Clinical, ultrasound parameters and tumor marker-based mathematical models and scoring systems in pre-surgical diagnosis of adnexal tumors

The choice of management for patients with adnexal tumors requires careful pre-surgical assessment. In case of adnexal masses, the diagnostic difficulties arise from the heterogenic nature of the adnexal diseases, presence of multiple functional changes, and lack of early symptoms of malignancy. A reliable pre-surgical differentiation cannot be performed using clinical features, ultrasound examination, or tumor markers alone. New diagnostic techniques and novel markers are under investigations, however no single test can be used to conclusively differentiate between malignant and non-malignant adnexal masses. Mathematical models and scoring systems based on different clinical, ultrasonographic and laboratory parameters alone or together may facilitate the diagnosis. Selected mathematical models and scoring systems are presented in this article. Models using only ultrasound features include simple rules, regression models, Gynecologic Imaging Report and Data System, and various morphologic scores. Some logistic regression models are based on multiple clinical and ultrasound data. The OVA1 test is based on five tumor markers without using other data. The Risk of Malignancy Algorithm uses two tumor markers with one clinical parameter. i.e. the menopausal status. Some models used clinical, ultrasound and tumor marker data together. This group of models includes risk of malignancy indices, artificial neural networks, and the ADNEX model. Although some of these models have been compared in the literature, more prospective studies are needed to select the most effective model, to develop the existing models, or to create new more effective models of oncological assessment of the adnexal tumors

Causes of hoarseness - systematic review

Introduction and purpose of the work: Hoarseness is a symptom of a disease characterized by a hoarse, tense or hoarse voice resulting from disturbance of the vibration of the vocal folds. It is a common symptom of the disease in patients during medical consultations in primary health care, and the causes of its occurrence can be varied. State of knowledge (brief description): Treating hoarseness depends on what causes it. For this reason, during the diagnosis, various causes that may be the cause of hoarseness should be taken into account, such as infections, structural changes caused by the use of the voice organ, psychogenic causes, autoimmune diseases, systemic diseases or neoplastic diseases. Summary: In-depth diagnosis and an interdisciplinary approach are necessary to identify the cause of chronic hoarseness and initiate effective treatment

Drugs increase the risk of suicide in the elderly

The purpose of this paper is a systematic review of articles and research in the context of drugs used and suicide in elderly patients. Suicide in the elderly may be much more frequent than in the younger population. In addition to factors such as mental illness, dementia, deteriorating health, or problems with adapting to old age, the impact of chronic and reliever medications in this age group should also be considered. The greatest challenge of pharmacotherapy in the elderly is polypharmacy, drug interactions, different metabolism, pharmacokinetics and pharmacodynamics of the drugs used, as well as the side effects appearing in chronic therapy. In elderly patients, strong groups of drugs such as benzodiazepines and opioids are used extensively and sometimes too often. These drugs can cause addiction and overdose. Prescribing benzodiazepines alone carries a high risk of suicide. On the other hand, opioids often lead to addiction and abuse of these drugs, which may be associated with the development of respiratory depression. According to estimates by the Centers for Disease Control and Prevention (CDC), suicide accounts for approximately 7% of all opioid overdose deaths. Therapy should be carefully selected with regard to the use of other medications, drug interactions, and possible dependence and drug abuse by patients.The use of some classes of drugs in the elderly requires increased vigilance and control in the context of depression and episodes of suicide attempts. Drugs such as B blockers, digitalis glycosides, NSAIDs, opioids, ACEIs, calcium channel blockers, corticosteroids, diuretics, levodopa, and benzodiazepines can cause symptoms of depression. Older people are more susceptible to side effects of drugs, for example because of polypharmacy and the chronicity of treatment

New treatment strategies for bipolar disorder in the elderly

Introduction and objective: The purpose of this paper is to systematically review articles and new research in the context of bipolar geriatric patients. Materials and methods: PubMed searches were completed using the key terms bipolar disorder, bipolar elderly, bipolar depression, bipolar elderly treatment and review articles. In addition, references in these resources were searched. Search dates: 2010 to 2022. Description of the state of knowledge: Mental disorders in the context of the elderly concern all depressive disorders. A problem with other disorders such as bipolar disorder is also increasingly recognized. In the elderly, it is quite rare in the general cross-section of society, but it may have a higher percentage, e.g. in nursing homes and care institutions. This review article shows both the difference and the similarities in the course of this disease in older and younger patients. The most important and common aspect for both age groups is psychotherapy with parallel pharmacological treatment. The greatest difficulty in pharmacotherapy in the elderly is polypharmacy and numerous drug interactions, as well as different pharmacodynamics and pharmacokinetics of the drugs used compared to younger patients. Attention should also be paid to the differentiation of bipolar disorder from different types of dementia and other cognitive disorders. Therefore, one should strive to carefully assess the patient's need for a given treatment, establish appropriate periodic monitoring of treatment, and assess the risk of taking or not intervening. This article also aims to review new research and drugs that seem promising, while the individualized and interdisciplinary approach to a geriatric patient with BD is the most important finding of this review. Summary: Bipolar disorder in older people, compared to the younger population, should be treated pharmacologically in combination with psychotherapy. The elderly patient population requires a multidisciplinary approach due to the number of drugs used in a large number of diseases

Antiemetic drugs used during anticancer chemotherapy, with special emphasis on aprepitant

Nausea and vomiting are symptoms occurring in 70% of patients treated for late-stage cancer, exerting a tremendous impact on their quality of life and everyday activity. Severity of nausea and vomiting depends on the following factors: type and dose of cytostatic agent, treatment protocol and way of administration, as well as on the patient’s age, gender and alcohol abuse. Novel antiemetic drugs include EMEND, containing aprepitant as active substance. It acts by blocking neurokinin 1 receptor (NK1). In vivo, NK1 receptor is activated by binding substance P, which results in feeling of nausea and vomiting. EMEND blocks this reaction by preventing binding of substance P to the NK1 receptor. Furthermore, this agent does not show any affinity to serotonin-, dopamine- or corticosteroid-associated receptors. In spite of a noticeable progress in cancer chemotherapy, no worthwhile improvement has been obtained in the treatment of nausea and vomiting – well known adverse effects of cytostatics, considerably compromising the patients’ quality of life. Therefore, in 2009, representatives of two scientific societies – the European Society for Medical Oncology (ESMO) and the Multinational Association of Supportive Care in Cancer (MASCC) – have met in Perugia, Italy, in order to develop a consensus concerning preventive and therapeutic management in this group of patients. This meeting has produced recommendations for prevention and treatment of chemotherapy-associated nausea and vomiting. These guidelines, depending on goal of prevention, are presented in the paper.Nudności i wymioty to objawy występujące u 70% leczonych pacjentów z zaawansowaną chorobą nowotworową, mające ogromny wpływ na ich jakość życia i codzienną aktywność. Nasilenie nudności i wymiotów zależy od następujących czynników: rodzaju chemioterapeutyku, dawki leku, programu leczenia oraz drogi podania leku, a także od wieku, płci, nadużywania alkoholu. Do nowych leków przeciwwymiotnych należy EMEND, którego substancją czynną jest aprepitant. Charakteryzuje się on działaniem antagonistycznym do receptora neurokininy 1 (NK1). In vivo receptor NK1 jest pobudzany przez połączenie z substancją P i to związanie powoduje wystąpienie uczucia nudności oraz wymioty. EMEND, wykazując działanie blokujące tę reakcję, uniemożliwia przyłączenie się substancji P do receptora NK1. Jednocześnie aprepitant nie wykazuje powinowactwa do receptora serotoninowego, dopaminowego ani dla kortykosteroidów. Pomimo ogromnego rozwoju w zakresie leczenia chemioterapeutycznego chorych na nowotwory złośliwe nie dokonał się znaczny postęp w zakresie leczenia nudności i wymiotów – objawów niepożądanych leczenia cytostatykami istotnie obniżających jakość życia pacjentów. Z tego względu w roku 2009 przedstawiciele dwóch towarzystw naukowych – European Society for Medical Oncology (ESMO) oraz Multinational Association of Supportive Care in Cancer (MASCC) – spotkali się w Perugii w celu wypracowania konsensusu w postępowaniu profilaktycznym i leczniczym w tej grupie chorych. W trakcie spotkania doprowadzono do przedstawienia zaleceń w postępowaniu profilaktycznym i leczniczym w tej grupie chorych. Zalecenia te w zależności od celu profilaktyki przedstawiono w poniższym tekście

Acrylamide Content in Breast Milk: The Evaluation of the Impact of Breastfeeding Women’s Diet and the Estimation of the Exposure of Breastfed Infants to Acrylamide in Breast Milk

Acrylamide in food is formed by the Maillard reaction. Numerous studies have shown that acrylamide is a neurotoxic and carcinogenic compound. The aim of this study was to determine the level of acrylamide in breast milk at different lactation stages and to evaluate the impact of breastfeeding women’s diet on the content of this compound in breast milk. The acrylamide level in breast milk samples was determined by LC–MS/MS. Breastfeeding women’s diet was evaluated based on the 24 h dietary recall. The median acrylamide level in colostrum (n = 47) was significantly (p < 0.0005) lower than in the mature milk (n = 26)—0.05 µg/L and 0.14 µg/L, respectively. The estimated breastfeeding women’s acrylamide intake from the hospital diet was significantly (p < 0.0001) lower than that from the home diet. We found positive—although modest and borderline significant—correlation between acrylamide intake by breastfeeding women from the hospital diet µg/day) and acrylamide level in the colostrum (µg/L). Acrylamide has been detected in human milk samples, and a positive correlation between dietary acrylamide intake by breastfeeding women and its content in breast milk was observed, which suggests that the concentration can be reduced. Breastfeeding women should avoid foods that may be a source of acrylamide in their diet

Acrylamide Content in Breast Milk: The Evaluation of the Impact of Breastfeeding Women’s Diet and the Estimation of the Exposure of Breastfed Infants to Acrylamide in Breast Milk

Acrylamide in food is formed by the Maillard reaction. Numerous studies have shown that acrylamide is a neurotoxic and carcinogenic compound. The aim of this study was to determine the level of acrylamide in breast milk at different lactation stages and to evaluate the impact of breastfeeding women’s diet on the content of this compound in breast milk. The acrylamide level in breast milk samples was determined by LC–MS/MS. Breastfeeding women’s diet was evaluated based on the 24 h dietary recall. The median acrylamide level in colostrum (n = 47) was significantly (p p < 0.0001) lower than that from the home diet. We found positive—although modest and borderline significant—correlation between acrylamide intake by breastfeeding women from the hospital diet µg/day) and acrylamide level in the colostrum (µg/L). Acrylamide has been detected in human milk samples, and a positive correlation between dietary acrylamide intake by breastfeeding women and its content in breast milk was observed, which suggests that the concentration can be reduced. Breastfeeding women should avoid foods that may be a source of acrylamide in their diet

Tyrosol and Hydroxytyrosol: Their Role in Cardioprotection

Introduction: Recent research are focused on natural compounds for preventing cardiovascular diseases, with emphasis on tyrosol and hydroxytyrosol in olive oil. Cardiovascular diseases are linked to risk factors, and adopting a Mediterranean diet rich in these compounds is recognized for reducing risks.  Understanding these compounds' actions may inform new strategies for preventing and treating cardiovascular diseases.  Aim: The aim of this paper is a systematic review of articles and research regarding the Role of tyrosol and hydroxytyrosol in Cardioprotection  Review methods: An systematic review of scientific literature was conducted using the following keywords: Tyrosol, hydroxytyrosol, cardioprotection, cardiovascular diseases, olive oil cardioprotective role. Thirty-four articles published until 2023 were searched and analyzed.  Abbreviated description of the state of knowledge: Tyrosol and hydroxytyrosol, prominent in olive oil, are studied for their potential cardioprotective properties. Linked to a Mediterranean diet, these compounds show promise in reducing cardiovascular disease risk. They counter oxidative stress, improve lipid profiles, and modulate inflammatory processes. Clinical studies suggest their positive impact, with tyrosol also explored as a potential anticoagulant. Ongoing research aims to uncover optimal doses and mechanisms, highlighting their significance in cardiovascular health.  Conclusions: Tyrosol and hydroxytyrosol, found in olive oil, show promise in cardioprotection by combating oxidative stress, improving lipid profiles, and modulating inflammation. Clinical studies suggest their positive impact on cardiovascular health. Tyrosol has potential as a anticoagulant and exhibits antioxidant effects. These compounds present a compelling avenue for future therapeutic interventions, with emphasis on understanding mechanisms and optimizing supplementation.

Astrocyte-Derived Exosomes Differentially Shape T Cells’ Immune Response in MS Patients

Astrocytes, the most abundant group of glia cells in the brain, provide support for neurons and indicate multiple various functions in the central nervous system (CNS). Growing data additionally describe their role in the regulation of immune system activity. They exert their function not only by direct contact with other cell types, but also through an indirect method, e.g., by secreting various molecules. One such structure is extracellular vesicles, which are important mediators of crosstalk between cells. In our study, we observed that the impact of exosomes derived from astrocytes with various functional phenotype differently affect the immune response of CD4+ T cells, both from healthy individuals and from patients with multiple sclerosis (MS). Astrocytes, by modulating exosome cargo, impacts the release of IFN-γ, IL-17A and CCL2 in our experimental conditions. Considering the proteins concentration in cell culture supernatants and the cellular percentage of Th phenotypes, it could be stated that human astrocytes, by the release of exosomes, are able to modify the activity of human T cells