Zaćma jako powikłanie przewlekłej steroidoterapii stosowanej w leczeniu choroby Leśniowskiego-Crohna

In this article we present a case of 49-year-old patient hospitalizated in the Department of Gastroenterology, Human Nutrition and Internal Diseases of Clinical Hospital in Poznan due to Lesniowski-Crohn’s disease. In order to the remission of ongoing inflammation and control of relapses, patient used an intense steroid therapy for period of 5 years. In the discussion we describe shortly Lesniowski-Crohn’s disease, one of the inflammatory bowel diseases, including gastrointensinal and parenteral symptoms. The authors focused on multi-organ complications of chronic steroid therapy. In the article we watch out for ocular symptoms and the development of posterior subcapsular cataract which was diagnosed in patient. It is a problem present in a large group of patients, including the side effects of long-term steroid therapy. It should be stressed that steroid-induced cataract is a major problem in the population of patients with long-term treatment, and might impact the quality of life. This article includes above all clinical symptoms, pathological mechanism and risk factors inducing cataract. We present also medical indications qualifying for surgical implantation of intraocular lenses (IOLs). It came out that discontinuation of steroid therapy does not cure cataract and does not prevent further side effects of the management, so long treatment and clinical supervision of the patient are necessary. The study highlights complications that can occur after ophthalmic surgery. The role of the physician who prescribes steroid therapy is very significant because he is in charge of implementation of prevention steps and treatment of complications. The aim is to underline that only interdisciplinary approach in patients with Lesniowski-Crohn’s disease can benefit and it concerns both specialist as well general practitioner.W artykule przedstawiono przypadek 49-letniego pacjenta leczonego w Klinice Gastroenterologii, Żywienia Człowieka i Chorób Wewnętrznych w Poznaniu z powodu choroby Leśniowskiego-Crohna. W celu remisji toczącego się stanu zapalnego oraz opanowania rzutów choroby u pacjenta stosowano intensywną steroidoterapię przez okres pięciu lat. W poniższym omówieniu zawarto krótką charakterystykę choroby Leśniowskiego-Crohna, należącej do nieswoistych chorób zapalnych jelit oraz poszczególnych objawów pozajelitowych, występujących w jej przebiegu. Autorzy skupili się na licznych wielonarządowych powikłaniach wynikających z przewlekłej steroidoterapii. W artykule zwrócono uwagę na objawy oczne i rozwój zaćmy podtorebkowej tylnej, którą rozpoznano u przedstawionego pacjenta podczas konsultacji okulistycznej. Stanowi ona problem obecny u sporej grupy pacjentów, u której opisano skutki uboczne wieloletniego leczenia glikokortykosteroidami. Należy zatem podkreślić, że zaćma posteroidowa stanowi istotny problem w populacji dłu­gotrwale leczonych pacjentów, wpływający na jakość życia oraz chęć dalszej współpracy z lekarzem. W pracy uwzględniono przede wszystkim objawy kliniczne, patomechanizm oraz czynniki predysponujące do rozwoju zaćmy posteroidowej. Omówiono wskazania kwalifikujące pacjenta do zabiegu operacyjnego wszczepienia sztucznych soczewek. Okazuje się, że samo odstawienie glikokortykosteroidów nie powoduje wyleczenia zaćmy, co dodatkowo komplikuje postępowanie z pacjentem oraz wydłuża konieczność postępowania terapeutycznego i obserwacji. W pracy wyróżniono również powikłania mogące wystąpić po przeprowadzonym zabiegu okulistycznym. Zwrócono uwagę na rolę lekarza zlecającego leczenie glikokortykosteroidami — jego rolę we wdrażaniu odpowiednich kroków w profilaktyce oraz w leczeniu powikłań, przed ich dalszym rozwinięciem. Celem pracy jest podkreślenie konieczności wieloaspektowego i wielodyscyplinarnego podejścia do pacjenta z chorobą Leśniowskiego-Crohna zarówno przez lekarza specjalistę, jak i lekarza medycyny rodzinnej

Osteoporoza posteroidowa w chorobie Leśniowskiego-Crohna — studium przypadku

Choroba Leśniowskiego-Crohna cechuje się przewlekłym przebiegiem i wymaga długotrwałego leczenia. Intensywna steroidoterapia prowadzi do wystąpienia licznych powikłań, w tym wtórnej osteoporozy. Wykonywanie odpowiednich badań diagnostycznych (densytometria), właściwa profilaktyka oraz wdrożenie leczenia w odpowiednim czasie minimalizują negatywne skutki steroidoterapii. W niniejszym artykule opisano pacjenta, u którego wystąpiła posteroidowa osteoporoza w przebiegu choroby Leśniowskiego-Crohna

Assessment of dietary habits among Polish women with Hashimoto's disease

Introduction. Selected dietary components are crucial for a properly functioning thyroid gland. Therefore a healthy and balanced diet is  crucial for treating patients with Hashimoto's disease. Aim. This study aims to evaluate the dietary habits of women suffering from autoimmune thyroiditis. Material and methods. A questionnaire study was conducted in a group of 58 women with Hashimoto's disease and among 42 women without autoimmune thyroiditis using the Food Frequency Questionnaire (FFQ-6). To assess compliance with the normal distribution, we used the Shapiro-Wilk test. The comparative assessment was made using the Student's t-test and Mann-Whitney test. The Chi-square test was used to assess the relationship between the response and the group. A p-value of less than 0.05 was considered significant. Results. The study showed no significant differences in dietary habits between the two groups. Only 29% (n=15) of women with HT declared daily consumption of fruits vs 31% (n=12) in the control group (p=0.3800), and only 2% (n=1) declared consuming berries daily vs. 5% (n=2), (p=0.5270). The consumption of the recommended several portions of vegetables per day was declared by only 22% (n=11) of women with HT vs 28% (n=11) in the control group (p=0.3983). 42% (n=24) of women with HT vs 38.5% (n=16) of controls reported eating cruciferous vegetables several times a week (p=0.8241). 14% (n=8) of women with HT vs 19% (n=8) of women in the control group declared daily consumption of green leafy vegetables (p=0.3653). Most people in the study group consume nuts and seeds several times a month, and those in the control group several times a week. Most HT respondents also declare not to consume the recommended amount of fish. Conclusions. The diet of patients with Hashimoto's disease does not differ significantly from that of non-Hashimoto's disease patients. Considering the study results and current scientific knowledge, it seems necessary to undertake educational activities for patients with Hashimoto's disease to increase patient awareness of the impact of diet on the course of the disease

Why are western diet and western lifestyle pro-inflammatory risk factors of celiac disease?

The prevalence of celiac disease increased in recent years. In addition to the genetic and immunological factors, it appears that environmental determinants are also involved in the pathophysiology of celiac disease. Gastrointestinal infections impact the development of celiac disease. Current research does not directly confirm the protective effect of natural childbirth and breastfeeding on celiac disease. However, it seems that in genetically predisposed children, the amount of gluten introduced into the diet may have an impact on celiac disease development. Also western lifestyle, including western dietary patterns high in fat, sugar, and gliadin, potentially may increase the risk of celiac disease due to changes in intestinal microbiota, intestinal permeability, or mucosal inflammation. Further research is needed to expand the knowledge of the relationship between environmental factors and the development of celiac disease to define evidence-based preventive interventions against the development of celiac disease. The manuscript summarizes current knowledge on factors predisposing to the development of celiac disease including factors associated with the western lifestyle

The influence of various endocrine disruptors on the reproductive system

Various stimulants (VS) are chemicals that disrupt the endocrine system — endocrine homeostasis of the reproductive system — which also known as endocrine-disrupting chemicals (EDCs). These substances are found in the human body, in both the blood and urine, amniotic fluid, or, among others, the adipose tissue. This article presents the current state of knowledge of the effect of EDCs and additional factors such as smoking, alcohol consumption, and cannabis on the gonads. The article is an overview of the impact of EDCs and their mechanism of action, with particular emphasis on gonads, based on databases such as PubMed, EMBASE and Google Scholar, and Web of Science available until May 2022. The impact of human exposure to bisphenol A (BPA) is not fully understood, but it has been shown that phthalates show a negative correlation in anti-androgenic activity in the case of men and women for the anti-Müllerian hormone (AMH). Smoking cigarettes and passive exposure to tobacco have a huge impact on the effects of endocrine disorders in both women and men, especially during the reproductive time. Also, the use of large amounts of cannabinoids during the reproductive years can lead to similar disorders. It has been documented that excessive alcohol consumption leads to disturbed function of the hypothalamus–pituitary–gonadal axis (HPG). Excess caffeine consumption may adversely affect male reproductive function, although this is not fully proven. Therefore, the following publication presents various stimulants (BPA, phthalates, nicotine, alcohol, cannabis) that disrupt the function of the endocrine system and, in particular, affect the function of the gonads

Where Do We Stand in the Behavioral Pathogenesis of Inflammatory Bowel Disease? The Western Dietary Pattern and Microbiota—A Narrative Review

Despite the increasing knowledge with regard to IBD (inflammatory bowel disease), including ulcerative colitis (UC) and Crohn’s disease (CD), the etiology of these conditions is still not fully understood. Apart from immunological, environmental and nutritional factors, which have already been well documented, it is worthwhile to look at the possible impact of genetic factors, as well as the composition of the microbiota in patients suffering from IBD. New technologies in biochemistry allow to obtain information that can add to the current state of knowledge in IBD etiology

Rak żołądka — opis przypadku

The article presents the case of an 80-year-old patient admitted to the Department of Gastroenterology, Internal Medicine and Dietetics in Poznań for the diagnosis of anaemia. The paper contains a short description of gastric cancer, etiology, diagnostics with an emphasis on a number of information particularly useful for family medicine doctors and treatment. The aim of the study is to emphasize the need for a multifaceted and multidisciplinary approach to a patient with a history of cancer.W artykule przedstawiono przypadek 80-letniego pacjenta przyjętego do Kliniki Gastroenterologii, Dietetyki i Chorób Wewnętrznych w Poznaniu w celu diagnostyki niedokrwistości. W pracy zawar to krótką charakterystykę raka żołądka, etiologię, diagnostykę z naciskiem na wiele informacji szczególnie przydatnych dla lekarzy medycyny rodzinnej, oraz leczenie. Celem pracy jest podkreślenie konieczności wieloaspektowego i wielodyscyplinarnego podejścia do pacjenta z wywiadem chorób nowotworowych

Multidimensional Disadvantages of a Gluten-Free Diet in Celiac Disease: A Narrative Review

A gluten-free diet is the mainstay method of treatment and the prevention of celiac disease complications. However, an inadequately balanced gluten-free diet can increase the risk of obesity, negatively affect glucose and lipid metabolism, and increase the risk of the metabolic syndrome. Therefore, an adequate nutritional counselling is necessary for patients diagnosed with celiac disease in order to prevent and treat the components of the metabolic syndrome

Pancreatic Injury after COVID-19 Vaccine—A Case Report

The COVID-19 pandemic has caused more than 3 million deaths worldwide. Recently developed genetically engineered vaccines are the most critical solution for controlling the pandemic. Clinical trials on a large number of participants confirmed their safety and efficacy. However, with the growing number of vaccinated people, new infrequent adverse effects have been reported, not described in the medicinal product characteristics. We would like to report a case of acute pancreatic injury that occurred shortly after administering Pfizer BioNTech COVID-19 mRNA vaccine (Comirnaty). The report points out the potential need for close monitoring of patients reporting abdominal pain after vaccination (unresponsive to standard oral painkillers) because such symptom can be associated with acute pancreatitis