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Introduction: All epidemiological studies suggest that vitamin D deficiency is prevalent among the Polish general population. Since vitamin D deficiency was shown to be among the risk factors for many diseases and for all-cause mortality, concern about this problem led us to update the previous Polish recommendations. Methods: After reviewing the epidemiological evidence, case-control studies and randomized control trials (RCTs), a Polish multidisciplinary group formulated questions on the recommendations for prophylaxis and treatment of vitamin D deficiency both for the general population and for the risk groups of patients. The scientific evidence of pleiotropic effects of vitamin D as well as the results of panelists’ voting were reviewed and discussed. Thirty-four authors representing different areas of expertise prepared position statements. The consensus group, representing eight Polish/international medical societies and eight national specialist consultants, prepared the final Polish recommendations. Results: Based on networking discussions, the ranges of total serum 25-hydroxyvitamin D concentration indicating vitamin D deficiency [

Pulse wave velocity (PWV) is commonly used for assessing arterial stiffness and it is a useful and accurate cardiovascular mortality predictor. Currently, many techniques and devices for PWV measurement are known, but they are usually expensive and require operator experience. One possible solution for PWV measurement is photoplethysmography (PPG), which is convenient, inexpensive and provides continuous PWV results. The aim of this paper is validation of a new device for PPG sensor-based measurement of multi-site arterial PWV using a SphygmoCor XCEL (as the reference device) according to the recommendations of the Artery Society Guidelines (ASG). In this study, 108 subjects (56 men and 52 women, 20–91 years in 3 required age groups) were enrolled. The multi-site PWV was simultaneous measured by 7 PPG sensors commonly used in pulse oximetry in clinical settings. These sensors were placed on the forehead, and right and left earlobes, fingers and toes. Pulse transit time (PTT) was measured offline as the difference of time delay between two onsets of the pulse wave determined by the intersecting tangent method. The PWV was calculated by dividing the distance between PPG sensors by PTT. During PPG signals measurement, reference carotid to femoral PWV (cfPWV) was performed with a SphygmoCor XCEL system. The Pearson correlation coefficient (r) between the obtained PWV results was calculated. The Bland-Altman method was used to establish the level of agreement between the two devices. Mean difference (md) and standard deviation (SD) were also calculated. The multi-site PWV was highly correlated with accuracy at the ASG-defined level of “Acceptable” (md

Abstract In Poland, no statistical data are available concerning the analysis of the incidence of pneumonia in inpatient children. The requirement for these data results mainly from the need to prepare systemic and economic solutions. Aim This study aimed to use reported data for evaluating pneumonia incidence rates among hospitalised children and other parameters in various age groups. Subject and methods A detailed analysis was performed as part of the Operational Programme Knowledge Education Development co-financed by the European Social Fund. Services reported to the National Health Fund in 2014 were considered, including pneumonia incidence among hospitalised children and mortality in specific age groups. Results In 2014, a total of 68,543 children were hospitalised for pneumonia (68% of all hospitalisations for acute respiratory diseases). Within each of the analysed age groups, boys were hospitalised more frequently. Irrespective of the place of residence, infants were most commonly hospitalised. It was observed that there was a significant difference between the incidence rate of pneumonia among hospitalised children in all analysed groups depending on the province. The average length of stay was 7.29 days, with infants requiring the longest stays (7.96 days), and 1.8% of children were rehospitalised within 30 days due to recurrence of pneumonia. The most commonly coded pathogens responsible for pneumonia included Mycoplasma pneumoniae, Streptococcus pneumoniae and Chlamydia spp. A total of 19 inpatient hospital deaths in the course of pneumonia were reported. Conclusions Based on our findings, it is warranted to utilize epidemiological knowledge for the planning of an appropriate level of service commissioned both in outpatient and inpatient facilities as well as for the estimation of institutional and staff needs necessary to secure these services.

Pleural effusion (PE) is excess fluid in the pleural cavity that stems from lung cancer, other diseases like extra-pulmonary tuberculosis (TB) and pneumonia, or from a variety of benign conditions. Diagnosing its cause is often a clinical challenge and we have applied targeted proteomic methods with the aim of aiding the determination of PE etiology. We developed a mass spectrometry (MS)-based multiple reaction monitoring (MRM)-protein-panel assay to precisely quantitate 53 established cancer-markers, TB-markers, and infection/inflammation-markers currently assessed individually in the clinic, as well as potential biomarkers suggested in the literature for PE classification. Since MS-based proteomic assays are on the cusp of entering clinical use, we assessed the merits of such an approach and this marker panel based on a single-center 209 patient cohort with established etiology. We observed groups of infection/inflammation markers (ADA2, WARS, CXCL10, S100A9, VIM, APCS, LGALS1, CRP, MMP9, and LDHA) that specifically discriminate TB-PEs and other-infectious-PEs, and a number of cancer markers (CDH1, MUC1/CA-15-3, THBS4, MSLN, HPX, SVEP1, SPINT1, CK-18, and CK-8) that discriminate cancerous-PEs. Some previously suggested potential biomarkers did not show any significant difference. Using a Decision Tree/Multiclass classification method, we show a very good discrimination ability for classifying PEs into one of four types: cancerous-PEs (AUC: 0.863), tuberculous-PEs (AUC of 0.859), other-infectious-PEs (AUC of 0.863), and benign-PEs (AUC: 0.842). This type of approach and the indicated markers have the potential to assist in clinical diagnosis in the future, and help with the difficult decision on therapy guidance.

Introduction: Statistical data on the structure of acute respiratory diseases incidence in the paediatric population are still scarce. The demand for such data results mainly from the need to constantly implement new systemic and economic solutions. The aim of the study was to attempt to use reported data for an assessment of the incidence of acute respiratory diseases in various age groups. Material and methods: An analysis of selected acute respiratory diseases was conducted in relation to diagnoses reported from 1 January to 31 December 2014 to the National Health Fund (NFZ, Narodowy Fundusz Zdrowia) in accordance with the codes of the International Statistical Classification of Diseases and Related Health Problems, 10th Revision. The study was conducted under the Knowledge Education Development operational programme co-funded by the European Social Fund. Results: A total of 101,000 children were hospitalised due to acute respiratory diseases, which amounted to 1,554 hospitalisa-tions per 100.000. The most common causes of hospitalisation were pneumonia and bronchitis/bronchiolitis. Boys were hospital-ised more often in each age group. The shortest average length of stay (ALOS) was 5.21 days and concerned hospitalisation due to bronchitis. The longest length of stay for children was due to tuberculosis (14.3 days). The highest age average of a child was recorded in pleural diseases (10.51 years) and the lowest in bronchitis (2.93 years). Rehospitalisation was necessary in children in whom tuberculosis or pleural diseases were diagnosed (1.43 vs 1.34). A total of 67 inpatient deaths were recorded, of which 19 were due to pneumonia or its complications. Conclusions: Epidemiological data reported to the National Health Fund (NFZ) seem quite reliable and do not differ significantly from those reported in other European countries. The analysed data may be useful in estimating health needs in paediatrics.

Sarcoidosis is a systemic multisystem inflammatory disease of unknown etiology. The disease is characterized by formation of non-caseating granulomas. The most common presentation is bilateral hilar lymphadenopathy and lung infiltration, but the disease is very heterogeneous, with an unpredictable clinical course. Musculoskeletal manifestations are common. Bone involvement is less frequent, and usually occurs in patients with chronic multisystem course of the disease. They are most commonly found in the phalanges of hands and feet, and are usually bilateral. The skull, long bones, ribs, pelvis, and axial skeleton may also be affected. Osseous involvement may be asymptomatic but in some cases can cause a severe disability. Imaging techniques are important for diagnosis. Radiological investigations revealed sclerotic or destructive lesions (involving also joints), cystic and punched out lesions and cortical abnormalities. Biopsy is required for differential diagnosis with respect to malignancy. Treatment is a part of systemic therapy and is not needed in all cases. Glucocorticoids and TNF-a antagonists are used for management.

Measurement of pulse wave velocity (PWV) is a simple and noninvasive way to assess stiffness of the arteries. PWV measurement can refer to both the aorta and peripheral arterial vessels. Currently, the most clinically significant is the measurement of PWV between the carotid artery and the femoral artery, which is defined as the speed of the aortic pulse wave. Numerous studies have demonstrated the significance of prognostic PWV aortic measurement as a recognized exponent of subclinical organ damage both among the general population as well as among patients with increased cardiovascular risk, examining patients in detail with hypertension, diabetes, chronic renal failure. The prognostic value of PWV aortic measurement was reflected in the guidelines of the European Society of Cardiology (ESC) and the European Society of Hypertension (ESH). In clinical trials, the repeatability and reproducibility of PWV measurements were also evaluated, both parameters being considered satisfactory. The paper presents reports from studies on the significance of pulse wave velocity results in the prognosis assessment in different disease entities as well as in age groups.

In the 2015 Ageing Report, the European Commission (EC) and the Economic Policy Committee stated that coping with the challenge posed by an ageing population will require determined policy action in Europe, particularly in reforming pension, health care and long-term care systems. The concern for this situation motivated the EC, the Parliament and many of the Member States (MS) to co-fund, in the 2015 call of the Third European Health Programme of the European Union 2014-2020, the first Joint Action (JA) on the prevention of frailty. ADVANTAGE JA brings together 33 partners from 22 MSs for 3 years. It aims to build a common understanding on frailty to be used in the MSs by policy makers and other stakeholders involved in the management, both at individual and population level, of older people who are frail or at risk for developing frailty throughout the European Union (EU). It is a formidable challenge but also a great opportunity for concerted action resulting in fostering effective and successful policies in frailty prevention and management in the participating MS. The Consortium has 2 years of hard work ahead to contribute to the needed change for frailty related disability free Europe. The first practical step towards this aim was the preparation of a document: the State of the Art on Frailty Report to support an overview of evidence of what works and what does not work on frailty prevention and management. Subsequently, this will be reflected in the advice that the JA will give to policy makers at MS level. Overall, these messages intend to be an instrument of added value to advocate for policy driven decisions on frailty prevention and management in the JA participating MSs and subsequently towards a frailty related disability free older population in Europe. The aim of this paper is to describe ADVANTAGE JA general structure, approach and recommendations towards a European health and social policy which will support frailty prevention in the participating MS.

Objectives We conducted a study on usefulness of the tuberculin skin test (TST) and the Quantiferon-TB Gold IT (QFT) tests as predictors of radiological changes after contact with tuberculosis. Materials and Methods The study group consisted of TB-exposed HCWs working in the Military Institute of Medicine (Warsaw, Poland). The usefulness of TST, QFT, and a combination of both tests was assessed for prediction of silent radiological findings. Results 83 previously TB-exposed participants were recruited. None of the participants had a history of active tuberculosis. Positive TST results were reported in 72 (86.8 %) participants, and positive QFTs were observed in 27 (32.5 %) cases. Chest radiographs revealed 23 findings specific for non-active tuberculosis in 18 (21.7 %) participants. The results of the QFTs were associated with the highest negative predictive value, positive predictive value, and positive likelihood ratio of silent chest X-ray findings suggestive of latent tuberculosis infection. Positive QFT was the only statistically significant variable that increases the odds ratio (OR–8.3) of the presence of typical of tuberculosis radiological changes in the lung. Conclusion A positive QFT result in an individual with no TB history who was exposed to tuberculosis in the past is associated with a significantly higher risk of clinically silent parenchymal lesions in lungs suggestive of previous tuberculosis.

Introduction For many years, Poland has had a mandatory vaccination program against tuberculosis, which recommended repeated vaccinations from birth to adulthood. Therefore, the clinical value of the tuberculin skin test (TST) in diagnosing latent tuberculosis infection (LTBI) in Poland remains unclear. Objectives We conducted a study on the usefulness of the TST and QuantiFERON®-TB test (QFT) for the evaluation of the prevalence and risk factors of L TBI among Polish health care workers. Patients and methods The study group consisted of the Polish health care workers. TST and QFT were performed in each participant. The usefulness of TST and QFT was tested in relation to occupational risk factors. Results A total of 305 participants were included. A positive TST result was observed in 149 cases (48.9%) and a positive QFT result was observed only in 27 cases (8.9%). In the subgroup that declared contact with tuberculosis (n = 44), positive QFT and TST results were found in 20.5% and 63.3% cases, respectively. Past contact with tuberculosis was the only significant variable associated with a positive TST result. Independent variables associated with positive QFT results were older age, lower education level, longer period of work in health care, and previous contact with tuberculosis. Conclusions The QFT has a higher diagnostic value than the TST in the assessment of LTBI in Polish health care workers.

Introduction: Chronic obstructive pulmonary disease (COPD) is one of the leading causes of death in Poland and worldwide. Cost-of-illness studies (analysing total, direct and indirect costs) are studies aimed to determine the economic burden of a disease. Acute exacerbations and hospitalisation are the major cost drivers in COPD. The aim of the study was to estimate the direct costs of COPD treatment in the setting of specialist outpatient care from the societal perspective. Material and methods: Chronic obstructive pulmonary disease costs were estimated from a compilation of data: medical records of patients managed at 8 specialist outpatient clinics and 5 teaching hospitals in Poland between 2007 and 2008. The direct costs, resulting from chronic treatment and treatment of acute exacerbations in the outpatient setting, were calculated using the bottom-up approach on the basis of data collected by pulmonary specialists at outpatient clinics. The mean cost of acute exacerbation managed in the inpatient setting was derived from a multicentre Polish study in which five clinical centres participated. Results: The total cost per patient per year was 4027.82 zlotys (1007 euro) and included the cost of chronic treatment in the amount of 2423.57 zlotys (606 euro) plus the cost of treatment of an acute exacerbation in the outpatient setting in the amount of 421.16 zlotys (105 euro) plus the cost of treatment of an acute exacerbation in the inpatient setting in the amount of 1183.09 zlotys (296 euro). Conclusions: Treatment of COPD in poses a considerable economic burden on the Polish society.

W pierwszym numerze “Pneumonologii i Alergologii Polskiej” z 2014 roku ukazała się kazuistyczna praca autorstwa Pani mgr Dagmary Borkowskiej i wsp [...]

Summary Purpose Evaluation of relationships between survival time of patients with advanced, non-resectable non-small cell lung cancer (NSCLC) and telomerase activity in aspirates, collected from primary lung tumours, and serum p53 protein levels. Material and methods The study group consisted of 52 patients with advanced (stage IIIB and IV) non-small cell lung cancer. In all of them, transthoracic fine-needle biopsy (TFNB) of focal pulmonary lesion was performed. The aspirates were subjected to telomerase activity by the PCR–ELISA PLUS method and serum levels of p53 protein were determined by the ELISA method. Additionally, clinical advancement of cancer and the time period of survival were assessed in the studied group. Kaplan–Meyer method and Cox analysis were used for statistical evaluation of survival prognosis. Results Increased telomerase activity was observed in 42 (81%) of the patients with non-resectable non-small cell lung cancer. Elevated concentrations of serum p53 protein were found in 28 (54%) of the participants. The following death rates were noted during the entire study period: twenty-three (23) (62%), out of 37 patients with increased telomerase activity, 7 (47%), out of 15 without detectable telomerase activity in primary lung tumour, 16 (57%), out of 28 subjects with increased serum levels of p53 protein and 14 (58%), out of 24 with no increased serum levels of p53. A significant relationship was observed in Cox hazard analysis between the time of survival and telomerase activity, while no such relationship was observed between the survival time period and serum p53 protein levels or sex, age, primary lung tumour size, lymph node status or development of distant metastases. Conclusion Telomerase activity in advanced primary non-small cell lung cancer is a better predictor of patients' survival than serum levels of p53 protein. The assessment of telomerase activity supplements in the prognosis of survival in the course of non-resectable NSCLC.

Toxins and venoms are silent weapons capable of killing people secretly. All around the world, there are a lot of such substances produced by bacteria, fungi, plants and animals. The threat to health and life, which are caused by toxins and venoms, meant that they are seen as a biological weapon. In the rescue proceedings with the victims the mechanism of toxin action is imported, because in some cases the antitoxins are known. However, in the most cases, the primary consideration is the symptomatic treatment. Conducted research on the usefulness of oxime and autofages in eliminating the effects of toxins are advanced, but not yet implemented into therapy. In each case the toxin action the victims must be evacuated to a safe location. It is also necessary to protect teams providing assistance in suitable protective clothing.

Firing smoke candle, on reaction of pyrotechnic mixture of zinc oxide and hexachloroethane, releases of white smoke, which can damage the pulmonary parenchyma. Presented case illustrates the effects of such an inhalation injury that has led to acute respiratory distress syndrome (ARDS). The use of mechanical ventilation and administration of antibiotics and corticosteroids give the possibility to obtain clinical improvement. The resulting changes in the lung parenchyma shown on imaging studies resulted in significant impairment of breathing.

Great interest of scientific community is observed recently over non-invasive tests methods dedicated to diagnose disease states using biomarkers. The ability to detect these substances in the human breath can provide valuable information about disorder of biochemical processes in the body. Breath analysis is non-invasive, painless and can provide a quick answer about the existence of the disease. In addition, the sampling process is carried out comfortably for both the patient and the medical staff.The aim of the study was to present opportunity of application the optoelectronic methods for screening tests in medical diagnostics. The results of the researches carried out at the Institute of Experimental Physics, Department of Physics UW and at the Institute of Optoelectronics MUT are presented.For the detection of methane and ammonia in breath the Multipass Spectroscopic Absorption Cells (MUPASS ) were used. In the case of nitric oxide and ethane observation, Cavity Enhanced Absorption Spectroscopy (CEAS) was applied. During the investigation modern tunable and sophisticated infrared radiation sources were used: single mode diode lasers (for CH4, NH3 detection), quantum cascade laser (NO sensing), and optical parametric generator (PG711/DFG) for ethane measurements. The investigations of developed sensors were conducted with use of reference samples of biomarkers, which were prepared with gas standards generator 491M from KIN-TEK company.Experiments showed that sensitivities of the sensors are suitable for human breath analyzing. In case of methane sensor, the detection limit (sensitivity) of ~ 0.1 ppm was obtained. This value is significantly lower than the upper limit of methane concentration in the breath of healthy humans (10 ppm). Therefore, our system well satisfies the requirements for diseases screening (e.g. intestines diseases ) and for methane monitoring in healthy human breath. Ammonia sensor is characterized with linear response in the concentration range higher than 1 ppm. The upper limit of ammonia concentration in healthy human breath is approx. 2 ppm, so this system is well suited for the determination of disease states (e.g. liver diseases). During the observation of nitrogen oxide the detection limit of 30 ppb was obtained. According to the ATS recommendation such NO detection limit is sufficient to monitor people's health state and for the detection of respiratory diseases like asthma or chronic bronchitis. For ethane detection with a wavelength of 3.348 microns the detection limit of 20 ppb was obtained.Developed sensors are characterized by high sensitivity (ppb-level) and high selectivity, simple and fast measurement procedure. Therefore, they can be applied as medical screening tools enabling biomarkers detection in exhaled air at the molecular level.

Background: Expression of CCR4 ligands, such as thymus and activation-regulated chemokine (TARC) and macrophage-derived chemokine (MDC), leads to preferential influx of T-helper (Th) 2-type lymphocytes to the lesional skin in atopic dermatitis (AD). Eotaxin, like the CCR3 ligand, is an important contributor of eosinophils recruitment in the course of AD. These chemokines are assumed to play an important role in the patomechanism of AD. Methods: In this study, the serum concentration of TARC, MDC, eotaxin and total immunoglobulin E (IgE) in AD patients and healthy people were compared. Correlation between the studied indices and activity of AD was established. Severity of AD was assessed according to the SCORAD score. The study comprised 44 healthy people and 43 patients with AD. The serum concentrations of TARC, MDC, eotaxin and IgE were measured with the use of enzyme-linked immunosorbent assay kits. Results: The serum levels of TARC, MDC, eotaxin and IgE appeared to be significantly higher in patients with AD than in healthy people. A strong positive correlation was revealed between the levels of TARC, MDC, total IgE in serum of patients with AD and SCORAD. In contrast, no significant relationship was found for the serum eotaxin concentration and TARC, MDC, IgE or disease severity. Conclusion: Our findings indicate that TARC and MDC are actively involved in the pathogenesis of AD and their expression, opposite to that of eotaxin, is strongly associated with clinical picture of atopic dermatitis.

The aim of the study was to compare humoral response to influenza vaccinations in healthy people and patients with bronchial asthma or COPD. Ninety-one subjects (20 with COPD, 21 with bronchial asthma and 45 healthy) were vaccinated with a single dose of influenza subunit vaccine. Antibody response to haemagglutinin (HI) and neuraminidase (NI) glycoproteins and pulmonary function were measured before and after vaccination. Influenza-like symptoms and intensity of COPD or asthma complaints after vaccination were also recorded. A significant increase of geometric mean titres of HI and NI antibodies was observed in all three vaccinated groups. No significant differences between the COPD, asthma and healthy groups were observed in mean fold increase of HI and NI antibodies and response rate to vaccination or proportion of subjects with the sufficient protection level of HI. No change in intensity of asthma or COPD symptoms was found. There were no differences between the groups in the proportion of subjects who experienced influenza-like symptoms. The results suggest that in patients with bronchial asthma or COPD humoral response to influenza vaccine and safety of vaccinations are comparable to those in healthy individuals.

Background: Allergen-specific immunotherapy (SIT) is believed to be a valuable remedy in several allergic diseases; however, an accurate immunological marker of the efficacy of this treatment method has not been found yet. Cc-chemokine eotaxin, owing to its selective action on eosinophils, seems to play an important role in the pathophysiology of allergic response. The purpose of this study was to assess the usefulness of eotaxin in monitoring of SIT efficacy in patients with IgE-mediated allergic rhinoconjunctivitis. Methods: One hundred and twenty-two patients with seasonal IgE-mediated allergic rhinoconjunctivitis due to tree- (birch, n = 42; hazel/alder, n = 14) or grass/cereal- (n = 66) pollen received allergen-specific immunotherapy.Serum eotaxin levels were determined four times in every patient, shortly before immunotherapy (Evaluation 0), immediately after the treatment (Evaluation 1), in the height of pollen season (Evaluation 2) and at least 2 weeks after the pollen season (Evaluation 3). Serum eotaxin levels were simultaneously measured in 59 healthy people from the control group. Changes in serum eotaxin levels were assessed in the healthy and allergic groups. Clinical symptoms of IgE-mediated rhinoconjunctivitis were evaluated and compared with serum eotaxin concentration changes. Results: Mean values of eotaxin concentrations in serum during Evaluations 0–3 did not significantly differ in the healthy subjects and the patients with IgE-mediated rhinoconjunctivitis (P > 0.05). Moreover, no statistically significant differences in the serum eotaxin levels between the visits were observed in the patients who received immunotherapy (P > 0.05); however, immediately after immunotherapy (Evaluation 1) the mean serum level of eotaxin was lowest and closest to the serum eotaxin concentration in the control group at the same visit. No significant correlation between the mean value of the serum eotaxin level in the height of pollen season (r = −0.12, P > 0.05) or mean changes of the eotaxin levels between Evaluations 2 and 1 (r = −0.03, P > 0.05), on the one hand, and the cumulative score of symptoms and drug, on the other, were found. Conclusions: The results allow to conclude that although eotaxin plays a significant role in the mechanism of antigen-specific immunotherapy, its serum expression remains a poor marker of SIT efficacy.

A new method in the diagnostics of respiratory failure is lung ultrasound (LUS). The test assesses the pleural line and its related artefacts caused by the changing content of extravascular lung water which conditions the degree of lung aeration. Assessment of the movement of the pleural line and the related artefacts (A lines and B lines) enables diagnosis of respiratory failure and treatment monitoring. The advantage of LUS is the possibility of assessing lung function in real time, and the possibility of obtaining information about aeration of the examined part of lung parenchyma. In comparison to other imaging methods, ultrasound is characterized by a considerable specificity and sensitivity in diagnostics and differentiation of numerous diseases, such as pneumothorax, pneumonia, ARDS, and pulmonary edema.

Background: A study was undertaken to evaluate the usefulness of telomerase activity assay in transthoracic fine needle biopsy (TFNB) aspirates collected from peripheral tumours of the lung in predicting the malignant aetiology of lung infiltrations. Methods: 100 patients with a peripheral infiltration of the lung underwent TFNB of the focal lesion. The aspirates were subjected to standard cytological evaluation. Telomerase activity in the specimens was determined with the PCR-ELISA PLUS method. The sensitivity, specificity, accuracy and predictive value of TFNB were calculated for cytological examination of aspirates alone and cytological examination with additional telomerase activity assessment. Results: Lung cancer was newly diagnosed in 84 subjects and benign peripheral lesions were found in 16. During the first TFNB, lung cancer was identified in 56 cases of cancer (66.7%) while increased telomerase activity was found in 61 cancer aspirates (72.6%). No subject with a benign infiltration had a false positive result from cytological examination, but in one case (6.25%) increased telomerase activity was observed. The diagnostic sensitivity, accuracy and negative predictive value of the combination of cytological examination and telomerase activity assay in TFNB specimens were significantly higher than for cytological examination alone (89.3% vs 66.7%, p = 0.0004; 90% vs 72%, p = 0.001; 62.5% vs 36.4%, p = 0.039), but a combination of the two examinations was associated with a lower specificity of TFNB (96.9% vs 100%, p = 0.002). Conclusion: Detection of telomerase activity in aspirates taken during TFNB of a peripheral lung infiltration should be considered as an indication of the risk of malignancy in cases with false negative cytological results.

Viral infections are the most common cause of acute respiratory diseases. They are caused by adenoviruses, rhinoviruses, influenza and parainfluenza viruses, metapneumoviruses, syncytial-respiratory viruses and coronaviruses. Respiratory symptoms also may be due to hemorrhagic fever viruses, especially hantaviruses, that not occur in Poland. The clinical course of viral infections varies from asymptomatic to rapidly-progressing, high- mortality disease. The diagnosis is based on serology and genetic methods. It is also possible to isolate the virus in the tissue culture. Virus-specyfic treatment is not available, except influenza virus.

Mycobacterioses are caused by nontuberculous mycobacteria which are common in natural environment. They were isolated from water and soil. Patients with suppressed immune system are most likely to be affected. Mycobacteria are transferred to human through damaged skin, the respiratory system, and digestive system. The most common clinical manifestation has been observed in the lungs. Diagnosis of disease is still current clinical problem and the effectiveness of therapy is not satisfy.

Community-acquired pneumonia is still serious disease with morbidity estimated at 5-12 per thousand adult population. The proper management of patients with pneumonia is crucial for effectiveness of therapy and decrease of mortality. There are few classifications of pneumonia severity. In clinical practice the most useful is division on community and hospital acquired pneumonia. This paper concerns recommendations and crucial information for diagnosis and treatment of community-acquired pneumonia based upon publications and own clinical experience.

Tuberculosis is an infectious disease caused by mycobacteria which belongs to the genus Mycobacterium and the family Mycobacteriaceae. Although tuberculosis is known for thousands of years, it is still an important diagnostic and therapeutic problem throughout the world, especially in poorer countries. Still correct diagnosis of active infection with M. tuberculosis causes many difficulties. The paper presents the most relevant issues concerning the diagnosis and treatment of tuberculosis, to be reflected in daily practice.

Rickettsioses are infectious diseases transmitted to human by arthropodes, characterized by different clinical manifestation, from subclinical symptoms, through the mild virus-like infection to severe disease with multiorgan complications. Rickettsiosis include typhus, spotted fevers, anaplasmosis, bartonellosis and Q fever. In some of these diseases respiratory symptoms predominate (i.e. acute Q fever), where as one do not occure in the others at all. Rickettsiosis treatment is based usually on the use of tetracycline antibiotics.

Invasive meningococcal disease a serious problem for public health. Two severe clinical manifestations--spinal meningitis and septicemia--are diseases extending very rapidly with serious prognosis. Pathogenic bacterium--Neisseria meningitidis--is the only natural reservoir in human beings. In Poland during the last 10 years, the incidence of meningococcal disease is steadily increasing with localized outbreaks of epidemic. Treatment of infection is effective when the early diagnosis has been done. In the recent years, significant progress has been made in immunoprophylaxis of infections, and the introduction of vaccines against Neisseria meningitidis into the national calendar gave the significant reduction of invasive infection.

Morbidity on allergic diseases has been increasing in the last years. They are becoming important medical, social and economical problem all over the world. Allergic rhinitis and asthma are one of the most common allergic diseases. Specific allergen immunotherapy (SIT) has additional effects, not shared by pharmacological therapy; it has long-lasting preventive effect, especially the capacity to modify the natural course of the allergic diseases.To evaluate the clinical efficacy and costs of specific immunotherapy in patients with allergic diseases.The study were carried out on the group of 83 allergic patients treated with three-years subcutaneous SIT Clinical efficacy of SIT, costs of SIT and costs of one-year symptomatic treatment before and after SIT were assessed.Three-years subcutaneous allergen-specific immunotherapy decreases allergic symptoms about 80% and reduces costs of symptoms-relieving drug about 70%. Patients with allergic bronchial asthma gain most clinical and economical benefits with SIT while presence of atopic dermatitis is correlated with less effective immunotherapy.From public payer's and patient's perspective, SIT essentially reduces costs of symptoms-relieving treatment, especially in patients with allergic bronchial asthma. It can be a premise to consider to increase a level of refund of specific immunotherapy in Poland.