Folia Medica Cracoviensia

Introduction: Proper use of insulin infusion sets (IIS) plays an important role in pump therapy of patients with type 1 diabetes mellitus (T1DM). We assessed the habits associated with the use of IIS in patients with T1DM treated with insulin pump.
Materials and Methods: This study included 79 T1DM patients who were examined for the presence of lipohypertrophy (LH) and retrained for proper IIS use. They completed a standard ques-tionnaire regarding IIS at the time of study entry and at the follow-up.
Results: At baseline, most of the patients declared to have been using a plastic cannula (n = 68; 86.1%), changing the infusion set regularly (n = 65; 82.3%), and placing the infusion sets on the abdomen wall (n = 68; 86.1%). The most common rotation habit was the “curve pattern” on both sides of the umbilicus (n = 16; 20.3%). After a median of 23 weeks (IQR 20–34), 58 patients were available for the follow-up. A rise in the proportion of patients who declared to change IIS regularly (n = 48; 82.8% vs. n = 57; 98.3%, p = 0.016), change IIS every 2 to 3 days (n = 27; 46.6% vs. n = 35; 60.3%, p = 0.043), use “crisscross” rotation (n = 5; 8.8% vs. n = 12; 21.4%, p = 0.027) was observed. There were less patients reporting not having repeatable rotation manner (n = 15; 26.3% vs. n = 2; 5.4%, p = 0.009).
Conclusions: A substantial proportion of T1DM patients on pump therapy declare that they do not follow the recommended principles of IIS use. The intervention consisting of LH assessment and retrain-ing of proper use of IIS might be effective in improving patient compliance.

Oncological surgery is the primary treatment for gynecological malignancies and is inseparably linked with anesthesia. The modern approach to interdisciplinary and multidisciplinary perioperative care in gynecologic oncological patients improves the outcome. This paper presents a review of perioperative management of patients with gynecologic oncology related to enhanced recovery after surgery and cytor-eductive surgery with hyperthermic intraperitoneal chemotherapy. We performed a literature search on MEDLINE, EMBASE, Google Scholar, the Cochrane Central Register of Controlled Trials, and Clinical Trials. The database search focused on selected topics related to perioperative gynecological oncology care. The authors also contributed through individual, independent literature searches.

The monograph analyzes health behaviors and main factors on the basis of which it is possible to transform a lifestyle generally focused on the well-being of an individual and society. According to WHO, health is a state of complete physical, mental and social well-being, and not only the absence of a disease. The definition clearly explains its multidimensional and multithreaded character dependent subjectively on every individual and on social and cultural conditions. Health in its general meaning becomes a sub-jective human feeling. Each individual plays an important role in the process of providing it. Good health condition can be achieved by proper nutrition, regular doctor’s check-up visits and active way of life. Health behaviors are still a key element of the daily activity of everyone. Despite the fact that full knowl-edge of the concept of “healthy lifestyle” prevails, still many people avoid categorical statements. In response to questions about lifestyle, a significant number of respondents often indicate an intention or willingness to change, or to partially comply with the requirements, which results from weakness and lack of determination in action. Knowledge supported by the offer of attractive models that promote the right patterns of behavior can have a positive impact on the global health of the society.

TMD is a disease within the masticatory system that increases its reach among the society every year in the third and fourth decade of life. The etiology of TMD is complex and it is often difficult to establish the cause in a specific case. The aim of the study was to determine the impact of TMD on pathomorphological changes within the temporomandibular joints, evaluated in USG examinations and evaluation the assessment of differences in the number of pathological changes between various forms of TMD.
Material and Methods: The study material included a group of 386 patients, both sexes, aged 20 to 46 years, who came for prosthetic treatment due to symptoms of TMD. Ultrasound examination of the temporomandibular joints supplemented the clinical diagnosis of TMD in all the subjects. Axis I of the DC/TMD were used.
Results: Group I included 116 women and 89 men, group II consisted of 102 women and 79 men. Pathological morphological changes in the temporomandibular joints were found in all the examined patients. The changes in soft tissue structures were significantly increased in group II, but numerous pathomorphological changes were also present in the group of patients with the muscle form of TMD.
Conclusion: The results of the conducted studies with the use of USG temporomandibular joints revealed numerous pathomorphological changes within the temporomandibular joints. This indicates the usefulness of the USG examination in additional diagnostic tests in the group of patients with TMD.

Hutch Diverticulum (HD) is defined as the protrusion of the mucosal and submucosal layer through the muscle bundles of the underlying detrusor muscle. HD is located at the vesicoureteral junction with a backward direction from the homolateral ureteral orifice. As far as its etiology is con-cerned, HD is caused either by a congenital muscle wall defect at the level where the Waldeyer’s fascia occupies the clefts between the vesical part of the homolateral ureter and the detrusor, or is associated with abortive ureteral duplication or defective incorporation of mesonephric duct into the bladder at the site of ureteral hiatus or finally is associated with the development of transient urethral obstruction. HD is usually unilateral and more common in male patients. It may be associated with the Ehlers-Danlos, Williams-Elfin and Menkes syndromes. HD usually occurs in childhood and rarely during adulthood. It is found in 0.2–13% of all children presenting with urinary tract infection. Through this short review article, we attempt to present in detail the most recent bibliographic data concerning this entity, focusing on pathophysiology, diagnostic approach, and treatment strategy.

The COVID-19 pandemic has significantly reduced the number of orthopedic surgeries world-wide. The main reason for this was an introduction of numerous restrictions in the field of mobility, which resulted in reduction of circumstances predisposing to injuries. This had a positive impact on the overall readiness of the health system to fight the pandemic, thanks to saving human and material resources that could be successfully allocated in order to fight a new, previously unknown threat. On the other hand, such aimed administration of the system was not indifferent in terms of care quality directed towards traumatized patients, often requiring immediate measures (risk of infection transmission). This study aims to evaluate in-hospital mortality in patients with COVID-19 operated on proximal femur fractures. An attempt was also made to determine predictors influencing mortality rate among patients operated over the analyzed period.

The current paper is a review of the results attained in the past and current anatomical studies, aimed at understanding the variability and function of the diploic venous system of the human skull. The diploic veins can serve as transit for infections from the scalp to the structures contained within the cranial cavity via the emissary veins, due to their interconnections with the pericranial veins, meningeal veins and dural sinuses. Thereby this clinical aspect has also been discussed.

Background: At the Department of Medical Education, Centre for Innovative Medical Education at Jagiellonian University Medical College, a completely remote OSCE (e-OSCE) was con-ducted for the first time using the Microsoft Teams platform. 255 test takers were tasked with presenting their communication and clinical skills in order to assess clinical reasoning.
Aim: Analysis of the assessment of the OSCE adaptation to the requirements of the COVID-19 pandemic at the Department of Medical Educations in the form of the e-OSCE from the students’ perspective.
Methods: Discussion of the OSCE modification was carried out among 6th-year medical students and graduates undergoing validation of their foreign medical degrees. In order to assess students’ opinions of the e-OSCE, we used questionnaires. The Statistica 12.0 program was used to analyse the results.
Results: According to 91.57% of respondents, the e-OSCE was well-prepared. 60% of students strongly agree and 29.47% rather agree that the order of the stations was appropriate and clear. A majority of respondents rated the e-OSCE as fair. 66.32% of respondents strongly agree and rather agree that the proportions of communication and clinical skills were appropriate. The vast majority of the participants of the exam (81.05%) had enough time for individual stations. A statistically significant (p <0.0001) correla-tion was found between the type of classes and preparation for the e-OSCE. For 61.05% of respondents, the Laboratory Training of Clinical Skills course was the best preparation for students taking the e-OSCE. Taking into account the stressfulness of the OSCE, only 15.96% of students found the online form more stressful than the traditional (in-person) exam.
Conclusions: The e-OSCE in students’ opinions was well-organized. Informing test-takers prior to the e-OSCE about the role of invigilators assessing individual stations should be improved. The e-OSCE has been proven to be suitable for assessing a wide range of material and validating communication and clinical skills in appropriate proportions. The e-OSCE is fair according to examinees’ opinion. The study proves that even in a pandemic, it is possible to prepare an online exam without exposing examiners and examinees to the dangers posed by COVID-19.

Background: The right phrenic nerve is vulnerable to injury (PNI) during cryoballoon ablation (CBA) isolation of the right pulmonary veins. The complication can be transient or persistent. The reported incidence of PNI fluctuates from 4.73% to 24.7% depending on changes over time, CBA generation, and selected protective methods.
Methods: Through September 2019, a database search was performed on MEDLINE, EMBASE, and Cochrane Database. In the selected articles, the references were also extensively searched. The study provides a comprehensive meta-analysis of the overall prevalence of PNI, assesses the transient to persis-tent PNI ratio, the outcome of using compound motor action potentials (CMAP), and estimated average time to nerve recovery.
Results: From 2008 to 2019, 10,341 records from 48 trials were included. Out of 783 PNI retrieved from the studies, 589 (5.7%) and 194 (1.9%) were persistent. CMAP caused a significant reduction in the risk of persistent PNI from 2.3% to 1.1% (p = 0.05; odds ratio [OR] 2.13) in all CBA groups. The mean time to PNI recovery extended beyond the hospital discharge was significantly shorter in CMAP group at three months on average versus non CMAP at six months (p = 0.012). CMAP (in contrast to non-CMAP procedures) detects PNI earlier from 4 to 16 sec (p <0.05; I2 = 74.53%) and 3 to 9º (p <0.05; I2 = 97.24%) earlier.
Conclusions: Right PNI extending beyond hospitalization is a relatively rare complication. CMAP use causes a significant decrease in the risk of prolonged injury and shortens the time to recovery.

Up to 2% of pregnancies may be extrauterine. Despite reproductive problems, they might increase the risk of serious complications. We present a case report of a 31-year-old woman with two extrauterine pregnancies — tubal and ovarian, which occurred at the same side with little time difference. In addition, we aimed to examine possible reasons underlying this rare pathology. Thus, surgically removed tissue specimens were morphologically assessed and further compared with specimens from healthy control patients. Telocytes were analysed in detail due to their pivotal role in the female repro-ductive system. Our study had observational character and obvious limitations typical for a clinical case. Yet, such a clinical case of two ectopic pregnancies has not been previously reported in the literature.

Introduction: Osteoporosis affects over 200 million people worldwide causing nearly 9 mil-lion fractures annually, with more than half in America and Europe.
Objectives: This meta-analysis was conducted to investigate whether low milk intake is associated with an increased risk of fractures by summarizing all the available evidence.
Methods: Relevant studies were identified by searching the PubMed and EMBASE databases up to June 2020. The pooled relative risks with 95% confidence intervals were calculated.
Results: In a meta-regression analysis of 20 included studies (11 cohort and 9 case-control studies), a higher milk intake was not associated with a reduction in the total fracture risk in both sexes (OR 0.95, 95% CI: 0.84– 1.08), either in cohort (OR 0.91; 95% CI: 0.79–1.05) or case-control studies (OR 1.09; 95% CI: 0.82–1.44), as well as separately in men (OR 0.87; 95% CI: 0.71–1.07) and women (OR 0.95; 95% CI: 0.80–1.13).
Conclusion: Higher milk consumption is not associated with fracture risk reduction and should not be recommended for fracture prevention.