Tuberculosis among the homeless and inmates kept in custody and in penitentiary institutions in the Silesia region

Wstęp: W skali globalnej w więzieniach przebywa równocześnie więcej niż 10 milionów osób. Częstość występowania gruźlicy u więźniów jest 10−100 razy wyższa niż w ogólnej populacji. Osadzeni kontaktują się pomiędzy sobą oraz z pracownikami i odwiedzającymi, co stwarza ryzyko zarażenia ich gruźlicą. Po odbyciu kary więźniowie mogą być źródłem gruźlicy dla osób z otoczenia. Celem pracy było określenie częstości występowania aktywnej gruźlicy u osób bezdomnych, aresztantów i więźniów w województwie śląskim.Materiał metody: Badaniami objęto 897 osób, w tym 177 podopiecznych Miejskiego Ośrodka Pomocy Społecznej (MOPS) i 720 osadzonych w zakładach penitencjarnych. W diagnostyce gruźlicy wykorzystano metody: BACTEC MGIT, MGIT TBc Identification Test i GenoType Mycobacteria Direct. Do określenia lekooporności prątków zastosowano zestawy SIRE KIT i PZA KIT.Wyniki: Gruźlicę rozpoznano u 13 spośród 897 osób (1,45%): u jedenastu osób na 720 (1,53%) osadzonych w śląskich zakładach penitencjarnych oraz u dwóch osób na 177 (1,13%) podopiecznych MOPS. Dane dotyczące lekooporności szczepów uzyskano w 11 przypadkach. Szczepy prątków gruźlicy wyhodowane od ośmiu chorych były wrażliwe na podstawowe leki przeciwprątkowe (streptomycyna, izoniazyd, rifampicyna, etambutol), natomiast trzy szczepy uzyskane od kolejnych chorych były oporne na leki: jeden — na etambutol, drugi — na streptomycynę i pirazynamid, a trzeci — na izoniazyd i etambutol. Uzyskane dane przemawiają za tym, że częstość gruźlicy płuc potwierdzonej badaniem bakteriologicznym była w badanej grupie osób 100 razy wyższa niż w populacji województwa śląskiego w tym samym okresie czasu.Wnioski: Realizowany program zdrowotny pozwala na efektywne wykrywanie przypadków gruźlicy w grupach ryzyka i dlatego powinien być kontynuowany w kolejnych latach. Zastosowany zestaw diagnostycznych metod laboratoryjnych umożliwił wykrycie w badanych subpopulacjach osób chorych na gruźlicę. Chorzy zostali poddani leczeniu przeciwprątkowemu, co zatrzyma dalsze rozprzestrzenianie się zakażenia za ich pośrednictwem.Introduction: There are more than 10 million prisoners in the world. Tuberculosis incidence is 10−100 times higher in prisoners than in the general population. Inmates have close contact with other prisoners and with prison workers and visitors, so tubercle bacilli may be easily spread. Most of the inmates come back to normal life and contact with the general population. The aim of the study was to assess active tuberculosis incidence among prisoners and homeless persons in the Silesia region.Material and methods: In total 897 people entered the study, of whom 720 were Silesian penitentiary system inmates, and 177 were homeless. BACTEC MGIT fast TB detection system and GenoType Mycobacteria Direct test were used. Drug susceptibility testing was done using SIRE KIT and PZA KIT.Results: Tuberculosis was diagnosed in 13 out of 897 persons (1.45%): in 11 out of 720 inmates (1.53%) and in 2 out of 177 homeless persons (1.13%). Data concerning drug susceptibility were obtained for 11 persons. M. tuberculosis strains isolated from eight persons were susceptible to four first-line antituberculosis drugs (streptomycin, isoniazid, rifampin, ethambutol), while M. tuberculosis strains isolated from three persons were drug-resistant. One out of three isolated strains was resistant to ethambutol, but susceptible to streptomycin, isoniazid, rifampin, and pirazynamide. The second strain was resistant to streptomycin and pyrazinamide but susceptible to isoniazid, rifampin, and ethambutol. The third strain was susceptible to rifampin but resistant to the other four tested drugs. According to the obtained data, culture-positive pulmonary tuberculosis was 100 times more frequent in the examined population than in the general population of the Silesia region in the same period of time.Conclusions: The health project enabled effective detection of tuberculosis in risk groups and should be continued in the following years. The set of the applied diagnostic methods allowed the detection of in the studied subpopulations people suffering from tuberculosis. Patients were treated with antituberculosis drugs that would stop them from spreading the disease to other people

Mycophenolic Acid Metabolites Acyl-Glucuronide and Glucoside Affect the Occurrence of Infectious Complications and Bone Marrow Dysfunction in Liver Transplant Recipients.

BACKGROUND Mycophenolic acid (MPA) prodrugs are anti-proliferative immunosuppressive agents commonly used after organ transplantation. Although they are generally well tolerated by patients, adverse effects may occur. It is postulated that MPA metabolites could also contribute to these adverse effects. MATERIAL AND METHODS The objective of this study was the assessment of concentrations of total MPA and its metabolites, phenyl glucuronide (MPAG), acyl glucuronide (AcMPAG) and glucoside (GluMPA), using liquid chromatography combined with mass spectrometry (LC/MS/MS) in two groups: kidney transplant recipients and liver transplant patients. Associations of MPA and its metabolites with adverse effects were analyzed. RESULTS The study group consisted of 211 recipients of liver or kidney transplants who received immunosuppressive therapy, including MPA prodrugs. Multivariant analysis showed a positive influence of MPA on gastroenterotoxicity in kidney transplant recipients. In liver patients, gastroenterotoxicity was associated with lower MPAG concentrations. A positive influence of AcMPAG on bacterial infections in liver transplant patients was observed. In liver transplant recipients, a positive influence of MPA and a negative influence of GluMPA levels on the PLT count were revealed. MPA and its metabolites did not influence the hemoglobin levels in both groups. There were no significant relationships among MPA, its metabolites and WBC counts. CONCLUSIONS In kidney transplant recipients, total MPA trough concentration is associated with gastroenterotoxicity and its monitoring could have important role in management of gastrointestinal complications. The quantification of AcMPAG in liver recipients receiving MPA may be helpful in avoiding bacterial infections. GluMPA seems to have a toxic effect on thrombopoiesis

Integracja finansowa w Europie po wprowadzeniu euro. Przegląd literatury

The introduction of the euro was one of the most important events in the process of European integration, especially in the financial sector. However, next to its many advantages, the joint currency and single monetary policy increased the probability of property bubbles in the EU low income countries. The excessive speculations, which resulted in the burst of the US property bubble, the financial crisis, as well as the fiscal problems and the recession in Europe in 2010, uncovered the weaknesses of the financial integration and the inability of the European financial system to absorb large shocks. The financial losses, and the risk that some banks and moreover, even some euro zone member countries might become insolvent, underlined the existence of large systemic risks. As a result, cross border lending declined, the European credit market was affected negatively and the uncertainty concerning the stability of the euro increased. The second phase of the crisis in Europe was a starting point to develop some new international solutions to those problems aimed at increasing the stability of the European financial system. Our paper presents an overview of the literature on the advancement of financial integration in the euro zone, as well as in other regions including Poland. The concluding part of this review summarizes also the results of own research of its authors

Integracja finansowa w Europie po wprowadzeniu euro. Przegląd literatury

The introduction of the euro was one of the most important events in the process of European integration, especially in the financial sector. However, next to its many advantages, the joint currency and single monetary policy increased the probability of property bubbles in the EU low income countries. The excessive speculations, which resulted in the burst of the US property bubble, the financial crisis, as well as the fiscal problems and the recession in Europe in 2010, uncovered the weaknesses of the financial integration and the inability of the European financial system to absorb large shocks. The financial losses, and the risk that some banks and moreover, even some euro zone member countries might become insolvent, underlined the existence of large systemic risks. As a result, cross border lending declined, the European credit market was affected negatively and the uncertainty concerning the stability of the euro increased. The second phase of the crisis in Europe was a starting point to develop some new international solutions to those problems aimed at increasing the stability of the European financial system. Our paper presents an overview of the literature on the advancement of financial integration in the euro zone, as well as in other regions including Poland. The concluding part of this review summarizes also the results of own research of its authors

Integracja finansowa w Europie po wprowadzeniu euro. Przegląd literatury

The introduction of the euro was one of the most important events in the process of European integration, especially in the financial sector. However, next to its many advantages, the joint currency and single monetary policy increased the probability of property bubbles in the EU low income countries. The excessive speculations, which resulted in the burst of the US property bubble, the financial crisis, as well as the fiscal problems and the recession in Europe in 2010, uncovered the weaknesses of the financial integration and the inability of the European financial system to absorb large shocks. The financial losses, and the risk that some banks and moreover, even some euro zone member countries might become insolvent, underlined the existence of large systemic risks. As a result, cross border lending declined, the European credit market was affected negatively and the uncertainty concerning the stability of the euro increased. The second phase of the crisis in Europe was a starting point to develop some new international solutions to those problems aimed at increasing the stability of the European financial system. Our paper presents an overview of the literature on the advancement of financial integration in the euro zone, as well as in other regions including Poland. The concluding part of this review summarizes also the results of own research of its authors