Diagnostic challenges in celiac disease.

Diagnosis of celiac disease in adults is currently based on serologic tests in combination with histopathological assessment of small intestinal biopsy specimens. High titers of celiac-specific antibodies in immunocompetent patients with villous atrophy in a good quality biopsy sample allow us to state a confident diagnosis. The relief of symptoms and histological improvement after embarking on a gluten free diet further support the initial diagnosis. However, in some cases, these conditions are not fulfilled, which requires a critical evaluation of laboratory and histopathology results and a consideration of other potential causes for the observed pathologies. To avoid diagnostic uncertainty, both biopsy and laboratory testing should be performed on a diet containing gluten. Immune deficiency, cross reaction of antibodies and possibilities of seronegative or latent celiac disease should be considered while evaluating serology results. Uneven distribution and variable intensity of histopathological changes in the small intestine along with multiple disorders presenting a similar specimen image may lead to invalid biopsy results. Additional laboratory testing and careful examination of a patient's history may deliver important data for a differential diagnosis and a more specific biopsy evaluation. Persistence or recurrence of symptoms, despite the ongoing treatment, requires a revision of the initial diagnosis, an evaluation of the gluten free diet and a search for concurrent disorders or complications.

13C-Methacetin Breath Testing in Patients with Non-Alcoholic Fatty Liver Disease.

BACKGROUND: Non-alcoholic fatty liver disease (NAFLD) is a very common chronic liver condition which may potentially develop into fibrosis and cirrhosis. Liver biopsy is still the gold standard for liver fibrosis detection in these patients. However, non-invasive tools for liver assessment in NAFLD patients, like the (13)C-methacetin breath test, may be useful. OBJECTIVES: The aim of the study was to evaluate the utility of the (13)C-methacetin breath test in NAFLD patients, especially in predicting significant fibrosis. MATERIAL AND METHODS: Thirty three patients (24 male and 9 female (average age 47.9)) with histologically proven NAFLD had the (13)C-methacetin breath test performed. RESULTS: Different forms of NAFLD were found during the histology phase, from simple steatosis to advanced fibrosis. Simple steatosis (SS) was found in 18 subjects (54.5%), in another 15 (45.5%) signs of inflammation and fibrosis (NASH) were observed. However, more than half of the patients with liver fibrosis had only minimal changes described (0/1). The sensitivity of the test was highest for cumulative recovery after 10 min of the test and for a combination of two parameters (the cumulative recovery after 40 min and the time of maximal momentary recovery). The positive predictive value was low for all the parameters under consideration, but the negative predictive value was over 0.8 in significant fibrosis detection. CONCLUSIONS: The (13)C-methacetin breath test could be a promising noninvasive tool for excluding at least F1 fibrosis in NAFLD patients.

[Pro-health prevention in perimenopausal women with regard to estrogen treatment]. / Profilaktyka prozdrowotna u kobiet w okresie okolomenopauzalnym z uwzglednieniem leczenia estrogenami.

According to the latest demographic forecast in Poland is observed the progressive aging of the population with growing population of perimenopausal women. This is a special time in woman's life, in which there are many metabolic changes, neurovegetative symptoms and mental changes. All of them are connected with decreased concentration of sex hormones. Very important in this period are health behaviors, including healthy lifestyle, regular exercises and proper diet. Highly effective in removing menopausal symptoms is hormone replacement therapy. It also prevents the effects of metabolic disorders. This therapy is primary prevention of cardiovascular diseases and osteoporosis, depression, Alzheimer's and Parkinson's disease and urogenital atrophy. It also has to delay the process of aging. Clinical studies of HERS, WHI and MWS caused extreme caution in the use of hormone replacement therapy and distrust for this therapy between doctors and their patients. It is therefore important to establish priorities for action and individualized therapy, depending on the indications and contraindications for its use.

Health behaviors of postmenopausal women.

INTRODUCTION: Health status and health-related quality of life of postmenopausal women are issues, which nowadays pose a serious challenge to many domains of science. Climacteric symptoms which occur at this stage of life, lower its quality and make a negative contribution to self-reported health status, are mostly observed in a particular group of women. Evaluation of health behaviors performed using a standardized questionnaire, the Health Behavior Inventory (HBI), may help establish a comprehensive diagnosis of women's health, and thus select effective interventions. A systemic approach to menopause assumes that full fitness of women and good quality of their lives can be maintained not only by means of pharmacotherapy but also other forms of action, especially health education oriented towards changes in the lifestyle and promotion of healthy behaviors. THE AIM OF THIS STUDY: Aim of the study is to perform a HBI-based assessment of women's health behaviors in such categories as healthy eating habits (HEH), preventive behaviors (PB), positive mental attitudes (PMA), and health practices (HP). MATERIAL AND METHODS: The study involved 151 healthy postmenopausal women. A research tool was a standardized questionnaire, the Health Behavior Inventory (HBI). RESULTS: The surveyed women obtained 70% of the maximum score on average, which suggests a medium level of health behaviors in this group. The levels of health behaviors in the categories of positive mental attitudes and health practices significantly differed between older women and their younger counterparts (higher levels were observed among older respondents). There were also significant differences in the levels of healthy behaviors between women with secondary and higher education (those better educated declared healthy behaviors more often). There was no correlation between the level of health behaviors and the BMI of the surveyed women. CONCLUSIONS: Older women attached greater importance to positive mental attitudes, and so they avoided tension, stress and depressing situations. They also attached more weight to health practices (HP), i.e. the number of hours devoted to sleeping, resting and physical activity. The main determinant of a healthy lifestyle was higher education.

Effects of substances on serum zinc levels in postmenopausal women.

INTRODUCTION: Demographic facts and forecasts about lengthening life expectancy motivate to systematize the knowledge of health problems experienced by women at the age of 50 and older. It refers to the whole health policy including health economics. Longer female life spans cause that an increasing number of women suffer from health problems associated with the perimenopausal period, and become health care recipients. Also a shift of retirement age is the reason to take interdisciplinary actions for women's health and quality of life. This study describes a decline in the levels of many bioelements in hair, urine and blood serum, which progresses with age. It not only correlates with a decrease in the synthesis and secretion of estrogen, but also environmental pollution, unhealthy lifestyle and the use of substances. AIM OF THE STUDY: The aim of this study was to determine the correlation between serum zinc levels in postmenopausal women and such variables as the use of substances (cigarettes, alcohol) and menopausal hormone therapy (MHT). Material and method: The study was conducted among 152 healthy women being 1-16 years after menopause. The women were divided into study group (MHT users) and control group (MHT non-users). A sub-division criterion was the use of substances (cigarettes, alcohol). Serum zinc levels were determined in all women. Results: The use of substances significantly contributed to the lowering of serum zinc levels in postmenopausal women. MHT users had statistically higher average zinc levels in blood serum, which referred both to smokers and consumers of alcohol and those who did not use these substances. CONCLUSIONS: (1) The use-of substances (cigarettes, alcohol) contributes to the lowering of zinc levels in blood serum. (2) MHT positively affects serum zinc levels in postmenopausal women regardless of whether they use substances (cigarettes, alcohol) or not.