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Authors = Magdalena Bujalska-Zadrozny

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11 pages, 611 KiB  
Article
Temporal Changes in Lead and Cadmium Levels in Amanita muscaria Samples Collected in Poland
by Michal Ordak, Aleksandra Galazka, Pawel Konieczynski, Marek Wesolowski, Alina Plenis, Elzbieta Muszynska, Przemyslaw Kurowski and Magdalena Bujalska-Zadrozny
Toxics 2025, 13(2), 101; https://doi.org/10.3390/toxics13020101 - 27 Jan 2025
Viewed by 1782
Abstract
In recent years, an increasing popularity of consuming Amanita muscaria has been observed in Poland, aimed at reducing various medical symptoms. However, there is a lack of data regarding the impact of variations in the content of toxic elements, such as cadmium (Cd) [...] Read more.
In recent years, an increasing popularity of consuming Amanita muscaria has been observed in Poland, aimed at reducing various medical symptoms. However, there is a lack of data regarding the impact of variations in the content of toxic elements, such as cadmium (Cd) and lead (Pb), in Amanita muscaria collected during late summer and mid-fall. The aim of this study was to determine the concentrations of Pb and Cd in Amanita muscaria samples collected at different times of the year, compare the concentrations of these elements in samples with and without cap skin, and compare the obtained values to permissible limits in dietary supplements. A total of 44 Amanita muscaria samples were collected during three different harvesting periods (August, September, and October 2023) from Puszcza Biała, located approximately 80 km from Warsaw. The mushrooms were subjected to mineralization using concentrated nitric acid and hydrogen peroxide, followed by the determination of Pb and Cd concentrations using an atomic absorption spectrometer. Significant statistical differences were found in the Pb concentrations of samples collected in three different seasons (η2 = 0.67, p < 0.001), with the concentration increasing progressively, reaching its highest value in October. Similarly, the Cd concentration also increased in the later collections, although the effect of time was weaker (η2 = 0.13, p = 0.03). No significant differences were observed in Pb and Cd concentrations between samples with and without cap skin. The average Cd concentrations in mushrooms were significantly higher than the permissible levels in dietary supplements; they were four times higher in August (p < 0.001), six times higher in September (p < 0.001), and nine times higher in October (p < 0.001). The Pb concentration in the October samples was close to the permissible limit but did not exceed it in a statistically significant manner (p = 0.85). Due to the high Cd concentrations and potentially hazardous levels of Pb, the consumption of Amanita muscaria carries a significant risk of toxicity, which may lead to serious health hazards, particularly in the context of prolonged exposure. Full article
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16 pages, 251 KiB  
Review
Clinical and Genetic Insights into Desbuquois Dysplasia: Review of 111 Case Reports
by Hubert Piwar, Michal Ordak and Magdalena Bujalska-Zadrozny
Int. J. Mol. Sci. 2024, 25(17), 9700; https://doi.org/10.3390/ijms25179700 - 7 Sep 2024
Cited by 3 | Viewed by 1904
Abstract
Skeletal disorders encompass a wide array of conditions, many of which are associated with short stature. Among these, Desbuquois dysplasia is a rare but severe condition characterized by profound dwarfism, distinct facial features, joint hypermobility with multiple dislocations, and unique vertebral and metaphyseal [...] Read more.
Skeletal disorders encompass a wide array of conditions, many of which are associated with short stature. Among these, Desbuquois dysplasia is a rare but severe condition characterized by profound dwarfism, distinct facial features, joint hypermobility with multiple dislocations, and unique vertebral and metaphyseal anomalies. Desbuquois dysplasia is inherited in an autosomal recessive manner, with both the DBQD1 (MIM 251450) and DBQD2 (MIM 615777) forms resulting from biallelic mutations. Specifically, DBQD1 is associated with homozygous or compound heterozygous mutations in the CANT1 gene, while DBQD2 can result from mutations in either the CANT1 or XYLT1 genes. This review synthesizes the findings of 111 published case reports, including 54 cases of DBQD1, 39 cases of DBQD2, and 14 cases of the Kim variant (DDKV). Patients in this cohort had a median birth weight of 2505 g, a median length of 40 cm, and a median occipitofrontal circumference of 33 cm. The review highlights the phenotypic variations across Desbuquois dysplasia subtypes, particularly in facial characteristics, joint dislocations, and bone deformities. Genetic analyses revealed a considerable diversity in mutations, with over 35% of cases involving missense mutations, primarily affecting the CANT1 gene. Additionally, approximately 60% of patients had a history of parental consanguinity, indicating a potential genetic predisposition in certain populations. The identified mutations included deletions, insertions, and nucleotide substitutions, many of which resulted in premature stop codons and the production of truncated, likely nonfunctional proteins. These findings underscore the genetic and clinical complexity of Desbuquois dysplasia, highlighting the importance of early diagnosis and the potential for personalized therapeutic approaches. Continued research is essential to uncover the underlying mechanisms of this disorder and improve outcomes for affected individuals through targeted treatments. Full article
13 pages, 1004 KiB  
Article
Assessment Study of ChatGPT-3.5’s Performance on the Final Polish Medical Examination: Accuracy in Answering 980 Questions
by Julia Siebielec, Michal Ordak, Agata Oskroba, Anna Dworakowska and Magdalena Bujalska-Zadrozny
Healthcare 2024, 12(16), 1637; https://doi.org/10.3390/healthcare12161637 - 16 Aug 2024
Cited by 10 | Viewed by 2584
Abstract
Background/Objectives: The use of artificial intelligence (AI) in education is dynamically growing, and models such as ChatGPT show potential in enhancing medical education. In Poland, to obtain a medical diploma, candidates must pass the Medical Final Examination, which consists of 200 questions with [...] Read more.
Background/Objectives: The use of artificial intelligence (AI) in education is dynamically growing, and models such as ChatGPT show potential in enhancing medical education. In Poland, to obtain a medical diploma, candidates must pass the Medical Final Examination, which consists of 200 questions with one correct answer per question, is administered in Polish, and assesses students’ comprehensive medical knowledge and readiness for clinical practice. The aim of this study was to determine how ChatGPT-3.5 handles questions included in this exam. Methods: This study considered 980 questions from five examination sessions of the Medical Final Examination conducted by the Medical Examination Center in the years 2022–2024. The analysis included the field of medicine, the difficulty index of the questions, and their type, namely theoretical versus case-study questions. Results: The average correct answer rate achieved by ChatGPT for the five examination sessions hovered around 60% and was lower (p < 0.001) than the average score achieved by the examinees. The lowest percentage of correct answers was in hematology (42.1%), while the highest was in endocrinology (78.6%). The difficulty index of the questions showed a statistically significant correlation with the correctness of the answers (p = 0.04). Questions for which ChatGPT-3.5 provided incorrect answers had a lower (p < 0.001) percentage of correct responses. The type of questions analyzed did not significantly affect the correctness of the answers (p = 0.46). Conclusions: This study indicates that ChatGPT-3.5 can be an effective tool for assisting in passing the final medical exam, but the results should be interpreted cautiously. It is recommended to further verify the correctness of the answers using various AI tools. Full article
(This article belongs to the Special Issue Artificial Intelligence in Healthcare: Opportunities and Challenges)
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16 pages, 860 KiB  
Review
Magnetic Resonance Imaging and Manganism: A Narrative Review and Laboratory Recommendations
by Michal Majewski, Karolina Piwko, Michal Ordak, Elzbieta Muszynska, Tadeusz Nasierowski and Magdalena Bujalska-Zadrozny
J. Clin. Med. 2024, 13(10), 2823; https://doi.org/10.3390/jcm13102823 - 10 May 2024
Cited by 5 | Viewed by 2159
Abstract
In recent years, a series of articles has been published concerning magnetic resonance imaging (MRI) studies in a group of patients exposed to manganism, specifically factory workers, welders, and individuals with liver diseases, as well as those abusing home-produced ephedrone. Some potential symptoms [...] Read more.
In recent years, a series of articles has been published concerning magnetic resonance imaging (MRI) studies in a group of patients exposed to manganism, specifically factory workers, welders, and individuals with liver diseases, as well as those abusing home-produced ephedrone. Some potential symptoms of manganese toxicity include motor disturbances, neurocognitive problems, sleep disorders, and psychosocial changes. Despite various publications on MRI research in individuals with an elevated risk of manganism, there is a noticeable absence of a comprehensive review in this field. The detection of the accumulation of manganese in the brain through MRI can confirm the diagnosis and guide appropriate treatment. Due to the high cost of determining manganese ion levels in biological material, an additional aim of the manuscript was to identify simple medical laboratory parameters that, when performed concurrently with MRI, could assist in the diagnosis of manganism. Among these types of parameters are the levels of bilirubin, magnesium, liver enzymes, creatinine, hemoglobin, and hematocrit. Full article
(This article belongs to the Section Clinical Neurology)
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33 pages, 1123 KiB  
Review
Advanced Biomarkers of Hepatotoxicity in Psychiatry: A Narrative Review and Recommendations for New Psychoactive Substances
by Aniela Golub, Michal Ordak, Tadeusz Nasierowski and Magdalena Bujalska-Zadrozny
Int. J. Mol. Sci. 2023, 24(11), 9413; https://doi.org/10.3390/ijms24119413 - 28 May 2023
Cited by 2 | Viewed by 3650
Abstract
One of the factors that increase the effectiveness of the pharmacotherapy used in patients abusing various types of new psychoactive substances (NPSs) is the proper functioning of the liver. However, the articles published to date on NPS hepatotoxicity only address non-specific hepatic parameters. [...] Read more.
One of the factors that increase the effectiveness of the pharmacotherapy used in patients abusing various types of new psychoactive substances (NPSs) is the proper functioning of the liver. However, the articles published to date on NPS hepatotoxicity only address non-specific hepatic parameters. The aim of this manuscript was to review three advanced markers of hepatotoxicity in psychiatry, namely, osteopontin (OPN), high-mobility group box 1 protein (HMGB1) and glutathione dehydrogenase (GDH, GLDH), and, on this basis, to identify recommendations that should be included in future studies in patients abusing NPSs. This will make it possible to determine whether NPSs do indeed have a hepatotoxic effect or whether other factors, such as additional substances taken or hepatitis C virus (HCV) infection, are responsible. NPS abusers are at particular risk of HCV infection, and for this reason, it is all the more important to determine what factors actually show a hepatotoxic effect in them. Full article
(This article belongs to the Special Issue Liver Diseases: From Bench to Bedside)
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10 pages, 1123 KiB  
Article
Reasons, Form of Ingestion and Side Effects Associated with Consumption of Amanita muscaria
by Michal Ordak, Aleksandra Galazka, Tadeusz Nasierowski, Elzbieta Muszynska and Magdalena Bujalska-Zadrozny
Toxics 2023, 11(4), 383; https://doi.org/10.3390/toxics11040383 - 17 Apr 2023
Cited by 10 | Viewed by 16137
Abstract
In recent months, there has been a new trend involving the consumption of Amanita muscaria. The aim of this article was to investigate the reasons for consumption, the form taken and the adverse symptoms that were indicated by those consuming Amanita muscaria [...] Read more.
In recent months, there has been a new trend involving the consumption of Amanita muscaria. The aim of this article was to investigate the reasons for consumption, the form taken and the adverse symptoms that were indicated by those consuming Amanita muscaria. After analysing 5600 comments, 684 people were included in the study, who, in social media groups such as Facebook, stated the purpose of consuming the mushroom (n = 250), the form of mushroom they were taking (n = 198) or the adverse symptoms they experienced (n = 236). The gender of the subjects differentiated the parameters analysed. In the study group of women, the main purpose of consuming Amanita muscaria was to reduce pain, as well as to reduce skin problems, while in men it was mainly to relieve stress, reduce the severity of depressive symptoms and reduce insomnia (p < 0.001). With regard to the form of mushroom ingested, tincture was predominant in the women’s study group, while dried was predominant in the men (p < 0.001). In terms of side effects, women reported primarily headaches, while men reported nausea, vomiting, abdominal pain and drowsiness (p < 0.001). Advanced research on Amanita muscaria should be carried out to make the community aware of the toxicity of this fungus. Full article
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17 pages, 1534 KiB  
Article
Mechanisms Underlining Inflammatory Pain Sensitivity in Mice Selected for High and Low Stress-Induced Analgesia—The Role of Endocannabinoids and Microglia
by Piotr Poznanski, Joanna Giebultowicz, Justyna Durdzinska, Tomasz Kocki, Mariusz Sacharczuk, Magdalena Bujalska-Zadrozny and Anna Lesniak
Int. J. Mol. Sci. 2022, 23(19), 11686; https://doi.org/10.3390/ijms231911686 - 2 Oct 2022
Cited by 4 | Viewed by 2288
Abstract
In this work we strived to determine whether endocannabinoid system activity could account for the differences in acute inflammatory pain sensitivity in mouse lines selected for high (HA) and low (LA) swim-stress-induced analgesia (SSIA). Mice received intraplantar injections of 5% formalin and the [...] Read more.
In this work we strived to determine whether endocannabinoid system activity could account for the differences in acute inflammatory pain sensitivity in mouse lines selected for high (HA) and low (LA) swim-stress-induced analgesia (SSIA). Mice received intraplantar injections of 5% formalin and the intensity of nocifensive behaviours was scored. To assess the contribution of the endocannabinoid system, mice were intraperitoneally (i.p.) injected with rimonabant (0.3–3 mg/kg) prior to formalin. Minocycline (45 and 100 mg/kg, i.p.) was administered to investigate microglial activation. The possible involvement of the endogenous opioid system was investigated with naloxone (1 mg/kg, i.p.). Cannabinoid receptor types 1 and 2 (Cnr1, Cnr2) and opioid receptor subtype (Oprm1, Oprd1, Oprk1) mRNA levels were quantified by qPCR in the structures of the central nociceptive circuit. Levels of anandamide (AEA) and 2-arachidonoylglycerol (2-AG) were measured by liquid chromatography coupled with the mass spectrometry method (LC-MS/MS). In the interphase, higher pain thresholds in the HA mice correlated with increased spinal anandamide and 2-AG release and higher Cnr1 transcription. Downregulation of Oprd1 and Oprm1 mRNA was noted in HA and LA mice, respectively, however no differences in naloxone sensitivity were observed in either line. As opposed to the LA mice, inflammatory pain sensitivity in the HA mice in the tonic phase was attributed to enhanced microglial activation, as evidenced by enhanced Aif1 and Il-1β mRNA levels. To conclude, Cnr1 inhibitory signaling is one mechanism responsible for decreased pain sensitivity in HA mice in the interphase, while increased microglial activation corresponds to decreased pain thresholds in the tonic inflammatory phase. Full article
(This article belongs to the Section Molecular Neurobiology)
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20 pages, 2484 KiB  
Article
Polypharmacotherapy in Psychiatry: Global Insights from a Rapid Online Survey of Psychiatrists
by Michal Ordak, Daria Tkacz, Aniela Golub, Tadeusz Nasierowski and Magdalena Bujalska-Zadrozny
J. Clin. Med. 2022, 11(8), 2129; https://doi.org/10.3390/jcm11082129 - 11 Apr 2022
Viewed by 2469
Abstract
In recent years, an increase in the problem of polypharmacotherapy in psychiatric patients has been observed, including the widespread problem of groups of people taking new psychoactive substances. One reason for this problem may be the poor knowledge of pharmacological interactions in psychiatry. [...] Read more.
In recent years, an increase in the problem of polypharmacotherapy in psychiatric patients has been observed, including the widespread problem of groups of people taking new psychoactive substances. One reason for this problem may be the poor knowledge of pharmacological interactions in psychiatry. The aim of this study was to explore the opinions and knowledge of psychiatrists from around the world on various aspects related to polypharmacotherapy. A total of 1335 psychiatrists from six continents were included in the study. The respondents’ opinion on the problem of hepatotoxicity in psychiatry was also examined. The greatest discrepancy among psychiatrists from different continents in the answers given concerned the definition of polypharmacotherapy (p < 0.001) and the approach to hepatotoxicity (p < 0.001). It is noteworthy that only about 20% of the psychiatrists surveyed (p < 0.001) believe that polypharmacotherapy is associated with a higher rate of patients’ hospitalisations. The most commonly used type of polypharmacy by psychiatrists was antidepressants and antipsychotics. Most of them also stated that polypharmacy was associated with reduced patient compliance with the doctor’s recommendations related to taking medications due to the increased complexity of the therapy. The continent that diversified the analysed questions to the greatest extent was Africa. Future educational activities for trainee psychiatrists should include more discussion of polypharmacotherapy in psychiatry. Full article
(This article belongs to the Special Issue Clinical Management of Substance Use Disorders: Future Trends)
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11 pages, 268 KiB  
Article
Psychoactive Substances Taken with Mephedrone and HCV Infection
by Michal Ordak, Tadeusz Nasierowski, Elzbieta Muszynska and Magdalena Bujalska-Zadrozny
J. Clin. Med. 2021, 10(15), 3218; https://doi.org/10.3390/jcm10153218 - 21 Jul 2021
Cited by 1 | Viewed by 2284
Abstract
Background: In recent years, the observed frequency of hospitalization of patients taking mephedrone with other psychoactive substances has increased. There are no data in the literature on the effect of mephedrone use on liver function in patients, including the frequency of HCV infection. [...] Read more.
Background: In recent years, the observed frequency of hospitalization of patients taking mephedrone with other psychoactive substances has increased. There are no data in the literature on the effect of mephedrone use on liver function in patients, including the frequency of HCV infection. We have analysed the impact of taking mephedrone together with other psychoactive substances on the incidence of HCV infection. We have also analysed the effect of taking mephedrone with heroin, alcohol, and benzodiazepines on liver enzyme levels. Methods: The study included patients taking mephedrone with: alcohol (n = 115), heroin (n = 85) and benzodiazepines (n = 130) hospitalized in 2010–2018. The control group consisted of patients addicted to alcohol (n = 180), heroin (n = 221) and benzodiazepines (n = 152). Clinical data and laboratory findings were collected from medical records. Results: Taking mephedrone together with benzodiazepines is a statistically significant predictor of HCV infection in this group of patients, OR (8.44); 95% CI 5.63–12.64; p < 0.001). A statistically significant interaction of the group with HCV infection was observed, i.e., for the level of alanine transaminase (p < 0.001) and aspartate transaminase (p < 0.001). Increased levels of liver enzymes in each of the studied groups was characteristic in patients with HCV infection (p < 0.001). Taking additional mephedrone by this group of patients did not increase the level of liver enzymes. Conclusion: HCV infection is a statistically significant factor affecting the increase in liver enzymes levels in the group of patients taking mephedrone. Full article
(This article belongs to the Special Issue Clinical Management of Substance Use Disorders: Future Trends)
12 pages, 1125 KiB  
Article
Increasing the Effectiveness of Pharmacotherapy in Psychiatry by Using a Pharmacological Interaction Database
by Michal Ordak, Tadeusz Nasierowski, Elzbieta Muszynska and Magdalena Bujalska-Zadrozny
J. Clin. Med. 2021, 10(10), 2185; https://doi.org/10.3390/jcm10102185 - 18 May 2021
Cited by 1 | Viewed by 2259
Abstract
Recent studies have shown that the knowledge of pharmacological interaction databases in global psychiatry is negligible. The frequency of hospitalizations in the case of patients taking new psychoactive substances along with other drugs continues to increase, very often resulting in the need for [...] Read more.
Recent studies have shown that the knowledge of pharmacological interaction databases in global psychiatry is negligible. The frequency of hospitalizations in the case of patients taking new psychoactive substances along with other drugs continues to increase, very often resulting in the need for polypharmacotherapy. The aim of our research was to make members of the worldwide psychiatric community aware of the need to use a pharmacological interaction database in their daily work. The study involved 2146 psychiatrists from around the world. Participants were primarily contacted through the LinkedIn Recruiter website. The surveyed psychiatrists answered 5 questions concerning case reports of patients taking new psychoactive substances along with other drugs. The questions were answered twice, i.e., before and after using the Medscape drug interaction database. The mean percentage of correct answers given by the group of psychiatrists who were studied separately in six individual continents turned out to be statistically significantly higher after using the pharmacological interaction database (p < 0.001). This also applies to providing correct answers separately, i.e., to each of the five questions asked concerning individual case reports (p < 0.001). Before using the drug interaction database, only 14.1% of psychiatrists stated that they knew and used this type of database (p < 0.001). In the second stage of the study, a statistically significant majority of subjects stated that they were interested in using the pharmacological interaction database from that moment on (p < 0.001) and expressed the opinion that it could be effective in everyday work (p < 0.001). Using a pharmacological interaction database in psychiatry can contribute to the effectiveness of pharmacotherapy. Full article
(This article belongs to the Special Issue Clinical Management of Substance Use Disorders: Future Trends)
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18 pages, 4557 KiB  
Article
Disulfiram Abrogates Morphine Tolerance—A Possible Role of µ-Opioid Receptor-Related G-Protein Activation in the Striatum
by Anna de Corde-Skurska, Pawel Krzascik, Anna Lesniak, Mariusz Sacharczuk, Lukasz Nagraba and Magdalena Bujalska-Zadrozny
Int. J. Mol. Sci. 2021, 22(8), 4057; https://doi.org/10.3390/ijms22084057 - 14 Apr 2021
Cited by 4 | Viewed by 3304
Abstract
One of the key strategies for effective pain management involves delaying analgesic tolerance. Early clinical reports indicate an extraordinary effectiveness of off-label disulfiram—an agent designed for alcohol use disorder—in potentiating opioid analgesia and abrogation of tolerance. Our study aimed to determine whether sustained [...] Read more.
One of the key strategies for effective pain management involves delaying analgesic tolerance. Early clinical reports indicate an extraordinary effectiveness of off-label disulfiram—an agent designed for alcohol use disorder—in potentiating opioid analgesia and abrogation of tolerance. Our study aimed to determine whether sustained µ-opioid signaling upon disulfiram exposure contributes to these phenomena. Wistar rats were exposed to acute and chronic disulfiram and morphine cotreatment. Nociceptive thresholds were assessed with the mechanical Randal-Selitto and thermal tail-flick tests. µ-opioid receptor activation in brain structures important for pain processing was carried out with the [35S]GTPγS assay. The results suggest that disulfiram (12.5–50 mg/kg i.g.) augmented morphine antinociception and diminished morphine (25 mg/kg, i.g.) tolerance in a supraspinal, opioid-dependent manner. Disulfiram (25 mg/kg, i.g.) induced a transient enhancement of µ-opioid receptor activation in the periaqueductal gray matter (PAG), rostral ventromedial medulla (RVM), hypothalamus, prefrontal cortex and the dorsal striatum at day 1 of morphine treatment. Disulfiram rescued µ-opioid receptor signaling in the nucleus accumbens and caudate-putamen 14 days following morphine and disulfiram cotreatment. The results of this study suggest that striatal µ-opioid receptors may contribute to the abolition of morphine tolerance following concomitant treatment with disulfiram. Full article
(This article belongs to the Special Issue Pharmacology of Chronic Pain Transmission and Its Modulation)
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17 pages, 2563 KiB  
Article
The Positive and Negative Outcome of Morphine and Disulfiram Subacute Co-Administration in Rats in the Absence of Ethanol Challenge
by Karolina Frączek, Agnieszka Kowalczyk, Martyna Pekala, Kaja Kasarello, Grażyna Sygitowicz, Dorota Sulejczak, Malgorzata Zaremba, Marek Konop, Malgorzata Frankowska, Malgorzata Filip, Magdalena Bujalska-Zadrozny and Patrycja Kleczkowska
Pharmaceutics 2021, 13(1), 29; https://doi.org/10.3390/pharmaceutics13010029 - 26 Dec 2020
Cited by 6 | Viewed by 3154
Abstract
Recently, a well-known anti-alcohol agent, disulfiram (DSF), has gain much interest, as it was found to be effective in the treatment of cocaine abusers, thus also giving hope for patients addicted to opioids and other illicit drugs. Therefore, this study was aimed to [...] Read more.
Recently, a well-known anti-alcohol agent, disulfiram (DSF), has gain much interest, as it was found to be effective in the treatment of cocaine abusers, thus also giving hope for patients addicted to opioids and other illicit drugs. Therefore, this study was aimed to investigate the possible outcome that might occur within the subacute co-administration of both morphine (MRF) and DSF in rats, but in the absence of ethanol challenge. As observed, intraperitoneal DSF dose-dependently enhanced MRF-mediated analgesia with the maximal efficacy at a dose of 100 mg/kg. Furthermore, MRF-induced tolerance and aggressive behavior were significantly reduced by DSF (100 mg/kg, i.p.) in comparison to MRF solely. Nonetheless, significant blood biochemical markers of hepatotoxicity were found (i.e., alteration in the levels of glutathione, blood urea nitrogen, etc.), following a combination of both drugs. Likewise, histological analysis of liver tissue revealed severe changes in the group of DSF + MRF, which includes swelling, cell death, damage to certain vessels, and hemorrhages into the liver parenchyma. Our findings indicate that DSF should be used with extreme caution, especially within the course of subacute concomitant use with MRF, as several possible side effects may take place. Full article
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