Secondary bacterial infections & extensively drug-resistant bacteria among COVID-19 hospitalized patients at the University Hospital in Kraków.

INTRODUCTION: Healthcare-associated infections (HAI) and bacterial antimicrobial resistance posed a therapeutic risk during the coronavirus disease 2019 (COVID-19) pandemic. The aim of this study was to analyze the HAIs in COVID-19 patients in the Intensive Care Unit (ICU) and non-ICU at the University Hospital in Krakow (UHK) with an emphasis on the susceptibility of the most frequently isolated pathogens and the prevalence of extensively drug resistant (XDR) microorganisms. METHODS: This laboratory-based study was carried out at the University Hospital in Krakow in the ICU and non-ICUs dedicated to COVID-19 patients between May 2021 and January 2022. All isolates of Klebsiella pneumoniae were analyzed using PFGE protocol. RESULTS: 292 independent HAI cases were identified, with the predominance of urinary tract infections (UTI), especially in the non-ICU setting. The most common ICU syndrome was pneumonia (PNA). The prevalence of XDR organisms was 22.6% in the ICU and 14.8% in non-ICUs among all isolates. The incidence of carbapenem-resistant Enterobacteriaceae infection was 24.8 cases per 10,000 hospitalizations and the carbapenem-resistant A. baumannii infection incidence was 208.8 cases per 10,000 hospitalizations. The prevalence of XDR strains was highest in Acinetobacter spp, in PNA cases. The PFGE typing demonstrated that almost all XDR strains varied widely from each other. CONCLUSIONS: In this study, there was a high incidence of HAI in COVID-19 patients, especially when compared to Western Europe and the United States. Similarly, the prevalence of XDR microorganisms, especially XDR-A.baumannii, was also high. PFGE did not confirm the horizontal spread of any organism strains.

The contact angle of nanofluids as thermophysical property.

Droplet volume and temperature affect contact angle significantly. Phase change heat transfer processes of nanofluids - suspensions containing nanometre-sized particles - can only be modelled properly by understanding these effects. The approach proposed here considers the limiting contact angle of a droplet asymptotically approaching zero-volume as a thermophysical property to characterise nanofluids positioned on a certain substrate under a certain atmosphere. Graphene oxide, alumina, and gold nanoparticles are suspended in deionised water. Within the framework of a round robin test carried out by nine independent European institutes the contact angle of these suspensions on a stainless steel solid substrate is measured with high accuracy. No dependence of nanofluids contact angle of sessile droplets on the measurement device is found. However, the measurements reveal clear differences of the contact angle of nanofluids compared to the pure base fluid. Physically founded correlations of the contact angle in dependency of droplet temperature and volume are obtained from the data. Extrapolating these functions to zero droplet volume delivers the searched limiting contact angle depending only on the temperature. It is for the first time, that this specific parameter, is understood as a characteristic material property of nanofluid droplets placed on a certain substrate under a certain atmosphere. Together with the surface tension it provides the foundation of proper modelling phase change heat transfer processes of nanofluids.

[99mTc Tetrofosmin in diagnosis of distant metastases from differentiated thyroid cancer]. / 99mTc Tetrofosmin w diagnostyce przerzutów odleglych zróznicowanego raka tarczycy.

UNLABELLED: Technetium 99mTc(TF), non-specific tumor-searching tracer was evaluated for its ability to detect distant metastases of differentiated thyroid carcinoma (DTC) and its reliability in the follow-up of DTC. Whole body scintigraphy (wbs) was performed 20-30 min after intravenous injection of 740 MBq 99mTc tetrofosmin by means of a dual-head gamma-camera (followed by spot images if needed) in 61 patients (pts) with DTC; 52 pts with distant metastases in 131I whole body scintigraphy (34) or in other methods (x-ray, CT, ultrasound) (7) or with negative 131I whole body scan and elevated thyroglobulin (11). In the group of 52 pts with signs of neoplasm dissemination, 36 showed positive TF whole body scan (69%), 16 (31%) pts were TF-negative. 23 of 34 131I positive wbs were also TF positive (68%), 11 out of 34 were TF negative (32%). In a group of 7 pts with metastases in x-ray, CT or ultrasound 4/7 were positive (57%), 3/7 were TF negative (18%). In a control group of 11 persons (2 diseases-free, 9 with DTC in clinical remission) TF whole body scans were negative in all cases. CONCLUSIONS: Technetium 99mTc tetrofosmin is clinically useful for detecting distant metastases of differentiated thyroid carcinoma and deserves complementary clinical application in follow-up in such patients.

Mortality among different occupational groups of workers with pneumoconiosis: results from a register-based cohort study.

A mortality cohort study was carried out on 11,224 men with pneumoconiosis diagnosed during the period 1970-1985. The cohort was selected from among subjects entered into the National Register of Occupational Diseases and included 7,065 coal miners, 924 employees of underground work enterprises, 1,796 workers of the metallurgical industry and iron and nonferrous foundries, as well as 1,439 refractory materials, china, ceramics, and quarry workers. The cohort was traced up to the end of 1991. The mortality of all groups enrolled in the study, as compared with that of general male population of Poland, showed a statistically significant excess of overall mortality (SMRs ranging from 105; 95% confidence interval [CI]: 100-110 to 136; CI: 121-153) as well as a great excess of deaths from diseases of the respiratory system (SMRs from 383; 95% CI: 345-424 to 588; 95% CI: 457-744). In workers of the metallurgical industry, foundries, and those from refractory materials, china, and ceramics manufacturing plants as well as quarries, a statistically significant excess of deaths from infectious diseases (mostly tuberculosis) was found (SMRs: 503; 95% CI: 364-677 and 286; 95% CI: 177-437, respectively). Mortality from lung cancer was significantly elevated only in the group of metallurgical industry and iron and nonferrous foundry workers (SMR: 159; 95% CI: 124-201). In the remaining subcohorts, no significant excess of deaths from lung cancer was noted. The study does not support the hypothesis on the role of exposure to crystalline silica in the induction of lung cancer. Significantly lower mortality was seen for diseases of the circulatory system (SMR: 89; 95% CI: 82-96), hypertensive disease (SMR: 63; 95% CI: 38-98), cerebrovascular disease (SMR: 79; 95% CI: 62-99), atherosclerosis (SMR: 79; 95% CI: 66-93), and injuries and poisonings (SMR: 50; 95% CI: 38-64) in coal miners. In addition, lower mortality was noted for cerebrovascular disease (SMR: 56; 95% CI: 32-91) and injuries and poisonings (SMR: 34; 95% CI: 17-61) in metallurgical industry and iron and nonferrous foundry workers.

Mortality among coal miners with pneumoconiosis in Poland.

A mortality cohort study was carried out on 7,065 coal miners with pneumoconiosis first diagnosed during the years of 1970-85. The cohort was selected from among subjects entered into the National Register of Occupational Diseases and followed up through to the end of 1991. The general male population of Poland was considered as a reference group. The PYRS-3 programme was used to identify, by means of standardized mortality ratios (SMRs), total and selected cause-specific mortality. An analysis revealed significantly elevated total mortality (SMR = 105; 95% confidence interval (CI): 100-110) in the whole cohort of coal miners. The risk of selected cause-specific mortality was significantly enhanced due to diseases of the respiratory system among which pneumoconiosis predominated (SMR = 383; 95% CI: 345-424). While mortality from all diseases of the circulatory system (SmR = 89; CI: 82-96), arterial hypertension (SMR = 63; 95% CI: 38-98), cerebrovascular diseases (SMR = 79; 95% CI: 62-99), atherosclerosis (SMR = 79; 95% CI: 66-93), and injury in poisoning (SMR = 50; 95% CI: 38-64) was significantly lower. The risk of death from malignant neoplasm of lung in the whole study population as well as in individual groups and categories of coal miners with pneumoconiosis, which varied in the risk of pneumoconiosis and the level of exposure to ionizing radiation, was not increased.

Mortality pattern in men with pneumoconiosis in Poland.

Mortality study was carried out on the cohort of 11,224 men with coal workers' pneumoconiosis or silicosis diagnosed during the period 1970-1985. The cohort was selected from the register of occupational diseases and was traced up to the end of 1991. The general male population of Poland was a reference group. The study showed small but significant excess of total mortality (SMR = 115; p < 0.01). The analysis of death causes revealed an elevated mortality from infectious diseases, among which tuberculosis was most prevalent (SMR = 212; p < 0.01) and from pneumoconioses predominant in diseases of the respiratory system, (SMR = 426; p < 0.01) and lung cancer (SMR = 116; p < 0.01). The comparison of the prevalence of smoking in the population under study with that in the reference general male population of Poland indicated that this habit is mostly responsible for the excess of lung cancer deaths. This finding contradicts the hypothesis that there is a causal relationship between exposure to dusts containing crystalline silica, pneumoconiosis and lung cancer.

[Interpretation of early radiological changes in the diagnosis of pneumoconiosis among coal miners]. / Interpretacja wczesnych zmian radiologicznych w diagnostyce pylicy górników kopaln wegla kamiennego.

Apart from certain changes which are typical for pneumoconiosis, the radiological picture of the lungs of sigma coal miners does frequently show some irregular small opacities of s, t and u types. The role and specificity of these changes in the early diagnosis of pneumoconiosis has not been too well defined by now. A 10-year study (conducted at 2 or 3 year intervals) was carried out among 150 miners from 2 mines characterized by different dust loading. Some irregular changes in the miners' lungs were observed. The control group derived from the same mines comprised 115 miners with no radiological changes found in their lungs. The evolution of radiological changes took place in 55.3% of the miners and was more intensive in the heavily dusted mine. Radiological changes were revealed in 38.3% of the controls. It was indicated that pneumoconiosis results much more frequently (38.6%) from the evolution of the irregular changes rather than directly from the proper radiological picture of the lungs (5.3%). In 44.7% of the subjects the changes of s, t and u type did not undergo any evolution, which may be due to their non-specific characteristics. The evolution of irregular opacities is dominating in the patients with bronchitis and emphysema. No significant correlation between smoking and the progress of irregular opacities was found. The observation of the further exposure to the dusts did not produce any clear results. The progress of the changes of s, t and u type was observed more frequently in those still working under ground, but more cases of pneumoconiosis were found in the miners who stopped working. This fact indicates that the further exposure affects the s, t and u type changes and confirms the observations by other authors concerning the manifestation of pneumoconiosis after the break of exposure. The results of the 10-year study prove that the miners with this sort of changes are exposed to a higher risk of pneumoconiosis, although the answer concerning specificity of irregular changes in the radiological picture has not yet been found.

[Analysis of the incidence of pneumoconiosis among coal miners]. / Analiza zachorowalnosci na pylice u górników jednej kopalni wegla kamiennego.

Basing on the prevention system for pneumoconiosis in ++coal mining, an analysis of the disease incidence in the workers of a selected ++coal mine was performed. The subjects were 2.495 miners with the work period longer than 8 years and a group of 822 retired miners. In the former group 16 cases (0.64%) of pneumoconiosis were diagnosed, whereas in the latter as many as 89 cases (10.8%) were found which would indicate a necessity for more detailed examinations in ex-miners of this ++coal mine. The pneumoconiosis changes were detected in the early period of their development. The highest risk was found to refer to longwall and blasting miners and cutter-loadermen. The correlation between radiological changes of the s, t, and u type and the duration of work as well as the high frequency of these changes at highly polluted workplaces seem to point to their relation to dust exposure.

[Chronic bronchitis and respiratory capacity of the lungs in miners from a specific coal mine]. / Przewlekle zapalenie oskrzeli i sprawnosc wentylacyjna pluc u górników jednej kopalni wegla.

In the group of 3317 miners of one coal mine, who were employed for over 8 years, the prevalence of chronic bronchitis (ch.b.) and lung ventilation disorders was analysed. The frequency of ch.b. in the subjects under study was almost twice as high as in the general male population in Poland and significantly more frequent in miners with pneumoconiosis than in those without pneumoconiosis. Simple pneumoconiosis and ch.b. contributed to decreased ventilatory capacity of the lung.

Validation of clinical criteria for diagnosing asbestosis in asbestos-cement workers.

The recently developed diagnostic criteria for asbestosis, including chest x-ray abnormalities and respiratory impairment consistent with interstitial lung fibrosis, were tested in 550 current asbestos-cement workers. The findings showed the correlation of x-ray ILO/UC scores for small irregular opacities (s, t, u) with duration of exposure, especially evident in relation to category of 1/2 and above ("cutoff category") detected in 48 subjects. An increasing x-ray score was accompanied by more functional abnormality, demonstrated by a restrictive defect in ventilation, followed by a fall in arterial oxygen pressure on exercise and impaired diffusing capacity. Amongst subjects working for at least 10 years, thirty met the roentgenographic and functional criteria for asbestosis. On the basis of these criteria, asbestosis could be diagnosed only in one subject employed for not longer than 5 years and two others working for not longer than 9 years, which can be explained by a false--positive effect.

[Evaluation of the effectiveness of medical prevention of pneumoconiosis based on studies of its incidence in selected coal mines]. / Ocena skutecznosci profilaktyki medycznej pylic w oparciu o badania chorobowosci w wybranych kopalniach wegla kamiennego.

In a group of 3,938 persons--pit miners of 3 coal mines--employed over 8 years, full-size X-ray pictures of the chest have been taken and through a special questionnaire information has been collected on the length of employment, workstation, risk of dustiness, exposure to fibrogenic dusts outside the mine. Basing on the studies, the mean annual incidence of pneumoconiosis in particular mines has been calculated. The data has been compared with the mean annual incidence rate of pneumoconiosis calculated for 10 years prior to epidemiological studies and based on the primary selection by means of small-size pictures. This comparison indicated that the full-size pictures revealed 3-7 times more pneumoconioses as compared to the hitherto applied system. The comparison of full-size and small-size X-ray pictures demonstrated that the lesions visible in full-size pictures have not been registered in small-size pictures in as many as half of the cases. The obtained results indicate that the effectiveness of the hitherto applied system of medical prevention of pneumoconiosis is insufficient. A change in this system is indispensable; miniature roentgenography should be replaced by full-size X-ray pictures.

[A plan for the medical prevention of pneumoconiosis in coal mining]. / Projekt profilaktyki medycznej pylic w górnictwie wegla kamiennego.

Some assumptions of a system of pneumoconiosis prevention for coal miners have been presented. An essential element of the system consists in replacing fluororadiograms with full-size X-ray pictures, as a method of primary selection. Provisions have been also made for promotion of the detection and treatment of chronic bronchitis and some other respiratory system diseases, along with obligatory spirometric tests. It is planned that the examinations will also involve pensioners. The current analysis of the collected information will be made using the electronic data processing.

[Incidence of pneumoconiosis in coal mines with different levels of mechanization]. / Wystepowanie pylicy w kopalniach wegla kamiennego o róznym stopniu mechanizacji.

2717 miners working more than eight years in four collieries have been examined. Two of those mines were mechanized, whereas in the other two the degree of mechanization was low. Anamnestic data and radiological examinations have been correlated with dust concentration, silica content and individual index of energy expenditure. Mechanization has been found to increase dustiness but it is not necessarily responsible for pneumoconiosis risk, the degree of the risk being dependent on the efficiency of dust prophylaxis. On the other hand, mechanization reduces physical effort and, consequently, lung ventilation, and so it may reduce the effect of excessive dustiness as well. Thus, pneumoconiosis risk due to mechanization is a resultant of several factors sometimes exhibiting opposite impact.

[Effect of metal dust on the respiratory system. I. Experimental studies]. / Wplyw pylów metali na uklad oddechowy. Czesc I. Badania doswiadczalene.

The Wistar rats were intratracheally administered 50 mg of PbO dust, the same amounts of metalliferous dust from one of lead--and zinc works and of ferrotungsten dust, and 10--15 mg of cadmium dust (greater doses of cadmium dust resulted in animals' death). After 6 months, and in the case of cadmium dust after 9--12 months, the animals were dissected and their lungs were morphologically examined and hydroxyproline level was determined. In all groups hydroxyproline was found to be increased but fibrosis was different, especially in the group exposed to cadmium dust.

[Effect of metal dust on the respiratory system. II. Clinical examinations]. / Wplyw pylów metali na uklad oddechowy. Czesc II. Badania kliniczne.

Studies were carried out in 4 groups of workers occupationally exposed to cadmium, tungsten, manganese and lead. All those groups were homogeneous, composed exclusively of men aged 35--45, of similar height, body weight, and duration of employment above 10 years. Following the same criteria, a group of forestry workers, unexposed to dust, was randomly selected. The smoking habit was similar in all groups. Several--days--clinical observation included a detailed interview (MRC questionnaire), physical and radiological examination and a wide range of functional tests of lungs. The results reveal clinical and physiopathological symptoms which might be indicative of emphysema. The results of some studies also indicate the possibility of intraparenchymatous fibrosis of lungs in the tungsten--exposed--workers. No clear effects upon the respiratory system were found.

[Radiological picture of pneumoconiosis in welders]. / Obraz radiologiczny pylicy spawaczy.

In the group of 35 welders with pneumoconiosis, the evolution of radiological changes was observed, after cessation of work in exposure. In 9 cases radiological changes retreated completely; in 16 cases they were clearly reduced, whereas in the remaining 10 persons no changes in radiological picture were found. The findings indicate that the radiological changes in welders' lungs may be reversible and as such they are most probably induced by dust retention.

[Cerebral bioelectrical activity disorders in acute hydrazine poisoning]. / Zaburzenia czynnosci bioelektrycznej mózgu w ostrych zatruciach hydrazydem.

The authors report changes in the bioelectric activity of the brain in acute, severe, suicidal poisoning with hydrazide. The observed group comprised 10 patients, 9 were admitted in coma, 7 had convulsions. Normal EEG tracing was found in a case of combined poisoning with hydrazide and diazepam. Low-voltage tracings with a tendency for bioelectric inactivity development were observed in 2 cases with lethal outcome. In the remaining cases high-grade diffuse changes were present, in three of them seizure activity was present additionally. Full evolution of bioelectric changes was observed in 5 patients. The time of return of normal activity ranged from several days to several weeks. Very slow improvement with incomplete normalization was found in mixed intoxication (hydrazide, barbiturates) treated with haemodialysis. The authors think that in cases with persistence of EEG changes despite regression of acute signs of poisoning intensive treatment with vitamins B should be continued.

[Epidemiological examinations for peptic ulcer in miners of pit-coal mines. I. Effect of socioeconomic factors]. / Epidemiologiczne badania choroby wrzodowej u górników kopaln wegla kamiennego. Czesc I. Wplyw czynników socjalno-bytowych.

In 3-pit coal mines, all workers were examined by means of an inquiry. Apart from personal data the inquiry included information on the category of work performed, length of employment, family state and socio-living conditions as well as diseases of digestive tract. The diagnosis of peptic ulcer and data on its course were based on medical documentation of Plant Outpatient Departments. Collected material comprised 9361 persons, i.e. 95% of the whole population examined. After having excluded women, employed only on surface, results were worked out concerning the population of 8302 men employed both underground and on surface. In this mining population one found 7.92% persons suffering from peptic ulcer; thus the occurrence of the disease resembled that of general population. The rate of duodenal and gastric ulcer was identical. The studies indicated that the percentage of peptic ulcer was increased proportionally to age and number of children and was greater in married than in bachelors. No greater percentage was found in widowers and divorcees, or in those eating in canteens, partaking cold meals during work or drinking alcohol. Instead in smokers a greater percentage of peptic ulcer was found. The rate of the occurrence of peptic ulcer is greater with higher salaries, additional paid, or social, work, and in case of daily travelling on a motorcycle or bicycle. Finally it was indicated that those suffering from peptic ulcer limited smoking and drinking habits and endeavoured to be fed properly.

[Epidemiological studies of peptic ulcer in coal miners. II. Effect of occupational factors]. / Epidemiologiczne badania choroby wrzodowej u górników kopaln wegla kamiennego. Czesc II. Wplyw czynnikow zawodowych.

In the part I the effect of social and life factors on the development of peptic ulcer in miners has been analysed. Now, in the same population of 8302 miners composing the crew of three coal mines, an evaluation of the role of occupational factors has been performed on the basis of inquiry and documentation data of the outpatient department. It was found that the frequency of peptic ulcer is more dependent on years of employment than on age. The percentage of peptic ulcer cases among the underground crew and this working on the surface did not reveal distinct differences. Only in miners, working underground a shortest time, it was less than in the analogous groups working on the surface. Among miners performing the longest time very arduous work, the frequency of peptic ulcer is less than in the remaining crew. The psychical burden and the paid by the job system as well as night shift work influence the increase of patients. These results demonstrate that in the mining the peptic ulcer hazard is augmented by similar factors as in other industries, the effect of underground work however has not been observed. The conditions of mining induce miners suffering from peptic ulcer to avoid more burdening job and this is why percentage of ill miners is less among those whose work is more arduous.