Immunosuppressive Therapy and Nutritional Status of Patients after Kidney Transplantation: A Protocol for a Systematic Review.

(1) Background: Kidney transplantation is widely recognized as the most effective method of treating end-stage renal disease. Immunosuppressive therapy plays a pivotal role in the treatment of kidney transplant patients, encompassing all patients (except identical twins), and is administered from organ transplantation until the end of its function. The aim of this systematic review is to identify the evidence of the association between immunosuppressive therapy and nutritional status of patients following kidney transplantation. (2) Methods: This protocol has been designed in line with Preferred Items for Systematic Reviews (PRISMA-P). Our search encompasses several databases, including MEDLINE (via PubMed), EMBASE (Elsevier), Scopus and Web of Science. We intend to include observational studies (cross-sectional, case-control, and cohort designs), randomized controlled trials (RCTs), as well as completed and ongoing non-randomized study designs. We will confine our search to studies published in English within the past decade (from inception to 17 February 2023). Qualitative studies, case studies, and conference reports will be excluded. The selection process will be done in Covidence by two independent reviewers. Data extraction will be conducted using a standardized MS Excel template version 16.0. Quality assessment of included studies will be performed using the Cochrane Risk of Bias tool for randomized trials (RoB2), or the Risk of Bias in Non-randomized Studies of Interventions (ROBINS-I) tool. Risk-of-bias plots will be generated using the web application Robvis. Relevant data that have been extracted from eligible studies will be presented in a narrative synthesis. We expect the studies to be too heterogeneous to perform subgroup analyses. (3) Conclusion: This systematic review will offer insights into the evidence regarding association between immunosuppressive therapy and nutritional status of adult patients (18 years of age or older) within the initial year following kidney transplantation. To our knowledge, there is no systematic review addressing that question.

A Comparative Analysis of Quality of Life in Women Diagnosed with Breast and Ovarian Cancer.

Background: Previous studies showed that cancer significantly reduces the quality of life of patients. The purpose of this study was to analyze changes in the quality of life of women diagnosed with ovarian and breast cancer after surgical treatment followed by adjuvant cancer therapy. Methods: The study covered 220 women diagnosed with ovarian (n = 89) or breast cancer (n = 131) after surgical treatment followed by adjuvant cancer therapy (chemotherapy, radiotherapy, hormone therapy). The tools used to measure the patients' quality of life were the standardized EORTC QLQ-C30 questionnaire, the QLQ-BR23 module for breast cancer and the QLQ-OV28 module for ovarian cancer. Results: The subjective assessment of the health and quality of life of the women was carried out using the EORTC QLQ-C30 questionnaire and the QLQ-OV28 and QLQ-BR23 modules. Women with breast cancer rated their health higher than women with ovarian cancer. The health assessment performed by the patients was not related to the type of cancer (p > 0.05). They experienced pain, dyspnea and weakness regardless of the cancer location. Moreover, women's health status had a clinically significant impact on their family and social life, although no statistically significant differences were found between the two groups (p > 0.05). Whilst the patients with breast cancer rated their quality of life and health higher than the patients with ovarian cancer, the differences were not statistically significant (p > 0.05). Conclusions: Changes in the quality of life of women with breast and ovarian cancer concern the physical sphere, hobbies, fatigue/rest, pain, family and social spheres, and material conditions. It is necessary to support specialists at every stage of treatment of these patients, which may improve the results of the treatment and patients' perception of health and quality of life.

The prevalence and types of oral- and pharyngeal-stage dysphagia in patients with demyelinating diseases based on subjective assessment by the study subjects.

BACKGROUND: Studies show that dysphagia is a common problem in patients with demyelinating diseases. However, there are no published studies on dysphagia in this group of patients, which would include the individual phases or the safety and effectiveness of the swallowing process. OBJECTIVE: The main objective of this study was to assess the prevalence of swallowing disorders and to characterize them based on subjective assessment by the study subjects with multiple sclerosis and Devic's syndrome. METHOD: The study included 72 patients (47 F, 25 M). Patients at risk of dysphagia were identified using the DYMUS, EAT-10 and SDQ questionnaires. To assess the type of oral- and pharyngeal-stage dysphagia, questions in the questionnaires were classified into groups according to symptoms typical of each stage. RESULTS: The risk of dysphagia and the need for instrumental examination were identified in 37.5% of the study subjects. Pharyngeal-stage dysphagia (repeated swallowing, increased effort of swallowing, cough, a feeling of food sticking in the throat) was reported to occur at a significantly higher frequency. However, no differences were found between difficulty in swallowing liquids and difficulty in swallowing solid food. CONCLUSION: There is a need for further research, which should include a detailed dysphagia-oriented diagnosis, with a view to gaining a detailed insight into the pathophysiology of deglutition in this group of patients.

The impact on quality of life of dialysis patients with renal insufficiency.

AIM: The aim of the study was the subjective assessment of the quality of life (QoL) of 140 patients treated with dialysis (peritoneal dialysis and hemodialysis). BACKGROUND: Chronic kidney disease and the methods of its treatment play an important part in shaping the QoL of patients receiving dialysis. As a result, kidney failure causes many limitations in patients' physical, mental, and social activities. METHODS: The instrument to measure the QoL was the authors' own questionnaire made on the basis of Kidney Disease and Quality of Life Short Form version 1.2 (KDQOL - SF 1.2) and their selection of areas influencing the perceived QoL of chronically ill patients. RESULTS: The research showed that patients receiving peritoneal dialysis assessed their QoL in its different dimensions as much higher than patients receiving hemodialysis. The parameter having the biggest negative impact on the QoL of patients receiving hemodialysis was an impeded possibility to continue work or studies and a change of life plans. The will to live was more highly assessed by patients receiving peritoneal dialysis as compared to patients receiving hemodialysis. CONCLUSION: In order to improve the functioning of hemodialysis patients in a manner most similar to healthy persons, the renal replacement therapy should consider patients' individual needs and expectations, ie, guarantee flexible hours of work or study and of receiving dialysis. In addition, patients treated with hemodialysis should receive psychological care, in particular those demonstrating emotional problems, in order to achieve better results in therapy and improve their QoL.

Awareness and attitudes towards clinical trials among Polish oncological patients who had never participated in a clinical trial.

BACKGROUND: Participation in a clinical trial significantly shortens waiting time associated with receiving specialist care. Furthermore, it may be the case that, through clinical trials, subjects can access medicines that are not typically available in Poland. OBJECTIVES: The aim of this study was to determine the opinions of oncological patients about clinical trials. MATERIAL AND METHODS: The research has been carried out during the years 2014-2016. A proprietary questionnaire consisting of 10 closed, single and multiple choice questions about awareness and perceptions of clinical trials, and 5 questions concerning demographic information was used. A group of 256 patients with cancer (54% women, 46% men), aged 21-77 years, was surveyed. RESULTS: Respondents were statistically more likely to decide to participate in a clinical trial as oncological patients than the healthy volunteers (Pearson's χ2 test p = 0.00006). The desire to qualify for clinical trials in no way depends on the knowledge of side effects (Pearson's χ2 test p = 0.16796). CONCLUSIONS: Our study found that the patients' awareness about clinical trials varied. However, a positive attitude towards research was visible. The main identified barriers to clinical trial participation were fear of possible side effects. Most patients regarded clinical trials as useful, and considered that they are conducted to introduce new treatment/new drug.

Acceptance of disease and lifestyle modification after diagnosis among young adults with epilepsy.

AIM: Assessment of factors affecting the degree of illness acceptance in patients with epilepsy and determination of whether the diagnosis of epilepsy influenced the functioning of this population group. MATERIALS AND METHODS: The Acceptance of Illness Scale (AIS) and authors' own questionnaire were used in this study. The study included 264 patients with epilepsy aged 20-40 years. The study was carried out during the period from June 2015 to June 2016. Participants were recruited through multiple channels, including online websites, a forum for people suffering from epilepsy, and from a neurological outpatient clinic in Warsaw. RESULTS: The mean value for overall rates of illness acceptance for all patients was 25.05±5.23, which indicated a mean level of illness acceptance of the patients. A significant correlation was observed between the results on AIS and the marital status of patients (P=0.04541). However, statistical analysis did not support the significant association between the illness acceptance and other socio-demographic factors and clinical aspects (P>0.05 in all cases). An analysis of the correlation between the level of illness acceptance and taking life decisions by the patients showed that the only statistically significant difference was the influence of an illness on the decision about marriage (P=0.032383). CONCLUSION: The problem of illness acceptance is often addressed in scientific research. It seems to be difficult to attain the state of full illness acceptance, especially in a situation when a number of changes have to be made in a patient's current life and everyday functioning. It can be argued that illness acceptance has a positive meaning because it entails benefits resulting from better mental and physical comfort of a patient. The time needed for the attainment of full illness acceptance is individual for every patient and also depends on many factors.

Patient knowledge on reporting adverse drug reactions in Poland.

AIM: The aim of the study was to assess patient knowledge on reporting of adverse drug reactions. MATERIALS AND METHODS: A prospective study was conducted among 200 patients. The study was based on an original survey composed of 15 single- and multiple-choice questions. The study involved individuals who have experienced adverse reactions as well as individuals who have never experienced any adverse reactions; people over the age of 18; literate; residing in Mazowieckie Voivodeship, who have not been diagnosed with any disease that could compromise their logical thinking skills. RESULTS: The respondents who lived in the city had a greater knowledge compared to the respondents who lived in the countryside (Pearson's χ2=47.70, P=0.0013). The respondents who lived in the city were also more statistically likely to provide a correct answer to the question about the type of adverse reactions to be reported (Pearson's χ2=50.66, P=0.012). Statistically significant associations were found between the place of residence of the respondents and the correct answer to the question about the data that must be included in the report on adverse reactions (Pearson's χ2=11.7, P<0.0001).

The Impact of Ischemic Cerebral Stroke on the Quality of Life of Patients Based on Clinical, Social, and Psychoemotional Factors.

BACKGROUND: Cerebral stroke is the major cause of disability in the modern world and, given its consequences, poses serious medical and social problems. The purpose of the study was to evaluate the quality of life of patients who suffered from an ischemic cerebral stroke with respect to various areas of life, including, in particular, clinical and psychoemotional factors. The study hypothesis states that the poststroke quality of life is reduced in the general context as well as in the context of specific areas of life. It was also considered of key importance to assess how the quality of life of patients is affected by depression. MATERIALS AND METHODS: The study included 44 patients with the first ischemic cerebral stroke of moderate and mild severity according to the National Institutes of Health Stroke Scale, currently treated in the Neurology Department of the Miedzyleski Specialist Hospital in Warsaw. The quality of life was measured based on the standardized Ferrans and Powers Quality of Life Index questionnaire and the Beck Depression Inventory. RESULTS: Based on the results, it was demonstrated that the quality of life of the patients was significantly reduced on the psychological and spiritual well-being subscale and that depression is a more frequent occurrence among patients with cerebral stroke of moderate severity. CONCLUSIONS: Continued and complex posthospitalization care, including treatment for depression and increased social support, may to a significant extent reduce the negative impact of the disease on the perceived quality of life.

Analysis of Quality of Life Subjective Perception by Patients Treated for Prostate Cancer with the EORTC QLQ-C30 Questionnaire and QLQ-PR25 Module.

Prostate cancer in men is the second most occurring cancer in Poland and represents approximately 13.2 % of all cancers. At the same time, it is the third largest cause of death in men, being responsible for approximately 8 % of deaths. The study was conducted among patients of Oncological Hospital in Wieliszew. The study included 83 men diagnosed with prostate cancer at the age of 51-84 years. The patients gave their written consent to participate in the study, to which the overall standardized questionnaires EORTC QLQ-C30 and QLQ-PR25 for patients with prostate cancer was applied. Significant deterioration of the state of health due to cancer was indicated by a total of 10.84 % of patients. At the same time, it was found that although there are differences between quality of life in various age groups of respondents, they are statistically insignificant (Chi2 = 59.96; p = 0.00734; R = 0.09; p > 0.05). Subjective QoL did not depend on the stage of cancer treatment, type of therapy, or significant deterioration in the patient's state of health in the last stage of disease. Both disease and therapy have impact on quality of life in all its dimensions, in particular as regards the patient's physical functioning and his frequent fatigue. There is a strong relationship between a patient's subjective assessment of quality of life and pain that significantly hampers everyday activities. This demonstrates the need for continuous monitoring and relieving pain directly associated with cancer and methods of its treatment.

[Two compartment model of body composition and abdominal fat area in postmenopausal women - pilot study].

INTRODUCTION: Both menopausal period and aging have influence on body composition, increase of total body fat and visceral fat in particular. We should be aware that changes in body composition, mainly fat translocation to abdominal region, can occur without significant changes in body weight. Therefore quantitative abdominal fat assessment should be our aim. THE AIM: Body composition analysis based on two compartment model and abdominal fat area assessment in cross section. MATERIAL AND METHODS: Subjects in postmenopausal period (41 women) were recruited for this study and divided into 2 groups: group 1 - women aged 45-56 years and group 2 - women aged 57-79 years. Body composition analysis and abdominal fat area assessment were conducted by using bioelectrical impedance method with BioScan 920 (Maltron int.) accordingly with standardized procedure. RESULTS: Women in early postmenopausal stage (Group 1) had statistically significant lower total body fat percentage in comparison with women in late postmenopausal period (Group 2) (41.09 ± 7.72% vs. 50.7 ± 9.88%, p=0.0021). Also women in group 1 were characterized by significant lower visceral fat area (VAT) as well as subcutaneous fat area (SAT) in comparison with group 2 (respectively VAT 119.25 ± 30.09 cm2 vs. 199.36 ± 87.38 cm2, p=0.0011; SAT 175.19 ±57.67 cm2 vs. 223.4±74.29 cm2, p=0.0336). According to VAT criteria (>120 cm2), 44% of women in group 1 and 80% in group 2 had excess of visceral fat. CONCLUSIONS: Both total body fat and intra-abdominal fat increased with age, independently of weight changes.