Cytokines and clinical manifestations of malaria in adults with severe and uncomplicated disease

Pro- and anti-inflammatory cytokines are supposed to be involved in malaria pathogenesis. Their relationship with clinical manifestations of the disease, however, is rarely studied in adults from non-endemic countries with imported disease, particularly with severe malaria. In this study we compared serum levels of gamma interferon (IFNg) and interleukins: IL-12, IL-18, IL-10 in healthy adults and patients with severe or uncomplicated imported malaria, with predominance of Plasmodium falciparum and Plasmodium vivax infections within studied group. Severe malaria was shown to be associated with elevated serum levels of IFNg and IL-18 as well as with relative deficiency of IL-12 mediated response in comparison to uncomplicated malaria cases, while IL-10 was found to be higher in all malaria patients compared to the controls

Severe malaria – analysis of prognostic symptoms and signs in 169 patients treated in Gdynia in 1991-2005

In the period 1991-2005, 169 patients with the diagnosis of malaria were hospitalized in the Department of Tropical and Parasitic Diseases, Institute of Maritime and Tropical Medicine in Gdynia (from 2003 – the Academic Centre of Maritime and Tropical Medicine, Medical University of Gdansk). All the cases were analysed for severity, occurrence of complications and permanent sequelae of the disease.According to the criteria set by the WHO (5), malaria was classified as severe in 36 cases. All of them were Plasmodium falciparum infections or mixed infections: P.f. and another species of the parasite. Patients in this group developed a number of complications, inter alia shock, acute respiratory distress syndrome (ARDS), acute renal failure, blackwater fever, severe anemia, disseminated intravascular coagulation, myocarditis, consciousness disorders of varied degree, acute transient psychoses, and exacerbation of ischemic heart disease. In one case of a pregnant woman, necrosis of the fetus occurred in the course of disease in the 4th month of pregnancy. Moreover, meningoencephalitis was diagnosed in two patients – in one of them concurrently with symptoms and signs of malaria, while in the other one - 3 weeks after the symptoms subsided. In 6 patients, permanent sequelae of the disease developed and in 4 patients the disease was fatal. The cause of death was multi-organ failure, with the first sign of poor prognosis being rapidly progressing renal failure resistant to treatment in three men; in one case death resulted from cerebral malaria. In cases of suspected malaria, relapsing malaria or in mixed infections, molecular testing was a valuable complementary tool of diagnosis, which helped in beginning the appropriate treatment

Investigations on the occurrence of Plasmodium knowlesi in travellers returning from the endemic areas of simian malaria

Malaria remains an important public health issue all over the world. Among 5 Plasmodium species invasive to humans, Plasmodium knowlesi has been identified most recently. It is sometimes difficult to differentiate this species from P. malariae with the use of microscopic examination. However, P. knowlesi infection may be associated with rapidly increasing parasitaemia and severe clinical course with the risk of death. Samples from Polish travellers returning from areas where simian malaria is endemic were examined with the use of polymerase chain reaction (PCR). The small subunit of ribosomal RNA (SSU rRNA) genes was subjected to analysis using nested PCR reaction. No positive results of P. knowlesi were obtained. Due to morphological similarities to P. malariae, potentially severe clinical course of infection and P. knowlesi endemic regions being a common tourist destination, diagnostic and clinical vigilance is necessary, including molecular methods use for precise parasite identification

THE GUIDELINES OF THE BOLOGNA PROCESS AS SEEN BY THE STUDENTS OF POMERANIAN UNIVERSITIES

For more than ten years, the European direction of higher education transformation is outlined by the Bologna Process. The main purpose of the research was to find out about students’ opinions concerning fulfilling of the Process’ guidelines. In order to carry out the research, an auditorium questionnaire method was chosen. Thanks to the given research sample, it was possible to have a representative group of students varying in terms of universities (Polish Naval Academy (AMW), Medical University of Gdańsk (GUMED)), specificity of studies (full-time, extramural), degree (BA, MA), department (nursing, midwifery, national security, internal domestic security, pedagogy). A total number of respondents was 598. An obtained research material constitutes a source of information helping to asset students’ readiness and openness towards the proposed system transformations. Among the following instruments of the Bologna Process: a multi-staged studies’ mode, ECTS points, a diploma supplement, students’ mobility and the activity of Accreditation Commission, the positive opinions concerned students’ mobility, the activity of Accreditation Commission and multi-staged studies’ mode mostly. According to the statistics, the Polish Naval Academy students formulate opinions that multi-staged studies prolong the process of education and are the source of extra responsibilities (connected with BA writing and defense). GUMED’s students are positive about ECTS points and diploma supplements. Looking at the statistics, women are visibly more positive about students’ mobility and exchange as they allow to get to know and understand different cultures, whereas men put on emphasis on an unclear criteria of giving ECTS points. The obtained research material was analyzed using a statistics package SPSS 20 and a Microsoft Excel 2010 spread sheet

Human Alveolar Echinococcosis in Poland: 1990–2011

<div><h3>Background</h3><p>Alveolar echinococcosis (AE) caused by <em>Echinococcus multilocularis</em> infections is a dangerous old disease in the Northern Hemisphere. The aim of the paper was to collect and analyze data on human AE in Poland in the last two decades.</p> <h3>Methodology/Principal Findings</h3><p>The sources of data were both the cases officially registered and detected by an active field and laboratory surveillance. The cases were verified by clinical, epidemiological, and laboratory criteria. Altogether 121 human cases of AE were detected. Among these 83 (68,6%) cases were classified as confirmed, 16 as probable and 22 as possible. During the two decades a continuous increase in detection rate was noticed. The cases were 6–82 years old at the time of diagnosis (mean - 47.7 years). Sex ratio M/F was 0.86/1.0. The AE was fatal in 23 (19%) patients (mean age at death - 54.1 years). Family agglomeration of AE was found in 4 foci, involving 9 patients. Seventy six of the cases were diagnosed in an advanced stage of disease. In all cases the liver was the primary location of AE. In 30 (24.8%) patients a spread to other organs was observed. Ninety four of the patients were treated with albendazole. In 73 (60%) patients a surgical operation was performed, including 15 liver transplantations.</p> <h3>Conclusions/Significance</h3><p>The studies confirmed that AE is an emerging disease in Poland, which is the fourth country in Europe with over 120 cases detected. The results also indicate the need of a wider national programme for implementation of screening in the highest AE risk areas (north-eastern Poland) with an effort to increase the public awareness of the possibility of contracting <em>E. multilocularis</em>, and above all, training of the primary care physicians in the recognition of the risk of AE to allow for an early detection of this dangerous disease.</p> </div

Geographical distribution of human AE cases in Poland.

<p><b>A – Number of AE cases in each province.</b> Localizations of three patients could not be determined. A – Pomorskie Province; B – Varmia-Masuria Province; C- Podlaskie Province. <b>B – Distribution of 65 AE cases in the Varmia - Masuria Province.</b> Global area amounts to 24 173 km², and population 1 426 155 (2008). a – Elbląski district; b – Lidzbarski district; c – Kętrzyński district; d – Węgorzewski district; e – Iławski district.</p