Usefulness of IGRA and tuberculin skin test in diagnosis of latent tuberculosis infection in the groups threatened with occupational risk factors — commentary to article of D. Borkowska et al.

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

Costs of chronic obstructive pulmonary disease in patients receiving specialist outpatient care in Poland

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). Conclusion: Treatment of COPD in poses a considerable economic burden on the Polish society. Pneumonol. Alergol. Pol. 2011; 79, 5: 337–342Wstęp: Przewlekła obturacyjna choroba płuc (POChP) jest jedną z wiodących przyczyn śmiertelności w Polsce i na świecie. Badanie kosztów choroby (całkowitych, bezpośrednich i pośrednich) pokazuje, jaki jest jej ekonomiczny wpływ na budżet państwa. W kontekście POChP szczególnie istotną rolę w tworzeniu kosztów odgrywają zaostrzenia choroby i hospitalizacje. Celem pracy była ocena bezpośrednich kosztów leczenia POChP w warunkach ambulatoryjnej opieki specjalistycznej z perspektywy społecznej. Materiał i metody: Koszty POChP były oszacowane na podstawie kompilacji danych — dokumentacji chorych leczonych w 8 poradniach specjalistycznych i 5 szpitalach klinicznych w Polsce w latach 2007–2008. Koszty bezpośrednie, wynikające z przewlekłego leczenia pacjentów i zaostrzenia leczonego ambulatoryjnie, były liczone metodą “z dołu do góry” na podstawie danych zebranych przez specjalistów chorób płuc w poradniach. Średni koszt zaostrzenia leczonego w szpitalu pochodził natomiast z wieloośrodkowego badania polskiego, w którym uczestniczyło 5 ośrodków klinicznych. Wyniki: Całkowity koszt jednego pacjenta na rok wyniósł 4027,82 PLN (1007 EURO), w tym koszt przewlekłego leczenia choroby wynosił 2423,57 PLN (606 EURO), zaostrzenia leczonego ambulatoryjnie — 421,16 PLN (105 EURO), a zaostrzenia leczonego w szpitalu — 1183,09 PLN (296 EURO). Wnioski: Leczenie POChP generuje istotne koszty dla społeczeństwa w Polsce. Pneumonol. Alergol. Pol. 2011; 79, 5: 337–34

Analysis of the incidence of acute respiratory diseases in the paediatric population in Poland in the light of the “Health Needs Map”

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

Comparison of outpatient and inpatient costs of moderate and severe exacerbations of chronic obstructive pulmonary disease in Poland

Wstęp: Celem pracy była ocena bezpośrednich i pośrednich kosztów leczenia zaostrzeń przewlekłej obturacyjnej choroby płuc (POChP) w praktyce lekarskiej z perspektywy społecznej w Polsce. Materiał i metody: Badanie prospektywne przeprowadzono na grupie 73 chorych z POChP leczonych w warunkach szpitalnych (n = 39) lub ambulatoryjnych (n = 34). W kosztach bezpośrednich uwzględniono koszty opieki w szpitalu i ambulatorium, leków oraz testów diagnostycznych. Koszty pośrednie objęły koszty transportu i utraconych dni pracy. Wyniki: Średni czas trwania zaostrzenia POChP nie różnił się istotnie w obu badanych grupach (hospitalizacja: 11,2 dnia [CI 95%: 9,6-12,8]; leczenie ambulatoryjne: 10,8 [CI 95%: 9,1-12,1]; p > 0,05). Całkowity koszt zaostrzenia wyniósł średnio 1197 EUR (4137,9 PLN) w opiece szpitalnej, a w opiece ambulatoryjnej był 6-krotnie niższy i wyniósł średnio 199,8 EUR (446,9 PLN). Koszty testów laboratoryjnych i leków były istotnie wyższe w grupie leczonej w warunkach szpitalnych. Najistotniejszy wpływ na koszty leczenia szpitalnego miała hospitalizacja (tzw. łóżkodzień). Wnioski: W 2006 roku koszty leczenia zaostrzeń POChP w szpitalu były 6-krotnie wyższe niż w ambulatorium. Należy więc zwracać uwagę na właściwą kwalifikację chorych do leczenia szpitalnego.Introduction: The aim of the study was to examine the direct and indirect costs of COPD exacerbations under usual clinical practice in primary and secondary care from a societal perspective in Poland. Material and methods: An observational, prospective study was conducted among patients with exacerbation of moderate or severe COPD. Seventy-three patients were included in the study - 39 treated in hospital (HC) and 34 treated in ambulatory care (AC). The direct costs included the cost of drugs, diagnostic tests, in-hospital and outpatient care. The indirect costs included costs of transportation to the health-care provider and work days lost. Results: The mean duration of COPD exacerbation did not differ significantly between the groups [HC: 11.2 (CI 95%: 9.6-12.8) days; AC: 10.8 (CI 95%: 9.1-12.1); p > 0.05]. The total health-care cost per exacerbation was EUR 1197 (4137.9 PLN) in secondary care (the HC group), and it was 6 times higher than the total cost of exacerbation in primary care (the AC group) - EUR 199.8 (446.9 PLN). The costs of drugs and diagnostic tests were significantly higher in the HC group than in the AC group; however, it was the cost of in-hospital stay and medical visits in the HC group that most influenced expenditure related to COPD exacerbations, as they were 27 times higher than in the AC group. Conclusions: In Poland the costs of COPD exacerbation managed in secondary care are 6-fold higher than in primary care. Therefore, the decisions about admission of patients with COPD exacerbation to hospital should be made carefully

Effect of influenza vaccinations on immune response and serum eotaxin level in patients with allergic bronchial asthma.

BACKGROUND: One of the most promising markers of allergic inflammation is eotaxin, which has a selective influence on the migration of eosinophils. Its serum content significantly correlates with the intensity of allergic symptoms, so it might be interesting to know whether vaccination has any influence on serum expression of this chemokine. AIMS: Comparison of the humoral response to influenza vaccine and post-vaccination changes in the serum eotaxin level in patients with allergic bronchial asthma and healthy controls. METHODS: Forty-two asthmatics and 45 healthy individuals were vaccinated with a single dose of influenza subunit vaccine (Influvac). The serum eotaxin level and the antibody response to haemagglutinin (HI) and neuraminidase (NI) glycoproteins were measured before and after vaccination. RESULTS: A significant increase of geometric mean titres of HI and NI was observed in both groups. There were no significant differences between the groups in meanfold increase of HI and NI titres, response rate and protective level of HI. After vaccination, a significant decrease of the mean serum eotaxin value was observed in patients with asthma (149.4 +/- 71.0 versus 125.1 +/- 67.0, p= 0.0017), while no similar effect was present in healthy individuals (153.4 +/- 56.9 versus 159.3 +/- 54.4, p= 0.5). CONCLUSIONS: The results indicate that in patients with allergic bronchial asthma influenza vaccinations assure efficient protective antibody level and modulate the serum level of eotaxin

Influence of some demographical and social factors on degree of nicotine addiction and motivation to quit smoking in healthy people

Aim: Estimation of the influence of some demographical and social factors on degree of nicotine addiction and motivation to quit smoking. Material and method: 208 healthy, smoking people entered the study. The Fagerström test was used for analyzing degree of nicotine addiction (heavy addiction > 7 points). Motivation for smoking cessation was estimated by Schneider test (high motivation > 5 positive answers). Tests results were analyzed in connection with age, gender, education and intensity of nicotine addiction definedaspack-years. Results: In 37% of patients (77/208) heavy nicotine addiction was diagnosed. High motivation for quitting smoking was recognized in 74% people (150/208). Subjects with wild nicotine addiction had significantly higher motivation for smoking cessation (chi2, p = 0.002). There was not influence of gender, age, education and addiction intensity(definedaspack-years)on the grade of nicotine addiction. We didn't notic relation between gender and motivation to quit. Young, well educated patients are significantly stronger motivated for smoking cessation. Conclusions: There was not direct dependence between the number of smoked cigarettes and degree of nicotine addiction. In the group of healthy subjects, young, well educated people have a better chance for smoking cessation

Tubercular inflammation of cervical lymph nodes with a colliquative tuberculosis focus - a case study

Gruźlica skóry jest szczególną postacią gruźlicy, o zróżnicowanym obrazie klinicznym wynikającym z wewnątrz- lub zewnątrzpochodnej drogi zakażenia, mechanizmów odpornościowych oraz niekorzystnych warunków rozwoju dla prątka. Nietypowy przebieg i objawy mogą powodować trudności w postawieniu prawidłowego rozpoznania oraz odpowiednio wczesnego rozpoczęcia leczenia. Przy rozpoznaniu gruźlicy skóry należy brać pod uwagę szeroką diagnostykę różnicową obejmującą między innymi leiszmaniozę, promienicę, trąd, grzybice głębokie. W pracy przedstawiono przypadek gruźlicy węzłów chłonnych i gruźlicy rozpływnej skóry, początkowo mylnie rozpoznanej jako promienica i powikłanej rumieniem wielopostaciowym. W opisywanym przypadku w badaniach bakteriologicznych bioptatów ze zmian skórnych prątków gruźlicy nie wykryto. Rozpoznanie choroby ustalono na podstawie obecności ziarniny swoistej w ostatnim z wykonanych badań histopatologicznych, nadwrażliwości na tuberkulinę oraz obecności DNA prątków w badaniu łańcuchowej reakcji polimerazy (PCR). Zdaniem autorów w przypadku klinicznego podejrzenia gruźlicy skóry wydaje się być uzasadnione nawet kilkukrotne wykonywanie badania histopatologicznego ze zmian. Wynik powinien być uzupełniony jedną z metod badania materiałów skąpoprątkowych, na przykład przez identyfikację materiału genetycznego prątków za pomocą amplifikacji kwasów nukleinowych metodą PCR.Cutaneous tuberculosis is a specific form of tuberculosis, characteristic of a differentiated clinical picture and resulting from either endo- or exogenous way of infection, immunological mechanisms and unfavourable conditions for mycobacterium development. The untypical course and symptoms of the disease may cause certain difficulties in obtaining a proper diagnosis and, in consequence, result in delayed onset of appropriate treatment. When diagnosing cutaneous tuberculosis, a broad apparatus of differential diagnostics should be applied, taking into account other diseases such as leishmaniasis, actinomycosis, leprosy or deep mycoses. We report a case of lymph node tuberculosis and of colliquative tuberculosis of the skin, at first erroneously diagnosed as actinomycosis, complicated by multiform erythema. In the reported case, no tuberculous bacilli were identified in bacteriological evaluations of bioptates collected from the skin changes. The final diagnosis of the disease was determined by the presence of specific granulation tissue in the last performed histopathological studies, as well as by hypersensitivity to tuberculin and the presence of mycobacterial DNA in PCR evaluation. According to the authors, in case of clinically suspected cutaneous tuberculosis, repeated (several) histopathological studies of samples from observed changes seem to be fairly justified. The results of histopathological studies should be completed by one of the methods of oligomycobacterial material evaluation, e.g. by identification of mycobacterial genetic material by means of nucleic acid amplification in the PCR method

Systematic review and meta-analysis of the co-occurrence of atrial fibrillation and liver transplantation: a lethal combination

INTRODUCTION: This systematic review and meta-analysis is aimed to evaluate the role of new-onset atrial fibrillation (NOAF) in patients after liver transplantation (LT) and determine the effect of NOAF on the incidence of mortality and graft rejection. MATERIAL AND METHODS: Published studies until the end of April 15, 2023, were systematically searched in PubMed, Google Scholar, Scopus, Embase, Web of Science, and the Cochrane databases. Odds ratios (ORs) with 95% confidence intervals (CI) for mortality and graft rejection were extracted. RESULTS: Five studies with a total of 4788 unique post-LT patients were included in the meta-analysis. Pooled analysis showed that mortality in patients with and without NOAF varied and amounted to 24.1% vs. 12.5%, respectively (OR = 2.51; 95%CI: 1.92 to 3.27; p < 0.001). Moreover, pooled analysis showed that graft rejection in the NOAF cohort was 26.3%, and was higher vs. patients without NOAF (13.1%; OR = 2.98; 95%CI: 2.14 to 4.15; p < 0.001) CONCLUSIONS: Post-LT NOAF is associated with increased mortality and a higher risk of graft rejection. It is likely that the development of a standard procedure for early identification of NOAF, as well as to develop recommendations for specific treatment targeted at avoiding the impacts of the illness, could provide a mortality reduction and provide an increased rate of successful LT