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Wróbel D, Wrona P, Homa T, Jakobschy K, Wrona G, Sawczyńska K, Giełczyński M, Popiela T, Słowik A, Turaj W. Sex alters the effect of perfusion deficits on functional outcome in patients with acute ischemic stroke undergoing mechanical thrombectomy. Cerebrovasc Dis 2024:000538633. [PMID: 38631293 DOI: 10.1159/000538633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Accepted: 03/25/2024] [Indexed: 04/19/2024] Open
Abstract
INTRODUCTION The discourse surrounding differences in cerebral hemodynamics and clinical outcomes among male and female patients treated with mechanical thrombectomy (MT) for acute ischemic stroke (AIS) remains unresolved. We aimed to elucidate these differences by employing computed tomography perfusion (CTP) imaging before MT and examining the influence of perfusion deficits on the 90-day functional outcome. METHODS This single-center retrospective analysis involved patients with anterior circulation AIS treated with MT at the Comprehensive Stroke Center, University Hospital, Krakow from January 2019 to July 2023. We compared male and female patients in terms of baseline characteristics, CTP deficits, hypoperfusion intensity ratio (HIR, defined as T10max/T6max) and complications. The endpoints included the 90-day excellent functional outcome, defined as modified Rankin Score (mRS)<2, and the 90-day mortality rate. RESULTS We included 794 patients, of whom 408 were female (51.4%). Female patients had a smaller early infarct volume (median: 7 mL; IQR: [0-24.8] vs 10 mL [0-33], p=0.004), smaller penumbra volume (77.5 mL [46-117] vs 99.5 mL [59.8-140], p<0.001), lower HIR (0.34 [0.16-0.5] vs 0.37 [0.2-9.53], p=0.043) and were less likely to achieve an excellent functional outcome (55.6% vs 66.1%, p=0.003). For every 10 mL increase in early infarct volume, the odds for achieving an excellent outcome were lower in females (odds ratio (OR): 0.82 [95% confidence interval: 0.73-0.92]) compared to males (OR: 0.96 [0.88-1.04]), whereas the risk of death was higher for females (OR: 1.25 [1.13-1.39] than for males (OR: 1.05 [0.98-1.14]). DISCUSSION Despite more favorable cerebral hemodynamic profile, female AIS patients have worse outcomes than their male counterparts. This effect seems to be independently mediated by the more pronounced impact of early infarct volume on the prognosis in female patients. These findings underscore the possible explanatory power arising for from sex-specific interpretation of early infarct volume in clinical practice.
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Krzyżak AT, Lasek J, Schneider Z, Wnuk M, Bryll A, Popiela T, Słowik A. Diffusion tensor imaging metrics as natural markers of multiple sclerosis-induced brain disorders with a low Expanded Disability Status Scale score. Neuroimage 2024; 290:120567. [PMID: 38471597 DOI: 10.1016/j.neuroimage.2024.120567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 02/12/2024] [Accepted: 03/05/2024] [Indexed: 03/14/2024] Open
Abstract
Non-invasive and effective differentiation along with determining the degree of deviations compared to the healthy cohort is important in the case of various brain disorders, including multiple sclerosis (MS). Evaluation of the effectiveness of diffusion tensor metrics (DTM) in 3T DTI for recording MS-related deviations was performed using a time-acceptable MRI protocol with unique comprehensive detection of systematic errors related to spatial heterogeneity of magnetic field gradients. In a clinical study, DTMs were acquired in segmented regions of interest (ROIs) for 50 randomly selected healthy controls (HC) and 50 multiple sclerosis patients. Identical phantom imaging was performed for each clinical measurement to estimate and remove the influence of systematic errors using the b-matrix spatial distribution in the DTI (BSD-DTI) technique. In the absence of statistically significant differences due to age in healthy volunteers and patients with multiple sclerosis, the existence of significant differences between groups was proven using DTM. Moreover, a statistically significant impact of spatial systematic errors occurs for all ROIs and DTMs in the phantom and for approximately 90 % in the HC and MS groups. In the case of a single patient measurement, this appears for all the examined ROIs and DTMs. The obtained DTMs effectively discriminate healthy volunteers from multiple sclerosis patients with a low mean score on the Expanded Disability Status Scale. The magnitude of the group differences is typically significant, with an effect size of approximately 0.5, and similar in both the standard approach and after elimination of systematic errors. Differences were also observed between metrics obtained using these two approaches. Despite a small alterations in mean DTMs values for groups and ROIs (1-3 %), these differences were characterized by a huge effect (effect size ∼0.8 or more). These findings indicate the importance of determining the spatial distribution of systematic errors specific to each MR scanner and DTI acquisition protocol in order to assess their impact on DTM in the ROIs examined. This is crucial to establish accurate DTM values for both individual patients and mean values for a healthy population as a reference. This approach allows for an initial reliable diagnosis based on DTI metrics.
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Affiliation(s)
| | - Julia Lasek
- AGH University of Kraków, 30-059 Krakow, Poland
| | | | - Marcin Wnuk
- UJ CM: Department of Neurology, Jagiellonian University Medical College, University Hospital in Krakow, Krakow, Poland; University Hospital in Krakow, Krakow, Poland
| | - Amira Bryll
- UJ CM: Department of Neurology, Jagiellonian University Medical College, University Hospital in Krakow, Krakow, Poland
| | | | - Agnieszka Słowik
- UJ CM: Department of Neurology, Jagiellonian University Medical College, University Hospital in Krakow, Krakow, Poland
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Chatys-Bogacka Ż, Mazurkiewicz I, Słowik J, Słowik A, Drabik L, Wnuk M. Association between brain fog, cardiac injury, and quality of life at work after hospitalization due to COVID-19. Med Pr 2024; 75:3-17. [PMID: 38523497 DOI: 10.13075/mp.5893.01428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2024] Open
Abstract
BACKGROUND To evaluate incidence and search for possible predictors of brain fog and quality of life at work (QoL-W) among low-to-moderate risk subjects previously hospitalized due to COVID-19. MATERIAL AND METHODS Participants aged ≥18 retrospectively reported 8 brain fog symptoms pre-COVID-19, at 0-4, 4-12 and >12 weeks post-infection via validated clinical questionnaire. The QoL-W was assessed with a 4-point Likert scale where 0, 1, 2, and 3 meant no, mild, moderate, and severe impairment in performing activities at work, respectively. Data on age, sex, comorbidities, and laboratory results (including first in-hospital high-sensitivity cardiac troponin I [hs-cTnI] measurement) were gathered. RESULTS The study included 181 hospitalized subjects (age Me = 57 years), 37.02% women. Most had low disease severity (Modified Early Warning Score = 1, 77.90%) and low comorbidity (Charlson Comorbidity Index 0: 28.72%, 1-2: 34.09%), with no intensive care unit treatment needed. COVID-19 led to almost 3-fold increased brain fog symptoms, with incidence of 58.56%, 53.59%, and 49.17% within 4, 4-12, and >12 weeks, respectively (p < 0.001). First in-hospital hs-cTnI levels were 47.3% higher in participants who later presented with brain fog at median follow-up of 26.7 weeks since the diagnosis of the SARS-CoV-2 infection. Individuals who experienced at least one brain fog symptom at follow-up, had elevated hs-cTnI, less often presented with atrial fibrillation, and used anticoagulants during initial hospitalization due to COVID-19. The Hs-cTnI >11.90 ng/l predicted brain fog symptoms in multivariable model. COVID-19 was associated with 3.6‑fold, 3.0‑fold, and 2.4-fold QoL-W deterioration within 4, 4-12, and >12 weeks post-infection (p < 0.05). Subjects with QoL-W decline >12 weeks were younger, mostly women, had more brain fog symptoms, and higher platelet counts. Multivariable models with self-reported brain fog symptoms (responding coherently and recalling recent information), age, and sex exhibited good discriminatory power for QoL-W impairment (area under the receiver operating characteristic curve 0.846, 95% CI: 0.780-0.912). CONCLUSIONS This study highlighted that in non-high-risk subjects hospitalized during the first 2 pandemic's waves: 1) brain fog was common, affecting nearly half of individuals, and impacting QoL-W >12 weeks after initial infection, 2) after 3 months of COVID-19 onset, the decline in QoL-W was primarily attributed to brain fog symptoms rather than demographic factors, health conditions, admission status, and laboratory findings, 3) components of brain fog, such as answering in an understandable way or recalling new information increased the likelihood of significantly lower QoL-W up to tenfold, 4) biochemical indicators, such as the first hs-cTnI level, might predict the risk of experiencing brain fog symptoms and indirectly decreased QoL-W >12 weeks after COVID-19 onset. Occupational medicine practitioners should pay particular attention to younger and female subjects after COVID-19 complaining of problems with answering questions in understandable way or recalling new information as they have an increased risk of QoL-W impairment. Med Pr Work Health Saf. 2024;75(1):3-17.
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Affiliation(s)
- Żaneta Chatys-Bogacka
- Jagiellonian University Medical College, Kraków, Poland (Department of Neurology)
- University Hospital in Krakow, Kraków, Poland (Department of Neurology)
| | - Iwona Mazurkiewicz
- Jagiellonian University Medical College, Kraków, Poland (Department of Neurology)
- University Hospital in Krakow, Kraków, Poland (Department of Neurology)
| | - Joanna Słowik
- Jagiellonian University Medical College, Kraków, Poland (Department of Periodontology, Preventive Dentistry and Oral Medicine, Institute of Dentistry, Faculty of Medicine)
| | - Agnieszka Słowik
- Jagiellonian University Medical College, Kraków, Poland (Department of Neurology)
- University Hospital in Krakow, Kraków, Poland (Department of Neurology)
| | - Leszek Drabik
- Jagiellonian University Medical College, Kraków, Poland (Department of Pharmacology)
- John Paul II Hospital, Kraków, Poland (Department of Cardiac and Vascular Diseases)
| | - Marcin Wnuk
- Jagiellonian University Medical College, Kraków, Poland (Department of Neurology)
- University Hospital in Krakow, Kraków, Poland (Department of Neurology)
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Karliński MA, Grabowski M, Kempa M, Farkowski MM, Sławek J, Rejdak K, Mitkowski P, Hryniewiecki T, Słowik A. Expert opinion of the Heart Rhythm Association of the Polish Cardiac Society and the Polish Neurological Society on evidence-driven implementation of implantable loop recorders in Poland. Kardiol Pol 2024; 82:353-359. [PMID: 38493471 DOI: 10.33963/v.phj.99401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 02/28/2024] [Indexed: 03/19/2024]
Abstract
Implantable loop recorders (ILR) are considered increasingly helpful in diagnosing cardio-neurological conditions, especially if arrhythmic events are of high clinical importance but are unlikely to be captured by standard methods of electrocardiogram recording due to the low frequency of events and short duration of a single event. The compelling evidence from randomized trials and observational studies strongly supports ILR utilization in patients after cryptogenic stroke or transient ischemic attack and in patients with recurrent transient loss of consciousness of unknown origin. These two groups of patients are expected to gain the most from initiating ILR-driven clinically effective management strategies. Stroke or transient ischemic attack survivors with detected subclinical atrial fibrillation can be switched from antiplatelets to anticoagulants, whilst patients with recurrent syncope may avoid severe injuries and/or substantial impairment of their quality of life. This joint opinion of the Heart Rhythm Association of the Polish Cardiac Society and experts from the Polish Neurological Society summarizes the up-to-date rationale for using ILR in everyday clinical practice and describes the road map for implementing this technology in Poland. Special emphasis is placed on the most recent guidelines issued by both cardiological and neurological scientific societies.
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Affiliation(s)
- Michał A Karliński
- 2nd Department of Neurology, Institute of Psychiatry and Neurology, Warszawa, Poland.
| | - Marcin Grabowski
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Warszawa, Poland
| | - Maciej Kempa
- Department of Cardiology and Electrotherapy, Faculty of Medicine, Medical University of Gdansk, Gdańsk, Poland
| | - Michał M Farkowski
- Department of Cardiology, Ministry of Interior and Administration National Medical Institute, Warszawa, Poland
| | - Jarosław Sławek
- Department of Neurological-Psychiatric Nursing, Faculty of Health Sciences, Medical University of Gdansk and Neurology Stroke Department, St. Adalbert Hospital, Gdańsk, Poland
| | - Konrad Rejdak
- Department of Neurology, Medical University of Lublin, Lublin, Poland
| | - Przemysław Mitkowski
- 1st Department of Cardiology, Poznan University of Medical Sciences, Poznań, Poland
| | - Tomasz Hryniewiecki
- Department of Valvular Heart Disease, National Institute of Cardiology, Warszawa, Poland
| | - Agnieszka Słowik
- Department of Neurology, Jagiellonian University, Kraków, Poland
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Wrona P, Sawczyńska K, Wróbel D, Zdrojewska K, Giełczyński M, Mizera P, Brzegowy P, Popiela T, Słowik A, Krzanowski M. Risk factors of acute kidney injury during hospitalization in acute ischaemic stroke patients undergoing mechanical thrombectomy. Postepy Kardiol Interwencyjnej 2024; 20:89-94. [PMID: 38616933 PMCID: PMC11008514 DOI: 10.5114/aic.2024.136374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Accepted: 12/27/2023] [Indexed: 04/16/2024] Open
Abstract
Introduction Acute kidney injury (AKI) seems to worsen the prognosis of acute ischaemic stroke (AIS) patients treated with mechanical thrombectomy (MT). At the same time, the procedure of MT increases AKI risk by iodinated contrast use. Identification of factors predisposing to AKI after MT is important for recognizing vulnerable patients and successful prevention. Aim To identify factors associated with the occurrence of AKI during hospitalization in MT-treated AIS patients. Material and methods The study included all AIS patients treated with MT in the University Hospital in Krakow from 2019 to 2021. The diagnosis of AKI during hospitalisation was based on serum creatinine concentration levels, according to the Kidney Disease Improving Global Outcomes guidelines. We compared patients with and without AKI in terms of age, sex, comorbidities, stroke course and laboratory test results at admission. We identified factors associated with the occurrence of AKI using univariate logistic regression analysis, with significant variables subsequently added to the multivariate analyses. Results Among 593 MT-treated AIS patients the incidence of AKI during hospitalisation was 12.6%. AKI development was associated with diabetes, chronic kidney disease, total volume of iodinated contrast obtained during hospitalisation, posterior circulation stroke, lack of intravenous thrombolysis, and laboratory test results at admission: haemoglobin, glucose, urea, potassium, and creatinine. Total contrast volume and urea level were the most important independent risk factors associated with occurrence of AKI. Conclusions AKI is common in MT-treated AIS patients. There is a need to establish a protocol for decreasing the risk of AKI in AIS patients undergoing MT and, in case it occurs, a procedure for its treatment.
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Affiliation(s)
- Paweł Wrona
- Department of Neurology, Jagiellonian University Medical College, Krakow, Poland
| | - Katarzyna Sawczyńska
- Department of Neurology, Jagiellonian University Medical College, Krakow, Poland
| | - Dominik Wróbel
- Student Scientific Group in Cerebrovascular Diseases, Jagiellonian University Medical College, Krakow, Poland
| | - Kaja Zdrojewska
- Student Scientific Group in Cerebrovascular Diseases, Jagiellonian University Medical College, Krakow, Poland
| | - Mateusz Giełczyński
- Student Scientific Group in Cerebrovascular Diseases, Jagiellonian University Medical College, Krakow, Poland
| | - Paweł Mizera
- Student Scientific Group in Cerebrovascular Diseases, Jagiellonian University Medical College, Krakow, Poland
| | - Paweł Brzegowy
- Department of Radiology, Jagiellonian University Medical College, Krakow, Poland
| | - Tadeusz Popiela
- Department of Radiology, Jagiellonian University Medical College, Krakow, Poland
| | - Agnieszka Słowik
- Department of Neurology, Jagiellonian University Medical College, Krakow, Poland
| | - Marcin Krzanowski
- Department of Nephrology and Dialysis, Jagiellonian University Medical College, Krakow, Poland
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Włodarczyk E, Wrona P, Homa T, Sobolewska M, Wróbel D, Rolkiewicz D, Popiela T, Słowik A, Sawczyńska K. Long-term outcomes of mechanical thrombectomy in acute ischaemic stroke patients with concomitant malignancy. Postepy Kardiol Interwencyjnej 2024; 20:95-102. [PMID: 38616929 PMCID: PMC11008522 DOI: 10.5114/aic.2024.137433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Accepted: 03/12/2024] [Indexed: 04/16/2024] Open
Abstract
Introduction Patients with cancer (CP) need a different approach to acute ischaemic stroke (AIS) treatment as intravenous thrombolysis (IVT) may be contraindicated. Mechanical thrombectomy (MT) is a treatment of choice for otherwise eligible patients, although the literature on its long-term outcomes in CP is limited. Aim Assessing outcomes of MT-treated AIS patients with concomitant malignancy in a year-long follow-up. Material and methods The study included 593 MT-treated AIS patients admitted in 2019-2021. The group was divided into CP (defined as a diagnosis of malignancy and undergoing/qualified for cancer treatment within previous 5 years) and a control group. The profile of cardiovascular risk factors, stroke severity and discharge, 90-day and 365-day outcomes were compared between the groups. Results CP and controls had a similar profile of cardiovascular risk factors and comparable stroke severity. CP were less frequently treated with IVT (25.7% vs. 59.1%, p < 0.001). There were no differences between the groups in the successful reperfusion rate and occurrence of haemorrhagic complications. Discharge and 90-day outcomes were similar. CP had higher 365-day mortality (48.6% vs. 29.9%, p = 0.024) but the percentage of patients achieving good functional outcome in a year-long observation was comparable. Conclusions Treatment with MT seems beneficial for AIS patients with concomitant malignancy both in short- and long-term observation.
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Affiliation(s)
- Ewa Włodarczyk
- Department of Neurology, University Hospital, Krakow, Poland
| | - Paweł Wrona
- Department of Neurology, Jagiellonian University Medical College, Krakow, Poland
| | - Tomasz Homa
- Department of Neurology, University Hospital, Krakow, Poland
| | - Maria Sobolewska
- Student Scientific Group in Cerebrovascular Diseases, Jagiellonian University Medical College, Krakow, Poland
| | - Dominik Wróbel
- Student Scientific Group in Cerebrovascular Diseases, Jagiellonian University Medical College, Krakow, Poland
| | - Dawid Rolkiewicz
- Student Scientific Group in Cerebrovascular Diseases, Jagiellonian University Medical College, Krakow, Poland
| | - Tadeusz Popiela
- Department of Radiology, Jagiellonian University Medical College, Krakow, Poland
| | - Agnieszka Słowik
- Department of Neurology, Jagiellonian University Medical College, Krakow, Poland
| | - Katarzyna Sawczyńska
- Department of Neurology, Jagiellonian University Medical College, Krakow, Poland
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Wrona P, Wróbel D, Popadynets V, Jóźwik J, Sawczyńska K, Homa T, Włodarczyk E, Pułyk R, Popiela T, Słowik A, Turaj W. Predictors of good functional outcome in ischaemic stroke patients without delayed neurological improvement after mechanical thrombectomy. Neurol Neurochir Pol 2024; 58:185-192. [PMID: 38324116 DOI: 10.5603/pjnns.98219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 01/04/2024] [Accepted: 01/09/2024] [Indexed: 02/08/2024]
Abstract
INTRODUCTION This study aimed to identify predictors of 90-day good functional outcome (GFO) in patients with acute ischaemic stroke (AIS) who were treated with mechanical thrombectomy but did not achieve a delayed neurological improvement (DNI). CLINICAL RATIONALE FOR THE STUDY In-hospital neurological improvement in patients with AIS is consistently associated with long- -term GFO. Patients who experience neither early nor delayed neurological improvement can still achieve long-term GFO, but predictors of such an outcome have not been studied. MATERIAL AND METHODS This single-centre retrospective study involved 307 patients with anterior circulation AIS treated with mechanical thrombectomy. Multiple clinical, biochemical, radiological, and treatment-related variables were collected and analysed. DNI on day 7 was defined as at least a 10-point reduction in the National Institutes of Health Stroke Scale (NIHSS) score or NIHSS score < 2. GFO on day 90 was defined as a modified Rankin Scale (mRS) score ≤ 2. We compared the characteristics of patients with and without DNI, with special attention paid to patients who achieved 90-GFO despite a lack of DNI. Multivariate analyses were then performed to establish independent predictors of 90-day GFO among patients without DNI. RESULTS DNI occurred in 150 out of 307 patients (48.7%) and significantly increased the odds for 90-day GFO (odds ratio [OR]: 13.99; p < 0.001). Among patients without DNI, 41.4% achieved 90-day GFO. Younger age (OR: 0.96; 95% confidence interval [CI]: 0.93-0.99; p = 0.008), lower baseline NIHSS score (OR: 0.80; 95% CI: 0.73-0.89; p < 0.001), treatment with intravenous thrombolysis (OR: 3.06; 95% CI: 1.25-7.49; p = 0.014), lack of an undetermined aetiology (OR: 0.40; 95% CI: 0.16-0.998; p = 0.050), lack of pneumonia (OR: 0.08; 95% CI: 0.02-0.31; p < 0.001), and higher haemoglobin concentration on admission (OR: 1.31; 95% CI: 1.04-1.69; p = 0.024) were identified as predictors of 90-day GFO in this subgroup. CONCLUSION Almost half of patients with AIS in anterior circulation treated with mechanical thrombectomy experience DNI, which is a good predictor of 90-day GFO. Furthermore, 40% of patients without DNI achieve 90-day GFO which can be independently predicted by younger age, lower baseline NIHSS score, treatment with intravenous thrombolysis, higher haemoglobin concentration on admission, lack of undetermined ischaemic stroke aetiology, and lack of pneumonia.
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Affiliation(s)
- Paweł Wrona
- Department of Neurology, Jagiellonian University Medical College, Krakow, Poland
- Department of Neurology, University Hospital, Krakow, Poland
| | - Dominik Wróbel
- Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland.
| | | | - Joanna Jóźwik
- Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Katarzyna Sawczyńska
- Department of Neurology, Jagiellonian University Medical College, Krakow, Poland
- Department of Neurology, University Hospital, Krakow, Poland
| | - Tomasz Homa
- Department of Neurology, University Hospital, Krakow, Poland
| | - Ewa Włodarczyk
- Department of Neurology, University Hospital, Krakow, Poland
| | - Roman Pułyk
- Department of Neurology, Jagiellonian University Medical College, Krakow, Poland
- Department of Neurology, University Hospital, Krakow, Poland
| | - Tadeusz Popiela
- Department of Radiology, University Hospital, Krakow, Poland
- Department of Radiology, Jagiellonian University, Krakow, Poland
| | - Agnieszka Słowik
- Department of Neurology, Jagiellonian University Medical College, Krakow, Poland
- Department of Neurology, University Hospital, Krakow, Poland
| | - Wojciech Turaj
- Department of Neurology, Jagiellonian University Medical College, Krakow, Poland
- Department of Neurology, University Hospital, Krakow, Poland
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Bosak M, Dziedzic R, Matwiej K, Słowik A. Outcomes following exposure to lacosamide monotherapy during pregnancy and breastfeeding - a prospective case series. Neurol Neurochir Pol 2024; 58:203-206. [PMID: 38305480 DOI: 10.5603/pjnns.97120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 01/09/2024] [Accepted: 01/11/2024] [Indexed: 02/03/2024]
Abstract
AIM OF THE STUDY To evaluate the safety of lacosamide (LCM) monotherapy during pregnancy and breastfeeding. MATERIAL AND METHODS Patients taking LCM monotherapy treated at the university epilepsy clinic were prospectively followed up during pregnancy, delivery, and breastfeeding. Data on seizure frequency, LCM dosage, pregnancy course, delivery and breastfeeding, birth outcome, congenital malformation, and development of newborns was collected. RESULTS Four pregnancies in three patients with refractory focal epilepsy treated with LCM monotherapy were reported. One of these pregnancies ended in a miscarriage during the seventh week of gestation. The average daily LCM dose at the time of conception was 300 mg. Treatment with LCM was continued throughout pregnancy and breastfeeding. The dose of LCM was increased in two pregnancies: in one case following a seizure relapse, and in the other case as a preventive measure to avoid an increase in seizure frequency. Seizure frequency remained stable during pregnancy in two cases. All deliveries were carried out via caesarean section, with an average gestational age at birth of 37.6 weeks. The Apgar score was 10 in all newborns, and no congenital malformations were detected. At the age of 12 months, normal developmental milestones were reached. Infants were breastfed without any complications. CONCLUSIONS AND CLINICAL IMPLICATIONS This case series adds to a growing body of evidence suggesting the relative safety of LCM monotherapy throughout pregnancy and breastfeeding.
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Affiliation(s)
- Magdalena Bosak
- Collegium Medicum, Jagiellonian University of Krakow, Krakow, Poland.
| | - Radosław Dziedzic
- Collegium Medicum, Jagiellonian University of Krakow, Krakow, Poland
| | - Katarzyna Matwiej
- Collegium Medicum, Jagiellonian University of Krakow, Krakow, Poland
| | - Agnieszka Słowik
- Collegium Medicum, Jagiellonian University of Krakow, Krakow, Poland
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Wójcik K, Kruk M, Koń B, Słowik A, Bosak M. Treatment patterns in women of childbearing age and pregnant women with epilepsy in Poland between the years 2019 and 2022-A nationwide population-based cohort study. Seizure 2024; 115:75-80. [PMID: 38232647 DOI: 10.1016/j.seizure.2024.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 12/25/2023] [Accepted: 01/11/2024] [Indexed: 01/19/2024] Open
Abstract
AIM To describe the antiseizure medications (ASMs) prescription pattern in women of childbearing age (WOCA) and pregnant women with epilepsy in the 2019-2022 period in Poland MATERIALS AND METHODS: The National Health Fund (NHF) databases were analyzed. Women aged 15-49 years were considered as being of childbearing age, while exposure during pregnancy was estimated taking into account 15 months before delivery. ASMs belonging to the N03A subgroup of the Anatomical Therapeutic Chemical Classification System, reimbursed by NHF were analyzed. RESULTS During 2019, 36 784 WOCA and 921 pregnant women filled at least 1 ASM prescription. In 2022, these numbers were 32 304 and 594, respectively. Valproate was the most widely used ASM in WOCA (38.4 %) in 2019, followed by levetiracetam (35.6 %), lamotrigine (30.1 %), and carbamazepine (20.0 %). The percentage of ASM users decreased in 2022 for valproate (32.1 %; p < 0.001) and carbamazepine (17 %; p < 0.001) and increased for levetiracetam (40.8 %; p < 0.001) and lamotrigine (32.7 %; p < 0.001). In 2019 lamotrigine (42.1 %) and levetiracetam (41.5 %) were the most frequently prescribed ASMs to pregnant women. During the study period, a significant increase in prescriptions for levetiracetam was observed (49.5 %; p = 0.003). The proportion of ASMs exposed pregnancies declined for valproate (from 24.7 to 16 %; p < 0.001) and topiramate (from 6.6 to 3.2 %; p = 0.005). The percentage of polytherapy regimens remained stable over the years, both for WOCA (39 %) and pregnant women (32 %). CONCLUSION Despite the decline in valproate usage, the drug was still among the most commonly prescribed ASMs in women of childbearing age and pregnant women with epilepsy. The awareness of teratogenic risks and new treatment guidelines should be improved in Poland.
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Affiliation(s)
| | | | - Beata Koń
- National Health Fund, Warszawa, Poland
| | - Agnieszka Słowik
- Jagiellonian University, Medical College, Department of Neurology, Kraków, Poland
| | - Magdalena Bosak
- Jagiellonian University, Medical College, Department of Neurology, Kraków, Poland.
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Kazimierczyk E, Dąbrowska M, Gierlotka M, Kapica-Topczewska K, Karaszewski B, Kobayashi A, Krasiński Z, Kubica J, Kułakowska A, Kurek K, Ładny R, Pleban E, Rejdak K, Rydzewska G, Słowik A, Szopiński P, Woźniak A, Tycińska A. The use of andexanet alpha in the Polish setting: An interdisciplinary protocol. Expert consensus statement of the Polish Cardiac Society. Kardiol Pol 2024; 82:123-139. [PMID: 38230495 DOI: 10.33963/v.kp.98059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 10/31/2023] [Indexed: 01/18/2024]
Abstract
Andexanet alfa (AA) is a recombinant inactive analog of human activated factor X (FXa), effectively reversing the effects of its inhibitors - rivaroxaban and apixaban, which are available in Poland. The drug was approved for clinical use registration after the publication of the results of the ANNEXA-4 trial (Andexanet Alfa, a Novel Antidote to the Anticoagulation Effects of FXa Inhibitors 4), in which its efficacy in restoring hemostasis in life-threatening hemorrhages in patients receiving using the aforementioned anticoagulants was demonstrated. Hence, AA is now recommended for patients on apixaban or rivaroxaban therapy with massive and uncontrollable hemorrhages, including hemorrhagic strokes (HS) and gastrointestinal bleeding. Drug-specific chromogenic anti-Xa assays are generally best suited for estimating rivaroxaban and apixaban plasma levels, aside from direct assessment of their concentrations. The absence of anti-Xa activity, determined using these assays, allows us to rule out the presence of clinically relevant plasma concentrations of any FXa inhibitor. On the other hand, the dose of AA should not be modified based on the results of coagulation tests, as it depends solely on the time that elapsed since the last dose of FXa inhibitor and oon the dose and type of FXa inhibitor. AA is administered as an intravenous (i.v.) bolus, followed by an i.v. infusion of the drug. The maximum reversal of anti-Xa activity occurs within two minutes of the end of the bolus treatment, with the continuation of the continuous i.v. infusion allowing the effect to be maintained for up to two hours afterwards. Because anticoagulant activity can reappear after the infusion is completed, it is currently unclear at what point after AA administration FXa inhibitors or heparin should be re-administered. In Poland AA is starting to become available and its urgent need to administer it to patients with severe bleeding on apixaban or rivaroxaban.
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Affiliation(s)
- Ewelina Kazimierczyk
- Department of Cardiology, University Clinical Hospital in Bialystok, Białystok, Poland.
| | - Milena Dąbrowska
- Department of Hematology Diagnostic, University Clinical Hospital in Bialystok, Białystok, Poland
| | - Marek Gierlotka
- Department of Cardiology, University Clinical Hospital in Opole, Opole, Poland
| | | | | | - Adam Kobayashi
- Department of Pharmacology and Clinical Pharmacology, Institute of Medical Sciences, Faculty of Medicine - Collegium Medicum, Cardinal Stefan Wyszynski University in Warsaw, Warszawa, Poland
| | - Zbigniew Krasiński
- Department of Vascular, Endovascular, Angiology and Phlebology Surgery (CNWA), Poznan University of Medical Sciences, Poznań, Poland
| | - Jacek Kubica
- Department of Cardiology and Internal Medicine, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Poland
| | - Alina Kułakowska
- Department of Neurology and Stroke Unit, University Clinical Hospital in Bialystok, Białystok, Poland
| | - Krzysztof Kurek
- Department of Gastroenterology and Internal Medicine, University Clinical Hospital in Bialystok, Białystok, Poland
| | - Robert Ładny
- 1st Clinic of General and Endocrine Surgery, University Clinical Hospital in Bialystok, Białystok, Poland
| | - Eliza Pleban
- Vascular Surgery Clinic, Cardinal Stefan Wyszynski National Institute of Cardiology in Warsaw, Warszawa, Poland
| | - Konrad Rejdak
- Department of Neurology, Medical University of Lublin, Lublin, Poland
| | - Grażyna Rydzewska
- Department of Internal Medicine and Gastroenterology and Subdivision of Inflammatory Bowel Diseases of the Ministry of Internal Affairs and Administration in Warsaw, Warszawa, Poland
| | - Agnieszka Słowik
- Clinical Department of Neurology, University Hospital in Krakow, Kraków, Poland
| | - Piotr Szopiński
- Vascular Surgery Clinic, Cardinal Stefan Wyszynski National Institute of Cardiology in Warsaw, Warszawa, Poland
| | - Arkadiusz Woźniak
- Department of Vascular Surgery, University Clinical Hospital in Bialystok, Białystok, Poland
| | - Agnieszka Tycińska
- Department of Cardiology, University Clinical Hospital in Bialystok, Białystok, Poland
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11
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Włodarczyk E, Sawczyńska K, Wrona P, Słowik A. Reversing dabigatran effect with idarucizumab to enable intravenous thrombolysis in patients with acute ischaemic stroke - a single centre experience. Neurol Neurochir Pol 2023; 57:465-476. [PMID: 37955597 DOI: 10.5603/pjnns.96469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 08/25/2023] [Accepted: 09/26/2023] [Indexed: 11/14/2023]
Abstract
INTRODUCTION Our study analysed the safety and effectiveness of idarucizumab in enabling intravenous thrombolysis (IVT) in dabigatran-treated patients with acute ischaemic stroke (AIS). CLINICAL RATIONALE FOR THE STUDY New oral anticoagulants (NOAC), including dabigatran, are the first-choice treatment option for preventing ischaemic stroke in patients with non-valvular atrial fibrillation (AF). However, a significant percentage of AF patients develops AIS despite NOAC treatment. According to current guidelines, treatment with IVT is contraindicated in patients who have received NOAC within the last 48 hours. Idarucizumab is a fragment of a monoclonal antibody that reverses the anticoagulation effect of dabigatran. The latest research shows that it can enable safe and successful IVT in patients with recent dabigatran intake, but more data is needed to confirm the safety and effectiveness of such treatment. MATERIAL AND METHODS Our study included dabigatran-treated patients who received idarucizumab to allow AIS treatment with IVT in the University Hospital in Kraków (Poland) from December 2018 to June 2023. We gathered data on their past medical history, stroke severity, course of treatment and outcomes as defined by modified Rankin Scale (mRS) and National Institutes of Health Stroke Scale (NIHSS) scores at discharge. A good functional outcome was defined as mRS 0-2 points at discharge. RESULTS This observational study included 19 patients (13 male and six female) with a median age of 74 (IQR = 13) years. In all patients (100%), the reason for dabigatran treatment was AF. A good functional outcome after treatment (mRS 0-2) was achieved in 68.4% of patients, but mRS was already ≥ 3 points before stroke onset in three (15.8%) patients. Haemorrhagic transformation of stroke occurred in three (15.8%) patients, including symptomatic intracranial haemorrhage in two (10.5%). The mortality rate was 5.3%. CONCLUSIONS AND CLINICAL IMPLICATIONS Our study results are in line with previous research on this topic, showing that IVT after idarucizumab can be successfully administered and is reasonably safe in dabigatran-treated patients with AIS.
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Affiliation(s)
- Ewa Włodarczyk
- Department of Neurology, University Hospital in Krakow, Poland.
| | - Katarzyna Sawczyńska
- Department of Neurology, University Hospital in Krakow, Poland
- Department of Neurology, Jagiellonian University Medical College, Krakow, Poland
| | - Paweł Wrona
- Department of Neurology, University Hospital in Krakow, Poland
- Department of Neurology, Jagiellonian University Medical College, Krakow, Poland
| | - Agnieszka Słowik
- Department of Neurology, University Hospital in Krakow, Poland
- Department of Neurology, Jagiellonian University Medical College, Krakow, Poland
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12
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Rusin G, Morga R, Spaczyńska-Boczar M, Rudnicki W, Kwinta BM, Luczynska E, Słowik A, Antczak J. Neuralgic amyotrophy with bilateral radial nerve torsion: A unique case and review of the literature. Neurologia 2023; 38:707-710. [PMID: 37996215 DOI: 10.1016/j.nrleng.2022.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 11/29/2022] [Indexed: 11/25/2023] Open
Affiliation(s)
- G Rusin
- Department of Neurology, University Hospital in Krakow, Jakubowskiego 2, Krakow, Poland.
| | - R Morga
- Department of Neurosurgery, University Hospital in Krakow, Jakubowskiego 2, Krakow, Poland
| | - M Spaczyńska-Boczar
- Department of Neurology, University Hospital in Krakow, Jakubowskiego 2, Krakow, Poland
| | - W Rudnicki
- Electroradiology Department, Jagiellonian University Medical College, Jakubowskiego 2, Krakow, Poland
| | - B M Kwinta
- Department of Neurosurgery and Neurotraumatology, Jagiellonian University Medical College, Jakubowskiego 2, Krakow, Poland
| | - E Luczynska
- Electroradiology Department, Jagiellonian University Medical College, Jakubowskiego 2, Krakow, Poland
| | - A Słowik
- Department of Neurology, University Hospital in Krakow, Jakubowskiego 2, Krakow, Poland; Department of Neurology, Jagiellonian University Medical College, Jakubowskiego 2, Krakow, Poland
| | - J Antczak
- Department of Neurology, University Hospital in Krakow, Jakubowskiego 2, Krakow, Poland; Department of Neurology, Jagiellonian University Medical College, Jakubowskiego 2, Krakow, Poland
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13
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Bosak M, Woźniak M, Kasprzycki M, Słowik A. Safety of brand name to generic substitution of lacosamide in patients with epilepsy - A prospective single-center observational study. Seizure 2023; 111:203-205. [PMID: 37683453 DOI: 10.1016/j.seizure.2023.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 09/01/2023] [Accepted: 09/03/2023] [Indexed: 09/10/2023] Open
Abstract
PURPOSE Lacosamide is a widely used third-generation antiseizure medication. However, there is a lack of evidence regarding the safety of substituting brand-name lacosamide with its generic version. This study aimed to determine the clinical outcomes associated with switching from the brand-name to the generic form of lacosamide (LCM) in patients with epilepsy. METHODS This prospective observational study involved patients undergoing treatment with LCM at the university epilepsy clinic. In 2018, the price of the brand-name LCM in Poland increased up to 110-fold compared to generic products. Anticipating that most patients would opt to switch to the generic formulations due to financial constraints, we chose to follow up them prospectively to assess the safety of transitioning from the brand-name to the generic form of LCM. RESULTS A total of 81 patients, aged 18-62 years, diagnosed with focal epilepsy and undergoing LCM treatment at our institution, decided to switch from the brand-name (Vimpat) to generic variations (Lacosamide TEVA, Lacosamide Glenmark, and Lacosamide Accord). Following the switch, no significant difference was observed in terms of seizure frequency before and after (p = 0.55, Wilcoxon signed-rank test). Subsequently, adverse events were recorded in four patients (4.9%) during the initial follow-up visit post-switch, including somnolence (2 patients) and dizziness (2 patients). Notably, all adverse events resolved by the second follow-up visit without necessitating treatment modification. Importantly, no patient switched back to brand-name medication CONCLUSION: The generic substitution of lacosamide was found to be generally safe in our study. Nonetheless, to confirm our findings, larger prospective studies are required.
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Affiliation(s)
- Magdalena Bosak
- Faculty of Medicine, Department of Neurology, Jagiellonian University Medical College, Krakow, Poland; University Hospital, Krakow, Poland.
| | - Martyna Woźniak
- School of Medicine, Jagiellonian University Medical College, Poland
| | | | - Agnieszka Słowik
- Faculty of Medicine, Department of Neurology, Jagiellonian University Medical College, Krakow, Poland; University Hospital, Krakow, Poland
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Kulczyńska-Przybik A, Dulewicz M, Doroszkiewicz J, Borawska R, Słowik A, Zetterberg H, Hanrieder J, Blennow K, Mroczko B. The Relationships between Cerebrospinal Fluid Glial (CXCL12, CX3CL, YKL-40) and Synaptic Biomarkers (Ng, NPTXR) in Early Alzheimer's Disease. Int J Mol Sci 2023; 24:13166. [PMID: 37685973 PMCID: PMC10487764 DOI: 10.3390/ijms241713166] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 08/17/2023] [Accepted: 08/22/2023] [Indexed: 09/10/2023] Open
Abstract
In addition to amyloid and tau pathology in the central nervous system (CNS), inflammatory processes and synaptic dysfunction are highly important mechanisms involved in the development and progression of dementia diseases. In the present study, we conducted a comparative analysis of selected pro-inflammatory proteins in the CNS with proteins reflecting synaptic damage and core biomarkers in mild cognitive impairment (MCI) and early Alzheimer's disease (AD). To our knowledge, no studies have yet compared CXCL12 and CX3CL1 with markers of synaptic disturbance in cerebrospinal fluid (CSF) in the early stages of dementia. The quantitative assessment of selected proteins in the CSF of patients with MCI, AD, and non-demented controls (CTRL) was performed using immunoassays (single- and multiplex techniques). In this study, increased CSF concentration of CX3CL1 in MCI and AD patients correlated positively with neurogranin (r = 0.74; p < 0.001, and r = 0.40; p = 0.020, respectively), ptau181 (r = 0.49; p = 0.040), and YKL-40 (r = 0.47; p = 0.050) in MCI subjects. In addition, elevated CSF levels of CXCL12 in the AD group were significantly associated with mini-mental state examination score (r = -0.32; p = 0.040). We found significant evidence to support an association between CX3CL1 and neurogranin, already in the early stages of cognitive decline. Furthermore, our findings indicate that CXCL12 might be a useful marker for tract severity of cognitive impairment.
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Affiliation(s)
| | - Maciej Dulewicz
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, 405 30 Gothenburg, Sweden
| | - Julia Doroszkiewicz
- Department of Neurodegeneration Diagnostics, Medical University of Bialystok, 15-269 Bialystok, Poland
| | - Renata Borawska
- Department of Neurodegeneration Diagnostics, Medical University of Bialystok, 15-269 Bialystok, Poland
| | - Agnieszka Słowik
- Department of Neurology, Jagiellonian University, 30-688 Kraków, Poland
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, 405 30 Gothenburg, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, 431 80 Mölndal, Sweden
- Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London WC1N 3BG, UK
- UK Dementia Research Institute at UCL, London WC1N 3AR, UK
- Hong Kong Center for Neurodegenerative Diseases, Clear Water Bay, Hong Kong, China
- Wisconsin Alzheimer’s Disease Research Center, University of Wisconsin School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI 53792-2460, USA
| | - Jörg Hanrieder
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, 405 30 Gothenburg, Sweden
- Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London WC1N 3BG, UK
- SciLifeLab, University of Gothenburg, 405 30 Gothenburg, Sweden
| | - Kaj Blennow
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, 405 30 Gothenburg, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, 431 80 Mölndal, Sweden
| | - Barbara Mroczko
- Department of Neurodegeneration Diagnostics, Medical University of Bialystok, 15-269 Bialystok, Poland
- Department of Biochemical Diagnostics, Medical University of Bialystok, 15-269 Bialystok, Poland
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Stępień A, Pogoda-Wesołowska A, Tokarz-Kupczyk E, Słowik A, Puz P, Adamczyk-Sowa M, Kurkowska-Jastrzębska I, Kułakowska A, Chorąży M, Piasecka-Stryczyńska K, Jamróz-Wiśniewska A, Bartosik-Psujek H, Rejdak K. Cladribine tablets for highly active relapsing-remitting multiple sclerosis in Poland: a real-world, multi-centre, retrospective, cohort study during the COVID-19 pandemic. Neurol Neurochir Pol 2023; 57:371-378. [PMID: 37490356 DOI: 10.5603/pjnns.a2023.0050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 05/01/2023] [Accepted: 05/11/2023] [Indexed: 07/27/2023]
Abstract
INTRODUCTION Treatment with cladribine tablets is indicated in highly active relapsing-remitting multiple sclerosis (RRMS). Cladribine tablets proved safe and effective in the pivotal CLARITY trial, but that trial included primarily treatment-naïve patients. In clinical practice however, cladribine tablets are often given to patients who have failed other treatments. Therefore, this study investigated the real-world safety and efficacy of cladribine tablets. MATERIAL AND METHODS We gathered data from nine MS clinical centres across Poland for patients with RRMS who started treatment with cladribine tablets from December 2019 to June 2022. RESULTS We enrolled 140 patients, with follow-up data available for 136 in year 1 and for 66 in year 2. At baseline, the mean age was 35.6 years, mean disease duration was 7.3 years, median EDSS score was 2.5, and 94% of patients were treatment- -experienced. Thirty-nine patients (27.9%) had undergone COVID-19, and 94 (67.1%) were vaccinated against COVID-19. The annualised relapse rate (ARR) decreased from 1.49 at baseline to 0.33 in year 1 (p < 0.001) and to 0.25 in year 2 (p < 0.001). The percentage of relapse-free patients increased from 11.5% at baseline to 70.2% in year 1 and 82.1% in year 2. The percentage of patients with active lesions decreased from 91.4% at baseline to 36.2% in year 1 and 18.2% in year 2. EDSS score remained stable or improved in 83.7% of patients in year 1 and 89.6% in year 2. No evidence of disease activity (NEDA-3) was achieved in 42.7% of patients in year 1 and 66.7% in year 2. Only one patient (0.72%) had grade 4 lymphopenia and 21 (15.1%) had grade 3 lymphopenia. Varicella zoster virus infections occurred in three patients. Eight patients discontinued treatment with cladribine: five due to inefficacy, one due to lymphopenia, and two due to a personal decision. CONCLUSIONS Cladribine tablets proved safe and effective in a real-world cohort of treatment-experienced patients. However, the efficacy measures improved to a lesser extent in our cohort than in the pivotal clinical trial, which is probably due to a higher proportion of treatment-experienced patients in our cohort.
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Affiliation(s)
- Adam Stępień
- Department of Neurology, Military Institute of Medicine, Warsaw, Poland.
| | | | | | - Agnieszka Słowik
- Department of Neurology, Jagiellonian University Medical College, Krakow, Poland
| | - Przemysław Puz
- Department of Neurology, Upper-Silesian Medical Center of the Silesian Medical University, Katowice, Poland
| | | | | | - Alina Kułakowska
- Department of Neurology, Medical University of Bialystok, Bialystok, Poland
| | - Monika Chorąży
- Department of Neurology, Medical University of Bialystok, Bialystok, Poland
| | - Karolina Piasecka-Stryczyńska
- Department of Neurology, Poznan University of Medical Sciences, Poznan, Poland
- Department of Neurology, SPZOZ MSWiA, Poznan, Poland
| | | | | | - Konrad Rejdak
- Department of Neurology, Medical University of Lublin, Lublin, Poland
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Doroszkiewicz J, Kulczyńska-Przybik A, Dulewicz M, Borawska R, Zajkowska M, Słowik A, Mroczko B. Potential Utility of Cerebrospinal Fluid Glycoprotein Nonmetastatic Melanoma Protein B as a Neuroinflammatory Diagnostic Biomarker in Mild Cognitive Impairment and Alzheimer's Disease. J Clin Med 2023; 12:4689. [PMID: 37510803 PMCID: PMC10380476 DOI: 10.3390/jcm12144689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 06/27/2023] [Accepted: 07/04/2023] [Indexed: 07/30/2023] Open
Abstract
Alzheimer's disease (AD) is a very common neurodegenerative disorder characterized by the gradual loss of neurons and extracellular amyloid-peptide buildup. There is compelling evidence that the disease process depends on neuroinflammatory alterations, such as the activation of astrocytes and microglia cells. A transmembrane glycoprotein known as glycoprotein nonmetastatic melanoma protein B (GPNMB) plays a neuroprotective role during the development of neurodegeneration. To the best of our knowledge, this is the first investigation discussing the potential clinical usefulness of this protein in the AD continuum, especially in the MCI (mild cognitive impairment) stage. A total of 71 patients with AD or MCI as well as controls were enrolled in this study. The concentrations of GPNMB, YKL-40, Aβ1-42 (amyloid beta 1-42), Tau, and pTau and the Aβ1-42/1-40 ratio in the CSF (cerebrospinal fluid) were tested using immunological methods. The concentrations of both GPNMB and YKL-40 in the cerebrospinal fluid were significantly higher in patients with AD and MCI compared to the controls. Moreover, both proteins were biochemically associated with classical biomarkers of AD and were especially associated with the Aβ1-42/1-40 ratio and Tau and pTau levels in the whole study group. Elevated concentrations of GPNMB were observed in the Aβ(+) group of AD patients compared to the Aβ(-) subjects. Additionally, the diagnostic performance (AUC value) of GPNMB was higher than that of amyloid β1-42 in MCI patients compared with controls. Our study indicates that GPNMB might be a promising neuroinflammatory biomarker for the early diagnosis and prognosis of the AD continuum, with potential utility as a therapeutic target.
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Affiliation(s)
- Julia Doroszkiewicz
- Department of Neurodegeneration Diagnostics, Medical University of Bialystok, 15-269 Bialystok, Poland
| | | | - Maciej Dulewicz
- Department of Neurodegeneration Diagnostics, Medical University of Bialystok, 15-269 Bialystok, Poland
| | - Renata Borawska
- Department of Neurodegeneration Diagnostics, Medical University of Bialystok, 15-269 Bialystok, Poland
| | - Monika Zajkowska
- Department of Neurodegeneration Diagnostics, Medical University of Bialystok, 15-269 Bialystok, Poland
| | - Agnieszka Słowik
- Department of Neurology, Jagiellonian University, 30-688 Cracow, Poland
| | - Barbara Mroczko
- Department of Neurodegeneration Diagnostics, Medical University of Bialystok, 15-269 Bialystok, Poland
- Department of Biochemical Diagnostics, Medical University of Bialystok, 15-269 Bialystok, Poland
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Chatys-Bogacka Ż, Mazurkiewicz I, Słowik J, Nowak K, Sydor W, Wizner B, Słowik A, Wnuk M, Drabik L. Response to Letter to the Editors regarding article entitled 'Sex-related patient-reported brain fog symptoms in nonhospitalised COVID-19 patients'. Neurol Neurochir Pol 2023; 57:326-327. [PMID: 37154432 DOI: 10.5603/pjnns.a2023.0033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 05/08/2023] [Indexed: 05/10/2023]
Affiliation(s)
- Żaneta Chatys-Bogacka
- Department of Neurology, Jagiellonian University Medical College, Krakow, Poland.
- Department of Neurology, University Hospital in Krakow, Poland.
| | - Iwona Mazurkiewicz
- Department of Neurology, Jagiellonian University Medical College, Krakow, Poland
- Department of Neurology, University Hospital in Krakow, Poland
| | - Joanna Słowik
- Department of Periodontology, Preventive Dentistry and Oral Medicine, Institute of Dentistry, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Klaudia Nowak
- Department of Neurology, Jagiellonian University Medical College, Krakow, Poland
- Department of Neurology, University Hospital in Krakow, Poland
| | - Wojciech Sydor
- Centre for Innovative Therapies, Clinical Research Coordination Centre, University Hospital in Krakow, Poland
- Department of Rheumatology and Immunology, Jagiellonian University Medical College, Krakow, Poland
| | - Barbara Wizner
- Department of Internal Medicine and Gerontology, Jagiellonian University Medical College, Krakow, Poland
- Department of Internal Medicine and Geriatrics, University Hospital in Krakow, Poland
| | - Agnieszka Słowik
- Department of Neurology, Jagiellonian University Medical College, Krakow, Poland
- Department of Neurology, University Hospital in Krakow, Poland
| | - Marcin Wnuk
- Department of Neurology, Jagiellonian University Medical College, Krakow, Poland
- Department of Neurology, University Hospital in Krakow, Poland
| | - Leszek Drabik
- Department of Pharmacology, Jagiellonian University Medical College, Krakow, Poland
- John Paul II Hospital, Krakow, Poland
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Mazurkiewicz I, Chatys-Bogacka Ż, Słowik J, Zdanecka M, Siwiec-Koźlik A, Słowik A, Drabik L, Wnuk M. Course of fatigue among patients previously hospitalised due to COVID-19. Neurol Neurochir Pol 2023; 57:101-110. [PMID: 36810758 DOI: 10.5603/pjnns.a2023.0015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 02/16/2023] [Indexed: 02/24/2023]
Abstract
INTRODUCTION Discrepancies exist regarding the clinical course and prognostic factors for post-COVID fatigue. Therefore, our aim was to assess the timely course of fatigue and its possible predictors in patients previously hospitalised due to SARS-CoV-2 infection. MATERIAL AND METHODS Patients and employees of the University Hospital in Krakow were assessed with the use of a validated neuropsychological questionnaire. Included were participants aged 18 or more, previously hospitalised due to COVID-19, who completed questionnaires only once > 3 months after the onset of infection. Individuals were retrospectively asked about the presence of eight symptoms of chronic fatigue syndrome at four timepoints: before COVID-19, within 0-4 weeks, 4-12 weeks, and > 12 weeks post-infection. RESULTS We enrolled 204 patients [40.2% women, median age 58 (46-66) years] evaluated after a median of 187 (156-220) days from the first positive nasal swab test for SARS-CoV-2. The most common comorbidities were hypertension (44.61%), obesity (36.27%), smoking (28.43%), and hypercholesterolemia (21.08%); none of the patients required mechanical ventilation during hospitalisation. Before COVID-19, 43.62% of patients reported at least one symptom of chronic fatigue. Within 4, 4-12, and > 12 weeks after COVID-19, the prevalence of chronic fatigue was 76.96%, 75.49%, and 66.17%, respectively (all p < 0.001). The frequency of chronic fatigue symptoms decreased within > 12 weeks following the onset of infection but did not return to baseline values, except for self-reported lymph node enlargement. In a multivariable linear regression model, the number of fatigue symptoms was predicted by female sex [β 0.25 (0.12; 0.39), p < 0.001 and 0.26 (0.13; 0.39), p < 0.001 for weeks 0-12 and > 12, respectively], and age [for < 4 weeks, β -0.12 (-0.28; -0.01), p = 0.029]. CONCLUSIONS Most patients previously hospitalised due to COVID-19 suffer from fatigue > 12 weeks after infection onset. The presence of fatigue is predicted by female sex and - only for the acute phase - age.
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Affiliation(s)
- Iwona Mazurkiewicz
- Department of Neurology, Jagiellonian University Medical College, Krakow, Poland.,Department of Neurology, University Hospital in Krakow, Poland
| | - Żaneta Chatys-Bogacka
- Department of Neurology, Jagiellonian University Medical College, Krakow, Poland.,Department of Neurology, University Hospital in Krakow, Poland
| | - Joanna Słowik
- Department of Periodontology, Preventive Dentistry and Oral Medicine, Institute of Dentistry, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Magdalena Zdanecka
- Clinical Department of Gynaecological Endocrinology and Gynaecology, University Hospital in Krakow, Poland
| | - Andżelika Siwiec-Koźlik
- Department of Rheumatology and Immunology, Jagiellonian University Medical College, Krakow, Poland.,Rheumatology and Immunology Clinical Department, University Hospital in Krakow, Poland
| | - Agnieszka Słowik
- Department of Neurology, Jagiellonian University Medical College, Krakow, Poland.,Department of Neurology, University Hospital in Krakow, Poland
| | - Leszek Drabik
- Department of Pharmacology, Jagiellonian University Medical College, Krakow, Poland.,John Paul II Hospital, Krakow, Poland
| | - Marcin Wnuk
- Department of Neurology, Jagiellonian University Medical College, Krakow, Poland. .,Department of Neurology, University Hospital in Krakow, Poland.
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Chatys-Bogacka Ż, Mazurkiewicz I, Słowik J, Nowak K, Sydor W, Wizner B, Słowik A, Wnuk M, Drabik L. Sex-related patient-reported brain fog symptoms in non-hospitalised COVID-19 patients. Neurol Neurochir Pol 2023; 57:111-120. [PMID: 36799525 DOI: 10.5603/pjnns.a2023.0010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 01/30/2023] [Indexed: 02/18/2023]
Abstract
INTRODUCTION Previous studies on the prognostic role of sex in post-COVID-associated brain fog have yielded divergent results. Moreover, limited evidence exists regarding the evolution of brain fog symptoms over time, especially in ambulatory patients and separately for women and men. Therefore, the aim of the current study was to assess brain fog symptoms in nonhospitalised patients with COVID-19, according to their sex. MATERIAL AND METHODS We created a neuropsychological questionnaire including eight questions on the presence of brain fog symptoms in the following four time periods: before COVID-19, and 0-4, 4-12, and > 12 weeks post-infection. The validity and reliability of the questionnaire were assessed. In this cross-sectional study, questionnaires were filled out anonymously and retrospectively once only by patients or through a survey link posted online. Included were patients ≥ 18 years, with > 3 months since the SARS-CoV-2 infection onset confirmed by RT-PCR from a nasopharyngeal swab. RESULTS The study included 303 patients (79.53% women, 47.52% medical personnel). Median time between COVID-19 onset and questionnaire completion was 208 (IQR 161-248) days. Women, compared to men, reported a higher prevalence of problems with writing, reading, and counting (< 4 weeks, OR 3.05, 95% CI: 1.38-6.72; 4-12 weeks, OR 2.51, 95% CI: 1.02-6.14; > 12 weeks, OR 3.74, 95% CI: 1.12-12.56) and thoughts communication (< 4 weeks, OR 2.53, 95% CI: 1.41-4.54; 4-12 weeks, OR 3.74, 95% CI: 1.93-7.24; > 12 weeks, OR 2.00, 95% CI: 1.01-3.99). The difference between the two sexes in answering questions in an understandable/unambiguous manner was statistically significant between four and 12 weeks after infection (OR 2.63, 95% CI: 1.36-5.10), while a sex difference in recalling new information was found below 12 weeks (OR 2.54, 95% CI: 1.44-4.48 and OR 2.43, 95% CI: 1.37-4.31 for < 4 and 4-12 weeks, respectively). No sex differences in reporting problems with multitasking, remembering information from the past, determining the current date, or field orientation were noted. CONCLUSIONS Non-hospitalised women and men retrospectively report a different course of COVID-19-associated brain fog.
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Affiliation(s)
- Żaneta Chatys-Bogacka
- Department of Neurology, Jagiellonian University Medical College, Krakow, Poland
- Department of Neurology, University Hospital in Krakow, Poland
| | - Iwona Mazurkiewicz
- Department of Neurology, Jagiellonian University Medical College, Krakow, Poland
- Department of Neurology, University Hospital in Krakow, Poland
| | - Joanna Słowik
- Department of Periodontology, Preventive Dentistry and Oral Medicine, Institute of Dentistry, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Klaudia Nowak
- Department of Neurology, Jagiellonian University Medical College, Krakow, Poland
- Department of Neurology, University Hospital in Krakow, Poland
| | - Wojciech Sydor
- Centre for Innovative Therapies, Clinical Research Coordination Centre, University Hospital in Krakow, Poland
- Department of Rheumatology and Immunology, Jagiellonian University Medical College, Krakow, Poland
| | - Barbara Wizner
- Department of Internal Medicine and Gerontology, Jagiellonian University Medical College, Krakow, Poland
- Department of Internal Medicine and Geriatrics, University Hospital in Krakow, Poland
| | - Agnieszka Słowik
- Department of Neurology, Jagiellonian University Medical College, Krakow, Poland
- Department of Neurology, University Hospital in Krakow, Poland
| | - Marcin Wnuk
- Department of Neurology, Jagiellonian University Medical College, Krakow, Poland.
- Department of Neurology, University Hospital in Krakow, Poland.
| | - Leszek Drabik
- Department of Pharmacology, Jagiellonian University Medical College, Krakow, Poland
- John Paul II Hospital, Krakow, Poland
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20
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Buda-Nowak A, Kwinta Ł, Potocki P, Michałowska-Kaczmarczyk A, Słowik A, Konopka K, Streb J, Koniewski M, Wysocki PJ. Metronomic Chemo-Endocrine Therapy (FulVEC) as a Salvage Treatment for Patients with Advanced, Treatment-Refractory ER+/HER2-Breast Cancer-A Retrospective Analysis of Consecutive Patients Data. J Clin Med 2023; 12:jcm12041350. [PMID: 36835886 PMCID: PMC9958758 DOI: 10.3390/jcm12041350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 01/16/2023] [Accepted: 02/06/2023] [Indexed: 02/10/2023] Open
Abstract
BACKGROUND Breast cancer, with 2.3 million new cases and 0.7 million deaths every year, represents a great medical challenge worldwide. These numbers confirm that approx. 30% of BC patients will develop an incurable disease requiring life-long, palliative systemic treatment. Endocrine treatment and chemotherapy administered in a sequential fashion are the basic treatment options in advanced ER+/HER2- BC, which is the most common BC type. The palliative, long-term treatment of advanced BC should not only be highly active but also minimally toxic to allow long-term survival with the optimal quality of life. A combination of metronomic chemotherapy (MC) with endocrine treatment (ET) in patients who failed earlier lines of ET represents an interesting and promising option. METHODS The methodology includes retrospective data analyses of pretreated, metastatic ER+/HER2- BC (mBC) patients who were treated with the FulVEC regimen combining fulvestrant and MC (cyclophosphamide, vinorelbine, and capecitabine). RESULTS Thirty-nine previously treated (median 2 lines 1-9) mBC patients received FulVEC. The median PFS and OS were 8.4 and 21.5 months, respectively. Biochemical responses (CA-15.3 serum marker decline ≥50%) were observed in 48.7%, and any increase in CA-15.3 was observed in 23.1% of patients. The activity of FulVEC was independent of previous treatments with fulvestrant of cytotoxic components of the FulVEC regimen. The treatment was safe and well tolerated. CONCLUSIONS Metronomic chemo-endocrine therapy with FulVEC regimen represents an interesting option and compares favorably with other approaches in patients' refractory to endocrine treatments. A phase II randomized trial is warranted.
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Affiliation(s)
- Anna Buda-Nowak
- Department of Oncology, Jagiellonian University Medical College, University Hospital, 30-501 Krakow, Poland
| | - Łukasz Kwinta
- Department of Oncology, Jagiellonian University Medical College, University Hospital, 30-501 Krakow, Poland
- Department of Oncology, Jagiellonian University Medical College, 31-008 Krakow, Poland
| | - Paweł Potocki
- Department of Oncology, Jagiellonian University Medical College, University Hospital, 30-501 Krakow, Poland
- Department of Oncology, Jagiellonian University Medical College, 31-008 Krakow, Poland
| | - Anna Michałowska-Kaczmarczyk
- Department of Oncology, Jagiellonian University Medical College, University Hospital, 30-501 Krakow, Poland
- Department of Oncology, Jagiellonian University Medical College, 31-008 Krakow, Poland
| | - Agnieszka Słowik
- Department of Oncology, Jagiellonian University Medical College, University Hospital, 30-501 Krakow, Poland
| | - Kamil Konopka
- Department of Oncology, Jagiellonian University Medical College, University Hospital, 30-501 Krakow, Poland
- Department of Oncology, Jagiellonian University Medical College, 31-008 Krakow, Poland
| | - Joanna Streb
- Department of Oncology, Jagiellonian University Medical College, University Hospital, 30-501 Krakow, Poland
- Department of Oncology, Jagiellonian University Medical College, 31-008 Krakow, Poland
| | - Maciej Koniewski
- Institute of Sociology, Jagiellonian University, 30-962 Krakow, Poland
| | - Piotr J. Wysocki
- Department of Oncology, Jagiellonian University Medical College, University Hospital, 30-501 Krakow, Poland
- Department of Oncology, Jagiellonian University Medical College, 31-008 Krakow, Poland
- Correspondence:
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21
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Wójcik K, Franciszek Kołek M, Dec-Ćwiek M, Słowik A, Bosak M. Trends in antiseizure medications utilization among women of childbearing age with epilepsy in Poland between 2015 and 2019. Epilepsy Behav 2023; 139:109091. [PMID: 36682232 DOI: 10.1016/j.yebeh.2023.109091] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 01/01/2023] [Accepted: 01/05/2023] [Indexed: 01/21/2023]
Abstract
PURPOSE To determine trends in the use of antiseizure medications (ASMs) among women of childbearing age (WOCA) and girls aged 12-14 years with epilepsy between 2015 and 2019 in Poland. METHODS The study used data from the Pex database, which captures information on prescriptions dispensed from 85% of community pharmacies in Poland. The prescriptions issued by neurologists who provide epilepsy care in Poland were studied. Six of the most commonly prescribed ASMs were analyzed: carbamazepine, lamotrigine, levetiracetam, oxcarbazepine, topiramate, and valproate. RESULTS The use of valproate and carbamazepine decreased in all age groups. Among the newer ASMs, the use of lamotrigine, levetiracetam, and topiramate increased and oxcarbazepine decreased significantly in WOCA. The only subgroup with statistically significant changes in all ASMs prescriptions were women aged 19-34 years. For girls aged 12-14 years, significant changes were found only for valproate and carbamazepine. In the last year of observation (2019) valproate and lamotrigine accounted for two-thirds of ASMs units prescribed to WOCA. Valproate accounted for half of the prescribed drug units in girls aged 12-14 years. The lowest rates of VPA prescriptions were found in women aged 19-34 years. CONCLUSIONS There is a change in prescribing habits in WOCA with epilepsy in Poland with trends toward using less teratogenic ASMs. However, many WOCAs are treated with valproate and topiramate despite their known teratogenicity risk. Valproate is still the most commonly prescribed ASM in WOCA and girls aged 12-14 years. Educational interventions for healthcare professionals are needed to improve prescribing practices in WOCA with epilepsy in Poland.
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Affiliation(s)
| | | | - Małgorzata Dec-Ćwiek
- University Hospital in Kraków, Poland; Jagiellonian University, Faculty of Medicine, Department of Neurology, Poland
| | - Agnieszka Słowik
- University Hospital in Kraków, Poland; Jagiellonian University, Faculty of Medicine, Department of Neurology, Poland
| | - Magdalena Bosak
- University Hospital in Kraków, Poland; Jagiellonian University, Faculty of Medicine, Department of Neurology, Poland.
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22
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Pawlicka A, Wężyk K, Matwiej K, Dziedzic R, Słowik A, Bosak M. Safety of COVID-19 vaccines and factors influencing the vaccine take-up rate in Polish adults with epilepsy: a single-center study. Pol Arch Intern Med 2023; 133. [PMID: 36547224 DOI: 10.20452/pamw.16389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
| | - Kamil Wężyk
- Department of Neurology, University Hospital in Krakow, Kraków, Poland,Faculty of Health Sciences, Jagiellonian University Medical College, Kraków, Poland
| | - Katarzyna Matwiej
- School of Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Radosław Dziedzic
- School of Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Agnieszka Słowik
- Department of Neurology, University Hospital in Krakow, Kraków, Poland,Department of Neurology, Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Magdalena Bosak
- Department of Neurology, University Hospital in Krakow, Kraków, Poland; Department of Neurology, Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland.
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23
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Rusin G, Kubica J, Malinowski KP, Słowik A, Undas A. Factors affecting self-reported bleeding acceptance in acute ischemic stroke survivors on various types of antithrombotic therapy. J Stroke Cerebrovasc Dis 2023; 32:106894. [PMID: 36402092 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 11/07/2022] [Accepted: 11/11/2022] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES Prior ischemic cerebrovascular event and younger age have been shown to increase bleeding acceptance among anticoagulated outpatients with atrial fibrillation (AF). We sought to determine factors affecting bleeding acceptance in acute ischemic stroke (AIS) survivors on various types of antithrombotic therapy. MATERIALS AND METHODS We enrolled 173 consecutive patients hospitalized for AIS (aged 68.2±11.7 years, 54.9% male), including 54 (31.2%) with AF, who had favorable functional outcome. On discharge, the Bleeding ratio, defined as the declared maximum number of major bleedings that a patient is willing to accept to prevent one major stroke, was evaluated. We assessed the predicted bleeding risk in non-cardioembolic and cardioembolic stroke survivors using S2TOP-BLEED and HAS-BLED scores, respectively. RESULTS Patients with the low Bleeding ratio, defined as 5 (median) or less accepted bleeds (n=92; 53.2%), were older and more likely to receive thrombolysis and/or thrombectomy, with no impact of previous stroke. Prior major bleed (odds ratio [OR] 4.67; 95% confidence interval [CI] 0.92-23.72), AF with use of oral anticoagulants (OR 2.35, 95% CI 1.12-4.93), reperfusion treatment (OR 1.95, 95% CI 1.02-3.76), and hospitalization ≤10 days (OR 4.56; 95% CI 1.50-13.87) were associated with the low Bleeding Ratio. Prior use of anticoagulants or aspirin as well as HAS-BLED and S2TOP-BLEED scores did not affect the bleeding acceptance. CONCLUSIONS Lower bleeding acceptance declared on discharge by AIS survivors is determined by prior bleeding, anticoagulation in AF, reperfusion treatment, and duration of hospitalization, which might affect medication adherence. The results might help optimize post-discharge management and educational efforts in patients on antithrombotic therapy.
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Affiliation(s)
- Gabriela Rusin
- Department of Neurology, University Hospital, Krakow, Poland
| | - Jadwiga Kubica
- Department of Neurology, University Hospital, Krakow, Poland; Institute of Physiotherapy, Faculty of Health Science, Jagiellonian University Medical College, Krakow, Poland
| | - Krzysztof Piotr Malinowski
- Department of Bioinformatics and Telemedicine, Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland; Center for Digital Medicine and Robotics, Jagiellonian University Medical College, Kraków, Poland
| | - Agnieszka Słowik
- Department of Neurology, University Hospital, Krakow, Poland; Department of Neurology, Jagiellonian University Medical College, Kraków, Poland
| | - Anetta Undas
- Department of Thromboembolic Disorders, Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland; Center for Research and Innovative Technology John Paul II Hospital, Kraków, Poland.
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24
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Bosak M, Mazurkiewicz I, Włoch-Kopeć D, Jagiełła J, Woźniak M, Kasprzycki M, Słowik A, Turaj W. High prevalence of electroencephalographic frontal intermittent rhythmic delta activity in patients with moderately severe COVID-19. Neurol Neurochir Pol 2023; 57:131-135. [PMID: 36426929 DOI: 10.5603/pjnns.a2022.0069] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 11/07/2022] [Accepted: 11/08/2022] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The aim of our study was to analyse EEG findings in patients with COVID-19 not requiring respiratory support. MATERIAL AND METHODS We reviewed EEGs performed in patients with COVID-19 between April 2020 and May 2021 at the University Hospital in Kraków, Poland. Demographic and clinical data, including comorbid conditions, discharge disposition, survival, neuroimaging findings, laboratory results, and treatment was collected. RESULTS The study included 44 EEGs performed in 35 patients (51.4% females), aged 65.5 ± 13.9 years. Almost all patients had at least one comorbidity, and one-third had one or more preexisting neurological conditions. Three quarters of EEGs were abnormal. The most frequent EEG finding was background slowing (16 patients; 45.7%). Frontal findings included frontally predominant rhythmic delta (FIRDA) in 10 (28.6%) patients and focal slowing in the left frontal lobe. Patients with abnormal EEG significantly more often required oxygen supplementation (p = 0.003) and were less likely to recover (p = 0.048). CONCLUSIONS AND CLINICAL IMPLICATIONS Patients with COVID-19 infection may frequently manifest with an abnormal EEG. FIRDA seems to be a frequent EEG pattern in less severe cases of COVID-19 infection. Future studies are needed to establish whether COVID-19 infection increases the risk for FIRDA, and to investigate its pathogenesis.
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Affiliation(s)
- Magdalena Bosak
- Collegium Medicum, Jagiellonian University of Krakow, Krakow, Poland. .,University Hospital in Krakow, Krakow, Poland.
| | | | - Dorota Włoch-Kopeć
- Collegium Medicum, Jagiellonian University of Krakow, Krakow, Poland.,University Hospital in Krakow, Krakow, Poland
| | - Jeremiasz Jagiełła
- Collegium Medicum, Jagiellonian University of Krakow, Krakow, Poland.,University Hospital in Krakow, Krakow, Poland
| | | | | | - Agnieszka Słowik
- Collegium Medicum, Jagiellonian University of Krakow, Krakow, Poland.,University Hospital in Krakow, Krakow, Poland
| | - Wojciech Turaj
- Collegium Medicum, Jagiellonian University of Krakow, Krakow, Poland.,University Hospital in Krakow, Krakow, Poland
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25
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Bosak M, Słowik A, Domitrz I. EEG changes during left- and right-sided weakness in patient with sporadic hemiplegic migraine. Neurol Neurochir Pol 2022; 56:508-510. [PMID: 36394220 DOI: 10.5603/pjnns.a2022.0064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 10/13/2022] [Accepted: 10/19/2022] [Indexed: 11/18/2022]
Affiliation(s)
- Magdalena Bosak
- Collegium Medicum, Jagiellonian University of Krakow, Krakow, Poland.
| | - Agnieszka Słowik
- Collegium Medicum, Jagiellonian University of Krakow, Krakow, Poland
| | - Izabela Domitrz
- Department of Neurology, Faculty of Medical Sciences, Medical University of Warsaw, Warsaw, Poland
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26
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Klimiec-Moskal E, Pera J, Słowik A, Dziedzic T. Various courses of early post-stroke apathy symptoms are associated with different outcomes. Eur J Clin Invest 2022; 52:e13833. [PMID: 35842831 DOI: 10.1111/eci.13833] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 07/12/2022] [Accepted: 07/14/2022] [Indexed: 11/27/2022]
Affiliation(s)
| | - Joanna Pera
- Department of Neurology, Jagiellonian University Medical College, Krakow, Poland
| | - Agnieszka Słowik
- Department of Neurology, Jagiellonian University Medical College, Krakow, Poland
| | - Tomasz Dziedzic
- Department of Neurology, Jagiellonian University Medical College, Krakow, Poland
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27
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Gałuszka-Bulaga A, Hajto J, Borczyk M, Gołda S, Piechota M, Korostyński M, Rutkowska-Zapała M, Latacz P, Guła Z, Korkosz M, Pera J, Słowik A, Siedlar M, Baran J. Transcriptional Response of Blood Mononuclear Cells from Patients with Inflammatory and Autoimmune Disorders Exposed to "Krakow Smog". Cells 2022; 11:cells11162586. [PMID: 36010662 PMCID: PMC9406644 DOI: 10.3390/cells11162586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 08/10/2022] [Accepted: 08/17/2022] [Indexed: 11/16/2022] Open
Abstract
Despite the general awareness of the need to reduce air pollution, the efforts were undertaken in Poland to eliminate the pollutants and their harmful effect on human health seem to be insufficient. Moreover, the latest data indicate that the city of Krakow is at the forefront of the most polluted cities worldwide. Hence, in this report, we investigated the impact of particulate matter isolated from the air of Krakow (PM KRK) on the gene expression profile of peripheral blood mononuclear cells (PBMCs) in healthy donors (HD) and patients with atherosclerosis (AS), rheumatoid arthritis (RA) and multiple sclerosis (MS), after in vitro exposure. Blood samples were collected in two seasons, differing in the concentration of PM in the air (below or above a daily limit of 50 µg/m3 for PM 10). Data show that PBMCs exposed in vitro to PM KRK upregulated the expression of genes involved, among others, in pro-inflammatory response, cell motility, and regulation of cell metabolism. The transcriptional effects were observed predominantly in the group of patients with AS and MS. The observed changes seem to be dependent on the seasonal concentration of PM in the air of Krakow and may suggest their important role in the progression of AS, MS, and RA in the residents of Krakow.
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Affiliation(s)
- Adrianna Gałuszka-Bulaga
- Department of Clinical Immunology, Institute of Pediatrics, Jagiellonian University Medical College, 30-663 Krakow, Poland
| | - Jacek Hajto
- Laboratory of Pharmacogenomics, Department of Molecular Neuropharmacology, Maj Institute of Pharmacology, Polish Academy of Sciences, 31-343 Krakow, Poland
| | - Małgorzata Borczyk
- Laboratory of Pharmacogenomics, Department of Molecular Neuropharmacology, Maj Institute of Pharmacology, Polish Academy of Sciences, 31-343 Krakow, Poland
| | - Sławomir Gołda
- Laboratory of Pharmacogenomics, Department of Molecular Neuropharmacology, Maj Institute of Pharmacology, Polish Academy of Sciences, 31-343 Krakow, Poland
| | - Marcin Piechota
- Laboratory of Pharmacogenomics, Department of Molecular Neuropharmacology, Maj Institute of Pharmacology, Polish Academy of Sciences, 31-343 Krakow, Poland
| | - Michał Korostyński
- Laboratory of Pharmacogenomics, Department of Molecular Neuropharmacology, Maj Institute of Pharmacology, Polish Academy of Sciences, 31-343 Krakow, Poland
| | - Magdalena Rutkowska-Zapała
- Department of Clinical Immunology, Institute of Pediatrics, Jagiellonian University Medical College, 30-663 Krakow, Poland
| | - Paweł Latacz
- Department of Clinical Neurology, Jagiellonian University Medical College, 30-688 Krakow, Poland
| | - Zofia Guła
- Department of Rheumatology and Immunology, Jagiellonian University Medical College, 30-688 Krakow, Poland
| | - Mariusz Korkosz
- Department of Rheumatology and Immunology, Jagiellonian University Medical College, 30-688 Krakow, Poland
| | - Joanna Pera
- Department of Clinical Neurology, Jagiellonian University Medical College, 30-688 Krakow, Poland
| | - Agnieszka Słowik
- Department of Clinical Neurology, Jagiellonian University Medical College, 30-688 Krakow, Poland
| | - Maciej Siedlar
- Department of Clinical Immunology, Institute of Pediatrics, Jagiellonian University Medical College, 30-663 Krakow, Poland
| | - Jarek Baran
- Department of Clinical Immunology, Institute of Pediatrics, Jagiellonian University Medical College, 30-663 Krakow, Poland
- Correspondence: ; Tel.: +48-12-65-82-011
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Czarnowska A, Tarasiuk J, Zajkowska O, Wnuk M, Marona M, Nowak K, Słowik A, Jamroz-Wiśniewska A, Rejdak K, Lech B, Popiel M, Rościszewska-Żukowska I, Perenc A, Bartosik-Psujek H, Świderek-Matysiak M, Siger M, Ciach A, Walczak A, Jurewicz A, Stasiołek M, Kania K, Dyczkowska K, Kalinowska-Łyszczarz A, Galus W, Walawska-Hrycek A, Krzystanek E, Chojdak-Łukasiewicz J, Ubysz J, Pokryszko-Dragan A, Kapica-Topczewska K, Chorąży M, Bazylewicz M, Mirończuk A, Kulikowska J, Kochanowicz J, Białek M, Stolarz M, Kubicka-Bączyk K, Niedziela N, Warmus P, Adamczyk-Sowa M, Podlecka-Piçtowska A, Nojszewska M, Zakrzewska-Pniewska B, Jasińska E, Zaborski J, Milewska-Jȩdrzejczak M, Zwiernik J, Zwiernik B, Potemkowski A, Brola W, Kułakowska A. Analysis of Side Effects Following Vaccination Against COVID-19 Among Individuals With Multiple Sclerosis Treated With DMTs in Poland. Front Neurol 2022; 13:913283. [PMID: 35775049 PMCID: PMC9237390 DOI: 10.3389/fneur.2022.913283] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 05/20/2022] [Indexed: 11/13/2022] Open
Abstract
Background and Objectives Since vaccination against COVID-19 is available for over a year and the population of immunized individuals with autoimmune disorders is higher than several months before, an evaluation of safety and registered adverse events can be made. We conducted a large study of side effects following the COVID-19 vaccine among patients with multiple (MS) sclerosis treated with disease-modifying therapies (DMTs) and analyzed factors predisposing for particular adverse events. Methods We gathered data of individuals with MS treated with DMTs from 19 Polish MS Centers, who reported at least one adverse event following COVID-19 vaccination. The information was obtained by neurologists using a questionnaire. The same questionnaire was used at all MS Centers. To assess the relevance of reported adverse events, we used Fisher's exact test, t-test, and U-Menn-Whutney test. Results A total of 1,668 patients with MS and reports of adverse events after COVID-19 vaccination were finally included in the study. Besides one case marked as “red flag”, all adverse events were classified as mild. Pain at the injection site was the most common adverse event, with a greater frequency after the first dose. Pain at the injection site was significantly more frequent after the first dose among individuals with a lower disability (EDSS ≤2). The reported adverse events following immunization did not differ over sex. According to age, pain at the injection site was more common among individuals between 30 and 40 years old, only after the first vaccination dose. None of the DMTs predisposed for particular side effects. Conclusions According to our findings, vaccination against COVID-19 among patients with MS treated with DMTs is safe. Our study can contribute to reducing hesitancy toward vaccination among patients with MS.
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Affiliation(s)
- Agata Czarnowska
- Department of Neurology, Medical University of Białystok, Białystok, Poland
- *Correspondence: Agata Czarnowska
| | - Joanna Tarasiuk
- Department of Neurology, Medical University of Białystok, Białystok, Poland
| | - Olga Zajkowska
- Faculty of Economic Sciences, University of Warsaw, Warsaw, Poland
| | - Marcin Wnuk
- Department of Neurology, Jagiellonian University Medical College, Krakow, Poland
| | - Monika Marona
- Department of Neurology, Jagiellonian University Medical College, Krakow, Poland
| | - Klaudia Nowak
- Department of Neurology, Jagiellonian University Medical College, Krakow, Poland
| | - Agnieszka Słowik
- Department of Neurology, Jagiellonian University Medical College, Krakow, Poland
| | | | - Konrad Rejdak
- Department of Neurology, Medical University of Lublin, Lublin, Poland
| | - Beata Lech
- Neurology Clinic With Brain Stroke Sub-Unit, Clinical Hospital No. 2 in Rzeszow, Lwowska, Poland
| | - Małgorzata Popiel
- Neurology Clinic With Brain Stroke Sub-Unit, Clinical Hospital No. 2 in Rzeszow, Lwowska, Poland
| | - Iwona Rościszewska-Żukowska
- Department of Neurology, Institute of Medical Sciences, Medical College of Rzeszow University, Rzeszów, Poland
| | - Adam Perenc
- Neurology Clinic With Brain Stroke Sub-Unit, Clinical Hospital No. 2 in Rzeszow, Lwowska, Poland
| | - Halina Bartosik-Psujek
- Department of Neurology, Institute of Medical Sciences, Medical College of Rzeszow University, Rzeszów, Poland
| | | | - Małgorzata Siger
- Department of Neurology, Medical University of Lodz, Łódz, Poland
| | - Agnieszka Ciach
- Department of Neurology, Medical University of Lodz, Łódz, Poland
| | - Agata Walczak
- Department of Neurology, Medical University of Lodz, Łódz, Poland
| | - Anna Jurewicz
- Department of Neurology, Medical University of Lodz, Łódz, Poland
| | | | - Karolina Kania
- Department of Neurology, Poznan University of Medical Sciences, Poznań, Poland
| | - Klara Dyczkowska
- Department of Neurology, Poznan University of Medical Sciences, Poznań, Poland
| | | | - Weronika Galus
- Department of Neurology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | - Anna Walawska-Hrycek
- Department of Neurology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | - Ewa Krzystanek
- Department of Neurology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | | | - Jakub Ubysz
- Department of Neurology, Wroclaw Medical University, Wroclaw, Poland
| | | | | | - Monika Chorąży
- Department of Neurology, Medical University of Białystok, Białystok, Poland
| | - Marcin Bazylewicz
- Department of Neurology, Medical University of Białystok, Białystok, Poland
| | - Anna Mirończuk
- Department of Neurology, Medical University of Białystok, Białystok, Poland
| | - Joanna Kulikowska
- Department of Neurology, Medical University of Białystok, Białystok, Poland
| | - Jan Kochanowicz
- Department of Neurology, Medical University of Białystok, Białystok, Poland
| | - Marta Białek
- Department of Neurology, Regional Specialised Hospital No. 4 in Bytom, Bytom, Poland
| | - Małgorzata Stolarz
- Department of Neurology, Regional Specialised Hospital No. 4 in Bytom, Bytom, Poland
| | - Katarzyna Kubicka-Bączyk
- Department of Neurology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, Katowice, Poland
| | - Natalia Niedziela
- Department of Neurology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, Katowice, Poland
| | - Paweł Warmus
- Department of Neurology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, Katowice, Poland
| | - Monika Adamczyk-Sowa
- Department of Neurology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, Katowice, Poland
| | | | - Monika Nojszewska
- Department of Neurology, Medical University of Warsaw, Warsaw, Poland
| | | | - Elżbieta Jasińska
- Jan Kochanowski University, Collegium Medicum, Kielce, Poland
- Clinical Center, Resmedica, Kielce, Poland
| | - Jacek Zaborski
- Department of Neurology and Neurorehabilitation, Miedzyleski Szpital Specjalistyczny, Warsaw, Poland
| | | | - Jacek Zwiernik
- Neurology Ward, Provincial Specialist Hospital, Olsztyn, Poland
- Department of Neurology, University of Warmia and Mazury, Olsztyn, Poland
| | - Beata Zwiernik
- Department of Neurology, University of Warmia and Mazury, Olsztyn, Poland
- Clinic of Neurology, University of Warmia and Mazury, Olsztyn, Poland
| | - Andrzej Potemkowski
- Department of Clinical Psychology and Psychoprophylaxis, University of Szczecin, Szczecin, Poland
| | - Waldemar Brola
- Department of Neurology, Specialist Hospital in Końskie, Collegium Medicum, Jan Kochanowski University in Kielce, Kielce, Poland
| | - Alina Kułakowska
- Department of Neurology, Medical University of Białystok, Białystok, Poland
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Sawczyńska K, Wrona P, Kęsek T, Wnuk M, Chrzan R, Homa T, Pułyk R, Jagiełła J, Popiela T, Słowik A. Mechanical thrombectomy in COVID-19-associated ischaemic stroke: patient characteristics and outcomes in a single-centre study. Neurol Neurochir Pol 2022; 56:163-170. [PMID: 35315928 DOI: 10.5603/pjnns.a2022.0026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 12/05/2021] [Accepted: 12/08/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The aim of this study was to assess the clinical profiles and outcomes of patients with confirmed COVID-19 infection and acute ischaemic stroke (AIS) treated with mechanical thrombectomy (MT) at the Comprehensive Stroke Centre (CSC) of the University Hospital in Krakow. CLINICAL RATIONALE FOR THE STUDY COVID-19 is a risk factor for AIS and worsens prognosis in patients with large artery occlusions. During the pandemic, the global number of MT has dropped. At the same time, studies assessing outcomes of this treatment in COVID-19-associated AIS have produced divergent results. MATERIAL AND METHODS In this single-centre study, we retrospectively analysed and compared the clinical profiles (age, sex, presence of cardiovascular risk factors, neurological deficit at admission), stroke size (measured using postprocessing analysis of perfusion CT with RAPID software), time from stroke onset to arrival at the CSC, time from arrival at the CSC to groin puncture, treatment with intravenous thrombolysis, length of hospitalisation, laboratory test results, and short-term outcomes (measured with Thrombolysis in Cerebral Infarction scale, modified Rankin Scale and National Health Institute Stroke Scale) in patients with AIS treated with MT during the pandemic. A comparison between patients with and without concomitant SARS-CoV2 infection was then performed. RESULTS There were no statistically significant differences between 15 COVID (+) and 167 COVID (-) AIS patients treated with AIS with respect to clinical profiles (p > 0.05), stroke size (p > 0.05) or outcomes (NIHSS at discharge, 8.1 (SD = 7.1) vs. 8.8 (SD = 9.6), p = 0.778, mRS at discharge 2.9 (SD = 2) vs. 3.1 (SD = 2.1), p = 0.817, death rate 6.7% vs. 12.6%, p = 0.699). There was a significant difference between patients with and without COVID-19 concerning time from arrival at the CSC to groin puncture [104.27 (SD = 51.47) vs. 97.63 (SD = 156.94) min., p = 0.044] and the length of hospitalisation [23.7 (SD = 11.9) vs. 10.5 (SD = 6.9) days, p < 0.001]. CONCLUSION In AIS patients treated with MT, concomitant SARS-CoV2 infection did not affect the outcome. Our observations need to be confirmed in larger, and preferably multicentre, studies.
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Affiliation(s)
- Katarzyna Sawczyńska
- Department of Neurology, Jagiellonian University Medical College, Krakow, Poland. .,Department of Neurology, University Hospital in Krakow, Poland.
| | - Paweł Wrona
- Department of Neurology, Jagiellonian University Medical College, Krakow, Poland.,Department of Neurology, University Hospital in Krakow, Poland
| | - Tomasz Kęsek
- Department of Neurology, University Hospital in Krakow, Poland
| | - Marcin Wnuk
- Department of Neurology, Jagiellonian University Medical College, Krakow, Poland.,Department of Neurology, University Hospital in Krakow, Poland
| | - Robert Chrzan
- Department of Radiology, Jagiellonian University Medical College, Krakow, Poland.,Department of Radiology, University Hospital in Krakow, Poland
| | | | - Roman Pułyk
- Department of Neurology, Jagiellonian University Medical College, Krakow, Poland.,Department of Neurology, University Hospital in Krakow, Poland
| | - Jeremiasz Jagiełła
- Department of Neurology, Jagiellonian University Medical College, Krakow, Poland.,Department of Neurology, University Hospital in Krakow, Poland
| | - Tadeusz Popiela
- Department of Radiology, Jagiellonian University Medical College, Krakow, Poland.,Department of Radiology, University Hospital in Krakow, Poland
| | - Agnieszka Słowik
- Department of Neurology, Jagiellonian University Medical College, Krakow, Poland.,Department of Neurology, University Hospital in Krakow, Poland
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Wnuk M, Drabik L, Derbisz J, Słowik A. Prognostic significance of age in patients with acute ischaemic stroke treated with intravenous thrombolysis. Neurol Neurochir Pol 2022; 56:81-88. [DOI: 10.5603/pjnns.a2022.0010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 12/18/2021] [Accepted: 12/20/2021] [Indexed: 11/25/2022]
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Sawczyńska K, Wężyk K, Bosak M, Jagiełła J, Andrasik S, Kępińska-Wnuk A, Dec-Ćwiek M, Słowik A. Acute-onset chorea and confusional state in 77-year-old COVID-19 patient: a case report. Neurol Neurochir Pol 2022; 56:106-110. [PMID: 34985113 DOI: 10.5603/pjnns.a2022.0003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 11/24/2021] [Accepted: 11/24/2021] [Indexed: 11/25/2022]
Affiliation(s)
- Katarzyna Sawczyńska
- Department of Neurology, Jagiellonian University Medical College, Krakow, Poland. .,Department of Neurology, University Hospital in Krakow, Poland.
| | - Kamil Wężyk
- Department of Neurology, University Hospital in Krakow, Poland.,Department of Physiotherapy, Jagiellonian University Medical College, Krakow, Poland
| | - Magdalena Bosak
- Department of Neurology, Jagiellonian University Medical College, Krakow, Poland.,Department of Neurology, University Hospital in Krakow, Poland
| | - Jeremiasz Jagiełła
- Department of Neurology, Jagiellonian University Medical College, Krakow, Poland.,Department of Neurology, University Hospital in Krakow, Poland
| | - Szymon Andrasik
- Department of Neurology, University Hospital in Krakow, Poland
| | - Alicja Kępińska-Wnuk
- Department of Neurology, Jagiellonian University Medical College, Krakow, Poland.,Department of Neurology, University Hospital in Krakow, Poland
| | - Małgorzata Dec-Ćwiek
- Department of Neurology, Jagiellonian University Medical College, Krakow, Poland.,Department of Neurology, University Hospital in Krakow, Poland
| | - Agnieszka Słowik
- Department of Neurology, Jagiellonian University Medical College, Krakow, Poland.,Department of Neurology, University Hospital in Krakow, Poland
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Kulczyńska-Przybik A, Dulewicz M, Słowik A, Borawska R, Kułakowska A, Kochanowicz J, Mroczko B. The Clinical Significance of Cerebrospinal Fluid Reticulon 4 (RTN4) Levels in the Differential Diagnosis of Neurodegenerative Diseases. J Clin Med 2021; 10:jcm10225281. [PMID: 34830564 PMCID: PMC8622503 DOI: 10.3390/jcm10225281] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 11/09/2021] [Accepted: 11/11/2021] [Indexed: 11/16/2022] Open
Abstract
Neurodegenerative diseases (NDs) belong to the top global causes of mortality. Diagnostic approaches to improve early diagnosis and differentiation of these diseases are constantly being sought. Therefore, we aimed to assess the cerebrospinal fluid (CSF) concentrations of Reticulon 4 (RTN4) in patients with neurodegenerative diseases and evaluate the potential clinical usefulness of this protein. RTNs are transmembrane proteins mediating neuroanatomical plasticity and functional recovery after central nervous system injury or diseases. According to our best knowledge, this is the first investigation providing the data concerning the dynamic of CSF RTN4 protein levels in patients with different NDs. Methods: Overall, 77 newly diagnosed patients with neurodegenerative diseases, including Alzheimer’s disease (AD), Parkinson’s disease (PD), and multiple sclerosis (MS), as well as 21 controls, were enrolled in the study. The CSF concentrations of tested proteins were assessed using immunological assays. Results: We revealed significantly higher CSF RTN4A levels in patients with AD, PD, and MS in comparison to the controls. Moreover, the comparative analysis of RTN4 concentration between different neurodegenerative diseases revealed the highest concentration of RTN4A in AD patients and a statistically significant difference between AD vs. PD, and AD vs. MS groups. The increased CSF level of the protein correlated with Tau, and pTau181 proteins in AD as well as in PD patients. Conclusions: Our study presents a previously not identified clinical utility of RTN4 in the differential diagnosis of neurodegenerative diseases.
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Affiliation(s)
- Agnieszka Kulczyńska-Przybik
- Department of Neurodegeneration Diagnostics, Medical University of Bialystok, 15-269 Bialystok, Poland; (M.D.); (R.B.); (B.M.)
- Correspondence:
| | - Maciej Dulewicz
- Department of Neurodegeneration Diagnostics, Medical University of Bialystok, 15-269 Bialystok, Poland; (M.D.); (R.B.); (B.M.)
| | - Agnieszka Słowik
- Department of Neurology, Jagiellonian University, 30-688 Kraków, Poland;
| | - Renata Borawska
- Department of Neurodegeneration Diagnostics, Medical University of Bialystok, 15-269 Bialystok, Poland; (M.D.); (R.B.); (B.M.)
| | - Alina Kułakowska
- Department of Neurology, Medical University of Bialystok, 15-269 Bialystok, Poland; (A.K.); (J.K.)
| | - Jan Kochanowicz
- Department of Neurology, Medical University of Bialystok, 15-269 Bialystok, Poland; (A.K.); (J.K.)
| | - Barbara Mroczko
- Department of Neurodegeneration Diagnostics, Medical University of Bialystok, 15-269 Bialystok, Poland; (M.D.); (R.B.); (B.M.)
- Department of Biochemical Diagnostics, Medical University of Bialystok, 15-269 Bialystok, Poland
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Czarnowska A, Kapica-Topczewska K, Zajkowska O, Adamczyk-Sowa M, Kubicka-Bączyk K, Niedziela N, Warmus P, Kalinowska-Łyszczarz A, Kania K, Słowik A, Wnuk M, Marona M, Nowak K, Bartosik-Psujek H, Lech B, Perenc A, Popiel M, Kucharska-Lipowska M, Chorąży M, Tarasiuk J, Mirończuk A, Kochanowicz J, Lasek-Bal A, Puz P, Maciejowska K, Wawrzyniak S, Niezgodzińska-Maciejek A, Pokryszko-Dragan A, Gruszka E, Budrewicz S, Białek M, Zwiernik J, Michałowska A, Nosek K, Zwiernik B, Lewańczyk B, Brola W, Kułakowska A. Symptoms after COVID-19 Infection in Individuals with Multiple Sclerosis in Poland. J Clin Med 2021; 10:jcm10225225. [PMID: 34830507 PMCID: PMC8618380 DOI: 10.3390/jcm10225225] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 10/14/2021] [Accepted: 11/04/2021] [Indexed: 12/13/2022] Open
Abstract
(1) Background: To report and analyze the presence of residual symptoms after SARS-CoV-2 infection among Polish patients with multiple sclerosis (MS) treated with different disease-modifying therapies (DMTs). (2) Methods: The study included 426 individuals with MS treated with DMTs and confirmed SARS-CoV-2 infection from 12 Polish MS centers. The data were collected through to 31 May 2021. The information included demographics, specific MS characteristics, course of SARS-CoV-2 infection, and residual (general and neurological) symptoms lasting more than four and 12 weeks after the initial infection. The results were obtained using maximum likelihood estimates for odds ratio and logistic regression. (3) Results: A total of 44.84% patients with MS reported symptoms lasting between four and 12 weeks after the initial infection; 24.41% people had symptoms that resolved up to 12 weeks, and 20.42% patients had symptoms that lasted over 12 weeks. The most common symptoms were: fatigue, disturbance of concentration, attention, and memory, cognitive complaints, and headache. None of the DMTs were predisposed to the development of residual symptoms after the initial infection. A total of 11.97% of patients had relapse three months prior or after SARS-CoV-2 infection. (4) Conclusion: Almost half of individuals with MS treated with different DMTs had residual symptoms after SARS-CoV-2 infection. None of the DMTs raised the probability of developing post-acute COVID symptoms.
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Affiliation(s)
- Agata Czarnowska
- Department of Neurology, Medical University of Białystok, M. Skłodowskiej-Curie 24A, 15-276 Białystok, Poland; (K.K.-T.); (M.C.); (J.T.); (A.M.); (J.K.); (A.K.)
- Correspondence: ; Tel.: +48-85-746-83-26; Fax: +48-85-746-86-08
| | - Katarzyna Kapica-Topczewska
- Department of Neurology, Medical University of Białystok, M. Skłodowskiej-Curie 24A, 15-276 Białystok, Poland; (K.K.-T.); (M.C.); (J.T.); (A.M.); (J.K.); (A.K.)
| | - Olga Zajkowska
- Faculty of Economic Sciences, University of Warsaw, 00-241 Warszawa, Poland;
| | - Monika Adamczyk-Sowa
- Department of Neurology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-055 Katowice, Poland; (M.A.-S.); (K.K.-B.); (N.N.); (P.W.)
| | - Katarzyna Kubicka-Bączyk
- Department of Neurology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-055 Katowice, Poland; (M.A.-S.); (K.K.-B.); (N.N.); (P.W.)
| | - Natalia Niedziela
- Department of Neurology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-055 Katowice, Poland; (M.A.-S.); (K.K.-B.); (N.N.); (P.W.)
| | - Paweł Warmus
- Department of Neurology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-055 Katowice, Poland; (M.A.-S.); (K.K.-B.); (N.N.); (P.W.)
| | - Alicja Kalinowska-Łyszczarz
- Department of Neurology, Division of Neurochemistry and Neuropathology, Poznan University of Medical Sciences, 61-701 Poznań, Poland; (A.K.-Ł.); (K.K.)
| | - Karolina Kania
- Department of Neurology, Division of Neurochemistry and Neuropathology, Poznan University of Medical Sciences, 61-701 Poznań, Poland; (A.K.-Ł.); (K.K.)
| | - Agnieszka Słowik
- Department of Neurology, Jagiellonian University Medical College, University Hospital, 30-688 Krakow, Poland; (A.S.); (M.W.); (M.M.); (K.N.)
| | - Marcin Wnuk
- Department of Neurology, Jagiellonian University Medical College, University Hospital, 30-688 Krakow, Poland; (A.S.); (M.W.); (M.M.); (K.N.)
| | - Monika Marona
- Department of Neurology, Jagiellonian University Medical College, University Hospital, 30-688 Krakow, Poland; (A.S.); (M.W.); (M.M.); (K.N.)
| | - Klaudia Nowak
- Department of Neurology, Jagiellonian University Medical College, University Hospital, 30-688 Krakow, Poland; (A.S.); (M.W.); (M.M.); (K.N.)
| | - Halina Bartosik-Psujek
- Department of Neurology, Institute of Medical Sciences, Medical College of Rzeszow University, 35-310 Rzeszów, Poland;
| | - Beata Lech
- Neurology Clinic with Brain Stroke Sub-Unit, Clinical Hospital No. 2 in Rzeszow, 35-301 Rzeszów, Poland; (B.L.); (A.P.); (M.P.)
| | - Adam Perenc
- Neurology Clinic with Brain Stroke Sub-Unit, Clinical Hospital No. 2 in Rzeszow, 35-301 Rzeszów, Poland; (B.L.); (A.P.); (M.P.)
| | - Małgorzata Popiel
- Neurology Clinic with Brain Stroke Sub-Unit, Clinical Hospital No. 2 in Rzeszow, 35-301 Rzeszów, Poland; (B.L.); (A.P.); (M.P.)
| | | | - Monika Chorąży
- Department of Neurology, Medical University of Białystok, M. Skłodowskiej-Curie 24A, 15-276 Białystok, Poland; (K.K.-T.); (M.C.); (J.T.); (A.M.); (J.K.); (A.K.)
| | - Joanna Tarasiuk
- Department of Neurology, Medical University of Białystok, M. Skłodowskiej-Curie 24A, 15-276 Białystok, Poland; (K.K.-T.); (M.C.); (J.T.); (A.M.); (J.K.); (A.K.)
| | - Anna Mirończuk
- Department of Neurology, Medical University of Białystok, M. Skłodowskiej-Curie 24A, 15-276 Białystok, Poland; (K.K.-T.); (M.C.); (J.T.); (A.M.); (J.K.); (A.K.)
| | - Jan Kochanowicz
- Department of Neurology, Medical University of Białystok, M. Skłodowskiej-Curie 24A, 15-276 Białystok, Poland; (K.K.-T.); (M.C.); (J.T.); (A.M.); (J.K.); (A.K.)
| | - Anetta Lasek-Bal
- Department of Neurology, School of Health Sciences, Medical University of Silesia, 40-055 Katowice, Poland; (A.L.-B.); (P.P.); (K.M.)
| | - Przemysław Puz
- Department of Neurology, School of Health Sciences, Medical University of Silesia, 40-055 Katowice, Poland; (A.L.-B.); (P.P.); (K.M.)
| | - Katarzyna Maciejowska
- Department of Neurology, School of Health Sciences, Medical University of Silesia, 40-055 Katowice, Poland; (A.L.-B.); (P.P.); (K.M.)
| | - Sławomir Wawrzyniak
- Department of Neurology, 10th Military Research Hospital and Polyclinic, Independent Public Healthcare Centre, 85-681 Bydgoszcz, Poland; (S.W.); (A.N.-M.)
| | - Anna Niezgodzińska-Maciejek
- Department of Neurology, 10th Military Research Hospital and Polyclinic, Independent Public Healthcare Centre, 85-681 Bydgoszcz, Poland; (S.W.); (A.N.-M.)
| | - Anna Pokryszko-Dragan
- Department of Neurology, Wroclaw Medical University, 50-367 Wroclaw, Poland; (A.P.-D.); (E.G.); (S.B.)
| | - Ewa Gruszka
- Department of Neurology, Wroclaw Medical University, 50-367 Wroclaw, Poland; (A.P.-D.); (E.G.); (S.B.)
| | - Sławomir Budrewicz
- Department of Neurology, Wroclaw Medical University, 50-367 Wroclaw, Poland; (A.P.-D.); (E.G.); (S.B.)
| | - Marta Białek
- Department of Neurology, Regional Specialised Hospital No. 4 in Bytom, 41-902 Bytom, Poland;
| | - Jacek Zwiernik
- Neurology Ward, Provincial Specialist Hospital, 10-561 Olsztyn, Poland; (J.Z.); (A.M.)
- Department of Neurology, University of Warmia and Mazury, 10-719 Olsztyn, Poland;
| | - Anna Michałowska
- Neurology Ward, Provincial Specialist Hospital, 10-561 Olsztyn, Poland; (J.Z.); (A.M.)
| | - Krzysztof Nosek
- Department of Pharmacology and Toxicology, Faculty of Medicine, University of Warmia and Mazury, 10-719 Olsztyn, Poland;
| | - Beata Zwiernik
- Department of Neurology, University of Warmia and Mazury, 10-719 Olsztyn, Poland;
- Clinic of Neurology, University of Warmia and Mazury, 10-719 Olsztyn, Poland
| | - Bożena Lewańczyk
- Neurology Ward, Provincial Integrated Hospital, 82-300 Elbląg, Poland;
| | - Waldemar Brola
- Department of Neurology, Specialist Hospital in Końskie, Collegium Medicum, Jan Kochanowski University Kielce, 26-200 Końskie, Poland;
| | - Alina Kułakowska
- Department of Neurology, Medical University of Białystok, M. Skłodowskiej-Curie 24A, 15-276 Białystok, Poland; (K.K.-T.); (M.C.); (J.T.); (A.M.); (J.K.); (A.K.)
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Dulewicz M, Kulczyńska-Przybik A, Słowik A, Borawska R, Mroczko B. Neurogranin and Neuronal Pentraxin Receptor as Synaptic Dysfunction Biomarkers in Alzheimer's Disease. J Clin Med 2021; 10:jcm10194575. [PMID: 34640593 PMCID: PMC8509697 DOI: 10.3390/jcm10194575] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 09/27/2021] [Accepted: 09/29/2021] [Indexed: 12/24/2022] Open
Abstract
Synaptic loss and dysfunction are one of the earliest signs of neurodegeneration associated with cognitive decline in Alzheimer’s disease (AD). It seems that by assessing proteins related to synapses, one may reflect their dysfunction and improve the understanding of neurobiological processes in the early stage of the disease. To our best knowledge, this is the first study that analyzes the CSF concentrations of two synaptic proteins together, such as neurogranin (Ng) and neuronal pentraxins receptor (NPTXR) in relation to neurochemical dementia biomarkers in Alzheimer’s disease. Methods: Ng, NPTXR and classical AD biomarkers concentrations were measured in the CSF of patients with AD and non-demented controls (CTRL) using an enzyme-linked immunosorbent assay (ELISA) and Luminex xMAP technology. Results: The CSF level of Ng was significantly higher, whereas the NPTXR was significantly lower in the AD patients than in cognitively healthy controls. As a first, we calculated the NPTXR/Ng ratio as an indicator of synaptic disturbance. The patients with AD presented a significantly decreased NPTXR/Ng ratio. The correlation was observed between both proteins in the AD and the whole study group. Furthermore, the relationship between the Ng level and pTau181 was found in the AD group of patients. Conclusions: The Ng and NPTXR concentrations in CSF are promising synaptic dysfunction biomarkers reflecting pathological changes in AD.
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Affiliation(s)
- Maciej Dulewicz
- Department of Neurodegeneration Diagnostics, Medical University of Bialystok, 15-269 Bialystok, Poland; (A.K.-P.); (R.B.); (B.M.)
- Correspondence:
| | - Agnieszka Kulczyńska-Przybik
- Department of Neurodegeneration Diagnostics, Medical University of Bialystok, 15-269 Bialystok, Poland; (A.K.-P.); (R.B.); (B.M.)
| | - Agnieszka Słowik
- Department of Neurology, Jagiellonian University, 30-688 Krakow, Poland;
| | - Renata Borawska
- Department of Neurodegeneration Diagnostics, Medical University of Bialystok, 15-269 Bialystok, Poland; (A.K.-P.); (R.B.); (B.M.)
| | - Barbara Mroczko
- Department of Neurodegeneration Diagnostics, Medical University of Bialystok, 15-269 Bialystok, Poland; (A.K.-P.); (R.B.); (B.M.)
- Department of Biochemical Diagnostics, Medical University of Bialystok, 15-269 Bialystok, Poland
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35
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Łasocha B, Grochowska AM, Wrona P, Brzegowy PJ, Pułyk R, Słowik A, Latacz PR, Popiela TJ. Venous return in acute ischaemic stroke patients measured during computed tomography angiography of head and neck. Neurol Neurochir Pol 2021; 55:462-468. [PMID: 34477214 DOI: 10.5603/pjnns.a2021.0060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 06/21/2021] [Accepted: 06/22/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The aim of this study was to analyse the general features and usefulness of the time elapsed between the start of contrast agent infusion and its appearance in the aortic arch in acute ischaemic stroke patients subjected to baseline computed tomographic angiography. This is, to the best of our knowledge, the first study of this parameter in a clinical context. We will refer to it hereafter as 'needle-to-aorta delay' (NAD). MATERIAL AND METHODS The following were recorded: the time it took iodinated contrast media to reach the aorta, the site of occlusion, and automatic perfusion assessments of infarct and salvageable tissue volumes. Demographic data such as age and sex, comorbidities, and clinical factors including heart rate, blood pressure, time elapsed from symptom onset, initial stroke severity, and course of disease, were also assessed. RESULTS We analysed 252 cases of stroke. NAD correlated with tissue at risk volume, and was greater for patients with hypertension and atrial fibrillation. The observed time was significantly shorter with less favourable core-to-penumbra ratios. No link was found between NAD and either the rate of infarct progression or the long-term clinical result. CONCLUSIONS Although no clinical benefit was proven as a result of measuring the time it took contrast media to reach the aorta, our study implies that not only is the brain subject to circulation, but it may also affect its functioning.
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Affiliation(s)
| | - Anna M Grochowska
- Chair of Radiology, Jagiellonian University Medical College, Krakow, Poland
| | - Paweł Wrona
- Chair of Neurology, Jagiellonian University, Medical College, Krakow, 31-501, Poland
| | - Paweł J Brzegowy
- Chair of Radiology, Jagiellonian University Medical College, Krakow, Poland
| | - Roman Pułyk
- Chair of Neurology, Jagiellonian University, Medical College, Krakow, 31-501, Poland
| | - Agnieszka Słowik
- Chair of Neurology, Jagiellonian University, Medical College, Krakow, 31-501, Poland
| | - Paweł R Latacz
- Chair of Neurology, Jagiellonian University, Medical College, Krakow, 31-501, Poland
| | - Tadeusz J Popiela
- Chair of Radiology, Jagiellonian University Medical College, Krakow, Poland
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Domitrz I, Sławek J, Słowik A, Boczarska-Jedynak M, Stępień A, Rejdak K, Gierczyński J, Rożniecki J. Onabotulinumtoxin A (ONA-BoNT/A) in the treatment of chronic migraine. Neurol Neurochir Pol 2021; 56:39-47. [PMID: 34477213 DOI: 10.5603/pjnns.a2021.0061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 07/09/2021] [Accepted: 07/09/2021] [Indexed: 11/25/2022]
Abstract
Migraine is a common primary headache disease, which reduces quality of life. About 8% of migraineurs suffer from chronic migraine (CM), which is the most severe and troublesome type. It has been proven that onabotulinumtoxinA (ONA-BoNT/A) significantly improves CM, presumably inhibiting the release of calcitonin gene-related peptide (CGRP) and other neurotransmitters from c-fibres endings, and thus decreasing activation of nociceptive pathways and transmission of pain. The aim of this position paper was to assess the place of ONA-BoNT/A for the prophylaxis of CM in adults. The authors have compared the efficacy, safety and tolerance of the toxin to those of classical oral preventive therapies as well as to recently introduced anti-CGRP-pathway monoclonal antibodies. The results of randomised controlled studies of ONA-BoNT/A have been compared to open label (real world practice) trials.
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Affiliation(s)
- Izabela Domitrz
- Department of Neurology, Faculty of Medical Sciences, Medical University of Warsaw, Poland.
| | - Jarosław Sławek
- Division of Neurological and Psychiatric Nursing, Faculty of Health Sciences, Medical University of Gdansk, Poland.,Department of Neurology & Stroke, St. Adalbert Hospital, "Copernicus" Ltd., Gdansk, Poland
| | - Agnieszka Słowik
- Department of Neurology, Jagiellonian University, Medical College, Kraków, Poland
| | | | - Adam Stępień
- Department of Neurology, Military Institute of Medicine, Warsaw, Poland
| | - Konrad Rejdak
- Department of Neurology; Medical University of Lublin, Poland
| | - Jakub Gierczyński
- Healthcare Management Institute and Center of Value Based Healthcare, Łazarski University, Warsaw, Poland
| | - Jacek Rożniecki
- Department of Neurology, Stroke and Neurorehabilitation, Medical University of Lodz, Poland
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Stepień A, Słowik A, Domitrz I, Kozubski W, Rejdak K, Rożniecki J, Woroń J, Wachowska K, Gałecki P. Experts’ and national consultants’ recommendations regarding management of patients treated for migraine with comorbid depression. Diagnosis. Therapeutic strategies. Part 2. Psychiatr Pol 2021; 56:711-728. [PMID: 37074825 DOI: 10.12740/pp/onlinefirst/139596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Depressive disorders are currently diagnosed based on the ICD-10 and DSM-5 diagnostic criteria and include axial depressive symptoms and additional symptoms that must coexist for at least two weeks. Migraine is diagnosed based on the International Classification of Headache Disorders. It is generally divided into migraine with and without aura, and with regard to the frequency of attacks into episodic and chronic migraine. The therapeutic strategy in the treatment of depression is pharmacotherapy combined with psychotherapy, whereas in the treatment of migraine the strategy depends on the frequency of headache attacks (episodic migraine vs. chronic migraine) and comorbidities. A novelty is the introduction of monoclonal antibodies directed against CGRP or the receptor of CGRP. There are numerous reports which indicate specific usefulness of monoclonal antibodies that modify the action of CGRP in the treatment of migraine in people suffering from depression.
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Affiliation(s)
- Adam Stepień
- Wojskowy Instytut Medyczny, Centralny Szpital Kliniczny MON, Klinika Neurologiczna
| | - Agnieszka Słowik
- Uniwersytet Jagielloński Collegium Medicum, Katedra i Klinika Neurologii
| | - Izabela Domitrz
- Warszawski Uniwersytet Medyczny, Wydział Medyczny, Klinika Neurologii
| | - Wojciech Kozubski
- Uniwersytet Medyczny im. Karola Marcinkowskiego w Poznaniu, Katedra Klinika Neurologii
| | - Konrad Rejdak
- Lubelski Uniwersytet Medyczny, Katedra i Klinika Neurologii
| | - Jacek Rożniecki
- Uniwersytet Medyczny w Łodzi, Klinika Neurologii, Udarów Mózgu i Neurorehabilitacji
| | - Jarosław Woroń
- Szpital Uniwersytecki w Krakowie, Kliniczny Oddział Anestezjologii i Intensywnej Terapii nr 1
- Uniwersytet Jagielloński Collegium Medicum, Klinika Leczenia Bólu i Opieki Paliatywnej
- Uniwersytet Jagielloński Collegium Medicum, Katedra Farmakologii, Zakład Farmakologii Klinicznej
| | | | - Piotr Gałecki
- Uniwersytet Medyczny w Łodzi, Klinika Psychiatrii Dorosłych
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Stępień A, Domitrz I, Kozubski W, Rejdak K, Rożniecki J, Słowik A, Woroń J, Wachowska K, Gałecki P. Experts’ and national consultants’ recommendations regarding management of patients treated for migraine with comorbid depression. Epidemiology. Pathomechanism. Comorbidity. Part 1. Psychiatr Pol 2021; 56:697-710. [PMID: 37074824 DOI: 10.12740/pp/onlinefirst/136489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Coexistence of migraine and depression is a significant clinical problem. Health examination surveys indicate that patients who suffer from migraine are more likely to develop depression than the general population. The inverse relationship is also observed. The etiopathogenesis of both migraine and depression is not fully understood and is probably multifactorial and complex. Neurotransmission disorders, the immune system, and genetic predisposition are considered in the literature. The authors present etiopathogenetic theories of both diseases and their prevalence. They analyze data on the comorbidity of these conditions and discuss likely underlying factors. They describe clinical predictors of depression onset in people with migraine.
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Affiliation(s)
- Adam Stępień
- Wojskowy Instytut Medyczny, Centralny Szpital Kliniczny Ministerstwa Obrony Narodowej, Klinika Neurologiczna, Warszawa
| | - Izabela Domitrz
- Warszawski Uniwersytet Medyczny, Wydział Medyczny, Klinika Neurologii
| | - Wojciech Kozubski
- Uniwersytet Medyczny im. Karola Marcinkowskiego w Poznaniu, Katedra i Klinika Neurologii
| | - Konrad Rejdak
- Lubelski Uniwersytet Medyczny, Katedra i Klinika Neurologii
| | - Jacek Rożniecki
- Uniwersytet Medyczny w Łodzi, Klinika Neurologii, Udarów Mózgu i Neurorehabilitacji
| | - Agnieszka Słowik
- Uniwersytet Jagielloński Collegium Medicum, Katedra i Klinika Neurologii
| | - Jarosław Woroń
- Szpital Uniwersytecki w Krakowie, Kliniczny Oddział Anestezjologii i Intensywnej Terapii nr 1
- Uniwersytet Jagielloński Collegium Medicum, Klinika Leczenia Bólu i Opieki Paliatywnej
- Uniwersytet Jagielloński Collegium Medicum, Katedra Farmakologii, Zakład Farmakologii Klinicznej
| | | | - Piotr Gałecki
- Uniwersytet Medyczny w Łodzi, Klinika Psychiatrii Dorosłych
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Bosak M, Mazurkiewicz I, Wężyk K, Słowik A, Turaj W. COVID-19 among patients with epilepsy: Risk factors and course of the disease. Epilepsy Behav 2021; 120:107996. [PMID: 33957438 PMCID: PMC8064834 DOI: 10.1016/j.yebeh.2021.107996] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 04/01/2021] [Accepted: 04/13/2021] [Indexed: 10/31/2022]
Abstract
INTRODUCTION The study assessed the prevalence and risk factors for SARS-CoV-2 infection in patients with epilepsy (PWE). Additionally, the course of COVID-19 and its impact on seizure control was investigated. MATERIAL AND METHODS Subjects with definite (confirmed by positive RT-PCR nasopharyngeal swab or serum anti-SARS-CoV-2 antibodies) and probable COVID-19 were identified via telephone survey among PWE treated at the university epilepsy clinic. RESULTS Of 252 screened subjects, 17 (6.7%) had definite and 14 (5.5%) probable COVID-19. The percentage of PWE with definite COVID-19 was much higher than the percentage of subjects with confirmed COVID-19 in Polish general population (3.65%). In the heterogenous population of PWE, including patients with drug-resistant epilepsy, physical/intellectual disability, and comorbidities, we were not able to identify any risk factors for contracting COVID-19. The course of infection was mild or moderate in all subjects, not requiring oxygen therapy or respiratory support. The most common symptoms were fever, fatigue, headaches, muscle aches, and loss of smell/taste and continued for approximately 7-21 days, except for loss of smell/taste which lasted usually several weeks. Seizure exacerbation was noted in only one pregnant patient with confirmed COVID-19 and it was likely related to decreased serum level of levetiracetam in the third trimester. CONCLUSION The study provided reassuring findings related to the low risk of seizure exacerbation in PWE during the course of COVID-19. Patients with epilepsy may be at increased risk of SARS-CoV-2 infection. Epilepsy characteristics are not likely to modify the risk of COVID-19.
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Affiliation(s)
- Magdalena Bosak
- Jagiellonian University Medical College, Faculty of Medicine, Department of Neurology, Krakow, Poland.
| | | | | | - Agnieszka Słowik
- Jagiellonian University Medical College, Faculty of Medicine, Department of Neurology, Krakow, Poland
| | - Wojciech Turaj
- Jagiellonian University Medical College, Faculty of Medicine, Department of Neurology, Krakow, Poland
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40
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Antczak J, Rusin G, Słowik A. Transcranial Magnetic Stimulation as a Diagnostic and Therapeutic Tool in Various Types of Dementia. J Clin Med 2021; 10:jcm10132875. [PMID: 34203558 PMCID: PMC8267667 DOI: 10.3390/jcm10132875] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 06/23/2021] [Accepted: 06/25/2021] [Indexed: 02/03/2023] Open
Abstract
Dementia is recognized as a healthcare and social burden and remains challenging in terms of proper diagnosis and treatment. Transcranial magnetic stimulation (TMS) is a diagnostic and therapeutic tool in various neurological diseases that noninvasively investigates cortical excitability and connectivity and can induce brain plasticity. This article reviews findings on TMS in common dementia types as well as therapeutic results. Alzheimer’s disease (AD) is characterized by increased cortical excitability and reduced cortical inhibition, especially as mediated by cholinergic neurons and as documented by impairment of short latency inhibition (SAI). In vascular dementia, excitability is also increased. SAI may have various outcomes, which probably reflects its frequent overlap with AD. Dementia with Lewy bodies (DLB) is associated with SAI decrease. Motor cortical excitability is usually normal, reflecting the lack of corticospinal tract involvement. DLB and other dementia types are also characterized by impairment of short interval intracortical inhibition. In frontotemporal dementia, cortical excitability is increased, but SAI is normal. Repetitive transcranial magnetic stimulation has the potential to improve cognitive function. It has been extensively studied in AD, showing promising results after multisite stimulation. TMS with electroencephalography recording opens new possibilities for improving diagnostic accuracy; however, more studies are needed to support the existing data.
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41
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Wnuk M, Sawczyńska K, Kęsek T, Wrona P, Chatys-Bogacka Ż, Mazurkiewicz I, Drabik L, Jagiełła J, Szaleniec J, Czepiel J, Pawliński Ł, Bień AI, Kania M, Fiema M, Zięba-Parkitny J, Hajek A, Ucieklak D, Wilk M, Pośpiech K, Lechowicz P, Kasprzycki K, Kopka M, Hohendorff J, Katra B, Kostrzycka M, Adamczyk M, Surowiec P, Rybicka M, Walczewska J, Kamińska B, Piętak E, Bryniarski P, Marona M, Motyl M, Kępińska-Wnuk A, Włodarczyk M, Nowak K, Gradek-Kwinta E, Czyżycki M, Dwojak M, Rzemińska A, Wężyk K, Koźmiński W, Pułyk A, Garlicki A, Grodzicki T, Małecki M, Słowik A. Neurological symptoms in hospitalised patients with COVID-19 and their association with in-hospital mortality. Neurol Neurochir Pol 2021; 55:314-321. [PMID: 34037979 DOI: 10.5603/pjnns.a2021.0039] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 04/11/2021] [Accepted: 04/13/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To evaluate the spectrum of neurological symptoms in patients with COVID-19 during the first 14 days of hospitalisation and its association with in-hospital mortality. MATERIAL AND METHODS We included 200 patients with RT-PCR-confirmed COVID-19 admitted to University Hospital in Krakow, Poland. In 164 patients, a detailed questionnaire concerning neurological symptoms and signs was performed prospectively within 14 days of hospitalisation. In the remaining 36 patients, such questionnaires were completed retrospectively based on daily observations in the Department of Neurology. RESULTS During hospitalisation, 169 patients (84.5%) experienced neurological symptoms; the most common were: fatigue (62.5%), decreased mood (45.5%), myalgia (43.5%), and muscle weakness (42.5%). Patients who died during hospitalisation compared to the remainder were older (79 [70.5-88.5] vs. 63.5 [51-77] years, p = 0.001), and more often had decreased level of consciousness (50.0% vs. 9.3%, p < 0.001), delirium (33.3% vs. 4.4%, p < 0.001), arterial hypotension (50.0% vs. 19.6%, p = 0.005) or stroke during (18.8% vs. 3.3%, p = 0.026) or before hospitalisation (50.0% vs. 7.1, p < 0.001), whereas those who survived more often suffered from headache (42.1% vs. 0%, p = 0.012) or decreased mood (51.7% vs. 0%, p = 0.003). CONCLUSIONS Most hospitalised patients with COVID-19 experience neurological symptoms. Decreased level of consciousness, delirium, arterial hypotension, and stroke during or before hospitalisation increase the risk of in-hospital mortality.
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Affiliation(s)
- Marcin Wnuk
- Department of Neurology, University Hospital in Krakow, Poland. .,Jagiellonian University Medical College, Department of Neurology, Krakow, Poland.
| | - Katarzyna Sawczyńska
- Jagiellonian University Medical College, Department of Neurology, Krakow, Poland
| | - Tomasz Kęsek
- Department of Metabolic Diseases and Diabetology, University Hospital in Krakow, Poland
| | - Paweł Wrona
- Department of Metabolic Diseases and Diabetology, University Hospital in Krakow, Poland
| | | | - Iwona Mazurkiewicz
- Department of Metabolic Diseases and Diabetology, University Hospital in Krakow, Poland
| | - Leszek Drabik
- Jagiellonian University Medical College, Department of Pharmacology, Krakow, Poland.,John Paul II Hospital, Krakow, Poland
| | - Jeremiasz Jagiełła
- Jagiellonian University Medical College, Department of Neurology, Krakow, Poland
| | - Joanna Szaleniec
- Jagiellonian University Medical College, Department of Otorhinolaryngology, Krakow, Poland.,Department of Otorhinolaryngology, University Hospital in Krakow, Poland
| | - Jacek Czepiel
- Jagiellonian University Medical College, Department of Infectious and Tropical Diseases, Krakow, Poland.,Department of Infectious Diseases, University Hospital in Krakow, Poland
| | - Łukasz Pawliński
- Department of Metabolic Diseases and Diabetology, University Hospital in Krakow, Poland.,Jagiellonian University Medical College, Department of Metabolic Diseases and Diabetology, Krakow, Poland
| | - Artur Igor Bień
- Department of Metabolic Diseases and Diabetology, University Hospital in Krakow, Poland.,Jagiellonian University Medical College, Department of Metabolic Diseases and Diabetology, Krakow, Poland
| | - Michał Kania
- Department of Metabolic Diseases and Diabetology, University Hospital in Krakow, Poland.,Jagiellonian University Medical College, Department of Metabolic Diseases and Diabetology, Krakow, Poland
| | - Mateusz Fiema
- Department of Metabolic Diseases and Diabetology, University Hospital in Krakow, Poland.,Jagiellonian University Medical College, Department of Metabolic Diseases and Diabetology, Krakow, Poland
| | - Joanna Zięba-Parkitny
- Department of Metabolic Diseases and Diabetology, University Hospital in Krakow, Poland.,Jagiellonian University Medical College, Department of Metabolic Diseases and Diabetology, Krakow, Poland
| | - Agnes Hajek
- Department of Metabolic Diseases and Diabetology, University Hospital in Krakow, Poland.,Jagiellonian University Medical College, Department of Metabolic Diseases and Diabetology, Krakow, Poland
| | - Damian Ucieklak
- Department of Metabolic Diseases and Diabetology, University Hospital in Krakow, Poland.,Jagiellonian University Medical College, Department of Metabolic Diseases and Diabetology, Krakow, Poland
| | - Magdalena Wilk
- Department of Metabolic Diseases and Diabetology, University Hospital in Krakow, Poland.,Jagiellonian University Medical College, Department of Metabolic Diseases and Diabetology, Krakow, Poland
| | - Kamila Pośpiech
- Department of Metabolic Diseases and Diabetology, University Hospital in Krakow, Poland.,Jagiellonian University Medical College, Department of Metabolic Diseases and Diabetology, Krakow, Poland
| | - Patrycja Lechowicz
- Department of Metabolic Diseases and Diabetology, University Hospital in Krakow, Poland.,Jagiellonian University Medical College, Department of Metabolic Diseases and Diabetology, Krakow, Poland
| | - Karol Kasprzycki
- Department of Metabolic Diseases and Diabetology, University Hospital in Krakow, Poland.,Jagiellonian University Medical College, Department of Metabolic Diseases and Diabetology, Krakow, Poland
| | - Marianna Kopka
- Department of Metabolic Diseases and Diabetology, University Hospital in Krakow, Poland.,Jagiellonian University Medical College, Department of Metabolic Diseases and Diabetology, Krakow, Poland
| | - Jerzy Hohendorff
- Department of Metabolic Diseases and Diabetology, University Hospital in Krakow, Poland.,Jagiellonian University Medical College, Department of Metabolic Diseases and Diabetology, Krakow, Poland
| | - Barbara Katra
- Department of Metabolic Diseases and Diabetology, University Hospital in Krakow, Poland.,Jagiellonian University Medical College, Department of Metabolic Diseases and Diabetology, Krakow, Poland
| | - Małgorzata Kostrzycka
- Department of Metabolic Diseases and Diabetology, University Hospital in Krakow, Poland.,Jagiellonian University Medical College, Department of Metabolic Diseases and Diabetology, Krakow, Poland
| | - Michalina Adamczyk
- Department of Metabolic Diseases and Diabetology, University Hospital in Krakow, Poland.,Jagiellonian University Medical College, Department of Metabolic Diseases and Diabetology, Krakow, Poland
| | - Paulina Surowiec
- Department of Metabolic Diseases and Diabetology, University Hospital in Krakow, Poland.,Jagiellonian University Medical College, Department of Metabolic Diseases and Diabetology, Krakow, Poland
| | - Monika Rybicka
- Jagiellonian University Medical College, Department of Internal Medicine and Gerontology, Krakow, Poland.,Department of Internal Medicine and Gerontology, University Hospital in Krakow, Poland
| | - Jolanta Walczewska
- Jagiellonian University Medical College, Department of Internal Medicine and Gerontology, Krakow, Poland.,Department of Internal Medicine and Gerontology, University Hospital in Krakow, Poland
| | - Barbara Kamińska
- Jagiellonian University Medical College, Department of Internal Medicine and Gerontology, Krakow, Poland.,Department of Internal Medicine and Gerontology, University Hospital in Krakow, Poland
| | - Ewelina Piętak
- Jagiellonian University Medical College, Department of Internal Medicine and Gerontology, Krakow, Poland.,Department of Internal Medicine and Gerontology, University Hospital in Krakow, Poland
| | - Paweł Bryniarski
- Jagiellonian University Medical College, Department of Internal Medicine and Gerontology, Krakow, Poland.,Department of Internal Medicine and Gerontology, University Hospital in Krakow, Poland.,Jagiellonian University Medical College, Department of Immunology, Krakow, Poland
| | - Monika Marona
- Jagiellonian University Medical College, Department of Neurology, Krakow, Poland.,Department of Neurology, University Hospital in Krakow, Poland
| | - Maciej Motyl
- Department of Neurology, University Hospital in Krakow, Poland
| | - Alicja Kępińska-Wnuk
- Jagiellonian University Medical College, Department of Neurology, Krakow, Poland.,Department of Neurology, University Hospital in Krakow, Poland
| | | | - Klaudia Nowak
- Jagiellonian University Medical College, Department of Neurology, Krakow, Poland.,Department of Neurology, University Hospital in Krakow, Poland
| | | | | | - Mateusz Dwojak
- Department of Neurology, University Hospital in Krakow, Poland
| | | | - Kamil Wężyk
- Department of Neurology, University Hospital in Krakow, Poland
| | | | - Agnieszka Pułyk
- Department of Neurology, University Hospital in Krakow, Poland
| | - Aleksander Garlicki
- Department of Infectious Diseases, University Hospital in Krakow, Poland.,Jagiellonian University Medical College, Department of Infectious and Tropical Diseases, Krakow, Poland
| | - Tomasz Grodzicki
- Jagiellonian University Medical College, Department of Internal Medicine and Gerontology, Krakow, Poland.,Department of Internal Medicine and Gerontology, University Hospital in Krakow, Poland
| | - Maciej Małecki
- Jagiellonian University Medical College, Department of Metabolic Diseases and Diabetology, Krakow, Poland.,Department of Metabolic Diseases and Diabetology, University Hospital in Krakow, Poland
| | - Agnieszka Słowik
- Department of Neurology, University Hospital in Krakow, Poland.,Jagiellonian University Medical College, Department of Neurology, Krakow, Poland
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Sawczyńska K, Wnuk M, Jagiełła J, Kęsek T, Wolska-Sikora M, Szara-Cichoń M, Zagata-Szewczyk K, Uchacz A, Filipowicz K, Plaszczak M, Spisak-Borowska K, Baranowska A, Wójcik-Pędziwiatr M, Swarowska-Skuza M, Szczygieł-Pilut E, Kłos M, Grzyb P, Biela M, Mierzwińska J, Sinkiewicz I, Machowski J, Węgrzyn A, Michalski M, Nowak R, Słowik A. 4C Mortality Score correlates with in-hospital functional outcome after COVID-19-associated ischaemic stroke. Neurol Neurochir Pol 2021; 55:295-299. [PMID: 33949676 DOI: 10.5603/pjnns.a2021.0037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 04/07/2021] [Accepted: 04/08/2021] [Indexed: 11/25/2022]
Abstract
AIM OF THE STUDY The 4C Mortality Score was created to predict mortality in hospitalised patients with COVID-19 and has to date been evaluated only in respiratory system disorders. The aim of this study was to investigate its application in patients with COVID-19-associated acute ischaemic stroke (AIS). CLINICAL RATIONALE FOR STUDY COVID-19 is a risk factor for AIS. COVID-19-associated AIS results in higher mortality and worse functional outcome. Predictors of functional outcome in COVID-19-associated AIS are required. MATERIALS AND METHODS This was a retrospective observational study of patients with AIS hospitalised in seven neurological wards in Małopolska Voivodship (Poland) between August and December 2020. We gathered data concerning the patients' age, sex, presence of cardiovascular risk factors, type of treatment received, and the presence of stroke-associated infections (including pneumonia, urinary tract infection and infection of unknown source). We calculated 4C Mortality Score at stroke onset, and investigated whether there was a correlation with neurological deficit measured using the National Health Institute Stroke Scale (NIHSS) and functional outcome assessed using the modified Rankin Scale (mRS) at discharge. RESULTS The study included 52 patients with COVID-19-associated AIS. The 4C Mortality Score at stroke onset correlated with mRS (rs = 0.565, p < 0.01) at discharge. There was also a statistically significant difference in the mean 4C Mortality Score between patients who died and patients who survived the stroke (13.08 ± 2.71 vs. 9.85 ± 3.47, p = 0.04). CONCLUSIONS AND CLINICAL IMPLICATIONS 4C Mortality Score predicts functional outcome at discharge in COVID-19-associated AIS patients.
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Affiliation(s)
- Katarzyna Sawczyńska
- Department of Neurology, Jagiellonian University Medical College, Krakow, Poland. .,Department of Neurology, University Hospital in Krakow, Poland.
| | - Marcin Wnuk
- Department of Neurology, Jagiellonian University Medical College, Krakow, Poland.,Department of Neurology, University Hospital in Krakow, Poland
| | - Jeremiasz Jagiełła
- Department of Neurology, Jagiellonian University Medical College, Krakow, Poland.,Department of Neurology, University Hospital in Krakow, Poland
| | - Tomasz Kęsek
- Department of Neurology, University Hospital in Krakow, Poland
| | | | | | - Kinga Zagata-Szewczyk
- Department of Neurology, John Paul II Podhale Specialist Hospital, Nowy Targ, Poland
| | - Adela Uchacz
- Department of Neurology, John Paul II Podhale Specialist Hospital, Nowy Targ, Poland
| | - Katarzyna Filipowicz
- Department of Neurology, John Paul II Podhale Specialist Hospital, Nowy Targ, Poland
| | - Marcin Plaszczak
- Department of Neurology, John Paul II Podhale Specialist Hospital, Nowy Targ, Poland
| | | | - Anna Baranowska
- Department of Neurology, Jedrzej Sniadecki Specialist Hospital, Nowy Sacz, Poland
| | | | | | | | - Mariusz Kłos
- Department of Neurology, Ludwik Rydygier Specialist Hospital, Krakow, Poland
| | - Piotr Grzyb
- Department of Neurology, Ludwik Rydygier Specialist Hospital, Krakow, Poland
| | - Michał Biela
- Department of Neurology, Ludwik Rydygier Specialist Hospital, Krakow, Poland
| | - Joanna Mierzwińska
- Department of Neurology, Henryk Klimontowicz Specialist Hospital, Gorlice, Poland
| | - Iwona Sinkiewicz
- Department of Neurology, John Paul II Podhale Specialist Hospital, Nowy Targ, Poland
| | - Jerzy Machowski
- Department of Neurology, Saint Maximillian County Hospital, Oswiecim, Poland
| | - Anna Węgrzyn
- Department of Neurology, Jedrzej Sniadecki Specialist Hospital, Nowy Sacz, Poland
| | - Michał Michalski
- Department of Neurology, John Paul II Specialist Hospital, Krakow, Poland
| | - Ryszard Nowak
- Department of Neurology, Ludwik Rydygier Specialist Hospital, Krakow, Poland
| | - Agnieszka Słowik
- Department of Neurology, Jagiellonian University Medical College, Krakow, Poland.,Department of Neurology, University Hospital in Krakow, Poland
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Terlecki M, Wojciechowska W, Klocek M, Olszanecka A, Stolarz-Skrzypek K, Grodzicki T, Małecki M, Katra B, Garlicki A, Bociąga-Jasik M, Sładek K, Matyja A, Wordliczek J, Słowik A, Mach T, Krzanowska K, Krzanowski M, Stręk P, Chłosta P, Hydzik P, Korkosz M, Popiela T, Pilecki M, Gądek A, Rajzer M. Association between cardiovascular disease, cardiovascular drug therapy, and in-hospital outcomes in patients with COVID-19: data from a large single-center registry in Poland. Kardiol Pol 2021; 79:773-780. [PMID: 33926173 DOI: 10.33963/kp.15990] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND COVID-19 recently became one of the leading causes of death worldwide, similar to cardiovascular disease (CVD). Coexisting CVD may influence the prognosis of patients with COVID-19. AIMS To analyze the impact of CVD and use of cardiovascular drugs on the in-hospital course and mortality of patients with COVID-19. METHODS We retrospectively studied data for consecutive patients admitted to our hospital, with COVID-19 between March 6th and October 15th, 2020. RESULTS 1729 patients (median (Q1 - Q3) age 63 (50-75) years; women 48.8%) were included. Overall, in-hospital mortality was 12.9%. The most prevalent CVD was arterial hypertension (56.1%), followed by hyperlipidemia (27.4%), diabetes mellitus (DM) (25.7%), coronary artery disease (16.8%), heart failure (HF) (10.3%), atrial fibrillation (13.5%), and stroke (8%). Angiotensin converting enzyme inhibitors or angiotensin receptor blockers (ACEIs/ARBs) were used in 25.0% of patients, β-blockers in 40.7%, statins in 15.6%, and antiplatelet therapy in 19.9%. Age over 65 years (odds ratio [OR] 6.4, 95% CI 4.3-9.6), male sex (OR 1.4, 95% CI 1.1-2.0), pre-existing DM (OR 1.5, 95% CI 1.1-2.1), and HF (OR 2.3, 95% CI 1.5-3.5) were independent predictors of in-hospital death, whereas treatment with ACEIs/ARBs (OR 0.4, 95% CI 0.3-0.6), β-blockers (OR 0.6, 95% CI 0.4-0.9), statins (OR 0.5, 95% CI 0.3-0.8), or antiplatelet therapy (OR 0.6, 95% CI 0.4-0.9) was associated with lower risk of death. CONCLUSION Among cardiovascular risk factors and diseases, HF and DM appeared to increase in-hospital COVID-19 mortality, whereas the use of cardiovascular drugs was associated with lower mortality.
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Jamroz-Wiśniewska A, Zajdel R, Słowik A, Marona M, Wnuk M, Adamczyk-Sowa M, Adamczyk B, Lasek-Bal A, Puz P, Stęposz A, Krzystanek E, Patalong-Ogiewa M, Pokryszko-Dragan A, Budrewicz S, Koziarska D, Karbicka A, Wawrzyniak S, Fryze W, Furtak-Niczyporuk M, Rejdak K. Modified Rio Score with Platform Therapy Predicts Treatment Success with Fingolimod and Natalizumab in Relapsing-Remitting Multiple Sclerosis Patients. J Clin Med 2021; 10:jcm10091830. [PMID: 33922368 PMCID: PMC8122749 DOI: 10.3390/jcm10091830] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 04/12/2021] [Accepted: 04/20/2021] [Indexed: 01/16/2023] Open
Abstract
Background: Reliable markers of disease outcomes in multiple sclerosis (MS) would help to predict the response to treatment in patients treated with high efficacy drugs. No evidence of disease activity (NEDA) has become a treatment goal whereas the modified Rio score (MRS) predicts future suboptimal responders to treatment. The aim of our study was to identify factors that would predict poor response to treatment with natalizumab and fingolimod. Methods: In the multicenter prospective trial, 336 subjects were enrolled, initiating therapy with natalizumab (n = 135) or fingolimod (n = 201). Data on relapse rate, the expanded disability status scale, and MRI results were collected, and MRS was estimated. Results: NEDA-3 after the first year of therapy was 73.9% for natalizumab and 54.8% for fingolimod (p < 0.0001). Patients with MRS = 0 in the last year on platform therapy had the best NEDA-3 (71%) and patients with MRS = 3 had the worst NEDA-3 (41%) in the first year of treatment with the second-line therapy. Conclusion: We conclude that switching to the second-line therapy should occur earlier to enable better results for patients treated with natalizumab or fingolimod. The outcome on both drugs is better with better neurological conditions and lower MRS of the patient on the platform therapy.
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Affiliation(s)
- Anna Jamroz-Wiśniewska
- Department of Neurology, Medical University of Lublin, Jaczewskiego 8, 20-054 Lublin, Poland;
- Correspondence: ; Tel.: +48-81-72-44-720
| | - Radosław Zajdel
- Chair of Informatics in Business, University of Lodz, Rewolucji 1905 Roku 37/39, 91-001 Lodz, Poland;
| | - Agnieszka Słowik
- Department of Neurology, Collegium Medicum, Jagiellonian University, Jakubowskiego 2, 30-688 Krakow, Poland; (A.S.); (M.M.); (M.W.)
| | - Monika Marona
- Department of Neurology, Collegium Medicum, Jagiellonian University, Jakubowskiego 2, 30-688 Krakow, Poland; (A.S.); (M.M.); (M.W.)
| | - Marcin Wnuk
- Department of Neurology, Collegium Medicum, Jagiellonian University, Jakubowskiego 2, 30-688 Krakow, Poland; (A.S.); (M.M.); (M.W.)
| | - Monika Adamczyk-Sowa
- Department of Neurology, School of Health Sciences in Zabrze, Medical University of Silesia in Katowice, 3-go Maja 13-15, 41-800 Zabrze, Poland; (M.A.-S.); (B.A.)
| | - Bożena Adamczyk
- Department of Neurology, School of Health Sciences in Zabrze, Medical University of Silesia in Katowice, 3-go Maja 13-15, 41-800 Zabrze, Poland; (M.A.-S.); (B.A.)
| | - Anetta Lasek-Bal
- Department of Neurology, School of Health Sciences, Medical University of Silesia in Katowice, Ziolowa 45-47, 40-635 Katowice, Poland; (A.L.-B.); (P.P.); (A.S.)
| | - Przemysław Puz
- Department of Neurology, School of Health Sciences, Medical University of Silesia in Katowice, Ziolowa 45-47, 40-635 Katowice, Poland; (A.L.-B.); (P.P.); (A.S.)
| | - Arkadiusz Stęposz
- Department of Neurology, School of Health Sciences, Medical University of Silesia in Katowice, Ziolowa 45-47, 40-635 Katowice, Poland; (A.L.-B.); (P.P.); (A.S.)
| | - Ewa Krzystanek
- Department of Neurology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Medykow 14, 40-752 Katowice, Poland;
| | - Maja Patalong-Ogiewa
- Department of Neurorehabilitation, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Medykow 14, 40-752 Katowice, Poland;
| | - Anna Pokryszko-Dragan
- Department of Neurology, Wroclaw Medical University, Borowska 213, 50-566 Wroclaw, Poland; (A.P.-D.); (S.B.)
| | - Sławomir Budrewicz
- Department of Neurology, Wroclaw Medical University, Borowska 213, 50-566 Wroclaw, Poland; (A.P.-D.); (S.B.)
| | - Dorota Koziarska
- Department of Neurology, Pomeranian Medical University in Szczecin, Unii Lubelskiej 1, 71-252 Szczecin, Poland;
| | - Anna Karbicka
- Department of Neurology, Regional Hospital, Arkonska 4, 71-455 Szczecin, Poland;
| | - Sławomir Wawrzyniak
- Department of Neurology, 10th Military Research Hospital and Polyclinic, Powstancow Warszawy 5, 85-681 Bydgoszcz, Poland;
| | - Waldemar Fryze
- Department of Neurology, Copernicus Pl, M. Kopernik Hospital, Nowe Ogrody 1-6, 80-803 Gdansk, Poland;
| | | | - Konrad Rejdak
- Department of Neurology, Medical University of Lublin, Jaczewskiego 8, 20-054 Lublin, Poland;
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Czarnowska A, Brola W, Zajkowska O, Rusek S, Adamczyk-Sowa M, Kubicka-Bączyk K, Kalinowska-Łyszczarz A, Kania K, Słowik A, Wnuk M, Marona M, Podlecka-Piętowska A, Nojszewska M, Zakrzewska-Pniewska B, Jasińska E, Gołuch K, Lech B, Noga M, Perenc A, Popiel M, Lasek-Bal A, Puz P, Maciejowska K, Kucharska-Lipowska M, Lipowski M, Kapica-Topczewska K, Chorąży M, Tarasiuk J, Kochanowicz J, Kulikowska J, Wawrzyniak S, Niezgodzińska-Maciejek A, Pokryszko-Dragan A, Gruszka E, Budrewicz S, Białek M, Kurkowska-Jastrzębska I, Kurowska K, Stępień A, Włodek A, Ptasznik V, Pawełczyk M, Sobolewski P, Lejmel H, Strzalińska K, Maciejowski M, Tutaj A, Zwiernik J, Litwin A, Lewańczyk B, Paprocka I, Zwiernik B, Pawlos A, Borysowicz A, Narożnik A, Michałowska A, Nosek K, Fudala M, Milewska-Jędrzejczak M, Kułakowska A, Bartosik-Psujek H. Clinical course and outcome of SARS-CoV-2 infection in multiple sclerosis patients treated with disease-modifying therapies - the Polish experience. Neurol Neurochir Pol 2021; 55:212-222. [PMID: 33856686 DOI: 10.5603/pjnns.a2021.0031] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 03/12/2021] [Accepted: 03/15/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The aim of this study was to report the course and outcome of SARS-CoV-2 infection in multiple sclerosis (MS) patients treated with disease-modifying therapies (DMTs) in Poland. A major concern for neurologists worldwide is the course and outcome of SARS-CoV-2 infection in patients with MS treated with different DMTs. Although initial studies do not suggest an unfavourable course of infection in this group of patients, the data is limited. MATERIALS AND METHODS This study included 396 MS patients treated with DMTs and confirmed SARS-CoV-2 infection from 28 Polish MS centres. Information concerning patient demographics, comorbidities, clinical course of MS, current DMT use, as well as symptoms of SARS-CoV-2 infection, need for pharmacotherapy, oxygen therapy, and/or hospitalisation, and short-term outcomes was collected up to 30 January 2021. Additional data about COVID-19 cases in the general population in Poland was obtained from official reports of the Polish Ministry of Health. RESULTS There were 114 males (28.8%) and 282 females (71.2%). The median age was 39 years (IQR 13). The great majority of patients with MS exhibited relapsing-remitting course (372 patients; 93.9%). The median EDSS was 2 (SD 1.38), and the mean disease duration was 8.95 (IQR 8) years. Most of the MS patients were treated with dimethyl fumarate (164; 41.41%). Other DMTs were less frequently used: interferon beta (82; 20.70%), glatiramer acetate (42; 10.60%), natalizumab (35;8.84%), teriflunomide (25; 6.31%), ocrelizumab (20; 5.05%), fingolimod (16; 4.04), cladribine (5; 1.26%), mitoxantrone (3; 0.76%), ozanimod (3; 0.76%), and alemtuzumab (1; 0.25%). The overall hospitalisation rate due to COVID-19 in the cohort was 6.81% (27 patients). Only one patient (0.3%) died due to SARS-CoV-2 infection, and three (0.76%) patients were treated with mechanical ventilation; 106 (26.8%) patients had at least one comorbid condition. There were no significant differences in the severity of SARS-CoV-2 infection regarding patient age, duration of the disease, degree of disability (EDSS), lymphocyte count, or type of DMT used. CONCLUSIONS AND CLINICAL IMPLICATIONS Most MS patients included in this study had a favourable course of SARS-CoV-2 infection. The hospitalisation rate and the mortality rate were not higher in the MS cohort compared to the general Polish population. Continued multicentre data collection is needed to increase the understanding of SARS-CoV-2 infection impact on the course of MS in patients treated with DMTs.
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Affiliation(s)
| | - Waldemar Brola
- Collegium Medicum, Jan Kochanowski University, Kielce, Poland
| | - Olga Zajkowska
- Faculty of Economic Sciences, University of Warsaw, Poland
| | - Stanisław Rusek
- Department of Neurology, Specialist Hospital Ludwika Rydygiera in Krakow, Poland
| | - Monika Adamczyk-Sowa
- Department of Neurology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, Poland
| | - Katarzyna Kubicka-Bączyk
- Department of Neurology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, Poland
| | - Alicja Kalinowska-Łyszczarz
- Department of Neurology, Division of Neurochemistry and Neuropathology, Poznan University of Medical Sciences, Poland
| | - Karolina Kania
- Department of Neurology, Poznan University of Medical Sciences, Poland
| | - Agnieszka Słowik
- Department of Neurology, Jagiellonian University Medical College, Krakow, Poland
| | - Marcin Wnuk
- Department of Neurology, Jagiellonian University Medical College, Krakow, Poland
| | - Monika Marona
- Department of Neurology, Jagiellonian University Medical College, Krakow, Poland
| | | | | | | | - Elżbieta Jasińska
- Collegium Medicum UJK, and Clinical Center, RESMEDICA, Kielce, Poland
| | | | - Beata Lech
- Neurology Clinic with Brain Stroke Sub-Unit, Clinical Hospital No. 2 in Rzeszow, Poland
| | - Magdalena Noga
- Neurology Clinic with Brain Stroke Sub-Unit, Clinical Hospital No. 2 in Rzeszow, Poland
| | - Adam Perenc
- Neurology Clinic with Brain Stroke Sub-Unit, Clinical Hospital No. 2 in Rzeszow, Poland
| | - Małgorzata Popiel
- Neurology Clinic with Brain Stroke Sub-Unit, Clinical Hospital No. 2 in Rzeszow, Poland
| | - Anetta Lasek-Bal
- Department of Neurology, School of Health Sciences, Medical University of Silesia in Katowice, Poland
| | - Przemysław Puz
- Department of Neurology, School of Health Sciences, Medical University of Silesia in Katowice, Poland
| | - Katarzyna Maciejowska
- Department of Neurology, School of Health Sciences, Medical University of Silesia in Katowice, Poland
| | | | - Michał Lipowski
- Department of Urology, Specialist Hospital in Końskie, Poland
| | | | | | | | | | | | - Sławomir Wawrzyniak
- Department of Neurology, 10th Military Research Hospital and Polyclinic, Independent Public Healthcare Centre, Bydgoszcz, Poland
| | - Anna Niezgodzińska-Maciejek
- Department of Neurology, 10th Military Research Hospital and Polyclinic, Independent Public Healthcare Centre, Bydgoszcz, Poland
| | | | - Ewa Gruszka
- Department of Neurology, Wroclaw Medical University, Wroclaw, Poland
| | | | - Marta Białek
- Department of Neurology, Regional Specialised Hospital No. 4 in Bytom, Poland
| | | | - Katarzyna Kurowska
- 2nd Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Adam Stępień
- Department of Neurology, Military Institute of Medicine, Warsaw, Poland
| | - Agata Włodek
- Department of Neurology, Masovian Voivodeship Hospital in Siedlce, Poland
| | | | | | - Piotr Sobolewski
- Department of Neurology and Stroke Unit in Sandomierz, Collegium Medicum, Jan Kochanowski University in Kielce
| | - Henryka Lejmel
- Department of Neurology, The Regional Hospital in Suwalki, Poland
| | | | | | - Andrzej Tutaj
- Neurology Ward, Provincial Specialist Hospital, Olsztyn, Poland
| | - Jacek Zwiernik
- Neurology Ward, Provincial Specialist Hospital, Olsztyn, Poland; Department of Neurology, University of Warmia and Mazury, Olsztyn, Poland
| | - Anna Litwin
- Neurology Ward, Provincial Specialist Hospital, Olsztyn, Poland
| | | | | | - Beata Zwiernik
- Department of Neurology, University of Warmia and Mazury, Olsztyn, Poland; Clinic of Neurology, University of Warmia and Mazury, Olsztyn, Poland
| | - Aleksandra Pawlos
- Department of Pharmacology and Toxicology, Faculty of Medicine, University of Warmia and Mazury, Olsztyn, Poland
| | - Andrzej Borysowicz
- Department of Neurology, Specialist Hospital Dr Tytus Chałubiński Radom, Poland
| | - Anna Narożnik
- Department of Neurology, Specialist Hospital Dr Tytus Chałubiński Radom, Poland
| | | | - Krzysztof Nosek
- Department of Pharmacology and Toxicology, Faculty of Medicine, University of Warmia and Mazury, Olsztyn, Poland
| | - Małgorzata Fudala
- Department of Neurology, Regional Hospital in Skarżysko-Kamienna, Poland
| | | | | | - Halina Bartosik-Psujek
- Department of Neurology, Institute of Medical Sciences, Medical College of Rzeszow University, Poland
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Bosak M, Wężyk K, Słowik A. Lacosamide and myoclonic seizures: what is the risk of aggravation? Neurol Neurochir Pol 2021; 55:107-109. [PMID: 33512706 DOI: 10.5603/pjnns.a2021.0008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 01/07/2021] [Accepted: 01/08/2021] [Indexed: 11/25/2022]
Affiliation(s)
- Magdalena Bosak
- Collegium Medicum, Jagiellonian University of Krakow, Poland.
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47
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Kulczyńska-Przybik A, Słowik A, Mroczko P, Borawski B, Groblewska M, Borawska R, Mroczko B. Cerebrospinal Fluid and Blood CX3CL1 as a Potential Biomarker in Early Diagnosis and Prognosis of Dementia. Curr Alzheimer Res 2020; 17:709-721. [PMID: 33167838 DOI: 10.2174/1567205017666201109095657] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 09/11/2020] [Accepted: 10/13/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND A growing body of evidence highlights the crucial role of neuroinflammation and chemokine involvement in cognitive impairment pathophysiology. Fractalkine (CX3CL1) appears to be a relevant causative factor in the development of dementia, particularly at the early stages of the disease. However, limited data are available on the levels of CX3CL1 in the cerebrospinal fluid (CSF) and blood. Additionally, to date, its utility as a biomarker for MCI or AD has not been studied. OBJECTIVE The aim of the present study was to evaluate the clinical utility of CX3CL1 in the early diagnosis of cognitive impairment. We also compared the diagnostic usefulness of CX3CL1 with other biomarkers associated with neuroinflammation. METHODS A total of 60 patients with cognitive impairment, including 42 patients with AD and 18 subjects with MCI, as well as 20 cognitively healthy controls were enrolled in the study. CSF and blood concentrations of CX3CL1, CCL-2, and YKL-40 were measured by ELISA. RESULTS Significantly higher CSF and blood concentrations of CX3CL1 were observed in MCI and AD patients compared to older individuals without cognitive impairment. The increase in the levels of CX3CL1 and YKL-40 in non-demented subjects was associated with MCI. The area under the ROC curve for CX3CL1 in MCI subjects was larger in comparison to classical AD markers. CONCLUSION Presented results indicate a crucial role of CX3CL1 in the pathology of cognitive impairment and the potential usefulness of this protein in the early diagnosis of MCI and AD.
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Affiliation(s)
| | - Agnieszka Słowik
- Department of Neurology, Jagiellonian University, Krakow, Poland
| | - Piotr Mroczko
- Department of Criminal Law and Criminology, Faculty of Law, University of Bialystok, Bialystok, Poland
| | - Bartłomiej Borawski
- Department of Neurodegeneration Diagnostics, Medical University of Bialystok, Waszyngtona, Bialystok, Poland
| | - Magdalena Groblewska
- Department of Biochemical Diagnostics, University Hospital in Bialystok, Bialystok, Poland
| | - Renata Borawska
- Department of Neurodegeneration Diagnostics, Medical University of Bialystok, Waszyngtona, Bialystok, Poland
| | - Barbara Mroczko
- Department of Neurodegeneration Diagnostics, Medical University of Bialystok, Waszyngtona, Bialystok, Poland.,Department of Biochemical Diagnostics, University Hospital in Bialystok, Bialystok, Poland.,Department of Biochemical Diagnostics, Medical University of Bialystok, Bialystok, Poland
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48
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Nowak K, Włodarczyk E, Porębska K, Chatys-Bogacka Ż, Jagiełła J, Pułyk R, Słowik J, Popiela T, Słowik A. Mechanical thrombectomy for acute ischaemic stroke during therapeutic anticoagulation: long-term outcomes. Neurol Neurochir Pol 2020; 54:538-543. [PMID: 33202029 DOI: 10.5603/pjnns.a2020.0088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 09/22/2020] [Accepted: 09/25/2020] [Indexed: 11/25/2022]
Abstract
AIM OF STUDY Mechanical thrombectomy (MT) is one of the aetiological treatment options recommended for anticoagulated patients with acute ischaemic stroke (AIS). We analysed its long-term outcomes using the modified Rankin Score (mRS) or mortality on day 90. CLINICAL RATIONALE FOR THE STUDY Data describing the anticoagulant efficacy and safety of MT in patients with AIS is limited. MATERIALS AND METHODS This study included 291 patients with AIS (49% women, mean [SD] age 66 [15] years) who underwent MT in the Comprehensive Stroke Centre in Krakow, Poland. Data describing demographics, stroke risk factors, NIHSS on admission, postprocedural thrombolysis in cerebral infarction score, 24-hour postprocedural haemorrhagic transformation (ECASS-2) as seen on computed tomography, and time between stroke onset and groin puncture was collected. The outcome measure was the mRS on day 90 after stroke onset (a favourable outcome was defined as an mRS not exceeding 2 points; an unfavourable outcome was death). RESULTS Thirty-seven patients (13%) were on therapeutic anticoagulation during MT. Univariate analysis showed that anticoagulated patients were older and more likely to have been diagnosed with hypertension, ischaemic heart disease, or atrial fibrillation. The patient groups did not differ in terms of clot location, postprocedural thrombolysis in cerebral infarction score, haemorrhagic transformation on computed tomography, or mRS on day 90. Multivariate logistic regression analysis showed that younger age, male sex, no history of diabetes mellitus, lower NIHSS score on admission, shorter time between stroke onset and groin puncture, and better recanalisation were associated with favourable outcomes at day 90, and that therapeutic anticoagulation was not (OR, 1.00; 95%CI, 0.46-2.15; p = 0.99). Anticoagulation did not affect mortality at day 90 (OR, 1.28; 95%CI, 0.56-2.92; p = 0.55). CONCLUSION AND CLINICAL IMPLICATIONS In anticoagulated patients with AIS, MT does not affect long-term outcomes.
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Affiliation(s)
- Klaudia Nowak
- Neurology Department, Jagiellonian University, Krakow, Poland. .,Neurology Department, University Hospital in Krakow.
| | | | | | | | | | - Roman Pułyk
- Neurology Department, University Hospital in Krakow
| | - Joanna Słowik
- Department of Dental Prophylaxis and Experimental Dentistry, Jagiellonian University Medical College, Montelupich 4 Str., 31-155 Krakow, Poland, 31-155 Krakow, Poland
| | - Tadeusz Popiela
- Department of Radiology, Jagiellonian University Medical College, Krakow, Poland., Jakubowskiego 2, 30-688 Krakow, Poland
| | - Agnieszka Słowik
- Neurology Department, Jagiellonian University, Krakow, Poland.,Neurology Department, University Hospital in Krakow
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49
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Bosak M, Sułek A, Łukasik M, Żak A, Słowik A, Lasek-Bal A. Genetic testing and the phenotype of Polish patients with Unverricht-Lundborg disease (EPM1) - A cohort study. Epilepsy Behav 2020; 112:107439. [PMID: 32920378 DOI: 10.1016/j.yebeh.2020.107439] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 08/21/2020] [Accepted: 08/21/2020] [Indexed: 11/17/2022]
Abstract
AIM OF THE STUDY The aim of this study was to explore genetic findings and the phenotype in Polish patients with Unverricht-Lundborg disease (ULD). MATERIALS AND METHODS We retrospectively evaluated mutations in the cystatin B (CSTB) gene and clinical presentation in a cohort of patients with ULD. The study population consisted of 19 (14 males) patients with genetically confirmed disease. RESULTS Sixteen patients were homozygous for the expanded dodecamer repeat mutation alleles, one subject was compound heterozygous for the dodecamer repeat expansion and other mutation, in two, the type of mutation has not yet been established. The numbers of repeats in the CSTB gene varied from 60 to 81. Clinical information was available for 16 subjects. The disease course was progressive in all patients, leading to severe disability, mainly due to myoclonus, in nine. CONCLUSIONS AND CLINICAL IMPLICATIONS Genetic findings and the clinical picture of our patients with ULD were in accordance with available studies. The most common genetic defect underlying ULD was homozygosity for an unstable expansion of a dodecamer repeat in the CSTB gene. Patients with action or/and stimulus sensitive myoclonus or intractable myoclonus epilepsy, especially with onset in late childhood/adolescence should be screened for ULD.
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Affiliation(s)
- Magdalena Bosak
- Jagiellonian University Medical College, Faculty of Medicine, Department of Neurology, Jakubowskiego 2, 30-688 Kraków, Poland.
| | - Anna Sułek
- Department of Genetics, Institute of Psychiatry and Neurology, Sobieskiego 9, 02-957 Warszawa, Poland
| | - Maria Łukasik
- Laboratory of Flow Cytometry and Vascular Biology, Department of Neurology, University of Medical Sciences, Przybyszewskiego 49, 60-355 Poznań, Poland
| | - Amadeusz Żak
- Department of Neurology, School of Health Sciences, Medical University of Silesia, Ziołowa 45/47, 40-635 Katowice, Poland
| | - Agnieszka Słowik
- Jagiellonian University Medical College, Faculty of Medicine, Department of Neurology, Jakubowskiego 2, 30-688 Kraków, Poland
| | - Anetta Lasek-Bal
- Department of Neurology, School of Health Sciences, Medical University of Silesia, Ziołowa 45/47, 40-635 Katowice, Poland
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50
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Sąsiadek M, Hartel M, Siger M, Katulska K, Majos A, Kluczewska E, Bartosik-Psujek H, Kułakowska A, Słowik A, Steinborn B, Adamczyk-Sowa M, Kalinowska A, Krzystanek E, Bonek R, Serafin Z, Sławek J, Nowacki P, Stępień A, Jóżwiak S, Rejdak K, Selmaj K, Walecki J. Recommendations of the Polish Medical Society of Radiology and the Polish Society of Neurology for a protocol concerning routinely used magnetic resonance imaging in patients with multiple sclerosis. Neurol Neurochir Pol 2020; 54:410-415. [PMID: 33085075 DOI: 10.5603/pjnns.a2020.0084] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 09/03/2020] [Accepted: 09/03/2020] [Indexed: 11/25/2022]
Abstract
Magnetic resonance imaging (MRI) is a widely used method for the diagnosis of multiple sclerosis that is essential for the detection and follow-up of the disease. OBJECTIVE: The Polish Medical Society of Radiology (PLTR) and the Polish Society of Neurology (PTN) present the second version of their recommendations for investigations routinely conducted in magnetic resonance imaging departments in patients with multiple sclerosis. This version includes new data and practical comments for electroradiology technologists and radiologists. The recommended protocol aims to improve the MRI procedure and, most importantly, to standardise the method of conducting scans in all MRI departments. This is crucial for the initial diagnostics necessary for establishing a diagnosis, as well as for MS patient monitoring, which directly translates into significant clinical decisions. INTRODUCTION: Multiple sclerosis (MS) is a chronic immune mediated inflammatory demyelinating disease of the central nervous system (CNS), the aetiology of which is still unknown. The nature of the disease lies in a CNS destruction process disseminated in time (DIT) and space (DIS). MRI detects focal lesions in the white and grey matter with high sensitivity (although with significantly lower specificity in the latter). It is also the best tool to assess brain atrophy in patients with MS in terms of grey matter volume (GMV) and white matter volume (WMV) as well as local atrophy (by measuring the volume of thalamus, corpus callosum, subcortical nuclei, and hippocampus) as parameters that correlate with disability progression and cognitive dysfunctions. Progress in MR techniques, as well as advances in postprocessing the obtained data, has driven the dynamic development of computer programs that allow for a more repeatable assessment of brain atrophy in both cross-sectional and longitudinal studies. MR imaging is unquestionably the best diagnostic tool available to follow up the course of the disease and support clinicians in choosing the most appropriate treatment strategy for their MS patient. However, to diagnose and follow up MS patients on the basis of MRI in accordance with the latest standards, the MRI study must adhere to certain quality criteria. Such criteria are the subject of this paper.
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Affiliation(s)
- Marek Sąsiadek
- Department of General and Interventional Radiology and Neuroradiology, Wroclaw Medical University, Poland
| | | | | | - Katarzyna Katulska
- Department of Neuroradiology, Poznan University of Medical Sciences, Poznan, Poland
| | - Agata Majos
- Department of Radiological and Isotopic Diagnosis and Therapy, Medical University of Lodz, Poland
| | - Ewa Kluczewska
- Department and Institute of Medical Radiology and Radiodiagnostics in Zabrze, Medical University of Silesia in Katowice, Poland
| | | | - Alina Kułakowska
- Department of Neurology, Medical University of Bialystok, Poland
| | - Agnieszka Słowik
- Jagiellonian University Medical College, Department of Neurology, Krakow, Poland; University Hospital in Krakow, Poland
| | - Barbara Steinborn
- Department of Developmental Neurology, Poznan University of Medical Sciences, Poznan, Poland
| | - Monika Adamczyk-Sowa
- Department of Neurology in Zabrze, Medical University of Silesia, Zabrze, Poland
| | - Alicja Kalinowska
- Department of Neurology, Division of Neurochemistry and Neuropathology, Poznan University of Medical Sciences, Poland
| | - Ewa Krzystanek
- Department of Neurology, School of Medicine in Katowice, Medical University of Silesia, 40-055 Katowice, Poland
| | - Robert Bonek
- Department of Neurology and Clinical Neuroimmunology, Regional Specialist Hospital, Grudziądz, Poland
| | - Zbigniew Serafin
- Department of Radiology and Diagnostic Imaging, Nicolaus Copernicus University, Collegium Medicum, Bydgoszcz, Poland
| | | | - Przemysław Nowacki
- Department of Neurology, Pomeranian Medical University, Szczecin, Poland
| | - Adam Stępień
- Department of Neurology, Military Institute of Medicine, Warsaw, Poland
| | - Sergiusz Jóżwiak
- Department of Pediatric Neurology, Warsaw Medical University, Warsaw, Poland
| | - Konrad Rejdak
- Department of Neurology; Medical University of Lublin, Poland
| | - Krzysztof Selmaj
- Department of Neurology, Laboratory of Neuroimmunology, Faculty of Medicine, University of Warmia and Mazury, Olsztyn, Poland
| | - Jerzy Walecki
- Department of Radiology, Medical Centre for Postgraduate Education, Warsaw, Poland
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