University Hospital Olomouc

Wild-type transthyretin cardiac amyloidosis (ATTRwt-CA) is an increasingly recognized disease in elderly individuals. We aimed to perform a cross-sectional survey investigating the current diagnostic journey of ATTRwt patients in the Czech Republic from initial symptoms to final diagnosis. Between November 2022 and May 2023, most data were prospectively obtained using a dedicated questionnaire from 118 ATTRwt-CA patients during the regular outpatient consultation. The rest of the data were taken by attending physicians from medical records. The mean age of the patients at the time of diagnosis was 77 ± 6 years, 85.6% were males. The time interval from the onset of clinical scenario leading to suspicion of CA to suspected diagnosis was 14±24 months, while the subsequent period to definite ATTRwt-CA diagnosis was 2.5±2.3 months. Heart failure primarily led to the suspicion of CA in 61.9%, followed by suspicious echocardiographic findings (12.7%) and atrial fibrillation or flutter (6.8%). The history of carpal tunnel syndrome was the most common extracardiac manifestation found in 53.9% subjects, with median duration of 99 months. The diagnosis of CA was most often first suspected by outpatient cardiologists (33.1%) and cardiologists working at a cardiocenter (25.4%). At the time of diagnosis, NYHA class I or II was present in 10% and 56% of patients, respectively. The definite ATTRwt-CA diagnosis was made noninvasively in 63% cases. A relatively long-time delay still exists between the onset of clinical manifestations and suspicion of CA. Nevertheless, once CA is suspected, the definite ATTRwt-CA diagnosis is made early. Although heart failure still represents the most common clinical scenario, several other clinical profiles lead quite frequently to suspicion of the disease. The non-invasive diagnostics of ATTRwt-CA is done in majority of our patients, who are diagnosed mostly in early stages of the disease. The awareness of ATTRwt manifestations must be increased in order to shorten the whole diagnostic process of the disease.

To identify mild cognitive impairment (MCI) in Parkinson's disease (PD) using two brief tests the Amnesia Light and Brief Asssment (ALBA) and the door Picture Naming and Immediate Recall (dPICNIR) in 6-8 minutes. The ALBA, the dPICNIR and the third version of the Addenbrooke's Cognitive Examination III (ACE-III) were administered to 124 participants, equally divided into PD patients and socio-demographically matched normal controls (NC). The PD group was divided into those with normal cognitive functions (PD-CN) and with MCI (PD-MCI) using neuropsychological tests. Cognitive impairment in the PD group was mild, with significantly lower ACE-III scores than in NC (91 vs. 96 points). Despite these subtle deficits, gesture recall in the ALBA was significantly lower even in the PD-CN group compared to the NC. PD-MCI patients had other significant deficits in the ALBA and PICNIR tests. In the PD group, the gesture recall in the ALBA and correctly recalled pictures in the dPICNIR correlated with the results of verbal fluency and trail making tests, followed by memory tests and all ACE-III scores except visuospatial one. In contrast, correctly recalled sentence words in the ALBA correlated with the memory and language scores in the ACE-III test and memory test scores. Subtle cognitive changes in PD can be detected through gesture recall test, even in those with normal cognition. The ALBA and PICNIR tests are effective in identifying MCI in PD and provide a brief and valid assessment of cognitive functions. They are freely available at www.abadeco.cz.

This study investigated the effects of temperature and concentration on the short-term stability of colistin and colistin methanesulphonate in three biological matrices; whole blood, plasma and serum. Human whole blood, plasma or serum containing colistin (2; 10; 20 mg/L) or colistin methanesulphonate (2; 10; 20 mg/L) was stored at room temperatrure or at 37 °C for a predetermined time interval. The concentrations of colistin in colistin spiked samples, and formed colistin in colistin methanesulphonate spiked samples, were analysed by LC-MS method. Findings indicate that colistin A and B were stable at the room temperature, but degradation accelerated at 37 °C, particularly at lower concentrations. The conversion of CMS to colistin was also temperature-dependent, where the concersion was significantly accelerated at elevated temperatures. Freeze-thaw stability were tested, COL A as well as COL B were stable for at least three freeze-thaw cycles. These results underscore the importance of rapid sample processing to ensure reliable therapeutic drug monitoring and emphasize the importance of considering temperature and concentration factors in clinical practice to optimise dosing and minimise toxicity. Further research is required to investigate the full range of factors affecting the stability of colistin and colistin methanesulphonate in biological matrices.

The Usutu virus (USUV; Orthoflavivirus, Flaviviridae) is a mosquito-borne pathogen causing fatal neuroinfections in susceptible wild and captive birds, particularly blackbirds, other passerines, and owls. Zoological gardens provide favourable conditions for the circulation of such viruses due to the proximity of diverse species and limited options for prevention. Following the sudden death of several Chilean tinamous kept in the Brno zoological garden, we tested tissues sampled from 22 bird cadavers (from zoos, private owners, and free-living birds) for the presence of USUV and West Nile virus (WNV) RNA using duplex reverse transcription qPCR. Near-complete whole-genome sequences were acquired from positive samples by next-generation sequencing and subjected to phylogenetic analyses. Furthermore, serum samples from additional zoo animals and privately owned birds were screened for anti-flavivirus antibodies using ELISA and subsequently confirmed by the virus neutralization test. We report fatal USUV infections in multiple bird species from three zoological gardens in the Czech Republic. Duplex RT-qPCR targeting USUV and West Nile virus (WNV) detected USUV RNA in tissues from two Boreal owls (Aegolius funereus), one Eurasian pygmy owl (Glaucidium passerinum), two Brahminy starlings (Sturnia pagodarum), and four Chilean tinamous (Nothoprocta perdicaria). Additionally, three randomly found cadavers of free-living blackbirds (Turdus merula) tested positive. Pathological findings ranged from minimal pathological changes to pronounced hepatosplenomegaly with intestinal bleeding. Phylogenetic analysis of near-complete genome sequences assigned all viruses to the Europe 2 genetic lineage, revealing partial geographic clustering among isolates obtained in this study. Serological testing confirmed exposure in additional birds and demonstrated cross-neutralisation between anti-USUV and anti-WNV-positive sera. In zoological gardens, flavivirus infections can cause substantial losses, even among rarely bred or endangered species. Given the zoonotic potential of both USUV and WNV, documenting their occurrence in avian hosts is important not only for animal health but also for human disease surveillance from the One Health perspective.

ObjectivesNeuromodulation is an advanced therapy for managing chronic pain by modulating nerve activity through electrical stimulation. This study evaluates the clinical outcomes of neuromodulation therapies, including spinal cord stimulation (SCS), occipital nerve stimulation (ONS), and peripheral nerve field stimulation (PNFS) in patients with refractory chronic pain.MethodsA retrospective analysis was conducted at the Department of Neurosurgery, Department of Neurosurgery, University Hospital Olomouc, on 70 patients who underwent neuromodulation therapy between 2019 and 2024. Indications included Persistent Spinal Pain Syndrome Type 2 (PSPS-T2), Persistent Spinal Pain Syndrome Type 1 (PSPS-T1), Complex Regional Pain Syndrome (CRPS), Failed Neck Surgery Syndrome, and neuropathic pain. Pain relief was assessed using the Visual Analog Scale (VAS) before and after implantation. Only patients with a successful trial stimulation who proceeded to permanent implantation were included in the analysis, and outcomes aree therefore interpreted as descriptive results in a responder-selected cohort.ResultsPatients experienced significant pain reduction post-implantation. Among PSPS-T2 patients (n = 40), mean VAS scores decreased from 5.58 to 1.80 (67.2% reduction). Similar trends were observed in PSPS-T1 (64.5% reduction), CRPS (85% reduction), and other conditions, with an overall mean pain reduction of 58.3%. Percutaneous electrodes and non-rechargeable implantable pulse generators (IPGs) were most commonly used.ConclusionIn this single-center, retrospective real-world cohort, neuromodulation was associated with clinically meaningful pain reduction among patients who responded to trial stimulation. These data primarily illustrate contemporary neuromodulation practice and outcomes in a Central European academic center.

Abstract Background JAK inhibitors (JAKi) are small molecules that cross the placenta from early pregnancy.1 Evidence on the safety of in utero JAKi exposure remains limited, particularly regarding pregnancy outcomes, infant infections, vaccine responses, and early development.2, 3 Methods We conducted a multicenter retrospective study within the ECCO CONFER network, including pregnant women with inflammatory bowel disease (IBD) exposed to tofacitinib (TOFA), upadacitinib (UPA), or filgotinib (FILGO). Data were collected from 22 centers across 16 countries and included maternal characteristics, disease activity, medication patterns, and pregnancy and infant outcomes. Results Among 55 JAKi exposed pregnancies, 21 (38.2%) were unplanned and 30 (54.6%) had active disease. Nine women (16.4%) initiated JAKi during pregnancy. Overall, 38 (69.1%) received TOFA, 15 (27.3%) UPA, and 2 (3.6%) FILGO; 39 (70.9%) continued treatment throughout pregnancy. JAKi discontinuation in 1st-2nd trimester led to disease activity in 9/16 cases (56.3%). Maternal complication risk was low: no DVT or (pre) eclampsia occurred; three cases of premature rupture of membranes (GA 34–37) and four required hospitalizations due to infection or other complications. A total of 10 abortions occurred - five spontaneous (9.1%) and five induced (9.1%), including three due to concern about JAKi exposure. Among 45 live births, two infants (3.6%) were preterm, four (7.3%) small for gestational age, and two (3.6%) had Apgar <7 at 5 minutes. No congenital abnormalities were reported. Infant follow-up findings are summarized in Table 1. One-third of breastfeeding women continued JAKi postpartum. A high adherence rate to the national immunization schedule was seen. Eight (19.5%) received the live BCG-vaccine within the first 30 days of life. No adverse events followed live or inactivated vaccines, and no malignancies were observed. Conclusion In this global cohort of JAKi-exposed pregnancies in women with IBD, maternal complication rates were low, and no increased risk of adverse outcomes among live births was identified. While disease activity was common, particularly following discontinuation of JAKi, infant outcomes - including development, infection risk, and vaccine response - were reassuring. These findings provide important preliminary safety data to inform decision-making regarding JAKi use in pregnancy, though prospective studies are needed to confirm long-term safety.

Abstract Background Comparative data on risankizumab (RISA) and upadacitinib (UPA) in Crohn’s disease (CD) are limited. In this preliminary analysis, we assessed treatment persistence with these agents and explored whether the choice should be modified according to disease location. Methods Data from the Czech National Prospective Registry of Biological and Innovative Therapies for Inflammatory Bowel Disease (CREdIT) were analysed to evaluate treatment persistence in adult and paediatric patients with CD who began treatment with RISA or UPA, with a minimum follow-up period of three months. Patients with missing outcomes or dual advanced therapy were excluded. Inverse-probability-of-treatment weighting (IPTW) based on a propensity score including demographic, disease activity and treatment history variables was applied to reduce confounding factors. Treatment persistence was analysed using Kaplan–Meier curves and Cox proportional hazards models, clustered by patient. We evaluated whether disease location (ileal vs non-ileal) altered treatment persistence by using group-specific survival analyses. Results A total of 474 treatment observations were identified in patients receiving RISA or UPA. Following the application of exclusion criteria, the analysis included 370 observations from 323 patients, of which 157 (42%) were on RISA and 213 (58%) were on UPA. Of these, 11 (7%) were paediatric patients in the RISA group and 22 (10%) in the UPA group. The median number of actual lines of advanced therapy was four in both groups, with 38% of RISA observations and 39% of UPA observations representing ≥ 5th treatment line. Groups differed only in age at treatment start (median 38 vs 37 years). Ileal disease only was present in 23 (15%) RISA patients and 28 (13%) UPA patients. Unadjusted data (Figure 1) demonstrated higher persistence of RISA vs. UPA treatment. After balancing the cohort using IPTW, all standardised mean differences between groups were below 0.1. Compared with RISA, UPA was associated with a higher risk of treatment discontinuation (hazard ratio: 2.83; 95% confidence interval: 1.50–6.34). Interaction analysis by disease location was not feasible because no RISA failures occurred in the ileal subgroup. Therefore, only descriptive stratified curves are shown in Figure 2. Conclusion In this preliminary analysis of refractory CD, treatment persistence was greater with RISA than with UPA. These real-world data suggest that RISA may be a more durable treatment option, particularly for patients with ileal CD. However, confirmation in larger patient groups is required. Conflict of interest: Dr. Hradsky, Ondrej: Lectures/congress fees/consultancy from MSD, AbbVie, Takeda, Sandoz, Nutricia, Ferring, Pfizer, and Lilly. Duricova, Dana: Lectures/congress fees/consultancy (outside the scope of the submitted work) from Johnson & Johnson, Takeda, AbbVie, Pfizer, Ferring, Eli Lilly, and Celltrion. Lukás, Milan: Research Support / Clinical trials: Biogen, Takeda, Janssen Consultant / Speaker : Abbvie, Ferring, Takeda, Janssen Speakers Bureau / Advisory Board Member: Pfizer, Roche, Egis, Celltrion, Takeda, Janssen, Eli Lilly Employee: ISCARE a.s./1stMedical Faculty, Charles University, Prague Nedbalova, Lenka: No conflict of interest Bouchner, Luděk: No conflict of interest Pipek, Barbora: Lectures/congress fees/consultancy (outside the scope of the submitted work) from Johnson & Johnson, Takeda, AbbVie, Pfizer, and Eli Lilly. Svoboda, Pavel: Lectures/congress fees/consultancy (outside the scope of the submitted work) from AbbVie, Takeda, Janssen-Cilag, Celltrion, Tillotts, Alfasigma, Sandoz, Pfizer, and Eli Lilly. Siroky, Milan: No conflict of interest Bronsky, Jiri: Lectures/congress fees/consultancy (outside the scope of the submitted work) from AbbVie, Sandoz, Danone-Nutricia, Nestlé, Sanofi, Pfizer, and Vitabalans. Bortlik, Martin: Lectures/congress fees/consultancy (outside the scope of the submitted work) from AbbVie, Takeda, Janssen-Cilag, Celltrion, Roche, AstraZeneca, Biogen, Tillotts, Ferring, Alfasigma, PRO.MED.CS, Sandoz, Bristol-Myers Squibb, Pfizer, and Swedish Orphan Biovitrum.

Background and Aims: Between 2004 and 2025, 72 paediatric patients were treated for aplastic anaemia (AA) in the Czech Republic, comprising 43 idiopathic and 29 hepatitis-associated (HA-AA). Among HA-AA patients, 21 were classified as AA, and 8 as refractory cytopenia of childhood (RCC). 20 of 29 HA-AA patients were male. Of 43 idiopathic AA patients, 12 received upfront HSCT and 31 IST (13 later transplanted); in HA-AA, 7 received upfront HSCT and 22 IST (9 later transplanted). Two patients required liver transplantation.