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Management of severe heart failure following STEMI. A case report of LM occlusion in a 54-year-old patient
No full textZawał serca z uniesieniem odcinka ST (STEMI, ST-elevation myocardial infarction) spowodowany zamknięciem pnia lewej tętnicy wieńcowej (LMCA, left main coronary artery) wiąże się z wysokim ryzykiem zgonu i wymaga natychmiastowej interwencji. Opisano przypadek 54-letniego rolnika bez wcześniejszych chorób przewlekłych, który trafił do szpitala w stanie krytycznym z objawami wstrząsu kardiogennego. Angiografia wykazała zamknięcie LMCA, które leczono angioplastyką i wszczepieniem stentu uwalniającego lek antyproliferacyjny. Mimo zastosowania wazopresorów pacjent utrzymywał się w stanie hipotensji, a echokardiografia wykazała ciężką dysfunkcję skurczową lewej komory (LVEF ~10%), poprawiającą się do 27% po kilku dniach.
Z powodu objawów niewydolności serca wdrożono leczenie lewozymendanem, a następnie przeprowadzono rehabilitację kardiologiczną. Ze względu na epizody nieutrwalonego częstoskurczu komorowego pacjent został zabezpieczony kamizelką defibrylującą. Po dwóch miesiącach wykonano kolejną angioplastykę z implantacją stentu w gałęzi przedniej zstępującej (LAD, left anterior descending artery). Echokardiografia wykazała poszerzenie lewej komory, istotną niedomykalność mitralną i spadek LVEF do 15%. Pacjent (NYHA III) został zakwalifikowany do wszczepienia wspomagania lewej komory (LVAD, left ventricular assist device), co przeprowadzono bez powikłań. Obecnie znajduje się pod opieką ambulatoryjną (NYHA II).
Zamknięcie LMCA to stan wymagający szybkiej interwencji, a w przypadkach ciężkiego uszkodzenia mięśnia sercowego konieczne może być zastosowanie zaawansowanych terapii mechanicznych. Kluczowe jest kompleksowe podejście, obejmujące leczenie ostrej fazy, monitorowanie szpitalne, terapie farmakologiczne i mechaniczne oraz długoterminową opiekę ambulatoryjną, co pozwala na poprawę rokowania i jakości życia pacjentów.ST-elevation myocardial infarction (STEMI) caused by left main coronary artery (LMCA) occlusion is a life-threatening condition requiring immediate intervention. This report describes a case of a 54-year-old farmer with no history of chronic illnesses who was admitted in critical condition with cardiogenic shock. Coronary angiography revealed LMCA occlusion, which was treated with immediate angioplasty and drug-eluting stent implantation. Despite vasopressor therapy, the patient remained hypotensive, and echocardiography showed severely impaired left ventricular systolic function (LVEF ~10%), which improved to 27% after several days. Due to persistent heart failure symptoms, levosimendan therapy was initiated, followed by cardiac rehabilitation. Given episodes of nonsustained ventricular tachycardia, a wearable defibrillator was provided. Two months later, the patient underwent a second-stage percutaneous coronary intervention (PCI) of the left anterior descending artery (LAD) with stent implantation. Follow-up echocardiography revealed left ventricular dilation, significant mitral regurgitation, and LVEF decline to 15%. The patient (NYHA III) was referred for left ventricular assist device (LVAD) implantation, which was performed successfully without complications. He is currently under outpatient care (NYHA II). LMCA occlusion necessitates urgent intervention, and in cases of severe myocardial damage, advanced mechanical support may be required. A multidisciplinary approach, including early invasive treatment, close in-hospital monitoring, pharmacological and mechanical therapies, and long-term outpatient care, is essential for improving survival and quality of life in these patients
Isolated left ventricular injury following a suicide attempt
No full textWstęp. Penetrujące urazy serca, najczęściej spowodowane ranami postrzałowymi lub kłutymi, zazwyczaj dotyczą prawej komory. Prowadzą one do poważnych powikłań, takich jak tamponada serca i wstrząs kardiogenny. Ze względu na wysoką śmiertelność kluczowe jest natychmiastowe leczenie operacyjne. W niniejszej pracy zaprezentowano przypadek pacjenta z raną lewej komory serca spowodowaną próbą samobójczą.
Opis przypadku. 37-letni pacjent został przyjęty do szpitalnego oddziału ratunkowego po próbie samobójczej z trzema ranami kłutymi przedniej ściany klatki piersiowej. Pilne badania echokardiograficzne i tomografia komputerowa wykazały uszkodzenie lewej komory serca. Pacjent został natychmiast zakwalifikowany do operacji kardiochirurgicznej. Po wykonaniu sternotomii ewakuowano 300 ml płynu z worka osierdziowego. Znaleziono penetrującą ranę lewej komory, zlokalizowaną między tętnicą zstępującą lewą a gałęzią diagonalną, którą zszyto szwami oraz wzmocniono łatami. Po operacji pacjent został przeniesiony na oddział intensywnej terapii kardiochirurgicznej. W kontrolnym badaniu echokar-diograficznym stwierdzono do 5 mm płynu w osierdziu. Ze względu na ciężkie zaburzenia depresyjne i próbę samobójczą pacjent został przekazany do dalszego leczenia psychiatrycznego.
Wnioski. Urazy serca charakteryzują się wysoką śmiertelnością, jednak szybka interwencja chirurgiczna może znacząco zwiększyć szanse przeżycia. W przedstawionym przypadku rzadkiej rany lewej komory z tamponadą serca, szybkie zszy-cie rany i stabilizacja hemodynamiczna uratowały życie pacjenta. W związku z samobójczym podłożem urazu wdrożono również leczenie psychiatryczne.Introduction. Penetrating injuries, typically caused by gunshot or stab wounds, most commonly affect the right ven-tricle and often lead to life-threatening complications such as cardiac tamponade and cardiogenic shock. Due to the high mortality risk, immediate surgical intervention is essential. We present a case of a left ventricular injury following a suicide attempt.
Case report. A 37-year-old patient was admitted to the Emergency Department after a suicide attempt, presenting with three stab wounds to the anterior chest wall. Urgent echocardiography and contrast-enhanced chest computed tomo-graphy (CT) confirmed a penetrating injury to the left ventricle. The patient was promptly taken for emergency cardiac surgery. During sternotomy, 300 mL of pericardial effusion was evacuated. A penetrating wound to the left ventricle, located between the left anterior descending artery and the diagonal branch, was sutured with stitches and reinforced with patches. Postoperatively, the patient was transferred to the cardiac surgical intensive care unit. A follow-up echocar-diogram showed up to 5 mm of pericardial fluid. Due to severe depressive disorder and the suicide attempt, the patient was transferred to the psychiatric ward for further care.
Conclusions. Cardiac injuries have high mortality rates, but rapid surgical intervention significantly improves survival. In this rare case of left ventricular injury with tamponade, timely wound suturing and hemodynamic stabilization were lifesaving. Given the self-inflicted nature of the injury, psychiatric treatment was also initiated.
Lifestyle modification and novel pharmacological treatment options for patients with peripheral arterial disease
No full textAdvancements in translational research and an increasingly refined understanding of the pathophysiological mechanisms underlying vascular and metabolic diseases have contributed to the emergence of novel therapeutic strategies in patients with peripheral artery disease (PAD). Among these, growing attention has been directed towards the use of glucagon-like peptide-1 receptor agonists (GLP-1 RAs), and to a lesser extent glucagon-like peptide-2 (GLP-2), as adjuncts to conventional therapy. Beyond their glucose-lowering properties, these agents exhibit cardioprotective, cytoprotective, vasoprotective and anti-inflammatory effects, along with beneficial modulation of microcirculation and exercise tolerance. This narrative review aims to synthesise clinical, obser-vational and experimental data regarding the impact of GLP-1 and GLP-2 receptor agonists on cardiovascular risk and functional parameters in patients with T2DM and PAD. The analysis integrates the 2024 European Society of Cardiology (ESC) guidelines for PAD management, which emphasise the “four pillars” of treatment and introduces the concept of GLP-1 RAs as a potential “fifth pillar” in an integrated therapeutic approach. Particular attention is devoted to mechanisms of action, effects on intermittent claudication symptoms, and the potential to improve quality of life in a population characterised by extreme vascular risk
Prevention and treatment of type II endoleaks — a retrospective analysis
No full textIntroduction: Endovascular aneurysm repair (EVAR) is a widely adopted method for treating abdominal aorticaneurysms. The most common complication of this procedure is the occurrence of endoleaks, i.e., leakages inthe area of the endograft, with type II endoleaks being the most frequently observed. Several strategies existfor both the treatment and prevention of type II endoleaks, including preemptive embolization of aortic sidebranches within the aneurysmal sac before stent graft implantation.
Objective: The aim of the study was to compare the effectiveness of various strategies regarding the preventionand treatment of type II endoleaks following EVAR.
Materials and methods: A retrospective comparative cohort study including 186 patients treated with EVARwas carried out. In 11 patients, embolization was performed either before or during the EVAR procedure. In9 patients, type II endoleaks were managed through transarterial embolization via brachial or femoral arteryaccess.
Results: None of the patients who underwent successful embolization before or during EVAR developed endoleaks.In 5 patients, initially qualified for embolization before EVAR, however, embolization proved unsuccessful.Type II endoleaks requiring intervention were diagnosed in 16 patients, with 2 of these cases requiring repeatintervention.
Conclusions: EVAR is an effective method for the treatment of abdominal aortic aneurysms. In the event ofa type II endoleak following EVAR, embolization may be required, and in some cases, more than one interventionis necessary. Preemptive embolization of aortic side branches within the aneurysmal sac, performed before orduring the EVAR procedure, represents a justified management strategy that may help reduce the occurrenceof endoleaks
Assessment of physical activity and modifiable cardiovascular risk factors among medical students in Poland
No full textIntroduction: Cardiovascular diseases remain the leading cause of death worldwide despite declining mortality. Regular physical activity-even of low intensity-plays a key preventive role. Globally, 31% of the population fails to attain the recommended level of physical activity; this includes healthcare workers. The lifestyle of medical- -faculty students may affect their own health and their effectiveness in promoting healthy behaviors.
Materials and methods: In 2025, a nationwide survey was conducted among 448 medical-faculty students from 22 Polish universities using an original standardized online questionnaire. Statistical analysis employed Pearson’s Chi², the Chi² test for independence of rows (Chi² NW), and Fisher’s exact test (p < 0.05). Respondents were grouped by field and year of study.
Results: 74.8% of students rated their physical activity as moderate or high, of whom 57.8% exercised regularly. A higher activity level correlated significantly with better self-rated health (p < 0.0001), suggesting both an objective benefit of exercise and greater health awareness. The most popular activities were strength training, running, and cycling, with the gym ranked first. Motivations included improved well-being, health, appearance, and stress reduction. Women preferred yoga, dance, and group classes, whereas men opted for the gym, running, and team sports. During the examination period, 82.6% of students reduced activity, illustrating the impact of study workload on lifestyle.
Conclusions: Physical activity among medical-faculty students is often insufficient, potentially increasing cardiovascular risk. Promoting exercise during their training is crucial for their own health and for effective prevention in the general population
Interpopulation variation in facial sexual dimorphism: a review with implications for forensic anthropology and medicine
No full textBackground: Understanding how human facial morphology varies across populations and what factors drive these differences is essential for both theoretical and applied biological and medical disciplines. The aims of this study were to: I) outline the dimorphic sex-based differences in facial morphology, II) examine the interpopulation variation in the degree of dimorphism and its potential causes, and III) highlight the significance of this knowledge for medical science.
Review methodology: A systematic review was conducted using the PubMed, Scopus and Web of Science databases from January to March 2025, following the PRISMA guidelines.
Main findings: Individuals of European and South American origin consistently exhibit a higher degree of facial sexual dimorphism than those of African origin. Additionally, significant differences (p < 0.01) in morphological variation between the sexes have been reported in relation to population size, with smaller or more isolated populations exhibiting less dimorphism. Interpopulation variation in facial morphology is the result of multiple processes, primarily natural and sexual selection. At present, the influence of the natural environment on adaptive or adaptability-based changes in morphology is diminishing, while cultural factors are becoming increasingly important.
Clinical relevance and future directions: Facial morphology and sexual dimorphism data obtained from one population can neither be considered representative of another population nor be used as a basis for developing methods in forensic anthropology. Algorithms that use facial features or craniofacial structures to determine sex should also take biogeographical ancestry into account. Similarly, in aesthetic and corrective medicine, culturally sensitive approaches should be applied to achieve optimal patient outcomes
Fasting Serum Adiponectin Shows No Association with Body Mass Index in Pregnant Women with or without Gestational Diabetes
No full textObjective: To measure and compare serum adiponectin in pregnant women with gestational diabetes mellitus (GDM) and with normal glucose tolerance (NGT) in obese and non-obese subjects.
Material and methods: Women at 24–28 weeks of gestation were consecutively recruited as GDM (n = 40) [age: 27.60 ± 3.93 years, mean ± SD; BMI: 27.01 (24.12–29.97), kg/m2, median (IQR)] and NGT (n = 41), age: 26.27 ± 5.25 years, mean ± SD; BMI: 25.82 (23.42–28.93), kg/m2, median (IQR)] based on 75-g oral glucose tolerance test (OGTT) under WHO 2013 criteria. Fasting venous blood samples were collected and analyzed for serum adiponectin using enzyme-linked immunosorbent assay (ELISA) method. At screening for GDM, body mass index (BMI) < 23 kg/m2 was labelled as non-obese, while BMI ≥ 23 kg/m2 was labelled as overweight/obese, regardless of pre-gestational BMI.
Results: Serum adiponectin did not differ between GDM and NGT [2.36 (1.37–3.36) vs. 2.12 (1.54–2.99), median & IQR, p = 0.901]. Even when compared between obese and non-obese subgroups, no differences were observed [GDM vs. NGT; BMI < 23 kg/m2, (2.49 vs. 2.14, median, p = 0.560) and BMI ≥ 23 kg/m2, (2.09 vs. 2.10, median, p = 0.876)]. BMI subgroups (< 23 kg/m2 vs. ≥ 23 kg/m2) within GDM and NGT also showed similar adiponectin (GDM; 2.49 vs. 2.09, median, p = 0.841 and NGT; 2.14 vs. 2.10, median, p = 0.719). No significant correlation was observed between adiponectin and maternal age, gestational age, or BMI.
Conclusions: Serum adiponectin has no significant association with BMI during pregnancy, regardless of GDM
Comparison of Gut Microbiota Composition in Type 2 Diabetes Remission and Non-Remission (COMMUTER Study) — A Systematic Review
No full textObjective: The purpose of this study was to summarize the existing evidence concerning differences in the gut microbiome composition and diversion between individuals with type 2 diabetes (T2D) who achieve remission and those who do not achieve remission through various interventions.
Material and methods: The PubMed, Scopus, and Cochrane databases were searched for study articles that compared the gut microbiota composition of pre-T2D or T2D individuals who achieved remission (DR) and non-remission (NDR), in accordance with the Preferred Reporting Items for Systematic Reviews and Metaanalyses (PRISMA). The quality of the cohort study was assessed with the Joanna Briggs Institute (JBI) critical appraisal checklist, while the Cochrane Risk of Bias Tool was used for Randomized Controlled Trial (RCT) studies.
Results: A total of 7 studies were included, with a total of 303 participants (138 with DR and 165 with NDR). Five studies used bariatric surgery for the main intervention. Most studies showed that the increased abundances of Ruminoccoccus sp., Firmicutes, and Alistipes sp. in participants achieve diabetic remission, whereas the abundances of Bacteroides, Desulfovibrio, and Escherichia coli increase significantly in participants who do not achieve remission.
Conclusions: The gut microbiome composition in individuals who achieved remission shifted compared with that in individuals without remission. These changes were influenced by factors such as the intervention used and the initial microbiome composition. Additionally, meta-analyses are needed to quantify microbiome changes following T2D remission
Expert opinion of the Heart Rhythm Association of the Polish Cardiac Society on pulsed field ablation for atrial fibrillation
No full textPulsed field ablation (PFA) has emerged as an innovative non-thermal technique for the treatment of atrial fibrillation, offering a unique mechanism based on irreversible electroporation that selectively targets myocardial tissue while minimizing damage to surrounding structures. This expert opinion by the Heart Rhythm Association of the Polish Cardiac Society provides a comprehensive review of current evidence, practical experience, and recommendations for the implementation of PFA in Poland. The document summarizes the biophysical principles, clinical outcomes from major trials, safety profile, sedation strategies, device characteristics, and national experience since the technology’s introduction. PFA demonstrates comparable efficacy and hope for superior safety compared to conventional radiofrequency and cryothermal ablation, with shorter procedure times and reduced collateral injury. However, unresolved issues remain, including long-term outcomes, optimal procedural protocols, and specific safety considerations such as hemolysis, silent cerebral lesions, and coronary spasm. The Polish experience supports the rapid adoption of PFA as a first-line ablation strategy for atrial fibrillation in appropriately equipped and experienced centers, with the need for ongoing research and standardization of procedural and anesthesia protocols
Niwolumab z relatlimabem w leczeniu chorych na czerniaki — stanowisko Sekcji Immunoonkologii Polskiego Towarzystwa Onkologicznego
No full textTreatment of melanoma patients has undergone significant modification in recent years, resulting in improved outcomes. Still, the prognosis of patients with advanced stage or metastatic disease is not the best, and new therapeutic options are being sought. One direction of research is the combination of molecules with different mechanisms of action, the so-called fixed-dose combination (FDC) formulations, which are expected to improve the quality of life and safety of patients and provide improved treatment outcomes.
This article presents the position of the Immuno-oncology Section of the Polish Society of Oncology on the use of the combination of nivolumab and relatlimab in the treatment of patients with inoperable melanoma or metastatic disease. Leczenie chorych na czerniaka uległo w ostatnich latach znacznej modyfikacji, co przełożyło się na poprawę jego wyników. Nadal jednak rokowanie chorych w stadium zaawansowanym lub z chorobą przerzutową nie jest najlepsze i poszukuje się nowych opcji terapeutycznych. Jednym z kierunków badawczych jest łączenie cząsteczek o różnym mechanizmie działania, tak zwanych preparatów złożonych o stałej dawce (FDC, fixed-dose combination), które mają poprawić jakość życia i bezpieczeństwo chorych oraz zapewnić poprawę wyników leczenia. W niniejszym artykule przedstawiono stanowisko Sekcji Immunoonkologii Polskiego Towarzystwa Onkologicznego dotyczące stosowania połączenia niwolumabu z relatlimabem w leczeniu chorych na czerniaka w stadium nieoperacyjnym lub z chorobą przerzutową