The PFAPA syndrome: review on diagnosis and management

Introduction and purpose: Periodic fever, aphthous stomatitis, pharyngitis, and adenitis (PFAPA syndrome) is the most common periodic fever condition in child age. Discussed syndrome is generally a self-limited condition, but it can significantly decrease the quality of child’s life. It can be also challenge for parents, as well as medical professionals. Knowledge of the syndrome is very important among many specialists because early detection is the basis of the correct differentia and proper treatment. Many researches has been made to explain the genetic and immunologic elements which play a significant role in the pathogenesis of PFAPA, but it is not fully undestood. This review will focus on current knowledge regarding the pathogenesis of PFAPA, as well as surgical and conservative treatment strategies. Material and methods: This review was based on available data collected in the PubMed database and published between 2013 and 2022. The study was conducted by reviewing key words as follows: "PFAPA","treatment", "diagnosis","tonsillectomy". Results: The diagnosis of PFAPA syndrome consists of a typical clinical presentation, but sometimes diagnosis of this syndrome can be problematic. Some clinical criteria can be useful. We have vary of treatment arms depends on clinical targets. Depite that PFAPA is self limiting syndrome which can dissappear in later years of children’s life.   Conclusions: PFAPA syndrom is rare disease, but is very important to put emphasis on knowledge about it. Early diagnosis of this syndrome can make physicians send patient to specialized ward, and it will be possible to start proper and efficient treatment. It is a question of the future that we will get more patophysiologic knowledge about this disease

SGLT-2 inhibitors: new effective drugs for treatment of heart failure

Introduction: SGLT-2 inhibitors having selectivity to sodium glucose cotransporter 2 were introduced on the market in 2012 as drugs for the pharmacotherapy of type 2 diabetes.Aim of the work: To summarize the current state of knowledge about the drugs: SGLT-2 inhibitors and their mechanism of action and application in cardiology.Materials and Methods: A review of the literature available in PubMed and Google Scholar database was conducted.Results: In addition to glucosuria, the diuretic effect is caused by natriuresis. A study was conducted, after which it was deduced that the natriuretic effect of empagliflozin did not depend on the degree of renal dysfunction, and was exacerbated under the influence of loop diuretics.SGLT-2 inhibitors reduce cardiac preload. Flozins also lead to a reduction in afterload.The DAPA-HF study of 4744 patients with HF, taking 10 mg of dapagliflozin or placebo. The primary outcome of the study, was data in the form of death from cardiovascular causes or exacerbation of heart failure. These accounted for 16.3% in the flozin group compared to 21.2% in the control group. Adverse events were rare. Dapagliflozin was effective in 55% of subjects, in both patients and non-diabetics with type 2 diabetes.EMPEROR-REDUCED studied the effect of taking 10 mg of emagliflozin or placebo in 3730 patients. Flozin reduced the risk of cardiovascular death and hospitalizations. Fewer deaths from any cause were also observed.Summary: Both studies highlighted significant benefits of SGLT-2 inhibitors- they reduced the risk of death from any cause and from cardiovascular causes. The therapeutic benefits, regardless of the degree of renal dysfunction, the synergy with other drugs in heart failure, and the low number of serious side effects, led to the inclusion of flozins in the latest ESC 2021 guidelines for therapy in heart failure with reduced ejection fraction, regardless of the presence of diabetes