Przegla̧d lekarski
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The significant increase in the prevalence of obesity in children and adolescents over past decades caused the concomitant rise in the incidence of glucose intolerance and diabetes. Impaired glucose tolerance is present in 10-27% of obese children, while type 2 diabetes accounts for more than 10% of all cases of diabetes in Caucasian adolescents. ⋯ This article presented the influence of obesity on the development and clinical presentation of different types of diabetes and addresses the problems of differential diagnosis of diabetes type in obese children and adolescents. The recommendations for case finding and the treatment options taking into account the pathophysiology underlying hyperglycemia were discussed.
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Clinical and experimental studies indicate that either active or passive cigarette smoke exposure promotes vasomotor dysfunction, atherogenesis, and thrombosis in multiple vascular beds. Although the precise mechanisms responsible remain undetermined, free radical-mediated oxidative stress appears to play a central role in cigarette smoking mediated athero-thrombotic diseases. ⋯ Furthermore, potentiated by multiple prothrombotic and antifibrynolytic effects, intravascular thrombosis is the predominant cause of acute cardiovascular events. Epidemiologic, clinical, and experimental data also suggest that the pathophysiologic effects of cigarette smoke exposure on cardiovascular function may be nonlinear.
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Various pharmacological approaches can be used to improve glucose homeostasis. These pharmacological treatments may be used individually for certain types of patients, or may be combined to provide a more ideal glycaemic control. Metformin is widely used in pediatric patients and is considered to be the most effective oral agent. ⋯ The first oral agent used should be metformin. More severe pancreatic beta-cell dysfunction in the group of children requires insulin therapy. Some forms of monogenic diabetes can be successfully managed by sulphonylurea agents.
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Transoesophageal echocardiography is an effective tool in visualisation of intrathoracic aorta. It is highly sensitive in diagnosis of aneurysms, atheromas, posttraumatic ruptures, abnormalities of aortic valve, and complications of bacterial endocarditis. It is superior to other methods in diagnosis of aortic dissection. ⋯ TEE is especially helpful in patients undergoing cardiac operations. It makes possible the detection of atheromatosis and assessment of plaque morphology in thoracic aorta. In cases with high risk of peripheral embolisation the surgical strategy is changed.
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The article presents the clinical picture of delirium characterized with acute, fluctuating altered levels of consciousness, inattention and cognitive function disorders. The article is comprised the most popular assessment scales for detecting (CAM - Confusion Assessment Method) and monitoring the course of delirium (DRS-R-98: Delirium Rating Scale-Revised-98; DOM: Delirium-O-Meter). ⋯ Categories of recommendation of possible therapeutic intervention are presented with special emphasis being put on interventions that are always beneficial, useful, successful and safe. Moreover, recommendable pharmacological treatment methods (haloperidol, new antipsychotic drugs) as well as non-pharmacological ones (comprising routine screening of cognitive functions, comprehensive medical and nursing care) are described.