Comparison of local cryotherapy and sonotherapy effectiveness in the treatment of gonarthrosis symptoms

The aim of this study was comparison of local cryotherapy and sonotherapy effectiveness in the treatment of gonarthrosis symptoms. Material and methods: The studies on the comparison of local cryotherapy and sonotherapy effectiveness were conducted in a research group of one hundred people singled out from the patients staying at the Wieniec Zdrój Sanatorium in Wieniec Zdrój. Before the series of sonotherapy and cryotherapy treatments and after their completion, all patients were assessed using: Centimeter tape, Goniometer, VAS (Visual Analog Scale), Laitinen Questionnaire and Sit-up Test. Results: After the rehabilitation, the intensity of pain was determined at 4.45 points, on a scale from 0 to 8 points. The intensity of pain in the VAS scale among respondents decreased significantly by 1.750 points. The average pain intensity was 1.40 points (SD = 0.778), which resulted in a significant change in the form of pain relief (p = 0.580). The frequency of pain ranges from 0 to 4 points (M = 1.35). The frequency of its occurrence decreased significantly (p = 0.670). After rehabilitation, the frequency of analgesics was on average 0.66 points, and the limit on physical activity was 1.40 points (p = 0.520). The limitation of physical activity was determined on average at the level of 1.04 points, which reduced its limit by 0.560 points. After rehabilitation, the range of motion in the knee joint increased to 99.60°. On average, the range of movement of patients in the knee joint after rehabilitation increased by -1.429°. After rehabilitation, knee circumference of the kneecap was between 30 cm and 76 cm. The average result was 42.375 cm and decreased significantly by 0.1676 cm. The circumference of the knee joint above the kneecap oscillated between 28 - 80.5 cm (D = 44.335 cm), which gave the effect of reducing the edema by 0.320 cm. The treatments performed varied only the results in the frequency of analgesics (p = 0.45). Better effects occurred in patients undergoing sonotherapy (M = 0.048) than in cryotherapy (M = 0.84). Conclusions: Local cryotherapy and sonotherapy reduces the severity and frequency of pain and reduces swelling in the knee joints. Positive effects of therapy reduce the amount of analgesics used. However, better results are obtained in patients undergoing sonotherapy than in cryotherapy. In addition, the range of flexion movements of the knee joints is increased under the influence of treatments. There are significant differences in the improvement of the range of motion among patients treated with sonotherapy than cryotherapy

The effect of kinesiotherapy supported by visual biofeedback on a stabilometric platform on health-related quality of life among patients with non-specific low back pain. A randomized, open-label study with a 6-month follow-up

Introduction: Non-specific low back pain (NSLBP) influences health-related quality of life (HRQoL) in a significant number of people. This study aimed to evaluate the effect of two rehabilitation programs, kinesiotherapy combined with visual biofeedback on a stabilometric platform and kinesiotherapy alone, on HRQoL during a 6-month follow-up. Material and methods: The study was performed using a randomized open-label design with a 6-month follow-up. Forty-nine patients with NSLBP were assigned to the study group (SG) and treated with kinesiotherapy supported by visual feedback on a stabilometric platform (TecnoBody ST 310 Plus), and 51 patients to the control group (CG) and treated with kinesiotherapy alone. HRQoL was evaluated using the SF-36v2 Health Survey Standard Polish Version 1.0 9/02 (SF-36). Results: Compared to those in the CG, SG patients achieved greater improvement in physical HRQoL domain scores. This effect was lower in patients with initially greater NSLBP intensity (numeric rating scale [NRS] ≥ 7), and with a higher number of NSLBP recurrences (≥ 3) during the follow-up. The recurrence of NSLBP influenced not only the physical but also the mental health domains of the SF-36 Survey. Conclusions: Compared to NSLBP patients who underwent kinesiotherapy alone, those who were treated with kinesiotherapy supported by visual feedback on a stabilometric platform achieved a greater improvement in HRQoL domain scores by the end of the 6-month follow-up. The level of HRQoL improvement was related to the initial severity of NSLBP and the number of NSLBP recurrences, which should be considered when assessing the effectiveness of NSLBP treatment

Rak pęcherzykowy tarczycy z przerzutami do wątroby — diagnostyka, leczenie i prognoza

  Follicular thyroid carcinoma (FTC) is the second most common type of thyroid cancer (TC) and accounts for approximately 10% of all TC cases. Liver metastases are a rare presentation in 0.5–1% of follicular thyroid cancers, usually occurring in the setting of widely disseminated FTC disease, and their presence is associated with poor prognosis. Until now, there have been only 30 cases of FTC liver metastases described in the literature. Herein, we review publications and describe diagnostic tools that may be used in the diagnosis and follow-up of FTC metastases to the liver, including biopsy and imaging techniques like US, CT, MRI, SPECT, PET, and radioiodine scintigraphy. We also present and discuss current methods of treatment, e.g. TSH suppressive therapy with levothyroxine, surgery, radiofrequency ablation (RFA), transarterial embolisation (TAE), liver transarterial chemoembolisation (TACE), chemotherapy with cisplatin and doxorubicin, treatment with Indium- 111-octreotide (or its analogues), and tyrosine kinase inhibitors (sorafenib, sunitinib). At the end we describe the course, results of diagnostics, and treatment in a patient with large multiple FTC metastases to the liver. (Endokrynol Pol 2016; 67 (3): 332–347)    Rak pęcherzykowy tarczycy (FTC) jest drugim najczęstszym typem raka tarczycy (TC) i stanowi około 10% wszystkich TC. Przerzuty do wątroby występują w 0,5–1% przypadków FTC, zwykle w przypadku znacznie zaawansowanej choroby nowotworowej i wiążą się ze złą prognozą. Do tej pory, tylko 30 przypadków FTC z przerzutami do wątroby zostało opisanych w literaturze. W niniejszej pracy dokonano przeglądu literatury i opisu metod diagnostycznych jakie mogą być użyte w badaniu i kontroli przerzutów FTC do wątroby, w tym biopsji, technik obrazowych, takich jak: USG, KT, MRI, SPECT, PET i scyntygrafii jodowej. Zaprezentowano i omówiono aktualne metody leczenia: terapię L-tyroksyną w dawce supresyjnej, leczenie operacyjne, ablację prądem o częstotliwości fal radiowych (RFA), embolizację przeztętniczą (TAE), przeztętniczą chemoembolizację, chemioterapię z użyciem cisplatyny i doksyrubicyny, leczenie z użyciem analogów somatostatyny w tym octreotydu znakowanego izotopem indu 111In, czy terapię z użyciem inhibitorów kinazy tyrozynowej (sorafenib, sunitynib). Na końcu opisano przebieg choroby, wyniki badań diagnostycznych i podjęte leczenie u chorej z ogromnymi mnogimi przerzutami FTC do wątroby. (Endokrynol Pol 2016; 67 (3): 332–347)

Assessment of dietary habits among Polish women with Hashimoto's disease

Introduction. Selected dietary components are crucial for a properly functioning thyroid gland. Therefore a healthy and balanced diet is  crucial for treating patients with Hashimoto's disease. Aim. This study aims to evaluate the dietary habits of women suffering from autoimmune thyroiditis. Material and methods. A questionnaire study was conducted in a group of 58 women with Hashimoto's disease and among 42 women without autoimmune thyroiditis using the Food Frequency Questionnaire (FFQ-6). To assess compliance with the normal distribution, we used the Shapiro-Wilk test. The comparative assessment was made using the Student's t-test and Mann-Whitney test. The Chi-square test was used to assess the relationship between the response and the group. A p-value of less than 0.05 was considered significant. Results. The study showed no significant differences in dietary habits between the two groups. Only 29% (n=15) of women with HT declared daily consumption of fruits vs 31% (n=12) in the control group (p=0.3800), and only 2% (n=1) declared consuming berries daily vs. 5% (n=2), (p=0.5270). The consumption of the recommended several portions of vegetables per day was declared by only 22% (n=11) of women with HT vs 28% (n=11) in the control group (p=0.3983). 42% (n=24) of women with HT vs 38.5% (n=16) of controls reported eating cruciferous vegetables several times a week (p=0.8241). 14% (n=8) of women with HT vs 19% (n=8) of women in the control group declared daily consumption of green leafy vegetables (p=0.3653). Most people in the study group consume nuts and seeds several times a month, and those in the control group several times a week. Most HT respondents also declare not to consume the recommended amount of fish. Conclusions. The diet of patients with Hashimoto's disease does not differ significantly from that of non-Hashimoto's disease patients. Considering the study results and current scientific knowledge, it seems necessary to undertake educational activities for patients with Hashimoto's disease to increase patient awareness of the impact of diet on the course of the disease

Variety of genetic defects in GnRH and hypothalamic–pituitary signaling and development in normosmic patients with IHH

IntroductionNormosmic isolated hypogonadotropic hypogonadism (nIHH) is a clinically and genetically heterogeneous disorder. Deleterious variants in over 50 genes have been implicated in the etiology of IHH, which also indicates a possible role of digenicity and oligogenicity. Both classes of genes controlling GnRH neuron migration/development and hypothalamic/pituitary signaling and development are strongly implicated in nIHH pathogenesis. The study aimed to investigate the genetic background of nIHH and further expand the genotype–phenotype correlation.MethodsA total of 67 patients with nIHH were enrolled in the study. NGS technology and a 38-gene panel were applied.ResultsCausative defects regarded as at least one pathogenic/likely pathogenic (P/LP) variant were found in 23 patients (34%). For another 30 individuals, variants of unknown significance (VUS) or benign (B) were evidenced (45%). The most frequently mutated genes presenting P/LP alterations were GNRHR (n = 5), TACR3 (n = 3), and CHD7, FGFR1, NSMF, BMP4, and NROB1 (n = 2 each). Monogenic variants with solid clinical significance (P/LP) were observed in 15% of subjects, whereas oligogenic defects were detected in 19% of patients. Regarding recurrence, 17 novel pathogenic variants affecting 10 genes were identified for 17 patients. The most recurrent pathogenic change was GNRHR:p.Arg139His, detected in four unrelated subjects. Another interesting observation is that P/LP defects were found more often in genes related to hypothalamic–pituitary pathways than those related to GnRH.ConclusionsThe growing importance of the neuroendocrine pathway and related genes is drawing increasing attention to nIHH. However, the underestimated potential of VUS variants in IHH etiology, particularly those presenting recurrence, should be further elucidated

The impact of left circumflex coronary artery ostium stenosis on outcomes of patients after percutaneous coronary intervention for unprotected left main disease

Background: The impact of left circumflex coronary artery (LCX) ostium atherosclerosis in left main coronary artery (LM) bifurcation disease is not well-known. Aim: The aim of the study was to assess whether the involvement of LCX ostium carries prognostic implications in patients undergoing unprotected LM percutaneous coronary intervention (PCI). Methods: Consecutive 564 patients with unprotected LM (ULMCA) disease who underwent LM PCI between January 2015 and February 2021, with at least 1-year available follow-up were included in the study. First group composed of 145 patients with ULMCA disease with LCX ostium stenosis and the second group consisted of 419 patients with ULMCA disease without LCX ostium stenosis. Results: Patients in group with ULMCA disease with LCX ostium stenosis were significantly older and comorbidities were found more often in this group. Two stents technique was used more often in group with LCX ostium stenosis (62.8% vs 14.6%; P<0.001). During 7 years follow-up, all-cause mortality between groups with and without LCX ostium stenosis did not differ significantly (P=0.50). The use of one-stent or two-stent technique also did not impact the mortality in patients with LCX ostial lesions group (P=0.75). Long-term mortality subanalysis for three groups of patients (1) patients with LM + LCX ostium stenosis, (2) LM + left anterior descending artery (LAD) ostium stenosis, (3) LM + LCX ostium + LAD ostium stenosis also did not differ significantly (P=0.63). Conclusions: LCX ostium involvement in LM disease PCI is not associated with adverse long-term outcomes, which is highly beneficial for the Heart Team decision making process

The impact of right coronary artery support on outcomes of patients with unprotected left main disease undergoing percutaneous coronary intervention

Background: Many operators are discouraged from performing left main (LM) percutaneous coronary interventions (PCI) in the absence of right coronary artery (RCA) support due to the increased procedure risk. Aims: We aimed at assessing the impact of absent functional RCA on prognostic implications in patients undergoing unprotected LM PCI. Methods: 613 patients underwent LM PCI in our department between 2015 and 2019. Consecutive 385 patients with unprotected LM and at least 1-year follow-up were included in the study. The study population comprised 272 patients with unprotected left main coronary artery disease (ULMCAD) with dominant RCA, without any significant lesions (Group 1), and 113 ULMCAD patients and without RCA support (Group 2). Results: In Group 2, 32.7% patients had a significant RCA stenosis, 48.7% had chronic total occlusion (CTO) of RCA, and 18.6% had recessive RCA. Patients in Group 2 were older and had higher prevalence of chronic obstructive pulmonary disease (COPD). SYNTAX Score (median [IQR] 26.0 [20.0–33.0] vs 19.0 [13.0–25.5]; P < 0.001) was higher and left ventricular ejection fraction was lower (median [IQR] 50.0 [40.0–60.0]% vs 55.0 [45.0–60.0]%; P = 0.01) in this group. All periprocedural complications did not differ among the groups. Long-term all-cause mortality at a median follow-up of 1149 days did not differ significantly (23% vs 20%; P = 0.37). The long-term mortality in CTO-RCA group was also not significantly different. Conclusions: Patients with ULMCAD who have undergone LM PCI in the absence of RCA support, compared with those with ULMCAD and RCA support, differed neither in the prevalence of periprocedural complications nor in long-term all-cause mortality

Reduced Quality of Life and Sexual Satisfaction in Isolated Hypogonadotropic Hypogonadism

(1) Background: Isolated hypogonadotropic hypogonadism (IHH) is a genetic condition characterized by impaired puberty and fertility. IHH can significantly impact patient health-related quality of life (HRQoL), sexual satisfaction (SS) and mood. (2) Methods: Participants included 132 IHH subjects (89 men and 43 women) and 132 sex- and age-matched controls. HRQoL, depressive symptoms, erectile dysfunction (ED), and SS were assessed in an online survey using the Zung Self-Rating Depression Scale (SDS), 15D instrument of HRQoL (15D), Sexual Satisfaction Questionnaire (SSQ), and 5-item International Index of Erectile Function (IIEF-5). (3) Results: QoL and SS were significantly lower in the IHH group vs. controls. There was a high rate of ED (53.2% vs. 33%, p = 0.008) and depressive symptoms (45.00 ± 17.00 vs. 32.00 ± 12.00, p < 0.001) in patients vs. controls. The age of patients at IHH diagnosis inversely correlated with their overall 15D scores. An alarming non-compliance rate was seen (51.6%). No differences were found between scores of patients receiving hormone replacement therapy (HRT) and untreated subjects in any of the scales. (4) Conclusions: The HRQoL, SS, ED, and depression levels observed in IHH patients, despite HRT, are alarming. Late IHH diagnosis may have a particularly negative impact on HRQoL. More attention should be devoted to HRT adherence and various HRQoL aspects of IHH patients

Initial clinical experience with the first drug (sacubitril/valsartan) in a new class - ARNIs in patients with heart failure with reduced left ventricular ejection fraction in Poland

Background: Sacubitril/valsartan is the first drug from a new class of angiotensin receptor neprilysin inhibitors (ARNIs) recommended in the new European Society of Cardiology guidelines instead of angiotensin converting enzyme inhibitors (ACEI), or angiotensin receptor blockers (ARB) that are used if ACEI are not tolerated. Sacubitril/valsartan is recommended for further reduction in the risk of hospitalisation or death in outpatients with heart failure with reduced ejection fraction (HFrEF) if symptoms continue despite optimal treatment with ACEI/ARB, beta-blockers, and mineralocorticoid antagonists. Aim: The aim of this study is to present the initial experience with regard to the effectiveness, tolerance, and safety of sacubitril/valsartan in the outpatient cardiology practice in Poland. Methods: The study is a retrospective analysis of data obtained through a questionnaire filled in by the physicians who initiated the sacubitril/valsartan treatment in patients with HFrEF between 1 June 2016 and 30 September 2016. Patients were followed-up for three months. Results: The analysis included data on 28 patients aged 61 ± 16 years, of whom 85.7% were males. The drug was used in patients in New York Heart Association (NYHA) class I–III. In 25 (89.2%) patients sacubitril/valsartan was started at the lowest dose (24/26 mg BID). During follow-up the sacubitril/valsartan-treated patients had a reduction in HF symptoms assessed using the NYHA functional class (p = 0.001), a significant drop in N-terminal-pro B-type natriuretic peptide levels (mean, from 2900 to 2270 pg/mL; p = 0.008), and improved exercise tolerance, which occurred shortly after treatment initiation — after a mean of 28 days. Conclusions: It was demonstrated that the use of sacubitril/valsartan in outpatients with HFrEF is safe and is associated with a significant clinical improvement.Wstęp: Sakubitril/walsatran to pierwszy lek z nowej grupy inhibitorów neprilizyny blokerów receptora angiotensyny (ARNI, angiotensyn receptor neprilisin inhibitor) rekomendowany w nowych wytycznych Europejskiego Towarzystwa Kardiologicznego w miejsce ACEI lub ARB (antagonisty receptora angiotensyny) stosowanego, jeśli ACEI jest nietolerowany, w celu dalszej redukcji ryzyka hospitalizacji i zgonu u pacjentów ambulatoryjnych z niewydolnością serca z obniżoną frakcją wyrzutową (HFrEF), jeśli pozostają objawowi, mimo optymalnej terapii z zastosowaniem ACEI/ARB, beta-adrenolityku i antagonisty mineralokortykoidów (MRA). Cel: Celem pracy jest przedstawienie pierwszych doświadczeń dotyczących efektywności, tolerancji i bezpieczeństwa stosowania sakubitrilu/walsartanu w kardiologicznej praktyce ambulatoryjnej w Polsce. Wyniki i wnioski: Wykazano, że stosowanie sakubitrilu/walsartanu u ambulatoryjnych pacjentów z HFrEF jest bezpieczne i wiąże się z istotną poprawą kliniczną wyrażaną jako zmniejszenie w zakresie klasy NYHA i stężenia NT-proBNP, a odczuwalna poprawa tolerancji wysiłku nastąpiła w krótkim czasie od zainicjowania leczenia, średnio po 28 dniach

Defects in gnrh neuron migration/development and hypothalamic-pituitary signaling impact clinical variability of Kallmann Syndrome

Kallmann syndrome (KS) is a combination of isolated hypogonadotropic hypogonadism (IHH) with olfactory dysfunction, representing a heterogeneous disorder with a broad phenotypic spectrum. The genetic background of KS has not yet been fully established. This study was conducted on 46 Polish KS subjects (41 males, 5 females; average age: 29 years old). The studied KS patients were screened for defects in a 38-gene panel with next-generation sequencing (NGS) technology. The analysis revealed 27 pathogenic and likely pathogenic (P/LP) variants, and 21 variants of uncertain significance (VUS). The P/LP variants were detected in 20 patients (43.5%). The prevalence of oligogenic P/LP defects in selected genes among KS patients was 26% (12/46), whereas the co-occurrence of other variants was detected in 43% (20 probands). The examined KS patients showed substantial genotypic and phenotypic variability. A marked difference in non-reproductive phenotypes, involving defects in genes responsible for GnRH neuron development/migration and genes contributing to pituitary development and signaling, was observed. A comprehensive gene panel for IHH testing enabled the detection of clinically relevant variants in the majority of KS patients, which makes targeted NGS an effective molecular tool. The significance of oligogenicity and the high incidence of alterations in selected genes should be further elucidated