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Definition. Pelvic congestion syndrome (or more precisely - pelvic venous disorders) is a collective concept of diseases with different pathophysiology, with the main symptom chronic pain in the pelvis. It is most often caused by increase in the pressure, number and caliber of the intrapelvic venous structures. Usually, this syndrome is either neglected or not well known, leading to delays in diagnosis and treatment. Diagnostic approach. In addition to the typical clinical presentation, pelvic venous disorders are most often detected by color duplex sonography (transvaginal), but for the preparation of a therapeutic algorithm, computer tomography venography and, to a lesser extent, invasive venography play a key role. The tomographic study gives valuable information about the compression, the affected structures and their sizes. Among the additional tests, we should mention the dynamic renal scintigraphy with which we evaluate the renal function. Therapeutic algorithm. Pathophysiological mechanisms mainly involve reflux and/or obstruction. Finding the exact mechanism of venous system involvement in any of the four areas (renal, gonad/iliac, pelvic, or lower extremity) is critical to successful treatment. In certain cases, the treatment of reflux may not lead to the desired results and, on the contrary, may even harm. In cases of pure reflux to the gonadal veins, the main method of treatment is endovascular - embolization; in cases of compression also - venous stenting. Combined pathologies are a challenge, in which an individual approach and additional exams are essential for their correct treatment. Conclusion. Pelvic venous disorders are a real challenge to the vascular specialist. A good knowledge of venous anatomy and pathophysiology is a cornerstone in the adequate and thorough treatment of this pathology. [ABSTRACT FROM AUTHOR]

Mycotoxin binders, in combination with enzymes degrading some mycotoxins, contribute to feed detoxification. Their use reduces economic losses and the negative impacts of mycotoxins on animal health and productivity in farm animals. The aim of this study was to evaluate the efficacy of a mycotoxin detoxifier on the expression of the ATP-binding cassette efflux transporters ABCB1 mRNA and ABCC2 mRNA, which transport xenobiotics and thus have a barrier function, in the tissues of pigs exposed to low doses of deoxynivalenol (DON, 1 mg/kg feed) and zearalenone (ZEN, 0.4 mg/kg feed) for 37 days. The levels of expression were determined by an RT-PCR, and the effect of the mycotoxin detoxifier (Mycofix Plus3.E) was evaluated by a comparison of results between healthy pigs ( n = 6), animals treated with DON and ZEN ( n = 6), and a group that received both mycotoxins and the detoxifier ( n = 6). A significant downregulation of ABCB1 mRNA and ABCC2 mRNA was observed in the jejunum ( p < 0.05). A tendencies toward the downregulation of ABCB1 mRNA and ABCC2 mRNA were found in the ileum and duodenum, respectively. The mycotoxin detoxifier restored the expression of ABCB1 mRNA to the level found in healthy animals but did not restore that of ABCC2 mRNA to the level of healthy animals in the jejunum.

Background: Kratom ( Mitragyna speciosa ) use in the United States is becoming increasingly popular and its legal status varies widely from state to state. Multiple reports of adverse events associated with kratom use have ranged from liver injury, seizures, psychiatric disturbance, and rarely death., Methods: This study investigated coroner autopsy reports from Kern County in California for the year 2020 which included qualitative data on substances from blood toxicological reports. Of the 214 opioid-associated accidental overdoses reported, 4 subjects (1.9%) had mitragynine (kratom) exposure on the autopsy report and were included in the study. We reported available demographic information and comorbid substance findings from the associated autopsy reports., Results: All 4 individuals with mitragynine (kratom) toxicology had accidental opioid overdose deaths noted in autopsy reports. Each subject also had toxicology positive for at least one other substance. Fentanyl was found in 3 (75%) of the cases and suspected to be the primary contributor to opioid-related deaths in those cases. However, one fatality was without fentanyl, but instead had tested positive for benzodiazepines, cannabis, and other psychiatric medications., Discussion: The findings of this brief report provide insight into the role that mitragynine (kratom) may have in modulating risk of opioid-related deaths. The combined use of kratom with opioids such as fentanyl appears most likely to increase the risk of a fatal overdose, but it may also occur with other medications such as benzodiazepines and psychiatric medications. It is a serious concern that in the midst of the opioid overdose epidemic there is a growing presence of kratom use in the U.S. population with a largely unregulated status., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Torrico, Patel, Nikolov, Salam, Padhy and Weinstein.)