Lekarska Fakulta

Prague, Czech Republic

Lekarska Fakulta

Prague, Czech Republic
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Hruba D.,Lekarska Fakulta | Perina A.,Lekarska Fakulta
Prakticky Lekar | Year: 2017

The term multiple chemical sensitivity (MCS) has been adopted for the description of individual's multi-organ sensitivities following exposures to very low levels of chemicals commonly tolerated by majority of people. People with MCS obviously response to odours by acute respiratory distress, palpitations, skin eruptions and other physical symptoms. The spectrum of chemical triggers becomes wider over time; the reactions become more severe and long lasting. A large number of toxicological, immunological, psychological and neurological mechanisms have been suggested, but none of them could clearly explain the basis of MCS. It is also discussed a possibility of some genetic predisposition. It is estimated that about 9-33% of the population can show the MCS responses, about 2% of them ask physicians for the help. MCS can seriously disrupt the quality of life. Unfortunately, this uncertainty about aetiology and pathogenesis of MCS is attended with the absence of effective treatment. The clinical approach advices to adopt chemical-free, isolated lifestyle, which can minimize continual exposure. The neuro-behavioural approach is oriented on the stress coping, even with the support of antidepressive drugs. The recent recommendation is the multi-disciplinary approach (general practitioners, immunologists, allergists, gynaecologists, dentists, neurologists, psychologists) after controlling and excluding of possible somatic or psychiatric disease.

Dzupova O.,Lekarska fakulta | Kulichova J.,Klinika Infekcnich Nemoci
Klinicka Mikrobiologie a Infekcni Lekarstvi | Year: 2016

Lactic acidosis is the most severe adverse effect associated with metformin therapy of type 2 diabetes mellitus. The risk increases in patients with impaired renal function, most commonly due to diabetic nephropathy, and may be augmented when concurrent medication with a negative impact on renal function is used. The authors present a series of three patients who were admitted to a department of infectious diseases for acute gastroenteritis and within a few hours developed shock syndrome caused by severe lactic acidosis due to accumulation of metformin.

This survey study is divided into five sections. The first section describes how traditional, and for centuries in medicine dominating interest in the disease itself, has been gradually completed by the interest in personal peculiarities of patients suffering from certain diseases. The second section presents the historical context of that change, mainly three impulses involved: the interest of specialists in handicapped and elderly persons; understanding the patient as a client, whose individual needs must be met by the health care; the effort to assess the social impact of health care. The third section explains the content of basic terms used in this field: person-centered care; patient- -centered care; patient-centered medicine; patient and their family centered care; people or population centered care. The fourth section notes that although WHO supports the approach focusing on the person/patient and on the population, there are many barriers that complicate the implementation of the new approach in everyday real practice; the study informs about the most important ones. The fifth section draws attention to the weak points of the new approach. The study concludes that the goal of patient-centered care is to improve the quality of care provided, outcomes of the care, to increase peoples' satisfaction, and ultimately to improve the health of the entire population.

A role of Helicobacter pylori infection in the etiopathogenesis of immune thrombocytopenic purpura is still investigated and discussed. The infection of Helicobacter pylori in 58-years old female with severe thrombocytopenia and the clinical manifestation of cholecystitis was confirmed by antigen detection in stool. The regression of cholecystitis as well as the normalization of platelets count were achieved with standard eradication therapy. Presented case report is an example of immune thrombocytopenia induced by Helicobacter pylori infection with dominating extragastric manifestation.

Background: An imbalance between pro- and anti-inflammatory cytokine activities favors the induction of autoimmunity, chronic inflammation and joint damage in patients with rheumatoid arthritis (RA). Adipokines are bioactive proteins that are important regulators of inflammation. IL-35 is a new cytokine involved in the inflammatory processes in mouse models and is of unknown function in humans. The aim of the work was to study the levels and role of several adipokines and IL-35 in the joint and blood compartment and the association with the disease activity in patients with RA or other rheumatic diseases. Results: We found increased levels of adiponectin in serum of patients with erosive osteoarthritis (OA) of the hand, differential regulation of new adipokines vaspin and omentin in synovial fluid of patients with RA compared with OA and the effect of therapy using TNFa inhibitor on the expression profile of adipokines in subcutaneous adipose tissue of RA patients. B cell depletion therapy in RA resulted in decrease of serum levels of visfatin that correlated with following change of disease activity. The levels of IL-35 in synovial fluid are significantly higher in RA than in OA and correlate with the disease activity and functional status. IL-35 subunits p35 and EBI3 are overexpressed in RA synovial tissue than that in OA. IL-35 is increased at transcriptional and protein levels after stimulation with proinflammatory cytokine TNFa in RA synovial fibroblasts and peripheral blood mononuclear cells (PBMC). IL-35 induces release of some inflammatory mediators in PBMC. Conclusion: Our results show the role of adipokines and IL-35 in inflammation in patients with rheumatic diseases and the association with disease activity in RA. Thus, the discovery of new therapeutic targets would be beneficial for patient resistant to current therapy.

The article deals with the psychological aspects of the medical examiner during the execution of his examination praxis. He comes often into conflict with the doctor in charge, with the examined person, as well as by the dealing with the medical reports for the purposes of the judicial proceeding and by the control of the superiors. The medical assessor has to be aware of his own personality to be able to constructively handle the chronic stress and the pressure from several sides. He must to be at home in the psychology basics; person's attributes, act empathetically and assertively, in the communication and must avoid self-manipulation. He has to be fit in the medicine and legislative field. The author deals with the conflict solving situations with the aim of achieving a compromise, which would bring positive changes in the social security of seriously ill patients.

The authors present several notices to the practical indication and evaluation of serological methods. Detailed pathophysiology neither treatment are aim of the paper; the most frequent mistakes with emphasis on actually emerging disease - lyme borreliosis are discussed.

Svetlak M.,Lekarska fakulta | Cernik M.,Lekarska fakulta
Prakticky Lekar | Year: 2010

Recent findings show that food craving is strongly related to body weight and causes excessive eating patterns observed in obesity, binge eating and bulimia nervosa and its severity represents a good predictor of relapse. Our study aimed to validate the Czech translation of the General Food-Craving Questionnaire - Trait (G-FCQ-T) that currently represents one of the most reliable tools for food craving measurement. In order to achieve this goal we measured indices of food craving in 257 university students. The statistical analysis of the acquired data revealed that the Czech version of the G-FCQ-T has satisfactory psychometric properties and it is ready to be used in common clinical practice.

Kucova J.,Lekarska Fakulta | Sikorova L.,Lekarska Fakulta
Rehabilitacia | Year: 2014

Basis: If the healthcare professionals should provide the care, corresponding with Family Centred Care philosophy, it is necessary to know the needs of the children patients' families. The knowledge of these needs can help in care planning, concerning not only the child, but also whole family Group: 123 parents who take care of a child with ICP aged 1 to 7 years. Methods: Data were obtained via Family Needs Survey (FNS) questionnaire. Functional abilities of children were assessed via Gross Motor Function Classification System (GMFCS). Results: Most needs (60%) were formulated by respondents in the area of information. Parents of children with mild functional abilities have statistically more needs in the financial area. Functional abilities of a child are significantly influenced by five particular needs of parents. Statistical significant difference was showed in six needs, influenced by the age of child. Conclusion: Saturated needs of parents can significantly influence the quality of interactions among family and child and subsequently improve the development of children's abilities.

Introduction: Systemic sclerosis (SSc) is a generalized connective tissue disease affecting the skin and internal organs. The pathogenesis of SSc is characterized by inflammation, vasculopathy and fibrosis. To date, none of the tested drugs have demonstrated convincing efficacy in the treatment of SSc. S100A4 is involved in the regulation of cell motility, proliferation, apoptosis, angiogenesis and remodeling of the extracellular matrix. It was originally described as a promoter of metastasis in tumors, however, its pro-inflammatory properties have recently been demonstrated in inflammatory rheumatic diseases. The aim of this study was to assess the role of S100A4 in pathological activation of fibroblasts in SSc and in experimental models of dermal fibrosis. Results: The expression of S100A4 was increased in the skin of SSc patients, in SSc fibroblasts and in experimental fibrosis in a TGF-β / Smad dependent manner. Overexpression of S100A4 or stimulation with recombinant S100A4 induced an activated phenotype in resting normal fibroblasts. In contrast, inhibition of S100A4 or its complete deficit abrogated the pro-fibrotic effects of TGF-β and decreased the release of collagen. S100A4 knock-out mice (S100A4-/-) were protected from bleomycin-induced skin fibrosis with reduced dermal thickening, decreased hydroxyproline content and lower counts of activated fibroblasts, so called myofibroblasts. Similarly, deficiency of S100A4 also ameliorated fibrosis in the Tight skin-1 (Tsk-1) mouse model. Anti-fibrotic effects of the inactivation of S100A4 in both experimental models of dermal fibrosis were mediated by inhibition of TGF-β / Smad signaling. Conclusion: Our results characterize S100A4 as a positive regulator of the stimmulatory effects of TGF-β on fibroblasts in SSc. S100A4 is induced by TGF-β and in turn amplifies the stimulatory effects of canonical TGF-β / Smad signaling on collagen synthesis by SSc fibroblasts and on induction of fibrosis. Since S100A4 is essentially required for the pro-fibrotic effects of TGF-β and neutralizing antibodies against S100A4 are currently evaluated in tumors, S100A4 might become a candidate molecule for novel anti-fibrotic therapies.

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