Polish standard of treatment with racemic ketamine for patients with depressive disorders developed by a Working Group appointed by the National Consultant in the field of psychiatry. / Polski standard leczenia racemiczna ketamina pacjentów z zaburzeniami depresyjnymi opracowany przez zespól roboczy powolany przez Konsultanta Krajowegow dziedzinie psychiatrii.

The Polish standard of treatment with racemic ketamine for patients with depressive disorders was developed by a Working Group appointed by the National Consultant in the field of psychiatry. Despite the wide range of available medications, as many as one-third of depressed patients do not respond to standard antidepressant treatment, raising the need for an ongoing search for new effective and safe therapies. In recent years, the possible role of overactivity of the glutamatergic system in the etiopathogenesis of depression has again attracted the attention of many experts. The possibility of using substances with a modulating effect on the glutamatergic system in the treatment of depressive disorders has been postulated, among others, the long-known anesthetic ketamine, which is a noncompetitive NMDA receptor antagonist. This paper summarizes the results of studies on the efficacy and safety of racemic ketamine (administered intravenously) in the treatment of patients with depressive symptoms in the course of both unipolar and bipolar affective disorder, and, meeting the expectations of many practicing psychiatrists wishing to broaden the range of therapies offered to their patients, presents recommendations on indications, contraindications, precautions and the treatment regimen itself with intravenous ketamine for patients with mood disorders.

Treatment of the Fluoroquinolone-Associated Disability: The Pathobiochemical Implications.

Long-term fluoroquinolone-associated disability (FQAD) after fluoroquinolone (FQ) antibiotic therapy appears in recent years as a significant medical and social problem, because patients suffer for many years after prescribed antimicrobial FQ treatment from tiredness, concentration problems, neuropathies, tendinopathies, and other symptoms. The knowledge about the molecular activity of FQs in the cells remains unclear in many details. The effective treatment of this chronic state remains difficult and not effective. The current paper reviews the pathobiochemical properties of FQs, hints the directions for further research, and reviews the research concerning the proposed treatment of patients. Based on the analysis of literature, the main directions of possible effective treatment of FQAD are proposed: (a) reduction of the oxidative stress, (b) restoring reduced mitochondrion potential ΔΨm,

Key Roles of Glutamine Pathways in Reprogramming the Cancer Metabolism.

Glutamine (GLN) is commonly known as an important metabolite used for the growth of cancer cells but the effects of its intake in cancer patients are still not clear. However, GLN is the main substrate for DNA and fatty acid synthesis. On the other hand, it reduces the oxidative stress by glutathione synthesis stimulation, stops the process of cancer cachexia, and nourishes the immunological system and the intestine epithelium, as well. The current paper deals with possible positive effects of GLN supplementation and conditions that should be fulfilled to obtain these effects. The analysis of GLN metabolism suggests that the separation of GLN and carbohydrates in the diet can minimize simultaneous supply of ATP (from glucose) and NADPH2 (from glutamine) to cancer cells. It should support to a larger extent the organism to fight against the cancer rather than the cancer cells. GLN cannot be considered the effective source of ATP for cancers with the impaired oxidative phosphorylation and pyruvate dehydrogenase inhibition. GLN intake restores decreased levels of glutathione in the case of chemotherapy and radiotherapy; thus, it facilitates regeneration processes of the intestine epithelium and immunological system.

The toxic impact of local anaesthetics in menopausal women: causes, prevention and treatment after local anaesthetic overdose. Local anaesthetic systemic toxicity syndrome.

Gynaecologists often use local anaesthetics in their medical practice. Some concomitant diseases during the menopausal period may cause problems during the qualification of postmenopausal women for general anaesthesia in gynaecological surgery. Many authors suggest the application of local analgesia for particular kinds of gynaecological surgery procedures performed on postmenopausal women, taking into consideration health determinants. While applying local anaesthetics, the possibility of their overdose has to be taken into account. Generalised toxic symptoms which appeared after the local anaesthesia are rare, but potentially are lethal complications. Toxic symptoms after local anaesthetic administration are manifested after accidental administration of a medicine into a blood vessel, when extravascular administration of a large volume of a local anaesthetic is absorbed into a bloodstream or with the reproducible doses of local anaesthetics which are administered when metabolism does not work sufficiently and cannot eliminate these substances. Clinical overdose of local anaesthetics is manifested by disorders in two systems. Firstly, the pathological symptoms come from the central nervous system (CNS). In the second phase, the pathological symptoms will additionally appear in the cardiovascular system. The aim of the present thesis is to remind clinical manifestations of the local anaesthetic overdose and suggest the management of patients with the aforementioned symptoms, especially in the case of intravenous lipid emulsions which have the status of an antidote in life-threatening conditions caused by cardiotoxic effects of local anaesthetics.