Type 2 diabetes mellitus (DM2) and depression are chronic non-communicable diseases that affect millions of people worldwide. The interaction of these two diseases is complex and has a huge clinical significance. The association between DM2 and depression was recognized decades ago; however, the cause of the high prevalence of this comorbidity is not fully understood. It is assumed that shared genetic and environmental risk factors play a role, such as certain gene polymorphisms related to the secretion and effects of cortisol, obesity and others. Pathophysiological mechanisms underlying depression, such as HPA axis dysregulation and inflammation, impair insulin resistance and contribute to the development of DM2, while on the other hand, chronic stress linked to DM2 may cause depression. This relationship, which is often described as bidirectional, leads to the formation of the so-called “vicious cycle” that results in poor health outcomes of both conditions. Patients with DM2 and comorbid depression have a higher incidence of long-term complications, primarily macrovascular, lower quality of life and a higher mortality rate. Therefore, the prevention, early detection and treatment of depression in DM2 is extremely important. The treatment of comorbidity of these diseases includes a multidisciplinary approach aimed at the simultaneous improvement of mental and physical health. Treatment involves pharmacotherapy, psychotherapy and psychosocial interventions, with the main goal of reducing the incidence of DM2 complications and improving the quality of life of affected individuals.
Total laryngectomy presents the standard therapeutic protocol in the treatment of advanced laryngeal cancer. There is not enough research in this area to indicate the necessity of performing thyroidectomy in patients with advanced squamous cell carcinoma of the larynx, although some studies indicate that unilateral thyroidectomy is performed routinely in some centers. The National Comprehensive Cancer Network (NCCN) recommends ipsilateral hemithyroidectomy with laryngectomy for advanced squamous cell carcinoma of the larynx. However, in these cases, the risk of hypothyroidism and hypoparathyroidism is significantly higher, which requires postoperative monitoring of hormone status and thyroid replacement therapy. Invasion of the thyroid gland can occur due to direct or lymphovascular spread of advanced squamous cell carcinoma of the larynx, and the risk of locoregional recurrence and distant metastases in these cases increases significantly. The incidence of thyroid gland invasion in patients with advanced laryngeal squamous carcinoma is relatively low, and the most common predictors for infiltration are subglottic and transglottic extension of the laryngeal tumor, as well as direct invasion of the thyroid cartilage. Preservation of thyroid tissue during laryngectomy significantly reduces postoperative morbidity, however, thyroidectomy may be indicated if the presence of risk factors for thyroid invasion is assessed based on clinical, radiological and intraoperative findings. A careful assessment of risk factors is necessary to avoid the occurrence of locoregional recurrence, and thus a significantly worse prognosis.
Introduction: Coarctation of the aorta (CoA) is a narrowing of the thoracic aorta, most often localized at the junction of the ductus arteriosus. Data on risk factors for the development of recoarctation remain contradictory in the literature. Aim: To determine the frequency of recoarctation and to identify risk factors for recoarctation after surgical correction of CoA. Material and methods: The research included 94 patients who underwent surgery for coarctation of the aorta from 2012 to 2017. Demographic and clinical characteristics, preoperative, intraoperative, postoperative and echocardiographic parameters were observed. Pressure gradient over 25 mm Hg immediately after operation is considered predictor for recoarctation of the aorta. The data was processed using methods of descriptive and analytical statistics. Results: The median age at the time of surgery was 2 months (4 days - 19 years). The dominant technique was extended end-to-end anastomosis (90.4%). Kaplan Meier survival analysis showed a higher incidence of recoarctation in the group of patients with immediate postoperative gradient > 25 mm Hg (p < 0.001). Also, Cox logistic regression showed higher immediate postoperative gradient to be a predictor (HR 4.57, p = 0.009, 95% CI 1.47 - 14.22). After correction for other cofactors, including sex, genetic syndrome, small body weight, administration of prostaglandine E1, presence of bicuspid aortic valve, surgical technique, it was shown that the group of patients with higher immediate postoperative gradient has 4-fold higher probability for recoarctation (HR 4.37, p = 0.035, 95% CI 1,11 - 17,16) . Conclusion: Immediate postoperative pressure gradient > 25 mm Hg is an independent predictor for recoarctation after surgical correction of the coarctation of the aorta.
Obesity represents a multifactorial, systemic disorder strongly associated with adverse health outcomes, including cardiometabolic syndrome. Beyond caloric imbalance between caloric intake and expenditure, recent evidence highlights the essential role of gut microbiota in the development and progression of obesity and related metabolic dysfunctions. The gut microbiota, composed of diverse bacterial species, archaea, fungi, and viruses, influences host metabolism through the production of low-molecular-weight metabolites and gastrointestinal hormones, significantly modulating energy homeostasis, appetite regulation, and insulin sensitivity. Specific bacterial taxa are implicated in either promoting metabolic health or contributing to obesity through mechanisms involving chronic systemic low-grade inflammation, increased intestinal permeability, and altered energy harvest. Dysbiosis - marked by reduced microbial diversity and compositional imbalance is consistently linked to enhanced adiposity and systemic inflammation. Dietary patterns are key modulators of gut microbial composition and function. This review underscores the complex interplay between dietary patterns, gut microbiota-derived metabolites and host endocrine responses that contribute to dysregulation of gut-brain axis communication observed in obesity.
