The Impact of COVID-19 Incidence on Motivation to Participate in a Triathlon.

The COVID-19 pandemic has caused many changes that have influenced the lives of people around the world and have left their mark in the world of sports, as well. Numerous restrictions resulted in the cancellation of the organization of many sports events, and the players themselves had restricted access to training. The main goal of the study was to identify the motivation to participate in a triathlon between athletes who have undergone COVID-19, those who have never been infected and those who do not know if they have ever caught the virus and to evaluate the differences between them. The assessment of the motives for participating in a sports event was conducted according to four types of orientation: social, experience, factual and results to check what benefits for well-being and self-improvement are brought about by participation in a triathlon as a mass sports event. The desire to feel unity, to develop passion, to integrate with other people and to get away from everyday life were the most important motives for those who have never been infected. It turns out that 100% of the respondents who had a history of COVID-19 disease indicated the desire to prove themselves. The desire to maintain good physical condition and health was reported by the majority of researched people, but again, all respondents (100%) who had been infected with COVID-19 indicated these motives as the most important.

Effectiveness of Folic Acid Supplementation Recommendations among Polish Female Students from the Podkarpackie Region.

Adequate folic acid supplementation during the preconception period is an important element in the primary prevention of neural tube defects (NTDs). This study aims to study the effectiveness of folic acid supplementation recommendations among women of childbearing age, and to assess and characterise their awareness about this public health measure. The cross-sectional study included women (N = 1285) aged 22.27 ± 4.6 years old on average. Some of the results were obtained on a subgroup of women (N = 1127) aged 21.0 ± 2.1. This study was performed using a questionnaire. The analysis was performed with the use of a logistic regression model, chi-square test for independence and odds ratio (OR). According to the results, only 13.9% of women supplement folic acid, and 65.3% of them do so daily. A total of 91.1% of the respondents were not aware of its recommended dose and 43% did not know the role it plays in the human body. Among women who do not currently supplement folic acid (N = 1052), 52.4% declared doing so while planning their pregnancy. Women's awareness about the role of folic acid in NTD prevention (OR = 4.58) and the information they got from physicians (OR = 1.68) are key factors that increased the odds of the women taking folic acid before pregnancy. There is therefore a need for more information and education campaigns to raise awareness about folic acid.

Carotid Artery Stiffness in Metabolic Syndrome: Sex Differences.

INTRODUCTION: The effect of metabolic syndrome (MS) on carotid stiffness (CS) in the context of gender is under research. OBJECTIVE: We examined the relationship between the MS and CS in men (M) and women (W) and investigated if the impact of cardiovascular risk factors on CS is modulated by gender. PATIENTS AND METHODS: The study included 419 subjects (mean age 54.3 years): 215 (51%) with MS (109 W and 106 M) and 204 (49%) without MS (98 W and 106 M). Carotid intima-media thickness (IMT) and CS parameters (beta stiffness index (beta), Peterson's elastic modulus (Ep), arterial compliance (AC) and one-point pulse wave velocity (PWV-beta)) were measured with the echo-tracking (eT) system. RESULTS: ANCOVA demonstrated that MS was associated with elevated CS indices (p = 0.003 for beta and 0.025 for PWV-beta), although further sex-specific analysis revealed that this relationship was significant only in W (p = 0.021 for beta). Age was associated with CS in both M and W, pulse pressure (PP) and body mass index turned out to be determinants of CS solely in W, while the effect of mean arterial pressure (MAP) and heart rate was more pronounced in M. MANOVA performed in subjects with MS revealed that age and diabetes mellitus type 2 were determinants of CS in both sexes, diastolic blood pressure and MAP - solely in M and systolic blood pressure, PP and waist circumference - solely in W (the relationship between the waist circumference and AC was paradoxical). CONCLUSION: The relationship between MS and CS is stronger in W than in M. In subjects with MS, various components of arterial pressure exert different sex-specific effects on CS - with the impact of the pulsative component of arterial pressure (PP) observed in W and the impact of the steady component (MAP) observed in M.

Difficulties Limiting Access to Sports and Recreational Facilities in the City in the Perceptions of Service Users. Sports and Recreational Infrastructure Management Policy-Poznan Case Study.

The range of sports and recreation facilities' offer should be very wide in order for all social groups of the examined environment to have access to sports and recreation facilities. Therefore, Poznan City Hall should take into account all difficulties that limit the access to these facilities when preparing management policy of sports and recreation infrastructure and its functioning. That is why the main goal of this study is to recognize difficulties limiting the access to sports and recreation facilities in this city. The research carried out at indoor tennis courts (16 facilities), indoor swimming polls (12 facilities) and fitness clubs (11 facilities) in Poznan covered 1159 service recipients (using the services of a given sports and recreation facility). The author-constructed questionnaire addressed to the service recipients (residents of the city of Poznan who use the services offered at the examined sports and recreation facilities). Furthermore, the service recipients were divided into a group of people doing sports competitively and a group of recipients who have never practiced sports as professional athletes. The validated questionnaire sent to the examined service recipients included suggestions of difficulties that may limit the access to sports and recreation facilities in the city of Poznan. Further analysis of the importance of difficulties that limit the access to sports and recreation facilities may allow indicating the reason why recreational activity of residents is limited. A lower level of satisfaction and thus a lower rating of the respondents was obtained by a set of features constituting, according to the respondents, difficulties limiting the access to the use of sports and recreation facilities (high prices and too great of a distance of the sports and recreation facility from the place of residence).

Hierarchy of Factors Affecting the Condition and Development of Sports and Recreation Infrastructure-Impact on the Recreational Activity and Health of the Residents of a City (Poznan Case Study).

The aim of the article is to identify which groups of factors (economic, social, and spatial) significantly determine the condition and development of the sports and recreation infrastructure of the city of Poznan and shape the needs and expectations of its residents. Standardized interviews among 39 service providers and 1159 service recipients made it possible to collect primary data on the presentation of the pace and directions of changes taking place in the sports and recreational facilities of the city, paying special attention to identifying and prioritizing factors determining this development. In order to establish the hierarchy of factors analyzed in the paper and operating within the same research problem for both groups of respondents (service recipients and service providers), the Anderson-Darling test was used. The test results were referenced to the already existing "Sportowy Poznan" ("Sports Poznan") program. The assessment made by service recipients shows that the factor having the strongest limiting effect on the use of sports and recreation services is the economic factor. In the assessment made by the respondents using their services, the efforts of city authorities to make Poznan sports clubs operate in a professional manner gained the lowest score. The results of the Anderson⁻Darling test show that the social factor of preparing infrastructure for the residents of the city of Poznan was the most important for the respondents, obtaining a test value of 0.886.

Gender-related differences in the progression of carotid stiffness with age and in the influence of risk factors on carotid stiffness.

BACKGROUND: In recent years, there has been growing interest in the impact of gender-related factors on the function and structure of the arterial tree. The aim of our study was to identify gender-specific differences in the progression of carotid stiffness parameters with age and in the impact of risk factors on carotid stiffness. SUBJECTS AND METHODS: The study group included 256 subjects (mean age: 54.7 years): 134 women (52%) and 122 men (48%) with cardiovascular risk factors: hypertension, type 2 diabetes mellitus, dyslipidemia, smoking, and obesity. Local parameters of carotid stiffness: ß stiffness index (ß), Peterson's elastic modulus (Ep), pulse wave velocity ß (PWV-ß) and arterial compliance (AC) were determined with ultrasound echo-tracking software application. RESULTS: Women were characterized by lower AC than men (women: 0.57 mm2/kPa vs men: 0.69 mm2/kPa, p < 0.001) and the subanalysis in three age groups revealed that the difference in AC value between genders became significant over the age of 45 years. Although no significant difference in the value of ß, Ep and PWV-ß were found between genders in the whole study group, women <45 years were characterized by lower values of ß and Ep than their men counterparts (ß: women: 5.4 vs men: 6.6, p = 0.002; Ep: women: 72 kPa vs men: 84 kPa, p = 0.015). Among analyzed risk factors, the significant determinants of carotid stiffness were age, blood pressure components (pulse pressure and mean arterial pressure), type 2 diabetes mellitus and heart rate. The relationship between carotid stiffness and pulse pressure was observed only in women and between carotid stiffness and heart rate - only in men. CONCLUSION: There are gender-related differences in the progression of carotid stiffness parameters with age and in the influence of risk factors on carotid stiffness.

The Relationship of Carotid Arterial Stiffness and Left Ventricular Concentric Hypertrophy in Hypertension.

BACKGROUND: Left ventricular hypertrophy (LVH) and geometry patterns vary in different hemodynamic profiles The concentric hypertrophy (CH) pattern has been proved to have the worst prognosis. OBJECTIVES: The aim of the study was to test the hypothesis that carotid artery stiffness, as a marker of vascular damage, is associated with CH, independently of other potential determinants such as demographic factors (age, sex, BMI), clinical parameters (smoking, diabetes, creatinine level) and hemodynamic variables (blood pressure, pulse pressure [PP]). MATERIAL AND METHODS: The study involved 262 subjects (89 men): 202 patients with hypertension (153 untreated, 49 on medication), aged 55.7 ± 10 years, and 60 age-matched normal controls. The subjects were examined by echocardiography and carotid ultrasound with a high-resolution echo-tracking system. Based on the left ventricular mass index (LVMI) and relative wall thickness (RWT), the patients with hypertension were divided into four patterns of LVH and geometry: normal geometry (N, n = 57), concentric remodeling (CR, n = 48), concentric hypertrophy CH (n = 62) and eccentric hypertrophy (EH, n = 35). Intima-media thickness (IMT) and the parameters of arterial stiffness were also assessed using the ß stiffness index (ß), Young elastic modulus (Ep), arterial compliance (AC), one-point pulse wave velocity (PWVß) and the wave reflection augmentation index (AI). RESULTS: Univariate analysis showed that the following variables are significant in determining CH: ß > 8.4, Ep > 136 kPa, PWVß > 7.1 m/s, AI > 21.9%, systolic BP > 151 mm Hg, PP > 54, IMT > 0.56 and the presence of diabetes. However, by multivariate analysis only AI (OR 3.65, p = 0.003), PWVß > 7.1 m/s (OR 2.86, p = 0.014), systolic BP (OR 3.12, p = 0037) and the presence of diabetes (OR 3.75, p = 0.007) were associated independently with the occurrence of CH. CONCLUSIONS: Concentric hypertrophy in hypertension is strongly associated with carotid arterial stiffness and wave reflection parameters, independently of the influence of systolic blood pressure and diabetes.

Predictors of left atrial appendage thrombogenic milieu in patients subjected to transesophageal echocardiography prior to cardioversion of persistent atrial fibrillation.

INTRODUCTION: Evidence of left atrial appendage thrombogenic milieu (LAA TM) on transesophageal echocardiography (TEE) is recognized as a surrogate marker for an increased stroke risk. Although the CHA2DS2-VASc scale is commonly used as a measure of thromboembolic risk in patients with atrial fibrillation (AF), it was shown to have only low-to-moderate ability to predict the presence of LAA TM. The potential role of transthoracic echocardiography (TTE) in the refinement of clinical scales for the detection of LAA TM in patients with AF has been readdressed recently. OBJECTIVES: The aim of the study was to identify the predictors of LAA TM among the components of the CHA2DS2-VASc scale and TTE parameters in patients scheduled for electrical cardioversion due to persistent AF. PATIENTS AND METHODS: We conducted a retrospective analysis of demographic, clinical, laboratory, echocardiographic, and medication data of 202 patients (123 men and 79 women; mean age, 65.6 years) with persistent AF, who underwent TEE before electrical cardioversion. RESULTS: Duration of AF exceeding 1 year (odds ratio [OR] = 13.9; P = 0.02), left atrial diameter exceeding 51 mm (OR = 3.98; P = 0.009), left ventricular end-diastolic dimension (LVEDd) exceeding 52 mm (OR = 2.42; P = 0.01), and radiographic evidence of aortic plaques (OR = 2.97; P = 0.007) were shown to be independent predictors of LAA TM in a multivariate regression analysis. CONCLUSIONS: The CHA2DS2-VASc scale did not predict the presence of LAA TM on TEE in patients scheduled for electrical cardioversion due to persistent AF. Of the CHA2DS2-VASc components, only radiographic evidence of aortic plaques, and of TTE parameters, only left atrial enlargement and LVEDd were independent predictors of LAA TM. A comprehensive clinical and echocardiographic assessment of individual risk is indicated in patients before electrical cardioversion due to persistent AF.

Arterial-atrial coupling in untreated hypertension.

Recently, there has been growing interest in an interplay of vascular mechanics and heart function (arterial-ventricular-atrial coupling). The contribution of arterial stiffness (AS) to left atrial (LA) enlargement is unclear. The aim of this study was to verify whether the association between carotid AS and LA volume in untreated arterial hypertension is independent of such confounders as age, sex, body mass index (BMI), blood pressure, left ventricular hypertrophy (LVH), left ventricular (LV) diastolic and systolic function. The study included 133 patients, among them 107 individuals with hypertension (51 men and 56 women, mean age 56.8 ± 10.3 years) and 26 matched controls. Each patient was subjected to echocardiography, ultrasonographic measurement of mean carotid intima-media thickness (IMT) and echo-tracking assessment of AS and wave reflection. LA volume was calculated by ellipsoid method. The indexed LA volume showed significant linear correlations with age (r = 0.32; p < 0.05), BMI (r = 0.21; p < 0.05), pulse pressure (r = 0.26; p < 0.05), B-type natriuretic peptide (r = 0.64; p < 0.05), LV end-diastolic volume (r = 0.42; p < 0.05), LV mass index (LVMI; r = 0.58; p < 0.05), septum thickness (r = 0.40; p < 0.05), posterior wall thickness (r = 0.34; p < 0.05), early filling wave of mitral inflow (E; r = 0.30; p < 0.05), early diastolic myocardial velocity of mitral annulus (e'; r = - 0.22; p < 0.05), E/e' ratio (r = 0.45; p < 0.05), IMT (r = 0.26; p < 0.05) and augmentation index (AI; r = 0.27; p < 0.05). Progressive multivariate analysis identified LVMI, age, AI and BMI as independent determinants of indexed LA volume in patients with arterial hypertension. The study showed the significant relationship between wave reflection expressed by AI and LA structural remodeling, which supports the hypothesis of arterial-atrial coupling in hypertension.

Relationship between vascular age and classic cardiovascular risk factors and arterial stiffness.

BACKGROUND: We aimed at establishing if the substitution of vascular age (VA) for chronological age (CA) causes a change in the Framingham Risk Score (FRS) categories. Sex differences in predictors of increased VA among cardiovascular (CV) risk factors and arterial stiffness (AS) parameters were identifi ed. METHODS: In 187 asymptomatic subjects with CV risk factors, classifi ed into 3 FRS categories the VA was derived from the nomograms of the carotid intima-media thickness. Two groups: 1 - subjects whose VA has exceeded CA for at least 5 years and 2 - others were established. Carotid AS parameters were obtained from echo-tracking. RESULTS: Substitution of VA for CA changed the FRS category into the higher one in 11.8% of subjects. Diabetes mellitus (DM) was the predictor of increased VA in both sexes, while metabolic syndrome (MS) only in women. The cut-off values of AS parameters that allow for prediction of increased VA were determined from the ROC-curve analysis - in men: b > 7.3, Ep > 103 kPa, AC < 0.61 mm2/kPa after adjustment for DM, BMI > 29.1 kg/m2, WHR > 0.85 and CA > 51 years; in women: b > 9.6, Ep > 126 kPa, AC < 0.75 mm2/kPa, PWV-b > 7.4 m/s after adjustment for DM, BMI > 25.8 kg/m2, WHR > 0.80 and CA > 60 years. CONCLUSIONS: The substitution of VA for CA may increase the FRS category. Sex differences in predictors of increased VA were identifi ed. AS parameters proved to be predictors of increased VA besides the classic risk factors.

The relationship of carotid arterial stiffness to left ventricular diastolic dysfunction in untreated hypertension.

BACKGROUND: Interest in the role of arterial stiffness in the pathomechanism of left ventricular (LV) diastolic dysfunction has grown in recent years. AIM: To examine the relationship between local carotid arterial stiffness parameters assessed by the ultrasonic high-resolution echo-tracking (eT) method and LV diastolic function indices in patients with untreated hypertension (H). METHODS: The study group consisted of 173 subjects, 78 male and 95 female, 113 of them with untreated H, mean age 55.7 ± 10.4 years, and 60 age-matched controls. Using 2D echo, conventional and tissue Doppler echocardiography, LV systolic and diastolic function and left ventricular hypertrophy (LVH) indices were assessed. Hypertensives were divided into two groups: those with diastolic dysfunction (HDD+: with relaxation abnormalities, n = 55 and with pseudonormalisation pattern, n = 12); and those without diastolic dysfunction (HDD-, n = 46). Using carotid arteries ultrasound, intima media thickness (IMT) and eT arterial stiffness parameters were evaluated, as also were ß - beta, Ep - epsilon, AC - arterial compliance, PWVß - one-point pulse wave velocity and AI - augmentation index. RESULTS: Linear regression analysis revealed significant correlations between arterial stiffness indices and diastolic function parameters in the study groups: the ratio of early to late transmitral pulse Doppler velocities - E/A - correlated to Ep,ß, AC and PWVß (r = -0.30, r = -0.25, r = 0.26, r = -0.30, respectively, p < 0.05); early diastolic mitral annular velocity - e' - correlated to Ep, ß and PWVß (r = -0.22, r = -0.26, r = -0.25, respectively, p < 0.05); the ratio of early to late diastolic mitral annular velocities - e'/a' - was correlated with ß and PWVß (r = -0.28, r = -0.28, respectively, p < 0.05). HDD+ did not present echocardiographic LVH. Using ROC curve analysis, we identified optimal cut-off values of different parameters in the determination of diastolic dysfunction occurrence. Univariable analysis revealed the following significant variables in determining LV diastolic dysfunction: ß > 9.2 (OR 2.65, p = 0.026), Ep > 118 kPa (OR 3.53, p = 0.040), PWVß > 6.2 m/s (OR 3.92, p = 0.002), AI > 7.8 (OR 2.62, p = 0.049), age > 54 (OR 4.76, p < 0.001), diabetes presence (OR 2.78, p = 0.013), IMT > 0.51 mm (OR 4.49, p < 0.001), diastolic blood pressure < 70 mm Hg (OR 3.38, p = 0.047), pulse pressure > 64 (OR 2,90, p = 0.031) and ejection fraction < 76 (OR 3.38, p = 0.019). However, at multivariate analysis, only age (OR = 2.43, p = 0.073), IMT (OR = 4.56, p = 0.002) and PWVß (OR = 2.18; p = 0.091) were independently associated with diastolic dysfunction occurrence. CONCLUSIONS: Carotid IMT as a marker of subclinical atherosclerosis and PWVß as an index of carotid arterial stiffness are, besides age, independently associated with LV early diastolic dysfunction occurrence in untreated middle-aged hypertensives.

[First isolation of metallo-beta-lactamase producing Klebsiella pneumoniae strain in Poland]. / Izolacja pierwszego w Polsce szczepu Klebsiella pneumoniae wytwarzajacego metalo-beta-laktamazy.

BACKGROUND: Metallo-beta-lactamases (MBL) are the enzymes that are able to hydrolyse almost the full range of beta-lactame antibiotics--penicillins, cephalosporins and carbapenems. The latter are the drugs of choice for treatment of serious infections caused by Enterobacteriaceae strains, which produce extended-spectrum-beta-lactamases. The presence of MBL-producing strains markedly decreases the therapeutic possibilities in severe, life-threatening infections. CASE REPORT: We present the case of a 61-yr-old man who underwent surgery for acute leg ischemia, and in whom a bifurcation prosthesis was implanted. The postoperative course was complicated with serious nosocomial infection, caused by MBL-positive Klebsiella pneumoniae strains. Despite multi drug treatment and intensive care, the patient died 30 days after surgery due to multi organ failure. All isolates cultured from the patient were resistant to carbapenems with their MICs exceeding 32 microg mL(-1). The presence of MBLs was detected with the double-disk synergy test. The presence of genes encoding MBLs was determined with a commercial kit, hyplex MBL ID (Bag Health Care, USA). The isolate from blood was found to carry the blaVIM-like family gene, located in a conjugative plasmid. CONCLUSION: The MBL-producing isolates were the first K. pneumoniae isolates of the kind identified in Poland. They present a serious danger, limiting the usefulness of carbapenems in ITU patients. We recommend that detection of MBLs in Enterobacteriaceae should be regarded as a standard in Polish hospitals.

Toxin A-producing Clostridium difficile as an aetiological factor of post-traumatic wound infection.

Clostridium difficile is a well-known cause of hospital-acquired infection such as antibiotic associated diarrhoea or pseudomembranous colitis. Extraintestinal infections caused by this pathogen are described rarely. A case of post-traumatic wound infection caused by C. difficile in an immunocompetent, young and otherwise healthy trauma patient is reported. A 31-year-old female, a car accident victim, was admitted to hospital because of polytrauma. After open reduction and internal fixation of a supracondylar femoral fracture by means of the dynamic condylar screw (DCS) system, a purulent fistula occurred. Microbiological examination of the pus revealed C. difficile as the single aetiological factor of this infection. Empirical antibiotic treatment with cefazoline and metronidazole had been administered right after the surgery, but was found to be ineffective. The strain isolated from the patient was sensitive to most antimicrobials except for clindamycin, and amoxicillin/clavulanic acid was chosen for the guided therapy. Such treatment combined with the removal of the DCS system produced a desirable effect.

[Prevalence of Proteus mirabilis strains in clinical specimens and evaluation of their resistance to selected antibiotics]. / Wystepowanie w materialach klinicznych i ocena opornosci na wybrane antybiotyki szczepów Proteus mirabilis.

Proteus mirabilis are opportunistic microorganisms which cause serious hospital infections. The resistance of 1038 strains of P. mirabilis to selected antibiotics (lactams, aminoglycosides, fluoroquinolones, nitrofurantoin, cotrimoxazole, tetracycline) was tested by disk diffusion method. The least of P. mirabilis strains were resistant to imipenem and aztreonam. Most of P. mirabilis strains were isolated from urine, wounds and ulcers from patients of departments of urology, dermatology, general surgery and cardiosurgery. P. mirabilis strains were isolated from 4.3% of all positive samples.