Karolina Pełka

Background: Endometriosis affects 10–15% of reproductive-aged women and is a leading cause of infertility through anatomical, inflammatory, and molecular mechanisms. Objective: This review synthesizes current evidence on the pathophysiology of endometriosis-associated infertility and evaluates medical, surgical, and ART strategies to guide individualized management. Methods: We conducted a narrative review (2000–2025; PubMed, Scopus, WoS) synthesizing RCTs, meta-analyses, and observational studies on mechanisms and treatment outcomes. Results: In rASRM stage III–IV, tubo-ovarian distortion and adhesions mechanically impair oocyte pickup and embryo transport. In superficial disease, animal models demonstrate that peritoneal inflammatory mediators and ROS can impair oocyte maturation, though direct causal evidence in humans is lacking. Epigenetic dysregulation has been identified in the eutopic endometrium and linked to progesterone resistance, though its direct causal role in infertility remains unestablished. Hormonal suppression controls pain but does not improve spontaneous conception rates. Laparoscopic surgery in stage I–II remains debated. Prospective evidence supporting fertility benefit from DIE excision without mechanical obstruction is lacking. Cystectomy consistently reduces AMH, favoring IVF over surgery unless symptoms or retrieval barriers exist. IVF/ICSI live birth rates per cycle in stage I–II are comparable to those without endometriosis; cumulative rates after ≤5 cycles reach 43–46% in treated vs. 28% in untreated stage III–IV patients. Conclusions: Management requires two sequential decisions: first, whether to perform a diagnostic laparoscopy to identify minimal disease and adhesions, and second, whether to proceed with surgery or transfer directly to ART. Age ≥ 35, infertility > 2 years, or low AMH/AFC favor immediate IVF. Post-surgical EFI guides timing: high EFI supports expectant management or IUI; low EFI should prompt ART referral. When cystectomy is necessary, tissue-sparing techniques should be prioritized and fertility preservation, including oocyte cryopreservation, discussed preoperatively.

Background: Increasing antimicrobial resistance (AMR) is one of the leading causes of death worldwide. The predominant pathogens that exacerbate the AMR problem are multidrug-resistant (MDR) Gram-negative bacteria (GNB). Due to the increasing adaptation of MDR GNB to commercially available antimicrobial drugs, such as carbapenems as well as third- and fourth-generation cephalosporins, pharmaceutical companies around the world have been forced to produce increasingly innovative chemotherapeutics. Cefiderocol (CFDC) is a novel injectable cephalosporin 5 generation developed by Shionogi, directed against MDR GNB, including strains resistant to carbapenems. Results: Analysis demonstrated its significant efficacy across a wide range of in vitro and in vivo studies against MDR GNB, including Carbapenem-resistant Pseudomonas aeruginosa (CRPA), Carbapenem-resistant Acinetobacter baumannii (CRAB), and carbapenem-resistant Enterobacterales (CRE) (WHO Critical Priority Pathogens). Clinical studies have shown CFDC to be an effective drug with few adverse effects. Conclusions: When used CFDC appropriately within antibiotic stewardship guidelines, this drug is an effective, well-tolerated targeted treatment option for patients with severe clinical conditions.

Background/Objectives: Asthma exacerbations are among the most frequent causes of pediatric emergency department (ED) visits, with over 700,000 annual cases in the United States and a significant number in Europe. Children under five years of age are particularly vulnerable to hospitalization. Methods: As timely assessment of exacerbation severity in the ED is critical, this review synthetizes data about tools such as the Pediatric Respiratory Assessment Measure (PRAM) and the Asthma Severity Score (ASS) aid in evaluating clinical status based on respiratory rate, oxygen saturation, accessory muscle use, and response to treatment. We also analyzed the proper management following established guidelines from GINA, NAEPP and other articles. Results: First-line therapy includes oxygen supplementation, short-acting beta-agonists (SABAs) administered frequently during the first hour, and early systemic corticosteroids. In moderate to severe cases, ipratropium bromide is added. For refractory or life-threatening presentations, intravenous magnesium sulfate, epinephrine, or ventilatory support may be required. Discharge is appropriate when symptoms resolve, oxygen saturation remains >94% on room air, and the child demonstrates adequate inhaler use. Hospitalization is indicated in cases of persistent hypoxemia, poor response, feeding difficulties, or social concerns. Post-discharge care includes thorough caregiver education, medication access, and a personalized asthma action plan to reduce recurrence risk. Conclusions: The effective diagnosis, appropriate exacerbation treatment, monitoring of patients in the post-attack period, as well as successful preventive medication play a key role in the management of pediatric patients with asthma.

Background/Objectives: Twin pregnancies have long been of interest to the scientific community. Particular attention has been paid to factors influencing the postnatal condition of newborns. However, findings related to this issue, obtained in various centres, remain inconclusive. Methods: Data from 845 pairs of twins born between 1990 and 2017 at the University Centre of Obstetrics and Gynecology in the Wroclaw Medical University were analyzed. The postnatal condition was assessed based on the Apgar score at the 5th minute after birth. The Apgar scores were categorized into three groups: 8–10 indicated a good condition, 4–7 moderate, and 0–3 poor. Pregnancies with unknown chorionicity and amnionicity, monochorionic and monoamniotic pregnancies, still births, and cases with fetal defects were excluded from the study (126 cases). Finally, data of 719 pairs of twins were included. Results: Twins with a birth weight difference of less than 15% were more likely to receive a good Apgar score compared to those with a greater weight discrepancy (p < 0.001). The second-born twin was more likely to receive a good Apgar score compared to the first-born (p < 0.001). A higher proportion of twins delivered by cesarean section received a good Apgar score compared to those delivered vaginally (p < 0.001). The method of conception, chorionicity, amnionicity and being the smaller or bigger twin in the pair did not significantly affect the perinatal outcomes. Conclusions: Delivery method, birth order, and weight discrepancy play a key role in postnatal condition of twins, highlighting the importance of understanding these factors to optimize the management of twin pregnancies.

Background/Objectives: Crohn’s disease is a chronic inflammatory condition with periods of exacerbation and remission that can involve any part of the gastrointestinal tract. The basic intestinal manifestation is frequently accompanied by extraintestinal involvement and may lead to complications such as perforations, fistulas and abscesses. Despite Crohn’s disease being the most common reason of intestinal perforation, the other causes should be considered as well. Internalization of a foreign body, although rare, may still occur, especially in the pediatric population. Methods: The following case report presents the medical history of an 11-year-old patient who developed an enterocutaneous fistula two years after the diagnosis of Crohn’s disease. Data analysis was carried out on the basis of patient medical records. Results: The fistula formed in the course of biological treatment during a period free of other symptoms indicating disease exacerbation. The imaging tests revealed the presence of a foreign body in the gastrointestinal tract, which could have been a potential cause of the observed inflammation that resulted in the development of the fistula. Conclusions: The presented case report as well as the literature indicate a correlation between the formation of intestinal fistulas and an active disease process. However, in the absence of symptoms of Crohn’s disease exacerbation, other causes should be considered.