The aim of the study was to identify the characteristics of missions performed by HEMS (Helicopter Emergency Medical Service) crews and the analysis of health problems, which are the most common cause of intervention in rural areas in Poland. The study was conducted using a retrospective analysis based on the medical records of patients provided by the HEMS crew, who were present for the emergencies in rural areas in the period from January 2011 to December 2018. The final analysis included 37,085 cases of intervention by HEMS crews, which accounted for 54.91% of all the missions carried out in the study period. The majority (67.4%) of patients rescued were male, and just under a quarter of those rescued were aged between 50–64 years. Injuries (51.04%) and cardiovascular diseases (36.49%) were the main diagnoses found in the study group. Whereas injuries were significantly higher in the male group and patients below 64 years of age, cardiovascular diseases were higher in women and elderly patients (p < 0.001). Moreover, in the group of women myocardial infarction was significantly more frequent (30.95%) than men, while in the group of men head injuries (27.10%), multiple and multi-organ injuries (25.93%), sudden cardiac arrest (14.52%), stroke (12.19%), and epilepsy (4.95%) was significantly higher. Factors that are associated with the most common health problems of rural patients are: gender and age, as well as the seasons of the year and the values of the Glasgow Coma Scale (GCS), Revised Trauma Score (RTS), and National Advisory Committee for Aeronautics (NACA) used to assess the clinical status of patients.

BACKGROUND:Traumatic brain injury (TBI) is a major cause of mortality and disability in Western countries. The diagnosis of TBI mainly involves computed tomography (CT), and Glasgow Coma Scale assessment. As frequent use of CT is associated with excessive radiation exposure, discovery of a biomarker for TBI could reduce unnecessary head CT scans. Thus, the main aim of this study was to evaluate a TBI assessment kit measuring glial fibrillary acidic protein (GFAP) and ubiquitin carboxyl-terminal hydrolase-L1 (UCH-L1), for its suitability to diagnose mild TBI in emergency departments (EDs). MATERIAL AND METHODS:The records of 123 patients with head injuries admitted to the Clinical Emergency Department of the Regional Specialist Hospital in Olsztyn, Poland between December 2023 and August 2024, were prospectively analyzed. Patients underwent CT, were classified as isolated head injury (IHI, n=61) or injuries beside TBI (non-IHI, n=62), and tested for serum GFAP and UCH-L1 concentrations using immuno-chemical chemiluminescence. RESULTS:No significant differences in GFAP and UCH-L1 concentrations were observed between IHI and Non-IHI patients. While CT showed brain alterations in 7 patients, GFAP and UCH-L1 concentrations were above the threshold in 6 patients with brain injury confirmed by CT. The sensitivity of the TBI test was 83.3%, with specificity 29.1%. The sensitivity of GFAP was 83.3% and that of UCH-L1 was 50.0%, with specificities of 37.9% and 65.0%, respectively. CONCLUSIONS:Based on our study, further investigations are required before GFAP and UCH-L1 blood test samples can be recommended as an adjunct to CT scans as a standard procedure.

Background: Ischemic stroke is one of the leading causes of mortality and disability. The neuroimaging methods are the gold standard for diagnostics. Biomarkers of cerebral ischemia are considered to be potentially helpful in the determination of the etiology and prognosis of patients with ischemic stroke. Aim: This study aimed to investigate the usefulness of serum S100B protein levels as a short- and long-term prognostic factor in patients with ischemic stroke. Study design and methods: The study group comprised 65 patients with ischemic stroke. S100B protein levels were measured by immunoenzymatic assay. Short-term functional outcome was determined by the NIHSS score on day 1 and the difference in the NIHSS scores between day 1 and day 9 (delta NIHSS). Long-term outcome was assessed by the modified Rankin Scale (MRS) at 3 months after the stroke. At the end of the study, patients were divided into groups based on the NIHSS score on day 9 (0–8 “good” and >8 “poor”), the delta NIHSS (“no improvement” ≤0 and >0 “improvement”), and the MRS (“good” 0–2 and >2 “poor”). Differences in S100B levels between groups were analyzed with the ROC curve to establish the optimal cut-off point for S100B. The odds ratio was calculated to determine the strength of association. Correlations between S100B levels at three time points and these variables were evaluated. Results: We revealed a statistically significant correlation between S100B levels at each measurement point (<24 h, 24–48 H, 48–72 h) and the NIHSS score on day 9 (R Spearman 0.534, 0.631, and 0.517, respectively) and the MRS score after 3 months (R Spearman 0.620, 0.657, and 0.617, respectively). No statistically significant correlation was found between S100B levels and the delta NIHSS. Analysis of the ROC curve confirmed a high sensitivity and specificity for S100B. The calculated AUC for the NIHSS on day 9 were 90.2%, 95.0%, and 82.2%, respectively, and for the MRS, 83.5%, 83.4%, and 84.0%, respectively. After determining the S100B cut-off, the odds ratio for beneficial effect (NIHSS ≤ 8 at day 9 or MRS 0–2 after 3 months) was determined for each sampling point. Conclusion: S100B is a useful marker for predicting short- and long-term functional outcomes in patients with ischemic stroke.

Despite the progress in the management of cerebral arterial aneurysms, subarachnoid hemorrhage (SAH) remains the major cause of neurological disability. While SAH-related deaths usually occur as a result of brain impairment due to hemorrhage, permanent neurological deficits are caused by cerebral ischemia due to edema and spasm of cerebral arteries. Additionally, ~20%–30% of patients with SAH develop secondary cardiomyopathy; this phenomenon is known as neurogenic stress cardiomyopathy (NSC), which is associated with increased mortality and poor long-term prognosis. Levosimendan is a new inotropic drug that causes calcium sensitization of troponin C, thus increasing contraction force of myofilaments. The drug also causes opening of ATP-dependent potassium channels in vascular smooth muscles, which results in dilatation of veins and arteries, including cerebral arteries. To date, there have been several reports of levosimendan application in patients with SAH and neurogenic stress cardiomyopathy, and the effect of the drug on vasospasm has been previously advocated. This paper presents a case report of a 57-year-old patient with massive SAH, where levosimendan was used for reducing vasospasm.