Liver damage profile in COVID-19 pregnant patients.

INTRODUCTION: SARS-CoV-2 unsparingly impacts all areas of medicine. Pregnant women are particularly affected by the pandemic and COVID-19 related liver damage seems to be another threat to maternal and fetal health. The aim of this study is to define liver damage profile including bile acids serum levels in COVID-19 pregnant patients and to determine predictors of disease aggravation and poor obstetrics outcomes. METHODS: This study has been carried out in the Obstetrics and Gynecology Department, at the National Medical Institute in Warsaw, Poland between 01.02.2021 and 01.11.2022 The study cohort comprises 148 pregnant patients with COVID-19 and 102 pregnant controls who has been tested negative for SARS-CoV-2. RESULTS: COVID-19 pregnant patients presented liver involvement at admission in 41,9%. Hepatotoxic damage accounted for 27 (19.85%), cholestatic type was diagnosed in 11 (8.09%) and mixed type of liver injury was presented in 19 (13.97%) of patients. Higher serum levels of AST, ALT, GGT, total bilirubin and bile acids as well as mixed type of liver injury at admission were correlated with severe form of an illness. AST and ALT above upper reference limit as well as hepatotoxic type of liver damage predisposed pregnant patients with COVID-19 to poor obstetrics outcomes. CONCLUSION: Hepatic damage in pregnant women with COVID-19 is a common, mild, transaminase-dominant, or mixed type of injury, and often correlates with elevated inflammatory markers. SARS-CoV-2 test should be performed as a part of differential diagnosis in elevated liver function tests. Although bile acids serum levels were commonly elevated they seems to be clinically irrelevant in terms of pregnancy outcomes. Video Abstract.

Effects of adding the second drainage cannula in severely hypoxemic patients supported with VV ECMO due to COVID-19-associated ARDS.

BACKGROUND: Extracorporeal membrane oxygenation (ECMO) is a recognized method of support in patients with severe and refractory acute respiratory distress syndrome (ARDS) caused by SARS-CoV-2 infection. While veno-venous (VV) ECMO is the most common type, some patients with severe hypoxemia may require modifications to the ECMO circuit. In this study, we aimed to investigate the effects of adding a second drainage cannula to the circuit in patients with refractory hypoxemia, on their gas exchange, mechanical ventilation, ECMO settings, and clinical outcomes. METHODS: We conducted an observational retrospective study based on a single-center institutional registry including all consecutive cases of COVID-19 patients requiring ECMO admitted to the Centre of Extracorporeal Therapies in Warsaw between March 1, 2020 and March 1, 2022. We selected patients who had an additional drainage cannula inserted. Changes in ECMO and ventilator settings, blood oxygenation, and hemodynamic parameters, as well as clinical outcomes were assessed. RESULTS: Of 138 VV ECMO patients, 12 (9%) patients met the inclusion criteria. Ten patients (83%) were men, and mean age was 42.2 ± 6.8. An addition of drainage cannula resulted in a significant raise in ECMO blood flow (4.77 ± 0.44 to 5.94 ± 0.81 [L/min]; p = 0.001), and the ratio of ECMO blood flow to ECMO pump rotations per minute (RPM), whereas the raise in ECMO RPM alone was not statistically significant (3432 ± 258 to 3673 ± 340 [1/min]; p = 0.064). We observed a significant drop in ventilator FiO2 and a raise in PaO2 to FiO2 ratio, while blood lactates did not change significantly. Nine patients died in hospital, one was referred to lung transplantation center, two were discharged uneventfully. CONCLUSIONS: The use of an additional drainage cannula in severe ARDS associated with COVID-19 allows for an increased ECMO blood flow and improved oxygenation. However, we observed no further improvement in lung-protective ventilation and poor survival.

The persistence of SARS-CoV-2 neutralizing antibodies after COVID-19: A one-year observation. Is a SARS-CoV-2 vaccination booster dose necessary?

Introduction: The aim of this study was to investigate the persistence of SARS-CoV-2 neutralizing antibodies (NAbs) one year after contracting COVID-19. Material and methods: The study included 38 patients - 34 men and 4 women - suffering from COVID-19 between March 15 and May 26, 2020. The median age in the group was 31 years, ranging from 22 to 67 years. The levels of neutralizing antibodies were measured at three time-points - baseline, 6 months, and 12 months. The primary endpoint was a post-infection positive result for NAbs (> 15 AU/ml; Liaison SARS-CoV-2 S1/S2 IgG quantitative test) 12 months after infection. Results: The median level of NAbs after 12 months was 26.5 AU/ml. At the end of observation (12 months), 21 of the 38 patients had a NAb level of >15 AU/ml (positive). The median antibody half-life was 5.8 months. Conclusions: A high percentage of the patients maintained positive levels of antibodies 6 and 12 months after COVID-19 infection. The dynamics of the antibody level decline suggests the need for booster vaccination at least once a year.

Effect of Vitamin D Concentration on Course of COVID-19.

BACKGROUND The course of COVID-19 disease is associated with immune deregulation and excessive release of pro-inflammatory cytokines. Vitamin D has an immunomodulatory effect. We aimed to assess the possible correlation between the incidence and severity of SARS-CoV-2 infection and serum vitamin D concentration. MATERIAL AND METHODS A total of 505 successive patients admitted to a COVID-19-dedicated hospital were included in the retrospective analysis. Serum 25-hydroxyvitamin D (25-OHD) levels and SARS-CoV-2 RT-PCR throat swab test results were determined for each patient. The course of COVID-19 was assessed on the basis of the serum Vitamin Modified Early Warning Score (MEWS), which includes respiratory rate, systolic blood pressure, heart rate, temperature, and state of consciousness), as well as number of days spent in the intensive care unit (ICU) and need for oxygen therapy. RESULTS There was no difference in 25-OHD concentration between COVID-19-confirmed and negative results of the PCR tests. No correlation was found between serum 25-OHD in the COVID(+) group and the need for and time spend in the ICU, as well as the MEWS score. Multivariate analyses showed a positive correlation between need for oxygen therapy and lower 25-OHD concentration, as well as older age (P<0.001) and similar positive correlation between need for ventilation therapy with lower 25-OHD concentration, as well as older age (P=0.005). CONCLUSIONS Our findings do not support a potential link between vitamin D concentrations and the incidence of COVID-19, but low vitamin D serum level in COVID-19 patients might worsen the course of the disease and increase the need for oxygen supplementation or ventilation therapy.

The Thousand Polish Genomes-A Database of Polish Variant Allele Frequencies.

Although Slavic populations account for over 4.5% of world inhabitants, no centralised, open-source reference database of genetic variation of any Slavic population exists to date. Such data are crucial for clinical genetics, biomedical research, as well as archeological and historical studies. The Polish population, which is homogenous and sedentary in its nature but influenced by many migrations of the past, is unique and could serve as a genetic reference for the Slavic nations. In this study, we analysed whole genomes of 1222 Poles to identify and genotype a wide spectrum of genomic variation, such as small and structural variants, runs of homozygosity, mitochondrial haplogroups, and de novo variants. Common variant analyses showed that the Polish cohort is highly homogenous and shares ancestry with other European populations. In rare variant analyses, we identified 32 autosomal-recessive genes with significantly different frequencies of pathogenic alleles in the Polish population as compared to the non-Finish Europeans, including C2, TGM5, NUP93, C19orf12, and PROP1. The allele frequencies for small and structural variants, calculated for 1076 unrelated individuals, are released publicly as The Thousand Polish Genomes database, and will contribute to the worldwide genomic resources available to researchers and clinicians.

Current Applications and Selected Technical Details of Dual-Energy X-Ray Absorptiometry.

The application of dual-energy X-ray absorptiometry (DXA) examinations in the assessment of bone mineral density (BMD) in the lumbar spine, hip, and forearm is the basic diagnostic method for recognition of osteoporosis. The constant development of DXA technique is due to the aging of societies and the increasing importance of osteoporosis as a public health problem. In order to assess the degree of bone demineralization in patients with hyperparathyroidism, forearm DXA examination is recommended. The vertebral fracture assessment (VFA) of the thoracic and lumbar spine, performed by a highly-skilled technician, is an interesting alternative to the X-ray examination. The DXA total body examination can be useful in the evaluation of fat redistribution among patients after bariatric surgery, in patients infected with HIV and receiving antiretroviral therapy, and in patients with metabolic diseases and suspected to have sarcopenia. The assessment of visceral adipose tissue (VAT) and detection of abdominal aortic calcifications may be useful in the prediction of cardiovascular events. The positive effect of anti-resorptive therapy may affect some parameters of DXA hip structure analysis (HSA). Long-term anti-resorptive therapy, especially with the use of bisphosphonates, may result in changes in the DXA image, which may herald atypical femur fractures (AFF). Reduction of the periprosthetic BMD in the DXA measurements can be used to estimate the likelihood of loosening the prosthesis and periprosthetic fractures. The present review aims to present current applications and selected technical details of DXA.

Comparison of the Characteristics of Back Pain in Women with Postmenopausal Osteoporosis with and without Vertebral Compression Fracture: A Retrospective Study at a Single Osteoporosis Center in Poland.

BACKGROUND The incidence of unspecific back pain and osteoporotic vertebral compression fractures increases significantly with age. Considering the difficulties in the diagnosis of spontaneous osteoporotic vertebral fractures, this retrospective study aimed to compare the characteristics of back pain in women with postmenopausal osteoporosis with and without vertebral compression fractures. MATERIAL AND METHODS This study enrolled 334 women with postmenopausal osteoporosis; 150 had vertebral fractures, and 184 had no vertebral fractures. Densitometric vertebral fracture assessment and bone mineral density measurements in the central skeleton were performed for each patient. The participants completed a survey about features of their back pain. RESULTS Patients with vertebral fractures had more severe back pain based on the numeric rating scale: 6.14 vs. 4.33 (P<0.001, odds ratio [OR]=1.43, 95% confidence interval [CI]: 1.29-1.59). Among these individuals, back pain caused reduction in normal activity during the day (P<0.001, OR=4.68, 95% CI: 2.86-7.68), and pain occurred more often (P<0.001, OR=1.77, 95% CI: 1.47-2.13), lasted longer (P<0.001, OR=2.01, 95% CI: 1.65-2.46), predominantly occurred in the lumbar spine (P<0.001, OR=4.70, 95% CI: 1.96-11.29), and intensified during normal everyday activities (P<0.001). Based on these results, a new survey was created. It demonstrated a sensitivity of 70.67% and a specificity of 67.37% in predicting a current compression fracture. CONCLUSIONS Patients with vertebral compression fractures experience higher pain intensity and exhibit specific features of back pain. The new survey can be considered a supportive tool in assessing the possibility of vertebral compression fractures.

Trends in psoriatic arthritis epidemiology in Poland.

Psoriatic arthritis (PsA) is a heterogeneous inflammatory arthritis, usually seronegative and associated with psoriasis (Ps). The prevalence and incidence of psoriatic arthritis show strong ethnic and geographic variations. The aim of the study was to assess the epidemiological trends in psoriatic arthritis in Poland. The National Health Fund (NHF) database for the period 2008-2018 was analyzed. PsA was defined as ICD-10 codes L40.5, M07, M07.0, M07.1, M07.2 and M07.3, while psoriasis as ICD-10 codes L40 and L40.X (L40.0 to L40.9). A steady increase in the number of PsA patients (from 16,790 to 32,644) and in PsA recorded prevalence (from 38.47 per 100,000 in 2008 to 73.11 per 100,000 in 2018) was observed between 2008 and 2018. The PsA/Ps ratio increased to a similar extent (from 8.3 to 17.5%). The percentage of PsA patients receiving rehabilitation services remained constant throughout the observation period (mean: 17.35%; range 16.7-18.9%). The study showed a steady and continuous increase in PsA recorded prevalence. A simultaneous increase in the PsA/Ps ratio suggests that the main reason for the observed trend is greater disease detection .

Absence of SARS-CoV-2 RNA in Peritoneal Fluid During Surgery in Pregnant Women Who Are COVID-19 Positive.

STUDY OBJECTIVE: Coronavirus disease 2019 (COVID-19) infection poses significant risks during surgical interventions. We investigated the intraperitoneal presence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in patients who are COVID-19 positive. DESIGN: A prospective group study. SETTING: Department of Obstetrics and Gynecology designated for patients with COVID-19, Central Clinical Hospital of the Ministry of Interior, Warsaw. PATIENTS: Overall, 65 pregnant women with COVID-19 infection underwent cesarian section. The diagnosis was confirmed either by positive antigen test or by positive reverse transcriptase-polymerase chain reaction assay performed within no more than 13 days before the operation. INTERVENTIONS: On the day of the operation, a nasopharyngeal swab was taken, and peritoneal fluid was collected at the beginning of the operation. Both the nasopharyngeal swab and peritoneal fluid samples were tested for SARS-CoV-2. MEASUREMENTS AND MAIN RESULTS: A total of 65 pregnant women with COVID-19 infection were enrolled in the study. The SARS-CoV-2 ribonucleic acid test by nasopharyngeal swab produced positive results in 34 patients. In this group as well as in 31 nonconfirmed patients, all peritoneal fluid samples tested negative for SARS-CoV-2 ribonucleic acid. CONCLUSION: These results suggest a low risk of COVID-19 transmission from the peritoneal cavity at the time of laparoscopy or laparotomy.

COVID-19 and Extracorporeal Membrane Oxygenation.

INTRODUCTION: Infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has recently and rapidly emerged and developed into a global pandemic. In SARS-CoV-2 patients with refractory respiratory failure, there may be a role for veno-venous extracorporeal membrane oxygenation (V-V ECMO) as a life-saving rescue intervention. METHODS: This review summarizes the evidence gathered until June 12, 2020; electronic databases were screened for pertinent reports on coronavirus and V-V ECMO. Search was conducted by two independent investigators; keywords used were SARS-CoV-2, COVID-19, ECMO, and extracorporeal life support (ECLS). RESULTS: Many patients with COVID-19 experience moderate symptoms and a relatively quick recovery, but others must be admitted into the intensive care unit due to severe respiratory failure and often must be mechanically ventilated. Further deterioration may require institution of extracorporeal oxygenation. Infection mechanisms may trigger "cytokine storm," an inflammatory disorder notable for multi-organ system failure; together with other metabolic and hematological changes, these amplify the changes pertinent to ECMO therapy, often exaggerating blood coagulation disorders. Thirty-two studies were found describing experiences with ECMO in the treatment of COVID-19. Of 4,912 COVID-19 patients, 2,119 (43%) developed ARDS and 2,086 (42%) were transferred to the ICU; 1,015 patients (21%) were treated with ECMO. While in an overall cohort, observed mortality was 640 (13%), the mortality within ECMO subgroups reached up to 34.6% (range 0-100%). CONCLUSION: The efficacy of ECMO treatment for COVID-19 is largely dependent on the expertise of the center in ECLS due to the interplay between the changes in hematological and inflammatory modulators associated with both COVID-19 and ECMO. In order to support gas exchange during early infection with SARS-CoV-2, ECMO has a strong rationale for the treatment of the most critically ill patients. Due to the limited resources during a global pandemic, ECMO should be reserved for only the most severe cases of COVID-19.

Public Health Interventions to Mitigate Early Spread of SARS-CoV-2 in Poland.

This study aimed (1) to present public health interventions to mitigate the early spread of SARS-CoV-2 implemented in Poland between January 9 and March 29, 2020, and (2) to analyze the potential impact of these regulations on the early phase of the COVID-19 outbreak in Poland. All legal regulations published in the Journal of Laws between January 9 and March 29, 2020, were analyzed. Out of 406 legal regulations identified, 56 were related to the COVID-19 outbreak. Moreover, the official announcements published on the governmental websites dedicated to the coronavirus and health issues were analyzed. On March 4, Poland reported the first laboratory-confirmed COVID-19 case. On March 9, Poland introduced border sanitary control. Six days after the first laboratory-confirmed COVID-19 case, all mass events in Poland were banned. All schools and universities were closed 8 days after the first COVID-19 case. All gastronomic facilities and sport and entertainment services were limited starting on March 14. Eleven days after the first COVID-19 case, controls at all Polish borders were introduced, and a ban on entry into Poland by foreigners (with some exemptions) was implemented. Starting on March 15, all citizens returning from abroad had to undergo compulsory 14 days self-quarantine. On March 20, a state of epidemic was announced, which resulted in new social distancing measures starting on March 25. In Poland, compared to other European countries, far-reaching solutions were implemented relatively early to reduce the spread of infection.

Prevalence of axial spondyloarthritis in Poland.

The prevalence of axial spondyloarthritis (axSpA) in the published data varies significantly. Two types of axSpA can be distinguished depending upon the presence of abnormalities consistent with sacroiliitis on plain radiography: ankylosing spondylitis (AS) and nonradiographic axial SpA (nr-axSpA). The aim of this study is to perform a retrospective analysis of axSpA prevalence in Poland in the years 2008-2017. The National Health Fund (NHF) database for the period 2008-2017 was analysed. Data of all patients with the ICD-10 codes M46 (M46.1, M46.8, M46.9) or M45 (further named other inflammatory spondylopathies-OIS and AS, respectively) as the main or co-existing diagnosis were extracted and analysed. The AS prevalence was stable during the period under examination amounting to approximately 0.083%, while the OIS prevalence increased from 0.036 to 0.059%. For both men and women, the AS prevalence increased with age, reaching a maximum around the age of 70; however, in men, a marked increase in prevalence was observed earlier as compared to women (20-24 vs. 40-44 years, respectively). The OIS prevalence also increased with age; however, the maximum was reached earlier as in case of AS. Moreover, a sharp increase in OIS prevalence occurred earlier than in AS (15-19 years) with no difference between sexes. In Poland, approximately 0.1% of the population suffers from AS-the prevalence remained stable over the last decade. The prevalence of OIS increased markedly over the studied period which presumably reflects an increasing prevalence of nr-axSpA as the effect of the introduction of ASAS classification criteria for axSpA.

Analysis of National Health and Insurance Registers for All-Cause Mortality in Patients with Heart Failure with and without Diabetes Mellitus in Poland in 2012.

BACKGROUND This retrospective study aimed to analyze all-cause mortality in patients with heart failure with and without diabetes mellitus in 2012 in Poland using data from the National Health Fund [Narodowy Fundusz Zdrowia] (NFZ), the Central Register of the Insured [Centralna Baza Ubezpieczonych] (CBU), and the Polish Universal Electronic System for Registration of the Population (PESEL). MATERIAL AND METHODS Between 1st January 2012 and 31st December 2012, data were analyzed from the NFZ, CBU, and PESEL to include all patients with a primary diagnosis of heart failure, with and without diabetes mellitus and all-cause mortality data. Structured Query Language (SQL) was used to retrieve and manage data from NFZ, CBU, and PESEL. RESULTS In Poland, 32.58% of 201,586 patients with a primary diagnosis of heart failure who died in 2012 also had a diagnosis of diabetes mellitus. The overall mortality rate in men with heart failure and diabetes was eight times higher than for men with heart failure without diabetes. The overall mortality rate in women with diabetes and heart failure was 5.5 times higher compared with women with heart failure without diabetes. More than 90% of deaths in female patients with heart failure, with or without diabetes, occurred in women >60 years. For male patients with heart failure with or without diabetes, 70% of deaths occurred in men >60 years. CONCLUSIONS These findings support the need for continued prevention programs, early diagnosis, and treatment of diabetes, and highlight the increase in mortality for patients with heart failure and diabetes.

Knowledge and Beliefs of E-Cigarettes Among Physicians in Poland.

BACKGROUND Electronic nicotine delivery systems, including electronic cigarettes (e-cigarettes) are gaining popularity. The objectives of this study were to assess the knowledge and beliefs about e-cigarettes among physicians in Poland. MATERIAL AND METHODS A questionnaire-based survey was conducted among physicians attending mandatory courses delivered at the School of Public Health, Centre of Postgraduate Medical Education (Warsaw, Poland). The questionnaire included 24 questions concerning beliefs and attitudes about e-cigarettes. RESULTS Data were obtained from 412 physicians (64.3% females; aged 31.9±5.7 years) with a response rate of 82.4%. Among participants, 99.8% were aware of e-cigarettes. The main sources of information about e-cigarettes were: news stories (67.2%) or points of sale of e-cigarettes (67.6%). Approximately half of respondents (50.2%) declared moderate knowledge about e-cigarettes, and over three-quarters (78.1%) declared willingness to learn more about e-cigarettes. The majority (96.5%) of participants agreed with the statement that e-cigarette use is harmful to the user's health, and most (80.5%) agreed that exhaled e-cigarette aerosol is harmful to bystanders. The statement that e-cigarettes could be "gateway" to conventional smoking was supported by 87% of participants. Only 11.5% of physicians agreed that e-cigarettes should be recommended as a smoking cessation method. CONCLUSIONS Physicians in Poland perceive e-cigarettes as harmful and addictive. Physicians' knowledge about e-cigarettes is mostly based on non-scientific sources, which points out the urgent need to develop national smoking cessation guidelines regulating the issue of e-cigarettes based on scientific evidence.

Real-World Evidence of Patient Outcome Following Treatment of Advanced Gastrointestinal Stromal Tumor (GIST) with Imatinib, Sunitinib, and Sorafenib in Publicly Funded Health Care in Poland.

BACKGROUND This study aimed to undertake an analysis of ten years of real-world evidence (RWE) on overall survival (OS) following treatment of advanced gastrointestinal stromal tumor (GIST) with imatinib, sunitinib, and sorafenib using data from the Polish National Health Fund. MATERIAL AND METHODS Data from the Polish National Health Fund, the sole Polish public payer, identified 1,641 patients with advanced GIST who were treated with imatinib (n=1047), sunitinib (n=457), and sorafenib (n=137). The differences in overall survival (OS) were analyzed. RESULTS For patients with advanced GIST, the median follow-up time for patients treated with imatinib was 71 months (95% CI, 64.8-79.2), the median OS was 56.9 months (95% CI, 50.4-61.2), with survival at 12 months (89.5%), 24 months (77.9%), 36 months (66.9%), and 60 months (48.4%). The median follow-up time for patients treated with sunitinib was 41.4 months (95% CI, 34.6-49.3), the median OS was 22.8 months (95% CI, 19.2-26.8), with survival at 12 months (68.2%), 24 months (47.1%), and 36 months (31%). The median follow-up time for patients treated with sorafenib was 17.4 months (95% CI, 14.6-22.9), the median OS was 16.9 months (95% CI, 13.7-24.3), with survival at 12 months (61.9%), at 24 months (36.2%), and at 36 months (16.8%). CONCLUSIONS Real-world data collected in a ten-year period confirmed the effectiveness of the use of imatinib, sunitinib, or sorafenib for the treatment of advanced GIST and was comparable with the findings from clinical trials.

Syphilis in Poland is on the rise and underreported.

INTRODUCTION: Despite the availability of diagnostic tests and effective treatment, there has been a problem with vigilance and reporting of that infectious disease in many countries including Poland. AIM: To compare the incidence of syphilis in Poland in years 2010-2016 according to the mandatory epidemiological surveillance system with the data of the National Health Fund (NHF). MATERIAL AND METHODS: Data of the NHF in Poland were collected. The total number of patients with syphilis (all forms) was estimated on the basis of their unique identifying numbers (PESEL). RESULTS: The steady increase in the incidence of syphilis in Poland throughout 2010-2016 was found, apart from the congenital form of the disease, which decreased since 2010. The higher prevalence of syphilis was noted in men. The number of hospitalized patients remained constant. According to the data of the NHF, the number of cases of syphilis in Poland was twofold higher as compared to the statistics of the mandatory epidemiological surveillance system (National Institute of Public Health - National Institute of Hygiene, NIPH-NIH), which was the basis of reports published up to date. CONCLUSIONS: Our work shows that there is a remarkable underreporting of syphilis in the mandatory epidemiological surveillance system in Poland, involving also hospitalized patients. The use of the data of NHF in the surveillance of syphilis in Poland is proposed.

Analysis of the survival of patients receiving systemic treatment for melanoma of the skin: a retrospective population study with patients treated in Poland in 2011-2015.

INTRODUCTION: In Poland, it is uniquely possible to assess real effects of the introduction of new oncological therapies on the overall survival in patients as such therapies are funded by one payer only - the National Health Fund (NHF). Data collected by the NHF make it possible to analyse the survival of all patients who were diagnosed with melanoma. AIM: The paper presents findings of a retrospective analysis of the efficacy of systemic treatment in patients with malignant melanoma of the skin in Poland with regard to the overall survival. MATERIAL AND METHODS: The analysis of the overall survival was performed with the Kaplan-Meier method in the population receiving systemic treatment. Three groups of patients were analysed. Group 1 included all patients who had started systemic treatment between 1 March 2011 and 1 March 2015: 1,258 patients. The median overall survival was 8.4 months. Group 2 included 444 patients who had started systemic treatment between 1 March 2011 and 28 February 2013. The median overall survival was 6.6 months in this group. Group 3 included 814 patients who had started systemic treatment between 1 March 2013 and 1 March 2015 and included 546 patients who were also treated in drug programmes with ipilimumab and vemurafenib (approx. 67%). The median overall survival was 9.4 months. RESULTS: A difference in the overall survival between group 3 and 2 was statistically significant (p < 0.05). CONCLUSIONS: The introduction of vemurafenib and ipilimumab into systemic treatment in Poland using public funds had a significant effect on the prolongation of the overall survival in patients with malignant melanoma of the skin.

The duration of pregnancy in ecologically-challenged area. The effects of environmental pollution with aromatic hydrocarbons on the angiogenesis and elements of the mesenchymal tissue of the human placenta.

INTRODUCTION: The literature presents only few reports regarding the effects of elevated levels of aromatic hydrocarbons (AH) on the functions of the human placenta. The effects of environmental contamination with AH (including phenol and 1-hydroxypyrene) have certain negative effects on parenchymal organs such as human placenta. OBJECTIVE: The paper aimed to assess the effects of elevated levels of AH on the placental angiogenesis and elements of the mesenchymal tissue of the placenta. MATERIAL AND METHODS: Tissue material from 50 afterbirths from Plock constituted a study group, whereas 50 afterbirths from Kutno constituted a control group. Immunohistochemical reactions with the peroxidase method using LSAB kits (DAKO) were performed. The extent and intensity of reactions were analysed. The levels of phenols and 1-hydroxypyrene in the excreted urine of pregnant women (undergoing delivery) were detected using gas chromatography and colorimetry. RESULTS: The levels of phenol and 1-hydroxypyrene in the excreted urine were demonstrated to be statistically significantly higher in patients living in the area of Plock. Statistically significantly higher expression of antibodies indicating placental angiogenesis was observed in the placentas in the Plock group (p < 0.01). Moreover, lower expression of vimentin indicating reactions with proteins in mesenchymal cells was observed in the Kutno group (p < 0.01). CONCLUSIONS: Pregnancy in the environment with elevated levels of aromatic hydrocarbons has detrimental effects on the human placenta. The foetus is protected by activation of adaptation and compensation mechanisms that are manifested as significant angiogenesis and greater development and differentiation of mesenchymal cells compared to the control group.

Proliferation and apoptosis of human placental cells exposed to aromatic hydrocarbons.

OBJECTIVES: The objective of this study is to assess the effect of elevated urinary levels of aromatic hydrocarbons (AH) on the proliferation and apoptosis of human placental trophoblast cells obtained in the course of normal pregnancy in an AH-polluted region. MATERIAL AND METHODS: Tissue material was obtained for study purposes from 50 afterbirths from Plock as the study group and 50 afterbirths from Kutno as the control group. The extent and intensity of reactions were analyzed. The levels of phenol and 1-hydroxypyrene in the excreted urine of pregnant (in labor) patients were determined by gas chromatography and colorimetry. The proliferative activity of trophoblast cells was assessed using MPM-2 antibodies against phosphoprotein synthesized upon mitotic induction and Ki-67 antigen while the intensity of apoptosis in trophoblast cells was assessed using p53 and bcl-2 oncoproteins involved in apoptosis-regulating mechanisms. The immunohistochemical reactions were assessed for their extent and intensity. RESULTS: The levels of phenol and 1-hydroxypyrene excreted in the urine were statistically significantly higher in patients from Plock region. The proliferative activity of trophoblast cells was statistically significantly higher in the study group (p < 0.05). The activity of oncoprotein bcl-2 was significantly higher in the study group while the activity of p53 was sig¬nificantly higher in the control group. Pregnancy in an aromatic hydrocarbon-polluted environment has a significantly negative impact on placental tissue. Ad¬aptation mechanisms are induced as manifested by increased proliferative activity within the trophoblast and extensive inhibition of apoptosis in the study group.

Gestational diabetes mellitus/hyperglycaemia during pregnancy in Poland in the years 2010-2012 based on the data from the National Health Fund.

OBJECTIVES: The incidence of gestational diabetes varies depending on a country and it is extremely difficult to analyse. The aim of the study was to assess the incidence of gestational diabetes in Polish population. MATERIAL AND METHODS: Based on the data from the National Health Fund (NHF) the authors analysed reports regarding deliveries performed and then, determined the rates of gestational diabetes/hyperglycaemia during pregnancy and pregestational diabetes in Poland in the years 2010-2012. RESULTS AND CONCLUSIONS: In Poland, the incidence of gestational diabetes was estimated to be 4.665% in 2010, 6.918% in 2011 and 7.489% in 2012. The incidence of pregestational diabetes was 1.067% in 2010, 1.116% in 2011 and 0.932% in 2012.