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.

• MeSH
• akční potenciály MeSH
• akutní nemoc MeSH
• časové faktory MeSH
• fibrilace síní * patofyziologie   chirurgie   diagnóza   MeSH
• funkce levé komory srdeční * MeSH
• katetrizační ablace * škodlivé účinky   MeSH
• lidé středního věku MeSH
• lidé MeSH
• recidiva * MeSH
• retrospektivní studie MeSH
• rizikové faktory MeSH
• senioři MeSH
• srdeční frekvence MeSH
• srdeční selhání * patofyziologie   diagnóza   terapie   mortalita   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
• srovnávací studie 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   MeSH
• potkani Wistar * MeSH
• štítná žláza * patologie   ultrastruktura   metabolismus   MeSH
• stupeň závažnosti nemoci MeSH
• zvířata MeSH
• Check Tag
• krysa rodu rattus MeSH
• mužské pohlaví MeSH
• zvířata MeSH
• Publikační typ
• časopisecké články 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.

• 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

Publikace se zaměřuje na intenzivní a urgentní terapii nemocí nervového systému. Určeno odborné veřejnosti.; Monografie je věnována nejčastějším akutním neurologickým diagnózám, se kterými se mohou setkat lékaři urgentního příjmu, neurologie, neurochirurgie, anesteziologie a resuscitace. Kniha je koncipována jako stručné a názorné vodítko v diferenciálnědiagnostickém a terapeutickém procesu. Cílem je usnadnit čtenářům orientaci v akutní a subakutní péči o tyto pacienty včetně multidisciplinárního přístupu. Struktura kapitol umožňuje velmi rychlou orientaci – od epidemiologie přes diagnostiku až po specifickou a podpůrnou léčbu – v problematice traumatických poškození mozku, status epilepticus (včetně non-konvulzivního status epilepticus), cévních mozkových příhod (se zaměřením na CMP ve vertebrobazilárním povodí a uzávěry velkých mozkových tepen v přední mozkové cirkulaci), intracerebrálních krvácení, myasthenia gravis (se zaměřením na myastenickou krizi) a akutních polyneuropatií. Samostatné kapitoly jsou věnovány terapeutickým aferézám v neurointenzivní péči u vybraných neurologických diagnóz, výživě a rehabilitaci v neurointenzivní péči a neuroinfekcím. Kniha je doplněna o řadu názorných obrázků a schémat, které mají jediný cíl, a sice zefektivnit diagnostiku a péči o pacienty na základě nejaktuálnějších doporučených postupů.

• MeSH
• akutní nemoc MeSH
• ambulantní péče MeSH
• náhlé příhody MeSH
• nemoci nervového systému diagnóza   terapie   MeSH
• péče o pacienty v kritickém stavu MeSH
• terapie náhlých příhod MeSH

• Konspekt
• Patologie. Klinická medicína
• NLK Obory
• neurologie
• anesteziologie a intenzivní lékařství
• urgentní lékařství
• NLK Publikační typ
• kolektivní monografie

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.

• 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

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.

• 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.

• 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

Acute cellular rejection (ACR) frequently occurs following lung transplantation (LuTx) and represents a risk factor for the development of chronic lung allograft dysfunction (CLAD) as well as long-term survival. The histopathological diagnosis of ACR carries a burden of interobserver variability. The widespread utilization and cost-effectiveness of immunohistochemistry (IHC) was proven beneficial in diagnosing rejection in human kidney transplantations and LuTx rat models. However, its potential for ACR detection in patients remains unexplored. We analyzed surface markers (CD3, CD4, CD8, CD20, CD68, CD47, PD-1, PD-L1, and CD31/PECAM-1) on lung tissue cryobiopsy samples collected within 6 months post-LuTx from 60 LuTx recipients, 48 of whom were diagnosed with ACR. Additionally, serum samples from 51 patients were analyzed using a multiplex bead-based Luminex assay. The cytokines and markers included PD-L1, IL2, TNFα, IFNγ, and Granzyme B. We observed a significant increase in PD-L1 tissue expression within the rejection group, suggesting a concerted effort to suppress immune responses, especially those mediated by T-cells. Furthermore, we noted significant differences in PECAM-1 levels between ACR/non-ACR. Additionally, peripheral blood C-reactive-protein levels tended to be higher in the ACR group, while Luminex serum analyses did not reveal any significant differences between groups. In conclusion, our findings suggest the potential value of PECAM-1 and PD-L1 markers in diagnosing ACR.

• MeSH
• akutní nemoc MeSH
• antigeny CD274 * metabolismus   krev   MeSH
• antigeny CD31 * metabolismus   MeSH
• biologické markery * krev   metabolismus   MeSH
• dospělí MeSH
• imunohistochemie MeSH
• lidé středního věku MeSH
• lidé MeSH
• plíce patologie   MeSH
• rejekce štěpu * diagnóza   krev   MeSH
• senioři MeSH
• transplantace plic * škodlivé účinky   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

Diabetic foot attack je akutní manifestací syndromu diabetické nohy, která vyžaduje rychlou diagnózu a časně zahájenou komplexní terapii založenou na multidisciplinární spolupráci s cílem zachránit postiženou končetinu či nemocného. Termín attack má právě evokovat nutnost rychlé reakce po vzoru heart attack. Pacienti s diabetem a akutní manifestací syndromu diabetické nohy jsou ohroženi v případě neadekvátních opatření vysokou amputací dolní končetiny, která je spojena s vysokou celkovou morbiditou a mortalitou. Komplexní terapie zahrnuje systémovou antibiotickou terapii, opakovaný chirurgický débridement ulcerace, revaskularizaci v případě prokázané ischémie dolní končetiny a individualizovanou formu odlehčení končetiny. Bez zajištění následné ambulantní podiatrické dispenzarizace významně narůstá riziko recidivy.

Diabetic foot attack is an acute manifestation of diabetic foot syndrome that requires rapid diagnosis and early initiation of complex therapy based on multidisciplinary team cooperation to save the affected limb. The term "attack" evokes the need for a rapid reaction as for "heart attack". Patients with diabetes mellitus and acute manifestations of diabetic foot syndrome have high risk for amputation of the lower limb, which is associated with higher morbidity and mortality. Complex therapy includes systemic antibiotic therapy, surgical debridement of ulceration, revascularization in the case of proven lower limb ischemia and an individualized offloading. Without the subsequent outpatient podiatric follow-up, the risk of recurrence increases significantly.

• MeSH
• akutní nemoc MeSH
• antibakteriální látky terapeutické užití   MeSH
• diabetická noha * diagnóza   komplikace   terapie   MeSH
• lidé MeSH
• neuropatická artropatie * diagnóza   komplikace   terapie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• přehledy MeSH

BACKGROUND: Heterotopic pancreas is defined as pancreatic tissue located outside the pancreatic parenchyma that lacks an anatomic or vascular connection to the normal pancreas. Symptomatic gastric heterotopic pancreas is a rare condition that can manifest as acute or chronic pancreatitis. Asymptomatic heterotopic pancreas does not require treatment, while symptomatic lesions should be resected. The modality of final resection of heterotopic pancreas depends on its size and the depth of gastric wall involvement. METHODS AND RESULTS: A 36-year-old woman was admitted for recurrent epigastralgia. Abdominal computed tomography (CT) scan revealed that an abscess had formed in the gastric antrum. After multidisciplinary discussion we decided for conservative treatment with intravenous antibiotics and further detailed endoscopic diagnostic. Esophagogastroduodenoscopy revealed a submucosal mass with a central fistula and intermittent pus secretion in the prepyloric region of the gastric antrum, which was subsequently drained with a double pigtail stent under endoscopic ultrasound (EUS) and fluoroscopy. The possibility of pancreatic fluid collection in the case of heterotopic pancreas was suggested during the EUS examination, and histology subsequently confirmed heterotopic pancreatic tissue. The patient was in good condition and without any abdominal pain. According to a control CT scan after 10 weeks, the fluid collection was completely resolved. Due to the possible recurrence of pancreatitis, resection of heterotopic pancreas was proposed to the patient. Since the lesion involved the muscularis propria of the gastric wall, surgical resection of the mass was indicated. CONCLUSION: Fluid collections after acute pancreatitis in heterotopic pancreas in the gastric antrum can be successfully managed by endoscopy.

• MeSH
• akutní nemoc MeSH
• dospělí MeSH
• endoskopie MeSH
• endosonografie MeSH
• lidé MeSH
• pankreas MeSH
• pankreatitida * chirurgie   MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• kazuistiky MeSH