Our observation of a distinctive extrapyramidal syndrome, changes in the MRI signal in the basal ganglia, and elevated blood manganese levels in methcathinone users suggests that manganese in the methcathinone solution causes a persistent neurologic disorder.

No improvement in this Mn-induced movement disorder occurs after cessation of methcathinone abuse despite improvement of Mn blood levels and/or MRI abnormalities. Ultrastructural abnormalities in a former user confirm structural damage to white matter is associated with the disorder. Methcathinone/Mn toxicity is an important, disabling and permanent medical sequel of intravenous drug abuse in the former Soviet Union.

Introduction: Human immunodeficiency virus (HIV)/hepatits C virus (HCV) co-infection has a significant impact on liver-related morbidity and mortality. Among many other pathogenic mechanisms leading to accelerated hepatic disease are liver fibrosis and hepatocyte apoptosis. Hence the objective of this investigator-initiated cross-sectional study was to analyse the plasma levels of hyaluronic acid, cytokeratin-18, and cytochrome c in order to assess their impact on progression of liver disease in patients with HIV/HCV co-infection comparing to those with HIV mono-infection. Material and methods: There were 80 patients with HIV infection included in the study. HCV co-infection was in 46 (57.5%) patients and HIV mono-infection in 34 patients. Blood levels of hyaluronic acid were tested using a Hyaluronic Acid test Kit, cytokeratin-18 neoepitope levels using M30-Apoptose ELISA test, and cytochrome c using human Cytochrome c ELISA test. Results: The levels of cytokeratin-18 and of hyaluronic acid were significantly higher in the group of patients with HIV/HCV co-infection. The differences in the level of cytochrome c were not significant. The analysis revealed that the main effect of HCV co-infection on the level of cytokeratin-18 is indirect. It is mediated by the level of hyaluronic acid. Conclusions: The progression of liver disease in patients with HIV/HCV co-infection is more pronounced compared to those with HIV mono-infection. It is shown by the higher plasma levels of hyaluronic acid, which is a relevant liver fibrosis marker and hepatocyte apoptosis marker cytokeratin-18 in patients with HIV/HCV co-infection. The hyaluronic acid level is important in assessing the impact of HCV co-infection on liver apoptosis.

Cytokeratin 18 (CK18) is a specific marker of hepatocellular apoptosis, which is a useful noninvasive indicator of liver fibrosis in the HIV/HCV group. However, data on the CK18 level in serum are limited for this group. This study demonstrated CK18 levels in serum in HIV/HCV co-infected and HIV mono-infected patients; investigated the association of CK18 levels with other non-invasive markers of liver fibrosis; and presents CK18 dynamics in a four-month-long period. The sample included 273 patients with HIV infection (128 of them were with HIV/HCV co-infection) aged from 23 to 65 (35% females). Levels of hyaluronic acid, CK18, ALT, and AST were determined in serum, and the FIB4 index was calculated. All markers had higher levels in the HIV/HCV group than in the HIV mono-infection group. The HIV/HCV group demonstrated coherent correlations among the markers and their associations with the level of CK18 than the HIV mono-infection group. During the four-month-long period, the CK18 level in serum showed no significant changes.

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