Olczyk-Wieczorkowska M, Kaczmarczyk O, Dąbek A
… +3 more, Zagrodzki PT, Piątek-Guziewicz AB, Zwolińska-Wcisło MM
Pol Arch Intern Med
· 2026 Feb · PMID 41498169
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INTRODUCTION: Inflammatory bowel disease (IBD), including Crohn disease (CD) and ulcerative colitis (UC), can lead to malnutrition and sarcopenia due to inflammation, reduced dietary intake, and side effects of treatment...INTRODUCTION: Inflammatory bowel disease (IBD), including Crohn disease (CD) and ulcerative colitis (UC), can lead to malnutrition and sarcopenia due to inflammation, reduced dietary intake, and side effects of treatment. OBJECTIVES: This study aimed to assess the prevalence of sarcopenia, myopenia, and malnutrition in Polish IBD patients using practical clinical tools, and to examine the relationship between patient nutritional knowledge and their nutritional status. PATIENTS AND METHODS: The study included 91 IBD patients (48 with CD, 43 with UC), aged 18-65 years. Sarcopenia was assessed using the SARC‑F questionnaire and 5‑times sit‑to‑stand test, while myopenia was evaluated using the fat‑free mass index. Nutritional status was determined based on body mass index (BMI), Nutritional Risk Screening (NRS‑2002) scale, biochemical parameters, and body composition analysis. A custom‑designed questionnaire was used to assess patient nutritional knowledge. RESULTS: Malnutrition was identified in 22% (BMI) and 31.9% (NRS‑2002) of the patients. Hypoalbuminemia and low ferritin levels were observed in 64% and 38.3% of the participants, respectively. Sarcopenia was present in 24.3% (SARC‑F) and 17.6% (sit‑to‑stand test) of the patients, while myopenia was detected in 36.7%. Both were more frequent during active disease. Nutritional knowledge was adequate in 23% of the patients but showed no association with nutritional status or muscle mass. Biologic therapy was associated with better nutritional status. CONCLUSIONS: Malnutrition and sarcopenia are common in IBD, particularly during active disease. While biologic therapy may improve nutritional status, its effect on muscle mass is unclear. The lack of association between nutritional knowledge and clinical outcomes highlights the importance of continuous dietary support.
Gajda M, Kapturkiewicz C, Kapusta D
… +4 more, Hareza D, Pomorska-Wesołowska M, Kawałek A, Wójkowska-Mach J
Pol Arch Intern Med
· 2026 Feb · PMID 41498168
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INTRODUCTION: Urinary tract infections (UTIs) are a common condition and represent the second most prevalent infectious illness globally. OBJECTIVES: This study aimed to determine the species‑specific share in positive...INTRODUCTION: Urinary tract infections (UTIs) are a common condition and represent the second most prevalent infectious illness globally. OBJECTIVES: This study aimed to determine the species‑specific share in positive cultures of UTIs in both inpatients and outpatients, and to assess the applicability of recent UTI treatment guidelines in patients from Silesia, southern Poland. PATIENTS AND METHODS: This retrospective multicenter study analyzed 85 485 urine samples collected in Poland (2022-2023) from inpatients (n = 52 294) and outpatients (n = 33 191) with suspected UTIs. The study participants were grouped into 3 categories: premenopausal women, postmenopausal women, and men. Antibiotics were classified according to the World Health Organization Access, Watch, Reserve framework. RESULTS: The study showed low antibiotic susceptibility. The potential risk of empirically available therapy ineffectiveness was between 26.7% and 44.6%, depending on in- or outpatient status. In the inpatients, susceptibility of Escherichia coli to cotrimoxazole was 73%, and to cephalosporins at least 86.9% in premenopausal women, and about 76.6% in men and postmenopausal women. Susceptibility of Klebsiella pneumoniae exceeded 80% only in the case of cefoperazone / sulbactam (86.3%), but was below 60% for other drugs. Outpatient E. coli isolates showed 91.9% susceptibility to nitrofurantoin, but most other Access group agents fell below 60%, except for gentamicin (92%). Resistance was frequent: extended‑spectrum β‑lactamases occurred in 12.8% of the outpatients and 32.9% of the inpatients, Enterobacterales and high‑level aminoglycoside resistance in 56.5% of the inpatients with Enterococcus faecalis and 63.7% of E. faecium. CONCLUSIONS: Due to a high potential risk of ineffective empirical therapy based on current guidelines, its applicability to clinical practice should be further evaluated using more locally derived data.
Dziewierz A, Malinowski K, Dardzińska N
… +5 more, Jaskulska P, Zabojszcz M, Tkaczyk F, Rakowski T, Siudak Z
Pol Arch Intern Med
· 2026 Jan · PMID 41498155
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INTRODUCTION: ST‑segment elevation myocardial infarction (STEMI) onset follows a circadian rhythm, yet data from large contemporary national registries remain limited, particularly regarding how the onset time influences...INTRODUCTION: ST‑segment elevation myocardial infarction (STEMI) onset follows a circadian rhythm, yet data from large contemporary national registries remain limited, particularly regarding how the onset time influences treatment delays and coronary pathology. OBJECTIVES: We aimed to examine circadian patterns of STEMI onset and their impact on treatment delays, culprit vessel involvement, and periprocedural mortality. PATIENTS AND METHODS: We retrospectively analyzed 153 543 STEMI patients from the Polish National Percutaneous Intervention Registry hospitalized between 2014 and 2022. We examined the hourly distribution of symptom onset and its associations with patient characteristics, treatment delays, and infarct‑related artery location. RESULTS: STEMI onset showed pronounced circadian variation, peaking at 8:00 AM. Although the overall pattern was similar between sexes (P for interaction = 0.15), median onset time occurred earlier in men than women (10:00 AM vs 11:00 AM; P = 0.007). Nocturnal onset (eg, 3:00 AM) was associated with substantially longer median pain‑to‑first‑medical‑contact times than daytime onset (180 vs 90 min at 1:00 PM; P <0.001). We identified a novel opposing circadian rhythm for the infarct‑related artery location-the left anterior descending (LAD) artery seemed to be the main culprit during nocturnal hours with a nadir at noon, while the right coronary artery (RCA) involvement demonstrated an inverse pattern (P <0.001). Despite delayed presentation, periprocedural mortality did not vary significantly by onset time. CONCLUSIONS: This large nationwide cohort demonstrates that STEMI onset follows a robust circadian pattern significantly affecting system delays. The discovery of opposing circadian rhythms for LAD and RCA involvement suggests that time of day influences not only STEMI triggering but also its pathophysiological manifestation.
Trofimiuk-Müldner M, Nowak A, Podlewski J
… +2 more, Sokołowski G, Hubalewska-Dydejczyk A
Pol Arch Intern Med
· 2026 Jan · PMID 41498154
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INTRODUCTION: Thyroid dysfunction and thyroid autoimmunity during pregnancy are linked to an increased risks of adverse maternal and fetal outcomes. Guidelines recommend population‑specific thyroid hormone reference rang...INTRODUCTION: Thyroid dysfunction and thyroid autoimmunity during pregnancy are linked to an increased risks of adverse maternal and fetal outcomes. Guidelines recommend population‑specific thyroid hormone reference ranges in pregnancy, though adherence and effectiveness vary. OBJECTIVES: We aimed to evaluate the performance of thyroid function reference ranges recommended by Polish national guidelines in pregnancy and to assess clinical and demographic factors affecting thyroid hormone levels and autoimmunity. PATIENTS AND METHODS: A cohort of 1339 pregnant women across all trimesters was recruited in Poland (2007-2017). Serum levels of thyroid‑stimulating hormone (TSH), free thyroxine (FT4), free triiodothyronine (FT3), and thyroid peroxidase antibodies (TPOAbs), and urinary iodine concentration (UIC) were measured. Associations between thyroid status and maternal age, body mass index (BMI), gestational age, and UIC were analyzed. RESULTS: Over 91% of the participants had TSH concentrations within Polish trimester‑specific reference ranges. TPOAbs were positive in 12% of the cases, and were strongly associated with higher TSH and lower FT4 concentrations (P <0.001). TSH level was negatively associated with FT4 concentrations and age (P <0.001), and positively with TPOAb (P <0.001). FT4 concentrations were positively associated with TPOAb (P = 0.04) and FT3 concentrations (P <0.001), but negatively influenced by trimester, TSH, age, BMI, and pregnancy week (P <0.001). CONCLUSIONS: TPOAb presence correlated with elevated TSH concentrations and impaired FT4 response, which supported the role of TPOAb as a key marker in pregnancy screening. Maternal age and BMI significantly influenced FT4 levels, pointing at the new factors to be considered when interpreting thyroid function tests results. Our findings support current Polish reference ranges and emphasize the need for locally adapted criteria in thyroid management during pregnancy.
Dziadowiec A, Kwitniewski M, Kopac P
… +5 more, Sedlackova L, Srotova A, Koren A, Gluck J, Porebski G
Pol Arch Intern Med
· 2026 Jan · PMID 41498153
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INTRODUCTION: Mas‑related G protein-coupled receptor X2 (MRGPRX2) has emerged as a mediator of mast cell activation in acute and chronic conditions. Exogenous ligands, such as neuromuscular blocking agents (NMBAs) and fl...INTRODUCTION: Mas‑related G protein-coupled receptor X2 (MRGPRX2) has emerged as a mediator of mast cell activation in acute and chronic conditions. Exogenous ligands, such as neuromuscular blocking agents (NMBAs) and fluoroquinolones (FQs), can trigger MRGPRX2‑dependent activation and may augment immunoglobulin E (IgE)-mediated pathways. Although investigators have measured serum MRGPRX2 level in asthma, mastocytosis, and chronic urticaria, its role in immediate hypersensitivity reactions (IHRs) to FQs or NMBAs remains unclear. OBJECTIVES: We conducted this study to determine whether increased serum MRGPRX2 concentration is a risk factor for IHRs to NMBAs or FQs, and whether its concentration is related to reaction severity, causative agent, or serum tryptase. PATIENTS AND METHODS: We studied 43 patients with a history of IHRs to NMBAs or FQs, and compared them with 50 patients with IHR to Hymenoptera venom and 40 control individuals. The participants underwent a diagnostic evaluation that included skin testing, specific IgE measurement, and a basophil activation test when indicated. We measured serum MRGPRX2 level with an enzyme‑linked immunosorbent assay. RESULTS: Median serum MRGPRX2 concentrations with interquartile ranges for the drug‑induced reactions group, the Hymenoptera venom-induced reactions group, and the control group were 7.5 (3.73-15.64), 7 (3.96-10.62), and 5.89 (2.43-9.98) ng/ml, respectively (P = 0.32). Serum MRGPRX2 concentration showed no relationship with reaction severity, specific causative agents, or serum tryptase level. CONCLUSIONS: In this cohort, serum MRGPRX2 concentration was not a risk factor for the investigated drug- and venom‑induced IHRs. These findings do not support using serum MRGPRX2 level as a predictor of the reaction occurrence or severity in these settings.
Cichocka E, Maj-Podsiadło A, Szweda-Gandor N
… +1 more, Gumprecht J
Pol Arch Intern Med
· 2026 Jan · PMID 41498152
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INTRODUCTION: Genetic predisposition is a common determinant of autoimmune endocrinopathies, particularly type 1 diabetes (T1D) and autoimmune thyroid disease (AITD). Although their coexistence is frequent, the underlyin...INTRODUCTION: Genetic predisposition is a common determinant of autoimmune endocrinopathies, particularly type 1 diabetes (T1D) and autoimmune thyroid disease (AITD). Although their coexistence is frequent, the underlying genetic background is not fully understood. OBJECTIVES: We aimed to identify genetic polymorphisms predictive of an increased risk for co‑occurring T1D and AITD, and to assess their potential impact on glycemic control. PATIENTS AND METHODS: We genotyped 5 selected polymorphisms (rs3087243 and rs231775 in the CTLA4 gene; rs12730735 in the PTPN22 gene; and rs2802292 and rs9400239 in the FOXO3A gene) in 277 patients with T1D. Clinical data on thyroid status, the presence of thyroid antibodies, treatment, and metabolic control were analyzed. RESULTS: Thyroid disorders, mostly Hashimoto hypothyroidism, were diagnosed in 32.9% of the patients. As many as 75% required L‑thyroxine (mean thyroid‑stimulating hormone level, 2.15 IU/l). Among thyroid peroxidase- and thyroglobulin‑positive patients, 81.6% and 75%, respectively, had a prior diagnosis of a thyroid disorder. The GG genotype of rs3087243 (CTLA4) conferred a higher risk of hypothyroidism and other thyroid diseases. The GG variant of rs2802292 (FOXO3A) was associated with a reduced prevalence of thyroid disease in family history. Carriers of the AG genotypes in rs3087243 and rs231775 (CTLA4), as well as the GG genotype in rs2802292 (FOXO3A), showed a lower probability of achieving diabetes control, particularly with longer disease duration. However, the CT genotype of rs12730735 (PTPN22) increased the likelihood of achieving glycemic control. CONCLUSIONS: CTLA4 polymorphisms were associated with an elevated risk of a thyroid disease and poorer glycemic control; FOXO3A showed a dual role, that is, protective against familial thyroid disease but unfavorable for glycemic regulation; and the PTPN22 variant improved glycemic control. Genetic profiling may improve risk assessment and management in patients with T1D.
Żur-Wyrozumska K, Szeląg M, Borowy P
… +9 more, Krajewska-Włodarczyk M, Żuber Z, Podwójcic K, Maluchnik M, Batko K, Kwiatkowska B, Stajszczyk M, Krawiec P, Batko B
Pol Arch Intern Med
· 2026 Jan · PMID 41498151
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INTRODUCTION: Multiple sclerosis (MS) and rheumatoid arthritis (RA) are common, chronic immune‑mediated diseases that share pathogenetic pathways, but their epidemiologic relationship is uncertain. OBJECTIVES: We aimed t...INTRODUCTION: Multiple sclerosis (MS) and rheumatoid arthritis (RA) are common, chronic immune‑mediated diseases that share pathogenetic pathways, but their epidemiologic relationship is uncertain. OBJECTIVES: We aimed to describe the association between MS and RA in the Polish population. PATIENTS AND METHODS: This pilot, nationwide study was based on administrative health care claims sourced from the Polish National Health Fund (NHF). Between 2009 and 2021, MS and RA cases were identified through a combination of the International Classification of Diseases, Tenth Revision claims, in conjunction with the Anatomical Therapeutic Chemical codes for medications or drug program records. Annual prevalence and incidence trends were assessed. Within the study timeframe, a retrospective cohort of RA patients and a general population-based comparator were recruited, with year‑ by year assessment of MS burden. The controls were matched 1:1 for age, sex, and calendar year of RA diagnoses, from individuals with any NHF contact in the corresponding year. RESULTS: In the years 2009-2021, 464 cases of concurrent MS were identified among patients with RA, whereas 813 MS cases were found in the matched control group (n = 307 519 per group). While the overall population trends suggest increased MS prevalence, annual incidence declined (P <0.001 for both RA and control), in combination with increasing age at MS diagnosis. Age- and serotype‑ specific analyses suggested that young (16-39 y) women with RA had higher MS prevalence (37.2 vs 26.9 per 10 000 patients; prevalence ratio, 1.39; 95% CI, 1-1.92; P = 0.048) than the controls. Conversely, older women with RA showed significantly lower MS prevalence rates. Mortality was comparable in both groups. CONCLUSIONS: Overall, RA was not associated with an increased overall MS risk, as compared with the general population. Young women with seronegative RA may be at a greater risk of MS, which warrants clarification of age, sex, and serotype‑ specific risk disparities in future prospective longitudinal studies. However, clinical vigilance for atypical MS symptoms in young women with RA should be maintained.
Raventos A, Minasyan M, Puente de la Vega C
… +2 more, Valassi E, Puig-Domingo M
Pol Arch Intern Med
· 2026 Jan · PMID 41498150
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Pituitary neuroendocrine tumors (PitNETs) are a heterogeneous group of neoplasms originating from anterior pituitary cells, encompassing a spectrum from indolent microadenomas to highly invasive, aggressive tumors. Their...Pituitary neuroendocrine tumors (PitNETs) are a heterogeneous group of neoplasms originating from anterior pituitary cells, encompassing a spectrum from indolent microadenomas to highly invasive, aggressive tumors. Their clinical presentation varies from classic endocrine hyper- or hyposecretory syndromes to mass effect symptoms or incidental imaging findings. The 2022 World Health Organization classification has redefined PitNETs, emphasizing their neuroendocrine nature and the central role of transcription factor-based immunohistochemistry. Recent years have witnessed rapid progress in molecular characterization, multiomics, radiomics, and theragnostic approaches, which are reshaping the approach to these tumors regarding their diagnosis, risk stratification, and management. This review provides a comprehensive and practical synthesis of current evidence, focusing on the integration of biomarkers, advanced imaging, and personalized therapies that could be useful in clinical practice, and discusses future directions in precision management of PitNETs.