The Impact of the War in Ukraine on the Epidemiological Situation of Tuberculosis in Europe

Ukraine is at the forefront of one of the largest outbreaks of tuberculosis (TB) in Europe, including multidrug-resistant tuberculosis. Due to the ongoing armed conflict in this area, there is a significant number of refugees from Ukraine to other European countries. The aim of the study is to emphasize the essence of the problem of the increased incidence of tuberculosis, taking into account the impact of the armed conflict in Ukraine, resulting in the intensification of migration movements. A descriptive epidemiological method was used as the research method. The material was collected by analyzing source statistical data from WHO and statistical yearbooks of selected European countries. Particularly, Ukrainian refugees in Poland, Germany, the Czech Republic, and Slovakia are at higher risk of contracting tuberculosis due to factors like migration stress, poor nutrition, and comorbidities. Epidemiological data from these countries show a rise in tuberculosis cases among foreigners, emphasizing the need for European specialists to be more vigilant in this unique situation, focusing on refugees and other vulnerable populations. More research and collaborative efforts are essential to closely monitor and prevent the severe outcomes of tuberculosis transmission.

Trace Elements Levels in Major Depressive Disorder-Evaluation of Potential Threats and Possible Therapeutic Approaches

The multifactorial etiology of major depressive disorder (MDD) includes biological, environmental, genetic, and psychological aspects. Recently, there has been an increasing interest in metallomic studies in psychiatry, aiming to evaluate the role of chosen trace elements in the MDD etiology as well as the progression of symptoms. This narrative review aims to summarize the available literature on the relationship between the concentration of chosen elements in the serum of patients with MDD and the onset and progression of this psychiatric condition. The authors reviewed PubMed, Web of Science, and Scopus databases searching for elements that had been investigated so far and further evaluated them in this paper. Ultimately, 15 elements were evaluated, namely, zinc, magnesium, selenium, iron, copper, aluminium, cadmium, lead, mercury, arsenic, calcium, manganese, chromium, nickel, and phosphorus. The association between metallomic studies and psychiatry has been developing dynamically recently. According to the results of current research, metallomics might act as a potential screening tool for patients with MDD while at the same time providing an assessment of the severity of symptoms. Either deficiencies or excessive amounts of chosen elements might be associated with the progression of depressive symptoms or even the onset of the disease among people predisposed to MDD.

Extracorporeal Rewarming Is Associated With Increased Survival Rate in Severely Hypothermic Patients With Preserved Spontaneous Circulation

Treatment recommendations for rewarming patients in severe accidental hypothermia with preserved spontaneous circulation have a weak evidence due to the absence of randomized clinical trials. We aimed to compare the outcomes of extracorporeal versus less-invasive rewarming of severely hypothermic patients with preserved spontaneous circulation. We conducted a multicenter retrospective study. The patient population was compiled based on data from the HELP Registry, the International Hypothermia Registry, and a literature review. Adult patients with a core temperature <28°C and preserved spontaneous circulation were included. Patients who underwent extracorporeal rewarming were compared with patients rewarmed with less-invasive methods, using a matched-pair analysis. The study population consisted of 50 patients rewarmed extracorporeally and 85 patients rewarmed with other, less-invasive methods. Variables significantly associated with survival included: lower age; outdoor cooling circumstances; higher blood pressure; higher PaCO 2 ; higher BE; higher HCO 3 ; and the absence of comorbidities. The survival rate was higher in patients rewarmed extracorporeally ( p = 0.049). The relative risk of death was twice as high in patients rewarmed less invasively. Based on our data, we conclude that patients in severe accidental hypothermia with circulatory instability can benefit from extracorporeal rewarming without an increased risk of complications.

Application of bioelectrical impedance analysis in monitoring patients with head and neck cancer after surgical intervention

INTRODUCTION

It is estimated that about 60% of patients with head and neck cancer (HNC) show poor nutritional status, and approximately 80% lose weight during treatment. The impact of surgical procedures on the risk of further weight loss, severe malnutrition and cachexia is a significant clinical problem that determines the higher incidence of postoperative complications, reduced effectiveness of the treatment used, longer hospitalization time, poor quality of life and higher mortality among patients. Bioelectrical impedance analysis (BIA) is currently recognized as a useful method of assessing the body composition and therefore the nutritional status of cancer patients. The aim of this study is to investigate whether measured and calculated parameters of BIA change shortly after surgery and could reflect the health of cells and body composition changes.

MATERIALS AND METHODS

We enrolled 54 patients (males) with advanced HNC in this observational study. We collected detailed anthropometric and BIA derived data. The Subjective Global Assessment (SGA) was used to assess the nutrition.

RESULTS

In the assessment performed one week after the surgery, compared to the condition on the day of surgery, the patients had significantly lower values of nutritional status (weight; body mass index - BMI; SGA), body composition (free fat mass - FFM; intracellular fluid - ICF; total body water - TBW). Other changes include a significant increase in fat mass (FM) or extracellular fluid (ECF). Moreover, a significant reduction of phase angle (PA, one of the most important BIA derived prognostic factors) was also noted.

CONCLUSIONS

Apart from the baseline assessment of the body composition and diagnosing nutritional disorders, it seems, that BIA should be considered also in the monitoring of HNC patients undergoing surgery.

Citrobacter freundii and Acinetobacter baumanii infection in a patient with neoplastic lung disease - Case report

An 85-year-old male with a tumour in his right lung was admitted to Internal Diseases Ward to continue treatment after suffering a sudden cardiac arrest. An empiric antibiotic therapy with amoxycillin was introduced due to increased inflammation markers. Blood and sputum were collected. An abundant growth of AmpC β-lactamase-producing Citrobacter freundii was observed in culture grown from the sputum. The antibiogram showed retained sensitivity to fluoroquinolones. The therapy was modified by replacing β-lactam with ciprofloxacin. Neither clinical nor laboratory improvement were observed. Blood culture indicated sepsis of Acinetobacter baumannii etiology. The strain was suspected of producing OXA carbapenemase (CARBA test positive), KPC (-), MBL (-). Antibiogram illustrated retained sensitivity to gentamicin and colistin with complete resistance to ciprofloxacin. Another modification in treatment was implemented and ciprofloxacin was replaced with colistin.

Effect of Spirulina Supplementation on Systolic and Diastolic Blood Pressure: Systematic Review and Meta-Analysis of Randomized Controlled Trials

Spirulina is a microalga that presents various important pro-health properties, for instance lowering blood pressure in the research. The study aims to appraise the efficacy of Spirulina administration on systolic (SBP) and diastolic blood pressure (DBP). Randomized controlled trials (RCTs) were retrieved by a systematic search of PubMed, Web of Science, and the Cochrane Library databases from inception to June 2021 according to a standardized protocol. The effect size of each study was counted from mean and standard deviation before and after the intervention and shown as Un-standardized mean difference and 95% confidence interval. Sensitivity analyses were performed. Meta-analysis on 5 RCTs with 230 subjects was eligible. The amount of Spirulina ranged from 1 to 8 g per day, and intervention durations ranged from 2 to 12 weeks. Data analysis indicated that Spirulina supplementation led to a significant lowering of SBP (Mean Difference (MD): -4.59 mmHg, 95% Confidence Interval (CI): -8.20 to -0.99, I square statistic (I²) = 65%) and significant lowering of DBP (MD: -7.02 mmHg, CI: -8.86 to -5.18, I² = 11%), particularly in a subgroup of hypertensive patients. Spirulina administration might have a supportive effect on the prevention and treatment of hypertension. More exact randomized controlled trials are needed to clarify the effect of Spirulina supplementation on blood pressure.

Impact of rescue collapse on mortality rate in severe accidental hypothermia: A matched-pair analysis

AIM

To assess the impact of the occurrence of cardiac arrest associated with initial management on the outcome of severely hypothermic patients who were rewarmed with Extracorporeal Life Support (ECLS).

METHODS

We collected the individual data of patients in a state of severe accidental hypothermia who were found with spontaneous circulation and rewarmed with ECLS, from cardiac surgery departments. Patients were divided into two groups: those with a subsequent cardiac arrest (RC group); and those with the retained circulation (HT3 group), and compared by using a matched-pair analysis. The mortality rates and the neurological status in survivors were compared as the main outcomes. The difference in the risk of death between the HT3 and RC groups was calculated.

RESULTS

A total of 124 patients were included into the study: 45 in the HT3 group and 79 in the RC group. The matched cohorts consisted of 45 HT3 patients and 45 RC patients. The mortality rate in both groups was 24% and 49% (p = 0.02) respectively; the relative risk of death was 2.0 (p = 0.02). ICU length of stay was significantly longer in the RC group (p < 0.001). Factors associated with survival in the HT3 group included patient age, rewarming rate, and blood BE; while in the RC group, patient age and lactate concentration.

CONCLUSIONS

The occurrence of rescue collapse is linked to a doubling of the risk of death in severely hypothermic patients. Procedures which are known as potential triggers of rescue collapse should be performed with special attention, including in conscious patients.

Risk Assessment of Endometrial Hyperplasia or Endometrial Cancer with Simplified Ultrasound-Based Scoring Systems

BACKGROUND

Abnormal uterine bleeding (AUB) represents a common diagnostic challenge, as it might be related to both benign and malignant conditions. Endometrial cancer may not be detected with blind uterine cavity sampling by dilatation and curettage or suction devices. Several scoring systems using different ultrasound image characteristics were recently proposed to estimate the risk of endometrial cancer (EC) in women with AUB.

AIM

The aim of the present study was to externally validate the predictive value of the recently proposed scoring systems including the Risk of Endometrial Cancer scoring model (REC) for EC risk stratification.

MATERIAL AND METHODS

It was a retrospective cohort study of women with postmenopausal bleeding. From June 2012 to June 2020 we studied a group of 394 women who underwent standard transvaginal ultrasound examination followed by power Doppler intrauterine vascularity assessment. Selected ultrasound features of endometrial lesions were assessed in each patient.

RESULTS

The median age was 60.3 years (range ± 10.7). The median body mass index (BMI) was 30.4 (range ± 6.0). Histological examination revealed 158 cases of endometrial hyperplasia (EH) and 236 cases of EC. Of the studied ultrasound endometrial features, the highest areas under the curve (AUCs) were found for endometrial thickness (ET) (AUC = 0.76; 95% CI: 0.71-0.81) and for interrupted endomyometrial junction (AUC = 0.70, 95% CI: 0.65-0.75). Selected scoring systems presented moderate to good predictive performance in differentiating EC and EH. The highest AUC was found for REC model (AUC = 0.75, 95% CI: 0.70-0.79) and for the basic model that included ET, Doppler score and interrupted endometrial junction (AUC = 0.77, 95% CI: 0.73-0.82). REC model was more accurate than other scoring systems and selected single features for differentiating benign hyperplasia from EC at early stages, regardless of menopausal status.

CONCLUSIONS

New scoring systems, including the REC model may be used in women with AUB for more efficient differentiation between benign and malignant conditions.

Impact of experimental diabetes and chronic hypoxia on rat fetal body weight

OBJECTIVES

The aim of the study is to determine the impact of the experimental diabetes and the chronic hypoxia on pregnancy development and rat fetal body weight.

MATERIAL AND METHODS

The experiment was performed on female Wistar rats. Animals were divided into the experimen-tal groups. I - Controls, II - Untreated diabetes, III - Insulin-treated diabetes, IV - No diabetes with chronic hypoxia, V - Untreated diabetes and chronic hypoxia, VI - Insulin- treated diabetes and chronic hypoxia. Diabetes was induced in groups II, III, V and VI with intraperitoneal injection of streptozocin (STZ) at a dose of 40 mg/kg. Chronic hypoxia was induced by placing dams (groups IV, V and VI) in conditions of 10.5% oxygen and 89.5%. Insulin was administered subcutaneously at the dose of 9 IU/kg. Starting from the 6th day after STZ injection and chronic hypoxia conditions animals were caged together for 12 hours for 3 consecutive days to ensure fertilization. On day 21 of gestation the animals were decapitated, the fetuses were removed and weighted.

RESULTS

Mean fetal body weight in separate groups were: I - 5.38 g, II - 6.04g, III - 5.32g, IV- 5.56 g, V - 3.45 g, VI - 6.23 g.

CONCLUSIONS

Pre-existing type 1 diabetes does not affect fetal body weight compared to healthy newborn control rats. Pro-longed hypoxia does not impact on fetal body weight. Chronic hypoxia during pregnancy complicated with untreated type 1 diabetes mellitus leads to significant reduction of fetal body weight. Insulin treatment reversed the detrimental effect of chronic hypoxia on fetal development.

Does the Epstein-Barr Virus Play a Role in the Pathogenesis of Graves' Disease?

Graves’ disease (GD) it the most common chronic organ-specific thyroid disorder without a fully recognized etiology. The pathogenesis of the disease accounts for an interaction between genetic, environmental, and immunological factors. The most important environmental factors include viral and bacterial infections. The Epstein-Barr virus (EBV) is one of the most common latent human viruses. Literature has suggested its role in the development of certain allergic and autoimmune diseases. EBV also exhibits oncogenic properties. The aim of the study was to analyze and compare the presence of EBV DNA in peripheral blood mononuclear cells (PBMCs) in patients with newly recognized GD and to find a correlation between EBV infection and the clinical picture of GD. The study included 39 untreated patients with newly diagnosed GD and a control group of 20 healthy volunteers who were gender and age matched. EBV DNA was detected with reverse transcription polymerase chain reaction (RT PCR) assay. The studies showed a significantly higher incidence of EBV copies in PBMCs among GD patients compared to the control group. Whereas, no significant correlations were found between the incidence of EBV copies and the evaluated clinical parameters. Our results suggest a probable role of EBV in GD development. EBV infection does not affect the clinical picture of Graves’ disease.

[Breasts self examination - everything we want you to know about it - survey study]

OBJECTIVE

Introduction: Breasts self examination is first line prevention in case of breast cancer. It is cheap, it is easy and it can save your life. That is why it is so important that every woman and even man know how to do it. The aim: To estimate the level of knowledge about breasts self examination among women and also among people connected with medicine.

PATIENTS AND METHODS

Materials and methods: The data were gathered through the internet questionnaire, which contained of 14 questions. There were 204 respondents : 53% women and 47% men. Among them there were 93% people related with medicine. Average age was 23,5 years. The participation was voluntary and annonymous.

RESULTS

Results: Among female respondents 57% admit doing breasts self examination, however only 23% of them do that regularly every month. Also only 36% of the respondents know how to do proper examination. When asked if they ever had their breasts examined by the doctor, only 20% replied positively. We also prepared questions for people connected with medical field: we asked them if doing breasts examination for the patient they would feel confident (61% replied negatively.) and also if they had a chance to do breasts examination during studies most of them replied negatively.

CONCLUSION

Conclusions: To conclude, even among women connected with medical field the knowledge is not enough, which is the most concerning since they should educate others and diagnose concerning symptoms. We should put more afford to break the tabu and pay more attention to breast examination.

Subclinical hyperthyroidism in the course of autonomous nodules - clinical evaluation

INTRODUCTION

Subclinical hyperthyroidism (SCH), also known as mildly symptomatic hyperthyroidism, has recently been diagnosed more frequently. One of the main endogenous causes of this disorder is autonomously functioning thyroid nodule (AFTN). Despite the fact that it is usually asymptomatic, SCH entails repercussions on the cardiovascular system and bone, and it carries a risk of progression to overt hyperthyroidism with a typical clinical picture. Treatment is still controversial, and its benefits are widely debated in literature.

MATERIAL AND METHODS

From 459 patients authors selected a group of 49 patients (10.6% of all subjects with hyperthyroidism), 41 women (83.7%) with AFTN at the stage SCH treated in the Outpatient Endocrinological Clinic and the Department of Endocrinology of the Medical University of Lublin over a three-year period. The method applied in the study was a retrospective analysis of medical records with a particular account of medical history, physical examination, and additional tests obtained during the process of diagnostic and therapeutic procedures.

RESULTS

Forty-one patients (83.7%) suffered from typical symptoms of hyperthyroidism; only eight patients (16.3%) were asymptomatic. The most frequently reported symptoms were tachycardia in women (51.2%) and anxiety in men (50%). The type of thyrostatic drugs and the length of therapy did not affect the outcome of iodine-131 therapy. In the vast majority of the patients (87.8%) radioidodine therapy was effective; 30 patients (61.2%) reached euthyreosis and 13 patients (22.5%) developed hypothyroidism.

CONCLUSIONS

Most patients with SCH in the course of AFTN suffered from typical symptoms of overt hyperthyroidism; only every sixth patient was asymptomatic. The volume of autonomous adenomas did not affect the result of 131I therapy; however, the impact of AFTN volume as well as the thyroid volume on RIT efficacy requires futher investigation. In the vast majority of patients 131I therapy was an effective method of treatment, and an earlier therapeutic effect was observed more often in the patients with focal lesions located in the right lobe.

Prevalence of neoplasms in patients with acromegaly - the need for a national registry

INTRODUCTION

Acromegaly is an endocrine disorder caused predominantly by pituitary adenoma leading to autonomic oversecretion of growth hormone and secondary elevation of insulin-like growth factor 1 (IGF-1). Consequently, there are both theoretical and experimental grounds for establishing a correlation between this disorder and the higher incidence of neoplasms.

OBJECTIVE

The aim of the study is to evaluate the incidence and types of neoplasms among patients with acromegaly.

MATERIAL AND METHODS

The study included 67 patients with acromegaly, aged between 24 and 75±18.8 years, 46 women (68.7%) and 21 men (31.3%), BMI: 30.7±5.7 kg/m2, age at diagnosis 49.1±12.5 years, with the medians of GH and IGF-1 levels at diagnosis of 11.3 ng/ml and 663.8 ng/ml, respectively. A retrospective analysis of medical records with particular regard to physical examination, medical history, laboratory and imaging tests was performed.

RESULTS

Fifty-one patients (76.1%) suffered from at least one neoplasm, among whom 48 patients (71.6%) had benign proliferations, whereas malignant neoplasms (larynx, endometrial and colon cancers) were found in only three patients (4.5%).

CONCLUSIONS

Benign neoplasms were found in majority of patients with acromegaly (71.6%) most notably: nodular goiter and colon polyps; malignant lesions were rare (4.5%). Only every fifth patient suffered from no neoplastic proliferations. No correlations between the studied parameters and the incidence of neoplasms were found, most likely due to the small number of patients. This is the reason for proposing the creating of the first national register of incidences of neoplasms among acromegalic patients.

[Public knowledge of the infertility and legal aspects of infertility treatment in Poland]

OBJECTIVE

Introduction: The awareness of infertility is limited in Polish society despite the fact that this problem affects around one million couples in our country. Some of them decide to undergo specialistic treatment. Issues pertaining techniques of contributed reproduction are strictly regulated by Polish law.

PATIENTS AND METHODS

Material and methods: The study was conducted among the residents of Lublin in the period from October 1, 2017 to May 1, 2018. The research tool was an original, anonymous questionnaire containing 24 questions. The study group consisted of 164 people. Statistical analysis was performed using T-student test for non-parametric variables.

RESULTS

Results: The majority of the examined group were people who worked the medical profession (71%). It is significant that as much as 79.3% of respondents are religious. Only 8,5% of respondents know that the Polish law on infertility treatment is regulated in Act on the treatment of infertility of 25 June 2015. Almost half of the respondents (44.2%) answered correctly to the question regarding the treatment of infertility according to the binding Act. Only 28,5% of respondents were able to give the definition of embryo included in the Act. Moreover, almost all respondents (92.1%) never met with lectures about legal aspects in the treatment of infertility. Half of the respondents (47.3%) correctly indicated the most common cause of female infertility, the reason of men infertility was correctly indicated more respondents (65.5%).

CONCLUSION

Conclusions: The respondents knowledge of infertility is more extensive than their knowledge of the legal regulations about infertility treatment. Respondents asked about regulations included in the Act on the treatment of infertility of June 25, 2015 mostly did not answer questions or gave wrong answers. The respondents whose field of study was related to medicine gave more correct answers compared to people who study non-medical fields. Practicing Catholic (45%) more often gave wrong answers.

[testicles self examination - knowledge and abilities - survey study]

OBJECTIVE

Introduction: Testicle cancer is a common malignant cancer among young men (20 to 44 years). In 90% of cases we can feel nodule or change of consistency, which means during testicles self examination we can quickly discover cancer. The aim: To estimate the level of knowledge about testicles self examination among men and also medical stuff and students.

PATIENTS AND METHODS

Materials and methods: We gathered the data through the internet questionnaire, which contained of 13 questions. There were 204 respondents (53% women and 47% men). 93% were related with medicine. Average age was 23,5 years old. The participation in the study was voluntary and annonymous.

RESULTS

Results: Only 41% of our respondents perform self examination. When asked if They every had Their testicles checked by a doctor only 33% responded positively. Most of the respondents almost correctly point out symtpoms and risk factors of testicles cancer. Only 22% of medical related respondents feel confident while performing testicles examination with the patient and just 12% of them had a chance to do it during studies. We also asked our respondents if They have ever seen a social campaign about priopriate testicles self exmiantion and 80% of them respondet negatively.

CONCLUSION

Conclusions: The level of education about testicles examination is on low level. Men are usually aware of the risk, but They neglect it. In most cases doctors do not examine testicles and are not confident about it. We have to put more concern to that case.

Frequencies of PD-1- positive T CD3+CD4+, T CD3+CD8+ and B CD19+ lymphocytes in female patients with Graves' disease and healthy controls- preliminary study

PD-1 maintains tolerance and inhibits autoimmune responses. Graves' disease (GD) is one of the most frequent autoimmune diseases of unclear etiology. The aim of this study was to evaluate the percentage and absolute counts of PD-1 positive T and B cells in newly diagnosed, untreated patients with hyperthyroidism due to GD. The study group included 30 patients and the control group comprised of 20 age- and sex-matched healthy individuals. Results showed significantly higher frequencies and absolute counts of PD-1 positive CD3+CD4+ T cells, CD3+CD8+ T cells and CD19+B cells in patients with GD in comparison to the healthy volunteers. Moreover, higher mean fluorescence intensity of PD-1 was found on CD3+CD4+ T cells, CD3+CD8+ T cells and CD19+B cells in the study group than in the control group. These results suggest that PD-1 protein might involved in the pathogenesis of GD.

Diagnostics of intestinal parasites in light microscopy among the population of children in eastern Afghanistan

OBJECTIVES

The Afghans, living in poor socioeconomic conditions, are estimated to be a community with a high rate of intestinal parasitic infections. The aim of the study was to estimate the prevalence and species of intestinal parasites among children's population in eastern Afghanistan and to present the methods of optimizing the techniques for identification of pathogens in light microscopy. The research was carried out as a part of humanitarian project Capacity building of health care system in Ghazni Province.

MATERIALS AND METHOD

The study involved 500 children aged 7-18 attending the Share Kona and the Khuija Ali High Schools in Ghazni, eastern Afghanistan in the period November 2013-April 2014. Three stool samples were collected from each patient at 2-day intervals, the samples were fixed in 10% formalin, transported to the Military Institute of Medicine in Poland, where they were pooled and examined using five different diagnostic methods in light microscopy (direct smear in Lugol's solution, Fülleborne's flotation, decantation in distilled water, Kato-Miura thick smear, and DiaSys/PARASYS sedimentation system).

RESULTS

Pathogenic intestinal parasites were detected in 217 patients (43.4%), with the most common Ascaris lumbricoides (35.3%), Giardia intestinalis (31.1%), and Hymenolepis nana (15.7%). The use of direct smear method allowed for the detection of intestinal parasites in 161 individuals. The application of four following testing methods has improved the detection rates of infected patients by 11.2%.

CONCLUSIONS

The variety of detected intestinal pathogens in examined children's population has required the use of combination of multiple diagnostic methods in light microscopy, and finally improved the detection rates of intestinal parasites and helped eliminate infections with nematodes, cestodes, trematodes, and protozoa using appropriate treatment in the study population.

Capacitance of Membrane As a Prognostic Indicator of Survival in Head and Neck Cancer

BACKGROUND

Evaluation of prognostic value of capacitance of membrane (Cm), parameter measured by bioelectrical impedance (BIA) as an alternative to known clinical factors in patients with Head and Neck Cancer (HNC).

METHODS

A cohort of 75 stage IIIB and IV HNC patients treated in Department of Otolaryngology, Head and Neck Surgery, Medical University of Lublin, Poland were prospectively evaluated. Cm measurements were performed in all patients using a bioelectrical impedance analyzer that was set on a frequency of 50 kHz. Results of Cm measurements were presented in nF. Survival differences were estimated using Kaplan-Meier method.

RESULTS

Significantly higher Cm median was noted in well-nourished(n = 45) compared to malnourished (n = 30) patients (1.41 vs 1.01 respectively; p = 0.0009). Established in ROC curves analysis cut-off value (0.743) was characterized by 98% specificity and 37% sensitivity in the detection of malnutrition. Median overall survival (mOS) in the cohort was 32months. At the time of analysis deaths were recorded in 47 cases (62.7%). In patients who had Cm below the level of 0.743 risk of OS shortening was significantly higher than in other patients (12.1 and 43.4 months respectively; HR = 8.47, 95%CI: 2.91-24.66; χ2 = 15.38, p = 0.0001).

CONCLUSION

Cm is a strong, independent prognostic factor in head and neck cancer.

Epidemiology of intestinal parasitic infections in school children in Ghazni Province, eastern Afghanistan

OBJECTIVE

To estimate the prevalence of intestinal parasites and their species in Afghan school children and to establish appropriate treatment methods for detected pathogens.

METHODS

Parasitological examination of stool samples collected from 1369 children aged 8-18, students of the Jahan Malika High School in Ghazni Province in eastern Afghanistan, was conducted in the period November 2013-April 2014. Three stool samples were collected from each patient every second day; the samples were fixed in 10% formalin and tested by light microscopy using the methods of direct smear in Lugol's solution, decantation in distilled water, and Fülleborn's flotation.

RESULTS

Of 535 examined children (39.1% of the study group) were infected with nematodes (n=324), cestodes (n=118), trematodes (n=12), and protozoa (n=228), 132 were diagnosed with co-infections (mainly ascariasis+giardiasis, ascariasis+hymenolepiasis) and received single or combined therapy.

CONCLUSIONS

The Afghan community is an example of population characterized by a high rate of parasitic infections. Owing to high prevalence of multiple infections among inhabitants of Afghanistan, it seems that a mass deworming campaign with a single-dose chemotherapy may prove ineffective in eradicating intestinal parasites in the local population.

Validation of the Polish version of Diabetes Quality of Life - Brief Clinical Inventory (DQL-BCI) among patients with type 2 diabetes

INTRODUCTION

The aim of the study was to develop a Polish version of the Diabetes Quality of Life Brief Clinical Inventory (DQL-BCI) and to perform validating evaluation of selected psychometric aspects.

MATERIAL AND METHODS

The translation process was performed in accordance with generally accepted international principles of translation and cultural adaptation of measurement tools. Two hundred and seventy-four subjects with type 2 diabetes completed the Polish version of DQL-BCI, the generic EQ-5D questionnaire and the diabetes-specific DSC-R. The examination provides information about the reliability (internal consistency, test-retest) and the construct validity of the studied tool (the relationship between the DQL-BCI score and EQ-5D and DSC-R scales, as well as selected clinical patient characteristics).

RESULTS

Cronbach's α (internal consistency) for the translated version of DQL-BCI was 0.76. Test-retest Pearson correlation coefficient was 0.96. Spearman's coefficient correlation between DQL-BCI score and EQ-5D index and EQ-VAS were 0.6 (p = 0.0000001) and 0.61 (p = 0.0000001) respectively. The correlation between scores of the examined tool and DSC-R total score was -0.6 (p = 0.0000001). Quality of life was lower among patients with microvascular as well as macrovascular complications and with occurring hypoglycemic episodes.

CONCLUSIONS

The result of this study is the Polish scale used to test the quality of life of patients with diabetes, which includes the range of problems faced by patients while maintaining a patient-friendly form. High reliability of the scale and good construct validity qualify the Polish version of DQL-BCI as a reliable tool in both research and individual diagnostics.

Extracellular-to-body cell mass ratio and subjective global assessment in head-and-neck cancers

BACKGROUND

The ratio of extracellular mass to body cell mass (ecm/bcm), determined by bioelectrical impedance analysis, has been found to be a potentially useful indicator of nutrition status. Subjective global assessment (sga) is a subjective method of evaluating nutrition status in head-and-neck cancer. The present study was conducted to investigate the association between ecm/bcm and sga in head-and-neck cancer.

METHODS

Patients were classified as either well-nourished or malnourished by sga. Bioelectrical impedance analysis was conducted on a population of 75 patients with histologically confirmed head-and-neck cancer, and the ecm/bcm was calculated. Receiver operating characteristic curves were estimated using the nonparametric method to determine an optimal cut-off value of the ecm/bcm.

RESULTS

Compared with malnourished patients, those who were well-nourished had a statistically significantly lower ecm/bcm (1.11 vs. 1.28, p = 0.005). An ecm/bcm cut-off of 1.194 was 76% sensitive and 63% specific in detecting malnutrition.

CONCLUSIONS

The ecm/bcm can be an indicator that detects malnutrition in patients with head-and-neck cancer. Further observations are needed to validate the significance of the ecm/bcm and to monitor nutrition interventions.

[Assessment of the angle between puborectal muscles in women with and without stress urinary incontinence in three-dimensional sonograph]

Contemporary care of the woman, especially in the postmenopausal period is based not only on gynaecological periodic inspections, but also on the routine evaluation of the pelvis minorwith the ultrasound examination. Based on this examination we can manytimes initially diversify causes of wrong manifestations, so like, e.g., urinary incontinence, of social pathologies coming into existence in the result rolling within the pelvis minor. Urinary incontinence is a complaint which is changing the quality of life. Three-dimensional sonography (3D USG) supplies us more information than traditional two-dimensional sonography. It let us to make dynamic representation of examining structures and let us to observe them in any angle we need. The best way for sonographic examination of lower pelvis minor is translabial sonography, because it doesn't change mutual relationship of any parts in lower pelvic area, just like transrectal ortransvaginal probes can make. For good treatment of symptoms of urinary incontinence we have to perform not only functional examination of lower urinary tract, but also make very accurate rate of the static of female genital organs and pelvic floor.

BACKGROUND

The aim of study was to rate the angle between both puborectal muscles measurements using translabial three-dimensional sonography in women with stress urinary incontinence without descension of the female genital tract.

MATERIAL AND METHODS

Studied group included 100 patients who were examined with GE Kretz Voluson 730 (GE, Austria) scaner equipped 6-9 MHztranslabial probe. First group with stress urinary incontinence comprised 50 women in the mean age 56.22 (+/- 10.43) years old and the second without symptoms--50 women in the mean age 49.0 (+/- 13.22) years old. All cases of urinary stress incontinence in first group was confirm with urodynamic examination. Women in both groups were in similar body mass index, means (+/-SD): 26.88 (+/- 2.02) and 26.20 (+/- 4.14), respectively. Menopausal status in both groups was not statistically significant and aggregate 7.21 (+/- 8.71) in group of women with stress urinary incontinence and 4.70 (+/- 6.32) in group of women without symptoms. Means (+/- SD) quantity of deliveries was significantly higher in group of women with stress urinary incontinence than in control group and amount to 2.40 (+/- 1.03) and 1.56 (+/- 1.34), respectively. In all cases 3D USG coronal view of pelvic diaphragm was obtained and the angle between both puborectal muscles were measured. All women had about 200 ml urine in the bladder.

RESULTS

Means (+/-SD) of this angle in these groups were 65.48 +/- 9.22 and 58.64 +/- 9.17 degrees, respectively. The differences between both groups in all measurements were statistically significant (p<0.0015).

CONCLUSION

Stated during translabial three-dimensional ultrasound examination considerably different values of the angle between puborectal muscles at women with and without the urinary incontinence can be more helpful in a accurate diagnosing of the type of the urinary incontinence.

Type 2 diabetes mellitus in relation to place of residence: evaluation of selected aspects of socio-demographic status, course of diabetes and quality of life--a cross-sectional study

INTRODUCTION AND OBJECTIVE

This study aims at answering what are the differences in socio-demographic status of patients with type 2 diabetes living in the city and the countryside and what is the impact of a place of residence on the level of metabolic control, the incidence of complications of diabetes and quality of life (QoL).

MATERIALS AND METHODS

274 patients were divided into 2 groups: residents of rural areas-28.2% (n=77) and residents of urban areas-71.9% (n=197). Self-reported questionnaires was used: EQ-5D, DQL-BCI and DSC-R.

RESULTS

The group of residents of the countryside was characterized by a lower income and education level and a higher number of persons with disability pension. Patients living in the country had a higher body mass index in comparison to town inhabitants (32.6 kg/m(2) vs 30.9 kg/m(2), p=0.008) and shorter diabetes duration (8.4 versus 11.3 years, p=0.008). There were no differences between residents of the countryside and towns in terms of the method of treatment (oral antidiabetic drugs: 70.1% and 65.5%, p=0.3, Insulin: 29.9% and 36.5%, p=0.3, respectively), occurring chronic complications of diabetes (retinopathy: 14.3% and 14.2%, neuropathy: 6.5% and 7.6%, coronary heart disease: 44.45 and 37.1%, respectively) and the availability of diabetologists. Patients living in the countryside did not differ from town inhabitants in metabolic control and QoL assessment (EQ-5D index: 0.80 vs 0.79, p=0.9, EQ-VAS: 56.2 vs 54.3, p=0.2, DQL-BCI: 56.0 vs 53.9, p=0.1, DSC-R: 29.6 vs 29.4, p=0.7).

CONCLUSIONS

The socio-demographic differences between groups dependent on the place of living did not exert a significant influence on the level of metabolic control of diabetes, the incidence of late complications or QoL assessment in the population studied.

Altered tissue electrical properties in women with breast cancer--preliminary observations

INTRODUCTION AND OBJECTIVES

In the United States, breast cancer (BC) is the most common non-skin cancer. In Poland, it is estimated that the number of new breast cancer cases affects about 13,500 women each year. There are many methods for nutritional status assessment. One of them is bioimpedance analysis (BIA). Direct bioimpedance measures (resistance, reactance, phase angle (PA)) determined by bioelectrical impedance analysis (BIA) detectf changes in tissue electrical properties. The study was conducted to investigate whether there are any tissue electrical differences in patients with breast cancer.

MATERIALS AND METHODS

The direct bioimpedance measures determined by bioelectrical impedance analysis (BIA) were performed on 34 patients with BC and 34 healthy volunteers. The measurements were made with ImpediMed bioimpedance analysis SFB7 BioImp v1.55 (Pinkenba Qld 4008, Australia).

RESULTS

Reactance and resistance at 50 kHz was found to be significantly greater in patients with BC than in the control group (53.59° ± 1.53 vs. 47.26° ± 1.25, respectively, p=0.0031; 603.24° ± 15.38 ohm vs. 515.87° ± 11.48 ohm, respectively, p=0.00004).

CONCLUSION

Pre-surgical patients diagnosed with BC have altered tissue electrical properties. Further observations of a larger patient group would be valuable to calculate survival, validate the prognostic significance of PA, and monitor nutritional and therapeutic interventions in this patient population.

[Sonographic evaluation of the levator ani muscle in women with stress urinary incontinence]

Three-dimensional sonography has been used for about 15 years, not only to examine the female genital organs, but also the lower urinary tract and pelvic floor. Three-dimensional sonography offers more information than traditional two-dimensional sonography allowing for a dynamic representation of the examined structures and observation at any angle necessary. Translabial sonography is the best way of a sonographic examination of the lower urinary tract, because it does not affect the mutual relationship of any parts in the lower pelvic area, contrary to the transrectal or transvaginal probes. In order to establish proper treatment of the urinary incontinence symptoms, not only a functional examination of the lower urinary tract, but also a very accurate assessment of the statics of the female genital organs and pelvic floor need to be performed.

BACKGROUND

The aim of the study was to rate the area and diameters of the limbs of the levator ani muscle using a three-dimensional (3D) translabial sonography in women with stress urinary incontinence without the female genital tract prolapse.

MATERIAL AND METHODS

The study group included 100 patients who were examined with the GE Kretz Voluson 730 (GE, Austria), equipped with 6-9 MHz translabial probe. The first group with stress urinary incontinence consisted of 50 women (mean age 56.22 (+/- 10.43) years) and the second group included 50 women without symptoms (mean age 49.40 (+/- 13.22) years). All cases of urinary stress incontinence in the first group were confirm by means of a urodynamic examination. Women in both groups had similar body weight (kilograms), mean (+/- SD): 26.88 (+/- 2.02) and 26.20 (+/- 4,14), respectively. Menopausal status in both groups was not statistically significant and amounted to 7.21 (+/- 8.71) in the group of women with stress urinary incontinence and 4.70 (+/- 6.32) in the group without symptoms. Mean (+/- SD) number of deliveries was significantly higher in the group of women with stress urinary incontinence than in the control group (2.40 (+/- 1.03) and 1.56 (+/- 1.34), respectively). In all cases 3D coronal view of the pelvic diaphragm was obtained and the area and thickness of limbs of the levator ani muscle were measured. All women had about 200 ml urine in the bladder.

RESULTS

The results are presented as means +/- SD. Mean measurements of this area in both groups were 8.54 +/- 1.62 cm2 and 10.57 +/- 1.29 cm2, respectively. Mean thickness of the limbs in the groups were: 8.72 +/- 0.64mm and 10.85 +/- 0.89mm on the left side and 8.85 +/- 0.67mm and 10.89 +/- 0.87mm on right side, respectively. The differences between both groups in all measurements were statistically significant (p < 0.001).

CONCLUSIONS

There are some differences involving measurements of the thickness and the area of the limbs of the levator ani muscle in women with and without stress urinary incontinence and without the genital tract prolapse in both groups. The observed differences could have implications in physiotherapy of the pelvic floor muscles in women without statics abnormalities.

Evaluation of tracheal stenosis: comparison between computed tomography virtual tracheobronchoscopy with multiplanar reformatting, flexible tracheofiberoscopy and intra-operative findings

The aim of the study was to evaluate and compare various helical CT display modes [virtual endoscopy (VE)] and multiplanar reformations (MPR), conventional flexible tracheobronchoscopy (FT) and intra-operative (IO) findings in patients with tracheal stenosis and to analyze the advantage of MPR and VE in diagnosis and treatment planning and in postoperative follow-up. Thirty-seven patients with tracheal stenosis underwent standard neck and chest CT followed by MPR and VE. Results were correlated with the results of FT and IO findings. Thirty-three of the 37 stenoses were correctly graded and measured adequately using VE. Complete correlation among CT, fiberoptic tracheoscopy, and surgery of stenosis grading, stenosis length and length of planned resection segment of the trachea was noted between 33 of 37 patients with tracheal stenosis. Correlation between VE and IO was noted in 35 of 37 patients and between FT and VE was noted in 33 of 37 patients with tracheal stenosis. The sensitivity of VE was 94–97%, specificity was 100% with comparison to IO findings. The sensitivity and accuracy of MPR was 86–89% and specificity was 100% with comparison to FT findings. The results of the study indicate that VE is an excellent, consistent, and objective technique. VE with MPR is very useful in diagnostic evaluation and treatment planning in patients with tracheal stenosis.

Effects of vitamin D3 on selected biochemical parameters of nutritional status, inflammation, and cardiovascular disease in patients undergoing long-term hemodialysis

INTRODUCTION

Vitamin D3 has diverse biological effects extending beyond the maintenance of calcium and phosphorus homeostasis and ensuring the proper functioning of the body.

OBJECTIVES

This study evaluated the levels of vitamin D3 and its association with nutritional status, immunological activity, and selected markers of cardiovascular disease in patients on long-term hemodialysis (HD).

PATIENTS AND METHODS

We measured 25-hydroxyvitamin D3 (25(OH)D3) levels in a group of 84 patients (mean age, 65 years; average time on dialysis, 32.5 months) and investigated correlations between 25(OH)D3 levels and the following parameters: albumin, body mass index, hemoglobin (Hb), interleukin 6 (IL-6), interleukin 10, C-reactive protein, asymmetric dimethylarginine (ADMA), N-terminal pro-B-type natriuretic peptide (NT-proBNP), and comorbidity score.

RESULTS

A mean 25(OH)D3 level was 15.4 +/-7.2 ng/ml and only 5% of patients had 25(OH)D3 levels above the normal value of 30 ng/ml. There was no statistically significant difference in 25(OH)D3 levels between women and men (P = 0.06). A negative correlation was observed between 25(OH)D3 and IL-6 (R = -0.31, P = 0.009) and ADMA (R = -0.26, P = 0.03), as well as a positive correlation between 25(OH)D3 and Hb (R= 0.21, P = 0.05). There was no association between 25(OH)D3 levels and nutritional status.

CONCLUSIONS

A significant vitamin D3 deficiency observed in the majority of patients undergoing long-term HD contributes to the development of chronic inflammation, anemia, and indirectly, to endothelial cell injury.

[The estimation of the probability of tumor malignacy on the basis of test combination in the primary diagnosis of adnexal tumors]

PURPOSE

The aim was to evaluate the risk of ovarian tumor malignancy based on logistic regression analysis and to construct a practical tool which might be used at the bedside.

MATERIAL AND METHODS

379 women with adnexal masses were enrolled to the study The results of the two-dimensional (2D) gray-scale ultrasound examination, color and spectral Doppler blood flow measurement, three-dimensional (3D) sonoangiography examination and serum levels of CA-125 measurement were analyzed. 160 out of 379 women with abnormal findings, (42.2%), were diagnosed with a malignant ovarian tumor and 219 (57.8%) were found to have a non-malignant adnexal mass. To improve the sensitivity and specificity of ultrasound scan findings, postmenopausal status and preoperative serum CA-125 levels, the risk of malignancy index (RMI) was calculated and compared to the result of logistic regression analysis. Furthermore, the nomograms applicable at the bedside for estimation of the probability of malignancy for the examined adnexal tumor were derived.

RESULTS

The highest values of the area under the receiver operating characteristic (ROC) curves in univariate analysis were 0.87 for serum levels of CA-125 and 0.83 for the color score. For the RML, the value of the area under ROC curve was 0.91. The results of logistic regression revealed that papillary growth, color score, age, pulsatility index (PI) and level of serum CA 125 were significant factors in the multivariate model. The obtained classification accuracies for MLRA model in the training set and the test set were 88% and 92%, respectively. The value of the area under the ROC curve was 0.94 and significantly differed from the value of area for CA-125 (p<0.05).

CONCLUSIONS

The results of the study suggest that the combined use of ultrasound parameters and serum level of CA-125 in the prognostic model improves the diagnostic precision in the primary discrimination of benign and malignant ovarian tumors in women.

[The use of 2-dimensional and 3-dimensional color and power-Doppler in the diagnosis of blood flow indices of adnexal tumors]

OBJECTIVES

The purpose of this study was to compare 2-dimensional and 3-dimensional color and power-Doppler as measured with blood flow indices for the prediction of malignancy in complex adnexal masses.

METHODS

Two hundred eighty women with complex adnexal masses (mean age, 46,3 years (range, 13-83 years) were evaluated by 2-dimensional and 3-dimensional power-Doppler imaging. Complex adnexal mass was defined as the presence of at least one of the following features: solid areas, thick papillary projections, thick septa, or purely solid echogenicity. Tumor volume, sonomorphology and Doppler indices (PI, RI), as well 3-dimensional power-Doppler assessment (VI, FI, VFI) were calculated. All tumors were surgically removed and definitive histological diagnosis was obtained in each case. Diagnostic accuracy and areas under ROC curve (AUROC's) were calculated for each test.

RESULTS

Seventy one tumors (25.3%) were proved to be malignant, and 209 tumors (74.7%) were proved to be benign. Statistically significant differences between benign and malignant tumors were found for PI (1.06 vs 0.76; p = 0.001), RI (0.62 vs 0.51; p = 0.002), VI (0.55 vs 1.52; p = 0.002) oraz VFI (0.18 vs 0.49; p = 0.001). However, the highest sensitivity of 3D indices for malignant tumor detection was found for FI (42.9%). Specificity of 2D and 3D indices was between 93.6% for VI to 98.2% for RI. Accuracy and positive and negative predictive values were fund to be between 66.8% to 79.8%, respectively. AUROC's analysis indicated that the most useful test for the discrimination between benign and malignant tumors was VI followed by VFI and PI with RI.

CONCLUSION

Three-dimensional power-Doppler imaging has diagnostic potential for the discrimination of benign and malignant complex adnexal masses, but specific, possibly most vascularised areas of each tumor have to be examined in detail to improve not yet satisfactory predictive values of this method.

Estimation of prognostic value of Bcl-xL gene expression in non-small cell lung cancer

The aim of our study was to estimate the expression of the Bcl-xL gene, a member of Bcl-2 family, in NSCLC patients. A total of 60 consecutive patients diagnosed with NSCLC that underwent chemotherapy prior to surgery were reviewed. Bcl-xL expression was assessed on paraffin sections by in situ hybridization (ISH) and immunohistochemistry (IMH). We observed the presence of mRNA of Bcl-xL gene and its protein product overexpression in most patients (60 and 81.7%, respectively). In material examined no significant correlation was observed between the pattern of Bcl-xL or protein expression and any clinicopathological factors evaluated. The expression of Bcl-xL protein was low (less than 10% positive cells) in 11 patients (median survival time 29 months) as compared to 49 patients with overexpression (median survival time 21.0 months). The difference was not of statistic significance (p=0.27). In examined group the Bcl-xL mRNA was found in 36 patients, while it was absent in 24 cases. Median survival time was 14.5 and 86.5 months, respectively (p=0.001). In addition, 19.4% of 5-year survivals were achieved in patients with overexpression and 54.2% in patients with no mRNA present (p=0.002). The percentage of 5-year survival in patients with protein expression assessed by IMH was 30.6% (p=0.31). The estimation of Bcl-xL expression on mRNA and protein level was compared by the means of sign test and the significant difference was found (p=0.009). The inconsistency was related to 35% of cases. In comparison with IMH, ISH technique appeared to be more specific and accurate in assessment of 5-year survival (25 and 65%; 65 and 70%, respectively). The results of our study indicate that Bcl-xL mRNA overexpression may suggest poor prognosis in NSCLC.

[Three-dimensional sonoangiography in diagnostic of endometrial hyperplasia and carcinoma. An assessment of vascularization indices and endometrial volume]

Three-dimensional sono-angiography was executed in 123 women with uterine bleedings in perimenopausal period. With the use of software for automatic measurement of volume of blocks (VOCAL, Kretztechnik, Austria) vascular indices (VI, Fl, VFI) and endometrial volume (EV) were estimated. Based on histopathological estimation of endometrium the patients were divided into the following groups: atrophic, proliferative, secretive endometrium, hyperplasia and endometrial cancer (EC). Mean EV in women with EC amounted to 16.82 ml and was significantly higher (p < 0.005) than in women with hyperplasia or without pathological changes. Mean values of vascular indices VI, Fl and VFI in the group of women with EC amounted to respectively 5.464; 25.995 and 1.898 and were also significantly higher in comparison to remaining groups of patients. The results of the investigation suggest, that three-dimensional measurement of endometrial volume with assessment of vascular indices (VI, Fl, VFI) can be valuable prognostic element improving a diagnostic precision of sonographic estimation of pathological changes of endometrium.

Survivin antiapoptotic gene expression as a prognostic factor in non-small cell lung cancer: in situ hybridization study

Survivin is an inhibitor of apoptosis that plays a significant role in cell cycle regulation and is important for survival prognosis in many neoplasms. Survivin expression was assessed by in situ hybridization (ISH) in 60 consecutive patients (54 males and 4 females) with NSCLC treated between 1993 and 1997. The examined patients had IIB and IIIA stage according to TNM system. In all cases the chemotherapy with cisplatin and etoposide (2 cycles) was administered prior the surgery; in patients responding to the therapy one more cycle was applied. Survivin gene overexpression was observed in 35 patients (58.3%). There was no correlation between survivin mRNA level and histological type of tumor, stage of cell differentiation, stage of disease according to TNM classification, performance status according to WHO and number of chemotherapy regimens administered (p > 0.05). However, the correlation between survivin gene expression and response to the chemotherapy was statistically significant (p = 0.04). Statistical analysis showed that median survival in patients with survivin gene overexpression was shorter (14.0 months) as compared to patients with no expression (60.0 months; p = 0.00002). In survival assessment by means of Kaplan-Meier test, 14.3% of five-year survival was achieved in the former group versus 60% in the latter (p = 0.00003). Univariate analysis (log-rank test) showed that significant independent prognostic factors in NSCLC included: stage of the disease according to TNM classification (p = 0.006), response to chemotherapy (p = 0.005) and pattern of survivin gene expression (p = 0.00003). Multivariate analysis utilizing Cox's model showed that for survival assessment the stage according to TNM, response to the chemotherapy and survivin expression estimated by means of ISH are of statistical significance (p=0.00001). The calculated predictive values showed that ISH technique was quite accurate in assessment of five-year survival. Our data show that survivin expression may be used as a prognostic factor and a target for therapy.

[Active and passive smoking among students of Polish high schools]

The survey was conducted among 29540 students in different secondary schools. All interviewers were 17.42 +/- 1.14 years old. The aim od this work was to define the relation between smoking adolescent and their health. The group of smokers consisted of 5112 (60.26%) men and 3370 (33.70%) women. The main causes of initiating smoking reported by respondents included curiosity--(47.91%) followed by stress (39.82%) and alcohol (6.77%). Smoking tobacco by parents at home results in inspiring by their children the unwholesome ingredients of tobacco smoke. Frequent staying among tobacco smokers significantly influences decision of starting or giving up smoking tobacco (59.24%). The obtain results may be helpful in preparing effective educational and preventive project among students, which can eliminate or lower the influence of factors predisposing to start and continue smoking tobacco. Special programs should be worked out for children showing early health consequences of smoking cigarettes. Giving up smoking is possible for "young" smokers, if they have not developed the symptoms of addiction.

[Smoking among secondary school students in Stalowa Wola]

Smoking is recognized as major, the most prevalent, and at the same time the only removable factor of many diseases. The major causes of starting smoking are: stress, curiosity and staying among people who smoke tobacco. The research was conducted among students of secondary school in Stalowa Wola in the form of an anonymous poll. The sample group included 2763 people. The group of smokers included 334 people (12.09%). Results of the research were subjected to a precise statistical analysis. The fact that 24.55% young age smokers smoke more than 20 cigarettes a day is worth stressing. In spite of short time of tobacco smoking, the investigated group has reported some negative health ailments. An attempt was made to identify the combination of features affecting smoking, including sex, origin, company of smokers, economic conditions (p < 0.05). The statistical analysis revealed a significant correlation between the number of cigarette smoked, economic conditions and the intention to stop smoking (p < 0.05). The obtained results may be helpful in preparing effective educational and preventive project among students, which can eliminate or lower the influence of factors predisposing to start and continue smoking tobacco.

[Characteristics of ovarian tumors with color Doppler sonography: a comparison of predictive models derived from two academic centers data]

OBJECTIVE

To construct and cross-validate logistic regression models used for the prediction of ovarian malignancies in two groups of women with adnexal tumors.

MATERIALS AND METHODS

Preoperative clinical, gray-scale and color Doppler ultrasound data of 307 women treated in the Ist Dept of Gynecology of the Medical University in Lublin (group I) and 464 of women treated in the Dept of Surgical Gynecology, Medical University in Poznan (group II) were analyzed retrospectively. These data were used to construct predictive models which were developed for both groups separately and then cross-validated (12 cases in each group, six malignant and 6 benign) between the groups. Multiple logistic regression analysis was chosen to calculate probability of malignancy in each examined mass.

RESULTS

There were 228 (74.2%) benign tumors and 79 (25.7%) malignant tumors in group I. Group II consisted of 299 (64.4%) benign tumors and 165 (35.6%) malignant masses. Only six variables were included in the logistic regression model in group I. These were age, bilaterality, septae, papillary projections, volume and color score. In group II there were also 6 variables included in the regression model (menopausal status, septae, bilaterality, ascites, blood vessel localization and PI). At 50% probability of malignancy the model constructed for group I had a sensitivity and specificity of 74.6% i 94.7%, respectively. At the same probability level in group II sensitivity and specificity were 86.1% i 93.6%, respectively. Cross-validation of the predictive model constructed for group I in randomly selected cases from group II had sensitivity of 66.4% and specificity of 79.2%. Sensitivity and specificity of the group II model tested in cases from group I were 64.3% and 75.2%, respectively.

CONCLUSIONS

We conclude that predictive models created with the use of multiple logistic regression analysis may be useful in preoperative discrimination of adnexal tumors. However, much better definition of diagnostic criteria, especially color Doppler score must be achieved before these models could be widely used in clinical practice.

[Use of multilayer perception artificial neutral networks for the prediction of the probability of malignancy in adnexal tumors]

BACKGROUND

Advanced statistical methods are currently are more often used in the prediction of ovarian malignancy when adnexal tumor is detected. These methods include logistic regression analysis and artificial neural networks (ANN's), i.e. computer programs which are capable of learning from presented data and further predict various events, such as clinical diagnosis or outcome of a given treatment.

MATERIALS AND METHODS

We have analyzed data of 307 women with adnexal tumors who were operated in the Ist Dept. of Gynecology, Medical University in Lublin between 2000-2002. Following clinical and sonographic variables were included: age, menopausal status, serum CA-125, bilaterality, tumor size and volume, papillary projections, septa, solid parts presence, Doppler blood flow indices (PI, RI, Vmax), and subjective-color Doppler score. A multiple layer perceptron (MLP) neural network with 13 input variables, 11 hidden neurons and one output variable was constructed to assess probability of malignancy in each women (Statistica v. 6.0 for Windows, Statsoft, USA). Sensitivity, specificity and accuracy of the model were calculated. Receiver-Operating Characteristics curves were generated and corresponding Areas Under ROC Curves (AUROC's) for all diagnostic tests were compared.

RESULTS

Final histologic examination revealed 228 (74.3%) benign tumors and 79 (25.7%) malignant masses including 21 women with FIGO stage I ovarian cancer. With a 75% cut-off probability of malignancy level the sensitivity and specificity of the best network in the testing set was 96.7% and 100%, respectively. In the validation set the corresponding values of sensitivity and specificity were 82.3% and 97.5%. The highest of all used tests AUROC equal to 0.9749 was found for the ANN predictive model.

CONCLUSIONS

ANN may help in the extraction of the most useful predictive clinical and ultrasound data. The sensitivity and specificity of the ANN's generated model were higher than currently used single clinical and diagnostic tests. However, a prospective testing in a new, much larger group of women with adnexal tumors is essential for the clinical usefulness of the proposed statistical model.

[Usefulness of logistic regression model to predict the endometrial carcinoma based on blood flow indices measured wit the of three-dimensional Doppler sonography]

AIM

Construction and prospective verification of predictive model permitting to rate individual probability of existence of endometrial carcinoma with use of three-dimensional Doppler Doppler sonography.

MATERIAL AND METHODS

We analyzed the results of 3D sonography of 123 women (mean age 53.8 +/- 10.6; mean BMI--28.2 +/- 5.4). We estimated: endometrial thickness and volume, blood flow indices. All ultrasound measurements were verified by histology. In aim of finding the best combination of features essentially affect on endometrial cancer's risk and for estimate individual probability of endometrial cancer we use a logistic regression analysis. The obtained model was verified on 20 new cases.

RESULTS

There were 24 women with endometrial cancer, 59 women with endometrial hyperplasia and 40 women without endometrial changes. We affirmed that only three variables had statistical significant influence on the constructed predictive model. Probability of endometrial carcinoma was: P(X) = 1/(1 + e-z), where "e" is mathematical constant and z = 0.12 x age + 0.16 x endometrial thickness + 0.47 x VI -11.3. The best sensitivity and specificity were 70.8% and 98.9%. The sensitivity and specificity in 20 new cases was adequately 75% and 91.6%.

CONCLUSION

The usefulness of a predictive model built with the help of logistic regression analysis increase sonographic diagnostic precision. The usefulness of endometrial blood flow indices permit to estimate the individual risk of endometrial cancer in women examined with three-dimensional sonography.

[Three dimensional sonography and 3D power angiography in differentiation of adnexal tumors]

BACKGROUND

Three-dimensional sonography is a novel diagnostic method proposed to be an additional non-invasive tool in the assessment of ovarian tumors.

OBJECTIVE

To study diagnostic potential of 3D sonography and power Doppler angiography in the preoperative differentiation of adnexal masses.

MATERIAL AND METHODS

One hundred twenty-eight women with tumors thought to be of adnexal origin were examined preoperatively. Following morphological (papillae, septae, tumor size and volume) and color Doppler (PI, RI, Vmax and TAMX) assessment, 3D ultrasound of adnexal tumors according to Kurjak et al. (2000) was performed. Various scanners were used and included: ATL 5000 HDI (Phillips, USA) and Combison 530 and Voluson 730 (Kretztechnik, Austria) machines. Following variables were studied: inner wall structure, presence of papillae, thickening > 3 mm of septa as well as vascular branching pattern, number and localization of small blood vessels and the presence of vascular anastomoses.

RESULTS

Twenty-one tumors were malignant (3 FIGO stage I) and 101 masses were benign. Power Doppler combined with 3D sonography predicted malignancy with a sensitivity of 92.6% (25 of 27 patients). Commonly used morphological and Doppler criteria produced lower sensitivity, the values being in range of 45% to 87.5%. Negative predictive value of 97.2% was the highest for 3D sonography (> 7 points in Kurjak's scale).

CONCLUSIONS

Selective use of 3D ultrasound and power Doppler angiography could be used to better characterize adnexal tumors. Detailed 3D sonography may help to identify women who, if needed, may have less invasive surgical procedure such as laparoscopy or be referred to gynecological oncologist.

[Sonoangiography and logistic regression analysis in the preoperative differentiation of ovarian tumors]

OBJECTIVE

To apply logistic regression analysis for several clinical and sonographic data for the construction of a predictive model that could be helpful in the preoperative differentiation of adnexal masses.

MATERIALS AND METHODS

Two hundred and eight women with tumors thought to be of adnexal origin were examined preoperatively. Initial analysis included age and menopausal status, ultrasound derived morphological features of adnexal masses (unilateral/bilateral tumors, papillae, septae, tumor size and volume) as well as color Doppler criteria such as PI, RI, Peak Systolic Velocity, PSV assessment. In all examinations we used B&K 2002 ADI (Denmark) and Kretz Voluson V730 (Austria) scanners with transvaginal probes 5-9 MHz. Stepwise logistic regression analysis was used to construct a predictive model that would allow probability of malignancy calculation for individual patient.

RESULTS

There were 159 benign and 49 malignant masses. Seven cancers were in FIGO stage one. Statistical analysis revealed that only 5 of initially tested 14 variables had significant influence on the regression equation. These were: age, bilateral mass, presence of septa > 3 mm, papillary projections > 3 mm in the tumor wall and subjective color scale assessment according to Timmerman et al. (1999). Sensitivity and specificity at the 50% probability level of malignancy in the studied tumor were 77.5% and 96.8%, respectively. When 25% cut-off probability level was used, sensitivity increased to 87.7% and specificity dropped to 89.9%. Prospective testing in a new group of 30 patients (5 ovarian cancers) gave sensitivity of 80% and specificity of 100%.

CONCLUSIONS

The use of logistic regression analysis can help in modeling clinical and sonographic data. Our model had better predictive value than individual tests and allowed to calculate true probability figure of ovarian malignancy for any given patient with adnexal mass.

[Family labor from the father's point of view]

Family labor becomes increasingly popular in our country. The aim of the study was answering the question: what the main motive for the men attending to labor was, whether fathers were satisfied of their participation and what the main reason of their satisfaction was. The study was performed in the district and local hospitals in south-eastern Poland during 7 months. 110 fathers were in the study group, 78 (70.9%) of urban population, and 32 (29.1%) of rural. The obtained results indicate firm acceptance of such a way of labor among majority of fathers. It was supported by the fact that almost all of them were satisfied of their participation in labor, and wished to attend the next one. The main reason for inclining them for the participation in labor was the granting of the partners' request, and internal willing. The source of satisfaction from sharing of the labor was providing the safety for the partner and setting up early contact with the baby. Significant influence of the labor schools on the feeling of readiness for delivery and the level of father's satisfaction were not evident.

[Ultrasound fetal biometry and birth weight prognosis with the use of Aoki method and classical regression analysis]

We have attempted to estimate prognostic value of neonatal birth weight prediction with the use of fetal sonographic data: biparietal diameter, femur length, transverse and longitudinal abdominal diameter. Clinical and ultrasound data from 265 pregnant women with singleton gestation who delivered within 7 days from the last ultrasound scan were analyzed. For the fetal weight estimation we have calculated fetal abdominal area in the equation proposed by Aoki in 1990. Predicted and observed neonatal birth weight centiles and coefficients of determination were calculated with the use of regression analysis. Prediction method of neonatal weight with Aoki method explained 70% of variability in our population. In contrast, regression analysis on ultrasound data explained 99% of observer variability in neonatal birth weight. We conclude that own method of birth weight prediction could be of value, however it should be tested in a new prospectively examined population.

[Changes in carbohydrate metabolism of PCOS patients in cycle stimulated by rFSH]

24 patients with clomiphene citrate-resistant PCOS were enrolled in the study. We used low-dose step up protocol of recombinant FSH administration. Ovulation induction by rFSH injection was commenced on 3 day of cycle, at a dose of 50 IU for 7 days initially. The dose was continued at 50 IU, and ultrasonographic scans were performed daily until a dominant follicle had developed to a size of at least 18-20 mm, at which point 5,000 IU of hCG was administrated. If no response was noted after 7 days, the dose was increased by 50 IU for a further 7 days. Insulin and glucose serum levels were determined 7 times: in days 3, 5, 8 of a cycle and later when diameter of ovarian follicle was 10, 12, 16 mm and in the day of hCG injection. Estradiol serum level was determined in 8 day of cycle and when diameter of ovarian follicle was 10, 12, 16 mm and in the day of hCG injection. BMI and WHR was determined in the day of admission to hospital.

RESULTS

The correlation between mean insulin level in the examined cycle and BMI and as well as the correlation between mean insulin level and WHR were determined. Mean level of serum glucose increased as the level of estradiol raised. No influence of growth level on insulin level was detected.

[Men's acceptance of continuous hormone therapy]

The aim of the study was the assessment of males' willingness to long-term administration of hormonal drugs in substitutive and contraceptive means. Eighty males in their third and fifth decade were inquired a questionnaire. The patients were divided according to age into two groups: A (20-30 yrs of age) 55 males, and B (41-50 yrs of age) 25 males. University education was a condition required to be enrolled into the study. The results was statistically analyzed with Chi 2 test. 65.5% of males in their third decade would not accept hormonal contraception. 40% of males declared their acceptance for hormonal substitutive therapy and they were also aware of the necessity of prophylactic examinations, 7.3% accepted the therapy but without regular follow-ups, 16.3% did not accept the therapy and 36.4% did not consider it as necessary. 56% of the respondents from group B would accept an administration of contraceptive pill. 44% would not accept hormonal substitutive therapy, 24% did not see the necessity of the therapy, 16% would accept the therapy and the necessity of regular prophylaxis, and the last 16% would accept the therapy, however without control examining.