Interleukin 1 level, cognitive performance, and severity of depressive symptoms in patients treated with systemic anticancer therapy: a prospective study

Aim To assess the relationship between cognitive functions, severity of depressive symptoms, and expression of interleukin 1 (IL)-1 in patients treated with systemic anticancer therapy. Methods This prospective study, conducted in 2017-2018, involved 55 patients (56% men) subjected to systemic anticancer therapy. Forty-one patients had lung cancer (74.55%) and 14 had breast cancer (25.45%). Patients’ mean age was 55.5 ± 9.3 (from 26 to 65 years). Neuropsychological tests were conducted twice: on the day of qualifying for the study before the start of chemotherapy and after the end of the full treatment cycle. We assessed patients’ cognitive functioning using Trail Making Test A&B (TMT), Stroop Color-Word Interference Test, and Verbal Fluency Test (VFT). Severity of depressive symptoms and the level of IL-1 expression were also examined.Results After chemotherapy, patients had significantly lower expression of IL-1α (P < 0.005) and IL-1β (P < 0.001) at the protein level. They also had lower severity of depressive symptoms (borderline significant, P = 0.063), needed more time to complete the first part of the Stroop test (P = 0.03), and had worse score on the first part of the VFT (P < 0.001). Before chemotherapy there was a significant negative correlation between IL-1β expression and the speed at which the first part of the TMT test was completed. Conclusions The severity of depressive symptoms after chemotherapy was lower than before chemotherapy. Patients’ cognitive performance did not significantly deteriorate after chemotherapy, except the performance at the first part of the Stroop test and the first part of the VFT

Respiratory and motor rehabilitation in the patients with chest drainage

Introduction: Chest drainage is a procedure applied in life or health-threatening situations. It is an integral part accompanying patients undergoing thoracic surgery. It allows evacuation from the pleural cavity of pathological fluid, blood, air and perulence. The patients with chest drainage are struggling with many symptoms, such as pain, feeling of pressure or dyspnoea associated with a given disease entity through movement restrictions, especially on the side affected by drainage. Currently, respiratory and motor rehabilitation is an important part of treatment in patients undergoing thoracic surgery. Breathing and movement exercises and other elements of rehabilitation are of great importance in the whole treatment process, and when applied together, properly and regularly contribute to improvement of patient's health, reduce the risk of complications and improve the comfort of treated person. The goal of the thesis: The goal of the thesis was to review literature about pulmonary rehabilitation in patients with chest drainage. Results: Respiratory and motor rehabilitation conducted in the patients with chest drainage has a significant impact on their recovery. Educating patients about postoperative rehabilitation has a beneficial effect on their performance of individual rehabilitation elements

Efficacy and safety of a vaginal medicinal product containing three strains of probiotic bacteria : a multicenter, randomized, double-blind, and placebo-controlled trial

Objective: The main objective of this study was to evaluate whether vaginal administration of probiotic Lactobacillus results in their colonization and persistence in the vagina and whether Lactobacillus colonization promotes normalization and maintenance of pH and Nugent score. Patients and methods: The study was a multicenter, randomized, double-blind, and placebocontrolled trial. Altogether, 376 women were assessed for eligibility, and signed informed consent. One hundred and sixty eligible women with abnormal, also called intermediate, vaginal microflora, as indicated by a Nugent score of 4-6 and pH >4.5 and zero or low Lactobacillus count, were randomized. Each participant was examined four times during the study. Women were randomly allocated to receive either the probiotic preparation inVag®, or a placebo (one capsule for seven consecutive days vaginally). The product inVag includes the probiotic strains Lactobacillus fermentum 57A, Lactobacillus plantarum 57B, and Lactobacillus gasseri 57C. We took vaginal swabs during visits I, III, and IV to determine the presence and abundance of bacteria from the Lactobacillus genus, measure the pH, and estimate the Nugent score. Drug safety evaluation was based on analysis of the types and occurrence of adverse events. Results: Administration of inVag contributed to a significant decrease (between visits) in both vaginal pH (P<0.05) and Nugent score (P<0.05), and a significant increase in the abundance of Lactobacillus between visit I and visits III and IV (P<0.05). Molecular typing revealed the presence of Lactobacillus strains originating from inVag in 82% of women taking the drug at visit III, and 47.5% at visit IV. There was no serious adverse event related to inVag administration during the study. Conclusion: The probiotic inVag is safe for administration to sustainably restore the healthy vaginal microbiota, as demonstrated by predominance of the Lactobacillus bacteria in vaginal microbiota

Disparities in knowledge of cardiovascular risk factors and prevention methods related to cardiovascular status and functional health literacy, Poland, 2020–2021

Background: Numerous studies have reported a significant role for health literacy (HL) in the prevention or treatment of various diseases. However, in Poland there was no scientific research involving the status of cardiovascular disease (CVD) and HL in the assessment of health knowledge simultaneously, therefore, it became the objective of the study. Aims: We aimed to evaluate the level of CVD knowledge depending on CVD status and functional HL in Polish population. Methods: The study population consisted of 2827 participants from the WOBASZ II Survey aged 20–89 years: 2266 were CVD-free (non-CVD), 361 were hospitalized with CVD (CVDH[+]) and 200 were diagnosed with CVD, but not hospitalized (CVDH[-]). The Newest Vital Sign test (NVS) was applied to determine functional HL. Self-reported knowledge of CVD risk factors (RFs) and prevention methods (PMs) between people with different CVD status depending on HL was estimated. Multivariable ordinal and binary logistic regression analyzes were performed to find predictors of RFs and PMs knowledge. Results: The knowledge of CVD RFs and/or PMs was strictly related to HL and CVD status. Inadequate HL decreased the satisfactory (≥5 RFs/PMs) knowledge of RFs (odds ratio [OR], 0.50; 95% confidence interval [CI], 0.40–0.62) and PMs (OR, 0.56; 95% CI, 0.45–0.71). CVDH(-) people were more likely to have a satisfactory PMs knowledge (OR, 1.49; 95% CI, 1.02–2.16), while CVDH(+) persons a satisfactory RFs knowledge (OR, 1.85; 95% CI, 1.35–2.53). Conclusions: HL and CVD status are the key determinants of CDV RFs/PMs knowledge. Functional HL significantly affects health knowledge; therefore, HL screening should be recommended in primary care to increase the effectiveness of primary CVD prevention

Supplementation of standard antibiotic therapy with oral probiotics for bacterial vaginosis and aerobic vaginitis : a randomised, double-blind, placebo-controlled trial

BACKGROUND: This multicentre, randomised, double-blind, placebo-controlled trial was performed to determine whether the use of oral probiotic preparation (prOVag®) containing three Lactobacillus strains together with standard metronidazole treatment and also targeted antibiotic treatment (following the failure of metronidazole therapy) could reduce the recurrence rates of bacterial vaginosis (BV) and aerobic vaginitis (AV). METHODS: Patients at private gynaecological clinics in Poland with histories of recurrent BV/AV and current symptoms were randomly allocated to receive metronidazole and probiotic or placebo, and assessed monthly on visits II and III-V. The total number of study visits was 5–6 (I, II, II bis – if applicable, III, IV, V). One probiotic or placebo capsule was administered with metronidazole/targeted antibiotic twice daily for 10 days; during follow up, patients took one capsule daily for 10 days perimenstrually. Clinical examination and vaginal swabbing were performed at each visit. Primary outcomes were clinical or microbiological BV/AV recurrence and probiotic safety. Secondary outcomes were vaginal pH, Nugent score, and Lactobacillus counts in the vaginal microbiota. Safety analysis was performed in 578 (probiotic, n = 285; placebo, n = 293) 18–50-year-old women who were randomised. RESULTS: BV/AV was confirmed microbiologically in 241 (probiotic, n = 118; placebo, n = 123) participants, who continued the trial. Data from 154 (probiotic, n = 73; placebo, n = 81) participants who completed the study were analysed to determine the efficacy of prOVag. Additional analyses included 37 (probiotic, n = 22; placebo, n = 15) participants who received targeted antibiotics and probiotics or placebo. prOVag lengthened the time to clinical relapse of BV/AV symptoms up to 51 % (p < 0.05) compared with placebo; AV relapse was delayed by up to 76 % (p < 0.05). Probiotic use also reduced and maintained low vaginal pH and Nugent score, and increased vaginal Lactobacillus counts following standard treatment. CONCLUSION: This study demonstrated that oral probiotics lengthened remission in patients with recurrent BV/AV and improved clinical and microbiological parameters. TRIAL REGISTRATION: NCT01993524; 20 November 2013. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12905-015-0246-6) contains supplementary material, which is available to authorized users

Pluronic® F-127 enhances antifungal activity of fluconazole against resistant Candida strains

Candida strains as the most frequent causes of infections, along with their increased drug resistance, pose significant clinical and financial challenges to the healthcare system. Some polymeric excipients were reported to interfere with the multidrug resistance mechanism. Bearing in mind that there are a limited number of marketed products with fluconazole (FLU) for the topical route of administration, Pluronic F-127 (PLX)/FLU formulations were investigated in this work. The aims of this study were to investigate (i) whether PLX-based formulations can increase the susceptibility of resistant Candida strains to FLU, (ii) whether there is a correlation between block polymer concentration and the antifungal efficacy of the FLU-loaded PLX formulations, and (iii) what the potential mode of action of PLX assisting FLU is. The yeast growth inhibition upon incubation with PLX formulations loaded with FLU was statistically significant. The highest efficacy of the azole agent was observed in the presence of 5.0 and 10.0% w/v of PLX. The upregulation of the CDR1/CDR2 genes was detected in the investigated Candida strains, indicating that the efflux of the drug from the fungal cell was the main mechanism of the resistance

Effect of immunostimulation with bacterial lysate on the clinical course of allergic rhinitis and the level of γδT, iNKT and cytotoxic T cells in children sensitized to grass pollen allergens: A randomized controlled trial

BackgroundThere are many drugs for allergic rhinitis (AR), however, these drugs show variable clinical effectiveness and some side effects. Therefore, new methods of AR pharmacotherapy are being sought.ObjectivesThe objectives of this study were to evaluate the efficacy of polyvalent mechanical bacterial lysate (PMBL) therapy in improving the clinical course of grass pollen-induced AR (seasonal AR, SAR) in children and its effect on changes in the blood level of the γδT, iNKT and cytotoxic T cell subsets.MethodsFifty children with SAR were enrolled in this study and were randomly assigned to either the PMBL group or the placebo group. The severity of SAR symptoms was assessed using the total nasal symptom score (TNSS) and visual analogue scale (VAS). During two visits (V1, V2), peak nasal inspiratory flow (PNIF) was measured and peripheral blood was collected for immunological analyses. The study also included 2 telephone contacts (TC1, TC2).ResultsThe severity of the nasal symptoms of SAR on the TNSS scale was revealed to have a significantly lower impact in the PMBL group vs the placebo group at measuring points TC1 and V2 (p = 0.01, p = 0.009, respectively). A statistically significantly lower mean severity of nasal symptoms of SAR on the VAS scale was recorded for children in the PMBL group compared to the placebo group at measuring points TC1, V2 and TC2 (p = 0.04, p = 0.04, p = 0.03, respectively). The compared groups do not show significant differences in terms of PNIF values at individual measuring points. There were no statistically significant changes in immune variables. For both groups, there was a statistically significant association between the level of Th1-like γδT cells and the severity of SAR symptoms expressed on the TNSS scale (p = 0.03) – the lower the level of Th1-like γδT cells, the higher the TNSS value.ConclusionAdministration of sublingual PMBL tablets during the grass pollen season proves to have a high efficacy in alleviating SAR symptoms in children sensitized to grass pollen allergens. Th1-like γδT cells may be used as potential markers for SAR severity in children.Clinical trial registrationClinicalTrials.gov, identifier (NCT04802616)

The issue of non-therapeutic interventions in connection with medical experiment (with special emphasis on therapeutic experiment)

Medycyna doby współczesnej stwarza coraz większe pola działania dla działalności lekarzy. Obecnie wiele różnorodnych działań wchodzi w zakres pojęcia czynności medycznych. Tradycyjne działania medyczne już dawno przestały być jedynymi metodami stosowanymi w dziedzinie medycyny. Czynności medyczne wykonywane przez lekarzy nie ograniczają się już tylko do działań podejmowanych w celu ratowania życia lub zdrowia bądź poprawy samopoczucia fizycznego i psychicznego pacjenta. Coraz bardziej na popularności zyskują czynności lekarskie określane jako nieterapeutyczne czynności medyczne, których przedmiotem jest co prawda organizm ludzki, jednak nie są podejmowane w celu leczniczym, bądź nie wyłącznie w tym celu. Wyodrębnienie pozaleczniczych czynności medycznych ma doniosłe znaczenie dla wielu kwestii prawnych, w szczególności dla określenia charakteru prawnego i przesłanek legalności ich przeprowadzania. Bowiem, o ile dokonywanie czynności leczniczych przez lekarza trudno uznać za niezgodne z prawem, o tyle w przypadku czynności nieterapeutycznych zagadnienie to nie jest takie oczywiste.Celem niniejszej pracy jest przedstawienie problematyki czynności nieterapeutycznych na tle eksperymentu medycznego jako jednej z czynności o takim właśnie charakterze. Nie można kwestionować potrzeby istnienia eksperymentów w medycynie i ich użyteczności. Bez wątpienia przyczyniają się one do postępu naukowego, bowiem to dzięki nim zawdzięczamy rozwój techniki i metod leczenia. Eksperyment medyczny na ludziach nie tylko dąży do poprawy metod profilaktyki, terapii czy diagnostyki pod względem skuteczności, wydajności czy jakości, lecz również przyczynia się do zrozumienia etiologii i patogenezy chorób.W pracy zostały przedstawione i szczegółowo omówione wybrane regulacje prawne, zarówno krajowe jak i międzynarodowe, związane z problematyką eksperymentu medycznego. Analiza problemów poruszonych w pracy prowadzi do sprecyzowania pojęcia eksperymentu medycznego zarówno w sferze prawnej, etycznej, jak i doktrynalnej. W opracowaniu dużo uwagi poświęcone zostało eksperymentowi leczniczemu ze względu na jego szczególny charakter jako czynności nieterapeutycznej. Ponadto, bardzo szczegółowo została omówiona problematyka zgody na zabiegi o charakterze eksperymentalnym, bowiem zagadnienie zgody stanowi kluczowy element problematyki prawnej eksperymentu. Istotność tego zagadnienia wynika z autonomii woli pacjenta i poszanowania jego prawa do samostanowienia oraz ze względu na zagrożenia i możliwości nadużyć, znane skądinąd z historii. Należy także pamiętać, że poza tym, iż stosowanie eksperymentów medycznych jest ogromnie potrzebne, to wiążą się one w większym lub mniejszym stopniu z nieuniknionym ryzykiem. Dlatego też w pracy szczegółowo zostało omówione to zagadnienie, zwłaszcza że odnosi się ono do wszystkich czynności pozaleczniczych, gdyż tolerancja dla ryzyka w sytuacji ich przeprowadzania jest znacznie większa niż przy czynnościach terapeutycznych. Wyznaczenie granic legalności eksperymentu oraz zasad jego przeprowadzania stanowi istotne zagadnienie przy rozważaniu problematyki eksperymentów medycznych.Nowadays, medicine creates a growing field of activities for doctors. Currently, a wide variety of activities fall within the definition of medical acts. Traditional medical interventions have long ceased to be the only methods used in the medical field. Medical procedures performed by doctors are no longer limited only to actions taken to save life or health or to improve the physical and mental well-being of the patient. Increasingly popular become medical activities defined as ‘non-therapeutic medical acts’ where the human body is indeed the object, however, they are not taken solely for medicinal purpose. Distinction of non-therapeutic medical acts is of major importance for many legal issues, in particular to the legal nature and rationale legality of their conduct. As far as making therapeutic interventions by a doctor can hardly be considered illegal, whereas in the case of non-therapeutic activities this issue is not so obvious.The aim of this master thesis is to present the issue of non-therapeutic actions in connection with medical experiment as one of the activities of such a character. One can not question the need for experimentation in medicine and its usefulness. Undoubtely, they contribute to scientific progress through the opportunity of developing techniques and methods of treatment. Human medical experimentation not only strives to improve the methods for prevention, treatment or diagnosis in terms of efficacy, efficiency or quality, but also contributes to the understanding of the etiology and pathogenesis. In this work were presented and discussed in detail selected regulations, both domestic and international, related to the issue of a medical experiment. The analysis of the issue raised in this work leads to the specification of the concept of a medical experiment in legal, ethical and doctrinal field. Because of its specific character, in the study has been devoted much attention on medicinal experiment as an example of non-therapeutic intervention. Moreover, in the thesis the consent issue has been disscussed in detail as a key matter for the treatments of an experimantal nature. The significance of this issue stems from the patient's autonomy and respect for their right to self-determination and because of the threats and opportunities of fraud, otherwise known from history. Although, apart from the fact that the use of medical experiments is extremely necessary, it is important to keep in mind that they are related to a greater or lesser degree of inherent risk. Therefore, this issue also has been raised in the study, especially beacause it is connected with all non-therapeutic acts, as the tolerance for risk while conducting them is much greater than in case of therapeutic intervention