Bratislava Medical Journal-Bratislavske Lekarske Listy最新文献

Important metabolic variables that lead to the development of many diseases, including "mitochondrial diseases," include increased oxidative stress and mitochondrial malfunction. Given that the clinical picture and metabolic alterations in individuals suspected of having mitochondrial illnesses lack distinct characteristics, the development of sensitive and specific diagnostic techniques to detect alterations in mitochondrial bioenergetics is imperative. High-resolution respirometry (HRR), is a minimally invasive technique that enables the analysis of mitochondrial function in platelets taken from peripheral blood. This method allows for the detection of even the most subtle changes prior to disease development. HRR can identify minute variations in mitochondrial bioenergetics. Determining mitochondrial function and endogenous levels of CoQ10 in platelets can aid in the early detection of pathobiochemical changes in mitochondria and assessment of treatment efficacy. When combined with the measurement of endogenous coenzyme Q10 levels, HRR may be an effective approach for early identification of compromised mitochondrial function along with monitoring the therapeutic outcomes. Supplementing with coenzyme Q10, applying molecular hydrogen, transplanting mitochondria, and applying platelet-rich plasma (PRP) are some of the therapeutic strategies utilized to enhance mitochondrial function and reduce oxidative stress (Tab. 1, Fig. 1, Ref. 62). Text in PDF www.elis.sk Keywords: mitochondrial dysfunction, oxidative stress, mitochondrial bioenergetics, high-resolution respirometry, therapeutic approaches.

Porphyria cutanea tarda (PCT) is the most common chronic porphyria, with approximate prevalence of 1:10,000. PCT is frequently associated with hepatitis C virus (HCV), malignant lymphoma and iron overload. Here, we present a case of PCT onset subsequent to hepatitis E virus infection (HEV), characterised by symptoms including skin fragility, haemorrhagic bullous skin exanthema, and onycholysis. The patient was successfully treated by erythrocytapheresis and hydroxychloroquine. After exclusion of other possible causes of PCT, HEV infection was identified as the likely trigger of the disease in this genetically predisposed individual, representing the first reported instance of such an association. Erythrocytapheresis emerged as a viable alternative to phlebotomy for PCT treatment. This case underscores the significance of considering HEV infection in the aetiology of PCT and highlights erythrocytapheresis as a promising therapeutic approach (Ref. 8). Text in PDF www.elis.sk Keywords: hepatitis E, porphyria cutanea tarda, erythrocytapheresis, hydroxychloroquine.

Background: The goal of our work was to develop a composition for antimicrobial photodynamic inactivation (aPDI) of anaerobic periodontopathogenic pathogens.

Methods: The three test groups were as follows: light plus doxycycline (L+DOX+), light plus doxycycline and hypericin (L + DOX + HYP +), and control groups. aPDI was evaluated by the number of grown colonies on a dense nutrient medium after 12, 24, and 48 hours of bacterial suspension cultivation.

Results: Based on the results of microbiological studies, the combined photosensitising effect of a subinhibitory dose of doxycycline and hypericin was determined. The delay of growth of A. israelii, P. melaninogenica in the second group (L+DOX+HYP) was significantly significant compared to the first group (L+DOX+), and the statistical difference in colony formation activity was found for both gram-positive and gram-negative cultures (p<0.05).

Conclusions: aPDT is a promising therapeutic alternative for the local treatment of purulent-inflammatory diseases of various localisation caused by antibiotic-resistant bacteria, including in the oral cavity (Fig. 3, Ref. 57). Text in PDF www.elis.sk Keywords: peri-implant diseases, photodynamic therapy, photosensitiser, anaerobic bacteria.

Background: This prospective study aims to evaluate the demographic and histopathological characteristics of patients who underwent resection of malignant skin tumors of the lower eyelid. It also seeks to assess the size of the defect and outline the management strategies for reconstructing anterior and posterior lamellae.

Methods: The study enrolled 87 patients treated between January 1, 2018, and December 31, 2022. The article outlines a reconstructive strategy based on the defect characteristics.

Results: The most prevalent type of tumor was basal cell carcinoma (86%), followed by squamous cell carcinoma (8%), malignant melanoma (5%), and Merkel cell carcinoma (1%). There was a slight male preponderance (52%). No significant difference was found in the incidence of lower eyelid malignant tumor between the sex subgroups (p=0.97). The mean age of the patients was 73.52 years (SD=10.582; range 37-92 years). No statistically significant difference in laterality (p=0.108) was observed. A larger tumor size was significantly associated with a higher tumor grade (p=0.008; r=0.926). A significant correlation was identified between the tumor location and the size of the excision (p<0.001). Furthermore, a significant correlation was identified between the histopathological types of tumors and the excision area (p=0.016). Reconstruction of the anterior lamella in small- and medium-sized defects was achieved by using local randomized flaps (61%), primary closure (29%), and skin grafts (10%). For large-sized defects, the anterior lamella was reconstructed by flap (88%) or skin graft (22%). Altogether, posterior lamella was replaced in 25 cases (29%) of all defects using nasal chondromucosa (40%), conchal cartilage (28%), buccal mucosa (8%), periosteal flap (12%), Hewes flap (8%) and Hughes flap (4%).

Conclusion: Advanced techniques are necessary when reconstructing a larger lower lid area. In such cases, various subunits must be reconstructed separately to achieve optimal functional and aesthetic outcomes. However, the choice of reconstructive technique mainly depends on the extent of the lid resection (Fig. 9, Ref. 44). Text in PDF www.elis.sk Keywords: defects, eyelid, malignant neoplasms, reconstructive surgical procedures, resection.

Objectives: The present work aimed to study the efficacy and patient compliance of oral theophylline treatment in the prevention of vasovagal syncope recurrences.

Background: High blood adenosine may trigger vasovagal syncope. Theophylline is an adenosine receptor antagonist.

Methods: In 44 patients with vasovagal syncope (8 men and 34 women, age 46.4±3.2 years) with an average 4.8±0.74 syncopal episodes (range 1-20, median 4,5 episodes) oral theophylline therapy was started with dose 2x100/200 mg, which was further increased if necessary. All patients were treated by non-pharmacological measures which were not effective. Patients were followed in regular intervals on an outpatient basis in 6-month intervals.

Results: After the start of treatment patients were followed for the mean of 17.1±2.1 months (2-51 months, median 12 months). The total number of syncopal episodes decreased from 4.8±0.74 to 1.73±0.45 (p=0.0006). The occurrence of syncopal episodes per year decreased from 4.07±0.80/year to 1.50±0.54 /year during the treatment period (p=0.001). After a gradual increase in theophylline dosage, in 34 patients no syncopal recurrences were observed. In 10 persons syncopal recurrences persisted despite treatment. Side effects leading to discontinuation of treatment were present in 14 patients - gastrointestinal intolerance (7 patients), palpitations (6 patients) and headache (3 patients).

Conclusion: The addition of oral theophylline preparation to non-pharmacological treatment led to a marked reduction of syncopal recurrence in patients with vasovagal syncope. About one-third of study subjects discontinued therapy because of side effects (Tab. 2, Fig. 4, Ref. 22). Text in PDF www.elis.sk Keywords: heophylline, adenosine, vasovagal syncope, treatment.

Conn's syndrome, defined as unilateral aldosterone-producing adenoma, accounts for 35-40% of cases of primary hyperaldosteronism. Primary hyperaldosteronism typically occurs in younger patients with poorly controlled arterial hypertension due to extracellular fluid retention, in whom at least a triple combination of antihypertensives, including a diuretic, is needed to maintain normotension. The clinical picture of arterial hypertension may be complemented by symptoms associated with hypokalaemia, such as weakness, fatigue, palpitations, convulsions, polydipsia, or polyuria. In addition to arterial hypertension and hypokalaemia, the diagnosis of Conn's syndrome relies on examination of serum renin and aldosterone concentrations, plasma renin activity, exercise or furosemide stimulation tests, and imaging studies, preferably computed tomography. The method of treatment of Conn's syndrome is adrenalectomy. In patients with primary hyperaldosteronism with underlying bilateral adrenal cortical hyperplasia or patients contraindicated for surgery, mineralocorticoid receptor antagonists are administered in combination with antihypertensives targeted for optimal blood pressure control.In the group of patients after kidney transplantation, the exact incidence of primary hyperaldosteronism is unknown. Based on a cross-sectional study performed in 2020, it is estimated to be approximately 15% in the group of patients with unsatisfactorily compensated arterial hypertension; in the cohort of normotensive recipients, the incidence of primary hyperaldosteronism is not documented. Diagnosis of Conn's syndrome in patients in the early period after kidney transplantation is problematic, as the prevalence of arterial hypertension in transplanted patients is high (70-90%) according to the literature. Mineral abnormalities, including hypokalaemia, are also common in the early post-transplant period, mainly due to factors such as duration of cold ischaemia, onset of graft function, donor parameters, post-transplant tubulopathy, and diuretics, the effects of immunosuppressive drugs (especially calcineurin inhibitors and corticosteroids), and possibly potassium-restricted dietary habits that the patient brings from the pre-transplant period, which may mask the effect of hyperaldosteronism on potassium.We present the case of a patient who was diagnosed with Conn's syndrome 7 months after primary kidney transplantation from a deceased donor based on persistent hypokalaemia unresponsive to replacement therapy. At the time of the first manifestation of severe hypokalaemia, the patient was treated with a dual combination of antihypertensives (amlodipine at a daily dose of 5 mg and carvedilol at a daily dose of 50 mg), without the need for a diuretics.We consider the case interesting because the spectrum of mineral and acid-base abnormalities in advanced renal failure and in the early post-transplant period, as well as acid-base and mineral imbalances, including hypokal

Background: In this study, we aimed to examine the telomerase activity and hTERT gene expression in patients with acute coronary syndrome (ACS) and those with stable coronary artery disease (SCAD) and compare the results to controls. Additionally, we compared overall mortality rates relative to the telomerase activity.

Methods: A total of 211 patients (78 ACS and 71 SCAD patients) were included in the study. The telomerase concentration was measured by ELISA and used to determine telomerase activity. The hTERT gene expression was determined by real-time PCR.

Results: The serum telomerase enzyme concentration was lower in ACS (36.61 ± 1.54) and SCAD (36.79 ± 1.57) when compared to the control group (37.03 ± 2.25). However, this difference did not reach statistical significance (p = 0.890). The hTERT gene expression acting in telomerase enzyme synthesis was 2.7-fold lower in ACS group (p = 0.070) and 2.2-fold lower in the SCAD group (p = 0.101) compared to the control group. Patients were followed for a median of 32 months (minimum: 0.1, maximum: 46.8). The serum telomerase concentrations in patients who died and those survived in the SCAD group (35.98 ± 2.02 vs 36.86 ± 1.52 ng/ml, respectively; p = 0.529) were similar to those in the ACS group (36.39 ± 1.08 vs 36.63 ± 1.60 ng/ml, respectively p = 0.993).

Conclusions: In the current study, telomerase activity or hTERT expression was similar in patients with ACS, SCAD, and controls. Moreover, telomerase activity was not associated with all- cause mortality during the 32-month follow-up (Tab. 3, Fig. 1, Ref. 29).

Objectives: Cisplatin is a widely used anticancer drug for the treatment of many solid cancers. DNA damage is thought to be the key mechanism of cisplatin's anticancer activity. However, cisplatin may also affect cellular metabolism. The aim of this study was to determine the effect of cisplatin on the types of ATP production (OXPHOS versus glycolysis) and their rate in prostate cancer cells and to determine the potentially protective effect of autophagy and amino acids during cisplatin treatment. We also wanted to investigate the potential synergy between the metabolic effects of cisplatin on ATP production and the inhibition of autophagy.

Methods: Cisplatin treatment can significantly affect the metabolism of cancer cells. Important metabolic pathways can be altered, leading to changes in energy production and nutrient utilization. Autophagy and amino acid pool modulations can serve as protective mechanisms significantly affecting tumor cell survival under metabolic stress caused by anticancer treatment. By enabling the recycling of amino acids, autophagy helps cancer cells maintain cellular homeostasis and overcome nutrient limitations. Thus, inhibition of autophagy could have a supportive effect on the metabolic effects of cisplatin.

Results: After cisplatin treatment, ATP production by way of OXPHOS was significantly decreased in 22Rv1 and PC-3 cells. On the other hand, ATP production by glycolysis was not significantly affected in 22Rv1 cells. DU145 cells with dysfunctional autophagy were the most sensitive to cisplatin treatment and showed the lowest ATP production. However, short-term autophagy inhibition (24h) by autophinib or SAR405 in 22Rv1 and PC-3 cells did not alter the effect of cisplatin on ATP production. Levels of some amino acids (arginine, methionine) significantly affected the fitness of cancer cells.

Conclusion: Persistent defects of autophagy can affect the metabolic sensitivity of cancer cells due to interference with arginine metabolism. Amino acids contained in the culture medium had an impact on the overall effect of cisplatin (Fig. 3, Ref. 38).

Background: Toxoplasma gondii infection in pregnant women could lead to significant changes during the pregnancy, affect the outcomes of pregnancy and the timing of labour. Small‑for‑gestational‑age (SGA) newborns are defined by birthweight below the 10th percentile for gestational age. We tested an association between latent toxoplasmosis in pregnant women and deliveries of SGA babies.

Material and methods: For testing, we included 1,647 women who gave birth to a singleton baby at ≥ 37 weeks of gestation. The complement-fixation test (CFT) and enzyme-linked immunosorbent assay (ELISA) tests for IgG and IgM were used. The latent form of toxoplasmosis was defined as a CFT titre of 1:8 or higher, together with index positivity IgG ELISA > 1.1 and negative IgM.

Results: There were 406 (24.7 %) women positive, and 1,241 (75.3 %) women negative for latent toxoplasmosis. Of all deliveries. 190 were SGA‑positive and 1,457 were SGA‑negative. Our study found a statistically significant association between latent toxoplasmosis and SGA foetuses born at term. The Pearson chi-square model was statistically significant (χ2(1) = 7.365, p = .007). The odds ratio was 1.567.

Conclusion: Pregnant women with latent toxoplasmosis giving birth at ≥ 37 weeks of gestation have a 1.567 times higher risk of delivering an SGA baby (Tab. 2, Fig. 1, Ref. 30).

Background: In the 21st century, endoscopic retrograde cholangiopancreatography (ERCP) has emerged as a diagnostic and therapeutic method for diseases of the pancreaticobiliary duct system. However, like any other diagnostic and therapeutic method, ERCP carries the risk of unwanted complications.

Material and methods: We retrospectively followed patients who underwent ERCP examinations from January 2013 to April 2023. We focused on early post-ERCP complications and their risk factors, prevention, treatment, and mortality.

Results: A total of 4,814 patients were recorded, of which 175 patients had early post-ERCP complications, including acute pancreatitis, acute cholangitis, perforation, and bleeding. We focused on the statistical significance of risk factors such as BMI, repeated ERCP, bleeding disorders, and repeated pancreatitis or cholangitis.

Conclusion: Ensuring proper preparation and appropriate indication for ERCP examination can significantly mitigate the risk of post-ERCP complications. Additionally, early diagnosis and prompt treatment of any post-ERCP complications are essential strategies for reducing mortality associated with these conditions (Tab. 3, Fig. 3, Ref. 32). Text in PDF www.elis.sk Keywords: post-ERCP complication, risk factor, BMI, prevention.