The Predictive Role of Lactate in the Emergency Department in Patients with Severe Dyspnea.

Objective: An accurate identification of patients at the need for prioritized diagnostics and care are crucial in the emergency department (ED). Blood gas (BG) analysis is a widely available laboratory test, which allows to measure vital parameters, including markers of ventilation and perfusion. The aim of our analysis was to assess whether blood gas parameters in patients with dyspnea at an increased risk of respiratory failure admitted to the ED can predict short-term outcomes. Methods: The study group eventually consisted of 108 patients, with available BG analysis. The clinical and laboratory parameters were retrospectively evaluated, and three groups were distinguished-arterial blood gas (ABG), venous blood gas (VBG), and mixed blood gas. The primary endpoint was short-term, all-cause mortality during the follow-up of median (quartile 1-quartile 3) 2 (1-4) months. The independent risk factors for mortality that could be obtained from blood gas sampling were evaluated. Results: The short-term mortality was 35.2% (38/108). Patients who died were more frequently initially assigned to the red triage risk group, more burdened with comorbidities, and the median SpO2 on admission was significantly lower than in patients who survived the follow-up period. In the multivariable analysis, lactate was the strongest independent predictor of death, with 1 mmol/L increasing all-cause mortality by 58% in ABG (95% CI: 1.01-2.47), by 80% in VBG (95% CI: 1.13-2.88), and by 68% in the mixed blood gas analysis (95% CI: 1.22-2.31), what remained significant in VBG and mixed group after correction for base excess. In each group, pH, pO2, and pCO2 did not predict short-term mortality. Conclusions: In patients admitted to the ED due to dyspnea, at risk of respiratory failure, lactate levels in arterial, venous, and mixed blood samples are independent predictors of short-term mortality.

Affordability of medicines in the European Union.

BACKGROUND: Medications and their prices are key issues for healthcare. Although access to medicines at affordable prices had been specified as a key objective of the European Health Policy, it seems that these goals have not been achieved. Therefore, we attempted an evaluation of affordability of selected medicines at full prices. METHODS: The analysis concerned 2012 and was conducted between 2013 and 2015 in all the European Union (EU) countries divided into 3 groups depending on the date of their accession to the EU. Finally, we considered 9 originators used in the treatment of schizophrenia and multiple sclerosis. Information on drug prices were collected from pharmacies. Participation in the study was voluntary and anonymous in order to avoid accusations of advertising. To evaluate affordability, several factors were used (e.g. minimum earnings and Gini coefficient). Due to unavailability in some countries, the exact number of analyzed medicines varies. RESULTS: Drug prices vary significantly between EU Member States. Almost eleven fold difference was observed between Germany (EUR 1451.17) and Croatia (EUR 132.77) in relation to Interferone beta-1a 22 µg. Generally, prices were the highest in Germany. The cheapest drugs were found in various countries but never in the poorest ones like Bulgaria or Romania. Discrepancies in wages were observed too (the smallest minimum wage was EUR 138.00 in Bulgaria and the highest EUR 1801.00 in Luxembourg). Full price of olanzapine 5mg, however, was higher in Bulgaria (EUR 64.53) than, for instance, in Belgium (EUR 37.26). CONCLUSIONS: Analyzed medications are still unaffordable for many citizens of the EU. Besides, access to medicines is also impaired e.g. due to parallel trade. Unaffordability of medications may lead to the patients' non-compliance and therefore to increased direct and indirect costs of treatment. Common European solutions are needed to achieve a real affordability and accessibility of medications.

Evaluation the Aortic Aneurysm Remodeling After a Successful Stentgraft Implantation.

BACKGROUND: Routine imaging follow-up after endovascular treatment of abdominal aortic aneurysms (EVAR) is mainly aimed at detection of endoleaks. The aim of the study was to assess changes in the size of the abdominal aortic aneurysm sack using CT angiography (CTA) after successful treatment using endovascular stent graft implantation. MATERIAL/METHODS: A retrospective analysis of CTA results included 102 patients aged 54-88, who had no postoperative complications. Patients underwent CTA before EVAR and after the treatment (mean time between studies, 7.6 months). The largest cross-sectional area of the aneurysm sac was measured using a curved multiplanar reconstruction. A change of the aneurysm cross-sectional over 10% was considered significant. RESULTS: The average cross-sectional area decreased after EVAR by 3% and this change was not statistically significant. Regression of the cross-sectional area was observed in 18.6% of patients, progression was in 23.5%, and no change was seen in 57.8%. Cross-sectional areas before and after EVAR were significantly correlated (r=0.75, p<0.0001). There was no correlation between the cross-sectional area change after EVAR and patients' age or the time between the treatment and the follow-up CTA. Cross-sectional area before the treatment predicted changes in the aneurysm size after EVAR (p=0.0045). CONCLUSIONS: Remodeling of abdominal aortic aneurysms after EVAR is not uniform. The change of aneurysm size depends on the initial aneurysm size but not on the time from EVAR. The size of the aneurysm after EVAR should not be considered as a measure of the treatment efficacy.

[Radiographic assessment of accuracy of tracheal tube placement in children]. / Ocena prawidlowego polozenia rurki dotchawiczej u dzieci na podstawie radiogramu klatki piersiowej.

BACKGROUND: Accidental migration of endotracheal tubes has been recognized by the European Resuscitation Council (ERC) as an important morbidity factor in ventilated children. Several equations have been proposed for prediction of the ideal position of the endotracheal tube, but none of them was found to be ideal. METHODS: We have retrospectively assessed the positions of endotracheal tubes in 108 intubated children. Infants were nasally intubated and oral intubation was used in older children. We compared the measured distances with theoretical lengths, obtained from various equations. RESULTS: We found that if the tube was placed according to the Lau equation (age/2+13 mm) or the ALS group equation (age/2+12 mm), the estimation was correct in 83% (Lau equation) and in 94.7% (ALS recommendations). CONCLUSION: Since results depended very much on the age and route of intubation, we suggest that extended studies may be recommended.

[Abdominal compartment syndrome as advanced abdominal hypertension]. / Zespól przedzialu brzusznego jako zaawansowana postac nadcisnienia w jamie brzusznej.

The aim of the article is to present the definition and criteria of diagnosis of abdominal compartment syndrome (ACS) due to abdominal hypertension. Epidemiology of ACS is discussed. Secondary ACS is described. There is also an overview of clinical consequences and a scheme for ACS management.

[Parents' and caregivers' theoretical and practical knowledge of first aid in case of accidents and minor injuries in children]. / Wiedza oraz umiejetnosci rodziców i opiekunów w zakresie udzielania pierwszej pomocy dzieciom ulegajacym wypadkom.

Accidents and injuries cause most serious health problems in pediatric group of patients in Poland. We asked a group of 93 parents and tutors (11 men and 82 women) to complete a questionnaire containing 20 questions. It referred to their knowledge on first aid treatment. We have analyzed the answers using statistical methods and couched our conclusions. 1. The results of the enquiry show a great extent of self-satisfaction in the questioned group of parents. Most of them (64.5%) think they know first aid rules, although only 35 people (37.6%) were ever trained in this field. Parents declare they known, how to deal with such conditions as bums, slight contusions and injuries, fractures, torsions, choking and high temperature. 2. Most parents (71%) have already treated minor injuries and dealt with minor accidents which took place while they took care of a child. Most common health problems were: high temperature--23.9%, slight contusions--22.4%, minor injuries--16.1%, hemorrhage--8.8%, scalding--8.3%, choking--7.3%. Accidents occur mainly during playground activities or cycling (63%) and at home (17%). 3. When an accident involving children occurs, 29.2% of parents call for medical help, 63.8% of them do it only if very serious injuries occur and 9% always try to treat a child themselves. In our enquiry most parents knew the names of popular analgesic and antipyretic drugs. They also knew how to deal with a slight burn or scald. 4. In questioned adults' opinion health care professionals do not give enough first aid information to the society. In our examined group, 58.1% of parents try to read and learn themselves. This shows the need for training people who take care of children in first aid treatment. As the best places for such training enquired parents pointed schools, kindergartens, pediatric and obstetric clinics.