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Facial aesthetic medicine is a young component of aesthetic medicine that raises a lively polemic on a number of issues on both medical and ethical grounds. The main focus of (non‑therapeutic) aesthetics turns to the improvement and correction of the face and neck to get from what is good to an even better, more beautiful, aesthetically pleasing, younger face. However, when qualifying a patient for aesthetic treatments, it is important to approach the issue holistically, to pay attention to all aspects: psychological state, social and cultural conditions and a holistic attitude towards life. Any worrying symptoms should not be underestimated. Thus, the practitioner of aesthetic medicine should always bear in mind two very topical truths of ancient origin: primum non nocere and salus aegroti suprema lex.

Celem artykułu jest analiza wykorzystania metod związanych z jogą dla ochrony zdrowia psychicznego oraz wspomagania leczenia zaburzeń psychicznych w Polsce. W tekście dominuje pespektywa historyczna, prześledzono dokonania prekursorów wykorzystania technik jogi w promocji zdrowia oraz leczeniu. Współczesne analizy biomedyczne potwierdzają prozdrowotną funkcję jogi, jednak w znacznie mniejszym stopniu odwołują się do aspektów związanych duchowością i jej znaczeniem dla zdrowia psychicznego. Z uwagi na rosnącą świadomość wpływu stylu życia, redukcji stresu oraz znaczenia umiarkowanego wysiłku fizycznego dla zdrowia techniki relaksacyjno-ruchowe mogą stanowić uzupełnienie terapii stosowanych w wielu chorobach psychicznych. Analizowane teksty historyczne potwierdzają pozytywny wpływ ćwiczeń opartych o techniki jogi na zdrowie psychiczne. Badania nad wpływem jogi na psychikę człowieka wymagają pogłębienia, żadna z zaprezentowanych analiz nie wykazała negatywnych skutków ubocznych uzupełnienia standardowych terapii o ćwiczenia oparte o różne formy jogi. Dla zbadania postawionego celu badań zastosowano metodę historyczno- porównawczą oraz analizę dyskursu. Dokonano przeglądu treści związanych z historią jogi w Polsce pod kątem zastosowania ćwiczeń bazujących na technice jogi w psychiatrii. W kolejnych etapach prac osadzono uzyskane treści w kontekście medycznym, kulturowym i historycznym i dokonano krytycznej analizy.

Streszczenie Klauzula sumienia została wprowadzona do obszaru prawnych regulacji międzynarodowych w związku z uchwałą Rady Europy o nr 1763 z dnia 7 października 2010 r. Zgodnie z treścią dokumentu istnieje przyzwolenie odstąpienia od wykonania określonego świadczenia medycznego ze względu na zastrzeżenia moralne (religijne lub światopoglądowe) zgłaszane przez przedstawicieli opieki zdrowotnej. W przepisach polskiego prawa medycznego powołanie się na zasadę klauzuli sumienia jest dozwolone, ale wyłącznie dla lekarzy, pielęgniarek i położnych. Farmaceuci są pozbawieni tej możliwości. Jednak wykonywanie niektórych czynności zawodowych budzi zastrzeżenia etyczne wśród farmaceutów. Autorzy artykułu postanowili zbadać opinię farmaceutów zarówno na temat klauzuli sumienia oraz określonych regulacji prawnych, które zdaniem respondentów powinny podlegać zmianom legislacyjnym. Celem pracy jest zaprezentowanie wyników z przeprowadzonych badań, które zostały zrealizowane w 2020 r. na terenie Wielkopolskiej Okręgowej Izby Farmaceutycznej w Poznaniu. Słowa kluczowe: wolność sumienia i wyznania, klauzula sumienia, farmacja, antykoncepcja, Polska

Background: Vinyasa yoga practice improves body fitness and potentially positively affects practitioners’ well-being and health. Due to the diverse intensity of practice and positions customized to the practitioner’s needs, it can also support cancer patients. Undertaking physical activity that has a potentially positive effect on well-being and health was particularly important during the self-isolation that followed the COVID-19 pandemic. The purpose of this study was to evaluate the impact of three-month mild and moderate intensity vinyasa yoga practice on breast-cancer patients’ stress perception, self-confidence, and sleep quality during COVID-19 induced self-isolation. Methods: Female breast-cancer patients participated in twelve-weeks of online vinyasa practice during the COVID-19 induced self-isolation period. Meetings were held once a week, where 60-min vinyasa yoga sequences were followed by 15 min of relaxation. Patients completed pre- and post-intervention surveys to evaluate changes in the following outcomes: stress perception, self-confidence, and sleep quality. Forty-one female patients enrolled in the Vinyasa course completed the pre-intervention survey, while 13 attended all the meetings and completed the post-intervention survey. Results: The effect of the twelve-week yoga and relaxation practice significantly reduced sleep problems and stress of oncological patients. The participants also declared an improvement in their general well-being and self-acceptance. Conclusion: Dynamic forms of yoga combined with mindfulness techniques can be applied to patients treated for oncological diseases. It contributes to improving their well-being. However, in-depth studies are needed to analyze the complexity of this effect.

Teamwork, as the preferred method of cooperation in healthcare, became prevalent in the 1960s, and since then has been universally recognized as a measure to improve the quality of healthcare. Research indicates that medical care based on interdisciplinary cooperation is associated with increased patient safety, lower hospitalization rates, and reduced rates of complications and medical errors. Furthermore, it enhances the coordination of care and improves patient access to medical services. This model of providing medical care also results in considerable benefits for medical professionals. These include greater job satisfaction and a reduced risk of professional burnout syndrome. Aim: The aim of the study was to explore the opinions of medical students with regard to cooperation in the interdisciplinary team, as well as the factors affecting the formation of opinions. Material and methods: The study was conducted using the Polish version of the questionnaire Attitudes Towards Interprofessional Health Care Teams. The study involved 1266 participants, including students of medicine (n = 308), midwifery (n = 348), nursing (n = 316) and physiotherapy (n = 294). Results: According to the opinions of the students participating in the study, the therapeutic process based on the interdisciplinary model improves the quality of medical care provided, increases patient safety, and improves communication between members of the therapeutic team. The factors affecting the assessment of cooperation in interdisciplinary medical care teams included the faculty and the year of studies, gender, as well as participation in the multidisciplinary courses. Conclusions: Students recognize the need for interdisciplinary medical teams. The training of future medical professionals should incorporate the elements of interprofessional education. This form of education allows students to develop both a professional identity and identification with their own profession, as well as encourages teamwork skills and shapes the attitude of openness towards representatives of other medical professions. However, in order to provide the students with the relevant knowledge, skills and competencies, it is essential to respect their diversity in terms of the faculty, as well as to account for the impact of gender and the year of studies which may affect their readiness to engage in teamwork.

The outbreak of the COVID-19 pandemic had an impact on the global economy, including the provision of health services, with medical facilities and patients cancelling or postponing medical appointments. An alternative to in-person appointments was through the available forms of telemedicine. Scientific reports around the world have suggested that the accessibility and quality of health services declined. The aim of this study was to investigate the accessibility and quality of health services in Poland and to verify whether there were differences between men and women in this respect. The study was based on the authors’ own survey questionnaire filled in by 265 respondents, including 181 women, 82 men, and 2 persons without a defined gender. The study revealed that during the COVID-19 pandemic, the accessibility and quality of health services declined. Additionally, women were more likely to use general and specialist health services than men, but a comparison of changes in the assessment of accessibility and quality of services by gender revealed no differences in the assessment of accessibility and quality.

The aim of this study was to analyse the relationship between the following three assessments: the Neonatal Behavioral Assessment Scale (NBAS), the Alberta Infant Motor Scale (AIMS), and the General Movement Assessment (GMA). 29 patients from the neonatal unit of the Gynecology and Obstetrics Clinical Hospital were examined. The study was conducted between feedings by a person properly trained in the use of the NBAS, the AIMS, and the GMA. The average postmenstrual age of the examined newborns was 35.6 weeks. The average week of gestation was the 29th, the average birth weight was 1469 g, and the Median Apgar score in the fifth minute of life was 7. A relationship was found between the AIMS and the NBAS. It was concluded that the Neonatal Behavioral Assessment Scale and the Alberta Infant Motor Scale may be used to determine the motor development of preterm infants. Moreover, it is advisable to use more than one assessment method in order to adjust the intervention.

This paper focuses on three areas: the first is a review of current knowledge about social and service robots for elderly care. The second is an optimization conceptual model aimed at maximizing the efficiency of assigning robots to serve the elderly. The proposed multi-criteria optimization model is the first one proposed in the area of optimization for robot assignment for the elderly with robot utilization level and caregiver stress level. The third is the findings of studies on the needs, requirements, and adoption of technology in elderly care. We consider the use of robots as a part of the ENRICHME project for long-term interaction and monitoring of older persons with mild cognitive impairment, to optimize their independence. Additionally, we performed focus group discussions (FGD) to collect opinions about robot-related requirements of the elderly and their caregivers. Four FDGs of six persons were organized: two comprising older adults, and two of the other formal and informal caregivers, based on a detailed script. The statements of older participants and their caregivers were consistent in several areas. The analysis revealed user characteristics, robot-related issues, functionality, and barriers to overcome before the deployment of the robot. An introduction of the robot must be thoroughly planned, include comprehensive pre-training, and take the ethical and practical issues into account. The involvement of future users in the customization of the robot is essential. This research was part of the ENRICHME project (ENabling Robot and assisted living environment for Independent Care and Health Monitoring of the Elderly), funded by the European Union Horizon 2020 Program, No: 643691C. This research was also partly supported by Poznan University of Medical Sciences in Poland and AGH University of Science and Technology in Krakow, Poland (16.16.200.396). Likewise, we appreciate the help of the Polish Ministry of Science & Higher Education grants (N N519 405934; 6459/B/T02/2011/40), and the Polish National Science Centre research grant (DEC-2013/11/B/ST8/04458) and the financial aid of the Spanish Ministry of Science, Innovation, and Universities (RED2022-134703-T; PID2019-111100RB-C22/AEI/10.13039/501100011033).

The COVID-19 pandemic is related to changes in rates of suicide and suicide attempts in many countries, and some differences have been observed regarding the prevalence of suicidal behaviours in different age and gender groups. The aim of this study is to analyse the number of suicides and suicide attempts per 100,000 people between 2019 and 2021 in Poland. Using police and government data on suicide and suicide attempts in Poland, three age categories were investigated: 13-24 years old, 25-65 years old, and above 65 years old, and the analysis encompassed the whole population and the populations of men and women separately. Study results indicated an increase in suicide attempts in the two younger age categories (aged 7-24 years and 25-65 years) between 2021 and 2019-2020. There was an increase in suicide among women in all age categories during the study period, whilst no increase was observed in suicide in men in any age group. The differences in the prevalence of suicide and attempted suicide in Poland during the COVID-19 pandemic in different age and gender groups indicate the need for tailored suicide prevention activities. ispartof: INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH vol:19 issue:15 ispartof: location:Switzerland status: published

This pilot study was conducted on the reported hypothesis that the COVID-19 pandemic outbreak had an impact on the accessibility and quality of healthcare services and exacerbated socioeconomic inequalities. The aim was to determine whether economic status and education had an impact on the perception of access and quality to healthcare services during the COVID-19 pandemic and whether, according to patients, accessibility and quality had changed significantly compared to the pre-pandemic period in Poland. The study was based on the authors’ questionnaire and the results were statistically analyzed. Two hundred forty-seven feedback responses were received with a responsiveness rate of 93 percent. Statistically significant differences were found when comparing education level and utilization of healthcare services during the COVID-19 pandemic. A comparison of gender and economic situation, and average monthly income found no statistically significant differences. The outbreak of the COVID-19 pandemic has undoubtedly affected the provision of health services in many countries around the world. One result of the pandemic crisis has been widening socioeconomic inequalities among patients.

The increase in suicidal behaviour among elderly people makes it necessary to take action in the field of broadly understood prevention. This includes helplines, which play an essential role in anti-suicidal measures. The aim of this study was to obtain information about the experience of Polish helpline workers in communicating with older people in suicidal crisis. The study was conducted among 106 helpline workers from various helpline centres across Poland. It proved that helpline workers in Poland have considerable experience in communicating with elderly people in suicidal crisis, albeit the majority of respondents feel they need additional training in the area of broadly understood suicidology.

Decision-making procedures in medical practice are often analysed by both philosophers of science and ethicists, as well as statisticians, clinicians and methodologists. The paper focuses on decisions made by patients in situations of moral dilemma. The main purpose is to analyse the strategies used in resolving such dilemmas. First, the concept of a ‘situation of moral dilemma’ is clarified. Then, two types of strategies for resolving such situations are distinguished. The first strategy requires revising the patient’s belief system or moral orientation. The second one includes a group of non-revision beliefs strategies (NRB). The authors argue in support of the thesis that NRB strategies are, in fact, the patient’s first choice when it comes to resolving moral dilemmas. The paper analyses situations where the NRB strategies may prove effective, as well as situations where they fail and where the solution of the moral dilemma must be addressed by revising the accepted belief system. The findings will help to better understand patients’ decision-making processes.

Human dreams of a long and healthy life are becoming increasingly real. The advancement of medical technology allows to modify the genome or personalised therapy in order to avoid troublesome side effects. This process also leads to the blurring of boundaries between humans and animals. Rats with induced human diseases are used for testing drugs for incurable illness; humanised pigs can donate organs that are compatible with the genome and immune system of the recipient. A brave new human is approaching, and new “human” animals are making this possible. The main objective of the article is to show the differences between the refinement of people and other animals and to analyse this phenomenon from an ethical point of view.

Introduction: Spiritual care is needed in a clinical setting to improve the patients’ quality of life. Deep connection with another person and delight with the beauty of nature or art and (in some cases) with God are all transcendental experiences. They may enable patients to ascribe meaning to their life with a chronic illness, find hope and well-being despite burdening symptoms. The opposite situation: lack of inner peace, inability to accept what is happening, feeling disconnected from others is called spiritual distress. Objectives: The aim of this research is to assess spiritual distress and spiritual needs of a group of Polish chronically ill patients and find associations with independent variables in order to provide data for recommendations on spiritual care in Poland. Patients and methods: 204 patients treated at the University Hospital and the Cystic Fibrosis Clinic in Poznan were surveyed in 2017 and 2018 with an original questionnaire. Results: Over half of the patients felt that their illness was life-threatening. A little more than half reported that faith was a resource to cope with suffering. Almost all patients showed signs of spiritual distress, and more than half expressed spiritual needs. The intensity of distress correlated only with the severity of the disease. The most important predictor of having spiritual needs was recognizing faith as a resource. Conclusions: Spiritual needs are associated with personal beliefs; however, spirituality spans beyond the religious context since spiritual distress is unrelated to the level of religious devotion. Therefore, any patient with a severe chronic disease needs basic spiritual care, which includes being treated with compassion.

Increasing cultural and linguistic diversities of populations have created a challenge for medical educators to provide authentic learning experiences fostering cross-cultural understanding and interprofessional attitudes of students. Simulations with actors portraying patients (commonly referred to as simulated patients) are effective learning modalities to teach students to provide culturally competent care and influence the quality of patient-centered care. The aim of this systematic review was to identify and synthesize available evidence on the use of simulations with simulated patients as a learning intervention to teach cultural competence to the students of healthcare professions. The PubMed, Medline Complete, and CINAHL databases were searched for articles, which resulted in 27 papers being included in the review. Results revealed that engaging students in cross-cultural interactions with patients increases their level of cultural competence, confidence, and learning satisfaction, and therefore, simulations with simulated patients can serve as a powerful reinforcement of cross-cultural education.

The COVID-19 pandemic resulted in unprecedented changes in the functioning of the health care system, which were connected with the occurrence of new challenges for both the health care system’s employees and for the patients. The purpose of the present article is to analyze the needs of persons with oncological diseases. Taking into account the multiple aspects of the term health, psychological, social, and existential needs of the patients were analyzed. This article is directed mainly at persons who remain in a direct therapeutic relation with a patient. It is to facilitate recognizing the needs of ill people and to increase sensitivity to the issue of maintaining or improving the well-being of patients which requires paying special attention to their psychological, social, and existential needs during the period of hindered access to the health care system. This systematic review takes advantage of quantitative and qualitative methods of text analysis with phenomenological analysis factored in. The COVID-19 pandemic resulted in the appearance of new problems in the population of oncological patients or it made the existing problems more severe. As a consequence, it made it significantly more difficult to meet their needs on various levels and sometimes it even made it impossible. It seems necessary to determine and introduce strategies to ensure that patients with oncological diseases have access to psychological and spiritual support in the period of the pandemic.

Background: The neonatal behavioral assessment scale (NBAS) was primarily developed to aid in the assessment of full-term neonates. The aim of this study was to detect if the NBAS was also valuable in the assessment of preterm neonates. Materials and Methods: We assessed 112 infants at a neonatal unit using the NBAS, 4th edition. The inclusion criteria included an oxygen saturation level between 88–95% and a heartrate of 100–205 beats per minute. Infant neurobehavior was assessed using the NBAS. Results: For full-term and preterm neonates, we observed that the NBAS enabled us to assess both groups of infants and gave relevant information pertaining to them. We found a significant correlation between the average week of gestation and response to touch, sensory input, peak of excitement, cost of attention, hand-to-mouth, and quality of alertness. Conclusions: The NBAS is a valuable scale for evaluating the neurobehavior of preterm neonates. The week of gestation at birth affects certain aspects of neurobehavior, such as response to sensory input, putting hand to mouth, peak of excitement, and cost of attention. The NBAS as an individually structured assessment may help in planning for early rehabilitation and intervention for this vulnerable population.

The study aims to analyse the clinical proceedings in pregnant women diagnosed with brain death. Apart from the diagnostic premises and the patient’s rights, the ontological status of the foetus proves to be a severe problem. In reference to the principles of zeroth-order logic, the assumption of potential used by personalists is not a tautology.

Background Klotho, originally identified as an anti-aging factor, is a transmembrane protein expressed in the kidney. It has been reported that Klotho deficiency could be associated with a loss of residual renal function and cardiovascular complications in peritoneal dialysis (PD) patients. Objectives The main aim of the study was to evaluate whether serum levels of Klotho correlate with residual diuresis and hydration status in PD patients. Material and methods The cross-sectional study involved 57 PD patients ≥18 years of age who had been on PD ≥ 3 months. Serum Klotho was measured using high-sensitivity enzyme-linked immunosorbent assay (ELISA). Hydration status was assessed with bioimpedance analysis (BIA). Results Serum levels of soluble Klotho ranged from 100 pg/mL to 700 pg/mL. The patients were divided into 2 subgroups, with Klotho levels below and above the median (260 pg/mL). The data revealed a tendency for lower residual diuresis (1.3 ±1.0 L vs 1.8 ±0.8 L; p = 0.055) in patients with lower levels of Klotho in serum. Serum Klotho correlated negatively with overhydration according to BIA (r = -0.27; p = 0.044) and positively with residual diuresis (r = 0.26; p = 0.045). Conclusions Soluble Klotho correlates inversely with hydration status in BIA. Residual urine output, but not dialysis parameters, could be associated with the levels of serum soluble Klotho in PD patients.

Glassy Cell carcinoma (GCC) of the cervix is classified as a unique, aggressive neoplasm, with different sensitivity to chemotherapy and radiotherapy. It is such an extremely rare tumor that it is practically not observed during pregnancy. Information on the coexistence of cervical GCC with pregnancy is also unique, so it seems extremely important to disseminate it in order to develop the most effective treatment regimen. Additionally, making any decisions regarding therapeutic methods during pregnancy encounters great ethical problems. We present the case of a 26-year-old pregnant woman, 18 weeks gestation, diagnosed with GCC of the cervix, IB3 grade in the International Federation of Gynecology and Obstetrics (FIGO) scale. Despite the unfavorable prognosis, the use of chemotherapy in a pregnant patient brought on a favorable therapeutic effect, without any negative effects on the fetus. The article also presents a literature review on the epidemiology, pathology, immunohistochemistry, treatment and prognosis of this rare disease.

Background Pursuant to the Resolution of the Council of Europe No. 1763 of October 7, 2010, physicians, nurses and midwives may resign from performing medical activities for ethical reasons. In Poland, these provisions do not apply to pharmacists, therefore it is considered granting pharmacists the right to refuse dispensing a drug on the basis of conscientious objection.Objective The authors of the study decided to present the opinion of pharmacists (from the Greater Poland Voivodeship in Poland) on the conscience clause.Method The research was carried out on the basis of a self-developed questionnaire. The survey questionnaire was addressed to 105 pharmacists. The participants were asked 29 questions, 21 related to pharmacists' opinions on the conscience clause, and the remaining 8 related to demographic data.Results Responses were received from 100 pharmacists (74 women and 26 men, mean age 34 years). Most - 82 participants (82%) answered that they had never provided a service that was against their conscience. Nevertheless, 18 respondents (18%) expressed a different opinion.Conclusion Most pharmacists are against the conscience clause. Nevertheless, about one-fifth of the respondents were in the situation of providing the service against their own ethical reservations, therefore this topic cannot be ignored.

Background The aim of this study was to determine the impact of umbilical cord arterial pH, gestational age, and birth weight on neurodevelopmental outcomes for preterm neonates. Methods We examined 112 neonates. Inclusion criteria were: Saturations greater than 88%, and heart rates between 100–205 beats per minute. Measurements We assessed several neurodevelopmental factors as part of the Brazelton Neonatal Behavioral Assessment Scale (NBAS), 4th edition, such as asymmetric tonic neck reflex (ATNR), motor maturity, response to sensory stimuli, habituation, and state regulation. Initial assessment parameters such as APGAR score and umbilical cord arterial pH were used to assess neonates. Results We found a strong correlation between the presence of the sucking reflex and umbilical cord arterial pH (r = 0.32; p = 0.018981). Umbilical cord arterial pH was also correlated with the presence of asymmetric tonic neck reflex (r = 0.27; p = 0.047124), cost of attention (r = 0.31; p = 0.025381) and general motor maturity (r = 0.34; p = 0.011741). Conclusions We found that the sucking reflex may be affected in infants with low umbilical cord arterial pH values. Practitioners and parents can use the NBAS to help determine neurodevelopmental factors and outcomes in preterm infants, possibly leading to safer and more effective feeding practices and interventions.

Background The paper presents an analysis of opinions concerning the use of stem cells (SCs), using tools developed in the field of moral psychology. Objectives To determine the factors that affect beliefs regarding the status of SCs and to evaluate the impact of these factors. The paper investigated whether factors of a moral nature prevail over the knowledge that makes it possible to use SCs in practice. Material and methods The analysis of psychological perception is based on a study carried out on a group of 172 Polish and 161 English-speaking first-year medical students. The study was conducted between 2005 and 2007, and in 2019 at the Poznan University of Medical Sciences (Poland). Results Knowledge is not the main factor that differentiates approaches towards the use of SCs. The importance of religion in the lives of the respondents has a significant impact on the perception of the use of SCs, and is associated with indications of ethically saturated terms. Focusing on the usefulness of cells is associated with lesser significance of religion and greater value placed on scientific knowledge. Conclusions Although the research results indicate a correlation between religiousness and the respondents' perception of the use of SCs, further research is needed into the relationship between the influence of scientific knowledge on views related to SCs.

The COVID-19 pandemic had a huge impact on the learning and teaching processes, particularly in healthcare education and training, because of the principal position of the cutting-edge student–patient interaction. Replacing the traditional form of organization and implementation of knowledge evaluation with its web-based equivalent on an e-learning platform optimizes the whole didactic process not only for the unit carrying it out but, above all, for students. This research is focused on the effectiveness of the application of e-learning for computer-based knowledge evaluation and optimizing exam administration for students of medical sciences. The proposed approach is considered in two categories: from the perspective of the providers of the evaluation process, that is, the teaching unit, and the recipients of the evaluation process, that is, the students.

Maximal individualism, which is currently a prevalent trend in the way many patients think, places high hopes in the achievements of biomedicine and assumes that everyone should always receive optimal medical care. Such an approach is in line with many normative and legal acts operating worldwide, including the Declaration of Human Rights. However, its feasibility and effectiveness in the time of the COVID-19 pandemic raises numerous ethical, social and economic dilemmas. The culture of prosperity and excess, characteristic of contemporary Western societies, makes it even more challenging to come to terms with this situation.

Background High mortality in peritoneal dialysis (PD) patients is associated with the presence of nontraditional cardiovascular risk factors, such as malnutrition. However, hypoalbuminemia in patients undergoing PD may have gender-dependent consequences. Objectives The aim of the study was to evaluate the relationship between hypoalbuminemia, overhydration (OH), inflammation, and cardiovascular risk, depending on gender. Material and methods The group studied consisted of 54 PD patients: 26 male (mean age: 59 ±19 years) and 28 female (mean age: 52 ±15 years). Serum albumin levels were measured routinely by the hospital central laboratory. The degree of OH was assessed by bioelectrical impedance analysis (BIA). Serum concentrations of C-reactive protein (CRP) and interleukin (IL)-6 were measured as inflammatory markers. Levels of N-terminal prohormone of brain natriuretic peptide (NT-proBNP) and troponin T (TnT) were used to assess cardiovascular risk. Results Median serum albumin concentration was 3.9 g/dL (3.6-4.2 g/dL). Both genders were comparable regarding most parameters except body weight (79 ±16 kg vs 67 ±16 kg; p = 0.009), but no differences were observed in body mass index (BMI) (26.3 ±5.0 kg/m2 vs 26.2 ±5.9 kg/m2; non significant (NS)). There was also no difference in the prevalence of hypoalbuminemia between female and male PD patients (23% vs 21%; NS). In females, low serum albumin concentrations were associated with OH, inflammation and cardiovascular risk, while in males serum albumin levels correlated with the parameters of dialysis and cardiovascular risk. Conclusions The impact of hypoalbuminemia may be gender-dependent. It seems that hypoalbuminemia is more important for female patients. It is also possible that different mechanisms regulate serum albumin concentration in female and male PD patients.

Background/Aims: Hemodialysis induces an intravascular inflammatory reaction which may further deteriorate renal function. We studied changes of serum interleukin 6 (IL6) and hepatocyte growth factor (HGF) concentrations during dialysis sessions, and at 12 month intervals. The synthesis of these cytokines in arterial endothelial cells in the presence of serum obtained from dialyzed patients was studied. Changes of the inflammatory reaction during 12 months of treatment were correlated with GFR. Methods: The study was performed on a group of 30 uremic patients treated with hemodialysis. Serum samples were collected before the start of dialysis, 15 minutes, and 4 hours later, when the session was finished. Serum levels of IL6 and HGF were measured with ELISA, as was the effect of serum samples on the synthesis of these cytokines in arterial endothelial cells. Results: At baseline hemodialysis induced an increase of serum IL6 (+10%) and HGF (+164%) levels at the end of the session. After 12 months of treatment predialysis serum IL 6 level was increased as compared to the beginning of the study (+22%), but no change in serum HGF level was observed. At that time the dialysis-induced rise of serum IL6 level was stronger than at the start (+18%), but the observed effect for HGF was weaker (+116%). An inverse correlation was observed between the dialysis-induced increase of HGF level and decrease of GFR after 12 months of study. The same relation was seen for HGF synthesis in the endothelium, but opposite for IL6 synthesis in the endothelium. Conclusions: We found that a higher HGF serum level during hemodialysis treatment is associated with a slower loss of residual renal function.

Peritoneal dialysis (PD) patients with preserved residual diuresis have a lower risk of death and complications. Here we analyzed associations between residual diuresis and presence of fluid overload and biomarkers of cardiac strain and nutrition in PD patients. Among 44 PD patients placed into three subgroups, depending on volume of residual diuresis (group A ≤ 500; group B 600–1900; and group C ≥ 2000 mL/day), we examined: overhydration (OH) assessed by bioimpedance analysis (BIA; yielding OH index OHBIA) and by clinical criteria (edema and hypertension); nutritional status (by subjective global assessment, SGA); metabolic status (electrolytes, serum lipid profile, CRP, and albumin); biomarkers of fluid overload and cardiac strain (N-terminal probrain natriuretic peptide, NT-proBNP, and troponin T, TnT); and, echocardiography and chest X-ray. With increasing residual diuresis in group A, B and C, fewer patients had signs of overhydration defined as OHBIA > 1.1 L (75.0, 42.9 and 33.3 %) or peripheral edema (25.0, 21.4 and 0 %) and NT-proBNP (15199 ± 16150 vs. 5930 ± 9256 vs. 2600 ± 3907 pg/mL; p

The twentieth century witnessed the emergence of a new paradigm in science: genetic determinism, which permeates present-day science, ethics and culture. Concurrently, the rapid growth in genetic knowledge generates many concerns related to the ethical and social consequences of the development of biotechnology. It is, in fact, suggested that it leads to the geneticization of bioethics. Hence, the objective of this text is to present the major dilemmas that accompany the development of genetics in the context of medical and reproductive ethics. Starting with the matter of human dignity, we discuss the basic principles of ethics and medical law: the principles of non-maleficence, beneficence and justice, with particular emphasis on an individual’s autonomy and the right to happiness, as well as the functioning of the partnership model seen as a metaphor for friendship or alliance. The exemplification of the presented dilemmas is an attempt to reconstruct the arguments used in the current discussion on the right to genetic ignorance. Whilst some researchers consider this right the guarantee of the individual right to privacy and autonomy, others have argued that, in the context of genetic risk, it contradicts other people’s right to knowledge, which leads to various problems and concerns of ethical, psychological, social and legal nature.