The combination of type 1 diabetes and eating disorder during pregnancy

The problem of eating disorders currently holds a special place in clinical practice. Bulimia nervosa is one of the main forms of eating disorders, characterized by the difficulty in its treatment and a long, recurrent course. Eating disorders are common in patients with type 1 diabetes mellitus (T1D), especially in adolescent girls.In this article, we present a clinical case of a patient with T1D and bulimia nervosa, which developed before the manifestation of T1D and progressed against its background. The patient is overly concerned with controlling body weight, specifically restricted the intake of carbohydrates, forcibly caused vomiting. During pregnancy fasting ketonuria («low-carb ketone») was repeatedly detected. The minimum weight was 37 kg (BMI 15.2 kg/m2). Particular interest of this case is the course of pregnancy, which ended in the antenatal death. The possible cause could be the restriction on carbohydrate food and prolonged stay in ketosis, that might lead to the development of pregnancy pathology. Additional examination also revealed multiple complications of diabetes and recurrent depressive disorder, which requires conjoint monitoring by an endocrinologist and a psychiatrist.Combination of T1D and eating disorder in a pregnant patient should be considered as an atypical course of the disease

Feasibility, efficacy and safety of stent insertion as a palliative treatment for malignant strictures in the cervical segment of the esophagus and the hypopharynx

Background: 50% of esophageal cancers are inoperable at the time of diagnosis, and around 15% involve the cervical esophagus. The hypopharynx is often involved by these malignancies as well. Palliation of cervical esophageal malignancies through stent insertion is considered limited due to technical challenges, poor patient tolerance and high complication rate. The aim of this study is to review our experience with stent insertion in the cervical segment of the esophagus and to evaluate outcome differences between stent insertions involving or sparing the hypopharynx. Methods: We retrospectively reviewed data on 69 consecutive patients that underwent stent insertion for malignant strictures in the cervical esophagus at our Department. Patients were divided according to involvement or sparing of the lower hypopharynx. Dysphagia severity was measured with the Mellow-Pinkas scale before the procedure and on monthly follow-ups. Any complication and its management were recorded. The main outcome parameters were as follows: dysphagia improvement, rate of successful dysphagia palliation (i.e., a reduction of the score to 0 or 1 after stent insertion) and complication rate. Multivariable analysis was carried out to assess the influence of patient- and procedure-related factors on the outcome of the procedure. Results: Stent insertion was achieved in 100% patients. At 4 weeks, dysphagia score improved from a median of 3-0 (p < 0.001), and a successful palliation was achieved in 76.8% patients. The 30-day mortality rate was 14.5%. Successful palliation throughout the follow-up was achieved in 72.9% of the surviving patients. Complications occurred in 31.9% patients. Dilation before stent insertion was associated with a less efficient short-term dysphagia palliation (OR 6.77, 95% CI 1.46-31.29, p = 0.02). Conclusions: Stent insertion is a safe and effective palliative treatment for malignant cervical esophageal strictures. Results are consistent even in patients with hypopharyngeal lesions. Dilation should be avoided before stent insertion. © 2015, Springer Science+Business Media New York

Influence of predation risk on the sheltering behaviour of the coral-dwelling damselfish, Pomacentrus moluccensis

Predation is a key ecosystem function, especially in high diversity systems such as coral reefs. Not only is predation one of the strongest top-down controls of prey population density, but it also is a strong driver of prey behaviour and function through non-lethal effects. We ask whether predation risk influences sheltering behaviour of damselfish living in mutualism with branching corals. Host corals gain multiple advantages from the mutualistic relationship which are determined by the strength of damselfish sheltering. Distance travelled by the Lemon Damselfish Pomacentrus moluccensis away from their host colony was measured here as a proxy for sheltering strength and was expected to be shortest under highest predation risk. Predation risk, defined as a function of predator abundance and activity, turbidity and habitat complexity, was quantified at four reef slope sites in Kepulauan Seribu, Indonesia. Damselfish sheltering strength was measured using stationary unmanned video cameras. Small damselfish (&lt; 2 cm) increased their sheltering strength under high turbidity. Predator feeding activity, but not abundance, influenced damselfish sheltering strength. Contrary to our expectations, sheltering behaviour of adult damselfish decreased under high predator activity. While these observations are in line with risk-averse behaviour by juvenile P. moluccensis, they may indicate the presence of sentinel behaviour in the adults of this species. Habitat complexity seemed to be less important as a driver of damselfish behaviour. These counterintuitive results may indicate complex social behaviour and age-specific strategies for predator avoidance