Self medication in the age of connectivity and its risks - the case report

Introduction: Public healthcare systems throughout the world are strained by demographic changes, soaring costs and insufficient resources. This can negatively affect access to health services, which forces patients to seek other treatment options. Websites and online forums have become one of the most common sources of health advice, with online medicine trade burgeoning as well. However, while the internet provides vast knowledge database, using unverified advice or product can have dangerous consequences. We present a patient with acute amphetamine poisoning, caused by ingestion of substance marketed online as weight loss drug. Aim of study: to discuss potential risks and problems of using online advice and products in self medication Results: Our patient, the 36 year old female, was admitted to Department of Toxicology and Cardiology with symptoms suggestive of poisoning of some kind. She admitted to using a weight- loss medication throughout the last month, in increasing dosages. The drug was bought from online trading platform. She lost 8 kilograms of body weight through this period. Subsequently, she noticed some disturbing symptoms, including dystonia movements of limbs, paresthesia in right half of the body and blurred vision. Episodes of tachycardia were reported as well. On admission, the patient was weakened and mildly depressed. She reported not eating anything for the last 2 days. Toxicological examination revealed the presence of psychoactive substances in the urine- amphetamine at 7800 ng/ml and LSD at 1,08ng/ml. Our patient was consulted by psychiatrist and psychologist. Fluid therapy was applied, along with Relanium, low molecular weight heparin, Dexaven and Polprazol. Due to elevated blood pressure, a 24-hour blood pressure measurement was performed. Next, hypotensive therapy was administered. The patient’s condition improved and she was discharged from the hospital after 4 days, with scheduled control in ambulatory setting and recommendation of beginning the psychotherapy. Conclusions: Online health advice and products can be dangerous if used inappropriately. A focus on education and provision of freely available, high quality medical information can make it safe and useful complement to healthcare systems throughout the world. Appropriate systems controlling online medicine distribution should also be instituted, with patients’ safety and wellbeing as prime goals

The case series of baclofen intoxication

Baclofen, a gamma-amino butyric acid type B (GABAb) inhibitor, is commonly used in management of spasticity and other medical conditions, such as alcohol dependency. However, given its mechanism of action, increasing usage of baclofen raises concerns about possibility of intoxication. The authors present herein three cases of baclofen intoxication of patients in various age and general condition

New psychoactive substances abuse and its clinical consequences - the case report

Introduction: The meteoric rise of new psychoactive substances' use has been a public health problem for at least few years. Their presence was noticed by EU authorities around 2005. First cases of NPS poisoning in Poland appeared shortly thereafter, in 2008. Due to great variety of used substances and lack of information about them, precise diagnosis and targeted treatment remain a significant problem. Hereby, we present a patient with multi-drug poisoning related to NPS abuse and discuss new psychoactive substances that are often found in such cases. Aim of study: To discuss most common new psychoactive substances and their health effects on the basis of the case report Results: A 28-year old patient was admitted to the Department of Toxicology and Cardiology with symptoms suggesting acute intoxication with psychoactive substances. The patient had a history of drug abuse. A few pouches containing unidentified psychoactive substances were found near the patient. On admission, his condition was serious- he was unconscious and required mechanical ventilation. Tachycardia and aspiration pneumonia were present as well.The applied therapy focused on restoring acid- base homeostasis, electrolyte balance and mitigating toxic influence of detected drugs, with preventive antibiotic administration used as well. His general and psychological condition improved with treatment, and he was discharged from the department after ten days, with continuation of the therapy in ambulatory setting. Conclusions: An increasing amount of patients present cases of polysubstance abuse, whose treatment may prove especially difficult. Such cases require extensive therapy to prevent debilitating complications. A focus on drug regulation and patient education could diminish the number of such cases in the future

Internal carotid and vertebral artery dissections — a comparison of clinical, radiological and prognostic characteristics

Aim of study. To examine whether baseline characteristics, potential risk factors, clinical symptoms, radiological presentation, and long-term outcomes differ between internal carotid artery dissection (ICAD) and vertebral artery dissection (VAD).Clinical rationale for study. Cervical artery dissection (CeAD) is a major cause of cerebral ischaemia in young adults. Its clinical course is highly variable, resulting in challenges in making a proper diagnosis.Methods. We performed a retrospective analysis of 31 patients (mean age 42.2 years) with CeAD (18 with ICAD, 13 with VAD) treated in our neurology department from 2008 to 2018. Appropriate imaging confirmed the diagnosis of CeAD.Results. Patients with ICAD presented Horner syndrome significantly more often (44.4% vs 7.6%; p = 0.04). Patients with VAD more often had ischaemic events (ischaemic stroke, TIA or transient blindness) (84.6% vs 44.6%; p = 0.0032). Ischaemic stroke was more severe in patients with ICAD [(median NIHSS 6, interquartile range 4–12) vs VAD (median NIHSS 4, interquartile range 1.5–5.5), p = 0,03]. Occlusion occurred more often in patients with VAD (69.2% vs 22.2%; p = 0.013). Most patients had a favourable outcome (mRS 0–2).Conclusions and clinical implications. In a series of patients with CeAD, we observed significant differences between VAD and ICAD in terms of clinical symptoms and radiological features

Cyanide poisoning from an alternative medicine treatment with apricot kernels in a 80-year-old female.

Introduction: Amygdaline, one of the most common cyanogenic glycosides, is present in the seeds and fruit pits of Prunus species. The excessive administration of this glycoside might lead to cyanide poisoning. Aim: The aim of the study is to depict the risk associated with apricot kernels ingestion on the base of the case report. Methods: The analysis of the patient’s medical history and the review of available literature. Results: 80- year- old female with the medical history of papillary thyroid cancer was admitted to the toxicology department due to accidental cyanide poisoning. The patient consumed extract consisted of milled apricot kernels, then suffered from dyspnea, vertigo and vomiting. After that, she lost consciousness. Lactic acidosis, highly specific for cyanide intoxication, was diagnosed during hospitalization. The patient was treated with fluid and steroid therapy, sodium bicarbonate and supplemental oxygen. On the 3rd day of stay, the patient was discharged with recommendation of control in toxicological clinic. Conclusions: Initial symptoms of cyanide poisoning are not specific, therefore it is worth taking this poisoning into account in differential diagnosis, especially in oncological patients or in children

Lead poisoning linked to occupational exposure - case reports

Introduction: Lead is one of the oldest widely used industrial metals. Throughout the ages, its significant toxicity caused poisoning of exposed people. Even today occupational exposure remains a significant hazard. Aim: The aim of the study is to depict the risk associated with lead exposure on the base of the case report. Methods: Patient’s medical history analysis and the review of available literature. Results: Two patients with history of occupational lead exposure were admitted to hospital. Their symptoms suggested chronic lead poisoning. Blood lead level was excessive in both cases. The patients were treated with antioxidants and advised to reduce their exposure to lead, with continuing ambulatory therapy. Conclusions: All known effects of Pb are extremely harmful to humans. Lead poisoning still appears to be a problem in some jobs and environments, particularly in cases of chronic low level exposure. Proper monitoring of workplace conditions and regular medical checkups for those at risk should be practiced to avoid cases of chronic poisoning in the future

Ischemic stroke as a rare cause of seizures in a newborn – case report

Background: Identifying etiology of seizures is the primary clinical objective in the management of neonatal seizures (NS). About 85 % of NS cases occurr as a consequence of a specific, identifiable etiology. Causes of symptomatic NS can be broadly categorized as: hypoxic-ischemic encephalopathy, electrolyte or metabolic disturbances, CNS or systemic infections, developmental defects and acquired structural brain lesions, including hemorrhagic or ischemic stroke. Ischemic stroke is characterized as a sudden focal or generalized brain function disruption, whose symptoms tend to last longer than 24 hours (or cause death) and have no other reason but a vascular one. The reported annual incidence is estimated at one per 4000 live births for neonates. The aim of this case report is to present diagnostic difficulties in case of ischemic stroke in apparently healthy neonate. This case concerns a patient – a full-term male newborn, who was in a good condition in the first 3 days after birth. At the beginning of the 4th day of life 3 episodes of right-sided clonic seizures with right-sided nystagmus occurred and which was the reason for admitting the patient to the Department of Neonate and Infant Pathology. Shortly after arrival the seizures appeared again. Laboratory tests showed slightly lowered glucose level and elevated serum concentration of lactic acid. The ultrasound examination of the head revealed a small right-sided subependymal cyst. The patient’s condition was deteriorating, with recurring righ-sided clonic and tonic seizures accompanied by apnea and desaturation that required resuscitation efforts. Because of worsening state of the patient, CT scan was performed. The CT examination revealed a hypodensic area in the left parietal region and cerebral edema, which indicated a possible ischemic stroke. Conclusions: The absence of visible pathologies in the ultrasound examination of the head does not necessarily indicate a lack of CSN abnormalities. More precise imaging tests are needed to identify the cause of NS

The mRNA expression of pro- and anti-inflammatory cytokines in T regulatory cells in children with type 1 diabetes.

Type 1 diabetes mellitus (T1DM) is caused by the autoimmune-mediated destruction of insulin-producing beta cells in the pancreas. T regulatory cells (Tregs) represent an active mechanism of suppressing autoreactive T cells that escape central tolerance. The aim of our study was to test the hypothesis that T regulatory cells express pro- and anti-inflammatory cytokines, elements of cytotoxicity and OX40/4-1BB molecules. The examined group consisted of 50 children with T1DM. Fifty two healthy individuals (control group) were enrolled into the study. A flow cytometric analysis of T-cell subpopulations was performed using the following markers: anti-CD3, anti-CD4, anti-CD25, anti-CD127, anti-CD134 and anti-CD137. Concurrently with the flow cytometric assessment of Tregs we separated CD4+CD25+CD127dim/- cells for further mRNA analysis. mRNA levels for transcription factor FoxP3, pro- and anti-inflammatory cytokines (interferon gamma, interleukin-2, interleukin-4, interleukin-10, transforming growth factor beta1 and tumor necrosis factor alpha), activatory molecules (OX40, 4-1BB) and elements of cytotoxicity (granzyme B, perforin 1) were determined by real-time PCR technique. We found no alterations in the frequency of CD4+CD25highCD127low cells between diabetic and control children. Treg cells expressed mRNA for pro- and anti-inflammatory cytokines. Lower OX40 and higher 4-1BB mRNA but not protein levels in Treg cells in diabetic patients compared to the healthy children were noted. Our observations confirm the presence of mRNA for pro- and anti-inflammatory cytokines in CD4+CD25+CD127dim/- cells in the peripheral blood of children with T1DM. Further studies with the goal of developing new strategies to potentiate Treg function in autoimmune diseases are warranted

Ocena stężenia produków zaawansowanej glikacji białek i przeciwciał anty-CEL i anty-CML w surowicy pacjentów chorujących na orbitopatię Gravesa przed i po leczeniu metyloprednizolonem

  Introduction: The glycation process is a non-enzymatic modification of proteins occurring due to the reactions of reductive carbohydrates. The glycated residues lose their biological functions, and their removal process is ineffective. They accumulate, and as a result they cause an immunological response. The aim of this study was a determination of the concentrations of advanced glycation end-products and antibodies against carboxymethyl lysine (anti-CML) and carboxyethyl lysine (anti-CEL) in the sera of Graves’ orbitopathy patients. Material and methods: The study group were patients from the Division of Endocrinology of the Medical University of Silesia (n = 25) suffering from Graves’ orbitopathy. The concentration of AGE-peptides using flow spectrofluorimetry method, and anti-CML and anti-CEL IgG antibodies using immunoenzymatic technique (ELISA), were measured in patients sera before and after methylprednisolone treatment. Results: In sera of the study group the concentrations of AGE-peptides and anti-CML were significantly lower before and after treatment in comparison to the control group (p < 0.05). Mean values of anti-CEL concentrations were comparable (at both phases of treatment) with the value observed in the control group. After treatment the concentrations of AGE-peptides and anti-CEL significantly decreased (p < 0.05); however, the concentration of anti-CML was also lower but the observed change was not significant (p > 0.05). Conclusions: In the course of Graves’ orbitopathy the glycation process is disturbed. The treatment modifies significantly the process by lowering the concentration of advanced glycation end-products and suppressing the immune response to them. (Endokrynol Pol 2016; 67 (4): 383–389)    Wstęp: Glikacja jest nieenzymatyczną modyfikacją białek zachodzącą z udziałem cukrów redukujących. Produkty glikacji białek tracą swoje biologiczne funkcje, przez co ich usuwanie staje się nieefektywne. Kumulują się one, a jako neoepitopy wywołują odpowiedź immunologiczną. Celem pracy była ocena stężeń końcowych produktów zaawansowanej glikacji białek (AGE-peptydów) i przeciwciał przeciwko karboksymetylolizynie (anty-CML) i karboksyetylolizynie (anty-CEL) w surowicy chorych na orbitopatię Gravesa. Materiał i metody: Badaną grupę stanowili pacjenci Kliniki Endokrynologii Śląskiego Uniwersytetu Medycznego (n = 25) cierpiący na orbitopatię Gravesa. W surowicy krwi żylnej oznaczono zawartość AGE-peptydów przy użyciu metody spektrofluorymetrii przepływowej oraz przeciwciał anty-CML i anty-CEL w klasie IgG przy użyciu techniki immunoenzymatycznej (ELISA), przed i po leczeniu preparatem metyloprednizolonu. Wyniki: W próbkach surowicy grupy badanej wykazano istotne statystycznie niższe stężenia AGE-peptydów i anty-CML zarówno przed, jak i po leczeniu w porównaniu z grupą kontrolną (p < 0,05). Średnie stężenia anty-CEL były porównywalne (w obu etapach leczenia) do obserwowanych w grupie kontrolnej. Po zastosowanym leczeniu stężenie AGE-peptydów oraz anty-CEL uległo znaczącemu obniżeniu (p < 0,05); stężenie anty-CML również było niższe, lecz zaobserwowana różnica nie była znamienna statystycznie (p > 0,05). Wnioski: W przebiegu orbitiopatii Gravesa procesy glikacji białek ulegają zaburzeniu. Na podstawie wyników wstępnych badań można stwierdzić, że leczenie istotnie modyfikuje ten proces, zmniejszając stężenie końcowych produktów zaawansowanej glikacji oraz hamując odpowiedź immunologiczną przeciwko nim. (Endokrynol Pol 2016; 67 (4): 383–389)