Refugees' right to health: A case study of Poland's disparate migration policies.

Poland has faced two waves of migration: the first was of irregular asylum seekers, which led to the humanitarian crisis on the eastern EU-Belarusian border since 2021; the second was of Ukrainians fleeing the Russian invasion. Although there are noticeable differences between these situations, and between the different reactions of the Polish authorities, it is possible to juxtapose them in terms of the right to health. The normative content of refugee and human rights law is the starting point for reconstructing the meaning of the terms 'refugee' and 'right to health'. A refugee is a person who needs international protection because of a well-founded fear of harm, which is not limited to persecution as defined by the Refugee Convention but also includes situations of international and non-international armed conflict. The right to health, which includes, inter alia, entitlements to a 'system of health protection' and 'underlying determinations of health', is reconstructed on the basis of human rights law and refugee and migration law. There are no legal and moral grounds to grant the right to health differentially to different groups of refugees. Nondiscriminatory health policy requires that refugees have the same access to health care as nationals, although their specific health needs resulting from past experiences and refugee situation require special treatment, that is, an appropriate refugee health policy. The broad understanding of the underlying determinants of health demonstrates the importance of overall migration policy for refugees' health, which can jeopardise the fragile good of refugee health.

XDR-TB Transmitted from Mother to 10-Month-Old Infant: Diagnostic and Therapeutic Problems.

Drug-resistant TB (DR-TB) in children is a special epidemiological, clinical, and diagnostic problem, and its global incidence remains unknown. DR-TB in children is usually of a primary nature and is most often transmitted to the child from a household contact, so these cases reflect the prevalence of DR-TB in the population of adult patients. The risk of infection with Mycobacterium tuberculosis complex (MTBC) in children depends on age, duration of exposure, proximity of contact with the infected person, and the level of source virulence. Most cases of TB in children, especially in infants, are caused by household contacts, where the main sources of infection are parents, grandparents or older siblings. However, there are many documented cases of TB transmission outside the family. The most common source of infection is an adult who is profusely positive for mycobacteria, diagnosed too late, and inadequately treated. It has been estimated that a sputum-positive patient might infect 30-50% of their household members. For this reason, active epidemiological investigation and contact tracing in the environment of sputum-positive patients are the most appropriate methods of identifying infected family members. This paper presents a case report concerning the transmission of extensively drug-resistant TB, Beijing 265 genotype, from a mother to her 10-month-old daughter. It is the first case diagnosed in Poland, and one of very few described in the literature where treatment was effective in the mother and the infant recovered spontaneously.

False chordae tendineae in right ventricle of adult human hearts - morphological aspects.

INTRODUCTION: False chordae tendineae are fibrous-muscular bundles which do not interconnect with right atrioventricular valves. The structures have occasionally been described in the right ventricle. There are reports suggesting their influence on electromechanical processes taking place in the heart, in thromboembolic events as well as in the course of cardiac invasive procedures. The objective of the study was to perform a macroscopic evaluation of false chordae tendineae in the right ventricle. MATERIAL AND METHODS: The research specimens consisted of 100 hearts of adult humans, aged from 18 to 59 years, fixed in a solution of 10% formaldehyde and 98% ethanol. The ratio of false chordae tendineae to individual elements of the right ventricle, such as its walls, papillary muscles, septomarginal trabecula and the apex of the ventricle, was examined. RESULTS: During examination, six types of chordae tendineae were described based on the criterion of the type of structures they connected. The most common were false chordae connecting ventricle walls within its apex, while the least common were individual segments of papillary muscles. The research proved that the examined structures are morphologically extremely diverse. Substantial clinical implications of their presence seem very probable. CONCLUSIONS: The present work is the first of a scheduled series devoted to the problem of false chordae tendineae. Further analyses will cover the subject of morphological aspects in a microscopic perspective.

Morphological remarks regarding the structure of conduction system in the right ventricle.

BACKGROUND: The knowledge of conduction system morphology has a vital significance in cardiology and cardiac surgery - it enables to interpret pathologies and choose treatment. This has been confirmed by numerous accounts, both in the context of e.g. atrial fibrillation ablations as well as treating septum defects. Due to diversity and changeability of conduction system structure and their clinical implications, its thorough analyses seem to bear special importance. AIM: To examine the structure of selected elements of conduction system present in the right ventricle (RV). METHODS: Elements of conduction system present in RV of 6 foetuses (from 12 to 32 weeks of foetus age), 6 children (from 1 day to 7-year-old) and 10 adults (from 37 to 79-year-old) were histologically examined. Cross sections of 10 moderator bands and 10 anterior papillary muscles of adult human hearts were made. Specimens including membranous and muscular parts of the septum along with diverging moderator band were taken from a group of foetus, child and adult hearts. Cuttings of 10 micron width were stained with Masson's method in Goldner's modification. On the basis of the sections of membranous and muscular parts of the septum, the continuities of the elements of the conduction system were analysed. RESULTS: It was observed that in most cases the right branch of His' bundle locates itself deep in the muscular tissue of the septum irrespective of age; it is clearly separate along its whole run and gradually penetrates the muscular tissue with its fibers. Hardly ever does the right branch of His' bundle locate itself on the surface, subendocardially, with a minimum penetration into the muscular tissue. Moreover, in most cases, elements of conduction system are present in moderator band. The main tissue constituting its stroma is above all muscular tissue and to a lesser extent, connective tissue. In addition to this, fat tissue in variable proportion was also observed. In cross sections of the moderator band a distinctively circumscribed stripe of fibers of the conduction system was found. However, one could also observe samples in which its identification was not possible. CONCLUSIONS: The right branch of His bundle within the muscular part of the septum in most cases is located intramuscularly irrespective of age. The results of analyses prove a relatively constant character of the presence of the conduction system within the moderator band.

[Invasive aspergillosis of the paranasal sinuses, lung and brain]. / Inwazyjna grzybica kropidlakowa zatok przynosowych, pluc i mózgowia.

A case of invasive aspergillosis (IA) of paranasal sinuses, lung and brain with a fulminant fatal outcome is reported. A 43-year-old man with a history of skin carcinoma of the nasal region and a course of systemic corticosteroids, presented with symptoms of lung infection. Aspergillus fumigatus was cultured from respiratory and nasal samples. Erosion of adjacent bones of the nasal cavity was acknowledged, but no sinus surgery was performed. A computed tomography of the thorax showed thick-walled cavities of different sizes with air and scarce fluid levels in both lungs. Treatment with voriconazole was administered. The patient deteriorated in the ensuing 2 weeks because central nervous system involvement was observed. No aggressive surgical resection was performed and the patient died 2 weeks later. IA was not confirmed by histopathology because no necropsy was performed.

[The effects of pulmonary rehabilitation on the quality of life in patients with COPD]. / Wplyw rehabilitacji na jakosc zycia u chorych na przewlekla obturacyjna chorobe pluc.

INTRODUCTION: Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity, hospitalization and disability among lung diseases. Its chronic, progressive nature and acute exacerbations influence the quality and expectancy of life of COPD patients. The pulmonary rehabilitation is a basic non-pharmacological intervention in COPD and its role is increasing in recent years. The goal of this work was to evaluate the impact on quality of life patients undergoing 3 weeks pulmonary rehabilitation program. MATERIAL AND METHODS: 132 patients with COPD were admitted to pulmonary rehabilitation program; 70 completed the 3 weeks long program. Pulmonary function tests, exercise endurance, quality of life (St. George's Respiratory Questionnaire) were measured at baseline, 3 weeks, and 3 months. RESULTS: There was significant improvement in quality of life in St. George's Respiratory Questionnaire and exercise endurance (treadmill) measured at 3 weeks and at 3 months. Parameters of lung function tests did not improved after completion of rehabilitation. CONCLUSIONS: 3 weeks pulmonary rehabilitation program of patients with COPD was effective in improving exercise endurance and the quality of life. The improvement was noted as well at 3 months post rehabilitation.

[Is COPD an autoimmune disease caused by smoking?]. / Czy PoChP jest choroba autoimmunologiczna powodowana przez palenie papierosów?

Cigarette smoking is the main trigger for the development of chronic obstructive pulmonary disease (COPD). For years the inflammatory reaction in COPD was focused on neutrophils, macrophages and protease-antiprotease balance. The concept of inflammation has been changed since the findings in the bronchoalveolar lavage (BAL) of smokers and COPD patients. It is now evident that the inflammatory reaction composed of neutrophils and macrophages represents the innate immunity reaction. This reaction will proceed over time to damage the lung, producing peptides and modified proteins from matrix destruction, cell necrosis and cell apoptosis. These products have the potential to act as antigen determinants. Dendritic cells which are abundantly present in smokers' lungs are important link between innate and adaptive immunity involving T-cells. These cells mature and migrate to draining lymphatic organs, where they could present antigens to CD-4+ and CD-8+. T-cells that induce their activation and differentiation. As a result T-cells are important component of the chronic inflammation in smokers and in COPD patients. So one of the possible conclusions could be that COPD is a disease produced, at least in part, by self-antigens from the lung secondary to smoking.