INTRODUCTION AND PURPOSE: Mycobacterium (M.) chelonae is responsible for a half of relatively rare nontuberculous mycobacteria (NTM) keratitis. We report a case of M. chelonae keratitis in a woman following sclerocorneal suture extraction after cataract surgery. RESULTS: A 70-year-old woman presented with a red eye and corneal infiltration of her left eye six weeks following sclerocorneal suture extraction after an elective cataract surgery in another institute. She complained of a sharp, cutting pain and photophobia. Since initial corneal scrapes and conjunctival swabs proved no pathogen using culture and PCR methods, non-specific antibiotics and antifungal agents were administered. As keratitis was complicated by an inflammation in the anterior chamber and vitreous, samples of the vitreous fluid were sent for microbiologic examination. DNA of Epstein-Barr virus (EBV) was repeatedly detected. Since the intrastromal abscess had formed, corneal re-scrapings were performed and M. chelonae was detected using culture, MALDI-TOF MS and PCR methods. Therapy was changed to a combination of oral and topical clarithromycin, intravitreal, topical and intracameral amikacin, and oral and topical moxifloxacin. The successful therapy led to stabilization. The optical penetrating keratoplasty was performed and no signs of the infection recurrence were found. CONCLUSIONS: The diagnosis of nontuberculous mycobacterial keratitis is difficult and often delayed. An aggressive and prolonged antimicrobial therapy should include systemic and topical antibiotics. Surgical intervention in the form of corneal transplantation may be required in the active and nonresponsive infection. In the presented case this was necessary for visual rehabilitation due to scarring.

• MeSH
• amikacin terapeutické užití   MeSH
• antibakteriální látky * terapeutické užití   MeSH
• atypické mykobakteriální infekce * diagnóza   farmakoterapie   mikrobiologie   chirurgie   MeSH
• fluorochinolony terapeutické užití   MeSH
• keratitida * diagnóza   farmakoterapie   mikrobiologie   chirurgie   MeSH
• klarithromycin terapeutické užití   MeSH
• lidé MeSH
• moxifloxacin * terapeutické užití   MeSH
• Mycobacterium chelonae * izolace a purifikace   MeSH
• senioři MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH
• přehledy MeSH
• Geografické názvy
• Evropa MeSH

BACKGROUND: This study focuses on the hearing threshold for bone conduction (BC) after middle-ear surgery. METHODS: A total of 92 patients (120 ears) were treated for newly diagnosed chronic otitis media with cholesteatoma (2013-2018). BC was examined at frequencies of 0.5, 1, 2, and 4 kHz prior to and 1 year after surgery. STAM classification for cholesteatoma location, EAONO/JOS for stage, and surgery according to SAMEO-ATO classification were applied. The bone conduction threshold was compared for individual frequencies in patients with occurrence/absence of cholesteatoma in different locations. RESULTS: For the occurrence of cholesteatoma in the attic (A), a statistically significant difference was found at 4 kHz (p < 0.001), in the supratubal recess (S1) at 4 kHz (p = 0.003), and for the mastoid (M) at 0.5 kHz (p = 0.024), at 1 kHz (p = 0.032), and at 2 kHz (p = 0.039). CONCLUSIONS: Cholesteatoma location can influence the post-operative hearing threshold for bone conduction.

• Publikační typ
• časopisecké články MeSH

Bacillus cereus is relatively resistant to pasteurization. We assessed the risk of B. cereus growth during warming and subsequent storage of pasteurized banked milk (PBM) in the warmed state using a predictive mathematical model. Holder pasteurization followed by storage below -18 °C was used. Temperature maps, water activity values, and B. cereus growth in artificially inoculated PBM were obtained during a simulation of manipulation of PBM after its release from a Human Milk Bank. As a real risk level, we chose a B. cereus concentration of 100 CFU/mL; the risk was assessed for three cases: 1. For an immediate post-pasteurization B. cereus concentration below 1 CFU/mL (level of detection); 2. For a B. cereus concentration of 10 CFU/mL, which is allowed in some countries; 3. For a B. cereus concentration of 50 CFU/mL, which is approved for milk formulas. In the first and second cases, no risk was detected after 1 h of storage in the warmed state, while after 2 h of storage, B. cereus concentrations of 102 CFU/mL were occasionally encountered. In the third case, exceeding the B. cereus concentration of 102 CFU/mL could be regularly expected after 2 h of storage. Based on these results, we recommend that post-pasteurization bacteriological analysis be performed as recommended by the European Milk Bank Association (EMBA) and using warmed PBM within 1 h after warming (no exceptions).

• Publikační typ
• časopisecké články MeSH

BACKGROUND: The diagnosis of SARS-CoV-2 is almost exclusively performed by PCR or antigen detection. The detection of specific antibodies has not yet been considered in official diagnostic guidelines as major laboratory evidence for a case definition. The aim the present study is to analyze antibody responses in outpatient and inpatient cohorts of COVID-19 patients in the Czech Republic over a 12-month period, and assess the potential of antibodies as a diagnostic tool. METHODS: A total of 644 patients was enrolled in the prospective study. IgA, IgM and IgG antibody levels, as well as virus neutralization titers, were analyzed over a 12-month period. RESULTS: Our study showed low antibody positivity levels at the admission. However, at 2 weeks after infection, 98.75% and 95.00% of hospitalized patients were IgA and IgG positive, respectively. Even in the outpatient cohort characterized by milder disease courses, the IgG antibody response was still sustained at 9 and 12 months. The data show a high correlation between the IgG levels and virus neutralization titers (VNTs). Samples from later time-points showed positive antibody responses after vaccination in both cohorts characterized by high IgG levels and VNT over 1:640. The samples from unvaccinated persons indicated a relatively high level of reinfection at 6.87%. CONCLUSIONS: Our results show that the detection of antibodies against the SARS-CoV-2 shows an increasing sensitivity from week 2 after infection and remains highly positive over the 12-month period. The levels of IgG antibodies correlate significantly with the VNTs. This suggests that the serological data may be a valuable tool in the diagnosis of SARS-CoV-2 infection.

• MeSH
• COVID-19 * diagnóza   epidemiologie   MeSH
• lidé MeSH
• prospektivní studie MeSH
• protilátky virové MeSH
• SARS-CoV-2 MeSH
• tvorba protilátek * MeSH
• vakcinace MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Geografické názvy
• Česká republika MeSH

BACKGROUND: Hematopoietic stem cell transplantation (HSCT) can induce serious oral complications, including oral mucositis (OM). The presence of periodontal inflammation before HSCT is believed to be associated with OM. The aim of our study was to determine the prevalence and severity of OM in patients undergoing HSCT and its relation to periodontal status. PATIENTS AND METHODS: This is a retrospective study of patients who underwent HSCT and a detailed dental examination between 2007 and 2015. The dental and periodontal status of all patients was evaluated by clinical and radiographic examination prior to HSCT. Oral health was assessed with the gingival index, the the community periodontal index, presence of plaque-related gingivitis, and marginal periodontitis. During the HSCT period, patients were examined daily for the presence of OM, which was graded according to World Health Organization (WHO) classification if present. The patients were assigned to the groups according to type of transplantation: autologous HSCT, myeloablative allogeneic HSCT, and non-myeloablative allogeneic HSCT. RESULTS: A total of 496 patients were included in the study. OM was present in 314 of 496 patients (63.3%): 184/251 (73.3%) in the autologous group, 100/151 (66.2%) in the myeloablative allogeneic group, and 30/94 (31.9%) in the nonmyeloablative allogeneic group. Significantly more patients suffered from OM in the autologous and myeloablative groups versus the nonmyeloablative conditioning group (p < 0.001). The presence of periodontal inflammation did not significantly differ among the groups. There was only a borderline trend for the higher prevalence of OM in the non-myeloablative allogeneic nonmyeloablative group when periodontal inflammation was present (0.073939). CONCLUSIONS: Oral mucositis prevalence and severity after stem cell transplantation is not widely affected by the oral hygiene and periodontal disease presence before HSCT. We confirmed the wide-known connection of the conditioning regimen intensity to the prevalence of OM.

• Publikační typ
• časopisecké články MeSH

The paradigm of first-line treatment of chronic lymphocytic leukaemia (CLL) is currently undergoing a radical change. On the basis of several randomised phase III trials showing prolongation of progression-free survival, chemoimmunotherapy is being replaced by treatment based on novel, orally available targeted inhibitors such as Bruton tyrosine kinase inhibitors ibrutinib and acalabrutinib or bcl-2 inhibitor venetoclax. However, the use of these agents may be associated with other disadvantages. First, with the exception of one trial in younger/fit patients, no studies have so far demonstrated benefit regarding the ultimate endpoint of overall survival. Second, oral inhibitors are extremely expensive and thus currently unavailable due to the absence of reimbursement in some countries. Third, treatment with ibrutinib and acalabrutinib necessitates long-term administration until progression; this may be associated with accumulation of late side effects, problems with patient compliance, and selection of resistant clones. Therefore, the identification of a subset of patients who could benefit from chemoimmunotherapy would be ideal. Current data suggest that patients with the mutated variable region of the immunoglobulin heavy chain (IGHV) achieve fairly durable remissions, especially when treated with fludarabine, cyclophosphamide, and rituximab (FCR) regimen. This review discusses current options for treatment-naïve patients with CLL.

• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

OBJECTIVE: Oncocytic papillary cystadenomas (OPCs) of the larynx are rare benign cystic lesions that usually present as supraglottic masses arising from the laryngeal ventricles. OPCs are found in patients older than 60 years, with a female predominance. Symptoms vary from asymptomatic to hoarseness, dyspnea, and dysphagia; often, they mimic a laryngocele. The treatment is surgical. Diagnosis is based on histopathologic examination. MATERIALS AND METHODS: Surgical records for laryngeal masses diagnosed between 2005 and 2020 were searched retrospectively. RESULTS: Ten patients were identified and included in the study. OPCs predominantly occurred in women (9/10), and the mean age at presentation was 73 years. Most patients (8/10) presented with hoarseness and were smokers. OPCs were localized in the ventricle in eight out of ten patients. Surgical treatment was performed in all cases, mostly using transoral endolaryngeal approach (9/10). Histopathologic examination revealed oncocytic cyst or oncocytic papillary cystadenoma (the former term being the older synonym for OPC). CONCLUSION: OPCs present a separate clinicopathologic entity, distinct from other cystic laryngeal lesions. They have a characteristic location, age and sex group, microscopic appearance, and potential for local recurrence.

• MeSH
• cystadenom papilární * MeSH
• larynx * MeSH
• lidé MeSH
• lokální recidiva nádoru MeSH
• nádory hrtanu * diagnóza   chirurgie   MeSH
• retrospektivní studie MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

Multiple myeloma is the second most common hematologic malignancy. Current treatment strategies are mainly based on immunomodulatory drugs, proteasome inhibitors or combination of both. Novel agents added to these backbone treatments represent a promising strategy in treatment of newly diagnosed as well as relapsed and refractory multiple myeloma patients. In this respect, the incorporation of monoclonal antibodies into standard-of-care regimens markedly improved prognosis of myeloma patients during the last years. More specifically, monoclonal anti-CD38 antibodies, daratumumab and isatuximab, have been implemented into treatment strategies from first-line treatment to refractory disease. In addition, the monoclonal anti-SLAM-F7 antibody elotuzumab in combination with immunomodulatory drugs has improved the clinical outcomes of patients with relapsed/refractory disease. Belantamab mafodotin is the first approved antibody drug conjugate directed against B cell maturation antigen and is currently used as a monotherapy for patients with advanced disease. This review focuses on clinical efficacy and safety of monoclonal antibodies as well as antibody drug conjugates in multiple myeloma.

• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

The present study aims to evaluate the diagnostic yield of bronchoalveolar lavage (BAL) fluid in patients with hematological malignancies and describe the most common pathogens detected in BAL fluid (BALF.) An analysis of 480 BALF samples was performed in patients with hematological malignancies over a period of 7 years. The results of culture methods, PCR, and immunoenzymatic sandwich microplate assays for Aspergillus galactomannan (GM) in BALF were analyzed. Further, the diagnostic thresholds for Aspergillus GM and Pneumocystis jiroveci were also calculated. Microbiological findings were present in 87% of BALF samples. Possible infectious pathogens were detected in 55% of cases; 32% were classified as colonizing. No significant difference in diagnostic yield or pathogen spectrum was found between non-neutropenic and neutropenic patients. There was one significant difference in BALF findings among intensive care units (ICU) versus non-ICU patients for Aspergillus spp. (22% versus 9%, p = 0.03). The most common pathogens were Aspergillus spp. (n = 86, 33% of BAL with causative pathogens) and Streptococcus pneumoniae (n = 46, 18%); polymicrobial etiology was documented in 20% of cases. A quantitative PCR value of > 1860 cp/mL for Pneumocystis jirovecii was set as a diagnostic threshold for pneumocystis pneumonia. The absorbance index of GM in BALF of 0.5 was set as a diagnostic threshold for aspergillosis. The examination of BAL fluid revealed the presence of pathogen in more than 50% of cases and is, therefore, highly useful in this regard when concerning pulmonary infiltrates.

• MeSH
• Aspergillus genetika   izolace a purifikace   patogenita   MeSH
• bronchoalveolární lavážní tekutina mikrobiologie   MeSH
• DNA fungální genetika   MeSH
• dospělí MeSH
• hematologické nádory komplikace   mikrobiologie   MeSH
• jednotky intenzivní péče MeSH
• lidé středního věku MeSH
• lidé MeSH
• mannany analýza   MeSH
• mladiství MeSH
• mladý dospělý MeSH
• neutropenie mikrobiologie   MeSH
• Pneumocystis carinii genetika   izolace a purifikace   patogenita   MeSH
• pneumocystová pneumonie diagnóza   mikrobiologie   MeSH
• retrospektivní studie MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• Streptococcus pneumoniae genetika   izolace a purifikace   patogenita   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

Chronická lymfocytární leukemie je onemocnění starších nemocných, z nichž většina trpí významnými přidruženými onemocněními či funkčním omezením (tzv. slow‑go nemocní). Klinická hodnocení u chronické lymfocytární leukemie se donedávna bohužel zaměřovala zejména na podskupinu mladších nemocných v dobrém celkovém stavu („go‑go“). Klinicko‑biologické parametry jako výkonnostní stav, vypočtená clearance kreatininu, počet a závažnost přidružených onemocnění a další nám společně s individuálním klinickým posouzením mohou být vodítkem při rozhodování o cílech a intenzitě léčby. Dvě velké randomizované studie prokázaly, že přidání monoklonálních protilátek proti CD20 (obinutuzumab, rituximab a ofatumumab) k chlorambucilu u neléčených starších/komorbidních nemocných vedlo k významnému zvýšení počtu kompletních remisí, přežití bez progrese a dokonce i celkového přežití (v případě obinutuzumabu a rituximabu) s přijatelným bezpečnostním profilem. Chemoimunoterapie kombinující chlorambucil s anti‑CD20 protilátkou je tedy nový standard léčby 1. linie u této skupiny nemocných. Léčba relabující/refrakterní chronické lymfocytární leukemie je u „slow‑go“ nemocných velmi obtížná a specifických dat je málo. V této indikaci jsme svědky revolučního průlomu zaváděním nových, perorálně dostupných malých molekul působících na principu inhibice signálních drah B buněčného receptoru: ibrutinibu, inhibitoru Brutonovy tyrozinkinázy a idelalisibu, inhibitoru fosfatidylinositol‑3 kinázy δ. Oba tyto léky radikálně změnily přístup k léčbě relabující/refrakterní chronické lymfocytární leukemie; relativně mírná toxicita je předurčuje také pro použití u starších/komorbidních nemocných. Další možnosti léčby relabující/refrakterní chronické lymfocytární leukemie pro „slow‑go“ nemocné zahrnují alemtuzumab, ofatumumab, vysokodávkované glukokortikoidy + rituximab či ofatumumab a režim bendamustin + rituximab. Tento přehledný článek shrnuje současné poznatky o léčbě starších a komorbidních nemocných s chronickou lymfocytární leukemií.

Chronic lymphocytic leukemia is a disease of older patients, most of them suffering from significant comorbidities or functional limitations (so‑called 'slow‑go' patients). Unfortunately, clinical trials in chronic lymphocytic leukemia have until recently focused mainly on the subgroup of younger patients in good overall condition (‘go‑go' patients). Clinico‑biological parameters, such as performance status, calculated creatinine clearance, the number and severity of comorbidities along with individual clinical assessment can help guide decisions relating to the objectives and ultimately the intensity of treatment. Two large randomized studies have recently demonstrated that the addition of monoclonal antibodies against CD20 (obinutuzumab, rituximab and ofatumumab) to chlorambucil in untreated ‘slow‑go' patients resulted in a significant increase in the number of complete remissions, progression‑free survival and even overall survival (for obinutuzumab and rituximab) with an acceptable safety profile. Chemoimmunotherapy combining chlorambucil with anti‑CD20 antibody is thus the new standard 1st line therapy in this group of patients. Treatment of relapsed/refractory chronic lymphocytic leukemia in ‘slow‑go' patients is very difficult and specific data is sparse. In this indication, we have witnessed an extraordinary breakthrough by means of small oral inhibitors interfering with B‑cell receptor downstream signaling pathways: ibrutinib, the Bruton‘s tyrosine kinase inhibitor, and idelalisib, the inhibitor of phosphatidylinositol 3-kinase δ. Both drugs radically changed the approach to the treatment of relapsed/refractory chronic lymphocytic leukemia; relatively mild toxicity also predetermines their use in elderly/comorbid patients. Other treatment options for relapsed/refractory chronic lymphocytic leukemia in this subgroup include alemtuzumab, ofatumumab, high‑dose glucocorticoids + antiCD20 antibodies, or bendamustine + rituximab regimen. This review summarizes current data regarding the treatment of elderly and comorbid patients with chronic lymphocytic leukemia. Key words: chronic lymphocytic leukemia – comorbidity – geriatric assessment – obinutuzumab – rituximab – ofatumumab – ibrutinib – idelalisib This work was supported by the grant IGA MH CZ NT13412-4/2012, MH CZ – DRO (UHHK, 00179906) and by the programme PRVOUK P37/08. I declare that, in connection with the above-mentioned contribution, which I am an author, I have a conflict of interest with the typed the following companies: Roche, Janssen-Cilag , Gilead and GlaxoSmithKline (honoraria for lectures or consultations, travel grants). The Editorial Board declares that the manuscript met the ICMJE recommendation for biomedical papers. Submitted: 23. 7. 2015 Accepted: 29. 7. 2015

• Klíčová slova
• obinutuzumab, idelalisib, ibrutinib, ofatumumab, fludarabine, bendamustin,
• MeSH
• analýza přežití MeSH
• antigeny CD20 MeSH
• chinazoliny aplikace a dávkování   škodlivé účinky   MeSH
• chlorambucil aplikace a dávkování   MeSH
• chronická lymfatická leukemie * farmakoterapie   komplikace   MeSH
• geriatrické hodnocení * MeSH
• humanizované monoklonální protilátky aplikace a dávkování   škodlivé účinky   MeSH
• kvalita života MeSH
• lidé MeSH
• monoklonální protilátky aplikace a dávkování   škodlivé účinky   MeSH
• myší monoklonální protilátky aplikace a dávkování   škodlivé účinky   MeSH
• protokoly antitumorózní kombinované chemoterapie * MeSH
• puriny aplikace a dávkování   škodlivé účinky   MeSH
• pyrazoly aplikace a dávkování   škodlivé účinky   MeSH
• pyrimidiny aplikace a dávkování   škodlivé účinky   MeSH
• recidiva MeSH
• rituximab MeSH
• senioři MeSH
• sloučeniny dusíkatého yperitu aplikace a dávkování   MeSH
• vidarabin analogy a deriváty   škodlivé účinky   terapeutické užití   MeSH
• vztah mezi dávkou a účinkem léčiva MeSH
• záchranná terapie metody   MeSH
• Check Tag
• lidé MeSH
• senioři MeSH
• Publikační typ
• práce podpořená grantem MeSH
• přehledy MeSH