Polski merkuriusz lekarski : organ Polskiego Towarzystwa Lekarskiego
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Pol. Merkur. Lekarski · Mar 2014
Comparative Study[Patients with implanted pacemakers in the primary hospital and stay under the care of an outpatient cardiology clinic--differences in comparison with the reference center].
The aim of the study was to find an answer for a question whether a newly created primary centre ensures the same level of safety as a reference centre in terms of complications of pacemaker implantation and whether the outpatient care of patients with an implanted pacemaker is as competent as in a reference centre. MATERIAL AND METHODS. The analysis of documentation of the patients (274 pts, 135 men, mean age = 74 + 9 years) who underwent implantation of a permanent single (VVI, 222pts) or dual-chamber (DDD, 52pts) pacemaker at the department of cardiology of the primary centre compared to the reference centre (80 pts) at the department of cardiology. The following data was analyzed: gender, age, length of hospitalization, type of pacemaker, type of electrode, place of pacing, indications for permanent pacing, co-existing diseases, periprocedural complications, complications, technique of electrode implantation and the type of electrode fixation. ⋯ Patients who underwent implantation of a pacemaker in the primary centre were hospitalized longer than those treated in the reference centre, p < 0.001. The technique of subclavian venipuncture used to implant the passive endocardial electrode was more common in the primary centre, p = 0.034. The number of complications after implantation of pacemaker was not significantly statistically. The technique of electrode implantation has a statistically significant effect on the number of complications (OR = 0.11, p < 0.04). Subclavian venipuncture was associated with a statistically significantly higher incidence of pneumothorax (p < 0.019). The type of pacemaker, electrodes or indication for implantation did not have a statistically significant influence on the complications. The patients with ischemic heart disease and myocardial infarction are the most exposed to the complications (OR = 3.73, p < 0.03). All check-ups at the primary centre were carried out by a physician who used suitable programmers. Most visits in the reference centre were carried out by a technician who used the "IMPULS-BIS" set. Pacemaker implantation costs were directly connected with the duration of hospitalization. CONCLUSIONS. High percentage of ventricular stimulation, stimulation of the apex of the right ventricle, the application of passive electrode, avoiding the use of cephalic vein indicates further the need deepen cooperation between centers. Outpatient care of patients with an implanted pacemaker in the primary centre was as competent as in the reference centre. Pacemaker implantation costs are directly connected with the duration of hospitalisation.
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Pol. Merkur. Lekarski · Feb 2014
Editorial[Recommendations for prevention of community-acquired pneumonia with bacteremia as the leading form of invasive pneumococcal infections in the population of people over 50 years of age and risk groups above 19 years of age].
Invasive pneumococcal disease (IPD) is a main cause of mortality associated with pneumococcal infections. Although, IPD is regarding mainly small children and persons in the age > 65 years, the investigations showed that because of IPD exactly sick persons are burdened with the greatest mortality in the older age, rather than of children. The most frequent form of IPD is community acquired pneumonia (CAP) with the bacteremia. ⋯ They are recommending applying PCV13 at first in them, while PPV23, if to her readings exist should be given to > or = 8 of weeks from PCV13. In persons > or = 19 years which earlier received 1 or should receive more PPV23 doses first PCV13 dose should be given after the year or later than the last PPV23 dose, and then again PPV23 > or = 8 of weeks from PCV13 and the second PPV23 dose not earlier than 5 years from last PPV23. If the PPV23 application seems to be justified, it is irrespective of the more previous state vaccination against pneumococci, PCV13 should be given to as first.
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Pol. Merkur. Lekarski · Feb 2014
Clinical Trial[The influence of laser therapy on selected functional parameters of patients with spondyloarthrosis of the lower section of the spine].
Spondyloarthrosis is a quickly growing disease in highly civilized communities. It is one of the most frequent causes for movement limitations and is listed as the main reason for the incapacitation for work among people of the working age. The following symptoms can be observed in patients with spondyloarthrosis: pain, limited spine mobility, increased muscle tone. Chronic pain and the associated limitation of movement underlie the quest for an effective therapy. Using laser therapy as part of physical therapy prompts research into the effectiveness of the measure in patients with spondyloarthrosis. The aim of this study was to evaluate the effectiveness of laser therapy on spondyloarthrosis of the lumbar spine. ⋯ The study showed a slight analgesic effect and a substantial increase in spine mobility through laser biostimulation.
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Modern cancer therapy prolongs patients life but commonly increases incidence of treatment-related complications. One of such adverse effect is a neurotoxicity, which usually manifestates as peripheral neuropathies (CIPN), characterised by various sensory (tingling, numbness, pain), motor (foot and hands drop, fastening buttons difficulties) and autonomic (constipation, arythmia) abnormalities as well as pain. ⋯ The most commonly used form of treatment is symptomatic therapy, including anticonvulsant and antidepressant drugs. Proper education of patients and their families of symptoms and neuropathy consequences is desirable to reduce anxiety and stress.
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Leptospirosis is a zoonotic disease of global reach caused by pathogenic spirochetes of the genus Leptospira. The disease has two periodic phases (septic and immune phase) and its clinical manifestations are diverse. Central nervous system involvement in leptospirosis most commonly occurs as aseptic meningitis, often asymptomatic, only with abnormal cerebrospinal fluid findings. ⋯ The prognosis depends on a rapid identification and treatment with antibiotics. The paper presents selected cases of leptospirosis with its different clinical manifestations. The common feature was a severe illness and sometimes the need for cooperation of doctors of various specialities.