The treatment of diabetes with new generation drugs

Introduction: Diabetes is a global problem, affecting nearly 422 million people around the world. Pathogenesis includes a defect in secretion or insulin activity. This results in an increase in the glucose level, which is associated with the development of complications. These include changes in peripheral vessels and nerves that lead to their damage. It is necessary to introduce appropriate treatment in the earliest stages of the disease to prevent these effects.Materials and methods: The aim of this work is to present knowledge about the treatment based on the recommendations of the Polish Diabetes Association, American Diabetes Association, as well as a literature review and analysis of publications published on PubMed and Google Scholar platforms.Results: Over the years, the recommendations and recommendations for treatment change. Recently, a greater role has been given to the latest antidiabetic drugs. This group includes SGLT-2 inhibitors as well as incremental drugs, the main representatives of which are GLP-1 analogues. These drugs affect the level of glycemia, but also have a beneficial effect on weight reduction and reduce the risk of cardiovascular events. Recently, Poland has introduced reimbursement of some new generation antidiabetic drugs such as dapaglyphosin, empaglyphosin and canaglyphosin.Conclusions: Dynamic development of diabetes treatment helps to slow down the course of the disease and postpones the introduction of insulin therapy as the final treatment method. Reimbursement of some antidiabetic drugs enables patients to have better access to drugs that have not been within their reach so far. The changes introduced are, in a way, groundbreaking in the treatment of diabetes.

Design guidelines for multi-service centre in municipality Wilkowic

The transition period in Poland has allowed to establish a new segment of investors which are small towns and municipalities. This new group of investors undertake the task of new investment building new objects and elements of infrastructure. services, many of which manages to successfully finalize. New investments are usually successful in case of favorable location of the town in the region, its tourism attractiveness and good communication links. Already existing services and development also enable to start the new ventures as well as a precise vision and mission of the local government competently translates into strategic objectives then expressed by the idea of investment. This study presents a method of creating an information system for investment decisions in a small town - a seat of the municipality. It is related to the service buildings development. This paper shows the method of analysing and evaluating the location of the planned investment options in the context of the local master plan and the characteristics of the land. A method of a questionnaire survey was used to measure the level of acceptance for the planned investment by the future users. Selected segments of stakeholder groups were interviewed to get the opinions on the future program and architecture of the planned buildings

Przeciwdziałanie agresji i przemocy w szkole

Poradnik dla dyrektorów szkół, nauczycieli i edukatoró

Comprehensive Management of Child Maltreatment Syndrome: A Case Study and Clinical Implications in An Infant

Introduction and purpose   The World Health Organization (WHO) defines violence against children as “all forms of physical and emotional maltreatment, sexual abuse, neglect and exploitation that result in actual or potential harm to a child's health, development or dignity.” In Poland, 17,392 cases of violence against children and adolescents were reported in 2015. In the U.S. in 2012, 3.4 million children were reported to facilities for maltreatment. Violence against children leads to serious health problems, both physical and mental, as well as long-term social consequences. Despite its prevalence, many cases remain unreported, with victims, particularly infants, being highly vulnerable. In the case described, a boy born at 36 weeks gestation was admitted to the hospital with symptoms of apathy. Examination revealed neurological symptoms, multiple intracranial hematomas, skull bone fractures and hearing loss. The ophthalmic consultation and examination revealed the presence of retinal hemorrhages, confirming the diagnosis of child maltreatment syndrome. Prompt medical and legal intervention allowed the child's condition to be stabilized, allowing for proper further development in foster care. This article presents a clinical case of maltreatment syndrome in an infant, with a discussion of complications and abnormalities in the performed investigations and a discussion of the treatment administered.    Conclusion    Prompt recognition of such cases is vital, considering the potential long-term physical and psychological consequences. Practical implications for medical personnel and the need to cooperate with social and legal institutions to provide adequate care for abused children are discussed. The presented case underscores the need for comprehensive approaches to address child maltreatment, involving medical, legal, and social interventions to safeguard the welfare of affected children

Putative neuroprotective role of visfatin against cognitive dysfunction in obese patients

Objectives: Visfatin (adipokine) is thought to have neuroprotective properties. The aims of to determine the type and extent of prefrontal cortical dysfunction and to evaluate the potential neuroprotective role of visfatin. Methods: Sixty-one obese patients were included. A diagnosis of primary obesity was made on the basis of a BMI > 30. Visfatin serum levels were determined by enzyme immunoassay. The Wisconsin Card Sorting Test (WCST) was used to assess prefrontal cortex-mediated cognitive function. Results: Visfatin levels were not correlated with age or BMI. However, patients with higher visfatin levels tended to show an overall improvement in WCST scores. Nonetheless, a significant positive correlation (P = 0.032) was found only between high serum visfatin levels and the number of correctly completed categories in the WCST. Discussion: The results described herein indicate a possible neuroprotective effect of visfatin against obesity-related cognition dysfunction, particularly in regard to the categorizing capacity associated with executive function

Time of onset of coronary artery disease in diabetic patients depends on genetic polymorphism in region 9p21 but not in 1p25

Introduction. Type 2 diabetes (T2DM) is an important risk factor for development of coronary artery disease (CAD) and its complications. Recent genetic studies revealed possible association between those two conditions on the genome level. In our study we analysed whether polymorphisms in loci 1q25 and 9p21, previously characterized as risk factors of CVD, have an influence on early-onset CAD in T2DM patients. Materials and methods. Our case-control study included 338 patients suffering from T2DM and CAD. For the study purpose the cohort was divided into two groups based on the age of CAD onset: case group with earlyonset CAD (< 55 for males and < 65 years for females, n = 180) and control group (≥ 55 and ≥ 65 years respectively, n = 158). Epidemiological data was taken from medical history and retrospective questionnaire; blood samples were collected. The rs2383206, rs1333049 and rs10911021 were genotyped using method of fluorescently labelled allele specific oligonucleotides. Results. Statistical analysis did not reveal any significant differences between two groups in the mean duration of diabetes, metabolic parameters (weight, waist circum- ference, frequency of obesity according to BMI, mean blood pressure or lipids levels) and smoking history. There were statistical differences between groups in family incidence of CAD (70.0% patients in cases vs. 45.6% in controls; p < 0.005), hypertension (77.1% vs. 47.8%; p < 0.005) and obesity (61.2% vs. 49.0%; p < 0.05). Genetic analysis revealed that frequency of the G allele of rs2383206 in 9p21 region was significantly higher in cases than in controls (62.4% vs 44.0% p < 0.00001). Homozygotes GG were 39.4% of cases and 18.8% in controls (p = 0.0001). The OR for increased risk of early CAD in GG homozygotes was 2.81, 95% CI: 2.39–3.24, after adjustment for conventional risk factors it was reduced to 2.58. There was statistically significantly higher frequency of GG homozygotes among patients with poor glycaemic control (HbA1c ≥ 7%; 41.3% vs. 15.9; p = 0.0011) and non-obese subjects (BMI < 30 kg/m2; 39.7% vs. 18.2%, p = 0.0002). Similar association between genotype and risk of early CAD was found for another polymorphism rs1333049 in 9p21 region. Frequency of allele C was significantly higher in cases than in controls (56.3% vs 43.4, p = 0.0036) and homozygotes CC were 31.6% in cases and 17.4% in controls (p = 0.0083). OR for this association was 2.2 (95% CI: 1.83–2.56); after adjustments 1.96. We didn’t find any association between genotypes distribution of rs10911021 and early onset of CAD. Conclusions. Our findings clearly suggest that polymorphisms in 9p21 region have an influence on development of early-onset CAD in T2DM, especially in non-obese patients and subjects with poor glycaemic control. (Clin Diabet 2016; 5, 1: 7–14

The polymorphisms in serotonin-related genes (5-HT2A and SERT) and the prevalence of depressive symptoms in obese patients.

As overweight and obesity are a growing problem in industrialized societies, they become a main focus of many studies. The aim of this study was to determine whether there is an association between the occurrence of polymorphisms in serotonin-related genes and the prevalence of depressive symptoms in obese patients. Two polymorphisms were tested: a 44-bp insertion/deletion in the serotonin transporter (SERT) gene and a single-nucleotide variation (1438G/A) in the serotonin 2A receptor (5-HT2A) gene. The study involved 180 patients (41 men; 139 women) previously diagnosed as obese. All patients were subjected to clinical, biochemical, and neuropsychological evaluation and genotyping. Amplification of the gene fragments was obtained by the polymerase chain reaction (PCR) method. Products of the genotyping were separated via electrophoresis. The intensity of depressive symptoms was measured using the Beck Depression Inventory (BDI) and Hamilton Depression Scale (HAM-D). Clinically relevant depressive symptoms were diagnosed in 39% of subjects. The lowest intensities of depressive symptoms were ascertained in the group with the least advanced obesity, but this trend was statistically insignificant. Small differences were observed in obesity indicators among three groups of patients with various genotypes of the SERT gene, but these differences were also statistically insignificant. Furthermore, in the context of the intensity of depressive symptoms, no significant associations were observed in these two groups. Furthermore, no statistically significant differences were observed among specific obesity parameters and intensity of depressive symptoms as a function of the 5-HT2A gene polymorphism. To conclude, depressive symptoms were prevalent in obese participants: 39% of subjects experienced symptoms of clinical relevance. However, no significant associations were observed between 5-HT2A and SERT gene polymorphisms and depressive symptoms in this study group

Short and long-term effects of high-intensity interval training applied alone or with whole-body cryostimulation on glucose homeostasis and myokine levels in overweight to obese subjects.

Background: COVID-19 pandemic has exacerbated the problem of physical inactivity and weight gain. Consequently, new strategies to counteract weight gain are being sought. Because of their accessibility, interval training and cold therapy are the most popular such strategies. We here aimed to examine the effect of 6 units of high-intensity interval training (HIIT), applied alone or in combination with 10 sessions of whole-body cryotherapy (WBC; 3 min at -110 ∘C per session) on incretins, myokines, and adipokines levels. Materials and methods: The study involved 65 subjects (body mass index of approximately 30 kg•m-2). The subjects were randomly divided into training group (TR; n = 27) and training supported by WBC group (TR-WBC; n = 38). Blood samples were collected before, immediately following, and 4 weeks after the intervention. Results: Fibroblast growth factor 21 (FGF21) levels significantly increased (p = 0.03) and adiponectin levels increased in the TR group (p = 0.05) compared with those recorded in TR-WBC group 24 h after the end of experimental protocol. Beneficial changes in the lipid profile (p = 0.07), a significant drop in visfatin levels (p < 0.05), and the improvement in β-cell function (HOMA-B; p = 0.02) were also observed in the TR group in the same time point of study. While TR-WBC did not induce similar changes, it ameliorated blood glucose levels (p = 0.03). Changes induced by both interventions were only sustained for 4 weeks after treatment. Conclusion: Collectively, HIIT, alone and in combination with WBC, positively affects metabolic indicators, albeit, most likely, different mechanisms drive the beneficial effects of different treatments

Depressive and anxiety symptoms among patients with inflammatory bowel diseases

Introduction. This study was conducted on a population of patients with inflammatory bowel disease (IBD) and was based on an assessment of the prevalence and severity of depression and anxiety symptoms in various clinical aspects. The psychological features of IBD patients are very important in the perception of symptoms, but crucial as triggers of IBD or as a releasing factor for IBD symptoms recurrence. Methods. The study included 130 patients with IBD, including 68 with Crohn’s disease (CD) and 62 with ulcerative colitis (UC). The severity of anxiety and depression symptoms were examined by the Hospital Anxiety and Depression Scale (HADS). Patients were also subjected to assessment of anthropometric attributes, clinical factors, quality of life, and symptoms of the disease, with dedicated clinical scales. Results. The occurrence of significant symptoms of anxiety was estimated at 45.5% in patients with CD and 30.5% in the UC patients. Significant depressive symptoms related to 20.5% of people with CD and 17.5% of patients with UC. The parameters of anxiety and depression showed significant associations with parameters of quality of life, BMI, and the scales describing the exacerbation of the diseases. Conclusions. The analyses did not reveal significant differences in the severity and prevalence of symptoms of anxiety and depression in subgroups with IBD. The expansion of relevant symptoms of anxiety and depression in this population was greater than in the general population. In addition, there was a significant correlation between parameters of HADS and clinical factors

Time of onset of coronary artery disease in diabetic patients depends on genetic polymorphism in region 9p21 but not in 1p25

Wstęp. Cukrzyca typu 2 (DM2) jest ważnym czynnikiem ryzyka rozwoju choroby niedokrwiennej serca (CAD) i jej powikłań. W badaniach genetycznych prowadzonych w ciągu ostatnich lat wykazano potencjalny związek między tymi chorobami na poziomie genetycznym. Celem pracy była analiza związku między polimorfizmem w loci 1q25 oraz 9p21 (znanym jako czynnik ryzyka chorób sercowo-naczyniowych) a wczesnym początkiem choroby niedokrwiennej serca u chorych na cukrzycę typu 2. Materiał i metody. Do kliniczno-kontrolnego badania włączono 338 chorych na cukrzycę typu 2 ze współistniejącą chorobą niedokrwienną serca. Na potrzeby badania uczestników podzielono na dwie grupy w zależności od wieku w momencie rozpoznania choroby niedokrwiennej serca: grupę osób z wczesnym początkiem choroby (&lt; 55. rż. u mężczyzn i &lt; 65. rż. u kobiet, n = 180) oraz grupę kontrolną (odpowiednio ≥ 55. oraz ≥ 65. rż., n = 158). Dane epidemiologiczne uzyskano z dokumentacji medycznej oraz retrospektywnego kwestionariusza, od każdego chorego pobrano próbkę krwi do badań genetycznych, polimorfizmy rs2383206, rs1333049 i rs10911021 oznaczono za pomocą specyficznych primerów. Wyniki. W analizie statystycznej nie wykazano istotnych różnic pomiędzy średnim czasem trwania cukrzycy, parametrami metabolicznymi (masa ciała, obwód talii, otyłość, wartości ciśnienia tętniczego krwi, profil lipidowy) ani wywiadem w kierunku palenia tytoniu. Wykazano istotną statystycznie różnicę między grupami pod względem rodzinnego występowania choroby niedokrwiennej serca (70,0% chorych w grupie badanej vs. 45,6% w grupie kontrolnej; p &lt; 0,005), nadciśnienia tętniczego (77,1% vs. 47,8%; p &lt; 0,005) oraz otyłości (61,2% vs. 49,0%; p &lt; 0,05). W analizie genetycznej wykazano, że allel G rs2383206 istotnie częściej występował w badanej grupie (62,4% vs. 44,0%; p &lt; 0,00001). Homozygoty GG stanowiły 39,4% grupy badanej oraz 18,8% grupy kontrolnej (p = 0,0001). Iloraz szans (OR) wystąpienia wczesnej choroby niedokrwiennej serca wynosił 2,81; 95-procentowy przedział ufności (95% CI) 2,39–3,24, a po skorygowaniu względem innych tradycyjnych czynników ryzyka wartość OR zmniejszyła się do 2,58. Homozygoty GG istotnie częściej występowały u chorych z niewyrównaną glikemią [wartość hemoglobiny glikowanej (HbA1c) ≥ 7% — 41,3% vs. 15,9; p = 0,0011) oraz szczupłych [wskaźnik masy ciała (BMI) &lt; 30 kg/m2 — 39,7% vs. 18,2%; p = 0,0002]. Podobny związek między wczesnym występowaniem choroby niedokrwiennej serca obserwowano w przypadku innego polimorfizmu w regionie 9p21 rs1333049. Częstość allelu C była znamiennie wyższa w u chorych z wczesną chorobą niedokrwienną serca (56,3% vs. 43,4, p = 0,0036). Homozygoty CC stanowiły w tej podgrupie 31,6%, natomiast w grupie kontrolnej — 17,4% (p = 0,0083). Iloraz szans wynosił 2,2 (95%CI 1,83–2,56), a po skorygowaniu względem innych czynników ryzyka — 1,96. Nie obserwowano istotnej statystycznie różnicy pod względem dystrybucji genotypów rs10911021 w badanych grupach. Wnioski. Uzyskane przez autorów wyniki pozwalają potwierdzić, że polimorfizmy w regionie 9p21 wpływają na wczesny wiek wystąpienia choroby niedokrwiennej serca u osób chorych na cukrzycę typu 2, szczególnie w grupie szczupłych chorych z niewyrównaną glikemią.  Introduction. Type 2 diabetes (T2DM) is an important risk factor for development of coronary artery disease (CAD) and its complications. Recent genetic studies revealed possible association between those two conditions on the genome level. In our study we analysed whether polymorphisms in loci 1q25 and 9p21, previously characterized as risk factors of CVD, have an influence on early-onset CAD in T2DM patients. Materials and methods. Our case-control study included 338 patients suffering from T2DM and CAD. For the study purpose the cohort was divided into two groups based on the age of CAD onset: case group with earlyonset CAD (&lt; 55 for males and &lt; 65 years for females, n = 180) and control group (≥ 55 and ≥ 65 years respectively, n = 158). Epidemiological data was taken from medical history and retrospective questionnaire; blood samples were collected. The rs2383206, rs1333049 and rs10911021 were genotyped using method of fluorescently labelled allele specific oligonucleotides. Results. Statistical analysis did not reveal any significant differences between two groups in the mean duration of diabetes, metabolic parameters (weight, waist circumference, frequency of obesity according to BMI, mean blood pressure or lipids levels) and smoking history. There were statistical differences between groups in family incidence of CAD (70.0% patients in cases vs. 45.6% in controls; p &lt; 0.005), hypertension (77.1% vs. 47.8%; p &lt; 0.005) and obesity (61.2% vs. 49.0%; p &lt; 0.05). Genetic analysis revealed that frequency of the G allele of rs2383206 in 9p21 region was significantly higher in cases than in controls (62.4% vs. 44.0% p &lt; 0.00001). Homozygotes GG were 39.4% of cases and 18.8% in controls (p = 0.0001). The OR for increased risk of early CAD in GG homozygotes was 2.81, 95% CI: 2.39–3.24, after adjustment for conventional risk factors it was reduced to 2.58. There was statistically significantly higher frequency of GG homozygotes among patients with poor glycaemic control (HbA1c ≥ 7%; 41.3% vs. 15.9; p = 0.0011) and non-obese subjects (BMI &lt; 30 kg/m2; 39.7% vs. 18.2%, p = 0.0002). Similar association between genotype and risk of early CAD was found for another polymorphism rs1333049 in 9p21 region. Frequency of allele C was significantly higher in cases than in controls (56.3% vs. 43.4, p = 0.0036) and homozygotes CC were 31.6% in cases and 17.4% in controls (p = 0.0083). OR for this association was 2.2 (95% CI: 1.83–2.56); after adjustments 1.96. We didn’t find any association between genotypes distribution of rs10911021 and early onset of CAD. Conclusions. Our findings clearly suggest that polymorphisms in 9p21 region have an influence on development of early-onset CAD in T2DM, especially in non-obese patients and subjects with poor glycaemic control.