Bratislava Medical Journal-Bratislavske Lekarske Listy最新文献

Vestibular neuropathy represents the third most common cause of peripheral vestibular disorders. The clinical picture of the disease is characterized by acute vertigo with vegetative accompaniment. A typical course is monophasic with the resolution of symptoms within a few days to complete adjustment. In some patients, secondary complications may occur, which we define into three groups: organic, cognitive, and functional. The occurrence of complications and their persistence is often an overlooked issue, which does not receive sufficient attention and can lead to a significant deterioration in quality of life. Therefore, the management of these patients requires a comprehensive approach and interdisciplinary cooperation between neurologists, physiotherapists, psychologists, and psychiatrists. In the following text, the authors attempt to elucidate this issue further (Fig. 1, Ref. 49). Keywords: vestibular neuropathy, secondary complications, vertigo, acute vestibular syndrome.

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.

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.

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.

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.

Coronary artery disease remains a leading cause of morbidity and mortality worldwide. Non-invasive imaging techniques have revolutionized the diagnosis and management of coronary artery disease. This review aims to compare the utility and effectiveness of two emerging non-invasive imaging modalities: coronary computed tomography angiography and myocardial perfusion imaging. Thus we provide here a comprehensive overview of the advancements in non-invasive imaging techniques for coronary artery disease assessment. In parallel, we discuss the role of coronary computed tomography angiography and myocardial perfusion imaging in the diagnosis and management of coronary artery disease, their comparative efficacy, and their potential to guide subsequent interventions (Fig. 4, Ref. 70). Keywords: angiography, heart, perfusion, myocardial blood flow, ischemic heart disease.

Background: The endoscopic-assisted approach for intracerebral hemorrhage minimizes traumatization of the brain and allows direct access to hematoma. The study aimed to compare the results of the endoscopic-assisted evacuation for supratentorial hemorrhage versus conventional craniotomy.

Methods: A retrospective study analyzed medical records of patients with supratentorial intracerebral hemorrhage treated at our Neurosurgical Department between January 2015 and December 2023. The study included 91 patients who underwent either neuronavigational-assisted neuroendoscopy (n=25) or conventional craniotomy treatment (n=66).

Results: For conventional craniectomy procedures, the average residual volume was 10.1 ml, representing an average 82.1% hematoma evacuation efficacy. After endoscopically assisted procedures, the average residual volume was 3.9 ml, achieving a 92.5% hematoma evacuation efficacy. After the endoscopically assisted procedure, fewer than 10% of patients were revised for early or late complications (2 out of 25 patients), whereas after the craniectomy procedure, revision or the introduction of lumbar drainage for cerebrospinal fluid leakage was performed on 35% of patients (20 patients).

Conclusions: The endoscopic-assisted evacuation of supratentorial intracerebral hemorrhage is becoming preferred because of its efficacy, a small number of complications, and minor trauma for the patient (Tab. 1, Fig. 3, Ref. 16). Text in PDF www.elis.sk Keywords: intracerebral hemorrhage, treatment, endoscopy.

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).

Aim: We aimed to investigate the role and importance of immature granulocyte percentage and neutrophil/lymphocyte ratio in the etiology, diagnosis and follow-up of acute pancreatitis (AP) in patients tentatively diagnosed with AP in the emergency department. We evaluated these factors alongside other established markers proven effective in the diagnosis and follow-up of AP.

Material and methods: A total of 139 patients with a tentative diagnosis of acute pancreatitis who were hospitalized and followed up in the gastroenterology clinic in 2021‒2022 were included in the study. In addition, a control group, consisting of 139 individuals admitted to the clinic for various other reasons, was established. The cases were also compared with the control group in terms of NLR, ICG and IG%.

Results: There was a significant difference in the NLR, IGC and IG% measurements between the patients in the AP group and the control group. In all three markers, the average values of the patient group were higher than those of the control group. Furthermore, a significant difference in IGC and IG% blood measurements was noted between sub-groups of patients categorized based on the severity of acute pancreatitis, particularly the patients with severe pancreatitis exhibited higher mean IGC and IG% blood measurements compared to those with mild or moderate pancreatitis.

Conclusion: IGC and IG% values emerged as superior indicators to other acute-phase reactants for detecting inflammation, determining its severity, and establishing prognosis in acute pancreatitis. While the N/L ratio remains an important parameter in acute pancreatitis, our findings indicate that it was not significantly superior to other investigated markers in terms of prognosis (Tab. 5, Ref. 35).

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.