Management of Metastatic Pancreatic Cancer-Comparison of Global Guidelines over the Last 5 Years.

Pancreatic cancer (PC) is usually diagnosed at an advanced stage of its development, which results in lower overall survival (OS). Prognosis is also poor even with curative-intent surgery. Approximately 80% of patients with localized PDAC have micrometastases at the time of diagnosis, which leads to a worse prognosis than in other cancers. The objective of this study is to present the progress in the treatment of metastatic pancreatic cancer based on the recommendations of oncological scientific societies, such as ESMO, NCCN, ASCO, NICE and SEOM, over the last 5 years. Combined FOLFIRINOX therapy is mostly a recommended therapy among patients with good performance statuses, while gemcitabine is recommended for more fragile patients as a first-line treatment. The newest guidelines suggest that molecular profiling of the tumor should be the first step in determining the course of treatment. The use of modern molecular therapies in patients with specific gene mutations should extend the survival of patients with this disease.

Evaluation of Health Pattern and Stress Levels among Patients Undergoing Alcohol Addiction Treatment-A Cross Sectional Study.

Alcohol consumption is linked to over 200 diseases and injuries. It is also classified as a risk factor for several types of neoplasms as well as infectious diseases (i.e., HIV and tuberculosis). In 2019, among people aged 25 to 49, alcohol use was the leading risk factor for attributable burden of disease. There are many factors that affect alcohol drinking patterns such as social and economic status, social norms, cultural customs, availability of alcohol, etc. Stress also plays a significant role in the process of developing alcohol addiction. The aim of our study was to examine health patterns and stress levels among patients undergoing alcohol addiction treatment. The study sample consisted of 104 patients who were treated in a hospital ward due to alcohol dependence. Three standardized questionnaire tools were used to measure the sense of coherence and the level of stress among those patients. The main results suggest that the level of perceived stress correlated negatively with all dimensions of sense of coherence and all indicators of health behaviors, however, age was positively correlated with positive mental attitude, proper eating habits, and health behaviors. In conclusion, it is worth noting that developing patterns for positive health behaviors will make it possible to avoid alcohol dependence or reinforce the treatment results if alcohol dependence syndrome occurs.

Overview of Pancreatic Cancer Epidemiology in Europe and Recommendations for Screening in High-Risk Populations.

Pancreatic cancer is the seventh most common cause of death in the group of oncological diseases. Due to the asymptomatic course, early diagnosis is difficult. Currently, early detection methods are only used in high-risk groups. A literature review based on the available results of observational studies on patients with pancreatic cancer and people from high-risk groups was used to summarize the knowledge on risk factors. The GLOBOCAN 2020 data were used to assess the epidemiological situation in Europe. A summary of screening recommendations was prepared based on the available documents from medical organizations and associations. Pancreatic cancer risk factors are divided into two main groups: non-modifiable factors, e.g., hereditary factors and age, which increase the risk of developing this disease, and modifiable factors-BMI, smoking, and alcohol consumption. Hereditary factors account for 10% of pancreatic cancer cases. The highly specialized methods of early detection, (MRI, CT, or EUS) are used for screening high-risk populations. Of all the imaging methods, EUS is considered the most sensitive for pancreatic cancer and allows an accurate assessment of the size of even small lesions (<30 mm) and the extent of tumour infiltration into blood vessels. The available studies vary on the level of sensitivity and specificity of these methods for the diagnosis of pancreatic cancer. EUS, MRI, and CT are also expensive procedures and in some patients can be invasive, which is one of the arguments against the introduction of population screening programs based on imaging methods. Therefore, it is important to look for viable solutions that would improve early detection. This is important from the point of view of healthcare systems in Europe, where almost 29% of all global pancreatic cancer cases are reported.

Treatment Costs and Social Burden of Pancreatic Cancer.

(1) Background: Pancreatic cancer is the cancer with the third-highest mortality rate, and forecasts indicate its growing share in morbidity. The basis of treatment is inpatient chemotherapy and there is a strong focus on palliative care. (2) Methods: A literature review was conducted based on the rapid review methodology in PubMed and Cochrane databases. The search was supplemented with publications from the snowball search. Qualitative assessment of included publications was performed using AMSTAR2 modified scheme. (3) Results: The review included 17 publications, of which majority concerned direct costs related to the adopted treatment regimen. Most of the publications focused on comparing the cost-effectiveness of drug therapies and the costs of palliative treatment. Other publications concerned indirect costs generated by pancreatic cancer. They particularly focused on the economic burden of lost productivity due to sickness absence. (4) Conclusion: The increase in the incidence of pancreatic cancer translates into an increase in the costs of the health care system and indirect costs. Due to the significant share of hospitalization in the health care structure, direct costs are increasing. The inpatient treatment regimen and side effects translate into a loss of productivity for patients with pancreatic cancer. Among gastrointestinal cancers, pancreatic cancer generates the second largest indirect costs, although it has a much lower incidence rate than the dominant colorectal cancer. This indicates a significant problem of the economic burden of this cancer.

Quality of Life in Patients with Pancreatic Cancer-A Literature Review.

Pancreatic cancer is the malignant disease with the highest mortality rate, and it ranks third in the world after lung and colon cancer. Identified factors that increase the risk of developing pancreatic cancer include chronic pancreatitis, radiation therapy to the pancreatic area due to another cancer, diabetes mellitus, obesity, smoking, and age. The objective of this study was to present the current state of knowledge on the quality of life of patients diagnosed with pancreatic cancer, factors that determine QoL, and ways of coping with the disease. The low curability and low survival rates of pancreatic cancer significantly affect the quality of life of patients, often in the form of significant deterioration, especially in terms of mental changes, cognitive functions, and coping with the disease. Cognitive decline with comorbid depression is also typical for patients with this type of cancer. Research has shown that the health-related quality of life of patients with pancreatic cancer is low, so further research is needed to improve the situation in this area.

Awareness of Tobacco-Related Diseases among Adults in Poland: A 2022 Nationwide Cross-Sectional Survey.

Warning about the dangers of tobacco use is a key element of tobacco control policy. The COVID-19 pandemic may impact public perception of the health risks of tobacco use. The aim of this study was to assess the level of knowledge of tobacco-related diseases among adults in Poland, as well as to identify sociodemographic factors associated with awareness of tobacco-related diseases. This cross-sectional survey was carried out in March 2022 on a representative nationwide sample of 1090 adults in Poland using the computer-assisted web interview (CAWI) technique. Lung cancer was the most recognized tobacco-related disease (92.7%), followed by COPD (89.7%) and myocardial infarction (84%). Three-quarters of the respondents (76.8%) were aware that smoking causes stroke and 51% were aware that smoking increases the risk for type 2 diabetes. Out of 9 factors analyzed in this study, female gender, an age of 50 years and over, and being a non-smoker were significantly associated with a higher awareness of tobacco-related diseases. This study showed an increase in public awareness of smoking-related diseases during the COVID-19 pandemic. While awareness of lung cancer and COPD was very high, there are still significant gaps in the awareness of the non-respiratory effects of tobacco use.

Willingness to Oppose Smoking among Pregnant Women.

Even though smoking causes numerous threats to the developing foetus, it is the most common addiction in Polish women of reproductive age. Most studies undertake to examine the subject of opposing second-hand smoking or creating tools to reprimand pregnant women more effectively using a qualitative methodology. The study aimed to determine the profile of a pregnant woman who is willing to oppose the smoking of another pregnant woman. The research was conducted using an original multiple-choice questionnaire. The survey was shared on websites for expecting parents. Completed questionnaires were collected from 11,448 pregnant women. The Wald test for logistic regression was used for statistical analysis. Predictors of whether someone would draw another pregnant women's attention to the fact that smoking is harmful were: intellectual work (OR 1.136; p-value 0.020) and currently being a student (OR 1.363; p-value 0.004), involvement of the child's father (OR 1.377; p-value < 0.001), contact with social campaigns (OR 1.150; p-value 0.005) and knowledge about the consequences of smoking, as well as talking to the midwife about the harmfulness of cigarettes during pregnancy (OR 1.655; p-value < 0.001). Interpersonal relationships leave scope for public health interventions. It is worth enhancing criticism against smoking by specialists through information and education campaigns.

The effect of infectious agents on the prevalence of allergies.

PURPOSE: The role of infectious agents in allergy development is ambivalent. On one hand, there are reports of an association between a previous infection (especially a viral respiratory tract infection) and developing hypersensitivity to inhaled allergens, which in turn may increase the risk of developing allergic reactions. On the other hand, there are reports emphasizing a protective effect of a number of infectious agents against allergy development. The aim the study was to find possible associations between a past infectious or parasitic disease and an allergic condition. MATERIAL AND METHODS: The study population was a group of 18,648 subjects. The study, which was a part of the project: 'Implementation of a System for the Prevention and Early Detection of Allergic Diseases in Poland', was conducted in 9 selected regions of Poland and used the ECRHS and ISAAC questionnaires adapted for Europe. The following statistical tools were used: Pearson's chi-squared test, Fisher's exact test, and logistic regression. RESULTS: This research was an attempt to clear association between a history of measles or viral hepatitis and the likelihood of developing asthma, especially in males (χ2 = 5.29; p<0.05). Past parasitic disease showed a clear association with a suspected allergic rhinitis in various groups of patients (differing both in terms of sex and age). CONCLUSIONS: A history of some forms of either infectious or parasitic diseases has a measurable effect on the risk of developing allergies.

The relationship between nasal polyps, bronchial asthma, allergic rhinitis, atopic dermatitis, and non-allergic rhinitis.

INTRODUCTION: Nasal polyps are frequently associated with bronchial asthma and rhinitis. The chronic nature of the symptoms, the high post-treatment recurrence rates, as well as various comorbidities, constitute key factors that significantly affect the quality of life of patients diagnosed with this condition. AIM: The purpose of the study was to estimate the prevalence of nasal polyps in the examined population and to assess the possible associative occurrence of nasal polyps (NP) with bronchial asthma (BA), allergic (AR) and non-allergic rhinitis (NAR), and atopic dermatitis (AD). MATERIAL AND METHODS: The ECRHS II and ISAAC questionnaires of the study group of 18,458 individuals, including 4,473 6-7-year-olds (24.2%), 4,675 13-14-year-olds (25.4%), and 9,310 20-44-year-olds (50.4%) were performed. RESULTS: The prevalence of nasal polyps in the examined group was 1.1%, reported by a total of 204 individuals. Nasal polyps were reported more frequently among urban residents (191 (1.1%)) than rural residents (13 (0.6%)). Our study demonstrated a correlation between the presence of nasal polyps and asthma, as well as allergic and non-allergic rhinitis The greatest risk factor for NP in the evaluated subpopulation with multiple allergic conditions was the co-existence of non-allergic rhinitis and atopic dermatitis (OR = 6.09; 95% CI: 3.4-10.93). CONCLUSIONS: Nasal polyps are relatively rare in the evaluated Polish population. Nonetheless, we believe their co-occurrence with non-allergic rhinitis, allergic rhinitis, bronchial asthma, and atopic dermatitis to be of significant importance, as it illustrates the phenomenon of multimorbidity of inflammatory conditions affecting the upper and lower respiratory tract.

The prevalence of cigarette smoking, e-cigarette use and heated tobacco use among police employees in Poland: a 2020 cross-sectional survey.

OBJECTIVES: Uniformed services such as police employees are exposed to acute and chronic stressful events at work that may lead to tobacco use. This study aimed to assess the prevalence of cigarette smoking, e-cigarette use and heated tobacco use among police employees in Poland, and to investigate personal characteristics associated with tobacco or e-cigarette use. MATERIAL AND METHODS: This cross-sectional study was carried out in June-July 2020 on a randomly selected sample of 8789 police employees from the Mazowieckie Province, Poland. RESULTS: Completed questionnaires were obtained from 5082 police employees (79.2% being police officers) with an overall response rate of 57.8%. Smoking ≥100 cigarettes or similar amounts of other tobacco products was declared by 54.6% of the respondents, with significant differences (p < 0.001) between males (56.8%) and females (50.3%). Daily cigarette smoking was declared by 19.5% of the respondents, and 13.4% were occasional cigarette smokers. Daily e-cigarette use was declared by 3.1% of the respondents, and 3.2% were occasional e-cigarette users. Daily heated tobacco use was declared by 2.6% of the respondents, and 2.9% were occasional heated tobacco users. Higher odds of occasional cigarette smoking were observed among men compared to women (OR = 1.254, 95% CI: 1.009-1.558), and among the participants aged 20-29 years (OR = 7.982, 95% CI: 3.066-20.775) or 30-44 years (OR = 3.730, 95% CI: 1.44-9.599) vs. those aged ≥60 years. Higher odds of occasional e-cigarette use were observed among the participants aged 20-29 years (OR = 4.554, 95% CI: 1.213-17.101) vs. those aged 60 years. Police employees with office-based work had lower odds of daily cigarette smoking vs. those with fieldwork (OR = 0.726, 95% CI: 0.55-0.946). Police officers had higher odds of daily heated tobacco use compared to civil workers (OR = 3.362, 95% CI: 1.325-8.534). CONCLUSIONS: The authors observed a marked proportion of police employees who declared occasional tobacco or e-cigarette use, which may indicate the common social smoking phenomenon in this occupational group. Int J Occup Med Environ Health. 2021;34(5):629-45.

Wplyw wybranych czynników srodowiskowych na maksymalny przeplyw nosowy wdechowy - czesc projektu ECAP (Epidemiologia Chorób Alergicznych w Polsce).

Celem niniejszej pracy byla próba okreslenia wplywu wybranych czynników/parametrów na wynik maksymalnego przeplywu nosowego wdechowego (PNIF, ang. peak nasal inspiratory flow) w badanej populacji polskiej projektu Epidemiologia Chorób Alergicznych w Polsce (ECAP). Material/metody: Badana populacje stanowila grupa dzieci w wieku 6-7 lat (n=1123), mlodziezy w wieku 13-14 lat (n=1136) oraz doroslych (n=1876) zamieszkalych w siedmiu duzych polskich miastach. W badaniu posluzono sie pomiarem maksymalnego przeplywu nosowego wdechowego (PNIF). Do oceny wplywu wybranych czynników na wartosci PNIF wykorzystano przetlumaczone i walidowane kwestionariusze opracowane na potrzeby swiatowych badan ECRHS II (European Community Respiratory Health Survey II) i ISAAC (International Study of Asthma and Allergies in Childhood). Wyniki: Okreslone warunki wewnatrz gospodarstwa domowego, m.in. ogrzewanie weglem, drewnem lub piecem gazowym, istotnie zwiekszaja przekrwienie blony sluzowej nosa. W grupie biernych palaczy PNIF byl nizszy niz w grupie czynnych palaczy. Wskaznik PNIF malal wraz ze wzrostem liczby domowników palacych papierosy. Wnioski: Wybrane czynniki srodowiska.

Levels of exhaled carbon monoxide in healthy active and passive smokers.

BACKGROUND: Cigarette smoke is the major and most common indoor source of carbon monoxide. CO combines with haemoglobin to form carboxyhaemoglobin (COHb) which hinders oxygen transport and causes myocardial infarction and coronary heart disease. CO damages the endothelium of large and medium arteries and contributes to the development of atherosclerosis. MATERIAL AND METHOD: Participants in the study included 148 active and 306 passive smokers. In both groups the largest proportion of respondents were aged 30-49. Numbers of male and female participants were identical among the active smokers, while the majority of the passive smokers were women. Majority of the participants in both groups lived in large towns (over 100,000 inhabitants). The levels of exhaled CO were measured with Micro+smokerlyzer distributed in Poland by Synecpol. Every participant was provided with relevant instructions and the test was conducted by trained researchers. RESULTS: The mean level of exhaled carbon monoxide in active smokers was 12.57 ppm with higher levels found in men. The highest mean level of eCO was found in participants with body weight between 60 kg and 80 kg (mean eCO = 13.39 ppm). The highest levels were observed in participants living in towns with 51,000-100,000 inhabitants. In passive smokers, the mean level of exhaled carbon monoxide was 3.55 +/- 1.26 ppm with higher levels found in men. CONCLUSIONS: For non-smokers, the study identified a significant relationship between the level of exhaled CO and the participants' gender (p < 0.05), weight (p = 0.003), and height (p = 0.0005). For smokers, there is a relationship between the level of eCO and the daily cigarette consumption (p = 0.01), the type of cigarettes most frequently smoked (p < 0.05) and the favoured cigarette brand (p = 0.005).

Intranasal glucocorticosteroids - not only in allergic rhinitis In the 40th anniversary of intranasal glucocorticosteroids' introduction.

It has been 40 years since Niels Mygind's publication in British Medical Journal on intranasal application of beclomethasone dipropionate aerosol in allergic rhinitis (AR). Since then a new era in treatment of allergic and nonallergic upper airway diseases began. This publication presents current concepts on application of intranasal glucocorticosteroids (inGCS) in treatment of upper airway diseases and in particular of AR and rhinosinusitis. Nonquestionable advantage of inGCS is their strong anti-inflammatory local action with little impact on general health responsible for few and benign side effects. Main way of action of glucocorticosteroids is connected with binding to the intracellular glucocorticosteroid receptor and its impact on nuclear cytoplasmic transcriptional factors. Glucocorticosteroids suppress gene expression of factors responsible for generating and supporting inflammatory processes, proinflammatory cytokines and chemokines production, and adhesive molecules expression. It appears that glucocorticosteroids have also other mechanisms of action, non-involving intracellular receptors, leading to inhibition of early and late phase of allergic reaction. At the moment the following glucocorticosteroids are registered in Poland: beclomethasone, budesonide, fluticasone propionate, fluticasone furoate, and mometasone furoate. Furoates earn special attention as their lateral furoate ester chain makes the molecules highly lipophilic, and hence easily absorbed by nasal mucous membranes, epithelium and cell membrane phospholipids. This minimizes their general action and maximizes local action. According to current state of knowledge topical glucocorticosteroids are used in the following upper airway diseases with different inflammatory mechanisms: AR, non-AR, particularly NARES, acute rhinosinusitis, chronic rhinosinusitis with and without nasal polyps, adenoid hypertrophy and rhinitis in bronchial asthma.

[Is smoking cigarettes affects the nasal patency in the light of the project ECAP (Epidemiology of Allergic Diseases in Poland) in the Polish population in 2006-2009?]. / Czy palenie papierosów wplywa na droznosc nosa w swietle badan projektu ECAP (Epidemiologia Chorób Alergicznych w Polsce) w populacji polskiej w latach 2006-2009?

UNLABELLED: The purpose of the study was an attempt to estimate the impact of tobacco smoke on the nasal patency in the light of the ECAP study. The subjects in the study was a group of 4674 people, including 1291 children aged 6-7 years (643 girls and 648 boys), 1293 children aged 13-14 years (625 girls, 668 boys) and 2090 adults (1284 women, 806 men). The research method used in the study was the measurement of the peak nasal flow using a peak flow meter with a dedicated mask used in rhinomanometry tests, with a measurement scale of 20-350 l/min. The study was carried out in 2006-2007, in the following cities Katowice, Wroclaw, Kraków, Lublin, Warszawa, Bydgoszcz, Gdansk, and in the rural areas of the former Zamojskie province. RESULTS: For the purposes of the study, the average PNIF levels were calculated for the subjects in terms of the following criteria: age: In the case of the children aged 6-7 years (n=1291), the average PNIF level was 52.4 I/min. For the children aged 13-14 years (n=1291), the average level was 94.7 l/min., and in the case of adults (n=2090)--approx. 108.0 l/min. gender: The nasal patency level was definitely higher in the male subjects than in the female subjects in all the age groups. passive smokers: 105.3 l/min (n=1202) and active smokers: 119.1 l/min (n=885). CONCLUSION: The possible effect of tobacco smoke on nasal patency in the population included in the study is not a direct risk factor in breathing disorders.

[PNIF (Peak nasal inspiratory flow) as a method for assessing nasal airway patency in the ECAP (Epidemiology of Allergic Disorders in Poland) multicenter study]. / PNIF (Przeplyw nosowy wdechowy) jako metoda oceny droznosci nosa w wieloosrodkowym badaniu ECAP (Epidemiologia Chorób Alergicznych w Polsce).

AIM: The aim of the study was to evaluate the usefulness of PNIF in assessing nasal airway patency based on test results. The sample in the study was a group of 4 674 subjects, including 1291 people aged 6-7 years (woman 643, men 648), 1293 people aged 13-14 years (woman 625, men 668) and 2090 adults (woman 1284, men 806). The research method employed in the study was the measurement of peak nasal inspiratory flow using a peak flow meter with a suitable mask as used in rhinomanometry tests and with a flow rate ranging from 20 to 350 l/min. The study was conducted in 2006-2008 at the following centres: Katowice, Wroclaw, Krakow, Lublin, Warszawa, Bydgoszcz, Gdansk and in the rural areas of the former province of Zamosc. RESULTS: For the purposes of the study, the average values for the subjects were calculated for a number of criteria: - subject age: The average PNIF value was 52,41/min for subjects aged 6-7 years(n=1291), 94.7 l/min for subjects aged 13-14 (n=1293) and 108.0 l/min for the adults (n=2090). Indeed statistical dependences for all aged groups were observed on level p<0,0005. -diagnosis: The average PNIF value for healthy was 52,3 l/min p=0,338 for subjects aged 6-7 years (n=680), 97,3 l/min p=0,279 for subjects aged 13-14 (n=640) and 111,7 l/min p=0,438 for the adults (n=1035) and for allergic rhinitis PNIF value was 50,41/min p=0,028 for subjects aged 6-7 years(n=310), 93,3 l/min p=0,299 for subjects aged 13-14 (n=389) and 107,71 1/min p=0,276 for the adults (n=623) and asthma PNIF value was 51,6/min for subjects aged 6-7 years(n=149) 87,3 l/min p=0,062 for subjects aged 13-14 (n=145) p=0,097 and 105,3 l/min p=0,13 for the adults (n=198) -exposure to tobacco smoke (adults): passive smoking - 105,311 min (n=1202) p=0,017, active smoking-119.1 l/min(n=885) p=0,108. CONCLUSIONS: PINF is important investigative tool thanks which we can: to differentiate in dependence the functional state of nose from: put the recognition (the patients with allergic rhinitis, the bronchial asthma), the age and the studied sexes.