Praktický komentář
Vydání první xi, 323 stran ; 18 cm
Publikace obsahuje komentář aktuálního českého zákona, který se zaměřuje na nelékařská povolání. Určeno odborné veřejnosti.
- MeSH
- nelékařská zdravotnická povolání MeSH
- zákonodárství lékařské MeSH
- Publikační typ
- komentáře MeSH
- Geografické názvy
- Česká republika MeSH
- Konspekt
- Právo
- NLK Obory
- právo, zákonodárství
- NLK Publikační typ
- zákony
CONTEXT: Active surveillance (AS) is a standard of care for patients with low-risk and selected intermediate-risk prostate cancer (PCa). Nevertheless, there is a lack of summary evidence on how to impact disease trajectory during AS. OBJECTIVE: To assess which interventions prevent PCa progression effectively during AS. EVIDENCE ACQUISITION: We queried PubMed, Scopus, and Web of Science databases to identify studies examining the impact of interventions aimed at slowing disease progression during AS. The primary endpoint was PCa progression, the definition of which must have included pathological upgrading. The secondary endpoint included treatment toxicities. EVIDENCE SYNTHESIS: We identified 22 studies, six randomized controlled trials and 16 observational studies, which analyzed the association between different interventions and PCa progression during AS. The interventions considered in the studies included 5-alpha reductase inhibitors (5-ARIs), statins, diet, exercise, chlormadinone, fexapotide triflutate (FT), enzalutamide, coffee, vitamin D3, and PROSTVAC. We found that administration of 5-ARIs was associated with improved progression-free survival (PFS; hazard ratio: 0.59; 95% confidence interval 0.48-0.72), with no increased toxicity signals. Therapies such as vitamin D3, chlormadinone, FT, and enzalutamide have shown some efficacy. However, these anticancer drugs have been associated with treatment-related adverse events in up to 88% of patients. CONCLUSIONS: The use of 5-ARIs in PCa patients on AS is associated with longer PFS. However, for the other interventions, it is difficult to draw clear conclusions based on the weak available evidence. PATIENT SUMMARY: Patients with prostate cancer managed with active surveillance (AS) who are treated with 5-alpha reductase inhibitors have a lower risk of disease progression, with minimal adverse events. Other interventions require more studies to determine their efficacy and safety profile in men on AS.
- MeSH
- inhibitory 5-alfa-reduktasy terapeutické užití MeSH
- lidé MeSH
- nádory prostaty * farmakoterapie patologie terapie MeSH
- pozorné vyčkávání * MeSH
- progrese nemoci * MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- metaanalýza MeSH
- přehledy MeSH
- systematický přehled MeSH
Parapharyngeal abscess in an infant is a very rare condition. We present the case of a 4-month-old girl with large masses on the neck's left side. Computed tomography showed an extensive parapharyngeal abscess. Left tonsillectomy was performed under general anesthesia from a transoral approach, followed by an incision and evacuation of the abscess from the parapharyngeal space. Microbiological analysis identified a massive occurrence of Streptococcus intermedius.
- MeSH
- absces * mikrobiologie chirurgie MeSH
- kojenec MeSH
- lidé MeSH
- nemoci faryngu mikrobiologie chirurgie MeSH
- počítačová rentgenová tomografie MeSH
- spatium parapharyngeum * chirurgie diagnostické zobrazování mikrobiologie MeSH
- Streptococcus intermedius izolace a purifikace MeSH
- streptokokové infekce * mikrobiologie chirurgie MeSH
- tonzilektomie MeSH
- Check Tag
- kojenec MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
Burns are a major global healthcare concern, often complicated by the presence of bacteria such as Pseudomonas aeruginosa in the wounds. Silver-based dressings are commonly used in the treatment of burns but can cause skin irritation and delay healing time. Medical-grade honey (MGH) provides an interesting alternative. This study investigated the antimicrobial effects and possible cytotoxicity of L-Mesitran Soft (MGH-gel) and its individual components, Medihoney (Manuka), Flammazine (silver sulphadiazine), and silver nitrate (AgNO3) in an ex vivo human burn wound model. Bacterial survival and wound healing parameters, including re-epithelialization and keratinocyte proliferation were assessed. L-Mesitran, Flammazine, and AgNO3 reduced P. aeruginosa numbers below detection levels. L-Mesitran Soft exhibited a significantly stronger antimicrobial effect compared to Medihoney. The individual components of L-Mesitran contributed significantly to its antibacterial efficacy, thus suggesting synergistic activities. Moreover, L-Mesitran, Flammazine, and AgNO3 slightly inhibited re-epithelialization while Medihoney treatment resulted in a complete lack of re-epithelialization and keratinocyte proliferation. Furthermore, clinical cases illustrated the effectiveness of MGH therapy in infected burns. Overall, L-Mesitran Soft had similar effects as silver-based products on bacterial load and epidermal regeneration, but outperformed Medihoney. Therefore, supplemented MGH could be used as an effective alternative to silver-based dressings for P. aeruginosa-infected burns.
Rhizarthrosis is accompanied by decreased mobility, poor grip, and progressive pain. Surgical treatment, which involves various techniques, is the only definitive solution sparing the joint. First carpometacarpal (CMC) joint arthroplasty helps reduce the discomfort associated with rhizarthrosis and restores joint function. From 2020 to the end of March 2024, 35 arthroplasties of the first CMC joint have been performed. In this study, the implant survival was recorded at a five-year follow-up. Evaluation of functional outcomes was conducted using preoperative and postoperative Disabilities of the Arm, Shoulder, and Hand (DASH), visual analogue scale (VAS), and Kapandji scores. Two types of implants were used, and their postoperative DASH and Kapandji scores were compared. The one-year implant survival was 0.97, and the three-year implant survival was 0.86. Range of motion showed significant improvement in patients after the first CMC arthroplasty. The VAS score, which assesses pain, and the DASH score, used to subjectively assess upper extremity disability, showed similar postoperative improvement. There is no significant difference in postoperative outcomes (DASH score and Kapandji score) between the "standard" and "dual mobility" implant types when evaluating postoperative outcomes. One intraoperative and two postoperative complications were observed in this study. First CMC joint arthroplasty effectively relieves pain, improves range of motion, and enhances functional outcomes in patients with rhizarthrosis. Both implant types demonstrated similar postoperative results in terms of DASH and Kapandji scores. While the study observed a few complications, the overall results support the efficacy of first CMC joint arthroplasty as a reliable treatment option for restoring joint function and reducing pain.
- Publikační typ
- časopisecké články MeSH
This literature review provides a novel exploration of zinc's multifaceted roles in dermatology, with a particular focus on its potential integration into botulinum toxin formulations-an area that remains relatively underexplored in clinical practice. Zinc is widely recognized for its critical functions in skin health, including morphogenesis, regeneration, and protection, and its use in aesthetic medicine offers a unique opportunity for innovation. Specifically, incorporating zinc into botulinum toxin formulations could enhance the efficacy and stability of these treatments. Although zinc has historically been used in topical dermatological products and systemic health interventions, its potential in cosmetic preparations, such as anti-aging therapies or non-invasive aesthetic treatments, remains under-researched. Emerging patents suggest promising formulations combining zinc with botulinum toxin that may improve product stability and extend therapeutic effects. While current studies on oral zinc supplementation present mixed results concerning its ability to prolong botulinum toxin effects, this underscores the need for more rigorous investigation in the realm of aesthetic medicine. Zinc's well-established role in stabilizing dermatological products, such as sunscreens, and its applications in wound healing and skin regeneration, further highlights its potential for broader therapeutic uses beyond cosmetic applications. This review identifies a critical gap in the literature and calls for future research to optimize zinc concentrations and delivery methods specifically for aesthetic medical procedures, offering new insights into improving dermatological treatments beyond the scope of traditional cosmetic preparations.
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
A newly identified subtype of hereditary axonal motor neuropathy, characterized by early proximal limb involvement, has been discovered in a cohort of 34 individuals with biallelic variants in von Willebrand factor A domain-containing 1 (VWA1). This study further delineates the disease characteristics in a cohort of 20 individuals diagnosed through genome or exome sequencing, incorporating neurophysiological, laboratory and imaging data, along with data from previously reported cases across three different studies. Newly reported clinical features include hypermobility/hyperlaxity, axial weakness, dysmorphic signs, asymmetric presentation, dystonic features and, notably, upper motor neuron signs. Foot drop, foot deformities and distal leg weakness followed by early proximal leg weakness are confirmed to be initial manifestations. Additionally, this study identified 11 novel VWA1 variants, reaffirming the 10 bp insertion-induced p.Gly25ArgfsTer74 as the most prevalent disease-causing allele, with a carrier frequency of ∼1 in 441 in the UK and Western European population. Importantly, VWA1-related pathology may mimic various neuromuscular conditions, advocating for its inclusion in diverse gene panels spanning hereditary neuropathies to muscular dystrophies. The study highlights the potential of lower quality control filters in exome analysis to enhance diagnostic yield of VWA1 disease that may account for up to 1% of unexplained hereditary neuropathies.
- Publikační typ
- časopisecké články MeSH
BACKGROUND: Alemtuzumab (ALEM) is a humanised monoclonal antibody that depletes circulating lymphocytes by selectively targeting CD52, which is expressed in high levels on T- and B-lymphocytes. This depletion is followed by lymphocyte repopulation and a cytokine expression shift towards a lesser inflammatory profile, both of which may contribute to prolonged efficacy. National recommendations for enrolling and treating multiple sclerosis (MS) patients with ALEM have been established. However, there are no recommendations in place for the treatment of MS reactivation after the ALEM treatment. OBJECTIVES: To evaluate the effectiveness and safety of the use of ALEM and to analyse subsequent disease-modifying treatments (DMTs). A multidimensional prediction model was developed to make a patient-specific prognosis regarding the response to ALEM. DESIGN: A multicentre, prospective, non-controlled, non-interventional, observational cohort study. METHODS: Relapsing multiple sclerosis patients (RMSp) who received ⩾1 dose of ALEM were enrolled. In each treatment year, the following baseline and prospective data were collected: age, MS history, number, type and duration of previous disease-modifying treatment (PDMT), relapse rate (REL), expanded disability status scale (EDSS), magnetic resonance imaging and serious adverse events (AE). In cases of reactivation of MS, all data about the subsequent DMT were collected. RESULTS: A total of 142 RMSp from 10 MS Slovak Centres fulfilled the inclusion criteria. The average age was 35 years (standard error 8.56). The overall average EDSS was 3.87 (1.46) when ALEM was started. The average duration of PDMT was 6.0 (4.04) years, and the median number of PDMTs was 3 (0-5), while the patients were mostly treated with 2 or 3 DMTs (>65.00%). Post-ALEM treatment was needed in 39 cases (27.46%). The most frequent post-ALEM treatment indicated was ocrelizumab, followed by natalizumab (NAT), siponimod and cladribine. The ocrelizumab and NAT treatment bring little benefit to patients. Siponimod showed less EDSS increase in contrast to ocrelizumab and NAT. Another repopulation therapy, cladribine, may also be an effective option. Statistically significant predictors for the expected EDSS are age (p-value <0.0001), number of ALEM cycles (0.0066), high number of PDMT (0.0459) and the occurrence of relapses (<0.0001). There was no statistically significant effect on the patient's gender (0.6038), duration of disease-modifying treatment before alemtuzumab (0.4466), or the occurrence of AE (0.6668). CONCLUSION: The study confirms the positive effect of ALEM on clinical and radiological outcomes. We need more data from long-term sequencing studies.
- Publikační typ
- časopisecké články MeSH
BACKGROUND: Childhood overweight and obesity are global health concerns associated with insufficient physical activity (PA), excessive sedentary behaviour (SB), and inadequate sleep. This study aimed to determine whether differences exist in 24 h movement behaviours between Czech non-overweight children and children with overweight/obesity aged 3-10 years, with respect to their gender, age, or family socioeconomic status (SES). METHODS: A total of 381 children (49.9% girls), aged 3-10 years, participated. Their PA, SB, and sleep were continuously monitored over a regular week using wrist-worn accelerometers. Weight status was determined by BMI z-scores, according to World Health Organization standards. SES was assessed using the Family Affluence Scale. RESULTS: Non-overweight children had averages of 414 min of PA, 472 min of SB, and 554 min of sleep per day, while children with overweight/obesity had averages of 392 min of PA, 503 min of SB, and 545 min of sleep. Non-overweight children engaged in significantly more PA (22 min per day; p = 0.014) and significantly less SB (31 min per day; p = 0.002) than children with overweight/obesity. No significant differences were found between the weight groups in gender distribution, age, family SES, or maternal and paternal obesity. CONCLUSIONS: Non-overweight children exhibited higher levels of PA and lower levels of SB compared to their counterparts with overweight/obesity, independent of gender, age, or family SES. These findings highlight an association between daily movement behaviours and weight status in young children. Further research is needed to explore the impact of modifying PA and SB on weight outcomes.
- Publikační typ
- časopisecké články MeSH
Ocrelizumab is a second generation recombinant humanized IgG1 monoclonal antibody used for the treatment of multiple sclerosis that selectively target B cells expressing the CD20 antigen. This study aimed to develop and validate a UPLC-MS/MS method for quantification of ocrelizumab in human serum, which can be used in clinical applications for therapeutic drug monitoring. The analysis of ocrelizumab was performed using a bottom-up approach on a liquid chromatography coupled to tandem mass spectrometry detection. The method involved immunoglobulin precipitation with cold methanol followed by peptide digestion with trypsin. The resulting specific peptides were separated on an Acquity UPLC BEH C18 column at 55 °C using gradient elution. The method was validated according to European Medicines Agency (EMEA) guidelines and demonstrated intra- and inter-assay precision with coefficients of variation ranging from 1.6 % to 6.1 % and accuracies between 90.2 % and 107.2 %. Stability testing, including autosampler, long-term and freeze-thaw stability, showed no more than 15 % variation. The method was successfully applied to 169 patient samples, revealing ocrelizumab concentrations ranging from 0.5 to 21.8 mg/L in patients on 6-month dosing regimen and 20.5-65.0 mg/L in 16 patients receiving an initial two-week dose of 300 mg. The newly developed UPLC-MS/MS method met all criteria for accuracy, precision and stability, confirming its suitability for clinical use in monitoring ocrelizumab levels in multiple sclerosis patients.
- MeSH
- chromatografie kapalinová metody MeSH
- humanizované monoklonální protilátky * terapeutické užití krev MeSH
- lidé MeSH
- monitorování léčiv metody MeSH
- roztroušená skleróza * farmakoterapie krev MeSH
- tandemová hmotnostní spektrometrie * metody MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
