Medical sciences

Folia Medica Cracoviensia

Content

Folia Medica Cracoviensia | 2019 | vol. 59 | No 1 |

Abstract

Lyme disease is an emerging problem in Poland. Analysis has been undertaken of the medical documentation of 86 patients hospitalized in the Infectious Diseases Department, University Hospital in Cracow in 2013–2016, suspected of Lyme arthritis. It has especially considered medical history including potential exposure to the infection, detailed characteristics of the symptoms, diagnostic challenges and results of the treatment. Only some patients had a history of erythema migrans and not all of them recalled tick-bite. The majority of the patients had affected large joints, especially knee joints, and polyarthritis was rarely observed. Symptoms were resolved completely or partially after antibiotic treatment in most patients. The diagnosis of Lyme arthritis in areas endemic for Lyme disease is still a diagnostic challenge in patients with other rheumatic diseases, including osteoarthritis.

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Abstract

I n t r o d u c t i o n: Interactions between oral microbiota and systemic diseases have been suggested. We aimed to examine the composition of oral microbiota with reference to antioxidative defense and its correlation with clinical state in Crohn’s disease (CD) in comparison to ulcerative colitis (UC).

Ma t e r i a l s a n d Me t h o d s: Smears were taken from the buccal and tongue mucosa of patients with CD, UC and controls, and cultured with classical microbiology methods. Bacterial colonies were identified using matrix-assisted laser desorption/ionization (MALDI) with a time-of-flight analyzer (TOF). Blood morphology and C-reactive protein (CRP) were analyzed in the hospital laboratory. Antioxidative defense potential (FRAP) was determined using spectrophotometry in saliva and serum.

R e s u l t s: Oral microbiota in CD patients were characterized by lower diversity in terms of the isolated bacteria species compared to UC and this correlated with reduced FRAP in the oral cavity and intensified systemic infl ammation. Oral microbiota composition in CD did not depend on the applied treatment. In CD patients, a negative correlation was observed between the FRAP value in saliva and serum and the CRP value in serum. Individual differences in the composition of oral microbiota suggest that different bacteria species may be involved in the induction of oxidative stress associated with a weakening of antioxidative defense in the oral cavity, manifested by ongoing systemic inflammation.

C o n c l u s i o n s: Analysis of both the state of the microbiota and antioxidative defense of the oral cavity, as well as their referencing to systemic inflammation may potentially prove helpful in routine diagnostic applications and in aiding a better understanding of CD and UC pathogenesis associated with oral microbiota.

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Abstract

B a c k g r o u n d: Parechovirus and enterovirus belong to a family of Picornaviridae, nonenveloped, small-sized RNA viruses, responsible for multiple human diseases. Recent introduction of molecular tests enabled the identifi cation of parechovirus and enterovirus infections. Our aim was a retrospective analysis of signs and symptoms associated with confirmed parechovirus or enterovirus infections among children treated in the Department of Neonatology, St. Louis Regional Children’s Hospital in Kraków, Poland.

M e t h o d s: Based on laboratory records, we identified all cases of parecho- or enterovirus infections confirmed by identification of viral RNA in nasal swab or cerebrospinal fluid samples. Hospital records and laboratory tests results of selected patients were then analyzed, and selected data were summarized, with emphasis on clinical and laboratory findings at admission.

R e s u l t s: We identified 11 cases of parechovirus and three of enterovirus infections. All cases were neonates admitted to hospital with fever and irritability. Except for leukopenia in 50% of patients, no significant abnormalities were noted in blood counts and serum biochemistry, including low C-reactive protein and procalcitonin. In nine cases, cerebrospinal fluid was collected, the fluid protein concentrations and cell counts were moderately increased. Final diagnosis was meningitis in 12 children, and other viral infections in two.

C o n c l u s i o n s: Viral infection, including parecho- and enteroviruses, should be considered in the etiology of fever and meningitis in neonates. The available molecular tests allow for detection of viral genetic material even in a scant biological specimen collected from neonates.

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Abstract

I n t r o d u c t i o n: Peripheral arterial occlusive disease (PAOD) is a disease with worldwide increasing occurrence. Diabetic patients are greatly exposed on the risk of PAOD and its complications. The aim of the study was to check the influence of preoperative HbA1C on the outcomes of patients with diabetes undergoing PAOD related endovascular treatment.

M a t e r i a l a n d Me t h o d s: The study was conducted among 59 patients with PAOD referred from the diabetic foot outpatient for endovascular treatment. They were included in one-year observation based on follow-up visits in 1, 3, 6 and 12 months after angioplasty and divided into 2 groups basing on their preoperative glycaemia. Th e clinical condition of the lower limbs was assessed by use of the Rutherford classification, ankle-brachial index (ABI) and toe-brachial index (TBI). Changes in patients’ quality of life (QoL) were also evaluated.

R e s u l t s: Reintervention within 12 months were less frequent in patients with HbA1C ≤8.0% than in HbA1C >8.0% patients (9.09% vs. 35.48%, p = 0.03). TBI of the treated limb was lower in patients with elevated than in patients with proper glycaemia at 6 month [0.2 (0.0–0.38) vs. 0.38 (0.31–0.46); p <0.008] and 12 month follow-up [0.17 (0.0–0.27) vs. 0.32 (0.25–0.38); p <0,001]. The rate of healed ulcerations after 6 months was higher in patients HbA1C ≤8.0% (45.0% vs. 16.13%; p = 0.02) and they had significantly greater improvement of QoL.

C on c l u s i o n: Results of this study shows that preoperative level of glycaemia is an important factor for long-term prognosis in diabetic patients with PAOD. Elevated HbA1C level decreases significantly long-term improvement of QoL in DM patients undergoing endovascular treatment.

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Abstract

Constantly increasing prevalence of allergic diseases determines the attempts to elaborate the therapeutic strategies activating immune tolerance to particular allergen. Our current research focuses on the antigen-specifi c action of CD8+ suppressor T (Ts) lymphocytes induced in mice by intravenous administration of a high dose of haptenated syngeneic erythrocytes. While the regulatory activity of Ts cells mediated by exosome-delivered miRNA-150 is well defi ned, the mechanism of their induction remained unclear. Th erefore, the current studies investigated the immune eff ects induced in mice by intravenous administration of contact allergens coupled to syngeneic erythrocytes. In mouse models of hapten-induced contact hypersensitivity (CHS) and delayed-type hypersensitivity to ovalbumin, we have shown that intravenous administration of hapten-coupled erythrocytes failed to induce CHS effector cells. Moreover, hapten-induced CHS reaction occurred to be suppressed in mice intravenously administered with syngeneic erythrocytes coupled with protein allergen. Finally, we have demonstrated that intravenously administered allergen induces immune tolerance only when bound to syngeneic erythrocytes, proving that intravenously delivered allergens are deprived of their immunizing properties when coupled with membrane of self cells. Altogether, our current studies suggest that alteration of self cell membrane by allergen binding is enough to induce Ts cell-mediated immune tolerance to nonpathogenic agents, which express a great translational potential in such conditions as allergies and hypersensitivity-related autoimmune disorders.

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Abstract

I n t r o d u c t i o n: Co-occurrence of physical and cognitive dysfunctions contribute to functional decline and a gradual loss of independence.

O b j e c t i v e s: The purpose of this study was to evaluate the association between global cognitive impairment and physical mobility in older adults with and without mild cognitive impairment (MCI).

Ma t e r i a l a n d Me t h o d s: A total of 800 older adults were recruited (653 with normal cognitive functioning and 147 participants with MCI). Motor performance was measured with the Timed Up and Go test (TUG) and the 6 Minute Walk Test (6MWT). Cognitive functions were evaluated using Mini- Mental State Examination (MMSE) and Addenbrooke’s Cognitive Examination (ACE-III).

R e s u l t s: ACE-III scores were associated with the TUG test performance in older adults (with and without MCI), but not with 6MWT results. The overall score in ACE-III and its subscales, i.e. a) memory and fluency in the MCI group and in the total group, and b) fluency in the control group, were associated with TUG aft er adjusting for age, sex, body mass index, medication use, depressive symptoms, hypertension, coronary artery disease and diabetes. In the case of the 6MWT test results, only the ACE-III fluency subscale scores and not the overall ACE-III score were associated with them.

C o n c l u s i o n s: Global cognitive function, verbal fluency and memory were independently associated with the TUG. ACE-III, being a more extensive testing tool than MMSE, made it possible to show the relationship between global cognition and motor skills.

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Abstract

The aim of the study was to choose and validate the tool(s) to predict the number of hospitalized patients by testing three predictive algorithms: a linear regression model, Auto-Regressive Moving Average (ARMA) model, and Generalized Auto-Regressive Conditional Heteroskedasticity (GARCH) model. The study used data from the collection of data on infl ammatory bowel diseases (IBD) from the public database of the National Health Fund for the years 2009–2017, data recalculation taking into account the population of provinces and the country in particular years, and prediction making for the number of patients who would require hospitalization in 2017. Th e anticipated numbers were compared with real data and percentage prediction errors were calculated. Results of prediction for 2017 indicated the number of hospitalizations for Crohn’s disease (CD) and ulcerative colitis (UC) at 17 and 16 respectively per 100,000 persons and 72 per 100,000 persons for all IBD cases. Th e actual outcomes were 21 for both CD and UC (81% and 75% accuracy of prediction, respectively), and 99 for all IBD cases (73% accuracy). The prediction results do not diff er signifi cantly from the actual outcome, this means that the prediction tool (in the form of a linear regression) actually gives good results. Our study showed that the newly developed tool may be used to predict with good enough accuracy the number of patients hospitalized due to IBD in order to organize appropriate therapeutic resources.

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Abstract

O b j e c t i v e s: To evaluate the properties of natural sweetener solutions in whole organ preservation and assess their influence on the dimension, weight and shape of cardiac tissue samples in stated time intervals, up to a one-year period of observation.

B a c k g r o u n d: Tissue fixation is essential for biological sample examination. Many negative toxic effects of formaldehyde-based fixatives have forced us to seek alternatives for formaldehyde based solutions. It has been demonstrated that natural sweeteners can preserve small tissue samples well and that these solutions can be used in histopathological processes. However, their ability to preserve whole human organs are unknown.

M e t h o d s: A total of 30 swine hearts were investigated. Th ree study groups (n = 10 in each case) were formed and classifi ed on the type of fixative: (1) 10% formaldehyde phosphate-buffered solution (FPBS), (2) 10% alcohol-based honey solution (ABHS), (3) 10% water-based honey solution (WBHS). Samples were measured before fi xation and in the following time points: 24 hours, 72 hours, 168 hours, 3 months, 6 months and 12 months.

R e s u l t s: The WBHS failed to preserve heart samples and decomposition of tissues was observed one week after fixation. In half of the studied parameters, the ABHS had similar modifying tendencies as compared to FPBS. Th e overall condition of preserved tissue, weight, left ventricular wall thickness, right ventricular wall thickness and the diameter of the papillary muscle differed considerably.

C o n c l u s i o n s: The ABHS may be used as an alternative fi xative for macroscopic studies of cardiac tissue, whereas the WBHS is not suited for tissue preservation.

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Abstract

B a c k g r o u n d: The digital rectal examination (DRE) is a part of the standard physical examination and a useful diagnostic tool for detecting various lower gastrointestinal tract abnormalities. However nowadays it has been observed that medical students might not be properly prepared for performing and interpreting of DRE. The purpose of the study was to evaluate the knowledge and experience of Polish medical students about DRE.

Ma t e r i a l a n d M e t h o d s: A prospective study was carried out using a questionnaire accessible via internet platform. The survey consisted of 12 questions and considered experience as well as practical and theoretical knowledge about DRE. 976 responses from nine Polish medical universities were included in the study.

R e s u l t s: 38.68% of students have never performed DRE with “lack of opportunity during courses” (71.09%) as the most common reason. Among responders who performed this examination only 12.72% had done it more than two times. Usefulness of DRE was mostly assessed as high and very high (55.63%). Students in the self-assessment part indicated low and very low (18.72% and 39.61%) technical abilities and also low (25.34%) interpretation skills.

C on c l u s i o n: The knowledge of Polish medical students about DRE is insuffi cient. Medical universities should pay particular attention to this fi eld of examination to improve theoretical as well as practical skills of future doctors.

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Abstract

Monorchism in children can be caused by congenital and acquired conditions, and can potentially infl uence the hormonal and reproductive function of an individual in the long term. Depending on the etiology, diff erent approaches to the solitary testis have been suggested; however, studies on this topic are scarce. Prevention of anorchia is the main goal in the management of a child with monarchism. The risk of bilateral testicular loss must be weighed against the risk of performing surgery on a healthy gonad. Little is known about the long-term consequences of the various methods for fixation of the testis. This paper provides an up-to-date summary of the current literature on congenital and acquired monarchism in childhood.

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Editorial office

KOMITET REDAKCYJNY

Redaktor Naczelny
Dr hab. Krzysztof Gil, prof. UJ

Zastępca Redaktora Naczelnego
Prof. Andrzej Surdacki

Sekretarz Redakcji
Dr hab. Beata Kuśnierz – Cabala, prof. UJ

Członkowie
Prof. Benjamin Chain (London, UK),
Prof. Paul Enck (Tübingen, Germany),
Prof. Tomasz Grodzicki (Kraków, Poland),
Prof. Kalina Kawecka-Jaszcz (Kraków, Poland)
Prof. Maciej Małecki (Kraków, Poland),
Prof. Janusz Marcinkiewicz (Kraków, Poland),
Prof. Franz H. Messerli (New York, USA),
Prof. Jacek Musiał (Kraków, Poland),
Prof. Wiesław Pawlik (Kraków, Poland),
Prof. Jacek J. Pietrzyk (Kraków, Poland)
Prof. Władysław Sułowicz (Kraków, Poland)
Prof. Piotr Thor (Kraków, Poland)
Prof. Jerzy A. Walocha (Kraków, Poland)

Redaktor techniczny
Danuta Ambrożewicz

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