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Limb amputation often results in a change of profession or withdrawal from the workforce. Occupational rehabilitation plays a key role in assisting individuals with finding, maintaining, and advancing in employment. The aim of this review was to determine the precise number of amputations performed in Poland from January 2014 to June 2022 and to present selected available rehabilitation programs aimed at the social reintegration of individuals after amputations, with a particular focus on vocational rehabilitation. The analysis was conducted in 2 stages. First, the team reviewed data obtained from the central IT system of the National Health Fund and analyzed it. Then, a literature review was conducted using English-language databases: PubMed, Scopus, Science Direct, Medline, and websites searched through Google Scholar and Google. A total of 29 sources (from the years 2006-2024) out of 75 found were analyzed. Articles were searched using the following keywords: "rehabilitation programs," "amputations," "occupational rehabilitation," "disability," "vocational activation," and "rehabilitation effectiveness." A significant number of amputations are performed in Poland. Individuals who undergo such procedures can benefit from occupational rehabilitation programs that facilitate a faster return to professional activity. It is crucial to develop and implement preventive measures aimed at reducing the incidence of amputations in Poland, as well as to introduce new vocational rehabilitation programs that will enable individuals with disabilities to return to professional activity more effectively and efficiently. Med Pr Work Health Saf. 2024;75(5)., (This work is available in Open Access model and licensed under a CC BY-NC 3.0 PL license.)

Objectives: Anxiety disorders are significant predictors of suicidality and are proposed to be independent risk factors for suicide attempts. They are common in people with type 2 diabetes (T2DM) and are associated with longer duration of diabetes and poorer treatment outcomes. The aim was to examine associations between anxiety disorders and suicidal thoughts and behaviour in people with T2DM, to establish the prevalence of suicidality among people with T2DM in the selected European countries and to examine whether anxiety disorders were predictive of current outcomes of suicidality in this population using data from the International Prevalence and Treatment of Diabetes and Depression study., Methods: The study sample comprised 1063 adults with T2DM from 6 European countries. The presence of anxiety disorders and suicidality was assessed with the MINI International Neuropsychiatric Interview. The group of participants with current suicidal risk was compared with the group of participants with no suicidal risk., Results: The participants from Germany were more likely to report suicidality than those from other countries, whereas people from Serbia and Ukraine were less likely to report it. Depression and anxiety disorders significantly contributed to the increased presence of suicidality among people with T2DM. Agoraphobia was a significant predictor of suicidality when controlling for depression. The participants with T2DM and comorbid agoraphobia had 4.86 times higher odds to report suicidality than those without agoraphobia., Conclusions: Agoraphobia was a significant predictor of suicidality in people with T2DM.

Apart from insulin, physical exercise is a crucial component of therapy in patients with type 1 diabetes mellitus (T1DM). The benefits of physical activity in such patients include improved insulin sensitivity, lowered blood glucose, reduced body fat and improved cardiovascular function and physical performance. Hypoglycemia is a crucial issue in the peri-training period in insulin-treated patients. Proper preparation for exercise is the key to reducing the risk of hypoglycemia. The selection of the training type and the patient's knowledge of the effect of such training on glycemia are also significant. Physical exercise under normobaric hypoxia in the training rooms is also available commercially and is becoming increasingly popular. Under such conditions, the air consists of 15.4% oxygen and 84.5% nitrogen, which corresponds to the conditions at an altitude of approximately 2,500 meters above sea level. Hypoxia induces the production of the hypoxia-inducible factor (HIF-1), which regulates the expression of over 100 genes. It modulates key metabolic pathways to optimize glucose utilization by increasing cell sensitivity to insulin, more efficient glucose uptake from the blood and activating effect on glycolytic enzymes. Additionally, HIF-1 shows beneficial effects on the lipid profile, vascular endothelium and performance as measured by the maximal oxygen uptake (VO2max). The aim of this paper was to review and summarize the most recent studies on the effects of exercise on glycemic control and physical performance under normoxia and normobaric hypoxia in patients with T1DM.

IgG4-related disease belongs to the group of immune-mediated diseases. It is a relatively new condition, classified in 2003. It is characterized by involvement of multiple organs, over time causing organ failure. The observed radiological changes are slow growing. As a rule, the course of the disease is subclinical, which means that the diagnosis is often made incidentally, retrospectively and many years after the onset of symptoms. In the initial stage of diagnosis, it is often confused with Sjögren's syndrome, systemic vasculitis, or neoplastic disorders., A Case Report: We report the case of a female patient who was diagnosed with glomerulonephritis at the age of 34. The patient was qualified for renal replacement therapy with chronic hemodialyses in 2020 due to end-stage renal disease. In the same year, the patient was hospitalized for pneumonia of unknown etiology. After discharge from the hospital, the patient developed fever up to 39oC, chills, and pleural fluid. A suspicion of systemic disease was raised. Computed tomography of the chest showed enlargement of the anterior and middle mediastinum with increased densitization of adipose tissue and enlargement of mediastinal lymph nodes. Antibiotic therapy was introduced, followed by systemic corticosteroids, resulting in clinical improvement and remission of infiltrative lesions in radiological studies. The differential diagnosis excluded neoplastic lesions of the left lung, systemic connective tissue diseases, e.g. systemic lupus erythematosus and systemic vasculitis. Taking into account the whole clinical picture the suspicion of IgG4-related disease was raised. After the treatment, serum IgG4 level was found to be normal at 36.6 mg/ dl, anti-nuclear antibodies (ANA) were negative, rheumatoid factor was not elevated, complement component 4 (C4) was normal, complement component 3 (C3) decreased to 71 mg/dl (n: 90-180 mg/dl). Treatment with prednisone 10 mg/day was maintained. Histopathologic reanalysis of the renal biopsy (from a biopsy performed in 2012) was performed, which showed lymphocytic infiltration in the renal interstitium with segmental vascular loop sclerosis in the glomeruli and the presence of abundant granular IgG4 deposits in the glomerular mesangium by immunofluorescence., Conclusions: IgG4-related disease poses great diagnostic difficulty due to its non-specific and long-term course. Patients usually seek help with various specialists many years before the full picture of the disease is presented. It is poorly understood as it is a recently described condition (two decades ago). The classification criteria of IgG4 disease developed in 2019, the growing number of publications and recommendations being developed give hope for better understanding and more efficient diagnosis of the disease., (© 2022 MEDPRESS.)

Red man syndrome (RMS) is a side effect of vancomycin therapy and manifests itself mainly by a red blotchy rash with itching and sometimes muscle pain and a decrease of arterial blood pressure., A Case Report: 24-year-old patient admitted to hospital with a history of chest pain radiating to the back. EKG has shown the depression of PQ, in the ECHO mark of liquid in the pericardial cavity and the increase of CRP and troponin concentrations. The patient was diagnosed with acute pericarditis and treated with ibuprofen and colchicine. Due to the increasing parameters of inflammation, a bacterial etiology was suspected and vancomycin was administered. During antibiotic therapy, there were symptoms of a mild adverse reaction in the form of a maculopapular rash and periodic decreases in blood pressure. RMS was diagnosed and symptoms resolved after treatment with cetirizine., Conclusions: RMS should be distinguished from anaphylaxis and treated according to the diagnosis., (© 2022 MEDPRESS.)

The ongoing pandemic of coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has completely transformed the functioning of health care facilities. These changes have also significantly affected the work of dental health professionals. Due to the high infectivity of the virus and the fact that transmission occurs primarily through respiratory droplets, both dental patients and professionals are particularly exposed to coronavirus infection. In order to reduce the risk of COVID-19 transmission, a number of medical societies have issued recommendations for the provision of health care services during the pandemic. The article is based mainly on the recommendations of the Polish Ministry of Health, since WHO recommendations underline that following updated local guidelines is of highest importance. It is impossible to outline uniform guidelines for all dental specialists in the world, as the pandemic develops at differing rates in different countries and each country requires guidelines adapted to the current local epidemiological situation. The publication features an additional review of foreign literature and guidelines proposed by individual dental societies. The article presents an overview of guidelines related to the functioning of dental offices, dental treatment procedures and recommended personal protective equipment, as well as underlines the overriding principle that both physicians and dental practitioners should first and foremost take care of their own health in order to be able to protect others. Med Pr. 2021;72(5):561-8., (This work is available in Open Access model and licensed under a CC BY-NC 3.0 PL license.)

Still disease is a rare systemic connective tissue disease of unknown etiology, which due to nonspecific symptoms, requires thorough diagnostics. Steroids are the basis treatment, while other immunosuppressive drugs should be applied for patients who are resistant to standard therapy., A Case Report: A 36-year-old woman was admitted to the Department of Rheumatology due to a month history of persisting fever, arthralgia, cervical lymphadenopathy, soar throat, cutaneous lesions, liver transaminases elevation, hyperferritinemia and elevated inflamatory markers. Basing on the clinical presentation and additional diagnostic examinations the adult-onset Still's disease (AOSD) was diagnosed. Initially the patient was placed on steroids and cyclosporine but due to the severe clinical course requiring high doses of steroids and relapses triggered by the tapering of the dose, the decision to initate the treatment with cyclophosphamide was made. It eventually led to the fast and lasting remission and allowed tapering and subsequent discontinuation of the steroids., Conclusions: Treatment with cyclophosphamide may be a viable and efficient therapeutic option in severe and refractory cases of AOSD., (© 2021 MEDPRESS.)

Background: Vitamins A, C and E are important parts of the antioxidant barrier. Polish data on antioxidant vitamins deficiency in the population are rare, especially among physically active people with metabolic disorders. The aim of this study was to evaluate the serum concentrations of vitamins A, C and E in people with metabolic syndrome (MS) working in agriculture, the prevalence of their deficiency in these workers, and the correlation between antioxidant vitamins concentration and traditional biomarkers of cardiovascular diseases., Material and Methods: The study included 332 residents of the Łódź Voivodeship working in agriculture: 231 people with MS and 101 healthy ones. The serum concentrations of vitamins A, C and E were assessed using the chemiluminescent immunoassay technology. The antioxidant vitamins intake was assessed by means of a 24-h recall questionnaire using Diet 5.0 software., Results: The mean serum concentrations of vitamins A, C and E were significantly lower in the MS workers than in the healthy ones No correlation was found between the antioxidant vitamins concentration and the dietary intake but there was a correlation between the antioxidant vitamins concentration and high-density lipoprotein cholesterol (HDL-C). A correlation was found between the serum concentrations of vitamins A and C, and vitamins A and E, in the MS workers., Conclusions: The serum concentrations of antioxidant vitamins in the MS workers were significantly lower than in the healthy controls, despite the similar physical activity level. The dietary intake had no impact on the serum concentrations of these vitamins. The HDL-C concentration in the MS workers correlated with the concentrations of all antioxidant vitamins. Med Pr. 2021;72(2):123-9., (This work is available in Open Access model and licensed under a CC BY-NC 3.0 PL license.)

Background: Polish data on vitamin D deficiency in the population are incomplete. Vitamin D deficiency seems to be common, but there is a lack of studies concerning the concentration of 25(OH)D in people with high UV exposure. The aim of this study was to evaluate the plasma concentration of 25(OH)D in people with and without metabolic syndrome (MS), working in agriculture, the prevalence of its deficiency in these workers, and the correlation between the plasma concentration of 25(OH)D and traditional biomarkers of cardiovascular diseases., Material and Methods: The study included 332 people working in agriculture in the Łódź voivodeship, including 231 people with MS and 101 healthy ones. The plasma concentration of 25(OH)D was assessed using the chemiluminescent immunoassay technology. The vitamin D intake was assessed using a 24-h recall questionnaire using Diet 5.0 software., Results: The mean plasma concentration of 25(OH)D was 13.64±8.01 ng/ml in MS workers, and it was significantly lower than in the healthy ones (26.61±10.12 ng/ml, p < 0.00001); the highest concentration of 25(OH)D was noted in summer months. Deficient plasma concentrations of 25(OH)D were found significantly more often in MS workers than in the controls (81.82% and 20.79%, respectively, p < 0.00001). No correlation was found between the plasma vitamin D concentration and its dietary intake. The plasma concentration of 25(OH)D correlated with age of the examined workers (r = -0.28, p = 0.023), high density lipoprotein concentration (r = 0.19, p = 0.036) and glucose concentration (Rho = -0.24, p = 0.02). A multivariate analysis of variance demonstrated that the body mass index affected significantly the mean value of the 25(OH)D concentration in MS workers., Conclusions: The concentration of vitamin D in the plasma of workers with MS was significantly lower than in the healthy controls despite the same high UV exposure; these workers also manifested significantly higher 25(OH)D deficiency than the control subjects. This study indicates the need for further research on the concentration of 25(OH)D in people with metabolic disorders regardless of UV exposure and vitamin D intake with a diet. Med Pr. 2021;72(1):9-18., (This work is available in Open Access model and licensed under a CC BY-NC 3.0 PL license.)

Graves' orbitopathy (GO) is an extrathyroidal manifestation of Graves' disease (GD). The majority of patients has mild form of the disease, with no need of additional treatment. A few percent of patients can have a severe or very severe course of disease. In severe forms of GO there might occur considerable exophthalmos complicated in some cases with corneal ulceration or pressure on optic nerve leading to neuropathy (DON, dysthyroid optic neuropathy). In therapy of severe forms of GO different types of treatment are used depending on diagnosis and activity of disease. The pharmacological (among the others very high doses of intravenous methylprednisolone) and surgery treatment (orbit decompression) are used. The orbital decompression is a procedure performed in order to decrease the intraorbital pressure by removing part of its bony borders in cases with excessive mass in orbit. For decades many external approaches have been used. With the progress of the endoscopic techniques the endoscopic orbit decompression has become the first line treatment. The lack of facial incisions is connected with many benefits for patients. In our article endoscopic decompression technique in GO was described, as well as available medical literature concerning this technique and its outcomes was performed., (© 2019 MEDPRESS.)

The recognition of sepsis is connected with potentially bad prognosis, high mortality rate and high costs of the therapy. A new definition of sepsis was introduced in 2016. The main role of dysfunction of organs in the course of infection, the potential threat for life and necessity to perform quick diagnosis result from this definition. The review of worldwide literature on sepsis epidemiology and therapy costs was done in the current article. It was observed that the data concerning incidence of sepsis in Polish hospitals are incomplete, related to single observations, and in most cases they come from retrospective analyses. Therefore, the nation-wide registry comprising the data of the sepsis cases should be established., (© 2018 MEDPRESS.)

The exponetial growth in popularity of electronic cigarettes in the world markets intensifies the debate about their health effects. The smoking of traditional tabacoo products is a factor associated with the endothelium damage and progression of atherosclerosis. The elimination of the combustion process in electronic cigarettes allows to conclude that they are less harmful to a vascular endothelium than traditional tobacco products. E-cigarette aerosol contains many compounds that have an influence on initiation and progression of atherosclerosis. Nicotine protherogenic action is not fully explained. On one hand, nicotine modifies metabolic pathways leading to atherosclerosis, whereas epidemiological studies do not show an increased risk of cardiovascular disease in the population using nicotine replacement therapy or snuff. Acrolein, formaldehyde and the ultrafine particles generated during e-liquid heating have an impact on initiation and progression of atherosclerosis, but their level is lower than that of tobacco smoke. In order to assess accurately the longterm effects of e-cigarettes, it is necessary to conduct epidemiological studies measuring the effects of using e-cigarettes. It is claimed that the use of electronic cigarettes has a potential impact on the development of atherosclerosis, but is significantly lower than that of traditional cigarettes.

Indacaterol, as well glycopyronium has been reimbursed lately in Poland, so patients have a greater access to this treatment in medical practice. Physicians do not realize the potential benefit of once daily ultra-LABA indacaterol and/or modern LAMA with fast-acting glycopyrronium on treatment results., Aim: The aim of the study was to evaluate the impact of routinely administered treatment with either indacaterol (Onbrez) or glycopyrronium (Seebri) or both on patient reported outcomes in form of the health status (CCQ score - clinical COPD questionnaire) and level of dyspnoea (mMRC - modified Medical Research Council) in treatment naive COPD patients after the change of treatment as addon from any other COPD treatment in "real life" settings., Materials and Methods: This study was designed as an observational, non-interventional and multicenter project in COPD patients being treated with Onbrez and/or Seebri in 32 medical centers in Poland. The observation period covered 6 months from the first taking of Onbrez and/or Seebri. No diagnostic or monitoring or treatment procedures have been applied to the patients, other than those which are applied in the course of standard, current practice. The total number of enrolled patients was 633. Because of inability of verification the medical records or failure to meet data collection requirements 587 patients enrolled to the registry has been evaluated. Within this number of patients 171 had delayed the time of visits or they had not second visit. Due to therapy change additional 20 patients has been withdrawn. 396 patients were taken for the final analysis., Results: Improvement of mMRC and CCQ scores was observed in all treatment groups e.g. indacaterol solely, glycopyrronium solely and combination therapy of indacaterol and glypyrronium., Conclusions: The study revealed that the best results can be achieved with combination therapy accordingly with clinical recommendation for COPD treatment (GOLD). The results have been achieved in the real world settings, showing that this treatment may be used in daily routine practice by general practitioners.

Immunoglobulin G4-related disease (IgG4-RD) is a comparatively new condition that may involve more than one organ. The lack of characteristic, pathognomonic clinical symptoms may delay the diagnosis of this disease. The diagnosis is based upon clinical manifestation, elevated serum levels of IgG4 and histopathologic examination with immunohistochemical staining to reveal infiltration of IgG4-positive plasma cells. The first line treatment is oral glucocorticoids., A Case Report: 38-year-old woman with Hashimoto disease, chronic sinusitis and chronic hepatitis of unknown etiology was admitted to the Department of Endocrinology because of moderate eyelids swelling accompanied by redness for 3 years. Graves' orbitopathy and systemic vasculitis were suspected, however both were excluded (negative antibodies results: anty-TSHR, ANCA, ANA). Serologic investigation of Sjögren's syndrome was also negative. In Magnetic Resonance Imaging (MRI) of orbits there were described bilateral mild extension of lateral rectus muscles, normal signal of adipose tissue and bilateral lacrimal glands enlargement. Moreover, increased IgG4 serum levels were detected. The material derived from perinasal sinuses surgery was analyzed in histopathology examination with immunohistochemical staining, which revealed characteristic features of chronic inflammatory process and increased numbers of IgG4 - positive plasma cells (>50 in a large field of view). The diagnosis of IgG4-RD was established. Because of non-effective oral methylprednisolone therapy in the past, the patient was referred to Clinic of Rheumatology for further treatment. After the therapy with methylprednisolone and azathioprine there were observed the significant reduction of symptoms., Conclusions: Because of lack of characteristic symptoms of IgG4- RD, it should be always considered in differential diagnosis of chronic inflammatory diseases of various organs.

Atherosclerosis is an inflammatory process that develops in the coronary arteries. Clinically active agents such as proinflammatory interleukins, TNF-α, tissue inhibitors of metalloproteinases (including TIMP-1), and vascular endothelial growth factor (VEGF), are important factors in the development of acute coronary syndromes., Aim: The aim of the study was to evaluate the effect of cardiac rehabilitation (stage II) on the concentration of selected vascular active factors (IL- 1, IL-6, TIMP-1, VEGF)., Materials and Methods: The study involved 24 patients after ACS who underwent complex cardiac rehabilitation (stage II) in the Department of Internal Medicine and Cardiac Rehabilitation at the Medical University of Lodz. The study involved 20 men and 4 women aged 42-78 years (average age 58.75 ± 8.45 years). The ELISA method was used in the vascular endothelial cell assay using readymade sets for determining individual molecules: Human Quantum ELISA Kit (DTM100; R & D Systems, BIOKOM, Poland), Human VEGF Quantikine ELISA Kit (DVE00; R & D Systems, BIOKOM, Poland) Human IL-1 beta / IL-1F2 Quantikine ELISA Kit (DLB50; R & D Systems, BIOKOM, Poland), Human IL-6 Quantikine ELISA Kit (D6050, R & D Systems, BIOKOM, Poland). TIMP-1 concentration is expressed in ng / ml, VEGF in pg / ml, IL-1 in pg / ml, IL-6 pg / ml. The results of the study were analyzed statistically at significance level p <0,05., Results: There was no significant effect of cardiac rehabilitation on vascular endothelial factors: TIMP-1, VEGF, IL-6. Significant effect of cardiac rehabilitation was observed on the increase of IL-1 concentration (p=0.016)., Conclusions: The absence of post-cardiac rehabilitation in patients after ACS, significant changes in vascular endothelial activity, confirm the hypothesis that adequate physical effort does not involve changes in blood concentrations and justifies perception of rehabilitation as a safe and risk-free intervention.

Cough is the reflex defense response of the respiratory tract to the present secretions in the throat, trachea and bronchi, and ongoing inflammation in the mucous membranes of the upper and lower respiratory tract. From a practical point of view, cough is dry (unproductive) and productive cough with expulsion of significant amounts of secretion. Drugs used to treat cough differ in both mechanism of action and pharmacokinetic activity. Butamirate citrate belongs to a new class of cough suppressants acting centrally through the receptors in the brainstem. In addition, it has a very beneficial effect, because it reduces the resistance in the airways by inhibiting bronchospasm and anti-inflammatory effect. It is rapidly absorbed after oral administration and its therapeutic plasma concentration is determined after 5-10 minutes of administration, irrespective of the dose. Possible side effects are rarely seen in 0.5-1% of patients, mainly in the form of skin rash, nausea, diarrhea, dizziness, which usually resolves during treatment. The cough effect of most cough suppressants is good, but their mechanisms are different and for that reason they should be individually selected. An important asset of this group of drugs is peripheral activity and effects on bronchodilator muscles, such as in the case of butamirate. Inclusion of this feature is particularly beneficial in chronic inflammatory bronchial diseases.

Role in the pathogenesis of atherosclerosis play a reactive oxygen species. In the case of disturbance of dynamic balance between their production and antioxidant defense mechanisms comes to undesirable consequences - oxidative stress. Excessive exercise can, among others, disrupting the balance., Aim: The aim of the study was to evaluate the exponents of the processes of oxidation - reduction of blood in patients with ACS undergoing rehabilitation in a hospital setting., Materials and Methods: The study included 25 patients after ACS STEMI, including 19 men and 6 women, aged 51.5±6.5 years, underwent rehabilitation in the Department of Internal Medicine and Cardiac Rehabilitation, University Hospital im. WAM in Lodz. Blood samples were taken after an initial exercise test (I) and after the final exercise test (IV). Marked: SOD-1, CAT, GPX- in red blood cells, plasma antioxidant activity (TAS) and the concentration of MDA in the red blood cells. Cardiac rehabilitation program included 15 interval training, each lasting 40-45 minutes., Results: The results were statistically analyzed. For the statistically significant level of p<0.05. No significant effect of cardiac rehabilitation on the activity of GPX, SOD-1, MDA and antioxidant activity of plasma. There was only a significant impact on the rehabilitation of CAT activity (p=0.002)., Conclusions: Properly conducted cardiac rehabilitation does not disturb the balance of oxidation - reduction of blood in patients with ACS. Exercise should be selected in such a way that this balance is maintained.

Myocardial ischemia can be assessed by ECG at rest or doing the stress test, which also serves to evaluate the results of cardiac rehabilitation., Aim: The aim of this study was to determine the usefulness of the scale before exercise and exercise to assess the risk of coronary heart disease and recognition by physiotherapists., Materials and Methods: The study included three groups of people: 1. 65 patients with stable coronary heart disease (IHD), including 45 men and 20 women, ranging in age from 33 to 79 years, an average of 60.18 ± 9.43 years who exercise test was positive; 2. 24 patients after myocardial infarction undergoing subsequent rehabilitation, including 20 men and 4 women, aged from 42 to 78 years, an average of 58.75 ± 8.45 years; 3. 70 healthy subjects without ischemic heart disease, including 34 men and 36 women, ranging in age from 24 to 70 years, an average of 56.24 ± 12.33 years. All healthy people and patients were hospitalized in the Department of Internal Medicine and Cardiac Rehabilitation, University Hospital im. WAM in Lodz. The study groups were assessed risk of coronary heart disease based on the result obtained in the scale before exercise and exercise. The results were statistically analyzed using Statistica version 12 (StatSoft, Poland). For the statistically significant level of p<0.05., Results: Compared to healthy individuals in both the ischemic heart disease (p=0.04) and in the group treated with rehabilitation (p=0.03) results in a scale before stress was significant higher. Compared to healthy individuals, both in the group of ischemic heart disease (p <0.001) and in the group treated with rehabilitation (p<0.001) The results on a scale of exercise were significantly higher., Conclusions: The use of scale before exercise to assess the risk of coronary heart disease is useful for physical therapists in their professional practice. There legitimacy of the use of scale exercise for the initial diagnosis of coronary artery disease without knowing the interpretation of the ECG stress test.

Bizarre parosteal osteochondromatous proliferation (BPOP) is an unusual lesion mostly affecting the bones of the hand. The mass grows from the bone surface and consists of cartilaginous, osseous and fibrous tissue. The lesion is commonly under/misdiagnosed and confused with other lesions, mostly the osteochondromas. We present a patient with BPOP that initially confused the practitioner and radiologist in their diagnosis. We discuss the clinical, radiologic and histologic characteristics of BPOP of the hand since its first report in 1983 and present its main differential diagnosis. We reviewed 184 cases. Female were affected in 52% and male in 48%. Pro ximal phalanges were most commonly affected, followed by middle phalanges and metacarpals. Pain was reported in 47,9 % of all reported papers. The most common surgical treatment was by excision, and the rate of recurrence was 47.3%.

According to the WHO, hypertension is one of the major causes of death worldwide. It leads to a number of severe complications. Diastolic heart failure, that is heart failure with preserved ejection fraction (HFPEF), is especially common. New, but simple, indices for the early detection of patients who have not yet developed complications or are in their early developmental stages are still searched for., Aim: The aim of this study is to examine the correlation between pulse wave velocity (PWV) and markers of diastolic heart failure (DHF) assessed in echocardiography in patients with hypertension and no symptoms of heart failure., Materials and Methods: The study was comprised of 65 patients with treated hypertension. Patients with symptoms of heart failure, those with diabetes and smokers were excluded. Arterial stiffness was measured with the Mobil-O-Graph NG PWA. Pulse wave velocity (PWV) was estimated. The following markers of diastolic heart failure were assessed in the echocardiographic examination: E/A ratio - the ratio of the early (E) to late (A) ventricular filling velocities, DT - decceleration time, E/E' - the ratio of mitral peak velocity of early filling (E) to early diastolic mitral annular velocity E' in tissue Doppler echocardiography., Results: PWV was statistically significantly higher in the DHF group. In the group of patients with heart failure, the average E/A ratio was significantly lower as compared to the group with no heart failure., Conclusions: Oscillometric measurement of pulse wave velocity is non-invasive, lasts a few minutes and does not require the presence of a specialist. It allows for an early detection of patients at risk of diastolic heart failure even within the conditions of primary health care.

Hypothyroidism in patients with renal failure (RF) causes many metabolic and clinical problems, and both these diseases can mutually exacerbate their disturbances., Aim: The aim of this study was to evaluate the effect of hypothyroidism, and end-stage renal disease (ESRD) on conversion of thyroid hormones (TH) in patients with ESRD treated with chronic hemodialysis (HD)., Materials and Methods: The study was performed in 74 patients, including 41 women (K) and 33 men (M) aged 28-83 y.o. in 4 groups: G1 - 12 people with ESRD treated with HD and with newly diagnosed hypothyroidism without substitution (6 K and M 6) aged 66,83±12,90 y.o., G2 - 26 patients with ESRD treated with HD without hypothyroidism (10 F, 16 M) aged 58,85±15,52 y.o., G3 - 11 hypothyroid patients without RF (9 K, 2 M) aged 54,73±21,26 y.o., G4 - 25-persons from control group of healthy subjects (16 M, 9 M) aged 51,24±12,58 y.o. In all subjects the concentration of TSH and TH (T4, T3, fT4, TSH, FT3, rT3) were measured and values of conversion factors (T3/T4, FT3/ fT4, rT3/fT4 and rT3/fT3) and binding TH to protein factors (fT4/T4 and fT3/T3) were calculated., Results: Lower concentration of T3 (p=0.012), fT3 (p<0.001) i fT4 (p=0.014) was found in patients without hypothyroidism than in healthy subjects. Renal failure with concomitant hypothyroidism intensify the disturbances of T4 to T3 conversion (p=0.034) and hypothyroidism with concomitant renal failure disrupts binding of T3 to proteins (p=0.001). FT3 to fT4 ratio in renal failure with concomitant hypothyroidism group was significantly lower than in each other group. rT3 concentrations were the highest in healthy subjects., Conclusions: Concomitance of hypothyroidism and end-stage renal disease reduces the conversion of thyroxine to triiodothyronine, but does not increase the production of rT3. Hypothyroidism significantly increases the disorders of thyroid hormones in end-stage renal disease. There is decreased tendency to bind of thyroid hormone to protein in hypothyroidism in patients with end-stage renal disease.

Metabolic syndrome (MS) is a coexistence of metabolic risk factors affecting development of cardiovascular diseases. The SCORE system estimates fatal cardiovascular disease events over a ten-year period., Aim: The aim of the study was to estimate cardiovascular risk in patients with symptoms of MS., Materials and Methods: The study included 268 patients with symptoms of MS according to International Diabetes Federation criteria (2005), 136 men and 132 women, mean age 59,62±9,21 years. The cardiovascular risk was estimated on based of pulse pressure and SCORE table in these patients., Results: In subjects with MS the mean value of pulse pressure (pp) was 58,96±2,34 mmHg, increased values of pp was found in 33,21% subjects with MS. High and very high cardiovascular death risk occurred in 80,97% subjects with MS, significantly more often in men than women., Conclusions: In majority of patients with MS high cardiovascular risk was found. In every three subjects with MS high pulse pressure was stated.

The clinical efficacy of inhaled therapy in patients with asthma and COPD is dependent on the choice of inhaler and proper use of it. The need to instruct patients in the use of the recommended inhaler seems obvious, but in clinical practice is not always followed., Aim: The aim of the study was the comparative evaluation of the selection criteria and the method of instructing in operating the device in asthma and COPD patients., Materials and Methods: The study was conducted in 80 patients with asthma and COPD in 9 European countries: France, Germany, Italy, Spain, Great Britain, Holland, Belgium, Denmark, Sweden. Patients (asthma / COPD) - 10 from each country - aged 18-65 years were diagnosed by a physician for asthma (2/3 patients) and COPD (1/3 patients) at least one year ago. The study involved using Symbicort Turbuhaler (8 patients in each country) or Seretide Accuhaler (2 in each country, 3 patients in the Netherlands). Evaluated the criteria for selecting the inhaler and the time and place of transfer of information technology inhalation., Results: It has been shown that the main criterion for choosing an inhaler by a doctor was the construction of an inhaler and size of particles generated by it. More than 1/3 of the patients did not receive information about how to use the inhaler. In turn, granted briefing in most lasts less than 5 minutes., Conclusions: In the selection of the inhaler taken into account in the construction and the ability to generate particles of the expected size. Informing patients about how to use the inhaler it is considered marginal in most of the resorts in Europe.

ACS (acute coronary syndrome) NSTEMI is more prevalent than ACS STEMI. Within four years the mortality rate was twice higher in NSTEMI group than in the STEMI group. Studies have demonstrated that cardiac rehabilitation decreases the risk of all-cause mortality as well as the mortality related to cardiovascular events., Aim: The aim of the study was to evaluate with the use of an index of own design the prognostic value of the complete blood count (CBC) in predicting cardiac rehabilitation failure in post-NSTEMI patients., Materials and Methods: The study comprised 116 post-NSTEMI patients, 81 men and 35 women, aged 64,12±11,29 years, admitted for cardiac rehabilitation to the Department of Internal Medicine and Cardiac Rehabilitation, MU in Lodz. On admission fasting blood cell count was performed, serum glucose and creatinine level was determined (GFR assessment). The following results were considered abnormal: glucose level ≥100 mg/dl, GFR<60 ml/min/1.73m2, RBC < 4x106 μl, WBC > 10x103/μl, PLT < 150x103/μl. Exercise test (cycloergometer) was performed twice in all patients - before and after the completion (4 weeks) of the II phase of the rehabilitation to assess its effects., Results: Basing on logistic regression analysis and the results of individual odds ratio (OR) of the tested blood parameters, their prognostic impact on the risk of cardiac rehabilitation failure was determined. This risk was defined on the basis of patient's inability to tolerate any workload increment (0 Watt) between the initial and final result of the exercise test despite the applied cardiac rehabilitation program. The most statistically significant risk factors were selected as the result of logistic regression model building on the basis of which cardiac rehabilitation failure index was determined. Anemia and leucocytosis determined most significantly the failure of cardiac rehabilitation (respectively OR=2,77 and OR=2,36; p=0,01). They were used to construct a rehabilitation failure index with the values ranging from 0 to 2, where 0 - corresponds to absence of anemia and leucocytosis, 1 - corresponds to the occurrence of anemia or leucocytosis in post-NSTEMI patients and was associated with 2,65-fold increase of the risk of cardiac rehabilitation failure, 2 - corresponds to simultaneous occurrence of anemia and leucocytosis and was associated with 7,02-fold increase of the risk of cardiac rehabilitation failure., Conclusions: Complete blood count is useful in predicting cardiac rehabilitation failure. Anemia and leucocytosis are the most significant determinants of cardiac rehabilitation failure in post-NSTEMI patients. Cardiac rehabilitation failure index can be used for its individual programming. Then optimal rehabilitation effects can be obtained maintaining its safety in post-NSTEMI patients.

Rivaroxaban, a selective inhibitor of active factor X belongs to the group of direct-acting oral anticoagulants (DOAC), more and more often replacing vitamin K antagonists (VKA) in venous thromboembolic disease and nonvalvular atrial fibrillation. Attempts are also being made to use DOAC to treat locally formed intracardiac thrombi, mainly in the left atrium and its appendage, in atrial fibrillation and in heart failure. Rarely diagnosed local right ventricular thrombus (RVT) may be a complication of dilated cardiomyopathy (DCM)., Case Report: The authors present a case of a 40-year-old male with DCM and RVT located in the apex, which was imaged in echocardiography, magnetic resonance and multislice computed tomography. During treatment with rivaroksaban (2x15 mg: 4 weeks; 1x20 mg: 4 months) diminishing of RVT was not observed. After 2 months of VKA use complete resolution of RVT was noted. The case presented is probably the first described RVT treated with rivaroxaban. The authors conclude that in some cases, anticoagulation with VKA may be more effective than DOAC in intracardiac thrombi therapy, especially when it is meticulously monitored. Overlapping effect on RVT due to anticoagulants use with a different mechanism of action cannot be excluded.

19-year-old hirsute woman with obesity, skin lesions with features of acanthosis nigricans around neck, armpits, thoracic cage and wrists escalating for couple of months, elevated testosterone and insulin plasma levels was admitted to hospital to perform diagnostic approach. The final diagnosis was hyperandrogenism-insulin resistance-acanthosis nigricans syndrome (HAIR-AN syndrome), considered as a subtype of policystic ovary syndrome (PCOS) and impaired glucose tolerance. HAIR-AN is characterized by coexistence of: hyperandrogenism (HA), insulin resistance (IR) and acanthosis nigricans (AN). These symptoms are result of increased insulin and androgens levels. Due to accompanying complications (obesity, hyperglycemia, hyperlipidemia, infertility) patients with HAIR-AN syndrome should be monitored and treated. Rarely acanthosis nigricans, especially when occurs rapidly and extensively, may be a paraneoplastic disorder. Life style modification with BMI reduction was recommended and metformin, a drug improving sensitivity to insulin, was administered. Patient should be monitored due to possible complications of obesity, diabetes and hyperinsulinemia.

Systemic sclerosis (SSc) is coccenctive tissue disease characterized by progressive fibrosis of the skin and internal organs leading to their failure, autoimmune dysfunction and the morphological and functional changes in the blood vessels. Primary cardiac involvement is common for patients with SSc, and when it becomes clinically evident appears as a bad prognostic factor. There is increasing evidence that heart failure occurs as a result of repeated episodes of ischemia leading to focal irreversible myocardial fibrosis. The reasons for this phenomenon are impaired microcirculation and abnormal vasoreactivity with or without associated structural abnormalities. Myocardial fibrosis and vascular microangiopathy lead to arrhythmias and impaired contractility with secondary left and right heart failure, as evidenced by the latest quantitative methods, such as echocardiography and MRI.

Recently, in the prognostic assessment of ACS patients attention has been paid to hyperglycemia, leukocytosis, decreased GFR, anemia and thrombocytopenia as they are believed to worsen the prognosis., Aim: The aim of this study was to evaluate the results of basic laboratory blood tests in predicting the failure of in-hospital cardiac rehabilitation in post-STEMI patients - using an index of own design., Materials and Methods: The study comprised 100 post-STEMI patients, 70 men and 30 women, aged 60,1±10,3 years, admitted for cardiac rehabilitation (phase II) to the Department of Internal Medicine and Cardiac Rehabilitation, WAM University Hospital in Lodz. On admission fasting blood cell count and glucose and creatinine level was determined (for GFR assessment). The following results were considered abnormal: glucose level ≥100 mg/dl, GFR<60 ml/min/ 1,73m2, WBC> 10x103/μl, RBC<4x106/μl, PLT<150x103/μl. Exercise test was performed twice in all patients - before and after the completion of the II phase of cardiac rehabilitation to assess its effects., Results: Basing on logistic regression analysis and on the results of individual odds ratio (OR) of the tested blood parameters, their prognostic impact on the risk of cardiac rehabilitation failure was determined. This risk was defined on the basis of post-STEMI patients' inability to tolerate any workload increment (0 Watt) between the initial and final result of the exercise test despite the applied cardiac rehabilitation program. This concerned 54 out of 100 post- STEMI patients. Leukocytosis (WBC>10x103/μl) and GFR<60 ml/ min/1,73 m2 determined most significantly the failure of cardiac rehabilitation (respectively: OR=6,65 and OR=3,43; p=0,05). Thus, they were used to construct a cardiac rehabilitation index. The occurrence of leukocytosis or decreased GFR in post-STEMI patients was associated with a 4,5-fold increase of the risk of cardiac rehabilitation failure, whereas simultaneous occurrence of leukocytosis and decreased GFR was associated with over 20-fold increase of this risk., Conclusions: The results of peripheral blood laboratory tests are useful in predicting cardiac rehabilitation effects. Leukocytosis and decreased GFR (<60 ml/min/1,73 m2) determine to the highest degree the risk of cardiac rehabilitation failure (phase II) in post-STEMI patients. Cardiac rehabilitation failure index can be useful in developing individualized rehabilitation program for post-STEMI patients.

Unlabelled: Pneumomediastinum is a rare disorder which often occurs without symptoms. It is sometimes a result of an injury but most often it is spontaneous. Pneumothorax may be iatrogenic; one of the reasons might be tracheotomy. Pneumomediastinum in some cases may be the threat to life and health. In this rare cases surgical intervention is needed, however pneumomediastinum is usually spontaneously absorbed., Aim: The aim of this study was to present the differential diagnosis of pneumomediastinum based on the case of a 60-year-old woman with tracheostomy, diagnosed eight years ago with generalized irreversible narrowing of the trachea and bronchi (suspicion of tracheobronchopathia osteochondroplastica)., A Case Report: Patient complained of increasing shortness of breath, dry cough and symptoms of upper respiratory tract infections for 2 weeks. In chest CT pneumomediastinum was detected. During bronchoscopy and endoscopic examination of trachea and larynx, no focal lesions of upper respiratory tract and bronchi were detected. By using noninvasive treatment, clinical improvement was achieved. In control chest CT, significant resorption of the air from the mediastinum was detected. Pneumomediastinum occurs often without characteristic symptoms or can be asymptomatic and it is discovered incidentally. If there is no obvious trauma, the cause is usually unknown. In the presented case, after exclusion of the majority of possible causes, we suspected that pneumomediastinum was a complication of tracheotomy but it was not confirmed in endoscopy. It might have been a complication of severe coughing in the course of upper respiratory tract infection or it might have been spontaneous., Conclusions: Patient complained of increasing shortness of breath, dry cough and symptoms of upper respiratory tract infections for 2 weeks. In chest CT pneumomediastinum was detected. During bronchoscopy and endoscopic examination of trachea and larynx, no focal lesions of upper respiratory tract and bronchi were detected. By using noninvasive treatment, clinical improvement was achieved. In control chest CT, significant resorption of the air from the mediastinum was detected. Pneumomediastinum occurs often without characteristic symptoms or can be asymptomatic and it is discovered incidentally. If there is no obvious trauma, the cause is usually unknown. In the presented case, after exclusion of the majority of possible causes, we suspected that pneumomediastinum was a complication of tracheotomy but it was not confirmed in endoscopy. It might have been a complication of severe coughing in the course of upper respiratory tract infection or it might have been spontaneous., (© 2016 MEDPRESS.)

Chronic heart failure (CHF), despite the preventive measures taken is the most common problem of modern cardiology. The aging of the body predisposes to the development of PNS, because qualitative changes taking place in the heart of the patient in the elderly are similar to those occurring among patients with heart failure. A growing problem of eldery patients becomes a deterioration of physical fitness leading to the reduction of activity and sedentary lifestyle. There is no doubt that increasing physical activity in the elderly should aim not only to restore the patient to a previous level of functioning, but also improve their physical resources to a higher level of efficiency and to facilitate independent functioning in everyday life., Aim: The aim of the study was to analyze the assessment of 12-week controlled physical training on the concentration of NT-proBNP and D-Dimer in patients with heart failure and impaired functional capacity in VII-X decade of life., Materials and Methods: The study included a group of 72 patients, elderly men and women (within a mean age of 81,6 ± 6,4) with stable heart failure. The plasma concentration of B-type natriuretic peptide and D-Dimer was measured in each and every subject. The subjects were also asked to perform a Timed Up and Go Test (TUG) and the normal gait speed was analyzed over a 6 meter distance., Results: 12-weeks cardiac rehabilitation process, improved the functional capacity of patients which is proved by reduction in duration of the TUG. Analysis of the results showed a correlation between the results of the test TUG and speed of gait. In the group of patients who underwent rehabilitation, a decrease in the concentration of plasma NT-proBNP and D-Dimer were observed., Conclusions: The low-intensity physical training increases functional capacity which is shown to shorten the duration of the TUG test and affects the modulation of neuroendocrine and concentration of NT-proBNP in patients with CHF, regardless of gender.

Takotsubo cardiomyopathy (TC) is characterized as an acute, reversible left ventricular dysfunction which may be triggered by mental or physical stress. In the case of a 32-year-old woman severe heart failure was observed after a traffic accident with blunt chest trauma. ECG showed ST changes mimicking acute myocardial infarction; although, echocardiography revealed a profile of left ventricular contractile disturbances typical of TC, with ejection fraction reduced to 20%. Additionally, repeated echocardiography showed transient left ventricular wall thickness, suggestive of myocardial edema. Recovery to normal heart function and morphology was confirmed in cardiovascular magnetic resonance. Coronary arteries potency was verified in multi-slice computed tomography. Summing up, it seems that TC should be included in differential diagnosis of heart failure in posttraumatic patients; however, it is impossible to say conclusively which factor was dominant in TC pathogenesis in the case presented: emotional stress or chest trauma., (© 2016 MEDPRESS.)

Non-bacterial thrombotic endocarditis (NBTE) is characterized by presence of sterile vegetations that develop from fibrin and platelets on heart valves. The main conditions predisposing to NBTE are malignancy, autoimmune diseases and other hypercoagulable states. The authors describe a case of a 25-year-old male, in whom NBTE was diagnosed on the bicuspid aortic valve. The presence of significant aortic regurgitation and dental caries were initially suggestive of infective endocarditis; although, serial blood culture were negative and procalcytonin concentration was within normal ranges. Empiric antibiotic therapy did not result in diminishing of vegetations, similarly to the anticoagulation treatment initiated when strongly positive lupus anticoagulant was detected in laboratory findings. Aortic valve replacement was necessary. Bacteriologic examination of the excised valve was negative. Widespread fibrin masses at different stages of organization on the leaflets confirmed NBTE in histopathologic assessment. Lupus anticoagulant was probably secondary to thyroid autoimmune disease., (© 2016 MEDPRESS.)

Unlabelled: Cholangiocarcinoma (CCA) is the second most frequent liver malignancy, responsible for 10-15% primary liver cancers. This tumor is difficult to diagnose and characterized by high mortality rate. Extrahepatic CCA is a specific type known as Klatskin tumor., A Case Report: The patient was admitted to the Clinic of Internal Medicine and Gastroenterology with intrahepatic cholestasis. Imaging revealed Bismuth type IV hilum tumor. Due to rare occurrence of this malignancy the patient was directed to the tertiary center. During surgical exploration radical treatment was abandoned as a result of tumor's advanced stadium. Histology evaluation revealed infiltrating adenocarcinoma. ERCP and biliary duct stenting was performed. The patient was qualified for paliative chemotherapy according to gemcytabine+cisplatine protocol (d1, d15 every 28 days). Posttreatment follow-up revealed total remission of the tumor., (© 2016 MEDPRESS.)

The varicella zoster virus (VZV) belongs to cardiotropic viruses, although the frequency of cardiac complications during VZV infection is low. Diagnosis of myocarditis or myopericarditis is rare during varicella - primary infection of VZV and sporadic in zoster - reactivation of latent VZV. Only few such cases have been described. The authors present a case of a 23-year-old male in whom clinical symptoms of myopericarditis developed a week after diagnosis of zoster that was localized in the left-upper part of the thorax. Retrosternal chest pain and fever were accompanied by ECG mimicking acute myocardial infarction. A dynamic pattern of troponin I release and slow normalization of ECG were observed. Serial echocardiography showed normal left ventricular function, transient changes in echogenicity of the interventricular septum and small pericardial effusion. In magnetic resonance imaging subepicardial and intramyocardial areas of late gadolinium enhancement were found. He was treated with intravenous acyclovir. No late sequels of the disease were observed., (© 2016 MEDPRESS.)

Nowadays, self-management of diabetes is more and more often based on continuous and flash glucose monitoring systems. In addition to measuring current glucose levels, both systems provide blood glucose levels from the past few hours in the form of a graph, as well as an indication of glucose trends via arrows. This information adds a new dimension to the self-management of diabetes, and should result in the modification of diabetes therapy. The paper presents proposals for modifications of treatment decisions based on glucose trends in patients with type 1 diabetes. By considering glucose trends, it is hoped that glycemic variability and numbers of hypoglycemia and hyperglycemia episodes will be reduced., (© Polish Society for Pediatric Endocrinology and Diabetology.)

Atrial fibrillation and heart failure are factors predisposing to locally formed intracardiac thrombosis, which is usually localized in left-sided chambers. A case report. The authors present a case of a 50-year-old male with permanent atrial fibrillation and dilated cardiomyopathy in whom recurrent right atrial thrombus was observed. Initially, the lesion was detected in echocardiography while he was hospitalized due to extensive right-sided pneumonia. The thrombus was successfully treated with heparin, followed by warfarin. Even though the patient continued warfarin use properly, there was recurrence of the thrombus two years later during a new episode of heart failure exacerbation. Because the thrombus was resistant to intensified anticoagulation, cardiac surgery was needed. A large (30 x 25 mm) pedunculated thrombus, as well as two smaller ones (each of 10 x 10 mm) attached closely to the atrial wall and previously not detected either by echocardiography or by magnetic resonance imaging, were excited. A partially organized pattern of the thrombi in histological examination can explain lack of anticoagulation effectiveness., (© 2015 MEDPRESS.)

Chronic heart failure (CHF) is a condition in which both structure and functional capacity of cardiac muscle are impaired, resulting in ineffective peripheral tissue perfusion. Affecting numerous organs and systems, it is currently considered to be a systemic illness. Among significant, however until now, hardly recognized consequences of CHF there are ventilatory disorders. Their presence may be explained by proximity of heart and lungs inside rib cage or by close functional cooperation between these two organs. Ventilatory disorders clinically manifest as exacerbations of the underlying disease, i.e. intense dyspnea--primarily exertional in nature, over time, present even at rest. On the basis of functional pulmonary tests, ventilatory disorders may be classified into three categories: restrictive, obstructive and most commonly--mixed. The restrictive model is represented in bodypletysmography as reduction in the total lung capacity to values less than 5th percentile of the predicted values for normals, while Tiffeneau index remains intact. Such condition may probably result from the chronic inflammatory process affecting lung tissue, for which the reaction of macrophage cells to both pulmonary stasis, as well as increased volume of interstitial and alveolar fluid remains the underlying cause. The increased formation of connective tissue fibers engenders thickening of alveolar-capillary membrane, occurrence of disturbed oxygen diffusion and emergence of hypoxemic respiratory failure. Ventilatory disorders of obstructive nature are characterised by reduction of Tiffeneau index--the calculated ratio between forced expiratory volume in 1. second and forced vital capacity--to values below 5th percentile of the predicted range. The research results indicate for the presence of bronchiolar narrowing--dominant in small-diameter bronchi and bronchioles, with larger structures being unaffected--clearly depicted in spirometry as reduced levels of forced expiratory flow after exhaling 50% and 75% of forced vital capacity. Due to a considerable epidemiological problem, as well as significance of the clinical symptoms manifesting ventilatory disorders in course of chronic heart failure, there should be put emphasis on cardiac injury prevention in individuals from risk groups and the proper treatment of patients already suffering from chronic heart failure., (© 2015 MEDPRESS.)

Unlabelled: Rivaroxaban, a selective inhibitor of active factor X, is metabolized by cytochrom P450 3A4 (CYP3A4) and is a substrate for transporter protein--P-glycoprotein (P-gp). Amiodarone, an antiarrhytmic agent, is classified as moderate CYP3A4 and P-gp inhibitor., A Case Report: A 75-year-old male, who underwent lobectomy for bronchiectasis many years ago, is presented. For one year the patient was treated with rivaroxaban (20 mg/d) due to venous thromboembolism and recurrent episodes of atrial fibrillation. Two weeks after amiodarone initiation (200 mg/d) hemoptysis occurred and computed tomography revealed unilateral pulmonary infiltrates with ground-glass opacities limited to the lower lobe of the left lung. The symptoms disappeared following discontinuation of the two medications and did not recur while rivaroxaban was reintroduced in a dose of 15 mg/d; measurement of anti-Xa activity confirmed it as a therapeutic dose. Amiodarone, that had been used for a short time and well tolerated a few years before, was definitely withdrawn., Conclusions: The authors suggest, that the concomitant use of rivaroxaban and amiodarone should be very careful in patients with a history of pulmonary disease., (© 2015 MEDPRESS.)

Saxitoxins (STX) and tetrodotoxins (TTX) are a group of chemical compounds produced by certain species of marine algae and fish. Lethal dose for a human is about 0.5-2.0 mg when the toxin enters the body via food, and 0.05 mg of poisoning at the time of injection. In the case of aerosol the lethal dose for human being is 5 mg/min/m(3). STX and TTX poisoning cause mostly symptoms from the nervous system in the form of: paresthesia around the lips, tongue, gums, distal segments of the limbs, headache, dysphonia, astigmatism, floating feeling, muscle weakness, paralysis of cranial and peripheral nerves. There is no specific antidote for STX and TTX. It is recommended supportive treatment., (© 2015 MEDPRESS.)

Since the late 70s of the last century there were more than 700 incidents related to the use of the ricin toxin. For this reason, CDC (Center of Disease Control and Prevention) recognized toxin as a biological weapon category B. The lethal dose of ricin toxin after parenteral administration is 0.0001 mg/kg and after oral administration 0.2 mg. The first symptoms of poisoning occur within a few hours after application of toxin as a nausea, vomiting and abdominal pain. In the final stage there are observed: cardiac arrhythmia, collapse and symptoms suggestive of involvement of the central nervous system. Stage immediately preceding death is a state of coma. The ricin toxin is still the substance against which action has no optimal antidote. Developed a vaccine called RiVax is waiting for its registration. It should be pointed out that the availability of a ricin toxin makes it possible to use it for real bioterrorists., (© 2015 MEDPRESS.)

Organophosphates are stable cholinesterases inhibitors (AChE). Inhibition of AChE activity leads to the accumulation of large amounts of acetylcholine and hyperactivity of the cholinergic system by stimulating acetylcholine receptors - muscarinic and nicotinic. This group included tabun, sarin, soman and VX gases. Exposure to gaseous form causes symptoms within a few seconds of exposure. This depends on the gas concentration in the atmosphere. The most sensitive organ is the eyes and the respiratory system. Severe poisoning are characterized by the immediate loss of consciousness with convulsions. Therapeutic management of acute poisoning organophosphorus compounds boils down to treating symptomatic and supportive vital functions. Monitoring of cardiovascular, respiratory and renal failure in intensive care gives only guarantee the effective treatment of poisoning. Properties toxic organophosphorus compounds also are of interest to terrorist groups., (© 2015 MEDPRESS.)