Cíl: Observační studie pacientů diagnostikovaných s těžkou komunitní pneumonií (sCAP) sledovala hladiny interleukinu-17A a počtu T helper 17 (Th17) lymfocytů v periferní cirkulaci a tekutině z bronchoalveolární laváže (BAL) v časném průběhu komunitní pneumonie různé etiologie a porovnala je s charakteristikami pacientů a klinickým výsledkem. Materiál a metody: Kohorta 74 pacientů s těžkou komunitní pneumonií byla analyzována s identifikací jednotlivých původců pneumonie. Podle etiologie byli pacienti rozděleni do tří skupin: bakteriální, virové a smíšené etiologie. Počet Th17 lymfocytů a koncentrace IL-17A byly měřeny s využitím průtokové cytometrie a metody ELISA v periferní krvi a tekutině z BAL. Data byla porovnána podle etiologie sCAP a statistickou analýzou stanovena jejich korelace s 30a 90denní mortalitou. Výsledky: Statistická korelace mezi počtem Th17 lymfocytů a koncentrací IL-17A v krvi ani v tekutině z BAL s 30a 90denní mortalitou nebyla prokázána. Nicméně, zvýšený počet Th17 lymfocytů v periferní cirkulaci, nikoli však v tekutině z BAL, v časném průběhu sCAP koreloval se zvýšeným relativním rizikem úmrtí. Dalšími faktory zvyšujícími relativní riziko smrti byl věk a mužské pohlaví. Závěr: Hladiny Th17 a IL-17A v systémové cirkulaci v časném průběhu sCAP (v prvních 7 dnech od diagnózy) mohou korelovat s tíží a mortalitou sCAP.
Objective: Observational study of patients diagnosed with severe community acquired pneumonia (sCAP) carried out to evaluate levels of interleukin 17A (IL-17A) and T helper 17 (Th17) lymphocyte count in peripheral circulation and bronchoalveolar lavage fluid (BALF) in the early course of sCAP of different etiology and to compare them with patient’s characteristics and outcome. Material and methods: Cohort of 74 patients with sCAP was analyzed and respective microbial etiology established. According to pathogens, 3 subgroups of patients were created: bacterial, viral and mixed etiology. Th17 count and IL-17A levels were measured using flow cytometry and ELISA in peripheral blood and BALF. Data were compared with respect to etiology and their correlation with 30and 90-day mortality was statistically analyzed. Results: There was no statistically significant correlation in Th17 count and IL-17A levels in blood and BALF between etiological subgroups of CAP and no correlation was found with respect to measured parameters and 30and 90-day mortality. Nevertheless, increased Th17 cell count and IL-17A levels in peripheral blood, but not in BALF, in the early course of sCAP are correlated with increased relative risk of death from sCAP. Other factors increasing relative risk of death in patients with sCAP found in our cohort were male sex and advanced age. Conclusions: Systemic Th17 count and IL-17A levels in the early course (up to 7 days from admission) of sCAP may be correlated with severity and outcome of sCAP.
- MeSH
- buňky Th17 * imunologie MeSH
- imunologické testy metody MeSH
- infekce získané v komunitě diagnóza imunologie mortalita MeSH
- interleukin-17 * analýza imunologie MeSH
- lidé MeSH
- mikrobiologické techniky metody MeSH
- pneumonie * etiologie imunologie mortalita MeSH
- pozorovací studie jako téma metody MeSH
- prognóza MeSH
- rizikové faktory MeSH
- stupeň závažnosti nemoci MeSH
- Check Tag
- lidé MeSH
Úvod: Koronavirus typu 2, jako původce těžkého akutního respiračního syndromu (SARS-CoV-2) zapříčinil celosvětovou pandemii onemocnění COVID-19, která vypukla již koncem roku 2019. Virus postihuje různé orgány, vč. nervového systému. Tato studie zkoumá neurologické komplikace u dětí s COVID-19 nebo multisystem inflammatory syndrome in children (MIS-C) v Jihomoravském kraji (ČR), kde vysoká četnost infekce COVID-19 u dětí (35 790/100 000) umožňuje komplexní analýzu. Metodika: Data Fakultní nemocnice Brno (březen 2020 až únor 2022) byla analyzována pro dvě skupiny hospitalizovaných dětí s diagnózou COVID-19 nebo MIS-C: jednu s neurologickými komplikacemi a druhou bez neurologických komplikací. Analýza zahrnovala demografické údaje, důvod přijetí, tíži infekce a její vývoj, objektivní neurologický nález, detaily hospitalizace, přítomnost MIS-C a specifikaci terapeutických postupů. K posouzení jednotlivých faktorů ovlivňujících výskyt neurologických komplikací v rámci těchto skupin byly použity metody deskriptivní statistiky a statistické testy. Výsledky: Ze 420 hospitalizovaných dětí s COVID-19 nebo MIS-C mělo 26 (6,2 %) neurologické komplikace. Dřívější neurologický deficit zvyšoval pravděpodobnost horšího výsledného stavu (p = 0,0224). Mezi skupinami se objevily významné rozdíly v délce hospitalizace (p = 0,0012), závažnosti průběhu infekce (p = 0,0052) a výsledném stavu (p < 0,0001). Závěr: Pro lepší pochopení průběhu onemocnění a minimalizaci komplikací po infekci je zásadní průběžné sledování a další výzkum neurologických projevů u dětí s COVID-19 nebo MIS-C.
Introduction: Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has caused the enduring global COVID-19 pandemic, which has already begun in late 2019. The virus affects various organs, including the nervous system. This study investigates neurological complications in children with COVID-19 or multisystem inflammatory syndrome in children (MIS-C) in the South Moravia region (Czech republic), where a high COVID-19 rate among children (35.790/100.000) allows for a comprehensive analysis. Methods: Data from the University Hospital Brno (from March 2020 to February 2022) were analyzed to study two groups of hospitalized children diagnosed with COVID-19 or MIS-C: one experiencing neurological complications, and the other without neurological symptoms. The analysis included demographics, admission reasons, infection severity and progression, objective neurological findings, hospitalization details, MIS-C presence and therapies used. Descriptive statistics and statistical testing were employed to assess how individual factors influenced neurological complication rates within these groups. Results: Among 420 hospitalized children with COVID-19 or MIS-C, 26 (6.2%) had neurological complications. Preexisting neurological deficits increased the likelihood of worse outcomes (P = 0.0224). Significant differences in hospitalization length (P = 0.0012), infection severity (P = 0.0052), and outcome (P < 0.0001) occurred between groups. Conclusion: Continuous monitoring and further research on neurological complications in children with COVID-19 or MIS-C are crucial for better understanding of the course of the disease and minimize complications after infection.
BACKGROUND: Heart failure (HF) is a frequent cause of morbidity and mortality of end-stage kidney disease (ESKD) patients on hemodialysis. It is not easy to distinguish HF from water overload. The traditional HF definition has low sensitivity and specificity in this population. Moreover, many patients on hemodialysis have exercise limitations unrelated to HF. Therefore, we postulated two new HF definitions ((1) Modified definition of the Acute Dialysis Quality Improvement working group; (2) Hemodynamic definition based on the calculation of the effective cardiac output). We hypothesize that the newer definitions will better identify patients with higher number of endpoints and with more advanced structural heart disease. METHODS: Cohort, observational, longitudinal study with recording predefined endpoints. Patients (n = 300) treated by hemodialysis in six collaborating centers will be examined centrally in a tertiary cardiovascular center every 6-12 months lifelong or till kidney transplantation by detailed expert echocardiography with the calculation of cardiac output, arteriovenous dialysis fistula flow volume calculation, bio-impedance, and basic laboratory analysis including NTproBNP. Effective cardiac output will be measured as the difference between measured total cardiac output and arteriovenous fistula flow volume and systemic vascular resistance will be also assessed non-invasively. In case of water overload during examination, dry weight adjustment will be recommended, and the patient invited for another examination within 6 weeks. A composite major endpoint will consist of (1) Cardiovascular death; (2) HF worsening/new diagnosis of; (3) Non-fatal myocardial infarction or stroke. The two newer HF definitions will be compared with the traditional one in terms of time to major endpoint analysis. DISCUSSION: This trial will differ from others by: (1) detailed repeated hemodynamic assessment including arteriovenous access flow and (2) by careful assessment of adequate hydration to avoid confusion between HF and water overload.
- MeSH
- chronická renální insuficience * komplikace MeSH
- chronické selhání ledvin * diagnóza terapie komplikace MeSH
- dialýza ledvin škodlivé účinky MeSH
- lidé MeSH
- longitudinální studie MeSH
- pozorovací studie jako téma MeSH
- srdeční selhání * diagnóza etiologie terapie MeSH
- voda MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- protokol klinické studie MeSH
- Geografické názvy
- Česká republika MeSH
V populaci s genetickým rizikem (GR+, HLA DQ2/DQ8 pozitivní) rozvoje CD (celiakie) výlučné nebo žádné kojení a delší doba kojení nesnížily riziko vzniku CD/CDA (pozitivita antitransglutaminázy nebo antiendomysiálních protilátek) v dětství při zavedení lepku nebyla spojena s kumulativním rizikem CD/CDA. Důkazy ze šesti observačních studií naznačují, že konzumace vyššího množství lepku při odstavení a/nebo po něm může zvýšit riziko CD. Neexistují dostatečné důkazy pro stanovení množství lepku spojeného se zvýšeným rizikem CD/CDA. Pokud jde o to, zda postupy kojenecké výživy modulují riziko spojené s různými genotypy HLA, výsledky byly nekonzistentní.
In the population at genetic risk of developing CD (HLA DQ2/DQ8-positive), exclusive or any breastfeeding and longer breastfeeding duration did not reduce the risk of developing CD/CDA during childhood. Age at gluten introduction was not associated with cumulative CD/CDA risk. Evidence from six observational studies suggests that consumption of a higher amount of gluten at weaning and/or thereafter may increase CD risk. There is insufficient evidence to determine the amount of gluten associated with an increased CD/CDA risk. Regarding whether infant feeding practices modulate the risk conferred by different HLA genotypes results were inconsistent.
- MeSH
- celiakie * genetika MeSH
- fyziologie výživy kojenců * MeSH
- gluteny škodlivé účinky MeSH
- klinická studie jako téma MeSH
- kohortové studie MeSH
- kojenec MeSH
- kojení MeSH
- lidé MeSH
- odstavení MeSH
- pozorovací studie jako téma MeSH
- riziko MeSH
- Check Tag
- kojenec MeSH
- lidé MeSH
- Publikační typ
- tabulky MeSH
As the world population ages, there will be an increasing need for effective therapies for aging-associated neurodegenerative disorders, which remain untreatable. Dementia due to Alzheimer's disease (AD) is one of the leading neurological diseases in the aging population. Current therapeutic approaches to treat this disorder are solely symptomatic, making the need for new molecular entities acting on the causes of the disease extremely urgent. One of the potential solutions is to use compounds that are already in the market. The structures have known pharmacokinetics, pharmacodynamics, toxicity profiles, and patient data available in several countries. Several drugs have been used successfully to treat diseases different from their original purposes, such as autoimmunity and peripheral inflammation. Herein, we divulge the repurposing of drugs in the area of neurodegenerative diseases, focusing on the therapeutic potential of antineoplastics to treat dementia due to AD and dementia. We briefly touch upon the shared pathological mechanism between AD and cancer and drug repurposing strategies, with a focus on artificial intelligence. Next, we bring out the current status of research on the development of drugs, provide supporting evidence from retrospective, clinical, and preclinical studies on antineoplastic use, and bring in new areas, such as repurposing drugs for the prion-like spreading of pathologies in treating AD.
- MeSH
- Alzheimerova nemoc * farmakoterapie MeSH
- antitumorózní látky * farmakologie terapeutické užití chemie MeSH
- demence * farmakoterapie MeSH
- lidé MeSH
- pozorovací studie jako téma MeSH
- přehodnocení terapeutických indikací léčivého přípravku * MeSH
- preklinické hodnocení léčiv MeSH
- zvířata MeSH
- Check Tag
- lidé MeSH
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- přehledy MeSH
Introduction: Thermoregulation is a complex process in the human body with the ability to maintain a constant optimal body temperature. Biochemical processes of the organism, as well as metabolic processes, are closely correlated with body temperature. Human temperature is determined by several laws, in particular metabolic production and heat flow between the organism and the environment. For the proper functioning of the organs in the human body, it is essential to maintain a constant optimum body temperature. This can be disturbed by inadequate internal and external factors and thermal discomfort can affect the patient's overall outcome. Aim: The aim of this study is to evaluate the development of body temperature in critically ill patients in the emergency department and its effect on overall patient outcome. Design: Quasi-experiment. Methods: Direct observation was performed, including measurement and analysis of body temperature in patients with serious condition in emergency admission. Data were collected in the emergency department of a teaching hospital with a trauma center status between March and December 2021. Statistical tests were evaluated at the level of statistical significance α=0.05. Results: The study population consisted of 274 (100%) patients. Most negative readings were recorded at the time of patient admission. During the course of treatment, there was a gradual adjustment of body temperature to the physiological limit. The resulting body temperature values were within the desired or expected parameters. In terms of a more detailed description, the most significant values were identified in patients with cardiac problems. Conclusions: Knowing the direction of body temperature skew can be considered beneficial. Early correction of pathological values can have a major effect on the overall outcome of the patient.
Ciele: Dvojrozmerná „speckle tracking“ (2D ST) analýza umožňuje zhodnotenie deformácie myokardu a môže byť využitá v determinácii funkcie ľavej komory (ĽK) a ľavej predsiene (ĽP). Cieľom našej štúdie bolo porovnať výsledky globálneho longitudinálneho „strain“ ĽK (LV‐GLS) a „reservoir strain“ ĽP (R ‐LAS) medzi pacientami s akútnou dekompenzáciou chronického srdcového zlyhávania (SZ) a jedincami bez známeho kardiovaskulárneho ochorenia (KVO), a taktiež pozorovať zmeny v plazmatickej koncentrácii vaskulárneho endotelového rastového faktora (VEGF) počas liečby akútnej dekompenzácie SZ. Metódy: Realizovali sme pilotnú, prospektívnu, observačnú štúdiu zahŕňajúcu 16 pacientov prijatých pre akútnu dekompenzáciu SZ. Každý pacient absolvoval transtorakálne echokardiografické vyšetrenie (TTE) vrátane 2D ST analýzy s určením hodnôt LV‐GLS a R‐LAS. Pacienti boli rozdelení na základe hodnoty ejekčnej frakcie (EF) ĽK, pričom hodnota ≤ 40 % odlišovala SZ so zachovanou ejekčnou frakciou (SZpEF) – 10 pacientov, od SZ s redukovanou ejekčnou frakciou (SZrEF) – 6 pacientov. U každého pacienta boli odobraté dve vzorky venóznej krvi na vyšetrenie plazmatickej koncentrácie VEGF – pred liečbou a po liečbe. Kontrolná skupina pozostávala zo 16 jedincov bez KVO, u každého bolo realizované TTE vyšetrenie vrátane 2D ST analýzy. Výsledky: Zistili sme, že hodnoty parametrov LV‐GLS a R‐LAS boli signifikantne nižšie u oboch podskupín SZpEF aj SZrEF v porovnaní s kontrolnou skupinou (LV‐GLS: ‐13,4 ± 4,7 % vs. ‐19,7 ± 2,5 %, p < 0,05; R‐LAS: +12,2 ± 6,9 % vs. +40,3 ± 7,4 %, p < 0,05). Navyše, medzi SZrEF a SZpEF podskupinami bol zaznamenaný signifikantný rozdiel v parametri LV‐GLS (‐9,6 ± 3,2 % vs. ‐15,2 ± 4,3 %, p < 0,05), ale nie v parametri R ‐LAS (+13,7 ± 8,6 % vs. +11,4 ± 6,2 %). Plazmatické koncentrácie VEGF po liečbe boli signifikantne vyššie v podskupine so SZpEF v porovnaní s podskupinou so SZrEF (213 ± 161 pg/ml vs. 142 ± 130 pg/ml, p < 0,05). Záver: Naša štúdia preukázala signifikantný rozdiel v parametroch LV‐GLS a R ‐LAS u všetkých pacientov so SZ v porovnaní s kontrolnou skupinou. Taktiež bol dokázaný signifikantný rozdiel v parametri LV ‐GLS medzi SZrEF a SZpEF podskupinami. Bol preukázaný aj signifikantný rozdiel v plazmatickej koncentrácii VEGF po liečbe medzi oboma podskupinami.
Aims: Two-dimensional speckle tracking (2D ST) analysis provides assessment of myocardial deformation and can be used as a diagnostic tool to determine the function of the left ventricle (LV) and the left atrium (LA). This study aimed to compare global longitudinal strain of LV (LV-GLS) and reservoir strain of LA (R-LAS) results between patients hospitalised for acute decompensation of heart failure (HF) and individuals with no known cardiovascular disease (CVD); and to observe the plasma concentration of vascular endothelial growth factor (VEGF) with treatment of acute decompensation of HF. Methods: We performed a pilot, prospective and observational study involving 16 patients hospitalised for acute decompensation of HF. Each patient underwent transthoracic echocardiography (TTE) with 2D ST and the values of LV-GLS and R-LAS were obtained. The patients were divided into 2 subgroups according to the value of the left ventricular ejection fraction (EF) using a cut-off value of ≤ 40% to distinguish heart failure with preserved ejection fraction (HFpEF) - 10 patients, from heart failure with reduced ejection fraction (HFrEF) - 6 patients. Two samples of venous blood, one before and one after treatment, were also taken in each patient to be examined for the plasma concentration of VEGF. The control involved 16 persons without a history of CVD, each of whom underwent 2D ST analysis as well. Results: We found that LV-GLS and R-LAS were significantly lower in both HFpEF and HFrEF subgroups in comparison with the control (LV-GLS: -13.4±4.7 % vs. -19.7±2.5 %, p < 0.05; R-LAS: +12.2±6.9 % vs. +40.3±7.4 %, p < 0.05). Furthermore, there was a significant difference in LV-GLS (-9.6±3.2 % vs. -15.2±4.3 %, p<0.05), but not in R-LAS (+13.7±8.6 % vs. +11.4±6.2 %) between HFrEF and HFpEF subgroups. The VEGF plasma concentrations after treatment were significantly greater in the HFpEF compared to the HFrEF group (213±161 pg/ml vs. 142±130 pg/ml, p<0.05). Conclusion: Our study showed a significant difference in LV-GLS and R-LAS in all patients with HF compared to the control. There was also a significant difference in LV-GLS between the HFrEF and HFpEF subgroups. Ultimately, there was also a significant difference in the VEGF plasma concentrations after treatment between the subgroups.
BACKGROUND: In the first part of this report, the European Association of Neurosurgical Societies' section of peripheral nerve surgery presented a systematic literature review and consensus statements on anatomy, classification, and diagnosis of thoracic outlet syndrome (TOS) along with a subclassification system of neurogenic TOS (nTOS). Because of the lack of level 1 evidence, especially regarding the management of nTOS, we now add a consensus statement on nTOS treatment among experienced neurosurgeons. OBJECTIVE: To document consensus and controversy on nTOS management, with emphasis on timing and types of surgical and nonsurgical nTOS treatment, and to support patient counseling and clinical decision-making within the neurosurgical community. METHODS: The literature available on PubMed/MEDLINE was systematically searched on February 13, 2021, and yielded 2853 results. Screening and classification of abstracts was performed. In an online meeting that was held on December 16, 2021, 14 recommendations on nTOS management were developed and refined in a group process according to the Delphi consensus method. RESULTS: Five RCTs reported on management strategies in nTOS. Three prospective observational studies present outcomes after therapeutic interventions. Fourteen statements on nonsurgical nTOS treatment, timing, and type of surgical therapy were developed. Within our expert group, the agreement rate was high with a mean of 97.8% (± 0.04) for each statement, ranging between 86.7% and 100%. CONCLUSION: Our work may help to improve clinical decision-making among the neurosurgical community and may guide nonspecialized or inexperienced neurosurgeons with initial patient management before patient referral to a specialized center.
- MeSH
- chirurgická dekomprese škodlivé účinky MeSH
- lidé MeSH
- neurochirurgické výkony škodlivé účinky MeSH
- periferní nervy chirurgie MeSH
- pozorovací studie jako téma MeSH
- prospektivní studie MeSH
- syndrom horní hrudní apertury * diagnóza chirurgie MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- systematický přehled MeSH
