Hospital Jihlava

ABSTRACTAimThis study aimed to investigate the incidence and severity of acute poststreptococcal glomerulonephritis (APSGN) in the Czech paediatric population before, during and after the coronavirus disease 2019 (COVID‐19) pandemic.MethodsThe data were collected from 15 centres. The patients were divided into three periods: 2016–2019 (pre‐COVID), 2020–2021 (COVID) and 2022–2023 (post‐COVID). The incidence of APSGN during the studied period was assessed. The clinical and laboratory parameters were compared between the pre‐COVID and post‐COVID periods.ResultsOf the 117 patients with possible APSGN, 95 met the inclusion criteria. There were 67 (70.5%) males. The incidence of APSGN was significantly higher during the post‐COVID period (32/year) than during the pre‐COVID (6/year) and COVID (3.5/year) periods (p < 0.0001). The highest number of cases occurred in 2023 (n = 55). During the post‐COVID period there was more frequent use (p = 0.0448) and duration (p = 0.0131) of furosemide; more frequent antihypertensive treatment (p = 0.0104); and a higher prevalence of acute kidney injury (p = 0.0145), hypertension (p = 0.0178), and hypertension stage 2 (p = 0.0372) compared to the pre‐COVID period. Kidney replacement therapy and crescentic glomerulonephritis were found only during the post‐COVID period.ConclusionWe found a significantly higher incidence of APSGN and its associated complications during the post‐COVID period.

Multiple sclerosis (MS) is a chronic inflammatory neurodegenerative disease of the central nervous system. The manifestation of MS is related to steroid changes during the menstrual cycle and pregnancy. As data focusing on the effect of anti-MS drug treatment on steroidome are scarce, we evaluated steroidomic changes (79 steroids) in 61 female MS patients of reproductive age 39 (29, 47) years (median with quartiles) after treatment with anti-MS drugs on the GC-MS/MS platform and immunoassays (cortisol and estradiol). The changes were assessed using steroid levels and steroid molar ratios (SMRs) that may reflect the activities of steroidogenic enzymes (SMRs). A repeated measures ANOVA, followed by multiple comparisons and OPLS models, were used for statistical analyses. The anti-MS treatment decreased steroid levels in the follicular phase. Anti-CD20 monoclonal antibodies (mAb), such as ofatumumab and ocrelizumab; inhibitors of the sphingosine-1-phosphate receptor (S1PRI); and IFNβ-1a decreased circulating 17-hydroxy-pregnanes and shifted the CYP17A1 functioning from the hydroxylase- toward the lyase step. Decreased conjugated/unconjugated steroid ratios were found after treatment with anti-MS drugs, especially for glatiramer acetate and anti-CD20 mAb. In the luteal phase, IFN-β1a treatment increased steroidogenesis; both IFN-β1a and ocrelizumab increased AKR1D1, and S1PRI increased SRD5A functioning. Anti-CD20 mAb reduced the functioning of enzymes catalyzing the synthesis of immunomodulatory 7α/β and 16α-hydroxy-androgens, which may affect the severity of MS. The above findings may be important concerning the alterations in bioactive steroids, such as cortisol; active androgens and estrogens; and neuroactive, neuroprotective, and immunomodulatory steroids in terms of optimization of anti-MS treatment.

A 2-year national genomic screening in the Czech Republic identified a notable prevalence of the New Delhi metallo-β-lactamase 5 (NDM-5)-producing Escherichia coli sequence type 38 (ST38) in the city of Brno. Forty-two ST38 E. coli isolates harbored the blaNDM-5 gene on the chromosome. Virulence factors confirmed the persistence of these isolates through biofilm formation. Single Nucleotide Polymorphisms (SNPs)-based phylogeny and CRISPR assay typing showed minimal genomic variations, implying a clonally driven outbreak. Results suggest that this high-risk clone may impose a nationwide problem.

Aim To evaluate the real-world comparative effectiveness and the cost-effectiveness, from a UK National Health Service perspective, of natalizumab versus fingolimod in patients with rapidly evolving severe relapsing-remitting multiple sclerosis (RES-RRMS). Methods Real-world data from the MSBase Registry were obtained for patients with RES-RRMS who were previously either naive to disease-modifying therapies or had been treated with interferon-based therapies, glatiramer acetate, dimethyl fumarate, or teriflunomide (collectively known as BRACETD). Matched cohorts were selected by 3-way multinomial propensity score matching, and the annualized relapse rate (ARR) and 6-month–confirmed disability worsening (CDW6M) and improvement (CDI6M) were compared between treatment groups. Comparative effectiveness results were used in a cost-effectiveness model comparing natalizumab and fingolimod, using an established Markov structure over a lifetime horizon with health states based on the Expanded Disability Status Scale. Additional model data sources included the UK MS Survey 2015, published literature, and publicly available sources. Results In the comparative effectiveness analysis, we found a significantly lower ARR for patients starting natalizumab compared with fingolimod (rate ratio [RR] = 0.65; 95% confidence interval [CI], 0.57–0.73) or BRACETD (RR = 0.46; 95% CI, 0.42–0.53). Similarly, CDI6M was higher for patients starting natalizumab compared with fingolimod (hazard ratio [HR] = 1.25; 95% CI, 1.01–1.55) and BRACETD (HR = 1.46; 95% CI, 1.16–1.85). In patients starting fingolimod, we found a lower ARR (RR = 0.72; 95% CI, 0.65–0.80) compared with starting BRACETD, but no difference in CDI6M (HR = 1.17; 95% CI, 0.91–1.50). Differences in CDW6M were not found between the treatment groups. In the base-case cost-effectiveness analysis, natalizumab dominated fingolimod (0.302 higher quality-adjusted life-years [QALYs] and £17,141 lower predicted lifetime costs). Similar cost-effectiveness results were observed across sensitivity analyses. Conclusions This MSBase Registry analysis suggests that natalizumab improves clinical outcomes when compared with fingolimod, which translates to higher QALYs and lower costs in UK patients with RES-RRMS.

Challenges in timing of lung transplantation (LTx) in patients on antifibrotic treatment were recently acknowledged in 2021 ISHLT consensus document. <b>Aim:</b> To retrospectively analyze, if idiopathic pulmonary fibrosis (IPF) patients under 65 years at diagnosis, who fulfill criteria for LTx listing, profit from antifibrotic treatment or LTx (assessed with survival). Cohort A included 67 IPF patients, who underwent LTx for IPF in 2000-2021. Cohort B included subjects from EMPIRE registry diagnosed IPF in 1999-2021 meeting criteria for LuTx listing: under 65 years, BMI ≤ 30, nonsmokers or exsmokers, drop in forced vital capacity (FVC) of more than 10 % and/or drop in lung diffusing capacity for carbon monoxide (DLco) of for more than 15 % in previous six months and absence of LTx absolute contraindications (Figure 1). LTx listing criteria were enriched with dyspnea grade NYHA III at the time of diagnosis, as historic patients were usually diagnosed very lately. Only those never listed for LTx were put in cohort B. Median survival since diagnosis of transplanted patients was longer then in those, who were not transplanted (158 vs 95 months). Difference was not statistically significant (HR 0.66, 95% CI 0.42-1.05; p=0.17). Survival of transplanted patients adjusted to age was significantly higher than in not transplanted group (HR 0.53, 95% CI 0.32-0.91; p=0.02).&nbsp;Patients in cohort B on antifibrotic treatment had similar survival as patients in cohort A, adjusted to age at the time of diagnosis (HR 0.75, 95% CI 0.41-1.37; p=0.35). LTx in carefully selected IPF patients adds years of life to them and prolongs patient´s survival compared to antifibrotic treatment without LTx.

<b>Background:</b> Electrocardiography (ECG) is a cheap widely available examination and its contribution in predicting mortality in patients with chronic obstructive pulmonary disease (COPD) is not well established. <b>Aim:</b> The aim of the study was to evaluate the significance of ECG parameters in prediction of mortality in patients with COPD. <b>Methods:</b> ECG parameters were analysed in patients enrolled in the Czech COPD registry - a non-interventional multicentre observational prospective database focusing on the collection and analysis of data on real mortality and morbidity in an unselected population of COPD patients (ClinicalTrials.gov NCT01923051). We analysed ECG parameters of subjects who died during follow up and those who survived from randomization until 31.12.2019. Cox proportional-hazards model was used for investigating the association between the survival time of patients and one or more predictor variables (ECG parameters). <b>Results:</b> 300 patients with COPD were enrolled and 143 patients died during follow up. Patients were divided into three groups. Patients in group A with severe pathology on ECG (heart rate &gt;90/min, QRS≥120ms, P pulmonale, P mitrale, right ventricle hypertrophy or combination of these) had 3,7 times (p&lt;0,001) higher mortality risk in five years than those with normal ECG (group B). Patients with other ECG abnormalities than mentioned above (group C) had 1,8 times higher risk of death in five years which was not statistically significant. <b>Conclusion:</b> Severe electrocardiographic pathologies were associated with higher risk of death which makes electrocardiography a valuable tool in predicting mortality in patients with COPD.

In cat breeding, an important step is reproduction and obtaining healthy offspring. The main factor determining the survival of newborn kittens is the normal course and length of pregnancy. The purpose of this study was to determine the effect of gestation length on the early development of kittens. It was shown that kittens (premature kittens) later double their body weight (p < .01), have lower daily gains (p < .01) and higher body weight during eye-opening (p < .01), which occurs later than in kittens born on time. In addition, due to a shorter period of prenatal development, they require more time until the day of eye-opening, which, together with the length of pregnancy, was defined as development age.