The etiology of lower respiratory tract infections in people with diabetes

Patients with diabetes mellitus (DM) are likely to develop many types of infections, which affect the transport of glucose into tissues. Diabetes increases the susceptibility to different kinds of respiratory infections, is often identified as an independent risk factor for developing lower respiratory tract infections. Pulmonary infections caused by Mycobacterium tuberculosis, Staphylococcus aureus, gram-negative bacteria and fungi may occur with an increased frequency, whereas infections due to Streptococcus pneumonia or influenza virus may be associated with increased morbidity and mortality. During lung infection, there are changes in the local and ciliary epithelial lining. Increased susceptibility to pneumococcal infection by people with diabetes is the result of reduced defense capability of antibodies to protein antigens. The relationship between diabetes and pulmonary tuberculosis is well known, and the incidence of tuberculosis in diabetic individuals is 4−5 times greater than among the non-diabetic population. It is thought that malfunction of monocytes in patients with diabetes may contribute to the increased susceptibility to tuberculosis and/or a worse prognosis. Hospitalization of patients with diabetes due to influenza virus or flu-like infections is up to 6 times more likely to occur compared to healthy individuals, also diabetic patients are more likely to be hospitalized due to infection complications. Immunization with influenza and anti-pneumococcal vaccines is recommended to reduce hospitalizations, deaths, and medical expenses. Diabetes, especially the uncontrolled one, predisposes to fungal infection, the most common candidiasis and mucormycosis

Attempt at application of the International Classification of Functioning, Disability and Health (ICF) in the domains of body and structure function and activity and participation in the assessment of the rate of disability in patients with morbid obesity : pilot study

Background. Due to the constant increase in the number of morbidly obese patients, an adequate tool for assessing the functioning and disability of these patients is being sought. The International Classification of Functioning, Disability and Health (IC F) could be that tool. Objectives. The aim of this study is to examine the usefulness of the IC F scale in assessing the functioning of morbidly obese patients in two selected areas in reference to recognized scales. Material and methods . The study group included 76 patients with morbid obesity qualified for bariatric treatment. The ICF was applied to assess the function and limitations of each individual. Two domains of the IC F were selected: Body Functions and Structures and Activities and Participation. The usefulness of the IC F was compared to that of the Barthel and EPQ-R scales. Results . In morbidly obese patients, a correlation between motor functions and IC F and BMI, as well as age, was observed. A significant correlation was observed between BMI and psychomotor control, appropriateness and range of emotions experienced, age and amount of sleep, quality of sleep, memory retrieval and psychomotor functions. Women’s mental functions were significantly worse than those of men. In terms of interpersonal relations, a correlation between BMI and regulating behavior within interactions was observed. Conclusions . The IC F is a useful tool for the study and description of the functioning of patients with morbid obesity. The selected domains are described better than by the previously used Barthel scale. Women with morbid obesity tend to have more impaired mental functioning than morbidly obese men

Evaluation of the frequency of ADIPOQ c.45 T>G and ADIPOQ c.276 G>T polymorphisms in adiponectin coding gene in girls with anorexia nervosa

Introduction: Anorexia nervosa (AN) is a serious chronic psychosomatic disorder, the essence of which are attempts by the sufferer to obtain a slim silhouette by deliberate weight loss (restrictive diet, strenuous physical exercise, provoking vomiting). The aetiology of this disorder is multifactorial. Genetic factors that influence the predisposition to AN have been sought. A broad meta-analysis points to a strong genetic correlation between AN and insulin resistance. Adiponectin (ADIPO) increases insulin sensitivity. In our pilot study we demonstrated that the TT genotype in locus ADIPOQ c.276 G>T of the ADIPO gene and a higher concentration of ADIPO in blood serum occurred significantly more frequently in 68 girls suffering from AN than in 38 healthy girls. The objective of this study was to evaluate the frequency of the occurrence of ADIPOQ c.45 T>G and ADIPOQ c.276 G>T in the ADIPO gene in a larger cohort of girls with AN and healthy girls, as well as an analysis of correlations between variants of the aforementioned polymorphisms and the levels of ADIPO in blood serum. Material and methods: The study covered 472 girls (age: 11–19 years): 308 with the restrictive form of AN (AN) and 164 healthy girls (C). The level of ADIPO in blood serum was determined by means of the ELISA method on a Bio-Vendor, LLC (Asheville, North Carolina, USA). The DNA isolation was carried out by means of Genomic Mini AX BLOOD (SPIN). The PCR reaction was carried out in a ThermoCycle T100 thermocycler. 80–150 ng of the studied DNA and relevant F and R starters were added to the reaction mixture. The reaction products were subjected to digestion by restriction enzymes and separated on agarose gels (RFLP). Results: The distribution of genotypes in the polymorphic site ADP c.45 of the ADIPO gene and ADP c.276 was similar in both groups. In both groups the T allele was most frequent in locus ADIPOQ c.45 and the G allele in locus ADIPOQ c.276. In all the study subjects collectively (AN and C) a statistically significant negative correlation between the levels of ADIPO in blood serum on one hand and body weight (r = –0.46; p < 0.0001) and BMI (r = –0.67; p < 0.0001) on the other was demonstrated. Exclusively in the AN group a significant correlation between the level of ADIPO in blood and the distribution of TG, TT, and GG alleles in loci ADIPOQ c.45 and ADIPOQ c.276 was demonstrated (p = 0.0052 and p < 0.0001, respectively). Conclusions: The genotype in loci ADIPOQ c.45 and ADIPOQ c.276 of the ADIPO gene seems to have no effect on the predisposition to AN. Girls suffering from AN with the TT genotype in loci ADIPOQ c.45 and ADIPOQ c. 276 may demonstrate higher insulin sensitivity because they have significantly higher levels of ADIPO than girls suffering from AN with other genotypes. This may be suggestive of their better adaptation to the state of malnutrition, and it has a potential effect on treatment results

Evaluation of the frequency of RETN c.62G>A and RETN c.-180C>G polymorphisms in the resistin coding gene in girls with anorexia nervosa

Introduction: Anorexia nervosa (AN) is a serious psychosomatic syndrome, classified as an eating disorder. AN patients strive to lose weight below the normal limits defined for a specific age and height, achieving their goal even at the expense of extreme emaciation. AN has a multifactorial aetiology. Genetic factors are believed to be significant in the predisposition to the development of AN. In girls suffering from AN significantly lower levels of resistin (RES) in blood serum are observed as compared to healthy girls. These differences may lead to a thesis that functional genetic polymorphisms in RES coding genes can be responsible for this phenomenon. In our pilot study we demonstrated significant differences in the distribution of genotypes in the locus RETN c.-180C>G of the RES gene in 67 girls with AN and 38 healthy girls. It seems reasonable to compare the frequency of polymorphisms of RETN c.62G>A and RETN c.-180C>G in the RES gene in girls with AN and in healthy subjects in a bigger cohort and to analyse correlations between individual variants of the polymorphisms referred to above and the RES levels in blood plasma. Material and methods: The study covered 308 girls with the restrictive form of AN (AN) and 164 healthy girls (C) (aged 11–19 years). The RES levels in blood serum were determined by means of the ELISA method on a Bio-Vendor machine from LLC (Asheville, North Carolina, USA). The DNA isolation was carried out by means of Genomic Mini AX BLOOD (SPIN). The PCR reaction was carried out on a ThermoCycle T100 thermocycler. 80–150 ng of the studied DNA and relevant F and R starters were added to the reaction mixture. The reaction products were subjected to digestion by restriction enzymes and separated on agarose gels (RFLP). Results: The average RES level in blood serum in the AN group was significantly lower (p < 0.0001) than in the C group. The distribution of genotypes in the locus RETN c.62 of the RES gene was similar in both groups. A significant difference was demonstrated in the distribution of genotypes in the polymorphic site RETN c.-180 of the RES gene between AN and C (p = 0.0145) and in the distribution of the C and G alleles in the locus RETN c.-180 (p < 0.0001). The C allele occurred significantly more frequently than the G allele in the C group as compared to the AN group. In all the study subjects jointly (AN and C) a significant positive correlation between the blood RES levels on one hand and the body mass (r = 0.42; p < 0.0001) and BMI (r = 0.61; p< 0.0001) on the other was observed. There was no correlation between the concentration of RES in blood serum and the distribution of genotypes in the loci of the resistin gene referred to above. Conclusions: The CG genotype in the locus RETN c.-180 C>G of the RES gene may constitute one of the factors predisposing to the development of AN in girls. The genotype in the loci RETN c.62 G>A and RETN c.-180 C>G of the resistin gene has no influence on the levels of this hormone in blood in AN patients

Prevention of cardiovascular disease in a rural general practice

Introduction. Cardiovascular disease (CVD) prophylaxis in general practice, especially in rural areas, is a major organizational challenge. Objective. The aim of this study was to determine the prevalence of CVD risk factors in the studied population, and to identify the effect of the number of planned prophylactic consultations on selected clinical parameters, risk factors, and total cardiovascular risk on the SCORE scale (Systemic Coronary Risk Evaluation). Materials and method. The study included patients of a rural general practice, aged 35–55 years, with at least one modifiable CVD risk factor. Medical history was obtained, a physical examination performed, blood glucose levels, lipid profile, BMI, waist circumference and blood pressure measured and the SCORE cardiovascular risk at baseline and at the end of the study calculated. All participants were provided with targeted specific education. Analysis was performed in two groups of patients (1 and 2), where group 1 had one more prophylactic consultation than Group 2. Results. The results at baseline and a year later were compared in pharmacologically untreated patients, 26 in Group 1 and 34 in Group 2. In Group 1, which had had more prophylactic consultations, a statistically significant decrease was found in the mean systolic blood pressure: 131.000–124.782 (p= 0.02721), mean diastolic blood pressure: 86.846–83.462 (p=0.01111), and a statistically significant decrease in total cardiovascular risk on the SCORE scale (p=0.0478). Conclusions. The higher number of preventive consultations had an impact on a statistically significant decrease in mean blood pressure and mean SCORE value. The year-long cardiovascular disease prophylaxis programme proved less effective than expected, and neither a decrease in body weight nor an improvement in lipid metabolism was achieved in any of the groups

Halitoza: prprzyczyny, diagnostyka, leczenie

Nowadays halitosis is a common disorder, with a wide range of causes, mostly dental, laryngological, and gastrological. There are many ways to diagnose halitosis, but it is not always possible to determine its cause. There are also many ways of managing it, therefore patients should be encouraged to seek diagnosis and treatment for this troublesome ailment. Halitosis (halitus: smell; osis: chronic dysfunction) refers to the presence of a persistent unpleasant mouth odor, which can last for years. Halitosis can also be referred to as fetor oris, bad breath, oral malodor, ozostomia, and stomatodysodia. Apart from actual halitosis, there are also pseudohalitosis and halitophobia, when the people around the patient detect no unpleasant mouth odor, but the patient believes it is present. Fetor oris is quite a common problem, with studies confirming about 15–30% incidence among the population. Bad breath may be a symptom of other diseases, such as gastrointestinal and respiratory tract disorders or metabolic disorders. Dietary and hygienic habits are of great significance in causing halitosis. The easiest and most common diagnostic method of establishing halitosis is for the doctor to smell the patient’s exhaled air (the organoleptic method). Another easy test is the BANA test, which detects one of the proteolytic enzymes generated by the bacteria that colonise the plaque and the back of the tongue. There is also a test to objectively measure the severity of halitosis using the halimeter, a device that measures the amount of volatile sulfides in the exhaled air. Furthermore, there is gas chromatography, a very sensitive and accurate method of separately measuring the amount of each of the volatile sulfides in the exhaled air; unfortunately the test is very expensive. Halitosis management consists primarily of treating the underlying disease, and maintaining strict oral hygiene, using appropriate oral mouthwashes and chewing gums.W dzisiejszych czasach halitoza jest często występującym schorzeniem o różnych podłożach, na ogół stomatologicznym, laryngologicznym i gastrologicznym. Halitozę można diagnozować na wiele sposobów, lecz nie zawsze daje się ustalić jej przyczynę. Istnieje wiele dostępnych możliwości leczenia tej dolegliwości, dlatego należy zachęcać pacjentów, by zgłaszali się do lekarza i rozpoczynali kurację. Halitoza (halitus: zapach; osis: przewlekłe zaburzenie) to uporczywy, nierzadko utrzymujący się przez lata, nieprzyjemny zapach z jamy ustnej. Inne nazewnictwo halitozy, które spotykamy w literaturze to: fetor oris, przykry zapach z ust, nieświeży oddech, ozostomia i stomatodysodia. Oprócz halitozy prawdziwej rozpoznajemy również pseudohalitozę i halitofobię, kiedy to nieprzyjemny zapach z ust nie jest wyczuwalny przez otoczenie, ale pacjent uparcie skarży się na jego występowanie. Fetor ex ore jest obecnie dość powszechnym problemem, zgodnie z wynikami badań stwierdzonym u około 15–30% populacji. Dolegliwość ta może być objawem chorób nie tylko jamy ustnej, ale również przewodu pokarmowego, układu oddechowego, a także chorób metabolicznych. Bardzo istotnymi czynnikami w wywoływaniu halitozy są nasze przyzwyczajenia dietetyczne i higieniczne. Najprostszą i najpowszechniej stosowaną metodą określenia halitozy jest ocena zapachu powietrza wydychanego przez pacjenta za pomocą własnego węchu (badanie organoleptyczne). Praktycznym i łatwym w użyciu jest test BANA, wykrywający jeden z enzymów proteolitycznych wytwarzanych przez bakterie kolonizujące płytkę poddziąsłową i grzbiet języka. Do metod obiektywizujących zjawisko halitozy zaliczamy badanie za pomocą halimetru, urządzenia mierzącego zawartość lotnych związków siarki w powietrzu wydychanym przez pacjenta. Do bardzo dokładnych i czułych, ale zarazem i bardzo kosztownych metod diagnostycznych zalicza się chromatografię gazową, mierzącą pojedynczo związki siarki w wydychanym powietrzu. Leczenie halitozy polega przede wszystkim na leczeniu choroby podstawowej, poza tym na utrzymywaniu bardzo dobrej higieny jamy ustnej, stosowaniu odpowiednich płukanek i gum do żucia

Osteoarthrosis in general practice

The aim of this study is to collect the most important information concerning OA, from the general practitioner's point of view, to guide the patient in the initial diagnosis, cooperate with doctors in other areas, assist in the thera-peutic process, and provide medical support in the case of a lack of access to a consulting specialist or a long period of waiting for the consultation. The paper presents the definition of OA, pathological mechanism of its formation as well as forms depending on the aetiology. The symptoms of the disease with particular emphasis on the location and the principles of diagnostic and therapeutic procedures in the daily practice of the general practitioner are presented. The important role of rehabilitation in order to improve the quality of life of patients is also highlighted. Osteoarthritis is a progressive, irreversible disease, leading to deterioration of the quality of life of the patient. Applying treatment is not able to stop disease progression, but it is able to slow the development and improve the quality of life of patients. The study highlights the important role of the general practitioner as a guide to the health care system for patients with OA.Celem pracy było zebranie najistotniejszych z punktu widzenia lekarza rodzinnego wiadomości dotyczących ChZS, by w swojej praktyce mógł on, współpracując z lekarzami innych dziedzin, poprowadzić pacjenta we wstępnej diag-nostyce, wspomóc proces terapeutyczny, a także stanowić wsparcie medyczne w razie braku dostępności do konsul-tacji specjalistycznej lub długiego okresu oczekiwania na nią. W pracy przedstawiono definicję ChZS, patomechanizm jej powstawania oraz postaci w zależności od etiologii. Przedstawiono objawy choroby ze szczególnym uwzględnieniem lokalizacji oraz zasady postępowania diagnostycz-nego i terapeutycznego w codziennej praktyce lekarza rodzinnego. Zwrócono również uwagę na istotną rolę rehabilitacji w celu uzyskania poprawy komfortu życia pacjentów. Choroba zwyrodnieniowa stawów jest schorzeniem postępującym, nieodwracalnym, prowadzącym do ograniczenia sprawności i pogorszenia jakości życia chorego. Zastosowane leczenie nie jest w stanie zahamować postępu choroby, może natomiast spowolnić jej rozwój i poprawić jakość życia pacjentów. W pracy podkreślono istotną rolę lekarza rodzinnego jako przewodnika po systemie opieki zdrowotnej w przypadku pacjentów z ChZS

Styles of coping with stress and level of sense of self-efficacy among VI year medical students of Medical University of Silesia in Katowice

INTRODUCTION: The medical profession belongs to those professions having one of the highest levels of stress. The aim of the work was to define the styles of coping with stress and the level of sense of self-efficacy and to establish the dependencies of the factors mentioned by students of medicine. MATERIAL AND METHODS: The survey study included a group of 184 VI year students of medicine. The following were used: Questionnaire for coping in stressful situations CISS, Generalized self-efficacy scale – GSES, authors’ own multiple-choice research questionnaire for the specialization of medicine. Analysis was conducted using the statistical package for IBM, SPSS Statistics 22. RESULTS: Among the 184 surveyed students, there were 122 women and 62 men. 57 people considered the choice of family medicine as their target specialization and 127 subjects chose other specializations. More than half of the students had a task-oriented style of coping, among 32% the the evasion style dominated and 14.6% of the emotional style, equally in men and women. There were no inter-group differences in the styles of coping with stress. CONCLUSIONS: 1. Medical students, regardless of their choice of specialization, have a task style of coping with stress and a high level of self-efficacy. 2. Students with higher levels of self-efficacy often display the task style of coping with stress and engage in seeking social contacts. 3. Students choosing a specialization other than family medicine had a significantly higher sense of self-efficacy. 4. A high level of self-efficacy and task style of coping with stress as part of the personality profile of a future doctor may indicate the possibility of better functioning in the profession.WSTĘP: Zawód lekarza należy do profesji cechujących się jednym z najwyższych wskaźników poziomu stresu. Celem pracy było określenie stylów radzenia sobie ze stresem i poziomu poczucia własnej skuteczności oraz ustalenie zależności wymienionych czynników u studentów VI roku medycyny. MATERIAŁ I METODY: Badaniem ankietowym objęto grupę 184 studentów VI roku medycyny SUM w Katowicach. Zastosowano Kwestionariusz Radzenia Sobie w Sytuacjach Stresowych – CISS, Skalę Uogólnionej Własnej Skuteczności – GSES, autorską ankietę badania wyboru specjalizacji medycznej. Analizę przeprowadzono za pomocą pakietu statystycznego IBM SPSS Statistics 22. WYNIKI: Spośród 184 badanych studentów (122 kobiety i 62 mężczyzn) 57 osób rozważało wybór medycyny rodzinnej jako specjalizacji docelowej, a 127 wybrało inne specjalizacje. Ponad połowa studentów charakteryzowała się stylem zadaniowym radzenia sobie ze stresem, u 32% dominował styl unikowy, a u 14,6% styl emocjonalny, w równym stopniu u kobiet i mężczyzn. Nie stwierdzono różnic międzygrupowych w stylach radzenia sobie ze stresem. WNIOSKI: 1. Studenci medycyny, niezależnie od wyboru specjalizacji, w większości charakteryzują się zadaniowym stylem radzenia sobie ze stresem i wysokim poziomem poczucia własnej skuteczności. 2. Badani studenci o wyższym poziomie poczucia własnej skuteczności częściej radzą sobie ze stresem w sposób zadaniowy i angażują się w poszukiwanie kontaktów towarzyskich. 3. Studenci wybierający specjalizację inną niż medycyna rodzinna charakteryzują się istotnie wyższym poczuciem własnej skuteczności. 4. Wysoki poziom poczucia własnej skuteczności i zadaniowy styl radzenia sobie ze stresem, jako elementy profilu osobowościowego przyszłego lekarza, mogą wskazywać na możliwości lepszego funkcjonowania w zawodzie

Styles of coping with stress and level of sense of self-efficacy among VI year medical students of Medical University of Silesia in Katowice

INTRODUCTION: The medical profession belongs to those professions having one of the highest levels of stress. The aim of the work was to define the styles of coping with stress and the level of sense of self-efficacy and to establish the dependencies of the factors mentioned by students of medicine. MATERIAL AND METHODS: The survey study included a group of 184 VI year students of medicine. The following were used: Questionnaire for coping in stressful situations CISS, Generalized self-efficacy scale – GSES, authors’ own multiple-choice research questionnaire for the specialization of medicine. Analysis was conducted using the statistical package for IBM, SPSS Statistics 22. RESULTS: Among the 184 surveyed students, there were 122 women and 62 men. 57 people considered the choice of family medicine as their target specialization and 127 subjects chose other specializations. More than half of the students had a task-oriented style of coping, among 32% the the evasion style dominated and 14.6% of the emotional style, equally in men and women. There were no inter-group differences in the styles of coping with stress. CONCLUSIONS: 1. Medical students, regardless of their choice of specialization, have a task style of coping with stress and a high level of self-efficacy. 2. Students with higher levels of self-efficacy often display the task style of coping with stress and engage in seeking social contacts. 3. Students choosing a specialization other than family medicine had a significantly higher sense of self-efficacy. 4. A high level of self-efficacy and task style of coping with stress as part of the personality profile of a future doctor may indicate the possibility of better functioning in the profession.WSTĘP: Zawód lekarza należy do profesji cechujących się jednym z najwyższych wskaźników poziomu stresu. Celem pracy było określenie stylów radzenia sobie ze stresem i poziomu poczucia własnej skuteczności oraz ustalenie zależności wymienionych czynników u studentów VI roku medycyny. MATERIAŁ I METODY: Badaniem ankietowym objęto grupę 184 studentów VI roku medycyny SUM w Katowicach. Zastosowano Kwestionariusz Radzenia Sobie w Sytuacjach Stresowych – CISS, Skalę Uogólnionej Własnej Skuteczności – GSES, autorską ankietę badania wyboru specjalizacji medycznej. Analizę przeprowadzono za pomocą pakietu statystycznego IBM SPSS Statistics 22. WYNIKI: Spośród 184 badanych studentów (122 kobiety i 62 mężczyzn) 57 osób rozważało wybór medycyny rodzinnej jako specjalizacji docelowej, a 127 wybrało inne specjalizacje. Ponad połowa studentów charakteryzowała się stylem zadaniowym radzenia sobie ze stresem, u 32% dominował styl unikowy, a u 14,6% styl emocjonalny, w równym stopniu u kobiet i mężczyzn. Nie stwierdzono różnic międzygrupowych w stylach radzenia sobie ze stresem. WNIOSKI: 1. Studenci medycyny, niezależnie od wyboru specjalizacji, w większości charakteryzują się zadaniowym stylem radzenia sobie ze stresem i wysokim poziomem poczucia własnej skuteczności. 2. Badani studenci o wyższym poziomie poczucia własnej skuteczności częściej radzą sobie ze stresem w sposób zadaniowy i angażują się w poszukiwanie kontaktów towarzyskich. 3. Studenci wybierający specjalizację inną niż medycyna rodzinna charakteryzują się istotnie wyższym poczuciem własnej skuteczności. 4. Wysoki poziom poczucia własnej skuteczności i zadaniowy styl radzenia sobie ze stresem, jako elementy profilu osobowościowego przyszłego lekarza, mogą wskazywać na możliwości lepszego funkcjonowania w zawodzie