Health Inequalities Across The European Union Regions: A Beta-Convergence Approach

This work is devoted to the study of the variations of health status (measured by life expectancy) across the EU regions of NUTS II level. We apply existing tools developed in economic growth literature to study a mortality convergence. Using the idea of unconditional convergence model developed for economic growth, we can confirm a decrease or increase of regional health inequalities. The main research hypothesis is as follows: whether regions with lower initial life expectancies have experienced the largest increases in life expectancies. To verify the hypothesis of beta-convergence we use spatial econometric models which additionally allow to take the geographic dependence among the surveyed regions into consideration. Due to the heterogeneity of the surveyed spatial units we also verify the hypothesis of the club beta-convergence

Intercultural Competences in Health Care - Jehovah's Witnesses

After Poland's accession to the European Union, borders were opened and migrations from many culturally different countries intensified, which led to an increase in immigrants and refugees assimilating in Poland. Numerous ethnic, religious, linguistic and cultural groups existed and exist in Poland. All of these groups benefit from health services. The above situation requires medical personnel to perceive the patient through the prism of his biological, psychological, social and health problems, as well as in terms of spiritual needs of religions, as well as beliefs and socio-cultural origin. Therefore, knowledge about the cultural differences of healthcare service recipients and shaping intercultural sensitivity among healthcare workers is essential. This work examines multiculturalism in health care based on the example of the confession of Jehovah's Witnesses. Its aim was to get to know the health service opinions regarding cultural competences in specific work with patients

The use of selected commercial molecular assays for the microbiological diagnosis of tuberculosis

Introduction: We performed a retrospective assessment of the AMPLICOR Mycobacterium tuberculosis (MTB) assay for the molecular diagnosis of tuberculosis based on our own determinations between 1999 and 2009 and a preliminary assessment of the Xpert MTB/RIF system, which we are currently using. Materials and methods: The study groups comprised 1875 samples (including 104 inhibited samples) and 213 samples, respectively. Results: The sensitivities of the AMPLICOR MTB and the Xpert MTB/RIF assays were 81.9% and 81.8%, respectively, and their specificities were 97.2% and 99.5%, respectively, versus culture on Loewenstein-Jensen medium. Both assays showed a considerable difference in sensitivity depending on whether the test samples were smear-positive (AFB+) or smearnegative (AFB–). The sensitivities of the AMPLICOR MTB and the Xpert MTB/RIF assays were 97.8% and 100.0%, respectively, for AFB+ samples and 58.1% and 50.0%, respectively, for AFB– samples. Conclusions: Our results confirm full usefulness of the Xpert MTB/RIF assay for routine diagnosis in the case of smearpositive clinical samples.Wstęp: W pracy, retrospektywnie oceniono test AMPLICOR Mycobacterium tuberculosis (MTB) w molekularnej diagnostyce gruźlicy, na podstawie własnych oznaczeń w latach 1999–2009 oraz wstępnie oceniono system Xpert MTB/RIF, który jest na bieżąco w użyciu. Materiał i metody: Grupy badane obejmowały odpowiednio 1875 próbek (w tym 104 reakcje zahamowane) i 213 próbek. Wyniki: Czułość testów AMPLICOR MTB i Xpert MTB/RIF oceniono na 81,9% i 81,8%, a swoistość wynosiła odpowiednio 97,2% i 99,5%, wobec hodowli na pożywce Loewensteina-Jensena. Obydwa testy wykazywały znaczącą różnicę w czułości, w zależności od tego czy badane próbki były dodatnie (AFB+) czy ujemne (AFB–) w rozmazie. I tak dla próbek AFB+ czułość wynosiła 97,8% i 100%, a dla próbek AFB– czułość była 58,1% i 50%, odpowiednio dla testów AMPLICOR MTB i Xpert MTB/RIF. Wnioski: Przedstawione wyniki wykazują pełną przydatność testu Xpert MTB/RIF w rutynowej diagnostyce dla próbek klinicznych, dodatnich w mikroskopowym badaniu rozmazu. Pneumonol. Alergol. Pol. 2012; 80, 1: 6–1

Diagnostic utility of the molecular assay GenoType MTBC (HAIN Lifesciences, Germany) for identification of tuberculous mycobacteria

Wstęp: Nowy kompleksowy system GenoType firmy HAIN Lifescience (Niemcy) stwarza szerokie możliwości w diagnostyce gruźlicy i innych zakażeń prątkowych na poziomie molekularnym. Dzięki wprowadzeniu 5 wzajemnie uzupełniających się testów, system ten pozwala na wykrycie i typowanie mykobakterii oraz określenie lekowrażliwości na rifampicynę i izoniazyd na różnych etapach postępowania diagnostycznego, od badania materiałów bezpośrednich do wyizolowanych szczepów. Zaletą systemu jest dowolność w wyborze stosowanych testów (bez konieczności wykonywania wszystkich), w zależności od potrzeb i aktualnie stosowanych innych metod wykrywania prątków. System posiada certyfikat Unii Europejskiej do stosowania w rutynowej diagnostyce. Dotychczas żaden z testów systemu GenoType nie był stosowany w Polsce. Celem prezentowanej pracy była ocena precyzji typowania testem GenoType MTBC izolatów klinicznych zidentyfikowanych uprzednio jako M. tuberculosis complex metodą wysokociśnieniowej chromatografii cieczowej w ramach rutynowego postępowania diagnostycznego. Materiał i metody: Badanie miało charakter retrospektywny. Testem GenoType MTBC zbadano 161 izolatów klinicznych M. tuberculosis complex. Szczepy pochodziły od chorych na gruźlicę hospitalizowanych w Centralnym Szpitalu Klinicznym Warszawskiego Uniwersytetu Medycznego w latach 1999-2007. Wyniki: Typowanie testem GenoType MTBC okazało się w 100% zgodne z typowaniem metodą analizy kwasów mykolowych. Test GenoType MTBC wykazał ponadto, że wszystkie izolaty miały wzór hybrydyzacji charakterystyczny dla M. tuberculosis/M. canettii. Wnioski: 1. Test GenoType MTBC (HAIN Lifescience, Niemcy) prawidłowo rozpoznaje kliniczne szczepy M. tuberculosis complex i może w tym zakresie zastąpić wysokociśnieniową chromatografię cieczową w rutynowej diagnostyce gruźlicy. 2. W świetle pozytywnej oceny testu GenoType MTBC celowe wydaje się rozpatrzenie możliwości stosowania pozostałych testów systemu GenoType (HAIN Lifescience, Niemcy) w diagnostyce zakażeń prątkowych.Introduction: The GenoType system (HAIN Lifescience, Germany) offers new perspectives of detecting the tuberculous and non-tuberculous mycobacteria at the molecular level. The system compromises five independent tests that could be performed either on direct specimens or isolated strains, to identify the strains and test the resistance against rifampin and isoniazid. Up to now, non GenoType test was applied in Poland. The aim of the study was an evaluation the accuracy of GenoType MTBC test in speciation of the clinical isolates, previously classified as M. tuberculosis complex by HPLC analyze of mycolic acids. Material and methods: 161 clinical isolates, derived from the TB patients hospitalized in the Warsaw Medical University Hospital between 1999 and 2007 were assayed. Results: On the basis of the hybridization patterns, all 161 studied strains were identified as M. tuberculosis/M. canettii. Conclusions: 1. The GenoType MTBC test (HAIN Lifescience, Germany) precisely recognizes M. tuberculosis complex. The 100% accordance in speciation of M. tuberculosis by the GenoType MTBC test as compared to HPLC method was demonstrated. The GenoType MTBC test can replace HPLC in detection of tuberculous mycobacteria in clinical isolates. 2. As the GenoType MTBC test performs well, the other tests of GenoType system may be considered to be verified in diagnostic procedure of mycobacterial infection

The mycolic acids analysis with HPLC technique in drug susceptibility testing of Mycobacterium tuberculosis strains

The aim of this study was to evaluate the utility of the quantitative analysis of mycolic acids by HPLC technique in drug susceptibility testing of the M.tuberculosis isolates to the first-lineantituberculousdrugs:isoniazid and rifampicin. Drug susceptibility of the 30 clinical M.tbc isolates was examined by the mycolic acids analysis with HPLC technique and results were compared to the proportion method on solid L-J medium and liquid medium in MGIT system. In HPLC method drug susceptibility of M.tuberculosis strains was described by TAMA index defined as the ratio of the total area under mycolic acids peaks (TAMA) from cultures with drug to the TAMA of control. At critical concentrations of drugs, TAMA indexes of resistant strains were > 0.5, and TAMA indexes of susceptible strains were < 0.05. The average error of the TAMA analysis was &plusmn; 9.5% The quantitative analysis of mycolic acids by HPLC gives results compatible with standard proportion method and is a reliable method for determination of drug susceptibility of M.tuberculosis

Sequential sonographic features in neonatal renal vein thrombosis

Objectives: Renal vein thrombosis in newborns is a rare but serious and acute disease. Clinical representations of RVT can vary from discrete symptoms to life-threatening conditions. Therefore imaging, and in particular sonography, plays an important role in the diagnosis of RVT in neonates. Gray-scale, color and spectral/power Doppler ultrasound are all used in the diagnosis of RVT. Material and methods: We present retrospective sequential ultrasonic imaging of three patients (two term and one preterm infant) with findings characteristic of RVT. Results: Initial ultrasound diagnostic features include: renal enlargement, echogenic medullary streaks, lack of the flow pattern characteristic of arcuate vessels and subsequently loss of corticomedullary differentiation, reduced echogenicity around pyramids and echogenic band at the extreme apex of the pyramid. Higher resistance index or less pulsatile venous flow on the affected kidney are helpful Doppler signs. Conclusions: Knowledge and identification of specific features of each phase of the evolution of RTV seems essential to prompt diagnosis. We would like to highlight the evolution of specific sonographic features in each subsequent phase of RVT

The comparison between two methods for typing of nontuberculous mycobacteria: high pressure liquid chromatography and molecular assay GenoType Mycobacterium CM/AS

Wstęp: W pracy oceniano przydatność diagnostyczną molekularnego systemu GenoType Mycobacterium CM/AS (HAIN Lifescience, Niemcy) w różnicowaniu izolatów klinicznych mykobakterii w porównaniu z analizą kwasów mykolowych z zastosowaniem cieczowej chromatografii wysokociśnieniowej. Zastosowanie obydwu testów umożliwia wyróżnienie 38 wzorów molekularnych, z których 24 można przypisać do poszczególnych gatunków mykobakterii, 10 wzorów odpowiada mykobaktedwóm, czasem kilku gatunkom, a 4 wzory odpowiadają Mycobacterium sp. lub Gram-dodatnim bakteriom z dużą zawartością par G-C w genomie. Materiał i metody: Badanie miało charakter retrospektywny i obejmowało 127 szczepów mykobakterii wyizolowanych na podłożu stałym Loewensteina-Jensena od pacjentów szpitala klinicznego Warszawskiego Uniwersytetu Medycznego w latach 1999-2007. Prątki identyfikowano metodą analizy kwasów mykolowych cieczową chromatografią wysokociśnieniową (HPLC) w ramach rutynowego postępowania diagnostycznego. Szczepy typowano powtórnie testami molekularnymi, najpierw GenoType Mycobacterium CM, a następnie - jeśli uzyskanego wzoru molekularnego nie można było przypisać do żadnego z wzorców - testem GenoType Mycobacterium AS. Wyniki: Spośród 127 badanych szczepów porównanie obu technik było możliwe dla 113 izolatów. Dla 105 ze 113 (93%) szczepów uzyskano wyniki zgodne. Należy podkreślić, że spośród 8 izolatów rozbieżnie typowanych w jednym przypadku w systemie GenoType Mycobacterium CM/AS stwierdzono obecność genomu M. tuberculosis complex. Szczep ten w typowaniu HPLC określono jako szybkorosnący gatunek M. abscessus/M. chelonae. Spośród pozostałych 14 ze 127 izolatów klinicznych 11 wytypowano tylko jedną z metod: 6 szczepów - techniką HPLC i 5 szczepów - w systemie molekularnym. W przypadku 3 szczepów identyfikacja nie powiodła się żadną z metod. Wnioski: System GenoType Mycobacterium CM/AS pozwala na szybką i rzetelną identyfikację gatunkową izolatów klinicznych mykobakterii. W porównaniu z obecnie stosowaną metodą HPLC system molekularny jest przyjazny dla środowiska i prostszy w wykonaniu. Pneumonol. Alergol. Pol. 2010; 78, 5: 363-368Introduction: The GenoType Mycobacterium CM and the GenoType Mycobacterium AS (HAIN Lifescience, Germany) were evaluated for the ability to differentiate mycobacterial species of clinical isolates. Serial use of the both assays is aimed to identify 38 different molecular patterns, of which 24 patterns can be assigned to single species, 10 patterns are allocated to two or more Mycobacterium species, and 4 patterns correspond to Mycobacterium species and gram-positive bacteria with a high G + C content. The analysis of mycolic acids by high pressure liquid chromatography (HPLC) was the reference method. Material and methods: A set of 127 nontuberculous mycobacterial isolates on Loewenstein-Jensen slants, derived from different patients between 1999 and 2007, was analyzed. The strains were primary classified by HPLC following the diagnostic procedure, and retyped by GenoType Mycobacterium CM/AS. Results: In total, results obtained by both methods were interpretable for 113 strains. Concordant results were obtained for 105 (93%) mycobacterial strains. One out of 8 inconcordant classified strains, which was classified a

Clinical spectrum and outcome of invasive mucormycosis in children and adults: Polish experience of the decade 2010–2019

No epidemiological data exist so far on invasive mucormycosis (IM) in Polish hematopoietic cell transplantation (HCT) and pediatric hemato-oncology (PHO) centers. The objective of this study was to analyze the incidence, clinical course, therapy, and outcome of IM in pediatric and adult patients undergoing HCT and children with hemato-oncological diseases in Poland. A total number of 12425 at-risk patients were retrospectively analyzed, and the period between 2010 and 2019 was included. Patients were analyzed in three groups: nontransplant children with malignancies, children undergoing HCT, and adults after HCT. Twenty-one patients were diagnosed with IM, including 15 children (10 non-HCT, 5 HCT) and 6 HCT adults. Proven IM was confirmed in 18 patients, probable in 2 patients, and possible in 1 patient. Proven IM was diagnosed in 7.1% of all patients with invasive fungal diseases (IFDs), including 8.1% among PHO patients, 5.4% among pediatric HCT patients, and 7.0% among adult HCT patients. Clinically, pneumonia was diagnosed in 10 (47.6%) patients, involvement of the paranasal sinuses was found in 3 (14.3%) patients, gastrointestinal disease was noted in 2 (9.5%) patients, and disseminated mucormycosis was found in 6 (28.6%) patients. The probability of overall survival in IM patients was 0.50 ± 0.11. Infection-related mortality (IRM) was 10% for pediatric nontransplant IM patients and 82% for transplant IM (pediatric + adult) patients ( = 0.004). Among the transplant patients, all adults died within 120 days. IRM for pediatric HCT patients was 60% ( = 0.038). The only prognostic factor was HCT, which adversely influenced survival in IM patients