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Aromatase plays an important rolein the estrogen biosynthesis. Its gen(CYP19A1) is expressed in preadipocytes(stromal vascular fraction, SVF)of adipose tissue. Estrogens are foundto be protective for metabolism homeostasis,and cardiovascular system.Disturbed dietary and endogenousfatty acids (FAs) turnover is responsiblefor development of metabolicsyndrome and it complications.Aim of the work was to investigatethe effect of physiological concentrationsof acids: arachidonic (AA), oleic(OA), palmitynoic (PA) and eikozapentaenoic(EPA) on CYP19A1 expressionin differentiating human SVF, able toform adipocytes as well as endothelialcells.

Material and methods: Human (n=38 healthy woman) SVF cells wereisolated from subcutaneous adiposetissue harvested intrasurgery. SVFcells were incubated in proadipogenicor angiogenic media to obtainadipocytes (Adipo-SVF) or endothelial(Angio-SVF) cells (confirmed bymicroarray). Changes in the CYP19A1expression induced by 24hs incubationin the presence of FAs (10 – 30μM )were monitored by the Real timePCR (qRT -PCR).

Results: The aromatase gene expressioncorrelated positively withBMI of patients, but only in groupof obese or overweight women. Thenegative correlation was found inthe group of young, slim women. Thehighest expression of aromatase wasfound in the fresh, not differentiatedSVF. In differentiating to endothelialcells (Angio - SVF) OA inhibited(p=0.008), when n-3 polyunsaturatedAA activated (p=0.003) the CYP19A1gene expression. In differentiating topreadipocytes (Adipo-SVF) AA significantly(p=0.031) inhibited CYP19A1expression.

Conclusion: The changes in thearomatase gene expression in differentiatingSVF has been confirmed. Thedifferent effect of the dietary FA (OA vs.AA) on the aromatase gene expression argue for the roleof the locally formed proangiogenic estrogens.

Background: In inflammatory boweldisease (IBD) the imbalance betweencytokines pro- and antinflammatory isobserved.The aim of this study was the assessmentof interleukin-10 (IL-10),interleukin-6 (IL-6) and tumor necrosisfactor-α (TNF-α) concentration usefulnessin the evaluation of the activityof ulcerative colitis (UC) and Cohn’sdisease (CD).

Methods: 35 patients diagnosedwith UC and 39 with CD were examined.The control group (CG) consistedof 35 healthy volunteers. Diagnosis ofthe disease was confirmed by videocolonoscopyand histopathologicalevaluation of intestinal biopsies.Disease activity of UC was assessedaccording to the Mayo Scoring Systemand by the Crohn Disease Activiti Index(CDAI) in CD patients. Among patientswith UC 18 (51%) had severe, 14 (40%)moderate and 3 (9%) mild disease.Among patients with CD 7 (18%) wasdiagnosed with high, 27 (69%) moderate,and 5 (13%) with low activity ofthe disease. WBC, PLT, serum concentrationof TNF-α, IL-6 i IL-10 weredetermined.

Results: The average concentrationof TNF-α in UC patients was: 14.3(IQR=12.6), in CD: 12.6 (IQR=11.9), inthe CG: 3.1 (IQR=1.7). The averageconcentration of IL-6 in UC was: 19.6(IQR=21), in CD: 10.8 (IQR=7.6), in CG: 3.2 (IQR=1.6). The average concentrationof IL-10 in UC was: 14.4 (IQR=5.9),in CD: 10.4 (IQR=9.3), in the CG: 3.3(IQR=2.5). In the IBD TNF-α, IL-6 andIL-10 concentration was significantlyhigher than in CG. However, IL-10 wassignificantly higher in UC than CD. Inpatients with UC statistically significantpositive correlation between theconcentration of TNF-α, IL-6 and IL-10and disease activity was noticed. Therewere no correlation between TNF-α,IL-6 and IL-10 concentration and CDactivity.

Conclusion: Determination ofTNF-α, IL-6 and IL-10 serum concentrationcan be used for noninvasiveevaluation of inflammation activity inpatients with IBD. IL-10 concentrationmay be helpful in differentiation of UC and CD.

Women have an increased risk ofstroke and peripheral embolization inatrial fibrillation (AF), which is in partassociated with a higher prevalence ofcomorbidities, including heart failure(HF). Clinical outcomes of anticoagulanttherapy with vitamin K antagonists(VKA) are often unsatisfactory inwomen regardless of age largely due toa higher risk of unstable anticoagulationcompared with men. Non-vitaminK oral anticoagulants (NOAC) areincreasingly used for prevention ofstroke in patients with nonvalvular AFappear to be particularly beneficial inwomen overcoming adverse events relatedto unstable anticoagulation. Thecurrent review highlights problems ofanticoagulation in women with AF andHF in the era of NOAC.

There are several gender differencesin epidemiology, the course,prognosis and treatment of heartfailure which is called the epidemic of21st century. In women heart failureappears at a later age and this canbe a sufficient reason for incidenceof concomitant diseases. Clinicalsymptoms of heart failure in femalesare caused at a higher percentage bynon-ischaemic cardiomyopathy andheart failure with preserved ejectionfraction of the left ventricle. The historyof development of current guidelinesfor ICD has significantly influenceddifferent, gender-dependent access ofpatients to ICD implantation in preventionof sudden cardiac death. Womenwith heart failure are qualified for ICDless frequently than men. It seems thatthe existing disparities in utilization ofICD are significantly higher than sexdependentdifferences in the risk ofsudden cardiac death. Most probablythe guidelines for ICD will be improvedonly after establishment of the indicationsfor ICD in patients with heartfailure with preserved ejection fraction.Participation of females in CRT issignificantly smaller despite the lackof separate indications for this modeof heart failure treatment. Women,however, demonstrate a greater improvementafter CRT, especially asfar as survival rate is concerned. Ahigh rate of non-responders to CRTimpels the search for its reason. Presentlythere is a considerable interestin morphology and duration of initialQRS. Including the parameter of “true”LBBB and more effective ways ofdescribing mechanical dyssynchronyof the heart, with higher participationof women in CRT therapy, has thechance to decreasing the number ofnon-responders.Women are additionally at a greaterrisk of complications of endocardiallead implantation procedure as well asof late mechanical lead damage. Thisis a challenge for the producers of thedevices and electrotherapy operators.

The paper presents the etiology, diagnostics,management, treatment andprognosis of carpal tunnel syndrome.The mechanism of the median nervecompression as well as the predisposingfactors that cause the syndromeare discussed, as well as the sequenceof specific symptoms and the classificationof the level of severity ofdisease. The diagnostic methods arepresented with both the benefits andconsequences of each method. Thetreatment of carpal tunnel syndrome isdivided into conservative and surgicalapproaches. Conservative treatmentconsists of keeping the wrist immobileusing wrist splints, physiotherapy, systemicand local pharmacotherapy, aswell as local steroid injections into thecarpal tunnel. The results of conservativetreatment are often short-term.Operative treatment consists of cuttingthe flexor retinaculum tendon. This directlyeliminates the cause of CTS, theincreased pressure in the carpal tunnelof the wrist. A certain percentageof patients experience complicationspost treatment or disease recurrence.

The total number of out-patientsand hospitalized poisoned patientsabove 14 years old in Krakow in1966 was 520 and 2132 in 1983. Theincidence of poisoning per 10 000 ofKraków population in 1966 was 25.0and increased to 36.2 in 1983. Themortality in 1966 was 0.75%. It was lowalso in 1983 – 1.01%, whatever reached7.8% if forensic data were included (thefatalities on the spot). There were 847poisoned patient hospitalized in Clinicof Toxicology UJ CM in 2015 and mortalityin this group was 1.06%. Forensicanalysis shown decreasing number ofdeaths on the spot (154 in 1983 and 89in 2015). The percentage of poisonedwith ethanol was declining (78.9% in1983 and 57.3% in 2015). The frequencyof patients treated in intensive careunit were increased from 6% in 1966to 21.7% in 2015. The percentage ofaddicted acute intoxicated patientswas lower (8%) in 1983 and achieved21.7% in 2015. Poisoning structure,particularly pharmaceuticals, significantlyinfluenced medical proceduresperformed in intensive care unit, especiallyadministration of antidotes(5% in 1966 and 48.9% in 2015). Socialevolution and changes of culture habitsincreased percentage of addictionbut the number of deaths caused byethanol on the spot was smaller.

Hyponatremia, defined as a serumsodium <135 mmol/l, is the most commonclinical disorder of water andelectrolyte balance. Hyponatremiaoccurs in approximately 15-20% ofhospitalized patients and up to 20% ofpatients in critical condition. It can leadto a wide range of clinical symptoms,from mild to even life-threatening, andis associated with increased mortalityand longer duration of hospitalizationin patients affected by many differentsyndromes. The diagnosis and treatmentof hyponatremia in patients’ isstill a major problem.Hyponatremia is a disorder observedcommonly in toxicologicalpractice. It most often occurs in peoplewho abuse alcohol, narcotics - mainlyecstasy, drugs, as well as the so-calledwater intoxication in athletes and thepeople who are mentally ill.In view of the complex pathomechanismsand a variety of symptomsobserved in poisoned patients,hyponatremia should be considered asone of the reasons and the exponentof the general condition of the patient.

Introduction: Plasmapheresis is atherapeutic method based on removalof high molecular weight particles fromblood. It is used in a variety of clinicalentities in which pathogenic role ofsuch particles has been proven e.g.ANCA-associated vasculitides (granulomatosiswith polyangiitis [GPA]and microscopic polyangiitis [MPA]).Efficacy of plasmapheresis in ANCAantibodies removal and its impacton disease activity has not been adequatelyinvestigated so far. Influenceof antibodies levels on disease activityalso remains unknown.

Objectives: Analysis of plasmapheresiseffect on serum ANCA levelsin patients with ANCA-associatedvasculitides.

Patients and methods: Seven patients with diagnoses of ANCA-associatedvasculitides were enrolledin the study between November 2015and April 2016. All of them underwentplasmapheresis procedures. SerumANCA levels were measured beforeand after plasmaphereses using fluoroimmunoenzymaticassay (FEIA).Disease activity was assessed usingBirmingham Activity Vasculitis Score;BVAS ver. 3 before first plasma exchangeprocedure.

Results: Patients in disease exacerbation(BVAS 5-10) with positive ANCAantibodies were enrolled in the study:2 patients with GPA and 5 patients withMPA. Number of performed plasmapheresisprocedures ranged from 5 to7 (median=7). Decrease of serum antibodiesconcentration was observedin all patients (mean decrease of 88.3%(±10.1%)) with statistically significantdifference in mean antibodies concentrationbefore and after plasmapheresisprocedures (113.0 vs 15.4; p=0.014).

Conclusions: Plasmapheresis is aneffective method of ANCA antibodiesremoval in patients in disease exacerbation.

Background: Maternal colonizationof Streptococcus agalactiae inpregnancy constitute an importantclinical problem, that may result in seriousconsequences, especially for thenewborn. Streptococcus agalactiae isa gram-positive beta-hemolytic streptococcibelonging to the serologicalgroup B (GBS). According to recentdata the GBS is found in 10-30% ofhealthy women, and the carriage ofpathogen is usually asymptomatic. Inorder to minimize the risk of verticaltransmission of the infection to thenewborn during the labor, the PolishSociety of Gynecology (PTG) has introducedthe guidelines of GBS colonizationscreening for all pregnant women.

Objectives: In this paper, the levelof implementation of the screeningtests in accordance to the recommendationsof the PTG was evaluated. Wealso assessed the level of knowledgeand awareness of pregnant women indetection of GBS colonization duringthe pregnancy and the prevention ofinfection in newborn.

Material and method: The surveywas conducted among the 172 womenhospitalized in hospital maternitywards in the first days of postpartum.

Results: Despite the introductionof the Polish Society of Gynecologyguidelines, there are still cases of improperscreening methods and medicalinterventions in the event of positivetest results. Biological material wascollected in 86% of patients (swabsfrom the genital tract, anus or urineculture). A positive result was foundin 22% of patients. In 54% of patientsswabs were taken at the recommendedperiod of 35-37 weeks. The recommendedcollection of the materialboth from vagina and anus was takenonly in 39% of patients. The majorityof participated women described theirknowledge of the risk associated with group B Streptococcalcolonization as good, however only half of them foundacquired information sufficient. Despite the implementationof guidelines Polish Gynaecological Society the incorrectconduct of the prevention against GBS is still performedin some cases.

Conclusion: It is appropriate to perform consciousnessraisingcampaigns on screening of GBS among patientsand doctors.

The European Union drew attentionto the increased consumptionand the reports of adverse reactionsto caffeine in recent years.The EU Commission in RegulationNo. 536/2013 dated 11 June 2013 expressedconcern about the caffeinecontent in the products. It is importantto develop a simple and accuratemethods for determining the level ofcaffeine in the biological material foraccurate exposure assessment, aswell as in the caffeinated products.The use of saliva as a diagnosticmaterial is painless, non-invasiveand does not require the participationof professional medical personnel.The compounds identified in salivashowed relatively high durability.The developed method for the determinationof caffeine by high performanceliquid chromatography withdiode array detection (HPLC-DAD)after extraction of caffeine from salivaby solid phase extraction (SPE)is characterized by the linearity in theconcentration range 50 - 2000 ng/mL.This method have low detection (12ng/mL) and quantification (40 ng/mL)limits and high intra-day (4.87% forlow concentration and 2.10% for highconcentration) and inter-day (5.84%for low concentration and 2.43% forhigh concentration) repeatability.