Depressive and anxiety symptom trajectories in Polish adolescents during the COVID-19 pandemic and the outbreak of war in Ukraine: uncovering the role of family relations.

INTRODUCTION: The aim of the study was to investigate longitudinal trajectories of change in anxiety and depression symptoms in Polish adolescents during the second year of the COVID-19 pandemic and after the outbreak of the war in Ukraine. Additionally, we aimed to identify risk/protective factors and outcomes associated with these trajectories. METHOD: We collected data in three waves between November 2021 and May 2022. Adolescents (N = 281 in the first wave) completed the Patient Health Questionnaire-9, the Generalized Anxiety Disorder-7, the Filial Responsibility Scale for Youth, and questions related to the COVID-19 pandemic and war in Ukraine. RESULTS: We identified three trajectories of depressive symptoms: resilient with low, stable symptoms (71% of participants), chronically elevated symptoms (11%), and acute symptoms followed by recovery (18%). We distinguished two trajectories of anxiety symptoms: resilient (75%) and chronic (25%). Non-resilient trajectories were predicted by higher levels of familial unfairness (perceived lack of equality and reciprocity in the family), relationship difficulties at school and at home, older age, and poor socioeconomic status. Chronic depressive and anxiety symptoms were associated with higher war-related concerns. DISCUSSION: These findings can inform preventive and therapeutic interventions for at-risk adolescents to reduce negative long-term outcomes of social crises.

Collective action mitigates the negative effects of COVID-19 threat and anti-abortion restrictions on mental health.

BACKGROUND: The COVID-19 pandemic changed our lives in many different domains, forcing people to adapt to countrywide lockdowns, school shutdowns, and business closures. The burden of the COVID-19 pandemic resulted also in deterioration of mental health. At the same time, political conflicts and social inequalities was reinforced and many people engaged in demonstrations to fight for their rights. This study examines whether collective acting for an important cause during the pandemic might mitigate the impact of both political tension related to anti-abortion restrictions and COVID-19 threats on mental health. METHODS: We conducted a two-wave study with a representative sample of the Polish population, investigating the effect of participating in Polish pro-choice demonstrations on depressive and anxiety symptoms. RESULTS: Participating in protests attenuated the negative effects of COVID-19 threat and anti-abortion restrictions on mental health. Moreover, we found that the feeling of solidarity with other demonstrators and sense of agency derived from such demonstrations led to lower levels of depressive and anxiety symptoms. CONCLUSION: The results of the study indicate that participating in meaningful and value-oriented collective action may serve as a buffer against the detrimental effects of social and health threats.

Predictors of pretraumatic stress during the COVID-19 pandemic in Poland.

BACKGROUND: Pretraumatic stress has the same symptoms as post-traumatic stress but instead pertains to anticipated threats. There is evidence that pretraumatic stress occurs among soldiers and pregnant people. OBJECTIVE: We analyzed correlates of pretraumatic stress concerning the threat of COVID-19 infection. METHOD: Our pilot study was cross-sectional (N = 74); our main study was longitudinal and consisted of three waves (N = 1067, N = 894, and N = 752 for Waves 1, 2, and 3, respectively). Our pilot study used correlation and multiple linear regression. Our main study used quadratic regression and a random intercept cross-lagged panel model. RESULTS: The pilot study found that pretraumatic stress was positively correlated with agreeableness (r = .24, p < .01) and negatively correlated with emotional stability (r = -.30, p < .01) and intellect/imagination (r = -.37, p < .01). The main study demonstrated that pretraumatic stress was positively correlated with other measures of mental health problems during the COVID-19 pandemic and with perceived positive aspects of the pandemic (r = .11, p < .01). There is evidence of a U-shaped relationship between pretraumatic stress and perceived positive aspects of the pandemic. A random intercept cross-lagged panel model analysis demonstrated that pretraumatic stress in Wave 2 was negatively predicted by levels of prosocial behavior in Wave 1 (B = -1.130, p < .01). CONCLUSION: Mental health professionals should take into account pretraumatic stress, not only as a possible consequence of the COVID-19 pandemic outbreak but more generally as a risk in situations that are new, difficult, and challenging for people.

Barriers and facilitators of willingness to vaccinate against COVID-19: Role of prosociality, authoritarianism and conspiracy mentality. A four-wave longitudinal study.

AIM: We investigated longitudinal relations between individual willingness to undergo vaccination against COVID-19 and three social factors: conspiracy mentality, prosociality, and authoritarianism. METHOD: This longitudinal study comprised four measurement points. The first wave sample included 1130 responses and was representative of the Polish population in terms of gender, age, and place of residence. Analyses were performed using random intercept cross-lagged panel models. RESULTS: We observed bidirectional positive cross-lagged relationships between prosociality and willingness to undergo vaccination in the first three waves of measurement. Authoritarianism and conspiracy mentality translated into a lower willingness to vaccinate between the third and fourth points of measurement when the vaccination became a near-term possibility. CONCLUSIONS: Eliciting prosocial motivation to vaccinate can be paramount in overcoming vaccine hesitancy. Because conspiracy thinking may be a crucial barrier to willingness to be vaccinated, it is critical to focus on planning interventions and campaigns undermining conspiracy theories about COVID-19.

Dynamic relationships between different types of conspiracy theories about COVID-19 and protective behaviour: A four-wave panel study in Poland.

RATIONALE: Conspiracy theories about COVID-19 pose a serious threat to public health by providing false information and undermining official health recommendations. However, existing studies rarely employed longitudinal designs, precluding the determination of the directionality between endorsement of conspiracy theories and its societal consequences. Also, relatively little research examined whether the association between protective health behaviour and the endorsement of conspiracy theories is affected by the content of a given theory. METHODS: A four-wave longitudinal panel survey on the association between belief in a wide range of conspiracy theories about COVID-19 and protective behaviour was carried out on a representative sample of Polish citizens (T1 = 1130, T2 = 971, T3 = 818, T4 = 688). Analyses were performed using Random Intercept Cross-Lagged Panel Models. RESULTS: The results showed a reciprocal, bidirectional association between conspiracy mentality and protective behaviour. The same effect was also observed between protective behaviour and threat of authoritarianism. We did not find evidence that specific COVID-19 related conspiracy theories directly (and differently) predict within-person changes in protective behaviour over time. CONCLUSIONS: Our results showed that the association between various conspiracy-related variables and anti-pandemic COVID-19 variables differs at within- and between-person levels. Changes in the adherence to pro-health measures were negatively predicted by conspiracy mentality and a feeling of threat that the solutions introduced by the government may limit civil rights. Specific conspiracy beliefs were significantly related to protective behaviour only at the between-person level.

Generalized anxiety and depressive symptoms in various age groups during the COVID-19 lockdown in Poland. Specific predictors and differences in symptoms severity.

BACKGROUND: Previous studies carried out in different countries have indicated that young adults experienced higher levels of emotional distress, in the form of depressive and anxiety symptoms, than older age groups during the COVID-19 pandemic. However, little is known about which pandemic-related difficulties and factors may contribute to these forms of emotional distress in various age groups. PURPOSE: The aim of the current study was to investigate: (i) differences in levels of depressive and generalized anxiety symptoms in four age groups in the Polish population during the COVID-19 lockdown; (ii) differences in perceived difficulties related to the pandemic in these groups; and (iii) which factors and difficulties related to the pandemic are the best predictors of generalized anxiety and depressive symptoms in various age groups during the COVID-19 lockdown. METHOD: A total of 1115 participants (aged 18-85) took part in the study. The sample was representative of the Polish population in terms of sex, age, and place of residence. Participants completed the following online: the Patient Health Questionnaire-9, the Generalized Anxiety Disorder-7, a Scale of Perceived Health and Life Risk of COVID-19, a Social Support Scale, and a Scale of Pandemic-Related Difficulties. RESULTS: Younger age groups (18-29 and 30-44) experienced higher levels of depressive and generalized anxiety symptoms than older adults (45-59 and 60-85 years). Household relationship difficulties were among the most significant predictors of depressive and generalized anxiety symptoms in all age groups. Fear and uncertainty related to the spread of the virus was one of the most important predictors of emotional distress in all the groups apart from the adults between 18 and 29 years, whereas difficulties related to external restrictions were one of the most significant predictors of depressive and anxiety symptoms exclusively in the youngest group. CONCLUSIONS: The youngest adults and those experiencing difficulties in relationships among household members are the most vulnerable to depressive and generalized anxiety symptoms during the COVID-19 lockdown. It is important to plan preventive and therapeutic interventions to support these at-risk individuals in dealing with the various challenges related to the COVID-19 pandemic.

Prosociality and endorsement of liberty: Communal and individual predictors of attitudes towards surveillance technologies.

BACKGROUND: During the coronavirus disease 2019 (COVID-19) pandemic, digital tracking technologies were recognised as one of the key tools in preventing the spread of the virus and maintaining health security. However, they also raised numerous controversies because of their potential to endanger civil rights and privacy. Most studies on the acceptance of anti-COVID-19 tracking technologies did not include important social factors and did not examine the directionality between variables. We aimed to fill this gap in the present study. METHODS: We conducted a four-wave, representative longitudinal panel survey among Polish citizens on the relationship between acceptance of anti-COVID-19 tracking technologies and prosociality, national identification, and endorsement of individual liberty. Analyses were performed using random-intercept cross-lagged panel models. RESULTS: We observed bidirectional cross-lagged relationships between prosociality and acceptance of anti-COVID 19 tracking technologies, with a stronger path from prosociality to acceptance than the other way around. Endorsement of individual liberty predicted negative attitudes towards technologies and this relation was strengthened by perceived threat of future technological surveillance. We did not find a significant relationship between acceptance of technologies and national identification at the within-subject level. CONCLUSIONS: This is the first study to analyse dynamic within-person relationships between communal and individual aspects and acceptance of anti-COVID-19 surveillance technologies. We conclude that prosocial attitude may lead to social acceptance of technology that, while helpful to fight with a pandemic, might also infringe on personal rights.

Content matters. Different predictors and social consequences of general and government-related conspiracy theories on COVID-19.

In times of crisis, people are more prone to endorse conspiracy theories. Conspiracy thinking provides answers about the causes of an event, but it can also have harmful social consequences. Our research tested both the predictor and the consequences of two types of conspiracy beliefs related to the Covid-19 pandemic: (1) general conspiracy beliefs and (2) government-related conspiracy theories. In two studies in Poland (Ntotal = 2726), we found that a perceived lack of individual control predicted both types of conspiracy theories, while a sense of collective control was positively related to general conspiracy beliefs but negatively associated with government-related conspiracy theories. Moreover, general conspiracy theories were related to the acceptance of xenophobic policies and to a less favourable attitude towards outgroups whereas government-related conspiracy theories were not. Additionally, people who believed in conspiratorial governments less frequently indicated that they used prevention methods, such as social distancing and handwashing. Our research demonstrates the importance of considering the content of various conspiracy theories when studying their social effects and potential causes. Knowing which attitudes may be associated with the endorsement of specific conspiracy theories can contribute to counteracting their negative consequences during crises.

The acceptance of Covid-19 tracking technologies: The role of perceived threat, lack of control, and ideological beliefs.

New technological solutions play an important role in preventing the spread of Covid-19. Many countries have implemented tracking applications or other surveillance systems, which may raise concerns about privacy and civil rights violations but may be also perceived by citizens as a way to reduce threat and uncertainty. Our research examined whether feelings evoked by the pandemic (perceived threat and lack of control) as well as more stable ideological views predict the acceptance of such technologies. In two studies conducted in Poland, we found that perceived personal threat and lack of personal control were significantly positively related to the acceptance of surveillance technologies, but their predictive value was smaller than that of individual differences in authoritarianism and endorsement of liberty. Moreover, we found that the relationship between the acceptance of surveillance technologies and both perceived threat and lack of control was particularly strong among people high in authoritarianism. Our research shows that the negative feelings evoked by the unprecedented global crisis may inspire positive attitudes towards helpful but controversial surveillance technologies but that they do so to a lesser extent than ideological beliefs.

Can adipokine visfatin be a novel marker of pregnancy-related disorders in women with obesity?

Overweight and obesity have become a dangerous disease requiring multiple interventions, treatment and preventions. In women of reproductive age, obesity is one of the most common medical conditions. Among others, obese state is characterized by low-grade systemic inflammation and enhanced oxidative stress. Increased maternal body mass index might amplify inflammation and reactive oxygen species production, which is associated with unfavourable clinical outcomes that affect both mother and child. Intrauterine growth retardation, preeclampsia, or gestational diabetes mellitus are examples of the hampered maternal and foetoplacental unit interactions. Visfatin is the obesity-related adipokine produced mainly by the visceral adipose tissue. Visfatin affects glucose homeostasis, as well as the regulation of genes related to oxidative stress and inflammatory response. Here, we review visfatin interactions in pregnancy-related disorders linked to obesity. We highlight the possible predictive and prognostic value of visfatin in diagnostic strategies on gravidas with obesity.

Presurgical diagnostic difficulties in an asymptomatic patient with primary transitional cell carcinoma of the oviduct: case report.

Primary transitional cell carcinoma of the fallopian tube is a very rare condition. We present a case of a 70-year-old asymptomatic Caucasian patient with an irregular solid right adnexal mass of 67 × 35 × 59 mm which was discovered during routine ultrasound pelvic examination. There was no acoustic shadow and the patient did not feel pain during examination. No evidence of metastases or ascites was found by ultrasound. There was moderate vascularization of the mass. The mass was considered malignant according to the subjective assessment of the examiner. Serum level of CA125 was elevated to 519 U/ml. The results of logistic regression model LR2 according to the International Ovarian Tumor Analysis (IOTA) group was 64.4%, suggesting the malignant nature of the mass. The IOTA-ADNEX model showed 97% probability of malignancy, probably (85.5%) stage II-IV ovarian cancer. The risk of malignancy being borderline, stage I and metastatic was 0.6%, 3.9% and 7%, respectively. Omitting CA125 in the IOTA-ADNEX model slightly decreased the probability of malignancy to 81.3%, still most likely (54.2%) stage II-IV ovarian cancer. The results of risk of malignancy indices RMI I-IV were 1557, 2076, 1557 and 2076, respectively, reflecting the malignant nature of the mass. The final diagnosis was transitional cell carcinoma of the fallopian tube, stage IIIc according to FIGO.

Current knowledge on the use of ultrasound measurements of fetal soft tissues for the assessment of pregnancy development.

Ultrasonography, with its detailed imaging of the fetus, is very widely used in obstetrics. The primary aim of ultrasound scanning in pregnancy is to limit the risk of obstetric complications by early detection of abnormalities, such as intrauterine growth restriction and macrosomia. Currently, morphometric formulae are used for estimating fetal weight. They utilize basic biometric parameters. However, Hadlock formula, used for fetal weight estimation, has an error rate of 20%. For this reason, researchers all over the world have been looking for other sonographic parameters correlating with fetal weight, with a higher predictive value. The current scientific reports indicate that new sonographic parameters, such as soft tissue thickness values, are useful for fetal weight assessment. The measurements can be conducted in various parts of the fetus's body, e.g. thigh, upper arm, abdomen or the subscapular area. Different types of measurements are characterized by different levels of correlation with other sonographic and anthropometric parameters as well as body mass and gestational age. Based on the reports, numerous studies proposing new fetal weight calculation formulae have been produced. Apart from soft tissue, some more advanced and detailed measurements are taken, such as those involving adipose and lean tissue or using three-dimensional ultrasound (3D), for determining fetal weight. Ultrasound measurement of subcutaneous tissue thickness in various parts of the body may prove to be a strong predictor of fetal weight, which is useful for sonographic assessment of pregnancy.

Intrafamilial phenotypic variability in a Polish family with Sensenbrenner syndrome and biallelic WDR35 mutations.

Sensenbrenner syndrome (cranioectodermal dysplasia, CED) is a very rare autosomal recessive ciliopathy. Cranioectodermal dysplasia is characterized by craniofacial, skeletal, and ectodermal abnormalities. About 50 patients have been described to date. Sensenbrenner syndrome belongs to a group of ciliary chondrodysplasias and is a genetically heterogeneous disorder. Mutations in five genes: IFT122, WDR35, IFT43, WDR19, and IFT52 have been associated with CED. All known genes encode proteins that are part of the intraflagellar transport complex, which plays an important role in the assembly and maintenance of cilia. Here, we report a family with two children affected by Sensenbrenner syndrome, a 9-year-old girl and her older sister who died in infancy due to respiratory, liver, and renal insufficiency. Dysmorphic features included short stature with rhizomelic shortening of limbs, short fingers, preaxial polydactyly of left hand, narrow chest, craniosynostosis, dolichocephaly, high anterior hairline, epicanthal folds and telecanthus, depressed nasal bridge, low-set ears, and additional ectodermal abnormalities. The patient presented with chronic tubulointerstitial renal disease. She had abnormal echogenicity on renal ultrasound, reduced glomerular filtration, albuminuria and tubular proteinuria, hypocalciuria and hypocitraturia, accompanied by pre-hypertensive state. This pattern of renal abnormality was regarded as nephronophthisis. Psychomotor development was apparently normal. Molecular analysis in one of the affected individuals identified compound heterozygosity for a nonsense (c.1922T>G, p.(Leu641*)) and missense (c.2522A>T, p.(Asp841Val)) variants in WDR35. We present a detailed clinical descriptions of two female siblings showing an intrafamilial phenotypic variability of the disease, and illustrating the potential lethality of CED.

Maternal hemoglobin concentration and hematocrit values may affect fetus development by influencing placental angiogenesis.

OBJECTIVE: Vasculogenesis and angiogenesis are crucial for maintaining proper placental perfusion and optimal fetal development. Among other physical and chemical factors, hypoxia is known to stimulate angiogenic processes. Preplacental type of hypoxia is often associated with maternal anemia and is thought to enhance vascularization within the fetoplacental unit. The goal of this study was to establish the correlation between the local expression of vascular endothelial growth factor (VEGF) and placenta growth factor (PlGF) receptors (flt-1, flk-1) with maternal hemoglobin (Hb) concentration, hematocrit (Ht) values and the infant birthweight. METHODS: In total, 43 specimens of term placentas obtained from normal course pregnancies delivered at term were included in the study. The expression of flt-1 and flk-1 receptors was analyzed by immunohistochemical staining. Vascular/extravascular tissular index (V/EVTI) was measured by assessing a total vascular area. Nonparametric Mann-Whitney U-test and Spearman's rank correlation were used to compare the various parameters and their differences between the groups. RESULTS: Among the patients with low Hb concentration, nearly 2-fold greater expression of the flt-1 receptor was positively correlated with infants birthweight (p = 0.028). CONCLUSIONS: Increased placental vascular density (increased flt-1 expression), during a physiological course of gestation, may be an adaptive response to lowered maternal Hb concentration and Ht values encountered during pregnancy.

Growth factors, silver dressings and negative pressure wound therapy in the management of hard-to-heal postoperative wounds in obstetrics and gynecology: a review.

PURPOSE: The last two decades witnessed the development of numerous innovative regimens for the management of patients with abnormally healing and infected wounds. Growth factors, negative pressure wound therapy (NPWT) and antiseptic dressings containing silver are examples of methods with best documented efficacy, being widely used in the treatment of acute and chronic post-traumatic wounds, burns and ulcers of various etiology. As far as obstetrics and gynecology are concerned, prevention and treatment of infected, hard-to-heal postoperative wounds is of crucial importance. This article reviews the available literature to discuss the possibilities for use, efficacy and cost-effectiveness of growth factors, NPWT and silver dressings in the treatment of difficult-to-heal postsurgical wounds in obstetrics and gynecology. MATERIALS AND METHODS: An extensive search of the English and Polish literature via PubMed and EMBASE databases was undertaken for articles published between January 1960 and April 30, 2014 to identify articles that described and assessed use, efficacy and cost-effectiveness of growth factors, silver dressings and NPWT in patients with hard-to-heal postoperative wounds following obstetric or gynecological surgery. CONCLUSIONS: Literature review regarding the use of growth factors, NPWT and silver dressings suggests that these methods may play an important role in the management of wounds after invasive obstetric and gynecological procedures. Obese patients, patients after vulvectomy or prior radiation therapy may benefit most, however, due to non-numerous randomized reports, prospective studies on the use of above-mentioned methods in the treatment of postsurgical wounds following obstetric and gynecological interventions are required.

Diagnostic value of plasma asymmetric and symmetric dimethylarginine levels in liver transplant recipients.

INTRODUCTION: Nitric oxide is an important factor in the pathogenesis of liver cirrhosis. Its synthesis depends on the availability of L­arginine and is inhibited by asymmetric dimethylarginine (ADMA). Symmetric dimethylarginine (SDMA) seems to be a good marker of multiorgan failure, especially renal failure. OBJECTIVES: The aim of the present study was to evaluate the diagnostic significance of dimethylarginines in patients after liver transplantation. PATIENTS AND METHODS: The study included 30 cadaver liver donors and 30 recipients with liver cirrhosis. The following parameters were estimated in donors and in liver recipients before and at days 1 and 3 after transplantation: serum alanine transaminase (ALT), aspartate transaminase (AST), and γ­glutamyltranspeptidase (GGT) activity, international normalized ratio (INR), concentrations of bilirubin, albumin, creatinine, electrolytes, ADMA, SDMA, and L­arginine. RESULTS: Before transplantation cirrhotic patients showed higher bilirubin concentrations, higher ALT and GGT activity, and lower sodium and albumin levels compared with donors. At day 3 after transplantation, we observed a significant increase in ALT, AST, creatinine, sodium, ADMA, SDMA, and L­arginine, and a decrease in bilirubin levels. A significant positive correlation between SDMA and creatinine was found in donors (P <0.001), recipients before transplantation (P <0.0005), and at days 1 (P <0.004) and 2 after transplantation (P <0.0005). A significant positive correlation was also observed before transplantation between ADMA and bilirubin concentrations (P = 0.0264), ADMA and albumin concentrations at day 1 after transplantation (P = 0.02), while a negative correlation was observed between ADMA and INR before transplantation (P = 0.008) and at day 3 after transplantation (P = 0.03) in recipients. CONCLUSIONS: An increase in dimethylarginine levels after liver transplantation seems to be due not only to the dysfunction of the transplanted liver, but also to impaired kidney function caused by the surgery itself and/or the use of a nephrotoxic calcineurin inhibitor--tacrolimus. A significant correlation between serum creatinine and SDMA concentrations both in liver donors and recipients suggests that SDMA renal clearance may have diagnostic value to evaluate the glomerular filtration rate in these patients.

[Cathether related blood stream infection in ICU patients with prolonged central venous catheterisation--cause and prevention]. / Przyczyny i zapobieganie zakazeniom u chorych po zalozeniu cewnika do duzych naczyn krwionosnych.

UNLABELLED: Colonization of the tip of the intravenous catheter is often observed in the ICU practice and can be the source of dangerous bacteriemia (CRBSI--catheter related bloodstream bacteraemia) and sepsis with multiorgan failure. There are many cases conected with bacterial colonization of the tip of the catheter in the ICU practice, which could be the source of dangerous bacteriemia--CRBSI (catheter related bloodstream bacteriemia) and sepsis with organs failure. MATERIAL AND METHODS: 105 patients with sepsis were examined, which clinical state pointed, that CVC was the source of infection. We removed the CVC in this patient, and its tip and patient's blood were examined microbiologically. In the case of positive result, the antibiogram was made. OBJECTIVE: Evaluation of colonisation and infections of central venous catheters and catheter related blood stream infections (CRBSI) in general ICU patients' and with identification of most frequent microorganisms and their antibiotic sensibility. Results. After examining of 105 samples in 37 (35, 24%) cases we did not culture bacteria. From the rest of 68 (64, 76%) samples we cultured 110 bacterial colonies. 8 of them were admitted to be contaminated samples. 60 tips of the catheter were used to proper analysis from which we isolated 102 bacterial colonies: 44 (43.1%) Gram positive cocci, 32 (31.5%) Enterobacteriaceae, 23 (22.5%) glucose non-fermentative gram-negative rods rods Gram negative non glucose fermentation and 3 (2.9%) fungi (C. albicans). We analized 60 blood samples that derived from patients with confirmed catheter colonisation. It was found that 8 blood samples indicated bacteriemia, but only in 2 cases isolated bacteria came from the CVC. Conclusions. (1) The majority of central venous catheters on ICU are colonized by pathogenic microorganisms. (2) Aerobic Gram positive and Gram negative bacteria are responsible for CVCs' infection. (3) Bacterial colonization of CVCs' is not very often the reason of CRBSI. (4) Prolonged use of central venous catheters needs careful prophylactic standards of an microbiological monitoring.

[Rhabdomyolysis, disseminated intravascular coagulation and acute renal failure after severe narcotics intoxication (MDMA, THC, amphetamine)]. / Rabdomioliza, rozsiane krzepniecie wewnatrznaczyniowe i ostra niewydolnosc nerek po ostrym zatruciu srodkami odurzajacymi (MDMA, THC, amfetamina).

More often we are faced with the cases of young people (who are in a serious condition) who land in ICU, because of severe narcotics intoxication, which they took occasionally on the concerts, discotheques and social events. From 1997 we observed rapid increase of admission to hospitals due to amphetamine, MDMA (2,3-methylenedeoxymethamphetamine which is a main component of a tablet called ecstasy) and THC (9-d tetrahydrocannabinols which are a component of sunn hemps) intoxication and decrease of opioid's poisoning. 23 years old patient was admitted to ICU in critical condition after severe narcotics intoxication. Patient was deeply unconscious (GCS 3) with tetraplegia and high temperature (39.6 degrees C). He had endotracheal tube (artificially ventilated) and hypovolemic shock with circulatory insufficiency (blood pressure was supported by 3 catecholamines). We observed many petechias and ecchymoses which suggested vascular haemorrhagic diathesis. It was found that the patient had disseminated intravascular coagulation and rhabdomyolysis with acute renal failure which was treated by dialysis. After 26 days of intensive treatment the patient was conscious, he had also efficient circulatory and respiratory system but with slight improvement of neurological state. In this condition he was admitted on nephrology ward to continue the treatment and start rehabilitation. The presence of high concentration of amphetamine, MDMA and THC in blood, extreme dehydration and electrolytes disturbances caused rhabdomyolysis, DIC syndrome and acute renal failure which make the prognosis worse and complicate the treatment. Estimating probability of death of this patient in SAPS II scale (Simplified Acute Physiology Scale) he has bad prognosis (86 points gives 95% of death probability). The patient is alive (what is a big success), probably thanks to quick arrival to specialized medical centre and dialysis treatment which was started early.

The use of recombinant human activated protein C (rhAPC) in the treatment of severe sepsis in immunosuppressed patients in the course of hematological diseases.

BACKGROUND: Treatment of hemopoietic system neoplasias involves severe complications associated with immunosuppression. We present two cases of treating severe sepsis utilizing recombinant human activated protein C (rhAPC) in the course of bilateral pneumonia in patients with hairy cell leukemia (HCL) and T-cell acute lymphoblastic leukemia (ALL). RhAPC, limited the coagulation cascade by inactivating FVa and FVIIIa, directly and indirectly limiting systemic inflammatory response syndrome (SIRS), and improved the fibrinolysis process. These actions break the pathomechanism of sepsis and improve survival. CASE REPORT: Besides intensive, multidirectional treatment of severe sepsis, Xigris (activated drotrecogin alfa) was administered on the second day in both cases. The infusion continued, as recommended, for 96 hours without complications. During treatment the patients' general condition and respiratory efficiency improved, allowing respirator weaning on days 5 and 8 of therapy. These cases of severe sepsis and immunosuppression indicate a high therapeutic efficacy of drotrecogin alfa (activated). Treatment outcome was uncertain because of the patients' hematological condition, so rapid restoration of respiratory efficiency and no disease progression after discontinuing treatment was a great success, possibly due to implementing Xigris at a relatively early stage of sepsis and the intensive therapy conducted according to Surviving Sepsis Campaign guidelines. CONCLUSIONS: Patient survival in severe sepsis directly depends on early diagnosis and institution of treatment. 1. These cases confirm the effectiveness of drotrecogin alfa in severe sepsis as part of multidirectional therapy. 2. Microorganisms causing atypical pneumonia should be considered in diagnosing infections in patients treated with cytostatic agents.