Assessment of white blood cell distribution as a prognostic factor in type 2 diabetes mellitus and its complications - literature overview

Introduction: Type 2 diabetes (T2DM) mellitus is the chronic, low-grade inflammatory disorder, which is considered to be the leading cause of morbidity and mortality worldwide. Wherefore, it is indispensable to look for new, non-invasive and widely available markers that will allow for early detection of predisposition to the development of diabetes as well as its macro- and microvascular complications. Aim of the study: The aim of our study was to present the role of white blood cells (WBC) count as a prognostic factor in type 2 diabetes mellitus. Moreover, we discussed the perspectives for the usefulness of WBC subtypes and neutrophil to lymphocyte ratio (NLR) as a marker of glycemic control as well as an indicator of the risk of developing diabetes complications. Description of knowledge: The abundant number of previous studies revealed that the elevated level of total WBC count strongly correlates with the predisposition to prediabetes and T2DM development. There is also association between the insulin resistance as well as the function and mass of beta-cells. The numerous research confirm that the increase in NLR may be the useful laboratory tool to evaluate the glycemic control and the effectiveness of antidiabetic treatment. NLR ratio as a marker, which directly reflects the level of inflammation is considered to indicate the risk of development of cardiovascular complications, diabetic peripheral neuropathy or nephropathy, even in the early stage of T2DM duration. Conclusions: Measurements of WBC count and changes in the number of subpopulations of them seem to be a useful, widely accessible marker of development of T2DM as well as its complications and may be helpful in management of T2DM patients

Vitamin D Receptor Polymorphisms Predispose to Primary Biliary Cirrhosis and Severity of the Disease in Polish Population

Primary biliary cirrhosis (PBC) is a chronic cholestatic liver condition characterized by the immune-mediated damage of the intrahepatic bile ducts. Polymorphisms of vitamin D receptor (VDR) are considered to contribute to its pathogenesis however their incidence varies in different populations and their potential association with the course of the disease has not been studied. In this paper we investigated the incidence and correlation of three VDR polymorphisms (BsmI, ApaI or TaqI) with various clinical, biochemical, and serological factors in a homogenous group of 143 Caucasian patients with PBC. Control group comprises 306 DNA samples from umbilical cord blood of healthy newborn children. When compared to controls, we observed a significant dominance of the b allele in the BsmI (OR = 1.69 [1.27–2.24]; P = 0.0003) and t allele in the TaqI (OR = 0.62 [0.47–0.82], P = 0.0001) in patients with PBC. Moreover the BsmI and TaqI polymorphisms were associated with the presence of advanced fibrosis/liver cirrhosis at the diagnosis of PBC. Pairwise linkage disequilibrium (LD) calculations proved that the analyzed SNPs are within an LD block (100% of LDs were D'>0.9). Our study showed, for the first time, that the analyzed polymorphisms of VRD may exert an effect on a natural history of PBC

Thrombotic thrombocytopenic purpura - a disease with multiple organ manifestations. Diagnostic and therapeutic difficulties in clinical practice

Introduction: Thrombotic thrombocytopenic purpura (TTP) is a rare, heterogeneous and life-threating disease requiring prompt differential diagnosis. The most common form of that disease is idiopathic form affects usually young adults. The etiopathogenesis is most likely based on the excessive formation of platelet aggregates and microthrombosis in small vessels, capillaries due to the deficiency of a specific enzyme, ADAMTS13 (disintegrin and metalloproteinase with thrombospondin type 1 motif, member 13). Aim of the study: The aim of this review was to present the diagnostic difficulties of the TTP, which are mainly related to the range of multi-organ deficiency and symptoms that resemble lots of other diseases. Moreover, we discussed the current, as well as future perspectives of the treatment of thrombotic thrombocytopenic purpura. Description of knowledge: The principal symptoms, which occur in TTP patient are caused by microangiopathic hemolytic anemia and thrombocytopenia. Moreover, that disease may also manifest by neurological, renal, cardiac abnormalities as well as abdominal disturbances, fever and flu-like symptoms. The other thrombotic microangiopathies, especially hemolytic-uremic syndrome, immune-mediated diseases, infections, stroke, myocardial infarction should be taken initially in the differential diagnosis. The current management is based on plasma exchange therapy, steroids, rituximab, but the novel methods are investigated. Conclusions: The differential diagnosis of hematological patients presenting clinical symptoms of thrombocytopenia, anemia associated with multi-organ dysfunction, especially when we suspect an autoimmune background of a given disease is crucial to implement the appropriate therapy and save the patient's life

ACE I/D polymorphism associated with muscle strength and its relation to the health status of people over 60 years of age

Among older people, a big problem is the decrease in both muscle strength and general physical fitness. This often prevents the proper functioning of a person, which makes him or her dependent on their guardians or family. It is believed that the ACE gene is associated with better results achieved in strength sports. It may also be related to the health condition of older people. For this purpose, a study was conducted on a group of 60 people over 60 years of age. The study was conducted with the consent of the bioethical commission and under the supervision of physiotherapists. The relationship between overall fitness and muscle strength of older people with ACE genotypic variants was checked. For this purpose, a questionnaire on physical activity of IPAQ was used. On its basis, the values ​​of MET and BMI coefficients were determined. Fitness tests were also carried out, i.e. SPPB, DGI and Up & Go. The ACE gene was tested by PCR. The insertion-deletion polymorphism of the Alu sequence in this gene was examined. It was found that: DD gene genotype ACE is associated with higher values ​​of BMI and shorter standing time on the left leg (p<0.05), genotype II is associated with lower overall physical activity determined on the basis of MET (p<0.05), genotype ID is associated with better results in the left leg test (p<0.05). Based on obtained results it is impossible to determine if ACE gene has clear impact on muscle strength and health of the older adults

Can physical activity influence the quality of sleep among the elderly?

Introduction: Research shows that over the half of people in the age of more than fifty have got problems with lowered quality of sleep. The cause of lowered quality of sleep is i.a. waking up early, lengthened sleep latency, increased number of waking during the night or shortened time of sleep. The aim of the study was to show how significant are sleep related problems which appear after the age of fifty and how regular physical activity can improve the quality of sleep and as a result functioning of the elderly. Physical activity delays involutional changes and the process of ageing, which lets the elderly stay independent and self-reliant in everyday activities. The aim of the study: The study was to mark the connection between physical activity intensity and the quality of sleep of the elderly. 290 Material and methods: Research for the study was made by means of anonymous survey which consisted of two questionnaires: The Pittsburgh Sleep Quality Index (PSQI) and The International Physical Activity Questionnaire. The survey was targeted at people in the age of over fifty. 100 people took part in the research. Results: Significant statistical correlation between early falling asleep, waking up at night or before dawn with the intensive or moderate physical effort has been obtained. Conclusions: The research has shown that people who performed intense or moderate physical activity woke up less frequently during the night, fell asleep faster and reported better quality of sleep. In addition, it has been noticed that the lowered quality of sleep has got a negative influence on i.a. energy levels and staying alert

Association between ACTN3 gene polymorphism and muscle strength in older adults

The decrease of muscle strength and general physical fitness is a big problem in the elderly group. It often prevents the proper functioning of a person, which makes him/her dependent on caretakers. It is believed that the some polymorphisms in ACTN3 geneare associated with better results in strength sports. If those polymorphisms affect muscle strength, they may also be related to the health condition of older people. Our study was conducted on a group of 60 people over 60 years of age. The relationship between overall fitness and muscular strength of elderly patients with ACTN R577X gene polymorphism was checked. The ACTN3 gene was tested by PCR-RFLP. Overall fitness was tested using the IPAQ questionnaire and fitness tests: Tinetti, DGI, Up&Go, SPPB, standing on one leg (both right and left). Based on the results of the survey, the MET and BMI coefficients were determined. It was found that the RX genotype is associated with better results achieved in the SPPB test. Genotype XX was associated with worse results in the right leg standing test (p<0.05). The R-allele of the ACTN3 gene wasassociated with better results obtained during the standing test on the right leg (p<0.05).Based on obtained results it was impossible to determine a clear impact of the ACTN3 gene on muscle strength and health of the older adults

Cognitive disorders and fitness of the elderly in residential homes in Bydgoszcz

Introduction. Process of ageing and the growing number of people in retirement age is one of the main problems of the modern world. Together with advancing age both fitness and mental capacity deteriorate. Research proves that there is dependence between cognitive functions and fitness of the elderly. Aim. The aim of the study was to compare fitness with cognitive functions among residents of residential home in Bydgoszcz. Material and methods. 59 people (35 women and 24 men) at the age of 60 to 98 participated in the study. Mini-Mental State Examination (MMSE) was used to assess cognitive functions. Fitness was assessed by means of Tinetti Test. The subjects were divided according to a) age: group 60-75 and 75+ and b) gender. Results. Negative correlation was observed between age and Tinetti Test results. In the study there was positive and moderate correlation between MMSE scale and Tinetti Test results. In Tinetti Test results regarding differences due to gender were close to statistical significance. Conclusions. There is a dependence between age and weakening of fitness in the elderly in residential homes in Bydgoszcz. Risk of falls increases with age. There is a dependence between cognitive functions disorders and fitness of the elderly from residential homes in Bydgoszcz

The diagnostic difficulties of eosinophilia in clinical practice - case series

Introduction: Eosinophilia, defined as elevated level of eosinophils in peripheral blood above 5 x 109/L, is the hematological disorder, which may occur in multiple conditions, such as allergies, gastrointestinal, autoimmune diseases, parasite, fungal infections as well as drug related eosinophilia. Although hematological causes of eosinophilia (idiopathic, myeloproliferative and lymphocytic variant) should be taken into consideration. Aim of the study: The aim of our study was to performed the difficulties related to the differential diagnosis of eosinophilia, especially associated with the diverse symptoms. Materials and methods: The study included 5 patients hospitalized in the Department of Hematooncology and Bone Marrow Transplantation, due to eosinophilia associated with diverse symptoms. Medical history, physical examination, the peripheral blood as well as bone marrow samples analysis and the genetic tests for the presence of mutations or rearrangements that detect leukemia or lymphoma were analyzed. Moreover, patients were evaluated due to the presence of parasites. Results: The case series revealed that eosinophilia may have a various etiological background. Three patient demonstrated the reactive eosinophilia, caused by bacterial, parasite infections and eosinophilic granulomatosis with polyangitis, however in two other cases the chronic eosinophilic leukemia with abnormalities of PDGFRA were diagnosed. Conclusions: Eosinophilia is an important diagnostic and prognostic feature in a varied range of pathological conditions from infections, allergies to malignancies. For this reason, it is an enormous diagnostic as well as therapeutic challenge and requires an interdisciplinary clinical approach, especially in cases with unclear manifestations

Powikłania endokrynologiczne i metaboliczne terapii chorób rozrostowych układu krwiotwórczego

Despite the significant progress in the treatment of haematological malignancies and the improvement of treatment efficacy, it is still associated with numerous side effects. Among them, endocrinological and diabetic complications of immunotherapy are of particular importance, and they belong to the most frequently observed, mainly due to the interference of the treatment with functioning of the immune system. As a result, it can lead to the induction of autoimmune processes in many systems, including endocrine glands. The effectiveness of some therapies may also be determined by the occurrence of side effects in the form of autoimmune diseases. Increasing use of tyrosine kinase inhibitors, immune checkpoint inhibitors, as well as glucocorticosteroids exerting immunosuppressive effect, which are applied, leads to the development of various pathologies of the endocrine system. The most common complications developing on the background of autoimmune inflammation are disturbances in the function of thyroid gland, pituitary gland in its anterior lobe, and very rarely in the posterior lobe in the form of diabetes insipidus. The above-mentioned disorders may occur in patients of all ages, regardless of gender. Some dysfunctions are subclinical and are found incidentally during routine check-up, both in the course of the treatment process or after its completion. Taking into account the possibility of serious consequences of the therapy, it is now recommended to periodically control the patients.Mimo znacznego postępu, jaki dokonał się w terapii chorób rozrostowych układu krwiotwórczego, nadal z leczeniem wiążą się liczne działania niepożądane. Wśród nich istotne miejsce zajmują powikłania endokrynologiczne oraz diabetologiczne, które należą do jednych z częściej obserwowanych. Wynikają one przede wszystkim z ingerencji stosowanego leczenia w funkcjonowanie układu immunologicznego, w rezultacie czego może dochodzić do indukcji procesów o podłożu autoimmunologicznym w obrębie wielu układów, w tym gruczołów dokrewnych. Coraz powszechniejsze stosowanie inhibitorów kinaz tyrozynowych, inhibitorów punktów kontrolnych układu odpornościowego, jak również glikokortykosteroidów o działaniu immunosupresyjnym może prowadzić do rozwoju patologii układu wewnątrzwydzielniczego. Najczęstszymi powikłaniami rozwijającymi się na tle autoimmunizacyjnego zapalenia są zaburzenia funkcji tarczycy, przysadki w zakresie jej przedniego płata, a także niezwykle rzadko tylnego pod postacią moczówki prostej. Mogą one wystąpić u pacjentów we wszystkich grupach wiekowych, niezależnie od płci. Niektóre dysfunkcje mają przebieg subkliniczny i są stwierdzane przypadkowo, podczas rutynowych kontroli zarówno w trakcie leczenia, jak i po jego zakończeniu. Biorąc pod uwagę możliwość wystąpienia poważnych powikłań endokrynologicznych i diabetologicznych, obecnie zaleca się stałe monitorowanie chorych