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
The prognostic impact of PICALM::MLLT10 status in childhood leukaemia is not well described. Ten International Berlin Frankfurt Münster-affiliated study groups and the Children's Oncology Group collaborated in this multicentre retrospective study. The presence of the PICALM::MLLT10 fusion gene was confirmed by fluorescence in situ hybridization and/or RNA sequencing at participating sites. Ninety-eight children met the study criteria. T-cell acute lymphoblastic leukaemia (T-ALL) and acute myeloid leukaemia (AML) predominated 55 (56%) and 39 (40%) patients, respectively. Most patients received a chemotherapy regimen per their disease phenotype: 58% received an ALL regimen, 40% an AML regimen and 1% a hybrid regimen. Outcomes for children with PICALM::MLLT10 ALL were reasonable: 5-year event-free survival (EFS) 67% and 5-year overall survival (OS) 76%, but children with PICALM::MLLT10 AML had poor outcomes: 5-year EFS 22% and 5-year OS 26%. Haematopoietic stem cell transplant (HSCT) did not result in a significant improvement in outcomes for PICALM::MLLT10 AML: 5-year EFS 20% for those who received HSCT versus 23% for those who did not (p = 0.6) and 5-year OS 37% versus 36% (p = 0.7). In summary, this study confirms that PICALM::MLLT10 AML is associated with a dismal prognosis and patients cannot be salvaged with HSCT; exploration of novel therapeutic options is warranted.
- MeSH
- akutní myeloidní leukemie * genetika MeSH
- akutní nemoc MeSH
- dítě MeSH
- fúzní onkogenní proteiny genetika MeSH
- hybridizace in situ fluorescenční MeSH
- lidé MeSH
- monomerní proteiny vytvářející klathrin * genetika MeSH
- prognóza MeSH
- retrospektivní studie MeSH
- transkripční faktory genetika MeSH
- výsledek terapie MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
- práce podpořená grantem MeSH
- MeSH
- akutní nemoc MeSH
- kardiovaskulární látky * aplikace a dávkování farmakologie terapeutické užití MeSH
- lidé MeSH
- srdeční selhání * farmakoterapie prevence a kontrola MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
- MeSH
- akutní nemoc * MeSH
- lidé MeSH
- systémová sklerodermie * komplikace MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
Akutní končetinová ischemie (acute limb ischemia, ALI) představuje zásadní hrozbu pro životaschopnost končetin vyžadující urgentní revaskularizační intervence. V této kazuistice popisujeme případ 47leté Asiatky s bilaterální ALI v důsledku těžké mitrální stenózy (MS) revmatické etiologie a fibrilace síní (FS) se zanedbanou úpravou mezinárodního normalizačního poměru (INR). Pacientka byla přivezena do nemocnice s náhlou klidovou bolestí obou dolních končetin, již namodralých a naprosto bez čití. Echokardiografické vyšetření prokázalo těžkou MS revmatické etiologie spolu s trombem v oušku levé síně. CT angiogram odhalil téměř úplně obturující trombus v místě odstupu horní břišní aorty. Okamžitě byla provedena bilaterální tromboembolektomie, po níž došlo ke zlepšení stavu, a pacientka byla nakonec propuštěna z nemocnice ve stabilizovaném stavu. Pro optimální výsledek v případě ALI zahrnujících současně MS a FS jsou absolutně nezbytné vhodná antikoagulační terapie, důsledné monitorování INR a použití vhodné strategie k náhradě chlopně.
Acute limb ischemia (ALI) poses a critical threat to limb viability, necessitating urgent revascularization interventions. This case report discusses a 47-year-old Asian woman with bilateral ALI due to severe rheumatic mitral stenosis (MS) and atrial fibrillation (AF), with neglected international normalized ratio (INR) control. The patient presented with sudden bilateral leg pain at rest, accompanied by bluish discoloration and sensory loss. Echocardiographic findings indicated severe rheumatic MS along with a thrombus in the left atrial appendage. The computed tomography angiogram revealed a near-total thrombus originating from the upper abdominal aorta. Immediate bilateral thromboembolectomy was performed. Subsequent improvements were observed, and the patient was eventually discharged in stable condition. Proper anticoagulant therapy, vigilant INR monitoring, and a strategic approach to valve replacement are crucial for optimizing outcomes in cases of ALI involving concurrent MS and AF.
- MeSH
- akutní nemoc terapie MeSH
- antikoagulancia farmakologie terapeutické užití MeSH
- diagnostické zobrazování metody MeSH
- dolní končetina * patologie MeSH
- fibrilace síní diagnóza etiologie farmakoterapie MeSH
- INR metody normy MeSH
- ischemie * chirurgie etiologie farmakoterapie MeSH
- lidé středního věku MeSH
- lidé MeSH
- mitrální stenóza etiologie komplikace MeSH
- revmatická karditida * komplikace MeSH
- trombektomie metody MeSH
- trombotická příhoda chirurgie farmakoterapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
OBJECTIVES: Acute appendicitis is the most common non-gynaecological indication for surgical intervention during pregnancy. The aim of this study was to compare perioperative and postoperative results of surgical treatment of acute appendicitis in the early and late stage of pregnancy. MATERIAL AND METHODS: This is a retrospective study focused on the evaluation of perioperative and postoperative results of appendectomy in pregnancy. The study included all pregnant patients who underwent laparoscopic or open appendectomy at the University Hospital Ostrava during the observed 10-year period (January 2012-December 2021). The patients were divided into two subgroups according to the stage of pregnancy in relation to the expected viability of the foetus (the viability limit was defined as the 23rd week of pregnancy). RESULTS: In the monitored 10-year period, a total of 25 pregnant patients underwent appendectomy. Comparing the two subgroups of patients, there were no statistically significant differences in any of the admission parameters. Laparoscopy was performed in 100% of the patients in the lower stage of pregnancy (< 23 g.w.) and in 61% of the subgroup of patients with more advanced pregnancy (> 23 g.w.); this difference was statistically significant (p = 0.039). Differences in subgroups regarding duration of surgery, risk of revision and 30-day postoperative morbidity were not statistically significant. In the subgroup of patients < 23 g.w., uncomplicated forms of appendicitis predominated (66%), whereas in the subgroup > 23 g.w., complicated forms predominated (69%); this difference was statistically significant (p = 0.026). When comparing the two subgroups of patients, there was a statistically significant difference in the length of hospitalization (p = 0.006). The mortality rate of the group was zero. CONCLUSIONS: The results of the study confirm the fact that advanced pregnancy may be related to complicated forms of appendicitis. Therefore, early appendectomy is still the method of choice. In accordance with the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) recommendations, laparoscopic approach is preferred in pregnant patients, even in advanced pregnancy.
- MeSH
- akutní nemoc MeSH
- apendektomie metody MeSH
- apendicitida * chirurgie MeSH
- délka pobytu MeSH
- hospitalizace MeSH
- laparoskopie * metody MeSH
- lidé MeSH
- pooperační komplikace chirurgie MeSH
- retrospektivní studie MeSH
- těhotenství MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
Cieľ práce: Analyzovať klinické, laboratórne a epidemiologické údaje v súbore pacientov s akútnou hepatitídou E na Klinike infektológie a cestovnej medicíny v Košiciach (KICM). Materiál a metodiky: Retrospektívna analýza údajov z nemocničného informačného systému u pacientov s diagnózou akútnej hepatitídy E, ktorí boli vyšetrení alebo hospitalizovaní na KICM v rokoch 2015–2023. Štatistické vyhodnotenie sledovaných údajov so zameraním na epidemiológiu, priebeh, komplikácie. Výsledky: Súbor tvorilo 62 pacientov. Mužov bolo 58 %. Priemerný vek bol 56 rokov. Bolo hospitalizovaných 74 % pacientov s priemernou dĺžkou hospitalizácie 10 dní. Najčastejším klinickým prejavom bol ikterus (40 % pacientov). Šiesti pacienti mali vyšetrené HEV RNA v stolici, u všetkých sa potvrdil genotyp 3. U 5 % pacientov sa jednalo o importovanú nákazu (HEV RNA vyšetrené nemali), 95 % prípadov bolo autochtónnych. Kontakt s nakazeným hepatitídou E v anamnéze udávalo 26 % pacientov. V anamnéze malo preexistujúce ochorenie pečene 13 % pacientov, u týchto sa potvrdili vyššie hodnoty bilirubínu, GMT a amoniaku. U pacientov s poruchou imunity v anamnéze neboli zaznamenané štatisticky významné odchýlky. U jedného pacienta s preexistujúcim ochorením pečene bol priebeh ochorenia fulminantný s úmrtím. U štyroch pacientov, ktorí mali pri hepatitíde E aj neurologické symptómy boli zistené nižšie hodnoty bilirubínu. Závery: V súbore dominovali starší muži. U všetkých pacientov, u ktorých bolo realizované vyšetrenie HEV RNA, bol potvrdený genotyp 3. Potvrdili sa vyššie hodnoty bilirubínu, amoniaku a GMT u pacientov s preexistujúcim ochorením pečene. Pacienti s neurologickými komplikáciami mali nižšie hodnoty bilirubínu. U jedného pacienta s preexistujúcim ochorením pečene došlo k úmrtiu.
Aim: To analyse clinical, laboratory, and epidemiological data of a cohort of patients with acute hepatitis E treated at the Clinic of Infectology and Travel Medicine (CITM) in Košice. Material and methods: Retrospective analysis of hospital information system data on patients diagnosed with acute hepatitis E who were examined or hospitalized at CITM in 2015-2023. Statistical evaluation of the available data with a focus on epidemiology, course, and complications. Results: The cohort consisted of 62 patients. Fifty-eight percent were male. The mean age was 56 years. Seventy-four percent of patients were hospitalized, with a mean length of hospital stay of 10 days. The most common clinical manifestation was jaundice (in 40% of patients). Six patients had stool HEV RNA testing and all were confirmed to have genotype 3. In 5% of patients, the infection was classified as imported (they did not have HEV RNA tested), and 95% of cases were autochthonous. A history of contact with an HEV infected person was reported by 26% of patients. A history of preexisting liver disease was noted in 13% of patients who were confirmed with higher bilirubin, GMT, and ammonia levels. No statistically significant differences were found for patients with a history of immune deficiency. One patient with preexisting liver disease developed fulminant infection resulting in death. Four hepatitis E patients with neurological symptoms had lower bilirubin levels. Conclusions: The study cohort included predominantly older men. Genotype 3 was confirmed in all patients who underwent HEV RNA testing. Higher bilirubin, ammonia, and GMT levels were confirmed in patients with preexisting liver disease. Patients with neurological complications had lower bilirubin levels. One patient with preexisting liver disease died.
- MeSH
- akutní nemoc MeSH
- hepatitida E * diagnóza epidemiologie přenos MeSH
- lidé MeSH
- přenos infekční nemoci MeSH
- retrospektivní studie MeSH
- virus hepatitidy E MeSH
- Check Tag
- lidé MeSH
- Geografické názvy
- Slovenská republika MeSH
The monocyte distribution width (MDW) has emerged as a promising biomarker for accurate and early identification of patients with potentially life-threatening infections. Here we tested the diagnostic performance of MDW in adult patients requiring hospital admission for community-acquired infections and sepsis, evaluated sources of heterogeneity in the estimates of diagnostic accuracy, and assessed the meaning of MDW in a patient population presenting to the emergency department (ED) for acute non-infectious conditions. 1925 consecutive patients were categorized into three groups: non-infection (n = 1507), infection (n = 316), and sepsis/septic shock (n = 102). Diagnostic performance for infection or sepsis of MDW alone or in combination with components of SOFA was tested using AUC of ROC curves, sensitivity, and specificity. The relationship between MDW and different pathogens as well as the impact of non-infectious conditions on MDW values were explored. For the prediction of infection, the AUC/ROC of MDW (0.84) was nearly overlapping that of procalcitonin (0.83), and C-reactive protein (0.89). Statistical optimal cut-off value for MDW was 21 for predicting infection (sensitivity 73%, specificity 82%) and 22 for predicting sepsis (sensitivity 79%, specificity 83%). The best threshold to rule out infection was MDW ≤ 17 (NPV 96.9, 95% CI 88.3-100.0), and ≤ 18 (NPV 99.5, 95% CI 98.3-100.0) to rule out sepsis. The combination of MDW with markers of organ dysfunction (creatinine, bilirubin, platelets) substantially improved the AUC (0.96 (95% CI 0.94-0.97); specificity and sensitivity of 88% and 94%, respectively). In conclusion, MDW has a good diagnostic performance in diagnosing infection and sepsis in patients presenting in ED. Its use as an infection marker even increases when combined with other markers of organ dysfunction. Understanding the impact of interactions of non-infectious conditions and comorbidities on MDW and its diagnostic accuracy requires further elucidation.
- MeSH
- akutní nemoc MeSH
- biologické markery * krev MeSH
- dospělí MeSH
- infekce získané v komunitě diagnóza MeSH
- lidé středního věku MeSH
- lidé MeSH
- monocyty * metabolismus MeSH
- prospektivní studie MeSH
- ROC křivka MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- senzitivita a specificita MeSH
- sepse * diagnóza krev MeSH
- urgentní služby nemocnice * 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
