Oblastní nemocnice Kladno

Abstract Background Surgical mesh is commonly used in hernia repair to reduce recurrence, but it is associated with a risk of postoperative wound infections, most often caused by Staphylococcus aureus. Cannabidiol has shown antibacterial and anti-inflammatory effects in laboratory studies. Objective This study aimed to assess whether mesh implants treated with cannabidiol could reduce infection rates compared to untreated mesh in an animal model. Methods 60 rats were randomized into four groups: one received standard mesh without bacterial exposure, one received standard mesh with bacterial exposure, one received cannabidiol-treated mesh with bacterial exposure, and one received cannabidiol-treated mesh without bacterial exposure. After implantation, animals were monitored for 14 days, and infection was assessed through clinical signs, microbiological cultures, histology, and inflammatory markers. Results Rats with cannabidiol-treated mesh showed a reduced infection rate (40%) compared to the infected control group (80%) (p = 0.0604). Histological inflammation and bacterial load were also lower in the CBD group, though not statistically significant. Inflammatory markers were comparable between groups. Conclusion The study found that CBD-impregnated mesh implants exhibited a lower incidence of bacterial infections compared to the control group. These findings suggest that CBD-impregnated hernia mesh implants may offer a protective effect against S. aureus-related wound infections, potentially improving postoperative outcomes.

Aneurysm formation is a complication of the use of arteriovenous fistulas, and symptomatic aneurysms require surgical treatment. The optimum treatment is aneurysmorrhaphy, because this salvages the function of the fistula. Aneurysmorrhaphy outcomes may be improved by implanting an external prosthesis over the repaired aneurysm. This study aimed to compare aneurysmorrhaphy performed with and without an external prosthesis. This was a multicenter, randomized, prospective non-blinded study. Patients with symptomatic aneurysms of arteriovenous fistulas were recruited between February 2018 and September 2022. Recruited patients were assigned randomly to undergoing aneurysmorrhaphy with or without an external prosthesis. The study compared patency and aneurysm recurrence rates at 1-year follow-up. Forty-six patients underwent aneurysmorrhaphy with an external prosthesis and fifty-five underwent aneurysmorrhaphy without an external prosthesis. There were no differences in patient and aneurysm characteristics between the two groups. At 1 year follow-up, the patency rates were 86% for aneurysmorrhaphy with external prosthesis and 80% for aneurysmorrhaphy without external prosthesis (p = 0.87). Aneurysm recurrences occurred in 2 patients (4.3%) who underwent aneurysmorrhaphy with external prosthesis and in 6 patients (10.9%) who underwent aneurysmorrhaphy without external prosthesis (p = 0.114). There was no statistically significant difference in primary patency rates and aneurysm recurrence between patients treated with aneurysmorrhaphy with and without external prosthetic support.

We present a case report of a 26-year-old patient with an incidental finding of intra-abdominal fibromatosis (desmoid) in the small pelvis who presented to the urology outpatient clinic for erectile dysfunction. Ultrasound examination revealed hydronephrosis of the right kidney with parenchymal reduction, and a bulky tumor was detected in the small pelvis, which was compressing the right-sided ureter. The patient was followed up with a CT scan which confirmed a solid tumour in the small pelvis of unclear origin, the nature of the tumour and the treatment were discussed by the multidisciplinary team and a decision was made to resect the tumour. Pathologist confirmed sporadic variant of desmoid. Desmoid tumors are characterized by both locally aggressive carcinomas mimicking growth and frequent recurrences after resection, which may require subsequent oncological treatment. For these reasons, patients with desmoids should be fol-lowed up by an oncologist, ideally at centers experienced in treating this rare disease.

The article provides a justification of the possibility of using public geoportals and GIS data to establish the circumstances of a road traffic accident when conducting auto-technical and video-technical forensic examination and gives the relevant examples as well. Distinctive features of examination of video and photo images taken on the accident scene are considered. The terms and definitions essential for presentation of the examination procedure and its findings in the expert opinion are given.

Goal: To seek and describe current scientific knowledge on the preparedness of medical personnel for an active shooter attack, with the identification of an optimal preparation strategy concerning prevention and potential management of this emergency on the premises of a medical facility. Methods: A scoping study with five phases of methodological steps was applied on the basis of the identified research question. According to the PCC (population, concept, context) format, the research question was divided into individual keywords in selected languages used for the search. Primary studies published between 2000 and December 2023 were included in the selection process. The sources were searched in December 2023 and freely available. Licensed databases EBSCOhost, Cinahl Plus with Full text, Medline, Medline Complete, and Google were used to find relevant studies. We used the "find similar articles" function in many databases. Selected English language keywords were searched using Boolean operators and placeholders. Results: The final analysis included nine studies. As precautions, the authors recommended the development of guidelines and establishment of a system, not only at the national level, but also within individual facilities interconnected with the police, regular training of employees with practical simulation, orientation signs in buildings, communication links for quick information and, last but not least, knowledge of warning behaviour. Conclusion: Healthcare providers should be systematically prepared for an active shooter emergency.

Abstract Many aspects of the activity of a medical laboratory have to be documented so as to facilitate the maintenance of the ongoing quality of service. As a consequence, many documents, forms and reports are generated. The retention time for each of these has to be specified. In addition to medical laboratory reports as part of the patient’s medical record, the medical laboratory has to retain many documents and specimens according to national legislation or guidance from professional organizations, if these exist. If not, the laboratory management needs to define a retention schedule, which shall define the storage conditions and period of storage, according to ISO 15189:2022 requirements for retention of general quality management documents and records. The EFLM Working Group on Accreditation and ISO/CEN standards provides here a proposal on retention periods of documentation and specimens based on a failure-mode-effects-analysis (FMEA) risk-based approach, a concept of risk reduction that has become an integral part of modern standards.

The aim of the present study was to investigate the relationship between intraocular pressure (IOP), vessel density (VD), retinal nerve fiber layer (RNFL) parameters and overall defect (OD) of the visual field in eyes where antiglaucoma treatment had not yet been initiated. A total of 61 subjects (122 eyes) who had an IOP of >20 mmHg on several occasions, in at least one eye, in routine outpatient care were included. These were subjects who had never been treated for hypertension glaucoma. The cohort was divided into four subgroups. In the first group, there were 18 eyes with an IOP value of <20 mmHg. In the second group, there were 39 eyes with IOP values of 20-22 mmHg. The third group consisted of 32 eyes with IOP values of 22-24 mmHg and the final group consisted of 33 eyes with IOP values of >24 mmHg. The IOP results were compared with VD, RNFL and OD using Pearson's correlation coefficient to assess the relationship between the selected parameters. RNFL and OD were moderately correlated only in the group of eyes with an IOP value >24 (r=0.48); in the other groups the correlation was very weak. However, changes in visual field were already observed in eyes with IOP 20-22 mmHg (r=-0.27). There was a moderate correlation in eyes with an IOP value >24 mmHg (r=-0.53). The most significant result observed was the relationship between VD and RNFL. In eyes with an IOP value ≤20, a moderate to strong correlation between these parameters was observed. This relationship increased with increasing IOP values up to a very strong correlation in the group with an IOP value >24 mmHg. A moderate to strong dependence between VD and RNFL in eyes with an IOP value ≤20 mmHg was observed, and this dependence was very strongly correlated in the eyes with an IOP value >24 mmHg.

Clinicians trust medical laboratories to provide reliable results on which they rely for clinical decisions. Laboratories fulfil their responsibility for accurate and consistent results by utilizing an arsenal of approaches, ranging from validation and verification experiments to daily quality control procedures. All these procedures verify, on different moments, that the results of a certain examination procedure have analytical performance characteristics (APC) that meet analytical performance specifications (APS) set for a particular intended use. The APC can in part be determined by estimating the measurement uncertainty component under conditions of within-laboratory precision (uRw), which comprises all components influencing the measurement uncertainty of random sources. To maintain the adequacy of their measurement procedures, laboratories need to distinguish aspects that are manageable vs. those that are not. One of the aspects that may influence uRw is the momentary significant bias caused by shifts in reagent and/or calibrator lots, which, when accepted or unnoticed, become a factor of the APC. In this paper, we postulate a model for allocating a part of allowable uRw to between-reagent lot variation, based on the need for long-term consistency of the measurement variability for that specific measurand. The allocation manages the ratio between short-term and long-term variation and indicates laboratories when to reject or correct certain variations due to reagent lots.