Applications to augment patient care for Internal Medicine specialists: a position paper from the EFIM working group on telemedicine, innovative technologies & digital health.

Telemedicine applications present virtually limitless prospects for innovating and enhancing established and new models of patient care in the field of Internal Medicine. Although there is a wide range of innovative technological solutions in Europe, there are overarching elements associated with such technologies when applied to the practices of Internal Medicine specialists. The European Federation of Internal Medicine (EFIM) strongly advocates for active leadership and influence from the Internal Medicine societies and specialist physicians across Europe in the development and application of telemedicine and digital technologies in healthcare. This position paper's conclusions were drawn via Delphi method, which was developed collaboratively from July 2021 to December 2023. The panel, consisting of experts in clinical medicine, public health, health economics and statistics, assessed various aspects related to telemedicine. Participants assigned scores on a Likert scale reflecting perceived value and potential risks. The findings were consolidated in a comprehensive checklist aligning with relevant literature and a SWOT analysis. Specifically, key issues that need to be addressed include promoting the professional development of e-health competencies in the healthcare and medical workforce, using educational campaigns to promote digital literacy among patients and caregivers, designing and implementing telemedicine applications tailored to local conditions and needs and considering the ethical and legal contexts under which these applications are employed. Importantly, there is currently no consensus on care models or standardized protocols among European Internal Medicine specialists regarding the utilization of telemedicine. This position paper aims to outline the opportunities and challenges associated with the application of telemedicine in Internal Medical practice in Europe.

Dietary supplements and herbal preparations in renal and liver transplant recipients.

BACKGROUND: Dietary supplements (DS) and herbal preparations (HP) are advertised to be safe and have therapeutic potential. They are sold over the counter. Therefore, a considerable increase in the frequency of their use has been observed; for example in the United States one in four persons taking medicines uses DS. The use of DS and HP in renal and liver transplant recipients remains unknown. OBJECTIVES: The aim of our study was to determine the proportion of patients who used DS or HP, as well as to assess their awareness of the benefits and risks related to ingestion of these products. METHODS: We enrolled 100 renal, liver, or combined renal and heart transplant patients into the study. They underwent a survey consisting of 14 multiple-choice questions, concerning demographic features, transplant-related data, and information about the use of DS and HP, including the frequency of use, the reasons for the purchase, the knowledge of risks and benefits, as well as the sources of information about these products. RESULTS: Among the 58 (58%) patients who admitted their use of DS and/or HP, 20 (34.5%) ingested more than one preparation. Among liver patients, 51%, and among renal, 44%, of patients took these products for a variety of indications. Vitamins, minerals, diuretics, gastrointestinal tract-regulating, and sedative herbs were chosen most frequently. While 27% of respondents alleged to have obtained the information on DS and HP from a physician, 14% were from a pharmacist, 9% from a friend, acquaintance or neighbor, 8% from an attached leaflet, 4% from an advertisement, and 4% from the internet. CONCLUSIONS: A high proportion of patients use DS and HP. Most preparations were taken without medical consultation. Awareness of their toxicity or drug interactions was low. Therefore, a tailored education program should be proposed for this group of patients.

IL-6 promoter polymorphism in patients with rheumatoid arthritis.

OBJECTIVE: Rheumatoid arthritis (RA) is a chronic inflammatory disease in which cytokines play an important role. The aim of the present study was to examine the interleukin-6 (IL-6) -174 promoter polymorphism in patients with RA and its association with disease susceptibility and activity. METHODS: The study included 98 patients with RA diagnosed according to the criteria of the American College of Rheumatology. Polymerase chain reaction (PCR) amplification was used for analysis of the polymorphism at position -174 in the promoter of the IL-6 gene. RESULTS: The distribution of IL-6 genotypes in RA patients did not differ from that in control subjects. Nevertheless, in patients with a GG genotype the active form of RA was more frequently diagnosed compared with homozygous CC and GC patients. Moreover, in carriers of two G alleles the parameters of disease activity score (DAS28), erythrocyte sedimentation rate (ESR), number of swollen and tender joints] were significantly increased. CONCLUSION: We suggest that the IL-6 promoter polymorphism may be a genetic risk factor for RA activity.

IL-2 and TNF-alpha promoter polymorphisms in patients with acute kidney graft rejection.

INTRODUCTION: Proinflammatory cytokines have been implicated in the pathogenesis of acute kidney allograft rejection. The aim of the study was to examine the association between interleukin (IL)-2 -330 and tumor necrosis factor (TNF)-alpha -308 promoter polymorphisms and acute kidney allograft rejection. METHODS: The study included 72 patients with long-term stable graft function, and 57 diagnosed with acute kidney allograft rejection. RESULTS: Patients with acute kidney allograft rejection showed a prevalence of subjects with TNF-alpha T2 allele (P < .05). The risk of acute kidney allograft rejection diagnosis was 2.5-fold greater among carriers of the T2 allele than those homozygous for T1T1 (OR 2.53, 95% CI 1.19 to 5.37, P < .05) There was no statistically significant difference in the distribution of IL-2 genotypes between patients with stable graft function and acute kidney allograft rejection. CONCLUSION: The results suggest that TNF-alpha-308 promoter polymorphism is a risk factor for acute kidney allograft rejection.

TNF-alpha -308 promoter polymorphism in patients with rheumatoid arthritis.

OBJECTIVES: Rheumatoid arthritis (RA) is a chronic inflammatory disease in which tumour necrosis factor-alpha (TNF-alpha) plays an important role. There are, however, controversial reports that TNF-alpha promoter polymorphism may be an independent marker of susceptibility and severity of RA. The aim of the present study was to examine the TNF-alpha -308 promoter polymorphism in patients with RA. METHODS: We examined 91 patients with RA diagnosed according to the criteria of the American College of Rheumatology. Polymerase chain reaction (PCR) amplification was used for analysis of the polymorphism at position -308 in promoter of TNF-alpha gene. RESULTS: Distribution of TNF-alpha genotypes in RA patients did not differ from that in control subjects. Moreover, there was no association between TNF-alpha genotypes and age at disease diagnosis, disease activity in global physician's assessment, and joint and extra-articular involvement. There was also no correlation between TNF-alpha polymorphism and disease activity measures, including erythrocyte sedimentation rate (ESR), CRP, number of swollen and tender joints, and morning stiffness duration. CONCLUSIONS: We suggest that TNF-alpha -308 promoter polymorphism is not a genetic risk factor for RA susceptibility and severity.

IL1beta+3953 exon 5 and IL-2 -330 promoter polymorphisms in patients with rheumatoid arthritis.

OBJECTIVE: Rheumatoid arthritis (RA) is chronic inflammatory disease in which cytokines play an important role. The aim of present study was to evaluate the exon 5 +3953 IL-1beta and IL-2 -330 promoter polymorphisms in patients with RA in association with disease activity and severity. METHODS: In the study 93 patients with rheumatoid arthritis diagnosed according to the criteria of American College of Rheumatology were included. Polymerase chain reaction amplification was used for analysis of the polymorphisms studied. RESULTS: The distribution of IL-1beta and IL-2 genotypes in RA patients did not differ from control subjects. Nevertheless in patients with A2 allele of IL-1beta and GG genotype of IL-2, the active form of RA was more frequently diagnosed. Moreover in these patients the measurements of disease activity (DAS 28 score, ESR, number of swollen and tender joints) were significantly increased. CONCLUSION: We suggest that exon 5 +3953 IL1beta and IL-2 -330 promoter polymorphisms may be a genetic risk factor for RA severity.

The cytokine gene polymorphisms in patients with chronic kidney graft rejection.

Chronic allograft rejection remains an important cause of morbidity after kidney transplantation. The aim of the study was to examine the association between IL-2, IL-6 and TNF-alpha promoter polymorphisms and chronic kidney allograft rejection. The study included 64 patients with long-term stable graft function and 62 with chronic allograft nephropathy. Among patients with chronic allograft nephropathy a statistically significant prevalence of the IL-6 CC genotype associated with low IL-6 expression was observed (p < 0.01, OR 3.18; 95% CI 1.27-8.15). There were no statistically significant differences in distribution of IL-2 and TNF-alpha genotypes between patients with stable graft function and chronic allograft rejection. The results of present study suggest that the genetically determined low IL-6 production may be the risk factor of chronic allograft nephropathy development.

The FcgammaRIIa polymorphism in patients with chronic kidney graft rejection.

The FcgammaRIIa receptors, which provide a crucial link between cellular and humoral components of the immune response, display allelic polymorphism. Individuals are homozygous for either arginine 131 (RR131) or histidine 131 (HH131) or are heterozygous for these two alleles (RH131). The HH131 genotype binds human IgG2 with high RR131 with low, and RH131 with intermediate affinity. The aim of the study was to evaluate the FcgammaRIIa polymorphism in patients with chronic kidney graft rejection. The study included 121 renal transplant recipients: 53 patients with long-term stable graft function and 68 with chronic allograft rejection. The distribution of FcgammaRIIa genotypes in patients with chronic kidney graft rejection did not differ significantly from that in patients with stable graft function. The results suggest that the FcgammaRIIa polymorphism is not an important genetic risk factor for chronic rejection of kidney allografts.

The expansion of CD4+CD28- T cells in patients with chronic kidney graft rejection.

CD4+CD28- T cells are oligoclonal lymphocytes rarely found in healthy subjects, but are present in high frequencies in patients with inflammatory diseases. Contrary to paradigm, they are functionally active and produce interferon gamma and cytolytic proteins, are cytotoxic in vessels and may contribute to tissue damage. The size of the peripheral blood CD4+CD28- T cell compartments was determined in 20 healthy individuals, 20 patients after renal transplantation with stable graft function, and 20 with chronic graft rejection by two-color FACS analysis. In patients with stable graft function, the median frequency of CD4+CD28- T cells was 3.1% and was significantly higher in comparison to the control group (1.4%) (P <.01). The highest subset CD4+CD28- cells was detected in patients with chronic graft rejection (10.65%). The amount of CD4+CD28- cells was significantly higher in this group in comparison to patients with stable graft function (P <.01). The evaluated number of CD4+CD28- cells in patients after renal transplantation, especially in graft recipients with chronic graft rejection, suggests a role of these cells in chronic graft destruction.

The Fc gamma RIIa polymorphism in patients with acute kidney graft rejection.

The Fc gamma RIIa receptors are the most widely distributed of the three classes of Fc receptors and expresses an allelic polymorphism. This polymorphism may modulate the immune response and may be a factor for some diseases. The aim of the study was to evaluate the association between the Fc gamma RIIa polymorphism and acute kidney graft rejection. The study was carried out in 115 kidney allograft recipients. The frequency of acute kidney graft rejection was similar in relation to Fc gamma RIIa genotypes. We suggest that Fc gamma RIIa polymorphism is not important risk factor for acute kidney graft rejection susceptibility.

FC gamma RIIa polymorphism in patients with rheumatoid arthritis.

OBJECTIVE: Polymorphism of phagocyte IgG receptor Fc gamma RIIa may modulate immune complex mediated inflammation, particularly when immune complex contain IgG2. METHODS: Fc gamma RIIa genotyping in 82 patients with rheumatoid arthritis (RA) and 148 healthy subjects was performed using the polymerase chain reaction technique with allele specific primers. RESULTS: No significant relation between Fc gamma RIIa genotypes and susceptibility to RA was observed, but extraarticular complications with high frequency were revealed in patients with R/R131 genotype. CONCLUSION: The results suggest that the Fc gamma RIIa polymorphism is not a risk factor for RA.

Discovery of a basaltic asteroid in the outer main belt

Visible and near-infrared spectroscopic observations of the asteroid 1459 Magnya indicate that it has a basaltic surface. Magnya is at 3. 15 astronomical units (AU) from the sun and has no known dynamical link to any family, to any nearby large asteroid, or to asteroid 4 Vesta at 2.36 AU, which is the only other known large basaltic asteroid. We show that the region of the belt around Magnya is densely filled by mean-motion resonances, generating slow orbital diffusion processes and providing a potential mechanism for removing other basaltic fragments that may have been created on the same parent body as Magnya. Magnya may represent a rare surviving fragment from a larger, differentiated planetesimal that was disrupted long ago.

[Multicenter study of Klimonorm (R) by the Jenapharm firm for treating the climacteric syndrome]. / Wieloosrodkowa ocena preparatu Klimonorm(R) firmy Jenapharm w leczeniuzespolu klimakterycznego.

In our work we evaluated according to Kupperman Index the effectiveness of treating menopausal signs and symptoms during the therapy with estrogen--progestagen preparation Klimonorm firm Jenapharm. During 6 months observation increase in blood pressure was not observed, neither an increase in body weight in a group of 116 women was not observed. Among these, mean Kupperman index was decreased from 28.38 to 11.6 after 3 months and up to 5.47 after 6 months therapy with Klimonorm. These patients estimated this agent as very good and good in 93.21% tolerated as very good and good in 91.43% and 91.59% of these patients planned to continue treatment with Klimonorm.

[Prostaglandins PGF2alpha in the fight against bleeding and hemorrhage the uterus during the climacteric period]. / Prostaglandyny PgF2 alpha w zwalczaniu krwotoków i krwawien macicznych okresu przekwitania.

This article is about usage prostaglandins to fight against bleeding and haemorrhage from uterus in climacteric period. Prostaglandins are used widely by gynecologist and obstetrics as most powerful contracting drugs, namely in this situations when we observe returning, plentiful bleeding from uterus. Women with climacteric bleeding had administer prostaglandins intravenous or immediate intra-cervix. They are very good drug, strongly and a long time hold up bleeding. This method give us time to better preparing patients to operation and diminish losses of blood. Side effects are small and not trouble. Prostaglandins are very simply in usage and characterise very good haemostatic effect, recognised faster then in typical methods like hormonal, mechanical antifibrinolytic etc.