BACKGROUND: Low CD4 recovery among HIV-positive individuals who achieve virologic suppression is common but has not been studied among individuals initiating treatment at CD4 counts of >500 cells/mm. SETTING: United States, Africa, Asia, Europe and Israel, Australia, Latin America. METHODS: Among participants randomized to immediate antiretroviral therapy (ART) in the Strategic Timing of AntiRetroviral Therapy trial, low CD4 recovery was defined as a CD4 increase of <50 cells/mm from baseline after 8 months despite viral load of ≤200 copies/mL. Risk factors for low recovery were investigated with logistic regression. RESULTS: Low CD4 recovery was observed in 39.7% of participants. Male sex [odds ratio (OR), 1.53; P = 0.007], lower screening CD4 cell counts (OR, 1.09 per 100 fewer cells/mm; P = 0.004), higher baseline CD8 cell counts (OR, 1.05 per 100 more cells/mm; P < 0.001), and lower HIV RNA levels (OR, 1.93 per log10 decrease; P < 0.001) were associated with low CD4 recovery. D-dimer had a quadratic association with low CD4 recovery, with lowest odds occurring at 0.32 μg/mL. At lower HIV RNA levels, the odds of low CD4 recovery were elevated across the levels of screening CD4 count; but at higher HIV RNA levels, the odds of low CD4 recovery were higher among those with lower vs. higher screening CD4. CONCLUSIONS: Low CD4 recovery is frequent among participants starting ART at high CD4 counts. Risk factors include male sex, lower screening CD4 cell counts, higher CD8 cell counts, and lower HIV RNA levels. More follow-up is required to determine the impact of low CD4 recovery on clinical outcomes.

• MeSH
• CD4-pozitivní T-lymfocyty účinky léků   MeSH
• dospělí MeSH
• HIV infekce farmakoterapie   MeSH
• látky proti HIV terapeutické užití   MeSH
• lidé MeSH
• logistické modely MeSH
• neúspěšná terapie MeSH
• počet CD4 lymfocytů * statistika a číselné údaje   MeSH
• rizikové faktory MeSH
• sexuální faktory MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• randomizované kontrolované studie MeSH
• Research Support, N.I.H., Extramural MeSH

Background: Randomized trials have shown increased risk of suicidality associated with efavirenz (EFV). The START (Strategic Timing of Antiretroviral Treatment) trial randomized treatment-naive human immunodeficiency virus (HIV)-positive adults with high CD4 cell counts to immediate vs deferred antiretroviral therapy (ART). Methods: The initial ART regimen was selected prior to randomization (prespecified). We compared the incidence of suicidal and self-injurious behaviours (suicidal behavior) between the immediate vs deferred ART groups using proportional hazards models, separately for those with EFV and other prespecified regimens, by intention to treat, and after censoring participants in the deferred arm at ART initiation. Results: Of 4684 participants, 271 (5.8%) had a prior psychiatric diagnosis. EFV was prespecified for 3515 participants (75%), less often in those with psychiatric diagnoses (40%) than without (77%). While the overall intention-to-treat comparison showed no difference in suicidal behavior between arms (hazard ratio [HR], 1.07, P = .81), subgroup analyses suggest that initiation of EFV, but not other ART, is associated with increased risk of suicidal behavior. When censoring follow-up at ART initiation in the deferred group, the immediate vs deferred HR among those who were prespecified EFV was 3.31 (P = .03) and 1.04 (P = .93) among those with other prespecified ART; (P = .07 for interaction). In the immediate group, the risk was higher among those with prior psychiatric diagnoses, regardless of prespecified treatment group. Conclusions: Participants who used EFV in the immediate ART group had increased risk of suicidal behavior compared with ART-naive controls. Those with prior psychiatric diagnoses were at higher risk.

• MeSH
• benzoxaziny škodlivé účinky   MeSH
• chování sebezraňující epidemiologie   MeSH
• dospělí MeSH
• HIV infekce komplikace   farmakoterapie   MeSH
• HIV séropozitivita farmakoterapie   MeSH
• látky proti HIV škodlivé účinky   MeSH
• lidé středního věku MeSH
• lidé MeSH
• počet CD4 lymfocytů MeSH
• sebevražda * MeSH
• virová nálož MeSH
• vysoce aktivní antiretrovirová terapie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH
• práce podpořená grantem MeSH
• randomizované kontrolované studie MeSH
• Research Support, N.I.H., Extramural MeSH

V roce 1999 byly poprvé prezentovány výsledky studie HOPE, která zahájila „zlatou éru“ inhibitorů ACE podávaných v léčbě po infarktu myokardu. Tato data byla později potvrzena studiemi EUROPA a PEACE. Cíle studie HOPE byly sledovány i ve studii TRANSCEND u nemocných netolerujících inhibitory ACE. V článku podáváme přehled současných poznatků o blokádě systému renin-angiotenzin-aldosteron po infarktu myokardu. Zmíněny jsou zavedené lékové skupiny, inhibitory ACE a sartany. Podrobněji je rozebrána studie HOPE a její extenze. Data ze studií léčby hypertenze ukazovala na některé přednosti inhibitorů ACE, výsledky přímého srovnání z velkých multicentrických studií však potvrzují předpoklad, že skupiny inhibitorů ACE a sartanů jsou účinné, bezpečné a srovnatelné, není však zřejmě vhodná jejich kombinace. Blokáda systému renin-angiotenzin-aldosteron je dnes základem léčby nemocných po infarktu myokardu a v sekundární prevenci ischemické choroby srdeční, teprve další studie ale ukáží, na které úrovni je celý systém nejvhodnější blokovat.

In 1999, the HOPE trial results were first presented and started the golden era of ACE inhibitors in post-myocardial infarction treatment. The reported data were later confirmed by the EUROPA and PEACE trials. The TRANSCEND trial extended the HOPE trial objectives in patients intolerant to ACE inhibitors. The article provides an overview of the state of the art in the renin-angiotensin-aldosterone system blockade in patients after myocardial infarction. The groups of pharmaceuticals in use, ACE inhibitors (ACEI) and angiotensin IIAT1 receptor blockers (sartans), are presented. The HOPE trial and its extensions are analyzed in detail. Data from hypertension treatment trials indicated some benefits of ACE inhibitors; nevertheless, the comparison in large multicentric studies confirmed the assumption that ACEI and sartans are comparably effective and safe, but are not suitable for use in combination. The renin-angiotensin-aldosterone system blockade is currently the first-line treatment in patients after myocardial infarction and for secondary prevention of coronary heart disease. Nevertheless, further studies are needed to better understand at which level the renin-angiotensin-aldosterone system should be best blocked.

• Klíčová slova
• sartany,
• MeSH
• antihypertenziva klasifikace   terapeutické užití   MeSH
• blokátory receptorů AT1 pro angiotensin II farmakologie   terapeutické užití   MeSH
• financování organizované MeSH
• hypertenze MeSH
• infarkt myokardu farmakoterapie   mortalita   prevence a kontrola   MeSH
• inhibitory ACE farmakologie   škodlivé účinky   terapeutické užití   MeSH
• ischemická choroba srdeční farmakoterapie   mortalita   prevence a kontrola   MeSH
• lidé MeSH
• Check Tag
• lidé MeSH

A communication strategy was developed by The Consortium to Perform Human Biomonitoring on a European Scale (COPHES), as part of its objectives to develop a framework and protocols to enable the collection of comparable human biomonitoring data throughout Europe. The framework and protocols were tested in the pilot study DEMOCOPHES (Demonstration of a study to Coordinate and Perform Human biomonitoring on a European Scale). The aims of the communication strategy were to raise awareness of human biomonitoring, encourage participation in the study and to communicate the study results and their public health significance. It identified the audiences and key messages, documented the procedure for dissemination of results and was updated as the project progressed. A communication plan listed the tools and materials such as press releases, flyers, recruitment letters and information leaflets required for each audience with a time frame for releasing them. Public insight research was used to evaluate the recruitment material, and the feedback was used to improve the documents. Dissemination of results was coordinated in a step by step approach by the participating countries within DEMOCOPHES, taking into account specific national messages according to the needs of each country. Participants received individual results, unless they refused to be informed, along with guidance on what the results meant. The aggregate results and policy recommendations were then communicated to the general public and stakeholders, followed by dissemination at European level. Several lessons were learnt that may assist other future human biomonitoring studies. Recruitment took longer than anticipated and so social scientists, to help with community engagement, should be part of the research team from the start. As a European study, involving multiple countries, additional considerations were needed for the numerous organisations, different languages, cultures, policies and priorities. Therefore, communication documents should be seen as templates with essential information clearly indicated and the option for each country to tailor the material to reflect these differences. Future studies should consider setting up multidisciplinary networks of medical professionals and communication experts, and holding training workshops to discuss the interpretation of results and risk communication. Publicity and wide dissemination of the results helped to raise awareness of human biomonitoring to the general public, policy makers and other key stakeholders. Effective and timely communication, at all stages of a study, is essential if the potential of human biomonitoring research to improve public health is to be realised.

• MeSH
• komunikace * MeSH
• lidé MeSH
• mezinárodní spolupráce * MeSH
• monitorování životního prostředí metody   MeSH
• rozvoj plánování * MeSH
• šíření informací MeSH
• účast komunity * MeSH
• veřejná politika MeSH
• výzkumný projekt MeSH
• vzorkové studie MeSH
• zdravotní politika MeSH
• zjišťování skupinových postojů * MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Geografické názvy
• Evropa MeSH

• MeSH
• AIDS MeSH
• dítě MeSH
• finanční podpora výzkumu jako téma MeSH
• HIV infekce MeSH
• kognice MeSH
• lidé MeSH
• mladiství MeSH
• sociální identifikace MeSH
• sociální percepce MeSH
• teoretické modely MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• mladiství MeSH
• Publikační typ
• přehledy MeSH
• srovnávací studie MeSH

BACKGROUND: Autosomal dominant polycystic kidney disease (ADPKD) is the most common monogenic inherited kidney disease, affecting an estimated 600 000 individuals in Europe. The disease is characterized by age-dependent development of a multiple cysts in the kidneys, ultimately leading to end-stage renal failure and the need of renal replacement therapy in the majority of patients, typically by the fifth or sixth decade of life. The variable disease course, even within the same family, remains largely unexplained. Similarly, assessing disease severity and prognosis in an individual with ADPKD remains difficult. Epidemiological studies are limited due to the fragmentation of ADPKD research in Europe. METHODS: The EuroCYST initiative aims: (i) to harmonize and develop common standards for ADPKD research by starting a collaborative effort to build a network of ADPKD reference centres across Europe and (ii) to establish a multicentric observational cohort of ADPKD patients. This cohort will be used to study factors influencing the rate of disease progression, disease modifiers, disease stage-specific morbidity and mortality, health economic issues and to identify predictive disease progression markers. Overall, 1100 patients will be enrolled in 14 study sites across Europe. Patients will be prospectively followed for at least 3 years. Eligible patients will not have participated in a pharmaceutical clinical trial 1 year before enrollment, have clinically proven ADPKD, an estimated glomerular filtration rate (eGFR) of 30 mL/min/1.73 m(2) and above, and be able to provide written informed consent. The baseline visit will include a physical examination and collection of blood, urine and DNA for biomarker and genetic studies. In addition, all participants will be asked to complete questionnaires detailing self-reported health status, quality of life, socioeconomic status, health-care use and reproductive planning. All subjects will undergo annual follow-up. A magnetic resonance imaging (MRI) scan will be carried out at baseline, and patients are encouraged to undergo a second MRI at 3-year follow-up for qualitative and quantitative kidney and liver assessments. CONCLUSIONS: The ADPKD reference centre network across Europe and the observational cohort study will enable European ADPKD researchers to gain insights into the natural history, heterogeneity and associated complications of the disease as well as how it affects the lives of patients across Europe.

• MeSH
• biologické markery analýza   MeSH
• hodnoty glomerulární filtrace MeSH
• konziliární vyšetření a konzultace * MeSH
• lidé MeSH
• longitudinální studie MeSH
• magnetická rezonanční tomografie MeSH
• mladý dospělý MeSH
• polycystické ledviny autozomálně dominantní patofyziologie   terapie   MeSH
• prognóza MeSH
• průzkumy a dotazníky MeSH
• standardní péče organizace a řízení   MeSH
• výzkumný projekt * MeSH
• zdravotní stav MeSH
• zdravotnické služby * MeSH
• Check Tag
• lidé MeSH
• mladý dospělý MeSH
• Publikační typ
• časopisecké články MeSH
• pozorovací studie MeSH
• práce podpořená grantem MeSH
• Geografické názvy
• Evropa MeSH

OBJECTIVES AND DESIGN: A novel risk stratification algorithm estimating risk of death in patients with relapsed multiple myeloma starting second-line treatment was recently developed using multivariable Cox regression of data from a Czech registry. It uses 16 parameters routinely collected in medical practice to stratify patients into four distinct risk groups in terms of survival expectation. To provide insight into generalisability of the risk stratification algorithm, the study aimed to validate the risk stratification algorithm using real-world data from specifically designed retrospective chart audits from three European countries. PARTICIPANTS AND SETTING: Physicians collected data from 998 patients (France, 386; Germany, 344; UK, 268) and applied the risk stratification algorithm. METHODS: The performance of the Cox regression model for predicting risk of death was assessed by Nagelkerke's R2, goodness of fit and the C-index. The risk stratification algorithm's ability to discriminate overall survival across four risk groups was evaluated using Kaplan-Meier curves and HRs. RESULTS: Consistent with the Czech registry, the stratification performance of the risk stratification algorithm demonstrated clear differentiation in risk of death between the four groups. As risk groups increased, risk of death doubled. The C-index was 0.715 (95% CI 0.690 to 0.734). CONCLUSIONS: Validation of the novel risk stratification algorithm in an independent 'real-world' dataset demonstrated that it stratifies patients in four subgroups according to survival expectation.

• MeSH
• algoritmy MeSH
• hodnocení rizik MeSH
• lidé MeSH
• mnohočetný myelom * MeSH
• retrospektivní studie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Geografické názvy
• Evropa MeSH
• Francie MeSH
• Německo MeSH

Časopis přináší vědecké články a recenze o dějinách ekonomie, kultuře a společnosti zemí Afriky a Asie. Je určen badatelům a zájemcům o tuto problematiku

• MeSH
• archivy MeSH
• filologie orientální MeSH
• humanitní vědy MeSH
• kulturní charakteristiky dějiny   MeSH
• Publikační typ
• periodika MeSH

• Konspekt
• Historická věda. Pomocné vědy historické. Archivnictví
• NLK Obory
• humanitní vědy a umění

INTRODUCTION: Multiple sclerosis (MS) is a chronic inflammatory autoimmune demyelinating disease that secondarily leads to axonal loss and associated brain atrophy. Disease-modifying drugs (DMDs) have previously been studied for their ability to affect specific immunity. This study investigates the effect of interferon beta-1a (INF) and glatiramer acetate (GA) administration on changes in innate immunity cell populations. METHODS: Sixty Caucasian female patients with relapsing-remitting MS undergo blood sample testing for 15 blood parameters at baseline, 1 month, 3 months, and 6 months after treatment by GA or IFN (started as their first-line DMD). RESULTS: A statistically significant difference in the change after 6 months was found in the parameter monocytes (relative count) in the group of patients treated with IFN. The median increase was 27.8%. Changes in many of the other 15 parameters studied were 10-20%. CONCLUSION: Innate immunity has long been neglected in MS immunopathology. The findings suggest that IFN treatment may modulate the immune response in MS by affecting monocyte function and may provide insight into the mechanisms of action of IFN in MS.

• MeSH
• glatiramer acetát terapeutické užití   MeSH
• interferon beta 1a terapeutické užití   MeSH
• interferon beta terapeutické užití   MeSH
• lidé MeSH
• peptidy terapeutické užití   MeSH
• přirozená imunita MeSH
• relabující-remitující roztroušená skleróza * farmakoterapie   patologie   MeSH
• roztroušená skleróza * farmakoterapie   MeSH
• Check Tag
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

BACKGROUND: The COVID-19 pandemic heightened risks for individuals with hematological malignancies due to compromised immune systems, leading to more severe outcomes and increased mortality. While interventions like vaccines, targeted antivirals, and monoclonal antibodies have been effective for the general population, their benefits for these patients may not be as pronounced. METHODS: The EPICOVIDEHA registry (National Clinical Trials Identifier, NCT04733729) gathers COVID-19 data from hematological malignancy patients since the pandemic's start worldwide. It spans various global locations, allowing comprehensive analysis over the first three years (2020-2022). FINDINGS: The EPICOVIDEHA registry collected data from January 2020 to December 2022, involving 8767 COVID-19 cases in hematological malignancy patients from 152 centers across 41 countries, with 42% being female. Over this period, there was a significant reduction in critical infections and an overall decrease in mortality from 29% to 4%. However, hospitalization, particularly in the ICU, remained associated with higher mortality rates. Factors contributing to increased mortality included age, multiple comorbidities, active malignancy at COVID-19 onset, pulmonary symptoms, and hospitalization. On the positive side, vaccination with one to two doses or three or more doses, as well as encountering COVID-19 in 2022, were associated with improved survival. INTERPRETATION: Patients with hematological malignancies still face elevated risks, despite reductions in critical infections and overall mortality rates over time. Hospitalization, especially in ICUs, remains a significant concern. The study underscores the importance of vaccination and the timing of COVID-19 exposure in 2022 for enhanced survival in this patient group. Ongoing monitoring and targeted interventions are essential to support this vulnerable population, emphasizing the critical role of timely diagnosis and prompt treatment in preventing severe COVID-19 cases. FUNDING: Not applicable.

• Publikační typ
• časopisecké články MeSH