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Introduction: Sleep disorders can develop as a result of exposure to stressors. The outbreak of the COVID-19 pandemic was an additional source of stress for paramedics, due to the fear of the unknown nature of the new pathogen. The main aim of this study was to identify factors influencing the development of sleep disorders among paramedics working during the COVID-19 pandemic. Material and methods: This was a cross-sectional, anonymous, voluntary, online survey conducted on social networks among paramedics working during the COVID-19 pandemic in Poland from 10/11/2020 to 14/01/2021. The survey included 387 participants, the majority of whom were men (72.35%). A proprietary questionnaire and standardized scales were used to identify risk factors: Athens Insomnia Scale (AIS) and Epworth Sleepiness Scale. Results: Among all participants, there were 107 (27.65%) women and 280 (72.35%) men. Significantly higher scores of the analyzed scales were observed in the female gender. Based on the AIS scale, mild sleep disorders were found in 3.6% of women and 2.9% of men. Excessive sleepiness on the Epworth scale was assessed in more than 70% of women and 58.8% of men working in Emergency Medical Teams (EMTs). Conclusions: The main factors influencing the development of sleep disorders were female gender, use of sleep aids and not having a life partner. In contrast, older age and longer job tenure, being married, and having good relationships with family members had a protective effect.

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Apelin is a biologically active protein encoded by the APLN gene. It was first isolated in 1998 as a ligand for the APJ receptor. It exists in several isoforms differing in polypeptide chain length and biological activity. It is secreted by white adipose tissue, and its expression has been identified in many body tissues, including the cardiovascular system, kidneys, lungs, CNS (especially the hypothalamus, suprachiasmatic and ventricular nuclei), skeletal muscle, mammary glands, adrenal glands, ovaries, stomach, liver cells, placenta, and breast milk. However, the highest concentrations were observed in the endocardium and endothelium of vascular smooth muscle cells. In myocardial tissue, apelin has a positive inotropic effect and exerts an opposing effect to the RAA (renin-angiotensin-aldosterone) system, lowering blood pressure. Therefore, its positive role in early stages of heart failure, in patients with hypertension and ischemic heart disease is emphasized. The synthesis and secretion of apelin by adipocytes makes it possible to classify this peptide as an adipokine. Therefore, its production in adipose tissue is enhanced in obesity. Furthermore, apelin has been shown to increase cellular sensitivity to insulin and improve glucose tolerance in the onset of type 2 diabetes, and therefore appears to play a significant role in the pathogenesis of metabolic disease. An accurate assessment of the importance of apelin in cardiovascular disease requires further studies, which may contribute to the use of apelin in the treatment of heart failure.

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INTRODUCTION: The emergence of the SARS-CoV-2 virus, which caused the outbreak of the pandemic declared by the World Health Organization (WHO, World Health Organization) on 11 March 2020, has resulted in the introduction of many restrictions worldwide to contain the rapidly spreading pathogen. A particularly vulnerable professional group are paramedics working in Emergency Medical Teams. AIM: The main aim of this study was to investigate the influence of selected sociodemographic and clinical parameters on anxiety and depression symptoms in paramedics during the COVID-19 pandemic. MATERIALS AND METHODS: The study involved 387 paramedics working in Medical Rescue Teams in Poland. The majority of respondents were male (72.35%). In order to achieve the aim of the study, an online diagnostic survey was conducted using a questionnaire of the author's own design and standardized questionnaires: Hospital Anxiety and Depression Scale (HADS) and General Anxiety Disorders (GAD-7). RESULTS: Significantly higher values were observed for all analysed scales in females compared to males. The main factors influencing the occurrence of anxiety and depression symptoms were gender, seniority at work, family relations, use of sleeping pills. Alcohol consumption increased in this professional group during the pandemic. CONCLUSIONS: Females and users of sleep medication who work in the emergency department during a pandemic are more likely to experience symptoms of depression and anxiety. A longer length of service and satisfying relationships with family are factors in reducing these symptoms. Paramedics who are in informal relationships and single manifest more emotional problems compared to those who are married. Increased alcohol consumption can be considered as a way of coping with stress. However, further studies in this professional group are needed to assess the further impact of the pandemic on psychiatric symptoms among emergency medical workers.

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The pandemic of coronavirus disease 2019 (COVID-19) has posed a major health challenge for over 2 years. The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that causes it belongs to single-stranded ribonucleic acid viruses and causes acute respiratory distress syndrome. The initial outbreak was discovered in December 2019 in Wuhan province, where SARS-CoV-2 quickly spread to other countries. In addition to respiratory disorders, it has been shown that during and after COVID-19 infection, cardiovascular diseases are often developed or exacerbated, such as: arterial hypertension, coronary artery disease, arrhythmias, heart failure and thromboembolic complications. In view of the higher prevalence of atherosclerosis in patients with COVID-19, we described the pathomechanisms of the development of this infection and the possible correlations between SARS-CoV-2 infection and thromboembolic complications. We focused on the role of the inflammatory response, renin-angiotensin system and endothelial dysfunction in the development of atherosclerosis in patients with COVID-19. A thorough understanding of the hemodynamic mechanisms and the impact of the infection on the cardiovascular system will allow for the proper selection of appropriate therapy in patients after SARS-CoV-2 infection.

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Cardiovascular diseases remain the leading cause of death worldwide for the past 20 years. Of these, ischemic heart disease has the highest mortality rate. In over 98% of cases it is caused by atherosclerosis of the coronary arteries. Homocysteine is an amino acid, containing a sulfhydryl group, which is formed as a result of the metabolism of the amino acids methionine and cysteine, which is supplied with protein-containing foods. A small amount of it is necessary for the proper functioning of the body, however, an increased concentration in blood plasma, which hyperhomocysteinemia, negatively affects blood vessels leading to the development of atherosclerosis and thrombotic com¬plications. The adverse effect on blood vessels results from various mechanisms, such as: excessive activation of Toll-like 4 receptor, activation N-methyl-d-aspartate receptors, increased production of reactive oxygen species, and impairment of nitric oxide synthesis. Elevated levels of reactive oxygen species are associated with increased expression of proinflammatory cytokines such as IL-1ß, IL-6, TNF-α (tumor necrosis tumor necrosis factor), MCP-1 and intracellular adhesion molecule-1. Another factor contributing to hyperhomocysteinemia is mutation of the MTHFR gene, which in normal conditions is responsible for maintaining homocysteine levels within the normal range. People with MTHFR mutation are more prone to develop atherosclerosis and the following complications: myocardial infarction, stroke, thrombotic episodes and coronary artery disease. The aim of this paper is to present evidence supporting the role of homocysteine in the development of many cardiovascular diseases.

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