Hospital In Warsaw Research Articles

Current strategies for the treatment of malignant gliomas - experience of the Department of Neurosurgery, Brodno Masovian Hospital in Warsaw.

Malignant gliomas (HGG) are the most common primary malignant brain tumors arising from glial cells. Between HGG, glioblastoma is the most common and the most malignant histological subtype with only a 27% 2-year survival rate. Current standard medical treatment of malignant gliomas is still not satisfactory, and may need some development and modification. We presented and discussed the achievements of the Department of Neurosurgery at Brodno Masovian Hospital in the treatment of malignant gliomas. We step by step presented and discussed the policy in the treatment of malignant gliomas. We showed all steps starting from preparation of surgery (eg. neuroimaging) and finishing on the presentation the development of perioperative management - from intraoperative electrical stimulation mapping and monitoring which is nowadays already standard method to convection-enhanced delivery (CED) and gamma knife (GK) which are new and promising methods in the treatment of glioblastoma. All surgical methods described in this manuscript were introduced to achieve maximal and safe resection of malignant glioma. CED and GK are the last resort methods for patients with recurrent HGG. Department of Neurosurgery at Brodno Masovian Hospital deal with all types of brain tumors, including all types of high grade gliomas. As the first Department in Europe with close cooperation with the Department of Neurosurgery in San Francisco, we have started local infusions of drugs directly to the tumor in the real time of magnetic field, and we think that technology may change all approaches to the treatment of high grade gliomas.

Variations in Magnesium Concentration Are Associated with Increased Mortality: Study in an Unselected Population of Hospitalized Patients.

Dysmagnesemia is a serious disturbance of microelement homeostasis. The aim of this study was to analyze the distribution of serum magnesium concentrations in hospitalized patients according to gender, age, and result of hospitalization. The study was conducted from February 2018 to January 2019 at the Central Clinical Hospital in Warsaw. Laboratory test results from 20,438 patients were included in this retrospective analysis. When a lower reference value 0.65 mmol/L was applied, hypermagnesemia occurred in 196 patients (1%), hypomagnesemia in 1505 patients (7%), and normomagnesemia in 18,711 patients (92%). At a lower reference value of 0.75 mmol/L, hypomagnesemia was found in 25% and normomagnesemia in 74% of patients. At a lower reference value of 0.85 mmol/L, hypomagnesemia was found in 60% and normomagnesemia in 39% of patients. Either hypo- or hyper-magnesemia was associated with increased risk of in-hospital mortality. This risk is the highest in patients with hypermagnesemia (40.1% of deaths), but also increases inversely with magnesium concentration below 0.85 mmol/L. Serum magnesium concentration was not gender-dependent, and there was a slight positive correlation with age (p < 0.0001, r = 0.07). Large fluctuations in serum magnesium level were associated with increased mortality (p = 0.0017). The results indicate that dysmagnesemia is associated with severe diseases and generally severe conditions. To avoid misdiagnosis, an increase of a lower cut-off for serum magnesium concentration to at least 0.75 mmol/L is suggested.

Assessment of Hemodynamic Parameters in Recipients of a Liver Transplant

IntroductionThe control of all hemodynamic parameters among patients after liver transplantation is critical for better graft survival and to reduce the risk of perioperative complications. The value of cardiac output (CO) and stroke volume (SV) below normal promote the development of cardiovascular diseases. Materials and MethodsThe study was conducted on a group of 43 patients after liver transplantation: 16 women and 27 men 0.5 to 29 years after the surgery at the Department of Transplantation Medicine, Nephrology and Internal Diseases, Institute of Transplantology, Medical University of Warsaw, Infant Jesus Clinical Hospital in Warsaw, Poland. The hemodynamic parameters were measured due to 4 electrocardiogram electrodes with the Cardiac Monitor ICON Osypka Medical. ResultsPatients after liver transplantation (LTx) showed values of CO (average 5.27 L/min, standard deviation [SD] = 0.92) and stroke volume (average 67.08 mL, SD = 10.96) below normal. The average thoracic fluid content value among women is 21.81 (1/kΩ), SD = 3.28, and for men 24.04 (1/kΩ), SD = 4.75. Only 37% of patients had a body mass index with normal values, with 63% above expected values: 42% with overwise and 21% with a first stage of obesity. ConclusionThe hemodynamic parameters should be controlled among patients after LTx. CO and SV below normal are predictors of a higher risk of cardiovascular diseases.

Organ Donation in Intensive Care Units of Hospitals in Warsaw

BackgroundIn recent years a systematic decrease in donation activity in Poland (15.4 vs 13.0) has been observed. A significant reduction has been noticed in Warsaw (36.2 vs 19.2) as well. MethodsData on deaths of patients admitted to intensive care units (ICUs) of Warsaw hospitals in from 2014 to 2018 were analyzed. Analysis was conducted in compliance with the Helsinki Congress and the Istanbul Declaration. Population of the city during this period averaged 1,753,480, although specialized capital hospitals service substantially bigger area than Warsaw alone. There are 18,500 to 18,600 deaths affecting this population every year. A total of 333 patients diagnosed as having brain death were included in analysis. ResultsIn 42 cases (12.7%) data collection was given up because of lack of authorization. In all donors, death was diagnosed according to neurologic criteria. The most common causes were vascular brain diseases (64.1%) and craniocerebral trauma (21.4%). In 14.5% brain death occurred from other reasons. There are 20 hospitals with ICUs in Warsaw, which totals 318 intensive care beds. Program of identification of deceased organ donors was active in only 14 hospitals. A total of 243 potential donors (73%) were identified in the 3 most active hospitals. ConclusionAnalysis of ICU deaths of Warsaw hospitals showed a gradual decrease in the number of reported donors (from 75 in 2014 to 46 in 2018), although the number of all deaths did not decrease (the number of deaths in ICUs was on average 2.571/y).

Pomiar i ocena kultury bezpieczeństwa pacjenta w warszawskich szpitalach za pomocą polskiej adaptacji amerykańskiego kwestionariusza Hospital Survey on Patient Safety Culture

Pomiar i ocena kultury bezpieczeństwa pacjenta w warszawskich szpitalach za pomocą polskiej adaptacji amerykańskiego kwestionariusza Hospital Survey on Patient Safety Culture

Epidemiology of complex hand injuries treated in the Plastic Surgery Department of a tertiary referral hospital in Warsaw

BackgroundTrauma to the hand is common and potentially serious, impairing daily living and general quality of life. Patients are often unable to work for several months, with hand function improving only gradually. Here, we review the epidemiology of hand injuries treated at a tertiary referral hospital in Warsaw, Poland.Material and methodsIn this single-centre, retrospective study, we reviewed medical records of patients presenting to the A&E Unit of the Plastic Surgery Department, Centre of Postgraduate Medical Education in Warsaw, Poland, between January 2001 and December 2005. We assessed a number of patient and injury characteristics, including severity, scored with the Hand Injury Severity Scoring System (HISS), and time off work.ResultsOf 1091 patients with a hand injury, 84% were male and over half were under the age of 40 years. Hand injury commonly resulted in tendon damage (56.1%), especially to finger flexors (79%), and in skin loss (37.8%). Amputations occurred in 24.1% of cases, while fractures (9.6%) and nerve (6.1%) or joint (5.5%) damage were less common. HISS-graded injury severity was moderate in 28.6% of cases, over half of the patients suffered severe (25.5%) or major (26.5%) injuries, and minor injuries were relatively uncommon (19.4%).ConclusionsAmongst patients admitted to our Department, the most common injuries were tendon damage, skin loss, and amputations. Over half of the patients presented with severe or major injuries and took six months or longer to return to work, suggesting they were likely to face substantial social and economic consequences of their injury.Level of evidenceIV: retrospective series.

Influence of two different methods of nutrition education on the quality of life in children and adolescents with type 1 diabetes mellitus - a randomized study.

Background. Nutrition education is one of the most important factors determining the effectiveness of treatment and maintaining an adequate quality of life (QoL) in children and adolescents with type 1 diabetes. Objective. The primary objective was to compare the influence of two methods of nutrition education on the QoL. The secondary objective was to identify other determinants of the QoL. Material and Methods. A randomized single-blind study was conducted between October 2017 and April 2019 at the Children’s Clinical Hospital in Warsaw. The study included 170 patients (aged 8-17) with at least 1-year history of type 1 diabetes, treated with insulin pumps. The participants were randomly divided into two groups: a control group (C) – traditional/ informative education methods, and an experimental group (E) – modern/interactive methods. PedsQL Diabetes Module 3.0 questionnaire was used in the assessment of the QoL. Total PedsQL score was the primary outcome. The secondary outcomes included the results obtained in five subscales of the questionnaire. The relationships between selected variables and changes in scores were also verified. Results. Data obtained from 136 patients were analyzed. In both groups no significant changes regarding total PedsQL were noted 6 months after the intervention. However, a significant reduction occurred as regards the scores of ‘Communication’ subscale in group C. Analyzing other determinants of the QoL, significant dependencies were observed between: the level of physical activity and a change in ‘Diabetes symptoms’ subscale, and the level of parents’ education and a change in ‘Treatment barriers’ subscale. Conclusions. Both methods of nutrition education exerted a comparable influence on the total QoL. However, modern methods were more effective in terms of the improvement in the aspect of communication. Additionally, moderate physical activity and parents’ tertiary education constituted valid determinants of various aspects of the QoL in children and adolescents with type 1 diabetes.

Między okiem i uchem. O Szpitalu żydowskim w Warszawie Marii Konopnickiej

Between the Eye and the Ear. About Szpital żydowski w Warszawie by Maria Konopnicka In my article, I interpret the work Szpital żydowski w Warszawie [Jewish Hospital in Warsaw] by Maria Konopnicka with emphasis on the way it depicts acoustic phenomena. For the purpose of the analysis, I juxtapose their function with the role assigned to visual references. To this end, I refer to the methodology of sound studies and visual studies. As it turns out, Konopnicka recognizes acoustic phenomena as a way of expressing extreme emotions and limit-experiences (in this case – mental illness) as well as human authenticity. Moreover, by constructing an opposition between sight and hearing, she is able to contrast the world’s rational and irrational aspect and express a crisis of faith in terms of positivistic epistemology.

Five years prospective survey of antibiotic resistance in Bacteroides and Parabacteroides isolated from inpatients of clinical hospital in Warsaw, Poland

Objectives: Diagnostics of anaerobic bacterial infections and determination of drug susceptibility are technically difficult and time-consuming; therefore, the number of studies on Anaerobic Gram-negative bacilli is significantly limited, especially in Europe. The aim of the study was to analyze the antibiotic susceptibility of clinically important anaerobic bacteria Bacteroides spp. and Parabacteroides distasonis. Strains were isolated from infections of patients hospitalized at one Polish hospital as a result of routine microbiological diagnostics. Material and methods: Clinical isolates were identified with MALDI-TOF MS. Antimicrobial susceptibility of 276 strains was carried out by E-test gradient strip to commonly used antibiotics i.e. benzylpenicillin, amoxicillin with clavulanic acid, imipenem, clindamycin and metronidazole. MIC values were determined. The interpretation of antimicrobial susceptibility tests were conducted in accordance with The European Committee on Antimicrobial Susceptibility Testing (EUCAST) recommendations. Results: Susceptibility tests of all isolates yielded the following rates of resistance to the evaluated β-lactam antibiotics: benzylpenicillin (96%), amoxicillin/clavulanic acid (7.6%), imipenem (2.1%). In presented study 38.8% of clindamycin-resistant strains were isolated, among them 18.3% of B. fragilis and 53.85% P. distasonis. All strain were susceptible to metronidazole. Conclusions: Obtained results and analysis of the results of other researchers convinces us that it is necessary to routinely or at least periodically monitor drug susceptibility of clinical isolates of anaerobic bacteria and use targeted therapy based on the result of the antibiogram. Although high percentage of the tested Bacteroides and Parabacteroides strains remained susceptible to metronidazole and β-lactam antibiotics the use of clindamycin in empirical therapy may not be efficacious. Antibiogram results should be consult with the staff responsible for patient treatment and hospital antibiotic policies.

Karol Kaczkowski (1787-1867) General of Staff of the Polish Army, epidemiologist, innovator, teacher

The name of Karol Kaczkowski, one of the pioneers of Polish epidemiology of the 19th century, has been somewhat forgotten. Hence, it is worth getting acquainted with his actions that he made contributing to the effective inhibition of the spread of the cholera epidemic that hit Polish territory in the 1830s. KAROL KACZKOWSKI (1797-1867) General of Staff of the Polish Army, doctor, professor, He was born in Warsaw on 2 February 1797. In 1805 his parents moved to Krzemieniec. In 1815, he began medical studies at the University of Vilnius. He was friends with philomaths: Adam Mickiewicz and Tomasz Zan. In 1821 he obtained the degree of doctor of medicine. In the years 1824-1828 he traveled around Europe. In 1829, he was nominated the Head of the Therapeutic Clinic at the University of Warsaw. After the outbreak of the November Uprising on November 29, 1830, he joined the artillery and in 1831 was appointed chief physician of the Polish Army. He organized the command of the military health service, hospitals and field hospitals. After the battle of Grochów, he organized battalion dressing points and a cordon of doctors who provided quick help to the wounded. On February 5, 1831, Karol Kaczkowski was appointed the Chief Physician of the Polish Army. When the first cholera patients, brought in by the Russian army, arrived in Warsaw in the spring of 1831, he prepared instructions on how to detect and treat cholera. He created cholera hospitals in Mienia and Warsaw, and sanitary supervision in military units. For this he was awarded the Wirtuti Militari Gold Cross. After the fall of the uprising, he left Poland with a group of 2,000. injured. He got to Prussia, and then to Lviv. In 1854 he settled in Żytomierz. He suffered harassment from the tsarist authorities. In 1863, during the January Uprising, he was sent to the Voronezh Governorate. In 1867, he obtained a permit to travel to Kherson, where he died on September 14, 1867.

Level of health behaviours of HCV infected patients treated with dialysotherapy

Introduction. Hepatitis C virus (HCV) infection is one of the greatest epidemiological risks worldwide (3% infected globally). Dialysis patients are the group at high risk of infections transmitted via blood, are often infected with HCV virus, and suffer from acute or chronic hepatitis. Anti-health behaviours enhance the process of liver fibrosis. The objective of the study was recognition of the level of health behaviours in HCV-infected haemodialysis patients. Materials and Method. The study included 149 adult patients on dialysis infected with HCV, hospitalized in two dialysotherapy centres: the Military Medical Institute and Clinical Hospital in Warsaw. In the study there also participated family members and acquaintances of students of the Higher School in Radom. The study was conducted during the first half of 2017 by a diagnostic survey, using research instrument Health Behaviours Inventory (HBI) according to Z. Juczyński. The questionnaire concerned: eating habits, prophylactic behaviours, everyday health practice, and positive psychological attitude.Results. 73.8% of respondents presented a high level of health behaviours (7–10 sten scores), mediocre - 19.5% (5–6 sten scores), and low – 6.7% (1–4 sten scores). The highest mean value evidencing health promoting life style of the patients was observed with respect to prophylactic behaviours (4.0±0.4), while eating habits and health practices were on the level 3.9±0.4-0.5. The lowest value indicating the least pro-health behaviours concerned positive psychological attitude (3.7±0.4). Conclusions. The overall rate of health behaviours of dialysed HCV patients was high. The dominant category was prophylactic behaviours, whereas the lowest results were obtained with respect to positive psychological attitude. The respondents infected with HCV for longer than 10 years, mainly males, those aged 60-84, with primary vocational education, living in rural areas, and non-active occupationally, had the greatest needs for psychotherapy. It is necessary to provide psychological support for dialysis patients infected with HCV.

Dr Stanisław Michałek-Grodzki (1889?1951) – twórca polskiej szkoły chirurgii plastycznej

Dr Stanisław Michałek-Grodzki was the first plastic surgeon in Poland. To obtain the appropriate qualifications he was trained in foreign clinics in France, Italy and Czechoslovakia. During the First World War he was a military doctor. From the early 1930s, he sought to create a clinic for people requiring reconstructive and plastic surgery, and to create a special plastic surgery department. During the German occupation of Poland, he worked at the Ujazdowski Hospital in Warsaw, where he performed hundreds of reconstruction operations to save injured Polish soldiers from disability. Despite the imminent danger, he performed procedures reversing the effects of circumcision on Jews hiding on the so-called Aryan side. In 1951 he became the director of the first hospital in Poland dealing in plastic and reconstructive surgery. He left behind unpublished medical documentation, including photos, radiographs and videos of his procedures, and a book of his own authorship.

225Ac-PSMA617 for Therapy of Prostate Cancer – Where Do We Stand?

225Ac-PSMA617 is a novel and highly promising compound for treatment of prostate cancer. Since treatment of the first patient in early 2014, to date more than 330 prostate cancer patients have received a total of approximately 800 therapeutic applications through collaboration of the European Commission’s Joint Research Center with hospitals in Heidelberg (Germany), Pretoria (South Africa), Munich (Germany) and Warsaw (Poland). This lecture will give an overview on the current state of clinical development of 225Ac-PSMA617, focusing on its benefits and limitations for treatment of patients suffering from late-stage prostate cancer that have exhausted available established therapies, for patients that have also failed therapy with 177Lu-PSMA617 and for patients that have received fewer pretreatments, e.g. chemo-naive patients. The safety and efficacy of various dosing regimes, e.g. administration of fixed activities, dose de-escalation strategies and combination therapies with 177Lu-PSMA617 as well as strategies for mitigation of xerostomia, the main toxicity associated with 225Ac-PSMA617 therapy will be reviewed.

Prevalence and Antifungal Susceptibility of the Emerging Fungal Species, Candida nivariensis, Isolated in a Teaching Hospital in Poland.

The data on susceptibility to antifungals of new species within Candida glabrata complex are limited. Our study was to enrich a global knowledge of yeast epidemiology and drug resistance. The study was focused on the identification of species within clinical isolates of the C. glabrata complex and on the determination of their resistance to antifungals. Four hundred forty-five clinical C. glabrata sensu lato strains were isolated from different clinical samples at routine mycological exams at the Infant Jesus Teaching Hospital in Warsaw. The identification of the most of tested isolates to species complex level was performed using the ID 32 C system. The identification of C. nivariensis and C. bracarensis species within the C. glabrata complex was performed by DNA sequencing. The MICs of amphotericin B, fluconazole, itraconazole, posaconazole, voriconazole, caspofungin, anidulafungin, and micafungin were determined by E-test. Twenty-four isolates did not have an ITS-1 region, characteristic of C. glabrata sensu stricto and their D1/D2 regions of the 26S rRNA were 99% homologous to C. nivariensis 26S rRNA. No strains of C. bracarensis were recovered. C. nivariensis strains were very susceptible to amphotericin B, anidulafungin, micafungin, and caspofungin. Ninety-two percent of C. nivariensis were resistant to itraconazole. The halves of the strains was resistant to posaconazole. Eighty-three percent of C. nivariensis were susceptible to voriconazole. None of the tested strains were susceptible to fluconazole. In the present study, none of the C. nivariensis strains were simultaneously resistant to azoles and echinocandins. C. nivariensis should be recognized as an emerging pathogen, resistant to azoles.

Analiza leczenia pacjentów zakażonych pałeczką Salmonella na Oddziale Pediatrycznym Warszawskiego Szpitala dla Dzieci

Introduction. Salmonella poisoning (salmonellosis) poses a serious clinical problem for pediatricians. Consumption of infected food is the primary cause of the illness. The symptoms of salmonella poisoning can vary, ranging from mild gastroenteritis to the more severe, including septicaemia which can be life-threatening. Aim. The aim is to analyse the treatment of salmonella poisoning in children admitted to the Children's Hospital in Warsaw and to study the impact of certain clinical symptoms, the outcome of laboratory tests and scans and the effectiveness of different therapies. Material and methods. This is a retrospective study of 79 children admitted to the Children's Ward during the time period of January 2016 to May 2016. The children were diagnosed with salmonella poisoning following microbiological tests. Two different pathways were studied: firstly, the treatment administered solely to alleviate symptoms, and secondly, the treatment which included administration of antibiotics. Results. The time period of the presentation of symptoms prior to hospital admission was similar for both groups. The percentage of patients with fever, high levels of infection and raised levels of immature neutrophils in blood samples and signs of bowel inflammation showing in scan tests was significantly higher in those children requiring antibiotics. The number of patients where blood in the stools and enlarged lymph glands were observed was similar in both groups. Conclusions. The most common serotype to be isolated was Salmonella enteridis. The majority of patients in the ward diagnosed with salmonella poisoning required only symptomatic treatment. Antibiotics were administered only in the more severe cases where bacteremia was suspected. In all the cases the most frequently administered medication was Sulfamethoxazole. In children presenting a systemic inflammatory response third generation cephalosporins were administered.

Effectiveness of postoperative pain therapy in children assessed by their parents – is inadequate analgesia potentially dangerous?

Inadequate pain therapy can lead to negative physical and psychological consequences, increase complications and even mortality. We aimed to assess effectiveness of postoperative analgesia in children from their parents’ point of view. We also wanted to evaluate their degree of satisfaction of postoperative analgesia and to identify areas for improvement. Patients’ parents (n = 85) from Paediatric University Hospital in Warsaw, Poland, took part in our survey. They evaluated pain intensity on five-point Likert Scale and on numerical rating scale (NRS). Mean value of pain on NRS was 4.22 (SD±2,53). On Likert scale the majority of parents described pain intensity as moderate. High percentage (38.82%) of children were in pain while their parents took the survey and only 19% of children did not feel pain at all. In 36 children (42.36%) pain caused sleep disturbances. In same cases non-pharmacological methods of analgesia were effective. Due to inadequate pain relief one of the parents arbitrarily administered a formulation containing paracetamol and codeine. The study revealed low efficacy of analgesia among children of surveyed parents. Their level of satisfaction was inadequately high (91% of them were „very satisfied” or “rather satisfied”). The survey confirmed the need for systematic pain assessment tools. Parental education seems necessary to make them aware that postoperative pain can be treated effectively. Administration of drugs without consulting medical staff is dangerous. It may result in the use of contraindicated agents (as in the case described), drug overdose or unexpected interactions.

Charakterystyka pacjentów z ostrym niedokrwieniem tętniczym — badanie retrospektywne, jednoośrodkowe

Introduction. Acute peripheral arterial occlusion is a serious medical condition that requires an immediate action. De- lays in diagnosis or treatment could lead to death or serious disability. The appropriate and early clinical evaluation of acute ischaemia is crucial. The goal of therapy for both acute embolic and thrombotic occlusion is reperfusion of the ischaemic organ. Materials and methods. The aim of this study was a retrospective analysis of the demographic and epidemiological data of patients admitted to Surgical Department of Mazovian Brodnowski Hospital in Warsaw from 2014 to 2018 due to displaying symptoms of acute peripheral arterial ischaemia. 208 patients were evaluated. Our analysis included anthro- pometric parameters, history of cardiovascular and other important chronic diseases, and addictions. The aetiology, localisation, and type of primary surgery were also assessed. Results. The analysed group contained 112 men (53.8%, average age: 67.9 years) and 96 women (46.2%, average age: 76.4). We find a statistically significant correlation was found between epidemiological factors [ i.e. age, hypertension, atrial fibrillation (AF), peripheral artery disease, myocardial infarction, and smoking] and gender. Embolic ischaemia occurred in 50.5% of cases. Thrombosis was diagnosed in the remaining 49.5%. Lower extremity ischaemia occurred most frequently (81.3%). Open embolectomy/thrombectomy was the primary surgery in 155 cases. We find significance of the aetiology in relation to the type of intervention and to the ischaemia localisation, but there was no significance in terms of mortality. The presence of ischaemic heart disease, atherosclerosis and tobacco smoking were relevant factors affecting the aetiology of acute ischaemia. Conclusion. Acute arterial ischaemia can occur regardless of gender. Embolic and thrombotic aetiologies occur with a very similar frequencies. Upper extremity arterial thrombosis occurs very rarely. An embolism is more often respon- sible for acute intestinal ischaemia. In patients with atherosclerosis and a history of previous vascular surgery, the presence of a vascular graft/stent graft is associated with a higher risk of arterial thrombosis. Among patients with AF and who were receiving vitamin K antagonists, the average level of international normalized ratio was non-therapeutic.

Congenital cochlear deafness in mitochondrial diseases related to RRM2B and SERAC1 gene defects. A study of the mitochondrial patients of the CMHI hospital in Warsaw, Poland

ObjectivesAlthough hearing loss is a well-known symptom of mitochondria-related disorders, it is not clear how often it is a congenital and cochlear impairment. The Newborn Hearing Screening Program (NHSP) enables to distinguish congenital cochlear deafness from an acquired hearing deficit.The initial aim of the study was to research the frequency of the congenital cochlear hearing loss among patients with various gene defects resulting in mitochondrial disorders. The research process brought on an additional gain: basing on our preliminary study group of 80 patients, in 12 patients altogether we identified two defected genes responsible for mitochondrial disorders, whose carriers did not pass the NHSP. Finally, these patients were diagnosed with the congenital cochlear deafness. Material and methodsThe results of the NHSP in the patients with mitochondrial disorders diagnosed in our tertiary reference center were analyzed. Only the cases with confirmed mutations were qualified for the study group. The NHSP database included 80 patients with mutations in 31 different genes: 25 nuclear-encoded and 6 mtDNA-encoded.We searched the literature for the presence of a congenital hearing impairment (CHI) in mitochondrial disorders caused by changes in 278 already known genes. ResultsFor 68 patients from the study group the NHSP test indicated a proper cochlear function and thus suggested normal hearing. For 12 mitochondrial patients, the NHSP test indicated the requirement for the further audiological diagnosis, and finally CHI was confirmed in 8 of them. This latter subset included patients with pathogenic variants in RRM2B and SERAC1, known as “deafness-causing genes”. Contrary to our initial expectations, the patients carrying mutations in other “deafness-causing genes”: MPV17, POLG, COX10, as well as other mitochondria-related genes, all reported in literature, did not indicate any CHI following the NHSP test. ConclusionOur study indicates that the cochlear CHI is a phenotypic feature of the RRM2B and SERAC1 related defects. The diagnosis of the CHI following the NHSP allows to early distinguish those defects from other mitochondria-related disorders in which the NHSP test result is correct. Wider studies are needed to assess the significance of this observation.

Hepatitis C infection among pregnant women in central Poland: Significance of epidemiological anamnesis and impact of screening tests to detect infection

Mother-to-child transmission is one of the main sources of hepatitis C virus (HCV) infection in children. However, because of the asymptomatic course of the illness, certain women may not be aware of their infection. The aim of this study was to estimate the significance of epidemiological anamnesis in diagnoses of HCV infection in women of reproductive age and to evaluate how screening among pregnant women impacts the detection of HCV infection. Epidemiological interviews of 432 mothers infected with HCV (but free of human immunodeficiency virus (HIV)) were conducted in the Warsaw Hospital for Infectious Diseases (Poland) from 1998 to 2012. Complaints or abnormalities in laboratory tests were the reasons for anti-HCV antibody testing in 28.2% of mothers, whereas specific interview responses or occupational health care services group affiliation were the reasons for testing in 35.6%. However, in a large group of women, infection was only detected because of screening examinations. The introduction of routine screening for pregnant women (since 2010 in Poland) has led to the increased detection of HCV infection in women who did not present with infection risk factors (9.9% before 2010 vs 46.1% after 2010). This practice has also led to an increase in the percentage of women diagnosed during pregnancy (21.5% before 2010 vs 30.8% after 2010). Establishing HCV infection risk factors during the interview process is the most common indicator for serological testing; however, not all infected cases can be diagnosed in this manner. Screening for anti-HCV antibodies in pregnant women increases the detection of HCV infection in this group.

Genetic typing of Enterococcus faecium VRE strains isolated in three hospitals in Warsaw and Siedlce in 2015-2016

Since the first report of vancomycin-resistant enterococci (VRE) in Poland, in 1996, these strains have spread in Polish hospitals, mainly due to selective pressure associated with increased use of vancomycin in the treatment of infections caused by methicillin-resistant staphylococci and Clostridium difficile. At the beginning of 2016 a growing number of patients colonized with VRE in the gastrointestinal tract was observed in the Children’s Memorial Health Institute (IPCZD). Some of these patients were transferred from other hospitals, and VRE colonization was found on admission. To analyze genetic similarity of VRE strains isolated from patients hospitalized in IPCZD and two other hospitals in Mazovian district, genetic typing by pulsed field gel electrophoresis (PFGE) was performed. VRE strains were isolated from rectal swabs, and other clinical samples such as blood, cerebrospinal fluid, other body fluids, and environmental samples. A total of 56 VRE strains from IPCZD, 20 strains from Siedlce and 4 strains from patients from Grochowski Hospital in Warsaw were typed by PFGE. PFGE typing revealed 4 VRE clones containing several strains with identical restriction patterns. Among VRE strains isolated from neonates hospitalized in IPCZD, two clones with 24 and 20 identical strains were found. Respectively, 16 (67%) and 12 (60%) isolates were originated from rectal swabs from patients at admission to the hospital. Clonal strains were identified in all three hospitals included in the study. Our results showed that VRE strains had spread in the region. Isolation of clonal strains on admission to the hospital suggested independent VRE introductions from environment or other hospitals. Identification of clonal strains obtained from rectal swabs and other clinical samples during hospitalization indicated horizontal transmission.