Pharmaceutical Household Waste Practices: Preliminary Findings from a Case Study in Poland.

Pharmaceutical consumption continues to grow constantly. Unused/expired pharmaceuticals are disposed of to the municipal sewage system or waste disposal. Consequently, many countries have implemented a system of collecting pharmaceutical waste, with pharmacies playing an important role. It is important to educate consumers on rational consumption and the appropriate disposal of unused/expired pharmaceuticals and to identify the level of public awareness. Two studies were conducted in Poland to estimate the problem of collection and disposal of expired/unused pharmaceuticals. The purpose of the Survey I was to identify the scale of pharmaceutical consumption and the way pharmaceuticals are disposed of by various social groups. The Survey II was aimed to identify patients' attitudes regarding expired/unused pharmaceuticals at home. Of the respondents who participated in in Survey I, almost 74% indicated that analgesics were among the over-the-counter drugs they purchased. Group of pharmaceuticals 65% of the respondents purchased were medicines for treating flu symptoms. Almost 68% of the respondents said they usually disposed of expired pharmaceuticals in their household waste or by flushing them down the toilet. In Survey II more than 35% reported that they disposed of pharmaceuticals in the same ways. Of all respondents, ~30% returned their expired pharmaceuticals to pharmacies. Most respondents (over 65%) who participated Survey I indicated that they were aware that pharmaceutical waste can be returned to pharmacies. It should be noted that local governments are currently not obliged by law to work with or compensate pharmacies in the collection and proper disposal of unused pharmaceuticals.

[Antibiotics in primary care]. / Antybiotyki w podstawowej opiece zdrowotnej.

Discovered in the forties of the twentieth century antimicrobial agents have changed the world. Currently, due to their overuse, we are threatened by the increasing resistance of bacteria to antibiotics, and soon we may face a threat of inability to fight these pathogens. For that reason, the world, European and national organizations introduce antibiotics protection programs. In Poland since 2004, the National Program of Protection of Antibiotics is being held. The concept of rational antibiotic therapy is associated not only with the appropriate choice of therapy or antimicrobial dosage but also with a reduction in costs associated with a refund of medicines. Antibiotics are prescribed mostly by primary care physicians (GP), and about one fifth of visits to family doctor's office ends with prescribing antimicrobial drug. These trends are probably related to both the difficulty in applying the differential diagnosis of viral and bacterial infection in a primary care doctor's office, as well as patient's conviction about the effectiveness of antibiotic therapy in viral infections. However, although patients often want to influence the therapeutic decisions and ask their doctor for prescribing antimicrobial drug, the right conversation with a doctor alone is the critical component in satisfaction with medical care. Many countries have established standards to clarify the indications for use of antibiotics and thereby reduce their consumption. The next step is to monitor the prescribing and use of these drugs and to assess the rise of drug resistance in the area. In Poland, the recommendations regarding outpatient respiratory tract infections treatment were published and usage of antimicrobial agents monitoring has begun. However, lack of publications covering a broad analysis of antibiotic therapy and drug resistance on Polish territory is still a problem. Modem medicine has yet another tool in the fight against bacteria--they are bacteriophages. Phage therapy is unfortunately still an experimental therapy and its use has many limitations. To preserve antibiotics healing abilities, we must follow the rules of rational antibiotic therapy, and primary health care is a place where the physician can significantly contribute to deterioration or protection of antibiotics.

[Neuroradiologic imaging results suggestive of parasitic cysts in central nervous system in course of neoplastic disorders--cases report]. / Obraz neuroradiologiczny imitujacy torbiele pasozytnicze osrodkowego ukladu nerwowego w przebiegu chorób nowotworowych--opisy przypadków.

Cystic changes within CNS, revealed by computed tomography or magnetic resonance imaging, pose difficult diagnostic and therapeutic problem. We present two patients with primary diagnosis of parasitic cysts of CNS, in whom neoplastic etiology was finally confirmed. Differential diagnosis of cystic foci should from the beginning include not only parasitic infections, but also neoplastic diseases, which are much more frequent in Poland at present and in which prolonged diagnostic process and delayed treatment is highly unfavorable.

[Blood-brain barrier--function of Mato cells]. / Bariera krew-plyn mózgowo-rdzeniowy--szczególna rola komórek Mato.

Brain because of its functions, is isolated from either external or internal environment. This function is performed by skull, cerebral meninges, cerebrospinal fluid and unique system of mechanisms and barriers restricting exchange of oxygen, soluble substances between blood, nervous tissue and cerebrospinal fluid. Mato cells, located in Virchow-Robin's space play a key role in blood-brain barrier. Mato cells are rich in hydrolytic enzymes. They act as phagocytes in blood-brain barrier by scavenger receptors, which take part in eliminating excess of unfavorable substances from environment. Ageing, hypercholesterolemia and vitamin E deficiency can cause degeneration of perivascular cells and limit their protective function. Mato cells probably are responsible for pathogenesis of various diseases, f.e. Alzheimer disease, diabetic rethinopathy, encephalitis.

[Hereditary angioedema--pathophysiology, genetics, symptoms]. / Dziedziczny obrzek naczynioruchowy--patofizjologia, genetyka, objawy kliniczne.

Hereditary angioedema (HAE) is a rare but important disease because of the occurrence of life-threatening symptoms during attacks as well as due to diagnostic and therapeutic problems. Deficiency or absence of plasma protein--C1 esterase inhibitor is autosomal dominant condition and is connected with uncontrolled complement and contact systems activation which leads to the generation of vasoactive mediators, most likely bradykinin. The main syndromes are recurrent attacks of localized swelling of submucosal and subcutaneous tissue, or both. In consequence skin and visceral organs may be involved by the typically massive local edema without pruritus. Authors discuss epidemiology, pathophysiology, genetics and classification of angioedema also with regard to its triggers and localization. This paper also reviews clinical symptoms diversity, diagnostic methods and type differentiation for HAE.

[Hereditary angioedema--treatment]. / Dziedziczny obrzek naczynioruchowy--leczenie.

Hereditary angioedema (HAE) is an autosomal-dominant condition, characterized by episodic recurrent attacks of angioedema, which can be occasionally life-threatening. Therapy for HAE consists of three points: treatment of acute attacks and both short- and long-term prophylaxis. Authors describe the methods which should be performed during the attacks of angioedema and drugs for those situations. Besides we describe the main rules of prophylaxis including potentially triggering events. Finally authors present future therapeutic options including new drugs being in clinical trial at present. In the near future, such drugs will be available to provide more effective treatment for HAE attacks with fewer adverse effects than the currently available treatment options.

[Concentrations of soluble forms of adhesive particles: sVCAM-1, sPECAM-1, sVAP in early localized and late disseminated borreliosis]. / Stezenie rozpuszczalnych form czasteczek adhezyjnych sVCAM-1, sPECAM-1, sVAP w boreliozie, w postaci wczesnej zlokalizowanej i rozsianej.

OBJECTIVE: Serum concentration of sVCAM-1, sPECAM- i sVAP in Lyme borreliosis patients with early localized-erythema migrans (EM) and disseminated Lyme arthritis (LA), before and after treatment were estimated. MATERIAL AND METHODS: Twenty subjects with EM, and 20 persons with LA were enrolled to examinations. Control group consisted of 10 healthy blood donors. Concentrations of sVCAM-1, sPECAM- and sVAP were performed with ELISA kits (Bender Med. System) Statistic analysis were performer with ANSTAT i Statistica PI, programs as well ROC curves. RESULTS: In group of early localized Lyme borreliosis essentially increase of serum concentrations of sVCAM and sPECAM were stated, in late, disseminated (LA), essentially increase of sVAP concentration was stated. CONCLUSION: Measurement of serum concentrations of soluble forms some adhesion molecules In liquid compartments can be a potential marker of disease activity, and differentiation among Early localized and late disseminated stages of Lyme borreliosis.