Anti-inflammatory effects of ketamine in the treatment-resistant depression: a narrative review

Background: In some depressed patients, especially those not responding to standard antidepressants or with suicidal thoughts or attempts, inflammation as a source of cytokines contributes to a lack of response to the therapies used. An opportunity for such individuals is therapy with ketamine. S-ketamine is a fast-acting antidepressant with high efficacy in treating patients with treatment-resistant depression (TRD). Ketamine is a derivative of phencyclidine, a substance belonging to the group of psychodysleptic agents, also known as hallucinogens. The mechanism of ketamine's antidepressant effect is complex and not yet fully understood. It is thought that it acts mainly by modulating the functioning of the glutamatergic system, which is responsible for the rapid antidepressant effect of ketamine and plays a significant role in the process of neuroplasticity in the course of depression. In recent years, the anti-inflammatory properties of ketamine and its effects on tryptophan metabolism have attracted research interest. Aim of the study: This review aims to discuss and present the current state of knowledge regarding the anti-inflammatory effects of ketamine, which could serve as a crucial component in the effective therapy for depression. This is particularly relevant for the subgroup of patients with TRD who have increased levels of pro-inflammatory cytokines. Materials and methods: The issue was analysed on the basis of a current literature review in both Polish and English languages (published between November 2006 and November 2023) by searching scientific databases: PubMed/Medline and Google Scholar. A search for relevant articles on the anti-inflammatory effects of ketamine was conducted using the keywords: "ketamine" (ketamine), "depression" (depression), treatment-resistant depression (treatment-resistant depression), "inflammation" (inflammation), "kynurenine pathway" (kynurenine pathway), "anti-inflammatory action" (anti-inflammatory action). The described methodology allowed for obtaining reliable information. Results: Preclinical and clinical studies have demonstrated that ketamine appears to induce anti-inflammatory effects, either directly or indirectly (by activating neuroprotective branches of the kynurenine pathway), at least in some patients with TRD. Conclusions: This publication not only expands the current understanding of the mechanism of action of ketamine, but also represents an important addition to the scientific literature in Polish, shedding new light on the complex interactions between the anti-inflammatory and antidepressant effects of this drug

Dermoscopic Features of Giant Molluscum Contagio Contagiosum in a Patient with Acquired Immunodeficiency Syndrome

Giant molluscum contagiosum (MC) is a peculiar variant of the disease with the presence of multiple or single lesions larger than 5 mm. In contrast to typical molluscum contagiosum, dermoscopic features of giant lesions have been poorly described, and none of the reports included multiple giant lesions in an immunocompromised patient. We present a patient with acquired immunodeficiency syndrome diagnosed with multiple giant molluscum contagiosum along with the dermoscopic features of this entity

Kamica nerkowa – Metody leczenia u pacjentów geriatrycznych = Urolithiasis - Methods of treatment of geriatric patients

Radajewski Kamil, Mirlak Izabela, Sokołowska Natalia, Sokołowski Remigiusz, Podhorecka Marta, Stemplowski Wojciech, Zukow Walery. Kamica nerkowa – Metody leczenia u pacjentów geriatrycznych = Urolithiasis - Methods of treatment of geriatric patients. Journal of Education, Health and Sport. 2016;6(8):128-134. eISSN 2391-8306. DOI http://dx.doi.org/10.5281/zenodo.59898 http://ojs.ukw.edu.pl/index.php/johs/article/view/3739 The journal has had 7 points in Ministry of Science and Higher Education parametric evaluation. Part B item 755 (23.12.2015). 755 Journal of Education, Health and Sport eISSN 2391-8306 7 © The Author (s) 2016; This article is published with open access at Licensee Open Journal Systems of Kazimierz Wielki University in Bydgoszcz, Poland Open Access. This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited. This is an open access article licensed under the terms of the Creative Commons Attribution Non Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted, non commercial use, distribution and reproduction in any medium, provided the work is properly cited. This is an open access article licensed under the terms of the Creative Commons Attribution Non Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted, non commercial use, distribution and reproduction in any medium, provided the work is properly cited. The authors declare that there is no conflict of interests regarding the publication of this paper. Received: 02.07.2016. Revised 25.07.2016. Accepted: 28.07.2016. Kamica nerkowa – Metody leczenia u pacjentów geriatrycznych Urolithiasis - Methods of treatment of geriatric patients Kamil Radajewski1, Izabela Mirlak1, Natalia Sokołowska2, Remigiusz Sokołowski2, Marta Podhorecka2, Wojciech Stemplowski2, Walery Zukow3 1Specialist Hospital. Sniadecki in Nowy Sącz, Poland 2Department and Clinic of Geriatrics, Ludwik Rydygier Collegium Medicum in Bydgoszcz NCU, Poland 3WKFZIT, Kazimierz Wielki University, Bydgoszcz, Poland Słowa klucze: kamica nerkowa, ESWL, PCNL, RIRS, geriatria. Key words: urolithiasis, ESWL, PCNL, RIRS, geriatrics. Streszczenie Wstęp. Kamica nerkowa jest to obecność w drogach moczowych nierozpuszczalnych złogów, które powstają w wyniku wytrącania się substancji chemicznych zawartych w moczu, gdy ich stężenie przekracza próg rozpuszczalności. Największy wzrost zachorowań obserwowany jest w przedziale wiekowym 60-74 lata. Coraz częściej w leczeniu kamicy stosowane są mało inwazyjne metody leczenia, wśród których wyróżniamy przezskórną nefrolitotrypsję, litotrypsję zewnątrzustrojową falą uderzeniową, oraz wsteczną ureterorenoskopię giętką. Cel. Porównanie mało inwazyjnych metod leczenia kamicy moczowej u pacjentów geriatrycznych. Materiały i metody. Posługując się słowami kluczowymi przeszukano zagraniczne bazy bibliograficze: Embase, Medline, ScienceDirect, Web of Sciense. Przeanalizowano badanie kliniczne opublikowane w języku angielskim i międzynarodowych czasopismach. Wyniki. Najczęściej stosowaną metodą leczenia u pacjentów geriatrycznych jest itotrypsja zewnątrzustrojową falą uderzeniową. Na wybór metody wpływa nie tylko wielkość kamienia ale również choroby współistniejące takie jak cukrzyca, nadciśnienie tętnicze, niewydolność nerek. Wnioski. Z przeprowadzonych dotychczas badań wynika, że sam wiek nie jest czynnikiem determinującym wybór metody. Jakkolwiek, wciąż potrzeba dalszych badań w grupie pacjentów geriatrycznych, aby zmniejszyć liczbę powikłań po leczeniu inwazyjnym kamicy nerkowej. Summary Admission. Urolithiasis is present in the urinary insoluble deposits, which result from precipitation chemicals in the urine when their concentration exceeds the limit of solubility. The highest increase in incidence is observed in the age group 60-74 years. More and more frequently in the treatment of urolithiasis are used in minimally invasive treatments, among which we distinguish percutaneous nephronlithotripsy, lithotripsy extracorporeal shock wave and backward ureterorenoscopy flexible. Objective. Comparison of minimally invasive treatment of urolithiasis geriatric patients. Materials and methods. Using the keywords searched international bibliographic databases: Embase, Medline, Science Direct, Web of Science. We analyzed clinical trial published in English and international journals. Results. The most commonly used treatment for geriatric patients is extracorporeal shock wave lithotripsy. The choice of the method is affected not only the size but also stone co-morbidities such as diabetes, hypertension, renal failure. Conclusions. From the studies to date show that age alone is not the determining factor in the choice of method. However, we still need further research in geriatric patients, to reduce the number of complications after invasive treatment urolithiasis

Usefulness of the Polish versions of the Montreal Cognitive Assessment 7.2 and the Mini-Mental State Examination as screening instruments for the detection of mild neurocognitive disorder

Introduction. Screening tests are a key step in the diagnosis of dementia and should therefore be highly sensitive to the detection of mild neurocognitive disorders (NCD). The Mini Mental State Examination (MMSE) is the most commonly used screening method. The Montreal Cognitive Assessment (MoCA) is a newer and less well-known screening tool, which has none of the limitations of the MMSE.Aim. The aim of this study was to analyse the reliability of the Polish versions of MoCA 7.2 vs MMSE in the detection of mild NCD among people aged over 60.Material and methods. The study was carried out at the Department and Clinic of Geriatrics from September 2014 to March 2017. The study included 281 participants, 91 of whom were assigned to the group without NCD. The other 190 had been diagnosed with mild NCD.Results. In the analysis of the ROC curve of the MoCA 7.2 results, the AUC was 0.925 (p < 0.001). The optimal cut-off point for mild NCD was 23/24 points, with sensitivity and specificity of 83.2% and 79.1%. In the ROC curve of MMSE results, the AUC was 0.847 (p < 0.001). The optimal cut-off point for mild NCD was 27/28 points, with sensitivity and specificity of 75.8% and 66.7%. The difference between AUC MoCA 7.2 and MMSE was 0.078 (p = 0.036).Conclusions. MoCA 7.2 detects mild NCD with more sensitivity than MMSE. We recommend using the cut-off point for MoCA of 23/24 points, because this is characterised by a higher sensitivity than the previously recommended cut-off point of 25/26 points. For the MMSE, the recommended cut-off point should be 27/28, which gives greater diagnostic accuracy than the previously recommended 25/26 points

Vaginal and cervical bacterial colonization in patients with threatening preterm labor

Objectives: The aim of the following work was to evaluate vaginal and cervical colonization in patients with threatening preterm labor and comparing the frequency of colonization of the term and preterm labor groups. Material and methods: 532 pregnant women with threatening preterm labor were included into the clinical trial. The frequency of colonization was established and the frequency of colonization depending on the duration of pregnancy was checked. Results: Positive vaginal cultures were found in 29.5% of patients. The most frequent were: Escherichia coli and Streptoccocus agalactiae. There was no relationship between the duration of pregnancy, the frequency of colonization or the type of bacterial culture. Conclusions: 30% of positive vaginal and cervical cultures may indicate about the deficiency of the used method. The most frequent microorganisms remain to be Candida, Escherichia coli and GBS. However, the frequency of colonization with rare bacteria increases. Not only bacterial colonization but a group of different factors may be the reason of preterm labor

Relationship Between Nutritional Habits and Hair Calcium Levels in Young Women

The present study was conducted to investigate whether hair calcium levels are related to nutritional habits, selected status parameters, and life-style factors in young women. Eighty-five healthy female students neither pregnant nor lactating, using no hair dyes or permanents were recruited for the study. Food consumption data, including fortified products and dietary supplements were collected with 4-day records. The calcium levels in hair and serum were analyzed by atomic absorption spectroscopy. Serum osteocalcin and the C-terminal telopeptide of type I collagen were assayed by ELISA. The women were divided into four groups according to their total vitamin D and calcium intakes and hair calcium levels. At adequate calcium intake and comparable serum bone biomarker levels, supplemental vitamin D increased the hair calcium levels. On the other hand, at lower than estimated adequate requirement of vitamin D intake the hair calcium levels were comparable in women with low calcium intakes but consuming high amounts of meat products or those whose diets were rich in dairy products, possibly due to homeostatic mechanisms. Elevated hair calcium was seen in 25% of subjects and could not be related to nutritional or life-style factors. The results show that the hair calcium levels were weakly related to the quality of diet, with some synergistic interactions between nutrients, especially vitamin D and magnesium

A hybrid protocol CLAG-M, a possible player for the first-line therapy of patients with mixed phenotype acute leukemia. A Polish Adult Leukemia Group experience

IntroductionMixed-phenotype acute leukemia (MPAL) is a rare disease with poor prognosis. So far, no standard approach has been established as the “know-how” of MPAL is based only on retrospective analyses performed on small groups of patients.Materials and methodsIn this study, a retrospective analysis of the outcomes of adult MPAL patients included in the PALG registry between 2005 and 2024 who received the CLAG-M hybrid protocol as induction or salvage therapy was performed.ResultsSixteen of 98 MPAL patients received CLAG-M: eight as first-line and eight as salvage therapy. In the first line, two patients achieved partial response (PR), and six achieved complete remission (CR), of whom four successfully underwent allogeneic hematopoietic stem cell transplantation (alloHSCT). Two patients who did not undergo alloHSCT promptly relapsed. Within the whole group, the overall response rate (ORR) was 75% (n = 12/16). With the median follow-up of 13 months, six out of eight patients remain in CR, however, two of them died due to acute graft versus host disease. Out of eight patients who received CLAG-M in the second line, four patients (50%) obtained CR. AlloHSCT was conducted in seven cases, six of which were in CR. Only two patients remained in CR at the time of the last follow-up. Tolerance to treatment was good. The median times for severe neutropenia and thrombocytopenia were 22 days (range, 16–24) and 17 days (range, 12–24), respectively. Overall, grade 3-4 infections were observed in 12 cases, and all infections presented successful outcomes.ConclusionsCLAG-M is an effective first-line salvage regimen for MPAL with an acceptable safety profile. Early achievement of CR with prompt alloHSCT allows for satisfactory disease control

Clinical features, etiology, and survival in patients with restrictive cardiomyopathy: A single-center experience

Background: Numerous prognostic factors have been proposed for cardiac amyloidosis (CA). The knowledge about other subtypes of restrictive cardiomyopathy (RCM) is scant.Aims: This study aimed to elucidate the etiology and prognostic factors of RCM as well as assess cardiac biomarkers: high-sensitive troponin T (hs-TnT), growth differentiation factor-15 (GDF-15), N-terminal pro-B-type natriuretic peptide (NT-proBNP), and soluble suppression of tumorigenicity 2, as mortality predictors in RCM.Methods: We enrolled 36 RCM patients in our tertiary cardiac department. All patients were screened for CA. Genetic testing was performed in 17 patients without CA.Results: Pathogenic or likely pathogenic gene variants were found in 86% of patients, including 5 novel variants. Twenty patients died, and 4 had a heart transplantation during the study. Median overall survival was 29 months (8–55). The univariate Cox models analysis indicated that systolic and diastolic blood pressure, GDF-15, hs-TnT, NT-proBNP, left ventricular stroke volume, the ratio of the transmitral early peak velocity (E) estimated by pulsed wave Doppler over the early mitral annulus velocity (e’), tricuspid annulus plane systolic excursion, early tricuspid valve annular systolic velocity, the presence of pulmonary hypertension, and pericardial effusion influenced survival (P <0.05). A worse prognosis was observed in patients with GDF-15 >1316 pg/ml, hs-TnT >42 ng/l, NT-proBNP >3383 pg/ml, and pericardial effusion >3.5 mm (Kaplan-Meier analysis, log-rank test, P <0.001).Conclusions: Genetic testing should be considered in every RCM patient where light-chain amyloidosis has been excluded. Survival remains poor regardless of etiology. Increased concentrations of GDF-15, hs-TNT, NT-proBNP, and pericardial effusion are associated with worse prognosis. Further studies are warranted

Common, low-frequency, rare, and ultra-rare coding variants contribute to COVID-19 severity

The combined impact of common and rare exonic variants in COVID-19 host genetics is currently insufficiently understood. Here, common and rare variants from whole-exome sequencing data of about 4000 SARS-CoV-2-positive individuals were used to define an interpretable machine-learning model for predicting COVID-19 severity. First, variants were converted into separate sets of Boolean features, depending on the absence or the presence of variants in each gene. An ensemble of LASSO logistic regression models was used to identify the most informative Boolean features with respect to the genetic bases of severity. The Boolean features selected by these logistic models were combined into an Integrated PolyGenic Score that offers a synthetic and interpretable index for describing the contribution of host genetics in COVID-19 severity, as demonstrated through testing in several independent cohorts. Selected features belong to ultra-rare, rare, low-frequency, and common variants, including those in linkage disequilibrium with known GWAS loci. Noteworthily, around one quarter of the selected genes are sex-specific. Pathway analysis of the selected genes associated with COVID-19 severity reflected the multi-organ nature of the disease. The proposed model might provide useful information for developing diagnostics and therapeutics, while also being able to guide bedside disease management. © 2021, The Author(s)