- MeSH
- poskytování zdravotní péče organizace a řízení MeSH
- studium lékařství specializační postgraduální organizace a řízení MeSH
- Publikační typ
- rozhovory MeSH
- Geografické názvy
- Švýcarsko MeSH
- Publikační typ
- abstrakt z konference MeSH
Aims: We aimed to evaluate the impact of age on the performance of the European Society of Cardiology (ESC) 0/1h-algorithms and to derive and externally validate alternative cut-offs specific to older patients. Methods and results: We prospectively enrolled patients presenting to the emergency department (ED) with symptoms suggestive of acute myocardial infarction in three large diagnostic studies. Final diagnoses were adjudicated by two independent cardiologists. High-sensitivity cardiac troponin (hs-cTn) T and I concentrations were measured at presentation and after 1 h. Patients were stratified according to age [<55 years (young), ≥55 to <70 years (middle-age), ≥70 years (old)]. Rule-out safety of the ESC hs-cTnT 0/1h-algorithm was very high in all age-strata: sensitivity 100% [95% confidence interval (95% CI) 94.9-100] in young, 99.3% (95% CI 96.0-99.9) in middle-age, and 99.3% (95% CI 97.5-99.8) in old patients. Accuracy of rule-in decreased with age: specificity 97.0% (95% CI 95.8-97.9) in young, 96.1% (95% CI 94.5-97.2) in middle-age, and 92.7% (95% CI 90.7-94.3) in older patients. Triage efficacy decreased with increasing age (young 93%, middle-age 80%, old 55%, P < 0.001). Similar results were found for the ESC hs-cTnT 0/1h-algorithm. Alternative, slightly higher cut-off concentrations optimized for older patients maintained very high safety of rule-out, increased specificity of rule-in (P < 0.01), reduced overall efficacy for hs-cTnT (P < 0.01), while maintaining efficacy for hs-cTnI. Findings were confirmed in two validation cohorts (n = 2767). Conclusion: While safety of the ESC 0/1h-algorithms remained very high, increasing age significantly reduced overall efficacy and the accuracy of rule-in. Alternative slightly higher cut-off concentrations may be considered for older patients, particularly if using hs-cTnI. Clinical Trial Registration: https://clinicaltrials.gov/ct2/show/NCT00470587, number NCT00470587 and NCT02355457 (BACC).
- MeSH
- algoritmy MeSH
- časná diagnóza MeSH
- dospělí MeSH
- infarkt myokardu diagnóza epidemiologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- prospektivní studie MeSH
- senioři MeSH
- senzitivita a specificita MeSH
- směrnice pro lékařskou praxi jako téma MeSH
- troponin krev MeSH
- věkové faktory MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
Thyroid hormones are crucial for the growth and maturation of many target tissues, especially the brain and skeleton. During critical periods in the first trimester of pregnancy, maternal thyroxine is essential for fetal development as it supplies thyroid hormone-dependent tissues. The ontogeny of mature thyroid function involves organogenesis, and maturation of the hypothalamus, pituitary and the thyroid gland; and it is almost complete by the 12th-14th gestational week. In case of maternal hypothyroidism, substitution with levothyroxine must be started in early pregnancy. After the 14th gestational week, fetal brain development may already be irreversibly affected by lack of thyroid hormones. The prevalence of manifest hypothyroidism in pregnancy is about 0.3-0.5%. The prevalence of subclinical hypothyroidism varies between 4 and 17%, strongly depending on the definition of the upper TSH cutoff limit. Hyperthyroidism occurs in 0.1-1% of all pregnancies. Positivity for antibodies against thyroid peroxidase (TPOAb) is common in women of childbearing age with an incidence rate of 5.1-12.4%. TPOAb-positivity may be regarded as a manifestation of a general autoimmune state which may alter the fertilization and implantation processes or cause early missed abortions. Women positive for TPOAb are at a significant risk of developing hypothyroidism during pregnancy and postpartum. Laboratory diagnosis of thyroid dysfunction during pregnancy is based upon serum TSH concentration. TSH in pregnancy is physiologically lower than the non-pregnant population. Results of multiple international studies point toward creation of trimester-specific reference intervals for TSH in pregnancy. Screening for hypothyroidism in pregnancy is controversial and its implementation varies from country to country. Currently, the case-finding approach of screening high-risk women is preferred in most countries to universal screening. However, numerous studies have shown that one-third to one-half of women with thyroid disorders escape the case-finding approach. Moreover, the universal screening has been shown to be more cost-effective. Screening for thyroid disorders in pregnancy should include assessment of both TSH and TPOAb, regardless of the screening approach. This review summarizes the current knowledge on physiology of thyroid hormones in pregnancy, causes of maternal thyroid dysfunction and its effects on pregnancy course and fetal development. We discuss the question of case-finding versus universal screening strategies and we display an overview of the analytical methods and their reference intervals in the assessment of thyroid function and thyroid autoimmunity in pregnancy. Finally, we present our results supporting the implementation of universal screening.
Objective. To determine the expression of chemokine receptors in lymphocytes from thyroid nodules and peripheral blood in patients with and without Hashimoto's thyroiditis (HT). Patients and Methods. The study included 46 women with thyroid nodules and HT and 60 women with thyroid nodules without HT (controls) who underwent a fine needle aspiration biopsy (FNAB). Expression of chemokine receptors CXCR3, CCR5, and CRTH2 was assessed by flow cytometry in lymphocytes from FNAB samples and from peripheral blood. Results. The percentage of CRTH2+ lymphocytes was higher in nodules with HT in comparison with controls, both in FNAB samples (13.95 versus 6.7%, p = 0.008) and in peripheral blood (6.7 versus 5.13%, p = 0.047), and positively correlated with serum antibodies to thyroid peroxidase (r = 0.243; p = 0.026) and negatively correlated with thyroid volume (r = -0.346; p = 0.008). Lymphocytes from neoplastic nodules showed a higher expression of both CXCR3 and CCR5 than those from hyperplastic ones. Conclusion. Flow cytometry performed in FNAB samples may serve as a good tool in investigation of intrathyroidal expression of immunological parameters. In our study, the CRTH2 expression on thyroid-infiltrating lymphocytes as well as on lymphocytes from peripheral blood was increased in HT as compared to controls.
- MeSH
- biologické markery MeSH
- cytokiny metabolismus MeSH
- dospělí MeSH
- exprese genu MeSH
- Hashimotova nemoc diagnóza imunologie MeSH
- imunofenotypizace MeSH
- lidé středního věku MeSH
- lidé MeSH
- lymfocyty imunologie metabolismus patologie MeSH
- receptory CCR5 genetika metabolismus MeSH
- receptory CXCR3 genetika metabolismus MeSH
- receptory imunologické genetika metabolismus MeSH
- receptory prostaglandinů genetika metabolismus MeSH
- senioři MeSH
- studie případů a kontrol MeSH
- tenkojehlová biopsie MeSH
- ultrasonografie MeSH
- uzle štítné žlázy diagnóza imunologie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
BACKGROUND: Autoantibodies against monomeric C-reactive protein (anti-CRP-Ab) observed in patients with systemic lupus erythematosus (SLE) and lupus nephritis (LN) were suggested to be associated with active LN and a poor response to therapy during short-term follow-up. The aim of this study was to confirm this finding and to investigate the prognostic value of anti-CRP-Ab in patients with LN during long-term follow-up. METHODS: Sera of 57 SLE patients (47 women, 10 men) with biopsy proven LN and 122 healthy individuals were analyzed for the presence of anti-CRP-Ab by in-house ELISA. Anti-CRP-Ab levels were studied in relation to routine laboratory tests, urine analysis, levels of C3, C4, other immunological markers and the overall disease activity as assessed by Systemic Lupus Erythematosus Disease Activity Index (SLEDAI). The prognostic value of anti-CRP-Ab was tested in a subgroup of 29 newly diagnosed LN patients (median follow-up 5.9 years). Response to therapy at various time points was assessed with respect to baseline anti-CRP-Ab levels. At least partial response in the first/second year of treatment was considered as a "favorable outcome", while non-response, renal flare or end stage renal disease were considered as "unfavorable outcome". RESULTS: Anti-CRP-Ab were only detected in patients with active renal disease and their levels correlated with SLEDAI (rs = 0.165, p = 0.002). The time to response was shorter in patients being anti-CRP-Ab negative at baseline compared to anti-CRP-Ab positive patients, p = 0.037. In the second year of therapy, baseline anti-CRP-Ab positivity was a significant predictor of "unfavorable outcome" (OR [95% CI] = 15.6 [1.2-771]; p = 0.021). The predictive value of "baseline anti-CRP positivity" further increased when combined with "non-response to therapy in the first year". Baseline anti-CRP-Ab positivity was not a predictor of "unfavorable outcome" at the end of follow-up, (OR [95% CI] = 5.5 [0.6-71.1], p = 0.169). CONCLUSIONS: Baseline serum levels of anti-CRP-Ab seem to be a strong risk factor for a composite outcome of non-response, renal flare or end stage renal disease after two years of standard treatment of LN. The response to therapy seems to be delayed in anti-CRP-Ab positive patients.
- MeSH
- autoantigeny imunologie MeSH
- autoprotilátky krev imunologie MeSH
- biologické markery krev MeSH
- C-reaktivní protein imunologie MeSH
- dospělí MeSH
- ELISA MeSH
- lidé MeSH
- následné studie MeSH
- nefritida při lupus erythematodes krev imunologie MeSH
- prognóza MeSH
- stupeň závažnosti nemoci MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
Atomové katastrofy se udály v posledních 70 letech několikrát. Výbuch nukleárního zařízení v roce 1986 v severní částí střední Ukrajiny byl mimořádnou zkušeností proto, že radiační zátěž dopadla na všechny věkové kategorie populace. Následné studie pak přinesly velké množství informací o účinku záření na lidský organismus. Vzhledem k tomu, že probíhá globální zhoršující se bezpečnost a současně slyšíme názory některých světových lídrů, získávají nový rozměr nejen znalosti o biologickém dopadu ionizujícího záření, ale i preventivní navržená opatření ke snížení zhoubných účinků záření. A navíc – týkají se nás všech. Tento přehled se zaměřuje na dlouhodobé důsledky černobylské katastrofy, zvláště pak na dopad na endokrinní systém u dětí a dospělých. Přehled zahrnuje souhrn preventivních opatření pro případ atomové katastrofy. Klíčová slova: černobylská atomová katastrofa – jonizující záření – endokrinní systém – štítná žláza – rakovina –mamma – těhotenství – děti
In the last 70 years, atomic disasters have occurred several times. The nuclear power plant accident at Chernobyl in 1986 in North-Central Ukraine was a unique experience in population exposures to radiation by all ages, and ongoing studies have brought a large amount of information on effects of radiation on human organism. Concerning the deteriorating global security situation and the strong rhetoric of some of the world leaders, the knowledge on the biological effects of ionizing radiation and the preventive measures designed to decrease the detrimental effects of radiation gains a new dimension, and involves all of us. This review focuses on the long-term effects of Chernobyl catastrophe especially on the endocrine system in children and in adults, and includes a summary of preventive measures in case of an atomic disaster. Keywords: Chernobyl atomic disaster – ionizing radiation – endocrine system – thyroid – cancer – breast – pregnancy – children
- Klíčová slova
- jaderná katastrofa, karcinogenní účinky,
- MeSH
- časové faktory MeSH
- černobylská havárie * MeSH
- dítě MeSH
- dospělí MeSH
- endokrinní systém * účinky záření MeSH
- ionizující záření MeSH
- jaderné elektrárny MeSH
- katastrofy MeSH
- lidé MeSH
- nádory prsu epidemiologie etiologie MeSH
- nádory štítné žlázy * epidemiologie etiologie MeSH
- nemoci endokrinního systému etiologie MeSH
- obsah radioaktivních látek v organizmu MeSH
- radiační poranění MeSH
- únik radioaktivních látek MeSH
- věkové faktory MeSH
- vystavení vlivu životního prostředí škodlivé účinky MeSH
- zdravotní stav MeSH
- zpožděný efekt prenatální expozice MeSH
- Check Tag
- dítě MeSH
- dospělí MeSH
- lidé MeSH
- Publikační typ
- přehledy MeSH
- Geografické názvy
- Ukrajina MeSH
Atomové katastrofy se udály v posledních 70 letech několikrát. Výbuch nukleárního zařízení v roce 1986 v severní částí střední Ukrajiny byl mimořádnou zkušeností proto, že radiační zátěž dopadla na všechny věkové kategorie populace. Následné studie pak přinesly velké množství informací o účinku záření na lidský organismus. Vzhledem k tomu, že se globální bezpečnost postupně zhoršuje, získávají znalosti o biologickém dopadu ionizujícího záření i preventivní opatření k omezeni jeho zhoubných účinků novy rozměr a týkají se nás všech. Tento přehled se zaměřuje na dlouhodobé důsledky černobylské katastrofy, zvláště pak na dopad na endokrinní systém u dětí a dospělých. Přehled zahrnuje souhrn preventivních opatření pro případ atomové katastrofy.
In the last 70 years, atomic disasters have occurred several times. The nuclear power plant accident at Chernobyl in 1986 in North-Central Ukraine was a unique experience in population exposures to radiation by all ages, and ongoing studies have brought a large amount of information effects of radiation on human organism. Concerning the deteriorating global security situation and the strong rhetoric of some of the world leaders, the knowledge on the biological effects of ionizing radiation and the preventive measures designed to decrease the detrimental effects of radiation gains a new dimension, and involves all of us. This review focuses on the long-term effects of Chernobyl catastrophe especially on the endocrine system in children and in adults, and includes a summary of preventive measures in case of an atomic disaster.
- Klíčová slova
- černobylská atomová katastrofa,
- MeSH
- černobylská havárie * MeSH
- dítě MeSH
- dospělí MeSH
- endokrinní systém účinky záření MeSH
- ionizující záření MeSH
- jaderné elektrárny MeSH
- jod terapeutické užití MeSH
- jodid draselný terapeutické užití MeSH
- katastrofy MeSH
- lidé MeSH
- nádory prsu etiologie MeSH
- nemoci endokrinního systému * etiologie MeSH
- nemoci štítné žlázy etiologie MeSH
- radiační poranění * etiologie komplikace prevence a kontrola MeSH
- snížení rizika poškození MeSH
- únik radioaktivních látek MeSH
- vystavení vlivu životního prostředí prevence a kontrola škodlivé účinky MeSH
- Check Tag
- dítě MeSH
- dospělí MeSH
- lidé MeSH
- Publikační typ
- přehledy MeSH
- Geografické názvy
- Ukrajina MeSH
- Klíčová slova
- levotyroxin,
- MeSH
- generika * aplikace a dávkování farmakokinetika škodlivé účinky MeSH
- hypotyreóza * etiologie farmakoterapie krev MeSH
- jod aplikace a dávkování moč nedostatek MeSH
- jodidperoxidasa fyziologie účinky léků MeSH
- léčivé přípravky MeSH
- lékové interakce MeSH
- lidé MeSH
- terapeutická ekvivalence * MeSH
- thyreotropin krev MeSH
- thyroxin * aplikace a dávkování farmakokinetika MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
BACKGROUND: Toxoplasmosis, one of the most common zoonotic diseases worldwide, can induce various hormonal and behavioural alterations in infected hosts, and its most common form, latent toxoplasmosis, influences the course of pregnancy. Autoimmune thyroid diseases (AITD) belong to the well-defined risk factors for adverse pregnancy outcomes. The aim of this study was to investigate whether there is a link between latent toxoplasmosis and maternal AITD in pregnancy. METHODS: Cross-sectional study in 1248 consecutive pregnant women in the 9-12th gestational weeks. Serum thyroid-stimulating hormone (TSH), thyroperoxidase antibodies (TPOAb), and free thyroxine (FT4) were assessed by chemiluminescence; the Toxoplasma status was detected by the complement fixation test (CFT) and anti-Toxoplasma IgG enzyme-linked immunosorbent assay (ELISA). RESULTS: Overall, 22.5% of the women were positive for latent toxoplasmosis and 14.7% were screened positive for AITD. Women with latent toxoplasmosis had more often highly elevated TPOAb than the Toxoplasma-negative ones (p = 0.004), and latent toxoplasmosis was associated with decrease in serum TSH levels (p = 0.049). Moreover, we found a positive correlation between FT4 and the index of positivity for anti-Toxoplasma IgG antibodies (p = 0.033), which was even stronger in the TPOAb-positive Toxoplasma-positive women, (p = 0.014), as well as a positive correlation between FT4 and log2 CFT (p = 0.009). CONCLUSIONS: Latent toxoplasmosis was associated with a mild increase in thyroid hormone production in pregnancy. The observed Toxoplasma-associated changes in the parameters of AITD are mild and do not seem to be clinically relevant; however, they could provide new clues to the complex pathogenesis of autoimmune thyroid diseases.
- MeSH
- autoimunitní nemoci epidemiologie etiologie MeSH
- autoprotilátky krev imunologie MeSH
- dospělí MeSH
- hormony štítné žlázy krev MeSH
- imunoglobulin G krev imunologie MeSH
- komplikace těhotenství epidemiologie etiologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- nemoci štítné žlázy epidemiologie etiologie MeSH
- protilátky protozoální krev imunologie MeSH
- průřezové studie MeSH
- rizikové faktory MeSH
- těhotenství MeSH
- toxoplazmóza komplikace diagnóza MeSH
- výsledek těhotenství MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- Geografické názvy
- Česká republika MeSH
