Non-compliance with medical recommendations results in delayed hospitalization and poorer prognosis in patients with cerebral ischemic stroke in Poland: Non-compliance effects on post-ischemic stroke prognosis.

OBJECTIVES: This study aimed to reveal and analyze the causes of delays in reaching the hospital of patients with cerebral ischemic stroke and to assess their clinical picture. MATERIAL AND METHODS: The study group included 161 patients with stroke, who reported to the hospital beyond the thrombolytic treatment therapeutic window. The control group consisted of 85 patients recruited consecutively with stroke who received thrombolytic treatment per eligibility criteria. Laboratory and medical imaging tests essential for neurological condition assessment were conducted in the study group. Control group research was based on retrospective analysis of medical records. RESULTS: The rate of deaths during hospitalization was lower in the control group (4.7%) compared to the study group (14.9%). In the study group, more patients (16.8%) admitted to non-compliance with medical recommendations than in the control group (5.9%). There were no statistically significant differences in nicotinism and alcohol dependence syndrome frequency between both groups. CONCLUSIONS: Based on each group inclusion criteria, a lower mortality rate in the control group indicates a crucial role of the therapeutic window in cerebral stroke treatment. Analysis of reasons for delay points out that efficient prophylaxis is the education of patients with stroke risk factors and their families.

An impaired metabolism of nucleotides underpins a novel mechanism of cardiac remodeling leading to Huntington's disease related cardiomyopathy.

Huntington's disease (HD) is mainly thought of as a neurological disease, but multiple epidemiological studies have demonstrated a number of cardiovascular events leading to heart failure in HD patients. Our recent studies showed an increased risk of heart contractile dysfunction and dilated cardiomyopathy in HD pre-clinical models. This could potentially involve metabolic remodeling, that is a typical feature of the failing heart, with reduced activities of high energy phosphate generating pathways. In this study, we sought to identify metabolic abnormalities leading to HD-related cardiomyopathy in pre-clinical and clinical settings. We found that HD mouse models developed a profound deterioration in cardiac energy equilibrium, despite AMP-activated protein kinase hyperphosphorylation. This was accompanied by a reduced glucose usage and a significant deregulation of genes involved in de novo purine biosynthesis, in conversion of adenine nucleotides, and in adenosine metabolism. Consequently, we observed increased levels of nucleotide catabolites such as inosine, hypoxanthine, xanthine and uric acid, in murine and human HD serum. These effects may be caused locally by mutant HTT, via gain or loss of function effects, or distally by a lack of trophic signals from central nerve stimulation. Either may lead to energy equilibrium imbalances in cardiac cells, with activation of nucleotide catabolism plus an inhibition of re-synthesis. Our study suggests that future therapies should target cardiac mitochondrial dysfunction to ameliorate energetic dysfunction. Importantly, we describe the first set of biomarkers related to heart and skeletal muscle dysfunction in both pre-clinical and clinical HD settings.

Melatonin and cortisol profiles in patients with pituitary tumors.

The optic tract section at the optic chiasm is expected to disturb the suprachiasmatic nucleus (SCN) rhythm, circadian rhythm and melatonin secretion rhythms in humans, although detailed studies have never been conducted. The aim of this paper was to describe melatonin and cortisol profiles in patients with a pituitary tumor exerting optic chiasm compression. Six patients with pituitary tumors of different size, four of whom had significant optic chiasm compression, were examined. In each brain, MRI, an ophthalmological examination including the vision field and laboratory tests were performed. Melatonin and cortisol concentrations were measured at 22:00 h, 02:00 h, 06:00 h, and 10:00 h in patients lying in a dark, isolated room. One of the four cases with significant optic chiasm compression presented a flattened melatonin rhythm. The melatonin rhythm was also disturbed in one patient without optic chiasm compression. Larger tumors may play a role in the destruction of neurons connecting the retina with the suprachiasmatic nucleus (SCN) and breaking of basic way for inhibiting effect to the SCN from the retina.

A study of molecular changes relating to energy metabolism and cellular stress in people with Huntington's disease: looking for biomarkers.

Huntington's disease (HD) is a neurodegenerative disorder characterized by a progressive motor and cognitive decline and the development of psychiatric symptoms. The origin of molecular and biochemical disturbances in HD is a mutation in the HTT gene, which is autosomally dominantly inherited. The altered huntingtin protein is ubiquitously expressed in the CNS, as well as in peripheral tissues. In this study we measured the metabolism changes in gene transcription in blood of HD gene carriers (premanifest and manifest combined) versus 28 healthy controls. The comparison revealed statistically significant Global Pattern Recognition Fold Change (FC) for 6 mRNA transcripts, reflecting an increase of: MAOB (FC = 3.07; p = 0.0005) which encodes an outer mitochondrial membrane-bound enzyme called monoamine oxidase type B; TGM2 (FC = 1.8; p = 0.02) encoding a transglutaminase 2 that mediates cellular stress; SLC2A4 (FC = 1.64; p = 0.02) solute carrier family 2 (facilitated glucose transporter) member 4; branched chain ketoacid dehydrogenase kinase (BCKDK) (FC = 1.34; p = 0.02); decrease of LDHA (FC = -1.16; p = 0.03) lactate dehydrogenase A; and brain-derived neurotrophic factor (BDNF) (FC = -2,11; p = 0.03). These distinguished changes coincided with HD progress. The analyses of gene transcription levels in sub-cohorts confirmed these changes and also revealed 28 statistically significant FCs of gene transcripts involved in ATP production and BCAA metabolism.

The relationship of purpose in life and hope in shaping happiness among patients with cancer in Poland.

The authors investigated the relationship of purpose of life, and hope in the happiness and life satisfaction of patients with cancer during or following cancer treatment. Fifty cancer patients were interviewed during recovery in two Warsaw medical centers. The primary measures used were Purpose in Life Test, Herth Hope Index, Happiness and Social Well-Being tools by Czapinski, and the Cantril Ladder of Satisfaction with Life, as well as medical and demographic measures. Purpose in life was correlated with measures of happiness, and satisfaction with life. Hope was correlated with current happiness, and four measures of satisfaction with life. Patients who had cancer longer, that is, duration of disease, showed lower scores for purpose in life, and number of friends. The longer the time of cancer treatment, the lower were patients' scores for desire for life. Purpose in life and hope were positively correlated with eleven measures of happiness and satisfaction in life. The cancer variables negatively correlated with loss of friends and six variables of happiness, and satisfaction in life, suggesting the impact that having cancer treatment had on patients' lives. Psychological support in the cancer center was helpful to patients in and out of treatment.

The contribution of gender differences in motor, behavioral and cognitive features to functional capacity, independence and quality of life in patients with Huntington's disease.

INTRODUCTION: Huntington's disease (HD) is a neurodegenerative autosomal dominant disorder affecting patients' motor, behavioral and cognitive domains leading to total dependency for activities of daily life. This study compares whether gender differences in motor, cognitive and behavioral symptoms affect function and how functional impairment affects quality of life (QoL). METHODS: We recruited 2191 subjects from the REGISTRY data base that provides personal data, HD age of onset, visit date, CAG mutation size, UHDRS and TFC scores from at least one visit. For 1166 participants SF-36 was also available. We calculated Spearman coefficients for correlations between particular symptomatic domains and functional scales, Fisher z-transform was used to test whether differences in correlations between genders were statistically significant. Simultaneous linear regression with least-square fit method was used to determine for how much variability in functional scales the particular symptomatic domains are responsible. ANOVA was used to look for QoL differences between TFC-stage based groups. Baseline statistics showed no significant differences between genders. RESULTS: Motor, cognitive and behavioral domains contributed significantly to function and independence. The motor domain contributed most followed by the cognitive and to a lesser degree by the behavioral domain. Motor symptoms correlated more with functional ability and influenced function variability more in women than in men. The decline in functional abilities correlated significantly with QoL decline. CONCLUSION: Motor symptoms have highest impact on function in HD, moreover these symptoms affect female function and independence more than males. Results indicate that symptomatic treatment targeting motor symptoms is needed to improve HD function and QoL.

[Can total loss of ability to paid work mean a simultaneous maintenance of ability to paid work at wages exceeding 100%?]. / Czy calkowita utrata zdolnosci ci do pracy zarobkowej moze oznaczac równoczesnie zachowanie zdolnosci do zarobkowania w ponad 100%?

To illustrate and evaluate the efficiency of presently enforced limits of earning for pensioners and the percentage of working pensioners whose earnings are within the limits, the authors compared data from 2001 and 2005 that described declared income from paid work of pensioners with different grades of inability established by the Pita Branch of the Social Insurance Institute (ZUS). It was demonstrated that only 14.75% of all pensioners in the ZUS Pita Branch declared income from paid work, with 96.55% declaring income below 70% of the average national monthly earnings, 2.12%--between 70-130% of the average monthly earnings, and only 1.32% of individuals declaring income over 130% of the average salary. As it follows from the above analysis, the legal limits of allowable income were applicable to 3.34% of all working pensioners only, imposing limits on their earnings. If the number of professionally active pensioners nationwide subject to income restrictions due to earnings in excess of 70% of the average national monthly salary was compared to the total number of pensioners in the ZUS Pita Branch, the percentage of the latter was only 0.51% in 2005.

[How to interpret the notion of partial inability to work?]. / Jak interpretowac pojecie czesciowej niezdolnosci do pracy?

The authors start from a seemingly absurd question whether it is possible to forfeit the ability to paid work in more than 100%. Referring to such legal acts as the Decree of the Ministry of Work and Social Politics of December 18, 2002, and the Bill on old-age and disability pensions paid from the Social Security Fund of December 17, 1998, the investigators perform an analysis and interpret the notions of "permanent" and "partial inability to work" in their semantic and economic aspects. The authors emphasize the fact that the two different categories: "ability to work" and "inability to work", when referring to a single individual, constitute a mathematical "unity". Hence, they believe the rule in force that decrees that a pension received due to inability to work is suspended only when the individual's income exceeds 130% of the average national monthly salary to be inappropriate and not corresponding to the principle of social security-associated compensation of the loss of the said individual's ability to work.

[Medical certification standards in the evaluation of inability to work]. / Standardy orzecznicze w ocenie niezdolnosci do pracy.

The authors attempt to address the question whether it is possible to establish medical certification standards that would be helpful in assessing inability to work. The need for developing such relatively uniform certification standards is indicated in the Report of the Supreme Chamber of Control issued in July 2005. Searching for the answer to the question to what degree such standards can be established, the authors briefly present and review the presently enforced "certification standards" and provided several examples from the history of social security and medical certification in Poland. They also discuss the first Polish textbook of medical certification published by Dr. Franciszek Witaszek in 1935. Another "historical example" recalled in the paper is the textbook edited by Professor Karol Szaniewicz (1959) and entitled: "Medical certification for disability and employment". The authors also mention that several years ago, the Central Institute of Occupational Medicine published an "Occupational guide" that might be of help in developing certification standards in cases of inability to work.

[Medico-legal opinions in cases for annulment of testament. Part I. Characteristics of investigative material. Characteristics of testators]. / Opiniowanie sadowo-lekarskie w sprawach o uniewaznienie testamentu. Cz. I. charakterystyka materialu badawczego. Charakterystyka testatorów.

A very important issue in preparing medico-legal opinions is the establishment whether the devisor had the ability to bequeath at the date of preparing a testament. The subsequent loss of the ability of bequeathing does not have any impact on execution of the previously prepared testament. Experts who pass opinions in testament cases evaluate: 1) the testament itself and the circumstances of its preparation, excluding, however, the reliability of records, 2) statements obtained while interrogating witnesses (descriptions of daily life, motivation to bequeath), 3) medical records (files, case histories, discharge records). The investigative material consisted of judicial files in 73 testament cases referred to the Chair and Department of Forensic Medicine (CDFM), University of Medical Sciences, Poznan, by courts from all over Poland in the period 1990-2005 for formulation of medico-legal opinions based on these documents. In 63.0% of cases, CDFM in Poznan was the first opinionating institution; in the remaining instances, previous medico-legal opinions had been given elsewhere; in six cases they were antagonistic. The investigative material included a predominant percentage (75.2%) of ordinary testaments (made before a notary and oligraphic) as opposed to 22% of informal testaments (oral only). Although in the majority of cases (67.2%) only one testament was drawn up, there were also instances (2.7%) where the devisor prepared as many as five testaments. The length of devisors survival following the drawing up of the final testament was generally short. In total, testaments not only in the oral form, but also made before a notary, were prepared by chronically ill individuals presenting with marked clinical symptoms, what was perceived by their family and caregivers as a sign of the imminent death. Hence, the testaments were often drawn up in a hospital room or in a notary office where the patient was taken between consecutive hospitalizations.

[Medico-legal opinions in cases for annulment of testament. Part II. Final conclusions of opinions. Quality of medical documentation. Evaluation of witnesses' testimonies]. / Opiniowanie sadowo-lekarskie w sprawach o uniewaznienie testamentu. Cz. II. wnioski koncowe opinii. Jakosc dokumentacji lekarskiej. Ocena zeznan swiadków.

The percentage of cases, in which devisors were unable to devise properly was high, what was mostly associated with the frequent drawing up of testaments by chronically ill individuals immediately before death. Grounds for pronouncing the devisor lacking in testamentary capacity were observed in 46.6% of cases, while 39.7% of devisors were found to lack free expression of will. Medical records were available in all the cases, including psychiatric records in 20.5% of cases and neurological records in 20.5%. In the majority of instances, the low quality of medical records hindered formulating expert opinions. The fact that in the majority of cases, the testimonies of witnesses were highly divergent indicated that they were either unable to assess the mental state of the devisor or else were themselves interested in the settlement of the case. Frequently, attending physicians from non-psychiatric wards were unable to answer questions on the mental state of the devisor, what resulted from their focusing on the somatic cause of hospitalization and the fact that their contact with the patient was very limited in time. Problems with certification on the basis of medical records were mainly associated with lacking psychiatric or neurological consults performed at the time the testament was drawn up; in some instances, the entire medical records from that period were missing. For this reason, individuals desiring to prepare a last will should be advised to undergo voluntary psychiatric assessment in this period. Medico-legal opinions in testament cases are difficult and time-consuming, but pleading one's case before the court is even more tedious and difficult.

[Vindication for detriment to health due to mental stress resulting from a sudden death of a close relative in an accident--a case analysis]. / Dochodzenie uszczerbku na zdrowiu za stres psychiczny spowodowany nagla smiercia bliskiej osoby wskutek wypadku - analiza przypadków.

The sequelae of traffic accidents affect not only the victims, but may also affect members of their families, who have not been involved in the accident but, nevertheless, in association with the demise of their close relative, they suffer from adaptive (reactive) disturbances which, in their opinion, provide grounds for litigation for their permanent loss of health resulting from the accident. Such opinionating problems are encountered with increasing frequency by insurance companies, when families of the victims killed in traffic accidents demand recuperation for the loss of health, developed due to the traumatizing experiences. The paper presents two cases of such litigation, filed by family members of deceased victims of traffic accidents.

[Driver and epilepsy]. / Kierowca a padaczka.

A family physician managing a 54-year-old patient with a past cranio-cerebral trauma in his medical history, followed by an intracerebral hematoma in the right frontal lobe, with secondary posttraumatic epilepsy, repeatedly prescribed anti-epileptic drugs (recommended by a consulting neurologist) and described in the patient's medical records frequent generalized seizures as reported by the patient and his wife. The doctor himself witnessed the patient driving a car, despite the fact that he received a disability pension resulting from frequent epileptic seizures. According to the doctor, he was "shocked" by the patient driving a car and felt obliged to report the matter to the Transport Division Administration, suggesting that the driving license should be revoked. The patient's driving license had been withdrawn, what caused considerable resentment in the individual, who, in turn, filed a suit against the physician for violating professional medical secrecy by informing the Transport Division Administration about his suffering from epilepsy. The described situations point to the necessity of: 1) striving for the highest possible objectivity of diagnosing epilepsy, and 2) standardization of criteria for certification of epilepsy.

[Overdiagnosis of cranio-cerebral injuries as a diagnisis error]. / Przediagnozowanie w rozpoznawaniu obrazen czaszkowo- -mózgowych jako blad diagnostyczny.

The report presents the problem of a diagnostic error consisting in abusing the diagnosis of cerebro-cranial injuries, and especially cerebral concussion. Diagnoses of cerebro-cranial injuries, including brain concussion established by physicians, including specialists, are often inappropriate in view of the medical history, clinical manifestations and laboratory findings. There are several reasons for the misdiagnoses (diagnostic abuse), but most commonly they result from an inappropriately taken medical history, excessive trust in the patient, and willingness to help the patient in receiving higher compensation. Overdiagnosing is also caused by the conviction shared by physicians that a diagnostic error lies in non-detection of a disease or injury rather than in overdiagnosing the patient in order to avoid subsequent charges. This is why proceedings at law against physicians who have overdiagnosed injuries occur only sporadically.

[Diagnostic errors in head injuries]. / Bledy diagnostyczne w urazach glowy.

Cranio-cerebral injuries pose a significant problem not only for clinicians, but also for forensic medicine specialists. Due to the specific character of such injuries, they are a relatively frequent cause of diagnostic errors. The most common type of diagnostic errors involves failure to diagnose cranio-cerebral injuries, especially in emergency cases. The authors present cases, in which imaging diagnostic studies, implemented therapeutic procedures and numerous consultations have not prevented misdiagnosing the patients and their resultant death.

Monitoring risk behaviour in adolescent pupils regarding consumption of psychoactive substances.

Introduction. Taking psychoactive substances constitutes a significant problem for Public Health, particularly in preventing drug abuse and addiction. Objectives. To estimate the amount and incidence of drug consumption in middle and high school pupils, including the circumstances in which drug taking first started, and to determine pupils' knowledge about the consequences of taking psychoactive substances and designer drugs (DDs). Materials and methods. A randomised study was conducted throughout Poland on 9,360 pupils attending middle school (junior high school) in 2009 and 7,971 pupils from middle and high school pupils in 2011. The survey consisted of a questionnaire devised by the Chief Sanitary Inspectorate (GIS) and the replies obtained were subject to the relevant statistical analyses. Results. Drug taking was found to have increased between 2009-2011, especially among those attending high school; proportionally rising from 4% - 11%. The numbers who had ever taken designer drugs were 3% for middle school pupils and 4% from high school. Conclusions. 1) Adolescent drug consumption has increased, particularly in those of older age and in boys. 2) Despite the only brief interval for which designer drugs were legal, they have gained high popularity among the young. 3) Adolescents have insufficient knowledge about the dangers of using DDs. 4) Faced with the growing threat of a dynamic designer drug market, appropriate counter-measures in education and prevention are therefore necessary.

Trends in smoking among secondary school and high school students in Poland, 2009 and 2011.

OBJECTIVES: To determine the age and the most common circumstances for smoking initiation along with smoking rates and to evaluate smoking trends for secondary and high school students in Poland during 2009 and 2011. MATERIAL AND METHODS: In 2009, a pilot study was conducted in districts of Poland on high school students and their parents. For statistical analysis, correctly completed questionnaires from 999 students and 667 parents were qualified for use. After the pilot study, a nationwide study of secondary school students and their parents was also conducted in 2009. For statistical analysis, correctly completed questionnaires were used from 9360 students and 6951 from their parents. The research tool was a questionnaire developed by the Chief Sanitary Inspectorate. These studies were then compared to the nationwide research study from 2011. Questionnaires were obtained from a survey of 3548 students from secondary schools and 4423 of those from high schools. RESULTS: Smoking initiation usually begins at ages 12-15 years. Rates of secondary school student smoking at least once in their lifetime were about the same level in the surveyed years (2009 - 9%, 2011 - 11%), whereas rates of high school student smoking increased (2009 - 15%, 2011 - 24%). Moreover, 34% of secondary school student smoked less than once a week, whereas in 2009, only 8% of students had done so. For high school students, a 1/2 smoked every day; similar to 2009. Students usually smoked in parks, on streets or any other open space areas. CONCLUSIONS: From analyzing the smoking trends over the survey period it can be concluded that the problem of smoking increases with respondent age. Int J Occup Med Environ Health 2017;30(5):763-773.

HDAC4 as a potential therapeutic target in neurodegenerative diseases: a summary of recent achievements.

For the past decade protein acetylation has been shown to be a crucial post-transcriptional modification involved in the regulation of protein functions. Histone acetyltransferases (HATs) mediate acetylation of histones which results in the nucleosomal relaxation associated with gene expression. The reverse reaction, histone deacetylation, is mediated by histone deacetylases (HDACs) leading to chromatin condensation followed by transcriptional repression. HDACs are divided into distinct classes: I, IIa, IIb, III, and IV, on the basis of size and sequence homology, as well as formation of distinct repressor complexes. Implications of HDACs in many diseases, such as cancer, heart failure, and neurodegeneration, have identified these molecules as unique and attractive therapeutic targets. The emergence of HDAC4 among the members of class IIa family as a major player in synaptic plasticity raises important questions about its functions in the brain. The characterization of HDAC4 specific substrates and molecular partners in the brain will not only provide a better understanding of HDAC4 biological functions but also might help to develop new therapeutic strategies to target numerous malignancies. In this review we highlight and summarize recent achievements in understanding the biological role of HDAC4 in neurodegenerative processes.

[Selected comments about the need for consistency standards in diagnosing occupational accidents and to improve professional skill and competence]. / O koniecznosci ustalania jednolitych kryteriów orzeczniczych i podnoszenia kwalifikacji lekarzy orzekajacych w sprawach wypadków przy pracy.

An accident at work is a sudden occupation-related event induced by an external agent resulting in trauma or death. The analysis covered 3215 records of proceedings in cases of accidents at work sent for certification to the Department of Forensic Medicine, Poznan University of Medical Sciences, from all over the country in the years 1989-2003. Of this number 19 most interesting cases with two or more opinions and varied final conclusions were selected. Medical certifications are issued by experts of various institutions, mostly of forensic medicine departments of medical universities, but also by independent experts. The fact that final conclusions drawn by different experts differ although based on the same records of proceedings indicates the need for setting uniform criteria for medical certification. The cases described in this paper may also serve as a strong argument for organizing more frequent conferences addressing this issue and for considering a possible introduction of specialization in medical certification.