Sodium–glucose cotransporter-2 (SGLT-2) inhibitors, also called gliflozins or flozins, are a class of drugs that have been increasingly used in the management of type 2 diabetes mellitus (T2DM) due to their glucose-lowering, cardiovascular (CV), and renal positive effects. However, recent studies suggest that SGLT-2 inhibitors might also have a ketogenic effect, increasing ketone body production. While this can be beneficial for some patients, it may also result in several potential unfavorable effects, such as decreased bone mineral density, infections, and ketoacidosis, among others. Due to the intricate and multifaceted impact caused by SGLT-2 inhibitors, this initially anti-diabetic class of medications has been effectively used to treat both patients with chronic kidney disease (CKD) and those with heart failure (HF). Additionally, their therapeutic potential appears to extend beyond the currently investigated conditions. The objective of this review article is to present a thorough summary of the latest research on the mechanism of action of SGLT-2 inhibitors, their ketogenesis, and their potential synergy with the ketogenic diet for managing diabetes. The article particularly discusses the benefits and risks of combining SGLT-2 inhibitors with the ketogenic diet and their clinical applications and compares them with other anti-diabetic agents in terms of ketogenic effects. It also explores future directions regarding the ketogenic effects of SGLT-2 inhibitors.

Introduction and objective: Vitamin D is a group of steroidal compounds that play an important role in calcium and phosphate metabolism. It exists in two forms, as ergocalciferol and cholecalciferol. Its deficiency is widespread globally, including Poland, especially during the autumn-winter...

INTRODUCTION Depression is a common and serious mood disorder mainly manifested by sadness, anhedonia, lack of hope and interest in activities once enjoyed. According to WHO depression is a leading cause of disability and inability to work worldwide. Chronic disease is every condition lasting more than 1 year and requiring medical attention. The aim of this article is to show challenges of depression and chronic diseases coexistence. DISCUSSION Depression might be a factor causing difficulties in diagnosing chronic diseases as patients are less likely to cooperate. On the other it might lead to worse compliance and higher risk of chronic diseases’ development. Studies show depression coexisting with chronic illnesses is a valid problem for public health and aggravates the course and effects of treatment of those conditions. Treating an underlying disease is as important as treating depression itself as it might lead to reduction in symptoms of depression. Moreover doctors should choose drugs having regard to depression as well as lingering conditions. SUMMARY Depression still seems to be diminished and ignored in patients with chronic illnesses even though it is proved to have a destructive influence on the health of patients. It is of high importance to raise an awareness of doctors on that subject and its scale. There are plenty of treatment methods for depression in case of chronic diseases co-occurence which gives hope for improving a quality of life of patients and achieving better effects of therapy of an underlying disease.

Introduction Celiac disease is a quite common condition resulting from the interaction of genetic, immunological, and environmental factors, with the main environmental factor being exposure to gluten. Non-celiac gluten sensitivity (NCGS) affects individuals without celiac disease or wheat allergy and is characterized by intestinal and extraintestinal symptoms related to the consumption of grain products, without accompanying damage to the intestinal mucosa. Discussion Gluten is a grain protein that is resistant to digestive enzymes and accumulates in the intestines, leading to tissue damage and the release of tissue transglutaminase 2 (tTG2) enzyme, which increases gluten immunogenicity. The presence of HLA-DQ2 or HLA-DQ8 gene variants in the genome is a necessary condition for the development of the disease, but it does not always lead to celiac disease. The pathomechanism of non-celiac gluten sensitivity is not yet fully understood. Diagnosis of celiac disease involves serological tests, genetic tests, and histological examination. Conclusions The only effective treatment for celiac disease is a strict gluten-free diet, which involves eliminating wheat, rye, barley, and triticale from one's diet. Further research is necessary to search for effective therapies. The approach for NCGS involves introducing an appropriate diet - either low FODMAP or gluten-free.

Introduction Irritable bowel syndrome (IBS) is the most frequent functional disorder of the gastrointestinal tract. Main symptoms are recurring stomach ache connected with defecation, changes of frequency of defecation and/or stool’s consistency. Cause of IBS is still unknown unlike its pathomechanism. Continuous research allows doctors to understand and treat it better. Discussion Diagnosing IBS might be difficult even for the most experienced doctors due to its uncharacteristic symptoms. Therefore diagnosis should be made by using Rome IV Criteria. IBS is divided into 4 subtypes basing on clinical picture: IBS with predominant constipation, IBS with predominant diarrhea, IBS with mixed bowel habits and IBS unclassified. Classification is being performed with the use of Bristol Stool Chart. Choice of remedy should be made depending on the subtype of IBS. Pharmacological treatment is symptomatic and focuses on relieving pain, diarrhea, constipation and bloating. Drugs that can be used are: loperamide, rifaximin, antispasmodic (e.g. hyoscine), antidepressants or laxatives. Treatment should also contain nonpharmacological methods. Nonpharmacological techniques which are proved to help patients contain regular physical activity, body mass reduction, low-FODMAP diet, using probiotics, psychotherapy and supplementing soluble fibre. Conclusions IBS is a big issue for public health as it is lowering quality of life and is generating big indirect costs. Difficulties in diagnosing are increasing those costs. That’s why it is of high importance to find more effective therapy. Raising awareness among doctors is crucial as plenty of methods are available to treat the disease which allows to reduce symptoms and costs.

Introduction and objective: Percutaneous coronary intervention (PCI) is the method of choice for the treatment of coronary artery disease or acute coronary syndromes, but clinicians often refrain from performing it on elderly and/or frail patients. The aimed of the study was to determine the...