Folia medica Cracoviensia最新文献

Introduction: Bronchofiberoscopy, particularly when combined with real-time endobronchial ultrasound-guided transbronchial needle aspiration (RT-EBUS-TBNA), is a widely available, long-established, and safe diagnostic modality for respiratory diseases, with particular relevance to the evaluation of primary and secondary lung neoplasms. The aim of this study is to present a case of purulent mediastinitis as a complication of RT-EBUS-TBNA, which highlights the increased likelihood of infectious complications in patients with additional risk factors such as diabetes mellitus and immunosuppression, in this instance related to chronic systemic corticosteroid therapy. Furthermore, this report reviews the available literature on the incidence of complications, including infectious events, following EBUS-guided transbronchial biopsy.

Conclusions: Complications following EBUS-guided transbronchial biopsy are rare; therefore, the procedure should be regarded as a safe and recommended diagnostic method.

Introduction: Amyotrophic lateral sclerosis (ALS) represents a heterogeneous group of neurodegenerative disorders sharing a common ALS phenotype but arising from diverse genetic and molecular mechanisms. Among the genes implicated in ALS, SQSTM1, encoding the multifunctional protein p62, plays a pivotal role in maintaining neuronal homeostasis through the regulation of autophagy and the crosstalk between NF-κB and Nrf2 pathways. Disruption of these mechanisms contributes to oxidative stress, neuroinflammation, and protein aggregation in motor neurons.

Material and methods: A comprehensive genetic analysis, including next-generation sequencing (NGS), whole-exome sequencing (WES), and multiplex ligation-dependent probe amplification (MLPA), was performed in a patient clinically diagnosed with ALS. Literature data regarding the role of SQSTM1, NF-κB/Nrf2 signaling, and autophagy modulation in ALS pathogenesis were reviewed to contextualize the findings.

Case presentation: We describe a 49-year-old woman with a 12-month history of progressive - bulbar-onset ALS. Genetic testing revealed a heterozygous SQSTM1 c.1175C>T (p.Pro392Leu) variant inherited from her father, classified as likely pathogenic. The patient received dimethyl fumarate (Nrf2 activator), celecoxib (NF-κB inhibitor), and rapamycin (mTOR pathway modulator) as part of an individualized treatment strategy.

Discussion: Mutations in SQSTM1 contribute to ALS pathogenesis through dysregulation of autophagy, impaired protein clearance, and excessive neuroinflammation mediated by NF-κB activation. The interplay between NF-κB and Nrf2 signaling pathways suggests that targeted therapeutic modulation may attenuate neurodegeneration. The patient's case illustrates the clinical and molecular heterogeneity of ALS and supports the concept of pathway-specific, precision medicine approaches.

Conclusions: This case highlights the relevance of SQSTM1-related pathogenic mechanisms within the heterogeneous ALS spectrum and underscores the importance of advanced genetic testing for identifying candidates for personalized therapy.

Background: Monoclonal gammopathies, including monoclonal gammopathy of undetermined significance (MGUS) and multiple myeloma (MM), are plasma-cell disorders linked to profound metabolic remodeling. Lipid metabolism, particularly the balance between n-3 and n-6 polyunsaturated fatty acids (PUFAs), plays a pivotal role in inflammation, membrane dynamics, and tumor progression.

Methods: Plasma fatty acid (FA) profiles were analyzed in patients with MGUS, MM, and healthy controls via gas chromatography. Desaturase indices (Δ5D, Δ6D, Δ9SCD1, Δ9SCD2) were calculated from FA ratios.

Results: MM patients exhibited significantly higher palmitic acid and lower n-3 PUFA levels (EPA, DHA) compared to controls (p <0.05), reflecting a pro-inflammatory lipid milieu. MGUS patients showed increased oleic acid and markedly elevated Δ9-desaturase activity, suggesting enhanced monounsaturated FA synthesis during early plasma-cell transformation. The n-3/n-6 ratio decreased progressively from controls (1.0) to MGUS (0.5) and MM (0.4). Trans fatty acids were substantially elevated in MGUS and MM compared to the control group.

Conclusion: Altered plasma FA composition and desaturase activity indicate lipid metabolic reprogram- ming in MGUS and MM. The progressive reduction of the n-3/n-6 PUFA ratio underscores a shift toward a pro-inflammatory state that may promote malignant transformation. Lipidomic profiling could serve as an early biomarker of disease evolution, and dietary modulation of n-3 PUFAs may hold therapeutic potential.

The autonomic nervous system (ANS) plays a key role in maintaining physiological homeostasis by regulating cardiovascular activity, gastrointestinal motility, and stress responses. The aim of this review was to analyze how selected dietary components, and complete nutritional models affect ANS activity, with particular emphasis on underlying physiological mechanisms and practical dietary recommendations in cases of sympathetic or parasympathetic hyperactivity. This paper discusses how caffeine, simple sugars, and highly processed foods tend to enhance sympathetic output, whereas omega-3 fatty acids, magnesium, dietary fiber, promote autonomic balance by reducing sympathetic tone and enhancing parasympathetic function. Based on a review of recent scientific studies, it can be concluded that nutrition and lifestyle interventions can significantly modulate ANS function and serve as valuable tools in the management of chronic stress, anxiety, hypertension, and functional gastrointestinal disorders.

Background: The increasing prevalence of multimorbidity among older adults, particularly those with cancer, highlights the need for coordinated post-hospital care. This study aimed to assess the demand for multidisciplinary post-discharge services among older patients, with a focus on oncological individuals.

Methods: We conducted a retrospective analysis of medical records from 200 patients aged ≥65 years hospitalized at the Department of Internal Medicine and Geriatrics, University Hospital in Krakow, Poland. Patients were divided into two age groups: 65-79 and ≥80 years. Data on medical history, cancer diagnosis, nutrition, rehabilitation needs, pharmacotherapy, and psychosocial aspects were extracted to determine post-discharge care needs.

Results: The most frequently identified needs included dietary counseling (54 patients), pharmacological review (27), psychological support (21), nursing care (13), and social work services (6). Cancer patients had significantly higher needs for psychological (100% vs. 40.1%, p <0.001) and nutritional support (85.7% vs. 64.2%, p = 0.002) compared to non-cancer patients. Older patients (≥80 years) showed significantly greater demand for social support (p = 0.045), with all requiring at least one type of post-hospital intervention.

Conclusion: Older adults, especially those with cancer, have high and complex post-discharge care needs that are inadequately addressed by existing services. The findings support the development of integrated geriatric care models to enhance continuity of care and patient outcomes following hospitalization.

The primary role of the healthcare system and its cooperating entities is to ensure the health security of citizens and individuals residing in a given country. Over the past twenty years, chemical, biological, radiological, nuclear, and explosive (CBRNE) threats have become an increasingly significant problem. This underscores the need to include this topic in the education and training of medical personnel. The aim of this article is to identify and analyze current gaps in the education and training of Polish healthcare workers regarding CBRNE threats. Based on a review of the literature, curriculum documents, and applicable educational standards, it has been demonstrated that the preparation of medical professionals to respond to CBRNE incidents is insufficient and requires systemic intervention. The article presents and analyzes the main areas of educational deficits regarding CBRNE, including a lack of awareness of the need for training, insufficient standardized training protocols, limited integration of modern didactic methods, and inadequate institutional preparation. The authors also present possible educational solutions in the field of CBRNE that could be implemented in Poland, as well as proposals for cooperation with the crisis management system. The conclusions drawn from the analysis point to the need to develop comprehensive educational programs to increase the readiness of medical personnel to respond to CBRNE threats. However, this area requires continuous monitoring and the implementation of regularly updated solutions.

There is a lack of research that methodically clarifies baseline muscle tone values and demonstrates their activation during balance tests using selected parts of the 4-Stage Balance Test. The study involved 41 men and 34 women (mean age approximately 22 years (X = 21.83 y, SD 1.5 y)). Data were collected using a questionnaire containing socio-demographic and anthropometric data. Range of motion was measured using a goniometer (SFTR Goniometer Baseline 360 degrees), limb length and circumference were measured using a ADE MZ10021 tape measure and static balance was assessed using two tests from the 4-Stage Balance Test. Eight muscles (Rectus Femoris (RF), Vastus Lateralis (VL), Vastus Medialis (VM), Semitendinosus (S), Biceps Femoris (BF), Tibialis Anterior (TA), Gastrocnemius Medialis (GM), Gastrocnemius Lateralis (GL)) bioelectrical activity data were obtained using a Noraxon MR 400 sEMG device and MyoTrace software. Statistical analysis was performed using SPSS Statistics v25. In parallel foot position the highest EMG activity was observed in the VM (99.18 mV), S (55.27 mV) and RF (33.06 mV) muscles. In semi-tandem foot position the highest activity was observed in S (120.8 mV), GM (59.03 mV), and TA (47.84 mV) muscles, with the lowest in BF (6.58 mV) muscle. 1. Lowered base of support increases the activity of the semitendinosus and medial gastrocnemius muscles. 2. Maintaining the feet-together stance depends on the synergy between the semitendinosus and medial gastrocnemius muscles. 3. Maintaining semi-tandem positioned halfway in front of the other foot depends on the synergy between the vastus lateralis and tibialis anterior muscles.

Aim: This study aimed to assess the impact of chronic hepatitis B on fatty acids (FA) composition in erythrocyte membranes (RBC) and plasma, and its effect on lipoxin A4 and resolvin D1 levels.

Materials and methods: Sixty participants were enrolled: 30 hepatitis B patients (15 with cirrhosis, 15 without) and 30 healthy controls. Fatty acids content in plasma and RBC membranes was analyzed by gas chromatography. Serum lipoxin A4 (LXA4) and resolvin D1 (RvD1) were measured via enzyme immunoassay. Principal component analysis (PCA) assessed correlations between fatty acid composition, LXA4 and RvD1 levels.

Results: Hepatitis B patients with cirrhosis exhibited significantly lower plasma lipoxin A4 (1812 pg/mL) compared to controls (2230 pg/mL) and non-cirrhotic hepatitis B patients (2453 pg/mL). Plasma n-3 FA levels (15.4% vs. 8.7%) and the n-3/n-6 ratio (0.8 vs. 0.4) were significantly reduced in cirrhotic patients. PCA data revealed associations between LXA4 and saturated fatty acids, and between n-3 FA and RvD1 pathways, suggesting disrupted lipid-mediated inflammation resolution. Erythrocyte membranes showed elevated trans C18:1 in cirrhotic hepatitis B.

Conclusions: Chronic HBV infection, especially with cirrhosis, alters fatty acid profiles and reduces lipoxin A4 level, contributing to persistent hepatic inflammation and highlighting potential lipid-targeted therapies.

Loss of voice in patients after total laryngectomy is a significant issue that medicine has been grappling with since the 19th century. Scientific literature reports unequivocally confirm the substantial impact of total laryngectomy on patients' quality of life, which directly translates into their psychological well-being. The purpose of this study is to compile and organize the latest scientific findings on tracheoesophageal prostheses and subsequently integrate the description of this treatment modality with its rehabilitative aspects. In light of the growing number of patients using TEP, this paper also aims to reintroduce and clarify the topic for a broad range of ENT surgeons and other physicians who are increasingly likely to encounter TEP patients in clinical practice. The tracheoesophageal prosthesis (TEP), first described in 1972 by Professor Erwin Mozolewski and independently introduced into the English-language literature in 1980 by Blom and Singer, has become a key method for voice rehabilitation in patients who have undergone total laryngectomy and currently, used prostheses function based on a one-way air valve implanted in a surgically created tracheoesophageal fistula. This method is considered highly effective, as it is utilized in over 90% of cases. In addition to providing better voice quality compared to other techniques, the TEP prosthesis also positively impacts the overall quality of life of the patients who use it. Scientific studies highlight the analysis of quality of life and the effectiveness of voice rehabilitation as key endpoints in assessing the success of both surgical and rehabilitative treatment in laryngectomized patients. Over the years, various methods of voice rehabilitation have been developed in an effort to find the best approach that meets the needs of patients.

Intestinal dysbiosis affects numerous health conditions in human body. At the same time its impact on the bone remodelling process has been discovered quite recently. Studies are in agreement that the gut microbiota might directly or indirectly affect on bone metabolism through the functions of the immune system, hormone levels or calcium absorption. Having said that regulation of the intestinal microbiota will play a significant role in the bone metabolism it may represent a potential therapeutic measure in those at the risk of osteoporosis. The purpose of the following review was to assess the impact of probiotics, as major gut microbiota regulators, on the parameters of bone health. In particular as it refers to the bone mineral density, bone turnover markers as well as calcium and vitamin D in the blood serum. Special attention was placed on postmenopausal women, due to their increased risk of osteoporosis and fragility fractures. The analysis of the available literature suggests potential anti osteoporotic effect of some selected probiotic bacteria strains. Therapy with the use of probiotics might be complementary in the prophylactics and treatment of osteoporosis due to its good tolerance and well documented effectiveness in majority of the studies. Despite the promising results, there is still a great need for further clinical studies which would allow to determine the optimal dosage, duration of the supplementation as well as the efficiency confirmation of particular probiotic strains.