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Case Reports 2015; 36(4): 311-315 PubMed PMID: 26454485 Citation  Keywords:  Heavy Metal Poisoning, Nervous System:complications, Humans, Male, Metals, Heavy:poisoning, Poisoning:complications, Self-Injurious Behavior:complications, Thallium:poisoning, Young Adult,.   

: We report a rare case of serious voluntary intoxication by laboratory thallium monobromate combined with alcohol intake by a 24-years old man. The diagnosis of thallium intoxication was based on history, nonspecific but typical clinical symptoms including gastrointestinal complaints, painful polyneuropathy, alopecia, and confirmed by the finding of increased thallium concentration in the urine. The treatment, performed at the due time, consisted of decontamination of the stomach by irrigation, administration of active charcoal and Prussian blue, correction of water and mineral dysbalance, symptomatic treatment, and led to complete recovery....

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Case Reports 2015; 36(4): 306-310 PubMed PMID: 26454484 Citation  Keywords:  Adolescent, Child, Preschool, Female, Humans, Hyponatremia:drug therapy, Male, Sodium:blood, Tuberculosis, Meningeal:complications,.   

: Cerebral salt wasting syndrome (CSWS) is characterized by severe natriuresis and volume depletion in the presence of cerebral pathology. In literature, there are few reports about tuberculous meningitis and cerebral CSWS. In this article, we report two tuberculous meningitis cases with CSWS and present a review of the literature on this topic. Cerebral salt wasting diagnosis was based on hyponatraemia associated with high urinary sodium excretion and inappropriately high urine output in the presence of dehydration. Treatment was made with sodium-fluid replacement plus fludrocortisone therapy in both cases. In agreement with the literature we argue that cerebral salt wasting syndrome might be more common than the syndromes of inappropriate antidiuretic hormone secretion (SIADH) in cerebral disorders. Differentiating the cerebral salt wasting syndrome from the SIADH is very important because unrecognized cerebral salt wasting syndrome can lead to inadequate management and result in unnecessary hyponatremia-related morbidity. The electrolyte and hydration status of patients should be monitored closely in patients with tuberculous meningitis....

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Case Reports 2015; 36(4): 303-305 PubMed PMID: 26454483 Citation  Keywords:  Adolescent, Female, Hashimoto Disease:complications, Hormone Replacement Therapy:methods, Humans, Magnetic Resonance Imaging, Oculomotor Nerve Diseases:drug therapy, Recurrence, Steroids:therapeutic use, Thyroiditis, Autoimmune:complications,.   

: Ophthalmopathy related to thyroid disease is due mainly to diffuse periorbital or eye muscle inflammation. It is more common in Grave's hyperthyroidism and rare in Hashimoto's hypothyroidism. Here we report a case of recurrent oculomotor nerve palsy associated with autoimmune hypothyroidism. Brain MRI revealed enhancement of the oculomotor nerves. Despite thyroid hormone replacement therapy, oculomotor nerve palsy recurred at the side contralateral to the initially involved nerve and the autoimmune antibody titer remained high. The symptom was responsive to high-dose steroid therapy....

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Journal Article 2015; 36(3): 294-300 PubMed PMID: 26313398 Citation  Keywords:  Adult, Aged, Bipolar Disorder:epidemiology, Cognition Disorders:epidemiology, Comorbidity, Female, Humans, Hypertension:epidemiology, Male, Middle Aged.   

OBJECTIVES: Cognitive impairment in euthymic phase of bipolar disorder has been documented in many studies. Several factors may contribute to such impairment, e.g. sedative medication, thyreopathy. Metabolic syndrome with its components represents another frequent condition found in bipolar disorder exerting probably adverse impact on cognition. Since it is treatable factor and current literature suggests possible connection with cognitive dysfunction, we aimed to explore such associations to identify promising targets of complex treatment.

METHODS: Forty euthymic bipolar patients have been enrolled. Their body and metabolic parameters were measured. Medical history data were collected. Cognition was evaluated using battery of tests. Neuropsychological performance was transformed into neurocognitive composite score. Cognition of subjects was compared dichotomously according to presence or absence of pathological body and metabolic parameters. Correlations of selected parameters and composite score were done.

RESULTS: Low neurocognitive score was found in presence of hypertension, metabolic syndrome, abdominal obesity and hyperglycemia. Only connection of hypertension and cognitive score reached sufficient statistical power. Patients presenting hypertension performed worse in all tested domains of cognition when compared with normal blood pressure group. Subjects using lithium performed substantially worse in cognitive tests. However, in comparison with anticonvulsant group, lithium users had markedly longer disorder history as well as longer duration of thymoprofylaxis. No significant correlation of HDRS score, insulinemia or HOMA-IR was found.

CONCLUSION: Despite relatively small sample size, noticeable association of hypertension and cognitive impairment was revealed. This might indicate possible way of enhancing cognition in bipolar disorder by treating elevated blood pressure....

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Journal Article 2015; 36(3): 288-293 PubMed PMID: 26313397 Citation  Keywords:  Adolescent, Adult, Czech Republic, Female, Health Services Needs and Demand:standards, Humans, Inpatients:psychology, Male, Middle Aged, Quality of Life:psychology, Schizophrenia:therapy, Young Adult,.   

OBJECTIVES: The main aim of the study was to investigate the quality of life and the medicinal and social needs of patients hospitalized with schizophrenia in the Czech Republic to uncover potential issues in these areas.

METHODS: Relevant self-evaluating questionnaires (SQUALA for quality of life; CANSAS for medicinal and social needs) were used in a cohort of hospitalized schizophrenic patients undergoing rehabilitation before discharge from the mental hospital.

RESULTS: Two hundred and forty-four patients (women N=115) aged 18-58 years were involved in the study. The quality of life of hospitalized patients with schizophrenia was subjectively assessed as universally worse in comparison with the general Czech population (p<0.05 in most cases; two-sample Student's t-test), but patients were not wholly critical of their own health status and overestimated its quality (arithmetic mean 63.79 in the patients vs the range of 45.5-59.8 as the norm in the general Czech population). Intimate relations, financial matters, treatment of psychotic symptoms, and sexual life were among the most pressing medicinal and social needs in our study subjects.

CONCLUSION: The results of our study should stimulate psychiatric nurses in their effort not only to detect but also address the problems of schizophrenic patients concerning quality of life and unfulfilled needs. This can be done via education, guidance towards a healthy lifestyle, or providing patients with adequate exercise. Overall this issue is of significant importance in the Czech Republic due to the fact that legislative reform of mental health care emphasizing community care and psychiatric nursing has just been implemented....

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Journal Article 2015; 36(3): 282-287 PubMed PMID: 26313396 Citation  Keywords:  Adolescent, Adult, Case-Control Studies, Chromosomes, Human, Pair 2:genetics, Female, Fetal Growth Retardation:genetics, Humans, Hypertension, Pregnancy-Induced:genetics, Polymorphism, Single Nucleotide, Pre-Eclampsia:genetics, Pregnancy, Pregnancy Outcom.   

BACKGROUND: Hypertension during pregnancy is a heterogeneous group of disorders with elevated blood pressure with or without proteinuria. The multiple researches are held on the subject of a genetic conditioning of preeclampsia and pregnancy induced hypertension.

OBJECTIVES: The study was designed to evaluate the impact of the single nucleotide polymorphism (SNP) rs7579169 on hypertension disorders in pregnancy, especially on PE and PIH as well as on the perinatal outcome.

METHODS: It is a case-control study. The study included 104 women with uncomplicated pregnancies in the control group and 75 pregnant women with hypertension disorders in the study group, hospitalized in the Perinatology and Obstetrics Department of the University Hospital in Cracow. Genomic DNA was extracted from peripheral blood leukocytes and SNP rs7579169 was genotyped from all patients. We analyzed the genotypes distribution and allele frequencies of polymorphism rs7579169 and its association with perinatal outcome in all groups. A p-value<0.05 was considered as significant.

RESULTS: Clinical evaluation included standard anthropometric measures like weight and height for the calculation of the body mass index in the beginning and in the end of the pregnancy, blood pressure, time and a method of delivery, birth weight, Apgar score. The heterozygote CT was associated with a 4.5-fold increased risk of preeclampsia in pregnant patients. The presence of TT genotype significantly increased the risk of intrauterine growth restriction (<10 percentile).

CONCLUSIONS: The study show probable impact of SNP rs7579169 on pregnancy, but further studies on larger groups are needed....

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Journal Article 2015; 36(3): 269-281 PubMed PMID: 26313395 Citation  Keywords:  Adult, Amygdala:physiopathology, Cognitive Therapy:methods, Female, Frontal Lobe:physiopathology, Humans, Magnetic Resonance Imaging, Male, Outcome Assessment (Health Care), Panic Disorder:diagnosis, Parietal Lobe:physiopathology, Prognosis,.   

OBJECTIVE: Previous functional brain imaging studies have described various and contradictory activation findings in patients with panic disorder (PD). Our study focused on patients with a chronic PD, who were investigated and treated in a conventional manner, which represents the real PD patients in clinical practice.

METHODS: Continuing their medication, patients were included in a six-week cognitive-behavioral therapy (CBT) program in the psychiatry department. At the onset of the study, participants underwent clinical evaluation using standard scales and were examined using fMRI while listening to verbal threat-related stimuli contrasted to neutral words. According to the therapeutic outcome, they were subsequently divided into two groups, responders, and nonresponders and the two groups were mutually compared.

RESULTS: In non-responders compared to responders, we found increased pre-treatment activation in dorsolateral prefrontal cortex bilaterally, left orbitofrontal cortex, left frontal eye field, right parietal lobule and left amygdala. In addition, both groups showed negative fMRI BOLD correlation with BAI improvement and positive correlation with CGI improvement across the ROIs. We suggest that DLPFC over-activation may reveal a lack of cognitive control over emotional processing, which makes subsequent CBT less effective.

CONCLUSION: Despite several limitations, we found neuroimaging predictors of poor CBT response, under the conditions of standard clinical practice, in real PD patients....

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Journal Article 2015; 36(3): 262-268 PubMed PMID: 26313394 Citation  Keywords:  China:epidemiology, Humans, Ischemic Attack, Transient:epidemiology, Severity of Illness Index, Stroke:diagnosis,.   

OBJECTIVES: The ABCD2 score has been commonly used to triage patients with transient ischemic attack (TIA) who are at high risk for imminent stroke. However, its accuracy in predicting short-term stroke risk among TIA patients in China remains unclear.

METHODS: All eligible studies published up to May 2014 were identified by searching Medline, PubMed, Embase, the China Knowledge Resource Integrated Database (CNKI) and the China Biological Medicine Database (CBM-disc), as well as unpublished articles manually scanned. The strength of the associations between treatments and outcomes was estimated by incorporated risk ratios (RRs) and 95% confidence intervals (CIs) using the Mantel-Haenszel statistical method.

RESULTS: Eight and 32 studies, which validated the value for predicting the risk of stroke 2 and 7 days after TIA respectively, were included. We calculated the RRs and CIs for 2- and 7-day prediction for stroke (low: RR=0.43, 95% CI=0.17-1.10, I2=0%; moderate: RR=0.42, 95% CI=0.26-0.67, I2=0%; high: RR=0.32, 95% CI=0.21-0.48, I2=0%; and low: RR=0.29, 95% CI=0.20-0.44, I2=0%; moderate: RR=0.27, 95% CI=0.23-0.33, I2=0%; high: RR=0.22, 95% CI=0.18-0.27, I2=1%).

CONCLUSIONS: This meta-analysis indicated that the ABCD2 score may highly under-predict the short-term occurrence of stroke after TIA for the Chinese population compared with the original model derived from Caucasian populations, which may lead to neglect of the short-term risk for stroke in the clinical practice....

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