Folia Medica Cracoviensia

Background: Due to current increased life expectancy, the quality of life (QoL) of senior patients is gaining in importance. The aims of this study were: to estimate QoL in a group of patients, aged above 64 years, that is cared for by general practitioners (GPs) in Krakow, Poland, and to find relation-ships between elements of QoL and the results of comprehensive geriatric assessment (CGA) and other important medical and social factors.
Methods: We designed a cross-sectional, questionnaire study among patients who attended GPs’ sur-geries from April 2018 to April 2019. To examine the patients, we used the Euro-Quality of Life Ques-tionnaire (EQ-5D-5L) and eight scales forming CGA: the Activities of Daily Living, the Instrumental Activities of Daily Living, Mini-Mental State Examination, Geriatric Depression Scale, Timed Up and Go Test, Mini Nutritional Assessment, Clinical Frailty Scale and Athens Insomnia Scale.
Results: The lowest QoL was observed in dimensions of pain/discomfort and mobility, where 70% and 52% of patients, respectively, reported problems in these areas. Only 91 (21%) respondents had highest results in all five dimensions of QoL. The average score in the Visual Analogue Scale (VAS) of the EQ-5D- 5L (representing self-rated health on a given day) was 62.36 ± 18.98 points. Statistically significant relationships were observed between QoL and age, physical activity and multimorbidity (in all cases p <0.001). The results of QoL were correlated with every aspect of CGA, while the strongest relationship was noticed between scores in the EQ-5D-5L VAS scale and scales assessing depression and frailty (p <0.001; r = –0.57 both).
Conclusions: Our study showed that in senior patients in Krakow QoL was relatively high. Seniors mostly complained of pain/discomfort and problems with mobility. Moreover, dimensions of QoL were connected with the results of CGA. During visits, GPs should specifically question patients about the above mentioned aspects of QoL.

Carcinoma of unknown primary (CUP) is a heterogeneous group of oncological diseases in which it is impossible to determine the primary tumor. The incidence is 3–5% of oncologic patients, but the survival time varies from 6 weeks to 5 months.
The diagnostics should begin with a clinical evaluation and basic laboratory tests. For CUP placed in head and neck the positron emission tomography — computed tomography is recommended; pancreatic or lung neoplasms are diagnosed with the computed tomography as well. Recently, the magnetic resonance, especially whole-body diffusion-weighted imaging has been introduced to the imaging panel. The lesion obtained during surgically removed metastases or biopsy material should be histopathological and mole-cularly examined to define the type of tumor. The basic immunoexpression panel should include cyto-keratin-5/6, -7 and -20, EMA, synaptophysin, chromogranin, vimentin and GATA3 and molecular ex-pression of ERBB2, PIK3CA, NF1, NF2, BRAF, IDH1, PTEN, FGFR2, EGFR, MET and CDK6. During the accurate diagnostics enable to classify malignancy of undefined primary origin as provisional CUP or finally confirmed CUP in which the primary place of tumor remains undetectable. The detailed diag-nostics should be performed in highly specified centers to establish an accurate diagnosis and to initiate personalized treatment. Majority of patients are diagnosed with adenocarcinoma (70%), undifferentiated carcinoma (20%), squamous cell or transitional cell/uroepithelial carcinoma (5–10%), neuroendocrine tumor (5%) and with minor incidence other histological types, including melanoma.

Introduction: Seasonal variation has been observed for bacterial and viral infections (e.g., COVID-19 [1]), but also for numerous cardiac problems. However, little information is available on the seasonality of infectious endocarditis (IE), a rare disease that is usually linked to a bacterial origin. Data from the Polish population are lacking.
Materials and Methods: Our retrospective study focused on the identification of patients with IE, who were hospitalized at the University Hospital in Krakow between 2005–2022. For this purpose, we searched the medical records system using the ICD-10 code. We decided to divide our patients into four groups (winter, spring, summer, autumn), based on the date of admission to the hospital. Comparison of the distribution of IE incidents by season was performed with the ch2 test.
Results: One hundred and ten patients were included in the study (median age 62.5 years (range 20–94), 72 men (65.45%)). The left native valve IE was diagnosed in 49% of the patients, the prosthetic valve IE in 16%, the right valve IE in 27% and the implantable cardiac electronic devices IE in 12% of the subjects. The outcomes comprised of cardiac surgery (n = 53), embolism (n = 16), death (n = 15) and metastatic infections (n = 5). No differences in the incidence of IE by season were observed.
Conclusions: In the preliminary observation of IE cases of patients admitted to the University Hospital in Krakow, Poland no seasonal pattern of IE was detected. Therefore, IE should be taken into account in the differential diagnosis at any time of the year.

Temporomandibular disorder (TMD) is a disease of multifactorial etiology and a complex of symptoms, related to disorders of the masticatory muscles, temporomandibular joints and the surround-ing orofacial structures. One of the main problems in the course of TMD disorders is the systematic increase in the tension of the masticatory muscles (masseter muscles, temporalis and medial and lateral pterygoid muscles), what is the cause of many damages and the development of pathological conditions in the stomatognathic system.
The article discusses the differences in the structure of the masticatory and skeletal muscles, as well as the different nature and isoforms of myosin, which determines the much faster generation of contraction in the masticatory muscles and consequently easier generation of excessive, harmful tensions in the masti-catory muscles.
The article describes the causes of increased tension in the masticatory muscles and methods of their relaxation used in the basic and supportive treatment of temporomandibular disorders. The use of occlusal splints, physiotherapeutic procedures and TMD treatment with botulinum toxin type A were character-ized. A role of psychological support and the methods used for patients with TMD were emphasized.

Anorexia nervosa (AN) is an eating disorder characterized by distinct etiopathogenetic concepts that are gradually being linked together to unravel the dominant pathophysiological pathways underlying the disease. Excessive food restrictions, often accompanied by over-exercise and undertaken to lose weight, lead to the development of numerous complications. The biological concept of neurohormonal dysfunc-tion in AN seems incomplete without demonstrating or excluding the role of the enteric nervous system (ENS). Using an animal model of activity-based anorexia (ABA), we conducted the preliminary assess-ment of the ENS structure. Here we show, in preparations stained by immunohistochemistry with anti- ChAT, anti-NOS, anti-PGP 9.5, anti-c-fos, and anti-TH antibodies, a lower density of cholinergic and nitrergic nerve fibers as well as reduced neuronal activity in myenteric plexus. Such structural and functional damage to the ENS may be responsible for a number of gastrointestinal symptoms that worsen the course of the disease. In addition, we expanded the study to address the unresolved issue of mechanical and thermal pain sensitivity in AN. The Von Frey and hot plate tests revealed, that in ABA animals, the pain threshold for mechanical stimulus decreases while for thermal increases. In this way, we have sig-nificantly supplemented the background of AN with potentially observable nervous system changes which may influence the evolution of the therapeutic approach in the future.

Aim: Assessment of the effectiveness and efficiency of three mobile (portable) rescue aspirators models in the opinion of state fire service officers. Comparison with the use of the medical simulation element.
Material and Methods: The study was conducted in organizational units of the State Fire Service (24-hour officers). The research consisted in carrying out the task with the use of three models of mobile rescue aspirators (manual, hand-foot, battery). Each participating firefighter had the task of sucking up an equal amount of fluid (100 ml, respectively) with each model of an aspirator. The test fluid was water at room temperature in a homogeneous 1:1 mixture with sugar (increased viscosity and density, simulated real conditions). Immediately after three suction attempts (with measured suction time), each officer completed a questionnaire on the three models used. Descriptive statistics were used to characterize the variables. The following measures were calculated for the variables: mean (M) and standard deviation (SD), minimum, maximum. The following measures were calculated for categorical variables: number (n) and frequency (%).
Results: 184 officers (182 M and 2 F) took part in the study, including commanders 18.43%, rescuers 65.22%, drivers 16.30%. In the study area 1,609 officers serve in the combat division as at the end of 2021. The studied group accounts for 11.43%. Age of respondents M 34.04 SD 8.24 Min 21 Max 52, length of service M 8.48, SD 7.20 Min 1, Max 25. The longest mean time of completing the task was recorded for model 2 (hand-foot) and it was 6.77 sec.
Conclusions: SFS officers highly appreciated the usefulness and effectiveness of the battery-operated automatic aspirator. This assessment may contribute to the widespread introduction of such a model to rescue sets in the SFS. Time of performing the task by mode 1 was significantly longer by elderly people. People with experience with the model 1 during rescue and firefighting operations had a significantly shorter time of performing the task with the use of the model 2. According to the subjective assessment of firefighters, the most effective is model 3, which is confirmed by the suction time obtained at the work station.

The Buschke–Löwenstein tumor is a rare disease associated with human papillomavirus infec-tion. The condition manifests with an ulcerative, exophytic tumor localized in the perineal area. Generally considered as non-cancerous, the growth may develop malignant transformation. Our manuscript high-lights the importance of early diagnosis with histopathological analysis.

Atopic dermatitis (AD) is the most common inflammatory skin disease. However, recent reports concerning the simple clinical aspects of treatment with topical glucocorticosteroids (TCS) and calcineurin inhibitors (TCI) are lacking. The objective of this study is providing an update on these characteristics of AD management. A group of 150 adults suffering from AD treated with TCS during last year was asked to fill an anonymous questionnaire. The course of topical treatment was analyzed in the context of the severity of symptoms and the knowledge of the patients about therapy. During the last year, the majority of patients (66%) were treated with class IV TCS; however, in the last two weeks, class I TCS was used the most frequently (35%). Only 11% were familiar with the concept of intermittent therapy and 4% used the fingertip unit (FTU). In total, 77% of them used TCI. Most of the patients used the same class of TCS permanently. Unfortunately, patients are unaware of simple approaches (like intermittent therapy or FTU) that increase both the effectiveness and safety of the treatment. Practicians should be aware of these problems to identify and eliminate them, primarily through the education of patients.

The epidemic process of COVID-19 in the world developed rapidly. The situation with mor-bidity, despite the establishment of quarantine, the introduction of restrictive anti-epidemic measures, and vaccination, remains difficult. The results of research on the influence of meteorological factors on the dynamics of the incidence of COVID-19, hospitalization, and mortality are ambiguous and contradictory. The purpose of this study is to analyze the indicators of morbidity, hospitalization, and mortality from COVID-19 in Ukraine, and to establish the level of influence of meteorological factors on them. A high variation in morbidity, hospitalization, and mortality rates was observed in Ukraine, in 2020–2021. A total of 3 waves of disease growth were established. The curve of hospitalization indicators of patients with COVID-19 had a correlation dependence on the incidence curve r = 0.766 (р <0.05), the maximum rates of hospitalization and mortality were registered in September–December 2021. A direct strong correlation was established between the frequency of registration of cases of COVID-19 and mortality — r = 0.899 (р <0.05). Most cases of COVID-19 were registered in the cold season, the least in June–August. Inverse correlations of moderate strength were established between the indicators of morbidity, hospitalization, and mortality and air temperature levels (–0.370< r <–0.461). Direct correlations of average strength (0.538< r <0.632) were established with the levels of relative air humidity.

Background: Medical education has changed in response to scientific advances and social needs.
Aim: The aim of the study was to examine curricula of medical schools around the world and to observe the trends that currently dominate in medical education.
Method: We have collected information on the current curricula of various medical schools using their official websites. When necessary, we supplemented the information using published articles describing the curriculum of a given medical school. Results: Our findings reveal that medical schools demonstrate the need for constant reforms and adaptation to changing conditions worldwide. Generally, there is a tendency to integrate basic and clinical fields, to sooner establish bedside teaching, to provide less theoretical and more practical approaches to teaching, to implement more communication skills, and provide students with research training.
Conclusions: Medical education has evolved and will continue to change with time. Medical schools introduce modifications to their curricula and share their experiences.