Bratislava Medical Journal-Bratislavske Lekarske Listy最新文献

True aneurysm of the radial artery is very rare. Aneurysmal expansion of arteries due to degenerative changes, possibly infections, primarily affects the abdominal and thoracic aorta, intra and extracranial sections of cerebral arteries, popliteal artery, and visceral arteries. Published literature does not address the aneurysm on the distal sections of the arteries of upper or lower limb. Unlike the classic symptoms of aneurysmally altered arteries such as rupture, thrombosis and embolization, we encounter more often vascular compression syndrome in distal peripheral aneurysms. We demonstrate the case management of a patient with over 20 years increasing wrist resistance. A fusiform aneurysm of the distal section of the radial artery was identified by sonography. Under general anesthesia, we performed aneurysm resection and artery reconstruction using an interpositum from the ipsilateral cephalic vein. The histological examination of the resected tissue confirmed the presence of all three layers of the vascular wall, confirming the true aneurysm of the radial artery. No complications developed in the patient in the postoperative period and all problems related to the aneurysm subsided (Fig. 4, Ref. 23). Keywords: aneurysm, arteria radialis, surgical reconstruction.

Objective: Given the multisystem nature of COVID-19 and its potential neuro-psychiatric effects along with the recognized role of systemic inflammation in the prognosis of both COVID-19 and psychiatric disorders, it is imperative to assess psychiatric symptoms in COVID-19 patients. This study sought to investigate the value of systemic immune-inflammation index (SII) scores, levels of anxiety and depressive symptoms assessed within the initial 24 hours following COVID-19 diagnosis as potential predictors of the clinical trajectory of COVID-19.

Methods: This study involved 64 patients admitted to our COVID-19 ward with mild-to-moderate COVID-19 pneumonia, all of whom underwent a psychiatric evaluation within 24 hours of admission. Upon admission, levels of c-reactive protein and inflammatory markers including leukocyte, neutrophil, thrombocyte, and lymphocyte counts were measured to calculate individual SII scores. Psychiatric evaluations were conducted using the State-Trait Anxiety Inventory (STAI), Hamilton Depression Rating Scale (HDRS), and Standardized Mini-Mental Test (SMMT).

Results: The patients with clinical deterioration of COVID-19 exhibited higher STAI-Trait and STAI-State subscale scores measured upon admission compared to those without clinical deterioration. HDRS scores showed no significant correlation with clinical deterioration. STAI-State subscale scores correlated with SII scores and the duration of hospital stay. High baseline STAI scores and SII scores predicted COVID-19 clinical deterioration.

Conclusion: Our study demonstrated that the initial SII and STAI scores assessed within the initial 24 hours of hospitalization for COVID-19 significantly predicted the clinical progression of the disease during the hospital stay (Tab. 5, Ref. 37). Text in PDF www.elis.sk Keywords: COVID-19, systemic inflammatory response index, disease severity, inflammation.

Background and objectives: The relevance of the use of intra-aortic balloon pump (IABP) in cardiogenic shock (CS) has been discussed over the past years. The aim of this study is to describe a single-centre 10-year experience with IABP and analyse the risk factors for 30-day mortality.

Methods: The data for this single-centre, observational, retrospective study were drawn from records dated from January 2012 to May 2022 pertaining to patients presenting with CS, treated with IABP and hospitalised at the Department of Acute Cardiology, Institute for Clinical and Experimental Medicine, Prague.

Results: Among the patients included in the study, 87% patients presented with newly developed heart failure. The leading cause of CS was acute myocardial infarction accounting for 86% of cases. Hospital mortality was recorded at 39% and the 30-day mortality reached 43%. Upon multi-variable analysis, only the vasoactive inotropic score on day 5 emerged as a statistically significant predictor for 30-day mortality (p=0.0055). Cox regression analysis revealed that the presence of mechanical complications was the only variable identified as yielding a statistically significant impact on the 30-day survival (Log-rank p=0.014, HR 2.19, 95% CI: 1.15‒4.15). There was no statistically significant difference in the 30-day mortality across the SCAI classes.

Conclusion: The main cause of CS was a newly developed acute heart failure secondary to acute myocardial infarction. Despite the implementation of mechanical circulatory support, both in-hospital and 30-day mortality rates remained high. Increased vasoactive inotropic score and presence of mechanical complications were identified as significant predictors the 30-day survival (Tab. 6, Fig. 1, Ref. 36). Text in PDF www.elis.sk Keywords: cardiogenic shock, IABP, risk factors, mortality, Czech Republic, AMICS.

Background: Interferon gamma release assay (IGRA) is an in vitro blood test to measure interferon gamma (IFN-γ) released from antigen-specific T cells after stimulation with pathogen-specific peptides. In this study, it was aimed to investigate the T-cell response using IGRA and to compare various laboratory values in Coronavirus Disease (COVID-19) patients hospitalized either in hospital inpatient departments or in intensive care units.

Methods: A total of 100 patients (50+50) who were identified as positive for COVID-19 through the molecular method in Selcuk University Faculty of Medicine Infectious Diseases Service and Reanimation Intensive Care Unit were included in the study. IFN-γ levels in blood samples collected from patients were determined using the QuantiFERON Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV-2) (QIAGEN, Germany) kit. The patients' gender, age, c-reactive protein (CRP), aspartate aminotransferase (AST), alanine transaminase (ALT), interleukin (IL)-6, lymphocyte count, procalcitonin, and D-dimer results were obtained from the hospital automation system.

Results: Thirty-eight of the IGRA test results were negative, 44 were positive and 18 were inconclusive. The age of patients with negative IGRA test results was significantly higher (p<0.001) compared to patients with positive results. There were no significant differences between patients' IGRA test results and gender, prognosis, IL-6, lymphocyte counts, CRP, AST, and ALT values.Age, death rates, D-dimer, CRP, procalcitonin, AST and ALT values of patients hospitalized in the intensive care unit were significantly higher (p<0.001) compared to the those hospitalized in the inpatient department, while conversely, the lymphocyte values were lower (p<0.001).

Conclusion: The relatively higher IGRA negative results in the elderly, negative and intermediate results in intensive-care patients, and low lymphocyte levels in intensive-care patients indicate that the cellular immune response is diminished and/or absent. The death rates, D-dimer, CRP, procalcitonin, AST and ALT values of the patients hospitalized in the intensive care unit were higher compared to those from the in-patient department, indicating the severity of inflammation and signaling the development of organ failure. In the light of these findings, we suggest that IGRA tests may serve as a guide in immunomodulatory therapy (Tab. 2, Fig. 2, Ref. 27). Text in PDF www.elis.sk Keywords: COVID-19, interferon gamma release assay test, T cell response.

Background: Fetal alcohol syndrome (FAS) is the most common preventable cause of impaired fetal development. The amount of alcohol consumed by expectant mothers varies by country. Studies on the prevalence of alcohol use among pregnant women in Slovakia and the risk factors linked to alcohol consumption during pregnancy are scarce. Similarly lacking are the data regarding pregnant women's awareness of the negative consequences of alcohol use during pregnancy.

Methods: The study comprised women who gave birth at the 2nd Department of Gynecology and Obstetrics between July 1, 2023, and December 31, 2023. All respondents received an anonymous retrospective questionnaire following childbirth. The questionnaire investigated alcohol consumption throughout the year preceding conception as well as during each of the trimesters. The questionnaire also included questions on the woman's plans to become pregnant, her demographics, and her awareness of the hazards associated with alcohol consumption during pregnancy.

Results: A filled-out questionnaire was obtained from 402 women. Of these, 51 women (12.8%) reported being completely abstinent before becoming pregnant. Complete abstinence before pregnancy was the greatest strongest protection against drinking during pregnancy (RR: 0.03). Among the 351 women who drank before pregnancy, 108 women (30.8%) continued to drink while pregnant, which constitutes 26.9% of all pregnant women. Risk factors of alcohol use during pregnancy included unplanned pregnancy (RR: 1.32), inadequate knowledge of the negative consequences of alcohol intake during pregnancy (71.9% vs 75.4%), and heavy drinking prior to pregnancy (RR: 2.55).

Conclusions: In accordance with certain European data, the best means of protection against alcohol consumption during pregnancy include complete abstinence prior to conception, pregnancy planning, and high-quality education regarding the negative effects of alcohol during pregnancy (Tab. 4, Ref. 19). Text in PDF www.elis.sk Keywords: fetal alcohol syndrome spectrum, alcohol drinking in pregnancy, pregnancy planning, prenatal alcohol exposure, pregnancy.

Clinical swabs with suspected viral infection are usually transported in virus transport medium (VMT). During epidemics/pandemics, tampons without VTM would be more suitable for saving space and cost. This study was conducted to verify the applicability of throat swabs without VTM in the diagnosis/screening of enteroviral infections by polymerase chain reaction (PCR) in a volunteer study group. Three different swab types were used in 40 volunteers: swabs with two different tips (cotton- or synthetic-tipped) without VTM and standard synthetic tips with VTM. The swabs were processed immediately or after 12 days of storage at either -80°C or +4°C. The molecular analysis included viral RNA extraction, and combination of reverse transcriptase PCR and nested PCR. Enteroviral RNA was detected in 15% (6/40) of the studied volunteers. When processed immediately, the results for all three swab types were compatible. Swabs without VTM may be used for collection of clinical samples in the diagnosis of suspected enteroviral infections or as potential screening tools for enteroviruses (Tab. 2, Ref. 15). Keywords: enterovirus infection, swab, transport medium, PCR, molecular diagnostics.

Objective: This study aimed to assess the perceived need among surgical residents to revisit their anatomical knowledge and evaluate their attitude towards integrating clinical anatomists into surgical residency program curriculum.

Background: While medical students learn human anatomy during undergraduate years, the practical application of clinically oriented anatomy becomes vital in surgical specialties. However, this aspect has not been adequately addressed in Indian surgical residency programs.

Methods: An 11-item questionnaire, including closed-ended and Likert-scale questions, was administered to 153 surgical residents. Consent was obtained, and responses were collected via Google Forms.

Results: Half of the respondents (50%) felt confident in their self-directed anatomy learning, but 87% believed integrating clinical anatomists would enhance their surgical expertise. Additionally, 88% saw value in revisiting cadaveric dissection. Third-year residents showed a significantly higher inclination towards cadaveric dissection. Deficiencies in the curriculum and time constraints were identified as major barriers.

Conclusion: The study highlights a perceived need among surgical residents to augment their anatomical knowledge, advocating for the integration of clinical anatomists and cadaveric dissection into training. A collaborative approach, emphasizing both horizontal and vertical integration of anatomy, is recommended to enhance surgical education and practice. (Tab. 4, Fig. 1, Ref. 25).

Objectives: Deviations in haemostasis are found in about 50 % of patients with cancer and up to 90% of those with metastatic disease. Many studies investigate the dynamics of the processes of coagulation and fibrinolysis and their role as a predictor of therapeutic response, early relapse, or metastasis risk.

Background: To investigate the serum levels of urokinase plasminogen activator (uPA) in patients with brain metastases treated with robotic stereotactic radiosurgery (SRS) with CyberKnife.

Material and methods: Serum levels of urokinase plasminogen activator (uPA) were measured in 66 patients with solid tumours, divided into two groups, with oligometastatic disease and brain metastases. In this prospective longitudinal study, the serum levels of uPA were measured before starting the therapy and at the first, third, and sixth months after patients were irradiated with the CyberKnife system.

Results: Analysis of serum uPA levels in the post-treatment period showed a statistically significant decrease between the baseline and the 6 months post-treatment time point in both patient groups. The baseline value of serum uPA in the group with lung cancer decreased by 62.7 %, and in the group with other types of cancer - by 60 %. Despite the significant reduction of serum uPA levels 6 months after the treatment, the levels remained significantly higher in both groups than in healthy controls.

Conclusion: Ongoing research on uPA and cancer will enrich our knowledge and expand the possibilities for clinical utilization of the marker in the oncology setting (Tab. 2, Ref. 18).

Dental caries remains the most prevalent chronic, oral biofilm-associated disease affecting majority of the globe's population in all age categories. Despite enormous and revolutionary progress in omics technologies, it´s aetiology is not fully understood. The interest of current research is primarily focused on the identification and understanding of the crosstalk between main players such as host cell genome, oral microbiome´s genome, factors of immune response, saliva content and nutrition. For accurate, multi-omix analyses, it is essential to know which patient´s genes enter into crucial interactions. Identifying genes and understanding the mechanism of their action is the key for deeper understanding of their involvement in the pathogenesis of this disease. Serious alterations of these genes should be consequently used as markers to determine the extent of genetic predisposition to dental caries and identify susceptible patients. That should significantly improve the prevention, diagnostic and therapy of the disease with an individual approach and provide more efficient and effective implementation of newer preventive measures and novel therapeutic approaches in the management of the disease. This review focuses on contemporary evidence on genetics factors affecting dental caries and to provide an up-to-date comprehensive description and classification of the genes and their alterations influencing the disease. It also aims to delineate and discuss evidence gaps and potential novel applications of genetics in the context of recent advances (Tab. 2, Ref. 113). Text in PDF www.elis.sk Keywords: dental caries, candidate gene, genetic variation, multifactorial disease.

Objective: A retrospective analysis of invasive and metastatic hydatidiform moles (HM) in the Slovak Republic (SR)‒epidemiology, patient characteristics and treatment outcomes.

Backround: Invasive and metastatic mole is a highly curable type of gestational trophoblastic neoplasia. Both invasive and metastatic HM may be cured by hysterectomy without adjuvant chemotherapy.

Methods: Nineteen cases of histopathologically confirmed HM (10 invasive and 9 metastatic) were treated in SR from 1993 to 2022. Patients were divided into two groups according to treatment modality (hysterectomy only ‒ 8; hysterectomy and chemotherapy ‒ 11). The parameters included in the analysis were patient age, antecedent pregnancy, human chorionic gonadotropin level, tumor size and time to remission.

Results: The incidence of invasive and metastatic HM in the SR was 1:121,253 pregnancies, or 1:86,589 live births. The overall cure rate was 100%, without recurrence. Hysterectomy was performed as first-line therapy in 14 patients, with a cure rate of 57.1%. 4 out of 8 patients (50%) with metastatic moles, who underwent first-line hysterectomy, were cured without chemotherapy. There was no statistically significant difference between the two groups in all selected parameters.

Conclusion: First-line hysterectomy may lead to remission without adjuvant chemotherapy or reduce the number of chemotherapies in invasive and metastatic HM (Tab. 4, Fig. 2, Ref. 21).