Radzisław Mierzyński

Polyunsaturated Fatty Acids in Pregnancy and Metabolic Syndrome: A Review

This review presents available evidence for possible application of n-3 long chain polyunsaturated fatty acids (PUFAs) in pregnant obese women with metabolic syndrome (MS) and focuses on prophylaxis of pregnancy complications associated with MS such as gestational hypertension, preeclampsia and gestational diabetes. Dietary supplementation with n-3 PUFAs has recently become popular and their adequate intake during pregnancy and early childhood is of clinical importance. The results of experimental and epidemiological investigations reveal that n-3 PUFAs, especially α- linolenic acid (ALA), eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA), may decrease the risk of cardiovascular diseases. It is believed that n-3 PUFAs affect a multitude of molecular pathways, involving regulation of gene expression, alteration of physical and chemical properties of cellular membranes and modulation of membrane channels and proteins. A large body of evidence focuses on anti-inflammatory properties of PUFAs which seem to be fundamental in prevention and reversing of insulin resistance, atherogenic dyslipidemia, hypertension, thromboembolism and in improving vascular function. Despite the potential PUFAs benefits of decreasing insulin resistance, their application in order to prevent preeclampsia, gestational hypertension and gestational diabetes mellitus in pregnant women with MS has not yet been established. Numerous reports have revealed that appropriate fetal development, including neuronal, retinal and immune function depends on EPA and DHA which are crucial also for prevention of preterm birth. Thus the supplementation with EPA and DHA is highly recommended during pregnancy although the optimal dosing and treatment strategies still need to be determined.

Anticoagulant Therapy in Pregnant Patients with Metabolic Syndrome: A Review

Pregnancy is a specific state of heightened coagulability related to the increase in procoagulant agents and to the reduced fibrinolysis. Pregnancy is associated with a 4-fold increased risk of developing venous thromboembolism (VTE) and this risk still increases to 14-fold during puerperium. A correlation between the metabolic syndrome and development of cardiovascular events and cerebrovascular incidents has been described. Such a relationship is referred to a hypercoagulable state due to increased serum levels of the plasminogen activator inhibitor-1 (PAI-1), fibrinogen, factor (F) VII and VIII, von Willebrand factor and from endothelial activation, caused by increased circulating adhesion molecules. As to the risk of VTE, the probability for its association with cardiovascular incidents is increased by common underlying mechanisms such as the activation of platelets and the blood coagulation. A correlation between idiopathic VTE and the metabolic syndrome has been reported. The anticoagulant therapy may be recommended during the pregnancy for the treatment or the prophylaxis of VTE and, in women with artificial heart valves, for the prevention of the valve thrombosis and systemic embolisation. There are also specific conditions during pregnancy which benefit from anticoagulant use, such as recurrent fetal loss, thrombophilia and assisted reproductive technology. There are no published specific data about using of anticoagulant agents in pregnant patients with the metabolic syndrome except for a few articles addressing reproductive problems. The mechanisms of anticoagulant action were studied with the focus on heparinoids, because of their safety not only for the patient but also for the fetus. The new oral anticoagulants were also shortly described although they have been contraindicated during the pregnancy.

Intercellular Adhesion Molecule and Endogenous NOS Inhibitor: Asymmetric Dimethylarginine in Pregnant Women with Gestational Diabetes Mellitus

Objective. The aim of the study was to evaluate the concentrations of soluble intercellular adhesion molecule-1 (s-ICAM-1) and endogenous NOS inhibitor, asymmetric dimethylarginine (ADMA), as markers of endothelium dysfunction in patients with gestational diabetes mellitus (GDM). Patients and Methods. The levels of s-ICAM-1 and ADMA were analysed in the group of 56 patients with GDM and compared to 25 healthy pregnant women. The concentrations of s-ICAM-1 and ADMA were measured in serum using ELISA tests. Results. The groups did not differ by baseline descriptors: age (30.75 ± 6.32 versus 28.50 ± 4.95 years, NS) and gestational age (28.96 ± 2.85 versus 29.12 ± 2.96 hbd, NS). The patients with GDM were more obese (BMI 27.93 ± 7.02 versus 22.34 ± 4.21 kg/m2, p = 0.032) and had higher concentration of C-reactive protein (6.46 ± 6.03 versus 3.18 ± 3.83 mg/L, p = 0.029). In the GDM group the level of ADMA was lower (0.38 ± 0.17 versus 0.60 ± 0.28 μmol/L, p = 0.001) and the level of s-ICAM-1 was significantly higher (289.95 ± 118.12 versus 232.56 ± 43.31 ng/mL, p = 0.036) compared to controls. Conclusions. The pregnant women with GDM are characterized by higher concentration of s-ICAM-1 that reflects the activation and dysfunction of the endothelial cells. The decreased ADMA level in GDM patients seems to be preventive in the limitation of NO synthesis caused by the impaired insulin action and the endothelial dysfunction.

A Prevention of Pre-eclampsia with the Use of Acetylsalicylic Acid and Low-molecular Weight Heparin – Molecular Mechanisms

Pre-eclampsia appears to be the main cause for the maternal and fetal morbidity and mortality. Pregnant women with pre-eclampsia are more likely to be threatened with conditions which potentially may be lethal, such as: disseminated intravascular coagulation, cerebral hemorrhage, liver and renal failure. Pregnancy complicated with pre-eclampsia is also associated with a greater risk for iatrogenic prematurity, intrauterine growth retardation, premature abruption of placenta, and even intrauterine fetal death. In the majority of cases the reasons for arterial hypertension among pregnant women remain obscure. For the past decades, there were many abortive attempts in the use of some microelements, vitamins or specific diets, such as polyunsaturated fatty acids, for the prophylaxis of pre-eclampsia. Recently, it has been shown that a prevention of pre-eclampsia with the use of a lowmolecular- weight heparins (LMWHs) and acetylsalicylic acid (ASA) could considerably reduce the frequency of preeclampsia. In this review, we present the studies concerning the applications of LMWHs and aspirin in the prophylaxis of pre-eclampsia and some important data about the mechanisms of anti-inflammatory actions of LMWHs and ASA.

Pregnancy complicated by ovarian planoepithelial carcinoma arising in mature cystic teratoma

An adnexal tumour can be expected in 2–10% of pregnancies. A mature cystic teratoma (MCT) constitutes 10–20% of all ovarian tumours and is the most frequent germ cell tumour of the ovary. The incidence of a malignant transformation in an MCT appears in 0.17–2% cases. The most frequent malignancy in an MCT is a planoepithelial carcinoma (squamous cell carcinoma) – 80–90% of cases (Hackethal et al. 2008). The malignant transformation of an MCT to a planoepithelial carcinoma in pregnancy is very rare. We found only two cases in the literature (Mekaru et al. 2008; Budiman et al. 2010). Although the management of ovarian tumours during a pregnancy is similar to the treatment in the case of nonpregnant patients, far more new studies are needed to confirm the most optimal management, due to the absence of standard recommendations. Case reports provide significant data on the management of these cancers (Palmer et al. 2009; Aggarwal and Kehoe 2011). We report an extremely rare case of a maternal planoepithelial carcinoma (G2) in a dermoid cyst detected during a caesarean section.

Ghrelin in Serum and Urine of Post-Partum Women with Gestational Diabetes Mellitus

Women with a previous history of gestational diabetes mellitus (GDM) have a significantly increased risk of developing type 2 diabetes, obesity, and cardiovascular diseases in the future. The aim of the study was to evaluate ghrelin concentrations in serum and urine in the GDM group in the early post-partum period, with reference to laboratory results, body composition, and hydration status. The study subjects were divided into two groups, that is, 28 healthy controls and 26 patients with diagnosed GDM. The maternal body composition and hydration status were evaluated by the bioelectrical impedance analysis (BIA) method. The concentrations of ghrelin in the maternal serum and urine were determined via enzyme-linked immunosorbent assay (ELISA). The laboratory and BIA results of the mothers with GDM were different from those without GDM. Urine ghrelin positively correlated with serum ghrelin and high-density lipoprotein cholesterol (HDL) levels in healthy mothers. There were direct correlations between urine ghrelin and HDL as well as triglycerides levels in the GDM group. Neither the lean tissue index nor body cell mass index were related to the serum ghrelin concentrations in this group. Only the urine ghrelin of healthy mothers correlated with the fat tissue index. Our results draw attention to urine as an easily available and appropriable biological material for further studies.

The role of new adipokines in gestational diabetes mellitus pathogenesis

Gestational diabetes mellitus (GDM) is defined as any degree of glucose intolerance with onset or first recognition dur-ing pregnancy. Explanation of the GDM pathogenesis is important due to preventing gestational complications. During pregnancy there are significant changes in maternal metabolism. Many of these changes are influenced by different adi-pokines produced in the placenta and adipose tissue. The exact role of adipokines in the pathogenesis of GDM remains still unknown. Several adipokines have been analysed throughout gestation and their levels have been suggested as biomarkers of maternal-perinatal outcomes. Some of them have been postulated as significant in the pathogenesis of pregnancy complications like GDM. This report aims to review some of the recent topics of adipokine research that may be of particular importance in patho-physiology and diagnosis of gestational diabetes mellitus. Because of manuscript length limitations, after thorough literature review and in view of the recent evidence, we focus on the one of the most well-known adipokine: adiponectin, and not so well-studied: nesfatin-1, chemerin, ghrelin, and CTRP 1.

Adiponectin and Omentin Levels as Predictive Biomarkers of Preterm Birth in Patients with Gestational Diabetes Mellitus

Objective The aim of this study was to determine any changes in adiponectin and omentin levels in GDM patients who delivered at term and preterm and to evaluate whether adipokines can be useful as a clinical biomarker to predict subsequent preterm delivery. Patients and Methods The levels of adiponectin and omentin were measured in four groups: (1) women with GDM who delivered at term (n=63); (2) women with GDM who had the symptoms of threatened preterm labor and delivered at term (n=23); (3) women with GDM and spontaneous preterm birth (before 37 completed weeks of gestation) (n=19); (4) women with physiological pregnancy (n=55). Results In comparison with control group the median adiponectin concentrations were significantly lower in all GDM groups (10737 versus 8879; 7057; 6253 ng/ml, respectively; p<0.01). The median omentin concentrations were also significantly lower in all GDM groups in comparison with control group (469 versus 432; 357; 308 ng/ml, respectively; p<0.01). No significant differences in adiponectin and omentin levels between the GDM, preterm labor, and preterm birth groups were observed. However, there was a trend towards lower adiponectin and omentin levels in preterm birth group. The strong correlations between adiponectin and omentin levels were observed in all groups (R=0.801, p<0.001; R=0.824, p<0.001; R=0.705, p<0.001; R=0.764, respectively; p<0.001). In the univariable logistic regression model, significant correlation between omentin concentrations and preterm birth occurrence was found. Conclusions Our findings suggest that omentin-1, rather than adiponectin, could be useful as a predictor of preterm birth in patients with gestational diabetes mellitus.

The professional image of a nurse as seen by parents of children hospitalized in the oncology department

Abstract Introduction. The professional image of a nurse which is influenced by a whole variety of factors is the main subject of this work. The social attitudes toward nurses are related to people’s own beliefs, opinions, stereotypes, as well as the nurses’ professional, personal and interpersonal skills. The proper image of a nurse is very important. Patients are becoming increasingly demanding toward nurses which poses new challenges for nurses attempting at creating a positive image of this profession. Aim. The aim of this work was to elicit the opinions about nurses’ work from parents of children hospitalized on the oncologic ward. Material and methods. The authors used a questionnaire of their own making and conducted a literature analysis. The literature review was made using the data taken from Main Medical Library. The research group consisted of 50 parents of children hospitalized in Oncology, Hematology and Child Transplantology Department in Lublin. All the parents were advised about the aim of the study and informed that the questionnaire is anonymous and voluntary. The obtained results have then undergone a statistical analysis, using a Chi2 test. Statistical significance was reached at the level of p<0.05. Results. The most important factors affecting the professional image of a nurse are as follows: the parent’s sex, their place of residence, nurse’s appearance, as well as the following traits: being nice, protective and friendly. Discussion. The image of a nurse as someone who is smiling, friendly and calm appears to be the closest to an ideal picture of such a professional. This pertains not only to parents but to the society as a whole. The nurse should pay attention to patients’ physical needs and expectations, as well as their spiritual side. Conclusions. The researched group provided a positive opinion about the work of nurses at the Department. They paid special attention to their being nice, protective and friendly. It is the nurses’ physical appearance that sheds a positive light on them, as competent and friendly professionals. Even though most people perceive nursing as a rather unattractive profession, there is a huge deal of respect for nurses.

Examining the image of nursing among the children hospitalized in the oncology ward

Abstract Introduction. Patients, as subjects of medical care, are becoming increasingly more demanding toward medical professionals which poses a challenge both for doctors and nurses. A variety of factors influences the professional image of a nurse. Different features are involved, including the nurse’s professional or interpersonal skills their personal beliefs, attitude, as well as social stereotypes about nurses. Aim. Looking at the image of nursing among the children hospitalized in the oncology ward. Material and methods. The authors used both literature review and a questionnaire of their own making. The literature review was done using data from the databases of Polish Central Medical Library. The research group comprised 32 children (aged from 8 to 17), all undergoing hospitalization in Hematology/Oncology and Child Transplantology in Lublin. The statistical calculations are made using Chi2 tests. The test results of p<0.05 were held as statistically significant. Results. The group was mostly composed of children aged 14 to 17 (56.25%). There were more boys (62.5%) than girls. The majority of children came from rural areas (71.87%) and most of them read through the documentation concerning the rules of the ward. Both nurses’ work and relations with patients were graded as “good” by the patients. Children pointed to “nice appearance” as the most important feature of every nurse. Discussion. A pediatric nurse should be patient, have lots of understanding, be sympathetic, caring and able to hold their nerve. Unfortunately, according to authors of earlier studies, not all nurses have these traits. This is due to the fact that the staff rarely involve in communication with the patients and they lack interpersonal skills. Conclusions. Children have a very high opinion on the work of nurses at the Hematology/Oncology and Child Transplantology Clinics. The children emphasized that the following features have the highest impact on their picture of the nurse: nice looks, being protective and caring. A research study conducted at the Hematology/Oncology and Child Transplantology Clinics shows the right features that a nurse should have