Does morphine administration affect ticagrelor conversion to its active metabolite in patients with acute myocardial infarction? A sub-analysis of the randomized, double-blind, placebo- -controlled IMPRESSION trial

Background. Therapy with aspirin and one of the platelet P2Y12 receptor inhibitors, preferably ticagrelor or prasugrel, is the mainstay of acute myocardial infarction (AMI) treatment. Morphine is the most commonly used analgesic in AMI patients. The IMPRESSION study was the first randomized trial to confirm that morphine use in this clinical setting leads to a delayed and attenuated exposure to ticagrelor and its active metabolite (AR-C124910XX). The mechanism underlying this drug-drug interaction remains hypothetical. Material and methods. A post hoc sub-analysis of the IMPRESSION study, a phase IV, single center, randomized, double-blind, placebo-controlled trial, was performed to examine whether morphine administration interferes with the proportion of AR-C124910XX produced from ticagrelor in AMI patients. Pharmacokinetic results of all subjects pretreated with placebo (n = 35) and morphine (n = 35) were analyzed. The ratio of total exposure to AR-C124910XX to total exposure to ticagrelor for 12 h was used to illustrate the rate of ticagrelor metabolism. Total exposure to investigated compounds was measured as the area under the plasma concentration-time curve (AUC). Results. The ratios of AUC(0–12) for AR-C124910XX to AUC(0–12) for ticagrelor were comparable between morphine and placebo pretreated patients (20.9 [13.9–34.6] v. 24.7 [18.1–29.6] %; p = 0.58). Importantly, visual inspection of the relationship between AUC(0–12) for AR-C124910XX and AUC(0–12) for ticagrelor revealed that regression lines for the morphine and placebo groups were located closely to each other, with a tendency for superimposing. Additionally, we observed similar values of slope coefficients for both study arms in the linear regression equations illustrating the relationship between AUC(0–12) for AR-C124910XX and AUC(0–12) for ticagrelor (0.19 [± 0.03] v. 0.21 [± 0.04]; p for the statistical significance of both slope coefficients < 0.0001). Conclusions. In the IMPRESSION study, conversion of ticagrelor to AR-C124910XX in AMI patients was not affected by morphine administration

La voix du traducteur à l’école = The translator’s voice at school

The cultural mediation role of translation is particularly important in the context of literature for children and young adults. Translations can provide an opportunity for young readers to access literary works from around the world and develop a positive outlook about cultural difference. However, when used by an institution of socialisation, they can also lead to distortion, misunderstanding and division. Working from a variety of cultural contexts, the articles in this volume make a remarkable contribution to understanding how literary translations are used at school, what historical, ideological, political or pedagogical criteria affect the choice of works studied, and how school canons of foreign works and their place in the curriculum can vary

Infantile seborrheic dermatitis differential diagnosis based on case report

Infantile seborrheic dermatitis often occurs during the first three months of life and most frequently presents as erythema and greasy scales located especially on the scalp (commonly called “cradle cap”). Usually, it is a mild, self-limiting condition. The severe, erythrodermic clinical appearance is rare and often demands differential diagnosis with other more serious skin conditions. We report a case of severe seborrheic dermatitis in an infant. A 5-weeks male infant presented with erythrodermic scaling lesions and exfoliation of the outermost layer of the epidermis, which had appeared after birth. Greasy scales were observed on the scalp, eyelids, and face accompanied by inflammation of the eyelids. Moreover, erythematous, well-demarcated lesions were noticed in the neck folds, behind the ears, in the axillary region, and diaper area. Considering the severe clinical appearance, additional tests such as skin biopsy and genetic analysis were performed to exclude other possible causes such as atopic dermatitis, Langerhans histiocytosis, congenital ichthyosis, and psoriasis. Based on clinical presentation and additional test results, infantile seborrheic dermatitis seemed to be the most probable diagnosis. The treatment including 1% tannic acid, 0.5% erythromycin eye cream, clotrimazole cream, hydrocortisone cream, and emollients was started in the hospital with a good response. After a month of therapy, the patient was re-admitted for the follow-up, with further improvement of the skin condition. It is essential to remember that the dermatoses that we should take into consideration during the differential diagnosis of severe infantile seborrheic dermatitis are atopic dermatitis, Langerhans histiocytosis, congenital ichthyosis, and psoriasis

Epidemiological evaluation of paediatric psoriasis patients at the Dermatology Department

Introduction: Psoriasis is a chronic autoinflammatory disease, which mostly affects skin and joints. Patients with psoriasis are at risk of developing comorbidities such as diabetes, cardiovascular diseases or mental disorders. It is reported that even one-third of the total psoriatic cases may have skin symptoms in childhood.  Material and methods: The study aimed to perform a retrospective analysis of paediatric patients with psoriasis admitted to the dermatological department between 2018 and 2020. Patients’ data were analysed for age, gender, medical diagnosis (ICD-10) including subtypes of psoriasis, treatment, the clinical course of the disease and results of the diagnostic tests including cholesterol fractions and blood glucose level.  Results: In the years 2018–2020 73 children were admitted to the dermatological department. The number of female patients 47 (64.38%) significantly dominated over the number of male patients 26 (35.62%). Almost 95% of them were diagnosed with psoriasis vulgaris. Only 3 cases (4.11%) of generalized pustular psoriasis and 1 case (1.37%) of psoriatic arthritis were reported. Almost 20% of children had a positive family history of psoriasis. Readmission to the ward was required in 35.62% of the cases. 23.4% of patients presented abnormality in lipid profile. 15% had various comorbidities.  Conclusions: Better understanding of psoriasis and its management from an early age, may improve the quality of life of psoriasis patients and prevent them from developing serious comorbidities in the future.Introduction: Psoriasis is a chronic autoinflammatory disease, which mostly affects skin and joints. Patients with psoriasis are at risk of developing comorbidities such as diabetes, cardiovascular diseases or mental disorders. It is reported that even one-third of the total psoriatic cases may have skin symptoms in childhood.  Material and methods: The study aimed to perform a retrospective analysis of paediatric patients with psoriasis admitted to the dermatological department between 2018 and 2020. Patients’ data were analysed for age, gender, medical diagnosis (ICD-10) including subtypes of psoriasis, treatment, the clinical course of the disease and results of the diagnostic tests including cholesterol fractions and blood glucose level.  Results: In the years 2018–2020 73 children were admitted to the dermatological department. The number of female patients 47 (64.38%) significantly dominated over the number of male patients 26 (35.62%). Almost 95% of them were diagnosed with psoriasis vulgaris. Only 3 cases (4.11%) of generalized pustular psoriasis and 1 case (1.37%) of psoriatic arthritis were reported. Almost 20% of children had a positive family history of psoriasis. Readmission to the ward was required in 35.62% of the cases. 23.4% of patients presented abnormality in lipid profile. 15% had various comorbidities.  Conclusions: Better understanding of psoriasis and its management from an early age, may improve the quality of life of psoriasis patients and prevent them from developing serious comorbidities in the future

Diagnostyka różnicowa łojotokowego zapalenia skóry u niemowląt — opis przypadku

Łojotokowe zapalenie skóry u niemowląt często występuje w ciągu pierwszych trzech miesięcy życia i najczęściej objawia się rumieniem oraz obecnością tłustych łusek występujących zwłaszcza na skórze głowy (potocznie nazywanych „ciemieniuchą”). Zazwyczaj ma charakter łagodny i samoograniczający się. Ciężka, erytrodermiczna postać kliniczna jest rzadka i często wymaga diagnostyki różnicowej z innymi poważniejszymi chorobami skóry. W niniejszej pracy opisano przypadek ciężkiego łojotokowego zapalenia skóry u niemowlęcia. U pięciotygodniowego dziecka płci męskiej pojawiły się po urodzeniu erytrodermiczne zmiany skórne i złuszczanie zewnętrznej warstwy naskórka. Na skórze głowy, powiekach i twarzy zaobserwowano tłuste łuski, którym towarzyszył stan zapalny powiek. Ponadto stwierdzono dobrze odgraniczone zmiany rumieniowe w fałdach szyi, za uszami, w okolicy pach i okolicy pieluszkowej. Ze względu na ciężką postać kliniczną choroby wykonano dodatkowe badania, takie jak biopsja skóry i analiza genetyczna. Celem tego było wykluczenie innych możliwych przyczyn, takich jak atopowe zapalenie skóry, histiocytoza Langerhansa, wrodzona rybia łuska i łuszczyca. Na podstawie obrazu klinicznego i wyników badań dodatkowych za najbardziej prawdopodobną diagnozę uznano łojotokowe zapalenie skóry niemowląt. Pacjent wykazał dobrą odpowiedź na rozpoczęte w szpitalu leczenie obejmujące 1-procentowy kwas taninowy, 0,5-procentowy krem pod oczy z erytromycyną, krem z klotrimazolem, krem z hydrokortyzonem i emolienty. Po miesiącu leczenia przeprowadzono badanie kontrolne, stwierdzając dalszą poprawę stanu skóry. Należy pamiętać, że dermatozami, które trzeba wziąć pod uwagę podczas diagnostyki różnicowej ciężkiego łojotokowego zapalenia skóry u niemowląt są atopowe zapalenie skóry, histiocytoza Langerhansa, wrodzona rybia łuska i łuszczyca

Platelet reactivity over time in STEMI and NSTEMI patients.

<p>Platelet reactivity evaluated with (A) the VASP assay and (B) Multiplate at baseline, and at 0.5 h, 1 h, 2 h, 3 h, 4 h, 6 h, and 12 h after administration of a 180 mg ticagrelor loading dose in patients with STEMI and NSTEMI. NSTEMI: non-ST-elevation myocardial infarction, STEMI: ST-elevation myocardial infarction, VASP: vasodilator-stimulated phosphoprotein.</p

Baseline characteristics of study participants.

<p>Baseline characteristics of study participants.</p