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Numerous studies have demonstrated the clinical benefits of using continuous glucose monitoring (CGM) systems among patients with type 1 diabetes (T1D). Aim of the study was to assess the effectiveness of CGM on metabolic control in children with T1D and well-controlled disease prior to the study.This prospective analysis included 99 children (46 girls) at the median age of 11.23 years and diabetes duration of at least 1 year (median: 5.16 years), generally well controlled metabolically (median HbA1c: 7.0%), and treated with continuous subcutaneous insulin infusion (CSII). The patients had used CGM for at least 150 days. We analysed the participants in subgroups based on baseline HbA1c 7%, ≥ 7%, age, and sex.Children with baseline HbA1c 7% were characterized by significantly increased HbA1c after the median of 273 days (217; 320) of CGM usage (6.3% vs. 6.6%, respectively; p = 0.002). No significant change in HbA1c was noted in children with baseline HbA1c ≥ 7% (7.5% vs. 7.4%, respectively; p = 0.191), but 20% of the group reached the target of HbA1c 7.0%. The analysis of CGM data revealed that no group achieved the CGM targets of good metabolic control. Total daily insulin requirements remained stable in both groups (p = 0.752; p = 0.274), but the amount of basal insulin increased statistically in both groups (p = 0.009; p ≤ 0.001).The application of CGM provides detailed information concerning glycaemic control and is beneficial in some, but not all, T1D children with good diabetes control.W wielu dotychczas przeprowadzonych badaniach wykazano liczne korzyści wynikające z zastosowania systemu ciągłego monitorowania glikemii (CGM) u dzieci chorujących na cukrzycę typu 1 (CT1). Cel pracy : Celem przeprowadzonego badania było oszacowanie wpływu zastosowania CGM na kontrolę metaboliczną CT1 u dzieci i młodzieży z dotychczas dobrze kontrolowaną chorobą.Przeprowadzono prospektywną analizę danych 99 pacjentów (46 dziewczynek) z medianą wieku 11.23 roku chorujących na CT1 co najmniej 1 rok (mediana 5.16 roku), z cukrzycą dobrze wyrównaną metabolicznie (mediana HbA1c 7%) leczonych ciągłym podskórnym wlewem insuliny za pomocą pompy. Pacjenci używali CGM przez co najmniej 150 dni. Podzielono i przeanalizowano dane uczestników zależnie od wyjściowego stężenia HbA1c 7%, ≥ 7%, wieku oraz płci.Pacjenci początkowo dobrze wyrównani metabolicznie uzyskali istotny statystycznie wzrost HbA1c po 273 dniach obserwacji (odpowiednio 6.3% vs. 6.6%; p = 0.002). Nie odnotowano istotnych statystycznie różnic dotyczących HbA1c wśród pacjentów z wyjściowym HbA1c ≥ 7% (odpowiednio 7.5% vs. 7.4%; p = 0.191), ale 20% grupy osiągnęło poziom HbA1c 7.0%. Analiza danych z CGM wykazała, iż żadna z grup nie osiągnęła celów leczenia. Całkowite dobowe zapotrzebowanie na insulinę nie uległo zmianie w obu grupach (p = 0.752; p = 0.274), ale doszło do zwiększenia ilości insuliny podawanej jako baza (p = 0.009; p ≤ 0.001).Zastosowanie CGM dostarcza szczegółowych informacji na temat kontroli glikemii i jest korzystne u wielu, lecz nie wszystkich dzieci leczonych ciągłym podskórnym wlewem insuliny za pomocą pompy, które osiągnęły dobrą kontrolę metaboliczną choroby.

Introduction Small bowel adenocarcinoma (SBA) is an unusual complication of Crohn's disease (CD). Aim To describe the incidence rate, clinical features, and outcomes of SBA in a group of subsequent patients with CD. Material and methods We retrospectively analysed outpatient and hospital records and identified a group of patients with diagnosed CD. Then we reviewed all medical records of patients who reported for follow-up visits in a 14-year period. We identified a group of 103 patients, whose medical records were evaluated for the presence of SBA. Results Long-term follow-up carried out in the group of consecutively treated patients with CD revealed an 0.97% incidence rate of SBA. Cancer was located in the ileum and the clinical presentation was subileus and anaemia. The patient underwent ileocaecal resection, and the postoperative period was uneventful. Conclusions SBA is a rare complication of CD. Although the authors are aware that the number of patients enrolled in the study is insufficient to draw far-reaching conclusions, the results obtained are significant for determination of the incidence rate of SBA in the Caucasian population of patients with CD. The key issue of effective treatment of patients with SBA was early detection of the lesion and R0 resection with proper lymphadenectomy. However, it is worth noting that in more advanced stages of SBA the future belongs to, and outcome improvement depends on, new regimes of adjuvant personalised chemotherapies. Further studies on the mechanisms of carcinogenesis in patients with CD are essential.

BACKGROUND Bullous pemphigoid (BP) is a distressing autoimmune bullous disease strongly associated with severe pruritus; however, data concerning pruritus in BP are still scarce. No clinical research evaluating the effect of BP on sleep quality has been conducted. AIM To evaluate the intensity of pruritus measured by nocturnal wrist movements (NWMs) and the sleep quality in patients with BP using actigraphy in comparison with nonpruritic healthy controls (HCs) with subsequent correlations with an itch visual analogue scale (VAS) as a subjective measure, disease severity [Bullous Pemphigoid Disease Area Index (BPDAI), urticaria/erythema, erosions/blisters] and serum total IgE level. METHODS In total, 31 patients with newly diagnosed BP (mean ± SD age 75.4 ± 12.3 years) and 40 nonpruritic HCs (age 73.5 ± 11.7 years) were recruited. All participants wore a sleep monitor (ActiSleep+) on the dominant wrist. RESULTS For patients with BP, median VAS score was 5.5 and median BPDAI was 43 (urticaria/erythema BPDAI was 16, erosions/blisters BPDAI was 29). Scratching, defined as bouts of NWMs, was significantly (P

Introduction The roles of galectin-3 (Gal-3) and galectin-3 binding protein (G3BP) in systemic lupus erythematosus (SLE) are of ongoing interest, but the data are insufficient due to highly limited available studies. There are no data on cutaneous lupus erythematosus (CLE). Aim To assess serum Gal-3 and G3BP concentrations in SLE patients with and without LE-specific skin lesions, CLE patients and to correlate levels of proteins with clinical and laboratory parameters. Material and methods The study included 71 SLE patients with and without LE-specific skin lesions, 23 CLE patients and 40 controls. Gal-3 and G3BP were measured by specific enzyme-linked immunosorbent assays (ELISA). Results Serum Gal-3 and G3BP concentrations were significantly higher in SLE with and without LE-specific lesions compared to controls, but without differences between SLE groups. Gal-3 and G3BP levels were also elevated in CLE compared to controls (p = 0.001, p = 0.005; respectively). There was a positive correlation between G3BP level and CLASI activity score both in CLE (r = 0.55, p = 0.006) and in SLE patients with LE-specific lesions (r = 0.36, p = 0.02). G3BP and Gal-3 levels did not differ in SLE with LE-specific lesions and CLE. There was a positive correlation between serum G3BP level and the SLEDAI score in SLE patients (r = 0.26, p = 0.03). Conclusions Our findings indicate that serum G3BP and Gal-3 are elevated in CLE. Additionally, G3BP might be associated with the extent of skin lesions. There are no differences between G3BP and Gal-3 concentrations in SLE with and without LE-specific skin lesions.

Background: Postprandial hyperglycemia (PPH) is common clinical problem among patients with type 1 diabetes (T1D), especially in relation to high glycemic index (h-GI) meals. The main problem are high, sharp glycemic spikes with following hypoglycemia after h-GI meal consumption. There is lack of effective and satisfactory solutions concerning insulin dose adjustment to cover the h-GI meal. The goal of this research is to find out whether a Super Bolus is an effective strategy to prevent postprandial hyperglycemia and late hypoglycemia after h-GI meal in comparison to the normal bolus.Methods: A total of 72 children aged 10-18 years with T1D for at least 1 year, treated with continuous subcutaneous insulin infusion for more than 3 months will be enrolled in a double-blind, randomized, cross-over clinical trial. Participants will receive the prandial insulin bolus for h-GI breakfast in the form of Super Bolus and as Normal Bolus another day. The primary outcome measure will be the glucose level 90 minutes after administration the prandial bolus. The secondary endpoints will refer to glucose level 30, 60, 120, 150, 180 minutes postprandially; the area under the blood glucose curve within 180 min postprandially; the peak glucose and time to peak glucose level; the glycemic rise, mean amplitude of glycemic excursion, time in postprandial glucose range and the number of hypoglycemia episodes.Discussion: There is a lack of clinical studies concerning this kind of bolus. Available literature refers only to in-silico studies and case reports. The Super Bolus was defined as a prandial insulin dose increased by 50% in comparison to the dose calculated based on individualized patient’s Insulin-Carbohydrate Ratio (ICR) and simultaneous suspension of the basal insulin for 2 hours. The comprehensive and effective solution to this frequent clinical difficulty of PPH after h-GI meals has not been found yet. The problem is known and important but the presented solution innovatory and easy to apply in every-day life.Trial registration: The trial was registered at the ClinicalTrials.gov prior to the inclusion of the first patient, 15 July 2019 on registration number: NCT04019821.

Small bowel adenocarcinoma (SBA) is a rare but increasing cause of gastrointestinal malignancy, being both a diagnostic and therapeutic challenge. The goal of treatment is margin negative resection of a lesion and local lymphadenectomy, followed by modern adjuvant chemotherapy combinations in selected cases. Improved outcomes in patients with SBA are encouraging, but elucidation of mechanisms of carcinogenesis and risk factors as well as improved treatment for this malignancy is very needed.

AIMS: Therapy with an implantable cardioverter defibrillator (ICD) is established for the prevention of sudden cardiac death (SCD) in high risk patients. We aimed to determine the effectiveness of primary prevention ICD therapy by analysing registry data from 14 centres in 11 European countries compiled between 2002 and 2014, with emphasis on outcomes in women who have been underrepresented in all trials. METHODS AND RESULTS: Retrospective data of 14 local registries of primary prevention ICD implantations between 2002 and 2014 were compiled in a central database. Predefined primary outcome measures were overall mortality and first appropriate and first inappropriate shocks. A multivariable model enforcing a common hazard ratio for sex category across the centres, but allowing for centre-specific baseline hazards and centre specific effects of other covariates, was adjusted for age, the presence of ischaemic cardiomyopathy or a CRT-D, and left ventricular ejection fraction ≤25%. Of the 5033 patients, 957 (19%) were women. During a median follow-up of 33 months (IQR 16-55 months) 129 women (13%) and 807 men (20%) died (HR 0.65; 95% CI: [0.53, 0.79], P-value

BACKGROUND Bullous pemphigoid (BP) is the most common autoimmune bullous disease associated with higher mortality and coexisting comorbidities. The strongest relationship has been reported with neurological diseases (NDs) but the particular type of ND differed depending on the study. There are some doubts on the prevalence of other comorbidities. OBJECTIVES The aim of this study was to compare the incidence of various comorbidities in a cohort of BP patients with controls. MATERIAL AND METHODS A cohort of 218 patients (137 females, 81 males, aged 76.2 ±11.6 years) with newly diagnosed BP who were hospitalized at a specialized center in Poland in the years 2000-2014 was included in this retrospective study. The controls consisted of 168 sexand age-matched individuals. Univariate and multivariate logistic regression analyses were performed to assess the association between the groups studied. RESULTS At least 1 ND was present in 33.5% of BP patients vs 11.3% of controls. A strong association between the incidence of NDs and BP was found (OR = 3.76; 95% CI = 2.13-6.65; p < 0.001), especially for dementia (20.6% vs 2.9%, OR = 7.89; 95% CI = 2.99-20.85; p < 0.001). Surprisingly, BP patients with ND were older than the BP patients without ND (79.2 vs 74.7 years), and similarly for dementia (81.08 vs 74.90 years). The same was observed in comparison with controls. Arterial hypertension, among other comorbidities, was a strong independent factor associated with BP (OR = 2.17; 95% CI = 1.35-3.49; p < 0.001). Malignancies were observed more frequently in BP patients than in controls (12.8% vs 9%) but such association was significant in univariate analysis only. CONCLUSIONS Neurological diseases, particularly dementia, had a significant association with BP. A strong relationship with arterial hypertension and weak relationship with malignancies were noted. Thus, for appropriate medical care, patients with BP need accurate screening for dementia and control of comorbidities with interdisciplinary management.

Background Bullous pemphigoid (BP) is an autoimmune blistering disease associated with preexisting comorbidities and higher mortality. The interest in using therapy other than oral steroids in BP management results from severe complications and increased risk of death. The efficacy of oral doxycycline or whole-body application of topical clobetasol has been proven in randomized controlled trials. The case series study suggested that combination of tetracycline, nicotinamide, and lesionally administered clobetasol may also be useful. Methods We conducted a clinical 3-year retrospective study of treatment with tetracycline, nicotinamide, and lesionally administered clobetasol (TNC) in comparison to prednisone (P). Out of 106 patients (mean age 78 ± 9.9 years) with newly diagnosed BP, 59 received tetracycline 1.5 g/daily, nicotinamide 1.2 g/daily, and 0.05% lesionally administered clobetasol cream, and 47 patients - prednisone 0.5 mg/kg daily. Results The median time to disease control was achieved after 7 days in both groups. At 4 weeks, 93.2% of patients treated with TNC and 89.1% from P group achieved disease control. The median period between complete remission and relapse was 60 days in the TNC group and 90 days in the P group (P = 0.84). At least one relapse within 1 year was noted in 32.1% of patients from the TNC group and 50% from the P group (P = 0.09). The 1-year survival for the TNC and P groups was 83% and 65.9%, respectively (P = 0.04), and the 3-year survival was 71.2% and 48% (P = 0.019), respectively. Conclusions Tetracycline and nicotinamide combined with lesionally administered clobetasol is an alternative, effective treatment with better survival rates compared to prednisone in BP.

Gastrointestinal stromal tumours (GISTs) are the most common mesenchymal tumours of the gastrointestinal tract, but they represent less than 3% of all gastrointestinal tract malignancies. This is a detailed case study of a 52-year-old male patient treated for very uncommon histological subtype of gastric GIST with atypical clinical presentation, asymptomatic progress and late diagnosis. The resected tumour, giant in diameters, was confirmed to represent the most rare histopathologic subtype of GISTs - sarcomatoid epithelioid GIST. We report this case and review the literature with a special focus on pathomorphological evaluation, biological aggressiveness and prognostic factors. To our knowledge this is the first report of giant GIST of very uncommon sarcomatoid epithelioid subtype. It is concluded that clinicians should pay attention to the fact that initial diagnosis may be delayed due to mildly asymptomatic and non-specific clinical presentation. Asymptomatic tumours diagnosed at a late stage, which is often the case, can be large on presentation. Prognosis for patients diagnosed with GIST depend on tumour size, mitotic rate, histopathologic subtype and tumour location. That is why early diagnosis and R0 resection, which is usually feasible and safe even in giant gastric sarcomatoid epithelioid subtype of GISTs, are the key factors for further treatment and good prognosis.

Background: Obscure gastrointestinal bleeding seems to be important problem affecting increasing group of patients. Due to its localization and mild symptoms investigation is difficult and usually requires advanced procedures. Unfortunately, it is often impossible to show precisely a source of bleeding what delays treatment and can cause severe bleeding. Methods: We describe a case report of the patient who refused surgical treatment despite proper bleeding localization by enteral capsule what caused serious bleeding few months later. Patient was operated on duty intraoperative endoscopy was necessary to perform. After treatment he left hospital in a good condition without any negative consequences. Discussion: Authors discussed investigation methods, a role of endoscopy performed intraoperatively and propose a scheme helpful during obscure bleeding investigation.