[Regional registry of pulmonary embolism]. / Regionální registr plicní embolie.

INTRODUCTION: Pulmonary embolism (PE) together with coronary heart disease and arterial hypertension are most common diseases of cardiovascular system. Due to its high mortality rate it is worth of attention. AIM: to describe characteristics of patients with PE, provide data about treatment and inpatient mortality rate. Also to identify an occurence of right-sided heart thrombi in patients with PE and efficiency/safety of thrombolytic therapy in this subpopulation. To evaluate effectiveness/importance of basic oncology screening in patients with PE (meaning efficiency of provided examinations to uncover hidden malignancy). METHODS: Our registry is based on observation of consecutive patients with PE hospitalized in our hospital (catchment area of Znojmo region, 130,000 inhabitants) since July 2011 until April 2014. We collected data about 188 patients diagnosed with acute or subacute PE by perfusion lung scan, CT angiography or typical symptoms with echocardiography findings. RESULTS: In the cohort there were 71 men (37.8%) and 117 women (62.2%), average age 66 years (16-94), 72.9% of patients were older than 60 years of age. History of thromboembolic disease was present in 37 patients (19.7%), malignancy in 36 of them (19.1%), signs of deep vein thrombosis in 36 patients (19.1%), hereditary thrombophilia in 11 (5.9%), recent injury with immobilisation in 10 (5.3%), recent surgery in 14 patients (7.4%) and atrial fibrillation in 22 patients (11.7%). Right heart thrombi were found in 3 patients (1.6%) out of 176 who were examined. Hospital mortality rate reached 5.6%, 3 months mortality rate was 9.4% (data collected from 85.1% of all patients) and 1 year mortality rate was 19.1% (data from 61.2% of all patients). An occult cancer was diagnosed during hospital stay only in 3 patients (1.6%), another 6 malignancies manifested themselves after longer period of time. Median length of hospital stay was 7 days. Thrombolysis was used in 14 patients (7.4%). Bleeding complications of anticoagulant or thrombolytic therapy occured in 4 patients (2.1%) during hospital care--epistaxis, severe haematoma of extremities with necessity of surgical treatment and haematemesis in 2 patients. Cerebral hemorrhage was not present in our cohort of patients. CONCLUSION: PE isnt rare condition, we can encounter it in various medical fields, but due to its diversity of symptoms and unclear prognosis, it continues to be serious clinical problem. Hospital mortality rate is higher in patients with PE than in those with acute coronary syndrome, which is in accordance with published data. Detection of right-sided heart thrombi is about half of that described in literature. Prevalence of dyspnoe and chest pain are consistent with reported data, but occurence of syncope and hemoptysis in our registry is far less common. Screening of occult cancer could be more effective. The therapy seems to be safe, a life threatening bleeding was not present even when thrombolysis was used.

Anamnestic immune response in 3- to 4-year-old children previously immunized with 10-valent pneumococcal nontypeable Haemophilus influenzae protein D conjugate vaccine as 2-dose or 3-dose priming and a booster dose in the first year of life.

BACKGROUND: Immunogenicity of 10-valent pneumococcal nontypeable Haemophilus influenzae protein d conjugate vaccine (PHiD-CV), administered as 2-dose or 3-dose priming followed by a booster dose, has been described previously. The present study evaluated immunologic memory following PHiD-CV vaccination according to these vaccination schedules. METHODS: A dose of PHiD-CV (to test anamnestic responses) was administered to 172 children at 36 to 46 months of age; 110 of them had previously been vaccinated with PHiD-CV according to 2 + 1 or 3 + 1 schedules (PHiD-CV [2 + 1] and PHiD-CV [3 + 1] groups) and 62 were unprimed age-matched controls. To measure immune responses before and 7 to 10 days after the PHiD-CV dose, 22F-inhibition enzyme-linked immunosorbent assay and opsonophagocytic activity (OPA) assay were used. RESULTS: Serotype-specific IgG geometric mean concentrations (GMCs) and OPA geometric mean titers increased substantially (from before to 7 to 10 days after the additional PHiD-CV dose) for all 10 vaccines and 2 cross-reactive serotypes (6A and 19A) in the children previously vaccinated with PHiD-CV, regardless of the vaccination schedule used. Antibody GMCs and OPA geometric mean titers after the administration of the PHiD-CV dose were markedly higher in both previously PHiD-CV-vaccinated groups than in the unprimed control group, clearly demonstrating prior induction of immunologic memory. Antiprotein D antibody GMCs had also increased substantially from before to 7 to 10 days after vaccination in all 3 groups, with higher antibody GMCs in the previously vaccinated groups than in the control group. CONCLUSION: PHiD-CV vaccination according to 2 + 1 or 3 + 1 schedules resulted in comparable anamnestic immune responses. These findings suggest that similar protective efficacy may be achieved with both the schedules.