Základním symptomem diabetes mellitus je hyperglykemie. Zvýšené kardiovaskulární riziko (KVR) u pacientů s diabetes mellitus 1. i 2. typu má však multifaktoriální etiologii. Současný negativní vliv hyperglykemie, hypertenze a hyperlipidemie na cévní systém se navzájem potencuje. Důsledná prevence kardiovaskulárních rizikových parametrů u pacientů s diabetes mellitus 2. typu (DM2T) významně snížila mortalitu a morbiditu na kardiovaskulární nemoci. Přesto zbývá „reziduální riziko“. Plné využití potenciálu statinů a jejich kombinace s ezetimibem může ještě více snížit KVR a prodloužit tak život pacientů s DM2T. Význam intervence inhibitory PCSK9 pro snížení kardiovaskulárního rizika u pacientů s diabetes mellitus je předmětem studia., The basic symptom of diabetes mellitus is hyperglycemia. However the increased cardiovascular risk in patients with both type 1 and type 2 diabetes mellitus has a multifactorial etiology. Concurrent negative effects of hyperglycemia, hypertension and hyperlipidemia on the vascular system reinforce one another. Consistent prevention of cardiovascular risk parameters in patients with type 2 diabetes mellitus (DM2T) has brought significant decline in mortality and morbidity due to cardiovascular diseases. Still there is “residual risk” remaining. The full use of the potential of statins and their combination with ezetimibe may lower the CV risk even more and extend the life of patients with DM2. The importance of an intervention by means of PCSK9 inhibitors for the cardiovascular risk reduction in patients with diabetes mellitus is the subject of study., and Milan Kvapil
Plicní hypertenze (PH) je onemocnění s bohatou etiologií. Také její patofyziologie je značně složitá a možnosti léčby zatím omezené. Většina známých patofyziologických mechanizmů se uplatňuje napříč všemi etiologickými skupinami PH a dochází u nich ke stejným histologickým a funkčním změnám plicní arterie. Většinou však stále nejsme schopni určit, zda příslušný mechanizmus je příčinou nebo následkem jiných. Hlavní funkční změnou plicního řečiště při PH je nerovnováha mezi vazokonstrikcí a vazodilatací. Mezi hlavní morfologické změny označované souhrnně jako remodeling patří hyperplazie buněk plicní arterie vedoucí k jejímu ztluštění a zúžení lumen a dále porušená regulace tvorby extracelulární matrix vedoucí ke snížení její elasticity. Důsledkem všech těchto změn je narůstající periferní vaskulární rezistence plicního řečiště, tedy zvyšování afterloadu pravé srdeční komory progredující až k jejímu selhání. Tento přehledový článek si klade za cíl shrnout a vysvětlit podstatu funkčních a histologických změn plicního řečiště, ke kterým dochází při plicní hypertenzi, odděleně definovat role endotelu a myocytů plicní arterie a představit nejdůležitější známé patofyziologické mechanizmy, které k těmto změnám vedou. Klíčová slova: endotel – myocyt – oxid dusnatý – plicní arterie – plicní hypertenze – regulace intracelulárního kalcia – remodeling, Pulmonary hypertension (PH) is known for its variable etiology. PH pathophysiology is very complex and our therapeutic options are limited. Most of known underlying disease mechanisms play a role across all etiological groups of PH, and they are followed by the same morphological and functional changes of pulmonary vasculature. Mostly, we are not able to determine whether one particular mechanism works as a cause or consequence in the chain of events. An imbalance between vasoconstriction and vasodilation becomes the major functional change of pulmonary vasculature in PH. The main morphological changes (termed together as “remodeling”) include cell hyperplasia of pulmonary artery leading to its thickening and narrowing, and impaired regulation of extracellular matrix production leading to reduction in its elasticity. As a result of all these changes, the peripheral vascular resistance in pulmonary vascular bed rises, thus increasing afterload of the right ventricle and finally progressing to its failure. This review aims to summarize and explain the nature of the functional and histological changes in pulmonary arteries which occur in pulmonary hypertension, separately define the role of endothelium and pulmonary artery myocytes, and discuss the most important known pathophysiological mechanisms that lead to these changes. Key words: endothelium – intracellular calcium signaling – nitric oxide – pulmonary artery – pulmonary hypertension – remodeling – smooth muscle cell, and Martin Helán, Anna Konieczna, Martin Klabusay, Vladimír Šrámek
The profile of hemolymph ecdysteroid was studied in the gram pod borer, Helicoverpa armigera, during larval-pupal transformation. The changes closely correspond to the developmental events occurring at metamorphosis. Two insect growth regulators, plumbagin and azadirachtin, significantly depleted the content and altered the profile of ecdysteroids at crucial stages, when applied at ED50 doses. The activity profiles of two fat body lysosomal enzymes, acid phosphatase and b-galactosidase, were also significantly affected by the insect growth regulators. It is suggested that plumbagin and azadirachtin treatments primarily modify the ecdysteroid titer, which in turn leads to changes in lysosomal enzyme activity causing overt morphological abnormalities during the metamorphic molt., Arulappan Josephrajkumar, Bhattiprolu Subrahmanyam, Srinivasan, and Lit
Only a few cases of pneumocystis pneumonia (PCP) in Cushing’s syndrome have been published in the literature so far. In the majority of these patients, the pneumonia occurred after reduction of the hypercortisolism with medicamentous treatment. We report two cases of PCP during conservative treatment of hypercortisolism. We describe clinical, imaging and laboratory findings in two patients and review published cases of pneumocystits pneumonia in Cushing’s syndrome. A 60-year-old woman and 20-year-old man with Cushing’s syndrome due to ectopic ACTH syndrome were treated at our department. Both developed pneumocystis pneumonia early after treatment with ketoconazole and ethomidate bromide had been introduced and the levels of cortisol rapidly decreased. PCP prophylaxis in patients with high cortisolemia should be started before treatment of hypercortisolism in current practice. Gradual lowering of plasma cortisol should also reduce the risk of infection by Pneumocystis jiroveci., Filip Gabalec, Alžběta Zavřelová, Eduard Havel, Jaroslav Cerman, jr., Jakub Radocha, Ioannis Svilias, Jan Čáp, and Literatura 10
INTRODUCTION: Hirschsprung's disease is a congenital colonic aganglionosis, usually presented as inability or difficulty in passing of meconium, chronic and persistent obstipation, maleficent feeding, vomiting, distension and lethargy. CASE PRESENTATION: We presented a case of an in-vitro conceived quadruplet premature neonate who presented with pneumoperitoneum caused by transverse colon spontaneous perforation and microcolon appearance of distal bowel, treated by resection and temporary colostomy turns to be a rare manifestation of Hirschsprung's disease. CONCLUSION: Assisted reproductive technologies increases chances for multiple pregnancies and may increase chance for major congenital anomalies. Rare manifestation of Hirschsprung's disease is spontaneous pneumoperitoneum which remains a surgical emergency. Delay in recognizing and treatment can significantly worsen prognosis. In neonate with intestinal perforation one should consider Hirschsprung's disease. and J. Mihanović, I. Jurić, Z. Pogorelić, I. Mrklić, M. Jukić, D. Furlan