Hospital In Warsaw Research Articles

The notion and practice of psychotherapy in Polish psychiatry of the interwar period. Part 1.

The paper explores the development of psychotherapy in Polish psychiatry in the interwar period from the perspective of Kurt Danziger's historical psychology. Firstly, the organizational and social context of the development of Polish psychiatric care in the interwar period and its impact on the development of psychotherapy is outlined. Then, the most influential in Poland, European psychotherapeutic developments in the interwar period are reconstructed. Finally, the views of psychiatric personnel of three psychiatric facilities proposing psychotherapy as one of the main means of treatment of mentally ill patients are introduced: Dziekanka Psychiatric Hospital, the Jewish Hospital in Warsaw and Psychiatry and Neuropathology Clinic of the Jagiellonian University in Krakow. Psychiatric personnel from Dziekanka Psychiatric Hospital, directed by Aleksander Piotrowski, understood psychotherapy broadly, as the influence of the environment on the patient's psyche. Psychiatrists of the Jewish Hospital in Warsaw, Adam Wizel, Gustaw Bychowski, Władysław Matecki, and Maurycy Bornsztajn developed psychoanalytically influenced psychotherapy of schizophrenia. Bychowski also advocated for the application of psychotherapy in such neglected groups of patients as children and the intellectually disabled. Jan Piltz and Eugeniusz Artwiński pursued psychotherapy in the treatment of war neuroses at the Psychiatry and Neuropathology Clinic of the Jagiellonian University.

"It's a fight - the whole personality of the patient to win." The development of concepts of psychosis in the Jewish Hospital in Warsaw, 1898-1943.

This study investigates the development of concepts of psychosis in the Jewish Hospital in Warsaw, within the context of social and historical processes to which the hospital was the subject and a broader scope of European concepts of psychosis. In the years 1898-1909, the first chief physician of the psychiatric ward, Adam Wizel, focused mainly on hysteria. The interest in psychoses was initiated by Maurycy Bornsztajn, who started to promote psychoanalytic ideas. The second decade of the functioning of the Jewish Hospital's psychiatric ward was marked by issues concerning the classification of psychoses. In the third decade, after Poland regained independence, psychosis became the main focus of the hospital's staff. Newly appointed psychiatrists, Gustaw Bychowski and Władysław Matecki, contributed substantially to the psychoanalytic understanding of psychosis. Bornsztajn continued to develop his psychoanalytically based concept of psychosis. Wizel changed his attitude toward psychoanalysis and acknowledged the importance of Freud's discoveries. Władysław Sterling contributed to the biological understanding of schizophrenia. In the last period, 1931-1943, the Jewish Hospital in Warsaw struggled with the consequences of the economic crisis in Poland, Wizel's death, and Bychowski's departure, which resulted in the reduced number of publications in the field of psychosis. Nevertheless, Bornsztajn managed to further develop his concept of somatopsychic schizophrenia and Matecki introduced the category of pseudo-neurotic schizophrenia. The psychoanalytic approach developed by Wizel, Bornsztajn, Bychowski, and Matecki was supplemented with other influences, especially phenomenology. Wizel, Bychowski, and Matecki were advocates of the psychoanalytic psychotherapy of psychotic patients.

Effect of the Organ Donation Quality System on Donation Activity of Warsaw Hospitals.

BACKGROUND Like many other countries, Poland faces a shortage of transplantable organs despite implementing strategies to develop donation programs. Increasing the effectiveness of deceased organ donation programs requires the implementation of protocols and quality standards for the entire process. The aim of this study was to assess the organ donation potential in Warsaw hospitals (with and without implemented donation procedures) in the years 2017-2018, before the COVID-19 pandemic affected donation activity. The obtained results were compared with quality indicators established in the ODEQUS project and the European Commission project "Improving Knowledge and Practices in Organ Donation" (DOPKI). MATERIAL AND METHODS Retrospective analysis was performed of hospitalization and death causes (including deaths in the brain death mechanism) in the hospitals and intensive care units in 2017-2018. We divided 15 Warsaw hospitals into 2 groups: those with implemented quality programs for organ donation (n=4) and those without such programs (n=11). RESULTS Hospitals with procedures obtained significantly higher values than hospitals without procedures, but were lower than the values in DOPKI and ODEQUS. The success rate of the organ donation process after brain death recognition was comparable in all groups. The conversion rate to actual donors was 73% in hospitals with procedures compared to 68% in hospitals without procedures, significantly higher than in the 42% reported in the DOPKI project. CONCLUSIONS Low numbers of brain death declarations in Warsaw hospitals result from low recognition of deaths in the brain death mechanism. Implementing procedures at each hospital level will enable identification of critical points and comparison of solution outcomes.

Incidence of SARS-CoV-2 infection among healthcare workers before and after COVID-19 vaccination in a tertiary paediatric hospital in Warsaw: A retrospective cohort study.

A retrospective observational study was conducted among healthcare workers (HCWs) in a tertiary paediatric hospital. The study covered the period before and after implementation of the vaccination programme and evaluated the incidence of new SARS-CoV-2 infections in both periods. Risk factors of the new SARS-CoV-2 infection and COVID-19 vaccine effectiveness was also assessed in a real-world setting. The overall incidence of SARS-CoV-2 infections among HCWs in the study period was 19.4% with a high proportion of asymptomatic individuals (45.1%). The incidence before vaccination was 16.6% and nurses had a higher risk of infection, while physicians had a reduced risk (OR 1.80, 95% CI 1.29-2.52; and OR 0.45, 95% CI 0.30-0.68). Within two months of implementation, the programme achieved a high (88.9%) vaccination coverage in our cohort, although some disparities in vaccination rates were observed. In particular, older individuals, physicians, those working in clinical settings, and those previously uninfected were more likely to be vaccinated. The overall incidence of SARS-CoV-2 infection after vaccination deployment was 6.4% (40.0% in unvaccinated individuals and 3.2% in individuals vaccinated with at least one dose). The estimated vaccine efficacy was high (95.0%) in fully vaccinated HCWs and similar to those observed previously in clinical trials and real-world settings.

Clinical and pharmacological factors influencing serum clozapine and norclozapine levels.

Clozapine (CLO) is a very effective antipsychotic, whose use is associated with dose-dependent risk of complications. Due to high interindividual variability in CLO metabolism, there is a need to identify factors affecting the blood concentrations of CLO and its active metabolite, norclozapine (NCLO). A total of 446 blood samples (collected from 233 women and 213 men, aged from 18 to 77 years) were included in this study and analyzed for CLO and NCLO concentrations. The patients were treated at a psychiatric hospital in Warsaw in the years 2016-2021. Serum CLO and NCLO concentrations were determined with high-performance liquid chromatography coupled to UV. The following factors were shown to increase serum CLO and NCLO levels: higher CLO dose (p < 0.001), female sex (p < 0.001), nonsmoker status (p < 0.001), the use of more than two additional psychotropic drugs (only in the case of CLO; p = 0.046), concomitant use of beta-blockers (for CLO p = 0.049; for NCLO p < 0.001), and older age (for CLO p < 0.001; for NCLO p = 0.011). Despite the use of CLO at daily doses within the recommended range (200-450mg), the evaluated serum CLO and NCLO levels were within the therapeutic ranges in only 37% and 75% of cases, respectively, with 5.6% of cases exceeding the CLO toxicity threshold. The use of CLO at recommended doses does not guarantee achieving therapeutic concentrations of CLO or NCLO. Women and nonsmokers were at the highest risk of having toxic CLO levels.

Ślady ajurwedy w dziewiętnastowiecznej medycynie polskiej: kazus szpitali cholerycznych w Warszawie i Poznaniu w latach 1831 i 1866

Elements of Ayurveda in nineteenthcentury Polish medicine: the case of cholera hospitals in Warsaw and Poznań in 1831 and 1866 The article contributed to the history of translational medicine and presents the transfer of elements of the Ayurvedic treatment of cholera to the medical practice in Poland in the 19th century, carried out through Western European doctors. Special attention is paid to the role played in this process by foreign physicians and surgeons working in Warsaw hospitals during the November Uprising. Their education, medical experience and competence as regards cholera treatment were described, as well as the scientific research they carried out in Warsaw and their preferences for cholera treatment. It was demonstrated that the Hindu treatment regimen was accepted by colonial doctors and after some modifications disseminated in Europe. To assess the persistence of the treatment in Poland, the medications used in 1831 in Warsaw hospitals were compared with those administered to patients in the Poznan lazarette in 1866. The article is based on foreign doctors reports on the fight against cholera in 1831 in the Kingdom of Poland, as well as a unique report on the treatment of cholera at the Sisters of Charity Hospital in Poznan in 1866.

Stress and anxiety levels and factors affecting coping mechanisms in patients hospitalised with COVID-19

Introduction and objective: The purpose of the present study was to assess stress and anxiety levels during hospitalisation due to COVID-19 and the relationship between them and personality traits, and coping strategies among women and men, and assessment of stress predictors. Materials and methods: The study was conducted in a reference single-name hospital in Warsaw. The Perceived Stress Scale-10 (PSS-10), the BRIEF-COPE Questionnaire, the State and Trait Anxiety Inventory (STAI), and the Ten Item Personality Inventory (TIPI-PL) were used. Results: The study involved 60 patients (30 women and 30 men) aged 24 to 82 years (M = 52.42, standard deviation, SD = 12.94). Elevated stress levels were found in half of the subjects studied; state anxiety levels were increased in 70% of the participants, and trait anxiety in 77% of them. Compared to men, women had significantly higher levels of state anxiety, and lower levels of openness to new experiences. It was shown that reducing stress levels during hospitalisation depends on the use of either an Active Coping strategy or an avoidance of the Helplessness strategy, with the level of state anxiety being the moderator in both models. Conclusions: Half of the patients hospitalised with COVID-19 did not experience elevated stress levels; women felt state anxiety more intensely as a condition during their hospital stay than men, and 40% of the subjects had an increased level of trait anxiety. For lower stress levels and/or state anxiety, adaptive coping strategies and personality traits were crucial: conscientiousness and agreeableness for women, and openness to experiences and agreeableness for men.

An analysis of placental chorionic villous and decidual basalis tissue immunoreactivity in patients after cesarean section due to a placenta accreta spectrum disorder and elective cesarean section followed by the depressed mood.

Over the past few years, interest in investigating immune dysfunction in patients with psychiatric disorders has increased. B7-H4 is a molecule with immunosuppressive properties that seems to play a key role in establishing maternal tolerance against fetal antigens. The aim of this study was to compare the B7-H4 immunoreactivity levels in patients after cesarean section. Placental and decidual tissue samples were obtained from 49 women who delivered at Bielański Hospital in Warsaw between 2009 and 2015. Fifteen of the patients developed postpartum depression and 14 had a diagnosis of placenta accreta spectrum. The control group consisted of 20 healthy patients on whom cesarean section was performed due to breech presentation at term. The highest levels of B7-H4 immunoreactivity were found in the placental chorionic villous and decidual basalis tissue samples of the patients who later developed postpartum depression, while the lowest levels were found in the samples of those patients with a placenta accreta spectrum disorder. The difference between the B7-H4 immunoreactivity levels of these two groups was statistically significant. The B7-H4 expression levels were statistically significantly higher in the women in the postpartum depression group than in the control group. Postpartum depression follows a disturbance of the suppressive milieu responsible for rebalancing the maternal immune system after the initial cytotoxic activation during labor.

Independence of midwives in a therapeutic team - a midwife as a coordinator of the patient's stay at St. Sophia Hospital in Warsaw, Poland

Independence of midwives in a therapeutic team - a midwife as a coordinator of the patient's stay at St. Sophia Hospital in Warsaw, Poland

Non-cardiac sequelae of Kawasaki Disease. The survey study of 90 cases and literature review

Introduction and objectiveThe best-known long-term complications of Kawasaki Disease (KD) are coronary artery aneurysms. However, there are numerous case reports about other unusual chronic complications. These data are only anecdotal, and more systematic observation is missing. We aimed to detect and describe chronic non-cardiac complications of KD.Material and methodsWe surveyed parents of children with KD diagnosed between 2014 and 2019 by phone with the use of standardized questionnaire. Clinical data about the acute phase of the disease, treatment, outcome, and symptoms and signs observed within three months since KD diagnosis were recorded from the caregivers. We recruited children from 3 children’s hospitals in Warsaw and a support group on social media.ResultsNinety children met the inclusion criteria. Parents of 30 children (33%) reported some neurologic sequelae, with persistent irritability being the most common, followed by sleep disturbances, aggression, and chronic fatigue. Seventeen children (19%) suffered either arthralgia or unspecific pain in the upper and lower extremities. In nine children (10%), either atopic or seborrheic dermatitis began shortly after KD. Five children (6%) presented with ophthalmic complications.ConclusionsVarious unspecific complications may emerge after the acute phase of KD. Although correlation does not imply causation, and possible explanations of observed abnormalities are numerous, our data may enhance clinicians’ awareness of frequent and poorly understood findings observed after KD in children. It also might help reassure parents that what they observe lies within a range of common and usually transient KD sequelae.

Henryk Julian Levittoux – orthopaedist, soldier, pioneer of sports traumatology

Major Henryk Levittoux was born on March 31, 1899, in Rokitna. He began his studies at the University of Kiev and completed them at the University of Warsaw, earning a medical doctor degree. He participated in the Polish-Bolshevik War in 1920. He practiced medicine at the 1st District Hospital in Warsaw under the guidance of Prof. Adolf Wojciechowski. There, in 1933, he was promoted from the position of attending physician to senior attending physician. Under his care was the famous polish athlete Janusz Kusociński. After the outbreak of World War II, during the September campaign, he was in a hospital in Brest. After the Soviet aggression against Poland, he was arrested, and in 1940, he was executed by NKVD in Kharkiv.

Determination of vitamin D status in singleton and twin gestations using CLIA and LC-MS/MS.

Vitamin D plays an important role during pregnancy. The aim was to compare vitamin D status in a group of singleton (SP) and twin pregnancies (TP) using two diagnostic methods: chemiluminescence immunoassay (CLIA) and liquid chromatography with tandem mass spectrometry (LC-MS/MS). This is a cross-sectional study. The study was conducted in the population of SP and TP at the gestational age above 20 + 0 at the Bielanski Hospital in Warsaw, Poland, between October 2020 and January 2023. All patients had their venous blood samples collected and were given an original survey containing questions on demography and vitamin D supplementation. The study group included 53 Caucasian women with SP and 78 with TP aged from 21 to 47. Considering LC-MS/MS, patients with TP had lower concentrations of 25-hydroxyvitamin D (25(OH)D) than patients with SP. However, no significant difference was observed in the frequency of the occurrence of vitamin D deficiency (25(OH)D < 30 ng/mL). In both groups, the levels obtained with CLIA were significantly lower than in case of LC-MS/MS, however, strongly correlated. The intermethod agreement accounted for 52.4% and the Cohen's kappa coefficient was 0.142. The concentration of 25(OH)D in pregnant women depends on the type of gestation (SP/TP) and on the diagnostic methods used (CLIA/LC-MS/MS). Based on LC-MS/MS, the incidence of vitamin D deficiency was low in our group and no differences occurred in its frequency between SP and TP. The intermethod agreement between CLIA and LC-MS/MS on the detection of vitamin D deficiency was low. This is the first study to compare the concentration of 25(OH)D levels between SP and TP using two methods: CLIA and the gold standard - LC-MS/MS. Based on LC-MS/MS, a low incidence of vitamin D deficiency was observed in our group, in which the vast majority of patients took cholecalciferol supplements. Moreover, there were no differences in its frequency between SP and TP. However, the 25(OH)D level was significantly lower in TP. The intermethod agreement between CLIA and LC-MS/MS on the detection of vitamin D deficiency was low, which is associated with substantial clinical implications.

Influenza vaccination from the perspective of health care workers at university hospitals.

The influenza vaccination rate of healthcare workers (HWs) in Poland is low. Before implementing methods for promoting influenza vaccination, it is crucial to identify attitudes towards vaccination. We aimed to examine the knowledge and attitudes towards influenza vaccination of HWs at university hospitals. Moreover, we evaluated the incentives for getting influenza vaccination among HWs. From September 2020 to October 2020, we surveyed HWs in one children's hospital and two adults' hospitals in Warsaw (Poland). We included only fully and correctly completed surveys into final analysis. A total of 950 questionnaires (85% women, 45% <40 years old, 33% physicians and 48% nurses, 56% working in a children's hospital) were evaluated. Of all HWs, 25% declared they were vaccinated and 54% planned to get vaccinated in the next season. We have analyzed attitudes towards influenza vaccination and motivations to get vaccinated. Among HWs in academic hospitals, males, people <40 years old, physicians and those working in children's hospital are more likely to get vaccinated and their attitudes towards influenza vaccination are more positive. Of those less likely to get vaccinated, people >40 years old and nurses could be effectively persuaded by free and on-site influenza vaccination. Moreover, free access to vaccination is the strongest motivator for vaccination among all HWs. The attitudes towards mandatory influenza vaccination differ sharply among HWs-while physicians are ready to accept it, nurses are not. ClinicalTrials.gov Identifier: NCT04569019.

An analysis of perinatal outcomes in pregnant women with arterial hypertension in Poland and Ukraine during times of conflict

Hypertensive problems are present in 10% of all pregnancies. Hypertensive disorders in pregnancy constitute one of the reasonsfor maternal death and perinatal too in the world.Women with hypertension are always at higher risk for preterm birth than women without disorder. The article is dedicated to analyzing pregnancy and its consequences, including perinatal outcomes, in women with arterial hypertension. The analysis was conducted at two powerful medical centers - the Princess Anna maternity hospital in city Warsaw, Poland, and the KNP KMPB No. 5 in city Kyiv, Ukraine. The prolonged war in Ukraine has complicated the timely diagnosis and proper treatment of pathological conditions. To assess this problem, two groups were created: control and experimental, and a total of 366 pregnant patients were studied. In Warsaw, 206 patients were analyzed, while in the Kyiv maternity hospital, 160 patients were analyzed. During the analysis, one of the conclusions drawn was that chronic hypertension during pregnancy is strongly associated with pregnancy complications and negatively affected by other complicating factors such as maternal age, previous pregnancy complications, and obesity. Separate groups were identified and calculated for complications in each center separately. The degree of depression among pregnant women undergoing examination was also taken into account, and those who needed help from specialists were referred to psychologists. The authors declare no conflicts of interest.

Association between Parity and Preterm Birth-Retrospective Analysis from a Single Center in Poland.

Preterm births and parity are two medical areas that seem to be entirely different from each other. The aim of this study was to analyze the relationships between parity and maternal and neonatal outcomes associated with preterm birth. This study involved a retrospective analysis of electronic medical records from St. Sophia Hospital in Warsaw (Poland). This study was conducted among women who gave birth to preterm infants between 1 January 2017 and 31 December 2021. A total of 2043 cases of preterm births were included in the final analysis. A higher odds ratio of preterm birth in primiparas was found in women living in a city/town (OR = 1.56) and having secondary (OR = 1.46) and higher education (OR = 1.82). Multiparas who gave birth to preterm infants were more frequently diagnosed with gestational diabetes (19.69%) than primiparas. Multiparas were more likely to give birth to preterm infants who received an Apgar score of ≤7 both at 1 and 5 min after birth (25.80% and 15.34%). The results of our study emphasize the differences between primiparas and multiparas who give birth to preterm infants. Knowledge of these differences is essential to improve the perinatal care provided to mothers and their infants.

Epidural analgesia: effect on labor duration and delivery mode - a single-center cohort study.

Parturients in labor experiencing severe pain may develop several complications, which could be avoided using various forms of labor analgesia. Researchers hold divergent opinions about the effect of epidural analgesia (EA) on labor duration and delivery mode. This paper aims to establish if EA affects the duration of the 1st and the 2nd phase of labor and the percentage of emergency Cesarean sections (CS) and instrumental delivery. The patients in this cohort study were recruited at St. Sophia's Specialist Hospital in Warsaw, between 1/1/2020 and 6/1/2020. We used following inclusion criteria: patients aged 18-40 with singleton pregnancies and cephalic presentation of the fetus who gave live birth at a gestational age of 37-42 weeks to neonates with birthweight 2500-4250 g and received EA at the cervical dilation between three and six centimeters. The control group didn't receive anesthesia. We excluded planned CS and vaginal births after CS. Data analysis was performed for all parturients and separately for multiparas and nulliparas. Results Out of 2550 deliveries, we included 1052 patients - 443 participants with EA and 609 in the control group. Patients with epidural analgesia experienced longer labor 415 vs 255 min (p < 0.01), longer 1st and 2nd stage (p < 0.01). They had a lower risk of emergency CS (OR = 0.56) (p < 0.01) but were more likely to have instrumental delivery. EA prolongs the first and the second stage of labor yet doesn't affect neonatal outcomes. Moreover, the risk of emergency CS in nulliparas with EA is three times lower.

Analysis of Etiology of Community-Acquired and Nosocomial Urinary Tract Infections and Antibiotic Resistance of Isolated Strains: Results of a 3-Year Surveillance (2020-2022) at the Pediatric Teaching Hospital in Warsaw.

Urinary tract infections (UTIs) remain the most common infections diagnosed in outpatients and hospitalized patients. This study was designed to determine the patterns of antibiotic resistance and the prevalence of uropathogens causing UTIs in pediatric patients hospitalized between 1 January 2020 and 31 December 2022 at Teaching Hospital in Warsaw. The most frequent species isolated from urine samples were E. coli (64.5%), Klebsiella spp. (11.6%), and Enterococcus spp. (6.1%). UTIs caused by Enterobacter spp., Enterococcus spp., and Klebsiella spp. were significantly more common in children younger than three months of age than in children older than three months (p < 0.001). Trimethoprim and trimethoprim-sulfamethoxazole were the least active compounds against Enterobacterales with the resistance of E. coli, Klebsiella spp., P. mirabilis, and Enterobacter spp. in the range of 26.7/25.2%, 48.4/40.4%, 51.1/40.4%, and 15.8/13.2% respectively. Ampicillin was also found to have resistance rates for E. coli of 54.9% and P. mirabilis of 44.7%. Cefalexin and cefuroxime were highly active towards Enterobacterales except for Klebsiella spp., in which the resistance level reached 40%. Regarding third- and fourth- generation cephalosporins, resistance in E. coli and P. mirabilis was observed in approximately 2-10% of the isolates, but in Klebsiella spp. and Enterobacter spp. ranged over 30%. The resistance of Enterobacterales to carbapenems, nitrofurantoin, and fosfomycin was below 1%. The quinolones resistance was very high for Klebsiella spp. (31.1%) and P. mirabilis (29.8%) and three times lower for E. coli (11.9%), P. aeruginosa (9.3%), Enterobacter spp. (2.6%), and E. faecalis (4.6%). Resistance to multiple antibiotic classes was identified in 396 Enterobacterales strains, 394 of which were multi-drug resistant (MDR) and 2 were extensive drug-resistant (XDR). In the case of E. coli, 30% of isolates were MDR, with the proportion of strains having this exact resistance pattern similar in all of the analyzed years; no E. coli XDR strains were isolated. The number of Klebsiella spp. MDR strains was much higher in 2022 (60%) than in 2021 (47.5%). In the analyzed time, only one strain of K. pneumonia XDR, producing New Delhi metallo-β-lactamase, was isolated. Monitoring infection trends is essential to improve control and limit the rise of bacterial resistance.

Clinical Course of 53 Previously Vaccinated Patients Admitted to the National Hospital in Warsaw, Poland with COVID-19 Between November 2021 and March 2022.

BACKGROUND Current vaccines against SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) and vaccine booster programs aim to reduce hospitalizations due to severe COVID-19 (coronavirus disease 2019). It is now accepted that vaccination does not completely prevent infection and that breakthrough COVID-19 does occur. This study included 53 vaccinated patients who were hospitalized at a single center in Poland with breakthrough COVID-19 and aimed to evaluate the factors associated with their clinical course. MATERIAL AND METHODS This study covered the period 26 November 2021 to 11 March 2022. All patients had been vaccinated against COVID-19 with one of the following 4 vaccines: the mRNA-1273 (Moderna) mRNA vaccine (Spikevax); the BNT162b2 (Pfizer-BioNTech) mRNA vaccine (nucleoside-modified) (Comirnaty); the Ad26.COV2.S (Janssen/J0ohnson & Johnson) recombinant vaccine (Jcovden); and the AZD1222 (ChAdOx1) (Oxford/AstraZeneca) recombinant vaccine (Vaxzevria). RESULTS The course of COVID-19 in vaccinated patients was relatively similar. The patients vaccinated more than 24 weeks earlier rarely needed a stay in the Intensive Care Unit (ICU) (P=0.021), and the occurrence of deaths was significantly lower in this group (P=0.046). Women remained in hospital considerably longer than men (P=0.011). Age and comorbidities did not affect the course of this infection. CONCLUSIONS Despite the many advantages of the COVID-19 vaccination, our observations indicate a potential risk of infection after vaccination. The assessment of the course of COVID-19 in vaccinated patients gives the possibility to compare different vaccines and indicate factors that can reduce immunity.

The Course of COVID-19 among Unvaccinated Patients-Data from the National Hospital in Warsaw, Poland.

Studies to date indicate the relatively high effectiveness of vaccinations in preventing severe COVID-19 symptoms. However, in Poland, 40% of the population remains unvaccinated. The objective of this study was to describe the natural history of COVID-19 in unvaccinated hospital patients in Warsaw, Poland. This study evaluated data from 50 adult patients from the National Hospital in Warsaw, Poland, in the period 26 November 2021 to 11 March 2022. None of these patients had been vaccinated against COVID-19. Analysis showed that the average hospitalisation time for these unvaccinated COVID-19 patients was 13 days. Clinical deterioration was observed in 70% of these patients, 40% required the intensive care unit, and 34% subsequently died prior to the end of the study. There was a significant deterioration and high mortality rate in the unvaccinated patients. For this reason, it seems prudent to take measures to increase the vaccination coverage level of the population against COVID-19.

Clinical, hormonal and pathomorphological markers of somatotroph pituitary neuroendocrine tumors predicting the treatment outcome in acromegaly.

BackgroundTranssphenoidal adenomectomy (TSS) of somatotroph pituitary neuroendocrine tumor (PitNET) is the first-line treatment of acromegaly. Pharmacological treatment is recommended if surgery is contraindicated or did not lead to disease remission. The choice of treatment best fitting each patient should be based on thorough investigation of patients’ characteristics. The current analysis attempts to create a tool for personalized treatment planning.AimThis study aimed to assess whether clinical, biochemical, imaging and pathological characteristics can predict surgical remission and response to first-generation somatostatin receptor ligands (SRLs) and pasireotide-LAR in acromegaly.Patients and methodsA retrospective study of 153 acromegaly patients, treated in the Department of Endocrinology in Bielanski Hospital in Warsaw, Poland was performed. Data on demographics, hormonal and imaging results, pathological evaluation, and treatment outcome was extracted from the Polish Acromegaly Registry collecting information from 11 endocrinology centers in Poland and analyzed.ResultsPatients with surgical remission had lower GH and IGF-1 concentrations at diagnosis (median GH 5.5 µg/L [IQR: 3.1-16.0] vs. 19.9 µg/L [IQR: 9.8-42.4], p=<0.001 and mean IGF-1 3.1xULN ± SD=1.2 vs. 3.7xULN ± SD=1.2, p=0.007, respectively) and smaller tumors (median 12.5mm [IQR: 9-19] vs. 23mm [IQR: 18-30], p<0.001). These tumors were more often densely granulated (DG) (73.2% vs. 40.0%, p=0.001) with positive staining for alpha-subunit (α-SU) (58.3% vs. 35.5%, p=0.021) and lower Ki-67 index (p=0.002). Patients responding well to SRLs were more often male (55.6% vs 44.4%, p=0.026), presented lower GH concentration (median GH 17.2 µg/L [IQR: 6.2-29.0] vs. 23.8 µg/L [IQR: 11.2-49.5], p=0.048) and had more often DG tumors (63.0% vs. 14.3%, p<0.001). No significant differences between good and poor-response to pasireotide-LAR groups were found. In multivariate logistic regression analysis fasting GH concentration <8.63 µg/L, maximal tumor diameter <15.5mm, normoprolactinemia and DG tumor turned out to be independent predictors of surgical remission (OR=0.92, p=0.026; OR=0.87, p=0.069, OR=3.86, p=0.096 and OR=3.05, p=0.181, respectively). Fasting GH concentration <36.6 µg/L and DG tumor turned out to be independent predictors of good response to first-generation SRLs (OR=0.96, p=0.06 and OR=10.68, p=0.002, respectively).ConclusionsYounger age at diagnosis, male sex, lower GH, IGF-1 and PRL concentrations, smaller tumor size at diagnosis as well as positive α-SU staining, lower Ki-67 index and DG tumors predicted better treatment outcome in acromegaly patients.