Bacterial Pneumonia and Cryptogenic Pleuritis after Probable Monkeypox Virus Infection: A Case Report.

A large number of monkeypox (MPOX) cases have been reported in Europe and North America in 2022, and a new outbreak of this disease was declared. We describe a case of a patient with probable monkeypox during the height of this epidemic in Poland. The patient's symptoms resolved within two weeks, but over the next two months, he developed community-acquired pneumonia requiring hospitalization and, subsequently, non-specific pleuritis. The simultaneous occurrence of such severe infections in a previously healthy young man is not typical and suggests a potential underlying cause. We believe the potential association of these diseases with probable monkeypox virus infection is very likely. Cases of monkeypox pneumonia, both viral and secondary bacterial, have already been reported in the literature. Cases of viral pleuritis in the course of MPOX in animals have also been described; however, to our knowledge, no similar cases have been described in humans to date. Our case indicates that it is important to monitor patients after MPOX in order to respond promptly to potentially life-threatening but, as of yet, not fully understood complications.

Analysis of Deaths among HIV-Infected Patients Hospitalized in 2009-2018 in Main Centre of Infectious Disease in Region of Lower Silesia in Poland, Detailing Lesions in the Central Nervous System.

Background and Objectives: Patients living with HIV (PLWH), especially those diagnosed too late or not receiving treatment with antiretroviral drugs in the stage of advanced immunodeficiency AIDS for various reasons, develop additional opportunistic infections or AIDS-defining diseases that may contribute directly to the death of these patients. Material and Methods: In this work, we focused on disorders of the central nervous system (CNS) by retrospectively analyzing the symptoms, clinical and autopsy diagnoses of patients diagnosed with HIV infection who died in the provincial specialist hospital in the Lower Silesia region in Poland. Results: The autopsy was performed in 27.4% cases. The cause of death was determined to be HIV-related/AIDS-associated in 78% patients. The most common AIDS-defining CNS diseases in our cohort were toxoplasmosis and cryptococcosis. Conslusions: The presented results of the most common causes of changes in the central nervous system among deceased HIV-infected patients are comparable to the results of studies by other scientists cited in the publication.

Liver Injury in Patients with COVID-19 without Underlying Liver Disease.

SARS-CoV-2 shows a high affinity for the ACE-2 receptor, present on the epithelial cells of the upper and lower respiratory tract, within the intestine, kidneys, heart, testes, biliary epithelium, and-where it is particularly challenging-on vascular endothelial cells. Liver involvement is a rare manifestation of COVID-19. MATERIAL AND METHODS: We reviewed 450 patients admitted due to the fact of SARS-CoV-2 infection (COVID-19) including 88 with liver injury. Based on medical history and previous laboratory test results, we excluded cases of underlying liver disease. The analysis involved a clinical course of COVID-19 in patients without underlying liver disease as well as the type and course of liver injury. RESULTS: Signs and symptoms of liver injury were present in 20% of patients, mostly presenting as a mixed-type pattern of injury with less common cases of standalone hepatocellular (parenchymal) or cholestatic injury. The liver injury symptoms resolved at the end of inpatient treatment in 20% of cases. Sixteen patients died with no cases where liver injury would be deemed a cause of death. CONCLUSIONS: (1) Liver injury secondary to COVID-19 was mild, and in in 20%, the signs and symptoms of liver injury resolved by the end of hospitalization. (2) It seems that liver injury in patients with COVID-19 was not associated with a higher risk of mortality. (3) The underlying mechanism of liver injury as well as its sequelae are not fully known. Therefore, caution and further monitoring are advised, especially in patients whose liver function tests have not returned to normal values.

Tocilizumab for patients with severe COVID-19: a retrospective, multi-center study.

BACKGROUND: Tocilizumab, an inhibitor of the interleukin-6 receptor, may decrease the inflammatory response and control the symptoms of severe coronavirus disease 2019 (COVID-19), but the evidence is scarce. METHODS: This retrospective study included patients with severe COVID-19 requiring oxygen therapy who received tocilizumab in seven centers across Poland. We assessed on-treatment changes in clinical status and inflammatory markers. RESULTS: Twenty-eight patients were included (19 male), with a mean age of 61.7 ± 12.4 years. The mean time from symptom onset to the first tocilizumab dose was 10.5 ± 5.7 days. Clinical status improved within 24 hours in 11 (39%) patients, within one week in 23 (82%) patients, and within two weeks in 25 (89%); one (4%) patient showed no change and two (7%) patients died. Sixteen patients (57%) no longer needed oxygen therapy within a week (p < 0.001). The serum concentrations of C-reactive protein, procalcitonin, and fibrinogen decreased significantly (p ≤ 0.001). Lung changes improved in 21 (84%) patients within two weeks of treatment; 19 had minimal or no changes upon final examination. CONCLUSIONS: Tocilizumab can control the symptoms of severe COVID-19 by reducing the inflammatory response and rapidly improves the clinical status in most patients.

Nutrition principles and recommendations in different types of hepatic encephalopathy.

Appropriate nutrition - in terms of both quantity and quality - is not only one of the main life processes. A well-balanced diet including sufficient amounts of minerals and vitamins supports proper human development and functioning from fetal development to very advanced old age; it promotes regeneration after intensive exercise and is a key element for successful treatment of most acute and chronic diseases, including liver diseases.

The influence of anti-HBc status on the sustained virological response rate in HCV-infected patients treated with pegylated interferon alfa 2 and ribavirin.

AIM OF THE STUDY: To determine the influence of HBsAg and HBeAg negative but anti-HBc positive status on the sustained virological response (SVR) rate in HCV-infected patients treated with pegylated interferon alfa 2 (Peg-IFNα-2) and ribavirin (RBV). MATERIAL AND METHODS: The study was based on the retrospective analysis of medical records of HCV-infected patients who started Peg-IFNα and RBV treatment between 1 January 2011 and 31 December 2013 at the 1st and 2nd Department of Infectious Diseases of the Regional Hospital in Wroclaw, Poland. RESULTS: Among 240 patients included in the analysis 99 were anti-HBc positive and 141 anti-HBc negative. In the genotype 1, anti-HBc positive group the SVR rate was 47% and in the anti-HBc negative group it was 42.7% (p = 0.591). In the genotype 3, anti-HBc positive group the SVR rate was 60% and in anti-HBc negative patients it was 63.2% (p = 0.79). Differences in SVR rates between anti-HBc positive and negative groups were not statistically significant. None of the anti-HBc positive patients developed reactivation of HBV infection during or in the 24 weeks following the end of treatment. CONCLUSIONS: Anti-HBc determination does not seem to be useful in predicting treatment outcome of conventional Peg-IFNα/RBV therapy in patients infected with HCV genotypes 1 and 3.

Diagnostic challenges in primary hepatocellular carcinoma: case reports and review of the literature.

Hepatocellular carcinoma is the fifth most common malignancy and the third leading mortality cause worldwide. It typically develops secondarily to liver cirrhosis, due to hepatitis B or C infection, alcohol abuse, metabolic disease, and so forth. According to the American Association for the Study of Liver Diseases (AASLD) guidelines, which constitute diagnostic standards, the diagnosis of primary hepatocellular carcinoma (HCC) should be based on contrast-enhanced imaging. Lesion hyperenhancement should be observed throughout the arterial phase, followed by the washout during the venous phase. The diagnosis can also be based on the histopathological evaluation of liver biopsy specimen. Although the standards are clear, we often see patients with advanced HCC in clinical practice, who cannot be offered any effective treatment. Patients with chronic liver disease, presenting with inconclusive and changeable test results, constitute a separate problem. In such cases the diagnostic process is typically long-term and delayed. In this paper we present three case reports where the diagnosis could not be made promptly and the patients died as a result of a delayed diagnostic process.

Manganese Encephalopathy among Ephedron Abusers.

Ephedrone encephalopathy is referred to as a group of symptoms of manganese deposition within the central nervous system (CNS), resulting from the abuse of ephedrone (methcathinone), obtained in reaction using the excess amount of manganese-containing oxidants. The diagnosis is based on the contrast-enhanced head MRI findings characteristic for this syndrome, clinical manifestation and history of ephedrone use. The syndrome has been reported in recent years in young people from Eastern Europe and Russia with a history of ephedrone overuse. However, no report has ever been published on ephedrone encephalopathy in Polish patients.

Surveillance programmes for early detection of hepatocellular carcinoma.

Primary hepatocellular carcinoma (HCC) is the most commonly diagnosed primary malignancy of the liver. The number of new diagnosed cases of HCC seems to be on a rise worldwide. HCC is typically diagnosed in patients with underlying liver cirrhosis (> 90% cases) regardless of aetiology; over a five-year follow-up period HCC develops in 15-20% of patients with cirrhosis. Patients who are at a high risk of HCC development (i.e. individuals with liver cirrhosis, especially/or chronically infected with HBV or HCV) should undergo regular screening for HCC; the current screening standard comprises liver ultrasonography and determination of α-fetoprotein (AFP) concentration in blood serum at ca. 6 months' intervals (now has been excluded from current diagnostic standards). Only such diagnostic methods are capable of detecting HCC early, and thus make it possible to treat the cancer effectively.

HIV/AIDS and aging.

Average life expectancy in developed countries has rapidly increased in the middle of the 20th century and the geriatric problems have become an increasingly important issue. Many diseases in the elderly are more frequent and more severe in comparison to the younger population. This is certainly true for the infectious diseases which are in the elderly associated with poor outcome, moreover they have often the distinct features with respect to clinical presentation, laboratory and imaging test results, microbial epidemiology, and methods of treatment. The most important reasons why the diseases in the elderly are more frequent and more severe these are: typical for advanced age immunosenescence, malnutrition, large number of age-associated social, psychological, economical, moreover physiological and anatomical alterations. The older HIV positive adults, have lower CD4 counts at moment of diagnosis, faster progression to AIDS, more opportunistic infections, shorter survival rate than younger adults--regardless of when they were first diagnosed with HIV.

[Critical evaluation of reporting on postexposure skin damage incidents and its consequences for Polish health workers]. / Krytyczna ocena rejestracji ekspozycji zawodowych zwiazanych z naruszeniem ciaglosci tkanek oraz wynikajacych z tego konsekwencji--wsród pracowników polskiej sluzby zdrowia.

BACKGROUND: The principles of uniform reports on infections with HBV, HCV, HIV due to occupational exposure have not yet been established in Poland. Usually, reporting on such incidents is governed by internal rules of individual health care institutions. The aim of the study was to assess the possibility of obtaining data on postexposure incidents among health care workers in different voivodeships (regions) and to identify a group of persons who most frequently reported such cases in a given calendar year. MATERIAL AND METHODS: Nineteen medical centers from all 16 voivodeships were invited to participate in the study. The main condition to be enrolled in the study was to provide full postexposure prophylaxis log. RESULTS AND CONCLUSIONS: In all, 8 centers from 8 voivodeships were enrolled in the final study. Only in 4 voivodehips, completely centralized postexposure prophylaxis logs were in operation. Women with secondary education (nurses) formed the major group of exposed persons. Exposure incidents occurred most frequently in wards or operation rooms while performing medical procedures or immediately after. Blood collection predominated among various kinds of exposure. The majority (75.7%) of health workers underwent full vaccination program against HBV. The analysis revealed large differences in exposure reporting between individual voivodeships. Sometimes they made it even difficult to complete full demographic data concerning exposed persons. Therefore, a universal tool of nationwide system should be elaborated. Such a system (an example is presented by the authors), regularly verified, might provide grounds for a wider analysis of postexposure prophylaxis efficacy, details concerning exposure incidents and their consequences in the future. This may greatly contribute to the reduction of exposure rates among health care workers.

[Underestimation of exposure incidence rates in Polish health workers: a prospective study]. / Ocena niedoszacowania czestosci ekspozycji na material biologiczny wsród pracowników polskiej sluzby zdrowia--analiza prospektywna.

BACKGROUND: Analyses of exposure rates among health care workers comprise both risk and epidemiology of blood borne pathogenic factors. In Poland, a possible extent of underestimation of such incidents has not yet been widely studied in the population of this group of employees. The aim of the study was to observe a group of population chosen as an example to assess the actual exposure incidence rates, especially those not subjected to registration. MATERIALS AND METHODS: A prospective six-month survey covered 319 Lower Silesia health care workers: physicians, nurses and auxiliary staff. Statistical methods were used to analyze the obtained data, especially those concerning the job performance, the number of medical procedures performed and frequency of exposures, both registered in each case and not registered in the post-exposure prophylaxis log. RESULTS AND CONCLUSIONS: Finally, 269 persons were under observation. Actual exposure incidence rate was several fold higher than that officially registered and differed depending on the department and subgroup of health care workers. In summary, the ratio of all the registered cases to those not registered was 1: 6. An overall proportion of not registered cases of exposure was as high as 86%. Most frequent job activities of exposed health care workers comprised preparatory procedures like parenteral drug administration or injections. Post-procedure activities were less frequently the cause of exposure. Non-registration of such exposures were motivated by a self-assessment of a low infection risk or a conviction that self-protection on the incidence site was optimal. Lack of current knowledge was rather rarely admitted as a reason for underreporting.

[Endocrine disorders in HCV infection]. / Zaburzenia endokrynologiczne zwiazane z zakazeniem HCV.

Thyroid disorders and diabetes mellitus t. II are the most common disorders observed among of endocrine extrahepatic manifestations of HCV infection. The mechanism of this disorders is still unclear. Two main hypothesis are considered: primary cytopathic effect of virus and secondary-induced autoimmunity. The ability of HCV to infect central nervous system cells seems to be significant in the hypothalamus--epiphysis--axis dysfunction. Further clinical researches are awaited in order to explain phenomenon mentioned above.

[Autoimmune liver diseases and overlap syndromes--overview of past and present reports]. / Autoimmunologiczne choroby watroby a zespoly nakladania--poglad na dawne i aktualne doniesienia.

Autoimmune liver diseases are unique among other liver diseases mainly for its unknown pathogenesis, treatment and prognosis. Within their natural course strong correlation between clinical view and serologic markers (autoimmune hepatitis, primary biliary cirrhosis) or X-ray image abnormalities (primary sclerocholangitis) are observed. Significant diagnostic progress, recently seen, revealed major discrepancies in diagnosing and management of classic types of the diseases, suggesting co-association of their symptoms. This review presents former and most up-to-date reports of such cases in terms of overlap syndromes.