Piotr Książek

The effect of a single dialysis session on spatial QRS-T angle in haemodialysis patients

BACKGROUND Abnormal values of the spatial angle between the directions of ventricular depolarization and repolarization (QRS-T) reflect the action potential inhomogeneities and predict cardiac events and mortality in various patient groups. The study was designed to (i) compare QRS-T in haemodialysis (HD) patients and healthy subjects, (ii) assess the influence of HD on QRS-T and (iii) evaluate the possible associations between QRS-T and echocardiography, haemodynamic as well as biochemical parameters. METHODS The angular differences between the maximum spatial QRS and T vectors were measured in 73 HD patients and in 57 controls. QRS-T in patients was estimated pre- and post-dialysis together with the evaluation of blood chemistry and haemodynamic parameters. RESULTS Pre-dialysis QRS-T was higher compared with controls (30.18 ± 9.84 and 13.65 ± 7.23, respectively; P < 0.001). HD induced an increase of QRS-T (41.09 ± 11.74; P < 0.001). Pre-dialysis QRS-T adjusted for left ventricular mass index correlated with troponin T (r = 0.398, P = 0.001) and HDL (r = -0.270, P = 0.043). The differences between pre- and post-dialysis (Δ) QRS-T correlated with Δ potassium (r = 0.453, P < 0.001), Δ calcium (r = -0.309, P = 0.011) and Δ stroke index (SI; r = 0.311, P = 0.017). On multivariate analysis, troponin T was found to be an independent predictor of pre-dialysis QRS-T, whereas independent predictors of the HD-induced increase in QRS-T were potassium and cardiac index changes. CONCLUSIONS QRS-T is high in HD patients. HD enhances the inhomogeneities of action potential. Pre-dialysis QRS-T is mainly associated with troponin T elevation. HD-induced increase in QRS-T is mainly associated with potassium and SI changes. The possible clinical importance of the higher QRS-T in HD patients remains to be confirmed in further studies.

The role of long term care centers in the Polish system of mental health care

Abstract Objective: The aim of this work is to review the role of mental health care center and treatment center specialized in psychiatry in the Polish system of mental health care as a whole. Review: For many years in Poland, the process of transformation of psychiatric care model from the institutional (inpatient setting, most expensive) to community care model (personalized, much cheaper), has been taking place. The effective - coordinated system of community care should significantly improve cooperation in the treatment, while the community forms of health care should ensure full availability, complexity, and continuity of care provision. In many cases, the community support is inadequate and cannot provide patient with care at his home environment. For mentally ill, there may be a need for the use of the long term health care centers specialized in psychiatry. Conclusions: A long term mental health care center specialised in mental health plays an important role in long-term care for the mentally ill. As far as a mental health service user’s perspective is concerned, the continuity of care and treatment in the long term health care center (as a health care unit) appears to be more useful and satisfying compared to a residential home for people with chronic mental illnesses. There is a need for broad discussion on the special place of the long term health care center specialized in psychiatry in the present Polish system of mental health care and on the improving of care pathways between inpatient-, day care-and, community care package.

Comparison of two treatment methods of congenital clubfoot in the orthopaedists’ opinion

Abstract Introduction. Clubfoot is the second most common birth defect of the lower limb. In Europe (including Poland) it concerns about 1-2 in 1000 newborns. What is characteristic for a clubfoot, is change in the foot shape and its impairment with preserving anatomical structures. Aim. The aim of this work is to gather opinions of orthopedic physicians on the effectiveness of the two methods used to treat congenital clubfoot: the Turco method and the Ponseti method. Material and methods. The research method used in the work was a diagnostic survey and research technique was the author’s questionnaire designed to gather opinions of orthopedic surgeons on the two methods of clubfoot treatment. The questionnaires were collected in the Orthopaedic Clinics in Lublin and Rzeszów, as well as during the specialization courses for orthopaedic surgeons in Lublin. Results. The most important advantages of the Ponseti method according to respondents are high clinical effectiveness (average 4.48) and short duration of hospitalization (average 4.31). While the most important disadvantages of the method is length of rehabilitation (average 2.85) and convalescence (average 2.36). Top assets of the Turco method in turn, according to respondents, are high clinical efficiency (average 2.92) and certainty of the patient’s recovery (2.74). In turn, the downsides of the Turco method according to the respondents are high invasiveness (average 4.11) and length of convalescence (average 3.87). Conclusion. The Ponseti method is the surveyed doctors’ preferred method of congenital clubfoot treatment.

Preventive examinations participation and satisfaction of women in peri- and postmenopausal age

Abstract Introduction. Breast cancer is the second major cause of death in the world, after lung cancer. The purpose of screening tests is to diagnose cancer at non-clinical symptoms stage, when the prognosis is good and treatment less costly. Among different currently available screening methods, mammography plays a key role in early breast cancer detection. Aim. The purpose of this work was to evaluate women’s in pre- and postmenopausal age in Lublin basic knowledge about preventive examination, their participation level and satisfaction with mammography. Material and methods. The study included 258 women, participants of mammography examination at the Witold Chodzko Institute of Rural Health in Lublin and in Specialist Clinic of the Stefan Cardinal Wyszynski Province Specialist Hospital in Lublin, at the turn of years 2011/2012. The research method was a diagnostic survey and research tool – the Original Questionnaire. Results. An opinion that prophylaxis should come as a result of aware lifestyle is not common (22.1% of participants is committed to expand their knowledge about health threats). Almost 20% of women has never participated in any prevention examination. Approximately 39% of respondents admitted that they have received an invitation for free examination in mammography mobile unit (MMU). Almost 52% respondents (out of those who correctly identified the term MMU) said that they are interested in visiting MMUs in the future. Conclusions. The number of participants taking part in preventive examinations and in screening tests is unsatisfactory. Numerous subjective factors cause this situation. Many women still does not trust mammography tests made in mobile mammography facilities.

The issue of alcohol abuse among the youth – students of Lublin schools

Abstract Introduction. Alcohol abuse among the youth is a pressing social issue. It is not only related to one’s individual susceptibility to risky or harmful drinking but also the issue of one’s family living with the individual that abuses alcohol. It needs emphasizing that alcohol consumption is on the rise and the age at which young people have their first alcoholic drink is declining as well. Also, girls tend to drink as much as boys. Aim. The aim of this work was to investigate the issue of alcohol abuse among young people of school age and the relationship between the following variables: school educational level, sex, satisfaction with home life and drinking patterns. Material and methods. The authors interviewed some 1444 students of 32 schools (12 elementary schools, 10 junior high schools and 10 high schools) chosen at random, using an anonymous questionnaire. The collected data were analyzed statistically, taking the following factors into consideration: sex, school level, atmosphere at home. Results and conclusions. One’s sex, school level and satisfaction with home life had influence over the respondents’ answers concerning alcohol consumption. The research study shows that students of schools at all levels drink alcohol - high school students drink vodka, junior high school students (gimnazjum in Polish) prefer beer, while elementary school students, who tend to drink the least, prefer wine. Interestingly enough, boys are drinking more than girls, yet girls are more likely to try all types of alcohol. Children who reported good atmosphere at home are less likely to drink, while in case of troubled homes, only every eighth respondent does not drink. The atmosphere at home also affects one’s drinking habits. Most of the respondents have no idea about ways of helping people addicted to alcohol.

Influence of alcohol consumption on risky behaviors among students of first and fourth year of the Medical Faculty

Abstract Introduction. The problem university students’ drinking in Poland has evoked greater interest lately. Numerous studies conducted in the recent years have indicated an increase in consumption of high-proof alcoholic beverages among students. Aim. The aim of the study was to explore the influence of alcohol over on risky behavior among first and fourth year students of the Medical Faculty at the Medical University in Lublin during the academic year 2011/2012. Material and methods. The study looked at 120 students, 45 men and 75 women; 60 people from the first and 60 people from the fourth year of the Medical Faculty. The method of an author’s original questionnaire, which was fully anonymous, was used. Answering 22 questions included in the questionnaire was voluntary, those completing the questionnaires could refuse to participate in the study at any time. Results. Statistically significant correlations between students who abused alcohol and their risky behaviors were found. Conclusions. There are some negative consequences of young people’s drinking alcohol and the most frequent symptoms They include: driving under the influence, engaging in risky sexual behaviors or starting fights. Several respondents admitted that they were passengers while the driver was intoxicated. Students being in a state of intoxication more often engaged in sexual activities. Alcohol consumption might also result in irrational decisions which could endanger health and lives e.g.: jumping from a roof. A few students of the fourth year were occasionally involved in gambling. A number of students admitted undergoing medical assistance after alcohol consumption.

Stress and methods of coping with it among students of the Medical University of Lublin

Abstract Introduction. Stress is a complex and ubiquitous phenomenon. According to the World Health Organization, it is one of the most common problems of the 21st century. It is no surprise that the majority of people associate stress with something entirely negative. However, there is no life without stress and a certain amount of stress in life is necessary. Aim. The aim of the study was to assess the occurrence of stress among students of the Medical University from the faculties of Medicine, Pharmacy, Dentistry and Public Health, and evaluate its influence on physiological changes and behavior, and present the ways of coping with it. Material and methods. The study comprised 240 students from the faculties mentioned above. Stress was measured by means of a questionnaire consisting of 14 fully anonymous questions which concerned factors causing stress, ways of reacting to it and methods of coping with it. Results. It was found out that stress as an intense emotional reaction to a number of stimuli triggers some physiological and psychological adaptation responses among students. Conclusions. The findings of this research suggest that pharmacy students are the most exposed to high levels of stress. Oral examination is considered to be the most stressful form of testing students’ knowledge. According to survey respondents, the most common symptoms of stress include abdominal pain palpitations, sleep disorders, excessive sweating, hand shaking. The majority of respondents listed the following activities to beat stress: sports, sleeping or listening to music, as most effective in reducing stress. Some of the respondents also turned to substances, such as tobacco or alcohol. The respondents admitted that they have also used drugs

The Nutritional Knowledge of Pregnant Women

Abstract Introduction. Rational nutrition of women during pregnancy has a great influence on the developing fetus. In the properly developing pregnancy, woman should eat 3-4 quality meals per day. What is more, for the proper development of the fetus, as well as the placenta, uterus and the mammary gland, it is necessary to consume high-value protein products. Moreover, vitamins and mineral compounds are important due to the serious implications that arise if not properly provided. Aim. The aim of the paper is to assess the nutritional practices, the level of knowledge held by pregnant women with respect to proper nourishment practices, and to define the influence of level of formal education achieved upon this issue. Material and methods. The research involved 87 pregnant women who were under the care of the outpatient womens health centre and high-risk pregnancy unit of the Regional Specialist Hospital in Biała Podlaska. Results and discussion. According to most of the female respondents, information concerning proper nutrition of pregnant women is not generally available. Because of this, in completing the questionnaire, more than half of the subjects stated that they often consume white bakery products, white rice and refined pasta - with insufficient consumption of brown bread, rice and wholemeal pasta. Furthermore, while the respondents seem to consume the proper amount of potatoes, barely 8% consume other vegetables with the advised frequency. Moreover, only 31% of the respondents take-in fruits in necessary quantities. However, a majority of them frequently consume milk, yoghurt, cheese, kefir and buttermilk; plus, more than half of the respondents drink at least 1-2 litres of various kinds of liquids per day. Our results also reveal that they very rarely consume fresh fish, poultry and red beef meat, preferring cooked products. Indeed, the respondents stated that they consume meat and fish mainly in a fried form, while 52.9% of the women take-in fast food products. Of note, the surveyed women prefer animal fats. In addition, nearly 70% of the subjects consume too many eggs. Furthermore, more than 40% consume an excessive amount of sugar and sweets. To conclude, the proper amount of meals is consumed by only 52.7% of the respondents, no matter their formal education level. Conclusions. Many abnormalities were found while verifying negatively the hypothesis, according to which, level of formal education achieved has an impact on the increase of consciousness in terms of proper nourishment during the pregnancy.

The impact of medical knowledge on attitudes towards the use of OTC drugs

Abstract Introduction. In many countries, the concept of OTC drugs, among others, is defined in advance by the assumed maximum period of their use – usually 3-5 days. In fact, many patients often benefit from these opportunities too often, use medication for longer than 3-5 days and prefer symptomatic treatment rather than causal. OTC drugs give people a sense of freedom and subjectivity. Numerous doctors claim that too much freedom in this case can prove dangerous. Aim. The aim of this study was to analyze the changes in attitudes towards the use of OTC drugs in medicine students as they acquire knowledge and medical experience. Material and methods. The study looked at 178 students of the Faculty of Medicine, Medical University of Lublin (89 – 1 and 2 year students as well 89 – 5 and 6 year ones). A diagnostic survey was used as a tool for obtaining responses from the participants. The survey was conducted between October 2014 and November 2014. Results. Almost 90% of medical students use OTC drugs for self-medication, while only 11% of them have never used such medicine. Analysis of students’ attitudes indicate that acquired medical knowledge has no effect on the frequency using this type of treatment. Overall, students tend to use such drugs occasionally. Only some 14-23% of them use the OTC drugs on a regular basis. The motivations for the use such drugs include: convenience, the previous experiences implying the efficacy of drugs, less frequent are other reasons. Some 28% of the students participating in the study and at least 13% of graduating medical students accept prolonged use of OTC drugs. As the consequence acquisition of medical knowledge, the students are less likely to consult their self-medication attitudes with doctors, families and friends, more often and accurately read the leaflets for drugs, and are more and more reluctant to proposals for extending the assortment of available OTC drugs. Conclusions. 1. Almost 90% of medical students use OTC drugs for self-treatment. 2. 28% of polled 1-2 year medical students and at least 13% of graduating ones may have tendencies to abuse drugs. 3. Over the subsequent years of study, medical students more often read medicine leaflets, they become less reliant on the advice they receive from their family or friends regarding self-treatment or they are less willing to extend the range of available OTC drugs.

Frequency of hospitalization in patients diagnosed with congenital talipes equinovarus (CTEV)

Abstract Introduction. Congenital talipes equinovarus (CTEV), also called clubfoot is the second after congenital dysplasia of the hip (CDH) most frequently occurring congenital limb defect. In Europe the deformity affects 1-2 newborns in 1000 live births. Aim. The aim of the study was to determine frequency of the deformity among other reasons for hospitalization, as well as depicting the profile of patients treated for clubfoot. Material and methods. Study method was the analysis of medical documentation from two Orthopaedic Wards of Prof. Antoni Gębala Children’s Hospital of Lublin. Medical records of patients treated for congenital talipes equinovarus (IDC 10-Q66.0) between 2008 and 2013 were the study material. Results. Results of the study show that in the analyzed period of time 310 children were hospitalized for clubfoot in hospotal. 39.35% (n=122) of the total number of patients were girls and 60.65% (n=188) were boys. The average age of patients was 3.69 years, (Me=1.09 years). Average age of girls was 4.17 (Me=1.35 years) and boys 3.89 (Me=0.83 years). The most numerous group consisted of infants up to 1 year (n=154; 49.68%). Conclusions. Clubfoot affects boys twice as often as girls. Moreover, in the examined hospital the average length of stay for patients with clubfoot has decreased. The research reveals that the average hospitalization length in children with congenital talipes equinovarus is systematically decreasing. The study shows that the number of patients being admitted to the Children’s Orthopedics Institute of the Hospital is increasing while the number of patients with clubfoot remains on the same level.