Damian Chruścicki

Pulmonary-renal syndrome is called alveolar hemorrhage accompanied by glomerulonephritis. The above condition can occur as a manifestation of ANCA-associated granulomatosis with vasculitis. The course of the disease varies from mild, limited inflammation to rapid progression with multi-organ changes that can be life-threatening. The mainstay of therapy is immunosuppression - both in the acute phase of the disease and after clinical improvement. Unfortunately, common causes of death in addition to complications of the disease include side effects of immunosuppressive treatment. A 72-year-old man is transferred to the Nephrology Unit for acute kidney injury of unclear etiology. On the basis of clinical examination, laboratory and imaging studies, a diagnosis of systemic small vessel inflammation with c-ANCA occupying the kidneys, lungs and intestines was made. Due to acute respiratory failure, the patient was transferred to the ICU, where renal replacement therapy, plasmapheresis, steroid pulses and cyclophosphamide were administered. After clinical improvement, it was decided to continue cyclophosphamide therapy and monitor blood IgG levels. Unfortunately, 4 months later, the patient died of multiple organ failure caused by septic shock of bacterial etiology. In the described case, age and comorbidities were the biggest risk factors for infectious complications of immunosuppression. The population is aging, so it is necessary to analyze the current standards of immunosuppressive treatment to improve the prognosis of the elderly.

Introduction Buerger's disease (BD) is an inflammatory disease with an etiology that is still not fully understood. It involves venous and arterial vessels, of small and medium caliber, of the lower and upper extremities (Cacione et al., 2020). This inflammation predominantly affects young, tobacco-smoking men, usually those before the age of 40. Literature data relating to peripheral arterial disease in general, put the prevalence of BD at between 0.5%-5.6% in Western European countries (Liu et al., 2023; Öztan et al., 2023). In this paper, we summarized the latest literature reports on rare clinical images and new directions in the treatment of Buerger's disease. Aim of the study The purpose of this systematic review was to compile the latest literature on the etiology, atypical disease presentation, associations with other diseases and modern treatment of Buerger's disease. Materials and methods The materials used by our team were obtained from a review of the currently available literature in the PubMed database. To search for articles, we used keywords such as: Buerger’s disease, thromboangiitis obliterans, thrombosis, atherosclerosis, Peripheral arterial disease, vasculitis. Conclusion In addition to its characteristic clinical presentation, Buerger's disease can present under a number of atypical forms. Such examples, less common conditions in the course of BD are intestinal vascular involvement mimicking the condition of acute abdomen, infertility condition due to gonadal involvement in the patient, possible correlation between the level of ASA (anti-sperm antibodies) and reduced fertility, the occurrence of nail lesions, renal complications, including the nephrotic syndrome, ocular or psychiatric manifestations. It is important for the clinician, in the diagnostic and therapeutic process at the onset of the described symptoms, not to exclude the possibility of an uncommon course of BD, to make a correct diagnosis and undertake optimal treatment.

A desmoid tumor is a clonal fibroblast proliferation, occurring in deep soft tissues with a significant recurrence tendency. Aggressive fibromatosis is a rare disease. The prevalence in the population ranges from 2 to 4 cases per million. Mentioned neoplasms are highly unpredictable in terms of development. Typically, in the course of desmoid tumors, metastases do not occur, but they often infiltrate the surrounding tissues, which may be associated with numerous complications. There are currently no randomized standards of therapy designated, which is undoubtedly a challenge when referring to treatment. To a 37 year old patient, due to a pathological mass in the abdomen, the MR examination was performed. It showed the presence of an irregular, heterogeneous structure on the right side of the abdominal cavity. A laparotomy was performed. During the procedure adhesions were released and the giant abdominal tumor was removed in one block with part of the duodenum, caecum, ascending colon and part of ileum. End-to-end duodenal anastomosis and stapled, side-to-side ileo-transverse anastomosis were used. The surgical field was being drained. The postoperative course was uneventful. Tissue material was collected for a routine, histopathological examination in which the intra-abdominal form of fibromatosis was diagnosed. The macroscopic image describes a tumor with dimensions of 25.0 cm x 25.0 cm x 20.0 cm.

Introduction: Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition marked by painful nodules and abscesses. It frequently coexists with autoimmune diseases, complicating management. Autoimmune conditions such as thyroid disorders, irritable bowel syndrome (IBS), systemic lupus erythematosus (SLE), and psoriasis are common in HS patients, necessitating a comprehensive care approach. Aim of the Study: This review evaluates the prevalence and impact of autoimmune diseases—autoimmune thyroid disorders, IBS, SLE, and psoriasis—on individuals with HS. Materials and Methods: A literature search of PubMed, Scopus, and Web of Science from 2018 to 2024 identified studies relevant to HS co-morbidities based on quality and relevance. Results: HS shows significant links with autoimmune thyroid disorders, IBS, SLE, and psoriasis. HS patients often have higher rates of hypothyroidism, hyperthyroidism, IBS, and SLE compared to the general population, suggesting shared inflammatory mechanisms. Conclusion: Recognizing co-morbid autoimmune diseases is vital for effective HS management. These associations emphasize the need for a multidisciplinary approach and further research to enhance understanding and treatment strategies.

Introduction Cardiovascular diseases are the most numerous group of diseases prevalent in the world. They are a challenge for many health systems, in terms of keeping life comfortable and also economics. The cause of selected disease entities is too much cholesterol in the blood. The most popular treatment for hypercholesterolemia is based on statins. Many patients are affected by intolerance to these drugs, so an important issue is the discovery and improvement of alternatives to statins. Purpose of work The purpose of this review is to collect literature data on the latest treatments for hypercholesterolemia with drugs other than statins and ezetimibe. Materials and methods Materials are from a review of recent literature available in PubMed. To search for articles, we used keywords such as: bempedoic acid, non-statin therapy, cardiovascular risk, inclisiran, alirocumab, cardiovascular disease, dyslipidemia, evolocumab. Summary Treatment of hypercholesterolemia with statins remains the most popular management strategy. Intolerance to treatment with these drugs creates serious clinical problems for patients. Recently, we could see the emergence of new drugs as alternatives to statins. As the results show, the new drugs can effectively replace statins in the hypolipemic treatment especially of patients who cannot be treated with them.

Background: Pes planovalgus, or flexible flatfoot, deformity is a common problem in pediatric orthopedic patients. There is no consensus on using the technique of arthroereisis in the treatment of symptomatic pes planovalgus. The aim of our study was to prospectively assess the functional outcomes following symptomatic pes planovalgus treatment with the use of the Spherus talar screw. Methods: Twenty-seven patients (11 females, 16 males), at a mean age of 10.5 years (7–14 years) were included in the prospective study. We assessed the level of physical activity (including sports) based on the University of California, Los Angeles (UCLA) activity scale, a 10-point level-of-activity VAS scale, and the Grimby physical activity scale. Pain was assessed based on a VAS pain scale; foot function was assessed with the revised Foot Function Index (FFI-R); and ankle joint mobility was measured. Results: The mean follow-up period was 18 months (14–26 months). There was a significant improvement in VAS-measured physical activity scores from 5.47 to 7 at follow-up, p = 0.048. There was a significant improvement in UCLA activity scale scores from 4.78 to 6.05 at follow-up, p = 0.045. Pain levels decreased from a mean VAS score of 4.73 prior to surgery to a mean score of 2.73 at follow-up, p = 0.047. The functional FFI-R scores showed a significant improvement from 140 points prior to surgery to 97.75 points at follow-up, p = 0.017. Comparison of the preoperative and follow-up values of the range of plantar flexion, adduction, and abduction in the operated limb also showed no significant changes in those individual parameters. The mean values of dorsiflexion, plantar flexion, adduction, and abduction at the ankle joint at follow-up, compared individually between the operated and non-operated foot showed no statistically significant differences. Conclusions: The use of a talar screw in the treatment of symptomatic pes planovalgus helps reduce pain and improve functional outcomes after treatment. Foot function assessments showed diminished pain, improved levels of physical and sport activity, and no effect on the range of motion after surgery in comparison with preoperative data. Arthroereisis with a talar screw is a valid surgical technique for the treatment of symptomatic pes planovalgus.

Funding Acknowledgements: Type of funding sources: Public Institution(s). Main funding source(s): This work was supported by a grant from the Institute of Medical Sciences, University of Opole, Poland. Background: Acute heart failure (AHF) is a life-threatening multifaceted clinical condition requiring intensive and expensive treatment. Earlier studies highlighted the difference in characteristics and prognosis of new onset AHF (NO- AHF) and acute decompensated heart failure (ADHF). Protein Klotho and FGF23 could be attractive tools in the evaluation of patients with AHF. GDF-15 is a recognized marker of the risk of death and complications, including bleeding in many cardiovascular diseases. Aim: The aim of the study was to compare selected biomarkers (Protein Klotho, FGF-23, GDF-15) with clinical characteristics and 12-month outcomes of patients with NO-AHF and ADHF. Methods: As part of the prospective Acute Heart Failure Registry (OP-AHF), data from 112 patients hospitalized in Intensive Cardiac Care Unit (ICCU) were collected from June 2019. Inclusion criteria were: hospitalization for AHF and the use of at least one of: intravenous diuretics, catecholamines or mechanical circulatory support. Blood samples were collected on admission, at discharge as well as at the 30-day. Patients were than follow-up for one year. Results: Patients with NO-AHF constituted 46% of the study group (52 out of 112) and compared to patients with ADHF they were more often aged under 65 years (44% vs. 30%, p=0.12), better educated (25% vs. 8%, p=0.03), less frequently with diabetes (31% vs. 43%, p=0.17), hypertension (58% vs. 83%, p=0.03), and prior myocardial infarction (19% vs. 45%, p=0.004). In both groups there were more men (69% vs. 80%,p=0.19) and ischemic etiology of heart failure were more frequent (33% vs. 51%, p=0.42) in NO-AHF and ADHF, respectively. Left ventricular ejection fraction (LVEF) was insignificantly higher in patients with NO-AHF on admission (30% vs. 26%, p=0.6) and at discharge (35% vs. 30%, p=0.27).Only patient with NO-AHF improved LVEF at the 12- month follow–up (50% vs. 35%, p=0,003).It was no signifcant differences between median value of Klotho protein in both groups at admission, discharge and 30–day follow up visit. We observed significant reduction in FGF-23 and GDF-16 at tree time points (Table 1). 12-month mortality in patients with NO-AHF was insignificantly lower (17% vs. 28% in ADHF HR=1,7 (95% Cl=0.25-1.18)),also after correction for age, sex and ,LVEF- 20% vs. 25%, respectively, p=0.58; HR=1,26 (0.3-1.8). In the Cox multivariate model, the risk of death was presented as hazard ratio (HR) and was highest for GDF-15 in both groups (Table2). Conclusion: Patients with the NO- AHF have different clinical profile than patients with acute decompensated heart failure with a tendency to lower 12-month mortality. There were no significant differences in the median value of Klotho protein in both groups. Reduction of the FGF-23 during hospitalization can serve as a marker of AHF compensation, thus FGF-23 could be a valuable tool for assessing response to treatment. GDF-15 seems to be the strongest predictor of death in both groups of AHF.