Hradecký Písek (Czechia)

BACKGROUNDCandidozyma auris has emerged globally as a major threat to public health due to its outbreak causing capacity and antifungal resistance. Outbreaks have proven difficult to control despite enhanced infection prevention measures. Thus, national surveillance is warranted.AIMWe aim to characterise the epidemiology of C. auris cases in Czechia between 2022 and 2024 to investigate whether autochthonous spread is occurring and asses antifungal resistance.METHODSHigh-resolution genotyping was performed to assess genetic relatedness between isolates. Microbroth dilution was performed on all isolates and underlying mechanisms resistance were inspected with whole genome sequencing.RESULTSEight cases from seven different hospitals were reported, mainly collected from non-sterile sites, in addition to the first documented prosthetic joint infection by C. auris. Only two patients reported travel history. Three clades were found, with the first report of Clade IV in Europe. For one patient, initial isolates were pan-susceptible but after short exposure to fluconazole became resistant with a novel mechanism.CONCLUSIONC. auris reported in Czechia in patients without travel history suggests autochthonous spread. Three clades were present, often with unknown route of introduction. Development of fluconazole resistance upon brief exposure highlights the ability of C. auris to rapidly evolve.

Despite the established value of genomic testing strategies, practice guidelines for their use do not exist in many indications. We sought to validate a recently introduced scoring algorithm for dystonia, predicting the diagnostic utility of whole-exome sequencing (WES) based on individual phenotypic aspects (age-at-onset, body distribution, presenting comorbidity). We prospectively enrolled a set of 209 dystonia-affected families and obtained summary scores (0-5 points) according to the algorithm. Singleton (N=146), duo (N=11), and trio (N=52) WES data were generated to identify genetic diagnoses. Diagnostic yield was highest (51%) among individuals with a summary score of 5, corresponding to a manifestation of early-onset segmental or generalized dystonia with coexisting non-movement disorder-related neurological symptoms. Sensitivity and specificity at the previously suggested threshold for implementation of WES (3 points) was 96% and 52%, with area under the curve of 0.81. The algorithm is a useful predictive tool and could be integrated into dystonia routine diagnostic protocols. © 2021 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson Movement Disorder Society.

We retrospectively assessed the utility of a flow cytometry–based test quantifying the percentage of CD3+ T cells with the CD4–/CD8– phenotype for predicting tularemia diagnoses in 64 probable and confirmed tularemia patients treated during 2003–2015 and 342 controls with tularemia-like illnesses treated during 2012–2015 in the Czech Republic. The median percentage of CD3+/CD4–/CD8– T cells in peripheral blood was higher in tularemia patients (19%, 95% CI 17%–22%) than in controls (3%, 95% CI 2%–3%). When we used 8% as the cutoff, this test’s sensitivity was 0.953 and specificity 0.895 for distinguishing cases from controls. The CD3+/CD4–/CD8– T cells increased a median of 7 days before tularemia serologic test results became positive. This test supports early presumptive diagnosis of tularemia for clinically suspected cases 7–14 days before diagnosis can be confirmed by serologic testing in regions with low prevalences of tularemia-like illnesses.

Although many studies have investigated the relationships of several adipokines to metabolic syndrome (MetS), the interrelationships of adiponectin (ADP), adipocyte fatty acid binding protein (A-FABP) and fibroblast growth factor 21 (FGF 21) have not been described in detail. We examined 209 asymptomatic dyslipidemic patients divided into MetS+ (n=73) and MetS- (n=136) groups. The aim of study was to evaluate the relationships between observed adipokines, to compare the levels of total ADP, A-FABP and FGF 21 in individuals with and without MetS, and to elucidate the relationships of individual adipokines to lipid parameters, markers of insulin resistance and endothelial hemostatic markers in these groups. In MetS+ group, we found the independent positive association ADP with A-FABP (beta=0.4888, p=0.0382), A-FABP with FGF 21 (beta=0.3811, p=0.0002) and von Willebrand factor (beta=0.4502, p=0.0013), and FGF 21 with A-FABP (beta=0.4422, p=0.0002). Our study has confirmed the well-established risk profile of subjects with MetS, although clinically asymptomatic. MetS+ patients had also lower levels of ADP and higher levels of A-FABP and FGF 21. Our study evaluated the interrelationships of ADP, A-FABP and FGF 21 in asymptomatic dyslipidemic subjects with diagnosis of MetS. Especially strong association between A-FABP and FGF 21 needs to be clarified in further studies.

The purpose of this study was to evaluate cognitive functions in patients undergoing extracranial-intracranial (EC-IC) bypass surgery for cerebral ischemia. From August 2003 to January 2009, 276 patients with occluded internal carotid arteries (ICA) were screened. Forty of these met the criteria for a low-flow EC-IC bypass. These patients were identified based on evidence of exhausted vasomotor reactivity (VMR) using the Doppler CO(2) test and CT perfusion. These patients were invited to have a complete battery of neuropsychological tests preoperatively and 12months after surgery. Complete neurocognitive testing was finished in 20 patients. This group of 20 patients showed preoperative cognitive impairment ranging from mild to medium-severe. There were no cases of stroke ipsilateral to the operated side during the follow-up period. VMR improvement was seen in all patients within 6 months of surgery. A comparison using a paired t-test demonstrated significant improvement 12months after surgery in the following neuropsychological tests: WAIS-R (p = 0.01), Number Collection Test (p = 0.02), Trail Making Test (p = 0.03), and Benton Visual Retention Test (p = 0.05). Repeat analysis of variance (ANOVA) suggested the following predictors associated with cognitive improvement:the presence of ophthalmic collateral flow (p = 0.04), preoperative amaurosis fugax (p = 0.02), and external watershed infarction detected by MRI (p = 0.04). Patients with occlusion of the ICA and exhausted VMR have cognitive impairment prior to EC-IC bypass surgery. Twelve months after surgery, there is significant improvement in various areas of cognition.

The aim was to evaluate effects of the therapy initiated at the day of admission on in-hospital mortality (HM) in patients with FMI - 5-year pilot registry (2003–2007) of six Czech small district hospitals referring patients for primary PCI to larger cathlab centers. The sample consisted of 2108 eligible patients, 56.2 men and 43.8 % women, aged 65.3 and 73.9 years, respectively. Their risk factors (RF) were (in %): hypertension (EH: 71.5), dyslipidemia (DLP: 44.9), diabetes (36.2) and smoking (27.2). There were 35.8 % STEMI and HM was 8.8 %. The previous therapy consisted of aspirin (ASA) in 28.7, β-blockers (BB) 32.1, ACEI/ARB 48.1 and statins in 13.9 % of patients. The odds of death (OD) increased with each year of age (1.1 in odds ratio – OR), influence of gender on death was not proven. Smoking was not significant as it was strongly negatively correlated with age. OD were associated especially with presence of heart failure (HF, OR = 3.5), DM (OR = 1.5) and STEMI compared to NSTEMI (OR = 4.1). The reperfusion therapy for STEMI decreased OD to the level of NSTEMI. Contrary to DM, the partially treated EH and DLP significantly reduced OD (both OR = 0.6). Aspirin (OR = 0.5), β-blockers (OR = 0.6) and statins (OR = 0.4) reduced OD. ACEI/ARB did not change OD (OR = 1.0) but reduced them significantly when used in HF (OR = 0.4). OD decreased with increasing number of recommended drugs – 1: OR = 0.55, 2: OR = 0.34, 3: OR = 0.15 and 4 drugs: OR = 0.10. The most frequent drug in monotherapy was ASA (23.8) and drug combinations ASA+BB (10.3), ASA+BB+statin (12.5) and ASA+BB+statin+ACEI/ARB (19.3 %). The therapy for both dyslipidemia and hypertension reduced OD below the risk level of normolipidemic and normotensive patiens with FMI. Due to the fact that the study is observational, the loss of RF significance could happen when a given therapy during hospitalization overwhelms its significance. The simultaneous use of aspirin, statin, β-blocker and ACEI/ARB reduced the odds of death in FMI to one tenth.

Kardiálne tumory (KT) delíme na primárne a sekundárne. Sekundárne KT sú 20-40-krát frekventovanejšie ako primárne KT. V článku pojednávame o dvoch vlastných kazuistikách malignity srdca. V prvom prípade sa jednalo o recidívu karcinómu maternice intrakavitárnou metastázou pravej komory po 11 rokoch od hysterektómie a radioterapie. V druhom prípade o angiosarkóm pravej predsiene. Prípady sú zaujímavé rôznorodou históriou, podobným klinickým prejavom (embolizácia do pulmonálneho riečiska s dušnosťou) a ďalším veľmi odlišným osudom pacientiek.Pacientky boli vyšetrené dostupnými metódami, okrem základného klinického vyšetrenia, laboratórnych vyšetrení, transtorakálnou echokardiografiou, špirálovým CT; ako posledné bolo prevedené u oboch histologické vyšetrenie.Pacientka č. 1 - s recidívou karcinómu maternice intrakavitárnou metastázou bola na základe rýchlej diagnostiky a kooperácie s kardiochirurgom zbavená bezprostredného ohrozenia života, následne absolvovala šesť cyklov chemoterapie, do bu-dúcna zostáva otázna ďalšia onkologická stratégia a prognóza.Pacientka č. 2 - s angiosarkómom pravej predsiene v priebehu niekoľkých dní progredovala do multiorgánového zlyhania a exitovala v priebehu necelých desiatich dní.Kazuistika č. 1. potvrdila, že najlepšiu prognózu majú pacienti so sekundárnymi KT, u ktorých bolo možné radikálne odstránenie primárneho tumoru. Kazuistika č. 2 potvrdila rýchly priebeh angiosarkómu a veľmi zlú prognózu.