Repetitive transcranial magnetic stimulation in treatment of post polio syndrome

Background Post polio syndrome is a rare disease that occurs decades after polio virus infection. Repetitive transcranial magnetic stimulation (rTMS) is a treatment option with proved effectiveness in drug resistant depression. Possibly it can be helpful in therapy of other neurological diseases including post polio syndrome. Objective To describe a case of patient diagnosed with post polio syndrome who was treated with rTMS stimulation with a good effect. Methods Patient had rTMS stimulation of left prefrontal cortex twice a week for an eight weeks. Patient's health status was evaluated before treatment, after last rTMS session and after three months from the end of the treatment. Results Improvement of fatigue score, mood disturbances and motor functions was observed after treatment. Conclusion rTMS can be an effective method in treatment of post polio syndrome but further studies with larger group need to be done to confirm that data

Association between hemostatic markers, serum lipid fractions and progression of cerebral small vessel disease: A 2-year follow-up study

Introduction Little is known if hemostatic markers and serum lipid fractions can predict further radiological progression beyond vascular risk factors in cerebral small vessel disease (SVD). We investigated whether they are associated with SVD radiological progression and if they are related to different SVD clinical manifestations. Methods A single-center, prospective, cohort study with 2 years of radiological follow-up was performed in consecutive patients with different SVD manifestations. The study group consisted of 123 patients: 49 with lacunar stroke (LS), 48 with vascular dementia (VaD) and 26 with vascular parkinsonism (VaP). We assessed SVD progression by a visual SVD scale. We determined the relationship between serum or plasma concentrations of tissue factor (TF), thrombomodulin, beta-thromboglobulin (BTG), fibrinogen, D-dimer and total cholesterol, HDL-C, LDL-C, triglycerides and SVD progression by logistic regression analysis. Results 34.9% patients had SVD radiological progression: 43% had isolated WMLs progression, 23.2% had new lacunes, 34.8% had both WMLs progression and new lacunes. Fibrinogen [OR 1.02 (95% CI 1.006–1.011] was significantly associated with risk of new lacunes or WMLs progression regardless of the clinical SVD manifestation. While low HDL [OR 0.96 (0.93–1)] and TF [OR 1.07 (0.99–1.1)] were marginally associated with new lacunes, BTG [OR 1.005 (0.99–1.01)] was associated with WMLs progression. Conclusion We found a relationship between fibrinogen and risk of radiological progression of SVD regardless of the clinical SVD manifestation. In addition, lower HDL and increased TF predicted development of new lacunes, and higher BTG was associated with risk of WMLs progression

Post-polio syndrome. Cases report and review of literature

It is estimated that around 15 million people survived polio infection worldwide since early twentieth century. In 1950 effective vaccination was used for first time. Since that time number of affected people decreased. The last epidemic of Haine–Medine disease in Poland was in 1950s. Another rare cases of infections were observed till 1970s. About at least 15 years after polio virus infection, slowly progressive muscle limbs paresis with muscle atrophy, joints pain, paresthesia were observed in polio survivors. That constellation of symptoms was called post-polio syndrome (PPS). PPS frequency among people after paralytic and nonparalytic polio infectious is ranged from 30% to 80%. Fatigue that leads to physical and mental activity deterioration is another important symptom that is observed in 90% of patients with PPS. Etiology of disease remains elusive. Probably it is an effect of spine frontal horns motoneurons damage during acute virus polio infection that leads to overloading and degeneration of remaining ones. The most important risk factors of PPS are female sex and respiratory symptoms during acute polio infection. Electromyography is an important part of PPS diagnostic process. Electrophysiological abnormalities are seen in clinically affected and unaffected muscles. The most frequent are fasciculations and fibrillations during rest activity, extension of motor unit area, time duration and amplitude. In this study we described three cases of people who developed PPS years after Haine–Medine disease and correlation between their EMG results and clinical status. We also analyzed electromyography results both after one month since first PPS signs occurred as well as after few years. Presentation of dynamic changes in EMG was the most important aim of that study

Cardiac effects of mitoxanthrone therapy in patients with multiple sclerosis

Wstęp: Mitoksantron (MTX) jest syntetycznym antybiotykiem antracyklinowym stosowanym od kilku lat w leczeniu chorych z postacią pierwotnie i wtórnie postępującą oraz rzutowo-remisyjną stwardnienia rozsianego (MS), nieodpowiadających na terapię innymi lekami. Wykazuje działanie przeciwnowotworowe, immunomodulujące i przeciwbakteryjne. Najczęstszymi działaniami niepożądanymi stosowania MTX są nudności i wymioty, wypadanie włosów, zwiększone ryzyko infekcji dróg moczowych i oddechowych, brak miesiączki. Rzadziej występują: leukopenia, trombocytopenia, niedokrwistość, wzrost stężenia enzymów wątrobowych i bilirubiny. Innym groźnym następstwem stosowania MTX jest kardiotoksyczność leku oraz możliwość wywołania białaczki. Toksyczność leku wynika z jego powinowactwa do jonów żelaza. Kompleks ten ma silne właściwości tworzenia rodników tlenowych, a także nasilenia peroksydacji lipidów. U chorych na MS obserwowano bezob­jawowe klinicznie obniżenie frakcji wyrzutowej lewej komory (LVEF) w dwuwymiarowym badaniu echokardiograficznym (ECHO 2D), kardiomiopatię oraz zastoinową niewydolność serca, występującą z częstością 2,6–5%. W niewielu badaniach oceniono kardiotoksyczność MTX u chorych na MS. Większość dotychczasowych opracowań opiera się na małych grupach chorych leczonych onkologicznie i na ocenie funkcjonowania serca w badaniu przedmiotowym. Cel: Celem niniejszej pracy była ocena wpływu leczenia MTX na LVEF określonej w ECHO 2D. Metody: Badaniem objęto 72 pacjentów z MS w wieku 25–63 lat leczonych MTX w latach 2002–2014. Stwardnienie rozsiane rozpoznano na podstawie kryteriów McDonalda z 2001 r., uaktualnionych w 2005 r. W grupie z postacią pierwotnie postępującą było 40 (56%) osób, z wtórnie postępującą — 5 (7%) chorych oraz rzutowo-remisyjną MS — 27 (37%) pacjentów. Chorym podawano MTX w dawce 12 mg/m2 powierzchni ciała co 3 miesiące (do maksymalnej łącznej dawki 140 mg/m2). Warunkami włączenia pacjenta do leczenia MTX były: brak objawów niewydolności serca w badaniu przedmiotowym i prawidłowy zapis elektrokardiograficzny, prawidłowy wynik ECHO 2D z oceną LVEF, prawidłowe wyniki badań morfologicznych i biochemicznych krwi, w tym wartości enzymów wątrobowych i parametrów nerkowych. Przed każdorazowym podaniem MTX wykonywano ECHO 2D z pomiarem LVEF i elektrokardiogram oraz oceniano funkcjonowanie układu sercowo-naczyniowego w badaniu przedmiotowym. Wpływ leczenia MTX na wartość LVEF oceniano, porównując wartości LVEF przed rozpoczęciem terapii w stosunku do pomiaru wykonanego przed podaniem ostatniej dawki MTX. W analizie danych posłużono się testem t-Studenta. Wyniki: W wyjściowym ECHO 2D serca u chorych na MS wykonanym przed podaniem pierwszej dawki MTX średnia wartość LVEF wynosiła 65 ± 3,3%. Najniższa wartość LVEF w końcowym ECHO 2D wynosiła 60 ± 2,1%. Nie wykazano istotnego statystycznie obniżenia LVEF w czasie leczenia MTX chorych na MS w stosunku do wartości sprzed terapii. W badanej grupie chorych nie odnotowano ciężkiego uszkodzenia mięśnia sercowego objawiającego się znacznym obniżeniem LVEF w ECHO 2D lub niewydolnością serca w badaniu przedmiotowym. Wnioski: Wyniki badań nie wykazały istotnego obniżenia LVEF w trakcie monoterapii MTX u chorych na MS, nieobciążo­nych kardiologicznie, z prawidłowym wynikiem wstępnego badania echokardiograficznego. Dalszych badań wymaga ocena długoterminowego wpływu MTX na mięsień sercowy.  Background: Mitoxanthrone (MTX) is a synthetic anthracycline antibiotic that has been used for several years in the treatment of patients with primary progressive, secondary progressive, and relapsing remitting multiple sclerosis (MS) who do not respond to other drugs. MTX has antineoplastic, immunomodulatory, and antibacterial properties. The most common adverse effects of MTX include nausea and vomiting, hair loss, increased risk of urinary and respiratory tract infections, and amenorrhea. Less frequent problems include leukopenia, thrombocytopenia, anaemia, and an increase in hepatic enzyme and bilirubin levels. Other severe sequelae of MTX treatment are drug cardiotoxicity and a potential to induce leukaemia. Drug toxicity results from its affinity to iron ions. The resulting complex strongly induces formation of free oxygen radicals and increases lipid peroxidation. Asymptomatic reduction in left ventricular ejection fraction (LVEF) by two-dimensional (2D) echocardiography, cardiomyopathy, and congestive heart failure have been observed in patients with MS at a rate of about 2.6–5%. Few studies evaluated cardiotoxicity of MTX in MS patients. Most previous studies were performed in small groups of cancer patients and cardiac evaluation was limited to physical examination. Aim: To evaluate the effect of MTX treatment on LVEF by 2D echocardiography. Methods: We studied 72 MS patients aged 25–63 years who were treated with MTX in 2002–2014. The diagnosis of MS was made using the 2001 McDonald criteria updated in 2005. The study group included primary progressive MS in 40 (56%) patients, secondary progressive MS in 5 (7%) patients, and relapsing remitting MS in 27 (37%) patients. MTX was administered at 12 mg/m2 of body surface area every 3 months (up to the total dose of 140 mg/m2). MTX treatment was initiated in patients with no signs of heart failure on physical examination, normal electrocardiogram (ECG), normal LVEF by 2D echocardiogra­phy, and normal laboratory test findings including complete blood count and hepatic and renal function parameters. Each MTX administration was preceded by 2D echocardiography with LVEF measurement, ECG, and physical examination of the cardiovascular system. The effect of MTX treatment on LVEF was evaluated by comparing baseline LVEF with LVEF measure­ments before the last MTX dose. Statistical analysis was performed using the Student t test. Results: The mean LVEF before administration of the first MTX dose was 65 ± 3.3%. The lowest LVEF at the final 2D echo­cardiographic examination was 60 ± 2.1%. We did not find a significant LVEF reduction during MTX treatment in MS patients compared to baseline values. Severe myocardial dysfunction manifesting with significant LVEF reduction by 2D echocardiog­raphy or clinical evidence of heart failure was not noted in any patient in the study group. Conclusions: Our study showed no significant LVEF reduction during MTX monotherapy in MS patients without a history of a cardiac disease and with normal echocardiographic findings at baseline. Long-term cardiac effects of MTX require fur­ther studies.

Integrative and Conjugative Elements and Prophage DNA as Carriers of Resistance Genes in <i>Erysipelothrix rhusiopathiae</i> Strains from Domestic Geese in Poland

Goose erysipelas is a serious problem in waterfowl breeding in Poland. However, knowledge of the characteristics of Erysipelothrix rhusiopathiae strains causing this disease is limited. In this study, the antimicrobial susceptibility and serotypes of four E. rhusiopathiae strains from domestic geese were determined, and their whole-genome sequences (WGSs) were analyzed to detect resistance genes, integrative and conjugative elements (ICEs), and prophage DNA. Sequence type and the presence of resistance genes and transposons were compared with 363 publicly available E. rhusiopathiae strains, as well as 13 strains of other Erysipelothrix species. Four strains tested represented serotypes 2 and 5 and the MLST groups ST 4, 32, 242, and 243. Their assembled circular genomes ranged from 1.8 to 1.9 kb with a GC content of 36–37%; a small plasmid was detected in strain 1023. Strains 1023 and 267 were multidrug-resistant. The resistance genes detected in the genome of strain 1023 were erm47, tetM, and lsaE-lnuB-ant(6)-Ia-spw cluster, while strain 267 contained the tetM and ermB genes. Mutations in the gyrA gene were detected in both strains. The tetM gene was embedded in a Tn916-like transposon, which in strain 1023, together with the other resistance genes, was located on a large integrative and conjugative-like element of 130 kb designated as ICEEr1023. A minor integrative element of 74 kb was identified in strain 1012 (ICEEr1012). This work contributes to knowledge about the characteristics of E. rhusiopathiae bacteria and, for the first time, reveals the occurrence of erm47 and ermB resistance genes in strains of this species. Phage infection appears to be responsible for the introduction of the ermB gene into the genome of strain 267, while ICEs most likely play a key role in the spread of the other resistance genes identified in E. rhusiopathiae

Diagnosis and management of neuropathic pain: Review of literature and recommendations of the Polish Association for the Study of Pain and the Polish Neurological Society – Part one

Neuropathic pain still present a major diagnostic and therapeutic challenge despite considerable progress in understanding of its mechanisms and publication of number of studies which assessed the efficacy and safety of drugs used in the symptomatic treatment. In practice, it is diagnosed less frequently than recognised in the epidemiological studies, and many patients do not achieve satisfactory outcomes of treatment. A multidisciplinary team of Polish experts, commissioned by the Polish Association for the Study of Pain and the Polish Neurological Society, has reviewed the literature on neuropathic pain, with special focus on the published international recommendations, and formulated recommendations on neuropathic pain diagnosis and treatment, in accordance with the principles of evidence-based medicine. The paper presents also background information on the neuropathic pain definition, epidemiology, pathomechanism and method of assessment. The diagnosis of neuropathic pain may be established based on medical history and physical examination including special assessment of the somatosensory system. First-line drugs used in pharmacological management of neuropathic pain are: tricyclic antidepressants, serotonin and norepinephrine reuptake inhibitors, gabapentin, pregabalin, opioids and lidocaine patches

Diagnosis and management of neuropathic pain: Review of literature and recommendations of the Polish Association for the Study of Pain and the Polish Neurological Society – Part Two

Neuropathic pain may be caused by a variety of lesions or diseases of both the peripheral and central nervous system. The most common and best known syndromes of peripheral neuropathic pain are painful diabetic neuropathy, trigeminal and post-herpetic neuralgia, persistent post-operative and post-traumatic pain, complex regional pain syndrome, cancer-related neuropathic pain, HIV-related neuropathic pain and pain after amputation. The less common central pain comprises primarily central post-stroke pain, pain after spinal cord injury, central pain in Parkinson disease or in other neurodegenerative diseases, pain in syringomyelia and in multiple sclerosis. A multidisciplinary team of Polish experts, commissioned by the Polish Association for the Study of Pain and the Polish Neurological Society, has reviewed the literature on various types of neuropathic pain, with special focus on the available international guidelines, and has formulated recommendations on their diagnosis and treatment, in accordance with the principles of evidence-based medicine (EBM). High quality studies on the efficacy of various medicines and medical procedures in many neuropathic pain syndromes are scarce, which makes the recommendations less robust

ProTheRaMon : a GATE simulation framework for proton therapy range monitoring using PET imaging

Objective. This paper reports on the implementation and shows examples of the use of the ProTheRaMon framework for simulating the delivery of proton therapy treatment plans and range monitoring using positron emission tomography (PET). ProTheRaMon offers complete processing of proton therapy treatment plans, patient CT geometries, and intra-treatment PET imaging, taking into account therapy and imaging coordinate systems and activity decay during the PET imaging protocol specific to a given proton therapy facility. We present the ProTheRaMon framework and illustrate its potential use case and data processing steps for a patient treated at the Cyclotron Centre Bronowice (CCB) proton therapy center in Krakow, Poland. Approach. The ProTheRaMon framework is based on GATE Monte Carlo software, the CASToR reconstruction package and in-house developed Python and bash scripts. The framework consists of five separated simulation and data processing steps, that can be further optimized according to the user’s needs and specific settings of a given proton therapy facility and PET scanner design. Main results. ProTheRaMon is presented using example data from a patient treated at CCB and the J-PET scanner to demonstrate the application of the framework for proton therapy range monitoring. The output of each simulation and data processing stage is described and visualized. Significance. We demonstrate that the ProTheRaMon simulation platform is a high-performance tool, capable of running on a computational cluster and suitable for multi-parameter studies, with databases consisting of large number of patients, as well as different PET scanner geometries and settings for range monitoring in a clinical environment. Due to its modular structure, the ProTheRaMon framework can be adjusted for different proton therapy centers and/or different PET detector geometries. It is available to the community via github (Borys et al 2022)

The 42nd Symposium Chromatographic Methods of Investigating Organic Compounds : Book of abstracts

The 42nd Symposium Chromatographic Methods of Investigating Organic Compounds : Book of abstracts. June 4-7, 2019, Szczyrk, Polan