Application of nuclear medicine techniques in sports medicine

Introduction and purpose: To briefly introduce the reader to the application of nuclear medicine studies in the diagnosis and treatment of musculoskeletal disorders developed among athletes.    Materials and methods: To prepare this review, publications indexed in the PubMed and Google Scholar databases were analyzed. Special attention was given to full-text articles published in English between 2015 and 2023, as well as to the references cited by the authors of selected publications. Description of the state of knowledge: Nuclear medicine is applied in the diagnosis and therapy of orthopedic conditions. Commonly used nuclear medicine techniques include planar bone scintigraphy (WBS), single-photon emission computed tomography (SPECT) combined with computed tomography (CT), and positron emission tomography (PET) combined with computed tomography (CT). Summary: The utilization of nuclear medicine techniques allows for proper diagnosis and early treatment of musculoskeletal disorders, including pathologies resulting from sports-related physical activity

Andexanet alfa - what we know about this promising drug

Introduction and purpose. Andexanet alfa (AA) is a recombinant modified version of human activated factor X. It is used as an antidote for apixsaban and rivaroxaban when reversal of anticoagulation due to life-threatening or uncontrolled bleeding is necessary. The aim of this paper is to present AA’s characteristics, treatment costs, clinical trial outcomes, and its use in medicine. Material and methods. A review of the available literature was performed by searching the PubMed and GoogleScholar databases using the following keywords: “andexanet alfa”, “factor Xa inhibitors”, “anticoagulant reversal”. Literature analysis. AA sequesters factor Xa inhibitors, which reactivates the endogenous factor Xa and reverses the anticoagulant effect. It is well tolerated, with a rapid onset of action. Side effects such as pneumonia, urinary tract infections and augmented thromboembolic risk have been observed. There are two dosing regimens, dependant on the ingested anticoagulant dose. Single dose cost is as high as 30 or 60 thousand USD. Conclusion. AA represents a therapeutic advancement and can prove life-saving in patients who experience an acute major bleeding while treated with direct oral anticoagulants. Single dose cost is high, therefore its availability for use may be restricted

Intranasal Treatment of Acute Rhinosinusitis - Recommendations, Efficacy and Safety

Introduction and purpose: Acute rhinosinusitis is a common condition worldwide, usually caused by respiratory viruses. Nasal epithelium is their primary point of entry and an active responder to the infection. Therefore, it seems reasonable for the treatment approach to include locally applied drugs. Our purpose is to bring forward up-to-date recommendations of intranasal treatment options for acute rhinosinusitis, and assess their efficacy and safety. Description of the state of knowledge: Rhinosinusitis is an inflammation of the mucosa present in the nose and the paranasal sinuses. It affects many patients yearly, bearing significant adverse effects on quality of life, productivity and healthcare expenditure. Acute rhinosinusitis lasts less than 12 weeks and is divided into viral, post-viral and acute bacterial rhinosinusitis. It is one of the prevailing reasons for unfounded antibiotics prescription, although it is usually self-limiting. Its treatment depends on the clinical stage of the infection, however, each of them encloses medications administered intranasally. Based on EPOS2020 and scientific publications it seems that nasal decongestants may be prescribed in viral rhinosinusitis, nasal corticosteroids in post-viral rhinosinusitis and nasal saline can prove beneficial in all clinical stages of rhinosinusitis. While used appropriately all aforementioned medications prove to be safe. Conclusions: In the light of the findings presented in this paper, it can be concluded that acute rhinosinusitis should be treated not only with oral, but also with intranasal drugs. Nasal decongestants are to be considered in viral rhinosinusitis mainly. Nasal corticosteroids show some positive effect in post-viral rhinosinusitis. Nasal saline can be administered in all clinical stages of acute rhinosinusitis. It is crucial to caution the patients against misuse of the medications, in order to prevent their adverse effects

Pharmacology and non-pharmacology treatment in a way of well controlled childhood asthma

Introduction and purpose: Asthma is a chronic disease of air pathways which is characterized by episodic or persistent reversible airflow obstruction with chronic inflammation of respiratory tract and increased bronchial reactivity. Our aim is to broaden patients’ knowledge concerning suitable diet and exercises which can help in controlling asthma symptoms. Description of the state of knowledge: A diet rich in vegetables and fruit contains a huge amount of fiber and anti-inflammatory flavonoids. introducing plant products into the diet of children with asthma improves parameters such as FEV1, FVC and PEF. Dairy products, on the other hand, are associated with worsening of these parameters and are not recommended for patients with asthma. The aforementioned effects are related to the presence of cow's milk protein and increased activity of interleukin 17. The Western diet being rich in animal fats and low in fiber is not recommended for patients with asthma. This is primarily due to resulting difficulty in maintaining a healthy body weight and the pro-inflammatory properties of animal fats. Conclusions: In light of the impact of a suitable diet on the reduction of asthma symptoms, it is recommended to increase the share of vegetables and fruit in the daily menu of asthmatics and to limit their consumption of animal fats. In addition, young patients are encouraged to undertake physical activity adapted to their individual abilities

The wind of change – PCSK9 inhibitors in hypolipidemic treatment. The Polish perspective

Introduction and aim. Cardiovascular diseases are the main cause of mortality in the world. One of the alterable risk factors of ischaemic heart disease is dyslipidemia. Discovery and usage of a new group of drugs - PCSK9 (proprotein convertase subtilisin/kexin type 9) inhibitors lead to a decrease of LDL-C (low-density lipoprotein cholesterol) levels in patients who are resistant to standard hypolipidemic therapy. The aim of this paper is to introduce PCSK9 inhibitors and describe their usage in medicine.  Material and methods. A review of the available literature was performed by searching the PubMed and GoogleScholar databases using the following key words: PCSK9 inhibitors; alirocumab; evolocumab; inclisiran.  Analysis of the literature. According to the European Society of Cardiology guidelines for dyslipidemias from year 2019, the main aim of dyslipidemia treatment is LDL-C reduction to target values depending on patient risk levels. It may be achieved in 2 ways, namely, by lifestyle modification or by pharmacological treatment with statins, fibrates and cholesterol absorption inhibitors. However, a therapy with PCSK9 inhibitors may be considered the most effective in certain groups of patients. Evolocumab and alirocumab are 2 representatives of those new drugs, which are allowed for use in 3 scenarios – in patients with familial hypercholesterolemia, in those with high risk of cardiovascular incident, and in those with statin intolerance. The major advantage of the aforementioned drugs is their safety. Since 2021 inclisiran (the first drug in siRNA class) is available for use as a new type of PCSK9 blocker.  Conclusion. PCSK9 inhibitors can be life-saving for patients with a high risk of cardiovascular incidents associated with an elevated level of LDL-C. They reduce LDL-C more efficiently and have fewer side effects in comparison with the other hypolipidemic drugs. Therefore, PCSK9 inhibitors play a very important role in the lipid-lowering treatment

Anabolic-androgenic steroids. Mechanism of action and clinical effects

Introduction and aim. Anabolic-androgenic steroids (AAS) are used for the rapid enhancement of muscular mass and optimization of athletic performance. Their administration is frequently linked with a plethora of adverse health implications. The primary objective of this study is to provide a comprehensive analysis of multifaceted impacts of anabolic-androgenic steroids on the human body. Material and methods. A review of literature was performed by searching PubMed and GoogleScholar databases using the following key words: anabolic-androgenic steroids, muscular hypertrophy, female masculinization. Analysis of the literature. Anabolic-androgenic steroids are synthetically manufactured derivatives of testosterone. Given the widespread distribution of the androgen receptor, the effects of these steroids are broad, influencing almost all bodily functions. Their impacts include, promoting muscular hypertrophy including that of the cardiac muscle, premature epiphyseal closure, liver diseases, masculinization in females, feminization in males, and degradation in sperm quality. Conclusion. AAS consumption is a significant public health problem. While they may appeal to users by enhancing their physical attractiveness they carry multiple health consequences. Patients should be educated about the adverse effects of taking AAS so they can make informed decision about starting or stopping their use

Supplementation of creatine and its role in brain function

Introduction and aim. In recent years growing awareness of the society regarding healthy lifestyle leads to increased interest in regular physical activity and usage of dietary supplements. Creatine supplementation is often used among athletes to improve muscle mass, performance and recovery. The aim of this paper is to present the effects of creatine supplementation as well as its function in the body, forms and ways of intake, and potential benefits of its use.   Material and methods. A review of the available literature was performed by searching the PubMed and GoogleScholar databases using the following keywords: creatine, creatine supplementation, sports nutrition, brain function  Analysis of literature. Creatine is one of the most popular supplements recommended for athletes. It catalyzes transfer of phosphate groups into high energy compounds contributing in energy transportation and cellular energy buffering for cells and tissues with high energy demands. Its supplementation improves exercise performance, increases muscle mass and enhances recovery after training. In addition, there are indications that creatine shows promise in reducing symptoms associated with concussion, mild traumatic brain injury, and depression.  Conclusion. Creatine supplementation is used in sport mainly to improve exercise performance and muscle gain,  however, it also plays an important role in brain function. In future it may be used in reducing symptoms associated with concussion, mild traumatic brain injury and depression. &nbsp

Intestinal microbiota and obesity

Introduction and purpose: The growing number of obese people is one of the greatest problems of modern medicine. It is estimated that every 10th person is obese. Recent studies also suggest that the gut microbiome may contribute to the pathogenesis of obesity. Description of the state of knowledge: Microbiota is named a super organ that has the ability to evolve in response to changing conditions within the host organism. It is named so because it is made up of over 100,000 billion cells that belong to different groups of organisms. Microbiota consists of bacteria, fungi, protists, viruses and archaea. This taxonomically diverse collective plays a vital role in maintaining the homeostasis of the human body. A well-balanced intestinal flora protects the digestive tract from colonization by pathogenic microorganisms, it is also important in maintaining the integrity of the intestinal walls, is involved in the synthesis of certain vitamins and plays a role in nourishing mucosa cells. Moreover, it is known that the microflora can influence body weight, insulin sensitivity, and  metabolism of certain sugars and lipids. Disturbances in the composition of the microbiome (dysbiosis) lead to an increased absorption of short-chain fatty acids, which leads to an increase in endogenous YY peptide synthesis. This protein slows down the intestinal transit and indirectly leads to increased absorption of nutrients. This predisposes to the development of obesity. The use of prebiotics, probiotics and some antibiotics reduces intestinal dysbiosis. For obese patients, it is associated with reduction of insulin resistance and decrease in blood glucose level. Conclusions: In the light of the available studies, it can be concluded that intestinal dysbiosis may play a role in the pathogenesis of obesity. Unfortunately, the practical application of this knowledge is not yet well documented. Therefore this topic requires further experiments and analysis. &nbsp

Lefamulin - a recently developed antibiotic for treatment of community-acquired bacterial pneumonia (CABP)

Introduction and aim. Nowadays, the increasing resistance of bacteria is a concerning and challenging issue in terms of effective treatment of bacterial infections. The amount of available antibiotics has been quite constant for many years. The search for substances alternative to older classes of drugs, among which resistance is growing, has been ongoing for years. One of the newly introduced available alternatives is lefamulin. The aim of this paper is to present the potential benefits of its use in comunity-acquired bacterial pneumonia (CABP).  Material and methods. A review of the available literature was performed by searching the PubMed and GoogleScholar databases using the following key words: lefamulin; BC3781; pleuromutilin; CABP; community acquired pneumonia. Analysis of literature. Lefamulin is a bacteriostatic antibiotic from the group of pleuromutilins, which has a unique mechanism of action consisting in binding to the bacterial 50S ribosomal subunit in the peptidyl transferase center. Thanks to this, it rarely causes resistance among other groups of antibiotics and is characterized by a safe action profile. Its spectrum of action includes bacteria causing CABP. In phase III studies, the efficacy of lefamulin monotherapy was comparable to that of moxifloxacin with or without linezolid in CABP.  Thanks to broad spectrum of action its usefulness may also extend to treatment of methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococcus faecium, and multidrug-resistant organisms associated with sexually transmitted infections, e.g., Neisseria gonorrhoeae, Mycoplasma genitalium, although more additional clinical and pharmacodynamic data is needed. Conclusion. Lefamulin is a promising addition to the antibiotic armamentarium for treating CABP. Its unique mechanism of action, activity against typical and atypical bacteria, flexible dosing options, and favorable safety profile make it a beneficial choice for clinicians.&nbsp

CT or Invasive Coronary Angiography in Stable Chest Pain.

Background: In the diagnosis of obstructive coronary artery disease (CAD), computed tomography (CT) is an accurate, noninvasive alternative to invasive coronary angiography (ICA). However, the comparative effectiveness of CT and ICA in the management of CAD to reduce the frequency of major adverse cardiovascular events is uncertain. Methods: We conducted a pragmatic, randomized trial comparing CT with ICA as initial diagnostic imaging strategies for guiding the treatment of patients with stable chest pain who had an intermediate pretest probability of obstructive CAD and were referred for ICA at one of 26 European centers. The primary outcome was major adverse cardiovascular events (cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke) over 3.5 years. Key secondary outcomes were procedure-related complications and angina pectoris. Results: Among 3561 patients (56.2% of whom were women), follow-up was complete for 3523 (98.9%). Major adverse cardiovascular events occurred in 38 of 1808 patients (2.1%) in the CT group and in 52 of 1753 (3.0%) in the ICA group (hazard ratio, 0.70; 95% confidence interval [CI], 0.46 to 1.07; P = 0.10). Major procedure-related complications occurred in 9 patients (0.5%) in the CT group and in 33 (1.9%) in the ICA group (hazard ratio, 0.26; 95% CI, 0.13 to 0.55). Angina during the final 4 weeks of follow-up was reported in 8.8% of the patients in the CT group and in 7.5% of those in the ICA group (odds ratio, 1.17; 95% CI, 0.92 to 1.48). Conclusions: Among patients referred for ICA because of stable chest pain and intermediate pretest probability of CAD, the risk of major adverse cardiovascular events was similar in the CT group and the ICA group. The frequency of major procedure-related complications was lower with an initial CT strategy. (Funded by the European Union Seventh Framework Program and others; DISCHARGE ClinicalTrials.gov number, NCT02400229.)