Autoři předkládají výsledky prvního roku grantové studie zabývající se preemptivní terapií kvasinkových infekcí na chirurgické JIP. Do studie byli zařazeni pacienti s mírou rizika hodnocenou 10 body (podle uvedeného seznamu). Celkem 147 pacientů dosáhlo skóre 10 bodů a vyšší. V první skupině byl podáván jako preemptivní terapie itrakonazol dle uvedeného schématu, jednalo se o 87 pacientů s průměrnou délkou pobytu na JIP 11,6 dne. v této skupině se nevyskytla pozitivita hemokultury ani pozitivní kultivace žilní kanyly a ani klinicky nebyla určena kandidová sepse. V druhé skupině itrakonazol podáván nebyl, počet pacientů byl 60, průměrná délka pobytu na JIP 11,8 dne. Pozitivita hemokultury či klinicky jasně prokazatelná sepse v souvislosti s mikrobiologicky prokázanou invazivní kvasinkovou infekcí se vyskytla v 6 případech, tj. 10,0%. V obou skupinách nezemřel žádný pacient v přímé souvislosti s kvasinkovou infekcí. Z předložených výsledků vyplývá, že preemptivní terapie antimykotiky u rizikových pacientů snižuje počet rozvinutých kvasinkových infekcí a zejména vznik kvasinkových sepsí.

This article presents the results of the first year of the grant study that deal with preemptive treatment of yeast infection in surgical ICU. This research included patients with a large number of risk factors (ten and more). These risk factors indicated in the chart. 147 patients reached a score often and more points. This number was divided in two groups. In the first group there were 87 patients who received treatment of itraconazol by prescribed scheme. They were hospitalized in ICU for 11.6 days, on average. The first group did not display any positive hemoculture and also other microbial culture from intravenous cannula. No patients fell from ill Candida sepsis. Itraconazol was not administered to the 60 patients, who were hospitalizated 11.8 days, on average. Positive hemoculture or yeast sepsis with connection invasive yeast infection was proven in six cases (10%). No patient died in direct connection with yeast infection in either groups. The presented results show a reduction in the number of developing yeast infections and mainly yeast sepsis in patients undergoing preemptive treatment with itraconazol.

• MeSH
• antifungální látky aplikace a dávkování   farmakologie   terapeutické užití   MeSH
• Candida klasifikace   patogenita   MeSH
• chirurgie MeSH
• finanční podpora výzkumu jako téma MeSH
• itrakonazol aplikace a dávkování   farmakologie   terapeutické užití   MeSH
• jednotky intenzivní péče MeSH
• kandidóza diagnóza   etiologie   terapie   MeSH
• lidé MeSH
• rizikové faktory MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• přehledy MeSH
• srovnávací studie MeSH

Cíl studie:N-metyl D-aspartátové receptory (NMDAR) se účastní na centrální pooperační senzitizaci, a tím i na vzniku chronické pooperační bolesti. Blokátorem N-metyl D-aspartátových receptorů je také ketamin. V literatuře chybějí data o účinku perioperačně podávaného ketaminu na incidenci chronické pooperační bolesti, proto jsme se rozhodli tento efekt ověřit. Typ studie:Intervenční, prospektivní zaslepená randomizovaná klinická studie. Název a sídlo pracoviště:Klinika anesteziologie a resuscitace, Praha. Materiál a metoda:Po souhlasu etické komise a písemném poučeném souhlasu bylo do studie zařazeno 100 pa- cientek, kterým byla provedena totální mastektomie nebo kvadrantektomie pro zhoubný nádor prsu. Náhodně byly rozděleny na skupinu K, která dostávala od úvodu do operace kontinuálně ketamin 48 hodin v dávce 1 mg . kg-1.den- 1, a na skupinu C, která dostala v tomtéž režimu placebo. Ostatní anestetický a analgetický režim byl shodný. Po 6 měsících od operace byly pacientky obeslány dotazníkem týkajícím se chronické bolesti. Výsledky:Celkem odpovědělo 40 respondentek ze skupiny C a 46 ze skupiny K (návratnost 86 %). Mezi skupina- mi nebyly rozdíly v demografických ani v pooperačně sledovaných parametrech včetně intenzity pooperační boles- ti a typu operace. Ze sledovaných parametrů byla ve skupině C vs skupina K incidence chronické bolesti 14 (35 %) vs 14 (30 %, NS); z tohoto počtu byla bolest trvalá u 5 (36 %) vs 2 (14 %) respondentek (p = 0,15), a bolest intenzivnější než mírná u 9 (64 %) vs 5 (35 %) respondentek (p = 0,20). Závěr: Perioperačně kontinuálně podávaný ketamin vykazuje trend ke snížení výskytu trvalé, střední a silnější chronické bolesti po operaci prsu.

Objective: The N-methyl D-aspartate receptor is involved both in the postoperative central sensitization and the development of chronic postoperative pain. Its antagonist ketamine is used for the enhancement of postoperative analgesia and treatment of chronic pain. There is little information concerning the long-term effect of perioperative administration of ketamine on chronic pain. We have designed a study to test the hypothesis that pre-emptive and long-term postoperative administration of low-dose ketamine lowers the incidence of chronic postoperative pain. Design: Prospective, blind clinical trial. Setting: Dept. of Anaesthesiology and Intensive Care, Charles University Prague. Material and Method:After the institutional ethics committee approval and written consent, 100 total or partial mas- tectomy patients were randomly assigned to the control (C) or ketamine (K) groups. Group K patients were blind- ly commenced on continuous infusion of ketamine 1.0 mg . kg-1.day-1 for 48 hours after the induction of anaesthe- sia, group C were administered normal saline. The general anaesthesia, surgical procedure and post-operative care were standard and not different between the groups. Six months after the surgery we sent the patients a ques- tionnaire concerning the incidence and characteristics of chronic pain. Results: There was no difference in demography, type of surgery, postoperative course and postoperative pain intensity between the groups. We retrieved 40 questionnaires from group C and 46 from group K (the response rate was 86 %). The incidence of chronic pain in group C vs. group K was 14 (35 %) vs. 14 (30 %), the pain was permanent in 5 (36 %) vs. 2 (14 %) and more intense than mild in 9 (64 %) vs. 5 (35 %) respondents. Due to the sample size, the results were not statistically significant (P = 0.15 and 0.2). Conclusion:Low-dose ketamine administered for 48 hours after mastectomy exhibits a trend towards reduction of the incidence of permanent and moderate to severe post-mastectomy chronic pain.

• MeSH
• finanční podpora výzkumu jako téma MeSH
• ketamin aplikace a dávkování   farmakologie   MeSH
• lidé MeSH
• mastektomie MeSH
• N-methylaspartát antagonisté a inhibitory   fyziologie   MeSH
• peroperační péče MeSH
• placebo MeSH
• pooperační bolest diagnóza   farmakoterapie   prevence a kontrola   MeSH
• prevalence MeSH
• prospektivní studie MeSH
• průzkumy a dotazníky MeSH
• Check Tag
• lidé MeSH
• ženské pohlaví MeSH

BACKGROUND: Vascular accesses (especially polytetrafluoroethylene grafts) with a permanently low flow (Qa <600 ml/min) are prone to thrombosis and thus have short patency. The reason for a permanently low flow is usually medial calcinosis of the inflow artery in diabetics. We retrospectively studied the long-term patency of low-flow grafts with careful ultrasound surveillance and preemptive interventions. METHODS: Twenty subjects with Qa permanently <600 ml/min were included. Ultrasound surveillance was performed every 3 months in addition to classical monitoring techniques. Significant stenosis was strictly defined as the combination of B-mode narrowing >50% + >2-fold peak systolic velocity increase + 1 additional criterion (residual diameter <2.0 mm or flow volume decrease by >20%). Such stenoses were treated by preemptive percutaneous intervention. Primary and secondary patencies were calculated. RESULTS: The primary patency was 357 ± 316 days and the secondary (cumulative) patency was 996 ± 702 days. The number of interventions was 2.09/patient year, but >10 in 6 (33%) subjects. 93 and 80% of grafts were patent 1 and 2 years after access creation, respectively. CONCLUSION: Low-flow accesses undergoing ultrasound surveillance with strict diagnostic criteria and preemptive interventions had patencies similar to accesses with normal Qa in our study. This was enabled by a relatively high rate of interventions.

• MeSH
• cévní protézy normy   trendy   MeSH
• dospělí MeSH
• kardiovaskulární nemoci chirurgie   ultrasonografie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• polytetrafluoroethylen normy   MeSH
• retrospektivní studie MeSH
• rychlost toku krve * fyziologie   MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

Both preemptive therapy and universal prophylaxis are used to prevent cytomegalovirus (CMV) disease after transplantation. Randomized trials comparing both strategies are sparse. Renal transplant recipients at risk for CMV (D+/R-, D+/R+, D-/R+) were randomized to 3-month prophylaxis with valacyclovir (2 g q.i.d., n = 34) or preemptive therapy with valganciclovir (900 mg b.i.d. for a minimum of 14 days, n = 36) for significant CMV DNAemia (>/=2000 copies/mL by quantitative PCR in whole blood) assessed weekly for 16 weeks and at 5, 6, 9 and 12 months. The 12-month incidence of CMV DNAemia was higher in the preemptive group (92% vs. 59%, p < 0.001) while the incidence of CMV disease was not different (6% vs. 9%, p = 0.567). The onset of CMV DNAemia was delayed in the valacyclovir group (37 +/- 22 vs. 187 +/- 110 days, p < 0.001). Significantly higher rate of biopsy-proven acute rejection during 12 months was observed in the preemptive group (36% vs. 15%, p = 0.034). The average CMV-associated costs per patient were $5525 and $2629 in preemptive therapy and valacyclovir, respectively (p < 0.001). However, assuming the cost of $60 per PCR test, there was no difference in overall costs. In conclusion, preemptive valganciclovir therapy and valacyclovir prophylaxis are equally effective in the prevention of CMV disease after renal transplantation.

• MeSH
• acyklovir analogy a deriváty   ekonomika   terapeutické užití   MeSH
• antivirové látky ekonomika   terapeutické užití   MeSH
• cytomegalovirové infekce ekonomika   epidemiologie   prevence a kontrola   MeSH
• Cytomegalovirus MeSH
• dospělí MeSH
• financování organizované MeSH
• ganciklovir analogy a deriváty   ekonomika   terapeutické užití   MeSH
• incidence MeSH
• lidé středního věku MeSH
• lidé MeSH
• prospektivní studie MeSH
• senioři MeSH
• transplantace ledvin ekonomika   škodlivé účinky   MeSH
• valin analogy a deriváty   ekonomika   terapeutické užití   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• senioři MeSH
• Publikační typ
• randomizované kontrolované studie MeSH
• srovnávací studie MeSH
• Geografické názvy
• Česká republika MeSH

Background Cytomegalovirus (CMV) is a major cause of infection in the early period after heart transplantation (HTx). There are limited data comparing universal prophylaxis with preemptive treatment of CMV infection in HTx recipients. Therefore, the goal of this study was to evaluate efficacy and safety of both strategies. Methods A total of 17 HTx recipients were prospectively enrolled in the universal prophylaxis group. This study cohort was matched with 18 HTx recipients who had the same immunosuppressive regimen and received preemptive therapy for CMV infection. All patients were CMV-seropositive. The study group received oral valganciclovir in a dose of 900 mg daily for 100 days. The second group was treated in case of CMV viraemia higher than 500 copies/ml. The incidence of CMV infection, other opportunistic infections and acute graft rejection and adverse events were evaluated at 3th, 6th and 12th months post-transplant. Results Universal prophylaxis was tolerated in 87.5% of the patients for a period of 100 days. Leukopenia was the most frequent side-effect that appeared in 25% of this group. This strategy decreased the rate of asymptomatic CMV infection during the first 3 months after HTx (11.7% vs. 55.6%, p=0.006) compared with preemptive therapy. This positive effect was associated with lower incidence of acute graft rejection at 12 months of follow up (6.3% vs. 41.2%, p=0.015). Conclusion Universal prophylaxis, with valganciclovir in CMV-seropositive HTx recipients, was acceptably safe and compared with preemptive therapy of CMV infection reduced the incidence of asymptomatic CMV infection and of acute graft rejection.

• Klíčová slova
• rejekce,
• MeSH
• chemoprofylaxe metody   MeSH
• cytomegalovirové infekce epidemiologie   krev   prevence a kontrola   MeSH
• financování organizované MeSH
• ganciklovir aplikace a dávkování   farmakologie   škodlivé účinky   MeSH
• leukopenie epidemiologie   chemicky indukované   MeSH
• lidé MeSH
• oportunní infekce epidemiologie   virologie   MeSH
• prospektivní studie MeSH
• rejekce štěpu etiologie   virologie   MeSH
• transplantace srdce imunologie   MeSH
• viremie epidemiologie   farmakoterapie   MeSH
• Check Tag
• lidé MeSH

OBJECTIVES: Preemptive versus therapeutic effects of levetiracetam were investigated in a model of postoperative incisional pain in rats.

• MeSH
• analgetika aplikace a dávkování   farmakologie   MeSH
• analýza rozptylu MeSH
• antikonvulziva aplikace a dávkování   farmakologie   MeSH
• financování organizované MeSH
• krysa rodu rattus MeSH
• modely nemocí na zvířatech MeSH
• morfin aplikace a dávkování   MeSH
• náhodné rozdělení MeSH
• neparametrická statistika MeSH
• piracetam analogy a deriváty   aplikace a dávkování   farmakologie   MeSH
• pooperační bolest prevence a kontrola   MeSH
• potkani Wistar MeSH
• předoperační péče MeSH
• premedikace MeSH
• výsledek terapie MeSH
• vztah mezi dávkou a účinkem léčiva MeSH
• zvířata MeSH
• Check Tag
• krysa rodu rattus MeSH
• mužské pohlaví MeSH
• zvířata MeSH

The incidence of Candida afflictions in critically ill patients is still growing in the Czech Republic. We looked for a method that not only decreases Candida afflictions but also decreases treatment expenses. This method is preemptive therapy. Critically ill patients were determined by a risk score system. This system was based on summarizing all the risk factors in one patient. Patients who reach the risk score were randomized into groups A and B. Patients in group A were administered itraconazole; patients in group B were not administered any antimycotics. Results of the study show that preemptive treatment decreases Candida infection and Candidemia. A decrease of treatment expenses was reached by identifying the specific group of patients at risk using the risk score system and administering antimycotics.

• MeSH
• antifungální látky terapeutické užití   MeSH
• infekce spojené se zdravotní péčí prevence a kontrola   MeSH
• itrakonazol terapeutické užití   MeSH
• kandidóza prevence a kontrola   MeSH
• kritický stav MeSH
• lidé MeSH
• prospektivní studie MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• randomizované kontrolované studie MeSH
• Geografické názvy
• Česká republika MeSH

SIGNIFICANCE STATEMENT: Although cytomegalovirus (CMV) infection is an important factor in the pathogenesis of kidney allograft rejection, previous studies have not determined the optimal CMV prevention strategy to avoid indirect effects of the virus. In this randomized trial involving 140 kidney transplant recipients, incidence of acute rejection at 12 months was not lower with valganciclovir prophylaxis (for at least 3 months) compared with preemptive therapy initiated after detection of CMV DNA in whole blood. However, prophylaxis was associated with a lower risk of subclinical rejection at 3 months. Although both regimens were effective in preventing CMV disease, the incidence of CMV DNAemia (including episodes with higher viral loads) was significantly higher with preemptive therapy. Further research with long-term follow-up is warranted to better compare the two approaches. BACKGROUND: The optimal regimen for preventing cytomegalovirus (CMV) infection in kidney transplant recipients, primarily in reducing indirect CMV effects, has not been defined. METHODS: This open-label, single-center, randomized clinical trial of valganciclovir prophylaxis versus preemptive therapy included kidney transplant recipients recruited between June 2013 and May 2018. After excluding CMV-seronegative recipients with transplants from seronegative donors, we randomized 140 participants 1:1 to receive valganciclovir prophylaxis (900 mg, daily for 3 or 6 months for CMV-seronegative recipients who received a kidney from a CMV-seropositive donor) or preemptive therapy (valganciclovir, 900 mg, twice daily) that was initiated after detection of CMV DNA in whole blood (≥1000 IU/ml) and stopped after two consecutive negative tests (preemptive therapy patients received weekly CMV PCR tests for 4 months). The primary outcome was the incidence of biopsy-confirmed acute rejection at 12 months. Key secondary outcomes included subclinical rejection, CMV disease and DNAemia, and neutropenia. RESULTS: The incidence of acute rejection was lower with valganciclovir prophylaxis than with preemptive therapy (13%, 9/70 versus 23%, 16/70), but the difference was not statistically significant. Subclinical rejection at 3 months was lower in the prophylaxis group (13% versus 29%, P = 0.027). Both regimens prevented CMV disease (in 4% of patients in both groups). Compared with prophylaxis, preemptive therapy resulted in significantly higher rates of CMV DNAemia (44% versus 75%, P < 0.001) and a higher proportion of patients experiencing episodes with higher viral load (≥2000 IU/ml), but significantly lower valganciclovir exposure and neutropenia. CONCLUSION: Among kidney transplant recipients, the use of valganciclovir prophylaxis did not result in a significantly lower incidence of acute rejection compared with the use of preemptive therapy. CLINICAL TRIAL REGISTRY NAME AND REGISTRATION NUMBER: Optimizing Valganciclovir Efficacy in Renal Transplantation (OVERT Study), ACTRN12613000554763 .

• MeSH
• antivirové látky škodlivé účinky   MeSH
• cytomegalovirové infekce * epidemiologie   MeSH
• Cytomegalovirus genetika   MeSH
• lidé MeSH
• neutropenie * chemicky indukované   komplikace   MeSH
• příjemce transplantátu MeSH
• transplantace ledvin * škodlivé účinky   MeSH
• valganciklovir škodlivé účinky   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• randomizované kontrolované studie MeSH

• MeSH
• cytomegalovirové infekce diagnóza   MeSH
• hematologické nádory MeSH
• lidé MeSH
• polymerázová řetězová reakce MeSH
• transplantace hematopoetických kmenových buněk MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• srovnávací studie MeSH

BACKGROUND: Cytomegalovirus (CMV) is a risk factor for acute renal allograft rejection. The aim of this study was to determine the impact of CMV viremia on subclinical rejection (SCR) and interstitial fibrosis and tubular atrophy (IF/TA) in protocol biopsy at 3 months after transplantation. METHODS: A total of 118 consecutive renal transplant recipients at risk for CMV (donor and recipient CMV seropositive) were included and followed up prospectively. Protocol biopsies with sufficient tissue were obtained in 102 patients. CMV activity was monitored using real-time polymerase chain reaction in whole blood. Three-month prophylaxis with valacyclovir or ganciclovir was given in 60 patients, whereas the remaining 42 patients were managed by preemptive therapy. Multivariate logistic stepwise regression analysis was used to estimate the effect of CMV viremia and other covariates on SCR and IF/TA. RESULTS: CMV viremia occurred in 41% of the patients with a median peak viral load of 1300 copies/mL. The incidence of SCR and IF/TA was 29% and 28%, respectively. CMV viremia was not a risk factor for SCR (OR=0.77, P=0.551); however, viremia of more than or equal to 2000 copies/mL increased the risk of IF/TA (OR=3.83, P=0.023). Biopsy-proven acute rejection (OR=3.34, P=0.009) and sirolimus-based immunosuppression (OR=6.13, P=0.008) were independent predictors of SCR. Delayed-graft function (OR=6.02, P=0.001) and donor age (OR=1.53 per 10-year increase, P=0.009) were associated with IF/TA. CONCLUSIONS: CMV viremia is not an independent risk factor for SCR. CMV viremia with viral load of more than or equal to 2000 copies/mL is associated with increased risk of IF/TA in protocol biopsy at 3 months after transplantation

• MeSH
• analýza přežití MeSH
• antivirové látky terapeutické užití   MeSH
• atrofie MeSH
• biopsie MeSH
• časové faktory MeSH
• cyklosporin terapeutické užití   MeSH
• cytomegalovirové infekce epidemiologie   farmakoterapie   prevence a kontrola   MeSH
• dospělí MeSH
• fibróza MeSH
• financování organizované MeSH
• imunosupresiva terapeutické užití   MeSH
• ledvinové kanálky patologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• následné studie MeSH
• přežívající MeSH
• retrospektivní studie MeSH
• rizikové faktory MeSH
• transplantace ledvin imunologie   mortalita   patologie   škodlivé účinky   MeSH
• viremie epidemiologie   farmakoterapie   prevence a kontrola   MeSH
• virová nálož MeSH
• výběr pacientů MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH