Edyta Zagrodnik

Background: The tryptophan catabolic pathway may play an important role in maternal–fetal immune tolerance, placental function, and metabolic programming, yet its clinical correlates in uncomplicated term pregnancies are not well defined. This study examined how maternal and umbilical artery blood tryptophan metabolites relate to maternal characteristics in women undergoing cesarean section. Methods: In this cross-sectional study, 73 women delivering by cesarean section at a mean gestational age of 38.9 ± 0.96 weeks were enrolled. Maternal venous and umbilical cord arterial blood were collected at delivery, and serum tryptophan (TRP), kynurenine (KYN), kynurenic acid (KYNA), and quinolinic acid (QUIN) were measured using ELISA. Maternal anthropometry, pregnancy complications, antibiotic treatment, and indications for cesarean section were obtained from medical records. Group comparisons used Mann–Whitney U tests, associations were assessed with Spearman’s rank correlations, and selected outcomes were analyzed in multivariable linear regression models. Results: Umbilical concentrations of TRP, KYN, KYNA, and QUIN were higher than the corresponding maternal levels. Maternal TRP was inversely associated with gestational age at delivery and was independently higher in women treated with antibiotics during pregnancy. Cord KYNA correlated positively with pre-pregnancy and pre-delivery BMI, with a stronger association for postpartum BMI, and remained independently associated with pre-delivery BMI in multivariable analysis. Maternal QUIN was higher in women undergoing intrapartum or emergency cesarean section and in those delivered by cesarean section for breech presentation, and both indications were independently associated with higher QUIN in the regression model. No robust associations were observed between TRP, KYN, KYNA, or QUIN and most pregnancy complications, neonatal birth weight, or Apgar scores. Conclusions: Maternal and fetal tryptophan–kynurenine metabolites show distinct, domain-specific relationships with gestational timing, maternal antibiotic exposure during pregnancy, adiposity, and indications or mode of cesarean delivery in term pregnancies. Maternal TRP levels may primarily reflect gestational age and concurrent inflammatory status. Cord blood KYNA may mirror maternal metabolic condition, whereas maternal QUIN appears to be more closely associated with complex obstetric phenotypes than with neonatal status. These exploratory, uncorrected findings suggest that kynurenine pathway metabolites may be associated with selected maternal anthropometric and obstetric factors; none of these associations survived correction for multiple comparisons, and they are strictly hypothesis-generating, requiring confirmation in larger, prospectively designed studies before any biomarker application can be considered. The parallel elevation of the cord KYN/TRP and KYNA/KYN ratios, together with a relative reduction in the QUIN/KYN ratio in the fetal compartment, suggests a metabolic profile characterized by preferential conversion of kynurenine toward the KYNA branch rather than the QUIN branch. This pattern may be consistent with a more neuroprotective metabolic environment in the fetal circulation; however, mechanistic studies are required to confirm this interpretation. The maternal QUIN should be regarded as a marker of obstetric complexity rather than a direct consequence of delivery mode. The study included only women undergoing cesarean delivery; therefore, the findings cannot be generalized to vaginal deliveries.

Background/Objectives: Endometriosis is a chronic condition affecting women of reproductive age. Its symptoms have a negative impact on the quality of life and fertility of many women in the population. The aim of this literature review was to examine the use of phototherapy, heating and acupuncture in the treatment of endometriosis. Methods: A structured review of the available literature using the PubMed, Embase and Scopus databases, including studies from the last 10 years and with full free access, was applied. The literature search was conducted using the keywords: “endometriosis”, “phototherapy”, “heating” and “acupuncture”. Results: Phototherapy, including photothermal (PTT) and photodynamic therapy (PDT), demonstrated promising results in preclinical animal models, suggesting a potential for reducing endometrial lesions, primarily through mechanisms involving apoptosis, necrosis, and oxidative stress. However, most studies were limited to animal models. Thermal interventions, including magnetic hyperthermia and perioperative heating strategies, were associated with pain reduction, although improper use may lead to adverse effects such as erythema. Acupuncture showed effectiveness in reducing pain and improving quality of life, although its effects may be temporary and supported mainly by small-scale studies and case reports. Conclusions: Studies available in the literature demonstrate the effectiveness of the phototherapy effect, utilizing the mechanism of apoptosis or necrosis, in eliminating endometrial tissue and reducing pain. Acupuncture, derived from Traditional Chinese Medicine, also reduces pain. Non-pharmacological interventions may provide supportive benefits in the management of endometriosis, particularly in pain reduction and lesion control.

Data on cardiac and hemodynamic parameters associated with preeclampsia (PE), particularly changes occurring in the immediate perioperative period, remain scarce. These changes are clinically important for the management of patients with severe PE or underlying cardiac dysfunction. Maternal hemodynamics undergo substantial alterations during cesarean section (CS) as a result of sympathetic blockade induced by spinal anesthesia, the vasodilatory effects of general anesthetics, and changes in blood flow related to aortocaval compression in the supine position and during delivery. Massive hemorrhage represents an additional factor contributing to these alterations. In routine clinical practice, maternal heart rate (HR) and blood pressure (BP) are monitored to assess circulatory status. However, a more precise evaluation can be achieved by measuring stroke volume (SV), cardiac output (CO), and systemic vascular resistance (SVR). These parameters are particularly relevant in cases of severe hemorrhage or hypertension, as they may facilitate targeted hemodynamic management. Overall, hemodynamic responses to cesarean delivery under spinal anesthesia appear to differ between normotensive and hypertensive pregnancies. Normotensive parturients seem to be more susceptible to pronounced hypotension following sympathetic blockade, whereas hypertensive disorders of pregnancy are associated with altered vascular reactivity and modified intraoperative hemodynamic responses. Nevertheless, interpretation of these findings remains limited by the heterogeneity of the available studies and the lack of quantitative evidence synthesis.

Background/Objectives: Cardiac surgery, particularly procedures performed with cardiopulmonary bypass (CPB), carries a high risk of neurological complications, including postoperative delirium (POD), which affects 16–73% of patients and increases the likelihood of long-term cognitive impairment. Brain-derived neurotrophic factor (BDNF), a neurotrophin involved in neuronal function, synaptic plasticity, and inflammatory regulation processes, including its Val66Met polymorphism, has been implicated as a potential predictor of POD. This study aimed to evaluate the relationship between perioperative plasma BDNF levels, the BDNF Val66Met polymorphism, and the incidence of POD in patients undergoing elective cardiac surgery with CPB. Methods: This prospective observational single-center study enrolled 287 adults scheduled for elective isolated coronary artery bypass grafting (CABG) with CPB, of whom 107 met all inclusion criteria for final analysis. Exclusion criteria included urgent surgery and pre-existing cognitive or psychiatric disorders. Preoperative evaluation included cognitive testing (MoCA), laboratory and biochemical analysis, and genotyping for BDNF Val66Met. Postoperatively, patients were assessed for POD using the CAM-ICU scale for the first three consecutive days. Cognitive function (using MoCA) and other neurological complications were evaluated during hospitalization, at 30-day and 12-month follow-up. Associations between biomarkers, genetic factors, and clinical outcomes were analyzed. Results: POD occurred in 19.6% of patients who were older, had higher EuroSCORE II, greater coronary disease burden, more frequent prior stroke and chronic kidney disease, and lower neutrophil counts. POD was significantly associated with prolonged hospital stay, need for continuous renal replacement therapy, and reoperation. The BDNF Val66Met polymorphism was present in 31.8% of patients but was not associated with POD, although carriers exhibited higher plasma BDNF concentrations across all time points. Conclusions: Perioperative plasma BDNF concentrations and the BDNF Val66Met polymorphism were not independently associated with the occurrence of POD in elective CABG patients. However, POD was significantly linked to prolonged hospitalization and reoperations. Neurological complications remain an important challenge in cardiac surgery, emphasizing the need for further research and early identification strategies to improve postoperative outcomes.

Background/Objectives: The aim of this study is to analyze the frequency and type of subjective adverse events reported after the use of oxytocin and carbetocin in women giving birth by cesarean section. Methods: A total of 70 pregnant women, previously scheduled for elective cesarean section, were enrolled in this study and divided into two groups. One group (OXY) received intrapartum oxytocin at a dose of 5 IU intravenously, and the other group (CARBE) received intrapartum carbetocin at a dose of 100 μg intravenously. Both drugs were used alternately to contract the uterus immediately after the expulsion of baby during the cesarean section. Results: An analysis of reported subjective adverse symptoms associated with the administration of uterotonic drugs showed a higher incidence of adverse effects in the group of women receiving oxytocin compared to those receiving carbetocin. Statistical significance was observed for all of the following reported symptoms: headache, chest pain, burning sensation and heaviness in the chest, and palpitations. Conclusions: Although chest pain, burning and heaviness in the chest, palpitations, and headaches are more common in women giving birth by cesarean section after administration of oxytocin than after administration of carbetocin, this fact appears to be of limited clinical significance from a clinical point of view.

Background: Pathological pregnancy is associated with various complications that may affect the health of both the mother and her offspring. In recent years, lipid metabolites such as hydroxyeicosatetraenoic (HETE) fatty acids and hydroxyoctadecadienoic (HODE) fatty acids have gained increasing interest as potential biomarkers of pathological processes in pregnancy. The aims of the present study were to investigate changes in HETE and HODE levels during pathological pregnancy and to assess their potential role in the development and monitoring of pregnancy complications. Attempts were made to determine associations in cross-sectional studies and relationships in longitudinal ones. Methods: In this study, a liquid chromatograph (HPLC) was used to separate the eicosanoids. The study group consisted of 72 Caucasian women, divided into a control group (n = 51) and a group with non-physiological pregnancy (n = 21). Results: The study results show that the levels of the tested metabolites of the cyclooxygenase (COX) and lipoxygenase (LOX) pathways increased as pregnancy progressed. Women with non-physiological courses of pregnancy who developed gestational diabetes and/or preeclampsia were characterized by dysregulation of the inflammatory signaling processes involving eicosanoids. Conclusions: Carbohydrate abnormalities during pregnancy were mainly associated with increased synthesis of 5-oxoETE and the use of 5-HETE in the control group but were not visible in the diabetic group. HODE acids probably do not play a significant role in pathological pregnancy. The relatively small size of the pathological group and the wide range of gestational age mean that the tests should be standardized and carried out on a larger scale.

Background: In recent years, the incidence of thyroid cancer has been increasing due to environmental, biological, and genetic factors. One of the treatment methods for thyroid cancer is strumectomy, a procedure associated with a high risk of postoperative complications. Methods: The following case presents septic shock with sudden cardiac arrest and cardiopulmonary resuscitation, caused by Streptococcus pyogenes, in a 45-year-old woman who underwent surgery for papillary carcinoma. Results: The patient required long-term interdisciplinary treatment in the Clinical Department of Anesthesiology and Intensive Care. Conclusions: Necrotizing mediastinitis after thyroidectomy caused by Streptococcus pyogenes is a rare and dangerous complication. The analysis of the case proves how important the preoperative assessment of the patient’s health (especially taking a detailed history) and the patients’ awareness of possible risk factors are. An equally important aspect is the awareness of the therapeutic team regarding the transmission of infections, their dynamics, and the consequences of the procedures undertaken.

Patients undergoing immunosuppressive therapy are at risk of adverse gastrointestinal symptoms such as diarrhea, nausea, intestinal barrier leakage, and nutrient malabsorption. One mechanism underlying these complications may be increased levels of oxidative stress in the cell, and thus an increased predisposition of enterocytes to programmed death. We examined the effects of triple immunosuppressive regimens on the concentration of glutathione, the SLC1A5 receptor, caspase-3, caspase-9, Bcl-2, Bax, and apoptosis in the rat intestine. For this purpose, we used Western blot analysis, ELISA, and the TUNEL method. The study began with 36 rats divided into six groups, which were administered the drugs for a period of six months. Our results suggest that chronic use of standard immunosuppressive regimens increases the risk of oxidative stress in the rat intestine, as manifested by increased expression of glutathione or the SLC1A5 transporter. The use of rapamycin in combination with cyclosporine A or mycophenolate mofetil leads to increased cellular apoptosis in the rat intestine, which is associated with a failure of compensatory mechanisms for elevated oxidative stress. The combination of tacrolimus with rapamycin results in the highest percentage of TUNEL positivity, and the apoptotic pathway is not a result of increased oxidative stress in the tissue.

Background: Larval debridement therapy is used to cleanse necrotic tissue wounds and/or decontaminate wounds that are not amenable to standard therapies. Methods: A patient was diagnosed with septic shock and multiple organ failure caused by Streptococcus pyogenes after thyroidectomy (the patient had experienced contact with a child with scarlet fever six days before admission to the hospital). As a result of systemic infection, numerous necrotic skin lesions appeared, which involved the surgical site, chest and scalp. A tracheocutaneous fistula was confirmed. Due to the ineffectiveness of typical therapy and the patient’s severe clinical condition, she qualified for unconventional therapy (larval debridement therapy). Results: Larval wound debridement therapy and negative-pressure wound therapy were used for the tracheocutaneous fistula; this is the first case of this alternative therapy being described in the English-language literature. In this case, based on an analysis of the health benefits for the patient and the uncertain prognosis, larval therapy was used for a postoperative wound after strumectomy with the presence of a tracheocutaneous fistula, and negative-pressure wound therapy ultimately led to complete wound healing. Conclusions: Sepsis caused by Streptococcus pyogenes can be fulminant and often leads to complications or death, especially if it develops in the perioperative period. Larval therapy can be effectively used in cases of fistulas, such as tracheocutaneous fistulas, to prepare the wound bed for the next stage of healing using negative-pressure therapy, which ultimately leads to complete wound healing.

Background/Objectives: Oxytocin as well as carbetocin, a synthetic analog of oxytocin with a longer duration of action, can affect the cardiovascular system, which can be recorded in electrocardiographic Holter recordings. The choice of the appropriate dose of oxytocin or carbetocin should take into account potential cardiovascular effects. Methods: A total of 70 pregnant women who previously qualified for elective cesarean section and enrolled in the study were divided into two groups. The oxytocin group (OXY) received 5 IU of oxytocin intravenously (i.v.). The carbetocin group (CARBE) received 100 µg of carbetocin intravenously. Both drugs were used alternatively to contract the uterine muscle. Continuous Holter electrocardiograph recording started 30 min before the procedure and continued until about 3 h after the procedure. Results: No abnormalities were observed in either of the analyzed groups during intraoperative ECG recordings at either the highest or lowest recorded heart rate values. The incidence of ST-segment-lowering episodes, the depth of the denivelation and its duration did not differ between the groups studied. The incidence of additional ventricular beats was comparable in the OXY and CARBE groups, both before and after the administration of uterotonic drugs. In the CARBE group, no significant changes in MAP were recorded during the entire ST-segment-lowering period. Analysis of heart rate changes during ST lowering showed no differences between the study groups. Conclusions: A thorough analysis of perioperative ECG recordings revealed no significant alterations in ECG patterns, neither in response to oxytocin nor carbetocin administration during cesarean sections.