Nieinwazyjny pomiar ilości tkanki tłuszczowej trzewnej metodą ultrasonograficzną — potencjalne zastosowanie w ocenie zaawansowania subklinicznej miażdżycy u mężczyzn z niedoczynnością przysadki i niedoborem hormonu wzrostu

Introduction: Growth hormone (GH) deficiency, either isolated or combined with other pituitary hormone deficiencies, is associated with increased mortality and abnormal body composition, particularly visceral adiposity. We aimed to investigate the effects of GH deficiency with or without sex steroid deficiencies on ultrasonographic visceral fat (VF) and cardiovascular risk markers in patients with hypopituitarism on conventional hormone replacement therapy.Material and methods: Forty hypopituitarism patients (24 women, 16 men; mean age 48 ± 16.1 years) with GH deficiency and 15 age- and sex-matched healthy controls were included in this cross-sectional study. The patients were stable on conventional hormone replacement but they were not on GH therapy. Patients who had sex steroid replacement were classified as Group 1 (n = 19), and patients who did not use sex steroids were classified as Group 2 (n = 21). Anthropometric measurements were performed. VF in three regions, subcutaneous fat, and carotid intima-media thickness (CIMT) were measured. VF volume was calculated by using a formula.Results: Visceral fat volume and mean CIMT were significantly higher in patients than healthy controls (p = 0.001 and 0.019 respectively). Homocysteine and hs-CRP were higher in patients (p < 0.05). In males, VF volume and VF thickness measured between abdominal muscle and splenic vein were significantly correlated with CIMT (r = 0.54, p = 0.047 and r = 0.66, p = 0.010 respectively). Furthermore, there was a strong positive correlation between VF thickness in pararenal region and homocysteine (r = 0.74, p = 0.001) in males.Conclusions: VF volume evaluated by ultrasound can be accepted as a cause of subclinical atherosclerosis in GH deficient hypopituitary patients, particularly males.Wstęp: Niedobór hormonu wzrostu (GH, growth hormone) może występować jako zaburzenie izolowane lub współistnieć z niedoborami innych hormonów przysadki. Wszyscy pacjenci z niedoborem GH są jednak obarczeni większym ryzykiem zgonu i mają nieprawidłowy skład tkanek ciała, z tendencją do otyłości brzusznej. Celem pracy była ocena zależności pomiędzy niedoborem GH, niezależnie od ewentualnego współistnienia niedoborów hormonów płciowych a grubością tkanki tłuszczowej trzewnej (VF, visceral fat) mierzoną metodą ultrasonograficzną oraz czynnikami ryzyka sercowo-naczyniowego u pacjentów z niedoczynnością przysadki, leczonych konwencjonalnymi preparatami hormonalnymi.Materiał i metody: Badanie miało charakter przekrojowy i zakwalifikowano do niego 40 pacjentów z niedoczynnością przysadki i niedoborem GH, w tym 24 kobiety, 16 mężczyzn; średni wiek badanych wynosił 48 ± 16,1 lat. Do badania włączono też 15 osób w grupie kontrolnej, dobranych pod względem płci i wieku do osób z grupy badanej. Pacjenci w grupie badanej leczeni byli konwencjonalnie preparatami hormonalnymi, ale nie otrzymywali hormonu wzrostu. Pacjenci leczeni hormonami płciowymi zostali włączeni do grupy 1 (n = 19), a pacjenci nie otrzymujący takich preparatów do grupy 2 (n = 21). U wszystkich wykonano badania antropometryczne. Wykonywano pomiar grubości VF w trzech miejscach, badano grubość podskórnej tkanki tłuszczowej oraz grubość warstwy wewnętrznej i środkowej ściany tętnicy szyjnej (CIMT, carotid intima-media thickness). Objętość VF wyliczano według wzoru.Wyniki: U pacjentów w grupie badanej stwierdzono znamiennie większą objętość trzewnej tkanki tłuszczowej i średnią wartość CIMT w porównaniu z osobami zdrowymi (odpowiednio p = 0,001 i p = 0,019). Stężenie homocysteiny i hs-CRP były również większe w grupie badanej (p < 0,05). U mężczyzn stwierdzono istotną korelację pomiędzy objętością VF i grubością VF mierzoną pomiędzy mięśniami brzucha a żyłą śledzionową a wartością CIMT (odpowiednio r = 0,54 i p = 0,047 oraz r = 0,66 i p = 0,010). Ponadto, u mężczyzn stwierdzono wyraźną zależność pomiędzy grubością VF w okolicy nerek a stężeniem homocysteiny (r = 0,74 i p = 0,001).Wnioski: Objętość VF mierzona ultrasonograficznie może być wykładnikiem subklinicznie toczącej się miażdżycy u pacjentów z niedoborem hormonu wzrostu na skutek niedoczynności przysadki, w szczególności u mężczyzn

Wolke 7 : Bachelorthesis zum Leben in der sozialen Großwohnsiedlung Münster Brüningheide für den Entwurf einer Tiefgaragenumnutzung : 3 : [Wintersemester 2022/2023]

Diese Arbeit kann in der Bibliothek für Architektur, Design und Kunst (Leonardocampus 10) eingesehen werden

Patients´ experiences of care related to cancer pain : A litterature review

Bakgrund: Cancer är ett av de folkhälsoproblem som drabbar många människor i hela världen. På lång sikt kommer en tredjedel av Sveriges befolkning ha fått en cancerdiagnos. Cancer kan orsaka smärta, särskilt i de avancerade stadierna. Eftersom smärta är en subjektiv upplevelse spelar sjuksköterskans kunskap om smärta en viktig roll.  Bristande kunskap hos sjuksköterskan kan leda till att patientens smärta blir underbehandlad och ökar risken för att lidandet blir ännu större samt att upplevelsen av cancervården försämras Syfte: Syftet är att beskriva patienternas upplevelse av vård vid cancerrelaterad smärta Metod: En systematisk litteraturöversikt som bygger på tio granskade artiklar där artiklar med kvalitativa och mixade metoder använts. Valda artiklar analyserades utifrån Fribergs beskrivning av kvalitativ analys som bygger på fem steg  Resultat: Efter analys av datamaterialet identifierades tre teman: betydelsen av information och att dela kunskap, betydelsen av smärtlindring och alternativa behandlingsmetoder och betydelsen av närvaro, stöd och kontinuitet Sammanfattning: Sjuksköterskans kunskap är av stor betydelse när det gäller vård av personer med cancer. Sjuksköterskekunskaper relaterade till smärthanteringsstrategier har visat sig vara otillräckliga. Denna litteraturöversikt kan vara användbar för alla sjuksköterskor inom cancervården, eftersom den tar upp nödvändig kunskap som behövs i vården av personer med cancerBackground: Cancer is one of the public health diseases that afflict many people around the world. In the long run, three parts of Swedish population will be diagnosed with cancer. Cancer can cause pain, especially in the advanced stage. Pain is a subjective experience; therefore, the nurse's knowledge of pain plays an important role. Lack of knowledge among nurses can lead to patient pain being undertreated and increases risk of suffering among patients as well as giving them a bad experience of cancer health care Aim: The aim is to describe patients´ experiences of care related to cancer pain Method: A Systematic literature review based on ten reviewed articles where articles with a qualitative and mixed method were used. The selected articles were analyzed based on Friberg's description of qualitative analysis based on five steps Results: After analysis of data material, three themes were identified: the importance of information and sharing knowledge, the importance of pain relief and alternative treatment methods and the importance of presence, support, and continuity Conclusion: Nurse knowledge is of great importance when it comes to care for a person with cancer. Nursing skills related to pain management strategies have been found to be insufficient. This literature review can be useful to all nurses within cancer care because the article has addressed the needed knowledge in the care of person with cance

Patients´ experiences of care related to cancer pain : A litterature review

Bakgrund: Cancer är ett av de folkhälsoproblem som drabbar många människor i hela världen. På lång sikt kommer en tredjedel av Sveriges befolkning ha fått en cancerdiagnos. Cancer kan orsaka smärta, särskilt i de avancerade stadierna. Eftersom smärta är en subjektiv upplevelse spelar sjuksköterskans kunskap om smärta en viktig roll.  Bristande kunskap hos sjuksköterskan kan leda till att patientens smärta blir underbehandlad och ökar risken för att lidandet blir ännu större samt att upplevelsen av cancervården försämras Syfte: Syftet är att beskriva patienternas upplevelse av vård vid cancerrelaterad smärta Metod: En systematisk litteraturöversikt som bygger på tio granskade artiklar där artiklar med kvalitativa och mixade metoder använts. Valda artiklar analyserades utifrån Fribergs beskrivning av kvalitativ analys som bygger på fem steg  Resultat: Efter analys av datamaterialet identifierades tre teman: betydelsen av information och att dela kunskap, betydelsen av smärtlindring och alternativa behandlingsmetoder och betydelsen av närvaro, stöd och kontinuitet Sammanfattning: Sjuksköterskans kunskap är av stor betydelse när det gäller vård av personer med cancer. Sjuksköterskekunskaper relaterade till smärthanteringsstrategier har visat sig vara otillräckliga. Denna litteraturöversikt kan vara användbar för alla sjuksköterskor inom cancervården, eftersom den tar upp nödvändig kunskap som behövs i vården av personer med cancerBackground: Cancer is one of the public health diseases that afflict many people around the world. In the long run, three parts of Swedish population will be diagnosed with cancer. Cancer can cause pain, especially in the advanced stage. Pain is a subjective experience; therefore, the nurse's knowledge of pain plays an important role. Lack of knowledge among nurses can lead to patient pain being undertreated and increases risk of suffering among patients as well as giving them a bad experience of cancer health care Aim: The aim is to describe patients´ experiences of care related to cancer pain Method: A Systematic literature review based on ten reviewed articles where articles with a qualitative and mixed method were used. The selected articles were analyzed based on Friberg's description of qualitative analysis based on five steps Results: After analysis of data material, three themes were identified: the importance of information and sharing knowledge, the importance of pain relief and alternative treatment methods and the importance of presence, support, and continuity Conclusion: Nurse knowledge is of great importance when it comes to care for a person with cancer. Nursing skills related to pain management strategies have been found to be insufficient. This literature review can be useful to all nurses within cancer care because the article has addressed the needed knowledge in the care of person with cance

Evaluation of the common mistakes made by patients in the use of Levothyroxine

WOS: 000344951300004PubMed ID: 25240626Letter to Edito

An Overlooked Manifestation of Hypercortisolism - Cerebral Cortical Atrophy and Challenges in Identifying the Etiology of Hypercortisolism: A Report of 2 Pediatric Cases

Introduction: Endogenous Cushing’s syndrome (CS) is a rare, severe disease that can cause multiple systemic involvement and behavioral problems due to excessive cortisol production. Structural changes can be noted in the brain magnetic resonance imaging (MRI) scans of these cases. Cases: A 9-year-old girl and a 13-year-old boy were admitted with hypercortisolism. In the female patient, altered consciousness was prominent along with cerebral and cerebellar brain atrophy, and findings indicating posterior reversible encephalopathy syndrome were detected in the brain MRI. Although the male patient's neurological examination was normal, significant cerebral atrophy was seen in the brain MRI. Case 1 was diagnosed as having ectopic ACTH syndrome (EAS) due to a thymic carcinoid tumor. Case 2 underwent a pulmonary lobectomy upon detection of a bronchial lesion in the Ga-68 DOTATATE PET/CT scan while being examined for EAS due to a lack of suppression in the high-dose dexamethasone suppression test. However, hypercortisolism persisted despite the removal of the bronchial lesion, and subsequently, a diagnosis of Cushing’s disease was established following bilateral inferior petrosal sinus sampling. Discussion: Endogenous hypercortisolism may cause brain atrophy of varying severity. Central nervous system findings can be overlooked in children with CS. More comprehensive studies are needed to better understand the behavioral changes caused by the effects on the brain and to evaluate whether these changes are reversible. In addition, identifying the source of hypercortisolism can be difficult due to a lack of experience related to the rarity of the disease in children.</jats:p