Search

Background: Diabetic nephropathy (DN) is a major microvascular complication of type 2 diabetes mellitus (T2DM). Several lines of evidence implicate the endothelin (ET) system in the pathophysiology of DN. The aim of the present study was to analyze if genetic polymorphisms of the ET-1 (EDN1) gene affect susceptibility to DN in Caucasians with T2DM.

General medicine represents a field of primary health care, the functioning of which significantly affects the provision of subsequent health care as well. Ensuring competent general practitioners requires their quality education. To achieve this goal, it is advisable to start already during the undergraduate medical education and then as part of a specialized study in the specialized field of General Medicine. In recent years, the education of general practitioners in Slovakia has undergone several positive changes, the aim of which is to add high-quality, competent and knowledgeable general practitioners to practice. As of the date 31. 7. 2022, 433 doctors were enrolled in the education of general medicine at Slovak Medical University in Bratislava, (SMU) of which the so-called of the classical form 316 and residency study 117. In the classical form, out of the total number of 316 doctors, 22 were enrolled in additional training to obtain a specialization in the field of general medicine for doctors with a specialization in the field of internal medicine (AT-INT) and 25 in the field of anesthesiology and intensive care medicine (AT-AICM). Over the past 10 years at SMU, 375 doctors have completed specialized studies in the specialized field of general medicine, of which 261 in the so-called classical form, including 18 in AT-INT, 3 in AT-AICM and 114 residents. Since general medicine is a very dynamic field of medicine, education must also reflect its needs. [ABSTRACT FROM AUTHOR]

At the Department of Physical Medicine and Rehabilitation (DPM&R) a comprehensive rehabilitation program is provided to both inpatients and outpatients suffering from various medical problems. The department is led by the senior consultant and the head Physiotherapist. The department manager has to be experienced in his specialty as well as in the healthcare management. Objectives: The main aim of the thesis is to provide an insight on the attitude which the physiotherapists working at the Department of Physical Medicine and Rehabilitation have towards their work. Methodology: The research has been carried out empirically. One hundred sixteen physiotherapists working at DPM&R filled in an electronic questionnaire. It was non-standardized and anonymous and it was comprised of twenty-three questions, twenty-two of them being closed questions and one open. There were several options of answers added to every question. The respondents could choose one or more answers. The open question allowed the physiotherapists to express their opinion. The questionnaire had been sent to practicing physiotherapists and to extra-mural undergraduate students of Physiotherapy. Results: Based on the survey, we concluded that managers of the DPM&R prefer a democratic management style. Physiotherapists actively broaden their education, which is very encouraging information. On the other hand, we find it startling that only approximately one quarter of all the respondents are satisfied with putting new trends in physiotherapy into practice. On the bright side, the majority of the respondents find the profession of physiotherapist fulfilling and over a half of them would not consider changing a career. Conclusion: A pleasant working environment and good relations at the Department of Physical Medicine and Rehabilitation reflect positively on the patients' satisfaction with provided health services. [ABSTRACT FROM AUTHOR]

Background: The contribution of free oxygen radicals in the pathogenesis of bronchial asthma is generally accepted. The modulation of antioxidative defence by supplementation with antioxidants represents additive therapy in complex management of disease. The aim of the study was to assess the levels of coenzyme Q10 , α-tocopherol, and β-carotene both in plasma and whole blood, and malondialdehyde (MDA) and eosinophil cationic protein (ECP) in plasma of asthmatics (As). Methods: Fifty-six As (15 males and 41 females) aged from 19 to 72 years (mean age 46 years) suffering from allergic asthma were enrolled into the study. The control group comprised 25 healthy volunteers (16 males, 9 females) aged 25–50 years. Results: The concentrations of CoQ10 decreased significantly both in plasma and whole blood, compared with healthy volunteers (0.34 ± 0.15 μmol/l vs. 0.52 ± 0.15 μmol/l, 0.33 ± 0.14 μmol/l vs. 0.50 ± 0.13 μmol/l, P < 0.001, P < 0.001, respectively). The levels of α-tocopherol were decreased both in plasma and whole blood in comparison with controls [24.10 μmol/l (19.8; 30.5), vs. 33.20 μmol/l (28.25; 38.05), 17.22 ± 6.45 μmol/l vs. 21.58 ± 7.92 μmol/l, P = 0.006, P = 0.01, respectively]. The levels of MDA were elevated over the reference range in both groups (reference range < 4.5 μmol/l). No changes were seen in β-carotene concentrations. Positive correlation was found between whole blood CoQ 10 and α-tocopherol concentrations. Conclusion: Results of the study suggest a possible contribution of suboptimal concentrations of CoQ10 on antioxidative dysbalance in As and provide a rationale for its supplementation. [ABSTRACT FROM AUTHOR]

Introduction: Virus of hepatitis C (HCV) is the leading cause of chronic liver disease, including cirrhosis and cancer, and the most common indication for liver transplantation. In industrialised countries, injecting drug use is currently the most important risk factor for infection with hepatitis C, resulting in high prevalence of hepatitis C among injecting drug users (IDUs). The aim of the study was to assess the seroprevalence of HCV infection and distribution of genotypes among IDUs in the years 2004-2008., Probands and Methods: A total number of 846 probands, both sexes (590 males and 256 females) with mean age from 24 to 29 years were investigated in the years 2004-2008. Standard virological tests were performed., Results: The seroprevalence of anti-HCV positivity during the years 2004-2008 were in range 34-78% and positivity of HCV RNA assessed by PCR method were in range 17-71%. The genotypes distribution was in favour of genotype 3., Conclusions: In Slovakia IDUs represent risk group with high prevalence of hepatitis C. These results are comparable to those published in other European countries.

Introduction: The most risk group with high rate of infection of viral hepatitis C represents the former drug abusers (IDUs)., Objectives: The objectives of the clinical study were to assess the sustained virological response (SVR) in the group of former IDUs with chronic hepatitis C (CHC) treated with pegylated interferon-α and ribavirin., Patients and Methods: Of 293 previously untreated (naive) former IDUs with CHC who have started treatment, we assessed 239 (69 women, 170 men) with an average age of 27 years who completed treatment and received a follow-up examination after 24 weeks. Prior to therapy abstinence to drug abuse 6 and more months has been required. The CHC has been diagnostics by the standard virological diagnostic tests, increased activity of aminotranferases (ALT) and histology of liver biopsy. Patients were treated with combined immunomodulatory therapy in the standard duration and standard regimen. SVR was considered if qualitative test HCV RNA was negative 24 weeks after the completion of the treatment., Results: End-of-treatment virological response was in 224/94 % patients. Overall SVR rate was 95 %, 227 subjects had negative HCV RNA and only 12 patients no response. During treatment there was a statistically significant decrease in ALT. Treatment was accompanied by the expected side effects., Conclusion: Young age, short duration of HCV infection, high prevalence of genotype 3 and low grade of liver fibrosis in majority of patients and good adherence of patients to treatment were crucial predictive factors resulting in high SVR.

Background: Data on the efficacy and safety of long-term vitamin D supplementation in chronic kidney disease (CKD) are scarce. We assessed the effects of the 12-month vitamin D(3) treatment on mineral metabolism and calciotropic hormones in patients with CKD stages 2-4., Methods: Eighty-seven patients (mean age 66 years, men/women 33/54) were randomized to cholecalciferol treatment with either 5,000 or 20,000 IU/week. Serum calcium, phosphate, 25(OH)D(3), 1,25(OH)(2)D(3), PTH and urinary mineral concentrations were obtained at baseline and after 4, 8 and 12 months., Results: The median serum mineral concentrations were normal and not changed throughout the study. The number of hypercalciuric patients slightly increased with higher dose, but no sustained rise in calciuria was present. Vitamin D insufficiency/deficiency was revealed in 72 (83%) patients at baseline and 37 (43%) at month 12. The 25(OH)D(3) levels increased more with higher dose; a rise in 1,25(OH)(2)D(3) was less impressive. The parathyroid hormone (PTH) concentrations were reduced, but the number of subjects with PTH below the lower limit for CKD stage 3 increased equally with both doses., Conclusions: Vitamin D insufficiency/deficiency in CKD significantly improved after the 12-month cholecalciferol treatment, with higher dose being more effective and equally safe. Further studies of vitamin D(3) effects on bone metabolism are warranted., (Copyright 2008 S. Karger AG, Basel.)

Unlabelled: Bronchial asthma is a chronic inflammatory disease of respiratory system, with disturbances in the dynamic balance of oxidant-antioxidant capacity of the lungs. Long-term administration of corticosteroids has been shown to result in mitochondrial dysfunction and oxidative damage of mitochondrial and nuclear DNAs. We previously documented decreased coenzyme Q(10) (CoQ(10)) and alpha-tocopherol concentrations in plasma and blood in corticosteroid-dependent bronchial asthma patients. In the present study we demonstrate that CoQ(10) supplementation reduces the dosage of corticosteroids in these patients., Patients and Methods: This was an open, cross-over, randomized clinical study with 41 bronchial asthma patients (13 males, 28 females), ages 25-50 years. All patients suffered from persistent mild to moderate asthma. The patients were divided into two groups, one group receiving standard antiasthmatic therapy and clinically stabilized, and the second group receiving, in addition, antioxidants consisting of CoQ(10) as Q-Gel (120 mg) + 400 mg alpha-tocopherol + 250 mg vitamin C a day. The groups were crossed over at 16 weeks for a total duration of 32 weeks., Results and Conclusions: Data show that patients with corticosteroid-dependent bronchial asthma have low plasma CoQ(10) concentrations that may contribute to their antioxidant imbalance and oxidative stress. A reduction in the dosage of corticosteroids required by the patients following antioxidant supplementation was observed, indicating lower incidence of potential adverse effects of the drugs, decreased oxidative stress. This study also demonstrates the significant uptake of CoQ(10) by lung tissue in a rat model using hydrosoluble CoQ(10) (Q-Gel).

Hypokalemia is associated with some renal diseases manifested by renal tubular acidosis (type I and II) or by renal tubular syndrome (Bartter's, Gitelman's and Liddle's syndrome). Bartter's syndrome, originally described by Batter and colleagues in 1962, is a set of closely related renal tubular disorders characterized by hypokalemia, hypochloremia, metabolic alkalosis and hyperreninemia with normal blood pressure. The underlying renal abnormality results in excessive urinary losses of sodium, chloride, potassium and calcium. Muscle weakness, polydipsia, polyuria and mental retardation can be also present. Affected children have poor growth rates and they appear malnourished. The article is focused on ethiopathogenesis, laboratory and clinical characteristics and on the treatment of Bartter's syndrome.

Treatment by dialyzing represents an important contribution to the therapy of nephropathic patients. On the other hand, besides high financial costs it is not possible to forger significant social and psychic consequences of this therapy. The present paper aimed at a pharmacoeconomic evaluation of the costs of conservative treatment of nephropathic patients. The secondary aim was to compare the costs of conservative treatment in patients with markedly limited renal functions, creatinine clearance (Ccr < 0.4 ml/s), with those in patients with only slightly and medium-reduced renal functions (Ccr 0.4-1 ml/s). Health documentation from three nephrological out-patient surgeries was used to evaluate the results, the criterion for the selection of patients being a nephrological diagnosis with Ccr below 1 ml/s. The group comprised 102 patients aged 21-84 years (average age being 63.99 years), including 56 females (54.9%) and 46 males (45.1%). According to the stage of renal disease, they were divided into two groups. The patients with slightly and medium-reduced renal functions (Ccr 0.4-1.0 ml/s) represented nearly three quarters, whereas the patients with markedly reduced renal functions (Ccr < 0.4 ml/s) only slightly more than one quarter. In the group under study, the pharmacotherapeutic costs represented 2,889,778.0 SK/year (28,331.16 SK/1 patient/1 day), in patients with renal insufficiency the costs being markedly higher (47,427.3 SK/1 patient/1 day in comparison with 21,456.7 SK/1 patient/1 day). Of total pharmacotherapeutic costs, 29.38% was represented by antihypertensive agents, 24.47% by preparations supplementing essential amino acids, 14.83% by hypolipidemic agents, 14.37% by preparations supplementing calcium, 6.19% by antianaemic agents, and 7.76% by other drugs. The results demonstrate that pharmacotherapy of renal diseases is costly but in comparison with elimination methods (dialysis) it is incomparably less expensive. The spectrum of employed agents is in agreement with the present-day trends in conservative treatment which decelerates the progress of nephropathies.

The present paper aims to analyze therapeutic trends in allergic rhinitis and their relationships to selected pharmacoeconomic parameters. Health and Disease out-patient records from three out-patient allergologic-immunologic surgeries in the towns of Trencín, Nové Zámky, and Bratislava were surveyed. The analysis is based on the recorded prescription of drugs prescribed to the patients in the period of his or her "most recent season" in the years 1999-2000. Altogether 279 records (164 females, 115 males) were evaluated. The highest percentage of pollinotics was dispensed in Bratislava (73%) followed by Nové Zámky (55%) and Trencín (31%). In all three out-patient surgeries, the dominant therapy was a combination of specific immunotherapy (SIT) and antihistanime treatment (AH, 70-75%). Average costs for one day of treatment of allergic rhinitis in the out-patient surgeries under study did not significantly differ (22.20-24.50 Sk, the average value of the daily defined dose being 23.20 Sk). Due to confused kept records, the economic analysis did not take into account the financial costs connected with SIT. The present analysis shows a positive state in the field of diagnostics, connected with improved identification of the inducing allergen and application of causal therapy based on SIT (72%). Approximately one third of patients (27%) received only solo medicamentous therapy without application of SIT, and the SIT therapy alone was received by less than 2% of patients (1.4%).

Background: Coenzyme Q10 belongs to important antioxidants and it has a key role in the synthesis of adenosinetriphosphate. Its beneficial effect was proved in several diseases, e.g. in mitochondrial encephalopathy, mitochondrial myopathy, mitochondrial cardiomyopathy., Material and Methods: All 15 patients of the studied group (5 with tubulopathy and 10 with chronic tubulointersticial nephritis) received antioxidative therapy for three months (E vitamin, C vitamin, riboflavin) and for the last two months coenzyme Q10 was added. Renal functions, spectrum of lipids, parameters of lipid peroxidation (malondialdehyde), levels of alpha-tocopherol, beta-carotene, coenzyme Q10., Results: Before the substitutive antioxidative treatment, coenzyme Q10 levels reached in blood 0.11 +/- 0.03 mumol/l and 0.15 +/- 0.04 mumol/l in plasma. These values were well below the reference range (rr) is 0.4 +/- 1.0 mumol/l). After the substitution coenzyme Q10 levels significantly increased (p < 0.001) to the values of 1.66 +/- 0.16 mumol/l in blood and to 1.78 +/- 0.27 mumol/l in plasma. Plasma levels of beta-carotene increased from the markedly subnormal values 0.25 +/- 0.07 mumol/l (rr > 0.8 mumol/l) to 0.56 +/- 0.02 mumol/l (no statistical difference). Plasma levels of alpha-tocopherol remained within the reference range 32.15 +/- 4.73 mumol/l (rr 15-30 mumol/l) and they increased up to the plasma level of 44.83 +/- 5.82 mumol/l during the period of testing. Malondialdehyde levels did not significantly change within the testing period. No changes in renal functions and parameters of lipid metabolism were described. Patients well tolerated the treatment and no adverse effects were seen during the period of observation., Conclusions: Our results ascertained that levels of antioxidant CoQ10 were lower in patients with nephropathy who underwent conservative treatment with peroral substation. Such deficit can be amended by CoQ10 administration, which could be therefore taken as complementary treatment of nephrology.

Hippurate (Hip), an endogenous conjugate, belongs to the group of uremic toxins. Hip stimulates P-independent glutaminase (PIG) localized at the proximal luminal membrane, desamidating glutamine with the formation of ammonia, a dominant and adaptive elimination product of H+. This appears to be important because metabolic acidosis (MAC) does not stimulate PIG. Moreover, Hip inhibits ammonia production by P-dependent mitochondrial glutaminase (PDG) that is primarily stimulated by MAC. By this mechanism, it shifts the ammonia production from mitochondria to proximal tubular lumen. MAC stimulates Hip synthesis in the liver and kidney and increases Hip plasma concentration and even fractional excretion by the kidney, which creates an effective regulatory loop of ammoniagenesis. Thus, it appears that Hip by its participation in the correction of MAC possesses the modulatory function.

Mitochondrial diseases, rated as rarities in paediatrics and neurology, become more and more often diagnosed in various body systems. In nephrology, mitochondrial defects play an important role in the pathogeny of tubular syndromes, interstitial nephritis, focal and segmental glomerulosclerosis, and probably also some other diseases. Review is aimed to point out such defects and to form conditions for their diagnosis and therapy.

Nimodipine, a calcium antagonist, was administered to 33 patients with subarachnoidal haemorrhage as prophylaxis of late ischaemic neurological deficiency. Despite the relatively high frequency of vasospasm during repeated angiographic examinations (27%), the general therapeutic effect in the group of treated patients was favourable. 52% patients improved and had no or only a minimal neurological deficit. Possible mechanisms of the favourable effect of nimodipine in subarachnoidal haemorrhage are mentioned in the discussion.