GLP-1 analogs in the treatment of obesity

Introduction and purpose Obesity is a chronic disease that causes the development of numerous complications such as cardiovascular disease, cancer and type 2 diabetes. The 2017 global nutrition report showed that 2 billion adults and 41 million children worldwide are overweight or obese. Due to the growing problem of obesity, pharmacotherapy is recommended in patients with BMI ≥30 kg / m2 or BMI> 27 kg / m2 with accompanying risk factors. The aim of the study is to discuss the role of GLP-1 analogues in the treatment of obesity. Description of the state of knowledge  GLP-1 receptor agonists that were initially related to the treatment of type 2 diabetes are now being used successfully in the treatment of obesity. The GLP-1 hormone is released from intestinal enteroendocrine cells in response to an increase in glucose levels. Due to the wide neuroanatomical distribution of GLP-1R within the structures of the reward system, it is possible to suppress the need for food intake, which translates into a reduction in the amount of food consumed and a decrease in body weight. The most common side effects associated with the use of GLP-1 analogues include gastrointestinal symptoms such as nausea, vomiting, diarrhea and constipation, which rarely lead to discontinuation of treatment. Summary Numerous studies have shown that chronic systemic delivery of GLP-1 agonists led to weight loss and helped to maintain a lower body weight. Reduction in food intake is reported as the main mechanism. Discontinuation of the drug was associated with weight gain

The variety of clinical manifestations in the course of granulomatosis with polyangiitis

Introduction and purpose Granulomatosis with polyangiitis (GPA), formerly known as Wegener's granulomatosis, is a rare systemic autoimmune disease. It causes inflammation of small and medium-sized arteries in various organs, with the vessels of the kidneys and lungs being most frequently affected. Characteristic for GPA is the presence of antibodies (ANCA) directed against proteinase-3 (PR3) produced by neutrophils. The aim of the study is to present various clinical manifestations of GPA and current diagnostic tools. Description of the state of knowledge Currently, there is a marked increase in the incidence of GPA. This disease affects both men and women, most often between the ages of 45 and 60. Granulomas typical of GPA consist of giant cells surrounded by plasma cells, lymphocytes and dendritic cells that damage the submucosa and migrate to surrounding tissue, cartilage or bone, causing necrosis and permanent deformation. In making a diagnosis, you can use the ACR criteria and the acronym ELK. Summary  GPA is a multi-system disease. Initially, it causes a number of non-specific ailments. The first clinical manifestation is most often otorhinolaryngological symptoms, especially serous otitis media. Then it can gradually cause discomfort from any system. The most frequently involved vessels are the kidneys and lungs, but also the skin, nervous system and eyes. Prompt diagnosis of GPA is very important for prognostic reasons. Early initiation of immunosuppressive therapy can rapidly lead to clinical remission and, in the long term, reduce disease complications and mortality

Risk factors and diagnosis of iatrogenic damage of periodontal structures and roots during orthodontic Mini-Implants implantation procedures - a systematic literature review

Introduction and purpose In recent years, Mini-Implants (MI) have gained popularity and new complications have emerged with them. The article assesses the current reports on the scale of the problem, factors and diagnostic possibilities related to iatrogenic injuries of periodontal tissues and roots.   Description of the state of knowledge The incidence of complications was estimated to be 13.5%. Complications are more common in the mandible and are estimated at 20-27.1%. Periodontal and root damage are an important risk factor for treatment failure. The fact that the implant does not interfere with the alveolus structure gives the treatment effectiveness in 90%, and the contact with the alveolar “lamina dura” is 62.5%. Interference with the root structure is successful in only 31.2%. Risk factors for failure include: young age, poor hygiene, smoking, area of mandibular molars, contact with the root, thickness of the bone and lack of experience. The implant between the roots is a risk of root trauma, as the location close to the tooth cemento-enamel junction, no preparation for surgery, not using surgical templates, strenuous implantation or implant migration under the influence of orthodontic forces. Radiographs are the gold standard in the diagnosis of complications, but they do not allow for a full assessment of the three-dimensional structures of the implant. A promising method is the evaluation of the torque as the implant is placed in its final location. The patient's subjective feelings are questionable in diagnosis and require further research. Summary There are many complications in using MI and the most important of these is damage to the structures of the periodontium and the tooth root. Despite the low failure rate, failure should be prevented by pre-operative evaluation, in-operative monitoring, and post-operative diagnostics

Clinical features and management of iris melanoma - a systematic review

Introduction and purpose  Uveal melanoma is the most common primary intraocular malignancy in adults. Most of them arise in the choroid and ciliary body, whereas 2-5 % of the cases are located to the iris. Nevertheless, during the last few decades the incidence of this neoplasm has been increasing. The aim of the study is to discuss the risk factors, clinical features and methods of diagnosis and treatment of iris melanoma.  Description of the state of knowledge  Iris melanomas vary in their shape, size, degree of pigmentation and clinical behavior and most commonly present as a nodular tumor located in the lower temporal iris quadrant. This localisation is linked to exposure to solar radiation, which among light-colored iris, skin color and pre- existing iris naevus, is a risk factor for this malignancy. Gender predilection for the development of iris melanoma is unclear, however, some studies indicate a predominance of female patients. The most common clinical symptoms are growth of a pre-existing naevus, detection of new, dark lesion, pain secondary to elevated IOP and blurred vision. Due to anterior location of this site of uvea, early diagnosis and treatment is possible. Slit-lamp examination, gonioscopy, and ultrasound biomicroscopy (UBM) allow staging of the tumor to guide the most appropriate treatment. As many primary iris lesions have a benign prognosis, surgical resection or radiotherapy is efficient way of treatment and allows good local tumor control.   Summary  Iris melanoma is least frequent of all uveal melanomas and usually presents as variably pigmented, elevated, solitary lesion. When there is a clinical suspicion of malignancy slit- lamp examination and UBM should be performed. When early diagnosed it can be successfully treated.

Primary failure of eruption (PFE) - a systematic literature review

Introduction and purpose Primary Failure of Eruption (PFE) is a rare disease that occurs more often in women than in men. PFE is extremely important for orthodontists because conventional treatment of patients results in ankylosis of the teeth affected by the disease. The aim of the study is to discuss the epidemiology, etiology, diagnosis and treatment of Primary Failure of Eruption. Description of the state of knowledge PFE is present in 0.05% to 0.6% of the population. The average incidence is at the age of 13.65, more often in women. Most often it affects the lateral teeth, and therefore it results in open lateral bites because the teeth do not reach the occlusal plane. The condition was found to be of genetic origin and inherited autosomal dominantly with a low percentage of incomplete penetration. The gene responsible for the disease is the PTH1R. The diagnosis of the disease consists in excluding other causes of eruption failure, detecting disease in which such symptoms occur, and genetic tests (NGS). Treatment of an open lateral bite cannot be carried out in a conventional manner due to the deterioration of the condition after the application of orthodontic forces. The result of the above actions is ankylosis of teeth covered by PFE. The currently proposed methods of treatment are: single or multi-site osteotomy, selective extractions with subsequent implantations, direct or indirect composite restorations, distraction osteogenesis, removable prosthetic restorations. Summary Properly conducted clinical examination of the patient should take into account PFE. Genetic testing (PTH1R) is important in the diagnosis of people with eruption disorders, which is crucial for achieving partially positive treatment results. Orthodontic treatment is contraindicated and patients with a PTH1R mutation should be monitored long-term until their growth is complete, which is the time when interdisciplinary treatment is initiated

Primary adrenal insufficiency - Addison's disease

Introduction and purpose Addison's syndrome is defined as primary adrenal insufficiency, the symptoms of which result from hormonal deficiencies: glucocorticosteroids, mineralocorticosteroids and androgens. Currently, autoimmunity is considered the most common cause of Addison's Syndrome. Antibodies are most often directed against the enzymes 21-hydroxylase and 17-hydroxylase involved in steroidogenesis. The aim of the study is to present a typical clinical course, diagnostic path and current therapeutic options of Addison's syndrome. Description of the state of knowledge Currently, in developed countries, the number of cases is 100-140 people per million people. Initially, Addison's syndrome runs secretly. The clinical picture is closely correlated with the degree of adrenal cortex destruction. The most common symptoms include hypotonia, weight loss, weakness, salt craving, gastrointestinal disorders, and hyperpigmentation of the skin and mucous membranes. In extreme cases, adrenal crisis may develop, characterized by rapid clinical deterioration with hypotension, fever, vomiting, dehydration, and loss of consciousness. Diagnostics uses the measurement of the concentration of morning cortisol and corticotropin (ACTH) in the blood, and in doubtful situations, additionally a stimulation test using synthetic ACTH. Summary A diagnosis of Addison's syndrome requires end-of-life hormonal substitution. For this purpose, hydrocortisone or prednisone and fludrocortisone are used. In stressful situations, the doses of glucocorticoids should be adequately increased. Patients with adrenal crisis require intensive fluid resuscitation to restore intravascular volume, correct hypoglycemia and electrolyte disturbances, and administer rapidly high doses of hydrocortisone

Risk factors for infectious keratitis - a literature review

Introduction and purpose  Infectious keratitis represents the leading cause of corneal blindness worldwide, particularly in developing countries. Both risk factors and etiological patterns vary between economically developed and developing regions, with bacterial predominance in the former and fungal predominance in the latter. This review aims to provide an updated overview of the risk factors in relation to infectious keratitis. Description of the state of knowledge  Infectious keratitis is a painful and potentially vision-threatening ophthalmic condition characterized by decreased vision, photophobia and eye redness. In severe cases, it may require hospital admission for intensive medical treatment or surgical interventions. It can be caused by a wide array of organisms, including bacteria, fungi, viruses, parasites or polymicrobial infection. The most commonly observed predisposing factors for infectious keratitis include contact lens wear, trauma, ocular surface diseases, post-corneal surgery and systemic or local immunosuppression. Manual workers in construction or agricultural industry, exposed to vegetative matter, organic materials and animal products are particularly at risk. Higher rate of incidence is also observed in regions with poor environmental and personal hygiene, low level of education, poor access to sanitation and healthcare facility. Summary  Persistent prevalence of infectious keratitis in both developed and developing countries makes it a serious medical problem. Prevention, proper diagnosis and effective treatment are crucial for positive visual outcome

Zollinger-Ellison Syndrome - review

Introduction and purpose Zollinger-Ellison syndrome (ZES) is a constellation of symptoms that includes gastric ulcer, gastroesophageal reflux disease (GERD), and chronic diarrhea. They are caused by the presence of gastrinoma, which is a neuroendocrine tumor that secretes gastrin. Gastrinoma is most often found in the duodenum and pancreas. ZES occurs sporadically in about 80% of cases, while in 20-25% it is a component of multiple endocrine neoplasms (MEN1). It is malignant in 60-90% of cases. The aim of the study is to present the typical clinical course of ZES, the diagnostic path and current therapeutic recommendations. Description of the state of knowledge  ZES is present in about 0.1% -1% of patients with peptic ulcer disease. The direct cause of symptoms in patients with ZES is excessive gastric secretion stimulated by ectopic gastrin. Excess gastric acid damages the gastric mucosa and small intestine and disrupts the transport of fats, leading to the development of diarrhea. Other common symptoms include abdominal pain, nausea, or more rarely severe complications of GERD or peptic ulcer disease. Diagnostics include measurement of fasting serum gastrin, measurement of gastric pH, and assessment of basal gastric acid production. Summary  In pharmacological treatment, proton pump inhibitors (PPIs) are the first-line drugs to control excessive gastric acid secretion in patients with ZES. Other therapeutic options include histamine receptor antagonists or somatostatin analogues. Surgical intervention remains the only possible causal treatment. In the case of sporadic ZES routine exploratory laparotomy with curative intent is recommended. In the group of patients with coexisting MEN-1 syndrome, surgical intervention is reserved for patients with tumors> 2 cm

Standard and innovative options in the treatment of insulin resistance

Introduction and purpose  Insulin resistance is a state of decreased tissue sensitivity to insulin, despite normal or elevated levels of this hormone in the blood serum. People with insulin resistance for a long time do not show symptoms, which makes it particularly difficult to detect and treat in early stages. It mainly leads to impaired glucose homeostasis and the development of type 2 diabetes, which contributes to the exacerbation of the global problem that diabetes has become. This results in the search for innovative therapies that will help combat insulin resistance better and better. The purpose of this study is to highlight the complexity of the IR and review the current literature for non-pharmacological and pharmacological possibilities of treatment  for insulin resistance.  Description of the state of knowledge  Due to the increase in obesity and the metabolic syndrome, the number of people suffering from insulin resistance is constantly increasing.  In modern times, there are various diagnostic and therapeutic methods that affect the course of insulin resistance. Early detection and introduction of appropriate therapy become the main goal in preventing complications that may occur in the course of this disease.   Summary Treatment methods for insulin resistance can be divided into two groups - non-pharmacological and pharmacological. Both of them are often used together in the form of combination therapy aimed at obtaining the best results in the treatment of insulin resistance. For people for whom known therapies do not work, researches for new treatments is becoming a hope

Point-of-care ultrasound of abdominal as an useful diagnostic tool for the general practitioner

Introduction and purpose Ultrasonography (US) is a safe, non-invasive and widespread diagnostic tool. Point-of-care ultrasound (POCUS) is more and more often used in a general practitioner’s (GP) office as an element complementing the medical and physical examination. The aim of the study is to present ultrasonography as a useful diagnostic tool in the practice of a general practitioner (GP). Description of the state of knowledge Abdominal pain and gastrointestinal infections are among the most common reasons for patients visiting their GPs. A point-of-care ultrasound examination enable the shortening of the time necessary to make a diagnosis as well as the fastest possible implementation of appropriate treatment. This is especially important in acute conditions such as cholecystitis, cholelithiasis, appendicitis or renal colic.Patients who underwent ultrasound examination during their GP visit gave them a better understanding of their health problem, increased their sense of securityand confidence in the diagnosis made by the doctor. Summary Point-of-care ultrasound is an examination that is increasingly used by doctors working in primary care as a diagnostic tool ensuring earlier and more precise diagnosis. GP familiarization with ultrasound could reduce the number of incorrect referrals as well as improve the interpretation of the results. Performing the POCUS examination during a visit to the primary care physician allows GP to make a quick diagnosis and make a decision about conservative treatment, referral to the appropriate specialist or hospitalization