Advances in Respiratory Medicine-Aims and Scopes Update

Advances in Respiratory Medicine, which has been published by MDPI since 2022, serves as a platform for hosting pneumological studies [...].

Awareness and Attitude of Polish Gynecologists and General Practitioners towards Human Papillomavirus Vaccinations

Human papillomavirus (HPV) leads to diseases of the skin and mucous membranes of the anogenital and upper gastrointestinal tract, especially neoplasia. HPV vaccinations effectively protect against the development of HPV-related diseases. However, despite the wide availability of vaccination for patients, only a few percent of Polish children are vaccinated. The reasons for this are certainly complex. Therefore, the aim of the study was to evaluate gynecologists' and general practitioners' knowledge, awareness and attitudes towards HPV vaccination and analyze their opinions about the interest in HPV vaccinations among children and parents. An anonymous, voluntary, cross-sectional survey study was conducted among 300 Polish gynecologists and general practitioners. Participants were from a diverse group with a wide range of work experience and different workplaces. Most of the respondents (83%), especially the gynecologists (p = 0.03), declared informing and discussing with parents the HPV-related diseases and prevention methods. Only 8% of the participants reported a negative reaction from parents when talking about HPV vaccines. However, in practice, physicians very rarely recommend this vaccine. HPV vaccination was recommended more often by female physicians (p = 0.03), general practitioners (p < 0.001), physicians working over five years (p < 0.001), doctors who regularly vaccinated themselves against influenza (p = 0.01) and those who vaccinated their children against HPV (p =0.001). The availability of educational materials for parents and/or patients encouraged physicians to provide this information (p < 0.001). Polish gynecologists and general practitioners declared a positive attitude regarding HPV vaccines; however, they rarely recommended this vaccine. Physicians who vaccinate themselves against influenza and their own children against HPV are more likely to provide information and encourage HPV vaccination in others. Additionally, the availability of educational material for parents and adolescents plays an essential role in the popularization of this vaccination. Knowledge alone is not enough for physicians to recommend the vaccination to patients.

Knowledge and Awareness of Polish Parents on Vaccination against Human Papillomavirus

Background: Human papillomavirus (HPV) vaccinations are rare among Polish children, and the reasons are scant. The objective was to evaluate the knowledge, attitude and awareness of parents about HPV vaccination to investigate reasons for low HPV vaccination coverage. Methods: 387 parents of children hospitalized at the Children’s Hospital were asked to participate in an anonymous and voluntary survey study. Three hundred and two surveys were returned. Results: Only 54% of participants have heard about HPV, while 26% know that it is a sexually transmitted disease. According to 71% of responders, vaccines are generally effective, and 63% claim that they are safe. However, only 5% of daughters and 4% of sons are vaccinated against HPV. A total of 25% of parents spoke with their doctor about HPV-related diseases and prevention methods. A higher level of education (p = 0.01), knowledge of sexually transmitted diseases (p < 0.0001), perceiving vaccination as an effective and safe prophylactic method (p < 0.0001), and conversations with a doctor (p < 0.0001) are strong motivators to vaccinate children against HPV. This decision is free of religious beliefs, origin, age, gender and the number of children. Conclusions: Polish parents have a positive attitude towards vaccination. They recognize the limitations of their knowledge and express a desire to further it. Educational activity is an important element of physicians’ work.

Impact of inhalers used in the treatment of respiratory diseases on global warming

The term "carbon footprint" describes the emission of greenhouse gases into the environment as a result of human activities. The healthcare sector is responsible for 5-8% of the value of global greenhouse gas emissions, of which medical aerosols account for only 0.03% of the total emissions. The reduction of greenhouse gases, including those used for the production and use of medicinal products and medical devices, is part of the responsibilities that Poland and the respective countries should undertake in order to implement the assumptions of international law. At the level of medical law, this obligation correlates with the need to exercise due diligence in the process of providing health services, including the selection of low-emission medical products and devices (inhalers) and providing patients with information on how to handle used products and devices, with particular emphasis on those that imply greenhouse gas emissions. Pressurized metered dose inhalers (pMDI) containing the hydrofluoroalkane 134a demonstrate the largest carbon footprint, followed by a metered dose liquid inhaler and dry powder inhalers (DPI). The carbon footprint of DPI with a given drug is 13-32 times lower than it is in the case of the corresponding pMDI. Replacement of pMDI by DPI is one of the effective methods to reduce the carbon footprint of inhalers, and the replacement should be based on current medical knowledge. A recycling system for all types of inhalers must be urgently implemented.

Awareness of Polish physicians regarding the impact of air pollution on health

The air quality in Poland is the worst in Europe. The aim of the study was to assess the awareness of Polish physicians about the impact of air pollution on health, the sources of their knowledge and how this knowledge is used in clinical practice. The study was based on a voluntary and anonymous questionnaire and included 94% of doctors from a hospital in Warsaw. Only 25% of physicians think that their knowledge of the impact of air pollution on health is sufficient. The main sources of this knowledge were the internet and TV. Only 5% of physicians know what air pollution concentrations are acceptable, 17% follow the levels of air pollution in their region and 3% inform their patients when air pollution exceeds permissible limits. The older and noninterventional physicians inform patients more often about these dangers. The knowledge of physicians on air pollution is not sufficient and they need professional education in this area.

Human papillomavirus vaccination - limatations and opportunities in countries with low vaccine coverage

Persistent infection with oncogenic Human papillomavirus (HPV) types can lead to neoplasms involving urogenital and laryngeal tumors, which account for approximately 5% of all cancers worldwidely. Effective measures to reduce the morbidity and mortality associated with HPV cancers are regular examinations including the Papanicolaou test and preventive vaccination. However, despite the registration of the first HPV vaccine already in 2006, there is still huge disparity in the vaccination coverage between countries. In Poland, vaccination coverage is still very low in comparison to other European Union countries (only a few percent). Constraints exist on the part of the state and health system organizations, as well as in the attitudes of health professionals and parents. One of the primary factors influencing the decision to vaccinate against HPV is the presence of the vaccine in The National Immunization Program, while often with financial support. Formalization of vaccination also forces physicians to be more attentive to informing and recommending immunization, increasing their level of education. The role of medical workers is crucial from a social point of view. For parents, an adequate discussion with the physician is a vital factor influencing HPV vaccination decisions. At the same time, health care workers express the need to change their work organization due to insufficient time for health promotion and prophylaxis during visits. A thorough understanding of the barriers can allow for the development of effective strategies to increase vaccination coverage.

Factors Affecting Influenza Vaccination Rate in Adults with Asthma

Asthma is considered one of the most common noncommunicable diseases worldwide, with an incidence of 5.4% in the Polish, adult population. Symptoms of the disease can be triggered or worsened by a variety of factors including viral infection such as influenza, affirming the necessity for prophylactic vaccination. However, there is concern among the general population of the possibility of anaphylactic response to vaccination, which can deter patients with allergic asthma for fear of triggering exacerbation of their condition. The objective of the study was to determine the extent to which patients with asthma adhere to a schedule of recommended vaccinations in Poland. Two hundred fourteen patients were recruited from specialist outpatient clinics in Warsaw to complete voluntarily an anonymous questionnaire created for the purpose of this study. Within the past year, 82% stated having at least one respiratory infection, and 72% of patients were aware of the recommendation for annual vaccination against the flu. Forty-three percent of patients reported receiving the flu vaccine at least once, and only 20% followed through with annual vaccination. The most common sources of information about the importance of annual flu vaccination were from their doctors (47%) and the media (26%). Relatively few asthmatic patients in Warsaw get annual flu vaccinations despite the recommendations. These results were mainly sourced due to uncorrected fears and a lack of information about the importance of prophylaxis in asthma. It is essential to create effective strategies to inform patients with asthma of the importance of annual vaccinations.

Giant hiatal hernias

Dyspnoea is most often caused by disorders of the respiratory and/or cardiovascular systems. Much less often it is brought about by the displacement of abdominal organs into the thoracic cage. Hiatal hernias may give rise to diagnostic difficulties, as both clinical and radiological symptoms suggest different disorders. Computed tomography is the method of choice when making a diagnosis. We have presented a series of 7 cases of giant hiatal hernias, each with a varying course of the disease, clinical symptoms, radiological features and prognoses. In two of the cases, the hernias were of a post-traumatic nature. Four cases of large diaphragmatic hernias were found in elderly patients (over 90 years old). An advanced age and numerous coexisting chronic diseases disqualified most of the patients from surgical treatment despite the hernias' large sizes. In only one case was fundoplication performed with a good end result. Two patients died, and an extensive hernia was the cause of one of the deaths. Upper gastrointestinal symptoms were present only in a few of the patients. An early diagnosis of giant hiatal hernia is crucial for the patients to undergo prompt corrective surgeries.

[Kounis syndrome - allergic myocardial infarction. a case report]

Kounis syndrome or allergic myocardial infarction is an acute coronary syndrome in the course of an allergic reaction. In allergic patients in response to a specific condition - nourishment, inhalation, environmental substances, drug or insect bite there is an allergic reaction involving many different cells and mediators that can cause coronary artery spasm or initiate the process of rupture and activation of atherosclerotic plaque resulting in acute coronary syndrome. The paper describes a case of a young man with allergy to pollen and confirmed sensitization to nuts, who developed a full-blown anaphylactic shock after eating the nut mix and experienced a rapidly passing acute coronary syndrome with troponin up to 4.7 μg/L. An increased concentration of tryptase (15 μg/L), total IgE (> 3,000 IU/mL) and specific anti-nut IgE (55.1 kUA/L) were found. Based on the course of the disease and the results of allergic and cardiac tests, allergic type 1 myocardial infarction, i.e. caused by coronary artery spasm, was diagnosed. During the hospitalization, the patient's condition improved quickly and after a few days he left the hospital without the signs of permanent damage to the heart muscle.

[A cough in a patient with cholangitis in the course of caroli's disease. Case report]

Cough may be a manifestation of pulmonary and extra-pulmonary diseases. However, rarely liver disease is suspected as a cause of acute cough. A case of a 34-year-old patient with diagnosed Caroli's disease has been described, in which cough with fever was the main manifestation of cholangitis in the course of complications of the underlying disease. Caroli's disease is a congenital pathology of intrahepatic bile ducts, causing their cysts to widen. It usually has an asymptomatic course, however it promotes infectious complications such as liver abscesses and recurrent cholangitis. The patient was admitted to the ward because of high fever and cough, without any symptoms from the digestive system. On the basis of laboratory, microbiological and visual examinations, various causes of cough were excluded and a diagnosis of cholangitis was made. After appropriate antibiotic therapy, a rapid improvement in the clinical condition and resolution of symptoms was achieved.

Clinical Manifestations of Huge Diaphragmatic Hernias

Translocation of abdominal organs into the thoracic cavity may cause dyspnea, heart disorders, and gastric symptoms. Diaphragmatic hernias can cause diagnostic difficulties, since both clinical and radiological symptoms might imitate different disorders. In these cases computed tomography of the chest is the method of choice. The aim of this study was to assess clinical manifestations, risk factors, and prognosis in patients with huge diaphragmatic hernias with displacement of abdominal organs into the thorax, depending on the action taken. We carried out a retrospective study using data of patients hospitalized in the years 2012-2016. Ten patients were qualified for the study (8 women and 2 men). The mean age of the subjects was 86.5 ± 10.5 years. Thirty percent of the hernias were post-traumatic. All of the patients reported cardiovascular or respiratory symptoms. Upper gastrointestinal symptoms occurred in half of the patients. Twenty percent of patients underwent surgery with a positive outcome, while 30% of patients, who were not qualified for surgery due to numerous co-morbidities, died. The main risk factors predisposing to the occurrence of large diaphragmatic hernias were the following: old age, female gender, and thoracic cage deformities.

Mortality Due to Nosocomial Infection with Klebsiella pneumoniae ESBL<sup/>

Klebsiella pneumoniae is one of the most important hospital pathogens, particularly concerning the multidrug-resistant strain ESBL⁺. The aim of this study was to evaluate nosocomial infections with K. pneumoniae ESBL⁺ in the context of infection location, risk factors, and prognosis. This hospital study was conducted retrospectively and covered a 3 months' period. The infection with K. pneumoniae ESBL⁺ was diagnosed in 36 patients (19 women and 17 men) of the mean age of 74.2 ± 14.8 years. The number of infected patients amounted to 2.2% of all patients admitted to Czerniakowski Hospital in Warsaw, Poland, over the study time. Twenty of these patients died (13 women and 7 men), representing 14% of all hospital deaths at the time. The infection with K. pneumoniae ESBL⁺ occurred most frequently in the department of internal diseases, and rarely in neurology or intensive care wards. Bacteria was most often isolated from the urine, with the most distinct association between the use of urinary catheters and death (p = 0.019). We conclude that infections with K. pneumoniae ESBL⁺ were associated with over 55% mortality and usually occurred in the setting of internal diseases. Deaths due to K. pneumoniae ESBL⁺ infection were significantly related to the use of urinary bladder catheters.

Tuberculosis of the Urogenital Tract in Adults in a Tertiary Referral Center

The genitourinary system is the main location of extrapulmonary tuberculosis. In Poland, it occupies the third place after tuberculosis of the pleura and lymph nodes. The aim of this study was to evaluate the prevalence and characteristics of tuberculosis in the urogenital tract in adult patients in a tertiary referral center in the years 2007-2015. The retrospective study included 87 patients, 42 women and 45 men. The average age was 62 ± 15 years. Changes in the urinary tract were diagnosed in 91% of women and 64% of men. Testicular tuberculosis was found in ten men, prostate tuberculosis in five, and in individual cases tuberculosis of the epididymis, scrotum, uterus, and the fallopian tube were found. The diagnosis was confirmed by bacteriological methods in 47% of patients, by histopathological in 41%, and by molecular methods in 23% of patients. In 84% of patients urological or gynecological interventions had to be applied. Patients were burdened with a number of urological diseases or diseases affecting other systems which hampered the diagnosis of tuberculosis. Antituberculosis treatment gave good results. Urogenital tuberculosis is a multivariate disease and a standard unified approach is impossible.

[Emphysematous cystitis in a patient with type-1diabetes mellitus - diagnostic difficulties]

A case report of 28 year old female with medical history of bed controlled type 1 diabetes mellitus complicated by autonomic neuropathy in the form of gastroparesis, suffered by emphysematous cystitis caused by Escherichia coli was described. Emphysematous cystitis is a rare urinary tract infection connected with the presence of gas in the bladder lumen or/and within the bladder wall, which occurs mainly in women, in older age, suffering from type 2 diabetes, complicated by microangiopathy, neuropathy, with urinary tract obstruction and weakness of immunity system. Diagnostic difficulties and the delay in correct diagnosis in described case were caused by the dominated complaint of the upper gastrointestinal tract and difficulties in interpretation of imaging methods, such as abdominal X-ray and ultrasound scan. Eventually the use of computed tomography allowed to achieved an accurate diagnosis and choose appropriate treatment. It is possible that this is the first case of emphysematous cystitis described in Poland.

SERPINA1 Gene Variants in Granulomatosis with Polyangiitis

Alpha-1 antitrypsin (A1AT) deficiency is one of the most common genetic disorders in Caucasian population. There is a link between granulomatosis with polyangiitis (GPA) and most frequent variants of SERPINA1 gene encoding severe alpha-1 antitripsin deficiency. However, the potential effect of Pi*Z, Pi*S as well as other SERPINA1 variants on clinical course of vasculitis are not well understood. The aim of the study was to analyze the potential effect of A1AT protein phenotype representing the SERPINA1 gene variants on the clinical course of GPA. The study group consisted of 64 subjects with GPA, stratified according to the disease severity: patients in active phase (group I, n = 12), patients during remission on treatment (group II, n = 40) or untreated (group III, n = 12). Normal Pi*MM SERPINA1 genotype was detected by means of real-time polymerase chain reaction (PCR) or direct sequencing in 59 patients, Pi*MZ genotype in 2, and Pi*IM, Pi*MS or Pi*SZ in 1 patient respectively. The patients with abnormal Pi*Z, Pi*S, or Pi*I allele constituted 17% in group I, 5% in group II, and 8% in group III. The serum content of A1AT and high sensitivity C-reactive protein (hsCRP) assessed by nephelometry did not differ between the groups. Interestingly, the mean serum antiPR3-antibodies level detected by Elisa method was significantly greater in the GPA patients with Pi*Z, Pi*S, or Pi*I SERPINA1 variants than in the Pi*MM homozygotes. In summary, heterozygous Pi*MZ, Pi*MS, and Pi*SZ genotype was detected in 7.8% of total group of GPA patients, and in 10.5% of those with lung lesions. The abnormal alleles of Pi*S and Pi*Z may affect the clinical course of the disease.

[Von Meyenburg complexes. case report]

Von Meyenburg complexes is one of the polycystic liver diseases, characterized by bile duct hamartoma. These cysts come from the biliary tract but the cysts do not communicate with them. Because of asymptomatic course of the lesions usually are diagnosed in the course of diagnostic for another reason. It is not possible to define the entire diagnosis based upon ultrasonography imaging, as cyst could mimic metastasis, micro-abscesses and multiple focal nodular lesions. Because of the small size of the lesion (0.5-15 mm) usually inconclusive is also computed tomography. On the basis of magnetic resonance imaging (MRI) and cholangio-MRI we can determine the diagnosis of the complexes. Liver biopsy is obligatory in case of suspicion of neoplastic process. These complexes do not require treatment, but long-term follow-up is indicated because of the possibility to more frequent cholangiocarcinoma in patient with von Meyenburg complexes. It is probably the first case report of the von Meyenburg complexes described in Poland.

[Dyspnea in a patient after open reduction of fracture of the femur]

Acute dyspnoea in the postoperative period requires quick consideration of all possible causes and implementation of the proper treatment. During the differential diagnostic process, other than the most common cardio-pneumological and otolaryngological reasons, we should consider a whole array of rare causes such as neuromuscular illnesses, renal failure, and gastrointestinal diseases. This case is an example of sudden onset of dyspnoea presenting in a 67 year old woman with COPD. The dyspnoea occurred in first postoperative day after open reduction of fracture of the femur. Onset of respiratory insufficiency symptoms and circulatory instability appeared suddenly and advanced quickly, as result of a large Morgagni type retrosternal hernia, requiring urgent thoraco-surgical intervention. In the long term, the effects of this operation were very good.

[Tuberculosis of the urinary tract of women suspected of pulmonary tuberculosis. A case report]

Diagnosis of tuberculosis requires bacteriological confirmation. The sputum is the material most frequently used for this purpose. In the case of extra-pulmonary tuberculosis, it is necessary to obtain other materials, such as urine, pleural fluid, pericardial effusion, ascites, cerebrospinal fluid, sample of tissue, etc. However, compared with sputum, these materials are much less likely to successfully culture mycobacteria. We described a case of a young woman with suspected pulmonary tuberculosis, however confirmation of the disease was obtained from urine culture. Despite hemoptysis and radiological changes typical for tuberculosis, the cultures of mycobacteria from respiratory tract were negative. The patient did not report any symptoms from urinary tract, and urinalysis was normal, ultrasound however revealed changes in the left kidney which were typical for tuberculosis. The mycobacterial culture of urine was positive. Antimycobacterial drugs were applied with a good effect.

[Undernutrition in chronic respiratory diseases]

Respiratory diseases such as asthma, COPD, lung cancer, infections, including also tuberculosis constitute the most frequent diseases in the word. Undernutrition frequently accompanies these diseases. Early diagnosis of malnutrition and implementation of appropriate treatment is very important. A nutritional interview and anthropometric examinations, such as body mass index, fat free mass and fat mass are used to diagnose it. Nutritional therapy affects the course and prognosis of these diseases. Diet should be individually adjusted to the calculated caloric intake that increases during exacerbation of disease, because of increased respiratory effort. Too large supply of energy can cause increase metabolism, higher oxygen consumption and PaCO2 increase each dangerous for patients with respiratory insufficiency. Main source of carbohydrates for these patients should be products with low glycemic index and with high dietary fiber contents. Large meals should be avoided since they cause rapid satiety, abdominal discomfort and have negative impact on the work of the respiratory muscles, especially of the diaphragm. Dietary supplements can be used in case of ineffectiveness of diet or for the patients with severe undernutrition.

[Duties of TB patients or suspected patients and their close relations]

The effective laws impose the duty upon TB patients or persons suspected to have TB as well as their close relations to undergo compulsory sanitary and epidemiological examinations. Furthermore, treatment is also mandatory and in case of infective patients hospitalization and isolation. Duty does not however denote enforcement, which is required in certain particularly dangerous infectious diseases. Poland operates a system of mandatory TB vaccination applicable, today, only to infants. Persons suspected of TB have the obligation to provide necessary information helping in diagnosing the disease or helping to find the source of infection and transmission of the disease. TB patients are under obligation to discontinue performing their work to prevent the disease from spreading to other persons.

[What changes were introduced by the new law concerning infectious diseases for patients with tuberculosis?]

In July 2012, the act on preventing and counteracting infections and infectious diseases in humans was amended. Many changes concerning duties of physicians looking after patients with tuberculosis were proposed. Particularly important is the requirement of written certification by patients that they were notified by the physician of the obligation to undergo antituberculous treatment. It is also essential that the national sanitary inspector be notified as to which health-care institution the patient with tuberculosis was referred to for treatment, and also about an evasion of antituberculous therapy by the patient. Many paragraphs concerning the control of infectious diseases were formulated more precisely.

[Duties of physicians or other healthcare workers connected with diagnosis, treatment, dissemination of information, assessment and registration of TB patients]

Effective laws provide a series of duties to be performed by physicians and other medical personnel associated with TB. Every TB case and death resulting from TB as well as any case of undesirable result of BCG test requires notification and filling in of a special form. The physician has a duty to inform TB patients their legal guardians, close relatives or friends about the need to undergo sanitary and diagnostic procedure, treatment or vaccination, as well as on how to prevent disease from spreading. Persons failing to comply with the relevant numerous legal requirements in this respect are subject to a fine.TB patients can use special sick benefits extending up to 270 days. There is a requirement to use appropriate codes to define TB irrespective of LCD-10 classification.

[Duties of institutions and heads of health care centers in the area of infection control, information, assessment, registration and financing of benefits provided to TB patients]

The Act on preventing and counteracting infections and infectious diseases in humans effective in Poland requires the heads of health care outlets and institutions to counteract spreading of TB in units under their management. They are, by all means, responsible for monitoring infections in their respective units, including development, implementation and monitoring of the implementation of procedures into practice, aiming at limiting the dissemination of TB in hospitals and outpatient clinics. Medical service unit managers are also responsible for providing members of their staff with means of individual protection against infection with Mycobacterium tuberculosis bacillus. Their duties also include reporting all of the recognized TB cases in their respective units. TB is an infectious diseases included in the occupational disease list. Assessment of TB as an occupational disease is the responsibility of provincial TB prevention clinics. The Act also provides principles of financing of individual benefits available for the insured TB patients as well as those not insured.

Epidemiological situation of tuberculosis in the world based on a report of the World Health Organization 2013

The epidemiological situation of tuberculosis is regionally diverse and dynamically changing. It is related not only to the health status of people but also to the organization of health care, financial possibilities, and cultural problems affecting the dissemination of the infection. The actions taken by the WHO since the 90s have been effective and from 2005 a decrease in the prevalence has been noted and even earlier a decrease in mortality was observed. The best situation is in North America and in Western Europe. The highest number of TB cases are observed in South-East Asia; however the highest incidence index is in Sub-Saharan Africa. Demographic differences related to sex and age are still observed. Men suffer more often than women. In countries with a good epidemiological situation elderly people are ill more frequently, while in epidemic regions more children and young people are ill.

[Tuberculosis challenge to medicine in 21st century]

Although, since discovering Koch's bacilli over 130 years have passed, and 70 since the invention of the first antituberculous drug, the epidemic of this illness has not been brought under control. It is still an important health problem of the contemporary world. In the 21st century co-infection with the Koch's bacillus and HIV, as well as multidrug-resistance, will be a challenge for medicine. In countries with a good epidemiological situation the prevalence of the disease is becoming a problem in particular populations, such as immigrants, homeless, prisoners, elderly persons and people with immunodeficiency. A tighter control of infection in these groups is necessary.

Socio-economic status and the duration of pulmonary tuberculosis symptoms in women treated at the Mazovian Treatment Centre of Tuberculosis and Lung Diseases in Otwock

INTRODUCTION

The prevalence of tuberculosis depends on various factors such as migration, homelessness, malnutrition, unemployment, bad life conditions and the aging of a society. The aim of this study was to evaluate tuberculosis in females treated at the Mazovian Treatment Centre of Tuberculosis and Lung Diseases (Mazowieckie Centrum Leczenia Chorób Płuc i Gruźlicy) in Otwock, regarding the context of demographic, social and professional status of female patients. The duration of the illness and the extent of radiographic changes were also taken into consideration.

MATERIAL AND METHODS

The study was carried out retrospectively. The medical documentation that was evaluated concerned 100 women, aged between 20 and 92, hospitalized at the Mazovian Treatment Centre of Tuberculosis and Lung Diseases in Otwock in the years 2005 and 2006 due to bacteriologically confirmed tuberculosis.

RESULTS

Most women with tuberculosis lived in cities (65%), 32% of the evaluated patients lived in villages and 3% were homeless. 1/3 of females were under 40 years of age, and 1/3 were over 60 years of age. Only 29% of the women were professionally active and 25% were unemployed. 60% of women were not married. 35% of women with tuberculosis were bringing up children and 7% had abandoned their offspring. More than 1/3 of women had had tuberculosis symptoms for more than half a year before tuberculosis was diagnosed. 40% of women with tuberculosis had small radiological changes (1 to 2 lung fields); however, 26% of them had extensive changes covering 4 to 6 lung fields.

CONCLUSIONS

The majority of women with tuberculosis in the Mazovian district are single, over 40 years old, unemployed inhabitants of cities. 30% of women in the study group had had symptoms for more than 6 months before tuberculosis was diagnosed. 40% of women with tuberculosis had very extensive radiological changes covering 4 to 6 lung fields.

Risk factors for tuberculosis and specific manifestations of disease

In countries with good epidemiological situation, incidence of tuberculosis (TB) is relatively high in immigrants, prisoners, the homeless and unemployed. In a number of regions, co-infection of Mycobacterium tuberculosis and HIV raises difficulties in controlling TB epidemic. A problematic issue is also drug resistance, especially in the countries of the former Union of Soviet Socialist Republics (USSR). Neither co-infection of M.tuberculosis and HIV nor drug resistance are of special concern in Poland. Incidence of extrapulmonary TB is very diverse (6-44%), however, in Poland such manifestation of tuberculosis is diagnosed rarely. There is a necessity of monitoring local epidemiological trends and developing appropriate diagnostic and therapeutic models for better control of infection.

Sesja Naukowa z Okazji 100-Lecia Laboratorium Prątka w Rudce

W 2008 roku obchodzono setną rocznicę powstania Sanatorium dla Piersiowo Chorych w Rudce [...]

Atherosclerotic factors in PR3 pulmonary vasculitis

Autoimmune disease such as systemic lupus erythematosus or rheumatoid arthritis are connected with higher risk of atherosclerosis and cardiovascular complications and mortality. This results from inflammatory damage to the vessel wall by vasculitis. The aim of the present study was to evaluate whether patients with Wegener's granulomatosis (WG) and pulmonary involvement have an increased prevalence of atherosclerotic disease as characterized traditional risk factors. Twenty one patients with WG in remission and 15 control subject were entered to the study. Traditional risk factor for cardiovascular disease such as hyperglycemia, hypertension, smoking, obesity, and dyslipidemia were assessed. Both systolic and diastolic blood pressure were higher in WG patients (p<0.025). Total cholesterol, LDL and TG levels were markedly elevated in 18 of the 21 in pulmonary WG patients. Compared with controls, plasma levels of hsCRP were raised in WG patients; 3.68 (0.79-9.75) mg/l vs. 0.14 (0.12-0.59) mg/l (p<0.01). We conclude that non-pharmacological and pharmacological treatments of traditional risk factors are crucial to prevent cardiovascular disease in WG patients and thus should be part of therapy to control WG activity and damage caused by it.

[What changes were introduced by the new law concerning infectious diseases for patients with tuberculosis?]

On July 2012, the act on preventing and counteracting infections and infectious diseases in humans was amended. Many dchanges concemrning duties of physicians looking after patients with tuberculosis were proposed. Very important is the requirement of written certification by patients that they were notified by physician of the obligation of antituberculous treatment. It is also essential that the national sanitary inspector be notified as to which health-care institution the patient with tuberculosis was referred to for treatment, and also about an evasion of antituberculous therapy by the patient. Many paragraphs concernng the control of infectious diseases were formulated more precisely.

Cutaneous changes: an initial manifestation of pulmonary Wegener's granulomatosis

Cutaneous vasculitis can occur as an isolated dermatologic disorder or as manifestation of a potentially life-threatening systemic vasculitis such as Wegener's granulomatosis (WG). The aim of the study was to characterize cutaneous lesions in 66 WG patients (30 female, 36 male) and to assess the viability of skin biopsy the diagnosis of WG. Skin involvement was observed in 21 (32%) WG patients; in 14 (21%) patients as an initial manifestation and in other seven during the diagnosis establishment. Cutaneous lesions included palpable purpura(n=10), subcutaneous nodules(=4), hemorrhagic bullae (n=3), ulcers (n=2), pustules (n=1), pyoderma gangrenosum (n =1). The patient with pulmonary WG can present initially with cutaneous symptoms and positive PR3-ANCA serologic test results. Leukocytoclastic vasculitis (LCV) was the predominant histopathologic pattern.

Influence of sera from interstitial lung disease patients on angiogenic activity of mononuclear cells

Chronic inflammation stimulates of neovascularization. The aim of this study was to evaluate the effect of sera from interstitial lung diseases (ILD) patients on angiogenic capabilities of different subsets of mononuclear cells. Serum samples were obtained from 22 patients with sarcoidosis, 20 with hypersensitivity pneumonitis, 20 with idiopathic pulmonary fibrosis, 9 with systemic sclerosis, 6 with pulmonary Langerhans cells histiocytosis, and from 20 healthy volunteers. Animal model of leukocyte induced angiogenesis assay was used as an angiogenic test. The pattern of angiogenic reaction was different in different diseases. Sera from systemic sclerosis and pulmonary Langerhans cells histiocytosis patients exerted inhibitory effects on angiogenesis, but sera from sarcoidosis, hypersensitivity pneumonitis, and idiopathic pulmonary fibrosis patients stimulated angiogenesis. Sera from sarcoidosis and pulmonary Langerhans cells histiocytosis primed monocytes for the production of angiogenic factors. The number of microvessels created after incubation of mononuclear cells depleted of monocytes with sera from systemic sclerosis patients significantly decreased. We conclude that the role of monocytes in the modulation of angiogenesis varies depending on the type of ILD. Sera from sarcoidosis stimulate and from pulmonary Langerhans cells histiocytosis patients inhibit neovascularization induced by monocyte mediators. Sera from systemic sclerosis inhibit angiogenesis induced by lymphocyte products.

Medical students' aptitude toward smoking in Warsaw, Strasbourg and Teheran

Cigarette smoking is a leading cause of preventable death in the world. Medical students play a role in smoking prevention especially as future physicians, but also as role models in society. Their approach, although influenced by medical education, is based on cultural and socio-economic background. The aim of this study was to analyze smoking habits, prevalence and attitudes towards smoking cessation in medical students from three different countries: Poland, France and Iran. A questionnaire on tobacco smoking was distributed among medical students from three Medical Universities: in Warsaw, Strasbourg and Teheran. The study population consisted of 1,036 students: 499 from Poland, 367 from France and 170 from Iran. The percentage of smokers among medical students was 14% in Warsaw, 14.4% in Strasbourg and 3.5% in Teheran. The prevalence of ex-smokers was 13.6%, 18%, and 1.2% respectively. The use of nicotine replacement therapy or pharmacological aid in smoking cessation was 9% in Warsaw, 7% in Strasbourg, and none in Teheran. In Strasbourg students willing to choose surgical specialization were more likely to be smoking with OR 2.6 (95% CI 1.4-5.0). Never-smokers were more likely than actual smokers to discourage their friends and family from smoking. In Warsaw OR was 3.8 (95% CI 2.0-7.2), in Strasbourg 6.2 (2.6-14.4) and 7.2 (1.0-82.6) in Teheran. In conclusion, similarities in smoking prevalence and attitudes between medical students in Warsaw and Strasbourg were observed, while in Teheran the percentage of smokers reported was much lower. Pharmacological aid or nicotine replacement therapy in smoking cessation was rarely used among medical students.

[Socio-economic status and duration of TB symptoms in males treated at the Mazovian Treatment Centre of Tuberculosis and Lung Diseases in Otwock]

INTRODUCTION

The incidence of tuberculosis depends on many factors, not only on health issues but also on socioeconomic factors. The aim of this study was to assess the duration of symptoms and the extent of radiological changes in men with bacteriologically confirmed pulmonary tuberculosis in relation to their socioeconomic status.

MATERIAL AND METHODS

This was a retrospective study based on the analysis of 300 hospital records of patients hospitalised in 2004-2006 in the male ward of the Mazovian Treatment Centre of Lung Diseases and Tuberculosis in Otwock. In all patients, the diagnosis of tuberculosis was bacteriologically confirmed. We evaluated the duration of symptoms prior to hospitalisation, the extent of radiological changes and socioeconomic status. We also took into account the place of residence, professional activity, age and marital status.

RESULTS

Among patients with TB hospitalised in the Mazovia Region, 74% were professionally inactive persons and 57% were unemployed. Patients population in cities and villages were similar, but as much as 10% of the patients hospitalised who were actively spreading bacilli in Mazovia Region were homeless. In the study group, 60% of the men were unmarried. In 63% of the patients symptoms of tuberculosis were present for more than two months. Chronic symptoms were reported more often in the unemployed (60%) and in single patients. As much as 81% of the patients at the initiation of treatment, had extensive radiological changes in 3 or more lung fields. Quite often sweeping pulmonary changes were observed in the homeless, unemployed and pensioners. Sputum smear-positive tuberculosis, was demonstrated in 87% of the examined patients.

CONCLUSIONS

The incidence of tuberculosis observed in the Mazovia Region was especially observed in the unemployed, disabled and pensioners. Among these patients, many were homeless. The majority of patients in Mazovia Region at the start of treatment already had very extensive radiological changes and the symptoms were present with them for several weeks.

[Report of the VIth Tuberculosis Day Conference]

On 23 - 24 Mars in Warsaw a scientific conference was held sixth time organised to celebrate the World TB Day by Warsaw-Otwock Branch of the Polish Respiratory Society in collaboration with WHO, Poland. Welcoming lecture "TB Research in Poland, Past and Present" discussed TB diagnosis scientific research results, achieved during the last two centuries, and which contributed, after practical application, to improvement of TB epidemiological situation in our country. Sessions devoted to, as follows: 1) Discussion of multidrug-resistant TB with special focus on epidemiology, diagnostics and WHU guidelines relative to treatment; 2) Tuberculosis brought into Poland by refugees and methods of diagnosis and treatment; 3) TB among persons detained in penitentiary institutions with an outlook on molecular research (tests?) used in epidemiological investigations.

[Duties of TB patients or suspected patients and their close relations]

The effective laws impose the duty upon TB patients or persons suspected to have TB as well as their close relations to undergo compulsory sanitary, epidemiological and examinations. Furthermore, treatment is also mandatory and in case of infecting patients hospitalization, isolation and treatment. Duty does not denote enforcement required in certain particularly dangerous infectious diseases. Poland operates a system of mandatory TB vaccination applicable, today, only to infants. Persons suspected of TB have the obligation to provide necessary information helping in diagnosing the disease or helping to find the source of infection and transmission of the disease. TB patients are under obligation to discontinue performing their work in case it may prevent the disease from spreading onto other persons.