Czynny i bierny transport leków w łożysku ludzkim

The human placenta, characterized by the processes of passive transport and facilitated diffusion, contains numerous active transport proteins, usually located in the microvilli of the syncytiotrophoblast or in the endothelium of the capillaries of the villi. These proteins use either the energy from ATP hydrolysis or other mechanisms resulting, among others, from the formation of the maternofetal ion gradient, which facilitates the transfer of various endogenous substances or xenobiotics across the body membranes. The proteins either trigger the efflux of these substances from the fetal tissues via the placenta into the maternal bloodstream, or conversely, they accumulate them in the fetal tissues. Both the placenta and the fetus are equipped with independent systems of enzymes of 1st and 2nd phase of substrate metabolism, such as CYP450, glucuronyltransferase or sulphatase. An active therapy with a wide range of drugs, often at high toxicity levels, either shortly before or during pregnancy, has naturally posed a question concerning the degree of impermeability of the placental barrier and how effectively it can be crossed, including any possible negative embryotoxic or teratogenic consequences. Such hazards seem to be quite real, as many drugs are substrates for ABC transporters. Also the placenta itself, including its structure, is subject to vast transformations during pregnancy, which may be observed as the thinning of the barrier separating the maternal blood from the fetal one, from 20-30μm in the first trimester of gestation down to 2-4μm in the third trimester of gestation.Streszczenie W łożysku ludzi oprócz transportu biernego oraz dyfuzji ułatwionej zawartych jest wiele aktywnych białek transportowych zazwyczaj zlokalizowanych w mikrokosmkach syncytiotrofoblastu lub w śródbłonkach naczyń włosowatych kosmków. Wykorzystują energię z rozpadu ATP lub inne mechanizmy wynikające między innymi z formułującego się gradientu jonów pomiędzy płodem i matką sprzyjają przenikaniu przez błony różnorodnych substancji endogennych lub ksenobiotyków. Kreują albo ich wyrzut z tkanek płodu przez łożysko do krwi matki lub wręcz przeciwnie kumulują je w jego tkankach. Samo łożysko i płód dysponuje samodzielnymi układami enzymatycznymi pierwszej i drugiej fazy przemian substratów takimi jak: CYP450, glukuronylotransferazy czy sulafatazy. Aktywne postępowanie terapeutyczne z wykorzystaniem szerokiej gamy leków niejednokrotnie o wysokim poziomie toksyczności w okresie przed ciążowym oraz w ciąży rodzi pytanie na ile bariera łożyskowa jest szczelna oraz na ile jest skutecznie pokonywana z możliwymi negatywnymi konsekwencjami o charakterze embriotoksycznym lub teratogennym. Groźba wydaje się być całkowicie realna, bowiem wiele leków to substraty dla transporterów ABC. Również samo łożysko i jego struktura ulega w trakcie ciąży głębokim przewartościowaniom czego miarą może być redukcja dzielącej barierę krew matki od krwi płodu z 20-30μm w pierwszym trymestrze ciąży do 2-4μm w trzecim trymestrze ciąży

Correct and incorrect knowledge of the risk factors concerning the development of arterial hypertension. Part 2. Population of patients with identified arterial hypertension

Introduction. Hypertension (HT) and its complications significantly shorten the life expectancy in the world population. In addition to pharmacotherapy, life-style changes play a key role in treatment, which requires appropriate knowledge among patients. Material and methods. The study was conducted in a group of 613 adults with HT. After obtaining sociodemographic data, performing anthropometric measurements, measuring resting blood pressure twice, the knowledge was assessed using a personally conducted questionnaire. The questions evaluated the effects of smoking, alcohol, coffee, salt, fat, irregular diet, low fibre and vegetable intake, as well as skimmed dairy products in diet, overweight and obesity, cholesterol, physical activity and stressful lifestyle on the development of HT. Results. False knowledge of the influence on the development of HT in the case of alcohol drinking was found in 16% of the respondents, coffee — 56.4%, large amounts of salt — 7.2%, large amounts of fats — 88%, small amounts of fibre and vegetables and skimmed dairy products — 27.8%, irregular diet — 46.4%, cigarette smoking — 73.4%, overweight and obesity — 4.4%, high cholesterol — 86.9%, low physical activity — 11.2% %, stressful lifestyle — 5.4%. Conclusions. Incorrect knowledge of HT risk factors was most likely to be associated with excessive intake of fat, elevated cholesterol, smoking and coffee drinking. There were no common features of the people who answered the questions incorrectly. The results show the need to educate HT patients about the factors that aggravate this disease

Correct and incorrect knowledge of the risk factors concerning the development of arterial hypertension. Part 1. Population of people without hypertension

Introduction. Hypertension (HT) is one of the most common causes of death in the adult population in the world. The lifestyle factors play a significant role in its pathogenesis. To be effective in preventing its development or slowing its progress the society needs to have proper knowledge. Material and methods. The study was conducted in a population of 929 adults who had no known HT. Sociodemographic data were collected from each subject, anthropometric measurements were taken, blood pressure and heart rate were measured twice. The knowledge was assessed using the authorial questionnaire, and questions were related to knowledge about the effects of smoking, alcohol, coffee, salt, fat, irregular diet, low fibre and vegetables, and skimmed dairy products in diet, overweight and obesity, cholesterol, physical activity, stressful lifestyle on the development of HT. Results. Incorrect knowledge of the influence on the development of HT in the case of alcohol drinking was found in 16.9% of the respondents, coffee — 58.8%, large amounts of salt — 10.3%, large amounts of fat — 82.7%, small amounts of fibre and vegetables and skimmed dairy products — 26.2%, irregular diet — 46.4%, cigarette smoking — 70.9%, overweight and obesity — 5.1%, high cholesterol — 87.6%, low physical activity — 10.9%, stressful lifestyle — 6.5%. Conclusions. Incorrect knowledge of HT-related risk factors was associated particularly with higher level of cholesterol, excessive fat intake, smoking and coffee consumption. Most frequently incorrect answers were given by men, low-educated and non-smokers. In the above-mentioned groups emphasis on health promotion should be placed the most

Znaczenie przypadkowo rozpoznanego ogniskowego wychwytu 99mTc- sestamibi w tarczycy w trakcie scyntygrafii perfuzyjnej mięśnia sercowego

  Introduction: 99mTc-sestamibi, a radiopharmaceutical widely used in the assessment of myocardial perfusion, can be used as an indicator of thyroid disease due to its oncophilic character. The aim of this study was to establish the usefulness of performing additional examinations of radiotracer uptake in the thyroid gland during standard stress scintigraphy with sestamibi in order to identify thyroid diseases. Material and methods: After a retrospective evaluation of 330 consecutive myocardial perfusion scintigraphies performed in our hospital during one year, 41 patients with a focal accumulation of 99mTc-sestamibi in the thyroid were enrolled in the study. The patients underwent clinical examinations, including thyroid ultrasonography and TSH, fT4, fT3, aTPO, TRAB, calcitonin, and CEA levels. Based on the thyroid ultrasounds, 21 patients were referred for fine-needle aspiration biopsy of the thyroid. Results: An abnormal accumulation of radiotracer in the thyroid was found in 41(12.4%) of 330 patients who underwent stress cardiac scintigraphy. Thirteen (31.7%) of those patients had multinodular euthyroid goitres, 12 (29.2%) had a single thyroid nodule (including two autonomous nodules), 11 (26.8%) had autoimmune thyroid disease, and one (2.4%) had papillary thyroid carcinoma. In 12 (29.2%) with thyroid tracer uptake there was no thyroid pathology. Conclusions: Additional evaluation of radiotracer uptake in the thyroid during standard myocardial perfusion scintigraphy is a valuable tool in the detection of thyroid diseases. The additional or parallel evaluation of radiotracer uptake in the thyroid should be considered during every myocardial scintigraphy. (Endokrynol Pol 2015; 66 (6): 521–525)    Wstęp: 99mTc-sestamibi jest radiofarmaceutykiem stosowanym standardowo między innymi w ocenie perfuzji mięśnia sercowego. Ze względu na właściwości onkofilne może być także wykorzystywany w diagnostyce chorób tarczycy. Celem pracy była analiza przydatności dodatkowej oceny gruczołu tarczowego podczas scyntygraficznej próby wysiłkowej z wykorzystaniem sestamibi do wykrywania chorób tarczycy. Materiał i metody: Po ocenie 330 kolejnych badań scyntygrafii perfuzyjnej serca w Zakładzie Medycyny Nuklearnej WIM wykonanych w okresie od 01.01.2009 do 1.01.2010 do dalszych badań zakwalifikowano 41 chorych, u których rozpoznano ogniskowe gromadzenie 99mTc- sestamibi w tarczycy. Następnie przeprowadzono badanie kliniczne, wykonano USG tarczycy oraz oznaczono stężenie: TSH, fT4, fT3, aTPO, TRAb, kalcytoniny, CEA. Na podstawie wyniku badania ultrasonograficznego tarczycy 21 osób skierowano na biopsję cienkoigłową tarczycy. Wyniki: U 41 (12,4%) z 330 chorych poddanych scyntygrafii serca stwierdzono nieprawidłowe gromadzeniem radioznacznika w tarczycy. U 13 ( 31,7%) z nich rozpoznano wole wieloguzkowe, 12 (29,2%) miało pojedynczy guzek tarczycy ( w tym dwóch chorych guzek autonomiczny), 11 chorych (26,8%) prezentowało autoimmunizacyjną chorobę tarczycy, u jednej (2,4%) znaleziono raka brodawkowatego tarczycy. W 12 przypadkach (29,2%) nieprawidłowego gromadzenia radioznacznika nie potwierdzono choroby tarczycy. Wnioski: Dodatkowa ocena wychwytu radioznacznika w tarczycy podczas standardowej scyntygrafii perfuzyjnej serca jest cennym narzędziem w wykrywaniu chorób tarczycy. W opisie wyniku badania scyntygrafii perfuzyjnej serca powinno się także uwzględniać ocenę wychwytu radioznacznika w tarczycy. (Endokrynol Pol 2015; 66 (6): 521–525)

Current distribution of Pilularia globulifera L. in Poland : changes of geographical range and habitat preferences

Pilularia globulifera is a subatlantic European fern threatened with extinction. In Poland, it reaches the eastern border of its continuous range. Up to the end of the 20th century, it was observed here in 21 stands; only 2 of them existed by the second half of the century, so the species was categorized as critically endangered. Five new locations have been found in western and northwestern Poland during the last 10 years. Abundant and permanent populations grow in 3 locations, while 2 stands were ephemeral. All the current stands are situated in anthropogenic habitats with spontaneous vegetation, in oligotrophic to eutrophic waters. One of the new localities is about 280 km distant from the eastern range of the limit known previously. Pilularia forms its own plant community Pilularietum globuliferae, enters plots of Ranunculo-Juncetum bulbosi and occurs in mesotrophic to eutrophic rushes of Eleocharis palustris, Phragmites australis, Typha angustifolia and Equisetum fluviatile. Specimens are vigorous and regularly produce sporocarps

The current possible treatment approaches of Polycystic Ovary Syndrome (PCOS)

Introduction             Polycystic ovary syndrome (PCOS), first described by Stein and Leventhal in 1935, is one of the most prevalent endocrine system conditions affecting women of reproductive age. It affects between 6% and 13% of women and the majority of cases are identified between the ages of 20 and 30. Unfortunately, the disease is usually diagnosed only when bothersome symptoms such as hair loss, alopecia, acne, and infertility-related problems occur. Based on the Rotterdam criteria, four phenotypes of PCOS are distinguished. Aim of the study             This review aims to present the current state of knowledge about possible treatment approaches, both non-pharmacological and pharmacological. Materials and methods            The paper was created based on the Pubmed database. The literature was reviewed using the keywords: ”PCOS”, ”PCOS treatment” and “ PCOS medications “. The current state of knowledge           Treatments for PCOS must be tailored to the specific needs of each patient. In the management of PCOS, special attention is paid to diet, physical activity, and restoration of the Gut Microbiome. Medications used in therapy are oral contraceptives and anti-androgens, insulin sensitizers, ovulation inducers, calcium and vitamin D supplements, statins, Glucagon-like-peptide-1 (GLP-1) agonists, inositols and interleukin 22 (IL-22)  therapy. Summary            Treatment options for menstrual irregularities and hirsutism are based on the clinical goals and preferences of the patient. The ideal would be causal treatment, but due to the ongoing lack of full understanding of the pathogenesis of the syndrome, is not entirely feasible. The ideal would be causal treatment, but due to the ongoing lack of full understanding of the pathogenesis of the syndrome, is not entirely feasible. The most important is a multimodal approach to treat comorbid conditions such as diabetes mellitus type 2, obesity, hyperlipidemia, depression, and infertility

The multimodal approach to obesity treatment – current pharmacological and surgical methods and lifestyle changes

Introduction            Obesity is one of the major health problems of today’s population and is defined as a body mass index ≥ 30 kg/m2.  It is known that obesity may cause many complications such as type 2 diabetes, cardiovascular disease, osteoarthritis, obstructive sleep, apnoea, and several cancers. The only effective treatment of obesity can be pharmacological or surgical, especially when a years-long attempt to change habits has had no effects.  Aim of the study This review aims to present the current state of knowledge about non-pharmacological and pharmacological obesity treatment methods. Materials and methods            The paper was created based on the Pubmed database. The literature was reviewed using the keywords: ”obesity”, ”obesity treatment”, “ obesity lifestyle changes”, “obesity medications” and ”obesity surgery”. The current state of knowledge           The treatment of obesity requires a multimodal approach to treatment, including the addition of anti-obesity medications or bariatric surgery, or both, to assist people in reaching and sustaining sufficient weight loss to meet treatment goals. The 3 principal components of a comprehensive lifestyle intervention are diet, physical activity, and behavioral therapy. Among available anti-obesity medications include orlistat, phentermine, topiramate, naltrexone, bupropion, liraglutide, and semaglutide. Summary            The key challenge in the treatment of obesity is to maintain the effects obtained with multimodal therapy. Without proper motivation of patients and changes in eating and behavioral habits, it is impossible to achieve optimal results, therefore, in addition to medical interventions, more and more attention should be paid to psychological interventions

Genetic variability of the grey wolf Canis lupus in the Caucasus in comparison with Europe and the Middle East: distinct or intermediary population?

Despite continuous historical distribution of the grey wolf (Canis lupus) throughout Eurasia, the species displays considerable morphological differentiation that resulted in delimitation of a number of subspecies. However, these morphological discontinuities are not always consistent with patterns of genetic differentiation. Here we assess genetic distinctiveness of grey wolves from the Caucasus (a region at the border between Europe and West Asia) that have been classified as a distinct subspecies C. l. cubanensis. We analysed their genetic variability based on mtDNA control region, microsatellite loci and genome-wide SNP genotypes (obtained for a subset of the samples), and found similar or higher levels of genetic diversity at all these types of loci as compared with other Eurasian populations. Although we found no evidence for a recent genetic bottleneck, genome-wide linkage disequilibrium patterns suggest a long-term demographic decline in the Caucasian population – a trend consistent with other Eurasian populations. Caucasian wolves share mtDNA haplotypes with both Eastern European and West Asian wolves, suggesting past or ongoing gene flow. Microsatellite data also suggest gene flow between the Caucasus and Eastern Europe. We found evidence for moderate admixture between the Caucasian wolves and domestic dogs, at a level comparable with other Eurasian populations. Taken together, our results show that Caucasian wolves are not genetically isolated from other Eurasian populations, share with them the same demographic trends, and are affected by similar conservation problems