What will be the impact of the UK Supreme Court ruling declaring Uber drivers as employees on the gig economy?

The author presents the verdict of the Supreme Court of Great Britain, recognizing Uber drivers as employees in the light of current laws. The subject of consideration is also the influence of the British judgment on legal and factual relations based on digital platforms in Poland, particularly in relation to Uber drivers. The author analyses the scope of protection to which persons employed on a basis other than employment contract are entitled and points out the necessity to adapt the existing regulations to the requirements of the labour market

What factors may influence epidemiological situation of tuberculosis in Poland and in the world?

The authors present the review of factors influencing epidemiological situation of tuberculosis in Poland and in the world. The groups of increased risk of tuberculosis, and clinical conditions predisposing to activation of latent tuberculosis infection (LTBI) such as HIV, uremia, diabetes mellitus, transplantation of organs, treatment with glucocorticosteroids and with antibodies to TNF and to its receptors, were presented. The higher prevalence and worse prognosis of tuberculosis in elderly people was emphasised. The methods of LTBI recognition, according to recent recommendations, with special consideration to patients in immunosupression, were shown. Methods of treatment to prevent LTBI activation, according to WHO experts, were also presented. All data were discussed in relation to the actual epidemiological situation of tuberculosis in Poland.The authors present the review of factors influencing epidemiological situation of tuberculosis in Poland and in the world. The groups of increased risk of tuberculosis, and clinical conditions predisposing to activation of latent tuberculosis infection (LTBI) such as HIV, uremia, diabetes mellitus, transplantation of organs, treatment with glucocorticosteroids and with antibodies to TNF and to its receptors, were presented. The higher prevalence and worse prognosis of tuberculosis in elderly people was emphasised. The methods of LTBI recognition, according to recent recommendations, with special consideration to patients in immunosupression, were shown. Methods of treatment to prevent LTBI activation, according to WHO experts, were also presented. All data were discussed in relation to the actual epidemiological situation of tuberculosis in Poland

Electrophysiological and clinical assessment of dysautonomia in multiple system atrophy (MSA) and progressive supranuclear palsy (PSP): a comparative study

Clinical rationale for the study. Autonomic nervous system (ANS) involvement in different parkinsonian syndromes has been frequently discussed. It is well established in multiple system atrophy (MSA), whereas it is less evident in progressive supranuclear palsy (PSP). Aims of the study. The aims were to assess the presence and pattern of ANS involvement in MSA and PSP using noninvasive tests i.e. the sympathetic skin response (SSR) test and the R-R interval variation (RRIV) test; to analyse the relationship between clinical and electrophysiological abnormalities in both disorders; and to assess whether an autonomic profile might help to differentiate them. Materials and methods. Clinical and electrophysiological assessments of dysautonomia were performed in 59 patients with MSA (24 cases of MSA-C and 35 cases of MSA-P), these 59 cases including 31 females, mean disease duration 4.2 ± 2.7 years, mean age 60.3 ± 8.4 years, and in 37 patients with PSP (12 females, mean disease duration 4.6 ± 3.6 years, mean age 67.5 ± 6.1 years) and the results were compared to the results obtained from 23 healthy controls matched for age and sex. Results. Clinical dysautonomia assessed by an Autonomic Symptoms Questionnaire was observed in 97% of the MSA patients and in 84% of the PSP patients. SSR was abnormal in 64% and RRIV was abnormal in 73% of MSA cases. In PSP cases, these figures were 78% and 81% respectively. Dysautonomia was clinically more pronounced in MSA compared to PSP (p < 0.05), whereas electrophysiological testing revealed frequently subclinical ANS damage in PSP patients. Conclusions and clinical implications. Our results point to the complementary role of electrophysiological tests in the diagnostic work-up of dysautonomia in parkinsonian syndromes

Clinical and neuroimaging correlation of movement disorders in multiple sclerosis : case series and review of the literature

Multiple sclerosis (MS) is a chronic inflammatory demyelinating disease of the central nervous system, in which movement disorders (MD) have been reported very rarely. Anatomopathological studies of MS indicate two main processes: inflammation and neurodegeneration. The occurrence of the movement disorders symptoms in MS revises the question of aetiology of these two diseases. During the 10 years of observation in our out-patient clinic and MS units we examined about 2500 patients with clinically definite MS diagnosed according to the revised McDonald’s criteria. Only in 10 cases we found coexistence of MS and MD signs. Below we present rare cases of patients with coexistence of MS and chorea, pseudoathetosis, dystonia and parkinsonism. Searching for the strategic focal lesion in our case series showed demyelinating plaques placed in the thalamus most often. Detailed analysis of the clinical, pharmacological and neuroimaging correlations may help to explain the character of movement disorders in MS

Profil hormonalny u kobiet chorych na stwardnienie rozsiane w powiązaniu z aktywnością choroby — doniesienie wstępne

Background and purpose The influence of sex hormones on immune system activity in multiple sclerosis (MS) has been suggested by clinical evidence. The aim of the study was to analyse the pattern of sex hormones in MS women and to correlate the hormone pattern abnormalities to the disease course as well as to the magnetic resonance imaging (MRI) results. Material and methods We studied the serum level of the progesterone, β-oestradiol and prolactin in 46 women with clinical definite MS aged from 19 to 65; mean disease duration was 11.80 ± 9.86 years. The evaluation of the intensity of hormonal changes was done using a scoring system (0–3). On the brain MRI, the presence of brain atrophy, of hypothalamic demyelination as well as demyelination intensity (or degree) were analysed. The evaluation of the degree of demyelination and brain atrophy was done using a scoring system (0–4). Results The main hormonal abnormalities consisted of decreased progesterone level, increased oestradiol level or both. The sex hormone pattern was abnormal in 56% of patients. Hypothalamic lesions were found on MRI in 53% of cases. The abnormal hormonal pattern correlated with intensity of MR changes (p < 0.05, Fisher's exact test), but neither with presence of hypothalamic changes nor with disease parameters (Expanded Disability Status Scale, relapse rate, disease duration). Conclusions It is important to check the hormonal pattern in MS women because according to our results it may be related to the disease activity and probably affects the type of therapeutic intervention. This pilot study will be extended in a larger population.Wstęp i cel pracy Dane z piśmiennictwa sugerują częste występowanie zaburzeń hormonalnych u kobiet chorych na stwardnienie rozsiane (SR). Celem pracy była analiza profilu hormonalnego w zakresie hormonów płciowych u kobiet z SR w powiązaniu z przebiegiem klinicznym i obrazem rezonansu magnetycznego (RM) mózgowia. Materiał i metody Badano stężenie progesteronu, β-estradiolu i prolaktyny w surowicy u 46 pacjentek z klinicznie pewnym SR, w wieku od 19 lat do 65 lat, o średnim czasie trwania choroby 11,80 ± 9,86 roku, niestosujących żadnej terapii hormonalnej. Stopień zmian w profilu hormonalnym oceniano półilościowo wg przyjętego arbitralnie przez autorów systemu punktacji (0—3).W analizie RM brano pod uwagę obecność ognisk demielinizacji w obrębie struktur podwzgórza, nasilenie demielinizacji w obrębie mózgowia oraz współistnienie zaniku mózgu. Stopień zmian w RM oceniano także półilościowo wg przyjętego arbitralnie przez autorów systemu punktacji (0—4). Wyniki Nieprawidłowe stężenia hormonów stwierdzono u 26 pacjentek (56%). Nieprawidłowości polegały na zmniejszonym stężeniu progesteronu, zwiększonym stężeniu 17-β-estradiolu bądź na łącznym występowaniu obu tych zaburzeń. W badaniu RM w 53% przypadków stwierdzono obecność zmian demielinizacyjno-zapalnych w obrębie podwzgórza. Stopień zaburzeń hormonalnych oceniany półilościowo korelował ze stopniem zmian w RM mózgowia (p < 0,05; test dokładny Fishera), nie był natomiast związany z obecnością zmian w obrębie podwzgórza czy parametrami klinicznymi (punktacja w Expanded Disability Status Scale, częstość rzutów, czas trwania choroby). Wnioski Stan hormonalny kobiet chorych na SR powinien być brany pod uwagę w analizie klinicznej choroby i przy decyzjach terapeutycznych, gdyż wydaje się mieć związek z aktywnością SR. Badania te, w celu potwierdzenia uzyskanych wyników, należy kontynuować na szerszym materiale

Polimorfizmy genów paraoksonazy 1 oraz 2 jako czynnik ryzyka rozwoju stwardnienia rozsianego w populacji polskiej

Background and purpose The aim of this study was to test the hypothesis that polymorphisms of the paraoxonase genes PON1 and PON2 may be associated with increased risk of developing multiple sclerosis (MS) in the Polish population. Material and methods We studied the significance of the PON gene polymorphisms C311S, A162G, Q192R and L55M in 221 patients (including 145 women) with MS and in 661 healthy controls. In the MS population, mean Expanded Disability Status Scale score was 2.92, mean age was 36.8 years, and mean disease duration was 7.7 years. PON genotyping was determined using polymerase chain reaction and restriction enzyme digestion. Results According to our results, the PON1 and PON2 genotypes distribution did not differ between the MS patients and the controls. Conclusions The polymorphisms of the PON genes studied are not related to increased risk of MS in the Polish population.Wstęp i cel pracy Celem pracy było zweryfikowanie hipotezy, że polimorfizm genów PON1 i PON2 może być związany z ryzykiem wystąpienia stwardnienia rozsianego (SR) w populacji polskiej. Materiał i metody Autorzy badali znaczenie polimorfizmu genów PON: C311S, A162G, Q192R oraz L55M, u 221 chorych na SR (w tym 145 kobiet) oraz u 661 zdrowych osób z grupy kontrolnej. W grupie chorych na SR średnia punktacja w Expanded Disability Status Scale (EDSS) wynosiła 2,92 pkt, średnia wieku – 36,8 roku, a średni czas trwania choroby – 7,7 roku. Polimorfizm – A162G genu PON1 badano za pomocą reakcji łańcuchowej polimerazy (PCR) z analizą ilości produktu w czasie rzeczywistym, a pozostałe polimorfizmy za pomocą PCR i trawienia odpowiednimi enzymami restrykcyjnymi. Wyniki Nie stwierdzono istotnych statystycznie różnic w rozkładzie genotypów PON1 i PON2 pomiędzy grupą chorych a grupą kontrolną. Wnioski Wyniki pracy nie wskazują, aby istniała zależność pomiędzy polimorfizmem genów PON1 oraz PON2 a zwiększonym ryzykiem wystąpienia SR w populacji polskiej

Polymorphisms of paraoxonase 1 and 2 genes and the risk of multiple sclerosis in the Polish population

Background and purpose: The aim of this study was to test the hypothesis that polymorphisms of the paraoxonase genes PON1 and PON2 may be associated with increased risk of developing multiple sclerosis (MS) in the Polish population. Material and methods: We studied the significance of the PON gene polymorphisms C311S, A162G, Q192R and L55M in 221 patients (including 145 women) with MS and in 661 healthy controls. In the MS population, mean Expanded Disability Status Scale score was 2.92, mean age was 36.8 years, and mean disease duration was 7.7 years. PON ge notyping was determined using polymerase chain reaction and restriction enzyme digestion. Results: According to our results, the PON1 and PON2 genotypes distribution did not differ between the MS patients and the controls. Conclusions: The polymorphisms of the PON genes studied are not related to increased risk of MS in the Polish population

Frequency of chromosomal aberrations in material from abortions

Summary Examination of fetal tissue from spontaneous miscarriages shows that 50-70% of them were caused by abnormalkaryotype. The most frequent genetic abnormalities include abnormal number of chromosomes, aberration of chromosomes structure and chromosome mosaic anomalies. Objective: the aim of the study was to find out whether there is any difference in the frequency of chromosomal aberrations in patients who miscarried for the first time comparing to patients with recurrent miscarriages. Material and methods: Examination was performed on 129 miscarriage material samples from 128 women. Fluorescent hybridization in-situ (FISH) was used for genetic examination. Results: We received 120 results in which 45 (37,5%) were abnormal. The most frequent chromosomal aberration was trisomy, followed by triploidy and monosomy of chromosome X. Among 59 samples from first miscarriage we found 25 abnormal karyotypes. In the 61 samples from the second, third and the next miscarriages we found 20 chromosomal abnormalities. Conclusions: Frequency of chromosomal aberrations in the tissue from the first miscarriage is significantly higher than in samples from second or following miscarriages, which means that genetic factors are less likely to induce recurrent miscarriages. Genetic results confirm that most chromosomal abnormalities arise de-novo

Do chromosomal abnormalities reappear in subsequent pregnancies and how often?

Abstract Objective: Genetic factors are the most common causes of spontaneous abortions. 50% to 80% of first-trimester abortions reveal chromosome abnormalities. Evidence for the recurrence of the same or another chromosome abnormality in the next pregnancy is scarce. The aim: The aim of our study was to estimate recurrence risk of abortus aneuploidy and to find out whether karyotyping of the abortus allows the prognose subsequent pregnancy outcomes. Material and methods: Paraffin-embedded chorions have undergone cytogenetic examination using FISH with chromosome-specific probes. 57 chorions from 26 women have been assessed, including chorions from two consecutive abortions from 18 women and chorions from three consecutive abortions from 5 women. Results: 38.6% of 57 specimens had chromosome aberrations. The most prevalent anomalies were 16, 21 and 18 trisomies. 23 patients had a subsequent abortion karyotyped; 15 had a normal initial karyotype and 8 had an aberrant initial karyotype. 3 out of the 8 patients had a repeated chromosome anomaly. 5 out of the 15 patients who initially miscarried an aneuploid embryo, had a subsequent miscarriage of an aneuploid embryo. Only 3 (13.04%) out of the 23 patients displayed aneuploidy in each abortus. Conclusion: 1. Chromosome aberrations can reappear in subsequent pregnancies in the same patient and may be the cause of recurrent miscarriages. 2. The value of embryo/fetal karyotyping is not decisive in prognosis of subsequent pregnancy outcome. 3. Abnormal fetal karyotype can occur regardless of other causes of pregnancy loss

Zapalenie nerwów wzrokowych i rdzenia Devica (NMO) oraz choroby ze spektrum NMO

Zapalenie nerwów wzrokowych i rdzenia Devica jest autoimmunologicznym, zapalno-demielinizacyjnym schorzeniem ośrodkowego układu nerwowego o poważnym rokowaniu. Należy do chorób rzadkich, a chorobowość wśród rasy białej wynosi około 1/100 000. Od czasu pierwszego opisu tej jednostki chorobowej w XIX wieku prowadzono liczne badania dotyczące jej patogenezy oraz typowej symptomatologii. Początkowo obraz kliniczny sprowadzano jedynie do objawów zajęcia nerwów wzrokowych i rdzenia kręgowego, a choroba była traktowana jako jeden z wariantów stwardnienia rozsianego. Przełomowe znaczenie w wyodrębnieniu tej jednostki chorobowej oraz zrozumieniu jej etiopatogenezy miało odkrycie swoistych przeciwciał przeciwko antygenom kanału wodnego akwaporyny 4. W ostatnim czasie zmieniło się również spojrzenie na symptomatologię choroby. Obecnie wiadomo, że obraz kliniczny może obejmować, poza objawami osiowymi, również kliniczne cechy zajęcia pnia mózgu, podwzgórza, zaburzenia funkcji poznawczych i wiele innych. Ponadto zmiany demielinizacyjne w obrazie rezonansu magnetycznego mózgowia nie wykluczają rozpoznania choroby Devica. W ostatnich latach wprowadzono także nowe metody immunoterapii. W 2015 roku opublikowano nowe kryteria diagnostyczne, w których usystematyzowano standardy rozpoznania zapalenia nerwów wzrokowych i rdzenia, co jest kluczowe w przypadku włączania leczenia. Terapia choroby Devica jest odmienna niż w stwardnieniu rozsianym, dlatego konieczna jest prawidłowa diagnostyka różnicowa tych dwóch schorzeń