Kliniczne i elektrograficzne cechy pseudozawału u młodego mężczyzny z cukrzycą typu 1, kwasicą ketonową i normokaliemią

Kwasica ketonowa (DKA) może być przyczyną zmian w zapisie elektrogardiograficznym (EKG) pod postacią przejściowego obniżenia odcinka ST, wydłużenia odstępu QT, zmian kształtu zamka T oraz obecności załamka U, prawdopodobnie w związku ze zmianami kaliemii. Nieliczne doniesienia wskazują na możliwość przejściowego uniesienia odcinka ST, imitującego zawał serca w przebiegu hiperkaliemii towarzyszącej DKA. W artykule przedstawiono przypadek 20-letniego mężczyzny z cukrzycą typu 1, DKA i normokaliemią, który doświadczył silnego bólu zamostkowego, a zapis EKG wykazał uniesienie odcinka ST sugerujące zawał ściany przedniej mięśnia sercowego. Na podstawie badań dodatkowych obejmujących markery martwicy mięśnia sercowego, koronarografię oraz USG serca wykluczono ostry zespół wieńcowy. Ustąpienie bólu zamostkowego oraz zmian w EKG po nawodnieniu pacjenta i wyrównaniu stanu metabolicznego sugeruje rozpoznanie psudozapalenia osierdzia, odpowiadającego podrażnieniu blaszek osierdzia w wyniku braku płynu w worku osierdziowym, spowodowanego odwodnieniem. Diagnozę ostrego zawału serca na podstawie uniesienia odcinka ST u pacjenta z cukrzycą, DKA i normokaliemią należy stawiać bardzo ostrożnie, nawet jeśli towarzyszy temu typowy ból zamostkowy. Należy rozważyć rozpoznanie pseuozapalenia osierdzia towarzyszącego ciężkiemu odwodnieniu

Ocena zasobu słownictwa u dzieci w wieku przedszkolnym – nowe narzędzie testowe

Assessment of vocabulary size – a new tool for testing preschool childrenThe paper presents the first phase of research aimed at the construction of Picture Vocabulary Test (part I – Comprehension; OTS-R). Development of a mental lexicon is one of the basic components of linguistic and communicative competence (Michnick-Golinkoff et al., 2000; Hall and Waxman, 2004). Vocabulary size affects other aspects of language acquisition e.g. grammar (Dale et al., 2000; Dionne et al., 2003). Presented measure aims at the assessing word comprehension in preschool Polish children. In this phase of research, 351 children (age 2–6) took part in the study. Word comprehension was assessed by a picture choice task. Children were presented with a series of four pictures charts, each containing pictures depicting a target word (noun, verb, or adjective) and three distractors related to the target word phonetically, semantically, and thematically. Results show a gradual increase of vocabulary with age, better understanding of verbs over nous and adjectives, and a greater proportion of semantic errors over the other two types of errors. The study enabled the preparation of a new version of assessment tool which is going to be used in the subsequent phase of the research (norming study)

Praktyczna realizacja zaleceń dotyczących diagnostyki cukrzycy ciążowej

Background: Gestational diabetes mellitus (GDM) is associated with health consequences for both, the mother and her offspring. In Poland, the diagnosis of GDM is based on the recommendations of the Polish Gynecological Society (PTG) and is usually made by obstetricians. Objective: The aim of the study was to assess practical implementation of PTG standards of GDM screening and diagnosis. Material and methods: The study group consisted of 351 pregnant women consulted by a diabetologist: 102 patients between 2008-2010 (PTG guidelines of 2005) and 249 patients between 2011-2013 (PTG guidelines of 2011). Data concerning diagnostic procedures performed by obstetricians – time of diagnostic tests, fasting glucose levels, oral glucose tolerance test (OGTT) results, and GDM risk factors – were collected. Adherence to the diagnostic procedures was assessed. Results: Adherence to the diagnostic guidelines for 2008-2010 was 42.2%. The most common errors were incorrect time of OGGT (36.4%) and wrong interpretation of glycaemia (34.1%). Between 2011-2013 incorrect diagnostic testing was detected in 78.3% of the affected women. The most common deviation was lack of OGTT at the beginning of pregnancy in women with GDM risk factors (91.3%). Conclusions: A considerable number of GDM women underwent incorrect diagnostic procedures. More precise description of GDM risk factors in PTG recommendations seems to be necessary.Wstęp: Cukrzyca ciążowa (GDM) wiąże się ze zwiększonym ryzykiem zarówno dla matki, jak i dziecka. W Polsce diagnostyka prowadzona jest przez lekarzy położników w oparciu o Standardy Polskiego Towarzystwa Ginekologicznego (PTG). Cel: Ocena praktycznego stosowania standardów PTG w diagnostyce GDM. Materiał i metody: Grupę badaną stanowiło 351 ciężarnych kobiet konsultowanych diabetologicznie: 102 w latach 2008-2010 i 249 w latach 2011-2013. U wszystkich pacjentek zebrano wywiad dotyczący sposobu diagnostyki, obejmujący czas wykonania badań diagnostycznych, wyniki glikemii na czczo, wyniki doustnego testu tolerancji glukozy (DTTG) oraz obecności czynników ryzyka GDM. Uzyskane dane oceniono w odniesieniu do standardów PTG z 2005 r. obowiązujących w latach 2008-2010 oraz zaleceń z 2011 r., obowiązujących w latach 2011-2013. Wyniki: W latach 2008-2010 niezgodnie ze standardami diagnozowanych było 42.2% kobiet. Wśród nieprawidłowości głównym odstępstwem od procedur diagnostycznych był niewłaściwy czas przeprowadzenia DTTG (36.4%) oraz niewłaściwa interpretacja wyników glikemii (34.1%). W latach 2011-2013 niezgodnie ze standardami diagnozowanych było 78.3% kobiet. Najczęstszym odstępstwem od standardów był brak wykonania DTTG na początku ciąży u kobiet z obecnymi czynnikami ryzyka GDM (91.3%). Wnioski: W badanej grupie pacjentek z GDM znaczący odsetek kobiet był diagnozowany niewłaściwie. Wydaje się, że konieczne jest doprecyzowanie standardów PTG w zakresie czynników ryzyka GDM

Ocena zasobu słownictwa u dzieci w wieku przedszkolnym – nowe narzędzie testowe

Assessment of vocabulary size – a new tool for testing preschool childrenThe paper presents the first phase of research aimed at the construction of Picture Vocabulary Test (part I – Comprehension; OTS-R). Development of a mental lexicon is one of the basic components of linguistic and communicative competence (Michnick-Golinkoff et al., 2000; Hall and Waxman, 2004). Vocabulary size affects other aspects of language acquisition e.g. grammar (Dale et al., 2000; Dionne et al., 2003). Presented measure aims at the assessing word comprehension in preschool Polish children. In this phase of research, 351 children (age 2–6) took part in the study. Word comprehension was assessed by a picture choice task. Children were presented with a series of four pictures charts, each containing pictures depicting a target word (noun, verb, or adjective) and three distractors related to the target word phonetically, semantically, and thematically. Results show a gradual increase of vocabulary with age, better understanding of verbs over nous and adjectives, and a greater proportion of semantic errors over the other two types of errors. The study enabled the preparation of a new version of assessment tool which is going to be used in the subsequent phase of the research (norming study)

Clinical and ECG patterns of pseudoinfarction in a young man with type 1 diabetes, diabetic ketoacidosis and normokalaemia

Diabetic ketoacidosis (DKA) can cause changes in the electrocardiogram (ECG) in the form of transient ST-segment depression, QT prolongation, changes in T-wave morphology and the appearance of U wave, possibly due to changes in the serum potassium level. Occasional reports indicate the possibility of transient ST-segment elevation imitating myocardial infarction in the course of hyperkalaemia accompanying DKA. In this article we present a case of a 20-year-old male patient with type 1 diabetes mellitus, DKA and normokalaemia, who experienced severe retrosternal pain, and ECG presented ST-segment elevation imitating acute myocardial infarction of the anterior wall. On the basis of the performed cardiac tests, including laboratory testing, coronary angiography and ultrasound scan, acute coronary syndrome was ruled out. The regression of retrosternal pain and electrocardiographic changes with patient hydration and correction of metabolic disorders suggest the diagnosis of pseudopericarditis, i.e. non-infections irritation of the pericardial membranes due to the loss of fluid in the pericardial sac as a result of dehydration. The diagnosis of acute myocardial infarction based on ST-segment elevation in the ECG recording in a patient with diabetes mellitus and ketoacidosis, without concomitant hyperkalaemia, must be made very carefully, even in the presence of retrosternal pain. The possibility of pseudopericarditis associated with severe dehydration must also be considered

Is Uric Acid a Missing Link between Previous Gestational Diabetes Mellitus and the Development of Type 2 Diabetes at a Later Time of Life?

INTRODUCTION:A high level of uric acid (UA) is a strong, independent risk factor for type 2 diabetes mellitus. The relationship between UA levels and the development of type 2 diabetes in women with previous gestational diabetes mellitus (pGDM) remains unclear. The aim of study was to evaluate the UA levels in pGDM women in relation to their current nutritional status and carbohydrate metabolism. MATERIAL AND METHODS:199 women with pGDM diagnoses based on oral glucose tolerance tests (OGTTs) 5-12 years previously and a control group of 50 women without pGDM. The assessment included anthropometric parameters, body composition (Tanita SC-330S), current OGTT, insulin resistance index (HOMA-IR), β-cell function (HOMA-%B), HbA1c, lipids, and uric acid. RESULTS:No differences between groups were found in terms of age, time from the index pregnancy, anthropometric parameters, lipids or creatinine levels. The incidences of overweight and obesity were similar. Carbohydrate abnormalities were more frequent in the pGDM group than the control group (43.2% vs 12.0% p<0.001). The women with pGDM had significantly higher fasting glucose, HbA1c, glucose and insulin levels in the OGTTs, but similar HOMA-IR values. Their UA levels were significantly higher (258±58 vs 230±50 μmol/L, p<0.005) and correlated with BMI and the severity of carbohydrate disorders. The normal weight and normoglycemic pGDM women also demonstrated higher UA levels than a similar control subgroup (232±48 vs 208±48 μmol/L, p<0.05). Multivariate analysis revealed significant correlations of UA level with BMI (β = 0.38, 95% CI 0.25-0.51, p<0.0001), creatinine level (β = 0.23, 95% CI 0.11-0.35, p<0.0005), triglycerides (β = 0.20, 95% CI 0.07-0.33, p<0.005) and family history of diabetes (β = 0.13, 95% CI 0.01-0.25, p<0.05). In logistic regression analysis, the association between higher UA level (defined as value ≥297 μmol/L) and presence of any carbohydrate metabolism disorder (IFG, IGT or diabetes) was statistically significant (odds ratio 3.62 [95% CI 1.8-7.3], p<0.001). CONCLUSIONS:Higher UA levels may be associated with the development of type 2 diabetes in pGDM women, also in these with normal body weights

Characteristics of the NGT+NW subgroups.

<p>Characteristics of the NGT+NW subgroups.</p

UA levels according to BMI status.

<p>UA levels according to BMI status.</p