Predictors of outcomes of patients ≥ 80 years old admitted to intensive care units in Poland - a post-hoc analysis of the VIP2 prospective observational study.

INTRODUCTION: Elderly patients pose a significant challenge to intensive care unit (ICU) clinicians. In this study we attempted to characterise the population of patients over 80 years old admitted to ICUs in Poland and identify associations between clinical features and short-term outcomes. MATERIAL AND METHODS: The study is a post-hoc analysis of the Polish cohort of the VIP2 European prospective observational study enrolling patients > 80 years old admitted to ICUs over a 6-month period. Data including clinical features, clinical frailty scale (CFS), geriatric scales, interventions within the ICU, and outcomes (30-day and ICU mortality and length of stay) were gathered. Univariate analyses comparing frail (CFS > 4) to non-frail patients and survivors to non-survivors were performed. Multivariable models with CFS, activities of daily living score (ADL), and the cognitive decline questionnaire IQCODE as predictors and ICU or 30-day mortality as outcomes were formed. RESULTS: A total of 371 patients from 27 ICUs were enrolled. Frail patients had significantly higher ICU (58% vs. 44.45%, P = 0.03) and 30-day (65.61% vs. 54.14%, P = 0.01) mortality compared to non-frail counterparts. The survivors had significantly lower SOFA score, CFS, ADL, and IQCODE than non-survivors. In multivariable analysis CFS (OR 1.15, 95% CI: 1.00-1.34) and SOFA score (OR 1.29, 95% CI: 1.19-1.41) were identified as significant predictors for ICU mortality; however, CFS was not a predictor for 30-day mortality ( P = 0.07). No statistical significance was found for ADL, IQCODE, polypharmacy, or comorbidities. CONCLUSIONS: We found a positive correlation between CFS and ICU mortality, which might point to the value of assessing the score for every patient admitted to the ICU. The older Polish ICU patients were characterised by higher mortality compared to the other European countries.

Determining Antiradical Capacity of Medicinal Plant Extract Individual Constituents Using Post-Column Reaction Method.

The post-column reaction method enables the evaluation of the antiradical capacity of individual components in a mixture by separating the components using HPLC and measuring stable free radical (e.g., DPPH●) scavenging that occurs after the chromatography column. The equipment typically consists of two detectors. The first records signals of the analytes leaving the column. The second records radical scavenging by the analytes, which appears as a negative band. The recorded signals are found on two separate chromatograms, which must be combined to interpret the results. In this study, a single DAD detector was used behind the post-column reactor, enabling the simultaneous recording of the analyte bands and negative signals, indicating radical scavenging. The objective of this study was to evaluate the antiradical capacity of key compounds found in two herbal raw materials used in traditional Chinese medicine. Saposhnikovia divaricata roots contain phenolic acids, chromones, and furanocoumarins. Chlorogenic acid, rosmarinic acid, and imperatorin demonstrated strong radical scavenging, while prim-O-glucoslocimifugin showed a weaker response, both in standards and in root extracts. However, scavenging was not observed for cimifugin and 4'-O-ß-D-glucosyl-5-O-methylvisamminol. Astragalus mongholicus roots contain astragalosides I-IV (triterpene saponins). None of these showed DPPH● scavenging. Furthermore, additional signals were observed, indicating the presence of unidentified radical scavenging compounds.

Prevalence of life-sustaining treatment limitations in Polish very old intensive care patients (VIPs). A post-hoc analysis of two prospective observational studies.

PURPOSE: Several initiatives have recently focused on raising awareness about limitations of treatment in Poland. We aimed to assess if the propensity to limit LST among elderly patients in 2018-2019 increased compared to 2016-2017. METHODS: We analysed Polish cohorts from studies VIP1 (October 2016 - May 2017) and VIP2 (May 2018 - May 2019) that enrolled critical patients aged >80. We collected data on demographics, clinical features limitations of LST. Primary analysis assessed factors associated with prevalence of limitations of LST, A secondary analysis explored differences between patients with and without limitations of LST. RESULTS: 601 patients were enrolled. Prevalence of LST limitations was 16.1% in 2016-2017 and 20.5% in 2018-2019. No difference was found in univariate analysis (p = 0.22), multivariable model showed higher propensity towards limiting LST in the 2018-2019 cohort compared to 2016-2017 cohort (OR 1.07;95%CI, 1.01-1.14). There was higher mortality and a longer length of stay of patients with limitations of LST compared to the patients without limitations of LST. (11 vs. 6 days, p = 0.001). CONCLUSIONS: The clinicians in Poland have become more proactive in limiting LST in critically ill patients ≥80 years old over the studied period, however the prevalence of limitations of LST in Poland remains low.

Growing Season, Cultivar, and Nitrogen Supply Affect Leaf and Fruit Micronutrient Status of Field-Grown Kiwiberry Vines.

The N uptake can affect kiwiberry yield and quality; however, the relationship between an increasing N dose and micronutrient accumulation in leaves and fruit is still to be elucidated. Interrelationships between essential nutrients are one of the most important issues in terms of effectiveness in plant mineral nutrition. A pattern in leaf nutrient accumulation throughout the growing period is required to indicate a suitable sampling time for the purpose of nutrient diagnostics and controlled plant feeding. The experiment was conducted on two commercially available cultivars of kiwiberry, 'Weiki' and 'Geneva', during the 2015-2016 growing seasons with an increasing soil N fertility (30-50-80 mg N kg-1 soil DW) to test the relationship between soil N level and leaf/fruit micronutrient concentration. The leaf Zn, Cu, Fe, and Mn concentrations significantly increased with a higher N supply in 'Geneva', while in 'Weiki' only Mn increased. Leaf B, Fe, and Mn gradually increased throughout the growing season, while Cu decreased. Between mid-July and the beginning of August, the lowest fluctuations in the micronutrient contents were recorded. The effect of the growing season on leaf micronutrient accumulation was highly significant; except for Fe, significantly higher micronutrient levels were revealed in 2016. Compared to the leaves, the growing season effect was smaller in the case of fruit micronutrient concentrations. Irrespective of cultivar, the increase in N fertilization resulted in a higher fruit Mn concentration and was insignificant in the case of other micronutrients. The results indicate that the N dose may affect the accumulation of micronutrients within a certain range depending on the tissue type and the genotype.

Actinidia arguta Leaf as a Donor of Potentially Healthful Bioactive Compounds: Implications of Cultivar, Time of Sampling and Soil N Level.

The aim of this study was to assess the enzymatic and non-enzymatic antioxidant status of kiwiberry (Actinidia arguta) leaf under different N regimes tested three times in field conditions during the 2015 growing season in two cultivars ('Weiki' and 'Geneva'). Leaf total antioxidant capacity using ABTS, DPPH and FRAP tests was evaluated in the years 2015 to 2017, which experienced different weather conditions. Both cultivars exhibited a significant fall in leaf L-ascorbic acid (L-AA) and reduced glutathione (GSH) as well as global content of these compounds during the growing season, while total phenolic contents slightly ('Weiki') or significantly ('Geneva') increased. There was a large fluctuation in antioxidative enzyme activity during the season. The correlation between individual antioxidants and trolox equivalent antioxidant capacity (TEAC) depended on the plant development phase. The study revealed two peaks of an increase in TEAC at the start and end of the growing season. Leaf L-AA, global phenolics, APX, CAT and TEAC depended on the N level, but thiol compounds were not affected. Over the three years, TEAC decreased as soil N fertility increased, and the strength of the N effect was year dependent. The relationship between leaf N content and ABTS and FRAP tests was highly negative. The antioxidant properties of kiwiberry leaves were found to be closely related to the plant development phase and affected by soil N fertility.

Occupational hazards in anaesthesiology during the COVID-19 pandemic.

According to the Occupational Safety and Health Administration of the Department of Labor of the United States, the exposure risk for anaesthesiologists working with COVID-19 patients can be classified as high or very high. This is mostly due to fact that the anaesthesiologists work in close contact with patients' airways, and the aerosol-generating nature of some procedures they perform. Fortunately, despite the occupational hazard, the incidence of COVID-19 among anaesthesiologists and intensivists remains relatively low. Current evidence suggests that the majority of SARS-CoV-2 infections in this group were either contracted outside of the work environment or can be attributed to personal protective equipment (PPE) malfunction. This article focuses on different aspects of anaesthesiologists' safety, risks connected with different clinical scenarios and procedures, issues related to testing and screening, as well as modifiable and non-modifiable risk factors for severe illness or from COVID-19. This analysis is accompanied by a review of guidelines dedicated to mitigating said risks. Educating the personnel, introducing appropriate procedures, and proper utilisation of PPE are essential to the safety of all parties involved in hospital care, particularly those with significant exposure risk.

COVID-19 and haemodynamic failure: a point of view on mechanisms and treatment.

The SARS-CoV-2-related disease has an undoubted impact on the healthcare system. In the treatment of severe COVID-19 cases, the main focus is on respiratory failure. However, available data suggest an important contribution of haemodynamic impairment in the course of this disease. SARS-CoV-2 may affect the circulatory system in various ways that are universal for septic conditions. Nonetheless, unique features of this pathogen, e.g. direct insult leading to myocarditis and renin-angiotensin-aldosterone axis dysregulation, must be taken into account. Although current recommendations on COVID-19 resemble previous septic shock guidelines, special attention to haemodynamic monitoring and treatment is necessary. Regarding treatment, one must take into account the potential profound hypovolaemia of severe COVID-19 patients. Pharmacological cardiovascular support should follow existing guidelines and practice. Interesting concepts of decatecholaminisation and the effect of vasopressors on pulmonary circulation are also presented in this review on COVID-19-related haemodynamic failure.

Bioactive compounds, total antioxidant capacity and yield of kiwiberry fruit under different nitrogen regimes in field conditions.

BACKGROUND: Actinidia arguta known as the 'kiwiberry' or 'mini kiwi' is relatively new among the cultivated berry species. Recent studies indicate the kiwiberry fruit could be an important source of many health-promoting compounds. A knowledge-based fertilisation concept was evolved to define optimal strategies for feeding Actinidia with nitrogen (N) because a deficit and excess of N both have a negative impact on plants and the surrounding environment. RESULTS: Kiwiberry yield and fruit internal quality significantly depended on soil N level, cultivar and growing season. A higher soil N led to an increase in carotenoid content and a decrease in phenolic content, whereas ascorbic acid and glutathione contents were not affected by soil N fertility. Under the highest N dose, enzymatic antioxidants were activated. Trolox equivalent antioxidant capacity clearly decreased with an increasing N level. CONCLUSIONS: Competent and skilful fertilisation management should focus on balancing a high fruit yield and maintaining their high quality. Based on yield level and fruit antioxidant potential, the N guide values for A. arguta vary between 30 and 50 mg N per kg-1 of soil. The recommended N dose may depend on overall soil quality traits and cultivar N demand, as well as on weather conditions. © 2020 Society of Chemical Industry.

Frailty is associated with an increased mortality among patients ≥ 80 years old treated in Polish ICUs

BACKGROUND: The increasing population of very old intensive care patients (VIPs) is a major challenge currently faced by clinicians and policymakers. Reliable indicators of VIPs' prognosis and purposefulness of their admission to the intensive care unit (ICU) are urgently needed. METHODS: This is a report from the Polish sample of the VIP1 multicentre cohort study (NCT03134807). Patients ≥ 80 years of age admitted to the ICU were included in the study. Information on the type and reason for admission, demographics, utilisation of ICU procedures, ICU length of stay, organ dysfunction and the decision to apply end-of-life care was collected. The primary objective was to investigate the impact of frailty syndrome on ICU and 30-day survival of VIPs. Frailty was assessed with the Clinical Frailty Scale (≥ 5 points on a scale of 1-9). RESULTS: We enrolled 272 participants with a median age of 84 (81-87) years. Frailty was diagnosed in 170 (62.5%) patients. The ICU and 30-day survival rates were equal to 54.6% and 47.3% respectively. Three variables were found to significantly increase the odds of death in the ICU in a multiple logistic regression model: SOFA score (OR = 1.16; 95%CI 1.16-1.24), acute mode of admission (OR = 5.1; 95%CI 1.67-15.57) and frailty (OR = 2.25; 95%CI 1.26-4.01). CONCLUSION: Measuring frailty in critically ill older adults can facilitate making more informed clinical decisions and help avoid futile interventions.