Extremely Rare Complications in Uniportal Spinal Endoscopy: A Systematic Review with Unique Case Analyses.

Background: Endoscopic spine surgery represents a significant advancement in the minimally invasive treatment of spinal disorders, promising reduced surgical invasiveness while aiming to maintain or improve clinical outcomes. This study undertakes a comprehensive review of the literature on endoscopic spine surgery, with a particular focus on cataloging and analyzing the range of complications, from common postoperative issues to more severe, casuistic outcomes like dural tears and nerve damage. Methods: Our methodology encompassed a detailed review of meta-analyses, prospective randomized trials, cohort studies, and case reports to capture a broad spectrum of complications associated with endoscopic spine techniques. The emphasis was on identifying both the frequency and severity of these complications to understand better the procedural risks. Results: The findings suggest that endoscopic spine surgery generally exhibits a lower complication rate compared to traditional surgical approaches. Nonetheless, the identification of specific, rare complications peculiar to endoscopic methods underscores the critical need for surgeons' advanced skills, continuous learning, and awareness of potential risks. Conclusions: Recognizing and preparing for the potential complications associated with the rapid adoption of endoscopic techniques is paramount to ensuring patient safety and improving surgical outcomes in minimally invasive spine surgery.

PSYCHIATRIC DISORDERS IN AUTOIMMUNE ENCEPHALITIS - LITERATURE REVIEW.

Autoimmune encephalitis (AE) is a non-infectious inflammatory disease caused by the presence of autoantibodies directed against neuronal surface or intracellular antigens. Its incidence in Western countries is about 0.8 per 100,000 people. AE requires differentiation primarily with psychiatric diseases, but it also requires oncological vigilance. On the other hand, in the case of an acute episode of psychosis, differentiation with AE should always be pursued. This paper discusses the most common psychiatric disorders that occur in autoimmune encephalitis.

Autoimmune Encephalitis with Antibodies: Anti-NMDAR, Anti-AMPAR, Anti-GQ1b, Anti-DPPX, Anti-CASPR2, Anti-LGI1, Anti-RI, Anti-Yo, Anti-Hu, Anti-CV2 and Anti-GABAAR, in the Course of Psychoses, Neoplastic Diseases, and Paraneoplastic Syndromes.

Encephalitis is a condition with a variety of etiologies, clinical presentations, and degrees of severity. The causes of these disorders include both neuroinfections and autoimmune diseases in which host antibodies are pathologically directed against self-antigens. In autoimmune encephalitis, autoantibodies are expressed in the central nervous system. The incidence of this disease is approximately 4% of all reported cases of encephalitis. Autoimmune encephalitis can be induced by antibodies against neuronal surface antigens such as N-methyl-D-aspartate-activated glutamate receptors (NMDAR), α-amino-3-hydroxy-5-methyl-4-isoxazole propionate receptors (AMPAR) or gangliosides GQ1b, DPPX, CASPR2, LGI1, as well as by antibodies against neuronal intracellular antigens. The paper presents a number of both mental and neurological symptoms of autoimmune encephalitis. Moreover, the coexistence of psychoses, neoplastic diseases, and the methods of diagnosing autoimmune encephalitis are discussed. Attention was also drawn to the fact that early diagnosis, as well as early initiation of targeted treatment, increases the chance of a successful course of the therapeutic process. Strategy and Methodology: The articles on which the following paper was based were searched using search engines such as PubMed and Medline. Considering that anti-NMDAR antibodies were first described in 2007, the articles were from 2007 to 2023. The selection of papers was made by entering the phrases "autoimmune encephalitis and psychosis/paraneplastic syndromes or cancer". The total number of articles that could be searched was 747, of which 100 items were selected, the most recent reports illustrating the presented topic. Thirty-four of them were rejected in connection with case reports or papers that could not be accessed.

THE ROLE OF DIET IN MULTIPLE SCLEROSIS.

Multiple sclerosis (MS) is a disease of the central nervous system (CNS), characterized by chronic inflammation associated with autoimmune damage to myelin and axons leading to neurodegeneration. Although the etiology is not fully understood, some factors that increase the risk of disease have been identified. One of the key elements of multidisciplinary approach to the management of MS is a properly balanced diet, e.g. Swank diet. Its main assumption is to reduce the supply of animal fats in favor of fats of plant origin, which contain polyunsaturated fatty acids omega-3. One of the factors influencing the course of the disease is vitamin D deficiency. In 80-90% it is synthesized by exposure to the sun, while the other 10-20% may be supplied with ingested food. Although elevated plasma homocysteine levels have been demonstrated in MS patients, there is no need to modify the supply of B vitamins. Further studies are necessary to show the correlation between the supply of B vitamins and the course of the disease. Due to the antioxidant effect, it is recommended to include products that are sources of vitamin A, E and C, glutathione, coenzyme Q10. It is also beneficial to include compounds from the polyphenol group: quercetin, resveratrol and curcumin. Through proper nutrition model it is also possible to reduce side effects of applied medications, such as constipation, what improves patients' quality of life. Diet therapy is a key element supporting pharmacotherapy in patients with multiple sclerosis.

ASSOCIATION BETWEEN EATING HABITS AND PHYSICAL ACTIVITY IN PRIMARY SCHOOL STUDENTS.

OBJECTIVE: The aim: The study aimed to assess the association between the physical activity level and eating habits of primary school students. PATIENTS AND METHODS: Material and methods: 139 children attending one of the Polish primary school or football school were included. The research tool was author's anonymous survey. RESULTS: Results: The high physical activity level was observed in 34.1% of boys and in 8.8% of girls. As the level of physical activity increased, the consumption of vegetables and fruits also increased. Whole grain bread, coarse-grained groats, whole grain pasta and brown rice were more popular among students with a high physical activity level. The greater the physical activity, the greater the amount of water drank by students. The consumption of sweets, fast food, and ready-made meals, such as frozen pizza or Chinese soup, decreased with increased physical activity. The choice of healthier substitutes for unhealthy snacks was declared by students with moderate or high physical activity level. There was no correlation between BMI and age and the physical activity level. Girls were less active than boys. CONCLUSION: Conclusions: More active physically children had better eating habits and were more aware of healthy eating principles than less active people.

ASSESSMENT OF ADULT EATING HABITS IN THE NUTRITIONAL PREVENTION OF STROKE.

OBJECTIVE: Introduction: Lifestyle modification, including changing eating habits, plays an essential role in the prevention of stroke. The aim: The study aimed to assess the nutritional prevention of cerebrovascular diseases in adult inhabitants of Poland. PATIENTS AND METHODS: Material and Methods: The study was conducted using the author's questionnaire among 145 women and 76 men, aged 18 - 30 (53.9%) and 50 - 70 (46.1%) years. RESULTS: Results: The following stroke risk factors were found in the examined group: overweight or obesity (46.6%), lack of regular physical activity (48%), smoking (33%), hypertension (22.1%), dyslipidemia (8.6%), diabetes (5.9%), and cardiac arrhythmias (6.3%). The younger subjects compared to older ones more often declared the daily consumption of whole-grain cereal products and vegetables, fish at least once a week, and they preferred vegetable oils. On the other hand, older subjects declared the consumption of sweets, sweet drinks, salt, and fast food less frequently than younger ones. Also, fruits were more often chosen by older people. Both groups declared similar moderate consumption of milk and dairy products with reduced fat content, lean meat, and alcohol. Only 38% of respondents considered their eating habits to be appropriate. CONCLUSION: Conclusions: The eating habits of examined adults only partially met the recommendations regarding the nutritional prevention of stroke. In some elements, younger people were more likely to follow appropriate dietary recommendations, while older people were more appropriate in others. The education regarding the principles of the nutritional prevention of cerebrovascular diseases is still necessary and should be age-appropriate.

Effectiveness and safety of CyberKnife radiosurgery in treatment of trigeminalgia - experiences of Polish neurological and oncological centres.

Trigeminal neuralgia (TN) is one of the most common cranial neuropathies. Pathologies located alongside the long nerve can also cause its mechanical compression or secondary involvement in the inflammatory process, and thus cause pain. TN is characterised by severe paroxysmal unilateral facial pain in the innervation area of branches I-III of the nerve V when provoked by light touch or slight movement. Multiple therapeutic methods are available, but most of them yield unsatisfactory results. According to guidelines (AAN and EFNS) the first-line therapy in trigeminalgia is carbamazepine/oxcarbazepine, and if there is a poor response - surgical treatment [1]. The array of surgical options includes percutaneous retrogasserian glycerol injection, radiofrequency thermocoagulation, balloon decompression, thermal rhizotomy, and stereotactic radiosurgery [2-4]. This paper presents our own experiences with CyberKnife (CK), a new type of radiosurgical (RS) treatment of 64 TN patients. CONCLUSIONS: CyberKnife radiotherapy is characterised by high efficacy in 80% of patients with trigeminalgia, minimal invasiveness, and subsiding mild side effects. Radioablation of nerve V root in patients with neuralgia allows us to entirely stop antiepileptic therapy or reduce its doses, which in turn reduces the risk of potential side effects. CyberKnife can be a therapeutic option in those patients who have been offered ineffective therapies, or treatments with limited efficacy, and/or in older patients with comorbidities.

Multiple sclerosis: oral health, behaviours and limitations of daily oral hygiene - a questionnaire study.

CLINICAL RATIONALE FOR THE STUDY: Neurological deficits and progressing disability in patients with multiple sclerosis (MS) may hamper daily oral hygiene, but their relations with oral problems have not yet been clearly determined. AIM OF THE STUDY: The aim of this study was to identify the most significant dental problems and limitations of daily oral hygiene in Polish patients with MS. MATERIAL AND METHODS: 199 patients with diagnosed MS (median age 37 years) treated in the neurological outpatient clinic were interviewed using a paper-based questionnaire. They provided answers on oral health, behaviours and the limitations of their daily oral hygiene. Clinical information regarding symptoms, MS phenotype, relapses, medication and degrees of disability was based on medical records. RESULTS: The most frequent symptoms were dry mouth (43.2%) and bleeding from gums (28.1%). Dry mouth was more frequent in patients with secondary-progressive MS (SPMS) than relapsing-remitting MS (65.4% vs 41.3%, p = 0.023). Patients with bleeding from gums had had MS for a longer duration (median 6 vs 4 years, p = 0.002). Difficulties in daily oral hygiene were more frequent in patients with SPMS (24.0% vs 8.1%; p = 0.016). Greater proportions of patients with muscle weakness of limbs, imbalance or pain brushed their teeth irregularly. Frequent (i.e. at least every six months) visits to the dentist's surgery were uncommon in patients with SPMS (12.0% vs 39.7%, p = 0.010). CONCLUSIONS AND CLINICAL IMPLICATIONS: Dry mouth and bleeding from gums are more frequent in patients with longer lasting and more advanced types of MS. Daily oral hygiene and oral health self-control is limited in patients with MS, mainly due to motor deficits, balance problems and pain, and this becomes worse with disease duration. To minimise the burden of the disease, patients with MS require better education and improvement in their awareness regarding proper oral health control, such as the use of electric toothbrushes. In addition, patients with chronic and progressive disability from multiple sclerosis may benefit from better organised access to dental care.

Enteral nutrition in cystic fibrosis

Introduction: Cystic fibrosis is a genetically determined disease. It is currently detected right after birth thanks to a screening program. This early detection allows for quick treatment inclusion. Cystic fibrosis therapy has a comprehensive character. The way of nutrition is also very important. The aim of this study was to evaluate the benefits and risks of enteral nutrition in patients with cystic fibrosis. Material and methods: 53 people with cystic fibrosis participated in the study (15 men, 38 women). Qualification for the study required the fulfillment of three conditions: enteral nutrition used for at least one month, no increase in body weight when using a high energy diet, underweight. The research was carried with use of self-constructed questionnaire. Results: The mean age of the respondents was 19.9 ± 4 years. The median weight gain after enteral nutrition was 7 kg. Most (n = 42, 79.2%) did not report any side effects. Few reported local infections (n = 9; 17%) or prolapse of the balloon (n = 2, 3.8%). On the other hand, everyone reported benefits - it was mainly weight gain and improved quality of life. In some cases (n = 22, 41.5%) with the use of enteral nutrition, a decrease in the frequency of respiratory infections was observed. Conclusions: Enteral nutrition is a beneficial method in those patients with cystic fibrosis, in whom high-energy oral nutrition is inefficient.

[Knowledge on cardiovascular risk factors and symptoms of stroke among inhabitants of rural communite].

OBJECTIVE: Introduction: Stroke is one of the leading causes of mortality and disability in the world. A wide knowledge of risk factors for cerebrovascular diseases is one of the main elements of primary prevention, while knowledge of stroke symptoms can significantly speed up treatment and reduce negative health effects. The aim: To assess the knowledge about stroke and risk factors of cerebrovascular diseases among the inhabitants of the randomly selected rural community (in Lodz Province). PATIENTS AND METHODS: Material and methods: The study included 143 adult residents of Rzasnia. The research was carried out using a self-constructed questionnaire, prepared on the basis of available literature. RESULTS: Results: The average score obtained from the knowledge survey on stroke was 5.79 +/- 3.47 (maximum number of points - 14). The average number of points in people with a family history of stroke was statistically significantly higher (7.46±3.31) than in those with no stroke in the family (4.20±2.98 ) (p <0.001). There was no statistically significant difference between the average number of points and gender (women - 6.13±3.55 points, men - 5.64±3.55, NS) and age (R = -0.1, NS ). However, the positive correlation between educational level and the score obtained in our questionnaire was found (R =0.4, p <0.05). The average number of correctly listed risk factors was: 0.6 ± 1.6. At least one risk factor was reported by only 34% of respondents. Respondents most often mentioned: excessive alcohol consumption (18%), smoking (18%), hypertension (14%), atherosclerosis (11%). The average number of correctly listed symptoms of stroke was: 1.2±1.3. At least one symptom of stroke was reported by only 58% of respondents. The respondents most often reported: headache (29%), speech disorders (22%), gait disturbances (13%), and sensory disorders (13%). If a stroke was suspected, the majority of respondents would call an ambulance (94%). CONCLUSION: Conclusions: Knowledge of the residents of the chosen rural commune about the stroke is not satisfactory and should be supplemented with an educational program that would include as many people as possible.

[Eating habits of the youth from Ruda Slaska].

OBJECTIVE: Introduction: In recent years, interests on dietary and health food have grown considerably. Nutritional knowledge and eating habits determined in the youth have an impact on the health condition in adulthood. The aim: To evaluate the eating habits in the population of young people from Silesian province. PATIENTS AND METHODS: Materials and methods: The anonymous questionnaire survey was conducted in the group of high school students aged 17-21 years coming from Silesian province, randomly chosen from high schools in Ruda Slaska. The study group consisted of 262 students, 157 (59,9%) women and 105 (40,1%) men. The student`s participation in the study was voluntary. RESULTS: Results: The analysis showed that as many as 40% of high school students never eat regularly and eating of regular meals reported only 11,5%. Less than a half (46,9%) of participants eat breakfast every day. The most commonly consumed meals was lunch (n = 217; 82,8%) and dinner (n = 143; 54,6%). The vast majority of students (77,5%) didn't know the correct classification of the feeding pyramid floors. Moreover, in more than a half of young women (54,8%) and men (52,4%) the body mass deficiency was revealed (BMI<18kg/m2). CONCLUSION: Conclusions: The study showed abnormal nutritional behavior of high school youth. Therefore, there is a need to conduct activities under health prevention, which improve the eating habits of young people.

[Acetylsalicylic acid in the prevention and treatment of cardiovascular diseases].

Acetylsalicylic acid (ASA) is one of the most popular medicines in the world. ASA preparations have been used for over 100 years as anti-inflammatory, antipyretic and analgesic drugs. Since 1971, ASA has also been used as an antiplatelet drug. The main antiplatelet effect of aspirin is the irreversible inhibition of the key enzyme of arachidonic acid cascade, a prostaglandin H synthetase, also called cyclooxygenase (COX). ASA is a widely used drug in the prevention of cardiovascular diseases. In accordance with the current European guidelines, ASA is indicated in secondary prevention in all patients with established cardiovascular disease (coronary heart disease, previous myocardial infarction, previous stroke, peripheral atherosclerosis). Life therapy with low doses (75-150 mg daily) is recommended. ASA is also used to treat acute myocardial infarction, unstable coronary heart disease, coronary artery bypass surgery and angioplasty, as well as to treat acute stroke. Despite the proven benefits, approximately 10-20% of patients taking ASA are at risk for re-occurring cardiovascular events. In connection with the above, the phenomenon of the so-called resistance to ASA (or high on treatment platelet reactivity despite ASA). This phenomenon was reported in patients after stroke (up to 60% of subjects), in atherosclerosis of the lower limbs (up to 60%), in stable coronary disease (up to 70%) and in patients immediately after myocardial infarction (up to 80%). Despite studies conducted for several years, so far there are no clear guidelines for monitoring platelet function in patients taking ASA, both in primary and secondary stroke prevention.

Association between carotid plaque score and microvascular complications of type 2 diabetes.

INTRODUCTION: According to the "common soil" hypothesis, diabetic microangiopathy and macroangiopathy have a similar pathophysiological background. It has been well documented that carotid artery atherosclerosis in patients with type 2 diabetes is associated with cardiovascular complications; however, it remains unclear whether there is a similar association for microvascular complications. OBJECTIVES: We investigated whether the carotid plaque score and the carotid intima-media thickness (IMT) are associated with macroangiopathic and microangiopathic complications of type 2 diabetes. PATIENTS AND METHODS: We enrolled patients with type 2 diabetes and microvascular complications or overt macroangiopathy. A B­mode carotid ultrasound was performed in all participants, and anthropometric parameters, hemoglobin A1c (HbA1c) levels, lipid profile, and smoking status were assessed. RESULTS: The study included 73 patients (mean [SD] age, 63.6 [7.5] years; 36 men [49%]). The mean (SD) diabetes duration was 11.7 (8.1) years. Microvascular complications were observed in 32 patients (43.8%), and overt macroangiopathy, in 42 (57.5%). Hypertension was reported for 60 patients (82%); dyslipidemia, for 56 (77%); obesity, for 37 (51%); and smoking, for 10 (14%). A multivariate regression analysis showed that the carotid plaque score, but not carotid IMT, was significantly associated with dyslipidemia (P = 0.03) and microangiopathy (P = 0.01). CONCLUSIONS: Our results indicate that, unlike carotid IMT, the carotid plaque score is independently associated with microangiopathic complications in type 2 diabetes. Patients with a high plaque score should receive special care and the most intensive treatment to stop progression of these complications.

[Neurosarcoidosis - clinical characteristics, diagnosis and treatment]. / Neurosarkoidoza - obraz kliniczny, diagnostyka i leczenie.

Neurosarcoidosis (NS) manifests itself clinically in approximately 8-13% of patients with sarcoidosis. Granulomas are localized in both the central and peripheral nervous system, mainly within the meninges and cranial nerves. Changes may spread interstitially, occupying different structures of the brain and spinal cord. Diagnosis of NS is made by characteristic clinical symptoms and the exclusion of other diseases, with the presence of specific changes in the magnetic resonance and cerebrospinal fluid, and it is mainly based on histopathological examination. The first choice treatment are corticosteroids. In case of failure or adverse events, methotrexate, azathioprine, cyclosporine, cyclophosphamide, mycophenolate mofetil and infliximab could be used.

[Evaluation of frequency of fatigue syndrome in patients with multiple sclerosis]. / Ocena czestosci wystepowania zespolu zmeczenia u chorych na stwardnienie rozsiane.

INTRODUCTION: Fatigue is a common symptom occuring in different neurological diseases. It has an influence on social and proffesional live, and daily living activities of the patients. The aim of the study was to assess frequency of fatigue and its association with depression and anxiety in patients with multiple sclerosis (MS). MATERIAL AND METHODS: The examined group consisted of 44 patients with MS (mean age: 36.3+/-9.4 years). The control group involved 30 healthy volunteers. All the subjects fulfilled two questionnaires: Fatigue Severity Scale and Hospital Anxiety and Depression Scale. RESULTS: Fatigue was present in 29 MS patients (66%) and in 8 controls (26.7%) (p=0.0002). Anxiety was noticed in 11 MS patients (25%) and in 2 controls (6.7%) (p=0.002). Depression was diagnosed in 3 MS patients (6.8%) and 2 controls (6.7%) (NS). Frequency of fatigue was similar in women and men, but anxiety and depression were more common in women. There was no correlation between fatigue and age, duration of the disease and EDSS. An association between fatigue and depression, but not anxiety, was observed. CONCLUSIONS: Fatigue is a very common symptom in MS, sometimes associated with depression. It should be considered in every patient with MS, independently from age, sex, disability and duration of the disease.

[Analysis of cerebrovascular risk factors in patients with stroke treated in the stroke unit]. / Analiza czynników ryzyka chorób naczyniowych mózgu u chorych leczonych w pododdziale udarowym.

Stroke is one of the major public health problems worldwide. Determining the cerebrovascular risk factors (RF) is very important in the efforts of primary and secondary stroke prevention. The aim of the study was to establish the frequency of RF in patients with ischaemic (IS) or haemorrhagic stroke (HS) hospitalized in the stroke unit in the Department of Neurology of the Silesian Medical University from August 2000 to June 2002. We analysed data of 229 patients (29 with HS and 200 with IS). Functional outcome was evaluated by use of modified Rankin scale, Barthel Index and Scandinavian Neurological Stroke Scale at discharge. Statistical analysis was performed with Student's t-test, coefficient of correlation and multivariate logistic regression. 94.8% (n = 217) of all the patients had one or more RF. The most common RF were: hypertension (78.2%), coronary heart disease (54.2%), obesity (29.2%), diabetes mellitus (24.8%) and dyslipidaemia (24%). No correlation between the number of RF and functional outcome at discharge was observed. Cigarette smoking (p < 0.01) and alcohol abuse (p < 0.005) were more frequent in young patients (< 55 years). Previous ischaemic stroke was more common in older patients (>55 years). In male patients cigarette smoking and alcohol abuse were found more frequently than in female (p < 0.001). The mortality in examined patients was 22.2% (20.4% in patients with IS and 45.8% with HS). Male gender (p < 0.05), history of previous cardiac infarction (p < 0.05) and previous ischaemic stroke (p < 0.01) were associated with increased mortality. The other variables studied did not show significant differences.