Diagnosis and management of COPD in primary care

Chronic obstructive pulmonary disease is a significant health problem. However, a large proportion of cases remain undiagnosed. Early diagnosis of chronic obstructive pulmonary disease leads to earlier treatment initiation, and in consequence, to improvement of patients quality of life. The gold standard for chronic obstructive pulmonary disease diagnosis is spirometry and the presence of irreversible obstruction after a bronchodilator. One of the most important interventions in the treatment of chronic obstructive pulmonary disease is anti-smoking education. The main group of drugs used in chronic obstructive pulmonary disease treatment are the long-acting bronchodilators.

Experience in the use of olanzapine in an inpatient ward – clinical cases

Treating both schizophrenia and bipolar disorder require chronic drug therapy that must be chosen after careful consideration of the gains and losses associated with it. Hence, the process of the drug selection must take into account both the profile of patient’s symptoms and his coexisting diseases as well as the patient’s tolerance of earlier therapies. Olanzapine reduces positive symptoms of psychosis and enables stabilization in terms of affective episodes via blocking dopaminergic receptors. An important problem related to olanzapine therapy is its negative effect on the metabolism of carbohydrates and lipids. For this reason, appropriate information for the patient and implementation of appropriate prophylaxis, including monitoring of metabolic parameters, are recommended. Despite the risk of metabolic complications in some patients, olanzapine remains at the forefront of antipsychotic drugs, due to the good balance of benefits and losses associated with pharmacotherapy. In this paper, we present two clinical cases of patients who have been treated with olanzapine for schizophrenia and bipolar disorder.

Irritable bowel syndrome – a common problem, individual approach

Irritable bowel syndrome is a recurrent abdominal pain that occurs at least once a week for 3 months, with symptoms at least 6 months associated with at least two features: bowel movements, change in bowel frequency, change in the appearance of stools. According to the Rome IV Diagnostic Criteria, the disease is diagnosed on the basis of clinical symptoms. This does not apply to people over 50 years of age (and in the case of first-degree relatives of patients with colorectal cancer after 45 years of age) and patients with alarm symptoms. Due to the lack of a single etiological factor, the treatment of irritable bowel syndrome consists in reducing symptoms and improving the patient’s quality of life. Non-pharmacological treatment includes a high-fiber diet and modification of the microbiota. The most effective drugs are antispasmodics directly affecting the smooth muscle, inhibiting the influx of calcium, i.e. drotaverine, mebeverine and alverine. There has been proven effectiveness of antidepressants. This confirms that functional disorders of the gastrointestinal tract are a manifestation of the dysfunction of the brain–gut–microbiota axis.

Anxiety in cardiology. The use of pregabalin in the treatment of anxiety disorders in patients with cardiovascular diseases

The paper discusses two issues: the multidirectional relationship between the occurrence of anxiety symptoms and cardiovascular diseases, and the influence of the persistently high level of anxiety on the course of cardiological diseases and patient prognosis. In the discussion on the negative health consequences of anxiety disorders, there is emphasized importance of early diagnosis of these disorders and implementation of its treatment. As a starting point there were presented clinical cases of cardiovascular patients in whom developed anxiety disorders. The following sections discuss various aspects of the pharmacological treatment of anxiety disorders, focusing on the possible use of pregabalin in this.

Patient with rheumatic diseases during a pandemic

Interview

Reduction of blood pressure fluctuations by telmisartan molecule especially in combination with calcium channel antagonist

1.28 billion people suffer from hypertension, and its complications cause 10 million deaths each year. Effective antihypertensive therapy is therefore one of the priority tasks of health care. Achieving good BP control depends on many factors, but one of the primary ones is the use of maximally effective therapy in the simplest possible regimen. Amlodipine in combination with telmisartan in the single-pill combination, through its high smoothness index, makes it possible to achieve a satisfactory hypotensive effect lasting 24 h when taken once daily. This combination is also a good alternative for cardiovascularly burdened patients who cannot use angiotensin-converting enzyme inhibitors and for elderly patients, especially after stroke

Parkinson’s disease with concomitant generalized anxiety disorder – case report

Parkinson’s diseases, occuring most often between the ages of 50 and 60 years, on average at the age 58 years is a progressive degenerative disease of the central nervous system of global importance and serious consequences for public health. Its main symptoms are tremor at rest muscle stiffness and bradykinesia, i.e. slowness of movement (the so-called parkinsonian triad). Atrophic lessons of substantia nigra, located in the midbrain, responsible for the production of dopamine, contribute to the onset of symptoms of the disease. Patients with Parkinson’s diseases suffer from a variety of extra-motor symptoms often psychiatric disorders, especially panic or generalized anxiety. The author presents the case of 63 years old man diagnosed with Parkinson’s diseases 4 years ago, with quite a significant severity in the last 2 years. Left limb weakness (upper and lower) deepened and general slowing of movement developed then restless legs syndrome developed fully (specific sensations in the area of the feet and lower legs in the evening and night hours, temporarily decreasing when moving, walking, stretching the muscles). For about 6 months he have had attacks of anxiety and anxiety as well as a fully developed generalized anxiety disorder. The combination of levodopa and carbidopa and pregabalin was used, resulting in a reduction of slowness and stiffness as well as a significant reduction in anxiety and anxiety after approximately 8 weeks.

Depressive and anxiety disorders and the COVID-19 pandemic

COVID-19 has quickly become a global health emergency resulting in not only physical health concerns but also psychological concerns as people are exposed to unexpected deaths or threats of death. For example, healthcare workers who have close contact with COVID-19 patients are not only exposed to the virus on a regular basis, but they may also be witnessing increased illnesses, deaths, and supply shortages. In addition, patients admitted to the hospital with COVID-19 experience social isolation, physical discomfort, and fear for survival. These exposures increase the risk of developing PTSD. In addition, the risk may further be enhanced during the subsequent weeks when these individuals may lack immediate social support due to the need to self-quarantine. Moreover, the rates of depressive and anxiety disorders are presumably increasing, however, data are inconsistent.

Probiotics with estriol in the treatment of acute and recurrent vaginal and vulvar infections in women

The microbiome undergoes qualitative and quantitative changes at different times in a woman’s life, and their nature is due to many factors such as age, sexual activity, comorbidities, etc. As a result, vaginal dryness and inflammation can occur in the vagina. This problem is most important during the menopausal period, when estrogen secretion decreases – this induces a cascade of unfavorable biological effects. We can prevent them by adding probiotics to the standard menopausal hormonotherapy. Adding probiotics restore and maintain the proper microbiological condition of the vagina. The use of probiotics reduces the risk of developing ailments that require antibiotic therapy, which is also detrimental to the vaginal microbiome.

Multiple sclerosis – new perspectives

Interview