Telemedicine consultations in obstetrics and gynecology - a population based study in Polishspeaking women.

OBJECTIVES: Telemedicine is no longer in the realm of the future. It has already become an aspect of modern medicine. A number of countries across the world have successfully introduced telemedicine systems, which allows patients access to general healthcare and specialist consultations regardless of the distance separating patients from physicians. We aimed to evaluate the use of a telemedicine system by Polish-speaking women for the purpose of gynecological and obstetric consultations. MATERIAL AND METHODS: Our study used a telemedicine system operated by a healthcare entity offering healthcare services. We prospectively obtained data from Polish-speaking patients (residing all over the world) who underwent teleconsultations in gynecology or obstetrics in the period between Dec. 1, 2016, and Mar. 31, 2018. RESULTS: A total of 244 telemedicine consultations in 185 female patients were evaluated. These consultations were overwhelmingly for gynecological cases (76%). Obstetric consultations, which constituted only 24% of the total number of consultations, involved predominantly pathologies of pregnancy. The mean age of patients who used the telemedicine system was 27 years. Ten percent of the study subjects resided in a country other than Poland at the time of their consultation. Only one patient required an urgent referral for an in-person consultation at an emergency department. CONCLUSIONS: Telemedicine consultations not only offer an easier access to the relatively difficult to obtain consultations with a specialist in the field of gynecology and obstetrics but may also be an alternative to conventional doctors' appointments, chiefly for those women who currently reside abroad or for those who seek an immediate gynecological consultation.

[Polymorphism of helicobacter pylori and the presence of genes babA2 and sabA and endoscopic and histopathological changes in patients infected with Heicobacter pylori]. / Polimorfizm Helicobacter pylori i obecnoss genów babA2 i sabA a obraz endoskopowy i histopatologiczny u chorych zakazonych Helicobacter pylori.

UNLABELLED: The infection of Helicobacter pylori is the main reason of a duodenal and gastric ulcer disease. Among other virulence factors of Helicobacter pylori, there are outer membrane proteins (OMPs), such as babA2 and sabA. THE AIM OF THE STUDY: An assessment of a relationship between the presence of genes babA2 and sabA and endoscopic and histopathologic changes during gastritis, duodenitis and an ulcer disease. MATERIAL AND METHODS: We included 119 patients aged from 3 to 17 (average 13.6) with gastritis and duodenitis and the infection of Helicobacter pylori. The endoscopy was conducted with taking samples of the mucosa for the histopathologic and genetic examination. The degree of endoscopic and histopatologic changes were determined according to Sydney's classification. The patients were devided in the extra groups with a small level (without erosion) and with a large level (with erosion) of endoscopic changes. To identify the infection of Helicobacter pylori, the PCR technique was used and then the presence of the babA2 and sabA genes of Helicobacter pylori was verified. The genetic confirmation of Helicobacter pylori infection was obtained in 88 patients and material was directed to the further examination. RESULTS: Not statistically significant differences were determined between endoscopic and histopathologic pictures and either the presence or absence of the genes babA2 and sabA. CONCLUSION: The presence of the genes babA2 and sabA is not related with level of endoscopic and histopathologic changes in pediatrics patients.

[The prevalence of dupA (duodenal ulcer-promoting gene) of Helicobacter pylori in children and adolescents--own observation]. / Czestosc wystepowania genu dupA (duodenal ulcer-promoting gene) Helicobacter pylori u dzieci i mlodziezy--obserwacje wlasne.

UNLABELLED: The strains of Helicobacter pylori are described by many common features which determine their virulence. The genes which are connected with much higher virulence of some strains are vacA, cagA, oipA, dupA. Duodenal Ulcer Promoting Gene--dupA is the new virulence factor coexisting with a duodenum ulcer. There is a rationale that shows a protective character of dupA with reference to a stomach cancer. The dupA gene probably causes increasingly higher releasing of pro-infectious IL-8 via stomach cells and it influences the production of IL-12 and other cytokines. The aim of the study was to determine the frequency of dupA gene's appearance in the Polish children's group and in the Polish teenagers' group infected with H. pylori. The research was also aimed to determine the coexistence of dupA gene and duodenum ulcer disease or erosion infection of duodenum's mucous membrane. MATERIAL AND METHODS: The endoscopic examination of the upper part of digestive duct was performed in 119 qualified patients with dyspeptic symptoms and with suspicion of stomach and duodenum's mucous membrane infection. The segments were taken for histopathological identification of H. pylori and for genetic indicating via PCR method. To confirm the presence of H. pylori in the extract the amplification of DNA fragment sized 860 pz was used. The presence of dupA gene was detected by PCR reaction with using the starters which include the fragment of jhp0917-jhp0918 sequence in the plastic H. pylori's genome area. To confirm the infection the urea breathing test was taken. RESULTS: 88 patients confirm the infection of H. pylori. The presence of dupA gene was found in 20 patients--a group A (22.7%), whereas in 68 patients dupA gene was not found--a group B (77.2%). Pathological changes in duodenum was found in 20 patients infected with H. pylori (22.7%), included 4 patients in the group A (20%) and 16 in the group B (23.5%). There was an infection (swelling, redness, congestion) in duodenum was found in the group A in all cases and there was an erosion presented in 3 patients. In the group B in 2 patients the duodenum ulcer disease was diagnosed. The infectious changes in duodenum were found in 7 patients but they were not infected with H. pylori; 1 patient was diagnosed with the duodenum ulcer disease. CONCLUSION: The presence of dupA gene in the Polish children population infected with H. pylori is quite frequent but there is no clinical correlation with the duodenum ulcer disease.

[Can obstructive bronchitis be a risk factor of bronchial asthma in infants and small children?]. / Czy obturacyjne zapalenie oskrzeli u niemowlat i malych dzieci moze byc czynnikiem ryzyka astmy oskrzelowej?

One of more frequent reasons for hospitalizations concerning infants and small children are obstructive bronchitis. Great prevalence of bronchial tree obturation during infancy and in small children is a result of anatomical and functional differences of airways and immunological differences that occur in infants and small children. The most frequent cause of bronchial tree obturation is infection induced by viruses, rarely by bacteria. Recurrences of bronchial tree obturation are observed in some patients. Obturation recurrences can be caused by number of diseases that appear during infancy and in small children, for example cystic fibrosis of the pancreas. Also the presence of foreign body in the airways, immotile cilia syndrome, immunological disturbances, innate anomalies of the respiratory system and the circulatory system and bronchial asthma can result in obturation recurrences. Various clinical criteria are established and new markers of allergic inflammation are searched in view of difficulties to diagnose bronchial asthma in the youngest children. There are no unequivocal rules to diagnose bronchial asthma in infants and small children despite these searches.

[Analysis of L, E, and P selectins concentration in infants and young children with spastic bronchitis]. / Analiza stezenia selektyny L, E i P u niemowlat i malych dzieci chorych na obturacyjne zapalenie oskrzeli.

UNLABELLED: Spastic bronchitis in infants and young children is one of the most frequent causes of hospitalization in this age group. Both infectious and allergic inflammations lead to inflammation cells activation and their flow to the place of inflammation by the activation of adhesive molecules. One of groups of adhesive molecules are L, E and P selectins responsible for leucocytes migration through the vessel wall. The aim of the study was to assess the concentration of solved fractions of L, P and E selectins in infants and young children in the course of spastic bronchitis. MATERIAL AND METHODS: Fifty four patients with spastic bronchitis (group I) including 32 with the first bronchitis (group IA) and 22 patients with recurrent bronchitis (at last the third one--group IB) were included into the study. Comparative group (group II) was consisted of 26 patients hospitalized due to other causes and with no bronchitis in the past. Patients were from 1 to 36 months of age. Among all patients solved fractions of selectins L, E and P were analyzed by ELISA tests. RESULTS: Mean sL-selectin concentration in group I was 4126.3 ng/ml and in group II 4222.31 ng/ml and was not statistically significant. Concentrations of sL-selectin in the group of patients with the first episode of spastic bronchitis was 4099.37 ng/ml and in the group of patients with recurrent bronchitis was 4166 ng/ml and had no statistical difference. Mean sE-selectin concentration in group I was 205.49 ng/ml and in group II 214.50 ng/ml and was not statistically significant. Concentrations of sE-selectin in the group of patients with the first episode of spastic bronchitis was 195.22 ng/ml and in the group of patients with recurrent bronchitis was 220.43 ng/ml and had no statistical difference. Concentration of sP-selectin was assessed among 51 patients with bronchitis and among 26 patients from comparative group. Because of the lack of normal distribution values of sP-selectin concentrations were changed by decimal logarithm. Mean sP-selectin concentration in group I was 235.95 ng/ml and in group II 164.70 ng/ml. After logarithm change values of concentrations were: 2.249 and 2.005 and had statistical difference (p = 0.0221). Concentrations of sP-selectin in the group of patients with the first episode of spastic bronchitis was 234.0 ng/ml and in the group of patients with recurrent bronchitis was 238.20 ng/ml and after logarithm change concentrations were 2.26 in the group of patients with the first episode of spastic bronchitis and 2.24 in the group of patients with recurrent bronchitis and had no statistical difference. CONCLUSION: On the ground of our study in infants and young children with spastic bronchitis increase of sP-selectin concentration was observed and sE-selectin and sL-selectin concentrations were the same.

[Analysis of eosinophilic cationic protein levels in infants and children with wheezy bronchitis]. / Analiza wartosci stezenia eozynofilowego bialka kationowego u niemowlat i malych dzieci z obturacyjnymi zapaleniami oskrzeli.

UNLABELLED: Wheezy bronchitis can be the first sign of bronchial asthma thus wheezy bronchitis is under special supervision and its etiologic factors are especially analyzed among infants and young children. Due to diagnostic difficulties in this age group allergic inflammation markers are taken into consideration in aspect of recurrent bronchitis prevention. Such marker is eosinophillic cationic protein (ECP). ECP is released from eosinophilles during the late phase of allergic reaction. The aim of the study was to assess ECP concentrations among infants and young children with wheezy bronchitis. MATERIAL AND METHODS: Ninety-four patients with wheezy bronchitis between 1 month and 36 months old were included into the study (47 with the first episode and 47 with at least third episode). Forty-three patients hospitalized due to other causes, from the same age group (these patients haven't already had any wheezy bronchitis) were included into the control group. Among all patients concentrations of ECP were evaluated (among patients from the study group in the acute phase of the disease) by fluoroimmunoenzymatic method (FEIA) with the use of UniCAP 100 set (Pharmacia & Upjohn Diagnostics AB). RESULTS: Statistically significant differences of ECP concentrations in blood plasma during wheezy bronchitis among infants and young children in correlation to the control group and higher concentrations were observed among patients with wheezy bronchitis. No statistically significant differences were observed in aspect of ECP concentrations between patients with the first episode and patients with recurrent wheezing. No influence of family history of allergy nor symptoms of allergy were observed whereas higher concentrations of ECP were observed among patients with higher level of CRP CONCLUSION: ECP isn't a good marker of prediction of reccurrent wheezing

[Eosinophil cationic protein as a marker of eosinophil activity]. / Eozynofilowe bialko kationowe jako marker aktywacji eozynofilów.

Eosinophil cationic protein (ECP) is one of the markers released by eosinophils. It suggests that ECP can be a good laboratory measurement for late allergic phase assessment. ECP can be measured in serum, BAL, sputum or nasal lavage. There are many studies that document the use of ECP in such diseases like: bronchial asthma, pollinosis or food allergy, but their results are not uniform.

[Analysis of tryptase levels in infants and children with wheezy bronchitis]. / Analiza stezenia tryptazy u niemowlat i malych dzieci chorych na obturacyjne zapalenie oskrzeli.

UNLABELLED: Wheezy bronchitis is one of hospitalization causes of infants and young children. Significant problem is recurrent wheezing. Wheezy bronchitis can be the first sign of bronchial asthma. New markers are taken into consideration in aspect of recurrent bronchitis prevention. Such marker seems to be tryptase. Tryptase is released from mastocytes in early phase of allergic reaction. The aim of the study was to assess tryptase and ECP concentrations among infants and young children with wheezy bronchitis. MATERIAL AND METHODS: Ninety-four patients with wheezy bronchitis in age from between 1 month to 36 months old were included into the study (47 with the first episode and 47 with at least third episode). Forty-three patients hospitalized due to other causes, from the same age group (these patients haven't already had any wheezy bronchitis) were included into the control group. Among all patients concentrations of tryptase and ECP were evaluated (among patients from the study group in the acute phase of disease) by fluoroimmunoenzymatic method (FEIA) with the the use of UniCAP 100 set (Pharmacia & Upjohn Diagnostics AB). RESULTS: No statistically significant differences of tryptase concentrations in blood plasma during wheezy bronchitis among infants and young children in correlation to the control group were found. Statistically significant differences were identified in aspect of tryptase concentrations during wheezy bronchitis between patients with the first episode of wheezing and patients with recurrent wheezing and higher concentrations were observed among patients with the first episode. No statistically significant influence of family history of allergy and symptoms of allergy were identified in aspect of tryptase concentrations. CONCLUSIONS: Obtained results lead to conclusion that tryptase concentrations have a little significance in wheezy bronchitis.

[The analysis of lipidogram parameters and the parameters of coagulation and fibrynolysis systems as risk factors in overweight and obese children and adolescents]. / Analiza parametrów lipidogramu oraz ukladu krzepniecia i fibrynolizy jako czynników ryzyka miazdzycy u dzieci i mlodziezy z nadwaga i otyloscia.

UNLABELLED: Since artherosclerosis processes were proved to have their origins as early as in one's childhood, attempts have been made to find the risk factors in the population of the developmental age. AIM: The aim of this work was the analysis of lipidogram parameters and the parameters of coagulation and fibrynolysis systems in overweight and obese children and adolescents. MATERIAL AND METHODS: 101 children and adolescents aged 4-19 were examined, including 30 overweight and 34 obese ones, with the control group comprising 37 patients with normal body weight. RESULTS: No significant differences in the studied groups were noticed in the total cholesterol level, LDL, fibrinogen and in alpha2-antiplasmin activity. The HDL cholesterol level was actually lower in the group with obese patients, while the PAI-1 level was actually higher. CONCLUSIONS: Overweight and obese children and adolescents comprise a group threatened by premature development of atherosclerosis and need to be monitored for risk factors.

[Prevalence of soya allergy in children with cow's milk allergy]. / Czestosc wystepowania uczulenia na bialka soi u dzieci z alergia na bialka mleka krowiego.

UNLABELLED: Because of contradictory data about the prevalence of soya allergy in children recommendations for the use of the protein-based formulas are ambiguous. THE AIM of the study was to estimate the prevalence of soya allergy in children with IgE-associated cow's milk allergy. MATERIAL: Ninety seven patients aged from six months to four years with personal history suggestive of food allergy with specific IgE to cow's milk protein attending the Department of Pediatrics, Allergology and Gastroenterology between 2000-2002 were studied. In all patients specific IgE to soya protein were detected. RESULTS: In 45% children with IgE-associated cow's milk allergy specific IgE to soya protein were detected. Clinical manifestation in both groups of children with or without specific IgE to soya protein was similar. Gastrointestinal tract symptoms were observed more often in children with cow's milk and soya allergy than in children with cow's milk allergy (52 and 42% respectively) and atopic dermatitis was observed more often in children with cow's milk allergy than in children with cow's milk and soya allergy (81 and 74% respectively). The incidence of respiratory tract symptoms in both groups of children was similar. The differences were not statistically significant. CONCLUSION: It seems, that hydrolyzed formulas should be the preferred choice for children because of a high prevalence of soya protein allergy in children with IgE- associated cow's milk allergy.