Demographic and clinical profile of adolescents suicide attempters admitted to an emergency department during the COVID-19 pandemic - a retrospective cohort study using hospital information system.

Background: The prevalence of suicidal attempts among adolescents during COVID-19 significantly increased compared with pre-pandemic estimates. The aim of the study was to explore the demographic and clinical profile of adolescent suicide attempters admitted to the emergency department during the COVID-19 pandemic. Material and method: The retrospective analysis included, on the basis of electronic medical records in the CliniNet system, sociodemographic and clinical data of patients aged 10-18 years with a diagnosis of suicide attempt. Follow-up period: from March 20, 2020 to May 16, 2023. Results: During the COVID-19 pandemic, there were 425 emergency department visits among adolescents aged 11-17 due to a suicide attempt, with the largest number in the 15-17 (69%) age range. The percentage of emergency department visits was higher among females (80%) and urban residents (75.3%). Self-poisoning was the most common cause of suicide attempts (52.4%), followed by self-harm (41.4%), hanging (3.2%) and jumping from a height (2.1%). The most common toxic substances in self-poisonings were antidepressants and antipsychotics, followed by paracetamol. About 70% of visits were associated with adolescent mental disorders, of which depressive disorder was the most common. One death per 425 visits was recorded (0.2%). Conclusions: Adolescents attempting suicide during COVID-19 were most likely female, aged 15-17, city dwellers, undergoing psychiatric treatment mainly for depressive disorders. The mental health consequences of the pandemic may be more long term, and further monitoring will be needed in the years to come.

Outcomes and Complications after Left Ventricular Assist Device Implantation.

BACKGROUND: Heart transplantation is the treatment of choice for selected patients with end-stage heart failure. Persistent donor organ shortage causes a growing demand for mechanical circulatory support not only as a bridge to transplantation but mainly as a destination therapy (DT). METHODS: The aim of the study was to analyze the indications, comorbidities, and complications during the follow-up of all patients undergoing left ventricular assist device (LVAD) implantation with at least 12 months of follow-up time in one of the most experienced clinics in Poland between 2015 and 2023. RESULTS: There were 125 individuals with LVAD implantation, from which 90 had full 12 months of follow-up (85 males - 94%, 5 females - 6%), with a median age of 58 (50.25-63.75) years. The median body mass index was 27.12 (25.27-29.68). The etiology of heart failure was ischemic (n = 44, 49%), dilated cardiomyopathy (n = 44, 49%), and others. Preoperative echocardiography revealed a mean LV ejection fraction of 13.8% and a median LV dimension of 7.55 (6.92-8.2) cm. In 61 patients (68%), imaging confirmed pulmonary hypertension. Thirty-four patients (38%) had diabetes and 16 (18%) were active smokers. Median follow-up was 30 (17.25-42) months, with the longest period being about 82 months. 40 (44%) patients had kidney failure before LVAD implantation, and in 43 cases (48%), we observed relevant, transient deterioration of kidney function. Almost all patients (n = 82, 91%) suffered from anemia (Hb <13 g/dL in males and <12 g/dL in females) in different periods after LVAD implantation due to perioperative bleeding, gastrointestinal bleeding or unknown causes. The lowest Hb level was observed in the first week after LVAD implantation in 53 cases (58%). Median red cell concentrate transfusion demand before the discharge after surgery was 6 (2-8, 5) units. CONCLUSIONS: Appropriate selection of candidates and timing of LVAD implantation are critical for improved outcomes of DT. Anemia and kidney failure are the most frequent follow-up complications. Improved results and increased applicability and durability of LVADs have established this treatment option as an excellent alternative for patients with end-stage heart failure.

Driveline Infection in Patients With Left Ventricular Assist Devices Implanted as Destination Therapy.

BACKGROUND: Donor organ shortages cause increasing demand for mechanical circulatory support in patients with end-stage heart failure not only as a bridge to heart transplantation but mainly as a destination therapy. Improved results and increased applicability and durability of left ventricular assist devices (LVADs) have established this treatment option as an alternative to heart transplantation in selected patients. One of the most common complications after LVAD implantation is driveline infections (DLIs). METHODS: This study aimed to expand the understanding of DLI epidemiology and potential changes in implantation techniques regarding optimizing DLI prevention and treatment among all patients undergoing LVAD (Medtronic's Heartware HVAD and HeartMate 3 Abbott LVAD system) implantation with at least 12 months of follow-up time between 2015 and 2022. RESULTS: There were 120 individuals with LVAD implantation, of whom 90 had 12 months of follow-up (85 men [94%], 5 women [6%]) with a median age of 58 years (50.25-63.75). The median body mass index was 27.12 kg/m2 (25.27-29.68). Of the 90 patients, 43 had ischemic heart failure (48%), 43 had dilated cardiomyopathy (48%), and the remaining 3 had other etiologies (3%), such as postinflammatory, and the remaining 1 had congenital heart defect (1%). Preoperative echocardiography revealed a mean left ventricle ejection fraction of 13.8% and a median left ventricle dimension of 7.55 cm (6.92-8.2). Imaging confirmed pulmonary hypertension in 61 patients (68%). Thirty-four of the 90 patients had diabetes (38%), and 16 were active smokers (18%). Median follow-up was 30 months (17.25-42), with the longest period being 82 months. More than half of the patients (n = 52; 57%) experienced a DLI. The median time to the first episode of DLI was 13 months (6-25). The most common pathogen revealed in wound swab culture was methicillin-sensitive Staphylococcus aureus (n = 23; 44%), Pseudomonas aeruginosa (n = 9; 17%), Proteus mirabilis (n = 4; 7%), and others. We observed that deeper driveline implantation below the left rectus muscle and just above the posterior rectus sheath resulted in fewer DLIs and longer free-from-DLI follow-up time. There was no statistically significant difference in DLI frequency between patients with or without diabetes mellitus. CONCLUSIONS: Appropriate selection of candidates and timing of LVAD implantation are critical for improved outcomes of destination therapy. DLI is the most common complication after LVAD implantation. Optimal surgical techniques and early implementation of targeted antibiotics are crucial. Significant challenges remain in optimizing DLI prevention and treatment.

Personal Resources and Expectations and Health Behaviors Among Solid Organ Transplant Recipients-A Multicenter Study.

BACKGROUND: The long-term success of organ transplantation (Tx) depends on the transplant recipient's ability to self-manage symptoms, treatment, lifestyle changes, and psychosocial consequences. Health behavior (HB) determinants include personality traits such as optimism, self-efficacy, and health locus of control. PURPOSE: Assessing the relationship between personal resources and expectations and health behaviors of organ transplant recipients. MATERIAL AND METHODS: The study was conducted between 01/04/2018 and 30/10/2019 at 3 transplant centers in Poland. The study group consisted of 243 Tx recipients of kidney, heart, liver, and lung. The Health Behavior Inventory, Multidimensional Health Locus of Control Scale (MHLC), General Self-Efficacy Scale, Dispositional Optimism Scale, and Hospital Anxiety and Depression Scale were used to collect data. FINDINGS: The study group had medium levels of dispositional optimism (mean 15) and high levels of self-efficacy (mean 30.18). The MHLC scale was dominated by a belief in the influence of others and an internal locus of control over one's health. The respondents presented a high level of HB (mean 92.09). A positive relationship was found between personal resources (self-efficacy and optimism), MHLC and HB. The presence of depression and anxiety negatively affected personal resources and internal locus of health control and HB in terms of a positive mental attitude. Type of Tx differentiated internal locus of health control and HB. Predictors of HB were dispositional optimism, self-efficacy, influence of others with health locus of control, symptoms of depression, age and time since transplantation-explaining between 6.1% and 14.5% of health behavior categories. CONCLUSIONS: To improve health practices among organ recipients, strengthening their personal resources is recommended. It is necessary to form an internal locus of control for adherence to positive HB.

Knowledge and Attitudes of Dialysis Patients Toward Kidney Transplantation: Preliminary Report from a Pilot Study Preceding a Cross-Sectional Nationwide Evaluation.

BACKGROUND: The knowledge and attitudes of dialyzed patients toward the best method of renal replacement treatment (ie, kidney transplantation [KTx]) may be the main factor motivating them to apply and be put on the national kidney transplant waiting list, resulting in a better prognosis. OBJECTIVE: Assessment of the knowledge and attitudes of dialyzed patients toward KTx. METHODS: A pilot study is considered an introductory step before the nationwide project, which will cover dialysis centers in Poland from 2023 to 2024. The authorship 4-part questionnaire, including self-assessment knowledge, attitude dimension, pain and mental evaluation section, was made available to 30 patients with hemodialysis aged 30 to 75 years. RESULTS: The median age of the patients was 59 years. The primary cause of end-stage renal disease (ESRD) was glomerulonephritis (33%). Most of the patients stayed on hemodialysis for 2 years or less (57%); 43% of the patients declared insufficient knowledge in the field of KTx, 41% of the patients were not informed at the nephrology clinic that KTx remains one of the methods of renal replacement therapy, and 65% did not receive information about the possibility of preemptive or early transplantation from a relative donor. Only 34% of the patients considered KTx to be a much better treatment option than dialysis, but only 20% of those were on the national waiting list for KTx. CONCLUSIONS: The pilot study showed insufficient knowledge of patients with ESRD regarding kidney transplantation as a method of renal replacement therapy. There is a need to introduce an effective educational program.

Nutritional Risk Assessment and Adverse Events in Patients Undergoing Left Ventricular Assist Device Implantation-A Retrospective Cohort Study Using Hospital Information System.

Clinical or subclinical malnutrition occurs in 30% to 70% of patients with advanced heart failure and increases the risk of postoperative adverse events. The main objective of this study was to assess the nutritional status of patients prior to left ventricular assist device (LVAD) implantation using different methods of malnutrition assessment and to evaluate the relationship between nutritional status and postoperative adverse events. A retrospective cohort study included 120 patients aged 26-74 years referred for LVAD surgery. Preoperative nutritional status (NRS-2002-Nutritional Risk Score 2002, NRI-Nutritional Risk Index, PNI-Prognostic Nutritional Index; TLC-total lymphocyte count) and postoperative adverse events were assessed. Moderate to severe malnutrition was found in 55.8%, 43.3%, 40.0%, and 20% of all patients, respectively, according to the PNI, NRI, TLC, and NRS-2002 scores. Patients with a TLC < 1200 cells/m3 had a higher risk of postoperative acute renal failure [hazard ratio (HR): 2.5; 95% confidence interval (95% CI): 1.01-6.3] and death during the observation period [HR = 2.1; 95% CI: 1.2-3.5]. Moderate to severe malnutrition was also associated with a significantly increased risk of in-hospital death [for the NRI score, HR = 4.9 (95% CI: 1.1-22.0); for the PNI score, HR = 5.0 (95% CI: 1.1-22.3)]. In conclusion, moderate to severe malnutrition prior to LVAD implantation has been identified as a risk factor for postoperative acute renal failure and mortality. Assessment of nutritional risk may improve patient selection and early initiation of nutritional support.

Polish validation of the Transplant Effects Questionnaire.

Introduction: The Transplant Effects Questionnaire (TxEQ) assesses specific recipients' reactions to receiving a transplanted organ, including worry about the transplant, Guilt regarding the donor, disclosure of having undergone transplantation, adherence to medical treatment, and responsibility to the donor, family, or medical staff. Poland has no standardized tool for evaluating the emotional reaction to transplantation. The study aimed to assess the basic psychometric properties, such as the reliability and validity of the Polish translation of TxEQ-PL. Materials and methods: The study involved 84 patients after kidney transplantation. The average age of the subjects was 49.87 years (±15.27). The study used the diagnostic survey method, the Polish versions of the Revised Life Orientation Test (LOTR-R), the Mental Component Summary of the SF-36 (SF-36-MCS), and the Hospital Anxiety and Depression Scale (HADS). The Confirmatory Factor Analysis (CFA) was used to verify the factor structure of TxEQ -P.L. variables. Results: The TxEQ-PL version has satisfactory internal consistency for each subscale (Cronbach's alpha > 0.7). The analysis showed a significant negative relationship between optimism (LOT-R) and the TxEQ-PL subscales: worry about transplant and disclosure of having undergone transplantation and a positive relationship in the subscale of adherence to medical treatment. In addition, a significant negative relationship was found between the subscale: adherence to medical treatment and the severity of depression and intensity of anxiety (HADS); also, a positive relationship with the Mental Component Summary of the SF-36 (SF-36-MCS). The intensity of anxiety and severity of depression were positively related to the TxEQ-PL subscale of disclosure of having undergone transplantation and negatively associated with the Mental Component Summary of the SF-36 (SF-36-MCS). The Confirmatory Factor Analysis confirmed the five-factor structure of the TXEQ-PL questionnaire (RMSEA = 0.083). Not the best fit is indicated by the value of comparative fit indexCFI = 0.813 and SRMR = 0.10. The result of the chi-squared test (220) = 340 was statistically significant; p < 0.001. Conclusion: TxEQ-PL is useful for assessing emotional reactions to organ transplantation. The tool has a factor structure identical to the original English version and comparable psychometric properties.

Health Locus of Control and Health Behaviors in Organ Transplant Recipients: A Multicenter Study.

BACKGROUND: Adherence to health behaviors and to immunosuppressant medications are variables among heart transplant recipients with potential life-threatening outcomes. It is understood that patients with psychosocial barriers are at increased risk of poor outcomes due to various factors. Health locus of control includes any activity that can be done to prevent health problems. Health locus of control is defined as individual beliefs based on past experiences in health issues and having internal and or external control. The literature suggests that patients with a strong internal locus of control have a sense of responsibility for their health behaviors. PURPOSE: To investigate the effect of the health locus of control on the level of self-reported health behaviors among organ transplant recipients. MATERIALS AND METHODS: A cross-sectional design was used for this study. The study group comprises 222 individuals after heart, kidney, lung, and liver transplantation. The following standardized tools were used: The Multidimensional Health Locus of Control, The Health Behavior Inventory, Morisky Medication-Taking Adherence Scale 4-item. Data were analyzed using IBM SPSS. The level of significance for the statistical test was set at 0.05. RESULTS: Powerful Others scored the highest among the 3 Health Locus of Control scales in heart, kidney, and liver recipients. Participants paid little attention to Healthy eating habits; however, the total score of the Health Behavior Inventory was high (91.68-94.40). There was a difference between the kind of transplant and center for 4 aspects of health behavior. Higher scores of The Multidimensional Health Locus of Control were associated with higher scores of Health Behaviors and level of adherence. Greater Powerful Others and Internal Health Locus of control predict higher health behaviors explaining 42 % of the variance. CONCLUSIONS: The intensification of declared health behaviors is high. However, in educating posttransplant patients, attention should be paid to strengthening proper healthy eating habits. Associations between health locus of control dimensions and health behavior have been shown among transplant recipients. The health locus of control significantly predicts the intensity of health behaviors. these findings support the need to consider health control beliefs while designing preventive strategies in this group of patients.

Polish attitudes towards unspecified kidney donation: a cross-sectional study.

BACKGROUND: Chronic kidney disease effects about 4.2 million people in Poland, yet Polish organ donation research is rare. In addition, compared to other countries in the world, Poland has a relatively low living donation rate. Still, little is known about how Poles would react to the possibility of living kidney donation to strangers. A study was conducted to examine public opinion about living kidney donation, as well as their knowledge about it, willingness to donate to a stranger, and support for a possible expansion of existing Polish organ donation legislation to include living donation to strangers. METHODS: A self-report questionnaire, which included a socio-demographic datasheet (9 questions), 16 questions about attitudes towards living donation, and 1 question about knowledge concerning transplantation law was sent to the respondents from December 2020 - February 2021. Logistic regression was used to assess factors affecting the support of the legalization of unspecified kidney donation amongst the participants. RESULTS: More than sixty percent (62.1) of respondents supported legalization of unspecified living kidney donation. Such legalization would be accepted by people who accept a choice of a family member to donate a kidney to a stranger (OR = 3.50; Cl 95%: 1.49 to 4.85), who think bone-marrow transplant is safe (OR = 2.65; Cl 95%: 1.80 to 3.91), recognize the benefit of carrying out tests before donating a kidney (OR = 2.56; Cl 95%: 1.79 to 3.69), would agree to receive a kidney from another person (OR = 2.24; Cl 95%: 2.53 to 3.13), or would agree to donate organs after death (OR = 2.06; Cl 95%: 1.45 to 2.95). However, support for unspecified living kidney donation would not be given by respondents fearing the risk of organ trafficking (OR = 0.54; Cl 95%: 0.38 to 0.79). CONCLUSIONS: In Poland there is strong support for legalization of unspecified living kidney donation. It is vital that future legislation define organ trafficking as a crime with serious punishment so that legal unspecified living kidney donation is not hindered. TRIAL REGISTRATION: The study was registered with ClinicalTrials.gov (ID: NCT04789122 ) on 08/03/2021.

Factors Associated with the Willingness to Become a Living Kidney Donor: A National Cross-Sectional Study.

INTRODUCTION: Living donor kidney transplantation is the preferred method of treating kidney failure. The donor agrees to undergo an elective procedure for the benefit of the recipient. AIM: To assess the attitude toward living kidney donation and to investigate the factors that contribute to kidney donation willingness. METHODS: A cross-sectional study was carried out between December 2020 and February 2021. The study covered a representative group of 953 Poles aged 18-77, living in all Polish voivodships. The relationship between sociodemographic factors, personal values (Personal Values List), the total score of life satisfaction (Satisfaction with Life Scale) and the willingness to donate a kidney to another human was assessed using a logistic regression model. RESULTS: The most frequently chosen personal values were: good health; physical and mental fitness; love and friendship; knowledge and wisdom. The most frequently chosen symbols of happiness were: good health, successful family life, being needed by others. The median satisfaction with life for the entire group was 20 [16; 24]. Voluntary donation of a kidney to another human being i.e., family, friends, strangers were more often declared by women (OR = 1.21; Cl95%: 1.03-1.42), for whom the most important symbol of happiness was a life full of adventures, travels (OR = 1.39; Cl95%: 1.06-1.82) and the most important personal value was goodness and tenderness (OR = 1.21; Cl95%: 1.05-1.40). Total scores of The Satisfaction with Life Scale correlated positively with the willingness to voluntarily donate a kidney (OR = 1.03; Cl95%: 1.003-1.06), while age correlated negatively (OR = 0.99; Cl95%: 0.98-0.99). CONCLUSIONS: Respondents who declare their willingness to be a living kidney donor are mainly female, for which the most important symbol of happiness is a life full of adventures and travel, and the most important values are personal goodness and tenderness. The desire to donate a kidney to another person decreases with age and grows with life satisfaction. TRIAL REGISTRATION: ClinicalTrials.gov (ID: NCT04789122).

Mediating effect of coping strategies on the relation between social support and depressive symptoms among patients after cardiac transplantation. / Mediacyjny wplyw strategii radzenia sobie ze stresem na relacje miedzy wsparciem spolecznym a symptomami depresji u pacjentów po przeszczepieniu serca.

OBJECTIVES: This study aimed to evaluate the role of different types of coping strategies as a mediator in social support and depressive symptoms among patients after cardiac transplantation. METHODS: 123 participants after heart transplantation took part in the study. All the participants completed self-report questionnaires using the following instruments: Beck Depression Inventory Short Form (BDI SF), Berlin Social Support Scales (BSSS) and Coping Orientation to Problems Experienced (the brief COPE). RESULTS: Actually received social support and perceived available social support (both emotional and instrumental) proved to have a significant direct impact on the occurrence of depression. Coping strategies mediated the correlation between the actually received social support, the perceived available emotional social support and depressive symptoms. The individuals with low perceived available support and the actually received social support (both emotional and instrumental), as well as those resorting to the coping strategies of avoidance and denial, proved to be prone to experiencing depressive symptoms. A significant mediating effect on depressive symptoms was identified between active coping, planning, positive reframing, self-blame, and the actually received support. CONCLUSIONS: All social support types were found to be directly correlated with symptoms of depression. Coping strategies proved to mediate the correlation between the perceived social support and depression.

Factors Influencing Decision Making About Living Donation Among Medical Students.

AIM: This study aimed to assess the factors influencing decision making about living donation among medical students. METHOD: Three standardized survey questionnaires (the Altruism Questionnaire A-N, the Individual Questionnaire for studying approaches to transplantology, the Interpersonal Reactivity Index) were used among 316 students of nursing and paramedics. RESULTS: Nearly all the respondents (98%) approve cell transplantation, tissue transplantation, and organ transplantation if obtained from living donors. Of the respondents, 66% would consent to donate bone marrow, and 26% would give their consent only in specific situations. Most respondents reported to be encouraged to donate organs by the ability to help other people (56%), while their refusal would be because of the fear of undergoing medical procedures (13%). Older age and a higher score in the personal distress subscale are correlated with a lack of consent to donate bone marrow for transplantation. In the case of living organ donation, the increase in the scores in the fantasy scale caused a higher chance for consent to living donation, whereas older age was the predictor of lack of consent. Higher scores in the perspective taking subscale were found to be significantly correlated with fear of surgical treatment as the reason for refusing to give one's consent to living donation. The belief that willingness to become a donor shows a person who has a sense of prosocial behavior was influenced by the fantasy and the empathic concern subscales. CONCLUSIONS: The study group approves cell transplantation, tissue transplantation, and organ transplantation from living donors. These attitudes are determined by empathic behavior.

Postoperative Serum Lactate Levels for In-Hospital Mortality Prediction Among Heart Transplant Recipients.

BACKGROUND Hyperlactatemia is a common phenomenon following cardiac surgeries and is associated with prolonged ICU stay and higher morbidity and mortality rates, but such analyses have never focused on patients undergoing heart transplantation (HTX), in whom hyperlactatemia defined with the traditional threshold is observed in nearly every individual. The present study aimed to assess the prognostic value and clinical usefulness of postoperative serum lactate level measurements for in-hospital mortality prediction following HTX. MATERIAL AND METHODS Forty-six consecutive patients who underwent HTX in the Department of Cardiovascular Surgery and Transplantology between 2010 and 2015 were enrolled into a retrospective analysis. Serum lactate level measurements within the first 48 h after HTX were obtained from arterial blood gas analyses, that were routinely conducted every 6 h. Lactate clearance was determined for each patient individually throughout 3 different time frames: the first 24-h (Lac clear 0-24) and second 24-h period (Lac clear 24-48), and the first 48 h after surgery (Lac clear 0-48). RESULTS The ICU admission serum lactate levels differed between the deceased and survivors (7.6 vs. 4.3 mmol/L; p=0.000). Among all tested postoperative lactate level measurements, only the measurement taken upon ICU admission predicted in-hospital mortality (OR 1.94 95% CI [1.09-3.43]; p=0.024). The receiving operating characteristic (ROC) curve for in-hospital mortality was constructed for ICU admission measurement, with the optimal cut-off point estimated at 7.0 mmol/L. CONCLUSIONS Serum lactate level measurement upon ICU admission can be used as a predictive parameter for in-hospital mortality among heart transplant recipients. Values greater than 7.0 mmol/L can predict in-hospital mortality with 90% accuracy.

Level of Life Quality in Heart and Kidney Transplant Recipients: A Multicenter Study.

OBJECTIVE: The main objective of the researchers was to determine the level of life quality among heart and kidney transplant recipients depending on the time and type of the transplant. METHODS: The study was conducted using standardized questionnaires: the 36-Item Short-Form Health Survey, Life Orientation Test-Revised, and Hospital Anxiety and Depression Scale. The study included 146 recipients (109 heart transplant recipients and 37 kidney transplant recipients) from 1 to 26 years after the transplantation surgery (mean 9 years). RESULTS: The mean age of the study group was 52 years. The mean time since organ transplantation was 10 years for heart transplantation and 4.3 years for kidney transplantation. The study group obtained a slightly lower score for quality of life compared to the general population. In the Physical Component Summary (PCS), the study participants obtained the highest mean for the domain bodily pain (47.6), while the lowest score was in the domain role physical (41.82). As for the Mental Component Summary (MCS), the highest mean was obtained for the domain vitality (50.57), whereas the lowest one was for the domain role emotional (43.38). In 33% of the participants, risk of depression was identified. Statistically significant differences were observed depending on the type of the transplanted organ in the PCS for the domains general health, physical functioning, and bodily pain and the MCS for role emotional and social functioning. The statistically significant predictors for the PCS domain were the type of transplanted organ, recipients' age, and occurrence of anxiety. In turn, the predictor for the MCS was the occurrence of depression. CONCLUSIONS: The quality of life (QOL) assessment varies between kidney and heart transplant recipients. The QOL is determined by the recipients' age and the occurrence of anxiety and depression. The obtained QOL assessment results are slightly lower than those in the general population.

The Quality of Life as a Predictor of Social Support for Multiple Sclerosis Patients and Caregivers.

BACKGROUND: Coping with a diagnosis of multiple sclerosis (MS) is challenging. MS is one of the most common causes of nontraumatic disability in young adults, and patients may need assistance with daily life activities. This article explores the relation between quality of life (QOL) and the perceived available social support among patients with MS and their families. METHODS: The study included 120 subjects (60 patient-caregiver dyads). The average age of the patients was 53.95 ± 10.19 years, and for caregivers, it was 50.8 ± 13.3 years. The study used 2 subscales of the Berlin Social Support Scale (perceived availability of social support and need for social support) and the World Health Organization Quality of Life questionnaire for the assessment of QOL. RESULTS: QOL in MS is lower compared with that of their caregivers in all dimensions except the social domain (P < .001, r = 0.54-0.64). A higher need for social support was experienced by caregivers. The need for support in this group is affected by 3 predictors: QOL in the environmental domain and in the physical domain as well as their subjective health. An improvement in QOL in all the domains is related to an increase of perceived available support, in both the group of patients and that of their caregivers (P < .05, ρ = 0.28-0.59). CONCLUSIONS: Perceived available support is of great importance for both patients and their caregivers to enable them to function better in the physical, mental, social, and environmental domains of their QOL, where social relationships play a predictive role.

Postoperative hyperlactatemia and serum lactate level trends among heart transplant recipients.

BACKGROUND: Advanced heart failure (HF), that affects 10% of the HF population, is associated with high mortality rate, meeting 50% at 1-year from diagnosis. For these individuals, heart transplantation (HTX) remains the ultimate and the gold-standard treatment option. Serum lactate level measurements has been proven useful for determining the outcome following other cardiac surgeries and among critically ill patients. Increased serum lactate levels are expected following HTX; however, no detailed analysis has been yet performed in this population. The research aims to estimate the prevalence of hyperlactatemia and describe early postoperative serum lactate level trends among heart transplant recipients. MATERIALS AND METHODS: Forty-six consecutive patients, who underwent HTX between 2010 and 2015, were enrolled into the retrospective analysis. Serum lactate level measurements within first 48 hours post-HTX were obtained every 6 hours from routinely conducted arterial blood gas analyses. The threshold for hyperlactatemia was considered at >1.6 mmol/L, according to upper limit of normal, based on internal laboratory standardization. The highest observed measurement within the observation, regardless of the time point of observation was determined for each patient individually and was appointed as Peak Value. RESULTS: Consecutively measured serum lactate levels differed in time (p = 0.000), with the initial increase and subsequent decrease of the values (4.3 vs. 1.9 mmol/l; p = 0.000). The increase from the baseline level to the Peak Value was statistically significant (4.3 vs. 7.0 mmol/l; p = 0.000). Various serum lactate level trends were identified, with one or more hyperlactatemia episodes. Eventually, 50% of the individuals had normal serum lactate levels at the end of the study, and hyperlactatemia was observed in the other half. CONCLUSIONS: Throughout the observation, all of the patients experienced at least one episode of hyperlactatemia, with the median Peak Value of 7.0 (4.5-8.4) mmol/L. Various serum lactate level trends can be identified in post-HTX patients. Further research is required to determine the clinical usefulness of newly reported serum lactate level trends among heart transplant recipients.