to administer maggot therapy. Neither gender nor perceived stress level were exclusively associated with disgust for maggots or lack of readiness to implement MDT. Low professional experience and a deficit of knowledge in maggot therapy may negatively affect the readiness of nurses to administer biodebridement. Gender and personal stress levels do not affect nurses' readiness to utilize larval therapy.

Quality of life and its selected determinants in the group of patients with surgically treated spinal tumors.

Introduction: Spinal metastases are a common manifestation of advanced neoplastic disease. Destructive neoplastic lesions within the axial skeleton cause unrelieved pain and nervous system disorders involving spinal stenosis and other neural structures. The development of new systemic therapies, radiotherapy and minimally invasive spinal surgeries has increased patients' quality of life by minimising pain and neurological disorders due to vertebral neoplastic infiltration. The aim of the study was to assess the patients' quality of life before and after spine stabilisation surgery with spinal cord decompression to relieve the pressure associated with neoplastic destruction. Materials and Methods: The study involved 115 subjects with spinal metastases in the preoperative period and 3-4 months after the surgery based on the inclusion criteria (metastatic spinal tumour, sensorimotor dysfunction). The data were collected using the following tools: the Rotterdam Symptom Checklist (RSCL-Rotterdam Symptom Checklist), Acceptance Illness Scale (AIS scale), Activities of Daily Living Scale (ADL scale) and Visual Analogue Scale (VAS). The correlation coefficient was calculated using Spearman's rho assuming the significance level at α = 0.05 (p<0.05). Results: A higher quality of life was found after surgery (p<0.001) in terms of experiencing physical symptoms (30.7 ± 11.96 points before surgery vs. 20.91 ± 13.00 points after surgery) and psychological symptoms (43.98 ± 14.82 points before surgery vs. 31.35 ± 14.86 points after surgery). The activity level of the subjects also improved (p<0.001; 36.56 ± 22.43 points to 43.55 ± 20.40 points). The level of disease acceptance in the study group was higher after the surgery compared to the preoperative assessment. The subjects with a high level of disease acceptance presented a higher quality of life postoperatively. The independence of the subjects in performing everyday activities after the operation influenced the quality of life, in terms of somatic symptoms (p=0.006), mental symptoms (p=0.001) and activity (p<0.001). Along with the improvement in functional capacity, the quality of life in terms of symptoms and activity levels increased. Conclusion: The study showed that spinal cord decompression surgery improves the quality of life of patients by reducing neurological dysfunction, increasing the acceptance of the disease and the ability to perform activities of daily living (ADL). Sociodemographic variables did not affect the quality of life of the respondents.

Larval Wound Therapy: Possibilities and Potential Limitations-A Literature Review.

Patient-centered care (PCC) is recognized as a standard in healthcare for determining high quality. Honoring patients' values, experiences, needs, and preferences in devising, coordinating, and delivering care underscores the enhancement of the therapeutic rapport between patients and healthcare providers. Wound treatment involves a multi-stage process encompassing diagnostics and local wound dressing, which reduces the risk of infection through a coordinated interdisciplinary team. Within this team, nurses undertake specific professional functions and roles. The implementation of local therapy using innovative and scientifically substantiated methods may be hindered by a deficit of knowledge or inappropriate knowledge among staff and patients themselves. This study presents the challenges concerning the care of patients with chronic wounds treated using Lucilia sericata larvae, based on a review of the current scientific literature. A critical analysis of the literature spanning from 2002 to 2022 was conducted using the Medline, PubMed, Cochrane, and Termedia databases, employing keywords such as "maggot debridement therapy" in relation to acceptance and perception. As a result of the preliminary selection, 472 papers were identified, of which 12 publications were included in the development of this concept. The acquired data were organized and presented in the concluding section in the form of tables, accompanied by descriptions and references to individual studies. Negative psychological and somatic sensations were among the most prominent challenges among patients treated with Maggot Debridement Therapy (MDT). Pain related to peripheral ischemia or infection in this group of patients requires pain prophylaxis, including hyperalgesia and allodynia, in order to improve method tolerance. On the other hand, augmenting patients' understanding of MDT diminishes negative emotions, reinforces positive behaviors, and mitigates anxiety levels. MDT constitutes an effective and safe method. Its widespread use for chronic wounds requires substantial knowledge among healthcare professionals and patient education, along with that of their caregivers, to develop a positive attitude.

Nutritional Status of People with a Coexisting Chronic Wound and Extended Assessment Using Bioelectrical Impedance.

The diagnosis of malnutrition should be one of the pillars of comprehensive patient care, especially in the case of patients with large wounds, prolonged healing, or comorbidities. The condition for a reliable and accurate nutritional diagnosis is to link it with the parameters of nutritional status assessment at the basic level (anthropometric measurements and clinical assessment) and in depth (biochemical tests and bioelectrical impedance). A prospective study included a sample of 60 patients with coexisting chronic wounds (venous ulcers, diabetic foot syndrome, pressure injury) treated at the Wound Treatment Clinic of Fr. B. Markiewicz Podkarpackie Oncology Center (Poland). The method of estimation and diagnostic survey was used; the research tool was a scientific research protocol consisting of four parts. Self-care capacity was assessed based on the Barthel scale, nutritional status using blood biochemical parameters, and electrical bioimpedance. Wounds were classified according to the extent, depth of tissue structures, and potential infection. Subjects with pressure ulcers had statistically significantly lower fat-free mass component indices compared to those with diabetic foot syndrome and venous ulceration. The subjects with pressure ulcers had significantly lower values of body composition components compared to those with diabetic foot syndrome and venous ulcers. In the group of patients with pressure ulcers, the lowest values of albumin (3.20 g/dL), hemoglobin (10.81 g/dL), and nutritional risk index (NRI) (88.13 pts.) scores were confirmed. Subjects with pressure ulcers with limited self-care presented a non-physiological nutritional status, indicating a risk of malnutrition. Local actions related to wound treatment should be preceded by a general examination, considering the state of augmented nutrition with the use of electrical bioimpedance.

Defensins of Lucilia sericata Larvae and Their Influence on Wound Repair Processes in Practical Assessment-A Study of Three Cases.

Bacteria inhabiting chronic wounds form a biofilm that prolongs and slows down the healing process. Increasingly common antibiotic resistance requires clinicians to search for effective and alternative treatment methods. Defensins are the most common antimicrobial peptides capable of eradicating pathogens. Their discovery in maggot secretions allowed for a broader understanding of the healing mechanisms, and approving the use of Lucilia sericata fly larvae in the treatment of infected wounds resulted in an effective and safe procedure. The aim of the study was to present the possibility of biofilm elimination in a chronic wound by means of medical maggots (Lucilia sericata) with the example of three selected clinical cases. The observation included three women who met the inclusion criterion of having venous insufficiency ulcers with inhibited regeneration processes. Medical maggots were applied in a biobag for three days, and observation was conducted for 21 consecutive days. In 2 cases, a significant elimination of necrotic tissue from the wound bed with local granulation tissue was observed 72 h after application of a larvae colony on the wounds. In 1 case, the application of the larvae accelerated the repair process by reducing the wound area by approximately 40% at the time of observation. The formation of biofilm in a chronic wound is one of the main causes of disturbances in its effective healing. Combining procedures (scraping, antiseptic compresses, MDT, NPWT) related to wound debridement increases the effectiveness of biofilm elimination. The use of medical maggots is a safe and effective method of choice, and it enhances the processes of debridement. However, confirmed indisputable data on their effectiveness and frequency of use in the process of stimulating healing processes are still not available in the literature.

Nurses' Readiness to Undertake Controlled Negative Pressure Therapy in the Treatment of Chronic Wounds-Research Report.

Local wound treatment with negative pressure wound therapy (NPWT) shortens the healing process but requires the supervision of trained medical personnel for administering the therapeutic procedures. Professional supervision and control of the effectiveness of NPWT, as well as education conducted by nurses, are of particular importance for therapeutic and caring processes, both in hospital and at home. The aim of the study was the assessment of the perception of NPWT by certified nurses in the topical treatment of chronic wounds. The study was conducted using the method of estimation and a diagnostic survey with the proprietary NPWT perception questionnaire: 495 subjects were enrolled in the study and 401 respondents aged 25-67 years qualified for statistical analysis. Despite their experience and competence, the respondents critically assessed their knowledge, pointing to an average subjective level of knowledge related to wound treatment and a low level of knowledge related to NPWT. Most of the respondents had no experience of independent treatment using this method. The data obtained from the questionnaire clearly indicate theoretical preparation and high motivation to undertake activities related to the implementation of NPWT in their own practice. Low readiness values suggested that the subjects did not have the resources or the ability to implement the method. The perception of NPWT in the surveyed group of nurses was determined by numerous factors, including self-assessment of their own knowledge, motivation and readiness to use NPWT. A high level of NPWT perception was noted, despite low motivation related to the availability and knowledge of the method. Theoretical knowledge is insufficient to implement innovative methods in local wound treatment. Practical skills and motivation are indispensable elements that should be met during the training and education of nurses in the field of wound care.

Can Singing in a Choir Be a Key Strategy for Lifelong Health? A Cross-sectional Study.

INTRODUCTION: Singing in a choir can play a significant role in a strategy for lifelong health. This study aimed to assess the nutritional status and the quality of life of healthy adults singing in a choir. METHODS: The cross-sectional study, carried out from August 2017 to June 2018, was preceded by a weekly pilot study. A total of 100 choristers (72 women, 72.0%) aged 19-70 years (mean age was 38.30 ± 15.99 years) were included in the study. The control group consisted of 100 healthy adults (68 women, 68.0%) aged 19-70 years (mean age was 38.48 ± 16.09). RESULTS: Significantly lower body weight and body mass index and significantly lower results of selected body composition components (P< 0.05) were found in the study group in comparison with the control group. The choristers showed significantly lower values of basal metabolic rate (P= 0.004) and metabolic age (P< 0.001). In addition, a significantly higher quality of life was observed in the group of choristers in each of the domains tested (P < 0.05). CONCLUSION: Singing in the choir may have effect on lifelong health, defined as better nutritional status and better perception of quality of life and health.

Selected Factors Influencing the Intensity of Postoperative Pain in Patients after Orthopedic and Gynecological Surgeries.

Currently, pain is considered the fifth vital sign, and its effective relief is a priority in many surgical departments. The aim of this study was to determine the influence of selected factors on the intensity of postoperative pain after orthopedic and gynecological procedures. The study was conducted in a group of 200 patients undergoing orthopedic and gynecological procedures at the County Hospital in Nisko between August 2017 and January 2018. The method of estimation and document analysis was applied in the course of the study. A standardized tool was used­Polish adaptation of the Melzack Pain Questionnaire (MPQ), an individual documentation of patients and a scientific and research questionnaire developed by the authors. The tests were conducted for three consecutive days from the day of the operation. The strongest pain immediately after surgery was experienced by the patients after general endotracheal anesthesia, and the mildest after full intravenous short-term anesthesia (p < 0.05). Procedures lasting more than 60 min were associated with greater pain intensity on all tested days. The sex of the patient did not significantly affect the level of the perceived intensity of postoperative pain (p > 0.05). The highest intensity of pain occurred on day 0 after surgery, with a declining trend in the following days (p < 0.001). The highest intensity of postoperative pain was caused by gynecological procedures as well as laparotomy and arthroplasty (p < 0.001). The variability of the results indicates the need for an individual approach to each patient, both in pain assessment and treatment. Therefore, continuous improvement of the quality of health services provided in accordance with the guidelines for pain relief is necessary.

Does Body Position Influence Bioelectrical Impedance? An Observational Pilot Study.

As the availability of various bioelectric impedance analysis (BIA) tools is increasing, the patient's position during the test may be of significant importance for the comparability of the results. An observational pilot study was undertaken between March and May 2021 at the Center for Innovative Research in Medical and Natural Sciences at the University of Rzeszow, Rzeszów, Poland. All participants (n = 49: M: 21.05 y ± 1.12 vs. F: 21.34 y ± 2.06) were subjected to measurements of selected nutritional status indicators and body components in three positions: lying, sitting and standing. The body composition indicators were obtained using a bioelectrical impedance device, AKERN BIA 101 Anniversary Sport Edition Analyzer (Akern SRL, Pontassieve, Florence, Italy). The results were analyzed using dedicated software (BodygramPlus 1.2.2.12 from AKERN 2016, Florence, Italy). Our observations indicate that there is a significant difference between lying and standing as well as sitting and standing with respect to anthropometric and nutritional indicators (resistance, reactance, phase angle, standardized phase angle, body cell mass index and fat-free mass index) and body composition components, with particular reference to intracellular and extracellular water. The described differences are significant for both sexes. This study showed that this significantly influenced the scores of components directly related to resistance, reactance and hydrated cell mass, while not affecting the percentages or absolute values of fat and fat-free mass.

Perception and Readiness to Undertake Maggot Debridement Therapy with the Use of Lucilia sericata Larvae in the Group of Nurses.

The sight and smell of larvae in the wound may cause negative visual and olfactory impressions in sensitive individuals because of decaying body parts, carrion, and suffering. However, Maggot Debridement Therapy (MDT) is highly effective, safe, and cheap in wound healing and tissue revitalization for both the patient and health systems. The aim of the study was to assess the readiness to undertake MDT in a group of qualified nurses who perform therapeutic procedures in patients treated for chronic wounds. A diagnostic survey was used. The research tool was a scientific research protocol consisting of three questionnaires (sociodemographics, MDT perception questionnaire, pictures of wounds for visual assessment). The study included 290 nurses; the mean age was over 42.6 ± 9.9 years, and the median was 44 years. The perception and readiness to implement the method in the tested sample is at the average (standard) level. The image of maggots in the wound causes negative emotions among medical personnel. The higher the knowledge of the MDT method, the greater the motivation to implement it in practice.

The nutritional status of healthy children using bioelectrical impedance and anthropometric measurement.

OBJECTIVE: Monitoring of healthy children should include precise assessment of their nutritional status to identify children and adolescents at risk of nutrition disorders. Therefore, the aim of this study was to assess the nutritional status of healthy children using different nutritional risk screening tools. METHOD: The study sample consisted of 550 participants within the age range of 7-15 years. Anthropometric characteristics (body mass, height, body mass index) were collected using standard procedures. In addition, the following parameters were analyzed: fat mass, fat-free mass, body cell mass, and total body water. RESULTS: The results revealed that variables such as children's age and sex significantly differentiated the values of selected components of the body composition. CONCLUSIONS: This observation suggests that it is necessary to use different methods to evaluate nutritional status among healthy children.

Perceived stress and readiness to undertake biodebridement in the group of nurses undertaking prevention and treatment of chronic wounds.

Introduction: Stress as the body's response to adverse stimulus is recognized as one of the key problems in basic and clinical neurological studies. Stress is an indispensable component of modern nursing with its low doses being desirable, however, prolonged stress is detrimental to health increasing the risk of chronic disease i.e., hypertension, cardiovascular diseases, electrolyte disturbances, occupational burnout, depression, anxiety disorders. The implementation of certain techniques and therapeutic methods may have a stressful effect from the point of view of practice and the patient's condition. Methods: The authors undertook the study to assess the intensity of the perceived stress in the group of nurses dealing with wound care in the perspective of implementing wound debridment using Lucilia sericata larvae. The study group consisted of 290 nurses specialized in chronic wounds undergoing training at the Postgraduate Training Center of Nurses and Midwives in Rzeszów, out of the entire group of 1.136 individuals participating in training courses organized in Poland in 2020-2021. The study used the diagnostic survey method, the research tool was a scientific research protocol consisting of tools (MDT perception questionnaire, perceived stress scale (PSS-10). Results: Certain differences in the level of stress in the study sample were observed between age categories, but they were not statistically significant. The greatest differences between the levels of stress in the study sample were observed between people who completed treatment courses and those who did not complete these courses. The higher the stress level, the lower the willingness to undertake such therapy. The analysis of grouped data leads to interesting observations. There were statistically significant differences in the score in the MDT10 scale in the categories of people with different stress levels. The highest readiness to implement MDT was observed in the category of people with the lowest perceived level of stress. Conclusions: The level of professional experience related to postgraduate education increases opportunities addressing new professional challenges. The level of perceived stress may influence decisions related to the use of biological therapy. The higher the level of stress, the lower the readiness to undertake MDT.

Application of Lucilia sericata Larvae in Debridement of Pressure Wounds in Outpatient Settings.

Biological therapy using Lucilia sericata larvae has numerous advocates worldwide, yet it is still fairly unknown and not commonly applied in daily practice because of the limited awareness and insufficient experience of medical and nursing personnel. There are case reports suggesting that maggot therapy can be applied and supported by lay caregivers, provided they are supervised and informed by physicians/nurses. The foregoing observation suggests that the method should be considered for implementation by a wider group of caregivers if accepted and meticulously supervised by trained and experienced medical staff. The concerns related to the therapeutic use of maggots in certain regions seem understandable, but are not supported by scientific facts. It should be noted that many therapeutic agents (including brood) used in medicine are of natural origin, and are associated with low production costs and high possibilities of implementation in the course of therapy. By analyzing the literature and using our own clinical and research experience, we have come to conclusions related to using larvae therapy, as a quick and safe method providing cleaning and revitalization in the process of treating wounds of various etiologies, especially pressure ulcers. In the current study, medical-grade Lucilia sericata maggots were applied to remove necrotic tissue from deep pressure sores. The treatment is mostly accepted by both caregivers and patients. In most cases, it is conducted by trained and experienced medical personnel in home and outpatient settings. Over the course of the conducted analyzes involving the collected specimens, there were no statistically significant relationships (p> 0.05) confirmed between the wound surface successfully cleared by brood and variables, such as time from wound formation, location, surface size, and the depth of damage to the tissue structure. The lack of statistical dependence may result from the small size of the studied group. Based on the current findings, we have formulated the following conclusions: Maggot Debridement Therapy (MDT) is a fast and effective method enabling the preparation of the wound bed. The use of MDT in outpatient settings is safe and acceptable for patients and their caregivers.

Body Composition and Selected Nutritional Indicators in Healthy Adults-A Cross-Sectional Study.

BACKGROUND: Body mass composition is subject to constant change and is multifactorially determined. Its analysis in different age groups allows a better understanding of the determinants of the human organism in health and disease. AIM: The study was aimed to conduct cross-sectional assessment of body composition and selected nutritional indicators in healthy adults. METHODS: The cross-sectional study carried out from March 2016 to April 2018 was preceded by a monthly pilot study. All 1333 adults (women 795, 59.6%) aged 20-59 included in the study were from the urban and rural area of the Podkarpackie Province (Poland). These adults were classified into four 10-year age bands. To obtain reliable assessment, selected screening (anthropometry) and in-depth (bioelectrical impedance including phase angle and bioelectrical impedance vector analysis) methods were used. RESULTS: In women, the proportion of individuals affected by overweight and obesity increases significantly with age, with a less pronounced trend in men, as reflected in the observed differences in individual body composition components. A slight (0.45-0.60) correlation was also observed between body mass index (BMI) and percentage of fat mass (FM %) among men with an increasing strength of the association with age, decreasing in the 50-59 years group. In the female group, the correlations described are at a much higher level (0.80 or higher). The described changes in body composition were reflected in body type from athletic to obese, measured by means of the bioelectrical impedance vector analysis (BIVA) method. CONCLUSIONS: Age and gender significantly differentiate body composition of the adult human body. The body composition analysis should be considered as complement screening assessment method, especially as a support for the assessment of nutritional status expressed by BMI.

Selected Biochemical Blood Parameters and a Risk of Pressure Ulcers in Patients Receiving Treatment in Intensive Care Units.

Background and Objectives: This study aimed to assess the level of selected biochemical parameters in venous blood and their potential effects on the development of pressure ulcers in patients treated in intensive care settings. Materials and Methods: Fifty patients hospitalised in an intensive care unit (ICU) were enrolled for the study. The methods used included controlled observation, literature review and medical record analysis. The observation protocol applied in the study consisted of two parts comprising the basic information, sociodemographic data, results of laboratory tests (CRP, PCT, albumin, protein and haemoglobin concentrations) as well as the Braden Scale for Predicting Pressure Ulcer Risk. Results: The subjects presented moderate to high risk of pressure ulcers, reflected by the mean score of 8.18 ± 1.3 points, with minimum and maximum scores of 6 and 12 points, respectively. Normal albumin level was identified in only five subjects (10.0%) while 45 subjects (90.0%) were found with results below the norm. A statistical relationship was observed between such variables as albumin concentration (p < 0.01) and total protein level (p = 0.007). The findings show a strong correlation between the score in the Braden Scale and the level of albumins (R = 0.55). Conclusions: In our study, lower concentrations of albumins and total proteins correspond to a greater risk of pressure ulcers.

Using Maggot Debridement Therapy in Treatment of Necrosis in the Forearm Caused By Docetaxel Extravasation: A Case Report.

Extravasation of doxorubicin, vincristine or vinblastine leads to necrosis, damage of the muscles and nerves, deep ulceration, as well as limb dysfunction. Necrosis and deep ulcers develop within 7 to 28 days. Like necrotomy, Lucilia sericata maggot therapy is recognised as a method enabling effective, safe and quick removal of necrotic tissue. The purpose of the study was to present local treatment of hypodermic necrosis caused by docetaxel extravasation in course of systemic cancer therapy. A woman, 59 years of age, in course of systemic therapy due to advanced cancer of the left breast (T2N1M1 CS IV) with confirmed metastases within the body of the fourth lumbar vertebra and in the liver, receiving a combination treatment with pertuzumab, trastuzumab, and docetaxel. During the therapy, a conservative treatment was applied due to extravasation for over three months. Effects in the right forearm included swelling, redness, signs of 4x10cm inflammatory infiltrate, with 1x4cm necrotic crust visible in the central region. Hypodermic necrosis was debrided using L. sericata maggots, and subsequently specialist dressings were applied to promote granulation and healing. In the case discussed here, effectiveness of MDT was rather poor, however the treatment minimised the risk of infection associated with evacuation of necrosis. Attempts to use MDT should be continued to enable more comprehensive understanding of problems related to management of necrosis in wounds developing during cancer therapy.

The Relationship between Selected Body Composition Components and Cardiopulmonary Resuscitation Parameters in Nurses: An Observational Simulation Study.

The provision of cardiopulmonary resuscitation (CPR) may be related to the physical parameters of the medical personnel, including fat mass (FM) and fat-free mass (FFM) components. In this study, we aimed to assess the relationship between selected body composition components and chest compression and ventilation parameters provided by medical staff. An observational simulation study was undertaken between December 2017 and January 2019 at the Center for Innovative Research in Medical and Natural Sciences of Rzeszów. In all participants (505 nurses, 37.71 y ± 12.16), the body weight and height were measured and the body mass index (BMI) was calculated. The body composition indicators were obtained using a bioelectrical impedance device, AKERN BIA 101. Afterwards, all participants performed CPR sequences (30 chest compressions and rescue for 2 breaths) for 2 min on a Laerdal Resusci Anne simulator placed on an examination couch with a self-inflating bag and a face mask. Our observations proved that high values of the anthropometric, nutritional and body composition parameters of the medical staff demonstrated a positive significant correlation with the depth and rate chest parameters and were inversely related to the chest adequate recoil. No statistically significant differences were found between the FM or FFM components and ventilation parameters. This study showed that nutritional status and body composition components may be important factors affecting the quality of CPR.

Negative Pressure Wound Therapy in Pyoderma Gangrenosum Treatment.

BACKGROUND Pyoderma gangrenosum (PG) is a rare, non-infectious, fulminant dermatosis of the skin. The lack of objective diagnostic criteria requires differential diagnosis and exclusion of extensive ulcerative skin diseases. Currently, treatment includes a combination of systemic steroids, immunosuppressants, and topical agents, but after decades of research, no clear scientific evidence exists for a criterion standard treatment. The use of NPWT (negative pressure wound therapy) effectively reduces the wound area, eliminates exudate, and reduces bacterial titer, thereby stimulating neoangiogenesis. CASE REPORT We present the case of an 83-year-old man with confirmed pyoderma gangrenosum. In the examination, a pink-red wound was observed, measuring 5×15 cm, II/III° according to National Pressure Ulcer Advisory Panel (NPUAP), covered with a non-physiological, crusty (scar-like) epidermis, from under which a foul purulent discharge emerged when pressed. NPWT therapy was started in August. During this period, wound healing was observed, without signs of undermining. After 52 days of treatment, NPWT was completely discontinued. Further local actions were then carried out using specialized dressings and periodic tacrolimus. CONCLUSIONS We observed the positive effect of NPWT on the wound, which, together with doxycycline treatment, led to the elimination of purulent exudate from the wound and inhibition of wound enlargement. The use of NPWT as a supportive method in the treatment of PG wounds is safe and effective, and it can be successfully used in nursing.

Hypertension and selected indicators of health assessment in a population of 19-year-old men subject to military qualifications.

Assessment the prevalence of hypertension and its relation to selected indicators of health status and performance, including classification of BMI, obesity classifications, and body structure in a large test group of 19-year-old men.The study was observational-retrospective, and included a group of 17,282 men, aged 19, from the Malopolska region. All subjects met the qualifications for compulsory military service in 2017. We analyzed selected data obtained from the records of the Ministry of National Defense-spiral-ZINT. Data collection and analysis were carried out from April 1, 2018 to August 31, 2018.Hypertension was found at 0.6%, weak body structure at 0.8% and obesityco-existing with cardiorespiratory insufficiency has been reported 2.6% of respondents and it was more frequent in the recruiters from HT II than I. The underweight concerned almost 7%, and the overweight and obesity of 1/4 of conscripts. The vast majority of people with hypertension were characterized by excessive body weight (74.8%), mainly overweight.Hypertension was seen in a negligible percentage of males studied and was significantly associated with an increase in BMI, particularly with regards to being overweight.