Antimicrobial Resistance of Enterobacteriaceae in Bloodstream Infections in Hospitalized Patients in Southern Poland.

Aim: The aim of this study was to highlight antimicrobial resistance among Enterobacteriaceae isolated from bloodstream infections in hospitals in southern Poland. Materials and Methods: The present study includes laboratory-confirmed secondary bloodstream infections (LC-BSIs), in the years 2015-2018, in hospitalized adult patients (≥18). Episodes of BSIs were defined according to the strictly described guidelines. Antimicrobial susceptibility testing was performed with the automated system and the disc diffusion method. Extended-spectrum ß-lactamases (ESBLs)-producing Enterobacteriaceae were detected using the double-disc synergy test. Results: Between 2015 and 2018, 356 episodes of secondary BSIs in 997 patients aged 21-96 years were documented in a prospective study, including 134 (37.6%) ESBL-producing Enterobacteriaceae. Escherichia coli was the predominant pathogen in internal medicine (37.6%) and surgery units (46.8%); in intensive care units (ICUs), Klebsiella pneumoniae was isolated more frequently (33.3%). Enterobacteriaceae were highly resistant to most antimicrobial agents. K. pneumoniae isolates had a higher level of resistance than E. coli, regardless of the unit. Conclusions: The increase in AMR and the widespread distribution of ESBL-producing Enterobacteriaceae in Polish hospitals can be related to the lack of or inappropriate antibiotic treatment.

Serum concentration of interleukin 6 is related to inflammation and dyslipidemia in patients with psoriasis.

INTRODUCTION: Patients with psoriasis and psoriatic arthritis (PsA) have metabolic disturbances, which may be due to chronic inflammation. AIM: Because interleukin-6 (IL-6) regulates both metabolic and inflammatory processes, we evaluated IL-6 as a potential marker of inflammation and metabolic disturbances in psoriasis. MATERIAL AND METHODS: This study involved 93 patients with psoriasis, including 31 patients with concurrent PsA. We investigated whether serum markers of lipid metabolism and inflammation, including IL-6, were related to each other and to disease activity. RESULTS: We found that concurrent PsA was associated with higher serum concentrations of total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and IL-6. In patients with psoriasis alone, the IL-6 serum concentration correlated positively with the concentrations of TC and LDL-c and with erythrocyte sedimentation rates (ESRs). Moreover, IL-6 concentrations tended to correlate positively with the percentage of the body area affected by psoriatic lesions. Among all patients, those with normal blood lipids had lower ESRs and IL-6 concentrations than patients with abnormal blood lipids. A logistic regression model showed that PsA, Psoriasis Area Severity Index (PASI), and ESR were significant predictors of the serum IL-6 concentration. CONCLUSIONS: Interleukin-6 may be an indicator of inflammatory activity in psoriasis. Moreover, IL-6 may be related to lipid abnormalities in patients with this disease.

Serum lipid metabolism in psoriasis and psoriatic arthritis - an update.

INTRODUCTION: Psoriasis and psoriatic arthritis (PSA) are chronic, inflammatory, systemic diseases characterized by metabolic abnormalities, including an increased cardiovascular risk and an oxidative imbalance. This study assessed blood parameters of lipid metabolism and markers of oxidative stress in patients with psoriasis and PSA. MATERIAL AND METHODS: The study included 93 patients with psoriasis (31 patients with PSA and psoriasis, 62 patients with psoriasis vulgaris), and 60 healthy, age-matched controls. Serum concentrations of the glucose and the following lipid metabolism parameters were measured: triglycerides (TG), total cholesterol (TC), low-density lipoproteins (LDL), very low-density lipoproteins (VLDL), high-density lipoproteins (HDL), and apolipoproteins A and B (ApoA, ApoB). Oxidative status was determined as serum concentrations of ox-LDL/MDA Adduct. The Psoriasis Area and Severity Index (PASI) was used to determine disease severity. RESULTS: Among the three studied groups, controls had the highest HDL concentration (p < 0.001), patients with PSA had the highest ApoB concentration (p < 0.05), ApoA : ApoB ratio (p < 0.05), ox-LDL/MDA adduct concentration (p < 0.001), and TC: HDL and LDL : HDL ratios (accordingly p < 0.05, p < 0.01). In patients with psoriasis or PSA, oxidative status correlated positively with TC and ApoB concentrations. CONCLUSIONS: In line with previous research, among patients with psoriasis and PSA, we found lipid metabolism abnormalities and an oxidative imbalance, which might be due to chronic inflammation in these conditions. Effective treatment of patients with psoriasis or PSA could reduce the risk of cardiovascular diseases.

Clavicle fracture associated with atlantoaxial rotatory displacement, type II in an 8-year-old girl: A case report.

RATIONALE: Fracture of the clavicle is a very common injury in children. However, association between clavicle fracture and atlantoaxial rotatory displacement is rarely observed. PATIENT CONCERNS: We present a case of an 8-year-old girl, who suffered a right clavicle fracture as a result of a sledge accident. Six weeks after figure of 8 casting for a right clavicle fracture, an 8-year-old girl was brought to the Pediatric Orthopedic Department due to torticollis. DIAGNOSES: Standard X-ray examination revealed nonunion of the clavicle without any clinical symptoms. Computed tomography (CT) examination was performed and subluxation of cervical vertebrae 1/cervical vertebrae 2 was detected. INTERVENTIONS: The use of Glisson's traction followed by a soft cervical collar resulted in the resolution of all the symptoms. Control CT and magnetic resonance imaging confirmed reduction. OUTCOMES: The patient fully recovered and currently is fully active. The neurological status of the child before and after procedure remained normal. LESSONS: Clavicle fracture rarely may be associated with atlantoaxial rotatory displacement. Therefore, careful examination including rotation of the neck is necessary to confirm that associations. Moreover, three-dimensional CT scan enables proper spine examination and provides correct diagnosis. As shown in available literature and as well in presented case report, none operative treatment is usually effective.

Novel Mutation of the RUNX2 Gene in Patients with Cleidocranial Dysplasia.

Cleidocranial dysplasia (CCD) is an autosomal dominant disorder linked to mutations in the Runt-related transcription factor 2, encoded by the RUNX2 gene, which is essential for osteoblast differentiation and skeletal development. Here, we describe a novel nonsense mutation (c.532C>T; p.Q178X) in RUNX2 identified in 3 affected members of a Polish family with CCD. The localization and transcriptional transactivation studies show that the mutated form of the protein has altered the subcellular localization and significantly decreased transactivation properties, respectively. Consequently, our data show that the c.532C>T mutation generates a defective RUNX2 protein and is genetically linked to the CCD phenotype.

Bilateral congenital torticollis: a case report with 25 years of follow-up.

Unilateral congenital sternocleidomastoid muscle (SCM) contracture causing torticollis is well known. Although the unilateral muscular torticollis is quite often recognized, a bilateral contracture of SCM muscle is very rare. A review of the literature showed only three cases of bilateral congenital torticollis reported over the last two decades. We present a case report of a boy with congenital bilateral torticollis with 25 years of follow-up. Bilateral tenotomies of the right SCM were performed and the child was immobilized in Schanz's cervical orthosis. Three months after operative procedure, the physical examination indicated an increasing contracture of the left SCM with time. A similar operative procedure was applied to the left SCM. The follow-up examinations showed good wound healing and a positive outcome. Bilateral congenital muscular torticollis is a very rare form of muscle skeletal disorder. We describe a surgical treatment of such deformation that ended with a satisfactory result confirmed through a 25-year follow-up.

Shape of growth plate of proximal femur in children and its significance in the aetiology of slipped capital femoral epiphysis.

PURPOSE: The main objective of the study was to present the influence of the morphological shape of the proximal femoral growth plate in children as one of the risk factors for the incidence of slipped capital femoral epiphysis (SCFE) in adolescents. METHODS: This research is based on the X-ray, computed tomography (CT) and magnetic resonance imaging (MRI) data obtained for 100 children three to 13 years old, all treated at the Children's Orthopaedic Clinic and Rehabilitation Department and Department of Radiology Medical University of Lublin between 2005 and 2009. We took into account 83 children with healthy hip joints and 17 children with SCFE. We also performed morphological analysis of the shape of the proximal femoral growth plate together with X-ray, CT and MRI examinations of the proximal ends of cadaver femurs for two children aged six and 13. RESULTS: In the final findings we present an analysis of the shape of the proximal femoral growth plate in children between the third and 13th years of life and consider a correlation between the shape of the proximal femoral growth plate and its influence on the incidence of SCFE in adolescents. CONCLUSIONS: The change of shape of the proximal femoral growth plate from pleated to more spherical is one of the risk factors for the incidence of SCFE in children ten years old and older.

IFAP syndrome with severe cutaneous, neurologic and skeletal manifestations due to a novel MBTPS2 mutation in a Polish patient.

BACKGROUND: Ichthyosis Follicularis, Atrichia and Photophobia (IFAP) syndrome is a rare genodermatosis due to mutations of the MBTPS2 gene. To date fewer than 40 cases have been described in the literature. OBJECTIVES: To present the first case of IFAP diagnosed in Poland due to a novel mutation of MBTPS2, and to review the relevant literature on this rare genodermatosis. MATERIALS & METHODS: A 16-year-old male presented with typical clinical features of IFAP, along with psoriasiform skin plaques, nail dystrophy, facial dysmorphy, mental retardation, severe skeletal abnormalities and chorea-like movements. DNA analysis was performed in the patient and his clinically unaffected mother, maternal grandmother and sisters. RESULTS: A novel missense mutation p.Cys334Tyr (c.1001G>A) was found in exon 8 of the MBTPS2 gene. This mutation was also found in his clinically unaffected mother and maternal grandmother, but not his healthy sisters. CONCLUSIONS: This patient with IFAP, the first described from Poland, is original by virtue of its extensive skeletal, cutaneous and neurologic manifestations and the novel missense mutation of the MBPTS2 gene. The identification of a novel mutation further expands the known MBPTS2 molecular repertoire and the spectrum of associated clinical findings.

Florid-reactive periostitis of the phalanges: a 2-case report.

Florid-reactive periostitis, also known as fibroosseous pseudotumor, is a benign bone lesion. It occurs rarely among pediatric patients. Usually, it affects the phalanges of the hands and feet, where most lesions concern the proximal phalanx. Girls are more commonly affected than boys. The lesion appears benign radiographically but on histologic examination could be mistaken for a variety of malignant lesions, especially osteosarcoma. Therefore, histologic evaluation is a must for distinguishing this benign lesion from malignant and infectious etiologies. We present 2 patients with florid periactive periostitis of the phalanges who were treated in our clinic. After physical and microscopy examination of the soft and bone tissues, we found no evidence of malignant process. Because of a definitive diagnosis and the benign nature of the histologic findings, a conservative treatment, that is, no surgical intervention, with a close supervision of our patients was used. During follow-up observations in both patients, we did not notice any limitations of finger movements or an enlargement of the tumor. These findings confirmed that for cases with no aggressive growth, a conservative treatment may be effective and beneficial for a patient.

In-vitro mechanical impacts on calves' proximal femurs: significance of mechanical weakening of the femoral head in the etiology of Perthes disease in children.

Experimental research was conducted to determine the effects of mechanical forces on the hip joint in the etiology of Perthes disease in children. The authors aimed to identify areas of lower resistance to mechanical forces in a growing femoral head. Calves' femurs, used as experimental models, were repeatedly subjected to mechanical impacts. The results showed that the areas most susceptible to trauma were the layers of immature bone located underneath the epiphyseal growth zone and underneath the growth plate. The authors conclude that blood vessels in these areas are highly vulnerable to mechanical damage, and the resulting impairment of blood flow to the femoral head leads to the development of Perthes disease in children.

[Congenital disorders of hemostasis in children with Perthes disease]. / Wrodzone zaburzenia ukladu hemostazy u dzieci z choroba Perthesa.

The level of selected parameters of the coagulation system and fibrynolysis (prothrombin time, partial thromboplastin time, fibrinogen level, albumin C system, V Leiden factor and III antithrombin level) in 25 children who had been treated with Perthes disease was evaluated. In three children prolonged prothrombin time occurred; in one child anomalous protein C system was noted. The remaining parameters were normal in all children. The investigation results reveal that congenital disturbances of the haemostasis system were not the cause of Perthes disease in 24 children.

[Femur head necrosis in haemophilia and after prolonged steroid therapy--description of two cases]. / Jalowa martwica glowy kosci udowej w przebiegu hemofilii oraz po leczeniu hormonami kory nadnercza--opis 2 przypadków.

Clinical and radiological course of femoral head necrosis of known aetiology (in a boy, aged 8, with haemophilia and in a girl, aged 13, after prolonged steroid therapy) was compared with the typical course in children with Perthes disease.

Remarks on the etiology and pathogenesis of Perthes' disease: an experiment-based hypothesis.

The literature on Perthes' disease points up the significance of specific anatomical conditions affecting vascularization of the femoral head, as well as immaturity and mechanical weakening of the bone tissue in the etiology and pathogenesis of this disorder in children. An experimental study using calf femurs as models confirmed the author's hypothesis that the areas most susceptible to mechanical stress are found in the immature subchondrial layer of the head and neck of the femoral bone. Further investigation of the results suggested that disturbances in the activity of the two growth zones (the epiphyseal growth cartilage and the growth plate) of the proximal femur contribute significantly to the etiology of Perthes' disease. The temporary abnormalities detected radiologically in the healthy femoral heads in about 30% of patients with unilateral Perthes' disease but without clinical symptoms are probably caused by temporary disturbances in the blood supply to these growth layers. These changes are radiological risk factors potentially leading to Perthes' disease. The author concludes that impaired blood flow within the growth layers additionally weakens the immature bone tissue of the femoral head and neck, which may lead to mechanical damage of the bone tissue itself, as well as to the epiphyseal blood vessels entering bony epiphysis. Gradual mechanical destruction of blood vessels in the area of the immature bone tissue below the epiphyseal growth cartilage can eventually initiate the irreversible onset of Perthes' disease.

Capital femoral epiphysis and growth plate of the asymptomatic hip joint in unilateral Perthes disease.

Radiograms of 173 children with unilateral Perthes disease were reviewed with particular reference to the presence of flattening and irregularity of the 'unaffected' epiphyses. The slope and shape of the growth plate were also evaluated. About 35% of children with Perthes disease showed changes of the unaffected proximal femur in the first radiograms of the hip joints. These consisted of small epiphysis, flattening of the epiphysis, contour irregularities (20%), and changes in the growth plate (15%). The radiographic abnormalities were not accompanied by any clinical symptoms of the asymptomatic hip joint and they receded with age during treatment.

Radiological picture of "unaffected" proximal femoral growth plate in children with unilateral Perthes disease.

Background. A changed radiological picture has Bern observed in the initial x-rays of the unaffected proximal femoral growth plate in children with unilateral Perthes disease. The present study seeks to determine whether a thicker, horizontal growth plate in an etiological factor in Perthes disease.
Material and methods. The research involved 173 children diagnosed with unilateral Perthes diseas, and a control group of 174 children aged 3-10. Alsberg's angle was measured to detect horizontal growth plate, while x-ray images were examined if the growth plate was thickened.
Results. In 15 of the children with unilateral Perthes disease, the unaffected growth plate was horizontal (Alsberg's anle 840-900); in 8 children, the growth plate was thicker and radiolucent, mostly on its lateral side. No clinical symptoms accompanied these changes in the unaffected hip joint in the children we studied. In the control group, horizontal growth plate was noticed in the case of child (Alsberg's angle 840).
Conclusions. Transient radiographic abnormalities of proximal femoral growth plate are risk factors for increased incidence of Perthes disease in children above 3 years of age. The reason for these transient abnormalities of femoral growth plates is probably temporary disturbance of the blood supply and mechanical strain before manifestation of the symptoms of Perthes disease.