Guidelines for Preventing and Treating Vitamin D Deficiency: A 2023 Update in Poland.

Introduction: All epidemiological studies suggest that vitamin D deficiency is prevalent among the Polish general population. Since vitamin D deficiency was shown to be among the risk factors for many diseases and for all-cause mortality, concern about this problem led us to update the previous Polish recommendations. Methods: After reviewing the epidemiological evidence, case-control studies and randomized control trials (RCTs), a Polish multidisciplinary group formulated questions on the recommendations for prophylaxis and treatment of vitamin D deficiency both for the general population and for the risk groups of patients. The scientific evidence of pleiotropic effects of vitamin D as well as the results of panelists' voting were reviewed and discussed. Thirty-four authors representing different areas of expertise prepared position statements. The consensus group, representing eight Polish/international medical societies and eight national specialist consultants, prepared the final Polish recommendations. Results: Based on networking discussions, the ranges of total serum 25-hydroxyvitamin D concentration indicating vitamin D deficiency [<20 ng/mL (<50 nmol/L)], suboptimal status [20-30 ng/mL (50-75 nmol/L)], and optimal concentration [30-50 ng/mL (75-125 nmol/L)] were confirmed. Practical guidelines for cholecalciferol (vitamin D3) as the first choice for prophylaxis and treatment of vitamin D deficiency were developed. Calcifediol dosing as the second choice for preventing and treating vitamin D deficiency was introduced. Conclusions: Improving the vitamin D status of the general population and treatment of risk groups of patients must be again announced as healthcare policy to reduce a risk of spectrum of diseases. This paper offers consensus statements on prophylaxis and treatment strategies for vitamin D deficiency in Poland.

EFFICACY AND SAFETY OF CANDELABRA ALOE EXTRACT (ALOE ARBORESCENS MILL.) IN PREVENTION AND TREATMENT OF UPPER RESPIRATORY TRACT INFECTIONS OF VARIOUS AETIOLOGIES.

OBJECTIVE: The aim: To evaluate therapeutic effects of a product containing Aloe arborescens extract (AA) as the active substance in children aged 3-18 years with a diagnosed viral or bacterial upper respiratory tract infection and to assess their carers' satisfaction with the use of the product. The above-mentioned product is also indicated to control the loss of appetite. Thus, the study also assessed the effect of AA on this parameter. PATIENTS AND METHODS: Materials and methods: A total of 6764 patients (children aged 3-18 years) were included in the study, which was conducted by 279 paediatrics and family medicine specialists (or being in the course of specialisation) from 237 centres. The efficacy was evaluated of the basis of reduction of upper respiratory tract infections (URIs) symptoms between the first and second visits with the application of the chi-square test. RESULTS: Results: The most common primary diagnoses for which AA was used were common colds and recurrent acute URIs of viral aetiology. Symptoms reduction or resolution were reported in over: 81% of children with sore throat and/or hoarseness, 72% of children with earache, 64% of children with nasal discharge and/or the feeling of congested nose, 63% of children with cough, 89% of children with fever and 82% of children with sleep disturbances. Improvement in appetite was achieved in more than 66% of children. Almost 60% of the paediatric patients or their carers included in the study group were very satisfied with the efficacy of AA. More than 66% of carers were very satisfied with the dosing regimen and the vast majority of them (99%) would recommend the preparation to others. Two children demonstrated adverse effects (diarrhoea, abdominal pain) that were induced by application of the studied product. They resolved after its discontinuation. CONCLUSION: Conclusions: AA applied in treatment of URIs in children highly effectively reduces symptoms of the diseases. Paediatric patients and their carers are satisfied with therapeutic effects of the syrup with regards to its all indications.

Cladophora glomerata enriched by biosorption with Mn(II) ions alleviates lipopolysaccharide-induced osteomyelitis-like model in MC3T3-E1, and 4B12 osteoclastogenesis.

Chronic osteomyelitis, a bone infectious disease, is characterized by dysregulation of bone homeostasis, which results in excessive bone resorption. Lipopolysaccharide (LPS) which is a gram-negative endotoxin was shown to inhibit osteoblast differentiation and to induce apoptosis and osteoclasts formation in vitro. While effective therapy against bacteria-induced bone destruction is quite limited, the investigation of potential drugs that restore down-regulated osteoblast function remains a major goal in the prevention of bone destruction in infective bone diseases. This investigation aimed to rescue LPS-induced MC3T3-E1 pre-osteoblastic cell line using the methanolic extract of Cladophora glomerata enriched with Mn(II) ions by biosorption. LPS-induced MC3T3-E1 cultures supplemented with C. glomerata methanolic extract were tested for expression of the main genes and microRNAs involved in the osteogenesis pathway using RT-PCR. Moreover, osteoclastogenesis of 4B12 cells was also investigated by tartrate-resistant acid phosphatase (TRAP) assay. Treatment with algal extract significantly restored LPS-suppressed bone mineralization and the mRNA expression levels of osteoblast-specific genes such as runt-related transcription factor 2 (Runx2), alkaline phosphatase (ALP) and osteocalcin (OCN), osteopontin (OPN), miR-27a and miR-29b. The extract also inhibited osteoblast apoptosis, significantly restored the down-regulated expression of Bcl-2, and decreased the loss of MMP and reactive oxygen spices (ROS) production in MC3T3-E1 cells induced by LPS. Furthermore, pre-treatment with algal extract strongly decreased the activation of osteoclast in MC3T3-E1-4B12 coculture system stimulated by LPS. Our findings suggest that C. glomerata enriched with Mn(II) ions may be a potential raw material for the development of drug for preventing abnormal bone loss induced by LPS in bacteria-induced bone osteomyelitis.

efficacy of dry extract of ivy leaves in the treatment of productive cough.

OBJECTIVE: Introduction: Coughing is a physiological, spontaneous defense mechanism against irritants that stimulate respiratory mucosa. Productive cough should be not suppressed; instead, mucus-dissolving agents are recommended. One of the expectorants, which increases the excretion volume, is the herbal medicine derived from ivy leaves. The ivy extract contains triterpene saponins, which have secretory properties. The aim of this study was to determine the effectiveness and safety of the treatment with the medicinal product Hedussin®, containing dry ivy extract, in the therapy of productive cough in the course of the respiratory tract infection. PATIENTS AND METHODS: Material and methods:This was a non-randomized, non-interventional, multicenter, open-label, post-authorization effectiveness study (PAES). The study group consisted of 464 patients aged 2-12 years with productive cough. The study was supported by a questionnaire that included: the type of cough etiological factor, Bronchitis Severity Score (BSS), temperature, and prescription of antibiotic therapy. Effectiveness and safety of the therapy with Hedussin® was assessed at the follow-up visit. RESULTS: Results and conclusion: Improvement in cough was reported in 93.3% subjects; improvement in chest pain on coughing was reported in 84.7%, in wheezing - in 90.0%, in dyspnoea - in 88.7%, and in auscultation changes - in 94.8%. In addition, decline or normalization of body temperature was found in 96.0% of subjects. No adverse drug reactions were reported in the study population. The non-antibiotic treated group showed similar proportions. The results of this study support the efficacy of Hedussin® prescribed for the treatment of productive cough in the course of respiratory tract infections. Hedussin® was well tolerated by sick children aged 2-12 years.

Antiviral activity of the "Virus Blocking Factor" (VBF) derived i.a. from Pelargonium extract and Sambucus juice against different human-pathogenic cold viruses in vitro.

THE AIM: The in-vitro antiviral activity of the "Virus Blocking Factor" (VBF), a combination of Pelargonium extract and Sambucus juice with addition of Betaglucan 1,3 / 1,6, Zincum gluconium, Acidum ascorbicum, was studied against human pathogenic viruses: Influenza A H1N1 (FluA H1N1), Rhinovirus B subtype 14 (HRV14), Respiratory Syncytial Virus (RSV), Parainfluenzavirus subtype 3 (Para 3), and Adenovirus C subtype 5 (Adeno 5). METHOD: Antiviral activity was assessed using plaque-reduction assays after adding the test substance post infection of the MDCK, HeLa and HEp-2 cells with the viruses. Ribavirin Virazol and - in case of Adenovirus an internal laboratory standard - were used as positive controls. Cytotoxic effects of VBF and VBF Control onto the virus permissive MDCK, HeLa and HEp-2 cells were examined. Non-toxic concentrations of VBF were determined by the Methylthiazoletetrazolium test (MTT-Test). RESULTS AND CONCLUSIONS: In all antiviral studies VBF showed (2.1%) a dose-dependent antiviral activity against FluA H1N1 and HRV14 at non-toxic concentrations. A very strong effect was demonstrated in concentrations of 2.5% and 1.25% where replication of H1N1 and HRV14 was nearly completely blocked. Dose-dependent antiviral activity was detectable against RSV in a concentration range of 1.25% to 0.63% of the test item. Due to toxic side effects of a 2.5% concentration at least a "minor effect" of about 30% (1.25% solution) against Para 3 infected HEp-2 cells could be determined. Concerning Adeno 5 not any antiviral activity could be demonstrated in all studies with all tested substance concentrations of VBF. VBF Control did not show any cytotoxicity and antiviral effects. Further research is needed to elucidate clinical effect of VBF.

[Immunomodulatory role of Biostymina® and Bioaron® C in the prevention and treatment of upper respiratory tract infections]. / Immunomodulacyjna rola Biostyminy® i Bioaronu® C w profilaktyce i leczeniu infekcji górnych dróg oddechowych.

A properly functioning immune system among others protects the organism against the development of infections. In certain situations, its activity can be impaired, which can result in an increased risk of viral and bacterial infection development. An aqueous extract of aloe arborescens (Aloe arborescens Mill.) has been used as add-on therapy for many years due to its immunomodulatory effect resulting in increased anti-inflammatory, anti-viral and anti-bacterial activity. This effect is mainly due to lectins (glycoproteins) and mannans (polysaccharides). Over the past years products containing the aqueous extract of aloe arborescens have been subjected to numerous studies in vitro as well as pharmacological investigations and clinical-observational studies. Based on literature data as well as on the results of observational studies carried out in Poland, a positive immunomodulating effect of Aloe extract containing products has been demonstrated. This effect manifested in infection's symptoms amelioration and infection time shortening but also in general immune system stimulation resulting in less frequent infection recurrence. In Poland the only registered medicinal products containing aqueous extract of Aloe arborescens as an active substance, are Bioaron® C and Biostymina®. Both products showed good efficacy and safety profiles both in adults and in children.

[Treatment of cough in respiratory tract infections - the effect of combining the natural active compounds with thymol].

Cough is one of the characteristic symptoms of upper respiratory tract infections (URI). Herbal medicines are often used in the treatment of the cough associated with infection and to accelerate recovery or support the immune system. An example of such products are extracts of thyme and primrose, and also their combination with thymol. Thymus vulgaris is a spasmolytic, antimicrobial, anti-inflammatory, immunomodulatory and antioxidant agent. The most important component responsible for the activity of thyme is thymol contained in the volatile thyme oil. Primrose is, most of all, a saponine agent with expectorant and secretolytic activity, showing also spasmolytic, anti-inflammatory and antimicrobial effects. Because of the additive effects of the mentioned extracts and their wide activity profile they are often used as a combination drug. The use of this combination was assessed in the URI with the effects of alleviation of cough and dyspnea, and shortening the length of the disease. The effectiveness of the drug containing the extracts of thyme and primrose with the addition of thymol (Bronchosol®) was comparable to synthetic ambroxol and its safety has been proved. Moreover, the in-vitro antibacterial and antifungal effects of this drug have been evaluated.

Antiviral activity of the "Virus Blocking Factor" (VBF) derived i.a. from Pelargonium extract and Sambucus juice against different human-pathogenic cold viruses in vitro.

THE AIM: The in-vitro antiviral activity of the "Virus Blocking Factor" (VBF), a combination of Pelargonium extract and Sambucus juice with addition of Betaglucan 1,3 / 1,6, Zincum gluconium, Acidum ascorbicum, was studied against human pathogenic viruses: Influenza A H1N1 (FluA H1N1), Rhinovirus B subtype 14 (HRV14), Respiratory Syncytial Virus (RSV), Parainfluenzavirus subtype 3 (Para 3), and Adenovirus C subtype 5 (Adeno 5). METHOD: Antiviral activity was assessed using plaque-reduction assays after adding the test substance post infection of the MDCK, HeLa and HEp-2 cells with the viruses. Ribavirin Virazol and - in case of Adenovirus an internal laboratory standard - were used as positive controls. Cytotoxic effects of VBF and VBF Control onto the virus permissive MDCK, HeLa and HEp-2 cells were examined. Non-toxic concentrations of VBF were determined by the Methylthiazoletetrazolium test (MTT-Test). RESULTS AND CONCLUSIONS: In all antiviral studies VBF showed (2.1%) a dose-dependent antiviral activity against FluA H1N1 and HRV14 at non-toxic concentrations. A very strong effect was demonstrated in concentrations of 2.5% and 1.25% where replication of H1N1 and HRV14 was nearly completely blocked. Dose-dependent antiviral activity was detectable against RSV in a concentration range of 1.25% to 0.63% of the test item. Due to toxic side effects of a 2.5% concentration at least a "minor effect" of about 30% (1.25% solution) against Para 3 infected HEp-2 cells could be determined. Concerning Adeno 5 not any antiviral activity could be demonstrated in all studies with all tested substance concentrations of VBF. VBF Control did not show any cytotoxicity and antiviral effects. Further research is needed to elucidate clinical effect of VBF.

[Efficacy and safety of acute bronchitis treatment in adults--a comparison of Bronchosol® syrup and synthetic preparations with ambroxol. Results of observational study]. / Skutecznosc i tolerancja syropu Bronchosol® w leczeniu ostrego zapalenia oskrzeli u doroslych. Porównanie z preparatami syntetycznymi zawierajacymi ambroksol--badanie obserwacyjne.

INTRODUCTION: Upper respiratory tract infections (URTI), including acute bronchitis, are the frequent health problems and the most common reason for acute cough in adults. Even though the infections are caused mainly by viruses, and their course is usually not complicated, febrifuges, i.a. mucokinetics, or antitussives are used in the treatment of URTI in order to improve the quality of life and safety of patients. THE AIM: To evaluate the efficacy and safety of Bronchosol® herbal syrup in comparison to ambroxol preparations in the treatment of acute bronchitis in adult patients. MATERIALS AND METHODS: The Bronchosol®/2013 study was a non-interventional, prospective, open-label, observational study. Data from adult patients treated with Bronchosol® syrup for acute bronchitis were collected and compared with data from patients treated for the same condition with ambroxol preparations. The severity of bronchitis symptoms was evaluated with the BSS (Bronchitis Severity Score) scale, and patients'quality of life wasassessed with the VAS (Visual Analogue Scale) scale. Between visits patients conducted self-observations and filled out observation diaries. Moreover, the data on adverse events were collected. RESULTS: In 87.68% of patients the infections were cured. Most of patients considered the studied drugs to be the agent decreasing the duration of infection and its intensity. The percentage of patients who declared that they had a less intense cough than during earlier infections was higher in the group of patients treated with Bronchosol® syrup in comparison to ambroxol treated patients (60.22% vs. 45.03%). 91.94% of patients treated with Bronchosol® considered this syrup to be very safe; in the ambroxol group such a declaration was made by 76.61% of patients. CONCLUSIONS: Bronchosol® syrup is an efficient, well-tolerated, and safe drug. Its efficacy in the treatment of acute bronchitis symptoms in adult patients is similar to the efficacy of ambroxol preparations.

The statement of the Polish Society of Allergology experts on the treatment of difficult-to-treat asthma.

The main objective of asthma treatment is to control symptoms of the disease; however, despite the availability of guidelines and many groups of medications, the degree of control of this condition is insufficient. In difficult-to-treat asthma, the optimal control cannot be achieved due to reasons independent of the disease. Factors worsening asthma control include: inadequate treatment plan (low therapy adherence and compliance), inappropriate inhalation technique, insufficient symptom control using the available classes of medications, incomplete response to treatment (non-responders, steroid-resistance), incorrect diagnosis of asthma or comorbidities, and environmental factors. In order to achieve the optimal asthma control, it is recommended to: take therapeutic decisions with the patient, assess the probability of non-compliance, perform detailed diagnostics and initiate treatment of concomitant diseases, carry out differential diagnosis of conditions mimicking asthma, educate the patient as to the inhalation technique and check it, eliminate unfavourable environmental factors, and modify current treatment. New treatment options for patients with asthma include: ultra-long-acting beta2-agonists, long-acting muscarine receptor antagonists (LAMA), monoclonal antibodies, and non-pharmacological interventions. The only LAMA approved for treatment of asthma is tiotropium bromide. The analyses performed demonstrated a high efficacy of tiotropium in terms of improved lung function parameters and prolonged time to the first asthma exacerbation. It is recommended as an add-on therapy at asthma treatment steps 4 and 5 according to GINA (Global Initiative for Asthma) 2014. The optimal asthma control is important from the medical as well as the economical point of view.

Candelabra aloe (Aloe arborescens) in the therapy and prophylaxis of upper respiratory tract infections: traditional use and recent research results.

Aloe arborescens (Candelabra Aloe) has been used in the treatment of upper respiratory tract infections in Central and Eastern European countries for many decades. Originally introduced to support the healing and recovery in cornea transplant patients, aqueous A. arborescens extracts soon became popular in the treatment of upper respiratory tract infections with a focus on toddlers and children. Recent preclinical and clinical data show that immunomodulatory, antiinflammatory, and antiviral effects contribute to its therapeutic efficacy. Based on its well documented, longstanding traditional use and its excellent safety and tolerability, A. arborescens may be considered a valuable addition to the spectrum of herbal medicinal products for the treatment and prophylaxis of upper respiratory tract infections, in particular common cold, in adults and children.

[Integrated care for patients with advanced chronic obstructive pulmonary disease]. / Zintegrowana opieka medyczna u chorych na zaawansowana przewlekla obturacyjna chorobe pluc.

Chronic obstructive pulmonary disease (COPD) is the third cause of mortality and disability (assessed by DALY) among patients above 60 year old. Severe and very severe COPD (FEV(1) = equal or less than 50% and 30% of expected value, respectively) is estimated at 20% of all COPD patients. Advanced COPD usually leads to physical and mental deterioration, the patients often manage with the problems caused by the disease and other comorbidities poorly. This leads to increased risk of COPD exacerbations and further deterioration of the patient's status, increased costs of medical care and eventually increased risk of death. Current organization of medical care for those patients does not provide adequate health and social support for them. However, it seems that introducing an integrated approach proposed by World Health Organization, could improve the situation of advanced COPD patients. In Poland, this kind of care has been provided in advanced cancer patients throughout stationary palliative care units and hospices during the last several years. This experience should be helpful in integrating actions of general practitioners and specialized nurses, as well as providing access for the specialists' consultations according to the individual needs of the patients. It should also allow for broad cooperation with auxiliary staff, such as social workers, medical assistants and volunteers, as well as psychologists and clergymen (especially in the terminal phase of the disease).

[Contribution by Ksawery Wolfgang (-1864) to the development of Druskininkai]. / Osiagniecia Ksawerego Wolfganga (-1864) w rozwoju Druskiennik.

We present the history of the spa of Druskininkai which was founded in 1837. The professional and scientific career of Ksawery Wolfgang (-1864), an eminent physician of this spa, is described in the context of his importance for the development of Druskininkai. Wolfgang was a respected person in Druskininkai. He was the editor-in-chief and publisher of the magazine "Ondyna Druskienickich Zródel" ("Ondine of Druskininkai Springs") and the author of the book "On salt springs in Druskininkai" (Vilnius 1841), as well as of several other publications. The properties of Druskininkai salt springs and their therapeutic effects in many diseases are discussed. Wolfgang was able to establish indications and contraindications to treatment in Druskininkai. Mention is made of the book "Druskininkai. A literary and medical essay" by Józef Ignacy Kraszewski and Ksawery Wolfgang (Vilnius 1848).

[The influence of a three-year preseasonal specific immunotherapy on selected parameters of allergic inflammation in pollinosis patients]. / Wplyw trzyletniej przedsezonowej immunoterapii swoistej na wybrane parametry zapalenia alergicznego u chorych na pylkowice.

Specific immunotherapy (SIT) can in some cases influence the course of allergic inflammation (eosinophilia and ECP concentration in peripheral tissue). This study was set up to evaluate the efficacy of three-year pre-seasonal SIT with grass pollen allergoid. We measured NALf eosinophilia and ECP concentration both in NALf and blood serum after subsequent SITs. Twenty seven patients aged 26.7 +/- 7.4 (range 18-45) entered this study. They were randomly assigned to treatment with either Pollinex or Allergovit. We observed a progressive fall in NALf eosinophilia in subsequent years: 24.1 +/- 2.4%; 20.2 +/- 4.6%; 9.8 +/- 1.9% vs. 30.4 +/- 3.0% before treatment (p < 0.05, p < 0.05 and p < 0.001, respectively). Also ECP concentration fell after second and third SIT to 15.6 +/- 1.5 ng/ml i 12.96 +/- 1.75 ng/ml vs 23.3 +/- 3.7 ng/ml before SIT (p < 0.05). A significant drop in serum ECP concentration was recorded only after the third SIT season--2.5 +/- 1.23 micrograms/ml vs 5.8 +/- 1.3 micrograms/ml before treatment, p < 0.01. NALf eosinophilia correlated positively with NALf ECP concentration--R2 = 0.92, p < 0.05. Hence, SIT ameliorates allergic inflammation decreasing significantly activity of eosinophils in nasal mucosa measured as NALf eosinophilia and ECP concentration. This effect seems to be time-depended.