Genetic factors and impairment of central nervous system (CNS) are known factors in aetiology of adolescent idiopathic scoliosis. MRI pathology of CNS (brain asymmetry, syringomyelia) was found. Perinatal pathology could cause damage of CNS. Material and method: Perinatal risk factors are evaluated in adolescent idiopathic scoliosis – AIS group (39 patients) compared with normal individuals – N (28 persons). In the AIS group, the mean onset of right thoracic curve was 12,2 years, apex vertebrae were T7 – T11 (T8 in 8 cases, T8–9 in 5, T9 in 12 cases), mean Cobb angle measured 49,0 degrees (SD 14,500), thoracic kyphosis T3-T12 19,9 (SD 12,167), lumbar lordosis T12-S1 –53,1 (SD 8,338). A questionnaire was created to identify parental age, diseases, mother diseases and remedies during pregnancy, pregnancy duration, child resuscitation, childbirth pathology, incubator, jaundice duration, diseases during the first year of life, beginning of sitting and standing, right or left handing. Results have been processed by software Statistica 7.1. StatSoft, Inc. (2005). For evaluation of potential difference between AIS and N groups two-sample t-test for continuous parameters was used. Two-sample t-test and Fisher test were testing the hypothesis that the values of parameters make no difference between two groups (on the 0,05 significant level). Results: More children who required an incubator were found in AIS group – 4, N group – 1 (statistically insignificant). We found these statistically significant differences: - Occurrence of familiar scoliosis in AIS group – nine out of 39, 0 in N group. - Child diseases during the first year of life in N group –18 out of 28 in N, 10 out of 39 AIS. - Early sitting in AIS group (6,5 months), 7,6 in N. - More males in N group (15 out of 28), 8 out of 39 in AIS. Conclusion: These finding confirm the importance of genetic factors and support the influence of CNS dysbalance factors in early childhood. The earlier sitting (in AIS group) could start the dysbalance of postural motor system. Further studies are necessary.
The aim of the study was to compare efficacy and viral kinetics during antiviral treatment in different chronic hepatitis C patients--naïve, relapsers and non-responders to previous pegylated interferon alpha (PEG-IFN) and ribavirin treatment, with different genotypes, baseline viremia, body weight, age and gender--and to find some baseline parameters which can predict Sustained Virological Response (SVR; negative serum HCV RNA 24 weeks after treatment).216 chronic hepatitis C patients were treated with PEG-IFN alpha-2a 180 mg/wk and ribavirin 1 000 or 1 200 mg/day. There were 140 men and 76 women, mean age 40, range 19-70 years; 142 (66 %) naïve, 37 (17 %) relapsers after previous PEG-IFN and ribavirin treatment, and 37 (17 %) non-responders to this treatment. 172 (79,6%) has genotype 1 infection, 4 (1,9 %) genotype 2, 34 (15,6 %) genotype 3, 1 (0,5 %) genotype 4 or 6 infection, and 4 (1,9 %) were infected by unknown viral genotype. Quantitative detection of HCV RNA was done at baseline (216 pts.), 24 hours (83 pts.), 14 days (85 pts.), 28 days (88 pts.), and 84 days (211 pts.) after the first dose of PEG-IFN.195 patients have completed the treatment period and 179 patients the 24-week follow-up period. The probability of SVR was significantly higher (P < 0,001) in naïve patients (74/114, 64,9 %) and relapsers (22/30, 73,3 %) than in non-responders (9/35, 25,7 %) and in genotype 3 patients (23/28, 82,1%) than genotype 1 patient (77/143, 53,8 %) (P = 0,002). The patients with SVR comparing those without SVR have significantly lower weight (mean 72,8 kg vs. 79,1, P = 0,008(, were younger (mean 36,2, vs. 45,5, P > 0,001), and had lower baseline viremia (mean 1,014 3 106 IU/mL vs. 2,415 3 106 IU/mL, P > 0,001). SVR was more frequent in women than in men (43/63, 62,8 % vs. 62/116, 53,4 %) but difference was not significant (P = 0,059). Undetectable serum HCV RNA at week 12 was more predictive of SVR than early viral response (minimum 2 log decrease of serum HCV RNA during the first 12 weeks of treatment)--98/122 (80,3 %) versus 104/141 (73,1 %) of SVR.1) The monitoring of viral kinetics during first 12 weeks of antiviral therapy in hepatitis C patients was an important predictive value for SVR. 2) Negative serum HCV RNA at week 12 was more predictive of SVR than early viral response. 3) The probability of SVR was significantly higher in patients with lower baseline viremia, body weight and younger adults. 4) Gender was not significant for the efficacy of treatment.
Increased serum or urinary concentrations of neopterin are predictive of poor prognosis in patients with tumors across a spectrum of primary locations. Less information is available about the significance of changes of urinary neopterin concentrations during therapy. The aim of the present study was to examine the association between urinary neopterin and toxicity of radiotherapy.We analyzed changes of urinary neopterin and toxicity of therapy in 12 patients with head and neck carcinoma during external-beam radiation. Urinary neopterin was determined daily by high-performance liquid chromatography.In addition to a trend for increased neopterin concentrations during radiation therapy, a significant association between changes of neopterin and toxicity and vice versa was observed with a rise of neopterin predicting a later manifestation of toxicity as well as manifestion of toxicity predicting a later rise of neopterin.Urinary neopterin is predictive of toxicity in patients with head and neck carcinoma. An association between toxicity and subsequent rise of urinary neopterin concentrations was also observed.
Today, the standard therapy of patients with chronic HCV (hepatitis C virus) infection is based on combination of pegylated interferon alpha (PEG-IFN) and ribavirin.The aim of the study is to find correlations between patient's body weight, gender and baseline viral load and the efficacy of antiviral therapy in terms of achieving end-of-treatment viral response (ETVR) and sustained viral response (SVR). METHODS AND PATIENT SAMPLE: We enrolled 133 patients with chronic HCV infection. All of them were treated by combination of PEG-IFN alpha-2a (180 microg once a week) and ribavirin. Ribavirin doses were the following: For body weight < or = 74 kg - 800 mg daily in patients infected by genotype 2 (G2 - 3 patients) or G3 (18 patients), 1000 mg in patients infected by G1 (106 patients), G4 (1 patient) or G6 (1 patient); for body weight > or = 75 kg - 1200 mg daily in case of infection by G1.To date, 122 patients completed the therapy; 107 of them completed their therapy at least 24 weeks ago, so they can be assessed for SVR. ETVR was achieved in 76% and SVR in 60% patients. Statistically higher proportion of SVR was observed in women (p = 0.039), patients with relatively lower body weight (p = 0.034), patients in lower baseline viral load (p = 0.010) and patients with genotypes 2 and 3 (p = 0,008). Correlation analysis of individual predictive factors showed the statistically significant correlation between body weight and gender (p < 0.001), gender and baseline viral load (p = 0.027) and body weight and virus genotype (p = 0.003). Therefore, the only independent predictive factor of ETVR (p = 0.020) and SVR (p = 0.010) was the level of baseline viral load.Efficacy of PEG-IFN therapy is significantly influenced by the level of baseline viral load. According to the results of this study, patient's body weight and gender are not independent predictive factors that affect the therapy efficacy.
On the basis of 408 bronchoscopies done at the ICU the authors
prove the usefulness of bronchosocpy for diagnosis and
treatment of pulmonary complications in ICU patients.
Purpose: A national primary and secondary healthcare-level study in the Czech Republic has not yet been conducted to evaluate the prevalence of migraine. We analyzed the current treatment patterns (acute and prophylactic) in migraine patients and the number of migraine patients potentially eligible for treatment with recent calcitonin gene-related peptide (CGRP) pathway-targeted therapies. Methods: This retrospective study utilized the Ministry of the Interior Health Insurance Fund claims database of the Czech Republic wherein every citizen is insured. Migraine patients with or without aura, and potentially on triptan therapy were included in this study (index years 2012– 2016). The prevalence approach included all patients (new and old) present in each index year. Prophylactic therapies were followed f0or three and seven years prior to the index year, including the index year, until 2010. The incidence approach included all patients first diagnosed in each index year. Prophylactic therapies were followed for the next three years, including the index year, until 2017 following incidence approach. The primary endpoint of this study was to determine the rate of migraine prevalence and diagnosis for each index year during the period 2012– 2016. The study also evaluated prophylactic and acute treatment patterns and comorbidities among patients in 2016. Results: The rate of migraine prevalence was 1% and the rate of diagnosis was 0.2– 0.4%. By prevalence approach, approximately 39% of the patients were on prophylactics, and 11.2% and 21.6% of the patient population had two prior treatment failures (three- and seven-year recall period, respectively). Antiepileptics (26%) and beta blockers (15.8%) were the most prescribed prophylactics, and sumatriptan was the predominant triptan used (12%) for acute treatment. Conclusion: Taking into account the number of inhabitants in the Czech Republic (10.7 million), there could be up to 23,000 adult patients eligible for novel CGRP therapies. Keywords: CGRP, prophylactics, triptans, claims database
Osteoporosis is a disease causing higher bone fragility and bone ruptures occurring even in minimal traumas. Good patient compliance is the prerequisite for long-term efficacy of osteoporosis treatment. Compliance data from randomised clinical studies may not provide reliable information about compliance in clinical practice which is usually lower. CORAL (COmpliance with RALoxifene therapy) is a local, Slovak, non-interventional, open, prospective, uncontrolled and multicentre study of woman patients on raloxifen therapy in current clinical practice. Raloxifen is a selective estrogen receptor modulator (SERM) indicated for the treatment and prevention of postmenopausal osteoporosis.The primary objective of the study was to assess compliance with raloxifen therapy in the conditions of current clinical practice. The secondary objectives were the assessment of the impact of therapy on the quality of life, of treatment satisfaction and treatment safety.A total of 1497 patients with proven postmenopausal osteoporosis were enrolled in the 18-month study performed in 40 centres. Compliance was evaluated on the basis of the number of omissions in the use of the evaluated drug. Treatment satisfaction was evaluated by the patients who used a 0-100 visual analogue scale (VAS). Quality of life was evaluated by means of an EQ-5D quality of life questionnaire. In order to measure treatment safety, all adverse events were recorded by the supervising physician in a dedicated questionnaire at every visit. Statistical methods used: The non-parametrical Mann-Whitney test was used to assess the relation between raloxifen treatment compliance and the selected parametres (quality of life, treatment satisfaction, changes in health condition, premature discontinuation of therapy). The maximum likelihood ratio chi2 test and Fisher's exact test (for 2 x 2 tables) were used to analyse the ratio between compliance and reasons for enrolment in the study. Changes in treatment satisfaction in the course of the study were analysed using the Wilcoxon test. All the used tests were bilateral and data was assessed at a 5 % level of significance.The mean age of the patients enrolled in the study was 63.4 +/- 8.0 years. 58 % of patients were enrolled on the basis ofdensitometric evidence of osteoporosis, 74% of patients were enrolled for proven osteoporosis which had been manifested by a fracture, and osteoporotic fracture as such was the reason to start therapy in 10 % of patients. The majority of patients enrolled in the study (77%) had natural menopause. The mean period from menopause to the study was 15 years. Acceptable cooperation (> or =80% of medication used) was recorded for more than 90% of patients during the study, and total dosing adherence was recorded more than 58 % of patients. A significantly higher satisfaction with pharmacotherapy was observed in the patients who adhered to the prescribed dosing schedule. Adherence to the prescribed dosing schedule was also associated with a considerable better health condition and a higher quality of life. In a total of 1,497 evaluated patients, treatment was prematurely discontinued in 87 (5.8 %) women. The attending physician's decision, adverse events or the patient's request were relatively evenly distributed among the reasons for the discontinuation of therapy. Premature discontinuation of therapy was mostly recorded in patients who were not satisfied with the pharmacotherapy of osteoporosis as such, in women who were less satisfied with their overall health condition and who had a lower quality of life.The study showed very good patient compliance with raloxifen. The above findings associate with a significant correlation between the degree of adherence to therapy, treatment satisfaction and the overall health condition and quality of life. Premature discontinuation of therapy was observed in a very low number of women. It can be concluded that raloxifen therapy provides effective treatment of osteoporosis based on long-term cooperation of patients.Effective treatment of postmenopausal osteoporosis with raloxifen is related to excellent cooperation of patients on a long-term basis.
UNLABELLED Pegylated interferon alpha (PEG-IFN) and ribavirin combination therapy is the contemporary standard therapy of the patients chronically infected with hepatitis C virus (HCV). OBJECTIVE OF THE STUDY The study is monitoring the changes in viremy through the changes of HCV RNA in serum before and during antiviral therapy and it attempts to find a relationship between the viral kinetics in the beginning of the therapy and the sustained virologic response. SET OF THE PATIENTS AND THE METHODICS: The study involved 133 patients with chronic infection with HCV, of the average age of 38 years (ranged 18-68 years). 86 of them were men. There were 88 patients who had not been treated before (naive patients), 19 of them were relabing and 26 were non-responders to the previous therapy with conventional IFNalpha and ribavirin. 106 patients (80%) were infected with genotype (G) 1, 3 (2%) with G2, 18 (14%) with G3, 1 patient with G4 and 1 with G6 (under 1%), in 4 (3%) the genotype could not be determined. All of them were treated with the combination of PEG-IFNalpha-2a (180 microg once a week) and ribavirin (800 mg per day in the infection with G2 or G3, 1000 mg at the infection with G1 and the weight up to 74 kg, 1200 mg per day at the infection with G1 and the weight 75 kg and higher). RESULTS Up to now, 122 patients completed the therapy and 93 of them (76%) had negative HCV RNA in serum at the time of completion of the therapy. Negative HCV RNA after 24 weeks (sustained virologic response SVR) after the completion of the therapy had 64/107 (60%) of the treated patients. In the course of 12 weeks of the therapy the viremy decreased by at least 2 decadic logarithms (early virologic response - EVR) in 87 patients (82%) and in 63 of them (72%) also SVR was noted. Only 19 patients had not EVR and just 1 one of them, nevertheless, achieved SVR (5%). CONCLUSION The achievement of EVR is a prerequisite to the successful therapy for chronic infection with HCV with the combination of PEG-IFNalpha and ribavirin. Quantitative determination of HCV RNA in serum before and during antiviral therapy is a prerequisite to the modern antiviral therapy for chronic infection with HCV.
Common variable immunodeficiency (CVID) is primary
hypogammaglobulinemia with unknown etiopathogenesis. Although
various abnormalities of T- and B-cells were described, their
pathogenetic roles are unclear. Markers associated with B-cell
development were determined on B-lymphocytes (CD19+);
T-lymphocyte development and activations markers were
determined on CD4+ and CD8+ T-lymphocytes in 42 CVID patients
and in 33 healthy controls. Abnormalities in CD4+ T-lymphocyte
activation markers (increase in CD29, HLA-DR, CD45RO, decrease
in CD27, CD62L, CD45RA) were particularly observed in patients
with a decreased number of memory (CD27+) and mature (CD21+)
B-cells (group Ia according to Freiburg classification), while
abnormalities observed in CD8+ cells (increase in CD27 and CD28
and decrease in HLA-DR, CD57 and CD38) did not depend on
grouping patients together according to B-lymphocyte
developmental subpopulations. The expression of CD27 and CD45RA
on CD4+ T-lymphocytes, such as the percentage of IgD+CD27- and
IgD+CD27+ cells in B-lymphocytes, showed age dependency to be
more significant than in the control group.
