Andrzej K Jaworek

Jagiellonian University, Kraków, Lesser Poland Voivodeship, Poland

Are you Andrzej K Jaworek?

Claim your profile

Publications (18)14.11 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Acute pancreatitis is a disease, which could be manifested as either a mild edematous form or a more severe necrotizing pancreatitis which has a poor prognosis. The etiology and pathogenesis of this ailment is not completely clear. Melatonin is an indoleamine which is produced from L-tryptophan in the pineal gland and in the other tissue including gastrointestinal tract. Both melatonin and its precursor have been demonstrated to protect the pancreas against acute pancreatitis and to attenuate pancreatic tissue damage. In the pancreas melatonin and L-tryptophan activate complex mechanisms which involve direct scavenging of the radical oxygen and nitrogen species, activation of antioxidant enzymes (catalase, superoxide dydmutase, glutation peroxidase), reduction of pro-inflammatory cytokines and prostaglandins, activation of heat shock protein, and a decrease of necrosis and increase of regeneration in the pancreas. There are several arguments for the idea that endogenous melatonin produced in the pineal gland and in the gastrointestinal system could be the part of a native mechanisms for protecting the pancreas against acute damage: 1/ the melatonin precursor L-tryptophan exerts similar protective effect as melatonin, 2/ application of the melatonin receptor antagonist, luzindole aggravates acute pancreatitis, 3/ pinealectomy results in the exacerbation of acute pancreatitis, 4/ low melatonin plasma levels are associated with an increased risk of severe acute pancreatitis. These observations leads to the idea that perhaps melatonin could be used in clinical trials as supportive therapy in acute pancreatitis.
    Current pharmaceutical design 11/2013; · 4.41 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The mechanisms underlying the process of Treponema pallidum clearance from the central nervous system have not yet been established. Considering that neurosyphilis is associated with mild cerebrospinal fluid (CSF) pleocytosis with a lymphocytic predominance, it has been suggested that cells involved in the adaptive immune response may play a role in this process. In the current study, we assessed the cytokine production profile of T-helper cells in the serum and CSF of patients with early syphilis, with and without CSF abnormalities. Cerebrospinal fluid and blood samples were collected from 33 patients with secondary and early latent syphilis. Five patients (15%) had a reactive CSF Venereal Disease Research Laboratory test without any accompanying neurological symptoms. According to the Centers of Disease Control and Prevention classification, they were diagnosed with asymptomatic neurosyphilis. Serum and CSF levels of interferon-γ (IFN-γ; Th1-type cytokine), interleukin-4 (IL-4; Th2-type cytokine), and interleukin-17A (IL-17A; Th17-type cytokine) were determined by enzyme-linked immunosorbent assay. Patients with asymptomatic neurosyphilis had significantly higher levels of IL-17A (8-fold) and IFN-γ (7.8-fold) in the CSF compared with patients in the no-neurosyphilis group. Six individuals had CSF pleocytosis but a negative CSF Venereal Disease Research Laboratory test result (presumptive neurosyphilis group). In this group, CSF IFN-γ and CSF IL-17A levels were also significantly elevated when compared with no-neurosyphilis group. There was no correlation between serum and CSF concentrations of IL-17A. However, CSF pleocytosis correlated positively with both CSF IL-17A (r = 0.4, P = 0.01) and IFN-γ (r = 0.42, P = 0.01). Increased CSF levels of IFN-γ and IL-17A in syphilitic patients with CSF abnormalities suggest that cells of adaptive immunity (probably T-helper cells producing IFN-γ and IL-17) may contribute to the inflammatory response associated with neurosyphilis. In addition, the lack of correlation between serum and CSF IL-17A levels suggests intrathecal production of this cytokine. Further studies are needed to establish the exact nature of the immune response accompanying neurosyphilis and its clinical significance.
    Sexually transmitted diseases 10/2013; 40(10):808-12. · 2.58 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Syphilis is caused by a spirochete Treponema pallidum. Invasion of the central nervous system (CNS) by T. pallidum may appear early during the course of disease. The diagnosis of confirmed neurosyphilis is based on the reactive Venereal Disease Research Laboratory (VDRL) in cerebrospinal fluid (CSF). Recent studies indicated that serum RPR ≥ 1:32 are associated with higher risk of reactivity of CSF VDRL. The main aim of the current study was to assess cerebrospinal fluid serological and biochemical abnormalities in HIV negative subjects with secondary and early latent syphilis and serum VDRL ≥ 1:32. Clinical and laboratory data of 33 HIV-negative patients with secondary and early latent syphilis, with the serum VDRL titer ≥ 1:32, who underwent a lumbar puncture and were treated in Department of Dermatology at Jagiellonian University School of Medicine in Cracow, were collected. Clinical examination revealed no symptoms of CNS involvement in all patients. 18% (n = 6) of patients met the criteria of confirmed neurosyphilis (reactive CSF-VDRL). In 14 (42%) patients CSF WBC count ≥ 5/ul was found, and in 13 (39%) subjects there was elevated CSF protein concentration (≥ 45 mg/dL). 10 patients had CSF WBC count ≥ 5/ul and/or elevated CSF protein concentration (≥ 45 mg/dL) but CSF-VDRL was not reactive. Indications for CSF examination in HIV-negative patients with early syphilis are the subject of discussion. It seems that all patients with syphilis and with CSF abnormalities (reactive serological tests, elevated CSF WBC count, elevated protein concentration) should be treated according to protocols for neurosyphilis. But there is a need for identification of biomarkes in order to identify a group of patients with syphilis, in whom risk of such abnormalities is high.
    Indian Journal of Dermatology 07/2013; 58(4):325.
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Papulo- and vesiculo-necrotic lesions are rare manifestations of secondary syphilis. Until now it has been described only in HIV-infected patients with advanced stages of immunosuppression. This case report describes an unusual case of PLEVA-like syphilis in a 33-year-old man with newly diagnosed HIV infection. Despite that the CD4 cells level and viral load did not indicate the advance stage of immunosuppression, the unusual manifestation of syphilis and neurosyphilis occurred. The presented case indicates the need for HIV screening in every patient with syphilis especially when the clinical manifestation is unusual. Importance of syphilis testing in every case with atypical rashes should be also highlighted.
    Postepy Dermatologii I Alergologii 04/2013; 30(2):127-130. · 0.66 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: BACKGROUND: Linear immunoglobulin A (IgA) bullous dermatosis (LABD) is a rare autoimmune blistering disorder. The disease may be either idiopathic or druginduced. Over the past 30 years, approximately one hundred LABD cases have been described as induced by a wide range of drugs, chiefly antibiotics. MAIN OBSERVATIONS: We report the case of 37-year-old woman who developed pruritic bullous lesions spread all over the body three weeks after her last dose of cefuroxime axetil. Antibiotic therapy was started due to rhino-sinusitis. CONCLUSIONS: In most reported cases of drug-induced LABD, skin lesions occur within the time of drug administration. However, the onset of disease may be even after discontinuation of treatment. It seems that in such cases, other clinical conditions (like infection) act, as cofactors of immunologic response.
    Journal of Dermatological Case Reports 12/2012; 6(4):117-119.
  • Maciej Pastuszczak, Anna Wojas-Pelc, Andrzej K. Jaworek
    [Show abstract] [Hide abstract]
    ABSTRACT: The most specific criterion for diagnosing neurosyphilis is a reactive CSF VDRL. Unfortunately, there are in Europe, including Poland small number of specialized laboratories for serological diagnosis of syphilis. Thus, CSF serology results are obtained with delay. Therefore, the decision on recommended therapy for neurosyphilis is taken on the basis of CSF basic tests. In this paper we attempt to determine the utility of CSF glucose concentration and its cut-off values in prediction of asymptomatic neurosyphilis. CSF and blood were collected from 55 HIV-uninfected patients with syphilis of unknown duration. Patients with neurosyphilis (14.5%) were characterized by higher CSF pleocytosis (p<0.0001), elevated CSF protein concentration (p<0.05) and lower CSF glucose concentration (p<0.0001). Multivariate regression analysis identified CSF pleocytosis and CSF glucose concentration as the two independent predictors of reactive CSF VDRL (p<0.0001). In the selected group of patients with CSF pleocytosis ≥5/µL (n=25) CSF glucose concentration ≤2.72 mmol/L was associated with 100% sensitivity (95%CI: 63-100%) and 100% specificity (95%CI: 75.3–100%) for reactive CSF VDRL. CSF glucose concentration may be particularly useful as a predictive marker of neurosyphilis in HIV uninfected patients with syphilis of unknown duration with CSF plecytosis ≥5/µL.
    Central European Journal of Medicine 09/2012; · 0.26 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Introduction. Syphilis is a sexually transmitted disease (STD), caused by the spirochete Treponema pallidum. The disease occurs only in humans. In the course of syphilis several stages are distinguished, which reflect the gradual spread of bacteria in the organism. Variety of sexual practices (including anal and oral sex), and widespread empirical use of antibiotics, prescribed for reasons other than STD (e.g. upper respiratory tract infections) not having treponemicidal action, seem to lead to changes in the clinical course of syphilis and its characterization by sparse symptoms. Objective. The aim of this study was to analyse the clinical manifestation of secondary syphilis in patients treated in the Department of Dermatology at Jagiellonian University, School of Medicine in Cracow. Material and methods. Data obtained from 217 patients including those of sociodemographic status, sexual orientation and HIV infection were analysed. Results. The analysed group consisted of 23 women (10.6%) and 194 men (89.4%), of whom 107 declared they were homosexuals. In 153 patients due to the absence of clinical signs of infection early latent syphilis was diagnosed. The most common clinical symptom of secondary syphilis was macular rash (43.7%), followed by maculopapular changes on the palms and soles (36.8%), generalized lymphadenopathy (33.3%), syphilitic alopecia (21.8%), syphilitic angina (14.9%) and condylomata lata (6.9%). 58.2% of patients had only one clinical symptom of the disease. The most common signs of infection were generalized lymphadenopathy and maculopapular rash on the soles and palms (11.5%). Conclusions. It seems that in the past two decades the clinical manifestation of secondary syphilis has not changed significantly. However, in comparison to data available from the literature different incidence of individual symptoms of secondary syphilis was observed, which may be explained by locally contingent diversity of sexual practices, use of empiric antibiotic therapy for reasons other than sexually transmitted infections and different accessibility to health care.
    Przegl Dermatol. 05/2012; 3/2012(99):210-215.
  • Source
    Sexually transmitted infections 04/2012; 88(4):312. · 2.18 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Melatonin, a product of the pineal gland, is released from the gut mucosa in response to food ingestion. Specific receptors for melatonin have been detected in many gastrointestinal tissues including the pancreas. Melatonin as well as its precursor, L-tryptophan, attenuates the severity of acute pancreatitis and protects the pancreatic tissue from the damage caused by acute inflammation. The beneficial effect of melatonin on acute pancreatitis, which has been reported in many experimental studies and supported by clinical observations, is related to: (1) enhancement of antioxidant defense of the pancreatic tissue, through direct scavenging of toxic radical oxygen (ROS) and nitrogen (RNS) species, (2) preservation of the activity of antioxidant enzymes; such as superoxide dismutase (SOD), catalase (CAT), or glutathione peroxidase (GPx), (3) the decline of pro-inflammatory cytokine tumor necrosis α (TNFα) production, accompanied by stimulation of an anti-inflammatory IL-10, (4) improvement of pancreatic blood flow and decrease of neutrophil infiltration, (5) reduction of apoptosis and necrosis in the inflamed pancreatic tissue, (6) increased production of chaperon protein (HSP60), and (7) promotion of regenerative process in the pancreas. Conclusion. Endogenous melatonin produced from L-tryptophan could be one of the native mechanisms protecting the pancreas from acute damage and accelerating regeneration of this gland. The beneficial effects of melatonin shown in experimental studies suggest that melatonin ought to be employed in the clinical trials as a supportive therapy in acute pancreatitis and could be used in people at high risk for acute pancreatitis to prevent the development of pancreatic inflammation.
    International journal of inflammation. 01/2012; 2012:173675.
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Coronary artery bypass graft (CABG) surgery is associated with systemic response and increased concentrations of numerous cytokines. Vascular endothelial growth factor (VEGF) related pathway also seems to be involved in inflammatory response induced by CABG. The aim of this study was to analyze the association between the VEGF gene +405 G>C polymorphism (linked to serum VEGF production), and the short-term clinical outcome during the in-hospital period (30 days) in patients undergoing CABG. Genotyping for VEGF gene +405 G>C polymorphism was performed in 64 patients with coronary artery disease at a mean age of 66 years (76.6% males), with a mean EuroSCORE (European System for Cardiac Operative Risk Evaluation) of 2.5 (0-2 points: 50% patients, 3-4: 25%, > or =5 points: 25%), who underwent CABG surgery. Twenty-one (33%) patients were homozygous for the +405 G allele, 40 (63%) were heterozygous, and 3 were homozygous for the +405 C allele. Ten patients died during the 30-day follow-up (7 subjects with +405 GG genotype, and the other 3 carriers of the +405 C allele). Using multivariate logistic regression analysis, the risk of death after CABG was increased in patients with +405 GG genotype (odds ratio [OR] = 6.7; 95% confidence interval [CI] 1.5-29.4) and with EuroSCORE > or =5 points (OR = 4.4; 95% CI 1.1-18.1). The VEGF gene +405 G>C polymorphism might be a prognostic factor of an adverse postoperative course in patients undergoing CABG surgery. Apart from its proangiogenic action, VEGF may have additional, possibly proinflammatory properties.
    Polskie archiwum medycyny wewnȩtrznej 11/2009; 119(11):719-25. · 2.05 Impact Factor
  • Andrzej Kazimierz Jaworek, Anna Wojas-Pelc, Maciej Pastuszczak
    [Show abstract] [Hide abstract]
    ABSTRACT: Rosacea is a chronic, inflammatory skin disease which is mainly localized in the central region of the face. Papules and pustules appear on the erythematic ground. Rosacea is common in population. Four subtypes of rosacea (erythematoteleangiectatic rosacea, ETR; papulo - pustular rosacea, PPR; ocular rosacea and phymatous rosacea) are classified (according to current classification) and one variant rosacea (granulomatous rosacea, GR). It is considered that an attempt to determine of triggering factors of rosacea should be the first step to treatment. Then it should be tried to eliminate contact with them. The aim of this study was an analysis of triggering factors of rosacea. 43 women and 26 men treated in the Dermatology Outpatient's Clinic of Jagiellonian University School of Medicine in Cracow were enrolled in the study. All patients were asked which factors trigger skin changes according to them. Patients mentioned most often: stress (58 percent), sun exposure (56.5 per. cent), alcohol (33.3 percent), exercise (29 percent), drinking coffee (21.7 percent) and hot meals (20.3 percent). They regarded the sun as the most strongly aggravating factor of rosacea (29.2 percent). It seems, that elimination and reduction of contact with aggravating factors is still an undervalued aspect of rosacea's treatment. Patients' motivation for use of prevention seems to be also very important. Knowledge about aggravating factors of rosacea, coming directly from patients' observations, may help in more effective treatment.
    Przegla̧d lekarski 02/2008; 65(4):180-3.
  • [Show abstract] [Hide abstract]
    ABSTRACT: Psychodermatology descibes an interaction between dermatology and psychiatry and psychology. The incidence of psychiatric disorders among dermatological patients is estimated at about 30 to 60%. It appears that a significant group of patients who seek dermatologist's advice are those who can reveal psychiatric disorders. The most often diagnosed psychiatric disturbances are mood disorders, especially depressive, suicidal ideation and tendencies, anxiety disorders, obsessive disorders and delusional disorders. Knowledge of the psycho-dermatological diseases can contribute to more profitable therapy in both dermatology and psychiatry. This article characterises the particular disorders with their dermatological and psychological aspects. The basic principles of therapeutic interventions for each disorder are also discussed.
    Przegla̧d lekarski 02/2008; 65(5):244-8.
  • Anna Wojas-Pelc, Ana Alekseenko, Andrzej Kazimierz Jaworek
    [Show abstract] [Hide abstract]
    ABSTRACT: we studied erysipelas by conducting a retrospective analysis of 319 patients with erysipelas treated in Dermatology Department Jagiellonian University in Krakow between 1994 and 2004. we performed a retrospective analysis of 319 patients hospitalized for erysipelas in our institution during a 10 year period. The statistical significance was examined by chi square and Kruskal-Wallis test (significant value p< or =0.05). there were 35% males and 65% females patients. Median age was 63 years. Most of the female patients were pensioners (32.7%), most of the male patients were physical workers (40.5%). Summer time was the most frequent season for hospitalization (32.3%), and winter time was the rarest (17%). Most of the erysipelas has involved the lower limb (59.2%). There was significant dependence between the regional risk factors and occupation. The recurrent cases occurred in 67.3% cases with lower limb localisation in 69.44% cases. The most rare recurrent cases found on upper limb (6%). The systemic risk factors were associated with recurrent erysipelas in 69.44%. Complications, such as abscess formation, lymphangitis, venous insufficiency, osteitis, arthritis, septic tendonitis and elephantiasis were found in 25%. after review of the literature and our experiences it is clear that there is a strong need for interdisciplinary treatment to avoid various potential complications of erysipelas.
    Przegla̧d epidemiologiczny 02/2007; 61(3):457-64.
  • [Show abstract] [Hide abstract]
    ABSTRACT: Molecular biology, immunology, diagnostic and treatment of cutaneous melanoma have been analyzed on the basis of current literature due to the increasing frequency of this cancer. Due to the increasing frequency of melanoma it is crucial to detect early the malignant lesions on the basis of physical examination and noninvasive diagnostic methods (dermatoscopy, videodermatoscopy with total body photography). Histopathological examination is conclusive. In diagnostic imaging of early stage melanoma it is very important to evaluate the regional lymph node. In clinical practice, the cross-sectional imaging modalities including computed tomography (CT), ultrasound and magnetic resonance (MR) are widely used to assess lymph nodes. Sentinel lymph node (SLN) biopsy is currenly a valuable and reliable diagnostic procedure for precise staging of patients with clinically no cutaneous melanoma. The presence of SLN metastases is the most important negative factor for clinical outcome in melanoma patients. Introduction of RT-PCR allowed to detect individual cancer cells in tested sample of blood or tissue. Surgical treatment is an essential therapeutic modality in patients with melanoma. Treatment of a primary melanoma involves local excision of the tumour with a margin of skin and subcutaneous tissue. The role of systemic therapy is still a matter of clinical trials. Today's systemic therapy modalities include the use of biological agents (e.g. interferon alfa and interleukin 2) and cytotoxic agents. The efficacy of different types of melanoma vaccines (antigenic, cellular, DNA, GMTV) has been analyzed in numerous clinical trials. Results of these trials are still unsatisfactory. Dendritic cells in melanoma therapy will be very important in the future. Dendritic cells are the most efficient stimulators of T lymphocyte response among professional antygen presenting cells (APC) and the only APC capable to prime naive T lymphocytes with the antygen. A response to weakly immunogenic and tolerogenic tumor antigens can be achived with the use of DC as APC. This review represents an attempt to discuss current evidence on the place of adjuvant and palliative systemic therapy in melanoma.
    Przegla̧d lekarski 02/2006; 63(8):674-80.
  • [Show abstract] [Hide abstract]
    ABSTRACT: The so-called sexually transmitted diseases (STD) are the ones in which the transmission of pathogenic factors is mostly caused by sexual intercourse. Every year 333 million of documented new cases of STD occur all over the world. Due to an increase of incidence of STD, which was observed in the Province of Małopolska, the authors decided to check the knowledge of basic clinical symptoms and risk factors of transmission of venereal diseases. A group of 104 soldiers (quartered in military bases in Cracow) and a group of 41 medical students (the 1st and the 2nd year of medical studies at the CMUJ in Cracow) were included in the analysis. The investigated population was exclusively consisting of men, aged 19-25. The authors used their own questionnaire consisting of 25 multiple-choice questions. The result of the research revealed a very poor knowledge of basic clinical symptoms and risk factors of STD in both analysed groups. It implies the necessity of conducting educational activities on prophylaxis, risk factors and symptomatology of venereal diseases.
    Polski merkuriusz lekarski: organ Polskiego Towarzystwa Lekarskiego 06/2003; 14(83):436-40.
  • Anna Wojas Pelc, Andrzej Kazimierz Jaworek
    [Show abstract] [Hide abstract]
    ABSTRACT: Onychophagy is classified to the nail diseases caused by repeated injures. Nail-biting as autodestruction and onychophagy in its most aggressive form, is common not only among children but adults as well. Nail-biting in children belongs to the group of habits and habitual function, which allowed for relieving the anxiety, loneliness, inactivity in children deprived of safety feeling, love and nearest relationship. In most adults suffering from onychophagy psychiatric diseases are not diagnosed. There are different clinical symptoms of onychophagy depended on the degree and the way of performed injures. In this study we are promoting the multidisciplinary approach to the therapy of habitual nail-biting.
    Przegla̧d lekarski 02/2003; 60(11):737-9.
  • [Show abstract] [Hide abstract]
    ABSTRACT: Wrinkles are the most visible sign of the aging skin. The author presented characteristic changes in the epithelium and dermis for that type of skin and therapeutic possibilities utilised in the esthetic dermatology. They also undertook an attempt to classify patients for particular types of revitalization interventions (implants, botulin toxin, peelings).
    Przegla̧d lekarski 02/2002; 59(3):175-8.
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Melatonin, a pineal indoleamine, protects the pancreas against acute damage; however, the involvement of the pineal gland in the pancreatoprotective action of melatonin is unknown. The primary aim of this study was to determine the effects of pinealectomy on the course of acute caerulein-induced pancreatitis (AP) in rats. AP was induced by a subcutaneous infusion of caerulein (25 μg/kg) into pinealectomized or sham-operated animals. Melatonin (5 or 25 mg/kg) was given via intraperitoneal (ip) injection 30 min prior to the induction of AP. The pancreatic content of the lipid peroxidation products malondialdehyde and 4-hydroxynonenal (MDA + 4HNE) and the activity of an antioxidative enzyme, glutathione peroxidase (GSH-Px), were measured in each group of rats. Melatonin blood levels were measured by radioimmunoassay (RIA). In the sham-operated rats, AP was confirmed with histological examination and manifested as pancreatic edema and an increase in the blood lipase level (by 1,500%). In addition, the pancreatic content of MDA+ 4HNE was increased by 200%, and pancreatic glutathione peroxydase (GSH-Px) activity was reduced by 40%. Pinealectomy significantly aggravated the histological manifestations of AP, reduced the GSH-Px activity and markedly augmented the levels of MDA+ 4HNE in the pancreas of rats with or without AP as compared to sham-operated animals. Melatonin was undetectable in the blood of the pinealectomized rats with or without AP. Treatment with melatonin (25 mg/kg, ip) prevented the development of AP in the sham-operated rats and significantly reduced pancreatic inflammation in the animals previously subjected to pinealectomy. In conclusion, pineal melatonin contributes to the pancreatic protection through the activation of the antioxidative defense mechanism in pancreatic tissue as well as its direct antioxidant effects.
    Pharmacological reports: PR 62(5):864-73. · 1.97 Impact Factor