Cardiac manifestations of sarcoidosis

Introduction and purpose: Sarcoidosis is a chronic, multi-system inflammatory disorder of unknown etiology. Due to the varied clinical picture of patients, the diagnosis of the disease is complicated, especially when the heart is affected.The aim of this article is to review the available diagnostic tools used for the diagnosis, evaluation and monitoring of patients with suspected cardiac sarcoidosis. Description of the state of knowledge: Sarcoidosis may affect any organ, but in particular lungs, skin, lymph nodes, eyes, liver and spleen. The most common manifestations are persistent cough, skin changes, visual disturbances, peripheral lymphadenopathy, fatigue and incidental abnormal chest radiograph. Cardiac sarcoidosis, occurring in about 5% of patients, is clinically significant with a wide range of symptoms including conduction abnormalities, ventricular arrhythmias, heart failure and sudden death. The diagnosis of cardiac sarcoidosis is challenging and often requires a combined approach using clinical data and advanced imaging. Invasive and non-invasive diagnostic tests are helpful in assessing the severity of heart involvement, with non-invasive tests becoming increasingly important, due to low sensitivity (30%) and high complication rate of endomyocardial biopsy for the diagnosis of cardiac sarcoidosis. Summary: Sarcoidosis significantly increases the mortality of patients and furthermore causes impaired quality of life and disability. Attempts to accurately assess the development of disease provide a more comprehensive and personalized care for patients. Especially cardiac sarcoidosis, as a potentially life-threatening localization, requires early diagnosis and appropriate treatment

Acute tonsillopharyngitis - a review

Introduction and purpose: Acute pharyngitis and tonsillitis is the most common reason why people want to visit their primary care physician. Viruses are the most common cause of acute pharyngitis and acute tonsillitis in children and adults. The patient complains about pain with sudden onset and throat irritation, pain on swallowing, fever and headache, and in children also abdominal pain, nausea and vomiting. Brief description of the state of knowledge: Most acute tonsillopharyngitis is due to rhinoviruses (35%), influenza (30%), RSV and parainfluenza. Bacteria causes 30% of the infections and S. pyogenes is the most common cause. Viral infections are seasonal. S.pyogenes infection is most often in winter and early spring. Changes in the pharyngeal mucosa look similar in both bacterial and viral etiologies. Because of that, scales have been developed to assess the probability of a bacterial infection. The most used is Centor / McIsaac scale. The gold standard of diagnostics is throat swab culture. In the treatment of streptococcal pharyngitis and tonsillitis, penicillins are used as first-line treatment. Antibiotic treatment reduces infectivity, lowers the risk of rheumatic fever and made symptoms disappear two days earlier. Tonsillectomy does not reduce the number of recurrent pharyngitis and tonsillitis, therefore it cannot be recommended. Conclusion: Acute tonsillopharyngitis can result in many complications, the most serious of them is rheumatic fever. Therefore, it is very important to properly diagnose and use antibiotic therapy when necessary

Cardiovascular risk in patients with selected cutaneous diseases

Introduction and purpose: Cardiovascular diseases (CVD) are the leading cause of death worldwide. The classic cardiovascular risk factors include age, gender, obesity, diabetes, hypertension, dyslipidemia, smoking and genetic factors. Some dermatological disorders are also potential risk factors for the development of CVD. The aim of the study is to review recent knowledge on the impact of dermatological diseases on cardiovascular risk. Description of the state of knowledge: The relationship between skin diseases and cardiovascular risk is influenced by various common dependencies such as: shared pathophysiological basis of disorders, risk factors, presence of a chronic inflammatory process, genetic susceptibility and environmental influences. Increased cardiovascular risk has been reported for several dermatological conditions, including psoriasis, systemic lupus erythematosus, systemic sclerosis, pemphigus, hidradenitis suppurativa, rosacea, atopic dermatitis. Chronic systemic inflammation, typically present in skin conditions, is a cardiovascular risk factor, because inflammation accelerates atherosclerosis, and furthermore may predispose patients to the development of metabolic syndrome, insulin resistance and diabetes mellitus. In patients who are initially metabolically unbalanced, these processes may be even more intense. Cardiovascular disorders, the frequency of which increases in patients with skin diseases, include atherosclerosis, coronary artery disease, ischemic heart disease, cardiac dysfunction, arrhythmias, heart failure, cerebrovascular disease (stroke, TIA) and peripheral arterial disease. Summary: Many cutaneous disorders, in addition to significantly increasing cardiovascular morbidity and mortality, also reduce the patient's quality of life. The cooperation of dermatologists and cardiologists in the care of patients with dermatological diseases is crucial for the proper treatment of the disease and prevention of cardiovascular complications

46 XY, Female. Complete androgen insensitivity syndrome: a case report

Introduction: Androgen insensitivity syndrome (AIS) is an inherited disorder of sexual development caused by mutations in the androgen receptor encoding gene. Case report: A female patient born in 1984, at the age of 17, was diagnosed with complete androgen insensitivity syndrome, during the diagnosis of primary amenorrhea. She was assigned grade 7 in the Quigley scale. Cytogenetic analysis showed a 46 XY karyotype. Gynecological examination revealed a blind ending vagina and a lack of uterus. Physical examination revealed normal breast development and scanty pubic and axillary hair. The patient kept seeing herself as a woman. At the age of 18, the patient underwent laparoscopic gonadectomy. After the procedure, the patient was under medical supervision and was taking orally 1 mg of estradiol daily. At the age of 24 patient was diagnosed with. The patient received sodium alendronate and ibandronic acid. The level of FSH was 35.50 mlU / ml and LH was 13.05 mlU/ml. Discussion: Quigley grades 6 and 7 correspond to complete androgen insensitivity. The genitals are completely feminized and newborns at birth are assigned as females. The diagnosis is usually established during the diagnostics of primary amenorrhea. CAIS is associated with high risks of gonad carcinogenesis and therefore a gonadectomy must be performed. Hormone replacement therapy (HRT) is required after gonadectomy in order to maintain secondary sexual characteristics. Due to the high risk of osteoporosis patient requires calcium and vitamin D supplementation and bone density control. The prognosis is good, and gonadectomy and HRT usually give satisfactory long-term results

The prevalence of left atrial enlargement in Polish patients with atrial fibrillation — a single center study

Background. Atrial fibrillation (AF) remains one of the major causes of cardiovascular morbidity worldwide. Left atrial enlargement (LAE) is a common risk factor of AF. Left atrial enlargement is also connected with a higher prevalence of heart failure in AF patients. The aim of this study was to assess the prevalence of LAE in Polish patients with AF. Material and methods. Transthoracic echocardiography was performed in consecutive AF patients hospitalized in the Department of Heart Diseases. We assessed LAE using a two-dimensional method. Left atrial (LA) size was classified into the 4 categories: normal (LAE values < 39 mm in women and < 41 mm in men), mildly enlarged (39–42 mm in women and 41–46 mm in men), moderately enlarged (43–46 mm in women and 47–51 mm in men), and severely enlarged (≥ 47 mm in women and ≥ 52 mm in men). Results. We analyzed 113 individuals with AF (mean age 77.2 ± 9.8 years; 37.2% men). Of these, 71 (62.8%) patients had LAE (age 77.6 ± 9.9 years; 36.6% men). LA was mildly enlarged (39–42 mm in women and 41–46 mm in men) in 20 (28.2%) patients, moderately enlarged (43–46 mm in women and 47–51 mm in men) was observed in 30 (42.3%), and severely enlarged (≥ 47 mm in women and ≥ 52 mm in men) in 21 (29.6%) patients. The incidence of heart failure was significantly higher in AF patients with LAE [39 (54.9%) compared to the patients without LAE — 12 (28.6%) p = 0.01]. Conclusions. In patients with AF, LAE was highly prevalent. Patients with AF and LAE have more often HF compared to AF patients without LAE

Urinary incontinence in women - the overview of pharmacological and surgical methods

Introduction and purpose of the work: Urinary incontinence (UI) is a common problem among women and the incidence increases with age. It is estimated that about 50% of women will be affected by this problem. There are 5 types of urinary incontinence: exercise, pressure, mixed, overflow and functional. Stress UI is the most common cause among young women, while stress UI is the second most common cause among older women. The widespread use of this phenomenon makes it a significant economic burden. State of knowledge (brief description): Due to the different types of UI and its many causes, treating this disorder becomes a significant challenge. It is important to use combination therapy, starting with pelvic floor muscle strengthening exercise, lifestyle modification, weight loss, and smoking cessation, followed by drug therapy and surgery as necessary. Summary: Currently, many drugs are used in the treatment of urinary incontinence, with different mechanisms of action, which allow the treatment of various types of UI, but pharmacotherapy often does not bring the expected benefits. Surgical treatment appears to be a promising form of treatment, but more research is needed on the long-term effects

The popularity and usability of mobile applications for women and expecting mothers

Introduction and purpose: There are many applications for women, including those planning to conceive, being pregnant or having a small child. These applications have various functions, among others: menstrual cycle control, information about fetal development, labor contractions counting or lifestyle advice. Aim of the study was to assess the popularity, usability, most frequently used functions and expectations of users in relation to mobile applications designed for period tracking, for pregnant women and for parents. Material and methods: The study was conducted in the form of a self-prepared, anonymous survey shared on social media. Results: 522 correctly completed questionnaires were analysed. The main sources of knowledge about pregnancy and motherhood were: Internet (90.4%) and doctor (73.5%). 78.7% of participating women used period tracking applications. The most useful functions were: date of period (94.7%), fertile days and ovulation (86.4%) and menstrual cycle regularity (58,2%). 86.6% of women used pregnancy tracker applications. The most useful features were: information about week of pregnancy (98.5%), child development (95.3%) and countdown to childbirth (83%). Using application during pregnancy: 74.8% of women felt more aware and 68.6% enjoyed the expectation time more. Parenting applications were the least popular - only 25% of respondents used them. Conclusions: Thanks to the mobile applications, women can be more aware and better prepared for planning pregnancy and motherhood. Encouraging them to use the applications can bring many benefits in a doctor-patient relationships, provided that the information contained therein is properly constructed

Kawasaki disease: a comprehensive review

Introduction and purpose: Kawasaki disease is an acute, self-limited vasculitis of medium arteries, and it affects children under 5 years old. It can lead to coronary artery aneurysms. Brief description of the state of knowledge: Pathogenesis of Kawasaki disease is unclear. The diagnosis is based on the clinical findings. The characteristic symptoms are polymorphous skin rashes, conjunctivitis, erythema, dryness, cracking and bleeding of the lips, erythema and swelling of palms and soles and cervical lymphadenopathy. Kawasaki disease is defined as a fever for 5 days accompanied by 4 or more of the diagnostic symptoms described above. The classic diagnosis is based on the exclusion of other diseases too. The diagnosis of incomplete Kawasaki disease is suggested if less than 4 main clinical features are found.  It is the most common cause of acquired heart disease in children. Kawasaki disease can lead to coronary artery aneurysm, myocarditis and pericarditis so it is very important to treat this illness correctly. Basic treatment is a single infusion of intravenous immunoglobulin and high-dose aspirin. Recurrent Kawasaki disease (persistent fever after first line treatment with IVIG and aspirin) requires the same treatment as used for the first episode. Corticosteroids and immune-modulating therapies can be used as second and third line options. Quick recognition and early treatment result in a reduction of coronary artery abnormalities. Conclusion: This article reviews basic informations, history, epidemiology, pathophysiology, clinical presentation, diagnostic criteria, complications and treatment of Kawasaki disease

Hypothyroidism: clinical presentation, diagnosis, treatment

Introduction and purpose: Hypothyroidism is a common disorder of the endocrine system in which the thyroid gland is not able to produce enough of certain thyroid hormones. Brief description of the state of knowledge:  The prevalence of hypothyroidism is between 1 and 6% and it is more common in women and older adults. Untreated significantly decreases the quality of life and increases mortality. Symptoms of hypothyroidism are nonspecific and may be confused with signs of other clinical conditions. The most common symptoms are chronic tiredness and fatigue, weight gain, cold intolerance, dry skin and hair loss. Serum thyroid-stimulating hormone (TSH) is the primary screening test for thyroid disfunction. Standard treatment for hypothyroidism consists of thyroid hormone replacement called levothyroxine. Conclusion: This article reviews basic informations, clinical presentation, diagnosis and treatment of hypothyroidism

The influence of selected food ingredients on the reduction of the risk of endometriosis: a literature review

Endometriosis is a common disease that occurs in 6-10% of women of reproductive age. The disease is often associated with chronic pelvic pain and infertility. Endometriosis is an inflammatory disease and is estrogen dependent. Its definition is the presence of endometrial-like tissue outside the uterus. The etiology of the disease remains unclear. It is believed that a variety of immunological, genetic, hormonal, and environmental factors may be responsible for the development of endometriosis. Surgical confirmation of the presence of endometrial tissue outside the uterus is necessary for the diagnosis of endometriosis. For this reason, endometriosis is considered to be underdiagnosed. Currently, available treatments have many limitations and cause many side effects during their long-term use. For this reason, other treatment and prevention methods for this disease are being sought. Research on the influence of dietary factors on endometriosis allows concluding that diet and particular food ingredients can be considered a factor reducing the risk of endometriosis. Therefore, understanding the role of nutrition in the development of endometriosis is of great importance for the development of effective guidelines related to the prevention of this disease. Therefore, we have reviewed the available literature related to the impact of individual components of the daily diet on the risk of developing endometriosis. Omega-3 fatty acids, dairy products, and soy in particular appear to be promising dietary factors that could potentially reduce the risk of endometriosis. Further research is needed to solidify this knowledge