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Soska V.,Oddeleni klinicke biochemie | Soska V.,Katedra laboratornich metod
Interni Medicina pro Praxi | Year: 2015

Dyslipidemia is one of the main components of the metabolic syndrom. Is is characterized by elevated triglycerides, low HDL-cholesterol and elevated concentrations of small aterogenic LDL particles. The basic step in treatment should be always a lifestyle changes, especially changes in diet, weight optimization and ban of smoking. Pharmacotherapy DLP is indicated if a patient is in very high or high risk of fatal cardiovascular event during next 10 years and if (at the same time) is LDL-cholesterol higher than its target level. Pharmacotherapy is based on statins therapy, in case of their intolerance ezetimibe. If target level of LDL-cholesterol is achieved and persist elevated levels of triglycerides and/or decreased HDL-cholesterol, adding fenofibrate to a statin should be considered.

Drug hypersensitivity reactions are adverse effects of drugs that clinically resemble allergic reactions. They represent a significant health problem and a correct diagnosis is essential for its solution. This aim can be achieved by complete drug allergy work up only. A cornerstone of the diagnostic algorithm is a thorough and detailed clinical history followed by laboratory, skin and provocation tests. The article summarizes current diagnostic guidelines including its pitfalls and wider context of the issue and informs about the establishment of the Working group for drug allergy in the Czech Society of Allergology and Clinical Immunology.

Authors followed the article "Estimated glomerular filtration rate in diabetic patients" published by Šálek, T. and Ponížil, P. We expanded original data set (N=565) with additional 950 examinations and compared equations for glomerular filtration rate estimation (eGFR) from KDIGO 2012 Guidelines (equation CKD-EPI, version 2009 for creatinine only, version 2012 for cystatin C only and version 2012 for the combination of creatinine + cystatin C). Authors concluded, that CKD-EPI equations offer different results in different intervals of glomerular filtration. Cystatin C based equation (CKD-EPI 2012, cystatin C) offers higher values of eGFR in the interval above 1.5 ml/s per 1.73 m2 in comparison to the equation CKD-EPI 2009 (creatinine) and vice versa in the interval below 1.5 ml/s per 1.73 m2. Combined equation CKD-EPI 2012 (creatinine + cystatin C) is more related to the concentration of cystatin C than to the concentration of creatinine. These results may have impact on the interpretation and strategy of GFR estimation in clinical practice.

Hnikova O.,Klinika Deti a Dorostu | Vinohradska H.,Oddeleni klinicke biochemie | Dejmek P.,Klinika Deti a Dorostu | Al Taji E.,Klinika Deti a Dorostu
Cesko-Slovenska Pediatrie | Year: 2014

Neonatal population is in significantly higher risk of iodine deficiency (ID). Iodine saturation in newborns has been followed in the Czech Republic (CR) since 1991. In a pilot study in Prague 10 which included 50 neonates and their mothers, the median urinary iodine concentration observed on the 5th day after birth, revealed mild ID, according the WHO, UNICEF and the International Council for Control of Iodine Deficiency Disorders (ICCIDD). Grant supported study followed in 3 regions of CR (1993-95), ie. in Prague, Pribram and Ustí n. L. In each region ioduria, thyroid stimulating hormone (TSH), thyroxine (T4) measurements and thyroid ultrasound were performed in 50 neonates and their mothers. Median ioduria results were not consistent in three regions, varying from mild to middle ID. After extension of preventive measures, including recommendation of 100 μg of iodine/day in pregnant mothers, median ioduria values were close to normal in a study from 1997. Iodine saturation monitoring of neonatal population in CR has been initiated in 1996, using neoTSH method from neonatal screening for congenital hypothyroidism (SCH), according to WHO, ICCIDD and UNICEF. The adequate iodine saturation was evident if in less then 3% of newborns neoTSH was elevated in range 5,0-20,0 mIU/L. Blood samples were taken at 72-96 hours post partum (pp.). Since the year 2006 normal iodine intake, less than 3% of elevated neoTSH, was observed in newborns of CR until the end of September in 2009. Since October 1st 2009, new measures were introduced in neonatal screening in CR. Blood samples are taken earlier, ie. 48-72 hours pp. The percentage of newborns with neoTSH 5,0-20,0 mIU/L has doubled with earlier blood sampling and remained stable within this range during next years 2010-2013. The likely reason of this postpartum increase in neoTSH is associated with earlier sampling and intervention with after birth TSH elevation. In conclusion: neoTSH method for monitoring of iodine saturation in newborn population, using neoTSH 5,0-20,0 mIU/L from SCH, has been proven as an ideal method, reliable, cheap with easy organization in a long-term follow up. Earlier blood sampling (48-72 hours pp.) increased the upper range of normal iodine intake to 6% instead to 3% neoTSH (5,0-20,0 mIU/L) in newborn population of CR. Ongoing education, emphasizing iodine importance and its correct supply is crutial for pregnant and lactating mothers.

Vodicka M.,Lekarna | Salek T.,Oddeleni klinicke biochemie | Roderova E.,Interni klinika IPVZ | Cerny D.,Oddeleni Klinicke Farmacie
Klinicka Onkologie | Year: 2013

Background: Cyproterone acetate is associated with hepatotoxicity during prostate cancer treatment. The information about its toxic mechanism and risk factors is limited, based on pharmacovigilance reports and published case reports only. Case: We describe a case of a patient treated with cyproterone acetate (200 mg/day for 9 months) for adenocarcinoma of the prostate. The 75-year-old patient was admitted for the development of jaundice and loss of appetite to the T. Bata Regional Hospital in Zlin, Czech Republic. Laboratory values ALT 994 U/l, AST 1,046 U/l, ALP 193 U/l, GGT 1,128 U/l, bilirubin 177 μmol/l, conjugated bilirubin 138 μmol/l, albumin 26 g/l. Quick time INR 1.23. The concomitant medication included atorvastatin 10 mg daily. Clinical and laboratory outcomes showed acute fulminant liver failure caused predominantly by hepatocellular damage. Hepatotoxicity induced by cyproteron acetate was diagnosed after exclusion of other causes, with a gradual improvement after discontinuation of the respective drug treatment Conclusion: All patients treated with cyproteron acetate for prostate cancer are in risk for the development of liver failure and therefore should be monitored and well educated. More information is needed to sufficiently identify risk factors and explain mechanism of damage.

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