A 32-year-old active cyclist was referred fo r the evaluation because of syncope he had performed in preseason.He was found to be normostenic, acyanotic, normotensive with clear lungs and a regular pulse of 60 bp m, with normal dual heart sounds and a grade Levine 2/6 continuous diastolic murmu r in the second intercostal space of the left parasternal area. He had no family history of premature card iac death and his lipids were normal. Rest ECG showed a regular sinus rhythm of 62 bp m with inco mplete right bundle branch block and no significant ST-T changes. A transthoracic ECHO in parasternal short-axis view revealed an anomalous colour flow jet in diastole arising fro m the lateral wall into the main pulmonary artery and coronary artery fistula with non-significant left -to-right shunt (Qp/Qs ratio 1.2).came under suspicion. In contrast, it has not been confirmed clearly by the transoesophageal ECHO. Coronary angiography was without coronary stenosis and confirmed a 'serpentine' anomalous drainage supposedly from left anterior descending artery to the main pulmonary artery. A complex anato my of sacculary dilated fistula that originates fro m the pro ximal left anterio r descending artery and drainages the main pulmonary artery was showed in detail by a 64 slice MDCT scanning. Myocardial Tc-99m Myoview perfusion SPECT imag ing showed no perfusion defects in maximal physical stress and follo w-up without intervention was suggested. In addition, due to the results of holter ECG monitoring, head-up tilt testing, carotid sinus massage and programmed atrial stimulat ion syncope was concluded as vasovagal, but its nature still remains discussible. After a three year follow-up patient remains asympto matic and recently performed control myocardial perfusion SPECT showed no signs of stress related myocardial ischemia. In conclusion, several imaging techniques are needed for an accurate diagnosis of coronary fistula and for the suggestion of proper further management. In some cases syncope may be the first man ifestation of CAF, but it is still unclear if it is directly related to the coronary anomaly.

Objective: Period of elderly age preordains the occurrence of many health issues. People deported during World War II to concentration camps suffered from malnutrition, lack of sleep, physical and mental exhaustion. Recently, the health condition of Holocaust survivors is often complicated as a result of physical punishments and different torture methods as well as mental hardships which they had suffered during deportation. The consequences often have psychosomatic nature thus the survivors are often receivers of health care. The topic of bibliography review is based on the need to objectivize and systematically evaluate subjective health issues of Holocaust survivors in connection with trauma related to the stay in a concentration camp. The aim is to offer a review of effects of the Holocaust on health of different body systems for survivors in concentration camps and Jewish ghettos in the course of World War II.Methods: To map the subjective problems of Holocaust survivors, evidence-based medicine (EBM) method has been used with the help of scientific database PubMed, CINAHL Plus with full text, ProQuest and other sources with specific key words and Boole operators. Prognostic type of clinical/review questions has been selected for the bibliography review, which is trying to predict the probability of relation or output of illness/ condition and based on diseases or symptoms seriousness to find out expectancy for treatment/improvement of care.Results: 175 studies have been found in basic search with the use of key words both in English and in Czech language. The search has not been time-limited. The advanced search has focused on different body systems and health damage due to Nazi experiments. Fourteen studies have been used to complete the study. The research results have confirmed the significant effect of Holocaust trauma on body condition of the survivors. The reasons of this condition were insufficient nutrition, unsuitable and harmful hygienic, living and working conditions and brutality of the guards. According to the research, these factors have impacted all organ systems, mainly locomotion and cardiovascular ones. The results have shown a more frequent occurrence of osteoporosis, fractures of long bones and corresponding chronical pain of people of Jewish origin who had gone through different forms of torture during World War II. Other present symptoms include gastrointestinal problems, tumors mainly in the area of colorectum and lungs. Moreover, the stay in concentration camps had influence on women's menstrual cycle. Conclusion:The studies of Holocaust effects are an example of the influence of an extreme mental and physical burden on the body condition of the survivors' health. The results of the studies have shown a wide range of the effects also in mental and social areas.

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Authors' contribution Wkład autorów: A. Study design/planning zaplanowanie badań B. Data collection/entry zebranie danych C. Data analysis/statistics dane-analiza i statystyki D. Data interpretation interpretacja danych E. Preparation of manuscript przygotowanie artykułu F. literature analysis/search wyszukiwanie i analiza literatury G. Funds collection zebranie funduszy Summary Background. Education of diabetic patients is integral to effective treatment. Material and methods. In the presented work, we studied Eastern Slovakian patients with diabetes type 2 with or without insulin treatment. We focused on their diabetic self-care and compared their attitudes, education on their disease, and treatment provided by professionals. There were 411 patients in the insulin-treated group. We used the standardized Diabetes Care Profile questionnaire (DCP). Results. The groups had very different attitudes toward diabetic self-care. Patients with provided professional self-care education scored higher in all areas of diabetic care. Appropriate education influenced knowledge and consequently the management and attitudes of diabetic patients toward their disease. Educated patients scored higher in the categories 'Self-care ability', 'Importance of care', 'Self-care adherence', 'Diet adherence', 'Medical barriers', 'Exercise barriers', 'Monitoring barriers' and 'Understanding practice' (p < 0.01). Patients who had not received diabetes education presented higher scores in emotional areas, i.e., negative and positive attitudes toward diabetes mellitus (p < 0.01). Conclusions. We concluded that it is beneficial for a structured educational process to be integrated in diabetes treatment.

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Introduction: Data confirm a relatively high prevalence of silent myocardial ischemia (SMI) in elderly patients with type 2 diabetes mellitus (T2DM), while no data are available regarding working-age subjects (≤60 years). Methods: Medical records of 192 patients with T2DM aged ≤60 years (110 male patients; 57.3%), who had undergone myocardial perfusion imaging (MPI) between 2010 and 2014 followed by coronary angiography in case of abnormal result, were retrospectively analysed. Results: MPI was positive in 35 patients (18.2%); of those 31 (88.6%) had angiographically confirmed coronary stenosis. The positive predictive value of the MPI for predicting angiographic coronary stenosis in this age subgroup was 88.9%. Univariate analysis revealed post-stress LVEF drop ≥5% (p<0.03) and NT-proBNP levels detected in stress (p<0.05) to be associated with greater risk of ischemia in workingage T2DM patients. In multivariate analysis, LVEF drop ≥5% (p< 0.03) remained an independent predictor of SMI. Conclusion: Prevalence of SMI in diabetic working-age patients was similar to that observed in studies of subjects over 65 years-old. Poststress LVEF drop ≥5% and NT-proBNP levels can contribute to more precise identification of SMI. Our data suggest that "aggressive" management strategy should be implemented to reduce the risk of cardiac events in T2DM patients of working-age.

Early detection of silent myocardial ischemia (SMI) in asymptomatic middle-aged patients (pts) with type 2 diabetes mellitus (T2DM) may be important due to the generally poor prognosis and early myocardial involvement in this specific subgroup of diabetic population. Our goal was to evaluate whether subclinical left ventricular (LV) systolic dysfunction assessed by two-dimensional speckle-tracking echocardiography (2D-STE) is independently related to SMI detected by MPI (gated SPECT myocardial scintigraphy) and if it could provide incremental information over baseline characteristics to identify it. We have tested the hypothesis that the myocardial mechanics significantly differ in asymptomatic middle-aged diabetics, depending on the presence or absence of SMI. In total, 60 consecutive middle-aged (&lt;60 years; 42 males, 70.0%) asymptomatic T2DM pts were enrolled into the study. MPI was performed in one-day protocol according to the EANM procedural guidelines, and SMI was diagnosed consensually by two experts as myocardial perfusion abnormalities without associated symptoms. The T2DM pts were subdivided into two groups according to the results of MPI, namely SMI group (n = 11) and non-SMI group (n= 49) Global longitudinal peak systolic strain (GLPSS) was measured from two- and four-chamber views cines using Automated Function Imaging (Vivid S6, GE). Subclinical LV dysfunction was defined as GLPSS of &gt; -20%. Prevalence of SMI in T2DM pts was 18,3%. All pts in SMI group (n = 11) were of male gender, and disease duration ≥ 5 years. Pooled data from 2D-STE showed significant reduction in mean absolute GLPSS values (p&lt;.001). Further more, pts in SMI group had more impaired GLPSS when compared with patients in non-SMI group (-16.1 ± 1.5% vs. -20.4 ± 1.8%, P &lt; .01). At multivariate analysis, male gender, an amount of epicardial adipose tissue and erectile dysfunction in men were independently associated with SMI. The addition of the LV GLPSS values to other selected independent clinical variables significantly improved the ability to predict SMI in these patients (χ(2) = 48.62; P = .001). Asymptomatic middle-aged T2DM pts with SMI showed a more impaired LV GLPSS compared with patients without silent ischemia. The presence of subclinical LV systolic dysfunction provides significant incremental value for the identification of SMI in asymptomatic middle-aged diabetics.

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