Correlations between Problematic Mobile Phone Use and Depressiveness and Daytime Sleepiness, as Well as Perceived Social Support in Adolescents.

(1) The aim of this study was to estimate the scale of mobile phone addiction among young adults as well as to establish whether the low level of perceived social support is related to problematic smartphone use, and whether an addictive pattern of mobile phone use is related to the prevalence of depressiveness and excessive daytime sleepiness. (2) The study was carried out using the diagnostic poll method via the questionnaire technique. Both the author's own questionnaire and the following standardized research tools were used: the Mobile Phone Problem Use Scale for Adolescents (MPPUSA), the Beck Depression Inventory (BDI), the Epworth Sleepiness Scale (ESS), and the Multidimensional Scale of Perceived Social Support (MSPSS). (3) Perceived social support was significantly lower in the group of respondents who problematically used their mobile phones in comparison with the ones who used them in a proper way. Severity of depressive symptoms and daytime sleepiness was significantly higher in respondents addicted to their mobiles compared to nonaddicted ones. (4) Conclusions: An important correlation between phone addiction and the prevalence of depressive symptoms and excessive daytime sleepiness exists. Problematic mobile phone use concerns individuals with low levels of perceived social support.

Analysis of Nurses' Attitudes toward Patient Death.

(1) The aim of the study was to analyze nurses' attitudes toward a patient's death, taking into account the emotions they experience and the general perception of death. (2) The study involved 516 nurses from the West Pomeranian Voivodeship in Poland. The research was carried out using the diagnostic survey method using The Death Attitudes Profile Revisited (DAP-R-PL), the Scale of Fear and Fascination with Death, and a demographic questionnaire. (3) Research has shown that nurses accept the phenomenon of death as a natural process of human life; however, they adopt the attitude of fear of death. Most of the respondents experienced: sadness (73.4%), helplessness (58.5%), and regret (43.6%) due to the patient's death. (4) Both age, sex, marital status, and place of residence significantly influenced the attitudes of nurses toward the patient's death. Therefore, it is important to provide psychological support or special education in the case of dealing with the fear of death.

Incidence and Sociodemographic Correlates of Psychological Health Problems among Residents of the West Pomeranian Voivodeship during the COVID-19 Outbreak.

Background and Objectives: Psychological health problems have become an important topic of consideration for many scientists, because the epidemiology of these disorders is strongly influenced by stressful events such as the SARS-CoV-2 coronavirus pandemic. The aim of this study was to evaluate selected parameters of psychosocial functioning as well as socio-demographic correlates of depression, anxiety, sleep disorders and perceived stress among the residents of the West Pomeranian Voivodeship. Materials and Methods: An online questionnaire was completed by 323 participants, in whom the parameters of psychosocial functioning were assessed (symptoms of depression, anxiety, severity of sleep disorders and perceived stress). Results: The majority of the respondents (75.2%) scored high on the Perceived Stress Scale, and almost half of the respondents (47.1%) had sleep disorders. A total of 26% of the participants had no depressive symptoms. Age was significantly correlated with the severity of depressive symptoms and sleep disorders. There was a strong correlation between the severity of depression and anxiety (r = 0.76; p < 0.0001), a moderate correlation between depression and perceived stress (r = 0.47; p < 0.0001) and a strong correlation between depression and sleep disorders (r = 0.651; p < 0.0001). Conclusions: Age contributed to the severity of depressive symptoms and the occurrence of sleep disorders among the residents of the West Pomeranian Voivodeship during the SARS-CoV-2 pandemic. Some residents of the West Pomeranian Voivodeship showed moderate to severe depressive and anxiety symptoms, as well as high levels of stress and insomnia.

Body Composition and Biological Functioning in Polish Perimenopausal Women with Type 2 Diabetes.

BACKGROUND AND OBJECTIVES: The aim was to compare body composition and levels of biochemical blood parameters and identify relationships between biochemical parameters and body composition of women with type 2 diabetes and healthy ones, both in perimenopausal period (172 women aged between 45 and 65 come from the West Pomeranian Voivodeship, Poland). MATERIALS AND METHODS: The study consisted of an interview, body composition analysis with Jawon Medical IOI-353 (Yuseong, South Korea) analyser and venous blood biochemical analysis (lipid profile, levels of glucose, insulin, CRP, glycated haemoglobin). RESULTS: The vast majority of body composition measurements varied between study and control groups in a statistically significant way (p < 0.05) except protein and soft lean mass of the torso. Statistically significant differences between the two groups have been observed in case of all biochemical parameters (p < 0.001). CONCLUSIONS: Body composition of women suffering from type 2 diabetes significantly varied from body composition of healthy women. Results of the first group were characterised by higher values, especially in case of general parameters, abdominal area, content of adipose tissue and soft tissues. Relationship between body composition and biochemical results may be observed, especially in level of triglycerides, CRP and insulin. Higher concentrations of these parameters were associated with increased values of majority of body composition measurements regardless of type 2 diabetes incidence.

Analysis of the Impact of Type 2 Diabetes on the Psychosocial Functioning and Quality of Life of Perimenopausal Women.

Menopause is a natural period resulting from the decrease in hormonal activity of the ovaries. Growing hormonal deficiencies and changes in the body influence a variety of functions in women, leading to depression and decreased quality of life. The relationship between body composition, the severity of depressive and climacteric symptoms and the quality of life of women with type 2 diabetes and healthy women in the perimenopausal period was studied. Statistically significant differences were observed between the study and control groups regarding all body composition parameters except for protein and the content of torso soft tissues (p < 0.05). In both the study and control groups, resulting symptoms were significantly correlated with numerous body composition parameters (e.g., body mass, fat tissue mass, minerals, abdominal circumference), while symptoms of depression were significantly correlated with similar parameters only in the control group. A statistically relevant relationship was observed between the study and control groups with respect to quality of life in certain domains. The quality of life of women suffering from type 2 diabetes was worse compared with healthy women. Analysis of body composition showed significant differences between healthy women and those with type 2 diabetes. Healthy women showed a tendency to establish a link between body composition and depressiveness.

Anaesthesia in patients with liver disease.

PURPOSE OF REVIEW: The purpose of this review is to summarize the most recent up to date research data and recommendations regarding anaesthetic management of patients with liver disease undergoing surgery. The incidence of chronic liver disease (CLD) continues to rise and perioperative mortality and morbidity remains unacceptably high in this group. Meticulous preoperative assessment and carefully planned anaesthetic management are vital in improving outcomes in patients with liver disease undergoing surgery. RECENT FINDINGS: The presence of cirrhosis is associated with a significantly increased risk of postoperative morbidity and mortality in patients undergoing elective surgery. The Child--Pugh--Turcotte scale and model for end-stage liver disease (MELD) score remain the most commonly applied scoring systems in preoperative risk assessment, but new MELD-based indices and novel scoring systems might offer better prognostic value. Propofol and new inhalational agents (sevoflurane, desflurane) are recommended hypnotic agents. The titration of opiates in the perioperative period is recommended because of their altered metabolism in patients with liver disease. Perioperative management should include close haemodynamic monitoring and admission to a critical care area should be considered. SUMMARY: Patients with liver disease undergoing anaesthesia pose significant challenges and advanced planning and preparation are required in order to improve perioperative outcomes in this group. VIDEO ABSTRACT: http://links.lww.com/COAN/A43.

Perioperative bleeding in patients undergoing liver transplantation.

Liver transplantation (LT) remains one of the most challenging surgical procedures. For many years uncontrolled bleeding and catastrophic haemorrhages were one of the major causes of perioperative mortality and morbidity. During the past fifty years or so, significant progress in surgical techniques and perioperative management has led to a marked change in transfusion practice over time, where up to 79.6% of LTs in experienced transplant centers are performed without any blood product transfusion. Despite this, perioperative bleeding and transfusion requirements remain potent predictors of patient's mortality, as well as postoperative complications and graft survival. The major impact of blood product transfusion on LT recipient outcomes implies that all patients on waiting lists should be carefully screened for the presence of risk factors of perioperative bleeding. Although multiple predictors of transfusion requirements during LT have been identified, no predictive model validated across centers has been constructed. The most suitable strategies to reduce intraoperative blood loss in this group should be employed on a case-to-case basis. This paper aims to summarize the most up-to-date evidence in the management of haemostasis in LT recipients.

Prognostic scoring systems for mortality in intensive care units--the APACHE model.

The APACHE (Acute Physiology and Chronic Health Evaluation) scoring system is time consuming. The mean time for introducing a patient's data to APACHE IV is 37.3 min. Nevertheless, statisticians have known for years that the higher the number of variables the mathematical model describes, the more accurate the model. Because of the necessity of gathering data over a 24-hour period and of determining one cause for ICU admission, the system is troublesome and prone to mistakes. The evolution of the APACHE scoring system is an example of unfulfilled hopes for accurately estimating the risk of death for patients admitted to the ICU; satisfactory prognostic effects resulting from the use of APACHE II and III have been recently studied in patients undergoing liver transplantations. Because no increase in the predictive properties of successive versions has been observed, the search for other solutions continues. The APACHE IV scoring system is helpful; however, its use without prepared spreadsheets is almost impractical. Therefore, although many years have passed since its original publication, APACHE II or its extension APACHE III is currently used in clinical practice.

Usability of ultrasound assessment of gastric content. Case reports.

The paper presents the use of ultrasound assessment of gastric content in anesthesiological practice. Factors influencing pulmonary aspiration of gastric content and the risk of a complication in the form of aspiration pneumonia are discussed. The examination was performed on two patients hospitalized in a state of emergency who required surgical intervention. The first patient, a 46-year-old male with a phlegmon of the foot, treated for type 2 diabetes, ischemic heart disease and renal insufficiency, required urgent incision of the phlegmon. The second patient, a 36-year-old male with a post-traumatic pericerebral hematoma, qualified for an urgent trepanation. Interviews with the patients and their medical documentation indicated that they had been fasting for the recommended six hours before the surgery. However, during a gastric ultrasound examination it was found that food was still present in the stomach, which caused a change in the anesthesiological procedure chosen. The authors present a method of performing gastric ultrasound examination, determining the nature of the food content present and estimating its volume.

Will transoesophageal echocardiography become a standard tool for anesthetists to assess haemodynamic status during non-cardiac surgeries? Case report and literature review.

A 53-year-old male, with no history of cardiovascular diseases, underwent elective extended right hemihepatectomy for large metastatic tumor. Approximately 2 hours after the start of procedure sudden onset of severe hypotension associated with profound desaturation and significant fall in end-tidal carbon dioxide pressure was noted. Transoesophageal echocardiography was performed and massive air embolism was confirmed. Patient was turned into Trendelenburg position, inspired oxygen was increased to 100% and positive end-expiratiory pressure turned up to 10 cm H20. Patient was further resuscitated with iv fluids, blood products and vasopressors under surveillance of transoesophageal echocardiography. In this report we present a case in which intraoperative use of transoesophageal echocardiography by trained anaesthetist helped to immediately identify the cause of sudden hypotension and hypoxaemia. Transoesophageal echocardiographywas also a valuable tool for direct monitoring of efficacy of instituted treatment.

[Acute lupus pneumonitis--case report and literature review]. / Ostre toczniowe zapalenie pluc--opis przypadku i przeglad pismiennictwa.

Systemic lupus erythematosus (SLE) is an autoimmune connective tissue disease that is characterized by its chronic course and the involvement of many organs and systems. The most common abnormality in the respiratory system of SLE patients is lupus pleuritis. Less common is parenchymal involvement, which may present as acute lupus pneumonitis (ALP) or chronic interstitial lung disease. Other possible pulmonary manifestations of SLE include pulmonary embolism, diffuse alveolar haemorrhage, acute reversible hypoxaemia, and shrinking lung syndrome. We present the case report of a young woman with previously diagnosed membranous glomerulonephritis with nephrotic syndrome and antiphospholipid syndrome, who was admitted with marked of shortness of breath. The diagnostic process, including imaging studies and laboratory tests, enabled us to confirm a diagnosis of ALP. After initiation of treatment with high doses of methyloprednisolone, nearly complete remission of pulmonary changes was observed. We also perform a literature review regarding acute lupus pneumonitis.

Statin therapy and mortality among patients hospitalized with heart failure and preserved left ventricular function--a preliminary report.

BACKGROUND: A number of medications such as beta-blockers,ACE-inhibitors, angiotensin receptor blockers and aldosterone antagonists, improve survival in patients with heart failure (HF) and reduced ejection fraction. No therapy has been proved to be beneficial for patients with heart failure and preserved ejection fraction (PLVEF). OBJECTIVES: The aim of the study was to assess the effect of statin therapy on all-cause mortality and cardiovascular rehospitalization rate in patients with HF and PLVEF during one-year follow-up. METHODS: We evaluated 146 patients with HF and PLVEF (ejection fraction > or = 45%). Patients were divided into the statin therapy group (n = 103, mean age 69 +/- 11 y, 52 men) and the group without statins (n = 43, mean age 66 +/- 16 y, 25 men).We analysed the effects of the statin treatment prescribed to patients at discharge. Patients were followed up for one year. RESULTS: The age, gender, NYHA functional class, prevalence of co-morbidities (renal dysfunction, COPD, diabetes mellitus) did not differ between the groups (P = NS). Patients receiving statin therapy more frequently had an ischaemic aetiology of HF (79% vs. 39.5%; P < 0.001) and hypertension (76% vs. 58%; P < 0.05). No differences in ejection fraction were observed neither by echocardiography (58% vs. 55%; P = NS) nor by basic laboratory data. Patients who received statins were often additionally treated with beta-blockers (91% vs. 70%; P < 0.005), aspirin (77 vs. 44%; P < 0.01), thienopyridines (22% vs. 5%; P < 0.01) and less frequently with oral anticoagulants (5% vs. 23%; P < 0.005). In the group receiving statins a significantly lower mortality (4% vs. 21%; P < 0.001) and rehospitalization rate (43% vs. 69%; P < 0.05) was documented. After adjustment for all univariate predictors of the occurrence of study primary end-points, statin therapy was shown to be associated with significant and independent reduction in all-cause mortality (HR = 0.24 [95%CI:0.07 - 0.90] P < 0.05) and cardiovascular rehospitalization rate (HR = 0.55 [95%CI: 0.33 - 0.92] P< 0.05). After propensity matching statin therapy remained an independent factor reducing one-year mortality rate (HR = 0. 11 [95%CI: 0.01 - 0.99] P < 0.05]. CONCLUSIONS: This study showed that statin therapy may have beneficial effects on mortality and rehospitalization rates among patients with HF and PLVEF. It also suggests a potential role for statins as a new therapeutic option in patients with HF and PLVEF, but these observations need to be confirmed in large randomized trials.

[Effect of the optimal neurohormonal blockade on long-term survival in patients with chronic heart failure]. / Wplyw optymalnego hamowania neurohormonalnego na rokowanie odlegle u pacjentów z przewlekla niewydolnoscia serca.

BACKGROUND: In recent years large scale clinical trials have cleary shown that a number of pharmacological treatments can improve the outcomes of patients (pts) with chronic heart failure (CHF). AIM: The aim of this study was to assess the effect of optimal neurohormal blockade in pts with chronic heart failure on survival during 12 month follow-up. METHODS: We analyzed data on 489 pts in NYHA II-IV class of HF, referred to our Dept. (mean age was 69 +/- 12). We define doptimal neurohormonal therapy as beta-blocker and ACE-inhibitor in pts with NYHA II, and beta-blocker, ACE-Inhibitor and spironolactone in patients with NYHA III-IV class. Pts were divided into groups: group 1--optimal neurohormonal blockade (n = 232, mean age, 67 +/- 11), group 2--non-optimal neurohormonal blockade (n = 257, mean age, 70 +/- 13). Pts were followed for 12 month. RESULTS: Group with optimal therapy were frequent male gender, of ischemic aetiology, and NYHA class II (p < 0.05). Diabetes mellitus, hypertension, left ventricular ejection fraction did not differ the groups (p = NS). Pts with non-optimal therapy were more frequent with prior history of renal dysfunction and anemia at admission (p < 0.05). During 12 month follow-up 12% in optimal vs 40% in non-optimal therapy died (p < 0.005). The rehospitalisation rate during one-year was also significantly higher in pts receiving non-optimal therapy (69% vs 48%, p < 0.005). Cox multivariate analysis showed after adjusting for age, gender, etiology of HF, NYHA functional class, renal dysfunction, EF, had significantly 62% reduction in mortality and 41% reduction in cardiovascular rehospitalisation in pts receiving optimal therapy. CONCLUSIONS: The optimal neurohormonal therapy have favorable effects on outcomes in pts with CHF. This data strongly support that optimalization of care and evidence-based treatment of CHF pts can improve poor prognosis in this group.

The prognostic value of renal dysfunction in patients with chronic heart failure: 12-month follow-up.

INTRODUCTION: Renal function assessment is an important element of management and therapeutic decision-making in patients with chronic heart failure (CHF). AIM: To evaluate the prognostic value of renal dysfunction in patients with CHF in 12-month follow-up. METHODS: 639 consecutive patients hospitalised in our department from 1 July 2002 to 31 December 2003 with diagnosis of CHF (NYHA II-IV), based on medical records, were initially enrolled in the study. Patients underwent one-year follow-up. Finally, 498 patients, aged 22-98 years (mean age 69+/-12 years) in whom creatinine concentration was measured and creatinine clearance was estimated at admission with the Cockroft-Gault quotation and with long-term follow-up results obtained, were enrolled in the study. Patients were divided into two groups according to the creatinine level: Group I without renal dysfunction (creatinine level <1.4 mg/dl), and Group II--with renal dysfunction (creatinine level >1.4 mg/dl). RESULTS: Patients with renal dysfunction were significantly older and more likely to be male and in NYHA class III-IV (p <0.001). Analysis of pharmacotherapy for CHF revealed that patients with renal impairment significantly less frequently received beta-blockers (67% vs 81%, p <0.005), angiotensin-converting enzyme inhibitors (68% vs 82%, p <0.005) and combined treatment of beta-blocker and angiotensin-converting enzyme inhibitor (56% vs 71%, p <0.05), whereas loop diuretics were more frequently prescribed in this group (80% vs 70%, p <0.05). In patients with renal dysfunction, there was a significantly higher mortality rate at 30 days (32% vs 14%, p <0.001) as well as at 12 months (45% vs 20%, p <0.001). The incidence of re-hospitalisation for cardiovascular reasons (CHF worsening, myocardial infarction, stroke) was significantly higher in patients with renal dysfunction (70% vs 55%, p <0.005). Multivariate analysis of all factors affecting one-year mortality demonstrated that renal dysfunction is a strong and independent risk factor for death in patients with CHF (RR=2.13, 95% CI: 1.31-3.45; p <0.05) and it increases the risk of re-hospitalisation (RR=1.53, 95% CI: 1.01-2.14; p <0.05). CONCLUSIONS: Renal dysfunction is an independent prognostic factor in patients with CHF, which allows identification of a high-risk group and administration of optimal therapy, which in turn can result in a reduction of mortality.