Pregnant woman infected with SARS-COV-2 – diagnosis and treatment

Introduction: COVID-19 is an infection caused by the new SARS-CoV-2 virus. In pregnant women with COVID-19, compared to non-pregnant women, there is an increased risk of a severe course of the infection. Pregnant women are more often hospitalized in the Intensive Care Unit and require mechanical ventilation. In the course of COVID-19 infection, pregnant women have a greater risk of miscarriage, premature birth or having a baby with low birth weight, compared to their healthy pregnancy peers. The aim of the study: To present, based on the available literature, the principles of management of a pregnant woman infected with SARS-CoV-2 virus. State of knowledge: The evidence of infection is the detection of the virus in the clinical specimen confirmed by PCR. Chest computer tomography can be useful in diagnosis, especially when the PCR test result is negative. Particular attention should be paid to pharmacological treatment, which should be both effective and safe for the fetus. Certain antiviral and anti-inflammatory drugs as well as anticoagulants drugs are used in COVID-19 therapy. Oxygen and fluid therapy is also important. The condition of the fetus should be monitored regularly. It is recommended to measure the fetal heart rate, perform cardiotocography, pregnancy ultrasound and assess the volume of amniotic fluid. The decision about the time and method of delivery should be made individually on the basis of obstetric indications and the maternal-fetal condition. Summary: The therapy of a pregnant patient infected with SARS-CoV-2 should be adjusted individually depending on the woman's health condition. In therapeutic interventions, the welfare of both the mother and the fetus should be taken into account

The role of obstetricians and neonatologists in childcare in the time of the COVID-19 pandemic

Introduction: The COVID-19 pandemic has caused numerous changes to the healthcare system, including care for the newborns. Aim of the study: The aim of the study was to create a clear set of recommendations used in the care of a newborn during the SARS-CoV-2 pandemic. State of knowledge: Despite the low risk of infection of the newborn in utero or during vaginal delivery, in rare cases there is a possibility of vertical transmission of the SARS-CoV-2 virus. Every newborn baby whose mother has been diagnosed with COVID-19 disease should be screened for infection. Suspected neonates should be isolated from healthy children and kept in quarantine until the test result is obtained. It is essential to constantly monitor your baby's health and be alert to any possible signs of infection. Medical personnel should ensure adequate protection when handling an infected newborn. A healthy infant whose mother is SARS-Cov-2 positive may be discharged home provided it is looked after by a healthy caregiver. Summary: New patterns of management in maternity and neonatal departments are associated with changes that may have a significant impact on the mother-child relationship. When making decisions aimed at reducing the spread of SARS-CoV-2 infection, it is necessary to seek solutions taking into account the needs of this particular group of patients

Stosowanie zofenoprilu u pacjentów po zawale serca

Inhibitory konwertazy angiotensyny (ACE) są grupą leków powszechnie stosowanych w terapii nadciśnienia tętniczego. Wyniki licznych randomizowanych badań klinicznych wskazują, że dzięki dodatkowym właściwościom pozahipotensyjnym leki te zmniejszają ryzyko pozawałowej przebudowy mięśnia sercowego i niewydolności serca. Przesłanki patofizjologiczne, różnice farmakologiczne oraz wyniki dużych badań klinicznych sugerują możliwość braku efektu klasy w obrębie inhibitorów ACE. Zgodnie z wytycznymi Polskiego Towarzystwa Nadciśnienia Tętniczego z 2019 roku preferowanymi inhibitorami ACE u pacjentów z nadciśnieniem tętniczym i chorobą niedokrwienną serca są perindopril, ramipril i zofenopril. W badaniach head-to-head, porównujących inhibitory ACE, wykazano, że stosowanie zofenoprilu u pacjentów z zawałem serca prowadzi do zmniejszenia lewego przedsionka, wymiaru końcoworozkurczowego lewej i prawej komory, grubości ścian lewej komory oraz wzrostu frakcji wyrzutowej i frakcji skracania lewej komory

COVID-19 vaccination in pregnant and lactating women

Introduction: The COVID-19 pandemic significantly changed the lifestyle of pregnant women. Pregnant women with COVID-19 are more likely to suffer from severe disease, as well as unfavorable pregnancy and childbirth. Currently, there is no causal treatment for this disease available, so attention should be paid to preventing infection with vaccines. Aim of the study: A review of the literature on the influence of COVID-19 vaccines on the course of pregnancy and summary of recommendations regarding the use of COVID-19 vaccines during pregnancy and breastfeeding.  State of knwoledge: Three types of COVID-19 vaccines are most commonly used: mRNA vaccines, vector vaccines as well as subunit vaccines. In preclinical developmental and reproductive toxicity studies in animal models, there were no alarming safety signals, and observations of vaccinated pregnant women did not reveal any complications with respect to the course of pregnancy and development of the fetus. No cases of neonatal death have been reported in the first 28 days after birth. Most of the side effects following vaccination, such as injection site pain or tenderness, fatigue, fever or muscle pain, were moderate and resolved within 24 hours. The current research results confirm a positive immune response in pregnant women. Moreover, it is important that the presence of antibodies in the umbilical cord blood makes it possible to protect and reduce the risk of SARS-CoV-2 infection of the newborn. Summary: All pregnant women, irrespective of trimester, and breastfeeding mothers are advised to administer a booster dose of the COVID-19 vaccine within an appropriate period of time after the primary vaccination schedule

Poland’s Voivodeships and Poviats and the Geographies of Knowledge: Addressing Uneven Human Resources

In a postindustrial economic world, information economies are key components in local, regional and national development. These are service economies, built on the production, consumption and dissemination of information, including education, health care, outsourcing, tourism, sustainability and related human welfare services. We explore the geography/knowledge intersections in Poland’s voivodeships and poviats by using the volumes of information or hyperlinks about selected information economies. Google hyperlinks are electronic knowledge data that can be mapped to highlight the areas of most and least information about certain subject categories. While some mapping results are expected, such as Warsaw and Krakow, being prominent, in other regions there are unexpected gaps within eastern, northern and southern Poland, including some places near major metropolitan centers. There is a significant difference between the cities with poviat rights, which stand out in the number of information on items comparing to the poviats that surround them. The majority of poviats in Mazowieckie voivodeship are surprisingly recognized as core areas on the map of knowledge, nevertheless they are considered undeveloped from the economic point of view

Ocena skuteczności leczenia hipotensyjnego pacjentów z nadciśnieniem tętniczym i chorobą niedokrwienną serca lub ekwiwalentem wieńcowym

Introduction. Arterial hypertension (AH) is a well-known cardiovascular risk factor. Currently, in Poland, approximately 32% of adults suffer from AH, and only 26% of them are treated successfully. The study aims to determine the incidence of atherosclerosis risk factors and their influence on the effectiveness of hypotensive treatment in the population of patients with AH and coexisting coronary artery disease (CAD) or coronary equivalent. Material and methods. The study included 204 adults. The inclusion criteria were: diagnosis of AH with coexisting a diagnosis of CAD (138 people) or coronary equivalent defined as high (≥ 5%) atherosclerosis-related risk of death in 10-year prognosis, estimated using the EURO SCORE scale (66 people). During observation, pharmacological and nonpharmacological treatments were modified according to the current AH treating standards. After 6 months of observation, the effectiveness of AH control was assessed. Results. Multivariate logistic regression analysis revealed that main factors affecting poor blood pressure control after six months of observation were: obesity, age > 65 years, LDL cholesterol level > 130 mg/dL. Moreover, systolic blood pressure (SBP) < 140 mmHg was more frequent in patients with diabetes mellitus. After six months of therapy, good control of SBP was found in 42.7% of patients and normal values of diastolic blood pressure (DBP) — in 65.2 % of patients. Conclusion. Independent risk factors for poor control of blood pressure were: high level of LDL-cholesterol, age > 65 years and female sex. Paradoxically, diabetes was not a risk factor for poor control of hypertension. The introduction of combined hypotensive and lipid-lowering drugs should contribute to a better control of hypertension in Poland.Wstęp. Nadciśnienie tętnicze (AH) jest uznanym czynnikiem ryzyka schorzeń układu sercowo-naczyniowego. Obecnie 32% Polaków ma stwierdzone nadciśnienie tętnicze, z czego tylko 26% jest skutecznie leczonych. Celem pracy było określenie częstości występowania czynników ryzyka miażdżycy i ich wpływu na skuteczność leczenia hipotensyjnego w populacji pacjentów z AH i współistniejącą chorobą niedokrwienną serca (CAD) lub ekwiwalentem wieńcowym. Materiał i metody. Kryterium włączenia do badania dla 204 osób stanowiło rozpoznanie HA (204 osoby), rozpoznanie CAD (138 osób) lub obecność ekwiwalentu wieńcowego rozumianego jako wysokie (≥ 5%) ryzyko zgonu z powodu miażdżycy w ciągu najbliższych 10 lat, szacowane według skali oceny ryzyka SCORE (66 osób). W czasie obserwacji modyfikowano postępowanie niefarmakologiczne i farmakologiczne zgodnie z obowiązującymi standardami leczenia AH, ponownie oceniając uzyskaną skuteczność kontroli AH po 6 miesiącach. Wyniki. Analiza wieloczynnikowa wykazała, że niezależnymi czynnikami wpływającymi na brak prawidłowej kontroli wartości ciśnienia tętniczego po 6 miesiącach były: otyłość, wiek > 65 lat, stężenie cholesterolu frakcji LDL > 130 mg/dl. Wykazano również, że pacjenci z cukrzycą łatwiej osiągali wartości skurczowego ciśnienia tętniczego (SBP) < 140 mm Hg. Po 6 miesiącach terapii zadowalającą kontrolę SBP odnotowano u 42,7%, a rozkurczowego ciśnienia tętniczego u 65,2% pacjentów. Wnioski. Niezależnymi czynnikami ryzyka braku prawidłowej kontroli wartości ciśnienia tętniczego były: podwyższone stężenia cholesterolu frakcji LDL, otyłość, wiek > 65 lat i płeć żeńska. Paradoksalnie, cukrzyca nie była czynnikiem zwiększającym ryzyko nieprawidłowej kontroli wartości ciśnienia tętniczego. Wprowadzenie skojarzonych preparatów hipotensyjno-hipolipemizujących powinno w szczególny sposób przyczynić się do lepszej kontroli nadciśnienia tętniczego w Polsce

Prevalence of arterial hypertension in patients with atrial fibrillation undergoing ablation — a prospective, cohort study

Background Arterial hypertension is one of the major cofounders in the development of atrial fibrillation (AF) and hypertension is commonly found in AF patients. The aim of the study was to establish the prevalence of arterial hypertension in patients undergoing ablation, who are relatively young and healthy group of AF patients. Material and methods 266 consecutive patients admitted for AF ablation were screened for arterial hypertension. All patients had their blood pressure measured on admission by, prior to the ablation procedure by a qualified physician, according to the current guidelines. Also, medical records of patients were reviewed for the previous diagnosis of hypertension or taking hypotensive agents. Results The study group was predominantly male (65.0%; mean age 57.6 ± 10.1 years). Mean body mass index was 29.7 ± 5.0 kg/m2. Paroxysmal AF was present in 69.5% of patients. In 72.9% of patients hypertension was diagnosed previously. On admission, mean systolic and diastolic blood pressure values were 131.7 ± 16.7 and 80.7 ± 11.1 mm Hg. 123 (46.2%) patients had systolic and/or diastolic blood pressure values respectively > 140 and/or > 90 mm Hg. Patients with previously diagnosed hypertension were older (58.7 ± 8.7 vs 54.6 ± 12.7 years; p = 0.003), had higher BMI (30.3 ± 5.0 vs 28.1 ± 4.8 kg/m2; p = 0.002), and more often history of diabetes (10.8% vs 1.4%; p = 0.03) compared to non-hypertensive group. There were no differences in terms of history of dyslipidaemia, stroke, myocardial infarction or family history of cardiovascular disease. Conclusions In patients with AF undergoing ablation procedure, prevalence of diagnosed arterial hypertension is very high, much higher than in the general population. Nevertheless, majority of patients meet the criteria for adequate blood pressure control

Przewidywanie nagłego zgonu sercowego na podstawie 12-odprowadzeniowego zapisu EKG

Sudden cardiac death (SCD), which is often the first manifestation of cardiovascular disease, is defined as a non-traumatic, unexpected fatal event occurring within one hour of the onset of symptoms in an apparently healthy subject. According to the current guidelines, implantable cardioverter-defibrillator therapy is recommended for the primary prevention of SCD among patients with a reduced (i.e. less than 75/min, prolonged QTc interval (> 450 ms for men, > 460 ms for women), QRS-T angle > 90 degrees, delayed QRS transition zone (> V4), prolonged Tpeak-to-Tend (TpTe) > 89 ms and left ventri­cular hypertrophy (according to Sokolow-Lyon or Cornell criteria). This novel ECG risk score could be particularly effective for patients with left ventricular ejection fraction > 35% where risk stratification is currently unavailable.Nagły zgon sercowy (SCD), będący niejednokrotnie pierwszą manifestacją choroby układu sercowo-naczyniowego, definiuje się jako niespodziewany, śmiertelny incydent niezwiązany z urazem, powodujący zgon w ciągu godziny od początku objawów u pozornie zdrowej osoby. W aktualnych wytycznych w prewencji pierwotnej SCD zaleca się implantację układu kardiowertera-defibrylatora w grupie pacjentów z obniżoną (< 35%) frakcją wyrzutową lewej komory (LVEF). Autorzy Oregon Sudden Unexpected Death Study zaproponowali nowy, elektrokardiograficzny model oceny ryzyka SCD uwzględniający: spoczynkową czynność serca powyżej 75/min, wydłużony odstęp QTc (> 450 ms u mężczyzn, > 460 ms u kobiet), kąt QRS-T ponad 90 stopni, opóźnioną strefę przejściową zespołu QRS (> V4), wydłużony czas mierzony od szczytu załamka T do jego końca (TpTe, Tpeak-to-Tend) ponad 89 ms oraz elektrokardiograficzne cechy przerostu mięśnia lewej komory (wskaźnik Sokołowa-Lyona lub Cornella). Omawiany model może mieć szczególne znaczenie u pacjentów z LVEF przekraczającą 35% — grupy, dla której nie opracowano zwalidowanej skali ryzyka wystąpienia SCD

Does obstructive sleep apnoea influence BNP concentrations in atrial fibrillation patients?

Background B-type natriuretic peptide (BNP) is a biomarker commonly used in diagnosing and assessing prognosis in heart failure patients. Its concentration can be elevated in various conditions associated with excessive heart wall stretch including atrial fibrillation and obstructive sleep apnoea (OSA). The aim of the study was to assess if BNP levels in atrial fibrillation patients are associated with the value of apnoea-hypopnea index (AHI). Material and methods Study population were consecutive patients with atrial fibrillation, who underwent overnight sleep study, and had blood taken for BNP concentration assessment. Subsequently, patients were divided into group according to AHI: Group I (< 5/h), Group II (5–15/h), and Group III (> 15/h). Results Analysis covered 158 patients (males, 64.6%; mean age, 58.3 ± 9.2 years). 83 (52.5%) patients had AHI < 5/h, Group II consisted of 44 (27.9%), and Group III of 31 (19.6%) patients. Mean BMI and neck circumference rose with AHI value severity. BMI was as follows 28.7 ± 4.3, 30.7 ± 4.7, and 31.8 ± 5.2 kg/m2 (p for trend < 0.01), while neck circumference was 39.2 ± 3.5, 41.5 ± 3.9, and 41.2 ± 3.2 cm, (p for trend = 0.001) for Group I, II, and III respectively. BNP concentration was the lowest in Group I (53.0 ± 57.0 pg/mL), in middle ranges in Group II (69.2 ± 89.9 pg/mL), and the highest in patients with AHI > 15 (104.0 ± 150.8 pg/mL; p for trend = 0.03). Conclusions Majority of patients with atrial fibrillation have AHI < 5/h and these generally have lower BMI, and neck circumference. Patients who have AHI exceeding ≥ 5/h BNP levels tend to be elevated, and its values rise along with AHI

Czy możliwe jest wybranie „najlepszego” hipotensyjnego połączenia lekowego?

  Currently, approximately one third of adult Poles suffers from hypertension (HT). Most of current hy­potensive drugs in monotherapy lowers blood pres­sure values of less than 20/10 mm Hg. In most of the patients, this reduction is not sufficient. That is way, more and more is said about the use of hypotensive drugs consisting of several components, because due to their complimentary actions, the effectiveness of antihypertensive treatment is increased and better doctor-patient collaboration and treatment adherence is assured. The article presents clinical aspects of the use of telmisartan (“the best” angiotensin receptor blocker) with amlodipine, widely used calcium chan­nel antagonist.Około 1/3 dorosłych Polaków choruje na nadciśnienie tętnicze (HT). Większość współczesnych leków hipotensyjnych stosowanych pojedynczo wykazuje efekt hipotensyjny związany z redukcją wartości ciśnienia tętniczego w zakresie znacznie mniejszym niż 20/10 mmHg. U wielu pacjentów nie jest to redukcja wystarczająca. Dlatego też, coraz więcej mówi się o stosowaniu preparatów wieloskładnikowych, które dzięki wzajemnie uzupełniającemu się działaniu zawartych w nich substancji oraz pozytywnym wpływie na współpracę na linii lekarz — pacjent zwiększają skuteczność leczenia hipotensyjnego. W artykule przedstawiono kliniczne aspekty stosowania preparatu złożonego z telmisartanu, można powiedzieć „najlepszego” z sartanów, z amlodipiną, powszechnie stosowanym antagonistą wapnia