Is additive manufacturing a magic bullet to resupply lacking PPE? Producing respirators and face shields during COVID-19 pandemic: A systematic review.

Coronavirus Disease 2019 (COVID-19) pandemic caused an increase in the demand for personal protective equipment (PPE) and disruptions in production chains, resulting in an acute shortage of PPE. A possible solution to this problem was additive manufacturing (AM) technology - allowing for a quick start of the production of PPE and potentially able to meet the demand until the production is restored. In addition, AM allows for the production of PPE prototypes with potentially greater comfort of use or degree of protection. In order to assess the production of PPE in AM during the COVID-19 pandemic, previously published articles in this field were analyzed. After analyzing abstracts and full texts, 30 original works were selected from the initially collected 487 articles. Based on the analyzed literature, it was found that there are not enough studies comparing traditional and AM PPE as well as not enough comparisons of the different types of AM PPE with each other. In many cases, researchers focused only on the subjective assessment of the comfort of using PPE, without assessing their effectiveness in preventing infections. Despite that, AM has a great potential to quickly produce lacking PPE. Respirators and shields made by AM were rated by the vast majority of users as comfortable to wear. Some of the respirators could be adapted to a specific user, by designing on the basis of a face scan or after warming up the finished print and modeling the shape.

The Association Between Affective Temperament Traits and Dopamine Genes in Obese Population.

Studies indicate the heritable nature of affective temperament, which shows personality traits predisposing to the development of mental disorders. Dopaminergic gene polymorphisms such as DRD4, COMTVal158Met, and DAT1 have been linked to affective disorders in obesity. Due to possible correlation between the aforementioned polymorphisms and the affective temperament, the aim of our research was to investigate this connection in an obese population. The study enrolled 245 obese patients (178 females; 67 males). The affective temperament was assessed using the Temperament Evaluation of Memphis, Pisa, Paris, and San Diego autoquestionnaire (TEMPS-A). Genetic polymorphisms of DAT1, COMTVal158Met and DRD4 were collected from peripheral blood sample and determined using a polymerase chain reaction (PCR). Only in COMT polymorphisms, the cyclothymic and irritable dimensions were significantly associated with Met/Val carriers (p = 0.04; p = 0.01). Another interesting finding was the correlation between the affective temperament and age in men and women. We assume that dopamine transmission in heterozygotes of COMT may determine the role of the affective temperament in obese persons. Dopaminergic transmission modulated by COMT may be responsible for a greater temperament expression in obese individuals. To our knowledge, this is the first study describing the role of affective temperament in the obese population, but more research is needed in this regard.

The fructose tolerance test in patients with chronic kidney disease and metabolic syndrome in comparison to healthy controls.

BACKGROUND: Fructose acutely raises serum uric acid in normal subjects, but the effect in subjects with metabolic syndrome or subjects with chronic kidney disease is unknown. The aim of the study was to evaluate changes in serum uric acid during the fructose tolerance test in patients with chronic kidney disease, metabolic syndrome with comparison to healthy controls. METHODS: Studies were performed in 36 subjects with obesity (body mass index >30) and metabolic syndrome, 14 patients with stage 3 chronic kidney disease, and 25 healthy volunteers. The fructose tolerance test was performed in each patient. The change in serum uric acid during the fructose challenge was correlated with baseline ambulatory blood pressure, serum uric acid, metabolic, and inflammatory markers, and target organ injury including carotid intima media thickness and renal resistive index (determined by Doppler). RESULTS: Absolute serum uric acid values were highest in the chronic kidney disease group, followed by the metabolic syndrome and then healthy controls. Similar increases in serum uric acid in response to the fructose tolerance test was observed in all three groups, but the greatest percent rise was observed in healthy controls compared to the other two groups. No significant association was shown between the relative rise in uric acid and clinical or inflammatory parameters associated with kidney disease (albuminuria, eGFR) or metabolic syndrome. CONCLUSIONS: Subjects with chronic kidney disease and metabolic syndrome have higher absolute uric acid values following a fructose tolerance test, but show a relatively smaller percent increase in serum uric acid. Changes in serum uric acid during the fructose tolerance test did not correlate with changes in metabolic parameters, inflammatory mediators or with target organ injury. These studies suggest that acute changes in serum uric acid in response to fructose do not predict the metabolic phenotype or presence of inflammatory mediators in subjects with obesity, metabolic syndrome or chronic kidney disease. TRIAL REGISTRATION: The study was registered in ClinicalTrials.gov. Identifier : NCT01332526. www.register.clinicaltrials.gov/01332526.

[Thyrotoxicosis induced by interferonotherapy of chronic hepatitis C in a woman with Hashimoto's thyroiditis]. / Tyreotoksykoza indukowana interferonoterapia przewleklego zapalenia watroby typu C u kobiety z choroba Hashimoto.

Interferon alpha in combination with ribavirin has been for years a standard therapy of chronic hepatitis C (CHC). This treatment is burdened with numerous side effects, including thyroid dysfunctions. Their incidence in patients receiving dual therapy is estimated at 4.6-33.3%. The paper presents a case of a patient with Hashimoto's thyroiditis, in whom at the time of CHC therapy with pegylated interferon alfa and ribavirin hyperthyroidism episode evolved with an increased level of TSH receptor antibodies after introducing an antiviral treatment and its decrease after the use of antithyroid drugs. After a short break, this therapy was continued, without achieving the therapeutic success. The authors take up the discussion on the possibility of taking CHC therapy in this patient in the future. Participants are an endocrinologist and a hepatologist.

Congenital vascular malformations in scintigraphic evaluation.

BACKGROUND: Congenital vascular malformations are tumour-like, non-neoplastic lesions caused by disorders of vascular tissue morphogenesis. They are characterised by a normal cell replacement cycle throughout all growth phases and do not undergo spontaneous involution. Here we present a scintigraphic image of familial congenital vascular malformations in two sisters. MATERIAL/METHODS: A 17-years-old young woman with a history of multiple hospitalisations for foci of vascular anomalies appearing progressively in the upper and lower right limbs, chest wall and spleen. A Parkes Weber syndrome was diagnosed based on the clinical picture. Due to the occurrence of new foci of malformations, a whole-body scintigraphic examination was performed. A 12-years-old girl reported a lump in the right lower limb present for approximately 2 years, which was clinically identified as a vascular lesion in the area of calcaneus and talus. Phleboscintigraphy visualized normal radiomarker outflow from the feet via the deep venous system, also observed in the superficial venous system once the tourniquets were released. In static and whole-body examinations vascular malformations were visualised in the area of the medial cuneiform, navicular and talus bones of the left foot, as well as in the projection of right calcaneus and above the right talocrural joint. CONCLUSIONS: People with undiagnosed disorders related to the presence of vascular malformations should undergo periodic follow-up to identify lesions that may be the cause of potentially serious complications and to assess the results of treatment. Presented scintigraphic methods may be used for both diagnosing and monitoring of disease progression.

Metabolic-associated fatty liver disease and the role of hormones in its aetiopathogenesis.

Metabolic-associated fatty liver disease (MAFLD) is a newly coined term that links the presence of liver steatosis (characterised by the accumulation of lipids in at least 5% of liver cells) with a condition of overall systemic metabolic dysfunction. MAFLD impacts 24-36% of the global population. As per the official guidelines, a diagnosis of MAFLD can be made when hepatosteatosis is accompanied by type 2 diabetes mellitus, overweight, obesity, or at least 2 other specific metabolic abnormalities (increased waist circumference, hypertension, dyslipidaemia, prediabetes, elevated C-reactive protein level, or increased homeostasis model assessment of insulin resistance: HOMA-IR). MAFLD is a heterogeneous illness associated with multiple diseases that impact various organs, particularly endocrine organs. Endocrinopathies can significantly influence the progression and severity of MAFLD. This paper provides a brief overview of the existing research on the connection between liver steatosis and the functioning of endocrine organs. The authors also propose dividing endocrine diseases into those having a possible, strong, and clear relationship with hepatosteatosis (for the purpose of preliminary recommendations regarding the need for monitoring the possible progression of MAFLD in these groups of patients).

Body Mass Index and Waist Circumference as Predictors of Above-Average Increased Cardiovascular Risk Assessed by the SCORE2 and SCORE2-OP Calculators and the Proposition of New Optimal Cut-Off Values: Cross-Sectional Single-Center Study.

Background: Obesity has been perceived as one of the important cardiovascular risk factors, but SCORE2 calculators used in clinical practice do not include the most popular parameters assessed for body composition: body mass index (BMI) and waist circumference (WC). The objective of this research was to determine which of the aforementioned variables is a more reliable predictor of an above-average increased cardiovascular risk for gender and age (ICVR). Methods: Data from 2061 patients were analyzed; the 10-year risk of cardiovascular events was assessed by SCORE2 tables, and the correlations with BMI and WC were analyzed. Results: BMI and WC independently predicted ICVR (OR 1.10-1.27). In males, BMI was a more accurate predictor (AUC = 0.816); however, in females, it was WC (AUC = 0.739). A novel threshold for BMI (27.6 kg/m2) was suggested, which increases the risk of cardiovascular disease by 3.3-5.3 times depending on gender; the same holds true for WC (93 cm in women and 99 cm in men; 3.8-4.8-fold higher risk). Conclusions: Despite their heterogeneity, BMI and WC are effective cardiovascular risk predictors, especially BMI for males and WC for females; therefore, more research is needed to include them in future models for predicting unfavorable cardiometabolic events.

Iron and ferritin deficiency in women with hypothyroidism and chronic lymphocytic thyroiditis - systematic review.

Iron is one of the essential microelements necessary for maintaining the body's homeostasis. It serves various roles, including being a crucial component in the proper structure of many enzymes and supporting the transport of oxygen and electrons. Its deficiency can lead to anaemia, which is a common clinical condition often associated with thyroid diseases. Iron deficiency is one of the most common nutritional deficiencies, and its prevalence is strongly associated with socioeconomic status. It is the primary cause of anaemia in 42% of children and 50% of women. Importantly, iron deficiency is placed among the top 5 causes of disability in women. Thyroid peroxidase (TPO) is an enzyme essential for the production of thyroid hormones, and iron is a key factor in its proper functioning. Therefore, in the case of iron deficiency, the activity of this enzyme is also reduced. Iron is also a factor that is important in epigenetic modification processes, and its deficiency may contribute to genomic changes potentially promoting the development of autoimmune thyroid diseases. Adequate supplementation in patients with Hashimoto's disease is one of the crucial elements of effective therapy. In addition to iodine, selenium, and magnesium supplementation, attention should be paid to proper iron intake. Iron is an element that is a component of the heme enzyme- thyroid peroxidase, which owes its activity to the binding of haem, and its function is the production of thyroid hormones. Iron can be delivered to the body in haem and non-haem forms. The haem form is found particularly in haemoglobin-rich red meat, but also in eggs, fish, and poultry. On the other hand, non-haem iron can be found in legumes, grains, fruits, and vegetables. Our study aimed to gather and summarise knowledge from scientific literature regarding iron deficiency anaemia and its association with hypothyroidism in women, as well as the possible mechanisms and pathogenesis of these conditions. The paper also aims to highlight that considering the high risk of iron deficiency, assessing iron status along with ferritin should be an integral part of additional diagnostic measures in cases of hypothyroidism, particularly Hashimoto's disease.

Performance Evaluation of a Novel Non-Invasive Test for the Detection of Advanced Liver Fibrosis in Metabolic Dysfunction-Associated Fatty Liver Disease.

Metabolic dysfunction-associated fatty liver disease (MAFLD) may progress to advanced liver fibrosis (ALF). We evaluated the diagnostic accuracy of a novel Liver Fibrosis Risk Index (LFRI) in MAFLD subjects using transient elastography (TE) as the reference method for liver fibrosis measurement and then the diagnostic performance of a new two-step non-invasive algorithm for the detection of ALF risk in MAFLD, using Fibrosis-4 (FIB-4) followed by LFRI and comparing it to the reference algorithm based on FIB-4 and TE. We conducted a prospective study on 104 MAFLD European adult subjects. All consenting subjects underwent TE and measurements of FIB-4 and LFRI. For FIB-4 and TE, validated cut-offs were used. An ROC analysis showed that LFRI diagnosed severe fibrosis with moderate accuracy in MAFLD subjects with a negative predictive value above 90%. Using the new algorithm with LFRI thresholds recommended by the manufacturer, the number of subjects classified into ALF risk groups (low, intermediate, or high) differed significantly when compared with the reference algorithm (p = 0.001), with moderate agreement between them (weighted kappa (95% CI) = 0.59 (0.41-0.77)). To improve the performance of the LFRI-based algorithm, we modified cut-off points based on ROC curves obtained by dividing the study population according to the reference algorithm and observed no difference between algorithms (p = 0.054) in categorizing ALF risk, with a slight increase in the total agreement (weighted kappa (95% CI) = 0.63 (0.44-0.82)). Our findings suggest that using the novel LFRI as a second-line test may represent a potential alternative for liver fibrosis risk stratification in MAFLD patients; however, modified cut-offs are needed to optimize its performance.

ChatGPT-3.5 passes Poland's medical final examination-Is it possible for ChatGPT to become a doctor in Poland?

Objectives: ChatGPT is an advanced chatbot based on Large Language Model that has the ability to answer questions. Undoubtedly, ChatGPT is capable of transforming communication, education, and customer support; however, can it play the role of a doctor? In Poland, prior to obtaining a medical diploma, candidates must successfully pass the Medical Final Examination. Methods: The purpose of this research was to determine how well ChatGPT performed on the Polish Medical Final Examination, which passing is required to become a doctor in Poland (an exam is considered passed if at least 56% of the tasks are answered correctly). A total of 2138 categorized Medical Final Examination questions (from 11 examination sessions held between 2013-2015 and 2021-2023) were presented to ChatGPT-3.5 from 19 to 26 May 2023. For further analysis, the questions were divided into quintiles based on difficulty and duration, as well as question types (simple A-type or complex K-type). The answers provided by ChatGPT were compared to the official answer key, reviewed for any changes resulting from the advancement of medical knowledge. Results: ChatGPT correctly answered 53.4%-64.9% of questions. In 8 out of 11 exam sessions, ChatGPT achieved the scores required to successfully pass the examination (60%). The correlation between the efficacy of artificial intelligence and the level of complexity, difficulty, and length of a question was found to be negative. AI outperformed humans in one category: psychiatry (77.18% vs. 70.25%, p = 0.081). Conclusions: The performance of artificial intelligence is deemed satisfactory; however, it is observed to be markedly inferior to that of human graduates in the majority of instances. Despite its potential utility in many medical areas, ChatGPT is constrained by its inherent limitations that prevent it from entirely supplanting human expertise and knowledge.

Assessment of real-world usage of lanreotide AUTOGEL 120 in Polish acromegalic patients - results from the prospective 12-month phase of Lanro-Study.

AIM OF THE STUDY: To assess resource utilization and costs of treatment with lanreotide AUTOGEL 120 mg (ATG120) administered as part of routine acromegaly care in Poland. MATERIAL AND METHODS: A multicentre, non-interventional, observational study on resource utilization in Polish acromegalic patients treated with ATG120 at 4 weeks or extended (> 4 weeks) dosing interval. The study recruited adult acromegalic patients treated medically for ≥ 1 year including at least 3 injections of ATG120. Data on dosing interval, aspects of administration, and resource utilization were collected prospectively during 12 months. Costs were calculated in PLN from the public health-care payer perspective for the year 2013. RESULTS: 139 patients were included in the analysis. Changes in dosing regimen were reported in 14 (9.4%) patients. Combined treatment was used in 11 (8%) patients. Seventy patients (50%) received ATG120 at an extended dosing interval; the mean number of days between injections was 35.56 (SD 8.4). ATG120 was predominantly administered in an out-patient setting (77%), by health-care professionals (94%). Mean time needed for preparation and administration was 4.33 and 1.58 min, respectively, mean product wastage - 0.13 mg. Patients were predominantly treated in an out-patient setting with 7.06 physician visits/patient/year. The most common control examinations were magnetic resonance imaging of brain and brain stem (1.36/patient/year), ultrasound of the neck (1.35/patient/year), GH (1.69/patient/year), glycaemia (1.12/patient/year), IGF-1 (0.84/patient/year), pituitary-thyroid axis hormone levels assessment (TSH-0.58/patient/year, T4-0.78/patient/year). There were 0.43 hospitalizations/patient/year. For direct medical costs estimated at PLN 50 692/patient/year the main item was the costs of ATG120 (PLN 4103.87/patient/month; 97%). The mean medical cost, excluding pharmacotherapy, was PLN 1445/patient/year (out-patient care - 49%, hospitalization - 23%, diagnostics/laboratory tests - 28%). CONCLUSIONS: These results represent the current use of ATG120 in the population of Polish acromegalic patients in a realistic clinical setting. Findings that 50% of patients could be treated with dose intervals of longer than 28 days support the potential of ATG120 to reduce the treatment burden.

The Level of Intima-Media Thickness in Patients with Metabolic Syndrome in Poland Depending on the Prevalence of Type 2 Diabetes.

BACKGROUND: Metabolic syndrome (MetS), increasingly diagnosed among the Polish population, is a combination of factors that are associated with an increased risk of atherosclerosis and cardiovascular diseases. Intima-media thickness (IMT) of the common carotid artery has been suggested as, simply, a non-invasive and reproducible marker of the early stages of the atherosclerotic process. The carotid IMT can also be a strong predictor of future cerebral and cardiovascular events. The aim of our study was to evaluate atherosclerotic lesions in carotid vessels in patients with MetS depending on the presence of DMt2 and to assess which demographic factors affect the level of IMT. The study involved 335 subjects diagnosed with MetS, including 211 females (65%) and 124 males (37%) aged 37-82. The diagnosis of MetS was made on the basis of the International Diabetes Federation (IDF) criteria. The patients were divided into two subgroups: with DMt2 and without DMt2. The value of IMT depended on gender, education, and smoking status. We noticed that patients with DMt2 had the highest measurement of IMT compared with other groups (1.01 vs. 0.98). Additionally, a statistically significant difference between the subgroup with DMt2 and those without DMt2 was found (1.01 vs. 0.92; p < 0.005). Ultrasound assessment of the carotid IMT should be used more often in the diagnosis and monitoring of high cardiovascular risk and early progression of atherosclerosis, especially in patients with MetS with current DMt2.

Assessment of Metabolic Parameters in Female Triathletes with Hashimoto's Thyroiditis in Poland.

Background: Hypothyroidism is a complex disorder characterized by an increase in body weight. About 15-30% of hypothyroid patients are reported to be overweight. The triathlon is an endurance combination sport that comprises a sequential swim, cycle, and run. Triathletes must withstand high training loads with various combinations of intensity and volume. Adequate body structure, the ratio of fat and muscle tissue, and adequate hydration play a huge role. The aim of our study was to show the potential differences in metabolic parameters assessed by medical Body Composition Analyzer before the initiation of treatment with L-thyroxine and after 3 and 6 months of treatment in females who practiced triathlon and who were newly diagnosed with Hashimoto's thyroiditis. Methods: The study group included 32 females practicing triathlon. They were recruited for 10 months from March to December 2021. Analysis of anthropometric measurements was performed using a seca device mBCA 515 medical Body Composition Analyzer. Results: We observed significant differences in FM and VAT before and after L-thyroxine treatment. We also noticed lower BMI levels after treatment, along with significant differences in thyroid function tests (TSH and fT4) carried out during the recruitment period and after 3 and 6 months of treatment. Conclusion: Due to their higher daily energy consumption, further research is needed into the treatment of Hashimoto's thyroiditis in athletes who practice triathlon. Frequent bioelectrical impedance analysis of body composition during treatment can be very helpful.

The role of vitamin D in women with Hashimoto's thyroiditis.

INTRODUCTION: Autoimmune thyroid diseases (AITD), including Hashimoto's thyroiditis (HT), are the most common organ specific autoimmune disorders. Vitamin D (vit-D) is a steroid molecule, mainly produced in the skin, which regulates the expression of many genes. The vitamin D receptor (VDR) is found in most tissues and cells in the body. Many studies suggests that vit-D deficiency, which is common worldwide, could also play an important role in autoimmune diseases, including HT. The aim of our study was to show the potential differences in vit-D levels between healthy women and individuals with hypothyroidism and HT. Additionally, we assessed the correlation between vit-D concentration and the level of TSH and anti-thyroid antibodies in females diagnosed with HT. MATERIAL AND METHODS: The study group included 370 subjects. The group was divided into 3 subgroups: (125 - healthy individuals, 111 - hypothyreosis, 134 - HT). Anthropometric measurements including height and weight were obtained in all participants. Body mass index (BMI) was calculated as body weight (in kilograms) divided by the square of body height (in metres). The measurement of the thyroid gland was performed using an ultrasound scan with a 10-MHz linear probe by one endocrinologist (Vivid S60N). RESULTS: We noticed that a lower level of vit-D was connected with a higher level of TSH in each subgroup. There was also strong, negative correlation between TSH and vit-D levels in all the study groups. Moreover, there was a weak, negative correlation between antithyroid peroxidase antibody (anti-TPO) and antithyroglobulin antibody (anti-TG) and vit-D levels in females with HT regardless of vit-D status: < 20 ng/mL, 20-30 ng/mL, and > 30 ng/mL. CONCLUSIONS: To our knowledge, the current study is the first in Poland to compare vit-D status in healthy patients and patients with hypothyroidism, taking into account the level of antibodies (anti-TPO and anti-TG). The results of our study suggest that vit-D supplementation in patients with hypothyroidism, especially in the course of AITD, although determining its optimal, safe dose requires further research.

Prevalence and Crucial Parameters in Diabesity-Related Liver Fibrosis: A Preliminary Study.

Diabetes and obesity have been recognized as confirmed risk factors for the occurrence of liver fibrosis. Despite the long-standing acknowledgment of "diabesity", the simultaneous existence of diabetes and obesity, scholarly literature has shown limited attention to this topic. The aim of this pilot study was to assess the prevalence of liver fibrosis among individuals with diabetes (specifically those who are obese) in order to identify the key factors associated with hepatofibrosis and determine the most important associations and differences between patients with and without liver fibrosis. The research included a total of 164 participants (48.17% had comorbid obesity). Liver elastography (Fibroscan) was performed on these individuals in addition to laboratory tests. Liver fibrosis was found in 34.76% of type 2 diabetes patients; male gender almost doubled the risk of hepatofibrosis (RR 1.81) and diabesity nearly tripled this risk (RR 2.81; however, in degree III of obesity, the risk was elevated to 3.65 times higher). Anisocytosis, thrombocytopenia, or elevated liver enzymes raised the incidence of liver fibrosis by 1.78 to 2.47 times. In these individuals, liver stiffness was negatively correlated with MCV, platelet count, and albumin concentration; GGTP activity and HbA1c percentage were positively correlated. The regression analysis results suggest that the concentration of albumin and the activity of GGTP are likely to have a substantial influence on the future management of liver fibrosis in patients with diabesity. The findings of this study can serve as the basis for subsequent investigations and actions focused on identifying potential therapeutic and diagnostic avenues.

Basics of prevention and management of iodine-based contrast media-induced thyroid dysfunction - position paper by the Polish Society of Endocrinology.

Medical practice involves a high number of radiological examinations using iodinated contrast media (ICM). Therefore, it is crucial for doctors of different specialties to be aware of possible adverse effects associated with ICM use. The most common and well characterized adverse effect is contrast-induced nephropathy, whereas thyroidal adverse reactions remain a diagnostic and therapeutic dilemma. ICM-induced thyroid dysfunction represents a highly heterogenous group of thyroid disorders. Due to supraphysiological iodine concentration, ICM can induce both hyper- and hypothyroidism. In most cases, the ICM-induced thyroid dysfunction is oligo- or asymptomatic, mild, and transient. In rare cases, however, the ICM-induced thyroid dysfunction may be severe and life threatening. Recently, the European Thyroid Association (ETA) Guidelines for the Management of Iodine-Based Contrast Media-Induced Thyroid Dysfunction were published. The authors advise an individualized approach to prevention and treatment of ICM-induced thyroid dysfunction, based on patient's age, clinical symptoms, pre-existing thyroid diseases, coexisting morbidities, and iodine intake. There is a geographic variation of ICM-induced thyroid dysfunction prevalence, which is linked to iodine intake. The prevalence of ICM-induced hyperthyroidism, which may pose a serious therapeutic challenge, is greater in countries with iodine deficiency. Poland is a region with a history of iodine deficiency, contributing to an increased prevalence of nodular thyroid disease, especially in the elderly. Therefore, the Polish Society of Endocrinology has proposed national, simplified principles of ICM-induced thyroid dysfunction prevention and treatment.

PCSK9 Inhibition During the Inflammatory Stage of SARS-CoV-2 Infection.

BACKGROUND: The intensity of inflammation during COVID-19 is related to adverse outcomes. Proprotein convertase subtilisin/kexin type 9 (PCSK9) is involved in low-density lipoprotein receptor homeostasis, with potential influence on vascular inflammation and on COVID-19 inflammatory response. OBJECTIVES: The goal of this study was to investigate the impact of PCSK9 inhibition vs placebo on clinical and laboratory outcomes in patients with severe COVID-19. METHODS: In this double-blind, placebo-controlled, multicenter pilot trial, 60 patients hospitalized for severe COVID-19, with ground-glass opacity pneumonia and arterial partial oxygen pressure to fraction of inspired oxygen ratio ≤300 mm Hg, were randomized 1:1 to receive a single 140-mg subcutaneous injection of evolocumab or placebo. The primary endpoint was death or need for intubation at 30 days. The main secondary endpoint was change in circulating interleukin (IL)-6 at 7 and 30 days from baseline. RESULTS: Patients randomized to receive the PCSK9 inhibitor had lower rates of death or need for intubation within 30 days vs placebo (23.3% vs 53.3%, risk difference: -30%; 95% CI: -53.40% to -6.59%). Serum IL-6 across time was lower with the PCSK9 inhibitor than with placebo (30-day decline: -56% vs -21%). Patients with baseline IL-6 above the median had lower mortality with PCSK9 inhibition vs placebo (risk difference: -37.50%; 95% CI: -68.20% to -6.70%). CONCLUSIONS: PCSK9 inhibition compared with placebo reduced the primary endpoint of death or need for intubation and IL-6 levels in severe COVID-19. Patients with more intense inflammation at randomization had better survival with PCSK9 inhibition vs placebo, indicating that inflammatory intensity may drive therapeutic benefits. (Impact of PCSK9 Inhibition on Clinical Outcome in Patients During the Inflammatory Stage of the COVID-19 [IMPACT-SIRIO 5]; NCT04941105).

Metabolic syndrome in women - correlation between BMI and waist circumference.

INTRODUCTION: Metabolic syndrome (MetS), which includes abdominal obesity, hypertension, hypertriglyceridaemia, low high-density lipoprotein cholesterol and elevated fasting plasma glucose, is now well understood. The prevalence of MetS is increasing all over the world. Central obesity is the main and the most common component of MetS. The most simple, practical, and frequently used tool for assessing body weight is body mass index. The aim of our study was to show the correlation between waist circumference (WC) and BMI in women with MetS depending on its components. MATERIAL AND METHODS: It was a study of 36-month duration (2016-2019) conducted in University Hospital No. 1 in Bydgoszcz, Poland. The study included 696 women with diagnosed MetS according to the 2009 International Diabetes Federation criteria. RESULTS: In the study group, WC was found to be significantly correlated with BMI according to the arterial hypertension, T2DM, IFG, lower HDL-C, and higher TG level. CONCLUSION: We should consider changing the WC guidelines for Europeans, but for this we need more prospective studies.

Aberrations in carbohydrate metabolism in patients with diagnosed acromegaly - observational study.

INTRODUCTION: Acromegaly is characterized by excessive secretion of growth hormone (GH). The incidence rate of acromegaly is 40 to 70 persons per one million people. Carbohydrate disorders often accompany the above pathology. The aim of this study was to examine the influence of high levels of somatotropin on aberrations in glycaemia in patients with acromegaly, and then a 5-year observation. MATERIAL AND METHODS: The study group consisted of 86 patients (48 females and 38 males) with acromegaly diagnosed on the basis of clinical features, elevated insulin-like growth factor 1 (IGF-1) levels, and/or no inhibition of GH ≤ 1 ug/L secretion during 2 hours after an oral glucose load. RESULTS: In the study group type 2 diabetes mellitus (T2DM) was diagnosed in 21 patients (24.4%). There were also 14 cases (16.3%) of the diagnosis of impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) combined. The mean age of participants with concomitant T2DM was 52.1 years, while the mean age of those without carbohydrate metabolism disturbances was 46.1 years. During a 5-year observation, we noticed an increase level of glycated haemoglobin (HbA1c) and new cases of pre-diabetes and T2DM. CONCLUSION: In patients with acromegaly the incidence rate of T2DM is 3-4 times higher than in the rest of the population, and it increases with age, especially after the patient reaches 55 years old.

Hyperprolactinemia and insulin resistance.

Hyperprolactinaemia is the most common dysfunction of the hypothalamic-pituitary axis and occurs more commonly in women. The prevalence of hyperprolactinaemia ranges from 0.4% in the general adult population to as high as 9-17% in women with reproductive diseases. It is accompanied by the phenomenon of insulin resistance (IR), which is also a significant clinical problem nowadays. The prevalence of IR is increasing, particularly in developing countries and in younger populations, with estimates of prevalence ranging from 20 to 40% in different populations. The aim of our review is to summarize recent data on the possible association between IR and hyperprolactinaemia. This review is based on an electronic search of the literature in the PubMed database published from 2000 to 2022 using combinations of the following keywords: IR, hyperprolactinemia or IR and hyperprolactinemia. The references included in previously published review articles were also checked, and any relevant papers were also included. Numerous scientific studies have shown a relationship between IR and hyperprolactinaemia. Increased plasma prolactin (PRL) levels are often associated with an increase in tissue resistance to insulin. There are many scientific theories explaining the probable mechanisms of this phenomenon. One is the finding that glucose and PRL act synergistically in inducing the transcription of insulin genes. It is also suggested that PRL may act as a regulator of insulin sensitivity and metabolic homeostasis in adipose tissue. The topic of the mutual correlation of hyperprolactinaemia and IR is important, and it certainly requires further research and observation.