Hepatitis C virus genotypes in liver transplant recipients: Impact on posttransplant recurrence, infections, response to interferon-α therapy and outcome

Background. End-stage liver disease due to hepatitis C virus (HCV) is the most common indication for liver transplantation in U.S. veterans. We investigated the influence of HCV genotypes on the incidence and timing of recurrent HCV hepatitis, survival, infectious morbidity, and response to interferon-α therapy in this unique patient population. Methods. HCV genotype was determined by direct sequencing of the NS5 region of HCV with type-specific primers. Results. Genotype 1a (66%, 32/47) was the predominant genotype. Type 1b was found in 25% (12/47) of patients and type 2b was found in 9% (4/47). His topathologically recurrent HCV hepatitis developed in 53% (25/47) of the patients after transplantation. This group included 45% (14/31) of the patients with type 1a, 67% (8/12) of the patients with type 1b, and 25% (1/4) of the patients with type 2b (P>0.5). The time to recurrence and the severity of HCV recurrence as defined by aminotransferase levels or Knodell scores were not different among the three genotypes. There was a trend toward a higher incidence of major infections in patients with type 1b (75%) versus type 1a (48%) and type 2b (50%) (P=0.11). The response to interferon-α therapy did not differ significantly among the genotypes. Mortality at 5 years was 16% (5/31) in patients with genotype 1a, 42% (5/12) in patients with genotype 1b, and 50% (2/4) in patients with genotype 2b (P=0.06). Conclusions. The incidence, time to recurrence, and response to interferon-α therapy did not differ be tween the various genotypes in our liver transplant recipients. However, there was a trend toward higher infectious morbidity and overall mortality in patients with genotype 1b after transplantation

Pancreatic insufficiency in patients with HIV infection: role of didanosine questioned.

OBJECTIVES: The aim of the study was to identify possible causes of pancreatic insufficiency in patients with HIV infection. METHODS: A retrospective analysis of 233 HIV-positive patients for whom faecal elastase measurement was available was performed to investigate potential associations with core demographic data, HIV infection characteristics, degree of immunosuppresion, exposure to antiretroviral therapy (ART), alcohol misuse, diabetes, hepatitis C virus (HCV) infection, triglyceride and cholesterol levels and symptomatology. The response to pancreatic enzyme replacement for patients with evidence of insufficiency was also evaluated. RESULTS: Of 233 patients, 104 (45%) had evidence of pancreatic exocrine insufficiency (faecal elastase < 200 mcg/g). A positive association with exocrine pancreatic insufficiency was found for HCV infection (P = 0.007), previous or current HCV treatment (P = 0.003), alcohol misuse history (P = 0.006) and the presence of steatorrhoea (P = 0.03). There was no demonstrated association between exocrine pancreatic insufficiency and didanosine (ddI) exposure (P = 0.43) or stavudine (d4T) exposure (P = 0.62). Seventy-seven per cent of patients who were treated with pancreatic enzymatic supplementation reported a subjective improvement in symptoms. CONCLUSIONS: Faecal elastase sampling should form part of the routine work-up for HIV-positive patients with chronic diarrhoea even in the absence of 'traditional' risk factors such as ddI exposure. In particular, if the patient has steatorrhoea, a history of alcohol exposure or their HCV serology is positive, they should be considered for investigation. Treatment with pancreatic enzyme supplementation appears to be effective in the treatment of chronic diarrhoea caused by pancreatic insufficiency in the majority of patients

Hydroxyapatite-Based Materials for Potential Use in Bone Tissue Infections

Hydroxyapatite materials, due to their high biocompatibility, play a crucial role in orthopaedics and bone surgery as alternatives to autologous bone grafts. It was also found that coatings of metallic implants with hydroxyapatite layer improve significantly their osseointegration. Due to its bioactivity, osteoconductivity and non-toxicity, hydroxyapatite is also widely used as a component of hybrid biomaterials. The implantation of “foreign” materials brings one major concern that is the risk of potential bone tissue infections or chronic osteomyelitis. In turn, the main problem concerning bacterial infection treatment is to obtain an adequate, bactericidal drug concentration maintained for a sufficient period of time in the bone tissue. Therefore, recent developments of materials engineering are focused on delivery antibiotics directly into the affected bone. To achieve this goal, hydroxyapatite-based materials are frequently studied as carriers for antibacterial drugs. For effective support of antibiotic therapy, the antibacterial activity of certain ions (including silver, zinc or copper) may be applied. In our work, we present recent developments on ceramic materials for bacterial bone infections: hydroxyapatite-based carriers for antibiotics and modifications of hydroxyapatite with antibacterial ions. In this review, state-of-the-art and current applications of such materials are presented and discussed. We want to also present our recent results

76. Retrospektywna ocena wczesnych i póżnych odczynów popromiennych w śluzówkach jamy ustnej po pooperacyjnym napromienianiu z powodu raka przyusznicy

Cel pracyocena częstości rejestrowanych odczynów i ich wpływu na jakość życia pacjenta.Materiał i metodaW II Zakł. Teleterapii w latach 1984–1997 leczono 86 chorych z rakiem przyusznicy. Zebrano retrospektywne dane z zapisu w historiach chorób, dotyczące pojawienia się, trwania i nasilenia wczesnych późnych odczynów popromiennych w śluzówkach. Oceniono też przeżycia chorych (60% przeżyć 5-cioletnich) i porównano je z danymi z literatury dotyczącymi przeżyć u pacjentów leczonych samodzielną chirurgią (20–30% przeżyć 5-cioletnich).WynikiOdczyn wczesny w śluzówkach opisano u 50 chorych (58%), odczyn póżny u 17 chorych (19,8%). Wyrażną kserostomię (przejaw odczynu póżnego II stopnia) klinicznie stwierdzono u 2 chorych, w tym po 2 latach od rozpoczęcia leczenia – u 1 chorego. Częstą przyczyną niepowodzeń leczenia w tej lokalizacji Są przerzuty odległe występujące mimo miejscowej kontoli choroby. Przeuty do płuc stwierdzono u 6 chorych (7%), przerzuty do kości u 11 chorych (12,8%), do OUN u 3 chorych (3,5%), do wątroby-u 3 chorych (3,5%), w kilku lokalizacjach jednocześnie stwierdzano przerzuty u 1 chorego (0,5%). Przerzuty do płuc długo Są nieme klinicznie i ryzyko ich wystąpienia: nie umniejsza roli pooperacyjnego napromieniania, gdyż wznowy miejscowe Są bardzo dokuczliwe. Wznowa miejscowa mimo napromieniania wystapiła u 9/186 chorych (10,5%).WnioskiWobec złych wyników leczenia samodzielną chirurgią raków przyusznicy i nieznacznych (nawet bez stosowania technik konformacyjnych) odczynów popromiennych późnych w śluzówkach, konieczne w tej lokalizacji leczenie operacyjne skojarzone z napromienianiem nie wiąże się z pogarszającymi jakość życia późnymi odczynami popromiennymi. Nie jest w tej lokalizacji obligatoryjne stosowanie preparatów promienioochronnych czy też zwiększających wydzielenie śliny

How the Workplace Influences Teachers’ Creativity: A Two-Wave Study on Workplace Bullying, Organisational Bullying Risk Factors and Creativity

Based on affective events theory, the present two-wave study investigated the predictive role of organisational features and exposure to workplace bullying in generating decreased creativity. Although several inhibitors of creativity at work have been identified, few longitudinal studies have aimed to determine whether affective events such as workplace bullying impact employees’ creativity. In the present two-wave, time-lagged panel design study (N = 261), teachers. completed the Negative Activities Questionnaire, the Risk Assessment of Workplace Bullying Questionnaire and the Creative Behavior Questionnaire twice, with a six-month interval between waves. The results indicate that specific negative workplace conditions – that is, workplace bullying risk factors – in the first wave were related to exposure to workplace bullying in the first and second waves and also led to a decrease in individual creativity in the second wave. Moreover, exposure to workplace bullying in the first wave predicted a drop in two creativity facets, self-realisation and ego strength, in the second wave. However, when organisational factors were included in the model, exposure to bullying no longer predicted a decrease in creative aspects. It is suggested that to promote teachers’ creativity, it is essential to prevent workplace bullying by building a constructive social climate and fostering proper leadership practices.Based on affective events theory, the present two-wave study investigated the predictive role of organisational features and exposure to workplace bullying in generating decreased creativity. Although several inhibitors of creativity at work have been identified, few longitudinal studies have aimed to determine whether affective events such as workplace bullying impact employees’ creativity. In the present two-wave, time-lagged panel design study (N = 261), teachers. completed the Negative Activities Questionnaire, the Risk Assessment of Workplace Bullying Questionnaire and the Creative Behavior Questionnaire twice, with a six-month interval between waves. The results indicate that specific negative workplace conditions – that is, workplace bullying risk factors – in the first wave were related to exposure to workplace bullying in the first and second waves and also led to a decrease in individual creativity in the second wave. Moreover, exposure to workplace bullying in the first wave predicted a drop in two creativity facets, self-realisation and ego strength, in the second wave. However, when organisational factors were included in the model, exposure to bullying no longer predicted a decrease in creative aspects. It is suggested that to promote teachers’ creativity, it is essential to prevent workplace bullying by building a constructive social climate and fostering proper leadership practices

Efficiency of mobile apps for monitoring and management of mental health - review article

Introduction and purpose Mobile health apps are becoming increasingly popular. Many of them deal with improving mental well-being. This work aims to determine the effectiveness of using self-help forms of mental health care using mobile phones. Material and Methods The literature on mobile applications for mental health was reviewed using the databases of PubMed and Google Scholar. State of knowledge Mental illness is a severe problem for a large part of society. There is often effective treatment for them, but access to health care resources is limited. There are many applications that offer users psychoeducation and elements of psychotherapy. Many studies have shown their effectiveness in treating depression, anxiety disorders and dealing with excessive stress. Some research papers show the usefulness of mobile services in coping with distorted body image in body dysmorphic disorder, as well as in controlling physical activity and sleep time in the case of insomnia. Some of the programs seem to be useful in the functioning of people suffering from bipolar affective disorder, but their effectiveness in this disease is limited and still being analyzed. Summary Mobile health applications for monitoring and improving mental health are a promising form of helping patients. Some of them have been proven to work, but more research is needed on specific programs. It is important to remember that apps are used to supplement treatment, and do not fully replace contact with psychiatrists and psychologists

Potential clinical usage of ashwagandha root extract: A review

INTRODUCTION AND OBJECTIVE Ashwagandha, an herb commonly used in traditional Indian medicine, has been gathering attention as a potential drug in various specialties such as psychiatry, neurology, or endocrinology and even as a possible cancer treatment. In this review we aim to summarize reports form recent years on potential clinical usage of Ashwagandha. REVIEW METHODS The literature review was conducted using PubMed and Google Scholar online databases. THE STATE OF KNOWLEDGE Several studies evaluating potential pharmacological uses of Ashwagandha root extract has been published. There are clinical trials conducted in India using the plant in treatment of insomnia that resulted in improved sleep quality. Ashwagandha root extract has been successfully administered in stress-related disorders. There are reports of improvement in cognitive functions in patients with mild cognitive impairment and better symptom control in obsessive-compulsive disorder after Ashwagandha supplementation. Ashwagandha has been studied in endocrine diseases, showing potential in alleviating climacteric symptoms during perimenopause and in subclinical hypothyroidism. The study aimed to assess effect of Ashwagandha on vitality and hormonal changes in elderly men showed mixed results, with improvement in some hormonal levels and not statistically significant improvement in quality of life compared to placebo group. It has also been noted that ashwagandha root extract has positive effect on cardiovascular system, as well as enhancing muscle strength and recovery in otherwise healthy adults. SUMMARYAshwagandha root extract seems to possess beneficial properties that allow for its use in several branches of medicine. However as current findings are reported from small sample studies, further research on a larger scale is needed

Przemijające niedokrwienie mózgu czy aura migrenowa bez bólu głowy u chorego z płodowym wariantem odejścia tętnic mózgu tylnych — opis przypadku

Migrena należy do najczęstszych chorób neurologicznych. Ostatnio zwrócono uwagę na rozpowszechnienie wrodzonych wariantów anatomicznych koła Willisa u osób cierpiących na migrenowe bóle głowy. Patofizjologii migreny do tej pory jednoznacznie nie wyjaśniono. W przypadku migreny z aurą przyjmuje się najczęściej hipotezę neurogenną. Zgodnie z jej założeniem powodem wystąpienia bólu głowy jest postępujące hamowanie czynności kory mózgowej, czemu mogą sprzyjać niektóre warianty koła Willisa. Autorzy opisali przypadek 57-letniego chorego, którego hospitalizowano z powodu zaburzeń czucia powierzchniowego w obrębie lewych kończyn. W wywiadzie stwierdzono migrenowe bóle głowy z aurą wzrokową. W badaniach pomocniczych wykazano wrodzone warianty naczyń mózgowych często występujące u chorych na migrenę — płodowe odejście obu tętnic mózgu tylnych od tętnic szyjnych wewnętrznych oraz hipoplazję lewej tętnicy kręgowej, a w badaniu rezonansu magnetycznego głowy uwidoczniono naczyniak jamisty w lewym płacie czołowym. U opisanego chorego występowały w przeszłości incydenty typowej, migrenowej aury wzrokowej bez bólu głowy. Objawy ogniskowego deficytu neurologicznego, które były przyczyną hospitalizacji, nie były jednak podawanymi wcześniej przez chorego zaburzeniami widzenia. Również czas trwania tych objawów był dłuższy niż zwykle trwa aura migrenowa. Przemawia to za rozpoznaniem przemijającego ogniskowego niedokrwienia mózgu u chorego z migrenowymi bólami głowy z aurą w wywiadzie. Konsekwencją rozpoznania przemijającego ogniskowego niedokrwienia mózgu powinno być zawsze wdrożenie postępowania diagnostycznego umożliwiającego ustalenie jego przyczyn oraz zastosowanie odpowiedniego leczenia. Jest to o tyle istotne, że ryzyko udaru mózgu w następnych 30 dniach po przemijającym incydencie niedokrwiennym wynosi aż 10%

Sleep duration and cardiovascular outcomes

Cardiovascular diseases (CVD) are the leading cause of death worldwide, causing approximately 17.9 deaths annually. Their risk factors are mainly related to an inappropriate lifestyle and include, among others, low physical activity, obesity, hypertension or type 2 diabetes. Nowadays, there is an increase in the incidence of CVD as well as sleeping disorders, so many studies have focused on finding the connection between these phenomena. The impact of sleep duration on the occurrence of cardiovascular diseases and their risk factors was analyzed based on a systematic analysis of the literature. The review was carried out using keywords, based on data contained in the Google Scholar search engine database, in the PubMed scientific database and medical electronic journals. The analyzed studies indicate that sleep duration, its both excessive shortening and lengthening, as well as poor quality, may be associated with CVD, their risk factors and increased overall mortality. Researchers point to the connection between sleep duration and development of hypertension, obesity and type 2 diabetes, with short sleep identified as a stronger risk factor. In addition long sleep was associated with poor health and overall worse results of the subjects more often than short sleep. This suggests that long sleep may not be the cause, but a consequence of yet undiagnosed, coexisting chronic diseases. The results&nbsp;indicate the need to assess sleep disorders as a goal for primary and secondary prevention of CVD and reduction of their risk factors. The importance of long sleep remains ambiguous, whether it is the reason for health deterioration or results from it and requires further research. Large intervention studies are also still needed to assess whether improvements in sleep duration and its quality can reduce cardiovascular risk and improve long-term health outcomes