Search NEL Online

Journal Article 2013; 34(7): 660-668 PubMed PMID: 24464005 Citation  Keywords:  Adult, Aged, Antineoplastic Combined Chemotherapy Protocols:administration & dosage, Breast Neoplasms:drug therapy, Cholecalciferol:administration & dosage, Cyclophosphamide:administration & dosage, Female, Follow-Up Studies, Humans, Melatonin:administrat.   

OBJECTIVE: The current strategies for the treatment of breast cancer are essentially based on surgery, preceded and/or followed by chemotherapy often supplemented by radiotherapy and/or the administration of hormonal therapy and monoclonal antibodies. Their combined use has made it possible to increase an overall survival but they are still penalized by adverse effects and toxicity. The marked anti-cancer effects of biological molecule such as somatostatin, melatonin, retinoid, vitamin D3 and prolactin inhibitors have been studied and documented for several decades. Their integrated and synergic action have been demonstrated, but only a few studies have as yet been carried out on their combined application in humans. The aim of the present investigation was to evaluate both the objective clinical response and toxicity of the biological multimodal treatment named Di Bella Method (DBM).r />r /> MATERIAL AND METHODS: The clinical data from a total of 20 women with a certified diagnosis of breast cancer,defined disease stage, and who independently decided to follow the DBM as first-line treatment, were retrospectively reviewed.r />r /> RESULTS: The mean age of the patients was 51 years (min 30; max 73). Twelve (12) patients (60%) presented an early stage disease, while the other 40% had a locally advanced/metastatic stage. An overall clinical benefit was achieved in 75% of cases, with 55% of complete response and 20% of partial response. For metastatic patients, the overall survival rate was 71%. The main toxicity effects included leukopenia, gastrointestinal phenomena and drowsiness.r />r /> CONCLUSIONS: The preliminary results of this report confirm the positive action of the biological treatment in terms of efficacy and survival, showing a more than favorable profile of tolerability....

Read abstract  Full text PDF

Journal Article 2013; 34(7): 590-600 PubMed PMID: 24464004 Citation  Keywords:  Humans, Mental Disorders:therapy, Professional-Patient Relations:ethics, Psychotherapy:ethics, Social Values,.   

OBJECTIVE: Theories of ethics and ethical reflection may be applied to both theory and practice in psychotherapy. There is a natural affinity between ethics and psychotherapy. Psychotherapy practice is concerned with human problems, dilemmas and emotions related to both one's own and other people's values. Ethics is also concerned with dilemmas in human thinking and with how these dilemmas reflect other individuals' values. Philosophical reflection itself is not a sufficient basis for the ethics of psychotherapy but it may aid in exploring attitudes related to psychotherapy, psychiatry and health care.r />r /> METHODS: PubMed, Web of Science and Scopus databases were searched for articles containing the keywords "psychotherapy", "ethics", "therapeutic relationship" and "supervision". The search was conducted by repeating the terms in various combinations without language or time restrictions. Also included were data from monographs cited in reviews. The resulting text is a review with conclusions concerning ethical aspects of psychotherapy.r />r /> RESULTS: The ability to behave altruistically, sense for justice and reciprocity and mutual help are likely to be genetically determined as dispositions to be later developed by upbringing or to be formed or deformed by upbringing. Early experiences lead to formation of ethical attitudes which are internalized and then applied to both one's own and other people's behavior. Altruistic behavior has a strong impact on an individual's health and its acceptance may positively influence the pathophysiological mechanisms underlying numerous diseases. Ethical theory and reflection, however, may be applied to both theory and practice of psychotherapy in a conscious, targeted and thoughtful manner. In everyday practice, psychotherapists and organizations must necessarily deal with conscious conflicts between therapeutic possibilities, clients' wishes, their own as well as clients' ideas and the real world. Understanding one's own motives in therapy is one of the aims of a psychotherapist's personal therapy and a frequent goal of supervision interventions. It is a psychotherapist's ethical obligation to do no harm, maintain clear therapeutic borders, not abuse patients, undertake supervision and learn good self-reflection.r />r /> CONCLUSION: Knowledge of ethical questions and related issues as well as continuous ethical self-reflection are essential components of high-quality psychotherapeutic management. This requires both good psychotherapy training and systematic supervision....

Read abstract  Full text PDF

Comparative Study 2013; 34(7): 669-674 PubMed PMID: 24464003 Citation  Keywords:  Adrenocorticotropic Hormone:blood, Adult, Affective Symptoms:metabolism, Anxiety:metabolism, Body Mass Index, Body Weight:physiology, Depression:metabolism, Female, Ghrelin:blood, Gonadal Steroid Hormones:blood, Hormones:blood, Humans, Obesity:metabolism,.   

BACKGROUND: Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders found in women of reproductive age. Differences in hormonal and metabolic profiles are observed in groups of patients with normal and elevated BMI. Cause of disturbances observed in the two groups of patients with PCOS is analyzed. The aim of the study is to assess whether psychological parameters of lean and obese patients with PCOS are comparably significantly different and whether there is a correlation between these characteristics and the concentration of various hormones.r />r /> PARTICIPANTS AND PROCEDURES: The study consisted of 20 patients with diagnosed polycystic ovary syndrome and 20 healthy women of similar age. Both groups were stratified according to BMI. Specific psychological parameters and hormones were estimated in all patients.r />r /> RESULTS: In our study, we found that patients with BMI <25 represented personality traits associated with lower resistance to stress. We also observed significantly higher ACTH levels in the same group as compared to patients with BMI >25. A correlation between plasma ghrelin and the severity of anxiety experienced by test subjects was also observed.r />r /> CONCLUSION: The type of personality and emotional disorders in lean PCOS patients may lead to the activation of the hypothalamic-pituitary-adrenal (HPA) axis and disturbences in hypothalamic-pituitary-ovary (HPO) axis. The results suggest participation of primary hypothalamic dysfunction in the pathogenesis of PCOS in patients with specific fenotype. Ghrelin is a hormone that may affect the symptoms of PCOS in lean patients. Psychological therapy should be considered as a permanent element in the therapeutic plan provided to PCOS patients....

Read abstract  Full text PDF

Journal Article 2013; 34(7): 624-634 PubMed PMID: 24464002 Citation  Keywords:  Animals, Animals, Newborn, Brain:drug effects, Brain-Derived Neurotrophic Factor:genetics, Dexamethasone:toxicity, Disease Models, Animal, Drug Interactions, Female, Glucocorticoids:toxicity, Hormone Antagonists:pharmacology, Insulin-Like Growth Factor I:.   

OBJECTIVES: Dexamethasone (Dex) causes neurodegeneration in developing brain. Insulin-like growth factor-I (IGF-I) and -II (IGF-II) are potent neurotrophic and differentiation factors and play key roles in the regulation of growth and development of CNS. Current project evaluated the effects of Dex on IGF-I and -II in developing rat brains.r />r /> MATERIAL AND METHODS: Sprague-Dawley rat pups in each litter were divided into vehicle (n=230) or Dex-treated (n=234) groups. Rat pups in the Dex group received one of the 3 different regimens of i.p. Dex: tapering doses (DexTD) on postnatal days (PD) 3 to PD 6 or repeated doses on PD 4 to PD 6 or single dose on PD 6. To quantify the glucocorticoid receptor (GR) blockade effect, rat pups in the DexTD group on PD 3 and 5 received vehicle or RU486 (GR blocker, 60 mg/kg) s.c., twenty minutes prior to Dex treatment.r />r /> RESULTS: Dex decreased the gain of body and brain weight while RU486 inhibited these effects. RU486 also prevented the DexTD-induced increase in caspase-3 activity and reduction in IGF-I and -II proteins. Compared to the vehicle, the expression of mRNA of IGF-I and -II decreased at 24 h after DexTD treatment, while RU486 prevented this decrease on IGF-II but not IGF-I.r />r /> CONCLUSIONS: Our findings indicate that Dex via GR decreases IGF-I and -II and causes neurodegeneration in the neonatal rat brain....

Read abstract  Full text PDF

Journal Article 2013; 34(7): 635-642 PubMed PMID: 24464001 Citation  Keywords:  Aged, Apolipoprotein E2:genetics, Apolipoprotein E4:genetics, Cognition:drug effects, Cognition Disorders:epidemiology, Dementia:epidemiology, Estrogen Replacement Therapy:methods, Female, Humans, Middle Aged, Polymorphism, Genetic, Postmenopause:drug eff.   

OBJECTIVE: The results of many studies revealed that estrogen plus progestogen therapy (EPT) may modify dementia development risk in relation to the apolipoprotein E gene (APOE) polymorphisms. However, the mechanism and subsequently clinical importance of such an effect are still unexplained. The objective of this study was to explore the influence of EPT on cognitive functioning of women in their postmenopausal life in relation to APOE polymorphism.r />r /> METHODS: The group of 214 women was recruited (106 out of this group with EPT) to the study. The inclusion criteria were: minimum two years after the last menstruation, FSH concentration over 30 U/ml and no dementia signs on Montreal Cognitive Assessment (MoCA). Computerized battery of Central Nervous System Vital Signs (CNS VS) test was used to diagnostic cognitive functions. APOE genotype was performed by multiplex PCR. Statistical analysis was performed using two-way analysis of variance in STATISTICA software.r />r /> RESULTS & CONCLUSION: The women after menopause have reduced neurocognitive index (NCI) and cognitive functions. NCI and all studied cognitive functions of the patients depended significantly on APOE polymorphisms. The presence of APOE4 corresponded with decreased cognitive functions as opposed to APOE2 which was present in women with better level of cognitive functions. Constantly using EPT correlated with three cognitive functions: memory, verbal memory and processing speed, which were significantly worse for women taking EPT than not taking ones. The interaction between APOE polymorphisms and EPT application was significant only for processing speed. EPT applying women with ε2/ε3 and ε4 obtained better scores in processing speed than women not taking EPT with these APOE polymorphisms. The opposite situation concerned women with ε3/ε3, women taking EPT achieved worse processing scores in comparison with those not taking EPT. It should be noted that APOE polymorphism assessment may be a factor in predicting the effect of EPT on cognitive functioning in postmenopausal period....

Read abstract  Full text PDF

Journal Article 2013; 34(7): 585-589 PubMed PMID: 24464000 Citation  Keywords:  Cardiovascular Diseases:epidemiology, Contraceptives, Oral, Combined:administration & dosage, Female, Humans, Risk Factors,.   

rong>:rong> The use of combined oral contraceptives (COCs) is associated with approximately 2-fold and over 4-fold increased relative risks of arterial and venous thromboembolic events, respectively. The highest risk of venous thromboembolism occurs in the first year of use (OR: 4.17) and is reduced to 2.76 over baseline risk after 4 years of therapy. The risk of myocardial infarction does not correlate to the length of therapy and disappears after treatment termination. Most of women, using COCs, have low absolute cardiovascular risks and benefits outweigh the risk associated with this method of birth control. However, in some cases, COCs may be contraindicated due to excessively increased cardiovascular risks. Current users of COCs, older than 35 years, appear to show an estimated 2.5-fold and 10-fold increased risk of venous thromboembolism in comparison to younger than 35 years COCs non-users and users, respectively. COCs users, who are current smokers, have 10-fold increased risk of myocardial infarction, whereas the risk of stroke increases nearly 3-fold. The presence of poorly controlled hypertension is associated with approximately 3-fold increased risks of myocardial infarction and ischemic stroke, while the risk of haemorrhagic stroke rises 15-fold. In women suffering from hypertension, discontinuation of COCs may improve blood pressure control. Women, who had their blood pressure measured before COCs use, have 2-2.5-fold decreased risk of myocardial infarction and ischaemic stroke. In women with multiple cardiovascular risk factors the use of progestogen-only contraceptives (POCs) should be considered. POC therapy is associated with substantially less risk of cardiovascular events than COCs.

...

Read abstract  Full text PDF

Journal Article 2013; 34(7): 655-659 PubMed PMID: 24463999 Citation  Keywords:  Contraception, Postcoital:utilization, Female, Health Knowledge, Attitudes, Practice, Health Services Accessibility:statistics & numerical data, Humans, Lithuania, Nonprescription Drugs:therapeutic use, Poland, Students:statistics & numerical data, Survey.   

OBJECTIVES: To compare usage patterns, accessibility and knowledge about over-the counter (OTC) emergency contraception (EC) in comparison to prescription-only EC.r />r /> DESIGN AND SETTING: Self-designed, paper-based validated questionnaires containing 26 questions were distributed among students and high school pupils in Poland (PL) - 1000 questionnaires and in Lithuania (LT) - 650. In Lithuania EC is available OTC, whereas in Poland EC is a prescription-only drug. Statistical analysis was performed using SAS software with p<0.05 considered significant.r />r /> RESULTS: 74.01% of Poles and 70.89% of Lithuanians reported a history of sexual activity. About one third of the respondents in both countries used EC at least once in a lifetime (PL: 29.01%, LT: 32.2%; p>0.05). The main reason for EC usage in both countries was a broken condom (PL: 60.63%, LT: 57.66 %; p>0.05). In case of emergency more than half of the questioned women in both countries would use EC pill. The knowledge about EC was significantly lower in Poland (PL median - 8 out of 16; LT - 10 out of 16 true/false statements; p<0.01).r />r /> CONCLUSIONS: Over-the-counter availability of EC does not cause repetitive or increased usage. Moreover, an easier access to EC improves patients' knowledge about the drug....

Read abstract  Full text PDF

Case Reports 2013; 34(7): 693-700 PubMed PMID: 24463998 Citation  Keywords:  Adrenocorticotropic Hormone:blood, Aged, Endocrine System Diseases:blood, Female, Genetic Diseases, Inborn:blood, Glucocorticoids:therapeutic use, Humans, Hydrocortisone:blood, Hypoglycemia:blood, Hyponatremia:blood, Male, Middle Aged, Prednisone:therapeu.   

OBJECTIVES: Adult idiopathic isolated ACTH deficiency (AIIAD) is an underestimated disorder which is frequently misdiagnosed. We presented 3 new Chinese AIIAD cases, summarized their clinical characteristics and analyzed the available literature.r />r /> METHODS: Three cases of AIIAD managed in Chinese PLA General Hospital during the period 1998-2003 were retrospectively identified. We have collected information on clinical presentation, laboratory findings and treatment response. The clinical characteristics were summarized and pertinent literatures were analyzed.r />r /> RESULTS: Our 3 cases with AIIAD aged 52-68 years old were misdiagnosed for a long period of time. Clinical features of AIIAD were summarized by reviewing the limited literature: 1. Most patients were over 40 years; 2. Clinical presentations were insidious; 3. Usually no pigmentation; 4. Hypogonadism and amenorrhea could present; 5. mild hypoglycemia, hyponatremia, normal-high potassium, mild anemia, lymphocytosis and eosinophilia could present; 6. With low or absent cortisol, normal secretion of pituitary hormones other than ACTH; 7. High prevalence of thyroid disorder; 8. Usually present concomitantly with other autoimmune disease, which usually disappeared on steroid replacement; 9. Absence of structural pituitary defects except for empty sella; 10. No evidence in any infiltration, trauma, surgery, infectious or radiotherapy, or glucocorticoid medication; 11. No growth abnormalities.r />r /> CONCLUSION: AIIAD is an unspecified and underestimated condition with much misdiagnosis. We summarized the clinical features to improve the recognition. Indeed, every patient with unexplained hyponatremia and malaise, particularly in patients with autoimmune diseases, needs to be evaluated for the possibility of AIIAD....

Read abstract  Full text PDF