Bratislava Medical Journal-Bratislavske Lekarske Listy最新文献

Background: The pathophysiology of mental illnesses is not fully understood, leading to insufficient remission, frequent adverse drug reactions, and treatment resistance. Pharmacogenetic (PGx) testing, a personalized approach recently adopted also in psychiatry, can guide effective drug therapy and minimize side effects. The objective of this study was to determine the perspective of Slovak clinicians regarding the integration of PGx testing in psychiatric clinical practice.

Methods: Questionnaires covering various aspects such as prior experience with PGx testing, self-perceived competence, perceived utility, potential risks and challenges were distributed directly to attendees at two psychiatric conferences held in Slovakia in 2023 and their responses were statistically analysed.

Results: Out of 54 respondents, only 7.4% had previous experience with PGx in clinical practice. The most clinicians felt that they should possess the skills to apply PGx testing in psychiatric clinical practice and were enthusiastic about increasing their expertise. They found PGx useful in medication selection, adverse effect management, and treatment-resistant depression. The primary concerns centered around the lack of well-defined guidelines and the financial considerations linked to the testing.

Conclusions: Considering the participants' interest in PGx and its integration into clinical practice, educational programmes based on recommendations, guidelines, and convincing evidence could be organized (Tab. 4, Ref. 30). Text in PDF www.elis.sk Keywords: pharmacogenetics, pharmacogenomics, psychiatry, personalized treatment, Slovakia, perspective.

This study aims to explore new treatments for type 1 diabetes that could serve as an alternative or adjunct to insulin therapy. This is a literature review based on a search of relevant scientific articles in PubMed, Scopus, Google Scholar, and Cochrane Library databases. The scrutiny of publications revealed that the introduction of glucagon-like peptide-1 agonists into insulin therapy can improve disease control and reduce the frequency of hypoglycaemic episodes. While immune therapy is pathogenetically justified, its utility is limited in patients with recent onset of type 1 diabetes. It may, however, find application in prophylaxis in individuals at increased risk of developing this type of diabetes. Concurrently, stem cell therapy is under active investigation in clinical trials and has shown promise in reducing insulin dependence, improving β-cell function and controlling glucose levels. In addition, stem cells have demonstrated efficacy in treating complications of diabetes such as diabetic nephropathy, peripheral neuropathy and diabetic angiopathy. There is compelling evidence supporting the significant potential of gene-editing technology. Intravenous administration of T-regulatory cells, as one method of cell therapy, shows potential in stabilising the course of diabetes and slowing its progression. However, further research is warranted to confirm efficacy. While gene therapy holds promise, much of its research is currently in the preclinical stage. Further development of innovative therapies for type 1 diabetes has the potential to enhance the quality of life of patients, improve disease control and prevent the development of complications (Fig. 1, Ref. 54). Keywords: diabetes type 1, treatment, cell therapy, insulin, pancreatic β-cells.

Aims: Individuals with a higher De Ritis ratio (aspartate transaminase/alanine transaminase) and neutrophil-to-lymphocyte ratio (NLR) have an inferior survival in varied malignancies. To our knowledge, the prognostic potential of the De Ritis ratio and NLR to predict the survival in nonmetastatic glioblastoma multiforme (GBM) patients remains unclear. In this study, we aimed to explore the prognostic power of the De Ritis ratio and NLR in patients with nonmetastatic glioblastoma multiforme.

Methods: Data of 262 patients with glioblastoma multiforme have been retrospectively analyzed. Their age, gender, tumor characteristics, AST/ALT ratio, NLR and hemogram values, including age at diagnosis and date of diagnosis were recorded.

Results: The median survival time of the study group was 21 months (95% CI: 19‒23 months). The first-year and second-year survival rates were 73.0% and 40.5%, respectively. The univariate analysis revealed that the correlation of survival with age, gender, left/right location of tumor, mean platelet volume and De Ritis ratio did not reach the level of significance. The univariate analysis of the prognostic potential of NLR indicated that a 1-unit increase in NLR value translates to a 1.05 times higher risk of death (95% CI: 1.01‒1.09).

Conclusion: The results of this study lead to the observation that NLR value can serve as an effective prognostic marker in predicting the outcomes of patients with glioblastoma multiforme. It can be positioned as an easily accessible and cost-effective biomarker for establishing appropriate therapeutic strategies (Tab. 2, Fig. 1, Ref. 20).

Despite being the second most often diagnosed form of cancer, lung cancers are rarely found in the general population. It is proposed in this study to employ a methodology of extracting both global and local features from CT scan images for the identification of lung cancer. Data gathering, globalised and localised training as well as testing the model are all part of this structure. This study makes use of 800 CT scan images. Images are pre-processed by warping and cropping in advance of the global testing step. Each image is represented by a feature vector employing eight distinct types of image characteristics, which are taken from the images. After creating feature vectors, three machine learning methods are employed to create detection models. Every medical image has been partitioned over a series of simple divisions throughout the training and testing process locally. To describe each block, feature vectors are derived from the image features that worked effectively in the general phase of the experiment. Similar extracted features are then used to build detection systems for all picture blocks using the learning strategies that were effective in the global stage. SVM using Haar Wavelet characteristics had an accuracy, sensitivity, and specificity of 89%, 90%, and 89%, respectively. One might get 90%‑accurate results with SVM and 91%‑sensitive and 91%‑specific results using SVM plus HOG features. Finally, the utilisation of SVM with Gabor Filter characteristics achieved the greatest correctness, specificity, and sensitivity values, particularly 87%, 86%, and 87%, respectively (Tab. 3, Fig. 7, Ref. 18). Keywords: feature extraction, support vector machine, lung cancer, classification, machine learning.

Objective: To study the risk factors of cognitive impairment in elderly people in the Republic of Kazakhstan.

Methods: Study design - cross - sectional. 385 elderly people randomly selected from all over Kazakhstan took part in the survey. The questionnaire for the elderly included socio-demographic data and a small test that determines the absence or the risk of developing cognitive impairment.

Results: Incomplete secondary education increases the risk of developing CI 4.92 times, secondary education 1.24, secondary special education 2.25 times compared to higher education. The absence of work at this time increases the risk of cognitive impairment compared to those who continue to work 2.24 times, being retired 0.42 times. Smoking increases the risk of developing CI compared to those who do not smoke 2.51 times, smoking history 0.86 times. Alcohol consumption increases the risk of developing CI compared to those who do not drink alcohol 1.62 times, other (on holidays) 0.31 times    .

Conclusion: Prevention of dementia does not exist today, but it is possible to reduce the risk of its development. Risk factors increase the chances of getting sick but also serve as guidelines that can be influenced (Tab. 3, Ref. 17).

One of the most prevalent influenceable risk factors for poor cardiovascular outcome is arterial hypertension.This is a prospective analysis of liver transplant recipients in which 24-hour blood pressure (BP) measurement was performed. The primary aim was to identify post-LT (liver transplantation) patients without a history of arterial hypertension who meet the criteria for arterial hypertension using 24-hour BP monitoring. Secondary objectives were to determine how many patients with known treated arterial hypertension had suboptimal BP control. The group included 88 patients (men, 52.3%, history of arterial hypertension group: n=56, no history of arterial hypertension group: n=32) with an average age at the time of measurement of 62.4 years±11. The average time since LT at the time of measurement was 45.2 months. De novo arterial hypertension using 24-hour BP monitoring was diagnosed in 28%. Hypertonic changes in the fundus oculi were confirmed as predictor for suboptimally controlled hypertension [OR 5,1265, p=0.0279]. On the other hand, male sex [OR 3.1840, p=0.0311], together with age [OR 1.3347, p=0.0153] and waist circumference [OR 4.3490, p=0.0418] predicted the need of intensification of antihypertensive treatment. Male sex, age and waist circumference should increase the index of suspicion and lead to zoom-in on a possibility of poorly controlled blood pressure. Where automated blood pressure monitoring is unavailable, regular examination of the fundus could serve as an available surrogate marker of suboptimally controlled arterial hypertension (Tab.6, Fig. 1, Ref. 36). Text in PDF www.elis.sk Keywords: liver transplantation, arterial hypertension, automated blood pressure monitoring.

Objectives: Superoxide dismutase (SOD) is an enzyme that plays a crucial role in protecting cells from oxidative damage. Our study aims to address the lack of papers simultaneously analyzing the immunoreactivity of all three distinct isoforms of SOD in human exocrine pancreas cells.

Background: Superoxide dismutases (SODs) facilitate the conversion of superoxide radicals into less harmful substances. By neutralizing superoxide radicals, SODs help prevent the formation of highly reactive and destructive species that can adversely affect manifold cellular components.

Methods: The study analyzed immunoreactivity of SODs in samples of six healthy adult human pancreases, while using the indirect immunohistochemical method under a light microscope.

Results: SOD1 was predominantly found in centroacinar cells and epithelial cells of the duct system while SOD2 was mainly detected in the epithelial cells of interlobular ducts. Both enzymes were prominently present in the basal region of acinar cells near the cell nucleus. The expression of SOD3 was observed to be rare.

Conclusion: Understanding the intracellular metabolism of SODs in healthy exocrine pancreas cells serves as a basis for determining the precise role of oxidative damage and SOD signaling in the pathogenesis of various pancreatic diseases, including chronic pancreatitis and pancreatic cancer (Fig. 6, Ref. 24). Text in PDF www.elis.sk Keywords: antioxidants, histology, immunohistochemistry, pancreas, superoxide dismutase.

Objective: The aim of the study is to evaluate the functional status and quality of life parameters of patients in the 1st and 6th months post-COVID and to determine contributing factors.

Background: The effects of COVID-19 can continue in the post-COVID period. The mostcommon post-COVID symptoms are weakness, fatigue, nonproductive cough and exertionaldyspnea.

Method: The radiological findings of the patients at diagnosis, post-COVID 1st and 6th months; functional status and quality of life parameters at the 1st and 6th months of the post-COVID period were compared, and the factors affecting them were evaluated. The relationship between radiological involvement, quality of life and functional status parameters was investigated.

Results: Six months after the COVID infection, inpatient's resting oxygen saturation and effort capacity were comparable, even though they were significantly lower in the first month post-COVID. There was a correlation between functional and quality of life measures at 1 and 6 months after COVID-19 infection. In all patients, a significant improvement was found in the functional status and quality of life scales at 6 months after post-COVID infection compared to the 1st month. Even though radiological findings of both groups improved within the first month after COVID-19 infection, there remained a difference between them that disappeared after six months.

Conclusion: It was found that in the post-COVID period, the severity of the disease had a negative effect on functional measurements and quality of life; however, regardless of the severity of the disease, after six months improvements in radiological findings, effort capacity, and quality of life measures were noted (Tab. 2, Fig. 5, Ref. 20). Text in PDF www.elis.sk Keywords: post-COVID, quality of life, functional measurements, chest x-ray.

Background: Few studies have evaluated health-related quality of life (HRQoL) with abiraterone acetate plus prednisone (abiraterone) compared to enzalutamide in metastatic castration resistant prostate cancer (mCRPC). So, this study aimed to assess impact of abiraterone and enzalutamide on patients´ functioning in mCRPC real-world setting.

Methods: In this 12-month, prospective, observational study, 36 mCRPC patients from Slovakia were included. Patients were treated with abiraterone or enzalutamide according to routine practice. HRQoL was assessed at baseline and 3-/6-/9-/12-month visits using the Functional Assessment of Cancer Therapy-Prostate (FACT‑P) and European Quality of Life 5 Dimensions (EQ-5D) questionnaires. Changes from baseline and occurrence of deteriorations/improvements were compared using two-sample t-test/Mann-Whitney test and Pearson's chi-square/Fisher's exact test, respectively. Mixed-effects model for repeated measures was used to evaluate the difference between the two arms in mean changes of quality of life after 12 months.

Results: Frequency of clinically meaningful deterioration of quality of life assessed by FACT-P was similar for abiraterone and enzalutamide: 0%, 14.3%, 23.1%, 16.7% vs. 10%, 26.3%, 22.2%, 40% at 3-, 6-, 9- and 12 months of therapy (p=0.496, 0.670, 1.000 and 0.236, respectively). After 12 months of treatment, no statistically significant difference between the treatment arms was observed in estimated mean changes in FACT-P total scores (p=0.620) and its components, EQ-5D index (p=0.108), and EQ-5D visual analogue scale (p=0.324).

Conclusion: According to the results of this study, abiraterone and enzalutamide had a comparable impact on quality of life in chemo-naive mCRPC in routine practice (Tab. 4, Fig. 4, Ref. 23). Text in PDF www.elis.sk Keywords: quality of life, abiraterone, enzalutamide, castration resistant prostate cancer.

The disorders of temporomandibular joint manifest clinically with disruptions in its movement and facial pain. Women exhibit a three-fold higher propensity for developing temporomandibular joint disorders compared to men. There are several studies describing the effects of female reproductive hormones on temporomandibular joint structures and pain perception, shedding light on the genetic influence underlying these conditions. Several polymorphisms have been studied and documented in the literature, shedding light on the genetic background of temporomandibular joint disorders.This review aims to propose a novel approach to the complex diagnosis and treatment of this type of disorders. Specifically, we advocate for heightening the emphasis on young women diagnosed with temporomandibular joint disorders during their reproductive years, as such manifestation could potentially serve as early indicators of other underlying health conditions linked to the reproductive system. We posit that genetic studies hold promise as a cornerstone for tailoring personalized treatment strategies for TMJD in the future (Tab. 1, Ref. 46). Text in PDF www.elis.sk Keywords: temporomandibular joint disorders, infertility, female reproductive hormones, genetic polymorphism.