Sylwia Kwiatkowska

Increased serum concentrations of conjugated diens and malondialdehyde in patients with pulmonary tuberculosis.

During pulmonary inflammation increased amounts of reactive oxygen species (ROS) and reactive nitrogen intermediates (RNI) are produced as a consequence of phagocyte respiratory burst. One of the manifestation of these free radical-mediated processes is lipid peroxidation (LP). The aim of our study was to assess the concentration of lipid peroxidation products (LPPs), conjugated diens (CD) and malondialdehyde (MDA), in patients with active TB. Forty-two patients were enrolled into the study. Half (group I) had advanced TB and were sputum smear-positive. The remainder (group II) had only small radiographical changes and were sputum smear-negative. Serum concentrations of CD and MDA were measured at days 0, 7, 14 and 28 in group I and day 0 in group II. We found that in all patients with active TB CCD (1.0 +/- 0.05A233) and CMDA (2.01 +/- 0.16 nmol dl-1) were significantly elevated compared to healthy controls (0.67 +/- 0.03A233 and 1.36 +/- 0.08 nmol dl-1, respectively) (P < 0.001). The highest levels of LPPs were in patients with advanced TB. These concentrations were stable during the first month of anti-tuberculous therapy. Our data indicated that, as in bacterial pneumonia, LPPs were enhanced in active TB. The levels of LPPs depended on the form of the disease as they were higher in subjects with advanced disease than in those with only small radiographical changes. Further studies are needed to assess the role of antioxidants as adjuvant therapy in patients with pulmonary TB.

A clinic-epidemiological study of head and neck tuberculosis — a single-center experience

INTRODUCTION Extrapulmonary tuberculosis (EPTB) accounts for less than 6% of all tuberculosis (TB) cases in Poland, although in other countries (European in particular) this proportion is much higher. The study was undertaken to evaluate the clinical and epidemiological differences in patients hospitalized in one of Otolaryngology Departments in Poland during 36 years. MATERIAL AND METHODS In a retrospective study, 71 patients were identified and divided into three groups according to the study period: I - 1978-1989 (30 patients, 42%), II - 1990-2001 (19 patients, 27%) and III - 2002-2013 (22 patients, 31% of all cases). In each case histological examination of biopsy specimens was available. RESULTS Larynx TB (54.9%) was most common, followed by cervical lymph nodes TB (29.6%) and auris TB (8.5%). In laryngeal TB, glottic region was most often affected (76.9%). Patients with larynx TB were mainly men (87.2%), 10 years older than women in each study period. However, in lymph nodes TB group, women constituted 66.7% of cases and were twice as old as men (64.0 vs. 34.7 yrs). Bacteriological confirmation was made in only one patient. CONCLUSIONS The number of patients diagnosed in our center declined in the first period of 12 years and remained stable over the last 24 years, as were the common sites of head and neck EPTB (larynx and cervical lymph nodes). In patients with head and neck TB the biopsy specimens should be examined not only histologically but also for the presence of Mycobacterium tuberculosis.

Elevated exhalation of hydrogen peroxide in patients with non-small cell lung cancer is not affected by chemotherapy.

ABSTRACT Objectives: Reactive oxygen species, which are implicated in the process of carcinogenesis, are also responsible for cell death during chemotherapy (CHT). Therefore, the aim of the study was to evaluate exhaled H2O2 levels in non-small cell lung cancer (NSCLC) patients before and after CHT. Methods: Thirty patients (age 61.3 ± 9.3 years) with advanced NSCLC (stage IIIB–IV) and 15 age-matched healthy cigarette smokers were enrolled into the study. Patients received four cycles of cisplatin or carboplatin with vinorelbine every three weeks. Before and after the first, second, and fourth cycle, the concentration of H2O2 in exhaled breath condensate was measured with respect to treatment response. Results: At the baseline, NSCLC patients exhaled 3.8 times more H2O2 than the control group (0.49 ± 0.14 vs. 0.13 ± 0.03 µmol/L, P < 0.05); this difference persisted throughout the study. CHT had no noticeable effect on exhaled H2O2 levels independent of the treatment response (partial remission vs. progressive disease). Pre- and post-CHT cycles of H2O2 levels generally correlated positively. Discussion: The study demonstrated the occurrence of oxidative stress in the airways of advanced NSCLC patients. Exhaled H2O2 level was not affected by CHT and independent of treatment results and changes in the number of circulating neutrophils.

The IGRA tests: where are we now?

In the early 1990s, WHO declared TB a global emergency [1]. Since that time after introduction of DOTS strategy and National TB Programs, the reduction of global incidence rate (2002), as well as of total number of TB cases (2006) were recorded. However, in 2012, about 8.6 million cases were established, of which only two third were registered. It means that 3 million cases were missed and untreated. According to the new-post 2015 Global TB Strategy, TB epidemic will end by 2035, when the incidence rate decrease to < 10 TB cases/100 000 population.

Acute laryngeal dyspnea as first presentation of granulomatosis with polyangiitis

Granulomatosis with polyangiitis (GPA) is a multi-organ disease which mostly affects lungs, kidney, and head and neck region. We report a rare case of acute laryngeal dyspnea and rapidly progressive pulmonary changes as first manifestations of disease. A 53 year-old woman presented with symptoms of two-week dyspnea, which aggravated rapidly in the preceding hours. Laryngological examination revealed subglottic infiltrations and vocal fold oedema which required urgent tracheotomy. During few days she developed gingival ulcerations and pulmonary infiltration with negative serum c-ANCA titers. The histopathological examination of subglottic and gingival biopsies and the clinical picture established the diagnosis of GPA. She was treated with prednisone and cyclophosphamide with recovery; however, during over 3 years of follow-up, pulmonary symptoms relapsed and subglottic stenosis persisted. The difficulties in diagnosis and treatment in this unusual presentation of GPA are outlined with conclusion that in patients with subglottic infiltration, which develops rapidly, even when this is a sole presentation of the disease, and when c-ANCA are negative, GPA should always be considered.

IPF and CPFE — the two different entities or two different presentations of the same disease?

In this article the co-existence of pulmonary emphysema with lung fibrosis of typical pattern and distribution for usual interstitial pneumonia (UIP) was compared with idiopathic pulmonary fibrosis (IPF) alone. Author discusses the etiopathogenesis of these diseases, differences in signaling pathways and the role of senescent cells. Moreover, clinical course, pulmonary function tests as well as main complications are reviewed. However, the lack of well-established diagnostic criteria for CPFE along with mainly retrospective character of the studies make current knowledge about this entity rather deficient.