Prenatal echocardiography – the impact on neonatal management

Congenital heart disease (CHD) results in neonatal morbidity and mortality. Prenatal diagnosis allows preparing an appropriate perinatal and postnatal care. Babies born in low-risk level sites with unexpected CHD may have poorer outcomes. The purpose of this study was to compare results of foetal echocardiography to postnatal findings and assess the impact of antenatal suspicions of CHD on postnatal management. Medical records of mother-infant pairs with CHD admitted to the Neonatal Intensive Care Unit (NICU) of the Medical University of Gdansk from 01.01. to 31.12.2013 were reviewed. We analysed if the defect was detected pre- or postnatally, and if the diagnosis was made by the obstetrician from low-risk level sites (level I) or from a tertiary care centre (level II sonography). The overall incidence of CHD was 68 (3,4%). Critical congenital heart defects (CCHD) were found in 24 neonates (1,2%), 21 were diagnosed prenatally, 3 were transferred from 1st level units. Correlation between prenatal diagnosis made at our centre and postnatal findings was achieved in 47,7%. Accuracy in all prenatal and postnatal findings for both I and II sonography levels was 35,2%. There were major differences in the disproportion of the great vessels and postnatal confirmation of coarctation of the aorta (CoAo) (7,1%). We obtained a high accuracy of prenatal and postnatal findings in detection of lesions such as Tetralogy of Fallot (ToF), transposition of the great arteries (TGA), DORV (double outlet right ventricle) and Critical Pulmonary Stenosis, which require an outflow tract view (92,9% of cases). Conclusions: We confirmed increasing diagnostic rates when the diagnostics is performed at a tertiary care centre. These results are in agreement with literature stating that prenatal detection of CoAo is still challenging. Despite the high rates of misdiagnosis, majority of infants benefited from prenatally diagnosed CCHD

Children with corpus callosum anomalies: clinical characteristics and developmental outcomes

Introduction. Corpus callosum abnormalities are complex, aetiologically diverse, and clinically heterogeneous conditions. Counselling parents regarding their causes and associated syndromes, and predicting the neurodevelopmental and seizure risk prognosis, is challenging. Material and methods. We describe the clinical characteristics, associated anomalies, and neurodevelopmental outcomes of children with agenesis of corpus callosum (ACC). Fifty-one neonates with ACC/hypoplasia of the corpus callosum were identified over a 17-year period, and their medical records were retrospectively reviewed. Results. Patients were classified into two groups depending on the presence or absence of associated abnormalities. The first group (17 patients, 33.4%) presented with isolated callosal anomalies. The second group included 34 patients (66.6%) with associated cerebral and extracerebral anomalies. We achieved an identifiable genetic aetiology in 23.5% of our cohort. Magnetic resonance imaging was performed in 28 patients (55%), and of these 39.3% had additional brain anomalies. During the study period, five patients died early in the neonatal period and four were lost to follow up. Of the 42 followed patients, 13 (31%) showed normal neurodevelopment, 13 (31%) showed mild delay, and 16 (38%) had a severe delay. Fifteen (35.7%) had epilepsy. Conclusions and clinical implications. We have confirmed that callosal defects are frequently accompanied by brain and somatic anomalies. Additional abnormalities were shown to be significantly associated with developmental delay and increased risk of epilepsy. We have highlighted essential clinical features that may provide diagnostic clues to physicians and we have given examples of underlying genetic disorders. We have provided recommendations about extended neuroimaging diagnostics and widespread genetic testing that may impact upon daily clinical practice. Paediatric neurologists may therefore use our findings to help base their decisions regarding this matter

Przydatność kliniczna siatek centylowych urodzeniowej masy ciała w opiece nad noworodkiem

In view of the last few decades of progress within neonatology , the clinicians’ attentionis now focused on children with low bir th rate (&lt; 2,500 g) and with extremely low bir thrate (&lt; 1,000 g) in par ticular. Most of these patients are born prematurely . Assessmentof their physical maturity should be per formed within the first hours of their life. Whencross-referenced with anthropological measurements it guides fu rther management, aswell as mortality and morbidity prognostication. Various scales/scores are used to verifythe gestational age determined by the obstetricians. The current standard is the NewBallard Score (Dubowitz/Ballard). Centile charts allow for objective determination of theintrauterine growth as well as birth weight and measurements. Clinical utility of the chartsdepends on: population representativity, consideration for special cases (e.g. prematurity,number of foetuses in multiple pregnancy), if they are up to date and include seculartrends. Current neonatological standard in polish clinical practise are the Fenton’s growthcharts. However, they are based on a different population and there are no separate chartsfor multiple pregnancies available. Therefore, Polish growth charts are needed. These chartswould be representative for the neonatal population of this part of Europe and would takeinto account the social developments of the last few decades. Ideally, they should take thegestational age, gender and a number of foetuses into account. They would require a largeprospective study to validate them.W obliczu postępu, jaki dokonał się w neonatologii w ostatnich dekadach, uwaga lekarzy skupia się na populacji dzieci z małą [ < 2500g], a w szczególności skrajnie małą [500-999g] urodzeniową masą ciała. Większość z tych pacjentów stanowią noworodki urodzone przedwcześnie. Ocena ich dojrzałości powinna być dokonywana w pierwszych godzinach życia zewnątrzmacicznego. Odniesienie jej do wyników pomiarów antropometrycznych, dostarcza podstawowych informacji mających wpływ na postępowanie z noworodkiem i rokowanie względem chorobowości oraz śmiertelności. Pourodzeniowej weryfikacji wieku płodowego, oszacowanego przez położników, służą różne skale oceny. Obecnie podstawową jest New Ballard Score. W określeniu prawidłowości wewnątrzmacicznego wzrastania, a precyzyjniej - w obiektywizacji obserwacji z okresu ciąży i z pierwszego badania fizykalnego, pomocne są odpowiednio dobrane siatki centylowe wymiarów i urodzeniowej masy ciała. Przydatność kliniczna krzywych wzrastania zależy od ich: reprezentatywności dla danej populacji, uwzględnienia szczególnych uwarunkowań (np. wcześniactwa, ilości płodów w danej ciąży), oraz aktualności – z uwzględnieniem trendów, w tym sekularnych. W Polsce, w standardach w neonatologii, zalecane do stosowania w praktyce klinicznej są siatki centylowe Fentona. Przy ich tworzeniu nie wykorzystywano danych z populacji dzieci z tego regionu. Nie mają one także oddzielnych krzywych dla noworodków z ciąż wielopłodowych. Istnieje zatem potrzeba stworzenia polskich siatek centylowych, reprezentatywnych dla noworodków z tej części Europy i uwzględniających zmiany zachodzące w naszym społeczeństwie w ostatnich dekadach. Optymalnie, powinny być sporządzone z uwzględnieniem wieku postkoncepcyjnego, płci oraz z rozgraniczeniem ilości płodów w danej ciąży. Wskazane byłoby także przeprowadzenie prospektywnego badania, służącego ich walidacji

Association of low ficolin-2 concentration in cord serum with respiratory distress syndrome in preterm newborns

IntroductionFicolin-2 is a serum pattern recognition molecule, involved in complement activation via the lectin pathway. This study aimed to investigate the association of ficolin-2 concentration in cord blood serum with complications related to premature birth.Methods546 premature neonates were included. The concentration of ficolin-2 in cord blood serum was determined by a sandwich TRIFMA method. FCN2 genetic variants were analysed with RFLP-PCR, allele-specific PCR, Sanger sequencing or allelic discrimination using TaqMan probes method.FindingsCord blood serum ficolin-2 concentration correlated positively with Apgar score and inversely with the length of hospitalisation and stay at Neonatal Intensive Care Unit (NICU). Multivariate logistic regression analysis indicated that low ficolin-2 increased the possibility of respiratory distress syndrome (RDS) diagnosis [OR=2.05, 95% CI (1.24-3.37), p=0.005]. Median ficolin-2 concentration was significantly lower in neonates with RDS than in premature babies without this complication, irrespective of FCN2 gene polymorphisms localised to promoter and 3’untranslated regions: for patients born &lt;33 GA: 1471 ng/ml vs. 2115 ng/ml (p=0.0003), and for patients born ≥33 GA 1610 ng/ml vs. 2081 ng/ml (p=0.012). Ficolin-2 level was also significantly lower in neonates requiring intubation in the delivery room (1461 ng/ml vs. 1938 ng/ml, p=0.023) and inversely correlated weakly with the duration of respiratory support (R=-0.154, p&lt;0.001). Interestingly, in the neonates born at GA &lt;33, ficolin-2 concentration permitted differentiation of those with/without RDS [AUC=0.712, 95% CI (0.612-0.817), p&lt;0.001] and effective separation of babies with mild RDS from those with moderate/severe form of the disease [AUC=0.807, 95% CI (0.644-0.97), p=0.0002].ConclusionLow cord serum ficolin-2 concentration (especially in neonates born at GA &lt;33 weeks) is associated with a higher risk of developing moderate/severe RDS, requiring respiratory support and intensive care

SITUATION OF EX-PRISONERS ON THE LABOUR MARKET

W artykule zaprezentowano wybrane zagadnienia dotyczące aktywizacji zawodowej byłych skazanych, opracowane na podstawie wyników badań ilościowych i jakościowych, związanych z omawianym tematem. W tekście dokonano analizy zasobów i deficytów w obszarze kompetencji społecznych i zawodowych byłych więźniów, ukazując przy tym postawy społeczne wobec skazanych i byłych skazanych. Artykuł porusza także tematykę roli organizacji rządowych i pozarządowych, wspierających byłych więźniów w procesie readaptacji społecznej.The article shows selected issues concerning vocational activation of ex-convicted. It contains results of qualitative and quantitative researches related to the presented subject. The article analyses the matter of resources and shortage in the area of social and professional abilities of ex-convicted. Moreover, it presents social attitude towards convicted and ex-convicted. There was special attention drawn to the role of governmental and non-governmental organisations, which support the process of social re-adaptation

Fathers’ imprisonment as perceived by their children

The author presents the results of a study on selected aspects of fathers’ imprisonment from the perspective of their children. The study included 72 children, aged 12 to 18 years, whose fathers were imprisoned in penal institutions in Poland. The analysis of results revealed that all of the children knew that their fathers were serving a prison sentence. Most children report unpleasant emotions related to this fact, such as regret, sadness, anger, and shame. On the other hand, the vast majority of the children understood that their parent had made a mistake and that they were bearing the consequences of their act. The vast majority of respondents maintained contact with their fathers (e.g., visitations, telephone calls, letters), but the frequency of these contacts was quite low. The children claimed that during contact with their fathers they experienced various emotions: from nervousness, sadness, and shame at where their parent was, to satisfaction with and joy at the possibility of meeting the father. The vast majority of prisoners’ children reported that the frequency and quality of their contact with the father was inadequate and suggested changes. Taking account of prisoners’ children’s perspective, the study encourages further local research addressing this issue

Photography in Polish poetry of the twenty century

Praca dotyczy funkcjonowania motywu fotografii w tekście poetyckim. Przykłady wierszy, na podstawie których pracowałam pochodzą z twórczości Wisławy Szymborskiej, Zbigniewa Herberta i Janusza Szubera. Praca składa się z trzech rozdziałów: pierwszy dotyczy funkcji szczegółu i jego wpływu na odbierany obraz literacko- fotograficzny; drugi dotyczy przemijalności życia, które zostaje zatrzymane na fotografiach; natomiast trzeci dotyczy funkcjonowania wartości, które zależne są od czasów, w których się je powołuje. Ponadto uzupełniona jest o zdjęcia dotyczące katastrofy Warld Trade Center z 2001 roku.The work concerns the functioning of the theme of photography in the poetic text. Examples of lines on which I worked derived from the works of Wislawa Szymborska, Zbigniew Herbert and Janusz Szuber. The work consists of three chapters: the first concerns the function of detail and its impact on the perceived image of literary and photographic; the second refers to the transience of life, which is retained in the photographs; and the third concerns the functioning values ​​that are dependent on the times in which they are appointed. In addition, supplemented by a photo on a disaster Warld Trade Center in 2001

Sensors to the Diagnostic Assessment of Anticancer and Antimicrobial Therapies Effectiveness by Drugs a with Pyrazine Scaffold

Treatment with pyrazine derivatives&mdash;antituberculosis pyrazinamide (PZA), anticancer bortezomib (BZM), and antifungal pyrazine-2-amidoxime (PAOX) and pyrazine-2-thiocarboxamide (PTCA)&mdash;is associated with side effects, as observed in the case of other therapeutic drugs. To prevent the side effects of pyrazine derivatives, researchers are working to develop a universal method that will detect these compounds in body fluids. There is a lack of literature data about voltammetric measurements with poly-L-amino acid-modified GCEs surfaces. The available reports describe the application of various modifications of these electrodes for the detection of different active substances of drugs; however, they do not indicate one particular method for the detection of drugs with a pyrazine skeleton. This research aimed to prepare three types of glassy carbon electrodes (GCEs) with modified surfaces by electropolymerization using 1, 10, and 100 mM solutions of L-glycine (Gly), L-alanine (Ala), L-lysine (Lys), respectively. The poly-amino acid coatings applied on GCE surfaces were analyzed in detail under a three-dimensional (3D) microscope and were used as chemosensors of four pyrazine drugs in stoichiometric tests. The results were compared with the measurements made on an unmodified GCE. To obtain reliable results, the linearity of measurements was also verified in the concentration gradient and appropriate scanning speed was chosen to achieve the most accurate measurements

CONVICTED PEOPLE’S CHILDREN

Uwięzienie jednego z członków rodziny pociąga za sobą negatywne skutki nie tylko dla funkcjonowania osoby skazanej ale także dla całego systemu rodzinnego. Niniejszy artykuł prezentuje wybrane elementy funkcjonowania dzieci rodziców pozbawionych wolności, z uwzględnieniem ich sytuacji emocjonalnej, wychowawczej i społecznej. Opracowanie zawiera także wnioski i postulaty dotyczące opisanej problematyki.The imprisonment of one of the members of the family has negativeconsequences not only for the functioning of the convicted person butalso for the entire family system. The article presents some elements of the functioning of children where the parents are deprived of their liberty, including demonstrating their emotional, educational and social needs. The material also contains conclusions and recommendations relating to the described topic