Analysis of the causes of vitamin B12 deficiency in different age groups - a review of the literature

Introduction and purpose  Vitamin B12 plays an important role in the process of erythropoiesis and the proper functioning of the nervous system. Its source for humans is food, in particular meat, eggs and shellfish. Cobalamin deficiency is a common problem among both geriatric and younger patients. The aim of this review is to analyze the causes of the deficit, to compare its incidence in different age groups and to try to explain potential differences between the groups. A brief description of the state knowledge Cobalamin deficiency can result from many different reasons, such as Addison-Biermer disease, damage to the ileum, use of metformin or proton pump inhibitors, insufficient supply in the diet, and less often genetic disorders. The deficiency phenomenon is more common in the elderly compared to other age groups, especially male patients with multiple comorbidities or in long-term care facilities. On the other hand, among younger people, a higher incidence is observed in the case of high body weight or height. Summary Vitamin B12 deficiency is a common clinical problem, especially among geriatric patients. Most often, cobalamin deficiency may result from reasons related to its improper absorption or deficiency in the diet, while the factors contributing to the deficiency vary depending on the age group. Elderly patients, especially those with additional risk factors, should be carefully monitored for vitamin B12 deficiency

New treatment strategies for bipolar disorder in the elderly

Introduction and objective: The purpose of this paper is to systematically review articles and new research in the context of bipolar geriatric patients. Materials and methods: PubMed searches were completed using the key terms bipolar disorder, bipolar elderly, bipolar depression, bipolar elderly treatment and review articles. In addition, references in these resources were searched. Search dates: 2010 to 2022. Description of the state of knowledge: Mental disorders in the context of the elderly concern all depressive disorders. A problem with other disorders such as bipolar disorder is also increasingly recognized. In the elderly, it is quite rare in the general cross-section of society, but it may have a higher percentage, e.g. in nursing homes and care institutions. This review article shows both the difference and the similarities in the course of this disease in older and younger patients. The most important and common aspect for both age groups is psychotherapy with parallel pharmacological treatment. The greatest difficulty in pharmacotherapy in the elderly is polypharmacy and numerous drug interactions, as well as different pharmacodynamics and pharmacokinetics of the drugs used compared to younger patients. Attention should also be paid to the differentiation of bipolar disorder from different types of dementia and other cognitive disorders. Therefore, one should strive to carefully assess the patient's need for a given treatment, establish appropriate periodic monitoring of treatment, and assess the risk of taking or not intervening. This article also aims to review new research and drugs that seem promising, while the individualized and interdisciplinary approach to a geriatric patient with BD is the most important finding of this review. Summary: Bipolar disorder in older people, compared to the younger population, should be treated pharmacologically in combination with psychotherapy. The elderly patient population requires a multidisciplinary approach due to the number of drugs used in a large number of diseases

Effectiveness of physiotherapeutic techniques in urinary incontinence: a review of the literature

Introduction and purpose : Urinary incontinence is a common condition characterized by involuntary urine leakage from urethra. It particularly affects elderly women and is a serious medical, social and economic problem. As a result of recently observed population ageing, the incidence of this anomaly is expected to rise. Due to multifactorial etiology, several types of incontinence are distinguished. Proper diagnostic procedures lead to diagnosis confirmation and allow appropriate therapeutic intervention. Both conservative and surgical methods are used in management of urine incontinence. In addition to pharmacological therapy, physiotherapeutic methods have an important meaning in conservative approach. The aim of this article is a review presenting the results of recent studies on the effectiveness of physiotherapy procedures in treatment of various types of urine incontinence. Description of the state of knowledge: In the study 33 articles which published physiotherapy techniques in 2004-2021 regarding the role of physiotherapeutic methods in the treatment of urinary incontinence were analyzed. The results of studies assessing the effectiveness of physiotherapy techniques (acupuncture, behavioral therapy, yoga, magnetic stimulation, pelvic floor muscle training, vaginal cones, vibration therapy, kinesiotheraphy techniques, stimulation) in reducing the severity of urinary incontinence symptoms and improving the quality of patients’ life were presented on the basis of analyzed literature. Conclusions: Physiotherapy is an effective method of treatment of urinary incontinence and it supports other types of therapy. Therapy should be interdisciplinary approached and the choice of physiotherapeutic methods should be dependent on the individual needs of the patient

The problem of anemia in elderly patients

Introduction and purpose:  As healthcare develops, life expectancy increases. This makes anemia of the elderly an increasingly common problem. The appearance of this disease is influenced by many factors related to the aging process of the organism. The purpose of this study is to review information about the different mechanisms of anemia development in the elderly and to present the associated difficulties in medical practice. Description of the state of knowledge: Many different factors can affect the process of anemia. The causes of this disorder include chronic inflammatory diseases, cancer and nutritional deficiencies. Endocrine status is also important. The chronic inflammatory process may induce haemolysis and lead to the increased synthesis of hepcidin, which by blocking the activity of ferroportin leads to a decrease in the level of iron ions in the blood. Deficiency anemia often results from reduced appetite, inadequate quality of meals, chronic inflammation or taking medications without consulting a doctor. The consequence is a reduced level of iron and vitamin B12 and folic acid, which play a role in erythropoiesis. The hormones that play a significant role in the process of making red blood cells include erythropoietin, testosterone and thyroid hormones. Summary:  Anemia is a common problem among geriatric patients and one of the factors contributing to the increase in mortality in this age group. In medical care it is difficult to distinguish which symptoms are pathological and which are related to the natural aging process, overlapping symptoms of many diseases and related diagnostic problems. Diagnostics is a particular challenge due to the multi-morbidity, which is associated with taking many drugs with different mechanisms of action and side effects.  Keywords: anemia; aging; comorbidity; nutrient-deficiency anemia; inflammatio

Pharmacotherapy of depression in palliative patients

Introduction: Depression often affects people suffering from serious illnesses, including oncological and palliative patients. It reduces their quality of life and worsens their prognosis. This is why it is so important to properly treat depression in palliative patients. Material and Methods: The information provided was collected as a result of analysis of various articles and textbooks on development, diagnosis and treatment, as well as prevention of depression in terminally ill patients using Google Scholar and PubMed databases. Results: The results show that the most common drug in therapy for palliative patients with depression are the sluggish serotonin reuptake inhibitors (SSRIs). SSRIs inhibit serotonin transporter reducing serotonin reuptake. This raises the level of neurotransmitter - serotonin - in the synaptic cleft. They are well tolerated and have fewer side effects than older antidepressants (tricyclic antidepressants and monoamine oxidase inhibitors). Tricyclic antidepressants may relieve neuropathic pain and they are also beneficial for patients with insomnia. Mirtazapine in addition to antidepressant effects also causes increasing appetite, reducing nausea and sedative effect. In cancer-diagnosed patients particular attention should be paid to side effects such as nausea and vomiting that may occur in patients undergoing radiotherapy and chemotherapy using SSRIs or TCAs. SSRI therapy have a good safety profile and also interacts less frequently, while atypical antipsychotics may reduce the discomforts of taking chemotherapy. An alternative method of treating depression is the use of psychostimulants such as methylphenidate. Another way to treat depression is psychotherapy. Conclusions: There are several options for treating depression in palliative patients. It is important to pay attention to the side effects of prescribed medicines. Nevertheless, the best results are obtained by combining pharmacotherapy with psychotherapy

Rational Mitomycin Nanocarriers Based on Hydrophobically Functionalized Polyelectrolytes and Poly(lactide-co-glycolide)

[Image: see text] Encapsulation of hydrophilic and amphiphilic drugs in appropriate colloidal carrier systems for sustained release is an emerging problem. In general, hydrophobic bioactive substances tend to accumulate in water-immiscible polymeric domains, and the release process is controlled by their low aqueous solubility and limited diffusion from the nanocarrier matrix. Conversely, hydrophilic/amphiphilic drugs are typically water-soluble and insoluble in numerous polymers. Therefore, a core–shell approach—nanocarriers comprising an internal core and external shell microenvironments of different properties—can be exploited for hydrophilic/amphiphilic drugs. To produce colloidally stable poly(lactic-co-glycolic) (PLGA) nanoparticles for mitomycin C (MMC) delivery and controlled release, a unique class of amphiphilic polymers—hydrophobically functionalized polyelectrolytes—were utilized as shell-forming materials, comprising both stabilization via electrostatic repulsive forces and anchoring to the core via hydrophobic interactions. Undoubtedly, the use of these polymeric building blocks for the core–shell approach contributes to the enhancement of the payload chemical stability and sustained release profiles. The studied nanoparticles were prepared via nanoprecipitation of the PLGA polymer and were dissolved in acetone as a good solvent and in an aqueous solution containing hydrophobically functionalized poly(4-styrenesulfonic-co-maleic acid) and poly(acrylic acid) of differing hydrophilic–lipophilic balance values. The type of the hydrophobically functionalized polyelectrolyte (HF-PE) was crucial for the chemical stability of the payload—derivatives of poly(acrylic acid) were found to cause very rapid degradation (hydrolysis) of MMC, in contrast to poly(4-styrenesulfonic-co-maleic acid). The present contribution allowed us to gain crucial information about novel colloidal nanocarrier systems for MMC delivery, especially in the fields of optimal HF-PE concentrations, appropriate core and shell building materials, and the colloidal and chemical stability of the system

Abnormal muscle tension as one of the main problems after a stroke

Background: Stroke is a growing problem in an aging society. According to WHO data, it is the second most common cause of death. An increase in the number of strokes causes an increase in the number of patients struggling with its consequences. People who have suffered a stroke are dealing with various neurological defects. One of them is abnormal muscle tension. Material and methods: Analysis of available literature, articles in the Google Scholar and PubMed database using keywords: stroke, muscle tension, spasticity. Results: The problem of disturbed tension is common in people who have had a stroke. Spasticity, i.e. increased muscle tone in response to stretching, results from damage to the central nervous system. Direct and indirect methods are used to assess spasticity. In the fight against destroyed muscle tension, it is important to implement treatment as soon as possible. It is based on the use of various forms of therapy: pharmacotherapy and physiotherapy. Physiotherapy and kinesitherapy treatments as well as specialized rehabilitation methods, such as PNF. The rehabilitation process should be supplemented with appropriate pharmacological treatment. Equally important is the implementation of stroke prevention. These activities are associated with the promotion of a healthy lifestyle, for example, regular exercise and stress reduction. Conclusion: Muscle tension disorder, including spasticity, is a problem affecting many patients who have had a stroke. A timely diagnosis is important to get the right therapy. Treatment should have a holistic dimension and combine different methods. The goal of therapy is to normalize muscle tone and thus improve the patient's quality of life

Media jako przestrzeń komunikacji wiary i kultury w nauczaniu Jana Pawła II. Szkic do problemu

Media as a space for communication of faith and culture in the teaching of John Paul II. Sketch for the problem. Culture is reality suitable only for man. The means of social communication which to a large extent create culture and pass it, serve the human being and the whole society. They are a kind of a bridge between culture and faith; they broaden and explore religious knowledge, inspire and serve as an evangelization tool. The Pope John Paul II draws attention how important in culture is religious content, which gives a full picture of man as a psychophysical one, unity of soul and body and its calling to love.Media jako przestrzeń komunikacji wiary i kultury w nauczaniu Jana Pawła II. Szkic do problemu. Kultura jest rzeczywistością właściwą tylko człowiekowi. Środki społecznego przekazu, które w dużej mierze tworzą kulturę i ją przekazują, służą osobie ludzkiej i całemu społeczeństwu. Stanowią swoisty pomost między kulturą a wiarą; poszerzają i zgłębiają wiedzę religijną, inspirują, intrygują i służą jako narzędzie ewangelizacji. Jan Paweł II zwraca uwagę na to, jak ważne w kulturze są treści religijne, które oddają pełny obraz człowieka jako jedności psychofizycznej, jedności duszy i ciała, i jego powołania do miłości

Media as a space for communication of faith and culture in the teaching of John Paul II. Sketch for the problem

Media jako przestrzeń komunikacji wiary i kultury w nauczaniu Jana Pawła II. Szkic do problemu. Kultura jest rzeczywistością właściwą tylko człowiekowi. Środki społecznego przekazu, które w dużej mierze tworzą kulturę i ją przekazują, służą osobie ludzkiej i całemu społeczeństwu. Stanowią swoisty pomost między kulturą a wiarą; poszerzają i zgłębiają wiedzę religijną, inspirują, intrygują i służą jako narzędzie ewangelizacji. Jan Paweł II zwraca uwagę na to, jak ważne w kulturze są treści religijne, które oddają pełny obraz człowieka jako jedności psychofizycznej, jedności duszy i ciała, i jego powołania do miłości.Media as a space for communication of faith and culture in the teaching of John Paul II. Sketch for the problem. Culture is reality suitable only for man. The means of social communication which to a large extent create culture and pass it, serve the human being and the whole society. They are a kind of a bridge between culture and faith; they broaden and explore religious knowledge, inspire and serve as an evangelization tool. The Pope John Paul II draws attention how important in culture is religious content, which gives a full picture of man as a psychophysical one, unity of soul and body and its calling to love

An outline of the development and operation of Germany's integration policy towards immigrants with particular emphasis on Polish immigration

Integration policy of the Federal Republic of Germany has evolved considerably over the last several years. The paper presents an outline of German integration policy towards immigrants, the analysis of the reforms taking place between 1998 and 2005 and attempt to determine the situation of Polish immigrants in Germany.Since coming to power by a coalition of German Social Democratic Party and the Alliance 90 / the Greens in 1998 started a groundbreaking stage for Germany's integration policy towards immigrants.Under the influence of increasing problems with the newcomers politicians of Germany were forced to identify their homeland as a country of immigration.Only a conservative, opposed to immigration, the Christian Democrats was still trying to fight off the recognition the actual situation.The increasing demographic and economic problems have forced the Christian Democrats to consider the existing circumstances and the debate on changing the paradigm in action against the foreigners.Situation of Poles (the people with Polish origin) in Germany is described in the research for compliance fact situation with the provisions of the "Treaty between Poland and the Federal Republic of Germany on good neighborhood and friendly cooperation" from the 17th June 1991.The author has made every effort to make the most objective perspective on this subjectPolityka integracyjna Republiki Federalnej Niemiec ewoluowała znacznie w ciągu ostatnich kilkunastu lat. Praca zawiera zarys działania polityki integracyjnej Niemiec wobec imigrantów, analizę reform mających miejsce między rokiem 1998 a 2005 oraz próbę określenia sytuacji polskich imigrantów w Niemczech.Od momentu objęcia władzy przez koalicję Socjaldemokratycznej Partii Niemiec oraz Sojuszu 90/ Zielonych w 1998 roku rozpoczął się etap przełomowy dla polityki integracyjnej RFN wobec imigrantów. Pod wpływem wzrastających problemów z przybyszami środowisko polityczne Niemiec zmuszone zostały do określenia swej ojczyzny mianem kraju imigracyjnego.Jedynie konserwatywna, przeciwna imigracji, chadecja wciąż próbowała odeprzeć stwierdzenie faktycznej sytuacji. Wzrastające problemy demograficzne i ekonomiczne zmusiły CDU/ CSU do uznania istniejących okoliczności oraz udziału w debacie nad zmianą paradygmatu w działaniach wobec cudzoziemców. Sytuacja osób pochodzenia polskiego w RFN opisana jest w pracy pod kątem zgodności stanu faktycznego z postanowieniami "Traktatu między Rzeczpospolitą a Republiką Federalną Niemiec o dobrym sąsiedztwie i przyjaznej współpracy" z 17.czerwca 1991 roku. Autor dokonał wszelki starań dokonania jak najbardziej obiektywnego ujęcia tego tematu