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Interferon alpha in combination with ribavirin has been for years a standard therapy of chronic hepatitis C (CHC). This treatment is burdened with numerous side effects, including thyroid dysfunctions. Their incidence in patients receiving dual therapy is estimated at 4.6-33.3%. The paper presents a case of a patient with Hashimoto's thyroiditis, in whom at the time of CHC therapy with pegylated interferon alfa and ribavirin hyperthyroidism episode evolved with an increased level of TSH receptor antibodies after introducing an antiviral treatment and its decrease after the use of antithyroid drugs. After a short break, this therapy was continued, without achieving the therapeutic success. The authors take up the discussion on the possibility of taking CHC therapy in this patient in the future. Participants are an endocrinologist and a hepatologist.

Leptospirosis is a zoonotic disease of global reach caused by pathogenic spirochetes of the genus Leptospira. The disease has two periodic phases (septic and immune phase) and its clinical manifestations are diverse. Central nervous system involvement in leptospirosis most commonly occurs as aseptic meningitis, often asymptomatic, only with abnormal cerebrospinal fluid findings. Weil's syndrome is defined as liver damage with acute renal failure and bleeding diathesis, has a high mortality rate. A pulmonary form may occur as an acute respiratory distress syndrome. The reference standard assay is the microscopic agglutination test. A titer of at least 1:400 in the presence of symptoms confirms the diagnosis. The prognosis depends on a rapid identification and treatment with antibiotics. The paper presents selected cases of leptospirosis with its different clinical manifestations. The common feature was a severe illness and sometimes the need for cooperation of doctors of various specialities.

In 2011 the European Medicines Agency approved two new drugs (boceprevir and telaprevir) to treat patients with chronic hepatitis C or compensated liver cirrhosis infected with genotype 1 HCV. Their usage together with a standard therapy, ie. pegylated interferon alfa and ribavirin significantly increased the chance of sustained virologic response among both previously unsuccessfully treated and naïve patients. However, this involves a greater number of side effects that poorly monitored can be life threatening. To the known side effects of standard therapy joined new, such as dysguasia, anorectal symptoms. Both drugs can compromise cardiac complications, especially in predisposed patients. Furthermore there is also a greater risk of rash and serious skin reactions. New problem is the interaction between drugs and first generation protease inhibitors resulting from the inhibition of cytochrome p450, common to many drugs pathway.

Since ten years pegylated interferon alpha and ribavirin (PR) are a standard treatment for the patients with chronic HCV infection. Recently, new drugs emerge called direct-acting antivirals. The first of them, telaprevir (TVR) and boceprevir (BOC), which peptidomimetic NS3/4A HCV serine protease inhibitors, have been recorded this year in Europe. Adding them to the PR significantly increases efficacy of standard treatment and creates the possibility of its reduction. This paper presents, based on the results of the third phase studies, the efficacy of triple therapy in selected groups of patients. Also includes current recommendations for treatment with BOC or TVR in combination with PR.

Predictors of effective chronic hepatitis B therapy were described in that article. The predictors are: ALT, HBV genotype, HBV DNA, qantification of HBsAg. New predictors as cccDNA and level of HBeAg were described too.

Budd-Chiari syndrome is a rare disease, caused by obstruction of the hepatic venous outflow at the level of either the large hepatic veins or (and) the subdiaphragm segment of the inferior vena cava. The hematological disorders (myeloproliferative disorders, factor V Leiden deficiency), tumor and chronic inflammatory diseases are the most frequent causes of BCS in Europe and North America. Two cases of BCS, recognized in 24 and 43 years old females with subacute and chronic forms of the disease are presented in this article. The underlying cause was polycythemia rubra vera and osteomyolofibrosis. In first case, except causal and anticoagulation therapy, a transjugular intrahepatic portosystemic stent has been performed. In the second one low - sodium diet and diuretic for the control of ascites and oedemas were used. Hydroxycarbamid was the first choice line medication in treatment hematological disorders and acenocumarol in the prevention of the trombotic complications.

The results of retrospective analysis of 97 children treated at Observation and Liver Diseases Unit in Bydgoszcz between 1st Jun and 30th Jun 2006 because of retrovirus diarrhea were presented. Those results took the liver activity into consideration. The age of children with hypertransaminazemia was assessed--the duration, intensity and date of occurrence of hypertransaminazemia was taken into consideration. In 25% of analyzed cases an increased activity of ALT (lasting from 7 days to 6 months) without other disturbance of liver activities was stated.

The aim of study was to determine clinical presentation and outcome of tuberculosis among patients infected with human immunodeficiency virus type 1 (HIV-1). During 2001-2006, 36 cases of tuberculosis (TB) was recognized in 33 patients infected with HIV. The majority of patients were men infected with HIV in through intravenous drug using and had a CD4 cell count <200cells/microl at the time of TB diagnosis. The most frequent form of TB was pulmonary localization and lymphadenitis as extrapulmonary localization. Meningitis was recognized in two cases. The diagnosis was confirmed by positive culture for mycobacteria and PCR in 34/36 patients. Mycobacterial smears were positive in 2/36 cases, the skin test reaction with nodule >5mm was positive in 60% cases. Immune reconstruction syndrome was recognized in 4 patients.

Unlabelled: The aim of the study was an assessment of the incidence and types of neuropsychiatric serious adverse events (NSAE) in patients with compensated chronic hepatitis C (CHC) treated with recombinant or pegylated interferon-alpha (IFN-alpha) plus ribavirin (RBV)., Method: NSAE were defined as neuropsychiatric consequences of IFN-alpha+RBV therapy that resulted in discontinuation therapy or initiation of disorders requiring hospitalization or chronic neuropsychiatric treatment. A group of 273 patients (144 males and 129 females, mean age 41) without significant past psychiatric and neurological disorders was prospectively observed. Of them 89 patients were treated with recombinant IFN-alpha+RBV. Both subgroups did not differ with regard to demographic or hepatological parameters., Results: Overall NSAE were present in 13 patients (4.8% of the sample): psychiatric SAE emerged in 10 patients and 3 patients suffered from neurological SAE. NSAE emerged in nine patients treated with recombinant IFN-alpha and in four patients treated with pegylated IFN-alpha (p=0.03)., Conclusions: NSAE in CHC patients during IFN-alpha+RBV therapy occur rarely. However, potentially severe neuropsychiatric consequences of the treatment in some patients indicate the need for neuropsychiatric monitoring during the therapy. Treatment with pegylated IFN-alpha may be associated with less neuropsychiatric SAE than treatment with recombinant IFN-alpha in patients with compensated CHC.

Unlabelled: Prevalence and clinical manifestation of borreliosis were analyzed. Evaluation of frequency of anti-Borrelia burgdorferi in sera collected from forestry workers were performed too., Materials and Methods: 113 forestry workers from Kujawsko-Pomorskie voivodeship were examined (56 from Szubin district, 29 from Runowo district and 28 from Lutówko district). Duration of works, frequency of exposition for tick, presence of erythema migrans (EM) in the past and present manifestation of Lyme disease were analyzed. Serological studies were performed in each case., Results: Duration of works balanced between one and 47 years. In 92 cases exposition took place more than one time. 24 suffered from EM in the past but only two of them were treated with antibiotics because of this manifestation. 14 of 113 patients suffered from Lyme arthritis. Serological markers of infection with B.b. were finding in 37 cases., Conclusions: (1) Not every infection with B.b. are clinically manifested. (2) The risk of infection with B.b. is higher in patient frequently exposed on ticks. (3) There is no correlation between duration of works in a forest and frequency of B.b. infection in forestry workers what indicate that infected with B.b. ticks expanded on kujawsko-pomorskie voivodeship recently. (4) Forestry workers should be systematically examined because of high risk of Lime disease. (5) The information about borreliosis should be widespread.

This work presents a case of Q fever in a 55-year-old man who came back from Lebanon. The dominant symptoms of the disease were fever and dry cough and in physical testing fine rales at the bottom of the right lung. An epidemiologic investigation (a monthly stay in Lebanon) and a serologic testing (indirect immunofluorescence assay) were useful to confirm a diagnosis of Q fever. Moreover the authors of the work paid attention to the differential diagnosis of Q fever and effectiveness of tetracycline in the treatment. The basic methods of the prevention of the disease were also described. In the case of a fever in individuals coming back from the region of the Mediterranean Sea Q fever should be taking into consideration in the differential diagnosis.

Among the infectious virus hepatitis diseases, types A and B can be successfully prevented with vaccinations. WHO recommend effective control of hepatitis A through immunisation, especially among populations with indirect or high endemicity. Since 1991 WHO has been recommending vaccinations against hepatitis B. It is planned to introduce it in all countries by the year 2007. Vaccinations against hepatitis A & B are recommended for people travelling to the regions endemic for these infections or for those with high professional risk of HAV and HBV. Presented here are the characteristic features of the vaccine, the analysis concerning the evaluation of its effectiveness, comparison of this effectiveness with monovalent vaccine effectiveness, as well as evaluation of the tolerance and safety.

The authors presented an outline of modern knowledge about anthrax. Some aspects of the use of Bacillus anthracis as a biological terrorist agent are also described.