Anti-Mullerian hormone levels in girls and adolescents.

Anti-Mullerian hormone (AMH) is a homodimeric glycoprotein which belongs to the TGF-beta superfamily of growth and differentiation factors. There are few studies that present AMH concentrations in premenarcheal and early postmenarcheal girls. The aim of this study is to evaluate AMH levels in girls. A serum AMH increase of 1 pmol/L is related with a higher possibility of menarche occurrence. AMH levels are significantly higher in postmenarcheal girls than in prepubertal girls.

The role of anti-Müllerian Hormone (AMH) in girls and adolescents.

Anti-mullerian hormone (AMH) is produced by the granular cells of primary, preantral and antral follicles. The circulating levels of AMH in adult women reflect the number of remaining primordial follicles. AMH determination plays an increasingly important role in diagnostics in endocrinology and gynecology in adult women. Although the determination of AMH levels is used in pediatric practice, still little is known about its role in various pubertal disorders in girls. This article presents the clinical use of AMH in girls and adolescents.

Mortality Prediction Using SOFA Score in Critically Ill Surgical and Non-Surgical Patients: Which Parameter Is the Most Valuable?

Background and Objectives: assessment systems, such as the Sequential Organ Failure Assessment (SOFA) scale, are routinely used in intensive care units (ICUs) worldwide in order to predict patients' outcome. We aimed to investigate SOFA's usefulness in the prognostication of ICU mortality, including an analysis of the importance of its variables. Materials and Method: this single-centre observational study covered 905 patients that were admitted from 01.01.2015 to 31.12.2017 to a tertiary mixed ICU. The SOFA score was calculated on ICU admission. The worst results recorded within 24 h post admission were included into the calculation. The assessment was performed within subgroups of surgical (SP) and non-surgical patients (NSP). The subjects were followed-up until ICU discharge or death. ICU mortality was considered to be the outcome. Results: ICU mortality reached 35.4% (i.e., 320 deceased out of 905 ICU stays) and it was significantly lower in SP (n = 158, 25.3%) as compared with NSP (n = 162, 57.9%) (p < 0.001). A one-point increase in the SOFA score resulted in 1.35 times higher risk of death in the ICU in the whole studied population. Among the individual variables of SOFA, creatinine concentration was the most powerful in prognostication (OR = 1.92) in univariate analysis, while the Glasgow Coma Scale (GCS) score appeared to be the most important variable in multivariate analysis (OR = 1.8). Mortality prediction using consecutive SOFA variables differed between SP and NSP, as well as between men and women. Conclusions: The overall SOFA score predicts mortality to a similar extent in both surgical and non-surgical subjects. However, there are significant differences in prognostication using its particular components.

The use of levonorgestrel-releasing intrauterine devices in adolescents - own experience.

It is estimated that 19% of adolescents in Poland begin their sexual life when they are 15 years old and more than 50% of people aged 17-19 years have already had their first sexual contact. World Health Organization recommends teenagers to use the method of 'dual protection' (condom and other method of contraception, i.e. intrauterine devices). In this study, we sought to present our own experience in the field of the use of levonorgestrel-releasing intrauterine devices in adolescents and to compare it with the experience of other researchers worldwide. Low- dose levonorgestrel-releasing intrauterine device is safe and effective method of contraception in adolescents. It is also an alternative treatment used in heavy chronic abnormal uterine bleeding. It can be also used as an alternative in women with cyanotic heart disease who have contraindications for standard contraception. Gynecologists and pediatricians should be well informed in the topic of intrauterine device use among adolescents and they should provide them reliable knowledge in this field.

The Pros and Cons of the Prediction Game: The Never-ending Debate of Mortality in the Intensive Care Unit.

BACKGROUND: The Simplified Acute Physiology Score (SAPS) II, Acute Physiology and Chronic Health Evaluation (APACHE) II, and Sequential Organ Failure Assessment (SOFA) scales are scoring systems used in intensive care units (ICUs) worldwide. We aimed to investigate their usefulness in predicting short- and long-term prognosis in the local ICU. METHODS: This single-center observational study covered 905 patients admitted from 1 January 2015 to 31 December 2017 to a tertiary mixed ICU. SAPS II, APACHE II, and SOFA scores were calculated based on the worst values from the first 24 h post-admission. Patients were divided into surgical (SP) and nonsurgical (NSP) subjects. Unadjusted ICU and post-ICU discharge mortality rates were considered the outcomes. RESULTS: Baseline SAPS II, APACHE II, and SOFA scores were 41.1 ± 20.34, 14.07 ± 8.73, and 6.33 ± 4.12 points, respectively. All scores were significantly lower among SP compared to NSP (p < 0.05). ICU mortality reached 35.4% and was significantly lower for SP (25.3%) than NSP (57.9%) (p < 0.001). The areas under the receiver-operating characteristic (ROC) curves were 0.826, 0.836, and 0.788 for SAPS II, APACHE II, and SOFA scales, respectively, for predicting ICU prognosis, and 0.708, 0.709, and 0.661 for SAPS II, APACHE II, and SOFA, respectively, for post-ICU prognosis. CONCLUSIONS: Although APACHE II and SAPS II are good predictors of ICU mortality, they failed to predict survival after discharge. Surgical patients had a better prognosis than medical ICU patients.