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How the wearable cardioverter defibrillator helps as temporary sudden cardiac death protection and a monitoring tool during pregnancy
No full textHow to treat coronary in-stent restenosis? Recent advances and their practical implications: State-of-the-Art Review
No full textPercutaneous coronary intervention with stent implantation has revolutionized the treatment of coronary artery disease. However, a significant drawback of this approach is the risk of in-stent restenosis (ISR), which increases each year following stent placement. This review of the current literature aims to enhance our understanding of the mechanisms behind ISR and its treatment. To accurately evaluate these mechanisms, intravascular imaging should be utilized during all the steps of revascularization. In particular, multiple mechanisms of ISR can coexist in a single patient, each influenced by various clinical and angiographic risk factors. It is essential to focus on adequate lesion preparation, including plaque-modifying or plaque-ablative techniques, because these are crucial for achieving positive outcomes. In the contemporary era, advancements like new, thin-strut, drug-eluting stents and drug-coated balloons offer promising options for addressing ISR. In this review paper, we address the limitations and advantages of both technologies
Subclinical atrial fibrillation: Who benefits from oral anticoagulation?
No full textThe value of anticoagulation to prevent embolic stroke in subclinical atrial fibrillation detected by implantable cardiac devices has not been established. Recently, two randomized controlled studies scrutinized whether such patients benefit from oral anticoagulation to prevent embolic strokes. These two studies were the NOAH-AFNET-6 (anticoagulation with edoxaban in patients with atrial highrate episodes) trial and the ARTESiA (Apixaban for stroke prevention in subclinical atrial fibrillation) study, but they came to different conclusions using different primary endpoints. While the investigators of NOAH-AFNET-6, based on a composite primary endpoint, concluded that no patient with device-detected AF should be anticoagulated, the ARTESiA investigators demonstrated the overall value of anticoagulation based on stroke/systemic embolism as the sole endpoint. However, the main question for subclinical atrial fibrillation patients is to which extent stroke and thromboembolism can be prevented by anticoagulation and weighing such a benefit to the risk of major bleeding. After initial confusion a meta-analysis of both studies focusing on the endpoints “ischemic stroke” and “all-cause stroke” showed an overall superiority of anticoagulation against placebo/aspirin therapy. The combined evidence demonstrated to the cardiovascular community the superiority of anticoagulation but confined to those with high risk, i.e., CHA2DS2-VASc score > 4, particularly in those with any type of vascular disease. The meta-analysis also showed that no anticoagulation is indicated in patients with CHA2DS2-VASc score < 4, and with shared decision-making recommended for those with CHA2DS2-VASc score of 4. It is reassuring that despite the first impression of diverging results in the two major trials, a meta-analysis helped to clarify the uniformity and consistency of the results across the studies, which will help physicians and nurses in their daily care of patients with implantable devices
Nutritional state, inflammation and TAVI outcomes. Just prognostic factors or a call to action?
No full textMay high blood pressure variability contribute to increased cardiovascular risk in women?
No full textLeft and right atrial echocardiographic parameters and outcomes in patients with atrial fibrillation
No full textBackground: This study evaluates the association between left atrial and right atrial (LA, RA) parameters and a composite endpoint (CEP) of all-cause death, thromboembolism, acute coronary syndrome, and heart failure hospitalization in atrial fibrillation (AF) patients.Material and methods: Patients were prospectively enrolled. At baseline, the following echocardiogram parameters were measured: LA and RA antero-posterior diameter index (iLAAPD, iRAAPD), LA and RA volume index (LAVi, RAVi), LA and RA sphericity index (LASI, RASI), LA and RA emptying fraction.Results: A total of 489 patients (61.3% males) with a median age of 75 (66–80) years and a median CHA2DS2VASc score of 3 (2–5) were enrolled (92.2% receiving anticoagulation). Permanent AF was present in 40.5% of the total cohort. After a median follow-up of 1114 (392–1384) days, 129 patients (26.3%) reached the CEP. The highest sensitivity for CEP was for LA emptying fraction <28% and iRAAPD >24 mm/m2 (72% and 73%, respectively) while the best negative predictive values were for iLAAPD and LAVi (both 81%). Right atrial parameters were not associated with CEP. Discrimination analysis using net reclassification improvement (NRI) showed that iLAAPD and LAVi significantly improved patient reclassification compared to a null model without atrial parameters (iLAAPD NRI 0.30; P = 0.005; LAVi NRI 0.32; P = 0.002). Multivariate Cox regression analysis found that LA dimensions, volume, and function were associated with a higher risk of adverse outcomes and significantly improved risk prediction for the CEP.Conclusions: LAVi and iLAAPD enhance discrimination and risk prediction for adverse outcomes in AF patients
Wyzwania w diagnostyce somatycznej pacjentów z zaburzeniami psychicznymi
No full textMultimorbidity of patients with mental disorders is a common occurrence and requires an interdisciplinary approach to diagnostics and treatment. Mental disorders and u sing of psychotropic drugs increase the risk of liver and carbohydrate-lipid metabolism disfunctions. Metabolic syndrome screening enables early diagnosis and treatment of hiperlipidaemia, which increases the risk of cardiovascular incidents. Symptoms of patients with mental disorders should be differentiate from those of somatic disorders. Delirium is a mental disorder caused by a somatic illness. Mixed psychiatric and somatic care units are thought to be an interdisciplinary medical institution for patients with mental disorders, who need an emergency treatment of physical illnesses. Coordinated medical care for patients with mental disorders in surgical ward reduces the risk of treatment complications.Wielochorobowość pacjentów z dodatnim wywiadem psychiatrycznym stanowi częste zjawisko i wymaga interdyscyplinarnego podejścia w prowadzeniu prawidłowej diagnostyki i skutecznego leczenia. Zabur zenia psychiczne oraz stosowanie niektór ych leków psy - chotropowych, a w szczególności neuroleptyków atypowych, wiążą się z podwyższonym ryzykiem wystąpienia dysfunkcji wątroby i gospodarki węglowodanowo-lipidowej. Choroby fizyczne, nawet te o bezobjawowym pr zebiegu, wywierają istotny wpływ na wyrównanie chorób psychicznych i wyniki odległe leczenia. Screening w kierunku zespołu metabolicznego u pacjentów hospitalizowanych na oddziałach psychiatrycznych umożliwia wczesną diagnostykę i leczenie hiperlipidemii zwiększającej r yzyko wystąpienia niekor zystnych incydentów sercowo-naczyniowych. Objawy fizyczne zgłaszane przez pacjentów obciążonych zaburzeniami psychicznymi wymagają różnicowania symptomów chorób organicznych z działaniami niepożądanymi terapii lekami psychotropowymi. Delirium stanowi zaburzenie psychiczne wywołane pr zyczyną somatyczną, a jego leczenie polega na terapii choroby podstawowej. Idea tworzenia ośrodków medyczno-psychiatrycznych ma na celu objęcie interdyscyplinarnym leczeniem pacjentów obciążonych chorobami p sychicznymi, którzy wymagają doraźnej terapii na oddziałach somatycznych. Skoordynowana opieka lekarska nad pacjentami z zaburzeniami psychicznymi na oddziałach zabiegowych jest uzasadniona i wpływa na zmniejszenie ryzyka wystąpienia powikłań pooperacyjnych i skrócenie przewidywanego czasu hospitalizacji
Izotretynoina w leczeniu ciężkiego trądziku pospolitego — skuteczność, bezpieczeństwo i nowe perspektywy terapeutyczne
No full textIsotretinoin, a retinoid, has long been considered the most effective systemic treatment for severe acne vulgaris that is resistant to standard therapies. A cne is a chronic inflamma - tory disease of the pilosebaceous units that affects a significant percentage of people in adolescence and early adulthood, often compromising their quality of life and psychosocial functioning. Thanks to its multifaceted mechanism of action — including reduced sebaceous gland activity, normalization of keratinization, anti-inflammator y effects, and indirect inhibition of Cutibacterium acnes colonization — isotretinoin enables long-term remission of skin lesions. The effectiveness of therapy depends largely on the selected dosing regimen — from classic, through low-dose and pulsed strategies, to microdose — which optimizes treatment benefits and minimizes side effects. Furthermore, combining isotretinoin treatment with topical therapies and dermatological procedures can significantly improve treatment outcomes. However, therapy is associated with the risk of adverse effects, inclu ding dry skin and mucous membranes, lipid abnormalities, liver dysfunction, psychiatric disorders, and teratogenicity. Therefore, regular health check-ups and thorough patient education are crucial, and can be implemented within primary care; the management of severe acne with isotretinoin should remain under the supervision of a dermatologist, while family physicians are primarily responsible for diagnosing and treating mild to moderate forms and referring severe cases to specialists. The article also presents new therapeutic perspectives, including the use of pharmacogenomics to personalize treatment, the development of alternative pharmaceutical forms, and off-label options for other dermatoses. The article emphasizes the need for individualized isotretinoin therapy and the importance of interdisciplinary collaboration to increase the effectiveness and safety of treatment for patients with severe acne.Izotretynoina, należąca do grupy retinoidów, od lat uznawana jest za najskuteczniejsze ogólnoustrojowe leczenie ciężkiego i opornego na standardowe terapie trądziku pospolitego. Trądzik to przewlekła choroba zapalna jednostek włosowo-łojowych, która dotyka znaczący odsetek osób w okresie dojrzewania i wczesnej dorosłości, często obniżając ich komfort życia i funkcjonowanie psychospołeczne. Dzięki wielokierunkowemu mechanizmowi działania — obejmującemu redukcję aktywności gruczołów łojowych, normalizację keratynizacji, działanie przeciwzapalne oraz pośrednie ograniczenie kolonizacji Cutibacterium acnes — izotretynoina umożliwia osiągnięcie długotrwałej remisji zmian skórnych. Skuteczność terapii zależy w dużej mierze od doboru schematu dawkowania — od klasycznego, przez strategie niskodawkowe i pulsacyjne, aż po mikrodawkowe podejście — co pozwala zoptymalizować korzyści leczenia i ograniczyć działania niepożądane. Dodatkowo le czenie skojarzone izotretynoiną z terapiami miejscowymi i procedurami dermatologicznymi może istotnie poprawić wyniki leczenia. Terapia wiąże się jednak z ryzykiem działań niepożądanych, w tym suchości skór y i błon śluzowych, zabur zeń lipidowych, zabur zeń funkcji wątroby, zaburzeń psychicznych oraz teratogenności. W obec powyższego kluczowe są regularne kontrole stanu zdrowia oraz r zetelna edukacja pacjenta, które mogą być re - alizowane w ramach Podstawowej Opieki Zdrowotnej (POZ), przy czym leczenie ciężkich postaci trądziku pozostaje domeną dermatologa, a rola lekarza rodzinnego koncentruje się na prowadzeniu łagodnych i umiarkowanych postaci oraz kierowaniu pacjentów z ciężkimi zmianami do specjalisty. W artykule zaprezentowano również nowe perspektywy terapeutyczne, w tym zastosowanie farmakogenomiki do personalizacji leczenia, rozwój alternatywnych form farmaceutycznych oraz możliwości off-label w innych dermatozach. Artykuł podkreśla konieczność indywidualizacji terapii izotretynoiną oraz znaczenie współpracy interdyscyplinarnej w celu zwiększenia skuteczności i bezpieczeństwa leczenia pacjentów z ciężkimi postaciami trądziku
Chest radiography in dockworkers
No full textBackground: Dockers are occupationally exposed to respirable particles derived from organic dust, inorganic dust and/or diesel combustion particles.
Objective: To analyse chest radiological findings in a group of dockworkers and the influencing factors.
Material and methods: Descriptive study of dockers in a port whose main activity is loading and unloading sand. Applying the specific Health Surveillance Protocol for exposure to silicosis, chest X-rays were taken in situ with a mobile unit. Radiographic data taken between 2016 and 2023 are included. The interpretation of the images was performed according to the ILO Guidelines, by radiologists with expertise in this technique.
Results: Of the 268 workers (258 men and 10 women), with a median age of 40 years and an average length of service of 16 years, 43% were smokers and 18% were ex-smokers. Chest radiological abnormalities were observed in 22 workers (8.2%), all males. There were no cases of silicosis. Profusion 1/0 was observed in 5 workers (all smokers, in 4 the profusion changed from 0/1 in 2019 to 1/0 in 2023 and in 1 it was detected in the initial health examination) and in 6 the profusion was 0/1. The rest of the alterations are findings in soft tissue, skeleton or residual pleuroparenchymal lesions.
Conclusions: The absence of established silicosis indicates that the preventive measures carried out in this group are effective. Of the relevant radiological findings, two are possible tumours and in cases of progression of images suggestive of pneumoconiosis, all of them are smokers. It is necessary to insist on anti-smoking campaigns among workers
Development and psychometric validation of the Condom Attitude Scale: preliminary findings
No full textIntroduction: Condom use remains the only effective method for preventing sexually transmitted infections(STIs) during sexual activity. Beyond medical and preventive factors, the effectiveness of condom useis strongly influenced by individuals’ attitudes towards them. This study aimed to develop and conducta preliminary psychometric evaluation of the Condom Attitude Scale (CAS), a tool designed to measureattitudes towards condom use.Materials and methods: An 11-item preliminary version of the CAS was developed based on a literaturereview and tested in Poland in December 2024 as part of the POLARES project. Data were collected viaCAWI. Out of 693 respondents, 313 sexually active individuals who used condoms irregularly or not at all,and were not trying to conceive, were included in the analysis. Most participants were women (69.3%).Psychometric properties were assessed using principal component analysis (PCA) and Cronbach’s alpha.Results: PCA supported a one-factor structure, resulting in a six-item final scale with factor loadings from0.647 to 0.772. The scale showed satisfactory internal consistency (α = 0.790). Items reflect key barrierssuch as concerns about sexual satisfaction and fear of negative social judgment. Scores range from 6 to30; higher scores indicate more negative attitudes. The mean score in the sample was 13.75 (SD = 5.92).Conclusions: CAS is a concise, six-item instrument demonstrating good psychometric properties. The scaleholds potential for application in epidemiological research, as well as in health education, sex education,and STI prevention initiatives.Introduction: Condom use remains the only effective method for preventing sexually transmitted infections (STIs) during sexual activity. Beyond medical and preventive factors, the effectiveness of condom use is strongly influenced by individuals’ attitudes towards them. This study aimed to develop and conduct a preliminary psychometric evaluation of the Condom Attitude Scale (CAS), a tool designed to measure attitudes towards condom use.
Materials and methods: An 11-item preliminary version of the CAS was developed based on a literature review and tested in Poland in December 2024 as part of the POLARES project. Data were collected via CAWI. Out of 693 respondents, 313 sexually active individuals who used condoms irregularly or not at all, and were not trying to conceive, were included in the analysis. Most participants were women (69.3%). Psychometric properties were assessed using principal component analysis (PCA) and Cronbach’s α.
Results: PCA supported a one-factor structure, resulting in a six-item final scale with factor loadings from 0.647 to 0.772. The scale showed satisfactory internal consistency (α = 0.790). Items reflect key barriers such as concerns about sexual satisfaction and fear of negative social judgment. Scores range from 6 to 30; higher scores indicate more negative attitudes. The mean score in the sample was 13.75 (SD = 5.92).
Conclusions: CAS is a concise, six-item instrument demonstrating good psychometric properties. The scale holds potential for application in epidemiological research, as well as in health education, sex education, and STI prevention initiatives