Piotr Michał Jarosz

A 62-year-old woman with a history of hypertension, hypercholesterolemia, and tobacco use was transported directly to the catheterization laboratory with suspected acute ST-segment elevation myocardial infarction (STEMI). She presented with sudden-onset chest pain radiating to her back and abdomen, accompanied by lower extremity weakness without sensory deficits. Passive muscle tone and peripheral pulses remained intact. Initial physical examination showed a blood pressure of 106/68 mm Hg and a regular heart rate of 82 beats per minute. The electrocardiogram demonstrated inferior wall STEMI (Figure 1). Dual antiplatelet therapy was loaded pre-hospitally-ticagrelor and acetylsalicylic acid were used. Emergency coronary angiography showed no significant lesions in the left coronary artery. However, the procedure identified ascending aortic dissection with occlusion of the mid-segment of the right coronary artery (RCA), which appeared to originate from the false lumen (Figure 2A, Supplementary material, Video S1). The procedure was immediately terminated upon recognition of these findings. Urgent computed tomography angiography confirmed a DeBakey type I aortic

Introduction and purpose: Insulin resistance (IR) is a health problem as it can accompany obesity and lead to serious metabolic complications. In recent years, it has been "overdiagnosed" in clinical practice due to the lack of specific diagnostic criteria. The article summarizes the current knowledge in the field of pathophysiology, clinical picture and diagnostics. State of knowledge: Obesity remains the leading cause of IR, especially in the 21st century. In a positive energy balance, the adipocyte overloaded with fat protects itself against further influx of glucose and fats and becomes insulin insensitive. A component of IR development is subclinical inflammation of macrophage-rich adipose tissue which is exacerbated by an adipocytokine imbalance, which in turn generates IR. The markers of cellular resistance to insulin are free fatty acids in the bloodstream which are responsible for the lipotoxicity in hepatocytes and myocytes. Compensatory fasting hyperinsulinemia, which is currently considered the most sensitive diagnostic criterion, provides evidence of IR. An effective method of sensitizing cells to insulin is lifestyle modification, including a low-energy diet with regular physical activity in the form of aerobic-resistance exercise. Literature recommends no pharmacological treatment of IR alone, without obesity or other concomitant diseases. Conclusions: IR is not a separate disease, but only a pathological expression of cells' adaptation to excess of consumed energy. However, in its systemic form, when the protective mechanisms become ineffective, it induces metabolic disturbances. Only the causal treatment of IR guarantees therapeutic success.

Introduction: Hypothyroidism is a global health problem. Primary thyroid hormone deficiency may be caused by a wide spectrum of health problems, e.g. chronic autoimmune thyroiditis, postpartum thyroiditis, iodine deficiency, thyroid or parathyroid surgery and drugs. In recent years, scientific studies have also been published indicating a correlation between excessive intake of fluoride and hypothyroidism. Fluoride is added to the water sources of many countries. Objective: The purpose of the study was to review and compare currently available data on PubMed about fluoride-induced hypothyroidism. A brief description of the state of knowledge: Evidence based knowledge suggests that there is a potential relationship between water fluoridation and endocrine system disorders, especially hypothyroidism. Current studies indicate that TSH hormone levels get elevated with increased fluoride intake. The reason is supposed to be that fluorine is more electronegative than iodine and therefore easily displaces iodine from the body, thus affecting thyroid function. Conclusions: Current studies do not clearly show a simple correlation between excessive fluoridation of drinking water and the occurrence of hypothyroidism. However, inconclusive scientific evidence and the prevalence of hypothyroidism in the population indicate the need for further research in this area.

Introduction: Bee pollen is a natural substance obtained from flowers by bees. It is a rich source of protein, vitamins and minerals. It can be used as a dietary supplement. Bee pollen has been investigated for the treatment of some diseases with promising potential. It can be helpful in supportive therapy for dyslipidemia, metabolic syndrome, diabetes type 2, as well the prevention and control of coronary heart disease and myocardial infarction. Whey protein is a rich source of amino acids. It is a basic dietary supplement for many athletes, both professional and amateur. It stimulates muscle growth and provides nutrition for cachectic patients. Aim of the study: The objective of the study was to assess the impact of dietary supplementation of bee pollen or whey protein on the Wistar rat liver histological structure and expression of interleukin 12, smooth muscle actin and nitric oxide synthases among running and non-running rats. Material and methods: Thirty male Wistar rats were divided into six equal groups, three running and three non-running. Among both there was one control, one supplemented with bee pollen and one receiving whey proteins. After 8 weeks, all animals were decapitated and their livers were collected. Five micrometer thick slides were prepared and used for classical histological staining and immuno-histochemistry. ImageJ image analysis software was used to measure optical density and immunohistochemistry profile coverage. Results: Among all groups, morphology of liver was similar. In the running control group, expression of interleukin-12 (IL-12) was decreased as well as expression of endothelial nitric oxide synthase (eNOS) in a group of bee pollen supplemented rats. No significant changes in α- smooth muscle actin (α-SMA) expression was observed. Conclusions: Bee pollen is proving to be a questionable choice for athletes as an alternative to whey protein. Bee pollen supplementation affects hepatocyte cellular activity and has hepatoprotective effects. Whey protein performs worse in this regard. Lower antioxidant properties were found in groups supplemented with bee pollen than with whey protein.

Pituitary tumours are a significant diagnostic problem in clinical practice. Considering all the rarity of thyrotropic hormone secreting adenoma it is a diagnostic and therapeutic challenge in part due to the lack of the preoperative standards. TSH-oma, besides hyperthyroidism symptoms, might be a cause of other endocrine disorders, most often dysfunction of other tropic axes and may cause neurological symptoms associated with sella expansion. We report a case of a 49-year-old male patient with macroadenoma, overt clinical hyperthyroidism, secondary adrenal insufficiency and hypogonadotropic hypogonadism. The diagnosis of thyrotropinoma was confirmed by blood tests that revealed elevated FT3 and FT4 levels together with high TSH. Thyrotropin-releasing hormone (TRH) test was performed and magnetic resonance imaging (MRI) imaging revealed the presence of macroadenoma. Histopathology examination confirmed the diagnosis of thyrotropic cell pituitary adenoma. The appropriate therapy for thyrotropin pituitary adenoma has not been elaborated in reports of this domain. Preoperatively the patient was prepared by long-acting somatostatin analogue (Sandostatin LAR) injections to reduce tumor size with good therapeutic effect afterwards underwent surgical transsphenoidal treatment successfully. However, specific treatment guidelines for pituitary thyrotropic tumors need to be elaborated more in details.

Introduction: The apiculture is an old and long-established craft. Bee pollen is a flower pollen packed by bees and used as a food source for a hive. Mainly, it consists of simple sugars, protein, fatty acid but also minerals and vitamins. Bee pollen has multiple properties: antioxidative, antineoplastic, antibacterial and much more. It is commonly used by herbalists in treatment of certain medical conditions. Nevertheless, it is unsure whether bee pollen has any health benefits.Purpose: The aim of our study was to assess initially a knowledge of respondents about bee pollen and find out which factors can determine bee pollen supplementation.Materials and methods: The study was based on an on-line questionnaire, which was created by using Google Forms tool. It consisted of 27 both open and closed questions. Anonymity and resignation opportunity were warranted. The statistical analysis based on questionnaires were elaborated by using R custom script.The Pearson Chi-square test was applied to investigate the relationship between bee pollen usage and: (a) gender, (b) body mass index (BMI) and (c) living area.Results: The study was based on questionnaires given to 511 respondents, 153 of them were represented by men, whereas 358 by women. The 403 respondents gathered what was bee pollen. Bee pollen has been used by 123 persons (24% of respondents). Majority of respondents knew what bee pollen is. However, only one third of this group already used this product in their diet. People who took bee pollen had awareness about the advantages of this dietary supplement. Interestingly, Chi-square test analysis showed that the relationship between bee pollen usage and gender, as well as bee pollen usage and BMI is statistically significant. Contrary, there is no relationship between bee pollen and living area. Conclusions: Our study has highlighted the issue of this problem area among polish society. Quarter of respondents have ever used bee pollen as a part of their diet. Current results show that polish society has been able to have the knowledge about its beneficial properties, because of their declaration submitted to our survey.

Introduction and purpose: Cytology of urine sediment is a diagnostic tool used to screen for urinary tract lesions in two cases: surveillance of patients with a history of urothelial malignancies and patients with unexplained, new onset haematuria. Since 2015 histopathological laboratories have been able to report urine cytology according to The Paris System (TPS). Current studies suggest usefulness of urinary cytology in follow-up of urinary tract malignancies, especially urinary bladder cancer, which is the 13^th most deadly throughout the world being responsible for 200 000 deaths in 2018 among neoplasms. Objective: To review currently available data on PubMed about usefulness urine cytology reporting in follow-up and diagnosis of urinary tract malignancies. A brief description of the state of knowledge: Advantages of urine cytology examination contain non-invasiveness, high specificity, lower cost than cystoscopy and enable immunohistochemistry performance as well. Implementation of The Paris System for reporting urine cytology has created an universally acceptable and globally used report system. Reporting according to TPS significantly reduced the number of cases described as atypical changes. Conclusions: Urinary cytology is used to supplement endoscopic evaluation of the urinary tract in the screening and the surveillance of urothelial carcinoma. The Paris System for reporting urinary cytology has clarified the diagnostic categories of urine sediment examination. Cystoscopy and urine cytology are the standard tools for monitoring urinary tract malignancies.

Introduction and purpose: Gastric cancer (GC) is one of the most frequent malignancies around the world. There were nearly 1 million new cases in 2018. Gastric malignancies have heterogeneous etiopathogenesis. Lifestyle, socioeconomic status, blood group A, medical condition, Helicobacter Pylori infection, family history, genetic polymorphism, diet, demographic characteristics, occupational exposure, ionizing radiation are considered as predisposing factors. Objective: The purpose of our study is to review a currently available data on PubMed about risk factors of gastric cancer to consider better understanding of gastric cancer etiology. A brief description of the state of knowledge: Current studies suggest that red meat, pickled vegetable or alcohol consumption, low socioeconomic status, cigarette smoking, blood group A and Helicobacter Pylori infection increase risk of GC. Decreased risk of gastric cancer is observed in case of white meat consumption, statin and non-steroidal anti-inflammatory drugs intake. It seems that family history and other genetic predispositions may have a crucial role in gastric cancer development. Conclusions: Variety of environmental, genetic and medical factors are considered with an increased risk of gastric cancer. The awareness of its existence facilitates pathogenesis of gastric malignancies and enables the implementation of proper diagnostic procedures, screening programs and prophylaxis.