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Katarzyna Leszczyńska

Bio: Katarzyna Leszczyńska is an academic researcher from Gdańsk Medical University. The author has contributed to research in topics: Pregnancy & Gestational hypertension. The author has an hindex of 4, co-authored 21 publications receiving 82 citations.

Papers
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Journal ArticleDOI
TL;DR: Implementation of a CCR program improves physical capacity, exercise tolerance, and quality of life and reduces depressive symptoms in patients late after surgical correction of CHD.
Abstract: Wstep: Waznym etapem leczenia doroslych pacjentow z wrodzonymi wadami serca po operacjach kardiochirurgicznych jest kompleksowa rehabilitacja kardiologiczna (CCR), jednak dostep do tej formy terapii jest wciąz ograniczony. Brakuje polskich wytycznych dotyczących prowadzenia CCR, w tym treningow kontrolowanych u ,,mlodych doroslych”, kilkanaście lat po zabiegu korygującym wrodzoną wade serca. Cel: Celem pracy byla ocena wplywu CCR na wydolnośc fizyczną, tolerancje wysilku, jakośc zycia i nasilenie objawow depresyjnych pacjentow w odleglym okresie po chirurgicznej korekcji wrodzonych wad serca. Metody: Do badania wlączono 57 pacjentow z wrodzonymi wadami serca (30 kobiet i 27 mezczyzn) w wieku 23 ± 3,4 roku, w okresie minimum 12 miesiecy po zabiegu zamkniecia ubytku w przegrodzie miedzykomorowej (VSD) lub ubytku w przegrodzie miedzyprzedsionkowej typu ostium secundum (ASD II). Wszystkim pacjentom zaproponowano udzial w programie CCR: 31 pacjentow wzielo udzial w programie (grupa Reh), natomiast 26 pacjentow odmowilo udzialu w programie CCR (grupa NReh). U wszystkich pacjentow wykonano wstepny test wysilkowy spiroergometryczny na cykloergometrze rowerowym, stosując protokol typu ramp o początkowym obciązeniu 20 W i przyroście obciązenia 10 W na minute. Test byl limitowany maksymalnym zmeczeniem i standardowymi wskazaniami do przerwania proby wysilkowej. Do oceny psychologicznej wykorzystano kwestionariusz Becka i test sluzący do oceny jakości zycia — Euro QoL 5D. Po 30 dniach od badania wstepnego ponownie oceniono pacjentow z obu grup, stosując takie same narzedzia badawcze jak we wstepnym badaniu. Wyniki: Podczas prob wysilkowych wszyscy pacjenci osiągneli maksymalny poziom zmeczenia na poziomie 15–17 punktow w skali Borga, bez towarzyszących powiklan. Spoczynkowy rytm serca byl nizszy w grupie Reh (74 ± 8/min) niz w grupie NReh (81 ± 14/min). Pacjenci z grupy Reh osiągneli istotnie wyzszy maksymalny rytm serca w czasie proby wysilkowej; rowniez wspolczynnik tetna maksymalnego byl wyzszy u osob trenujących. Obciązenie wysilkiem bylo nieistotnie wieksze, natomiast czas trwania wysilku znamiennie dluzszy w grupie Reh niz w grupie NReh, odpowiednio 144 W vs . 124 W (p = 0,121) oraz 14 min vs . 11 min (p = 0,001). Wyzsze szczytowe zuzycie tlenu (VO2peak) uzyskaly osoby z grupy Reh w porownaniu z pacjentami z grupy NReh (27,5 ml/kg/min vs . 23 ml/kg/min; p = 0,003). Wyzsze nasilenie objawow depresyjnych wg Becka po zakonczeniu programu stwierdzono w grupie NReh niz w grupie Reh (średnio 4,8 vs . 2,2 pkt; p = 0,59). Natomiast subiektywna i obiektywna jakośc zycia byla wyzsza w grupie Reh niz w grupie NReh, odpowiednio 89 vs . 74,4 pkt (p < 0,01) oraz 94 vs . 83 pkt (p < 0,01). Wnioski: Wdrozenie programu CCR poprawia wydolnośc fizyczną, tolerancje wysilku fizycznego, jakośc zycia i zmniejsza objawy depresyjne pacjentow w poźnym okresie po chirurgicznej korekcji wrodzonych wad serca. Wprowadzenie programu CCR wydaje sie celowe jako uzupelnienie holistycznej opieki w tej grupie pacjentow.

36 citations

Journal ArticleDOI
21 Jan 2016-PLOS ONE
TL;DR: There is no contraindication to pregnancy when mastocytosis-related pathologies are under appropriate medical control, and none of the patients showed the signs of anaphylaxis, either before becoming pregnant, or during pregnancy and puerperium.
Abstract: Objective To present current guidelines regarding treatment of mastocytosis in pregnancy on the example of observed patients. Design Case control national study. Setting Polish Center of the European Competence Network on Mastocytosis (ECNM). Population or sample 23 singleton spontaneous pregnancies in 17 women diagnosed with mastocytosis in years 1999-2014, before becoming pregnant. Methods Prospective analysis outcomes of pregnancies and deliveries. Main outcome measures Survey developed in cooperation with the Spanish Instituto de Estudios de Mastocitosis de Castilla-La Mancha (CLMast), Hospital Virgen del Valle, Toledo, Red Espanola de Mastocitosis (REMA), Spain. Results All 23 pregnancies resulted from natural conception. Obstetrical complications recorded in the first trimester included spontaneous miscarriage (5 pregnancies). Four patients delivered preterm, including one delivery due to preeclampsia at 26 weeks which resulted with neonate death due to extreme prematurity. Five women delivered via cesarean: four due to obstetrical indications and one due to mastocytosis, during which no anesthesia related complications were recorded. Of patients delivering vaginally, two received extradural anesthesia, three required oxytocin infusion due to uterine hypotonia. No labor complications were recorded. In one woman with pregnancy-induced hypertension, early puerperium was complicated by the presence of persistent arterial hypertension. One neonate was born with the signs of cutaneous mastocytosis. Another neonate was diagnosed with Patau syndrome. Four women were treated for mastocytosis prior to conception and continued therapy after becoming pregnant. One patient was put on medications in the first trimester due to worsening of her symptoms. Pregnancy exerted only a slight effect on the intensity and frequency of mastocytosis-related symptoms observed. Worsening of the disease-related symptoms was documented in only four patients (23%). None of the patients showed the signs of anaphylaxis, either before becoming pregnant, or during pregnancy and puerperium. Conclusions There is no contraindication to pregnancy when mastocystosis-related pathologies are under appropriate medical control.

22 citations

Journal ArticleDOI
TL;DR: UPCR determination is a reliable, relatively faster, and equally accurate method for the quantitation of proteinuria, correlates well with 24 h urine protein estimations, and could be used as an alternative to the 24 h proteinuria test for the diagnosis of preeclampsia.
Abstract: Preeclampsia affects 2-5% of pregnant women and is one of the leading causes of maternal and perinatal morbidity and mortality. We aimed to extensively evaluate proteinuria in women with preeclampsia and to determine the analytical sensitivity and specificity of and the cutoff values for urine protein-to-creatinine ratio (UPCR) and total protein in 24 h urine samples. This study included 88 women. We used the urine dipstick test, UPCR, and total protein measurement in a 24 h urine sample. The patients were divided in gestational hypertension (GH, n = 44) and preeclampsia (PE, n = 44) groups. In the GH group, 25% (11/44) of the patients presented incidentally positive results. UPCR and total protein in 24 h urine specimens were increased in the GH group compared to the PE group. Receiver operating characteristic analysis showed a UPCR cutoff of 30 mg/mmol as significant for preeclampsia, while the sensitivity and specificity were 89% (95% CI, 75-97) and 100% (95% CI, 87-100), respectively. In the 24 h urine protein test, sensitivity and specificity were 80% (95% CI, 61-92) and 100% (95% CI, 88-100), respectively, for the cutoff value of 0.26 g/24 h. In comparison to the other commonly used tests here considered, UPCR determination is a reliable, relatively faster, and equally accurate method for the quantitation of proteinuria, correlates well with 24 h urine protein estimations, and could be used as an alternative to the 24 h proteinuria test for the diagnosis of preeclampsia.

9 citations

Journal ArticleDOI
TL;DR: Results of hybrid treatment in children with congenital heart disease in this centre in 2008-2013 encourage further development of these methods and strategies to provide optimal benefits for the patients.
Abstract: Wstep: Mimo ciąglego postepu w zakresie technik diagnostycznych i terapeutycznych w ostatnich latach brakuje istotnego postepu w leczeniu wrodzonych wad serca. Czynione są intensywne wysilki w kierunku doskonalenia kardiochirurgicznych technik operacyjnych oraz interwencji kardiologicznych, a takze lączenia ich w celu uzyskania lepszego wyniku terapii. Zabiegi hybrydowe w leczeniu wrodzonych wad serca u dzieci zyskują coraz wiekszą popularnośc, rozszerza sie zakres wad serca leczonych w ten sposob oraz populacja pacjentow mogących byc beneficjentami terapii hybrydowej. Wspolcześnie procedury hybrydowe stosuje sie w sytuacjach, gdy rutynowe zabiegi kardiochirurgiczne lub przezskorne zabiegi interwencyjne nie przynioslyby zadowalającego efektu terapeutycznego. Cel: Celem pracy bylo przedstawienie wlasnych doświadczen ośrodka we wdrazaniu i praktycznym zastosowaniu procedur hybrydowych w leczeniu wybranych wrodzonych wad serca u dzieci w latach 2008–2013. Metody: Retrospektywnej analizie poddano wlasny material stanowiący grupe 80 pacjentow kwalifikowanych do procedur hybrydowych, wykonanych na Oddziale Kardiochirurgii Dzieciecej PCT w Gdansku. Wyniki: Wśrod prezentowanej grupy 80 pacjentow zyje 73 dzieci; zanotowano 4 zgony wczesne i 3 poźne. Wnioski: Zabiegi hybrydowe u dzieci z wrodzonymi wadami serca lączą doświadczenia kardiochirurgii oraz kardiologii interwencyjneji stanowią dodatkową opcje terapii dla wybranej grupy pacjentow. Wstepne wyniki leczenia hybrydowego są zachetą do dalszego rozwoju opisywanych metod i wypracowywania strategii w celu osiągniecia optymalnej korzyści dla pacjenta.

6 citations

Journal ArticleDOI
TL;DR: SLPCV is reflected by a significantly increased myocardial contractility in recipients, reflected in a significant increase in postoperative FS LV and FS RV in recipients.
Abstract: Objectives: To evaluate changes in myocardial contractility that occur after selective laser photocoagulation of communicating vessels (SLPCV) in fetuses from pregnancies complicated with twin-to-twin transfusion syndrome (TTTS). Methods: The study included 51 pregnant women between 16 and 26 weeks of gestation who underwent SLPCV due to TTTS. Ultrasonography was performed before SLPCV and on postoperative day 1, 3(4) and 7. Fetal heart contractility in both fetuses was evaluated by determining the shortening fractions of the left and right ventricles (FS LV and FS RV), and the myocardial performance index (Tei-Index). Results: There was a significant increase in postoperative FS LV and FS RV in recipients (from 35.7% to 44%, P=0.037 and from 27.6% to 32.9%, P=0.021, respectively). Pre-operative Tei-Index values for both the left (0.55) and right ventricle (0.6) were above normal. The mean postoperative Tei-Index for the left ventricle decreased significantly to 0.49 (P=0.011), while no significant change was observed in the right ventricle (0.57). No significant differences between pre- and postoperative FS and Tei-Index values were noted in the donors. Conclusions: SLPCV is reflected by a significantly increased myocardial contractility in recipients.

5 citations


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TL;DR: Endoscopic laser coagulation of anastomoses is a more effective first linetreatment than serial amnioreduction for severe twin totwin transfusion syndrome diagnosed before 26 weeks of gestation.
Abstract: BACKGROUND: Monochorionic twin pregnancies complicated by severe twin to twin transfusion syndrome at midgestation can be treated by either serial amnioreduction(removal of large volumes of amniotic fluid) or selective fetoscopic laser coagulation of the communicating vessels on the chorionic plate. We conducted a randomized trial to compare the efficacy and safety of these two treatments. METHODS: Pregnant women with severe twin to twin transfusion syndrome before 26 weeks of gestation were randomly assigned to laser therapy or amnioreduction. We assessed perinatal survival of at least one twin (a prespecified primary outcome),survival of at least one twin at six months of age, and survival without neurologic complications at six months of age on the basis of the number of pregnancies or the number of fetuses or infants, as appropriate. RESULTS:The study was concluded early, after 72 women had been assigned to the laser group and 70 to the amnioreduction group, because a planned interim analysis demonstrated a significant benefit in the laser group. As compared with the amnioreduction group, the laser group had a higher likelihood of the survival of at least one twin to 28 days of age (76 percent vs. 56 percent; relative risk of the death of both fetuses, 0.63; 95 percent confidence interval, 0.25to 0.93; P=0.009) and 6 months of age (P=0.002). Infants in the laser group also had a lower incidence of cystic periventricular leukomalacia (6 percent vs. 14 percent,P=0.02) and were more likely to be free of neurologic complications at six months of age (52 percent vs. 31 percent, P=0.003). CONCLUSIONS: Endoscopic laser coagulation of anastomoses is a more effective first linetreatment than serial amnioreduction for severe twin totwin transfusion syndrome diagnosed before 26 weeks of gestation.

207 citations

Journal ArticleDOI
TL;DR: The growing number and aging of ACHD patients led to an overall increase in hospitalizations over the last decade and a substantial increase in patients presenting with heart failure (HF) (∼20%), which was summarized in Table 1.
Abstract: Improved medical care of congenital heart disease patients increased survival into adulthood from 15% in the 1960s to over 85% in the current era. As a consequence, the prevalence of adult congenital heart disease (ACHD) increased rapidly,1 which is estimated to be >1 million ACHD patients in North America and 1.2 million in Europe. The growing number and aging of ACHD patients led to an overall increase in hospitalizations over the last decade and a substantial increase in patients presenting with heart failure (HF) (∼20%).2 The incidence of first HF-admission was 1.2 per 1000 patient-years in the Dutch national ‘CONCOR’ registry. Patients admitted with HF had a five-fold higher risk of death than those not admitted. From the same registry, the mortality was 2.8% during a follow-up period of 24 865 patient-years. Chronic HF (26%) and sudden death (19%) were recorded most frequently. The median age at death from HF was 51.0 years (range: 20.3–91.2 years).3 In another ACHD cohort, sudden death (26%) was the most common cause of death, followed by progressive HF (21%) and perioperative death (18%).4 Although patients with ACHD may not readily report symptoms, clinical HF is documented in 22.2% of patients with a Mustard repair for transposition of the great arteries (TGAs), 32.3% with congenitally corrected transposition of the great arteries (ccTGA), and 40% of patients after Fontan palliation. ### Heart failure with impaired systolic ventricular function The aetiology and triggers of impaired systolic ventricular function in ACHD patients are summarized in Table 1 . View this table: Table 1 Pathophysiology of heart failure with impaired systolic function: triggers (examples) ### Heart failure with preserved systolic ventricular function This occurs less often in ACHD patients, but is associated with specific conditions such as Shone complex and restrictive …

163 citations

Journal ArticleDOI
TL;DR: In this paper, a group of 26 international experts in perioperative allergy contributed to a modified Delphi consensus process, which covered areas such as differential diagnosis, management during and after anaphylaxis, allergy investigations, and plans for a subsequent anaesthetic.
Abstract: Suspected perioperative allergic reactions are rare but can be life-threatening. The diagnosis is difficult to make in the perioperative setting, but prompt recognition and correct treatment is necessary to ensure a good outcome. A group of 26 international experts in perioperative allergy (anaesthesiologists, allergists, and immunologists) contributed to a modified Delphi consensus process, which covered areas such as differential diagnosis, management during and after anaphylaxis, allergy investigations, and plans for a subsequent anaesthetic. They were asked to rank the appropriateness of statements related to the immediate management of suspected perioperative allergic reactions. Statements were selected to represent areas where there is a lack of consensus in existing guidelines, such as dosing of epinephrine and fluids, the management of impending cardiac arrest, and reactions refractory to standard treatment. The results of the modified Delphi consensus process have been included in the recommendations on the management of suspected perioperative allergic reactions. This paper provides anaesthetists with an overview of relevant knowledge on the immediate and postoperative management of suspected perioperative allergic reactions based on current literature and expert opinion. In addition, it provides practical advice and recommendations in areas where consensus has been lacking in existing guidelines.

111 citations

Journal ArticleDOI
TL;DR: Increasing use of EQ-5D is observed throughout CEE, but improvement in informed use and methodological quality of reporting is needed, and in jurisdictions where no national value set is available, in order to ensure comparability the authors recommend to apply the most frequently used UK tariff.
Abstract: Cost per quality-adjusted life year data are required for reimbursement decisions in many Central and Eastern European (CEE) countries. EQ-5D is by far the most commonly used instrument to generate utility values in CEE. This study aims to systematically review the literature on EQ-5D from eight CEE countries. An electronic database search was performed up to 1 July 2015 to identify original EQ-5D studies from the countries of interest. We analysed the use of EQ-5D with respect to clinical areas, methodological rigor, population norms and value sets. We identified 143 studies providing 152 country-specific results with a total sample size of 81,619: Austria (n = 11), Bulgaria (n = 6), Czech Republic (n = 18), Hungary (n = 47), Poland (n = 51), Romania (n = 2), Slovakia (n = 3) and Slovenia (n = 14). Cardiovascular (21 %), neurologic (17 %), musculoskeletal (15 %) and endocrine, nutritional and metabolic diseases (13 %) were the most frequently studied clinical areas. Overall, 112 (78 %) of the studies reported EQ VAS results and 86 (60 %) EQ-5D index scores, of which 27 (31 %) did not specify the applied tariff. Hungary, Poland and Slovenia have population norms. Poland and Slovenia also have a national value set. Increasing use of EQ-5D is observed throughout CEE. The spread of health technology assessment activities in countries seems to be reflected in the number of EQ-5D studies. However, improvement in informed use and methodological quality of reporting is needed. In jurisdictions where no national value set is available, in order to ensure comparability we recommend to apply the most frequently used UK tariff. Regional collaboration between CEE countries should be strengthened.

92 citations

Journal ArticleDOI
TL;DR: Recommendations for exercise training are provided, with consideration for the type of congenital heart disease, the nature of the physical activity, and associated factors such as systemic ventricular dysfunction and residual defects.

54 citations