The impact of quantitative and semi-quantitative culture of respiratory tract secretions on clinical decisions in a patient with suspected pneumonia – case study

Pneumonia is one of the most common disease entities treated in the Intensive Care Unit. The standard diagnostic procedure for patients with suspected pneumonia is to evaluate the presence of symptoms of infection, physical examination, imaging, laboratory and microbiological tests, arterial blood gasometry and culture of respiratory tract secretions. In many Intensive Care Units, the preferred method of collecting material from the lower respiratory tract is an endotracheal aspirate. However, its semi-quantitative culture does not distinguish respiratory tract colonization from infection. Samples obtained by bronchoscopy are believed to be more representative of the presence of true pathogens in the lungs. An 87-year-old patient with myasthenia gravis was admitted to the Intensive Care Unit for suspected pneumonia. Laboratory tests showed elevated inflammatory markers and a chest X-ray showed interstitial densities in the left lower lobe. The result of semi-quantitative culture of tracheal aspirate was heavy growth of Staphylococcus aureus and heavy growth of Pseudomonas aeruginosa. The result of the quantitative BAL culture was S.aureus MSSA 105 colony-forming unit (CFU) per ml, Pseudomonas aeruginosa 102 CFU/ml. To consider a microorganism responsible for infection, the number of bacteria cells must exceed a designated threshold. For BAL it is ≥104 CFU/ml, for TA it is ≥106 CFU/ml, for PSB it is ≥ 103/ml. In this case, the cutoff point for identifying the pathogen responsible for the infection was reached only by Staphylococcus aureus (105 CFU/ml), not by Pseudomonas aeruginosa (102 CFU/ml). The final diagnosis was left-sided PN1 pneumonia of S.aureus etiology. A cloxacillin was used for the treatment. Clinical improvement was achieved. The described case proves the advantage of quantitative culture over semi-quantitative culture of respiratory tract secretions. The advantage of bronchoalveolar lavage over tracheal aspirate is also noticeable

Management of wet AMD in an elderly patient - case report

Introduction: Age-related macular degeneration (AMD) is the most common cause of central vision loss in elderly people over 50 years of age. It is characterized by the presence of drusen on the fundus and may be associated with choroidal neovascularization (CNV) or geographic atrophy. AMD is a condition caused by many factors including environmental, genetic, and vascular. Currently, it affects over 25 million people worldwide, but with the progressive aging of the population, the incidence of the disease is increasing. Disease is therefore an important issue in geriatrics.Case report: A 75-year-old patient was referred to the General and Pediatric Ophthalmology Clinic of the Medical University of Lublin due to the three-week deterioration of visual acuity in the left eye. The visual acuity of the left eye was: counting fingers at a distance of 1.5 m. Initial cataracts of this eye and wet AMD were diagnosed. In July 2018. an injection of ranibizumab was administered into the vitreous humor of the left eye. After achieving an improvement in visual acuity to 0.2 (on Snellen charts), in September the patient was qualified to the Drug Program for the treatment of the wet form of AMD. From September to October 2019. the patient received 9 doses of ranibizumab. In October 2019. visual acuity improved to 0.4. In November, due to the unsatisfactory results of the therapy, the drug was changed to aflibercept. The patient received a total of 3 injections of this drug and his visual acuity improved to a value of 0.7. The last injection was given in July 2020 and the clinical condition and visual acuity stabilized. After the end of the drug program, the patient regularly shows up for checkups, and the visual acuity of the left eye has normalized since July 2020. and is now 0.4 (due in part to atrophic changes and scarring).Conclusions: Treatment of the wet form of AMD is a difficult and lengthy process. Early diagnosis of the disease, starting treatment as soon as possible, regular checkups and cooperation with the patient are very important for the success of the therapy. During 3 years of treatment, the patient experienced a significant improvement in visual acuity for one year. The treatment allowed the disease progression to slow down. The morphological condition of the retina improved. The applied treatment and management of the elderly patient turned out to be effective, and the achieved effects of the therapy are satisfactory

Maximizing the efficiency of resistance training

Introduction and objective: Resistance training is the main intervention that can develop an individual’s strength and muscle mass. When executed regularly, it provides significant health benefits. The aim of this study is to analyze the current level of knowledge on maximizing the efficiency of resistance training in the context of muscle hypertrophy and increase in muscle strength. Materials and methods: PubMed and Google Scholar databases were searched. The criteria for qualifying the article for the review were the following keywords: hypertrophy, resistance training, muscle strength, and efficiency. 10 articles from 2017 to 2022 were analyzed. Description of the state of knowledge: To optimize the way of performing RT, its assumptions should be individually adapted to the exercising person.  In the conventional model of muscle hypertrophy, three main factors are distinguished: muscle tension, metabolic stress, and muscle damage. Maintaining greater mechanical muscle tension during training primarily promotes an increase in its strength while increasing metabolic stress is responsible for the intensification of hypertrophy. In terms of hypertrophy, it has been observed that more series of exercises per week means greater gains in muscle mass. Multi-joint exercises involve more muscle mass than single-joint exercises. Summary: To control the effectiveness of training 1RM should be measured before and after the training cycle. Performing exercises with a high load (RM ≤7) may be the most effective training method for people with limited time resources. To maximize the efficiency of training, only multi-joint exercises may be used.Introduction and objective: Resistance training is the main intervention that can develop an individual’s strength and muscle mass. When executed regularly, it provides significant health benefits. The aim of this study is to analyze the current level of knowledge on maximizing the efficiency of resistance training in the context of muscle hypertrophy and increase in muscle strength. Materials and methods: PubMed and Google Scholar databases were searched. The criteria for qualifying the article for the review were the following keywords: hypertrophy, resistance training, muscle strength, and efficiency. 10 articles from 2017 to 2022 were analyzed. Description of the state of knowledge: To optimize the way of performing RT, its assumptions should be individually adapted to the exercising person.  In the conventional model of muscle hypertrophy, three main factors are distinguished: muscle tension, metabolic stress, and muscle damage. Maintaining greater mechanical muscle tension during training primarily promotes an increase in its strength while increasing metabolic stress is responsible for the intensification of hypertrophy. In terms of hypertrophy, it has been observed that more series of exercises per week means greater gains in muscle mass. Multi-joint exercises involve more muscle mass than single-joint exercises. Summary: To control the effectiveness of training 1RM should be measured before and after the training cycle. Performing exercises with a high load (RM ≤7) may be the most effective training method for people with limited time resources. To maximize the efficiency of training, only multi-joint exercises may be used. Key words: hypertrophy; resistance training; muscle strength; efficienc

Efficacy and safety of atropine to control childhood myopia progression

Introduction: Nearsightedness is one of the most common eye defects in people all over the world. If left untreated, it leads to a number of serious eye complications that can result in irreversible loss of vision. It is estimated that by 2050. Half of humanity will be burdened with this disadvantage, so it has become a priority to try to find ways to prevent and treat myopia, among which the administration of atropine drops is very effective. Aim of the study: The aim of this study is to evaluate the safety and efficacy of atropine in controlling the progression of myopia and to investigate the relationship between the dose of atropine and the effectiveness of controlling the progression of myopia. Material and methods: The PubMed and Google Scholar databases were used to review the literature. Results: Eye drops with 1% atropine showed the greatest efficacy in the control of myopia. However, their use was limited due to the occurrence of side effects such as impaired accommodation and photophobia. In the ATOM 2 study, which investigated the use of atropine in a variety of concentrations, it was found that 0.01% is the optimal concentration with good efficacy and minimal side effects. One of the breakthroughs was the LAMP study using atropine at a concentration of 0.05%, 0.025%, 0.01% in eye drops. This study provided evidence for the first time that low-concentration atropine is effective compared with placebo in myopia. In addition, both efficacy and side effects followed a concentration-dependent response ranging from 0.01% to 0.05% of atropine. Among them, 0.05% of atropine was the optimal concentration to achieve the best efficacy and safety profile. Conclusion: Low concentration of atropine is effective in the control of myopia. Its widespread use can help prevent the progression of myopia. However, further investigation of the rebound phenomenon and a long term, individualized approach to treatment are warranted.   &nbsp

The ketogenic diet in the treatment of diabetes type 2

Despite  advances in the medical world, obesity remains a major worldwide health hazard .The majority of chronic diseases like diabetes is largely related to obesity which is usually a product of an unhealthy lifestyle and poor dietary habits. The ketogenic diet has become an increasingly popular approach for both weight loss and as an alternative diet for type 2 diabetes mellitus (T2DM). In addition, this diet has a positive effect on body weight, blood glucose level, glycosylated hemoglobin and plasma lipid profile. This review focuses on the therapeutic effectiveness of using LCKD for the treatment of type 2 diabetes.Despite  advances in the medical world, obesity remains a major worldwide health hazard .The majority of chronic diseases like diabetes is largely related to obesity which is usually a product of an unhealthy lifestyle and poor dietary habits. The ketogenic diet has become an increasingly popular approach for both weight loss and as an alternative diet for type 2 diabetes mellitus (T2DM). In addition, this diet has a positive effect on body weight, blood glucose level, glycosylated hemoglobin and plasma lipid profile. This review focuses on the therapeutic effectiveness of using LCKD for the treatment of type 2 diabetes

The impact of quantitative and semi-quantitative culture of respiratory tract secretions on clinical decisions in a patient with suspected pneumonia – case study

Pneumonia is one of the most common disease entities treated in the Intensive Care Unit. The standard diagnostic procedure for patients with suspected pneumonia is to evaluate the presence of symptoms of infection, physical examination, imaging, laboratory and microbiological tests, arterial blood gasometry and culture of respiratory tract secretions. In many Intensive Care Units, the preferred method of collecting material from the lower respiratory tract is an endotracheal aspirate. However, its semi-quantitative culture does not distinguish respiratory tract colonization from infection. Samples obtained by bronchoscopy are believed to be more representative of the presence of true pathogens in the lungs. An 87-year-old patient with myasthenia gravis was admitted to the Intensive Care Unit for suspected pneumonia. Laboratory tests showed elevated inflammatory markers and a chest X-ray showed interstitial densities in the left lower lobe. The result of semi-quantitative culture of tracheal aspirate was heavy growth of Staphylococcus aureus and heavy growth of Pseudomonas aeruginosa. The result of the quantitative BAL culture was S.aureus MSSA 105 colony-forming unit (CFU) per ml, Pseudomonas aeruginosa 102 CFU/ml. To consider a microorganism responsible for infection, the number of bacteria cells must exceed a designated threshold. For BAL it is ≥104 CFU/ml, for TA it is ≥106 CFU/ml, for PSB it is ≥ 103/ml. In this case, the cutoff point for identifying the pathogen responsible for the infection was reached only by Staphylococcus aureus (105 CFU/ml), not by Pseudomonas aeruginosa (102 CFU/ml). The final diagnosis was left-sided PN1 pneumonia of S.aureus etiology. A cloxacillin was used for the treatment. Clinical improvement was achieved. The described case proves the advantage of quantitative culture over semi-quantitative culture of respiratory tract secretions. The advantage of bronchoalveolar lavage over tracheal aspirate is also noticeable

Mindfulness sessions delivered via smartphone applications and their potential benefits

Mindfulness, as a practice of focusing one’s attention on the present moment without evaluating, is used in mindfulness based interventions (MBI) therapy. Traditionally, these sessions are conducted in person. At this moment, we are witnessing a global trend in which patients are turning to technology and are looking for alternative, more convenient solutions. There are studies assessing the effectiveness of mindfulness training conducted in a new unconventional way, which is using an application installed on patient's smartphone. This paper discusses possible benefits of online conducted mindfulness sessions.&nbsp

Teplizumab - current state of knowledge on the effects of teplizumab in preventing the development of type 1 diabetes in people at risk

Background and Purpose: Type 1 diabetes is a chronic autoimmune disease from the group of metabolic disorders, where the immune system attacks and destroys the insulin producing cells of the pancreas, leading to hyperglycemia and the need for lifelong exogenous insulin supplementation. This results in increased morbidity, life threatening complications, shortened lifespan and quality of life. So there is an urgent need to develop prevention and treatment for people at risk of developing type 1 diabetes. Current state of knowledge: Recently, there has been significant progress in the field of immunotherapy with therapeutic strategies that focus on stopping the disease in the presymptomatic stage by preserving residual beta-cell function. Randomized, double-blind clinical trials of teplizumab were conducted in relatives of patients with established type 1 diabetes who had not yet been diagnosed with the disease, but were at high risk of developing clinical disease, based on these studies The FDA has approved teplizumab, under trade name Tzield, as a treatment to delay the onset of type 1 diabetes. Conclusion: The reviewed research papers present strong evidence that teplizumab halts the severe decline in beta cells and possibly improves their function after treatment in a high-risk population. In addition, the effect persists

Therapeutic methods in the treatment of triple-negative breast cancer - a review

Breast cancer is a common female malignancy characterized by the presence of multiple subtypes taking into account, among other things, hormonal activity. The purpose of this study is to show the therapeutic options for triple-negative breast cancer (TNBC). A review of the literature in databases such as PubMed, Google Scholar, and Web of Science by keywords was performed, taking into account papers from 2017-2022. The main therapeutic approaches are surgical intervention and systemic chemotherapy (neoadjuvant and adjuvant). Unsatisfactory results from chemotherapy have prompted researchers to work on other methods to combat TNBC. Clinical trials are being conducted on the use of immunotherapy focusing mainly on molecules against PD-1, PD-L1, and CTLA-4. Targeted therapy is the latest proposed form of therapy, which offers the possibility of introducing a drug in the future that will be tailored to the patient's needs limiting the negative therapeutic impact