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Abstract Background There is a growing burden of non-obese people with diabetes mellitus (DM). However, their cardiovascular risk (CV), especially in the presence of cardiovascular-kidney-metabolic (CKM) comorbidities is poorly characterised. The aim of this study was to analyse the risk of major CV adverse events in people with DM according to the presence of obesity and comorbidities (hypertension, chronic kidney disease, and dyslipidaemia). Methods We analysed persons who were enrolled in the prospective Silesia Diabetes Heart Project (NCT05626413). Individuals were divided into 6 categories according to the presence of different clinical risk factors (obesity and CKM comorbidities): (i) Group 1: non-obese with 0 CKM comorbidities; (ii) Group 2: non-obese with 1–2 CKM comorbidities; (iii) Group 3: non-obese with 3 CKM comorbidities (non-obese “extremely unhealthy”); (iv) Group 4: obese with 0 CKM comorbidities; (v) Group 5: obese with 1–2 CKM comorbidities; and (vi) Group 6: obese with 3 CKM comorbidities (obese “extremely unhealthy”). The primary outcome was a composite of CV death, myocardial infarction (MI), new onset of heart failure (HF), and ischemic stroke. Results 2105 people with DM were included [median age 60 (IQR 45–70), 48.8% females]. Both Group 1 and Group 6 were associated with a higher risk of events of the primary composite outcome (aHR 4.50, 95% CI 1.20-16.88; and aHR 3.78, 95% CI 1.06–13.47, respectively). On interaction analysis, in “extremely unhealthy” persons the impact of CKM comorbidities in determining the risk of adverse events was consistent in obese and non-obese ones (Pint=0.824), but more pronounced in individuals aged

Splenosis is a heterotopic autotransplantation of splenic tissue after rupture of the splenic capsule caused by injury or during elective splenectomy in the management of haematological diseases. Splenosis might cause nonspecific abdominal symptoms but is usually asymptomatic, and it is diagnosed accidentally as an abdominal tumour. It is rarely diagnosed in the paediatric population. We describe a 12-year-old female patient with hereditary spherocytosis admitted to the hospital 3 years after elective splenectomy and cholecystectomy. In medical imaging abdominal and pelvic tumours together with enlarged lymph nodes were found. During laparoscopic surgery many nodules were found with morphology similar to splenic tissue in the omentum, on the surface of small intestine, colon and peritoneum. Results of histopathological examination confirmed splenosis. Splenosis should be considered in differential diagnosis of abdominal tumours in paediatric patients with a history of elective splenectomy or spleen injury.

Abstract Background Nonalcoholic fatty liver disease is associated with an increased cardiovascular disease (CVD) risk, although the exact mechanism(s) are less clear. Moreover, the relationship between newly redefined metabolic-associated fatty liver disease (MAFLD) and CVD risk has been poorly investigated. Data-driven machine learning (ML) techniques may be beneficial in discovering the most important risk factors for CVD in patients with MAFLD. Methods In this observational study, the patients with MAFLD underwent subclinical atherosclerosis assessment and blood biochemical analysis. Patients were split into two groups based on the presence of CVD (defined as at least one of the following: coronary artery disease; myocardial infarction; coronary bypass grafting; stroke; carotid stenosis; lower extremities artery stenosis). The ML techniques were utilized to construct a model which could identify individuals with the highest risk of CVD. We exploited the multiple logistic regression classifier operating on the most discriminative patient’s parameters selected by univariate feature ranking or extracted using principal component analysis (PCA). Receiver operating characteristic (ROC) curves and area under the ROC curve (AUC) were calculated for the investigated classifiers, and the optimal cut-point values were extracted from the ROC curves using the Youden index, the closest to (0, 1) criteria and the Index of Union methods. Results In 191 patients with MAFLD (mean age: 58, SD: 12 years; 46% female), there were 47 (25%) patients who had the history of CVD. The most important clinical variables included hypercholesterolemia, the plaque scores, and duration of diabetes. The five, ten and fifteen most discriminative parameters extracted using univariate feature ranking and utilized to fit the ML models resulted in AUC of 0.84 (95% confidence interval [CI]: 0.77–0.90, p

Tetany is a condition in which serum electrolyte disturbances lead to increased neuronal excitability. We describe a case of life-threatening tetany in a 2.5-year-old boy with Dent’s disease linked with the CLCN5 gene. Dent’s disease is a renal tubular disorder characterized by a proximal tubule defect resulting in low-weight proteinuria, hypercalciuria, phosphaturia, impaired urinary acidification, nephrolithiasis/nephrocalcinosis and progressive renal failure. In the presented patient, multiple electrolyte derangements in the form of hyponatremia, hypochloremia, hypokalemia, hypocalcemia, and hypomagnesemia, determined by Dent’s disease, led to the development of diffuse muscle spasm and rhabdomyolysis, which ended with acute hyperthermia and seizures. Although, due to acuity of symptoms sepsis was suspected, the child showed dramatic improvement after the aggressive electrolyte repletion. We emphasize the need for considering tetany in patients with unstable vital signs, muscle cramping and medical conditions underlying electrolyte disorders.