Portal hypertension as a result of the incomplete surgically treated advanced alveolar echinococcosis: a case description.

BACKGROUND: Infection of Echinococcus multilocularis causes in humans the alveolar echinococcosis. Although the infection has world-wide distribution it is rarely detected. Diagnosis of alveococcosis is difficult because of not typical clinical picture and irregular results of radiological examinations suggesting neoplasmatic process which begins in the liver tissue or in the biliary tracts. The parasitic growth is slow, so the illness is quite often established in late invasion period. Treatment of long-lasting and late diagnosed infection is difficult and requires cooperation of parasitologists together with surgeons to avoid life-threatening organ dysfunction. CASE PRESENTATION: We describe a young male patient, diagnosed, according to the radiological, immunological and histological examination results, infection of Echinococcus multilocularis, who was treated with not radical resection of pathologic mass together with persistent albendazole intake. The right hepatectomy was performed. In addition, visible cysts were removed from the left lobe of the liver in nonanatomical resection and suspicious calcified lesions in hepatoduodenal ligament were also removed. After the operation portal hypertension, with splenomegaly and symptoms of the liver cirrhosis occurred (thrombocytopenia, collateral venous circulation, first degree varices oesophagii). The portal hypertension probably could be a result of incomplete surgery due to extended parasitic infection and liver anathomical changes due to performed procedures, because the portal hypertension and it's further complications had not been observed before the operation. CONCLUSIONS: Echinococcus multilocularis should be taken under consideration in differential diagnosis of irregular lesions within the liver. Lon-lasting invasion could be responsible for the irreversible secondary liver changes such as cirrhosis and portal hypertension. The surgery treatment (treatment of choice) is difficult and it's results depends on the invasion period the patient is operated on. After the surgery the patient requires careful follow - up, to detect early complications.

The association of pre-operative anaemia with survival after orthotopic liver transplantation.

Anaemia is common in patients with end-stage liver disease. Pre-operative anaemia is associated with greater mortality after major surgery. We analysed the association of pre-operative anaemia (World Health Organization classification) with survival and complications after orthotopic liver transplantation using Cox and logistic regression models. We included patients undergoing their first orthotopic liver transplantation between 2004 and 2016. Out of 599 included patients, 455 (76%) were anaemic before transplantation. Pre-operative anaemia was not associated with the survival of 485/599 (81%) patients to 1 year after liver transplantation, OR (95%CI) 1.04 (0.64-1.68), p = 0.88. Pre-operative anaemia was associated with higher rates of intra-operative blood transfusions and acute postoperative kidney injury on multivariable analysis, OR (95%CI) 1.70 (0.82-2.59) and 1.72 (1.11-2.67), respectively, p < 0.001 for both. Postoperative renal replacement therapy was associated with pre-operative anaemia on univariate analysis, OR (95%CI) 1.87 (1.11-3.15), p = 0.018.

Effect of intravenous S-ketamine on the MAC of sevoflurane: a randomised, placebo-controlled, double-blinded clinical trial.

BACKGROUND: Ketamine is routinely used in operating theatres, emergency departments, ICUs, and even outpatient units. Despite the widespread use of ketamine, only basic aspects of its interactions with inhalation anaesthetic agents are known, and formal testing of interactions in humans is lacking. The minimum alveolar concentration (MAC) of inhalation anaesthetics is used to guide the depth of anaesthesia, and several drugs are known to influence the MAC. The aim of this study was to investigate whether intravenous application of ketamine influences the MAC of sevoflurane in humans. METHODS: Adult patients undergoing elective surgery were included in this randomised, double-blinded, placebo-controlled study. Patients were assigned to one of three groups, each of which received a bolus of placebo, 0.5 mg kg-1S-ketamine, or 1 mg kg-1S-ketamine followed by an infusion of the same amount per hour after inhalation induction with sevoflurane was performed. The response to skin incision (movement vs non-movement) was recorded. The MAC of sevoflurane was assessed using an up-and-down titration method. RESULTS: Sixty patients aged 30-65 yr were included. Each group consisted of 20 patients. The MAC of sevoflurane was higher in the placebo group (2.1 (sd 0.1) %) than in the low-dose ketamine group (0.9 (0.1)%, P<0.01) and the high-dose ketamine group (0.5 (0.1)%, P<0.01). In addition, the MAC of sevoflurane was higher in the low-dose ketamine group compared with the high-dose ketamine group (P<0.01). CONCLUSIONS: The administration of S-ketamine significantly and dose-dependently reduced the MAC of sevoflurane in humans. CLINICAL TRIAL NUMBER: EudraCT ref. no. 2012-001908-38.

A systematic review of calcium channel antagonists in bipolar disorder and some considerations for their future development.

l-type calcium channel (LTCC) antagonists have been used in bipolar disorder for over 30 years, without becoming an established therapeutic approach. Interest in this class of drugs has been rekindled by the discovery that LTCC genes are part of the genetic aetiology of bipolar disorder and related phenotypes. We have therefore conducted a systematic review of LTCC antagonists in the treatment and prophylaxis of bipolar disorder. We identified 23 eligible studies, with six randomised, double-blind, controlled clinical trials, all of which investigated verapamil in acute mania, and finding no evidence that it is effective. Data for other LTCC antagonists (diltiazem, nimodipine, nifedipine, methyoxyverapamil and isradipine) and for other phases of the illness are limited to observational studies, and therefore no robust conclusions can be drawn. Given the increasingly strong evidence for calcium signalling dysfunction in bipolar disorder, the therapeutic candidacy of this class of drugs has become stronger, and hence we also discuss issues relevant to their future development and evaluation. In particular, we consider how genetic, molecular and pharmacological data can be used to improve the selectivity, efficacy and tolerability of LTCC antagonists. We suggest that a renewed focus on LTCCs as targets, and the development of 'brain-selective' LTCC ligands, could be one fruitful approach to innovative pharmacotherapy for bipolar disorder and related phenotypes.

Discontinuation and non-publication of neurodegenerative disease trials: a cross-sectional analysis.

BACKGROUND AND PURPOSE: Trial discontinuation and non-publication represent major sources of research waste in clinical medicine. No previous studies have investigated non-dissemination bias in clinical trials of neurodegenerative diseases. METHODS: ClinicalTrials.gov was searched for all randomized, interventional, phase II-IV trials that were registered between 1 January 2000 and 31 December 2009 and included adults with Alzheimer's disease, motor neurone disease, multiple sclerosis or Parkinson's disease. Publications from these trials were identified by extensive online searching and contact with authors, and multiple logistic regression analysis was performed to identify characteristics associated with trial discontinuation and non-publication. RESULTS: In all, 362 eligible trials were identified, of which 12% (42/362) were discontinued. 28% (91/320) of completed trials remained unpublished after 5 years. Trial discontinuation was independently associated with number of patients (P = 0.015; more likely in trials with ≤100 patients; odds ratio 2.65, 95% confidence interval 1.21-5.78) and phase of trial (P = 0.009; more likely in phase IV than phase III trials; odds ratio 3.90, 95% confidence interval 1.41-10.83). Trial non-publication was independently associated with blinding status (P = 0.005; more likely in single-blind than double-blind trials; odds ratio 5.63, 95% confidence interval 1.70-18.71), number of centres (P = 0.010; more likely in single-centre than multi-centre trials; odds ratio 2.49, 95% confidence interval 1.25-4.99), phase of trial (P = 0.041; more likely in phase II than phase IV trials; odds ratio 2.88, 95% confidence interval 1.04-7.93) and sponsor category (P = 0.001; more likely in industry-sponsored than university-sponsored trials; odds ratio 5.05, 95% confidence interval 1.87-13.63). CONCLUSIONS: There is evidence of non-dissemination bias in randomized trials of interventions for neurodegenerative diseases. Associations with trial discontinuation and non-publication were similar to findings in other diseases. These biases may distort the therapeutic information available to inform clinical practice.

Environmental assessment of different dewatering and drying methods on the basis of life cycle assessment.

Sewage sludge is an inevitable product of wastewater treatment in municipal wastewater plants and its amount has increased dramatically due to the growing number of sewage systems users. This sludge needs to be adequately treated in order to decrease its hazardous properties and any negative influence on the environment. In this paper, gate to gate analysis, on the basis of life cycle assessment (LCA), was carried out in order to compare the environmental impact of alternative ways of sludge processing employing a dewatering press and three different kinds of dryers - belt dryer, container dryer and batch dryer. SimaPro 7.2 software and Ecoinvent 2.2 database were used to estimate the carbon footprint and energy balance of these processes. The main energy consumption in the scenarios analyzed is caused by the drying process. The solution based on application of the batch dryer allows a saving of 39.6% of energy compared with the most energy-consuming solution using a belt dryer. Sludge processing using belt and container dryers cause greater environmental burdens.

Medical, Health and Wellness Tourism Research-A Review of the Literature (1970-2020) and Research Agenda.

Medical, health and wellness tourism and travel represent a dynamic and rapidly growing multi-disciplinary economic activity and field of knowledge. This research responds to earlier calls to integrate research on travel medicine and tourism. It critically reviews the literature published on these topics over a 50-year period (1970 to 2020) using CiteSpace software. Some 802 articles were gathered and analyzed from major databases including the Web of Science and Scopus. Markets (demand and behavior), destinations (development and promotion), and development environments (policies and impacts) emerged as the main three research themes in medical-health-wellness tourism. Medical-health-wellness tourism will integrate with other care sectors and become more embedded in policy-making related to sustainable development, especially with regards to quality of life initiatives. A future research agenda for medical-health-tourism is discussed.

Changing Grocery Shopping Behaviours Among Chinese Consumers At The Outset Of The COVID-19 Outbreak.

This study focuses on the embryonic stages of the COVID-19 pandemic in China, where most people affected opted to abide by the Chinese government's national self-quarantine campaign. This resulted in major disruptions to one of the most common market processes in retail: food retailing. The research adopts the theory of planned behaviour to provide early empirical insights into changes in consumer behaviour related to food purchases during the initial stages of the COVID-19 outbreak in China. Data from the online survey carried out suggest that the outbreak triggered considerable levels of switching behaviours among customers, with farmers' markets losing most of their customers, while local small independent retailers experienced the highest levels of resilience in terms of customer retention. This study suggests avenues for further scholarly research and policy making related to the impact this behaviour may be having around the world on society's more vulnerable groups, particularly the elderly.

In vitro sensitivity of leukemic cells to nucleoside derivatives in childhood acute leukemias: good activity in leukemic relapses.

Nucleoside analogues such as fludarabine and cladribine are used in therapy of indolent lymphomas and leukemias in adults, while cytarabine is used mainly in protocols for acute leukemias. Mechanisms of their activity is based on inhibition of enzymes involved in DNA, RNA and protein synthesis. The objective of the study was the analysis of in vitro cellular drug sensitivity in childhood acute lymphoblastic (ALL) and myeloid (AML) leukemia. Isolated leukemic cells obtained from 264 patients, including 152 initial ALL, 45 relapsed ALL, 54 initial AML and 13 relapsed AML were tested for cytotoxicity for fludarabine, cladribine, and cytarabine by the MTT assay. Drug concentration lethal to 50% of tested cells was regarded as a value of drug resistance. Three tested nucleoside analogues showed highest cytotoxicity against initial ALL samples. Samples of relapsed ALL and initial AML were more resistant than ALL de novo ones. Unexpectedly, no differences were observed between initial and relapsed AML samples for all tested drugs, what suggests that nucleoside analogues are active drugs in relapsed AML, which is commonly regarded as a resistant disease. All tested drugs presented significant cross-resistance in each of analyzed subgroups. In summary, tested nucleoside analogues presented relatively good activity against childhood leukemias at relapse stage.

Fine needle aspiration biopsy in the differential diagnosis of the liver cystic echinococcosis.

Liver cystic echinococcosis (CE) in non-endemic areas poses several problems in the differential diagnosis of various space occupying lesions detected by US examination. Fine needle aspiration biopsy (FNAB) using teflon covered needles with a US visible marker may be very useful for the definitive diagnosis. In the Clinic of Parasitic and Tropical Diseases in Poznan, FNAB were performed in 121 patients with liver space occupying lesions, with an addition of an anthelmintic cover of albendazole. The biopsy material was examined parasitologically, cytologically, bacteriologically and immunologically. E. granulosus infection has been confirmed in 25 patients (20.6%), in 16 cases by finding parasite protoscoleces or hooks and in nine cases by detection of an antigen specific for E. granulosus, antigen 5 (Ag5). Additionally nine cases of malignancy (7.4%), four of angioma (3.3%) and three bacterial abscesses (2.5%) were diagnosed. There were no complications related to FNAB puncture. The algorithm of the clinical management of space occupying lesions suspected for CE was proposed. FNAB is a very important technique in the differential diagnosis of cystic echinococcosis.

Detection of specific Echinococcus granulosus antigen 5 in liver cyst bioptate from human patients.

Eighty one liver cyst fluid samples obtained by fine needle aspiration biopsy (FNAB) in human patients were examined for specific E. granulosus antigen 5 (Ag5). The patients were suspected cases of hepatic cystic echinococcosis (CE) but protoscolices and hooks had not been found in the cyst bioptates. Presence of Ag5 was tested for using enzyme linked immuno-sorbent assay (ELISA) technique with monoclonal antibody against Ag5. Sensitivity of the test was approximately 1 ng of antigen/1 ml of examined fluid. Positive results were obtained in the control group of six patients having protoscolices and/or hooks in biopsy samples from liver cysts. Positive Ag5 results were also obtained in the samples from 89 fertile cysts and 28 sterile cysts originated from 15 naturally infected pigs as an experimental control group. Ag5 was present in nine cases (11.1%) out of 81 liver cyst fluid samples from suspected CE patients. In 25 human patients the sensitivity of the microscopic examination for protoscolices and/or hooks in FNAB material was 64% (16/25). In pig hydatid cysts the sensitivity of the microscopic examination for protoscolices and/or hooks in FNAB material was 86.5% and of the detection of Ag5-100%. In conclusion, examination of hepatic cyst biopsy samples for specific Ag5 resulted in increased detection of liver echinococcosis in human patients.

Comparison of the dot immunobinding assay and two enzyme-linked immunosorbent assay kits for the diagnosis of liver cystic echinococcosis.

The dot immunobinding assay for the detection of hydatid antigen-specific antibodies (HA-DIA) was evaluated in patients with liver cystic and alveolar echinococcosis in comparison to two commercial ELISA kits. In 30 patients, E. granulosus infection (CE) was confirmed by histopathology or by the presence of parasite protoscoleces and/or hooks or specific antigen 5 (Ag5) in cyst fluid samples obtained by the fine needle aspiration biopsy (FNAB). Infection of E. multilocularis (AE) was diagnosed in two patients by the detection of specific anti-Em2(plus) ELISA and -Em18 Western blot antibodies and finally confirmed by histopathology. The HA-DIA using bovine hydatid antigens showed a high sensitivity in serum samples from CE patients; specific antibodies were found in 29 of 30 CE patients (96.7%). One negative result has been observed in a patient 2.6 years after radical surgery with a subsequent albendazole chemotherapy. The Echinococcosis ELISA(R) (Dialab Diagnostic) was positive in 23 CE cases (76.7%). The correlation between the HA-DIA and the Echinococcosis ELISA(R) was statistically significant. By contrast, Echinococcus granulosus IgG ELISA(R) (Bordier Affinity Products) gave positive results in only 12 of 30 CE patients (40.0%). Sera from two AE patients were high positive in all three methods analysed in our study. In non-endemic areas, due to the between-strains variations and differences in cyst immunogenic activity, related to the natural history of the parasite, a choice of an optimal method for a diagnosis of liver cystic echinococcosis has been discussed.The high diagnostic sensitivity and a faster one-step procedure, in comparison to traditional enzyme immunoassays, make the HA-DIA a very useful method for the diagnosis of CE in non-endemic areas, especially in a case of small or degenerating lesions and sterile echinococcal cysts with a low immunogenicity. The positive serology for CE frequently requires additional differentiation with E. multilocularis-specific antibodies.

Human cystic and alveolar echinococcoses as indication to liver transplantation.

The human cystic and alveolar echinococcoses are zoonotic diseases caused by larval stages of the tapeworms Echinococcus granulosus and E multilocularis. In man the liver form of the diseases develops most frequently. Recent epidemiological data indicate that the distribution of E multilocularis in the central Europe is wider than was previously anticipated; more cases of human alveococcosis during the last years have also been noted in Poland. In the present paper we analyzed several cases of human echinococcoses from Poland with respect to diagnosis and treatment as well as the indications for liver transplantation.

[2 cases of cryptosporidiosis in adults]. / Dwa przypadki kryptosporidiozy u osób doroslych.

Two cases of cryptosporidiosis in adults were described. A 38 years old men presented with temporally reduced immunodeficiency and typical syndromes of 3 weeks duration. His wife had asymptomatic infection.

[Studies of secretory activity and pathomorphology of the gastric mucosa in taeniasis (Taenia saginata)]. / Badania czynnosci wydzielniczej i patomorfologii blony sluzowej zoladka w tasiemczycy (Taenia saginata).

Studies were performed on 149 patients, aged 18 to 50, hospitalized in the Department of Parasitic and Tropical Diseases, Medical Academy in Poznan. The following examinations were performed: gastric contents testing with histamine stimulus according to Kay, the histological and cytological examination of gastric mucosa biopsies. Among patients with Taenia saginata invasion, disturbances in secretory activity of gastric mucosa were demonstrated in 57.7% of studied patients. Hypoacidity was found in 49.7% of patients; it appeared both in the oldest group, over 40 years (71.4%), as well as in two younger, although at two times lower frequency (38.2 and 39.6%, respectively). At set of histological and cytological studies was performed on gastric mucosa biopsies in a chosen group of 30 patients (average age of 26.2 years) with taeniasis and hypoacidity, before and after the treatment of the invasion. Before the treatment cellular infiltrates consisting of mononuclear cells were observed in gastric mucosa biopsies; cytological analysis of gastric gland cross-sections demonstrated 3 to 4 times lower number of parietal cells as compared to that of mucous cells. After the treatment of taeniasis, secretory activity of gastric mucosa returned to the normal level in 20 patients (66.7% of total). At the same time, the histological and cytological analysis of the biopsies showed decreased intensity of cell infiltrates in the glandular layer of the mucosa and an increased number of parietal cells as compared to the number of mucous cells. In 10 patients (33.3% of total), hypoacidity of the gastric juice as well as gastric mucosa lesions persisted despite the elimination of T. saginata. No relation could be found between the duration of T. saginata invasion on the one hand and secretory disturbances on the other. The subsidance of functional disturbances in gastric mucosa and of their morphological exponents in 2/3 of patients after taeniasis treatment indicates a causal relationship between time of taeniasis and secretory disturbances and histological lesions in gastric mucosa.

[Delayed diagnosis of Trichinelliasis focused in the Poznan Province]. / Opóznione rozpoznanie wlosnicy w ognisku na terenie Wielkopolski.

The study compares chronologically the weeks in which Trichinella spiralis infected meat was consumed. The first symptoms appeared and clinical diagnosis of trichinellosis was made in 37 patients. Several factors were responsible for the delay in final diagnosis of trichinellosis: widely distributed infected meat, contemporary common respiratory viral infections in population with fever and myalgia, diagnostic difficulties in the first index case.

[Clinical value of Echinococcus granulosus--specific immunoglobulin G antibody avidity in liver cystic echinococcosis]. / Znaczenie kliniczne oznaczania awidnosci swoistych przeciwcial IgG w bablowicy watroby wywolanej przez Echinococcus granulosus.

Role of E. granulosus-specific IgG antibody avidity in evaluation of a natural history of the parasite cysts in the liver, duration of infection and immunogenic cysts activity was studied. Thirty-one patients with liver cysts suspected of echinococcosis were examined; E. granulosus infection was finally confirmed by a fine needle aspiration biopsy or surgery in 29 cases (93.5%) and two non-parasitic simple cysts in the liver were diagnosed. E. granulosus-specific IgG antibody was found in 21 patients (67.7%). High IgG avidity values were observed in 14 patients with liver cysts in a degeneration stage confirmed by imaging techniques. Low IgG avidity values were mostly detected in children with hypoechogenic echinococcal cysts being in a recent stage of infection. Determination of anti-E. granulosus immunoglobulin G antibody avidity is a very usefull diagnostic tool for a determination of parasitic cysts activity and their developmental age.

[Evaluation of the postnatal treatment efficacy in congenital toxoplasmosis identified by the newborn screening programme]. / Ocena skutecznosci leczenia toksoplazmozy wrodzonej rozpoznanej na podstawie wielkopolskiego programu badan przesiewowych noworodków.

The effectiveness of neonatal screening for anti-Toxoplasma IgM or IgA and IgM specific antibodies followed by an intensive anti-parasitic therapy for a prevention of clinical and immunological reactivations of congenital infection was studied. Thirty-five congenitally infected infants were included into clinical and serological follow-up. The children were mostly asymptomatic at birth or they expressed some non-specific reversible clinical abnormalities in neonatal period. Clinically overt toxoplasmosis occurred in 10 patients, including one infant with a severe form; 2 children had co-existing CMV infections. During the follow-up period, no clinical relapses were reported. Asymptomatic immunological rebounds of IgG or of IgG and IgA specific antibodies were observed in 16 patients. Anti-parasitic treatment initiated soon after birth seems to be promising in a prevention of early clinical sequelae of congenital T. gondii infection.