Tag: pubmed

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

JAMA Netw Open. 2024 Dec 2;7(12):e2450172. doi: 10.1001/jamanetworkopen.2024.50172.

ABSTRACT

IMPORTANCE: Poor-quality handoffs can lead to medical errors when transitioning patient care. Biased language within handoffs may contribute to errors and lead to disparities in health care delivery.

OBJECTIVE: To compare clinical information recall accuracy and attitudes toward patients among trainees in paired cases of biased vs neutral language in simulated handoffs.

DESIGN, SETTING, AND PARTICIPANTS: Surveys administered from April 29 to June 15 and from July 20 to October 10, 2023, included 3 simulated verbal handoffs, randomized between biased and neutral, and measured clinical information recall, attitudes toward patients, and key takeaways after each handoff. Participants included residents in internal medicine, pediatrics, and internal medicine-pediatrics and senior medical students at 2 academic medical centers in different geographic regions of the US. Data were analyzed from November 2023 to June 2024.

EXPOSURES: Each participant received 3 handoffs that were based on real handoffs about Black patients at 1 academic center. These handoffs were each randomized to either a biased or neutral version. Biased handoffs had 1 of 3 types of bias: stereotype, blame, or doubt. The order of handoff presentation was also randomized. Internal medicine and pediatrics residents received slightly different surveys, tailored for their specialty. Internal medicine-pediatrics residents received the pediatric survey. Medical students were randomly assigned the survey type.

MAIN OUTCOMES AND MEASURES: Each handoff was followed by a clinical information recall question, an adapted version of the Provider Attitudes Toward Sickle Cell Patients Scale (PASS), and 3 free-response takeaways.

RESULTS: Of 748 trainees contacted, 169 participants (142 residents and 27 medical students) completed the survey (23% overall response rate), distributed across institutions, residency programs, and years of training (95 female [56%]; mean [SD] age, 28.6 [2.3] years). Participants who received handoffs with blame-based bias had less accurate information recall than those who received neutral handoffs (77% vs 93%; P = .005). Those who reported bias as a key takeaway of the handoff had lower clinical information recall accuracy than those who did not (85% vs 93%; P = .01). Participants had less positive attitudes toward patients per PASS scores after receiving biased compared with neutral handoffs (mean scores, 22.9 [3.3] vs 25.2 [2.7]; P < .001). More positive attitudes toward patients were associated with higher clinical information recall accuracy (odds ratio, 1.12; 95% CI, 1.02-1.22).

CONCLUSIONS AND RELEVANCE: In this survey study of residents and medical students, biased handoffs impeded accurate transfer of key clinical information and decreased empathy, potentially endangering patients and worsening health disparities. Handoff standardization is critical to addressing racial bias and improving patient safety.

PMID:39688867 | DOI:10.1001/jamanetworkopen.2024.50172

JAMA Netw Open. 2024 Dec 2;7(12):e2451597. doi: 10.1001/jamanetworkopen.2024.51597.

ABSTRACT

IMPORTANCE: Cannabis use among pregnant individuals has increased. Depression and stress are frequently reported motives for cannabis use that may prolong using cannabis during pregnancy.

OBJECTIVE: To examine associations between changes in depression, stress, and self-reported prenatal cannabis use (PCU), to examine motives for PCU, and to examine whether trajectories of depression and stress vary across individuals who report using cannabis to cope with mental health symptoms and/or stress, those who use cannabis for other reasons, and those who do not report PCU.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study recruited pregnant individuals at an obstetric clinic at an academic hospital between July 2019 and January 2024 and followed them during pregnancy. Pregnant individuals with a history of lifetime cannabis use were included. Individuals reporting heavy episodic alcohol use or with other illicit drug use were excluded.

EXPOSURE: Self-reported PCU.

MAIN OUTCOMES AND MEASURES: The primary outcomes were self-reported depression (Edinburgh Postnatal Depression Scale), stress (Cohen Perceived Stress Scale), and cannabis use at each trimester during pregnancy, as well as motives for cannabis use during the first trimester (T1). Stability and changes in depression and stress scores and categorical self-reported prenatal cannabis use from T1 to the third trimester (T3) were estimated using individual linear growth curve models.

RESULTS: In this sample of 504 patients (all identified as women; median [IQR] age, 26 [18-40] years), 236 individuals (46.8%) reported PCU after pregnancy knowledge. Depression, stress, and PCU decreased from T1 to T3 (all slope estimates less than -0.29; SEs, 0.23-0.7; all P < .001). There were positive associations between depression and PCU at T1 (r = 0.17; P = .004) and in their rate of change (r = 0.18; P = .01). Only T1 stress and PCU were correlated (r = 0.14; P = .004). Participants reporting PCU for mental health reasons (137 participants [58.1%]) had the highest depression scores at each trimester; however, their rate of change in depression was statistically equivalent to those who did not use cannabis.

CONCLUSIONS AND RELEVANCE: In this cohort study of PCU, participants who used cannabis did not experience a more significant decline in stress or depression symptoms compared with those who did not use cannabis. Individuals who used cannabis for mental health reasons did not hasten a decrease in their symptoms. Health care professionals are encouraged to enhance prenatal individuals’ access to empirically supported treatments for depression and stress.

PMID:39688865 | DOI:10.1001/jamanetworkopen.2024.51597