Clinical similarity and diagnostic difficulties in differentiation of diabetes mellitus type 1 and type 2 in adolescence - case report

The authors would like to present the difficulties in differentiation of diabetes mellitus type 1 and type 2 in adolescence on the basis of two 17 years-old patients. In both patients' cases the following symptoms: polydipsia, polyuria and weight loss with hyperglycemia and glycosuria have been observed for a few months. During laboratory studies some additional abnormalities were observed: elevated HbA1c, dyslipidemia and high level of liver enzymes. Normal level of insulin as well as C-peptide lack of ketonuria and negative parameters of autoimmunologic reaction the supported diagnosis of diabetes mellitus type 2. Due to insulin therapy and metformin a correct level of glycemia was achieved. CONCLUSION: Decompensated diabetes mellitus type 2 in adolescents may be difficult to differentiate with type 1.     

Popular Views on Addictions and on Prospects for Recovery in Poland

Background: Popular views of addictive substances and behaviors constitute an important research topic because these views have an impact upon the functioning of treatment systems and societal responses to substance use disorders. Methods: The analysis is based on a random sample of N = 1000 telephone interviews collected in Poland in 2013. Questionnaire measures targeted such issues as the perceived risks of addictions and beliefs about potential recovery from various types of addictions. Results: First, a coherent view of the addiction potential of various addictive substances and/or behaviors emerges, distinguishing licit drugs and types of behavior from illicit drugs. Second, treatment optimism proves to be quite high independent of the type of addictive behavior, while chances of recovery without treatment are considered less likely. Third, chances for assisted change (change with treatment) and self-change are considered largely independent of perceived addiction-related risks and are not perceived as contradictory. Conclusions: The results point to the persistence of the disease model of addiction in Poland, placing responsibility for addiction on the individual and pairing it with the expectation of undergoing specialized treatment. This individualistic approach was applied as a framework for addiction problems in the 1950s to deflect from the shortcomings of the ‘‘new socialist society.’’ Neo-liberal market reform and socioeconomic changes have provided reinforcement for this individualistic framework.     

Peritoneal dialysis with solutions low in glucose degradation products is associated with improved biocompatibility profile towards peritoneal mesothelial cells.

BACKGROUND: In vitro experiments point to a better biocompatibility profile of new pH-neutral peritoneal dialysis fluids (PDFs) containing low levels of glucose degradation products (GDPs). The present study examines the impact on human peritoneal mesothelial cells (HPMCs) of equilibrated dialysates obtained during dialysis with either conventional or new PDFs. METHODS: Peritoneal dialysate was collected from 17 patients participating in a randomized, controlled, cross-over trial comparing a pH-neutral low-GDP solution (Balance) to a conventional solution (S-PDF). All patients were treated sequentially for 3 months with both PDFs. At the end of each treatment phase, peritoneal effluent was drained after a timed 10 h dwell. Samples of dialysate were then mixed with standard culture medium and added to in vitro cultures of HPMCs from healthy donors. Cells were assessed for proliferation, viability and cytokine release. RESULTS: Proliferation and viability of HPMCs were better preserved in the presence of effluent obtained during dialysis with Balance (P<0.046 and P<0.035, respectively). The proliferative response of HPMCs correlated with the concentration of fibronectin in dialysates (P = 0.0024). Effluent drained following a 3 month dialysis with Balance contained significantly increased levels of fibronectin (P = 0.004) and CA125 antigen (P = 0.0004) compared with S-PDF. There was no significant difference in constitutive and stimulated cytokine (IL-6, MCP-1, VEGF) synthesis by HPMCs treated with either Balance- or S-PDF-derived effluents. CONCLUSIONS: These results suggest that therapy with new pH-neutral low-GDP solutions contribute to an intraperitoneal milieu that improves mesothelial cell proliferation and viability. It may positively impact on the preservation of the peritoneal membrane integrity during long-term dialysis.     

Regulation of the sigmaE stress response by DegS: how the PDZ domain keeps the protease inactive in the resting state and allows integration of different OMP-derived stress signals upon folding stress

The unfolded protein response of Escherichia coli is triggered by the accumulation of unassembled outer membrane proteins (OMPs) in the cellular envelope. The PDZ-protease DegS recognizes these mislocalized OMPs and initiates a proteolytic cascade that ultimately leads to the sigmaE-driven expression of a variety of factors dealing with folding stress in the periplasm and OMP assembly. The general features of how OMPs activate the protease function of DegS have not yet been systematically addressed. Furthermore, it is unknown how the PDZ domain keeps the protease inactive in the resting state, which is of crucial importance for the functioning of the entire sigmaE stress response. Here we show in atomic detail how DegS is able to integrate the information of distinct stress signals that originate from different OMPs containing a -x-Phe C-terminal motif. A dedicated loop of the protease domain, loop L3, serves as a versatile sensor for allosteric ligands. L3 is capable of interacting differently with ligands but reorients in a conserved manner to activate DegS. Our data also indicate that the PDZ domain directly inhibits protease function in the absence of stress signals by wedging loop L3 in a conformation that ultimately disrupts the proteolytic site. Thus, the PDZ domain and loop L3 of DegS define a novel molecular switch allowing strict regulation of the sigmaE stress response system.     

Gender and the gynecological examination: women's identities in doctors' narratives

The authors explore the constructions of gender in male doctors' narratives of gynecological examinations. Focusing on the ways in which gender identities are constructed in the stories of the medical encounter, they argue, first, that gender is more flexible during the visit with a gynecologist than has been suggested. Gendered identities are assumed and put aside as the interaction progresses, with its final stage--the pelvic examination--being constructed with gender removed. Second, they argue that undressing is invested with a special status during the examination. It is a gendered rite of passage between the two different ungendered subject positions of the doctor and the patient. They conclude that contrary to the assumptions in the literature on gynecological interactions, it is the genderization of undressing that is most conducive to securing the least face-threatening gynecological examination for the woman.     

Successful extracorporeal photochemotherapy for chronic graft-versus-host disease in pediatric patients

A total of 254 extracorporeal photochemotherapy (ECP) procedures were performed in 8 children (median age 10 years; range 5-15) with extensive resistant chronic graft-versus-host disease (GVHD). ECP was carried out in the pediatric environment using a Cobe Spectra separator and UV-MATIC irradiator. A peripheral venous with a single-lumen permanent central catheter access (69% of ECP-apheresis) or a dual-lumen permanent central catheter access (26% of ECP-apheresis) were used preferentially. A median platelet decrease of 17% (0-71) (p = 0.0001) and median hemoglobin level decrease of 15 g/L (0-31)(p = 0.0001) were noted following each ECP-apheresis. However, none of the patients had profound thrombocytopenia or anemia. Two minor episodes of catheter related-bacteriemia (Staphylococcus aureus) were noted (2310 catheter-days). A negative correlation was found between lymphocyte collection efficacy (median = 38%) and pre ECP-apheresis lymphocyte count (r = 0.4, p = 0.00001). The median of 5 x 10(7) lymphocytes/kg (0.1-50.10(7)/kg) was irradiated in each procedure. All patients are alive and well, and 7/8 experienced a dramatic improvement in their cutaneous status. Liver and gut disease resolved completely in 4/6 and 5/5 patients, respectively. In all patients, a concomitant immunosuppressive therapy was stopped (5/8) or considerably reduced (3/8). Five patients with more than 2 years follow-up after discontinuation of ECP are in remission with no immunosuppression treatment. They have normal growth rates and normal school and sport activity. Our study shows that ECP is beneficial, well tolerated, and can be safely used for chronic GVHD treatment even in young children with low body weight and a poor performance status. We believe that having a dedicated pediatric environment together with an experienced, motivated, and specifically pediatric team is of crucial importance for improving patient's acceptance of this long-term therapeutic program.     

Surgical decompression of Wirsung duct reduces serum concentration of SPINK1 in patients with chronic pancreatitis

Objectives

The primary aim of this study was to determine the blood levels of SPINK1 in patients with chronic pancreatitis (CP) submitted to surgical or endoscopic decompression of pancreatic duct (PD). Additionally, we measured trypsin activity levels.

Differences in plasma gastrin,CEA, and CA 19-9 concentration in patients with proximal and distal colorectal cancer

Summary Aim. We investigated whether there are differences in plasma gastrin, as compared with carcinoembryonic antigen (CEA) and cancer antigen (CA) 19-9 between patients with proximal and distal colorectal cancer. Gastrin concentration has also been analyzed, dependent on the tumor stage, in order to evaluate the possible prognostic role of this measurement. Methods. In 50 patients with colon cancer-fasting gastrin, CA 19-9 and CEA levels were evaluated. Results. Mean plasma-gastrin level in patients with distal tumor yielded 105.31 ± 12.5 μU/L and was significantly higher than in patients with the proximal tumor site (42.2 ± 3.1 μU/L) as well as in controls (p<0.001). No significant difference was observed between mean plasma gastrin in patients with proximal tumors and the control group. The mean CEA plasma level was significantly higher (p<0.01) in patients with distal tumors (9.1 ± 1.1 ng/mL) than in those with proximal tumors (1.48 ± 0.1 ng/mL). Similarly, the mean CA 19-9 plasma level was significantly higher (p<0.01) in patients with distal tumor (19.9 ± 2.1 U/mL) than in those with proximal tumor: 1.8 ± 0.2 U/mL. The mean gastrin plasma, CA 19-9, and CEA level was significantly higher in group of Duke’s stage C and D as compared to A and B. Conclusion. We speculate that observed differences in gastrin concentration in patients with distal and proximal tumors may contribute to the distinct pathogenesis and biological properties of those cancers. The significance of gastrin as a marker for diagnostic or prognostic purposes in colorectal cancer requires further study.