Acta medica (Hradec Kralove)最新文献

Background: Point-of-care testing (POCT) helps accelerate and streamline many processes in primary care. However, there is little information on the characteristics of their users.

Methods: Data were provided by the largest Czech health insurance company, covering 60% of the population. A proprietary spatial categorization model based on OECD typology, adapted to Czech primary care conditions, was used for localization.

Results: In all monitored groups, we observed continuous growth in the number of general practices using POCT methods, unaffected by Covid-19. Absolute numbers of POCT-INR and POCT-CRP examinations decreased during the pandemic years. The number of POCT-INR tests is more affected by practice location, while the number of POCT-CRP tests is influenced by the age of GPs.

Conclusions: Although POCT methods are a voluntary part of general practitioners' office equipment in Czechia, their more frequent use indicates that system-level conditions are appropriately set. The interest of GPs aged 60+ is surprising. Despite using POCT examinations the least, they show similar growth to other groups.

Background: Pyogenic spondylodiscitis is a severe spinal infection. Surgery can provide source control, neural decompression, and stability when indicated, but practice varies. We assessed outcomes of surgically treated cases at a tertiary neurosurgical center (2015-2024).

Methods: Retrospective cohort of consecutive adults admitted with pyogenic spondylodiscitis to a tertiary neurosurgical center (2015-2024). Surgical and non-surgical cases were recorded; analyses focus on surgically managed patients with whole-cohort descriptors where indicated.

Methods: We retrospectively analysed consecutive patients indicated for surgery. Variables included procedure type (decompression alone vs. instrumentation), presence of epidural abscess, reoperation for relapse or new-onset instability, microbiology, length of hospital stay (LOS), early outcomes, and admission clinical status.

Results: We included 126 patients (87 men, 69%); mean age 65 years (range 13-91). Surgery was performed in 108 (85.7%): decompression alone in 76/108 (70.4%), instrumented decompression in 21/108 (19.4%), standalone instrumentation in 4/108 (3.7%), and multistage combined procedures in 7/108 (6.5%). Epidural abscess was present at the index operation in 98/108 (90.7%). Relapse, either confirmed intraoperatively or on preoperative MRI occurred in 29/126 (23.0%); reoperation for progressive instability in 17/108 (15.7%). Among patients with confirmed etiology (121/126, 96.0%), the most frequent pathogens were Staphylococcus aureus 69/121 (57.0%), Enterobacterales 18/121 (14.9%), and streptococci 16/121 (13.2%). Mean LOS was 35.3 days (median 27). Multiorgan failure developed in 44/126 (35.0%); in-hospital mortality was 7/126 (5.6%). No implant-related complications were observed.

Conclusions: Early surgical source control with decompression without instrumentation was sufficient in most operated cases. When radiographic or intraoperative instability was present, instrumentation appeared safe despite active infection, provided meticulous debridement and pathogen-directed antibiotics were employed. Blood cultures and tissue samples should be taken timely and repeated if needed, as they both provide high diagnostic yield.

Purpose: To analyze the clinical characteristics and outcomes of patients with acute heart failure (AHF) admitted to an internal medicine department (IMD), with a focus on their trajectories, risk factors, and rehospitalisation/mortality rate.

Methods: This retrospective cohort study included 410 hospitalisations (280 patients; 28% readmissions) for AHF during 2023. Diagnosis was validated using the European Society of Cardiology age-specific NT-proBNP thresholds and echocardiographic criteria. Baseline clinical and laboratory data were analyzed, prognostic markers were identified, and a risk algorithm was developed.

Results: Mean patient age was 82 years (54% women). Most cases involved nonischemic etiology (80%) and HF with preserved ejection fraction (HFpEF, 69%). Frequent comorbidities included hypertension (85%), diabetes (45%), atrial fibrillation (44%), and multiple non-cardiac conditions. In-hospital mortality was 19.6%; 30-day readmission was 9.9%. Three clinical trajectories (index/first hospitalisation) were identified: single admission (n: 169), rehospitalisation (with/without death) (n: 73), and in-hospital death (n: 38). Prognostic markers included advanced age, elevated NT-proBNP, renal dysfunction, anemia, and non-cardiac cause of HF decompensation.

Conclusions: This elderly IMD-HF cohort, mainly female and multimorbid, showed high HFpEF prevalence and adverse outcomes. NT-proBNP, renal function, haemoglobin, and non-cardiac causes of HF decompensation were key prognostic indicators.

Arteriovenous fistulas (AVFs) are widely accepted as the gold standard for vascular access in chronic hemodialysis patients due to their superior long-term patency and low complication rates. However, up to half of all created AVFs fail to mature adequately, and many develop late complications such as stenosis, thrombosis, or aneurysmal degeneration. This review provides an overview of the AVF development process, focusing on the biomechanical forces that drive vascular remodeling and contribute to maturation and pathological changes. We summarize the role of endothelial mechanotransduction and insights from recent studies that reveal how wall shear stress (WSS) patterns and oscillatory flow relate to the genesis of neointimal hyperplasia and later stenosis. Understanding these mechanobiological processes has led to novel surgical techniques, anastomosis design optimization, and better cannulation strategies. Although the knowledge of hemodynamic-biological interactions remain limited, further research can offer directions for better AVF performance.

Myosteatosis refers to the infiltration of fat into skeletal muscle tissue, being influenced by factors such as advanced age and overweight, which increase the inability of adipocytes to store lipids. This condition not only alters the structure of the muscle but is also associated with endocrinological imbalances such as insulin resistance (IR) and hyperinsulinemia, increasing the risk of developing type 2 diabetes mellitus (T2DM) and cardiovascular diseases. Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) are effective methods for measuring myosteatosis, identifying areas of fat accumulation that may indicate specific regional patterns. This review aimed to evaluate the main evidence that associates myosteatosis with T2DM, compiling the epidemiological data already available on the subject and the main gaps in the literature. Ten observational studies were selected, from different regions of the world, which showed a relationship between myosteatosis and a higher incidence of T2DM, as well as IR, worse glycemic status, increased inflammatory mediators and a tendency to coronary artery disease. In conclusion, myosteatosis and T2DM are conditions with a relevant relationship and that have significant implications for public health, requiring greater standardization of myosteatosis assessment methods and interventional studies that address potential therapeutic strategies for this condition.

A case of a young Caucasian man presenting to the Emergency Department (ED) with lower limb weakness, anxiety, and sweating is described. Clinical and laboratory evaluations revealed severe hypokalemia (1.4 mmol/L) associated with thyrotoxicosis, leading to a diagnosis of Thyrotoxic Periodic Paralysis (TPP). After initial improvement following potassium infusion, the patient experienced symptom exacerbation. Further investigation linked the recurrence to excessive carbohydrate intake from vending machine snacks. TPP, a complication of hyperthyroidism, is extremely rare in Western countries but must be promptly recognized due to its potential life-threatening complications.

Introduction: Health literacy is a fundamental tool for improving patients self-care, so this study evaluated the association between health literacy and self-care in patients with hypertension and type 2 diabetes mellitus.

Method: Cross-sectional observational study of 200 patients at Hospital Florencia de Mora (June-November 2024), using the Health Literacy Survey Questionnaire (HLS-Q12), Diabetes Self-Management Questionnaire, and Self-Care of Hypertension Inventory. Parametric tests (t-test, ANOVA) and multivariate analyses were applied.

Results: The sample included 47.5% patients with hypertension, 39.5% with diabetes, and 13% with both conditions, mean age 67.54 years (±8.82), female predominance (58.5%). Health literacy demonstrated a moderate correlation with self-care in patients with hypertension (r = 0.648; p < 0.001) and weak but significant correlation in patients with diabetes (r = 0.274; p < 0.001). Multivariate analyses revealed that health literacy was associated with 42% of self-care variance in patients with hypertension (β = 0.927; 95% CI: 0.729-1.125; p < 0.001), while in patients with diabetes, together with sex factor, it was associated with 10.6% of variance (β = 0.117; 95% CI: 0.027-0.207; p = 0.011).

Conclusion: Health literacy shows a stronger association with self-care hypertension's patients than in patients with diabetes, suggesting the need for differentiated strategies to improve self-care in both populations.

Despite advances in neonatal care, neonatal jaundice remains a common problem in maternity wards. The present retrospective epidemiological study collected data on a sample of 710 newborns and compared the incidence of neonatal jaundice in infants born to Rh (D) negative and 0 Rh (D) positive mothers. The primary aim was to determine whether the higher incidence of maternal alloimmunisation in newborns was causally related to a potentially higher incidence of neonatal jaundice in newborns of 0 Rh (D) positive mothers. To the end, we investigated a possible association between the incidence of neonatal jaundice in 0 Rh (D) positive mothers and the neonatal blood group. The incidence of neonatal jaundice was not found to differ between maternal blood groups. We discuss new preventive measures that may reduce the incidence of neonatal jaundice and thereby reduce the length of hospital stay.

Contrast-induced sialadenitis (CIS), a rare inflammatory reaction of the salivary glands, occurs after exposure to iodinated contrast media (ICM). This self-limiting condition typically manifests as glandular swelling and pain, with variable severity, from hours to days post-contrast administration. Its etiology includes inflammatory edema, ductal obstruction, and pseudoallergic or idiosyncratic reactions. Non-ionic, low-osmolar agents such as Iohexol and Iodixanol are frequently implicated. Risk factors include iodine allergy, renal dysfunction, and inadequate premedication. Diagnostic imaging via CT or ultrasound reveals characteristic findings such as glandular enlargement, periglandular fat stranding, and heterogeneous enhancement, aiding differentiation from other causes like infection or neoplasms. This case series presents three patients who developed sialadenitis following contrast-enhanced CT scans. Presentations ranged from mild, localized submandibular swelling to rapid-onset bilateral glandular inflammation involving the parotid and submandibular glands. All cases highlight the need for prompt recognition and adherence to preventive measures, including premedication with corticosteroids and hydration, especially in high-risk patients. Management is largely supportive, involving corticosteroids, antihistamines, and NSAIDs, with severe cases requiring closer monitoring. By raising awareness of this underreported condition, this article underscores the importance of early recognition and differentiation from other conditions by radiologists, emphasizing their role in timely diagnosis and management. It also calls for further research to optimize prevention and management strategies.

The study aimed to establish the impact of age on the predictive capability of ferritin, ferritin-hemoglobin ratio (FHR), IL-6, and sIL-2R in COVID-19 patients. Compared to patients with moderate condition, patients with severe condition had higher ferritin level (441.0 [188.0-829.8] ng/mL vs 281.0 [172.0-388.0] ng/mL, p = 0.002), sIL-2R level (6.0 [4.7-9.0] pg/mL vs 5.3 [3.7-6.9] pg/mL, p = 0.020), FHR (38.4 [15.1-63.4] vs 22.0 [12.1-32.1], p = 0.002). The area under the curves (AUC) for discriminative capabilities of the following biomarkers for severe condition were assessed in patients aged <65 years and patients aged ≥65 years: ferritin (AUC = 0.585, p = 0.309 vs AUC = 0.683, p = 0.002), FHR (AUC = 0.589, p = 0.302 vs AUC = 0.688, p = 0.002), IL-6 (AUC = 0.503, p = 0.972 vs AUC = 0.647, p = 0.019), and sIL-2R (AUC = 0.549, p = 0.552 vs AUC = 0.646, p = 0.017). Also AUCs for discriminative capabilities for in-hospital mortality were compared in patients aged <65 years and ≥65 years: ferritin (AUC = 0.607, p = 0.628 vs AUC = 0.661, p = 0.105), FHR (AUC = 0.612, p = 0.621 vs AUC = 0.688, p = 0.002), IL-6 (AUC = 0.580, p = 0.724 vs AUC = 0.695, p = 0.016), and sIL-2R (AUC = 0.620, p = 0.491 vs AUC = 0.695, p = 0.029). Thus, ferritin, FHR, IL-6, and sIL-2R didn't show acceptable predictive value for severe condition and lethal outcome in patients aged <65 years but had high predictive value for lethal outcome in patients aged ≥65 years.