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This study reports the application of hierarchical porous monoliths as carriers for controlled and dose-adjustable release of model pharmaceutical (dexketoprofen, DEX). The synthesis and detailed characterization of the hierarchical porous scaffolds are provided before and after the adsorption of three doses of DEX─a widely used nonsteroidal anti-inflammatory drug. The drug incorporated in the mesopores of silica was stabilized in an amorphous state, while the presence of macropores provided sufficient space for drug crystallization as we demonstrated via a combination of powder X-ray diffraction, differential scanning calorimetry, and imaging techniques (scanning electron microscopy and EDX analysis). Drug release from silica matrices was tested, and a mechanistic model of this release based on the Fick diffusion equation was proposed. The hierarchical structure of the carrier, due to the presence of micrometric macropores and nanometric mesopores, turned out to be critical for the control of the drug phase and drug release from the monoliths. It was found that at low drug content, the presence of an amorphous component in the pores promoted the rapid release of the drug, while at higher drug contents, the presence of macropores favored the crystallization of DEX, which naturally slowed down its release. Both the hierarchical porous structure and the control of the drug phase (amorphous and/or crystalline) were proven important for adjustable (fast or prolonged) release kinetics, desirable for effective pharmacotherapy and patient compliance. Therefore, the developed materials may serve as a versatile formulation platform for the smart manipulation of drug release kinetics.

Anorexia is a disease that affects more and more people, it ffects many more women and girls than men and boys. In most cases, the disease is diagnosed between 14 and 18 years of age. People with anorexia nervosa suddenly and excessively start losing weight by eating meals in mall, low-calorie portions. In addition to excessive weight loss, there may be dangerous hormonal disorders in the body. By conducting activities aimed at creating proper psychosocial health, it is possible to avoid an increase in the incidence of anorexia. Aim of the study. The purpose of the work is to apply appropriate nursing activities to a patient with anorexia in a psychiatric ward. Case study. A 20-year-old patient in a psychiatric ward complains of feeling strong anxiety due to fear of weight gain. He avoids watching himself in the mirror. Significant dehydration of the body occurred through prolonged use of laxatives. The patient requires education regarding the disease and help in self-care activities. According to the interview, the patient was affected by this type of symptoms for the first time. Conclusions. The comprehensive care provided by medical staff has significantly improved the patient's well-being, but all activities should be continued so that the patient can recover fully.

So far, little is known about the impact of the coronavirus disease 2019 (COVID-19) on pregnancy and data is often inconsistent. Even less information has been published on the management of severe courses of COVID-19 in pregnant women. By writing this article, we aim to share our experience in the treatment of pregnant woman critically ill with COVID-19 and newborn's condition, FNAIT (Fetal and neonatal alloimmune thrombocytopenia), as well as literature review of this disease. After admission,the woman's respiratory status rapidly worsened, requiring administration of oxygen and in the end ECMO therapy. At the 9th day of ECMO support, and 28 weeks 3 days of gestation, due to mother's prognosis and increased feto-placental vascular resistance a decision of Caesarean section was taken. The neonate required intensive care not only due to extreme prematurity but coagulation disorder, alloimmune thrombocytopenia, which we diagnosed a few weeks after delivery.

Introduction. Alzheimer's disease (AD – Alzheimer Disease) is an incurable neurodegenerative disease. The main source of memory discomfort is destruc-tion. With age, irresistibly falling ill with it. Risk factors for the development of Alzheimer's disease are primarily: diabetes, female gender, hypertension and the lack of a control field. It is estimated that in Poland Alzheimer's disease affects about 200,000 people. According to statistics, 60% of all forms of de-mentia are AD. Aim of the study. The aim of the study is to present the activities that should be performed by a nurse caring for a patient with diagnosed Alzheimer's dis-ease. Case study. A 75-year-old patient admitted to the internal medicine ward, she has communication, content swallowing and spatial orientation disorders. It requires constant assistance in the performance of everyday activities. He complains of urinary and faecal incontinence. Conclusion. Thanks to the holistic approach to the patient, it is possible to ensure her correctness and the approach of the patient and her family.

The aim of this EMINENTS prospective, single-center, open-label, single-arm study was to evaluate the cumulative efficacy and safety of reduced doses of everolimus (maintenance therapy) in patients with tuberous sclerosis and subependymal giant cell astrocytoma (SEGA).Methods: The trial included 15 patients who had undergone at least 12 months of treatment with a standard everolimus dose. The dose of everolimus was reduced to three times a week, with a daily dose as in standard regimen. Data of 14 patients were analyzed. SEGA volume (SV) was evaluated at study entry and subsequent time points by an experienced radiologist. Adverse events (AEs) noted during maintenance therapy were compared to the AEs of standard dose period.Results: Patients were followed over a mean duration 58.37 months (95%CI: 45.95–70.78). The differences in SEGA volume between subsequent time points (0, 3, 6,12, 18, 24, 36, 48, and 60 months) were not statistically significant (p = 0.16). At the end of the study, 7 out of 10 patients had stable SEGA volume. No clinical symptoms of progression were observed in any patients. No patient or tumor-related risk factors of progression were identified. Regarding AEs, infections (stomatitis, bronchitis, diarrhea) and laboratory abnormalities (neutropenia, anemia, hyperglycemia) occurred less frequently during maintenance therapy compared to the standard dose regimen.Conclusions: Final results from EMINENTS study confirm that maintenance therapy with everolimus might represent a rational therapeutic option for patients TSC and SEGA after effective full dose treatment. It could be an option for patients who experienced everolimus-related AEs, instead of discontinuation of therapy. Careful evaluation of possible progression, especially concerning first six months of maintenance therapy should be advised.Clinical Trial Registration:www.drks.de, identifier DRKS00005584.

Objective The aim of the study was to evaluate feasibility of diffusion-weighted whole-body imaging with background body signal suppression (DWIBS) method in diagnosing Hodgkin lymphoma in pediatric patients and to compare it with 18F-FDG PET/CT as a gold standard. Materials and methods Eleven patients (median age 14) with newly diagnosed Hodgkin lymphoma were examined with 18F-FDG PET/CT and MRI including whole-body DWIBS sequence (b = 0, 800 s/mm2), before the oncologic treatment. About 26 locations of lymphatic tissues were evaluated visually and quantitatively using ADCmean (DWIBS) and SUVmax (18F-FDG PET/CT), respectively. Results All affected lymph node regions (n = 134) diagnosed in 18F-FDG PET/CT were found with DWIBS, presenting decreased diffusion. Significant correlation was found between ADC and SUV values (R2 = − 0.37; p = 0.0001). Nevertheless, additional 33 regions were recognized only by DWIBS. They were significantly smaller than regions diagnosed by both methods. Discussion Agreement between DWIBS and 18F-FDG PET/CT for detection and staging of malignant lymphoma is high. DWIBS can be used for the evaluation of pediatric Hodgkin lymphoma.

It is now more than a year since the first case of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) disease (COVID-19) was diagnosed in China. Current data suggest that pregnancy may not only be a risk factor for the development of severe forms of COVID-19, but that the SARS-CoV-2 infection may impact on common pregnancy complications as well. Healthy pregnant women are likely to be more susceptible to viral infection and therefore are at higher risk of developing severe COVID-19 because of adaptive changes in their immune and respiratory systems, their altered endothelial cell functions, and modified coagulation responses. However, studies show that most pregnant women diagnosed with COVID-19 developed mild-to-moderate symptoms and only a few of them have required critical care facilities. In contrast with preeclampsia, preeclampsia-like syndrome can resolve spontaneously following recovery from severe pneumonia and may not be an obstetric indication for delivery. Preeclampsia-like syndrome is one symptom of COVID-19, but its cause is different from obstetric preeclampsia and therefore not connected with placental failure. Vertical transmission of SARS-CoV-2 infection is rare but can probably occur. No evidence has been found that COVID-19 developed during pregnancy leads to unfavourable outcomes in the fetus. Most health authorities indicate that standard procedures should be used when managing pregnancy complications in asymptomatic women with confirmed SARS-CoV-2. Vaccines should not be withheld from pregnant and lactating individuals who otherwise meet the vaccination criteria.

Ovarian carcinoma is an extremely rare malignancy in children, often developing on the underlying inherited background. Female carriers of pathogenic germline mutations of SMARCA4 are at risk of an aggressive type of undifferentiated ovarian cancer called small cell carcinoma of the ovary, hypercalcemic type (SCCOHT). Regardless of age of the patient, stage of the disease, and oncological treatment, the prognosis for SCCOHT is poor. Therefore, early intervention with risk-reducing surgeries is recommended for these patients. In this study, we report genetic testing of a family with two children carrying pathogenic germline mutations of SMARCA4 and summarize the course of SCCOHT in all pediatric patients reported in the literature with constitutional defects identified within the SMARCA4 locus.

Objective To investigate the potential value of repeat measurements of maternal serum concentration of soluble fms-like tyrosine kinase-1 (sFlt-1) at 22 and 32 weeks' gestation in the prediction of pre-eclampsia (PE) in women delivering after 32 weeks. Methods The data were derived from prospective screening for adverse obstetric outcomes in women attending their routine hospital visit at 19-24 and/or 30-34 weeks' gestation in one of two maternity hospitals in England. Serum sFlt-1 was measured in 7565 and 8264 singleton pregnancies at 19-24 and 30-34 weeks, respectively. Bayes' theorem was used to combine the a-priori risk from maternal factors with sFlt-1 multiples of the median (MoM) values. The performance of screening for PE developing after the 30-34-week visit by sFlt-1, measured at 19-24, 30-34 and at both 19-24 and 30-34 weeks was examined. Results In pregnancies with PE, sFlt-1 in both the second and third trimesters was increased and the deviation from normal was inversely related to the gestational age at which delivery became necessary for maternal or fetal indications. Serum sFlt-1 at 19-24 weeks was not useful in predicting PE beyond the 30-34-week visit, but the addition of sFlt-1 at 19-24 weeks improved the prediction of PE provided by sFlt-1 at 30-34 weeks. Screening by maternal factors and sFlt-1 at 30-34 weeks predicted 94% of preterm PE and 54% of term PE, at a false-positive rate of 10%; this was improved to 99% and 64%, respectively, by the additional measurement of sFlt-1 at 19-24 weeks. Conclusions Measurement of sFlt-1 in the second trimester improves the prediction of PE provided by screening in the early third-trimester. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.

Objective To estimate the diagnostic accuracy of a two-stage strategy for early prediction of morbidly adherent placenta (MAP). In the first stage, at 11-13 weeks' gestation, women with low-lying placenta and history of uterine surgery are classified as being at high risk for MAP and, in the second stage, at 12-16 weeks, these high-risk pregnancies are assessed at a specialist MAP clinic. Methods This was a prospective study in women having an ultrasound scan at 11-13 weeks' gestation as a part of routine pregnancy care. Women with low-lying placenta and a history of uterine surgery were followed up at a specialist MAP clinic at 12-16 weeks' gestation, 20-24 weeks and 28-34 weeks. At each visit to the MAP clinic, an ultrasound scan was carried out and the following features suggestive of MAP were recorded: non-visible Cesarean section scar; bladder wall interruption; thin retroplacental myometrium; presence of intraplacental lacunar spaces; presence of retroplacental arterial-trophoblastic blood flow; and irregular placental vascularization demonstrated by three-dimensional power Doppler. Results Screening at 11-13 weeks was carried out in 22 604 singleton pregnancies, 1298 (6%) of which were considered to be at high risk of MAP because they had previous uterine surgery and low-lying placenta. At the MAP clinic at 12-16 weeks, the diagnosis of MAP was suspected in 14 cases and this was confirmed at delivery in 13. In the rest of the population, there were no cases of MAP. Conclusion Accurate prediction of MAP can be achieved by ultrasound examination at 12-16 weeks' gestation. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.