Polycystic ovarian syndrome - management and treatment

The polycystic ovarian syndrome is an endocrine disorder with a high prevalence affecting reproductive-aged women and adolescent girls. The most common symptoms are infertility, numerous ovarian cysts, hyperandrogenism, menstrual cycle abnormalities. The disease has a great impact on patients, impairing their quality of life. Bearing that in mind, innovative therapeutic approaches are needed. We aim to describe current management and treatment concepts adopted in PCOS therapy. The analysis of previously published studies was conducted by using the PubMed, Google Scholar, and Scopus databases.Mentioned studies show that lifestyle changes may benefit PCOS therapy in multiple ways. Dietary and exercise interventions have a notable influence on women’s body composition as well as biochemical parameters. The reduction of body weight or BMI is a therapeutic achievement likewise patients’ contribution to managing PCOS. Pharmacotherapy provides plentiful treatment choices to adopt. Studies show that hormonal contraceptive has a significant impact on both hyperandrogenism and menstrual abnormalities. Metformin is proven to reduce BMI, improve LDL levels, and lower the risk of OHSS in women undergoing IVF/ICSI-ET. A meta-analysis proved metformin’s monotherapy superiority over clomifene citrate or their combination in treating infertility. However, both substances are not recommended as the first-line choice. Regrettably, many studies mention short of evidence, lack of larger sample sizes, or insufficient duration preventing further research.The conclusion we draw is that approaches of managing and treating PCOS are constantly advancing and updating. However, there is a necessity for future studies to expand their research by gathering more data and considering diverse cases

Novel immunotherapy in the management of advanced urothelial cancer - review of the literature

Bladder neoplasms, with the most common urothelial carcinoma, are responsible for approximately 200,000 deaths annually, which is 2.1% of the total cancer deaths in 2018. Recent decades have brought a steadily growing share of this cancer in the statistics. The 5-year survival rate is 77.1% for the United States and it varies depending on the stage of the diagnosed neoplasm, from 96% for cancer in situ to only 5% for the disseminated form with distant metastases. The treatment of urothelial cancer can be divided depending on the stage and advancement. Three main categories of bladder cancer can be distinguished: non-muscle invasive bladder cancer, treated by surgical approaches, and muscle-invasive bladder cancer, treated with chemotherapeutics, lastly advanced bladder cancer with distant metastases, treated with intensive chemotherapy in the MVAC scheme (methotrexate, vinblastine, doxorubicin, and cisplatin). Recently introduced checkpoint inhibitors have revolutionized the treatment of patients with metastatic urothelial carcinoma by increasing patient life expectancy, progression-free survival, and durability of clinical response. This review of the literature will discuss the use of immunotherapy in the treatment of advanced bladder cancer

Irritable bowel syndrome dietary modifications - what to forbid and what to recommend?

Irritable bowel syndrom is a gastrointestinal disorder, that affects about 10 % of worlds population. The etiology remains unclear, however studies show, that bad dietary habits may aggravate the symptoms. The most frequent signs of IBS are: abdominal pain, bloating, constipation, diarrhea and change in bowel habits. The aim of this study was to describe dietary modifications that can alleviate the symptoms and improve patients quality of life. The study material consisted of publications, that we’ve found on databases as PubMed, ResearchGate and Google Scholar. Patients find out, that certain food aggravate the symptoms. The most frequent triggering factors are: coffee, diary products, alcohol, spicy foods and lipids. Our review shows, there are some recommendations that help patients in their everyday diet change. For example drinking at least 3 cups of coffee per day can reduce bloating and diarrhea, while drinking more than 1,5 L of other fluids per day can alleviate symptoms as constipation. According to studies, following a IBS diet can minimize the signs. Moreover, recently developed  „IBS food pyramid” is based on actual recommendations and knowledge a visual and user-friendly tool helping patients in everyday diet changes.Unfortunately, still there is insufficient evidence of studies about dietary approaches. Well designed and randomized control trials are needed to improve efficacy, safety and knowledge about dietary modifications

Elemental changes in the hippocampal formation following two different formulas of ketogenic diet : an X-ray fluorescence microscopy study

The main purpose of the following study was the determination of elemental changes occurring within hippocampal formation as a result of high-fat and carbohydrate-restricted ketogenic diet (KD). To realize it, X-ray fluorescence microscopy was applied for topographic and quantitative analysis of P, S, K, Ca, Fe, Cu, Zn and Se in hippocampal formations taken from rats fed with two different KDs and naive controls. The detailed comparisons were done for sectors 1 and 3 of the Ammon’s, the dentate gyrus and hilus of dentate gyrus. The results of elemental analysis showed that the KDs induced statistically significant changes in the accumulation of P, K, Ca, Zn and Se in particular areas of hippocampal formation and these alterations strongly depended on the composition of the diets. Much greater influence on the hippocampal areal densities of examined elements was found for the KD which was characterized by a lower content of carbohydrates, higher content of fats and increased proportion of unsaturated fatty acids. The levels of P, K and Zn decreased whilst those of Ca and Se increased as a result of the treatment with the KDs

Glaucoma - the significant challenge for the healthcare system in Poland

Introduction Glaucoma is a group of optic neuropathies characterized by progressive degeneration of retinal ganglion cells (RGCs) and visual field loss. Glaucoma is the leading cause of irreversible blindness in the world. The World Health Organization classifies it as a social and civilization disease and emphasizes the need to improve ophthalmic care systems in order to meet the constantly growing challenge for public health, which is glaucoma. The aim of this article is to identify the main problems that affect the health care system of patients with glaucoma in Poland. Review methods The review of literature on glaucoma was performed using the PubMed and Google Scholar databases. The latest available epidemiological data and the current legal acts concerning the health care system of patients with glaucoma in Poland were also analyzed. Abbreviated description of the state of knowledge The incidence of glaucoma in Poland is constantly increasing, due to the aging of the population. The insidious course of the disease, low public awareness and difficulties in access effective ophthalmic services mean that the disease is diagnosed too late, when significant damage to the optic nerve has already occurred. In addition, the poor mental health of patients, treatment difficulties related to the frequent comorbidity of general diseases and the use of other drug therapies, complicate the course of glaucoma and make it difficult to inhibit its progression. Summary Glaucoma is a significant challenge for public health and the healthcare system in Poland. Therefore, it is very important to take systemic measures as soon as possible that contribute to improve public awareness of eye diseases, increase the availability of ophthalmic care, early detection and appropriate monitoring of the course of glaucoma

Epidemiologia krótkowzroczności oraz wpływ ortokeratologii na kontrolę schorzenia

Introduction and objective Myopia is a defect of vision, which makes it impossible to see remote objects clearly. The disease can also lead to serious ocular problems. Myopia affects about 30% of the world population and -according to the estimates- that percentage is about to increase up to 50% within the next 30 years. Orthokeratology is a relatively new method on non-surgical, reversible correction of myopia. Specially designed lenses, worn at night, affects the shape of the cornea, which results in proper vision during the day. Review methods The aim of the study was evaluation of effectiveness of wearing orthokeratology contact lenses based on a review of medical literature published on PubMed in the last 5 years. Abbreviated description of the state of knowledge Research results show that wearing orthokeratology lenses have beneficial effects. Reduction of axial length of the eyeball and curvature of the cornea were observed. Progression of myopia was five times slower in children study group and three times slower in adult study group compared to control groups. It was proved, that favourable health effects persist through the first eight years of treatment. Due to the fact, that cornea has a limited susceptibility, a decrease in efficiency occurs in the following years. Usually no undesirable side effects are reported, yet the possible side effects are mild and disappear after a short time. Summary According to the results of recent studies, we can assume that orthokeratology is a safe and effective method of inhibition of myopia progression. The method may be especially recommended to children, to people working in such conditions, that make wearing standard contact lenses impossible and to people not qualified for laser or surgical vision correction.Wprowadzenie i cel Krótkowzroczność (miopia) jest wadą wzroku, która uniemożliwia wyraźne widzenie przedmiotów znajdujących się w oddali. Może również prowadzić do innych chorób narządu wzroku. Chorobą tą dotknięte jest obecnie około 30% populacji światowej, a według szacunków, odsetek ten wzrośnie do 50% w ciągu najbliższych 30 lat. Ortokeratologia jest stosunkowo nową metodą niechirurgicznej, odwracalnej korekcji krótkowzroczności. Specjalnie zaprojektowane soczewki, noszone w nocy, modyfikują kształt rogówki, co pozwala na prawidłowe widzenie w ciągu dnia. Metody przeglądu Celem pracy była ocena efektywności soczewek ortokeratologicznych na podstawie przeglądu literatury medycznej opublikowanej w bazie PubMed w ciągu ostatnich 5 lat. Opis stanu wiedzy Dokonany przegląd literatury wskazuje na korzystne efekty stosowania soczewek ortokeratologicznych. Zaobserwowano redukcję długości osiowej gałki ocznej oraz zmianę krzywizny rogówki. Progresja krótkowzroczności u dzieci stosujących opisywane soczewki była pięć razy, a u dorosłych trzy razy wolniejsza niż w odpowiednich grupach kontrolnych. Wykazano, ze korzystne efekty utrzymują się przez pierwsze 8 lat leczenia. Z powodu ograniczonej podatności rogówki, w ciągu kolejnych lat dochodzi do spadku efektywności. Zazwyczaj nie obserwuje się działań niepożądanych lub są to łagodne i przemijające skutki uboczne. Podsumowanie Zgodnie z wynikami najnowszych badań można stwierdzić, ze ortokeratologia jest skuteczną i bezpieczną metodą hamowania progresji miopii. Metoda ta może być rekomendowana zwłaszcza dzieciom oraz osobom, którym warunki pracy uniemożliwiają stosowanie standardowych soczewek kontaktowych lub którzy nie kwalifikują się do zabiegu laserowej lub chirurgicznej korekcji krótkowzroczności

Analysis of the role of education and sport in the heavy burden of obesity

Obesity has become the global pandemic of the world. The epidemiological rise has only happened in recent decades. Unfortunately, the disease affects people of all ages. The most prominent characteristics of the disorder are excessive fat accumulation, body mass index exceeding the number of 30, and general lowering of the quality of life. The consequences are observed in the whole organism. The disruptions affect one’s overall homeostasis. Certain diseases are specifically associated with excessive fat mass. When not properly managed, obesity leads to chronic illnesses and severe comorbidities, the most morbid one being death. Thus, effective therapeutic approaches are needed. Focus on education and physical activity are the best way to tackle this problem. The aim of this study is to check the factors and changes necessary to lose weight in obese patients in Poland. The main question regarded the role of sport and proper education in maintaining or losing weight in the Polish society. In order to analyse the issue, an Internet survey was prepared and disseminated in March and April 2023. Over half of the respondents have ever used a diet. Over 8 out of ten of them achieved the success in the set task. When asked about physical activity, the most respondents chose option 30-60 minutes per day. The preferred type of physical activity was most commonly walking. When asked if sport enabled the respondents to lose or maintain weight – 63,5% confirmed. 72% of respondents experienced education regarding healthy lifestyle, most commonly at home. Over 60% of respondents believed they were well informed about recommended behaviours. Over 50% of them confirmed their education is sufficient to lose weight. Maintaining healthy regimes is key to a healthy life. However, not all people are properly educated how to do that. In fact, there is a tendency of overestimation of one’s education in those topics. All in all, proper experience and routines are necessary

Perinatal outcome according to chorionicity in twins — a Polish multicenter study

Objectives: The aim of the study was to analyze the perinatal outcome of twin gestations and estimate the influence of chorionicity on the outcome in a large cohort of twin pregnancies in Poland. Material and methods: A retrospective analysis of 465 twin deliveries in 6 Polish centers in 2012 was conducted. Baseline characteristics, the course of pregnancy and labor, as well as the neonatal outcome were analyzed in the study group and according to chorionicity. Results: A total of 356 twin pregnancies were dichorionic (DC group) (76.6%), and 109 were monochorionic (MC group) (23.4%). There were no differences in the occurrence of pregnancy complications according to chorionicity, except for IUGR of at least one fetus (MC 43.1% vs. DC 34.6%; p = 0.003). 66.5% of the women delivered preterm, significantly more in the MC group (78% vs. 62.9%; p = 0.004). Cesarean delivery was performed in 432 patients (92.9%). Mean neonatal birthweight was statistically lower in the MC group (2074 g vs. 2370 g; p < 0.001). Perinatal mortality of at least one twin was 4.3% (2.8% in the DC group vs. 9.2% in the MC group; p = 0.004). Neonatal complications, including NICU admission, respiratory disorders, and infections requiring antibiotic therapy, were significantly more often observed among the MC twins. Conclusions: The overall perinatal outcome in the presented subpopulation of Polish twins and its dependence on cho­rionicity is similar to the reports in the literature. Nevertheless, the rates of preterm and cesarean deliveries remain higher. It seems that proper counselling of pregnant women and education of obstetricians may result in reduction of these rates