Objective: The optimal corticosteroid treatment regimen for subacute thyroiditis has not yet been established. To avoid side-effects, tapering of the initial dose of corticosteroid is recommended. ...With reducing dose, the symptoms can recur. Design: In a prospective clinical study, a 30-day methylprednisolone (MPSL) treatment protocol with a starting dose of 24 mg/day and tapered by 4 mg every 5 days was assessed for effectiveness and safety regarding possible adrenal insufficiency. Methods: Fifty-nine patients with subacute thyroiditis were included. At visit 1, after establishing the diagnosis, a short stimulation ACTH test was performed and methylprednisolone treatment prescribed. At visit 2 (40±5 days after visit 1), clinical, laboratory (including short stimulation ACTH test), and ultrasound evaluation were repeated. Results: Forty-eight patients (81.4%) were cured by the prescribed protocol, having significantly lower cortisol levels after stimulation at visit 1 than patients who were not cured (mean, 674.9 nmol/L and 764.0 nmol/L, respectively, p=0.012). Seven patients (12.3%) developed adrenal insufficiency; this group had significantly lower cortisol level after stimulation at visit 1 than patients who did not (mean, 561.5 nmol/L and 704.7 nmol/L, respectively, p=0.005). Using stimulated cortisol level at visit 1 as the explanatory variable, logistic models were optimized to determine treatment efficacy (AUC=0.745, optimal threshold 729 nmol/L, specificity 71%, sensitivity 73%), and adrenal function (AUC=0.861, optimal threshold 629 nmol/L, specificity 73%, sensitivity 100%). Conclusions: The described protocol was efficient for more than 80% of patients. Using this protocol, the corticosteroid treatment interval is shorter than proposed in current guidelines.
Amanita muscaria contains more excitatory ibotenic acid and less depressant muscimol compared to Amanita pantherina. In this study A. muscaria poisoned patients were more often confused (26/32, ...p = 0.01) and agitated (20/32, p = 0.03) compared to those poisoned with A. pantherina (8/17 and 5/17). Patients poisoned with A. pantherina were more commonly comatose (5/17) compared to those poisoned with A. muscaria (2/32) (p = 0.03). In conclusion, the so-called ibotenic or pantherina-muscaria syndrome might be divided into two subtypes.
•In neurological symptoms Amanita muscaria or pantherina poisoning should be considered.•A. muscaria results more often in confusion and agitation.•Amanita pantherina causes coma more often.•Pantherina-muscaria or ibotenic syndrome might be divided into two subtypes.
Occupational exposure to ionizing radiation for medical workers Background: Health workers in some diagnostic and therapeutic procedures are exposed to low doses of ionizing radiation. Chronic ...exposure to low doses of radiation can have many negative consequences on the human health, such as cataracts and, among the most serious consequences, the increased risk of morbidity for certain types of cancer. Guidelines for the safety of working with radiation sources and the legislation aim to reduce workers' exposure to ionizing radiation to the lowest as reasonably achievable. This article focuses on the presentation and discussion of the effective annual doses for the period from 2006 to 2010 received by Slovenian health care workers exposed to the artificial sources of ionizing radiation. Methods: We obtained personal dosimetry data from 2006 to 2010 collected by the Slovenian Radiation Protection Administration (SRPA). Results: The effective annual dose limit in Slovenia is 20 mSv. The annual dose received by health workers did not exceed 9.99 mSv in any group and in most groups, more than 95 % of doses were in the dose area below 1 mSv (in nuclear medicine and brachytherapy, around 80 %). The average doses for the period from 2006 to 2010 are 0.47 mSv for nuclear medicine, 0.19 mSv for interventional radiology, 0.09 mSv for other radiology, 0.10 mSv for brachytherapy, 0.07 mSv for teleradiotherapy, 0.05 mSv for dental medicine and 0.02 mSv for other employees in medicine. Conclusions: In the last five years, health workers in Slovenia received some ten times less effective annual doses than the effective annual dose limit prescribed by law, which is comparable to the developed world. PUBLICATION ABSTRACT
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