Imported parasitosis as a diagnostic challenge in Primary Healthcare Clinic in the non-endemic region — a case study of schistosomiasis in English Division student

Schistosomiasis is a parasitosis, most commonly caused by Schistosoma mansoni or Schistosoma haematobium, eventually by other species from the genus Schistosoma (blood flukes). This study presents a case of schistosomiasis in an African-origin student cured in the Primary Healthcare Clinic (PHC) in Lublin, Poland. The young adult male patient from Zimbabwe, studying in Poland, presented to the PHC, due to pain in the left down quadrant of the abdomen, bloody stools, and a single episode of drooling with a blood-stained jelly-like mass, without fever. In blood tests, there was neutropenia, lymphocytosis and eosinophilia. In a colonoscopy, numerous lymphoid nodules were observed with small regions of mucosal erythema, faded vascular drawing, and delayed small contact bleeding. The patient had an elevated level of IgE (329,5 IU/mL; N < 158) and minor abnormalities in the proteinogram. Abdominal CT showed calcification of intestinal walls, suggesting infection of flukes from the Schistosoma genus. The result of histopathological examination confirmed the presence of structures interpreted as parasite eggs in intestinal crypts, lamina propria and the lumen of mesenteric vessels. It is of great importance, that general medicine physicians working in schistosomiasis non-endemic regions are aware and pay attention to various risks as well as provide referrals to advanced imaging and endoscopic procedures in patients with unusual health problems. Keeping in mind, that early signs and symptoms of schistosomiasis, and results of blood tests may remain unspecific in contrast to a more complex gastrointestinal diagnostic approach, a chance of early diagnosis and successful therapeutic intervention may be facilitated

Proton pump inhibitor (PPI) administration and Clostridioides difficile infection - is this a real clinical problem? A critical review of the literature

Background: Proton pump inhibitors (PPIs) are widely used drugs that reduce gastric acid secretion. In recent years, there has been a gradual increase in their use. The safety of prolonged PPI therapy and the potential for cumulative side effects of these drugs raise legitimate concerns. An association between PPI administration and the risk of Clostridioides difficile infection has been suggested. The findings regarding this phenomenon require further unequivocal verification. Material and methods: A review of publications obtained from the PubMed database and published between 2016-2023. Based on the keywords "proton pump inhibitor", "PPI" and "Clostridium", 132 articles were selected. Finally, 6 meta-analyses were included in the analysis. Results: Studies conducted in recent years have shown a statistically significant increase in the risk of C. difficile infection in patients taking PPIs compared to those who avoid this therapy. The aforementioned relationship was observed in both adults and pediatric patients. One study proved that the risk remained high even up to 1 year after the end of treatment. The described relationship is still a matter of debate due to the fact that patients using antacids are usually elderly, have several comorbidities and a higher risk of developing C. difficile infection regardless of PPI use. Conclusions: The relationship between the use of PPIs and the risk of developing C. difficile infection is still controversial, which justifies the need for continued clinical trials to objectively resolve this issue. PPIs exert high efficacy in the treatment of acid-dependent diseases, but due to the many ambiguities surrounding possible side effects, caution in their administration seems warranted, especially for long-term therapy in elderly patients with polypharmacy

The role of probiotics in the treatment of depressive disorders. A critical review

Depressive disorders are a widespread problem in modern medicine. According to current data from the World Health Organisation, an estimated 280 million people worldwide suffer from depression. In recent years, there have been reports of a correlation between the composition of the gut microbiota and the development of depressive disorders and attempts to modify it through the use of psychobiotics. The literature from the PubMed database published between 2018-2023 has been explored. 596 articles were selected based on the keywords "probiotics" and "depression". Six randomized clinical trials were finally included in the analysis. As defined elsewhere, psychobiotics are probiotic bacteria which supplemented in adequate amounts, interact with the gut-brain axis and show beneficial effects on patients' mental health. Results from recent RCTs suggest that daily probiotic supplementation significantly reduces the severity of depression compared to placebo (p<0.05). Additionally, this effect may be enhanced by the combined use of a probiotic with a prebiotic. Furthermore, some researchers indicate that probiotics may lead to significant improvements in cognitive function in patients suffering from depressive disorders. In conclusion, intestinal dysbiosis may be an important factor leading to the development of mental illness. Results of recent studies suggest that specific strains of probiotic bacteria may offer therapeutic benefits in the treatment of the aforementioned disorders. However, further clinical studies are needed to objectively confirm the relationship between gut microbiota composition and the development of depression

The role of probiotics in the treatment of depressive disorders. A critical review

Depressive disorders are a widespread problem in modern medicine. According to current data from the World Health Organisation, an estimated 280 million people worldwide suffer from depression. In recent years, there have been reports of a correlation between the composition of the gut microbiota and the development of depressive disorders and attempts to modify it through the use of psychobiotics. The literature from the PubMed database published between 2018-2023 has been explored. 596 articles were selected based on the keywords "probiotics" and "depression". Six randomized clinical trials were finally included in the analysis. As defined elsewhere, psychobiotics are probiotic bacteria which supplemented in adequate amounts, interact with the gut-brain axis and show beneficial effects on patients' mental health. Results from recent RCTs suggest that daily probiotic supplementation significantly reduces the severity of depression compared to placebo (p<0.05). Additionally, this effect may be enhanced by the combined use of a probiotic with a prebiotic. Furthermore, some researchers indicate that probiotics may lead to significant improvements in cognitive function in patients suffering from depressive disorders. In conclusion, intestinal dysbiosis may be an important factor leading to the development of mental illness. Results of recent studies suggest that specific strains of probiotic bacteria may offer therapeutic benefits in the treatment of the aforementioned disorders. However, further clinical studies are needed to objectively confirm the relationship between gut microbiota composition and the development of depression

Impact of Obesity on the Course of Management of Inflammatory Bowel Disease&mdash;A Review

It is already well-known that visceral adipose tissue is inseparably related to the pathogenesis, activity, and general outcome of inflammatory bowel disease (IBD). We are getting closer and closer to the molecular background of this loop, finding certain relationships between activated mesenteric tissue and inflammation within the lumen of the gastrointestinal tract. Recently, relatively new data have been uncovered, indicating a direct impact of body fat on the pattern of pharmacological treatment in the course of IBD. On the other hand, ileal and colonic types of Crohn&rsquo;s disease and ulcerative colitis appear to be more diversified than it was thought in the past. However, the question arises whether at this stage we are able to translate this knowledge into the practical management of IBD patients or we are still exploring the scientific background of this pathology, having no specific tools to be used directly in patients. Our review explores IBD in the context of obesity and associated disorders, focusing on adipokines, creeping fat, and possible relationships between these disorders and the treatment of IBD patients

Nie tylko alkoholowa choroba wątroby — alternatywne zastosowania wskaźnika de Ritisa w świetle najnowszych badań

The de Ritis index is the result obtained by dividing the value of aspartate transaminase (AST) by the value of alanine transaminase (ALT). Its main application in clinical practice is to determine the etiology and severity of liver diseases. Th e aim of the review is to analyze the existing studies on the potential applications of the de Ritis index, including those not related to the differentiation of the etiology of liver diseases. In order to analyze the available publications on the subject of this issue, two basic literature databases were used — PubMed and GoogleScholar. Two keywords were used to search the database: „de Ritis ratio” and „de Ritis index”. The literature describes the use of the de Ritis index as a pro gnostic factor for many disease states. The strongest evidence (systematized in metaanalyses) was presented for urological cancers and COVID -19 infections. Weaker evidence, usually based on retrospective studies, applies to many diseases in the fields of cardiology, nephrology, oncology, infectious diseases, emergency medicine and toxicology. The multitude of diseases and clinical conditions in which the importance of the de Ritis index as a prognostic factor is confirmed (most strongly for urological cancers and COVID-19 infections) may emphasize the importance of the liver and its biochemical changes for human well-being. From the cited studies, a picture emerges of the de Ritis index as a universal prognostic marker, summarizing the disease status of a given patient. Nevertheless, these correlations, for the majority of disease states, have been confirmed in single or few retrospective studies — require confirmation in prospective multicentre studies, including meta-analyses.Wskaźnikiem de Ritisa nazywa się wynik uzyskany z dzielenia (ilo raz) wartości transaminazy asparaginianowej (AspAT) przez wartość transaminazy alaninowej (ALT). Jego głównym zastosowaniem w praktyce klinicznej jest określanie etiologii i zaawansowania chorób wątroby. Celem przeglądu jest analiza dotychczasowych badań dotyczących potencjalnych zastosowań wskaźnika de Ritisa, w tym niezwiązanych z różnicowaniem etiologii chorób wątroby. W celu analizy dostępnych publikacji dotyczących tematyki tego zagadnienia, skorzystano z dwóch podstawowych baz piśmiennictwa — PubMed oraz GoogleScho lar. Do pr zeszukania bazy danych zastosowano 2 słowa kliczowe: de Ritis ratio oraz de Ritis index. W literaturze przedmiotu opisano zastosowanie wskaźnika de Ritisa jako czynnika rokowniczego dla wielu stanów chorobowych. Najsilniejsze dowody (usystematyzowane w metaanalizach) przedstawiono dla nowotworów urologicznych i infekcji COVID-19. Słabsze dowody, zazwyczaj oparte na badaniach retrospektywnych, dotyczą wielu chorób z takich dziedzin jak kardiologia, nefrologia, onkologia, choroby zakaźne, medycyna ratunkowa i toksykologia. Mnogość chorób i stanów klinicznych, w któr ych znaczenie wskaźnika de Ritisa jako czynnika prognostycznego jest potwierdzone (najsilniej dla nowotworów urologicznych oraz infekcji COVID-19), może podkreślać znaczenie wątroby i jej przemian biochemicznych dla dobrostanu człowieka. Z przytoczonych badań wyłania się obraz wskaźnika de Ritisa jako uniwersalnego markera rokowniczego, podsumowującego status chorobowy danego pacjenta. Tym niemniej, korelacje te dla większości stanów chorobowych uzyskane zostały w pojedynczych lub nielicznych badaniach retrospektywnych — wymagają więc potwierdzenia w prospektywnych badaniach wieloośrodkowych, w tym metaanalizach

New view on alcoholic liver disease - potential role of PD1/PDL-1 pathway in the disease pathogenesis

Introduction: Exposure to chronic, excessive alcohol consumption, its breakdown metabolites, and gut-derived endotoxins dysregulate immune signaling leading to activation of inflammation. As a result, the non-resolving inflammatory response and development of alcoholic liver disease (ALD) may occur. There are still no pharmacological or nutritional therapies for treating patients with alcoholic liver disease. Material and Methods: The information provided was collected as a result of various article’s analyses on the development, diagnosis, and treatment of patients with alcoholic liver disease using Google Scholar and PubMed databases. Results: The pathway consisting of the programmed cell death 1 (PD-1) receptor and its ligand PD-L1 may play a critical role in the inhibition of self-reactive and inflammatory effector cells and the protection against immune-mediated tissue damage. There is a possibility of the potential gender-related differences in PD1/PD-L1 signaling in ALD. Conclusion: The better understanding of ALD as a dynamic process and all aspects of immune dysregulation may be important for the development of novel therapies in alcoholic liver disease. Results from a further study on the PD1/PDL-1 pathway might be exploited to re-define therapeutic targets and create sex-tailored treatments according to individual patient needs

Human Neutrophil Alpha-Defensins Promote NETosis and Liver Injury in Alcohol-Related Liver Cirrhosis: Potential Therapeutic Agents

Background: Neutrophils are thought to play a pivotal role in the pathogenesis of many inflammatory diseases, such as hepatitis, liver cirrhosis, etc. Activated human neutrophils release human neutrophil peptides (HNP1-3) or alpha-defensins that are antimicrobial peptides in azurophil granules. Furthermore, HNP1-3 build a scaffold of neutrophil extracellular traps (NETs) and promote the process of programmed cell death called NETosis. Our study aimed to investigate the role of alpha-defensins in the pathogenesis of alcohol-related liver cirrhosis (ALC). Methods: The concentrations of alpha-defensins in the plasma of 62 patients with ALC and 24 healthy subjects were measured by ELISA. The patients with ALC were prospectively recruited based on the severity of liver dysfunction according to the Child-Pugh and Model of End-Stage Liver Disease-Natrium (MELD-Na) scores, modified Maddrey’s Discriminant Function (mDF), and the presence of ALC complications. Results: The concentrations of alpha-defensins in plasma were significantly higher in the ALC patients than in the controls. The plasma levels of HNP1-3 correlated with the MELD and mDF scores. ALC subgroups with MELD > 20 and mDF > 32 displayed significantly higher HNP1-3 concentrations. The plasma levels of HNP1-3 revealed a good predictive AUC for hepatic encephalopathy and ascites development (0.81 and 0.74, respectively) and for patient survival (0.87) in those over 40 years of age. Conclusion: These findings suggest that alpha-defensins play an important role in the assessment of ALC

Results of screening in Lublin Province, Poland, for colorectal cancer and neoplastic polyps - the role of environmental factors

Introduction Screening colonoscopy is a recommended tool, and the most sensitive and cost-effective method for reducing the incidence of colorectal cancer (CRC). Objective The purpose of the study was to present the results of a 5-year screening for early detection of CRC carried out among the population of the central-eastern regions of Poland, primarily in Lublin Province. Material and Methods Screening colonoscopy was conducted in a group of 1,009 patients – 636 women and 373 men, aged 40–65 years. Results Neoplastic polyps were found in 275 patients, advanced adenomas in 49 patients and adenocarcinoma in 13. 70.55% of neoplastic polyps was located in the distal colon, 18.9% in the proximal part and 10.55% in both regions, advanced adenomas in 79.59%, 8.16% and 12.25%, respectively. Adenocarcinoma was located in the proximal colon in 2 cases and in the distal region in 11 cases. Neoplastic polyps and advanced adenomas occurred significantly more frequently in smokers than in non-smokers. Neoplastic polyps were found statistically more frequent in males than in females, among the overweight and obese patients, than in subjects with normal BMI, and more frequently in the group of urban, compared to rural patients. However, the frequency of advanced adenomas and CRC was not statistically different in those groups. The incidence of CRC was statistically more frequent in males than in females. Smoking and male gender were significant risk factors for developing neoplastic polyps. Male gender seemed to predispose to CRC. Obesity was found to favour advanced adenomas. Conclusions The results of screening found neoplastic polyps in every third person (mean) who did not have any symptoms suggestive of colon pathology. Advanced adenomas were found in 5% of the examined and CRC was detected in 1.29% of participants. Smoking, male gender and overweight were significant risk factors for developing neoplastic polyps. No correlation was found between gender and the location of neoplastic polyps and advanced adenomas in the colon

Results of screening in Lublin Province, Poland, for colorectal cancer and neoplastic polyps - the role of environmental factors

Introduction Screening colonoscopy is a recommended tool, and the most sensitive and cost-effective method for reducing the incidence of colorectal cancer (CRC). Objective The purpose of the study was to present the results of a 5-year screening for early detection of CRC carried out among the population of the central-eastern regions of Poland, primarily in Lublin Province. Material and Methods Screening colonoscopy was conducted in a group of 1,009 patients – 636 women and 373 men, aged 40–65 years. Results Neoplastic polyps were found in 275 patients, advanced adenomas in 49 patients and adenocarcinoma in 13. 70.55% of neoplastic polyps was located in the distal colon, 18.9% in the proximal part and 10.55% in both regions, advanced adenomas in 79.59%, 8.16% and 12.25%, respectively. Adenocarcinoma was located in the proximal colon in 2 cases and in the distal region in 11 cases. Neoplastic polyps and advanced adenomas occurred significantly more frequently in smokers than in non-smokers. Neoplastic polyps were found statistically more frequent in males than in females, among the overweight and obese patients, than in subjects with normal BMI, and more frequently in the group of urban, compared to rural patients. However, the frequency of advanced adenomas and CRC was not statistically different in those groups. The incidence of CRC was statistically more frequent in males than in females. Smoking and male gender were significant risk factors for developing neoplastic polyps. Male gender seemed to predispose to CRC. Obesity was found to favour advanced adenomas. Conclusions The results of screening found neoplastic polyps in every third person (mean) who did not have any symptoms suggestive of colon pathology. Advanced adenomas were found in 5% of the examined and CRC was detected in 1.29% of participants. Smoking, male gender and overweight were significant risk factors for developing neoplastic polyps. No correlation was found between gender and the location of neoplastic polyps and advanced adenomas in the colon