Prague medical report最新文献

Passive immunotherapy has been evaluated in many infections. The present study aims to evaluate purified F(ab')2 fraction of equine hyperimmune IgG (anti-SARS-CoV-2) in the treatment of coronavirus lung disease. Patients with coronavirus disease of 2019 (COVID-19) with World Health Organization (WHO) score 3, 4 or 5 up to 72 hours of evolution from the onset of symptoms were included. They were randomly assigned to anti-SARS-CoV-2 or placebo. Follow-up was performed for 28 days to assess efficacy, safety, pharmacokinetics, detection of anti-horse antibodies, circulating cytokines and determination of anti-SARS neutralizing activity. The 20 initial patients (44±14 years) were included. On the third day of treatment there was an improvement (P=0.02) in arterial saturation (95±1.6 vs. 93±2.5%) with increasing differences over time between treatments (day 8: 97±0.1 vs. 94±0.3%). The length of oxygen therapy treatment was 2±0.8 vs. 3±0.9 (0.048) in patients falling within WHO 5 category (no difference to WHO 4). Mean hospitalization was 13±2.5 vs. 14±0.8 days (P=0.095) and time to clinical improvement was 2±0.5 vs. 3±0.9 days (P=0.048) in patients with initial 5 WHO category, with no differences to patients who started with WHO stage 4. The time to nasal swab negativization was 10±2.1 vs. 12±0 day (P=0.015). No adverse reactions or intercurrences were detected. All patients presented heterophile antibodies without clinical correlate. The new treatment shows improvement in arterial saturation (days 3 to 12), and a decrease on detectable viral RNA (days 8 to 11) with good pharmacokinetic and safety profile.

Tooth loss, darkened teeth, and disproportionate shape and size of teeth can compromise the way an individual sees themselves and their interpersonal relationships. The present study aims to report a case report of a plastic smile. After initial clinical examinations, it was proposed to perform an adhesive-fixed dental prosthesis, fiberglass post-restoration, and direct veneers in resin composite. For tooth 11, which had extensive coronary damage, a fiberglass post-restoration was performed. The fiberglass post was cemented with dual resin cement and the tooth was sculpted using the indirect resin composite technique. For the tooth loss (13), an adhesive fixed dental prosthesis was made of fiberglass, with wear of the abutment teeth (12 and 14) to support the prosthesis. From teeth 14 to 24, wear to veneers was performed. The veneers were implemented with resin composed by the direct hands-free technique. Treatment was completed with occlusal adjustments, finishing, and polishing. Rehabilitation treatment performed emphasizes the importance of associating adequate planning, dentist dexterity, and the choice of materials and techniques used.

Subacute sclerosing panencephalitis (SSPE) is the result of a chronic infection of the central nervous system caused by a mutated measles virus. We present a case of SSPE in a 19-year-old female with congenital HIV-infection. The patient has been using antiretroviral therapy regularly since she was 4 years old. At the age of 15, she contracted measles of moderate severity. At the age 17, she had the HIV viral load < 20 copies/ml and the CD4 count 420 cells/μl. Three years after measles, bilateral necrotizing retinitis developed, and five months later, myoclonic seizures of the left limbs. Symptoms progressed gradually, with fever, generalised seizures, and lost consciousness. She was hospitalized in department for treatment patient with HIV-infection. Magnetic resonance imaging of the brain revealed massive areas of the altered signal without clear contours in both hemispheres of the brain, which captured the white and grey matter of the fronto-parietal, temporal-occipital lobes. The electroencephalography showed the flashes of slow-wave paroxysmal activity of the brain in the delta range, mainly in the fronto-parietal area. In the cerebral spinal fluid, anti-measles IgG was detected at a titre of 3738,408 U/ml, and in the blood - 9.4 U/ml. A diagnosis of SSPE was established. Supportive, corticosteroids and anticonvulsant treatment were ineffective. Patient died 10 months after the onset of the disease. Therefore, measles at any age in a person with congenital HIV-infection poses a risk of developing SSPE.

Intussusception is a rare condition in adults, and often presents with non-specific symptoms. Lipoma, a benign tumour of adipose tissue, is an infrequent cause of intussusception. Standard diagnostic methods include computed tomography (CT) imaging, with typical radiological features such as "bowel-within-bowel" sign enabling a prompt diagnosis with a high sensitivity and specificity. This case report describes a 51-year-old female patient who presented to the emergency department with abdominal pain caused by intussusception, with a gastrointestinal lipoma as the lead point, diagnosed through CT imaging. The article highlights the rarity of colonic lipoma, its potential to cause intussusception and the importance of timely diagnosis to avoid complications like bowel obstruction or necrosis.

Glucocorticoid remediable aldosteronism (GRA) also known as familial hyperaldosteronism type 1 (FH1) is a rare genetic form of primary aldosteronism characterized by aldosterone overproduction regulated by adrenocorticotropic hormone (ACTH). We present the case of a 54-year-old woman with severe hypertension and hypokalemia. Genetic testing confirmed GRA by identifying a chimeric gene involving CYP11B1 and CYP11B2. This case highlights the importance of considering GRA in patients with resistant hypertension and a family history of cerebral aneurysms. Management involved glucocorticoid therapy and mineralocorticoid receptor antagonists, leading to significant improvement in blood pressure control.

Iliac crest is common site for harvesting bone grafts. Morphometry of iliac crest is of vital importance in orthopedic surgery. Measurements were done on male (n=85) and female (n=85) hip bones. Length of iliac crest, thickness of iliac crest and ilium were measured. Thickness was measured at pre-defined points on crest and ilium 2 cm apart starting from anterior superior iliac spine (ASIS). Ilium was measured at a depth of 2.5 cm from crest. Statistical analysis was done. Iliac crests were longer in male bones. Ventral iliac crest was thickest at 6 cm from ASIS in both sexes. While iliac crest bore minimum thickness at 12 cm and 10 cm from ASIS in male and female bones respectively, however at 2.5 cm below iliac crest surface ilium was thickest at 4 cm from ASIS and at ASIS in male and female bones respectively. In case of male bones, dorsal part of iliac crest was thickest at 2.15 ± 1.29 cm from posterior superior iliac spine (PSIS) while in females it was at 1.78 ± 1.31 cm from PSIS. In dorsal part of ilium, it was observed at 2.31 ± 1.47 cm and 1.9 ± 1.79 cm from PSIS for male and female bones respectively. This study provided detailed variable morphometry and significant sexual dimorphism observed in iliac crest and ilium. Thickest safe zones in both sexes are a useful guide for harvesting appropriate bone grafts.

Hailey-Hailey disease (HHD), also known as benign familial pemphigus, is a rare autosomal dominant genodermatosis caused by mutations in the ATP2C1 gene. These mutations impair keratinocyte adhesion and disrupt calcium homeostasis, leading to characteristic clinical and histopathological findings. Herein, we present the case of a 50-year-old male with a ten-year history of recurrent, pruritic, erythematous erosions and maceration in the left axilla and groin. Clinical examination revealed no systemic comorbidities or relevant family history. Histopathological analysis of skin biopsy demonstrated hallmark features, including epidermal hyperkeratosis, suprabasal and intraepidermal clefting, and acantholysis with the distinctive "dilapidated brick wall" appearance, confirming the diagnosis of HHD. Differential diagnoses, including intertrigo, Darier disease, and pemphigus vegetans, were excluded based on clinical and histological findings. The patient was managed with immunomodulators and topical antibiotics, with follow-up care focused on symptom alleviation and infection prevention. This case underscores the importance of correlating clinical and histopathological findings in diagnosing HHD and differentiating it from other intertriginous dermatoses. Despite its chronic and recurrent nature, timely and accurate diagnosis, coupled with individualized management, significantly enhances patient outcomes. This report also highlights the unique histological feature of acantholysis resembling a "dilapidated brick wall", pivotal in distinguishing HHD. Advances in understanding the molecular pathogenesis of ATP2C1 mutations hold promise for the development of targeted therapies, offering hope for more effective management of this challenging condition in the future.

This study analyses trends in orofacial infection hospital admissions at a single department, focusing on the impact of the COVID-19 pandemic. Admission counts fluctuated over the study period, but 2020 (n=65) and 2021 (n=56) showed a statistically significant decrease, falling slightly outside the 95% confidence interval of a linear trend established for 2014-2019. In 2022, the number of admitted patients (n=63) remained below average but within the confidence interval, while 2023 saw an increase to 97 patients. A notable shift in treatment methods was observed during the pandemic years. The proportion of patients treated with extraoral revision increased, with the most pronounced disparity in 2020 (n=40:10, 80%:20% extraoral revision-to-local treatment ratio). Statistical analysis (chi-square test, p<0.001) confirmed significant differences across the years. Comparing COVID-19-affected years (2020-2022) with non-COVID years (2014-2019 and 2023), 73% of patients were treated with extraoral revision during the pandemic, compared to 49% in non-COVID years (p<0.001). Additionally, only 44 patients were treated with antibiotics alone, whereas 75 would have been expected in the absence of COVID-19-related disruptions. These findings suggest that the pandemic influenced both the number of orofacial infection admissions and the treatment approach.

Endoscopic vein harvest of the greater saphenous vein for aortocoronary bypass grafting presents a relatively newer and less invasive mode of vein harvest that has become a more popular approach used in the field of cardiac surgery. This study aimed to compare the long-term patency of saphenous vein grafts and clinical outcomes (a minimum of 10 years) after endoscopic harvest with open vein harvest in patients after isolated surgical myocardial revascularization. Fifty patients (25 after endoscopic and 25 after open harvest) who underwent isolated myocardial revascularization between 2009 and 2011 assessed. The study comprised two phases: completion of questionnaires assessing recurring symptoms of ischemic heart disease and visualisation of vein grafts via coronary computed tomography angiography to assess graft patency. The primary outcome showed higher patency rates after open vein harvest (76.1 vs. 68.8%); without significant statistical difference (p=0.873). Differences in clinical outcomes were not statistically significant regarding recurring angina (28% endoscopic group, 32% open group, p=0.519), dyspnea (24 vs. 16%, p=0.817) and myocardial infarctions with catheter-based revascularization of vein grafts (8% endoscopic group, 16% open, p=0.734). Redo surgery was not reported in neither group. Endoscopic and open vein harvest yielded comparable long-term patency rates both angiographically and clinically. That strenghtens endoscopic approach as a non-inferior mode to the traditional approach in patients undergoing surgical myocardial revascularization.

Interhemispheric fissure is the midline groove present between the cerebral hemispheres. It provides access to corpus callosum, lateral ventricles and third ventricle during interhemispheric approach in neurosurgery. The knowledge and established data about its morphometry are limited. 90 participants who underwent magnetic resonance imaging scans were studied. The data was divided into 4 age groups (25-45, 45-65, 65-85 and >85 years) as well as among males and females. The depth of interhemispheric fissure was measured from 6 predetermined reference points from the superomedial border of cerebral hemisphere to the floor of corpus callosum which is formed by corpus callosum. Mean along with standard deviation and confidence interval were calculated. Unpaired t-test and ANOVA was used to analyse the statistical difference between various age groups. The mean value of depth of interhemispheric fissure from frontal pole to genu is 35.08 ± 3.20 mm, at the level of coronal suture is 35.64 ± 4.27 mm, 1 cm anterior to coronal suture is 35.50 ± 3.27 mm, 1 cm posterior to coronal suture is 34.38 ± 4.95 mm. The depth from superomedial border at the level of parietooccipital sulcus is 43.72 ± 3.63 mm and at the level of calcarine sulcus is 54.13 ± 5.96 mm. This data is useful for neurosurgeons in order to perform interhemispheric approach.