Journal of Clinical Medicine

Background: COVID-19 caused by SARS-CoV-2 is an acute disease which may lead to severe systemic inflammation, causing multi-organ dysfunction and death. Studies indicated that thyroid-stimulating hormone (TSH) levels were lower when the infection was more severe. Methods: We conducted a retrospective study of 105 patients admitted from 2020 to 2023 to the University Clinical Centre in Katowice with a positive COVID-19 test. TSH levels, white blood cell count (WBC), platelet count (PLT), C-reactive protein (CRP), D-dimers, procalcitonin levels, lymphocyte count and percentage, and neutrophil-to-lymphocyte ratio (NLR) were evaluated. Results: The average age was 69.49 (SD 14.14) and the range was 36–95 years. A total of 53.2% of the population were male. After statistical analysis, lymphocyte count (p = 0.0038) correlated positively and NLR (p = 0.04682) correlated negatively with TSH level in COVID-19 patients, and PLT correlated positively with TSH level in the female population (p = 0.0384), while CRP (p = 0.81320), D-dimers (p = 0.974), WBC (p = 0.6862), Lymphocyte percentage (p = 0.1838), and procalcitonin (p = 0.906) did not reach statistical significance. Conclusions: TSH levels may be associated with lymphocyte count and NLR in patients with confirmed cases of SARS-CoV-2 infection, and with PLT in the female subgroup. Other evaluated inflammatory markers were not significant. These findings suggest that TSH has potential as a biomarker of disease severity, but further studies are needed to investigate this claim, and consideration should be given to other indicators of inflammation.

Introduction: Chronic rhinosinusitis (CRS) with frontal sinus outflow tract (FSOT) obstruction frequently requires frontal beak reduction during endoscopic sinus surgery (ESS). While technical approaches such as rotary drilling or piezoelectric osteotomy may differ in precision and tissue preservation, it is unclear whether surgical instrument choice or patient-specific clinical characteristics influence postoperative quality of life (QoL). Methods: In this prospective cohort study, 49 adult CRS patients undergoing ESS with frontal beak reduction were enrolled (28 males, mean age 50 ± 15 years). Osteotomy was performed using either a conventional drill (n = 25) or piezoelectric knife (n = 24). Baseline clinical data included presence of nasal polyps, asthma, and radiologic severity (Lund–Mackay and Zinreich CT scores). Outcomes included patient-reported symptoms with the 22-item Sino-Nasal Outcome Test (SNOT-22) and visual analogue scale (VAS), and endoscopic Lund–Kennedy scores, recorded preoperatively and at 1, 4, and 24 weeks postoperatively. Results: Both groups demonstrated significant postoperative improvement in SNOT-22 and VAS scores. No significant correlation was observed between SNOT-22 changes and Lund–Kennedy scores in either tool group. Presence of nasal polyps was associated with higher pre- and postoperative Zinreich and Lund–Mackay scores (p < 0.05). Asthma was linked to higher early postoperative symptom burden (nasal blockage, clear discharge; p < 0.05). Tool choice did not significantly influence QoL recovery or modify the effect of clinical characteristics on outcomes. Conclusions: Postoperative QoL improvement was driven primarily by baseline disease phenotype—particularly nasal polyposis and asthma—while the choice of osteotomy instrument did not significantly influence recovery trajectories. The Zinreich score provided additional phenotypic stratification in CRS with FSOT obstruction.

Background: Deep sternal wound infections (DSWIs) remain a serious complication after median sternotomy, often requiring complex wound management strategies. While modern approaches include vacuum-assisted closure (VAC) and plating techniques, the pedicled pectoralis major muscle flap (PMF) continues to play a pivotal role in surgical reconstruction, especially in cases with sternal destruction or osteomyelitis. Methods: In this retrospective single-centre analysis, 166 patients with DSWI following cardiac surgery were reviewed. Clinical data, comorbidities, laboratory parameters, and surgical management were evaluated. Logistic regression was performed to assess predictors for reinfection and need for reoperation. Results: Initial wound revision was most frequently performed using sternal rewiring (60.2%), followed by reconstruction with a pectoralis major flap (33.7%). Despite initial surgical treatment, 27.1% of patients developed post-revision wound healing disturbances, and 24.1% ultimately required a second surgical intervention. Among second-time procedures, VAC therapy (32.5%) and PMF reconstruction (20.0%) were the most common approaches. Reinfection was significantly associated with higher preoperative EuroSCOREs (p = 0.044), while initial rewiring carried a higher risk of treatment failure compared to the pectoralis major flap (p = 0.0024). Conclusions: In the setting of sternal destruction or osteomyelitis, the pectoralis major muscle flap remains a fast, effective, and robust solution. Despite its long-standing use, it continues to offer excellent vascularized coverage and infection control in complex DSWI cases.