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Hradec Králové, Czech Republic

Rilmenidine is an antihypertensive from the group of imidazoline receptor agonists. The basis of its mechanism of action is significant reduction of cardiac and renal sympathetic baroreflex response at the level of I1- imidazoline receptors with subsequent reduction of the sympathetic activity. The effectiveness and tolerability of rilmenidine were proved in randomized comparative studies in elderly patients, patients suffering from hypertension together with diabetes and metabolic syndrome, and in patients with renal failure. The indication for administering rilmenidine is treatment of essential hypertension in adult patients of all age groups. The recommended dose is 1 mg a day (in the morning). Source

Objective: To assess women's satisfaction with psychosocial aspects of perinatal care provided in Czech maternity hospitals, to identify areas that need improvement and to compare satisfaction with maternity care between selected subgroups of parturients. Design: Original study. Setting: Department of Psychology, Faculty of Philosophy, Charles University, Prague. Methods: A survey on satisfaction with perinatal care was conducted with a sample of 1195 Czech parturients. The sample was representative of the Czech parturients' population in terms of educational level, age, parity, and rate of vaginal and caesarean section delivery. The sample was proportionated as regards the number of births at small and large hospitals and at hospitals in different regions as well. All currently existing Czech maternity hospitals were included. For the data collection, the original Czech questionnaire KLI-P was used. The KLI-P measures psychosocial climate of maternity hospitals on following six scales: helpfulness and empathy of caregivers; control and involvement in decision-making; communication of information and availability of caregivers; dismissive attitude and lack of interest; physical comfort and services. In addition, differences in satisfaction rates between different subgroups of respondents were investigated: primiparas/multiparas, women with lower/higher educational status, women who gave birth at smaller/lager hospitals (< 800 / > 800 births per year), women who gave birth at university/other hospitals, women after vaginal delivery/caesarean section, women accommodated in high-standard rooms at after-birth unit, and women who filled the questionnaire within one year after/later than one year after delivery. Results: The overall satisfaction with care provided at delivery unit (DU) and after-birth unit (ABU) was 70% and 61%, respectively. The best rated scale at DU was physical comfort and services (69%), the worst evaluation score received the scale control and involvement in decision-making (34%). At ABU, the best rated scale was control and involvement in decision-making (76%) while the lowest evaluation score was found for the scale dismissive attitude and lack of interest (48% - reverse-scored). The items with the best scores referred to the cleanliness at DU and mother-infant contact at ABU, the items with the lowest evaluation scores referred to emotional support provided by physicians at DU, involvement in decision-making concerning the position during the second stage of labour and quality of food. Significantly more satisfied with care provided at DU were multiparas, women who gave birth at non-university hospitals and women who gave birth vaginally. Significantly more satisfied with care at ABU were multiparas, women with lower educational status, women who gave birth at non-university and smaller hospitals (< 800 births per year) and women who evaluated a given hospital within one year after delivery. Conclusion: Despite its rather high quality, the Czech perinatal care suffers from several shortcomings as regards its psychosocial aspects. These shortcomings include lack of respect and empathy shown by caregivers, poor communication of information and low involvement of parturients in decision-making. Improving the quality of care at the Czech maternity hospitals requires empowe-rement of parturients in the system of perinatal care and development of psychological and psychosocial compteneces of health care providers. Source

It is well-known that leukemic cells in chronic lymphocytic leukemia (CLL) successfully resist apoptosis in vivo, but they are prone to apoptosis in vitro. Recent research shows that this fact can be explained by interactions of malignant cells with T-cells, stromal cells, nurse-like cells, endothelial cells and dendritic cells in microenvironment of bone marrow, lymph nodes and spleen where the CLL cells are protected from apoptosis and stimulated to increased proliferation. Angiogenesis participates in progression of CLL by enhanced supply of nutrients as well as protection from apoptosis. This new knowledge on CLL biology will translate in future into novel therapeutic approaches: clinical studies are already testing new agents able to disrupt the communication of leukemic cells with microenvironment as well as angiogenic processes. Source

The immunoglobulins are built from two identical heavy and two identical light chains. However, more light than heavy chains are produced under physiological conditions. Thus, the free light chains (FLC) may be detected in serum and other biological fluids using sensitive and specific quantitative nephelometric assay. Changes of FLC level in serum are associated with monoclonal proliferation or polyclonal activation of B cells, and with deficiency of renal functions. Monoclonal proliferation of B cells is associated with high serum level of FLC kappa or lambda, and abnormal relation of FLC kappa : FLC lambda. Polyclonal activation of B cells is associated with high serum level of both FLC, and normal relation of FLC kappa : FLC lambda. Both types of these changes are important in rheumatic diseases. Serum changes of monoclonal FLC are present in the following main conditions: (1) In differential diagnosis of non-inflammatory back pain persisting more than one month, because this type of back pain may be present as early manifestation of multiple myeloma or any other monoclonal gammopathy, and (2) also in depistage of B cell lymphoma in primary Sjögren's syndrome or another diffuse connective tissue disease. High serum level of both FLC is useful biomarker of activity in systemic lupus erythematosus (SLE) incl. follow-up controls of flare. The monitoring of FLC serum level in SLE and rheumatoid arthritis is also successfully used as sensitive biomarker of response to anti CD20 therapy by means of rituximab. Source

Cap J.,II. Interni Klinika
Vnitrni Lekarstvi

Low testosterone level is common in obese men and even more frequent in the presence of type 2 diabetes mellitus. Low testosterone level is probably not caused by increased aromatization of testosterone to estradiol in fat tissue. Increase of inflammation mediators, insulin and leptin resistance and low SHBG level may play more important role. Low testosterone level may manifest with low libido, erectile dysfunction, fatigue and depressive mood; it has a role in development of anaemia, osteoporosis, worsening of insulin resistance and it is probably marker of increased all-case and cardiovascular mortality. Routine investigation of testosterone level is indicated in every man with type 2 diabetes mellitus. As in non-diabetic men of middle and higher age substitution is indicated only in presence of clinical symptoms of hypogonadism. The substitution improves mainly libido, erectile dysfunction is influenced less. However, the phosphodiasterase-5 inhibitors efficiency is markedly improved. Metabolic changes during testosterone substitution are small. Source

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