University Hospital Olomouc Research Articles

XU-NetFullSharp: The Novel Deep Learning Architecture for Chest X-ray Bone Shadow Suppression

Background and objectivesChest X-ray image (CXR) is vital for screening, preventing, and monitoring various lung diseases. In particular, the early detection of lung cancer can significantly improve patients’ chances of survival and quality of life. Unfortunately, approximately 82–95 % of missed pulmonary nodules are estimated to be obscured by rib shadows, making them difficult to recognize. This study addresses this problem by considering the rib shadows in CXRs as noise that can be reduced using deep learning. The result of the proposed model is a CXR with improved clarity for easier and more accurate analysis by radiologists or computer algorithms. MethodsAn automated deep learning-based model for bone shadow suppression from frontal CXRs, called xU-NetFullSharp, was proposed. This network is inspired by the most modern U-NetSharp architecture and was modified using different approaches to preserve as many details as possible and accurately suppress bone shadows. For comparison, recent state-of-the-art models were implemented and trained. JSRT, VinDr-CXR, and Gusarev DES datasets were utilized for the experiments, where the JSRT dataset was extensively augmented. ResultsThe performance of the proposed xU-NetFullSharp was analyzed using statistical measures and compared with that of other architectures. The proposed model significantly outperformed the others, reaching the best values of the most used metrics (0.9846 SSIM; 0.9870 MS-SSIM). It also achieves a correlation of 96.31 % and an intersection of 10.0285 between the predicted and ground truth histograms, together with the smallest value of the Bhattacharyya distance. The obtained results were validated by experts from the University Hospital Olomouc with positive feedback, thus achieving the best objective and subjective results. The proposed method has the potential to be implemented in hospital environments. ConclusionA comprehensive comparison of the proposed architecture with state-of-the-art methods proves its efficiency in suppressing noise in CXRs and its ability to distinguish the signals of important tissues from noise components. This methodology can potentially improve the performance of the existing CXR processing methods. The source code is released in a GitHub repository that can be accessed from the following link: https://github.com/xKev1n/xU-NetFullSharp.

Copy number variation and clinical response to chemotherapy and bevacizumab in the Czech metastatic colorectal cancer patients.

Despite bevacizumab being the first biological agent approved for the treatment of metastatic colorectal cancer (mCRC), there is not any established DNA biomarker to improve its efficacy and personalize the treatment. Thirty patients with mCRC on bevacizumab therapy (15 with a good response and 15 with a poor response) from the University Hospital Olomouc were followed. Formalin-fixed paraffin-embedded (FFPE) samples were used for copy number variation (CNV) analysis using the OncoScan FFPE Assay Kit in order to capture approx. 900 tumor genes. In the group of good responding patients, 102 genes (classified as ATPases, type AAA, neuronal signal transmission, regulation of transcription, and superior domain PH type), potentially significant positive predictive tumor biomarkers of bevacizumab treatment, were found. In the poorly responding group, 74 potentially negative predictive genes (classified as galectines, Jak-STAT signalling pathway, MAPK cascade, differentiation, and F-box associated domain) were identified. In the pilot study, we found promising copy number variation biomarkers of bevacizumab response in FFPE samples of mCRC patients. The validation phase should be focused especially on the genes associated with angiogenesis (AGRN, MAPK8, ARHGAP22, LGALS13, LGALS4, ZFP36, and MYC), tumorigenesis (DVL1), and tumor proliferation (IFNL1, IFNL2, IFNL3, MAP3K10, and MAP4K1).

Bacterial Community- and Hospital-Acquired Pneumonia in Patients with Critical COVID-19-A Prospective Monocentric Cohort Study.

The impact of bacterial pneumonia on patients with COVID-19 infection remains unclear. This prospective observational monocentric cohort study aims to determine the incidence of bacterial community- and hospital-acquired pneumonia (CAP and HAP) and its effect on mortality in critically ill COVID-19 patients admitted to the intensive care unit (ICU) at University Hospital Olomouc between 1 November 2020 and 31 December 2022. The secondary objectives of this study include identifying the bacterial etiology of CAP and HAP and exploring the capabilities of diagnostic tools, with a focus on inflammatory biomarkers. Data were collected from the electronic information hospital system, encompassing biomarkers, microbiological findings, and daily visit records, and subsequently evaluated by ICU physicians and clinical microbiologists. Out of 171 patients suffering from critical COVID-19, 46 (27%) had CAP, while 78 (46%) developed HAP. Critically ill COVID-19 patients who experienced bacterial CAP and HAP exhibited higher mortality compared to COVID-19 patients without any bacterial infection, with rates of 38% and 56% versus 11%, respectively. In CAP, the most frequent causative agents were chlamydophila and mycoplasma; Enterobacterales, which were multidrug-resistant in 71% of cases; Gram-negative non-fermenting rods; and Staphylococcus aureus. Notably, no strains of Streptococcus pneumoniae were detected, and only a single strain each of Haemophilus influenzae and Moraxella catarrhalis was isolated. The most frequent etiologic agents causing HAP were Enterobacterales and Gram-negative non-fermenting rods. Based on the presented results, commonly used biochemical markers demonstrated poor predictive and diagnostic accuracy. To confirm the diagnosis of bacterial CAP in our patient cohort, it was necessary to assess the initial values of inflammatory markers (particularly procalcitonin), consider clinical signs indicative of bacterial infection, and/or rely on positive microbiological findings. For HAP diagnostics, it was appropriate to conduct regular detailed clinical examinations (with a focus on evaluating respiratory functions) and closely monitor the dynamics of inflammatory markers (preferably Interleukin-6).

Evaluation of Clinical Results of Implantation of Toric Intraocular Lenses Including their Rotational Stability.

The aim of the study was to evaluate the clinical results of the implantation of the toric intraocular lens Acrysof IQ Toric SN6AT3_8(Alcon Laboratories, Inc., Fort Worth, TX, USA), including an evaluation of its rotational stability. 30 eyes of 16 patients (4 males, 12 females; mean age 68 years) with regular corneal astigmatism ranging from -1.5 to -4.0 Dcyl were included in this retrospective study. All the patients underwent uncomplicated cataract surgery with the implantation of a toric intraocular lens (TIOL) at the Department of Ophthalmology of the Faculty of Medicine and Dentistry of Palacký University in Olomouc and University Hospital Olomouc during the course of 2020. Follow-up examinations were performed 3-6 months after cataract surgery. We monitored the resulting uncorrected distance visual acuity (UDVA), postoperative refraction, rotational stability of the implanted lens and subjective patient satisfaction. mean preoperative corneal astigmatism was -2.41 ±0.67 Dcyl. UDVA improved from a mean value of 0.45 ±0.25 (expressed in decimal Snellen optotype values) to 0.91 ±0.16. The spherical equivalent value of 0.41 ±2.92 improved to -0.11 ±0.27 postoperatively. The mean deviation from the planned axis was 4.87 ±4.75. Subjective satisfaction was rated by patients on a scale of 1-5, with a mean score of 1.5. TIOL implantation is a safe and effective solution for patients with corneal astigmatism and cataract. Our results demonstrate improved UDVA, rotational stability of the TIOL and subjective patient satisfaction with the outcome of the surgery.

The effectiveness of glucocorticoid treatment in post-COVID-19 pulmonary involvement

RationalePersistent respiratory symptoms following Coronavirus Disease 2019 (COVID-19) are associated with residual radiological changes in lung parenchyma, with a risk of development into lung fibrosis, and with impaired pulmonary function. Previous studies hinted at the possible efficacy of corticosteroids (CS) in facilitating the resolution of post-COVID residual changes in the lungs, but the available data is limited.AimTo evaluate the effects of CS treatment in post-COVID respiratory syndrome patients.Patients and methodsPost-COVID patients were recruited into a prospective single-center observational study and scheduled for an initial (V1) and follow-up visit (V2) at the Department of Respiratory Medicine and Tuberculosis, University Hospital Olomouc, comprising of pulmonary function testing, chest x-ray, and complex clinical examination. The decision to administer CS or maintain watchful waiting (WW) was in line with Czech national guidelines.ResultsThe study involved 2729 COVID-19 survivors (45.7% male; mean age: 54.6). From 2026 patients with complete V1 data, 131 patients were indicated for CS therapy. These patients showed significantly worse radiological and functional impairment at V1. Mean initial dose was 27.6 mg (SD ± 10,64), and the mean duration of CS therapy was 13.3 weeks (SD ± 10,06). Following therapy, significantly better improvement of static lung volumes and transfer factor for carbon monoxide (DLCO), and significantly better rates of good or complete radiological and subjective improvement were observed in the CS group compared to controls with available follow-up data (n = 894).ConclusionBetter improvement of pulmonary function, radiological findings and subjective symptoms were observed in patients CS compared to watchful waiting. Our findings suggest that glucocorticoid therapy could benefit selected patients with persistent dyspnea, significant radiological changes, and decreased DLCO.

Intravitreal Dexamethasone Implant in the Treatment of Diabetic Macular Edema Focusing.

The aim of this study was to evaluate the outcomes of Ozurdex® (DEX) implant in patients with diabetic macular edema (DME) in real-world clinical practice, and to determine the correlation between known OCT biomarkers and the effect of treatment. This retrospective study included 42 eyes of 33 patients (16 women, 17 men) treated with DEX at the Department of Ophthalmology, Faculty of Medicine and Dentistry of Palacký University and University Hospital Olomouc for DME indication between 2020 and 2023. Follow-up examinations were conducted at 1, 3, and 6 months after the first DEX application. The main assessed parameters were: best-corrected visual acuity (BCVA), intraocular pressure (IOP), central retinal thickness (CRT), OCT biomarkers. The results were subsequently statistically evaluated. At the first follow-up after DEX application, there was an average decrease in CRT of 186 ±146µm and a gain of 3 ±7 letters. Positive morphological and functional responses were observed in 39 eyes (92.9%) and 23 eyes (54.8%) respectively. The disorganization of retinal inner layers (DRIL) biomarker was initially present in 41 eyes (97.6%), with reduction or disappearance observed in 13 eyes (31%) post-application. Eyes with ellipsoid zone disruption (EZ disruption) had an average initial BCVA of 49.6 letters, compared to 57.8 letters in the group without this biomarker. The mean gain in BCVA was +8.7 letters in treatment-naive eyes and +2.1 letters in previously treated eyes. Chronic DME was less frequent in treatment-naive (n = 1, 14.3%) compared to previously treated eyes (n = 28, 84.8%). All these results were statistically significant (p < 0.05). An increase in IOP post-DEX application occurred in 9 patients (21.4%). Our results confirm DEX as a safe and effective treatment option for DME. Treatment-naive patients achieved better functional outcomes. We confirmed ellipsoid zone disruption (EZ disruption) as a negative biomarker. Additionally, we demonstrated the capacity of DEX to reduce disorganization of the retinal inner layers (DRIL).

Results of surgical therapy of functioning pituitary adenomas.

Functioning pituitary adenomas lead to substantial morbidity and increased mortality associated with typical endocrine syndromes. Surgical therapy is an integral part of the management of these tumours. The aim of this study was to evaluate the results of surgical transnasal procedures in patients with functioning pituitary adenomas who underwent the surgery at the Department of Neurosurgery, University Hospital Olomouc. Patients with functioning pituitary adenoma (ACTH, GH, PRL) were indicated for surgery. All patients underwent preoperative and postoperative endocrinological examination and laboratory tests to assess excessive or deficient hormonal production and imaging examination. The cohort consisted of 58 patients, 33 of whom were women and 25 men. The age range was 12-77 years (mean age 47.6 years). Microadenoma was diagnosed in 58.6% of patients and macroadenoma in 41.4% of patients. The most common hypersecretory syndrome was excessive production of growth hormone (56.9%), followed by excessive production of adrenocorticotropic hormone (24.1%) and prolactin (12.1%). In the group with excessive production of ACTH, complete remission was achieved after the first surgery in 78.6% of cases (72.8% for microadenomas (8) and 100% (3) cases in macroadenomas); in the group with excessive GH production in 51.4% (63.2% (7) in microadenomas and 46.2% (12) cases in macroadenomas). In the group with excessive production of PRL, it was 57.1% (100% (2) in microadenomas and 40% (2) cases in macroadenomas). Surgical therapy in the presented cohort led to the normalisation of hormonal excessive production in 58.6% of cases. A combination of drug therapy and radiotherapeutic methods was necessary in the remaining cases to achieve hormonal remission.

Acute drug intoxication in childhood: a 10-year retrospective observational single-centre study and case reports.

Medication poisoning in children is a severe condition that can endanger a child's life. Although drug intoxications are easily preventable, awareness of the proper handling of drugs and their safe storage out of the reach of children is not widespread among the general public. In this work, we investigated the demographic and clinical data of children admitted to the Department of Pediatrics of the University Hospital Olomouc for acute drug-induced intoxication. We also selected several case reports to illustrate the wide range of both presentations and outcomes in individual patients. Cases of drug-induced intoxications were selected from a group of patients under the age of 19 years admitted to the hospital for poisoning between January 1, 2010, and December 31, 2019. Medical records of these patients were prospectively evaluated, and overview tables and graphs of predefined research objectives were created. During the given time period, 162 children with suspected drug intoxications were hospitalized at the Department of Pediatrics, University Hospital Olomouc. Of these, 108 cases were reported in girls and 54 in boys (66.7% vs. 33.3%). In 16 cases (9.9%), there was a severe intoxication requiring follow-up intensive care. There was also one case of fatal accidental intoxication. Most poisonings were seen in toddlers (65; 40.1%). Intoxication with suicidal ideation was found in 44 cases (27.2%), with a higher incidence of suicide attempts in girls (40 vs. 4). Repeated intoxication was recorded in nine cases. Analgesics were the most common drug group (61; 37.7%), with paracetamol (28; 17.3%) being the leading drug. In 154 cases (95.1%), the drugs were taken orally, most often in the form of tablets. Accidental drug intoxications most frequently occurred in the age group from one to three years old. The second highest incidence was among adolescents most of which were suicide attempts. Analgesics and psychoactive agents accounted for the majority of cases. Medications should be kept in places where children cannot reach them.

Cost-Effectiveness Analysis of Biologics in the Treatment of Moderate-to-Severe Plaque Psoriasis from a Health Care Provider's Perspective

Introduction: Psoriasis (psoriasis) is a chronic disease with a number of significant comorbidities and often with a very significant impact on the quality of life of patients. Recently, a relatively large number of biological treatment products with a significant effect have entered the market, but they are also significantly more expensive than systemic conventional treatment. In the context of the published long period of inadequate treatment of patients with psoriasis in the Czech Republic, the health care system and the limited costs of center drugs, it is necessary to make the greatest possible effort at the level of the provider of this health care to effectively spend financial resources and provide highly effective treatment to the greatest possible number of patients. Method: With a model-set amount of the unit prices of the packaging of preparations according to the maximum reimbursements in the Czech Republic in 2021, a fictitiously set amount of bonuses for only two selected preparations (this is a model example that does not reflect the real state of business policy at the University Hospital Olomouc), and the conditions for reimbursement of biological treatment preparations psoriasis in the Czech Republic in 2021, a cost-effectiveness analysis (CEA) was carried out in the selected PASI 100 efficiency parameter. The analysis was carried out and processed interactively in the Excel software into the graphical form of the outputs, especially in the form of forest plot graphs (in the CER and ICER parameters) and in a two-dimensional efficient frontiers graph (costs vs. efficiency). Results: The differences in the cost-effectiveness of individual preparations according to the point values of the CER and ICER parameters are up to several times. Taking into account the 95% confidence intervals, some of the differences between the preparations are also statistically significant. With the most cost-effective sequence of treatment for a gradually more effective drug in one patient during the induction period of treatment, we can, based on the saved costs, start induction treatment with a less effective biologic in two more patients than when using the second cost-effective sequence of treatment escalation. Conclusion: The cost-effectiveness analysis (CEA) of biological drugs in the treatment of psoriasis at the level of the health service provider has great potential in the effort to make the treatment as effective as possible with limited financial resources, or in the effort to provide effective treatment to additional patients with the same limitations

Pancreaticoduodenectomy in patients with an unusual course of the hepatic artery.

Variations in hepatic artery anatomy are very common in the population. The aim of this study is to evaluate the rates of individual types of hepatic artery variants in the population of patients undergoing pancreaticoduodenectomy (PD), assess the accuracy of preoperative staging CT imaging to identify hepatic artery variants, and evaluate the impact of the hepatic artery variants on perioperative and postoperative morbidity of PD patients. A prospective observation study of 147 patients undergoing PD for a pancreatic head pathology at the 1st Department of Surgery, University Hospital Olomouc between 1/2015-12/2018. Preoperative diagnosis of the course of the hepatic artery was made based on staging CT imaging analysis of the abdomen. The result was classified according to the Michels' scale and correlated with the final perioperative finding. Demographic, histopathological and clinicopathological data were included in a prospectively maintained database. A total of 147 patients were included in the study, 83 (56.5%) males and 64 (43.5%) females, median age 65.0 (37-83) years. A variant course of the hepatic artery was found in 37 (25.2%) patients. The accuracy of preoperative CT imaging in determining the variant was 100%. The presence of a hepatic artery variant was not statistically significant as a factor in terms of postoperative complications - CD I-II (50.0% vs 47.2%), CD III-IV (8.3% vs 13.8%). Similarly, the 30-day (4.2% vs 2.4%) and 90-day mortality rates (4.2% vs 3.3%) were comparable in both groups. Preoperative diagnosis of vascular variants based on multidetector CT imaging of the abdomen is routinely available and shows high detection accuracy. There was no difference in postoperative morbidity and mortality in patients with and without a variant hepatic artery undergoing PD.

Erratum for: Pregnancy lipid profile and different lipid patterns of gestational diabetes treated by diet itself.

List of changes Authors and affiliation: Lubica CIBICKOVA1,3, Katerina LANGOVA2, Jan SCHOVANEK1,3, Dominika MACAKOVA1,3, Ondrej KRYSTYNIK1,3, David KARASEK1,3 1Department of Internal Medicine III - Nephrology, Rheumatology and Endocrinology, Faculty of Medicine and Dentistry, Palacky University, Olomouc, Czech Republic, 2Department of Medical Biophysics, Faculty of Medicine and Dentistry, Palacky University, Olomouc, Czech Republic, 3Department of Internal Medicine III - Nephrology, Rheumatology and Endocrinology, University Hospital Olomouc, Olomouc, Czech Republic Acknowledgement: Supported by the grants: MH CZ - DRO (FNOl, 00098892); AZV NV18-01-00139.

Thrombocyte decrease and hemoglobin level as simple non-inflammatory predictors of anastomotic leakage in rectal-cancer surger.

The study aimed to determine a simple diagnostic test that could predict the risk of anastomotic leakage in early postoperative period. A single-center, retrospective study was conducted. The electronic medical records of patients who underwent resection for rectal tumor between January 1, 2016, and December 31, 2021, in University Hospital Olomouc, were reviewed. The data included risk factors for leakage and laboratory parameters commonly obtained. The decrease in platelets was significant as for the possibility of being a marker of anastomotic leakage; OR = 0.980 (p = 0.036). A decrease of 34 or higher predicts leakage with a sensitivity of 45 % (95 % CI: 23.1-68.5 %) and specificity of 81.1 % (95 % CI: 75.2-86.1 %). Postoperative leukocyte blood level (OR = 1.134; p = 0.019) and leukocyte level on postoperative day 1 (OR = 1.184; p = 0.023) were significant predictors for leakage. WBC values ≥ 8.8 predict leakage with a sensitivity of 70.0 % (95 % CI: 45.7-88.1 %) and specificity of 55.3 % (95 % CI: 48.4-62.0 %). Hemoglobin blood level ≤ 79.5 predicts leakage with a sensitivity of 70.0 % (95 % CI: 45.7-88.1 %) and specificity of 62.2 % (95 % CI: 55.5-68.7 %). Despite the fact that the specificity and sensitivity of the followed parameters are low, they could serve as markers useful for early diagnosis or suspicion for leakage (Tab. 5, Fig. 3, Ref. 14).

Development of Local interventions within JADECARE – Key learnings from two Next Adopters

Abstract In this third presentation, the NA representatives Roberta Papa (Regional Health Agency Marche Region, Italy) and Zdislav Dolecek (University Hospital Olomouc, Czech Republic), will present the Local interventions and action plans they developed during the pre-implementation phase, pre-final results of their implementation phase and preliminary lessons learned from the implementation.

Long-term decline of renal function in patients with resistant and non-resistant arterial hypertension

Abstract Background The negative effect of arterial hypertension on renal function is well known. Until present, the detrimental effect of resistant arterial hypertension (RAH) on kidneys was not clearly defined. Purpose To assess the deterioration of renal function in patients with RAH in comparison to patients with non-resistant arterial hypertension (AH) during a long term follow-up. Methods We retrospectively reviewed records of 307 patients followed between May 2007 and January 2019 in an Hypertension Excellence Centre of a tertiary hospital. In all patients we assessed basic demographic characteristics, co-morbidities, laboratory findings, secondary causes of AH, medication, blood pressure including ambulatory blood pressure monitoring, studies and invasive procedures (CT, MRI, coronarography). We statistically evaluated differences in both groups and compared the decline of renal function. Results 160 patients had resistant and 147 patients non-resistant hypertension. Patients were followed for a mean of 6 years. Patients with RAH were older (58.1±10.8 years vs. 51±13 years), more frequently diabetics (39.3% vs. 8.7%), had more frequent exposure to diagnostic studies and invasive procedures (86,5% vs. 64%). Age at baseline visit and diabetes mellitus were established as statistically significant independent risk factors. Linear mixed effect model adjusted to age and diabetes demonstrated that patients with RAH have increased decline of renal function than patients with AH: patients with AH had mean increase of creatinine +0.24 μmol/l per year, while patients with RAH + 2.12 μmol/l per year (P=0.005). Similarly the decrease of eGFR in patients with AH was −0.66 compared to −1.5 mL/s/1.73 m2 per year in patients with RAH (P=0.005). Figures 1 and 2 show the difference in mean slope of creatinine and eGFR in patients with resistant and non-resistant hypertension (based on linear mixed effect models)). Conclusion Patients with resistant hypertension had faster decline of renal function in comparison to patients with non-resistant hypertension independently on age and diabetes. Further studies are needed to determine the key factors affecting renal function decline in both subgroups. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): University Hospital Olomouc, Palacky University Olomouc, Faculty of Medicine, Czech Republic

Bacterial Resistance to Antibiotics and Clonal Spread in COVID-19-Positive Patients on a Tertiary Hospital Intensive Care Unit, Czech Republic.

This observational retrospective study aimed to analyze whether/how the spectrum of bacterial pathogens and their resistance to antibiotics changed during the worst part of the COVID-19 pandemic (1 November 2020 to 30 April 2021) among intensive care patients in University Hospital Olomouc, Czech Republic, as compared with the pre-pandemic period (1 November 2018 to 30 April 2019). A total of 789 clinically important bacterial isolates from 189 patients were cultured during the pre-COVID-19 period. The most frequent etiologic agents causing nosocomial infections were strains of Klebsiella pneumoniae (17%), Pseudomonas aeruginosa (11%), Escherichia coli (10%), coagulase-negative staphylococci (9%), Burkholderia multivorans (8%), Enterococcus faecium (6%), Enterococcus faecalis (5%), Proteus mirabilis (5%) and Staphylococcus aureus (5%). Over the comparable COVID-19 period, a total of 1500 bacterial isolates from 372 SARS-CoV-2-positive patients were assessed. While the percentage of etiological agents causing nosocomial infections increased in Enterococcus faecium (from 6% to 19%, p < 0.0001), Klebsiella variicola (from 1% to 6%, p = 0.0004) and Serratia marcescens (from 1% to 8%, p < 0.0001), there were significant decreases in Escherichia coli (from 10% to 3%, p < 0.0001), Proteus mirabilis (from 5% to 2%, p = 0.004) and Staphylococcus aureus (from 5% to 2%, p = 0.004). The study demonstrated that the changes in bacterial resistance to antibiotics are ambiguous. An increase in the frequency of ESBL-positive strains of some species (Serratia marcescens and Enterobacter cloacae) was confirmed; on the other hand, resistance decreased (Escherichia coli, Acinetobacter baumannii) or the proportion of resistant strains remained unchanged over both periods (Klebsiella pneumoniae, Enterococcus faecium). Changes in pathogen distribution and resistance were caused partly due to antibiotic selection pressure (cefotaxime consumption increased significantly in the COVID-19 period), but mainly due to clonal spread of identical bacterial isolates from patient to patient, which was confirmed by the pulse field gel electrophoresis methodology. In addition to the above shown results, the importance of infection prevention and control in healthcare facilities is discussed, not only for dealing with SARS-CoV-2 but also for limiting the spread of bacteria.

BLOOD PRESSURE AND OTHER CLINICAL CHARACTERISTICS OF PATIENTS WITH MYOCARDIAL INFARCTION UNDER 50 YEARS OF AGE

Objective: Arterial hypertension is the main risk factor for the development of cardiovascular diseases throughout the world. The prevalence of acute myocardial infarction (AMI) is increasing in young adults, especially men. Previous studies have identified that risk factors for AMI included tobacco use, obesity, arterial hypertension, and diabetes may be crucial to young individuals. Compared to the elderly, the risk factors are not well studied among the young patients with AMI. Design and method: We enrolled to our study 41 patients younger than 50 years (thirty-six men) admitted to the Department of Internal I - Cardiology, University Hospital Olomouc, with first episode AMI. We collected detailed information regarding family history of premature CVD (MI/ischaemic stroke in men aged &lt; 55 and in women aged &lt; 65 years, body mass index (BMI), smoking, hypertension, dyslipidemia, diabetes mellitus (DM). Hypertension was defined, according to ESH/ESC (European Society of Hypertension, European Society of Cardiology) guidelines, based on repeated blood pressure measurements, medical history and ongoing blood-pressure-lowering treatment. Results: Among 41 young patients with AMI (average 46 ± 3,4 years old), 15 patients (36,6%) had a known diagnosis of arterial hypertension prior to admisison. Mean level of systolic blood at admission were 128,6 ± 18,22 mmHg, diastolic blood pressure 81,35 ± 12,49 mmHg, mean heart rate was 76,32 ± 13,11 bpm. Uncontrolled arterial hypertension was diagnosed at admision in 6 patients, newly diagnosed hypertension in 4 patients. In our group, we diagnosed ST-elevation MI (STEMI) in 54 % of patients, NSTEMI in 46%. Mean level of TRPI was 24051,43 ± 32860,98 ng/l, NTproBNP was 731,1 ± 1019,92 pg/ml. Mean LDL-cholesterol was 3,26 ± 0,83 mmol/l. We newly diagnosed diabetes mellitus in 2 patients, mean HbA1c was 38,42 ± 9,43 (mmol/mol). Conclusions: In our group of young patients with myocardial infarction was prevalence of uncontrolled hypertension 17%. Compared to a group of healthy patients (data from literature), we found out a higher prevalence of arterial hypertension in our group.

Fractional CO2 laser therapy of hypertrophic scars - evaluation of efficacy and treatment protocol optimization.

Hypertrophic scars are an unwanted and mutilating consequence of deep burns, and are further exacerbated by extensive burn injuries. Fractional CO2 laser therapy is one of the methods for complex treatment of hypertrophic scars, it has been used since 2007 [1]. Although its effectiveness has been objectively proven in clinical practice, the optimal settings parameters have not been determined. To evaluate the effect of laser therapy, previously designed evaluation tools are used, which evaluate the quality of scars well, but fail to capture specific changes for the performed laser therapy. Fractional CO2 laser therapy of hypertrophic scars is performed at the Department of Plastic and Esthetic Surgery, University Hospital Olomouc, since 2017 and the systematic study took place in 2019-2020. In common, 25 hypertrophic scars were treated in 13 patients; each scar was treated by fractional CO2 laser therapy more than once. Statistical analysis detected statistically significant improvement of the texture of the scars and the improvement of overall functional and esthetic result. We found significant reduction of the height under 2 mm (62,5% of scars) in scars with the height &gt; 2 mm before the initiation of laser therapy. Correlation analysis detected astatistically significant positive correlation between the energy of laser beam and the reduction volume of the scar protruding above the niveau of healthy surrounding tissue. Fractional CO2 laser therapy showed statistically significant efficacy in the reduction of the risks associated with full-format CO2 laser-therapy. Fractional treatment was very well tolerated by the patients. Topical 5% lidocaine gel was effective in 24 out of 25 patients. Further healing was without complications in all patients. Fractional CO2 laser therapy has achieved statistically significant improvement of the texture and reduction of hypertrophic scars and overall improvement of functional and esthetic result in our study.

Motivation for COVID-19 Vaccination in Priority Occupational Groups: A Cross-Sectional Survey.

Due to the limited availability of COVID-19 vaccines, occupational groups with priority access were identified prior to vaccination. The study aimed to analyze motives for vaccination in these occupational groups. Methods: Members of occupational groups, who were vaccinated at the vaccination center of University Hospital Olomouc before 30 April 2021, were asked to fill in an online questionnaire. Results: A total of 3224 completed questionnaires were obtained from 1332 healthcare workers, 1257 school employees, 363 social service workers, 210 security force members, and 62 critical infrastructure workers. The most frequent motive for vaccination was the effort to protect family members (76.2%), the effort to prevent the spread of COVID-19 in one’s profession (72.3%), followed by concerns about COVID-19 itself (49.1%) and exemptions from anti-epidemic measures (36.8%). Only for social services, the motive focused on one’s profession was mentioned more often (75.2%) than the motive focused on the family (71.1%). At the level of detailed profession-oriented motives, a collegial effort of security force members to protect co-workers and not to endanger the workplace was dominant. Conclusions: The effort to prevent the spread of COVID-19 in the professional environment is a strong motive for vaccination, and strongest among social service workers.

Gender, Age and TP53 Aberrations in Context of Complex Karyotypes in Chronic Lymphocytic Leukemia Patients in the Era of Chemo +/- Immunotherapy

Chronic lymphocytic leukemia (CLL) is the most common adult leukemia characterized by a heterogeneous course of the disease. Determination of prognosis of patients (pts) is based on clinical and laboratory parameters, where cytogenetic examination plays a significant role. According to recent studies the complex karyotype (CK) shows to have adverse prognostic value and occurrence of CK is reported in 15-20% of untreated pts. Multiple diverse chromosomal translocations, deletions, duplications, numerical changes or dicentric chromosomes arise within complex karyotypes.Our aims were to determine the CK frequency in our cohort of untreated CLL pts, to verify its prognostic significance and to validate whether TP53 disruptions or ATM deletions involved in CK affect survival of pts. Moreover we aimed to investigate types of chromosomal aberrations implied within the CK in detail and to identify their possible adverse prognostic impact.A total of 644 untreated CLL pts (diagnosed according to iwCLL criteria) were examined at Department of Hemato-Oncology, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Olomouc, Czech Republic (in years 1996-2017). Peripheral blood or bone marrow samples were examined by classical and molecular cytogenetic and molecular genetic methods (G-banding, FISH, mFISH, arrayCGH, PCR, sequencing, NGS - Illumina, MiSeq) using standard protocols.CK was detected in 79 pts (12.3%, 57 men and 22 women), median of age at diagnosis was 64 years (34-87 years). The most frequently detected recurrent changes in pts with CK were deletions of 13q14 (68%), 11q22 (43%), 17p13 (33%) and duplication of 8q24 (27%). Chromosomes mostly included in CK were chromosomes 13, 11, 17, 2, 8 and 6, respectively. Sixty pts (76%) had unmutated IGHV status and 6 pts (8%) mutated IGHV3-21 . TP53 gene mutations were detected in 25 pts out of 71 examined ptswith CK (35%), 19 of pts (27%) had both deletion and TP53 mutation.Statistical analysis has shown a lower overall survival (OS) rate of CK pts compared to pts without CK (77 months vs. 115 months, p<0.0001). We also observed influence of gender and age on the OS of CK pts. More adverse outcome has been seen in women with CK compared to women without CK (37 months vs. 154 months, p<0.0001; men with CK vs. men without CK 84 months vs. 106 months, p = 0.0049) and also in pts with CK with age over 60 years (pts with CK over 60 vs. pts with CK under 60: 68 months vs. 123 months, p=0.0075). The effect of presence of translocations, numerical changes and dicentric chromosomes as part of the CK on patient´s survival has not been demonstrated (p=0.5; p=0.35; p=0.62). The deletions of TP53 and ATM genes have not occurred simultaneously in our CK cohort and the survival of these pts has not been worse. Nevertheless we could see a trend to worse survival in pts with CK and TP53 deletion/mutation (p=0.076). However, pts without CK with the occurrence of ATM or TP5 3 deletions have had a comparable negative prognostic impact just as the pts with CK (p=0.37/p=0.78).In accordance with other authors we proved that pts with CK occurring before treatment had significantly shorter survival compared to pts without CK. Importantly, the occurrence of CK in CLL has the worst impact on OS of pts older than 60 years. Moreover OS has shortened the most significantly in women with CK compared to women without CK in our single center experience. To our best knowledge these findings was not reported by other authors so far. To explain this phenomenon it would be necessary to extend studied cohort of pts with CK. Using of standard cytogenetic methods completed with modern molecular genetic analyses remains essential for risk stratification of CLL pts. Finally, not only pts with TP53 aberrations, but also pts with CK could be possible candidates for new treatment approaches.This work was supported by grants: VES16-32339A, IGA_LF_2017_007. DisclosuresPapajik:Abbvie: Consultancy, Research Funding; Janssen: Consultancy, Speakers Bureau; Gilead: Consultancy, Speakers Bureau; Celgene: Research Funding; Roche: Other: Travel/accomodation expenses, Speakers Bureau.

Bacterial Pathogens and Evaluation of a Cut-Off for Defining Early and Late Neonatal Infection.

Bacterial infections are an important cause of mortality and morbidity in newborns. The main risk factors include low birth weight and prematurity. The study identified the most common bacterial pathogens causing neonatal infections including their resistance to antibiotics in the Neonatal Department of the University Hospital Olomouc. Additionally, the cut-off for distinguishing early- from late-onset neonatal infections was assessed. The results of this study show that a cut-off value of 72 h after birth is more suitable. Only in case of early-onset infections arising within 72 h of birth, initial antibiotic therapy based on gentamicin with ampicillin or amoxicillin/clavulanic acid may be recommended. It has been established that with the 72-h cut-off, late-onset infections caused by bacteria more resistant to antibiotics may be detected more frequently, a finding that is absolutely crucial for antibiotic treatment strategy.