ESPEN guideline on home parenteral nutrition

This guideline will inform physicians, nurses, dieticians, pharmacists, caregivers and other home parenteral nutrition (HPN) providers, as well as healthcare administrators and policy makers, about appropriate and safe HPN provision. This guideline will also inform patients requiring HPN. The guideline is based on previous published guidelines and provides an update of current evidence and expert opinion; it consists of 71 recommendations that address the indications for HPN, central venous access device (CVAD) and infusion pump, infusion line and CVAD site care, nutritional admixtures, program monitoring and management. Meta-analyses, systematic reviews and single clinical trials based on clinical questions were searched according to the PICO format. The evidence was evaluated and used to develop clinical recommendations implementing Scottish Intercollegiate Guidelines Network methodology. The guideline was commissioned and financially supported by ESPEN and members of the guideline group were selected by ESPEN

Toxic liver failure in paracetamol poisoned patient abusing ethyl alcohol – case study

Paracetamol jest lekiem powszechnie stosowanym w terapii bólu i gorączki, wchodzącym w skład zarówno preparatów jednoskładnikowych, jak i złożonych. Przyjmowany w dawkach terapeutycznych jest lekiem stosunkowo bezpiecznym. Jednak powszechna dostępność tego preparatu oraz niska świadomość społeczna dotycząca ryzyka przedawkowania stwarza możliwość niekontrolowanego przyjmowania tego leku i prowadzi do występowania zatruć powikłanych ciężkim uszkodzeniem wątroby. Paracetamol przekształcany jest w wątrobie w około 4% przez CYP2E1 do toksycznego metabolitu, jakim jest N-acetylo-p-benzochinonoimina (NAPQI). U osób zdrowych metabolit ten jest wychwytywany przez grupy sulfhydrylowe glutationu i wydalany z organizmu. Alkohol etylowy jest również metabolizowany przy udziale CYP2E1, indukuje jego aktywność. Regularne spożywanie alkoholu zwiększa ilość aktywnego enzymu. Kiedy podaż alkoholu zostanie zakończona, poziom CYP2E1 jest znacznie podwyższony. Podanie wówczas paracetamolu powodujewzrost stężenia NAPQI ponad poziom, który może być usunięty przez glutation wątrobowy. NAPQI łączy się wówczas kowalencyjnie z makrocząsteczkami hepatocytów, co prowadzi do martwicy tych komórek [1]. Stosując paracetamol, nie należy spożywać alkoholu ze względu na zwiększone ryzyko wystąpienia toksycznego uszkodzenia wątroby. Dotyczy to przede wszystkim osób regularnie pijących alkohol. Alkoholizm w krajach Europy Środkowej i Wschodniej opiera się na tradycji picia dużych ilości mocnych trunków. Ból głowy spowodowany nadużyciem alkoholu staje się przyczyną przedawkowania środków przeciwbólowych. Coraz częściej jednak zdarzają się przypadki zatruć paracetamolem w celach samobójczych u osób uzależnionych od alkoholu.Paracetamol is a drug which is commonly used in pain and fever therapy. Its composition includes many single and multiple ingredient medications. When used in therapeutic doses, it is considered to be quite safe. However, its common availability and low public awareness concerning the risk of overdose can be the reason of uncontrolled ingestion and may lead to poisoning resulting in severe liver failure. About 5% of paracetamol is metabolized in the liver by CYP2E1 into a toxic metabolite called N-acetyl-p-benzoquinoneimine (NAPQI). In healthy organisms, this metabolite is caught by sulfhydryl groups of hepatic glutathione and removed from the body. Ethyl alcohol is also metabolized by CYP2E1, ethanol induces its activity. Chronic ingestion of ethanol increases the level of this enzyme. When the ingestion of ethanol is stopped, the level of CYP2E1 is significantly increased. In such cases, the dosage of paracetamol results in increased level of NAPQI that cannot be removed by hepatic glutathione. NAPQI creates a covalent bond withhepatocyte macromolecules which may end in the demise of these cells. During paracetamol treatment, drinking alcohol is not allowed because of the higher risk of hepatotoxicity. It especially concerns people who drink alcohol regularly (chronic alcohol addicts). Alcoholism in Central and Eastern European countries is based on the tradition of drinking large amounts of strong liquors. A headache caused by misuse of alcohol often becomes the reason of painkillers overdose. However, paracetamol poisonings linked to suicide attempts have become commonplace

Problems Associated with the Misuse of Drugs Among Young People. Benzydamine Poisoning – Case Study

Obrót substancjami psychotropowymi w Polsce reguluje ustawa o przeciwdziałaniu narkomanii (Dz.U. 2005 Nr 179 poz. 1485) wraz z jej nowelizacjami. Mimo tego że do listy substancji zakazanych w 2010 r. dołączyło 17 nowych związków, wchodzących w skład tzw. „dopalaczy”, oraz wprowadzono pojęcie środka zastępczego, co dało Państwowej Inspekcji Sanitarnej narzędzie ułatwiające i przyśpieszające proces usuwania z rynku nowych substancji psychoaktywnych, podaż tego typu produktów na rynek polski nie spadła. Wzrasta także zainteresowanie młodzieży możliwością wykorzystania w celach odurzania się substancji występujących w popularnych preparatach, dostępnych w aptekach bez recepty, a które przyjmowane w dawkach znacznie przekraczających terapeutyczne, wykazują działanie psychoaktywne. Rekreacyjne stosowanie benzydaminy – występującej w preparatach ginekologicznych, i dekstrometorfanu – składnika preparatów stosowanych w leczeniu suchego kaszlu, staje się zjawiskiem niepokojącym ze względu na jego skalę. Działanie dysocjacyjne, pobudzenie, silne halucynacje wywoływane przez te leki, a także łączenie ich z alkoholem, kanabinoidami może stanowić zagrożenie dla zdrowia i życia osób je nadużywających. W pracy przedstawiono przypadek ostrego zatrucia benzydaminą u 17-letniego chłopca hospitalizowanego w Ośrodku Toksykologii Szpitala Wojewódzkiego nr 2 w Rzeszowie.Psychotropic substances market in Poland is regulated by the Drug Abuse Prevention Bill (Dz.U.2005 Nr 179 poz.1485) with amendments. Despite adding 17 new substances, which are typical ingredients in “legal highs”, to the prohibited drug list and introducing the concept of “substitute”, which gave the State Health Inspection a tool to simplify and accelerate the process of removing new psychotropic substances from the market, the supply of products of this kind to the Polish market did not decrease. Also, teenagers’ interest in the possibility of intoxicating themselves using substances found in popular over-the-counter medications which, when ingested in doses significantly exceeding therapeutic levels, cause psychoactive effects, is on the increase. The recreational usage of benzydamine, contained in gynaecological formulations, and dextromethorphane, the ingredient of medications used in dry cough treatment, is becoming alarming because of its scale. Dissociative effects, arousal, strong hallucinations caused by these drugs, and especially their combination with alcohol or cannabinoids may become a threat to the users’ health and life. In this article, we describe a case of acute poisoning due to benzydamine usage of a 17-year-old boy who was treated at the Department of Toxicology at Regional Hospital No 2 in Rzeszów

An attempt to identify factors determining the prevalence and intensity of depression in patients with diabetes in Polish population — preliminary report

Introduction. Diabetes is included in the group of metabolic diseases. According to the estimates of the World Health Organization (WHO) the global number of patients suffering from diabetes has increased to 387 million in just 11 years. 5% of Polish society, which is about 2 million, is diagnosed with this particular illness in Poland. Metabolic disorders occur 2 to 3 times more often in patients with mental diseases than in the general population. Often diabetes is accompanied by depression making it a chronic illness. Aim. The aim of the study is to identify factors determining the prevalence and intensification of depression in patients suffering from diabetes. Material and methods. The study included 100 patients with diabetes in the Subcarpathian region, who are being treated in specialist clinics. The study was conducted from 12th to 20th April 2016 using an original questionnaire. Verification of differences was performed by means of chi-square test of independence and U Manna-Whitney test, applying the significance level at p < 0.05. Calculations were performed using SPSS. Results. The average age of the respondents was 41.25 years, SD = 15.38. The prevalence of depression in family history was pointed by 31% of responders and 40.0% of them declared permanent psychiatric consultations. Depression was diagnosed in 25.0% of the diabetic patients. Among the symptoms observed the respondents enumerated fatigue, lack of energy, lack of motivation to make any effort (60.0%). Depression was treated more often among patients treated for diabetes for over 20 years (53.8%). Conclusions. The prevalence of depression symptoms was observed by all of the patients in the study. The most common ones included fatigue, lack of energy and lack of motivation to make any effort. More men than women stated that they were consulting a psychiatrist. The patients who suffered from diabetic complications are more eager to consult a psychiatrist and undergo the treatment for depression. Fluctuations of blood glucose may have an impact on depression symptoms in diabetic patients.

ESPEN practical guideline: Home enteral nutrition.

This ESPEN practical guideline will inform physicians, nurses, dieticians, pharmacists, caregivers and other home enteral nutrition (HEN) providers in a concise way about the indications and contraindications for HEN, as well as its implementation and monitoring. This guideline will also inform interested patients requiring HEN. Home parenteral nutrition is not included but will be addressed in a separate ESPEN guideline. The guideline is based on the ESPEN scientific guideline published before, which consists of 61 recommendations that have been reproduced and renumbered, along with the associated commentaries that have been shorted compared to the scientific guideline. Evidence grades and consensus levels are indicated. The guideline was commissioned and financially supported by ESPEN and the members of the guideline group were selected by ESPEN

ESPEN guideline on home enteral nutrition.

This guideline will inform physicians, nurses, dieticians, pharmacists, caregivers and other home enteral nutrition (HEN) providers about the indications and contraindications for HEN, and its implementation and monitoring. Home parenteral nutrition is not included but will be addressed in a separate ESPEN guideline. This guideline will also inform interested patients requiring HEN. The guideline is based on current evidence and expert opinion and consists of 61 recommendations that address the indications for HEN, relevant access devices and their use, the products recommended, the monitoring and criteria for termination of HEN, and the structural requirements needed to perform HEN. We searched for meta-analyses, systematic reviews and single clinical trials based on clinical questions according to the PICO format. The evidence was evaluated and used to develop clinical recommendations implementing the SIGN method. The guideline was commissioned and financially supported by ESPEN and the members of the guideline group were selected by ESPEN

Analysis of Outcomes in Ischemic vs Nonischemic Cardiomyopathy in Patients With Atrial Fibrillation A Report From the GARFIELD-AF Registry

IMPORTANCE Congestive heart failure (CHF) is commonly associated with nonvalvular atrial fibrillation (AF), and their combination may affect treatment strategies and outcomes