Polski Merkuriusz Lekarski最新文献

Objective: Aim: To investigate hepcidin as a marker of iron status in chronic kidney disease (CKD) patients (stage 5 vs. stage 3), and to assess its association with iron injection status within the maintenance hemodialysis group.

Patients and methods: Materials and Methods: This cross-sectional study compared 69 hemodialysis (stage 5 CKD [G1]) and 19 non-dialysis (stage 3 CKD [G2]) patients, assessing hepcidin, ferritin and hemoglobin. As a part of their standard anemia management, patients requiring iron administration received scheduled injections of ferric carboxymaltose.

Results: Results: Hemodialysis patients (G1) had significantly lower hemoglobin and higher anemia prevalence than non-dialysis patients (G2), while baseline hepcidin and ferritin levels were comparable. Importantly, hepcidin levels were above the normal range in 85,5% and 84,2% of G1 and G2 patients, respectively. Hepcidin correlated positively with ferritin in both groups (G1: ρ=0,66, p<0,001; G2: ρ=0,87, p<0,001). Within G1, recent iron injections, administered in 24 patients, were significantly associated with higher hepcidin and ferritin, but not hemoglobin, as compared to patients without additional ferric therapy (n=45) (effect size: r=0,09 [by hemoglobin], r=0,80 [by hepcidin] and r=0,58 [by ferritin]).

Conclusion: Conclusions: Significant iron metabolism impairment, marked by high hepcidin and ferritin prevalence, exists in both CKD stages studied. Although hemodialysis patients had lower hemoglobin, baseline hepcidin/ferritin levels were similar between groups. Within the hemodialysis group, recent iron injections were associated with increased hepcidin/ferritin but not hemoglobin. Findings suggest hepcidin may be a crucial indicator of functional iron availability in CKD, potentially offering more insight than ferritin, particularly reflecting acute changes following iron administration in hemodialysis patients.

Objective: Aim: To evaluate the association between statin use and muscle strength in older adults with heart failure (HF).

Patients and methods: Materials and Methods: Hospitalized, older adults with HF were divided into two subgroups: use statin (US) and not use statin (N-US). Muscle strength was measured using a hand-held dynamometer and HF was assessed based on the New York Heart Association NYHA functional classification.

Results: Results: 194 patients (median age 82 [78-86] years), 90 patients in US and 104 in N-US group. Muscle strength didn't differ significantly in US vs N-US group, 19.74kg (15.48-27.18) vs 17.58kg (12.73-25.66), p=0.098. In a multivariate analysis age, sex, NYHA class, hemoglobin concentration, presence of atrial fibrillation, and hypothyroidism were found to be independent factors of muscle strength (p<0.001, p<0.001, p<0.01, p<0.001, p=0.02, p=0.04 respectively).

Conclusion: Conclusions: statin use is not related to decreased muscle strength in older adults with HF.

Objective: Aim: Evaluataion of the diagnostic accuracy and clinical utility of the Medicine GPT model in identifying and managing rare diseases in the emergency department.

Patients and methods: Materials and methods: A retrospective study was conducted using 100 published rare case reports retrieved from PubMed. Cases were selected based on three common complaints: chest pain (n = 50), abdominal pain (n = 30), and shortness of breath (n = 20). Each case's clinical presentation was input into Medicine GPT, which then generated a leading diagnosis. The primary outcome was the proportion of correct diagnoses. Cohen's Kappa (κ) was calculated to determine inter-rater reliability. Diagnostic accuracy varied by symptom category: chest pain (92%, κ = 0.84), abdominal pain (87%, κ = 0.81), and shortness of breath (90%, κ = 0.875). Based on full clinical presentations, overall diagnostic agreement reached 90% (κ = 0.84), indicating substantial to almost perfect consistency.

Conclusion: Conclusions: Medicine GPT demonstrated substantial diagnostic accuracy for rare emergency department presentations, indicating potential to enhance clinical decision-making. It may serve as a foundation for refining future AI models in real-world settings, but always should remain only as an assistive tool for professional clinical judgment.

Objective: Aim: The aim of the present study is to analyse and summarize the experience of the Department of Reconstructive and Plastic Microsurgery of the National Scientific Center of Surgery named after A.N. Syzganov in the field of treatment of hand injuries..

Patients and methods: Materials and Methods: The study sample included 295 patients who applied to the Department of Reconstructive and Plastic Microsurgery of the National Scientific Center of Surgery named after A.N. Syzganov from the beginning of 2021 to the end of 2022, in relation to which general clinical methods of research, including the method of dynamic observation and innovative microsurgical techniques, were applied. Innovative minimally invasive surgical techniques were developed and successfully applied to the flexor tendons of the fingers, ensuring precise juxtaposition of tendon ends, reducing tissue trauma, and facilitating smooth passage of the repaired tendons in bone-fibrous canals.

Results: Results: The application of the developed methods demonstrated high clinical efficacy, as evidenced by the high percentage of good and satisfactory treatment results - 98.8% in one group and 93.7% in the other. Nevertheless, in 3.4% of cases, the development of flexion contractures of fingers of different severity was observed, which was associated with insufficient intensity of rehabilitation, lack of proper dynamic control and indiscipline of some patients.

Conclusion: Conclusions: The result of the work was a comprehensive analysis of the experience of microsurgery of the hand obtained in the Republic of Kazakhstan during the study period.

Objective: Aim: To find out new objective criteria for laser histological differential diagnosis of thyroid pathology based on the use of a digital method of layer-by-layer polarization-interference mapping of polarization ellipticity maps of microscopic images of native histological sections of thyroid biopsy.

Patients and methods: Materials and Methods: Four groups of patients were studied: control group 1 - healthy donors (51 patients); study group 2 - patients with nodular goiter (51 patients); study group 3 - patients with autoimmune thyroiditis (51 patients); study group 4 - patients with papillary cancer (51 patients). Methods used: polarization-interference, statistical.

Results: Results: A brief theory and model concepts of the formation of structural optical anisotropy of polycrystalline networks of native histological sections of thyroid biopsy are considered. The structural and logical scheme of the method of polarization-interference layer-by-layer mapping of microscopic images of thyroid biopsies is presented. The statistical analysis of algorithmically reproduced maps of polarization ellipticity of experimental samples of biopsies of donors and patients with nodular goiter, autoimmune thyroiditis and papillary cancer was performed. Statistical objective markers for the differential diagnosis of thyroid pathology have been determined.

Conclusion: Conclusions: An excellent level (~93%-95%) of the balanced accuracy of differentiation of pathological conditions by the method of polarization-interference layer mapping was demonstrated.

Objective: Aim: The aim of this work is to analyze the provision of medical care to military personnel on the example of the activities of the Poltava Military Hospital (Poltava, Ukraine) for the period 2021-2023.

Patients and methods: Materials and Methods: The design of our study was descriptive. During the research, the reporting and accounting documentation of the Poltava Military Hospital for the relevant years was used. Descriptive statistics methods were used to analyze the main indicators of the hospital's activity: growth rates and growth rates were calculated to describe changes in the main indicators.

Results: Results: The average number of staffed beds in the hospital as a whole is growing. Thus, compared to 2021, in 2023, this figure increased by 200% (100% growth increment rate). The bed utilization, we can note that in 2022, the utilization of both staffed beds (67.29%) and actually deployed beds (47.93%) was inefficient, and during the war it reached a sufficient level - 89.27% and 63.84.8%, respectively, bed occupancy rates in all hospital departments were 7.7-7.3.

Conclusion: Conclusions: The ultimate impact of the ongoing war in Ukraine on the organization of medical care for injured servicemen and women remains uncertain, and we plan to explore this issue in our next work.

The aim of the paper is to reflect on the importance of the teacher of the medical profession in graduate and postgraduate education. The objective of the analysis was a narrative reflection on the profession of a teacher of medical professionals based on the principles of medical education and specialization programs applicable in Poland. The core curriculum for teaching in the field of medicine was analysed in detail, including also the insufficiently developed principles of selection and education of academic and vocational teachers. It has been demonstrated that there is no uniform concept of teaching competences for teachers of the medical profession in Poland. Academic teachers are usually recruited by medical universities based on their education and declaration of scientific work. Much less attention is paid to the development of their teaching competences. The current medical study programs are increasingly focused on practical skills. However, the limitation of theoretical subjects sometimes fails to provide sufficient knowledge to ensure the proper and in-depth education of medical students. Teaching future doctors requires reasonable care and reflection on the structure of the curricula, specialization programs, as well as on appropriate preparation of the teachers.

Air pollution currently plays a vital role in the increase in the number of deaths in the world. The problem of air pollution is now a very important public health problem. The effects of this pollution on the cardiovascular system have long been known. This impact is known in the field of PM2.5 and PM10 particulate matter. There are fewer reports on this impact in the field of heavy metals. The authors of this study present a brief description of acute ischemia of the lower limb and the possible effect of heavy metals from polluted air on the formation of thrombus in the arteries of the lower limbs and thus on acute ischemia of the lower limbs. The authors present an outline of the possible impact of polluted air elements on the formation of thrombus. This process can be combined with coagulation inside the peripheral arteries. The above problem requires research in the future. The authors plan such studies. This issue requires further research, and the authors plan to conduct such studies in the future.

Objective: Aim: To indicate the morphofunctional changes in the endocardium, wall of the arteries of various types, prostate gland, and adrenal glands in the dynamics of iodine deficiency during postnatal ontogenesis.

Patients and methods: Materials and Methods: The experiment involved 50 male Wistar rats (25 immature, aged 3-5 months, and 25 mature, aged 6-8 months). Group 1 (control) included 11 animals of both age groups, while Groups 2 and 3 (with iodine deficiency) consisted of 14 animals each, with material sampling on days 60 and 90 of the experiment, respectively. Morphological (light and electron microscopy), morphometric, biochemical studies, and statistical data processing were conducted.

Results: Results: Key components of thyroid signaling were found in the prostate gland, indicating a possible direct effect of thyroid hormones on this organ. Edematous changes in the epithelium of terminal secretory parts result from ischemia caused by edema in vascular walls and connective tissue elements of the prostate. Structural changes found in endocrine cells of the glomerular, fascicular, and reticular zones of the adrenal glands, along with the dynamic increase in cortical thickness during the experiment, suggest trophic disturbances, as edema was detected in vessel walls and stromal components.

Conclusion: Conclusions: Thus, on both day 60 and day 90 of iodine deficiency, edematous changes occur in all organs in connective tissue components, wall of blood vessels, and epithelial tissues. Altered thyroid status triggers systemic interrelated changes in the organism.