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
Count Joseph of Auersperg (1767-1829) was a lawyer, the president of the Bohemian Land Court and a member of the Prague Masonic lodge "At the Truth and Unity at the three Crowned Pillars" (Zur Wahrheit und Einigkeit zu den drei gekrönten Säulen). After the so called Jacobin trials (1794-1795) the Masonry was forbidden in the Habsburg monarchy and the Masonic lodges stopped their activities in order to avoid the state persecution. Despite the official proscription of Masonic lodges count Auersperg attempted to renew this lodge. Auersperg made use of the atmosphere of the illusive political thaw after the defeat of the Austrian army in 1809. He managed to succeed in his efforts until 1812 when the Austrian police traced this activity on the grounds of opening and controlling his correspondence. The count was then punished by transfer to Brno to serve there as the president of the Appellate Court in Moravia. In Brno he entered the environment influenced by local masons who after the dissolution of their lodge channelled their activities to philanthropy, culture and organization of science. They initiated a plan to found the Moravian museum in Brno after the example of Joanneum in Graz in Styria. In the person of Auersperg these men found an ardent supporter of this idea. Auersperg participated in presenting the programme of the new museum to the MoravianSilesian Gubernium. The plan was approved by the authorities and Auersperg thus became one of the founders of this prominent institution. The harassment he suffered from the police regime and his overall case are illustrative of the methods used by the Austrian state against its real as well as supposed opponents. In his private correspondence with friends Auersperg made critical remarks about the situation at the Land Court in Prague, which was also revealed by the police and reported to the emperor. Moreover, the contacts Auers, Dušan Uhlíř., and Obsahuje bibliografické odkazy
napsal Robert Louis Stevenson ; z angličtiny přeložil Josef Bartoš, Údaje o edici převzaty z SKC ČR, and Rok vyd. z bibliografického katalogu 19. stol.
Příspěvek zdůrazňuje souvislost globalizace světa a potažmo ošetřovatelství (migrace pacientů i zdravotnických pracovníků) a nutnost akceptace této skutečnosti v ošetřovatelském vzdělávání i klinické praxi. Akcentována je potřeba účelné spolupráce s jedinci různé kultury a etnika. Hlavním nástrojem interkulturně kompetentního zdravotníka se stává účelná komunikace, založená na poznání individuálních potřeb pacienta odlišné kultury a jejich uspokojení, nicméně s důrazem na individualitu jedince a ne skupinovou příslušnost. Prezentován je základní model a předpoklady pro podporu sociokulturní kompetence. Základním zmiňovaným kritériem je vytváření kulturně bezpečného prostředí pro sestry i pacienty v podmínkách českého ošetřovatelského systému, který je stále ještě poměrně hodně etnocentrický., This paper highlights the globalisation of world and the internationalisation of nursing (patient and health care givers migration) which has to lead to being embedded into nursing curricula and also clinical practice. Accentuated is the need for effective and practical cooperation with individuals of different cultures and ethnicity. The main tool for interculturally competent health care professional becomes effective communication, based on knowledge of the individual patient‘s needs according to the different cultures and their satisfaction, but with an emphasis on the individuality of the patients and no the group affiliation. Presented is basic model and assumptions for the socio-cultural competence. The basic mentioned criterion is creating a culturally safe environment for nurses and patients in the conditions of the Czech nursing system which is still quite a lot ethnocentric., Andrea Pokorná, and Literatura
Neutropenie a febrilní neutropenie jsou běžným nežádoucím účinkem většiny chemoterapeutických režimů. Riziko vzniku infekce a nutnost hospitalizace pacienta a užívání antibiotik lze snížit podáváním G-CSF. Všechny hodnocené charakteristiky, včetně nákladové efektivity, umožnění podání plné dávky chemoterapie a dokonce lepšího krátkodobého přežití a nižší mortality upřednostňují pegfilgrastim před filgrastimem. Jednoznačně by rovněž měla být preferována profylaxe primární před sekundární., The common side effect of majority of chemotherapy regimens is neutropenia and fibrile neutropenia. Risk of infection development and need of hospitál admission or antibiotik use can be reduces by G-CSF administration. All evaluated characteristics including cost- -effectivity, possibility of full chemotherapy dose administration and even better short-term outcome as far as lower mortality give preference for pegfilgrastim over filgrastim. Definitely, primary rather than secondary prophylaxis should be favoured., Tomáš Svoboda, and Literatura