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Fontan-associated liver disease (FALD) is a common complication in patients with Fontan circulation. We aimed to evaluate the red blood cell distribution width-to-platelet ratio (RPR) index as a non-invasive marker for assessing FALD severity, given its reported usefulness in in conditions such as hepatitis. This retrospective, cross-sectional study included adult Fontan patients. Laboratory tests, liver elastography, and hemodynamic parameters were analyzed. Fifty-six patients (24 females, 43%; median age 24 years, interquartile range [22-28]) were enrolled. Patients were grouped by liver stiffness (LS) stage: METAVIR ≤ F2 (22 patients, 39%) and > F2 (34 patients, 61%). The RPR index was significantly higher in the > F2 group (0.08 vs. 0.12, = 0.02), along with FIB-4 (0.68 vs. 1.06) and APRI (0.36 vs. 0.57). RPR correlated positively with liver stiffness ( = 0.27), total bilirubin ( = 0.43), cystatin C ( = 0.36), and creatinine ( = 0.38) but not with NT-proBNP, pulmonary artery pressure, or maximal oxygen consumption. The ROC curve analysis for predicting LS > F2 showed an AUC of 0.74 (95% CI: 0.61-0.87), comparable to FIB-4. Moreover, in the logistic regression model that accounted for age, gender, height, body weight, and systemic chamber morphology, RPR showed a significant association with LS > F2, with an odds ratio indicating a 1.4-fold (95% CI: 1.1-1.7) increase for every 0.01-unit increase in RPR. The RPR index is a simple, helpful tool for evaluating FALD severity in Fontan patients.

Structural, hemodynamic, and morphological cardiac changes following Fontan operation (FO) can contribute to the development of arrhythmias and conduction disorders. Sinus node dysfunction, junction rhythms, tachyarrhythmias, and ventricular arrhythmias (VAs) are some of the commonly reported arrhythmias. Only a few studies have analyzed this condition in adults after FO. This study aimed to determine the type and prevalence of arrhythmias and conduction disorders among patients who underwent FO and were under the medical surveillance of the John Paul II Hospital in Krakow. Data for the study were obtained from 50 FO patients (mean age 24 ± 5.7 years; 28 men (56%)). The median follow-up time was 4 (2–9) years. Each patient received a physical examination, an echocardiographic assessment, and a 24 h electrocardiogram assessment. Bradyarrhythmia was diagnosed in 22 patients (44%), supraventricular tachyarrhythmias in 14 patients (28%), and VAs in 6 patients (12%). Six patients required pacemaker implantation, and three required radiofrequency catheter ablation (6%). Arrythmias is a widespread clinical problem in adults after FO. It can lead to serious haemodynamic impairment, and therefore requires early diagnosis and effective treatment with the use of modern approaches, including electrotherapy methods.

Despite successful repair of aortic coarctation, cardiovascular complications occur. To analyse type and frequency of late complications and their impact on exercise capacity in adults after aortic coarctation repair. Fifty-eight adults after aortic coarctation repair, 36 male, median age 27.46 ±10.57, were compared to 30 healthy volunteers. Physical examination, transthoracic echocardiography, carotid intima-media thickness measurement, cardiopulmonary exercise test and 24-hour ambulatory blood pressure monitoring were performed. The main complications were: arterial hypertension 48.3%, myocardial hypertrophy in echocardiography 29.34%, recoarctation 25.86%, aortic dilation 13.79% and coronary artery disease 6.89%. Exercise tolerance was reduced in the cardiopulmonary exercise test. The VO /kg peak was lower, 29.01 ±8.79 vs. 49.16 ±7.38 ml/kg/min, < 0.001, VE/VCO peak higher 28.18 ±4.69 vs. 26.78 ±3.13, = 0.017. The peak heart rate was reduced, 157.28 ±22.22 vs. 177.93 ±23.08 bpm, < 0.001, peak systolic blood pressure was higher, 174.79 ±17.62 vs. 153.33 ±4.79 mm Hg, < 0.001. Systolic blood pressure in 24-hour ambulatory monitoring correlated with left ventricle mass index, = 0.29, = 0.025, wall thickness, = 0.31, = 0.039. Age at operation was related to left ventricle wall thickness, = 0.27, = 0.041, and carotid intima-media thickness, = 0.26, = 0.046. There was no association of any cardio-pulmonary parameters with time from surgery, type of operation or echocardiography results. Adults after aortic coarctation repair suffer from arterial hypertension, recurrent aortic stenosis, aortic aneurysms, and coronary artery disease. Reduced exercise capacity in cardio-pulmonary exercise test is related to hypertensive reaction and chronotropic incompetence.

Hybrid procedures encompass surgical and catheter-based interventions aimed at enhancing survival rates and provide alternative treatment options for severely ill patients. This is a retrospective study aimed at analyzing hybrid procedures in infants with complex heart defects and duct-dependent systemic circulation at a high risk of cross-clamp circulation based on a single center's experience. We included 12 infants (7 boys, 5 girls) who were admitted to our department between 2019 and 2024 and who underwent hybrid surgery due to left-sided obstructive lesions. All neonates presented progressive heart failure and multiple organ dysfunction preceding hybrid procedures. The interventions were performed at a mean age of 8.6 days, with a mean body weight of 3.3 kg. Extracorporeal membrane oxygenation was required postoperatively in 2 patients. Early and late mortality were 8.3% and 16.6%, respectively. Interstage catheterization was performed in 7 patients requiring re-dilation of pulmonary artery bands and in 2 infants with arterial duct stent stenosis. Severe tricuspid regurgitation and progressive right ventricular dysfunction due to inadequate coronary perfusion were reported in 2 patients. Hybrid procedures are alternative options for infants with complex heart defects, especially when cross-clamp circulation poses high surgical risk. Multiple reinterventions are necessary to maintain stable hemodynamic status and relieve hypoxia or cardiac compromise. Future studies should aim to refine the timing and techniques of these interventions to improve survival and quality of life.

Although researchers extensively study the rapid generation and spread of misinformation about the novel coronavirus during the pandemic, numerous other health-related topics are contaminating the internet with misinformation that have not received as much attention. This study aims to gauge the reach of the most popular medical content on the World Wide Web, extending beyond the confines of the pandemic. We conducted evaluations of subject matter and credibility for the years 2021 and 2022, following the principles of evidence-based medicine with assessments performed by experienced clinicians. We used 274 keywords to conduct web page searches through the BuzzSumo Enterprise Application. These keywords were chosen based on medical topics derived from surveys administered to medical practitioners. The search parameters were confined to 2 distinct date ranges: (1) January 1, 2021, to December 31, 2021; (2) January 1, 2022, to December 31, 2022. Our searches were specifically limited to web pages in the Polish language and filtered by the specified date ranges. The analysis encompassed 161 web pages retrieved in 2021 and 105 retrieved in 2022. Each web page underwent scrutiny by a seasoned doctor to assess its credibility, aligning with evidence-based medicine standards. Furthermore, we gathered data on social media engagements associated with the web pages, considering platforms such as Facebook, Pinterest, Reddit, and Twitter. In 2022, the prevalence of unreliable information related to COVID-19 saw a noteworthy decline compared to 2021. Specifically, the percentage of noncredible web pages discussing COVID-19 and general vaccinations decreased from 57% (43/76) to 24% (6/25) and 42% (10/25) to 30% (3/10), respectively. However, during the same period, there was a considerable uptick in the dissemination of untrustworthy content on social media pertaining to other medical topics. The percentage of noncredible web pages covering cholesterol, statins, and cardiology rose from 11% (3/28) to 26% (9/35) and from 18% (5/28) to 26% (6/23), respectively. Efforts undertaken during the COVID-19 pandemic to curb the dissemination of misinformation seem to have yielded positive results. Nevertheless, our analysis suggests that these interventions need to be consistently implemented across both established and emerging medical subjects. It appears that as interest in the pandemic waned, other topics gained prominence, essentially \"filling the vacuum\" and necessitating ongoing measures to address misinformation across a broader spectrum of health-related subjects.

The aim of this study was to test the hypothesis that polymorphisms of the paraoxonase genes PON1 and PON2 may be associated with increased risk of developing multiple sclerosis (MS) in the Polish population. We studied the significance of the PON gene polymorphisms C311S, A162G, Q192R and L55M in 221 patients (including 145 women) with MS and in 661 healthy controls. In the MS population, mean Expanded Disability Status Scale score was 2.92, mean age was 36.8 years, and mean disease duration was 7.7 years. PON genotyping was determined using polymerase chain reaction and restriction enzyme digestion. According to our results, the PON1 and PON2 genotypes distribution did not differ between the MS patients and the controls. The polymorphisms of the PON genes studied are not related to increased risk of MS in the Polish population. Celem pracy było zweryfikowanie hipotezy, że polimorfizm genów PON1 i PON2 może być związany z ryzykiem wystąpienia stwardnienia rozsianego (SR) w populacji polskiej. Autorzy badali znaczenie polimorfizmu genów PON: C311S, A162G, Q192R oraz L55M, u 221 chorych na SR (w tym 145 kobiet) oraz u 661 zdrowych osób z grupy kontrolnej. W grupie chorych na SR średnia punktacja w Expanded Disability Status Scale (EDSS) wynosiła 2,92 pkt, średnia wieku – 36,8 roku, a średni czas trwania choroby – 7,7 roku. Polimorfizm – A162G genu PON1 badano za pomocą reakcji łańcuchowej polimerazy (PCR) z analizą ilości produktu w czasie rzeczywistym, a pozostałe polimorfizmy za pomocą PCR i trawienia odpowiednimi enzymami restrykcyjnymi. Nie stwierdzono istotnych statystycznie różnic w rozkładzie genotypów PON1 i PON2 pomiędzy grupą chorych a grupą kontrolną. Wyniki pracy nie wskazują, aby istniała zależność pomiędzy polimorfizmem genów PON1 oraz PON2 a zwiększonym ryzykiem wystąpienia SR w populacji polskiej.