Folia Medica Cracoviensia

Purpose: The jugular foramen (JF), located at the junction of the occipital and temporal bones, exhibits significant morphological variability due to its developmental origin. It transmits key neurovascular structures, including the glossopharyngeal (IX), vagus (X), and accessory (XI) cranial nerves, as well as the internal jugular vein. Detailed anatomical knowledge of the JF is essential for planning and safely performing surgical procedures in this region. The objective of this study was to provide a comprehensive quantitative synthesis of the anatomical characteristics of the JF based on global data.

Materials and Methods: A systematic search of major medical databases (PubMed, Embase, Scopus, Web of Science, and Google Scholar) was conducted to identify studies reporting on the morphometry and surgical anatomy of the JF. Data extraction and meta-analysis were performed across seven anatomical parameters: (1) length, (2) width, (3) depth, (4) area, (5) distance to the stylomastoid foramen, (6) maximum width of the jugular fossa, and (7) minimum distance between the round window and roof of the jugular fossa.

Results: Thirty studies met the inclusion criteria, comprising data from 5204 JFs. The analysis revealed significant asymmetry between the right and left JFs, with the right side generally larger across all measured parameters. Considerable heterogeneity was noted across populations and study types. The compiled morphometric data underscore notable geographic and demographic differences in JF anatomy.

Conclusions: This meta-analysis offers a detailed and up-to-date reference for the morphometric characteristics of the jugular foramen. These findings have critical implications for neurosurgeons and skull base surgeons, particularly in the management of lesions such as glomus jugulare tumors, schwannomas, or during decompressive procedures involving cranial nerves IX–XI. Enhanced anatomical awareness may contribute to improved surgical planning, reduced complication rates, and better clinical outcomes.

Background: Monoclonal gammopathies, including monoclonal gammopathy of undetermined significance (MGUS) and multiple myeloma (MM), are plasma-cell disorders linked to profound metabolic remodeling. Lipid metabolism, particularly the balance between n-3 and n-6 polyunsaturated fatty acids (PUFAs), plays a pivotal role in inflammation, membrane dynamics, and tumor progression.

Methods: Plasma fatty acid (FA) profiles were analyzed in patients with MGUS, MM, and healthy controls via gas chromatography. Desaturase indices (Δ5D, Δ6D, Δ9SCD1, Δ9SCD2) were calculated from FA ratios. Results: MM patients exhibited significantly higher palmitic acid and lower n-3 PUFA levels (EPA, DHA) compared to controls (p <0.05), reflecting a pro-inflammatory lipid milieu. MGUS patients showed increased oleic acid and markedly elevated Δ9-desaturase activity, suggesting enhanced monounsaturated FA synthesis during early plasma-cell transformation. The n-3/n-6 ratio decreased progressively from controls (1.0) to MGUS (0.5) and MM (0.4). Trans fatty acids were substantially elevated in MGUS and MM compared to the control group.

Conclusion: Altered plasma FA composition and desaturase activity indicate lipid metabolic reprogramming in MGUS and MM. The progressive reduction of the n-3/n-6 PUFA ratio underscores a shift toward a pro-inflammatory state that may promote malignant transformation. Lipidomic profiling could serve as an early biomarker of disease evolution, and dietary modulation of n-3 PUFAs may hold therapeutic potential.

Introduction: Bronchofiberoscopy, particularly when combined with real-time endobronchial ultrasound-guided transbronchial needle aspiration (RT-EBUS–TBNA), is a widely available, long-established, and safe diagnostic modality for respiratory diseases, with particular relevance to the evaluation of primary and secondary lung neoplasms.

The aim of this study is to present a case of purulent mediastinitis as a complication of RT-EBUS– TBNA, which highlights the increased likelihood of infectious complications in patients with additional risk factors such as diabetes mellitus and immunosuppression, in this instance related to chronic systemic corticosteroid therapy. Furthermore, this report reviews the available literature on the incidence of complications, including infectious events, following EBUS-guided transbronchial biopsy.

Conclusions: Complications following EBUS-guided transbronchial biopsy are rare; therefore, the procedure should be regarded as a safe and recommended diagnostic method.

The autonomic nervous system (ANS) plays a key role in maintaining physiological homeostasis by regulating cardiovascular activity, gastrointestinal motility, and stress responses.

The aim of this review was to analyze how selected dietary components, and complete nutritional models affect ANS activity, with particular emphasis on underlying physiological mechanisms and practical dietary recommendations in cases of sympathetic or parasympathetic hyperactivity.

This paper discusses how caffeine, simple sugars, and highly processed foods tend to enhance sympathetic output, whereas omega-3 fatty acids, magnesium, dietary fiber, promote autonomic balance by reducing sympathetic tone and enhancing parasympathetic function.

Based on a review of recent scientific studies, it can be concluded that nutrition and lifestyle interventions can significantly modulate ANS function and serve as valuable tools in the management of chronic stress, anxiety, hypertension, and functional gastrointestinal disorders.

Fractures of the carpal bones are rare compared to fractures of the metacarpals and phalanges. The triquetrum and scaphoid are the most frequently involved, and the other bones injuries are less common. The aim of the study was to analyze the incidence of carpal fractures other than the scaphoid bone, methods and results of their treatment.

Material and Methods: Between 2021 and 2023, 35 patients, 25 men (71%) and 10 women (29%), at the mean age of 49 years, with isolated fractures of the carpal bones other than the scaphoid, were treated at the author’s institution. Fractures of the triquetrum was the most commonly seen — 25 cases (71%), followed by the hamate bone — 6 cases (17%). Most fractures were treated conservatively with wrist immobilization for 5 weeks. Six patients (17%) required surgical treatment, most of them with the hamate fractures.

Results: In a telephone interview at a mean of 16 months post-treatment, 31 patients (88%) had no symptoms in an affected wrist, and 32 (91%) rated the hand as fully functional, the same as before the injury. Three patients who assessed their hands as less functional, had accompanying injuries: distal radial fracture, fracture of the base of the first metacarpal bone, and metacarpo-phalangeal joints dislocation. All of these injuries required surgical treatment.

Conclusions: Fractures of the carpal bones other than the scaphoid are moderately common, their treatment is mostly conservative, and the results of treatment, both conservative and surgical, are good.

Background: The increasing prevalence of multimorbidity among older adults, particularly those with cancer, highlights the need for coordinated post-hospital care. This study aimed to assess the demand for multidisciplinary post-discharge services among older patients, with a focus on oncological individuals. Methods: We conducted a retrospective analysis of medical records from 200 patients aged ≥65 years hospitalized at the Department of Internal Medicine and Geriatrics, University Hospital in Krakow, Poland. Patients were divided into two age groups: 65–79 and ≥80 years. Data on medical history, cancer diagnosis, nutrition, rehabilitation needs, pharmacotherapy, and psychosocial aspects were extracted to determine post-discharge care needs.

Results: The most frequently identified needs included dietary counseling (54 patients), pharmacological review (27), psychological support (21), nursing care (13), and social work services (6). Cancer patients had significantly higher needs for psychological (100% vs. 40.1%, p <0.001) and nutritional support (85.7% vs. 64.2%, p = 0.002) compared to non-cancer patients. Older patients (≥80 years) showed significantly greater demand for social support (p = 0.045), with all requiring at least one type of post-hospital intervention.

Conclusion: Older adults, especially those with cancer, have high and complex post-discharge care needs that are inadequately addressed by existing services. The findings support the development of integrated geriatric care models to enhance continuity of care and patient outcomes following hospitalization.

Background: Core stability allows to control and properly perform movements of all body. Optimal core stability level depends on deep muscles capacity and neuromuscular control. Poor core stability is a risk factor for injury, especially during physical activity.

Objective: The purpose of this study was to examine the differences in core stability between sport and recreational horse riders and people, who don’t do any sports. We hypothesized that horse riders demonstrate better core stability performance.

Methods: 75 people aged 15–30 (20 recreational horse riders, 20 sport horse riders and 35 non-horse riders) was examined in 4 core stability tests. Individuals were assigned to each group based on authors questionnaire. Differences between groups were assessed by analysis of variance (ANOVA).

Results: The study showed that sport horse riders have the best core stability. Recreational riders, who trained for shorter periods of time obtained much lower results in each test. The non-horse rider group demonstrated the worst results. There was no statistically significant relationship between the frequency of equestrian training and tests results.

Conclusions: Horse riding increases core stability and has a positive effect on all its parameters. The longer the equestrian training, the better core stability.

Introduction: Population aging is associated with increased problems of physical and functional fitness in geriatric patients. Fitness constitutes a key element of independence and quality of life in elderly individuals. The proprioceptive neuromuscular facilitation (PNF) method is widely used in orthopedic and neurological rehabilitation; however, there is a lack of research on its comprehensive application in elderly patients in hospital settings.

Objective: To assess the impact of the PNF concept on independence in elderly individuals and to compare the effectiveness of the PNF method with general rehabilitation (GR) during a maximum 10-day hospital treatment.

Material and Methods: The study included 80 randomly selected patients over 64 years of age hospitalized in the Department of Internal Medicine and Geriatrics. Patients were randomly divided into two 40-person groups: GR and PNF. Functional fitness assessment was conducted at the beginning of rehabilitation and after a maximum of 10 days of therapy or on the day of discharge. The following were used: ADL assessment, IADL, Up & Go test, SPPB test, balance assessment, gait speed measurement, 5-times sit-to-stand test, and NRS scale.

Results: Patients rehabilitated according to the PNF concept achieved statistically significantly greater improvement in functional and physical fitness compared to the GR group.

Conclusions: The PNF method in elderly individuals allows for more effective achievement of the main goal of rehabilitation, which is reaching maximum patient independence.

Sodium-glucose cotransporter 2 inhibitors (SGLT2i) are antidiabetic drugs that help lower high blood sugar levels by blocking the reabsorption of glucose in the kidneys. Although their primary function is to control blood sugar in type 2 diabetes mellitus (T2DM), growing evidence suggests they may also have additional benefits, particularly in reducing neurological and cardiovascular complications related to T2DM. This study explores the neuroprotective effects of SGLT2i, which appear to improve symptoms of peripheral neuropathy by enhancing nerve conduction for both sensory and motor functions and reducing neuropathic pain. These effects are believed to occur through mechanisms such as the activation of AMP-activated protein kinase and the reduction of mitogen-activated protein kinase phosphorylation, both of which protect nerve function. In terms of cardiovascular health, SGLT2i show cardioprotective effects by lowering sympathetic nervous system activity, reducing blood pressure, and minimizing the risk of heart failure-related hospitalizations and arrhythmias. Furthermore, these inhibitors may play a role in preventing diabetic retinopathy by reducing oxidative stress and blocking inflammatory pathways in retinal tissue. Although some research has hinted at a potential link between SGLT2i use and increased risk of diabetic foot complications, the results are not definitive and require further study. Overall, SGLT2 inhibitors represent a multifaceted approach in managing T2DM, offering additional neurological and cardiovascular benefits. Ongoing research is critical to fully understand their mechanisms, enhance therapeutic outcomes, and confirm their safety for a wide range of patients.

Background: Chronic Obstructive Pulmonary Disease (COPD) is characterized by persistent respiratory symptoms and airflow limitation. Acute exacerbations significantly impair lung function and increase the risk of hospitalization and mortality.

Methods: This case report describes a 66-year-old female patient with GOLD 2023 Group E COPD, admitted to the University Hospital in Cracow due to an acute exacerbation triggered by human metapneumovirus infection. Standard pharmacological therapy was initiated, followed by a 10-day program of individualized respiratory rehabilitation. The rehabilitation interventions included bronchodilator and hypertonic saline nebulization, oscillating positive expiratory pressure (OPEP), gravity-assisted drainage, vibratory massage, and the Active Cycle of Breathing Techniques (ACBT). In addition, limb muscle training using a bedside ergometer was implemented. The rehabilitation began on the second day of hospitalization and was conducted twice daily.

Results: Significant clinical improvements were observed: the patient reported reduced dyspnea (Borg scale decreased from 5 to 2), increased FEV₁ (from 30% to improved post-rehabilitation values), and an extended distance in the six-minute walk test (+80 meters), with no exertional desaturation. Inflammatory markers returned to normal. The patient was discharged with recommendations for continued home-based rehabilitation.

Conclusions: This case illustrates that early implementation of comprehensive respiratory physiotherapy during COPD exacerbation can result in functional improvement and symptom relief. These findings align with current evidence supporting the benefits of early pulmonary rehabilitation in reducing the impact of exacerbations and improving quality of life in patients with COPD.

In recent decades, there has been an increase in the incidence of both autoimmune and endocrine diseases, mainly in industrialized countries and may be partly due to human exposure to increasing levels of environmental pollutants. Research shows that environmental pollutants, specifically endocrine disrupting compounds (EDCs), adversely affect gonadal and thyroid function and are linked to type 1 diabetes development. Current data illustrates that the immune system is also a target of EDCs, including the possible exacerbation of autoimmune processes, which are the causes of many endocrine diseases.

In this paper, we have presented evidence that environmental pollutants, in addition to directly affecting endocrine glands, can also damage them by intensifying autoimmune processes. We collected experimental and epidemiological data on the effects of EDCs on testicular, ovarian and thyroid function, as well as on the impact of these compounds on the development of type 1 diabetes. The available data demonstrating the potential for particular EDCs to exacerbate autoimmune processes in selected autoimmune endocrine diseases, such as autoimmune orchitis, premature ovarian failure, autoimmune thyroid diseases, and type 1 diabetes were also shown. Because research demonstrating the effects of EDCs on the immune system and the involvement of these compounds in the pathogenesis of autoimmune endocrine diseases is in its early stages, we also presented scientific doubts about this problem and directions for further research. Confirmation of this mechanism of action of EDCs in further studies would help to clarify the current controversies regarding the assessment of their effects in humans.

Introduction: The burden on caregivers of chronically ill patients is a subject of concern for many specialists. The course of multiple sclerosis and the associated change in the patient’s functional ability, as well as the resources available to the caregiver, are related to the burden felt by the caregiver. It is extremely important in relation to the care provided to assess the factors that may determine the burden on caregivers. The aim of this study was to identify selected determinants of burden on caregivers of multiple sclerosis patients.

Material and Methods: A diagnostic survey was conducted among 107 caregivers of multiple sclerosis patients using the CBS Caregiver Burden Scale, Guy’s Neurological Disability Scale (GNDS), Berlin Social Support Scale (BSSS), Antonovsky’s SOC-29 Life Orientation Questionnaire, and the author’s own questionnaire. The collected survey data were entered into a Microsoft Excel spreadsheet and then analyzed using Statistica 13 software. The level of statistical significance was adopted as α = 0.05.

Results: The burden on caregivers was high in all subscales. Life orientation and social support were associated with the burden on caregivers. Low life orientation, decreasing perceived available support and currently provided support, as well as a shortage of currently received support and increased search for support resulted in a higher overall burden among caregivers. In addition, deteriorating functioning of patients exacerbated the caregivers’ feelings of social isolation, disappointment, and emotional involvement.

Conclusions: Caregivers experienced burdens in various dimensions related to the functional ability of patients and their own resources, such as social support and life orientation.

Background: Pleural drainage is the standard procedure after different thoracic procedures. The drainage rules used in various centers vary considerably. Although many centers use now single chest tube instead of the classical double-tube system, high-level evidence supporting this approach is scant.

Objectives: The aim of this trial was to compare effectiveness of single chest tube versus the double-tube system and factors influencing this effectiveness.

Material and Methods: A prospective randomized trial including patients treated between 2016 and 2017. The primary endpoint was drainage time and the secondary endpoints were drainage volume and air leak time.

Results: There were 312 patients: 153 finally analyzed in the single-tube group (ST) and 145 patients in the double-tube group (DT). Both groups were comparable regarding patients’ characteristics (p = 0.11–0.60). There was no significant difference in drainage time (p = 0.084). Single chest tube was associated with significantly lower drainage volume (1515 ml vs 1998 mL, p = 0.001), mean air leak intensity (26.5 vs 64.2 mL/ min, p = 0.005) and mean air leak time (59.9 vs 89.0 hours, p = 0.002). On the multivariate analysis only fused fissure (p = 0.027) was associated with total drainage time. Drainage volume was associated with double-tube (p = 0.039) and VC (p = 0.049), air leak intensity with double-tube (p = 0.032) and BMI (p = 0.048) and air leak time with double-tube (p = 0.008) and BMI (p = 0.043). Complications occurred more often in the DT group (p = 0.04).

Conclusions: in patients who underwent anatomical pulmonary resections single chest tube is associated with lower chest tube output, air leak intensity and air leak time.

Introduction: Amyotrophic lateral sclerosis (ALS) represents a heterogeneous group of neurodegenerative disorders sharing a common ALS phenotype but arising from diverse genetic and molecular mechanisms. Among the genes implicated in ALS, SQSTM1, encoding the multifunctional protein p62, plays a pivotal role in maintaining neuronal homeostasis through the regulation of autophagy and the crosstalk between NF-κB and Nrf2 pathways. Disruption of these mechanisms contributes to oxidative stress, neuroinflammation, and protein aggregation in motor neurons.

Material and Methods: A comprehensive genetic analysis, including next-generation sequencing (NGS), whole-exome sequencing (WES), and multiplex ligation-dependent probe amplification (MLPA), was performed in a patient clinically diagnosed with ALS. Literature data regarding the role of SQSTM1, NF-κB/ Nrf2 signaling, and autophagy modulation in ALS pathogenesis were reviewed to contextualize the findings.

Case Presentation: We describe a 49-year-old woman with a 12-month history of progressive bulbar- onset ALS. Genetic testing revealed a heterozygous SQSTM1 c.1175C>T (p.Pro392Leu) variant inherited from her father, classified as likely pathogenic. The patient received dimethyl fumarate (Nrf2 activator), celecoxib ( NF-κB inhibitor), and rapamycin (mTOR pathway modulator) as part of an individualized treatment strategy.

Discussion: Mutations in SQSTM1 contribute to ALS pathogenesis through dysregulation of autophagy, impaired protein clearance, and excessive neuroinflammation mediated by NF-κB activation. The interplay between NF-κB and Nrf2 signaling pathways suggests that targeted therapeutic modulation may attenuate neurodegeneration. The patient’s case illustrates the clinical and molecular heterogeneity of ALS and supports the concept of pathway-specific, precision medicine approaches.

Conclusions: This case highlights the relevance of SQSTM1-related pathogenic mechanisms within the heterogeneous ALS spectrum and underscores the importance of advanced genetic testing for identifying candidates for personalized therapy.

Objective: Several patterns of communication between the median nerve (MN) and the musculocutaneous nerve (MCN) have been described along with a number of classification systems. However, some atypical patterns of communication find no place in the existing classification systems. Knowledge about these variable communications is crucial for the accurate clinical management of peripheral nerve lesions of the upper limb.

Methods: 48 formalin-fixed dissected specimens of upper limb (36 right and 12 left) were examined for presence of communications between MN and MCN. The observed gross anatomical features were recorded and photographed using a digital camera. Measurement of length and thickness of communications was done using a non-stretchable measuring tape and digital Vernier callipers.

Results: A total of 8 communications were observed, all unilateral, extending from MCN to MN and located either in the axilla or in the arm. Five communications were on the right side and 3 on the left. Five communications adhered to typical previously reported patterns, while three were novel and atypical. Most communications arose from the MCN after it traversed the coracobrachialis (CRB) muscle, only one arising proximal to the CRB.

Conclusion: Eight cases of unilateral MN-MCN communication were found among the 48 upper limbs examined, including three atypical cases that cannot be categorized in any existing classification system and may therefore be easily missed during surgery. Their identification is crucial to avoid inadvertent damage during surgical procedures.