Adrenal venous sampling as a method of primary hyperaldosteronism assessment

We read with great interest the article by Orczyk et. al which discussed an unusual presentation and clinical course of primary hyperaldosteronism, which is frequently caused by Conn’s syndrome. Inspired by their engrossing work, we would like to address a diagnostic method that has not been employed in the aforecited case report despite accumulating evidence of its efficacy, called adrenal venous sampling

Potrzeba standaryzacji dawek witaminy D w suplementach diety

We read with great interest the article by Domański et al. describing the results of an analysis concerning vitamin D content in dietary supplements available in EU countries. In our opinion, the article raises a very important issue, which is the lack of regulated standardization of dietary supplements in terms of the contained doses of vitamin D. Recent data collected during a large observational study report that about 40% of Europeans are vitamin D deficient, and 13% are severely deficient [2]. A significantly reduced vitamin D level can cause serious metabolic disorders, leading to deregulation of calcium-phosphate metabolism, increased risk of infections, endocrine disorders, or increased risk of depression. With increasing public awareness of the potential consequences of vitamin D deficiency, the use of vitamin D-containing supplements has been steadily increasing in recent years

Niskokaloryczne substancje słodzące w leczeniu otyłości: obietnica na przyszłość?

We read with great interest the study by Reimisz which addressed the issue of whether zero calorie sweet drinks are able to induce sensory-specific satiety in order to reduce appetite for sweets. We feel that it brings up a relevant matter, as overweight and obesity are gradually becoming more and more significant morbidities among many societies, and physicians are striving to find the most effective approaches that would limit their incidence and severity

Metabolism of cyclic GMP in peritoneal macrophages of rat and guinea pig.

The aim of our studies was to establish which enzymes constitute the "cGMP pathway" in rat and guinea pig peritoneal macrophages (PM). We found that in guinea pig PM synthesis of the nucleotide was significantly enhanced in response to activators of soluble guanylyl cyclase (sGC) and it was only slightly stimulated by specific activators of particulate guanylyl cyclases (pGC). In contrast, rat PM responded strongly to atrial natriuretic peptide (ANP), the activator of pGC type A. The rat cells synthesized about three-fold more cGMP than an equal number of the guinea pig cells. The activity of phosphodiesterases (PDE) hydrolyzing cGMP was apparently regulated by cGMP itself in PM of both species and again it was higher in the rat cells than in those isolated from guinea pig. However, guinea pig PM revealed an activity of Ca2+/calmodulin-dependent PDE1, which was absent in the rat cells. Using Western blotting analysis we were unable to detect the presence of cGMP-dependent protein kinase 1 (PKG1) in PM isolated from either species. In summary, our findings indicate that particulate GC-A is the main active form of GC in the rat PM, while in guinea pig macrophages the sGC activity dominates. Since the profiles of the PDE activities in rat and guinea pig PM are also different, we conclude that the mechanisms regulating cGMP metabolism in PM are species-specific. Moreover, our results suggest that targets for cGMP other than PKG1 should be present in PM of both species

Pathophysiology and management of opioid-induced constipation: a narrative review

Background: Treatment of chronic pain is among the primary tasks of palliative care. Among the most commonly prescribed analgesics are opioid agents. Opioids, in addition to being highly effective in controlling severe pain, have a high risk of adverse effects (AEs). The most common gastrointestinal AE is opioid-induced constipation (OIC). Methods: A search through online databases was conducted including Google Scholar and PubMed and key information on the pathophysiology, epidemiology, diagnosis and current therapeutic options for OIC has been collected. Results: The pathophysiology of OIC is primarily related to the direct action of opioids on opioid receptors located in the wall of gastrointestinal tract. This leads to deregulation of the mechanisms responsible for the motor and secretory functions of the gastrointestinal tract. That results in impaired digestion and delayed intestinal transit, leading to the development of constipation. Opioid-induced constipation leads to a significant reduction in patients' quality of life, an increase in the cost of treatment and can lead to serious complications such as gastrointestinal perforation. Patients receiving palliative care due to their multiple burdens require a holistic diagnostic approach and thorough differential diagnosis of OIC. Among therapeutic approaches, we distinguish between non-specific methods related to lifestyle changes and laxatives, and cause-directed pharmacological methods related to the use of peripherally acting opioid receptor antagonists (PAMORA). The most commonly used PAMORA for the treatment of OIC include naloxegol, methylnaltrexone and naldemedine. Numerous clinical studies demonstrate the efficacy and high safety profile of PAMORA in the treatment of OIC. Conclusions: Proper diagnosis of OIC among patients taking opioid drugs allows for the implementation of effective therapeutic measures. Appropriate treatment reduces the risk of OIC-related complications and leads to an increase in patients' quality of life.Treatment of chronic pain is among the primary tasks of palliative care. Among the most commonly prescribed analgesics are opioid agents. Opioids, in addition to being highly effective in controlling severe pain, have a high risk of adverse effects (AEs). The most common gastrointestinal AE is opioid-induced constipation (OIC). In our work, we have collected key information on the pathophysiology, epidemiology, diagnosis and current therapeutic options for OIC. The pathophysiology of OIC is primarily related to the direct action of opioids on opioid receptors located directly in the wall of gastrointestinal tract. This leads to deregulation of the mechanisms responsible for the motor and secretory functions of the gastrointestinal tract. That results in impaired digestion and delayed intestinal transit, leading to the development of constipation. OIC leads to a significant reduction in patients' quality of life, an increase in the cost of treatment and can lead to serious complications such as gastrointestinal perforation. Patients receiving palliative care due to their multiple burdens require a holistic diagnostic approach and thorough differential diagnosis of OIC. Among therapeutic approaches, we distinguish between non-specific methods related to lifestyle changes and laxatives, and cause-directed pharmacological methods related to the use of peripherally acting opioid receptor antagonists (PAMORAs). The most commonly used PAMORAs for the treatment of OIC include naloxegol, methylnaltrexone and naldemedine. Numerous clinical studies demonstrate the efficacy and high safety profile of PAMORAs in the treatment of OIC