Zastosowanie arypiprazolu u kobiety w ciąży

INTRODUCTION: The article describes a case study of the administration of aripiprazole, a second- generatiotion antypsychotic in a pregnant woman. Due to the relatively short time of application, the knowledge about the potential side effects for the fetus development is limited, which is the main reason for its avoidance in the treatment of pregnant women. CASE PRESENTATION: The case of 34 years old woman with paranoid schizophrenia treated since 2007 has been described. In the psychopatological picture dominated: delusions of reference, persecutory delusions, social withdrawal, obsessions and compulsions. In 2009 the patient became pregnant. The drugs were discontinued, which resulted in an increase in the severity of delusions. Limited concentration, obsessions and psychotic anxiety prevented from professional activity. After the delivery, administration of aripiprazole resulted in improvement of the mental status. Persistent delusions did not have the impact on behaviour procedeed with partial judgment. In 2014 the patient got pregnat for the second time. Because of the previous severe course of the disease, the treatment was maintained. Te patient’s mental status was balanced, psychotic disorders did not occur, negative symptoms of schizophrenia were not observed. After the natural childbirth, lactation delay and productive symptoms were observed. The latter symptom caused the need to increase the dose of the aripiprazole. CONCLUSIONS: Aripiprazole turned out to be a good choice for a pregnant woman, she was free of psychotic sensations and accompanying anxiety. It beneficially affected the mental state during the pregnancy, childbirth and puerperium. Three weeks after the delivery, it was necessary to increase the dosage of the drug, as the psychotic induced anxiety occured. These disorders subsided after increasing the dosage of the drug.WSTĘP: Artykuł zawiera opis przypadku zastosowania arypiprazolu — leku przeciwpsychotycznego drugiej generacji u kobiety w ciąży. Ze względu na stosunkowo krótki czas stosowania (środek został dopuszczony do obrotu w Polsce w 2004 roku, a w 2009 znalazł się na liście leków refundowanych) wiedza na temat ewentualnych skutków przyjmowania leku dla rozwoju płodu jest ograniczona, co stanowi główny powód jego unikania w leczeniu kobiet ciężarnych. OPIS PRZYPADKU: Opisano przypadek 34-letniej pacjentki z rozpoznaniem schizofrenii paranoidalnej, leczonej psychiatrycznie od 2007 roku. W obrazie psychopatologicznym dominowały: urojenia ksobne i prześladowcze, wycofanie oraz natrętne myśli i czynności. W 2009 roku pacjentka zaszła w pierwszą ciążę. Odstawiono leki, czego następstwem było zwiększenie nasilenia urojeń. Problemy z koncentracją, natręctwa myślowe i lęki o podłożu psychotycznym uniemożliwiły aktywność zawodową. Włączenie arypiprazolu po urodzeniu pierwszego dziecka spowodowało poprawę stanu psychicznego. Przetrwałe przez kilka miesięcy urojenia nie wpływały na zachowanie i przebiegały z częściowym krytycyzmem. W 2014 roku pacjentka zaszła po raz drugi w ciążę. Wobec wcześniejszego ciężkiego przebiegu choroby utrzymano leczenie. Stan psychiczny chorej w ciąży był wyrównany, nie występowały zaburzenia psychotyczne ani nie obserwowano objawów negatywnych schizofrenii. Po porodzie, który odbył się siłami natury, zaobserwowano opóźnienie laktacji oraz pojawienie się doznań wytwórczych. Drugi z wymienionych objawów spowodował konieczność zwiększenia dawki arypiprazolu. WNIOSKI: Arypiprazol okazał się dobrym wyborem u pacjentki w ciąży: uwolnił ją od doznań psychotycznych i towarzyszących im lęków, korzystnie wpłynął na stan psychiczny w trakcie ciąży, porodu oraz połogu. Zastosowanie arypiprazolu nie zaburzyło rozwoju płodu, skutkiem zastosowania leku mogło być jednak opóźnienie laktacji. Trzy tygodnie po porodzie konieczne było zwiększenie dawki leku z powodu pojawienia się lęków indukowanych przeżyciami psychotycznymi (związanymi z obawami o możliwość zamiany dziecka); zaburzenia te ustąpiły po zwiększeniu dawki leku

Polska, Ukraina, świat

Od Wydawcy: "Krakowska Szkoła Wyższa im. Andrzeja Frycza Modrzewskiego, największa niepubliczna szkoła wyższa w Małopolsce od początku swego powstania przywiązuje wagę do kontaktów z uczelniami zagranicznymi. Współpraca nawiązana z wieloma partnerami zagranicznymi nie tylko pozwoliła kadrze dydaktycznej i studentom Frycza nawiązać interesujące kontakty naukowe i biznesowe, wzbogacić księgozbiór o specjalistyczne publikacje, ale zaowocowała także wieloma cennymi programami. Współpraca Szkoły z Międzynarodowym Uniwersytetem REG I im. Akademika Stepana Demianczuka w Równem na Ukrainie - pierwszym partnerem zagranicznym, z którym umowę podpisano w grudniu roku 2001 - przebiega na wielu płaszczyznach (wymiana studentów i pracowników, udział w konferencjach, wspólne publikacje). Owocem jej je st też poniższa książka Polska, Ukraina, Świat pod redakcją Klemensa Budzowskiego i Anatolija Stiepanowicza Demianczuka, zawierająca dorobek naukowy pracowników obu uczelni."(...

Munchausen syndrome – forgotten but dangerous disease. Diagnostic challenges in female patient

According to the International Statistical Classification of Diseases and Related Health Problems ICD-10, Munchausen syndrome is a mental disorder classified as an F68.1 diagnosis code – “Intentional production or feigning of symptoms or disabilities, either physical or psychological [factitious disorder]”. In contrast to people consciously simulating ailments for specific benefits, patients with suspected Munchausen syndrome persistently contacting health care providers are not aware of their inner motives (social gratification, need for control, high levels of self-harm), exposing themselves to a long diagnostic process. OBJECTIVE: To present the difficulties associated with differentiation, diagnosis and appropriate treatment of Munchausen syndrome. The presented case study concerns a young patient repeatedly hospitalized due to numerous somatic complaints. Despite many physical examinations, including imaging and treatment no diagnosis could be made which would explain all of the symptoms. Only psychiatric hospitalization, with full analysis of the patient’s medical history, made it possible to diagnose the Munchausen syndrome and to treat the patient accordingly. Paradoxically, that diagnosis might have contributed to undermining subsequent problems reported by the patient that emerged because of an expanding brain tumor. COMMENT: Proper understanding of the symptoms presented by the patient could have lead to a faster diagnosis. However, the later fatal symptoms show that one cannot focus on only one diagnosis. Properly planned imaging seems to play a huge role.Według Międzynarodowej Klasyfikacji Chorób i Problemów Zdrowotnych ICD-10, zespół Münchhausena jest zaburzeniem psychicznym, zaliczanym do kategorii diagnostycznej F68.1 „Zamierzone wytwarzanie lub naśladowanie objawów czy niewydolności fizycznych lub psychicznych (zaburzenia pozorowane)”. W przeciwieństwie do osób świadomie symulujących dolegliwości w celu uzyskania konkretnych korzyści, chorzy z podejrzeniem zespołu Münchhausena zgłaszając się kolejny raz do placówek służby zdrowia nie są świadomi swoich wewnętrznych motywów (społeczna gratyfikacja, potrzeba kontroli, wysoki poziom autoagresji), narażając się na długi proces diagnostyczny. CEL PRACY: Przedstawienie trudności związanych z różnicowaniem, rozpoznawaniem i odpowiednim leczeniem zespołu Münchhausena. Przedstawiony opis przypadku dotyczy młodej pacjentki, wielokrotnie hospitalizowanej z powodu licznych dolegliwości somatycznych, u której mimo wielu przeprowadzonych badań, w tym obrazowych i zabiegowych, nie można było postawić żadnego, tłumaczącego występujące objawy, rozpoznania. Dopiero hospitalizacja psychiatryczna, z pełną analizą dotychczasowej historii chorobowej pacjentki, pozwoliła na postawienie diagnozy zespołu Münchhausena i podjęcie właściwego leczenia. Paradoksalnie rozpoznanie to mogło przyczynić się do umniejszania zgłaszanych przez pacjentkę w późniejszym okresie dolegliwości, które pojawiły się w związku z rozrastającym się guzem mózgu. KOMENTARZ: Właściwe rozumienie prezentowanych przez chorą objawów mogło doprowadzić do znacznie szybszego postawienia diagnozy. Późniejsze, tragiczne w skutkach objawy pokazują, iż nie można zamykać się w obrębie jednego rozpoznania. Istotną rolę zdają się odgrywać właściwie zaplanowane badania obrazowe

Cangrelor Induces More Potent Platelet Inhibition without Increasing Bleeding in Resuscitated Patients

Dual antiplatelet therapy is the standard of care for patients with myocardial infarction (MI), who have been resuscitated and treated with therapeutic hypothermia (TH). We compare the antiplatelet effect and bleeding risk of intravenous cangrelor to oral P2Y12-inhibitors in patients with MI receiving TH in a prospective comparison of two matched patient cohorts. Twenty-five patients within the CANGRELOR cohort were compared to 17 patients receiving oral P2Y12-inhibitors. CANGRELOR group (NCT03445546) and the ORAL P2Y12 Group (NCT02914795) were registered at clinicaltrials.gov. Platelet function testing was performed using light-transmittance aggregometry and monitored for 4 days. P2Y12-inhibition was stronger in CANGRELOR compared to ORAL P2Y12 (adenosine diphosphate (ADP) (area under the curve (AUC)) 26.0 (5.9–71.6) vs. 160.9 (47.1–193.7)) at day 1. This difference decreased over the following days as more patients were switched from CANGRELOR to oral P2Y12-inhibitor treatment. There was no difference in the effect of aspirin between the two groups. We did not observe significant differences with respect to thrombolysis in myocardial infarction (TIMI) or Bleeding Academic Research Consortium (BARC) classified bleedings, number of blood transfusions or drop in haemoglobin B (Hb) or hematocrit (Hct) over time. Cangrelor treatment is not only feasible and effective in resuscitated patients, but also inhibited platelet function more effectively than orally administered P2Y12-inhibitors without an increased event rate for bleeding

Challenges in the management of the kidney allograft: from decline to failure: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference.

In March 2022, Kidney Disease: Improving Global Outcomes (KDIGO) held a virtual Controversies Conference to address the important but rarely examined phase during which the kidney transplant is failing or has failed. In addition to discussing the definition of a failing allograft, 4 broad areas were considered in the context of a declining functioning graft: prognosis and kidney failure trajectory; immunosuppression strategies; management of medical and psychological complications, and patient factors; and choice of kidney replacement therapy or supportive care following graft loss. Identifying and paying special attention to individuals with failing allografts was felt to be important in order to prepare patients psychologically, manage immunosuppression, address complications, prepare for dialysis and/or retransplantation, and transition to supportive care. Accurate prognostication tools, although not yet widely available, were embraced as necessary to define allograft survival trajectories and the likelihood of allograft failure. The decision of whether to withdraw or continue immunosuppression after allograft failure was deemed to be based most appropriately on risk-benefit analysis and likelihood of retransplantation within a few months. Psychological preparation and support was identified as a critical factor in patient adjustment to graft failure, as was early communication. Several models of care were noted that enabled a medically supportive transition back to dialysis or retransplantation. Emphasis was placed on the importance of dialysis-access readiness before initiation of dialysis, in order to avoid use of central venous catheters. The centrality of the patient to all management decisions and discussions was deemed to be paramount. Patient "activation," which can be defined as engaged agency, was seen as the most effective way to achieve success. Unresolved controversies, gaps in knowledge, and areas for research were also stressed in the conference deliberations

Range and Consistency of Cardiovascular Outcomes Reported by Clinical Trials in Kidney Transplant Recipients: A Systematic Review

International audienceCardiovascular disease is a major cause of morbidity and mortality in kidney transplant recipients. Trial evidence to improve cardiovascular outcomes is limited by inconsistent reporting of outcomes, which may also lack patient-relevance. This study aimed to assess the range and consistency of cardiovascular outcomes reported by contemporary trials in kidney transplant recipients.Methods: A systematic review of all randomized controlled trials involving adult kidney transplant recipients that reported at least 1 cardiovascular outcome from January 2012 to December 2019 was performed, including Embase, MEDLINE, Cochrane, and ClinicalTrials.gov electronic databases. Trial characteristics were extracted and all levels of specification of the cardiovascular outcome measures reported were analyzed (the measure definition, metric' and method of aggregation). Measures assessing a similar aspect of cardiovascular disease were categorized into outcomes.Results: From 93 eligible trials involving 27 609 participants, 490 outcome measures were identified. The outcome measures were grouped into 38 outcomes. A cardiovascular composite was the most common outcome reported (40 trials, 43%) followed by cardiovascular mortality (42%) and acute coronary syndrome (31%). Cardiovascular composite was also the most heterogeneous outcome with 77 measures reported followed by cardiovascular mortality (n = 58) and inflammatory biomarkers (n = 51). The most common cardiovascular composite outcome components reported were major cardiovascular events (18 trials), stroke unspecified (11 trials), and myocardial infarction unspecified (10 trials).Conclusions: There is substantial heterogeneity in cardiovascular outcome reporting in kidney transplant trials

Age influence on hypersensitivity pneumonitis induced in mice by exposure toPantoea agglomerans

Hypersensitivity pneumonitis (HP) represents the immunologically mediated lung disease induced by repeated inhalations of a wide variety of certain finely dispersed organic antigens. In susceptible subjects, these inhalations provoke a hypersensitivity reaction characterized by intense inflammation of the terminal bronchioles, the interstitium and the alveolar tree. The inflammation often organizes into granulomas and may progress to pulmonary fibrosis. Our previous work indicated that cell extract of gram-negative bacteria Pantoea agglomerans (SE-PA) causes, in young C57BL/6J mice, pulmonary changes that are very similar to the clinical manifestations of HP in men. The purpose of presented studies was to describe the response of mice immune system while exposed to SE-PA. Particular attention was paid to examine the age influence on SE-PA induced inflammation and fibrosis in lung tissue. We used 3- and 18-month-old C57BL/6J mice. Lung samples were collected from untreated mice and animals exposed to harmful agent for 7 and 28 days. HP development was monitored by histological and biochemical evaluation. Using ELISA tests, we examined concentration of pro- and anti-inflammatory cytokines in lung homogenates. Our study demonstrated again that SE-PA provokes in mice changes typical for the clinical picture of HP, and that successive stages of disease (acute, subacute and chronic) might be obtained by modulation of time exposure. Furthermore, we found that animals' age at the time of sensitization influences the nature of observed changes (cytokine expression pattern) and the final outcome (reaction intensity and scale of fibrosis)

Range and Consistency of Cardiovascular Outcomes Reported by Clinical Trials in Kidney Transplant Recipients: A Systematic Review

Background. Cardiovascular disease is a major cause of morbidity and mortality in kidney transplant recipients. Trial evidence to improve cardiovascular outcomes is limited by inconsistent reporting of outcomes, which may also lack patient-relevance. This study aimed to assess the range and consistency of cardiovascular outcomes reported by contemporary trials in kidney transplant recipients. Methods. A systematic review of all randomized controlled trials involving adult kidney transplant recipients that reported at least 1 cardiovascular outcome from January 2012 to December 2019 was performed, including Embase, MEDLINE, Cochrane, and ClinicalTrials.gov electronic databases. Trial characteristics were extracted and all levels of specification of the cardiovascular outcome measures reported were analyzed (the measure definition, metric‚ and method of aggregation). Measures assessing a similar aspect of cardiovascular disease were categorized into outcomes. Results. From 93 eligible trials involving 27 609 participants, 490 outcome measures were identified. The outcome measures were grouped into 38 outcomes. A cardiovascular composite was the most common outcome reported (40 trials, 43%) followed by cardiovascular mortality (42%) and acute coronary syndrome (31%). Cardiovascular composite was also the most heterogeneous outcome with 77 measures reported followed by cardiovascular mortality (n = 58) and inflammatory biomarkers (n = 51). The most common cardiovascular composite outcome components reported were major cardiovascular events (18 trials), stroke unspecified (11 trials), and myocardial infarction unspecified (10 trials). Conclusions. There is substantial heterogeneity in cardiovascular outcome reporting in kidney transplant trials

Search for Scalar Diphoton Resonances in the Mass Range 65−60065-600 GeV with the ATLAS Detector in pppp Collision Data at s\sqrt{s} = 8 TeVTeV

A search for scalar particles decaying via narrow resonances into two photons in the mass range 65–600 GeV is performed using $20.3\text{}\text{}{\mathrm{fb}}^{-1}$ of $\sqrt{s}=8\text{}\text{}\mathrm{TeV}$ $pp$ collision data collected with the ATLAS detector at the Large Hadron Collider. The recently discovered Higgs boson is treated as a background. No significant evidence for an additional signal is observed. The results are presented as limits at the 95% confidence level on the production cross section of a scalar boson times branching ratio into two photons, in a fiducial volume where the reconstruction efficiency is approximately independent of the event topology. The upper limits set extend over a considerably wider mass range than previous searches

Search for Higgs and ZZ Boson Decays to J/ψγJ/\psi\gamma and Υ(nS)γ\Upsilon(nS)\gamma with the ATLAS Detector

A search for the decays of the Higgs and $Z$ bosons to $J/\psi\gamma$ and $\Upsilon(nS)\gamma$ ($n=1,2,3$) is performed with $pp$ collision data samples corresponding to integrated luminosities of up to $20.3\mathrm{fb}^{-1}$ collected at $\sqrt{s}=8\mathrm{TeV}$ with the ATLAS detector at the CERN Large Hadron Collider. No significant excess of events is observed above expected backgrounds and 95% CL upper limits are placed on the branching fractions. In the $J/\psi\gamma$ final state the limits are $1.5\times10^{-3}$ and $2.6\times10^{-6}$ for the Higgs and $Z$ bosons, respectively, while in the $\Upsilon(1S,2S,3S)\,\gamma$ final states the limits are $(1.3,1.9,1.3)\times10^{-3}$ and $(3.4,6.5,5.4)\times10^{-6}$, respectively