SGLT-2 inhibitors as adjunctive to insulin therapy in type 1 diabetes

The absolute insulin deficiency that occurs in type 1 diabetes mellitus (T1DM) is associated with the need for intensive functional insulin therapy as the only appropriate treatment model. In the recent years, introduction of new classes of glucose-lowering drugs has led to an increasing interest in adjunct therapies for T1DM. These therapies are designed to support exogenous insulin therapy in achieving the therapeutic goal while reducing the risk of hypoglycaemia and exerting a beneficial effect on body weight. One potential therapeutic option are sodium-glucose co-transporter 2 (SGLT-2) inhibitors. In the present paper, we reviewed the current clinical research on SGLT-2 inhibitors as add-on therapy to insulin in patients with T1DM. This therapy modification contributes to an improvement in metabolic control without increasing the risk of severe hypoglycaemia and with a beneficial effect on body weight, translating to improved compliance, quality of life, and patient satisfaction with treatment. However, due to possible adverse effects including euglycaemic diabetic ketoacidosis, the decision to use SGLT-2 inhibitors in patients with T1DM should be made with caution, and patients require proper education regarding the prevention and treatment of acidosis

A Case of Extensive Infl ammatory Changes (Osteomyelitis) in an Infant’s Skeleton from the Medieval Burial Ground (11th–12th c) in Wawrzeńczyce (Near Krakow)

The aim of this study was to diagnose and describe extensive infl ammatory changes in a child’s skeleton from Wawrzeńczyce, (the medieval period). The aim of the analysis was to determine the nature of the infl ammatory changes and their etiology by means of macroscopic techniques as well as X-ray analysis. The tests revealed that the individual suffered from a hematogenous multifocal osteitis. This condition might have been a result of an acute or sub-acute osteitis, and the untreated form of osteomyelitis might have contributed to the infection of the entire developing organism, leading to death

Food intake changes across the menstrual cycle : a preliminary study

Wprowadzenie. Ostatnie doniesienia wskazują, że zmiana wydzielania hormonów w poszczególnych fazach cyklu u kobiet niestosujących terapii hormonalnej wpływa na ich zachowania żywieniowe. Cel pracy. Ocena zachowań żywieniowych kobiet w poszczególnych fazach cyklu menstruacyjnego w grupie kobiet niestosujących antykoncepcji hormonalnej. Materiał i metody. Do badania wykorzystano kwestionariusz składający się z 2 części. Oceny żywienia dokonano za pomocą wywiadu o spożyciu z 24 godzin. Obliczono dzienną podaż energetyczną diety (kcal) oraz zawartość białka, tłuszczu, węglowodanów i sacharozy (g, %). Grupę badaną stanowiły studentki jednej ze szkół wyższych. Do badania włączono 77 kobiet mających regularny cykl menstruacyjny. Kryterium wykluczenia z badania było przyjmowanie każdego rodzaju doustnej antykoncepcji hormonalnej, jakichkolwiek leków stosowanych w leczeniu chorób przewlekłych, zaburzenia odżywiania oraz brak zgody na udział w badaniu. Wyniki. Mediana podaży energii ze składników odżywczych była najwyższa w fazie lutealnej. W tej fazie zaobserwowano również najwyższe (mediana) spożycie białka, tłuszczu, węglowodanów i sacharozy. Procentowy udział energii pochodzącej z białka był najniższy w fazie lutealnej, a najwyższy w fazie folikularnej. Z kolei procentowy udział energii pochodzącej z sacharozy był najwyższy w fazie lutealnej i znacząco przewyższał udział energii z tego składnika w fazie owulacyjnej. Wnioski. Zachowania żywieniowe mogą być kształtowane przez hormony wydzielane podczas cyklu menstruacyjnego. Wzrost apetytu zaobserwowano w fazie lutealnej. Wartość energetyczna diety oraz spożycie tłuszczu, węglowodanów i białka ulega wahaniom w trakcie cyklu menstruacyjnego. Spożycie tłuszczu, białek, węglowodanów i sacharozy było najwyższe w fazie lutealnej.Background. Recent studies have reported that hormonal changes during the menstrual cycle in women who do not receive hormonal therapy have a significant influence on their eating habits. Objectives. The aim of this study was to evaluate the eating habits of women not receiving hormonal contraception in relation to menstrual cycle phases. Material and methods. A two-part survey questionnaire was used as a study tool. Eating habits were analyzed with a 24-hour dietary recall questionnaire. The following macronutrients were calculated: daily energy value (kcal), and amounts (g, %) of protein, fat, carbohydrates, and sucrose. The study group comprised 77 college students with regular menstrual cycles. Exclusion criteria included the use of any oral contraceptive, the use of medication for any chronic disease, any eating disorder, and a lack of written informed consent. Results. The median total energy intake from macronutrients was highest during the luteal phase. Median protein, fat, carbohydrate, and sucrose intake were also highest during the luteal phase. The percentage of energy intake from protein was lowest during the luteal phase and highest during the follicular phase. The percentage of energy intake from sucrose was highest during the luteal phase, which was significantly greater than that during the ovulation phase. Conclusions. Eating habits could be influenced by hormone secretion throughout the menstrual cycle. Increased appetite was observed in the luteal phase. Total energy, fat, carbohydrate, and protein intake fluctuated across the menstrual cycle. Fat, protein, carbohydrate, and sucrose intake were highest in the luteal phase

Should capnography be used as a guide for choosing a ventilation strategy in circulatory shock caused by severe hypothermia? : observational case-series study

BACKGROUND: Severe accidental hypothermia can cause circulatory disturbances ranging from cardiac arrhythmias through circulatory shock to cardiac arrest. Severity of shock, pulmonary hypoperfusion and ventilation-perfusion mismatch are reflected by a discrepancy between measurements of CO(2) levels in end-tidal air (EtCO(2)) and partial CO(2) pressure in arterial blood (PaCO(2)). This disparity can pose a problem in the choice of an optimal ventilation strategy for accidental hypothermia victims, particularly in the prehospital period. We hypothesized that in severely hypothermic patients capnometry should not be used as a reliable guide to choose optimal ventilatory parameters. METHODS: We undertook a pilot, observational case-series study, in which we included all consecutive patients admitted to the Severe Hypothermia Treatment Centre in Cracow, Poland for VA-ECMO in stage III hypothermia and with signs of circulatory shock. We performed serial measurements of arterial blood gases and EtCO(2), core temperature, and calculated a PaCO(2)/EtCO(2) quotient. RESULTS: The study population consisted of 13 consecutive patients (ten males, three females, median 60 years old). The core temperature measured in esophagus was 20.7–29.0 °C, median 25.7 °C. In extreme cases we have observed a Pa-EtCO(2) gradient of 35–36 mmHg. Median PaCO(2)/EtCO(2) quotient was 2.15. DISCUSSION AND CONCLUSION: Severe hypothermia seems to present an example of extremely large Pa-EtCO(2) gradient. EtCO(2) monitoring does not seem to be a reliable guide to ventilation parameters in severe hypothermia

Difficulties in funding of VA-ECMO therapy for patients with severe accidental hypothermia

Background: Severe accidental hypothermia is defined as a core temperature below 28 Celsius degrees. Within the last years, the issue of accidental hypothermia and accompanying cardiac arrest has been broadly discussed and European Resuscitation Council (ERC) Guidelines underline the importance of Extracorporeal Rewarming (ECR) in treatment of severely hypothermic victims. The study aimed to evaluate the actual costs of ECR with VA-ECMO and of further management in the Intensive Care Unit of patients admitted to the Severe Accidental Hypothermia Centre in Cracow, Poland. Methods: We carried out the economic analysis of 31 hypothermic adults in stage III-IV (Swiss Staging) treated with VA ECMO. Twenty-nine individuals were further managed in the Intensive Care Unit. The actual treatment costs were evaluated based on current medication, equipment, and dressing pricing. The costs incurred by the John Paul II Hospital were then collated with the National Health Service (NHS) funding, assessed based on current financial contract. Results: In most of the cases, the actual treatment cost was greater than the funding received by around 10,000 PLN per patient. The positive financial balance was achieved in only 4 (14%) individuals; other 25 cases (86%) showed a financial loss. Conclusion: Performed analysis clearly shows that hospitals undertaking ECR may experience financial loss due to implementation of effective treatment recommended by international guidelines. Thanks to new NHS funding policy since January 2017 such loss can be avoided, what shall encourage hospitals to perform this expensive, yet effective method of treatment

HorTILLUS - a rich and renewable source of induced mutations for forward/reverse genetics and pre-breeding programs in barley (Hordeum vulgare L.)

TILLING (Targeting Induced Local Lesions IN Genomes) is a strategy used for functional analysis of genes that combines the classical mutagenesis and a rapid, high-throughput identification of mutations within a gene of interest. TILLING has been initially developed as a discovery platform for functional genomics, but soon it has become a valuable tool in development of desired alleles for crop breeding, alternative to transgenic approach. Here we present the HorTILLUS (Hordeum—TILLING—University of Silesia) population created for spring barley cultivar “Sebastian” after double-treatment of seeds with two chemical mutagens: sodium azide (NaN3) and N-methyl-N-nitrosourea (MNU). The population comprises more than 9,600 M2 plants from which DNA was isolated, seeds harvested, vacuum-packed, and deposited in seed bank. M3 progeny of 3,481 M2 individuals was grown in the field and phenotyped. The screening for mutations was performed for 32 genes related to different aspects of plant growth and development. For each gene fragment, 3,072–6,912 M2 plants were used for mutation identification using LI-COR sequencer. In total, 382 mutations were found in 182.2Mb screened. The average mutation density in the HorTILLUS, estimated as 1 mutation per 477 kb, is among the highest mutation densities reported for barley. The majority of mutations were G/C to A/T transitions, however about 8% transversions were also detected. Sixty-one percent of mutations found in coding regions were missense, 37.5% silent and 1.1% nonsense. In each gene, the missense mutations with a potential effect on protein function were identified. The HorTILLUS platformis the largest of the TILLING populations reported for barley and best characterized. The population proved to be a useful tool, both in functional genomic studies and in forward selection of barley mutants with required phenotypic changes. We are constantly renewing the HorTILLUS population, which makes it a permanent source of new mutations.We offer the usage of this valuable resource to the interested barley researchers on cooperative basis