STUDY OBJECTIVE:To conduct a retrospective 15-year study to monitor trends in the number of employees at risk for occupational tuberculosis (TB) (levels III and IV) in the Slovak Republic, and in particular in the sector of economic activities Q (health care and social assistance). Furthermore, to analyze reported cases of occupational TB and to compare the incidence and sex-specific and age-specific prevalence with the data reported in the Czech Republic.MATERIAL AND METHODS:Data on the number of employees at risk of exposure to occupational TB were derived from the Automated Risk Classification System of the Slovak Republic. Data on cases of occupational TB were taken from health statistics (Institute of Health Information and Statistics/National Health Information Center in the Slovak Republic and the National Institute of Public Health in the Czech Republic). A retrospective analysis was conducted (for 1998-2012) of reported cases of occupational TB, selected from Article 24 of the List of occupational diseases (infectious and parasitic diseases except tropical infectious and parasitic diseases and diseases transmissible from animals to humans). The selection criterion was a TB diagnosis according to ICD-10. In the Czech Republic, the data were derived from Article 5.1.02 (tuberculosis), Chapter V. of the List of Occupational Diseases. The data obtained were analyzed by methods of descriptive statistics.RESULTS:The numbers of employees with a level III risk of exposure to occupational TB in the Slovak Republic declined by 30% over the 15 years of study and by 40% in category Q. In 2012, 2027 employees were classified in category III and 1442 of them belonged to group Q. Females accounted for 81-84% of employees at risk of exposure to occupational TB. Eighty-six and 181 cases of occupational TB were reported in the Slovak Republic and in the Czech Republic, respectively, in 1998-2012, with the incidence showing a downward trend in both countries. TB of the respiratory tract was reported most often (83.7% of the total of reported cases of occupational TB). As expected, more cases occurred in females than in males (1.9 times as many cases in females as in males in the Slovak Republic and three times as many cases in females as in males in the Czech Republic). The incidence of occupational TB was the highest in sector Q, with the highest absolute numbers reported in nurses. In 2012, the incidence rates of occupational TB were 0.22 cases per 100,000 sick benefit policy holders in the Slovak Republic and 0.13 cases per 100,000 sick benefit policy holders in the Czech Republic.CONCLUSION:The incidence of occupational TB has a downward trend in both countries, similarly to TB incidence in the general population. A negative aspect in both countries is the incidence of occupational TB at the middle productive age, in contrast to the population occupationally non-exposed to TB. Slovakia is surrounded by higher prevalence countries, with the exception of the Czech Republic. It cannot be ruled out that, in addition to the known factors influencing the prevalence of TB, including occupational TB, migration from eastern countries, including job search migration, can also play a role in increase in TB cases. It is vital to continue epidemiological surveillance and to reduce the risk of TB as much as possible also in healthcare settings by adhering to barrier nursing practices. Cases of active TB need early and adequately long, controlled treatment in order to reduce, among others, the incidence of multi-drug resistant TB.

Objectives and aims: The aim of the study was to investigate the impact of diurnal variations in healthy subjects and impact of atopy, pollen exposure and pharmacological treatment on exhaled nitric oxide levels (eNO) in patients with allergic rhinitis (AR). Methods: eNO levels were measured using analyzer NIOX. Measurements of eNO were performed in 81 nonasthmatics with seasonal AR outside and during the pollen season, before and 3 weeks after treatment and in 52 healthy controls in 4-hour intervals. Results: Diurnal variations of eNO in healthy individuals were not confirmed. Patients with AR had significantly higher levels of eNO than healthy controls not depending on pollen season or pharmacotherapy. Increased eNO levels (p Conclusion: This study has shown that patients with AR have significantly higher levels of eNO compared to healthy subjects and the levels of eNO increasing after pollen exposure. Application of topic corticosteroids and antihistamines caused significant decrease of eNO (almost to the starting levels) in the pollen season and depressed suspicious inflammation in the lower airways. Support: VEGA 1/0055/08, Grant MZ 2007/46 UK 11

Survivin is a member of the inhibitor of apoptotic gene family, which has been implicated in both the inhibition of apoptosis and mitosis regulation. p53 is one of the tumour suppressor genes; prevents tumour formation through cell cycle blocking and eliminates damaged cells via activation of apoptosis. To investigate the possible regulation of survivin by p 53 we examined the expression of both proteins in 67 patients with diagnosed lung cancer using immohistochemical visualisation. Survivin was predominantly expressed in both nucleus and cytoplasm, whereas p53 was expressed in nucleus. There was negative correlation between survivin and p53 expression. Decreased intensity of expression and less number of positive cells for survivin in small cell lung cancer in comparison to other lung cancer types was detected. There was no significant difference in intensity of expression and in number of positive cells for p53 between small cell and non-small cell lung cancer types. This work was supported by project “Center of excellency for research in personalized therapy (CEVYPET) co-financed from EC sources and European Regional Development Fund.

BACKGROUND:New biologic therapies blocking TNF undoubtly constitute a considerable advancement in the management mentioned diseases, but are also associated with higher risk of activation of tuberculosis.METHODS:An assessment of tuberculosis activation rate in the group of patients with rheumatoid arthritis, juvenile idiopatic arthritis, ankylosing spondylitis and psoriatic arthritis threated by anti-TNF inhibitors since January 1st 2001 to June 30th 2007 in Slovakia and went in for special anti-tuberculosis screening before start of therapy.RESULTS:A total 537 rheumatic patients received the anti-TNF therapy. There were 346 rheumatoid arthritis patients, 68 juvenile idiopatic arthritis patients, 71 patients suffered from ankylosing spondylitis and 52 from psoriatic arthritis. Duration of anti-TNF therapy was 843 of patient-years. Infliximab took 203 patients with duration of therapy 348 patient-years, etanercept 201 patients with duration of therapy 331 patient-years and adalimumab 133 patients with duration of therapy 164 patient-years. The activation of tuberculosis reached the incidence 0.37% (2 cases for 537 patients) representing 0.237 cases for 100 patient-years. Both patients had extrapulmonary forms of tuberculosis which was in one patient disseminated, but they fully recovered after the anti-TNF drugs were stopped and chemotherapy was completed.CONCLUSION:Our results demonstrate a low incidence of tuberculosis activation during anti-TNF treatment in patients with inflammatory rheumatic diseases in the Slovak Republic and confirm the high effectiveness ours specified complex screening measures (Tab. 3, Ref. 13). Full Text (Free, PDF) www.bmj.sk.

Retrospective clinical study was used to identify the role of selected important clinical factors according to TNM staging and used therapy in prognosis of the disease. 107 lung cancer patients treated in Martin Faculty Hospital in years 1990, 1995 and 2000. Only 7% of patients were non-smokers. 25% of patients had small cell lung carcinoma (SCLC) and 75% non-small cell carcinoma (NSCLC). One-year survival rate in NSCLC was 29% while in SCLC only 19%. Better prognosis was associated with surgical therapy compared to conservative one. The TNM stage I had dramatically better prognosis than cases in other stages. As a limit factor of the prognosis improvement is a lack of appropriate test diagnosing the diseases in its earlier stages. Prevention, i.e. smoking cessation, remains the most important way to decrease negative impact of the disease.

The authors submit a cross-sectional analysis of out-patient pharmacotherapy of chronic obstructive lung disease in 138 patients where long-term home oxygen therapy was indicated. To this group of patients no inhalatory bronchodilatating drugs were administered in 19.6% of the patients! The authors provide evidence of a non-significant better survival of patients who used inhalatory bronchodilatating drugs. From the mentioned group during the follow up period 41 (29.7%) died with a mean survival of 16.5 +/- 11.9 (0-39) months. Based on the mentioned results the authors draw attention to the relatively late indication of long-term home oxygen therapy and also to the fact that pharmacotherapy of patients with chronic obstructive lung disease indicated for long-term home oxygen therapy is not fully exploited and its optimalization could lead to better patient survival.

The authors present a clinical observation with the objective to test which objective indicators make it possible to predict the effect of treatment in patients with cryptogenic fibrotizing alveolitis. Retrospective analysis of the documentation of a longitudinal follow up of 34 patients with this diagnosis revealed that the presence of fibroproliferative changes on the high resolution CT image predicts significantly the absence of a therapeutic effect and conversely the absence of such changes predisposes for significant improvement of pulmonary functions during treatment. They found also a significant correlation between he ratio of lymphocytes in the bronchoalveolar lavage fluid and the dynamics of the development of pulmonary functions. The age of establishment of the diagnosis correlates also significantly with indicators of the therapeutic response. Based on these results the authors conclude that a favourable therapeutic effect can be expected in patients without fibroproliferative changes, with a significant lymphopcytosis in the bronchoalveolar lavage fluid and a younger age at the time of manifestation. On the other hand, in patients with a marked fibroproliferation and absence of alveolitis there is no point in attempting to influence the disease by pharmacological gents.

Medical doctors should be the leaders in tobacco prevention activities. As role models for their patients and as helpers, leaders and activists, they are needed in campaigns to reduce smoking. We were interested in the smoking behaviour and attitudes towards smoking of Slovak medical students, who represent the next generation of medical doctors.

Aim of study: to evaluate whether the measurement of T-cell subsets acitvated T-cells, IL-4 and INF-g in BAL could contribute to: 1/ differential diagnosis of ILD, 2/ determination of activity, 3/monitoring of the effect of treatment. Subjects: Patients with ILD divided into groups: Fibrotising alveolitis in Systemic Diseases(sFA), Cryptogenic fibrotising alveolitis(CFA),FA on immunosupressive treatment(IS)(FAIS), Active sarcoidosis(aSA), Inactive SA(iSA), SA on IS(SAIS). Studied parameters: CD3+, CD4+, CD8+, CD4/CD8, CD4+CD45RO+, CD3+HLADR+, CD3+CD25+, CD3+CD122+, CD3+CD69+, CD3+CD71+, CD4+ CD29+ (Flow cytometry(FC)), IFN-g and IL-4(ELISA) in both peripheral blood (PB) and BAL, Results were compared to a control group(CG)(PB) as well as to asthmatic patients(AB)(PB-cytokines). Results: I- CD markers : 1/ PB: No differences in CD markers were found neither among the study groups, nor when compared to a CG. 2/ BAL: Incresed % of lymphocytes in studied groups compared to normal values reported in literature(1). increased CD8 and decreased CD4/CD8 in CFA while in SA( both aSA and ISA) and sFA an increased CD4/CD8 was due to increased CD4.For the follow up of the activity of ILD expression of HLADR. CD69, CD45RO on CD3 or CD4 lymphocytes ( but not CD25, CD122 and CD7) seems to be benefitial. All these abnormalities showed significant improvement with IS(FAIS, SAIS).3/TH1 (INF-g) and TH2 (IL-4) cytokines: 1/PB: IL4 : No siginificant diferences were found either among the study groups, or when compared to a CG and AB. IFN-g :aSA > FAis > sFA > cFA > SAis > ISA 2/BAL : IL - 4: aSA > sFA > FAis > cFAiSA > SAis.IFN - g: aSA > FAis > sFA > cFA > iSA = Sais. In all subjects, plasma levels of IL - 4 inversely correlated with plasma levels of IFN -g(Tab.2) and with BAL level of IL-4. Because of small series in cytokine profiles those results should be taken as only preliminary.

Serum levels of alpha 1-antitrypsin were studied in 80 patients with chronic bronchitis. As a manifestation of the inflammatory response, nonsignificant increase was recorded compared to the group of healthy subjects. In discordance with literary data, no significant differences were found between bronchitics smokers and non-smokers. In 5 patients (6.2%), alpha 1-antitrypsin serum levels were below the lower limit of the reference range. The patients complained of cough, expectoration, and dyspnea. As a preventive measure, it is recommended to determine serum alpha 1-antitrypsin levels in smokers before they take up a job in a dusty environment and in bronchitics before inhalation treatment with proteolytic enzymes is administered. In alpha 1-antitrypsin deficit the value of substitution therapy in patients with emphysema is being emphasized.