Acute pancreatitis may present with a variety of complications, the whole range of thoracic complications is presented as the rare enzymatic ascending mediastinitis as well as rare mediastinal pseudocysts. The mortality rate of mediastinal complications is high, 14-47%. Due to the small number of described cases, no clear recommendations have been made regarding the treatment of mediastinal pseudocyst. From the documented cases, spontaneous regression of mediastinal pseudocysts is rare and the clear benefit is reached by endoscopic treatment. Surgical therapy should be indicated only in case of failure of pharmacotherapy or endoscopic treatment. The differential diagnosis of the patient's difficulties after pancreatitis includes a whole range of polymorphic manifestations. However, as we illustrate in this case report, we should not forget them, especially because of the mortality rate.

• Klíčová slova
• acute pancreatits, acute panctreatitis, case report, mediastinal pseudocysts,
• MeSH
• akutní nemoc MeSH
• cysty mediastina * etiologie   diagnóza   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mediastinitida etiologie   MeSH
• pankreatická pseudocysta * etiologie   MeSH
• pankreatitida * komplikace   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

OBJECTIVE: To present a case of a patient who developed acute Sheehan's syndrome, despite adequate estimated blood loss. CASE REPORT: Sheehan's syndrome is a relatively rare disease with various incidences, mainly due to different obstetric care factors in individual countries. Pathogenetic mechanisms are not fully understood. An important factor is reduced blood flow through the pituitary arteries caused by hypotension in the setting of postpartum hemorrhage. Subsequent clinical manifestations depend on the extent of damage to the pituitary gland, and consequently, on the loss of individual hormones, the secretion of which is controlled by the pituitary gland. Most patients are diagnosed years later. Our case describes a patient with Sheehan's syndrome that developed in the early postpartum period. The patient was successfully diagnosed and adequate replacement therapy was started. CONCLUSION: In summary, acute Sheehan's syndrome is a rare occurrence. Agalactia, amenorrhea, fatigue, and other non-specific symptoms should be considered despite its rarity.

• Klíčová slova
• acute Sheehan syndrome, hypopituitarism, puerperium,
• MeSH
• akutní nemoc MeSH
• dospělí MeSH
• hypopituitarismus * diagnóza   etiologie   MeSH
• lidé MeSH
• poporodní krvácení MeSH
• poruchy v puerperiu * diagnóza   MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

Although sodium-glucose cotransporter 2 inhibitors reduce the risk of cardiovascular death or worsening heart failure (HF) in patients with chronic HF, there are limited data on initiation in hospitalized patients with HF. DAPA ACT HF-TIMI 68 (Dapagliflozin and Effect on Cardiovascular Events in Acute Heart Failure - Thrombolysis in Myocardial Infarction 68) is an international, randomized, double-blind trial evaluating the initiation of dapagliflozin (10 mg daily) vs placebo in 2,401 patients hospitalized for acute HF. Patients were enrolled irrespective of left ventricular ejection fraction, type 2 diabetes status, or chronicity of HF (de novo and worsening chronic HF). Randomized participants receive blinded treatment for 2 months. The primary efficacy endpoint is time to first occurrence of cardiovascular death or worsening HF (worsening HF during the index admission, rehospitalization for worsening HF, or urgent HF visit). Key safety endpoints include symptomatic hypotension and worsening kidney function. This is the first cardiovascular outcomes trial designed specifically to evaluate the efficacy and safety of in-hospital initiation of dapagliflozin in patients hospitalized for the management of acute HF. (Dapagliflozin and Effect on Cardiovascular Events in Acute Heart Failure - Thrombolysis in Myocardial Infarction 68 [DAPA ACT HF-TIMI 68]; NCT04363697; EudraCT # 2022-001262-35).

• Klíčová slova
• clinical trial, hospitalization, sodium-glucose cotransporter 2 inhibitors, worsening heart failure,
• MeSH
• akutní nemoc MeSH
• benzhydrylové sloučeniny * terapeutické užití   aplikace a dávkování   MeSH
• diabetes mellitus 2. typu komplikace   farmakoterapie   MeSH
• dvojitá slepá metoda MeSH
• glifloziny * terapeutické užití   MeSH
• glukosidy * terapeutické užití   aplikace a dávkování   MeSH
• hospitalizace MeSH
• lidé středního věku MeSH
• lidé MeSH
• multicentrické studie jako téma MeSH
• randomizované kontrolované studie jako téma MeSH
• senioři MeSH
• srdeční selhání * farmakoterapie   patofyziologie   MeSH
• tepový objem MeSH
• výsledek terapie MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• protokol klinické studie MeSH
• Názvy látek
• benzhydrylové sloučeniny * MeSH
• dapagliflozin MeSH Prohlížeč
• glifloziny * MeSH
• glukosidy * MeSH

Severe acute pancreatitis (SAP) is associated with metabolic disorders, hypocalcemia, and multiple organ failure. The objective of this study was to investigate changes in thyroid ultrastructure and function in rats with SAP and to provide a theoretical basis for the clinical treatment of thyroid injury in patients with SAP. 64 male SPF Wistar rats were randomly divided into the SAP group and the control group. Pancreatic enzymatic indicators and thyroid hormones were detected, pathology scores were evaluated, and morphological changes were observed under light microscopy and transmission electron microscopy (TEM) in both groups. The serum levels of triiodothyronine (T3), tetraiodothyronine (T4) and Ca2+ were significantly lower in the SAP group than in the control group (P<0.05), whereas the level of calcitonin (CT) was significantly higher than that in the control group (P<0.05). The thyroid structure (pathology and electron microscopy) of the SAP rats was seriously damaged and worsened over time. SAP can cause thyroid injury through a variety of mechanisms, which can also retroact to pancreatitis to aggravate the inflammatory response. This study may have theoretical significance for basic research on SAP. Key words Severe acute pancreatitis, Thyroid, Structure and functional changes, Transmission electron microscopy.

• MeSH
• akutní nemoc MeSH
• hormony štítné žlázy krev   MeSH
• krysa rodu Rattus MeSH
• modely nemocí na zvířatech MeSH
• pankreatitida * patologie   krev   MeSH
• potkani Wistar MeSH
• štítná žláza * ultrastruktura   patologie   metabolismus   patofyziologie   MeSH
• stupeň závažnosti nemoci MeSH
• transmisní elektronová mikroskopie MeSH
• zvířata MeSH
• Check Tag
• krysa rodu Rattus MeSH
• mužské pohlaví MeSH
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH
• Názvy látek
• hormony štítné žlázy MeSH

BACKGROUND: Diarrhoea remains a leading cause of death in children. An intestinal adsorbent may reduce diarrhoea duration and severity. METHODS: Randomised controlled feasibility trial with two phases: phase 1 (0-4 hours and double-blind) and phase 2 (up to 5 days and open-label). 50 children aged 6-59 months with acute diarrhoea presenting with no or some dehydration to the emergency paediatric unit and outpatient clinic at Edward Francis Small Teaching Hospital, Banjul, The Gambia were randomised to either standard treatment (oral rehydration fluid and zinc) or standard treatment with polymethylsiloxane polyhydrate for up to 5 days. RESULTS: Recruitment was completed in 7 months. All but one child completed the study. There were no major protocol deviations although patient-held diaries did not collect reliable information. Time from randomisation to the last watery stool (primary outcome) was shorter in the intervention than control arm (mean difference -19.3 hours, 95% CI -30.9 to -7.8). Stool frequency was lower in the intervention arm on days 2 (95% CI -0.8 to -1.3 to -0.3) and 3 (95% CI -0.8; -1.3 to -0.3). One serious event (death) occurred in the control arm. CONCLUSIONS: A randomised, controlled trial is feasible. Further clinical trials are warranted to confirm the efficacy of polymethylsiloxane polyhydrate in acute diarrhoea and inform management guidelines. TRIAL REGISTRATION NUMBER: PACTR202302683128875.

• Klíčová slova
• Child Health, Gastroenterology, Low and Middle Income Countries,
• MeSH
• akutní nemoc MeSH
• dvojitá slepá metoda MeSH
• kojenec MeSH
• lidé MeSH
• předškolní dítě MeSH
• průjem * terapie   MeSH
• studie proveditelnosti MeSH
• tekutinová terapie * metody   MeSH
• výsledek terapie MeSH
• Check Tag
• kojenec MeSH
• lidé MeSH
• mužské pohlaví MeSH
• předškolní dítě MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• randomizované kontrolované studie MeSH
• Geografické názvy
• Gambie MeSH

Acute mesenteric ischaemia (AMI) is a sudden onset of impaired bowel perfusion. Has a high mortality rate and is difficult to diagnose. Therapy involves endovascular, surgical, or a combination of both. Because of baseline differences, the comparison between endovascular and open surgical treatment is subject to selection bias. The aim of this study was to evaluate the results of treatment of AMI by open or endovascular approach in combination with laparotomy, and evaluation of treatment strategy in similar situations. Clinical data from 21 patients treated for AMI between 2018 and 2022 were retrospectively reviewed and compared. The primary endpoint of the study was in-hospital mortality. The secondary endpoint was the statistical evaluation of risk factors for mortality. All patients underwent acute endovascular revascularisation. Aspiration thromboembolectomy was performed in nine patients, stenting in seven, PTA in one and surgery in three. Endovascular therapy was unsuccessful for technical reasons in 3 patients. None of the monitored parameters reached statistical significance. The best results were achieved in the early diagnosis group. The overall mortality of acute mesenteric ischaemia in our cohort was 34.8%. Acute mesenteric ischaemia is a serious condition affecting mainly elderly patients with a high mortality rate, but the diagnosis of mesenteric ischaemia is not an automatic death sentence. To achieve the best therapeutic outcome, mesenteric ischaemia needs to be diagnosed and treated at an early stage. The best therapeutic outcomes are achieved in centres with 24-hour access to endovascular revascularisation and surgical therapy.

• Klíčová slova
• Acute mesenteric ischaemia, Combined procedure, Endovascular revascularisation, Surgical therapy,
• MeSH
• akutní nemoc MeSH
• endovaskulární výkony * metody   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mezenteriální ischemie * chirurgie   mortalita   MeSH
• mortalita v nemocnicích MeSH
• retrospektivní studie MeSH
• rizikové faktory MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• stenty MeSH
• výsledek terapie MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

INTRODUCTION: Atrial fibrillation (AF) can cause or aggravate heart failure (HF). Catheter ablation (CA) is an effective treatment for AF. This study focused on the feasibility and outcomes of emergent AF ablation performed during hospitalization for acute HF. METHODS AND RESULTS: We retrospectively investigated patients who underwent emergent CA for AF during hospitalization for acute HF in 2018-2024. Arrhythmia recurrence was the primary endpoint. The combination of arrhythmia recurrence, HF hospitalization, and all-cause death was the secondary endpoint. Patients were censored 1 year after the index procedure. We included 46 patients, 35% females, with median age of 67 [interquartile rage: 61, 72] years and left ventricular ejection fraction (LVEF) of 25 [23, 28]%. Thermal CA was performed in 14 patients, and pulsed field ablation (PFA) in 32 patients. Procedure time was significantly shorter with PFA compared to thermal CA (77 [57, 91] vs. 166 [142, 200] minutes, p < 0.001). Fluoroscopy time was longer with PFA (9.5 [7.6, 12.0] vs. 3.9 [2.9, 6.0] minutes, p < 0.001), with a borderline trend towards higher radiation dose (75 [53, 170] vs. 50 [30, 94] μGy.m2, p = 0.056). Extrapulmonary ablation was frequent (86% and 84% for thermal CA and PFA, p > 0.9). The estimated freedom from the primary endpoint was 79% after PFA and 64% after thermal CA (p = 0.44). The estimated freedom from the secondary endpoint was 76% after PFA and 57% after thermal CA (p = 0.43). LVEF improved by 24% ± 2% (p < 0.001) in patients with the first manifestation of HF and by 14% ± 4% (p = .004) in patients with decompensated HF diagnosed earlier. CONCLUSIONS: Emergent CA of AF during acute HF hospitalization is safe and associated with improved LVEF and good clinical outcomes. In the PFA era, the rate of these procedures is progressively increasing as they are readily available and easy to perform compared to thermal ablation.

• Klíčová slova
• acute heart failure, atrial fibrillation, catheter ablation, electroporation, posterior wall isolation, pulsed field ablation, thermal ablation,
• MeSH
• akční potenciály MeSH
• akutní nemoc MeSH
• časové faktory MeSH
• fibrilace síní * chirurgie   patofyziologie   mortalita   diagnóza   komplikace   MeSH
• funkce levé komory srdeční MeSH
• hospitalizace * MeSH
• katetrizační ablace * škodlivé účinky   mortalita   metody   MeSH
• lidé středního věku MeSH
• lidé MeSH
• obnova funkce MeSH
• příjem pacientů * MeSH
• recidiva MeSH
• retrospektivní studie MeSH
• rizikové faktory MeSH
• senioři MeSH
• srdeční frekvence MeSH
• srdeční selhání * patofyziologie   mortalita   diagnóza   terapie   MeSH
• studie proveditelnosti MeSH
• tepový objem MeSH
• výsledek terapie MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

Recurrent acute otitis media (rAOM) poses a significant challenge in children aged 1 to 6 years, characterized by frequent and treatment-resistant ear infections. While existing studies predominantly focus on alterations in the nasopharyngeal microbiome associated with rAOM, our research explores the understudied association with the gut microbiome. In this cross-sectional observational prospective study, we enrolled 35 children aged 1 to 6 years during the 2021/2022 cold season. The test group comprised children with rAOM (n = 16), and the control group consisted of generally healthy children (n = 19). Samples (stool and nasopharyngeal swabs) were collected in late spring to ensure an antibiotic-free period. Detailed metadata was gathered through a questionnaire examining factors potentially influencing microbiota. Microbiota composition was assessed through amplicon sequencing of the V3-V4 region of the 16S rRNA gene. Our findings revealed limited alterations in gut microbiota composition among children with rAOM compared to healthy controls. Six bacterial taxa (Veillonella, Lachnospiraceae, Ruminococcaceae, Lachnospiraceae, Bacteroides and Blautia) were differentially represented with weak statistical significance. However, several bacterial taxa displayed correlations with multiple consecutive infections, with Turicibacter showing the most significant association. Additionally, day care centre attendance emerged as a potent gut microbiota modifier, independent of rAOM. Although our study identified limited differences in gut microbiota composition between children with rAOM and healthy controls, the observed correlations between the number of infections and specific bacterial taxa suggest a potential link between rAOM and the gut microbiota, warranting further investigation.

• Klíčová slova
• Turicibacter, Gut microbiota, Metagenomics, Nasopharynx, Recurrent acute otitis media,
• MeSH
• akutní nemoc MeSH
• Bacteria * klasifikace   genetika   izolace a purifikace   MeSH
• dítě MeSH
• feces mikrobiologie   MeSH
• kojenec MeSH
• lidé MeSH
• nazofarynx mikrobiologie   MeSH
• otitis media * mikrobiologie   MeSH
• předškolní dítě MeSH
• prospektivní studie MeSH
• průřezové studie MeSH
• recidiva MeSH
• RNA ribozomální 16S * genetika   MeSH
• střevní mikroflóra * MeSH
• Check Tag
• dítě MeSH
• kojenec MeSH
• lidé MeSH
• mužské pohlaví MeSH
• předškolní dítě MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• pozorovací studie MeSH
• Názvy látek
• RNA ribozomální 16S * MeSH

Fluid collections are common manifestations of local complications of acute pancreatitis (AP). The determination of fluid collections is important in stratifying the severity of the course of acute pancreatitis and choosing the appropriate management. In this study, the frequency of detection of fluid effusions by various instrumental methods and their clinical significance in 677 patient was assessed, taking into account the severity of the course of AP and anatomical localization of fluid accumulations. The computed tomography (CT) method showed its advantage in detecting fluid effusions in the pleural cavities, while the ultrasound method showed its indisputable significant advantage in the diagnosis of fluid effusions located parapancreatically and in the lesser sac: the highest frequency of detection of fluid effusion was in 65.3% of all patients in the general group using CT compared to 39% using ultrasound and 12.5% using chest X-ray (p<0.05). Each of the above methods showed different sensitivity depending on the anatomical areas of fluid effusion detection. In particular, the CT method revealed the presence of fluid in the pleural cavities in 50.7% of the total group, in the abdominal cavity in 36.0% of cases, and only in 8.0% of cases in the parapancreatic or lesser sac. The opposite picture was revealed when using the ultrasound method, in which fluid was found in the parapancreatic/lesser sac in the largest number of cases - 28.1%, in the abdominal cavity - in 22.6% of cases, and in the pleural cavity - in 14.3% of cases.

• Klíčová slova
• Acute pancreatitis, Fluid effusions, Radiological detection,
• MeSH
• akutní nemoc MeSH
• ascites * diagnostické zobrazování   etiologie   MeSH
• dospělí MeSH
• klinická relevance MeSH
• lidé středního věku MeSH
• lidé MeSH
• pankreatitida * diagnostické zobrazování   komplikace   diagnóza   MeSH
• pleurální výpotek * diagnostické zobrazování   etiologie   diagnóza   MeSH
• počítačová rentgenová tomografie * metody   MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ultrasonografie * metody   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

Referrals to emergency services are frequently made for acute appendicitis and renal colic. This conundrum of patients with acute appendicitis and right ureteral stones frequently presents itself to emergency physicians. The hematological parameters of patients suffering from acute appendicitis and right ureteral stones were compared in this study. From May 2022 to April 2023 the patients who applied to emergency department were reviewed retrospectively. Of these patients, age, sex, complete blood test results including white blood cell, procalcitonin and C-reactive protein were recorded. The platelet to lymphocyte ratio and the neutrophil to lymphocyte ratio were calculated by dividing the platelet count by the lymphocyte, and the neutrophil count by the lymphocyte count, respectively. We used the receiver operating characteristic curves to assess the diagnostic efficacy of hematological markers. There were 106 patients in the study. The mean age of the patients was 43.83 ± 15.82 years. The significant difference was found for age, white blood cell, neutrophil, lymphocyte, neutrophil to lymphocyte ratio, platelet to lymphocyte ratio and monocyte between groups. The white blood cell and neutrophil to lymphocyte ratio have the biggest area than the other parameters in the receiver operating characteristic curves. Patients with acute appendicitis have a high level of neutrophil to lymphocyte ratio, platelet to lymphocyte ratio than ureteral stones. Further studies are needed to define the diagnostic efficacy of hematological markers for acute appendicitis and ureteral stones.

• Klíčová slova
• Acute appendicitis, Emergency, Neutrophil to lymphocyte ratio, Ureteral stone,
• MeSH
• akutní nemoc MeSH
• apendicitida * krev   diagnóza   MeSH
• biologické markery * krev   MeSH
• dospělí MeSH
• kameny v močovodu * krev   diagnóza   MeSH
• lidé středního věku MeSH
• lidé MeSH
• počet leukocytů MeSH
• retrospektivní studie MeSH
• ROC křivka MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• srovnávací studie MeSH
• Názvy látek
• biologické markery * MeSH