[Assessment of neuropeptide Y, leptin and leptin-receptor concentrations in teenagers suffering from anorexia nervosa]. / Ocena wartosci stezen neuropeptydu Y, leptyny oraz receptora leptyny u nastolatek chorych na anoreksje.

INTRODUCTION: Anorexia nervosa (AN) is the third most common chronic disorder affecting adolescents and is associated with high mortality risk. The predominant symptom of anorexia nervosa is persistent and intentional striving to achieve weight loss initiated and/or sustained by the patient, leading to cachexia. Until now the cause of the condition remains unknown, but seems to be multifactoral. Patients with AN develop multi-organ complications and endocrine disorders affecting multiple disturbances of energy metabolism. Neuropeptide Y and leptin can be found between chemical substances regulating feelings of hunger and satiety. Neuropeptide Y plays the main role in the regulation of energetic homeostasis of the organism, feeding customs, sexual and reproductive functions. Concentration of neuropeptide Y increases during starvation and decreases after feeding. In anorexia nervosa the concentration of neuropeptide Y increases and, by doing that, decreases the excrection of gonadoliberines and gonadotropines. Leptin influences the feeling of hunger and its synthesis takes part, among others, in adiposal tissue. It also influences the menstruation disturbances. Rising leptin concentrations, with accompanying increasing adiposity is known to be the main factor influencing the puberty and the reverse of the malfunction of hypothalamic-pituitary-gonadal axis in malnourished persons. During hunger and low calorie intake, leptin concentration decreases, independently of adiposity. AIM: The main aim of the study was to assess concentrations of neuropeptide Y, leptin and leptin receptor in teenagers treated for anorexia nervosa. MATERIALS AND METHODS: The study was conducted between 2007- 2011 in a group of 45 female teenagers with anorexia nervosa and a control group consisting of 59 healthy regularly menstruating female age peers. Concentrations of leptin, leptin receptor and neuropeptide Y (NPY) have been determined by using immunoenzymatic tests. Blood samples were obtained in fasting state. The Ethics Committee of the Medical University of Lodz approved of the study. RESULTS: There were statistically significant differences between mean values of BMI (14.6 vs. 19.83), median value of leptin concentration (3.79 vs. 12.09), proportions of LEP/BMI (0.1986 vs. 0.5701) in the study group when compared to controls. Higher values were found in the study group if compared to the percentage of body mass insufficiency--(23.09 vs. 3.97), neuropeptide Y concentration--(0.33 vs. 0.19), proportions of NPY/BMI--(0.023 vs. 0.0095), concentration of leptin receptor--(30.25 vs. 19.45), proportions of LR/BMI--(2.1048 vs. 0.9744). CONCLUSIONS: Low concentrations of leptine correlate to high concentrations of leptin receptor. A positive correlation between low body mass index and leptin receptor concentration and proportions of LR to BMI was found. A negative correlation was found between body mass loss and leptin concentration. The increasing concentration of neuropeptide Y, correlated to body mass deficency with existing high concentrations of leptin, could suggest disturbances of their regulatory axis.

Vitamin D insufficiency in healthy pregnant women living in Warsaw.

BACKGROUND/OBJECTIVES: Ensuring the optimal level of 25-hydroxy-vitamin D (250HD) in serum (concentration above 30 ng/ml) is essential for protecting the health of the mother and the developing fetus. Vitamin D plays an important role in maintaining proper bone structure, preventing infections, reducing the risk of premature birth and gestational diabetes. The aim of the study was to verify whether healthy pregnant residents of Warsaw were deficient in vitamin D. MATERIAL AND METHODS: The material consisted of 150 serum samples of 50 healthy women in 1st, 2nd and 3rd trimester of pregnancy 72.7% of the sera were from women who reported taking multivitamin supplements containing vitamin D3 (71% out of that group was taking 400 IU daily). The concentration of 250HD was measured using the vitamin D total assay on Elecsys 2010 automatic analyzer (Roche Diagnostics). RESULTS: The average serum 250HD concentrations of 50 women in 1st, 2nd and 3rd trimester of pregnancy were respectively: 23.1 ng/ml, 24.8 ng/ml, and 25.1 ng/ml, with no statistically significant differences. The optimal levels of 250HD (30-80 ng/ml) were found in 30.0% of samples, hypovitaminosis (20-30 ng/ml) occurred in 38.7%, deficiency (10-20 ng/ml) in 24.0% and severe deficiency (less than 10 ng/ml) in 7.3% of cases. Mean concentration of 250HD in winter season (October 1 - March 31) was 23.6 ng/ml and in summer season (April 1 - September 30) was 25.5 ng/ml, with no statistically significant difference. On the basis of the BMI in 1st trimester two subgroups were distinguished from the studied subjects: BMI <21 (13 patients, 39 samples) and BMI >25 (14 patients, 42 samples). Mean 250HD concentration in these groups were 27.3 and 23.5 ng/ml respectively (p<0.05). High statistical significance (p<0.001) was found among the total number of samples with 250HD deficiency and severe deficiency (<20 ng/ml) and samples with hypovitaminosis and optimal 250HD level (>20 ng/ml) in these groups. CONCLUSIONS: Regardless of trimester and season, vitamin D below the optimal level is a common occurrence during pregnancy and the current level of supplementation among Polish pregnant women appears to be insufficient. Our data suggest that special attention should be paid to the problem of vitamin D insufficiency in overweight pregnant women.

[Iodine supply and thyroid function in the group of healthy pregnant women living in Warsaw]. / Zaopatrzenie wjod oraz czynnosc tarczycy w grupie zdrowych kobiet ciezarnych zamieszkujacych Warszawe.

UNLABELLED: Iodine deficiency and thyroid gland disorders are especially harmful for pregnant women and normal fetal development. After initiation in 1997 of obligatory iodine prophylaxis, Poland has been found since 2003 a country with sufficient delivery of this microelement. However, in the population of pregnant women, slight deficiency of this element still exists. Insufficient iodine supply results in abnormalities of thyroid hormones'biosynthesis. Simultaneously, adaptive changes, occurring in pregnancy, make the proper interpretation of hormone's assays difficult. Lack of normative data for the thyroid hormones concentration in the each pregnancy trimester for Polish population cause additional difficulties in the interpretation of these results. The aim of the study was prospective observation of iodine intake and thyroid function in healthy pregnant women supplemented with 150 pg of iodine daily MATERIALS AND METHODS: 62 healthy pregnant women living in Warsaw in the early weeks of pregnancy, confirmed by ultrasonographic examination, were included to this study. Pregnancies were singleton resulting in birth of healthy neonates. Urinary iodine concentrations (UIC), serum TSH, fT4, fT3, antyTPO, thyroid volume and morphology by the ultrasonography examination were assessed in consecutive trimesters of pregnancy. TSH level was measured in the each newborn. RESULTS: Low urinary iodine concentrations (UIC)-median 96 microg/l was found at the beginning of pregnancy Only in 14% of pregnant women UIC exceeded 150 microg/l. In spite of intended supplementation of at least 150 microg of extra iodine per day, medians of UIC in the next trimesters were 122 microg/l and 129 microg/l, respectively. TSH levels kept reference values for the 1st trimester of pregnancy in 86% of participants and in the next trimesters in 85% and 95%, respectively. Levels of fT4 were within reference range for the women in the 1st trimester. In 2nd trimester 12% and in 3rd trimester 33% of pregnant women had fT4 level below the reference value. Concentrations of fT3 were within reference values during whole pregnancy. Median thyroid volume was respectively 11.12 ml; 13.0 ml and 15.75 ml (range: 6.8-26.8 ml) in subsequent trimesters.Median neonatal' TSH level on the 3rd day of life, as a screening of thyroid insufficiency, was 1.34 mlU/l (range: 0.01-6.6 mlU/l) and in 4.41 % of newborns TSH concentrations were higher than 5 mlU/I. CONCLUSION: Despite the sufficient supply of iodine in the whole population, iodine consumption among the pregnant women is still not satisfactory. The increase of TSH values above the upper reference level for pregnant women in 15% of patients may be related to iodine deficiency. It is important to educate pregnancy planning women about this problem. Our observations confirm the importance of the recommendations that during the pregnancy every woman should receive supplementation of iodine at the minimal amount of 150 microg daily.

Management of a large splenic cyst in pregnancy--a case report.

Splenic cysts in pregnancy are an extremely rare disorder and to date only seven such cases have been reported in literature. The consensus for the management of pregnant patients with splenic cysts is therefore yet to be established. A 25-year old nullipara with a large (10 cm in diameter) splenic cyst located in the upper pole and the hilum was qualified for surgery in the second trimester of pregnancy. Open total splenectomy was performed because of the central location and large diameter of the cyst. No complications were reported. The pathology report demonstrated secondary cyst (pseudocyst). The remaining antepartum course was uneventful and the patient spontaneously delivered a healthy baby at 39 weeks of pregnancy. We are of the opinion that splenic cysts should be operated on in the second trimester of pregnancy because of the risk of spontaneous rupture. Total splenectomy is a safe and effective procedure for centrally located large cysts.

Reference Values for TSH and Free Thyroid Hormones in Healthy Pregnant Women in Poland: A Prospective, Multicenter Study.

OBJECTIVES: The diagnosis and treatment of thyroid diseases in pregnant women remains a challenge. Various medical associations recommend establishing the reference intervals for thyroid hormones by a local laboratory. Considering differences within geophysical, socioeconomic conditions, and iodine prophylaxis in various populations, it is advisable to assess reference intervals for thyroid hormones specific to a region of residence. The objective was to assess trimester-specific reference intervals for TSH, fT3, and fT4 for pregnant women in the Polish population. METHODS AND RESULTS: We conducted a prospective study in 4 centers representing different regions of Poland (Krakow, Warsaw, Poznan, and Bialystok). Our study included consecutive, healthy pregnant women (172 patients), with an age range of 27-47 years. All women had a negative history for thyroid diseases, normal thyroid peroxidase antibody levels, and proper iodine prophylaxis. All newborns had TSH levels in the appropriate reference range. Serum TSH, fT3, fT4, and thyroid-peroxidase antibodies were measured in each trimester. The reference intervals were calculated using the percentile method, as recommended by the International Federation of Clinical Chemistry. The reference values calculated were 0.009-3.177, 0.05-3.442, and 0.11-3.53 mIU/L for TSH; 3.63-6.55, 3.29-5.45, and 3.1-5.37 pmol/L for fT3; and 11.99-21.89, 10.46-16.67, and 8.96-17.23 pmol/L for fT4 in consecutive trimesters of pregnancy. Reference intervals for pregnant women when compared to the general population showed a lower concentration of TSH in every trimester of pregnancy and lower fT4 in the 2nd and 3rd trimesters. CONCLUSIONS: Using appropriate trimester-specific reference intervals may improve care of pregnant women by preventing misdiagnosis and inadequate treatment.

The impact of muscle training by Kotz phasal currents on increased strength and mass of the medial head of the quadriceps muscle of the thigh in patients with degenerative disease of the femoropatellar joint.

Background. This article presents the results of research on the impact of muscle training using Kotz phasal currents on rehabilitation outcome in patients with degenerative disease of the femoropatellar joint.
Material and methods. Our research involved 40 patients undergoing isometric exercises of the quadriceps muscle of the thigh. In 20 of these patients (the experimental group) we also applied Kotz phasal currents. In the course of rehabilitation we measured any changes occurring in the circumference of the thigh 10 cm from the base of the patella, as well as muscle strength on the Lovett scale.
Results. A significantly greater reduction in pain was achieved in the experimental group. After the first two weeks, the differences between the two groups in the circumference of the thigh and in muscle strength were only slight, but after the next two weeks visible changes emerged in both parameters. In the control group there was slight improvement in circumference of the thigh, but muscle strength remained unchanged.
Conclusions. The results we obtained indicate that training with Kotz currents and isometric exercises are an effective means of treatment in rebuilding muscle mass and strength.