Examination of Hyaluronic Acid as a Potential Fibromarker in Patients with Chronic Hepatitis Type C

Barbora Piteková1, Lukáš Greguš2, Karol Laktiš2, Monika Ďurfinová1, Eva Uhlíková1, Ladislav Turecký1

1Ústav lekárskej chémie, biochémie a klinickej biochémie LF UK, Univerzita Komenského v Bratislave, prednosta
prof. MUDr. L. Turecký, CSc.
2Klinika infektológie a geografickej medicíny LF UK a Univerzitnej nemocnice Bratislava, prednosta doc. MUDr. I. Stankovič, CSc.

SUMMARY
Liver fibrosis is an important process in the development of chronic hepatopathy. Therefore, the diagnosis and monitoring of this process is also of great importance in clinical practice. One of the possible ways to investigate fibrogenesis activity is also biochemical examination of blood fibromarker concentration. In our work we studied changes in the concentration of hyaluronic acid in the serum of patients with chronic hepatitis C. In a group of 45 patients with chronic hepatitis C, we examined the serum concentration of hyaluronic acid at the start of treatment and compared it with the result of a liver biopsy. In our group of patients with hepatitis, there were 4 patients with F0 fibrosis, 29 patients with F1 – F2 fibrosis and 4 patients with F3 fibrosis. The concentration of hyaluronic acid in the F0 and F1 – F2 groups did not exceed the reference values. In group F3, the concentration of hyaluronic acid was increased, but in no patient did it exceed 150 ng.ml–1, which represents a significant degree of fibrosis. Comparison of hyaluronic acid values with FibroTest values showed a statistically significant positive correlation (correlation coefficient: 0.57, p < 0.05). Based on our results, we can conclude that hyaluronic acid can be used as a fibromarker. However, it only provides more accurate and reliable results for more severe fibrosis.
Key words: hepatitis C, hyaluronic acid, fibromarker, FibroTest, liver fibrosis, prealbumin.
Lek Obz (Med Horizon), 2019, 68 (12): 415 – 420

Diagnostics of Stroke in the General Hospital in Rimavská Sobota

Timea OSTRIHOŇOVÁ, Anna RÁKAYOVÁ

Rádiologické oddelenie, Všeobecná nemocnica, Rimavská Sobota, primárka MUDr. A. Rákayová

SUMMARY
In recent decades we have been following rapid development in the possibilities of diagnosis and treatment of stroke that is the second to third most common cause of death in both developing and developed countries for years. The aim of this work is to analyse the imaging examinations and other selected data in a group of 230 patients hospitalized in 2018 in the hospital in Rimavská Sobota with stroke of 87.8 % with cerebral infarction, 9.6 % with cerebral haemorrhage and 2.6 % with subarachnoid bleeding and other non-traumatic intracranial bleeding. In 17.8 % of patients with cerebral infarction we evaluated the success of realized intravenous thrombolysis and / or mechanical thrombectomy.
Key words: stroke, neuroimaging, intravenous thrombolysis, mechanical thrombectomy.
Lek Obz (Med Horizon), 2019, 68 (12): 421  –  425

Catheter related Sepsis in Patients on Home Parenteral Nutrition – Retrospective Analysis

Júlia SLEZÁKOVÁ, Mária VOLEKOVÁ

Svet zdravia, a. s., Všeobecná nemocnica Rimavská Sobota, Stredisko pre domácu parenterálnu výživu, vedúca
MUDr. M. Voleková

SUMMARY
Background: The aim of the study was to review the experience with catheter related sepsis and succes of treatment with stadardized practice.
Patients: We examined catheter related sepsis in group of 44 patients included in the home parenteral nutrition program for a period of seven years at the Centre for home parenteral nutrition in Rimavská Sobota.
Methods: The study was performed as a retrospective analysis, we observed incidence, etiological agent of sepsis, association with the underlying disease, effectiveness of prevention program.
Results: We recorded 24 cases of catheter related sepsis in 44 patients with a total of 25 890 catheters-days. The catheter related sepsis incidence was 0,92 cases per 1000 catheter-days. Causative agent of sepsis was Staphylococcus epidermidis and CoNS (7 cases, 25.92 %), Staphylococcus aureus (6 cases, 22.22 %), Candida spp. (3 preparations, 11.11 %), Enterococcus spp. (2 cases, 7.40 %), E. coli (3 cases, 11.11 %), Enterobacter spp. (3 cases, 11.11 %), Klebsiella spp. (2 cases, 7.40 %) and one case caused by Citrobacter spp. (3.70 %).
Most often, catheter related sepsis has been found in patients with extremely short intestine or with no tolerance of oral food intake. The success of maintaining a long-term central venous catheter with catheter related sepsis was 45.83 %. We recorded only one case of death cased by sepsis and septic complications (mortality 4.16 %). After the tightening of prevention program, the incidence of catheter related sepsis decreased from 0.99/1000 catheter days (year 2012  –  2016) to 0.77/1000 catheter days (year 2017  –  2018).
Conclusion: By a retrospective analysis of the observed period, we confirmed quality and safe health care of our patients comparable with other home or foreign centres.
Key words: home parenteral nutrition, catheter related sepsis.
Lek Obz (Med Horizon), 2019, 68(12): 426  –  431

Centre for Home Parenteral Nutrition in Rimavská Sobota – 7 years of experience

Júlia SLEZÁKOVÁ, Mária VOLEKOVÁ, Richard HRUBÝ

Svet zdravia, a. s., Všeobecná nemocnica Rimavská Sobota, Stredisko pre domácu parenterálnu výživu, vedúca: MUDr. M. Voleková

SUMMARY
Background: The target of the work was to evaluate the work of the Centre for home parenteral nutrition in Rimavská Sobota, the first nonacademic centre approved by the Ministry of Health.
Patients: We examined patients included in the home parenteral nutrition program for the period from Januray 1, 2012 to December 31, 2018.
Methods: We realized the study as a retrospective analysis. The observed parameters were: age of the patients, gender, indication leading to home parenteral nutrition, duration of the program, type of venous catheter, presence of infectious and metabolic complications.
Results: 44 patients, 24 (54.55 %) women and 20 (45.45 %) men, with average age of 49.5 years (range 25 – 71) were included. Leading cause was chronic intestinal failure of oncology pacients in 19 (43.18 %) cases, short bowel syndrome in 16 (36.36 %) patients and protein-energy malnutrition with the necessity of parenteral nutrition in 9 (20.45 %) patients. The total number of catheters-days was 25 890. The average number of catheter-days of the oncology patient was 153.26 and 919.12 catheter-days in patients without malignant disease. The most of patients (95.45 %) had Hickman‘s tunneled central venous catheter. The incidence of catheter related sepsis was 0.92 cases/1000 catheters-days. Liver disease associated with parenteral nutrition was confirmed in 5 cases, osteoporosis in 5 cases. 31 patients quit the home parenteral nutrition program. Death associated with parenteral nutrition was reported 1 time (catheter related sepsis). The indication for home parenteral nutrition disappeared in 11 patients. The program was terminated once for noncompliance. 16 oncology patients and three non-oncology patients died.
Conclusion: Data on the results and complications of home parenteral nutrition from one regional center are similar to centers with a larger number of patients and longer follow-up periods.
Key words: home parenteral nutrition, centre of home parenteral nutrition, chronic intestinal failure.
Lek Obz (Med Horizon), 2019, 68 (12): 432 – 436

New Therapeutic Strategies for Relapsed or/and Refractory Multiple Myeloma with Focus on Oral Regimens

Juraj CHUDEJ1, Matej HRNČÁR2, Juraj SOKOL1, Ľubica VÁLEKOVÁ1, Emília FLOCHOVÁ1, Eva MIKUŠKOVÁ3, Tomáš GUMAN4, Monika HLEBAŠKOVÁ4, Ján STAŠKO1

1Klinika hematológie a transfuziológie, Univerzitná nemocnica Martin, Jesseniova lekárska fakulta v Martine, Univerzita Komenského v Bratislave, prednosta prof. MUDr. J. Staško, PhD.
2Onkologická klinika, Fakultná nemocnica s poliklinikou F.D. Roosevelta, Banská Bystrica, primár MUDr. V. Malec, PhD.
3Oddelenie onkohematológie II, Klinika onkohematológie LF UK a NOÚ, Bratislava, prednosta doc. Ľ. Drgoňa, CSc., MHA
4Klinika hematológie a onhohematológie, Univerzitná nemocnica L. Pasteura, Košice, prednosta MUDr. T. Guman, PhD.

SUMMARY
Proteasome inhibitors play an essential role in MM treatment. The oral proteasome inhibitor ixazomib is a promising option for MM treatment as it has demonstrated antimyeloma activity. It was generally well tolerated and had a generally manageable tolerability profile when used in combination therapy. Data from the phase 3 TOURMALINE-MM1 study demonstrated that ixazomib adds another option to the RRMM treatment armamentarium, with a similar HR seen for ixazomib plus Rd versus Rd as seen in other studies of proteasome inhibitors plus Rd. An additional cost is limited toxicity and positive impact to the quality of life experienced by patients. In summary, the oral administration of ixazomib may offer a simpler, less burdensome, and sustained proteasome inhibitor therapy. Particularly encouraging data have also been reported in patients with a poor prognosis, such as those with multiple prior lines of therapy and those with high-risk cytogenetic abnormalities. The efficacy in patients with high-risk cytogenetics is particularly notable, as these patients appear to need prolonged, sustained, active therapy with a proteasome inhibitor, all of which appears feasible with ixazomib. Importantly in the era of triplet regimens, PK studies have demonstrated that ixazomib can be readily combined at full dose with other therapeutic agents. Of relevance to the global, real-world MM patient population, PK studies have also shown that ixazomib can be administered without any dose adjustment to Asian patients and, at a lower dose of 3 mg, to patients with severe renal impairment or end-stage renal disease and to patients with moderate or severe hepatic impairment. Investigation of ixazomib is ongoing, in NDMM and as long-term maintenance therapy in R/RMM, and in combination with other agents in patients with RRMM. The results of these trials are awaited with interest and will be used to further define the role of ixazomib in the treatment of MM in terms of optimal combination regimens and therapeutic approaches in different patient populations. In summary, ixazomib is an effective therapeutic option in the treatment of RRMM, which, due to its oral administration, limited additional toxicity, and the demonstrated feasibility of its administration in combination regimens, is likely to have an important role in the long-term treatment of patients with MM.
Key words: multiple myeloma, proteasome inhibitors, clinical efficacy, tolerability, pharmacokinetics.
Lek Obzor (Med Horizon), 2019, 68 (12): 437 – 449