Case report: Successful treatment with biologics in a pediatric patient with a severe inflammatory skin disease and novel CARD14 mutation.

CARD14 (caspase activation and recruitment domain) mutations have been associated with psoriasis vulgaris, psoriatic arthritis, generalized and palmoplantar pustular psoriasis, pityriasis rubra pilaris, and atopic dermatitis. We present a pediatric patient with a novel CARD14: c.394A > T/- (Ile123Phe) mutation, diagnosed with CARD14-associated papulosquamous eruption (CAPE), who was successfully treated with biological treatment.

Folic acid - importance for human health and its role in COVID-19 therapy.

Folic acid (folacin, B9) is a vitamin that performs many very important functions in the human body, and its inadequate level - deficiency as well as excess, may contribute to an increased risk of developing many disease processes. The aim of this study was to analyze the available scientific literature on folic acid and its impact on human health. A systematic review of the studies, published until November 2022, was made on the basis of searching bibliographic databases such as: PubMed, Elsevier and Google Scholar. The following keywords and combinations were used: folic acid, folate, folic acid supplementation, folate deficiency. Folic acid, thanks to its high biological activity, has a direct and indirect effect on the metabolism of the human body cells. It plays a very important role, among others in the prevention of neural tube defects and megaloblastic anemia, the proper functioning of the nervous system, as well as reducing the risk of developing certain cancers. Currently, the important role of folic acid in maintaining the proper functioning of the immune system is also emphasized, which is of particular importance both in the prevention and in the situation of SARS-CoV-2 (COVID-19) infection. The effects of deficiency and excess of vitamin B9 may turn out to be dangerous to health and even life. There is a need for nutritional and health education of the society regarding the importance of folic acid for human health, due to the presence of large deficiencies in the population, which is particularly important for some social groups, such as, for example, women of procreation age, pregnant or breastfeeding, people with a nutrient malabsorption, and people who smoke or abuse alcohol.

Body Composition and Anthropometric Indicators in Children and Adolescents 6-15 Years Old.

The problem of overweight and obesity among children and adolescents has now become a major public health challenge worldwide. The aim of this study was to assess the effect of age and gender on body composition components and anthropometric indices of children and adolescents aged 6-15 years; in addition, the study aimed to assess body composition indices in relation to BMI (Body Mass Index) levels. The study was conducted at the end of 2019 and in the first quarter of 2020 among 181 pupils attending primary schools. Waist circumference, hip circumference, body weight, and body height were measured. The collected data were used to calculate and then to analyse BMI, WHR (Waist-Hip Ratio), and WHtR (Waist to Height Ratio) indices. Body composition was determined with the use of the Bioelectrical Impedance Analysis (BIA). The analyses' statistics were performed using IBM SPSS Statistics 24 and Excel. The statistical methods used included Chi2 tests of independence, one-factor analysis of variance, and two-factor analysis of variance taking into account the level of α = 0.05. Based on the results, there were no statistically significant differences in the gender and age distributions of the BMI groups. However, the analysis of interaction effects confirmed that there were statistically significant differences according to pubertal age and gender in body fat, muscle mass, hydration, and WHR. Body composition in boys and girls before the age of 12 is similar while, after the age of 12, there are differences between boys and girls in terms of body composition so there is a need to deepen the assessment of body mass, especially in adolescents at the age of puberty, by body composition analysis using the BIA method.

Vitamin D in SARS-CoV-2 infection.

Background: Background. SARS-CoV-2 virus is one of the largest RNA viruses, included in the coronavirus group, showing tropism to airway epithelial cells. SARS-CoV-2 causes an acute respiratory infectious disease, Covid-19. According to WHO reports, mortality due to Covid-19 is higher in the elderly and in those burdened with comorbidities such as diabetes, obstructive pulmonary disease, coronary artery disease, cancer, hypertension, hepatitis B, obesity or chronic kidney disease. Objective: The aim of the study was to review the current literature on the influence and importance of vitamin D levels on the course of SARS-CoV-2 infection. Material and method: A systematic review of studies published from January 1, 2009 to June 31, 2021 has been performed. For this purpose, bibliographic databases such as PubMed and Scopus were searched. The following keywords and combinations were used: Covid-19, vitamin D, 25-hydroxy-vitamin D, vitamin D supplementation, SARS-CoV-2. Results: It has been shown that vitamin D plays an important role in the mechanisms of the innate immunity in the course of the acute respiratory infections. The overlapping factors of the severity of COVID-19 disease, vitamin D deficiency, and the prevalence of obesity, age scare, ethnicity, has led some researchers to hypothesize that vitamin D supplementation may be promising as a preventive or therapeutic measure for COVID-19. Conclusions: A very important factor that has an immunomodulatory character is vitamin D, the adequate supplementation of which can be a preventive or therapeutic measure in case of SARS-CoV-2 infection, especially in elderly people, with obesity and other chronic diseases.

Malnutrition in Obesity: Is It Possible?

BACKGROUND: The World Health Organization (WHO) classifies malnutrition as the biggest threat to public health worldwide, and this condition is observed in 20-60% of hospitalized patients. Malnutrition is a state of the body in which due to insufficient supply or incorrect absorption of essential nutrients, the body composition changes and the body's functions are impaired. Malnutrition is associated not only with reduced body mass index but also with obesity. SUMMARY: Obesity is defined as a paradoxical state of malnutrition, which despite excessive energy consumption is associated with a shortage of individual microelements. Deficiency or lack of homeostasis of essential micronutrients can significantly affect daily performance, intellectual and emotional state, but also the physical state of the body. Food deficiency can also contribute to further weight gain or the development of other metabolic diseases. Micronutrient deficiency may include not only incorrect dietary choices and insufficient access to nutrient-rich foods but also changes in the absorption, distribution or excretion of nutrients, and altered micronutrient metabolism resulting from systemic inflammation caused by obesity. An effective therapy method recommended for people with morbid obesity is bariatric surgery aimed at both weight loss and improving quality of life. Unfortunately, the effects of these treatments are often medium- and long-term complications associated with micronutrient deficiency as a result of reduced consumption or absorption. Therefore, the use of bariatric surgery in patients with extreme obesity can affect the metabolism of microelements and increase the risk of nutritional deficiencies. Key Messages: Studies by many authors indicate a higher incidence of food deficiency among people with excessive body weight, than in people with normal body weight of the same age and same sex. Monitoring the concentration of minerals and vitamins in blood serum is a good practice in the treatment of obesity. The proper nutritional status of the body affects not only the state of health but also the effectiveness of therapy. The aim of the review was to present the issue of malnutrition in the context of obesity.

Clinical and laboratory parameters by age for patients diagnosed with multiple sclerosis between 2000 and 2015.

AIM OF THE STUDY: To compare the demographic, clinical and laboratory characteristics of patients with multiple sclerosis (MS) analysed based on the age at which they were diagnosed. CLINICAL RATIONALE FOR THE STUDY: Most cases of MS are diagnosed between the ages of 20 and 40 years, but the clinical characteristics of patients with MS over this age range have rarely been studied. MATERIAL AND METHODS: 182 patients diagnosed with MS between 2000 and 2015 were divided into four groups by age at diagnosis: < 30 years (n = 62), 30-39 years (n = 54), 40-49 years (n = 27), and ≥ 50 years (n = 39). The demographic, clinical and laboratory features of each age group were investigated and between-groups comparisons analysed. RESULTS: There were no significant differences in the female-to-male ratio between groups, which was close to 3:1 in every group (p = 0.98). Motor symptoms were more common as the first manifestation of MS with increasing age (< 30: 19.3%; 30-39: 37.0%; 40-49: 44.4%; ≥ 50: 61.5%). Visual and sensory symptoms were responsible for nearly half of first manifestations in patients < 30 to 49, but affected a significantly lower proportion of patients in the oldest group (p = 0.01). Median (interquartile range [IQR]) Expanded Disability Status Scale at diagnosis was higher with advancing age (2 [1.5-3], 2.25 [1.5-3.5], 3 [2-3.5], and 3.5 [3-5]; p < 0.01). There was also a higher proportion of patients with progressive forms of the disease with age, especially primary progressive MS (0.0%, 3.7%, 14.8%, and 51.3%; p < 0.01). The median (IQR) time needed to confirm the diagnosis of MS became significantly longer as age increased (7 [2-25], 9 [2-32], 12 [6-58], and 26 [12-60] months; p < 0.01). In laboratory tests, significant differences were found only in the rate of post-contrast enhancement by magnetic resonance imaging, which was lower in the older age groups (63.2%, 50.0%, 31.6%, and 30.0%; p < 0.01). CONCLUSIONS AND CLINICAL IMPLICATIONS: Our study indicates significant differences in the demographic and clinical picture of MS depending on the age of the patient at diagnosis. Diagnostic delay in older patients is a common problem, and this study shows the features of later forms of MS to help inform neurologists and improve time to diagnosis.

Clinical course and outcome of SARS-CoV-2 infection in multiple sclerosis patients treated with disease-modifying therapies - the Polish experience.

INTRODUCTION: The aim of this study was to report the course and outcome of SARS-CoV-2 infection in multiple sclerosis (MS) patients treated with disease-modifying therapies (DMTs) in Poland. A major concern for neurologists worldwide is the course and outcome of SARS-CoV-2 infection in patients with MS treated with different DMTs. Although initial studies do not suggest an unfavourable course of infection in this group of patients, the data is limited. MATERIALS AND METHODS: This study included 396 MS patients treated with DMTs and confirmed SARS-CoV-2 infection from 28 Polish MS centres. Information concerning patient demographics, comorbidities, clinical course of MS, current DMT use, as well as symptoms of SARS-CoV-2 infection, need for pharmacotherapy, oxygen therapy, and/or hospitalisation, and short-term outcomes was collected up to 30 January 2021. Additional data about COVID-19 cases in the general population in Poland was obtained from official reports of the Polish Ministry of Health. RESULTS: There were 114 males (28.8%) and 282 females (71.2%). The median age was 39 years (IQR 13). The great majority of patients with MS exhibited relapsing-remitting course (372 patients; 93.9%). The median EDSS was 2 (SD 1.38), and the mean disease duration was 8.95 (IQR 8) years. Most of the MS patients were treated with dimethyl fumarate (164; 41.41%). Other DMTs were less frequently used: interferon beta (82; 20.70%), glatiramer acetate (42; 10.60%), natalizumab (35;8.84%), teriflunomide (25; 6.31%), ocrelizumab (20; 5.05%), fingolimod (16; 4.04), cladribine (5; 1.26%), mitoxantrone (3; 0.76%), ozanimod (3; 0.76%), and alemtuzumab (1; 0.25%). The overall hospitalisation rate due to COVID-19 in the cohort was 6.81% (27 patients). Only one patient (0.3%) died due to SARS-CoV-2 infection, and three (0.76%) patients were treated with mechanical ventilation; 106 (26.8%) patients had at least one comorbid condition. There were no significant differences in the severity of SARS-CoV-2 infection regarding patient age, duration of the disease, degree of disability (EDSS), lymphocyte count, or type of DMT used. CONCLUSIONS AND CLINICAL IMPLICATIONS: Most MS patients included in this study had a favourable course of SARS-CoV-2 infection. The hospitalisation rate and the mortality rate were not higher in the MS cohort compared to the general Polish population. Continued multicentre data collection is needed to increase the understanding of SARS-CoV-2 infection impact on the course of MS in patients treated with DMTs.

Recommendations for neurological, obstetrical and gynaecological care in women with multiple sclerosis: a statement by a working group convened by the Section of Multiple Sclerosis and Neuroimmunology of the Polish Neurological Society.

INTRODUCTION: Multiple sclerosis (MS) is the most common non-traumatic neurological cause of disability in young adults, affecting women 1-3 times more often than men. Several specific challenges arise from the fact that young women diagnosed with MS often have to make decisions related to treatment and family planning at the same time. These issues are connected with fertility, the impact of pregnancy on disease course, the choice of pregnancy timing, and the optimal mode of disease-modifying therapy in the context of a planned pregnancy, contraception, urological complaints, and sexual dysfunction. STATE OF THE ART: While MS does not in itself adversely affect fertility, pregnancy or childbirth, pregnancy needs to be carefully planned. This requires the interdisciplinary co-operation of a neurologist, gynaecologist and psychologist. Data on the impact of disease-modifying drugs on foetal development are very limited, and none of these drugs is 100% safe during pregnancy. In the second and third trimesters, MS relapse rate decreases. Unfortunately, it increases within the first 3-6 months after delivery. Adequate disease control should be achieved before pregnancy, as relapse rate in the period of two years preceding pregnancy is one of the strongest predictive factors for post-partum relapses. CLINICAL IMPLICATIONS: The following is a statement by a working group of experts in neurology, gynaecology, obstetrics and urology, convened by the Section of Multiple Sclerosis and Neuroimmunology of the Polish Neurological Society, addressing the issues that are specific to the female MS population. The aim of this statement is to provide guidance in pregnancy planning and disease management, both during pregnancy and post-partum. FUTURE DIRECTIONS: This statement reflects expert opinion and is not intended to be read as guidelines. It rather provides up-to-date information on how to optimise care of female MS patients of childbearing age.

Real-world effectiveness of fingolimod in Polish group of patients with relapsing-remitting multiple sclerosis.

OBJECTIVES: Fingolimod is indicated for the treatment of relapsing-remitting multiple sclerosis (RRMS) patients with highly aggressive disease characterized by frequent relapses and active magnetic resonance imaging. Its efficacy has been demonstrated in three large phase III trials, used in the regulatory submissions throughout the world. Fingolimod in licensed in Europe since 2011 but with a growing number of disease-modifying drugs (DMD) becoming available for RRMS, it is important to gather real-world evidence data regarding long-term effectiveness in treated patients with MS. The aim of this study was to assess fingolimod effectiveness in a real life Polish group of RRMS patients receiving fingolimod as second line treatment. PATIENTS AND METHODS: The observational study with retrospective data collection was performed at 13 sites that were asked to document eligible patients in consecutive chronological order to avoid selection bias. Demographic and clinical data from 253 adult patients with RRMS treated with fingolimod were analyzed. RESULTS: Mean treatment time with fingolimod was 42 months. Relapses reduction during 3 years treatment period was observed (2.0 v 0.2) and majority of patients were free of relapses. Mean EDSS score was stable during the time of observation. The proportion of patients who were free from any clinical disease activity, i.e. without relapses and disability progression, was over 70%. During the first and second year of observation significant reduction of new MRI lesions was observed. CONCLUSION: In the Polish group of patients with RRMS treated with fingolimod, the majority of them showed freedom from relapses, disability progression and reduction of new MRI lesions. Switching from injectable immunomodulatory drugs to fingolimod is associated with fewer relapses and lower disability progression.

The effect of clary sage oil on staphylococci responsible for wound infections.

INTRODUCTION: The spreading of bacterial antibiotic resistance among clinical strains of pathogenic bacteria has made investigators to search for other active antibacterial agents which could provide a valuable complement to the existing therapies. AIM: To determine the antibacterial activity of clary sage oil (Salvia sclarea L.) against Staphylococcus clinical strains which were isolated from patients with wound infections. MATERIAL AND METHODS: A comprehensive evaluation of Staphylococcus clinical strain resistance to antibiotics was performed. The constituents of clary sage oil were assayed by GC-FID-MS analysis. The minimal inhibitory concentration (MIC) of the tested essential oil against staphylococci by the micro-dilution broth method was determined. RESULTS: The clary sage oil was active against Staphylococcus aureus, S. epidermidis and S. xylosus with MIC values ranging from 3.75 to 7.00 µl/ml. CONCLUSIONS: The results of the in vitro tests encourage to use formulations containing sage oil as the active natural antimicrobial agent. Because of its antimicrobial properties clary sage oil may be applied to treat wounds and skin infections.

The antibacterial activity of geranium oil against Gram-negative bacteria isolated from difficult-to-heal wounds.

Hard-to-heal wounds represent a significant problem to patients, health care professionals, and health care system. They can be formed as a result of mechanical injuries and burns, and any co-existing chronic disease increases the risk of their emergence. Diabetics are at a greater risk of developing chronic wounds because of poor circulation, slow healing times, vascular disease and neuropathy. The aim of this study was to determine the antimicrobial activity of geranium oil against Gram-negative bacterial clinical strains. Clinical strains were isolated from patients with difficult-to-treat wounds and a comprehensive evaluation of their sensitivity to antibiotics was carried out. The constituents of geranium oil were specified by GC-FID-MS analysis. The micro-dilution broth method was used to check the inhibition of microbial growth at various concentrations of geranium oil. The tested geranium oil was efficacious against Gram-negative pathogens responsible for problems with wound treatment. The results suggest that geranium oil may be considered an effective component of therapy in the case of frequent recurrences of infections caused by resistant pathogens.

Long-term effect of high doses glucocorticosteroids on mRNA expression for IL-6 and IL-8 in relapsed multiple sclerosis patients.

Glucocorticosteroids (GS) are standard treatment of multiple sclerosis (MS) relapse, but no superiority of any commonly used doses is known. The aim of present study was to evaluate mRNA expression for two cytokines: IL-6 and IL-8. Ethylenediaminetetraacetic acid blood samples from 35 MS relapse patients were obtained before therapy, after 7, 14 days, and 3 months from treatment start (500 versus 1000 mg for 5 days). Significant neurological improvement measured with EDSS was independent to GS dose. Changes of mRNA cytokines expression were more evident in higher dose group but for IL-6 mainly in females.

High dose of intravenously given glucocorticosteroids decrease IL-8 production by monocytes in multiple sclerosis patients treated during relapse.

The aim of our study was to determine whether high doses of intravenous methylprednisolone have significant impact on immune parameters during the multiple sclerosis (MS) exacerbations. Peripheral blood of 32 MS patients was evaluated, using two-color flow cytometry before glucocorticosteroids and after 7 days from starting therapy. Significant increase of B cells, decrease of NK cells and monocytes producing IL-8 were observed after treatment. IL-8 is one of the cytokines responsible for blood-brain-barrier disruption and migration of immune cells to the central nervous system; in this aspect, explaining glucocorticosteroid effects during MS exacerbations.