Habitual constipation in children as a challenge in the physiotherapist’s practice

Stool constipation, according to the opinion of GPs, pediatrics and pediatric gastroenterology specialists, is one of the most common ailments among the youngest patients. The incidence of constipation varies and depends on many factors, mainly environmental, sociological and economic ones. It also depends on the gender and age of the child. It is estimated that up to 10% of the developmental age population suffers from chronic constipation. The above-mentioned ailment is most common in children from 2 to 4 years old and is slightly more common in boys than in girls. In 90–95% of cases, constipation develops on an idiopathic functional basis [1-4]. Habitual constipation in children is a very serious clinical problem because it prevents the patient from proper functioning, and thus contributes to a reduction in life quality and lowers self-esteem. In the international literature, issues related to physiotherapeutic treatment of habitual constipation appear quite rarely. Nowadays, there has been a significant increase in the interest in improving the quality of life in the youngest patients. An attempt to treat functional constipation in children should be made at the level of primary care, including comprehensive treatment and physiotherapy

Patient adherence to and tolerability of treatment with metformin extended-release formulation in patients with type 2 diabetes. GLUCOMP study

Introduction. Appropriate treatment of diabetes requires regular intake of recommended drugs. Multifactorial therapy, which necessitates the concomitant use of many medications, may decrease patient adherence. The purpose of the study was to assess type 2 diabetic patients’ adherence to and tolerability of metformin extended-release formulation in the outpatient setting. Materials and methods. This non-interventional study was conducted in a group of 4737 patients [including 2468 (52%) women] with mean age of 60.6 ± 9.4 years, diabetes duration of 5.6 ± 4.4 years, duration of treatment with metformin extended release formulation of 8.3 ± 12 months at an average dose of 1667 ± 350 mg. The study enrolled patients aged over 18 years with type 2 diabetes if they were treated with metformin extended- release formulation at a dose of 1500–2000 mg for less than 1 year prior to the study enrollment. The exclusion criteria included: pregnancy, breast-feeding and any contraindications for metformin treatment. Treatment adherence was assessed by a tablet count (percentage of prescribed tablets taken) and using the Morisky-Green scale. Treatment adherence was defined as follows: excellent patient adherence if > 90% of prescribed tablets were taken; good: 76–90%; moderate: 51–75%; poor: ≤ 50%. Treatment tolerability was also evaluated based on the medical history focused on gastrointestinal symptoms, as well as patient preference for using specific types of metformin. Other patient data, clinical data and laboratory test results were recorded at the beginning of the study and after 3 months. Results. After 3 months of treatment with metformin extended release formulation 96% of study subjects demonstrated excellent or good adherence. Treatment adherence was significantly lower with 2 or 3 concomitant medications as compared to one (p < 0.001). Adverse events occurred in 715 patients (15% out of 4758 patients undergoing safety analysis). The occurrence of adverse events significantly decreased treatment adherence (p < 0.001). Approximately 90% of patients declared they had preferred the use of metformin extended-release formulation. Conclusions. Metformin extended-release formulation is a suitable, well tolerated therapeutic option which helps to obtain good patient cooperation based on good adherence.

Okiem konsultanta krajowego

Czasopismo Diabetologia Kliniczna debiutuje właśnie w nowej formie po połączeniu dwóch wydawanych wcześniej pozycji. To dobry moment, aby podzielić się z Czytelnikami swoimi refleksjami na temat diabetologii z pozycji konsultanta krajowego. Chciałbym podzielić się z Państwem najistotniejszymi problemami, które w moim odczuciu nurtują polską diabetologię

Selection of proper footwear for people with diabetes and its complications

Diabetes, which commonly occurs in society, often contributes to the development of adverse complications in the form of micro and macroangiopathy and neuropathy. Irregularities within these structures are the causes of development of diabetic foot syndrome. The prophylaxis plays a very important role in case of people with diabetes. It is recommended to choose the right, individually designed footwear that will prevent the formation of wounds on the feet. In the period of prevention, hygiene and foot control also play an important role in preventing the development of calluses or the formation of cuts. Among people suffering from diabetes, wounds tend to be difficult to heal, therefore, if the wounds occur, comprehensive treatment should be undertaken. In addition to the standard methods of wound supply, it is necessary to unload this body part. It is recommended to wear unloading footwear or insoles that are specially designed for the patient's needs. Computer foot diagnostics is helpful in choosing the right footwear, it assesses the distribution of foot pressure on the ground while walking (dynamic test) and standing (static test)

The role of proprioceptive system in the rehabilitation of patients after Achilles tendon reconstruction

Achilles tendon injury is a major clinical problem because it prevents proper functioning of the patient. The recommended procedure in the event of tendon rupture is surgical treatment - reconstruction of tendon reconstruction. The aim of surgical treatment of Achilles tendon rupture is to bring back its function by restoring the correct length and tension of the tendon and to obtain the highest possible functional state of the patient. The selection of the optimal post-operative rehabilitation programme with a predominance of functional physiotherapy elements is an essential part of the treatment of Achilles tendon rupture. A proper rehabilitation after the surgery enables the patient to achieve better functional results. During the surgery proprioceptors are damaged, that is why the treatment working on three levels of motor control should be introduced as fast as possible, such as kinesthetic or proprioceptive training

Different forms movement therapy used in rehabilitation of Parkinson's disease

The causes of Parkinson's disease have not yet been strictly defined, which is why it is a serious social problem nowadays. The problem stems mainly from the fact that pharmacological methods have not been developed to such an extent to completely cure the disease. Due to the application of those methods, it is primarily expected to cause the delay in the development of disease symptoms. An important role in the reduction of progressive disease symptoms is performed by non-pharmacological forms of rehabilitation. In addition to standard kinesitherapy, the following are of great therapeutic importance: choreotherapy, music therapy, massage, physical therapy, and balneotherapy. The use of these methods positively affects the general state of physical fitness of the patient, moreover, it contributes to the delay in the development of characteristic symptoms of Parkinson's disease such as muscle stiffness, tremor, and slowness of movement. The variety of implemented interventions not only improves the patient's functional status but also contributes to the increase of self-esteem and psychological well-being

Analysis of the changes in the circumferences and the range of active motion of upper limbs in women after mastectomy participating in rehabilitation

Nipple cancer is the most frequent women's neoplastic disease. In Poland, it is approximately 20% of malignant detected neoplasm among this group. Breast cancer is not only one of the most serious women's numerous prevalence diseases; it is also a common reason of anxiety among healthy ones. Supplementary to basic treatment of breast cancer (radiotherapy and surgery) is early and constant rehabilitation program for women after mastectomy. The aim of the study was to valuate alternations within volumes of the upper limb followed by mastectomy and their accurate analysis regarding movement range in the course of therapeutic rehabilitation. 30 women who were after breast cancer dislodging participated in the study.. The patients were treated with therapeutic rehabilitation which lasted for 6 weeks. Before and after the therapy, the women were examined. In conclusion it was found that complex rehabilitation in women, who had mastectomy, has a crucial influence on increasing movement range and reduction of lymphedema regarding the limb on the operated side

Empagliflozin. Results of the EMPA-REG OUTCOME trial. A breakthrough in treatment of type 2 diabetes?

Cardiovascular (CV) complications are the main health challenge among type 2 diabetic patients. They may cause premature death, disability and reduce the quality of life. Administering a multifactorial intervention aimed at controlling glycaemia, lipaemia and arterial blood pressure allows to reduce the risk of their occurrence. FDA ruled that all newly introduced hypoglycaemic agents must undergo tests for CV safety. The EMPAREG OUTCOME trial was conducted on a group of type 2 diabetic patients at high CV risk. It showed that including empagliflozin in the standard therapy reduces the risk of primary outcome (death from CV causes, non-fatal myocardial infarction or non-fatal stroke) by 14% and all-cause mortality by 32%. The causes of this effect of empagliflozin — an inhibitor of SGLT2, which is an enzyme present only in renal proximal tubules — are unclear. Reduction in insulin resistance and in oxidative stress, changes in lipid levels, reduction in uric acid levels, in albuminuria, in blood pressure and reduction in sympathetic activity are all named as potential mechanisms underlying the  rotective effect of empagliflozin. Results of the EMPA-REG OUTCOME trial are a breakthrough in the treatment of diabetes, and if other SGLT2 inhibitors are found to have similar effects, a fundamental change in therapy recommendations for this patient population may be made

Physiotherapeutic management in the separation of the white borderline

Dissolution of the white border of the rectus abdominal muscle is a disruption of the functioning of the rectus muscle, which results in loosening of the white border. As a result, a characteristic muscle stretch is visible. This defect affects a significant number of pregnant women and is not just an aesthetic problem. There are many factors that contribute to the above-mentioned ailments. To get the best treatment results, it is important to diagnose the problem early. For this purpose, special tests are used. The ease with which they are made enables the patient to control the separation of the frontier by the patient. The implementation of therapy should take place already in the first days after delivery. It is important to start therapy with posture corrective exercises, breathing exercises and learning how to properly perform everyday activities. Then we implement exercises that involve the abdominal muscles. The exercise program can be supplemented with dynamic slicing. A holistic approach to the problem and combining different forms of therapy allows you to obtain optimal results