Very High Incidence of Chlamydia trachomatis, Neisseria gonorrhoeae, and Treponema pallidum among Low-Risk MSM in an Outpatient Clinic in Wroclaw, Poland in 2019-2020.

BACKGROUND: The rise in sexually transmitted infections and chemsex has led to syndemy with HIV, partly due to common routes of transmission and clustered transmissions. Despite this, barriers to STI care and PrEP still remain. We sought to determine whether MSM at low risk for HIV infection were also at low risk for other STIs. METHODS: The study group was tested for HIV, HCV, and Treponema pallidum, as well as had urethral, rectal, and oropharyngeal smears performed for Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) six months apart. The control group was tested once to define the background incidence. RESULTS: Treponema pallidum, CT, and NG prevalence was very high at both time points and was similar to the control group. CT was especially common in the control group (20.58%) and the study group at the rectal site at the second time point (9.37%). NG dominated the oropharyngeal site (15.87%), with urethral site sparing. NG infection was associated with an increased number of partners, not condom use (OR, 1.082 [95% CI; 1.009-1.171]). Risk behavior did not change between the time points. Treponema pallidum, CT, and NG incidence was exceptionally high (12.5/100PY, 25.39/100PY, 34.92/100PY, respectively; pooled 87.5/100PY) and was comparable to other studies of high-risk MSM. CONCLUSIONS: Despite a lower risk for HIV acquisition, the study group was at a very high risk for other STIs, and this risk remained high throughout the study. Patients and medical professionals should be aware of syphilis, gonorrhea, and chlamydiosis transmission risks, and screening should be performed accordingly. Prophylactic programs need to be updated to specifically include lower-risk individuals.

Making HIV clinic appointments for clients with positive HIV results at testing sites can improve referral rates.

BACKGROUND: The percentage of people living with undiagnosed HIV infection remains very high in Poland and exceeds 50% - one of the highest rates in Europe. At the same time, the number of HIV tests performed by medical doctors per 1000 inhabitants is the lowest in Europe. Thus, every effort should be made to keep diagnosed patients in care. However, a number of patients are lost to care (LTC), with the percentage depending on the testing modality used (voluntary counseling and testing sites - VCTs, private laboratories, medical clinics, clubs) and communication skills of persons giving the results. Until now, there was only 1 prospective study in Poland that looked into the problem of continuum of care. OBJECTIVES: The objective of the study was to assess VCT clients' willingness to accept help with making the first appointment at a local HIV clinic after receiving positive results and the percentage of patients getting into care at the clinic after referral. MATERIAL AND METHODS: Referral efficacy analysis between 2010 and 2014 was a joint venture between VCT site and the largest HIV clinic in Wroclaw. Every patient diagnosed with HIV infection was offered personal help with making the first appointment at the HIV clinic. Later, it was assessed whether the first visit actually took place. RESULTS: All the patients who collected their positive results came for their first visit at the HIV clinic with a referral rate reaching 100%, falling to 97.1% only in 2013. Most visits took place during 1-2 weeks. CONCLUSIONS: Patients were willing to use counselors' help with making appointments at the HIV clinic, which in turn increased referral rates and numbers of patients retained in care.

Comparison of clinical pharmacology of voriconazole and posaconazole.

Despite greater knowledge and possibilities in pharmacotherapy, fungal infections remain a challenge for clinicians. As the population of immunocompromised patients and those treated for their hematologic ailments increases, the number of fungal infections grows too. This is why there is still a quest for new antifungal drugs as well as for optimization of pharmacotherapy with already registered pharmaceutics. Voriconazole and posaconazole are broad-spectrum, new generation, triazole antifungal agents. The drugs are used in the pharmacotherapy of invasive aspergillosis, Candida and Fusarium infections. Voriconazole is also used in infections caused by Scedosporium. Posaconazole is used in the treatment of coccidioidomycosis and chromoblastomycosis. Besides some similarities, the two mentioned drugs also show differences in therapeutic indications, pharmacokinetics (mainly absorption and metabolism), frequency and severity of adverse drug reactions, drug-drug interactions and dosage. As both of the drugs are used in the treatment of invasive fungal infections in adults and children, detailed knowledge of the clinical pharmacology of antifungal agents is the main factor in pharmacotherapy optimization in treatment of fungal infections. The goal of the article is to present and compare the clinical pharmacology of voriconazole and posaconazole as well as to point out the indications and contraindications of using the drugs, determine factors influencing their pharmacotherapy, and provide information that might be helpful in the treatment of fungal infections.

Evaluation of the toxicity of anticancer chemotherapy in patients with colon cancer.

BACKGROUND: Modern anticancer chemotherapy can cause numerous adverse effects in the organism, whose functioning has already been disrupted by the neoplastic process itself. OBJECTIVES: The aim of the study was to evaluate and compare the frequency and severity of the toxicity of FOLFOX-4 and CLF-1 anticancer therapy in patients with colon cancer, and to analyze certain factors that might have increased the toxicity of the chemotherapy. MATERIAL AND METHODS: The study involved 64 patients suffering from generalized colon cancer, including 48 patients treated according to the FOLFOX-4 regimen and 16 patients treated according to the CLF-1 regimen. The toxicity of each regimen was analyzed on the basis of a confidential questionnaire formulated by the authors and laboratory research according to the extended WHO toxicity criteria. RESULTS: The analysis of the symptoms of toxicity symptoms associated with the use of the FOLFOX-4 and CLF-1 therapeutic regimens revealed that the most common side effects included nausea and vomiting, despite ondansetron premedication, and neurotoxicity. Disruption of the functioning of the nervous system under the FOLFOX-4 regimen statistically significant exacerbation that increased with the number of chemotherapy cycles administered; this was more common and more severe in women. Paresthesia was also revealed to be a neurotoxic effect of the FOLFOX-4 regimen after termination of therapy. A statistically significant relationship was observed between the use of vitamin supplements and the incidence and severity of the toxicity of the FOLFOX-4 regimen. CONCLUSIONS: The findings of the current study regarding the toxicity of the FOLFOX-4 and CLF-1 therapy regimens should be taken into consideration when monitoring chemotherapy safety in colon cancer. The patients' tolerance of the administered medication and the side effects reported by patients should be constantly evaluated, which will help prevent these side effects, apply appropriate therapy and contribute to the improvement of the patients' quality of life. The functioning of the central nervous system should be carefully evaluated when planning the anticancer therapy, especially if repeated administration of neurotoxic drugs is necessary in cases of a recurrence of the disease. Chemotherapy should be thoroughly monitored for safety, especially in women over 65 years of age suffering from coexisting diseases. Colon cancer patients and their families should be informed of the risks of nutritional supplements before the start of the anticancer chemotherapy, and may need to dispense with their use.

[Evaluation of efficacy and safety of hypertension treatment with original angiotensin-converting enzyme inhibitors: the comparison of original and generic formulations]. / Ocena skutecznosci i bezpieczenstwa leczenia nadcisnienia tetniczego inhibitorami konwertazy angiotensyny. Porównanie leków oryginalnych i generycznych.

UNLABELLED: The hypertension is a civilization disease, slowly destroying the cardio-vascular system and leading to serious complications, which may result in patient death. Critical factors enhancing the proper functioning of the body are: properly selected pharmacotherapy and the self-control of the blood pressure. THE AIM OF THIS STUDY: was to evaluate the effectiveness and safety of the hypertension treatment with generic and original formulations of angiotensin converting enzyme (ACE) inhibitors. MATERIAL AND METHODS: To the study, which consisted of an interview and completed a joint survey were enrolled 120 patients with hypertension therapy based on formulations of ACE inhibitors group. Data for the analysis were obtained from surveys conducted in: Department of Angiology, Hypertension and Diabetology, Department and Clinic of Endocrinology, Diabetology and Isotope Therapy and its Clinic for Diabetic Outpatients, in the period from 03/02/2011 to 20/04/2011. RESULTS: Out of 120 surveyed hypertensive patients treated with ACEI, 79 persons (66%) received the original preparations and 41 (34%) generic medications. Most preparations contained ramipril: 78 patients, of whom 50 received the original formulations and 28 a generic one. In this population no differences were found in the reduction of the systolic and the diastolic blood pressure between groups of patients receiving original and generic formulations. The most common adverse effects (AE) reported by patients were cough (n = 16), hypotension (n = 7), paresthesia (n = 6), skin lesions (n = 6), weakness (n = 5), headache and dizziness (n = 5). Some of these, i.e.: cough, weakness, headaches and dizziness, occurred more frequently in patients receiving therapy with generic preparations. CONCLUSIONS: Both the reference and generic preparations showed similar efficacy in reducing systolic and diastolic pressure. The therapy with original drugs leads less frequently to adverse effects such as cough, weakness, headaches and dizziness.

The investigation of specific biochemical markers in monitoring kidney function of drug addicts.

INTRODUCTION: An increasingly important issue in the Polish population is drug abuse. It leads to extensive damage of parenchymal organs, including kidney. Establishing early markers of organ damage and their monitoring during rehabilitation therapy is therefore of pivotal importance. This study evaluated the utility of highly specific and selective markers (NGAL, IL-18, a and π-GST isoenzyme, and ß2-M). The influence of opioid drugs and other factors on kidney function (HIV and HCV infections, duration and the kind of drugs abused) was determined. MATERIALS AND METHODS: Urine collected from 83 subjects who abused drugs and 33 healthy volunteers was tested with ELISA using specific antibodies (IBL, Biotron, Bioporto-Diagnostics). HIV infection was confirmed with western-blotting and HCV with PCR. CD4 lymphocytes were quantified with flow cytometry. RFLP and PCR were used to determine the viral load of HIV and HCV (genotype). RESULTS: A significant increase of IL-18, NGAL and ß2M activity in heroin addicts compared to the control group was noted as well as the influence of HIV infection on NGAL and ß2M excretion. A statistically significant (p=0.04) correlation between the viral load and IL-18 concentration was noted while no significant influence of the duration and the kind of drugs abused, the route of intake or the age of addicts was seen. Only the NGAL concentration was sex dependent and significantly higher in women. DISCUSSION: This study showed the specific, clinical utility of IL-18, NGAL, and ß2M in the evaluation of renal function in drug addicts. Early detection of nephropathy with biochemical indicators might help prevent severe conditions that require hospitalization and intensive care.

[Influence of different physical conditions on HIV infectivity]. / Czynniki wplywajace na zakaznosc HIV.

To date it has been impossible to establish borderline physical conditions which prevent HIV from infecting human cells. Full inactivation of the virus is not necessary to lose its capacity for infection--often damage of the mechanisms concerning e.g. HIV entry into the cell or integration with host DNA is sufficient. The presence of HIV RNA in a sample under certain conditions does not mean that the virions are infectious. Viral infectivity under certain conditions depends on temperature, humidity, sunlight, atmospheric pressure, pH of the environment, disinfectants, coagulation inhibitors, and the kind and amount of infectious biological material, especially HIV viremia in it. At present the influence of high temperature on HIV infectivity, inactivation or HIV RNA level is the best known phenomenon, while the influence of low temperature on the above parameters has been examined in less detail. In the paper the authors present the influence of various parameters on HIV infectivity, especially temperature variation.

Influence of anticancer therapy on oxidation phenotype and acetylation phenotype in patients with acute myeloblastic leukemia.

The aim of this study was to determine whether antineoplastic cytostatic therapy induces changes in the oxidation or acetylation phenotypes in patients with acute myeloblastic leukemia (AML). The investigations involved 22 patients with AML undergoing chemotherapy with daunorubicin, cytosine arabinoside, etoposide and mitoxantrone. The oxidation phenotype prior to therapy and after termination of induction was examined in all 22 patients and was examined in 10 patients after termination of the first consolidation cycle. The acetylation phenotype was examined prior to therapy and after termination of induction in 21 patients and after termination of the first remission consolidation cycle in 9 patients. The oxidation phenotype was determined by means of the method by Eichelbaum and Gross. The acetylation phenotype was determined using Varley's modification of the Bratton-Marshall method. Anticancer therapy affected the oxidation phenotype, causing decreased activity of the cytochrome P450 isoenzyme CYP2D6. This decrease suggests that daunorubicin, cytosine arabinoside, etoposide and mitoxantrone may impair the metabolism of other active substances metabolized by this isoenzyme, which should be taken into consideration in planning the dosage scheme in individual patients and considering interactions between drugs. Evaluation of the effect of administered cytostatic drugs on acetylation phenotype revealed no statistically significant decrease in the rate of sulfadimidine acetylation.