Peter Jackuliak

Background/Objectives: Vitamin D is a pleiotropic molecule involved in various physiological processes beyond skeletal health, including immune modulation and metabolic regulation. This prospective observational biomedical study aimed to assess the impact of short-term high-dose vitamin D supplementation on selected metabolic parameters in adult patients with type 2 diabetes mellitus (T2DM) and low serum 25-hydroxyvitamin D [25(OH)D] concentrations. Methods: Thirty patients were enrolled and assigned to receive either 10,000 IU/day of cholecalciferol (Group A) or a significantly lower dose (960 IU/day, Group B) for 12 weeks based on recruitment order (odd/even identification numbers). The primary endpoints were changes in parathyroid hormone (PTH), fasting blood glucose (FBG), calcium, phosphorus, and glycated haemoglobin (HbA1c). Results: A strong, statistically significant negative correlation between changes in 25(OH)D and PTH (Spearman r = –0.69052, p = 0.0044) was also observed. In the high-dose group, 25(OH)D increased from 17.2 to 31.8 ng/mL (median change 13.3 ng/mL), while PTH decreased from 3.27 to 2.76 pmol/L (median change –0.27 pmol/L). In the lower-dose group, 25(OH)D increased from 18.5 to 28.2 ng/mL (median change +8.1 ng/mL). The increase in 25(OH)D was significantly greater in the high-dose group than in the lower-dose group (median change +13.3 vs +8.1 ng/mL, p = 0.015). Within the observed range, patients with larger increases in 25(OH)D tended to show greater reductions in PTH. Other metabolic markers (HbA1c, FBG, calcium, and phosphorus) remained stable over 12 weeks. Conclusions: These findings support the effectiveness and safety of high-dose vitamin D supplementation in correcting vitamin D deficiency and reducing PTH levels in patients with T2DM while highlighting the need for longer-term studies to evaluate its broader metabolic effects.

Objectives: The “weekend effect” refers to the higher risk of death for patients admitted to hospitals on weekends compared to weekdays. While this pattern is well documented in many countries, there is limited data from Central Europe, including Slovakia. Study Design: We conducted a 13-year retrospective study at a large internal medicine department in Bratislava, Slovakia, to determine (1) whether there is a weekend effect, (2) which patient groups are most affected, and (3) what clinical and demographic factors might play a role. Methods: Using statistical tests, we analysed 45,955 hospitalisations between 2010 and 2022, comparing mortality rates between weekday (Monday–Friday) and weekend (Saturday–Sunday) admissions. We also used logistic regression to adjust for age, gender, length of stay, and re-hospitalisation. Causes of death were classified using ICD-10 codes. Results: Patients admitted on weekends had a significantly higher in-hospital mortality rate (15.58%, 1203 deaths among 7719 admissions) than patients admitted on weekdays (10.47%, 4002 deaths among 38,236 admissions, p < 0.0001). Even after adjusting for other factors, weekend admission remained a strong predictor of death (adjusted odds ratio = 1.31, 95% CI: 1.22–1.41). Cardiovascular disease was the most common cause of death on weekends. The weekend effect persisted across all years and was particularly pronounced in the COVID-19 pandemic (2020–2021). Conclusions: Our findings confirm the weekend effect in Slovakia, with patients admitted on weekends facing a higher risk of in-hospital death. Identifying the reasons behind this trend is critical to improving hospital care and ensuring consistent quality of care throughout the week.

As the spleen is a morphologically highly variable organ, radiologists and surgeons frequently encounter normal variants which might be misinterpreted. Accessory spleen is quite a common anatomical variation and generally does not causes any symptoms. However, the finding of an accessory spleen located outside its usual position—the splenic hilum or surrounding. peritoneal folds—is relatively rare in clinical practice and can cause serious diagnostic and/or therapeutic complications: It may mimic a solid tumour or an enlarged lymph. In the review, we summarise the possible anatomical localisations of the accessory spleens (from the thoracic cavity to lesser pelvis and scrotum in males), as well as the diagnostic problems and challenges that the atypical anatomical localisation often causes. We also summarise recent knowledge about the embryological background of accessory spleen formation and address the classification of such a finding—is it a harmless anatomical variation, a developmental defect or a pathological condition of the spleen? According to the recent scientific literature and based the modern imaging techniques, the frequency of accessory spleens is so high that it should be considered rather an anatomical variation than a developmental defect.

Background/Objectives: Type II diabetes mellitus (T2DM) is recognized as a condition of mild chronic inflammation, marked by increased levels of acute-phase proteins and various inflammatory indicators. These inflammatory substances, along with inflammation of adipose tissue and the secretion of adipocytokines, can contribute to insulin resistance and β cell dysfunction. By influencing both innate and adaptive immunity, vitamin D can inhibit the production of inflammatory cytokines and help mitigate the low-grade chronic inflammation associated with T2DM. Several strategies have been proposed to increase vitamin D levels effectively and safely, but the recent and strong ones have common tactics. Short-term high doses increase the level acutely, and long-term lower doses maintain sufficient levels. Methods: The aim of our work was to determine and verify the effectiveness of high doses of vitamin D to safely increase its level in patients with type 2 diabetes mellitus, as well as the effect of these doses on selected metabolic parameters. Data from 20 studies (vitamin D group n = 612, and control group n = 592) regarding the influence of vitamin D supplementation with doses above 4000 IU on serum 25(OH)D, fasting blood glucose (FBG), hemoglobin A1c (HbA1c), blood pressure, serum calcium, and parathormone were pooled. Results: Vitamin D supplementation significantly improved serum 25(OH)D levels, with an average increase after intervention versus baseline at 177.09%. Our studies suggest that vitamin D supplementation may benefit various parameters in T2DM patients, including glycemic control, blood pressure, and PTH levels. Conclusions: Vitamin D supplementation may have beneficial effects on various parameters in type 2 diabetes patients, including glycemic control, blood pressure, and parathormone levels. However, the results are only sometimes consistent across all studies. Further examination is needed.

This narrative review explores the potential, complexities, and consequences of using artificial intelligence (AI) to screen large government-held facial image databases for the early detection of rare genetic diseases. Government-held facial image databases, combined with the power of artificial intelligence, offer the potential to revolutionize the early diagnosis of rare genetic diseases. AI-powered phenotyping, as exemplified by the Face2Gene app, enables highly accurate genetic assessments from simple photographs. This and similar breakthrough technologies raise significant privacy and ethical concerns about potential government overreach augmented with the power of AI. This paper explores the concept, methods, and legal complexities of AI-based phenotyping within the EU. It highlights the transformative potential of such tools for public health while emphasizing the critical need to balance innovation with the protection of individual privacy and ethical boundaries. This comprehensive overview underscores the urgent need to develop robust safeguards around individual rights while responsibly utilizing AI’s potential for improved healthcare outcomes, including within a forensic context. Furthermore, the intersection of AI and sensitive genetic data necessitates proactive cybersecurity measures. Current and future developments must focus on securing AI models against attacks, ensuring data integrity, and safeguarding the privacy of individuals within this technological landscape.

The coronavirus disease 2019 (COVID-19) pandemic has led to changes in lifestyle, which could influence vitamin D status on a population level. The purpose of our study was to compare 25-hydroxyvitamin D (25[OH]D) levels in patients hospitalized because of severe COVID-19 during two waves of the pandemic (2020/21 vs. 2021/22). A total of 101 patients from the 2021/22 wave were compared with 101 sex- and age-matched subjects from the 2020/21 wave. Patients from both groups were hospitalized during the winter season from 1 December to 28 February. Men and women were analyzed together and separately. The mean 25(OH)D concentration increased from 17.8 ± 9.7 ng/mL to 25.2 ± 12.6 ng/mL between waves. The prevalence of vitamin D deficiency (30 ng/mL) increased from 10% to 34% (p < 0.0001). The proportion of patients with a history of vitamin D supplementation increased from 18% to 44% (p < 0.0001). Low serum 25(OH)D concentration was independently associated with mortality after adjusting for age and sex for the whole cohort of patients (p < 0.0001). The prevalence of inadequate vitamin D status in hospitalized patients with COVID-19 in Slovakia decreased significantly, probably due to a higher rate of vitamin D supplementation during the COVID-19 pandemic.

It is unclear how ongoing inflammation in Coronavirus Disease 2019 (COVID-19) affects 25-hydroxyvitamin D (25[OH]D) concentration. The objective of our study was to examine serum 25(OH)D levels during COVID-19 pneumonia. Patients were admitted between 1 November and 31 December 2021. Blood samples were taken on admission (day 0) and every 24 h for the subsequent four days (day 1–4). On admission, 59% of patients were 25(OH)D sufficient (>30 ng/mL), and 41% had 25(OH)D inadequacy (p < 0.0001). No subsequent significant change in 25(OH)D concentration was observed between day 2 and 3 (26.4 ng/mL vs. 25.9 ng/mL; p = 0.230) and day 3 and day 4 (25.8 ng/mL vs. 25.9 ng/mL; p = 0.703). The absolute 25(OH)D change between hospital admission and day 4 was 16% (4.8 ng/mL; p < 0.0001). On day 4, the number of patients with 25(OH)D inadequacy increased by 18% (p = 0.018). Therefore, serum 25(OH)D concentration after hospital admission in acutely ill COVID-19 patients should be interpreted with caution. Whether low 25(OH)D in COVID-19 reflects tissue level vitamin D deficiency or represents only a laboratory phenomenon remains to be elucidated in further prospective trials of vitamin D supplementation.

Patients with chronic kidney disease (CKD) have an increased risk of premature mortality, mainly due to cardiovascular causes. The association between hemodialysis and accelerated atherosclerosis has long been described. The ankle-brachial index (ABI) is a surrogate marker of atherosclerosis and recent studies indicate its utility as a predictor of future cardiovascular disease and all-cause mortality. The clinical implications of ABI cut-points are not well defined in patients with CKD. Echocardiography is the most widely used imaging method for cardiac evaluation. Structural and functional myocardial abnormalities are common in patients with CKD due to pressure and volume overload as well as non-hemodynamic factors associated with CKD. Our study aimed to identify markers of subclinical cardiovascular risk assessed using ABI and 2D and 3D echocardiographic parameters evaluating left ventricular (LV) structure and function in patients with end-stage renal disease (ESRD) (patients undergoing dialysis), patients after kidney transplantation and non-ESRD patients (control). In ESRD, particularly in hemodialysis patients, changes in cardiac structure, rather than function, seems to be more pronounced. 3D echocardiography appears to be more sensitive than 2D echocardiography in the assessment of myocardial structure and function in CKD patients. Particularly 3D derived end-diastolic volume and 3D derived LV mass indexed for body surface appears to deteriorate in dialyzed and transplanted patients. In 2D echocardiography, myocardial mass represented by left ventricular mass/body surface area index (LVMI) appears to be a more sensitive marker of cardiac structural changes, compared to relative wall thickness (RWT), left ventricle and diastolic diameter index (LVEDDI) and left atrial volume index (LAVI). We observed a generally favorable impact of kidney transplantation on cardiac structure and function; however, the differences were non-significant. The improvement seems to be more pronounced in cardiac function parameters, peak early diastolic velocity/average peak early diastolic velocity of mitral valve annulus (E/e´), 3D left ventricle ejection fraction (LV EF) and global longitudinal strain (GLS). We conclude that ABI is not an appropriate screening test to determine the cardiovascular risk in patients with ESRD.

Patients with chronic kidney disease (CKD) have an increased risk of premature mortality, mainly due to cardiovascular causes. The association between hemodialysis and accelerated atherosclerosis has long been described. The ankle-brachial index (ABI) is a surrogate marker of atherosclerosis and recent studies indicate its utility as a predictor of future cardiovascular disease and all-cause mortality. The clinical implications of ABI cut-points are not well defined in patients with CKD. Echocardiography is the most widely used imaging method for cardiac evaluation. Structural and functional myocardial abnormalities are common in patients with CKD due to pressure and volume overload as well as non-hemodynamic factors associated with CKD. Our study aimed to identify markers of subclinical cardiovascular risk assessed using ABI and 2D and 3D echocardiographic parameters evaluating left ventricular (LV) structure and function in patients with end-stage renal disease (ESRD) (patients undergoing dialysis), patients after kidney transplantation and non-ESRD patients (control). In ESRD, particularly in hemodialysis patients, changes in cardiac structure, rather than function, seems to be more pronounced. 3D echocardiography appears to be more sensitive than 2D echocardiography in the assessment of myocardial structure and function in CKD patients. Particularly 3D derived end-diastolic volume and 3D derived LV mass indexed for body surface appears to deteriorate in dialyzed and transplanted patients. In 2D echocardiography, myocardial mass represented by left ventricular mass/body surface area index (LVMI) appears to be a more sensitive marker of cardiac structural changes, compared to relative wall thickness (RVVT), left ventricle and diastolic diameter index (LVEDDI) and left atrial volume index (LAVI). We observed a generally favorable impact of kidney transplantation on cardiac structure and function; however, the differences were non-significant. The improvement seems to be more pronounced in cardiac function parameters, peak early diastolic velocity/average peak early diastolic velocity of mitral valve annulus (E/e'), 3D left ventricle ejection fraction (LV EF) and global longitudinal strain (GLS). We conclude that ABI is not an appropriate screening test to determine the cardiovascular risk in patients with ESRD.