Hemorrhagic fever with renal syndrome (HFRS) in Poland

Hemorrhagic fever with renal syndrome (HFRS) is an acute viral zoonosis occurring due to the hantavirus infection. On the territory it constitutes the only case of viral hemorrhagic fever. The infections occurring in Poland are mainly caused by the Puumala and Dobrava serotypes. The pathogenetic influence of other Hanta serotypes such as Boginia, Nova and Seewis on humans is still unknown. The endemic territory of the occurrence of the hantavirus infections in Poland is the Podkarpacie region. The morbidity is not high and ranges between 0.02 and 0.14 in every 100 000 but professional literature suggests that the data concerning the territory of Poland is underestimated. So far hantavirus infections have not been reported in other areas of Poland yet the presence of the virus may be excluded. In view of literature and the significant occurrence of Hanta antibodies in patients included in the risk group, it may be claimed that the diseases caused by Hanta virus constitute a significant factor influencing the medical status of the group in focus all over the country.

Biomechanical Analysis of Stability of Posterior Antiglide Plating in Osteoporotic Pronation Abduction Ankle Fracture Model With Posterior Tibial Fragment.

BACKGROUND: We performed a biomechanical comparison of 2 methods for operative stabilization of pronation-abduction stage III ankle fractures; group 1: Anterior-posterior lag screws fixing the posterior tibial fragment and lateral fibula plating (LSLFP) versus group 2: locked plate fixation of the posterior tibial fragment and posterior antiglide plate fixation of the fibula (LPFP). METHODS: Seven pairs of fresh-frozen osteoligamentous lower leg specimens (2 male, and 5 female donors) were used for the biomechanical testing. Bone mineral density (BMD) of each specimen was assessed by means of dual-energy x-ray absorptiometry. After open transection of the deltoid ligament, an osteotomy model of pronation abduction stage III ankle fracture was created. Specimens were systematically assigned to LSLFP (group 1, left ankles) or LPPFP (group 2, right ankles). After surgery, all specimens were evaluated via CT to verify reduction and fixation. Axial load was then applied onto each specimen using a servohydraulic testing machine starting from 0 N (Zwick/Roell, Ulm, Germany) at a speed of 10 N/s with the foot fixed in a 10 degrees pronation and 15 degrees dorsiflexion position. Construct stiffness, yield, and ultimate strength were measured and dislocation patterns were documented with a high-speed camera. The normal distribution of all data was analyzed using Shapiro-Wilk test. The group comparison was performed using paired Student t test. Statistical significance was assumed at a P value of .05. RESULTS: All specimens had BMD values consistent with osteoporosis. BMD values did not differ between the left and right ankles of the same pair ( P = .762). The mean BMD values between feet of men (0.603 g/cm2) and women (0.329 g/cm2) were statistically different ( P = .005). The ultimate strength for LSLFP (group 1) with 1139 ± 669 N and LPPFP (group 2) with 2008 ± 943 N was statistically different ( P = .036) as well as the yield in LSLFP (group 1) 812 ± 452 N and LPPFD (group 2) 1292 ± 625 N ( P = .016). Construct stiffness trended to be higher in group 2 (179 ± 100 kNn) compared to group 1 (127 ± 73 kN/m) but this difference was not statistically significant ( P = .120). BMD correlated with bone-construct failure. CONCLUSION: Fixation of the posterior tibial edge with a posterolateral locking plate resulted in higher biomechanical stability than anterior-posterior lag screw fixation in an osteoporotic pronation-abduction fracture model. CLINICAL RELEVANCE: The clinical implication of this biomechanical study is that the posterior antiglide plating might be advantageous in patients with osteoporotic pronation abduction stage III ankle fracture.

New cases of suspected HFRS (Hantavirus infection) in south-eastern Poland.

INTRODUCTION: HFRS--hemorrhagic fever with renal syndrome, found in Europe, is an acute viral zoonosis due to the hantavirus infection. The disease is characterized by the triad of symptoms: sudden, febrile onset, acute renal failure and haemorrhagic diathesis. The range of hantavirus infections in humans has not been yet established on the territory of Poland. The medical literature described 18 cases of seropositive HFRS in Poland--mainly in the district of Sanok, and single cases in the districts of: Brzozów, Debica, Krosno, Lesko, Przemysl and Stalowa Wola. AIM: The aim of the study was to verify the hypothesis, assuming that patients hospitalized in the Department of Nephrology, located in the Regional Hospital in Przemysl were infected with hantavirus and had HFRS. MATERIAL AND METHODS: Due to the fact that patients selected for the study were not tested serologically, verification was based on statistical comparison of the retrospectively selected group of patients suspected of HFRS with the seropositive group described in the study of Nowakowska, Heyman, Knap et al. in 2009, in terms of individual symptoms prevalence in conjunction with the structure of selected clinical and epidemiological parameters. RESULTS: 26 individuals with renal failure and influenza-like episode of several-day fever of unknown origin were indentified on the base of the retrospectively analyzed records of the patients hospitalized in the Department of Nephrology in Przemysl between 2001-2011. The significant differences in age, frequency of selected laboratory parameters (platelet count, serum electrolytes) and oliguria were not found in both compared groups. However, the study group included the higher percentage of men. Additionally, the differences in prevalence of symptoms (cough, diarrhea), which are not considered specific for HFRS were detected. Analogously to the reference group, seasonal morbidity was observed also in the study group, but the peak intensity was delayed for 4 weeks. CONCLUSIONS: The hypothesis cannot be rejected that, the group analyzed in the prestent study, hospitalized in the Department of Nephrology in the Regional Hospital in Przemysl--is the sample of patients with HFRS (similarly to the group described by Nowakowska et al.). The cases described in this study can be considered as suspected of HFRS. It is justifiable to perform serological testing in these individuals.