Diabetic foot (DF) can develop in diabetic patients after organ transplantation (Tx) due to several factors including peripheral arterial disease (PAD), diabetic neuropathy and inappropriate DF prevention. Aim: To assess the occurrence of DF and associated risk factors in transplant patients. Methods: Fifty-seven diabetic patients were enrolled as part of this prospective study. All patients underwent organ Tx (01/2013-12/2015) and were followed up for minimum of 12 months up to a maximum of 50 months. Over the study period we evaluated DF incidence and identified a number of factors likely to influence DF development, including organ function, presence of late complications, PAD, history of DF, levels of physical activity before and after Tx, patient education and standards of DF prevention. Results: Active DF developed in 31.6% (18/57) of patients after organ Tx within 11 months on average (10.7 ± 8 months). The following factors significantly correlated with DF development: diabetes control (p = .0065), PAD (p<0.0001), transcutaneous oxygen pressure (TcPO2;p = .01), history of DF (p = .0031), deformities (p = .0021) and increased leisure-time physical activity (LTPA) before Tx (p = .037). However, based on logistic stepwise regression analysis, the only factors significantly associated with DF during the post-transplant period were: PAD, deformities and increased LTPA. Education was provided to patients periodically (2.6 ± 2.5 times) during the observation period. Although 94.7% of patients regularly inspected their feet (4.5 ± 2.9 times/week), only 26.3% of transplant patients used appropriate footwear. Conclusions: Incidence of DF was relatively high, affecting almost 1/3 of pancreas and kidney/pancreas recipients. The predominant risk factors were: presence of PAD, foot deformities and higher LTPA before Tx. Therefore, we recommend a programme involving more detailed vascular and physical examinations and more intensive education focusing on physical activity and DF prevention in at-risk patients before transplantation.
- MeSH
- cvičení fyziologie MeSH
- diabetická noha * epidemiologie prevence a kontrola etiologie MeSH
- dospělí MeSH
- hodnocení rizik metody MeSH
- incidence MeSH
- lidé středního věku MeSH
- lidé MeSH
- pooperační komplikace epidemiologie prevence a kontrola etiologie MeSH
- prospektivní studie MeSH
- rizikové faktory MeSH
- transplantace ledvin * škodlivé účinky metody MeSH
- transplantace slinivky břišní * škodlivé účinky metody MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
PURPOSE: Magnetic resonance imaging (MRI) is a promising tool for risk assessment, potentially reducing the burden of unnecessary prostate biopsies. Risk prediction models that incorporate MRI data have gained attention, but their external validation and comparison are essential for guiding clinical practice. The aim is to externally validate and compare risk prediction models for the diagnosis of clinically significant prostate cancer (csPCa). METHODS: A cohort of 4606 patients across fifteen European tertiary referral centers were identified from a prospective maintained database between January 2016 and April 2023. Transrectal or transperineal image-fusion MRI-targeted and systematic biopsies for PI-RADS score of ≥ 3 or ≥ 2 depending on patient characteristics and physician preferences. Probabilities for csPCa, defined as International Society of Urological Pathology (ISUP) grade ≥ 2, were calculated for each patients using eight models. Performance was characterized by area under the receiver operating characteristic curve (AUC), calibration, and net benefit. Subgroup analyses were performed across various clinically relevant subgroups. RESULTS: Overall, csPCa was detected in 2154 (47%) patients. The models exhibited satisfactory performance, demonstrating good discrimination (AUC ranging from 0.75 to 0.78, p < 0.001), adequate calibration, and high net benefit. The model described by Alberts showed the highest clinical utility for threshold probabilities between 10 and 20%. Subgroup analyses highlighted variations in models' performance, particularly when stratified according to PSA level, biopsy technique and PI-RADS version. CONCLUSIONS: We report a comprehensive external validation of risk prediction models for csPCa diagnosis in patients who underwent MRI-targeted and systematic biopsies. The model by Alberts demonstrated superior clinical utility and should be favored when determining the need for a prostate biopsy.
- MeSH
- hodnocení rizik metody MeSH
- lidé středního věku MeSH
- lidé MeSH
- magnetická rezonanční tomografie * metody MeSH
- nádory prostaty * patologie diagnostické zobrazování MeSH
- prediktivní hodnota testů MeSH
- prostata * patologie diagnostické zobrazování MeSH
- senioři MeSH
- ultrazvukem navigovaná biopsie metody MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
- srovnávací studie MeSH
- validační studie MeSH
INTRODUCTION: Risk assessment and management in companies plays a significant role in the prevention section of any field. In the field of Occupational Health and Safety (OHS), its inconsistent or incorrect application has a direct impact on the life and health of employees. In some companies, even today, it is not properly implemented and adequate procedures and methods are not used. The article discusses the development of a step-by-step procedure for risk assessment in industrial environments in the area of OHS. METHODS: Main parts of the model and its steps present the partial results of a survey conducted on a sample of 500 small and micro enterprises in the field of risk assessment and the systematic procedure developed following the main survey results. The survey covered only enterprises located in the construction, manufacturing, transport and storage and agriculture, forestry and fishing sectors, which is also a significant statistical feature. Within the structure of respondents, statistical features such as: size of enterprise, sector, region by work are identified. Only enterprises with size by number of employees - micro enterprises from 1 to 9 employees and small enterprises from 10 to 49 employees - were included for the survey. RESULTS: New elements of the methods were integrated into the developed systematic procedure, which was subsequently validated in 7 plants of the one company on the same position. The application of the developed model was verified by an expert group consisting of 7 members, an odd number, and the developed checklists and risk register were applied. On the basis of the verification, the model, checklist and risk register were corrected. In addition, the scoring method and the risk matrix were also used, but they did not contain new elements. DISCUSION: The procedure is still in use today and employees have been trained to use it. On the basis of the developed methodology and the Checklist, the procedure has been transposed into the European OiRA tool and can be used by companies throughout the European Union.
- MeSH
- hodnocení rizik metody MeSH
- hygiena práce * MeSH
- lidé MeSH
- průmysl * MeSH
- průzkumy a dotazníky MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
BACKGROUND: New methods to identify patients who benefit from a primary prophylactic implantable cardioverter-defibrillator (ICD) are needed. T-wave alternans (TWA) has been shown to associate with arrhythmogenesis of the heart and sudden cardiac death. We hypothesized that TWA might be associated with benefit from ICD implantation in primary prevention. METHODS AND RESULTS: In the EU-CERT-ICD (European Comparative Effectiveness Research to Assess the Use of Primary Prophylactic Implantable Cardioverter-Defibrillators) study, we prospectively enrolled 2327 candidates for primary prophylactic ICD. A 24-hour Holter monitor reading was taken from all recruited patients at enrollment. TWA was assessed from Holter monitoring using the modified moving average method. Study outcomes were all-cause death, appropriate shock, and survival benefit. TWA was assessed both as a contiguous variable and as a dichotomized variable with cutoff points <47 μV and <60 μV. The final cohort included 1734 valid T-wave alternans samples, 1211 patients with ICD, and 523 control patients with conservative treatment, with a mean follow-up time of 2.3 years. TWA ≥60 μV was a predicter for a higher all-cause death in patients with an ICD on the basis of a univariate Cox regression model (hazard ratio, 1.484 [95% CI, 1.024-2.151]; P=0.0374; concordance statistic, 0.51). In multivariable models, TWA was not prognostic of death or appropriate shocks in patients with an ICD. In addition, TWA was not prognostic of death in control patients. In a propensity score-adjusted Cox regression model, TWA was not a predictor of ICD benefit. CONCLUSIONS: T-wave alternans is poorly prognostic in patients with a primary prophylactic ICD. Although it may be prognostic of life-threatening arrhythmias and sudden cardiac death in several patient populations, it does not seem to be useful in assessing benefit from ICD therapy in primary prevention among patients with an ejection fraction of ≤35%.
- MeSH
- časové faktory MeSH
- defibrilátory implantabilní * MeSH
- elektrická defibrilace přístrojové vybavení škodlivé účinky MeSH
- elektrokardiografie ambulantní * metody MeSH
- hodnocení rizik metody MeSH
- lidé středního věku MeSH
- lidé MeSH
- náhlá srdeční smrt * prevence a kontrola etiologie MeSH
- prediktivní hodnota testů MeSH
- primární prevence * metody MeSH
- prognóza MeSH
- prospektivní studie MeSH
- rizikové faktory MeSH
- senioři MeSH
- srdeční arytmie terapie patofyziologie diagnóza prevence a kontrola mortalita MeSH
- srdeční frekvence fyziologie MeSH
- výsledek terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
- Geografické názvy
- Evropa MeSH
Polygenetic Risk Scores are used to evaluate an individual's vulnerability to developing specific diseases or conditions based on their genetic composition, by taking into account numerous genetic variations. This article provides an overview of the concept of Polygenic Risk Scores (PRS). We elucidate the historical advancements of PRS, their advantages and shortcomings in comparison with other predictive methods, and discuss their conceptual limitations in light of the complexity of biological systems. Furthermore, we provide a survey of published tools for computing PRS and associated resources. The various tools and software packages are categorized based on their technical utility for users or prospective developers. Understanding the array of available tools and their limitations is crucial for accurately assessing and predicting disease risks, facilitating early interventions, and guiding personalized healthcare decisions. Additionally, we also identify potential new avenues for future bioinformatic analyzes and advancements related to PRS.
- MeSH
- celogenomová asociační studie metody MeSH
- genetická predispozice k nemoci * MeSH
- genetické rizikové skóre MeSH
- hodnocení rizik metody MeSH
- lidé MeSH
- multifaktoriální dědičnost * MeSH
- rizikové faktory MeSH
- software * MeSH
- výpočetní biologie metody MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
Alergie na bílkoviny kravského mléka (ABKM) je nejčastější alergií kojeneckého věku. Důležitým momentem v její diagnostice je včasné vytipování suspektního pacienta a provedení orálního eliminačně-expozičního testu. S cílem pomoci poskytovatelům zdravotní péče identifikovat rizika alergie vytvořili odborníci skóre symptomů potenciálně souvisejících s alergií na bílkovinu kravského mléka (Cow ́s Milk-related Symptom Score - CoMiSS). Dotazník přináší relevantní přehled o intenzitě symptomů ABKM a napomáhá v hodnocení rizika ABKM u symptomatických pacientů. V roce 2022 byl CoMiSS aktualizován: cut-off se snížil z ≥ 12 na ≥ 10, Bristolská škála stolic byla nahrazena Bruselskou škálou stolic pro kojence a batolata a angiodém byl zařazen jako nový příznak s identickým hodnocením jako kopřivka.
The cow ́s milk protein allergy (CMPA) is the most frequent allergy of infants and toddlers. It is challenging to early recognize the suspected patient and if indicated, start the diagnostic elimination followed by an oral challenge. To help the medical health care provider to identify infant at allergy risk experts published the Cow ́s Milk Related Symptom Score (CoMiSS). The questionnaire brings a relevant overview of CMPA symptoms ́ intensity and helps to work out the CMPA correctly. In 2022 the CoMiSS was updated: the cut-off decreased from ≥ 12 to ≥ 10, the Bristol Stool Scale was substituted by the Brussels Infant and Toddler Stool Scale intended for non-toilet trained subjects, an angioedema was included as a new symptom with equal rating as urticaria.
- Klíčová slova
- Cow ́s Milk-Related Symptom Score,
- MeSH
- alergie na mléko * imunologie metabolismus prevence a kontrola MeSH
- dítě MeSH
- hodnocení rizik metody MeSH
- imunoglobulin E imunologie MeSH
- lidé MeSH
- mléko imunologie MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- Publikační typ
- přehledy MeSH
While human regulatory risk assessment (RA) still largely relies on animal studies, new approach methodologies (NAMs) based on in vitro, in silico or non-mammalian alternative models are increasingly used to evaluate chemical hazards. Moreover, human epidemiological studies with biomarkers of effect (BoE) also play an invaluable role in identifying health effects associated with chemical exposures. To move towards the next generation risk assessment (NGRA), it is therefore crucial to establish bridges between NAMs and standard approaches, and to establish processes for increasing mechanistically-based biological plausibility in human studies. The Adverse Outcome Pathway (AOP) framework constitutes an important tool to address these needs but, despite a significant increase in knowledge and awareness, the use of AOPs in chemical RA remains limited. The objective of this paper is to address issues related to using AOPs in a regulatory context from various perspectives as it was discussed in a workshop organized within the European Union partnerships HBM4EU and PARC in spring 2022. The paper presents examples where the AOP framework has been proven useful for the human RA process, particularly in hazard prioritization and characterization, in integrated approaches to testing and assessment (IATA), and in the identification and validation of BoE in epidemiological studies. Nevertheless, several limitations were identified that hinder the optimal usability and acceptance of AOPs by the regulatory community including the lack of quantitative information on response-response relationships and of efficient ways to map chemical data (exposure and toxicity) onto AOPs. The paper summarizes suggestions, ongoing initiatives and third-party tools that may help to overcome these obstacles and thus assure better implementation of AOPs in the NGRA.
- MeSH
- dráhy škodlivých účinků * MeSH
- hodnocení rizik metody MeSH
- lidé MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- přehledy MeSH
Cieľom našej štúdie bolo zistiť prítomnosť Staphylococcus aureus rezistentného voči meticilínu (MRSA) medzi obyvateľmi vybraných domovov sociálnych služieb pre seniorov v dvoch krajoch Slovenska. Výsledky boli porovnané s neinštitucionalizovanými dobrovoľníkmi v rovnakom veku, ako aj s mladými dobrovoľníkmi (20–24 rokov). Výtery z nosovej dutiny od všetkých účastníkov (n = 424) boli spracované štandardnými metódami, ktoré sa bežne využívajú na izoláciu a identifikáciu S. aureus a MRSA. Štatisticky významné rozdiely v prevalencii MRSA boli zistené medzi obyvateľmi domovov dôchodcov a mladými dobrovoľníkmi (12 % vs. 1,5 %; OR 8,85; 95 % CI 2,087–37,706; p = 0,0007), ako aj medzi neinštitucionalizovanými seniormi a mladými dobrovoľníkmi (11 % vs. 1,5%; OR 8; 95% CI 1,888–33,901; p = 0,005). Naše výsledky naznačujú, že pobyt v domovoch sociálnej starostlivosti pre seniorov a vyšší vek by mohli byť rizikovým faktorom pre výskyt vysoko rizikových kmeňov MRSA.
The objective of our study was to examine the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) among residents of nursing homes for the elderly of selected institutions in two Slovak regions compared to non-institutionalized volunteers of the same age, as well as young volunteers (20–24 years old). Nasal swabs from all participants (n = 424) were processed using standard methods for the isolation and identification of S. aureus and MRSA. Statistically significant differences were found between nursing home residents and young volunteers (12% vs. 1.5%; OR 8.85; 95% CI 2.087–37.706; p = 0.0007), as well as between non-institutionalized seniors and young volunteers (11% vs. 1.5%; OR 8; 95% CI 1.888–33.901; p = 0.005) in the prevalence of MRSA. Our results suggest that nursing home residency and older age could be a risk factor for the occurrence of high-risk MRSA strains.
- MeSH
- antibiotická rezistence MeSH
- domovy pro seniory MeSH
- hodnocení rizik metody MeSH
- lidé MeSH
- methicilin rezistentní Staphylococcus aureus * patogenita MeSH
- mladý dospělý MeSH
- morbidita MeSH
- prevalence MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- Staphylococcus aureus patogenita MeSH
- Check Tag
- lidé MeSH
- mladý dospělý MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- Publikační typ
- klinická studie MeSH
- práce podpořená grantem MeSH
- Geografické názvy
- Slovenská republika MeSH
Kontext: Při akutní plicní embolii (PE) hrají významnou roli rychlé stanovení diagnózy a naplánování léčby podle klasifikace rizika úmrtí. Cíle: Posoudit přínos znalosti hodnot systolického tlaku v plicnici (systolic pulmonary artery pressure, sPAP) při stratifikaci rizika pacientů s akutní PE. Metody: Naše studie byla retrospektivní, průřezová. Bylo do ní zařazeno celkem 221 pacientů přijatých do naší nemocnice s diagnózou akutní PE, stanovenou CT angiografií plicnice (computed tomography pulmonary angiography, CTPA). Všichni pacienti byli vyšetřeni echokardiograficky (ECHO) a hodnota sPAP byla vypočítána pomocí Bernoulliho rovnice. Vztahy mezi proměnnými, jako jsou stratifikace rizika podle Evropské kardiologické společnosti (European Society of Cardiology, ESC), dysfunkce pravé komory (right ventricular dysfunction, RVD), hodnota troponinu T a sPAP, byly posuzovány pomocí Spearmanových korelačních koeficientů. Výsledky: Mezi hodnotami sPAP na jedné straně a hodnotami troponinu T, RVD a skupinami s vysokým a středně vysokým rizikem podle ESC na straně druhé byla nalezena těsná pozitivní lineární korelace (Spearmanův korelační koeficient r = 0,615; resp. 0,798; 0,411 a 0,408; p < 0,001). Jako optimální mezní hodnota pro sPAP byla stanovena hodnota 41,5 mm Hg s celkovou přesností 0,961 (95% CI 0,937-0,984). Kromě toho se prokázalo, že při mezní hodnotě 41,5 mm Hg dokáže sPAP účinně vyhledávat přítomnost RVD a rizikové skupiny podle ESC (p < 0,0001). Naše studie prokázala 85% senzitivitu a 92% specificitu sPAP při vyhledávání RVD nad mezní hodnotou 41,5 mm Hg. Závěry: I když nelze sPAP považovat za spolehlivý parametr při vyšetření pacientů s akutní PE metodou ECHO, potvrdily výsledky naší studie, že sPAP může představovat užitečný parametr při stratifikaci rizika akutní PE, a hodnotu sPAP by tak bylo vhodné zařadit mezi kritéria RVD ve stratifikaci rizika akutní PE.
Background: In acute pulmonary embolism (PE), rapid diagnosis and treatment planning according to mortality risk classification are important. Objectives: To explore the effectiveness of systolic pulmonary artery pressure (sPAP) values in the risk stratification of the patients with acute PE. Methods: This study is a retrospective, cross-sectional clinical trial design. A total of 221 patients who were admitted to our hospital and diagnosed as acute PE by thorax computed tomography pulmonary angiography (CTPA) was included in the study. All patients were evaluated by echocardiography (ECHO) and sPAP was calculated by Bernoulli equation. The relationships between variables such as the European Society of Cardiology (ESC) risk stratification, right ventricular dysfunction (RVD), troponin T, and sPAP levels were examined with Spearman's correlation coefficients. Results: A strong positive linear correlation was found between sPAP, and troponin T, RVD, ESC high-risk, intermediate-high risk groups (Spearman's r = 0.615, 0.798, 0.411, 0.408, p <0.001, respectively). The optimal cut-off value for sPAP was found as 41.5 mmHg with an overall accuracy of 0.961 (95% CI: 0.937-0.984). Besides, at the cut-off value of 41.5 mmHg, sPAP was found effective in determining RVD and ESC risk groups (p <0.0001). Sensitivity and specificity of sPAP was found as 85%, 92%, respectively in detecting RVD above 41.5 mmHg cut-off value. Conclusions: Although sPAP is not considered as a reliable finding of ECHO in the patients with acute PE, our study results confirmed that it can be valuable in the risk stratification of acute PE. It would be useful to include sPAP to RVD criteria for acute PE risk stratification.
