Tissue infections of the oropharynx
Al Nassrallah Majdi
Department of the origin: Department of Clinical Microbiology, Faculty of Medicine and University Hospital, Hradec Kralove
Tutor and Tutor’s Dept.: MUDr. Kristýna Vaverková, Department of Clinical Microbiology, Faculty of Medicine and University Hospital, Hradec Kralove Abstract:
Introduction: Oropharyngeal infections are a common cause of problems that dentists deal with in the outpatient departement. These types of infections may have different etiology and we can see them in all of age groups, more often as opportunistic infections but even as causes of primary infections. Oropharyngeal infections of bacterial or mycotic origin are mostly endogennic, caused by resident microflora of oral cavity and are very often polymicrobial.
Aim of study: To evaluate the microbiological findings in patiens from stomatology departement with oropharyngeal infection. To compare the main pathogens involved in infections from our hospital with general data.
Materials and methods: A retrospective evaluation of the bacterial strains which were gained from cultivation of samples from patients treated at stomatological and stomatosurgical department of University Hospital in Hradec Králové. The data were analyzed from a time period of five years from 2014 to 2018. The isolated strains were identified by MALDI – TOF mass spectrometer.
Conclusion: The differences of etiologies seemed to vary insignificantly among age groups and between males and females except for fungal infections which were more common in females. In general the infections were polymicrobial in nature and were dominated by anaerobic bacteria. Infections in deeper structures were usually caused by resident oral flora spreading into the neck and deeper tissues.
Vancomycin resistant enterococci
AttaAlla Marten Reda Youssef Ibrahim
Department of the origin: Department of Clinical Microbiology, Faculty of Medicine and University Hospital, Hradec Kralove
Tutor and Tutor’s Dept.: MUDr. Kristýna Vaverková, Department of Clinical Microbiology, Faculty of Medicine and University Hospital, Hradec Kralove Abstract:
Introduction:
Enterococci are generally not considered to be of high virulence. However, the species E.
feacium and E. fecalis may cause community and nosocomial infections – UTIs, endocarditis, biliary tree infections and sepsis.Vancomycin-resistant enterococci (VRE) were first identified in the mid-1980s in Europe and ever since, they have spread rapidly becoming a major issue in health care facilities acros the region and in the United States.
Enterococci have the intrinsic resistance to most of the commonly used antibiotics and are able to aqcuire new resistance via mutations or receipt of foreign genetic material, providing them with a selective advantage over other microorganisms in the intestinal flora.VRE may even transfer their vancomyocin resistance to other gram positives.
Aim of study:
Nosocomial rate of VRE has been increasing over the years, with an alarming leap from 1989 to 19993 where it increased from 0.3% to 7.9% a 34-fold rise (according to the Centers for Disease Control and Prevention's National Nosocomial Infections Surveillance). Thus, this study sought out to identify the prevalance of VRE in patients admitted to the faculty hospital and identify any patterns of major concern and compare results with other health care facilities.
Materials and methods:
Retrospective data gained from the evaluation of cultivation samples of patients admitted to the faculty hospital in the past 5 years. Isolated strains were identified by MALDI-TOF molecular diagnostics and susceptibility testing to vancomycin and teikoplanin, examinated by disc diffusion test and by E-tests.
Conclusion:
The prevelance of VRE at the faculty hospital has seen a steady increase from 2014 to 2018, it has risen from 1.2% to 12.2% of total enterococci colonized patients, with hematology being the major department of which VRE strains were isolated. This steady rise in VRE admissions is in concordance with the rest of the world but is a significantly lower than prevelance of some countries such as the United States which was at 12.6% in the year 2000.
Gastroenteritis – comparison of bacterial and viral etiology (1-2 years retrospective study)
Fernandes Caroline
Department of the origin: Department of Clinical Microbiology, Faculty of Medicine and University Hospital, Hradec Kralove
Tutor and Tutor’s Dept.: MVDr. Zuzana Čermáková, Ph.D., Department of Clinical Microbiology, Faculty of Medicine and University Hospital, Hradec Kralove
Abstract:
Gastroenteritis is described as the inflammation of the gastro-intestinal tract (mainly stomach and small intestines) usually by some infectious causative agent. The disease most commonly manifests clinically with diarrhea and vomiting as well as other non-specific symptoms such as fever and myalgia. The severity and duration of the illness as well as approach to treatment usually depends on the causative agents.
This epidemiological retrospective study aims to analyze the incidence of gastroenteritis among the patient population of the University Hospital in Hradec Kralove over the last two years (2017-2018). All results demonstrating a positive result for either viral or bacterial gastroenteritis were obtained from microbiological tests (such as cultivation or antigen tests) conducted on stool samples or rectal swabs from suspected patients. A total of 440 patients were shown to be positive for bacterial gastroenteritis and 485 patients were positive for viral gastroenteritis. The parameters of the study include identifying the incidence of gastroenteritis due to various bacterial causative agents (e.g. Salmonella Enteritidis, Clostridium Difficile etc.) versus incidence due to viral causative agents (namely Rotaviruses, Noroviruses and Adenoviruses) and exploring the prevalence of each causative agent among various groups mainly divided by factors such as sex and age. The statistical findings of the study will be presented in detail during the conference. Over time these retrospective studies show importance in understanding the changes within our microbiological environment and allow us to predict future patterns of infection as well as potentially equip the scientific community with valuable data that may lead to more efficient prevention and treatment of such diseases.
Patient with dialysis treatment - nosocomial strain findings (retrospective study)
Hoonjan Pryia Kaur
Department of the origin: Department of Clinical Microbiology, Faculty of Medicine and University Hospital, Hradec Kralove
Tutor and Tutor’s Dept.: MUDr. Miroslav Fajfr, Ph.D., Department of Clinical Microbiology, Faculty of Medicine and University Hospital, Hradec Kralove Abstract:
Study aim: The main purposes for this study were the evaluation of the microbiological findings in patients treated by haemodialysis and the determination of level of colonization by nosocomial strains (especially by the gram-negative bacteria producing some of extended spectrum betalactamases)
Materials and Method: Study time period was 2014-2017. In total 8565 relevant samples were chosen for other evaluation from 10255 samples collected from patients treated by hemodialysis during the study time period. Study cohort constituted by 1905 of patients, 51.1% were male and 48.1% were female.
Results: Our data shown that the most frequent gram-negative bacteria from our cohort were Escherichia, Klebsiella and Pseudomonas. And from the gram-positive bacteria were the most frequent Staphylococcus coagulase negative and Enterococcus.. In total we had found 636 gram-negative bacteria with beta-lactamases producing (ESBL, AmpC, K1 and inducibile AmpC), 663 gram-negative bacteria with resistance to fluoroquinolones, 57 multiresistant strains of Pseudomonas aeruginosa, 11 strains of MRSA and 4 times vancomycine-resistant Enterococci. During the evaluation we also found high number of non or low pathogenic bacteria in study samples like coagulase-negative staphylococci or corynebacteria.
Conclusion:
Our results were fully comparable with studies from foreign countries. The study from US (Ouikomonou and Alhaddad, 2017) shown the most frequent positivities as E. coli (29.3%) and Klebsiella (10.7%), and also in this study were highline the high ESBL level in these bacteria (41.4% in E. coli).
Hepatitis E (comparisoned data from the Czech Republic to student´s country), retrospective study
Joseph Rubin
Department of the origin: Department of Clinical Microbiology, Faculty of Medicine and University Hospital, Hradec Kralove
Tutor and Tutor’s Dept.: MUDr. Miroslav Fajfr, Ph.D., Department of Clinical Microbiology, Faculty of Medicine and University Hospital, Hradec Kralove Abstract:
Aim: The aim of the study was to evaluate Hepatitis E laboratory investigations during the years 2016-2017 in University hospital in Hradec Kralove. These published results from the Great Britain (Student´s country)
Materials & Method: During the study period, 2774 samples from 1997 patients were studied.
For study were admit all samples which were ordered for hepatitis E examination, no samples were excluded. In total 47.9 % samples were female and 52.1 % of samples were male. The samples were from hospitalized patients, outpatients and from the GP.
Results: We obtained paired sera only from 23.7% (n=473) patients were examined paired sera and 76.3% (n=1524) patients had single samples. In total 4.7% (n=93) patients had acute or ongoing infection of hepatitis E and 10.0% (n=200) patient had anamnestic serological result. Negative results were from 68.5% (n=1368) patients and in 16.8% (n=336) patients we were not able to assess the result.
Discussion: According to research done in 2016 in the UK, the seroprevalence of Anti-HEV IgG was 12.7%, compared to the Czech Republic which had a 10% seroprevalence of IgG (anamnestic serological result.) It could be argued that the results are low because of frequent misdiagnoses (frequently with Hepatitis A or even Drug Induced Liver Injury)
Conclusion: According to the data provided, there is a positive IgG seroprevalence for Hepatitis E in both countries at around similar numbers (differing by 2.7%) indicating that it is becoming a more prevalent cause of Hepatitis in developed countries, such as the Czech Republic and the UK as the findings were similar in their results. The two countries share a similar incidence rate of infection with Hepatitis E.
Retrospective study of leptospirosis in Hradec Králové and neighbouring regions
Sajith Gautham
Department of the origin: Department of Clinical Microbiology, Faculty of Medicine and University Hospital, Hradec Kralove
Tutor and Tutor’s Dept.: MVDr. Zuzana Čermáková, Ph.D., Department of Clinical Microbiology, Faculty of Medicine and University Hospital, Hradec Kralove
Abstract:
Introduction: Leptospirosis is a globally important zoonosis caused by the spirochetes of the genus Leptospira. It occurs in urban environments of industrialised and developing countries, as well as in rural regions worldwide, with the highest incidence being in countries that occupy the tropics and subtropics. Mortality remains significant related to both delays in diagnosis, due to lack of infrastructure and adequate clinical suspicion and, to other poorly understood reasons. On the basis of genetic analysis, 13 pathogenic types of Leptospires have been identified. Transmission of disease occurs from contact with moist substrates that have come in contact with the urine of reservoir animals, mostly rodents. The disease has a rather clinically broad spectrum of manifestations, but typically follows a two-phase progression.
Aim: To retrospectively analyse the medical history and clinical progression of disease in patients with cooperation from hospitals & clinics in Hradec Králové, Jičín, Rychnov, Vysoké Mýto, Moravská Třebová, Jevíčko, Jilemnice, Chrudim, Náchod, Havlíčkův Brod, Dvůr Králové, Pardubice and Brno to help further the current understanding of leptospirosis infection in central Europe, in hopes to mitigate the number of fatal outcomes due to misdiagnosis or due the poor understanding of risk factors.
Method: During the initial phase of the illness, before immune response, real-time PCR method is employed using surface lipoprotein LipL32 found in pathogenic types of Leptosipra. In the second phase of illness, after the body has had the time to produce anti- Leptospiral antibodies, Microagglutination test (MAT) has been used as the gold standard for detection. 1033 PCR and 1760 MAT results of patients tested between the years 2010-2017 have been evaluated to narrow down 67 true positive results.
In cooperation with doctors from concerned clinics & hospitals; patient history, clinical progression of illness, laboratory results, treatment etc. have been recorded and statistically evaluated.
Study and Design of 3D printed scaffolds for tissue engineering
Thirumushi Sairaj Revathi
Department of the origin: Department of Medical Biophysics , Faculty of Medicine, Hradec Kralove
Tutor and Tutor’s Dept.: Ing. Martin Kopeček, Department of Medical Biophysics, Faculty of Medicine, Hradec Kralove
Abstract:
3D printing is the process of combining cells into functional tissue and organ models from 3D-system based computerized applications. It has proven to have a fundamental role in the future of medicine to solve issues associated with shortage of donors for transplantation required during dire times. However, it comes with drawbacks such as ethnicity, cost, regulation and surgical challenges have to be looked out for. The research was focused towards the choice of material, elemental structure and key properties to consider application of them to the future use of living cells and construction of the tissue.
With the use of certified scaffold utilizing materials such as ABS and PLA, durability and other factors are to be considered in order to be useful as models to meet the demands of the future. Using pressure load tests, test samples of different engineering architectures portraying the same density were compressed under same pressure conditions to test and compare the compaction and elastic behaviors immediately after the impact load.
The Effect of a Single and Repeated Doses of Memantine on Gastric Myoelectric Activity in Experimental Pigs
Tsianou Chrysostomi Christina
Department of the origin: 2nd Department of Internal Medicine - Gastroenterology, Faculty of Medicine and University Hospital, Hradec Kralove
Tutor and Tutor’s Dept.: prof. MUDr. Jan Bureš, CSc., 2nd Department of Internal Medicine - Gastroenterology, Faculty of Medicine and University Hospital, Hradec Kralove Abstract:
Memantine is an uncompetitive antagonist of the N-methyl-D-aspartate type of glutamate receptors used for the treatment of Alzheimer’s disease. In humans, memantine administration is associated with different gastrointestinal side effects, thus limiting its clinical use.
Mechanism of these disorders has not been clarified yet. The aim of this study was to evaluate the impact of a single and repeated doses of memantine on porcine gastric myoelectric activity evaluated by means of electrogastrography (EEG). Six adult experimental pigs entered the study for two times. The EGG was recorded after a single intragastric dose (20 mg) and after a 7-day intragastric administration (20 mg per day, with a 40 mg extra dose last day).
Pharmacokinetics and organ distribution of memantine were accomplished. Analysis of memantine was performed by high-performance liquid chromatography. Both single and repeated doses of memantine increased dominant frequency at EGG. In comparison with a single dose, the EGG basal power was significantly higher after repetitively administrated memantine. Neither the dominant frequency nor EGG power correlated with plasma concentration of memantine. Severe gastric arrhythmia and long-lasting low power after repeated administration might explain possible gastric dysmotility side effects in the chronic use of memantine.
Microvascular abnormality as an endophenotype of schizophrenia
Ahmed Mariam Ahmed Abdelmonem
Department of the origin: Department of Psychiatry, Faculty of Medicine and University Hospital, Hradec Kralove
Tutor and Tutor’s Dept.: prof. MUDr. Ladislav Hosák, Ph.D., Department of Psychiatry, Faculty of Medicine and University Hospital, Hradec Kralove
Abstract:
The research project is aimed to assess whether microvascular abnormality evaluated by retinal imaging is an endophenotype of schizophrenia. If yes, it should be found significantly more frequently in patients’ healthy relatives than ins the general population. The project should contribute to our knowledge of the etiopatheogenesis in an innovative way. The following hypothesis are tested:
Microvascular abnormality detected by retinal imaging is significantly more frequent in the schizophrenia patients’ healthy relatives than in the healthy controls.
Microvascular abnormality has a generic background related to angiogenesis and inflammation.
Assessment of microvascular abnormality and genetic examination should be performed in 80 patients of schizophrenia, their 80 healthy first degree relatives, and 80 unrelated healthy controls.
Safety and efficacy of non-steroidal anti-inflammatory drugs to improve gastrointestinal recovery after surgery: international, prospective cohort study
Amjad Talal
Department of the origin: Department of Surgery, Faculty of Medicine and University Hospital, Hradec Kralove
Tutor and Tutor’s Dept.: MUDr. Július Örhalmi, Department of Surgery, Faculty of Medicine and University Hospital, Hradec Kralove
Abstract:
Introduction: Ileus is common after elective colorectal surgery and is associated with increased adverse events and length of stay. The aim was to assess the role of non-steroidalanti-inflammatory drugs (NSAIDs) for reducing ileus after surgery.
Methods: A prospective, multi-centre, cohort study was delivered by an international, student- and trainee-led collaborative group. Adult patients undergoing elective colorectal resection between January and April 2018 were included. The primary outcome was time to gastrointestinal recovery, measured using a composite measure of bowel function and oral tolerance (GI-2). The impact of NSAIDs was explored using Cox regression analyses, including the results of a centre-specific enhanced recovery questionnaire. Secondary safety outcomes included anastomotic leak and acute kidney injury.
Results: 4164 patients were included with median age 68 years (IQR: 57-75; 54.9% male).
A total of 1,153 (27.7%) received NSAIDs, of whom 1061 (92.0%) received non-selective cyclooxygenase inhibitors. After adjustment for baseline differences, mean time to gastrointestinal recovery did not significantly differ between patients receiving and not receiving NSAIDs (4.6 vs. 4.8 days; HR: 1.04, 95% CI: 0.96-1.12, p=0.360). There were no differences in anastomotic leak rate (5.4% vs. 4.6%; p=0.349) or acute kidney injury (14.3%%
vs. 13.8%; p=0.666), respectively. Fewer patients receiving NSAIDs required strong opioid analgesia (35.3% vs. 56.7%; p<0.001).
Conclusion: NSAIDs did not reduce the time for gastrointestinal recovery after colorectal surgery, but they were safe and associated with reduced post-operative opioid requirement.
High throughput screening of drugs passing the blood brain barrier using PAMPA
Bhorkar Aprajita Milind
Department of the origin: Center of Biomedical Research, University Hospital, Hradec Kralove
Tutor and Tutor´s Dept.: Mgr. Tereza Kobrlová, Center of Biomedical Research, University Hospital, Hradec Kralove
Abstract:
PAMPA (the parallel artificial membrane permeability assay) is a high-throughput screening tool applied to predict the passive transport of potential drugs across the blood-brain barrier (BBB). A non-cell-based in vitro assay was carried out in a coated 96-well membrane filter where a range of 10 drugs were tested for their potential to passively pass the BBB.
Concentration of the compounds in the donor and acceptor was calculated from the standard curve and expressed as the permeability (Pe) ,according the equation:
where
where compounds with values of Pe over 4.0 ×10-6 cm s-1 are considered to be substances with high probability to cross the BBB.
The results of these experiments provide starting points for drug design and for understanding their interaction and role in a particular biochemical process in biology. It is important for the testing of CNS drug candidates as well as for testing non therapeutic side effects of drugs caused by their penetration past the blood brain barrier.
This project was done as a part of an ongoing collaboration between the Biomedical Research department, University Hospital HK and Jagiellonian University, Faculty of Medicine and Pharmacy Poland.
Epidemiologie poranění hrudníku
Boštíková Nora
Pracoviště řešitele: Chirurgická klinika 2. lékařské fakulty Univerzity Karlovy a Ústřední vojenská nemocnice – VFN Praha
Školitel a pracoviště školitele: plk. MUDr. Radek Pohnán, Ph.D., Chirurgická klinika 2.
lékařské fakulty Univerzity Karlovy a Ústřední vojenská nemocnice – VFN Praha Abstrakt:
Poranění hrudníku patří k častým úrazům, které se mohou vyskytovat izolovaně nebo mohou doprovázet jiná zranění, jednak v podobě sdružených poranění anebo jako součást polytraumat. Z funkčního hlediska rozlišujeme lehká a těžká poranění hrudníku, kdy u těžkých poranění dochází k poškození ventilace a cirkulace.
K těžkým poraněním se řadí vícečetné zlomeniny žeber nebo vylomený segment hrudní stěny, které redukují plicní funkci, dále rozsáhlý poúrazový pneumotorax a hemotorax, stejně jako závažná poranění plíce, srdce, průdušnice, jícnu a bránice.
Příčinou úrazů hrudníku jsou údery, pády z výšek, dopravní nehody, sportovní kolize a pracovní úrazy. Méně častou, ale klinicky velmi závažnou příčinou hrudních traumat, jsou bodná a střelná poranění.
Tématem této SVOČ práce je zpracování a retrospektivní analýza dat mezi lety 2015-2019 u všech pacientů ošetřených pro poranění hrudníku v Ústřední vojenské nemocnici v Praze.
Sledovanými parametry jsou demografická data poraněných (věk, pohlaví), příčiny úrazů a úrazový děj, způsob ošetření, komplikace poranění, délka hospitalizace, celková nemocnost a následky poranění.
Očekávaným výstupem bude nejen informace o incidenci hrudních poranění, ale také definování ukazatelů vedoucích ke zlepšení hrudní terapie a vytvoření vlastní databáze shrnující tuto specifickou problematiku.
Jedním z dílčích cílů této práce je sledování výskytu poranění žeber, charakter zlomenin žeber a jejich souvislosti s dalšími poraněními hrudníku i ostatních orgánů. Takováto data ani studie nebyly dosud v České republice publikovány.
Refeeding syndrom u akutně přijímaných geriatrických pacientů s dehydratací
Lejsková Lucie
Pracoviště řešitele: III. interní gerontometabolická klinika LF a FN HK Školitel a pracoviště školitele: MUDr. Ondřej Sobotka, Ph.D., III. interní gerontometabolická klinika LF a FN HK, Ústav fyziologie LF HK
Abstrakt:
Realimentační neboli refeeding syndrom (RFS) je charakterizován významným poklesem fosfátů, magnézia a kalia v krvi, retencí sodíku a vody, deficitem thiaminu a manifestuje se rozličnou škálou klinických symptomů vyvolaných změnami vnitřního prostředí. Přestože je tento fenomén znám již mnoho let, v klinické praxi je často přehlížený a nediagnostikovaný i proto, že přesná kritéria definující RFS jsou problematická. Také příčiny RFS a jeho biochemický a patofyziologický mechanismus zůstávají nejasné. V současné literatuře převládá názor, že RFS je důsledek náhlého přechodu z katabolického do anabolického stavu, způsobeného zahájením realimentace u lidí adaptovaných na dlouhodobé hladovění. Dále bývá popisován abnormální metabolismus glukózy a tuků, hyperamonémie či změny v inzulinové sensitivitě. Geriatričtí pacienti trpí často chronicky nedostatečným příjmem potravy. Ten je zároveň se snížením fyzické aktivity a zvýšené nemocnosti těchto pacientů jednou z hlavních příčin vedoucích ke křehkosti geriatrických nemocných. Zároveň se ukazuje, že přibližně 80 % akutně přijímaných geriatrických pacientů trpí dehydratací s nutností parenterální hydratace.
Cílem naší studie bylo zhodnotit vliv glukózy v iniciální fázi rehydratace geriatrických pacientů a popsat její vliv na vnitřní prostředí a klinický stav po dobu hospitalizace.
Do prospektivní randomizované studie bylo zařazeno 30 nemocných starších 78 let, u kterých byla indikovaná rehydratační léčba. Protokol studie byl schválen etickou komisí FNHK, pacienti zařazení do studie dobrovolně podepsali informovaný souhlas. Kontrolní skupina nemocných byla léčena standardní rehydratační léčbou (Plasmalyte). Druhá skupina byla rehydratována roztokem s přidáním glukózy o koncentraci 100 g/L. Rychlost a objem podané infúze byly výhradně řízené individuální potřebou pacienta. Kromě klinického stavu byla sledována plasmatická hladina glukózy a koncentrace intracelulárních (draslík, fosfor, hořčík) a extracelulárních (chloridy, sodík) elektrolytů.
Sledované skupiny se významně nelišily věkem, počtem komorbidit, délkou hospitalizace ani mortalitou. Průměrná dávka rehydratačního roztoku v prvních 72 hodinách byla u kontrolní skupiny 2100 ml/den a roztoku s glukózou 2500 ml/den. U skupiny pacientů, kteří dostávali rehydratační roztok s glukózou došlo k významnému poklesu intracelulárních elektrolytů, a proto musely být hrazeny intravenózně. Množství pacientů vyžadujících substituci u skupiny s glukózou představovalo 33 % oproti 20 % v kontrolní skupině.
Přídavek glukózy během rehydratace vedl k signifikantnímu poklesu intracelulárních elektrolytů v plazmě. Nejvýrazněji byla ovlivněna hladina fosfátu a draslíku značící rozvoj RFS u těchto pacientů. Rozvoj těchto změn neměl negativní ani pozitivní vliv na délku hospitalizace či mortalitu.
Stav sluchu po operaci otosklerózy
Mrázová Kristýna
Pracoviště řešitele: Klinika otorinolaryngologie a chirurgie hlavy a krku LF a FN HK Školitel a pracoviště školitele: MUDr. Lukáš Školoudík, Ph.D., Klinika otorinolaryngologie a chirurgie hlavy a krku LF a FN HK
Abstrakt:
Úvod: Otoskleróza je onemocnění kostěného labyrintu vnitřního ucha, které se klinicky projevuje převodní nedoslýchavostí v důsledku fixace třmínku v oválném okénku. Principem operace otosklerózy je náhrada fixovaného třmínku protézou.
Cíle: Hlavním cílem je posouzení sluchu pacientů 1 rok po operaci otosklerózy. Vedlejším cílem je posouzení percepční složky nedoslýchavosti v důsledku operačního traumatu.
Metodika: Práce vychází z retrospektivního zpracování dat u pacientů operovaných na Klinice otorinolaryngologie a chirurgie hlavy a krku FNHK v období let 2013-2017. U každého pacienta je zaznamenán tónový audiogram před operací, 2 dny, 1 měsíc a 1 rok po operaci, doplněný o údaje z chorobopisů.
Výsledky: Ve sledovaném období bylo operováno 143 pacientů pro otosklerózu. Po vyřazení pacientů s nekompletní dokumentací byl zpracován soubor 109 pacientů, 78 žen, 31 mužů, věkový průměr byl 47 let, medián 46 let. V prvním měsíci po operaci došlo ke zlepšení sluchu v průměru o 19 dB, rok po operaci o 23 dB. Sluch byl zlepšen rok po operaci u 94 % pacientů, optimální převod zvuku se ztrátami < 10dB byl u 84 % pacientů. Pokles percepční složky nedoslýchavosti v důsledku operačního traumatu byl zaznamenán 2. pooperační den u 16 (15
%) pacientů, významný pokles > 20dB u 9 pacientů (8 %). K úpravě do 1 roku došlo u 10 pacientů, pokles přetrvával u 6 (6 %), významný pokles > 20dB jen u 2 (2 %) pacientů.
Závěr: Práce potvrdila přínos operace pro pacienty s otosklerózou. Zlepšení sluchu rok po operaci bylo prokázáno u 94 % pacientů. Vlivem operačního traumatu došlo 2. pooperační den u 15 % pacientů ke zhoršení percepční složky sluchu, který byl ale u většiny pacientů jen dočasný. Trvalé zhoršení percepční složky sluchu > 20dB bylo prokázáno pouze u 2 % pacientů.
Retrospective Study of Culture Findings from Patients Hospitalized at the Neurosurgery Department, HK in 2015-2018
Muhammad Altaf Rabiya
Department of the origin: Department of Clinical Microbiology, Faculty of Medicine and University Hospital, Hradec Kralove
Tutor and Tutor’s Dept.: MUDr. Kateřina Neradová, Department of Clinical Microbiology, Faculty of Medicine and University Hospital, Hradec Kralove
Abstract:
Brain abscesses are focal collections of purulent material in the brain parenchyma, which may be caused by bacteria, fungi, or parasites. Most are bacterial in origin though pathogens vary with source and route of infection as well as patient immune status. The majority of brain abscesses arise from direct extension of a parameningeal focus of infection, such as sinusitis, mastoiditis, or dental infections.
Aim: To evaluate microbial findings in patients with brain abscesses, their etiology and probable source of infection.
Method: A definitive diagnosis required aspiration of the brain lesion, which is usually performed stereotactically, with the aim of both providing diagnosis and abscess decompression. A retrospective analysis of laboratory findings of 22 patients (16 males and 6 females) after surgery performed between 2015 and 2018 was conducted at the Department of Clinical Microbiology, University Hospital Hradec Kralove.
Results: Among 22 samples submitted for cultures, we described polymicrobial etiology in 10 cases (45%). Anaerobic bacteria predominated (n=19, 46%), frequent findings were especially Fusobacterium spp. and Bacteroides spp. Streptococci were also very common, mostly oral streptococci, including the Streptococcus anginosus group (n=12, 29%). In our cohort, we also tried to describe the most probable source of infection.
Potřeby rodin pacientů a jejich naplnění na JIP
Rumíšková Denisa
Pracoviště řešitele: Ústav sociálního lékařství LF HK
Školitel a pracoviště školitele: Mgr. Veronika Gigalová, Ústav sociálního lékařství LF HK Abstrakt:
Potřeby rodin pacientů a jejich naplnění na JIP je, s rychle se rozvíjejícím moderním ošetřovatelstvím, aktuálním tématem dnešní doby. Nahlížíme na rodinné příslušníky, v pojetí holismu, jako na partnery v péči o nemocné. Zabýváme se oblastí intenzivní péče, významem rodiny pro kriticky nemocného pacienta, potřebami rodinných příslušníků a komunikací s nimi v oblasti intenzivní péče, stejně tak na potřebou sociální opory. Zmapovali jsme informace o aktuálních výzkumech v oblasti potřeb rodin v intenzivní péči, v České republice a zahraničí.
Cílem výzkumného šetření bylo zjistit, které potřeby rodinní příslušníci kriticky nemocného pacienta považují za důležité, jsou-li naplňovány a do jaké míry. Následně zjistit, jak působí hospitalizace blízké osoby na psychiku rodinného příslušníka.
Empirická část kombinuje kvantitativní s kvalitativním výzkumným šetřením. Pro účely práce byl použit standardizovaný dotazník FIN (Family Inventory Needs). Výzkum probíhal na JIP Akutní kardiologie I. interní kardioangiologické kliniky. Kvalitativní část zahrnuje 6 rozhovorů s rodinnými příslušníky pacientů aktuálně hospitalizovaných na JIP v kritickém stavu. Otázky byly zvoleny k navázání kontaktu, a postupnému uvolnění respondenta, s cílem zjistit jeho emoční rozpoložení, a potřebu sociální opory. Z odpovědí respondentů je patrné, že všichni měli potřebu podílet se na péči o jejich blízkého, kriticky nemocného, příbuzného, avšak tato potřeba nebyla vždy naplněna. Tento předpoklad podpořily i výsledky dotazníkového šetření. V oblasti sociální opory z rozhovorů vyplynula skutečnost, že rodinní příslušníci zanedbávají sebe samé, nemyslí tolik na své potřeby, například na potřebu zdraví, ale jejich prioritou je komfort, bezpečí a potřeby kriticky nemocného pacienta, jejich blízkého příbuzného. Stejné závěry vyplynuly i z dotazníkového šetření. Většina rodinných příslušníků hledá oporu v jejich nejbližší rodině, někteří užívají psychofarmaka, a najdou se i tací, co se snaží svou potřebu podpory saturovat prostřednictvím zdravotnických pracovníků.
Velký potenciál možnosti zlepšení kvality péče o pacienty i jejich příbuzné spatřujeme ve větší edukaci zdravotníků, zejména všeobecných sester, v oblasti proaktivní komunikace s rodinami pacientů, aktivním vyhledávání jejich potřeb, s jejich včasnou saturací.
