Odczyn popromienny u chorych poddanych radioterapii z powodu nowotworów ośrodkowego układu nerwowego

Radioterapia stanowi uznaną metodę leczenia nowotworów ośrodkowego układu nerwowego (OUN). Dzięki ciągłemu postępowi we wdrażaniu zaawansowanych technik leczenia technika ta ostatnio dynamicznie się rozwija. Niezależnie od skuteczności radioterapii zawsze istnieje ryzyko powikłań związanych z jednoczesnym napromienianiem zdrowych tkanek otaczających guz. W efekcie oprócz komórek nowotworowych uszkodzeniu ulegają zdrowe tkanki znajdujące się w obszarze napromienianym. Objawy niepożądane po radioterapii, tak zwane odczyny popromienne, zależnie od przyjętego kryterium dzieli się na wczesne (ujawniające się w trakcie leczenia i do 6 miesięcy po jego zakończeniu) oraz późne (występujące po miesiącach, a nawet latach). Zagadnienie powikłań po leczeniu za pomocą radioterapii powinno być jednym z podstawowych obszarów zainteresowania nie tylko onkologów, ale także lekarzy innych specjalności, którzy mogą mieć kontakt z chorymi po leczeniu przeciwnowotworowym. Celem pracy jest przybliżenie lekarzom klinicystom zagadnienia odczynów popromiennych u pacjentów z guzami OUN poddanych radioterapii oraz problemów związanych z procesem radioterapii w tej grupie chorych

Management of blood infection caused by colonization of the vascular port with klebsiella variicola in case of patient treated with palliative chemotherapy

Klebsiella variicola is a bacterial species that was originally identified as a mild endosymbiont in plants, it occurs in humans and cattle. It is a bacterium that has been discovered relatively recently and research on the broader understanding of the pathogen is still underway. Vascular catheters are very often used to receive chemotherapy by patients. The purpose of this work was to present the management of blood infection caused by colonization of the vascular port with klebsiella varicola. The material described can be used to conduct patient pharmacotherapy. Care for a patient with a vascular port should be developed. There is a need to conduct staff training on: proper care and use of the vascular port and Huber needle for pharmacotherapy. Huber needles could be standard material in the list of required equipment in hospital wards to improve patient care with a vascular port

Diagnostic difficulties in differentiating of arteriovenous fistula - case report

Przetoka tętniczo-żylna szyjno-jamista to nieprawidłowe połączenie pomiędzy oponowymi gałęziami tętnicy szyjnej lub kręgowej a zatokami opony twardej. Jej kliniczna manifestacja może przypominać główne objawy orbitopatii tarczycowej, zapalnego schorzenia oczodołu towarzyszącego chorobie Gravesa. Dlatego diagnostyka różnicowa orbitopatii tarczycowej i przekrwienia oczodołu obserwowanego w przebiegu przetoki tętniczo-żylnej często jest problematyczna dla klinicystów i radiologów. Opis przypadku dotyczy spontanicznej przetoki tętniczo-żylnej u 59-letniej pacjentki. Pierwszym objawem był jednostronny wytrzeszcz gałki ocznej. Po wykonaniu tomografii komputerowej (CT, computed tomography) i rezonansu magnetycznego (MRI, magnetic resonance imaging) ustalono wstępne rozpoznanie orbitopatii tarczycowej. Rezultatem leczenia kortykosteroidami było pogorszenie stanu miejscowego oka. Spowodowało to, że zaczęto się ponownie zastanawiać nad rozpoznaniem i oceną pacjentki z użyciem bardziej czułych technik, co doprowadziło do ostatecznego rozpoznania przetoki szyjno-jamistej.Arteriovenous carotid-cavernous fistula is an abnormal connection between the dural branches of carotid artery or vertebral artery and the dural sinuses. Its clinical manifestations can resemble the crucial signs of thyroid orbitopathy, an inflammatory disorder of the orbit associated with Graves’ disease. Therefore, differential diagnosis of thyroid orbitopathy and the congestion of the orbit seen in arteriovenous fistula is often clinically and radiologically confused. This is the case report of the simultaneous occurrence of dural arteriovenous fistula in 59 years old woman. The first manifestation was unilateral exophthalmia. After Computer Tomography and Magnetic Resonance Imaging were performed, the preliminary diagnosis of thyroid orbitopathy was established. The response of eye disorder to corticosteroid treatment resulted in evident deterioration. This prompted a reconsideration of the diagnosis and a new evaluation of the patient with sensitive techniques, leading to the final diagnosis of arteriovenous fistula

The influence of non-pharmacological methods in osteoporosis treatment

Introduction Osteoporosis is a systemic skeletal disorder which results from an imbalance in bone remodeling. The disease can occur because of failure to achieve peak bone mass and/or excessive bone resorption and/or decreased bone formation during remodelling. Multiple pathogenetic and regulatory mechanisms are responsible for these changes. In the above review, selected non-pharmacological therapies in osteoporosis are described. Material and methods Articles in the EBSCO database have been analyzed using keywords: osteoporosis, osteopenia, treatment. The available literature is subjectively selected. Then, the newest version of every paper was searched for. Results Results of researches on osteoporosis pathomechanism, quality of life in patients, comorbidities, non-pharmacological methods for treatment of osteoporosis, the impact of physical exercise, role of diet as adjunctive therapy in osteoporosis were described. Conclusions Osteoporosis and treatment influence on the patient's functioning and subjective assessment of the quality of life. Medical doctors need to take into account high occurrence of multimorbidity in adults with osteoporosis to be able to propose comprehensive treatment. The treatment of the affected patients should be improved to offer early or even preventive care for other diseases that coexist with osteoporosis. Non-pharmacological interventions, such as diet, seem to be effective in osteoporosis. Effects of physical exercise could be beneficial in osteoporosis patients, however further studies are needed to determine specifics of the most effective program

Glucocorticoid-regulated kinase CAMKIγ\gamma in the central amygdala controls anxiety-like behavior in mice

The expression of the Calcium/Calmodulin-Dependent Protein Kinase I gamma (encoded by the Camk1g gene) depends on the activation of glucocorticoid receptors (GR) and is strongly regulated by stress. Since Camk1g is primarily expressed in neuronal cells of the limbic system in the brain, we hypothesized that it could be involved in signaling mechanisms that underlie the adaptive or maladaptive responses to stress. Here, we find that restraint-induced stress and the GR agonist dexamethasone robustly increase the expression of Camk1g in neurons of the amygdalar nuclei in the mouse brain. To assess the functional role of Camk1g expression, we performed a virally induced knock-down of the transcript. Mice with bilateral amygdala-specific Camk1g knock-down showed increased anxiety-like behaviors in the light-dark box, and an increase in freezing behavior after fear-conditioning, but normal spatial working memory during exploration of a Y-maze. Thus, we confirm that Camk1g is a neuron-specific GR-regulated transcript, and show that it is specifically involved in behaviors related to anxiety, as well as responses conditioned by aversive stimuli

Antibacterial and cytocompatible coatings based on poly(adipic anhydride) for a Ti alloy surface

This paper describes a formation of hybrid coatings on a Ti–2Ta–3Zr–36Nb surface. This is accomplished by plasma electrolytic oxidation and a dip-coating technique with poly(adipic anhydride) ((C$_{6}$H$_{8}$O$_{3}$)n) that is loaded with drugs: amoxicillin (C$_{16}$H$_{19}$N$_{3}$O$_{5}$S), cefazolin (C$_{14}$H$_{14}$N$_{8}$O$_{4}$S$_{3}$) or vancomycin (C$_{6}6$H$_{75}$Cl$_{2}$N$_{9}$O$_{24}$ · xHCl). The characteristic microstructure of the polymer was evaluated using scanning electron microscopy and confocal microscopy. Depending on the surface treatment, the surface roughness varied (between 1.53 μm and 2.06 μm), and the wettability was change with the over of time. X-ray photoelectron spectroscopy analysis showed that the oxide layer did not affect the polymer layer or loaded drugs. However, the drugs lose their stability in a phosphate-buffered saline solution after 6.5 h of exposure, and its decrease was greater than 7% (HPLC analysis). The stability, drug release and concentration of the drug loaded into the material were precisely analyzed by high-performance liquid chromatography. The results correlated with the degradation of the polymer in which the addition of drugs caused the percent of degraded polymer to be between 35.5% and 49.4% after 1 h of material immersion, depending on the mass of the loaded drug and various biological responses that were obtained. However, all of the coatings were cytocompatible with MG-63 osteoblast-like cells. The drug concentrations released from the coatings were sufficient to inhibit adhesion of reference and clinical bacterial strains (S. aureus). The coatings with amoxicillin showed the best results in the bacterial inhibition zone, whereas coatings with cefazolin inhibited adhesion of the above bacteria on the surface

The eye wipes with polyhexanide (HexaClean) in preoperative prophylaxis of cataract surgery

Background: Progressively increasing number of eye surgeries forces the development of simple-to-use, effective methods to reduce the risk of postoperative endophthalmitis. We wondered whether the eyelid margin wipes containing 0.1% polyhexamethylene biguanide (PHMB) (HexaClean, VERCO, Poland) influence the reduction of bacterial flora localized in the conjunctival sac and whether it can be used for prophylaxis before the cataract surgery. Material and methods: 95 patients before the cataract surgery were included in the study. The conjunctival swab was collected from patients twice — before using eye wipes and after 5 days of eye wipes usage. The swabs were plated on microbiological enriched media and incubated under aerobic and microaerophilic conditions for 24–48 hours at 35°C ± 2°C. Then the identification of microorganisms was carried out using classic microbiological methods and tests. Results: Bacterial strains were isolated from the conjunctival sac in 84% of patients before using the eye wipes. The largest group of isolated pathogens was Gram-positive cocci, and these were mainly methicillin-sensitive and methicillin-resistant coagulase-negative staphylococci, which accounted for 72% of isolated strains. When the eye wipes were used, the bacterial flora was eliminated from the conjunctival sac in 54% of patients. A reduction in isolated strains and decreased variety of bacteria was observed in another 22% of patients. Conclusion: These results indicate that the application of eyelid wipes with polyhexanide reduces a significant amount of the conjunctival sac microbiota, which may prevent inflammation after cataract surgery

Results of Fullerton Test in older people. Group comparison due to the Nordic Walking and long walks undertaking

Introduction: Standardly, high level of physical activity is prescribed to the older patients. However, it is worth to examine if every kind of physical activity give the same amount of health benefits, or is it dependent on its modality.Aim: The purpose of above studies is to measure the differences in Fullerton subtests results in group who does vs in group who does not undertake regular long walks (LW) and Nordic Walking (NW).Material and methods: Subtests of Fullerton tests were used to examine the physical performance of patients. Physical activity questionnaire was used to distinguish groups of patients who do vs do not engage in long walks and Nordic Walking regularly.Results: There were no statistically significant differences in Fullerton scores due to NW-engagement. In contrary, group engaged in LW walked 42.41 meters more in 6-minute walk tests than group who do not undertake such activity. Moreover, Upper Right and Left Limbs Strength tests and its mean scores were better in LW-group by 4.23, 4.6 and 4.09 repetitions, respectively.Conclusions: There was no statistically significant differences in results of Fullerton subtests between group of NW-engaged older people comparing to group who do not undertake NW. Group of participants engaged in long walks had better scores aerobic capacity and upper limbs strength tests

Potential applications of virtual reality devices in older people. Narrative review

Introduction Many of the non-pharmacological therapeutic interventions such as physical and mental exercises are focused on some of the dimensions of human cognition only. Therefore, methods involving immersion in VR (VR) might presumably belong to the more effective treatment methods. VR is a rapidly evolving technology, which is successfully and increasingly present in various branches, including medicine. Despite its increasing popularity for many people it is still new and unexplored, which leads to negative opinions and unwillingness to use in geriatric population. Therefore, the main purpose of this article is to describe application of virtual reality and new technologies devices in geriatrics. Material and methods Articles in the EBSCO database were analyzed using keywords: virtual reality, frailty, pain, phobias, stroke rehabilitation, adverse effects. Available literature has been subjectively selected. Results Researches with applications of virtual reality techniques in sarcopenia and frailty, phobias, stroke rehabilitation, pain therapy were described. Moreover, potential adverse effects were discussed. Conclusions An overview of the research results in this area indicates that the virtual reality, possibly could be applied in mental and physical training in the cases of both physiological aging and various disorders. At the same time, the disadvantages and potential adverse effects have been pointed out. Further studies on application of VR in older people should be conducted to determine its effectiveness in various clinical and nonclinical settings