Biological therapies in Crohn’s disease

Crohn’s disease is one of the chronic inflammatory diseases of the digestive tract. Pathophysiology of this disease involves the genetic and environmental factors, but the most important causative factor is anti-inflammatory reaction of the organism, which eventually leads to inflammatory changes, fibrosis and necrosis. Glucocorticosteroids are commonly used in therapy and may cause many negative side effects. Nowadays, new biological medicines are being tested, which are supposed to be an alternative method of treating Crohn’s disease. Infliximab, adalimumab, certolizumab pegol, natalizumab, etanerecept, vedolizumab and ustekinumab are the examples of those drugs, on which the research was already carried out. They lead to healing of the mucous membrane of the digestive tract, and thus to remission of the disease

Cardiac amyloidosis: a review

Cardiac amyloidosis is a type of amyloidosis in which one of the affected organs is the heart. The disease is characterized by the formation of protein aggregates between the cells of the organ, namely amyloid, which disables its function. The following types of amyloidosis can be distinguished: systemic senile amyloidosis (wild-type ATTR), light chain amyloidosis (AL) and hereditary transthyretin-related amyloidosis. The symptoms include, e.g., systolic dysfunction or arrhythmia. The treatment is focused on the therapy with melphalan and, additionally, stem cells transplant and chemotherapy with dexamethasone or cyclophosphamide. In the advanced stage of the disease, a heart transplant is necessary. The diagnosis is made on the basis of laboratory testing, electrocardiogram changes, and echocardiography

Haloperidol and extrapyramidal symptoms: selected recent reports

Antipsychotic therapy by haloperidol is used from many decades and it still occupies a key place in the treatment ofsymptoms and prevention of recurrence of schizophrenia, mainly paranoid. It is also used in the treatment of bipolardisorder and behavioral disorders as well. It is also effective as an antiemetic and in drug-resistant hiccups. It can beused by both adults and children. The purpose of this review is to show selected articles describing methods, which mayreduce or even eliminate the risk of developing extrapyramidal syndrome, which is unavoidably accompanied by pharmacotherapywith this drug. These symptoms are a frequent cause of withdrawal of psychiatric medications by patientsand thus, they are the reasons of the therapy’s failure. This review includes interpretations of articles that present theresults of research on new methods for predicting the risk of extrapyramidal syndrome caused by haloperidol treatment.In this article we discussed predictive values of such factors as arterial blood lactate levels, creatine kinase activity, serumselenium level or early antipsychotic effect. In search of new methods of prevention of the extrapyramidal syndrome, weanalyzed the effect of caffeine, naproxen and cystamine. Evaluation of the clinical and morphological effects of chronichaloperidol administration has been based on results of patients who were suffering from paranoid schizophrenia froma minimum of 30 years. The results of experiments comparing the new form of administration of haloperidol with thepreviously known ones are also presented. The ideas presented in these works often require further clinical trials, whichmay be the reason for exploring these problems.Terapia przeciwpsychotyczna haloperidolem jest stosowana od wielu dekad i wciąż zajmuje kluczowe miejsce w leczeniu objawów i zapobieganiu nawrotom schizofrenii, głównie paranoidalnej. Jest stosowany również w terapii choroby afektywnej dwubiegunowej, jak również zaburzeń zachowania. Skuteczny też jako środek przeciwwymiotny i w opornej na leki czkawce. Dopuszcza się używanie zarówno u osób dorosłych jak i dzieci. Celem tego przeglądu jest ukazanie wybranych prac opisujących metody, które mogą w przyszłości zmniejszyć lub nawet wyeliminować ryzyko wywoływania zespołu pozapiramidowego, który nieodzownie towarzyszy farmakoterapii tym lekiem. Objawy te są częstą przyczyną odstawiania medykamentów psychiatrycznych przez pacjentów i tym samym niepowodzenia terapii. W niniejszym przeglądzie zawarte są interpretacje artykułów, które prezentują wyniki badań nad nowymi metodami przewidywania ryzyka wystąpienia zespołu pozapiramidowego wywołanego leczeniem haloperidolem. Omówiono wartości predykcyjne takich czynników jak stężenia mleczanów we krwi tętniczej, aktywność kinazy kreatynowej, poziom selenu w surowicy czy wczesny efekt przeciwpsychotyczny. W poszukiwaniu nowych sposobów prewencji zespołu pozapiramidowego przeanalizowano efekt działania kofeiny, naproksenu oraz cystaminy. Ocenie skutków klinicznych i morfologicznych przewlekłego stosowania haloperidolu zostali poddani pacjenci chorujący na schizofrenię paranoidalną od minimum 30 lat. Przedstawione zostały też wyniki doświadczeń porównujących nową formę podawania haloperidolu z dotychczas znanymi. Idee przedstawione w tych pracach nierzadko wymagają dalszych badań klinicznych, co może stać się przyczyną do zgłębiania tych problemów

Mirabegron: the review of current knowledge of safety and efficacy in the relief of overactive bladder symptoms

Mirabegron has been registered as the first strong and selective agonist of the β3 receptor. It is currently used for relief of symptoms of overactive bladder (OAB). That onerous illness involving urgency and detrusor overactivity, that may be accompanied by incontinence, affects approx. 16% of the population. Before registration of Mirabegron, the main pharmacological and non-surgical therapeutic method was the treatment with anti-muscarinic drugs, associated with burdensome adverse effects. Clinical trials on over 10,000 participants demonstrated efficacy and safety of Mirabegron. Besides monotherapy, attempts are being made to use Mirabegron in combined therapy of OAB. The innovative mechanism of action of the drug makes it an attractive option not only in treatment of conditions of the urinary system, but also of metabolic disorders and diseases of the cardiovascular system. This article provides a review of the current knowledge and recent reports regarding Mirabegron - an alternative in treatment of the common and onerous disease of overactive bladder

Sofosbuvir as a drug in recurrent HCV therapy occurring after liver transplantation

Sofosbuvir is a drug, which has been found useful in HCV (Hepatis C Virus) therapy. It replaced the previously used interferon, the applied of which has shown many side effects or lack of response to treatment. The usage of sofosbuvir with ribavirin shortens the time of treatment and minimizes the number of side effects. It is taken as a single dose of 400 mg for 12 or 24 weeks. The only place of activation of this prodrug is hepatocytes, where its active metabolite is formed (GS-461203). It should not be used together with P-glycoprotein inductors that can reduce the efficiency of its action and with amiodarone, because application of both of them together slows down the heart rate. Numerous tests have demonstrated the effectiveness of sofosbuvir in the treatment of patients who have relapsed disease after liver transplantation. A high percentage of sustained virologic response obtained in all phases of clinical trials has proven the efficacy of sofosbuvir in combination with ribavirin or another HCV drug in the therapy of hepatitis C infection

Current nosological status, pathomechanism and treatment of catatonia

Catatonia, otherwise known as catatonic syndrome is a frequent neuropsychiatric syndrome characterized mainly by motor disorders. There are many somatic and psychiatric dysfunctions, and the multitude of symptoms included in it make a problem in diagnosis. Moreover, until now the mechanism of pathophysiology of catatonia has not been recognized. Among the hypotheses proposed, one may find theories concerning dysregulation of neurotransmission within the dopamineergic D2 or GABA-A-ergic receptors. For years, catatonia was closely related to schizophrenia, but with the publication of the 5th edition of the Diagnostic and Statistical Manual of Psychiatric Disorders - DSM-5, these disorders were separated, creating the hope that catatonia would be considered as a separate disease entity in the future. Pharmacotherapy involves the use of benzodiazepines in the first line, which are effective in most patients. An alternative is N-methyl-D-aspartic acid (NMDA) antagonists and atypical antipsychotic drugs, the use of which is controversial due to the high risk of neuroleptic malignant syndrome, which is a direct threat to life. In the case of catatonia resistant to benzodiazepines, electroconvulsive therapy (ECT) is effective. At the same time, in order to increase the effectiveness of treatment, electroconvulsive therapy and benzodiazepines are used in parallel, which brings satisfactory results

Carbamazepine - hematologic effects of the use

Carbamazepine is an antiepileptic drug which exhibits a number of side effects, namely including a headache, abdominal pain, increased blood pressure, but also hematologic disorders. Thrombocytopenia, hypogammaglobulinemia, leukopenia, neutropenia, agranulocytosis, aplastic anemia, pure red cell aplasia, leukemia or eosinophilia with DRESS syndrome belong to the latter. There is a low incidence of carbamazepine pharmacotherapy related symptoms and their exact mechanisms of action are still unknown

Metallo-Beta-Lactamases: NDM

New Delhi, an enzyme belonging to the Metallo-beta-lactamases and Carbapenemases group, is most commonly found in Klebsiella pneumoniae and Escherichia coli. It determines these bacteria resistance to the majority of known antibiotics. NDM-1 was discovered in 2008 in a man treated in New Delhi for E. coli infection. Since the first appearance, 17 subtypes of this enzyme have been discovered. Its occurrence has been reported in Europe (Great Britain, France, Belgium - where even a national alert has been issued) as well as in the United States and in Africa. Most cases of New Delhi enzyme bacterial infections are reported in India or in people who have traveled to this country. There is no treatment method described so far. Therapy is based on antibiotic susceptibility test results. Colistin shows the highest effectiveness against NDM. There are also tests suggesting that Isomargololone and Nimbolide may be effective in most cases of NDM infection