Martin University Hospital

Extreme flood events naturally act as drivers of geomorphic heterogeneity, creating complex channel-floodplain systems characterized by diverse bedforms, bank erosion features, and sediment splays. However, the subsequent phase of flood recovery often involves rapid and extensive anthropogenic interventions that counteract these natural processes. This study evaluates the loss of geomorphological diversity in montane streams of the Opava River Basin (Czechia) by analyzing the conflict between natural recovery and technical river management.The research methodology employs a multi-temporal approach combining field investigation and remote sensing. While systematic geomorphological field mapping was conducted at two key stages—immediately following the 2024 flood to record the "pristine" impact and one year later to assess the final state—UAV photogrammetric campaigns were executed repeatedly throughout the post-flood year. This high-frequency monitoring provided multiple temporal windows, allowing us to track the precise sequence of changes and distinguish between gradual natural adjustments and abrupt anthropogenic modifications.The analysis of this time-series data reveals a significant trajectory of channel simplification:Erasure of Complexity: The repeated UAV models document how initial flood-created features (cut banks, gravel bars) were systematically removed by engineering works. In reaches subjected to heavy machinery, geomorphic diversity was reduced by up to 100%.Dynamics of Intervention: The multiple time windows highlighted that the most severe loss of diversity often occurred weeks or months after the flood event itself, during the "recovery" phase. Moreover, this loss of diversity was significantly stronger in proximity to habited areas compared to natural river reaches.Impact of Intensity: We identified a direct correlation between the intensity of technical adjustments and the degree of channel homogenization. While "soft" interventions allowed for the partial preservation of flood-induced forms, heavy engineering works resulted in the complete artificial straightening of the thalweg.The study demonstrates that high-resolution UAV monitoring is essential for capturing the transient states of river recovery. The findings suggest that current post-flood protocols often prioritize rapid hydraulic streamlining at the expense of ecological integrity, effectively "resetting" the river's geomorphic value to a pre-flood, or even simpler, state.

Bloodstream infection (BSI) is a serious clinical condition associated with high morbidity and mortality, requiring rapid identification of causative agents and timely antimicrobial susceptibility testing (AST). This study evaluated accelerated bacterial identification from positive blood culture samples using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) combined with two rapid processing approaches: a serum separation tube-based centrifugation method (SST method) and shortened cultivation on solid media. Rapid identification was followed by accelerated AST, performed either from a bacterial cell pellet (SST method) and from early-grown bacterial biomass (shortened cultivation protocol). The results were compared with those obtained using routine laboratory procedures. A total of 270 positive blood culture samples were analyzed, with 135 samples processed by each protocol. Both approaches achieved an identification success rate of 93.33%. Rapid AST using the SST method showed error rates of 0.51% minor errors, 0.57% major errors, and 0.23% very major errors, with an overall agreement of 98.69%. The shortened cultivation protocol demonstrated lower error rates (0.46% minor errors and 0.23% major errors) and an overall agreement of 99.31%. These findings confirm that MALDI-TOF MS enables reliable early identification of BSI pathogens and rapid AST, supporting timely optimization of antimicrobial therapy and early detection of multidrug-resistant strains.

Plain Language Summary The PROFILE study, published in 2024, compared two ways of treating people newly diagnosed with moderate to severe Crohn's disease. One approach starts highly effective anti‐TNF treatment immediately after diagnosis (‘top‐down’), whereas the other increases treatment step by step only if the disease worsens (‘step‐up’). The study showed that starting effective treatment early leads to better disease control and improved safety. This review focuses on the recently published economic analysis of the PROFILE study. Over a five‐year modelled period, the ‘top‐down’ approach was associated with lower overall healthcare costs, mainly because patients experienced fewer disease flare‐ups, required fewer hospital admissions and underwent fewer intestinal surgeries. Similar cost advantages were observed when lower cost anti‐TNF alternative, adalimumab, was taken into consideration. The reliability of these findings was supported by their consistency across multiple sensitivity analyses. Early anti‐TNF treatment may be particularly important for patients with more aggressive forms of Crohn's disease, as it may help prevent the development of complications. Ongoing follow‐up of the PROFILE study will provide further information on long‐term clinical outcomes and the broader economic impact of this treatment strategy, which in an era of widely available and increasingly affordable biosimilars, will be particularly relevant for healthcare systems and treatment guidelines.

Introduction: Multiple sclerosis (MS) is a chronic inflammatory and neurodegenerative disease of the central nervous system, frequently associated with visual and oculomotor disturbances. Quantitative analysis of eye movements represents a non-invasive method for assessing central nervous system dysfunction beyond conventional imaging; however, the diagnostic and predictive value of oculomotor metrics remains insufficiently defined. Objectives: The aims of this study were to compare smooth pursuit gain and reflexive saccade parameters (latency, velocity, and precision) between individuals with MS and healthy controls, and to evaluate their ability to discriminate disease status. Methods: This cross-sectional study included 46 clinically stable patients with MS (EDSS ≤ 6.5) and 46 age- and sex-matched healthy controls. Oculomotor function was assessed using videonystagmography under standardized conditions. Group differences across horizontal and vertical gaze directions were analyzed using linear mixed-effects models. Random forest models were applied to assess the discriminative performance of oculomotor parameters, with permutation-based feature importance and receiver operating characteristic (ROC) curve analysis. Results: Patients with MS showed significantly reduced smooth pursuit gain across most horizontal and vertical directions compared with controls. Saccadic latency was significantly prolonged in all tested movement directions. Saccadic velocity exhibited selective directional impairment consistent with subtle medial longitudinal fasciculus involvement, whereas saccadic precision did not differ significantly between groups. A random forest model combining pursuit and saccadic parameters demonstrated only moderate discriminative performance between MS patients and controls (AUC = 0.694), with saccadic latency contributing most strongly to classification. Conclusions: Quantitative eye-movement assessment revealed widespread oculomotor abnormalities in MS, particularly reduced smooth pursuit gain and prolonged saccadic latency. Although the overall discriminative accuracy of oculomotor parameters was limited, these findings support their potential role as complementary markers of central nervous system dysfunction. Further longitudinal and multimodal studies are required to clarify their clinical relevance and prognostic value.

Background: Acute respiratory infections (ARIs) pose a significant clinical challenge in paediatric populations, especially in children with comorbidities who may exhibit underlying immune dysregulation. Inosine pranobex (IP) is an immunomodulatory agent that enhances T-lymphocyte and Natural Killer (NK) cell function, offering a targeted therapeutic rationale for such cases. Objective: This study aimed to retrospectively describe the clinical characteristics, immunological profiles, and outcomes of paediatric patients with complex, PCR-confirmed viral ARIs and significant comorbidities, for whom adjunctive therapy with IP was initiated based on clinical judgment. Methods: This retrospective case series analysed data from 14 paediatric patients hospitalised at a specialised centre (National Institute of Paediatric Tuberculosis and Respiratory Diseases in Dolny Smokovec, Slovakia). Cases were selected based on PCR-confirmed viral ARI, a history of recurrent infections, significant comorbidities, and initiation of IP therapy. The indication for IP was guided by the treating physician in cases of severe, prolonged, or recurrent disease course, where immune dysregulation was suspected, often supported by prior immunophenotyping. Results: A frequent observation in this cohort was the presence of baseline cellular immune alterations with a frequent observation of baseline cellular immune alterations, most notably the depletion of natural killer (NK) cells. NK cell depletion was identified in half of the patients (7/14). Following the initiation of treatment regimens that included adjunctive IP, clinical stabilisation or improvement was observed in all 14 patients included in the study. The therapy was well tolerated, with no reported adverse events attributable to IP. Conclusions: This case series highlights the common presence of cellular immune alterations in children with complex ARIs. While the observational nature of this study precludes any conclusions about causality, the favourable clinical course, safety profile, and strong immunological rationale support the need for prospective controlled trials to evaluate the role of IP in this specific high-risk paediatric population.

Background and Clinical Significance: Immunoglobulin A nephropathy (IgAN) is the most common primary glomerulonephritis in adults, typically following a chronic course that often leads to end-stage kidney disease. Rapidly progressive glomerulonephritis is a rare and severe variant of IgAN with a poor prognosis. Case Presentation: We present the clinical case of a 68-year-old Caucasian female with a history of systemic lupus erythematosus and untreated chronic hepatitis B, who was admitted to the Transplant-Nephrology Department, University Hospital Martin, with acute kidney injury and nephrotic syndrome accompanied by hematuria. The clinical picture was marked by lower limb oedema and poorly controlled hypertension, both of which responded well to conservative management. Extrarenal causes were excluded through otolaryngologic, stomatologic, and gynecologic assessments, and autoantibody screening was negative. Renal biopsy revealed crescentic glomerulonephritis with endocapillary and mesangial proliferation and IgA deposits. Due to active hepatitis B, initial treatment was limited to corticosteroids. Following a decrease in viral load, pulse therapy with cyclophosphamide was administered, followed by mycophenolic acid; however, renal function did not recover. Conclusions: The rapidly progressive form of IgA nephropathy in the context of active hepatitis B presents a rare and challenging clinical case. Management requires a highly individualised, multidisciplinary approach due to the risk of infectious complications and the need to preserve renal function.

Abstract Medication-related osteonecrosis of the jaw (MRONJ) is a rare but severe complication of antiresorptive therapy with bisphosphonates or denosumab in osteoporotic patients. MRONJ can adversely affect both quality of life and the treatment of osteoporosis. The aim of this study was to evaluate the efficacy of early surgical treatment of MRONJ lesions and to assess the possible influence of variables such as advanced age, advanced stage of MRONJ, and concomitant treatment of rheumatoid arthritis on treatment outcomes. We performed a retrospective evaluation of osteoporotic patients treated for stage I-III MRONJ at a single institution between January 2016 and December 2022. All patients underwent early surgical treatment according to a standardized therapeutic protocol and were followed up for at least 6 months after surgical treatment. Eighty-eight patients, mostly women (95.5%), were surgically treated for 93 MRONJ stage I (9.8%), II (73.1%), and III (17.2%) lesions. Thirteen patients (14.8%) were concurrently treated for rheumatoid arthritis. Early surgical treatment resulted in complete cure of MRONJ lesions with a single surgical procedure in 86 of 88 patients (97.7%) and 91 of 93 MRONJ lesions (97.8%). Age over 75 years, advanced-stage MRONJ and concomitant treatment for rheumatoid arthritis were not negatively associated with surgical treatment outcomes in this study. Early surgical treatment according to the described treatment protocol is highly effective in achieving complete healing of MRONJ lesions in osteoporotic patients regardless of disease stage and can be used as a first-line treatment in patients with osteoporosis who have no contraindications and consent to surgical treatment.

Abstract Background and Aims It is well known that hyperglycaemia occurs very often after kidney transplantation (KT), but previous findings suggest that glycaemic variability (GV) may have a major impact on the development of later complications and patient's outcome. The aim of our study was to identify the impact of GV in the early post-transplant period on the development of metabolic complications using continuous glycaemic monitoring (GCM). Method This prospective study was performed in patients after primary KT at the Transplant-nephrology department of University hospital Martin, Slovakia. Adult patients with excluded diabetes and prediabetes were given a Dexcom G6 CGM before KT. This system was paired with a smartphone and continuously recorded blood glucose over a period of 7 days after KT. We recorded all patients' demographic and clinical characteristics on day 0, 5 and on the third and twelfth month, including findings in protocol biopsy, or donor specific antibodies. Oral glucose tolerance test was performed in the third and twelfth month. The total length of follow-up was 12 months, and all patients were set on the same immunosuppression. Results Currently, 20 patients (mean age 47.5 ± 14.6; 65% males) have completed the total length of follow up and were therefore included in the data analysis. The study group consisted of a total of 10 patients who were diagnosed with post-transplant diabetes mellitus—PTDM (n = 7) and prediabetes (n = 3). At baseline, we found no significant differences in basic characteristics between the control and the study group. On the 5th day after KT, we found significantly higher glycated haemoglobin—HbA1c (P = 0.0382) and lower insulin 2 hours post load (P = 0.0417) in the study group. In the study group, we identified significantly higher HbA1c (P = 0.0420), homeostatic model assessment index for insulin resistance, HOMA-IR (P = 0.0420) at month 3 and fasting insulin (P = 0.0219), HbA1c (P = 0.0059), HOMA-IR (P = 0.0060) at month 12 compared to the control group. By analysing the 7-day data from the CGM, we found a significantly higher average glucose (P = 0.0208), standard deviation - SD (P = 0.0006), estimated A1c (P = 0.0169), time in hyperglycaemia (TIH)—high (P = 0.0423), TIH—very high (P = 0.0194) and lower time in normal range (P = 0.0365) in the study group. We determined a criterion of >2.1 for SD as a predictor of PTDM/prediabetes occurrence using CGM models based on ROC curve analysis with a sensitivity of 70 and specificity of 80. Conclusion The first results of our study demonstrate the impact of GV in the early post-transplant period on the development of glucose metabolism disorders in the third and twelfth months after KT. CGM is an ideal tool for measuring GV in the early period after KT.

Abstract Background and Aims IgA nephropathy (IgAN) is the leading cause of primary glomerulopathy globally, presenting a high lifetime risk of kidney failure, with up to 50% of patients requiring kidney function replacement by age 51. Kidney transplantation (KT) is the preferred treatment method. The recurrence of IgAN post-transplantation is a significant factor leading to graft failure, occurring in 9%–61% of cases based on various studies. Younger age and aggressive disease are associated with higher recurrence risk. The predisposition to IgAN may be linked to specific HLA-DR and -DQ alleles. This analysis sought to identify risk and protective HLA alleles. Method This retrospective monocentric analysis included patients with biopsy-verified IgAN who underwent KT at the Transplant-Nephrology Department of the University Hospital Martin. Patients were monitored for IgAN recurrence through histological confirmation in graft biopsies. HLA typing was conducted before placing patients on the KT waiting list. The analysis included a comparison to a control group of 10,000 healthy donors from the Eurotransplant registry, capturing demographic and clinical characteristics of the patients. Results Out of 470 patients screened post-KT, 7.2% (n = 48) were found to have biopsy-verified IgAN, primarily affecting men (77%). The allele DRB111 was found in 47.92% of IgAN patients, indicating a significant risk for IgAN (OR 2.09), while DRB103 appeared in 4.17% and was protective against IgAN (OR 0.2). Recurrence of IgAN post-KT was confirmed histologically in 10% of patients (n = 5), all of whom were men, with an average time of 51.4 months to recurrence. All patients with confirmed recurrence had the risky allele DRB111, and 80% also had DRB103. Notably, one patient exhibited early recurrence after a secondary KT and carried both risk alleles. Conclusion The study found a 7.2% incidence of biopsy-confirmed IgAN and a 10% recurrence rate in grafts following KT. The allele DRB111 was identified as a risk factor, while DRB103 was protective against the development of IgAN and recurrent disease post-transplantation.