[Today's threat of ricin toxin]. / Wspólczesne zagrozenie toksyna rycynowa.

Since the late 70s of the last century there were more than 700 incidents related to the use of the ricin toxin. For this reason, CDC (Center of Disease Control and Prevention) recognized toxin as a biological weapon category B. The lethal dose of ricin toxin after parenteral administration is 0.0001 mg/kg and after oral administration 0.2 mg. The first symptoms of poisoning occur within a few hours after application of toxin as a nausea, vomiting and abdominal pain. In the final stage there are observed: cardiac arrhythmia, collapse and symptoms suggestive of involvement of the central nervous system. Stage immediately preceding death is a state of coma. The ricin toxin is still the substance against which action has no optimal antidote. Developed a vaccine called RiVax is waiting for its registration. It should be pointed out that the availability of a ricin toxin makes it possible to use it for real bioterrorists.

[Hospital-acquired pneumonia caused by biological pathogens]. / Wewnatrzszpitalne zapalenie pluc wywolane przez patogeny biologiczne.

Hospital-acquired pneumonia (HAP) is recognized when the clinical and radiological symptoms appear in the 48-72 hours from the admission to the hospital or in the case of pneumonia during the mechanical respiration after 72 hours of the patient's intubation. The frequency of HAP placed between 5 to 15 per 1000 patients undergoing hospital treatment. The appearance of clinical symptoms: high fever, cough with expelling of purulent sputum, an increased number of breaths or dyspnoe and the occurrence of inflammation's morphological markers and the presence of new changes in the radiography (or severity seen earlier) confirms the diagnosis. Difficulties arise during the treatment of pneumonia caused by several strains of bacteria or flora which are resistant to available antibiotics. This is the reasons of high mortality among patients with HAP, reaching above 35%.

[Recent indications for home oxygen therapy]. / Wspólczesne wskazania do domowego leczenia tlenem.

Home oxygen therapy is a treating method with an effect on improving the life comfort and long of life in the group of patients suffered from non-neoplasmic lung diseases complicated by partial respiratory failure, proved in many clinical trials according to some estimations the number of patients in Poland who fulfill home oxygen therapy qualification's criteria is twice higher then the number of patients who benefit from this method of therapy. This situation should make pneumonologists concern with problems of patients suffered from the respiratory failure who need this kind of therapy.

[Contemporary determinations of sarcoidosis ethiopathogenesis]. / Wspólczesne uwarunkowania etiopatogenetyczne sarkoidozy.

Sarcoidosis is a disease about unknown etiology. It's characterized by a chronic inflammation with creation of granuloma consisted of macrophages, lymphocytes and epithelial cells. The course of the disease may be different--from spontaneous remission to severe and chronic form. The most possible cause of sarcoidosis seems to be genetic etiology. Many trials indicated strong influence of human leukocyte antigens (HLA), cytokines and chemokines on sarcoidosis origin. On the other side the role of environmental factors, viral, atypical bacterial and mycobacterial infections is strongly stressed.

[Definition and epidemiology of sarcoidosis]. / Definicja i epidemiologia sarkoidozy.

Sarcoidosis is a systemic inflammatory disease of undetermined etiology with unexplained predilection for the lung. The definition of disease has been evaluated in many clinical centers but final results are still under discussion. Some historical facts of sarcoidosis presented in the paper show that histological and x-ray examinations are key diagnostic tools. Sarcoidosis occurs worldwide, with a high prevalence in Afro-Americans and Caribbeans, and in people of Nordic countries. Prevalence varies with geography and is dependent from environmental factors and immunogenetic mechanisms.

[Costs of chronic obstructive pulmonary disease in patients treated in ambulatory care in Poland]. / Koszty przewleklej obturacyjnej choroby pluc u pacjentów leczonych w ramach specjalistycznej opieki ambulatoryjnej w Polsce.

INTRODUCTION: Chronic obstructive pulmonary disease (COPD) is a leading cause of death worldwide. A cost-of-illness study aims to determine the total economic impact of a disease or health condition on society through the identification, measurement, and valuation of all direct and indirect costs. Exacerbations are believed to be a major cost driver in COPD. The aim of this study was to examine direct, mean costs of COPD in Poland under usual clinical practice form societal perspective. MATERIAL AND METHODS: It was an observational bottom-up-cost-of-illness study, based on a retrospective sample of patients presenting with COPD in pulmonary ambulatory care facilities in Poland. Total medical resources consumption of a sample were collected in 2007/2008 year by physician - lung specialists. Direct costs of COPD were evaluated based on data from different populations of five clinical hospitals and eight out-patient clinics. Resources utilisation and cost data are summarised as mean values per patient per year. 95% confidence intervals were derived using percentile bootstrapping. RESULTS: Total medicals resources consumption of a COPD patient per year was 1007 EURO (EUR 1 = PLN 4.0; year 2008). Among this cost 606 EURO was directly related to COPD follow up, 105 EURO was related to ambulatory exacerbation, and 296 EURO was related to exacerbation treated in hospital. CONCLUSIONS: The burden of COPD itself appeared to be considerable magnitude for society in Poland.

[Costs of exacerbations of chronic obstructive pulmonary disease in primary and secondary care in 2007--results of multicenter Polish study]. / Koszty leczenia zaostrzen przewleklej obturacyjnej choroby pluc w warunkach ambulatoryjnych i szpitalnych w 2007 roku--wyniki wieloosrodkowego badania polskiego.

OBJECTIVES: Exacerbations are the key drivers of the costs of chronic obstructive pulmonary disease (COPD). This was the multicenter study of patients with COPD aimed at evaluating direct and indirect cost of exacerbations under usual clinical practice in primary and secondary care form societal perspective. METHODS: It was observational, multicenter study with participation of 196 subjects with moderate or severe COPD, defined according to the current GOLD criteria. Patients presenting at the selected health care centres were included into the study in the sequential manner if they fulfilled the inclusion criteria. Exacerbations were divided into three different severity types according to Anthonisen N.R. classification. The management of exacerbations followed the usual clinical practice. RESULTS: The number of exacerbations was 3.8 (3.2-4.4) in hospitalised patients and 1.7 (1.4-1.9) in ambulatory treated patients (1EURO was 3.85 PLN in 2007). The average direct health-care cost per exacerbation was PLN 5548 (95% CI = 4543; 6502) and PLN 524.1 (95% CI = 443; 614) in secondary and primary care respectively. In secondary care, the drug acquisition and oxygen therapy cost represented 18.3% of total direct costs, diagnostic tests costs accounted for 14.5%, the other hospital care and post-discharge followup visit costs 67%. Costs varied considerably with the severity of COPD before the exacerbation as well as the duration of COPD. In primary care the cost structure was as follows: diagnostic tests and medical devices 47.5%, drug acquisition costs 41% and doctors visits 11.4%. The average indirect costs per exacerbation were PLN 127.78 and PLN 100.56, in secondary and primary respectively (n.s) CONCLUSION: Exacerbations of COPD are costly. Cost of exacerbation managed in secondary care is almost 10-fold higher than in primary care. Prevention of moderate-to-severe exacerbations, requiring hospitalization could be very cost-effective strategy.

Telomerase activity in transthoracic fine-needle biopsy aspirates from non-small cell lung cancer as prognostic factor of patients' survival.

PURPOSE: Evaluation of the relationship between telomerase activity in transthoracic fine-needle biopsy (TFNB) aspirates collected from peripheral non-small cell lung cancer (NSCLC), cancer advancement, risk of death and free of cancer recurrence survival. MATERIAL AND METHODS: The study group consisted of 93 patients with peripheral infiltration of the lung. All of them had TFNB of the focal pulmonary lesion performed. The aspirates were subjected to standard cytological evaluation. Telomerase activity in the specimens was determined with the PCR-ELISA PLUS method. Cancer advancement, manner of treatment and survival were assessed in patients with NSCLC. RESULTS: A benign lesion of the lung was recognised in 14 cases. NSCLC was newly diagnosed in 79 subjects. Nobody with benign infiltration had a detectable level of telomerase in lung infiltration. Increased telomerase activity was observed in 56 (70.9%) patients with lung cancer. It was significantly more often detected in patients with non-operable NSCLC (clinical stage IIIB plus IV) and patients with distant metastases (stage IV alone). Cox hazard analysis revealed that presence of telomerase activity in primary NSCLC is an independent prognostic factor of survival. Increased telomerase activity in TFNB aspirates was related to 7 times higher relative risk of death during the study [RR=6.9 (CI: 1.8-26.8); p<0.05] and 2.5 times higher risk of cancer recurrence after radical treatment [RR=2.5 (CI: 0.3-9.3); p<0.05]. CONCLUSION: Telomerase activity in aspirates collected through TFNB of primary peripheral NSCLC could be a helpful independent prognostic factor of distant metastases and risk of death or cancer recurrence.

[Fusion of pulmonary scintigraphy with Tc99m-depreotide imaging with CT scan in recognizing solitary pulmonary nodule]. / Scyntygrafia pluc z 99mTc-depreotydem i nakladanie obrazów tomografii komputerowej w rozpoznawaniu pojedynczego guza pluca.

UNLABELLED: At present also radionuclide methods are used to diagnose pulmonary malignancies. One of them is solitary pulmonary nodule (SPN) scintigraphy using 99mTc-depreotide. 99mTc-depreotide is a somatostatin analogue with affinity to 3 out of 5 subtypes of somatostatin receptors. AIM OF THE STUDY: was to confirmed the usefulness of 99mTc-depreotide in detecting malignancy in SPN; finding lymph nodes metastases; and overlapping scintigraphic scans and CT in precise localizsation of malignancy and its lymph nodes metastases. MATERIAL AND METHODS: The group studied comprised 50 patients with radiologically diagnosed SPN. Forty patients had a high resolution CT scan done with a GE Light Speed equipment-device. The acquired CT scans were sent via LAN (Local Area Network) to an ARPACS server in the Department of Nuclear Medicine, and thence to a Hermes Nuclear Diagnostics workstation. CT examinations were followed by scintigraphy with 99mTc-depreotide. RESULTS: In 32 patients 99mTc-depreotide was found to have accumulated excessively in SPN: in 23 cases malignancy was found, in the 9 remaining cases they were other abnormalities. In the 23 lung cancer patients, 99mTc-depreotide was found in 24 foci, including 18 in the mediastinum and axillary region. CT revealed affected lymph nodes only in 7 cases. The calculated sensitivity, specificity and accuracy in SPN were 89%, 60%, 82%, respectively. The tumour/background index in malignancies confirmed histologically was 2.58 +/- 0.89. Where lymph nodes metastases were suspected in the diagnosed malignancies, the lymph node/background index was 2.60 +/- 0.85. In 25 cases lesion localization was more accurate when scans were overlapped. CONCLUSIONS: 99mTc-depreotide based examination is a sensitive method in the evaluation of SPN malignancy. Overlapping SPECT and CT scans in diagnosing SPN enables both pathological and physiological changes to be localized precisely. This method seems particularly valuable in imaging lymph nodes where metastases are suspected, especially when CT scans revealed no abnormalities.

[Comparison of outpatient and inpatient costs of moderate and severe exacerbations of chronic obstructive pulmonary disease in Poland]. / Porównanie kosztów leczeniz umiarkowanych i ciezkich zaostrzen przewleklej obturacyjnej choroby pluc w Polsce w warunkach ambulatoryjnych i szpitalynych.

INTRODUCTION: The aim of the study was to examine the direct and indirect costs of COPD exacerbations under usual clinical practice in primary and secondary care from a societal perspective in Poland. MATERIAL AND METHODS: An observational, prospective study was conducted among patients with exacerbation of moderate or severe COPD. Seventy-three patients were included in the study - 39 treated in hospital (HC) and 34 treated in ambulatory care (AC). The direct costs included the cost of drugs, diagnostic tests, in-hospital and outpatient care. The indirect costs included costs of transportation to the health-care provider and work days lost. RESULTS: The mean duration of COPD exacerbation did not differ significantly between the groups [HC: 11.2 (CI 95%: 9.6-12.8) days; AC: 10.8 (CI 95%: 9.1-12.1); p > 0.05]. The total health-care cost per exacerbation was EUR 1197 (4137.9 PLN) in secondary care (the HC group), and it was 6 times higher than the total cost of exacerbation in primary care (the AC group) - EUR 199.8 (446.9 PLN). The costs of drugs and diagnostic tests were significantly higher in the HC group than in the AC group; however, it was the cost of in-hospital stay and medical visits in the HC group that most influenced expenditure related to COPD exacerbations, as they were 27 times higher than in the AC group. CONCLUSIONS: In Poland the costs of COPD exacerbation managed in secondary care are 6-fold higher than in primary care. Therefore, the decisions about admission of patients with COPD exacerbation to hospital should be made carefully.

[Metapneumoviruses--the "youngest" pathogens of respiratory tract infections in human]. / Metapneumowirusy--"najmlodsze" patogeny zakazenia dróg oddechowych u ludzi.

Acute respiratory infections are the most common diseases in all age groups in the world. Lower respiratory infections are the main reason of death, hospitalization and antibiotic use in immunocomprised patients and/or patients with respiratory system chronic diseases. The leading role plays viruses: rhinoviruses, influenza and parainfluenza viruses, respiratory syncytial viruses (RSV), adnenoviruses and coronaviruses. The "youngest" pathogen in this group are human metapneumowiruses (hMPV), identified in 2001. They are the reason of infections in infants, older adults and immunocomprised patients. Manifestation of the infection can have a form from a self-limiting upper respiratory tract inflammation, through bronchitis (in adults), bronchiolitis (in infants) and pneumonitis (in infants and adults), and extremely of severe acute respiratory failure with a need of mechanical ventilation. The authores describe microbiological, epidemiological and clinical features on infection with hMPVs.

[Alexithymia and depression: relationship to cigarette smoking, nicotine dependence and motivation to quit smoking]. / Aleksytymia i depresja: zwiazek z paleniem papierosów, uzaleznieniem od nikotyny i motywacja do rzucenia palenia.

The aim of the study was to examine an alexithymia score and depression among people smoking cigarettes and also to examine association between alexithymia, depression and smoking index, nicotine addiction, the motivation to quit smoking. The study comprised 46 people from Warsaw and its environs, without pulmonary, cardiovascular or neoplastic diseases, with at least medium education. The subjects were qualified into two groups: group I (n = 22) - subjects who had never smoked cigarettes, and group II - currently smoking (n=24). The total alexithymia score and scores of alexithymia subscales: difficulty in identifying feelings (TIE), b) difficulty in communicating feelings (TOU), c) externally oriented thinking (OSM) were assessed with Toronto Alexi. thymia Scale 20 (TAS-20). Beck Depression Inventory (Scale) (BDI) was used to evaluate presence and intensification of depression symptoms. The tobacco addiction rate was assessed with the Fagestrom questionnaire, and the motivation to quit smoking with the Schneider test. All data were obtained during individual exami. nations. The mean alexithymia score in the nonsmokers group was 38.6+/-8.8, in the smokers group: 46.6+/-13.0. The differences between the groups were statistically significant (p=0.02). Both difficulty in identifying feelings (TIE) and difficulty in communicating feelings (TOU) scores were significantly higher in the smokers (TIE p=0.01; TOU p=0.03). There were no differences in externally oriented thinking. It was found that people smoking cigarettes had a significantly higher level of intensification of depression symptoms than the controls. There was not any correlation between the total alexithymia score and depression symptoms or smoking index, the degree of nicotine addiction, the motivation to quit smoking.

[The influence of smoking on the metalloproteinase 1 (MMP-1) concentration in serum in the group of patients with chronic obstructive pulmonary disease]. / Wplyw palenia tytoniu na stezenie metaloproteinazy 1 (MMP-1) w surowicy u osób chorych na przewlekla obturacyjna chorobe pluc.

The aim of the study was to assess the influence of smoking on the metalloproteinase 1 (MMP-1) concentration in serum in the group of patients with chronic obstructive pulmonary disease (COPD). The study comprised 26 patients with COPD. The control group was created of 15 healthy non-smoking subjects. In the both group spirometry test was performed. The concentration of MMP-1, C-reactive protein, OB level was estimated in serum. Significant differences were noticed in the MMP-1 concentration in serum between groups (p=0.013). Significantly higher OB level (p=0.011) and C-reactive protein concentration (p=0.03) was found in the COPD group. In this same group positive correlation between MMP-1 concentration in serum and the packyears was noticed (r=0.50). No significant correlation was found between inflammatory indicators and the number of packyears. No significant correlation was noticed between MMP-1 level and FEV1 in COPD group. The analysis of the data shows significant influence of smoking on the increase of MMP-1 concentration in serum in the group of COPD patients.

[Relationship between disease severity, smoking index age and direct costs of hospital treatment of COPD exacerbations]. / Zaleznosc pomiedzy stopniem ciezkosci choroby, wskaznikiem palenia tytoniu i wiekiem chorych a bezposrednimi kosztami leczenia zaostrzen przewleklej obturacyjnej choroby pluc w szpitalu.

The aim of the study was the evaluation of influence of age, intensity of smoking habit and FEV1 value on the costs of inhospital treatment of COPD exacerbations. 71 cases of COPD exacerbation in current smoking males hospitalized in the Military Institute of Health Service in Warsaw were analyzed. The mean age of subjects was 68.8 +/- 9.5, the mean predicted value of FEV1 49.2 +/- 20.2% and the mean period of hospitalization 7.1 +/- 2.9 days. The mean smoking index (expressed in pack-years) was 41.9 +/- 17.7. The mean direct expenditure for treatment of COPD exacerbation per person amounted to PLN 2187.8 +/- 941.6 and included the cost of medical care PLN 1375.9 +/- 573.6, the cost of drugs PLN 393.3 +/- 287.5 and the cost of additional examinations PLN 415.5 +/- 200.4. In statistical analysis, multiple regression model was used and partial correlation coefficients were calculated for significantly different variables. No influence of age and predicted FEV1 value on the costs of COPD exacerbation was found. A significant relationship was found between the smoking index (expressed in pack-years) and disease severity, on the one side, and the direct costs of exacerbation treatment (r=0.281 and r=0.301 respectively, p<0.05). In active smokers male with COPD, smoking index and degree of the disease severity are independent factors, which equally strong determine the direct costs of hospital treatment of COPD exacerbation.

[Influence of nicotine addiction on telomerase activity in malignant non-small cell lung tumors]. / Wplyw nikotynizmu na aktywnosc telomerazy w niedrobnokomórkowych guzach zlosliwych pluc.

Telomerase synthesizes telomeric DNA repeats at the ends of eukaryotic chromosomes and inhibits the natural senescence of different cells. Its increased activity in malignant tumors is considered to be an independent prognostic factor of the disease course. Aim of the study was valuation of influence of prolonged tobacco smoking on telomerase expression in non-small cell lung cancer (NSCLC). The study comprised 33 patients with NSCLC (divided into two groups: smokers - n=21 and nonsmokers n=12), who had telomerase activity quantitatively assessed (PCR-ELISAPLUS, ROCHE, Mannheim, Germany) in aspirates collected from peripheral lung tumors through transthoracic fine-needle biopsy. No statistically significant differences were found between the studied groups with regard to the clinical stage of tumor. Telomerase activity in biopsy samples from smoking patients was higher than in samples from nonsmoking patients (statistically insignificant difference p=0.09). It was found that telomerase activity in tumor cells was significantly lower in patients smoking less than 40 pack years in comparison to patients smoking more than 40 pack-years (p=0.01). Telomerase activity in NSCLC cells correlated significantly with clinical stage of tumor in all the patients (r=0.66 for nonsmokers and r=0.58 for smokers; p< or =0.01), and in the smokers' group - additionally with pack-years (r=0.47; p=0.04). Tobacco smoking by patients with non-small cell lung cancer increases telomerase activity in tumor cells.

[The risk factors of death in community-acquired pneumonia]. / Czynniki zagrozenia zgonem w przebiegu pozaszpitalnego zapalenia pluc.

In this study we estimate influence of concomitant diseases and age on risk of death because of community-acquired pneumonia (CAP). We performed retrospective analysis of 405 CAP cases. All patients have been treated in Central Hospital of Military School of Medicine in Warsaw from 1990 to 1997. We showed statistically significant influence of age > 65 yr. (OR = 5.71; CI: 1.41-23.22; p = 0.015), chronic heart failure (OR = 2.57; CI: 1.1-5.99; p = 0.029) and chronic renal failure (OR = 3.35; CI: 1.06-10.54; p = 0.039) on high risk of death in patients with community-acquired pneumonia.

[Role of monoclonal anti-IgE antibodies (rhu-MAb) in the treatment of allergic bronchial asthma]. / Znaczenie przeciwcial monoklonalnych anty-IgE w leczeniu alergicznej astmy oskrzelowej.

The key role in the mechanism of immune response to allergenic exposure in bronchial asthma is played by immunoglobulins E (IgE), which bind to specific Fce receptors on mast cells, basophils, B-lymphocytes and eosinophils. The specific recombinant human monoclonal antibodies (rhu-MAb) directed against free IgE are a new promising therapeutic remedy for symptoms of allergic asthma. In this article the review of clinical studies concerning the usefulness of rhu-MAb in treatment of bronchial asthma is presented.

[Retrospective analysis of direct costs of hospital treatment of chronic obstructive pulmonary disease exacerbations]. / Retrospektywna analiza bezposrednich kosztów szpitalnego leczenia zaostrzen przewleklej obturacyjnej choroby pluc.

A one-year retrospective analysis of 175 cases of COPD exacerbation was conducted. A relationship was established between expenses, on the one side, age, smoking habit and pulmonary function tests results, on the other. The mean direct expenditure for hospital treatment of COPD exacerbation per person amounted to PLN 2374.9 +/- (1040.7) (PLN 1690.8 +/- 581.8 for exacerbation of mild COPD, PLN 2221.9 +/- 815.9 for exacerbation of moderate COPD and PLN 2961.4 +/- 1345.9 for exacerbation of severe COPD). A significant relationship was found between the costs of drugs and forced expiratory volume in the first second (FEV1%) and forced vital capacity (FVC%) (accordingly r = -0.19 and r = -0.26; p < or = 0.05). Smoking habit had significant influence on the costs of therapy only in men (r = 0.22; p < or = 0.05). Age did not have serious influence on the costs. The direct costs of COPD exacerbations in women were significantly higher than in men (accordingly: PLN 2723.3 +/- 1209.9 and 2206.7 +/- 906.9; p = 0.005). Pulmonary function test results, severity of disease and female sex are relevant factors influencing the direct costs of hospital treatment of COPD exacerbations.

[Pharmaco-economics of asthma and chronic obstructive lung disease]. / Farmakoekonomika astmy i przewleklej obturacyjnej choroby pluc.

Health economics has become accepted as an important aspect, as it provides useful information on the costs to society associated with particular diseases and the cost-effectiveness of different treatment options. These considerations are particularly important in relation to common and chronic conditions such as asthma and chronic obstructive pulmonary disease. The direct and indirect cost associated with asthma and COPD and trends in the use of outpatient care, drugs and inpatient care were presented in this paper. It should be stressed that asthma therapy has changed from inpatient to ambulatory care, while the treatment of COPD is still based to a higher degree on inpatient care.

[Evaluation of clinical effectiveness and direct costs of azithromycin treatment for exacerbation of chronic obstructive pulmonary disease in hospitalized patients and ambulatory care]. / Ocena klinicznej skutecznosci oraz porównanie bezposrednich kosztów leczenia azytromycyna chorych z zaostrzeniem przewleklej obturacyjnej choroby pluc leczonych ambulatoryjnie lub w warunkach szpitalnych.

This paper presents the efficacy and cost of therapy with azithromycin for the treatment of patients with acute exacerbation of chronic obstructive pulmonary disease (COPD). Two subgroups were investigated: out-patients and hospitalized patients--20 in each group (17 women and 23 men). Azithromycin 500 mg was administered sequentially once daily. A complete physical examination including temperature, respiratory rate, cough, production and characteristics of sputum so as general aspects of quality of life assessed by COPD exacerbation questionnaire was made in hospitalized patients on a daily base and in a day 10-14 after the end of therapy. Out-patients were assessed in day 1, 3-5 days after the start of study drug treatment and 10-14 days after the end of therapy. Pulmonary function tests were assessed three times during the whole study course. The results of the study suggest similar duration of therapy with azithromycin in both study subgroups, whereas in out-patients decrease and regression of symptoms were statistically significantly quicker with tendency approximately the same in both study subgroups. The cost of therapy with azithromycin was similar in both subgroups but the complete cost of COPD exacerbation treatment was significantly lower in out-patients in comparison to hospitalized patients group (473.71 PLN and 2587.87 respectively).