Introduction: Tacrolimus (TAC) metabolism rate has the potential to impact graft function after kidney transplantation (KTx). We aimed to analyze the relationship between the early post-KTx TAC C/D ratio (blood trough concentration normalized by total daily dose) and kidney graft function in a 2-year follow-up. Methods: We retrospectively analyzed data from 101 post-KTx patients at 3, 6, 12, and 24 months after KTx to identify the C/D ratio cutoff value optimal for dividing patients into fast and slow TAC metabolizers. We investigated the relationship between their TAC metabolism rate and graft function. Results: Patients were divided based on the TAC C/D ratio at 6 months after KTx of 1.47 ng/mL * 1 mg. Fast metabolizers (C/D ratio <1.47 ng/mL * 1 mg) presented with significantly worse graft function throughout the whole study period (p < 0.05 at each timepoint) and were significantly less likely to develop good graft function (estimated glomerular filtration rate ≥45 mL/min/1.73 m2) than slow metabolizers. Our model based on donor and recipient age, recipient sex and slow/fast metabolism status allowed for identification of patients with compromised graft function in 2-year follow-up with 66.7% sensitivity and 94.6% specificity. Conclusion: Estimating TAC C/D ratio at 6 months post-KTx might help identify patients at risk of developing deteriorated graft function in a 2-year follow-up.

Objective: Success in treatment with hemodialysis (HD) and kidney transplantation (KTx) requires good adherence. The objective of this study was to evaluate adherence to pharmacotherapy and health recommendations among HD and KTx patients using subjective and objective measures.Methods: Two hundred thirty-nine enrolled patients, with 132 KTx (39F, 93M) and 107 HD (48F, 59M) completed a questionnaire regarding over-the-counter (OTC) medications and dietary supplements (DS), adherence to pharmacotherapy, lifestyle recommendations, and self-evaluation of knowledge on them. The surveys were supplemented with objective data from patients' medical records, including interdialytic weight gain and laboratory parameters.Results: About 42.1% HD and 39.4% KTx patients reported using OTC medications without medical consultation (P 5 .677); 43.9% HD and 31.1% KTx used DS (P 5 .040); more HD than KTx failed to notify a doctor about it (52.2% vs. 21.4%; P , .001). More HD patients skipped medication doses (33.6% vs. 9.7%; P , .001). About 40.2% HD and 20.5% KTx patients drank alcohol (P , .001), 22.4% HD and 10.5% KTx smoked (P 5 .013). About 46.7% HD and 66.4% KTx patients limited their caloric intake (P 5 .002), 73.8% HD and 84.9% KTx limited their salt intake (P 5 .030). HD patients drank 1.17 6 0.57 L of fluids daily and KTx drank 2.51 6 0.67 L (P , .001). In HD patients, interdialytic weight gains positively correlated with dialysis vintage (R 5 0.26, P 5 .02) and fluid (R 5 0.28, P 5 .011) but not salt intake (P 5 .307). The variability of trough levels of calcineurin inhibitors was unrelated to use of DS or OTC medications. KTx rated their knowledge on recommendations higher compared with HD (mean score 4.0 6 1.0 vs. 3.7 6 1.0, P 5 .040).Conclusion: KTx recipients exhibit better adherence and rate their knowledge on recommendations higher than HD patients.

An increasing number of people, students in particular, seek substances that improve their cognitive functioning. The most popular group of pharmacological cognitive enhancers (PCEs) are stimulants. Available studies suggest a small beneficial effect of methylphenidate and amphetamine on memory, executive functions, and processing speed. However small, this effect can make the difference between success and failure. In recent years, research has focused on the additional beneficial effect on the emotional state, increased motivation, and placebo-induced cognitive enhancement. This paper briefly reviews the latest and most important research on the relationship between popular stimulants and cognitive enhancement. One cannot understand this relationship without understanding the Yerkes-Dodson law, which explains the relationship between the degree of arousal and performance. It suggests that the effect of stimulants is a dose-dependent continuum. This law has repeatedly been confirmed by studies in which an optimal level of psychoactivation for cognitive enhancement was obtained with low stimulant doses, whereas exceeding the effective dose resulted in cognitive deficits, psychomotor agitation, and addiction. A separate section has been devoted to modafinil, an increasingly popular stimulant that differs from the rest in neurochemical profile and behavioural effects.

INTRODUCTION.In Poland, an increasing number of psychoactive substances are becoming prohibited by law as psychotropic or narcotic substances, or as new psychoactive substances (NPSs). Owing to the enormous technological possibilities offered by today's science, synthesis of new derivatives of prohibited compounds is no longer a problem. The moment a dangerous substance is outlawed, new designer drugs (in Poland known as ‘dopalacze’) appear on the market. STATE OF KNOWLEDGE.An amendment to the Act on Counteracting Drug Addiction issued in July 2018 made it possible for the NPS to be considered drugs by law. Synthetic cannabinoids and cathinone derivatives make up the majority of NPSs identified by the authorities in Poland. Synthetic cannabinoids which can, unlike cannabinoid receptor agonists of plant origin, cause death by somatic toxicity, are particularly dangerous. The ability to quickly recognize poisoning with synthetic opioids is crucial, since an antidote reversing the depressive effect of opioids on the respiratory center can be administered. SUMMARY.This work collects the most important and up-to-date information on designer drugs, based on reports and articles published between 2015 and 2019. The covered aspects include: the current definition of designer drugs in relation to the Polish law, their exact division due to the clinical effects they cause and the description of the threats they pose. Emphasis was given to the current situation of the designer drug market in Poland.

(1) Patients on chronic hemodialysis (HD) experience impaired quality of life (QoL). We analyzed HD’s relationship with physical performance, body composition, and muscle strength; (2) QoL was assessed with the Short Form-36, composed of physical (PCS) and mental (MCS) health dimensions. Physical performance was assessed with the Short Physical Performance Battery (SPPB), body composition (lean tissue mass% (LTM%), fat tissue mass% (FTM%), and skeletal muscle mass% (SMM%)) was assessed with bioelectrical impedance, and lower extremity strength was assessed with a handheld dynamometer; and (3) we enrolled 76 patients (27 F, 49 M), age 62.26 ± 12.81 years, HD vintage 28.45 (8.65–77.49) months. Their QoL score was 53.57 (41.07–70.64); their PCS and MCS scores were 52.14 (38.69–65.95) and 63.39 (44.64–76.79) and strongly correlated (p < 0.0001, R = 0.738). QoL correlated positively with SPPB (R = 0.35, p ≤ 0.001), muscle strength (R from 0.21 to 0.41, p < 0.05), and LTM% (R = 0.38, p < 0.001) and negatively with FTM% (R = −0.32, p = 0.006). PCS correlated positively with SPPB (R = 0.42 p < 0.001), muscle strength (R 0.25–0.44, p < 0.05), and LTM% (R = 0.32, p = 0.006) and negatively with FTM% (R = −0.25, p = 0.031). MCS correlated positively with SPPB (R = 0.23, p = 0.047), SMM% (R = 0.25; p = 0.003), and LTM% (R = 0.39, p < 0.001) and negatively with FTM% (R = −0.34; p = 0.003). QoL was unrelated to sex (p = 0.213), age (p = 0.157), HD vintage (p = 0.156), and BMI (p = 0.202); (4) Better physical performance, leaner body composition, and higher muscle strength are associated with better mental and physical QoL in HD.