8 research outputs found
Atypical course of type 1 diabetes mellitus in a patient with Ollier's disease - a case report
Background
Nowadays, we can distinguish more than two types of diabetes mellitus. Due to blood glucose measurement and genetic tests, different types of diabetes (such as autoimmune, monogenetic, atypical) can be detected. Despite the constantly updated recommendations and the progress of diagnostic tests, making a diagnosis may be difficult.
Case report
A 23-year old patient was admitted to the Department of Endocrinology due to diagnosed diabetes mellitus to determine its primary cause. Elevated blood glucose level was identified during periodic medical test and was confirmed by OGTT test. In the patient’s medical history: Ollier’s disease with multiple enchondromas, treated surgically in childhood, no typical symptoms and risk factors of hyperglycaemia. During hospitalization the laboratory tests showed decreased level of C-peptide, nevertheless the patient represented acceptable levels of glycaemia following only by diet restriction. MODY, LADA and diabetes due to Ollier’s disease was speculated. Due to suspicion of autoimmunological cause the diagnostic was extended by testing antibodies: IAA, IA2, GAD, IC, which confirmation allowed to recognise untypical diabetes mellitus type 1. The patient objected to insulin treatment, limited it only to a diet and maintained normoglycemia for 15months. However, after an increase in glycaemia and in HbA1c, insulin therapy was introduced.
Disscussion with conclusion
Atypical course of diabetes should be considered in patients with a known disorder or with comorbidities associated with diabetes and without typical symptoms of hyperglycaemia. Atypical forms of diabetes are uncommon and require etiology-specific therapies
Etiological factors and treatment of chylothorax in paediatric patients - a systematic review
Chylothorax is an accumulation of chyle in the pleural cavity. It is a relatively rare cause of pleural effusion in children and its annual incidence is 14 cases per 100 000 children in Europe.
The pleural fluid triglyceride level greater than 110 mg/dl with a cholesterol level lower than 200 mg/dl confirms the diagnosis of chylothorax. Medical imaging are also necessary such as a non-invasive and easily accessible lung ultrasound. Symptoms of this disease are tachypnea, dyspnea, and in some cases dry cough.
This review aims to summarize the current literature regarding chylothorax in children, analyze its possible etiologies and treatments.
The causes of chylothorax are varied. It may appear after surgical interventions, traumas, infections and also be congenital. Iatrogenic factors are the most common cause of chylothorax in children with cardiothoracic surgeries. Management of chylothorax can be quite complex and highly variable, depending on patient’s condition and their response to the introduced treatment. Conservative treatment consisting of nutrition therapy, chest drain, and pharmacotherapy is typically a first-line of treatment. Diet modification consist in dietary supplements enriched with medium chain triglycerides (MCT) or starting the patient on a total parenteral nutrition (TPN). In most of the analyzed cases the conservative treatment alone proved sufficient in the management of chylothorax. In case of its failure, surgical treatment was a secondary therapy choice. One of the most common surgical procedures for pleural effusion is a thoracic duct ligation (TDL) or pleurodesis and both of these methods are highly effective therapy for chylothorax.
This review of the literature reveals a wide variety of causes and methods of treatment of chylothorax. There are no clear standards of management and the therapy is adjusted to the clinical condition of the patient
Primary sclerosing cholangitis - an insidious enemy of the liver - case report
Background and introduction
Primary sclerosing cholangitis (PSC) is a chronic liver disease with features of cholestasis as a result of inflammation and damage to the bile ducts, which can eventually lead to liver fibrosis and parenchymal failure at an advanced stage.
Case Report
A 22-year-old man was admitted urgently to the Department of Gastroenterology for complaints of abdominal pain, weakness and tarry stools. A panel of detailed examinations was performed to establish the diagnosis. An abdominal ultrasound scan showed significant enlargement of the liver and spleen. Gastroscopy revealed variceal columns of II degree in the lower esophagus, which were cauterized. Laboratory tests confirmed anemia, reduced platelet and white blood cell counts, increased activity of ALT, ASP, GTP, ALP and slight elevation of total bilirubin in the blood. Based on the clinical disease manifestation and the results of diagnostic tests, cirrhosis of unknown origin was suspected. Subsequent magnetic resonance cholangiopancreatography (MRCP) revealed the presence of multiple strictures in the intra- and extrahepatic bile ducts and gave rise to the diagnosis of PSC. Pharmacological treatment was administered. Currently, the patient remains under the close care of the Transplant Clinic, where he undergoes regular checks of liver function, and endoscopic variceal ligation (EVL) as required.
Discussion with conclusions
The case presented here shows that the course of PSC can be insidious and asymptomatic. Despite the absence of clinical symptoms, the disease can lead to the development of advanced cirrhosis even in patients of young age and be diagnosed as late as at the decompensated stage, when the only treatment option remains organ transplantation
Influence of environmental factors and diet on inflammatory bowel diseases – a review of the literature
Introduction and objectiveInflammatory bowel disease (IBD), leading to inflammation in the gastrointestinal tract, causes a number of bothersome symptoms that contribute to the deterioration of patients' quality of life both physically and psychologically. Therapy methods based on pharmacotherapy in IBD often remain insufficient in the treatment of these disorders, so other factors affecting the course of IBD are being sought. The purpose of this review is to present risk and prevention factors for the development of inflammatory bowel disease based on diet and environmental factors.
Abbreviated description of the state of knowledgeThe review has identified a number of factors that influence IBD. One of these is smoking, which shows a commonly detrimental effect on CD, while it has a protective effect in UC patients. Antibiotic therapy, by disrupting the composition of the endogenous intestinal microflora, contributes to an increased risk of IBD exacerbations. A review of the literature on surgical interventions does not allow a clear conclusion. Stress and psychiatric disorders increasing the production of pro-inflammatory cytokines, inhibiting the anti-inflammatory action of the vagus nerve increase the risk of IBD exacerbations. A healthy and balanced diet is an important aspect in the treatment of UC and CD. Scientific societies unanimously recognize breastfeeding and its effect on the development of the intestinal microflora as an important protective factor. On the other hand, introducing an elimination diet without a food intolerance confirmed by a blood test is unjustified and harmful.
SummaryAwareness of the risk factors for development and exacerbations in IBD patients is crucial. Further research into the impact of diet and environmental factors may support pharmacological treatment in achieving therapeutic success in patients with inflammatory bowel disease
Proton pump inhibitor (PPI) administration and Clostridioides difficile infection - is this a real clinical problem? A critical review of the literature
Background: Proton pump inhibitors (PPIs) are widely used drugs that reduce gastric acid secretion. In recent years, there has been a gradual increase in their use. The safety of prolonged PPI therapy and the potential for cumulative side effects of these drugs raise legitimate concerns. An association between PPI administration and the risk of Clostridioides difficile infection has been suggested. The findings regarding this phenomenon require further unequivocal verification.
Material and methods: A review of publications obtained from the PubMed database and published between 2016-2023. Based on the keywords "proton pump inhibitor", "PPI" and "Clostridium", 132 articles were selected. Finally, 6 meta-analyses were included in the analysis.
Results: Studies conducted in recent years have shown a statistically significant increase in the risk of C. difficile infection in patients taking PPIs compared to those who avoid this therapy. The aforementioned relationship was observed in both adults and pediatric patients. One study proved that the risk remained high even up to 1 year after the end of treatment. The described relationship is still a matter of debate due to the fact that patients using antacids are usually elderly, have several comorbidities and a higher risk of developing C. difficile infection regardless of PPI use.
Conclusions: The relationship between the use of PPIs and the risk of developing C. difficile infection is still controversial, which justifies the need for continued clinical trials to objectively resolve this issue. PPIs exert high efficacy in the treatment of acid-dependent diseases, but due to the many ambiguities surrounding possible side effects, caution in their administration seems warranted, especially for long-term therapy in elderly patients with polypharmacy
The role of probiotics in the treatment of depressive disorders. A critical review
Depressive disorders are a widespread problem in modern medicine. According to current data from the World Health Organisation, an estimated 280 million people worldwide suffer from depression. In recent years, there have been reports of a correlation between the composition of the gut microbiota and the development of depressive disorders and attempts to modify it through the use of psychobiotics.
The literature from the PubMed database published between 2018-2023 has been explored. 596 articles were selected based on the keywords "probiotics" and "depression". Six randomized clinical trials were finally included in the analysis.
As defined elsewhere, psychobiotics are probiotic bacteria which supplemented in adequate amounts, interact with the gut-brain axis and show beneficial effects on patients' mental health. Results from recent RCTs suggest that daily probiotic supplementation significantly reduces the severity of depression compared to placebo (p<0.05). Additionally, this effect may be enhanced by the combined use of a probiotic with a prebiotic. Furthermore, some researchers indicate that probiotics may lead to significant improvements in cognitive function in patients suffering from depressive disorders.
In conclusion, intestinal dysbiosis may be an important factor leading to the development of mental illness. Results of recent studies suggest that specific strains of probiotic bacteria may offer therapeutic benefits in the treatment of the aforementioned disorders. However, further clinical studies are needed to objectively confirm the relationship between gut microbiota composition and the development of depression
The role of probiotics in the treatment of depressive disorders. A critical review
Depressive disorders are a widespread problem in modern medicine. According to current data from the World Health Organisation, an estimated 280 million people worldwide suffer from depression. In recent years, there have been reports of a correlation between the composition of the gut microbiota and the development of depressive disorders and attempts to modify it through the use of psychobiotics.
The literature from the PubMed database published between 2018-2023 has been explored. 596 articles were selected based on the keywords "probiotics" and "depression". Six randomized clinical trials were finally included in the analysis.
As defined elsewhere, psychobiotics are probiotic bacteria which supplemented in adequate amounts, interact with the gut-brain axis and show beneficial effects on patients' mental health. Results from recent RCTs suggest that daily probiotic supplementation significantly reduces the severity of depression compared to placebo (p<0.05). Additionally, this effect may be enhanced by the combined use of a probiotic with a prebiotic. Furthermore, some researchers indicate that probiotics may lead to significant improvements in cognitive function in patients suffering from depressive disorders.
In conclusion, intestinal dysbiosis may be an important factor leading to the development of mental illness. Results of recent studies suggest that specific strains of probiotic bacteria may offer therapeutic benefits in the treatment of the aforementioned disorders. However, further clinical studies are needed to objectively confirm the relationship between gut microbiota composition and the development of depression