Objectives Osteoporosis, a condition characterized by decreased bone strength, is prevalent among postmenopausal women but also occurs in men and women with underlying conditions or major risk factors associated with bone demineralization. The aim of this study was first of all to identify the connection between osteoporosis/osteopenia and gastrointestinal diseases. Material and Methods Obtaining and processing of patients started on 2013 and finished on 2015. The study group consisted of 200 patients, 194 female patients and 6 male patients, aged from 35 to 92 years old. These patients were patients of osteoporotic outpatient department in I. Department of Internal Medicine, in Mickiewizcova. Assessment of bone mineral density (hip and spine) was investigated by the use of whole-body densitometer. Results From the 200 patients, 48 had osteoporosis and 152 had osteopenia. Moreover, 69 of them had a positive fracture history and the most common fracture was on upper extremities. In our survey, we found out that out of 200 patients 35% had associated osteoporotic fracture and 65% did not have. In an investigation, which was done in 2000, found that from 337 patients only 28% had associated osteoporotic fracture and 71% did not have any fracture [1]. In a study, which was done in 2002, about gastrointestinal diseases and osteoporosis they found out that the most common related gastrointestinal diseases to osteoporosis are Inflammatory Bowel Disease, Celiac Disease, post-gastrectomy [2]. According to our research, we discovered that out of 200 patients only one had Celiac disease and only had post-gastrectomy. In an another study, was demonstrated that patients, who received warfarin or heparin, have an increased risk of developing osteoporosis, which complies with the result from our probe [3]. 27 patients received drugs that have an extremely strong connection with high risk of osteoporosis (ex. levothyroxine sodium, warfarin etc). Conclusion Osteoporosis is a common disease and has become a major public health problem, especially in the United States and Europe, as the number of elderly people in the population has increased. Despite the profound effect of osteoporosis on the quality of life of millions of people, preventive measures and the various treatment options can be strategically used to minimize both the morbidity of the disease and its burden on society. References [1] Ping Guo, Shikai Wang, Xiping Zhu, Xinhnua Shen, Xuemin Jin, Mincai Qian, Hongu Tang. Shanghai 2012. Prevalence of osteopenia and osteoporosis and factors associated with decreased bone mineral density in elderly inpatients with psychiatric disorders in Huzhou, China [2] Charles N. Bernstein, William D. Leslie,Meryl S. Leboff. 2003. AGA technical review of osteoporosis in gastrointestinal diseases. Department of Internal Medicine and Inflammatory Bowel Disease Clinical and Research Centre University of Manitoba Winnipeg, Manitoba, Canada. [3] Lindsay Baun, PharmD, Tricia M. Russell, PharmD, BCPS, CDE. 20 Sepember, 2011. Overview of the management of osteoporosis in women. 2011; 36(9): 30-36

Abstract: Background: Neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), and prognostic nutritional index (PNI), are immunonutritional indices, have been shown as an independent factor to predict postoperative recurrence and/or overall survival in patients with hepatocellular carcinoma (HCC). Aim: to validate neutrophilsto-lymphocytes ratio (NLR) as a predictor of post radiofrequency ablation recurrence of hepatocellular carcinoma (HCC). Patients and methods: This cross sectional prospective study was conducted on 50 Egyptian patients had radiofrequency ablation for HCC within Barcelona clinical liver cancer (BCLC) stage A. Pre-treatment laboratory tests and imaging were used to measure NLR, PLR , PNI ,Child-Pugh (CP) score, tumor number and tumor size. HCC recurrences were collected after three month. NLR and PNI at 1.73 and 11.47 were used respectively as cut-off value to calculate its prognostic effect. Results: According to NLR cut-off value, the patients with NLR >1.73 had larger tumour size, and higher rates of tumor multiplicity .After 3 month follow up 30/50 (60%) patients had tumour recurrence. Regarding recurrence after RFA showed that CTP class B (P<0.05), tumor size (P<0.05), higher rates of tumor multiplicity (P<0.05), decrease PNI (P<0.001) and increased NLR (P<0.05) after RFA and at baseline were found to be worse prognosis. A receiver-operating characteristic (ROC) analysis was used to classify patients as follows: NLR-PNI 0 group (NLR ≤ 1.73 and PNI > 11.74), NLR-PNI 1 group (NLR > 1.73 or PNI ≤ 11.74) and NLR-PNI 2 group (NLR > 1.73 and PNI ≤ 11.74). The patients with NLR-PNI 2 group had increase in number of porta hepatis lymph node, number and size of tumor, decrease serum albumin and change in PNLR. Multivariate analyses suggested increased NLR (hazard ratio [HR] =2.09; 95% confidence interval [CI] =1.88–2.55; P<0.05), increased PLR (HR=0.07; 95% CI=0.06– 0.08; P<0.05), and increased AFP (HR=59.20; 95% CI =-99.74–638.78; P<0.05) contributed to post-RFA mortality .Conclusion: High blood NLR after RFA is a predictor for worse survival and also can predict recurrence of HCC. Higher NLR-PNI score predict a worse prognosis in patients who underwent RFA. Keywords: hepatocellular carcinoma, radiofrequency ablation, neutrophil to lymphocyte ratio.

Alesia Karpovich has completed the Faculty of Medicine at the age of 25 years from Grodno State Medical University and clinical internship from Grodno State Medical University. She is the assistant of the Department of Internal Medicine. She is the author of more than 40 publications. She is working on her PhD thesis on the study of the characteristics of melatonin secretion in patients with gastroesophageal reflux disease associated with obstructive sleep apnea syndrome.

Gastroesophageal reflux disease (GERD) and obstructive sleep apnea syndrome (OSAS) are widespread medical conditions and often occur as associated disorders. There is some evidence of probable association of Barrett's esophagus development and OSAS. However, it has been proved that timely OSAS treatment results in the reduction of GERD symptoms. The issues of OSAS prediction in GERD patients have not been properly described, therefore the investigations in this area are rather topical. The investigations were carried out in 42 persons, aged 30-60 years: patients with GERD (group I, n=21) and with GERD/OSAS (group II, n=21). Daily melatonin production was assessed by concentration of 6-sulfatoxymelatonin (6-SMT) in 24-hour urine (as well as separately for day and night). The average 6-SMT concentration in group I was 32.4 (8.1; 67.9) ng/ml in 24-hours urine and 37.7 (8.1; 75.3) ng/ml in a daytime portion of urine. In group II 6-SMT concentration was significantly higher than in group I: 101.9 (72.1; 145.4) ng/ml in the 24-hour urine and 129.4 (89.6; 164.8) ng/ml in a daytime portion of urine (p < 0.0001, p < 0.0001). The positive correlation was revealed between the severity of OSAS and the level of 6-SMT in daytime urine (r = 0.50, p = 0.0008). The predictive value of concentration of 6-SMT in a daytime portion of urine was analyzed using a receiver operator characteristic (ROC) curve (AUROC = 0.90; р = 0,00016). The threshold value of 6-SMT level in a daily portion of urine is 73.08 ng/ml (sensitivity 94.4%, specificity 75%).

Dr. Miguel Lorenzo Faustino completed his undergraduate degree in Molecular Biology and Biotechnology from the the National Institute of Molecular Biology and Biotechnology in the University of the Philippines. He obtained his medical degree from the University of the Philippines College of Medicine. He is currently completing his Internal Medicine residency training program from the World Citi Medical Center in Quezon City, the Philippines.

Gastric cancer is rare before the age 40. Establishing a diagnosis in this subset of younger patients is challenging because initial symptoms are nonspecific. This case report aims to present a case of diffuse gastric adenocarcinoma in a young patient with the intent of raising awareness on its subtle presentation whose clinical diagnosis is anchored on an astute physician’s high index of suspicion. We report the case of a 35 year old, Filipino male, with no known comorbidities and no family history of malignancy, who complained of early satiety and bothersome postprandial fullness 7 months in evolution. Repeated endoscopic evaluation and CT imaging revealed linitis plastica with a rigid and thickened gastric mucosa. Multiple biopsies taken only showed increased lymphoplasmacytic infiltrates with no evidence of dysplasia, metaplasia or atrophy. In this experience, subtle presentation, inconclusive results of the diagnostic investigation, and the aggressive biology of the disease underscores the importance of the physician’s high index of suspicion in diagnosing gastric cancer in this subset of patients. Establishing a diagnosis early is crucial so that key interventions may be offered and prolong our patient’s life