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BACKGROUND The phenomenon of the rapid generation and spread of misinformation about the novel coronavirus COVID-19 during the pandemic was evident and attracted many researchers. However, there are more health-related topics polluting the Internet with misinformation that are not as widely studied. OBJECTIVE The aim of our experiment was to assess the reach of the most popular medical content, not limited to the subject of the pandemic, in the World Wide Web (WWW). We evaluated the content for subject matter and credibility in 2021 and 2022. The content was evaluated according to the principles of Evidence Based Medicine (EBM) by experienced clinicians. METHODS We used 274 keywords to perform web page searches using the BuzzSumo Enterprise Application. The keywords were selected according to medical topics which were obtained via questionnaires given to the medical practitioners. The search was limited to two specific date ranges: (1) Jan. 1, 2021 to Dec. 31, 2021; (2) Jan. 1, 2022 to Dec. 31, 2022. We limited searches to web pages in Polish language and filtered them by the selected dates. The analysis included 161 web pages retrieved from 2021 and 105 retrieved from 2022. Each web page was reviewed by an experienced doctor in terms of credibility. The evaluation was performed in accordance with EBM standards. Additionally, we collected data about social media engagements related to the web pages. RESULTS The proportion of non-credible contents about COVID-19 significantly decreased in 2022 as compared to 2021. The percentage of non-credible web pages with the topics COVID-19 and general vaccinations changed from 57% to 24% and 42% to 30%, respectively. However, simultaneously there was a significant rise in non-credible contents and their spread in social media regarding other medical topics. The percentage of non-credible web pages with the topic cholesterol and statins and cardiology increased from 17% to 26% and from 18% to 26%, respectively. CONCLUSIONS Actions taken during the COVID-19 pandemic to prevent the spread of fake news appear to have been effective. However, our analysis indicates that such interventions should be applied continuously to existing and emergent medical topics. It seems that topics other than the virus were “filling up the vacuum” created by the decreasing interest in the pandemic.

There have been suggestions that tick-borne encephalitis (TBE) may cause neurodenenerative changes in the brain. The aim of this study was the assessment of the tau protein concentration in cerebrospinal fluid (CSF) of patients with different clinical forms of TBE. The concentration of tau protein in CSF was determined using Fujirebio tests (Ghent, Belgium) in 35 patients with TBE: group I—patients with meningitis (n = 16); group II—patients with meningoencephalitis (n = 19). None of the patients reported any neurodegenerative disorder that could affect the results of the study. The control group (CG) consisted of 10 patients in whom inflammatory process in central nervous system was excluded. Tau protein concentration in CSF before treatment did not differ significantly between the examined groups, while its concentration was significantly higher in encephalitis group than in CG after 14 days of treatment. Significant increase in tau protein concentration after treatment was observed in both examined groups. The comparison between the group of patients who fully recovered and patients who presented with persistent symptoms on discharge showed significant differences in tau protein concentration before and after treatment. ROC curve analysis indicates that CSF tau protein concentration before treatment may predict complicated course of the disease with 90.9% specificity and 80% sensitivity, while after treatment, specificity became 72.7% and 71.4% for sensitivity. Correlation analysis showed that in TBE patients (both meningoencephalitis and meningitis groups), CSF pleocytosis before treatment correlated negatively with tau protein concentration in CSF. (1) Neurodegeneration process is present in TBE encephalitis. (2) Tau protein concentration may be used as a predictor of complicated course of TBE.

Patient: Female, 71-year-old Final Diagnosis: Acute pleuropericarditis Symptoms: Weakness Medication:— Clinical Procedure: — Specialty: Cardiology Objective: Unusual clinical course Background: Pleuropericarditis after pacemaker (IPG) implantation is a rare post-cardiac injury syndrome (PCIS) condition. Pericarditis is one of the complications following insertion of a IPG; it affects 2–5% of patients within 5–21 days after IPG implementation and is associated with screw-in (active fixation) atrial lead positioning. Usually, pericarditis following IPG implantation is benign and has a self-limiting course. The mechanism of this complication remains unclear. It could involve a direct irritation of pericardium by minimally protruding electrodes, low bleeding, and autoimmune and inflammatory responses. The frequency of pleuropericarditis is not well defined. The etiopathogenesis is presumed to be the same as for pericarditis, yet there are no standardized criteria for the diagnosis, and treatment is based on the empirical anti-inflammatory therapy used in pericarditis. Case Report: A 71-year-old woman was admitted due to syncope. Sinus arrests with escape atrioventricular rhythm were observed during hospitalization; therefore, a dual-chamber pacemaker (IPG) was implanted with 2 active fixation (screw-in) electrodes. On the first day after implantation, a slight pericardial hemorrhage occurred with resorption in the following days, and an inflammatory reaction with pericardial and left pleural effusion occurred later. The first-line treatment was ineffective. However, prednisolone with colchicines with longer use than suggested by pericarditis recommendations was effective. Conclusions: Patients with even mild pericardial effusion after IPG insertion should be followed closely due to the risk of pleuropericarditis, with consideration of anti-inflammatory treatment for longer than in pericarditis.

Tick-borne diseases are a major threat to human and animal health. An increasing number of natural habitats have been transformed into urban areas by human activity; hence, the number of reported tick bites in urban and suburban areas has risen. This retrospective analysis evaluated 53 scientific reports concerning infections of Ixodes ricinus ticks collected from urban and suburban areas of Europe between 1991 and 2017. The results indicate significant differences in many variables, including a higher number of Anaplasma phagocytophilum infections in Eastern Europe than in Western Europe. The opposite result was observed for Candidatus Neoehrlichia mikurensis infections. A comparison of climate zones revealed that Borrelia burgdorferi s.l. infections have the greatest median incidence rate in subtropical climate zones. No statistical significance was found when comparing other tick-borne pathogens (TBPs), such as Borrelia miyamotoi, Rickettsia spp., Babesia spp., Bartonella spp., Ehrlichia spp., Coxiella burnetii and Francisella tularensis. The analysis also showed significant differences in the overall prevalence of TBPs according to average temperatures and rainfall across Europe. This retrospective study contributes to the knowledge on the occurrence and prevalence of TBPs in urbanized areas of Europe and their dependence on the habitats and geographical distributions of ticks. Due to the increased risk of tick bites, it is of great importance to investigate infections in ticks from urban and suburban areas.

Introduction: Glycoprotein (Gp) IIb/IIIa is a platelet receptor participating in platelet aggregation. According to ESC guidelines, glycoprotein IIb/IIIa inhibitors might be considered during percutaneous coronary interventions in patients with the acute coronary syndrome. Purpose: A case study of profound thrombocytopenia in 80-year-old man with the acute coronary syndrome. Case presentation: An 80-year-old, medicationnaive man with acute coronary syndrome was admitted to the Department of Invasive Cardiology. Due to the unsuccessful invasive strategy, an intracoronary bolus of Gp IIb/IIIa inhibitor – eptifibatide - was administered. During the following intravenous infusion, large subcutaneous hematomas were observed. Eptifibatide infusion was discontinued. Drop in platelet count to 1 thou/μL without significant anemia was registered. A control sample in sodium citrate showed similarly low platelet count - 2 thou/uL. Acetylsalicylic acid and clopidogrel were discontinued, steroids were introduced. Neither PLT nor FFP transfusion were necessary. Consecutive lab tests showed the gradual increase of PLT up to 35 thou/μL at discharge. A week later, the patient did not complain of any cardiovascular or bleeding symptoms; hematomas resented significant involution. Laboratory findings were normal. During follow-up visit 30 days after the discharge, the patient presented no cardiovascular symptoms. Conclusions: There are patients at risk of druginduced thrombocytopenia, especially those with impaired kidney function and the elderly. In such cases, decisions concerning anti-platelet and antithrombotic therapy should be taken cautiously. Because of its rare occurrence, every case of severe thrombocytopenia in ACS patients should be reported. Moreover, such patients should be followed-up to minimalize risk of similar adverse events in the future.

AIM There are many causes of facial nerve palsy. The most common causes are neuroborreliosis (NB), idiopathic paralysis or Herpes simplex virus (HSV) reactivation. The aim of this study was to characterize patients with facial palsy in the course of NB and to determine whether HSV-1 reactivation takes place during the acute phase of NB. METHODS A retrospective analysis of 66 patients with facial nerve palsy was performed. In 38 patients, facial palsy was caused by Borrelia burgdorferi sl infection. Immunological tests for HSV-1, tick-borne encephalitis virus and B burgdorferi sl in serum and cerebrospinal fluid (CSF) were performed. RESULTS In this analysis, 55.2% of NB patients had right nerve palsy and 21% bilateral palsy; 15.8% of patients had erythema migrans (EM). Lymphocytic meningitis was diagnosed in 92% of patients and Bannwarth's syndrome was diagnosed in 47% of patients. IgM anti-HSV-1 antibodies were detected in four patients with NB and two patients with facial nerve palsy of other origin. IgM anti-HSV-1 antibodies were detected in the CSF of three patients (7.9%) with NB, and one of them had bilateral VII paresis and EM simultaneously. Treatment with ceftriaxone or doxycycline led to complete recovery. CONCLUSIONS Neuroborreliosis should always be considered as a cause of peripheral facial nerve palsy. Peripheral facial nerve palsy is a significant symptom in the course of NB, especially in patients accompanied by meningitis. Pathomechanism of facial nerve paresis has not been well explained so far and may depend on two independent mechanisms in NB, including HSV-1 reactivation.

Background Occlusion of the circumflex artery (Cx) often does not present signs in the ECG. It can lead to delayed angiography during ST-elevation myocardial infarction (STEMI). The aim of this analysis was to determine if Cx narrowing is related to diverse outcomes in comparison with right coronary artery (RCA) stenosis in patients with STEMI, treated with percutaneous coronary intervention (PCI) of the left descending artery (LAD). Methods and results Inclusion criteria were as follows: first STEMI treated with PCI of the LAD and additional significant (≥ 70 %) Cx or RCA narrowing—two-vessel disease. A total of 234 consecutive patients with STEMI were included. Total mortality was estimated during long-term follow-up, at mean 639 (± 224) days after STEMI. Patients with Cx narrowing constituted 46 % (N = 108) of the study population, and patients with RCA narrowing amounted to 54 % (N = 126). Patients with narrowing of the Cx had worse long-term outcomes in terms of mortality than patients with RCA narrowing (22 vs. 11 %, p

The progress which has been made in interventional cardiology contributes to the gradual improvement of the results of CHD (coronary heart disease) therapy. The aim of the study was the assessment of early and long-term prognosis in all the patients with CHD treated invasively in one large-volume PCI center in 2005.1390 consecutive patients with CHD treated with PCI in 2005 were included in the analysis. Patients with ST-elevation myocardial infarction (STEMI) accounted for 50% of cases, patients with stable angina (SA) amounted to 25%, and patients with non-ST elevation acute coronary syndromes (NSTE-ACS) constituted 25%. Mean follow-up was 738 (±237) days.The highest mortality during the hospitalization was noted within the STEMI group(SA vs. NSTE-ACS vs. STEMI; 0% vs. 0.3% vs. 4.1%, respectively; p0.001). The highest mortality during a 2-year follow-up was also observed in the STEMI group (SA vs. NSTE-ACS vs. STEMI, 6.3% vs. 8.5% vs. 13.8%, respectively; p0.001). Multiple regression model showed that independent risk factors for death during the follow-up were: age, glycaemia at admission, heart rate, blood pressure, ejection fraction, STEMI, ineffective PCI (R=0.3613; F(10.131)=19.672; p0.0001 for the model).The highest relative increase of mortality after the discharge of patients with CHD undergoing PCI referred to the patients with NSTE-ACS. However, in the real life PCI practice STEMI patients have the worst hospital and long-term prognosis. Well recognized risk factors for death in patients with CHD are still of great importance in negative prognosis of patients undergoing PCI.