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Chronic wounds are becoming an increasingly common clinical problem due to an aging population and an increased incidence of diabetes, atherosclerosis, and venous insufficiency, which are the conditions that impair and delay the healing process. Patients with diabetes constitute a group of subjects in whom the healing process is particularly prolonged regardless of its initial etiology. Circulatory dysfunction, both at the microvascular and macrovascular levels, is a leading factor in delaying or precluding wound healing in diabetes. The prolonged period of wound healing increases the risk of complications such as the development of infection, including sepsis and even amputation. Currently, many substances applied topically or systemically are supposed to accelerate the process of wound regeneration and finally wound closure. The role of clinical trials and preclinical studies, including research based on animal models, is to create safe medicinal products and ensure the fastest possible healing. To achieve this goal and minimize the wide-ranging burdens associated with conducting clinical trials, a correct animal model is needed to replicate the wound conditions in patients with diabetes as closely as possible. The aim of the paper is to summarize the most important molecular pathways which are impaired in the hyperglycemic state in the context of designing an animal model of diabetic chronic wounds. The authors focus on research optimization, including economic aspects and model reproducibility, as well as the ethical dimension of minimizing the suffering of research subjects according to the 3 Rs principle (Replacement, Reduction, Refinement).

The most common form of Lyme carditis (LC) are different types of conduction abnormalities, especially atrioventricular (A-V) blocks. In most cases the course of the disease is benign and when the patient is diagnosed and treated appropriately, even the most advanced forms of A-V block typically resolve within one week. Implantation of a permanent pacemaker is only exceptionally necessary. We present a case of a patient with multiple cardiac arrests due to advanced A-V block. Despite the proper diagnosis of LC and targeted antibiotic therapy, the patient was completely dependent on temporary endocavitary pacing for more than one week. Finally, implantation of a permanent pacemaker was decided, however, during the next three months, A-V conduction abnormalities gradually subsided. This made us doubt whether the decision about implantation wasn’t made prematurely. The solution came at a one-year follow-up visit when it turned out that ventricular stimulation reappeared. We believe, that if A-V conduction disturbances in the course of Lyme disease persist for more than a week despite targeted antibiotic therapy, it is most likely a sign of serious and irreversible damage to the structures of the A-V node.

Immunotherapy is a widely used treatment modality in oncology. Immune checkpoint inhibitors, as a part of immunotherapy, caused a revolution in oncology, especially in melanoma therapy, due to the significant prolongation of patients’ overall survival. These drugs act by activation of inhibited immune responses of T lymphocytes against cancer cells. The mechanism responsible for the therapy’s high efficacy is also involved in immune tolerance of the patient’s own tissues. The administration of ICI therapy to a patient can cause severe immune reactions against non-neoplastic cells. Among them, cardiotoxicity seems most important due to the high mortality rate. In this article, we present the history of a 79 year-old patient diagnosed with melanoma who died due to myocarditis induced by ICI therapy, despite the fast administration of recommended immunosuppressive therapy, as an illustration of possible adverse events of ICI. Additionally, we summarize the mechanism, risk factors, biomarkers, and clinical data from currently published guidelines and studies about ICI-related myocarditis. The fast recognition of this fatal adverse effect of therapy may accelerate the rapid introduction of treatment and improve patients’ outcomes.

The management of diabetic patients after resection of large intestinal sections is a significant clinical problem, particularly when parenteral nutrition is required, which increases the risk of hyperglycaemia. On the example of a patient who underwent subtotal resection of the small intestine due to mesenteric artery embolism, possible approaches to blood glucose lowering treatment in such patients in the perioperative period were discussed. We presented the current perspective on insulin therapy during parenteral nutrition and proposed a regimen for such treatment. Potential use of glucagon-like peptide 2 analogues in patients with short bowel syndrome was also highlighted.

The COVID-19 pandemic revealed a breakdown of the system of DFU patient care. This retrospective national cohort study analyses the epidemiological status of DFU patients in relation to urgent and elective hospitalizations, amputation rates, and deaths in Poland from 2017 to 2019, and during 2020 when the COVID-19 pandemic began. The data were obtained from national medical records gathered by the National Health Fund (NHF). Discharge diagnoses were categorized according to ICD-10 and ICD-9 codes. Analysis of the data showed a statistically significant decrease in elective hospital admissions (from 29.6% to 26.3%, p = 0.001). There was a decrease in the percentage of hospitalizations related to limb-salvage procedures (from 79.4% to 71.3%, p = 0.001). The opposite tendency was observed among urgent hospital admissions (from 67.0% to 73.2%, p = 0.01), which was related to a significant increase in the number of minor amputations (from 3146 to 4269, p = 0.017). This rise was in parallel with the increase in the percentage of patients who died during hospitalization due to DFU (from 3.9% to 4.8%, p = 0.03). The number of deaths has not changed significantly (from 590.7 to 668.0, p = 0.26). The results of the conducted analyses confirm the negative tendencies in the medical care of patients with DFU during the first year of the pandemic in Poland. Changes in therapy schemes and stronger patient support following this period are necessary to avoid further complications in patients with DFU.

Few millions of new cancer cases are diagnosed worldwide every year. Due to significant progress in understanding cancer biology and developing new therapies, the mortality rates are decreasing with many of patients that can be completely cured. However, vast majority of them require chemotherapy which comes with high medical costs in terms of adverse events, of which cardiotoxicity is one of the most serious and challenging. Anthracyclines (doxorubicin, epirubicin) are a class of cytotoxic agents used in treatment of breast cancer, sarcomas, or hematological malignancies that are associated with high risk of cardiotoxicity that is observed in even up to 30% of patients and can be diagnosed years after the therapy. The mechanism, in which anthracyclines cause cardiotoxicity are not well known, but it is proposed that dysregulation of renin-angiotensin-aldosterone system (RAAS), one of main humoral regulators of cardiovascular system, may play a significant role. There is increasing evidence that drugs targeting this system can be effective in the prevention and treatment of anthracycline-induced cardiotoxicity what has recently found reflection in the recommendation of some scientific societies. In this review, we comprehensively describe possible mechanisms how anthracyclines affect RAAS and lead to cardiotoxicity. Moreover, we critically review available preclinical and clinical data on use of RAAS inhibitors in the primary and secondary prevention and treatment of cardiac adverse events associated with anthracycline-based chemotherapy.

Objective The aim was to compare the metabolic control of patients with type 2 diabetes mellitus (DM2) before and during the COVID-19 pandemic in Poland and assess its impact on cardiovascular risk. Methods Patients with DM2, treated with metformin and/or insulin were analysed with Pearson and ANOVA correlations. Blood levels of metabolic control biomarkers were checked throughout the first pandemic wave were compared to the results obtained before the 4th of March, 2020 (1st confirmed case in Poland). Results 598 patients cases with mean weight 87.07 kg (±19.54) were analysed. 22.41% (n=134) were treated solely with insulin, 42.64% (n=255) with metformin and 28.6% (n=171) were prescribed a combination of those. The baseline HbA1c and creatinine levels were at 7.33% (±1.39) and 1.16mg/dl (±0.76) respectively and rose by 0,19% (p=0.02) and 0.07mg/dl (p=0.004). The patient attendance for blood testing decreased by 42.18% in comparison to the pre-pandemic period. All patients have shown a rise in creatinine levels, but those treated only with metformin rose by 0,01mg/dl, which was a significantly smaller increase. Conclusions The increase in levels of creatinine and HbA1c, which may have an impact on cardiovascular risk, suggests that lockdown and its consequences resulted in a deterioration of metabolic control. Stronger support of patients and preparations for upcoming pandemic waves are necessary to avoid further complications in patients with DM2. The improvement of renal parameters in the group of patients treated only with metformin confirms its nephroprotective effect and it still should be used as first-line treatment..