Hospital Admission Factors Independently Affecting the Risk of Mortality of COVID-19 Patients.

INTRODUCTION: COVID-19 is a disease characterized by high in-hospital mortality, which seems to be dependent on many predisposing factors. OBJECTIVES: The aim of this study was to analyze the clinical symptoms, abnormalities in the results of laboratory tests, and coexisting chronic diseases that independently affected the risk of in-hospital mortality in patients with COVID-19. PATIENTS AND METHODS: We analyzed the records of patients with COVID-19 who were hospitalized from 6 March 2020 to 30 November 2021. RESULTS: Out of the entire group of 2138 patients who were analyzed, 12.82% died during hospitalization. In-hospital mortality was independently associated with older age (OR 1.53, 95% CI 1.20-1.97); lower arterial blood oxygen saturation (OR 0.95, 95% CI 0.92-0.99); the presence of a neoplasm (OR 4.45, 95% CI 2.01-9.62), a stomach ulcer (OR 3.35, 95% CI 0.94-11.31), and dementia (OR 3.40, 95% CI 1.36-8.26); a higher score on the SOFA scale (OR 1.73, 95% CI 1.52-1.99); higher lactate dehydrogenase (LDH) (OR 1.08, 95% CI 1.05-1.12); higher N-terminal pro-brain natriuretic peptide (NT pro BNP) (OR 1.06, 95% CI 1.01-1.11); and lower total bilirubin in blood concentration (OR 0.94, 95% CI 0.90-0.99). CONCLUSIONS: We found that low oxygen saturation, old age, and the coexistence of cancer, gastric ulcers, and dementia syndrome were variables that independently increased mortality during hospitalization due to COVID-19. Moreover, we found that decreased platelet count and bilirubin concentration and increased levels of LDH and NT-proBNP were laboratory test results that independently indicated a higher risk of mortality. We also confirmed the usefulness of the SOFA scale in predicting treatment results. The ability to identify mortality risk factors on admission to hospital will facilitate both adjusting the intensity of treatment and the monitoring of patients infected with SARS-CoV-2.

Impact of a structured medical staff education program on the effect of HIV testing in four multi-specialist hospitals of the mazowieckie voivodeship as a part of the "Stop late presenters" - project.

In half of newly detected cases of HIV infection in Europe, the diagnosis is made late. This has significant impact on the effects of antiretroviral therapy, long-term consequences of the disease, mortality, and the risk of HIV transmission in the environment. As part of the large "STOP Late Presenters" project, the number of HIV tests was assessed in four multi-specialist hospitals in the Mazowieckie voivodeship, which generally carry out over 112,000 hospitalizations per year. First, under the structured research program, the training of medical personnel was carried out in these hospitals, and then the number of HIV tests ordered was evaluated 2 months and 4 months after the training. 459 HIV tests were performed after the training in all hospitals, which is 2.44% of hospitalizations. It is interesting to note that after 4 months, the number of performed tests fell significantly. Staff training resulted in the number of tests higher by 5.8 %, compared to the same period of previous year. Four positive results were confirmed, which is 0.87% of all tests done. This is almost twice higher than in other European countries. Tests for HIV infection are most often ordered by doctors of infectious diseases, gynecologists and the staff of dialysis departments. We found that there is little interest in HIV testing among other specialists, despite reporting patients with clinical symptoms that suggest the likelihood of this infection. The improvement in HIV testing is of great importance for public health in our country and requires modification of diagnostic algorithms in hospital wards to reduce the number of late diagnoses of HIV / AIDS.

The Spectrum of Malignancies among Adult HIV Cohort in Poland between 1995 and 2012: A Retrospective Analysis of 288 Cases.

THE AIM OF THE STUDY: The aim of the study was to evaluate the spectrum of AIDS-defining malignancies (ADMs) and non-AIDS-defining malignancies (NADMs) in HIV-infected patients in Poland. MATERIAL AND METHODS: A retrospective observational study was conducted among HIV-infected adult patients who developed a malignancy between 1995 and 2012 in a Polish cohort. Malignancies were divided into ADMs and NADMs. Non-AIDS-defining malignancies were further categorised as virus-related (NADMs-VR) and unrelated (NADMs-VUR). Epidemiological data was analysed according to demographic data, medical history, and HIV-related information. Results were analysed by OR, EPITools package parameters and Fisher's exact test. RESULTS: In this study 288 malignancies were discovered. The mean age at diagnosis was 41.25 years (IQR20-81); for ADMs 38.05 years, and for NADMs-VURs 46.42 years; 72.22% were male, 40.28% were co-infected with HCV. The risk behaviours were: 37.85% IDU, 33.33% MSM, and 24.31% heterosexual. Mean CD4+ at the diagnosis was 282 cells/mm(3) (for ADMs 232 and for NADMs-VUR 395). Average duration of HIV infection at diagnosis was 5.69 years. There were 159 (55.2%) ADMs and 129 (44.8%) NADMs, among whom 58 (44.96%) NADMs-VR and 71 (55.04%) NADMs-VUR. The most frequent malignancies were: NHL (n = 76; 26.39%), KS (n = 49; 17.01%), ICC (n = 34; 11.81%), HD (n = 23; 7.99%), lung cancer (n = 18; 6.25%) and HCC (n = 14; 4.86%). The amount of NADMs, NADMs-VURs in particular, is increasing at present. Male gender (OR = 1.889; 95% CI: 1.104-3.233; p = 0.024), advanced age: 50-60 years (OR = 3.022; 95% CI: 1.359-6.720; p = 0.01) and ≥ 60 years (OR = 15.111; 95% CI: 3.122-73.151; p < 0.001), longer duration of HIV-infection and successful HAART (OR = 2.769; 95% CI: 1.675-4.577; p = 0) were independent predictors of NADMs overall, respectively. CONCLUSIONS: In a Polish cohort NHL was the most frequent malignancy among ADMs, whereas HD was the most frequent among NADMs. Increased incidence of NADMs appearing in elderly men with longer duration of HIV-infection and with better virological and immunological control was confirmed. As HIV-infected individuals live longer, better screening strategies, especially for NADMs-VUR, are needed. The spectrum of cancer diagnoses in Poland currently does not appear dissimilar to that observed in other European populations.

Outcomes of influenza A(H1N1)pdm09 virus infection: results from two international cohort studies.

BACKGROUND: Data from prospectively planned cohort studies on risk of major clinical outcomes and prognostic factors for patients with influenza A(H1N1)pdm09 virus are limited. In 2009, in order to assess outcomes and evaluate risk factors for progression of illness, two cohort studies were initiated: FLU 002 in outpatients and FLU 003 in hospitalized patients. METHODS AND FINDINGS: Between October 2009 and December 2012, adults with influenza-like illness (ILI) were enrolled; outpatients were followed for 14 days and inpatients for 60 days. Disease progression was defined as hospitalization and/or death for outpatients, and hospitalization for >28 days, transfer to intensive care unit (ICU) if enrolled from general ward, and/or death for inpatients. Infection was confirmed by RT-PCR. 590 FLU 002 and 392 FLU 003 patients with influenza A (H1N1)pdm09 were enrolled from 81 sites in 17 countries at 2 days (IQR 1-3) and 6 days (IQR 4-10) following ILI onset, respectively. Disease progression was experienced by 29 (1 death) outpatients (5.1%; 95% CI: 3.4-7.2%) and 80 inpatients [death (32), hospitalization >28 days (43) or ICU transfer (20)] (21.6%; 95% CI: 17.5-26.2%). Disease progression (death) for hospitalized patients was 53.1% (26.6%) and 12.8% (3.8%), respectively, for those enrolled in the ICU and general ward. In pooled analyses for both studies, predictors of disease progression were age, longer duration of symptoms at enrollment and immunosuppression. Patients hospitalized during the pandemic period had a poorer prognosis than in subsequent seasons. CONCLUSIONS: Patients with influenza A(H1N1)pdm09, particularly when requiring hospital admission, are at high risk for disease progression, especially if they are older, immunodeficient, or admitted late in infection. These data reinforce the need for international trials of novel treatment strategies for influenza infection and serve as a reminder of the need to monitor the severity of seasonal and pandemic influenza epidemics globally. TRIAL REGISTRATION: ClinicalTrials.gov Identifiers: FLU 002--NCT01056354, FLU 003--NCT01056185.

Physical activity long-term after liver transplantation yields better quality of life.

BACKGROUND: Transplantation is the only effective method of treatment for end-stage and acute liver failure. Increased average survival time has been observed, and results from improved surgical technique and amended immunosuppression protocols. However, longer survival of patients after orthotopic liver transplantation (OLT) results in higher rate of various complications and ailments (eg, chronic fatigue, anxiousness, social isolation). Hence, gradual deterioration of health-related quality of life (HRQoL) is likely. The goal of this study was to examine the relation between physical activity and quality of life in patients 5 years after OLT. MATERIAL/METHODS: Twenty-six randomly selected patients who survived more than 5 years after orthotopic liver transplantation were included into the study. An SF-36 questionnaire was used for assessment of quality of life. Physical activity was measured subjectively by characterizing its type, duration and frequency per week during the previous 12 months. Patients were divided into 2 groups according to the results of physical activity assessment. Group A consisted of patients who had indicated they had a sedentary life style, and group B of those regularly engaging in physical exercise. RESULTS: Results of the SF-36 questionnaire in 10 categories were compared between the 2 groups. The majority of aspects of health-related quality of life (physical function, body problems, general health, social function, and emotional reaction) were significantly improved in patients who indicated they regularly engaged in physical exercise. CONCLUSIONS: Better quality of life was observed in patients who were physically active after OLT. Improving life quality with regular physical activity could be a valuable supplementation of complex management of OLT recipients.

[The impact of UV radiation B and C in vitro on different of bacteria strains isolated from patients hospitalized in the Warsaw Medical University Clinics]. / Wplyw promieniowania uv w zakresie dlugosci b i C, w warunkach in vitro, na rózne szczepy bakterii izolowanych od pacjentów hospitalizowanych w klinikach Warszawskiego Uniwersytetu Medycznego.

INTRODUCTION: Infections in human body caused by various microbes are a significant problem in modern medicine. Special attention is put to infections of wounds, which are a significant threat to the life of patients. Attempts to treat these wounds base mainly on the application of various chemical preparations (locally) and systematic antibiotic treatment. UV radiation, because of its anti-bacterial activity, appear a complementary issue in therapy. AIM OF THE SURVEY: The aim of this study was an examination of the sensitivity of bacteria strains isolated from patients hospitalised in the Warsaw Medical University clinics, and prove that antibiotics and operation of UV B and C radiation with Endolamp 474 may become a complementary or alternative method of treatment. MATERIAL AND METHODOLOGY: The study used 65 strains grown aerobically (15 strains of Escherichia coli, 20 strains of Pseudomonas aeruginosa, 15 strains of Staphylococcus aureus, 15 strains of Streptococcus and Enterococcus sp). The same strains were planted on different excipients and were subjected to UV radiation using Endolamp 474. Correctly prepared strains were radiated from a 25 cm distance in various durations (from 5 seconds to 105 seconds). RESULTS AND CONCLUSIONS: As a result of UV irradiation of microorganisms studied B and C using 474 Endolampy received varied, but the great sensitivity to the effects of this radiation, in all tested bacterial strains. UV radiation on microorganisms requires further study, also in vivo.

[Clinical manifestations, diagnosis and treatment of swine flu (A/H1N1) infection among patients hospitalized in the Hospital of Infectious Diseases in Warsaw in 2009]. / Objawy kliniczne, rozpoznanie i leczenie grypy wywolanej wirusem A/H1N1 u osób hospitalizowanych w Szpitalu Zakaznym w Warszawie w 2009 r.

UNLABELLED: The aim of this paper was the evaluation of clinical characteristics, demographics and therapeutic response for oseltamivir, among patients with swine flu confirmed, hospitalized in the Hospital For Infectious Diseases in Warsaw, Poland. MATERIAL: We have observed infection A/H1N1 occurrence in 109 patients (Female-64, Male-45, aged 17-71 y), hospitalized between August and December 2009. The influenza specific test PCR (TaqMan A/H1N1) were used to pandemic flu confirmation. RESULTS: Out of 109 analyzed patients, 67% were young, before 40 y. old. The largest infected group were patients between 20 and 29 years. Among multiple acute symptoms we observed high temperature, cough, myalgia and neurological manifestations, very frequent. In 42 patients (38%) the interstitial pneumonia were observed. Eight patients developed severe respiratory insufficiencies -ARDS (7%) and one died. We observed also 10 infections A/H1N1 influenza during pregnancy, with good oseltamivir tolerance and without recent perinathal complications. CONCLUSIONS: Among 109 individuals with swine flu influenza, 67% have not complicated clinical manifestation and they recovered during 3-4 days. Eight patients developed ARDS and one of them died. Test PCR for influenza A/H1N1 was the basis in diagnostics procedures of the new pandemic influenza confirmation. Oseltamivir safety and tolerability were verified in patients with new variant infection A/H1N1.

[Influence of concomitant illness on clinical manifestations and severity of A/H1N1 influenza infection among patients hospitalized in the Hospital of Infectious Diseases in Warsaw--clinical cases]. / Wplyw chorób towarzyszacych na przebieg kliniczny grypy wywolanej przez wirus A/H1N1 u osób hospitalizowanych w Szpitalu Zakaznym w Warszawie--opis przypadków.

UNLABELLED: Many cases of swine flu is mild or even asymptomatic. The recent cases have been much more severe, and many patients have presented pneumonia, respiratory failure and acute respiratory distress syndrome (ARDS). Illness-related fatalities have been recorded among individuals hospitalized in The Hospital For Infectious Diseases in Warsaw, Poland. There were 109 patients (age: 17-71y), with A/H1N1 infection confirmed by PCR. In this article have shown cases of H1N1 influenza - related complications. We observed bacterial superinfections associated with swine flu, ARDS and shock syndrome, secondary bacterial pneumonia and neurological complications. Severe hypoxemia, multilobar pneumonia, and dramatic signs and symptoms progression, were reported in 8 individuals. All patients required admission to intensive care unit and the mechanical ventilation. One patient died due to ARDS and encephalitis. Many people have experienced risk factors, e.g.: asthma, sarcoidosis, or chronic bronchitis and other pulmonary illness. One patient after renal transplant with immunosuppressive therapy recovered, as well as two patients with chronic lymphatic leucaemia in remission. Two woman with clinically-relevant obesity have developed rapid progression of respiratory insufficiency and were still on mechanical ventilation. Influenza A/H1N1 were observed in 10 pregnant women, without co-morbidities. Three of them developed interstitial pneumonia. Consequently pregnant women with confirmed pandemic A/H1N1 infection received treatment with oseltamivir. IN CONCLUSION: Among 109 hospitalized individuals with A/H1N1 infection, eight (7%) developed severe pulmonary complications, and one of this patient died. The risk factors of progression to acute respiratory distress syndrome (ARDS) have all of this group patients.

[Hypersensitivity syndrome--the role of pharmacogenetics for prediction of efficacy and safety of antiretroviral therapy in patients with HIV/AIDS]. / Zespól nadwrazliwosci--znaczenie farmakogenetyki w przewidywaniu skutecznosci i bezpieczenstwa terapii antyretrowirusowej u pacjentów z HIV/AIDS.

Recent clinical study reported that the best choosing of antiretroviral therapy for an individual patients is one that physicians have always tried to practice, making use of whatever knowledge or tools are available to treatment decisions. Individual genetic variations provide scope for a wide range of host-drug interactions that will differentiate therapeutic outcomes within an otherwise homogenous population. Pharmacogenetics looks set to become an increasingly important field to refine the medical tools to personalize antiretroviral treatment. The integration of genetic tests into routine patient management has a great challenge for HIV-guidelines and for clinical care. Pharmacogenetics will increasingly impact all medical disciplines for the candidates to therapy. It was confirmed, that genetic screening enabled to prevent abacavir hypersensitivity reaction.

Therapeutic vaccination of chronic hepatitis C nonresponder patients with the peptide vaccine IC41.

BACKGROUND & AIMS: IC41 is a synthetic peptide vaccine containing 7 relevant hepatitis C virus (HCV) T-cell epitopes and the T helper cell (Th)1/Tc1 adjuvant poly-L-arginine. IC41 has been shown to be safe and to induce HCV-specific interferon (IFN)-gamma-secreting CD4+ and CD8+ T cells in healthy volunteers. We aimed to investigate whether IC41 is able to induce HCV-specific T-cell responses also in chronic hepatitis C patients. METHODS: Sixty HLA-A2-positive chronic HCV patients not responding to or relapsing from standard therapy were randomized in a double-blind phase II study into 5 groups to receive 6 vaccinations of IC41 (3 different dose groups), HCV peptides alone, or poly-L-arginine alone. RESULTS: IC41 was well tolerated, and no drug-related serious adverse events or induction of hepatitis were observed. T-cell proliferation was recorded in up to 67% of patients in the 3 IC41 vaccine groups but only in 17% of patients treated with peptides alone. IFN-gamma enzyme-linked immunospot assay responses were observed exclusively in the IC41 groups with response rates up to 42%. There were 3 RNA responders with transient >1-log declines of HCV serum RNA associated with the strongest IFN-gamma enzyme-linked immunospot assay values within all 60 patients. CONCLUSIONS: This study showed that the HCV peptide vaccine IC41 can induce HCV-specific Th1/Tc1 responses in a subset of difficult to treat HCV nonresponder patients despite persisting viremia. However, changes in HCV RNA occurred only in single patients. Because strongest T-cell responses were associated with HCV RNA decline, further studies with optimized vaccine regimens and combination therapies have been initiated.