Band 8, Heft 1

The main goal of our study is the analysis of data obtained from molecular modeling for a series of imidazole derivatives that possess strong antifungal activity. The research was designed to use artificial neural network (ANN) analysis to determine quantitative relationships between the structural parameters and anti-Streptococcus pyogenes activity of a series of imidazole derivatives. ANN in association with quantitative structure-activity relationships (QSAR) represents a promising tool in the search for drug candidates among the practically unlimited number of possible derivatives. In this work, a series of 286 imidazole derivatives presented as cationic three-dimensional structures was used. The activity was expressed as a logarithm of the reciprocal of the minimal inhibitory concentrations, log 1/MIC. Multilayer perceptron ANN was used for predictions of antimicrobial potency of new imidazole derivatives on the basis of their structural descriptors. The obtained correlation coefficient equaled 0.9461 for the learning set, 0.9060 for the validation set and 0.8824 for the testing set of imidazole derivatives. Hence, satisfactory and practically useful predictions of anti-Streptococcus pyogenes activity for a series of imidazole derivatives was obtained, supporting the future successful interpretation of QSAR analysis for those compounds.

A hospital-based analytical observational case-control study of 88 oesophageal cancer cases and 200 controls was conducted in the University Hospital Olomouc. A standardized questionnaire was used. The adjusted odds ratio (OR) are calculated by logistic regression. The adjusted odds ratios for tobacco smoking were 6.20 (95% CI 2.78–13.83), 10.64 (95% CI 3.46–32.72) and 3.53 (95% CI 1.26–9.88) for oesophageal cancer, for oesophageal squamous cell carcinoma, and oesophageal adenocarcinoma, respectively. An inverse association with overweight and obesity was found in both histological types. In adenocarcinoma, there was a relatively strong positive association with a statistically significant result for alcohol consumption only in a group consuming more than 300 g of alcohol weekly; the OR was 5.81 (95% CI 1.17–28.84). The strong, statistically significant association was found in alcohol consumption regardless of histological type: the OR was 4.41 (95% CI 1.09–17.84). In a group with 20 or more X-ray exposures, there was a very strong statistically significant positive association. In vegetable consumption, an inverse association was found that was statistically significant only if more than 8 portions of vegetables were eaten weekly, ORs were 0.02–0.11.

Coagulase-negative Staphylococcus warneri is a rare cause of human disease, which as a rule manifests as an insidious and protracted infection of various prostheses and endovascular catheters. A case of Staphylococcus warneri sepsis with multiple abscesses in an immunocompetent patient free from the usual predisposing factors for coagulase-negative staphylococcal infection is presented. To our knowledge, this is the first case of sepsis with multiple abscesess caused by this bacterium reported in the literature.

The most specific criterion for diagnosing neurosyphilis is a reactive CSF VDRL. Unfortunately, there are in Europe, including Poland small number of specialized laboratories for serological diagnosis of syphilis. Thus, CSF serology results are obtained with delay. Therefore, the decision on recommended therapy for neurosyphilis is taken on the basis of CSF basic tests. In this paper we attempt to determine the utility of CSF glucose concentration and its cut-off values in prediction of asymptomatic neurosyphilis. CSF and blood were collected from 55 HIV-uninfected patients with syphilis of unknown duration. Patients with neurosyphilis (14.5%) were characterized by higher CSF pleocytosis (p<0.0001), elevated CSF protein concentration (p<0.05) and lower CSF glucose concentration (p<0.0001). Multivariate regression analysis identified CSF pleocytosis and CSF glucose concentration as the two independent predictors of reactive CSF VDRL (p<0.0001). In the selected group of patients with CSF pleocytosis ≥5/µL (n=25) CSF glucose concentration ≤2.72 mmol/L was associated with 100% sensitivity (95%CI: 63–100%) and 100% specificity (95%CI: 75.3–100%) for reactive CSF VDRL. CSF glucose concentration may be particularly useful as a predictive marker of neurosyphilis in HIV uninfected patients with syphilis of unknown duration with CSF plecytosis ≥5/µL.

Angiosarcoma of the breast is a rare and very aggressive tumors originated from endothelial cells lining blood vessels. We report a case of a 55-year-old postmenopausal female with a primary breast angiosarcoma diagnosed just a one year after radical hysterectomy and radiation therapy due to endometrial cancer. The patient initially presented with postmenopausal bleeding. Cytology and biopsy of the endometrium were performed and endometrial adenosquamous carcinoma was diagnosed followed by radical hysterectomy and postoperative local radiatiotherapy (50 Gy). One year later patient presented with a great painful tumorous mass in the right breast. Physical examination revealed an oval tumor, located in upper and outer quadrant of the right breast, around 15 cm in diameter. Mammography and ultrasonography were performed. The angiosarcoma of the breast was confirmed by biopsy. The patient underwent radical mastectomy. Histopathology proved the diagnosis of angiosarcoma (high-grade, numerous mitoses over 10/10 HPF, necrosis, “blood lakes”, infiltrative borders). Differential diagnosis of a breast angiosarcoma should be considered in all painful breast tumours no mather the time and the location of the previous radiation treatment even if benign characteristics of these masses have been detected by mammography and breast ultrasound.

Despite that the prevalence of depression has been thoroughly analyzed in multiple sclerosis (MS) patients and affects approximately 15%–20% of the MS population, attention paid to social activities concomitant with anxiety is still too sporadic. The aim of this study was to find the prevalence of anxiety and social activities aggraded/aggravated with anxiety in the MS population in Lithuania and to analyze how it correlates with socio-demographic factors, clinical outcomes of MS and depression. Three hundred twelve MS patients took part in this study; anxiety prevalence was pointed in 20.2%. Only 23.4% of the study population was socially active. Our study shows a significant level of anxiety and low level of social activity in people with MS. Anxiety in MS patients was strongly related with younger age, shorter MS duration, prevalence of depression and lower level of social activity. A higher level of social activity was significantly related with older urban MS patients who indicated family status as living together and longer MS duration.

Introduction Cardiovascular diseases affect nearly 80% of the elderly, and they are the major cause of death in this population. The aim was to evaluate the clinical profile and prognostic factors for patients aged 80 years and more who have been hospitalized for cardiologic reasons. Material and Methods The study included 100 patients aged 80–91 years (46% men) referred to the Department of Cardiology. We analyzed the reasons and length of hospitalization, clinical factors, results of basic laboratory tests, echocardiography, angiography, comorbidities and number of deaths during the hospitalization and in one year of follow-up. Patients were divided and analyzed, depending on the total mortality rate.Results The most common causes of hospitalization were myocardial infarction (67%) and heart failure (10%). Coronary angiography was performed in 72% of patients and percutaneous coronary intervention in 81%. The most common cause of hospital deaths was myocardial infarction (67%). The proportion of deaths in hospital was 8%, and during a year of observation it was 26%. Deaths were found to be related to ventricular conduction blocks (OR=4.0; P=0.03) and atrial fibrillation (OR=11.15; P=0.04). Conclusions In the elderly hospitalized in cardiac wards, myocardial infarction was the most common cause of hospitalization and hospital death. The mortality rate was high and associated with ventricular conduction blocks and atrial fibrillation.

Advance directive and other declarations of will made by patients in a case of mental illness still raise ethical and legal issues. In Poland there is no legal regulation, neither research about code of conduct in situation of do not attempt resuscitation. There are also not enough studies regarding Healthcare workers’ opinion about DNAR declaration (Do Not Attempt Resuscitation). The study is aimed at finding out emergency medical system nurses opinion on the subject of enforcing do not attempt resuscitation in situation of circulatory and respiratory arrest. Methods: The research was conducted by means of the diagnostic survey method applying a self — constructed questionnaire. The study was carried out among 82 (100%) nurses, from September to December 2011. Obtained information were analyzed statistically, Chi-square of independence with assumed p ≤ 0.05. level of significance was used for statistical analysis. Results: The study of the respondents’ opinion shows that 67% Healthcare employees think that DNAR declaration should be obligatory in Poland. Contrary opinion has 7.3% of respondents. In their opinion the decision to refrain from resuscitating should be made by attending physician − 46.3% and medical board − 29.3%. Information enclosed within DNAR declaration, in most of respondents’ opinion − 59.5%, should be only passed on in written form. Conclusions: Majority of respondents agree that patients have a right to refrain from resuscitating as a self − determination act. Respondents concur the introduction of DNAR declaration in Polish Healthcare system. In respondents’ opinion that decision should be required in written form and an attending physician should decide about its implementation, what violates the existing rule. The execution of living will declaration raises ethical issues. Additionally, it also appears as public/social problem. The last stage of incurable disease is given as justifiable circumstances of DNAR.

In 2005, the European Commission presented a report on the current situation associated with the protection, promotion and support of breastfeeding in 29 European countries. According to the report, exclusive breastfeeding was undertaken by 71% of the mothers in Poland. We concluded that an attempt shall be made to verify these data values. The aim of our survey was to assess the duration of breastfeeding and identify the potential medical and social factors affecting this parameter in Poland. We surveyed 427 women aged 18 to 40 from Northeastern Poland. The duration of breastfeeding and the presence of selected potential factors that may affect this parameter were assessed in 591 children. The mean duration of exclusive breastfeeding was 4.73 months with breastfeeding being initiated in 97.87% and continued beyond 12 months (following the introduction of complementary foods) in 32.49 % of the children. In our region, nearly all mothers attempt to breastfeed. Exclusive breastfeeding is continued by 75.46% and 29.27% of the mothers by 3 and 6 months of the baby’s life. Breastfeeding with complementary feeding is continued by 56.01% and 32.49% of the mothers by 6 and 12 months of the baby’s life.

Different ocular findings have been described in association with neurofibromatosis 2 (NF2). Detailed ophthalmological examination of asymptomatic subjects with a family history of NF2 could help confirm the diagnosis in young patients. We present a case of unilateral cataract and bilateral epiretinal membranes in a 5-year-old boy with a family history of neurofibromatosis 2. The patient was referred to our department with diminished visual acuity bilaterally and an initial diagnosis of cataract in the right eye. Bestcorrected visual acuity was 3/19 in the right eye and 3/24 in the left eye (LH charts). On fundus examination, bilateral macular epiretinal membranes were found and confirmed by optical coherent tomography. In view of the ophthalmic signs mentioned above and the history of the patient’s father, who suffered from NF2 and died from meningioma and ependymoma, the patient was referred for genetic examination. Seventeen exons of the NF2 gene were tested with negative results. No pathology was found on clinical neurologic examination and magnetic resonance imaging of the brain. Although the patient has not met the criteria for NF2, he is now considered as an asymptomatic subject at risk and observed. Lens opacities with epiretinal membranes in children may be regarded as part of the clinical manifestation of NF2.

This retrospective study aims to identify and describe the problems associated with the laboratory and clinical diagnosis of leptospirosis. A total of 4,813 patients with suspected leptospirosis from an area of the Czech Republic, with a total population of 1.15 million, were examined during the period 2002–2010. Our study included only 855 patients: 545 men (mean age 41.03 ± 19.24) and 310 women (mean age 41.47 ± 20.3) who were examined using microscopic agglutination test (MAT) and a polymerase chain reaction (PCR). All patients and their physicians filled in questionnaires, which included anamnestic data, clinical symptoms and the results of laboratory tests. Out of total suspected, 89 patients (1.85%), tested positive for leptospirosis, of which 50 have been examined only serologically by MAT. Of 855 patients in our study undergoing both PCR and MAT tests, 39 have tested positive for leptospirosis. The most frequent symptom in patients with leptospirosis included fever (91.6%) and headache (69.4%). The correct laboratory diagnosis of leptospirosis depends on biological material being tested before the start of antibiotic treatment, since leptospires are extremely sensitive to antibiotics. Consequently, the PCR results alone may produce a false negative result after 24 hours following treatment with antibiotics.

Introduction. Methodological Instructions for Procedures of Healthcare Institution Reports on the Indicators of the Quality of Healthcare from 2007 also involve reaction times (RTs) I, II, I+II, III and IV, as the obligatory indicator of the quality of expert work of Emergency Medical Services (EMS). Objective. Evaluation of the quality of expert work of Belgrade EMS based on RTs. Methods. A retrospective analysis of priority 1 emergency calls in September 2009 vs September 2010, and RTs from I to IV as the recommended indicators of the quality of expert work of Belgrade EMS. Results. As detected, in 2010 there has been decrease in the total number of calls for physicians, and the total number of priority 1 emergency calls. By comparing RTs, the obtained data showed that in 2010 the time elapsed from when a priority 1 call was received until it was handed to the EMS team for implementation (RT I) was on average faster by 0.1 min (p<0.01), that the time elapsed from the dispatcher’s receipt of the call until the EMS team arrived to the patient (RT II) was faster on average by 0.42 min (p<0.05), and that the time for the team to reach the patient after the received call through the call centre (RT I+II) was faster by 0.15 min. Also, in 2010, RT III was shortened by 1.27 min and RT IV by 1.00 min. By summing RTs I, II and III, independently resolved level I emergency calls at the scene are obtained. In 2009, this time interval was, on average 38.02 min, and in 2010 it was an average of 36.23 min. By summing RTs I, II and IV, the time elapsed from the call received through the call centre until the patient’s hospital admission is obtained. In 2009 this time was average 31.08 min, and in 2010 it was average 29.16 min. Conclusion. One of the major advances in emergency medicine is providing assistance to a request for emergency medical care where this is produced. Therefore, the indicator of RTs may measure the quality of care provided by pre-hospital services.

Osteomas of external auditory canal are most often unilateral, solitary, pedunculated hard tumors located on the anterior and superior wall of the structure in its distal part. They have to be distinguished from exostoses of external auditory meatus. Osteomas of external auditory canal are very rare and apart from isolated cases are not described in children population. The case presented in the paper shows the possibility of a presence of unilateral multifocal osteoma of an external auditory canal in a child, which is not described in the literature concerning the topic.

In the pathology of respiratory tract, sequestration presents as a non-functional lung tissue with no communication with tracheobronchial tree. It represents a rare congenital bronchopulmonary and vascular malformation, which occurs at a frequency of 0.1 to 6%. Intralobar and extralobar sequestrations are extremely rare congenital anomalies, especially if they occur at the same time in a patient. Proper diagnosis and appropriate surgical therapy, in the absence of associated anomalies, provide an excellent prognosis. In this paper, we are describing the simultaneous presence of intralobar sequestration (ILS) in the lower lobe of the left lung and extralobar sequestration (ELS) which is positioned on the aortic arch, in a 53 years old man. Two years post surgery, there is no recurrence or any patomorphological and functional disorders in the respiratory tract.

Sarcoidosis is a multisystem granulomatous disease of unknown etiology and with variable presentation. Skin, lymph nodes, lungs, eyes and the central nervous system are mostly involved. Cardiac sarcoidosis (CS) is a rare condition with clinical manifestations in about 5% of patients. Since it increases the risk of acute cardiac failure, ventricular arrhythmia, conduction disturbances and even sudden death, it aggravates markedly the prognosis. The early diagnosis of CS is difficult, requiring the use of diagnostic tools such as electrocardiographic monitoring, two-dimensional echocardiography, radionuclide scan, cardiac magnetic resonance imaging, positron emission tomography and endomyocardial biopsy. Once the diagnosis of CS is established, there is a need for early corticosteroids treatment, with or without immunosuppressive therapy, to prevent deterioration of cardiac function. In patients with refractory ventricular tachyarrhythmia, markedly reduced left ventricular ejection fraction and high risk of sudden death, prophylactic insertion of a pacemaker or implantable defibrillator is recommended. We had the opportunity to treat a patient with CS and to review the currently accepted diagnostic and treatment approach.

The hypothalamic-pituitary-adrenal (HPA) axis overactivity is thought to contribute to increased vulnerability to maternal stress. We hypothesize that functionally relevant polymorphic variants of the glucocorticoid (NR3C1) and mineralocorticoid (NR3C2) receptor genes mediating biological effects of cortisol, a major stress hormone, could also modulate the capacity to cope with pregnancy-related anxiety. Genomic DNA from the blood of 42 women with pregnancy-related anxiety and 42 age-matched women with normal pregnancy (5–6th months of gestation) were genotyped for markers rs6195 and rs10482605 of NR3C1 and two NR3C2 polymorphisms (rs5522 and rs2070951) using a Taqman allele discrimination assay. Serum total cortisol was measured using an ELISA technique. The allele Ser363 of rs6195 (the N363S polymorphism of NR3C1) was found to be associated with a higher risk of maternal stress (odds ratio (OR)=5.27; P=0.001). For NR3C2, the allele Val180 of rs5522 (I180V) also showed association with increased risk of neonatal stress (OR=1.97; P=0.038). Both predisposing gene variants were also associated with significantly elevated levels of cortisol in normally pregnant women and females with pregnancy-related anxiety. Our results suggest that pregnancy-related anxiety can be modulated by variants of NR3C1 and NR3C2 associated with increased basal cortisol levels. Thus, our findings provide evidence in support of the suggestion that elevated cortisol levels and HPA axis hyperactivity are implicated in pregnancy-related anxiety.

Organophosphate compounds are nowadays the most frequently used pesticides. For these insecticides, the primary target is acetylcholinesterase and for this reason the main clinical effect of acute intoxication with organophosphate insecticides involves an irreversible inhibition of the activity of this enzyme. However, in the chronic or subchronic exposition oxidative stress has been reported as the main mechanism of its toxicity. The present study investigated the effect of three low doses (0.2, 2, 5 mg/kg bw) of chlorpyrifos for 14 or 28 days on serum liver enzymes and on oxidative stress parameters in the liver of rats. Chlorpyrifos treatment resulted in aminotransferases and alkaline phosphatase increase after 14 days (higher doses) and 28 days (all doses) treatment together with changes of antioxidative enzymes activities and reduced glutathione and malonyldialdehyde level in the liver. The enhancement of lipid peroxidation is temporary, reaching a peak after 14 days and decreasing after 28 days of treatment. Based on the experimental findings of this study the temporary liver injury caused by oxidative stress has been shown. The disturbances in the liver antioxidative status and increased liver membrane permeability may appear in case of doses near to the accepted human daily intake.