BACKGROUND Kearns-Sayre syndrome (KSS) is a rare genetic, mitochondrial disorder characterized by a triad of chronic progressive external ophthalmoplegia, pigmentary retina degeneration, and cardiac conduction disorders, with onset before the age of 20 years. The disease can also manifest as several cardiovascular (CV) disorders, such as conduction disorders or dilated cardiomyopathy, along with neuromuscular and endocrinological complications. CASE REPORT A 46-year-old man diagnosed with KSS was admitted to the Institute of Heart Diseases in the qualification process for heart transplantation (Htx). The patient's medical history began with a diagnosis of third-degree atrioventricular block, treated with pacemaker (PM) implantation at age 25. However, due to progressing left ventricle (LV) function deterioration, PM was upgraded to cardiac resynchronization therapy with defibrillator 10 years later. In the year before the admission, he had undergone 2 hospitalizations caused by acute decompensations of heart failure (ADHF). Upon admission, physical examination revealed features of congestion. Transthoracic echocardiography showed an enlarged LV with global hypokinesia, reduced ejection fraction, and right ventricle dysfunction. Due to the neurological complications and poor functional condition, the Heart Team qualified him for conservative treatment. The next hospitalization due to ADHF ended in the patient's death. CONCLUSIONS CV disorders are an important aspect of treatment of KSS patients. Our patient was referred with excessively developed complications, so he could not benefit from Htx or mechanical circulatory support. This case highlights the importance of early diagnosis and monitoring of KSS patients before the full development of complications, including HF.

Background: In psychiatry, gambling is classified as an addiction-related disorder and is characterized by a persistent, problematic pattern of behaviour that leads to significant distress and functional impairment. This study aims to explore the prevalence, underlying motivations, and potential academic impact of gambling behaviours among medical students in Poland. Methods: An anonymous online survey was conducted among students from multiple medical universities across Poland. Participants completed a sociodemographic questionnaire and the South Oaks Gambling Screen (SOGS). Respondents who reported any past or current gambling activity were additionally asked about their motivations and potential academic consequences. Results: The study included 281 participants. Active or past gambling was reported by 55% of respondents, with men significantly more likely to gamble currently. Women were predominantly non-problem gamblers, whereas men more often scored within the “some problems” range on the SOGS. Motivations also differed: women emphasised financial gain, while men cited fun, socializing, and competition. Lottery and scratch cards were most popular overall, though men preferred skill-based and casino activities. Conclusions: Although participants showed relatively low levels of gambling involvement, their risk of developing pathological gambling was comparable to that of the general population. Gender influenced involvement in different gambling patterns.

Background: Multi-organ failure (MOF) is a common complication of advanced heart failure (HF), significantly influencing patient prognosis. This study aimed to assess and compare the impact of orthotopic heart transplantation (HTx) and left ventricular assist device (LVAD) implantation on the severity of MOF, as measured by the model for end-stage liver disease excluding INR (MELD-XI) score. Methods: Data from 1 month before to 1 year after HTx or LVAD implantation were analysed. The MELD-XI score was calculated using average bilirubin and creatinine values. Comparative assessments of MELD-XI scores were performed within the HTx and LVAD groups at various time points pre- and post-procedure. Results: The analysis included 107 HTx patients and 30 LVAD patients. The median MELD-XI score 1 month pre-procedure was 11.7 (9.4–16.7) in all patients. There were no significant differences in MELD-XI scores between the groups at 3-, 6-, and 12-month follow-ups. However, a significant difference was observed 1 month post-procedure [HTx: 14.8 (9.4–17.7) vs. LVAD: 11.2 (7.3–14.9), p = 0.02]. In the LVAD group, a significant decrease in MELD-XI score was noted for 3 months post-procedure compared to 1 month pre-procedure (p < 0.001), whereas at 6- and 12-month follow-ups the score did not differ from pre-procedural scores. In the HTx group, significant decreases in MELD-XI scores were observed from 3 months, 6 months, and 1 year post-procedure compared to 1 month pre-procedure (p < 0.002). Conclusions: The MELD-XI scale reveals different MOF trajectories between HTx and LVAD recipients. Both interventions lead to early improvements in liver and kidney function, with sustained benefits in HTx patients, highlighting the distinct impacts on organ function.

Background/Objectives: Multi-organ failure (MOF) often complicates advanced heart failure (HF), contributing to a poor prognosis. The Model of End-Stage Liver Disease 3.0 (MELD-3.0) scale incorporates liver and kidney function parameters. This study aims to evaluate the prognostic significance of the MELD-3.0 score in patients with advanced HF who have undergone heart transplantation (HTx). Methods: The MELD-3.0 score was computed using the average values of the international normalized ratio and bilirubin, creatinine, sodium, and albumin levels during a hospital stay following HTx. The average MELD-3.0 scores from the period of 1 month preceding HTx and 1 week after HTx were analyzed. The primary endpoint of the study was the 6-month total mortality, and the secondary endpoint was ICU hospitalization time after HTx. Results: The analysis included 106 patients undergoing HTx, with a median age of 53 years (44–63), 81% of whom were male. Within 6 months post-HTx, 17 patients (16%) died; those patients had a higher 1-week post-HTx MELD-3.0 score of 18.3 (14.5–22.7) in comparison to survivors, whose average score was 13.9 (9.5–16.4), p < 0.01. There was no difference in MELD 3.0 score in the pre-HTx period: 16.6 (11.4–17.8) vs. 12.3 (8.6–17.1), p = 0.36. The post-HTx MELD-3.0 score independently predicted death: RR 1.17 (95% CI 1.05–1.30), p < 0.01. A Receiver Operating Characteristic (ROC) determined the cut-off value of the MELD-3.0 score as 17.3 (AUC = 0.83; sensitivity—67%; specificity—86%). Survivors with scores above this value had a longer ICU hospitalization time: 7 (5.0–11.0) vs. 12 (8–20) days (p = 0.01). Conclusions: The post-HTx MELD-3.0 score serves as an independent predictor of an unfavorable prognosis in patients with advanced HF undergoing HTx. The evaluation of MELD-3.0 scores provides additional prognostic information in this population.

Background: Cardiogenic shock (CS) often complicates out-of-hospital cardiac arrest (OHCA), contributing to high mortality despite therapeutic advances. Methods: This study retrospectively analysed patients admitted to a tertiary centre between 2021–2024. The cohort of patients with CS was divided into two groups: OHCA with return of spontaneous circulation and non-OHCA. Results: The study included 280 patients with a median age of 69 (60–76) years, of whom 197 (70%) males. There were 46 (16%) patients in the OHCA group and 234 (84%) in non-OHCA. Acute coronary syndrome (ACS) was a more frequent cause of CS in the OHCA group: 36 (78%) vs. 113 (48%), p < 0.01. The OHCA patients were less likely to have hypertension (41% vs. 63%, p < 0.01), chronic heart failure (CHF) (41% vs. 62%, p < 0.01), and a history of percutaneous coronary intervention (11% vs. 29%, p < 0.01). The OHCA patients exhibited lower C-reactive protein) levels and higher levels of white blood cells. Despite distinct profiles, there was no significant difference in mortality between the study groups. Conclusions: Patients with OHCA and non-OHCA CS exhibited distinct clinical profiles, with ACS as the leading cause of OHCA and chronic conditions were more often diagnosed in non-OHCA cases. Similar mortality rates suggest improved OHCA management, emphasizing the need for extensive data collection to assess shock risk. Keywords: cardiogenic shock out-of-hospital cardiac arrest heart failure acute coronary syndrome mechanical circulatory support hospitalization

Background/Objectives: Patients with advanced heart failure (HF) often suffer from impaired kidney function. Based on the pathophysiology of types I and II of cardiorenal syndrome, heart transplantation (Htx) may restore renal function. The aim of this study was to identify predictors of improvement in kidney function after HTx. Methods: Htx patients from a tertiary hospital were retrospectively divided into three groups—improvement (n = 24), deterioration (n = 31) and no significant change in eGFR (n = 45)—based on changes in their mean estimated glomerular filtration rate (eGFR) within the first three postoperative months, compared to the last three preoperative months. The threshold for eGFR improvement was defined as a ≥20% increase, while deterioration was defined as a ≥20% decrease. The no significant change group was defined as any change falling between these two values. Results: The median age of analyzed cohort was 54 (45–63) years, and 82% were male. Preoperatively, the improvement group was more frequently treated with inotropes or vasopressors and had significantly higher blood urea and total bilirubin levels before Htx. In the multivariate analysis, total bilirubin before Htx (OR 1.66; 95% CI; 1.24–2.69; p = 0.002) and no need for RRT early after Htx (OR 0.46; 95% CI 0.24–0.88; p = 0.02) were independent predictors of improved kidney function in the first three months after HTx. Conclusions: The improvement in renal function after HTx is uncommon. It could be expected in patients suffering from more severe forms of HF, with impaired kidney and liver function but who did not need RRT after the surgery.