Jakość życia chorych na stwardnienie rozsiane

Introduction. Multiple sclerosis (MS) is an incurable demyelinating disease of the central nervous system (c.n.s.). The chronic nature of this disease causes deterioration of the physical, mental, emotional and social condition of patients, which significantly reduces their quality of life.Aim. The aim of the study was to determine the quality of life of patients with multiple sclerosis.Material and Methods. The study involved 100 patients with multiple sclerosis, associated in support groups operating in the Silesian voivodeship. Among the respondents were 77 women and 23 men. The FAMS questionnaire — version 4 (Functional Assessment of Multiple Sclerosis Quality of Life Instrument) was chosen to measure the quality of life of patients with multiple sclerosis. The obtained research material was subjected to a statistical analysis, using the statistical package STATISTICA v12 for calculations. In order to calculate the variables, the following measures were used: arithmetic mean, standard deviation, coefficient of variation, asymmetry coefficient, kurtosis coefficient, Person linear correlation coefficient, Spearman rank correlation coefficient.Results. The average results of all subscales of the FAMS questionnaire-version 4 in the examined group reached the value of 111.1 points; that is, a satisfactory level (65% of all respondents), in the absence of bad assessments, and 35% of good grades. The result is at the second level of quality of life, in the numerical range of 58–117 points. The lowest scores were recorded in the “Mobility” subscale (14.39 points), and the highest in “Other ailments” (36.77 points). Strong correlations were found between the FAMS score and individual subscales. As the subscale score increased, the FAMS score increased, and the higher the score, the better the quality of life of MS patients. The higher the respondent’s age, the lower the FAMS results, while the one-way treatment process — either pharmacology or rehabilitation — does not improve the quality of life, only integrated actions increase the quality of life of patients with MS. In the case of a form of the disease — a primary progressive and primary progressive form with exacerbations affect the quality of life of patients with MS.Conclusions. Most MS patients assessed their quality of life as satisfactory, in the absence of bad and with one-third of good scores. The existence of links between the FAMS results and all subscales indicates that the higher the subscales rated, the higher the FAMS result, i.e. the better quality of life of MS patients. Gender does not determine the quality of life of the respondents, while age, the form of the disease and the type of treatment affect the quality of life. (JNNN 2019;8(3):95–101)Wstęp. Stwardnienie rozsiane (SM) jest nieuleczalną, demielinizacyjną chorobą ośrodkowego układu nerwowego (o.u.n.). Przewlekły charakter tej choroby powoduje pogorszenie stanu fizycznego, umysłowego, emocjonalnego i społecznego chorych, co znacząco obniża ich jakości życia.Cel. Celem badań było określenie jakości życia chorych na stwardnienie rozsiane.Materiał i metody. Badaniem objęto 100 chorych na stwardnienie rozsiane, zrzeszonych w grupach wsparcia działających w województwie śląskim. Wśród respondentów było 77 kobiet i 23 mężczyzn. Do pomiaru jakości życia chorych na stwardnienie rozsiane wybrano kwestionariusz FAMS — wersja 4 (Functional Assessment of Multiple Sclerosis Quality of Life Instrument). Uzyskany materiał badawczy poddano analizie statystycznej, wykorzystując do obliczeń pakiet statystyczny STATISTICA v12.W celu obliczenia zmiennych wykorzystano takie miary jak: średnia arytmetyczna, odchylenie standardowe, współczynnik zmienności, współczynnik asymetrii, współczynnik kurtozy, współczynnik korelacji liniowej Persona, współczynnik korelacji rang Spearmana.Wyniki. Średnie wyniki wszystkich podskal kwestionariusza FAMS — wersja 4 w badanej grupie osiągnęły wartości 111,1 pkt; czyli poziom zadowalający (65% ogółu badanych), przy braku ocen złych, i 35% ocen dobrych. Wynik mieści się na drugim poziomie jakości życia, w przedziale liczbowym 58–117 pkt. Najniższe oceny odnotowano w podskali „Zdolność poruszania się” (14,39 pkt), a najwyższe w „Innych dolegliwościach” (36,77 pkt). Odnotowano silne korelacje pomiędzy wynikiem FAMS, a poszczególnymi podskalami. Wraz ze wzrostem wyniku podskal, wzrastał wynik FAMS, a im wyższy wynik, tym lepsza jakość życia chorych na SM. Im wyższy wiek respondenta, tym niższe wyniki FAMS, natomiast jednokierunkowy proces leczenia — albo farmokologia, albo rehabilitacja — nie poprawiają jakości życia, dopiero zintegrowane działania podnoszą komfort życia chorych na SM. W przypadku postaci choroby — postać pierwotnie postępująca i pierwotnie postępująca z zaostrzeniami, wywierają wpływ na jakość życia chorych z SM.Wnioski. Większość badanych chorych na SM oceniła swoją jakość życia jako zadowalającą, przy braku ocen złych i przy jednej/trzeciej ocen dobrych. Istnienie powiązań między wynikami FAMS, a wszystkimi podskalami, pozwala stwierdzić, że im wyżej oceniane podskale, tym wyższy wynik FAMS, czyli lepsza jakość życia chorych na SM. Płeć nie determinuje jakości życia badanych, natomiast wiek, postać choroby i rodzaj leczenia mają wpływ na jakość życia. (PNN 2019;8(3):95–101

Jakość życia osób po urazie rdzenia kręgowego

Introduction. Each year approximately 250–500 people experience spinal cord injury, most often as a result of a fall from a height or a road accident. The injured are mostly young men. The quality of life is an increasingly popular topic, which in terms of medicine is conditioned by the state of health. Research on the quality of life of people with spinal cord injury provides valuable information on the needs of people with disabilities.Aim. The aim of the study was to determine the quality of life of people after spinal cord injury.Material and Methods. The study was conducted among 30 adults after spinal cord injury from various areas of Poland. The examined group of disabled persons consisted of women and men of various ages and with each level of spinal cord injury. A survey was also conducted among 53 people who were physically fit, matched in terms of gender, age and education. The research tool applied for both groups was the WHOQOL-BREF questionnaire (The World Health Organization, a shortened version of the quality of life survey), distinguishing four areas of the quality of life: somatic, psychological, social and environmental. The analysis of the results was based on: arithmetic mean, standard deviation, distribution normality study with the Shapiro–Wilk test. In order to compare particular variables, Pearson’s linear correlation coefficient was calculated. The Mann–Whitney U test was used to assess the significance of differences between the independent groups.Results. The arithmetic mean of the quality of life result in patients after spinal cord injury was 3.83±0.79, and in the control group 4.00±0.65. The average health assessment in both groups was also slightly different: in patients with spinal cord injury it was 3.4±1.1, and in those with mobility problems respectively 3.7±0.9. The average score obtained by people with spinal cord injury in the somatic field was lower than in those who were physically fit. Also, respondents with spinal cord injuries are less satisfied with the means of transport, health care centres or living conditions, compared to those in the control group.Conclusions. Summing up the results of the study, it can be said that people with spinal cord injury have a slightly lower overall subjective quality of life than those who are physically fit. Worse quality of life of people after spinal cord injury occurs particularly in the somatic and environmental fields. (JNNN 2018;7(2):64–69)Wstęp. Każdego roku na świecie urazu rdzenia kręgowego doświadcza 250–500 tys. osób, najczęściej w wyniku upadku z wysokości lub wypadku drogowego. Poszkodowanymi są przeważnie młodzi mężczyźni. Jakość życia to coraz bardziej popularny temat, który w aspekcie medycznym uwarunkowany jest stanem zdrowia. Badania jakości życia osób po urazie rdzenia kręgowego dostarczają cennych informacji na temat potrzeb osób niepełnosprawnych.Cel. Celem badań było określenie jakości życia osób po urazie rdzenia kręgowego.Materiał i metody. Badania przeprowadzono wśród 30 osób pełnoletnich po urazie rdzenia kręgowego z różnych obszarów Polski. Badana grupa osób niepełnosprawnych składała się z kobiet i mężczyzn w różnym wieku i z każdym poziomem uszkodzenia rdzenia kręgowego. Przeprowadzono również sondaż wśród grupy kontrolnej, 53 osób sprawnych ruchowo, dobranych pod względem płci, wieku i wykształcenia. Narzędzie badawcze dla obu grup stanowił kwestionariusz WHOQOL-BREF (ang. The World Health Organization Quality of Life, skrócona wersja ankiety oceniającej jakość życia), rozróżniająca cztery dziedziny jakości życia: somatyczną, psychologiczną, socjalną i środowiskową. Do analizy wyników stosowano: średnią arytmetyczną, odchylenie standardowe, badanie normalności rozkładu testem Shapiro–Wilka. W celu porównania poszczególnych zmiennych liczono współczynnik korelacji liniowej Pearsona. Do oceny istotności różnic między grupami niezależnymi stosowano test U Manna–Whitneya.Wyniki. Średnia arytmetyczna wyniku z jakości życia u osób po urazie rdzenia kręgowego wynosiła 3,83±0,79, a w grupie osób z grupy kontrolnej 4,00±0,65. Średnia ocena stanu zdrowia w obu grupach również różniła się nieznacznie: u osób po urazie rdzenia kręgowego wynosiła 3,4±1,1, a u osób sprawnych ruchowo 3,7±0,9. Średni wynik uzyskany przez osoby po urazie rdzenia kręgowego w dziedzinie somatycznej był niższy niż u osób sprawnych ruchowo. Także osoby z uszkodzonym rdzenia kręgowego są mniej zadowolone ze środków transportu, placówek ochrony zdrowia czy warunków bytowych, w porównaniu z osobami z grupy kontrolnej.Wnioski. Podsumowując wyniki badań można powiedzieć, że osoby po urazie rdzenia kręgowego mają nieznacznie niższą ogólną subiektywną jakość życia niż osoby sprawne ruchowo. Gorsza jakość życie osób po urazie rdzenia kręgowego występuje szczególnie w dziedzinie somatycznej i środowiskowej. (PNN 2018;7(2):64–69

The importance of atrial fibrillation and selected echocardiographic parameters for the effectiveness and safety of thrombolytic therapy in patients with stroke

Background The efficacy and safety of thrombolytic therapy in stroke depend on multiple factors. The aim of this study was to evaluate the significance of atrial fibrillation the prognosis in terms of the functional status in patients with stroke treated with intravenous thrombolysis. An additional aim was also to assess the potential significance of reduced ejection fraction (EF) and enlarged left atrium (LA) of the heart for the prognosis in patients with stroke who underwent thrombolytic therapy. Methodology A prospective study involved enrollment of 222 patients, mean age of 72 years with first-in-life ischemic stroke. In all participants there were realized procedures as follows: neurological status before administering rt-PA (NIHSS), selected echocardiographic parameters, functional status on the 14th day from the onset (mRankin scale) and analysis the bleeding events. Results Atrial fibrillation was significantly more frequent in women than men; females had higher CHA2DS2VASc scores and heavier neurological conditions on day 1 of stroke. Two independent factors for poor prognosis (3–5 points by mRankin) were found: the NIHSS score and the CHA2DS2VASc score ≥3. We identified 2 independent factors for death within 14 days from the onset: the result by NIHSS and the EF. The NIHSS score turned out to be the only independent predictor of hemorrhage during hospitalization: RR 1.19; CI [1.06–1.33]; p=0.003; p for model=0.0025. Conclusions The presence of atrial fibrillation worsens the patient's prognosis in terms of the functional status and survival during the acute period of stroke in patients treated with intravenous thrombolysis. Higher NIHSS and CHA2DS2VASc scores and reduced EF in patients with stroke treated with thrombolysis are the predictors of unfavorable short-term prognosis

Leczenie sorafenibem w zaawansowanym raku tarczycy - opis przypadku

Papillary thyroid cancer (PTC) usually has a good prognosis. The treatment, including total thyroidectomy and complementary radioiodine (RAI) therapy, gives complete remission in 90% of patients. However, in 10% of subjects with metastatic disease, the prognosis is poor. In the group of patients with disease progression and no 131I uptake, searching for new therapeutic modalities before all tyrosine kinase inhibitors and other antiangiogenic agents is necessary. The study presents the case of a 55-year-old male with advanced PTC /pT3mNxMo/ diagnosed in 1993. Primary treatment by total thyroidectomy and 131I ablation led to complete remission. In 2000 local as well as lymph node recurrence was diagnosed and successively treated by surgery. In 2006 an increasing serum thyroglobulin level was noted and a single lung metastasis was diagnosed and operated on. In 2007 new foci in CNS and vertebral column with no 131I uptake were stated. Further progression (bones, CNS, and pterygoid muscle) was confirmed by PET-CT. The patient underwent neurosurgical metastasectomy twice and palliative CNS and vertebra’s radiotherapy. Liver metastases were diagnosed in 2009. Treatment with increasing doses of thalidomide (up to 800 mg/d) was administered for 3 months with a good tolerance; however, the therapy was withdrawn due to cancer progression. Next, sorafenib (800 mg/d) was given for 16 weeks. Radiological examination performed after 16 weeks confirmed stable disease, whereas 2 months later, after sorafenib withdrawal due to lack of treatment possibility, further progression was observed. Metronomic chemotherapy with Adriamycin was instituted which gave disease stabilization for 6 months. The patient died with advanced disseminated disease due to pulmonary embolism. We present this case to document no adverse effects of therapy with sorafenib in a patient with brain DTC metastases. Sorafenib therapy was only short-term, but no progression occurred in this time. (Pol J Endocrinol 2010; 61 (5): 492-496)Rak brodawkowaty tarczycy należy do nowotworów o dobrym rokowaniu. Terapia oparta na całkowitym wycięciu tarczycy i uzupełniającym leczeniu jodem promieniotwórczym u 90% pacjentów prowadzi do całkowitej remisji choroby nowotworowej. U około 10% chorych, u których dochodzi do rozsiewu raka, rokowanie jest niepomyślne. U chorych, z rozsiewem raka, u których ogniska nowotworu nie wykazują zdolności wychwytu 131I konieczne jest poszukiwanie nowych możliwości terapeutycznych. W tym kontekście rozważa się zastosowanie leków antyangiogennych, w tym inhibitorów kinaz tyrozynowych. W pracy przedstawiono przypadek 55-letniego pacjenta z rozpoznaniem zaawansowanego raka brodawkowatego tarczycy/pT3mNxMo leczonego od 1993 roku, u którego w terapii zastosowano inhibitor angiogenezy (talidomid) i kinaz tyrozynowych (sorafenib). Leczenie pierwotne, dwuetapowe całkowite wycięcie tarczycy w 1994 i uzupełniające leczenie 131I (60 mCi) w 1994 roku doprowadziło do remisji choroby nowotworowej. W 2000 chory przebył operacyjne usunięcie wznowy miejscowej i przerzutów do węzłów chłonnych. W 2006 roku, w toku diagnostyki narastającej hipertyreoglobulinemii rozpoznano przerzut do płuca prawego, który usunięto operacyjnie. W 2007 roku stwierdzono niejodochwytny przerzut do kręgosłupa i ośrodkowego układu nerwowego (OUN). Kontrolne badania obrazowe, w tym PET-CT, potwierdziły dalszą progresję raka pod postacią nowych ognisk przerzutowych w OUN, kośćcu i mięśniu skrzydłowym. Chory przebył 2-krotne operacyjne usunięcie zmian ogniskowych w OUN, paliatywną radioterapię OUN i paliatywną radioterapię przerzutu do kręgosłupa. W 2009 roku rozpoznano przerzuty do wątroby. W dalszej terapii stosowano talidomid we wzrastającej dawce do 800 mg/d. przez okres 3 miesięcy, co nie zapobiegło dalszej progresji. Następnie chory otrzymywał sorafenib w dawce 800 mg/d. przez okres 16 tygodni. Badania obrazowe wykonane po 16 tygodniach terapii potwierdziły stabilizację choroby nowotworowej, natomiast 2 miesiące po odstawieniu leku ze względu na brak możliwości kontynuacji terapii doszło do dalszej progresji. Następnie chory otrzymywał przez okres 6 miesięcy metronomiczną chemioterapię (adriblastyna), która doprowadziła do stabilizacji choroby. Chory zmarł w stadium zaawansowanego raka tarczycy z powodu zatorowości płucnej. Wniosek: W prezentowanym przypadku chorego na raka brodawkowatego tarczycy z przerzutami do mózgu, terapia sorafenibem nie spowodowała żadnych powikłań, a w czasie 16 tygodni jej stosowania obserwowano stabilizację zaawansowanej choroby nowotworowej. (Endokrynol Pol 2010; 61 (5): 492-496

The potential of using exosomes in modern medicine

Introduction and purpose of the work: The purpose of this article is to determine the potential for the application of exosomes in modern medicine, inferring from research directions in world  literature. Among other things, this paper considers some of the most recent work in the fields of aesthetic medicine, dermatology and transplantation.  Methodology and materials: The search was conducted using PubMed, Google Scholarship, Scopus and Web of Science databases. The search strategy was based on the following terms: exosomes, regenerative medicine, dermatology. The variety of available scientific works on exosomes raises the question in which of the fields of medicine they will be used the fastest and/or most commonly. Given that a significant part of research focuses on their use in skin treatments, it can be expected that it will be dermatology and/or aesthetic medicine, given its exceptional openness to the implementation of new techniques and the constant search for new solutions that allow physiologically or optically to oppose aging. In addition, the use of exosomes is characterized by a relatively low risk of life-threatening complications or permanent damage to health. However, the potential applications of exosomes in other fields of medicine should not be underestimated. Therefore, it can be expected that procedures and therapies using exosomes will also be developed and implemented independently in transplantology, cardiology, or other fields that can use exosomes as drug carriers or markers for early detection of complications or diseases.

Medicinal plants in burns treatment – a systematic review

Introduction and aim. The World Health Organization (WHO) reports that around 11 million people experience burn injuries each year.1,2 Burn injuries occur when tissue damage is caused by various factors such as UV radiation, heat, chemicals, or electric current.3,4 While burns primarily affect the skin, they can also extend to deeper tissues like bones or muscles. When the skin is burned, its vital functions, including protection against the external environment, pathogens, and evaporation, are compromised.1 The appropriate treatment method must be chosen based on the burn stage, the patient's condition, and the cause. The aim of this paper is to provide a comprehensive review based on literature, concerning superficial burns and sunburns treatment, with a focus on nature-derived topical treatment methods. Material and methods. PubMed database was searched for the following terms: “burns”, “burn treatment”, “aloe vera”, “sunburn”, “centella asiatica”, “climate change”, “wound healing” for the articles published between 2005-2023 and written in the English language. Conclusion. Herbal-derived compounds, with their diverse mechanisms of action, antibacterial activity, and safety profiles present a competitive alternative to conventional treatment of burns and sunburns, however, there are still not enough clinical trials to assess the effectiveness and safety profiles of nature-derived compounds

Prevention and treatment of tuberculosis before two great discoveries of the 20th century: the Bacillus Calmette-Guérin vaccine and streptomycin

Introduction and Purpose. Fundamental milestone in fight against tuberculosis is the invention of the effective vaccine, but before Anthony van Leeuwenhoek was the first to observe the bacteria, which opened the door to the first vaccinations in the 19th century. Medicine had battled against infectious diseases in different ways. Some methods can be perceived as a kind of primitive vaccines, which couldn’t, however, considerably affect a decrease in the epidemic range, due to their uncommon use and limited effectiveness. The aim of this paper is to analyze the history of tuberculosis and the role of Poland in the fight against it. Materials and methods. PubMed database was used for review of the literature. The following phrases were searched in English: “tuberculosis”, “vaccination”, “BCG vaccine”, “sanatorium”. Description of the state of knowledge. Poland played an important role in the fight against tuberculosis. It was in the laboratory of Polish pharmacist, where Koch discovered its etiological factor. In the territory of Poland there are prototypes of modern sanatoria for tuberculosis patients. Article also presents old and modern methods of tuberculosis treatment, as the use of specific climatic conditions, which resulted in developing health-resort treatment. A breakthrough in the methods used was the discovery of streptomycin in the middle of the 20th century, which led to the development of pharmacological treatment, nowadays involving the administration of proper combinations of drugs. Summary. The increasingly strong anti-vaccine movement is slowly destroying what people have been fighting for the centuries. It is worth recalling how we reached milestones in this fight and why immunization is so important for all societies

Three successful pregnancies after kidney transplantation with long-term graft survival: case report

Pregnancies after kidney transplantation are considered high risk. Preconceive care is crucial for favorable mother-fetal outcome but also for good renal graft function. Herein, we report a case of kidney transplant recipient secondary to lupus nephritis with three consecutive successful pregnancies and excellent graft function after 16 post-transplant years. Preconception care included two protocolar biopsies performed prior to immunosuppressive treatment modifications. No signs of rejections were found in either biopsy, no additional treatment was necessary, and the patient was safely converted from mycophenolate mofetil to azathioprine. First pregnancy was naturally conceived, its course was uncomplicated and a healthy female newborn wasdelivered via vaginal birth. Within one year after delivery the patient presented proteinuria, borderline changes were found in the biopsy of allograft and were treated with immunosuppression augmentation and ACEI.  At 7th post implantation year, after surveillance biopsy showing no signs of rejection and appropriate pharmacotherapy adjustments, second pregnancy occurred from in vitro fertilization (IVF). It was complicated with deep vein thrombosis, intrauterine growth restriction and premature birth in 32nd week of gestation. Three months after delivery, the patient conceived spontaneously, third pregnancy course was uncomplicated. Close follow up, including protocol and indication biopsies, allowed to preserve excellent graft function in the context of multiple immunosuppressive treatment adjustments. Here we present a case where natural conception and in vitro fertilization intertwine without harming the transplanted organ

Selected aesthetic medicine treatment in patients with autoimmune diseases - a literature review

Introduction Interest in cosmetic procedures has been increasing. Data on practices for correcting aesthetic deficits, including those caused by autoimmune diseases are limited. There are fears of disease reactivation and exacerbation of inflammation after surgery. Aim of the study The aim of the study was to investigate the potential influence and safety of aesthetic medicine treatment - hyaluronic acid, botulinum toxin and breast augmentation with implants in patients with autoimmune diseases. Materials and methods A search was conducted using PubMed and Google Scholar databases. Articles were searched in English using the following key words: autoimmune disease, immunogenicity, inflammation, connective tissue, aesthetic medicine. Results Hyaluronic acid is considered the best filler for cosmetic procedures, mainly due to its lack of immunogenicity. No clinical studies have identified contraindications to the administration of hyaluronic acid-based dermal fillers in patients with inflammatory diseases. Botulinum toxin is essential in alleviating involuntary functions currently associated with dystonia, spasticity, and autonomic disorders. The long-term safety of implants should be assessed concerning genetic and environmental factors and whether the autoimmune disease is in remission.Conclusion With the increasing number of aesthetic procedures using hyaluronic acid, there are more reports of potential adverse events. Most side effects are associated with hypersensitivity reactions. The use of hyaluronic acid products in patients with autoimmune diseases is controversial. However, no clinical studies have identified contraindications to the administration of hyaluronic acid-based fillers. Botulinum toxin is used for healing and pain control in patients with systemic sclerosis who have suffered phalangeal ulcers. Despite epidemiological studies conducted to assess the association between breast implants and autoimmune diseases the results remain inconclusiv