Advances in Respiratory Medicine-Aims and Scopes Update.

Advances in Respiratory Medicine, which has been published by MDPI since 2022, serves as a platform for hosting pneumological studies [...].

Awareness and Attitude of Polish Gynecologists and General Practitioners towards Human Papillomavirus Vaccinations.

Human papillomavirus (HPV) leads to diseases of the skin and mucous membranes of the anogenital and upper gastrointestinal tract, especially neoplasia. HPV vaccinations effectively protect against the development of HPV-related diseases. However, despite the wide availability of vaccination for patients, only a few percent of Polish children are vaccinated. The reasons for this are certainly complex. Therefore, the aim of the study was to evaluate gynecologists' and general practitioners' knowledge, awareness and attitudes towards HPV vaccination and analyze their opinions about the interest in HPV vaccinations among children and parents. An anonymous, voluntary, cross-sectional survey study was conducted among 300 Polish gynecologists and general practitioners. Participants were from a diverse group with a wide range of work experience and different workplaces. Most of the respondents (83%), especially the gynecologists (p = 0.03), declared informing and discussing with parents the HPV-related diseases and prevention methods. Only 8% of the participants reported a negative reaction from parents when talking about HPV vaccines. However, in practice, physicians very rarely recommend this vaccine. HPV vaccination was recommended more often by female physicians (p = 0.03), general practitioners (p < 0.001), physicians working over five years (p < 0.001), doctors who regularly vaccinated themselves against influenza (p = 0.01) and those who vaccinated their children against HPV (p =0.001). The availability of educational materials for parents and/or patients encouraged physicians to provide this information (p < 0.001). Polish gynecologists and general practitioners declared a positive attitude regarding HPV vaccines; however, they rarely recommended this vaccine. Physicians who vaccinate themselves against influenza and their own children against HPV are more likely to provide information and encourage HPV vaccination in others. Additionally, the availability of educational material for parents and adolescents plays an essential role in the popularization of this vaccination. Knowledge alone is not enough for physicians to recommend the vaccination to patients.

Evaluation of Polish Adolescents' Knowledge About Human Papillomavirus and Vaccines.

Purpose: Human papillomavirus (HPV) vaccination can prevent more than 90% of cancers caused by HPV. However, they are still not common in Poland. The aim of the study was to evaluate Polish youths' knowledge of HPV vaccine and sexually transmitted diseases (STD). Methods: The cross-sectional study was performed with the use of an anonymous and voluntary survey distributed among 610 graduate high-school students, and 491 (81%) responded. Results: Only 24% were aware of potential oncological risk of HPV infection. Nearly all responders indicated HIV/AIDS as STD, while only 14% indicated HPV as well. In the opinion of 94% participants, vaccines are effective and safe, however, only 8% of girls and 5% of boys claimed that they were vaccinated against HPV. Simultaneously, 43% declared the will to vaccinate their own child in the future. As a barrier in performing HPV vaccinations, participants indicated first of all lack of enough knowledge (64%) and lack of awareness of the need to be vaccinated (51%). The main sources of knowledge about health were internet (93%) and school (67%). Only 10% of the participants had discussed the HPV and vaccine with a doctor. These adolescents had more knowledge about cervical cancer (P = 0.0002) and its relation to HPV infection (P = 0.0001). Conclusions: Polish adolescents present positive attitude toward HPV vaccines but their knowledge is still unsatisfactory. Schools and professional health providers should pay more attention to patient's education as well as developing online campaigns.

Knowledge and Awareness of Polish Parents on Vaccination against Human Papillomavirus.

Background: Human papillomavirus (HPV) vaccinations are rare among Polish children, and the reasons are scant. The objective was to evaluate the knowledge, attitude and awareness of parents about HPV vaccination to investigate reasons for low HPV vaccination coverage. Methods: 387 parents of children hospitalized at the Children's Hospital were asked to participate in an anonymous and voluntary survey study. Three hundred and two surveys were returned. Results: Only 54% of participants have heard about HPV, while 26% know that it is a sexually transmitted disease. According to 71% of responders, vaccines are generally effective, and 63% claim that they are safe. However, only 5% of daughters and 4% of sons are vaccinated against HPV. A total of 25% of parents spoke with their doctor about HPV-related diseases and prevention methods. A higher level of education (p = 0.01), knowledge of sexually transmitted diseases (p < 0.0001), perceiving vaccination as an effective and safe prophylactic method (p < 0.0001), and conversations with a doctor (p < 0.0001) are strong motivators to vaccinate children against HPV. This decision is free of religious beliefs, origin, age, gender and the number of children. Conclusions: Polish parents have a positive attitude towards vaccination. They recognize the limitations of their knowledge and express a desire to further it. Educational activity is an important element of physicians' work.

Awareness of Polish physicians regarding the impact of air pollution on health.

The air quality in Poland is the worst in Europe. The aim of the study was to assess the awareness of Polish physicians about the impact of air pollution on health, the sources of their knowledge and how this knowledge is used in clinical practice. The study was based on a voluntary and anonymous questionnaire and included 94% of doctors from a hospital in Warsaw. Only 25% of physicians think that their knowledge of the impact of air pollution on health is sufficient. The main sources of this knowledge were the internet and TV. Only 5% of physicians know what air pollution concentrations are acceptable, 17% follow the levels of air pollution in their region and 3% inform their patients when air pollution exceeds permissible limits. The older and noninterventional physicians inform patients more often about these dangers. The knowledge of physicians on air pollution is not sufficient and they need professional education in this area.

Impact of inhalers used in the treatment of respiratory diseases on global warming.

The term "carbon footprint" describes the emission of greenhouse gases into the environment as a result of human activities. The healthcare sector is responsible for 5-8% of the value of global greenhouse gas emissions, of which medical aerosols account for only 0.03% of the total emissions. The reduction of greenhouse gases, including those used for the production and use of medicinal products and medical devices, is part of the responsibilities that Poland and the respective countries should undertake in order to implement the assumptions of international law. At the level of medical law, this obligation correlates with the need to exercise due diligence in the process of providing health services, including the selection of low-emission medical products and devices (inhalers) and providing patients with information on how to handle used products and devices, with particular emphasis on those that imply greenhouse gas emissions. Pressurized metered dose inhalers (pMDI) containing the hydrofluoroalkane 134a demonstrate the largest carbon footprint, followed by a metered dose liquid inhaler and dry powder inhalers (DPI). The carbon footprint of DPI with a given drug is 13-32 times lower than it is in the case of the corresponding pMDI. Replacement of pMDI by DPI is one of the effective methods to reduce the carbon footprint of inhalers, and the replacement should be based on current medical knowledge. A recycling system for all types of inhalers must be urgently implemented.

The Awareness of Pulmonologists and Patients with Respiratory Diseases about the Impact of Air Pollution on Health in Poland.

Within the European Union, air pollution is highest in Poland. The aim of this study was to compare the awareness of Polish pulmonologists and that of patients with respiratory diseases about the impact of air pollution on health. It was a crossover study with voluntary and anonymous participation. The study included 309 pulmonologists and 262 patients with respiratory diseases. The majority of the patients declared good knowledge about the impact of air pollution on health, and only 16% of the pulmonologists declared sufficient knowledge on this topic. The main sources of information on air pollution were radio and television for patients and the medical press for doctors. Doctors rarely informed patients about the impact of air pollution on their disease. Patients followed information on the quality of air in their areas more often than doctors. Polish patients' knowledge about the main sources of air pollution in their areas was higher than the knowledge of pulmonologists. Patients declared knowledge of air pollution standards twice as often as doctors. Patients with respiratory diseases are interested in the effects of air pollution on their health. Polish patients' knowledge about air pollution and its health effects is higher than that of the specialists treating them. Professional education of Polish pulmonologists in this field is needed.

Human papillomavirus vaccination - limatations and opportunities in countries with low vaccine coverage.

Persistent infection with oncogenic Human papillomavirus (HPV) types can lead to neoplasms involving urogenital and laryngeal tumors, which account for approximately 5% of all cancers worldwidely. Effective measures to reduce the morbidity and mortality associated with HPV cancers are regular examinations including the Papanicolaou test and preventive vaccination. However, despite the registration of the first HPV vaccine already in 2006, there is still huge disparity in the vaccination coverage between countries. In Poland, vaccination coverage is still very low in comparison to other European Union countries (only a few percent). Constraints exist on the part of the state and health system organizations, as well as in the attitudes of health professionals and parents. One of the primary factors influencing the decision to vaccinate against HPV is the presence of the vaccine in The National Immunization Program, while often with financial support. Formalization of vaccination also forces physicians to be more attentive to informing and recommending immunization, increasing their level of education. The role of medical workers is crucial from a social point of view. For parents, an adequate discussion with the physician is a vital factor influencing HPV vaccination decisions. At the same time, health care workers express the need to change their work organization due to insufficient time for health promotion and prophylaxis during visits. A thorough understanding of the barriers can allow for the development of effective strategies to increase vaccination coverage.

Pneumococcal Vaccine in Adult Asthma Patients.

Streptococcus pneumoniae is the most frequent source of community-acquired bacterial pneumonia in adults. Respiratory tract infections are the foremost reasons for asthma exacerbations. The World Health Organization and the Centers for Disease Control and Prevention consider asthma a clear indication for pneumococcal vaccination. The aim of this study was to determine the extent to which adult patients with asthma in Poland adhere to a schedule of recommended pneumococcal vaccinations. In addition, the study attempted to assess the source of the patient knowledge on vaccination and the plausible determents for vaccination. The study was conducted among patients at specialist outpatient clinics in the form of an anonymous survey that contained questions about asthma, vaccines, and the knowledge and motivations. A total of 214 patients (149 females and 65 males) of the mean age of 52 ± 17 years were interviewed. A staggering 93% of patients did not receive pneumococcal vaccination, and only 24% of patients were aware of the need for this vaccine. Age, gender, and education did not affect whether patients chose to receive the vaccine. The most often quoted reason for not receiving the vaccine was lack of information, followed by lack of faith in vaccine efficacy, and the fear of adverse effects. From the standpoint of health hazard stemming from prophylaxis avoidance, it appears paramount to educate asthmatic patients on the benefits of receiving pneumococcal vaccination.

Factors Affecting Influenza Vaccination Rate in Adults with Asthma.

Asthma is considered one of the most common noncommunicable diseases worldwide, with an incidence of 5.4% in the Polish, adult population. Symptoms of the disease can be triggered or worsened by a variety of factors including viral infection such as influenza, affirming the necessity for prophylactic vaccination. However, there is concern among the general population of the possibility of anaphylactic response to vaccination, which can deter patients with allergic asthma for fear of triggering exacerbation of their condition. The objective of the study was to determine the extent to which patients with asthma adhere to a schedule of recommended vaccinations in Poland. Two hundred fourteen patients were recruited from specialist outpatient clinics in Warsaw to complete voluntarily an anonymous questionnaire created for the purpose of this study. Within the past year, 82% stated having at least one respiratory infection, and 72% of patients were aware of the recommendation for annual vaccination against the flu. Forty-three percent of patients reported receiving the flu vaccine at least once, and only 20% followed through with annual vaccination. The most common sources of information about the importance of annual flu vaccination were from their doctors (47%) and the media (26%). Relatively few asthmatic patients in Warsaw get annual flu vaccinations despite the recommendations. These results were mainly sourced due to uncorrected fears and a lack of information about the importance of prophylaxis in asthma. It is essential to create effective strategies to inform patients with asthma of the importance of annual vaccinations.

Giant hiatal hernias.

Dyspnoea is most often caused by disorders of the respiratory and/or cardiovascular systems. Much less often it is brought about by the displacement of abdominal organs into the thoracic cage. Hiatal hernias may give rise to diagnostic difficulties, as both clinical and radiological symptoms suggest different disorders. Computed tomography is the method of choice when making a diagnosis. We have presented a series of 7 cases of giant hiatal hernias, each with a varying course of the disease, clinical symptoms, radiological features and prognoses. In two of the cases, the hernias were of a post-traumatic nature. Four cases of large diaphragmatic hernias were found in elderly patients (over 90 years old). An advanced age and numerous coexisting chronic diseases disqualified most of the patients from surgical treatment despite the hernias' large sizes. In only one case was fundoplication performed with a good end result. Two patients died, and an extensive hernia was the cause of one of the deaths. Upper gastrointestinal symptoms were present only in a few of the patients. An early diagnosis of giant hiatal hernia is crucial for the patients to undergo prompt corrective surgeries.

[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.

[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.

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.

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.

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.

[Dyspnea in a patient after open reduction of fracture of the femur].

Acute dyspnoea in the postoperative period requires quick consideration of all possible causes and implementation of the proper treatment. During the differential diagnostic process, other than the most common cardio-pneumological and otolaryngological reasons, we should consider a whole array of rare causes such as neuromuscular illnesses, renal failure, and gastrointestinal diseases. This case is an example of sudden onset of dyspnoea presenting in a 67 year old woman with COPD. The dyspnoea occurred in first postoperative day after open reduction of fracture of the femur. Onset of respiratory insufficiency symptoms and circulatory instability appeared suddenly and advanced quickly, as result of a large Morgagni type retrosternal hernia, requiring urgent thoraco-surgical intervention. In the long term, the effects of this operation were very good.

Lung Lesions During Fever of Unknown Origin.

Fever of unknown origin (FUO) remains one of the most difficult diagnostic challenges. The causes of FUO can be various diseases located in different organs. The aim of the study was to determine the prevalence and nature of pulmonary lesions during FUO. One hundred and sixty one patients with FUO participated in this prospective study. We performed a detailed comprehensive history, physical examination, and a wide spectrum of tests. The most common causes of FUO were infections (39%), autoimmune conditions (28%), and neoplasms (17%). Lung lesions were found in 30% of patients. In this group 35% were infections, 30% autoimmune diseases, and 4% cancer. Among patients with respiratory infections, there were cases of tuberculosis, atypical pneumonia, lung abscess, and bronchiectases. Autoimmune pulmonary lesions were observed during vasculitis and systemic lupus. The causes of FUO in the group of patients with lung lesions were also pulmonary embolism, sarcoidosis, and pulmonary fibrosis. Chest CT played an important role in the diagnosis of the causes of FUO with pulmonary manifestations. Pulmonary lesions are a common cause of FUO. Most FUO with pulmonary lesions are recognized during infections and autoimmune diseases. An important part of diagnosing FUO is a detailed evaluation of the respiratory system.

Cardiac Arrhythmias in Patients with Exacerbation of COPD.

Supraventricular and ventricular arrhythmias are common among patients with chronic obstructive pulmonary disease (COPD). Multiple factors can contribute to the development of arrhythmias in patients with exacerbation of the disease, including: respiratory or heart failure, hypertension, coronary disease and also medications. In the present study we seek to determine the prevalence of cardiac arrhythmias and risk factors among patients with exacerbation of COPD. The study was a retrospective evaluation of 2753 24-h Holter recordings of patients hospitalized in 2004-2016. Exacerbation of COPD was diagnosed in 152 patients and the prevalence of arrhythmias in this group of patients was 97%. The commonest arrhythmia was ventricular premature beats (VPB) - 88.8%, followed by supraventricular premature beats (SPB) - 56.5%. Permanent atrial fibrillation accounted for 30.3% and paroxysmal atrial fibrillation (PAF) for 12.5%. Supraventricular tachycardia (SVT) was noted in 34.2% patients and ventricular tachycardia in 25.6%. Respiratory failure increased the risk of SPB, while heart failure increased the risk of VPB. Treatment with theophylline was associated with a higher proportion of PAF and SVT. In conclusion, COPD exacerbation is associated with a high prevalence of cardiac arrhythmias. COPD treatment and comorbidities increase the risk of arrhythmias.