Lactate in exhaled breath condensate and its correlation to cancer: challenges, promises and a call for data.

Owing to its connection to cancer metabolism, lactate is a compound that has been a focus of interest in field of cancer biochemistry for more than a century. Exhaled breath volatile organic compounds (VOCs) and condensate analyses can identify and monitor volatile and non-VOCs, respectively, present in exhaled breath to gain information about the health state of an individual. This work aims to take into account the possible use of breath lactate measurements in tumor diagnosis and treatment control, to discuss technical barriers to measurement, and to evaluate directions for the future improvement of this technique. The use of exhaled breath condensate (EBC) lactic acid levels in disorders other than cancer is also discussed in brief. Whilst the use of EBC for the detection of lactate in exhaled breath is a promising tool that could be used to monitor and screen for cancer, the reliability and sensitivity of detection are uncertain, and hence its value in clinical practice is still limited. Currently, lactate present in plasma and EBC can only be used as a biomarker for advanced cancer, and therefore it presently has limited differential diagnostic importance and is rather of prognostic value.

Metabolic Shades of S-D-Lactoylglutathione.

S-D-lactoylglutathione (SDL) is an intermediate of the glutathione-dependent metabolism of methylglyoxal (MGO) by glyoxalases. MGO is an electrophilic compound that is inevitably produced in conjunction with glucose breakdown and is essentially metabolized via the glyoxalase route. In the last decades, MGO metabolism and its cytotoxic effects have been under active investigation, while almost nothing is known about SDL. This article seeks to fill the gap by presenting an overview of the chemistry, biochemistry, physiological role and clinical importance of SDL. The effects of intracellular SDL are investigated in three main directions: as a substrate for post-translational protein modifications, as a reservoir for mitochondrial reduced glutathione and as an energy currency. In essence, all three approaches point to one direction, namely, a metabolism-related regulatory role, enhancing the cellular defense against insults. It is also suggested that an increased plasma concentration of SDL or its metabolites may possibly serve as marker molecules in hemolytic states, particularly when the cause of hemolysis is a disturbance of the pay-off phase of the glycolytic chain. Finally, SDL could also represent a useful marker in such metabolic disorders as diabetes mellitus or ketotic states, in which its formation is expected to be enhanced. Despite the lack of clear-cut evidence underlying the clinical and experimental findings, the investigation of SDL metabolism is a promising field of research.

Hidden biochemical fossils reveal an evolutionary trajectory for glycolysis in the prebiotic era.

Glycolysis is present in nearly all organisms alive today. This article proposes an evolutionary trajectory for the development of glycolysis in the framework of the chemoautotrophic theory for the origin of life. In the proposal, trioses and triose-phosphates were appointed to starting points. The six-carbon and the three-carbon intermediates developed in the direction of gluconeogenesis and glycolysis, respectively, differing from the from-bottom-to-up development of enzymatic glycolysis. The examination of enzymatic reaction mechanisms revealed that the enzymes incorporated chemical mechanisms of the nonenzymatic stage, making possible to identify kinship between glyoxalases and glyceraldehyde 3-phosphate dehydrogenase as well as methylglyoxal synthase and triose-phosphate isomerase. This developmental trajectory may shed light on how glycolysis might have developed in the nonenzymatic era.

[Hungarian psychiatric care in the light of the closure of the National Institute of Psychiatry and Neurology, and the reduction of the number of hospital beds. A decade and a half under investigation].

The "Act on the Development of the Health Care System, CXXXII/2006" ordered a general reduction in the number of hospital beds, which sensitively affected the care of psychiatric inpatients, too. In this wave of downsizing, the National Institute of Psychiatry and Neurology, an institute with the traditions of one and a half centuries, also ceased to exist. Based on statistical data, the article examined the effect of the law on inpatient and outpatient psychiatric/ addictological care. The reduction in the number of beds had a long-term effect only upon the reduction in the capacity of acute inpatient care; while the number of acute patients treated decreased, the number of involuntary hospital admissions increased and oddly enough, bed occupancy also decreased. This last phenomenon can in part be attributed to a reduction in nursing time. The patient care decreased in both adult and pediatric psychiatric out - patient care, as did similarly the turnover of outpatient clinics for addicts. However, the changes observed in outpatient care were not related to the bed number reduction, but rather meant the continuation of previously started decline in psychiatric/addictological care. There were no detectable changes in the trends for other examined characteristics, such as homelessness and involuntary treatment. A temporary increase was observed only in the number of completed suicides, but the previously seen decreasing trend was restored in this respect after 2011. All in all, the reduction in the number of beds forced by law caused only temporary care disruptions and had no significant effect, either positive or negative, on the negative trends in psychiatric/addictological care that started earlier. However, the reasons for these negative trends observed in Hungarian psychiatric/addictological care, and which still persist to this day, are unclear.

Evolutionary Aspects of the Oxido-Reductive Network of Methylglyoxal.

In the chemoautotrophic theory for the origin of life, offered as an alternative to broth theory, the archaic reductive citric acid cycle operating without enzymes is in the center. The non-enzymatic (methyl)glyoxalase pathway has been suggested to be the anaplerotic route for the reductive citric acid cycle. In the recent years, much has been learned about methylglyoxal, but its importance in the metabolic machinery is still uncovered. If methylglyoxal had been essential participant of the early stage of evolution, then it is a legitimate question whether it might have played a role in the early oxido-reduction network, too. Therefore, an oxido-reduction network of methylglyoxal that might have functioned under ancient circumstances without enzymes was constructed and analyzed by virtue of group contribution method. Taking methylglyoxal as input material, it turned out that the evolutionary value of reactions and biomolecules were not similar. Glycerol, glycerate, and tartonate, the output components, were conserved to different degrees. Although the tartonate route was similarly favorable from energetic point of view, its intermediates are almost not present in extant biochemistry. The presence of two carboxyl or aldehyde groups, or their combination in tricarbons of the constructed network seemed disadvantageous for selection, and the inductive effect, resulting in an asymmetry in electron cloud of chemicals, might have been important. The evolutionary role for cysteine, H2S, and formaldehyde in the emergence of high-energy bonds in the form of thioesters and in Fe-S cluster formation as well as in imidazole synthesis was shown to bridge the gap between prebiotic chemistry and contemporary biochemistry. Overall, the ideas developed here represent an approach fitting to chemoautotrophic origin of life and implying to the role of methylglyoxal in triose formation. The proposed network is expected to have an impact upon how one may think of prebiological chemical processes on methylglyoxal, too. Finally, along the evolutionary time line, the network functioning without enzymes is situated between the formation of simple organic compounds and primeval cells, being closer to the former and well preceding the last common metabolic ancestor developed after primitive cells emerged.

Changes in national rates of psychiatric beds and incarceration in Central Eastern Europe and Central Asia from 1990-2019: A retrospective database analysis.

BACKGROUND: Numbers of psychiatric beds (general, forensic, and residential) and prison populations have been considered to be indicators of institutionalisation of people with mental illnesses. The present study aimed to assess changes of those indicators across Central Eastern Europe and Central Asia (CEECA) over the last three decades to capture how care has developed during that historical period. METHODS: We retrospectively obtained data on numbers of psychiatric beds and prison populations from 30 countries in CEECA between 1990 and 2019. We calculated the median of the percent changes between the first and last available data points for all CEECA and for groups of countries based on former political alliances and income levels. FINDINGS: Primary national data were retrieved from 25 out of 30 countries. Data from international registries were used for the remaining five countries. For all of CEECA, the median decrease of the general psychiatric bed rates was 33•8% between 1990 and 2019. Median increases were observed for forensic psychiatric beds (24•7%), residential facility beds (12•0%), and for prison populations (36•0%). Greater reductions of rates of psychiatric beds were observed in countries with lower per capita income as well as in countries that were formerly part of the Soviet Union. Seventeen out of 30 countries showed inverse trends for general psychiatric beds and prison populations over time, indicating a possible shift of institutionalisation towards correctional settings. INTERPRETATION: Most countries had decreased rates of general psychiatric beds, while there was an increase of forensic capacities. There was an increase in incarceration rates in a majority of countries. The large variation of changes underlines the need for policies that are informed by data and by comparisons across countries. FUNDING: Agencia Nacional de Investigación y Desarrollo in Chile, grant scheme FONDECYT Regular, grant number 1190613.

Negative trends in outpatient care of addicted patients in Hungary.

OBJECTIVES: This article investigates how the numbers of registered addict patients have changed in the last three decades in Hungary and whether the predicted HIV epidemic among intravenous drug users has occurred. METHODS: Data were collected from the Annual Reports of the National Bureau of Statistics and National Epidemiological Centre as well as from the medical records of the author. RESULTS: The total number of registered alcoholics decreased by about 75% during the investigated period. This decrease was more pronounced among males than females. After initial increase, the number of registered drug addicts showed stagnation with an about 50% drop-out rate. Fortunately, the anticipated HIV epidemic did not manifest. The negative effect of a poor political action upon the number of client visits could, however, be documented. CONCLUSION: In conclusion, negative trends are seen in the Hungarian addiction care. Numerous variables may be taken into consideration as affecting factors, but it is not yet clear to what extent these negative factors are responsible for trends. These data, however, warrant further investigations.

[The changes of roles and their effects on the functioning of the family of alcoholics. The history of two families].

The alcohol dependence of a family member redraws familiar relationships and creates a dysfunctional network. Therefore, the relationship between the individual and the family, the interactions and processes that occur must be examined during the therapy in order to understand the behavior of an alcoholic. The observations obtained in stu - dying the role of family members in the development and maintenance of pathological alcohol use disorders provide the scientific basis for this. Living in a family is realized by fulfilling role expectations related to the role based on the family status. In the case of discrepancy between the role expectation associated with the status and the individual's ability to fulfill the role, a dysfunctional situation is seen. In the present work, the relationships in the families of two alcohol de - pendent patients were analyzed. In both families, it was possible to identify the conspirator/looking away family member, who was either the spouse or the mother, sometimes both. The dysfunctional fathers were also recognized and there was a self-sacrificing family member in both families, who was the daughter in both cases. As the relatives themselves con - tribute to the survival of both alcohol dependence and the alcoholic game, efforts should be made to involve the family in therapy. Since the most important relationship of a married man is optimally his wife, the interaction between them is decisive for the survival of addiction. This led to the birth of the "wife of alcoholic" technical term. But this approach probably needs to change, as the male/female ratio for drinking began to decline as early as the 1980s. Thus, presumably the "partner of alcoholic" concept better describes today's reality. The involvement of family members in the therapy is necessary for the recovery of addict patient. However, there is a serious difficulty, the alienation of family members from the addict. In addition, the available services are often insufficient for recovery, as already pointed out by Hungarian authors. And further, statistics indicate a decrease in the patient retention capacity of the care system. Therefore, it would be important to rethink the role and possibilities of the addiction care network, and modify its financing.

Interplay among Oxidative Stress, Methylglyoxal Pathway and S-Glutathionylation.

Reactive oxygen species (ROS) are produced constantly inside the cells as a consequence of nutrient catabolism. The balance between ROS production and elimination allows to maintain cell redox homeostasis and biological functions, avoiding the occurrence of oxidative distress causing irreversible oxidative damages. A fundamental player in this fine balance is reduced glutathione (GSH), required for the scavenging of ROS as well as of the reactive 2-oxoaldehydes methylglyoxal (MGO). MGO is a cytotoxic compound formed constitutively as byproduct of nutrient catabolism, and in particular of glycolysis, detoxified in a GSH-dependent manner by the glyoxalase pathway consisting in glyoxalase I and glyoxalase II reactions. A physiological increase in ROS production (oxidative eustress, OxeS) is promptly signaled by the decrease of cellular GSH/GSSG ratio which can induce the reversible S-glutathionylation of key proteins aimed at restoring the redox balance. An increase in MGO level also occurs under oxidative stress (OxS) conditions probably due to several events among which the decrease in GSH level and/or the bottleneck of glycolysis caused by the reversible S-glutathionylation and inhibition of glyceraldehyde-3-phosphate dehydrogenase. In the present review, it is shown how MGO can play a role as a stress signaling molecule in response to OxeS, contributing to the coordination of cell metabolism with gene expression by the glycation of specific proteins. Moreover, it is highlighted how the products of MGO metabolism, S-D-lactoylglutathione (SLG) and D-lactate, which can be taken up and metabolized by mitochondria, could play important roles in cell response to OxS, contributing to cytosol-mitochondria crosstalk, cytosolic and mitochondrial GSH pools, energy production, and the restoration of the GSH/GSSG ratio. The role for SLG and glyoxalase II in the regulation of protein function through S-glutathionylation under OxS conditions is also discussed. Overall, the data reported here stress the need for further studies aimed at understanding what role the evolutionary-conserved MGO formation and metabolism can play in cell signaling and response to OxS conditions, the aberration of which may importantly contribute to the pathogenesis of diseases associated to elevated OxS.

Does Penrose's Law apply to Hungary? Data of an extended survey and reappraisal.

Penrose described an observation in 1939, according to which an inverse relationship between the size of prison populations and the number of psychiatric beds existed. The purpose of this article was to investigate the validity of this statement for Hungary. The national data between 1989 and 2017 for 25 variables were extracted from the official reports of the Hungarian Central Statistical Office. The number of psychiatric beds decreased by 33%, while the number of prisoners increased by about 50%. At the same time, the number of mentally ill patients under compulsive treatment was low, but showed a slight, statistically significant increase. Variables measuring similar feature, for example, the psychiatric characteristics (alcoholics registered, suicide rate, number of hospital beds, welfare home inmates) are variables consistently moving in one direction or the other that may allow finding appropriate indicators of and explanations for the phenomena. An example is the number of psychiatric beds showing a parallel decrease to the numbers of total hospital beds, registered alcoholics, out-patient clinics for children, and suicide rate, and just the opposite direction with forensic settling, involuntary admissions, and welfare home inmates. Similarly, crimes, criminals, homicides, and prisoners can also be grouped. Correlation does not mean a cause and effect relationship, therefore, at the current state of knowledge the connection among variables is not clear in all the cases. To sum up, Hungarian statistical data for three decades support Penrose's original observation on psychiatric beds and prison population, while the Penrose's statement on the inverse relationship between the number of crimes and of psychiatric beds is not supported. However, until deeper relationships are explored, aggregation of variables into few factors seems impossible.

[The abuse and dependence of chemical agents in an evolutionary approach/From adaptation to the phenomenon of "run-away" and beyond].

A recent paradigm shift in medicine resulted in the emergence of so-called evolutionary medicine, which studies the interactions between the environment and biological phenomena in a timeline to understand diseases and develop new treatments. In the course of evolutionary discussion of chemical substance abuse, the issue was approached through five steps. The biological level helps to understand the interference and coevolution of chemical agents and biochemical mechanisms, thus demonstrating the vulnerability toward chemical agents. The psychological level approaches behavior and its change, taking into account the consequences of the substance-induced false feelings. The social, cultural and civilization levels take into account the effects of the non-physical environment by discussing the interactions among individuals, the benefits of communication and group formation, and the subsequently emerging conflicts. The integration at individual level is implemented by the Zinberg three-pillar model, while for the integration at the level of population the phenomenon of run-away is recommended in the literature. The paper disputes the latter and suggests the concept of civilization disease to describe the phenomenon. To explain the epidemic of chemical substance abuse in our age, two additional, interrelated reasons are listed: the change in the relation to time and spirituality. And also, the question whether the appearance of epigenetics in medical thinking means the renaissance of degenerationism is raised in the article. The author has finally arrived at the conclusion that the reasons for the increase of chemical substance use in the postmodern era are basically the consequences of the strengthened psycho-social mismatch such as the rate of environmental change, changes in social control, social insecurity and anxiety, and the secularization of drug use. Therefore, the clue to solve the problem is the rethinking of the opportunities provided by the development of technology and the role of human being therein. With other words a further paradigm changing is needed.

[Examination of the mortality data of patients, treated by the "TÁMASZ" Addictological Out-patient Clinic in Józsefváros (in Budapest, Hungary), who deceased in 2001-2018]. / A józsefvárosi "TÁMASZ" Addiktológiai Gondozóban kezelt és 2001­2018-ban elhunyt betegek haláloki adatainak vizsgálata.

Introduction: The analysis of the mortality data of patients is important. Aim: Examination of data from patients treated in the Addictological Out-patient Clinic in Józsefváros and deceased between 2001 and 2018. Method: Patients' data originated from medical records. The national and Budapest data were from the publications of the Hungarian Central Statistical Office. Results: The age of patients was 52.85 ± 11.81 years for women and 51.99 ± 12.47 years for men. Two-thirds, regardless of gender, were alcoholic. There were many violent deaths. A new phenomenon was the high number of drug- and murder-associated deaths. The former group was dominated by men. The latter group showed female dominance. The completed suicide rate was 14.6%. Suicide attempts occurred in 22.4% of patients. The majority of patients were skilled workers. Conclusion: Data support the view that addict patients die earlier. Leading deaths, unlike previous investigations, were violent deaths. The rate of suicide was higher than the national rate, but it was the same as previously reported, indicating a high risk of this population. Gender differences were observed with regard to violent death, requiring further elucidation. Orv Hetil. 2019; 160(47): 1864-1871.

Synthesis and metabolism of methylglyoxal, S-D-lactoylglutathione and D-lactate in cancer and Alzheimer's disease. Exploring the crossroad of eternal youth and premature aging.

Both cancer and Alzheimer's disease (AD) are emerging as metabolic diseases in which aberrant/dysregulated glucose metabolism and bioenergetics occur, and play a key role in disease progression. Interestingly, an enhancement of glucose uptake, glycolysis and pentose phosphate pathway occurs in both cancer cells and amyloid-ß-resistant neurons in the early phase of AD. However, this metabolic shift has its adverse effects. One of them is the increase in methylglyoxal production, a physiological cytotoxic by-product of glucose catabolism. Methylglyoxal is mainly detoxified via cytosolic glyoxalase route comprising glyoxalase 1 and glyoxalase 2 with the production of S-D-lactoylglutathione and D-lactate as intermediate and end-product, respectively. Due to the existence of mitochondrial carriers and intramitochondrial glyoxalase 2 and D-lactate dehydrogenase, the transport and metabolism of both S-D-lactoylglutathione and D-lactate in mitochondria can contribute to methylglyoxal elimination, cellular antioxidant power and energy production. In this review, it is supposed that the different ability of cancer cells and AD neurons to metabolize methylglyoxal, S-D-lactoylglutathione and D-lactate scores cell fate, therefore being at the very crossroad of the "eternal youth" of cancer and the "premature death" of AD neurons. Understanding of these processes would help to elaborate novel metabolism-based therapies for cancer and AD treatment.

Penrose's law: Methodological challenges and call for data.

The investigation of the relationship between the sizes of the mental health population and the prison population, outlined in Penrose's Law, has received renewed interest in recent decades. The problems that arise in the course of the deinstitutionalization have repeatedly drawn attention to this issue. This article presents methodological challenges to the examination of Penrose's Law and retrospectively reviews historical data from empirical studies. A critical element of surveys is the sampling method; longitudinal studies seem appropriate here. The relationship between the numbers of psychiatric beds and the size of the prison population is inverse in most cases. However, a serious failure is that almost all of the data were collected in countries historically belonging to a Christian or Jewish cultural community. Only very limited conclusions can be drawn from these sparse and non-comprehensive data: a reduction in the number of psychiatric beds seems to be accompanied by increases in the numbers of involuntary admissions and forensic treatments and an accumulation of mentally ill persons in prisons. A kind of transinstitutionalization is currently ongoing. A pragmatic balance between academic epidemiological numbers and cultural narratives should be found in order to confirm or refute the validity of Penrose's Law. Unless comprehensive research is undertaken, it is impossible to draw any real conclusion.

[Addiction therapy. Limits, problems, perspectives]. / Addiktológiai gondozás. Keretek, problémák, távlatok.

In health care, tending is a process, which offers for the patients a continuous watching on, a control, a treatment, and the prevention of worsening of their medical status as well as the reduction of their complaints. In the article, some fundamental segments of tending in addictology are reviewed, particularly paying attention to whom, how, where and how long to take care. On the basis of literature, the author stresses whatever method is used to treat addict patients it is more beneficial to society than the avoidance of any intervention due to the negligence of the problem. Addictology has lost a lot from its power in Hungary. The author recommends the introduction of the methods of health quality assurance to decrease the effect of negative trends seen in addictology. The paper also deals with special patient groups including homeless clients, adolescents, elderly and pregnant patients as well as health care professionals. The author critically mentions the double communication of society, the dual-face character of politics and has the opinion that competences are not clear making the situation confused. As a mistake of the point of view is it regarded that the addictological problems are classified as to belonging to the authority of psychiatry. It is emphasized that multidisciplinary approach is needed to understand the problem and to treat the client. General screening for addictological diseases does not seem possible in the light of low capacity of the system, but the screening of adolescents and pregnant women is definitely recommended. And finally, a financial support for medicines to prevent craving, a moratorium for the continuous changing of rules and law, the sponsoring of harm reduction programs as well as a better utilization of opportunities offered by local drug coordinating boards are proposed.

Where does plasma methylglyoxal originate from?

The elevation of plasma methylglyoxal levels in diabetic humans is widely observed, but it is unknown to what extent different sources of methylglyoxal contribute to its plasma concentration. A retrospective analysis of clinical findings has been undertaken. There is controversy about the correlation of plasma methylglyoxal concentrations with fasting or postprandial glucose levels, and the relationship with HbA1c. There is only one study in which plasma ketone body levels have been monitored in parallel with methylglyoxal and a positive correlation between plasma methylglyoxal and ß-hydroxybutyrate was observed. There are no reports on plasma aminoacetone levels and methylglyoxal in diabetic humans. This paper suggests that although there is a close association between methylglyoxal and carbohydrate metabolism, the presence of this 1,2-dicarbonyl in the plasma is mainly due to other mechanisms. Protein glycation and aminoacetone degradation are proposed to be the major and the minor sources of plasma methylglyoxal under normal conditions.

[Investigation of the frequency of alcohol related problems in Józsefváros, Budapest. Data and conclusions of three surveys conducted among doctors and outpatients]. / Az alkoholprobléma gyakoriságának vizsgálata Józsefvárosban. Betegek és orvosok körében végzett felmérések eredményei.

UNLABELLED: The role of permanent alcohol consumption in the development of diseases is well-known. AIMS: To study the occurrence of alcohol related problems among patients of a municipal pulmonology out-patient clinic as well as in the family practice of three physicians. In addition, a survey was performed among physicians of a municipal health service and also among family practitioners working in the same district by investigating health problems, habits and professional careers of physicians, and their addictive problems, their attitude toward addict patients and their opinion upon chemical dependency. METHODS: CAGE-test was used to examine the presence of alcohol problem and a questionnaire was constructed for the study undertaken among physicians. RESULTS: The response rate was 60.18% and 32.98% among patients who visited the pulmonology out-patient clinic and their family physician, respectively. Among those who responded to the test, as many as 6.02% and 4.82% of the cases would need a further medical examination to make clear whether alcohol related health problem was present or not, whilst 9.77% and 11.67% of the patients proved to be alcohol dependent, respectively. The response rate in the survey among physicians was 41.28%. As stated, physicians not only screen the patients for alcohol and drug dependence, but also refer them to a specialist. The general experience seems to oppose this statement. The majority of health professionals considered chemical dependence as a chronic disease, whereas a kind of moral judgment of the problem was also seen, particularly among family physicians. If they had the opportunity to choose whom to treat: an alcoholic or a drug dependent patient, the majority of them would treat patients brought under the first category. The CAGE test revealed alcohol problem in three family physicians, but none in specialists. Nearly all physicians consumed coffee, but the majority of them were non-smokers. As the risk for committing suicide is higher among physicians than in the general population, physicians were interviewed in this regard, too. Three physicians in the sample reported an attempt of suicide, and eleven physicians had suicidal ideas in the past. Although the majority of physicians were satisfied with their physical and mental health, several of them had serious health problems or were treated for depression. At the same time, the majority of physicians were unsatisfied with their financial and professional respect, and had the opinion that a career is unlikely to depend on the professional knowledge. DISCUSSION: Although the relatively low rate of physicians answering the questions did not make it possible to reveal the interrelationships among different variables, the study was able to direct the attention to the risk existing among physicians to commit suicide or use chemical substances. A proposal is made to establish an effective, but discreet and easy way to acquire psychiatric-addictological support. To avoid mental health problems among professionals working in psychiatry, organization of groups headed by someone not belonging to the same institute would be much encouraged. Parallel to these, the requirements and the conditions of making a career have to be made clear. On the basis of these surveys, as well as literature data, a continuous test examination of alcohol problem is recommended in the practice of family physicians as well as in the out-patient clinic of such disciplines like pulmonology and gastroenterology.

Changes in the provision of institutionalized mental health care in post-communist countries.

BACKGROUND: General psychiatric and forensic psychiatric beds, supported housing and the prison population have been suggested as indicators of institutionalized mental health care. According to the Penrose hypothesis, decreasing psychiatric bed numbers may lead to increasing prison populations. The study aimed to assess indicators of institutionalized mental health care in post-communist countries during the two decades following the political change, and to explore whether the data are consistent with the Penrose hypothesis in that historical context. METHODOLOGY/PRINCIPAL FINDINGS: General psychiatric and forensic psychiatric bed numbers, supported housing capacities and the prison population rates were collected in Azerbaijan, Belarus, Croatia, Czech Republic, East Germany, Hungary, Kazakhstan, Latvia, Poland, Romania, Russia and Slovenia. Percentage change of indicators over the decades 1989-1999, 1999-2009 and the whole period of 1989-2009 and correlations between changes of different indicators were calculated. Between 1989 and 2009, the number of general psychiatric beds was reduced in all countries. The decrease ranged from -11% in Croatia to -51% in East Germany. In 2009, the bed numbers per 100,000 population ranged from 44.7 in Azerbaijan to 134.4 in Latvia. Forensic psychiatric bed numbers and supported housing capacities increased in most countries. From 1989-2009, trends in the prison population ranged from a decrease of -58% in East Germany to an increase of 43% in Belarus and Poland. Trends in different indicators of institutionalised care did not show statistically significant associations. CONCLUSIONS/SIGNIFICANCE: After the political changes in 1989, post-communist countries experienced a substantial reduction in general psychiatric hospital beds, which in some countries may have partly been compensated by an increase in supported housing capacities and more forensic psychiatric beds. Changes in the prison population are inconsistent. The findings do not support the Penrose hypothesis in that historical context as a general rule for most of the countries.

[3,4-methylene-dioxy-pyrovalerone (MDPV) epidemic?]. / 3,4-metilén-dioxi-pirovaleron- (MDPV-) epidémia?

Little is known about 3,4-methylene-dioxy-pyrovalerone (MDPV), a new designer drug that has become popular in Hungary in the last couple of months. At the same time, its consumption, as a consequence of its low street-price, rises so fast that the event can be considered an epidemic. This paper reviews the chemistry, biochemistry and metabolism of MDPV. Then, on the basis of a few international reports and the author's own clinical observations, it discusses MDPV intoxication and withdrawal. In the metabolism of MDPV, the most important catalyst is the CYP2C19 isoenzyme, but the CYP1A2 and the CYP2D6 isoenzymes also play a crucial role. The formed catechols are conjugated with either glucuronic acid or sulfate. It is important to note that MDPV is consumed either together or in a sequence with other illicit drugs of abuse. As far as it can be established, MDPV use increases the activity and vigilance, decreases appetite and claim to sleep, but it can also provoke cardiac sensations and disturbance of perception. In the course of coming down, withdrawal after MDPV use, bone and muscle pain, hypersomnia, disturbance of vision are experienced, but panic attack may also occur. The appearance of new designer drugs on the market draws attention to a need of paradigm changing in spiritual field. Unless it happens these negative trends likely will speed up.