Co-occurrence of depression and chronic diseases

INTRODUCTION Depression is a common and serious mood disorder mainly manifested by sadness, anhedonia, lack of hope and interest in activities once enjoyed. According to WHO depression is a leading cause of disability and inability to work worldwide. Chronic disease is every condition lasting more than 1 year and requiring medical attention. The aim of this article is to show challenges of depression and chronic diseases coexistence. DISCUSSION Depression might be a factor causing difficulties in diagnosing chronic diseases as patients are less likely to cooperate. On the other it might lead to worse compliance and higher risk of chronic diseases’ development. Studies show depression coexisting with chronic illnesses is a valid problem for public health and aggravates the course and effects of treatment of those conditions. Treating an underlying disease is as important as treating depression itself as it might lead to reduction in symptoms of depression. Moreover doctors should choose drugs having regard to depression as well as lingering conditions. SUMMARY Depression still seems to be diminished and ignored in patients with chronic illnesses even though it is proved to have a destructive influence on the health of patients. It is of high importance to raise an awareness of doctors on that subject and its scale.  There are plenty of treatment methods for depression in case of chronic diseases co-occurence which gives hope for improving a quality of life of patients and achieving better effects of therapy of an underlying disease

Celiac disease and non-celiac gluten sensitivity – characteristics and differences

Introduction Celiac disease is a quite common condition resulting from the interaction of genetic, immunological, and environmental factors, with the main environmental factor being exposure to gluten. Non-celiac gluten sensitivity (NCGS) affects individuals without celiac disease or wheat allergy and is characterized by intestinal and extraintestinal symptoms related to the consumption of grain products, without accompanying damage to the intestinal mucosa. Discussion Gluten is a grain protein that is resistant to digestive enzymes and accumulates in the intestines, leading to tissue damage and the release of tissue transglutaminase 2 (tTG2) enzyme, which increases gluten immunogenicity. The presence of HLA-DQ2 or HLA-DQ8 gene variants in the genome is a necessary condition for the development of the disease, but it does not always lead to celiac disease. The pathomechanism of non-celiac gluten sensitivity is not yet fully understood. Diagnosis of celiac disease involves serological tests, genetic tests, and histological examination. Conclusions The only effective treatment for celiac disease is a strict gluten-free diet, which involves eliminating wheat, rye, barley, and triticale from one's diet. Further research is necessary to search for effective therapies. The approach for NCGS involves introducing an appropriate diet - either low FODMAP or gluten-free

Irritable bowel syndrome – modern ways of treatment

Introduction Irritable bowel syndrome (IBS) is the most frequent functional disorder of the gastrointestinal tract.  Main symptoms are recurring stomach ache connected with defecation, changes of frequency of defecation and/or stool’s consistency. Cause of IBS is still unknown unlike its pathomechanism. Continuous research allows doctors to understand and treat it better. Discussion Diagnosing IBS might be difficult even for the most experienced doctors due to its uncharacteristic symptoms. Therefore diagnosis should be made by using Rome IV Criteria. IBS is divided into 4 subtypes  basing on clinical picture: IBS with predominant constipation, IBS with predominant diarrhea, IBS with mixed bowel habits and IBS unclassified. Classification is being performed with the use of Bristol Stool Chart. Choice of remedy should be made depending on the subtype of IBS. Pharmacological treatment is symptomatic and focuses on relieving pain, diarrhea, constipation and bloating. Drugs that can be used are: loperamide, rifaximin, antispasmodic (e.g. hyoscine), antidepressants or laxatives. Treatment should also contain nonpharmacological methods. Nonpharmacological techniques which are proved to help patients contain regular physical activity, body mass reduction, low-FODMAP diet, using probiotics, psychotherapy and supplementing soluble fibre. Conclusions IBS is a big issue for public health as it is lowering quality of life and is generating big indirect costs. Difficulties in diagnosing are increasing those costs. That’s why it is of high importance to find more effective therapy. Raising awareness among doctors is crucial as plenty of methods are available to treat the disease which allows to reduce symptoms and costs

Emergency Endovascular Interventions on Descending Thoracic Aorta: A Single-Center Experience

Background. Implementation of emergency endovascular aortic repair provides an attractive opportunity in the treatment of complicated acute aortic syndromes involving descending aorta. Aim. The aim of this study was to analyze the effectiveness of thoracic endovascular aortic repair (TEVAR) for the treatment of acute surgical emergencies involving the descending thoracic aorta. Methods. A retrospective review of the medical records of all patients undergoing TEVAR in a single center since 2007 was undertaken. Patients with the aortic disease treated on emergency inclusion criteria were complicated spontaneous acute aortic syndrome (csAAS), traumatic aortic acute injuries (TAIs), and other indications requiring emergent intervention. Technical and clinical success with patient mortality, survival, and reoperation rate was evaluated according to Society for Vascular Surgery reporting standards for thoracic endovascular aortic repair (TEVAR). Results The emergency interventions were necessary in 74 cases (51.0%), including patients with the complicated spontaneous acute aortic syndrome (csAAS) (64.8%; n = 48) and traumatic aortic acute injuries (TAIs) (31.1%). In addition, in one case aortic iatrogenic dissection (AID) and in 2 other fistulas after the previous stent graft, implantations were diagnosed. All procedures were done through surgically exposed femoral arteries while 2 hybrid procedures required additional approaches. The primary technical success rate was 95.9%, in 3 cases endoleak was reported. The primary clinical success occurred in 94.5%. All patients survived the endovascular interventions, whereas during in-hospital stay one of them died due to multiorgan failure (early mortality 1.3%). During the follow-up period, lasting 6 through 164 months (median 67), 11 patients died. Annual, five- and ten-year probability of survival was 86.4 ± 0.04%, 80.0 ± 0.05%, and 76.6 ± 0.06%, respectively. However, the rate of 5-year survivors was significantly higher after TAI (95.2%) than scAAS (63.4%) (p=0.008). Early after the procedure, one individual developed transient paraparesis (1.3%). No other serious stent-graft-related adverse events were noted within the postdischarge follow-up period. Conclusions. Descending aortic pathologies requiring emergent interventions can be treated by endovascular techniques with optimal results and low morbidity and mortality in an experienced and dedicated team