Late diagnosis of HIV infection in Warsaw: Estimating the scale of the problem and demographic trends.

BACKGROUND: Late diagnosis of a significant number of people with HIV remains a problem. This study analysed 1711 patients from the Hospital for Infectious Diseases in Warsaw who were diagnosed with HIV infection in 2008-2010 and 2016-2018. METHODS: Patients with late diagnosis and advanced disease were distinguished on the basis of the consensus definition. In statistical analysis, non-parametric tests were used to compare the groups: the χ2 test for categorized data and the Mann-Whitney U test for the comparison of continuous variables. RESULTS: There were no statistically significant differences in the percentage of patients with early diagnosis, late diagnosis, advanced disease and patients with an indicator disease between the two analysed periods in the Warsaw centre. A much higher percentage of men than women was found. The dominant route of acquisition among newly diagnosed patients and among late presenters in both periods were men who have sex with men (MSM). The highest percentage of patients with late diagnosis was among heterosexual men and the lowest was among MSM in both periods. CONCLUSIONS: The results of the analysis of patients from the Warsaw centre confirmed that late diagnosis of HIV infection continues to be a problem, with no improvement seen over the analysed periods, although the scale of the problem is smaller than in national and European statistics. MSM and heterosexual men appear to be key groups in need of intensified testing.

Is the definition of late diagnosis correct?

BACKGROUND: The study analysed 1711 patients of the Hospital for Infectious Diseases in Warsaw diagnosed with HIV infection in 2008-2010 and 2016-2018. Research was conducted examining the changes in CD4 cell counts before starting antiretroviral (ARV) treatment in order to find people who were misclassified as late-diagnosed. METHODS: Patients with late diagnosis were distinguished on the basis of the consensus definition. The Mann-Whitney U-test was used to analyse the change in CD4 cell counts before starting ARV treatment. RESULTS: In the years 2008-2010, the CD4 count was remeasured before starting ARV treatment in 90 late-diagnosed patients. The median change in the CD4 count was 22 cells/µL. In 49 of these, the number of CD4 cells spontaneously increased before the start of treatment. We can suspect that these patients were misclassified as late-diagnosed. CONCLUSIONS: The consensus definition of late diagnosis often leads to overestimation of the number of late-diagnosed patients. The crucial problem is a transient decline in the CD4 lymphocyte count in the acute phase of HIV infection. A potential solution is to introduce serum HIV viral load measurement into the definition.

Higher Immunological Response after BNT162b2 Vaccination among COVID-19 Convalescents-The Data from the Study among Healthcare Workers in an Infectious Diseases Center.

Introduction: The BNT162b2 vaccination studies did not specifically focus on groups that were heavily exposed to SARS-CoV-2 infection. Therefore, we aimed to assess the safety and efficacy of the BNT162b2 vaccine among healthcare workers (HCWs). Methods: Study participants were recruited from hospital employees who received BNT162b2 vaccination at the Hospital for Infectious Diseases in Warsaw. Blood samples were collected before and after each vaccination dose. At each timepoint, the levels of anti-SARS CoV-2 IgM, anti-n SARS-CoV-2 IgG, and S-RBD antibodies were measured. Data on concomitant diseases and the vaccine's adverse events (VAE) were collected after each vaccination dose. In the statistical analyses, non-parametric tests were used. Results: In total, 170 healthcare workers were included in the analysis. Their median age was 51 years (interquartile range (IQR): 41−60 years); most of them were women (n = 137, 80.6%) working in direct contact with patients (n = 137, 73.2%); and 46 (27.0%) had concomitant diseases. More than one fifth of subjects had COVID-19 before their first dose of vaccination (n = 38, 22.6%). In terms of immunological responses, our investigations showed a high level of efficacy for the BNT162b2 mRNA vaccination as measured by S-RBD antibody concentrations: these were positive in 100% of participants 14 days after the second dose of the vaccine. It was also observed that employees with high S-RBD antibodies (>=433 BAU/mL) were more likely to be COVID-19 convalescents before receiving the first vaccine dose (p < 0.001). Conclusion: The BNT162b2 vaccine is safe and effective among HCWs. Vaccine adverse events occurred, but serious events were not observed. Moreover, the BNT162b2 vaccine is effective against symptomatic and severe COVID-19­none of the workers that acquired a SARS-CoV-2 infection after vaccination required hospitalization or medical care. We also observed higher immunological responses among COVID-19 convalescents.

The Clinical Course and Outcomes of Patients Hospitalized Due to COVID-19 during Three Pandemic Waves in Poland: A Single Center Observational Study.

Background: The first case of coronavirus disease 2019 (COVID-19) in Poland was reported on 4 March 2020. We aim to compare the clinical course and outcomes of patients hospitalized in the Hospital for Infectious Diseases in Warsaw due to COVID-19 during three pandemic waves. Materials and methods: The medical data were collected for all patients diagnosed with COVID-19 hospitalized in our hospital from 6 March 2020 till 30 November 2021. COVID-19 diagnosis was confirmed by nasopharyngeal swabs using real-time polymerase chain reaction assay (RT-PCR) or SARS-CoV-2 antigen test. COVID-19 waves were defined based on the number and dynamics of cases. Results: Altogether, 2138 patient medical records were analyzed. The majority of the cohort was male (1235/2138, 57.8%), and the median age was 65 years [IQR: 50−74 years]. Patients hospitalized during the third wave had lower oxygen saturation on admission (p < 0.001) and were more likely to receive oxygen supplementation (p < 0.001). Serious complications, including pneumothorax (p < 0.001) and thromboembolic complications (p < 0.001), intensive care unit admission (p = 0.034), and death (p = 0.003), occurred more often in patients of the third wave. Conclusions: During the third wave, patients in our cohort experienced a more severe course of the disease and poorer outcomes.

The Beneficial Effect of the COVID-19 Vaccine Booster Dose among Healthcare Workers in an Infectious Diseases Center.

Introduction: Healthcare workers in Poland received a booster dose of the BNT162b2 mRNA vaccine (Pfizer-BioNTech, Manufacturer: Pfizer, Inc., and BioNTech; Moguncja, Germany) at the beginning of October 2021. Here, we report on the preliminary results of an ongoing clinical study into the antibody response to SARS-CoV-2 of healthcare workers previously exposed to the virus, with or without evidence of past infection, in the Hospital for Infectious Diseases in Warsaw before and after the vaccine booster dose. Methods: Blood samples were collected on the day the vaccine booster dose was administered and again 14 days later. The levels of SARS-CoV-2 IgG antibodies (against the n-protein, indicative of disease) and S-RBD (indicative of a response to vaccination) were measured. Results: One hundred and ten health care workers from the Hospital for Infectious Diseases were included in the study. The percentage of subjects with a positive test for anti-n-protein IgG antibodies at both time points remained unchanged (16, 14%), while a statistically significant increase in the percentage of subjects producing high levels of S-RBD antibodies (i.e., >433 BAU/mL) was observed (from 23, 21% to 109, 99%; p = 0.00001). Conclusions: The results of the study indicate that the booster dose of the vaccine significantly increases the percentage of people with high levels of S-RBD antibodies, regardless of previous contact with the virus, which may indicate greater protection against both the disease and a severe course of COVID-19.

Fleeting Beauty-The World of Plant Fragrances and Their Application.

This article is devoted to some aspects of the fragrant substances of plant origin applied in the food industry and perfumery as well. Since antiquity many extractive techniques have been developed to obtain essential oils. Some of them are still applied, but new ones, like microwave or ultrasound-assisted extractions, are more and more popular and they save time and cost. Independently of the procedure, the resulting essential oils are the source of many so-called isolates. These can be applied as food additives, medicines, or can be used as starting materials for organic synthesis. Some substances exist in very small amounts in plant material so the extraction is not economically profitable but, after their chemical structures were established and synthetic procedures were developed, in some cases they are prepared on an industrial scale. The substances described below are only a small fraction of the 2000-3000 fragrant molecules used to make our life more enjoyable, either in food or perfumes. Additionally, a few examples of allelopathic fragrant compounds, present in their natural state, will be denoted and some of their biocidal features will be mentioned as an arising "green" knowledge in agriculture.

Effect of Aqueous Extracts from Solidago Canadensis L. Leaves on Germination and Early Growth Stages of Three Cultivars of Raphanus Sativus L. Var. Radicula Pers.

Solidago canadensis L. is an expansive perennial that forms persistent, species-poor plant communities. It often spreads in fallow areas, displacing native floristic ingredients. Its expansiveness is largely due to morphological features, but it can also be the effect of allelopathic interaction. The aim of the experiment was to investigate the effect of aqueous extracts (decoction, infusion, and maceration) from dry S. canadensis leaves on germination and early growth stages of Raphanus sativus L. var. radicula Pers., in three cultivars: 'Rowa', 'Póldluga', and 'Krakowianka'. In comparison to the control, the percentage of germinated radish seeds of 'Rowa' cultivar was statistically lower on the infusion and macerate. Regardless of the cultivar, the smallest changes in germination were found in seeds watered with decoction, and the largest with macerate. Seedlings length was most inhibited on macerate substrates, and least with infusion. Regardless of the form of the extract, each of them negatively affected the initial growth of radish seedlings. A fresh mass of 'Rowa' seedlings was inhibited by all Canadian goldenrod extracts. In relation to the control, the 'Krakowianka' cultivar was the least sensitive to S. canadensis extracts. The total chlorophyll content was the lowest in the seedlings of the 'Rowa' and 'Póldluga' cultivars germinated on macerate, compared to the control and two others extracts. The percentage of electrolyte leakage depended on the type of extract used and the radish cultivar. The study showed that depending on the cultivar, the aqueous extracts from S. canadensis leaves decreasing of germination and early growth of R. sativus.

Advanced age and increased CRP concentration are independent risk factors associated with Clostridioides difficile infection mortality.

Clostridioides difficile (C.difficile) is a Gram-positive, spore-forming, toxin-producing anaerobic bacillus, which is one of the most common causes of health-care-associated infection developed mainly by elderly patients. The objective of this study was to assess mortality among the patients of the Hospital for Infectious Diseases in Warsaw related to C.difficile infection. Analysis was conducted of 1638 records reporting the medical histories of patients hospitalized for the first time due to Clostridioides difficile infection (CDI) in the Hospital for Infectious Diseases in Warsaw from 2010 to 2017. The inclusion criteria were any (principal or secondary) discharge diagnosis code for CDI according to ICD-10 and being an adult (≥ 18 years). 108 out of 1638 (7%) of the patients died. The median age in this group was 83 years. The largest number of deaths (90%) occurred in the group of patients aged 65 years or older and 81-90 years old (53% of all the deaths). In the multivariate logistic regression model relevant only to the age groups, not to sepsis-age over 80 and over 90 were independent predictors of death, increasing the risk of death by 3.4 and 1.8 times, respectively. The result of the receiver operating curve (ROC) analysis determined the age of 77 years as the threshold value, indicating the increased risk of death (AUC 0.727, standard error 0.025, 95% CI 0.678-0.776, p < 0.0001). In addition, other quantitative variables, namely CRP, creatinine and leucocytes were studied and turned out to be independent death predictors as well. The diagnosis of sepsis increased the risk of death fourfold (OR = 4.042; 95% Cl 2.4-6.7; p < 0.001). Increased inflammatory parameters, namely CRP and white blood cell count, advanced age, particularly over the age of 80, as well as a diagnosis of sepsis are independent risk factors for death and could be used as predictive markers of poor outcome in CDI.

Clinical Course and Outcome of Community-Acquired Bacterial Meningitis in Cancer Patients.

The aim of the study was to determine the course and outcome of bacterial meningitis (BM) in patients with cancer. We retrospectively reviewed files of patients with community-acquired BM, hospitalized in a single neuroinfection center between January 2010 and December 2017. There were 209 patients included in the analysis: 28 had cancer (9 women, 19 men; median age 76, IQR 67-80 years) and 181 were cancer-free (76 women, 105 men; median age 52, IQR 33-65 years) and constituted the control group. Cancer patients, compared with controls, were more likely to present with seizures (25% vs. 8%, p = 0.019), scored higher on the Sequential Organ Failure Assessment, and had a higher mortality rate (32% vs. 13%, p = 0.025). Further, cancer patients were less likely (64% vs. 83%, p = 0.033) to present with two or more out of four clinical manifestations of BM (pyrexia, neck stiffness, altered mental status, and headache) and had a lower white blood cell (WBC) count than non-cancer controls. In multiple regression analysis, the presence of bacterial meningitis in cancer patients was independently associated only with older age (p = 0.001) and lower WBC count (p = 0.007), while mortality was associated with lower Glasgow Coma Score (p = 0.003). In conclusion, bacterial meningitis in cancer patients is characterized by atypical symptoms and high mortality, which requires physicians' vigilance and a prompt investigation of cerebrospinal fluid in suspected cases. However, multiple regression analysis suggests that differences in clinical presentation and outcomes of bacterial meningitis between cancer and cancer-free patients may also be attributable to other factors, such as age differences.

The clinical course and outcome of Listeria monocytogenes meningitis: A retrospective single center study.

BACKGROUND: The aim of the study was to determine clinical manifestations and outcome of Listeria monocytogenes meningitis (LM) and to compare with other forms of bacterial meningitis (BM). MATERIAL AND METHODS: We analyzed records of all adult patients with BM who were hospitalized between January 2010 and December 2017 in the largest neuroinfection center in Poland. RESULTS: Out of 343 analyzed patients with BM 24 were diagnosed to have LM. Patients with LM were older compared to patients with other forms of BM (62 years vs. 57 years, p=0.039), were more likely to have cancer (16.7% vs. 4.7%, p=0.045), receive immunosuppressive treatment (45.8% vs. 10.7%, p<0.001), or be immunocompromised in any way (62.5% vs. 35.5%, p=0.016). Blood tests showed lower WBC (10.7 × 103 cells/µl vs. 15.5 × 103 cells/µl, p=0.004), C-reactive protein (150 mg/L vs. 221 mg/L, p=0,019) and procalcitonin (1.27 ng/mL vs. 3.78 ng/mL, p=0.003) in LM group. Analysis of cerebrospinal fluid showed lower cell count (531.5 cells/µL vs. 1100 cells/µL, p<0.001) and lower chloride (113 mmol/L vs. 117 mmol/L, p=0.036) in patients with LM. In the multiple logistic regression analysis, immunosuppressive therapy was the only variable independently associated with LM (OR:8.72, CI 95%:1.41-64.34, p=0.024). CONCLUSIONS: LM is associated with older age, cancer and immunosuppressive therapy. However, in multivariate analysis only immunosuppressive therapy turned out to be an independent risk factor for LM.

Chronic alcohol abuse affects the clinical course and outcome of community-acquired bacterial meningitis.

The aim of the study was to determine the effect of chronic alcohol abuse on the course and outcome of bacterial meningitis (BM). We analyzed records of patients with BM who were hospitalized between January 2010 and December 2017 in the largest neuroinfection center in Poland. Out of 340 analyzed patients, 45 (13.2%) were alcoholics. Compared with non-alcoholics, alcoholics were more likely to present with seizures (p < 0.001), scored higher on the Sequential Organ Failure Assessment (SOFA) (p = 0.002) and lower on the Glasgow Coma Scale (GCS) (p < 0.001), and had worse outcome as measured by the Glasgow Outcome Score (GOS) (p < 0.001). Furthermore, alcoholics were less likely to complain of headache (p < 0.001) and nausea/vomiting (p = 0.005) and had lower concentration of glucose in cerebrospinal fluid (CSF) (p = 0.025). In the multiple logistic regression analysis, alcoholism was associated with lower GCS (p = 0.036), presence of seizures (p = 0.041), male gender (p = 0.042), and absence of nausea/vomiting (p = 0.040). Furthermore, alcoholism (p = 0.031), lower GCS score (p = 0.001), and higher blood urea concentration (p = 0.018) were independently associated with worse outcome measured by GOS. Compared with non-alcoholics, chronic alcohol abusers are more likely to present with seizures, altered mental status, and higher SOFA score and have an increased risk of unfavorable outcome. In multivariate analysis, seizures and low GCS were independently associated with alcoholism, while alcoholism was independently associated with worse outcome.

Usefulness of SOFA score and artesunate - based treatment in severe malaria ­ a single center study

INTRODUCTION: This study was conducted to assess the usefulness of the guidelines of treatment recommended in Malaria diagnosis and treatment guideline published by University College London Hospitals-NHS Foundation Trust on 26th June 2013, usefulness of artesunate-based therapy and usefulness of SOFA (sepsis-related organ failure assessment) score in treatment of severe malaria. Severe malaria is usually caused by Plasmodium falciparum and most of the time fulfills the criteria of sepsis which are specified in the new definition of sepsis. The other malaria species are commonly considered to be the cause of mild course of malaria, however more and more cases of severe malaria are reported in the course of tertian fever malaria caused by Plasmodium vivax and in the disease caused by Plasmodium knowlesi. MATERIALS AND METHODS: Fourteen patients with malaria were hospitalized in the Department of Adults' Infectious Diseases and in the Intensive Care Unit of the Hospital for Infectious Diseases in Warsaw between December 2013 and April 2017. All patients were treated according to Malaria diagnosis and treatment guideline UCLH. RESULTS: Thirteen patients in our study fulfilled the criteria of severe malaria. All fourteen patients presented with a SOFA score ≥2 points. Intravenous artesunate was administered to all patients in doses recommended in the UCLH guidelines. All patients presented with thrombocytopenia and elevated level of D-Dimers. The main factor influencing the dynamics of SOFA score was thrombocytopenia. All the patients fully recovered without any complications. CONCLUSIONS: The malaria treatment guidelines used in the Department for Infectious Diseases in Adults and in the Intensive Care Unit of the Hospital for Infectious Diseases in Warsaw in years 2013-2017 are effective. In assessing the severity of malaria SOFA score is useful especially as a warning of possibility of a severe course of the disease.