There is a close relationship between melatonin as a circadian regulator and insulin, glucagon and somatostatin production. This study aimed to describe subgroups of type 2 diabetes mellitus (T2DM) patients that may benefit from melatonin clock-targeting properties. The study involved 38 participants: 26 T2DM patients, and 12 participants without diabetes in the control group. Subjects were asked to complete the questionnaire of Pittsburgh Sleep Quality Index (PSQI). Standard biochemical venous sample testing was performed, and a sample of saliva was collected for melatonin testing. Melatonin concentration in participants without obesity (body mass index (BMI) < 30 kg/m2) was significantly higher than in obese participants: 13.2 (6.4; 23.50) pg/ml vs 5.9 (0.78; 13.1) pg/ml, p = 0.035. Subjects with BMI 30 kg/m2 had a significantly higher PSQI score than non-obese subjects: 7 (4.5; 10) vs 5.5 (3; 7), p = 0.043. T2DM patients showed significantly lower levels of melatonin than the control group: 6.1 (0.78; 12.2) pg/ml vs 17.8 (8.2; 25.5) pg/ml, p = 0.003. T2DM patients using short-acting insulin analogues showed a significantly higher PSQI score than patients not using insulin: 9 (6; 10) vs 6 (3; 8), respectively (p = 0.025). Poor sleep quality was more prevalent in patients with diabetic retinopathy than in those without this complication (p = 0.031). Lower melatonin levels were detected in T2DM and obese patients. Furthermore, poor sleep quality was observed in T2DM patients using short-acting insulin analogues and those with diabetic retinopathy, and obese individuals.

For many years, there has been a concern that inflammatory bowel disease carries an increased lymphoma risk. At the same time, patients with intestinal lymphomas are occasionally misdiag-nosed as having Crohn’s disease. We report a case of T-cell lymphoma of the bowel misdiag-nosed as Crohn’s disease, which illustrates the diagnostic challenges posed by peripheral extranodal lymphomas. A 68-year old female presented with clinical symptoms (diarrhoea, abdominal pain, poor appetite and significant weight loss), and colonoscopic and initial histological findings that were similar to inflammatory bowel disease. She was diagnosed with Crohn’s disease and received treatment with sulfasalazine with subsequent improvement of symptoms. Eight months after the initial diagnosis the patient experienced sudden abdominal pain. Laparotomy revealed necrosis in the small and large intestine and ileostomy was performed. On day 10 of a complicated postoperative period the patient died. Post-mortem histopathological examination of small and large intestine revealed highly malignant peripheral T-cell lymphoma, not otherwise specified. Differentiation of intestinal T-cell lymphoma from Crohn’s disease continues to be a challenge, because clinical, colonoscopic, radiological and histopathological findings can mimic Crohn’s disease. Careful multi-disciplinary assessment and knowledge of this rare disorder is crucial for timely diagnosis.

Esophageal stenting is used in patients with malignant esophageal tumours to reduce dysphagia and inanition. The objective of this study was to analyse the main reasons for esophageal stenting in Rīga East Clinical University Hospital (RECUH) and their association with dysphagia and mortality. A cross-sectional study of all patients hospitalised in RECUH who received esophageal self-expanding metal stents (SEMS) from October 2013 to December 2015 was performed. A total of 29 patients, 24 (82.8%) male and 5 (17.2%) female, with mean age 63.7 ± 11.3 years, underwent the procedure. The most common indications for stenting were tumour-related stenosis (52.9%) and fistulae (17.6%). Mean time from establishing the diagnosis of esophageal cancer to stent placement was 338.6 days. Median survival after stenting was 4.8 months. A complex case of a patient requiring placement of three palliative stents illustrates the challenges of esophageal cancer care. Esophageal stent placement is an effective palliative method for treating tumour-related symptoms but carries risks of stent complications and fistula development over time. SEMS are being successfully used in cancer patient treatment in Latvia.

No abstract