Background: Patients with heart failure (HF) are at high risk of unfavorable courses of COVID-19. The aim of this study was to evaluate characteristics and outcomes of COVID-19 patients with HF. Methods: Data of patients hospitalized in a tertiary hospital in Poland between March 2020 and May 2021 with laboratory-confirmed COVID-19 were analyzed. The study population was divided into a HF group (patients with a history of HF) and a non-HF group. Results: Out of 2184 patients (65 ± 13 years old, 50% male), 12% had a history of HF. Patients from the HF group were older, more often males, had more comorbidities, more often dyspnea, pulmonary and peripheral congestion, inflammation, and end-organ damage biomarkers. HF patients had longer and more complicated hospital stay, with more frequent acute HF development as compared with non-HF. They had significantly higher mortality assessed in hospital (35% vs. 12%) at three (53% vs. 22%) and six months (72% vs. 47%). Of 76 (4%) patients who developed acute HF, 71% died during hospitalization, 79% at three, and 87% at six months. Conclusions: The history of HF identifies patients with COVID-19 who are at high risk of in-hospital complications and mortality up to six months of follow-up.

Guidelines for the pharmacotherapy of pain in cancer patients were developed by a group of 21 experts of the Polish Association for the Study of Pain, Polish Society of Palliative Medicine, Polish Society of Oncology, Polish Society of Family Medicine, Polish Society of Anaesthesiology and Intensive Therapy and Association of Polish Surgeons. During a series of meetings, the experts carried out an overview of the available literature on the treatment of pain in cancer patients, paying particular attention to systematic reviews and more recent randomized studies not included in the reviews. The search was performed in the EMBASE, MEDLINE, and Cochrane Central Register of Controlled Trials databases using such keywords as “pain”, “cancer”, “pharmacotherapy”, “analgesics”, and similar. The overviewed articles included studies of pathomechanisms of pain in cancer patients, methods for the assessment of pain in cancer patients, and drugs used in the pharmacotherapy of pain in cancer patients, including non-opioid analgesics (paracetamol, metamizole, non-steroidal anti-inflammatory drugs), opioids (strong and weak), coanalgesics (glucocorticosteroids, α2-adrenergic receptor agonists, NMDA receptor antagonists, antidepressants, anticonvulsants, topical medications) as well as drugs used to reduce the adverse effects of the analgesic treatment and symptoms other than pain in patients subjected to opioid treatment. The principles of opioid rotation and the management of patients with opioidophobia were discussed and recommendations for the management of opioid-induced hyperalgesia were presented. Drugs used in different types of pain experienced by cancer patients, including neuropathic pain, visceral pain, bone pain, and breakthrough pain, were included in the overview. Most common interactions of drugs used in the pharmacotherapy of pain in cancer patients as well as the principles for the management of crisis situations. In the final part of the recommendations, the issues of pain and care in dying patients are discussed. Recommendations are addressed to physicians of different specialties involved in the diagnostics and treatment of cancer in their daily practice. It is the hope of the experts who took part in the development of these recommendations that the recommendations would become helpful in everyday medical practice and thus contribute to the improvement in the quality of care and the efficacy of pain treatment in this group of patients.

A -Study Design, B -Data Collection, C -Statistical analysis, D -Data interpretation, E -Manuscript Preparation, F -Literature Search, G -Funds Collection the recent massive worldwide wannaCry/wannnaDecryptor ransomware attack on medical information systems, beginning 12 May 2017, demonstrated that even a temporary loss of the ability to create, update, or access medical data is detrimental both to patients' medical safety and to medical professionals' ability to work. in Poland, medical documents exist in paper-based and electronic forms; complete migration to computer processing and storage of medical data has already been delayed for ten years. Securing paper-based medical documents is comparably easy; the most common problems are illegibility; loss of the file; and errors in filling out the document, such as failure to fill in the obligatory fields identifying the patient, the medical professional filling in the document, or the date and time of document creation; and faulty, missing, or irrelevant data pertaining to health state, diagnostics, or therapy. in contrast, making electronic medical files secure is no longer a single time-limited, well-defined event, but rather a dynamic, long-lasting process of balancing risks against protective measures in highly unpredictable environment. any electronic medical record can be attacked in many different ways, including using social hacking, penetrating physical barriers, destroying computer hardware, or overcoming software-based security. Preventive measures include continuous education of staff; using it specialists' help at setup and maintenance of computer systems; and repeatedly reassessing the threats that exist and the appropriateness of the measures taken to prevent the risks thus identified. the approaching coming into force of eu Regulation 2016/679 means increased medical data security requirements and elevated legal, formal, and financial risks resulting from infringement. Key words: forensic medicine, medical records, family medicine, data security, electronic medical records, hacker attack.

Efforts to limit severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections among hospital healthcare staff are crucial for controlling the Coronavirus Disease 19 (COVID-19) pandemics. The study aimed to explore the prevalence and clinical presentations of COVID-19 in healthcare workers (HCWs) at the University Clinical Hospital (UCH) in Wroclaw with 1677 beds. The retrospective study was performed in 2020 using a self-derived structured questionnaire in a sample of HCWs who were diagnosed with SARS-CoV-2 infection confirmed using a PCR double gene test and consented to be enrolled into the study. The significance level for all statistical tests was set to 0.05. The study showed that of the 4998 hospital workers, among 356 cases reported as COVID-19 infected, 70 consented to take part in the survey: nurses (48.5%), doctors (17.1%), HCWs with patient contact (10.0%), other HCWs without patient contact (7.1%), and cleaning personnel (5.7%). HCWs reported concurrent diseases such as hypertension (17.1%), bronchial asthma (5.7%), and diabetes (5.7%). Failure to keep 2 m distancing during contact (65.5%) and close contact with the infected person 14 days before the onset of symptoms or collection of biological material (58.6%) were identified as the increased risks of infection. A large part of infections in hospital healthcare staff were symptomatic (42.9%). The first symptoms of COVID-19 were general weakness (42.9%), poor mental condition (41.4%), and muscle pain (32.9%); whereas in the later stages of the illness, general weakness (38.6%), coughing (34.3%), lack of appetite (31.4%), and loss of taste (31.4%) were observed. In about 30% of the infected HCWs, there was no COVID-19 symptoms whatsoever. The vast majority of the patients were treated at home (85.7%). In conclusion, the majority of the SARS-CoV-2 infections in the hospital HCWs were asymptomatic or mildly symptomatic. Therefore, successful limitation of COVID-19 infection spread at hospitals requires a close attention to future cross-infections.

Background. in Poland, the number of parents or caregivers, mainly declaring concern about the occurrence of vaccine injuries, refusing to subject people under the age of 19 to mandatory vaccinations has increased from 3,437 in 2010 to 30,089 in 2017. Material and methods. Legal regulations concerning vaccinations and legal literature in Poland, as well as judicial decisions concerning cases of evasion of mandatory vaccinations were reviewed. Results. the Constitution of the Republic of Poland obliges public authorities to fight epidemic diseases. In judicial decisions, a connection between preventive vaccinations and safety and public health protection is taken for granted-mass vaccinations allow for protection of all people, who would be exposed to infectious diseases without them. Statutory obligation to submit to mandatory vaccinations exists in the law and is directly enforceable; only in the case of refusal, the State Poviat Sanitary Inspectorate (PPIS), as creditor of the obligation, may demand its implementation and indicate an effective enforcement measure; however, it is the voivode who is authorized to conduct enforcement proceedings regarding the non-pecuniary obligation. the imposed fine is a measure leading to fulfilment of the obligation of vaccination, not a penalty for its non-performance. Conclusions. a statutory obligation to submit to protective vaccinations does not constitute a violation of constitutionally guaranteed human freedoms. as a person authorized by a specific law in the form of the Act on Preventing and Combating Infections and Infectious Diseases in Humans, this obligation overcomes the individual's freedom to exercise the right to refuse to undergo health benefits resulting from general regulations, such as the Act on Patients' Rights and Patients' Rights Ombudsman. although the PPIS is the creditor of the statutory obligatory vaccinations, the voivode is the correct enforcement body.

Violent asphyxia can be subdivided into various kinds according to the mechanism, so that the resuscitation techniques are different in each case. The purpose of the present article was to analyze the autopsy reports of the Department of Forensic Medicine of the Medical University in Wroclaw, Poland of 2010, in which the established cause of death was violent asphyxia. We found that among the 890 autopsies performed, there were 164 cases of death due to violent asphyxia caused by drowning, choking on food, gastric fluid, or blood, hanging, manual strangulations, immobilization of the chest (positional asphyxia), environmental asphyxia due to substitution of the oxygen-rich air for some other gas, and others. The most common cause of death in the group was hanging, mostly suicidal hangings of alcohol-intoxicated males. Despite an early medical treatment consisting of removing the noose from the neck and suction the fluids from the mouth and bronchial tree to safe the central nervous system from imminent hypoxia, there were negative outcomes in most cases due to the development of critical brain ischemia, with deaths followed after several days spent in the intensive care units. No connection to gender or age of the deceased was noted. We conclude that violent asphyxia remains to be a quite commonly cause of death in the practice of forensic pathologists - among all the autopsies performed in 2010 every sixth was of an asphyxia victim.

Introduction: The aging of modern societies increases the general healthcare burden due to the growing demand for inpatient services, which lack adequate financing. Material and methods: Data concerning the costs of 312,250 hospitalizations at University Clinical Hospital in Wrocław, Poland in the years 2012-2015 were analyzed according to the age of the patients: below 65 years and 65 years and older, with subgroups (65-74, 75-84 and 85 years and older). Results: The mean length of stay (LOS) differed significantly for patients below 65 years and for patients 65 years old or older (3.5 vs. 4.7 person-days); over the 4 years covered by our data, these increased by 0.4 person-days, mostly among patients 85 years and older (by 0.7 person-days). The mean direct cost of hospitalization differed significantly for patients below 65 years and those 65 years or older (PLN 4,907.12 vs. PLN 6,357.15). The mean cost of laboratory tests and radiologic diagnostics was significantly higher among those in the 65+ group, and the difference had a rising trend. The differences between age groups in cost-related hospitalization characteristics and direct hospitalization costs that have been suggested by the medical literature have also been confirmed in Poland. Conclusions: The mean hospitalization costs of patients aged 65 years and older in Poland are higher than for younger patients due to longer LOS and more complex and expensive treatment, especially laboratory and radiologic diagnostics, which is increasingly common in the oldest age groups. This demands an urgent systemic solution, especially in terms of adjusted financing of elderly patients' hospital treatment.

Background As the number of elderly people is on the rise in societies throughout the world, providing them with optimal care is becoming a major demand, especially in the context of rising interest in institutional care. Quality of life is multidimensional notion and its perception depends highly on pain and mood levels. The aim of this study was to perform a comparative analysis of pain and depression symptoms in elderly people living in nursing homes in France, Germany, and Poland. Methods The research carried out in years 2014–2016 involved female residents of nursing homes in France, Germany, and Poland: 190 women from each country, aged over 65 years and not previously diagnosed with advanced dementia, were included. Collection of medical, demographic, and anthropomorphic data from medical documentation was followed by interviews with each senior and her caregiver. A questionnaire of authors’ own devising was used, along with the Beck Depression Inventory (BDI) and the scale of Behavioral Pain Assessment in the Elderly (DOLOPLUS). The results were subjected to statistical analysis, p < 0.05 was accepted as threshold of statistical significance. Results The main health complaints of nursing homes’ residents were constipation, diarrhea, back pain and dizziness. 44,38% of the residents self-assessed their health status as bad and complained of suffering pain (83,33%) and sleeping problems (72,98%) within the last month. According to BDI the average score was 17.01 points and 44,38% of seniors were free from depression or depressed mood. The average DOLOPLUS result was 8.86 points. Conclusion There are no significant differences, neither in prevalence of pain and symptoms of depression nor in average levels of quality of life, in elderly residents in institutions in the three studied European countries. The decrease in quality of life is mainly due to various complaints and pain and there is a close relationship between health status and quality of life. Further research should be performed in order to study interdependencies between the occurrence of pain and depression, including primary reasons leading to both phenomena. The recognition of factors that induce pain complaints and mood depression in elderly people will contribute to improving their comfort.