bluuebunny/crossref_metadata_2025 huggingface dataset:
Aksaray İlinde Koyun Yetiştiriciliğinin Yapısal Özellikleri
Authors: GÜL Sabri , OFLAZ Nida , KESKİN Mahmut , BEHREM Sedat
Published: June 2022

Bu çalışma, Aksaray ilinde koyun yetiştiricilerinin mevcut durumunu ve sorunlarını tespit etmek, koyunculuk işletmelerinin yapısal özelliklerini ortaya koymak amacıyla yürütülmüştür. Bu amaçla hazırlanan ve toplam 68 sorudan oluşan anket soruları koyun yetiştiricileri ile yüz yüze yöneltilmiş ve cevaplar kaydedilmiştir. Elde edilen bilgiler frekans analizi yapılarak değerlendirilmiştir. Anket sonucunda yetiştirici ailelerinin 5-7 kişilik fertlerden oluştuğu ve eğitim seviyesinin daha çok ilkokul düzeyinde olduğu tespit edilmiştir. Yetiştiriciler daha çok Akkaraman ırkını et, süt ve yapağı amacıyla yetiştirdiklerini bildirmişlerdir. Genellikle müstakil kapalı ağıla sahip olan yetiştiriciler, hayvanlarını mera ve elden besleme şeklinde yönetmektedirler. İlde koyunların genellikle 18 aylık yaşta ilk defa çiftleştirildiği ve koç katımı için genellikle Eylül ayının tercih edildiği belirlenmiştir. Üreticiler hayvanlarını elle sağmakta ve elde etmiş oldukları sütü peynire dönüştürmektedirler. Bu peynirlerin genellikle perakende olarak satıldığını beyan etmişlerdir. İşletmelerde en az bir sağlık koruma programı uygulanırken, en fazla ayak-tırnak hastalığı ve yavru atma sorunlarını yaşadıklarını iletmişlerdir. Yaşadıkları en büyük sorun yem pahalılığı olan üreticiler, devletten veteriner hizmeti ve damızlık temini talep ettiklerini belirtmişlerdir.
PENGARUH PELATIHAN TERHADAP PRODUKTIVITAS KERJA KARYAWAN PADA PT PP. LONDON SUMATERA INDONESIA, Tbk MEDAN
Authors: Endang Haryati  , Jessica Debora Sibarani
Published: June 2022

Penelitian ini bertujuan untuk mengetahui seberapa besar pengaruh pelatihan terhadap produktivitas kerja karyawan pada PT PP. London Sumatera Indonesia, Tbk Medan. Penelitian ini menggunakan sampel sebanyak 94 responden dan pengumpulan data diperoleh dari metod kuisioner serta studi pustaka dan metode analisis datanya dilakuka secara komputerisasi. Hasil penelitian ini terbukti dari : uji validitas dan reabilitas instrumen, koefisien korelasi (R), koefisien determinasi (R2), uji f, uji t, dan analisis regresi linier berganda. Dari hasil analisis validitas, semua item pernyataan dikatakan valid karena r hitung > r tabel dan hasil uji reabilitas, semua item pernyataan dikatakan reliabel karena nilai cronbach’s alpha > 0,06. Untuk uji korelasi nilai R sebesar 0,945 artinya terjadi hubungan yang kuat antara variabel independen dengan variabel dependen, hasil R square mampu menjelaskan 89,2% variabel dependen, sedangkan sisanya sebesar 10,8% dipengaruhi oleh variabel lain yang tidak dibahas dalam penelitian ini, hasil uji F denga F hitung > F tabel (77,353>1,99) maka H0 di tolak itu berarti bahwa semua variabel independen secara bersama-sama (simultan) berpengaruh terhadap variabel dependen hasil analisis uji t dengan nilai t hitung > t tabel pada variabel instruktur (2,717>1,663), tenik latihan (3,503>1663), dan metode penilaian latihan (10,262>1,663), H0 ditolak variabel instruktur, teknik latihan dan metode penilaian secara persial berpengaruh terhadap produktivitas kerja (dependen). Hasil analisis linier bergandan Y= -0,615 -0,772X1 -1,822X2 -0,057X3 +0,504X4 -304X5 +0,161X6

+0,582X7 +2,210X9 mengandung arti indikator jumlah dan kualifikasi peserta Latihan (X6), Instruktur (X7), Teknik Latihan (X8), dan metode penilaian latihan (X9) mempunyai kegiatan yang searah dengan variabel Produktivitas Kerja.
Comunidad y Estado moderno en Bertrand de Jouvenel y Wolfgang Reinhard
Authors: Ciampini Gabriele
Published: June 2022

Este trabajo se centrará en la génesis del Estado moderno europeo en las teorías liberales contemporáneas, para analizar la relación entre la libertad individual y el poder del Estado. El objetivo es examinar el pensamiento de dos autores liberales que han tratado este tema: Bertrand de Jouvenel y Wolfgang Reinhard. En Du Pouvoir (1945), Jouvenel recorre la historia de la política europea intentando demostrar cómo el poder del Estado ha crecido en el tiempo, socavando la libertad individual. Reinhard sostiene en su obra Geschichte der Staatsgewalt (1999, Historia del poder estatal) una tesis muy similar a la de Jouvenel. Compara el Estado del bienestar y el Estado totalitario: la intensa actividad estatal impregna cualquier aspecto de la vida humana, no solo en el totalitarismo, sino también en los sistemas democráticos. Esta situación se presenta como el resultado directo de la formación de las democracias modernas y de la identificación del ciudadano con el Estado como nación.
Tras dos siglos de independencia, ¿en qué nos convertimos?
Authors: Polanco Moris
Published: June 2022

Los países hispanoamericanos nacieron a la vida independiente cuando ya se habían producido dos importantes revoluciones: la americana y la francesa. Las circunstancias que rodearon los distintos procesos que culminaron en el surgimiento de las naciones-estado que hoy conocemos, aunque distintos en múltiples aspectos, comparten, sin embargo, una cultura y una forma de ver el mundo que adoptó los principios de la modernidad política con entusiasmo, pero un tanto precipitadamente.
PROBLEMATIKA GURU DI SEKOLAH
Authors: Sulton M. Sulton Baharuddin , Maunah Binti
Published: June 2022

Abstrak
P
This study aims to determine the understanding of teacher problems, the kinds of problems experienced by teachers in schools and how to minimize these problems. The research method that the author uses is a qualitative approach with the type of library research (library research) with research data sources coming from various literatures, such as journals, books, personal documents, newspapers and so on. The results of the study can be concluded as follows: 1) Teacher problems are problems or problems experienced by teachers both when carrying out their duties in educating, teaching, and guiding students while at school. 2) Teacher problems are generally divided into two groups, namely internal problems that come from within the teacher and external problems that come from outside the teacher's personality. 3) The author provides several ways to minimize teacher problems that can be applied in schools, namely: Emphasizing Teacher Professionalism, Teacher Motivation and Implementing Continuing Professional Programs (PKB).
Just när det blev viktigt blev det manligt
Authors: Abrahamsson Lena
Published: June 2022

This article is about the dynamics of gender in workplaces that are undergoing changes in organization. More precisely it is about the instability in femininity and masculinity and the links between the construction of gender and the construction of the modern organizations. On a general level the traditional gender order is based on stability, that is to say that men and women are seen as very different, even as each other's antithesis, and with different values. This kind of gender stability works as a strong restorative mechanism in the organization of local workplaces since the resulting attempts to maintain segregation and hierarchy are directly contradictory to the modern organizational concepts that aim for integration and de-centralization. Gender order in such organizations does not only provide stability, at the same time we can also see dynamic processes at work whereby parts of the contents of the concepts masculinity and femininity are transformed. For example, social competence is often seen as a "female" characteristic or ability, but is more and more becoming a "male" competence, something that men should have as well. The construction of masculinity in local organizations is thus modified in accordance with what is important to modern organizational concepts. In other words, the dynamics of gender construction makes it possible to implement modern organization concepts without changing the gender order too much.
Intersektionalitet - ett användbart begrepp för genusforskningen
Authors: Lykke Nina
Published: June 2022

This article presents the concept of "intersectionality" and argues for its usefulness for feminist research. The concept is used in recent international feminist debates in order to theorize how gender and other sociocultural power differentials such as ethnicity, race, sexual preference, age and nationality interact in the construction of subjectivity and material conditions of subjects. The first part of the article introduces the concept, a couple of key reference texts and political contexts. It is argued that thinking in terms of intersections between gender and other markers of sociocultural power differences is a much more integrated part of feminist thinking than a first glance at the actual use of the concept "intersectionality" reveils. The argument is based on references to feminist theoretical and political debates around the relationship between gender and class, gender and sexual preference, gender, race and ethnicity, gender and age - and discussions, started in the 1970s and early 1980s. Other related feminist theoretizations, transversalism (Yuval-Davis), nomadism (Braidotti), inappropriate/d otherness (Haraway), are also interpellated in order to sustain the argument that thinking in terms of intersections is an integrated dimension of much feminist thought.

The second part of the article mobilizes key arguments for the usefulness of intersectionality as a theoretical and political tool in feminism and refers, moreover, to possible problems. Six principles are articulated on which feminist intersectionality analysis, according to the author, should be based. The main argument in favour of feminist intersectionality analysis is that this approach makes it possible to speakabout differencesand diversity in political collectives, as for exemple, women's movements, and to take into account different positionalities, without creating a slippery slope towards a discursive situation, where gendered power differentials can be "legitimately" ignored in favour of an exclusive focus on other diversity markers.
Huge primary vaginal stone protruding through vaginal orifice damaging the hymen and associated with vesicovaginal fistula and urinary bladder stone: Case Report
Authors:   Assistant Professor of Urology, Prince Sattam bin Abdulaziz University, Faculty of Medicine, Al Kharj, KSA., Alzubier Mosab A.A , Adam Gamal K ,   Professor, Department of Obstetrics and Gynecology, Faculty of Medicine, Gadarif University, Gadarif, Sudan., Ali Abdelaziem A ,   Professor, Department of Obstetrics and Gynecology, Faculty of Medicine, Kassala University, Kassala, Sudan., Babiker Rabie A ,   Assistant Professor, Department of Medical Microbiology, Faculty of Medicine, Gadarif University, Gadarif, Sudan.
Published: June 2022

Background: vaginal stone (VS) is a rare condition with non-specific presentation, different predisposing factors and can affect different age groups. Its diagnosis is usually incidental and needs high index of suspicion. Case summary: we reported a case of 29 years old single lady presented with continuous urine leak for more than one year. Ultrasound study (USS) showed urinary bladder (UB) stone. Gynecological examination revealed huge VS damaging the hymen as it extended distal to the level of hymen, cystoscopy showed big UB stone and vesicovaginal fistula (VVF). VS extracted, UB stone removed by open vesicolithotomy (VL) and VVF was planned to be repaired after three months. To our knowledge this is the first VS that compromise the intactness of the hymen. Conclusion: This case demonstrate primary VS due to VVF associated with UB stone causing hymen damage. Key Words: Vaginal stone, urinary bladder stone, vesicovaginal fistula, hymen. Abbreviations: VS; vaginal stone. USS; ultrasound study. UB; urinary bladder. VVF; vesicovaginal fistula. VL; vesicolithotomy. CT; computed tomography. MRI; magnetic resonance imaging.
Anesthetic management in a patient with steinert syndrome undergoing laparoscopic cholecystectomy: A case report
Authors:   Federal Universtiy of Maranhão-UFMA, São Luís 65080-805, Maranhão, Brazil., Gomes Lyvia M R de S , Oliveira Eduardo J S G de ,   Federal Universtiy of Maranhão-UFMA, São Luís 65080-805, Maranhão, Brazil., Viana Luciano B R ,   Federal Universtiy of Maranhão-UFMA, São Luís 65080-805, Maranhão, Brazil., Antunes Ludmilla R C ,   Federal Universtiy of Maranhão-UFMA, São Luís 65080-805, Maranhão, Brazil., Neto João N ,   Federal Universtiy of Maranhão-UFMA, São Luís 65080-805, Maranhão, Brazil., Leal Plínio da C ,   Federal Universtiy of Maranhão-UFMA, São Luís 65080-805, Maranhão, Brazil., Oliveira Caio M B de ,   Federal Universtiy of Maranhão-UFMA, São Luís 65080-805, Maranhão, Brazil., Servin Elizabeth T N ,   Federal Universtiy of Maranhão-UFMA, São Luís 65080-805, Maranhão, Brazil., Moura Ed Carlos R ,   Federal Universtiy of Maranhão-UFMA, São Luís 65080-805, Maranhão, Brazil.
Published: June 2022

A male patient, 47 years old, 67 kg, 1.70 m, with SS for 30 years, on preanesthetic evaluation to perform LC. He had muscular atrophy, myotonia, history of asthma and cataract, and had been submitted to tracheostomy and gastrostomy three years ago.Domperidone (20 mg), amitriptyline (25 mg), lactulone (13 g), muvinlax (14 g), dipyrone (500 mg), montelukast (10 mg), and loratadine (10 mg) were used. He had a brother and mother with SS.In electroneuromyography of the limbs, during mild exertion, he presented motor unit potentials of decreased durations and amplitudes in all muscles. During rest, fibrillation potentials and positive spikes wore observed.
Benign Pulmonary Metastasizing Leiomyoma Uteri. Case Report and Review of Literature
Authors: Radzikowska Elżbieta , Szczepulska-Wójcik Ewa , Langfort Renata , Oniszh Karina , Wiatr Elżbieta
Published: June 2022

Benign metastasizing leiomyoma (BML) is a rare condition in middle-aged women with a history of uterine leiomyomata. It ischaracterized by the proliferation of, usually multiple, smooth muscle nodules. Approximately 100 cases have been reportedin the literature, and the lungs were the most common site of metastases.We report a case of 52-year-old obese woman (BMI 31), hospital worker, smoker, admitted to the hospital with exertionaldyspnoea, night sweats, loss of weight, and productive cough.Hysterectomy for a uterine leiomyoma was performed 9 years earlier. In addition, a history of two episodes of superficialvein thrombosis 3 and 2 years before admission was noted. Chest X-ray and subsequently CT chest examinations revealedmultiple, non-calcified nodules within the middle and lower parts of both lungs. Specimens obtained by transbronchialbiopsy (TBLB) and from open lung biopsy displayed benign muscle cell proliferation compatible with BML. The levels of sexhormones were characteristic for the menopause; therefore, observation was advised. Additionally, Streptococcuspneumoniae was cultured from bronchial washing, and bronchitis was diagnosed. Antibiotics, bronchodilators, andmucolytics were administered, and dyspnoea and cough with expectoration were diminished. Two years later pulmonarylesions have been stable; however, she has put on weight. Subsequently the patient has developed deep vein thrombosiswith pulmonary embolism. Anticoagulant treatment was introduced, with some improvement.
Nokardioza Płucna u Pacjenta z Przewlekłą Obturacyjną Chorobą Płuc—Opis Przypadku i Przegląd Literatury
Authors: Anderson Michael , Kuźniar Tomasz
Published: June 2022

Nokardioza jest rzadkim, lecz potencjalnie ciężkim zakażeniem płuca, zwykle występującym u chorych z niedoborami odporności lub z zaburzeniami struktury płuc. Przedstawiamy opis przypadku 70-letniej chorej z przewlekłą obturacyjną chorobą płuc (POChP) leczoną przewlekle kortykosterydami wziewnymi, teofiliną, krótko działającymi beta-mimetykami i antycholinergikami oraz tlenoterapią domową, która zgłosiła się z powodu opornego na leczenie zapalenia płuc. Rozpoznanie nokardiozy postawiono na podstawie posiewu plwociny, a następnie chorą leczono trimetoprimem/sulfametoksazolem i ze względu na pojawienie się działań niepożądanych, minocykliną. Przedstawiamy dane literaturowe dotyczące występowania nokardiozy u chorych na POChP.
The Use of Selected Commercial Molecular Assays for the Microbiological Diagnosis of Tuberculosis
Authors: Safianowska Aleksandra , Walkiewicz Renata , Nejman-Gryz Patrycja , Grubek-Jaworska Hanna
Published: June 2022

Introduction: We performed a retrospective assessment of the AMPLICOR Mycobacterium tuberculosis (MTB) assay for the molecular diagnosis of tuberculosis based on our own determinations between 1999 and 2009 and a preliminary assessment of the Xpert MTB/RIF system, which we are currently using. Materials and methods: The study groups comprised 1875 samples (including 104 inhibited samples) and 213 samples, respectively. Results: The sensitivities of the AMPLICOR MTB and the Xpert MTB/RIF assays were 81.9% and 81.8%, respectively, and their specificities were 97.2% and 99.5%, respectively, versus culture on Loewenstein-Jensen medium. Both assays showed a considerable difference in sensitivity depending on whether the test samples were smear-positive (AFB+) or smearnegative (AFB–). The sensitivities of the AMPLICOR MTB and the Xpert MTB/RIF assays were 97.8% and 100.0%, respectively, for AFB+ samples and 58.1% and 50.0%, respectively, for AFB– samples. Conclusions: Our results confirm full usefulness of the Xpert MTB/RIF assay for routine diagnosis in the case of smearpositive clinical samples.
The Impact of Comorbidities on the Length of Hospital Treatment in Patients with Chronic Obstructive Pulmonary Disease
Authors: Nowiński Adam , Kamiński Dariusz , Korzybski Damian , Stokłosa Anna , Górecka Dorota
Published: June 2022

Introduction: The aim of this study was to assess the relationship between the incidence of comorbidities of chronic obstructive pulmonary disease (COPD) and the duration of hospital stay due to acute AE COPD in a longitudinal prospective study. Material and methods: We evaluated the number of re-hospitalizations, length of stay, and number of comorbidities in 464 consecutive COPD patients admitted to the tertiary respiratory hospital due to AE COPD enrolled in a longitudinal prospective study from 2005 to 2009. Results: GOLD II stage COPD patients had 4.1 ± 1.2 comorbidities (p = 0.002), stage III 3.4 ± 1.3, and stage IV 3.6 ± 1.2 comorbidities. The duration of hospital stay (median) was longer in more severe conditions. Duration of hospitalization correlated with the urea level (r = 0.19 p < 0.001), pCO2 (r = 0.193, p = 0.0003), HCO3 (r = 0.25, p < 0.0001), haemoglobin (r = –0.18, p < 0.001), and haematocrit (r = –0.13, p = 0.008). Patients with the risk of readmissionhad a more severe GOLD stage and were hypercapnic (pCO2 = 47.6 mm Hg vs. 43.9 mm Hg in those withouthospitalization). Conclusions: Haemoglobin level, hypercapnia, and renal function are predictors of prolonged hospitalization. Patients with amore severe airflow limitation and a higher pCO2 level reveal an increased risk of readmission to hospital. More severedisease stage and clinical diagnosis of cor pulmonale or bronchiectasis were related to longer hospital stay.
Gruźlica pozapłucna—Ryzyko zachorowania i częstość występowania
Authors: Rowińska-Zakrzewska Ewa
Published: June 2022

Tuberculosis is transmitted mostly by inhalation [...]
Costs of Chronic Obstructive Pulmonary Disease in Patients Receiving Specialist Outpatient Care in Poland
Authors: Jahnz-Różyk Karina , Targowski Tomasz , From Sławomir , Faluta Tomasz , Borowiec Łukasz
Published: June 2022

Introduction: Chronic obstructive pulmonary disease (COPD) is one of the leading causes of death in Poland and worldwide. Cost-of-illness studies (analysing total, direct and indirect costs) are studies aimed to determine the economic burden of a disease. Acute exacerbations and hospitalisation are the major cost drivers in COPD. The aim of the study was to estimate the direct costs of COPD treatment in the setting of specialist outpatient care from the societal perspective. Material and methods: Chronic obstructive pulmonary disease costs were estimated from a compilation of data: medical records of patients managed at 8 specialist outpatient clinics and 5 teaching hospitals in Poland between 2007 and 2008. The direct costs, resulting from chronic treatment and treatment of acute exacerbations in the outpatient setting, were calculated using the bottom-up approach on the basis of data collected by pulmonary specialists at outpatient clinics. The mean cost of acute exacerbation managed in the inpatient setting was derived from a multicentre Polish study in which five clinical centres participated. Results: The total cost per patient per year was 4027.82 zlotys (1007 euro) and included the cost of chronic treatment in the amount of 2423.57 zlotys (606 euro) plus the cost of treatment of an acute exacerbation in the outpatient setting in the amount of 421.16 zlotys (105 euro) plus the cost of treatment of an acute exacerbation in the inpatient setting in the amount of 1183.09 zlotys (296 euro). Conclusions: Treatment of COPD in poses a considerable economic burden on the Polish society.
An Analysis of the Causes of Mortality and Co-Morbidities in Hospitalised Patients with Chronic Obstructive Pulmonary Disease
Authors: Rubinsztajn Renata , Chazan Ryszarda
Published: June 2022

Introduction: Chronic obstructive pulmonary disease (COPD) is the fourth leading cause of death in the United States. Patients with COPD often suffer from various co-morbidities, such as cardiovascular disease, osteoporosis, cachexia and anaemia, which are a consequence of systemic inflammation. The co-morbidities of COPD are believed to be associated with a more severe course of the underlying disease and with a poorer prognosis. It is being disputed whether extrapulmonary co-morbidities or respiratory complications are the main cause of mortality in patients with COPD. The aim of the study was to analyse the causes of death and co-morbidities in COPD patients who had died during hospitalisation at the Department of Internal Medicine, Pneumonology and Allergy, Medical University of Warsaw, Poland, between 2004 and 2008. Material and methods: We analysed 266 consecutive medical records of COPD patients who had died during hospitalisation. They included 179 men (67%) and 87 women (33%). The mean age at death was 73 ± 8 years (women: 74 ± 9 years). Results: The causes of death in the analysed group of patients included: acute exacerbation of COPD (n = 81 [81%]; 49 men and 32 women), pneumonia (n = 67 [25%]; 50 men and 17 women), lung cancer (n = 50 [19%]; 32 men and 18 women), ischaemic heart disease (n = 20 [7%]; 15 men and 5 women), heart failure (n = 14 [5%]; 8 men and 6 women) and other causes (n = 34 [14%]). Most of the deaths from lung cancer were observed among younger patients (p = 0.002), while most of the deaths from pneumonia among older patients (p = 0.02). The most common co-morbidities in the study population included: chronic heart failure (n = 169), hypertension (n = 103), ischaemic heart disease (n = 102), type 2 diabetes mellitus (n = 55), renal failure (n = 43), benign prostatic hyperplasia (n = 36), lower limb atherosclerosis (n = 28), osteoporosis (n = 19) and anaemia (n = 14). Conclusions: Respiratory tract pathologies, such as acute exacerbation of COPD, pneumonia and lung cancer, were the most common causes of death in the study population, while cardiovascular disease and type 2 diabetes mellitus were the most common co-morbidities seen in these patients.
Bacteriologically Confirmed Pulmonary Tuberculosis in a Patient with Lymphangioleiomyomatosis Accompanying Tuberous Sclerosis Syndrome
Authors: Lewandowska Katarzyna , Oniszh Karina , Augustynowicz-Kopeć Ewa , Radwan-Röhrenschef Piotr , Kuś Jan
Published: June 2022

Lymphangioleiomyomatosis (LAM) is a rare disease of unknown origin, that may be sporadic or develop in the course of tuberous sclerosis (TS). Patients do not present immune deficiency, but structural changes in the lung parenchyma (cysts) may encourage various infections, for example tuberculosis. Radiologic findings are often difficult to interpret, because of changes related to LAM itself. We present a young women with a history of TS and LAM in whom protracted respiratory tract infection was finally diagnosed as tuberculosis. Initial diagnosis was based primarily on clinical signs and symptoms and treatment was started despite a negative result of sputum microscopy for acid-fast bacilli. In the course of treatment, the diagnosis was supported by genetic test for M. tuberculosis in bronchoalveolar lavage fluid, positive tuberculin skin test, interferon-gamma release assay and finally, positive sputum culture in liquid media.
Three-Month Continuous Positive Airway Pressure (CPAP) Treatment Decreases Total and LDL-Cholesterol Levels but Does Not Affect Serum Homocysteine and Leptin Levels in Patients with Obstructive Sleep Apnoea Syndrome (OSAS) without Co-Existent Ischaemic Heart Disease (IHD)
Authors: Kumor Marta , Bielicki Piotr , Przybyłowski Tadeusz , Rubinsztajn Renata , Zieliński Jan , Chazan Ryszarda
Published: June 2022

Introduction: Continuous positive airway pressure (CPAP) treatment reduces cardiovascular morbidity and mortality in patients with obstructive sleep apnoea syndrome (OSAS). Homocysteine and leptin may play a role in the development of ischaemic heart disease (IHD) in these patients. The aim of the study was to assess the effects of 3-month CPAP treatment on the risk factors of IHD in patients with OSAS without co-existing IHD (OSAS without IHD) and on OSAS with co-existing IHD (OSAS with IHD). Material and methods: CPAP treatment was commenced in 42 patients with OSAS without IHD and in 23 patients with OSAS with IHD. Baseline and end-of-treatment levels of homocysteine, leptin, C-reactive protein (CRP), fibrinogen, lipids parameters and visceral obesity related parameters were determined. Results: No significant changes in the levels of homocysteine, leptin, fibrinogen or CRP in either of the study groups were observed at the end of the treatment. No changes in lipid parameters or the degree of obesity were observed in the OSAS with IHD group. A significant reduction in total and LDL-cholesterol levels were observed in the OSAS without IHD group (202.5 ± 38.5 mg/dl v. 186.7 ± 33.5 mg/dl, p = 0.001 and 127.3 ± 32.9 mg/dl v. 116.4 ± 26.9 mg/dl, p = 0.02, respectively). There were no significant changes in body mass index (30.4 ± 3.8 kg/m2 v. 30.6 ± 3.6 kg/m2, p = 0.5) or the amount of visceral fat, as measured by waist circumference (108.5 ± 8.0 cm v. 107.0 ± 7.5 cm, p = 0.09) and waist-to-hip ratio (1.03 ± 0.04 v. 1.01 ± 0.03, p = 0.07). Conclusions: Three-month CPAP treatment did not affect the levels of homocysteine or leptin in patients with OSAS, although there was a significant reduction in lipid parameters in patients with OSAS without co-existent IHD, which confirms the beneficial effect of this method of treatment on the risk factors of IHD.
Prevalence of Home Mechanical Ventilation in Poland
Authors: Nasiłowski Jacek , Szkulmowski Zbigniew , Migdał Marek , Andrzejewski Witalij , Drozd Wojciech , Czajkowska-Malinowska Małgorzata , Opuchlik Andrzej , Chazan Ryszarda
Published: June 2022

Introduction: Home mechanical ventilation (HMV) is increasingly used in the treatment of chronic respiratory failure further to rapid technological development, increasing number of elderly people and extension of indications. The aim of the study was to assess: prevalence of HMV in Poland, the proportions of lung disease and neuromuscular patients using HMV and the type of interface (invasive v. non-invasive). Material and methods: The questionnaire was sent to all institutions providing HMV in Poland and to regional departments of National Health System (NHS). Results: All NHS departments responded. They reported 846 HMV users, 31% of whom were children. The prevalence of HMV in Poland was assessed as 2.2 patient per 100.000 population without striking differences between provinces. Among 39 HMV centers in Poland 12 (31%) answered. They reported 206 patients (24% of all HMV users). Proportion of ventilation mode consisted of 59% (122 pts) treated via a tracheostomy and 41% (84 pts) with non invasive ventilation (NIV). 168 patients (82%) had neuromuscular diseases (ND), majority of them muscular dystrophy—57 patients ( 34% of ND) and amyotrophic lateral sclerosis—39 patients (23% of ND). There were only 38 patients (18%) with lung and thoracic cage diseases: 17 with COPD and 10 with kyphoscoliosis. Conclusions: The prevalence of HMV treatment in Poland has developed dramatically in the last decade, but is still very low comparing to other European countries, especially due to very low number of patients with lung and chest wall diseases. The prevalence of invasive mode of ventilation is extremely high. The most important factors which inhibit development of HMV in Poland are: omission of respiratory physicians in the process of qualification, lack of national guidelines, sophisticated demands for HMV providers. The awareness of the need of HMV especially in patients with respiratory failure due to obesity hypoventilation syndrome and restrictive lung diseases should be increased among chest physicians.
Rola zakażeń Chlamydia pneumoniae i Mycoplasma pneumoniae w przebiegu astmy
Authors: Specjalski Krzysztof
Published: June 2022

Respiratory infections are one of the major causes of asthma exacerbations. Among numerous pathogens that may lead to exacerbations, particular attention should be paid to atypical bacteria: Chlamydia pneumoniae and Mycoplasma pneumoniae. Despite significant frequency, infections caused by these species are underestimated due to untypical clinical course and lack of easily accessible diagnostic tests. Although acute infection can be easily linked with deterioration of asthma control, the role of respiratory colonisation by Chlamydia pneumoniae or Mycoplasma pneumoniae has not been precisely defined. It is known that serologic signs of both past infection and chronic current infection (IgA) with Chlamydia pneumoniae or Mycoplasma pneumoniae are found more often in asthmatics compared to healthy controls. Besides respiratory colonisation by Chlamydia pneumoniae or Mycoplasma pneumoniae confirmed by culture or molecular tests is also more common in asthmatics. This is particularly relevant in cases of uncontrolled asthma that followed symptoms of respiratory infection. This may lead to the conclusion that atypical infections can play a role in asthma induction in previously healthy individuals as well as deteriorations in the course of the disease. Studies mentioned above have led to the new therapeutic possibility—eradication of Chlamydia pneumoniae. In some of the studies on eradication with macrolides promising results have been gained in terms of asthma control, but in most of the cases improvement was only temporary.
Bronchial Bacterial Colonization in Patients with Lung Cancer
Authors: Dancewicz Maciej , Szymankiewicz Maria , Bella Mariusz , Świniarska Joanna , Kowalewski Janusz
Published: June 2022

Introduction: Infections are a part of the natural course of lung cancer but few studies have looked at the clinical and microbiological documentation of infections in these patients. The aim of this study is to analyze the profile of potentially pathogenic bacteria that colonize the bronchial tree in patients with primary lung cancer. Material and Methods: The study was conducted from January 2006 to August 2007. It included 44 consecutive patients (34 males and 10 females) with primary lung cancer aged from 38 to 77 (mean age of 57.9 years). In all patients, bronchoalveolar lavage (BAL) was performed during bronchofiberoscopy. Obtained BAL fluid was subjected to microbiological examination. The number of bacteria present in 1 ml of fluid was estimated by quantitative culture. A diagnostic level was set on ≥ 104 cfu/ml. Results: In 26 (59.1%) of 44 patients physiologic bacterial flora was found in the bronchial tree. In three cases (6.8%), potentially pathological bacteria were cultured but their number was < 104 cfu/ml. In 15 (34.1%) cases, the colonization of potentially pathogenic bacteria was ≥ 104 cfu/ml. Both Gram-positive and Gram-negative bacteria were isolated. The most frequently isolated bacterium in the first group was Streptococcus pneumoniae (n = 7), and in the second group Haemophilus influenzae (n = 3). Multibacterial colonization was found in five patients (11.4%). In four cases (9.1%), the bronchial tree was colonized simultaneously by two and in one case [2.3%] by three types of micro-organism. Multi-drug-resistant strains were not found in the examined materials but among Streptococcus pneumoniae the constitutive MLSB phenotype was observed. Conclusions: 1. Approximately 30% of patients with lung cancer had a respiratory tract colonized by micro-organisms whose number was higher than the assumed diagnostic level. 2. Among micro-organisms colonizing the lower respiratory tract, Gram-positive cocci such as Streptococcus pneumoniae and Staphylococcus aureus were dominant. 3. The analysis of antibiotic-resistance did not detect multi-drug-resistant micro-organisms but some strains of Streptococcus pneumoniae exhibited resistance to macrolide, lincosamide and streptogramin B.
Relationship between Airway Basement Membrane Thickness and Lung Function Tests in Patients with Asthma
Authors: Kościuch Justyna , Przybyłowski Tadeusz , Górska Katarzyna , Krenke Rafał , Baran Wojciech , Kujawa Marek , Hildebrand Katarzyna , Chazan Ryszarda
Published: June 2022

Introduction: Airway remodeling is a characteristic feature of asthma. It is believed that airway remodeling affects lung function and bronchial hyper-responsiveness. Therefore, the relationship between remodeling and lung function is still a matter of extensive research. However, the results of many studies are inconsistent. The aim of the study was to assess the relationship between lung function parameters and basement membrane (BM) thickness in patients with asthma. Material and Methods: Twenty asthma patients were chosen for the study (ten male, ten female, mean age 37 ± 15 yrs). Ten were newly diagnosed, steroid-naive patients and the other ten were patients known to have asthma who had not been treated with steroids for at least three months. The study group was selected based on the results of: clinical assessment, allergic skin-prick tests, lung function testing and bronchial challenge with methacholine. Nine (45%) patients had chronic mild, nine (45%) had moderate and two (10%) had intermittent asthma. Mean FEV1% pred. was 83 ± 18, mean FEV1%VC 69 ± 9, mean FVC% pred. 101 ± 14. All patients underwent research fiberoptic bronchoscopy with BAL and bronchial mucosal biopsies. Light-microscopic measurements of BM thickness were performed in hematoxylin-eosin stained slides of bronchial wall specimens with semi-automatic software analysis MultiScan Base 08.98. Results: Mean BM thickness was 12.8 ± 2.8 μm (range: 8.5–20.7 μm). No significant correlations between BM thickness and FEV1% pred., FEV1%VC, FVC% pred., RV% pred., TLC% pred., Raw (pre- and post-bronchodilator) and PC20 were observed. Conclusions: In our group of asthma patients, mean BM was significantly thickened. No relationship between BM thickness and lung function tests, including hyper-responsiveness, was found.
Invasive Aspergillosis of the Paranasal Sinuses, Lung and Brain
Authors: Kędziora Krzysztof , Słomiński Jan , Gil Katarzyna , Porzezińska Maria , Gorzewska Agnieszka
Published: June 2022

A case of invasive aspergillosis (IA) of paranasal sinuses, lung and brain with a fulminant fatal outcome is reported. A 43-year-old man with a history of skin carcinoma of the nasal region and a course of systemic corticosteroids, presented with symptoms of lung infection. Aspergillus fumigatus was cultured from respiratory and nasal samples. Erosion of adjacent bones of the nasal cavity was acknowledged, but no sinus surgery was performed. A computed tomography of the thorax showed thick-walled cavities of different sizes with air and scarce fluid levels in both lungs. Treatment with voriconazole was administered. The patient deteriorated in the ensuing 2 weeks because central nervous system involvement was observed. No aggressive surgical resection was performed and the patient died 2 weeks later. IA was not confirmed by histopathology because no necropsy was performed.
Pulmonary Epithelioid Haemangioendothelioma—Interferon 2-Alpha Treatment—Case Report
Authors: Radzikowska Elżbieta , Szczepulska-Wójcik Ewa , Chabowski Mariusz , Oniszh Karina , Langfort Renata , Roszkowski Kazimierz
Published: June 2022

A 62-year-old, obese woman, smoking 10 pack/year was admitted to the National Tuberculosis and Lung Diseases Research Institute to diagnose small, round opacities revealed by routine chest X-ray examination. These lesions had been observed for 5 years. The patient had been treated for psoriasis, hypertension, and insulin-independent diabetes. On admission she was in good condition, complaining of a slight productive cough as well as intermittent osteoarticular pain. Physical examination revealed cutaneous psoriatic lesions, slight edema of the lower limbs, and clubbed fingers. Tuberculin test was positive. Chest Computer Tomography scanning showed partially calcified nodules (up to 1cm in diameter) located in the middle and base areas of both lungs. No evidence of hilar nor mediastinal lymph node enlargement was seen. Lung specimens displayed intraalveolar and intravascular growth of neoplastic cells. Immunohistochemical expression of Factor VIII, CD31 and CD34 antigens was present. Pulmonary epithelioid haemangioendothelioma was diagnosed. After 6 months of observation, progression of the disease was shown. Interferon alpha treatment was introduced. During the therapy, a slight regression of pulmonary changes was noticed and since then stabilization of the disease was observed.
Neurobiologia Snu
Authors: Szelenberger Waldemar
Published: June 2022

Sen jest występującym spontanicznie i okresowo stanem fizjologicznym, polegającym na zniesieniu aktywności ruchowej, zmniejszeniu reaktywności na bodźce i stereotypowej pozycji [...]
Tuberculosis Caused by XDR Resistant Mycobacterium tuberculosis in Poland. Microbiological and Molecular Analysis
Authors: Augustynowicz-Kopeć Ewa , Zwolska Zofia
Published: June 2022

Introduction: The retrospective analysis of frequency of drug resistant tuberculosis XDR (XDR = MDR + resistance to: fluoroquinolones + amikacin and/or capreomycin) in Poland have been tested. Material and methods: Pattern of resistance to first, second and third line drugs has been tested among new and treated patients. The total number of 10,913 Mycobacterium tuberculosis strains isolated from the same number of the patients surveyed in 1997–2004 in WHO programme Drug resistance surveillance countrywide study. Results: One HIV-negative patient (43 years old men) was infected by XDR (0.4% among new and treated MDR cases). Molecular analysis of the XDR strain by spoligotyping has been shown the T11558 cluster. Three others tuberculosis patients living in the same region of Poland excreted the Mycobacterium tuberculosis strains belonged to the same T11558 cluster, but they had not pattern of XDR resistance. In the same T11558 molecular cluster 13/15—87% strains have been isolated from polish patients. Conclusions: In Poland Mycobacterium tuberculosis resistance to fluoroquinolones, capreomycin and amikacine among MDR strains has been observed very rarely.
Angiogenesis and Neoangiogenesis—The Role in Lung Cancer and Other Tumors
Authors: Swidzińska Ewa , Naumnik Wojciech , Chyczewska Elżbieta
Published: June 2022

Nowe naczynia tworzone są w dwóch procesach: waskulogenezy i angiogenezy [...]
Obstructive Sleep Apnoea Syndrome in Younger and Older Age Gropus—Differences and Similarities
Authors: Bielicki Piotr , Byśkiniewicz Krzysztof , Kumor Marta , Korczyński Piotr , Chazan Ryszarda
Published: June 2022

The prevalence of OSA rises with age, however it is also diagnosed in patients below the age of 35 years. Aim of the paper was the camparison of the severity and clinical features of OSA in young and elderly subjects. The study was a retrospective analysis of 561 subjects aged > 65 yrs and 319 subjects aged < 35 yrs who were investigated in our Sleep Laboratory between 1992–2005 due to snoring or daytime sleepiness. They all underwent full polisomnography or a limited recording. In patients with diagnosed OSA (AHI > 10) we initiated CPAP therapy. Results: OSA was diagnosed in 383 (63.3%) older patients and in 144 (45.1%) younger patients. BMI was significantly higher in younger subjects than in older (32.2 ± 6.9 vs. 28.9 ± 5.1 kg/m2). The prevalence of OSA amongwomen was significantly higher in older patients than in younger (26.4 vs. 5.8%). Younger patients with OSA had a significantly higher AHI (42.7 ± 32.1 vs. 32.2 ± 18.4) and a longer duration ofapneas expressed as percentage of total sleep time spent in apnea (31.6 ± 23.2 vs. 26.5 ± 17.7%). CPAP therapy was initiated in 185 older patients and 41% of them continue therapy. In younger group patients CPAP therapy was started in 51 patients and 47% of them continue therapy. The mean therapeutic pressure was significantly higher inyounger patients with OSA (9.2 ± 2.2 vs. 8.2 ± 2.2 cmH2O). Conclusions: 1/ OSA is more frequent in elderly patients ; 2/ in young patients OSA is more severe and requires higher pressures in CPAP therapy; 3/ OSA among women is four time more frequent in older patients than in younger.
Serum Concentration of Homocysteine and the Risk of Atherosclerosis in Patients with Obstructive Sleep Apnea Syndrome
Authors: Kumor Marta , Rubinsztajn Renata , Byskiniewicz Krzysztof , Bielicki Piotr , Chazan Ryszarda
Published: June 2022

Aim: to evaluate usefulness of serum homocysteine concentration in assessing the risk of atherosclerosis in patients with OSAS. Materials and methods: 47 patients (mean age 50.6 ± 10.3 years, mean BMI 31.52 ± 6.04 kg/m2), with OSAS confirmed by polisomnography and 12 healthy snoring subjects (mean age 42.8 ± 16.8 years, mean BMI 26.9 ± 2.95 kg/m2) were enrolled to the study. OSAS patients were divided into two groups–subjects with normal blood pressure (group A, n = 32, mean age 51.3 ± 10.3 years, mean BMI 30.6 ± 4.4 kg/m2) and subjects with arterial hypertension (group B, n = 15, mean age 52.7 ± 9.8 years, mean BMI 31.4 ± 5.0 kg/m2). None of the study subjects was treated with statins or fibrates. Serum concentration of homocysteine, uric acid, glucose level and lipid profile was evaluated inall subjects. Results: We found significant abnormalities in the lipid profile in all the study groups. The mean concentrations ofcholesterol (mg/dL), triglycerides (mg/dL) and homocysteine (μmol/L) were as follows: 215.0 ± 34.2, 200.0 ± 173.0, 8.2 ± 2.9 in group A, 216.5 ± 43.1, 189.3 ± 138.8, 8.40 ± 1.67 in group B. 195.0 ± 32.9, 154.3 ± 133.0, 9.3 ± 2.1 in the control group. No significant correlation between the homocysteine concentration and level of cholesterol or triglycerides was found. Conclusions: the serum concentration of homocysteine seems not to be a good marker in the evaluation of the risk of atherosclerosis in patients with OSAS.
Fatal Clinical Outcome in a Patient with Sarcoidosis-Lymphoma Syndrome
Authors: Goljan-Geremek Anna , Puścińska Elżbieta , Bednarek Michał , Nowiński Adam , Kamiński Dariusz , Ptak Jakub , Bestry Iwona , Langfort Renata , Staszewska Marzanna , Gorecka Dorota
Published: June 2022

U 62-letniej kobiety, z klinicznym podejrzeniem choroby rozrostowej układu krwiotwórczego, wykonano splenektomię. W badaniu histopatologicznym stwierdzono obecność licznych nieserowaciejących ziarniniaków. Badania obrazowe klatki piersiowej pozwoliły na rozpoznanie sarkoidozy płuc w stadium II, którą potwierdzono badaniem histopatologicznym materiału uzyskanego drogą przezoskrzelowej biopsji płuca. Chora początkowo nie wymagała leczenia systemowego, ponieważ w trakcie obserwacji stwierdzono samoistną częściową regresję zmian rozsianych w płucach. W toku obserwacji, z uwagi na progresję zmian rozsianych w płucach, których morfologia mogła odpowiadać zmianom o charakterze przerzutów oraz z uwagi na powiększenie węzłów obwodowych zweryfikowano rozpoznanie sarkoidozy pobierając wycinki z płuc podczas otwartej biopsji płuca oraz biopsję węzła chłonnego pachowego prawego. Nie znaleziono komórek nowotworowych. Ze względu na pogorszenie parametrów wentylacyjnych płuc oraz progresję sarkoidozy płucnej i układowej w toku dalszej obserwacji pacjentkę zakwalifikowano do leczenia steroidami systemowymi. Obserwowano poprawę kliniczną, radiologiczną i czynnościową. Po 8 miesiącach leczenia stwierdzono nagłe pogorszenie stanu ogólnego, niedokrwistość, leukocytozę, hipoksemię, znaczną hepatomegalię oraz nawrót uogólnionej limfadenopatii i zmian rozsianych w płucach. Chora zmarła przed ustaleniem ostatecznego rozpoznania. Na podstawie badania autopsyjnego rozpoznano uogólnionego chłoniaka strefy brzeżnej z komórek B, monocytoidalnego. Komórki chłoniaka stwierdzono w węzłach chłonnych szyjnych, śródpiersia, rozwidlenia tchawicy, krzywizny większej żołądka, krezki jelita i zaotrzewnowych oraz stwierdzono naciekanie narządów wewnętrznych: płuc, opłucnej płucnej, wątroby, tarczycy i trzustki. W badaniu autopsyjnym nie stwierdzono obecności ziarniniaków sarkoidalnych w badanych narządach.
Przydatność ultrasonograficznego badania płuc w rozpoznawaniu przyczyn nasilenia przewlekłej duszności
Authors: Rogoza Katarzyna , Kosiak Wojciech
Published: June 2022

Duszność jest nieswoistym objawem wymagającym szybkiej diagnostyki, trafnego rozpoznania i właściwego leczenia. Do najczęstszych przyczyn duszności należy zaostrzenie przewlekłej obturacyjnej choroby płuc (POChP) i przewlekłej niewydolności serca (PNS). Różnicowanie właśnie tych dwóch stanów chorobowych wydaje się kluczowe w diagnostyce stanów nagłych. Jednocześnie podstawowe narzędzia diagnostyczne jakimi dysponuje lekarz izby przyjęć, takie jak klasyczne badanie rentgenowskie (RTG) klatki piersiowej, elektrokardiografia (EKG) czy badanie stężenia peptydów natriuretycznych, bywają niejednoznaczne. Poszukiwanie dodatkowego narzędzia diagnostycznego wydaje się więc uzasadnione i potrzebne. Przezklatkowa ocena ultrasonograficzna płuc jest prostym i łatwo dostępnym badaniem, umożliwiającym wczesną i jednoznaczną diagnostykę obrzęku płuc oraz różnicowanie go z innymi, niekardiologicznymi przyczynami duszności. Poniższy artykuł poglądowy przybliża aktualną wiedzę na temat przezklatkowego badania ultrasonograficznego płuc (PBUP), zwłaszcza w odniesieniu do jego przydatności klinicznej w różnicowaniu przyczyn nasilenia duszności.
Pirfenidon—Skuteczny lek w leczeniu samoistnego włóknienia płuc
Authors: Piotrowski Wojciech
Published: June 2022

Samoistne włóknienie płuc (SWP) jest przewlekłą postępującą chorobą ograniczoną do płuc, prowadzącą do restrykcyjnych zaburzeń wentylacji, niewydolności oddechowej, inwalidztwa i przedwczesnego zgonu. Wykazuje charakterystyczne cechy w badaniu tomograficznym klatki piersiowej wysokiej rozdzielczości (tak zwany radiologiczny wzorzec zwykłego śródmiąższowego zapalenia płuc), a duża zgodność cech radiologicznych z obrazem histopatologicznym pozwala na rozpoznanie choroby bez konieczności wykonania biopsji płuca u większości chorych. Mediana przeżycia wynosi około 3.5 roku. Do niedawna nie było skutecznych leków, które mogłyby spowolnić postęp choroby. Dopiero w 2015 roku, na podstawie wyników przeprowadzonych badań klinicznych, eksperci reprezentujący najważniejsze międzynarodowe towarzystwa naukowe wprowadzili do międzynarodowych wytycznych pozytywną rekomendację dla dwóch leków: pirfenidonu (Esbriet®) i nintedanibu (Ofev®). W niniejszym opracowaniu omówiono historię leku pirfenidon, mechanizmy jego działania, najważniejsze badania kliniczne oraz wpływ leku na przebieg samoistnego włóknienia płuc.
Sprawozdanie z XII Konferencji Polsko-Białorusko-Ukraińskiej Grupy Roboczej PTChP w Grodnie (Białoruś)
Authors: Gutkowski Piotr
Published: June 2022

Grupa Robocza została powołana do życia w Łodzi w 2004 roku podczas XXVIII Zjazdu Polskiego Towarzystwa Chorób Płuc [...]