Elżbieta Bandurska-Stankiewicz

Effectiveness of the iodine prophylaxis model adopted in Poland

Objective: Most of the Polish territory has been classified as an iodine-deficient and endemic goiter area according to the International Council for Control of Iodine Deficiency (ICCIDD) criteria. In 1997 the obligatory model of iodine prophylaxis was implemented. Our investigations were aimed at the effectiveness of iodine prophylaxis in Poland. Methods: We assessed urinary iodine excretion and goiter prevalence in 5663 children aged 6–12 yr. The population of children from the same 27 schools was investigated from 1992 to 1994 (1406 girls and 1244 boys) and from 1999 to 2005 (1563 girls and 1450 boys) using identical laboratory and ultrasound methods. Results: We found significant increase in iodine urinary concentration (median 52 μg/l vs 93 ug/l, p<0.001) with accompanying drop in goiter prevalence (29.6% vs 5.2%, p<0.001) after implementation of iodine prophylaxis. Iodine excretion distribution changed significantly after 1997 with an increase in the percentage of children with iodine urinary concentration above 100 μg/l from 10.8% to 45.4%, respectively. A significantly higher iodine urinary concentration was observed in lowlands compared to uplands both before and after implementation of iodine prophylaxis (median, 50 νg/l vs 57 μg/l and 86 μg/l vs 114 μg/l, respectively, p<0.001). The goiter prevalence did not differ between girls and boys from 1992 to 1994 (28.8% vs 30.5%, p=0.35) and 1999 to 2005 (5.5% vs 4.9%, p=0.45). Conclusions: Implementation of the new model of iodine prophylaxis in Poland in 1997 has led to significant increase in iodine urinary concentration and decrease in goiter prevalence among Polish schoolchildren. In the youngest group of children (6–8 yr olds), prevalence of goiter decreased to 3.2% — i.e. below endemic levels.

Diabetic blindness significantly reduced in the Warmia and Mazury Region of Poland: Saint Vincent Declaration targets achieved

Purpose The authors’ aim was to verify if the targets of the Saint Vincent Declaration concerning the reduction of diabetes-related blindness in the Warmia and Mazury Region, Poland, had been achieved. Methods A register of World Health Organization-defined blindness due to diabetes was conducted in the Warmia and Mazury Region between 1989 and 2004. The incidence rate of blindness as the number of new cases/100,000 diabetic population/year and 100,000 total population/year was estimated for three subperiods differing in political-economic system and diabetologic care delivery: 1989–1994, 1995–1999, and 2000–2004. Results The major cause of blindness among diabetic patients was diabetic eye disease (97%). Out of 70 patients with Type 1 diabetes, 53% lost vision due to proliferative diabetologic vitreoretinopathy 20% due to neovascularization with glaucoma, while clinically significant macula edema and cataract associated with proliferative diabetologic vitreoretinopathy or clinically significant macula edema predominated in 210 patients with Type 2 diabetes. The incidence rate of blindness due to diabetes in the diabetic population ranged from 102.4/100,000 (confidence interval [CI]: 65.7–139.0) to 13.3/100,000 (3.8–24.9). The incidence rate of blindness due to Type 1 diabetes ranged from 1.3/100,000 (CI: 0.5–2.2) to 0.1/100,000 (CI: −0.1–0.4). The incidence rate of blindness due to Type 2 diabetes was variable in the first subperiod, and it next decreased by 19% each year from 3.9/100,000 (CI: 2.5–5.3) to 0.7/100,000 (CI: 0.1–1.2); p<0.001. Conclusions The Saint Vincent Declaration target of reducing diabetes-related blindness by one third appears to have been achieved in the Warmia and Mazury Region.

Primary hyperparathyroidism in pregnancy — a diagnostic and therapeutic challenge

Hypercalcaemia during pregnancy is uncommon, and mostly associated with primary hyperparathyroidism (pHPT). If unrecognised, it poses a significant risk for the mother and the foetus. Maternal symptoms include: hyperemesis, muscle weakness, pancreatitis, nephrolithiasis, bone disease, mental status changes, and hypercalcaemic crisis. Untreated disease complicates foetal development and foetal death is a significant risk. Our case illustrates the difficulty in detecting pHPT during pregnancy, serious complications connected with severe hypercalcaemia, and difficulties in preparing the patient for surgical treatment. Our review of the medical literature did not identify any previous case of a pregnant woman with hypercalcaemic crisis (total calcium 17 mg/dL, parathyroid hormone 2302 pg/mL), acute pancreatitis caused by pHPT, and with hyperthyroidism, who had undergone a successful surgical treatment.

Assessment of real-world usage of lanreotide AUTOGEL 120 in Polish acromegalic patients – results from the prospective 12-month phase of Lanro-Study

Aim of the study To assess resource utilization and costs of treatment with lanreotide AUTOGEL 120 mg (ATG120) administered as part of routine acromegaly care in Poland. Material and methods A multicentre, non-interventional, observational study on resource utilization in Polish acromegalic patients treated with ATG120 at 4 weeks or extended (> 4 weeks) dosing interval. The study recruited adult acromegalic patients treated medically for ≥ 1 year including at least 3 injections of ATG120. Data on dosing interval, aspects of administration, and resource utilization were collected prospectively during 12 months. Costs were calculated in PLN from the public health-care payer perspective for the year 2013. Results 139 patients were included in the analysis. Changes in dosing regimen were reported in 14 (9.4%) patients. Combined treatment was used in 11 (8%) patients. Seventy patients (50%) received ATG120 at an extended dosing interval; the mean number of days between injections was 35.56 (SD 8.4). ATG120 was predominantly administered in an out-patient setting (77%), by health-care professionals (94%). Mean time needed for preparation and administration was 4.33 and 1.58 min, respectively, mean product wastage – 0.13 mg. Patients were predominantly treated in an out-patient setting with 7.06 physician visits/patient/year. The most common control examinations were magnetic resonance imaging of brain and brain stem (1.36/patient/year), ultrasound of the neck (1.35/patient/year), GH (1.69/patient/year), glycaemia (1.12/patient/year), IGF-1 (0.84/patient/year), pituitary-thyroid axis hormone levels assessment (TSH-0.58/patient/year, T4-0.78/patient/year). There were 0.43 hospitalizations/patient/year. For direct medical costs estimated at PLN 50 692/patient/year the main item was the costs of ATG120 (PLN 4103.87/patient/month; 97%). The mean medical cost, excluding pharmacotherapy, was PLN 1445/patient/year (out-patient care – 49%, hospitalization – 23%, diagnostics/laboratory tests – 28%). Conclusions These results represent the current use of ATG120 in the population of Polish acromegalic patients in a realistic clinical setting. Findings that 50% of patients could be treated with dose intervals of longer than 28 days support the potential of ATG120 to reduce the treatment burden.

Posterior reversible encephalopathy syndrome (PRES) in the course of immunosuppressive therapy in A 45-year-old male with normal blood pressure – case study

1 Clinical Emergency Department, Regional Specialist Hospital in Olsztyn, Poland 2 Clinical Neurology Department, Regional Specialist Hospital in Olsztyn, Poland 3 Clinical Department of Endocrinology, Diabetology and Internal Diseases, Regional Specialist Hospital in Olsztyn, Poland 4 Cardiology Department, Regional Specialist Hospital in Olsztyn, Poland 5 School of Medicine, Collegium Medicum, University of Warmia and Mazury in Olsztyn, Poland

Diagnosis and treatment of diabetic retinopathy — historical overview

Before the discovery of insulin, diabetes had been a fatal disease. Insulin extended lifespan of diabetic patients, yet it also gave rise to a number of chronic vascular complications, including diabetic retinopathy. Ophthalmic lesions were first observed in 1798 by John Rollo. Precise assessment of the eye fundus became possible following the construction of ophthalmoscope, which later made it possible to propose a classification of diabetic eye disease. The history of diabetic retinopathy encompasses not only the discovery of diagnostic methods such as fluorescein angiography, ultrasound examination or optical coherence tomography, but also the history of its treatment. Both initially as well as at present, clinical nutrition constitutes the most important aspect of treatment. DCCT and UKPDS have shown that good metabolic balance plays a significant role in preventing and treating DR. Further studies proved that pharmacological treatment based on fibrates and angiotensin-convertingenzyme inhibitors. A turning point in the history of DR treatment appeared when laser photocoagulation was introduced in 1959. The discovery of epidermal growth factor in 1982 led to the use of anti-VEGF medications in treating maculopathy. Surgical treatment of DR primarily consisted of vitrectomy whose procedures are continually improved.

Vitamin D deficiency in women with gestational diabetes mellitus

Background . The relationships between vitamin D[25(OH)D] deficiency and gestational diabetes mellitus(GDM) are under investigation. We wanted to assessthe relationships between maternal 25(OH)D concentrationand metabolic indicators, and blood pressurein women with GDM. Methods . Prospective study was conducted in northernPoland between September 2012 and February2013. GDM was diagnosed by 75 g OGTT between 20––29 weeks of pregnancy. Pre-gestational BMI werecalculated, weight gain during pregnancy and bloodpressure were collected. Fasting glucose, insulin, lipids,25(OH)D were assessed. HOMA-IR was used to estimateinsulin resistance, defined as > 2.5. The women were dividedinto group A with 25(OH)D deficiency (≤ 20 ng/mL)and group B with 25(OH)D > 20 ng/mL. Statisticalanalysis was performed. Results . We analyzed 56 pregnant women with GDM,mean age 30.3 ± 5.1. 25(OH)D deficiency was found in25 women (44.6%) with its concentration 13.8 ± 3.9ng/mL. In the group B, the mean 25(OH)D concentrationwas 30.6 ± 9.3 ng/mL. 25(OH)D deficiency wasassociated with higher systolic blood pressure (p == 0.03), insulin resistance (p = 0.38) and with thethird and subsequent pregnancies (p = 0.047). 25(OH)D concentration was 22.8 ± 2.0 ng/mL in the first andsecond pregnancies, comparing to 14.3 ± 3.9 ng/mL inthe third and subsequent pregnancies. There was nocorrelation between 25(OH)D and other parameters. Conclusions . 1. Low 25(OH)D concentration in theanalyzed group of women with GDM was significantlycorrelated with increased insulin resistance and systolicblood pressure. 2. In multipara the incidence of 25(OH)Ddeficiency was higher. 3. The results imply necessity offocusing on guidelines implementation for 25(OH)Dsupplementation for women in childbearing age.