Bratislava Medical Journal-Bratislavske Lekarske Listy最新文献

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: The aim of the study was to evaluate pulmonary sequestration (PS). We report on location, blood supply, histology, clinical manifestation, and surgical treatment of PS, as well as on postoperative course in patients with PS.

Background: PS is a rare congenital defect of the lower respiratory tract, it represents locus minoris resistentiae of the body. Occasionally, PS is diagnosed for the first time in adulthood.

Methods: We evaluated 7 cases of PS treated at the Centre of Thoracic Surgery in Vyšné Hágy, Slovakia, between years 2013 and 2020.

Results: Four of our seven patients were asymptomatic; the PS was found incidentally upon chest imaging. Three patients had recurrent bronchopneumonia related specifically to the intralobar type of sequestration. The most significant complication, observed in a singular patient, was a life-threatening episode of haemoptysis, requiring urgent surgical intervention. In the other 6 cases, the sequestra were surgically resected during the period when they were asymptomatic. and their sputum was confirmed negative upon microbiological examination. Anatomical resection of the affected pulmonary lobe by thoracotomy was the most common type of operation performed (4 cases, n = 7). There was no surgical mortality.

Conclusion: To prevent complications, it is crucial to perform surgical treatment for pulmonary sequestration in patients who have sufficient functional capacity (Tab. 2, Fig. 4, Ref. 30). Text in PDF www.elis.sk Keywords: pulmonary sequestration, anatomic lobectomy, haemoptysis.

Insulin resistance (IR) is the most significant risk factor for post-transplant diabetes mellitus (PTDM). This study aimed to determine the effects of regular physical activity on IR and PTDM in patients after kidney transplantation (KT). The study group (n = 22) participated in aerobic or combined sports (aerobic and anaerobic). Monitoring was provided by a sports tracker (Xiaomi Mi Band 4, compatible with the Mi Fit mobile application). Waist circumference was significantly lower (p = 0.0437, p = 0.0372), graft function was better (p = 0.0036, p = 0.0137), fasting blood glucose was lower (p = 0.0016, p = 0.0003), C-peptide level was lower (p = 0.0447, p = 0014) in the 3rd and 6th months of monitoring, and low-density lipoprotein was lower at 6 months (p = 0.0444) in the observed group than in the control group. IR was significantly lower at 6 months (p = 0.0202), and fasting blood glucose was significantly lower at 3 and 6 months (p = 0.0227) in the observed group. We confirmed the significant effect of regular physical activity on preventing the development of IR and impaired fasting glucose levels in patients after KT (Tab. 1, Fig. 4, Ref. 27). Text in PDF www.elis.sk Keywords: kidney transplantation, insulin resistance, physical activity.

Background: Advanced pancreatic ductal adenocarcinoma (PDAC) remains a disease with a dismal prognosis, significantly limited therapeutic options, and few innovative drugs. Inflammation plays a significant role in the development and progression of PDAC. Systemic inflammatory indexes reflect the anti-tumor inflammatory capacity of and are of prognostic and predictive value in the treatment of patients with PDAC.

Methods: In our retrospective study, we investigated the prognostic and predictive significance of inflammatory markers in chemonaive patients with locally advanced unresectable pancreatic cancer (LAPC) and metastatic pancreatic cancer (mPDAC), in relation to progression-free survival (PFS) and overall survival (OS). Survival analysis was conducted using the Kaplan-Meier method with log-rank tests in univariate analysis. We used multivariate Cox regression analysis to determine the impact of inflammatory markers on survival time.

Results: The present clinical study included 46 patients with LAPC and mPDAC treated with FOLFIRINOX (folinic acid, fluorouracil, irinotecan, oxaliplatin) or GEM/Nab-P (gemcitabine/nab-paclitaxel) as first-line chemotherapy regimens. Performance status (PS) ECOG 0-1, neutrophil-to-lymphocyte ratio (NLR)≤2.09 and the prognostic nutritional index (PNI)≥49.09 were associated with significantly longer OS in the analyzed patient cohort, Multivariate analysis confirmed PS, NLR and PNI as independent prognostic factors for OS.

Conclusion: In our cohort of patients with advanced PDAC, PS, NLR and PNI were confirmed as independent prognostic factors for OS (Tab. 9, Fig. 2, Ref. 82). Text in PDF www.elis.sk Keywords: pancreatic cancer, inflammatory markers, tumor microenvironment, chemotherapy.

The number of patients on the waiting list for a kidney retransplant has increased. Patients who are candidates for a second kidney transplant often have higher levels of PRA (Panel of Reactive Antibodies). The previous failed kidney transplant is one of the main factors that leads to the production of antibodies against human leukocyte antigens ‒ HLA. The consequences of sensitisation are a long waiting time for repeated kidney transplantation and a negative effect on graft survival after retransplantation.The aim of our analysis was to evaluate the immunological parameters of patients undergoing renal retransplantation at the Kosice Transplant Centre, their influence on graft function, the occurrence of rejection episodes and to analyse the sensitisation status of recipients on the waiting list for renal retransplantation at the Kosice Transplant Centre.We retrospectively analysed 46 adult patients who underwent secondary renal transplantation. In the group of retransplanted patients, we found a higher immunological risk and PRA values (p<0.001) and a higher need for induction therapy to reduce the lymphocyte count (p<0.001). Retransplant patients with DGF were 48% more likely to experience acute rejection.In the context of the published literature, we have observed increased sensitisation in retransplanted patients, which is a major challenge to overcome the immunological barrier in transplantation medicine (Tab. 4, Fig. 1, Ref. 24). Keywords: retransplantation, sensitisation, panel of reactive antibodies.

The coronavirus disease 2019 (COVID-19) pandemic had a significant impact on the somatic and psychological state of the population worldwide, leading to a wide range of health complications. Most of the studies on the COVID-19 pandemic have focused on the direct psychological and somatic aspects of the disease. However, the negative consequences of the indirect aspect of the pandemic (i.e., stay-at-home orders leading to social isolation) represent a major stressor on psychosomatic health and warrant greater interest. This study examines the COVID-19 pandemic as a significant stressor of the 21st century through the lens of the "allostatic" stress response concept and highlights the stress-related psychosomatic consequences of the COVID-19 pandemic. A better understanding of the pathomechanisms underlying indirect impacts of the pandemic on psychosomatic health can contribute to the implementation of personalized interventions for managing stress responses, thereby reducing the pandemic-linked stress burden and preventing stress-associated disease emergence (Tab. 1, Fig. 1, Ref. 67). Text in PDF www.elis.sk Keywords: COVID-19 pandemic, social isolation, stress response, allostasis, allostatic load, psychosomatic symptoms.

Background: Breast cancer is one of the main Cancers affecting patients all over the world; however, till now, there has been no successful treatment without any side effects on patient health, but there are groups of medications similar to MDM2 inhibitors that have promising effects. The aim of this study was to find out whether the use of mdm2 inhibitors can help treat breast cancer using three cell lines. The use of treatments belonging to the MDM2 inhibitor alone or with the use of doxorubicin together with a combination of Nutlin-3, Miladometan, Yh239-EE, and doxorubicin in breast cancer cell lines HP100, MCF7.

Materials and methods: Cell lines were treated with different concentrations of MDM2 inhibitors 1,5,10, and 20 micromolar alone or in combinations with doxorubicin. After that, cell viability was estimated by the MTT assay method. Then, we have assessed the expression of caspase as an indicator of cell apoptosis after treatment, and the expression of P53 and MDM2 after and before treatment.

Results: The IC50 of Doxorubicin in the MCf7 cell line was about 1.12 µM. The best IC50% in MDM2 inhibitors was for Nutlin, about 5.9 µM, then for Yh239-EE about 8.45 µM, and Milademetan about 11.07 µM the high IC50% values in normal epithelial cell HBl100. Also, the MDM2 inhibitor increased P53 levels, as did doxorubicin.

Conclusion: Our research concluded that Nutlin 3 has a superior effect over Yh239-EE and Miladometan in treating Breast cancer; moreover, the combination group has shown to be more effective than treatment with Doxorubicin or MDM2 inhibitors alone. Interesting information is that Doxorubicin also causes an increase in P53 levels. This result provided us with a promising therapeutic strategy for the treatment of breast cancer. However, more research is required to be conducted on more types of cell lines and in human or animal models (Tab. 4, Fig. 8, Ref. 33). Text in PDF www.elis.sk Keywords: breast cancer, Miladometan, cell viability, proliferation, therapeutic strategy.