3D-Printed models as an improvement in medical professionals' education

Increasing usage of 3D-Printed models draws attention as a cheap alternative to traditional tools used in anatomy education and post-graduate training. Models can be self-prepared using existing DICOM files and printed on consumer-level printers using widely available materials. Prepared models benefit from high approval rate from students, multiplicity of printable structures and high detail accuracy. They can be used in wide range of medical training, for e.g., otolaryngology, neurosurgery, oncology, neuroradiology. Positive outcomes include greater eligibility for resident training, surgical planning and education, when compared to market available anatomical models. Additive manufacturing is expected to increase its presence in medical education

The endocrine background of meningioma carcinogenesis

Meningiomas, being mostly benign tumors, are derived from the arachnoid cap cells, their etiopathogenesis is based on various factors. The etiology of sporadic meningiomas is not yet known. Many factors have been identified as possible causes of the development of intracranial meningiomas. These include head trauma, viral infections, deletion in the NF2 gene, the use of cell phones, and sex hormones. The review is based on a endocrine factors, playing a role in meningioma carcinogenesis.             The carcinogenesis of meningioma appeals to be profoundly dependent from hormonal factors. Mayor ones, usually underlined in according to their prognostic significance, are female sex hormones. Due to this, meningiomas are twice as more likely to occur in female than in male patients. The other group of hormones appointed to play a role in meningioma carcinogenesis are adipokines in general – and leptin in particular. Leptin secretion correlates with BMI elevation, what may explain the confirmed linking between obesity and brain tumors. The scientific literature has documented the occurrence of meningioma in five patients with CAH, but the role of cortical axis and/or ACTH secretion impairments is still under consideration. Authors didn’t find any publication about the role of thyroid disorders in meningioma carcinogenesis. The carcinogenesis of meningioma appeals to be profoundly dependent from hormonal factors. The effects of female sex hormones and adipokines are under a significant consideration, and may be useful in severity prediction. Basic science research should be focused on ACTH secretion in meningioma and possible common genetic etiopathogenesis of meningioma and CAH

Czy nieprawidłowe rozpoznanie zespołu Wolframa jako cukrzycy typu 1 i jej powikłań może być przyczyną rzadkiego rozpoznawania tego zespołu?

Wolfram syndrome (WS), also known as DIDMOAD (Diabetes Insipidus, Diabetes Mellitus, Optic Atrophy and Deafness), is a rare autosomal recessive syndrome (1/770,000 in the United Kingdom), characterised by juvenile onset of diabetes mellitus, optic nerve atrophy, diabetes insipidus, sensorineural deafness, renal tract and neurological abnormalities, and primary gonadal atrophy. WS is caused mainly by biallelic mutations in the WFS1 gene, which encodes wolframin. Wide tissue distribution of wolframin and many mutations in the wolframin gene resulting in Wolfram syndrome may contribute to different phenotypes and the unusual combinations of clinical features. We describe a female patient with Wolfram syndrome diagnosed at the age of 25, with a previous false diagnosis of type 1 diabetes mellitus and misdiagnosed diabetic complications. The patient was found to be a compound heterozygote for two novel mutations in exon 8 of WFS1 gene: a 2-bp deletion AT at nt 1539 leading to a frameshift (Y513fs) and a single-base substitution 1174C > T resulting in a stop codon (Q392X). A detailed analysis of the patient’s medical history and a review of the literature suggest that many cases of Wolfram syndrome may remain undiagnosed due to misdiagnosis as type 1 diabetes mellitus and incorrect interpretation of clinical symptoms of neurodegenerative abnormalities, especially in their early stages. (Endokrynol Pol 2014; 65 (5): 398–400)Zespół Wolframa (WS), znany również jako DIDMOAD (moczówka prosta, cukrzyca, atrofia nerwu wzrokowego i głuchota), jest rzadkim zespołem dziedziczonym autosomalnie recesywnie (1/770000 w Wielkiej Brytanii), charakteryzującym się wystąpieniem cukrzycy w wieku młodzieńczym, zanikiem nerwu wzrokowego, moczówką prostą, głuchotą, niewydolnością oddechową i zaburzeniami neurologicznymi oraz pierwotną atrofią gonad. WS jest spowodowany głównie mutacją w genie WFS1, który koduje wolframinę. Obecność wolframiny w wielu tkankach organizmu oraz wiele różnych mutacji w genie wolframiny, których skutkiem jest wystąpienie zespołu Wolframa, może stanowić przyczynę różnych fenotypów tego zespołu oraz różnych kombinacji cech klinicznych. W poniższej publikacji opisano przypadek pacjentki z zespołem Wolframa, której choroba początkowo była błędnie zdiagnozowana jako cukrzyca typu 1 i jej powikłania. W badaniach genetycznych wykazano, że pacjentka była heterozygotą w zakresie dwóch nowych mutacji w egzonie 8 genu WFS1: 2-bp delecji AT w regionie nt 1539, prowadzącej do mutacji zmiany ramki odczytu (Y513fs) oraz substytucji pojedynczej zasady 1174 C > T, czego skutkiem był stop kodon (Q392X). Ze szczegółowej analizy historii medycznej pacjentki oraz przeglądu piśmiennictwa wynika, że duża liczba przypadków zespołu Wolframa może zostać niewłaściwie rozpoznana jako cukrzyca typu 1 lub zaburzenia neurodegeneracyjne, zwłaszcza w początkowej fazie ich rozwoju. (Endokrynol Pol 2014; 65 (5): 398–400

Pineal cyst-related sleep disorders – a narrative review

The pineal gland is an endocrine gland, which is responsible for the human circadian rhythm, through the regulation of its hormone – melatonin. The most common pathology of a pineal gland is pineal cyst – its population incidence is estimated as 1-23%, depending on the publication. The most common symptoms of a pineal cyst include headache (87%), visual field defects (54%), nausea/vomiting (34%), and dizziness/vertigo (31%). Among the majority of patients with the asymptomatic pineal cyst, the wait-and-see strategy is proper.             According to the newest meta-analyze, the prevalence of sleep disturbances among patients with pineal cyst estimates to be 17%. The results of direct melatonin level measurements in pineal cysts remain unclear. The study focused on sleep disturbances in pediatric patients with pineal cysts and showed a significantly higher score on Sleep Disturbance Scale for Children (SDSC) in the domains of disorders of excessive sleepiness and disorders of initiating and maintaining sleep than the control groups. The impact of lesion on sleep quality correlated with its size.             The pineal cyst may be considered a rare, and potentially reversible, cause of sleep disorders. Nevertheless, according to the present reports (often opposite to each other), this thesis and the mechanism of its occurrence need to be further researched

Psoriasiform lesions as a side effect of SGLT-2 therapy

SGLT-2 inhibitors (flozins) are one of the new classes of anti-diabetic drugs, used from 2012. They are highly recommended in case of intolerance or contraindication of metformin, but in Poland they are used usually as third-line drug after metformin and sulfonylurea. They growing popularity is caused by their significance in cardiovascular risk reduction and preventive role in according to diabetes complications like chronic kidney disease, or diabetes-induced dementia. The aid of this article is to summarize the knowledge on the risk of psoriasis development in diabetic patients cured with flozins.             In according to the newest studies, flozins may be considered as a pro-psoriatic factor, increasing the risk of this skin disease, especially in patients with diabetic kidney disease. But on the other hand, SGLT-2 inhibitors have significantly decreasing effect on cardiovascular risk, which is increased in psoriatic patients

Bevacizumab or standard chemotherapy in previously treated patients with metastatic colorectal cancer — a systematic review

Introduction. The BRAF V600E mutation (BRAFmt) occurring in the metastatic colorectal cancer (mCRC) patients is associated with poorer prognosis, in comparison to the wild-type variant of the BRAF gene (BRAFwt). Aim of this work was to assess the clinical efficacy of bevacizumab (BEVA) or standard chemotherapy (ChT) in the 2nd or further lines of treatment in mCRC BRAFmt population.  Material and methods. MEDLINE/PubMed, Embase and Cochrane CENTRAL databases were systematically searched. The reference lists of relevant studies were also checked.  Results. 6 eligible trials were identified: MOMA (BEVA ± ChT), allowing for limited overall survival (OS) assessment, WJOG 6210G (BEVA + FOLFIRI), RAISE and 20050181 (FOLFIRI), PICCOLO and Spindler 2013 (irinotecan monotherapy). None of those trials were designed for the treatment evaluation in BRAFmt population. Available evidence was restricted to limited analyses in small subgroups (from a few to several dozens of patients), occasionally comprising RAS gene mutation (RASmt) as well. Based on the identified studies, the comparison of BEVA ± ChT vs. ChT or among different ChTs in BRAFmt population was not feasible. In case of BEVA (MOMA), OS hazard ratio (HR) for BRAFmt vs. BRAFwt was 1.52 (95% CI: 0.79–2.89) with difference in medians equal to 12.1 months (19.2 vs. 31.3 months, respectivelly), and BRAFmt or RASmt patients had median OS lower by 7.9 months and median progression free survival (PFS) by 3.0 months in WJOG 6210G trial. In case of ChT, median PFS was lower in BRAFmt by 12–67% (HRs range: 1.01–5.3), and median OS by 34–73% (HRs range: 1.05–5.00).  Conclusions. Due to limited clinical evidence, assessment of further lines of treatment in BRAFmt mCRC patients is uncertain, however existing data consistently suggest lower effectiveness of BEVA ± ChT or ChT in BRAFmt, than in BRAFwt subgroup. Hopefully, combining anti-EGFR therapies with BRAF/MEK inhibitor is expected to improve prognosis of those patients.Introduction. The BRAF V600E mutation (BRAFmt) occurring in the metastatic colorectal cancer (mCRC) patients is associated with poorer prognosis, in comparison to the wild-type variant of the BRAF gene (BRAFwt). Aim of this work was to assess the clinical efficacy of bevacizumab (BEVA) or standard chemotherapy (ChT) in the 2nd or further lines of treatment in mCRC BRAFmt population.Material and methods. MEDLINE/PubMed, Embase and Cochrane CENTRAL databases were systematically searched. The reference lists of relevant studies were also checked.Results. 6 eligible trials were identified: MOMA (BEVA ± ChT), allowing for limited overall survival (OS) assessment, WJOG 6210G (BEVA + FOLFIRI), RAISE and 20050181 (FOLFIRI), PICCOLO and Spindler 2013 (irinotecan monotherapy). None of those trials were designed for the treatment evaluation in BRAFmt population. Available evidence was restricted to limited analyses in small subgroups (from a few to several dozens of patients), occasionally comprising RAS gene mutation (RASmt) as well. Based on the identified studies, the comparison of BEVA ± ChT vs. ChT or among different ChTs in BRAFmt population was not feasible. In case of BEVA (MOMA), OS hazard ratio (HR) for BRAFmt vs. BRAFwt was 1.52 (95% CI: 0.79–2.89) with difference in medians equal to 12.1 months (19.2 vs. 31.3 months, respectivelly), and BRAFmt or RASmt patients had median OS lower by 7.9 months and median progression free survival (PFS) by 3.0 months in WJOG 6210G trial. In case of ChT, median PFS was lower in BRAFmt by 12–67% (HRs range: 1.01–5.3), and median OS by 34–73% (HRs range: 1.05–5.00).Conclusions. Due to limited clinical evidence, assessment of further lines of treatment in BRAFmt mCRC patients is uncertain, however existing data consistently suggest lower effectiveness of BEVA ± ChT or ChT in BRAFmt, than in BRAFwt subgroup. Hopefully, combining anti-EGFR therapies with BRAF/MEK inhibitor is expected to improve prognosis of those patients

Multidisciplinary approach for a severe head burn caused by high-voltage electrical shock - a case report

In modern reconstructive medicine, personalized bone substitutes provide therapeutic hope for patients with non-standard bone defects. The study aims to present a description of a case of using a personalized bone substitute material, taking into account the vascular connections formed after a previous skin transplant.  The 29-year-old patient was admitted to the plastic surgery department urgently after being electrocuted with high voltage. Due to extensive scalp burns, a skin graft was performed in the area of previously removed skin along with a charred skull bone vault.  After a few months, the patient was qualified for cranioplasty with the use of personalized bone substitutes. The necessity to make cuts around the vascular connections present in the transplanted tissue was the main difficulty in the for the operator.  The operation was successful and the recovery was uneventful. The patient was discharged home in good general and local condition.  The presented case illustrates the need to take into account creating vascular connections with the use of personalized bone substitutes in patients after skin transplants

Management of diabetes mellitus in patients with type 2 diabetes residing in a rural district of westpomeranian province

WSTĘP. Zdecydowana większość chorych na cukrzycę typu 2 (ok. 95% wszystkich przypadków cukrzycy) pozostaje, zwłaszcza na terenach wiejskich, pod wyłączną opieką lekarzy rodzinnych. W badaniu UKPDS udowodniono, że lepsze wyrównanie cukrzycy typu 2 istotnie zmniejsza ryzyko rozwoju przewlekłych powikłań cukrzycowych. Celem przedstawionego badania była ocena wyrównania metabolicznego chorych na cukrzycę typu 2, zamieszkujących gminę rolniczą w województwie zachodniopomorskim. MATERIAŁ I METODY. Badanie przeprowadzono w Poradni Lekarza Rodzinnego NZOZ &#8222;Asklepios&#8221; w Bobolicach, pod opieką której pozostaje 279 pacjentów chorych na cukrzycę stanowiących 3,3% zarejestrowanych tam osób. Na badanie zaproszono wszystkich chorych, spośród których zgłosiło się 249 osób (89%). Wiek badanych wynosił 32-91 lat (śr. 66,5 &#177; &#177; 12,4 roku). Wskaźnik masy ciała (BMI) oznaczony u 174 chorych wynosił 32,3 &#177; 6,4 kg/m2. U wszystkich badanych rano, na czczo pobrano krew żylną w celu oznaczenia stężeń HbA1c oraz glukozy. WYNIKI. Średnie stężenie HbA1c w badanej próbie wynosiło 7,82 &#177; 1,95%, średnie stężenie glukozy na czczo - 156 &#177; 66 mg/dl. Stężenie HbA1c wynoszące maksymalnie 6,5% stwierdzono u 31% osób uczestniczących w badaniu. Pożądaną glikemię na czczo wynoszącą maksymalnie 110 mg/dl, stwierdzono u 25% chorych. Jedynie u 17% badanych oba parametry, HbA1c oraz glikemia na czczo, spełniały kryteria wyrównania wyznaczone przez PTD 2007. Stężenie HbA1c poniżej 7%, zalecane przez ADA, osiągnęło 38% uczestników badania, zaś glikemię na czczo w przedziale 90-130 mg/dl zaobserwowano u 37% badanych. Oba zalecane przez ADA kryteria wyrównania spełniło 22% chorych. Uzyskane wyniki porównano z danymi pochodzącymi z innych ośrodków, w których oceniano chorych zamieszkujących miasta. WNIOSKI. Wyrównanie metaboliczne chorych na cukrzycę typu 2 zamieszkujących tereny wiejskie jest niezadowalające i wydaje się gorsze niż u pacjentów mieszkających w miastach. Być może wpływa na to większy stopień otyłości i nadwagi obserwowany u tych chorych, a także mniejsza dostępność opieki specjalistycznej.INTRODUCTION. The great majority of patients with type 2 diabetes, which accounts for 95% of all dia betic subjects, are treated only by general practitioners, especially in rural areas. The UKPDS study demonstrated that a better control of type 2 diabetes considerably reduces the risk of chronic diabetic complications. The main goal of the study was to assess metabolic control in type 2 diabetes patients, residents of a rural district of Westpomeranian Province. MATERIAL AND METHODS. The study was conducted in the General Practitioner&#8217;s Clinic NZOZ &#8222;Asklepios&#8221; in Bobolice, who provides medical care for 279 diabetics who account for 3.3% of all registered subjects. All diabetic patients were invited to participate in the study, and 249 subjects volunteered (89%). The age of investigated subjects ranged from 32 to 91 years (mean 66.5 &#177; 12.4 years). The mean body mass index (BMI), calculated for 174 patients, was 32.3 &#177; 6.4 kg/m&#178;. In the morning after an overnight fast, in all participants venous blood samples were taken for measurement of HbA1c and serum glucose level. RESULTS. The mean HbA1c level was 7.82 &#177; 1.95% and mean fasting serum glucose 156 &#177; 66 mg/dl. Values of HbA1c &#8805; 6.5% were observed in 31% of participants. Recommended glucose level &#163; 110 mg/dl was observed in 25% patients. Only in 17% of subjects both parameters, HbA1c and fasting glycaemia met the criteria recommended by Polish Diabetes Association 2007. Values of HbA1c < 7%, recommended by the American Diabetes Association (ADA) were observed in 38% of subjects while fasting glycaemia 90-130 mg/dl in 37% of cases. Both criteria, recommended by the ADA were met in 22% of diabetic patients. Obtained results were compared with the published data concerning outpatients&#8217; clinics from urban areas. CONCLUSION. Metabolic control of type 2 diabetic subjects, residents of the rural area in North-West part of Poland, is unsatisfactory and seems to be worse than in the patients from urban areas. This may be a result of higher degree of obesity and overweight of these patients as well as worse access to specialist care

Systematic review and network meta-analysis (NMA) for cladribine tablets in achieving sustained disability improvement (SDI) in multiple sclerosis

Introduction. This study was performed to compare probabilities of SDI on the Expanded Disability Status Scale (EDSS) in patients with relapsing-remitting multiple sclerosis (RRMS), treated with cladribine tablets (CT) or fingolimod (FTY), natalizumab (NAT), alemtuzumab (ALE) and ocrelizumab (OCR). Clinical rationale for the study. Progression of neurological disability as measured by the EDSS has been a common endpoint in multiple sclerosis (MS) trials. Novel therapies can not only slow this process, but in some patients even reverse it. This effect can be measured by the sustained disability improvement (SDI) — an endpoint that seems to continuously gain importance in clinical practice. Despite that, SDI has rarely been explored as an outcome in MS clinical studies, mostly as post-hoc analyses from randomised trials or as retrospective analyses based on patient registry records. Material and methods. A systematic review was conducted in Medline, Embase and Cochrane to identify clinical trials (RCT or non-RCT) evaluating 6-month SDI. An indirect comparison via network meta-analysis (NMA) was performed. Bayesian inference with Markov chains Monte Carlo methods were applied. Results. Eight trials presenting SDI results and applicable for NMA were included: six non-RCTs, with control groups selected by propensity score matching, and two RCTs. NMA results revealed that probability of achieving 6-month SDI with CT was significantly higher compared to all other high efficacy disease-modifying drugs with available data — HR (95% Crl - Bayesian Credibility Interval) vs. FTY: 4.98 (2.11–11.79); vs. NAT: 3.12 (1.31–7.27); vs. ALE: 9.29 (3.40–25.21). The main results were confirmed in the sensitivity analyses. Conclusions. Of all considered therapies, treatment with cladribine tablets was associated with a higher probability of sustained disability improvement in RRMS patients. As this conclusion is based on available clinical data of limited quality, future studies, as well as real-world data, would be valuable to provide further evidence regarding the comparative effectiveness of RRMS therapies

Severe course of radiation-induced meningioma — a new insight in screening for patients after radiotherapy?

Meningiomas, being mostly benign tumours, are derived from the arachnoid cap cells. Their etiopathogenesis is based on various factors, including past radiation. The presented case of a 25-year-old patient, who developed a radiation-induced superior sagittal sinus meningioma based on his past head radiation distributed during acute lymphocytic leukaemia. The tumour’s clinical image presented at first as headache, nausea, and dizziness, computer tomography and subsequently MRI were performed. The imaging examination revealed a very extensive, contrast-enhanced tumour mass located centrally on both sides and within the superior sagittal sinus. With the most likely diagnosis of parasagittal meningioma, the patient was qualified for tumour excision. The surgery was performed successfully resulting in maximal safe subtotal resection. After the surgery, the patient developed complications including hydrocephalus, which resulted in 5-months long hospitalization. The presented case illustrated the need for increased clinical attention in patients threatened by radiation (including radiotherapy), focused on possible head lesions