Współistnienie choroby Addisona z niedoborem kortykotropiny z towarzyszącą przysadkową opornością na CRH — opis przypadku

A 36-year-old woman was found to have a low morning ACTH concentration despite a history of Addison’s disease. Past medical history: At the age of 23 years the subject developed Graves’s disease, which was treated with radioiodine. At about the same time, she claimed to have two episodes of pancreatitis treated with cholecystectomy. About seven months later she was euthyroid on L-thyroxine (TSH 1.51 mIU/mL) but was admitted with hypotension, hyponatraemia (sodium 109 mmol/L), and low morning cortisol (119 nmol/L). Further investigations confirmed primary adrenal failure with ACTH concentration of 779 pg/mL (ref. range 0–60) prior to the dose of hydrocortisone. About nine years later she complained about tiredness. Clinically she was normotensive and not pigmented. BMI 22.3 kg/m2. Periods were regular. ACTH concentration was surprisingly low (ACTH 8.53 pg/mL, ref. range 0–46), despite very low cortisol (3.37 nmol/L). She was admitted for further assessment. Investigations: Pituitary MRI scan was unremarkable. An insulin tolerance test was performed and showed a clear increase of ACTH (from 15.2 to 165 pg/mL). There was, however, hardly any increase of ACTH after CRH stimulation (from 6.05 pg/mL to 10.2 pg/mL), thus demonstrating central CRH resistance. In summary, this patient developed secondary adrenal failure in the setting of previous Addison’s disease. Interestingly, hypoglycaemia (but not CRH) provided a stimulus for ACTH release, thus demonstrating CRH resistance. The case confirms that besides CRH, other factors are responsible for stimulation of the ACTH-cortisol axis during insulin tolerance test.Prezentujemy przypadek 36-letniej pacjentki z chorobą Addisona, u której stwierdzono niskie poranne stężenie ACTH. Wywiad chorobowy: w wieku 23 lat pacjentka była poddana radiojodoterapii z powodu choroby Gravesa i Basedowa. Siedem miesięcy póź­niej została przyjęta do szpitala z powodu hipotonii z towarzyszącą hiponatremią (sód 109 mmol/l) i niskim porannym stężeniem kortyzolu (119 nmol/l). Dalsze badania potwierdziły rozpoznanie pierwotnej niewydolności kory nadnerczy. Oznaczone wówczas stężenie ACTH było wysokie i wynosiło 779 pg/ml (N: 0–60 pg/ml). Dziewięć lat później pacjentka została przyjęta do kliniki z powodu znacznego osłabienia. W badaniu przedmiotowym nie obserwowano ciemnego zabarwienia skóry, wartości ciśnienia tętniczego były prawidłowe. BMI wynosiło 22,3 kg/m2. Pacjentka miesiączkowała regularnie. W badaniach laboratoryjnych, pomimo bardzo niskiego stężenia kortyzolu (3,37 nmol/l), stwierdzono zaskakująco niskie stężenie ACTH (8,53 pg/ml, N: 0–46 pg/ml). W badaniu RM przysadki nie stwierdzono nieprawidłowości. W teście z hipoglikemią poinsulinową uzyskano znaczny wzrost stężenia ACTH (z 15,2 do 165 pg/ml). Natomiast w teście stymulacji z CRH wzrost stężenia ACTH był nieznamienny (z 6,05 pg/ml do 10,2 pg/ml). Wyniki te wskazywały na centralną oporność na CRH. W podsumowaniu, u pacjentki z wcześniej rozpoznaną chorobą Addisona rozwinęła się wtórna niewydolność kory nadnerczy. Brak wzrostu stężeń ACTH w teście stymulacji z CRH u tej chorej, przy zachowanej prawidłowej odpowiedzi przysadki w warunkach hipoglikemii, potwierdza, że poza CRH również inne czynniki są odpowiedzialne za pobudzenie wydzielania ACTH i kortyzolu w teście hipoglikemii poinsulinowej

Nano-bismuth sulfide based dispersive micro-solid phase extraction combined with energy dispersive X-ray fluorescence spectrometry for determination of mercury ions in waters

A selective method for the determination of mercury ions in different types of water samples by energy dispersive X-ray fluorescence spectrometry (EDXRF) was developed. Quantification of Hg(II) by EDXRF was preceded by ultra-sound assisted dispersive micro-solid phase extraction (USA-DMSPE) on nano-bismuth sulfide (nano-Bi2S3) as a solid sorbent. At pH 1 nano-Bi2S3 selectively adsorbs Hg(II) ions from aqueous samples with an adsorption capacity of 499.1 mg g -1. The experimental data fitted well with the Langmuir isotherm model, which confirms the chemical character of the adsorption process. Under optimized preconcentration conditions, i.e. a sample pH of 1, adsorbent mass of 1 mg, sample volume of 50 mL and sonication time of 15 min, the linear response between fluorescence radiation intensity and the metal concentration was obtained within 1–200 ng mL -1 range with a correlation coefficient of 0.9988. The method allows the detection of mercury ions at a concentration of only 0.06 ng mL -1. The determination of Hg(II) ions after the nano-Bi2S3 based USA-DMSPE-EDXRF procedure is possible even in the presence of a high concentration of anions and cations typically coexisting in surface waters. The described method was applied to the determination of Hg(II) ions in mineral, spring, river, and artificial sea waters. The correctness of the procedure was confirmed by analysis of the certified reference material (Seawater QC3163)

Zakażenie SARS-CoV-2 w okresie ciąży

Choroba koronawirusowa 2019 (COVID-19) to ostra choroba zakaźna wywołana koronawirusem zespołu ostrej niewydolnościoddechowej 2 (SARS-CoV-2). Kobiety w ciąży są bardziej narażone na ciężki przebieg choroby i śmierćw przebiegu COVID-19 niż kobiety niebędące w ciąży: 3-krotnie częściej rozwija się niewydolność oddechowa i sąobciążone 1,7-krotnie wyższym ryzykiem zgonu. Zakażenia SARS-CoV-2 w okresie ciąży wiążą się z podwyższonymryzykiem wystąpienia stanu przedrzucawkowego, porodu przedwczesnego, urodzenia noworodka z niskąmasą oraz zgonu płodu lub noworodka. Ponadto COVID-19 jest czynnikiem ryzyka choroby zakrzepowo-zatorowejw okresie ciąży. Szczególnie wysokie ryzyko powikłań występuje w ciężkim przebiegu COVID-19. Ryzyko transmisjiwertykalnej wynosi około 3%. Nie stwierdza się więc ochronnego wpływu cięcia cesarskiego na ryzyko zakażenianoworodka. W leczeniu zaleca się odpowiednie nawodnienie, leki przeciwbólowe i przeciwgorączkowe, stosowanienirmatrelwiru z ritonawirem, remdesiwiru, a w przypadku ciężkiego przebiegu z koniecznością stosowania tlenoterapii— deksametazonu. W ciąży rekomendowane jest podawanie szczepionek przeciwko SARS-CoV-2 opartychna technologii mRNA lub wektorowych

Retrospective study of the morphology of third maxillary molars among the population of Lower Silesia based on analysis of cone beam computed tomography.

IntroductionUnderstanding the anatomy of root canal systems and being aware of their variations is crucial for successful endodontic treatment. Specifically, the intricate and diverse nature of the root anatomy in maxillary third molars poses a significant challenge for dental clinicians. The study analyzed the morphology of the root canal system in maxillary third molars among residents of the Lower Silesia region in Poland using cone beam computed tomography (CBCT).Material and methodsThis retrospective cross-sectional imaging study was conducted at the X-Ray Diagnostics Laboratory of the Academic Dental Polyclinic of Wroclaw Medical University, Poland. The study evaluated 316 CBCT scans and included 196 maxillary third molars. They were obtained from 118 females and 78 males over the age of 18, in the period from January to April 2022 (three consecutive months). The number of roots, root canals, and root canal configurations according to Vertucci's classification were analyzed.ResultsThree-rooted maxillary molars were found most often (64.29%), followed by single-rooted (24.49%), two-rooted (7.65%), and four-rooted (3.57%) teeth. Among all the roots examined, Vertucci Type I root canals were the most prevalent. Our research found that single-rooted forms (40 teeth, 33.89% vs. 8 teeth, 10.26%, p = 0.0013) of maxillary third molars were significantly more common in females than in males. However, three-rooted forms (62 teeth, 79.49% vs. 64 teeth, 54.24%, p = 0.0013) of maxillary third molars were significantly more common in males than in females.DiscussionIn the Lower Silesia region, the typical maxillary third molar in the Polish population has a three-rooted structure with Vertucci Type I root canal configuration. We noted a sex-dependent correlation in maxillary third molar morphology, with single-rooted forms more prevalent in women and three-rooted forms in men

Acidic leaching of steam gasified, pyrolyzed and incinerated PCB waste from LCD screen

In the recycling of WEEE, two approaches are common: a pyrometallurgical or hydrometallurgical treatment, preceded by a mechanical and/or physical separation. In this study, twostep processing of unmodified waste samples of LCD screen inverters was investigated: hightemperature processing followed by acidic leaching under fixed conditions (1M H2SO4, 90 ℃, 1 bar). The analysis carried out concerned a correlation between the type of HT treatment (pyrolysis, incineration, or gasification) and the dynamics of metals’ leaching from samples pretreated this way. It was found that HT method can act as “thermal disintegration”, since it affects, to a varying degree, the structure of the samples and cause elimination of organics and carbonaceous residue (incineration/gasification). The greatest mass loss (~18%) and the most loosened structure was observed for the gasified sample. Varying oxygen potential in HT-processes correlates well with the leachability of thermally treated inverters. The incineration was found to be the most favorable for copper extraction (>95%) by acidic leaching due to oxidized form of Cu, whereas Cu leaching from pyrolyzed and gasified samples needed oxygen and was controlled by the oxygen supply achieving only 36/43% after 6 h. The course of Pd leaching was similar to copper, although with lower efficiencies; 47% of palladium was extracted from the incinerated sample, and only 4 or 7% from gasified and pyrolyzed samples, respectively. Au was leached immediately but only to a slight extent. Contrary to Pb, leaching of Zn, Sn, Sb, and Ni was gradual, probably due to the formation of alloys with copper

Limited Role of Endogenous Vasopressin/Copeptin in Stimulation of ACTH–Cortisol Secretion during Glucagon Stimulation Test in Humans

Copeptin is a stable part of a vasopressin precursor that closely mirrors arginine vasopressin (AVP) secretion. It is known that AVP/copeptin is also released in response to nonosmotic stimuli, such as stress evoked during anterior pituitary dynamic testing. In order to examine the role of AVP in challenging the hypothalamo-pituitary-adrenal axis, we assessed adrenocorticotropic hormone (ACTH), cortisol, copeptin and growth hormone (GH) during a glucagon stimulation test (GST) in 10 patients with satisfactory initial cortisol concentrations (mean ± SD: 20.34 ± 5.10 µg/dL) and failure to show any further cortisol increment on stimulation. For comparison, we measured copeptin in two subjects during an insulin tolerance test (ITT). During GST, there was an increase in copeptin (p = 0.02, average individual increase of 98%, range 10% to 321%). There was a robust increase in GH (p = 0.002, average increase 3300%), a decline in cortisol (p = 0.02, average decline 21.8%) and a fall in ACTH (p = 0.06). The relative increase in copeptin during ITT (176% and 52.2%) overlapped with increments observed during GST; however, here there was an increase in cortisol (20.45→24.26 µg/dL and 4.23→29.29 µg/dL, respectively). There was a moderate correlation between copeptin and GH concentrations (r = 0.4235, p = 0.0007). These results confirm that AVP is not crucial for ACTH–cortisol stimulation, though it might be an important factor in GH secretion

Exclusion criteria.

IntroductionUnderstanding the anatomy of root canal systems and being aware of their variations is crucial for successful endodontic treatment. Specifically, the intricate and diverse nature of the root anatomy in maxillary third molars poses a significant challenge for dental clinicians. The study analyzed the morphology of the root canal system in maxillary third molars among residents of the Lower Silesia region in Poland using cone beam computed tomography (CBCT).Material and methodsThis retrospective cross-sectional imaging study was conducted at the X-Ray Diagnostics Laboratory of the Academic Dental Polyclinic of Wroclaw Medical University, Poland. The study evaluated 316 CBCT scans and included 196 maxillary third molars. They were obtained from 118 females and 78 males over the age of 18, in the period from January to April 2022 (three consecutive months). The number of roots, root canals, and root canal configurations according to Vertucci’s classification were analyzed.ResultsThree-rooted maxillary molars were found most often (64.29%), followed by single-rooted (24.49%), two-rooted (7.65%), and four-rooted (3.57%) teeth. Among all the roots examined, Vertucci Type I root canals were the most prevalent. Our research found that single-rooted forms (40 teeth, 33.89% vs. 8 teeth, 10.26%, p = 0.0013) of maxillary third molars were significantly more common in females than in males. However, three-rooted forms (62 teeth, 79.49% vs. 64 teeth, 54.24%, p = 0.0013) of maxillary third molars were significantly more common in males than in females.DiscussionIn the Lower Silesia region, the typical maxillary third molar in the Polish population has a three-rooted structure with Vertucci Type I root canal configuration. We noted a sex-dependent correlation in maxillary third molar morphology, with single-rooted forms more prevalent in women and three-rooted forms in men.</div