Medicine and Public Health

Background: Both obese and underweight women with fertility problems often seek help from infertility treatment clinics using the  n vitro fertilization (IVF) procedure. The aim of our study was to analyze the results of IVF in obese patients (BMI ≥ 30 kg/m2) and underweight patients (BMI < 18.5 kg/m2) in comparison to patients of normal weight. Material and methods: This was a retrospective study of underweight (BMI < 18.5 kg/m2) and obese (BMI ≥ 30 kg/m2) women who underwent intracytoplasmic sperm injection (ICSI). The control group consisted of patients of normal weight. In order to exclude the influence of age on the results of IVF, patients in all groups were <38 years old. Results: Significantly fewer oocytes were obtained from obese patients compared to normal weight patients (8.4±2 vs. 11.3±3). In addition, the lowest numbers of mature oocytes at the metaphase II stage and of blastocysts were obtained from these patients (2.8±0.2 vs. 3.7±0.4a, 4±0.3), and the blastocysts were of worse morphological quality than in the other groups. In obese patients, 17% of cycles were cancelled due to a lack of oocytes or embryos for transfer. There was no difference in the implantation rate in underweight patients compared to those of normal weight (47% vs. 51%), but a lower implantation rate was noted in obese patients (38%).
Conclusions: Obese patients cannot rely on the same effectiveness of IVF as patients of normal weight. However, it seems that underweight patients are in a much better situation, for whom most stages of the in vitro procedure are as effective as in patients of normal weight.

Background: The twin reversed arterial perfusion syndrome (TRAP sequence) is a rare congenital sequence and a serious complication of monochorionic multiple pregnancies. The frequency of this sequence is estimated at 1:35,000 pregnancies and 1% of monochorionic pregnancies. In this sequence, one fetus is described as a “semi-donor” or “twin-pumping” (autosite), and the second as a twin acardiac (acardiac twin). The cause is considered to be arteriovenous anastomoses in the placenta, which lead to blood transfusion between the twins.
Material and methods: In this article, we report a case of monochorionic monoamniotic pregnancy resulting from natural fertilization, complicated by TRAP sequence.
Results: The patient gave birth by cesarean section at 34 weeks’ gestation to a neonate weighing 2350 g, length 43 cm, with an Apgar score of 8/10.
Conclusions: The outcome of a course of maternity care and possible treatment options in the event of TRAP sequence, as reviewed in the literature, are presented in the article.
Keywords: monochorionic pregnancy complications, Twin reversed arterial perfusion

Addison’s disease (AD) is a relatively uncommon illness presented by decreased adrenal production of adrenocortical hormones - mainly glucocorticoids. We present a case of a patient who had symptoms of chronic fatigue, depression that made it difficult for her to carry out everyday household activities. In basic laboratory tests, they mainly noted low sodium (Na), increased potassium (K) and low fasting glucose concentration. The patient’s informed consent was obtained for the presentation of anonymised laboratory, clinical and imaging data. On the basis of the clinical picture and hormonal tests, Addison’s disease was confirmed. Significant clinical improvement was observed following the addition of hydrocortisone to the treatment regimen. Advances in optimizing
treatment for patients with Addison’s disease have enabled them to lead normal lives. However, it is important to continuously educate patients and healthcare professionals about the ever-present threat of adrenal crisis.

Prehabilitation, understood as a targeted physiotherapeutic and educational intervention conducted before total knee arthroplasty (TKA), is becoming increasingly popular as a method of improving postoperative outcomes. The aim of this study is to analyze contemporary research on the effectiveness of prehabilitation in patients preparing for TKA, with particular focus on physical function, pain, and length of hospital stay, as well as to explore ways to enhance the effectiveness of prehabilitation programmes. The review includes one experimental study and one systematic review, covering a total of over 1,600 patients. The results suggest that prehabilitation programmes may shorten the hospital stay and reduce preoperative pain, whereas their effect on long-term function and muscle strength remains less clear. Further research is needed to optimize prehabilitation programmes and definitively determine their efficacy.