Health Outcomes of Judo Training as an Organized Physical Activity for Children and Adolescents: A Literature Review

Judo, an organized physical activity for children and adolescents, has gained popularity worldwide. Physical activity is vital during times of rising obesity and a sedentary lifestyle in this age group. The article aims to review the current knowledge of the health benefits of judo-specific exercises for children and youth. Six international scientific databases (PubMed, Scopus, UpToDate, Web of Science, EBSCOhost, and Google Scholar) were searched from 1 January 2007 to 30 September 2022. The search focused on health-related factors regarding healthy preschool and school-aged judo practitioners. Sixteen original studies met the inclusion criteria. School-aged children aged 7-15 years were included in the analysis. The average training time was between two and six hours a week, with the judo intervention mainly ranging from nine months to three years. Most studies registered positive changes caused by judo training. The outcomes focused on maintaining or reducing body fat, increasing bone mineralization, and improving the function of the cardiorespiratory system compared to the non-practicing control group. However, there were no differences between judo and other sports groups. The main conclusions presented health benefits from judo-specific training in school-aged children and may support the World Health Organization recommendations concerning daily physical activity.

The Role of Thyroid Hormones on Skeletal Muscle Thermogenesis

Nowadays obesity becomes a significant global problem. Hence, recently more and more attention has been paid to substances present in the body that have a significant impact on metabolic processes and thermogenesis, in the context of their potential use in the prevention and treatment of obesity. It is well known that the relationship between thyroid hormones and obesity is multilayered, however recently, more and more information about the possible relation between thyroid hormones and muscle metabolism has been published. The aim of this review is to present the most updated information on the physiological impact of thyroid hormones on muscle tissue, as well as pathological changes related to the occurrence of various types of thyroid disorders, including hypothyroidism, hyperthyroidism and sick euthyroid syndrome. However, the data in humans still remains insufficient, and further studies are needed to fully explore the thyroid-muscle cross-talk.

Evaluation of selected health behaviours in patients with inflammatory bowel diseases - a preliminary report

In treating inflammatory bowel diseases (IBD), regular physical activity (PA) and healthy behaviours play an increasingly important role.

AIM

The aim of the study was to analyse PA with motivation to undertake it, health behaviours, and level of self-esteem in individuals with IBD.

MATERIALS AND METHODS

The study involved 50 (mean age 39.1±11.5 years) adults with IBD hospitalised in Poznan. The control group consisted of 50 (mean age 40.7±9.1 years) healthy volunteers. The survey included sociodemographic data, Inventory of Physical Activity Objectives (IPAO), Inventory of Health Behaviours (IHB), and Rosenberg self-esteem scale. Differences between groups were calculated using the Mann-Whitney test (p<0.05).

RESULTS

Most respondents of both groups did not undertake any PA. The values of IPAO categories in a group with IBD were significantly higher compared to the control group. Also, people with IBD had a statistically more significant value of general intensity index of health behaviour and statistically higher self-esteem than a group of healthy people.

CONCLUSIONS

We found that people with IBD show a greater awareness of the impact of their health behaviour on their health when compared to control. However, the authors recorded the unsatisfactory level of motivation to undertake daily PA and practical pro-health activities. In treating these chronically ill patients, physicians should pay more attention to adequate education and motivation for regular exercise and appropriate health behaviours in everyday life.

Influence of SARS-CoV-2 infection on thyroid gland function: The current knowledge

The paper summarizes the current knowledge about the influence of SARS-CoV-2 on the thyroid gland and benign thyroid diseases, with emphasis on the situation in Poland. Based on the latest scientific literature published up to May 1, 2021 and the PubMed, Google Scholar, EMBASE and Web of Science database searches, keywords related to SARS-CoV-2 and its impact on the thyroid gland and benign thyroid diseases were searched. COVID-19-related thyroid disorders include non-thyroid syndrome, hypothyroidism and thyrotoxicosis. The authors paid special attention to the treatment of thyroid disease during the pandemic. The emphasis was on radioiodine therapy, which is of high clinical value due to the lower risk of neutropenia or agranulocytosis. It is currently unknown whether COVID-19 may lead to de novo thyroid dysfunction or if it can aggravate an existing thyroid disease. Patients with uncontrolled thyrotoxicosis are in a risk group for complications (e.g., cytokine storm) from any infection (especially from SARS-CoV-2 infection). Moreover, this group of patients should receive more extensive care, bearing in mind the neutropenia from taking antithyroid drugs, which may mask the symptoms of COVID-19.

Is low radioiodine uptake a contraindication to radioiodine therapy in patients with benign thyroid disease?

BACKGROUND

Radioiodine therapy (131I) is a standard procedure in the treatment of hyperthyroidism in the course of Graves' disease or toxic nodules. However, the use of 131I in patients with low radioiodine uptake (RAIU) may be controversial.

OBJECTIVES

To determine the influence of lithium carbonate (Li) on iodine kinetics.

MATERIAL AND METHODS

Patients with hyperthyroidism and low RAIU (< 30%) were divided into 2 groups: a Li(-) group of 305 patients not receiving Li adjuvant therapy and a Li(+) group of 264 patients receiving adjuvant therapy. The serum concentrations of free triiodothyronine (fT3), free thyroxine (fT4) and thyroid stimulating hormone (TSH) were assessed at baseline, 24 h, 48 h, 72 h and 96 h, and 1, 6 and 12 months after 131I therapy. The RAIU was assessed after 5 h, 24 h, 48 h, 72 h, and 96 h.

RESULTS

Levels of fT3 in the Li(+) group compared to the Li(-) group were significantly higher at baseline, lower after 48 h, 72 h, 96 h and 1 month, and did not differ significantly after 24 h, 6 months and 12 months. Levels of fT4 in the Li(+) group compared to the Li(-) group were significantly higher at baseline, lower after 24 h, 48 h, 72 h, 96 h and 1 month, and not differ significantly after 6 and 12 months. The RAIU in the hyperthyroidism Li(-) and Li(+) groups, respectively, was 11.9 ±5.6% compared to 23.9 ±10.1% (p < 0.001) after 5 h; 25.9 ±8.3% compared to 40.5 ±12.4% (p < 0.05) after 24 h; 7.8 ±8.1% compared to 40.9 ±13.7% (p < 0.05) after 48 h; 26.2 ±10.2% compared to 39.5 ±11.2% (p < 0.01) after 72 h; and 24.7 ±7.1% compared to 37.4 ±10.1% (p < 0.01) after 96 h.

CONCLUSIONS

Adjuvant therapy with Li in patients with hyperthyroidism caused a significant increase in RAIU and positive changes in the fT3 and fT4 profiles. The use of lithium carbonate prior to the inclusion of 131I in hyperthyroid patients with low RAIU should be considered.

Effect of lithium carbonate on the function of the thyroid gland: mechanism of action and clinical implications

Lithium carbonate, a drug known for more than 100 years, has been successfully used as a psychiatric medication. Currently, it is a commonly used drug to treat patients with unipolar and bipolar depression, and for the prophylaxis of bipolar disorders and acute mania. Lithium salts may cause the development of goiter, hypothyroidism, or rarely hyperthyroidism. The present review examined the current state of knowledge on the effect of lithium carbonate on the thyroid gland. The Pubmed database and Google Scholar were searched for articles related to the effects of lithium therapy on the thyroid gland function published up to February 2020. Studies that examined the mechanism of action of lithium at the molecular level, including pharmacokinetics, and focused on its effects on the thyroid gland were included. Lithium as a mood-stabilizing drug has a complex mechanism of action. Because of the active transport of Na⁺/I^- ions, lithium, despite its concentration gradient, is accumulated in the thyroid gland at a concentration 3 - 4 times higher than that in the plasma. It can inhibit the formation of colloid in thyrocytes, change the structure of thyroglobulin, weaken the iodination of tyrosines, and disrupt their coupling. In addition, it reduces the clearance of free thyroxine in the serum, thereby indirectly reducing the activity of 5-deiodinase type 1 and 2 and reducing the deiodination of these hormones in the liver. Taken together, this review provides recommendations for monitoring the thyroid gland in patients who require long-term lithium therapy. Prior to the initiation of lithium therapy, thyroid ultrasound should be performed, and the levels of thyroid hormones (fT3 and fT4), TSH, and antithyroid peroxidase and antithyroglobulin antibodies should be measured. If the patient shows normal thyroid function, TSH level measurement and thyroid ultrasound should be performed at 6- to 12-month intervals for long term.

Vitamin D deficiency and thyroid autoantibody fluctuations in patients with Graves' disease - A mere coincidence or a real relationship?

PURPOSE

The aim of this study was to evaluate the association between vitamin D (vitD) and changes in the titers of anti-TSH receptor (TSHR-Abs), antithyroglobulin (Tg-Abs), and antiperoxidase (TPO-Abs) autoantibodies.

MATERIALS/METHODS

The study involved 269 patients with Graves' disease (GD), divided into four subgroups (1-4), i.e. 65 smokers treated with vitD(+) (1), 76 smokers not treated with vitD(-) (2), 61 non-smokers treated with vitD(+) (3) and 67 non-smokers with vitD(-) (4). All thyroid parameters were analyzed at entry and 1, 3, 6, 9 and 12 months later.

RESULTS

The titer of TSHR-Abs in group 3 was significantly lower than in groups 1 and 2 across all time points. At 3, 6 and 12 months, the titers of TSHR-Abs were also lower in group 4 compared to groups 1 and 2. At 9 months, the titers in group 3 were lower than in all other groups. There was a significant inverse correlation between baseline levels of vitD and baseline titers of Tg-Abs (in group 1 only), Tg-Abs after 12 months (in group 1 only), TPO-Abs after 12 months (in groups 1 and 3), fT4 (in group 4 only), and a significant positive correlation with TPO-Abs (in group 2 only). VitD levels at 12 months were inversely correlated with Tg-Abs in group 1.

CONCLUSIONS

VitD measurements in patients with GD, especially smokers with an increased TSHR-Ab titers before 131I therapy, are recommended. Immunological remission is more likely in patients with GD who receive vitD, particularly smokers.

Radioiodine therapy and Graves' disease - Myths and reality

Introduction

Autoimmune reactions in Graves’ disease (GD) occur not only in the thyroid gland, but also in the orbital connective tissue, eyelids, extraocular muscles. The occurrence of orbitopathy in the course of GD is influenced by environmental factors, e.g. cigarette smoking.

Objectives

The aim of the study was to analyze the effect of cigarette smoking on the efficacy of activity of radioiodine(131I) therapy in patients with GD. We also studied the influence of cigarette smoking and the efficacy of prednisone prophylaxis on the risk of thyroid-associated ophthalmopathy (TAO) development after radioiodine therapy (RIT) during two years of follow-up.

Patients and methods

Medical records of hyperthyroid patients treated with radioiodine had been included. Patients were scheduled to visit outpatient clinics at baseline and 1, 3, 6, 9, 12, 18, and 24 months after RIT.

Results

The studied group consisted of 336 patients (274 women, 62 men) diagnosed with GD and treated with RIT; 130 patients received second therapeutic dose of ¹³¹I due to recurrent hyperthyroidism. Among all studied patients, 220 (65.5%) were smokers and 116 (34.5%) non-smokers. In the group of smokers 115 (52.2%) of patients received single RIT, 105 (47.8%) received second dose of RAI due to recurrent hyperthyroidism. In non-smokers 91 (78.6%) received single activity of RAI, while 25 (21.4%) patients required second RIT due to recurrent hyperthyroidism. The ophthalmic symptoms in the group of smokers after RIT were less frequent, if the patient received preventative treatment in the form of oral prednisone (P = 0.0088).

Conclusions

The results of our study suggest that cigarette smoking reduces the efficacy of treatment with ¹³¹I in patients with GD. The study also confirmed the effectiveness of steroid prophylaxis against TAO development or exacerbation after RIT.

Application of Pilates-based exercises in the treatment of chronic non-specific low back pain: state of the art

According to the current recommendations on the management of chronic non-specific low back pain (CNLBP), the intervention in this group of patients should include a programme of exercises. Pilates is a system of exercises widely used in patients with low back pain. The practices based on this method have promoted the restoration of the function of muscles involved in lumbopelvic stabilisation, that is, transversus abdominis, multifidus, diaphragm and pelvic floor muscles. During each exercise, specific principles of this method should be followed to restore or sustain the motor control of the lumbar spine and proper body posture. The aim of this study is to present the current state of knowledge concerning the application of Pilates method in the management of CNLBP as well as to define factors (eg, duration, frequency, exercises performed on a mat or specific equipment) influencing the effectiveness of Pilates in these individuals.

The Effects of Nerve and Tendon Gliding Exercises Combined with Low-level Laser or Ultrasound Therapy in Carpal Tunnel Syndrome

BACKGROUND

Carpal tunnel syndrome (CTS) is a common medical condition that doctors and physiotherapists come across in clinical practice. There are no explicit recommendations concerning which physical therapy methods should be applied in its treatment; however, there have also been no studies on the effects of combining low-level laser therapy (LLLT) or ultrasound with nerve and tendon gliding exercises. The purpose of this study was to evaluate the therapeutic efficacy of ultrasound and LLLT combined with gliding exercises.

MATERIALS AND METHODS

A total of seventy patients with mild to moderate CTS, divided into two groups, were included in this study. Group 1 received ultrasound treatment, whereas Group 2 underwent LLLT. The treatment lasted 2 weeks (5 sessions/week). In addition, both groups were treated with nerve and tendon gliding exercises three times daily. The clinical evaluation involved an interview on subjective and objective sensory abnormalities, the intensity of pain, the measurement of grip strength, Phalen's test, Tinel's sign, and the Boston Carpal Tunnel Questionnaire. The assessment was performed before and after the treatment.

RESULTS

A decrease in sensory impairments, improvement in visual analog scale, hand grip strength and the Boston Questionnaire results were significant in all patients after therapy. No meaningful differences between groups were noted in any of the examined variables after treatment. No adverse effects were observed.

CONCLUSIONS

The results of this study may suggest the clinical efficacy of LLLT or ultrasound combined with gliding exercises in patients with mild to moderate CTS.

Red cell distribution width - a new marker for exacerbation of heart failure in patients with hypothyroidism following radioiodine therapy

INTRODUCTION

Cardiovascular diseases constitute a major cause of health problems and death in developed countries across the world. The increased value of the index of distribution of red blood cells volume (RDW) may be a prognostic marker in patients diagnosed with chronic heart failure (CHF). Hypothyroid patients present higher RDW values if compared to healthy controls. Taking into consideration that RDW might be both affected by thyroid status and CHF, we decided to determine the effect of concomitant hypothyroidism following radioiodine therapy (RIT) and CHF on hematological parameters.

MATERIALS AND METHODS

Patients with toxic nodular goiter and heart failure with concomitant anemia were included. Patients underwent treatment with radioiodine before the planned heart transplant or pacemaker implantation (combined ICD/CRT-D). After RIT patients were divided into the three subgroups: with overt hypothyroidism (TSH ≥ 10µIU/mL, Group I), subclinically hypothyroid patients (TSH 4.3-9.0 µIU/mL, Group II) and with high-normal level of TSH (2.6-4.2 µIU/mL, Group III).

RESULTS

Significant correlation between TSH and RDW was observed (r=0.46; P < 0.0001) after RIT, whereas no correlation between serum TSH levels and TIBC and Fe was observed. In Group I significant correlation between TSH and RDW (r= 0.48; P = 0.002) after RIT was observed, whereas in two other subgroups there were no significant correlation.

CONCLUSIONS

Subclinical hypothyroidism or high-normal levels of TSH did not affect RDW in a significant manner in the studied population. Our results demonstrates that overt hypothyroidism may contribute to deterioration of CHF reflected in changes of RDW value. < p > < /p >.

Medicine and Physiotherapy students: are they physically active? Comparative research on Spanish and German population

Despite the fact that regular physical activity is beneficial to human life, there are still more and more overweight and obese people throughout the world today. Healthy habits taken from home or socioeconomic situation are factors which might influence on regular physical activity. People who lead a healthy lifestyle in childhood are also active during adulthood. On the other hand academic life might promote less healthy lifestyle.

AIM

The aim of the study was to assess and compare the level of physical activity of both German and Spanish students of Medicine and Physiotherapy.

MATERIALS AND METHODS

The study involved 100 Spanish and 100 German students aged from 19 to 24 years. Based on Eurobarometer 72.3, the respondents were asked a set of questions regarding physical activity. The chi-squared test (χ2) and Mann-Whitney U test were used for the statistical analysis.

RESULTS

The vast majority of students presented a normal BMI value, but it was not related to high physical activity. More than one-third of all students seldom practised any sports. The Spanish students usually did some form of physical activity outdoors, whereas the German students exercised in a fitness centre. Lack of time was to the Medicine and Physiotherapy students the most significant factor that did not allow them to be more physically active.

CONCLUSIONS

Medicine and Physiotherapy students should be more physically active in order to promote a good, healthy lifestyle model to society and there should be more physical activity education to encourage more students to practise sports.

Efficacy and safety of radioiodine therapy for mild Graves ophthalmopathy depending on cigarette consumption: a 6‑month follow‑up

INTRODUCTION    Graves ophthalmopathy (GO) is an autoimmune disease associated with Graves disease. Its treatment is largely dependent on the severity and activity of ocular lesions. Particular attention should be given to radioiodine (RAI) therapy. Although its use is a valuable therapeutic option for hyperthyroidism, it may be followed by worsening of GO.  OBJECTIVES    The aim of the present study was to analyze how the severity of nicotine addiction affects the response to RAI treatment in patients with GO. PATIENTS AND METHODS    A total of 106 patients (58 smokers and 48 nonsmokers) with mild GO treated with 800 MBq of RAI were included to the study. We assessed the serum levels of thyroid‑stimulating hormone (TSH), thyroid hormones, autoantibodies against thyroperoxidase, thyroglobulin, and TSH receptor (TSHR‑Abs), as well as urinary cotinine levels and severity of ophthalmopathy. Analyses were conducted at baseline (before RAI treatment) and 2 and 6 months after the therapy. RESULTS    Significant differences in serum levels of TSHR‑Abs were found between nonsmokers and smokers at 2 and 6 months after RAI therapy, whereas there were no differences at baseline. In smokers, there were significant differences in the severity of ophthalmopathy and the concentration of serum TSHR‑Abs assessed at baseline and at 6 months of follow‑up. Six months after RAI therapy, 46.2% of smokers and 4.3% of nonsmokers (P <0.001) progressed from mild to moderate GO.  CONCLUSIONS    High urinary cotinine levels in smokers were associated with the deterioration of ocular lesions after RAI treatment. A high dose of RAI did not induce an exacerbation of GO in nonsmokers who were administered oral steroid prophylaxis.

Dysfunction of the thyroid gland during amiodarone therapy: a study of 297 cases

AIM

This study aims to explore and compare the efficacy of radioiodine treatment (RIT) in hyperthyroid and euthyroid patients who have been treated with amiodarone (AM) in the past or are currently undergoing AM treatment. Clinical observation of a group of patients with amiodarone-induced hypothyroidism during a 12-month follow-up period was used for comparison.

DESIGN

This was a observational, two-centered study. Patients were assessed at baseline and at 2 months, 6 months, 8 months, and 12 months after RIT.

PATIENTS

Group A: At baseline (61 males [M] and 17 females [F], mean age 50±19 years), there were 78 euthyroid patients with cardiac arrhythmias, who were treated with AM and developed amiodarone-induced thyrotoxicosis, and currently require retreatment with AM. Group B: Hyperthyroid patients (92 M and 26 F, mean age 72±11.8 years) after AM therapy in the past. Group C: Hyperthyroid patients (66 M and 13 F, mean age 63.9±13.2 years) currently treated by AM. Group D: Hypothyroid patients (6 M and 16 F, mean age 61.4±10.4 years) after AM therapy. The patients from Groups A, B, and C were retreated with AM after ~3-6 weeks of RIT.

RESULTS

In Group A, after 12 months of RIT therapy, recurrent thyrotoxicosis was observed in six (7.7%) cases, and persistent hypothyroidism was diagnosed in 42 (53.8%) cases. In Group B, hyperthyroidism occurring during treatment with AM was found in 40 (33.9%) patients, and permanent hypothyroidism was observed in eleven (12.5%) cases. After annual follow-up in Group C, nine (11.4%) patients were diagnosed with hypothyroidism, while 27 (34.1%) patients were diagnosed with hyperthyroidism. In Group D, all patients had permanent hypothyroidism and when the concentration of serum thyroid-stimulating hormone was >10 µIU/mL, l-thyroxine was applied.

CONCLUSION

Our study showed that radioiodine administration is advisable in certain circumstances, even in euthyroid patients. It allows for continuation of further long-term AM treatment. Additionally, RIT allows for the reintroduction of AM therapy that was previously terminated. Hence, it can help control life-threatening tachyarrhythmias and decrease episodes of thyrotoxicosis.

The role of antithyroglobulin, antiperoxidase and anti-TSH receptor autoantibodies in amiodarone-induced thyrotoxicosis and amiodarone-induced hypothyroidism (A two-center study)

OBJECTIVE

It has been reported that patients experiencing side effects of amiodarone (AM) therapy, such as amiodarone-induced thyrotoxocosis (AIT) or amiodarone-induced hypothyroidism (AIH), have changes in serum concentrations of anti-TSH receptor (TSHR), antithyroglobulin (Tg), and antiperoxidase (TPO) autoantibodies (Abs). The purpose of our study was to identify and analyze the changes in levels of listed antibodies in patients with several thyroid disorders.

METHODS

280 patients from two centers in Poland were included. Titers of TSHR-Abs, TPO-Abs and Tg-Abs were analyzed retrospectively in the following groups of patients: A - euthyroid patients with a history of hyperthyroidism prior to re-administration of AM; B - patients with AIT who discontinued the AM therapy; C - patients with AIT chronically treated with AM; D - hypothyroid patients.

RESULTS

Serum Tg-Abs were not elevated in any of the studied groups. However, there were significant differences between A and B and also D and other groups (p<0.05). TPO-Abs titers were not elevated in most cases, there were no significant differences between groups. The serum titers of TSHR-Abs were not elevated in any group. We found statistically significant differences between B and D, C and other groups (p<0.05).

CONCLUSIONS

Regardless of the statistically significant differences observed for Tg-Abs and TSHR-Abs levels, this observation have a limited clinical applicability. In almost all cases we observed normal to slightly increased titers of TPO-Abs, Tg-Abs, TSHR-Abs. Discontinuation or continuation of AM therapy had no influence on autoantibody titers. Furthermore, we found it impossible to differentiate between the type I and II of AIT based on autoantibody titers.

[Analysis of effectiveness of selected treatment methods in patients with chronic low back pain]

Chronic low back pain (CLBP) are becoming more and more frequently met disorder in modern society. Appearance of these symptoms mainly contribute degenerative changes in spine joints. Preventive, noninvasive treatment constitutes an important factor in therapy of chronic pain, therefore effective treatment methods for inhibiting the disease progression, pain-reducing and retrieving patients the functional ability are still seeking.

AIM

The aim of the study was to evaluate the efficacy of ultrasounds, exercise therapy and combination therapy of both methods in the treatment of CLBP and comparing their effectiveness.

MATERIALS AND METHODS

The study included 90 patients in the age of 42-82 treated for CLBP as a result of degenerative changes. Patients were divided into three 30-members groups. The first group used treatment consisted of ultrasounds. The second one included only exercise therapy and the third one underwent the combination of both methods - exercise therapy and sonotherapy. Treatment was continued for 2 weeks and was performed daily with the weekend break. Assessment of the pain level of was done with a VAS scale and a Laitinen questionnaire. The level of functional disability was determined on the basis of a modified Oswestry questionnaire. The spine motion was measured according to the Zembaty's methodology. Patients were examined twice - before and after therapy.

RESULTS

In all patients significant pain reduction was noticed. In addition, level of disability of patients became considerably less and the mobility of the spine for all tests increased significantly. There were no significant differences between groups after all therapies.

CONCLUSIONS

Ultrasounds, exercise therapy and combination of these two methods had a similar effectiveness in treatment of CLBP.

[Analysis of using assistive devices by patients suffering from cerebral palsy - preliminary report]

Cerebral palsy (CP) is still significant health and social issue in the world. Adults who suffer from that illness have problem with mobility which make their functioning much harder. Common symptoms include spasticity, chronic pain of musculoskeletal system, disturbance of sensation, epilepsy or mental retardation.

AIM

The aim of the study was analysis of assistive devices used by patients with CP through childhood and adulthood. The results were compared with the situation in this field of CP patients in other countries.

MATERIALS AND METHODS

The study involved 30 patients with CP in age between 20-43 living in Poznan and under the care of Occupational Therapy Workshop and Enviromental Self-help Houses. The research method was questionnaire which was directed to caregivers of adults with CP. They were asked about diagnosis, accompanying symptoms as well as assistive devices used during childhood and adulthood.

RESULTS

During childhood wheelchair and standing frame were used the most often while during adulthood the most common were also the first mentioned above as well as rehabilitation lift. Although unfavourable evaluation of fitting assistive devices, majority of caregivers of CP sufferer claimed that there was varying improvement in patients motor functionality.

CONCLUSIONS

Comprehensive rehabilitation and assistive devices are necessary for patients with CP during adulthood not less than during childhood. Wheelchairs are even more essential for adults than for children.

The role of serum C-reactive protein measured by high-sensitive method in thyroid disease

The aim of this study was the evaluation of serum C-reactive protein (CRP) concentration as a marker of the inflammatory state in many different thyroid diseases and its dependence on the stage and duration of disease. We conducted a retrospective analysis of 444 randomly selected patients with different kinds of thyroid disease (106 men and 338 women, ranging 18-72 years of age; mean 56.2 ± 5.0 years; median 52 years). Group 1 (G1) comprised 250 patients with hyperthyroidism. Group 2 (G2) consisted of 72 euthyroid patients. Group 3 (G3) consisted of 122 patients with hypothyroidism. Free T4, free T3, and thyrotropin (TSH) levels were measured using the electrochemiluminescent method. Human serum thyroglobulin autoantibodies (Tg-Abs), thyroperoxidase autoantibodies (TPO-Abs), and autoantibodies against the thyrotropin receptor (TSHR-Abs) levels were measured by radioimmunoassay. The high-sensitive CRP (Hs-CRP) level (reference range <3 mg/L) was determined with a highly sensitive latex-based immunoassay. The mean value of Hs-CRP in G1 was 3.6 ± 2.8 mg/L, in G2 2.5 ± 1.5 mg/L and in G3 5.9 ± 5.8 mg/L. Hs-CRP (in mg/L) medians, interquartile and the total ranges in G1 were 3.0 (2.0 [0.1-21.0] 4.0); in G2: 2.3 [1.8 (0.2-9.2) 3.2]; and in G3: 4.3 [2.2 (0.3-31.5) 7.8]. We found statistically significant differences (Kruskal-Wallis test) in serum Hs-CRP values between G1 and G2 (P = 0.007), G1 and G3 (P = 0.001), G2 and G3 (P < 0.001). In G1, statistically significant correlation was confirmed between Hs-CRP and Tg-Abs (r = -0.22, P = 0.0016), CRP and TPO-Abs (r = -0.26, P < 0.001), and also between Hs-CRP and TSHR-Abs (r = -0.18, P = 0.02). In the remaining cases, differences between Hs-CRP and TSH levels (r = -0.09, P = 0.16) were not statistically significant. In G2, no statistically significant correlation was observed: Hs-CRP and Tg-Abs (r = -0.18, P = 0.13), Hs-CRP and TPO-Abs (r = -0.17, P = 0.15), Hs-CRP and TSH (r = 0.01, P = 0.91), Hs-CRP and TSHR-Abs (r = -0.19, P = 0.17). In G3, a statistically significant correlation was confirmed between Hs-CRP and Tg-Abs (r = 0.22, P = 0.012), Hs-CRP and TSH (r = -0.28, P = 0.001). No statistically significant correlation was observed between Hs-CRP and TPO-Abs (r = 0.20, P = 0.06) and between Hs-CRP and TSHR-Abs (r = -0.23, P = 0.11). Hs-CRP is increased in various types of hypothyroidism. This is particularly relevant in postpartum thyroiditis and in patients after radioiodine treatment. The impact of this situation on human health requires further research, however, one might assume that some types of thyroid disease may lead to systemic inflammatory reactions that are reflected in elevated CRP levels.

Amiodarone-induced thyrotoxicosis in a case of Eisenmenger's syndrome

Eisenmenger's syndrome is a condition due to any congenital heart defect with an intracardiac left-to-right communication that leads to pulmonary hypertension with reversed right-to-left blood flow and secondary cyanosis. The main complications of Eisenmenger's syndrome are heart failure and arrhythmias. Amiodarone, the drug of choice for arrhythmia treatment in such patients, can cause a number of complications, including amiodarone induced thyrotoxicosis (AIT). Hereby, we present a 41-year-old patient with Eisenmenger's syndrome who developed AIT and was successfully treated with radioactive iodine therapy. The patient had an accompanying heart failure and had been treated with amiodarone due to chronic atrial fibrillation. Twenty months later he developed an AIT for which was treated with 814 MBq (22 mCi) radioactive iodine. Since 7 weeks later only a slight decline in thyroid hormones was observed, the patient was received a transient treatment with methimazole, which had to be withdrawn soon due to severe leucopenia. Because of the need to maintain amiodarone, a second ablative radioactive iodine dose was administered leading to complete clinical remission. In conclusion, this case demonstrates that even though amiodarone reduces iodine uptake to a very low level, the therapy with radioactive iodine can be still effective if it is given in a repeated dose to patients who require continuation of amiodarone.

A rare case of Interferon-alpha-Induced Hyperthyroidism in patients with a chronic hepatitis C with granulocytopenia and transaminasemia treated successfully with radioiodine

BACKGROUND

Conventional management of Interferon-α-Induced Hyperthyroidism (IIH) with radioactive iodine (RAI) may be used when treatment with beta blockers or antithyroid drugs (ATD), proves ineffective or is contraindicated.

CASE PRESENTATION

We present a 38-year-old woman who has been treated with combined pegylated interferon alpha (INF-α) and Ribavirin for chronic hepatitis C. Destructive thyrotoxicosis appeared after four months of continuous IFN-α therapy and a beta blocker was prescribed. Initially, the patient presented normal TSH 2.4 µIU/mL, however during therapy with INF-α, TSH diminished to 0.05 and thyroid hormones were elevated: fT4 23.1 pmol/L, fT3 7.2 pmol/L. Ultrasound examination showed completely irregular and greatly decreased echogenicity of the thyroid gland. The radioiodine uptake (RAIU) was deeply decreased to 2 and 3% at 5 h and 24 h, respectively. The thyroid scintiscan showed lack of isotope accumulation. Hypothyroidism developed and L-thyroxine was prescribed. The following year, hyperthyroidism reoccurred with TSH 0.08 µIU/mL, fT4 26.4 pmol/L, fT3 8.2 pmol/L, positive TSHR-Abs 6.2 (normal <2 IU/L) and mild Graves' Ophthalmopathy (GO). RAIU values were 23% at 5 h and 46% at 24 h. Thyroid scintiscan showed diffuse goiter. At this point beta blocker was introduced and ATD was started. After three months of therapy an increased level of aminotransferases and granulocytopaenia were observed. Hence, the patient received RAI and glucocorticosteroid, while INF-α therapy was continued. After approximately 4 months, hypothyroidism reappeared with insignificantly raised TSH level. One year later the patient was euthyroid and required no further treatment.

CONCLUSIONS

Our report suggests that: 1. Radioiodine therapy might be an effective and safe method of treatment in cases of IIH with mild GO. 2. IFN-α therapy need not be discontinued in patients with IIH.

Thyroid associated orbitopathy--medication, radioiodine or operation?

This paper presents the current state of knowledge on the treatment of ophthalmopathy in the process of the Grave's disease. The question of prevention occupies a special place in the process of treatment as it has been clearly shown that exophthalmos is strongly associated with cigarette smoking. Therefore, before proceeding with any treatment, the patient should be advised to quit smoking as soon as possible. Further on in the publication, various forms of therapy are presented. Because of the unknown etiology, only symptomatic treatment can be applied, which includes steroids, radiotherapy and surgery. Patient care of patients with ophthalmopathy is a challenge even for an experienced clinician. Each case requires an individual approach that would take into account the severity of eye changes.

[Neurophysiological evaluation of cognitive functions in patients with anorexia nervosa--preliminary report]

INTRODUCTION

Anorexia nervosa (AN) is a disease with multi factorial etiology. Recent studies search the cause of its origin in impairments in neuroendocrinal transmission, genetics, psychological and socio-cultural factors. This disturbance affects the patient's attitude to eating. Many complex physical and psychiatric symptoms of AN require wide approach to the patient on the biological, psychiatric and psychological level.

AIM

The purpose of this studies was to determine implications in cognitive functioning in patients with AN.

MATERIAL AND METHODS

10 patients with AN and 20 healthy as a control group were recruited. Cognitive functioning was evaluated using P300 wave component of event related potentials (ERP) and Wisconsin Card Sorting Test. International Federation of Clinical Neurophysiology (IFCN) recommendations for recording and analyzing of ERP were used. These studies were performed using Viking Quest (Nicolet ViaSys Healthcare, U.S.A.). They were recorded using the "oddball paradigm" procedure. The reception of potentials was completed by unipolar method with far-field recording (Fz, Cz, Pz and 10, EOG, 10-20 system). The latencies of the first negative wave N1, next positive P2, the following N2 negative and positive component P300 were evaluated. Moreover, the amplitude differences N1-P2, P2-N2, N2-P3 were analyzed.

RESULTS

It was found that both latencies of P300 potential components and WCST results were quite normal. However, reduction of P300 amplitude was observed in patients with AN compared to control group, what can be the result of diminished absorption of cognitive structures during analyzing the stimuli.

CONCLUSIONS

The results did not show significant differences in cognitive functioning in patients. Changes in the components of P300 wave indicate the need for further neurophysiological research on larger group to determine the degree of impairments in cognitive functioning in patients with AN.

[Clinical application of visual evoked potentials in evaluation of the visual system in cerebral palsy. Studies on different modes of stimulation]

AIM

In cerebral palsy (CP), besides the early systematic management of the motor disability, there is also a need for a detection of disturbances of visual capacity. The research aimed at presenting various types of visual evoked potentials (VEP) in evaluation of visual impairment in children with CP.

MATERIAL AND METHODS

VEPs were registered on 100 children and adolescents, aged 2-19 years, presenting spastic type of CP. According to the degree of patient's cooperation VEPs were elicited with checkerboard pattern reversal (PR), light emitting diodes (LEDs) goggles and flashing screen (F) stimulation. They were recorded by means of Multiliner (Toennies, Germany). Latencies of maximum positive deflection P100, predicting N75 component and following N145 as well as amplitudes of N75/P100 and P1001 N145 were analyzed. The results of VEP obtained in the study group were compared with data recorded from healthy subjects of matched age and sex. The patients were subject of ophthalmological examination prior to electrophysiological testing.

RESULTS

Visual acuity ranged from apparently normal to lowered acuity of various degrees. Refractive errors appeared mostly in the form of hyperopia. The study showed that in children with CP, who underwent PR and F stimulation, the latencies of the N75, P100, N145 deflections were significantly longer and the amplitudes were shorter than in the control group. In case of LED stimulation only prolongation of P100 deflection reached statistically significant value in patients.

CONCLUSION

Our results indicate that VEPs are objective noninvasive and reproducible means which enable assessment of the functional state of visual system in CP. The data of the present study support the role of VEP in identification of visual impairment that can be an important complementary tool in ophthalmological examination.

[Changes in visual evoked potentials in developmental age. Comparative studies of pattern reversal and two types of flash stimulation]

BACKGROUND

Examination of visual evoked potentials (VEP) enables objective, non-invasive diagnostics of vision damage in children and adolescents. It is important to choose proper stimulus for individual patient.

AIM OF STUDY

The aim of this research was analysis of VEP variability and disclosure of possible differences recorded in healthy children and adolescents while binocular recording, using four various types of stimulus.

MATERIAL AND METHODS

VEPs with pattern reversal (PR 15 and 40 min arc), flashing screen and light emitting diodes (LEDs) in goggles were measured in 100 children and adolescents 1-18 year according to International Federation of Clinical Neurophysiology recommendations. Normative data for VEP's parameters and hemispheric differences under these kinds of simulations were reported.

RESULTS

Influence of used stimulation on value of only VEP component latency was confirmed. Application of PR brings longer latencies than with use of flash methods. Changes of VEP parameters connected with maturation of visual pathway in children up to age of 8 were demonstrated. The constant value of responses registered from above left and right cerebral hemispheres was observed which indicates symmetry of recording obtained.

CONCLUSION

Variability of VEP recording character depends on application of various stimulus parameters and various methods of their presentations. Consequently, every laboratory performing potential examinations should establish parameter pattern of VEP with strictly defined standardized conditions of stimulation and recording.

[Surgical treatment of perinatal brachial plexus palsy in children--late surgical technique]

Apart from the possibilities to predict and eliminate the risk factors (especially in highly developed countries) the perinatal brachial plexus palsy (PBPP) still constitutes severe labor complications. PBPP treatment may be divided into conservative and operative categories. It is considered that the time necessary to regain functioning of brachial and ulnar articulations in children with BPPP (treated conservatively and surgically) amounts to 2 years approximately. Therefore, second late surgical technique of muscles and tendons of paralysed limb is performed in children at this age and older. It is accompanied by orthopaedic treatment and therapeutic rehabilitation, the aim of which is the improvement of its efficiency. The choice of proper treatment method (especially when chronic paralysis is observed) is conditioned by disorders of functioning in particular parts of a limb. Most frequently detected impairments resulting from BPPP which are treated surgically are disorders of shoulder functioning which occurs in 50% of plexus palsies. Ulnar dysfunctions constitute 15%, forearm dysfunctions amount to 15% and finally hand dysfunction is equal to 10%. Dysfunctioning of the upper limb constitutes 10%. Its reconstruction procedure is not necessary. The positive aspect of surgical reconstruction in patients with PBPP is not only improvement of paralysed limb functioning but also of patient's self-evaluation.

[Primary reconstructive operation in surgical treatment of perinatal brachial plexus palsy in children]

Perinatal brachial plexus palsy (PBPP) constitutes a serious medical problem. PBPP treatment consists in conservative and operative procedures. The latter one is usually divided into primary operative procedures, conducted in the initial stage of child's life (aiming at suture of brachial plexus nerves in the early stage of life) and secondary (aiming at elimination of functional limitations, osseous deformations, articular contractures occuring at later stages of life). A significant but also controversial aspect arises at determining the date of operation performance and also at defining factors classifying a child for surgical operation and details concerning the application of definite operative method. The following microsurgical methods are applied in microsurgical reconstruction of PBPP: neurolysis (external and internal), end-to-end nerve suture, free nerve grafts. The most complicated are injuries which result in root avulsion from the spinal medulla. In such cases the avulsed roots are connected to nerves of cervical plexus, applying the method of neurotization. The reason of numerous controversies around the choice of treatment method for PBPP patients is the desire to balance procedures aiming at the proper functioning of the patient in future.

The influence of selected factors on the quality of life of children with headaches

PURPOSE

Headaches are one of frequent complaints diagnosed in children and adolescents. Due to their recurring character, they influence the bio-psycho-social functioning of the children. The aim of the study was to learn about the factors influencing the quality of life of children with headaches.

MATERIAL AND METHODS

The research was conducted on 140 children with headaches, ages 8 to 18, treated at the Chair and Department of Developmental Neurology, Karol Marcinkowski University of Medical Sciences in Poznań. The research tool was the Pediatric Quality of Life Inventory - PedsQL questionnaire.

RESULTS

In the studied group 85 (60.7%) children had tension headaches, 25 (17.8%) had migraine with aura and 30 (21.5%) had migraine without aura. Analyzing the particular domains of the quality of life from the PedsQL questionnaire, significant differences were noticed in the evaluation of the domain "physical functioning", depending on gender, age and the duration of pain, and in the domain "emotional functioning" depending on gender. The duration of pain additionally influenced the evaluation of their social functioning by the patients.

CONCLUSIONS

The difference in the evaluation of the quality of life depended on the gender and the age of the children, the duration of headaches and the severity of pain. The indicated factors influenced different domains of the quality of life of the adolescents participating in the study.

[The level of cotinine - marker of tobacco smoking, in patients with hyperthyroidism]

INTRODUCTION

Orbitopathy associated with Graves' disease TAO (thyroid associated orbitopathy) is likewise connected with environmental factors including tobacco smoking. Tobacco smoking increases the risk of ophthalmologic pathology and leads to the orbital tissue damage due to the hypoxia. The aim of the study was to correlate the concentration of urinecotinine (marker of tobacco smoking) in Graves' disease patients with TAO with points received on the Fagerström questionnaire.

MATERIALS AND METHODS

Thirty women with different degree of exacerbation of TAO in Graves' disease (34.28 +/- 12.04 yr.) were examined. As control we used 29 women with Graves' disease without TAO (29.35 +/- 12.33 yr.). The diagnosis was established according to level of TSH and level of thyrotropin receptor antibodies (TRAb). Measure of tobacco smoking or exposure to second hand tobacco smoke ETS (environmental tobacco smoke) carried out according to the Fagerström questionnaire, and measured cotinine level (the major metabolite of nicotine in urine). The level of clinical ophtalmopathy was measured according to the CAS (Clinical Activity Score) scale and degree of progression of TAO according to American Thyroid Association (NOSPECS scale). Additionally increase of exophthalmus was measured using the Hertl's exophthalmometer.

RESULTS

In the group with TAO: 19 (63.3%) persons had mild exophthalmos (according to CAS), medium in 13 (43.3%) patients, and pronounced exophthalmous in 10 (33%) patients. There was statistically significant difference in the level of TRAb (18.4 +/- 8.2 vs. 5.1 +/- 3.4 IU/l; p < 0.0001) between TAO and controls. There was no correlation between TSH (0.6 +/- 0.02 vs. 0.4 +/- 0.04; p = 0.18) and fT4 (38.8 +/- 29.3 vs. 26.1 +/- 17.3; p = 0.026) in both analyzed groups. Smokers and non-smokers with TAO had no statistically significant in level of TRAb (Mann-Whitney test p = 0.16). No correlation was found between smoking tobacco (cotinine level) and the level of TRAb in patients with TAO (Pearson r = 0.28 p = 0.58). There was a statistically significant difference between the level of urine cotinine in smoking patients with TAO in the highest level of ophthalmopathy exacerbation (> 24 mm; > or = 4 points according to CAS) and those without TAO (Mann-Whitney's test p = 0.04).

CONCLUSIONS

1. In patients with Graves' disease with TAO the highest score of tobacco smoking has been found in persons with the highest ophthalmopathy exacerbation. 2. Estimation of cotinine concentration in urine is the most objective and useful method of tobacco smoking.

Cerebral childhood and adolescent X-linked adrenoleukodystrophy. Clinical presentation, neurophysiological, neuroimaging and biochemical investigations

Clinical, neurophysiological, neuroimaging and biochemical studies were performed in five boys with childhood and adolescent form of cerebral X-ALD, which is a very rare disease in developmental age. In all patients, rapidly progressive spasticity, ataxia and mental deterioration were found. Seizures occurred in four of them. Additionally, visual and hearing impairment were observed in four and three patients respectively. Adrenal insufficiency was also diagnosed in four cases. MR revealed extensive demyelination located mainly symmetrically in the parieto-occipital areas, in one patient in whom asymmetrical lesions in that region were found. All patients had abnormal visual, brainstem and somatosensory evoked potentials recording, reflecting the central demyelination occurring in X-ALD. The clinical diagnosis in every case was confirmed by the significantly elevated concentration of very long chain fatty acids (VLCFA) measured in plasma in comparison to normal values.