Roczniki Akademii Medycznej w Bialymstoku (1995)最新文献

Patients who crossed operation where exteriorization stoma was integral her part the aside from of cause, location and far-gone of illness which hereinto brought require special care. In moment of entry we to European Union should advert on introduction by us the surgeons of new operating techniques not only, but to attach importance to quality of sick's life after operations also, particularly these which violate beauty of our body. They are of the patients' groups the nation from stoma, particularly if cause the exteriorization stoma the state the neoplasmic disease of alimentary canal or arrangement urinary. The stay in Clinic whether the surgical squad, perspective of operation which is final effect producing artificial accompanying urinary content tract intestinal or fecal it joins with high-level of phobia. The Information Bureau for Stoma in year 1993 at Medical University was created and on the basis of this the information bureau the therapeutic complex worked out own model of these patients' care over group. The model of care over sick from stomy hugs three periods: preoperative, early and late surgical period (ambulant). On the basis of The Information Bureau from Stoma in 1994 year The Department was created of Podlasie the Society of Care over Patients from Stoma in Bialystok--association of working on thing sick's good. Organization this assembles from stomy the men, their family and guardians, workers of medical service and different men of good will. Meetings are forms of working, which performance of bothering patient's problems connected with nurturing and supply stomy is aim, and also psychical and help support in readaptation to life in family, company and society. The volunteers' training is to help different form of working this sick's group. Volunteer in this case--then living from stomy over year happily, adopted to life in every respect, person which exemplifies for sick prepared to operation positive (exteriorization stoma) or beginning one's "path stoma". Both the analysis and opinion of work of therapeutic complex, as and the workings The Association be made by only patients, their family and guardians, and also the workers of medical service. The elaborate model of care over sick from stoma on the basis of Information Bureau is accepted universally and resoluteness improves quality of life of this patients' group. Patient in XXI age from stomia on Podlasie it can appropriately living in family, work professionally, grow sport and hobby not only thanks to work therapeutic complex, but also and men who earlier found oneself in similar situation, as he alone.

Purpose: The contamination of the indoor environment with yeast-like fungi and moulds in social welfare home in Czerewki was evaluated.

Material and methods: The concentration of airborne fungi (in front of the building and in the corridors, patient rooms, study rooms, recreation rooms, kitchens, bathrooms, toilets) was determined using SAS-Super 100 (Pbi International). The fungal concentration on walls was assessed using the Count-Tact applicator and the plate Count-Tact irradiated (BioMerieux). Swabs were taken from the skin of the interdigital spaces of feet and hands, nails and the oral cavity of the residents. The fungi from the swabs were cultured on Sabouraud medium. Fungi were identified using standard microbial procedures.

Results: Tests of air and walls revealed significant differences in mycological flora in depending on the place isolation (e.g. corridor, rooms, reading room, nurse, room, kitchen, dining room, bathroom) and season (summer, autumn, winter, spring). A significant increase in the fungi isolated from the air and walls in the social welfare home was found, depending on the season.

Conclusion: An increase in the fungi isolated from residents was found in relation to the season.

In years sixtieth in U.S.A. the process of nursing was introduced to the contemporary practice of nursing. U.S. was also the first country where the need of teaching the nurses on high standard was noticed and executed. In years 1960-1980 a very intensive development of nursing appeared there, the process of nursing strengthened it's position as a work method based on the theory of human's needs. In Poland idea of process of care developed from over twenty years. Instruction cares is based for scientific bases this of process. Process of nursing as dynamic work method, makes a work of nurse very active and raises the quality of care after a sick person. This process embraces with one's own range also healthy man, potentially threatened with disease, family, group of persons and environment. It is the modern form of nursing in the contrary to nursing understood in traditional way. The main purpose of introduction the process of evidencing to execution of classes like geriatrics and geriatric nursing with students of the third year Faculty of Health Sciences, UMK Collegium Medicum was moulding abilities of conducting the process looking after a sick person by students trough underlining the meaning of scientific bases of nursing.

Purpose: To evaluate serum pepsinogen I (PG I) and gastrin-17 (G-17) levels in patients with Helicobacter pylori (H. pylori)-associated chronic atrophic gastritis, with reference to endoscopical Kimura-Takemoto's staging, chromoendoscopical and histological features.

Material and methods: 267 dyspeptic H. pylori-infected patients were examined by chromoendoscopy with biopsy sampling according to the Sydney System and according to Kimura-Takemoto's scale. Simultaneous assessment of serum pepsinogen I (PG I) and gastrin-17 (G-17) levels by enzyme immunoassay was performed. The serologic and morphologic results were compared with correlation analysis.

Results: There was strong reverse correlation between the stomach mucosal atrophy (antral part or corpus) and the proper serologic markers (respectively, G-17 or PG I) in H. pylori-associated chronic gastritis when gastric biopsies taken according to the Sydney System were assessed. The use of Kimura-Takemoto's scale has revealed the decrease of serum PG I levels only at 0-2 and 0-3 grades of the corpus mucosa atrophy. Probably, these results reflects the development of functional failure of the stomach corpus mucosa at late stages of atrophy when its compensatory capacity becomes insufficient. There were not any advantages in sampling biopsies for the detecting of intestinal metaplasia (IM) by the Sydney System, or by Kimura-Takemoto's scheme. The obvious concordance between histologically proven extent of IM and the number of IM foci detected by chromoendoscopy has been revealed.

Conclusions: The biopsy sampling for the diagnosis of precancerous changes of the stomach mucosa after non-invasive screening of atrophic gastritis (e.g., by means of EIA) should be based preferably on the visual signs acquired via chromoendoscopy than through routine endoscopy, independently of the scheme of examination of stomach mucosa, either according to the Sydney System, or to the Kimura-Takemoto's scale.

It is well known that subjects with type 1 diabetes are at an increased risk of death from coronary heart disease in comparison to non-diabetic age-matched individuals because hyperglycaemia is believed to be a key risk factor for the development of micro- and macrovascular complications. On the other hand there is increasing evidence about the role of inflammatory mediators in the pathogenesis of atherosclerosis and the development of acute coronary syndromes. It has been recently suggested that IL-18 and sICAM-1 have a strong predictive value for cardiovascular diseases and deaths in patients with coronary artery disease and/or in apparently healthy men. The aim of our study was to estimate the serum levels of IL-18 and sICAM-1 in subjects with type 1 diabetes and their relatives, who share HLA diabetic susceptibility genes (with or without pancreatic autoantibodies), but still without glucose level disturbances, as an evaluation of the possible role of genetic predisposition to the presence of IL-18 in diabetic families. The study was carried out in 35 type 1 diabetic subjects, their 101 healthy first-degree relatives: 36 siblings and 65 parents and the control group consisted of 31 healthy volunteers. We have found increased IL-18 and sICAM-1 levels in subjects with type 1 diabetes and their first degree relatives, who share diabetic HLA haplotypes: DRB1*03/DRB1*04 or DRB1*03/*04/DQB1*02 independently of their autoimmune status. There was a strong positive correlation between IL-18 and sICAM-1 levels in diabetic subjects and their first degree relatives without glucose level disturbances. To our knowledge this is the first study, which suggests that sICAM-1 elevations could be a result of IL-18 overproduction in type 1 diabetic subjects and their first degree relatives. Since in previous studies IL-18 and sICAM-1 were found to be predictors of death in subjects with CHD, one could speculate that high levels of IL-18 observed in subjects with genetic predisposition, but still with normal glucose levels, are an in addition to hyperglycaemia, pathogenic factors responsible for a higher risk of acute coronary events in subjects with diabetes type 1.

Purpose: In the general population there is association between Chlamydia trachomatis (Ch. trachomatis) infection and reactive arthritis (RA). RA is a systemic illness characterized by inflammatory synovitis. Arthritis tends to be oligoarticular and involves mainly the lower limbs. The aim of this study is to assess the age and sex specific prevalence of Ch. trachomatis infection in dialysis population and to find possible relationship between manifestation of infection and renal osteodystrophy.

Material and methods: The study was conducted in 53 patients: 22 women (W) and 31 men (M), with a mean age of 58.1 +/- 15 years, treated with HD for 28.5 +/- 28.2 months. The Ch. trachomatis infection was assessed by the detection IgG antibodies for Ch. trachomatis. Also some other biochemical parameters of osteodystrophy, inflammation and malnutrition were measured.

Results: The presence of a high titre of anti-Ch. trachomatis antibodies was found in 22 patients--41% [G IgG (+)]. Mean level of anti-Ch. trachomatis antibodies was significantly higher in G IgG (+) than in seronegative patients [G IgG (-)]: 19.0 +/- 8.6 vs 4.0 +/- 2.1 U/ml, p<0.001. There was no difference in mean age of seropositive and seronegative patients for Ch. trachomatis (62.4 +/- 13.1 vs 56.2 +/- 15.9 years). We did not observe in both groups of patients any differences in mean level of C-reactive protein (CRP): 12106.2 +/- 10791.0 vs 14015.3 +/- 11194.3 ng/ml. The mean ferritin level was significantly higher in G IgG (+): 624.3 +/- 375.7 vs 418.3 +/- 341.4 ng/ml, p<0.05. Significant negative correlations were found in G IgG (+) between IgG antibodies and transferrin saturation (r=-0.645719, p<0.001) and between CRP and calcium (r=-0.4526, p<0.05). IgG antibodies were detected frequently in W (60%) than in M (29%). Mean level of IgG was significantly higher in seropositive W than in seropositive M (23.3 +/- 7.8 vs 12.1 +/- 4.2 U/ml, p<0.0001). The seropositive W were older (67.9 +/- 11.8 vs. 53.8 +/- 11.0 years, p<0.02) and seropositive W were shorter treated with HD (18.1 +/- 16.6 vs 43.7 +/- 30.6 months, p<0.02). The mean serum calcium conc. and phosphorus were significantly lower in seropositive W (2.1 +/- 0.1 vs 2.3 +/- 0.2 mmol/l, p<0.05 and respectively 1.3 +/- 0.3 vs 1.8 +/- 0.2 mmol/l, p<0.005). Likewise the mean transferrin saturation (TS) was significantly lower in that group (25.7 +/- 7.3 vs 38.0 +/- 11.3%, p<0.01). There were no differences between seropositive men and women in mean serum concentrations of CRP, iPTH, albumin and hemoglobin. We found in seropositive W significant negative correlation between IgG antibodies and age (r=-0.633, p<0.02).

Conclusions: The patients treated with HD were quite frequently shown significantly elevated level of IgG antibodies for Ch. trachomatis. It could have be connected with past infection. The antibodies were more commonly detected in women

Purpose: Evoked potentials were recorded in patients with DCD to evaluate the integrity the afferent pathways and to rule out the presence of any neurological lesions.

Material and methods: Two boys: 5 and 16 years old with recognized DCD were examined. Battery of tests: short-latency somatosensory evoked potentials (SEP), pattern-reversal visual evoked potentials (VEP), cognitive event-related potentials (CERP) and EEG were recorded. CT and neuropsychological assessment were also performed.

Results: N20 and P25 latencies and also central conduction time of SEPs in both patients were longer. N9, N11, N13 latencies were normal. VEP, CERP, EEG and neuroimaging scans were normal.

Conclusions: Relationship among perceptual--motor skills, cognitive impairment and electrophysiologic findings in children with developmental dyspraxia are discussed. The disturbances of the integrity of the afferent pathways could to be one of many causal factors. Further researches are required to determine the specific source of the neurological deficit of clumsy children.

Purpose: Worsening of health as well as raising disability in course of aging lead to the increase in the needs for medical and nursing services. The on-going reforms of the primary health care system has brought the organizational transformation in community nursing care into the forms of non-public community nursing units. The aim of the study was to describe the characteristics of community nursing care provided to older people with regard to the differences between a traditional model of the public (SPZOZ) and new model of non-public units (NZOZ).

Material and methods: The study was carried out in all 113-community nurses employed in Bialystok, regardless of the form of employment. The questionnaire was answered by 101 nurses, from which one was excluded due to double employment in public (SPZOZ) and non-public (NZOZ) settings. From among of the remaining 100, 76 were employed in SPZOZ and 24 in NZOZ. As the research tool was used the questionnaire.

Results: The data obtained show the predominance of the therapeutic (95%) and diagnostic (78%) services which were more frequently provided by nurses employed in public sector (SPZOZ). Assessment of social situation as well as a caring process, education was rarely provided in both groups of nurses.

Conclusions: Mostly instrumental and therapeutic activities predominated in the community nursing. Generally, any significant differences between two settings of nursing care there were not found. The traditional model of community nursing care enables the realization the full professional competence of nurse in the primary health care system.

Purpose: The aim of our study was risk assessment for the development of pressure ulcers and thus defining a group of patients considered to be at risk of developing pressure ulcers. It also helped to define the role of the nurse in the early assessment of the risk for developing pressure ulcers.

Material and methods: Risk assessment for the development of pressure ulcers was carried out in 199 patients hospitalised in The District Hospital in Bielsk Podlaski. The research was carried out with patients admitted to The Departments of General Medicine, Infectious Diseases and Long-Term Care. Risk assessment for the development of pressure ulcers was performed with the aid of the Norton scale.

Conclusions: An increased risk for the development of pressure ulcers was found in more than half of the patients examined (53.8%). Pressure sores developed in 17.6% of the patients, women being at significantly greater risk. Risk assessment for the development of pressure ulcers with the aid of one of the recommended scales facilitates the early recognition of those patients at risk of developing pressure ulcers.

Preparations containing organic and inorganic fluorine compounds are used for oral hygiene. Fluoride ions contained in these preparations display high bioactivity and can alter the environment of the mouth. The aim of the study was to determine the effect of preparations containing aminofluorides, commonly used in oral hygiene, on the activity of salivary cathepsin C (EC 3.4.14.1). The research material included mixed saliva, collected at rest before and after the application of the following preparations: Elmex gelee, Elmex red fluid, Elmex green fluid, Fluormex rinse. The salivary pH, concentration of fluoride ions and activity of cathepsin C were determined. Fluoride preparations inhibit the activity of cathepsin C and cause changes in human salivary pH. Saliva can serve as a diagnostic material in the examination of the environmental exposure to fluorides.