Medical sciences

Folia Medica Cracoviensia

Content

Folia Medica Cracoviensia | 2020 | Vol. 60 | No 2 |

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Abstract

Anatomical variations of the inferior vena cava, including the double inferior vena cava or isolated left inferior vena cava, are uncommon and of great clinical importance. Inferior vena cava variations signify predisposition to deep vein thrombosis and may complicate retroperitoneal surgeries including abdominal aortic surgery. Failure to recognize such variations may predispose a patient to life- threatening complications. This prospective anatomical study assessed 129 cadavers for variations of the inferior vena cava. One of the 129 cadavers (0.78%) possessed a double inferior vena cava and none (0%) possessed an isolated left inferior vena cava. The left-sided inferior vena cava was of a larger diameter than that of the right-sided inferior vena cava — opposite of what would be seen in a Type III duplication. Therefore, this observation expands the three-type classification system to include a Type IV duplication.

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Authors and Affiliations

Penprapa S. Klinkhachorn
Brianna K. Ritz
Samuel I. Umstot
Janusz Skrzat
Matthew J. Zdilla
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Abstract

Introduction: Graves’ Disease (GD) is an autoimmune hyperthyroidism occurring mostly in young women. The main pathogenic role of the disease is attributed to TSH receptor antibodies (TRAb), which stimulate the thyroid gland to increase production of the most active thyroid hormone- triiodothyronine (T3). High level of TRAb and a large goiter size are commonly known as poor prognostic factors for the disease and are used to predict relapse.

The aim: The purpose of our study was to check the correlation between fT3:fT4 ratio with TRAb concentration, total volume of thyroid and age of GD onset.

Materials and Methods: 114 patients with onset or relapse of GD were analyzed. Those after thyroidectomy or radioiodine therapy were not taken into analysis. The data was retrospectively retrieved from the hospital’s records consisting of patients’ sex, age, level of TRAb, fT3, fT4 and thyroid volume on ultrasonography. The association between fT3:fT4 and TRAb concentration, thyroid volume and age was evaluated using Pearson correlation coefficient.

Results: The group was predominated by women (19.3% men, 80.7% women). The average age was 47.0. The analysis revealed positive correlation between: 1) fT3:fT4 ratio and total volume of thyroid (correla-tion ratio: 0.37; p <0.05) 2) fT3:fT4 ratio and level of TRAb (correlation ratio: 0.26; p <0.05) 3) negative correlation between fT3:fT4 ratio and patient’s age (correlation ratio: –0.14; p = 0.144.

Conclusions: Positive correlations between fT3:fT4 ratio and TRAb level and total volume of thyroid (poor predictors of GD) may confirm that high level of fT3 can also be a prognostic factor for GD severity.

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Authors and Affiliations

Mari Minasyan
Aleksandra Dulęba
Anna Smalarz
Maria Stręk
Paweł Bryniarski
Elwira Przybylik-Mazurek
Alicja Hubalewska-Dydejczyk
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Abstract

Irritable bowel syndrome (IBS) is a chronic functional gastrointestinal disorder diagnosed on the basis of Rome IV criteria. Stress is an important contributor to the development of IBS symptoms, while personality, perceived self-efficacy, resilience, and coping strategies may be indirectly involved in the modulation of the body’s response to various stressors. The aim of this study was to assess the effect of selected personality traits and stress with IBS symptoms. We enrolled 129 participants (59 men and 70 women) aged from 18 to 61 years. The study group included 94 patients with IBS, while the control group comprised 35 participants without a diagnosed psychoso-matic disorder and chronic comorbidities. Participants were assessed using a self-designed questionnaire as well as the Coping Inventory for Stressful Situations, NEO-Five Factor Inventory, 25-item Resilience Coping Scale (Skala Pomiaru Prężności — SPP-25), and General Self-Efficacy Scale. We observed a significant effect of personality, perceived self-efficacy, resilience, and coping strategies in patients with IBS. Moreover, stress was shown to be associated with disease severity, while the type of a coping strategy was related to the frequency of symptoms. The groups differed in terms of personality traits such as resilience, self-efficacy, extraversion, and neuroticism. Our study confirms the significant effect of personality traits and coping strategies in patients with IBS.

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Authors and Affiliations

Agnieszka Dąbek-Drobny
Tomasz Mach
Małgorzata Zwolińska-Wcisło
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Abstract

Introduction: Dentin hypersensitivity is a painful clinical condition. The frequency of its occurrence varies from 8 to 57%, depending on tested group and different methods of investigations. Recommended desensitizing agents have different mechanism of action and effectiveness. We are still looking for solutions that will improve their effectiveness and simultaneously allow for wider use of e.g. as a base material, counteracting postoperative hypersensitivity, reducing marginal microleakage. The aim of the study was to assess the effect of a selected desensitizing agent occluding dentin tubules with calcium hydroxyapatite on marginal microleakage formation of a class V composite restorations subjected to thermocycles.

Materials and Methods: In study it was used 40 molars and premolars, which were alternately assigned into two groups. In both groups standardized cavities were prepared. In the study group (study group — SG) before application of bonding agent Teethmate Desensitizer (f. Kuraray, Noritake Dental Inc., Okayama, Japan) was used. In the control group (control group — CG) OptiBond All-in-one (f. Kerr, Bioggio, Switzerland) bonding agent was used and cavities were filled using composite material Gradia Direct (f. GC Europe N.V., Leuven, Belgium). After storage in saline, teeth were subjected to 600 thermo-cycles, passive dye penetration test was done, teeth were cut in the area of filling, according to its long axis. Under light microscope magnification value of microleakage was measured and marginal microleakage rate (M) was counted. The results of the tests were statistically analyzed using the package STATISTICA 12.0 (StatSoft, USA).

Results: The average value of M for the SG group was 0.46 (min 0.05, max 0.76, SD 0.226) and for CG was 0.22 (min 0, max 0.74, SD 0.235). The differences between M values were statistically significant (p = 0.0094).

Conclusion: A reduction in the number of retention sites for the bonding system, facilitates the formation of microleakage in the experimental conditions and reduces the degree of adhesion of the composite material to the hard tissues of the tooth.

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Authors and Affiliations

Elżbieta Zarzecka-Francica
Joanna Gołda
Olga Górnicka
Barbara Śliwowska
Przemysław Kustra
Małgorzata Pihut
Joanna Zarzecka
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Abstract

Objectives: Medical students are more susceptible to depression than other students. Moreover, students with the symptoms of depression statistically more often abuse drugs and have suicidal thoughts and anxiety. The level of stress and the factors that lead to in among medical students at Polish universities have not yet been measured. The aim of this study was to translate to Polish and validate the Perceived Medical School Stress Instrument (PMSS-PL) and to measure the resulting version’s psychometric abilities.

Materials and Methods: We validated the Polish translation of PMSS in accordance with the recommendations published by the Translation and Cultural Adaptation group of the Quality of Life Special Interest group of the International Society for Pharmacoeconomics and Outcomes Research. The Perceived Stress Scale (PSS-10) was used as an external test to validate the PMSS-PL questionnaire. A total of 430 undergraduate medical students at the Medical College of Jagiellonian University took part.

Results: The mean PMSS-PL score was 36.43 and it varied from 13 to 65. The mean PSS-10 was 21.35. The internal reliability, as indicated by Cronbach’s alpha, was 0.803, which means there was internal reliability between PSS-10 and PMSS-PL. Moreover, all questions from PMSS-PL had a positive discri-mination power, so each question correlated positively with the other questions in PMSS-PL.

Conclusions: PMSS-PL may be used to psychometrically analyze the stress load on undergraduate medical students at Polish universities. The PMSS-PL may also be used as an external test for validating and calculating the reliability and accuracy of other psychometric instruments.

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Authors and Affiliations

Wojciech Marchewka
Zofia Loster
Jakub Marchewka
Katarzyna Olszewska-Turek
Grzegorz Kopeć
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Abstract

Background: The aim of the study was to determine the predominant learning style and type of intelligence based on the VARK questionnaire and Multiple Intelligences Questionnaire respectively in second year medical students. Determining the relationship between individual preferences of students, based on their learning style and predominant type of intelligence and the perception of the modified Peyton’s four-step approach used to teach cardiac auscultation.

Methods: The opinion of participants 236 of the modified four-step approach was attained through the use of anonymous questionnaires. Using the VARK questionnaire, the participants’ learning style was defined. The predominant type of intelligence was determined by the Multiple Intelligences Question-naire.

Results: The kinesthetic style was the predominant unimodal learning style in second year medical students (in Polish and international students). The most predominant type of intelligence in Polish students was visual-spatial and mathematical and logical, while in international students the predominant types were visual-spatial and mixed type of intelligence. Quantitative analysis indicated that the modified Peyton’s approach is a valuable learning and teaching method for most students, independent of their predominant learning style or intelligence type. The exception was a small group of students with lin-guistic intelligence predominance according to the Multiple Intelligence Questionnaire, for which the Peyton method was more difficult.

Conclusions: This study proves that the modified Peyton’s approach is useful and effective didactic tool and can be successfully applied to most students. This is a new learning strategy for teaching cardiac auscultation in laboratory conditions in classes for a significant majority. Due to the fact that a group of students with a predominance of linguistic intelligence more often perceived the Peyton method to be difficult, it is worth combining traditional methods with new ones in class so that all students, regardless of unimodal learning style or prevailing type of intelligence, are taught satisfactorily.

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Authors and Affiliations

Agnieszka Skrzypek
Ian Perera
Marta Szeliga
Paweł Jagielski
Dorota Dębicka-Dąbrowska
Magdalena Wilczyńska-Golonka
Tomasz Górecki
Grzegorz Cebula
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Abstract

Background: Uterine leiomyoma is the most widespread benign tumor affecting women of childbearing age. There are still gaps in the understanding of its pathogenesis. Telocytes are unique cells found in more than 50 different locations inside the human body. The functional relationship between cells could clarify the pathogenesis of leiomyomata. Examination of membrane receptors on telocytes could explain their role in fibrosis, oxidative stress, and myometrial contractility.

Aim: This research was conducted to assess the density of telocytes in terms of their putative role in leiomyoma formation by focusing on their correlation with the expression of estrogen and progesterone receptors.

Methods: For gross evaluation of uterine tissue samples from leiomyoma, routine histology of adjacent and unaffected myometrium was performed. Immunohistochemical analysis of c-kit, tryptase, CD34, PDGFRα (telocyte-specific), and ER and PRs (estrogen and progesterone receptors) was performed to examine uterine telocytes and the expression of sex steroid receptors.

Results: The decline in telocyte density in leiomyoma foci was correlated with high progesterone expression and low estrogen receptor expression. The unchanged myometrium showed the opposite correlation and balance between both steroid hormone receptors. The difference in sex steroid receptor expression is correlated with the density of uterine telocytes, which emphasizes their conductor function.

Conclusions: A reduction in telocyte density and the changes in examined marker expression demon-strate the involvement of telocytes in local homeostasis. The expression of membrane receptors explicitly indicates their functional potential in the human myometrium, focusing attention on contractility and local homeostasis.

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Authors and Affiliations

Veronika Aleksandrovych
Anna Gil
Anna Wrona
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Abstract

Introduction: Cholecystolithiasis is one of the most frequent disorders of the human digestive system in a present population. It is common to point out that male gender is one of strong risk factors for complications during cholecystectomy, however the debate about that seems to be still open.

Aim of the study: The aim of this study was to compare the values related to the course and treatment effects between gender in patients undergoing cholecystectomy, based on own material.

Materials and Methods: The study encompassed 504 patients who were admitted to General Surgery And Polytraumatic Injury Department of University Hospital in Kraków, Poland between 2013 and 2018, with the initial diagnosis of cholecystolithiasis (scheduled cases) and acute cholecystitis (emer-gency cases). The patients underwent surgical gallbladder removal. In this group there were 326 (64.7%) female and 178 (35.3%) male patients.

Results: Statistically significant differences between both genders were found containing age, type of admission, numeric rating scale of pain during admission, results in American Society of Anesthesiologists physical status classification system, outcomes in Acute Physiology And Chronic Health Evaluation II severity-of-disease classification system, percentage of conversions, mortality, period of time from admis-sion to surgical procedure, mean duration of the procedure, blood tests and histopathological results.

Conclusions: Subgroups of the cases where determining factor is gender are strongly heterogeneous. Although treatment results were different for both subgroups and these differences were partly statistically significant, it cannot be clearly determined on the basis of a study with such selection of patients, that gender is an independent risk factor for surgical gallbladder removal.

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Authors and Affiliations

Czesław Osuch
Mirosław Dolecki
Wojciech Paweł Rogula
Aleksandra Łapiak
Maciej Matyja
Agata Czerwińska
Mateusz Rubinkiewicz
Andrzej Matyja
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Abstract

Objectives: The OSCE (Objective Structured Clinical Examination) is a common method of assessing clinical skills used at many universities. An important and simultaneously difficult aspect of good examination preparation is obtaining a properly trained and well-motivated group of assessors. To effectively recruit and maintain cooperation with assessors, it is worth knowing their opinion. The aim of this study was to investigate the opinions of teacher-examiners about the OSCE and to identify the factors that could shape this opinion and influence on motivation.

Methods: A cross-sectional study was conducted using a questionnaire on teachers who participated as OSCE examiners. This questionnaire consisted of 21 questions about their perceptions. Answers were rated in a five-point Likert-type scale. Chi-square or Fisher’s exact test was used to analyze the data.

Results: A total of 49 (out of 52) teachers participated in this study. Nearly 90% of examiners believed that it is fair, and more than 90% that it is transparent. Despite the fact that 67% of examiners believe that the examination is difficult to organize and 71% believe it is stressful for students; according to 72% of respondents the OSCE has a positive effect on learning. More than 91% of examiners believed that the OSCE is an appropriate test to assess students’ skills. Opinions about the examination were independent of specialty, seniority, gender or having taken the OSCE as students.

Conclusion: Teacher-examiners viewed the OSCE as a fair and transparent examination, adequate for the assessment of skills and, despite it being difficult to organize, worth doing as it is appropriate to assess practical skills and positively influences students’ motivation to learn tested skills.

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Authors and Affiliations

Agata Stalmach-Przygoda
Michał Nowakowski
Anna Kocurek
Ian Perera
Agnieszka Skrzypek
Jadwiga Mirecka
Jolanta Świerszcz
Bogumiła Kowalska
Stanisław Górski
Michał Pers
Grzegorz Cebula
Magdalena Szopa
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Abstract

Introduction: Temporomandibular disorders (TMD) are the second most common cause of chronic pain in the human musculoskeletal system. The triad of symptoms of TMD includes: pain within the temporomandibular joint (TMJ), limitation of its mobility and crepitations. The aim of the study was to present the methods of physiotherapy and to assess its effectiveness in patients with hypomobility of temporomandibular joints.

Material and Methods: 44 patients (40.2 ± 10.6 years) were examined for signs of TMD using the Manual Functional Analysis of masticatory system (MFA) questionnaire due to DC/TMD. In the above group, 20 patients showed hypomobility of TMJs and myofascial pain. They underwent a 3-week phy-siotherapy consisting of manual therapy and exercises. In the study group, linear measurements of TMJs mobility and palpation of selected masticatory muscles were performed. Pain was assessed before and after 3 weeks of therapy according to Numerical Rating Scale (NRS). Statistical processing of the data was done with STATISTICA 13 and was conducted considering significance at a p-value <0.05.

Results: Significant improvement in TMJ’s mobility, which increased on average by 6.6 mm (p = 0.0005) and reducing of pain, a decrease of 3 points on average on the NRS Scale (p = 0.00002) were achieved.

Conclusions: The applied physiotherapy algorithm, including manual therapy and exercises of mas-ticatory muscles, is effective in the case of improvement TMJ’s range of motion and reduction of pain in patients with hypomobility of TMJ’s.

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Authors and Affiliations

Joanna Piech
Małgorzata Pihut
Małgorzata Kulesa-Mrowiecka

Editorial office

KOMITET REDAKCYJNY

Redaktor Naczelny
Dr hab. Krzysztof Gil, prof. UJ

Zastępca Redaktora Naczelnego
Prof. Andrzej Surdacki

Sekretarz Redakcji
Prof. Beata Kuśnierz – Cabala

Członkowie
Prof. Benjamin Chain (London, UK),
Prof. Paul Enck (Tübingen, Germany),
Prof. Tomasz Grodzicki (Kraków, Poland),
Prof. Kalina Kawecka-Jaszcz (Kraków, Poland)
Prof. Maciej Małecki (Kraków, Poland),
Prof. Janusz Marcinkiewicz (Kraków, Poland),
Prof. Franz H. Messerli (New York, USA),
Prof. Jacek Musiał (Kraków, Poland),
Prof. Wiesław Pawlik (Kraków, Poland),
Prof. Jacek J. Pietrzyk (Kraków, Poland)
Prof. Władysław Sułowicz (Kraków, Poland)
Prof. Piotr Thor (Kraków, Poland)
Prof. Jerzy A. Walocha (Kraków, Poland)

Redaktor techniczny
Danuta Ambrożewicz

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