Górnośląskie Centrum Medyczne

Europejskie Towarzystwo Kardiologiczne (ESC, European Society of Cardiology ) oraz Europejskie Towarzystwo Miażdżycowe (EAS, European Atherosclerosis Society ) regularnie publikują wytyczne dotyczące postępowania w zaburzeniach lipidowych. W 2025 roku przedstawiono aktualizację wytycznych ESC/EAS z 2019 roku. Najnowszy dokument powinien przedstawiać całościową rewizję dotychczas obowiązujących wytycznych, ten ma jednak charakter ograniczonego objętościowo update’u, co budzi wątpliwości w kontekście 6 lat, które upłynęły od poprzedniej edycji zaleceń. Chociaż aktualizacja zawiera pewne istotne i oczekiwane modyfikacje, autorzy pominęli część dostępnych, wiarygodnych dowodów naukowych oraz danych klinicznych, co w kilku obszarach prowadzi do formułowania zaleceń budzących kontrowersje i potencjalnie trudnych do zastosowania w codziennej praktyce. Celem niniejszego opracowania jest krytyczna analiza wybranych fragmentów aktualizacji ESC/EAS 2025 dotyczących leczenia hipertriglicerydemii oraz przedstawienie autorskiej oceny rekomendacji w świetle aktualnej wiedzy naukowej i doświadczeń klinicznych, ze szczególnym uwzględnieniem ich potencjalnych implikacji dla realnego postępowania terapeutycznego.

Przedstawiono opis przypadku 71-letniej pacjentki, która została przyjęta na oddział intensywnej terapii (OIT) z powodu ostrej niewydolności oddechowej wywołanej zapaleniem płuc po zabiegu laparotomii. Ze względu na ostrą niewydolność narządową w przebiegu zakażenia, u pacjentki rozpoznano sepsę. Pacjentka była obciążona wielochorobowo: migotaniem przedsionków, nadciśnieniem tętniczym, cukrzycą typu 2, hiperurykemią oraz otyłością [wskaźnik masy ciała (BMI, body mass index) 47 kg/m²]. Przy przyjęciu na OIT rozpoznano również niedokrwistość zapalną z niedoborem żelaza. W związku z tym wdrożono doustną suplementację nowym preparatem żelaza sukrosomalnego. Po siedmiu dniach uzyskano istotną poprawę parametrów hematologicznych. Warto zaznaczyć, że niedokrwistość często występuje u pacjentów po zabiegach chirurgicznych, zwiększając ryzyko powikłań, wydłużając hospitalizację i obniżając jakość życia. Niedokrwistość pooperacyjna może wynikać z utraty krwi, upośledzenia erytropoezy wywołanego stresem chirurgicznym oraz niedoborem żelaza. Ponadto uogólniona reakcja zapalna, związana na przykład z zabiegiem operacyjnym lub sepsą, może zmniejszać wchłanianie żelaza w jelicie. Żelazo sukrosomalne może stanowić alternatywę dla dożylnych preparatów żelaza u pacjentów z uogólnioną reakcją zapalną. Ze względu na łatwiejsze wchłanianie i lepszą tolerancję ta postać żelaza stanowi również obiecującą alternatywę dla tradycyjnych doustnych preparatów żelaza w populacji pacjentów bez cech uogólnionego zapalenia.

Introduction: Plastic pollution, especially in the form of microplastics (MPs), is a growing global health concern. Due to their small size and chemical properties, MPs can enter the human body via ingestion, inhalation, or dermal absorption. Beyond accumulating in organs such as the lungs, liver, and kidneys, MPs have also been found in reproductive tissues. Aim: The aim of this review is to evaluate current evidence on the effects of MPs on male and female reproductive systems. Materials and Methods: A literature review of 57 studies published between 2004 and 2025 was conducted. Of these, 41 were from 2020–2025 and 39 were original research. The selection included in vivo and in vitro experiments, as well as human observational studies addressing exposure, tissue accumulation, toxicity, and reproductive outcomes. Results: Microplastics have been detected in both male and female reproductive organs. In females, MPs were primarily found in the placenta, follicular fluid, and endometrial tissue, and were associated with hormonal imbalances, impaired folliculogenesis, reduced oocyte quality, and endometrial dysfunction. In males, MPs mainly affect sperm quality, leading to sperm DNA damage. Decreased testosterone levels and testicular abnormalities were also observed. In vivo studies have shown that the mechanism of MP-induced reproductive toxicity involves oxidative stress, inflammation, and hormonal disruption. Conclusions: Microplastics may pose a serious threat to reproductive health, as confirmed by numerous in vivo studies. Alarmingly, the amount of evidence in humans is also increasing. Therefore, further research is needed to assess the long-term effects and to develop effective preventive strategies.

Both in Poland and worldwide, an increase in the number of smartphone users has been observed. It is estimated that two-thirds of the global population uses them. Smartphones significantly enhance many aspects of daily life. However, it is important to be aware that improper use of these devices can lead to negative health effects, both mental and physical. Adhering to digital hygiene principles can greatly reduce the risk of various ailments, which will undoubtedly improve users' quality of life. The aim of the study was to assess behaviors related to smartphone use in the context of digital hygiene among medical students. The study was conducted with a diagnostic survey method. The technique used was a questionnaire, and the tool was a validated Digital Hygiene Self-Assessment Questionnaire developed by Bigaj and Woynarowska. The study group consisted of 71 individuals. Data analysis was conducted using Google Sheets, MS Excel, and SPSS software. Statistical analysis included Spearman's rho correlation coefficient and the Mann-Whitney test. Most respondents described their daily smartphone usage time as long. Just over 73% of those surveyed reported experiencing negative effects from using the device (n=52). The most common behaviors related to digital hygiene included limiting the number of notifications (n=28, 39.4%), deleting unused apps (n=25, 35.2%), and avoiding keeping the phone with them all the time (n=17, 23.9%). Extensive daily smartphone usage may have negative health implications. Respondents are aware of the fact that they use smartphones too frequently, and their digital hygiene habits pose health risks. Systematic educational initiatives are necessary to not only raise awareness of the issue but also provide users with practical methods for implementing digital hygiene principles related to mobile device use.

Studies have shown that the narrative competence of children who stutter is similar to that of their peers who do not stutter. However, the communication attitudes of children who stutter may influence the development of their narrative skills. Given the lack of Polish research on this topic, there is a need to explore the narrative behaviours of Polish-speaking children who stutter. This study aimed to analyze narrative behaviors of children who stutter compared to children who do not stutter and to disseminate the acquired knowledge among speech-language therapists (SLTs) and parents. The research used a multiple-case method, supported by a focus group interview with parents. The results indicate that children who stutter may exhibit less favorable narrative behaviors than their peers without a stuttering experience. The focus group interview provided valuable insights into how the child’s immediate environment perceives and supports their communication skills. It allowed for the formulation of practical recommendations for SLTs and SLT students. Practical implications have been developed based on the obtained results.

Hipercholesterolemia to najczęstszy modyfikowalny czynnik ryzyka chorób sercowo-naczyniowych w Polsce, jednakże jedynie niewielki odsetek chorych osiąga docelowe stężenie cholesterolu LDL. Atorwastatyna, należąca do grupy silnych statyn, ma wysoką skuteczność w redukcji stężenia cholesterolu LDL oraz częstości incydentów sercowo-naczyniowych, w tym zawału serca i udaru mózgu. Jej plejotropowe działanie obejmuje poprawę funkcji śródbłonka, właściwości przeciwzapalne i nefroprotekcyjne. Dodanie ezetymibu do leczenia statyną umożliwia uzyskanie dalszej, istotnej redukcji stężenia cholesterolu LDL, sięgającej 20–25%, bez zwiększenia ryzyka działań niepożądanych. Terapia skojarzona atorwastatyną i ezetymibem zmniejsza śmiertelność całkowitą sercowo-naczyniową oraz częstość poważnych incydentów sercowo-naczyniowych. Zastosowanie tej strategii terapeutycznej jest szczególnie uzasadnione u pacjentów z dużym lub bardzo dużym ryzykiem sercowo-naczyniowym, zwłaszcza w przebiegu cukrzycy, przewlekłej choroby nerek lub przy nietolerancji dużych dawek statyn.

Tension pneumocephalus (TP) refers to air accumulation within the cranial cavity. While trauma is the most common cause, it can also result from various other factors, including surgical interventions. Clinical manifestations might include symptoms like headaches, decreased consciousness, seizures, specific neurological deficits, and even cardiac arrest. However, because these symptoms are not exclusive to TP, its diagnosis primarily relies on brain imaging techniques. Immediate decompression is essential for treatment. Herein, we discuss a severe case of TP that arose following complications from the resection of a calvaria squamous cell carcinoma. It is an exceptional case because, as the authors established, pneumocephalus as a complication of skin carcinoma has been described only once. An 88-year-old male patient was diagnosed with squamous cell carcinoma of the calvaria and underwent extensive resection of the lesion. After resection he was managed by an oncology team with adjuvant radiotherapy. Wound infection developed during this treatment. The patient was treated conservatively, and after a month he completed the final session of radiotherapy. The patient was admitted to our hospital following an episode resembling a stroke, manifesting as reduced consciousness (Glasgow Coma Scale = 13) and muscle weakness on the right side. A CT scan showed extensive intraparenchymal TP surrounded by brain edema causing a midline shift. Treatment involved craniectomy with gravitational subdural drainage. Over the subsequent 48 hours, the patient showed marked improvement. He was extubated, began to verbally respond, and showed diminishing muscle weakness. In this case, a “one-way valve” mechanism led to deterioration of the patient’s condition, which was not recognized for several months. This example illustrates that TP can occur without obvious signs of a brain abscess or other direct disturbances in the brain tissue.

The development of research on exercise physiology in the last several years has allowed to better understand mechanisms affecting exercise performance in athletes. Despite this, the causes of exercise intolerance in athletes are not fully elucidated. The exercise performance is a complex process and regardless of the proper functioning of the cardiovascular system may be subject to significant changes under the influence of nervous system and thermoregulatory mechanisms. The purpose of this work is to assess the relationship between psychomotor performance (sprawność psychomotoryczna - SP), core body temperature (Tc) and exercise performance parameters as measured by spiroergometry (cardiopulmonary exercise testing - CPX) and the diagnostic accuracy of neurothermometabolic index (NTMI) as a new marker of exercise performance in athletes. Forty-four healthy athletes participated in the study. Each of the examined athletes underwent CPX for the assessment of ventilatory parameters (maximal oxygen consumption - VO2max, minute ventilation - VE, ventilatory equivalent for carbon dioxide at anaerobic threshold - VECO2AT, maximal carbon dioxide output - VCO2 and anaerobic threshold), SP tests (average reaction time to light stimulus, the number of correctly received light stimuli, number of missed light stimuli) before and immediately after CPX. In addition, Tc was continually measured during CPX. Followingly, NTMI was calculated using Tc during the maximum exercise, oxygen consumption at anaerobic threshold and average reaction time to light stimulus as measured after CPX. A significant relationship was found between Tc during the maximum effort in CPX and SP after CPX. A significant relationship between SP before CPX and VECO2AT during CPX was also confirmed. Psychomotor performance shortly after CPX was also significantly related to VCO2. In addition, NTMI was significantly associated with CPX parameters. The study results confirmed the relevant relationship between SP, Tc during the maximum exercise and ventilatory parameters as measured by CPX in athletes. Neurothermometabolic index is a reliable marker of exercise performance in athletes. Med Pr Work Health Saf. 2025;76(3):179-192.

It is estimated that approximately 1% to 3% of people in the world suffer from celiac disease, which mainly affects Caucasians. The HLA-DQ2 and HLA-DQ8 haplotypes present in the majority of the European population diagnosed with celiac disease are helpful in diagnosing the disease. The main symptom is chronic inflammation of the small intestine and atrophy of the intestinal villi, but neurological and psychopathological symptoms, such as depression or severe anxiety, may also occur. Numerous studies show that a gluten-free diet alleviates the psychological symptoms associated with celiac disease. However, strict dietary requirements often constitute a challenge for patients, changing their current lifestyle and limiting its comfort. In patients with celiac disease, increased symptoms of depression and anxiety are observed, and the duration of the disease affects the severity of the above symptoms. Currently, therapeutic benefits are attributed especially to a gluten-free diet, but recent scientific reports indicate a comparable clinical effect in patients using probiotics. The course of the disease is also influenced by the emotional support of the patient's family, causing a milder course of the disease. Caregivers of patients should pay special attention to the symptoms of anxiety and depression in their patients, because they are often unnoticed, which leads to an unfavourable course of the disease.