Przegla̧d lekarski
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Migraine with aura is characterized by reversible focal neurological symptoms preceding or accompanying headache. Visual aura is the most common type of aura and its patognomic symptoms are scintillating fortification migrating across the visual field or scintillating scotoma. However, the symptoms are not always so typical and clinical doubts are greater when negative symptoms (loss of vision, numbness or paresis) are present. Differential diagnosis of migraine with aura includes in the first place transient ischemic attack (TIA) as well as epilepsy. Diagnosis of migraine in the developmental age is more difficult and associated with unprecise description of the symptoms. Thorough history taking is crucial in migraine diagnosis and following management. Knowledge of migraine with aura symptoms, clinical differences associated with developmental age and features enabling differentiation with other disorders imitating migraine is very important. ⋯ 1. Visual and somatosensory aura were the most frequent types of aura in children; basilar-type aura occurred with the lowest frequency. 2. Unilateral headache with severe or very severe pain intensity, aggravated by movement was found in more than half cases. Pulsating quality of headache was present in half of the patients. 3. Accompanying symptoms (nausea, vomiting, photo- and phonophobia) occurred in the combination, fulfilling ICHD II diagnostic criterion D for migraine in less then half cases. Vertigo and/or balance disturbances, were commonly found symptoms with no association to aura type. 4. Familial occurrence of migraine was reported in more than half patients. 5. Another modification of migraine diagnostic criteria for children is needed. 6. History takes crucial role in the diagnosis of childhood migraine.
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The article presents the clinical picture of delirium characterized with acute, fluctuating altered levels of consciousness, inattention and cognitive function disorders. The article is comprised the most popular assessment scales for detecting (CAM - Confusion Assessment Method) and monitoring the course of delirium (DRS-R-98: Delirium Rating Scale-Revised-98; DOM: Delirium-O-Meter). ⋯ Categories of recommendation of possible therapeutic intervention are presented with special emphasis being put on interventions that are always beneficial, useful, successful and safe. Moreover, recommendable pharmacological treatment methods (haloperidol, new antipsychotic drugs) as well as non-pharmacological ones (comprising routine screening of cognitive functions, comprehensive medical and nursing care) are described.
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Various pharmacological approaches can be used to improve glucose homeostasis. These pharmacological treatments may be used individually for certain types of patients, or may be combined to provide a more ideal glycaemic control. Metformin is widely used in pediatric patients and is considered to be the most effective oral agent. ⋯ The first oral agent used should be metformin. More severe pancreatic beta-cell dysfunction in the group of children requires insulin therapy. Some forms of monogenic diabetes can be successfully managed by sulphonylurea agents.
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It is known that exposure to smoking cues increases urge to smoke (UTS), but little is known about other media factors that might also increase UTS. We hypothesized that horror/ thriller movies might also increase UTS by increasing negative affect. We surveyed 536 movie patrons who were smokers aged 18 years or older. ⋯ Horror with smoking increased UTS by 2.8 points (95% C. I. 2.3, 3.5); the horror without smoking estimate was 0.88, but not statistically significant. This short report offers preliminary evidence that movie horror as one factor besides visual smoking cues that could increase UTS in a community setting.
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The significant increase in the prevalence of obesity in children and adolescents over past decades caused the concomitant rise in the incidence of glucose intolerance and diabetes. Impaired glucose tolerance is present in 10-27% of obese children, while type 2 diabetes accounts for more than 10% of all cases of diabetes in Caucasian adolescents. ⋯ This article presented the influence of obesity on the development and clinical presentation of different types of diabetes and addresses the problems of differential diagnosis of diabetes type in obese children and adolescents. The recommendations for case finding and the treatment options taking into account the pathophysiology underlying hyperglycemia were discussed.