The current possible treatment approaches of Polycystic Ovary Syndrome (PCOS)

Introduction             Polycystic ovary syndrome (PCOS), first described by Stein and Leventhal in 1935, is one of the most prevalent endocrine system conditions affecting women of reproductive age. It affects between 6% and 13% of women and the majority of cases are identified between the ages of 20 and 30. Unfortunately, the disease is usually diagnosed only when bothersome symptoms such as hair loss, alopecia, acne, and infertility-related problems occur. Based on the Rotterdam criteria, four phenotypes of PCOS are distinguished. Aim of the study             This review aims to present the current state of knowledge about possible treatment approaches, both non-pharmacological and pharmacological. Materials and methods            The paper was created based on the Pubmed database. The literature was reviewed using the keywords: ”PCOS”, ”PCOS treatment” and “ PCOS medications “. The current state of knowledge           Treatments for PCOS must be tailored to the specific needs of each patient. In the management of PCOS, special attention is paid to diet, physical activity, and restoration of the Gut Microbiome. Medications used in therapy are oral contraceptives and anti-androgens, insulin sensitizers, ovulation inducers, calcium and vitamin D supplements, statins, Glucagon-like-peptide-1 (GLP-1) agonists, inositols and interleukin 22 (IL-22)  therapy. Summary            Treatment options for menstrual irregularities and hirsutism are based on the clinical goals and preferences of the patient. The ideal would be causal treatment, but due to the ongoing lack of full understanding of the pathogenesis of the syndrome, is not entirely feasible. The ideal would be causal treatment, but due to the ongoing lack of full understanding of the pathogenesis of the syndrome, is not entirely feasible. The most important is a multimodal approach to treat comorbid conditions such as diabetes mellitus type 2, obesity, hyperlipidemia, depression, and infertility

The multimodal approach to obesity treatment – current pharmacological and surgical methods and lifestyle changes

Introduction            Obesity is one of the major health problems of today’s population and is defined as a body mass index ≥ 30 kg/m2.  It is known that obesity may cause many complications such as type 2 diabetes, cardiovascular disease, osteoarthritis, obstructive sleep, apnoea, and several cancers. The only effective treatment of obesity can be pharmacological or surgical, especially when a years-long attempt to change habits has had no effects.  Aim of the study This review aims to present the current state of knowledge about non-pharmacological and pharmacological obesity treatment methods. Materials and methods            The paper was created based on the Pubmed database. The literature was reviewed using the keywords: ”obesity”, ”obesity treatment”, “ obesity lifestyle changes”, “obesity medications” and ”obesity surgery”. The current state of knowledge           The treatment of obesity requires a multimodal approach to treatment, including the addition of anti-obesity medications or bariatric surgery, or both, to assist people in reaching and sustaining sufficient weight loss to meet treatment goals. The 3 principal components of a comprehensive lifestyle intervention are diet, physical activity, and behavioral therapy. Among available anti-obesity medications include orlistat, phentermine, topiramate, naltrexone, bupropion, liraglutide, and semaglutide. Summary            The key challenge in the treatment of obesity is to maintain the effects obtained with multimodal therapy. Without proper motivation of patients and changes in eating and behavioral habits, it is impossible to achieve optimal results, therefore, in addition to medical interventions, more and more attention should be paid to psychological interventions

Factors influencing occurrence and duration of partial remission in patients with type 1 diabetes

WSTĘP. Celem badania była ocena czynników wpływających na wystąpienie i czas trwania częściowej remisji u chorych na cukrzycę typu 1. MATERIAŁ I METODY. Obserwacją prospektywną objęto 136 pacjentów z nowo rozpoznaną cukrzycą typu 1. Analizie poddano ocenę parametrów wyrównania metabolicznego cukrzycy oraz liczne dane uzyskane z przeprowadzonego badania ankietowego. WYNIKI. Po 3 miesiącach od hospitalizacji remisję stwierdzono u 98 pacjentów. U 35 osób remisja trwała powyżej 2 lat, u 24 - 1-2 lata, a u 39 - poniżej 1 roku. Osoby z remisją w porównaniu z grupą bez remisji przy rozpoznaniu choroby charakteryzowały się niższymi wartościami glikemii: na czczo, 2 godziny po posiłku, o godzinie 3.00 w nocy i triglicerydemii oraz wyższymi wartościami cholesterolu frakcji HDL. Dzienne zapotrzebowanie na egzogenną insulinę w dniu wypisania ze szpitala było niższe w grupie pacjentów z remisją. W modelu regresji logistycznej stwierdzono statystycznie istotną zależność między wystąpieniem remisji a zapotrzebowaniem na egzogenną insulinę podczas pierwszej hospitalizacji oraz stężeniem triglicerydów. Osoby z częściową remisją dysponowały większymi środkami finansowymi na leczenie, cechowały się niższym poziomem stresu, rzadziej piły kawę i paliły tytoń. Pacjenci z ponad 2-letnim okresem remisji, w porównaniu z chorymi z okresem remisji poniżej 1 roku, charakteryzowali się krótszym okresem od rozpoznania cukrzycy do rozpoczęcia edukacji i leczenia metodą intensywnej czynnościowej insulinoterapii. WNIOSKI. Stopień zaburzeń metabolicznych przy rozpoznaniu cukrzycy typu 1, a także styl życia pacjentów mają istotny wpływ na wystąpienie okresu remisji. Szybkie rozpoznanie choroby i wdrożenie intensywnej czynnościowej insulinoterapii zwiększają szansę na wydłużenie okresu remisji.INTRODUCTION. The aim of this study was to analyze parameters influencing on occurrence and duration of remission in patients with type 1 diabetes. MATERIAL AND METHODS. 136 patients with newly diagnosed type 1 diabetes were qualified to the prospective study. Metabolic control parameters and several data collected on the basis of questionnaires were taken into analyze. RESULTS. Three months after hospitalization 98 subjects achieved partial remission. 35 patients had a duration of remission above 2 years, 24 patients between one year and two, and 39 subjects below one year. When compared with patients who didn’t experience remission remittents showed lower: fasting plasma glucose, postprandial plasma glucose, glycaemia on 3 a.m., serum triglyceride and higher HDL-cholesterol levels. Total daily insulin requirement at discharge from hospital was significantly lower in remission group. Using logistic regression significant association between insulin requirement level of triglyceride and occurrence of remission was found. According to the analysis of questionnaires group with remission characterized bigger founds to treatment, less stressful live, more seldom drinking coffee and smoking. In patients with duration of remission above 2 years we observed: shorter duration of diabetes before introduction of education and intensive functional insulin therapy, in comparison with subjects with duration below 1 year. CONCLUSIONS. Metabolic disturbances prior to diagnosis, as well as style of life determine occurrence of remission phase in patients with type 1 diabetes. The faster the diagnosis of type 1 diabetes is made and the earlier the intensive functional insulin therapy is introduced the longer the duration of partial remission is

A new approach to ticagrelor-based de-escalation of antiplatelet therapy after acute coronary syndrome. A rationale for a randomized, double-blind, placebo-controlled, investigator-initiated, multicenter clinical study

© 2021 Via Medica. This article is available in open access under Creative Common Attribution-Non-Commercial-No Derivatives 4.0 International (CC BY-NC-ND 4.0) license. https://creativecommons.org/licenses/by/4.0/The risk of ischemic events gradually decreases after acute coronary syndrome (ACS), reaching a stable level after 1 month, while the risk of bleeding remains steady during the whole period of dual antiplatelet treatment (DAPT). Several de-escalation strategies of antiplatelet treatment aiming to enhance safety of DAPT without depriving it of its efficacy have been evaluated so far. We hypothesized that reduction of the ticagrelor maintenance dose 1 month after ACS and its continuation until 12 months after ACS may improve adherence to antiplatelet treatment due to better tolerability compared with the standard dose of ticagrelor. Moreover, improved safety of treatment and preserved anti-ischemic benefit may also be expected with additional acetylsalicylic acid (ASA) withdrawal. To evaluate these hypotheses, we designed the Evaluating Safety and Efficacy of Two Ticagrelor-based De-escalation Antiplatelet Strategies in Acute Coronary Syndrome — a randomized clinical trial (ELECTRA-SIRIO 2), to assess the influence of ticagrelor dose reduction with or without continuation of ASA versus DAPT with standard dose ticagrelor in reducing clinically relevant bleeding and main-taining anti-ischemic efficacy in ACS patients. The study was designed as a phase III, randomized, multicenter, double-blind, investigator-initiated clinical study with a 12-month follow-up.Peer reviewedFinal Published versio

Comparison of reorganized versus unaltered cardiology departments during the COVID-19 era: a subanalysis of the COV-HF-SIRIO 6 study

Background: Since the beginning of the coronavirus disease-2019 (COVID-19) pandemic, numerous cardiology departments were reorganized to provide care for COVID-19 patients. We aimed to compare the impact of the COVID-19 pandemic on hospital admissions and in-hospital mortality in reorganized vs. unaltered cardiology departments. Methods: The present subanalysis is a multicenter retrospective COV-HF-SIRIO 6 study that includes all patients (n = 101,433) hospitalized in 24 cardiology departments in Poland between January 1, 2019 and December 31, 2020, with a focus on patients with acute heart failure (AHF). Results: Reduction of all-cause hospitalizations was 50.6% vs. 21.3% for reorganized vs. unaltered cardiology departments in 2020 vs. 2019, respectively (p < 0.0001). Considering AHF alone respective reductions by 46.5% and 15.2% were registered (p < 0.0001). A higher percentage of patients was brought in by ambulance to reorganized vs. unaltered cardiology departments (51.7% vs. 34.6%; p < 0.0001) alongside with a lower rate of self-referrals (45.7% vs. 58.4%; p < 0.0001). The rate of all-cause in-hospital mortality in AHF patients was higher in reorganized than unaltered cardiology departments (10.9% vs. 6.4%; p < 0.0001). After the exclusion of patients with concomitant COVID-19, the mortality rates did not differ significantly (6.9% vs. 6.4%; p = 0.55). Conclusions: In cardiology departments reorganized to provide care for COVID-19 patients vs. unaltered ones, observed: i) a greater reduction in hospital admissions in 2020 vs. 2019; ii) higher rates of patients brought by ambulance and lower rates of self-referrals; and iii) higher all-cause in-hospital mortality for AHF due to COVID-19 related deaths

Geomorphometric and Geophysical Constraints on Outlining Drained Shallow Mountain Mires

Long-term draining of peatlands results in transformation of vegetation and obliteration of their morphological features. In many areas, efforts are made to restore the original ecosystems and increase their water retention potential. Using combined analyses of a LiDAR-based digital terrain model (DTM), colour-infrared (CIR) imagery data, ground-penetrating radar (GPR) data and electrical resistivity tomography (ERT) data, we tested the applicability of these methods in outlining the extent and subsurface structure of drained mires located in the Stolowe Mountains National Park area, Poland. The LiDAR-DTMs enabled parameterisation of physiographic features of the mires and determination of their extent, runoff directions and potential waterlogging areas. CIR analysis enabled classification of vegetation types. GPR prospecting revealed the bedrock morphology, thickness and internal structure of the peat deposits, showing that this technique can also provide data on variability in the decomposition of phytogenic deposits. The obtained ERT sections indicate both the thickness of peat deposits and variability in the bedrock internal structure. The results show that integrated analyses of data obtained with different methods can be an effective tool in outlining the original extent of peatlands, with potential application in the planning of peatland ecosystem restitution

Effects of Concentration and Type of Lipids on the Droplet Size, Encapsulation, Colour and Viscosity in the Oil-in-Water Emulsions Stabilised by Rapeseed Protein

The objective of this study was to extract the rapeseed protein from by-products and further examine the effect of lab-made rapeseed protein on the droplet size, microstructure, colour, encapsulation and apparent viscosity of emulsions. Rapeseed protein-stabilised emulsions with an increasing gradient of milk fat or rapeseed oil (10, 20, 30, 40 and 50%, v/v) were fabricated using a high shear rate homogenisation. All emulsions showed 100% oil encapsulation for 30 days of storage, irrespective of lipid type and the concentration used. Rapeseed oil emulsions were stable against coalescence, whereas the milk fat emulsion showed a partial micro-coalescence. The apparent viscosity of emulsions raised with increased lipid concentrations. Each of the emulsions showed a shear thinning behaviour, a typical behaviour of non-Newtonian fluids. The average droplet size was raised in milk fat and rapeseed oil emulsions when the concentration of lipids increased. A simple approach to manufacturing stable emulsions offers a feasible hint to convert protein-rich by-products into a valuable carrier of saturated or unsaturated lipids for the design of foods with a targeted lipid profile