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Abstract Multiple sclerosis (MS) is a chronic, demyelinating disease of the central nervous system that affects mainly young people. It is believed that the autoimmune process observed in the pathogenesis of MS is influenced by a complex interaction between genetic and environmental factors, including infectious agents. The results of this study suggest the protective role of Toxoplasma gondii infections in MS. Interestingly, high Toxoplasma IgM seropositivity in MS patients receiving immunomodulatory drugs (IMDs) was identified. On the other hand, Borrelia infections seem to be positively associated with MS. Although the interpretation of our results is limited by the retrospective nature of the studies, the results strongly indicate that further experimental and clinical studies are needed to explain the role of infectious agents in the development and pathophysiological mechanisms of MS.

Abstract Dermacentor reticulatus ticks are sporadically removed from human skin and therefore the medical consequences of their feeding are neglected compared to Ixodes ricinus. We investigated the prevalence of pathogens in D. reticulatus removed from human skin and possible clinical manifestations suggestive of tick-borne diseases after a tick bite. A total of 2153 ticks were studied and of these only 34 were D. reticulatus. The mean prevalence of Rickettsia in D. reticulatus was 50.0% and R. raoultii was identified in 82.4% of infected D. reticulatus ticks. We confirmed the first case of R. aeschlimannii infection in D. reticulatus ticks. Among participants bitten by D. reticulatus, 13.3% reported reddening around the tick bite site and flu-like symptoms, including lymphadenopathy and 3.3% reported eschar on the tick site bite. All of the participants with flu-like symptoms after tick removal were bitten by ticks infected with R. raoultii. The results of this study indicate that even though D. reticulatus ticks bite humans sporadically, pathogenic Rickettsia have a remarkably high prevalence in this tick species. We can expect that the incidence of tick-borne lymphadenopathy might increase with the reported expansion of the D. reticulatus into new areas and its growing abundance in Central Europe.

Patients with Lyme neuroborreliosis (LNB) are rarely tested for the presence of neurovirulent viruses other than tick-borne encephalitis virus (TBEV); however, such coinfections could be of clinical importance. The aim of the study was to search for the presence of neurotropic viruses in a LNB patients.Fourteen patients admitted with signs and symptoms of neuroinfection who were eventually diagnosed to have LNB (according to the guidelines of the European Federation of Neurological Societies) were subjects of the study. Sera and cerebrospinal fluid (CSF) collected at the time of initial presentation were tested for viral pathogens most common in our geographical area: human enteroviruses (EV), herpes simplex virus type 1 and 2, varicella-zoster virus, Epstein-Barr virus, cytomegalovirus, human herpesvirus type 6, human adenoviruses, and TBEV using PCR/RT-PCR and serological assays. RNA and DNA-based metagenomic next-generation sequencing (mNGS) was used to detect other viral pathogens.EV was detected in CSF from two (14 %) LNB patients and viral loads were similar (220 and 270 copies/ml). The mMGS analysis were performed on CSFs from 10 patients and generated a total 213,750,885 NGS reads, 0.05 % of which were viral. However, none of potential pathogens fulfilled the criteria for positive viral detection by mNGS.Using a number of PCR/RT-PCR assays and mNGS we identified EV infection in two out of 14 LNB patients. The possible co-occurrence of enterovirus and Lyme neuroborreliosis infections may warrant further research.

Abstract Background Lyme borreliosis (LB) is the most common vector-borne disease in Europe. Monitoring changes in the prevalence of different Borrelia species in ticks may be an important indicator of risk assessment and of differences in pathogenicity in humans. The objective of our study was to assess the prevalence, co-infection and distribution of Borrelia and Babesia species in ticks removed from humans in a large sample collected during a study period of 4 years. Methods The ticks were collected throughout Poland from March to November over 4-year period from 2016 to 2019. All ticks (n = 1953) were morphologically identified in terms of species and developmental stage. Molecular screening for Borrelia and Babesia by amplification of the flagellin gene (flaB) or 18S rRNA marker was performed. Pathogen identity was confirmed by Sanger sequencing or PCR–restriction fragment length polymorphism analysis. Results The ticks removed from humans in Poland during this study belonged to two species: Ixodes ricinus (97%) and Dermacentor reticulatus (3%). High Borrelia prevalence (25.3%), including B. miyamotoi (8.4%), was confirmed in Ixodes ricinus ticks removed from humans, as was the change in frequency of occurrence of Borrelia species during the 4-year study. Despite Babesia prevalence being relatively low (1.3%), the majority of tested isolates are considered to be pathogenic to humans. Babesia infection was observed more frequently among Borrelia-positive ticks (2.7%) than among ticks uninfected with Borrelia (0.8%). The most frequent dual co-infections were between Borrelia afzelii and Babesia microti. The presence of Borrelia was also confirmed in D. reticulatus (12.7%); however the role of these ticks in spirochete transmission to susceptible hosts is still unclear. Conclusions Although the overall risk of developing LB after a tick bite is low in Europe, knowledge of the prevalence and distribution of Borrelia and Babesia species in ticks might be an important indicator of the risk of both these tick-borne diseases. Graphical abstract

Introduction: The BNT162b2 vaccination studies did not specifically focus on groups that were heavily exposed to SARS-CoV-2 infection. Therefore, we aimed to assess the safety and efficacy of the BNT162b2 vaccine among healthcare workers (HCWs). Methods: Study participants were recruited from hospital employees who received BNT162b2 vaccination at the Hospital for Infectious Diseases in Warsaw. Blood samples were collected before and after each vaccination dose. At each timepoint, the levels of anti-SARS CoV-2 IgM, anti-n SARS-CoV-2 IgG, and S-RBD antibodies were measured. Data on concomitant diseases and the vaccine’s adverse events (VAE) were collected after each vaccination dose. In the statistical analyses, non-parametric tests were used. Results: In total, 170 healthcare workers were included in the analysis. Their median age was 51 years (interquartile range (IQR): 41–60 years); most of them were women (n = 137, 80.6%) working in direct contact with patients (n = 137, 73.2%); and 46 (27.0%) had concomitant diseases. More than one fifth of subjects had COVID-19 before their first dose of vaccination (n = 38, 22.6%). In terms of immunological responses, our investigations showed a high level of efficacy for the BNT162b2 mRNA vaccination as measured by S-RBD antibody concentrations: these were positive in 100% of participants 14 days after the second dose of the vaccine. It was also observed that employees with high S-RBD antibodies (>=433 BAU/mL) were more likely to be COVID-19 convalescents before receiving the first vaccine dose (p < 0.001). Conclusion: The BNT162b2 vaccine is safe and effective among HCWs. Vaccine adverse events occurred, but serious events were not observed. Moreover, the BNT162b2 vaccine is effective against symptomatic and severe COVID-19—none of the workers that acquired a SARS-CoV-2 infection after vaccination required hospitalization or medical care. We also observed higher immunological responses among COVID-19 convalescents.

Neuroacanthocytosis – phenotypically and genetically heterogeneous disorders associated with acanthocytosis – are a group of abnormalities which affect the basal ganglion, causing movement disorders, other neurological symptoms and also cognitive and neuropsychiatric impairments. There are few reports on neuropsychiatric and neuropsychological symptom development in the course of the disease. We described a 33-year-old female patient, who was diagnosed with choreaacanthocytosis associated with neurological, psychiatric and neuropsychological disorders. The neurological disorders included increasing involuntary movements of face and tongue, upper limb chorea, dysarthric speech, slight upper limb deep reflexes, vivid knee jerks, tonic-clonic seizures and absence of Achilles reflexes. Psychiatrically, she was depressed and presented with obsessive thinking. Neuropsychological assessment revealed increasing dysfunctions of attention, immediate memory, learning, verbal fluency, praxia, calculia and difficulties in adjusting behaviour to environmental conditions and in flexible correction of wrong responses. Neuropsychiatric and neuropsychological dysfunctions should be considered in the differential diagnosis to ensure proper diagnosis and management, especially when differentiating disorders in patients with neuropsychiatric symptoms, chorea, or in the case of late (in adulthood) onset of Tourette’s syndrome.

Background: Despite the extensive research performed on prediction of psychosis from a Clinical High Risk for Psychosis state (CHR-P), the positive predictive value of the CHR-P designation remains unsatisfactory and further models including additional clinical and biological variables are required. Existing studies indicate that schizotypy assessed at baseline in “at-risk” individuals may be considered a predictor of transition from CHR-P to psychosis. This approach, however, is burdened with bias resulting from a possible overlap between current psychopathology and schizotypal features. No studies so far have assessed schizotypy in CHR-P from a developmental perspective. Aim: The aim of the study was to identify associations between a long-standing, parent-reported premorbid level of schizoid-schizotypal traits and the probability of psychotic transition in individuals with CHR-P. Methods: The mothers of 107 individuals diagnosed as presenting CHR-P with the use of Comprehensive Assessment of At Risk Mental States12/2006 were interviewed with the Scale for the Assessment of Premorbid Schizoid-Schizotypal Traits (PSST). Results: A high level of enduring schizotypy was found to be significantly associated with psychotic transition from CHR-P (HR: 1.78, 95% CI: 1.40–2.27, p

Introduction: Healthcare workers in Poland received a booster dose of the BNT162b2 mRNA vaccine (Pfizer-BioNTech, Manufacturer: Pfizer, Inc., and BioNTech; Moguncja, Germany) at the beginning of October 2021. Here, we report on the preliminary results of an ongoing clinical study into the antibody response to SARS-CoV-2 of healthcare workers previously exposed to the virus, with or without evidence of past infection, in the Hospital for Infectious Diseases in Warsaw before and after the vaccine booster dose. Methods: Blood samples were collected on the day the vaccine booster dose was administered and again 14 days later. The levels of SARS-CoV-2 IgG antibodies (against the n-protein, indicative of disease) and S-RBD (indicative of a response to vaccination) were measured. Results: One hundred and ten health care workers from the Hospital for Infectious Diseases were included in the study. The percentage of subjects with a positive test for anti-n-protein IgG antibodies at both time points remained unchanged (16, 14%), while a statistically significant increase in the percentage of subjects producing high levels of S-RBD antibodies (i.e., >433 BAU/mL) was observed (from 23, 21% to 109, 99%; p = 0.00001). Conclusions: The results of the study indicate that the booster dose of the vaccine significantly increases the percentage of people with high levels of S-RBD antibodies, regardless of previous contact with the virus, which may indicate greater protection against both the disease and a severe course of COVID-19.

Multiple sclerosis (MS) is a chronic, immune-mediated demyelinating disease of the central nervous system of unclear etiology, but there is some evidence that viral infections could be responsible for triggering autoimmune mechanisms against myelin. We searched for viral RNA and DNA in cerebrospinal fluid (CSF) of 34 MS patients and 13 controls using RT-PCR/PCR against common neurotropic viruses. In addition, shotgun DNA- and RNA-based metagenomics were done in 13 MS patients and 4 controls. Specific quantitative real-time RT-PCR/PCR testing revealed the presence of viral nucleic acid in seven (20.59%) MS patients and in one (7.69%) control patient. In MS patients the most frequently detected was human herpesvirus type 6 (HHV-6; 3 cases; 8.82%); followed by Epstein-Barr virus (EBV; 2 cases; 5.88%), varicella zoster virus (VZV; 1 case; 2.94%) and Enterovirus (EV; 1 case; 2.94%). The single identified virus among controls was EBV (7.69%). DNA and RNA metagenomic assays did not identify any known eukaryotic viruses even though three of the analyzed samples were low-level positive by specific quantitative real-time PCR. In conclusion, we detected the presence of Herpesviridae and occasionally Enteroviridae in CSF from patients with MS but their prevalence was not significantly higher than among controls. Metagenomic analysis seems to be less sensitive than real-time RT-PCR/PCR and it did not detect any potential viral pathogens.

Human pegivirus (HPgV), previously called hepatitis G virus or GB virus C, is a lymphotropic virus with undefined pathology. Because many viruses from the family Flaviviridae, to which HPgV belongs, are neurotropic, we studied whether HPgV could infect the central nervous system. We tested serum and cerebrospinal fluid samples from 96 patients with a diagnosis of encephalitis for a variety of pathogens by molecular methods and serology; we also tested for autoantibodies against neuronal antigens. We found HPgV in serum and cerebrospinal fluid from 3 patients who had encephalitis of unclear origin; that is, all the markers that had been tested were negative. Single-strand confirmation polymorphism and next-generation sequencing analysis revealed differences between the serum and cerebrospinal fluid–derived viral sequences, which is compatible with the presence of a separate HPgV compartment in the central nervous system. It is unclear whether HPgV was directly responsible for encephalitis in these patients.

Abstract Background The studies on the occurrence and diversity of tick-borne infections in HIV-infected individuals have been few, and the subject has been relatively neglected when compared with other common infections associated with HIV. In HIV-positive patients in whom a serological diagnostics is complicated due to reduced positive predictive value, a method where the microorganism is detected directly is of great value. Therefore, we performed a molecular study to ascertain the prevalence and incidence of tick-borne infections in HIV-infected persons in Poland, an endemic area for Ixodes ricinus ticks. Methods Genomic DNA was isolated from whole blood of tested patients. Detection of tick-borne pathogens was performed by amplification and sequencing of different loci. Molecular and phylogenetic analyses of obtained nucleotide sequences were performed. Serum samples were analyzed for antibodies against tick-borne pathogens by using commercial tests in all patients. Results Among 148 studied blood samples from HIV-infected patients, two cases (1.4%) of infection with tick-borne pathogen were reported. No symptoms of tick-borne infection were observed in these cases. In one case a patient was infected with Anaplasma phagocytophilum – the agent of human granulocytic anaplasmosis (HGA) and in the other with Borrelia garinii. Conclusions Our study revealed the first case of HIV positive patient infected with A. phagocytophilum. Asymptomatic tick-borne infection can occur in HIV-positive patients. The detailed history of tick bites, especially in endemic tick areas, should be considered as part of anamnesis in routine clinical care of HIV-positive patients.

Deficyt w obszarze funkcjonowania poznawczego jest stałym fenomenem opisywanym w populacji osób z rozpoznaniem schizofrenii – w okresie przedchorobowym, w trakcie pogorszeń, jak również między kolejnymi epizodami. Zaburzenie funkcjonowania poznawczego stanowi niezależny czynnik rokowniczy w schizofrenii. Badania wskazują, że właśnie od tego wymiaru patologii zależą takie wykładniki funkcjonowania pacjentów, jak: wyniki leczenia i rehabilitacji, współpraca w leczeniu, funkcjonowanie zawodowe, rodzinne i społeczne, zdolność do samodzielnej egzystencji oraz jakość życia. Dotychczasowe metody leczenia schizofrenii nie zapewniają wystarczającej poprawy w zakresie tego wymiaru choroby. W okresie ostatnich 25 lat testowano użyteczność wielonienasyconych kwasów tłuszczowych omega-3 jako monoterapii oraz jako augmentacji leczenia przeciwpsychotycznego w schizofrenii. Uzyskane wyniki są niejednoznaczne, choć podkreśla się tzw. pozytywny trend uzyskiwanych wyników w zakresie poprawy objawowej. Stosunkowo rzadko oceniano wpływ suplementacji preparatami wielonienasyconych kwasów tłuszczowych omega-3 na funkcjonowanie poznawcze osób z rozpoznaniem schizofrenii. Korzystny wpływ suplementacji wielonienasyconymi kwasami tłuszczowymi na funkcjonowanie poznawcze ma uzasadnienie teoretyczne. Wśród znanych działań tych substancji mogących wpływać na usprawnienie funkcji poznawczych należy wymienić: działanie immunomodulacyjne w obrębie ośrodkowego układu nerwowego, poprawę parametrów stresu oksydacyjnego, zmiany w zakresie neurotransmisji oraz wpływ na procesy plastyczności neuronalnej. Celem niniejszej pracy jest przedstawienie systematycznego przeglądu wyników badań dotyczących zmian sprawności funkcjonowania poznawczego u osób z rozpoznaniem schizofrenii będących w trakcie suplementacji wielonienasyconymi kwasami tłuszczowymi omega-3.

Molecular characterization of early hepatitis C virus (HCV) infection remains rare. Ten out of 78 patients of a hematology/oncology center were found to be HCV RNA positive two to four months after hospitalization. Only two of the ten patients were anti-HCV positive. HCV hypervariable region 1 (HVR1) was amplified in seven patients (including one anti-HCV positive) and analyzed by next generation sequencing (NGS). Genetic variants were reconstructed by Shorah and an empirically established 0.5% variant frequency cut-off was implemented. These sequences were compared by phylogenetic and diversity analyses. Ten unrelated blood donors with newly acquired HCV infection detected at the time of donation (HCV RNA positive and anti-HCV negative) served as controls. One to seven HVR1 variants were found in each patient. Sequences intermixed phylogenetically with no evidence of clustering in individual patients. These sequences were more similar to each other (similarity 95.4% to 100.0%) than to those of controls (similarity 64.8% to 82.6%). An identical predominant variant was present in four patients, whereas other closely related variants dominated in the remaining three patients. In five patients the HCV population was limited to a single variant or one predominant variant and minor variants of less than 10% frequency. In conclusion, NGS analysis of a cluster of HCV infections acquired in the hospital setting revealed the presence of low diversity, very closely related variants in all patients, suggesting an early-stage infection with the same virus. NGS combined with phylogenetic analysis and classical epidemiological analysis could help in tracking of HCV outbreaks.

Abstract Background Dermacentor reticulatus plays an important role in the maintenance of pathogens of medical and veterinary importance in the environment. Currently two isolated populations of D. reticulatus are present in Poland –Western and Eastern. The range of the Eastern population covers endemic areas in eastern Poland but this population is expanding westwards creating an expansion zone in the centre of the country. The expansion zone in western Poland is occupied by the recently discovered Western population, spreading eastwards. Methods Questing adult ticks (n = 2585) were collected in 2012–2014 in endemic regions of north-eastern (Warmińsko-Mazurskie Voivodeship) and central Poland (Masovian Voivodeship) and in the expansion zones in central and western Poland, in the region between the Vistula River and the western border of the country. Amplification of Babesia, Rickettsia spp. and Borrelia burgdorferi sensu lato DNAs was performed using specific starters. RNA of the TBE virus was detected using RT-PCR and representative PCR products were sequenced and compared with sequences deposited in GenBank. Results Of the total 2585 examined ticks, 1197 (46.3 %) were infected with at least one pathogen. Overall prevalence of pathogens was 4.18 % (108/2585) for Babesia spp., 44.10 % (1140/2585) for Rickettsia spp., 0.09 % (1/1107) for Borrelia afzelii and 7.6 % (7/92) for TBEV. Sequence analysis of DNA showed 99.86 % similarity to R. raoulti and 99.81 % to B. canis. One male from north-eastern Poland was infected with B. microti. Prevalence of R. raoulti was highest in the Western population (52.03 %) and lowest in the Eastern population in north-eastern Poland (34.18 %). Babesia canis was not detected in 592 ticks collected in the Western population, while in the Eastern population overall prevalence was 5.42 %. There were significant differences in the prevalence of B. canis between tick samples from northern (0.68 %), central (1.18 %) and southern (14.8 %) areas of the expansion zone in central Poland. Conclusions Our study found significant differences between the range and prevalence of vectored pathogens in D. reticulatus from the endemic areas and newly inhabited expansion zones. The differences were likely associated with the different time of settlement or ‘source’ of ticks populations, the Eastern and the Western one.

Human infection by [i]Babesia microti[/i] has been recognized as an emerging zoonosis with important public health implications worldwide. In Europe the reported cases of human babesiosis have been attributed mostly to [i]B. divergens[/i] infection, with only sporadic cases of the disease caused by [i]B. microti [/i]or [i]B. venatorum[/i]. This study, based on molecular methods (PCR, R-T PCR, DNA sequencing and phylogenetic analysis), reveals for the first time in Poland, asymptomatic infection with . microti in immunocompetent healthy individuals working in forest ecosystems. Of the 58 professional foresters examined, two (3.4%) were identified as [i]B. microti[/i]-positive by specific PCR. The results of this study also provide strong evidence that in eastern Poland, where tick-borne diseases (TBDs) are endemic, there is a potential risk of acquiring human babesiosis due to zoonotic [i]B. microti [/i]parasites commonly found in rodents and[i] I. ricinus[/i] ticks. The potential public health importance of this finding is discussed.

Human infection by Babesia microti has been recognized as an emerging zoonosis with important public health implications worldwide. In Europe the reported cases of human babesiosis have been attributed mostly to B. divergens infection, with only sporadic cases of the disease caused by B. microti or B. venatorum. This study, based on molecular methods (PCR, R-T PCR, DNA sequencing and phylogenetic analysis), reveals for the first time in Poland, asymptomatic infection with . microti in immunocompetent healthy individuals working in forest ecosystems. Of the 58 professional foresters examined, two (3.4%) were identified as B. microti-positive by specific PCR. The results of this study also provide strong evidence that in eastern Poland, where tick-borne diseases (TBDs) are endemic, there is a potential risk of acquiring human babesiosis due to zoonotic B. microti parasites commonly found in rodents and I. ricinus ticks. The potential public health importance of this finding is discussed.

Encephalitis is a severe neurological syndrome associated with high morbidity and mortality as well as long-term neurological sequelae. Despite being an important public health problem, very few extensive population-based studies were conducted so far in the world and none in Central Europe. Altogether 114 consecutive patients meeting the initial criteria for encephalitis were enrolled at the Warsaw Hospital for Infectious Diseases between June 2012 and July 2015. Eighteen patients were secondarily excluded from the analysis due to incomplete data or noinfectious cause. Potential pathogen sequences were searched for by molecular methods in the cerebrospinal fluid (CSF) and specific antibodies were detected in CSF and sera. An infectious agent was identified in 41 patients (42.7%). The most frequently diagnosed infections were Human herpesvirus 1 (HHV-1) (22 cases, 24%) followed by Enterovirus (6 cases, 6.3%), Varicella zoster virus (VZV) (5 cases, 5.2%), Tick-borne encephalitis virus (TBEV) (6 cases, 6.3%) and Cytomegalovirus (CMV) (2 cases, 2.1%). There were no cases of human adenovirus, Human herpesvirus 6 (HHV-6) or West Nile virus (WNV) infection identified. In 55 cases (57.3%) the cause of encephalitis remained unknown. Compared to patients in whom the diagnosis was determined the latter group contained more women, was less likely to manifest fever and had lower CSF pleocytosis (p < 0.05) In summary, we identified HHV-1 followed by Enterovirus, VZV and TBEV as the most common causes of encephalitis among adult patients in Poland. In a large proportion of patients the cause of encephalitis remained unknown.

Artykuł stanowi przegląd literatury na temat trudności językowych i komunikacyjnych w przebiegu zaburzeń psychotycznych i zaburzeń nastroju. Opisano zaburzenia dotyczące pozalingwistycznych aspektów wypowiedzi, tzn. rozumienia dyskursu, humoru, ironii, metafor, a także prozodycznych aspektów wypowiedzi. Występujące problemy językowe spowodowane są nieprawidłowym funkcjonowaniem prawej półkuli mózgu. W przebiegu zaburzeń psychotycznych najbardziej nasilone trudności dotyczą generowania i utrzymania dyskursu oraz prozodycznych aspektów wypowiedzi. Ponadto obserwowane są problemy z integracją informacji, dotyczące rozumienia żartu i sarkazmu. Pozajęzykowy charakter wypowiedzi nie jest spójny z wypowiadaną treścią, co powoduje zakłócenia komunikacji z otoczeniem. U chorych na schizofrenię dynamika zmian komunikacyjnych zależy od czasu trwania choroby, a także stosowanej farmakoterapii. Obserwowane są także różnice między chorymi na schizofrenię kobietami a mężczyznami w zdolności odczytywania emocji. W przebiegu zaburzeń nastroju deficyty językowe i komunikacyjne są bardziej dyskretne i obserwowane rzadziej. Najszerzej opisywanym problemem językowym są zakłócenia prozodii emocjonalnej, która znacząco wpływa na prawidłowy odbiór informacji przekazywanej werbalnie. Ponadto opisywane są trudności z rozumieniem metafor oraz uchwyceniem żartu i ironii, stwierdzono też zakłóconą zdolność w zakresie rozumienia dyskursu. W pracy porównano również dysfunkcje komunikacyjne w przebiegu zaburzeń psychotycznych i zaburzeń nastroju. Podobnie jak w zaburzeniach psychotycznych, w zaburzeniach nastroju trudności językowe występują w zakresie rozumienia dyskursu, a także umiejętności uchwycenia żartu, ironii oraz sarkazmu.

This article presents the prevalence of auditory verbal hallucinations (AVHs) across the life span in various clinical and nonclinical groups in childhood, adolescence, and adult populations. Data on the occurrence of this phenomenon in the general population vary and usually are in the range of 5–28%. The prevalence of non-clinical AVHs is similar in childhood, ado‑ lescence and adulthood. It seems possible that the mechanisms which cause AVHs in non-clinical populations are different from those which are behind AVHs presentations in psychotic illness. In this paper the characteristics of differentiating clini‑ cal forms of hallucinations from the non-clinical ones are discussed. These are: the location of sensations, their content, inhibition control disorders, metacognitive disorders, emotional dysregulation, stress level, and their influence on functioning dis‑ orders. Considered as etiological factors are abnormal activities of some areas of the brain and abnormal pruning. The triggering factors of both types of perception disorders are traumatic events and psychoactive substances use. Long-term studies have shown that the factors which lead to the transformation of non-clinical hallucinations into their clinical forms are: genetic predisposition, schizotypy, at-risk mental state, and stress. The future research needs to focus on the comparison of underlying factors and mechanisms that lead to the onset of AVHs in both patients and non-clinical populations.

Aim: The aim of the study was to determine differences in the image of ideal psychiatrist (IIP) among patients, doctors involved in psychiatric care and medical students and also between individuals with different work experience (doctors vs. students). The psychiatrist’s personality seems an important factor in supporting therapeutic process; therefore it is worth searching for the patient’s needs. Materials and methods: Three groups participated in the study: patients of the psychiatric units, medical students of 6th year and psychiatrists. The Gough and Heilbrun ACL (Adjective Check List) – based on Mur‑ ray’s theory of needs – was used to assess IIP. Results: Data analysis revealed statistically significant differences among patients, doctors and students involving five scales: Nurturance, Aggression, Change, Succorance and Deference. Patients had lower scores on Change scale than doctors and higher scores on the Nurturance, Succurance and Deference than stu‑ dents. Psychiatrists had higher scores on Nurturance and Deference scale and lower score on Aggression scale than students. Conclusions: The findings showed differences in the expectations of patients compared to those of students and doctors. The most significant difference that was observed involved the Change. It may indicate that patients prefer order, conventional approach and stability in psychiatrist’s personality traits more commonly than doctors. Study findings suggest that work experience has impact on IIP: with increasing work experience, opinion about IIP comes closer to patients’ expectations.

Hepatitis C virus (HCV) transmission between spouses remains poorly characterized, largely due to the limited availability of samples from the early stage of infection, as well as methodological constraints. A fifty-eight year-old male developed acute hepatitis C infection and his 53-year old spouse has been HCV-positive for over 10 years. Serum samples were collected from both at the time of acute hepatitis C diagnosis in male (baseline) and then at 9 and 13 months. Hypervariable region 1 (HVR1) and 5' untranslated region (5'UTR) sequences were amplified and subjected to next generation sequencing (NGS) using a pyrosequencing platform. Genetic variants were inferred by Shorah reconstruction method and compared by phylogenetic and sequence diversity analysis. As the sequencing error of the procedure was previously determined to be ≤ 1.5%, the analysis was conducted with and without the 1.5% cut-off with regard to the frequency of variants. No identical HVR1 variants were identified in spouses at baseline and follow-up samples regardless whether the cut-off was applied or not. However, there was high similarity (98.3%) between a minor baseline donor variant (1.7% frequency) and the most abundant baseline recipient variant (62.5% frequency). Furthermore, donor and recipient strains clustered together when compared to 10 control subjects from the same area and infected with the same HCV subtype. There was an increase in HVR1 complexity (number of genetic variants) over time in both spouses. In contrast, the 5'UTR region was stable and of low complexity throughout the study. In conclusion, intrafamilial HCV transmission may be established by a very minor variant and investigation of this phenomenon requires high-sensitivity assays, such as NGS.

Emotionally labile personality of borderline type (borderline personality) occurs in 1-2% of individuals from general population; 75% of this group are women. Similarly to most of the other mental disorders, the borderline personality results from a combination of biological, social and psychological factors. The subject of this study is a survey of the current knowledge on biological factors of borderline personality. Most researchers are of the opinion that these personality disorders are determined genetically, with such inherited temperamental traits as: dysregulation, impulsivity, and hypersensitivity. Perhaps hereditary is also a defect within the serotonergic system, endogenous opioid system and/or dopaminergic system related to the reward system. Many researchers have recently perceived the dysfunction of endogenous opioid system as an integral component of borderline personality. There is now a lot of evidence showing that this dysfunction as well as that of the reward system may account for most of the borderline personality symptoms which constitute an involuntary attempt of stimulating the inefficient systems. This is how e.g. the presence of reckless sexual behaviours, unstable interpersonal relationships and inability to delay the reward in borderline personality is accounted for. Such observations may in the future constitute an important indication for seeking a more effective pharmacotherapy for patients with borderline personality. It is possible that in some patients the described dysfunctions may be alleviated with time. This is implied by the results of comprehensive prospective studies which show a significant regression of symptoms and improvement in functioning of most patients with borderline personality after at least several years.

Zjawiska autoskopiczne definiowane są jako spostrzeganie własnego ciała w przestrzeni, z perspektywy wewnętrznej (tak jak w lustrze) lub z zewnętrznego punktu widzenia. Mają one różny obraz i w związku z nim zostały obecnie zaklasyfikowane do grup: „bycia poza ciałem”, heautoskopii i halucynacji autoskopicznych. „Bycie poza ciałem” definiowane jest jako wrażenie widzenia świata i własnego ciała z odległości, z podwyższonej wzrokowo-przestrzennej perspektywy, autoskopiczne halucynacje opisuje się jako widzenie swojego sobowtóra w przestrzeni poza własnym ciałem, lecz bez odczucia opuszczenia ciała, a heautoskopię – jako widzenie siebie w przestrzeni poza własnym ciałem, ale z trudnościami w określeniu, gdzie jest zlokalizowane „poczucie siebie” i „własne centrum świadomo- ści”. Analiza danych neurofizjologicznych i neuroobrazowych związanych z doświadczeniem autoskopii sugeruje obecność zakłóceń integracji informacji płynących z układu przedsionkowego i innych receptorów (wzrokowych, proprioceptywnych, dotykowych). W badaniach neuroobrazowych wykazano udział w tych procesach także kory przedczołowej, ciemieniowej i skroniowej, związanych z wyższym poziomem przetwarzania informacji o samym sobie. Deficyty te najprawdopodobniej wiążą się z uszkodzeniami w połączeniach ciemieniowo-skroniowych oraz w sieciach połączeń neuronalnych różnych okolic kory mózgu, w tym przedczołowej, ciemieniowej i skroniowej. W artykule oprócz przeglądu literatury zaprezentowano przypadek pacjenta, u którego w następstwie wstrząsu krwotocznego doszło do hipoksji w ośrodkowym układzie nerwowym. W wyniku niedotlenienia mózgu pacjent przeżył stan bliski śmierci i miał doznania heautoskopiczne. Autorzy przedstawiają opisy jego doświadczeń, zawierające wiele elementów powtarzających się w relacjach osób w podobnym stanie somatycznym. W końcowej części artykułu omówiono możliwe podłoże ich pojawienia się.

Aim of the study: Literature emphasizes a positive impact of emotional intelligence on interpersonal and commu‑ nication skills, the doctor‑patient relationship, and the level of empathy. On the other hand, few research studies dealing with the correlation between emotional intelligence and medical specialty choice or preference are availa‑ ble. Our research was aimed at checking if there are differences in the ability to perceive and identify emotions ac‑ cording to facial expression (one of the dimensions of emotional intelligence) between students preferring different medical specialties. Method: The research involved 251 six‑year students of the Medical Faculty, Medical Universi‑ ty of Łódź. The examined group consisted of 174 women (69.33%) and 77 men (30.67%). The subjects’ average age was 24.7 years. The surgical specialty was preferred by 44 women (28.21%) and 43 men (58.11%), non‑surgical by 112 women (71.79%) and 31 men (41.89%). The subjects were asked to fill in a questionnaire with demographic data (gender, age, preferred specialty) and the Emotional Intelligence Scale – Faces (SIE‑T) by Matczak, Piekarska and Studniarek. Results: Men significantly more frequently chose surgical specialty (58.11%), as compared to women (28.21%); chi2=19.08, p0.05. Similarly, no differences were found between the students preferring surgical and non‑surgical procedures; Mann‑Whitney U=‑0.93, p>0.05. Results: Male and fema‑ le students of the Medical Faculty do not differ in the level of emotional intelligence. Emotional intelligence does not differentiate the students preferring surgical and non‑surgical specialties.

Udar cieplny (UC) jest stanem nagłego zagrożenia życia i często kończy się śmiercią. Charakteryzuje się gorączką ponad 40°C, której towarzyszą objawy neurologiczne. W udarze cieplnym homeostatyczne mechanizmy termoregulacyjne stają się niewydolne i organizm nie jest w stanie utrzymywać właściwej temperatury ciała. Dysfunkcja procesów termoregulacji prowadzi do skrajnego wzrostu temperatury ciała i w następstwie do uszkodzenia wieloukładowego, niewydolności narządów i niekiedy śmierci. Największe ryzyko wystąpienia UC występuje u dzieci i osób w podeszłym wieku. Intensywny wysiłek fizyczny w wysokich temperaturach i przy znacznej wilgotności otoczenia oraz odwodnienie i przyjmowanie niektórych leków również zwiększają ryzyko wystąpienia UC. Udar cieplny występujący u młodych dorosłych i dorosłych w następstwie intensywnego wysiłku jest klasyfikowany jako wysiłkowy udar cieplny (WUC). Częstość występowania WUC w trakcie biegowych imprez masowych wynosi około 1 na 1000. Biorąc pod uwagę zwiększającą się popularność biegów długodystansowych w Polsce, prawdopodobieństwo wystąpienia i obserwacji przez lekarzy przypadków wysiłkowego udaru cieplnego będzie rosło. Szybkie rozpoznanie i właściwe postępowanie w przypadkach UC warunkuje przeżycie pacjenta oraz odległe rokowanie. Do standardu postępowania w WUC należy szybkie schłodzenie pacjenta aż do osiągnięcia temperatury głębokiej poniżej wartości krytycznej, tj. 40°C, oraz wyrównanie zaburzeń wodno-elektrolitowych, do czego służby medyczne organizujące opiekę zdrowotną w trakcie imprez masowych powinny być odpowiednio przygotowane. W artykule opisano przypadek pacjenta, u którego w następstwie uczestnictwa w biegu maratońskim rozpoznano WUC przebiegający z ogniskowymi objawami neurologicznymi oraz utrzymywaniem się wskaźników uszkodzenia wielonarządowego przez wiele dni po wystąpieniu zaburzenia. Przeanalizowano obraz kliniczny WUC wraz z czynnikami ryzyka i zalecanym postępowaniem i leczeniem.

Assumptions and aims: In recent years we have been observing an increasing number of adolescent patients exhibiting autoaggressive behaviour. These are often direct self-mutilations, defined as deliberate body injuries. The intention of such behaviours is physical self-injuring to reduce mental pain, relieve emotional tension and anxiety. This is accompanied by the sense of being “rewarded”. The study is aimed at analysing the correlation between the severity of general hostility and its respective subscales assessed by the Buss-Durkee Inventory on Moods and humours and the occurrence of selfmutilations in a group of adolescents with superficial self-mutilations. Material and methods: The examined population consisted of 67 persons aged 14-18 years, of both genders. Qualified to the examined group were 42 adolescent patients exhibiting autoaggressive behaviour. The control group consisted of 25 persons selected according to age and gender who did not exhibit such behaviours. Excluded from the study were subjects with depressive, psychotic disorders as well as significant somatic disorders, and those who used psychotropic drugs and psychoactive substances. The respondents completed the Buss-Durkee Inventory assessing the level of general hostility and its seven subscales: direct aggressiveness consisting of physical and verbal aggressiveness, indirect aggressiveness, resentment, negativism, suspiciousness and irritability. A separate scale assessed the sense of guilt. Conclusions: 1) Self-mutilations in the examined group were associated with severity of aggressiveness directed outwards (measured both by its general level and in respective subscales). 2) Self-mutilating patients require therapeutic measures (psychotherapeutic and pharmacological) aimed at reduction not only of autoaggression but also aggression directed outwards.

Konceptualizacja przypadku w terapii behawioralno-poznawczej opisuje i wyjaśnia problemy zgłaszane przez pacjenta w trakcie leczenia. Jej podstawową funkcją jest ukierunkowanie terapii na zmniejszenie stresu leczonej osoby i zwiększenie jej odporności na doświadczane trudności. Osiągnięcie tych celów jest możliwe, gdy konceptualizacja spełnia kilka funkcji: podsumowuje doświadczenia pacjenta, normalizuje jego doświadczenia, promuje zaangażowanie, złożone cele lub problemy czyni możliwymi do realizacji oraz porządkuje kolejne interwencje. Ponadto identyfikuje mocne strony pacjenta i sugeruje, jak zwiększyć odporność na doświadczany stres, proponuje najprostsze interwencje, uprzedza wystąpienie trudności, pomaga zrozumieć brak efektów w terapii oraz umożliwia prowadzenie wysokiej jakości superwizji. Z tego względu nabycie umiejętności dokonywania prawidłowej konceptualizacji w modelu poznawczo-behawioralnym jest jedną z podstawowych umiejętności terapeuty. W niniejszej pracy zaprezentowano metodę uczenia wstępnej konceptualizacji poznawczej, opierając się na analizie wybranych postaci literackich. Interpretując zachowania takich postaci z bajek, jak Czerwony Kapturek, Brzydkie Kaczątko, Królewna Śnieżka, Jaś i Małgosia oraz Kopciuszek, moż- na prześledzić, w jaki sposób wczesne doświadczenia dziecięce powodują powstawanie dezadaptacyjnych schematów oraz schematów kompensacyjnych. Śledząc losy wyżej wymienionych bohaterów, można zauważyć, że większość z nich znalazła się w trudnej sytuacji życiowej oraz że w zależności od swoich przekonań przyjmowała różne strategie – bezradność, aktywne przeciwstawianie się trudnościom, czekanie na pomoc innych. Podobnie jest w przypadku postaci literackich – Anny Kareniny, Geralta z Rivii (i jego ukochanej), Stanisława Wokulskiego i pani Dulskiej – możemy uczyć się, jak potencjalne przekonania wpływają na nasze wybory i działania. Zawarte w pracy przykłady mogą wspomóc proces nauczania. Jednak stosowanie tej metody jako opartej na dowodach wymaga jeszcze empirycznej weryfikacji.

Zgodnie z koncepcją neurorozwojową schizofrenię rozumie się jako stopniowo postępujący proces chorobowy, rozpoczynający się na podłożu podatności genetycznej w dzieciństwie i stopniowo postępujący, czemu początkowo towarzyszy występowanie niespecyficznych objawów i dysfunkcji. Kulminacją opisywanego ciągu zdarzeń jest wystąpienie pełnoobjawowej psychozy. Dający się wyróżnić objawowy okres przedchorobowy występuje u około 75% chorych w pierwszym epizodzie schizofrenii. Może on mieć różną długość, przy czym badania wskazują, że średni czas trwania objawowego okresu przedchorobowego w schizofrenii wynosi 5 lat, a w krajach wysoko rozwiniętych co najmniej 2 lata. Liczne badania wykazały, iż późne rozpoznanie choroby jest niezależnym czynnikiem ryzyka niekorzystnego przebiegu schizofrenii. Z tego względu wielu badaczy zwróciło uwagę na etapy choroby poprzedzające wystąpienie ostrej psychozy o obrazie schizofrenii, co doprowadziło do wyróżnienia grupy osób o podwyższonym, w stosunku do populacji ogólnej, ryzyku rozwoju psychozy (ultra-high risk syndrome, UHRS). Dotychczas przeprowadzono nieliczne badania interwencyjne mające na celu ocenę różnych strategii postępowania w grupie pacjentów z zespołem wysokiego ryzyka rozwoju psychozy. Dostępne wytyczne zagraniczne oraz zalecenia ekspertów wskazują na priorytet oddziaływań psychospołecznych, w tym szczególnie terapii behawioralno-poznawczej (TBP). W pracy przedstawiono przegląd badań nad skutecznością TBP w grupie UHRS. Wynika z niego, iż nasilenie objawów u pacjentów często nie wymaga stosowania farmakoterapii, a zastosowanie TBP jest związane z mniejszym ryzykiem rozwoju działań niepożądanych niż w przypadku wdrożenia farmakoterapii. Wyniki badań uzyskanych przez różne zespoły badawcze pozwalają na stwierdzenie, że TBP może być skuteczna w redukcji objawów towarzyszących wysokiemu ryzyku rozwoju schizofrenii. Ponadto TBP poprzez monitorowanie stanu psychicznego pacjenta umożliwia szybsze rozpoznanie przejścia w psychozę i tym samym skrócenie czasu nieleczonej psychozy, który stanowi uznany negatywny czynnik rokowniczy przebiegu psychoz schizofrenicznych.

Background: The aim of this study was the independent psychosis risk factors assessment in a group of subjects fulfilling the criteria of at risk mental state, under specialist outpatient psychiatric care. Participants: Seventy-one patients – 33 women and 38 men, were involved into this study, aged on average 17.34, all under psychiatric care. The patients were recruited into the study in the sequence of their outpatient clinic admission. The criterion to be included into the study was the diagnosis of ultra-high risk state (UHRS) – defined according to the Australian research group principles. Subsequently, the patients were divided into subgroups according to the clinical features of their mental state. Method: The author’s demographic questionnaire was applied in the study. Information regarding the family history of psychosis was obtained from patients and/or their relatives or carers. The patients’ mental state was assessed monthly – according to the presence of psychotic symptoms, change of their incidence and duration, presence of depressive symptoms or aggressive behaviour (measured by a three-level scale). On the basis of the obtained information, we evaluated: 1) conversion into psychosis time – measured from diagnosing of UHRS to the development of full-symptom psychosis, 2) therapeutic methods used (psychotherapy, pharmacotherapy or both), 3) use of psychoactive substances after being diagnosed with UHRS, 4) presence of serious life stressors (the patients’ subjective estimation) – during the six-month period preceding the conversion into psychosis. Results: 1) In the UHRS group of patients, staying under professional outpatient psychiatric care, the use of marijuana was an independent risk factor of conversion into psychosis. 2) In the investigated group of patients with at risk mental state we did not find any correlation between modulating factors (including: therapeutic methods used, depressive symptoms, aggression or clinical features of UHRS patients’ subgroups or duration of staying under professional psychiatric care) and controlled period without conversion into psychosis.

Zespół Stevensa-Johnsona (SJS) i toksyczna nekroliza naskórka (TEN) należą do potencjalnie zagrażających życiu manifestacji odczynów polekowych, których wystąpienie jest praktycznie niemożliwe do przewidzenia. Uważa się, że SJS i TEN mają podobną patogenezę, która dotychczas nie została dokładnie poznana, jednak prawdopodobnie wiąże się z indukcją odpowiedzi immunologicznej przez lek, w wyniku czego dochodzi do apoptozy keratynocytów na drodze swoistej cytotoksyczności komórkowej, humoralnej lub nieswoistej odpowiedzi immunologicznej mediowanej przez układ dopełniacza. Sądzi się, że SJS/TEN może powstawać także na drodze nieimmunologicznej: idiosynkrazji, nietolerancji lub reakcji rzekomoalergicznej. Za większość polekowych odczynów skórnych są odpowiedzialne sulfonamidy, antybiotyki beta-laktamowe oraz leki przeciwpadaczkowe. Leki należące do tej ostatniej grupy są powszechnie stosowane w psychiatrii, a największym ryzykiem wywołania SJS/TEN obarczone są karbamazepina, lamotrygina, walproinian. Autorzy pracy przedstawiają przypadek 28-letniego mężczyzny leczonego z powodu choroby afektywnej dwubiegunowej, u którego w 12. dobie po włączeniu do leczenia lamotryginy wystąpiły rumieniowo-obrzękowe zmiany śluzówkowo- -skórne mające tendencję do zlewania i szybkiego uogólniania, prowadząc do martwicy i spełzania pozornie niezmienionego naskórka (dodatni objaw Nikolskiego). Znacznie nasilone były zmiany śluzówkowe, występowały liczne, głę- bokie owrzodzenia w obrębie jamy ustnej, nosowej oraz spojówek, co uniemożliwiało przyjmowanie pokarmów drogą enteralną. W badaniach dodatkowych obserwowano istotny wzrost niespecyficznych markerów stanu zapalnego (CRP), hipoproteinemię, hipokaliemię, podwyższone wartości D-dimerów oraz nieznacznie podwyższone wartości aminotransferazy alaninowej. Pomimo szybkiej diagnozy i odstawienia leku podejrzewanego o związek przyczynowy pacjent z powodu ciężkiego stanu ogólnego wymagał leczenia na oddziale intensywnej terapii, gdzie otrzymał dożylne wlewy immunoglobulin G, cyklosporyny, glikokortykosteroidów, a także niezbędne leczenie wspomagające oraz miejscowe przeciwzapalno-odkażające. Po 24 dniach pobytu na oddziale intensywnej terapii został wypisany do domu w stanie poprawy.

Objective: This study was aimed at checking a hypothesis about a possible correlation between medical students’ temperamental traits and specialty preferences. Material and methods: The study was carried out among 202 students of the 6th year at the Medical University of Łódź in academic year 2008/2009. The examined group consisted of 140 women (69%) and 62 men (31%). The average age of the students included into the study was 24.7 years (range: 23-29). The subjects were asked to fill in a questionnaire on demographic variables and the Formal Characteristics of BehaviourTemperament Inventory (FCB-TI) by Zawadzki and Strelau. Results: The students taking part in the study preferred specialties in internal diseases (22%), surgery (18%) and paediatrics (11%). Two point five percent of the students were indecisive in the specialty choice, 26% preferred surgical specialty and 71% – non-surgical specialty. Differences in temperamental traits were indicated between the students preferring different specialties. Students preferring surgery scored higher than those preferring internal medicine in Endurance (p=0.0036, d=0.63) and Activity (p=0.0292, d=0.63). Significantly higher average values were observed within two temperamental traits: Briskness (p=0.0083, d=0.5) and Endurance (p=0.0070, d=0.49) in students preferring surgical specialties, as compared to those choosing non-surgical specialties. Conclusions: Students’ preferring different medical specialties differ in temperamental traits. They obtained different results on the scales of Briskness, Endurance and Activity. The obtained results may be useful in vocational guidance within the choice of medical specialty.

Introduction: Strabismus is a serious ophthalmological and cosmetic disorder which may cause psychological discomfort. An increased incidence of various mental disturbances in patients with squint has been described. Affected children and adolescents experience more difficulties at school and worse results in sport. Squint may cause a disadvantageous social reception and may sometimes make it difficult to get a satisfying job. It may considerably decrease the quality of life. Objective: This study addressed three questions: 1) Is strabismus linked to psychiatric and psychological disorders? 2) Can it influence social competences? 3) Is it linked to dysmorphophobia (DSM-IV)? Material and methods: Thirty persons with strabismus at the age of 13-17 years were compared with the control group of 30 persons of the same age, without eye problems. To detect psychiatric problems GHQ-28 scale was used. To assess social competences the Social Competence Questionnaire KKS (Kwestionariusz Kompetencji Społecznych) was used. Dysmorphophobia symptoms were measured using the Body Dysmorphic Disorder Examination (BDDE). Results: There were no statistically significant differences in the incidence of symptoms of depression, anxiety, sleep disorders, functioning, social competences or dysmorphophobia in adolescents with strabismus, as compared to the control group. Significantly worse social competences were shown by those adolescents with strabismus who underwent surgical treatment, as compared to other persons with squint (p=0.006). Discussion: In literature, we have not found any studies on social competences in young people with strabismus. The prevalence of dysmorphophobia was not confirmed among them. No higher incidence of psychiatric disorders was observed in our study in adolescents with strabismus.

Choreoakantocytoza lub zespół Levine’a-Critchleya (MIM 200150) jest postępującą wieloukładową chorobą dziedziczoną autosomalnie recesywnie z szerokim spektrum objawów obejmującym: ruchy mimowolne, uszkodzenie obwodowego układu nerwowego, miopatię, nieprawidłowości zachowania, spadek funkcji poznawczych, padaczkę oraz akantocytozę – przy nieobecności jakichkolwiek zaburzeń lipidowych. Choroba ta jest powodowana przez mutacje w genie VPS13A (CHAC), który jest położony na chromosomie 9., ramieniu dużym, w regionie 21. (9q21). Gen VPS13A obejmuje 250 kpz i zawiera 73 eksony. Koduje duże białko, które zostało nazwane choreiną – jego funkcja nie została dotychczas poznana. Leczenie choreoakantocytozy jest ukierunkowane na dolegliwości chorych, jednak nie modyfikuje naturalnego przebiegu choroby. Autorzy przedstawiają przypadek pacjentki z pozytywnym wywiadem rodzinnym, ruchami pląsawiczymi w obrębie kończyn górnych, mimowolnymi ruchami w obrębie twarzy i języka (które współistnieją z wokalizacjami, dyzartrią oraz dysfagią), postępującym spadkiem funkcji poznawczych, depresją, klinicznymi wykładnikami uszkodzenia obwodowego układu nerwowego lub/i miopatii, padaczką z napadami toniczno-klonicznymi oraz akantocytozą. Poziom kinazy kreatyninowej był podwyższony – 387 U/l (norma: 0-145 U/l), podobnie LDH – 244 U/l (norma: 80-240 U/l). Także bilirubiny bezpośrednia i niebezpośrednia były nieznacznie podwyższone. Rezonans magnetyczny mózgu ujawnił typowy zanik lewego jądra ogoniastego i rzadko obserwowany zanik prawego hipokampa. W dostępnej nam literaturze nie znaleźliśmy podobnego opisu przypadku rodzinnej postaci choreoakantocytozy w Polsce.

Fobia społeczna wiąże się ze stale utrzymującym się lękiem przed jedną lub kilkoma sytuacjami, w których osoba narażona jest na kontakt z nieznanymi sobie ludźmi lub na możliwość oceny ze strony innych osób. W zaburzeniu tym lęk oceniany jest jako nadmierny i nieracjonalny, a konieczność zaangażowania się w sytuacje społeczne wiąże się z silnym cierpieniem i lękiem pacjentów, dlatego też często stosują oni strategię unikania zachowań społecznych. Występuje u około 12% populacji. W leczeniu zaburzenia lęku społecznego głównym celem jest zmniejszenie lęku i fobicznego unikania do poziomu, na którym nie powoduje już istotnego stresu i zakłóceń funkcjonowania. Skuteczne leczenie tego zaburzenia obejmuje dwie kategorie: leczenie farmakologiczne lub/i terapię behawioralno-poznawczą (TBP). Najbardziej skuteczne interwencje TBP należą do czterech form oddziaływania i zawierają: ekspozycję, restrukturyzację poznawczą, trening umiejętności społecznych oraz relaksację. Celem niniejszego artykułu jest zaprezentowanie zmian w myśleniu i zachowaniu uzyskanych po zastosowaniu eksperymentów behawioralnych (EB) u nastoletnich i dorosłych pacjentów z rozpoznaniem fobii społecznej. Przedstawione zostały różne rodzaje eksperymentów wprowadzonych w czasie leczenia. Zaprezentowano eksperymenty przeprowadzone z udziałem osób obawiających się: oddania moczu w miejscu publicznym, rozmawiania z nieznajomymi, rozmawiania z dorosłymi oraz spotykania się z nowymi nastoletnimi kolegami. Przeprowadzone EB okazały się skuteczną metodą leczenia zgłaszanych objawów. Doprowadziły do poznawczej zmiany poprzez stworzenie nowych i bardziej przystosowawczych przekonań i zasad.

Association between hepatitis C virus (HCV) quasispecies and treatment outcome among patients with chronic hepatitis C has been the subject of many studies. However, these studies focused mainly on viral variable regions (E1 and E2) and usually did not include human immunodeficiency virus (HIV)-positive patients. The aim of the present study was to analyze heterogeneity of the 5' untranslated region (5'UTR) in HCV/HIV coinfected patients treated with interferon and ribavirin. The HCV 5'UTR was amplified from serum and peripheral blood mononuclear cells (PBMC) samples in 37 HCV/HIV coinfected patients treated for chronic hepatitis C. Samples were collected right before treatment, and at 2, 4, 6, 8, 12, 20, 24, 36, 44, 48, 60, and 72 weeks. Heterogeneity of the 5'UTR was analyzed by single strand conformational polymorphism (SSCP), cloning and sequencing. Sustained virological response (SVR) was achieved in 46% of analyzed HCV/HIV co-infected patients. Stable SSCP band pattern was observed in 22 patients (62.9%) and SVR rate among these patients was 23%. Decline in the number of bands and/or shift in band positions were found in 6 patients (17.1%), 5 (83%) of whom achieved SVR (p=0.009). A novel viral genotype was identified in all but one of these patients. In 5 of these 6 patients a new genotype was dominant. 5'UTR heterogeneity may correlate with interferon and ribavirin treatment outcome. In the analyzed group of HCV/HIV coinfected patients, viral quasispecies stability during treatment favored viral persistence, whereas decrease in the number of variants and/or emergence of new variants was associated with SVR. Among injection drug users (IDU) patients, a new genotype may become dominant during treatment, probably due to the presence of mixed infections with various strains, which have different susceptibility to treatment.