Grzegorz Przybylski

Analysis of the relation between level of asthma control and depression and anxiety

Summary Background Frequent co-existence of bronchial asthma and depression or anxiety is an unquestioned phenomenon. In contrast, little is known about the relationship between the degree of asthma control and the prevalence of depression and anxiety. The aim of this study was to determine the potential relationship between the degree of asthma control and the prevalence of depression and anxiety. Material/Methods This study included a group of 128 randomly selected asthmatic individuals with various degree of asthma control. The study was based on a questionnaire survey, using the following tools: the Asthma Control Test, Beck Depression Inventory, and State-Trait Anxiety Inventory (STAI) – X-1 and X-2 questionnaires. All the questionnaires were completed during a single follow-up visit at the clinic. Results The occurrence of depression and its severity significantly correlated with the degree of asthma control. Individuals with depression were characterized by a significantly lower degree of asthma control compared to depression-free individuals (p<0.001). The degree of asthma control decreased significantly with increasing severity of depression (R=−0.367; p<0.001). No significant correlation was observed between the degree of asthma control and the levels of trait anxiety (R=−0.095; p=0.295) and state anxiety (R=−0.093; p=0.308). Conclusions The prevalence of depression and its severity significantly correlate with the degree of asthma control. Large, standardized multicenter studies of the relationship between the degree of asthma control and the prevalence of depression and other psychopathological symptoms are needed. Furthermore, it seems reasonable to introduce the screening of asthmatics for mental disorders.

Alcoholism and other socio-demographic risk factors for adverse TB-drug reactions and unsuccessful tuberculosis treatment – data from ten years’ observation at the Regional Centre of Pulmonology, Bydgoszcz, Poland

Background Tuberculosis (TB) is one of the most dangerous infectious diseases and has one of the highest mortality rates. For decades a strong association has been evident between certain socio-economic factors and TB adverse events and failure of treatment, yet there is a limited quantity of literature available on this subject, especially in the Polish literature. Material/Methods We examined epidemiological data from 2025 TB patients treated at the Regional Centre of Pulmonology in Bydgoszcz, Poland between 2001 and 2010. This article focuses on the association between all forms of unsuccessful TB treatment outcomes or adverse drug reaction (ADR) and socio-demographic characteristics, condition on admission, and other biological, clinical, social, and healthcare access factors. Results The rate of TB-ADR during hospitalization was 38.9%. Multivariate logistic regression analysis showed that age (P<0.001) and alcohol abuse (P=0.007) were independently associated with the occurrence of TB-ADR. The rate of unsuccessful TB treatment was 10.5%. After adjusting for confounding variables, age (P<0.001), alcohol abuse (P=0.002), and education (P=0.01) were significantly associated with unsuccessful treatment. Smoking did not have any significant influence on occurrence of either TB-ADR during hospitalization or unsuccessful treatment. Conclusions Among our TB patients treated between 2001 and 2010, alcohol abuse significantly worsened the treatment outcome. This information will be crucial in developing strategies targeted at this demographic group.

Research on the occurrence of Mycobacterium tuberculosis antigens in the circulating immune complexes, isolated from serum of patients with tuberculosis

Background Tuberculosis is one of the most dangerous infectious diseases and has among the highest mortality rates of all infectious diseases. There are 9 million cases of active tuberculosis reported annually; however, an estimated one-third of the world’s population is infected with Mycobacterium tuberculosis and remains asymptomatic. Despite the great progress in its diagnosis and treatment, tuberculosis is still a serious health and social problem. The contact between the immune system and Mycobacterium tuberculosis initiates cell-specific (Th1) and humoral-specific (Th2) responses. Many studies about the presence of antituberculotic antibodies in the serum have produced inconsistent results because of a high proportion of false-positive or false-negative results. The purpose of this study was to confirm whether circulating immune complexes (CIC) isolated from the serum of patients with tuberculosis are accompanied by antigenic proteins typical of Mycobacterium tuberculosis. Material/Methods We assayed serum samples from 42 patients with tuberculosis. The control group consisted of the sera samples taken from 45 healthy subjects. The immunochemical analysis of dissociated immune complexes using the dot blot method demonstrated positive reaction on the presence of Mycobacterium tuberculosis antigens in all patients with tuberculosis. Results All patients with tuberculosis demonstrated a high serum concentration of CIC protein. The mean serum concentration of CIC protein was significantly higher in patients than in controls: 0.081 g/l in the control group and 0.211 g/l in the tuberculosis patients. Conclusions The analysis of CIC suggests that it may be a helpful test for patients with tuberculosis because of its quickness, simplicity of the idea, and limited invasiveness.

Unemployment in TB Patients – Ten-Year Observation at Regional Center of Pulmonology in Bydgoszcz, Poland

Background Tuberculosis (TB) affects the poorest of the poor and is an example of a disease that can contribute to the “disease-poverty trap”. The variable epidemiological situation is associated with social risk factors, such as unemployment, which may favor the occurrence of this disease. The aim of this study was to analyze unemployment as a factor that can influence the incidence and course of the disease. Material/Methods We analyzed TB patients with confirmed status of employment or unemployment admitted to the Regional Center of Pulmonology in Bydgoszcz in during the years 2001 to 2010. Out of 1130 patients, 604 were unemployed and the other confirmed their employment. Results The unemployed patients were mostly single men over age 40, with a low level of education, and living in a city. We observed that the proportions of smokers and alcohol abusers were significantly higher among the unemployed patients. The advanced radiological lesions, smear-positive pulmonary TB, and extra-pulmonary sites were diagnosed significantly more often in this group. The rate of death in the course of hospitalization was significantly higher in the group of unemployed patients. Conclusions Unemployment among TB patients is a serious problem. We found that more advanced radiological lesions were associated with more frequent treatment interruptions and a higher rate of death in the course of hospitalization. Increased efforts are needed to reduce and eliminate the problem of unemployment among patients with TB. This may, indirectly, contribute to a decrease in notifications of TB cases and improve treatment outcomes.

Enhanced expression of Fas Ligand (FasL) in the lower airways of patients with fibrotic interstitial lung diseases (ILDs).

The exact role of FasL, and particularly its soluble and membrane-bound forms, in the development of chronic ILDs and lung fibrosis has not been extensively explored. We aimed at analyzing membrane-bound FasL expression on alveolar macrophages (AM) and lymphocytes (AL) as well as soluble FasL (sFasL) levels in bronchoalveolar lavage (BAL) from ILDs patients, incl. pulmonary sarcoidosis (PS), hypersensitivity pneumonitis (HP), silicosis, asbestosis, idiopathic pulmonary fibrosis (IPF), nonspecific interstitial pneumonia (NSIP), and healthy subjects (n = 89, 12, 7, 8, 23, 6, 17, respectively). In IPF, significantly increased percentage of AM FasL(+) and CD8(+)FasL(+) cells as well as sFasL levels in BAL were found. Increased sFasL levels were also observed in HP. NSIP and asbestosis were characterized by higher AM FasL(+) relative number; CD8(+)FasL(+) population was expanded in asbestosis only. There was a significant decline in AL FasL(+) percentage in PS and HP. Vital capacity was negatively correlated with sFasL levels, AM FasL(+) and CD8(+)FasL(+) cell relative count. CD4(+)FasL(+) and CD8(+)FasL(+) percentage strongly correlated with BAL neutrophilia, an unfavorable prognostic factor in lung fibrosis. The concurrent comparative BAL analysis of FasL expression indicates that FasL(+) AM and AL (mainly Tc cells) comprise an important element of the fibrotic process, mostly in IPF. FasL might play a crucial role in other fibrosis-complicated ILDs, like NSIP and asbestosis.

Zaburzenia oddychania u dzieci z otyłością ze szczególnym uwzględnieniem zespołu Pradera i Williego

Otylośc staje sie w Polsce problemem zdrowotnym. Uwaza sie, ze czynniki genetyczne są odpowiedzialne za jej wystepowanie w 30–40%. Na genetyczną predyspozycje nakladają sie bardzo istotne czynniki środowiskowe. Wplyw środowiska jest najsilniejszy we wczesnym dziecinstwie, kiedy wytwarzają sie nawyki zywieniowe. Istnieją genetycznie uwarunkowane zespoly chorobowe, w ktorych dochodzi do nadmiernego gromadzenia sie tkanki tluszczowej w organizmie. Nalezy tu zespol Pradera-Williego. W zespole tym otylośc zmniejsza pojemnośc pluc przyczyniając sie do rozwoju nieprawidlowego stosunku wentylacji do perfuzji oraz zmniejszenia wysycenia krwi tlenem, co w konsekwencji moze prowadzic do niewydolności oddychania. Powiklaniem związanym z otylością znacznego stopnia są zaburzenia oddychania podczas snu, zespol hipowentylacji, ktory lączy sie z ryzykiem powstania nadciśnienia plucnego. Znaczące jest rowniez wspolwystepowanie astmy w otylości. Poniewaz otylośc moze prowadzic do niewydolności oddychania, dlatego tez redukcja masy ciala jest niezbednym warunkiem jej poprawy.