AIMS: In patients with recently diagnosed non-ischaemic LV systolic dysfunction, left ventricular reverse remodelling (LVRR) and favourable prognosis has been documented in studies with short-term follow-up. The aim of our study was to assess the long-term clinical course and stability of LVRR in these patients. METHODS AND RESULTS: We prospectively studied 133 patients (37 women; 55 [interquartile range 46, 61] years) with recently diagnosed unexplained LV systolic dysfunction, with heart failure symptoms lasting <6 months and LV ejection fraction <40% persisting after at least 1 week of therapy. All patients underwent endomyocardial biopsy (EMB) at the time of diagnosis and serial echocardiographic and clinical follow-up over 5 years. LVRR was defined as the combined presence of (1) LVEF ≥ 50% or increase in LVEF ≥ 10% points and (2) decrease in LV end-diastolic diameter index (LVEDDi) ≥ 10% or (3) LVEDDi ≤ 33 mm/m2. LVRR was observed in 46% patients at 1 year, in 60% at 2 years and 50% at 5 years. Additionally, 2% of patients underwent heart transplantation and 12% experienced heart failure hospitalization. During 5-year follow-up, 23 (17%) of the study cohort died. In multivariate analysis, independent predictors of mortality were baseline right atrial size (OR 1.097, CI 1.007-1.196), logBNP level (OR 2.02, CI 1.14-3.56), and PR interval (OR 1.02, CI 1.006-1.035) (P < 0.05 for all). The number of macrophages on EMB was associated with overall survival in univariate analysis only. LVRR at 1 year of follow-up was associated with a lower rate of mortality and heart failure hospitalization (P = 0.025). In multivariate analysis, independent predictors of LVRR were left ventricular end-diastolic volume index (OR 0.97, CI 0.946-0.988), LVEF (OR 0.89, CI 0.83-0.96), and diastolic blood pressure (OR 1.04, CI 1.01-1.08) (P < 0.05 for all). CONCLUSIONS: LVRR occurs in over half of patients with recent onset unexplained LV systolic dysfunction during first 2 years of optimally guided heart failure therapy and then remains relatively stable during 5-year follow-up. Normalization of adverse LV remodelling corresponds to a low rate of mortality and heart failure hospitalizations during long-term follow-up.

• MeSH
• dilatační kardiomyopatie * MeSH
• dysfunkce levé srdeční komory * komplikace   MeSH
• funkce levé komory srdeční fyziologie   MeSH
• lidé MeSH
• prognóza MeSH
• srdeční selhání * MeSH
• Check Tag
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

Příručka a směrnice, které se zaměřují na klinické laboratorní diagnostické metody. Určeno odborné veřejnosti, praktickým lékařům.

• MeSH
• klinické laboratorní techniky MeSH
• praktické lékařství MeSH
• Publikační typ
• příručky MeSH
• směrnice pro lékařskou praxi MeSH

• Konspekt
• Patologie. Klinická medicína
• NLK Obory
• diagnostika
• všeobecné lékařství
• NLK Publikační typ
• brožury

• Publikační typ
• abstrakt z konference MeSH

Cílem studie bylo vyhodnotit klinická, epidemiologická a demografická data pacientů se syfilis léčených na Dermatovenerologické klinice 1. LF UK a Všeobecné fakultní nemocnice v Praze (STD centrum) v roce 2017–2019 a porovnat je s předchozím průzkumem provedeným v roce 2007–2009, s celorepublikovými údaji z Registru pohlavních nemocí a s daty evropské databáze (The European Surveillance System of the ECDC). V průběhu let 2017–2019 jsme hospitalizovali 325 pacientů se syfilis, 83,4 % mužů a 16,6 % žen. Celkový počet pacientů se snížil o 148 případů (31,3 %), výraznější je pokles u žen (61,2 %) než u mužů (18,9 %). Nárůst poměru mužů vůči ženám je statisticky významný (p < 0,001). Podíl cizinců byl 26,5 % a signifikantně se nezměnil. V souboru mužů klesl podíl primární syfilis (24,4 % vs. 32,0 %; p = 0,046) a došlo k významnému nárůstu počtu HIV pozitivních mužů (7,7 % vs. 3,0 %; p = 0,017) při zachování přibližně stejného podílu homosexuálních mužů (p = 0,934). Podíl homo/bisexuálních mužů činil 48,4 % ze souboru všech pacientů a 58,3 % ze souboru mužů. V souboru žen byl tradičně zaznamenán nízký počet případů primární a sekundární syfilis, tento podíl se statisticky významně nezměnil. Rovněž se signifikantně nezměnil podíl gravidních žen (p = 0,371). Vyšetření vzorků na makrolidovou rezistenci ukázalo podstatné snížení počtu senzitivních vzorků pro období 2017–2019 (9,5 % vs. 57,6 %). Pro analýzu trendů a cílenou prevenci syfilis je nutný přesný a průběžný sběr epidemiologických a klinických dat. Z našich i celoevropských údajů vyplývá, že nejohroženější skupinou jsou muži mající sex s muži. Pravidelný screening na syfilis a ostatní sexuálně přenosné infekce musí být u této skupiny prioritou bez ohledu na HIV status.

The aim of the study was to evaluate clinical, epidemiological and demographic data of patients treated with syphilis at the Department of Dermatovenereology of the 1st faculty of medicine and General University Hospital in Prague (STD centre) in 2017–2019 and compare them with the previous survey carried out in 2007–2009 and with the nationwide data from the Czech Registry of veneral diseases and the european data from the European Surveillance System of the ECDC. A total of 325 patients (83,4 % men and 16,6 % women) were hospitalized during the period 2017–2019. The total number of hospitalised patients decreased by 148 cases (31.3 %), the decrease was more pronounced in the female group (61.2%) as compared to the male group (18.9%). The increase of the male-to-female ratio is statistically significant (p < 0.001). The patients’ age has not changed in the long term, most of them were aged between 30 and 40. The percentage of foreigners was 26.5% and did not change significantly. In the male group, the proportion of primary syphilis decreased (24.4% vs 32.0 %; p = 0.046) and there was a significant increase in the number of HIV-positive patients (7.7% vs 3.0 %; p = 0.017), while the proportion of homo/bisexual men remained approximately the same (p = 0.934). The proportion of homo/bisexual men was 48.4% of all patients and 58.3% of men. In the female group, the number of primary and secondary syphilis cases was low and this proportion did not change significantly. Similarly, the proportion of pregnant women did not change significantly either (p = 0.371). The testing of samples for macrolide resistance showed a significant decrease in the number of sensitive strains (9.5% vs 57.6%). Accurate and continuous collection of epidemiological and clinical data is necessary for trend analysis and targeted syphilis prevention. Our as well as European data show that men having sex with men are the most vulnerable group. Regular screening for syphilis and other sexually transmitted infections must be a priority in this group, regardless of the HIV status.

• Klíčová slova
• alelické profily,
• MeSH
• epidemiologické studie MeSH
• lidé MeSH
• sexuálně přenosné nemoci epidemiologie   přenos   MeSH
• syfilis * epidemiologie   MeSH
• Treponema pallidum MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH

BACKGROUND: Intravenous drug use (IVDU) represents the major factor of HCV transmission, but the treatment uptake among people who inject drugs (PWID) remains low owing to a false presumption of low efficacy. The aim of our study was to assess treatment efficacy in PWID and factors determining adherence to therapy. METHODS: A total of 278 consecutive patients starting DAA (direct-acting antivirals) therapy were included, divided into two groups: individuals with a history of IVDU, PWID group (N = 101) and the control group (N = 177) without a history of IVDU. RESULTS: Sustained virological response 12 weeks after the end of therapy (SVR12) was achieved by 99/101 (98%) and 172/177 (98%) patients in the PWID and control group, respectively; in PWID group, two patients were lost to follow-up, and in the control group, four patients relapsed and one was lost to follow-up. PWID patients postponed appointments significantly more often, 29 (28.7%) in PWID versus 7 (4%) in the control group, p = 0.001. Thirteen of 101 (12.9%) and six of 177 (3.4%) patients in the PWID and in the control group, respectively, missed at least one visit (p < 0.01). However, postponing visits led to a lack of medication in only one PWID. In the PWID group, older age (p < 0.05; OR 1.07, 95% CI 1.00-1.20) and stable housing (p < 0.01; OR 9.70, 95% CI 2.10-56.20) were factors positively contributing to adherence. Contrarily, a stable job was a factor negatively influencing adherence (p < 0.05; OR 0.24, 95% CI 0.06-0.81). In the control group, none of the analyzed social and demographic factors had an impact on adherence to therapy. CONCLUSIONS: In PWID, treatment efficacy was excellent and was comparable with SVR of the control group. Stable housing and older age contributed to a better adherence to therapy.

• MeSH
• antivirové látky terapeutické užití   MeSH
• chronická hepatitida C * komplikace   farmakoterapie   MeSH
• hepatitida C * farmakoterapie   MeSH
• intravenózní abúzus drog * komplikace   farmakoterapie   MeSH
• léčivé přípravky * MeSH
• lidé MeSH
• senioři MeSH
• setrvalá virologická odpověď MeSH
• Check Tag
• lidé MeSH
• senioři MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

Syphilis, caused by Treponema pallidum ssp. pallidum (TPA), is a persisting global health problem. Although syphilis diagnostics relies mainly on serology, serological tests have some limitations, and it is recommended that the final diagnosis be supported by additional tests. The purpose of this study was to analyze the relationship between serology and PCR in syphilis diagnostics. From the year 2004 to May 2019, a total of 941 samples were taken from 833 patients suspected of having syphilis, in Czech Republic. In all these samples, both nested PCR detection of TPA and serology testing were performed. Of the 941 samples, 126 were seronegative, 651 were seropositive, and 164 were serodiscrepant. Among seronegative samples (n = 126), 11 were PCR-positive (8.7%). Among seropositive samples (n = 651; i.e., samples positive for both non-treponemal and treponemal serology tests), 368 samples were PCR-positive (56.5%). The remaining 164 serodiscrepant samples included RPR negative and treponemal serological test-positive samples (n = 154) and a set of 10 RPR-positive samples negative in treponemal serological tests. While the first group revealed 73 PCR-positive samples (47.4%), the second revealed 5 PCR positive samples (50.0%). PCR detection rates were highest in primary syphilis, with lower rates in the secondary and undetermined syphilis stages. As shown here, the nested PCR can improve diagnostics of syphilis, especially in seronegative patients and in patients with discrepant serology.

• MeSH
• lidé MeSH
• polymerázová řetězová reakce * MeSH
• retrospektivní studie MeSH
• sérologická diagnostika syfilis metody   MeSH
• syfilis krev   diagnóza   MeSH
• Treponema genetika   imunologie   izolace a purifikace   fyziologie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

BACKGROUND: PNPLA3 rs738409 minor allele c.444G represents a risk factor for liver steatosis and fibrosis progression also in chronic hepatitis C (HCV). We investigated its impact on the timing of liver transplantation (LT) in patients with genotype 1b HCV cirrhosis. METHODS: We genotyped and evaluated 172 LT candidates with liver cirrhosis owing to chronic HCV infection, genotype 1b. One hundred patients needed LT for chronic liver failure (CLF) and 72 for a small hepatocellular carcinoma (HCC) in the cirrhotic liver without CLF. Population controls (n = 647) were selected from the Czech cross-sectional study MONICA. RESULTS: The CLF patients were younger (53.5 ± 7.2 vs. 59.6 ± 6.6, P < 0.001) with more advanced liver disease than HCC patients (Child-Pugh's score 9.1 ± 1.8 vs. 7.1 ± 1.9, P < 0.001, MELD 14.1 ± 3.9 vs. 11.1 ± 3.7, P < 0.001). PNPLA3 G allele increased the risk of LT for CLF in both allelic and recessive models (CG + GG vs. CC: OR, 1.90; 95% CI, 1.017-3.472, P = 0.045 and GG vs. CC + CG: OR, 2.94; 95% CI, 1.032-7.513, P = 0.042). Multivariate analysis identified younger age (P < 0.001) and the G allele (P < 0.05) as risk factors for CLF. The genotype frequencies between the CLF group and MONICA study significantly differed in both, allelic and recessive model (P = 0.004, OR 1.87, 95% CI 1.222-2.875; P < 0.001, OR 3.33, 95% CI 1.824-6.084, respectively). The OR values almost doubled in the recessive model compared with the allelic model suggesting the additive effect of allele G. In contrast, genotype frequencies in the HCC group were similar to the MONICA study in both models. Pretransplant viral load was significantly lower in GG than in CC + CG genotypes (median, IQR; 162,500 (61,550-319,000) IU/ml vs. 570,000 (172,000-1,595,000) IU/ml, P < 0.0009). CONCLUSIONS: Our results suggest that PNPLA3 rs738409 G allele carriage may be associated with a faster progression of HCV cirrhosis to chronic liver failure.

• MeSH
• alely MeSH
• chronická hepatitida C genetika   virologie   MeSH
• genetická predispozice k nemoci genetika   MeSH
• genotyp MeSH
• hepatocelulární karcinom genetika   virologie   MeSH
• jaterní cirhóza genetika   virologie   MeSH
• játra virologie   MeSH
• jednonukleotidový polymorfismus genetika   MeSH
• lidé středního věku MeSH
• lidé MeSH
• lipasa genetika   MeSH
• membránové proteiny genetika   MeSH
• nádory jater genetika   virologie   MeSH
• průřezové studie MeSH
• retrospektivní studie MeSH
• selhání jater genetika   virologie   MeSH
• studie případů a kontrol MeSH
• transplantace jater metody   MeSH
• virová nálož metody   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

• MeSH
• analýza moči klasifikace   MeSH
• biologické markery analýza   MeSH
• diagnostické techniky a postupy MeSH
• imunologické testy metody   MeSH
• jaterní testy klasifikace   MeSH
• klinická chemie * metody   MeSH
• klinické laboratorní techniky * metody   MeSH
• lidé MeSH
• lymeská nemoc diagnóza   MeSH
• metabolické nemoci kostí diagnóza   MeSH
• monitorování léčiv MeSH
• nádorové biomarkery klasifikace   MeSH
• odběr vzorku krve metody   ošetřování   MeSH
• point of care testing ekonomika   klasifikace   MeSH
• preanalytická fáze MeSH
• proteiny analýza   klasifikace   MeSH
• sexuálně přenosné nemoci diagnóza   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• přehledy MeSH

A recently introduced Multilocus Sequence Typing scheme for Treponema pallidum subsp. pallidum was applied to clinical samples collected from 2004 to 2017 from the two largest cities (Prague and Brno) in the Czech Republic. Altogether, a total of 675 samples were tested in this study and 281 of them were found PCR-positive for treponemal DNA and typeable. Most of the typed samples (n = 281) were swabs from primary or secondary syphilis lesions (n = 231), and only a minority were whole blood or tissue samples (n = 50). Swab samples from patients with rapid plasma regain (RPR) values of 1-1024 were more frequently PCR-positive (84.6%) compared to samples from patients with non-reactive RPR test (46.5%; p-value = 0.0001). Out of 281 typeable samples, 136 were fully-typed at all TP0136, TP0548, and TP0705 loci. Among the fully and partially typed samples, 25 different allelic profiles were identified. Altogether, eight novel allelic variants were found among fully (n = 5) and partially (n = 3) typed samples. The distribution of TPA allelic profiles identified in the Czech Republic from 2004 to 2017 revealed a dynamic character with allelic profiles disappearing and emerging over time. While the number of samples with the A2058G mutation was seen to increase (86.7% in 2016/2017), the number of samples harboring the A2059G mutation was found to have decreased over time (3.3% in 2016/2017). In addition, we found several allelic profile associations with macrolide resistance or susceptibility, the gender of patients, as well as patient residence.

• MeSH
• alely MeSH
• antibakteriální látky farmakologie   MeSH
• bakteriální léková rezistence genetika   MeSH
• DNA bakterií genetika   MeSH
• dospělí MeSH
• genotyp MeSH
• lidé MeSH
• mladý dospělý MeSH
• multilokusová sekvenční typizace * MeSH
• RNA ribozomální 23S genetika   MeSH
• syfilis genetika   mikrobiologie   patologie   MeSH
• Treponema pallidum genetika   patogenita   MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Geografické názvy
• Česká republika MeSH

BACKGROUND/AIMS: Chronic hepatitis C (HCV) virus infection reactivates under immunosuppressive drugs and therefore has a negative impact on long-term survival of kidney transplant recipients. Treatment-induced clearance of hepatitis C virus (HCV) in kidney transplant candidates prevents virus reactivation after transplantation. Paritaprevir/Ritonavir/Ombitasvir with Dasabuvir (PrOD) represents a highly effective treatment regimen for HCV genotype 1 (GT1), also suitable for patients with end-stage renal disease (ESRD). Serious drug-drug interactions may represent a limiting factor of this regimen. The aim of this retrospective study was to evaluate safety, efficacy and drug-drug interactions management associated with PrOD treatment in the Czech real-world cohort. METHODS: Emphasizing concomitant medication adjustment, we described the treatment course with PrOD regimen in 23 patients (4 with CKD4 and 19 on maintenance haemodialysis) infected with HCV GT1 (21 GT1b, 2 GT1a), 18 males and 5 females with an average age of 53.7 years. Six patients had compensated liver cirrhosis and 3 of them were liver transplant recipients. RESULTS: All 23 patients completed the 12-week treatment and achieved sustained virological response 12 weeks after the treatment (SVR12 rate 100%). None of the patients presented with a significant decrease in haemoglobin level, white blood cell and platelet count during the treatment period. The most frequent adverse events were nausea, hypotension, diarrhoea, and hyperkalemia. Four patients presented with a serious adverse event unrelated to the antiviral drugs (salmonellosis, non-functional kidney graft rejection, early gastric cancer, renal cyst infection, initiation of haemodialysis). Concomitant medication had to be modified with the treatment initiation in 10 out of 23 (43.5%) patients (calcium channel blockers, ACE inhibitors, statins, diuretics, tacrolimus); four patients required further adjustment of antihypertensive drugs or tacrolimus dosage on-treatment. CONCLUSION: PrOD regimen demonstrated an excellent efficacy and good tolerability. Both prospective adjustment of concomitant medication and further on-treatment adjustment allowed for a safe treatment course.

• MeSH
• anilidy terapeutické užití   MeSH
• antihypertenziva terapeutické užití   MeSH
• antivirové látky škodlivé účinky   terapeutické užití   MeSH
• chronická hepatitida C komplikace   farmakoterapie   virologie   MeSH
• chronické selhání ledvin terapie   virologie   MeSH
• genotyp MeSH
• Hepacivirus účinky léků   genetika   MeSH
• karbamáty terapeutické užití   MeSH
• kombinovaná farmakoterapie MeSH
• lidé středního věku MeSH
• lidé MeSH
• makrocyklické sloučeniny terapeutické užití   MeSH
• renální insuficience terapie   virologie   MeSH
• ritonavir terapeutické užití   MeSH
• sulfonamidy terapeutické užití   MeSH
• uracil analogy a deriváty   terapeutické užití   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH