Incidence of tuberculosis and mycobacteriosis among HIV-infected patients — clinical and epidemiological analysis of patients from north-eastern Poland

INTRODUCTION: According to WHO data, among patients infected with HIV, tuberculosis occurs in about 30% of patients and causes approximately 25% of deaths due to AIDS worldwide. The incidence rate of tuberculosis in the Polish population was 22.2/100,000 in 2011, while the average in European Union countries in 2011 was 14/100,000. Since 1985 to 30 April 2013 HIV infection in Poland was confirmed in 16,588 patients, while the number of reported tuberculosis cases in HIV-infected individuals in 2011 was 26. The aim of this study was to assess the prevalence and clinical course of tuberculosis and mycobacterial disease in HIV-infected patients treated in the Department of Infectious Diseases and Hepatology in Białystok.MATERIAL AND METHODS: We analysed documentation of 577 HIV-infected patients, their demographic data, epidemiological status, degree of immunosuppression (T CD4 and CD8 numbers) and stage of HIV infection.RESULTS: Complete follow-up was possible in 389 patients, of whom 265 (68%) were male. Tuberculosis (TB) was diagnosed in 41 patients (10.5%) and mycobacteriosis in 4 patients (1.03%). In 19 patients (42%) HIV and TB or mycobacteriosis were diagnosed simultaneously. The median CD4 T lymphocyte count was lower in patients with a simultaneous diagnosis of HIV and tuberculosis or mycobacteriosis compared to the group in whom TB/mycobacteriosis was diagnosed later. The number of CD4 T-cells less than 50 cells/μL was found in 63.2% (12/19) of patients when HIV and TB or mycobacteriosis were diagnosed simultaneously and in 38.5% (10/26) of patients who were diagnosed with TB or mycobacteriosis later than the HIV infection (p = 0.14). The median HIV viral load in patients in whom HIV infection and tuberculosis or mycobacteriosis were diagnosed at the same time was higher than in other patients and this difference was statistically significant. Pulmonary tuberculosis was the most common form of clinical disease and accounted for 60% of all cases. Among the analysed cases with HIV and tuberculosis or mycobacteriosis coinfection, tuberculosis or mycobacteriosis was the cause of death in 8 patients, and 9 died of other causes.CONCLUSION: In our material of 389 HIV-infected patients, tuberculosis was diagnosed in 41 (10.5%) and mycobacterial diseases in 4 (1.03%). In 42% of co-infected patients (HIV+TB or mycobacteriosis) the diagnosis of both diseases was made at the same time. In these patients, a deep deficit of cellular immunity (CD4 < 50 cells/μL) was observed more frequently than in patients diagnosed with TB or mycobacteriosis in the later course of HIV. HIV RNA viral load was significantly higher in the group diagnosed simultaneously than in the remaining patients with HIV and TB or mycobacteriosis coinfection.WSTĘP: Zgodnie z danymi WHO wśród pacjentów zakażonych HIV, gruźlica występuje u około 30% pacjentów i jest przyczyną około 25% zgonów z powodu AIDS na świecie. Zapadalność na gruźlicę wśród populacji polskiej w 2011 roku wynosiła 22,2/100 000, natomiast średnia zapadalności w krajach Unii Europejskiej w 2011 roku — 14/100 000. W Polsce, od 1985 roku do 30 kwietnia 2013 roku potwierdzono 16 588 zakażeń HIV, natomiast liczba zgłoszonych w 2011 roku przypadków gruźlicy u zakażonych HIV wynosiła 26 przypadków. Celem pracy była ocena częstości i objawów klinicznych gruźlicy i mykobakterioz w materiale chorych zakażonych HIV, hospitalizowanych w Klinice Chorób Zakaźnych i Hepatologii Uniwersytetu Medycznego w Białymstoku.MATERIAŁ I METODY: Analizowano dokumentację 577 chorych zakażonych HIV. Analizowano dane demograficzne, epidemiologiczne, stan układu immunologicznego w zakresie limfocytów T CD4 i CD8, fazę zakażenia HIV.WYNIKI: Pełna obserwacja możliwa była u 389 pacjentów, z których 265 (68%) to mężczyźni. Gruźlicę rozpoznano u 41 pacjentów (10,5%), mykobakteriozy u 4 pacjentów (1,03%). U 19 pacjentów (42%) rozpoznanie gruźlicy lub mykobakteriozy było równoczasowe z diagnozą HIV. Mediana liczby limfocytów T CD4 była niższa u pacjentów z równoczesnym rozpoznaniem gruźlicy i zakażenia HIV w porównaniu do grupy, u której gruźlicę rozpoznano później. Liczbę limfocytów T CD4 niższą niż 50 kom./μl stwierdzono u 63,2% (12/19) pacjentów, u których zakażenie HIV i gruźlicę (albo mykobakteriozę) rozpoznano równocześnie oraz u 38,5% (10/26) pacjentów, u których te choroby rozpoznano w późniejszym czasie (p = 0,14). Mediana wiremii HIV u pacjentów, u których zakażenie HIV i gruźlicę lub mykobakteriozę zdiagnozowano równocześnie, była wyższa niż u pozostałych pacjentów i różnica ta była istotna statystycznie. Gruźlica płuc była najczęstszą postacią kliniczną choroby i stanowiła 60% wszystkich przypadków. Wśród analizowanych przypadków pacjentów z współwystępowaniem gruźlicy lub mykobakteriozy i HIV, gruźlica/mykobakterioza była przyczyną zgonu 8 pacjentów, natomiast 9 zmarło z innych przyczyn.WNIOSKI: W badanej populacji pacjentów gruźlicę rozpoznano u 41 pacjentów (10,5%), a mykobakteriozę u 4/389 pacjentów (1,03%). W 42% przypadków wśród badanych osób rozpoznanie zakażenia HIV i gruźlicy nastąpiło równoczasowo. W tej grupie chorych częściej obserwowano głęboki deficyt odporności komórkowej (limfocyty T CD4 < 50 kom./μl), a wiremia HIV RNA była istotnie wyższa niż w grupie chorych z HIV, u których gruźlicę lub mykobakteriozę rozpoznano później

Jak być polskim Żydem i zwolennikiem syjonizmu rewizjonistycznego po 1939 r.? Rzecz o losach Jakuba Perelmana

Jakub Perelman, the author of memoirs, was born on 20 December 1902 in Warsaw. He was politically linked to the Zionist revisionists. This movement was created after the First World War thanks to the activity of Vladimir Jabotinsky. He was a poet, a soldier and a politician. Perelman’s memoirs concern his political activity, Polish-Jewish relations during the Second Polish Republic, events from the Second World War, and his views on life in People’s Poland. The last fragment of the memoir is related to Israel, where Perelman was in the early 1960s.Jakub Perelman, autor wspomnień urodził się 20 grudnia 1902 r. w Warszawie. Politycznie związany był z syjonistami – rewizjonistami. Ruch ten powstał po I wojnie światowej dzięki działalności Włodzimierza Żabotyńskiego. Był poetą, żołnierzem oraz politykiem. Wspomnienia J. Perelmana dotyczą jego aktywności politycznej, relacji polsko-żydowskich w okresie II Rzeczypospolitej Polskiej, wydarzeń z II wojny światowej, a także jego zapatrywań za życie w Polsce Ludowej. Ostatni fragment wspomnień jest związany z Izraelem, w którym J. Perelman znalazł się na początku lat 60. XX w.&nbsp

Evaluation of CD40, its ligand CD40L and Bcl-2 in psoriatic patients

Psoriasis is a chronic, recurrent, inflammatory disease. Recent investigations indicate an autoimmune pathogenesis of the disease. Apoptosis plays an important role in the regulation of immune mechanisms in many autoimmune diseases. Although CD40, CD40L, and Bcl-2 have already been studied in psoriatic skin lesions, little is known about their circulating forms. The aim of the present study was to evaluate the serum concentrations of Bcl-2, soluble CD40 and CD40L in psoriatic patients. The study was performed using ELISA kits in 39 psoriatic patients before treatment and after two weeks of topical ointment. Data was analyzed with respect to severity of psoriasis, duration of the disease, and coexisting psoriatic arthritis. Our results revealed that serum concentrations of soluble CD40 and CD40L before and after treatment were significantly higher (p < 0.01 and p < 0.001) in patients with psoriasis compared to the control group. Topical treatment of psoriatic lesions with dithranol ointment failed to decrease serum of CD40 and CD40L, which has not been described until now. There was no significant difference in serum Bcl-2 concentration between the compared groups. We did not find significant differences in serum concentrations of Bcl-2, CD40 or CD40L between patients with mild or severe psoriasis, nor any correlation between disease duration and the presence of psoriatic arthritis symptoms. Our data indicates upregulation of the CD40/CD40L system in psoriatic patients despite topical treatment and suggests their possible role in the pathogenesis of psoriasis

Methods of determining indicators of similarity of 3D motion

This paper includes methods for comparing three-dimensional movements with data saved in a C3D file usingPearson's linear correlation algorithms and a mean-quadratic error. Their accuracy was also examined. The movements of a person rowing on an ergometer at a distance of 500 meters were recorded by motion acquisition technology. The article presents the created application used for analysis

Delayed diagnosis of human immunodeficiency virus infection in a patient with non-specific neurological symptoms and pancytopenia: a case report

INTRODUCTION: Both non-specific presentation and asymptomatic course of human immunodeficiency virus infection lead to undiagnosed long-term persistence of the virus in a patient's organism. CASE PRESENTATION: Here, we present a case of a 31-year-old Caucasian man with non-specific neurological symptoms and pancytopenia, who was referred to an internal medicine ward for further diagnosis. Upon admission to our hospital, he denied any past risky behaviors and refused to have his blood collected for human immunodeficiency virus testing. Later, he eventually provided consent to conduct the human immunodeficiency virus test which turned out to have a positive result. The overall clinical pattern indicated an advanced-stage of acquired immunodeficiency syndrome, which contrasted with the history he had provided. CONCLUSIONS: This case report indicates the need to consider human immunodeficiency virus/acquired immunodeficiency syndrome diagnosis in patients with non-specific neurological and hematological disorders. Our report also demonstrates difficulties that can be experienced by the physician while trying to obtain both a clear history and consent to perform human immunodeficiency virus testing

Spatial and social conditions for the location of agricultural biogas plants in Poland (case study)

Biogas production in Poland is controversial. There is a lot of interest in the construction of installations of various scale, and protests of local communities take place at the same time. Residents do not agree to the construction of biogas plants due to the fear of nuisance related to its functioning. This work is a case study of the area of Kamionka – the rural commune in Poland, in terms of the possibility of locating an agricultural biogas plant. The main sources of substrates for biogas production in the commune were determined. When selecting the appropriate location for an agricultural biogas plant, the focus was on the areas designated in the “Study of conditions and directions for spatial development” as areas with the approval of locating devices generating energy from renewable sources. These properties were analyzed in terms of substrate availability (which are waste from animal production, fruit pomace, waste from processing, biomass of plants grown intentionally), plot size, infrastructure status and distance from protected areas. On this basis, one location was chosen that meets all those criteria. Surveys have shown that residents are afraid of unpleasant smell, noise, emerging waste and explosion risk. Nevertheless, the majority of respondents declared willingness to cooperate with the biogas plant

Interdyscyplinarne aspekty zespołu Wernera — opis przypadku

The paper presents a case of 40-year-old patient with a history on the Werner syndrome who was admitted to theDepartment of Dermatology due to recurrent eczema on lower legs and feet. The patient’s medical history revealednumerous internal diseases, hoarseness and premature hair loss. Physical examination showed visible erythema andtrophic changes on the skin of the lower legs. There were also other skin manifestations typical for the prematureaging syndrome — a generalized atrophy of the skin, subcutaneous tissue atrophy, muscle contractures in theelbows and hips and bird-like facial appearance. The treatment applied resulted in partial clinical improvement.Przedstawiono przypadek 40-letniego pacjenta z wywiadem dotyczącym zespołu Wernera, którego przyjęto do KlinikiDermatologii z powodu nawracających zmian o charakterze wyprysku podudzi i stóp. W wywiadzie stwierdzono liczne schorzenia internistyczne, chrypkę oraz przedwczesne łysienie. W obrębie skóry podudzi były widoczne zmiany rumieniowe i troficzne. Zaobserwowano także inne manifestacje skórne typowe dla zespołu przedwczesnego starzenia — uogólnioną atrofię skóry, zaniki tkanki podskórnej i mięśni, przykurcze w stawach łokciowych i biodrowych oraz ptasi wygląd twarzy. W wyniku zastosowanego leczenia uzyskano częściową poprawę kliniczną

The application of set-based concurrent engineering to enhance the design performance of surface jet pump

Set-Based Concurrent Engineering (SBCE) is an approach that has the capability to improve the efficiencies of the product development process. SBCE provides an environment where design space is explored thoroughly which lead to enhance innovation. This is achieved by considering an alternative set of solutions after gaining the right knowledge to support decision to narrow down the set of solutions until the single optimal design solution is reached. This paper presents a novel application SBCE in order to generate alternative design to enhance the efficiency of the Surface Jet Pump (SJP) in term of its productivity and performance of producing the oil and gas in oil and gas well

Trade-off curves applications to support set-based design of a surface jet pump

Knowledge has become the most important asset of companies, especially in improving their product development processes. The set-based design approach is an efficient way of designing high quality, optimised designs. However, it requires a proven knowledge environment. Trade-off curves (ToCs) have the capability of providing the right knowledge and displaying it in a visual form. Although there are a few applications of ToCs that have recently been published in the literature, none of them demonstrates an integrated implementation of ToCs throughout the SBCE process. This paper presents the integrated use of ToCs, based on both physics-knowledge and proven knowledge, in order to compare and narrow down the design-set and to achieve an optimal design solution. These are key activities of the SBCE process model. Since an accurate, documented and visual knowledge environment is created by the use of ToCs within SBCE, the integrated approach proposed in this paper plays a vital role in eliminating the need for prototyping and testing at the early stages of product development. The integrated approach was implemented in an industrial case study for a surface jet pump. Surface jet pumps are used to increase the production rate of low-pressure oil/gas wells. It has been found that through ToCs, the conflicting relationships between the characteristics of the product can be understood and communicated effectively among the designers. This facilitated the decision-making on an optimal design solution in a remarkably short period of time. Furthermore, the surface jet pump resulting from the case study achieved an increase of the oil/gas production by nearly 60%