Health behaviors and problems in Polish homeless men.

Introduction: Homelessness is considered to be a global problem, independent of the material situation of a given country and occurring in most societies around the world. Aim of the study: Assessment of the preferred health behaviors of homeless people. Materials and methods: The study covered 153 men who are homeless and 312 men who are not homeless. The original questionnaire of homeless, and validated the Satisfaction with Life Scale (SWLS), the Health Behavior Inventory (HBI), the General Self-Efficacy Scale (GSES) and the Multidimensional Health Locus of Control (MHLC) Scale were used. The research covered fully completed questionnaires from 153 homeless men staying in Bialystok and Gdansk homelss centers. Results: On average, the homeless men assessed their health at 6.0 ± 2.7 points, and the non-homeless at 7.8 ± 2.2 points (p < 0.001). Significant differences were found between people experiencing a homelessness crisis and the control group in selected aspects concerning the everyday life hygiene of the respondents, health self-assessment, declarations of visits to a specialist and carrying out check-ups, level of satisfaction with life, coping with difficult situations, preferred pro-health behaviors and dimensions of health control. In the used scales, SWLS, HBI, GES, and MHCL, the majority of homeless men obtained average scores. They were rather dissatisfied with their lives, with a low level of effectiveness in coping with difficult situations and obstacles, a low level of health behaviors, and in the scope of health, control increasing the impact of chance. Conclusion: The level of the presented health behaviors showed statistically significant diversification with all dimensions of the health locus of control, and its internal dimension with age, homelessness phase, the respondents' criminal history, being under constant medical care, and self-assessment of health.

Efficacy of Sildenafil in Patients with Severe COVID-19 and Pulmonary Arterial Hypertension.

Pulmonary arterial hypertension (PAH) is common in severe coronavirus disease 2019 (COVID-19) and worsens the prognosis. Sildenafil, a phosphodiesterase-5 inhibitor, is approved for PAH treatment but little is known about its efficacy in cases of severe COVID-19 with PAH. This study aimed to investigate the clinical efficacy of sildenafil in patients with severe COVID-19 and PAH. Intensive care unit (ICU) patients were randomly assigned to receive sildenafil or a placebo, with 75 participants in each group. Sildenafil was administered orally at 0.25 mg/kg t.i.d. for one week in a placebo-controlled, double-blind manner as an add-on therapy alongside the patient's routine treatment. The primary endpoint was one-week mortality, and the secondary endpoints were the one-week intubation rate and duration of ICU stay. The mortality rate was 4% vs. 13.3% (p = 0.078), the intubation rate was 8% and 18.7% (p = 0.09), and the length of ICU stay was 15 vs. 19 days (p < 0.001) for the sildenafil and placebo groups, respectively. If adjusted for PAH, sildenafil treatment significantly reduced mortality and intubation risks: OR = 0.21 (95% CI: 0.05-0.89) and OR = 0.26 (95% CI: 0.08-0.86), respectively. Sildenafil demonstrated some clinical efficacy in patients with severe COVID-19 and PAH and should be considered as an add-on therapy in these patients.

The Influence of the COVID-19 Pandemic on Women's Feelings during a Hospital Stay.

Introduction: The COVID-19 (coronavirus disease 2019) affected individuals and society and caused disruption, anxiety, stress, and loneliness. Being hospitalized during the pandemic increase a patient's negative feelings. This study aimed to evaluate the impact of the COVID-19 pandemic on patients' feelings (loneliness, depression, hope, self-efficacy) during a hospital stay. Materials and methods: This study included 207 women, aged from 15 to 83 years (55 ± 21.2) that were hospitalized during the pandemic in Bialystok, Lomza, and Biala Podlaska, Poland at internal medicine departments. The main reasons for hospitalization were cardiovascular diseases, abdominal pain, chronic obstructive pulmonary disease, pneumonia, diabetes, and unknown fever. Respondents were asked to complete the following questionnaires: Sense of Loneliness (the DJGLS), Depression Beck Inventory (BDI), Basic Hope (BHI-12), and Self-Efficacy (GSES). Results: Most of the studied group of women had an average sense of loneliness. A greater sense of loneliness was found among hospitalized women living in the countryside-the lowest sense of loneliness and depression was among women with higher education and the highest sense of effectiveness. One-third of respondents had a moderate degree of depression. Of the respondents, 39% had a relatively high level of basic hope. The assessment of self-efficacy demonstrated that 52% of the respondents showed a high sense of self-efficacy, an average sense of self-efficacy was shown by 35.5% of the respondents, and a low sense of self-efficacy was shown by 12.6% of the respondents. Conclusions: Numerous hospitalized women during the COVID-19 pandemic, despite experiencing moderate depression, had an average sense of loneliness and a high level of hope and self-efficacy.

Selected Aspects of the Mental Functioning of Women After Childbirth in a Hospital During a Pandemic.

Introduction: The COVID-19 pandemic is stressful for pregnant women, their families, and their unborn baby. Aim of the Study: The study aimed to assess the impact of a pandemic on the mental state of women after childbirth. Material and Methods: The study included 363 women hospitalized after delivery. The study used a diagnostic survey method using the proprietary questionnaire and the Family Affluence Scale (FAS), Edinburgh Postnatal Depression Scale (EPDS), Jong Gierveld Loneliness Scale (DJGLS), The Basic Hope Inventory (BHI-12), and General Self Efficacy Scale (GSES). Results: Suspicion of postpartum depression was found in 109 women (mean: 15.28 ± 2.22)-group I, and no suspicion of it in 254 subjects (mean: 6.03 ± 2.63)-group II. Mean values of the sense of loneliness in group I (27.11 ± 6.00) were higher than in group II (21.35 ± 7.02), and the basic hope-BHI-12, in group I-lower (27.92 ± 5.14) than in group II (31.75 ± 4.97). In the Generalized Own Efficacy Scale, the group I obtained lower mean values (28.07 ± 4.86 points and 5.87 ± 1.96 points) than group II (30.97 ± 3.77 points and 6.02 ± 1 points, 38 sten). Conclusions: As much as 30% of the respondents showed a risk of postpartum depression. The most felt was the limitation of family visits during the hospital stay. In addition, the respondents were most concerned about the child's health in both groups. The feeling of loneliness in group I was higher, and basic hope and generalized self-efficacy were lower than in group II. The differences between these relationships were statistically significant.

CHANGES IN THE STATE OF VEGETATIVE NERVOUS SYSTEM OF ALBINO RATS AT THE BACKGROUND OF CHRONIC ROUNDUP POISONING.

OBJECTIVE: The aim: The aim of this research was the study of low dose roundup, a well-known herbicide, chronic poisoning on the state of the vegetative nervous system in albino rats. PATIENTS AND METHODS: Materials and methods: The state of vegetative nervous system was assessed by the method of variation pulsometry The two-week chronic roundup poisoning at a dose of 40 mcg/kg having been simulated on 30 albino rats. RESULTS: Results: The chronic roundup poisoning was accompanied by impaired state of vegetative nervous system that revealed itself in the growing indices of variation pulsometry: tension index - 1.6 times (P<0.001), index of regulatory system activity - 1.52 times (P<0.001), vegetative balance index - 2.36 times (P<0.001), rhythm vegetative index - 1.39 times (P<0.001). Moderate regulatory system stress, requiring extra functional reserves to provide adaptation to environment, was observed. Such condition occurs in the process of adaptation to adverse environmental factors with impairing adaptive self-regulation mechanisms. CONCLUSION: Conclusions: Internal two-week use of the roundup on albino rats in a dose of 40 mcg/kg is accompanied by functional disorders of vegetative nervous system, which reveal themselves in the growing values of variation pulsometry. The results obtained were indicative of prevailing vegetative system sympathetic division as compared with parasympathetic one, as well as of disordered regulation of vegetative nervous system tone.

Comparison of the Effect of Unfractionated Heparin and Enoxaparin Sodium at Different Doses on the Course of COVID-19-Associated Coagulopathy.

BACKGROUND: COVID-19-associated coagulopathy (CAC) exacerbates the course of coronavirus infection and contributes to increased mortality. Current recommendations for CAC treatment include the use of low-molecular weight heparins (LMWH) at prophylactic or therapeutic doses, as well as the use of unfractionated heparin (UFH). METHODS: A randomised, controlled trial enrolled 126 patients hospitalised in the intensive care unit with severe COVID-19 complicated by CAC. The effects of LMWH at preventive and therapeutic doses and UFH at therapeutic doses on mortality and intubation rates were compared. RESULTS: The number of intubations and deaths showed no significant difference depending on the anticoagulant therapy used. However, multivariate logistic regression models revealed an increased risk of intubation (p = 0.026, odds ratio (OR) = 3.33, 95% confidence interval (CI) 1.15-9.59), and an increased risk of death (p = 0.046, OR = 3.01, 95% CI 1.02-8.90), for patients treated with LMWH at a prophylactic dose but not at a therapeutic dose as compared to patients treated with UFH when controlling for other risk factors. CONCLUSIONS: The use of unfractionated heparin in the treatment of COVID-19-associated coagulopathy seems to be more effective at reducing the risk of intubation and death than enoxaparin at prophylactic doses.

Analysis of the Interventions of Medical Emergency Teams in Older Patients in Selected Polish Cities with County Status: A Retrospective Cohort Study.

INTRODUCTION: Geriatric patients account for a large proportion of interventions of medical emergency teams (METs). The aim of this study was to analyse medical emergency interventions in the Biala Podlaska and Chelm (Poland) between 2016 and 2018 in a group of patients ≥ 65 years of age. MATERIALS AND METHODS: We analysed medical records of 1200 older patients treated by METs in Biala Podlaska and Chelm (Lublin Province, Poland). The research was conducted from June 2019 to March 2020 at the Emergency Medical Service Station in Biala Podlaska and the Medical Rescue Station in Chelm (Independent Public Complex of Health Care Facilities). RESULTS: A total of 92.5% of medical emergency service interventions took place at the patient's home. The mean time of stay at the scene was 20 min. The highest number of interventions occurred between 8:00 p.m. and 8:59 p.m. There were no statistically significant differences in the type of ambulance used depending on the patient's sex, while there was a statistically significant relationship between priority code and sex. Cardiovascular diseases were diagnosed in 40% of patients, and the symptoms were not precisely classified in almost the same percentage of patients. Mortality cases accounted for 3.1% of the 1200 interventions analysed. Ambulance dispatch resulted in the patient being transported to the hospital emergency department in 69.1% of cases. CONCLUSIONS: METs were called for a variety of diseases due to the fact that geriatric patients are not able to distinguish a life-threatening condition. Medical procedures performed by METs from Biala Podlaska and Chelm were closely related to the initial diagnoses made by these teams. It was irrelevant whether a specialist or non-specialist medical emergency service was used. Paramedics are very well trained to practice their profession and are able to provide treatment to older patients in a state of sudden life threat.

Efficacy of Tocilizumab Therapy in Different Subtypes of COVID-19 Cytokine Storm Syndrome.

BACKGROUND: Cytokine storm in COVID-19 is heterogenous. There are at least three subtypes: cytokine release syndrome (CRS), macrophage activation syndrome (MAS), and sepsis. METHODS: A retrospective study comprising 276 patients with SARS-CoV-2 pneumonia. All patients were tested for ferritin, interleukin-6, D-Dimer, fibrinogen, calcitonin, and C-reactive protein. According to the diagnostic criteria, three groups of patients with different subtypes of cytokine storm syndrome were identified: MAS, CRS or sepsis. In the MAS and CRS groups, treatment results were assessed depending on whether or not tocilizumab was used. RESULTS: MAS was diagnosed in 9.1% of the patients examined, CRS in 81.8%, and sepsis in 9.1%. Median serum ferritin in patients with MAS was significantly higher (5894 vs. 984 vs. 957 ng/mL, p < 0.001) than in those with CRS or sepsis. Hypofibrinogenemia and pancytopenia were also observed in MAS patients. In CRS patients, a higher mortality rate was observed among those who received tocilizumab, 21 vs. 10 patients (p = 0.043), RR = 2.1 (95% CI 1.0-4.3). In MAS patients, tocilizumab decreased the mortality, 13 vs. 6 patients (p = 0.013), RR = 0.50 (95% CI 0.25-0.99). CONCLUSIONS: Tocilizumab therapy in patients with COVID-19 and CRS was associated with increased mortality, while in MAS patients, it contributed to reduced mortality.

Analysis of Medical Management in Geriatric Patients in the Hospital Emergency Department by Example of Selected Cities with County Status in Poland: A Retrospective Cohort Study.

The aim of this study was to analyse medical management in geriatric patients in the Hospital Emergency Departments in the Biala Podlaska County and Chelm County (Poland) between 2016 and 2018 in a group of patients ≥65 years of age. We analysed medical records of 829 patients transported to Hospital Emergency Departments by Medical Emergency Teams. The research was conducted in the period from June 2019 to March 2020. We analysed emergency medical procedure forms and medical records of patients transported to the hospitals. Cardiovascular diseases were diagnosed in 40% of patients. Mortality cases accounted for 3.1% of the 1200 interventions analysed. Ambulance dispatch resulted in the patient being transported to the Hospital Emergency Departments in more than 2/3 of cases. The concordance between the diagnoses made by the Medical Emergency Teams and those made at the Hospital Emergency Departments was confirmed for 78% patients admitted to the department (n = 647), whereas the concordance of classification at the group level was estimated at 71.7% (n = 594). Further in-patient treatment was initiated in some of the patients admitted to the department (n = 385). The mean time of hospital stay was 10.1 days. In conclusion, differences between the initial diagnosis made by the heads of the Medical Emergency Teams and the diagnosis made by the doctor on duty in the Hospital Emergency Departments depended on the chapter of diseases in the ICD-10 classification, but they were acceptable. The majority of the patients were transported to Hospital Emergency Departments. The most common groups of diseases that require Hospital Emergency Departments admission include cardiovascular diseases, injuries due to external causes, and respiratory diseases. A moderate percentage of patients were qualified for further specialist treatment in hospital departments.