Tag: pubmed

J Urol. 2024 Dec 17:101097JU0000000000004392. doi: 10.1097/JU.0000000000004392. Online ahead of print.

ABSTRACT

PURPOSE: Patients with refractory neurogenic bladder dysfunction may require urinary reconstruction due to severe incontinence, difficulty with catheterization, and to prevent upper urinary tract compromise. We evaluated long-term decisional regret and associated factors following urinary reconstruction in spinal cord injury patients.

MATERIALS AND METHODS: We interviewed patients with spinal cord injuries who underwent bladder reconstruction surgery at least ten years ago, administering validated surveys on bowel quality of life and dysfunction, urinary tract infections, and decisional regret. Daily bladder management and symptoms were assessed using the Neurogenic Bladder Symptom Score (NBSS), a validated questionnaire consisting of three domains that examine incontinence, storage and voiding, and other health and quality of life consequences of neurogenic lower urinary tract dysfunction. Demographics, injury characteristics, and surgical modality were collected through chart reviews. Decisional regret was compared among subgroups and correlated with patient-reported outcomes.

RESULTS: We evaluated 52 patients (41 men, 78.8%; mean age 54.9±10 years) with average follow-up of 30±8.6 years post-injury and 21.9±5.3 years post-surgery. Reconstruction procedures mostly included bladder augmentation (n=38, 73.1%) and augmentation with continent catheterizable stoma (n=9, 17.3%). The majority of patients were of Hispanic origin (n=41, 78.8%) with complete spinal cord injuries (n=39, 76%). The median decision regret score was 7.5 (interquartile range: 0-25), indicating low regret among most participants. Bladder irrigation frequency (p=0.002) was associated with decision regret, while other patient and surgical factors (e.g., demographics, urinary tract infection frequency, and surgery type) were not. Surgical regret was moderately correlated with diminished bowel-related quality of life (ρ=0.333, p=0.016) and increased NBSS score (ρ=0.328, p=0.018). The Incontinence (ρ=0.286, p=0.040) and Consequences (ρ=0.299, p=0.031) domains of this measure showed weak statistically significant correlations with regret, while the Storage and Voiding domain did not reach significance (ρ=0.245, p=0.080).

CONCLUSIONS: Long-term follow-up suggests that lower urinary tract reconstruction with bowel interposition is a well-accepted and durable approach for managing refractory neurogenic bladder. Factors associated with decision regret, such as need for irrigation, should be incorporated in patient-centered decision-making.

PMID:39689225 | DOI:10.1097/JU.0000000000004392

Pol Merkur Lekarski. 2024;52(5):604-609. doi: 10.36740/Merkur202405120.

ABSTRACT

OBJECTIVE: Aim: To assess the level of occupational safety, health and hygiene of healthcare workers in the terms of the COVID-19 pandemic..

PATIENTS AND METHODS: Materials and Methods: bibliosemantic, bibliographic, analytical, statistical methods as well as a systemic approach have been used in the research. The data of the Cabinet of Ministers of Ukraine, the Ministry of Health of Ukraine, the State Labour Service and the scientific research findings from open sources have been analyzed.

CONCLUSION: Conclusions: The safety of healthcare workers with regard to infection is essential for a secure hospital environment. From an infection prevention perspective, PPE and sanitary requirements are fundamental to ensuring a safe environment for healthcare workers. The analysis revealed inadequate provision of PPE for healthcare workers during the pandemic, with levels ranging from 61,25% to 63,63%. The risk of contracting the novel coronavirus among healthcare personel during the pandemic was 12 times higher than in the general population. The risk of developing an occupational disease among those who treated patients infected with SARS-CoV-2 was 58,1 times higher. The analysis revealed that the provision of personal protective equipment (PPE) to healthcare workers during the study period was only two-thirds of the required amount, which consequently elevated the risk and incidence of morbidity among healthcare workers.

PMID:39689211 | DOI:10.36740/Merkur202405120

Pol Merkur Lekarski. 2024;52(5):562-567. doi: 10.36740/Merkur202405113.

ABSTRACT

OBJECTIVE: Aim: The aim of the study was evaluation of the methionine-enkephalin in patients with severe COVID-19 with various activities of the renin-aldosterone system in comparison with COVID-19 patients with pre-existing comorbidities (renal cell cancer, critical limb ischemia) and adverse pregnancy outcomes..

PATIENTS AND METHODS: Materials and Methods: To test our hypothesis, this case-control study consisted of 20 healthy donors (control group); 49 patients with a positive diagnosis of COVID-19 according to PCR analysis; 15 patients with a positive diagnosis of COVID-19 in combination with renal cell cancer; 29 patients with a positive diagnosis of COVID-19 in combination with critical limb ischemia, 10 pregnant womens with COVID-19. Methionine-enkephalin, plasma renin activity, plasma aldosterone was measured by radioimmunoassay. Statistical and graphical analyses were done using Statistica 7.0 StatSoft software and using MedCalc.

RESULTS: Results: As our results have shown, hyperreninemia against the background of hypoaldosteronism and inhibition of enkephalinergic activity is fatal for COVID-19 patients. In COVID-19 patients with renal cell carcinoma, met-enkephalin, aldsterone, and plasma renin activity also showed a high predictive value for mortality. Whereas in patients with critical limb ischemia the strongest predictor biomarkers of mortality were only renin plasma activity. In conditions of physiological hyperreninemia during pregnancy, met-enkephalin acts as a biomarker for preterm birth, and in pregnant patients with COVID-19, plasma renin activity acts as such a biomarker.

CONCLUSION: Conclusions: We found that in different categories of patients with COVID-19, the severity and outcome depend on the different activity of the renin-angiotensinaldosterone and enkephalinergic systems.

PMID:39689204 | DOI:10.36740/Merkur202405113

Pol Merkur Lekarski. 2024;52(5):557-561. doi: 10.36740/Merkur202405112.

ABSTRACT

OBJECTIVE: Aim: To study the psychological peculiarities of the manifestation of leadership qualities by modern managers of police organizations..

PATIENTS AND METHODS: Materials and Methods: The research conducted in 2022-2024 involved 64 mid-level managers of police organizations and 462 officers from police units directly subordinated to these managers. Research methods: bibliosemantic, psychological and diagnostic, system analysis and generalization method, statistical.

RESULTS: Results: It has been found that a significant number of modern mid-level managers of police organizations are not inclined to show leadership in their units. It has been found that 15,6% of today’s mid-level managers demonstrate low leadership. The average level of leadership qualities was recorded in 50,0% of managers, and this result generally coincides with the opinion of officers (51,1%). A sufficient level of leadership qualities of managers, which ensures the effectiveness of their management activities, was identified in 34,4% of respondents. It has been determined that a third of the respondents in both groups (35,9% of managers; 33,3% of officers) believe that the efficiency of management activities is above average and can be improved through various measures and means.

CONCLUSION: Conclusions: The obtained results indicate the practicality of using an integrated approach to developing leadership qualities and skills of successful team management (at the subsequent stages of work with personnel). Also this indicates problems in the organization of professional selection and psychological support of police managers.

PMID:39689203 | DOI:10.36740/Merkur202405112

Pol Merkur Lekarski. 2024;52(5):547-556. doi: 10.36740/Merkur202405111.

ABSTRACT

OBJECTIVE: Aim: The purpose of this study is to comprehensively assess the workload of general practitioners using the time study and the WISN method..

PATIENTS AND METHODS: Materials and Methods: Time studies are used to assess the objective workload of physicians, by measuring the duration of physicians’ activities, and the WISN method, which is based on the workload of a health care professional and determines how many health care professionals of a certain type are needed to cope with the workload of a given health care facility.

RESULTS: Results: The results show that general practitioners spend short period of time for one patient visits, which may be conditioned by high patient attendance. In addition, general practitioners perform unusual functional duties. When calculated based on the Republican standard, the needs assessment by the WISN method showed that there is a shortage of general practitioners in outpatient clinics.

CONCLUSION: Conclusions: The needs assessment for the first and second scenarios shows that general practitioners cope with the workload of receiving patients, so the WISN assessment shows that there is a surplus of general practitioners.

PMID:39689202 | DOI:10.36740/Merkur202405111

Pol Merkur Lekarski. 2024;52(5):536-540. doi: 10.36740/Merkur202405109.

ABSTRACT

OBJECTIVE: . Aim: To find out the influence of melatonin on the enzyme activities of glucose-6-phosphate dehydrogenase, 6-phosphogluconate dehydrogenase and transketolase in the liver of rats with alloxan diabetes under conditions of variable photoperiod.

PATIENTS AND METHODS: Materials and Methods: Experiments were conducted on male outbred white rats weighing 180±10 mg. Photoperiodic changes: 1) equinox (light from 8:00 a.m. to 8:00 p.m., 500 lux); 2) light throughout the day and night (500 lux); 3) darkness. Alloxan diabetes was induced by administration of a 5% solution of alloxan monohydrate at a dose of 170 mg/kg once. Groups: 1) control; 2) rats with diabetes mellitus; 3) rats with diabetes mellitus and melatonin injections at the rate of 10 mg/kg of weight for a week daily. Rats were sacrificed on the 12th day in accordance with the ethical principles of experiments on animals. Enzyme activities were determined according to standard methods. Statistical processing was performed according to Statistica 10 StatSoft Inc.

RESULTS: Results: In the liver of rats with diabetes mellitus, under the conditions of equinox activities of investigated enzymes decreased by 42, 32 and 40%, while an administration of melatonin let to: 1) an increase in enzyme activities by 40, 31, and 25%, respectively; 2) normalization under conditions of darkness; 3) an increase of the activities by 87, 120, and 60%, respectively in light conditions, compared to the control of equinox.

CONCLUSION: Conclusions: Melatonin contributed to the restoration of the amphibolic and energetic function of the pentose phosphate pathway of glucose-6-phosphate oxidation in liver of rats with alloxan diabetes under condition of variable photoperiod.

PMID:39689200 | DOI:10.36740/Merkur202405109

Pol Merkur Lekarski. 2024;52(5):529-535. doi: 10.36740/Merkur202405108.

ABSTRACT

OBJECTIVE: Aim: To study and analyze the treatment effectiveness in children with identified Coronavirus infection..

PATIENTS AND METHODS: Materials and Methods: included the treatment and analysis of the study results of of children (n=68, aged 14.36}3.62 years), with confirmed Coronavirus infection, who were observed in outpatient settings and in comparison with the control group (n=28).

RESULTS: Results: Positive dynamics after treatment were observed in all parameters of the CBC (р4<0.01-0.03), except in the level of Platelets (р1=0.65; р2=0.3, р3=0.21, р4=0.59) and Eosinophils (p1=0.40, p4=0.06). The levels of vitamin D3 and Zn were below the reference limit at the initial stage of the study and reached the physiological norms (р2=0.14,р2=0.09, respectively). Increasings of Ig M levels in 2.7 times, Ig E – in 10.6 and Ig A -in 3.3 were observed on the starting stage and have positive trend with the normalization of the levels after 6 months, which was confirmed by statistical significance (р4=0 ,06, p4=0.10, p4=0.54, respectively).

CONCLUSION: Conclusions: A level decrease in the the obtained indicators was observed after treatment in the next: IL-1 in 39.3 times, IL-4 in 6.6 times, IL-6 in 14.3 times, TNF-αin 49.2 times, γ-IFN in 11.2 times, D-dimer -in 14.1 times, Neopterin -in 10.1 times, CRP- in 5.4 times and Fibrinogen -1.9 times. The level of Anti IgGSARS-CoV-2S1-RBD exceeded the permissible level in 13.8 times. The levels of Adiponectin, Leptin and C-peptide significantly have decreased after treatment (p1<0.01) and after 6 months.

PMID:39689199 | DOI:10.36740/Merkur202405108

Pol Merkur Lekarski. 2024;52(5):522-528. doi: 10.36740/Merkur202405107.

ABSTRACT

OBJECTIVE: Aim: To analyze the results of the application of extracorporeal detoxification methods in the treatment of drug poisoning and their complications..

PATIENTS AND METHODS: Materials and Methods: The studied data of 129 patients aged 18-46 years with severe drug poisoning treated at the Kyiv toxicological center in 2010-2020. Statistical analysis was performed using the IBM SPSS Statistics 29.0.0.0 program; Kaplan-Meier method, log-rank test, p<0,05.

RESULTS: Results: Patients who started receiving renal replacement therapy 24-36 hours after hospitalization had the highest Kaplan-Meier survival rates. The Kaplan-Meier hazard ratio for death shows that the chances of survival progressively decrease from the 48th to the 72nd hour from the moment of admission of patients to hospital, and this trend is observed in patients with both anuria and oliguria. There was a statistically significant difference in Kaplan-Meier survival in patients receiving selective hemoperfusion on the background of renal replacement therapy (p=0,017); ozone therapy (p=0,051) and plasmapheresis (p=0,131) did not show statistical significance.

CONCLUSION: Conclusions: The combination of various methods of extracorporeal detoxification helps to increase the effectiveness of treatment of patients with drug poisoning due to the acceleration of the elimination of toxic substances and reduces the degree of manifestation of organotoxic effects.

PMID:39689198 | DOI:10.36740/Merkur202405107

Pol Merkur Lekarski. 2024;52(5):505-511. doi: 10.36740/Merkur202405115.

ABSTRACT

OBJECTIVE: . Aim: To analyze the complications during gynecologic surgery procedures and identify possible risk factors associated with this type of surgery in Ukraine.

PATIENTS AND METHODS: Materials and Methods: We conducted a multicenter, retrospective cohort study in tertiary care hospitals from 12 regions of Ukraine from January, 2021, to December, 2023. The study included women who underwent gynecologic surgery at these hospitals. Postoperative complications are defined by Clavien-Dindo classification.

RESULTS: Results: A total of 13,937 women were included in our study. The overall prevalence of 30-day complications was 13.9%. The most frequently postoperative complication types were surgical site infections, hemorrhage, urinary tract infection, bowel injury, urinary tract injury, and bladder injury. Age 60 years or older (adjusted odds ratio (aOR 1.81), BMI ≥30 kg/m2 (aOR 1.78), diabetes mellitus (aOR 1.45), procedures for gynecologic cancer (aOR 2.58), prior pelvic surgery (aOR 1.61), emergency procedure (aOR 1.83), ASA-physical status class 5 vs. 1 or 2 (aOR 4.31), operative time greater than 3 hours vs. less than 1 hour (aOR 2.92), wound class 4 vs. 1 (aOR 4.28), and open abdominal approach for surgery vs. laparoscopic procedure (aOR 2.65) were significantly associated with postoperative complications.

CONCLUSION: Conclusions: This study found a high prevalence of complications rate in gynecological surgery varied widely depending on the approach and type of procedure. Risk factors for complications are age, obesity, diabetes, procedures for gynecologic cancer, prior pelvic surgery, emergency procedure, open abdominal surgery, ASA-physical status, duration of surgery, and wound class.

PMID:39689196 | DOI:10.36740/Merkur202405115

JAMA Netw Open. 2024 Dec 2;7(12):e2449879. doi: 10.1001/jamanetworkopen.2024.49879.

ABSTRACT

IMPORTANCE: It is unclear whether daily physical activity and sports participation relate to executive function (EF) in children.

OBJECTIVE: To explore associations between early-life physical activity, sports participation, and executive function in primary school children.

DESIGN, SETTING, AND PARTICIPANTS: Data for this cohort study were collected from April 2006 to December 2017 from the Groningen Expert Center for Kids with Obesity (GECKO) Drenthe birth cohort, which includes Northern Dutch children. Preschool children aged 5 to 6 years and primary school children aged 10 to 11 years with valid EF, daily physical activity, and sports participation data were included in the analysis. Data were analyzed from May 2023 to February 2024.

EXPOSURES: At ages 5 to 6 years, daily physical activity was measured with accelerometry. At ages 10 to 11 years, sports participation data were collected using the Short Questionnaire to Assess Health-Enhancing Physical Activity.

MAIN OUTCOMES AND MEASURES: Executive function was assessed using the Behavior Rating Inventory of Executive Function at ages 10 to 11 years.

RESULTS: A total of 880 children (470 female [53.4%]; mean [SD] age at EF measurement, 11.1 [0.4] years) were included. Moderate to vigorous physical activity at ages 5 to 6 years did not correlate with EF at ages 10 to 11 years (eg, Global Executive Composite [GEC]: β, 0.16; 95% CI, -0.21 to 0.53). Higher levels of light physical activity at ages 5 to 6 years were associated with poorer inhibitory control (β, 0.86; 95% CI, 0.24-1.47) and self-monitoring (β, 0.79; 95% CI, 0.09-1.48) at ages 10 to 11 years, while greater sedentary time was associated with better inhibitory control (β, -0.62; 95% CI, -1.08 to -0.16) and self-monitoring (β, -0.57; 95% CI, -1.09 to -0.06). Compared with children engaged in individual sports, team sports participants exhibited better overall EF (mean difference [SE], -3.03 [0.81]), behavior regulation (mean difference [SE], -3.39 [0.77]), and metacognition (mean difference [SE], -2.55 [0.81]). Children involved in both types of sports vs only individual sports had better EF (GEC: mean difference [SE], -2.66 [0.93]).

CONCLUSIONS AND RELEVANCE: In this cohort study of Dutch children, early-life moderate to vigorous physical activity was not associated with EF in middle childhood. Children participating in team sports at ages 10 to 11 years consistently exhibited superior EF compared with participants in individual sports.

PMID:39688868 | DOI:10.1001/jamanetworkopen.2024.49879