64 research outputs found
Analysis of Prognostic Factors and Efficacy of Surgical Treatment for Non-small Cell Lung Cancer: Department of Surgery Ntldri (1998–1999)
No full textWprowadzenie: Postępowanie chirurgiczne stanowi podstawową metodę leczenia niedrobnokomórkowego raka płuca. Materiał i metody: W pracy przeprowadzono retrospektywną analizę skuteczności tego leczenia w grupie 431 chorych operowanych w Klinice Chirurgii Instytutu Gruźlicy i Chorób Płuc w Warszawie w latach 1998–1999. W 218 (50%) przypadkach wykonano lobektomię, w 21 (5%)—bilobektomię, w 188 (44%)—pneumonektomię, a w 4 (1%)—resekcję klinową. U 70 (16%) chorych rozpoznano stadium zaawansowania pIA, u 112 (26%)—pIB, u 22 (5%)—pIIA, u 110 (26%)—pIIB, u 88 (20%)—pIIIA, u 13 (3%)—pIIIB i u 16 (4%)—pIV. Wyniki: Wskaźnik 5-letniego przeżycia dla całej grupy wynosił 49.1%. Analiza statystyczna wykazała wyższy odsetek odległych przeżyć w grupie wiekowej do 50. rż. (p = 0.03), u płci żeńskiej (p = 0.01, HR = 0.63), w przypadku mniej rozległego zabiegu (lobektomia) (p < 0.005). Wskaźniki odległych przeżyć wykazywały znamienną zależność od stadium zaawansowania choroby nowotworowej (p < 0.005). Pięcioletnie przeżycie pacjentów w stadium IA wynosiło 81.7%, IB—62.2%, IIA—59.1%, IIB—38%, IIIA—21.3%, IIIB—8.3% oraz IV—8.3%. Typ histopatologiczny miał również znamienny wpływ na odległe przeżycia chorych (p < 0.005). Pięcioletnie przeżycie chorych na raka płaskonabłonkowego wynosiło 53.4%, na raka gruczołowego—38.3%, na raka wielkokomórkowego—37.5%, na rakowiaka—94.7%, a na pozostałe typy raka—39.1%. Wskaźnik odległego przeżycia zależał znamiennie od cechy T (p < 0.005). Obniżone wyjściowe stężenie hemoglobiny (p < 0.005, HR = 1.52) oraz przetoczenie masy erytrocytarnej w okresie pooperacyjnym (p = 0.03) były niekorzystnymi czynnikami rokowniczymi. Znamiennie gorsze rokowanie wykazano w przypadku cechy R1 lub R2 (p = 0.01) oraz cechy M1 (p < 0.005). Dodatkowo, w analizie wielowymiarowej Coxa wartość FEV1 poniżej 80% (HR = 1.46) była zmienną negatywnie wpływającą na odległe przeżycie, a brak objawów klinicznych choroby, z wyjątkiem kaszlu (HR = 0.73)—zmienną wpływającą korzystnie. Wnioski: W analizie jednowymiarowej wyłoniono następujące czynniki ryzyka: płeć męska, wiek powyżej 50. rż., obniżone stężenie Hb, zabieg operacyjny o poszerzonym zakresie, zaawansowane stadium, utkanie raka gruczołowego i wielkokomórkowego, cecha T, N, R i M oraz przetoczenie ME w okresie pooperacyjnym. Analiza wielowymiarowa Coxa wykazała następujące negatywne czynniki prognostyczne: obniżone wyjściowe stężenie Hb, wartość FEV1 poniżej 80%, zabieg operacyjny o poszerzonym zakresie (pneumonektomia), zaawansowane stadium raka, utkanie raka gruczołowego oraz następujące korzystne rokowniczo czynniki: płeć żeńska i brak objawów klinicznych, z wyjątkiem kaszlu
Acute and Subacute Effects of Urban Air Pollution on Cardiopulmonary Emergencies and Mortality: Time Series Studies in Austrian Cities
No full textDaily pollution data (collected in Graz over 16 years and in the Linz over 18 years) were used for time series studies (GAM and case-crossover) on the relationship with daily mortality (overall and specific causes of death). Diagnoses of patients who had been transported to hospitals in Linz were also available on a daily basis from eight years for time series analyses of cardiopulmonary emergencies. Increases in air pollutant levels over several days were followed by increases in mortality and the observed effects increased with the length of the exposure window considered, up to a maximum of 15 days. These mortality changes in Graz and Linz showed similar patterns like the ones found before in Vienna. A significant association of mortality could be demonstrated with NO2, PM2.5 and PM10 even in summer, when concentrations are lower and mainly related to motor traffic. Cardiorespiratory ambulance transports increased with NO2/PM2.5/PM10 by 2.0/6.1/1.7% per 10 µg/m³ on the same day. Monitoring of NO2 (related to motor traffic) and fine particulates at urban background stations predicts acute effects on cardiopulmonary emergencies and extended effects on cardiopulmonary mortality. Both components of urban air pollution are indicators of acute cardiopulmonary health risks, which need to be monitored and reduced, even below current standards
Alcohol as a Cause of Mortality in Societies Undergoing Rapid Transition to Market Economy
No full textCharacteristics and Clinical Outcomes of 116,539 Patients Hospitalized with COVID-19—Poland, March–December 2020
No full textThe severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes Coronavirus Disease 2019 (COVID-19). This study aimed to characterize patients hospitalized with COVID-19 in Poland between March and December 2020, as well as to identify factors associated with COVID 19–related risk of in-hospital death. This retrospective analysis was based on data from the hospital discharge reports on COVID-19 patients hospitalized in Poland between March and December 2020. A total of 116,539 discharge reports on patients hospitalized with COVID-19 were analyzed. Among patients with COVID-19, 21,490 (18.4%) died during hospitalization. Patients over 60 years of age (OR = 7.74; 95%CI: 7.37–8.12; p p p p p < 0.01). The following predictors of admission to ICU were found in multivariable analysis: age over 60 years (OR: 2.03; 95%CI: 1.90–2.16), male sex (OR: 1.79; 95%CI: 1.69–1.89), presence of at least one cardiovascular disease (OR: 1.26; 95%CI: 1.19–1.34), presence of at least one endocrine, nutritional and metabolic disease (OR: 1.17; 95%CI: 1.07–1.28)
The impact of heat waves on mortality.
No full textBACKGROUND: Heat waves have been linked with an increase in mortality, but the associated risk has been only partly characterized. METHODS: We examined this association by decomposing the risk for temperature into a "main effect" due to independent effects of daily high temperatures, and an "added" effect due to sustained duration of heat during waves, using data from 108 communities in the United States during 1987-2000. We adopted different definitions of heat-wave days on the basis of combinations of temperature thresholds and days of duration. The main effect was estimated through distributed lag nonlinear functions of temperature, which account for nonlinear delayed effects and short-time harvesting. We defined the main effect as the relative risk between the median city-specific temperature during heat-wave days and the 75th percentile of the year-round distribution. The added effect was defined first using a simple indicator, and then a function of consecutive heat-wave days. City-specific main and added effects were pooled through univariate and multivariate meta-analytic techniques. RESULTS: The added wave effect was small (0.2%-2.8% excess relative risk, depending on wave definition) compared with the main effect (4.9%-8.0%), and was apparent only after 4 consecutive heat-wave days. CONCLUSIONS: Most of the excess risk with heat waves in the United States can be simply summarized as the independent effects of individual days' temperatures. A smaller added effect arises in heat waves lasting more than 4 days
Ambient Particulate Air Pollution and Daily Hospital Admissions in 31 Cities in Poland
No full textA strong and consistent association has been observed between morbidity or mortality rates and PM concentration, and is well documented in many countries. In Poland, despite poor air quality, studies concerning the evaluation of acute health effects of ambient air pollution on morbidity from respiratory or cardiovascular diseases are rare. We examined the short-term impact of PMx concentration on hospital admission in 31 Polish cities based on the daily PM10, PM2.5 concentration, meteorological variables, and hospital data. The generalized additive model (GAM) and a random-effects meta-analysis were used to assess the impact of air pollution on morbidity within the exposed population. Almost 1.6 million cardiovascular admissions and 600 thousand respiratory disorders were analyzed. The RR values for PM10-related cardiovascular and respiratory hospital admissions in Poland are equal to 1.0077 (95% confidence interval, 1.0062 to 1.0092) and 1.0218 (95% confidence interval, 1.0182 to 1.0253), respectively, while for PM2.5 1.0088 (95% confidence interval, 1.0072 to 1.0103) and 1.0289 (95% confidence interval, 1.0244 to 1.0335), respectively. Moreover, a moderate heterogeneity of RR estimates was observed between the analyzed cities (I2 values from 27% to 45%). The presented analysis confirms the significant association between hospital admission and PMx concentration, especially during heating seasons
Regional differences in physicians’ behavior and factors influencing the intensity of PCSK9 inhibitor therapy with alirocumab: a subanalysis of the ODYSSEY APPRISE study
No full textBackground: Despite better accessibility of the effective lipid-lowering therapies, only about 20% of patients at very high cardiovascular risk achieve the low-density lipoprotein cholesterol (LDL-C) goals. There is a large disparity between European countries with worse results observed for the Central and Eastern Europe (CEE) patients. One of the main reasons for this ineffectiveness is therapeutic inertia related to the limited access to appropriate therapy and suitable dosage intensity. Thus, we aimed to compare the differences in physicians’ therapeutic decisions on alirocumab dose selection, and factors affecting these in CEE countries vs. other countries included in the ODYSSEY APPRISE study. Methods: ODYSSEY APPRISE was a prospective, single-arm, phase 3b open-label (≥12 weeks to ≤30 months) study with alirocumab. Patients received 75 or 150 mg of alirocumab every 2 weeks, with dose adjustment during the study based on physician's judgment. The CEE group in the study included Czechia, Greece, Hungary, Poland, Romania, Slovakia, and Slovenia, which we compared with the other nine European countries (Austria, Belgium, Denmark, Finland, France, Germany, Italy, Spain, and Switzerland) plus Canada. Results: A total of 921 patients on alirocumab were involved [modified intention-to-treat (mITT) analysis], including 114 (12.4%) subjects from CEE countries. Therapy in CEE vs. other countries was numerically more frequently started with lower alirocumab dose (75 mg) at the first visit (74.6 vs. 68%, p = 0.16). Since week 36, the higher dose was predominantly used in CEE patients (150 mg dose in 51.6% patients), which was maintained by the end of the study. Altogether, alirocumab dose was significantly more often increased by CEE physicians (54.1 vs. 39.9%, p = 0.013). Therefore, more patients achieved LDL-C goal at the end of the study (<55 mg/dl/1.4 mmol/L and 50% reduction of LDL-C: 32.5% vs. 28.8%). The only factor significantly influencing the decision on dose of alirocumab was LDL-C level for both countries’ groups (CEE: 199.2 vs. 175.3 mg/dl; p = 0.019; other: 205.9 vs. 171.6 mg/dl; p < 0.001, for 150 and 75 mg of alirocumab, respectively) which was also confirmed in multivariable analysis (OR = 1.10; 95% CI: 1.07–1.13). Conclusions: Despite larger unmet needs and regional disparities in LDL-C targets achievement in CEE countries, more physicians in this region tend to use the higher dose of alirocumab, they are more prone to increase the dose, which is associated with a higher proportion of patients reaching LDL-C goals. The only factor that significantly influences decision whether to increase or decrease the dose of alirocumab is LDL-C level. 2023 Banach, Lewek, Pol, Rabczenko, Balanescu, Blaha, Ceska, Jankowski, Surma, Kolovou, Liberopoulos, Mitu, Mitu, Naji, Paragh, Popławska, Vrablik and Pella
The Prevalence of Acute Respiratory Distress Syndrome (ARDS) and Outcomes in Hospitalized Patients with COVID-19—A Study Based on Data from the Polish National Hospital Register
No full textAcute respiratory distress syndrome (ARDS) is a serious complication of COVID-19. This study aimed to evaluate the prevalence of ARDS among patients hospitalized with COVID-19 in Poland as well as to characterize clinical outcomes in patients hospitalized with COVID-19-associated ARDS. This is a retrospective, secondary analysis of epidemiological data from 116,539 discharge reports on patients hospitalized with COVID-19 in Poland between March and December 2020. The overall prevalence of ARDS was 3.6%, respectively 2.9% among females, and 4.4% among males (p p p = 0.01). Among patients with COVID-19-associated ARDS, older age, male sex (OR = 1.27; 95% CI: 1.03–1.56; p = 0.02), and presence of cardiovascular diseases (OR = 1.26; 95% CI: 1.00–1.59; p = 0.048) were significantly associated with the risk of in-hospital death. Among patients hospitalized with COVID-19 in Poland, the prevalence of ARDS was relatively low, but the in-hospital mortality rate in patients with COVID-19-associated ARDS was higher compared to other EU countries
Evaluation of the SPECT radioisotope perfusion scan in the detection of ischemic heart disease
No full textObjectives: The aim of the study is to determine the diagnostic value of myocardial perfusion scintigraphy (MPS) depending on the location and size of stenosis of a coronary vessel or vessels. Methods: Results of examinations of patients hospitalized in two hospital departments of the same medical facility were analyzed. Retrospective research material consisted of results obtained for 200 patients with suspected ischemic heart disease (coronary artery disease - CAD). From this group, 83 examinations were selected where results of coronary angiography and perfusion scintigraphy (MPS) were available. The following tests were used for statistical studies: t-Student, Chi2, Fisher- -Sendecor, Kruskal-Wallis and Willcoxon. The use of these tests allowed for: – determination of predictive factors favoring development of ischemic heart disease in the analyzed group of patients, – determination of sensitivity and specificity of MPS, taking the coronary examination as the “gold standard”, – assessment of usefulness of the MPS imaging depending on location of a stenosis within the main coronary vessels, – evaluation of usefulness of MPS in detection of a multivessel disease. Results: I n t he a nalyzed g roup o f p atients, a rterial h ypertension was the main factor predisposing to CAD (p = 0.016). The highest sensitivity of MPS in the diagnosis of ischemia was found in the group of patients with stenosis of the right coronary artery (RCA) (p = 0.029) and the circumflex (Cx) and marginal (MB) branches (p = 0.028). A comparative analysis was performed between the degree of narrowing of the above vessels and the degree of perfusion disorders in the MPS study. There was a correlation between the severity of ischemia in MPS and the degree of stenosis in both RCA (p = 0.011, 95% sensitivity (83.1 - 99.4 CI; negative predictive value 83.3%) and the Cx/MB complex (p = 0.044, sensitivity 94.7% ( 83.1 - 99.4 CI), negative predictive value - 83.3%). There was a correlation between the result of the MPS perfusion scan and disease of two or three coronary vessels. There was a 97% agreement between the presence of permanent or transient defects in MPS and the presence of stenosis in 2 or 3 coronary vessels exceeding 80% of the vessel lumen. In the group of patients with stenosis ranging between 50-80%, abnormal results of the MPS occurred in 41.7% of patients. Conclusion: The results confirm that myocardial perfusion scintigraphy is a very valuable screening test in patients with suspected CAD. This examination shows high sensitivity also in the group of patients with multivessel disease
Cardiovascular therapy, diagnostic procedures, and control of risk factors in patients with diabetes or coronary artery disease in Poland: the Kardia‑Pol registry
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