The Utility of Intravenous Methylprednisolone as an Adjunct Treatment for Drug-Resistant Amiodarone-Induced Thyrotoxicosis

BACKGROUND

Amiodarone-induced thyrotoxicosis (AIT) may pose treatment challenges. We present a series of patients in which we achieved the normalisation of free T3 (FT3) using intravenous methylprednisolone (ivMP) in AIT refractory to thiamazole and oral prednisone. Namely, in three males (aged 56, 50 and 64, all with a history of AF and/or a low ejection fraction), an addition of ivMP resulted in the normalisation of FT3, which allowed successful thyroidectomy. In another case of a 65-year-old man, we initially succeeded in the normalisation of FT3 using ivMP from FT4 > 7.77 ng/dL (0.93-1.7) to 2.41 ng/dL and in that of FT3 from 14.95 pg/mL (2-4.4) to 2.05 pg/mL), but four weeks after stopping ivMP, despite the continuation of thiamazole and prednisone, there was rebound thyrotoxicosis: FT4 > 7.77 ng/dL and FT3-5.46 pg/mL. Intravenous MP was restated leading to a decline in FT4 to 2.51 ng/dL and in FT3 to 1.92 pg/mL, thus allowing a successful thyroidectomy. Finally, in a 78-year-old man with AF, goitre, and AIT resistant to thiamazole, prednisone and lithium carbonate, we obtained a reduction in FT4 to 1.51 ng/dL and in FT3 to 3.17 pg/mL after seven pulses of ivMP. Oral prednisone was gradually reduced and successfully stopped about six months later. He remained on low-dose thiamazole (5 mg od).

CONCLUSIONS

Pulse ivMP in addition to oral steroids may be a useful adjunct therapy either for the preparation of a thyroidectomy or as a treatment modality in drug-resistant AIT. Though a total cure is possible, there is a danger of a rebound worsening of thyrotoxicosis after premature discontinuation of ivMP.

A heterotypic assembly mechanism regulates CHIP E3 ligase activity

CHIP (C-terminus of Hsc70-interacting protein) and its worm ortholog CHN-1 are E3 ubiquitin ligases that link the chaperone system with the ubiquitin-proteasome system (UPS). CHN-1 can cooperate with UFD-2, another E3 ligase, to accelerate ubiquitin chain formation; however, the basis for the high processivity of this E3s set has remained obscure. Here, we studied the molecular mechanism and function of the CHN-1-UFD-2 complex in Caenorhabditis elegans. Our data show that UFD-2 binding promotes the cooperation between CHN-1 and ubiquitin-conjugating E2 enzymes by stabilizing the CHN-1 U-box dimer. However, HSP70/HSP-1 chaperone outcompetes UFD-2 for CHN-1 binding, thereby promoting a shift to the autoinhibited CHN-1 state by acting on a conserved residue in its U-box domain. The interaction with UFD-2 enables CHN-1 to efficiently ubiquitylate and regulate S-adenosylhomocysteinase (AHCY-1), a key enzyme in the S-adenosylmethionine (SAM) regeneration cycle, which is essential for SAM-dependent methylation. Our results define the molecular mechanism underlying the synergistic cooperation of CHN-1 and UFD-2 in substrate ubiquitylation.

Motives for using new psychoactive substances in three groups of Polish users: nightlife, marginalised and active on the In

OBJECTIVES

The aim of this article is to present the motives for using new psychoactive substances (NPS) among users in Poland and to evaluate the relationships between motives and consumption of different types of NPS.

METHODS

The fieldwork was conducted in four locations: in Warsaw, Krakow, Poznan, and Tricity. The study involved a total of 596 users of new psychoactive substances. Among them were: nightlife users, using NPS recreationally (N = 172), socially marginalised users (N = 86) and users active on the internet (N = 338). The technique used in the study was a self-filled questionnaire.

RESULTS

As assessed by all respondents, enhancement of mood was the most frequently indicated motive for using NPS. Among nightlife users, the NPS were most often used for the purpose of having more fun at parties. Among the marginalised users, the most common motive for using the new psychoactive substances was the desire to get intoxicated, which is a motive belonging to the group of motives related to enhancement. In the group of people active on the Internet, the most common motives for using these substances were those related to expansion.

CONCLUSIONS

Identifying motives for using new psychoactive substances may contribute to reducing the use of NPS. The recreational and marginalised users have different motives for using substances. The same conclusion applies to the use of the individual NPS. The motives of using them vary. Thus, preventive, educational and therapeutic programs should be judiciously adapted to the needs of the users as well as to the kind of substances they use.

Percutaneous Internal Ring Suturing (PIRS) – The Benefits of Laparoscopic Inguinal Hernia Repair

Introduction

The laparoscopic inguinal hernia repair in children using the PIRS technique is a well-established method. However, there are still opinions that this method does not bring more benefits than open surgery.

Purpose

The study aims to demonstrate the benefits of laparoscopic technique over conventional, open techniques.

Patients and Methods

We conducted a retrospective study that included children aged 0–18 treated using the PIRS technique in 2008–2016. The control group consisted of patients treated with the traditional, open method of inguinal hernia repair. A total of 276 children were qualified for laparoscopic surgery, and there were 274 patients in the control group. A full laparoscopic procedure was performed on 247 patients. Assessment of the pathology of the internal inguinal ring was done in all patients during the laparoscopic procedure. Intraoperatively 79 children had bilateral inguinal hernia diagnosed, 133 right-sided inguinal herniae, and 57 left-sided inguinal herniae. The occurrence of hernia was not confirmed in 7 children, whereas 53 patients had open contralateral patent processus vaginalis. In a case of contralateral patent processus vaginalis, the repair was performed using the PIRS method.

Results

The recurrence of the inguinal hernia was observed in 10 children in the laparoscopic group and in 5 cases in control group. The duration of the procedure was noted and compared to open inguinal hernia repair. There was a statistically shorter duration of the laparoscopic method. In the control group, there were 16 patients with a metachronous contralateral inguinal hernia.

Conclusion

The laparoscopic inguinal hernia repair was associated with a better assessment of hernia pathology, shorter operative time, and lower risk of contralateral hernia repair.

Electrospray-Induced Mass Spectrometry Is Not Suitable for Determination of Peptidic Cu(II) Complexes

The toolset of mass spectrometry (MS) is still expanding, and the number of metal ion complexes researched this way is growing. The Cu(II) ion forms particularly strong peptide complexes of biological interest which are frequent objects of MS studies, but quantitative aspects of some reported results are at odds with those of experiments performed in solution. Cu(II) complexes are usually characterized by fast ligand exchange rates, despite their high affinity, and we speculated that such kinetic lability could be responsible for the observed discrepancies. In order to resolve this issue, we selected peptides belonging to the ATCUN family characterized with high and thoroughly determined Cu(II) binding constants and re-estimated them using two ESI-MS techniques: standard conditions in combination with serial dilution experiments and very mild conditions for competition experiments. The sample acidification, which accompanies the electrospray formation, was simulated with the pH-jump stopped-flow technique. Our results indicate that ESI-MS should not be used for quantitative studies of Cu(II)-peptide complexes because the electrospray formation process compromises the entropic contribution to the complex stability, yielding underestimations of complex stability constants.

The Role of Nrf2 Transcription Factor and Sp1-Nrf2 Protein Complex in Glutamine Transporter SN1 Regulation in Mouse Cortical Astrocytes Exposed to Ammonia

Ammonia toxicity in the brain primarily affects astrocytes via a mechanism in which oxidative stress (OS), is coupled to the imbalance between glutamatergic and GABAergic transmission. Ammonia also downregulates the astrocytic N system transporter SN1 that controls glutamine supply from astrocytes to neurons for the replenishment of both neurotransmitters. Here, we tested the hypothesis that activation of Nrf2 is the process that links ammonia-induced OS formation in astrocytes to downregulation and inactivation of SN1 and that it may involve the formation of a complex between Nrf2 and Sp1. Treatment of cultured cortical mouse astrocytes with ammonia (5 mM NH₄Cl for 24 h) evoked Nrf2 nuclear translocation, increased its activity in a p38 MAPK pathway-dependent manner, and enhanced Nrf2 binding to Slc38a3 promoter. Nrf2 silencing increased SN1 mRNA and protein level without influencing astrocytic [³H]glutamine transport. Ammonia decreased SN1 expression in Nrf2 siRNA treated astrocytes and reduced [³H]glutamine uptake. In addition, while Nrf2 formed a complex with Sp1 in ammonia-treated astrocytes less efficiently than in control cells, treatment of astrocytes with hybrid-mode inactivated Sp1-Nrf2 complex (Nrf2 silencing + pharmacological inhibition of Sp1) did not affect SN1 protein level in ammonia-treated astrocytes. In summary, the results document that SN1 transporter dysregulation by ammonia in astrocytes involves activation of Nrf2 but does not require the formation of the Sp1-Nrf2 complex.

Negative consequences of novel psychoactive substances use among the Polish users

OBJECTIVES

The use of the novel psychoactive substances (NPS) is a relatively new phenomenon on the Polish drug scene. At the same time, it is rapidly growing group of substances. The aim of the article is to present the negative consequences to physical, mental and social health due to novel psychoactive substances use.

METHODS

Fieldwork was conducted in 2016 in four locations: Warsaw, Krakow, Poznan, and Tri-City. A total of 596 users of novel psychoactive substances participated in the study. Among them were: nightlife users (N = 172), marginalised users (N = 86) and users active on the internet (N = 338). A self-administered questionnaire was used.

RESULTS

The substances from the stimulant/empathogen/nootropics group were the most commonly used among nightlife users, marginalised users and users active on the internet. The herbal blends were less popular, and the synthetic cannabinoids appeared on the third position. The acute side effects were most common consequences. Prevalence of medium- and long-termproblems withmentaland physicalhealth as well as social problems was at a similar level. All types of negative consequences were most prevalent among marginalised users.

CONCLUSIONS

Novel psychoactive substances users experience several negative consequences. This poses a challenge to the treatment services that must answer with adequate form of help. This is not easy due to diagnostic difficulties as the effects of NPS use are often indistinguishable to the symptoms of the traditional drugs. Thus, there is a need for further research, which would allow to observe and closely monitor the problem.

Left ventricular diastolic dysfunction and diseases severity contribute to impaired exercise capacity in systemic lupus erythematosus

OBJECTIVES

Patients with systemic lupus erythematosus (SLE) have a higher risk of myocardial involvement, which can result in ventricular dysfunction. The aim of our study was to estimate potential relationship between exercise capacity assessed by six minute walk test (6MWT) and echocardiographic parameters of left and right ventricular function in SLE patients.

METHODS

We prospectively studied 66 SLE patients (57 F, age 44 (20-75) years) and 27 age matched healthy subjects. In addition to routine evaluation, 6MWT and transthoracic echocardiography including LV diastolic dysfunction parameters (E/A, E/É) were performed.

RESULTS

While E/A was similar in both groups, E/E' was higher in patients with SLE than in controls, 7.5 (4-22) vs 6.8 (1.6-9.4), p = 0.018. The mean 6MWT distance was significantly shorter in SLE (561.6 ± 150.7 vs 682.6 ± 98.1 m, p < 0.002). Among SLE patients only 53 (80.3%) were capable to walk at least 450 m, while in controls 27 (100%) (p = 0.013). We observed significant correlations between 6MWT distance and SLICC/ACR-DI (rho=-0.44, p < 0.001), E/A (rho = 0.30, p = 0.004), E/E' (rho=-0.36, p < 0.001) in SLE patients. Univariable logistic regression models revealed that SLICC/ACR-DI, E/E', tricuspid regurgitant peak gradient (TRPG), and right ventricular systolic pressure (RVSP) were associated with 6MWT distance lower than < 450 m. ROC curves shown high predictive value of E/E' ratio, TRPG, RVSP in the prediction for 6MWT distance < 450 m.

CONCLUSION

Impaired exercise tolerance seems to result mainly from the severity of SLE and LV diastolic dysfunction.

The Operative Time for Unilateral Inguinal Hernia Repair in Children Performed with Percutaneous Internal Ring Suturing (PIRS) or Open Approach Method

In this study, we compared the operative time for unilateral inguinal hernia repair in children performed with either an open approach (OA) or the Percutaneous Internal Ring Suturing (PIRS) method. It was a retrospective chart review of all patients ages 0 to 18 who underwent unilateral inguinal hernia repair in the Department of Pediatric Surgery, Urology and Traumatology of the Regional Hospital in Kielce between January 2011 and December 2018. Patients with bilateral hernias or additional problems were excluded. Of 878 patients qualified for the study, 701 were in the OA group and 177 in the PIRS group. Overall, the time needed to complete the procedure was significantly longer for the OA method. The operative time was longer if the hernia was left-sided (p = 0.024). Analysis by gender showed that operative time was generally longer in males. For both genders, surgery was shorter if the PIRS method was used. For males in the PIRS group the operative time was affected by the location of the hernia, and it was longer for a left-sided hernia. The take-home message is that the PIRS procedure is faster than the OA for inguinal hernia repair in children and it might be considered as a preferred method, especially in females.

Patients' and professionals' beliefs about the impact of social stigmatization on treatment of gambling-related disorders

OBJECTIVES

Studies carried out so far have shown that negative stereotypes concerning people with gambling disorders and, in particular, the belief that these people bear personal responsibility for their illness, can significantly contribute to the stigmatization of these people. Shame and fear of stigmatization significantly hinder the decision to start treatment. This study investigates the beliefs of respondents about the impact of stigmatization of people with gambling disorders on the social perception of treatment of gambling disorders and the beliefs of respondents about the impact of stigmatization on undertaking treatment or seeking help. Furthermore, the study investigates whether treatment can help reduce stigma and whether professionals, in some way, take this problem into account in their practice.

METHODS

In the first half of 2015, 90 semi structured individual interviews were conducted with people with gambling disorders, social workers, therapists employed in addiction treatment facilities, General Practitioners and psychiatrists.

RESULTS

The public reaction to the fact of starting treatment depends on how gambling disorder is perceived: in terms of a medical problem or rather in moral terms. Positive reviews were mainly manifested by significant others who, according to Goffman's terminology, are 'wise'. Very often, treatment means having to reveal your problem and face stigmatization. Women in particular are stigmatized because of gambling disorders. This study showed that treatment allows to getr id of guilt by acquiring knowledge on the subject of gambling disorders.

CONCLUSIONS

Addressing stigma during early stages of treatment may contribute to the continuity of treatment. Professionals should be aware of their prejudices, as their stigmatizing attitudes can influence treatment outcomes.

Psychometric properties of the Polish version of two screening tests for gambling disorders: the Problem Gambling Severity Index and Lie/Bet Questionnaire

To date, no screening tests for gambling disorders have been adapted and validated in Central and Eastern Europe. The aim of this study is to adapt the Problem Gambling Severity Index (PGSI) and Lie/Bet questionnaire (Lie/Bet) and assess their psychometric properties once translated for use with the Polish population. A mixed sample (N = 300) was drawn from venues, social media, snowballing and treatment centers. PGSI had a higher coefficient of predictive power than Lie/Bet. However, differences between validated tests are not significant. Validation of screening tests of gambling disorders showed the necessity for verification of the scale of interpretation of results when conducting tests in Poland, changing cutoff values. The PGSI and Lie/Bet tests are short and easy to apply, they can be implemented in various types of institutions: for screening patients in primary health care facilities and for identifying comorbid gambling disorders in alcohol- and drug-dependence treatment facilities, and in social welfare centers.

Antimicrobial Properties of Mandelic Acid, Gallic Acid and their Derivatives

PURPOSE

Alpha-hydroxy acids (AHAs) are one of the classes of hydroxy acids being beneficial for human health. The manuscript summarizes the biological properties of two popular members of AHAs i.e. mandelic acid (MA) and gallic acid (GA) with particular emphasis on antimicrobial properties. Moreover, attempts to design of new derivatives improving the natural properties of AHAs by using the chemical and physical approach, are discussed.

METHODS

Antimicrobial properties of MA, an arylalkyl AHA containing phenyl group attached to α-carbon, and GA, an aromatic trihydroxybenzoic acid containing the phenolic ring and carboxylic acid functional group, and their derivatives against common human and plant pathogenic fungi have been reviewed.

RESULTS

The antimicrobial activity of MA and GA is a complex phenomenon strictly correlated with other properties exhibited by these acids e.g. pro-oxidative activity, hydrophobicity. In most cases, the acids derivatives exhibited higher antimicrobial activity than acids itself. This is probably because of the higher lipophilicity of moiety that allows better penetration through the cell membrane.

CONCLUSION

MA and GA present an excellent health-promoting tool and are valuable starting materials for the design of new compounds such as metal complexes with alkali, or alkali earth metals. The lipophilic, antimicrobial, and pro-oxidative properties act synergistically supporting the pharmacological and therapeutic effect of acids and their derivatives.

Synergistic interaction of diclofenac and its metabolites with selected antibiotics and amygdalin in wastewaters

Diclofenac (DCF), a non-steroidal anti-inflammatory drug (NSAID) belongs to one of the most frequently detected pharmaceutical residues in the environment. Little is known on the interactions of DCF as well as its major biodegradation metabolites 4'-OHDCF and 5-OHDCF with chemical compounds found in wastewater, including antibiotics such as ampicillin and kanamycin. In the present work we examined the potential interactions between DCF, its metabolites 4'-OHDCF and 5-OHDCF and ampicyllin and kanamycin. We also measured the effect of the mixture of DCF with natural compound - amygdalin. We evaluated the following parameters: E. coli K-12 cells viability, growth inhibition of E. coli K-12 culture, genotoxicity, oxidative stress parameters: sodA promoter induction and ROS generation. The reactivity of E. coli SM recA:luxCDABE biosensor strain in wastewaters matrices contaminated with DCF and kanamycin was also monitored. Obtained results indicated that used antibiotics (ampicyllin, kanamycin) enhanced the toxic effect of DCF used individually and in the mixtures with its metabolites 4'-OHDCF and 5-OHDCF toward E. coli. Similar effect was also obtained in genotoxicity assay. The oxidative stress assays revealed that the highest level of ROS generation and sodA promoter induction were obtained also for the mixtures of DCF, its metabolites with antibiotics. It was also showed that amygdalin influenced the activity of DCF and its biodegradation metabolites. The strongest luminescence response of E. coli SM biosensor strain with recA:luxCDABE genetic construct in filtered treated wastewaters, comparable to control sample was noticed. Obtained results showed that DCF and its biodegradation metabolites 4'-OHDCF and 5-OHDCF can interact with tested antibiotics and compounds of natural origin, i.e. amygdalin to form mixtures showing stronger antimicrobial activity against E. coli than parent chemicals. Moreover the assays in wastewater matrices revealed that E. coli SM recA:luxCDABE biosensor strains is a good tool for bacteria monitoring in wastewater environments.

Why do people use new psychoactive substances? Development of a new measurement tool in six European countries

INTRODUCTION

New psychoactive substances (NPS) pose a public health threat. Many studies have tried to identify the reasons of NPS use; however, none of them have so far used any standardised measures. The aim of this study was (i) to develop and cross-culturally validate the New Psychoactive Substance Use Motives Measure (NPSMM) and (ii) to compare motives of NPS use across countries and user types.

METHODS

Three subgroups (socially marginalised users, nightlife attendees and members of online communities) of NPS users (N = 3023) were recruited from six EU member countries. Demographics, motives and types of NPS used were assessed. NPS use motives were measured by adapting the extended six-factor version of the Marijuana Motives Measure.

RESULTS

Exploratory and confirmatory factor analysis resulted in a similar five-factor solution across most of the countries: coping, enhancement, social, conformity and expansion motives. Marginalised users scored higher on coping and conformity motives, nightlife groups showed higher endorsement of social motive, whereas online community users showed higher scores on expansion motives. Various types of NPS were also associated with different motives.

CONCLUSION

NPS use motives might be associated with both the groups of users and the specific types of NPS being consumed. Expansion (psychedelics) and enhancement (stimulants) motives seemed to be linked to the chosen NPS product type, while coping, social and conformity motives were rather associated with user groups. NPSMM was found to be a valid instrument to measure NPS motives.

The study of biological activity of transformation products of diclofenac and its interaction with chlorogenic acid

In the present work we compared the biological activity of DCF, 4'-OHDCF and 5-OHDCF as molecules of most biodegradation pathways of DCF and selected transformation products (2-hydroxyphenylacetic acid; 2,5-dihydroxyphenylacetic acid and 2,6-dichloroaniline) which are produced during AOPs, such as ozonation and UV/H₂O₂. We also examined the interaction of DCF with chlorogenic acid (CGA). CGA is commonly used in human diet and entering the environment along with waste mainly from the processing and brewing of coffee and it can be toxic for microorganisms included in activated sludge. In the present experiment the evaluation of following parameters was performed: E. coli K-12 cells viability, growth inhibition of E. coli K-12 culture, LC₅₀ and mortality of Chironomus aprilinus, genotoxicity, sodA promoter induction and ROS generation. In addition the reactivity of E. coli SM recA:luxCDABE biosensor strain in wastewater matrices was measured. The results showed the influence of DCF, 4'-OHDCF and 5-OHDCF on E. coli K-12 cells viability and bacteria growth, comparable to AOPs by-products. The highest toxicity was observed for selected, tested AOPs by-products, in comparison to the DCF, 4'-OHDCF and 5-OHDCF. Genotoxicity assay indicated that 2,6-dichloroaniline (AOPs by-product) had the highest toxic effect. The oxidative stress assays revealed that the highest level of ROS generation and sodA promoter induction were obtained for DCF, 4'-OHDCF and 5-OHDCF, compared to other tested compounds. We have also found that there is an interaction between chlorogenic acid and DCF, which resulted in increased toxicity of the mixture of the both compounds to E. coli K-12, comparable to parent chemicals. The strongest response of E. coli SM biosensor strain with recA:luxCDABE genetic construct in filtered treated wastewaters, comparable to control sample was noticed. It indicates, that E. coli SM recA:luxCDABE biosensor strains is a good tool for bacteria monitoring in wastewater environment. Due to toxicity and biological activity of tested DCF transformation products, there is a need to use additional wastewater treatment systems for wastewater contaminated with pharmaceutical residues.

Analysis of the impact of bronchial asthma and hypersensitivity to aspirin on the clinical course of chronic sinusitis with nasal polyps

Chronic rhinosinusitis with nasal polyps (CRSwNP) is a disease with still not enough known pathogenesis despite the development of genetics, immunological and microbiological research. The number of patients with CRS has been constantly growing. The coexistence of CRS, bronchial asthma and aspirin intolerance (aspirin triad) is an adverse prognostic factor with higher risk of recurrences. The aim of study was to compare the severity of CRSwNP depending of coexistence of bronchial asthma and/or aspirin intolerance. The research was performed in the group of 204 patients operated 2009-2013 with 5 years follow-up. Higher nasal polyps growth in groups of patients with aspirin triad and CRSwNP and bronchial asthma in endoscopic examination (p=0,0005 and p=0,0030 respectively) and CT-scan according to Lund-Mackay point scale (p&lt;0,0001 and p=0,0009) was showed. Also, these patients presented increased severity of nasal symptoms before surgical treatment according to VAS scale (p=0,0126 for CRSwNP with bronchial asthma; p=0,0390 for aspirin triad). Similarly, 6 months after surgery the same groups of patients presented higher severity of the disease symptoms (p&lt;0,0001 for aspirin triad' patients; p=0,0174 for CRSwNP and bronchial asthma' patients) . Patients with aspirin triad had also statistically more surgeries in past (p=0,001), what proves that recurrences in this group are very likely to be observed in spite of the use of proper conservative treatment. No such differences have been shown in the group of patients with CRSwNP and isolated aspirin intolerance (without bronchial asthma). Allergy to inhaled allergens, hypersensitivity to aspirin are factors significantly worsening the course of CRSwNP. It would be advisable to consider, despite a lack of history of aspirin intolerance, a hypersensititvity to aspirin test in patients with particularly severe CRSwNP, especially those associated with bronchial asthma. It also seems reasonable to carry out such a test on every patient with newly diagnosed CRSwNP and bronchial asthma in order to be able to plan further treatment in this group of patients accordingly including biological treatment with antimonoclonal therapy against interleukin 4, 5 or13.

Perceived social stigmatisation of gambling disorders and coping with stigma

Aim:

This study concerns perceived social stigmatisation of gambling disorder and its determinants, the self-perceptions of people with gambling disorder (self-stigma) and how they cope with stigma.

Design:

In total, 30 interviews with persons with gambling disorder and 60 with professionals were conducted. Selective sampling procedures were employed in the recruitment phase. In the case of professionals, the inclusion criteria were employment in facilities where treatment of gambling disorder is offered, and profession. For people with gambling disorder, the criterion was a diagnosis confirmed by a psychiatrist.

Results:

Elements revealed in past research on stigma-creation processes were reflected in respondents’ statements. The type of gambling, the occurrence of negative consequences, the possibility of hiding, personal responsibility, social status and contact with stigmatised populations are perceived determinants of problem gamblers’ stigmatisation. Gambling disorder sufferers experience anxiety associated with the possibility of rejection and a fear related to their condition being revealed to others. Various manifestations of cognitive distancing and hiding were coping mechanisms identified in the study.

Conclusions:

People with gambling disorder experience anxiety associated with the possibility of rejection, and they often conceal their disorder, which may hinder their treatment. Therefore the issue of stigma should be addressed in therapy.

Metformin paradoxically worsens insulin resistance in SHORT syndrome

BACKGROUND

SHORT syndrome is an autosomal dominant condition associated severe insulin resistance (IR) and lipoatrophy due to post-receptor defect in insulin signaling involving phosphoinositide-3-kinase regulatory subunit 1 (PIK3R1), where no clear treatment guidelines are available.

METHODS

We attempted to test the efficacy metformin in a female patient with SHORT syndrome by measuring glucose and insulin during an extended Oral Glucose Tolerance Test (OGTT) in a 21-year old patient (BMI 17.5 kg/m²), who presented for endocrine assessment with a history of amenorrhoea.

RESULTS

She had lipid concentrations within the reference range, normal thyroid function tests, prolactin, gonadotropins, estradiol and androgens with Free Androgen Index 4.52. Extended Oral Glucose Tolerance Test was performed and showed severe IR. She was then started on metformin 850 mg twice a day, and had repeated OGTT. This showed dramatic worsening of glucose tolerance (e.g. glucose 96 mg/dl versus 187 mg/dl and 68 mg/dl versus 204 mg/dl at 120 and 150 min of OGTT, respectively). This was accompanied by a massive increase of already high insulin concentrations (e.g. from 488.6 to > 1000 µIU/ml, and from 246.8 to > 1000 µIU/ml at 120 and 150 min of OGTT, respectively). Insulin concentrations remained above upper assay detection limit also at 180 min of OGTT on metformin treatment (> 1000 µIU/ml versus 100.6 µIU/ml without metformin).

CONCLUSIONS

Metformin treatment may paradoxically lead to deterioration of insulin resistance and to development of glucose intolerance in SHORT syndrome. Hence, metformin treatment might be potentially harmful in these patients. Though, the precise cause of such profound and paradoxical worsening of glucose tolerance post metformin remains unknown, SHORT syndrome might prove to be an interesting model to study the mechanism(s) of metformin action.

Persistent Overexposure to N-Methyl-D-Aspartate (NMDA) Calcium-Dependently Downregulates Glutamine Synthetase, Aquaporin 4, and Kir4.1 Channel in Mouse Cortical Astrocytes

Astrocytes express N-methyl-d-aspartate (NMDA) receptor (NMDAR) but its functions in these cells are not well defined. This study shows that the sustained exposure (8–72 h) of mouse astrocytes to NMDA decreases the expression of the functional astroglia-specific proteins, glutamine synthetase (GS), and the water channel protein aquaporin-4 (AQP4) and also reduces GS activity. Similar to rat astrocytes (Obara-Michlewska et al. Neurochem Int 88:20–25, 2015), the exposure of mouse astrocytes to NMDA also decreased the expression of the inward rectifying potassium channel Kir4.1. NMDA failed to elicit the effects in those cells incubated in the absence of Ca²⁺ and in those in which the GluN1 subunit of the NMDAR was silenced with GluN1 siRNA. The downregulation of GS, AQP4, and Kir4.1 observed in vitro may reflect NMDAR-mediated alterations of astrocytic functions noted in central nervous system pathologies associated with increased glutamate (Glu) release and excitotoxic tissue damage.

What makes people with gambling disorder undergo treatment? Patient and professional perspectives

Aims:

The aim of the article is to identify factors which bring people with gambling disorder to undergo treatment. We are interested in exploring motives that trigger change; identifying factors determining choice of facility; recognising barriers and facilitators appearing during treatment.

Design:

Semi-structured interviews were conducted in Poland with people with gambling disorder, as well as with social workers, therapists, General Practitioners (GP) and psychiatrists. Purposive sampling was applied in selecting respondents. In total, 90 interviews were completed.

Results:

Internal and external motives that trigger change were identified. Among the internal motives were individuals’ own reflections often combined with a sense of guilt, and among the external motives, pressure from significant others, financial problems, law problems and somatic and mental problems. The choice of facility was made by those suffering from gambling disorder or by close family members. Factors which influenced the choice of clinics were availability (distance to the facility, sessions schedule), quality of infrastructure, assured anonymity, opinions on provided assistance, the renown of such a facility, apparent experience in treatment of gambling disorder, and the context behind the problems experienced. Individual (related to emotions and convictions,) and structural barriers (related to the treatment offer, infrastructure, personnel, and therapy programme) were identified along with the facilitators in the access to treatment.

Conclusions:

The identification of circumstances and determinants may contribute to improvements in the availability and quality of assistance provided, which could result in an increase in the percentage of patients undertaking treatment. There is a need for education aimed at increasing awareness of the problem and the possibilities of assistance as GPs and social workers very rarely recognise gambling disorder among their clients.

Correction to: Psychiatric comorbidity and intimate partner violence among women who inject drugs in Europe: a cross-sectional study

The original version of this article unfortunately missed the Acknowledgment.

Psychiatric comorbidity and intimate partner violence among women who inject drugs in Europe: a cross-sectional study

Women who inject drugs (WWID) are an especially vulnerable group of drug users. This study determined the prevalence of psychiatric comorbidity and intimate partrner violence (IPV), and factors associated with psychiatric comorbidity among WWID recruited from drug treatment services (67%) and harm reduction services in five European regions in Austria, Catalonia, Italy, Poland, and Scotland. Psychiatric comorbidity was assessed among 226 WWID using the Dual Diagnosis Screening Instrument. IPV was assessed using the Composite Abuse Scale and injecting and sexual risk behaviors were assessed using a battery of questionnaires adapted and developed for the study. Eighty-seven percent met criteria for at least one lifetime psychiatric disorder. The most common disorders were depression (76%), panic (54%), and post-traumatic stress (52%). WWID recruited in drug treatment services were almost three times as likely (OR 2.90 95% CI 1.30-6.43; p = 0.007) to meet criteria for a lifetime psychiatric disorder than those recruited from harm reduction services, specifically dysthymia (OR 5.32 95% CI 2.27-12.48; p = 0.000) and post-traumatic stress disorder (OR 1.83 95% CI 1.02-3.27; p = 0.040). WWID who reported sharing needles and syringes were almost three times as likely to meet criteria for lifetime psychiatric comorbidity than those who did not (OR 2.65 95% CI 1.07-6.56). Compared to WWID who had not experienced IPV, victims (70%) were almost two times more likely to meet criteria for post-traumatic stress disorder (OR 1.95 95% CI 1.10-3.48). Psychiatric comorbidity and IPV among WWID are common. Drug treatment and harm reduction services should address psychiatric comorbidity and IPV to improve treatment outcomes.

Barriers in Access to the Treatment for People with Gambling Disorders. Are They Different from Those Experienced by People with Alcohol and/or Drug Dependence?

A prevalence of gambling disorders is diversified depending on the region of the world. Almost three quarters of pathological gamblers had never sought a professional treatment as well as an assistance in self-help groups. Reasons why they do not initiate a treatment are complex. The aim of the article is to compare barriers to the treatment for people with gambling disorders found in presented study and barriers to alcohol and drug treatment identified in the available literature. The semi structured interviews were applied and conducted with people with gambling disorders, social workers, therapists employed in the addiction treatment facilities, General Practitioners and psychiatrists. Selection of the respondents was based on purposive sampling. In total, 90 interviews were completed. Respondents identified individual barriers as well as structural ones. Individual barriers include internal resistance and a fear of the treatment. In turn structural barriers apply to the organization of the therapy, infrastructure, personnel, and the therapeutic program. A comparison of barriers experienced by people with gambling disorders and substance use disorders showed that they are largely similar, but people with gambling disorders also experience specific barriers. Empirical studies focused specifically on treatment needs of people experiencing gambling disorders may improve an offer of help for them. More adequate treatment options could contribute to the increasing in the number of people who start the treatment. It can result in improving their quality of life and may have positive impact on public health.

Addison's disease concomitant with corticotropin deficiency and pituitary CRH resistance - a case report

A 36-year-old woman was found to have a low morning ACTH concentration despite a history of Addison's disease. Past medical history: At the age of 23 years the subject developed Graves's disease, which was treated with radioiodine. At about the same time, she claimed to have two episodes of pancreatitis treated with cholecystectomy. About seven months later she was euthyroid on L-thyroxine (TSH 1.51 mIU/mL) but was admitted with hypotension, hyponatraemia (sodium 109 mmol/L), and low morning cortisol (119 nmol/L). Further investigations confirmed primary adrenal failure with ACTH concentration of 779 pg/mL (ref. range 0-60) prior to the dose of hydrocortisone. About nine years later she complained about tiredness. Clinically she was normotensive and not pigmented. BMI 22.3 kg/m². Periods were regular. ACTH concentration was surprisingly low (ACTH 8.53 pg/mL, ref. range 0-46), despite very low cortisol (3.37 nmol/L). She was admitted for further assessment.

INVESTIGATIONS

Pituitary MRI scan was unremarkable. An insulin tolerance test was performed and showed a clear increase of ACTH (from 15.2 to 165 pg/mL). There was, however, hardly any increase of ACTH after CRH stimulation (from 6.05 pg/mL to 10.2 pg/mL), thus demonstrating central CRH resistance. In summary, this patient developed secondary adrenal failure in the setting of previous Addison's disease. Interestingly, hypoglycaemia (but not CRH) provided a stimulus for ACTH release, thus demonstrating CRH resistance. The case confirms that besides CRH, other factors are responsible for stimulation of the ACTH-cortisol axis during insulin tolerance test.

Barriers in Access to the Treatment for People with Gambling Disorders. Are They Different from Those Experienced by People with Alcohol and/or Drug Dependence?

A prevalence of gambling disorders is diversified depending on the region of the world. Almost three quarters of pathological gamblers had never sought a professional treatment as well as an assistance in self-help groups. Reasons why they do not initiate a treatment are complex. The aim of the article is to compare barriers to the treatment for people with gambling disorders found in presented study and barriers to alcohol and drug treatment identified in the available literature. The semi structured interviews were applied and conducted with people with gambling disorders, social workers, therapists employed in the addiction treatment facilities, General Practitioners and psychiatrists. Selection of the respondents was based on purposive sampling. In total, 90 interviews were completed. Respondents identified individual barriers as well as structural ones. Individual barriers include internal resistance and a fear of the treatment. In turn structural barriers apply to the organization of the therapy, infrastructure, personnel, and the therapeutic program. A comparison of barriers experienced by people with gambling disorders and substance use disorders showed that they are largely similar, but people with gambling disorders also experience specific barriers. Empirical studies focused specifically on treatment needs of people experiencing gambling disorders may improve an offer of help for them. More adequate treatment options could contribute to the increasing in the number of people who start the treatment. It can result in improving their quality of life and may have positive impact on public health.

Familial partial lipodystrophy as differential diagnosis of polycystic ovary syndrome

According to current diagnostic criteria, polycystic ovary syndrome (PCOS) is effective as a diagnosis of exclusion. Here, we present a case of a 31-year-old woman with a history of oligomenorrhoea and hirsutism, who, despite a "muscular" appearance and a normal body mass index (22.27 kg/m2), was found to have an extreme insulin resistance and diabetes accompanied by hyperandrogenism and polycystic ovaries. An autoimmune screen for possible latent autoimmune diabetes in adults was negative. She was subsequently found to have familial partial lipodystrophy (FPLD2, OMIM #151660) caused by an R482Q mutation in the LMNA gene encoding lamin A/C. This mutation results in arginine to glutamine substitution at the protein level, while phenotypically this condition presents with a loss of body fat, insulin resistance, dyslipidaemia, and other features mimicking PCOS. Interestingly her mother, with a history of myocardial infarction and diabetes at the age of 46 but no oligomenorrhoea, was also found to harbour the same mutation (LMNA R482Q).

CONCLUSIONS

Our case highlights the importance of assessment of adipose tissue distribution, as well as a significance of assessment of glucose tolerance and insulin resistance in the differential diagnosis of PCOS. Furthermore, patients with atypical adipose tissue distribution should be referred for formal genetic testing.

Pendulum swings from hypo- to hyperthyroidism: thyrotoxicosis after severe hypothyroidism following neck irradiation in a patient with a history of Hodgkin's lymphoma

Background

A change in a thyrometabolic state from severe hypothyroidism to thyrotoxicosis is very uncommon, but possible in some circumstances.

Case presentation

A 27-year old female presented with clinical and biochemical thyrotoxicosis with a previous history chemo- and radiotherapy (including the neck region) for a Hodgkin’s lymphoma (at the age of 18). At the age of 20 this was followed by severe hypothyrodism [TSH > 100 μIU/mL (reference range: 0.27–4.2)]. She was stated on L-thyroxine, but the dose was later reduced and subsequently discontinued. She had significantly elevated titres of both anti-thyroid peroxidase antibodies and anti-TSH-receptor antibodies throughout the course of disease. Thyroid scintigraphy revealed a normal and homogenous iodine uptake.

Conclusions

We suspect that a gradual switch from thyroid-blocking to thyroid-stimulating antibodies resulted in development of an overt thyrotoxicosis, possibly with a contributory effect of neck irradiation on her autoimmune status.

A single bolus of high dose levothyroxine (L-T4) as a test in cases of suspected poor compliance to L-T4 therapy

BACKGROUND

Though compliance (or adherence) problems, as well as inappropriate levothyroxine (L-T4) intake (e.g. with meal, other drugs or certain foods that can significantly affect absorption) are very common, the issue is often either not mentioned or even frankly denied by patients.

CASE PRESENTATION

We describe three cases of patients who presented with high TSH (ranging from about 30 to 200 mIU/l), with concomitantly either high, normal or low free thyroxine (FT4), despite treatment with high doses of L-T4. The above mentioned problems with adjustment of L-T4 dose persisted for several months or even years. Coeliac disease screen was negative in all cases. In all these patients administration of a single bolus of L-T4 (1000 μg) or two doses of 1000 μg of L-T4 within 48 h resulted in a quick increase in FT4 (thus confirming proper absorption) and in normalization of TSH within a week. No adverse effects of administration of these high doses of L-T4 were observed.

CONCLUSIONS

Our data support the efficacy, as well as safety of administration of single bolus of high dose L-T4 as a test for possible compliance/adherence problems.

The legal highs problem in the Polish printed media--actors, claims, and its hidden meanings

The authors present the results of a qualitative analysis of press articles focused on legal highs in Poland. The aim of analysis was the identification of all social actors involved in the media discourse, the arguments used, and the claims made in the frame of social, political, economical, legal, and moral issues. This analysis covered two major daily newspapers--Gazeta Wyborcza and Rzeczpospolita and two weeklies--Polityka and Newsweek. Articles were collected during a systematic analysis covering the complete number of issues starting from 2008 to 2011. As a result, a base of 386 articles was developed. The study was founded by the statutory budget.

Case report: When measured free T4 and free T3 may be misleading. Interference with free thyroid hormones measurements on Roche® and Siemens® platforms

: A 59-year old female patient presented with apathy and 6 kg weight gain. Investigations revealed severe primary hypothyroidism (TSH>100 μIU/ml). L-thyroxine (L-T4) was started and titrated up to 75 μg, once daily, with clinical improvement. Other investigations revealed very high titres of anti-thyroid peroxidase (anti-TPO) and anti-thyroglobulin (anti-Tg) antibodies. After three months, there was a fall in TSH to 12.74 μIU/ml, however, with unexpectedly high free T4 (FT4) - 6.8 ng/ml and free T3 (FT3) - 6.7 pg/ml concentrations [reference range (rr): 0.8-1.9 ng/ml and 1.5-4.1 pg/ml (Siemens®), respectively]. At this stage L-T4 was stopped, and this was followed by a rapid increase in TSH (to 77.76 μIU/ml) and some decrease in FT4 and FT3, however FT4 concentration remained elevated (2.1 ng/ml). Following this, L-T4 was restarted. On admission to our Department, she was clinically euthyroid on L-T4, 88 μg, once daily. Investigations on Roche® platform confirmed mildly elevated TSH - 5.14 (rr: 0.27-4.2 μIU/ml) with high FT4 [4.59 (rr: 0.93-1.7 ng/ml)] and FT3 [4.98 (rr: 2.6-4.4 pg/ml)] concentrations. Other tests revealed hypoechogenic ultrasound pattern typical for Hashimoto thyroiditis. There was no discrepancy in calculated TSH value following TSH dilution (101% recovery). Concentrations of FT4 and FT3 were assessed on the day of discontinuation of L-T4 and after four days by the means of Abbott® Architect I 1000SR platform. These revealed FT4 and FT3 concentrations within the reference range [e.g., FT4 - 1.08 ng/ml (rr: 0.7-1.48)] vs 4.59 ng/ml (rr: 0.93-1.7, Roche®), FT3 - 3.70 pg/ml (rr: 1.71-3.71) vs 4.98 (rr: 2.6-4.4, Roche®)], confirming assay interference. Concentrations of ferritin and SHBG were normal.

CONCLUSIONS

Clinicians must be aware of possible assay interference, including the measurements of FT4 and FT3 in the differential diagnosis of abnormal results of thyroid function tests that do not fit the patient clinical presentation.

[Fungal rhinosinusitis - still unsolved problem]

Chronic rhinosinusitis (CRS) is an inflammatory disease affecting the nose and paranasal sinuses. Fungi are considered to be one of the pathogens responsible for some kinds of CRS. Fungal rhinosinusitis - the classifications schemes, the diagnostic criteria and methods of treatment are still being discussed. 338 patients underwent the endoscopic sinus surgery due to CRS in the Otolaryngology Department of the Medical University of Lodz in the years 2009-2011 (February). The histopathological examination revealed fungi only in three patients. The authors report three cases of patients with fungal rhinosinustis - the fungal ball of the sphenoid sinus in one patients, the fungal ball of the maxillary sinus in the second one and non-invasive fungal rhinosinusitis. The different classifications and diagnostic criteria are also presented. Based on the publications using updated diagnostic standards and sensitive techniques to detect fungi, a higher number of patients can now be diagnosed with fungal rhinosinusitis.

Comparison of on-admission ST-segment elevation tako-tsubo patients and myocardial infarction women: in-hospital course and long-term follow-up

BACKGROUND

Tako-tsubo cardiomyopathy (TTC) is an uncommon transient cardiomyopathy with a clinical and electrocardiographic (ECG) presentation similar to that of ST-elevation myocardial infarction (STEMI).

AIM

To compare clinical presentation, in-hospital course, and long-term outcomes in TTC female patients with on-admission ST-segment elevation and anterior STEMI female patients.

METHODS

Consecutive TTC patients with on-admission ST-segment elevation were selected. Using a propensity score, a matching STEMI control group was put together. The patients were followed for a mean 1,002 ± 552 days. Major adverse cardiac events were defined as TTC recurrence, MI recurrence, heart failure requiring hospitalisation, percutaneous coronary intervention, coronary artery bypass grafting, stroke and death.

RESULTS

Forty one TTC patients were enrolled, including 29 women with on-admission ST-segment elevation. The control group consisted of 46 STEMI women with left anterior descending occlusion. The ECG at presentation showed greater ST- -segment elevation (6.0 ± 1.6 vs 2.0 ± 1.2 mm, p < 0.01) in the control STEMI patients than in the TTC group. Also, baseline CK-MB (16.2 ± 20.6 vs 66.0 ± 125.2 ng/mL, p < 0.01) and troponin-I levels (2.99 ± 5.36 vs 42.70 ± 64.79 ng/mL, p < 0.01) were significantly higher in the STEMI patients. Echocardiography showed higher follow-up ejection fraction in the TTC than in the STEMI group (57.0 ± 8.0 vs 49.5 ± 8.8%, p < 0.01). During follow-up, there was no significant difference in the major adverse cardiac events rate between the TTC and STEMI groups (-24.1% vs 41.3%, p = 0.13).

CONCLUSIONS

Although there is some diversity in ECG, laboratory, and ECHO parameters, none of these patterns alone can reliably distinguish TTC from MI in female patients. TTC and STEMI females have similar in-hospital and long-term outcomes.