Potential anti-cancer features of metformin

INTRODUCTION AND PURPOSE: Metformin is one of the most frequently prescribed medications in the whole world. This lipophilic biguanide is widely used as a first-line medicine for patients suffering from type 2 diabetes mellitus because of its high effectiveness in monotherapy, and in connection with other antidiabetic drugs. Glucose-lowering properties of metformin were initially used only in the therapy of type 2 diabetes mellitus, but some data indicate that these properties might state an alternative in the prevention or treatment of some cancers both among diabetic and non-diabetic patients. STATE OF KNOWLEDGE: Metformin molecular mechanisms of action were thoroughly investigated, differentiated, and described, but in the context of the glucose-lowering effect. As a multiway drug, used mainly in diseases characterized by an increased level of glucose in the blood, numerous medical trials were conducted to find other treating properties of metformin. Recently, a few reports presented the potential connection between using metformin in the prevention and treatment of neoplasms in the same mechanisms. The scientists analyzed the influence of metformin’s action on various cancers and drew conclusions. The research on potential anti-cancer features of metformin was conducted for a relatively short period and still presents a challenge to scientists. CONCLUSIONS: The aim of this review is to gather current knowledge and present the latest discoveries about potential anti-cancer features of metformin. We discuss the potential underlying molecular mechanisms of metformin’s action in the human body and indicate the connection between the prevention and treatment of neoplasms. Additionally, we point out the exact cancers in which metformin might play a significant role

Hypothermia as a treatment option for hypoxic-ischemic encephalopathy in newborns – A literature review

Introduction and purpose: Neonatal asphyxia is a medical condition in which the neonate is not able to maintain sufficient respiratory function. The hypoxia may be caused by either an impaired respiratory activity of the neonate or an interruption of blood flow to the placenta in the period immediately before or during delivery, which resulted in inadequate oxygen perfusion to vital organs. Description of the state of knowledge: Hypoxic-ischaemic encephalopathy (HIE) is a form of perinatal hypoxia, occurring in newborns after the 35th week of gestation and presenting along with neurological disorders. In fact, it is a major cause of death and infant disability. The incidence of HIE is approximately 2-5 per 1000 live births. The standard recommended treatment for perinatal hypoxic-ischaemic encephalopathy is therapeutic hypothermia. There are two methods used: selective head cooling with moderate whole-body hypothermia (SHC) and whole-body hypothermia (WBC). In both cases, metabolism and neural tissue destruction are slowed down. Conclusions: Therapeutic hypothermia is a promising treatment option for neonatal encephalopathy. Thus, it decreases the risk of death and neurological deficits in the form of cerebral palsy, epilepsy and psychomotor retardation. Whole-body hypothermia appears to be a more successful method than selective head cooling, however more research is still needed. &nbsp

Cardiometabolic consequences of PCOS

Polycystic ovary syndrome (PCOS) is a heterogeneous disorder in terms of clinical symptoms and laboratory findings. It is one of the most common endocrinopathies in women of childbearing age. The development of symptoms and the degree of severity in the course of the disease are the results of changes in the ovaries which may be caused by many genetic, metabolic, neuroendocrine, and environmental factors. The main clinical manifestations are menstrual disorders, difficulties with becoming pregnant, and changes related to hyperandrogenism, e.g., acne, hirsutism. Recognition is above mainly based on Rotterdam criteria.A comprehensive explanation of pathophysiology is still lacking. Nevertheless, it probably is a multifactorial condition with a genetic component. Women suffering from PCOS experience lipid and carbohydrate metabolism disorders, which lead to insulin resistance, obesity, hypertension, and cardiac complications. Insulin resistance affects 65-70% of women and not only plays a significant role in the development of the disease but also contributes to the development of hypertension and dyslipidemia. Potential mechanisms of hypertension in PCOS include endothelial dysfunction, increased aldosterone, and excess testosterone secretion, whereas lipid abnormalities consist of reduced high-density lipoprotein-cholesterol (HDL-C), increased triglycerides, and low-density lipoprotein-cholesterol (LDL-C). All of these factors cause high cardiovascular risk. Currently, therapy considers both lifestyle improvements and medications and must be tailored on a case-by-case basis.  It is very important not to consider PCOS only in the context of gynecological and endocrine diseases, but also metabolic changes and cardiovascular diseases. Treatment of PCOS should be individualized and dependent on the predominant disorders, as well as the short- and long-term goals chosen. It also should take the prevention of cardiovascular diseases into account

Celiac disease - a review on recent advances in characteristics, diagnostic and treatments

Introduction and purpose: Celiac disease occurs in 1% of the general population. However, many cases remain unrecognized. The disease is a chronic immune-mediated disorder triggered by the ingestion of gluten that appears in individuals with genetic susceptibility. Celiac disease can develop in paediatric patients as well as adults. The purpose of this review is to analyze the newest information on the characteristics, diagnosis and treatment of patients with celiac disease.  Material and methods: This review was based on available data collected in the PubMed database and published between 2015 and 2022. The research was done by looking through keywords such as: “celiac disease”, “Gluten-Free Diet”, “diagnosis” and “treatment”. Results: The diagnosis of celiac disease is most often delayed due to the broad spectrum of presentations. Screening of at-risk individuals is important to progress the diagnosis. It is additionally crucial to raise clinicians' attention to non-specific parenteral symptoms that may indicate celiac disease. The majority of the symptoms arise from nutritional deficiencies caused by intestinal malabsorption. According to scientific reports, the most common deficiencies of people with celiac disease are iron, folic acid, vitamin B12, fat-soluble vitamins and a calcium. Conclusions: Recent years have seen the emergence of research into new therapeutic options, but their efficacy and safety still need to be evaluated more thoroughly. Strict adherence to a gluten-free diet by patients is still the only treatment option at present. Celiac disease, due to the constant increase in knowledge about its pathogenesis, diagnosis and treatment is an important material for further research

Similarities and differences between multisystem inflammatory syndrome in children and Kawasaki disease – clinical presentations, laboratory features and treatment

Children infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are mostly asymptomatic or have mild symptoms. However SARS-CoV-2 is also associated with a recently widely reported pediatric systemic vasculitis. This multisystem inflammatory syndrome in children (MIS-C) is still poorly understood, further information and studies are urgently needed. MIS-C has features that overlap with many known multisystem inflammatory diseases, especially Kawasaki disease. In this review, we are comparing MIS-C associated with COVID-19 and Kawasaki disease. We are searching for similarities and differences based on clinical manifestations, diagnosis, and treatment. MIS-C jest stosunkowo nowym zespołem chorobowym, związanym z zakażeniem SARS-CoV-2. Nadal wymaga przeprowadzenia dalszych badań z perspektywy globalnej, w celu zrozumienia jego patogenezy, przebiegu i potencjalnych skutków. Chociaż objawy kliniczne MIS-C i KD mogą się pokrywać, wydają się być dwiema odrębnymi jednostkami klinicznymi i możemy spróbować je rozróżnić na podstawie objawów wspomnianych powyżej

Liraglutide as an innovative and multifunctional drug for patients with obesity – the current state of knowledge and future prospects

Obesity is considered a disease of civilization representing a global health and social problem. Currently, 21% of adult Poles suffer from obesity, so every fifth patient contacted by a doctor is obese. Obesity is a chronic disease, associated with excessive accumulation of adipose tissue, which causes a deterioration in the health and quality of life of an obese patient. It also consequently leads to an increased risk of developing many diseases - including cardiovascular, metabolic and neoplastic diseases. Excessive body weight ranks sixth in importance as a risk factor responsible for the number of deaths worldwide. The mainstay of obesity treatment is lifestyle modification. It includes changing eating habits and increasing physical activity. However, due to the high prevalence of obesity in developed countries, its serious consequences and the unsatisfactory effect of weight loss in some patients with an appropriate diet, pharmacological methods of obesity treatment were searched for. Currently, there are three drugs approved for the treatment of obesity in Poland: orlistat, a combined preparation of naltrexone + bupropion and liraglutide – agonist of a glucagon-like peptide-1 receptor. The effectiveness of one of them - liraglutide - is particularly significant, and the effect of this drug in reducing cardiovascular risk is also promising, which is extremely important in obese patients. For this reason, in the latest recommendations of the Polish Obesity Treatment Association, liraglutide is indicated as the drug of first choice for obese or overweight patients with a BMI ≥27 kg / m2, in whom coexisting: pre-diabetes, type 2 diabetes, arterial hypertension, polycystic ovary syndrome, nonalcoholic fatty liver disease, metabolic syndrome, atherosclerosis or sleep apnea syndrome. Due to the presence of GLP-1 receptors in many organs, the use of liraglutide in the future would probably extend to more diseases than obesity and type 2 diabetes

Does a gluten-free diet affect the course of Hashimoto's disease? - the review of the literature

Introduction and purpose The fashion for following a gluten-free diet is causing more and more people to opt for it. It is indicated in the treatment of celiac disease. Due to the high prevalence of Hashimoto's disease in the population and the lack of causal treatment for the disease, many researchers have tested the validity of gluten elimination for those burdened with it. This work aimed to review the results achieved so far and assess whether this diet has a real impact on the course of Hashimoto's disease. A brief description of the state of knowledge A PubMed database was searched for studies describing the relationship between gluten consumption and the course of Hashimoto's disease. Some studies indicated a potential beneficial effect of the introduced diet on thyroid function. However, these were mostly survey-based studies of questionable research quality. More reliable studies that took into account antibody and TSH levels showed no significant improvement in thyroid function in response to the diet. Conclusions Based on the studies reviewed, there is no need for a gluten-free diet in patients with chronic autoimmune thyroid disease. It has not been proven that gluten can provoke the body to produce autoantibodies that cause the destruction of thyroid tissue. It is more important to maintain a balanced diet rich in zinc, selenium, iodine, vitamin D3, and iron, as they are essential in the process of hormone production by the thyroid gland

Futile therapy in the conditions of the Covid-19 pandemic

Futile therapy is the prolonged maintenance of organ function. This process in this case does not bring therapeutic benefits, and its task is to maintain the failed organs. The article aims to present the differences between influenza and Covid-19 and to draw attention to the problem of the futility of therapy in the context of a pandemic

Optimizing treatment strategies for a MET exon 14 skipping mutation in non-small-cell lung cancer: a case report of sequential immunotherapy and targeted therapy and literature review

The MET exon 14 skipping mutation is found in approximately 3–4% of non-small cell lung cancers (NSCLC). In 2020, the American Food and Drug Administration approved the first drug targeting this mutation. Capmatinib is a selective MET tyrosine kinase inhibitor. In the European Union, capmatinib is used when the patient needs further treatment after receiving immunotherapy or platinum-based chemotherapy, or both. In the described case, due to disease progression during treatment with pembrolizumab and then with platinum-based chemotherapy, next-generation sequencing was performed, which allowed for detection of the MET gene exon 14 skipping mutation. Targeted therapy with capmatinib was the only method of treatment resulting in a partial response to the disease and improvement of the patient’s quality of life. This case indicates the importance of detailed molecular diagnosis and selection of the optimal method of treatment to prolong survival of the patient with advanced NSCLC. Due to promising results of research conducted so far, in the future, selective MET tyrosine kinase inhibitors — capmatinib and tepotinib — may become the new standard of first-line treatment in NSCLC patients with the MET exon 14 skipping mutation

Acute tricuspid valve regurgitation in a motorcycle accident

Tricuspid regurgitation is secondary in 90% of cases. We would like to present two case reports of primary tricuspid regurgitation caused by rupture of the papillary muscle as a result of traffic accidents. This series of cases presents a very rare heart injury caused by blunt chest trauma. Regular monitoring of echocardiographic parameters in the period between the stabilization of patients' condition after the accident and surgical correction of the tricuspid valve defect is an important point of patient care with severe tricuspid regurgitation.Tricuspid regurgitation is secondary in 90% of cases. We would like to present two case reports of primary tricuspid regurgitation caused by rupture of the papillary muscle as a result of traffic accidents. This series of cases presents a very rare heart injury caused by blunt chest trauma. Regular monitoring of echocardiographic parameters in the period between the stabilization of patients' condition after the accident and surgical correction of the tricuspid valve defect is an important point of patient care with severe tricuspid regurgitation