BACKGROUND: Dexamethasone 6 mg in patients with severe COVID-19 has been shown to decrease mortality and morbidity. The effects of higher doses of corticosteroid, that would further increase anti-inflammatory effects, are uncertain. The objective of our study was to assess the effect of 20 mg dexamethasone vs. 6 mg dexamethasone intravenously in patients with moderate-to-severe acute respiratory distress syndrome (ARDS) and COVID-19. METHODS: In a multicenter, open-label, randomized trial conducted in nine hospitals in the Czech Republic, we randomized adult patients with ARDS and COVID-19 requiring high-flow oxygen, noninvasive or invasive mechanical ventilation to receive either intravenous high-dose dexamethasone (20 mg/day on days 1-5, 10 mg/day on days 6-10) or standard-dose dexamethasone (6 mg/d, days 1-10). The primary outcome was 28-day ventilator-free days. The five secondary outcomes were 60-day mortality, C-reactive protein dynamics, 14-day WHO (World Health Organization) Clinical Progression Scale score, adverse events and 90-day Barthel index. The long-term outcomes were 180- and 360-day mortality and the Barthel index. The planned sample size was 300, with interim analysis after enrollment of 150 patients. RESULTS: The trial was stopped due to a lack of recruitment, and the follow-up was completed in February 2023. Among 234 randomized patients of 300 planned patients, the primary outcome was available for 224 patients (110 high-dose and 114 standard-dose dexamethasone; median [interquartile range (IQR)] age, 59.0 [48.5-66.0] years; 130 [58.0%] were receiving noninvasive or invasive mechanical ventilation at baseline). The mean number of 28-day ventilator-free days was 8.9 (± 11.5) days for high-dose dexamethasone and 8.0 (± 10.7) days for standard-dose dexamethasone, with an absolute difference of + 0.81 days (95% CI - 2.12-3.73 days). None of the prespecified secondary outcomes, including adverse events, differed between the groups. CONCLUSIONS: Despite not reaching its prespecified enrollment, there was no signal to either benefit or harm high-dose dexamethasone over standard-dose dexamethasone in patients with COVID-19 and moderate-to-severe ARDS. Trial registration Trial registration: ClinicalTrials.gov Identifier: NCT04663555. Registered 10 December 2020, https://clinicaltrials.gov/study/NCT04663555?term=NCT04663555&rank=1 and EudraCT: 2020-005887-70.

• MeSH
• COVID-19 * mortalita   komplikace   MeSH
• dexamethason * aplikace a dávkování   terapeutické užití   MeSH
• farmakoterapie COVID-19 * MeSH
• lidé středního věku MeSH
• lidé MeSH
• SARS-CoV-2 MeSH
• senioři MeSH
• syndrom dechové tísně * farmakoterapie   mortalita   MeSH
• umělé dýchání * MeSH
• výsledek terapie MeSH
• vztah mezi dávkou a účinkem léčiva MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH
• randomizované kontrolované studie MeSH
• Geografické názvy
• Česká republika MeSH

Rozštěpy rtu a patra patří mezi nejčastější vrozené vady obličeje. Léčba rozštěpů je centralizovaná, multioborová a podílí se na ní plastický chirurg, ortodontista, anesteziolog, klinický logoped a další profese. Incidence rozštěpů rtu a patra zůstává stále přibližně stejná, mění se však přístup k jejich léčbě. Mezi moderní postupy léčby se stále více přidává 3D tisk a léčebné a výukové možnosti s ním spojené.

Cleft lip and cleft palate are among the most common congenital defects of the head. The treatment of clefts is centralized, multidisciplinary, and involves a plastic surgeon, orthodontist, anesthesiologist, clinical speech therapist, and other specialists. While the incidence of cleft lip and cleft palate remains approximately unchanged, the approach to their treatment is evolving. Modern treatment methods increasingly include 3D printing and the associated therapeutic and educational possibilities.

• MeSH
• 3D tisk MeSH
• lidé MeSH
• obturátory patra MeSH
• rozštěp patra * chirurgie   diagnostické zobrazování   MeSH
• rozštěp rtu * chirurgie   diagnostické zobrazování   MeSH
• zákroky plastické chirurgie MeSH
• zobrazování trojrozměrné MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• práce podpořená grantem MeSH
• přehledy MeSH

BACKGROUND: We examined the clinical effectiveness of molnupiravir in reducing deaths in a real-world cohort of adult patients with COVID-19 during the Omicron outbreak. METHODS: This was a population-wide retrospective cohort study in the Czech Republic. We analyzed all 74 541 patients with an officially registered diagnosis of SARS-CoV-2 infection between 1 January and 31 December 2022, aged 18 years or older, treated with molnupiravir. The primary outcome was 30-day all-cause mortality; the secondary outcome was 30-day COVID-19-related mortality. Hazard ratios (HRs) were estimated using stratified Cox regression and the Fine-Gray model. RESULTS: The use of molnupiravir in adult SARS-CoV-2 positive patients was associated with a lower risk of both 30-day all-cause mortality: adjusted HR 0.58 (95% confidence interval, 0.53-0.64; P < .001) and 30-day COVID-19-related mortality: adjusted HR 0.50 (95% confidence interval, 0.42-0.58; P < .001). The effect of molnupiravir was highly significant regardless of sex, Deyo-Charlson Comorbidity Index score, hospitalization status, COVID-19 vaccination status, and patients older than age 65 years. CONCLUSIONS: In this cohort study, early initiation of molnupiravir was associated with a significant reduction in 30-day all-cause and COVID-19-related mortality in adult SARS-CoV-2 positive patients.

• Publikační typ
• časopisecké články MeSH
• klinické zkoušky MeSH

In the last decade, undiagnosed disease programs have emerged to address the significant number of individuals with suspected but undiagnosed rare genetic diseases. In our single-center study, we have launched a pilot program for pediatric patients with undiagnosed diseases in the second-largest university hospital in the Czech Republic. This study was prospectively conducted at the Department of Pediatrics at University Hospital Brno between 2020 and 2023. A total of 58 Czech patients with undiagnosed diseases were enrolled in the study. All children underwent singleton WES with targeted phenotype-driven analysis. We identified 28 variants, including 11 pathogenic, 13 likely pathogenic, and 4 VUS according to ACMG guidelines, as diagnostic of genetic diseases in 25 patients, resulting in an overall diagnostic yield of 43%. Eleven variants were novel and had not been previously reported in any public database. The overall clinical utility (actionability) enabling at least one type of change in the medical care of the patient was 76%, whereas the average number of clinical implications to individual patient care was two. Singleton WES facilitated the diagnostic process in the Czech undiagnosed pediatric population. We believe it is an effective approach to enable appropriate counseling, surveillance, and personalized clinical management.

• MeSH
• dítě MeSH
• genetické testování metody   MeSH
• kojenec MeSH
• lidé MeSH
• mladiství MeSH
• nediagnostikované nemoci * genetika   diagnóza   epidemiologie   MeSH
• novorozenec MeSH
• předškolní dítě MeSH
• prospektivní studie MeSH
• sekvenování exomu * metody   MeSH
• vzácné nemoci * genetika   diagnóza   MeSH
• Check Tag
• dítě MeSH
• kojenec MeSH
• lidé MeSH
• mladiství MeSH
• mužské pohlaví MeSH
• novorozenec MeSH
• předškolní dítě MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Česká republika MeSH

INTRODUCTION: The influence of various levels of sedation depth on motor evoked potentials (MEP) reproducibility in youth is still unclear because of a lack of data. We tested the hypothesis that a deeper level of total intravenous anesthesia (TIVA) [bispectral index (BIS) 40 ± 5 compared to 60 ± 5] can affect surgeon-directed MEP and their interpretation in youths. METHODS: All patients received TIVA combined with propofol and remifentanil. TIVA was initially maintained at a BIS level of 60 ± 5. The sedation anesthesia was deepened to BIS level 40 ± 5 before the skin incision. MEP were recorded and interpreted at both BIS levels. The primary endpoint was to evaluate the effect of the depth of sedation on the MEP reproducibility directed and interpreted by the surgical team in each patient separately. The secondary endpoint was to compare the relativized MEP parameters (amplitude and latency) in percentage at various levels of sedation in each patient separately. We planned to enroll 150 patients. Due to the COVID-19 pandemic, we decided to analyze the results of the first 50 patients. RESULTS: The surgical team successfully recorded and interpreted MEP in all 50 enrolled patients in both levels of sedation depth without any clinical doubts. The MEP parameters at BIS level 40 ± 5, proportionally compared with the baseline, were latency 104% (97-110%) and the MEP amplitudes 84.5% (51-109%). CONCLUSION: Preliminary data predict that deeper sedation (BIS 40 ± 5) does not affect the surgical team's interpretation of MEP in youth patients. These results support that surgeon-directed MEP may be an alternative when neurophysiologists are unavailable.

• Publikační typ
• časopisecké články MeSH

Publikace se zaměřuje na perioperační a anesteziologickou péči. Určeno odborné veřejnosti, zejména praktickým lékařům.

• MeSH
• anestezie MeSH
• klinické lékařství MeSH
• perioperační medicína MeSH
• perioperační období MeSH
• perioperační péče MeSH
• praktické lékařství MeSH

• Konspekt
• Patologie. Klinická medicína
• NLK Obory
• chirurgie
• všeobecné lékařství
• NLK Publikační typ
• kolektivní monografie

Úvod: Koronavirus typu 2, jako původce těžkého akutního respiračního syndromu (SARS-CoV-2) zapříčinil celosvětovou pandemii onemocnění COVID-19, která vypukla již koncem roku 2019. Virus postihuje různé orgány, vč. nervového systému. Tato studie zkoumá neurologické komplikace u dětí s COVID-19 nebo multisystem inflammatory syndrome in children (MIS-C) v Jihomoravském kraji (ČR), kde vysoká četnost infekce COVID-19 u dětí (35 790/100 000) umožňuje komplexní analýzu. Metodika: Data Fakultní nemocnice Brno (březen 2020 až únor 2022) byla analyzována pro dvě skupiny hospitalizovaných dětí s diagnózou COVID-19 nebo MIS-C: jednu s neurologickými komplikacemi a druhou bez neurologických komplikací. Analýza zahrnovala demografické údaje, důvod přijetí, tíži infekce a její vývoj, objektivní neurologický nález, detaily hospitalizace, přítomnost MIS-C a specifikaci terapeutických postupů. K posouzení jednotlivých faktorů ovlivňujících výskyt neurologických komplikací v rámci těchto skupin byly použity metody deskriptivní statistiky a statistické testy. Výsledky: Ze 420 hospitalizovaných dětí s COVID-19 nebo MIS-C mělo 26 (6,2 %) neurologické komplikace. Dřívější neurologický deficit zvyšoval pravděpodobnost horšího výsledného stavu (p = 0,0224). Mezi skupinami se objevily významné rozdíly v délce hospitalizace (p = 0,0012), závažnosti průběhu infekce (p = 0,0052) a výsledném stavu (p < 0,0001). Závěr: Pro lepší pochopení průběhu onemocnění a minimalizaci komplikací po infekci je zásadní průběžné sledování a další výzkum neurologických projevů u dětí s COVID-19 nebo MIS-C.

Introduction: Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has caused the enduring global COVID-19 pandemic, which has already begun in late 2019. The virus affects various organs, including the nervous system. This study investigates neurological complications in children with COVID-19 or multisystem inflammatory syndrome in children (MIS-C) in the South Moravia region (Czech republic), where a high COVID-19 rate among children (35.790/100.000) allows for a comprehensive analysis. Methods: Data from the University Hospital Brno (from March 2020 to February 2022) were analyzed to study two groups of hospitalized children diagnosed with COVID-19 or MIS-C: one experiencing neurological complications, and the other without neurological symptoms. The analysis included demographics, admission reasons, infection severity and progression, objective neurological findings, hospitalization details, MIS-C presence and therapies used. Descriptive statistics and statistical testing were employed to assess how individual factors influenced neurological complication rates within these groups. Results: Among 420 hospitalized children with COVID-19 or MIS-C, 26 (6.2%) had neurological complications. Preexisting neurological deficits increased the likelihood of worse outcomes (P = 0.0224). Significant differences in hospitalization length (P = 0.0012), infection severity (P = 0.0052), and outcome (P < 0.0001) occurred between groups. Conclusion: Continuous monitoring and further research on neurological complications in children with COVID-19 or MIS-C are crucial for better understanding of the course of the disease and minimize complications after infection.

• MeSH
• COVID-19 * komplikace   MeSH
• dítě * MeSH
• lidé MeSH
• nemoci nervového systému * etiologie   MeSH
• neurologické manifestace MeSH
• pozorovací studie jako téma metody   MeSH
• syndrom systémové zánětlivé reakce * etiologie   komplikace   MeSH
• Check Tag
• dítě * MeSH
• lidé MeSH

INTRODUCTION: This simulation-based study aimed to evaluate the efficacy of ventilation during paediatric cardiopulmonary resuscitation (CPR) provided by healthcare professionals (HCPs) and lay rescuers (LRs). The objective was to assess the number of effective breaths delivered during the initial sequence of CPR. Effective ventilation plays a critical role during paediatric CPR as most cardiac arrests are secondary to hypoxia in origin. The recommendations on initial resuscitation in unresponsive, non-breathing children differ worldwide. The European Resuscitation Council (ERC) guidelines recommend five breaths before starting the chest compressions. Yet, this recommendation was based on the expert consensus historically and has not changed since 2000 because of the lack of evidence. This research addresses the identified knowledge gap, with potential implications for improving resuscitation practices and ultimately enhancing patient outcomes. METHODS: HCPs and LRs performed 90 s of CPR involving two mannequins: 5-kg Baby and 20-kg Junior. Both groups (HCPs and LRs) performed the task before and after structured CPR training, and the efficacy of ventilation before and after the training was compared. The HCPs provided bag-mask ventilation; LR performed dispatcher-assisted CPR with mouth-to-mouth ventilation. RESULTS: The number of participants that reached the primary outcome before and after the training in Baby was 26 (65%) vs. 40 (100%) in HCPs and 28 (60.9%) vs. 45 (97.8%) in LRs (improvement in both p < 0.001), respectively. The number of participants that reached the primary outcome before and after the training in the Junior mannequin was 31 (77.5%) vs. 32 (82.1%) in HCPs (p = 0.77) and 32 (82.1%) vs. 37 (94.9%) in LRs (p = 0.005), respectively. DISCUSSION: This simulation-based study is the first to investigate ventilation efficacy during paediatric CPR provided by HCPs and LRs. Ventilation represents an important aspect of good-quality CPR in children. The concept of initiating paediatric CPR with initial breaths, as stated in ERC guidelines 2021, is justifiable. Trained HCPs and LRs providing dispatcher-assisted CPR could deliver effective ventilation to paediatric mannequins. These findings can contribute to future research in this area and address identified knowledge gaps concerning resuscitation guidelines, given the unique practical application of simulation as a research tool.

• Publikační typ
• časopisecké články MeSH

BACKGROUND: Orofacial clefts are the most common congenital abnormalities. Cleft lip reconstruction is performed mostly in 3 months of life including the neonatal period. The consumption of opioids during anesthesia is one of the monitored parameters of anesthesia safety. We investigated the effect of using an infraorbital nerve block for reducing opioid consumption during cleft lip surgery in neonates. PATIENTS/METHODS: Overall, 100 patients who underwent primary cleft lip surgery in neonatal age between 2018 and 2021 were included in the study. The primary outcome was to compare opioid requirements during cleft lip surgery with and without using regional anesthesia. Secondary outcomes included a first oral intake from surgery between neonates with and without regional anesthesia and complications rate of infraorbital nerve block. RESULTS: Data from 100 patients (46 patients with and 64 without regional anesthesia) were retrospectively analyzed and classified into two groups according to whether regional anesthesia during neonatal cleft lip surgery had been performed or not. The use of infraorbital block was found to be positively correlated with lower doses of opioids used during the general anesthesia for the surgery (mean 0.48 μg/kg vs 0.29 μg/kg, p < 0.05). The postoperative course was evaluated based on the interval from surgery to first oral intake which was statistically insignificant shorter (p = 0.16) in the group of patients using regional anesthesia. No complications were recorded in the group of patients with regional anesthesia. CONCLUSIONS: Regional anesthesia is associated with reduced opioid consumption during anesthesia thereby increasing the safety of anesthesia in neonates. GOV IDENTIFIER: NCT06067854https://clinicaltrials.gov/study/NCT06067854?cond=NCT06067854&rank=1.

• MeSH
• lidé MeSH
• nervová blokáda * metody   MeSH
• novorozenec MeSH
• opioidní analgetika * terapeutické užití   MeSH
• pooperační bolest farmakoterapie   prevence a kontrola   MeSH
• retrospektivní studie MeSH
• rozštěp patra * chirurgie   MeSH
• rozštěp rtu * chirurgie   MeSH
• svodná anestezie * metody   MeSH
• zákroky plastické chirurgie metody   škodlivé účinky   MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• novorozenec MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

Publikace se zaměřuje na různé aspekty náhlých, akutních stavů, zejména na jejich terapii. Určeno odborné veřejnosti a také jako vysokoškolská učebnice urgentního lékařství.

• MeSH
• terapie náhlých příhod MeSH
• urgentní lékařství MeSH

• Konspekt
• Patologie. Klinická medicína
• Učební osnovy. Vyučovací předměty. Učebnice
• NLK Obory
• urgentní lékařství
• NLK Publikační typ
• kolektivní monografie
• učebnice vysokých škol