Numerous concerns about menopause exist among women, and fear of an increase in body weight is one of the most important of them. This paper presents an overview of current knowledge concerning the etiology of obesity related to menopause and about the mechanisms of its development, with particular regard to the hormonal changes that occur during this period of life. The role of estrogens in the regulation of energy balance and the effect of sex hormones on metabolism of adipose tissue and other organs are presented. The consequence of the sharp decline in the secretion of estrogens with subsequent relative hyperandrogenemia is briefly discussed. The main intention of this review is to clarify what is inevitable and what perhaps results from negligence and unhealthy lifestyles. In the last part of the paper the possibilities of counteracting the progress of adverse changes in body composition, by promoting beneficial lifestyle modifications and the use of hormonal substitution treatment, in cases where it is reasonable and possible, are described.
Hyperthyroidism affects approximately 1.2% of the population and its routine treatment includes antithyroid drugs (ATDs), radioiodine and surgery. Management of patients with resistance or contraindications to ATDs who require thyroidectomy may be challenging. We present the experience of our department in preparing thyrotoxic patients for life‐saving thyroidectomy by using therapeutic plasma exchange (TPE) with albumin: one patient with Graves' disease and previous history of agranulocytosis and cholestatic jaundice after ATDs and two patients with amiodarone‐induced thyrotoxicosis. Five to six TPEs were applied to each patient resulting in a decrease of fT3 by 57% to 83%, fT4 by 21% to 60% and decrease/normalization of total thyroid hormones. All patients underwent surgery successfully. In case of drug‐resistant thyrotoxicosis or contraindications to ATDs, TPE can be a valuable tool in preparing patients for surgery. Albumin used as a replacement fluid appears to be effective in ameliorating clinical and laboratory symptoms of thyrotoxicosis.
Introduction:There is an increasing number of adrenal tumours discovered incidentally during imaging examinations performed for many different indications. Based on imaging results, it is possible to differentiate benign from malignant adrenal masses, although there is still a number of equivocal imaging findings. Our study presents 77 cases of adrenal tumours in which imaging was inconclusive and the final diagnosis was stated only after surgery and histopathological examination. Material and methods:Retrospective data analysis: 77 cases of indeterminate adrenal tumours with a presumptive diagnosis of "nonadenoma" in patients operated within a 16-year period (2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015)(2016)(2017)(2018)(2019). None of the patients had a history of malignancy, and all tumours were hormonally inactive. On contrast-enhanced CT, the native density of all tumours was higher than 10 Hounsfield Units (HU), and the absolute percentage washout (APW) and relative percentage washout (RPW) were lower than 60% and 40%, respectively. Results:The most common findings were adrenal adenoma (25.9%), macronodular adrenal hyperplasia (16.9%), ganglioneuroma (15.6%), and haemorrhage with posthaemorrhagic changes (13%). In total, there were 12 various histopathological diagnoses in this group. There were only 2 (2.6%) malignant (adrenal cancer and leiomyosarcoma) and 3 (3.9%) potentially malignant (pheochromocytoma) lesions in this group. Conclusions:It is often impossible to make a correct diagnosis in a clinical setting until it is histologically verified. "Nonadenoma" adrenal tumours constitute a heterogeneous group including very rare pathologies. The risk of malignancy in indeterminate adrenal tumours is relatively low.
Introduction: Observational studies indicate a significant impact of serum 25(OH)D concentration on incidence of hospital-acquired infections. However, we did not find any interventional study assessing the effect of vitamin D3 administration at the admission on the course of further hospitalization in internal medicine departments. Objective of the paper: Investigation of the impact of one-time high-dose vitamin D3 administration in elderly patients on the day of urgent admission to the hospital, on hospital-acquired infections. Materials and methods: A randomized, two-arms, open pilot study in 97 adults aged 60-100. A study group was given a single dose of 60,000 IU vitamin D3 and a control group was not subject to any intervention. Serum 25(OH)D and calcium were measured at the baseline and after 7 days. Results: 77.32% of studied patients were vitamin deficient, and among those, in 28.87% severe vitamin D deficiency was found. After single administration of 60,000 IU of vitamin D3, only 4 patients achieved recommended serum 25(OH)D concentration. The highest increase in serum 25(OH)D was observed in patients with severe deficiency. Numbers of observed nosocomial infections such as flu, hospital-acquired pneumonia or Klebsiella pneumoniae MBL+ infection did not differ significantly between study and control group, however there was a trend close to significance for lower incidence of Clostridium difficile infection in the vitamin D3 group. Conclusions: Preliminary results of the presented research indicate possible protective effect of single high dose of vitamin D3 against Clostridium difficile infection during hospitalization. Further research on larger group of patients, using higher dose of vitamin D3 is necessary.
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Objectives: Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) and tumor necrosis factor (TNF) blocking agents have been widely used in the treatment of SpA. Recent evidence has shown anti-TNF therapies may induce hepatic injury. Interleukin inhibitors, a newer drug class with potentially lower side effects, have recently been approved for use. We aim to assess the risk of treatment-related liver injury among patients with SpA utilizing real-world data. Methods: A retrospective, claims-based observational study was conducted in a multi-state health system from 2010 to 2017. SpA patients were identified by diagnosis codes and proposed treatment agents, including NSAIDs, anti-TNF agents, and interleukin inhibitors. The primary outcome was 12-month incidence of liver injury after each treatment. Liver injury was evaluated as abnormal liver function test lab values. Results: The majority of patients (98.9%, n=16,348) received NSAIDs only for first-line treatment. Of those, 1.6% (n=259) changed from NSAIDs to second-line monotherapy treatment with anti-TNF agents (n=249) or interleukin inhibitors (n=6), or polytherapy with at least 2 anti-TNFs 6 NSAIDs or anti-TNF + interleukin 6 NSAIDs (n=4). Before the second-line treatment, liver injury rate at first-line was 8.5% (22/259),serving as a benchmark. Patients receiving anti-TNF agents as second-line treatment had a similar incidence of liver injury compared to the benchmark (9.2% vs 8.5%, p=0.768). Patients receiving interleukin inhibitors as second-line treatment did not have any liver injuries incidence, however no statistical significance was found due to the small sample size (0% vs 8.5%, p=1.000). Additionally, patients receiving a polytherapy had a higher incidence of liver injury (50.0% vs 8.5%, p=0.043), and the incidence remained high (33.3%) in clinical perspective after excluding those pre-existing liver injuries at firstline. Conclusions: Treatment with a polytherapy of TNFs and/or interleukin inhibitors might increase the risk of liver injury. Further studies with larger sample sizes are needed to validate these findings.
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