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Abstract

The аim is to study family influence on formation of eating and weight disorders. The concept of an “alimentary family” is defined as a family with dysfunctional, disharmonious relationships, which is a prerequisite for emergence and support of distorted patterns of eating behaviour, leading in the future to children’s eating and weight disorders.

Methods: The research was carried out using the method of a thematic retrospective analysis (MTRA)-food, which is a variant of the narrative method, the questionnaire "Parental convictions and control tactics as for eating behaviour of their children during food taking". The data was processed by the content analysis method; Fisher's φ-criterion was used to compare differences between the groups.

Results: The research has allowed us to clarify eating behavioural characteristics and to identify the “roots” of eating disorders. Various forms of forcing at eating, direct and indirect ways of making children to eat or blocking of eating are manifested in ignoring of children’s taste preferences, their desire and readiness to eat. Parents often use manipulative techniques influencing children’s eating behaviour (encouragement, inducement, reward promises, approval, recognition, warning, or switching attention), direct means of influence (coercion: prohibition, restriction, rejection, destructive criticism, intimidation, deprivation from various pleasures). There is the statistical confirmation that parents’ use of manipulative means and / or direct coercion towards their children during eating predetermines formation of pathological processes of corporeality, attitudes and psychological mechanisms stipulating eating disorders.

Conclusions: The research results indicate necessity to develop psychotherapeutic programs for people with eating disorders, as well as programs to help parents improve family relationships and, accordingly, to apply correctional effects on their children.

Abstract

The issue of parental neglect is a constantly topical one. Neglect is not only the lack of satisfying basic needs, but also the lack of ensuring a sense of security, belonging, and insufficient physical, emotional or verbal closeness with the child. Poor parental care, lack of a sense of closeness and availability of the parent, along with other environmental factors (e.g. addictions, diseases and mental disorders in the family) result in abnormal formation of the child's personality, and can also be associated with depression, anxiety, self-harm or suicide attempts.

The aim of the study was to present the clinical cases of two teenage patients (AA. – 13 years old, BB. – 16 years old) staying in the I Department of Psychiatry, Psychotherapy and Early Intervention in Lublin (Department for Children and Youth), whose mental health problems were caused by a constant neglect on the part of parents.

Case reports: The patients came from dysfunctional families in which members showed a tendency to addiction (alcohol) and were emotionally and physically absent from the lives of the girls. Due to considerable upbringing problems, girls were hospitalized many times, both in paediatric wards and in psychiatric wards for children and adolescents, with various medical diagnoses.

Conclusions: The presented cases of two patients indicate a potential cause-and-effect relationship between parental neglect, coexisting environmental factors (addictions of family members) and abnormal formation of the child's personality, self-harm or suicide attempts. In such family systems, it is extremely important, apart from a court-appointed family guardian, to introduce a family assistant to provide emotional or advisory support.

Abstract

The Rorschach test is the most well-known psychological test ever invented; it has captured the imagination of entire generations of clinicians, researchers, artists, writers, and ordinary participants in mass culture. Yet, no psychological test has faced such heavily emotional criticism. The drastically ambiguous status of this test in the community of psychologists can be call an identity crisis. This is the diagnosis presented in the book titled Assessment Using the Rorschach Inkblot Test by James P. Choca and Edward D. Rossini, American professors of clinical psychology currently affiliated with the Roosevelt University in Chicago. It was this book that inspired the present article. Choca and Rossini claim that the crisis associated with the use of the inkblot test stems from the lack of understanding of what the essence of this test actually is and from its improper usage. They also indicate realistic and practical ways to overcome this crisis.

Faced with the excessively elaborate systems for processing and interpreting the material obtained using the test, the authors attempt to create a short version of the inkblot test (Basic Rorschach). In the short version it is possible to use a smaller number of categories or even limit oneself to use only four plates instead of ten. Choca and Rossini admit that the Basic Rorschach requires further studies; they are also willing to give psychologists a great degree of freedom and the possibility of deciding what to take into account and what to ignore in the interpretation of results. They also propose to introduce a new final phase of the test, which, in a way, involves the examinee in the process of analyzing his or her responses.

In this paper I address the changes proposed by the authors, concerning both the procedure and the manner of categorizing and interpreting responses. For this purpose, I use own clinical experience and the results of my empirical research.

Abstract

Introduction: Polycystic ovary syndrome (PCOS) is the most common endocrinopathy in women at the reproductive age. In 2018, the European Society of Human Reproduction and Embryology (ESHRE) developed and published new accurate recommendations for the diagnosis and management of women with PCOS. In this work, a separate chapter is devoted to the quality of life and mental disorders in patients with polycystic ovary syndrome.

Material and Methods: This article provides an overview of the literature regarding mental disorders associated with PCOS with the focus on the ESHRE recommendations.

Conclusion: The medical staff and patients should be aware of the negative impact of polycystic ovary syndrome on the quality of life, coexistence of depression, anxiety, psychosexual and eating disorders.

Abstract

Chimeric antigen receptors (CARs) are genetically engineered receptors that provide specific properties to an immune effector cell and these receptors gain the specificity of a monoclonal antibody targeted against specific tumor cells. T cells with engineered CARs acquire potent immunological properties and redirect the immune system in order to eliminate malignant cells. First-engineered T cells with chimeric molecule (CAR-T cells) were developed in 1989–1993 by Israeli immunologists Zelig Eshhar and Gideon Gross. The first clinical application of CAR-T cells was done in the University of Pennsylvania and Children’s Hospital in Philadelphia by the immunologist Carl June and hematologist David Porter to patients with chronic lymphocytic leukemia in 2011 and together with the pediatrician Stephan Grupp to patients with acute lymphoblastic leukemia (ALL) in 2012. The US Food and Drug Administration Agency (FDA) in 2017 and the European Medicines Agency (EMA) in 2018 have licensed two products of CAR-T cells: tisagenlecleucel for the use in children and young adults up to 25 years of age with B-cell ALL who do not respond to treatment or have relapsed two or more times and tisagenlecleucel and axicabtagene ciloleucel for the use in adult patients with relapsed or refractory diffuse large B-cell lymphoma (DLBCL). Current progress in CAR technology includes the use in other hematological malignancies, solid tumors, the use of dual CAR-T cells and chimeric antigen receptor natural killer cells (CAR-NK cells).

Abstract

Chimeric antigen receptor T-cell (CAR-T) therapy is an effective new treatment for hematologic malignancies. Two anti-CD19 CAR-T products, namely axicabtagene ciloleucel and tisagenlecleucel, have been approved for the management of relapsed/refractory large B-cell lymphoma after two lines of systemic therapy. Additionally, tisagenlecleucel is indicated for refractory acute lymphoblastic leukemia in pediatric patients and young adults up to 25 years of age. CAR-T cells are undoubtedly a major breakthrough therapy in hematooncology resulting in up to 90% response rate with durable remissions in population with refractory high-risk disease. However, there are serious side effects resulting from CAR-T therapy, including cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS). Manifestations of CRS mostly include fever, hypotension, hypoxia, and end organ dysfunction. Neurologic toxicities are diverse and include encephalopathy, cognitive defects, dysphasia, seizures, and cerebral edema. Since the symptoms are potentially severe, practitioners need to familiarize themselves with the unique toxicities associated with these therapies. In this article, we present a practical guideline for diagnosis, grading and management of CRS and CAR-T neurotoxicity. In addition, infectious complications and late toxicities including prolonged cytopenias and hypogammaglobulinemia are discussed.

Abstract

Introduction

Graft-versus-host disease (GVHD) is a common and serious complication after allogeneic stem cell transplantation (allo-SCT). However, a similar syndrome has been reported after autologous stem cell transplantation (ASCT) as well.

Case report

A 61-year-old female diagnosed with immunoglobulin (Ig) G lambda multiple myeloma completed 10 cycles of bortezomib, thalidomide, and dexamethasone (VTD) and 2 cycles of cyclophosphamide, thalidomide, and dexamethasone (CTD). High-dose of melphalan (200 mg/kg) was given as conditioning, followed by an infusion of 2.5 × 106 CD34+ cells/kg. Three months later, she received her second ASCT. On Day +25 after tandem ASCT, the patient developed a maculopapular, itchy skin rash, which covered her face, trunk, and limbs. A skin biopsy was in line with the diagnosis of GVHD. The other organs were not involved. Treatment with systemic and local corticosteroids (CSs) resulted in the improvement of skin lesions, but the CSs were slowly tapered due to toxicity. In the following weeks, she developed symptoms of liver and gut involvement, which were resistant to steroids. The introduction of other immunosuppressive agents failed to achieve a response. As a consequence, she had cytomegalovirus (CMV) reactivation, as well as pancytopenia, and eventually, she died of infectious complications.

Conclusions

GVHD after ASCT remains a rare but life-threatening complication with poor prognosis.

Abstract

The most frequent and severe complications after chimeric antigen receptor T-cells (CAR-T cells) therapy include cytokine release syndrome (CRS), immune effector cell-associated neurotoxicity syndrome (ICANS), macrophage activation syndrome/hemophagocytic lymphohistiocytosis (MAS/HLH), tumor lysis syndrome (TLS), followed by B-cell aplasia and hypogammaglobulinemia. With these immunologically related events, cytokine storm and immunosuppression, there is a high risk of sepsis and infectious complications. The objective of this review was to present current knowledge on incidence, risk factors, clinical characteristics, and outcome of infections in patients following CAR-T cells therapy, as well as to present current recommendations on prophylaxis of infections after CAR-T cells therapy. Comparable to hematopoietic cell transplantation setting, specific pre- and post-CAR-T cells infusion phases can be determined as early (from 0 to +30 days), intermediate (from +31 to +100 days), and late (beyond day +100). These phases are characterized by CAR-T cells therapy-related factors and immune system defects contributing to an increased risk of infections. It is recommended that in case of active infection, CAR-T cells infusion should be delayed until infection has been successfully treated. After CAR-T cells therapy, prophylaxis should be implemented (anti-bacterial, anti-viral, anti-fungal, anti-pneumocystis), as well as treatment of neutropenia and immunoglobulin replacement should be considered. No recommendations so far can be given on revaccinations after CAR-T cells therapy.

Abstract

Quality assurance and safety of hematopoietic stem cells (HSC) with special emphasis on bacterial and fungal contamination is the prerequisite for any transplantation procedure. The aim was to determine the incidence rate of such contamination during processing of transplantation material with regard to HSC source: peripheral blood stem cell (PBSC), bone marrow (BM), or cord blood (CB). Analysis involved autologous and allogenic products dedicated for patients and comprised in all 4135 donations, including 112 BM (2.70%), 3787 PBSC (91.60%), and 236 CB (5.70%) processed in cell bank over the period 1996–2016. Aerobic and anaerobic contamination was determined.

Analysis of the 20-year data revealed 42 contaminated products: 25 PBSC (0.66% of tested units) and 17 CB (7.20% of tested units). No microbial contamination of BM products was detected. Overall percentage of contaminated products was 1.01%, mostly with Staphylococcus epidermidis (61.36%). Bacterial contamination rate at cell bank is relatively low and processing in a closed system does not seem as crucial as might be expected. This is particularly true for BM components. Equally important are evaluation of donor’s medical status and condition of the puncture site for collection of source material. Implementation of appropriate sample collection procedures should help minimize the risk of false-positive results due to environmental contamination.

Abstract

Background

The International Prognostic Index and its modifications are used to estimate prognosis in non-Hodgkin lymphoma. However, the outcome is often different in patients with similar index scores.

Aim

The aim of this study was to elaborate a prognostic model for patients with mature B-cell non-Hodgkin lymphoma using a combination of predictive markers.

Material and methods

The study included 45 patients with mature B-cell non-Hodgkin lymphoma. Before the administration of treatment, clinical and laboratory parameters were measured. After the 35-month follow-up period, overall survival was studied in relation to the data obtained at initial examination.

Results

We revealed nine adverse predictive markers for overall survival of enrolled patients: Eastern Cooperative Oncology Group (ECOG) performance status >1; erythrocyte sedimentation rate >30 mm/h; levels of hemoglobin <120 g/L, fibrinogen ≥6 g/L, interleukin-6 ≥2 pg/mL, tumor necrosis factor ≥1.45 pg/mL, soluble fibrin monomer complexes >4 mg/dL, high-density lipoprotein cholesterol <1.03 mmol/L in men, and <1.29 mmol/L in women; and short activated partial thromboplastin time. A prognostic model for the estimation of the risk of death within the ensuing 1.5–2 years in patients with non-Hodgkin lymphoma was constructed.

Conclusion

Markers of inflammation, anemia, hypercoagulability, dyslipidemia, and poor ECOG status are associated with worse survival in patients with mature B-cell non-Hodgkin lymphoma.