SummaryBackgroundHyperlipidemia is an identified factor of premature vessel atherosclerosis. Lipemia retinalis is an unusual retinal manifestation of hyperlipidemia and is thought to be directly correlated with the serum triglyceride level.Case ReportThis paper discusses the case of a 55-year-old patient with lipemia retinalis, which deteriorated his visual acuity. The patient had an extremely high serum cholesterol level (1053 mg/dl) and a very high level of triglycerides (1513 mg/dl). The normalization of serum lipids, reversion of retinal vessels alterations and visual acuity improvement was achieved after an intensive statin lipid-lowering therapy. Pathological changes of the patient’s retina, connected with lipemia retinalis, disappeared completely.ConclusionsHyperlipidemia can cause lipemia retinalis, which is characterized by the hyperlipidemic vascular lesions-whitish color of vessels, lipid infiltration into the retina and decrease of visual acuity. The lipid-lowering therapy may lead to the normalization of the appearance of the fundus and restore the visual acuity.

Introduction. Late complications of diabetes mellitus are a serious challenge for physicians treating diabetic patients. Micro-and macro-angiopathic changes are of the most severe sequels. However, it should be remembered that the effects of long-term diabetes are also associated with changes in the peripheral nervous system. One of the complications most troublesome for patients is diabetic autonomic neuropathy of the gastrointestinal (GI) tract. Objective. The review article presents the pathogenesis of diabetic neuropathy of the autonomous gastrointestinal tract, and advances in the diagnosis and treatment of this disease. The study used materials in the database which demonstrate current standards of conduct, based on the principles of EBM. Brief description of the state of knowledge. Diabetic neuropathy is one of the most common complications of diabetes mellitus. According to epidemiologists, it affects 10% to even 100% of patients with long-standing disease. Damage to the nervous fibres mainly results from hyperglycaemia, which leads to the typical symptoms of dysfunction of GI tract segments. The main additional examinations include abdominal ultrasound (US) and abdominal X-ray. In cases with oesophageal disorders accompanied by dysphagia, gastroscopy is found useful for excluding possible neoplastic lesions. The gold standard for evaluation of gastric emptying is radioisotopic scintigraphy, however it is available only in some specialistic departments. Other recommended methods include: manometry, EGG, insulin tests, NMR and expiratory tests. To date, the problem has been managed symptomatically; in special cases, surgical interventions have been required. Conclusions. At present, a wide array of treatment options is available, including new forms of drugs and less radical surgical procedures carried out in numerous centres worldwide.

Fever develops in various diseases. It is mainly associated with infectious diseases but can also occur in non-infectious ailments. Clinical symptoms are not always explicit, which can hinder the diagnosis and delay the institution of appropriate treatment. The aim of the study is to present difficulties in diagnosing the cause of a febrile state in a patient with splenic abscess.

StreszczenieWstęp: Nadciśnienie tętnicze z brakiem spadku ciśnienia w czasie nocy (non-dippers) występuje częściej u kobiet po menopauzie i przyczynia się do wzrostu śmiertelności z przyczyn sercowo-naczyniowych.Cel pracy: Ocena zależności profilu dobowego ciśnienia tętniczego i profilu hormonów płciowych oraz gospodarki węglowodanowej u kobiet po menopauzie z nadciśnieniem tętniczym.Materiał i metody: U 135 kobiet po menopauzie z nadciśnieniem tętniczym wykonano 24-godzinne monitorowanie ciśnienia tętniczego, oznaczono stężenie estradiolu (E 2 ), testosteronu (T), siarczanu dihydroepiandrosteronu (DHEA-S), białka wiążącego hormony płciowe (sex hormone binding globulin -SHBG), insuliny i glukozy na czczo w surowicy.Wyniki: Zarówno grupa dippers, jak i non-dippers liczyła po 59 osób każda (40,9%). Badane grupy nie różniły się wiekiem, czasem trwania menopauzy i nadciśnienia tętniczego, średnim ciśnieniem skurczowym i rozkurczowym, odsetkiem leczonych beta-blokerem i inhibitorem konwertazy angiotensyny, wskaźnikami otyłości. Badane grupy nie różniły się statystycznie istotnie stężeniem E 2 , T, DHEA-S oraz SHBG. W grupie dippers i non-dippers stężenia glukozy na czczo były podobne, natomiast stężenie insuliny było statystycznie istotnie większe w grupie badanych non-dippers.Wnioski: U kobiet z nadciśnieniem tętniczym w okresie pomenopauzalnym dobowy profil ciśnienia tętniczego typu non-dippers występuje bardzo często (40,9%). U kobiet po menopauzie z nadciśnieniem tętniczym profilowi non-dippers towarzyszy hiperinsulinemia.Słowa kluczowe: nocne spadki ciśnienia tętniczego, menopauza, nadciśnienie tętnicze, hiperinsulinemia. SummaryIntroduction: Hypertension with no pressure drop during the night ("non-dippers") is more common in postmenopausal women and contributes to increased mortality for cardiovascular reasons.Aim of the study: The aim of the study was to evaluate the relation of the circadian blood pressure profile and the profile of sex hormones, and carbohydrate metabolism in postmenopausal women with hypertension.Material and methods: In 135 postmenopausal women with hypertension, 24-hour blood pressure monitoring was performed and the blood serum concentrations of estradiol, testosterone, dihydroepiandrosterone, sex hormone-binding protein, insulin and glucose levels were determined.Results: The "dippers" group consisted of 59 patients (40.9%), and "non-dippers" group of 59 patients (40.9%) as well. The study groups did not differ in age, duration of menopause and hypertension, mean systolic and diastolic blood pressure, percentage of patients treated with beta-blocker and angiotensin converting enzyme inhibitor or rates of obesity. The studied groups of "dippers" and "non-dippers" did not differ statistically significantly in the levels of serum estradiol, testosterone, dehydroepiandrosterone sulfate and sex hormonebinding protein. In the "dippers" and "non-dippers" groups, fasting glucose levels were similar, whereas insulin levels were significantly higher in the group of "non-dippers".Conclusions: In ...

Background An extension to the Mater Campus Hospital Development was anticipated to represent considerable logistical and functional difficulties for the delivery of drugs from one central Pharmacy site. It was proposed that a prospective study be conducted to identify areas of inefficiency in the current requisitions delivery schedule and determine how best to maximise efficiency and facilitate service expansion. Purpose To identify areas of inefficiency in the current requisitions delivery schedule from the MMUH Pharmacy dispensary to wards. To explore the needs and expectations of clinical pharmacists with respect to the current and future scheduling and delivery to identify key areas of concern for impact on clinical pharmacy service. Materials and methods A triangulated method was used to investigate the scheduling, personnel and workload components of the schedule of requisitios deliveries and their effect on the efficiency of medicines delivery. This incorporated direct structured observation of the delivery schedule, quantification of pharmacy ward requisitions using queuing theory and a census of clinical pharmacists with an anonymous structured questionnaire. Results Statistically significant variation (p < 0.001) was identified when deliveries were categorised according to scheduled delivery time and destination. Differences between peak delivery times and other deliveries demonstrated inefficient operation. Queuing theory enabled baseline operating characteristics to be derived. Fluctuations in operating characteristics on the basis of staff numbers were also identified. Clinical pharmacists were generally satisfied or very satisfied with the current delivery times but the inability to guarantee times of drug deliveries was the biggest perceived problem with the delivery schedule. Conclusions This investigation successfully identified inefficiencies within scheduled Pharmacy deliveries. The cumulative findings identified that improvement in productive efficiency can be achieved without additional resources. Recommendations to enhance efficiency were made, providing for the development of evidence-based solutions to the logistical and functional problem of hospital expansion. No conflict of interest.