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1.
BMC Med Educ ; 21(1): 450, 2021 Aug 26.
Artigo em Inglês | MEDLINE | ID: mdl-34445982

RESUMO

BACKGROUND: In March 2020, due to the SARS-CoV-2 pandemic, the Polish government ordered the closing of all medical faculties, with an obligatory shift to online learning. This lockdown continued, with a short period of blended learning, over the time of summer 2020. Distance learning had previously been rarely used within Polish medical schools, so such a sudden transfer was a major challenge. The aim of the study was to explore undergraduates' perception of online teaching provided at Polish medical faculties during the pandemic and to analyze how these experiences may inform future curriculum development. METHODS: The online survey was addressed to undergraduates at Polish medical faculties in November 2020. The questions captured demographics, epidemiological data and students' perception of various aspects of online teaching. Responses were subjected to thematic analysis and their distribution compared considering demographic parameters . RESULTS: Six hundred twenty students from thirteen medical faculties responded to the survey. Major benefits from online teaching perceived by respondents included increased convenience, enhanced quality, a sense of comfort and safety. Major complaints were associated with unsatisfactory content, technical issues, difficulties engaging, poor organization and lack of social life. Students claimed that online teaching required more self-directed learning and discipline and 57.9% considered this impact as negative. 44.5% of respondents took part in educational online activities beyond their scheduled classes. For 49.2% online examinations were reported as more stressful and for 24.8% - less stressful than traditional ones. Differences in the opinions on online teaching were found between men and women, students in early and senior years, Polish and non-Polish ones. CONCLUSIONS: The sudden move online inevitably was problematic for students. Their perspective afforded us the opportunity to consider shortcomings of pre-pandemic undergraduate curriculum. Online education requires a more self-directed learning, which was challenging for many students, so further enhancement of more autonomous study skills seems necessary. Distress expressed by students indicates the need for urgent support with mental health issues.


Assuntos
COVID-19 , Educação à Distância , Estudantes de Medicina , Controle de Doenças Transmissíveis , Feminino , Humanos , Masculino , Pandemias , Polônia/epidemiologia , SARS-CoV-2
2.
J Clin Med ; 10(14)2021 Jul 08.
Artigo em Inglês | MEDLINE | ID: mdl-34300202

RESUMO

Many studies have confirmed the positive effect of statins in the secondary prevention of ischemic stroke. Although several studies have concluded that statins may also be beneficial in patients with atrial fibrillation-related stroke, the results of those studies are inconclusive. Therefore, the aim of this study was to analyze the effect of pre-stroke statin therapy on atrial fibrillation-related stroke among patients with a well-controlled atrial fibrillation. This retrospective multicenter analysis comprised 2309 patients with acute stroke, with a total of 533 patients meeting the inclusion criteria. The results showed a significantly lower neurological deficit on the National Institutes of Health Stroke Scale at hospital admission and discharge in the group of atrial fibrillation-related stroke patients who took statins before hospitalization compared with those who did not (p < 0.001). In addition, in-hospital mortality was significantly higher in the atrial fibrillation-related stroke patients not taking statins before hospitalization than in those who did (p < 0.001). Based on the results of our previous research and this current study, we postulate that the addition of a statin to the oral anticoagulants may be helpful in the primary prevention of atrial fibrillation-related stroke.

3.
Int J Mol Sci ; 22(11)2021 May 24.
Artigo em Inglês | MEDLINE | ID: mdl-34073933

RESUMO

Migraine and sleep disorders are common chronic diseases in the general population, with significant negative social and economic impacts. The association between both of these phenomena has been observed by clinicians for years and is confirmed by many epidemiological studies. Despite this, the nature of this relationship is still not fully understood. In recent years, there has been rapid progress in understanding the common anatomical structures of and pathogenetic mechanism between sleep and migraine. Based on a literature review, the authors present the current view on this topic as well as ongoing research in this field, with reference to the key points of the biochemical and neurophysiological processes responsible for both these disorders. In the future, a better understanding of these mechanisms will significantly expand the range of treatment options.


Assuntos
Transtornos de Enxaqueca/complicações , Transtornos de Enxaqueca/metabolismo , Transtornos do Sono-Vigília/complicações , Transtornos do Sono-Vigília/metabolismo , Tronco Encefálico/fisiopatologia , Córtex Cerebral/fisiopatologia , Dopamina/metabolismo , Humanos , Hipotálamo/fisiopatologia , Melatonina/metabolismo , Transtornos de Enxaqueca/patologia , Transtornos de Enxaqueca/fisiopatologia , Orexinas/metabolismo , Serotonina/metabolismo , Sono/fisiologia , Transtornos do Sono-Vigília/patologia , Transtornos do Sono-Vigília/fisiopatologia , Tálamo/fisiopatologia
4.
J Clin Med ; 10(6)2021 Mar 16.
Artigo em Inglês | MEDLINE | ID: mdl-33809503

RESUMO

The most commonly used therapeutic option for the prevention of ischemic stroke in patients with atrial fibrillation is new- or old-generation oral anticoagulants. New oral anticoagulants are at least as effective as old-generation oral anticoagulants in the prevention of ischemic stroke, with a reduced risk of life-threatening hemorrhage. Moreover, the constant monitoring of these drugs in the patient's blood is not required during routine use. However, ischemic stroke can still occur in these patients. Therefore, the aim of this study was to investigate the pattern of risk factors for ischemic stroke in patients with atrial fibrillation treated with new oral anticoagulants. Our multicenter retrospective study involved 2032 patients with acute ischemic stroke. The experimental group consisted of 256 patients with acute ischemic stroke and nonvalvular atrial fibrillation, who were treated with new oral anticoagulants. The control group consisted of 1776 ischemic stroke patients without coexisting atrial fibrillation. The results of our study show that patients with atrial fibrillation treated with new oral anticoagulants are more likely to display thrombotic, proatherogenic, and proinflammatory factors in addition to the embolic factors associated with atrial fibrillation. Therefore, solely taking new oral anticoagulants is insufficient in protecting this group of patients from ischemic stroke.

5.
Neurol India ; 68(3): 624-629, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32643675

RESUMO

Objectives: Transient global amnesia (TGA) is a temporary short-term reversible memory loss. Etiology of TGA remains unclear with various hypotheses. We analyzed clinical characteristics, neuroimaging, and electrophysiological findings as well as comorbidities and seasonal variation in TGA patients with regard to possible background of the syndrome. Materials and Methods: A total of 56 patients (42 women and 14 men) with TGA hospitalized from 2008 to 2016 in the Department of Neurology, Wroclaw Medical University. Results: A total of 52 patients (92.9%) underwent their first-ever episode of TGA. The potential triggers or events before episode could be recognized in 22 patients (39.3%). 35.7% patients had TGA in summer and 26.8% in winter months. In 92.9% patients chronic diseases were found, included: Hypertension (60.7%), dyslipidemia (48.2%), autoimmune thyroiditis (17.9%), and ischemic heart disease (14.3%). One patient (1,8%) suffered from migraine. Doppler ultrasonography of carotid arteries revealed abnormalities in 29 patients (51.8%). Electroencephalography abnormalities were observed in 10 (17.6%) of patients. Conclusion: Our findings suggest a putative cerebrovascular background of transient global amnesia. No evidence has been provided for the association between TGA and epilepsy or migraine. Among comorbidities, autoimmune thyroiditis deserves further investigation with regard to its potential links with TGA.


Assuntos
Amnésia Global Transitória , Epilepsia , Transtornos de Enxaqueca , Amnésia Global Transitória/epidemiologia , Amnésia Global Transitória/etiologia , Eletroencefalografia , Epilepsia/epidemiologia , Feminino , Humanos , Masculino , Fatores de Risco
6.
Psychiatr Pol ; 54(1): 51-68, 2020 Feb 29.
Artigo em Inglês, Polonês | MEDLINE | ID: mdl-32447356

RESUMO

Mental disorders occur in patients with epilepsy significantly more frequently than in the general population or in those with other chronic diseases. The specificity of epilepsy as a condition of the central nervous system with complex somatic, psychic and social consequences contributes to co-occurrence of these disorders. Moreover, common patomechanisms are suggested for epilepsy and mental disorders, associated with disturbances of bioelectrical activity and neurotransmission in certain areas of the brain.The authors present a review of main groups of mental disorders observed in epileptic patients: psychotic, affective, anxiety, personality, and conduct disorders. They discuss their epidemiology and clinical presentation, with a particular focus on their risk factors and temporal relation to epileptic seizures. They also highlight problems associated with differential diagnosis and optimal therapeutic strategy. Mental disorders have a significant impact on the quality of life and functioning of patients with epilepsy. Further exploration of interrelationships between these illnesses, as well as cooperation between neurologists and psychiatrists promote an early and precise diagnosis of mental disturbances in this group of patients and their effective treatment.


Assuntos
Epilepsia/complicações , Transtornos Mentais/complicações , Qualidade de Vida , Adulto , Sintomas Afetivos/complicações , Transtorno da Personalidade Antissocial/complicações , Transtornos Dissociativos/complicações , Feminino , Humanos , Masculino , Prevalência , Fatores de Risco , Transtornos Somatoformes/complicações
7.
Adv Clin Exp Med ; 29(4): 469-473, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32343889

RESUMO

BACKGROUND: The effect multiple sclerosis (MS) has on the social functioning and integration of patients has been recently considered as an important factor of the disease. OBJECTIVES: To assess social participation of MS patients with regard to demographic and disease-related variables. MATERIAL AND METHODS: The study comprised 201 MS patients: 140 women, 61 men, aged 24-69 years. The World Health Organization Disability Assessment Schedule (WHODAS 2.0) was applied to assess the aspects of social functioning and the Beck Depression Inventory (BDI) was applied to evaluate the level of depression. Disease duration, degree of disability in Expanded Disability Status Scale (EDSS), most disabling symptoms and type of treatment were determined. WHODAS 2.0 scores (total and within particular domains) and their relationships with age, gender, disease-related variables and level of depression were analyzed. RESULTS: The results of WHODAS 2.0 for 27.4% of patients exceeded the 90th percentile compared to the population norms (with the highest scores for "getting around" and "participation in society" domains). The results of BDI and WHODAS 2.0 were strongly correlated (p < 0.001; ß = 0.73) and mobility impairment was related to both of them (p < 0.001; ß = -0.12 and 0.25, respectively). Other disabling symptoms were associated with scores in domains "understanding and communicating", "getting around" and "participation in society". CONCLUSIONS: Social participation of the MS patients is affected by the impact of disease and associated with depression. Particular symptoms of neurological deficit (motor and visual impairment, fatigue) influence social functioning more than general disease-related variables.


Assuntos
Depressão/diagnóstico , Depressão/psicologia , Fadiga/diagnóstico , Esclerose Múltipla/psicologia , Qualidade de Vida , Participação Social , Adulto , Idoso , Depressão/etiologia , Avaliação da Deficiência , Pessoas com Deficiência , Fadiga/etiologia , Fadiga/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Esclerose Múltipla/fisiopatologia , Escalas de Graduação Psiquiátrica , Perfil de Impacto da Doença , Transtornos da Visão , Adulto Jovem
8.
Kardiol Pol ; 77(12): 1206-1229, 2019 Dec 19.
Artigo em Inglês | MEDLINE | ID: mdl-31815926

RESUMO

Nowadays, the intensive cardiac care unit (ICCU) provides care for patients with acute coronary syndrome, acute and exacerbated chronic heart failure, cardiogenic shock, sudden cardiac arrest, electrical storm, as well as with indications for urgent cardiac surgical treatment. Most of these patients require the use of 1, 2, or frequently even 3 drugs that act on the blood coagulation pathway. While antithrombotic drugs prevent thromboembolic events, they are associated with a higher risk of bleeding. In this population of patients, bleeding may often have a worse impact on prognosis than the primary disease. In this expert opinion of the Association of Intensive Cardiac Care, we presented practical guidelines on the management of bleeding in patients hospitalized at the ICCU, including bleeding risk reduction and treatment recommendations. Because of multiple comorbidities and diverse organs that may be the source of bleeding, we provided also recommendations from specialists in other fields of medicine. We hope that this document will facilitate the management of one of the most challenging populations at the ICCU.


Assuntos
Fibrinolíticos/efeitos adversos , Hemorragia/tratamento farmacológico , Sociedades Médicas , Tromboembolia/prevenção & controle , Idoso , Idoso de 80 Anos ou mais , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Cardiologia , Gerenciamento Clínico , Feminino , Fibrinolíticos/uso terapêutico , Hemorragia/epidemiologia , Hemorragia/etiologia , Hemorragia/terapia , Humanos , Unidades de Terapia Intensiva , Masculino , Polônia , Fatores de Risco
9.
Adv Clin Exp Med ; 27(6): 787-794, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29893512

RESUMO

BACKGROUND: The clinical course of multiple sclerosis (MS) can vary significantly among patients and is affected by exogenous and endogenous factors. Among these, stress and personality type have been gaining more attention. OBJECTIVES: The aim of this study was to investigate the parameters of event-related potentials (ERPs) with regards to stress perception and personality type, as well as cognitive performance in MS patients. MATERIAL AND METHODS: The study group consisted of 30 MS patients and 26 healthy controls. Auditory ERPs were performed in both groups, including an analysis of P300 and N200 response parameters. The Perceived Stress Scale (PSS) was used in the MS group to measure the perception of stress. The D-type Scale (DS14) scale was used to determine the features of Type D personality, characterized by social inhibition and negative affectivity. RESULTS: The score on the PSS corresponded with a moderate or high level of stress perception in 63% of MS patients, while 23% of patients presented with a Type D personality. P300 latencies were significantly longer (p = 0.001), N200 amplitudes were significantly higher (p = 0.004), and N200 latencies were longer in MS patients than in the controls. Strong positive correlations were found between N200 and P300 amplitudes, as well as between the DS14 and PSS results. CONCLUSIONS: Most MS patients experience moderate to severe stress. ERP abnormalities were found in MS patients who did not have overt cognitive impairment and showed correlations with stress levels and negative affectivity. Event-related potentials may be useful in assessing the influence of stress and emotions on the course of MS.


Assuntos
Potenciais Evocados/fisiologia , Esclerose Múltipla Recidivante-Remitente/psicologia , Percepção/fisiologia , Personalidade/fisiologia , Estresse Psicológico/fisiopatologia , Adulto , Potenciais Evocados Auditivos/fisiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Esclerose Múltipla Recidivante-Remitente/fisiopatologia , Projetos Piloto
10.
J Anat ; 232(4): 596-603, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29315634

RESUMO

The evaluation of cerebellar growth in the fetal period forms a part of a widely used examination to identify any features of abnormalities in early stages of human development. It is well known that the development of anatomical structures, including the cerebellum, does not always follow a linear model of growth. The aim of the study was to analyse a variety of mathematical models of human cerebellar development in fetal life to determine their adequacy. The study comprised 101 fetuses (48 males and 53 females) between the 15th and 28th weeks of fetal life. The cerebellum was exposed and measurements of the vermis and hemispheres were performed, together with statistical analyses. The mathematical model parameters of fetal growth were assessed for crown-rump length (CRL) increases, transverse cerebellar diameter and ventrodorsal dimensions of the cerebellar vermis in the transverse plane, and rostrocaudal dimensions of the cerebellar vermis and hemispheres in the frontal plane. A variety of mathematical models were applied, including linear and non-linear functions. Taking into consideration the variance between models and measurements, as well as correlation parameters, the exponential and Gompertz models proved to be the most suitable for modelling cerebellar growth in the second and third trimesters of pregnancy. However, the linear model gave a satisfactory approximation of cerebellar growth, especially in older fetuses. The proposed models of fetal cerebellar growth constructed on the basis of anatomical examination and objective mathematical calculations could be useful in the estimation of fetal development.


Assuntos
Cerebelo/anatomia & histologia , Cerebelo/embriologia , Feto/anatomia & histologia , Feto/embriologia , Modelos Teóricos , Vermis Cerebelar/anatomia & histologia , Vermis Cerebelar/embriologia , Feminino , Idade Gestacional , Humanos , Modelos Lineares , Masculino , Gravidez , Terceiro Trimestre da Gravidez
11.
Psychiatr Pol ; 51(1): 117-124, 2017 Feb 26.
Artigo em Inglês, Polonês | MEDLINE | ID: mdl-28455899

RESUMO

The persistent genital arousal disorder (PGAD) may coexist with restless legs syndrome and overactive bladder syndrome and share some similarities with these conditions. Thus, the new term: restless genital syndrome (RGS) is proposed. The purpose of this paper is to present a case of PGAD, including the description of the etiology, the diagnostics and the treatment of the disorder. The described patient meets the criteria for PGAD. Organic lesions within nervous and urogenital system were excluded and the psychogenic background of the syndrome was assumed in this case. The patient was diagnosed with personality disorder with a predominance of dependent personality traits and emotional lability. After the failure of pharmacological treatment, systemic psychotherapy with cognitive-behavioral elements was initiated with moderate effect.


Assuntos
Síndrome das Pernas Inquietas/complicações , Síndrome das Pernas Inquietas/terapia , Disfunções Sexuais Fisiológicas/complicações , Disfunções Sexuais Fisiológicas/terapia , Adulto , Nível de Alerta , Terapia Cognitivo-Comportamental/métodos , Feminino , Humanos , Síndrome das Pernas Inquietas/diagnóstico , Disfunções Sexuais Fisiológicas/diagnóstico
12.
Noise Health ; 17(79): 422-8, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26572702

RESUMO

The objectives of this paper were to determine whether traffic noise influences the parameters of cerebral blood flow (CBF) measured by functional transcranial Doppler sonography (fTCD) during the performance of mental tasks, and to see whether impact of noise on CBF changes with age. The study comprised 36 healthy volunteers, 22 women and 14 men, aged 25-49 years. The fTCD was performed using a fixed 2-MHz probe, aiming for an evaluation of mean velocity (MFV) and the pulsatility index (PI) in the middle cerebral artery (MCA) on both sides. Subsequently, fTCD was monitored: At rest; during performance of the Paced Auditory Serial Addition Test (PASAT); during exposure to traffic noise; and during concomitant exposure to noise and PASAT performance. MFV and PI were compared for particular conditions and correlated with age. During exposure to noise, flow parameters did not change significantly. PASAT performance in silence increased MFV and decreased PI in MCA on both sides. During PASAT performance, on exposure to noise, MCV and PI changed significantly only in the left MCA. However, values of MFV were significantly lower during noise than in silence. Correlations with age were noted for velocities in the right MCA during PASAT performance in silence and for PI on both sides during PASAT performed in noise conditions. Noise impairs the CBF during mental tasks. A comparison of changes in CBF parameters correlated with age suggests that the involvement of the nondominant hemisphere in managing with noise effects increases with age.


Assuntos
Circulação Cerebrovascular , Artéria Cerebral Média/diagnóstico por imagem , Ruído dos Transportes , Fluxo Pulsátil , Análise e Desempenho de Tarefas , Adulto , Fatores Etários , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ultrassonografia Doppler Transcraniana
13.
Cerebellum ; 13(5): 541-8, 2014 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-24831768

RESUMO

In the fetal period, development of cerebellar lobes may proceed dissimilarly due to possible differentiated origins of the cells and diversified times of their migration to certain cerebellum regions. This can cause various growth trajectories for the external surfaces of cerebellar lobes. The goal of the study was to describe the development of the external surface of cerebellum lobes and fissures delineating them in the fetal period. The material consisted of 101 fetuses (48 males and 53 females)-crown rump length 89-229 mm corresponding to 15-28 weeks of fetal life. The methods were based on anthropometric measurements and preparation techniques combined with elicited image computer analysis. At the largest values of the cerebellum posterior lobe surface, the most dynamic growth rate was observed in the case of the anterior lobe. Among the cerebellar lobes, proportional change was observed as well as a gradual increase in anterior lobe surface area and a simultaneous decrease in the surface area of the flocculonodular lobe part of the cerebellum total external surface. This paper presents the different growth trajectories of cerebellar lobes and demonstrates the importance of the primary fissure as a delineating mark for two regions with different dynamics of development.


Assuntos
Cerebelo/embriologia , Cerebelo/anatomia & histologia , Feminino , Humanos , Processamento de Imagem Assistida por Computador , Masculino , Tamanho do Órgão
14.
Med Sci Monit ; 11(11): BR412-9, 2005 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-16258390

RESUMO

BACKGROUND: Because of numerous abnormalities of craniovertebraljunction development observed in the prenatal period, the region has been studied thoroughly in order to elucidate the mechanism of axial differentiation, dependence of vertebral morphology on the development of ossification centers and the mechanisms regulating the dynamics of growth. AIM: Analysis of morphological changes of the craniovertebral junction taking place during the prenatal period by quantitative assessment of some developmental changes such as growth rate, sexual dimorphism, interdependence of the analyzed parameters, taking into consideration the variable geometry of the studied area. MATERIAL/METHODS: he study was carried out on 48 fetuses (22 male, 26 female) of 86-212mm crown-rump length (CRL) range. The applied methods included: anthropometry, precise measurements, as well as trigonometric calculation of angles. RESULTS: All the investigated parameters demonstrated a strong, statistically significant correlation with CRL. No statistical significance of sexual dimorphism and differences between left- and right-sided measurements was demonstrated. The development rate indexes for the height of C1,C2 posterior vertebral arches, unlike those for the transversal dimensions of C1,C2 posterior vertebral arches, decrease after 5 months of gestational age. Little variability of the angles determined by geometrical reconstruction evidences close interdependence in the development of the analyzed craniovertebral junction elements. CONCLUSIONS: Geometrical configuration of the craniovertebraljunction during the fetal period is constant, with growth isometry preserved throughout intrauterine development. The occipital bone and Cl,1C2 cervical vertebrae are closely correlated according to structural and functional dependences.


Assuntos
Vértebras Cervicais/anatomia & histologia , Vértebras Cervicais/embriologia , Osso Occipital/anatomia & histologia , Osso Occipital/embriologia , Antropometria , Feminino , Feto/anatomia & histologia , Humanos , Masculino , Gravidez
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