Here are all the summaries from the Lekarsky obzor journal for citations. Full journal will be available in a few months.
Trauma System in the Slovak Republic - a cross-sectional questionnaire based study of the need of a trauma center network designation in a cohort of trauma surgeons
Radomír GAJDOŠ, Peter JACKO, Martin HOLAS, Juraj ŠVÁČ
Backround: Treatment of polytraumatized and severely injured patients is a specific and very demanding area of trauma care. Centralizing care for these patients to specialized centers reduces mortality and improves functional outcomes. As the Slovak Republic does not have a well-defined system of specialized trauma care centers, the aim of this study was to identify the attitude of trauma surgeons to the draft of a trauma center network designation with a two-tier system of regional and national trauma centers.
Methods: The project was designed as a voluntary cross-sectional questionnaire study in a cohort of trauma surgeons. An anonymous validated questionnaire was used in print form. The data obtained were statistically processed.
Results: In total 99 questionnaires were analyzed. These were obtained from surgeons from three types of hospitals - 14% from university, 37% from faculty and 47% from regional hospitals. Of this cohort, 98% of respondents were in favor of the need to improve the health care to polytraumatized patients and 100% in favor of the need of trauma centers designation. With the creation of a two-tier network of trauma centers manifested their agreement 80,8% of respondents. These results were not statistically influenced by the length of practice, staffing, material-technical equipment, or the type of hospital.
Conclusion: According to the cohort of trauma surgeons, it is necessary to reconfigure the current system of health care of severely injured patients according to international requirements. The most acceptable option for such a systemic change appears to be the creation of large national trauma centers of type I (supra-regional centers of highly specialized care) and around each of them a network of regional trauma centers of type II (regional centers of specialized care).
Key words: polytrauma, trauma network, trauma center designation, regionalization of care.
Lek Obz (Med Horizon), 68, 2019, č. 7, s. 179 – 185
Ethiological agents of urinal infections and microbial resistance: retrospective study
Oleksandr DOBROVANOV, Karol KRÁLINSKÝ, Valentín P. KOVALCHUK
Background: Improper use and increased consumption of antibiotics is one of the main causes of microbial resistance spreading. The spread of multi-resistant bacterial isolates poses a serious threat to public health. Escherichia coli is part of the normal intestinal microflora in humans but is also a frequent cause of severe infections and is the most common cause of febrile urinary tract infections in all age groups. The aim of the retrospective study was the analysis of microbiological agents and the effectiveness of antimicrobial therapy of urinary tract infections in 34 children. The results were evaluated according to various criteria, including the presence of congenital malformations of the uropoetic tract. We point to the rising trend of antibiotic resistance in Europe towards Escherichia coli, which is partly different from our results.
Patients and methods: Retrospectively were analyzed 34 patients with urinary tract infections, which were treated on The 3rd Children‘s Clinic of the Slovak Medical University in Luchenec from January 2018 to December 2018.
Results: The most common developer of febrile urinary tract infection in all age groups was Escherichia coli (27 children, 79.4 %). In a group of patients with E. coli infection and without congenital malformations of the uropoetic tract, resistance to selected antibiotics was minimal. Patients with congenital kidney malformations had higher rates of non-Escherichia coli infections and higher resistance to antibiotics tested.
Conclusion: Treatment of febrile urinary tract infections by third generation cephalosporins is appropriate in our workplace because the bacterial strains of these antibiotics show good sensitivity. In most cases, monotherapy with bactericidal antibiotics is sufficient. Treatment with second-generation cephalosporins was effective in some patients with uncomplicated lower urinary tract infection. Patients with congenital malformations of the uropoetic tract have more frequent non-E. coli infections and higher resistance to antimicrobial agents.
Key words: antibiotics, Escherichia coli, congenital malformations of the uropoetic tract, pyelonephritis, resistance, urinary tract infections, urosepsis.
Lek Obzor (Med Horizon), 2019, 68 (7): 186-190
Analysis of biomarkers of patients with thoracic aortic aneurysm
Miroslava RABAJDOVÁ, Klára LAKATOŠOVÁ, Zuzana BISČÁKOVÁ, Ivana ŠPAKOVÁ, Peter URBAN, Peter KOLARČÍK, František SABOL
Despite the increased eradication of the population and numerous prevention programs for the population, the incidence and prevalence of cardiovascular disease has a steadily rising character. The risk of aneurysm rupture is proportional to its size. The risk of aortic rupture or death is 14.1 % in patients with aneurysms greater than 6 cm. Based on the evaluated data of levels of expression of mRNAs of specific genes and their encoded proteins, was funded a statistically significant difference between patients with different aortic aneurysm diameter in stages I – III for high-sensitivity troponin I and natriuretic peptide. This work presents the use of diagnostic molecular methods of transcriptional activity of biomarkers in differential diagnosis of cardiovascular diseases.
Key words: biomarker, thoracic aortic aneurysm.
Lek Obzor (Med Horizon), 2019, 68(4): 191-194
Rare urogenital cancers in Slovakia
Dalibor ONDRUŠ, Bela MRIŇÁKOVÁ
Rare cancers are defined in the RARECARE project as those with incidence < 6/100,000 per year. Rare tumors are characterized by delayed diagnosis, often inadequate treatment, low availability of the optimal treatment strategy, as well as lack of clinical experience. The aim of this publication is to provide information about some epidemiological data concerning the tumors of urogenital localization in Slovakia belonging to the so-called rare cancers (orphan diseases). The etiology of these malignancies is mostly multifactorial. In the last published year 2011, the standardized incidence (ASR-W) of the penile cancer in Slovakia was 1.1/100,000 and mortality 0.3/100,000. The standardized incidence of the renal pelvis cancer was 1.0/100,000 in males and 0.5/100,000 in females, while mortality was 0.4/100,000 in males and 0.1/100,000 in females. The standardized incidence of the ureter cancer was 0.5/100,000 in males and 0.1/100,000 in females and a mortality was 0.2/100,000 and 0.0/100,000, respectively. The standardized incidence of the urethral cancer was 0.1/100,000 in both sexes and mortality was 0.2/100,000 in males and 0.1/100,000 in females. Centralization of diagnosis and treatment with a multidisciplinary approach and international cooperation is recommended for all patients with rare tumors.
Key words: penile cancer, renal pelvis cancer, ureter cancer, urethral cancer, incidence, mortality.
Lek Obzor (Med Horizon), 2019, 68(7): 195-199
Developmental dysplasia of the hip – etiopathogenesis, diagnostics and genetic aspects
Štefan HARSÁNYI, Radoslav ZAMBORSKÝ, Daniel BÖHMER, Ľuboš DANIŠOVIČ
1Ústav lekárskej biológie, genetiky a klinickej genetiky, Lekárska Fakulta, Univerzita Komenského v Bratislave, Bratislava, prednosta: doc. MUDr. D. Böhmer, PhD.
2Ortopedická klinika, Lekárska Fakulta, Univerzita Komenského v Bratislave, Bratislava, prednosta:
prof. MUDr. M. Kokavec, PhD., MPH
Affections of some parts of the locomotive apparatus in humans are more and more common. This fact is for example caused by the way of life (sport, sedentary work, lack of mobility), long-term unilateral stress or accidents. Congenital (developmental) hip dysplasia is a developmental disorder of the hip joint that results in the formation of an abnormal joint of the femoral head. It encompasses a wide range of morphological deviations, that results in defective functions with different characteristics. During individual phases of individual growth, the diagnosis may turn to physiological or to more severe pathology over time. Small acetabulum and loose capsule are the main anatomical signs for this disease. Present with the main signs are also secondary femoral damage and later also movement problems, which are typical for higher age, but are not an exception in youth. Congenital dysplasia of the hip may also be manifested in moderate forms that are typical by mild laxity of the capsule, or in with severe pathology, which can lead to complete luxation of the joint. Dysplasia of hip joint in children has been among the often-mentioned condition in the past, for which there is no exact cause yet. Molecular genetic examination methods allow us to investigate these causes in greater detail and link them to candidate genes involved in the formation of defective building structures of the connective tissue, thus leading to a damage in its integrity, resulting in joint disorders.
Key words: developmental dysplasia of the hip, dislocation of the hip, genetic factors, candidate genes.
Lek Obzor (Med Horizon), 2019, 68(7): 200-205
Arthropatia alcaptonurica and ochronotica
Jozef ROVENSKÝ, Tibor URBÁNEK, Richard IMRICH, Marián BERNADIČ
The authors at work remind the supporting areas of the scientific activity of a major Slovak physician-rheumatologist Doc. MUDr. Tibora Urbánka, CSc., with whom the medical public has said goodbye to 26. 4. 2019.
Alkaptonuria characterizes the accumulation of homogentian acid in the body, the presence of homogentian acid in the urine, visible, functionally harmless symptoms on the eyes and ears, debilitating changes on the musculoskeletal, damage to other organs (KVS (Mitral and aortic stenosis, kidneys, prostate).
A causal treatment for alkaptonuria is not yet available. Treatment interventions are in three ways: reducing the excretion of homogentian acid in the urine, limiting the emergence of ochronosis, treatment-prevention interventions to influence ochronotic arthropathy. Various dietary interventions (vitamins, hormonal and other) had only a transient effect.
The world gives 1 case to 250 000 to 1 million inhabitants. The increased incidence in Slovakia is explained by the fact that patients come from mountainous areas with a more frequent marriage of related parents in the last century.
Key words: alkaptonuria, ochronosis, homogentian acid, artropathy.
Lek Obzor (Med Horizon), 2019, 68(7): 206-209
Posttransplant diabetes mellitus
Ivana Dedinská, Ľudovít Laca, Marián Mokáň
Posttransplant diabetes mellitus (PTDM) is a serious and common metabolic complication after solid organ transplantation. PTDM increases cardiovascular mortality and morbidity seen in transplant recipients.
The most important risk factors for PTDM is age at time of kidney transplantation (over 50 years), obesity and pre-diabetes at the time of transplantation
Modification of risk factors for PTDM before placing patients on the waiting list can significantly reduce the incidence of PTDM and improve graft and patient survival. Decreased of PTDM incidence after kidney transplantation can logically reduce the incidence of cardiovascular complications and eliminate the mortality of patients with functional graft.
Key words: diabetes mellitus after transplantation, risk factors, obesity.
Lek Obzor (Med Horizon), 2019, 68(7): 210-213
Rhabdomyolysis – rare complication of a prolonged laparoscopic myomectomy
Rastislav DUDIČ, Viera DUDIČOVÁ, Peter URDZÍK
The objective of a laparoscopic operation is to achieve a satisfactory treatment result and at the same time to minimize the traumatic and metabolic effect in the patient. Damaging of tissues occurs in a significantly smaller range in comparison with common open operation procedures, and thus laparoscopy brings another advantage in the reducing of post-operative pain. Among the other advantages of laparoscopy are a better cosmetic effect, a lower risk of wound complications, a shorter period of hospitalization, a shorter re-convalescence, and last but not least cost savings. Despite these advantages laparoscopic surgery may lead to the origin of serious complications.
Many factors have been implicated in the development of rhabdomyolysis during surgery; these include patient positioning with obstructed blood flow of either a femoral vessel at the hip or a popliteal vessel at the knee, or muscle compression due to operative positioning during prolonged surgery, which may results in serious complications of rhabdomyolysis – acute renal failure. This case demonstrates a rare occurrence of rhabdomyolysis after prolonged lithotomy position for laparoscopic myomectomy.
Key words: laparoscopy, lithotomy position, myomectomy, rhabdomyolysis, acute renal failure.
Lek Obzor (Med Horizon), 2019, 68(7): 214-215