Search

Copyright of Wieki Stare i Nowe is the property of Wydawnictwo Uniwersytetu Slaskiego and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

In the article the author demonstrates that the criteria of nationality, state or ethnicity was not key to the potential military usefulness and actual use in warfare of courtiers of foreign origin by Sigismund the Old as well as Marshal Piotr Kmita Sobiedski and the commanders of the court regiment, Wojciech Sampolibski and Jan Boratyftski. This is evidenced not just by the lack of differences in the size of detachments or nature of military service of the curienses, but also by their deployment determined by purely military considerations . When delaying or reconnaissance operations were planned, courtiers sent to carry them out made up mainly light detachments facilitating surprise attacks and moving faster (by virtue of being lighter armed and armoured). On the other hand when a serious attack on the enemy's main forces was planned, the dominant group was that of lancers, who could bring a victory with their decisive charge. In this perspective the origin of the courtiers understood today as "foreign" did not matter. [ABSTRACT FROM AUTHOR]

Copyright of Medycyna Pracy is the property of Instytut Medycyny Pracy im. Jerzego Nofera and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

According to the report of the National Institutes of Health (NIH) in Bethesda, Maryland, USA, infectious diseases are one of the eight most common causes of illness since 1990. Due to breaking down barriers of interspecies, the state of immunosuppression, widespread use of antibiotics, there are still new threats, and earlier known to cause disease of a different course, resistant to previously effective therapies. The evolution of infectious diseases directs our attention primarily on the validity of the principles of rational antibiotic use to the increasing resistance of microorganisms. The movements of the opponents of vaccination appear to be more effective than the planned education of doctors and their patients, and the absence of sufficient administrative control performance of vaccination, raises a serious problem in contemporary clinical researcher. Infectious diseases will continue to exist as long as host organisms. It is important to the fight against them, making the best use of expertise and funds. In such a situation, the balance may move to benefit us--humans.

The drugs currently approved for treatment of HBV infections are: interferon alpha2a and alpha2b, pegylated interferon (PeglFN-al-pha2a) natural interferons and nucleos(t)ide analogues (NA): adefovir, entecavir, lamivudine, telbivudine (currently not available in Poland) and tenofovir. The following questions are described: the primary goal of antiviral treatment, criteria in therapeutic decision-making (including extrahepatic manifestations, compensated and decompensated cirrhosis of the liver), treatment failure (including: drug resistance), management of patients with HBV-positive markers, in whom chemotherapy or other immunosuppressive therapy is planned. In treatment-naive patients with chronic hepatitis B the first line therapy should be PeglFN-alpha2a monotherapy, and the first-line should be entecavir or tenofovir (highest potential for HBV replication suppression and high genetic barrier to resistance). In drug resistance the patient should be switched to another, preferably high-potency NA (entecavir or tenofovir) or start PeglFN-alpha2a therapy.

Background: Asymptomatic central nervous system involvement may occur in the early stages of the HIV infection. The aim of the study was to evaluate early brain metabolic changes by means of proton MR spectroscopy (H1MRS) in the HIV-1 seropositive patients without neurological deficits or significant abnormalities in the plain MR study., Material/methods: The H1MRS examinations were performed with the use of a MR GE Signa 1,5T system. There were 39 subjects examined, aged 21 to 57 years (mean age 35 years) were examined, including 25 patients infected with HIV-1 and 14 healthy volunteers who constituted a control group. The examinations were performed using the Single Voxel Spectroscopy technique with the PRESS sequence, with following parameters: TR=1500 ms, TE=35 ms, number of acquisitions =128, time of acquisition =3 min. 43 sec. Voxels of 8 cm(3) (20×20×20 mm) in size were located in the following 5 regions: posterior cingulate gyrus, grey matter of the frontal area, left basal ganglia, white matter of the left parietal area and white matter of the frontal area. The NAA/Cr, Cho/Cr, mI/Cr ratios in the defined regions of interest were statistically analyzed., Results: There was a statistically significant decrease (p<0.05) in the NAA/Cr ratios in the posterior cingulate area and white matter of the left parietal area in HIV-1 seropositive patients, as compared to the control group. Other metabolite ratios in all the above mentioned locations showed no statistically significant differences, as was also the case for NAA/Cr ratios in grey matter of the frontal area, left basal ganglia and white matter of the frontal area., Conclusions: The reduction of NAA/Cr values revealed in H1MRS studies suggests loss of neurons/neuronal activity in the posterior cingulate area and white matter of the left parietal area, in patients with HIV-1 at the stage before clinical manifestations of retroviral infection and structural changes in the plain MR study. This may reflect a direct neurotropic activity of HIV.

Immune reconstitution syndromes (IRS) in HIV-1-infected patients are associated with an exaggerated infl ammatory response against an opportunistic infection during highly active antiretroviral therapy (HAART). The most commonly described cases of this phenomenon concern mycobacterial (Mycobacterium avium and M. tuberculosis) infections, pneumocystodosis, cryptoccoccal meningitis, and CMV infections. Cutaneous cryptococcosis as IRS is less commonly observed. The case of a 45-year-old HIV-1-positive male is reported who developed subcutaneous abscesses due to Cryptococcus neoformans infection after four weeks of effective HAART following profound immune defi ciency.

We analysed a HCV RNA positive population with varied steatosis index admitted at Infectious Diseases and Hepatology Department, Medical University of Wroclaw in terms of existing abnormalities in biochemistry parameters, anthropometric differences as well as the antiviral therapy outcomes.

Unlabelled: Many articles concerning the hepatitis C virus (HCV) infection emphasize the role of cytokines Th1- and Th2-dependent. The aim of our study was to assess the changes in the concentration of cytokines (IL-2, IFN-gamma, IL-4, IL-10) determined by ELISA test in serum of HCV infected patients treated with interferon alpha (IFN-alpha) and ribavirine., Results: The cytokine levels in HCV patients (n = 40) were similar to levels observed in healthy volunteers (p > 0.05). During IFN-alpha and ribavirine therapy no statistically significant changes in cytokine levels were observed in patients who achieved sustained virological response (SVR) compared to unsuccessfully treated patients (p > 0.05)., Conclusions: 1. Serum is not useful compartment to determinate level of cytokines by ELISA method in chronic hepatitis C. 2. The measurement of cytokine levels using ELISA test was not confirmed to be useful in monitoring and assessment of the therapy results in HCV infected patients.

Although many years have passed since Borrelia burgdorferi was first identified, advances in understanding biology and clinical course of infection made and new diagnostic procedures developed, Lyme disease is still difficult to diagnose. Therefore, it is often wrongly diagnosed and unnecessarily treated. In this paper we analyzed the latest data on Lyme disease diagnostic methods, paying much attention to their limitations and correct interpretation of results. In routine diagnosis of this diseases, indirect tests, based on the detection of specific IgM and IgG antibodies, are most useful. The Lyme disease diagnosis should begin with screening tests, which are highly sensitive but not specific enough and sometimes yield false positive results, then all positive results should be verified by confirmation tests, which allow to distinguish between true positive results and healthy individuals with false positive ones.

Aim: analysis of data characterizing HCV infection in patients infected with HIV., Material and Methods: 37 persons (29 male and 8 female) aged 23-49 years (mediana 34), with HIV/HCV coinfection, treated (n=25) and untreated (n=12) with antiretroviral therapy. HAART was effective in treated patients; CD4+ count >350 cells/microl. Viral load of HIV and HCV, HCV genotypes, CD4/CD8, biochemical tests, histopathological examination were measured. Results were analyzed statistically., Results: the majority of patients were former IVDUs (n=31.84%), 3 persons (8%)--MSM, 3 (8%)--route of infection unknown. Duration of HCV infection 1-10 years, mediana 5. All patients were in A1 or A2 stage of HIV infection. Among patients treated with HAART (n=25) mediana of CD4+ count before treatment was 263 (69-595) cells/micro, mediana of HIV viral load 75000 copies/ml (n=7); 2040-263414 copies/ml. 17 patients were currently treated with PI, 17 with NNRTI, and 2 patients with NRTI only. HCV genotype was determined in 32 patients: 3a--n=19 (59%), 1--n= 9 (28%) 4--n=4 (13%). HCV viral load: 2.4 x 10(5)-7.73 x 10(6) IU/ml, mediana 1.6 x 10(6). Levels of ALT: 21-358 IU/ml, mediana 102, AST: 20-195 IU/ml, mediana 62, GGTP--9-463 IU/ml, mediana 58. ALT level was significantly higher in HCV genotype 3a infection (p=0.0214). Fibrosis stage above 2 was revealed in 3 patients and in majority (62%) was below 2. None patient had liver cirrhosis. Fibrosis was significantly higher in patients with low CD4+ nadir (p=0.03)., Conclusions: Progression of liver fibrosis is slow in patients coinfected with HIV/HCV with high CD4+ count. High percentage of HCV genotype 3 and mild fibrosis are good prognostic factors for effectiveness of HCV infection treatment in HIV infected persons.

The introduction of combination antiretroviral therapy (cART) has attracted the attention of scientists and physicians all over the world to the phenomenon known as IRD, immune restoration disease. The management of IRD depends on the correct diagnosis of the syndrome, which can be difficult to establish. The atypical presentation and unpredictable course of the disease may require individual decisions regarding a delay of cART or its interruption as well as the use of corticosteroids. Thus the frequent need for individualized management of IRD can make it difficult to obtain enough results from prospective randomized trials to establish strict recommendations. However, they should be initiated as soon as possible.

Background: The principles of uniform reports on infections with HBV, HCV, HIV due to occupational exposure have not yet been established in Poland. Usually, reporting on such incidents is governed by internal rules of individual health care institutions. The aim of the study was to assess the possibility of obtaining data on postexposure incidents among health care workers in different voivodeships (regions) and to identify a group of persons who most frequently reported such cases in a given calendar year., Material and Methods: Nineteen medical centers from all 16 voivodeships were invited to participate in the study. The main condition to be enrolled in the study was to provide full postexposure prophylaxis log., Results and Conclusions: In all, 8 centers from 8 voivodeships were enrolled in the final study. Only in 4 voivodehips, completely centralized postexposure prophylaxis logs were in operation. Women with secondary education (nurses) formed the major group of exposed persons. Exposure incidents occurred most frequently in wards or operation rooms while performing medical procedures or immediately after. Blood collection predominated among various kinds of exposure. The majority (75.7%) of health workers underwent full vaccination program against HBV. The analysis revealed large differences in exposure reporting between individual voivodeships. Sometimes they made it even difficult to complete full demographic data concerning exposed persons. Therefore, a universal tool of nationwide system should be elaborated. Such a system (an example is presented by the authors), regularly verified, might provide grounds for a wider analysis of postexposure prophylaxis efficacy, details concerning exposure incidents and their consequences in the future. This may greatly contribute to the reduction of exposure rates among health care workers.

Unlabelled: Approximately 10% of persons infected with human immunodeficiency virus (HIV) and 75-90% patients with acquired immunodeficiency syndrome (AIDS) present neurological symptoms. This group causes the greatest diagnostic difficulties among AIDS patients. The purpose of the study was to demonstrate the usefulness of the magnetic resonance imaging (MR) of the central nervous system (CNS) in the diagnosis and differentiation of primary and secondary lesions., Material and Methods: Fifty one patients with the symptoms suggesting CNS involvement were enrolled into the study. In 40 of them AIDS diagnosis was established based on the picture of CNS lesions. MR studies were performed using EDGE-ECLIPSE 1.5 T unit with FSE sequences, T1- and T2-weighted images, before and after paramagnetic contrast agent injection, in sagittal, coronal and transverse planes. In almost all cases FLAIR technique was also used. Thirteen persons were examined several times. Altogether we executed 62 studies. Magnetic resonance results were compared with the results of laboratory tests and sometimes histopathological examination at autopsy., Results: Pathological findings were visible on MR of CNS in 37 (92.5%) of 40 patients with AIDS. In 8 (20%) cases the diagnosis of AIDS dementia complex (ADC) was established. Toxoplasmosis was diagnosed in 9 (22.5%) cases, tuberculosis in 6 (15%), cryptococcosis in 5 (12.5%) patients, progressive multifocal leukoencephalopathy (PML) in 3 (7.5%) patients, primary lymphoma also in 3 (7.5%), and atypical mycobacteriosis in 2 patient. In 1 (2.5%) case we could not establish the final diagnosis. We described the patterns of MR appearance in the different types of lesions mentioned above based on our findings and the literature review., Conclusions: Magnetic resonance imaging has a high sensitivity in identifying lesions of the central nervous system. It is very useful, together with the results of other tests, in the final diagnosis of the lesions in the CNS. Magnetic resonance plays also an important role in the treatment planning and monitoring of the efficacy of therapy used in AIDS patients.

Background: Analyses of exposure rates among health care workers comprise both risk and epidemiology of blood borne pathogenic factors. In Poland, a possible extent of underestimation of such incidents has not yet been widely studied in the population of this group of employees. The aim of the study was to observe a group of population chosen as an example to assess the actual exposure incidence rates, especially those not subjected to registration., Materials and Methods: A prospective six-month survey covered 319 Lower Silesia health care workers: physicians, nurses and auxiliary staff. Statistical methods were used to analyze the obtained data, especially those concerning the job performance, the number of medical procedures performed and frequency of exposures, both registered in each case and not registered in the post-exposure prophylaxis log., Results and Conclusions: Finally, 269 persons were under observation. Actual exposure incidence rate was several fold higher than that officially registered and differed depending on the department and subgroup of health care workers. In summary, the ratio of all the registered cases to those not registered was 1: 6. An overall proportion of not registered cases of exposure was as high as 86%. Most frequent job activities of exposed health care workers comprised preparatory procedures like parenteral drug administration or injections. Post-procedure activities were less frequently the cause of exposure. Non-registration of such exposures were motivated by a self-assessment of a low infection risk or a conviction that self-protection on the incidence site was optimal. Lack of current knowledge was rather rarely admitted as a reason for underreporting.

Fatty liver disease is one of most frequently diagnosed hepatopathies while detailed examination of potential causes of liver enzymes abnormalities is done. Despite its isolated nosology fatty liver disease often co-exists with other liver pathologies or - more often - it is their natural consequence. Liver steatosis is also more often found in primary hepatotropic viral infections. However, it's more prevalent among HCV (hepatitis C virus) infected persons than in those HBV (hepatitis B virus) infected. It is described in 30-70% routinely pursued liver biopsies in HCV infected individuals. Hitherto, there were many analyses concerning clinical and prognostic implications pursued of HCV influence upon inflammatory and fibrotic process of the liver. This article is an up-to-date review of current clinical and therapeutic implications of hepatosteatosis supported by referent study results.

Combination antiretroviral therapy (cART) can improve immune system function through suppression of HIV-1 replication. However, paradoxical immune response may develop in some patients as a result of effective therapy followed by immune restoration. The phenomena is known as IRS, immune reconstitution syndrome/immune recovery syndrome. IRS can develop within weeks to months after cART is commenced and the time is related to the type of the disease. There are but scant reports concerning IRS-NHL (non-Hodgkin's lymphoma) in HIV-1 positive subjects. We observed 4 (33%) cases of IRS-NHL out of 12 patients in whom NHL was diagnosed. As a result of potent cART they reached viral suppression in a mean time of 15 weeks followed by a rise in CD4(+) T cells within 16.5 weeks. The diagnosis of NHL was established at a mean time of 36 weeks after cART was introduced and 20 weeks after the CD4 T cell increase was achieved. This may indicate that the immune reconstitution as a result of cART was a predisposing factor for the development of NHL in our patients. There was prompt progression of the disease and the outcome was fatal in all cases. IRS-NHL should be suspected in any case of lymphadenopathy, generalized or limited to the abdomen or periphery, which develops after immune recovery due to potent cART within a few months.

A case of small-cell lung cancer with prompt worsening of the clinical course was observed in a patient with significant immune restoration after receiving effective highly active antiretroviral therapy (HAART) for seven months. Rapid and enormous enlargement of metastatic liver was the main symptom. Chest x-ray showed an enlargement of the left hilus. The patient died 22 days after the onset of the fulminant disease. We suggest that the occurrence and aggressive course of the lung cancer resulted from the development of immune reconstitution syndrome.