Bratislava Medical Journal-Bratislavske Lekarske Listy最新文献

Objective: We aimed to evaluate the opinions of individuals aged 18 and above in our country regarding the use of artificial intelligence (AI) and robots in the field of healthcare.

Background: The growing population and patient load, coupled with increasing data, can expedite the diagnosis and treatment process for patients through faster, easier, and more accurate interpretation of information.

Methods: The study encompasses voluntary participants aged 18 and above, who have either undergone surgery in a hospital or have accompanied a family member during a surgical procedure and possess internet access as well as the capability to participate in online surveys.

Results: A total of 725 individuals participated in our study 61% (n=442) of respondents expressed trust in the operation of AI and robots in the hospital setting. 64.1% (n=465) of participants expressed trust in AI's contribution to disease diagnosis and laboratory tests. The confidence in AI's use in radiological examinations and its contribution reached 71.6% (n=519).

Conclusion: This study demonstrates that the use of AI and robots in healthcare services is accepted by our society and would be appropriate in our society (Tab. 5, Fig. 1, Ref. 24).

Malnutrition is a global health problem that is not limited to developing countries. So far, it is one of the underdiagnosed and curative medical problems. THE AIM of our observation was to evaluate the nutritional status of patients at risk of malnutrition.

Methods and patients: We retrospectively evaluated 140 patients from the Gastroenterology Clinic and the Center for Home Parenteral Nutrition (HPN) at the University Hospital Bratislava, Slovakia. Patients were indicated for examination as part of the entry screening for malnutrition or consultation examination in patients presenting with signs of malnutrition. Based on the determination of the body mass index (BMI), the completed questionnaire of nutritional risk screening (NRS) and the determination of the state of performance, we evaluated the nutritional status of the patient and subsequently started enteral, or parenteral nutrition.

Results: We recorded a statistically significant negative correlation between BMI and malnutrition risk (p<0.001), ie. the lower the BMI, the higher the risk of malnutrition. We did not observe a relationship between age, diagnoses and the incidence of BMI-related malnutrition in the study group of patients.

Conclusion: Properly applied clinical nutrition, whether enteral, parenteral, or a combination thereof, can significantly affect morbidity and mortality in patients with malnutrition or the risk of its development. Unfortunately, Slovakia is still lagging behind developed countries in its implementation as part of a comprehensive treatment of patients (Tab. 2, Fig. 4, Ref. 28).

Background: Vitamin D is a neuroactive steroid that carries out its biological functions through the vitamin D receptor (VDR). The VDR gene interacts with certain long noncoding RNAs (lncRNAs). The present study is aimed at evaluating the expression levels of the VDR gene as well as those of HOTAIR, H19, MALAT1, and P21 lncRNAs in patients with relapsing-remitting multiple sclerosis (RRMS).

Methods: This research was conducted on 38 RRMS patients and 38 healthy individuals. The expression levels of VDR and selected lncRNAs in peripheral blood as well as those of vitamin D in the plasma were measured.

Results: The results revealed a significant increase in the expression of lncRNA H19 in the RRMS group compared to the control group. The analysis of the receiver operating characteristic (ROC) curve for H19 gene expression demonstrated a diagnostic value of 0.699 (95% CI: 0.575-0.823). Positive correlations were detected between VDR and lncRNA HOTAIR (r = 0.446, p = 0.008), H19 (r = 0.351, p = 0.042), MALAT1 (r = 0.464, p = 0.006), and P21 (r = 0.512, p = 0.002) in MS patients.

Conclusion: The findings of this study suggest that lncRNA H19 could serve as a potential biomarker for MS diagnosis (Tab. 4, Fig. 1, Ref. 34).

Background: The COVID-19 pandemic reduced access to medical services and led to an increase in complications and exacerbation of many diseases that occurred during and after the pandemic, including deterioration in oral health. One of the main oral health indicators is the index of the number of decayed, extracted, and filled primary teeth (deft) or decayed, extracted, and filled permanent teeth (DEFT). The aim of this study was to determine whether restricted access to dental services during the COVID-19 pandemic led to a deterioration in oral health among schoolchildren.

Method: Data of oral systematic examinations before (school year: 2018-2019) and after (school year: 2021-2022) the pandemic were used for the study. Systematic oral examinations were conducted for all primary school students from the first to ninth grades at Murska Sobota Public Health Center, and the number of decayed, filled, and extracted (due to caries) primary and permanent teeth were recorded for each student. The deft and DEFT index values before and after the pandemic were calculated and compared for students in first (age range: six to seven years) to fifth (age range: 10-11 years) grades and students in fifth to ninth (age range 14-15 years) grades, respectively.

Results: We found that the median deft index of the whole population before the pandemic was 3, whereas it was 2 afterwards (p < 0.01). For students in the first and second grades, the median deft index was 3 before the pandemic and 2 afterwards (p = 0.01), and for students in the third grade, it was 4 before the pandemic and 2 afterwards (p < 0.01). The median DEFT index of the whole population was 1 before the pandemic and 0 afterwards (p < 0.01). For students in the seventh, eighth and ninth grades, the median DEFT index values were 1, 2 and 2, respectively, before the pandemic and 0, 0 and 1, respectively, afterwards (p < 0.01 for seventh and eighth grades and p = 0.02 for ninth grade).

Conclusion: The results of our study showed a lower deft/DEFT index after the pandemic, which could be explained by increased health and hygiene awareness during the pandemic, as children/parents were mostly responsible for maintaining good oral health. Limited access to dental services does not necessarily imply poor oral health (Tab. 1, Ref. 25).

Background: Several studies have investigated independently of clinical education, it has been emphasized that students experience fear, anxiety, sadness and uncertainty during the pandemic.

Aim: This study aimed to investigate the effect of fear of COVID-19 on the level of anxiety and self-confidence of midwifery students who did their clinical internship during the pandemic.

Methods: Convenience sampling yielded 181 senior midwifery students who had experienced clinical internships during the COVID-19 pandemic. Two state universities conducted an online cross-sectional predictive study from February to June 2021. Data were collected by an Information Form, the COVID-19 Fear Scale, the State-Trait Anxiety Inventory, and the Self-Confidence Scale.

Results: The study findings were that the students' fear of COVID-19 (16.72 ± 4.89), state anxiety (52.65 ± 8.41), and trait anxiety (48.66 ± 6.80) were above average, and their self-confidence was moderate. The result indicated that midwifery students' fear of COVID-19 increased, their state anxiety increased (p < 0.01), and their self-confidence decreased (p < 0.01). Fear of COVID-19 accounted for 47% of state anxiety, 6% of trait anxiety, and 22% of self-confidence.

Conclusion: The level of COVID-19 fear of midwifery students who did clinical internships during the pandemic negatively affected their anxiety and self-confidence levels (Tab. 4, Ref. 34). Text in PDF www.elis.sk Keywords: pandemic, midwifery, fear of COVID-19, anxiety, self-confidence.

Objectives: ASCT has been considered the standard of care for younger patients with NDMM, however, not all the studies published so far have uniformly demonstrated the complete superiority of ASCT over chemotherapy at standard doses. A systematic review and meta-analysis of randomized studies has shown a significant benefit with single ASCT in terms of prolonged progression-free survival (PFS), but not of overall survival (OS). In our retrospective analysis we investigated the impact of high dose (HD) chemotherapy followed by ASCT in special population of patients with high risk cytogenetic profile on the PFS and treatment outcome.

Methods: Retrospective analysis of NDMM patients eligible for HD chemotherapy followed by upfront ASCT in the era of novel agents, who underwent the ASCT in the Department of hematology and oncohematology LF UPJŠ and UNLP Košice in the timeframe of 54 months (from 01/JAN/2019 to 30/JUN/2023). Patients were stratified according to their cytogenetic profile. PFS was defined by the time from ASCT to the disease progression. The OS was defined as the time from the the start of treatment to the death from disease progression. The high risk cytogenetic abnormalities (HRCA) were defined as t(4;14), del(17/17p), t(14;16), t(14;20), nonhyperploidy, gain (1q).

Results: Inclusion criteria were met by 65 patients with NDMM who received HD chemotherpy followed by ASCT. We identified 22 (33.8 %) patients with HRCA and 43 (66.2 %) patients with standard cytogenetic risk. During the monitored period we recorded 4 deaths due to disease progression, all of them in the HCRA subgroup. The response was enhanced by the ASCT in both subgroups. The very good partial response (VGPR) increased from 42 % to 46 % and complete remission (CR) increased from 23 % to 45 % after the ASCT. The number of patients achieving only partial response (PR) decreased from 35 % to 9 % after ASCT. In the subgroup of patients with HRCA the median PFS after ASCT was lower compared to the patients with standard cytogenetic risk (17 vs 38 months). The average PFS in both subgroups was 22.9 months. The median OS in both subgroups was not reached, however the only deaths due to disease progression were recorded in the HRCA subgroup. At the time of analysis, 100 % (43) of patients are alive in the standard cytogenetic subgroup versus 72 % (18) of patients in HRCA subgroup.

Conclusion: HD chemotherapy followed by ASCT remains the standard of care for NDMM eligible for high dose chemotherapy. Our results confirm the benefit of ASCT even in the presence of HRCA. Lower PFS in the HRCA subgroup might indicate the need for more intensive treatment, which may be achieved by tandem ASCT defined as two ASCT performed within a period of no more than six months. Additionally, as three- and four-drug induction therapies are becoming increasingly available and effective, resulting in high minima

Patients with chronic pancreatitis are at risk of developing malabsorption and malnutrition. Exocrine pancreatic insufficiency is accompanied by decreased serum micronutrient levels and low vitamin D levels are a frequent finding in up to 60-80% of patients. The aim of our prospective study was to investigate vitamin D in the blood serum of subjects with chronic pancreatitis with the possibility of influencing the reduced vitamin D levels with supplementation therapy.

Material and methodology: Fifty patients with chronic pancreatitis and 20 subjects in the control group without gastrointestinal tract diseases, including pancreatic disease, were examined. The vitamin D level in blood serum was determined. The results were evaluated according to the age distribution of subjects with pancreatic disease and according to gender. Patients with low vitamin D levels were treated for 24 weeks with a dose of 1.500.000 IU of vitamin D3 per day, and then blood serum vitamin D levels were determined.

Results: In people with chronic pancreatitis, vitamin D levels were statistically significantly reduced compared to the control group. There was no statistically significant relationship of vitamin D with gender and age. Supplementation with vitamin D3 achieved an adjustment of vitamin D level to the level of the control group.

Conclusion: Blood serum vitamin D levels are significantly reduced in people with chronic pancreatitis. Its correction by oral vitamin D supplementation was effective. Whether this adjustment of levels will be effective also in terms of e.g. beneficial effect on fibrogenesis will require further representative studies, because the limitation of the interpretation of the results of our study is the smaller number of subjects with chronic pancreatitis (Tab. 4, Ref. 29).

Objectives: The objective of this study was to investigate whether there are differences between brain natriuretic peptide (BNP) levels and computed tomography pulmonary angiography (CTPA) parameters, in patients with acute PE, with respect of sex.

Background: Acute pulmonary embolism (PE) may provoke sudden right ventricle overload and stretching of their thin walls, causing significant raise of BNP blood levels, which correlates to acute PE severity. The properties of RV are different between sexes.

Methods: This retrospective analysis was gained from the data of 1612 PE patients from the regional PE register. The patients have had CTPA verification of PE, with described localization of thrombus masses, as well as the ratio between RV and left ventricle (RV/LV), and BNP as biomarker, measured during the first 24 hours upon admission.

Results: Out of 96 male patients with detected central thrombus, 75.0% patients had an increase in BNP level compared to 25.0% patients with normal BNP value (p<0.001). Of the 94 female patients with central thrombus, 85.1% patients had an elevated BNP level, compared to 14.9% patients, with BNP normal values (p<0.001). Of the 135 male patients with RV/LV˃1, 79.3% of them, had elevated BNP, compared to 20.7% patients whose BNP level was normal (p<0.001). Out of 123 female patients with RV/LV˃1, 91.1% patients had elevated BNP compared to 8.9%, whose BNP was normal (p<0.001).

Conclusion: Elevated BNP blood level correlates with CTPA parameters, such as the presence of central thrombus and the ratio between right and left ventricles greater than 1, in patients with acute PE, regardless of sex (Tab. 2, Fig. 2, Ref. 23). Text in PDF www.elis.sk Keywords: acute pulmonary embolism, computed tomography pulmonary angiography, brain natriuretic peptide, right ventricle.

Background: Human milk oligosaccharide (HMO) is a unique component of breastmilk. To date, no study has investigated the correlation between HMO and infant nutritional status particularly through the lens of gut microbiota. Therefore, our study aims to investigate the relationships between 2'-Fucosyllactose (2'-FL) in HMO and Firmicutes/Bacteroidetes (F/B) ratio among stunted infants.

Methods: A case-control study was conducted among 103 mother-infant pairs in Malang City, Indonesia. The quantification of 2'-FL HMO was assessed using High-Performance Liquid Chromatography (HPLC). The F/B ratio was analyzed with real-time poly-chain reaction (RT-PCR). For bivariate analysis, we employed the Spearman correlation and Mann‒Whitney tests, while for multivariate analysis, we utilized multiple linear regression.

Results: The findings showed that the stunted nutritional status was detected in 49 out of 103 infants. In this group, 40.81% of mothers of infants with a stunted nutritional status had a secretor-positive status, while all mothers of infants with appropriate nutritional status tested positive for the secretor status (100%). However, the association between maternal secretor status and infant nutritional status was not statistically significant (p>0.05). The average levels of 2'-FL HMO in breast milk were lower in the group with stunted infants compared to non-stunted infants (1.21 mg/L vs 1.40 mg/L). The regression analysis revealed a significant association of 2'-FL HMO levels with the presence of Bacteroidetes and value of the F/B ratio (p>0.05).

Conclusions: The breast milk component 2'-FL HMO significantly influences the gut microbiota of stunted infants. Future research aimed at elucidating the mechanisms by which 2'-FL HMO modulates infant gut microbiota should consider not only concentration and specific bacterial taxa but also intake levels (Tab. 2, Fig. 1, Ref. 37). Text in PDF www.elis.sk Keywords: 2'-fucosyllactose, human milk, oligosaccharide, firmicutes, bacteroidetes, stunting, infant.

Introduction: This study examines triage judgments in emergency settings and compares the outcomes of artificial intelligence models for healthcare professionals. It discusses the disparities in precision rates between subjective evaluations by health professionals with objective assessments of AI systems.

Material and method: For the analysis of the efficacy of emergency triage; 50 virtual patient scenarios had been created. Emergency medicine residents and other healthcare providers who had triage education were tasked with categorizing triage levels for virtual patient scenarios. Also artificial intelligence systems, tasked for resolving the same scenarios. All of them were asked to use three color-coded triage of the Republic of Turkey Ministry of Health. The answer keys were created by consensus of the researchers. In addition, Emergency medicine specialists were asked to evaluate the acuity level of each scenario in order to perform sub-analyses.

Results: The study consisted of 86 healthcare professionals, comprising 31 Emergency medicine residents (26.5%), 1 paramedic (0.9%), 5 emergency health technicians (4.3%), and 80 nurses (68.4%). Google Bard AI and OpenAI Chat GPT v.3.5 were used as artificial intelligence systems. The responses compared with the answer key to determine each groups efficacy. As planned the responses from healthcare professionals were analyzed individually for acuity level of scenarios. Emergency medicine residents and other groups of healthcare providers had significantly higher numbers of correct answers compared to Google Bard and Chat GPT (n=30.7 vs n=25.5). There was no significant difference between ChatGPT and Bard for low and high acuity scenarios (p=0.821)CONCLUSION: AI models can examine extensive data sets and make more accurate and quicker triage judgments with sophisticated algorithms. However, in this study, we found that the triage ability of artificial intelligence is not as sufficient as humans. A more efficient triage system can be developed by integrating artificial intelligence with human input, rather than solely relying on technology (Tab. 4, Ref. 41). Text in PDF www.elis.sk Keywords: emergency triage, AI applications, health technology, artificial intelligence, emergency management.