BACKGROUND Acute kidney injury (AKI) is a common cause of organ failure in patients after major trauma and is associated with increased morbidity and mortality. Early identification of patients at risk enables the implementation of a bundle of supportive care, which reduces the incidence of AKI. The primary objective of our study was to investigate whether the levels of biomarkers on admission predicted the onset of early AKI in patients with serious injuries. MATERIAL AND METHODS This prospective observational study included 98 adult patients of both sexes with a serious injury (injury severity score >16). At admission, blood samples were taken, and creatinine, neutrophil gelatinase-associated lipocalin (NGAL), high mobility group box 1 (HMGB-1), and markers of rhabdomyolysis (creatine kinase, myoglobin) were evaluated. The patients were provided with standard resuscitation care, and the occurrence of AKI was monitored during the first 7 days after admission to the Intensive Care Unit, according to the Kidney Disease Improving Global Outcomes diagnostic criteria. RESULTS AKI occurred in 25 (25.5%) patients, in whom the admission levels of HMGB-1, NGAL, creatinine, and myoglobin were significantly higher than in non-AKI patients (48.3±98.4 vs 113.0±209.4 μg/L, P=0.006; 150.2±349.9 vs 181.4±152.2 μg/L, P=0.004; 83.1±20.8 vs 118.8±32.2 μmol/L, P<0.005; 2734.4±2214.5 vs 4182.3±2477.1 μg/L, P=0.008, respectively). Creatine kinase was 14.5±9.2 μkat/L in non-AKI patients and 13.7±7.9 μkat/L in AKI patients (P=0.916). CONCLUSIONS Admission levels of HMGB-1, NGAL, creatinine, and myoglobin predicted the risk of AKI in severely injured patients.
- MeSH
- Acute Kidney Injury * diagnosis etiology MeSH
- Biomarkers MeSH
- Adult MeSH
- Creatinine MeSH
- Creatine Kinase MeSH
- Humans MeSH
- Lipocalin-2 MeSH
- Myoglobin * MeSH
- Check Tag
- Adult MeSH
- Humans MeSH
- Male MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Observational Study MeSH
Netraumatický kompartment syndrom je závažný stav, který postihuje svalové prostory typicky u nemocných po ischemickém inzultu při akutní končetinové ischemii a může mít vážné následky pro postiženou končetinu a celkový zdravotní stav pacienta. Tento syndrom je charakterizován zvýšeným tlakem v uzavřeném intrafasciálním prostoru, což vede ke kompresi svalů, cév a nervů vedoucí k prohloubení ischemie a až nevratnému poškození těchto struktur. Včasná diagnóza a léčba jsou klíčové pro minimalizaci rizika komplikací a zachování funkce končetiny. V tomto článku se zaměříme na definici, patofyziologii a důležité klinické aspekty netraumatického kompartmentového syndromu.
Non-traumatic compartment syndrome is a serious condition that affects muscle compartments typically in patients after ischemic insult during acute limb ischemia and can have serious consequences for the affected limb and the patient's overall health. This syndrome is characterized by increased pressure in the intrafascial space, leading to compression of muscles, blood vessels and nerves leading to worsening ischemia and even irreversible damage to these structures. Early diagnosis and treatment are crucial to reduce the risk of complications and preserve limb function. In this article, we review the definition, pathophysiology and important clinical aspects of non-traumatic compartment syndrome.
PURPOSE OF THE STUDY In this randomized prospective study, we monitored and compared perioperative changes in skeletal muscle enzymes blood levels in open and mini-invasive stabilization of thoracolumbar spine fractures. The established hypothesis was to confirm higher blood levels of muscle enzymes in open stabilization. MATERIAL AND METHODS This study included 38 patients with the mean age of 46.4 years. 19 injuries were managed in an open procedure and 19 procedures were mini-invasive. Venous blood was taken intermittently at short intervals to determine the levels of skeletal muscle enzymes. The catalytic concentration of creatine kinase was determined via an enzymatic UV-test, and the concentration of myoglobin via electro-chemiluminescent immunoassay. Enzyme levels were processed statistically. The Wilcoxon test was used. RESULTS The median increase in the values of both enzymes is higher in the mini-invasive method than in the open method in both the surgery phase for the injury and in the extraction phase. The median increase in the values of both enzymes is higher in both methods for the primary procedure phase compared to the extraction phase. All results are statistically significant at p of <0.05. All tests were calculated using the MATLAB Statistics Toolbox. DISCUSSION A very surprising finding, when testing the hypothesis of the levels increasing mainly in open stabilization, was confirming the opposite. Both enzymes were higher in the mini-invasive approach to stabilising the spine after the injury, but also after the extraction. This contradicts the available literature. However, this can be explained by the methodology of enzyme levels determination in the previously published studies. We believe that this phenomenon can be partially caused by an iatrogenic mini-compartment of muscles in the postoperative period, absence of wound drainage, but also by higher muscle contusion when inserting bolts through the tubes via small incisions, when the tubes penetrate to the entry points relatively violently and the muscles in this area are affected more than in the classical skeletization. CONCLUSIONS Analysis of biochemical changes in open and mini-invasive surgery did not confirm the hypothesis that levels of creatine kinase and myoglobin enzymes increase especially in open stabilization. On the contrary, they were statistically significantly higher in mini-invasive procedures. Key words: creatine kinase, myoglobin, muscle enzymes, spine fracture, spine surgery, miniinvasive surgery.
- MeSH
- Lumbar Vertebrae MeSH
- Spinal Fractures * complications surgery MeSH
- Thoracic Vertebrae MeSH
- Creatine Kinase * metabolism MeSH
- Middle Aged MeSH
- Humans MeSH
- Minimally Invasive Surgical Procedures MeSH
- Myoglobin * metabolism MeSH
- Muscular Diseases * diagnosis etiology MeSH
- Prospective Studies MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Publication type
- Journal Article MeSH
BACKGROUND: In December 2019, a new coronavirus, SARS-CoV-2, appeared in Wuhan, China. This virus is the cause of the COVID-19 disease. This infection later spread to the whole world. The goal of this article is to present the clinical and laboratory characteristics of patients with COVID-19 treated in the Faculty Hospital Pilsen. METHODS: In this monocentric, retrospective study, clinical and biochemical data of 89 adult patients with COVID-19 was analyzed. These patients were in the care of the Faculty Hospital Pilsen between March 14 and April 7. RESULTS: In this cohort, made up of 89 patients, 63 were treated as outpatients and 26 were hospitalized. 10 patients required intensive care. The most common symptoms among patients were cough and fever. Dyspnea was present in 29 patients. A CT scan showed bilateral pneumonia in 23 of the admitted patients. Fever and bilateral pneumonia were significantly more common in patients ≥ 60 years old (p=0.047, and p=0.001, respectively). Of lab results, the patients in intensive care had significantly higher values of C-reactive protein, procalcitonin, lactate dehydrogenase, interleukin 6, myoglobin and ferritin. CONCLUSION: The most common symptoms of COVID-19 are fever and cough. These two symptoms are simultaneously present in more than half the cases. Approximately 1/10th of patients requires intensive care. Higher values of lactate dehydrogenase, myoglobin and ferritin on patient admission appear to be a strong predictive factor of the patient's status progressing into requiring ICU attention.
- MeSH
- Ambulatory Care statistics & numerical data MeSH
- Arthralgia physiopathology MeSH
- Headache physiopathology MeSH
- C-Reactive Protein metabolism MeSH
- COVID-19 blood epidemiology physiopathology MeSH
- Diabetes Mellitus epidemiology MeSH
- Adult MeSH
- Dyspnea physiopathology MeSH
- Ferritins blood MeSH
- Fever physiopathology MeSH
- Hospitalization statistics & numerical data MeSH
- Hypertension epidemiology MeSH
- Interleukin-6 blood MeSH
- Intensive Care Units MeSH
- Cough physiopathology MeSH
- Comorbidity MeSH
- L-Lactate Dehydrogenase blood MeSH
- Middle Aged MeSH
- Humans MeSH
- Myalgia physiopathology MeSH
- Myoglobin blood MeSH
- Obesity epidemiology MeSH
- Tomography, X-Ray Computed MeSH
- Procalcitonin blood MeSH
- SARS-CoV-2 MeSH
- Aged MeSH
- Age Factors MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Geographicals
- Czech Republic MeSH
Povědomí o výskyty rabdomyolýzy není mezi pediatry příliš vysoké. Klinická manifestace zahrnuje široké spektrum projevů - od asymptomatických až po stavy život ohrožující. Únik intracelulárních komponent z dezintegrovaného svalu do systémové cirkulace je spojen s rizikem myoglobinurie a následným poškozením ledvin, dále s hypovolemií při úniku plazmy do třetího prostoru, minerálovými dysbalancemi a dalšími poruchami vnitřního prostředí. Článek se věnuje etiopatogenezi, klinickým projevům, diagnostickému procesu a terapii rabdomyolýzy u dětí.
In pediatric population, the prevalence of rhabdomyolysis is unknown. A clinical manifestation is wide - from asymptomatic to life-threatening. The intracellular components leakage from disintegrated muscle into the circulation is associated with the risk of myoglobinuria and acute kidney injury, hypovolaemia and mineral dysbalances. The article presents etiopathogenesis, clinical manifestations, diagnostic procedure and therapy of rhabdomyolysis in children.
Rhabdomyolýza představuje závažnou komplikaci v průběhu fáze popáleninového šoku i akutní nemoci z popálení. Pokud není promptně diagnostikována a léčena, může způsobit ireverzibilní poškození zejména renálních funkcí. Ambivalentní postoj k terapii rhabdomyolýzy u pacientů s vysokonapěťovým elektrotraumatem způsobuje, že v mnoha otázkách této problematiky neexistuje jednoznačný konsensus. Účelem tohoto článku je poukázat na potenciální riziko rozvoje rhabdomyolýzy u vysoce specifické skupiny pacientů a také shrnout současný management terapie takto postižených pacientů. Diagnostiko‑terapeutický postup je také znázorněn v prezentované kazuistice.
Rhabdomyolysis is a serious complication during the acute phase of burn truama. If not promptly diagnosed and treated, it can cause irreversible damage especially to renal function. An ambivalent attitude towards the therapy of rhabdomyolysis in patients with high-voltage electrotrauma causes that there is no unambiguous consensus on many issues. The purpose of this article is to point out the potential risk of developing rhabdomyolysis in a highly specific group of patients and also to summarize the current management of the therapy of the affected patients. Diagnostic-therapeutic procedure is also illustrated in the case studies.
- MeSH
- Acute Kidney Injury therapy MeSH
- Renal Dialysis methods MeSH
- Diuretics therapeutic use MeSH
- Humans MeSH
- Young Adult MeSH
- Myoglobin drug effects MeSH
- Myoglobinuria therapy MeSH
- Burns, Electric * complications therapy MeSH
- Rhabdomyolysis * diagnostic imaging diagnosis therapy MeSH
- Treatment Outcome MeSH
- Check Tag
- Humans MeSH
- Young Adult MeSH
- Male MeSH
- Publication type
- Case Reports MeSH
This work proposes a deep study on the interactions between sulphonate-terminated carbosilane dendrimers and proteins. Three different proteins with different molecular weights and isoelectric points were employed and different pHs, dendrimer concentrations and generations were tested. Variations in fluorescence intensity and emission wavelength were used as protein-dendrimer interaction probes. Interaction between dendrimers and proteins greatly depended on the protein itself and pH. Other important issues were the dendrimer concentration and generation. Protein-dendrimer interactions were favored under acidic working conditions when proteins were positively charged. Moreover, in general, high dendrimer generations promoted these interactions. Modeling of protein-dendrimer interactions allowed to understand the different behaviors observed for every protein.
- MeSH
- Dendrimers chemistry MeSH
- Spectrometry, Fluorescence MeSH
- Isoelectric Point MeSH
- Hydrogen-Ion Concentration MeSH
- Horses MeSH
- Chickens MeSH
- Molecular Weight MeSH
- Muramidase chemistry MeSH
- Myoglobin chemistry MeSH
- Serum Albumin, Bovine chemistry MeSH
- Silanes chemistry MeSH
- Molecular Dynamics Simulation MeSH
- Cattle MeSH
- Static Electricity MeSH
- Animals MeSH
- Check Tag
- Cattle MeSH
- Animals MeSH
- Publication type
- Journal Article MeSH
Akutní infarkt myokardu (IM) je celosvětově významnou příčinou mortality a morbidity. Včasná diagnostika tohoto onemocnění pomůže pacienty úspěšné léčit. Diagnostice a rizikové stratifikaci pomocí laboratorních cirkulujících biomarkerů se věnuje velká pozornost a byla publikována řada vědeckých prací. Cílem tohoto článku je podat ucelený přehled o těch nejzajímavějších a v současné době nejvíce zkoumaných biomarkerech u IM. Zatímco v diagnostice IM má zásadní místo troponin (především vysoce senzitivní metody) před MB-frakcí kreatinkinázy a myoglobinem, řada dalších markerů prokázala souvislost se zvýšeným výskytem následného úmrtí, reinfarktů a rozvoje srdečního selhání. Mezi ty nejdůležitější markery patří natriuretické peptidy, C-reaktivní protein, protein vážící se na mastné kyseliny srdečního typu (H fatty acid binding protein – H-FABP), s těhotenstvím asociovaný protein A (pregnancy associated plasma protein A – PAPP-A), CD146, cystatin C, NGAL, kopeptin, MR-proadrenomedulin a růstový diferenciační faktor 15. Pro jejich využití v klinické praxi je nutné provést prospektivní randomizované studie, které by prokázaly jejich přínos při vedení léčby pacientů s IM.
Acute myocardial infarction (AMI) is an important cause of mortality and morbidity worldwide. Early diagnostics of this disease helps in the appropriate treatment of patients. Great attention is paid to the diagnostic and risk stratification of patients according to circulating biomarkers. There are a lot of scientific publications describing this topic. The aim of this article is to provide a comprehensive overview of the most important and most examined biomarkers in acute coronary syndrome. Meanwhile troponin takes a fundamental place for AMI diagnostic (mostly the high-sensitive methods) in preference to MB-fraction of creatine kinase and myoglobin. The connection to a higher sudden death risk, reinfarcts and heart failure occurring was also proved by many other biomarkers. The most important of them are the natriuretic peptides, the C-reactive protein, the heart fatty acid binding protein, the pregnancy-associated plasma protein-A, CD146, cystatin C, NGAL, copeptin, MR-proadrenomedullin, and the growth differentiation factor-15. More prospective randomized studies are needed for the further use of these other biomarkers in clinical practice.
- MeSH
- Acute Coronary Syndrome * diagnosis MeSH
- Biomarkers MeSH
- C-Reactive Protein analysis MeSH
- Cystatin C physiology MeSH
- Diagnosis, Differential MeSH
- Myocardial Infarction MeSH
- Creatine Kinase MeSH
- Humans MeSH
- Myoglobin blood MeSH
- Natriuretic Peptide, Brain physiology MeSH
- Prognosis MeSH
- Growth Differentiation Factor 15 MeSH
- Practice Guidelines as Topic MeSH
- Pregnancy-Associated Plasma Protein-A MeSH
- Troponin I analysis blood MeSH
- Troponin T analysis blood MeSH
- Check Tag
- Humans MeSH
- Publication type
- Review MeSH
BACKGROUND: The mini-invasive open posterior lumbar fusion procedure (mini PLIF) procedure is an alternative to standard open procedure (open PLIF) and is intended to reduce surgery-related trauma. The measuring of suitable biochemical factors enables objective comparison of the invasiveness of spinal surgery procedures. METHODS: Prospectively collected data on myoglobin, creatine kinase, interleukin-6, C-reactive protein levels and intensity of low back pain and radicular pain in one-level mini PLIF and open PLIF procedures were analysed. The mini PLIF and the open PLIF groups included 27 and 23 patients, respectively. The collection of blood samples and clinical data were performed preoperatively and on postoperative days 1, 3 and 7. The non-paired t-test was used for statistical evaluation. RESULTS: We did not found any statistically significant differences of myoglobin and creatine kinase levels between the groups. In the open PLIF group the IL-6 levels were significantly higher than in the mini PLIF group on postoperative day 3. CRP levels showed significant lower stress response in favour of the mini PLIF group on postoperative days 3 and 7. Levels of post-op low back pain on day 3 were significantly lower in mini PLIF group. Also intensity of radicular pain on day 1 and 3 were lower also mini PLIF group. CONCLUSION: The extent of myonecrosis was comparable in both techniques. The analysis of the IL-6 and CRP levels showed significantly lower systemic inflammatory response in mini PLIF technique. The mini PLIF technique provides transiently lower postoperative pain levels.
- MeSH
- Lumbar Vertebrae surgery MeSH
- C-Reactive Protein MeSH
- Spinal Fusion methods MeSH
- Outcome Assessment, Health Care * MeSH
- Interleukin-6 blood MeSH
- Creatine Kinase blood MeSH
- Middle Aged MeSH
- Humans MeSH
- Low Back Pain blood physiopathology MeSH
- Minimally Invasive Surgical Procedures methods MeSH
- Myoglobin blood MeSH
- Postoperative Complications blood physiopathology MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Comparative Study MeSH
