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Zastosowanie pembrolizumabu u chorych z zaawansowanym płaskonabłonkowym niedrobnokomórkowym rakiem płuc bez ekspresji liganda receptora programowanej śmierci komórki typu 1 (PD-L1 TPS 0%) — opis przypadku
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Immunoterapia zastosowana w monoterapii w grupie chorych z wysoką ekspresją liganda receptora programowanej śmierci komórki typu 1 (PD-L1), jak i w połączeniu z chemioterapią, gdy ekspresja PD-L1 <50%, stanowi standard w leczeniu chorych z zaawansowanym płaskonabłonkowym niedrobnokomórkowym rakiem płuca (NDRP) w pierwszej linii leczenia. Terapia z wykorzystaniem pembrolizumabu wpływa na wydłużenie przeżycia całkowitego (OS) oraz czasu przeżycia wolnego od progresji (PFS) co potwierdzają badania kliniczne III fazy.
W poniższej pracy przedstawiono przypadek 66-letniego chorego z zaawansowanym rakiem płaskonabłonkowym płuc, bez ekspresji liganda receptora programowanej śmierci komórki typu 1 (PD-L1 TPS 0% ), u którego leczenie skojarzone pembrolizumabem i chemioterapią oraz kontynuacja immunoterapii, przyniosło wymierne korzyści - utrzymujący się efekt terapii wyrażony odpowiedzią radiologiczną i kliniczną przy jednoczesnym korzystnym profilu bezpieczeństwa stosowanych leków
Self-esteem, illness perception, and quality of life of individuals suffering from dermatological diseases in consideration of their personality dimensions
No full textIntroduction: Dermatological diseases, due to their visibility and chronic nature, can negatively impact self-esteem, illness perception, and quality of life. Their effects are not uniform and depend on various factors, including personality traits. The study aimed to assess self-esteem, quality of life, and illness perception in individuals with dermatoses and analyze their relationships with personality traits.
Material and methods: The study included 165 adults diagnosed with dermatological diseases. A diagnostic survey method was used, incorporating a sociodemographic questionnaire and standardized tools, the Polish adaptation of the Ten Item Personality Inventory (TIPI-PL), the Rosenberg Self-Esteem Scale (SES), the World Health Organization Quality of Life (WHOQOL)-BREF, and the Self-Assessment of One’s Own Illness Scale.
Results: The study revealed a significant link between low self-esteem and dermatological diseases (p < 0.05). Correlation analysis (p < 0.05) confirmed that higher self-esteem was associated with better functioning in all quality of life (QoL) domains (physical ρ = 0.47, social relationships ρ = 0.48, environmental, ρ = 0.49, psychological ρ = 0.74). Additionally, extraversion was positively correlated with higher quality of life ratings. The strongest positive correlations (p < 0.05) occurred between extraversion and the psychological domain (ρ = 0.499) as well as the social domain (ρ = 0.414).
Conclusions: Dermatological diseases significantly reduce quality of life, particularly in psychological and social aspects, highlighting the need to address mental health in treatment. Personality plays a crucial role in illness perception, with extroverted individuals coping best. These findings emphasize the importance of a holistic approach to dermatological care, integrating psychological support alongside medical treatment
A real-life clinical application of cardiac magnetic resonance imaging in patients with acute myocarditis — one-center observational retrospective study
Get PDFBackground: The diagnosis of acute myocarditis is complex, with cardiac magnetic resonance (CMR) being a recommended diagnostic method. This study aimed to evaluate the real-life use of CMR in the diagnosis of acute myocarditis and to correlate CMR results with the degree of myocardial damage.
Methods: This is a retrospective, observational tertiary single-center study of 90 consecutive patients (F/M:18/72, mean age:39 ± 14 years) hospitalized between 2015–2022 with a clinical diagnosis of acute myocarditis. The study population was divided into two groups: patients who underwent CMR+ and those who did not undergo CMR – In the CMR+ group, various sequences, including T1/T2-weighted imaging, late gadolinium enhancement (LGE), and mapping techniques, were used to assess myocardial inflammation and damage.
Results: CMR was performed in 39 patients (43.3%, F/M:10/29, mean age:41 ± 16 years). In this group, myocardial edema (increased T2 signal intensity) was detected in 29 patients, and LGE (signal intensity 2 standard deviations cabove normal on T1 images) was found in 39 patients. Diagnosis based on Lake Louise Criteria was possible in 29 cases. Edema negatively correlated with TnT levels (r = –0.412, p < 0.05) and positively with the number of LGE segments (r = 0.372, p < 0.05). Significant correlations were found between LVEF and LGE mass (r = –0.360, p < 0.05), and maximal TnT levels (r = –0.38, p < 0.05). CMR+ patients had lower myocardial damage markers and CRP concentrations compared to CMR– patients.
Conclusions: CMR is underused in diagnosing acute myocarditis. Myocardial damage markers correlate with CMR-detected edema and volumetric measures, but not LGE extent. More research is needed to enhance risk assessment and treatment
Optimization of systemic treatment in patients with bladder, ureter, and renal pelvis cancer — expert opinion of the Polish Society of Clinical Oncology
Get PDFThe effects of intragastric balloons on metabolic and inflammatory parameters in obese patients
Get PDFIntroduction: The prevalence of obesity worldwide has rapidly increased. One of the methods for treating obesity is endoscopic intragastric balloon (IGB) implantation. The aim of this study was to evaluate the effects of carbohydrate homeostasis and select cytokines in obese patients with a body mass index (BMI) ≥ 40 kg/m2.
Material and methods: We analysed 68 obese subjects who underwent IGB. There were 19 females and 49 males in the study, their ages ranged from 23–65 years, their weights were 169.04 ± 33 kg, and their BMIs were 54.81 ± 7.8 kg/m2. We measured carbohydrate parameters, including glucose, insulin and Homeostatic Model Assessment — Insulin Resistance (HOMA-IR), and cytokines, such as growth differentiation factor 15 (GDF15), human zinc-alpha-2-glycoprotein (ZAGa2), tumour necrosis factor alpha (TNF-α), and tumour necrosis factor weak inducer of apoptosis (TNFSF12/TWEAK). All parameters were measured before and at 6 months after the IGB was removed.
Results: Anthropometric parameters and carbohydrate homeostasis significantly changed 6 months after IGB implantation. We found significant decreases in body weight (p < 0.0001), BMI (p < 0.0001), glucose levels (p < 0.0001), insulin concentration (p < 0.0001), and HOMA-IR (p < 0.0001), regardless of sex. After 6 months, GDF15 (p < 0.0001), ZAGa2 (p < 0.0001) and TNFα (p < 0.0001) levels decreased. In contrast, the TNFSF12/TWEAK concentration increased (p < 0.0001). There was no difference between women and men in any of the parameters.
Conclusions: The results of this study indicate that IGB-induced weight loss leads to the normalization of metabolic parameters and inflammatory cytokines in obese individuals, regardless of sex
The costs of acromegaly management in Poland — analysis from one centre
Get PDFIntroduction: The analysis of the costs associated with treating acromegaly and its complications is important in planning diagnostics and treatment for a single patient, as well as in establishing the standard of care for the entire population of acromegaly patients. Data on the actual costs of treating patients with acromegaly in Poland are limited.
Aims of the study: To determine the direct cost (hospital stays, diagnostic imaging, surgical treatment, pharmacotherapy, tumour irradiation) of treating patients with acromegaly and its complications, assessing the relationship between acromegaly treatment costs and the radical nature of the treatment.
Materials and methods: A retrospective analysis of medical records was carried out in 124 patients with acromegaly who were hospitalised in the Department of Endocrinology in 2011–2016, including a group of 39 patients who were successfully operated on, 73 patients requiring treatment with a somatostatin analogue, and 12 patients with newly diagnosed disease. The costs of surgical procedures, hospitalisation,diagnostic tests, and the cost of pharmacological treatment of acromegaly and its complications were analysed and estimated based on the system of homogeneous groups of patients.
Results: The mean total annual cost of acromegaly treatment was PLN 43,419 (EUR 9731). The mean annual cost of treating patients undergoing effective neurosurgical treatment was lower than in the other groups, and the costs of pharmacological and surgical treatment of complications of acromegaly were also lower. The costs of hospitalisation and additional diagnostic tests were highest in patients with newly diagnosed acromegaly.
Conclusions: Treatment with somatostatin analogues is the major cost factor in patients requiring chronic therapy. Effective radical neurosurgical treatment reduces the incidence of chronic complications of acromegaly and lowers the overall treatment costs.
Electrocardiographic features suggesting mild myocarditis in the white athletes population during the COVID-19 pandemic
Get PDFWstęp. Trzyletnia pandemia SARS-CoV-2 (COVID-19) pokazała, że wirus był tak powszechny, że mógł powodować bezobjawowe zmiany w sercach sportowców. Uniesienie odcinka ST (STE) uważane jest za łagodną, typową zmianę adaptacyjną obserwowaną podczas ćwiczeń u sportowców. Podczas rutynowych corocznych badań sportowców zaob-serwowaliśmy zmiany w obrazie STE w badaniu elektrokardiograficznym (EKG), co może przełożyć się na nowe nieznane czynniki ryzyka nagłej śmierci sercowej u sportowców.
Materiał i metody. Ocena przetrwałego STE (wzorce A1, A2, B3, B2, B1) po pandemii COVID-19 jako wariantu przebytego zapalenia mięśnia sercowego w populacji zdrowych sportowców.
Wyniki. Nasza analiza EKG obejmująca 1011 sportowców w 2021 roku wykazała dwuletnią STE u ponad 80% osób, co najmniej w obrębie jednej ściany serca, a u niektórych wytrenowanych sportowców powszechną i dwukierunkową ewolucję zmian chorobowych wraz z uniesieniem punktu J > 1 mm. Minusem tej pracy jest brak możliwości wysłania do badań bezobjawowych zawodników, podobnie jak brak możliwości sprawdzenia obecności wirusa w organizmie za pomocą testu PCR i testu antygenowego.
Wnioski. Zaobserwowano statystycznie istotne zależności pomiędzy parametrami antropometrycznymi a obrazem STE na przedniej, dolnej i bocznej ścianie serca oraz innymi nieprawidłowościami w EKG u sportowców. Trwały zapis sugeruje historię zapalenia mięśnia sercowego. Konieczne jest dalsze monitorowanie populacji młodych i dorosłych sportowców ze STE, zarówno w dyscyplinach sportowych, w których uznaje się, że ryzyko zgonu jest niskie (golf, kajakarstwo), jak i wysokie (piłka nożna, sztuki walki, koszykówka) ze względu na ryzyko współistniejących chorób układu krążenia.
Introduction. The three-year SARS-CoV-2 (COVID-19) pandemic showed that the virus was so common that it could cause asymptomatic changes in the hearts of athletes. ST-elevation (STE) is considered a benign, typical adaptive change seen during exercise in athletes. We have noticed changes in the STE pattern on the ECG during routine annual examinations of athletes after the COVID-19 pandemic.
Material and methods. Assessment of persistent STE (patterns A1, A2, B3, B2, B1) after the COVID-19 pandemic as a variant of past myocarditis in the population of healthy athletes.
Results. Our ECG analysis of 1011 athletes from 2021 showed two years of STE in more than 80% of the people, at least over one heart wall, and in some trained athletes, common and bidirectional evolution of lesions with the elevation of the J point > 1 mm. The inability to send asymptomatic players for testing is the downside of this work, just like the inability to verify the presence of the virus in the body with a PCR and antigen test.
Conclusions. Statistically significant relationships were observed between anthropometric parameters and STE patterns on the heart’s anterior, inferior and lateral walls and other ECG abnormalities in athletes. A persistent record suggests a history of myocarditis. Further monitoring of the population of young and adult athletes with STE is necessary, both in sports disciplines considered low (golf, canoeing) and high risk of death (football, martial arts, basketball) due to the risk of comorbid cardiovascular diseases.
Radiochirurgia stereotaktyczna w leczeniu arytmii komorowej
No full textStereotactic radiosurgery (SRS) is gaining recognition as a promising treatment modality for ventricular arrhythmias, particularly in patients for whom conventional therapies, such as pharmacological management and catheter ablation, have failed or are contraindicated. SRS employs precise irradiation targeting of the arrhythmogenic foci, which enables the selective ablation of pathological cardiac tissues while preserving surrounding healthy tissue. Clinical studies, such as SMART-VT, have shown encouraging results, demonstrating significant reductions in ventricular tachycardia episodes and confirming the safety profile of this therapeutic approach. Despite these promising findings, further studies are needed, involving larger, more diverse patient populations and extended follow-up periods to thoroughly evaluate the long-term efficacy and safety of this method. The implementation of standardized treatment protocols and procedural guidelines could enhance therapeutic outcomes and improve the accessibility of SRS for a broader range of patients.Radiochirurgia stereotaktyczna (SRS) staje się obiecującą metodą leczenia arytmii komorowych, szczególnie u pa-cjentów, u których tradycyjne metody, takie jak farmakoterapia i ablacja cewnikowa, okazały się nieskuteczne lub są przeciwwskazane. SRS polega na precyzyjnym napromienieniu źródła arytmii, co pozwala na zniszczenie patologicznych tkanek serca bez uszkadzania zdrowych. Badania, takie jak SMART-VT, pokazują obiecujące wyniki w zakresie redukcji częstoskurczu komorowego i bezpieczeństwa terapii. Pomimo pozytywnych wyników, potrzeba dalszych badań na większych grupach pacjentów oraz długoterminowej obserwacji, aby w pełni ocenić skuteczność i bezpieczeństwo tej metody. Wprowadzenie standardów leczenia i standaryzacja procedur mogą znacząco poprawić skuteczność terapii i jej dostępność dla szerszej grupy pacjentów.
Pigtail catheter as an alternative option for malignant pleural effusion other than pleurodesis: a case series
Get PDFPatients with malignant pleural effusions should have pleural drainage as the preferred course of treatment. There are still issues in treating people who have malignant pleural effusions. There are several approaches for treating malignant pleural effusion. The following management methods are available: thoracentesis, implantation of a chest tube or indwelling pleural catheter, pleurodesis, and observation. Pigtail catheter use has emerged as a practical option that is less invasive, less uncomfortable and has fewer procedure-related problems other than pleurodesis. The purpose of this case series was to examine the effectiveness of pigtail catheter use in patients with malignant pleural effusion
Palliative care physicians workforce in Saudi Arabia: demographics, distributions, and future challenges
Get PDFBackground: Palliative care is an essential component of healthcare systems, particularly in the context of aging populations and the increasing prevalence of chronic diseases. Despite recent initiatives in Saudi Arabia, palliative care services face significant challenges in meeting the growing demands. This study aimed to investigate the current demographic characteristics, distribution, and challenges faced by the palliative care physicians workforce in Saudi Arabia, and to offer recommendations for policy and practice to enhance palliative care services.
Methods: A descriptive geolocation study was conducted in the year 2024 using data from the Saudi Commission for Health Specialties and the Saudi Census 2022. The number, distribution, and characteristics of palliative care physicians across 13 cities and 26 hospitals in Saudi Arabia were analyzed. A comprehensive literature review was conducted to contextualize these findings. The location of this study is Saudi Arabia.
Results: This study identified 110 palliative care physicians in Saudi Arabia, with 84.5% of them being Saudi nationals. The physician-to-population ratio was 1:292,500 with significant regional disparities. Only 9% of Ministry of Health hospitals have palliative care services. Key challenges include workforce shortages, the uneven distribution of services, and limited integration into primary care.
Conclusions: The palliative care physicians workforce in Saudi Arabia faces significant challenges including shortages and uneven distribution. Recommendations include expanding medical education and training programs, improving service distribution in underserved regions, and integrating palliative care into primary health care. These findings provide a foundation for future research and policymaking aimed at enhancing palliative care services in Saudi Arabia