cognitive function in depressed adults. International Journal of Neuropsychopharmacology. 2014; 17 (10): 1557-67. 12. Häggström L, Nielsen RZ, Poulsen L, Danchenko N. A randomised, double blind, active controlled study of vortioxetine (10–20 mg/day) versus agomelatine (25–50 mg/day) in adults with Major Depressive Disorder with inadequateresponse to antidepressant treatment. Poster presented at: 26th Congress of the European College of Neuropsychop harmacology (ECNP); October 5-9, 2013; Barcelona, Spain. 13. Alvarez E, Perez V, Dragheim M, Loft H, Artigas F. A double
Introduction: Major depressive disorder is a chronic and debilitating disease characterized by a wide range of emotional and physical symptoms that coexist during a depressive episode and may reoccur at some point during the progression of the disease for the majority of patients. The purpose of the study was to investigate psychiatrists’ experience regarding the response to antidepressive treatment and their options regarding augmentation strategies in depression with incomplete response to antidepressant monotherapy.
Method: We applied an 18-item questionnaire containing multiple choice questions to adult psychiatrists working in ambulatories, hospitals or mental health centers.
Results: Fourty-two psychiatrists have agreed to answer the questionnaire. The majority of them were psychiatry specialists, between 35 and 49 years of age, working in an outpatient unit. For the majority of doctors, SSRIs (Serotonin Reuptake Inhibitors) proved to be the first line treatment both for the first depressive episode and for recurrent depression, followed by SNRI (Serotonin and Noradrenalin Reuptake Inhibitors). Regarding the duration of maintenance treatment for the patients who achieved complete remission after the first episode of depression, the results showed a wide spectrum from 4 to 9 months.
Conclusions: Incomplete response to antidepressive monotherapy is very frequent both for the first depressive episode and for recurrent depression. Given the pharmacological profile that some atypical antipsychotic have, augmentation with atypical antipsychotics in patients with inadequate response to antidepressant monotherapy is a useful therapeutic strategy that should be considered.
Introduction. Anemia is a complication of chronic renal failure observed in patients on hemodialysis (HD) affecting morbidity and mortality of these patients. It is associated with erythropoietin (EPO) deficiency and can be treated by human recombinant erythropoietin (hrEPO). Iron deficiency has been reported as the first line cause for inadequate response to this treatment. Zinc deficiency in hemodialysis (HD) patients was previously reported and the relationship between iron and zinc deficiencies has been known for years. The aim of this study was to find out the relationship between serum zinc level, anemia and rhEPO consuming in HD patients.
Methods. A total of 69 HD patients and 34 healthy individuals were included in the study. Serum zinc levels, clinical, hematologic, biochemical parameters and rhEPO doses were evaluated.
Results. Serum zinc levels were found to be lower in HD patients in comparison to those in the control group (29.92±12.94, 44.82±27.69μg/dL, respectively) (p<0.001). There was a positive correlation between serum zinc and hemoglobin (Hb) in the control group (R2=0.06). In HD patients who needed less then 8000U/week rhEPO, Hb levels (p<0.05) and serum zinc levels were higher. Serum zinc and Hb levels were found to be higher in patients who were under HD treatment for more than 12 months (10.05±1.06 vs 10.69±1.29; p=0.022 and 26.96±13.29 vs 30.88±12.61; p=0.178).
Conclusions. HD patients who needed lower dose of EPO had higher serum zinc levels. Although the difference was not statistically significant, these results provide evidence that serum zinc level should be taken into consideration especially in HD patients resistant to EPO therapy.
Dual antiplatelet treatment with clopidogrel and aspirin represents standard regimen in prevention of thromboembolic events in patients with ischemic heart disease undergoing percutaneous coronary intervention (PCI). One of the greatest pitfalls of clopidogrel treatment is large inter-individual variability in response. Large amount of patients does not respond adequately and therefore are not „protected“ even in spite of receiving the therapy. Poor responders are exposed to three-fold increased risk of myocardial infarction, stent thrombosis and cardiac death.
Clopidogrel is an antiplatelet prodrug, whose active metabolite inhibits platelet function by irreversible binding to the (adenosine diphosphate) platelet receptor P2Y12. Receptor P2Y12 plays primal role in ADP-mediated platelet activation, and also in mechanism of action of ADP inhibitors such as clopidogrel, prasugrel etc. Reasons stated above, raised the necessity for implementing reliable laboratory test in order to identify the unprotected patients. In an ideal scenario, such test would serve to adjust the dose and guide the individual tailored treatment.
Vasodilator Stimulated Phosphoprotein (VASP) is an intracellular platelet protein which is non phosphorylated at basal state. Since its relation in cascade with P2Y12 receptor, VASP phosphorylation corerlates with inhibition of P2Y12 which is the receptor of prime importance in ADP mediated activation of platelets and as is primary target of ADP inhibitors action. Outcome of the assay is represented as the value of platelet reactivity index (PRI), where PRI values above 50% are considered inadequate response to treatment and signal exposure to increased risk of myocardial infarction, post-PCI stent thrombosis and cardiac death. VASP-P flow cytometric assay is emerging into the spotlight as the promising method, mostly for its specificity for ADP inhibitors, better outlook for standardising results and lesser sample manipulation compared to multiple electrode aggregometry.
Mycosis fungoides (MF) belongs to a group of primary cutaneous T-cell lymphomas, with characteristic small- to medium-sized neoplastic T-lymphocytes with hyperchromatic and cerebriform nuclei. Folliculotropic mycosis fungoides (FMF) represents a variant of mycosis fungoides, which is histologically characterized by folliculotropic T-cell infiltrates, with or without mucinous degeneration of the hair follicles. Clinical features of FMF are characterized by appearance of grouped follicular papules, acneiform lesions, indurated plaques, sometimes tumors, which usually involve the head and neck region. The diagnosis is based on clinical presentation, histopathological and immunohistochemical (IHC) findings of skin biopsy specimens. The treatment of FMF, and generally MF, should be stage-adapted. Case report: We present a case of a 33-year-old male with an eight-month history of erythematous papules on his forehead accompanied by intense pruritus. Histopathological findings showed folliculotropic and perivascular lymphocytic infiltrates. An increased CD4/CD8 ratio of interfollicular lymphocytes with accumulation of Langerhans cell confirmed the diagnosis of FMF. Our patient was diagnosed with an early stage - IA, and P-UVA phototherapy was recommended due to ineffectiveness of prescribed topical corticosteroids that had shortterm effects. Conclusion: Folliculotropic mycosis fungoides represents a diagnostic challenge due to the great diversity of clinical manifestations. We presented a rare case of folliculotropic mycosis fungoides in a young adult, who presented with erythematous papules, accompanied by intense pruritus on the forehead, which lasted for several months. Histopathological and IHC analysis confirmed the diagnosis of folliculotropic mycosis fungoides stage IA. Due to an inadequate response to a topical corticosteroid, P-UVA phototherapy was administered, as well as close follow-up, essential for timely treatment of this frequently therapy-resistant disease.
major depressive disorder (MDD): a pooled analysis. Int J Psychiatry ClinPract. 2013;17(2 suppl):16-17.  Farsky I, Smetanka A, Dubinska S. Spirituality of patients with selected psychiatric disorders. Osetrovatelstvi a PorodniAsistence. 2012;3(3):433-441.  Haggstrom L, Nielsen RZ, Poulsen L, Danchenko N. A randomised, double blind, active controlled study of vortioxetine (10-20 mg/ day) versus agomelatine (25-50 mg/day) in adults with Major Depressive Disorder with inadequateresponse to antidepressant treatment. Poster presented at: 26th Congress of the
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