(Im)permanence of Polish Constitutionalism: in Search of an Optimal Vision of the State

Poland is a state where the elites’ strong attachment to the idea of a written constitution prevails, as evidenced by the special place held by the Government Act of 3 May 1791 in political and academic discourse. The constitutional awareness of the citizens is also growing year after year as they are increasingly reliant on the provisions of the current Constitution of 2 April 1997, seeking the protec- tion of their rights and freedoms before the courts. However, the period between 1791 and 1997 is not a constitutional vacuum. At that time, although as many as eight Basic Laws1 were applicable on Polish lands, some of them were imposed on Poles against their will. In total, the ‘mathematical’ balance of constitutional experience, simplified to some extent, is as follows: 10 constitutional acts are attributable to a period of 206 years (counting from the adoption of the oldest until the adoption of the youngest Constitution); thus, the average lifespan of each of them is 20 years and 7 months. If we change the frame of reference and consider the period between 1791 and 2021, the average validity of the constitution on Polish lands increases to 23 years. If only the validity of individual Basic Laws is taken as a reference, the average decreases to approximately 12 years. In political practice, as discussed below, Polish constitutions were created slowly but quickly collapsed

Relationship between primary aldosteronism and obstructive sleep apnoea, metabolic abnormalities and cardiac structure in patients with resistant hypertension

Wstęp: Celem analizy była ocena związku pomiędzy pierwotnym hiperaldosteronizmem (PA) i obturacyjnym bezdechem sennym (OBS)w relacji do nasilenia zaburzeń metabolicznych i zmian struktury i funkcji lewej komory (LV) serca u chorych z prawdziwie opornymnadciśnieniem tętniczym (OPNT) włączonych do badania RESIST-POL.Materiał i metody: Badaniem objęto 204 chorych (123 M, 81 K, średni wiek 48,4 lat) z OPNT, eGFR > 60 ml/min/1,73 m2 i bez rozpoznanejwcześniej cukrzycy. Istotny klinicznie OBS zdefiniowano, jako wskaźnik bezdechów i oddechów spłyconych (AHI) > 15/h. Ocenionoskładowe zespołu metabolicznego (MS). W badaniu echokardiograficznym oceniono: przerost LV (LVH), koncetnryczną przebudowę LV(RWT > 0,45), prędkość fali E’, wskaźnik E/E’ i globalne odkształcenie włókien podłużnych (GLS).Wyniki: PA rozpoznano u 32 chorych (15,7%). OBS występował częściej u chorych z PA (59,4 v. 42,4%; p = 0,058). Chorych podzielonona cztery grupy: PA+ OBS+ , PA+ OBS-, PA-OBS+ and PA– OBS–. Świeżo wykryta cukrzyca, podwyższone stężenie glukozy na czczoi podwyższone stężenie glukozy po obciążeniu glukozą występowały najczęściej w grupie PA+ OBS +. OBS związany był z częstszymwystępowaniem koncentrycznej przebudowy LV, podczas gdy PA związany był z wyższą masą LV i częstszym występowaniem LVH.W grupach PA+ OBS+ I PA+ OBS – najczęstszymi typami geometrii LV były odpowiednio: przerost koncentryczny (68,4%) i przerostekscentryczny (54,5%). Prędkość fali E’ była najniższa i wskaźnik E/E’ był najwyższy w grupie PA+ OBS +. GLS był niższy u chorych zOBS w porównaniu z chorymi bez OBS.Wnioski: Zarówno zaburzenia metaboliczne jak i nasilenie zmian narządowych były najbardziej wyrażone u chorych z OPNT, u którychwspółistniały PA i OBS. PA i OBS w różny sposób wpływały na geometrię LV.(Endokrynol Pol 2013; 64 (5): 363–367)Introduction: The aim of this study was to evaluate in patients with resistant hypertension (RHTN) enrolled in the RESIST-POL study the relationshipbetween primary aldosteronism (PA) and obstructive sleep apnoea (OSA) and their effect on metabolic abnormalities and cardiac structure.Material and methods: We included 204 patients (123 M, 81 F, mean age 48.4 yrs) with true RHTN, eGFR > 60 mL/min/1,73 m2 and no knowndiabetes. OSA was defined as an apnoea/hypopnoea index of 15/h or more. Metabolic syndrome components were assessed. On echocardiography,left ventricular hypertrophy (LVH), concentric remodelling (RWT > 0.45), E’ velocity, E/E’ index and global strain (GLS) were evaluated.Results: PA was diagnosed in 32 patients (15.7%). OSA occurred more frequently in patients with PA (59.4 v. 42.4%; p = 0.058). Patientswere divided into four groups: PA+ OSA+ , PA+ OSA-, PA-OSA+ and PA–OSA–. Newly diagnosed diabetes, impaired glucose toleranceand increased fasting glucose were most frequent in the PA+ OSA+ group compared to other groups. The presence of OSA was associatedwith concentric remodelling, and the presence of PA was associated with higher left ventricular mass and higher frequency of leftventricular hypertrophy. In the PA+ OSA+ and PA+ OSA- groups, the most frequent geometry patterns were concentric hypertrophy(68.4%) and eccentric hypertrophy (54.5%) respectively. E’ velocity was lowest and E/E’ was highest in PA+ OSA+ compared to othergroups. GLS was lower in patients with OSA compared to those without OSA.Conclusions: Both metabolic abnormalities and target organ damage are more pronounced in patients with RHTN, PA and OSA. OSAand PA influence differently left ventricular geometry.(Endokrynol Pol 2013; 64 (5): 363–367

Pharmacotherapy of atrial fibrillation in COVID-19 patients

The coronavirus pandemic disease 2019 (COVID-19) has changed the face of contemporary medicine. However, each and every medical practitioner must be aware of potential early and late complications of COVID-19, its impact on chronic diseases — especially ones as common as atrial fibrillation (AF) — and the possible interactions between patients’ chronic medications and pharmacotherapy of COVID-19. Patients with AF due to comorbidities and, often, elderly age are assumed to be at a higher risk of a severe course of COVID-19. This expert consensus summarizes the current knowledge regarding the pharmacotherapy of AF patients in the setting of the COVID-19 pandemic. In general, anticoagulation principles in quarantined or asymptomatic individuals remain unchanged. Nevertheless, it is advisable to switch from vitamin K antagonists to non-vitamin K antagonist oral anticoagulants (NOACs) whenever possible due to their consistent benefits and safety with fixed dosing and no monitoring. Additionally, in AF patients hospitalized due to mild or moderate COVID-19 pneumonia, we recommend continuing NOAC treatment or to switching to low-molecular-weight heparin (LMWH). On the other hand, in severely ill patients hospitalized in intensive care units, intravenous or subcutaneous dosing is preferable to oral, which is why the treatment of choice is either LMWH or unfractionated heparin. Finally, particularly in critical scenarios, the treatment strategy in COVID-19 patients with AF should be individualized based on possible interactions between anticoagulants, antiarrhythmics, antivirals, and antibiotics. In this consensus, we also discuss how to safely perform COVID-19 vaccination in anticoagulated AF patients

Renal resistive index in patients with true resistant hypertension: results from the RESIST-POL study

Background: Increased ultrasound Doppler renal resistive index (RRI) is a marker of atherosclerotic and hypertensive organ damage both at renal and systemic level. Aim: To evaluate RRI in patients with true resistant hypertension (TRHT) in the RESIST-POL study. Methods: From 204 patients diagnosed with TRHT in the RESIST-POL study, 151 patients (90 male, 61 female, mean age: 47.7 ± 10.4, range: 19–65 years) without secondary hypertension were included into the analysis. All patients were charac­terised by estimated glomerular filtration rate > 60 mL/min/1.73 m2 and no history of diabetes prior to the study. As a control group we included 50 age- and gender-matched patients (35 male, 15 female, mean age: 46.8 ± 10.4, range: 19–65 years) with primary well-controlled hypertension. The groups also did not differ in respect to the number of years of known history of hypertension. The RRIs were evaluated on the basis of the Doppler ultrasound examination. Increased RRI was defined as ≥ 0.7. Results: Both groups did not differ in terms of renal function. Patients with TRHT were characterised by higher RRI as com­pared with the group with well-controlled hypertension (0.62 ± 0.05 vs. 0.60 ± 0.05, p < 0.05). In the TRHT group RRI correlated significantly with age, clinic and ambulatory blood pressure measurement, diastolic blood pressure (DBP) levels, as well as with clinic pulse pressure (PP) (r = 0.297; p = 0.001), with daytime (r = 0.355; p < 0.001) and nighttime (r = 0.313; p < 0.001) PP, and with fasting glucose concentration (r = 0.215; p = 0.008) and E/E’ ratio (r = 0.289; p = 0.001) on echocardiography. RRI values were significantly higher in TRHT patients with newly diagnosed diabetes as compared with TRHT patients without diabetes (0.65 ± 0.05 vs. 0.62 ± 0.05, p = 0.022). Age, daytime DBP, daytime PP, and E/E’ ratio but not fasting glucose concentration correlated independently with RRI in the model. Among patients with TRHT, patients with increased RRI were characterised by older age (52.2 ± 4.9 vs. 47.3 ± 10.6 years, p = 0.012), higher body mass index (32.8 ± 6.0 vs. 29.7 ± 4.5 kg/m2, p = 0.034), as well as lower daytime and nighttime DBP values and lower daytime and night­time heart rate, as compared to patients with RRI < 0.7. The TRHT patients with increased RRI as compared to patients with RRI < 0.7 were characterised also by higher daytime and nighttime PP. Both groups did not differ in respect of renal function. Conclusions: Our study showed that the patients with TRHT were characterised by significantly higher RRI values as compared to the subjects with well-controlled hypertension. It may also be suggested that in the subjects with TRHT renal vascular resis­tance is related to blood pressure values, selected echocardiographic abnormalities, and some surrogate markers for metabolic and cardiovascular events, including fasting glucose plasma concentration and PP, respectively.Wstęp: Postuluje się, że zwiększony ultrasonograficzny wskaźnik oporowości przepływu w tętnicach wewnątrznerkowych (RRI) może być wykładnikiem rozwoju miażdżycy i powikłań narządowych nadciśnienia tętniczego zarówno w obrębie nerek, jak i całego organizmu. Cel: Celem pracy była ocena RRI i czynników związanych z jego wyższymi wartościami u chorych z prawdziwie opornym nadciś­nieniem tętniczym (OPNT) włączonych do badania RESIST-POL. Metody: Spośród 204 chorych z prawdziwie OPNT włączonych do badania RESIST-POL analizą objęto 151 osób (90 mężczyzn, 61 ko­biet, średni wiek: 47,7 ± 10,4 roku, zakres: 19–65 lat), u których wykluczono wtórne postaci nadciśnienia tętniczego. Wszyscy chorzy charakteryzowali się zachowaną funkcją nerek (estymowany wskaźnik filtracji kłębuszkowej [eGFR] > 60 ml/min/1,73 m2) i brakiem wywiadu cukrzycy rozpoznanej przed włączeniem do badania. Grupę kontrolną stanowiło 50 dobranych pod względem wieku i płci pacjentów z dobrze kontrolowanym, pierwotnym nadciśnieniem tętniczym (35 mężczyzn, 15 kobiet, średni wiek: 46,8 ± 10,4 roku, zakres: 19–65 lat). Oceniane grupy nie różniły się także znanym czasem trwania nadciśnienia tętniczego. RRI oceniono w badaniu doplerowskim tętnic nerkowych. Za wartość podwyższoną uznano RRI ≥ 0,7. Wyniki: Chorzy z prawdziwie OPNT charakteryzowali się wyższym RRI w porównaniu z pacjentami z dobrze kontrolowanym nadciśnieniem tętniczym pierwotnym (0,62 ± 0,05 vs. 0,60 ± 0,05; p < 0,05). Porównywane grupy nie różniły się pod względem parametrów funkcji nerek — stężenia kreatyniny w osoczu (78,6 ± 17,7 vs. 81,1 ± 16,1 μmol/l; p = 0,39) i eGFR (92,2 ± 16,1 vs. 93,9 ± 18,8 ml/min/1,73 m2; p = 0,54). W grupie chorych z prawdziwie OPNT wartości RRI korelowały istotnie z: wiekiem, wartościami rozkurczowego ciśnienia tętniczego (DBP) i ciśnienia tętna w pomiarach klinicznych oraz w całodobowej rejestracji ciśnienia tętniczego, jak również ze stężeniem glukozy na czczo (r = 0,215; p = 0,008) oraz ze wskaźnikiem E/E’ (r = 0,289; p = 0,001) w badaniu echokardiograficznym. Wiek, wartości DBP oraz ciśnienia tętna z okresu dnia w całodobowej rejestracji oraz wskaźnik E/E’, ale nie stężenie glukozy na czczo, korelo­wały niezależnie z RRI w analizie wieloczynnikowej w grupie chorych z prawdziwie OPNT. Podwyższony RRI stwierdzono u 11 chorych z prawdziwie OPNT (7,3%) i u 1 pacjenta z dobrze kontrolowanym nadciśnieniem tętniczym pierwotnym (2%). Chorzy z prawdziwie OPNT z podwyższonym RRI w porównaniu z pacjentami z prawdziwie OPNT i prawidłowym RRI charakteryzowali się starszym wiekiem (52,2 ± 4,9 vs. 47,3 ± 10,6 roku; p = 0,012), wyższym wskaźnikiem masy ciała (32,8 ± 6,0 vs. 29,7 ± 4,5 kg/m2; p = 0,034), a także niższymi wartościami DBP z okresu dnia i nocy oraz wyższym ciśnieniem tętna z okresu dnia i nocy w całodobowej rejestracji ciśnienia tętniczego. Chorzy z prawdziwie OPNT z podwyższonym i prawidłowym RRI nie różnili się pod względem stężenia kreatyniny oraz eGFR. Wnioski: Wyniki wskazują, że chorzy z prawdziwie OPNT mogą się charakteryzować istotnie wyższymi wartościami RRI w porów­naniu z pacjentami z dobrze kontrolowanym nadciśnieniem tętniczym pierwotnym, jak również że wartości RRI u chorych z praw­dziwie OPNT mogą korelować z wartościami ciśnienia tętniczego i ciśnienia tętna oraz z wybranymi parametrami metabolicznymi i echokardiograficznymi

Metabolic syndrome — a new definition and management guidelines

The joint position paper by Polish Society of Hypertension, Polish Society for the Treatment of Obesity, Polish Lipid Association, Polish Association for Study of Liver, Polish Society of Family Medicine, Polish Society of Lifestyle Medicine, Division of Prevention and Epidemiology Polish Cardiac Society, “Club 30” Polish Cardiac Society, and Division of Metabolic and Bariatric Surgery Society of Polish Surgeons Reviewers: Agnieszka Olszanecka, Krzysztof J. Filipia

Out-of-hospital cardiac arrest: Do we have to perform coronary angiography?

Out-of-hospital cardiac arrest (OHCA) remains a leading cause of global mortality, while survivors are burdened with long-term neurological and cardiovascular complications. OHCA management at the hospital level remains challenging, due to heterogeneity of OHCA presentation, the critical status of OHCA patients reaching the return of spontaneous circulation (ROSC), and the demands of post ROSC treatment. The validity and optimal timing for coronary angiography is one important, yet not fully defined, component of OHCA management. Guidelines state clear recommendations for coronary angiography in OHCA patients with shockable rhythms, cardiogenic shock, or in patients with ST-segment elevation observed in electrocardiography after ROSC. However, there is no established consensus on the angiographic management in other clinical settings. While coronary angiography may accelerate the diagnostic and therapeutic process (provided OHCA was a consequence of coronary artery disease), it might come at the cost of impaired post-resuscitation care quality due to postponing of intensive care management. The aim of the current statement paper is to discuss clinical strategies for the management of OHCA including the stratification to invasive procedures and the rationale behind the risk-benefit ratio of coronary angiography, especially with patients in critical condition

Forward-central two-particle correlations in p-Pb collisions at root s(NN)=5.02 TeV

Two-particle angular correlations between trigger particles in the forward pseudorapidity range (2.5 2GeV/c. (C) 2015 CERN for the benefit of the ALICE Collaboration. Published by Elsevier B. V.Peer reviewe