Adrianna Zahorowska

Background and Objective: Body mass index (BMI) is widely used to classify obesity in children and adolescents but does not characterize fat distribution. Visceral adipose tissue (VAT) may provide information on cardiometabolic risk beyond BMI. This systematic review aimed to synthesize evidence on the associations between VAT and cardiometabolic risk in children and adolescents with obesity and to evaluate whether VAT provides additional information beyond BMI. Methods: PubMed and Scopus were searched for English-language studies published between 1 January 2016 and 28 February 2026. Eligible studies included participants aged 6–19 years, assessed VAT using dual-energy X-ray absorptiometry (DXA), magnetic resonance imaging (MRI), computed tomography (CT), or ultrasonography (USG), and reported at least one cardiometabolic outcome. Two reviewers independently screened the records. Methodological quality was assessed using the appropriate Joanna Briggs Institute Critical Appraisal Tools or the Newcastle–Ottawa Scale. Because of methodological and clinical heterogeneity, the findings were synthesized narratively. The review was reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 statement. Results: Twenty studies were included, most of which were cross-sectional. Higher VAT was generally associated with insulin resistance, adverse lipid profiles, elevated blood pressure, inflammatory biomarkers, and early vascular dysfunction, although findings were not uniform across all populations and outcomes. In several studies, associations remained significant after adjustment for BMI or other measures of general adiposity, suggesting that VAT may capture cardiometabolic risk not reflected by BMI alone. DXA was the most frequently used assessment method. Conclusions: VAT may complement BMI in cardiometabolic risk assessment among children and adolescents with obesity. However, predominantly cross-sectional evidence, methodological heterogeneity, and the absence of standardized pediatric thresholds preclude firm conclusions about its incremental predictive value or routine clinical use. Prospective studies directly comparing VAT and BMI are required.

Background: Paraneoplastic neurological syndromes are rare immune-mediated disorders that may represent the first clinical manifestation of an underlying tumor. Case Report: This report describes a 58-year-old woman with rapidly progressive cerebellar dysfunction and anti-Yo antibodies in serum and cerebrospinal fluid. Definite PNS was diagnosed according to the PNS-Care Score criteria (score: 10/10). Oncological evaluation revealed FIGO IIIC high-grade serous ovarian carcinoma (HGSOC) with extensive peritoneal dissemination. Despite corticosteroids, cytoreductive surgery, and carboplatin–paclitaxel chemotherapy, neurological disability progressed, although tumor control was achieved. Methods: A PRISMA-guided review of PubMed and Scopus identified 33 studies of PNSs associated with ovarian tumors published between 2016 and 2026. Results: Anti-NMDAR encephalitis, mainly associated with ovarian teratomas, generally showed favorable recovery, whereas anti-Yo-associated cerebellar degeneration, predominantly linked to epithelial ovarian malignancies, had poor neurological outcomes. Conclusions: Prompt antibody testing, oncological investigation, and multidisciplinary treatment are essential, although anti-Yo-associated neurological deficits may be irreversible.

The rate of caesarean sections has increased noticeably worldwide in recent years. Many efforts are being made to understand this phenomenon, one of which is to analyse the changing indications for caesarean deliveries over the years. To analyse and compare the indications for caesarean section over 3 years (2020-2022) and to identify the trends for the increasing caesarean section rate. All women who delivered in the Department of Obstetrics and Gynaecology of the University Clinical Hospital in Szczecin were included in the analysis between January 2020 and December 2022. We analysed outcomes of 6870 deliveries both vaginal and via caesarean section. The indications for caesarean section were analysed and the results were compared to the results of the study conducted at the same centre between 2014 and 2018. There were 3661 CS (53.29%) and 3309 vaginal deliveries (46.71%). 50.61% first time mothers (primipara) delivered with caesarean section. The most common obstetric indication for caesarean section was previous lower segment caesarean section 671 (19.65%) and the most common non-obstetric indication was psychological disorder 524 (50.68%). Based on the results of this study, we observed a persistently high rate of caesarean sections. Caesarean section is still a significant obstetric problem, especially among first-born women. There is a need to look for ways to reduce the caesarean section rate to the recommended 15-20%.

Background: The sFlt-1/PlGF ratio has proven predictive value in diagnosing preeclampsia. Referring to a study from 18 American perinatal centers, we present results from 2 European centers showing the significant value of those markers in predicting severe perinatal outcomes in hypertensive disorders of pregnancy. Methods: A total of 1630 patients with suspected or confirmed placental insufficiency, hospitalized in two tertiary perinatal centers in Poland and Macedonia, were assessed for their sFlt-1/PlGF ratio. Due to incomplete data, perinatal outcomes were only obtained for 1196 patients. They were sorted into two groups according to the value of the sFlt-1/PlGF ratio (p < 0.001). In a group of patients with an index value of ≥40, the AUC was 0.9955 (95% CI: 0.9913 to 0.9996), with a sensitivity of 52%, a specificity of 78%, a positive predictive value of 77%, and a negative predictive value of 53%. For patients who were tested before 37 weeks of gestation, 66% of women with a ratio of ≥40 delivered within 7 days of the test, and 80% of those with a ratio of <40 delivered more than 7 days after the test, with a sensitivity of 68%, a specificity of 79%, a positive predictive value of 66%, and a negative predictive value of 80%. Conclusions: In women with hypertensive disorders, the sFlt-1/PlGF ratio can be used to predict the time to delivery. A cut-off of 40 is very useful in predicting severe perinatal outcomes.

Background: For years, bone mineral density (BMD) has played a key role in assessing bone health, but the trabecular bone score (TBS) is emerging as an equivalent measure. However, BMD alone may not fully measure bone quality or predict osteoporosis risk. To evaluate the usefulness of TBS and BMD in estimating the risk of bone fracture in young women with FHA, this study examined the association between metabolic parameters and bone quality, which was measured using TBS and BMD. Methods: We analyzed the association of metabolic factors with tests assessing bone quality—TBS and BMD. Patients were checked for BMI, measured body fat, and determined serum glucose levels and insulin levels in a 75g glucose load test. Spearman correlation analysis was used. Results: Significant positive correlations were found between BMD and age (p < 0.001) and body fat (p < 0.001), as well as between TBS values and BMI (p < 0.001) and TBS and percent body fat (p < 0.001). Of the variables analyzed in the multivariate analysis, the only independent predictor of higher bone mineral density in the lumbar spine was found to be higher values of the trabecular bone index in the same segment (p < 0.001). Conclusions: The use of TBS provides a simple tool for estimating the risk of bone damage. Ultimately, early screening, diagnosis and treatment of patients with FHA may help prevent osteoporosis and fragility fractures in the long term.

The absence of non-invasive methods for assessing bone material and structural changes is a significant diagnostic challenge. Dual-energy X-ray absorptiometry (DXA) bone mineral density (BMD) testing is the gold standard for osteoporosis diagnosis. BMD and the trabecular bone score (TBS) have facilitated targeted osteoporosis prevention and treatment in clinical settings. The findings from this study indicate that BMD modulation in young women is influenced by various hormones, potentially compromising the diagnostic precision of BMD for subclinical bone demineralization. A total of 205 women aged 19 to 37 underwent anthropometric measurements and hormonal tests. BMD was determined using DXA, and TBS values were computed from the lumbar spine L1–L4 segment. The multivariate analysis findings suggest that BMD might not be determined by hormones. The relationship between TBS and TSH was statistically significant in the univariate analysis, which indicates the efficacy of further studies to determine the link between TBS and specific hormones. Analyzing the strength of the correlation between TBS and hormones in the univariate analysis shows which factors are worth considering in further analyses. This makes it possible to create better techniques that will help identify young women who are at a higher risk of developing osteoporosis.

Background: Nowadays, it is possible to identify a group at increased risk of preeclampsia (PE) and fetal growth restriction (FGR) using the principles of the Fetal Medicine Foundation (FMF). It has been established for several years that acetylsalicylic acid (ASA) reduces the incidence of PE and FGR in high-risk populations. This study aimed to evaluate the implementation of ASA use after the first-trimester screening in a Polish population without chronic hypertension, as well as its impact on perinatal complications. Material and methods: A total of 874 patients were enrolled in the study during the first-trimester ultrasound examination. The risk of PE and FGR was assessed according to the FMF guidelines, which include the maternal history, mean arterial pressure (MAP), uterine artery pulsatility index (UtPI), pregnancy-associated plasma protein A (PAPP-A) and placental growth factor (PLGF). Among patients with a risk higher than >1:100, ASA was administered at a dose of 150 mg. Perinatal outcomes were assessed among the different groups. Results: When comparing women in the high-risk group with those in the low-risk group, a statistically significantly higher risk of pregnancy complications was observed in the high-risk group. These complications included pregnancy-induced hypertension (PIH) (OR 3.6 (1.9–7)), any PE (OR 7.8 (3–20)), late-onset PE (OR 8.5 (3.3–22.4)), FGR or small for gestational age (SGA) (OR 4.8 (2.5–9.2)), and gestational diabetes mellitus type 1 (GDM1) (OR 2.4 (1.4–4.2)). The pregnancies in the high-risk group were more likely to end with a cesarean section (OR 1.9 (1.2–3.1)), while the newborns had significantly lower weights (<10 pc (OR 2.9 (1.2–6.9)), <3 pc (OR 10.2 (2.5–41.7))). Conclusions: The first-trimester screening test for PE and FGR is a necessary and effective tool in identifying high-risk pregnancies. ASA prophylaxis among high-risk patients may have the most beneficial effect. Furthermore, this screening tool may significantly reduce the incidence of early-onset PE (eo-PE).