Effects of thyroid hormone imbalance on colorectal cancer carcinogenesis and risk — a systematic review

Colorectal cancer (CRC) is the second leading cause of cancer-related death. The prevalence of colorectal neoplasm is increasing. Many studies have shown that thyroid dysfunction may be connected with the higher risk of pancreatic and breast cancer, but only a few described the role of thyroid dysfunction and thyroid hormone (TH) replacement in the development and risk of CRC. The aim of this study is to summarise all findings and potentially elucidate the connection between TH imbalance and colorectal cancer. The systematic review was conducted according to PICO and PRISMA guidelines. We searched MEDLINE, ClinicalTrials.gov, www.clinicaltrialsregister.eu, and Cochrane Library databases using the following keywords: “((((thyroid OR hypothyroidism OR hyperthyroidism OR levothyroxine OR hashimoto OR graves OR thyroidectomy)) AND (colon OR colorectal OR CRC)) NOT hashimoto[Author]) NOT graves[Author])”. No filters were used. Of total of 3054 articles identified by the search strategy, 11 met PICO criteria and were included into the review. Four of those were on cell lines and seven were human studies. Analysis of the included studies revealed an elevated risk of CRC in patients with hypothyroidism with aORs ranging from 1.16 (95% CI: 1.08–1.24, p < 0.001) to 1.69 (95% CI: 1.21–2.36, p = 0.002). Moreover, TH replacement therapy has a protective effect for CRC risk with aOR ranging from 0.60 (95% CI: 0.44–0.81, p = 0.001) to 0.92 (95% CI: 0.86–0.98, p = 0.009). THs seem to play a role in colorectal carcinogenesis. Further studies are warranted to define the exact role of thyroid hormone imbalance in prevention and treatment of CRC

Orientalism and Revulsion in a Science-Fiction TV Series "Stargate-SG1"

Analiza sposobu kreacji głównego antagonisty (obcej rasy Goa'uld) w serialu science-fiction Stargate-SG1 pod kątem dwóch teorii: orientalizmu wg Edwarda Saïda oraz czystości wg Mary Douglas. Przeciwnik bohaterów stworzony jest na bazie stereotypów o Oriencie – irracjonalny i arogancki, nadmiernie seksualny, pogrążony w stagnacji. Dodatkowym aspektem jest obrzydzenie, które wzbudza poprzez upodobnienie do oblepionego śluzem węża bądź robaka, penetrującego ludzkie ciała i odbierającego kontrolę nad ciałem. Połączenie tych dwóch czynników pozwoliło na wykreowanie antagonisty, który utrzymuje zainteresowanie widzów przez dziesięć sezonów serialu.An analysis of the way the main antagonist (an alien race called the Goa'uld) in a science-fiction TV series Stargate-SG1 was created according to two theories: orientalism by Edward Saïd and purity by Mary Douglas. The enemy is obviously inspired by stereotypes about Orient – irrational and arrogant, overly sexual, stagnant. An additional aspect is the revulsion caused by the enemy's resemblance of a slimy snake or worm, penetrating human bodies and assuming control of the body. The combination of those two ideas created an antagonist which remained interesting for the viewers for ten seasons of the series

Knowledge and Practice of Antibiotic Management and Prudent Prescribing among Polish Medical Doctors

Antimicrobial resistance (AMR) is an urgent public health issue. The role of medical doctors in proper antibiotic use is crucial. The aim of this study was to evaluate the knowledge and practices of Polish doctors of antimicrobial prescribing and antibiotic resistance. The study group consisted of 504 medical doctors with an average age 32.8 ± 5.9 years, mostly women (65%). The paper questionnaire was developed on the basis of a survey tool developed by the European Centre for Disease Prevention and Control (ECDC) and Public Health England (PHE). According to our study, physicians were aware that: taking antibiotics has side effects, antibiotics cannot be used against viruses, unnecessary use of antibiotics leads to AMR and that healthy people can carry resistant bacteria (each item ≥98% correct responses). Only 47% of respondents knew that the use of antibiotics as growth stimulants in livestock is illegal in the EU. Of the respondents, 98.61% saw the connection between prescribing antibiotics and AMR. However, 65.28% of the respondents reported a lack of appropriate materials on AMR counseling. Nearly 92.5% of participants “never” or “rarely” gave out resources on prudent antibiotic use. Physicians in Poland underestimate the role of hand hygiene in stimulating antibiotic resistance (ABR) (74.4%), while demonstrating satisfying knowledge about antimicrobial use, the clinical application of antimicrobial guidelines and prevention of ABR. However, educational interventions are needed to help lead challenging communication with assertive patients. Appropriate patient resources would be helpful in reaching this goal

Vitamin D Knowledge, Attitudes and Practices of Polish Medical Doctors

Background Vitamin D deficiency occurs in as much as 90–95% of the Polish population, although this condition is known to cause negative long-term health implications. The role of medical doctors in advising proper supplementation, monitoring and correcting the levels of 25-hydroxyvitamin D in individuals is of great importance and should be used to help mitigate its common deficits. The aim of this study was to evaluate knowledge, attitudes and practices of Polish physicians regarding vitamin D supplementation in order to identify areas for improvement and determinants for the knowledge gaps. Methods The study group comprised 701 medical doctors aged 32.1 ± 5.3 years on average, mostly women (71.61%). An original survey questionnaire was developed for the purpose of the study. Results The mean vitamin D knowledge score was 6.8 ± 2.3 (in a scale 0–13) and was related to gender (p < 0.001), type of specialization (p = 0.032), D3 supplements use (p < 0.001), recommending supplementation to patients (p = 0.005), to relatives and friends (p < 0.001) and to healthy adults (p < 0.001). In terms of self-administration, 14% of respondents take vitamin D all-year-round while 24% only in autumn and winter. 25% of respondents monitor their vitamin D (25-hydroxyvitamin D) serum concentration. Most participants (61%) did not recommend supplementing vitamin D to their patients on a regular basis. Conclusions The study indicates that medical doctors in Poland need to have more training and education on vitamin D supplementation in order to better address the problem of its deficits in the population

Acute cholecystitis in patients with diabetes mellitus - systematic review

Introduction: According to the WHO, an estimated 422 million people are suffering from diabetes worldwide. Among them, the incidence of cholelithiasis is higher than in the healthy population. The aim of this literature review was to summarize the available evidence about acute cholecystitis in patients with diabetes. Materials and methods: This study adhered to the PRISMA guidelines. The course of hospitalization of patients with and without diabetes who underwent cholecystectomy due to acute cholecystitis was compared. Following information was abstracted from original studies: general study information, patient characteristics, complications, and recommendations for patients with diabetes. Results: Initial search provided 1632 results. After full text assessment, 40 studies met the inclusions criteria. Operative and postoperative complication rates were significantly higher among the diabetic patients. Diabetes is a risk factor for conversion from laparoscopic to open cholecystectomy method. The authors' opinions on elective surgery before the onset of acute cholecystitis symptoms are divided. Conclusions: Diabetic patients are at greater risk of developing complications. An individualized screening and treatment approach, as well as proper preparation of the diabetic patient for an elective cholecystectomy could have a positive effect on the outcome. However, the low quality of the data from the systematic review does not allow for meta-analysis, which is why we cannot draw strong conclusions

Polish Medical Doctors’ Opinions on Available Resources and Information Campaigns concerning Antibiotics and Antibiotic Resistance, a Cross-Sectional Study

Background: Antibiotic resistance (ABR) is at the top of global health threats. This paper aims to assess Polish physicians’ readiness to impact ABR through prescribing routines. Methods: Surveying Polish physicians participating in specialization courses at the Center for Postgraduate Medical Education in Warsaw, Poland from October 2019 to March 2020. Results: Information was obtained from 504 physicians aged 25–59, mean 32.8 ± 5.9 years, mainly women (65%). Most doctors (78%) prescribed antibiotics at least once a week. Physicians indicated clinical practice guidelines as resources most often consulted in the management of infections (90%). However, clinical experience was also declared a powerful resource. In total, 54% of respondents recalled receiving information about the prudent use of antibiotics within 12 months, which partially translated into changing views (56%) and practice (42%). Physicians disagreed that national campaigns provide good promotion of prudent antibiotics use (75%) or that they are effective (61%). Only 40% of doctors were aware of the national campaign promoting responsible antibiotics use, 24% had heard about the European Antibiotic Awareness Day and 20% knew about the World Antimicrobial Awareness Week. Conclusions: Prescribers most often rely on clinical practice guidelines and their own experience as resources for antibiotics use. Doctors’ awareness of available resources and information campaigns concerning antibiotics and antibiotic resistance should be improved

Do clinical practice guidelines follow sustainable healthcare principles? A review of respiratory guidance

Background: Respiratory care is an important site for climate action, given that common treatments for conditions such as asthma and COPD produce significant greenhouse gas emissions, even as respiratory health is negatively impacted by climate change. Clinical guidelines provide key information for healthcare professionals and can promote approaches to healthcare that can mitigate negative environmental impacts, and optimise patient treatment, care delivery, and equitable outcomes, and bring awareness and legitimacy to sustainable healthcare practices. Methods: Twenty national and international clinical respiratory guidelines were purposively selected and screened for inclusion of four principles of sustainable clinical practice: prevention, patient empowerment and self-care, lean service delivery, and low carbon alternatives. A screening framework specific to respiratory care implications was developed and used to review each guideline for mention of relevant topics, recommendations, and explicit links to sustainability in relation to each principle. Findings: Sustainable clinical care principles were evident in most guidelines reviewed, environmental sustainability was mentioned infrequently. Many guidelines emphasised prevention (more secondary than primary) and support for patient preference and streamlining care, yet there was rarely mention of how these recommendations could contribute to lowering the environmental impacts of health systems. Low carbon alternatives were mentioned in only three guidelines. Conclusions: While many clinical respiratory guidelines make recommendations in accordance with the principles of prevention, patient empowerment and self-care, and lean service delivery, reducing the carbon footprint of healthcare was rarely mentioned in the guidelines. Including explicit attention to the environmental impact of clinical care in guidance could support efforts to reduce the wider harms of healthcare, meanwhile, noting the clinical benefits of sustainable approaches could promote the uptake of recommendations

Costs of elective vs emergency cholecystectomy in diabetic patients

Introduction: Hospitalization costs of diabetic patients are estimated to be higher than non-diabetic. Literature on the topic is however limited. The aim of this study was to compare the costs of elective and emergency cholecystectomy of diabetic and non-diabetic patients. Material and methods: A retrospective analysis involved diabetic versus non-diabetic age- and sex-matched patients who underwent emergency and elective cholecystectomy at a single center in Poland between 2016-2019. Results: The total costs of an elective cholecystectomy were 739.31 ± 423.07 USD for diabetic patients and 797.14 ± 772.24 USD for non-diabetic patients (p = 0.51). Whereas emergency cholecystectomy total costs were 3950.72 ± 2856.83 USD (diabetic patients) and 2464.31 ± 1718.21 USD (non-diabetic patients) (p = 0.04). The difference in total costs between elective cholecystectomy vs emergency cholecystectomy in both groups (diabetic vs non-diabetic patients) was statistically significant (p < 0.01 vs p < 0.05 respectively). Conclusions: In this study we demonstrated that emergency cholecystectomy is associated with a significant increase in hospitalization costs, particularly in diabetic patients. This suggests that early qualification of diabetic patients for an elective cholecystectomy could be beneficial for both diabetic patients and public health insurers