Predictive value of chest HRCT for survival in idiopathic pulmonary arterial hypertension.

BACKGROUND: Little attention has been paid to chest high resolution computed tomography (HRCT) findings in idiopathic pulmonary arterial hypertension (IPAH) patients so far, while a couple of small studies suggested that presence of centrilobular ground-glass opacifications (GGO) on lung scans could have a significant negative prognostic value. Therefore, the aims of the present study were: to assess frequency and clinical significance of GGO in IPAH, and to verify if it carries an add-on prognostic value in reference to multidimensional risk assessment tool recommended by the 2015 European pulmonary hypertension guidelines. METHODS: Chest HRCT scans of 110 IPAH patients were retrospectively analysed. Patients were divided into three groups: with panlobular (p)GGO, centrilobular (c)GGO, and normal lung pattern. Association of different GGO patterns with demographic, functional, haemodynamic, and biochemical parameters was tested. Survival analysis was also performed. RESULTS: GGO were found in 46% of the IPAH patients: pGGO in 24% and cGGO in 22%. Independent predictors of pGGO were: positive history of haemoptysis, higher number of low-risk factors, and lower cardiac output. Independent predictors of cGGO were: positive history of haemoptysis, younger age, higher right atrial pressure, and higher mixed venous blood oxygen saturation. CGGO had a negative prognostic value for outcome in a 2-year perspective. This effect was not seen in the longer term, probably due to short survival of cGGO patients. CONCLUSIONS: Lung HRCT carries a significant independent prognostic information in IPAH, and in patients with cGGO present on the scans an early referral to lung transplantation centres should be considered.

The potential association between a new angiogenic marker fractalkine and a placental vascularization in preeclampsia.

PURPOSE: Impaired angiogenesis is one of the most common findings in preeclamptic placentas. A new angiogenetic role of fractalkine (CX3CL1) is recently recognized apart from inflammatory activity. In this study, a link between CX3CL1 and the development of placental vasculature in preeclampsia was examined. METHODS: The study comprised 52 women allocated to Group 1 (normotensive, n = 23) and Group 2 (preeclampsia, n = 29). In each group Doppler parameters, serum levels of CX3CL1, soluble fms-like tyrosine kinase-1 (sFlt-1), and placental growth factor (PlGF) were assessed between 30 and 32 week of pregnancy. After the delivery, placental samples were taken and the vascularization and expression of CX3CR1 receptor were assessed after immunostaining. RESULTS: CX3CL1 and sFlt-1 serum levels were significantly higher levels in Group 2 vs Group 1, while PlGF serum levels was significantly lower in Group 2. Lower cerebroplacental ratio (CPR) was observed in Group 2. The vascular/extravascular tissue index (V/EVTI) was significantly lower in Group 2, while compared to Group 1, with the lowest value in the fetus growth restriction (FGR) subgroup (0.18 ± 0.02; 0.24 ± 0.03; 0.16 ± 0.02, respectively). The expression of examined CX3CR1 was higher in Group 2, while compared to Group 1, reaching the highest values in FGR subgroup. There was a moderate negative correlation between birth weight, V/EVTI and CX3CL1 serum level and CX3CR1 placental expression in the group of pregnancies complicated with preeclampsia. CONCLUSION: The significant underdevelopment of placental vascular network in preeclampsia is associated with the change in the CX3CL1/CX3CR1 system, especially in FGR complicated pregnancies.

Glacier Geometry Changes in the Western Shore of Admiralty Bay, King George Island over the Last Decades.

This paper presents changes in the range and thickness of glaciers in Antarctic Specially Protected Area (ASPA) No. 128 on King George Island in the period 1956-2015. The research indicates an intensification of the glacial retreat process over the last two decades, with the rate depending on the type of glacier front. In the period 2001-2015, the average recession rate of the ice cliffs of the Ecology Glacier and the northern part of the Baranowski Glacier was estimated to be approximately 15-25 m a-1 and 10-20 m a-1, respectively. Fronts of Sphinx Glacier and the southern part of the Baranowski Glacier, characterized by a gentle descent onto land, show a significantly lower rate of retreat (up to 5-10 m a-1 1). From 2001 to 2013, the glacier thickness in these areas decreased at an average rate of 1.7-2.5 m a-1 for the Ecology Glacier and the northern part of the Baranowski Glacier and 0.8-2.5 m a-1 for the southern part of the Baranowski Glacier and Sphinx Glacier. The presented deglaciation processes are related to changes of mass balance caused by the rapid temperature increase (1.0 °C since 1948). The work also contains considerations related to the important role of the longitudinal slope of the glacier surface in the connection of the glacier thickness changes and the front recession.

Insight into the Key Points of Preeclampsia Pathophysiology: Uterine Artery Remodeling and the Role of MicroRNAs.

Preeclampsia affects about 3-8% of all pregnancies. It represents a complex and multifaceted syndrome with at least several potential pathways leading to the development of disease. The main dogma in preeclampsia is the two-stage model of disease. Stage 1 (placental stage) takes place in early pregnancy and is thought to be impaired placentation due to inadequate trophoblastic invasion of the maternal spiral arteries that leads to reduced placental perfusion and release of numerous biological factors causing endothelial damage and development of acute maternal syndrome with systemic multiorgan failure (stage 2-the onset of maternal clinical symptoms, maternal stage). Recently, in the light of the vast body of evidence, two-stage model of preeclampsia has been updated with a few novel pathways leading to clinical manifestation in the second part of pregnancy. This paper reviews current state of knowledge about pathophysiology of preeclampsia and places particular focus on the recent advances in understanding of uterine artery remodeling alterations, as well as the role of microRNAs in preeclampsia.

Changes in physical activity of adolescent girls in the context of their perception of the Healthy Me programme.

BACKGROUND: An assumption was made that results of programme evaluation lead to better understanding for whom this intervention may work. The aim of the article is to compare the changes in physical activity of the intervention programme participants depending on subjective assessment of its impact. METHODS: The data were obtained from 14- to15-year-old Polish girls (N = 1120) from 48 random selected secondary schools participating in the 1-year Healthy Me programme in the 2017/2018. Schools were randomly assigned to one of two types of intervention or to a control (null) group. Satisfaction with the programme according to 21 criteria was measured retrospectively just after the intervention. Change in MVPA (moderate-to-vigorous physical activity) during the programme implementation was assessed in relation to satisfaction level, and adjusted for initial MVPA. RESULTS: In total, the MVPA did not change significantly comparing pre- and post-intervention surveys (3.94 ± 1.94 vs. 3.87 ± 1.93)-P = 0.093. However, the perceived notable improvement of functioning in 10 out of 21 areas was related to the unquestionable increase in MVPA (P ≤ 0.001). With respect to the four impact areas, an interaction was demonstrated between an intervention group and an improvement in the domain-specific functioning. The beneficial impact of the programme on these areas was associated with the improvement of physical activity only in case of full and null intervention. CONCLUSIONS: Indicators related to the implementation process and the results obtained during the Healthy Me programme evaluation could represent a change in motivational and environmental factors that indirectly affects adolescent girl's physical activity.

Non-obstetric complications in preeclampsia.

Preeclampsia is a multisystem disorder of pregnancy that remains a leading cause of maternal and foetal morbidity and mortality. It is still an underestimated risk factor for future cardiovascular, cerebrovascular, and kidney disease, developing often in the perimenopausal period of a woman's life. It remains unclear whether preeclampsia is an individual risk factor for future cardiovascular, cerebrovascular, and renal events or an early marker of women with high-risk profiles for these diseases. Risk factors for cardiovascular disorders and preeclampsia are very similar and include the following: obesity, dyslipidaemia, insulin resistance, pro-inflammatory and hypercoagulable state, and endothelial dysfunction. Thus, the pregnancy can only be a trigger for cardiovascular alterations that manifest in development of preeclampsia. On the other hand, there is strong evidence that changes in cardiovascular, endothelial, and metabolic systems occurring in the course of preeclampsia may not fully recover after delivery and can be a cause of future disease, especially in the presence of other metabolic risk factors regarding, for example, perimenopause. In this review the authors present current knowledge about short- and long-term maternal consequences of preeclampsia, such as: cardiovascular disease, cerebrovascular incidents (posterior reversible encephalopathy and stroke), kidney injury (including the risk of end-stage renal disease), liver failure, and coagulopathy (thrombocytopenia and disseminated intravascular coagulation).

The safety of low-molecular-weight heparins in the prevention of venous thromboembolism in surgically-treated cancer patients: results of a multicentre observational study.

AIM OF THE STUDY: Despite widespread use of pharmacological prophylaxis, venous thromboembolism (VTE) still constitutes a common complication in cancer patients. The aim of the study was to analyse the safety of low-molecular-weight heparins (LMWH) in the prevention of VTE in surgically-treated cancer patients. MATERIAL AND METHODS: A total of 5207 cancer patients (44.5% men and 55.5% women) aged 16-97 years participated in a prospective observational study conducted in 13 Polish cancer centres in 2005-2008. This cohort included 4782 subjects who were treated surgically and received LMWH as a pharmacological prophylaxis for VTE prior to or after the surgery. The incidence of haemorrhagic complications and thrombocytopaenia was analysed in this cohort, along with intra-hospital mortality. RESULTS: Mean duration of LMWH administration was 9.4 ±7.8 days. Haemorrhagic complications: heavy (n = 15) or light bleeding (n = 299), were observed in 314 patients (6.5%). A total of 314 patients (6.5%) presented with haemorrhagic complications: heavy (n = 15, 0.3%) or light bleeding (n = 299, 6.3%). Four cases of heavy bleeding: gastrointestinal bleeding (n = 2), retroperitoneal bleeding (n = 1), and central nervous system bleeding (n = 1), were classified as definitely related to LMWH. No significant association was found between the incidence of haemorrhagic complications and the type of administered LWMH (p = 0.523). No cases of thrombocytopaenia or deaths related to administration of LMWH were reported. CONCLUSIONS: LMWH seems to be a safe form of pharmacological prophylaxis for VTE in surgically-treated cancer patients.

Current trends in tobacco smoking among 15-year-old adolescents in Poland in the background of 30 countries.

The international HBSC (Health Behaviour in School-aged Children) survey has enabled the comparison of the patterns of changes with respect to a number of health indicators in adolescence. The aim of the study was to show international trends and how the position of Poland in international rankings of smoking prevalence has changed since 2002. Material and Methods: The study comprised 30 countries for which data was available from four rounds of HBSC survey (2002-2014). In total, 218 759 15-year-olds were surveyed, including 7289 in Poland. For each country a linear trend was estimated, separately for boys and girls, to describe changes in regular smoking (daily or at least once a week). Results: In the investigated period, the percentage of 15-year-old boys who smoke every week fell in Poland from 26.2% to 15.5%, and the respective percentage in girls decreased from 17.2% to 14.7%. This means annual decrease of 0.88% in boys and 0.24% in girls. In a combined international sample, exactly the same as in Poland rate of change was noted in boys; however, a definitely faster in girls (0.95% a year). The highest rate of change was observed in Ukraine, Germany and Norway, while the lowest in Greece, Croatia and Israel. Poland's position in the international ranking moved from 8th to 24th, providing that the countries are listed according to the growing percentage of 15-year-olds of both genders who smoke regularly. Conclusions: Decrease in the prevalence of smoking among Polish adolescents, observed from the beginning of this century, has been undoubtedly a success related to the implemented preventive measures. However, attention should be drawn to the strategies launched in countries which achieved better results than Poland, as well as to the reasons of less positive trends among Polish girls.

Centrilobular nodules in high resolution computed tomography of the lung in IPAH patients - preliminary data concerning clinico-radiological correlates.

INTRODUCTION: Inhomogeneity of lung attenuation pattern is observed in high resolution chest computed tomography (HRCT) in some IPAH patients despite lack of interstitial lung disease. Such radiological changes are described either as ill-defined centrilobular nodules (CN) or as focal ground glass opacities (FGGO). There is no consensus in the literature, whether they indicate the distinct type of IPAH, or pulmonary venoocclusive disease (PVOD) with subtle radiological changes. Thus the aim of the present pilot study was to assess the frequency and clinical significance of inhomogenic lung attenuation pattern in IPAH. MATERIAL AND METHODS: 52 IPAH patients (38 females, 14 males, mean age 41 years ± 15 years), entered the study. All available chest CT scans were reviewed retrospectively by the experienced radiologist, not aware about the clinical data of the patients. RESULTS: CN were found in 10 patients (19%), FGGO - in 12 patients (23%). No lymphadenopathy or interlobular septal thickening suggestive of PVOD were found. The significant differences between CN and the remaining patients included: lower mean age - 31 and 43.5 years, (p = 0.02), lack of persistent foramen ovale (PFO) - 0% and 43% (p = 0.03), and higher mean right atrial pressure (mRAP) - 12.5 mm Hg and 7.94 mm Hg (p = 0.01). No significant survival differences were observed between the groups of CN, FGGO and the remaining patients. CONCLUSION: Centrilobular nodules in IPAH were combined with lack of PFO, higher mRAP and younger age of patients.

Low DLCO in idiopathic pulmonary arterial hypertension - clinical correlates and prognostic significance.

INTRODUCTION: Decreased diffusing capacity of the lung for carbon monoxide (DLCO) is observed in some idiopathic pulmonary arterial hypertension (IPAH) patients, but its clinical significance is uncertain. We aimed to assess clinical correlates and prognostic significance of low DLCO in IPAH patients. MATERIAL AND METHODS: In the group of 65 IPAH patients the cut off value for low DLCO was set up based on histogram as < 55% of predicted value. Demographic data, exercise capacity, lung function tests, hemodynamic parameters and survival of the patients were compared depending on DLCO value. RESULTS: Low DLCO was found in 18% of the patients, and it was associated with male sex, older age, worse functional status and exercise capacity, and higher prevalence of coronary artery disease. Low DLCO carried a 4-fold increase of death risk in 5-year perspective. CONCLUSIONS: Low DLCO was a marker of worse functional capacity and increased risk of death in studied IPAH patients.

Severity of arterial and chronic thromboembolic pulmonary hypertension is associated with impairment of heart rate turbulence.

BACKGROUND: Heart rate turbulence (HRT) impairment is a validated and an independent indicator of cardiovascular death. There are limited data on HRT in pulmonary hypertension (PH), so we assessed potential HRT alterations in PH, especially in relation to its severity. METHODS: Thirty-three out of 41 patients were enrolled in the study aged 49.7 ± 15.9 years (22 with arterial, 11 with chronic thromboembolic PH). Routine evaluations, right heart catheterization, and 24-hour Holter monitoring with heart rate variability and HRT assessment were performed. RESULTS: HRT was significantly impaired in PH patients, as compared to 25 healthy controls: mean turbulence onset (TO) was -0.27% versus -2.60% (P < 0.0001), and median turbulence slope (TS) was 3.13 versus 13.5 msRR (P < 0.0001). Abnormal HRT (TO ≥ 0.0% and/or TS ≤ 2.5 ms/RR) was found in 63.3% of PH patients. Patients with PH and abnormal HRT presented more compromised functional, biochemical, and hemodynamic status than PH patients with normal TO and TS values. Multivariate stepwise regression analysis showed that TO value was related to oxygen desaturation <90% in 6-minute walking test (6-MWT; OR 0.41, P < 0.001) and was related to N-Terminal pro-B type Natriuretic Peptide concentration (OR 0.40, P < 0.001); TS was related to 6-MWT distance (OR 0.53, P < 0.0001). CONCLUSIONS: Patients with arterial or chronic thromboembolic PH are characterized by significant impairment of HRT which is related to the disease severity. We hypothesize that patients with abnormal HRT could be considered as subjects with an increased risk of cardiovascular death, however, it needs further investigation.

Functional class and type of pulmonary hypertension determinate severity of cardiac autonomic dysfunction assessed by heart rate variability and turbulence.

OBJECTIVE: Heart rate variability (HRV) and turbulence (HRT) are validated methods of evaluation of cardiac autonomic nervous system (cANS) dysfunction which is associated with sudden cardiac death. There is limited data on cANS imbalance and its significance,in patients with pulmonary hypertension (PH), so we assessed HRV and especially HRT alterations in PH. METHODS AND RESULTS: Thirty-three out of 41 PH patients were enrolled in the study: 22 (66.7%) with pulmonary arterial hypertension (PAH) and 11 (33.3%) with chronic thromboembolic PH (CTEPH), 11 patients were in World Health Organization Functional Class (WHO-FC) I-II, and 22 others in WHO-FC III-IV. The control group consisted of 25 healthy persons. Routine evaluations, echocardiography, right heart catheterization and 24-hour Holter monitoring with time-domain HRV and HRT evaluation were performed. Most of HRV indices and both of HRT parameters were significantly impaired in PH patients, as compared to control subjects. Abnormal HRT (turbulence onset 0.0% and/or turbulence slope 2.5 ms/RR) was found in 36.4% WHO-FC I-II and in 77.3% WHO-FC III-IV patients (P=0.05). Patients in WHO-FC III-IV or with CTEPH presented compromised HRV and HRT values when compared to patients in WHO-FC I-II or with PAH, respectively. Multivariate analysis showed that abnormal HRT occurrence in PH was influenced by higher WHO-FC only (odds ratio 5.3, 95% CI 1.4-19.9, P= 0.01). CONCLUSION: Higher WHO-FC and probably type of pulmonary hypertension (CTEPH more than PAH) determinate the severity of cANS dysfunction assessed by heart rate variability and turbulence. Potential clinical consequences of our findings need further investigations.

Non-tuberculous mycobacterial lung disease (NT MLD ) in patients with chronic thromboembolic pulmonary hypertension and idiopathic pulmonary arterial hypertension.

INTRODUCTION: Non-tuberculous mycobacterial lung diseases (NTMLD) occur rarely and are diagnosed mainly in patients belonging to risk groups. Pulmonary hypertension (PH) has not been recognised as a risk factor for NTMLD yet. The aim of the study was to analyse the clinical course and predisposing factors of NTMLD recognised in our centre between 2002 and 2012 in patients with chronic thromboembolic pulmonary hypertension (CTEPH) and idiopathic pulmonary arterial hypertension (IPAH). MATERIAL AND METHODS: Thirteen patients (10 - CTEPH, 3 - IPAH) entered the study. PH was recognised during right heart catheterisation. Median value of mean pulmonary artery pressure (mPAP) was 49 mm Hg (39-65 mm Hg). NTMLD was diagnosed according to ATS guidelines (2007). RESULTS: M. kansasii was the most frequent pathogen. Most patients complained of the exaggeration of dyspnoea and productive cough. Computed tomography of the chest with angiography revealed infiltrations with cavitation in seven patients and cavities surrounded by micronodules in six patients. In all CTEPH patients, NTMLD developed in the hypoperfused lung areas. No parenchymal abnormalities preceded the development of NTMLD. After diagnosis all of the patients received antituberculous treatment; in 12/13 improvement was achieved. By the end of March 2014 seven patients died due to right heart insufficiency, no deaths due to NTMLD were noted. CONCLUSIONS: NTMLD should be suspected in patients with CTEPH or IPAH, presenting with productive cough and a new pulmonary infiltrate with cavitation. In patients with CTEPH, special attention should be paid to a new cavitary lesions without accompanying thrombus in the artery supplying the area. High mPAP (CTEPH/IPAH) and hypoperfusion (CTEPH) are predisposing to NTMLD.

Is Feto-Maternal Transfusion after Cesarean Delivery Different in Singleton and Twin Pregnancy?

Background: The aim of the study was to investigate if feto-maternal transfusion was related to the size of the fetal-maternal interface, and, therefore, was larger in twin pregnancy in comparison with singleton pregnancy. Methods: Blood samples from women with singleton (n = 11), and monochorionic (n = 11) and dichorionic (n = 13) twin gestations were tested. Flow cytometry tests with hemoglobin F, glycophorin A, and hemoglobin F and carbonic anhydrase simultaneous staining were used to detect fetal red blood cells and maternal F cells. Results: In all cases, the volume of feto-maternal transfusion was estimated to be low. The highest rate of fetal red blood cells in the maternal circulation was observed in the blood of women with dichorionic twin gestations both before and after delivery. An increase in fetal red blood cells was observed after cesarean section in singletons and twins. The median rate of maternal F cells was 2.23% in singleton, 2.1% in monochorionic and 3.95% in dichorionic pregnancy. Conclusions: Feto-maternal transfusion during pregnancy may be related to the multiplicity and chorionicity of pregnancy.

Emotional sequelae among survivors of critical illness: a long-term retrospective study.

CONTEXT: Treatment in an ICU can be stressful and traumatic for patients, and can lead to various physical, psychological and cognitive sequelae. OBJECTIVES: The aim of the study was to assess the influence of the social, economic and working status of individuals in regard to long-term anxiety and depression among ICU convalescents. DESIGN: Retrospective, cross-sectional, 5-year survey between 2005 and 2009. SETTING: The general ICUs of two hospitals in Lublin (Poland): the Teaching Hospital, Medical University of Lublin and the District Hospital. PATIENTS: All adults surviving an ICU stay of more than 24 h were eligible. In December 2010, 533 questionnaires were sent to discharged ICU survivors, and 195 (36.6%) were returned. One hundred and eighty-six patients were enrolled in the study. Patients with brain injuries were excluded. MAIN OUTCOME MEASURES: The questionnaire consisted of the Hospital Anxiety and Depression Scale (HADS); questions defining social, economic and working status before and after intensive care stay, health status before intensive care stay, as well as questions about memories and readmissions to intensive care were included. RESULTS: According to HADS, 34.4% patients had an anxiety disorder and 27.4% were depressed. There was a strong positive correlation between anxiety and depression (r = +0.726, P<0.001). Better material and housing conditions correlated with lower anxiety and depression rates. Acute Physiology and Chronic Health Evaluation II scores on admission positively correlated with both anxiety (r =+0.187; P=0.011) and depression (r = +0.239; P=0.001). A negative correlation between health status before intensive care admission and HADS scores was observed (anxiety rs = -0.193; P=0.008; depression rs = -0.227; P=0.002); better health resulted in less anxiety and depression disorders. CONCLUSION: Adverse social and economic status is associated with higher rates of anxiety and depression following ICU stay.

[Normal D-dimer concentration in hospitalized patients with lung diseases]. / Czestosc prawidlowego stezenia D-dimerów u pacjentówhospitalizowanych z chorobami pluc.

INTRODUCTION: The use of D-dimer testing is an established part of the diagnosis of suspected pulmonary embolism (PE). However, in hospitalized patients many various factors might be responsible for increased D-dimer concentration and they could lower utility of D-dimer in exclusion of PE in such population. According to some published data, calculating the index D-dimer/fibrinogen could increase the specificity of D-dimer in the recognition of venous thromboembolism (VTE). The aim of the present study was to determine the frequency of normal D-dimer concentration in hospitalized patients with lung diseases in whom the differential diagnosis of PE is particularly difficult and to evaluate the utility of the index D-dimer/fibrinogen in subgroups of patients: with acute VTE and with lung cancer. MATERIAL AND METHODS: 619 consecutive patients aged 54.9 (± 15.4) hospitalized in reference pulmonary center were enrolled into observation. Among them, there were 96 (15%) patients with acute VTE, 65 (10%) with exacerbation of COPD and 172 (27%) with lung cancer. RESULTS: Mean D-dimer concentration (Vidas D-dimer New) was 1956 ± 3691 ng/ml and median value 842 (45-35 678) ng/ml. Normal D-dimer concentration (〈 500 ng/ml) was found in 225/523 (43%) without acute VTE. In 49% (32/65) patients with COPD and in 25% (43/172) patients with lung cancer D-dimer concentration was below 500 ng/ml as well. The index D-dimer/fibrinogen was significantly higher in acute VTE patients compared to lung cancer patients - 808 ± 688 and 289 ± 260 respectively, p 〈 0.001. CONCLUSIONS: Normal D-dimer concentration was found in more than 40% of patients with lung diseases hospitalized in reference pulmonary center. This observation could suggest higher than described in the literature utility of D-dimer measurement in exclusion of PE in such a population. The value of the index D-dimer/fibrinogen, which is significantly higher in acute VTE than in lung cancer requires further evaluation to establish its clinical utility.

Everyday challenges faced by Polish teenagers during the COVID-19 pandemic in the context of selected demographic factors.

BACKGROUND: The enforced restrictions, including physical isolation and school lockdowns after the outbreak of the COVID-19 pandemic, have brought about anxiety and uncertainty the younger generation. OBJECTIVE: The main objective is to analyse the everyday challenges faced by adolescents in Poland during the time of social isolation in the COVID-19 pandemic. MATERIAL AND METHODS: A nationwide, online survey of adolescents aged 11-18 (N=2408) was conducted in April 2020. Quantitative and qualitative analyses were undertaken. Differences in the everyday challenges experienced during the COVID-19 pandemic connected with gender, age and place of residence were analysed. RESULTS: Girls were significantly more likely than boys to perceive the limitations in contacts with others (friends and family) and the concerns about the health of relatives as a big difficulty. Among the youngest students (11-12 years of age), the lack of contact with friends and family and worries about their health and the fear of infection ranked higher than for other students. For the oldest (17-18) the lack of private time and space and not being able to meet one's boyfriend/ girlfriend were the most troublesome. The necessity to stay at home and the inconvenience resulting from the lack of outdoor exercise were ranked higher by urban students than by students living in rural areas. CONCLUSIONS: When planning campaigns in the near future to support the mental health of adolescents in the context of the pandemic it is recommended to include especially the youngest adolescents and those living in small and medium-sized cities.

The Impact of Coexisting Gestational Diabetes Mellitus on the Course of Preeclampsia.

A strict correlation between gestational diabetes mellitus (GDM) and preeclampsia (PE) has been shown in previous studies. This case-control observational study evaluates the influence of concomitant GDM on the severity of PE. Ninety-nine patients were included: thirty-eight with PE without GDM (group 1), fourteen with PE and concomitant GDM (group 2), and forty-seven with uncomplicated pregnancies (group 3). Adverse maternal/fetal and neonatal outcomes were registered. Patients underwent blood sample analysis of serum PlGF, sFlt-1, creatinine levels, and platelet count (PLT). The incidence of preterm birth, FGR, HELLP syndrome, and NICU admission was significantly higher in group 1 in comparison to groups 2 and 3, whereas RDS was diagnosed most often in group 2 in comparison to groups 1 and 3. All studied biochemical parameters differed between the control group and both PE groups; however, there were no differences between patients with PE with and without GDM. The presented study indicates that the coexistence of GDM may mitigate the course of PE. The lack of differences between patients with PE with and without GDM in serum levels of studied biomarkers may also confirm its usefulness in the diagnosis and management of PE in patients with coexisting GDM.

Gestational weight gain and blood pressure control in physiological pregnancy and pregnancy complicated by hypertension.

BACKGROUND: Obesity is a widely recognised risk factor for chronic and gestational hypertension. Influence of gestational weight gain on blood pressure control throughout the pregnancy is not well characterised. MATERIAL AND METHODS: Women in the third trimester of a singleton pregnancy were recruited to the study. Medical records were analysed and a special survey was conducted to obtain history on hypertensive disorders in pregnancy and weight changes during pregnancy. Blood pressure measurements were taken during the office visit in line with international guidelines. Relationships between gestational weight gain and maximal and office values of systolic and diastolic blood pressure values were analysed. RESULTS: Data of 90 women in normal pregnancy, 40 with gestational hypertension and 21 with chronic hypertension were analysed. Gestational weight gain was 11.9 ± 4.6 kg in the normal pregnancy group, 13.0 ± 5 kg in the gestational hypertension group and 10.6 ± 3.4 kg in the chronic hypertension group. Gestational weight gain positively correlated with both office (r = 0.48; p < 0.001) and maximal blood pressure values (r = 0.34; p = 0.004) in normal pregnancy and with maximal blood pressure values (r = 0.57; p = 0.02) in women with chronic hypertension. No correlation was observed between gestational weight gain and blood pressure values among women with gestational hypertension. CONCLUSION: In normal pregnancy and in women with chronic hypertension greater gestational weight gain is related to higher blood pressure values in the third trimester.

[Recurrent effusive pericarditis in the course of adult-onset Still's disease--case reports of two patients]. / Nawracajace wysiekowe zapalenie osierdzia w przebiegu choroby Stilla u doroslych--opis dwóch przypadków.

Pericardial effusion is caused by various pathological agents. In differential diagnosis infectious as well as non-infectious factors have to be considered. Adult-onset Still disease (AOSD)--relatively uncommon systemic inflammatory disorder of unknown etiology--is among possible diagnosis. The disease typically affects patients in the age between 16-35 years and is characterized by spiking fever, arthralgia, evanescent salmon rash with other abnormalities including pharingitis, serositis (especially pleuritis and pericarditis) and leucocytosis as well as increased serum levels of inflammatory indicators. We present two patients with recurrent pericardial effusion in the course of AOSD.