Benzodiazepines and z-drugs - between treatment effectiveness and the risk of addiction

Benzodiazepines (BZDs) and Z-drugs are commonly prescribed medications for anxiety and sleep disorders. This review examines their efficacy, associated risks, and alternative treatment options. BZDs enhance the activity of gamma-aminobutyric acid (GABA), reducing anxiety, while Z-drugs selectively target GABA-A receptors' alpha-1 subunits for sedative effects. Despite their effectiveness, both drug classes carry the risk of addiction, physical and psychological dependence, and withdrawal symptoms. Side effects, such as drowsiness, dizziness, and cognitive impairment, are also associated with their use. Recent studies indicate that chronic use of BZDs and Z-drugs may lead to cognitive impairment and an increased risk of dementia in older adults. Furthermore, individual factors, dosage, duration of use, and drug interactions can affect their efficacy. Prescribing trends show a decline in benzodiazepine prescriptions and an increase in Z-drug use due to perceived safety advantages. However, evidence suggests that Z-drugs carry similar risks of adverse effects and addiction potential as benzodiazepines. Healthcare professionals should carefully assess patients before prescribing these drugs and monitor their use to prevent dependence and addiction. Brief interventions, patient education, drug withdrawal support, and cognitive behavioral therapy have shown effectiveness in reducing long-term benzodiazepine and Z-drug use. Alternative treatments, including cognitive behavioral therapy and relaxation techniques, should be considered, particularly for patients with a history of addiction or those at high risk of addiction. In conclusion, the risk of addiction, withdrawal symptoms, and adverse effects associated with benzodiazepines and Z-drugs necessitates cautious prescribing and the exploration of alternative treatment options.&nbsp

Udar przysadki jako rzadka przyczyna hipoglikemii – opis przypadku

Introduction: Pituitary stroke is a relatively rare emergency in endocrine practice. In majority of patients, deficiencies of at least one hormone secretion are observed, and clinical manifestations in the form of hypotension and hypoglycemia results from insufficient secretion of adrenocorticotropic hormone. The aim of the study is to present a case report of a patient with symptoms of hypotension and hypoglycemia resulting from a pituitary stroke. Case report: A 72-year-old patient with type 2 diabetes, was admitted to the Department of Endocrinology due to severe hypoglycemia and hypotension accompanied by urinary retention. He was initially diagnosed with sulfonylurea-related hypoglycemia. In the physical examination, attention was drawn to the drooping of the left eyelid, suggesting nerve III palsy. An urgent CT examination was performed, which showed no signs of intracranial bleeding, but the blurred outline of the pituitary gland was visualized. Due to the clinical picture, a pituitary stroke was suspected, and an immediate evaluation of the pituitary function was ordered. The results showed decreased levels of ACTH, cortisol, TSH, FT4 and FT3 and patient was diagnosed with hypopituitarism. The MRI imaging showed recent hemorrhagic changes in the pituitary gland, most likely due to macroadenoma. Conclusion: If a pituitary gland stroke is suspected, MRI and laboratory tests, including assessment of hormonal function, should be performed. Treatment consists mainly of hormone replacement, and in some cases surgical treatment. The differential diagnosis mainly includes subarachnoid bleeding and meningitis.Wprowadzenie: Udar przysadki jest natychmiastowy, szybko spotykanym stanem nagłym w praktyce endokrynologicznej. Może być zakładem ostrym krwotokiem i/lub niedokrwieniem, na celowniku przy niezdiagnozowanym gruczolaka. U przewaŜającej części, we wnętrzu niedobory jednego hormonu, gdzie najczęściej pierwsze manifestacje w postaci hipoglikemii wynikają z niedostatecznego wydzielania hormonu adrenokortykotropowego.   Opis przypadku: 72-letnia z cukrzycą t.2 została przyjęta do nabytego nauczyciela z nauczonym hipoglikemią. Wstępnie rozpoznano hipoglikemię sulfonu zejściem na powitanie. Wykonane czynności uwidoczniły znacznej wielkości wielkość złóg w lewym moczdzie, który pozwala na ustabilizowanie poziomu poziomu badania po uwidocznieniu. W okresie pozabiegowym porażeniem w korzystaniu z wychowania, jakie postępno opadnięcie powieki oka lewego, przeprowadzonego po nerwu III. Pilnie reprezentacja rekwizyty, w którym nie ma nadzoruje zespół dla kogoś śródlądowego, uwidoczniono, odpowiednio zatarty obrys przybytków. Ze względu na obraz kliniczny wysunięto podejrzenie udaru przysadki, zlecono natychmiastową ocenę osi adrenokortykotropowej i tyreotropowej.W wynikach produkcyjnych produkcyjnych ACTH, kortyzol, TSH, FT4 i FT3 i rozpoznano niedoczynność przysadki. Celem badania rozpoznania zlecania wykonania badania rezonansu magnetycznego, które są uznawane za przesunięte w czasie w związku z infekcją chorego wirusem SARS-Cov2. W wykonanym wykonanym po ustąpieniu zakaźności, jakie miało miejsce nowe pokrwotoczne w wykonaniu przysadki, na rezonans i rezonans gruczolaka.  Wnioski: W przypadku podejrzeniau przysadki należy przetwarzać badanie MR oraz badania laboratoryjne, w ocenie funkcji hormonalnej. Uzupełnianie leczenia substytucją hormonalną, leczenie leczeniem leczenia zabiegowego. Diagnostyka zawszeca się do metod i przedepajęczynów oraz wszyscy oponenci mózgowo-rdzeniowi

A new mutation for Cantu's syndrome

Introduction: Cantu syndrome is one of the rare genetic syndromes. Formally, there are no diagnostic criteria for Cantu syndrome, but given the characteristic appearance and reproducible features in people with a mutation in the ABCC9 gene, there is a conventional clinical picture that may suggest a diagnosis with high probability. This publication presents a case study of a two-week-old female patient who was qualified for genetic testing on the basis of her characteristic clinical picture. Whole exome sequencing revealed the presence of a mutation so far unknown in the human mutation database... Case report: A two-week-old patient was referred to the Neonatal Pathology Unit due to the features of the dysmorphic syndrome in order to extend the diagnosis. Biased family history: the child's mother was diagnosed with hypogonadotrophic hypogonadism with suspected Kallman syndrome. The girl is very similar to her mother - in the physical examination, the following highlights: features of facial dysmorphia, a large, protruding tongue, excessive hair in the head and lumbar region. Due to the possibility of mutations in various genes correlating with Kallmann syndrome, a Whole Exome Sequencing (WES) study was commissioned. The study revealed the detection of a new Arg1116Pro mutation in the ABCC9 allele. Conclusions: In the presence of dimorphic features significant for Cantu syndrome, it is advisable to perform molecular genetic tests involving the use of a multigene panel. In the case of an uncertain clinical picture, it is worth performing Whole Exome Sequencing. Cantu's syndrome is still a little-known disease that is often associated with the coexistence of many serious multi-system diseases. Therefore, it is crucial to make the diagnosis as early as possible in the patient's life so that the patient is immediately provided with multidisciplinary medical care

The role of computed tomography in the diagnosis of lung cancer - a case report

Introduction Lung cancer has been the main oncological problem in the world for years. It is extremely important to use appropriate diagnostic methods that enable its detection and implementation of appropriate treatment. Aim The presented case shows the advantage of computed tomography over chest X-ray (X-ray) in visualizing neoplastic changes in the lungs. Case Study The paper presents a description of a patient diagnosed with centrally located advanced lung adenocarcinoma with a strong expression of PD-L1 qualified for treatment with pembrolizumab. Results and Discussion Presented case confirms that X-ray is less sensitive, especially in the case of centrally located tumors. Therefore, the emergence of a new cough in a smoker or ex-smoker should raise concerns related to lung cancer despite a normal X-ray image. The central location of the tumor may cause dramatic course of the symptoms. In the presented case, a sudden significant deterioration of the condition was observed due to atelectasis of the entire lung. Haemoptysis observed during hospitalization was another symptom of centraly located tumor mass. Conclusions In conclusion, the history of cigarette smoking, presence of typical symptoms should provide an in-depth diagnosis of lung cancer, despite normal X-ray. Diagnostic procedures include computed tomography in the first place. The course of centrally localized disease may change rapidly during on first cycle of treatment. Due to the possibility of serious complications of the ongoing neoplastic disease, the patient should be under constant medical supervision

Exacerbation of symptoms of rheumatoid arthritis in the course of immunotherapy of non-small cell lung cancer - an analysis of medical cases and a review of the literature

Background: Lung cancer has been at the forefront of cancers with the highest incidence and mortality rates. Nowadays, there are available more effective forms of treatment such as immunotherapy. In the case of cancer cells expressing the PD-L1 receptor, pembrolizumab, atezolizumab and nivolmab are of particular use. While these drugs have the great benefit of stabilizing the disease, they are not without side effects, especially inflammatory changes in the joints. The aim of the study is to show the risk of immunotherapy in the form of exacerbation of inflammatory symptoms in patients with rheumatoid arthritis (RA) as a concomitant disease. Case report: Lung cancer (PD-L1 +) was diagnosed in three patients with a history of RA. After meeting the criteria of the drug program, the patients started molecularly targeted therapy with pembrolizumab and atezolizumab. The applied treatment brought a great benefit in the form of stabilization the neoplastic disease. Over time an exacerbation of inflammatory changes within the joints was noted, which significantly impeded everyday functioning in two patients. Due to this situation, immunotherapy was discontinued. Conlusions: Studies show that as many as 1/4 of patients treated with PD-L1 inhibitors experience side effects related to the autoimmune system. In the case of people suffering from RA, the use of immunotherapy may intensify inflammatory changes and increase pain, which significantly reduce the quality of life. Therefore, the risk of RA exacerbation as a side effect of biological therapy for lung cancer treatment should be popularized. This awareness will enable quick intervention and minimize the number of interrupted immunotherapies

Cutaneous recurrence of long term pulmonary sarcoidosis - literature review and case report

Sarcoidosis is a systemic granulomatous disease, the exact etiology of which is unknown. This paper presents a case of a patient with a long course of pulmonary sarcoidosis with exacerbation of the disease in the form of skin lesions.                A 50-year-old female patient was admitted to the Department of Tuberculosis and Lung Diseases, Medical University of Lublin, because of cervical lymphadenopathy. Based on the histopathological examination, she was diagnosed with sarcoidosis. The patient reported constant fatigue, throat tightness and difficulty swallowing, as well as decreased exercise tolerance. Computed tomography studies revealed small nodular changes in both lungs and mediastinal lymphadenopathy. The patient was actively monitored. The results of spirometry tests improved spontaneously and remained at a satisfactory level for years. After 15 years of follow-up, the patient reported skin lesions that are constantly progressing. Examination of the cut from the skin lesion confirmed skin sarcoidosis. This case report highlights the varied course of sarcoidosis, which, as a multi-system disease, may show various manifestations. In clinical practice, therefore, one should consider the possibility of disease progression and transmission to multiple organs. It is important that the patient is under constant observation and that new lesions undergo differential diagnosis and histopathological examination

Comparative analysis of excretory-secretory antigens of Trichinella spiralis and Trichinella britovi muscle larvae by two-dimensional difference gel electrophoresis and immunoblotting

Abstract Background Trichinellosis is a zoonotic disease in humans caused by Trichinella spp. The present study was undertaken to discover excretory-secretory (E-S) proteins from T. spiralis and T. britovi muscle larvae (ML) that hold promise for species-specific diagnostics. To that end, the purified E-S proteins were analyzed by fluorescent two-dimensional difference gel electrophoresis (2-D DIGE) coupled with protein identification by liquid chromatography-tandem mass spectrometry (LC-MS/MS). To search for immunoreactive proteins that are specifically recognized by host antibodies the E-S proteins were subjected to two-dimensional (2-DE) immunoblotting with antisera derived from pigs experimentally infected with T. spiralis or T. britovi. Results According to 2-D DIGE analysis, a total of twenty-two proteins including potentially immunogenic proteins and proteins produced only by one of the two Trichinella species were subjected to LC-MS/MS for protein identification. From these proteins seventeen could be identified, of which many were identified in multiple spots, suggesting that they have undergone post-translational modification, possibly involving glycosylation and/or proteolysis. These proteins included 5'-nucleotidase, serine-type protease/proteinase, and p43 glycoprotein (gp43) as well as 49 kDa E-S protein (p49). Our findings also suggest that some of the commonly identified proteins were post-translationally modified to different extents, which in certain cases seemed to result in species-specific modification. Both commonly and specifically recognized immunoreactive proteins were identified by 2-DE immunoblotting; shared antigens were identified as gp43 and different protease variants, whereas those specific to T. britovi included multiple isoforms of the 5'-nucleotidase. Conclusions Both 2-D DIGE and 2-DE immunoblotting approaches indicate that T. spiralis and T. britovi produce somewhat distinctive antigen profiles, which contain E-S antigens with potential as species-specific diagnostic markers for Trichinella. Our results also demonstrate the value of 2-D DIGE as a versatile tool to compare secretomes of different Trichinella species for pinpointing factors contributing to the interaction with the host

Prevalence of antibodies against Neospora caninum in dogs from urban areas in Central Poland

Neospora caninum is a protozoan parasite which causes abortion in cattle as well as reproduction problems and neurological disorders in dogs. To assess the prevalence of the parasite in urban dogs in the Mazovian Voivodeship, Central Poland, serum samples from 257 dogs were analyzed for the presence of specific IgG antibodies. The examined dogs visited three private veterinary clinics located in Warsaw due to control tests, vaccinations, or other reasons not directly connected with neosporosis. Using ELISA and Western blot, antibodies against the parasite were detected in 56 out of 257 dogs, giving a prevalence of 21.7%. A greater prevalence was observed in female dogs than in males, 28% and 17.3%, respectively, and the differences were statistically significant (p < 0.05). There were no significant differences in seroprevalence of Neospora infection within the age groups (p > 0.05). This study indicates the presence of N. caninum in the Mazovian Voivodeship, in dogs which live in urban areas and exposure of these dogs to the parasite. The fact that seropositive dogs had no contact with cattle confirms the important role of dogs in the parasite’s epidemiology

Postacie kobiece w dramacie elżbietańskim: William Shakespeare, Thomas Kyd i Christopher Marlowe.

Niniejsza praca dotyczy wybranych bohaterek dramatów trzech popularnych dramaturgów okresu elżbietańskiego: napisanych przez Williama Shakespeare’a – Desdemony z Otello (1603) oraz Julii z Romeo i Julia (1579), Bel-Imperii z dramatu Thomasa Kyd’a Hiszpańska tragedia (1582) oraz Dydony z dramatu Christophera Marlowe’a Dydona, Królowa Kartaginy (1594). Celem pracy jest zaprezentowanie głównych ról kobiecych w wymienionych sztukach. Shakespeare jest nazywany często feministycznym autorem. Niniejsza praca ma za zadanie sprawdzić to oraz porównać z rolami kobiecymi innych autorów tej ery. W pierwszym rozdziale zarysowana została sytuacja kobiet w erze elżbietańskiej oraz pokazana została rola teatru w tamtych czasach. W drugim rozdziale przeanalizuję dwie najbardziej wyróżniające się role kobiece w dramatach Shakespeare’a – Desdemonę oraz Julię, które łamią najważniejsze zasady panujące w ich czasach. W następnym rozdziale skupiam się na Bel-Imperii z dramatu Thomasa Kyd’a – kobiecie, która stawia zemstę na pierwszym miejscu. Czwarty rozdział poświęcony jest Dydonie z dramatu Christophera Marlowe’a i jej nadzwyczajnej pozycji jako królowa. Analiza potwierdza, że William Shakespeare nie był jedynym autorem, który stworzył nadzwyczajne i feministyczne kobiece role i pozwala przypuszczać, że rosnąca liczba kobiet na widowni mogła mieć na to wpływ.This dissertation is concerned with selected female characters presented in the plays of three popular Elizabethan playwrights: William Shakespeare’s Desdemona from Othello (1603) and Juliet from Romeo and Juliet (1579), Bel-Imperia from Thomas Kyd’s The Spanish Tragedy (1582) and Dido the protagonist of the play written by Christopher Marlowe Dido, Queen of Carthage (1594). The aim of this thesis is to present the depiction of women in the listed plays. Many scholars call Shakespeare feminist, but I decided to challenge it and analyse other authors of that era and their depiction of women.In the first chapter I sketch the situation of women in the Elizabethan era and show the importance of the theatre in those times. In the second chapter I look at two of the most distinctive Shakespearian characters – Desdemona and Juliet, both breaking the most crucial social norms including marriage without parent’s consent. In the following chapter I analyse Kyd’s Bel-Imperia – woman for whom the revenge comes first. The fourth chapter touches upon Marlowe’s Dido and her unusual position of a queen.The analysis confirms that William Shakespeare was not the only one who created distinctive and feminist female characters and it lets us assume that the growing number of female spectators might have influenced that

Przedstawienie motywów miłości i nienawiści z dramatu ,,Romeo i Julia" Williama Shakespeare’a w wybranych adaptacjach filmowych

Niniejsza praca dotyczy trzech wybranych adaptacji filmowych dramatu Williama Shakespeare’a ,,Romeo i Julia": ,,Romeo i Julia" (1996, reż. Baz Luhrmann), ,,West Side Story" (1961, reż. Robert Wise i Jerome Robbins) i ,,Chinka" (1987, reż. Abel Ferrara). Celem mojej pracy jest ukazanie sposobu przedstawiania motywów miłości i nienawiści w wyżej wymienionych filmach. Większość analiz historii Romea i Julii skupia swoją uwagę na miłości. W mojej pracy skupiłam się na nienawiści oraz konfliktach, z których wynika. Akcja każdej z adaptacji rozgrywa się we współczesnych czasach i opisuje prawdziwe konflikty w Stanach Zjednoczonych.W pierwszym rozdziale analizuję film ,,Romeo i Julia", w którym reżyser przedstawił problem istnienia gangów, broni i przemocy w latach 90-tych XX wieku. W następnym rozdziale skupiam się na musicalu ,,West Side Story", który opisuje sytuację imigrantów z Portoryko, problemy, z którymi muszą się zmierzyć i konflikty z Amerykanami. W ostatniej analizowanej adaptacji, ,,Chinka" również mamy do czynienia z problemami mniejszości narodowych (Chińczycy i Włosi) oraz z konfliktami pomiędzy nimi. Wszystkie przeanalizowane adaptacje potwierdzają przesłanie, jakie niesie William Shakespeare w tragedii Romeo i Julia – nienawiść zabija wszystko, co piękne i ma katastrofalne skutki.This dissertation is concerned with three selected film adaptations of Romeo and Juliet by William Shakespeare: Romeo + Juliet (1996) directed by Baz Luhrmann, West Side Story (1961) directed by Jerome Robbins and Robert Wise and China Girl (1987) directed by Abel Ferrara. The aim of this thesis is to present the depiction of the motifs of love and hatred from the original play in the listed adaptations. Most people analysing the story of Romeo and Juliet focus on love, however, I decided to place more importance on hatred, which results from social problems. Each of the selected adaptations is set in the 20th century and depicts real social conflicts in America. In the first chapter I analyse Romeo + Juliet (1996), where the director depicted the problem of youth gangs, guns and violence in the 1990s. In the following chapter I look at the musical West Side Story (1961), which addresses the situation of immigrants from Puerto Rico in the 1950s – the problems they have to deal with and conflicts with Americans. The third chapter is devoted to the film China Girl (1987) that depicts the problems of racial minorities i.e. the Italians and the Chinese living in New York, the conflict between them and within their societies. The analysis of these film adaptations confirms the timeless message conveyed by William Shakespeare in Romeo and Juliet i.e. that hatred has disastrous consequences