The use of anti-asthmatic inhalation therapy and the risk of dental caries in a group of Polish children: a prospective study.

AIM: Assessment of the effect of inhaled therapy with anti-asthmatic medications on the development of caries in children between 3 and 17 years old. METHODS: Study design: The study involved 208 patients, 114 in the study group and 94 in the control group. Data on general health condition of patients, use of medications, dietary habits and oral hygiene were obtained. Information on the onset of asthma, its severity and type, doses and method of administration of asthma medications were obtained from the available medical records by the paediatrician. Dental examination was performed using the DMFT/dmft and DMFS/dmfs index, ICDAS II classification and Nyvad's criteria for noncavitated white spot lesion differentiation. Additionally, an assessment of salivary S. mutans (SM) and Lactobacillus spp. (LA) was carried out using the CRT Bacteria (Ivoclar Vivadent) test. CONCLUSION: There is still no clear consensus among the authors as to whether asthma and medications used in its treatment increase the risk of caries. Nowadays, despite better access to various sources of information, there is still a need for increased awareness in patients and medical doctors on the dental care and caries prevention in patients with asthma.

Virological and Epidemiological Situation in the Influenza Epidemic Seasons 2016/2017 and 2017/2018 in Poland.

The World Health Organization estimates that influenza virus infects 3-5 million people worldwide every year, of whom 290,000 to 650,000 die. In the 2016/2017 epidemic season in Poland, the incidence of influenza was 1,692 per 100,000 population. The influenza A virus, subtype A/H3N2/, was the predominant one in that season. However, in the most recent 2017/2018 epidemic season, the incidence exceeded 1,782 per 100,000 already by August of 2018. In this season, influenza B virus predominated, while the A/H1N1/pdm09 strain was most frequent among the influenza A subtypes. The peak incidence, based on the number of clinical specimens tested, was in weeks 4-5 of 2017 and week 8 of 2018 in the 2016/2017 and 2017/2018 epidemic seasons, respectively. As of the 2017/2018 season, a quadrivalent vaccine, consisting of two antigens of influenza A subtypes and another two of influenza B virus, was available in Poland. Nonetheless, the vaccination rate remained at one of the lowest level in Europe, fluctuating between 3% and 4% of the general Polish population.

Occurrence of Influenza Hemagglutinin Antibodies in the Polish Population during the Epidemic Season 2017/18.

This study seeks to define the level of antihemagglutinin antibodies, using the hemagglutination inhibition assay (HAI), in the serum of patients, stratified into seven age groups, in Poland during the influenza epidemic season of 2017/18. A quadrivalent influenza vaccine has been introduced in Poland as of this epidemic season, making it possible for the first time to conduct the analysis for four antigens: A/Michigan/45/2015 (H1N1) pdm09, A/Hong Kong/4801/2014 (H3N2), B/Brisbane/60/2008 - Victoria lineage, and B/Phuket/3073/2013 - Yamagata lineage. We found that the level of individual antihemagglutinin antibodies was different among the seven age groups studied; with the highest in patients of 5-9 years and 10-14 years of age. Interestingly, the protection factor, defined as the percentage of people with the level of antihemagglutinin antibodies of at least 1:40 after vaccination or due to a previous infection, was the highest for the antigen A/Hong Kong/4801/2014 (H3N2) in the same age groups (74% and 75%, respectively). Taking into account the dismal 3.6% of the vaccinated population in Poland, these findings point toward the sustained presence of an immune system response in patients after a prior influenza virus infection.

Respiratory Virus Infections in People Over 14 Years of Age in Poland in the Epidemic Season of 2017/18.

People most at risk of influenza complications are the elderly with impaired immunity. Clinical picture of influenza virus infection includes symptoms such as chills, increased body temperature, dry cough, chest pain, or dizziness as well as headaches and muscle aches. In the diagnosis of influenza, quick and effective tests are necessary. Sensitive diagnostic methods of molecular biology require more time, but the result firmly confirm or exclude the presence of the genetic material of influenza or other respiratory viruses. Influenza vaccination plays an important role in combating influenza infection. Unfortunately, the awareness of vaccination benefits is insufficient in Poland. In this study we demonstrate the results of examination of 4,507 people aged over 14 years toward the influenza infection in the epidemic season of 2017/18. Most of the confirmed infections were reported in older people aged over 65, a high-risk population group. A low percentage of the vaccinated population may affect an increased number of confirmed influenza viruses in the elderly. The findings demonstrate a need to increase awareness of vaccination benefits, which is particularly essential to avoid influenza infection in the elderly.

Collapsibility of the internal jugular veins in the lateral decubitus body position: A potential protective role of the cerebral venous outflow against neurodegeneration.

Recent research has revealed that patients with neurodegenerative disease sleep longer in the supine position, while healthy controls prefer sleeping in the lateral decubitus position. Thus, sleeping in the lateral position seems to be protective against neurodegeneration. It has also been suggested that a protective role of this body position could be associated with better cerebral venous drainage in this body position, which results in more active glymphatic system of the brain (the system responsible for clearance of the cerebral tissue from waste products, e.g. amyloid-ß). Since no published evidence exists regarding venous outflow from the cranial cavity in the lateral decubitus position, we performed a pilot sonographic study of the internal jugular veins in 3 young healthy volunteers and 2 patients presenting with abnormal jugular valves. In all healthy volunteers both internal jugular veins were opened in the supine position and collapsed in the sitting one. In the right lateral decubitus position the right internal jugular vein was opened, while the left one was partially collapsed; and-vice versa-in the left lateral decubitus position the right internal jugular vein was partially collapsed and the left one opened. In patients with abnormal jugular valves both internal jugular veins were opened in both lateral decubitus body positions. We hypothesize that in the lateral decubitus body position, because of decreased flow resistance in the extracranial veins, cerebral venous outflow is optimal, which in turn optimizes the activity of the glymphatic system. Therefore, people intuitively prefer this body position during sleep, while other positions are associated with a higher risk of neurodegenerative disorders. Yet, it should be emphasized that our results need to be interpreted with caution, since only a few individuals have been assessed and this discovery should be confirmed in more patients and healthy controls, and by precise quantitative measurements.

Evaluation of the 2017/18 Influenza Epidemic Season in Poland Based on the SENTINEL Surveillance System.

The SENTINEL influenza surveillance system is an important tool for monitoring influenza in Poland. Data from this system are necessary to determine the dynamics of seasonal infections and to announce the epidemic by the country level. For the 2017/18 epidemic season, the dominance of influenza type B was recorded and the highest percentage of infections was recorded in the age group 45-64 years. Among the subtypes of influenza type A, A/H1N1/pdm09 was the predominated subtype. Most cases were reported in the age group of 26-44 and 0-4 years. The influenza virus frequently undergoes modifications. Therefore, it is necessary to constantly monitor the emerging strains around the world.

Infections Caused by Influenza Viruses Among Children in Poland During the 2017/18 Epidemic Season.

Influenza is an infectious disease that is a threat to both children and adults. The most effective way to prevent infections among children is seasonal vaccination in every epidemic season, which is recommended from the age of 6 months onward. This study is a report of the prevalence of influenza infection in the population of children up to the age of 14 years and of the type of influenza virus involved during the 2017/18 epidemic season in Poland. We found that influenza A and B viruses co-dominated in the season. Among the influenza A viruses, A/H1N1/ pdm09 subtype was a more frequent source of infection than A/H3N2/ subtype. In addition, the prevalence of infection was re-analyzed in children stratified into the age groups of 0-4, 5-9, and 10-14 years old. We found a relation between the age of a child and the type of influenza virus causing infection. The youngest children under 4 years were the most vulnerable to both influenza and influenza-like infections; the former caused mostly by influenza A and the latter by RSV. In contradistinction, influenza B dominated in the oldest children aged 10-14 and RSV infections were not present in this age group. The characteristics of influenza viruses may however vary on the seasonal basis.

Ferric Sulfate and Formocresol pulpotomies in paediatric dental practice. A prospective-retrospective study.

AIM: To evaluate the use of formocresol (FC) and ferric sulfate (FS) as pulpotomy agents in vital pulp therapy (VPT) in primary molars by dental practitioners. MATERIALS AND METHODS: One hundred seventy-nine patients (aged 74.09 ± 20.75 months) who underwent pulpotomy were enrolled. The dmft, the number of visits, the filling materials, the clinical and radiological observations and complications were evaluated. STATISTICS: The data were analysed using chi-square, Spearman's rank correlation and odds ratio. RESULTS: The analysis included the documentation of 179 patients with 276 pulpotomies: 50 (FS) and 226 (FC). The dmft was 8.54 ± 3.44. The therapeutic success was greater for FS pulpotomy and that of the two-appointment FC pulpotomy (90.6%) was higher than the one-appointment method (77.1%). Glass-ionomer cements (GIC) (53.6%), amalgam (30.0%), composites (15.6%), and steel crowns (1.8%) were used for tooth restoration. The risk of complications was lower for GI (OR = 2.21; 95% CI 1.09-4.88) compared to composite (OR = 2.62; 95% CI: 1.19 - 5.80). CONCLUSIONS: For primary teeth pulpotomy dental practitioners use both FS and FC. FC has been proven to be more effective in a two-appointmet treatment. When restoration with stainless steel crown (SSC) is not feasible, it is advantageous to use GIC rather than composite.

Circulation of Influenza Virus in the 2015/2016 Epidemic Season in Poland: Serological Evaluation of Anti-hemagglutinin Antibodies.

The diagnostic of influenza virus infections is possible using molecular biology methods as well as the analysis of anti-hemagglutinin (anti-HA) antibodies in the blood serum. The aim of this study was to determine the level of anti-HA antibodies in 7 age groups of patients during the 2015/2016 epidemic season in Poland. A total of 1050 serum samples were tested using the hemagglutination inhibition (HAI) assay. We confirmed the presence of anti-HA antibodies for the influenza virus strains: A/California/7/2009(H1N1)pdm09, A/Switzerland/9715293/2013(H3N2), and B/Phuket/3073/2013, which were the components of the influenza vaccine for the 2015/2016 epidemic season. The level of specific anti-HA antibodies was different in each age group. The geometric mean titers were highest at age 5-9 years, where the antibody protection level reached 61.3% against B/Phuket/3073/2013 and 52.7% for A/Switzerland/9715293/2013(H3N2) antigen. The antibody level amounted to 56.7% against for antigen B at age 45-64. In the remaining age groups, the protection levels for all hemagglutinin types did not exceed 50%. These findings confirm the urgent need to increase a persistently low influenza vaccination coverage in the Polish population, which may have had its part in the noticeable increase in the confirmed cases of influenza and influenza-like virus infection during the season.

Respiratory Viruses in Different Provinces of Poland During the Epidemic Season 2016/2017.

In Poland, influenza surveillance is conducted by 16 Provincial Sanitary Epidemiological Stations, headed by the Department of Influenza Research, National Influenza Center at the National Institute of Health - National Institute of Hygiene (NIPH-NIH). During the epidemic season 2016/2017, more than 4000 samples were tested for respiratory infections, with approximately 1800 positive results, the most of which were among patients over 65 years old. Most samples were tested in the Western Pomeranian province, but the greatest proportion of positively diagnosed influenza infections, amounting to 72.7% was noted in the Lodz metropolitan area in central Poland. Twenty five deaths due to post-influenza infections and complications were recorded across the country, of which 20 were among individuals over 65 years of age. During the 2016/2017 season, the dominant subtype was A/H3N2/, unlike the subtype A/H1N1/California/7/2009 during the previous season. A high number of confirmed infections of subtype A/H3N2/can attest to low vaccination rates.

Evaluation of a relationship between malocclusion and idiopathic scoliosis in children and adolescents.

PURPOSE: Idiopathic scoliosis is a developmental deformation of the vertebral column of an unknown aetiology. Its clinical symptoms and hypothetical causative factors may affect the stomatognathic system. The aim of this study was to analyse the relationships between the prevalence and type of malocclusions, and the presence of idiopathic scoliosis, its location and severity. METHODS: This was a prospective longitudinal study. The study group consisted of 80 patients with idiopathic scoliosis and the control group of 61 healthy individuals. Standard standing long-cassette radiographs were taken of all of the patients in the idiopathic scoliosis group in order to confirm diagnosis, to determine localization and the Cobb angle of the curve. Both groups underwent standard clinical dental examination. RESULTS: The most commonly observed types included right main thoracic (R-MT) and thoracolumbar or left lumbar scoliosis (Cobb angle 11° to 125°). In the idiopathic scoliosis group, prevalence of malocclusions was greater than in the control group (95% versus 82%). In the idiopathic scoliosis group more than one type of malocclusion was observed with a higher incidence than that in the control group (63.8% versus 37.7%; p = 0.002). A correlation between the left proximal thoracic (L-PT) curve with anterior partial open bite was demonstrated (p = 0.323), between thoracic dextroscoliosis main thoracic with lateral partial cross bite (p = 0.230) and a correlation between scoliosis severity and malocclusion in the event of L-PT and anterior partial open bite (p = 0.330) and R-MT and scissors bite (p = 0.248). CONCLUSION: The incidence of malocclusions is greater in children with idiopathic scoliosis than in their healthy peers. LEVEL OF EVIDENCE: III.

Detection of Influenza in the Epidemic Season 2016/2017 Based on I-MOVE+ Project.

In the influenza season 2016/2017 in Europe, the predominant virus was A/H3N2/. In Poland, the percentage of people vaccinated against influenza was 3.33%. European I-MOVE+ project shows how important it is to monitor the effectiveness of influenza vaccine. The project demonstrates that a match between the circulating vaccine strains and those included in the vaccine for the Northern Hemisphere was low-to-moderate. In the present study, there were 379 patients and 296 control subjects examined in hospitals in Poland as part of I-MOVE+ project. The real-time reverse transcription polymerase chain reaction (qRT-PCR) method was used to detect the influenza virus in all subjects. We detected the influenza subtype A/H3N2/ in 59.1% and type B virus in 2.1%. There was one co-infection of subtype A/H3N2/ with subtype A/H1N1/ and eight co-infections of type B with subtype A/H3N2/. No influenza viruses were detected in the control group. Only 19 patients and 22 control subjects were vaccinated during the epidemic season in question. A proportion of people vaccinated against influenza in Poland remains dismally low compared to other European countries.

Influenza and Influenza-Like Viruses: Frequent Infections in Children Under 14 Years of Age During the 2016/2017 Epidemic Season.

Influenza is an infectious disease that is a common cause of infection among children. The main reason for it is the extremely low percentage of vaccinated people in Poland. In the 2016/2017 epidemic season more than 3,000 tests from children up to age 14 were examined. The dominance of subtype A/H3N2/ (40.9%) was confirmed. The evaluation was stratified by three age groups (0-4, 5-9, and 10-14 years), which revealed significant differences. The highest number of samples was available in the 0-4 years group. The highest percentage of positive samples was present in the 10-14 years group. Influenza-like viral infections, among them the respiratory syncytial virus, were also observed. Children due to immature immunity are at particular risk for influenza. A lack of proper vaccination coverage strongly increases the chance of serious complications of the infection.

Infections with Influenza A/H3N2/ Subtype in Poland in the 2016/2017 Epidemic Season.

The 2016/2017 epidemic season was characterized by a lower number of diagnostically tested samples of the nasal and throat swabs and bronchoalveolar lavage fluid, compared with the preceding season. The predominant influenza subtype found was A/H3N2/ which was notably diagnosed in patients over 25 years of age. This subtype was also often diagnosed in older people of 65+ years, which is in line with the risk assessment prepared by the European Center for Disease Prevention and Control (ECDC) at the beginning of the season. The A/H3N2/ subtype was most often diagnosed in the West Pomeranian and Warmian-Masurian Voivodeships. In this epidemic season, there were 11 coinfections of the A/H3N2/ subtype with other influenza and influenza-like viruses recorded in Poland. A different situation had occurred in the 2014/2015 season, when the subtype A/H3N2/ also was predominant, but the virus was most commonly diagnosed in children up to 14 years of age. In both seasons, the least confirmations were observed in patients between 15 and 24 years.

Antibodies to Influenza Virus Hemagglutinin in the 2016/2017 Epidemic Season in Poland.

The aim of the study was to determine the level of antibodies against hemagglutinin of influenza viruses in the sera of 1,050 patients stratified into 7 different age groups during the 2016/2017 epidemic season in Poland. The method consisted of using the hemagglutination inhibition test (HAI). The findings confirmed the presence of anti-hemagglutinin antibodies against the following influenza virus antigens: A/California/7/2009 (H1N1) pdm09, A/Hong Kong/4801/2014 (H3N2), and B/Brisbane/60/2008. The level of anti-hemagglutinin antibodies differed across the age groups investigated, with the highest values in patients aged 10-14 years. We also found that the protection factor was highest for B/Brisbane/60/2008 antigen. It amounted to 72.7% in 10-14-year olds and to 69.3% in both 15-25 and 26-44-year olds. Taking into account a dismally low percentage of vaccinated population in the 2016/2017 epidemic season in Poland, amounting to barely 3.33%, the findings should be interpreted as representing the patients' immune system response to influenza virus infection.

Virological Situation in Poland in the 2016/2017 Epidemic Season Based on Sentinel Data.

The influenza Sentinel surveillance system is a source of valuable data about the dynamics of epidemic seasons in Poland. During the epidemic season 2016/2017, more than 1,000 samples were examined, of which 48% were positive for influenza diagnosis. The predominance of influenza A/H3N2/ was confirmed. Influenza B viruses were noted in only 1% of the samples tested. After the analysis in age groups, the highest number of positive samples was observed in the group of 26-44 years. Infections caused by influenza-like viruses were confirmed only in 3% of cases. The Sentinel surveillance system makes it possible to evaluate the spread of the influenza virus in each epidemic season.

Respiratory Infections with Particular Emphasis on Influenza Virus Activity in Persons Over 14 Years of Age in the Epidemic Season 2016/2017 in Poland.

Influenza viruses cause respiratory infections every epidemic season regardless of the patient's age. The aim of this study was to determine the activity of respiratory viruses in the epidemic season 2016/2017 in Poland, with particular emphasis on influenza viruses among people aged over 14. There were 2982 clinical samples taken from patients from four age groups: 15-25, 26-44, 45-64, and ≥ 65 years tested under the Sentinel and non-Sentinel surveillance programs. The presence of influenza viruses was confirmed in more than 40% of cases, the predominant type was influenza A virus unsubtyped, followed by subtype A/H3N2/. The results for the four age groups indicate that the highest number of confirmed respiratory viruses was recorded in individuals ≥65 years of age, slightly less, in the decreasing order, in the age groups 45-64 years, 15-25 years, and 26-44 years. Influenza type B infections were observed only in sporadic cases. Given the epidemiological data, epidemic season 2016/2017 was characterized by similar dynamics compared to the previous season in Poland and also in most of the European countries. More than 4 million cases and suspected cases of influenza and influenza-like viruses have been reported in Poland, more than 16,000 hospitalizations, and 25 deaths, of which 20 cases occurred among people ≥65 years of age in the epidemic season 2016/2017.

Parenteral nutrition in childhood and consequences for dentition and gingivae.

AIM: Assessment of dentition in children under parenteral nutrition, risk factors for caries, and dental developmental abnormalities. MATERIALS AND METHODS: The study involved 63 patients (aged 2.25-16.6 years), i.e. 32 subjects receiving parenteral nutrition for a mean period of 5.6±2.94 years, and 31 healthy control subjects. Oral hygiene (OHI-S, PL-I), gingival (GI), and dentition status (caries, DMFT/dmft, enamel defects, shape alterations), frequency of oral meals and frequency of cariogenic snacks consumption were evaluated. Medical records provided information on parenteral meals per week, age parenteral nutrition started, birth body mass, Apgar score, weight deficiency, and antibiotic therapy until aged 1 year. The Mann-Whitney test, chi-squared test, and Spearman rank correlation coefficient were used (p≤0.05). RESULTS: Dental developmental abnormalities occurred more often in PN subjects (71.87% vs. 25.80%). The prevalence of caries in PN (56.25% vs. 90.32%) and dmft (2.00±3.30 vs. 4.21±3.33) and DMFT (2.47±4.08 vs. 3.33±3.50) were lower. Positive caries Spearman's rank correlation coefficients: frequency of oral meals and frequency of cariogenic snacks consumption, and GI. Negative correlation coefficients: low birth body mass, antibiotic therapy, and low body mass in the first year of life. Positive dental developmental abnormality Spearman's coefficients: low birth body mass, Apgar score < 7, parenteral nutrition duration, low body mass and antibiotic therapy in the first year of life. Beta- lactam, aminoglycoside, glycopeptide and nitroimidazole treatments were related to enamel hypoplasia. CONCLUSION: Parenteral nutrition in childhood is related to the risk of dental developmental abnormalities, promoted by malnutrition and antibiotic therapy in infancy. Limiting the number of meals and cariogenic snacks, and most probably administration of antibiotics, decreases the risk of caries.

Regional Diversification of Influenza Activity in Poland During the 2015/16 Epidemic Season.

The National Influenza Center (NIC) at the Department of Influenza Research of the National Institute for Public Health-National Institute of Hygiene (NIPH-NIH) participates in the Global Influenza Surveillance and Response System (GISRS) and continuously coordinates epidemiological and virological surveillance of influenza in Poland. The aim of this study was to determine the regional differences of influenza activity in Poland in the 2015/16 epidemic season. The influenza surveillance involved 16 administrative districts in which there are Voivodeship (province) Sanitary Epidemiological Stations set up to report influenza and influenza-like illness among the Polish population. Over 8000 specimens were tested in the season with regard to the respiratory viral infections in all regions investigated. The circulation of influenza viruses A and B was confirmed, with the subtype A/H1N1/pdm09 being predominant in the Pomerania, Podlaskie, Subcarpathian, Lubuskie, Silesian, and Warmian-Masuria provinces. The influenza-like virus occurred in individual cases, except for respiratory syncytial virus that also was detected in the Greater Poland and Warmia-Masuria provinces. The highest incidence of cases and suspected cases of influenza was recorded in Pomerania and the lowest one in Lubuskie provinces. The knowledge of regional differences in influenza activity is important for streamlining the distribution of preventive, therapeutic, and economic resources to combat the epidemic.

The Sentinel System as the Main Influenza Surveillance Tool.

Poland has implemented the influenza surveillance system called Sentinel as of 2004. The system consists of both epidemiological and virological surveillance. It is an important tool for monitoring the situation in the entire country, coordinated by the National Influenza Center situated at the National Institute of Public Health-National Institute of Hygiene (NIPH-NIH) in Warsaw, Poland. In the 2015/2016 epidemic season, more than 1600 samples were tested in the Sentinel System, of which 38.6% were positive. The samples were evaluated in seven age-groups: 0-4, 5-9, 10-14, 15-25, 26-44, 45-64, and over 65 years of age. Significant differences were reported in the number of confirmed cases of infection caused by influenza and influenza-like viruses, depending on the age-group. The highest number of confirmed cases of infections was reported for the age range of 26-44 years, accounting for 30% of the total. In each age-group, the presence of infection caused by influenza-like viruses, collectively accounting for only 3.8% of all positive tests, was also confirmed. Weekly reports generated by the Sentinel System enable to determine and control a current influenza activity in the country, which is of essential importance in case of the emergence of a new strain with a pandemic potential.