Bratislava Medical Journal-Bratislavske Lekarske Listy最新文献

Couples are increasingly using assisted reproduction technology (ART) to facilitate having children. This raises the question of whether using ART leads to the same health outcomes as spontaneous conception.One of the major health outcome factors concerns the weight of the newborn. Many foreign studies have proved that newborns conceived via ART evince lower birth weights than newborns that were conceived spontaneously. The purpose of this study is to determine whether the risk of low birth weight differs according to the ART method selected (in-vitro fertilisation with fresh embryo transfer, frozen embryo transfer, oocyte receipt), and which of these methods is associated with the lowest risk of a low birth weight. Anonymised individual data on all deliveries that took place in Czechia between 2013 and 2018 was used for the analysis. The dataset was obtained from the National Registry of Reproduction Health (administered by IHIS CR).The binary logistic regression revealed that concerning many of the covariates controlled, women who underwent IVF had a higher risk (30 %) of giving birth to a child with a low birth weight than women who received frozen embryo transfer treatment (CI 1.15-1.48). Women who underwent oocyte receipt treatment were found to have an even higher (52 %, CI 1.17-1.97) risk than women who received frozen embryo transfer. This study supports existing international knowledge of the specifics of the health outcomes of women who use ART (Tab. 1, Fig. 3, Ref. 32). Keywords: Low birth weight, assisted reproduction technology, in-vitro fertilisation, frozen embryo transfer, oocyte receipt.

Background: For many years, the physicians are searching for easily measurable marker of immune response to the stress and inflammation. More than, 20 years ago Zahorec (2001) proposed neutrophil-to-lymphocyte ratio (NLR) as an easy available and valid biomarker of inflammation, stress, and activation of immune system.

Methods: In this narrative review we focused on the utility of neutrophil-to-lymphocyte ratio (Zahorec's index) in clinical practice of general medicine (inflammation and infection), intensive medicine (sepsis), oncology (prediction of prognosis in cancer of solid organs), surgery and perioperative medicine (diagnosis of complications, and prediction of clinical outcome).

Results and conclusion: We provide many evidences of clinical research which confirm that Neutrophil-to-lymphocyte ratio is a very sensitive marker of inflammation, stress reliable and valid parameter in everyday clinical practice. NLR (Zahorec index) is an effective tool for diagnosis of infection and severity of disease of variable etiologies. NLR reflect the grade of inflammation in cancer disease, which has a significant impact on the prognosis of cancer patients. Zahorec index should be used routinely in emergency medicine, surgery and perioperative medicine as a marker of the severity of affliction, infection, and complications in general. NLR may help physicians in decision making process for early diagnosis and therapy. NLR should be investigated frequently in acute states (sepsis, shock, peritonitis, stroke, trauma) on a daily basis, in subacute states few times per week (during hospital stay), and few times per year in chronic disease (cancer, diabetes mellitus, ischemic heart disease, psychiatry disorders). NLR has a deep biological sense connecting together function of three suprasystems: immune, endocrinne and autonomous nervous system (Tab. 2, Fig. 3, Ref. 86).

Objectives: This study aimed to provide an overview on the HIV-1 subtypes circulating in Slovakia between 2017 and 2018 and to evaluate the risk of transmission of HIV‑resistant strains.

Background: The HIV epidemic in Slovakia is characterised by low incidence of new and pre-existing infections and a slightly elevated level of strain heterogeneity.

Methods: Partial HIV pol gene sequences of 110 individuals newly diagnosed with HIV between 2017 and 2018 were analysed.

Results: The genotypic analysis revealed sporadic occurrence of mutations linked to HIV resistance to antiretroviral therapy (ART). The HIV-1 B subtype has been found as predominant (84.55 %) and primarily linked to men who have sex with men (MSM). A total of eighteen individuals (15.45 %) were found to be infected with HIV-1 non-B subtypes.

Conclusion: The data suggest a minimal risk of a resistant HIV strain transmission and a marginal rise of HIV-1 subtypes´ diversity. The HIV-1 B subtype remains the most prevalent in the period 2017-2018 in Slovakia (Tab. 2, Fig. 2, Ref. 37).

Increased serum lactate dehydrogenase (LDH) activity is considered as a marker of cellular necrosis and serves as a metabolomic diagnostic marker in several types of cancer including head and neck squamous cell carcinoma (HNSCC). LDH, an enzyme involved in the glycolytic cycle, is correlated not only with the activation of oncogenes such as HIF-α and Myc, but also with effects such as tumor proliferation and metastasis. Serum alkaline phosphatase (ALP) is a marker of cell differentiation and tumor induction. Albumin-to-alkaline phosphatase ratio (AAPR) could be an advantageous biomarker due to its easily accessible dynamics and cost-effectiveness. Elevated values of AAPR could be associated with longer overall survival (OS) in cases with solid tumors. Diabetes mellitus (DM) could influence the outcome of patients with HNSCC by contributing to insulin resistance and chronic inflammation, and by being involved in various aspects of carcinogenesis, disease progression and metastasis. However, the use of antihyperglycemic medications (metformin) can have beneficial effects by inhibiting tumor metabolic pathways. The biomarker role of LDH and AAPR in HNSCC patients with DM has been less evaluated. The purpose of the study was to assess the prognostic value of pretreatment serum lactate dehydrogenase (LDH) and albumin-to-alkaline phosphatase ratio (AAPR) in predicting the duration of non-surgical oncological treatment and glycemic control in cases of head and neck cancers patients with DM, including cases selected from the database of the oncology clinic and oncology outpatient clinic of the Craiova County Hospital. Both LDH and AAPR can be used as pre-treatment biomarkers predictive of treatment response, or prognostic tools included in complex multi-parametric models in HNC associated with DM. However, given the impact of short-term glycemic control on the LDH level, it is necessary to evaluate these biomarkers after assessing and controlling for DM, and with the recommended cut-off value set around 0.5. Due to the limited number of cases, it is necessary to validate the results in multicentric trials with a larger number of patients (Tab. 5, Ref. 50). Keywords: diabetes mellitus, HNC, LDH, AAPR, biomarkers, predictive, head and neck cancers, lactate dehydrogenase, albumin-to-alkaline phosphatase ratio.

Objectives: The main objective was to explore the effect of exoskeleton-assisted rehabilitation on quality of life in the subacute state of ischemic stroke.

Background: Central upper extremity hemiparesis affects self-care, social participation, and quality of life. Exoskeleton devices serve as a therapeutic tool and an assessment tool that offers precise tracking of patient progress and evaluation of impairment.

Methods: The trial was carried out from April 2022 to September 2023. Twenty-seven patients were randomly assigned to the intervention (14 participants; mean age 64.71 years; 5 women, 9 men) and control group (13 participants; mean age 64.69 years; 6 women, 7 men). Both groups received equal total therapy (10 to 12 sessions, 5 times a week). The intervention group received 30 minutes of Armea®Spring training combined with conventional rehabilitation. The control group was subjected to conventional rehabilitation.

Results: In the comparison between groups, the experimental group achieved significant changes in quality of life, movement efficiency, and functional performance of the upper extremities.

Conclusions: Armeo®Spring therapy combined with usual care led to significantly larger changes in health-related quality of life and upper extremity movement efficiency compared to conventional rehabilitation (Tab. 4, Fig. 3, Ref. 64.) Text in PDF www.elis.sk Keywords: stroke, hemiparesis, health-related quality of life, Armeo®Spring, movement efficiency, activities of daily living.

Introduction: External ventricular drainage (EVD) is frequently used in neurosurgical interventions to drain cerebrospinal fluid (CSF). Nevertheless, it carries a high incidence of infectious complications, notably secondary meningitis and ventriculitis. In light of the previous rates of these EVD-related infections, we introduced a set of guidelines to lower the infection rate. This study aimed to assess the influence of the hospital-wide adoption of the EVD handling protocol on secondary infections related to EVD.

Material and methods: We enrolled 171 patients scheduled for EVD placement for reasons other than infectious meningitis or ventriculitis from January 2021 to March 2024. A matched cohort of patients underwent logistic regression to adjust for and analyze regression discontinuity.

Results: Infections were more prevalent in the group before the protocol's implementation (18.27% compared to 7.46%, p<0.0001). Regression analysis within the matched score cohort (n=104 in pre-protocol groups and n=67 in post-protocol groups) indicated that the period before the protocol was independently linked to a higher incidence of infections.

Conclusion: Implementing a stringent hospital-wide protocol for EVD handling can significantly diminish the rate of secondary infections associated with EVD (Tab. 3, Fig. 1, Ref. 15). Text in PDF www.elis.sk Keywords: external ventricular drainage, meningitis, ventriculitis, infection.

Background: Bullous pemphigoid (BP) is a rare autoimmune blistering disease predominantly affecting the elderly population.

Objectives: The present study aims to identify clinical factors that may influence outcomes of BP, including skin phenotype, serology, mucosal involvement, pruritus, and triggers.

Methods: A retrospective analysis was conducted on 70 cases with BP registered from January 2019 to December 2022. The Bullous Pemphigoid Disease Activity Index (BPDAI) score was used to assess disease intensity. The BPDAI-Pruritus score and a modified Brest questionnaire were used to document pruritus. Anti-BP180 and anti-BP230 autoantibodies were regularly recorded. Peripheral blood eosinophil counts were documented during flare-up and remission phases of BP.

Results: Of the cases, 81.4% were identified with bullous BP, 12.9% with nonbullous BP and 5.7% with localized BP. Oral involvement was documented in 17.1% of cases. Increased peripheral eosinophilia was prominent in the nonbullous phenotype and returned to normal level during remission in both phenotypes.

Conclusion: The outcomes of BP depended on the disease phenotype and trigger types. Bullous BP showed more intense disease activity, while nonbullous BP demonstrated more intense pruritus. BP associated with diabetes mellitus (DM) or psoriasis manifested as a more severe disease, predominantly with the bullous phenotype and pruritus, compared to cases without comorbidities. New triggers, including SARS-CoV-2 infection and vaccination, were documented (Tab. 6, Ref. 43). Text in PDF www.elis.sk Keywords: bullous pemphigoid, nonbullous pemphigoid, pruritus, comorbidity, eosinophilia, new triggers.

Background: Pancreatic carcinoma is one of the most severe oncological diseases of the gastrointestinal tract. At the time of diagnosis, up to 28% of patients have metastatic liver damage, and only 5% of patients survive five years. Scientific research focuses on non-invasive markers that could help screen for the disease and identify patients more quickly. Potential biomarkers also include matrix metalloproteinases, which play a role in oncogenesis.

Material and methods: We prospectively followed 46 patients with pancreatic cancer and benign pancreatic diseases from September 2022 to March 2023. We determined the level of MMP9 in serum and tissue biopsied during surgeries.

Result: As a result, MMP9 levels were elevated from the T2 stage. The correlation between disease stage and MMP9 level was not confirmed in lower stages, possibly due to the small group of patients.

Conclusion: MMP9 seems suitable for detecting late stages of pancreatic cancer, possibly for secondary prevention. We could not confirm a correlation between MMP9 levels and the initial stages of the disease (Tab. 1, Fig. 3, Ref. 21). Text in PDF www.elis.sk Keywords: pancreatic cancer, MMP9, marker, non-invasive, screening.

Anencephaly, a fatal anomaly of the central nervous system, belongs to the group of defects of the neural tube (NTDs). It is considered the most common congenital NTD, characterized by concurrent absence of a significant portion of the brain and cranial vault. This deformity occurs between days 23 and 26 after fertilization due to improper closure of the neural tube at its cranial end. Many genetic, epigenetic, and non-genetic factors (nutritional, environmental and geographical factors, parental socioeconomic status) contribute to the etiology of this disease. Despite significant advances in treatment and preventive measures, NTDs continue to pose a significant health and financial burden on patients and society as a whole. This study aimed to examine the incidence of anencephaly in Slovakia compared to the Czech Republic between 2012 and 2020. The authors seek to elucidate the reasons behind the higher incidence of this disease in Slovakia as compared to the Czech Republic, explore the male predominance of anencephaly in Slovakia, and investigate whether the prevention standards used in Slovakia differ from those employed in other countries (Tab. 1, Fig. 2, Ref. 129). Keywords: neural tube defects, anencephaly, risk factors, folic acid, food fortification.

Objectives: To create a new mucoadhesive dosage form based on PluronicF127 followed by transformation into a gel form upon intranasal administration for targeted delivery to brain tissueMETHODS: Citicoline, cytidine diphosphocholine, designated as CDP-choline, was purchased as a white powder with the molecular weight of 510.31 g/mol. The triblock copolymers of polyethylene glycol-block-polypropylene glycol-block-polyethylene glycol (PEG-PPG-PEG), branded as Pluronic F127, was used.

Results: When instilled into the nasal cavity, Pluronic F127 for intranasal administration is transformed into a gel that remains retained for 45-55 minutes, which promotes better penetration of drugs into the brain tissue.

Conclusion: The polymer's gelling and adhesive properties performed well, which is crucial for further research at the preclinical stage (Tab. 1, Fig. 5, Ref. 28).