Epidemiological investigation on hepatitis A virus infection outbreak in the area of Rzeszow city during the years 2017/18.

AIM OF THE STUDY: To define the threats and epidemiological differences between outbreaks of hepatitis A (HA) in adults and children, and to assess the efficiency of implemented prophylaxis. We also present a summary of treatment and sick leave costs as compared to the predicted money-load in the case of properly initiated prophylaxis in hepatitis A virus (HAV)-exposed persons. MATERIAL AND METHODS: The cause of two outbreaks was contamination related to food mishandling by a person infected with HAV. Especially health-threatening was exposure to the infection of 137 pre-school children. A second outbreak caused by the same source was observed among 25 exposed adults. On the basis of medical documentation we determined costs related to hospitalization and sickness leave absence at work, comparing it with money load related to implementation of required prophylaxis in both groups of people exposed to risk of HAV infection. RESULTS: As a consequence of exposure in the kindergarten area, an infection was confirmed in 32 patients from the first and subsequent generations and 7 cases were observed in the second outbreak. Costs of hospitalization and related to the sick leave were estimated to double the predicted costs of prophylaxis. CONCLUSIONS: In the case of lack of proper hand hygiene of a food handler with HA or in the case of food-borne exposure of children to HAV it is necessary to apply post-exposure prophylaxis. Costs of the prophylaxis are significantly lower than costs of HA. Both outbreaks underwent self-limitation with longer course of morbidity and larger number in the case of the kindergarten focus.

Opioid-like peptides and ghrelin mitigation of bariatric results depends on obesity level.

INTRODUCTION: Bariatric surgery, as the only effective treatment of obesity, has strong effects on the metabolism, and nervous and endocrine systems. Thus, based on the different opinions about the efficaciousness of morbid obesity treatments, the aim of the present study was to estimate the association of serum ghrelin and Met-enkephalin (native, five amino acids and cryptic, precursor of enkephalin) concentrations with body mass index (BMI) value in bariatric patients within 30 postoperative days. MATERIAL AND METHODS: The study was performed on 38 female patients divided into two groups: I - BMI lower than 40 kg/m² (n = 18) and II - BMI higher than 40 kg/m² (n = 20). Blood was taken before (-24 h), and 72 h and 30 days after the sleeve gastrectomy. Routine haematological, anthropometric, and metabolic parameters as well as thyroid-stimulating hormone (TSH), ghrelin, and Met-enkephalin values were measured in all patients. RESULTS: There were statistically significant differences between the two groups before the surgery in terms of TSH, both forms of Metenkephalin, triglycerides concentrations, and activity of alanine transaminase (ALT), gamma glutamyltransferase (GGTP), and C-reactive protein (CRP). After 72 h, the serum levels of cryptic Met-enkephalin and CRP, and activity of enzymes varied between the two groups of patients. Thirty days after the surgery, some metabolic and immune parameters were still different in both female groups in favour of patients with lover BMI. However, significant differences were noticed in the levels of ghrelin (increase), and native (decrease) and cryptic Met-enkephalins (increase). CONCLUSIONS: The activity of endogenous peptides in bariatric patients is connected with the degree of obesity. Ghrelin level increases are negatively correlated with native Met-enkephalin changes shortly after bariatric surgery. The interplay of ghrelin and opioids might be considered as a predictor of postoperative weight loss success.

Clinical course of primary sclerosing cholangitis and concomitant ulcerative colitis - a preliminary report of retrospective study among patients from Southern Poland.

UNLABELLED: Both ulcerative colitis (UC) and primary sclerosing cholangitis (PSC) are chronic and progressive diseases of uncertain etiology, that may affect one patient. Approximately 70% of PSC cases are also diagnosed with UC, whereas in the group of UC the prevalence of PSC is about 2-5%. The aim of the study was to compare clinical courses of PSC and UC in patients diagnosed with both diseases to those with the confirmed diagnosis of either PSC or UC. Three groups were distinguished and evaluated: patients with PSC and UC (n = 17) and two control groups: patients with PSC (n = 4) and with UC (n = 13). Clinical data, symptoms, laboratory tests, results of the magnetic resonance cholangiopancreatography and colonoscopy were analyzed to compare clinical courses of these diseases between the groups. CONCLUSION: there is no correlation between clinical course of simultaneous PSC and UC. However, it may differ depending on co-occurrence of the other disease.

Selected apoptotic markers in serum of patients with chronic viral hepatitis C.

BACKGROUND: In chronic viral hepatitis C, hepatocytes inflammation, necrosis and apoptosis occur. To evaluate hepatocyte apoptotic rate, a serum concentration of proapoptotic FaS protein and its ligand (FaS/FaSL) as well tumor necrosis factor-alpha (TNF-alpha) and antiapoptotic hepatocyte growth factor (HGF) may be used. The aim of the study was to evaluate the hepatic apoptosis rate in patients with hepatitis virus C infection and its correlations with the degree of liver inflammation and staging, biochemical tests, viral load and the duration of the infection. PATIENTS AND METHODS: 60 adults (30 chronic hepatitis C patients and 30 controls) were included into the study. Serum levels of FaS/FaSL, TNFalpha and HGF were evaluated using the ELISA method. The results were correlated with viral load, biochemical tests, as well ultrasonographic and histopathological (grading, staging) examinations. RESULTS: TNF-alpha level in HCV-infected patients was significantly higher than in the controls (11.0 +/- 19.3 pg/ml vs. 3.3 +/- 2.8 pg/ml, p = 0.04). FaS/ FaSL and HGF did not differ significantly in both groups. TNF-alpha level was higher in patients with low staging (fibrosis F-0) than in those with higher staging (F-1, F-2, F-3)--according to the Batts-Ludwig scale. Other markers (FaS/FaSL and HGF) did not differ in groups with variant staging. No significant differences were observed in relation to grading. CONCLUSIONS: The measurement of FaSIFaSL, TNF-alpha and HGF does not allow for the assessment about apoptotic rate in patients with chronic hepatitis C. Explanation of this problem need follow-up studies on larger groups with the use of more complex methods.

TNF-α and soluble forms of TNF receptors 1 and 2 in the serum of patients with Crohn's disease and ulcerative colitis.

INTRODUCTION: Soluble forms of tumor necrosis factor (TNF) membrane receptors 1 and 2 (sTNFR1 and sTNFR2) are present in body fluids. Their higher concentrations are observed in a number of diseases, including inflammatory bowel diseases (IBDs). sTNFR1 and sTNFR2 are capable of binding TNF-α, acting as an inhibitor that competes with a membrane receptor. The results of the available studies on sTNFR1 and sTNFR2 concentrations in IBDs and their association with disease activity are ambiguous. OBJECTIVES: The aim of the study was to assess sTNFR1 and sTNFR2 concentrations and their correlation with disease activity in patients with IBD. PATIENTS AND METHODS: Plasma levels of TNF-α, sTNFR1, and sTNFR2 were measured in 55 consecutive patients with ulcerative colitis (UC), 50 subjects with Crohn's disease (CD), and 41 healthy controls. We assessed the associations of those markers with other inflammatory markers, disease activity and location, type of treatment, and complications. RESULTS: Positive correlations were observed between CD activity and sTNFR1 and sTNFR2 levels (r = 0.42 for both, P <0.01) as well as between UC activity and sTNFR1 and sTNFR2 levels (r = 0.63, P <0.0001; r = 0.47, P <0.001; respectively). TNF-α levels correlated only with CD activity (r = 0.29, P <0.05). In patients with nonactive UC, higher sTNFR2 levels were observed compared with controls. In patients with CD, higher TNF-α and sTNFR2 levels were demonstrated in patients who developed complications. CONCLUSIONS: sTNFR1 and sTNFR2 are more sensitive inflammatory markers than TNF-α in the assessment of disease activity in patients with CD and UC. Higher sTNFR2 levels are observed in patients with CD and complications.

IL28B polymorphism as a predictor of antiviral response in chronic hepatitis C.

AIM: To evaluate the effect of single nucleotide polymorphisms of interleukin (IL)-28B, rs12979860 on progression and treatment response in chronic hepatitis C. METHODS: Patients (n = 64; 37 men, 27 women; mean age, 44 ± 12 years) with chronic hepatitis C, genotype 1, received treatment with peg-interferon plus ribavirin. Genotyping of rs12979860 was performed on peripheral blood DNA. Histopathological assessment of necroinflammatory grade and fibrosis stage were scored using the METAVIR system on a liver biopsy sample before treatment. Serum viral load, aminotransferase activity, and insulin level were measured. Insulin resistance index, body mass index, waist/hip ratio, percentage of body fat and fibrosis progression rate were calculated. Applied dose of interferon and ribavirin, platelet and neutrophil count and hemoglobin level were measured. RESULTS: A sustained virological response (SVR) was significantly associated with IL28B polymorphism (CC vs TT allele: odds ratio (OR), 25; CC vs CT allele: OR, 5.4), inflammation activity (G < 1 vs G > 1: OR, 3.9), fibrosis (F < 1 vs F > 1: OR, 5.9), platelet count (> 200 × 10(9)/L vs < 200 × 10(9)/L: OR, 4.7; OR in patients with genotype CT: 12.8), fatty liver (absence vs presence of steatosis: OR, 4.8), insulin resistance index (< 2.5 vs > 2.5: OR, 3.9), and baseline HCV viral load (< 10(6) IU/mL vs > 10(6) IU/mL: OR, 3.0). There was no association with age, sex, aminotransferases activity, body mass index, waist/hip ratio, or percentage body fat. There was borderline significance (P = 0.064) of increased fibrosis in patients with the TT allele, and no differences in the insulin resistance index between groups of patients with CC, CT and TT alleles (P = 0.12). Spearman's rank correlation coefficient between insulin resistance and stage of fibrosis and body mass index was r = 0.618 and r = 0.605, respectively (P < 0.001). Significant differences were found in the insulin resistance index (P = 0.01) between patients with and without steatosis. Patients with the CT allele and absence of a SVR had a higher incidence of requiring threshold dose reduction of interferon (P = 0.07). CONCLUSION: IL28B variation is the strongest host factor not related to insulin resistance that determines outcome of antiviral therapy. Baseline platelet count predicts the outcome of antiviral therapy in CT allele patients.

Intrahepatic expression of genes related to metabotropic receptors in chronic hepatitis.

AIM: To screen for genes related to metabotropic receptors that might be involved in the development of chronic hepatitis. METHODS: Assessment of 20 genes associated with metabotropic receptors was performed in liver specimens obtained by punch biopsy from 12 patients with autoimmune and chronic hepatitis type B and C. For this purpose, a microarray with low integrity grade and with oligonucleotide DNA probes complementary to target transcripts was used. Evaluation of gene expression was performed in relation to transcript level, correlation between samples and grouping of clinical parameters used in chronic hepatitis assessment. Clinical markers of chronic hepatitis included alanine and aspartate aminotransferase, γ-glutamyltranspeptidase, alkaline phosphatase and cholinesterase activity, levels of iron ions, total cholesterol, triglycerides, albumin, glucose, hemoglobin, platelets, histological analysis of inflammatory and necrotic status, fibrosis according to METAVIR score, steatosis, as well as anthropometric body mass index, waist/hip index, percentage of adipose tissue and liver size in ultrasound examination. Gender, age, concomitant diseases and drugs were also taken into account. Validation of oligonucleotide microarray gene expression results was done with the use of quantitative real-time polymerase chain reaction (qRT-PCR). RESULTS: The highest (0.002 < P < 0.046) expression among genes encoding main components of metabotropic receptor pathways, such as the α subunit of G-coupled protein, phosphoinositol-dependent protein kinase or arrestin was comparable to that of angiotensinogen synthesized in the liver. Carcinogenesis suppressor genes, such as chemokine ligand 4, transcription factor early growth response protein 1 and lysophosphatidic acid receptor, were characterized by the lowest expression (0.002 < P < 0.046), while the factor potentially triggering hepatic cancer, transcription factor JUN-B, had a 20-fold higher expression. The correlation between expression of genes of protein kinases PDPK1, phosphoinositide 3-kinase and protein kinase A (Spearman's coefficient range: 0.762-0.769) confirmed a functional link between these enzymes. Gender (P = 0.0046) and inflammation severity, measured by alanine aminotransferase activity (P = 0.035), were characterized by diverse metabotropic receptor gene expression patterns. The Pearson's coefficient ranging from -0.35 to 0.99 from the results of qRT-PCR and microarray indicated that qRT-PCR had certain limitations as a validation tool for oligonucleotide microarray studies. CONCLUSION: A microarray-based analysis of hepatocyte metabotropic G-protein-related gene expression can reveal the molecular basis of chronic hepatitis.

Anti-inflammatory and anticoagulant properties of the protein C system in inflammatory bowel disease.

INTRODUCTION: In patients with inflammatory bowel disease (IBD), disbalance between procoagulant, anticoagulant, and fibrinolytic factors has been shown. The hemostatic system is an indispensable component of the inflammatory process. Deficiencies in the protein C (PC) pathway components not only promote thrombosis, but also exacerbate inflammation. OBJECTIVES: The aim of the study was to assess the components of the PC system and their correlations with disease activity in patients with IBD. PATIENTS AND METHODS: The levels of PC, free protein S (PS), and soluble thrombomodulin (sTM) were measured in 55 consecutive patients with ulcerative colitis (UC), 50 patients with Crohn's disease (CD), and 41 healthy volunteers. Correlations between PC system components and disease activity, hemostatic variables, and inflammatory markers were assessed. RESULTS: sTM levels in patiens with UC were higher compared with controls (24.5 vs. 17.5 ng/ml; P = 0.0042). In patients with IBD, PC activity was higher and PS activity was lower compared with controls (P <0.001). Tumor necrosis factor α (TNF-α) levels were higher in patients with IBD, and interleukin 6 (IL-6) levels were higher only in patients with CD. In patients with UC, a positive correlation was observed between sTM and both PC and PS levels (r = 0.28 and r = 0.34, respectively, P <0.05). Only PC levels correlated with UC activity (r = 0.3, P <0.05). No correlations of TNF-α, IL-6, and C-reactive protein with PC, PS, and sTM levels were observed. CONCLUSIONS: The PC pathway is defective in patients with CD and UC. Hypercoagulability in IBD might be associated not only with the inflammatory process but also with disturbances in the anticoagulant system, since defective PC pathway was observed both in active and nonactive disease.

Efficacy of pegylated interferon alfa-2a or alfa-2b in combination with ribavirin in the treatment of chronic hepatitis caused by hepatitis C virus genotype 1b.

INTRODUCTION: Treatment of chronic hepatitis C (CHC) with pegylated interferon (Peg-IFN) and ribavirin leads to sustained virological response (SVR) in approximately 50% of the patients. SVR depends on hepatitis C virus (HCV) and host factors, including IL28B genotypes. OBJECTIVES: The aim of the study was to investigate the therapeutic efficacy of the difficult-to-treat HCV genotype 1b in patients from the south of Poland. PATIENTS AND METHODS: A total of 260 adult patients with CHC and HCV genotype 1b were treated with Peg-IFN alfa-2a or Peg-IFN alfa-2b with ribavirin for 48 weeks. Efficacy was assessed at 12 weeks (early virological response - EVR), 48 weeks (end-of-treatment response - ETR), and at 6 months (SVR). HCV-RNA, alanine transaminase (ALT), and other biochemical parameters were measured in serum at baseline and at 12, 48, and 72 weeks of therapy. RESULTS: HCV-RNA levels were 3.72 ±1.17 × 106 IU/ml at baseline and decreased significantly at 12 weeks (0.02 ±0.17 × 106 IU/ml); there were no differences between the group treated with Peg-INF alfa-2a and the group treated with Peg-INF alfa-2b. ALT was 94.1 ±7.6 IU/l at baseline and decreased significantly at 12 weeks (42.5 ±3.1 IU/l). The overall EVR, ETR, and SVR were achieved by 63.9%, 77.7%, and 48.1% of the patients, respectively. Tolerance of therapy was similar in both groups. CONCLUSIONS: Efficacy of Peg-IFN alfa-2a with ribavirin is not significantly different from that of Peg-IFN alfa-2b with ribavirin, and SVR was achieved in 48.3% and 44.3% of the patients, respectively. Our study confirms that the efficacy of treatment of patients with HCV genotype 1b from the southern region of Poland is similar to that observed in the overall Polish population.

Role of IL-6 and neopterin in the pathogenesis of herpetic encephalitis.

Herpetic encephalitis (HSE) is one of the most severe infection of the central nervous system (CNS), connected with high mortality rate, even when appropriate therapy has been introduced. Better understanding of pathomechanisms responsible for neuronal injury during the course of the disease can be useful in the assessment of the risk of the occurrence of severe complications, as well as in potential introduction of additional therapeutic methods. The purpose of this study is to assess the correlation between concentration of neopterin and IL-6 in the CSF and serum, and the course of HSE. In this study, 36 patients with HSE were investigated, and the control group consisted of 32 patients in whom the infection of the CNS was excluded. We observed significantly higher concentration of neopterin and IL-6 in the CSF of patients with HSV as compared with the control group. Neopterin and IL-6 levels in the CSF correlated with the course of HSE. Higher values were connected with the risk of respiratory failure, development of permanent neurologic complications and patient death. Negative correlations between concentration of IL-6 and neopterin and patient condition assessed by Glasgow Coma Scale (GCS) were observed. Neopterin with high sensitivity and specificity allowed to predict the risk of death or severe neurological complications. Increased concentration of neopterin and IL-6 in the CSF and serum revealed reciprocal positive correlation. Assessment of the concentration of IL-6 and neopterin in the serum was not useful to predict the course of HSE.

Morphological changes of the upper gastrointestinal tract mucosa and Helicobacter pylori infection in HIV-positive patients with severe immunodeficiency and symptoms of dyspepsia.

BACKGROUND: HIV infection causes progressive immune defense system dysfunction, including the gastrointestinal (GI) tract. The aim of the study was to evaluate the morphological changes in the upper-GI tract mucosa in HIV-infected patients in relation to the degree of immunodeficiency, presence of H. pylori, fungal colonization, and antiretroviral treatment (HAART). MATERIAL/METHODS: One hundred forty-six patients (94 HIV positive, 52 HIV negative) with dyspeptic symptoms were evaluated by upper GI endoscopy and biopsy. The HIV-infected were divided into two groups: 47 patients with CD4+ count >200/mm(3) and 47 with severe immunodeficiency (CD4+ count <200/mm(3)); 42 of the total patients were treated with HAART. Gastric biopsies for histopathology and urease test, esophageal swabs, and gastric aspirates for mycological evaluation were taken. RESULTS: The HIV-infected patients with severe immunodeficiency had a lower prevalence of H. pylori infection and active chronic gastritis in the gastric antrum compared with the other HIV-infected patients and controls (H. pylori in 40%, 72%, and 69%, respectively; p<0.05). Mycotic esophagitis and mycotic colonization of the stomach were more frequent in patients with severe immunodeficiency. The prevalence of gastric mucosa changes was not different between the patients treated and not treated with HAART; H. pylori infection was less frequent in HIV-infected patients treated with HAART (p<0.05). CONCLUSIONS: In severely immunodeficient patients with dyspeptic symptoms, the prevalence of H. pylori and active chronic gastritis in the gastric antrum is much lower than in HIV-negative patients. H. pylori infection is less frequent in patients treated with HAART.

[Prognosis of the bleeding as a complication of percutaneous thick needle biopsy of the liver]. / Prognozowanie krwawienia jako powiklania przezskórnej biopsji gruboiglowej watroby.

UNLABELLED: Bleeding after biopsy of the liver (LB) is a rare event, hard to prognose and occurs frequently in those cases, when we do not expect it. Bleeding is the main reason of complications and deaths subsequent to LB. The aim of the study was to prognose the bleeding on the basis of hemodynamic disturbances and clinical symptoms occurring just after LB. MATERIAL AND METHODS: The study was performed on 145 patients with LB. The blood pressure and heart rate were examined before and after procedure of biopsy. In the group of 142 patients without bleeding complications, circulating disturbances and clinical symptoms were compared with three patients of bleeding subsequent to LB. The patients with bleeding were analyzed retrospectively. RESULTS: In the group of patients without bleeding complications after LB there was observed statistically significant reduction of blood pressure. In 29 cases (46%) bradycardia occurred, in 15 cases (23.8%) clinical symptoms of vasovagal syndrome were noticed. Pain at the needle insertion site and shoulder pain happened in 15 (10.6%) patients. In one patient with low hypotension the pain was intense and localized in the whole abdominal cavity. In two cases with bleeding the hypotension occurred in 6th and 7th hour with the heart rate 60-70/min and in the third case the massive bleeding led to the shock. CONCLUSION: Hemodynamic disturbances including hypotension and bradycardia are frequent and difficult to diagnose. Bradycardia does not differentiate vasovagal reaction after LB with hypotension caused by bleeding. Coincidence of hypotension with abdominal pain indicates the high probability of bleeding subsequent to LB. Ultrasound examination of the abdomen is highly useful in the confirmation of bleeding complications.

[Changes of lipid metabolism in patients with chronic viral hepatitis treated with interferon alpha]. / Zaburzenia przemiany lipidów u chorych z przewleklym wirusowym zapaleniem watroby w przebiegu leczenia interferonem alfa.

UNLABELLED: Changes of lipid metabolism are often observed in patients (pts) with chronic viral hepatitis during interferon therapy. Many studies show changes in blood lipids including increase of triglycerides level, decrease of total cholesterol as well as HDL lipoprotein levels. This study was an attempt to widen our knowledge about additional factors responsible for changes in lipid metabolism of pts with chronic viral hepatitis during interferon therapy. The aim of this study was to assess the changes of total cholesterol, triglycerides and LDL-, HDL-lipoproteins levels in blood serum in comparison to: activity of hepatic inflammation, degrees of fibrosis, type of hepatotropic viruses and response to antiviral treatment. MATERIAL AND METHODS: In the group of 53 pts (18 female, 35 male), age 16-61 years old with chronic hepatitis B (13 pts) and chronic hepatitis C (40 pts) treated with interferon alpha we examined the cholesterol, HDL, LDL-lipoproteins and TG levels in blood serum at the beginning of therapy and in the sixth month. Changes of lipids values at the beginning and in the sixth month of therapy were assessed in respect to: necro-inflammatory changes of the liver in histopathological examination, degrees of fibrosis, obesity, loss of the weight during IFN therapy, response to treatment, type of hepatotropic viruses (HBV, HCV), sex and age. RESULTS AND CONCLUSIONS: During sixth month of interferon therapy there was significant decrease of total cholesterol level (before treatment 4.1 +/- 1.0, after treatment 3.8 +/- 0.9, p < 0.05) and HDL-lipoproteins level (before treatment 1.3 +/- 0.35, after treatment 1.1 +/- 0.35, p < 0.05). Increase of TG level was not statistically significant. The necro-inflammatory changes in the liver correlated with the values of TG level. Low activity of hepatic inflammation correlated with the increased TG level at sixth month of therapy. There was not observed effect of any other factors on the lipid metabolism.

[Clinical manifestations and effect of early therapy with interferon-alpha on the course of acute hepatitis C]. / Manifestacja kliniczna i wplyw wczesnego leczenia interferonem alfa na przebieg ostrego wirusowego zapalenia watroby typu C.

UNLABELLED: The aim of the study was to estimate the course of acute hepatitis C and efficacy of 24 weeks monotherapy with interferon alpha 2b (IFN). METHODS: Twenty one patients with acute hepatitis C (age between 26 and 79; 17 females, 4 males) treated in the University Hospital between March 2000 and December 2004 were included into this study. Acute phase of hepatitis C was diagnosed on the basis of HCV-RNA presence by PCR, seroconversion to anti-HCV, clinical symptoms of acute hepatitis and clinical view with epidemiological anamnesis. Biochemical, serological and virusological parameters as well as complete blood count were examined during observation. The efficacy of antiviral treatment with IFN (5 MU daily for 30 days, then 3 MU tiw for 24 week) was studied in 8 patients. Loss of HCV viremia after 24 weeks of treatment and sustained response after the next 24 weeks of follow-up were examined. RESULTS: Jaundice, the main clinical symptom, was observed in 17 (81%) patients, with mean bilirubin level of 147.7 micromol/l. Dyspeptic symptoms were noticed in 71% patients, arthralgia 24%, fatigue in 19% patients. The maximal ALT activity was 1744 U/l, AST 1235 U/l and GGT 372 U/l. The course subsequent to the acute phase was analyzed in 18 patients. Spontaneous loss of viremia was observed in 28% patients. Among the 8 patients included to the therapy early response was observed in 88% and sustained viral response in 75% of them. CONCLUSIONS: Early initiation of interferon alpha therapy in patients with acute hepatitis C significantly reduced the rate of chronicity and was well tolerated by patients.

[Met-enkephalin in the cerebrospinal fluid as an indicator of central nervous system injury in meningitis and encephalitis]. / Met-enkefalina plynu mózgowo-rdzeniowego jako wskaznik uszkodzenia osrodkowego ukladu nerwowego w zapaleniu opon mózgowo-rdzeniowych i mózgu.

THE AIM: Assessment of met-enkephalin level in the cerebrospinal fluid (CSF) of patients with inflammatory process of the central nervous system (CNS) was performed to estimate the role of opioid system in viral and bacterial meningitis, and encephalitis. MATERIAL AND METHOD: The met-enkephalin level, protein concentration and pleocytosis were analysed in the CSF of 53 patients with viral or bacterial meningitis, encephalitis, and in the control group of patients without inflammatory disease of the CNS. RESULTS: The biggest differences have been observed between the groups of patients with bacterial meningitis and those without inflammatory disease of the CNS, but they were statistically insignificant. There was a lack of correlation between met-enkephalin level and some factors of inflammatory process in CSF, such as pleocytosis and protein concentration. We have not revealed any correlation between etiological agent of CNS infection and opioid system of the brain. CONCLUSION: Despite the fact that, we observed in the study statistically insignificant changes, we suggest to continue investigations, including additional parameters which are characteristic for the CNS diseases.

[Studies on relationship between immunodeficiency in HIV-infected people and condition of upper gastrointestinal tract mucosa, prevalence of mycosis and Helicobacter pylori infection]. / Badania nad zaleznoscia uposledzenia odpornosci u osób zakazonych HIV a stanem blony sluzowej górnego odcinka przewodu pokarmowego, wystepowaniem grzybicy i infekcji Helicobacter pylori.

HIV infection leads to progressive deterioration of immunity. Upper gastrointestinal symptoms are often reported in patients with this infection. The aim of the study was to evaluate morphological changes in upper gastrointestinal tract mucosa and prevalence of opportunistic infections and Helicobacter pylori in HIV-infected people in relationship to the degree of immunosupression. We studied 94 HIV-infected patients with dyspeptic symptoms, 47 suffered from severe immunodeficiency expressed by low CD4+ lymphocyte count below 200/ mm3. Control group consisted of 52 non HIV-infected patients. During endoscopy, gastrointestinal tract mucosa was evaluated and biopsy samples were taken from gastric body and antrum for histopathological analysis and rapid urease test. In patients with CD4+ lymphocyte count below 200/mm3, endoscopic examination revealed significantly more frequent esophageal candidiasis (36%); whereas reflux esophagitis (13%) was significantly less often diagnosed in comparison to the rest of the patients. Duodenitis and duodenal erosions were also less frequent in them. Prevalence of Helicobacter pylori infection in gastric antrum was significantly lower in HIV-infected patients with severe immunodeficiency (40%) in comparison to the rest of the patients (72%) and control group (69%). Chronic active gastritis of the antral mucosa was less frequent in HIV-infected patients with CD4+ lymphocyte count below 200/mm3.

[Pegylated interferon-alfa 2a with ribavirin in chronic viral hepatitis C (final report)]. / Pegylowany interferon alpha-2a z rybawiryna w leczeniu przewleklego wirusowego zapalenia watroby typu C (raport koncowy z badan).

UNLABELLED: We evaluated the efficacy and safety of peginterferon alfa-2a [40KD] (Peg-IFNalpha-2a) plus ribavirin in patients with chronic hepatitis C in an open-label programme in a routine clinical setting in Poland. Patients received Peg-IFNalpha-2a 180mg/week plus ribavirin 800-1200 mg/d for 48 weeks. Sustained virological response (SVR) was defined as undetectable HCV RNA (<50IU/mL) at the end of follow-up (week 72). 466 adults were enrolled. Most patients (87.3%) had genotype 1 infection. 440 subjects (94,4%) completed treatment. The overall SVR rate was 55.7%. A higher SVR rate was obtained in treatment-naïve patients (58.7%) than in relapsers (47.8%; p=0,048). SVR rates in genotype 1 and non-1 patients were 51.1% and 88.5%, respectively (p<0.001). There were significant higher SVR rates in patients with lower baseline fibrosis (p=0,01). There were no differences in SVRs by gender or viral load. Hemoglobin, leukocyte and neutrophil levels decreased significantly during treatment, but returned to baseline after the end of treatment. ALT levels decreased significantly during treatment in patients with and without an SVR. 38.4% of patients experienced adverse events like neutropenia, anemia, thrombocytopenia, and other. There was one death (severe thrombocytopenia). CONCLUSIONS: The overall SVR achieved in this predominantly genotype 1 population was 55.7%. SVR rates were significantly higher in treatment-naïve patients, those with non-1 genotypes, and in patients with lower baseline fibrosis scores.