Answer to quiz: A round cyst-like structure in the right atrium Correct answer is #2: Atrial septal aneurysm (ASA)
protruding from the left atrium into the right atrium. This conclusion became clear after receiving other
echocardiographic images, particularly the apical fourchamber view (Fig. 1). It is possible to notice on this
image that in fact this formation is not a cyst, but a deep protrusion of the atrial septum in its central part
from left to right. This protrusion remains practically the same by its size during both systole and diastole.
Using the color Doppler we could not visualize the shunt of blood in the atrium from left to right side or
vice versa, so it was not possible to prove the presence of a patent foramen ovale (PFO) or atrial
septal defect, which often happens in such cases.

 In 2020 it is estimated that 281 million people were international migrants. Migrants constitute a potentially vulnerable population in terms of facing discrimination, poor living and housing conditions, and insufficient access to healthcare services. Due to the armed conflict in Ukraine in 2022, almost 10 million people crossed the Polish border within a year of the outbreak of the conflict. The objective of this paper is to present the use of primary healthcare services by people migrating from Ukraine to Poland and identify the barriers in access to healthcare by this group of
persons. This study used a qualitative research technique in the form of an expert interview using individual in-depth interviews (IDI). The study group consisted of professionally active primary healthcare providers (doctors, nurses, and facility managers) in Poland. Research was carried out in the areas regarding the availability of healthcare, the potential threats and challenges, and possible system solutions. The results showed that the most common cause for doctor’s appointments among migrants are respiratory infections, including COVID-19. Many cases were related to back pain, mainly resulting from the physical work of the patients. Additionally, some barriers to access and the provision of healthcare services for patients from Ukraine were identified. The majority (75%) of respondents indicated language as a significant barrier when providing services. Based on the study results, we recommend creating a dedicated website and telephone hotline for this group of persons as well as the use of traditional media to distribute information about access to healthcare services. It is also essential to focus on assistance for older people, since they may experience more difficultie with language and navigating the healthcare system. 

UDC  618.03-06:616.441-002-073.7:612.882.3

We examined 164 pregnant women who were divided into three groups. Group I included 76 pregnant women (46.4 %) with euthyroid goiter of I–II degree. Group II consisted of 63 pregnant women (38.4 %) with subclini¬cal hypothyroidism and diffuse thyroid goiter of I–II degree. Group III was the controls and consisted of 25 (15.2 %) pregnant women without thyroid pathology. The placenta was studied with the characteristics of ultrasound placentography, placental maturation disorders, the area and localization were determined, and pathological changes in the placental tissue were detected. Changes in the systolic-diastolic ratio in the uterine arteries and umbilical cord arteries were assessed, the resistance index in the uterine arteries, the pulsatile index in the fetal aorta and middle cerebral artery were determined using the method of color Doppler mapping of blood flow in the mother-placenta-fetus system. Study of the echographic picture of structural changes in the placenta revealed a significant impairment of its maturation, especially in the group with euthyroidism. Ultrasound screening revealed that in every second pregnant woman with thyroid disease, the condition of the placenta did not correspond to the gestational age, there were swelling, cysts and placental infarctions, a high frequency of diffuse changes in placental tissue, and hyperechogenic inclusions in the amniotic fluid. An increase in the resistance index in the uterine arteries of pregnant women, especially those with subclinical hypothyroidism, is noteworthy. With increasing gestational age, the peripheral resistance of the placental microvasculature increases due to involutional-dystrophic changes and circulatory disorders, which allows us to develop criteria for the prognosis and diagnosis of placental dysfunction, and to prevent perinatal disorders in pregnant women with thyroid disease.

The prevalence of COVID-19 and its polymorphic clinical manifestations are attributed to a systemic inflammatory response, which also plays a key role in the development of arterial hypertension (AH). The prognosis and effectiveness of treatment in patients with AH and COVID-19 should be assessed based on the levels of inflammatory biomarkers – activity of myeloperoxidase and inducible NO-synthase (iNOS), level of factor soluble suppression of tumorigenicity 2 (sST2).

Methods: Two groups of patients were examined: group 1 – 36 patients with AH and hypertensive crisis. Group 2 – 35 patients with AH and polysegmental pneumonia on the background of COVID-19. The control group – 16 practically healthy individuals. All patients underwent anthropometry, determination of biochemical blood tests, echocardiography, level of sST2, and activity of iNOS and MPO using ELISA in blood serum and lymphocytes.

Results: A 2.4-fold increase in sST2 content in blood serum was noted in AH and 2.9-fold in the background of COVID-19. The level of myeloperoxidase in blood serum increased 2.5 times in hypertension and 3.4 times in coronavirus disease. In lymphocytes, iNOS activity increased 3.25 times in hypertension and 4.3 times in COVID-19. sST2 level has a significant correlation with the size of the left atrium, left ventricle, and ejection fraction in patients with AH. A positive correlation with age was noted in the group of patients with AH and COVID-19.

Discussion: In patients with AH and with COVID-19, a significant increase of sST2, myeloperoxidase, and iNOS was observed compared to practically healthy individuals. A significant elevation in myeloperoxidase levels has been noted in patients with AH without COVID-19, indicating the utility of its use as a highly sensitive marker for low-intensity inflammation than C-reactive protein, particularly in arterial hypertension.

Conclusions: Measurement of the level of sST2, activity of iNOS, and MPO 3 biomarkers allows for evaluation of intensity of systemic inflammation, left ventricular hypertrophy and serves as an addictive tool in evaluating cardiac and endothelial dysfunction, indicating different directions of its development.

COVID-19 may cause or worsen cardiac dysfunction and patients with preexisting cardiovascular disease, including heart failure (HF), have an increased risk of severe and fatal outcomes of COVID-19.

The study aimed to establish the role of soluble suppression of tumorigenesis-2 protein (sST2) and natriuretic peptide test (NT-proBNP) in predicting the severe course and in-hospital mortality of patients with COVID-19 and arterial hypertension (AH).

Methods: 109 inpatients with COVID-19 and AH who were treated at the "Lviv Emergency Hospital" were examined. The determination of sST2 and NTproBNP in blood serum were done using the ELISA method. The clinical endpoint was assessed during the hospitalization period (death, hospitalization in ICU, prolonged hospitalization). The risk of the final event development was calculated for the patients who reached the threshold sST2 concentrations, and, separately, based on the diagnostic values of the NT-proBNP indicator.

Results: The cut-off values of sST2 recommended for the diagnosis of HF in our study reached 25% of patients. The risk of final clinical points development in these patients was OR=9.0; 95% CI: 1.61; 50.3; p=0.0123. The level of NT-proBNP, which meets the criteria for the diagnosis of HF, was constant in only 9.0% of individuals (p=0.0461) and the risk of clinical events developing was equal to OR=4.69; 95% CI: 1.49; 14.8; p=0.0083.

Discussion: High concentrations of sST2 and NTproBNP were associated with a severe course and a higher risk of mortality in patients with COVID-19 and AH. The additional determination of sST2 significantly complements the capabilities of NT-proBNP in risk stratification and determination of prognosis.

Conclusion: Thus, sST2 and NTproBNP are highly informative predictors of HF development in hospitalized patients. Stratification of patients based on sST2 values, in addition to NTproBNP parameters, may provide further prognostic value compared to NT-proBNP levels in patients with COVID-19 and AH.