OBJECTIVE: Hand hygiene (HH) compliance is associated with effective prevention of health care-associated infections (HAI), the topic being very important due to current COVID-19 pandemic. There is a growing debate about the role of educational institutions in the low HH compliance of health workers. This study aimed to assess HH knowledge, self-assessment and attitudes of medical students in relation to provided educational background. METHODS: A cross-sectional survey (mixed methods-approach) combined with the curriculum analysis and questionnaires. Quantitative method: a questionnaire of knowledge of HH issues (QK), and a questionnaire of self-assessment and attitudes (SAQ) towards HH. Qualitative method focused on an analysis of content of the curriculum documents. RESULTS: 250 (KQ) and 238 (SAQ) questionnaires were analysed from students of general medicine (n = 262; average age 22.5 years). Below-average knowledge of HH and a high self-assessment of knowledge and compliance with HH was reported by 72.2% and 76.0% of students, respectively. Significant differences in knowledge and self-assessment of HH were found among study years and gender. The content analysis has revealed gaps in HH-related information in general medicine educational programme. CONCLUSIONS: It is highly expected that there might be some association between low HH knowledge level, false self-assessment and educational programme in medical students.
- MeSH
- COVID-19 * MeSH
- dodržování směrnic MeSH
- dospělí MeSH
- hygiena rukou * MeSH
- infekce spojené se zdravotní péčí * prevence a kontrola MeSH
- lidé MeSH
- mladý dospělý MeSH
- nemocnice MeSH
- pandemie MeSH
- průřezové studie MeSH
- SARS-CoV-2 MeSH
- studium lékařství * MeSH
- univerzity MeSH
- zdraví - znalosti, postoje, praxe MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mladý dospělý MeSH
- Publikační typ
- časopisecké články MeSH
Acute respiratory distress syndrome (ARDS) is characterized by diffuse lung damage, inflammation, oedema formation, and surfactant dysfunction leading to hypoxemia. Severe ARDS can accelerate the injury of other organs, worsening the patient ́s status. There is an evidence that the lung tissue injury affects the right heart function causing cor pulmonale. However, heart tissue changes associated with ARDS are still poorly known. Therefore, this study evaluated oxidative and inflammatory modifications of the heart tissue in two experimental models of ARDS induced in New Zealand rabbits by intratracheal instillation of neonatal meconium (100 mg/kg) or by repetitive lung lavages with saline (30 ml/kg). Since induction of the respiratory insufficiency, all animals were oxygen-ventilated for next 5 h. Total and differential counts of leukocytes were measured in the arterial blood, markers of myocardial injury [(troponin, creatine kinase - myocardial band (CK-MB), lactate dehydrogenase (LD)] in the plasma, and markers of inflammation [tumour necrosis factor (TNF)alpha, interleukin (IL)-6], cardiovascular risk [galectin-3 (Gal-3)], oxidative changes [thiobarbituric acid reactive substances (TBARS), 3-nitrotyrosine (3NT)], and vascular damage [receptor for advanced glycation end products (RAGE)] in the heart tissue. Apoptosis of heart cells was investigated immunohistochemically. In both ARDS models, counts of total leukocytes and neutrophils in the blood, markers of myocardial injury, inflammation, oxidative and vascular damage in the plasma and heart tissue, and heart cell apoptosis increased compared to controls. This study indicates that changes associated with ARDS may contribute to early heart damage what can potentially deteriorate the cardiac function and contribute to its failure.
- MeSH
- apoptóza fyziologie MeSH
- biologické markery metabolismus MeSH
- králíci MeSH
- modely nemocí na zvířatech MeSH
- oxidační stres fyziologie MeSH
- poranění srdce metabolismus patologie MeSH
- poškození plic metabolismus patologie MeSH
- syndrom aspirace mekonia metabolismus patologie MeSH
- syndrom dechové tísně metabolismus patologie MeSH
- zánět metabolismus patologie MeSH
- zvířata MeSH
- Check Tag
- králíci MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
Incidencia predčasných pôrodov neustále narastá, pričom stále vyšší počet novorodencov sa zachraňuje v čoraz nižších gestačných týždňoch. Aj napriek výrazným pokrokom v starostlivosti o predčasne narodeného novorodenca, prematurita aj naďalej predstavuje limitujúci faktor pre ďalší vývoj týchto detí, keďže sa spája s veľkou mierou morbidity aj mortality. Medzi najčastejšie príčiny spôsobujúce predčasný pôrod patrí chorioamnionitída. Jej problém nespočíva len v procesoch, ktoré vedú k predčasnému pôrodu, ale aj v samotnom zápale, ktorý môže spôsobiť výrazné komplikácie a signifikantne zhoršiť prognózu prematúrneho novorodenca. Negatívne účinky pritom nie sú pripísané len samotnému mikroorganizmu, ale hlavne prooxidačným a prozápalovým procesom, ktoré tieto patogény navodzujú. Keďže antibiotická liečba je zameraná len na ich usmrtenie alebo inhibíciu ďalšieho rastu a množenia, cieľom viacerých výskumov je nájsť takú terapeutickú intervenciu, ktorá by potlačila produkciu cytokínov a voľných radikálov. Najviac nádejnými sa zdajú byť melatonín, pentoxyfylín, erytropoetín a N-acetylcysteín. Tieto liečivá môžu zmierniť ničivé účinky oxidačného stresu a zápalu na rôzne orgánové systémy u novorodenca a tak znížiť komplikácie súvisiace s predčasným pôrodom vyvolaným chorioamnionitídou.
Incidence of preterm labor is progressively rising and more newborns are being saved in lower gestational ages. However, despite of advances in neonatal care are being undisputable, immaturity is still very limiting factor in normal development of a newborn because it is connected with higher incidence of perinatal and neonatal mortality as well as morbidity. One of the most frequent causes of preterm labor is chorioamnionitis. Problem of chorioamnionitis dwells not just in activation of mechanisms leading to preterm labor but inflammation may be transmitted on the fetus too, causing serious complications that significantly worsen prognosis of premature newborn. Negative effect is not linked only to a specific microorganism itself but mainly to initiation of prooxidant and proinflammatory cascade. Because antibiotics serve only for growth inhibition or killing of bacteria and are not able to intervene with cytokines or free radicals, new therapeutic strategies aimed at cytokine and free radical inhibition are in research. Melatonine, Pentoxifylline, Erythropoietine and N-acetylcysteine seem to be most promising in this indication. These drugs may attenuate deleterious effect of inflammatory process on many organ systems and thus decrease complications connected with preterm labor caused by chorioamnionitis.
- MeSH
- chorioamnionitida * farmakoterapie patofyziologie MeSH
- lidé MeSH
- neuroprotekce účinky léků MeSH
- novorozenec MeSH
- oxidační stres * účinky léků MeSH
- předčasný porod etiologie patofyziologie MeSH
- zánět farmakoterapie MeSH
- Check Tag
- lidé MeSH
- novorozenec MeSH
- Publikační typ
- práce podpořená grantem MeSH
- přehledy MeSH
Pulmonary surfactant has a relaxing effect on the airway smooth muscle (ASM), which suggests its role in the pathogenesis of respiratory diseases associated with hyperreactivity of the ASM, such as asthma and chronic obstructive pulmonary disease (COPD). The ASM tone may be directly or indirectly modified by bacterial wall component lipopolysaccharide (LPS). This study elucidated the effect of LPS on the ASM reactivity and the role of surfactant in this interaction. The experiments were performed using ASM of adult guinea pigs by in vitro method of tissue organ bath (ASM unexposed-healthy or exposed to LPS under in vitro conditions) and ASM of animals intraperitoneally injected with LPS at a dose 1 mg/kg of b.w. once a day during 4-day period. Variable response of LPS was controlled by cyclooxygenase inhibitor indomethacin and relaxing effect of exogenous surfactant was studied using leukotriene and histamine receptor antagonists. The exogenous surfactant has relaxing effect on the ASM, but does not reverse LPS-induced smooth muscle contraction. The results further indicate participation of prostanoids and potential involvement of leukotriene and histamine H1 receptors in the airway smooth muscle contraction during LPS exposure.
Inflammation associated with acute respiratory distress syndrome (ARDS) can damage the alveolar epithelium and surfactant and worsen the respiratory failure. Glucocorticoids (GC) appear to be a rational therapeutic approach, but the effect is still unclear, especially for early administration and low-dose. In this study we compared two low doses of dexamethasone in early phase of surfactant-depleted model of acute respiratory distress syndrome (ARDS). In the study, lung-lavaged New Zealand rabbits with respiratory failure (PaO(2)<26.7 kPa in FiO(2) 1.0) were treated with intravenous dexamethasone (DEX): 0.5 mg/kg (DEX-0.5) and 1.0 mg/kg (DEX-1.0), or were untreated (ARDS). Animals without ARDS served as controls. Respiratory parameters, lung edema, leukocyte shifts, markers of inflammation and oxidative damage in the plasma and lung were evaluated. Both doses of DEX improved the lung function vs. untreated animals. DEX-1.0 had faster onset with significant improvement in gas exchange and ventilation efficiency vs. DEX-0.5. DEX-1.0 showed a trend to reduce lung neutrophils, local oxidative damage, and levels of TNFalpha, IL-6, IL-8 more effectively than DEX-0.5 vs. ARDS group. Both dosages of dexamethasone significantly improved the lung function and suppressed inflammation in early phase ARDS, while some additional enhancement was observed for higher dose (1 mg/kg) of DEX.
- MeSH
- antiflogistika aplikace a dávkování MeSH
- bronchoalveolární lavážní tekutina cytologie MeSH
- dexamethason aplikace a dávkování MeSH
- králíci MeSH
- modely nemocí na zvířatech MeSH
- plíce účinky léků MeSH
- počet leukocytů MeSH
- preklinické hodnocení léčiv MeSH
- respirační funkční testy MeSH
- syndrom dechové tísně krev farmakoterapie imunologie MeSH
- zánět farmakoterapie MeSH
- zvířata MeSH
- Check Tag
- králíci MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
Inflammation and other immune responses are involved in the variety of diseases and disorders. The acute response to endotoxemia includes activation of innate immune mechanisms as well as changes in autonomic nervous activity. The autonomic nervous system and the inflammatory response are intimately linked and sympathetic and vagal nerves are thought to have anti-inflammation functions. The basic functional circuit between vagus nerve and inflammatory response was identified and the neuroimmunomodulation loop was called cholinergic anti-inflammatory pathway. Unique function of vagus nerve in the anti-inflammatory reflex arc was found in many experimental and pre-clinical studies. They brought evidence on the cholinergic signaling interacting with systemic and local inflammation, particularly suppressing immune cells function. Pharmacological/electrical modulation of vagal activity suppressed TNF-alpha and other proinflammatory cytokines production and had beneficial therapeutic effects. Many questions related to mapping, linking and targeting of vagal-immune interactions have been elucidated and brought understanding of its basic physiology and provided the initial support for development of Tracey´s inflammatory reflex. This review summarizes and critically assesses the current knowledge defining cholinergic anti-inflammatory pathway with main focus on studies employing an experimental approach and emphasizes the potential of modulation of vagally-mediated anti-inflammatory pathway in the treatment strategies.
- MeSH
- antiflogistika imunologie metabolismus MeSH
- cholinergní látky imunologie metabolismus MeSH
- lidé MeSH
- nervus vagus imunologie metabolismus MeSH
- neuroimunomodulace fyziologie MeSH
- neurony cholinergní imunologie metabolismus MeSH
- signální transdukce fyziologie MeSH
- zánět imunologie metabolismus MeSH
- zvířata MeSH
- Check Tag
- lidé MeSH
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
Meconium aspiration syndrome (MAS) in newborns is characterized mainly by respiratory failure due to surfactant dysfunction and inflammation. Previous meta-analyses did not prove any effect of exogenous surfactant treatment nor glucocorticoid administration on final outcome of children with MAS despite oxygenation improvement. As we supposed there is the need to intervene in both these fields simultaneously, we evaluated therapeutic effect of combination of exogenous surfactant and selective inhibitor of NF-kappaB (IKK-NBD peptide). Young New Zealand rabbits were instilled by meconium suspension and treated by surfactant alone or surfactant in combination with IKK-NBD, and oxygen-ventilated for 5 h. PaO(2)/FiO(2), oxygenation index, oxygen saturation and ventilation efficiency index were evaluated every hour; post mortem, total and differential leukocyte counts were investigated in bronchoalveolar lavage fluid (BALF) and inflammatory, oxidative and apoptotic markers were assessed in lung tissue homogenates. Exogenous surfactant combined with IKK-NBD improved oxygenation, reduced neutrophil count in BALF and levels of IL-1beta, IL-6, p38 MAPK and caspase 3 in comparison with surfactant-only therapy. It seems that inhibition of inflammation may be strong supporting factor in surfactant treatment of MAS.
- MeSH
- králíci MeSH
- mediátory zánětu antagonisté a inhibitory metabolismus MeSH
- mekonium * MeSH
- náhodné rozdělení MeSH
- NF-kappa B antagonisté a inhibitory metabolismus MeSH
- novorozená zvířata MeSH
- plicní surfaktanty farmakologie terapeutické užití MeSH
- poškození plic chemicky indukované farmakoterapie metabolismus MeSH
- zvířata MeSH
- Check Tag
- králíci MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
Meconium aspiration syndrome (MAS) triggers inflammatory and oxidative pathways which can inactivate both pulmonary surfactant and therapeutically given exogenous surfactant. Glucocorticoid budesonide added to exogenous surfactant can inhibit inflammation and thereby enhance treatment efficacy. Neonatal meconium (25 mg/ml, 4 ml/kg) was administered intratracheally (i.t.) to rabbits. When the MAS model was prepared, animals were treated with budesonide i.t. (Pulmicort, 0.25 mg/kg, M+B); with surfactant lung lavage (Curosurf®, 10 ml/kg, 5 mg phospholipids/ml, M+S) followed by undiluted Curosurf® i.t. (100 mg phospholipids/kg); with combination of budesonide and surfactant (M+S+B); or were untreated (M); or served as controls with saline i.t. instead of meconium (C). Animals were oxygen-ventilated for additional 5 h. Cell counts in the blood and bronchoalveolar lavage fluid (BAL), lung edema formation (wet/dry weight ratio), oxidative damage of lipids/ proteins and inflammatory expression profiles (IL-2, IL-6, IL-13, TNF-alpha) in the lung homogenate and plasma were determined. Combined surfactant+budesonide therapy was the most effective in reduction of neutrophil counts in BAL, oxidative damage, levels and mRNA expression of cytokines in the lung, and lung edema formation compared to untreated animals. Curosurf fortified with budesonide mitigated lung inflammation and oxidative modifications what indicate the perspectives of this treatment combination for MAS therapy.
- MeSH
- antiflogistika aplikace a dávkování MeSH
- budesonid aplikace a dávkování MeSH
- kombinovaná farmakoterapie MeSH
- králíci MeSH
- mediátory zánětu antagonisté a inhibitory metabolismus MeSH
- modely nemocí na zvířatech * MeSH
- oxidační stres účinky léků fyziologie MeSH
- peroxidace lipidů účinky léků fyziologie MeSH
- plicní surfaktanty aplikace a dávkování MeSH
- syndrom aspirace mekonia farmakoterapie metabolismus MeSH
- zvířata MeSH
- Check Tag
- králíci MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
The aim of the study was to evaluate short-term heart rate variability (HRV) as an index of cardiac autonomic control in rats with lipopolysaccharide (LPS)-induced endotoxemia. Animals were injected intraperitoneally with LPS (100 microg/kg b.w.) and control group with an equivalent volume of saline. ECG recordings were done before (base) and 60, 120, 180, 240 and 300 min after LPS or saline administration. HRV magnitude was quantified by time and frequency-domain analysis (mean RR interval, SDRR, RMSSD, spectral powers in low (LF) and high frequency (HF) bands. Heart tissue homogenates and plasma were analyzed to determine interleukin 6 (IL-6), tumor necrosis factor alpha (TNF-alpha) and oxidative stress level (TBARS). Administration of lipopolysaccharide was followed by continuous rise in colonic body temperature compared to saline-treated controls. Endotoxemia in rats was accompanied by significant decrease in HRV spectral activity in high-frequency range at maximal body temperature (logHFpower: 1.2+/-0.5 vs. 1.9+/-0.6 ms(2), P<0.01). Increased IL-6 was found in heart tissue homogenates of LPS rats (8.0+/-0.6 vs. 26.4+/-4.8 pg/ml, (P<0.05). In conclusions, reduced HRV in HF band may indicate a decreased parasympathetic activity in LPS-induced endotoxemia as basic characteristics of altered cardiac control during response to endotoxemia.
- MeSH
- autonomní nervový systém patofyziologie MeSH
- bradykardie chemicky indukované patofyziologie MeSH
- časové faktory MeSH
- endotoxemie krev chemicky indukované patofyziologie MeSH
- interleukin-6 krev MeSH
- lipopolysacharidy * MeSH
- malondialdehyd krev MeSH
- mediátory zánětu krev MeSH
- modely nemocí na zvířatech MeSH
- myokard metabolismus MeSH
- oxidační stres MeSH
- potkani Wistar MeSH
- srdce inervace MeSH
- srdeční frekvence * MeSH
- termoregulace MeSH
- TNF-alfa krev MeSH
- zánět krev chemicky indukované patofyziologie MeSH
- zvířata MeSH
- Check Tag
- mužské pohlaví MeSH
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
Meconium aspiration syndrome (MAS) is meconium-induced respiratory failure of newborns associated with activation of inflammatory and oxidative pathways. For severe MAS, exogenous surfactant treatment is used which improves respiratory functions but does not treat the inflammation. Oxidative process can lead to later surfactant inactivation; hence, surfactant combination with antioxidative agent may enhance the therapeutic effect. Young New Zealand rabbits were instilled by meconium suspension and treated by surfactant alone, N-acetylcysteine (NAC) alone or by their combination and oxygen-ventilated for 5 h. Blood samples were taken before and 30 min after meconium application and 30 min, 1, 3 and 5 h after the treatment for evaluating of oxidative damage, total leukocyte count, leukocyte differential count and respiratory parameters. Leukocyte differential was assessed also in bronchoalveolar lavage fluid. NAC alone had only mild therapeutic effect on MAS. However, the combination of NAC and surfactant facilitated rapid onset of therapeutic effect in respiratory parameters (oxygenation index, PaO(2)/FiO(2)) compared to surfactant alone and was the only treatment which prevented neutrophil migration into the lungs, oxidative damage and lung edema. Moreover, NAC suppressed IL-8 and IL-beta formation and thus seems to be favorable agent for improving surfactant therapy in MAS.
- MeSH
- acetylcystein farmakologie terapeutické užití MeSH
- bronchoalveolární lavážní tekutina imunologie MeSH
- cytokiny metabolismus MeSH
- edém prevence a kontrola MeSH
- expektorancia farmakologie terapeutické užití MeSH
- kombinovaná farmakoterapie MeSH
- králíci MeSH
- látky reagující s kyselinou thiobarbiturovou metabolismus MeSH
- náhodné rozdělení MeSH
- novorozená zvířata MeSH
- pilotní projekty MeSH
- plíce účinky léků metabolismus MeSH
- plicní surfaktanty farmakologie terapeutické užití MeSH
- počet leukocytů MeSH
- preklinické hodnocení léčiv MeSH
- respirační funkční testy MeSH
- syndrom aspirace mekonia imunologie metabolismus prevence a kontrola MeSH
- testy migrace leukocytů MeSH
- tyrosin analogy a deriváty metabolismus MeSH
- zvířata MeSH
- Check Tag
- králíci MeSH
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
