first-in-man study
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Kazuistika popisuje případ mladého muže s diagnostikovaným akutním infarktem myokardu, v anamnéze bez významnějších kardiovaskulárních rizik, kromě kouření. Podle změn v krevním obraze byla jako příčina vzniku infarktu myokardu určena trombocytóza, která byla následně diagnostikována jako esenciální trombocytémie. Esenciální trombocytémie je vzácné onemocnění častěji se vyskytující spíše u starší populace, výskyt v mladším věku je ojedinělý, ale přesto je důležité na tuto diagnózu myslet. Tato kazuistika chce upozornit na riziko vzniku trombotických komplikací u esenciální trombocytémie. Aby bylo možné předejít těmto mnohdy fatálním komplikacím, je důležitá včasná diagnostika, určení míry rizika vzniku komplikací a následná léčba či sledování vývoje tohoto onemocnění. Obecně je hlavní příčinou vzniku infarktu myokardu ateroskleróza, nicméně u mladších pacientů je nutné myslet i na méně obvyklé rizikové faktory, jako je např. právě esenciální trombocytémie. Klíčová slova: esenciální trombocytémie – infarkt myokardu – trombocytóza – trombóza
The case study describes a young man diagnosed with acute myocardial infarction, without a history of significant cardiovascular risk factors – apart from smoking. Based on the changes in the blood picture, thrombocytosis was determined as the cause of the myocardial infarction, which was subsequently diagnosed as essential thrombocythemia. Essential thrombocythemia is a rare disease more frequently occurring in the elderly population. An incidence at younger age is rare, but it is vital not to forget about this diagnosis. The aim of this case report is to draw attention to the risk of thrombotic complications in essential thrombocythemia. In order to prevent these often fatal complications, it is important to make an early diagnosis, determine the risk of complications and carry out a follow-up treatment or monitoring of the development of this disease. Generally, the main cause of myocardial infarction is atherosclerosis; however, in younger patients it is also necessary to think of less common risk factors such as essential thrombocythemia. Keywords: essential thrombocythemia – myocardial infarction – thrombocytosis – thrombosis
- MeSH
- biochemická analýza krve MeSH
- dospělí MeSH
- echokardiografie MeSH
- esenciální trombocytemie * diagnóza komplikace patofyziologie terapie MeSH
- infarkt myokardu etiologie MeSH
- klinický obraz nemoci MeSH
- koronární angiografie MeSH
- lidé MeSH
- příznaky a symptomy MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
Background: Refractory angina pectoris (AP) significantly impairs quality of life in patients with chronic coronary syndrome. Several minimally invasive methods (coronary sinus reducer, cell therapy, laser or shockwave revascularization, and spinal cord stimulation) or non-invasive methods (external counterpulzation) have been studied. However, their routine clinical use has not been widely implemented. Surgical or endoscopic sympathectomy is feasible for permanently relieving angina, but is often contraindicated due to the extent of complications associated with it. Neuromodulation by anaesthetic blockade of the left-sided stellate ganglion (SG) has been shown to relieve angina for days or weeks. To provide a long-term anti-anginal effect, novel pharmacological (phenol-based) or radiofrequency ablation techniques have been individually used to permanently destroy sympathetic pathways. Case summary: We describe a first-in-man use of stereotactic radiosurgical SG ablation using a linear accelerator (CyberKnife) in a heart failure patient after myocardial infarction with chronic refractory AP. Repeated anaesthetic SG blockade in this patient resulted in a significant, but only short-term, clinical improvement. The left, and subsequently the right, SG was ablated by targeted irradiation. During the 1-year follow-up, the patient remained without angina. We did not observe any clinically relevant early or late complications. Atrial fibrillation that developed 2 months after the second procedure was deemed to be associated with a natural progression of co-existing heart failure. Discussion: We conclude that stereotactic radiosurgical SG ablation has the potential to become a minimally invasive and low-risk procedure to treat refractory angina patients. However, this procedure needs to be evaluated in larger patient populations.
- Publikační typ
- kazuistiky MeSH
18 chronic diseases were investigated in a population of 13,115 women living in six settings of West- (Avon UK, the Isle of Man), Central- (the Czech Republic and the Slovak Republic) and East-Europe (the Ukraine and Russia), that collaborate in the European Longitudinal Study of Pregnancy and Childhood (ELSPAC project). In prenatal questionnaires filled in after the first half of pregnancy, women reported 25,795 chronic diseases they ever suffered, out of them 11,188 having in present pregnancies. In the whole sample, lifelong prevalence was 11,2%, and prevalence in pregnancy 4,8% which means that 43,4% of all chronic diseases recurred in pregnancy. Up to mean age of 255 years in the whole sample, 39,6% women reported ever having indigestion, 29% back pains, 22,6% migraine, about 16% haemorrhoids, hay fever and eczema, about 10% varicose veins, anorexia nervosa, heavy depression and kidney diseases, over 5% rheumatism and 4% asthma. Less prevalent were infections of pelvic organs, febrile convulsions, joint inflammations, stomach ulcers, psoriasis and epilepsy. Lifetime prevalence of chronic diseases and their prevalence in pregnancy were the highest in the western zone and decreased eastwards, but recurrence grew in the opposite direction, being the highest in the eastern zone. The variation of each morbidity indicator is followed in all diseases between geographical zones as well as between individual study centres.
- MeSH
- chronická nemoc epidemiologie MeSH
- financování organizované MeSH
- komplikace těhotenství epidemiologie MeSH
- lidé MeSH
- longitudinální studie MeSH
- morbidita MeSH
- prevalence MeSH
- průzkumy a dotazníky MeSH
- těhotenství MeSH
- Check Tag
- lidé MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- srovnávací studie MeSH
- Geografické názvy
- Evropa MeSH
The emotion of disgust protects individuals against pathogens, and it has been found to be elevated during pregnancy. Physiological mechanisms discussed in relation to these changes include immune markers and progesterone levels. This study aimed to assess the association between steroids and disgust sensitivity in pregnancy. Using a prospective longitudinal design, we analyzed blood serum steroid concentrations and measured disgust sensitivity via text-based questionnaires in a sample of 179 pregnant women during their first and third trimesters. We found positive correlations between disgust sensitivity and the levels of C19 steroids (including testosterone) and its precursors in the Δ5 pathway (androstenediol, DHEA, and their sulfates) and the Δ4 pathway (androstenedione). Additionally, positive correlations were observed with 5α/β-reduced C19 steroid metabolites in both trimesters. In the first trimester, disgust sensitivity was positively associated with 17-hydroxypregnanolone and with some estrogens. In the third trimester, positive associations were observed with cortisol and immunoprotective Δ5 C19 7α/β-hydroxy-steroids. Our findings show that disgust sensitivity is positively correlated with immunomodulatory steroids, and in the third trimester, with steroids which may be related to potential maternal-anxiety-related symptoms. This study highlights the complex relationship between hormonal changes and disgust sensitivity during pregnancy.
- MeSH
- dospělí MeSH
- lidé MeSH
- longitudinální studie MeSH
- mladý dospělý MeSH
- odpor * MeSH
- prospektivní studie MeSH
- první trimestr těhotenství MeSH
- steroidy krev MeSH
- těhotenství MeSH
- třetí trimestr těhotenství krev MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mladý dospělý MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
Hebefrenní (desorganizovaná) schizofrenie je vzácnější formou schizofrenie chrakterizovanou především klinickým obrazem a průběhem. Patofyziologie a charakteristické změny metabolizmu mozku u tohoto podtypu nejsou dosud prozkoumané. V kazuistickém sdělení jsou prezentovány výsledky vyšetření pomocí 18FDG (18F-deoxuglukóza) PET a qEEG (kvantitativní elektroencefalografie) osmnáctiletého pacienta s první epizodou hebefrenní schizofrenie. Metodika: Mozkový metabolizmus byl vyšetřen pomocí 18FDG PET v klidovém stavu. Pomocí jednovýběrového t-testu (SPM99) byl porovnán metabolizmus s kontrolní skupinou zdravých jedinců. 3D intracerebrální rozložení mozkové elektrické aktivity (proudová hustota) bylo získáno z povrchového EEG za použití metody Low Resolution Brain Electromagnetic Tomography (LORETA). Výsledky: Nalezli jsme zvýšení vychytávání 18FDG v uncu, středním a horním temporálním gyru a dolním a středním frontálním gyru a precuneu na pravé straně, v levém dolním parietálním lobulu, horním temporálním gyru a oboustranně pak v claustru a okcipitálních oblastech a okcipitálně bilaterálně. Snížení metabolizmu bylo nalezeno pouze v pravém precentrálním gyru (p = 0,001). Ve srovnání se zdravými kontrolami jsme nalezli signifikantní zvýšení proudové hustoty v delta pásmu na pravé straně v dolním a středním frontálním gyru, dolním temporálním a středním okcipitálním gyru, cuneu a také v limbických strukturách: v uncu, zadním cingulu a inzule. Vlevo bylo zvýšení proudových hustot patrné v horním frontálním gyru, středním temporálním gyru, cingulu a precuneu. V theta pásmu jsme identifikovali zvýšení proudové hustoty v dolním a horním frontálním gyru, dolní části gyrus precentralis a horním temporálním gyru. V beta3 pásmu jsme nalezli signifikantně nižší proudovou hustotu v parietální oblasti precuneu (p = 0,001). Ve frekvenčních pásmech alfa1, alfa2, beta1 a beta2 jsme signifikantní rozdíly nenalezli. Shrnutí: Naše data poukazují na dominantní nárůst mozkového metabolizmu a změnu elektrické aktivity v pravých fronto-temporo-limbických a parietálních strukturách jako podklad neurobiologické dysfunkce u hebefrenní schizofrenie. Výsledky kvantitativní analýzy EEG s použitím metody LORETA jsou v souladu s publikovanými nálezy metabolických i neurofyziologických změn u pacientů se schizofrenií.
Hebephrenic (disorganized) schizophrenia is an uncommon type characterized by clinical course and symptoms. The pathophysiology and metabolic brain changes (regional brain metabolizm) of this type are not well established. In our case study we present results of 18FDG PET (18F-deoxyglucose Positron Emission Tomography) and qEEG (quantitative EEG analysis) investigation of an 18-years old man with the first episode of disorganized schizophrenia. Methods: The regional brain metabolizm was investigated by the use of 18FDG PET in the resting state. The one-sample t-test (SPM99) was used to determine the differences between the hebephrenic patient and the control group of healthy people. The 3D intracerebral distribution of neuronal electrical activity (current density) from the scalp-recorded potential distribution was assessed with Low Resolution Brain Electromagnetic Tomography (LORETA) qEEG. Results: We found increased metabolism in the uncus, middle and superior temporal gyrus, inferior and middle frontal gyrus and precuneus on the right side, in the left inferior parietal lobulus and superior temporal gyrus and in the occipital regions bilaterally. The lower metabolism (18FDG uptake) was found only in the right precentral gyrus (p = 0.001). In comparison with healthy controls, we found a significantly higher current density in the delta band on the right side particularly in the inferior and middle frontal gyrus, inferior temporal and middle occipital gyrus, cuneus and also in limbic structures: in the uncus, posterior cingulum, and insula. On the left side, the current density was higher in superior frontal gyrus, middle temporal gyrus, cingulum and precuneus. In the theta band, we identified higher current density in inferior and superior frontal gyrus, inferior part of gyrus praecentralis and superior temporal gyrus. In the beta3 band, we found a significant decrease of current density in the precuneus (p = 0.001). In the frequency bends alfa1, alfa2, beta1 and beta2, we did not found any significant changes in current density. Conclusions: Our data indicate the increase of brain metabolism in the right fronto-temporo-limbic and parietal structures as the substrate for the characteristic neurobiological dysfunction in the hebephrenic schizophrenia. The results of quantitative analysis of EEG (LORETA) are in accordance with previous studies focused on metabolic and neurophysiologic changes in schizophrenia.
- MeSH
- dezorganizovaná schizofrenie diagnóza farmakoterapie terapie MeSH
- elektroencefalografie metody MeSH
- finanční podpora výzkumu jako téma MeSH
- lidé MeSH
- mladiství MeSH
- mozek metabolismus MeSH
- pozitronová emisní tomografie metody MeSH
- Check Tag
- lidé MeSH
- mladiství MeSH
- mužské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
OBJECTIVE: Human resources are crucial for addiction treatment and prevention services, as well as for science and research. The aim of this historical case study is to explain and demonstrate the role of specialized university academic degree study programmes in addictions in the context of a national institutional infrastructure. This specific group of very highly specialized academic programmes represents the highest level of professional development and is producing a totally new generation of addiction specialists with a very distinctive professional identity. METHODS: The study protocol is based on a case study research design and the case is defined as the historical development of addiction specialized institutions closely related to self-help, prevention, and treatment activities on the historical territory of the Czech Republic. We identified relevant historical sources related to establishing and/or running activities or institutions according to the categories specified in our concept of the national institutional infrastructure. All the materials and sources that were collected were sorted according to a timeline and categories of institutions and we systematically determined the first recorded activity/institution in each particular category. For this simple sorting system we used open and selected coding according to Grounded Theory. RESULTS: The public health model developed by Thomas Babor recognizes six different structural mechanisms to support university-based programmes in addiction studies: specialized journals, research centres, professional societies, specialized libraries and documentation centres, training and education programmes and institutions, and funding agencies. We attempted to redefine the concept of addiction studies within the broader context of the addiction field and added three additional mechanisms of support: public interest groups, self-help groups, and service providers. Using a historical case study in the Czech Republic, we demonstrate the potential for a broader context and interaction between these support mechanisms and academic institutions hosting academic programmes in addiction studies. CONCLUSION: The process of establishing integrated addiction studies programmes at Charles University in the Czech Republic had its origins in, and support from, various national institutions and professional organizations. This allowed the university to develop academic programmes at the bachelor's, master's, and Ph.D. levels. The availability of career opportunities for advanced-level addiction professionals in the Czech Republic was also a critically important factor in developing sustainable academic programmes in addiction studies. Our experience is that the creation of successful and sustainable academic programmes for addiction professionals is difficult to achieve without broad infrastructure support, national advocacy efforts, and legislative change at the national level.
- MeSH
- adiktologie výchova MeSH
- dějiny 21. století MeSH
- hodnocení programu MeSH
- lidé MeSH
- případové studie organizací MeSH
- studium lékařství dějiny organizace a řízení MeSH
- Check Tag
- dějiny 21. století MeSH
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- historické články MeSH
- Geografické názvy
- Česká republika MeSH
