Predicting Mortality for COVID-19 Patients Admitted to an Emergency Department Using Early Warning Scores in Poland.

COVID-19 disease is characterised by a wide range of symptoms that in most cases resemble flu or cold. Early detection of infections, monitoring of patients' conditions, and identification of patients with worsening symptoms became crucial during the peak of pandemic. The aim of this study was to assess and compare the performance of common early warning scores at the time of admission to an emergency department in predicting in-hospital mortality in patients with COVID-19. The study was based on a retrospective analysis of patients with SARS-CoV-2 infection admitted to an emergency department between March 2020 and April 2022. The prognostic value of early warning scores in predicting in-hospital mortality was assessed using the receiver operating characteristic (ROC) curve. Patients' median age was 59 years, and 52.33% were male. Among all the EWS we assessed, REMS had the highest overall accuracy (AUC 0.84 (0.83-0.85)) and the highest NPV (97.4%). REMS was the most accurate scoring system, characterised by the highest discriminative power and negative predictive value compared to the other analysed scoring systems. Incorporating these tools into clinical practice in a hospital emergency department could provide more effective assessment of mortality and, consequently, avoid delayed medical assistance.

Cardiac valvular involvement in granulomatosis with polyangiitis in long-term observation.

INTRODUCTION AND OBJECTIVES: Granulomatosis with polyangiitis (GPA) is an antineutrophil cytoplasmic autoantibody (ANCA)-associated systemic vasculitis and is characterized by inflammation of blood vessels. The aim of the present study was to assess cardiac valvular changes in patients with GPA in a cohort of 105 patients followed for a mean of six years. METHODS: We followed 105 patients (mean age 50.4 years, 67 female) for a mean of 6.2±1.3 years. Echocardiography and laboratory tests were performed in all patients. RESULTS: At baseline, 43% of patients were diagnosed with aortic regurgitation (AR), which was the most common valvular lesion. Moreover, it was the only valvular involvement that significantly increased during observation (p=0.01). In a multivariate model, only D-dimer level was a predictor of AR in this group of patients (OR 8.0 (95% CI: 1.7-38.2, p=0.01). CONCLUSIONS: Involvement of the heart valves is a common finding in patients with GPA, but significant valvular disease is a rare complication. The most common valvular disease in this group of patients is AR. Aortic valves are also the most prone to degeneration in the course of the vasculitis.

Characteristics of osteoporotic vertebral fractures in association with symptomatic status in postmenopausal women - a retrospective study of a single centre in Poland.

INTRODUCTION AND OBJECTIVE: Vertebral compression fractures (VCFs), which are a complication of osteoporosis, often cause diagnostic and therapeutic difficulties. The aim of this study was to find association between the characteristics of VCFs and the symptomatic status of patients. MATERIAL AND METHODS: The study involved a total of 437 women with diagnosed postmenopausal osteoporosis (193 with at least one compression fracture and 244 without VCFs). To identify VCFs, all patients underwent morphometry using dual-energy X-ray absorptiometry. Based on the history of VCFs, subjects were divided into two groups: with symptomatic (n=59) and asymptomatic (n=134) VCFs. RESULTS: Each patient had, on average, 2.03 ± 1.50 VCFs. Patients with VCFs were older [p<0.001] and shorter [p<0.001] than those without VCFs. VCFs located in the thoracic spine and the lumbar spine occurred with similar frequency (p=0.112). Multiple fractures in both spine segments (50.13%) were more frequent than fractures limited to only one section of the spine, either thoracic (22.76%) or lumbar (27.11%). The decreasing number of subjects was exponentially associated with the increasing number of VCFs (p<0.001). Symptomatic patients compared to asymptomatic patients had a higher serum concentration of 25-hydroxyvitamin D, and lower serum activity of alkaline phosphatase (p<0.01; p<0.005, respectively). In the lumbar spin, the risk of symptomatic VCFs was more than twofold higher compared to asymptomatic VCFs (p <0.001, OR=2.57, 95% CI: 1.57-4.19). Symptomatic status depended on the number of lumbar VCFs (p<0.001, OR=2.47, 95% CI: 1.68-3.63), as well as higher T-score L1-L4 (p=0.009, OR=1.43, 95% CI: 1.09-1.88). CONCLUSIONS: Patients' symptomatic status depends on the location and number of VCFs, as well as T-score L1-L4.

Predictors of cardiovascular events in patients with primary systemic vasculitis: A 5 years prospective observational study.

INTRODUCTION: Granulomatosis with polyangiitis (GPA) is one of antineutrophil cytoplasmic autoantibody (ANCA) - associated systemic vasculitis and is characterised by inflammation of blood vessels. Systemic vasculitis exhibits an enhanced cardiovascular morbidity and cardiovascular disease (CVD) has become a leading cause of death in this group of patients. OBJECTIVES: The aim of the present study was to assess the prevalence of clinical manifestation of atherosclerosis and its relation with classic risk factors for atherosclerosis, echocardiographic parameters and laboratory findings in GPA patients. PATIENTS AND METHODS: The group of consecutive patients with GPA were followed in the study. RESULTS: One hundred six patients with GPA (mean age 50.4 ± 14.9 yrs, 67 female) were prospectively followed for 5.1 ± 1.6 yrs. In 19 patients (18%) cardiovascular disease (9 acute coronary syndromes, 4 symptomatic peripheral vascular diseases and 6 strokes) occurred in association with GPA. In a multivariate model, only age was predictive of cardiovascular events in this group of patients (OR=1.078, 95% CI: 1.025-1.134, p = 0.003). During observation in patients without CVD the level of hs-CRP and D-dimer were significantly reduced on the follow-up visit (p = 0.041, p = 0.0002). On the other hand, in patients with CV events there was no significant differences in both markers' concentrations despite clinical remission. CONCLUSIONS: The age was the only independent predictor of cardiovascular events. Persistent elevation of inflammatory and prothrombotic markers despite clinical remission of the disease could be an indicator of premature atherosclerosis development in patients with systemic vasculitis.

Current Applications and Selected Technical Details of Dual-Energy X-Ray Absorptiometry.

The application of dual-energy X-ray absorptiometry (DXA) examinations in the assessment of bone mineral density (BMD) in the lumbar spine, hip, and forearm is the basic diagnostic method for recognition of osteoporosis. The constant development of DXA technique is due to the aging of societies and the increasing importance of osteoporosis as a public health problem. In order to assess the degree of bone demineralization in patients with hyperparathyroidism, forearm DXA examination is recommended. The vertebral fracture assessment (VFA) of the thoracic and lumbar spine, performed by a highly-skilled technician, is an interesting alternative to the X-ray examination. The DXA total body examination can be useful in the evaluation of fat redistribution among patients after bariatric surgery, in patients infected with HIV and receiving antiretroviral therapy, and in patients with metabolic diseases and suspected to have sarcopenia. The assessment of visceral adipose tissue (VAT) and detection of abdominal aortic calcifications may be useful in the prediction of cardiovascular events. The positive effect of anti-resorptive therapy may affect some parameters of DXA hip structure analysis (HSA). Long-term anti-resorptive therapy, especially with the use of bisphosphonates, may result in changes in the DXA image, which may herald atypical femur fractures (AFF). Reduction of the periprosthetic BMD in the DXA measurements can be used to estimate the likelihood of loosening the prosthesis and periprosthetic fractures. The present review aims to present current applications and selected technical details of DXA.

Radiological markers of granulomatosis with polyangiitis with nasal involvement.

INTRODUCTION: Granulomatosis with polyangiitis (GPA) is an autoimmune disease leading to necrotizing lesions in the affected tissues. Computed tomography (CT) of paranasal sinuses reveals multiple lesions in patients with GPA, for example, sinus opacification, bone / cartilage destruction, and neoosteogenesis. OBJECTIVES: We aimed to describe and compare CT lesions found in patients with GPA and those with chronic rhinosinusitis (CRS) and to propose a new radiological marker of GPA-nasal strands. PATIENTS AND METHODS: This retrospective study (2014-2019) included 53 patients with GPA (22 men, 31 women) at a median (interquartile range) age of 45 (34-60) years. Computed tomography findings of mucosal lesions in paranasal sinuses, neoosteogenesis, bony and cartilaginous lesions, and nasal strands were analyzed. Nasal strands were described as intermucosal adhesions resembling bands. A total of 71 patients with CRS (reference group) were assessed for the presence of the same parameters. RESULTS: Computed tomography scans showed mucosal lesions in the sinuses of 35 patients (66%) with GPA. Nasal septum perforation was observed in 19 patients (35.8%), neoosteogenesis in 17 (32.1%), and bone damage in 14 (26.4%). External nose deformity was present in 16 patients (30.2%). Nasal strands on CT were found in 36 patients with GPA (68%) and 32 patients with CRS (45%). The presence of 5 or more strands was more characteristic of GPA than CRS (P <0.001). A positive correlation was found between the number of strands greater than or equal to 5 and the presence of proteinase 3 antineutrophil cytoplasmic antibodies (P = 0.046). CONCLUSIONS: Nasal strands, a parameter reflecting pathologic mucus and atrophic lesions (tissue loss), should have a place in CT evaluation of the nasal cavities in patients suspected of or diagnosed with GPA.

A cross-sectional comparison of selected anthropometric, laboratory, and densitometric parameters in postmenopausal osteoporotic women with and without vertebral compression fractures.

INTRODUCTION: Osteoporosis leads to an increased risk of vertebral compression fractures (VCFs). Most of them are spontaneous, which makes early diagnosis difficult. The aim of the study was to find parameters that distinguish osteoporotic women with and without vertebral compression fractures. MATERIAL AND METHODS: A total of 437 women with postmenopausal osteoporosis were enrolled to the study. Based on the results of densitometric vertebral fracture assessment, patients were divided into 2 groups: with (n = 193) and without (n = 244) VCFs. Then selected anthropometric, laboratory, and densitometric parameters as well as questionnaire data were compared. RESULTS: The following distinguishing factors were found among patients with VCFs in comparison to patients without such fractures: older age- 73.93 years vs. 69.63 years [p(1) < 0.001, p(2) < 0.001], shorter height - 1.56 m vs. 1.58 m [p(4) < 0.001], lower value of glomerular filtration rate (GFR) according to Cockcroft-Gault formula - 58.22 mL/min. vs. 66.25 mL/min. [p(1) < 0.025, p(2) = 0.002], lower peripheral blood haemoglobin and serum albumin concentration (OR = 1.24, 95% CI: 1.02-1.51, p(5) = 0.03; OR = 2.29, 95% CI: 1.09-4.80, p(5) = 0.03, respectively), and higher 10-year risk of major osteoporotic fracture (FRAX MOF) -12.01% vs. 9.69% [p(1) < 0.01, p(2) < 0.001] and hip fracture (FRAX HIP) - 3.85% vs. 2.55% [p(1) < 0.01, p(2) < 0.001]. In addition, among patients with VCFs a greater severity of back pain was found in the 11-grade scale of pain intensity - 6.12 vs. 4.29 [p(1) < 0.001, p(2) < 0.001, p(3) < 0.001]. The bone mineral content (BMC) and bone mineral density (BMD) of the hip were lower in patients with VCFs - 25.25 vs. 26.2 g and 0.72 g/cm² vs. 0.75 g/cm², respectively [p(4) = 0.04 and p(4) < 0.001, respectively]. CONCLUSIONS: Patients with VCFs were characterised by greater back pain intensity, higher fracture risk according to the FRAX calculator, and lower values of the following: GFR according to Cockcroft-Gault formula, peripheral blood haemoglobin and serum albumin concentration, and BMD of the hip. Further studies are required to validate the FRAX calculator to assess not only the risk of future fractures but also unrecognised VCFs.

Comparison of the Characteristics of Back Pain in Women with Postmenopausal Osteoporosis with and without Vertebral Compression Fracture: A Retrospective Study at a Single Osteoporosis Center in Poland.

BACKGROUND The incidence of unspecific back pain and osteoporotic vertebral compression fractures increases significantly with age. Considering the difficulties in the diagnosis of spontaneous osteoporotic vertebral fractures, this retrospective study aimed to compare the characteristics of back pain in women with postmenopausal osteoporosis with and without vertebral compression fractures. MATERIAL AND METHODS This study enrolled 334 women with postmenopausal osteoporosis; 150 had vertebral fractures, and 184 had no vertebral fractures. Densitometric vertebral fracture assessment and bone mineral density measurements in the central skeleton were performed for each patient. The participants completed a survey about features of their back pain. RESULTS Patients with vertebral fractures had more severe back pain based on the numeric rating scale: 6.14 vs. 4.33 (P<0.001, odds ratio [OR]=1.43, 95% confidence interval [CI]: 1.29-1.59). Among these individuals, back pain caused reduction in normal activity during the day (P<0.001, OR=4.68, 95% CI: 2.86-7.68), and pain occurred more often (P<0.001, OR=1.77, 95% CI: 1.47-2.13), lasted longer (P<0.001, OR=2.01, 95% CI: 1.65-2.46), predominantly occurred in the lumbar spine (P<0.001, OR=4.70, 95% CI: 1.96-11.29), and intensified during normal everyday activities (P<0.001). Based on these results, a new survey was created. It demonstrated a sensitivity of 70.67% and a specificity of 67.37% in predicting a current compression fracture. CONCLUSIONS Patients with vertebral compression fractures experience higher pain intensity and exhibit specific features of back pain. The new survey can be considered a supportive tool in assessing the possibility of vertebral compression fractures.

Convalescent plasma treatment is associated with lower mortality and better outcomes in high-risk COVID-19 patients - propensity-score matched case-control study.

OBJECTIVE: This study aimed to investigate the efficacy and safety of convalescent plasma (CP) transfusion in a group of high-risk COVID-19 patients. METHODS: This prospective study included 204 patients from a single tertiary-care hospital, hospitalized with COVID-19, of whom 102 were treated with CP administration and standard care (PG) and 102 others who received standard care only (CG). The CG was selected from 336 hospitalized patients using the propensity-score matching (PSM) technique using age, MEWS score, and comorbidities. The primary outcome was mortality rate; secondary outcomes were the requirement of a ventilator, length of ventilator need, length of intensive care unit (ICU) stay, and length of overall hospital confinement. Additionally, parameters predicting death in COVID-19 patients were identified. RESULTS: Findings confirmed a significantly lower mortality rate in the PG versus the CG (13.7% vs. 34.3 %, p = 0.001) and a significant difference in the cumulative incidence of death between the two groups (p < 0.001). CP treatment was associated with lower risk of death (OR = 0.25 CI95 [0.06; 0.91], p = 0.041). There were no significant differences in ICU stay, ventilator time, and hospitalization time between the two groups. CONCLUSIONS: A significantly lower mortality rate was observed in the group of patients treated with CP. Age, presence of cardiac insufficiency, active cancer, a ventilator requirement, and length of hospitalization significantly increased the risk of death in both groups. Our study shows that CP affords better outcomes when administrated in the earlier stage of high-risk COVID-19 disease.

Clinical characteristics and short-term outcomes of patients with coronavirus disease 2019: a retrospective single-center experience of a designated hospital in Poland.

INTRODUCTION: Since the first reported case of coronavirus disease 2019 (COVID­19) in Poland, the worldwide pandemic has spread throughout the country, leading to many hospital admissions. There has been an urgent need to determine clinical characteristics of Polish patients with laboratory­confirmed severe acute respiratory syndrome coronavirus 2 (SARS­CoV 2) infection in the clinical setting. OBJECTIVES: The aim of this retrospective study was to outline characteristics and short­ term outcomes of SARS­CoV­2-positive patients. PATIENTS AND METHODS: We retrospectively assessed 169 consecutive patients with laboratory­ confirmed COVID­ 19 with regard to their clinical manifestations, radiological findings, treatment, complications, and outcomes. RESULTS: Of the 169 patients, more than half was aged 65 years or older (88; 52.1%), 51.5% were male, and 78.3% had comorbidities. The majority of patients (106; 62.7%) were transferred from outbreak locations in medical facilities. The most common symptoms on admission were fever (42%), shortness of breath (35%), and fatigue (33%). Twenty seven (15.4%) patients required intensive care unit admission. Overall mortality was 26.3% (n = 46) and was significantly higher in patients transferred from other facilities (38 out of 106; 35.8%), than in patients admitted directly to the hospital (8 out of 63; 12.69%; P <0.001). Seventeen out of 29 patients admitted to the intensive care unit died (mortality, 58.6%), including 30 out of 41 patients with acute respiratory distress syndrome (73.2% mortality rate). CONCLUSIONS: Polish patients with COVID­19 have similar characteristics and risk factors for adverse outcomes to those observed in countries in which outbreaks occurred earlier. Significantly higher mortality in patients transferred from other centers warrants special attention and transfer policy should be verified.

Elevated levels of d-dimer are associated with inflammation and disease activity rather than risk of venous thromboembolism in patients with granulomatosis with polyangiitis in long term observation.

PURPOSE: Granulomatosis with polyangiitis (GPA) is one of antineutrophil cytoplasmic autoantibody (ANCA) - associated vasculitis. The disease is characterized by necrotizing inflammation of small vessels causing tissue ischemia in a variety of organs. The aim of the present study was an evaluation of inflammation, coagulation and fibrinolysis biomarkers, and their possible associations with various clinical and laboratory parameters in GPA patients. METHODS: A group of 100 consecutive patients with GPA were prospectively followed in the study. In all patients, echocardiography and laboratory tests were performed. RESULTS: The patients were followed-up for a median of 4.0 ± 1.9 years. Circulating d-dimer concentrations were elevated in a majority (56%) of GPA patients, and were significantly higher in GPA patients in the active stage compared to those in remission (median 652 vs. 405 ng/ml, p = 0.0002). In 23 patients (23%) venous thromboembolism (VTE) was diagnosed during observation. However, there were no differences in d-dimer concentrations between patients with and without VTE either in active stage or in remission. Correlation analysis showed that the levels of d-dimer correlated with hs-CRP (r = 0.42, p < 0.0001) and creatinine concentrations (r = 0.58; p < 0.0001), but not with ANCA levels. CONCLUSIONS: In patients with GPA elevated levels of d-dimer are associated with disease activity and inflammation rather than with the risk of venous thromboembolism. The value of d-dimer as a biomarker of venous thromboembolism episodes in patients with small vessel vasculitis is low.

Neutrophil extracellular traps generation and degradation in patients with granulomatosis with polyangiitis and systemic lupus erythematosus.

Neutrophils are one of the first cells to arrive at the site of infection, where they apply several strategies to kill pathogens: degranulation, respiratory burst, phagocytosis, and release of neutrophil extracellular traps (NETs). Recent discoveries try to connect NETs formation with autoimmune diseases, like systemic lupus erythematosus (SLE) or granulomatosis with polyangiitis (GPA) and place them among one of the factors responsible for disease pathogenesis. The aim of the study was to assess the NETotic capabilities of neutrophils obtained from freshly diagnosed autoimmune patients versus healthy controls. Further investigation involved assessing NETs production among treated patients. In the latter step, NETs degradation potency of collected sera from non-treated patients was checked. Lastly, the polymorphisms of the DNASE I gene among tested subjects were checked. NETs formation was measured in a neutrophil culture by fluorometry, while degradation assessment was performed with patients' sera and extracellular source of DNA. Additionally, Sanger sequencing was used to check potential SNP mutations between patients. About 121 subjects were enrolled into this study, 54 of them with a diagnosed autoimmune disorder. Neutrophils stimulated with NETosis inducers were able to release NETs in all cases. We have found that disease affected patients produce NETs more rapidly and in larger quantities than control groups, with up to 82.5% more released. Most importantly, we showed a difference between the diseases themselves. NETs release was 68.5% higher in GPA samples when compared to SLE ones while stimulated with Calcium Ionophore. Serum nucleases were less effective at degrading NETs in both autoimmune diseases, with a reduction in degradation of 20.9% observed for GPA and 18.2% for SLE when compared with the controls. Potential therapies targeting neutrophils and NETs should be specifically tailored to the type of the disease. Since there are significant differences between NETs release and disease type, a standard neutrophil targeted therapy could prevent over-generation of traps in some cases, while in others it would deplete the cells, leaving the immune system unresponsive to primary infections.

[A cough in a patient with cholangitis in the course of caroli's disease. Case report].

Cough may be a manifestation of pulmonary and extra-pulmonary diseases. However, rarely liver disease is suspected as a cause of acute cough. A case of a 34-year-old patient with diagnosed Caroli's disease has been described, in which cough with fever was the main manifestation of cholangitis in the course of complications of the underlying disease. Caroli's disease is a congenital pathology of intrahepatic bile ducts, causing their cysts to widen. It usually has an asymptomatic course, however it promotes infectious complications such as liver abscesses and recurrent cholangitis. The patient was admitted to the ward because of high fever and cough, without any symptoms from the digestive system. On the basis of laboratory, microbiological and visual examinations, various causes of cough were excluded and a diagnosis of cholangitis was made. After appropriate antibiotic therapy, a rapid improvement in the clinical condition and resolution of symptoms was achieved.

[Kounis syndrome - allergic myocardial infarction. a case report].

Kounis syndrome or allergic myocardial infarction is an acute coronary syndrome in the course of an allergic reaction. In allergic patients in response to a specific condition - nourishment, inhalation, environmental substances, drug or insect bite there is an allergic reaction involving many different cells and mediators that can cause coronary artery spasm or initiate the process of rupture and activation of atherosclerotic plaque resulting in acute coronary syndrome. The paper describes a case of a young man with allergy to pollen and confirmed sensitization to nuts, who developed a full-blown anaphylactic shock after eating the nut mix and experienced a rapidly passing acute coronary syndrome with troponin up to 4.7 µg/L. An increased concentration of tryptase (15 µg/L), total IgE (> 3,000 IU/mL) and specific anti-nut IgE (55.1 kUA/L) were found. Based on the course of the disease and the results of allergic and cardiac tests, allergic type 1 myocardial infarction, i.e. caused by coronary artery spasm, was diagnosed. During the hospitalization, the patient's condition improved quickly and after a few days he left the hospital without the signs of permanent damage to the heart muscle.

High incidence of venous thromboembolism but not of coronary artery disease in granulomatosis with polyangiitis in first years after diagnosis.

Objectives: Granulomatosis with polyangiitis (GPA), previously known as Wegener's granulomatosis, is one of antineutrophil cytoplasmic autoantibody (ANCA) - associated vasculitis. In patients with GPA an increased incidence of venous thromboembolism (VTE), mainly during active disease, has been described. The aim of the present study was to assess the incidence of VTE and its relation with classic risk factors for atherosclerosis, presence of coronary artery disease (CAD), echocardiographic parameters and laboratory findings in GPA patients. Methods: The group of consecutive patients with GPA were followed in the study. In all patients echocardiography and laboratory tests were performed. Results: Ninety six patients with GPA were followed for mean 3 years. In 16 patients (16.6%) VTEs occurred in association with GPA, of which 56% occurred 6 months before or one year after diagnosis of GPA. Classic risk factors for atherosclerosis were present in 77 patients (80.2%) at some moment during follow-up. In patients with VTE there were larger right ventricle diameter (p=0.041) and higher right ventricle systolic pressure (p=0.022) observed. VTEs occurred significantly less frequently in patients treated with cyclophosphamide (p=0.049). In this study group VTE occurred more frequently than CAD: 16 (16.7%) vs. 4 (4.2%); p=0,0049. Patients with VTE were younger than those with CAD (p=0.053) and had higher levels of ANCA-PR 3 (p=0.016). Conclusions: Patients with granulomatosis with polyangiitis in first years after diagnosis have higher risk of venous thromboembolism than coronary artery disease. This finding is probably related to hypercoagulability induced by the disease and its therapy.

[Emphysematous cystitis in a patient with type-1diabetes mellitus - diagnostic difficulties].

A case report of 28 year old female with medical history of bed controlled type 1 diabetes mellitus complicated by autonomic neuropathy in the form of gastroparesis, suffered by emphysematous cystitis caused by Escherichia coli was described. Emphysematous cystitis is a rare urinary tract infection connected with the presence of gas in the bladder lumen or/and within the bladder wall, which occurs mainly in women, in older age, suffering from type 2 diabetes, complicated by microangiopathy, neuropathy, with urinary tract obstruction and weakness of immunity system. Diagnostic difficulties and the delay in correct diagnosis in described case were caused by the dominated complaint of the upper gastrointestinal tract and difficulties in interpretation of imaging methods, such as abdominal X-ray and ultrasound scan. Eventually the use of computed tomography allowed to achieved an accurate diagnosis and choose appropriate treatment. It is possible that this is the first case of emphysematous cystitis described in Poland.

Tuberculosis of the Urogenital Tract in Adults in a Tertiary Referral Center.

The genitourinary system is the main location of extrapulmonary tuberculosis. In Poland, it occupies the third place after tuberculosis of the pleura and lymph nodes. The aim of this study was to evaluate the prevalence and characteristics of tuberculosis in the urogenital tract in adult patients in a tertiary referral center in the years 2007-2015. The retrospective study included 87 patients, 42 women and 45 men. The average age was 62 ± 15 years. Changes in the urinary tract were diagnosed in 91% of women and 64% of men. Testicular tuberculosis was found in ten men, prostate tuberculosis in five, and in individual cases tuberculosis of the epididymis, scrotum, uterus, and the fallopian tube were found. The diagnosis was confirmed by bacteriological methods in 47% of patients, by histopathological in 41%, and by molecular methods in 23% of patients. In 84% of patients urological or gynecological interventions had to be applied. Patients were burdened with a number of urological diseases or diseases affecting other systems which hampered the diagnosis of tuberculosis. Antituberculosis treatment gave good results. Urogenital tuberculosis is a multivariate disease and a standard unified approach is impossible.

SERPINA1 Gene Variants in Granulomatosis with Polyangiitis.

Alpha-1 antitrypsin (A1AT) deficiency is one of the most common genetic disorders in Caucasian population. There is a link between granulomatosis with polyangiitis (GPA) and most frequent variants of SERPINA1 gene encoding severe alpha-1 antitripsin deficiency. However, the potential effect of Pi*Z, Pi*S as well as other SERPINA1 variants on clinical course of vasculitis are not well understood. The aim of the study was to analyze the potential effect of A1AT protein phenotype representing the SERPINA1 gene variants on the clinical course of GPA. The study group consisted of 64 subjects with GPA, stratified according to the disease severity: patients in active phase (group I, n = 12), patients during remission on treatment (group II, n = 40) or untreated (group III, n = 12). Normal Pi*MM SERPINA1 genotype was detected by means of real-time polymerase chain reaction (PCR) or direct sequencing in 59 patients, Pi*MZ genotype in 2, and Pi*IM, Pi*MS or Pi*SZ in 1 patient respectively. The patients with abnormal Pi*Z, Pi*S, or Pi*I allele constituted 17% in group I, 5% in group II, and 8% in group III. The serum content of A1AT and high sensitivity C-reactive protein (hsCRP) assessed by nephelometry did not differ between the groups. Interestingly, the mean serum antiPR3-antibodies level detected by Elisa method was significantly greater in the GPA patients with Pi*Z, Pi*S, or Pi*I SERPINA1 variants than in the Pi*MM homozygotes. In summary, heterozygous Pi*MZ, Pi*MS, and Pi*SZ genotype was detected in 7.8% of total group of GPA patients, and in 10.5% of those with lung lesions. The abnormal alleles of Pi*S and Pi*Z may affect the clinical course of the disease.

Clinical Manifestations of Huge Diaphragmatic Hernias.

Translocation of abdominal organs into the thoracic cavity may cause dyspnea, heart disorders, and gastric symptoms. Diaphragmatic hernias can cause diagnostic difficulties, since both clinical and radiological symptoms might imitate different disorders. In these cases computed tomography of the chest is the method of choice. The aim of this study was to assess clinical manifestations, risk factors, and prognosis in patients with huge diaphragmatic hernias with displacement of abdominal organs into the thorax, depending on the action taken. We carried out a retrospective study using data of patients hospitalized in the years 2012-2016. Ten patients were qualified for the study (8 women and 2 men). The mean age of the subjects was 86.5 ± 10.5 years. Thirty percent of the hernias were post-traumatic. All of the patients reported cardiovascular or respiratory symptoms. Upper gastrointestinal symptoms occurred in half of the patients. Twenty percent of patients underwent surgery with a positive outcome, while 30% of patients, who were not qualified for surgery due to numerous co-morbidities, died. The main risk factors predisposing to the occurrence of large diaphragmatic hernias were the following: old age, female gender, and thoracic cage deformities.