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Doxorubicin (DOX) is an anthracycline anticancer agent that is highly effective in the treatment of solid tumors. Given the multiplicity of mechanisms involved in doxorubicin-induced cardiotoxicity, it is difficult to identify a precise molecular target for toxicity. The findings of a literature review suggest that natural products may offer cardioprotective benefits against doxorubicin-induced cardiotoxicity, both in vitro and in vivo. However, further confirmatory studies are required to substantiate this claim. It is of the utmost importance to direct greater attention towards the intricate signaling networks that are of paramount importance for the survival and dysfunction of cardiomyocytes. Notwithstanding encouraging progress made in preclinical studies of natural products for the prevention of DOX-induced cardiotoxicity, these have not yet been translated for clinical use. One of the most significant obstacles hindering the development of cardioprotective adjuvants based on natural products is the lack of adequate bioavailability in humans. This review presents an overview of current knowledge on doxorubicin DOX-induced cardiotoxicity, with a focus on the potential benefits of natural compounds and herbal preparations in preventing this adverse effect. As literature search engines, the browsers in the Scopus, PubMed, Web of Science databases and the ClinicalTrials.gov register were used. [ABSTRACT FROM AUTHOR]

As new sources of proteins, edible insects may be excellent additives in a new generation of environmentally friendly food products that are nutritionally valuable, safe, sustainable, and are needed in today's world. The aim of this study was to determine the effect of the application of cricket flour on extruded wheat-corn-based snack pellets' basic composition, fatty acids profile, nutritional value, antioxidant activity and selected physicochemical properties. Results showed that the application of cricket flour had a significant impact on the composition and properties of snack pellets based on wheat-corn blends. In newly developed products, the enhanced level of protein and almost triple increase in crude fiber was found as an insect flour supplementation reached 30% level in the recipe. The level of cricket flour and the applied processing conditions (various moisture contents and screw speeds) significantly affect the water absorption and water solubility index and texture and color profile. Results revealed that cricket flour application significantly increased the total polyphenols content in the assessed samples in comparison to plain wheat-corn bases. Antioxidant activity was also noted to be elevated with increasing cricket flour content. These new types of snack pellets with cricket flour addition may be interesting products with high nutritional value and pro-health properties. [ABSTRACT FROM AUTHOR]

Hallucinogenic mushrooms containing psilocin action and psilocybin has been known for centuries. They belong to the genera: Conocybe, Psylocibe, Gymnophilus and Panaeolus. Psilocin name is derived from Greek and loosely translated means "naked (psilo) head (Cybe)". In many cultures of these fungi were abused during the ritual and mystical rites. Psilocin is used mainly in order to apply the so-called. Tripping, or hallucinogenic pleasurable sensations, mainly in the form of visual hallucinations. However, it can cause side effects in the form of: tachycardia, hypotension, organ damage, and even the occurrence of unwanted "bad Tripping" so-called. "Bad trips". In Poland, despite the ban on their cultivation and use are still popular stimulant mainly among young people. Recently, more popular and more available on the illicit market are their synthetic derivatives. These include, among others 4-Acetoxy-N, N-dimethyltryptamine, known as 4-AcO-DMT. The paper presents the main symptoms of intoxication use and psilocin and its derivatives, as well as the rules of conduct in acute poisonings. Furthermore, a case of a 16-year-old patient hospitalized at the Regional Center of Clinical Toxicology in Lublin due to substance intoxication psychostimulants 4-AcO-DMT. [ABSTRACT FROM AUTHOR]

Clozapine is an antipsychotic drug, which belongs to the group of atypical antipsychotic agents for the treatment of schizophrenia. Clozapine is a very effective medicine, but because of the possibility of inducing severe side effects, clozapine should be recommended only for patients who do not respond to other treatments or do not tolerate other drugs. Case presentation: a young 29-year-old man was hospitalized in the Regional Centre of Clinical Toxicology in Lublin, because of suicidal overdose of dozens of clozapine pills. The patient was taking clozapine due to paranoid schizophrenia. At the time of admission to hospital the patient was in severe general condition and there was no logical contact with him. In the laboratory test we observed severe features of lactic acidosis, which could be typical for clozapine poisoning. In addition the patient developed acute respiratory failure and rhabdomyolysis. For the next 6 days, thepatient required intensive treatment and care, including periodic respiratory therapy. The patient was discharged from the hospital in good general condition after 13 days of treatment and he was referred to Neuropsychiatric Hospital in Lublin. The patient was diagnosed in the course of clozapine poisoning with: toxic coma, lactic acidosis, acute respiratory failure, pneumonia and rhabdomyolysis. [ABSTRACT FROM AUTHOR]

Antidepressants that target the monoaminergic system are prescribed most frequently in the psychiatric practice. However, not all patients benefit from their use. It is generally known that co-administration of agents aiming distinct targets may increase the therapeutic effect and at the same time permit dose reduction. A number of studies have suggested a CB 1 receptor-mediated interplay between the endocannabinoid system and the monoaminergic signalling in the brain. Therefore, we wanted to determine whether the CB 1 receptor ligands (oleamide and AM251) affect the activity of the common antidepressant drugs that influence the monoaminergic system. In order to determine the antidepressant-like activity, the forced swim test and the tail suspension test in mice were used. Additionally, brain concentrations of the tested antidepressants were evaluated by the HPLC method. Concurrent intraperitoneal administration of per se inactive doses of oleamide (5 mg/kg) or AM251 (0.25 mg/kg) and imipramine (15 mg/kg), escitalopram (2 mg/kg), and reboxetine (2.5 mg/kg) reduced the immobility time of animals in the forced swim test and the tail suspension test. The observed effect was not associated with hyperlocomotion of animals. Summarizing, the outcomes of the present study demonstrated that modulation (i.e., activation or inhibition) of the CB 1 receptor function potentiates the antidepressant activity of common drugs that influence the monoaminergic (serotonergic and noradrenergic) system. This effect is most probably predominantly pharmacodynamic in nature instead of pharmacokinetic., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Hyponatremia, defined as a serum sodium <135 mmol/l, is the most common clinical disorder of water and electrolyte balance. Hyponatremia occurs in approximately 15-20% of hospitalized patients and up to 20% of patients in critical condition. It can lead to a wide range of clinical symptoms, from mild to even life-threatening, and is associated with increased mortality and longer duration of hospitalization in patients affected by many different syndromes. The diagnosis and treatment of hyponatremia in patients’ is still a major problem. Hyponatremia is a disorder observed commonly in toxicological practice. It most often occurs in people who abuse alcohol, narcotics - mainly ecstasy, drugs, as well as the so-called water intoxication in athletes and the people who are mentally ill. In view of the complex pathomechanisms and a variety of symptoms observed in poisoned patients, hyponatremia should be considered as one of the reasons and the exponent of the general condition of the patient.

Transient and permanent myocardial damage is a vital element of toxicological practice. This applies both to poisonings in which heart injury is typical and to those in which it is only a rare complication. Vital signs of poisoned patients, especially unconscious ones, must be carefully monitored, because the consequences of late diagnosis or improper treatment can be potentially fatal. The following paper discusses the mechanisms leading to heart damage in the course of acute poisoning. It also presents clinical symptoms, treatment options and prognosis for myocardial injury in selected poisonings.

Nanoparticles are structures with at least one demension smaller than 100 nm. The rapid development of nanotechnology means that each day comes new nanostructures and also new opportunities for their use. However it should be remembered, that nanotechnology is not only benefits and progress, but the risk of side effects. Due to the unique properties of nanoparticles linked to their size and also large active surface, the nanoparticles interact virtually the entire human body, causing a variety of adverse effects also at the cellular level. The paper presents the general characteristics of the nanoparticles, their use, route of exposure and reports of their cardiotoxicity.

We present the case of 28 years old patient hospitalized at the Regional Center of Clinical Toxicology in Lublin after carbon monoxide poisoning. The level of carboxyhemoglobin was 33.3%. Because of neurological symptoms MR of brain was performed with normal result. During hospitalization the progression of clinical symptoms was observed and the patient underwent control MR of brain. The result was abnormal and show changes bilaterally in white matter.

The heart muscle is particularly sensitive to the toxic effects of carbon monoxide. Cardiovascular complications are present in 30-40% poisoned patients. Currently, multiple ECG records and at least two-time determination of cardiac markers' concentration (mainly troponin I) are known as the gold standard practice in the diagnosis of cardiac injury especially with regard to medium and severe poisoning. So far there have not been any recommendations for further diagnostic steps in case of abnormalities in these examinations. This paper presents a review of cardiac imaging techniques as well as the analysis of their usefulness in carbon monoxide poisoning. According to the authors echocardiography is considered to be an extremely important examination which, thanks to its accessibility and non-invasive nature, should be performed on all patients with myocardium injury suspicion made on the basis of clinical image, ECG records and biochemical markers.

Fast development of genetic engineering and biotechnology allows use of genetically modified organisms (GMO) more and more in different branches of science and economy. Every year we can see an increase of food amount produced with the use of modification of genetic material. In our supermarkets we can find brand new types of plants, products including genetically modified ingredients or meat from animals fed with food containing GMO. This article presents general information about genetically modified organisms, it also explains the range of genetic manipulation, use of newly developed products and current field area for GMO in the world. Based on scientific data the article presents benefits from development of biotechnology in reference to modified food. It also presents the voice of skeptics who are extremely concerned about the impact of those organisms on human health and natural environment. Problems that appear or can appear as a result of an increase of GMO are very important not only from a toxicologist's or a doctor's point of view but first of all from the point of view of ordinary consumers--all of us.

Analgesic usage without any consultation with a physician is very common in Poland. It increases the risk of occurrence of the harmful effect or harmful interaction with other medicaments taken by the patient. The abuse of painkillers applies not only to opioid but also to nonopioid analgesics. The largest group of commonly available medicaments are NSAIDs. The most frequent undesirable effect of NSAIDs' is dyspepsia. Among the most dangerous, and very often the ones without any symptoms, are gastric and duodenum ulceration for which the bleeding and perforation may be the first manifestation. Each non steroidal anti-inflammatory drug taken in large doses can be a cause of analgesic nephropathy. Its deceitful course can delay the diagnosis leading to chronic kidney failure. A complex supplements, that include central acting substances, increase the risk of kidney damage, as well as physical and psychological addiction. NSAIDs can cause: the heart failure to be more severe, treatment resistant arterial hypertension, increase an effectiveness of anticoagulants or antidiabetic drugs. The problem is also that some medicaments are available without a prescription (acetylsalicylic acid, ibuprofen, acetaminophen), especially that they are ingredients of many complex supplements considered safe. Taking doses larger than therapeutic or simultaneously taking many supplements of the same active substance had many times led to poisoning and even death. Equally dangerous can be an abuse of tramadol, codeine and COX-2 inhibitors. Therefore, prudential prescription of NSAIDs, knowledge of risks related to therapy and informing the patients about their side effects, may decrease the number of patients abusing the analgesics which can lead to lowering the number of deaths caused by serious complications.

Prolongation of QT interval is an indicator of bad prognosis in general population of people with heart disease, in patients after myocardial infarction and in people without recognized heart disease. Prolongation of QT interval occurs in many diseases and clinical states. It may be congenital or acquired ECG anomaly and it determines the basic symptom of long QT syndrome. In this paper we present clinical meaning of QT interval, measurement rules and problems with correct valuation of QT/QTc in electrocardiogram. We also discuss reasons of QT interval prolongation--congenital or acquired long QT syndrome, as well as the procedure in case of QT interval prolongation and possibilities of preventive treatment of iatrogenic long QT syndrome.

Unlabelled: The aim of the study was to describe MR imaging findings in patients after acute carbon monoxide poisoning., Material and Method: In the period of 7 months (from October 2011 to April in 2012), 72 patients were hospitalized at the Center of Clinical Toxicology after acute carbon monoxide poisoning. In all patients the level of carboxyhemoglobin (COHb) was determined. Brain MR examination was performed in 14 patients of this group due to persistent neurological symptoms., Results: In 72 patients the mean value of COHb was 21.52%. In 14 patients with persistent neurological symptoms mean value of COHb was 26.14%. In 14 patients who underwent MRI of the brain, in 4 there was no MR change and their COHb average value was 20.45%. In the remaining 10 patients MR brain abnormalities were diagnosed, including changes of basal ganglia, white matter or cortex, and their COHb average value was 26.56%., Conclusions: In patients with persistent neurological symptoms after acute carbon monoxide poisoning are changes in brain MRI. These changes correlate with the concentration of COHb. MRI seems to be the method of choice for imaging the brain in patients after acute carbon monoxide poisoning.

Obesity in rapidly developing countries has recently become an epidemic. That is why the need to fight against this chronic disease is becoming more and more apparent. In order to lose weight it is necessary to achieve negative energy balance either by increasing physical activity or using a low calorie diet. When these methods are ineffective, pharmacotherapy is used. The criterion for the application of medical treatment is a BMI above 30 kg/m2 or above 27 along with the presence of other risk factors. Drugs for weight loss fall into three groups: appetite inhibitors, those increasing energy expenditure by enhancing thermogenesis and those inhibiting the absorption of food in the intestines. This paper presents an overview of these classes of drugs and dietary supplements with an emphasis on their adverse effects and the possibility of poisoning. Despite the fact that in Poland only one drug - orlistat has been registered for the treatment of obesity, the availability of other products is unlimited due to the Internet. This fact, and the tendency of patients to treat obesity by themselves using pharmacological substances, poses a major threat and a challenge to the toxicologist.

Due to increasing availability of methyl alcohol, methanol poisoning becomes more common. Consumption of even relatively small amounts can lead to very serious consequences, including irreversible damage to the eye and death. Quickly implemented proper treatment can alleviate the course of poisoning. Since the victims of poisoning often come to medical facilities unconscious, unresponsive, with unknown or incomplete medical history, it is crucial, both for toxicologists and emergency physicians, to consider the possibility of methanol or ethylene glycol poisoning. It is important to be able to recognize the symptoms of such a poisoning and to order appropriate laboratory tests, especially arterial blood gas and if necessary serum concentrations of methanol and ethylene glycol. The article discusses the course of methanol poisoning, various diagnostic methods of detecting methyl alcohol and factors that affect the methanol concentration in serum. Two clinical cases of patients with non-respiratory acidosis and hyperglycemia, the presence of methanol determined by spectrophotometric method and no methanol intake in anamnesis were also presented. We are considering the possibility of false positive results of methanol determination in the course of diabetic ketoacidosis and significant hyperglycemia.

Gammabutyrolactone is included in the solvent such as wheel cleaners, pesticides, cosmetics, drugs. After ingestion GBL is converted to gamma-hydroxybutyrate. Both substances are classified as so called "club drugs" and their action is characterized by euphoria, sedation, and induction of retrograde amnesia of events. These activities were basis for the use of GHB and its lactone as rape pill. Acute poisoning with these compounds causes confusion, agitation, ataxia, nausea, vomiting, nystagmus, dyskinesia, hallucinations, coma, irregular breathing, hypothermia, bradycardia, hypotension, convulsions, respiratory paralysis and thus respiratory arrest. These substances carry a risk of development of physical addiction of the hard proceeding of abstinence syndrome. In the USA there is a ban on the sale and promotion of these compounds. In Poland despite the fact that GHB is a controlled substance, there is no regulation of GBL trading. The aim of this paper is to summarize current knowledge regarding the pharmacology, impact on the human body, toxicity, and the effects of chronic abuse of these substances.

Pulmonary edema is a severe, potentially fatal clinical condition. It happens, when interstitial fluid is accumulating in the alveoli, impeding proper gas exchange. Typically we distinguish cardiogenic and noncardiogenic pulmonary edema. The article describes the case of severe pulmonary edema, which occurred in a young woman, free of cardiac diseases, about 30 hours after a suicidal drug poisoning (clozapine, ketoprofen, thiethylperazine). Both clozapine and ketoprofen intoxication, may be severe. Complications in these poisonings affect not only the central nervous system, but also the circulatory or respiratory system and may even occur several hours after the overdose of these drugs. The study considered the causes and possible mechanisms of pulmonary edema in poisoning with these drugs.

Rhabdomyolysis and associated kidney failure is a medical problem, often faced by doctors working in the centers of toxicology. Its most common cause is mechanical damage to the muscles, but predisposing factors include a big group of other pathologies and clinical conditions, including: electrolyte imbalance, immobility, infections, drug or psychoactive substances poisoning. The article presents an example of a patient with severe rhabdomyolysis syndrome caused by an alcohol withdrawal syndrome. Based on our experience and scientific studies of other clinical centres the paper presents various causes of muscle damage, including the iatrogenic effects of ethanol intoxication treatment. The article explains the importance of a proper and quick treatment which prevents damage of internal organs, including kidney failure.

Doxepin is a tricyclic antidepressant from the group of dibenzoxepines. Apart from the antidepressant effect, it has also the sedative and anxiolytic effect, so it is used in the treatment of anxiety disorder in the course of psychosis, organic diseases and alcoholism. Doxepin increases concentration of norepinephrine and serotonin in the brain by preventing inactivation and blocking their reuptake. In addition, the drug has an antagonistic effect on receptors in CNS (muscarinic M1, histamine H1, alpha-1adrenergic, serotonergic 5-HT2) and also blocks sodium and potassium channels in cardiomyocytes. In this paper we present a case of severe poisoning by various drugs, including doxepin. The dominating symptom was prolonged toxic coma. Slow return of consciousness was observed from the fifth day after intoxication, logical verbal contact with the patient was possible on the seventh day. It seems that this symptom results from the pharmacokinetic properties of doxepin as well as the high drug dose and a synergistic effect of lorazepam and phenobarbital. Transient anisokoria was an unusual symptom that appeared in the course of intoxication. The patient was examined by a neurologist and underwent CT of the head twice - no organic causes were revealed. This phenomenon can be explained by physiological anisokoria, caused by asymmetry in the sympathetic innervation of pupil rectractor muscle, exacerbated by a complete parasympathetic conduction block as a result of anticholinergic action of doxepin. Tricyclic antidepressants are often used by patients for the purpose of suicide. Because of the serious cardiological and neurological symptoms the course of doxepin intoxication may be severe.

Silibinin is the most active component of a complex of flavonoids -silymarin contained in fruit milk thistle (Sylibum marianum). Its mechanism of action is complex and highly beneficial in protecting hepatocytes. On the one hand this compound blocks the penetration of various toxins (for example amanitin) into the hepatocytes not allowing in this way for the cell death and on the other hand, it prevents apoptosis through intracellular. It protects the liver from oxidative intracellular free radicals by increasing the activity of enzyme superoxide dismutase and peroxidase, as well as by increasing the concentration of glutathione and the activity of the peroxidase. Silibinin strengthens and stabilizes the cell membranes, inhibits the synthesis of prostaglandins associated with the lipid peroxidation and promotes regeneration of liver through the stimulation of protein synthesis and effect on the production of new hepatocytes. A particularly interesting topic from the perspective of a toxicologist is the application of silibinin in Amanita phalloides poisoning. Clinical trials conducted in this respect are very encouraging. The other beneficial application of silibinin is in therapy of the alcoholic liver cirrhosis. The evidence shows that the use of silymarin leads to a significant reduction in liver-related mortality and even reduction in the number of patients with encephalopathy in the course of the disease. Application of silibinin goes beyond liver disease and expands in the direction of cancer and even diabetes. What is interesting is the fact, that the substance of herbal origin occurring in the environment is so strong, favorable, beneficial and multidirectional. Science has contributed to improving the bioavailability of silibinin thus making it more effective.

Exposure to carbon monoxide (CO) accounts for a frequent cause for patient hospitalization in the Children's Clinical Hospital (DSK). The most common source of exposure includes the use of defective heating appliances operating on gas or coal and less frequently the fire toxic fumes. The purpose of the present study was to estimate the number of hospitalized patients in DSK in Lublin between the years 2006-2012 according to age, sex, urban-rural residence, season, carboxyheamoglobin (COHb) levels and hospitalization period. The subjects were assigned to three age groups: I - neonates and infants, II - children from 1 to 6 years of age, III - children aged between 7 to 17 years. In total 99 patients (50 female, 49 male) were admitted to hospital on account of carbon monoxide intoxication. Children aged 6 years and above constituted the most numerous age group. Furthermore 1 neonate and 5 infants (6.1%) and 43 children aged 1 to 6 years (43.4%) were hospitalized. The intoxications were visibly season-related. The highest frequency of CO poisoning lasted from October until March. The largest incidence was recorded in December and January. The majority of the children were urban residents - 67%, 33% were from rural areas. Carboxyhaemoglobin levels upon admission ranged from 0 to 26.7%. The average hospitalization lasted 2.4 days. Carbon monoxide intoxication remains a pressing health concern. The awareness of CO intoxication hazards among general public, application of appropriate first aid techniques, identification of clinical symptoms and treatment methods present the opportunity to save lives and reduce the long-term effects of CO poisoning.

These days young people use internet as a source of information. Internet offers knowledge that can be used not only for school education but also to obtain information about usage and effects of psychoactive substances. Recent research shows that young people more often use internet websites and chat rooms to exchange knowledge and experience with chemicals and everyday products used as intoxicants, for example: nutmeg, nonprescription medications, metal cleaning liquid or feminine hygiene products. This article shows the extend of knowledge young people can gain from popular internet websites. Information on the web is presented as appealing, attractive and encouraging. From a toxicologist point of view it is extremely important to be familiar with those new threats because more and more often we have to treat young patients with a serious poisoning from usage of experimental intoxicating substances.

Sodium azide poisonings are a rare reason for hospitalization in toxicological units. They are observed as rarely as once within a number of years per hospital. Consequently, an algorithm for the optimum procedure of treating such intoxications does not exist and, as a result, there is a need to describe every single clinical case. A female, aged 55, was directed to the toxicological unit from a county hospital after swallowing four tablets of sodium azide, 150 mg each, in the form of preservative for fresh milk samples. Two hours after the incident a gastric lavage was performed and the tableting blend was retrieved. In the clinical examination higher concentration of lactic acid, ALAT and TSH were observed. In the ECG record unspecific aberrations in the ST segment were noticed. Due to the patient's general good condition and the fact that the tableting blend had been retrieved from the gastric rinse, further use of the antidote indicated in the therapy of cyanide intoxications was abandoned. Symptomatic treatment was used along with the patient's eight-day observation. In the described case the early decontamination prevented the development of acute poisoning.

The following paper describes the case of the 59-year-old patient moved from Clinical Cardiology to the Centre of Clinical Toxicology because of severe ethylene glycol poisoning, which occurred in the course of myocardial infarction of inferior wall. Ethylene glycol concentration was 85 mg/dl, the blood pH - 6.9, troponin >50 ng/ml, CK-MB 297.1 U/L. ECG current of injury was found at the bottom of the wall cuts reflective reductions in section ST in leads I, aVL and the precordial leads. In the coronarography was RCA occlusion, OM critical stenosis and suspected mouth of LAD stenosis. RCA urgent angioplasty was performed with implantation of bare metal stents 5. In addition, toxicological treatment consisted of mechanical ventilation, hemodialysis, ethanol, and intensive medical care. On 19 day of hospitalization the patient in good general condition was discharged home.

This paper describes a case of now 49-year-old patient with alcohol dependence syndrome, hospitalized three times in the Center of Clinical Toxicology in 2009-2012 due to ethylene glycol poisoning. Twice, the course of poisoning was defined as severe. It was complicated by respiratory failure, severe metabolic acidosis, renal failure, disorders of the central nervous system; once referred to it as a medium, complicated by renal failure. He was treated with ethyl alcohol as an inhibitor of alcohol dehydrogenase, hemodialysess and intensive symptomatic and supportive therapy. This paper shows the great effectiveness of early hemodialysis and intensive therapy even in case of multiple and severe intoxication with toxic alcohols.

Tako-tsubo cardiomyopathy is a clinical syndrome induced by a strong mental or physical stress, characterized by a transient hypokinesia, akinesia or dyskinesia middle segments of the left ventricle and apical, with associated electrocardiographic changes of ST-T segment like in acute coronary syndrome, with no significant changes in coronary arteries in coronary angiography. Tako-tsubo cardiomyopathy is mainly found in women in the sixth and seventh decade of life and represents 1-2% of cases originally diagnosed as acute coronary syndrome. We present a case of tako-tsubo syndrome in the course of carbon monoxide poisoning in a 56-year-old patient, with a positive history of ischemic heart disease and hypertension. Moreover, the reasons for its occurrence were considered based on clinical course, laboratory tests and imaging, and available literature.

Rivaroxaban and dabigatran are the new anticoagulant drugs--factor Xa and IIa inhibitors. Recently registered in atrial fibrillation and venous thromboembolic disease became the serious competition to other anticoagulants. Blood coagulation parameters do not need to be monitored which can be seen as a huge advantage. At the same time their effectiveness in thromboembolic incidents prevention is comparable and the risk of serious hemorrhage is even lower comparing to therapy with vitamin K antagonists. Concerns arose around the fact that for the time being there is no effective antidote in case of intoxication and no possibility of quick reversal in case of hemorrhage or surgery. The purpose of this paper is to summarize current knowledge regarding the safety of new anticoagulants, and to answer the question--are we really prepared for them?

Doctors of many specialties, including the family doctors, encounter the problems of alcohol abuse in their patients. Due to the fact that many symptoms of dangerous diseases can be masked by the fact of alcoholism, a brief doctor's visit has to be conducted with watchfulness, caution and care. Family doctors have some brief testes (such as CAGE test, AUDIT test), besides of precise anamnesis and blood chemistry, which make it easier to identify a patient with an alcohol problem. People with disabilities are more exposed to alcohol abuse since they often experience additional factors such as unemployment, social isolation and homelessness. All of the above factors foster the more frequent alcohol usage. In Poland the main treatment method of alcohol addiction is psychotherapy practiced in the rehab centers. The detoxification treatment is voluntary and free of charge even though the patients checking into those facilities are doing it against their will. They are forced to do so by entourage, family, spouse or risk of unemployment. Acamprozate is considered as a drug, run to extend abstaining from alcohol. In the past, therapy with disulfiram substance was common, but now, it is considered as unethical behaviour. In practice of medicine, a patient with alcohol addiction creates not onlya medical but also legal problems. Therefore keeping of detailed medical documentation is very important as it may become significant evidence in the future.