Wladyslaw Gawel

Evaluation of the quality of life and satisfaction with the therapy in patients with type 1 diabetes — is Medtronic MiniMed 640G system able to improve it? Preliminary insights

Introduction. The quality of life (QoL) became a very important parameter in the XXI century which often decides about the type of treatment. The spectrum of treatment possibilities is constantly expanding due to the rapid technological development. Currently most up-to-date MiniMed 640G system which is able to predict hypoglycemia episode, flexibly and transiently stop insulin delivery before approaching programmed low glucose limit and automatically resume it (SmartGuard technology) can become a way to improve the QoL of diabetic patients. Material and methods. The questionnaire survey was conducted among 10 girls and 14 boys at the age of 2–15 (median 8) years with well-controlled DM1 (HbA 1c varied from 5.8 to 8.8%, mean 6.7%). The mean time from diagnosis was 3.7 years. The main inclusion criteria was the therapy with 640G system. Patients were previously treated with insulin pumps with or without hypoblocade (Paradigm® 722/MiniMed® Veo). 3–11 months after introducing 640G system to therapy during the follow-up visit two surveys were conducted simultaneously: PedsQLTM 3.0 Diabetes which measured the QoL in diabetic patients (Survey I) and the authorial questionnaire (Survey II) which measured the satisfaction of 640G therapy (consisted of 11 questions, 2 closed and 9 semi-closed-ended). Results. Considering participants’ answers in Survey I, the mean scores of QoL regarding communication (79%), concerns (60%), treatment (76%) and diabexadtes (69%) which according to our scale (0–19% no impact, 20–39% low impact, 40–59% moderate impact, 60–79% high impact, 80–100% very high impact) proved that QoL was perceived high. The results of Survey II showed gladness and assurxadance of the patients with 640G therapy. Relying on their self-observation, over a half of participants (17 people) certified a serious reduction of both hypo/hyperglycemia episodes. 8 patients/caregivers highlighted a great coherence between blood glucose measured by sensor and glucose meter which enabled them to decrease the frequency of pricking fingers. 11 patients considered management of DM1 to be easier, they also noticed better cooperation with 640G system. Conclusion. Patients with DM1 using 640G system are satisfied with the effects of the therapy, they feel safer and their QoL measured by PedsQL is relatively high.

Safety profile of autologous hematopoietic stem cell mobilization and transplantation in patients with systemic sclerosis

Autologous hematopoietic stem cell transplantation (AHSCT) is thought to be effective therapeutic approach in patients with poor prognosis systemic sclerosis; however, the toxicity remains a challenge. Between years 2003 and 2016, we enrolled 18 patients with systemic sclerosis at median age at transplant of 52xa0years (range 24–68). The median duration of disease before AHSCT was 14xa0months (range 2–85). Peripheral blood stem cells were mobilized with cyclophosphamide (CY) and granulocyte colony-stimulating factor. Conditioning regimen included CY (200xa0mg/kg) and alemtuzumab (median dose, 60xa0mg) [nu2009=u200911], melphalan (MEL; 140xa0mg/m2) and alemtuzumab [nu2009=u20092], CY and rabbit anti-thymocyte globulin (rATG; 7.5xa0mg/kg) [nu2009=u20094], and CY alone (nu2009=u20091). Four deaths occurred early after transplant. There were three males and one female at median age at death of 51xa0years (range 24–68). The AHSCT-related deaths have been observed on days +u20091, +u20094, +u20099, and +u200915 after procedure. The causes of death included bilateral pneumonia followed by multi-organ failure in three patients and myocardial infarction in one. Three patients expired late during post-transplant follow-up, after 5, 21, and 42xa0months. The causes of death were disease progression in two patients and sudden heart attack in one. Eleven patients are alive after median follow-up after AHSCT of 42.0xa0months (range 0–95). Before proceeding to AHSCT in systemic sclerosis, there is a strong need to optimize patient selection to reduce toxicity. The administration of alemtuzumab should be avoided due to high risk of life-threatening infectious complications.

Acute Lymphoblastic Leukemia Transformation in Polycythemia Vera: A Rare Phenomenon

Leukemic transformation in patients diagnosed with polycythemia vera (PV) is associated with poor prognosis and median survival not exceeding 3xa0months. To date only a few cases of post-PV acute lymphoblastic leukemia (ALL) have been reported. A 64-year-old female patient developed ALL 4xa0years after she had met PV criteria. At PV diagnosis a molecular study was positive for the JAK2V617F mutation. Due to high risk features (history of deep vein thrombosis) she was treated with hydroxyurea (HU) with moderate efficacy. She became anemic and thrombocytopenic with mild leukocytosis while still on HU. Blood and bone marrow smears revealed 40 and 100xa0% of blast cells, respectively. The immunophenotyping of blasts was consistent with a diagnosis of early precursor B cell ALL. She was found to be positive for the JAK2V617F mutation. Patient received an ALL induction regimen and achieved complete remission with negative minimal residual disease by flow cytometry. The post-chemotherapy study for the JAK2V617F mutation was positive. Patient has remained in remission for 4xa0months. A suitable donor searching was initiated. Post-PV ALL is an extremely rare phenomenon. Due to poor prognosis, an allogeneic stem cell transplantation should be considered in fit patients who achieved remission.

IMPACT OF A CPRMETER FEEDBACK DEVICE ON CHEST COMPRESSION QUALITY PERFORMED BY NURSES — A RANDOMIZED CROSSOVER STUDY

Jolanta Majer, Halla Kaminska, Wojciech Wieczorek, Wladyslaw Gawel Department of Emergency Medicine, Holy Mary Memorial Provincial Specialist Hospital, Czestochowa, Poland Department of Children’s Diabetology, Medical University of Silesia, Katowice, Poland Department of Anaesthesiology, Intensive Care and Emergency Medicine in Zabrze, Medical University of Silesia in Katowice, Poland Student’s Scientific Association of Children’s Diabetology of Medical University of Silesia, Poland

UESCOPE AS A METHOD OF ENDOTRACHEAL INTUBATION OF TRAUMA PATIENT

Wladyslaw Gawel, Halla Kaminska, Wojciech Wieczorek Student Scientific Association of Children’s Diabetology at Medical University of Silesia, Katowice, Poland Department of Children’s Diabetology, Medical University of Silesia, Katowice, Poland Department of Anaesthesiology, Intensive Care and Emergency Medicine in Zabrze, Medical University of Silesia, Katowice, Poland Disaster Emerg Med J 2017; 2(4): 175–176