A Call for a Modern Satyagraha Against Metabolic Syndrome

Objective: In 1923, while India was engaged in the Flag Satyagraha movement for independence, the medical community witnessed the discovery of insulin and the early recognition of metabolic syndrome (MetS) by Swedish physician Eskil Kylin. This article draws parallels between the historical Satyagraha movement and the current fight against MetS, advocating for a comprehensive and integrated approach to managing this syndrome. We explore the multifaceted role of sodium-glucose cotransporter-2 inhibitors (SGLT2i) in managing MetS, emphasizing their cardioprotective and renoprotective benefits. Materials and methods: A detailed review of existing literature on MetS, its definitions, prevalence, and management strategies was conducted. The therapeutic potential of SGLT2i was examined through a meta-analysis of randomized controlled trials (RCTs) to assess their impact on key components of MetS, including fasting plasma glucose, waist circumference (WC), blood pressure, body weight, and uric acid levels. Results and conclusions: SGLT2is, including empagliflozin, dapagliflozin, and canagliflozin, demonstrated significant efficacy in improving several components of MetS. Notably, these agents reduced fasting plasma glucose by up to 30.02 mg/dL and WC by 1.28 cm, while also providing modest reductions in systolic blood pressure and body weight. Additionally, SGLT2is were associated with significant reductions in uric acid levels, contributing to their renoprotective effects. Despite the minimal impact on high-density lipoprotein (HDL) cholesterol levels, SGLT2is showed broad cardiometabolic benefits, including anti-inflammatory effects and modulation of sympathetic nervous system activity. Public health initiatives must also prioritize lifestyle modifications and early detection to curb the rising prevalence of this condition

Visualization of sheep kidney vasculature by modified corrosion cast technique

This Letter to the Editor correlates with the article: Aycan K, Köse F, Kamaşak Arpaçay B, et al. A new corrosion method (Aycan’s method). Folia Morphol. 2025; 84(1): 249–255, doi: 10.5603/fm.100364, indexed in Pubmed: 38895752

Antibodies against the receptor for insulin-like growth factor 1 (IGF-1RAb), insulin-like growth factor 1 (IGF-1), and insulin-like growth factor binding protein 3 (IGFBP-3) in the serum of patients with Graves’ and Basedow’s disease with and without orbitopathy

Introduction: Proven risk factors for thyroid orbitopathy (TO) are thyroid dysfunction, smoking, and high levels of thyrotropin receptor antibodies (TRAb), and the role of insulin-like growth factor 1 (IGF-1), the receptor for IGF-1 (IGF-1R), and antibodies to the receptor for IGF-1 (IGF-1RAb) are also debated. IGF-1R is overexpressed in fibroblasts and orbital lymphocytes in TO patients. It forms a functional complex and mediates signal transduction through thyroid stimulating hormone receptor (TSHR). The study aimed to evaluate the levels of IGF-1RAb, IGF-1, and IGFBP-3 in a group of Graves’ and Basedow’s disease (GBD) patients with or without TO. Material and methods: Sixty-seven patients were included in the study, including 47 GBD and 20 control patients. In the GBD group, 31 patients were diagnosed with active TO and were treated with immunosuppressive therapy according to the standard of European Group on Graves’ Orbitopathy (EUGOGO) guidelines. In this group, 10 patients were in the sight-threatening stage of TO severity according to EUGOGO classification. IGF-1 and IGFBP-3 levels were determined with the use of chemiluminescence immunoassay (CLIA) methods. IGF-1RAb was measured by the “in-house” constructed enzyme-linked immunosorbent assay (ELISA) method. Results: Including our cut-off value (Q75 — 232.48 ng/mL), positive serum IGF-1RAb was found in 25% of patients in the control group (5 out of 20 patients), in 38.3 % (18 out of 47 patients) of patients with GBD, and in 22.5% of GBD patients with active TO (7 out of 31 patients). In GBD patients with active TO, there were no differences in IGF-1RAb when compared to the control group but with a significantly lower level when compared to the GBD patients without active TO. The group of patients with active TO in the sight-threatening stage had significantly lower values of IGF-1RAb compared to the group of patients with GBD without the presence of TO (p = 0.004). There was also a difference in IGF-1RAb concentration between the groups in moderate-to-severe and sight-threatening stages of TO before starting immunosuppressive treatment (p = 0.014). There was no difference in IGF-1 levels between the control group and GBD patients with active TO before starting immunosuppressive treatment and GBD patients without active TO. The was a significant difference in IGF-1 concentration between the group with moderate-to-severe and sight-threatening stages of TO before starting immunosuppressive treatment (p = 0.009). We found significantly lower IGFBP-3 concentrations in GBD patients regardless of the presence of TO compared to the control group (p = 0.016). There was no difference in IGFBP-3 concentrations between patients with moderate-to-severe and sight-threatening stages of TO (p = 0.203). Conclusion: It seems that high IGF-1RAb levels may have a protective effect against the onset or severe course of TO, and patients with low IGF-1RAb levels are at risk for severe TO. Our results suggest that anti-receptor antibodies to IGF-1 are inhibitory antibodies

Assessment of fracture risk based on FRAX score and Polish guidelines in patients with newly diagnosed osteoporosis

Introduction: The authors of the latest recommendations state that osteoporosis diagnosis should not rely solely on densitometric (DXA) criteria. Fracture risk assessment is crucial for determining diagnosis and intervention thresholds. Comprehensive assessment of fracture risk requires consideration of bone mineral density (BMD) results, use of risk calculators like Fracture Risk Assessment Tool (FRAXTM), and analysisof clinical and lifestyle factors. Experts highlight the need to identify patients at very high fracture risk to justify starting anabolic therapy. This retrospective study assessed fracture risk in newly diagnosed osteoporosis patients, identifying those at high and very high risk. Material and methods: The study included 159 postmenopausal women with newly diagnosed osteoporosis, identified by a T-score of ≤ –2.5 standard deviations (SD) from DXA scans of the femoral neck and/or lumbar spine. Demographic data and laboratory tests were collected, and the 10-year fracture risk for major osteoporotic fractures (FRAX MOF) and hip fractures (FRAX HF) was calculated using the FRAX-PL calculator, which included femoral neck BMD. Each patient was then classified into a risk group based on modified fracture risk assessment criteria. Results: The study found that the most common risk factor for osteoporosis was a previous fracture (56.6%). Other common risk factors included smoking (21.38%), parental hip fracture (13.21%), and glucocorticoid use (10.70%). The FRAX calculator showed that 47.80% of patients were at very high risk for HF and 23.90% for MOF. A high HF risk was present in 10.06% of patients, and high MOF risk in 34.59%, whereas a medium and low MOF risk concerned 25.79% and 15.72% of the subjects, respectively. With expanded criteria, 72.33% of patients were classified at very high risk, compared to 23.90% for MOF and 47.80% for HF based solely on FRAX. Most patients met the T-score ≤ –3.0 SD criterion (52.20%) and FRAX > 15% for MOF or FRAX > 4.5% for HF (52.20%). Women aged 65–70 and 70–75 years are at the highest risk and qualify for anabolic therapy. Conclusions: Our study highlights the importance of stratifying patients by fracture risk, showing that more individuals are identified at very high risk when using the expanded assessment criteria from the latest Polish guidelines

Genetic and functional analysis of TUBB1 variants in congenital hypothyroidism

Background: Congenital hypothyroidism (CH) is the most common neonatal disorder, primarily caused by thyroid dysgenesis (TD). While the genetic cause has been identified in less than 5% of TD cases, there is an urgent need to investigate additional gene mutations that may be responsible. In 2018, TUBB1 was identified as a novel candidate gene associated with TD. Nevertheless, further research is required to confirm the role of TUBB1 in TD pathogenesis and the association between TUBB1 mutations and TD in humans. Based on the previous genetic analysis of TUBB1 in 289 Chinese TD patients, this study aimed to further validate the association between TUBB1 and TD, and to explore the pathogenic mechanisms of TUBB1 c.952C>T at the cellular level. Material and methods: We performed real-time polymerase chain reaction (RT-PCR), western blot, Cell Counting Kit 8 (CCK8), and wound healing assay to evaluate the effect of TUBB1 c.952C>T on gene expression, cell proliferation, and migration. Results: The c.952C>T mutant decreased the expression of TUBB1 in both mRNA and protein level, and inhibited the proliferation of thyroid cells significantly. Also, c.952C>T mutant showed restrain effects on the migration, although there was no stistical significance. Notably, pathogenic TUBB1 variants were not detected in patients with dyshormonogenesis (DH). Conclusions: TUBB1 variants confer genetic susceptibility to TD but not DH. The pathogenic variant in TUBB1 was identified in 1.38% (4/289) of our Chinese TD patient cohort, and burden test analysis revealed an association between TUBB1 variants and TD. Functional experimental results indicated that the c.952C>T mutant dominantly affects gene expression and proliferation of thyroid cells

Primary and secondary cardiovascular prevention: Recent advances

Cardiovascular disease (CVD) remains a leading cause of morbidity and mortality worldwide with 20 million deaths annually. Recent advances in both primary and secondary prevention strategies have shown promising results in reducing the incidence and recurrence of cardiovascular events, but a question of fundamental importance is whether we are effective enough when predicting risk only in those over 40 years of age and only for 10 years. A similarly important question concerns the pathophysiological border between primary and secondary prevention and whether we should reorient our focus to atherosclerosis prevention as a continuous process that becomes clinically apparent later in life.The landscape of CVD prevention is rapidly evolving, with significant advancements in pharmacological treatments, technological innovations, and such lifestyle modifications as adopting a healthy diet, engaging in regular physical activity (PA), ensuring quality sleep, and quitting smoking, being crucial in the prevention of coronary artery disease. Integrating these strategies into clinical practice can enhance the effectiveness of both primary and secondary prevention, ultimately reducing the global burden of cardiovascular disease.This review highlights the latest developments and strategies aimed at diagnosis and preventing CVD. Key areas of focus include the use of novel agents and the role of digital health tools in improving both long-term patient adherence to evidence-based interventions and outcomes. The integration of these advancements into clinical practice has the potential to significantly enhance cardiovascular health and reduce the global burden of CVD

Outcomes of treatment, laboratory results, adverse effects, and tolerability of cancer treatment in patients with metastatic renal cell carcinoma treated with ipilimumab and nivolumab after cytoreductive nephrectomy

Introduction. This publication aims to present the results of a retrospective analysis of the treatment outcomes of patients with metastatic renal cell carcinoma (mRCC) treated with ipilimumab and nivolumab (IPI-NIVO) who underwent cytore­ductive nephrectomy (CN), radical nephrectomy (RN) or nephron-sparing surgery (NSS) and in whom surgery was omitted. Material and methods. The retrospective analysis includes the results of 34 patients treated and followed at the In­stitute of Oncology, Poznań University of Medical Sciences, from May 2022 to February 2024. Results. Progression-free survival (PFS) was compared in two groups of patients — those who underwent CN (n = 8) and those who had no prior surgical treatment before IPI-NIVO (n = 12). There was a statistically significant difference in the length of PFS between the two groups compared in favour of patients who underwent CN before starting systemic treatment (p = 0.004). The majority of patients (n = 27) reported adverse events during IPI-NIVO treatment. There was no effect of CN performed before initiation of systemic treatment on the occurrence of adverse events du­ring therapy (p = 0.677). The most common reasons for discontinuation of systemic treatment were the drugs adverse effects (n = 8) and disease progression (n = 7). Conclusions. The results presented in the study suggest the important role of CN in the treatment of mRCC. Appro­priate selection of patients suitable for CN is critical to achieving optimal treatment outcomes. Due to limited literature data, further studies are needed to evaluate the role and validity of performing CN in patients with mRCC treated with IPI-NIVO regimens