Changes in weight and body composition after initiating insulin therapy and their relationship with metabolic control during the first year of type 1 diabetes in adults. InLipoDiab1 Study

Introduction. As in the general population, an increase in the incidence of overweight has been observed in individuals with type 1 diabetes (T1DM). Nevertheless, weight gain in this group may contribute to the deterioration of the metabolic management. The aim of this study was to evaluate changes in the body weight and body composition after initiating insulin therapy and to assess their relationship with the metabolic management during the first year of T1DM in adults.Material and Methods. The prospective analysis included 139 adults patients with newly diagnosed T1DM, treated with Intensive functional insulin therapy (IFI) from the onset of the disease (age 26.3 ± 5.9 years). Patients were assessed at the time of the diagnosis and after 12 months. Metabolic parameters, including the HbA1c and lipid profile were investigated. The group was divided according to weight gain during the follow-up period.Results. Weight gain was observed in 68.3% of participants (n = 95). In most cases an increase in body fat was found (41% vs 59% p = 0.01). Changes in the body weight corresponded to significant changes in body composition. Conversely, HbA1c decreased during the follow-up in all groups. The highest reduction was observed in a group with “excessive weight gain”. Additionally, a significant increase in high density lipoproteins was observed in each group. However, weight gain was not accompanied by a deterioration of the lipid profile.Conclusions. Weight gain is a considerable problem among adults with newly diagnosed T1DM and is connected mainly with an increase of adipose tissue above the normal range. Changes in the body weight, associated with body composition changes, did not result in the dysfunctions of the metabolic management.

Spontaneous pneumomediastinum – a rare cause of chest pain and dyspnoe in children

Introduction. Spontaneous pneumomediastinum is a very rare condition in children. Nevertheless it should be considered in the differential diagnosis in patients who present with chest pain and dyspnoe.Aim. The aim of our study was to describe clinical presentation, management and outcomes of the paediatric patients with spontaneous pneumomediastinumMaterial and Methods. This was a retrospective analysis of the charts of all the patients who were admitted to the Department of Pneumonology, Paediatric Allergy and Clinical Immunology in a ten year period from 01.01.2011 till 31.12.2020 in whom spontaneous pneumomediastinum was diagnosed.Results. There were 11 children (7 females) with spontaneous pneumomediastinum. The median age of the children was 11 years (range 3 to 17.5 years). Most of the children presented to the hospital with chest pain, three children complained of the neck swelling and four children developed dyspnoe. Three children with the primary spontaneous pneumomediastinum had a history of physical exercise prior to the onset of symptoms. The secondary spontaneous pneumomediastinum occurred in two children with asthma and 4 children with pneumonia. Genetic material of human Bocavirus was identified in 3 cases. In 81.8% of children pneumomediastinum was accompanied by subcutaneous emphysema and in one case, in a child with severe pneumonia and respiratory insufficiency caused by Bocavirus with pneumorrhachis. In 10 children computed tomography was performed, bronchoscopy in 4 and esophagoscopy in two children. There was no evidence of esophageal rupture or bronchial tree rupture in any of our patients. Three children with pneumonia and pneumomediastinum developed respiratory insufficiency, two of these were treated with mechanical ventilation and one with High Flow Nasal Cannula oxygen therapy. All the children received oxygen. In one child surgical procedure was performed and the drain was inserted into mediastinal space in order to decompress it. Outcome was favourable in all children. Mean time to recovery was 10.6 ± 1.2 days. There was no recurrence of symptoms in any of our patients.Conclusions. Spontaneous pneumomediastinum in most cases is a benign condition, sporadically however it may progress rapidly, leading to respiratory insufficiency and warrant invasive management.

Dizziness as a first alarming symptom to neurological hospital admission: reasons and differentiation problem - a pilot study.

Aim. This prospective study aimed to assess the diversity of diagnoses in patients hospitalized in the neurology department, in whom the occurrence of dizziness was the presenting complaint during qualification for hospitalization, based on a joint assessment performed by a doctor and a physiotherapist and the implementation of treatment, including physiotherapy. Material and Methods. The study included consecutive patients selected from 2155 individuals hospitalized between 2018 and 2020 in the Neurology Unit who reported dizziness as the presenting complaint. Results. 100 patients (the mean age 58.68±16.57) were qualified for the study: 53 men (the mean age 59.47±15.44) and 47 women (the mean age 57.79±17.88). In the overwhelming number of cases, dizziness was associated with a vascular incident. However, cases of vertigo were also reported. Conclusion. A variety of diagnoses were made in patients hospitalized in the neurological department in whom the occurrence of dizziness was the presenting complaint during qualification for hospitalization.

Hypothetical Immunological and Immunogenetic Model of Heterogenous Effects of BCG Vaccination in SARS-CoV-2 Infections: BCG-induced Trained and Heterologous Immunity

Though SARS-CoV-2 infections are yet to be completely characterised in a host-pathogen interaction context, some of the mechanisms governing the interaction between the novel betacoronavirus and the human host, have been brought to light in satisfactory detail. Among the emerging evidence, postulates regarding potential benefits of innate immune memory and heterologous immunity have been put under discussion. Innate immune memory entails epigenetic reprogramming of innate immune cells caused by vaccination or infections, whereas heterologous immunity denotes cross-reactivity of T cells with unrelated epitopes and bystander CD8+ activation. Familiarization of the host immune system with a certain pathogen, educates monocytes, macrophages and other innate cells into phenotypes competent for combating unrelated pathogens. Indeed, the resolution at which non-specific innate immune memory occurs, is predominant at the level of enhanced cytokine secretion as a result of epigenetic alterations. One vaccine whose non-specific effects have been documented and harnessed in treating infections, cancer and autoimmunity, is the Bacillus Calmette–Guérin (BCG) vaccine currently used for immunization against pulmonary tuberculosis (TB). The BCG vaccine induces a diverse cytokine secretion profile in immunized subjects, which in turn may stimulate epigenetic changes mediated by immunoreceptor signalling. Herein, we provide a concise summarization of previous findings regarding the effects of the BCG vaccine on innate immune memory and heterologous immunity, supplemented with clinical evidence of the non-specific effects of this vaccine on non-mycobacterial infections, cancer and autoimmunity. This interpretative synthesis aims at providing a plausible immunological and immunogenetic model by which BCG vaccination may, in fact, be beneficial for the current efforts in combating COVID-19.

Acute Aortic Thrombus with Splenic Infarction in a Patient with COVID-19 Infection

Acute Aortic thrombus with splenic infarction is a rare complication of COVID-19. This manuscript highlights the importance of early identification of this complication with abdominal imaging and early initiation of anticoagulation despite moderate severity of the disease.

Cardiovascular risk factors of poor prognosis in COVID-19 – a review

Since the first report in 2019, COVID-19 has claimed many lives, even those previously in good health. Therefore, a proper diagnosis and identification of patients at the highest risk of serious complications is vital. In fact, COVID-19 can lead to systemic inflammation and multiorgan dysfunction. Apart from the respiratory system, the circulatory system is also affected, including numerous complications due to the cytokine storm, direct cytotoxic effects, downregulation of angiotensin-converting enzyme 2, and low oxygen blood levels. In this review, we discussed cardiovascular risk factors associated with a poor prognosis in COVID-19 patients, including pre-existing risk factors or those acquired in the course of the infection. We also analyzed the role of biomarkers, ECG, and imaging in the identification of patients at the highest risk of unfavorable outcomes, as even subtle abnormalities in additional tests may have a significant impact on disease management.

Application of a bottom-up approach to reduce healthcare disparity between the urban and rural areas

Disparity in access to healthcare between the rural and urban regions occurs world-wide, both in higher and lower income countries. In order to offset poor health outcomes, a number of approaches to structuring healthcare services can be used. Several factors have been identified to play a role; nevertheless, they contribute to the healthcare gap to various - depending on whether a higher or lower income country undergoes evaluation. Traditionally, healthcare systems worldwide adopt a top-down approach, which is initiated by large institutions providing resources required for large scale projects along with the centralisation of efforts. Therefore, although it does lead to change, the results can be short-lived. The authors discuss the bottom-up approach used in ASHWINI organisation in Gudalur, India which allowed for the development of accessible and sustainable healthcare system managed by the community. Other projects, based in part on the principles of a bottom-up approach, have been applied in other countries to reduce healthcare disparities. A bottom-up approach, designed to deliver geographically-accessible, locally managed, culturally appropriate care, can provide sustainable results, and since it is universal in nature, it can be applied in other setting with similar structures.

The possible role of molecular mimicry in SARS-CoV-2-mediated autoimmunity: an immunobiochemical basis

Coronavirus Disease 2019 (COVID-19), caused by the novel Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2), persists as a threat to global health and continues to be a rapidly evolving condition. Although COVID19 is negatively correlated with the existing comorbidities in terms of the clinical outcome, the ability of SARS-CoV-2 to mediate the novel, or to exacerbate the existing autoimmune conditions, has generated considerable interest, due to its potential implications both with regard to patients suffering from autoimmune conditions, as well as to the long-term consequences of the disease. However, although molecular mimicry has been postulated as a potential causative factor in post-COVID19 autoimmunity and multi-organ damage, a substantial body of research needs to emerge in order to achieve a more definitive conclusion. We investigated the possibility of SARS-CoV-2 peptide sequences behaving as molecular mimics with a potential to trigger an autoimmune response. Thus, on the basis of analysis in silico, we were able to develop a plausible case for the molecular mimicry as a potential aetiological mechanism of SARS-CoV-2-mediated autoimmunity, both in a multi-organ damage context or outside of the viral phase of infection. Interestingly, this is the first time that the peptide sequence of MACROD1 has been implicated in the COVID-19 autoimmunity. Additionally, we also confirm that PARP9 and PARP14 may be involved in the process.

Cardiovascular imaging in the acute phase of coronavirus disease 2019 (COVID-19)

The coronavirus disease 2019 (COVID-19) has become the most critical healthcare issue worldwide since the pandemic was announced in March 2020. Although respiratory symptoms remain the critical characteristic feature of COVID-19 (with acute respiratory syndrome as the leading cause of mortality), the disease also affects other organs. In fact, the involvement of the cardiovascular system during COVID-19 may include acute coronary symptoms, acute heart failure and myocarditis, arrhythmias, cardiac tamponade, pulmonary embolism, and right ventricular failure due to a high-pressure mechanical ventilation. It is vital to note that all of the abovementioned disorders require specific, pandemic-adapted imaging algorithms. This brief review aims to discuss different cardiac imaging modalities to demonstrate their effectiveness in managing patients in the acute phase of COVID-19.

Maternal and foetal outcome of pregnancy in women with connective tissue diseases

Introduction. The majority of patients diagnosed with systemic connective tissue diseases are women of childbearing age. Aim. The analysis of obstetric results and exacerbation rates in the pregnancies involving systemic connective tissue diseases. Material and Methods. We retrospectively reviewed perinatal outcomes of fourteen women with systemic connective tissue diseases hospitalised in the Department of Reproduction in the period between September 2019 and July 2021. Results. Median duration of a pregnancy was 37 weeks. One pregnancy ended in a stillbirth in week 28. Of the 13 live births, preterm delivery occurred in 5 cases. Of the 13 live-birth neonates, preterm delivery occurred in five cases. The Caesarean section rate was 57.1% and vaginal delivery rate was 42.9%. The mean birth weight of the live neonates was 2787g (SD 892), and the median Apgar score in the 1st and the 3rd minute was 10. In total, all 4 patients with the active disease at the time of conception and 1 who did not decide to undergo the recommended mitral valve surgery prior to pregnancy experienced symptoms indicating a disease flare-up in the course of pregnancy. None of the patients who planned their pregnancy experienced an exacerbation of the disease. Conclusions. All patients diagnosed with systemic connective tissue diseases should receive multidisciplinary care prior to conception, during pregnancy and in the postpartum period. Furthermore, they should be monitored by a team of specialists, due to the risk of a disease exacerbation and high rates of maternal and foetal complications resulting from the underlying condition.