Onemocnění COVID-19, způsobené virem SARS-CoV-2, vyvolává řadu změn v krevním obraze. Covid skóre (CS) je proměnná, vypočítaná z 10 parametrů krevního obrazu, umožňující predikci závažného průběhu onemocnění COVID-19. Hodnoty CS se mohou pohybovat od 0 do 28. V pilotní práci Linssen et al byla hodnota CS v rozmezí 0–3 asociována s klinicky nekomplikovaným průběhem onemocnění, naopak hodnoty 4 a více predikovaly závažný průběh s potřebou intenzivní péče nebo fatálním koncem. Cílem práce bylo ověřit prognostický potenciál CS v souboru 76 nemocných s prokázaným onemocněním COVID-19 vyšetřených ve FN Olomouc v průběhu prosince 2021 až února 2022. Celkem 44 (57,9 %) nemocných mělo hodnotu CS v rozmezí 0–3 a 32 (42,1 %) nemocných mělo CS 4 a více. Nemocní s CS ≥ 4 významně častěji vyžadovali hospitalizaci na lůžkách intenzivní péče (78,1 vs. 20,5 %; p < 0,0001) a artefi ciální ventilační podporu (75,0 vs. 20,5 %; p < 0,0001). Mortalita nemocných byla nesignifi kantně vyšší ve skupině s CS ≥ 4 ve srovnání s nemocnými s hodnotou CS 0–3 (25,0 vs. 11,4 %; p = 0,119). Práce dále prokázala asociaci mezi hodnotou CS a již známými rizikovými faktory komplikovaného průběhu COVID-19. Medián hodnoty D-dimerů a CRP byl významně vyšší při stanovení dia gnózy u nemocných s hodnotou CS ≥ 4 (2006,0 vs. 594,5 μg/ l; p < 0,0001; resp. 132,6 vs. 36,9 mg/ l; p < 0,0001) a signifi kantně častěji byla vstupně zjištěna zánětlivá plicní infi ltrace (96,9 vs. 47,7 %; p < 0,0001). Výsledky práce potvrdily prognostický potenciál CS v predikci komplikovaného průběhu onemocnění COVID-19, s potřebou hospitalizace a ventilační podpory. Při prognostické stratifi kaci nemocného je vždy nutné individuálně zvážit i rizikové faktory na straně pacienta, vakcinační status a podanou specifi ckou protivirovou terapii v kontextu aktuálně dominující varianty viru SARS-CoV-2.
COVID-19 disease, caused by the SARS-CoV-2 virus, induces a number of changes in the blood count. The Covid Score (CS) is a variable, calculated from 10 parameters of the blood count, enabling the prediction of COVID-19 disease severity. CS values can range from 0 to 28. In the pilot study by Linssen et al, a CS value in the range of 0–3 was associated with a clinically uncomplicated course of the disease, while values of 4 or more predicted a severe course with the need for intensive care or a fatal outcome. The aim of the work was to verify the prognostic potential of CS in a group of 76 patients with proven COVID-19 infection examined at the Olomouc University Hospital between December 2021 and February 2022. A total of 44 (57.9%) patients had a CS value in the range of 0–3 and 32 (42.1%) of patients had CS 4 or more. Patients with CS ≥ 4 were more likely to require hospitalization in intensive care units (78.1 vs. 20.5%; P < 0.0001) and artificial ventilation (75.0 vs. 20.5%; P < 0.0001). The mortality rate was non-significantly higher in the group with CS ≥ 4 compared to patients with CS 0–3 (25.0 vs. 11.4%; P = 0.119). The work also demonstrated the association between the CS value and already known risk factors for the complicated course of COVID-19. The median value of D-dimers and CRP was significantly higher at diagnosis in patients with CS value ≥ 4 (2006.0 vs. 594.5 μg/l; P < 0.0001; respectively 132.6 vs. 36.9 mg/L; P < 0.0001) and inflammatory lung infiltration was also detected significantly more often at admission (96.9 vs. 47.7%; P < 0.0001). The results of the work confirmed the prognostic potential of CS in predicting the course of COVID-19 disease, with the need for hospitalization and ventilation support. During the prognostic stratification of patients, it is always necessary to also consider the patient’s risk factors, vaccination status and specific antiviral therapy administered in the context of the currently dominant variants of the SARS-CoV-2 virus.
- Klíčová slova
- covid skóre,
- MeSH
- COVID-19 * diagnóza komplikace krev MeSH
- dospělí MeSH
- komorbidita MeSH
- lidé středního věku MeSH
- lidé MeSH
- prognóza MeSH
- retrospektivní studie MeSH
- rizikové faktory MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- stupeň závažnosti nemoci 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
- práce podpořená grantem MeSH
BACKGROUND: Clinically silent uterine rupture with complete fetal expulsion into the abdominal cavity is an extremely rare complication. Diagnosis can be difficult and the risk to the mother and fetus is high. Conservative management has been described only in a few cases of partial expulsion of the fetus so far. CASE PRESENTATION: We present a case of 43-year-old tercigravida with a history of previous laparotomic myomectomy and subsequent cesarean section. The subsequent pregnancy was complicated by uterine wall loosening and rupture at the site of the previous uterine scar after myomectomy and complete fetal expulsion into the abdominal cavity. The diagnosis was made at 24 + 6 weeks of gestation. Considering the absence of clinical symptomatology and the good condition of the fetus, a conservative approach was chosen with intensive monitoring of the maternal and fetal conditions. The pregnancy ended by elective cesarean section and hysterectomy at 28 + 0 weeks of gestation. The postpartum course was uneventful and the newborn was discharged to home care 63 days after delivery. CONCLUSIONS: Fetal expulsion into the abdominal cavity after silent uterine rupture of the scarred uterus may be accompanied by minimal symptomatology making early diagnosis difficult. This rare complication must be considered in the differential diagnosis in women after major uterine surgery. In selected cases and under conditions of intensive maternal and fetal monitoring, conservative management may be chosen to reduce the risks associated with prematurity.
- MeSH
- břišní dutina * MeSH
- císařský řez škodlivé účinky MeSH
- dospělí MeSH
- konzervativní terapie škodlivé účinky MeSH
- lidé MeSH
- novorozenec MeSH
- ruptura dělohy * etiologie chirurgie diagnóza MeSH
- těhotenství MeSH
- uterus MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- novorozenec MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
- Publikační typ
- abstrakt z konference MeSH
- MeSH
- abnormality očí * diagnóza klasifikace komplikace patologie terapie MeSH
- dědičné dystrofie rohovky diagnóza klasifikace komplikace patologie terapie MeSH
- dědičné nemoci očí diagnóza klasifikace komplikace patologie terapie MeSH
- degenerativní myopie diagnóza komplikace terapie MeSH
- diferenciální diagnóza MeSH
- dítě MeSH
- lidé MeSH
- oči anatomie a histologie patologie MeSH
- odchlípení sítnice etiologie klasifikace terapie MeSH
- retina abnormality anatomie a histologie patologie MeSH
- retinální dystrofie diagnóza klasifikace patologie terapie MeSH
- retinální teleangiektázie diagnóza komplikace terapie MeSH
- retinopatie nedonošených diagnóza klasifikace komplikace patofyziologie terapie MeSH
- sklivec abnormality anatomie a histologie patologie MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- Publikační typ
- přehledy MeSH
INTRODUCTION: To evaluate the results of the fluctuations of intraocular pressure (IOP) and calculated mean ocular perfusion pressure (MOPP) during the usual steps of standard phacoemulsification. METHODS: Nine human eyes were evaluated. The IOP was measured indirectly by electronic applanation tonometer. The MOPP was calculated using the systolic blood pressure (SBP), the diastolic blood pressure (DBP) and the IOP: MOPP = 2/3x[DBP + 1/3x(SBP - DBP)] - IOP. The operations were performed with the INFINITI® Vision System: main incision 2.2 mm, coaxial handpiece, 2 paracenteses 1.1 mm, bimanual irrigation/aspiration, bottle height 100 cm. As ocular viscoelastic device (OVD) Hypromel 2.5% (UNIMED) was used. RESULTS: The initial and final IOPs were 17-30 Torr (median 18) and 6-16 Torr (median 8), respectively. The IOP values oscillated between 4 and 63 Torr during the procedure. The highest values of the IOP were achieved at the beginning of phacoemulsification (from 42 to 63 Torr). The maximum pressure higher than 50 mmHg and 60 mmHg was found in 89% and 30% of cases, respectively. The mean ocular perfusion pressure (MOPP) at the beginning of the procedure was 46.4-67.0 (median 53.3) and 0.4-42.0 (median 19.3) during the maximum intraocular pressure. CONCLUSIONS: Measured IOP as well as MOPP varied in all normal steps of real phacoemulsification. High values of intraoperative IOL induced by irrigation may compromise the intraocular perfusion. These fluctuations may induce impairment of the optic nerve perfusion, as well as retina, or choroid.
- MeSH
- fakoemulzifikace škodlivé účinky metody MeSH
- glaukom chirurgie MeSH
- krevní tlak fyziologie MeSH
- lidé MeSH
- nitrooční tlak fyziologie MeSH
- reprodukovatelnost výsledků MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- tonometrie oční metody MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
AIMS: To describe the ultrasound features of benign struma ovarii that often mimic ovarian cancer in the background of complex clinical and histopathological pictures. MATERIAL AND METHODS: We retrospectively identified patients with histologically confirmed benign struma ovarii, treated in our institution between 2003-2016 with complete imaging, clinical, nd histopathological data available. Ultrasound findings were drawn from images, and reports using terms and definitions of the International Ovarian Tumor Analysis group and pattern recognition description was applied. RESULTS: In all, 19 patients were identified; 10 with pure and 9 with impure struma. Median age was 47 (range 24-69); 10 (53%) were premenopausal. Only four (21%) patients presented with pain, others were asymptomatic. Using pattern recognition, 74% strumas (14/19) were uni-/multilocular solid or solid tumors. The solid components were roundish with smooth contours. Six struma pearls were detected. The subjective color score was moderate or abundant in the majority of solid components. Only 5 (26%) tumors were purely cystic. CONCLUSIONS: The ultrasound characteristics differ widely from typical mature ovarian teratoma. Features such as, solid roundish components with smooth contours, struma pearls, acoustic shadowing and occasionally signs of dermoid are clues and may help preoperatively to differentiate benign struma from malignant adnexal lesions.
- MeSH
- diferenciální diagnóza MeSH
- dospělí MeSH
- hodnocení rizik MeSH
- invazivní růst nádoru patologie MeSH
- kohortové studie MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- nádory vaječníků diagnostické zobrazování patologie chirurgie MeSH
- ovarektomie metody MeSH
- prognóza MeSH
- retrospektivní studie MeSH
- staging nádorů MeSH
- struma ovarii diagnostické zobrazování patologie chirurgie MeSH
- ultrasonografie dopplerovská barevná metody MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- srovnávací studie MeSH
Introduction: The aim of this work is to evaluate our own results of surgical treatment of retinal detachment in immature newborns. Retinopathy of prematurity (ROP) is one of the most complicated ocular disorders, both in terms of diagnosis and therapy. It is a potentially blinding illness that arises from the incomplete development of the bloodstream of the neuroretina of preterm infants. Currently, the most effective therapy is ablation of the avascular retina by laser photocoagulation or cryocoagulation. Despite this treatment, the immature retina may develop it´s detachment. Methodology: We report 2 case-reports, retrospective results of 4-eyes in 2 patients with severe ocular and overall complications of prematurity. The ocular background of preterm babies was investigated in arteficial mydriasis by an indirect ophthalmoscope, and later with the RetCam photographic device. The ROP stages were evaluated according to the ICROP classification. All eyes were treated with cryo-retinopexy at the threshold stage of ROP, followed by intraocular surgery for progression of traction retinal detachment. The surgical technique was a 3-port 25-G PPV (pars-plicata vitrectomy) with insertion of ports 1.5 mm from limbus. The PPV was performed using the Constellation (ALCON) operating unit, controlling the intraocular pressure for 15 torr. The assessment of visual acuity was performed according to the scale: no light perception (no response of the child to light), light sensitivity (positive or negative reaction to illumination), fixation of light. Results: The retina stayed attached in all operated eyes, more in each case-report. Conclusion: Contemporary vitreoretinal surgery allows for the anatomical success of traction retinal detachment surgery during ROP already in neonatal age.
- MeSH
- design vybavení MeSH
- lidé MeSH
- následné studie MeSH
- novorozenec MeSH
- odchlípení sítnice * MeSH
- pooperační komplikace MeSH
- retinopatie nedonošených * chirurgie komplikace patologie MeSH
- stupeň závažnosti nemoci MeSH
- vitrektomie * přístrojové vybavení MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- novorozenec MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
- MeSH
- lidé MeSH
- porod MeSH
- porodnost * MeSH
- vedení porodu MeSH
- Check Tag
- lidé MeSH
- ženské pohlaví MeSH