Celiac disease in children - diagnosis in light of the current 2020 ESPGHAN guidelines

Celiac disease is a chronic immune disorder of the small intestine that is triggered by the consumption of gluten in genetically predisposed individuals. The disease is difficult to diagnose and treat, and its incidence is increasing. It can have different symptoms and clinical manifestations in individuals. Diagnosis is usually based on the presence of specific antibodies and histopathological examination of biopsy specimens from the small intestine. The only effective treatment is a gluten-free diet for life. Diagnosis of celiac disease in children is mainly based on the presence of specific an- tibodies in the blood, such as antibodies to tissue transglutaminase (tTG), antibodies to endomysium (EMA) or deamidated gliadin peptides (DGP). In addition, genetic testing is also used in diagnosis to detect the presence of HLA DQ2 or DQ8 genes, which are often present in people with celiac disease. The final diagnosis of celiac disease is based on a combination of the results of these tests and the presence of characteristic lesions in the small intestine, which are detected during endoscopy and small bowel biopsy

Colonic contained perforation of unknown etiology treated conservatively in a 34 year old female patient: a case report

A colon perforation is defined as a disruption in the continuity of the gastrointestinal wall. A contained perforation is a situation where the perforation is self-limited, usually by adhesion to other structures in the abdominal cavity. Many conditions can cause perforation, including cancer, diverticular disease, or iatrogenic perforation such as during an endoscopy procedure. Less commonly, the cause may be inflammatory bowel disease or the presence of a foreign body in gastrointestinal tract. Furthermore, there are also publications describing situations of spontaneous rupture of the intestinal wall, i.e. spontaneous perforations. This group includes spontaneous perforation caused by fecal stones and idiopathic perforation. In this article we present a case report of a 34 year old woman with perforation of the large intestine without any apparent cause. We discuss the differential diagnosis of patients with conservatively treated perforation with unknown colonoscopy result

Portal vein thrombosis and non-compliance in a high risk patient – a case study

Portal vein thrombosis is a pathological process that refers to the obstruction of blood flow secondary to thrombus formation. It may be caused by a variety of conditions including cancer, cirrhosis, myeloproliferative neoplasms (eg. polycythemia vera) or surgery in the area of the portal vein (eg. splenectomy). Recent studies suggest that patients with a positive history of SARS-CoV-2 infection have a higher risk of thromboembolic incidents. According to current procedures patients with increased thromboembolic risk should receive anticoagulants. Non-compliance to medical recommendations may develop a disease, directly threatening the patient's health and life. We present a case report of a 69 year old woman with a history of polycythemia vera, recent splenectomy, and SARS-CoV-2 infection who developed massive portal vein thrombosis two days after discontinuation of enoxaparin

Polypharmacotherapy with anti-obesity drugs - case report

Obesity is a chronic, relapsing, multi-factorial, neurobehavioral disease, wherein an increase in body fat promotes adipose tissue dysfunction and abnormal fat mass physical forces, resulting in adverse health consequences. It is diagnosed based on body mass index and waist circumference. In case of severe obesity, bariatric surgery or pharmacotherapy is recommended. We present a case report of a 28 years old man with class III obesity (77,6 kg/m2). In order to qualify the patient for bariatric surgery, a decision to combine two anti-obesity medications has been made. This kind of obesity management is neither recommended, not contraindicated, but has shown good effects on body mass reduction. This case report should initiate the discussion about recommendations modification towards combining anti-obesity medications of different mechanisms of action

The role of chemokines in liver disease

Chemokines are involved in many processes, including the normal immune response to infection, as well as pathological processes such as carcinogenesis, autoimmunity and inappropriate inflammatory responses. These processes represent an important aspect in the context of liver disease, its progression and the possibility of inhibiting fibrosis. Chemokines belong to low molecular weight proteins with a wide range of functions affecting cell migration, involving different physiological and pathological processes. Depending on whether they participate in the maintenance of homeostasis during periods of well-being or represent a type of intervention of the organism to its disorders, their secretion by cells is constitutive or induced. This article focuses on the classification, structure and functions of these molecules and their possible involvement in the pathogenesis of liver diseases, as well as the possibilities of therapeutic application of this knowledge

Graves-Basedow disease treated by complementary medicine leading to severe thyrotoxicosis – a case report

Graves' disease is a common cause of hyperthyroidism. Inadequate treatment or non-compliance can lead to serious complications, including thyroid storm.  We present the case of a 22-year-old woman who had been treated with antithyroid drugs (ATD) for almost 7 years, however decided to suspend conventional treatment and turned towards complementary and alternative medicine methods. Following the bioenergotherapist's advice, she began taking Lugol’s solution (LS) at a dose of 30 drops per day. After about one month of such therapy, the patient was urgently admitted to the Emergency Department with thyrotoxicosis with a high risk of thyroid storm development. With the implementation of intensive thyrostatic treatment and steroid therapy, euthyroidism was successfully restored