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Leczenie pierwszej linii pembrolizumabem chorej na zawansowanego niedrobnokomórkowego raka płuca z ekspresją PD-L1 ≥ 50%
No full textImmunoterapia stanowi standard leczenia pierwszej linii u chorych na zaawansowanego niedrobnokomórkowegoraka płuca (NDRP) z wysoką ekspresją liganda receptora programowanej śmierci komórki typu 1 (PD-L1, programmeddeath-ligand 1) i bez obecności mutacji kierunkowych. W niniejszej pracy przedstawiono przypadekchorej na zaawansowanego gruczołowego raka płuca, z ekspresją PD-L1 ≥ 50% oraz brakiem mutacji w genachEGFR, ALK i ROS1, leczonej w monoterapii pembrolizumabem. Uzyskano długotrwałą kontrolę choroby (ponad3,5 roku), utrzymującą się częściową odpowiedź oraz minimalną toksyczność leczenia
Molecular mechanisms of keloid development
No full textKeloids are benign, fibroproliferative skin lesions that result from abnormal wound healing. This review provides a current understanding of keloid pathogenesis, emphasizing the roles of genetic predisposition, dysregulated molecular pathways, and external influences. While genetic studies revealed familial inheritance patterns and specific polymorphisms, such as rs8032158 in NEDD4, which contribute to an increased risk of keloid development, a rare congenital syndromes suggest a broader spectrum of genetic susceptibility. At the molecular level, key features of keloid formation include dysregulated fibroblast activity, excessive deposition of extracellular matrix components, and persistent inflammation mediated by various growth factors, cytokines, and chemokines. Crucial signaling pathways, including TGF-β/Smad, Janus kinase (JAK)/signal transducer and activator of transcription (STAT), mitogen-activated protein kinase (MAPK), PI3K/Akt/mTOR, and Wnt/β-catenin are implicated in the activation of fibroblasts and the overproduction of collagen. Furthermore, external factors such as mechanical tension, elevated blood pressure, vitamin D deficiency, and psychological stress may exacerbate keloid formation, although the precise mechanisms involved remain partially understood. By synthesizing existing evidence, this review underscores the multifactorial nature of keloid formation and identifies potential therapeutic targets, paving the way for more effective treatment strategies
Affective temperament and emotional processing difficulties in women with PCOS and their potential impact on PCOS clinical presentation
No full textObjectives: To assess alexithymia and affective temperament in patients with polycystic ovary syndrome (PCOS) and compare these patients to a group of patients undergoing endocrinological evaluation without a diagnosis of PCOS (non-PCOS). Additionally, the study explored the relationship between affective temperament, alexithymia, body mass index (BMI), and the severity of hirsutism in the PCOS group.
Material and methods: A total of 46 patients with PCOS and 28 non-PCOS patients were recruited for the study. All participants underwent endocrinological and gynecological diagnostics. Alexithymia was assessed using the TAS-20 questionnaire, while affective temperament was evaluated with the TEMPS-A questionnaire.
Results: Both PCOS and non-PCOS patients were found to fall within the "intermediate alexithymic" range. Patients with PCOS exhibited more pronounced cyclothymic temperament (p = 0,019), and the difference in irritable temperament was close to statistical significance (p = 0,072). In a stepwise linear regression analysis, total alexithymia emerged as a statistically significant positive predictor of BMI in PCOS group (β = 0.368, p = 0.012).
Conclusions: Patients with PCOS exhibit higher cyclothymic temperament compared to the non-PCOS group. Both groups show “intermediate alexithymia”, which could impact treatment adherence and mental health, highlighting the importance of psychological interventions for improving outcomes and quality of life
Adaptation to cancer among Polish patients with cervical cancer in relation to illness acceptance, life satisfaction, and dispositional optimism
No full textObjectives: Activating positive coping strategies for cancer in the face of a new, changed health situation, good acceptance of the illness, life satisfaction, and dispositional optimism influence the quality of life of patients and are key factors important in the healing process.
Material and methods: The study was conducted among 101 women diagnosed with cervical cancer. The research took place between 2023 and 2024. The diagnostic survey method was used, along with the following research tools: an original questionnaire, the Acceptance of Illness Scale (AIS), the Satisfaction with Life Scale (SWLS), the Life Orientation Test-Revised (LOT-R), and the Mini-Mental Adjustment to Cancer Scale (Mini-MAC). Results:Sperman correlation analysis showed that LOT-R, SWLS and AIS significantly (p < 0.05) and negatively (r < 0) correlate with three Mini-MAC coping strategies: anxious preoccupation, helplessness-hopelessness, and destructive style. This means that higher levels of these strategies are associated with lower levels of dispositional optimism, life satisfaction, and acceptance of illness. Additionally, LOT-R, SWLS, and AIS significantly (p < 0.05) and positively (r > 0) correlate with two Mini-MAC strategies: fighting spirit and constructive style. Thus, higher levels of these adaptive coping strategies correspond to higher levels of optimism, life satisfaction, and illness acceptance.
Conclusions: The most chosen style by the patients was the constructive style, as opposed to the destructive style, which promotes acceptance of illness, life satisfaction, and dispositional optimism. The determinants influencing acceptance of illness, life satisfaction, and optimism, as well as adaptation to cancer, were age, place of residence, duration of illness, and type of procedure performed
Uterine fibroids — why you should choose tailored therapies based on the joint decision of the physician and the patient
No full textUterine fibroids (UFs) are the most common benign tumors of the myometrium, affecting up to 70% women by age 50. Although many cases remain asymptomatic, symptomatic UFs can significantly reduce quality of life through excessive bleeding, anemia, pelvic pain, infertility, and obstetric complications. Despite the availability of various conservative treatments — including pharmacotherapy, uterine artery embolization, and ultrasound thermoablation — surgical interventions, particularly hysterectomy, remain the dominant approach in many countries. This discrepancy between evidence-based recommendations and routine practice highlights the persistence of a paternalistic model of care, where patients are often excluded from treatment decisions and not informed about alternatives.
Emerging concepts such as shared decision making (SDM) and personalized therapy emphasize the need to adapt treatment plans to each woman’s clinical profile, reproductive goals, and preferences. SDM fosters trust, better adherence to therapy, and improved acceptance of complications by actively involving patients in choosing their care. The development of modern pharmacological options, like GnRH analogs, further expands possibilities for effective, reversible, fertility-preserving treatments.
A paradigm shift toward patient-centered, individualized management is essential to address ethical challenges, reduce unnecessary hysterectomies, and improve outcomes. Implementing SDM and expanding access to conservative therapies require systemic changes in reimbursement, training, and patient education to ensure that care focuses not only on the disease but on the woman as a whole
A retrospective analysis of perinatal outcomes in mothers with gestational diabetes and their newborns during the COVID-19 pandemic in Poland
No full textObjectives: The global pandemic caused by the SARS-CoV-2 virus resulted in a deterioration of access to healthcare services, with the increased utilization of telemedicine. The global pandemic has also had a significant impact on women’s experiences of maternity care, which may have affected gestational diabetes perinatal outcomes, which are associated with the glycemic control of the mother. The objective of this study was to present and compare the results of maternal and neonatal perinatal outcomes in pregnancies affected by gestational diabetes mellitus (GDM) in the years preceding and during the period of the COVID-19 pandemic.
Material and methods: The study was conducted as a retrospectively analyzed cohort study of neonates born from pregnancies complicated with GDM and their mothers born at gestational age of at least 34 + 0/7 weeks. The detailed analysis encompassed both neonatal and maternal perinatal outcomes. The patients’ feedback was obtained regarding the availability of necessary consultations and the quality of care provided.
Results: There was a notable decline in breastfeeding rates (p < 0.05). Few other perinatal outcomes differed between the years 2017–2019 and 2020–2021.
Conclusions: The degree of maternal glycemic control, the quality of medical care provided, and the effectiveness of maternal treatment constitute crucial factors influencing maternal and neonatal outcomes, as well as breastfeeding rates
Wybrane patologie łożyska — diagnostyka różnicowa
No full textPrawidłowy rozwój łożyska jest kluczowy dla fizjologicznego przebiegu ciąży oraz dobrostanu płodu, dlatego ocena ultrasonograficzna łożyska jest obligatoryjnym elementem każdego badania ultrasonograficznego w ciąży. Łożysko torbielowate jest stwierdzane podczas badania ultrasonograficznego i jest konsekwencją heterogennych nieprawidłowości, które dotyczyć mogą zarówno naczyń łożyska, jak i kosmków. Nieprawidłowa struktura łożyska może wpływać negatywnie na pełnione przez nie funkcje. Rokowanie zależy przede wszystkim od rodzaju i etiologii obserwowanych zmian. Celem prezentowanej pracy jest omówienie głównych przyczyn zmian torbielowatych w łożysku, ich diagnostyki różnicowej, rekomendowanego postępowania klinicznego oraz rokowania
Analysis of acute coronary syndrome ıncidence and mortality before and after the COVID-19 pandemic
No full textINTRODUCTION: During the pandemic, there was concern that mortality associated with acute coronary syndrome (ACS) would rise due to individuals’ hesitation towards seeking medical care. The effect of COVID-19 on the incidence, initial treatment, and mortality of ACS remains controversial. The objective of my study was to analyze the incidence, clinical characteristics, and outcomes of ACS cases before and after the COVID-19 pandemic, as well as to evaluate the influence of previous COVID-19 infection and vaccination status.
MATERIAL AND METHODS: I performed a retrospective analysis of patients diagnosed with ACS over two intervals: pre-pandemic (January–June 2019) and post-pandemic (February–July 2023). Demographic information, concomitant conditions, clinical manifestations, therapeutic interventions, and mortality rates were examined. The post-pandemic group had their COVID-19 history and vaccination status recorded.
RESULTS: The research comprised 184 patients in the pre-pandemic and 149 in the post-pandemic cohort. The post-pandemic group exhibited markedly elevated rates of stent insertion (p = 0.028), chest discomfort (p = 0.043), dyspnea (p = 0.009), palpitations (p < 0.001), and STEMI (p = 0.005). Mortality rates were comparable across both groups.
CONCLUSIONS: Although overall ACS hospitalization rates remained consistent, post-pandemic cases exhibited more severe presentations, indicating a change in the clinical pattern of ACS. These findings underscore the persistent cardiovascular burden of the pandemic and the necessity for adaptable techniques in ACS care
Oropharyngeal dysphagia in Parkinson’s disease: potential utility of speech acoustic analysis in detection and evaluation of swallowing impairment progression
No full textAim of the study. This study aimed to evaluate the utility of speech acoustic analysis as a tool for diagnosing dysphagia in Parkinson’s disease.Clinical rationale for the study. Swallowing impairment is a common and potentially life-threatening symptom of Parkinson’s disease (PD). Fiberoptic endoscopic examination of swallowing (FEES), considered the gold standard for dysphagia diagnosis, is often inaccessible in everyday clinical practice. Many studies highlight the link between speech and swallowing impairment in PD patients. Evaluating possible correlations between speech acoustic parameters and the presence or severity of dysphagia in PD could potentially indicate speech acoustic parameters for use in a non-invasive screening tool for swallowing impairment in PD patients.Material and methods. This study included 40 patients with a clinical diagnosis of PD aged from 36 to 82 years. The disease duration varied from 1 to 25 years. All study participants were treated with oral medications, allowing them to achieve and maintain the best possible performance status. All study participants underwent a subjective and objective neurological examination, speech acoustic analysis, which was performed based on a standardized speech recording, and FEES, according to a specific study protocol. The obtained results were analyzed statistically.Results. The presence of oropharyngeal dysphagia was confirmed among 92.5% of the analyzed patients. The FEES findings described in this study are consistent with the specific pattern of swallowing impairment characteristic of PD. The obtained results indicate the existence of multiple statistically significant correlations between the FEES findings and speech acoustic analysis parameters. The most important speech acoustic parameters in terms of swallowing impairment evaluation include the phonation time, efficiency coefficient, average efficiency, energy modulation depth, standard deviation of the length of the interval between segments, standard deviation of the length of the intervals between segments in the speech disfluency test, unharmonic-to-harmonic ratio (U2H), Yanagihara coefficient (YG), 1/Q, residual-to-harmonic ratio (R2H), and amplitude irregularity (APQ).Conclusions. Speech acoustic analysis could be useful in everyday clinical practice for performing non-invasive dysphagia screening tests in PD patients, especially when an endoscopic examination is unavailable. Results obtained in the study require further validation in larger cohorts. However, if confirmed, this tool could be used to identify patients who potentially require an invasive examination of swallowing for individualized dysphagia management