Bratislava Medical Journal-Bratislavske Lekarske Listy最新文献

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: The Roma population is a genetically isolated population with a shared origin, totaling between 10 to 14 million individuals worldwide, stemming from a limited number of "genetic founders". Roma individuals exhibit specific hereditary diseases, often stemming from recessive genetic variants due to a higher degree of consanguinity, with recent molecular-genetic investigations shedding light on several conditions prevalent within the Czech Roma population. However, an overview of stomatological issues in diagnosing such diseases proves challenging, leading to frequent underdiagnosis or misdiagnosis.

Methods: The contribution monitors the clinical description, typical symptoms and treatment options including dental abnormalities in rare genetic diseases in the Roma population which are treated in ERN CRANIO centre at Motol University Hospital in Prague.

Results: Our research provides examples of autosomal recessive diseases, which can be molecularly confirmed, and prevalent within the Roma community. These include congenital cataract syndrome, facial dysmorphism and demyelinating neuropathy, non-syndromic prelingual e.g. deafness with GJB2 gene impairment, and myasthenic syndrome.

Conclusion: Our report aimed to provide a systematic review of dental phenotypes which can relate to Czech Roma's rare genetic disorders therapy including dental treatment. Understanding is important for preventing unterdiagnosis or treatment for the patients affected review of observed (Fig. 6, Ref. 27).

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).

Objective: Vascular endothelium is a tissue in which several vasoactive substances are produced and secreted. Reactive oxygen species can cause endothelial dysfunction (ED). miRNAs can be implicated in the oxidative stress-related ED during vascular disease pathogeneses. Our aim is to investigate effect of H2O2-induced oxidative stress on expression levels of genes and miRNAs that are key players in ED.

Methods: H2O2 effect on cell viability of human umbilical-vein endothelial cells (HUVEC) at 24-hour was measured with MTT. Low sub-cytotoxic H2O2 concentrations (25, 50 µM) were selected to analyze their oxidative stress-inducing capacities with MDA assay and their effects on EDN1, NOS3, VCAM1, SERPINE1, miR21, miR22, miR126, and miR146a levels with RT-qPCR.

Results: Each tested H2O2 concentration reduced HUVEC cell viability. Fifty µM H2O2 augmented cellular MDA levels. Intriguingly, EDN1, VCAM1, and SERPINE1 and all analyzed miRNAs' levels attenuated upon H2O2 treatment whereas there was no change in NOS3 levels compared to control. There was a positive correlation between miR-21 and VCAM1.

Conclusion: Rather than individual alterations in analyzed parameters, consistent changes in our findings i.e., parallel decreases in EDN1, VCAM1, SERPINE1 mRNA levels as well as miRNAs, suggests that H2O2 concentration-dependent modulation of expression patterns can bring about various impacts on ED (Tab. 1, Fig. 5, Ref. 63).

Non-invasive diabetes detection refers to the utilization and development of technologies and methods that can monitor and diagnose diabetes without requiring invasive procedures, namely invasive glucose monitoring or blood sampling. The objective is to provide a more convenient and less burdensome approach to screening and management of diabetes. It is noteworthy that while non-invasive method offers promising avenues for diabetes detection, they frequently require validation through clinical studies and might have limitation in terms of reliability and accuracy than classical invasive approaches. In recent times, deep learning (DL) and feature selection (FS) are used to monitor and diagnose diabetes accurately without requiring invasive procedures. This technique combines the FS method with the DL algorithm for making accurate predictions and extracting relevant features from non-invasive data. This article introduces a new Binary Fire Hawks Optimizer with Deep Learning-Driven Non-Invasive Diabetes Detection and Classification (BFHODL-NIDDC) technique. The major intention of the BFHODL-NIDDC technique focuses on the involvement of non-invasive procedures for the detection of diabetes. In the BFHODL-NIDDC technique, data preprocessing is initially performed to preprocess the input data. Next, the BFHO algorithm chooses an optimal subset of features and improves the classifier results. For the identification of diabetes, multichannel convolutional bidirectional long short-term memory (MC-BLSTM) model is used. At last, the beetle antenna search (BAS) algorithm is used for the hyperparameter selection of the MC-BLSTM method which in turn enhances the detection performance of the MC-BLSTM model. A series of simulations were conducted on the diabetes dataset to assess the diabetes detection performance of the BFHODL-NIDDC technique. The experimental outcomes illustrated better performance of the BFHODL-NIDDC method over other recent approaches in terms of different metrics (Tab. 4, Fig. 9, Ref. 23). Keywords: diabetes, non-invasive detection, binary fire hawks optimizer, deep learning, hyperparameter tuning.

Medication adherence is crucial for optimal treatment outcomes, yet many patients struggle to follow their prescribed regimens, impacting patients, families, and healthcare systems. Measurement of adherence is vital for effective care planning and intervention. This review explores medication adherence challenges and measurement methods, including therapeutic drug monitoring (TDM), medication event monitoring system (MEMS), analysis of adherence in insurance/pharmacy database, pill counts, and self-reports, each with its advantages and limitations.This review advocates a partnership-based approach to adherence, stressing standardized reporting and team-based care. Adherence is influenced by many factors such as complex regimens, packaging, patient perspectives, side effects. Effectively addressing these factors is crucial for improving patient outcomes. In summary, medication adherence is vital but complex. The article covers various adherence measurement methods to promote medication adherence as an important matter (Tab. 5, Fig. 2, Ref. 91). Text in PDF www.elis.sk Keywords: medication adherence, adherence barriers, primary non-adherence, medication event monitoring system, pill count, self-report.

Patients infected with human immunodeficiency virus (HIV) have long been considered unsuitable candidates for solid organ transplantation due to their poor prognosis. After the introduction of combination antiretroviral therapy, the survival of this group of patients improved significantly. HIV positive patients had been successfully transplanted for the last 18 years. HIV positive patients encounter very specific issues after transplantation, specifically related to drug interactions and higher rejection rates. Despite that, HIV positive patients have similar results to HIV negative patients post transplantation. We present the case of the first kidney transplantation in an HIV positive patient in Slovakia. The procedure was possible due to a change in legislation, as HIV positivity was an absolute contraindication for transplantation in Slovakia until October 2023. The aim of our case report is to draw attention to the possibility of kidney transplantation in an HIV positive patient and to the specific problems related to the preparation of an HIV positive patient for transplantation, post-transplant complications and the possibilities of their management (Fig. 6, Ref. 37). Keywords: kidney transplantation, HIV, human immunodeficiency virus, acute rejection, HAART, drug interaction.

Introduction:  The sodium-glucose cotransporter-2 inhibitors (SGLT2i) represent the first-line treatment for chronic kidney disease. The question remains of their benefit and safety for patients after kidney transplantation. The study aimed to show the renoprotective effect and safety of use in patients with chronic kidney disease with or without kidney transplantation.

Material:  This is a prospective monocentric study of the Transplant-Nephrology Department in Martin in which patients with chronic kidney disease with or without kidney transplant in therapy with dapagliflozin were included (n=79). The changes in glomerular filtration rate, albuminuria and side effects associated with SGLT2i were studied in patients with chronic kidney disease with or without kidney transplantation and in patients with or without diabetes mellitus.

Results:  Patients without diabetes mellitus achieved a significantly higher decrease in albuminuria at the time of the third month of follow-up (p=0.0396), with the continuation of the decrease until the average follow-up (10.9 months) (p=0.7866) than patients with diabetes mellitus. During the observed period, we recorded the cessation of the primary decrease in glomerular filtration with a return to the baseline values. In our group, we did not confirm a significant occurrence of adverse effects associated with dapagliflozin.

Conclusion:  SGLT2i significantly reduces albuminuria and stabilizes glomerular filtration in patients with chronic kidney disease. Based on our analysis, treatment with gliflozins is effective and safe for patients after kidney transplantation (Tab. 4, Fig. 6, Ref. 16).