Differential diagnosis in children with musculoskeletal pain in Emergency Department

Objective: The study was aimed to analyze the diagnostic approach to a child with a non-traumatic musculoskeletal pain registered in the pediatric Hospital Emergency Department (HED). Since the pandemic COVID-19 affects patient health and the healthcare system, we also evaluated the impact of pandemic on type of musculoskeletal symptoms. Study design: A retrospective cross-sectional study was conducted by statistical analysis of data of patients with non-traumatic musculoskeletal pain registered in HED between January 2018 and December 2020. Data of patients referred and not referred to hospital ward and admitted to HED before and during COVID-19 pandemic have been compared. Results: Majority of patients presented acute, non-trauma related, single-site pain, usually localized in the hip, the knee and the spine. 21,49% of patients were referred to a hospital ward, usually rheumatological, neurological or orthopedic. Final diagnoses in almost ¾ patients belong to the group of musculoskeletal system and connective tissue disorders. During the pandemic significantly less patients with musculoskeletal pain reported to our HED. The duration of symptoms before admission was not significantly longer than in previous years, but the problem in children and the impact of the pandemic on the musculoskeletal system in children is complex. Conclusions: Our study provides detailed information on patterns of pediatric musculoskeletal consultations in HED. A positive history of trauma preceding musculoskeletal pain in a child may only be accidentally related to the final cause. Musculoskeletal pain can be also a symptom of a lot of various systemic conditions, not only diseases of the musculoskeletal system. The still ongoing COVID-19 pandemic may require changes in the organization of the HED. We believe that the presented results can help in organizing and planning care in pediatric HEDs, develop diagnostic algorithms and training for HED staff

Herbal nephropathy – a serious condition based on the innocence of nature

  Introduction and purpose: This study aimed to discuss herbal supplement usage in population and possible harmful effects with a strong emphasis on the kidneys health. Materials and methods: A literature search was conducted in the PubMed MEADLINE database of medical publications using the following keywords: herbal nephropathy, aristolochic nephropathy, herbal supplementation, Chinese traditional medicine Results: Despite the widespread use of herbs among the general public, awareness of possible side effects appears to be negligible. The herbal medicine market is often unregulated, moreover, there are problems with correct identification of the plant, variable cultivation, its processing and the lack of accurate information about its biological activity. Possible side effects include frequent contamination of preparations with heavy metals, other substances such as hormones, aflatoxins or pesticides. In addition, herbs can directly affect the metabolism of drugs taken for specific medical indications. They are able to change the level of their absorption, metabolism in the liver and secretion. The kidneys are a special organ exposed to the harmful effects of herbs due to their high blood flow, resorption from the renal tubules and high metabolic activity. Among kidney damage, aristolochic nephropathy is the one worth mentioning, induced by the herb Aristolochia fangchi and causing a rapidly progressing kidney disease, largely ending up with the need for dialysis or kidney transplantation. Conclusion: The use of herbs as medical substances carries dangers. They should be prevented through proper education of the society, appropriate legal regulations and doctors' awareness of their occurrence.   &nbsp

The complement system and its role in the treatment of ANCA-associated vasculitis

Objective: This study aimed to evaluate the role of the complement system in a therapy of the ANCA- associated vasculitis.   Methods and materials: A literature search was conducted in the PubMed MEADLINE database of medical publications using the following keywords: the complement system, AVV, C5a inhibitor, avacopan   Results: The complement system is a crucial part of the human immune system. Its cascade is involved in the pathogenesis of many disease entities, especially those with an inflammatory response. As anaphylatoxin, this is especially true of the C5a protein. C5a receptors are distributed mainly on tissue inflammatory cells, e.g. macrophages, mast cells, and endothelial cells. Therefore a C5a receptor inhibitor may reduce the inflammatory response of the body. This mechanism is used by the Avacopan, a newly approved drug for the treatment of ANCA-associated vasculitis as the main indication. Tavneos (avacopan) was only introduced in the UE in January 2022, as the first new drug to treat AVV in over a decade.   Conclusion: The C5a receptor inhibitor – Avacopan might be the future of a glucocorticoids-free or glucocorticoids – low dose therapy of ANCA-associated vasculitis. As the ADVOCATE clinical trial shows, Avacopan was neither superior, nor inferior to prednisone tamper with respect to sustained remission at 26 weeks, but proved to be superior with sustaining remission at 52 weeks. All the patients received rituximab or cyclophosphamide as a form of therapy.   Keywords: the complement system; C5a receptor inhibitor, AVV; Avacopa

Icodec insulin - revolution in diabetes type 2 insulin therapy

Introduction: Basal glucose control in diabetes type 2 is commonly maintained by a single, once-daily administration of insulin through subcutaneous injection. Insulin icodec, a novel ultralong-acting lipidated analog validates the concept of a once-weekly basal injection that is less burdensome, yet equally safe and efficacious as conventional once-daily treatment 1.Aim: The aim of the study is to introduce once-weekly injected insulin therapy and compare it with conventional basal insulin therapy in diabetes type 2 patients.Results: The results from phase II trials suggest that switching from an existing basal insulin to icodec, with or without a loading dose, provides effective glycemic control with comparable risk of hypoglycemia.In one of the studies TIR improved from baseline (mean: A 57.0%; B 55.2%; C 51.0%; IGlar U100 55.3%) through weeks 15 and 16 (estimated mean: A 76.6%; B 83.0%; C 80.9%; IGlar U100, 75.9%). No unexpected side effects were observed. It was reassuring that not a single episode of severe hypoglycemia (level 3) was reported for any treatment group throughout the trial duration and that the time spent below range (<3.9 mmol/L [<54 mg/dL]) during weeks 15 and 16 was well below the 4% target recommended by the International Consensus on Time in Range across all treatment groups 2.Conclusion: In conclusion,insulin icodec, a new acylated basal insulin analog, has been developed with optimized modifications to provide a long half-life suitable for weekly insulin dosing. In a patient population with type 2 diabetes receiving daily basal insulin therapy, switching to once-weekly icodec resulted in effective glycemic control without a transient elevation of fasting glucose levels during the switch and without increasing the risk of clinically relevant hypoglycemia compared with IGlar U100 2.Key words: Icodec, insulin, diabetes type

VLA15 - a potential Lyme disease vaccine

Introduction: Lyme disease is the most common disease transmitted by ticks. In Poland, over 20,000 cases of this disease were diagnosed in 2019. The first vaccine approved to prevent this condition was Lymerix. Currently, we do not have any preparation registered for this purpose. Data from Phase 2 trials of VLA15 show strong immunogenicity in both adults and children, with an acceptable safety and tolerability profile in both study populations Aim: The purpose of this paper is to present the current state of the art in research into the VLA15 vaccine. Results: Phase 3 of the VALOR study has started. Ultimately, about 6,000 participants aged 5 and older are to take part in it. The experiment is conducted in a dozen or so sites located in areas where Lyme disease is highly endemic. Participants will receive three doses of VLA15 180 µg or a placebo in saline as the first series of vaccinations, followed by one booster dose of VLA15 or placebo in 0.9% NaCl (1: 1 ratio). Conclusion: Phase 2 studies on VLA15 showed promising results. Phase 3 of the research is ongoing. Key words: VLA15, Lyme disease, Borrelia &nbsp

Etiological factors and treatment of chylothorax in paediatric patients - a systematic review

Chylothorax is an accumulation of chyle in the pleural cavity. It is a relatively rare cause of pleural effusion in children and its annual incidence is 14 cases per 100 000 children in Europe.  The pleural fluid triglyceride level greater than 110 mg/dl with a cholesterol level lower than 200 mg/dl confirms the diagnosis of chylothorax. Medical imaging are also necessary such as a non-invasive and easily accessible lung ultrasound. Symptoms of this disease are tachypnea, dyspnea, and in some cases dry cough. This review aims to summarize the current literature regarding chylothorax in children, analyze its possible etiologies and treatments. The causes of chylothorax are varied. It may appear after surgical interventions, traumas, infections and also be congenital. Iatrogenic factors are the most common cause of chylothorax in children with cardiothoracic surgeries. Management of chylothorax can be quite complex and highly variable, depending on patient’s condition and their response to the introduced treatment. Conservative treatment consisting of nutrition therapy, chest drain, and pharmacotherapy is typically a first-line of treatment. Diet modification consist in dietary supplements enriched with medium chain triglycerides (MCT) or starting the patient on a total parenteral nutrition (TPN). In most of the analyzed cases the conservative treatment alone proved sufficient in the management of chylothorax. In case of its failure, surgical treatment was a secondary therapy choice. One of the most common surgical procedures for pleural effusion is a thoracic duct ligation (TDL) or pleurodesis and both of these methods are highly effective therapy for chylothorax. This review of the literature reveals a wide variety of causes and methods of treatment of chylothorax. There are no clear standards of management and the therapy is adjusted to the clinical condition of the patient

The potential of cannabinoids in the treatment of lung cancer

Introduction: Lung cancer is the number-one cause of death due to neoplasms worldwide. The 5-year overall survival rate is only 22%. In advanced stages, the therapeutic options are limited to chemotherapy, radiotherapy, molecularly targeted therapy and immunotherapy. Phytocannabinoids, the components of Cannabis sativa, their synthetic derivatives and endogenous cannabinoids have demonstrated anticancer activity in various common cancers - breast, prostate, colorectal and lung cancers, among others. The aim of this review was to assess the potential value of cannabinoids in the treatment of lung cancer. State of knowledge: The majority of preclinical studies demonstrates that cannabinoids inhibit lung cancer cell viability both in vitro and in vivo. The main mechanism of anticancer  activity is the induction of apoptosis, triggered by activation of CB1, CB2 and TRPV1 receptors or independently via other pathways. Cannabinoids influence the components of the tumour microenvironment - cancer associated fibroblasts, macrophages and lymphokine-activated-killer cells. Cannabinoids alter leukocyte infiltration into anti-cancer proportions, inhibit expression of EGFR and PAI-1 and increase the expression of TIMP-1. As a result they induce cytotoxicity, decrease proliferation, migration and invasive potential of lung cancer cells, suppress angiogenesis and metastasis forming. Patients with advanced lung cancer may also benefit from analgesic, antiemetic and appetite improving properties of cannabinoids. Summary: Cannabinoids can be a supplementary agent in systemic anticancer therapeutic regimen in the future. The exact mechanisms of action, specific doses in anticancer treatment, routes of administration and interactions with other anticancer drugs has yet to be determined. Thus the clinical studies on cannabinoids in lung cancer should be performed in the future

Changes in the IGF-1 and TNF-α synthesis pathways before and after three-month reduction diet with low glicemic index in women with PCOS

Objectives: An increase in IGF-I and TNF-α may be a cardioprotective effect. To examine the relationships between IGF-I and TNF-α and test the anthropometric and biochemical parameters before and after a low-glycemic index reduction diet using a correlation matrix. Material and methods: Twenty-two women diagnosed with PCOS according to Rotterdam’s criteria were eligible for this study, which analysed the results before and after a three months dietary intervention. Body composition measurements were determined by bioimpedance and performed twice, along with the labelling of lipid, carbohydrate and hormonal profiles. IGF-I and TNF-α were also determined in the serum. Results: Before dietary intervention, a significant correlation was observed. A correlation was also noted between the increase in TNF-α and DHEA-SO4, FSH, glucose level and total cholesterol. The increase in IGF-I was not related to anth­ropometric measurements: however, its concentration was observed to be related to the level of SHBG and HDL. After dietary intervention, the correlation between TNF-α and muscle mass percentage was confirmed, as was the correlation between WHR and fasting blood glucose levels. A significant negative correlation was observed between extracellular water, provided in litres, and SHBG level. Conclusions: One important role of IGF-I in PCOS pathogenesis is the stimulation of increased synthesis of SHBG and HDL. The increased level of IGF-I after the reduction diet had a cardioprotective effect. TNF-α inhibits FSH synthesis, preventing the growth of numerous follicles. Its synthesis is also related to DHEA-SO4. After three-month reduction diet does not significantly reduce TNF-α

Study on the state of knowledge of medical students about the glycemic index of popular food products in Poland. A survey study

Introduction: The glycemic index (GI) is a helpful indicator in composing a healthy diet, especially for people at risk of carbohydrate metabolism disorders. High GI products are quickly digested and absorbed in the human body. There is a sharp increase in postprandial glucose and insulin secretion, followed by a rapid decrease in blood glucose level, which results in increased glucagon secretion and increased appetite. A high GI diet may be one of the causes of insulin resistance and obesity.Aim: The aim of the study is to examine the state of knowledge of medical students studying in Poland about the glycemic index of popular food products.Material and Methods: An anonymous online survey was conducted. The answers of 140 medical students of polish medical universities were analyzed.Results: Despite the fact that 52.1% of respondents declared that they are interested in the subject of healthy eating, milk chocolate and honey were most often recognized as high GI by the respondents (respectively 90.6% and 84,1% of answers). However, these products are classified as low/medium GI products. A baguette with a very high GI obtained 70.3% of responses. Another product with a medium Gi, boiled potatoes, got  56.5% response.Conclusion: The knowledge of medical students about the glycemic index is not large, despite expressed interest in the subject of healthy eating

The use of cannabinoids in the treatment of attention deficit hyperactivity disorder - a review of the latest literature

Introduction: Attention Deficit Hyperactivity Disorder (ADHD) is a common problem in adolescents and adults around the world. ADHD is particularly characterized by inattention, impulsiveness and hyperactivity, and in order to deal with these problems, patients often resort to other methods of treatment in addition to classic pharmacotherapy. Increasing numbers of ADHD patients are self-medicating with cannabis, despite the lack of specific evidence on its efficacy and safety. Aim of the study: The purpose of this study was to review the most recent available literature on the use of cannabidiol in the treatment of ADHD. For this purpose, PubMed and scopus databases were reviewed. The phrase "cannabidiol and ADHD" was used in the database search. After reviewing the titles and abstracts, 15 articles and articles cited in them were obtained and analyzed in detail. Results: Cannabinoids are reported to have pharmacological anxiolytic, neuroprotective, antidepressant, antipsychotic and hypnotic effects. Single-case studies of patients treated with them show that cannabinoids reduced hyperactivity, improved focus and control of impulsive behavior. Patients also reported side effects of cannabis use, the most common being mild short-term memory problems, dry mouth, sleepiness, and occasional experiences of constant thirst and greater forgetfulness. Most of the acute side effects were related to neuropsychiatric symptoms and were associated with cardiac sympathomimetic effects  Conclusion:  There is evidence for the effects of cannabinoids on ADHD symptoms as well as the influence of the cannabinoid system on involvement in neurological and psychiatric disorders. However, more controlled clinical trials are needed to determine the effect of cannabis use on ADHD symptoms and the norms of its use in this indication