Anna Masiak

Bio: Anna Masiak is an academic researcher from Gdańsk Medical University. The author has contributed to research in topics: Granulomatosis with polyangiitis & Vasculitis. The author has an hindex of 5, co-authored 39 publications receiving 112 citations. Previous affiliations of Anna Masiak include University of Gdańsk.

The usefulness of histopathological examinations of non-renal biopsies in the diagnosis of granulomatosis with polyangiitis

Abstract: Introduction Granulomatosis with polyangiitis (GPA) is a rare, ANCA-associated, systemic disease characterized by necrotizing small and medium vessel vasculitis of unknown etiology associated with granulomatous inflammation affecting the renal, pulmonary, upper airways, ocular systems and other tissues. Histological proof of the granulomatosis with polyangiitis (GPA) can be obtained by biopsy of clinically involved sites. The main purpose of this study was to examine histopathological changes in non-renal biopsies from patients with established diagnosis of GPA and evaluated the histological confirmation at diagnosis of this disease. Material and methods A retrospective analysis was performed in patients with GPA diagnosed and treated in clinics of the University Clinical Center (UCK) in Gdansk in 1988-2009. Results In the analyzed group of GPA patients the histopathological examination of biopsies taken from involved tissues (except kidney) was performed in 60% of patients. Thirty-six out of 93 biopsies (39%) were diagnosed as typical of GPA, 10 (10.7%) were suggestive and 51 (54.8%) were non-specific. Considering all biopsies, the diagnosis was confirmed in 24 patients (57% of patients in whom biopsies were taken). Epitheloid cell granulomas were present in 33 biopsies (43%), characteristic necrosis in 27 biopsies (35%), small vessel vasculitis in 18 biopsies (23%), while multinucleated giant cells were identified only in 9 biopsies (12%). Conclusions Histopathological examination of the affected tissues remains the gold standard of the diagnosis of GPA. Its usefulness increases, particularly in ANCA-negative patients, in the initial phase of the disease, or in patients with atypical clinical presentation. In many cases, it is necessary to repeat biopsy to establish the diagnosis. The role of the histopathological examination seems to be particularly important when ANCA is negative or clinical symptoms are atypical of GPA.

Clinical characteristics of patients with anti-TIF1-γ antibodies.

Abstract: Objectives Inflammatory myopathies are a group of idiopathic, heterogeneous systemic diseases affecting predominantly skeletal muscles, though they can also involve the skin and internal organs. The association between cancer and idiopathic inflammatory myopathies, particularly dermatomyositis, which is termed cancer-associated myositis (CAM), has been reported in the medical literature. A newly described autoantibody to a 155-kDa nuclear protein, identified as transcription intermediary factor 1-gamma (TIF1-γ), has proven useful for cancer screening in patients with dermatomyositis.

Gastrointestinal tract involvement in granulomatosis with polyangiitis

Abstract: Introduction Granulomatosis with polyangiitis (GPA) is a necrotising vasculitis of small arteries and veins. In its classical manifestation GPA affects the upper and lower respiratory tract and kidneys. However, other organs, including those of the gastrointestinal tract, may be affected as well. Aim To present the clinical manifestations of gastrointestinal tract involvement in patients with GPA. Material and methods We analysed case records of 34 patients with GPA treated in the Department of Nephrology, Transplantology, and Internal Medicine of the Medical University of Gdansk from 1991 to 2009. Results In 9 of 34 patients, 2 men and 7 women, aged 18 to 74 years, gastrointestinal complications were observed in the course of GPA. In two of them a localised and in seven a generalised type of GPA was diagnosed. The main symptoms relating to gastrointestinal tract were: oral mucosa ulcerations, gum mucosa hypertrophy, dyspepsia, vomiting, stomachache, gastrointestinal haemorrhage, diarrhoea, and symptoms of gastrointestinal tract perforation. Two patients required urgent surgical treatment. In 2 of the 5 patients who developed gastrointestinal bleeding, it was the direct cause of death. The histopathological confirmation of specificity of changes in gastrointestinal tract was established only in 2 cases. Tissue samples collected during endoscopy usually revealed only nonspecific inflammation or the presence of ulcers. Conclusions Therapeutic strategies accepted for GPA treatment are effective in treating patients with gastrointestinal involvement in the course of the disease. Some complications require surgical intervention.

Neuro-Sjögren: Uncommon or underestimated problem?

Abstract: Objectives Sjogren's syndrome (SS) is a chronic inflammatory disease with an autoimmune background with possible complications from peripheral (PNS) and central nervous system (CNS) The aim of this study was to assess the prevalence and to describe the phenotype of peripheral neuropathies in patients with SS Materials & methods We studied fifty patients with primary Sjogren's syndrome for peripheral nervous system involvement All patients underwent neurological and rheumatological examination followed by nerve conduction studies (NCS) of nine peripheral nerves Results Thirty-six patients (72%) fulfilled the criteria for the diagnosis of neuropathy Carpal tunnel syndrome (54%) and axonal sensorimotor neuropathy (22%) were the most common Neurological symptoms preceded the diagnosis of SS in eight patients Conclusions Peripheral neuropathies are frequent in SS patients Neurologists should be aware of possible autoimmune causes of neuropathies because clinical manifestations of neuropathy may precede the development of other symptoms of the autoimmune disease

Assessment of the worldwide burden of critical illness- the Intensive Care Over Nations (ICON) audit - APENDIX

Abstract: BACKGROUND Global epidemiological data regarding outcomes for patients in intensive care units (ICUs) are scarce, but are important in understanding the worldwide burden of critical illness. We, therefore, did an international audit of ICU patients worldwide and assessed variations between hospitals and countries in terms of ICU mortality. METHODS 730 participating centres in 84 countries prospectively collected data on all adult (>16 years) patients admitted to their ICU between May 8 and May 18, 2012, except those admitted for fewer than 24 h for routine postoperative monitoring. Participation was voluntary. Data were collected daily for a maximum of 28 days in the ICU and patients were followed up for outcome data until death or hospital discharge. In-hospital death was analysed using multilevel logistic regression with three levels: patient, hospital, and country. FINDINGS 10,069 patients were included from ICUs in Europe (5445 patients; 54·1%), Asia (1928; 19·2%), the Americas (1723; 17·1%), Oceania (439; 4·4%), the Middle East (393; 3·9%), and Africa (141; 1·4%). Overall, 2973 patients (29·5%) had sepsis on admission or during the ICU stay. ICU mortality rates were 16·2% (95% CI 15·5-16·9) across the whole population and 25·8% (24·2-27·4) in patients with sepsis. Hospital mortality rates were 22·4% (21·6-23·2) in the whole population and 35·3% (33·5-37·1) in patients with sepsis. Using a multilevel analysis, the unconditional model suggested significant between-country variations (var=0·19, p=0·002) and between-hospital variations (var=0·43, p<0·0001) in the individual risk of in-hospital death. There was a stepwise increase in the adjusted risk of in-hospital death according to decrease in global national income. INTERPRETATION This large database highlights that sepsis remains a major health problem worldwide, associated with high mortality rates in all countries. Our findings also show a significant association between the risk of death and the global national income and suggest that ICU organisation has an important effect on risk of death. FUNDING None.

Is Lung Ultrasound Useful for Diagnosing Pneumonia in Children?: A Meta-Analysis and Systematic Review.

Abstract: Background Childhood mortality due to pneumonia is high. Chest radiography is the primary imaging modality used for the evaluation of pneumonia in children. Lung ultrasonography (LUS) is a newer, alternative diagnostic method that has been gaining popularity in recent years. We conducted a meta-analysis to summarize the diagnostic usefulness of LUS for childhood pneumonia. Methods All studies included in this meta-analysis were retrieved from PubMed, Elsevier's Science Direct, and Springer, and by manual searches including the use of reference lists, through March 31, 2017. Two researchers independently screened the literature, extracted the data, and evaluated risks of bias in accordance with the inclusion and exclusion criteria. For the meta-analysis, we calculated the pooled sensitivity and specificity, pooled positive likelihood ratio, negative likelihood ratio, and the diagnostic odds ratio. Summary receiver operating characteristic curve was used to assess the overall performance of LUS. Results Our search identified 1038 articles, and we selected 51 of these for detailed review. Eight studies containing 1013 patients met all the inclusion criteria and were included in the final meta-analysis. The pooled sensitivity and specificity for the diagnosis of pneumonia using LUS were 93.0% (95% confidence interval, 88.0%-96.0%) and 96.0% (95% confidence interval, 92.0%-98.0%), respectively. The pooled positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio were 25.8 (11.0, 60.4), 0.07 (0.05, 0.12), and 344 (104, 1140), respectively. In addition, the summary receiver operating characteristic area under the curve was calculated to be 0.98 (0.97, 0.99). A Fagan plot analysis demonstrated that when pretest probabilities were 25%, 50%, and 75%, the positive posttest probabilities were 90%, 96%, and 99%, respectively, and the negative posttest probabilities were 2%, 7%, and 18%, respectively. Four clinical signs were most frequently observed using LUS in the screening of children with pneumonia: pulmonary consolidation, positive air bronchogram, abnormal pleural line, and pleural effusion. Conclusions Current evidence supports LUS as a useful imaging alternative for the diagnosis of childhood pneumonia. That it is easily carried out, readily available, relatively inexpensive, and free from the hazards of radiation make it an attractive alternative to chest radiography and physical examination for the diagnosis and the follow-up of pneumonia in children.

Recommendations for Lung Ultrasound in Internal Medicine

Abstract: A growing amount of evidence prompts us to update the first version of recommendations for lung ultrasound in internal medicine (POLLUS-IM) that was published in 2018. The recommendations were established in several stages, consisting of: literature review, assessment of literature data quality (with the application of QUADAS, QUADAS-2 and GRADE criteria) and expert evaluation carried out consistently with the modified Delphi method (three rounds of on-line discussions, followed by a secret ballot by the panel of experts after each completed discussion). Publications to be analyzed were selected from the following databases: Pubmed, Medline, OVID, and Embase. New reports published as of October 2019 were added to the existing POLLUS-IM database used for the original publication of 2018. Altogether, 528 publications were systematically reviewed, including 253 new reports published between September 2017 and October 2019. The new recommendations concern the following conditions and issues: pneumonia, heart failure, monitoring dialyzed patients’ hydration status, assessment of pleural effusion, pulmonary embolism and diaphragm function assessment. POLLUS-IM 2020 recommendations were established primarily for clinicians who utilize lung ultrasound in their everyday clinical work.

Carpal tunnel release: Lifetime prevalence, annual incidence, and risk factors

Abstract: INTRODUCTION We estimated the lifetime prevalence and incidence of carpal tunnel release (CTR) and identified risk factors for CTR. METHODS The study population consisted of individuals aged ≥30 years living in Finland during 2000-2001 (N = 6,256) and was linked to the Finnish Hospital Discharge Register from 2000 to 2011. RESULTS Lifetime prevalence of CTR was 3.1%, and incidence rate was 1.73 per 1,000 person-years. Female sex (adjusted hazard ratio [HR] = 1.8, 95% confidence interval [CI] 1.2-2.8), age of 40-49 years (HR = 2.5, CI 1.7-3.8 compared with other age groups), education (HR = 0.6, CI 0.4-0.9 for high level vs. low/medium level), obesity (HR = 1.7, CI 1.2-2.5 for body mass index ≥30 vs. < 30 kg/m2 ), and hand osteoarthritis (HR = 2.4, CI 1.4-3.9) were associated with incidence of CTR. DISCUSSION CTR is a common surgical procedure, performed on 1.9% of men and 4.1% of women during their lifetimes. Obesity and hand osteoarthritis are associated with an increased risk of CTR. Muscle Nerve 58: 497-502, 2018.