Suicide using an electric drill - case report and literature review. / Samobójstwo z uzyciem wiertarki elektrycznej ­ opis przypadku i przeglad pismiennictwa.

The use of an electric drill to commit suicide is rare in forensic practice. The aim of the work is to present the first case of this kind from the Upper Silesia. The results of post-mortem examinations and the results of prosecutor's examination of case files containing medical documentation from the patient's treatment were analyzed. People with mental disorders and diseases may choose unusual methods of taking their own lives, such as using an electric drill. This may cause investigators a lot of doubt as to whether the event was really a suicide. In addition to full post-mortem diagnostics, it is particularly important in such cases to assess the medical history of the deceased, often with the participation of a psychiatrist as a consultant.

Lower percentages of natural killer cells in children with type 1 diabetes and their siblings.

INTRODUCTION: One of the most common children's endocrine and autoimmune diseases in the world is type 1 diabetes mellitus (T1DM). The incidence of type 1 diabetes is constantly increasing, and according to current estimates, the number of children with T1DM in the world has exceeded 542,000. There are 3 main components emphasized in the pathogenesis: genetic and environmental factors, and the patient's immune system. Many publications have confirmed the role of natural killer cells (NK) in the pathogenesis of type 1 diabetes and other autoimmune diseases. AIM: The aim of the study was to evaluate the population of NK cells and pancreatic ß cell autoantibodies in a group of children with T1DM and their healthy siblings in comparison with children from families with no history of autoimmune diseases. MATERIAL AND METHODS: The research included 76 children with T1DM, 101 children from the sibling group, and 30 children from the control group. Peripheral blood was analysed on a FACSCalibur flow cytometer (Becton Dickinson) to evaluate the NK cell population. The results were presented as the percentage of NK cells among lymphocytes. Statistical analysis was performed using STATIS-TICA 10 PL software. RESULTS: The mean percentage of NK cells in children with T1D (10.59 ±5.37) and in the sibling group (11.93 ±5.62) was statistically reduced in comparison to the control group (14.89 ±7.78) in sequence (Student's t -test: t = -3.24; df = 103; p = 0.002) (Stu-dent's t -test: t = -2.30; df = 128; p = 0.02). There was no statistically significant difference in the percentage of NK cells be-tween the group of children with T1DM and their siblings (Student's t -test: t = -1.59; df = 173; p = 0.11). In the group of sib-lings, the younger the child, the lower the reported percentage of NK cells. This relationship was statistically significant (test for the Pearson correlation coefficient t = 3.41; p = 0.0009; r = 0.33). In the group of children with type 1 diabetes, a similar relationship was not found. The concentration of anti-IA2 and anti-Znt8 antibodies was statistically significantly higher in the sibling group compared to the control group (anti-IA2 p = 0.0000001; anti-ZnT8 p = 0.00001), and the concentration of anti-GAD antibodies was comparable in both groups. In the group of children with type 1 diabetes, a positive correlation was demonstrated between the reduced percentage of NK cells and the coexistence of anti-GAD and anti-ZnT8 antibodies (Mann-Whitney U test Z = -2.02; p = 0.04). There was no similar relationship in the group of siblings. CONCLUSIONS: The reduced percentage of NK cells in children with T1DM and in their siblings compared to the control group suggests the role of NK cells in the pathogenesis of T1DM. Genetic predisposition and dysfunction of NK cells probably underlie the pathogenesis of T1DM.

Diabetic ketoacidosis incidence among children with new-onset type 1 diabetes in Poland and its association with COVID-19 outbreak-Two-year cross-sectional national observation by PolPeDiab Study Group.

BACKGROUND: There are several observations that the onset of coronavirus 19 (COVID-19) pandemic was associated with an increase in the incidence of diabetic ketoacidosis (DKA). However, due to heterogeneity in study designs and country-specific healthcare policies, more national-level evidence is needed to provide generalizable conclusions. OBJECTIVE: To compare the rate of DKA in Polish children diagnosed with type 1 diabetes (T1D) between the first year of COVID-19 pandemic (15 March 2020 to 15 March 2021) and the preceding year (15 March 2019 to 15 March 2020). METHODS: Reference centers in 13 regions (covering ~88% of Polish children) retrospectively reported all new-onset T1D cases in children from assessed periods, including DKA status at admission, administered procedures and outcomes. Secondly, we collected regions' demographic characteristics and the daily-reported number of COVID-19-related deaths in each region. RESULTS: We recorded 3062 cases of new-onset T1D (53.3% boys, mean age 9.5 ± 4.3 years old) of which 1347 (44%) had DKA. Comparing pre- and post-COVID-19 period, we observed a significant increase in the rate of DKA (37.5%-49.4%, p < .0001). The fraction of moderate (+5.4%) and severe (+3.4%) DKA cases increased significantly (p = .0089), and more episodes required assisted ventilation (+2.1%, p = .0337). Two episodes of DKA during 2020/2021 period were fatal. By region, change in DKA frequency correlated with initial COVID-19 death toll (March/April 2020) (R = .6, p = .0287) and change in T1D incidence (R = .7, p = .0080). CONCLUSIONS: The clinical picture of new-onset children T1D in Poland deteriorated over a 2-year period. The observed increase in the frequency of DKA and its severity were significantly associated with the overlapping timing of the COVID-19 epidemic.

A rare case of fatal poisoning during long-term therapy with lithium carbonate - chronic poisoning, suicide or psychiatric malpractice? / Rzadki przypadek smiertelnego zatrucia w trakcie dlugotrwalej terapii weglanem litu ­ samobójstwo, przewlekle zatrucie czy blad medyczny psychiatry?

The study aims to present a case of atypical poisoning with lithium carbonate in a 57-year-old woman treated for bipolar affective disorder with lithium carbonate for about 30 years. The patient was admitted to the hospital with significant agitation. An important finding obtained from the family interview was the patient's significant weight loss over the past year. In the hospital, the patient received haloperidol and clonazepam. Laboratory tests showed a very high blood lithium concentration of 3.79 mmol/l [N: 0.6─1.2 mmol/l] and elevated serum concentrations of creatinine (3.6 mg/dl) and urea (110 mg/dl). The patient was transferred to the toxicology department, where hemodialysis was performed and intensive treatment initiated. Despite the rapid decrease in lithium levels, her condition gradually deteriorated. The patient died on the fifth day of hospitalization. The autopsy revealed polycystic kidney disease (PKD). During the preparation of the medico-legal report on the correctness of the medical treatment, it was assumed that the cause of death was lithium carbonate poisoning in the course of advanced chronic kidney disease due to PKD, probably a consequence of long-term lithium therapy. The analysis of medical records revealed that despite her psychiatrist's recommendation, the patient had been refusing the monitoring of lithium levels for the past 18 years. This case demonstrates that both psychiatrists and toxicologists should be aware of possible lithium poisoning upon the deterioration of renal function. Therefore, assessment of renal function should be an integral part of monitoring lithium therapy.

Thyroid Cancer Risk Factors in Children with Thyroid Nodules: A One-Center Study.

Thyroid nodules are common in the adult population (13%), but in childhood, they are relatively rarely diagnosed (0.2-5%). The risk factors and diagnostic and therapeutic algorithms are well-known and effectively used in adults, but no clear procedures supported by scientific research are available in the pediatric population. Our aim in this study was to identify predictive factors for thyroid cancer in a pediatric population. We retrospectively analyzed 112 children (80 girls and 32 boys, aged 0.6-18 years, with an average group age of 13.4 ± 4.5 years) with thyroid nodules who presented or were referred between 2010 and 2021. A total of 37 children qualified for partial or total thyroidectomy. After histopathological nodule examination, the most common cases were benign lesions in 23 patients (57.5%) and malignant lesions in 14 children (32.5%). Solitary benign thyroid nodules were found in 16 children (40%). Malignancy risk was higher in children with increased nodule diameter (greater than 7 mm; p = 0.018) or hypoechogenic lesions in ultrasound (p = 0.010), with no correlation between increased blood flow in the vessels and tumor diagnosis. The relative risk of developing thyroid cancer for class III was found to be higher in comparison to adults and 11.1 times higher than for classes I and II combined.

Potential Therapeutic Application of Regulatory T Cells in Diabetes Mellitus Type 1.

The autoimmune reaction against the beta cells of the pancreatic islets in type 1 diabetes mellitus (T1DM) patients is active in prediabetes and during the development of the clinical manifestation of T1DM, but it decreases within a few years of the clinical manifestation of this disease. A key role in the pathogenesis of T1DM is played by regulatory T cell (Treg) deficiency or dysfunction. Immune interventions, such as potential therapeutic applications or the induction of the Treg-cell population in T1DM, will be important in the development of new types of treatment. The aim of this study was to evaluate innovative immune interventions as treatments for T1DM. After an evaluation of full-length papers from the PubMed database from 2010 to 2021, 20 trials were included for the final analysis. The analysis led to the following conclusions: Treg cells play an important role in the limitation of the development of T1DM, the activation or application of Tregs may be more effective in the early stages of T1DM development, and the therapeutic use of Treg cells in T1DM is promising but requires long-term observation in a large group of patients.

Attitudes of women after the age of 50 towards preventive screening.

INTRODUCTION: Prevention is one of the major branches of the health sector. The National Health Programme encompasses main risk factors, elimination of which may lead to a reduced incidence of illnesses in the society. At the same time, the criteria of selecting people eligible for preventive screening are established according to risk groups determined by sex, as well as age in the population of women. The perimenopausal and menopausal period contributes to occurrence of numerous systemic diseases and to an increased risk of illnesses, especially cancers. OBJECTIVE: The objective of the research was to evaluate the performance of preventive screening tests of women after 50 aimed at early detection of cervical and breast cancer. Furthermore, the research estimated frequency of pathological lesions detected and regularity of their monitoring. MATERIALS AND METHODS: The research covered 150 women after 50 years of age. The database was statistically examined with STATISTICA software. RESULTS: A low percentage of the respondents, in comparison to the risk increasing with age, had a Pap test (61.3%) and mammography (51.3%) in the last two years. In the case of women whose latest Pap test or mammography showed abnormalities and was the basis for diagnosing pathological lesions, 69.2% of them were under regular medical supervision if abnormalities were identified by a Pap test and 68.7% if lesions were detected in breast structure. CONCLUSIONS: In the examined group we observed a small percentage of women undergo Pap tests and mammography. Furthermore, medical recommendations regarding early detection of cancers are frequently ignored and disregarded by patients.

Aggression in the work environment of physiotherapists.

BACKGROUND: Aggression in the medical environment can take on different forms. It can be inflicted both by patients and workmates and may also cause a rise of aggressive behavior performed by the physiotherapists themselves. The aim of the study was to evaluate possible danger that may occur in the working environment of physiotherapists as well as to assess the correlation between such factors as the length of professional experience and exposure to the aggression inflicted by patients and workmates in the workplace with the level of aggression occurring within the professional group of physiotherapists. SUBJECTS AND METHODS: The study was conducted among 50 physiotherapists from Opole and the Silesian Voivodships in Poland. Two types of questionnaires were used: the author's own questionnaire, assessing exposure of the physiotherapists to aggression in the workplace, and the Buss-Perry Aggression Questionnaire. The results were analyzed with the Statistica 8.0 application. RESULTS: 60% of participants suffered from patients' verbal aggression, 8% from physical aggression and 26% from the patients' emotional self-aggression at least twice a month. The study showed a minor correlation between the duration of the length of professional experience and the level of hostility (r=0.2; p>0.05). There is a considerable impact of negative emotions present in relations with workmates at the workplace causing mainly increase of general aggression among physiotherapists and hostility. Similarly, negative emotions that may appear in relations between psychiatrists and patients show a positive correlation with the level of general aggression developed by doctors. CONCLUSIONS: It can be observed that there is a huge impact of the impulsive behaviour and attitude (presented both by patients and workmates in the workplaces) on the appearance of aggressive actions by physiotherapists (especially anger and hostility). Further research in this field is needed.

Reasons for the choice to specialize in psychiatry - a retrospective study.

BACKGROUND: Providing the mental health service is one of the main tasks of every state. Its implementation obviously depends on the number of professionally active psychiatrists. The aim of the study was to analyze the motives in the choice of the specialization in psychiatry from the perspective of physicians-practitioners. SUBJECTS AND METHODS: An original questionnaire, containing 22 questions, was implemented. The study group was created by recruiting 132 psychiatrists participating in the International Scientific-Training Conference in Wisla, Poland in 2011. The obtained results were analyzed statistically. RESULTS: The majority of the respondents decided to become psychiatrists during their university studies (43.61%) and just after their studies (37.59%). Only 9.02% knew before starting university, which field of medicine to select, and 8.27% were originally practitioners in a different medical specialization. The factors having the greatest influence on making the decision were: self-esteem (58.64%), practical classes in college and the experience of special types of work with a patient (the percentage for both factors was 33.83%). Prestige (3%) and media influence (3.76%) seem to be the least important factors. 81% of respondents admitted that it was their own independent decision. In the group of those who were influenced by others, the strongest source of advice was the opinion of a partner (4.51%), while the opinion of the family and a well-known specialist in the field turned out to be much less important (the percentage for both factors was 1.5%). 94.73% participants said that they would choose the same specialization once again. CONCLUSIONS: Public perception of psychiatry is still not satisfactory and may have little impact on the popularity of this specialization. The form of teaching at universities is important in the selection process of the specialization. The results of our questionnaire may be a helpful tool to improve the image of psychiatry as an attractive path of professional career, and become an essential argument during the discussion about current problems in psychiatry.

Different dimensions of aggression occurring in the work environment of psychiatrists.

BACKGROUND: The term "aggression" refers to forceful behavior, action, or attitude that is expressed physically, verbally, or symbolically. Aggression in the medical environment can have different forms. The interactions between psychiatrists and patients may be one of the reasons for the appearance of symptoms of aggression in the behaviour of the physicians. The main aim of the study was to evaluate different aspects of aggression among psychiatric professionals. SUBJECT AND METHODS: The study was conducted among 132 psychiatrists (97 women and 34 men) from all over Poland. The average age was 43.1±9.48, the average professional experience was 15.76±10.09 years. Authors' original questionnaire and Buss-Perry Aggression Questionnaire were used to evaluate different aspects of aggression. RESULTS: The study showed a correlation between the length of professional experience and the level of verbal aggression (p=0.022) as well as with the level of hostility (p<0.05) presented by psychiatrists. Negative emotions appear in relations with workmates and causes the increase of general aggression among psychiatrists. These negative emotions are also present in relations with patients. The exposure to verbal aggression inflicted by patients causes the increase of verbal aggression, anger and hostility among psychiatrists. CONCLUSIONS: Significant occurrence of general aggression among psychiatrists caused by difficult relations with co-workers and patients suggests the importance and necessity of providing appropriate support for this professional group in their work environment.