Radicality and safety of mediastinal lymphadenectomy in lung resection: a comparative analysis of uniportal thoracoscopic, multiportal thoracoscopic, and thoracotomy approaches.

BACKGROUND: Lung cancer poses a significant challenge with high mortality rates. Minimally invasive surgical approaches, including the uniportal thoracoscopic technique, offer potential benefits in terms of recovery and patient compliance. This study focuses on evaluating the radicality of mediastinal lymphadenectomy during uniportal thoracoscopic lung resection, specifically assessing the reachability of established lymphatic stations. METHODS: A comparative study was conducted at the University Hospital Ostrava from January 2015 to July 2022, focusing on the evaluation of radicality in mediastinal lymphadenectomy across three patient subgroups: uniportal thoracoscopic approach, multiportal thoracoscopic approach, and thoracotomy approach. The study implemented the routine identification and excision of 8 lymph node stations from the respective hemithorax to assess the radicality of lymph node harvesting. RESULTS: A total of 428 patients were enrolled and evaluated. No significant differences were observed in the number of lymph nodes removed between the subgroups. The mean number of lymph nodes removed was 6.50 in the left hemithorax and 6.49 in the right hemithorax. The 30-day postoperative morbidity rate for the entire patient population was 27.3%, with 17.5% experiencing minor complications and 6.5% experiencing major complications. Statistically significant differences were observed in major complications between the uniportal approach and the thoracotomy approach (3.5% vs 12.0%, p = 0.002). The overall mortality rate in the study population was 3%, with a statistically significant difference in mortality between the uniportal and multiportal approaches (1.0% vs 6.4%, p = 0.020). CONCLUSIONS: The uniportal approach demonstrated comparable accessibility and lymph node yield to multiportal and thoracotomy techniques. It is equivalent to established methods in terms of postoperative complications, with fewer major complications compared to thoracotomy. While our study indicates a potential for lower mortality following uniportal lung resection in comparison to multiportal lung resection, and demonstrates comparable outcomes to thoracotomy, it is important to approach these findings cautiously and refrain from drawing definitive conclusions.

Extended high-frequency audiometry: hearing thresholds in adults.

PURPOSE: This study aimed to determine hearing thresholds in an otologically normal population without occupational noise exposure aged 18 to 64 years using extended high-frequency audiometry (EHFA). METHODS: Individuals from the general population who have never had hearing problems and whose job was not associated with noise exposure were included in the study and classified by age into 5 categories: 18-24 and, further, by 10 years of age. Each of these groups was further divided according to gender. All subjects underwent tympanometry, conventional pure-tone audiometry within the 0.125-8 kHz range, and extended high-frequency audiometry within the 9-16 kHz range, performed according to the standards. The significance level for statistical testing was set at 5%. RESULTS: Here, we established hearing thresholds in an otologically healthy population within the extended high-frequency (EHF) range (9-16 kHz). We found the EHFA to be a highly sensitive method for early detection of hearing loss, with hearing thresholds decreasing as soon as 35 years of age. In males, the hearing thresholds grew with age more rapidly than in women. The ability to respond at EHF gradually decreased with age and increasing frequency. CONCLUSION: Our results can help improve the knowledge of EHF hearing thresholds for individual sexes and age groups. So far, the standard 7029:2017 is not binding and, moreover, it only reaches up to the frequency of 12.5 kHz. EHFA is a highly sensitive method for the evaluation of hearing loss depending on age and sex.

Effect of Virtual Reality Therapy on Quality of Life and Self-Sufficiency in Post-Stroke Patients.

Background and Objectives: The consequences of stroke have a significant impact on self-sufficiency and health-related quality of life (HRQoL). Virtual reality (VR)-based rehabilitation has the potential to impact these modalities, but information on timing, volume, and intensity is not yet available. The aim of this randomized controlled trial (1:1) was to evaluate the impact of conventional rehabilitation combined with VR on self-care and domains of HRQoL in patients ≤6 months post-stroke. Materials and Methods: The intervention group completed a total of 270 min of conventional VR + rehabilitation sessions. The control group underwent conventional rehabilitation only. Primary assessments with the WHO disability assessment schedule 2.0 (WHODAS 2) questionnaire were conducted before rehabilitation (T0), after completion of the intervention (T1), and at the 4-week follow-up (T2); secondary outcomes included self-sufficiency and balance assessments. Results: Fifty patients completed the study (mean age 61.2 ± 9.0 years, time since stroke 114.3 ± 39.4 days). There were no statistically significant differences between the groups in WHODAS 2, self-sufficiency, and balance scores (p > 0.05). Conclusions: In the experimental group, there was a statistically significant difference in WHODAS 2, assessment of self-sufficiency, and balance scores before and after therapy (p < 0.05). VR appears to be a suitable tool to supplement and modify rehabilitation in patients after stroke.

Detecting Binocular Diplopia in Orbital Floor Blowout Fractures: Superiority of the Orthoptic Approach.

Background and Objectives: In patients with orbital floor blowout fracture (OFBF), accurate diagnosis of ocular motility disorder is important for decisions about conservative or surgical therapy. However, the accuracy of the traditional test for detecting binocular diplopia/ocular motility disorder using a moving pencil or finger (hereinafter, "finger test") has been generally accepted as correct and has not been subject to scrutiny so far. Hence, its accuracy relative to full orthoptic examination is unknown. Materials and Methods: In this paper, the results of the "finger test" were compared with those derived from a complex examination by orthoptic tests (considered "true" value in patients with OFBF). Results: "Finger test" detected ocular motility disorder in 23% of patients while the full orthoptic examination proved much more efficient, detecting ocular motility disorder in 65% of patients. Lancaster screen test and test with color filters were the most important tests in the battery of the orthoptic tests, capable of identifying 97.7% and 95.3% of patients with ocular motility disorder, respectively. Still, none of the tests were able to correctly detect all patients with ocular motility disorder in itself. Conclusions: As the presence of ocular motility disorder/binocular diplopia is an important indication criterion for the surgical solution of the orbital floor blowout fracture, we conclude that a complex orthoptic evaluation should be always performed in these patients.

Comparing results from vestibular caloric stimulation and vHIT from a specialised outpatient clinic.

BACKGROUND: Until recently, vestibular caloric stimulation was the only objective diagnostic method for isolating the function of the lateral semi-circular canals responsible for maintaining balance. Since 2014, the Video Head Impulse Test (vHIT) has been applied in the Czech Republic to investigate the function of all semi-circular canals. Studies conducted so far have shown that the results of these two methods do not often agree. METHODS: The aim of this study was to compare the results of vestibular caloric stimulation and vHIT in a cohort of patients with peripheral vestibular syndrome at a specialized outpatient clinic. The study lasted from July 2016 to August 2017 and included patients with unilateral peripheral vestibular syndrome (n=32; 24 females and 8 males, mean age 49.4 years) and a positive result with either vestibular caloric stimulation or vHIT. FINDINGS: 90% of the patients had a positive vestibular caloric stimulation result, while the vHIT was positive only in 50% of the patients. Both methods were positive in 13 subjects, vestibular caloric stimulation was positive and vHIT was negative in 16 subjects and in 3 cases vestibular caloric stimulation was negative and vHIT was positive. Based on these numbers, both methods concur in 45% of the cases. In 13 patients, apart from lateral canal disorders, vHIT revealed disorders in one of the vertical canals - the front right in 4, the rear right in 2, the front left in 3 and the rear left in 4. When sorted into subgroups of the "TiTrATE" diagnostic algorithm based on the time course and triggering factor, vHIT was found to be positive for acute spontaneous vertigo in 62.5% of cases. vHIT was negative for 70% of chronic and spontaneous episodic complaints. CONCLUSIONS: The diagnosis of peripheral vestibular disorders should take the pathophysiological basis of the disease into account, as this can differ in peripheral disorders. This could then explain the discrepancy between the results of the two methods. The time course of the disease can be a predictor of the vHIT outcome. Localizing the impaired function of particular semi-circular canals using vHIT can inform selective vestibular rehabilitation.

Meckel's Diverticulum in Children-Parameters Predicting the Presence of Gastric Heterotopia.

BACKGROUND: The presence of gastric ectopic mucosa in Meckel's diverticulum is associated with a higher risk of development of complications. The aim of the present study was to investigate which demographic/clinical parameters predict the presence of gastric heterotopia in Meckel's diverticulum. METHODS: This was a retrospective cohort study conducted in a single institution (University Hospital Ostrava, Czech republic). All children who underwent laparoscopic/open resection of Meckel's diverticulum within a 20-year study period were included in the study. RESULTS: In total, 88 pediatric patients underwent analysis. The mean age of the children was 4.6 ± 4.73 years; the male-female ratio was approximately 2:1. There were 50 (56.8%) patients with asymptomatic Meckel's diverticulum in our study group. Laparoscopic resection was performed in 24 (27.3%) patients; segmental bowel resection through laparotomy was performed in 13 (14.8%) patients. Gastric heterotopia was found in 39 (44.3%) patients; resection margins of all patients were clear of gastric heterotopia. No correlation was found between the presence of gastric heterotopia and the following parameters: age, gender, maternal age, prematurity, low birth weight, perinatal asphyxia, distance from Bauhin's valve and length of Meckel's diverticulum. The width of the diverticulum base was significantly higher in patients with gastric heterotopia (2.1 ± 0.57 vs. 1.2 ± 0.41 cm; p < 0.001). CONCLUSIONS: According to the study outcomes, the width of the diverticulum base seems to be a significant predictive factor associated with the presence of gastric heterotopia in Meckel's diverticulum. The laparoscopic/open resection of asymptomatic MD with a wide base should therefore be recommended.

Obesity paradox in patients undergoing lung lobectomy - myth or reality?

BACKGROUND: The aim of the present study was to evaluate the impact of BMI on the short-term outcomes of patients undergoing lung lobectomy. METHODS: This was a retrospective clinical cohort study conducted in a single institution to assess the short-term outcomes of obese patients undergoing lung resection. Intraoperative and postoperative parameters were compared between the two study subgroups: obese (BMI ≥30 kg/m2) and non-obese patients (BMI < 30 kg/m2). RESULTS: In total, 203 patients were enrolled in the study (70 obese and 133 non-obese patients). Both study subgroups were comparable with regards to demographics, clinical data and surgical approach (thoracoscopy vs. thoracotomy). The surgery time was significantly longer in obese patients (p = 0.048). There was no difference in the frequency of intraoperative complications between the study subgroups (p = 0.635). The postoperative hospital stay was similar in both study subgroups (p = 0.366). A 30-day postoperative morbidity was higher in a subgroup of non-obese patients (33.8% vs. 21.7%), but the difference was not significant (p = 0.249). In the subgroup of non-obese patients, a higher frequency of mild and severe postoperative complications was observed. However, the differences between the study subgroups were not statistically significant due to the borderline p-value (p = 0.053). The 30-day postoperative mortality was comparable between obese and non-obese patients (p = 0.167). CONCLUSIONS: Obesity does not increase the incidence and severity of intraoperative and postoperative complications after lung lobectomy. Slightly better outcomes in obese patients indicate that obesity paradox might be a reality in patients undergoing lung resection.

Serological survey of measles immunity in the Czech Republic, 2013.

OBJECTIVES: The aim of the serological survey of measles was to obtain information on the prevalence of antibodies against measles and to verify the effectiveness of vaccination in the Czech population in order to protect public health. METHODS: The serological survey was carried out in the Czech Republic in 2013. Antibodies against measles were tested in 3,111 serum samples of participants aged 1-64 years. Serum samples were tested for the presence of immunoglobulin G (IgG) antibodies by enzyme immunoassay (EIA). The vaccination status assessment was based on the medical documentation. Seroprevalence differences were evaluated by sex and age using the Pearson's χ2 test at 5% significance level. RESULTS: The overall seroprevalence reached 93.0% (2,893/3,111) (95% CI 92.0-93.9). No statistically significant difference was found between men and women (p=0.724). A lower seroprevalence was identified in the first age group (1-year old children) 62% (62/100), as the vaccination has not yet been completed in this age group. The second lowest seroprevalence 80.4% (160/199) was identified in the age group of 35-44 years. The highest seroprevalence 97.7% (387/396) (95% CI 95.7-99.0) was in the population with naturally-induced immunity (age above 45 years). In the individuals with two doses seroprevalence reached 94.1% (2,081/2,212) (95% CI 93.0-95.0). The level of IgG antibodies decreased in persons above 7 years of age. CONCLUSIONS: Based on the results of the serological survey carried out in 2013 in the Czech Republic, it has been decided to postpone the second MMR (measles, mumps and rubella) dose to the age of 5-6 years.

Verification of electronic device technology for measurement and evaluation of thermal exposure of fire fighters and members of rescue teams.

BACKGROUND: The work of members of rescue teams could be associated with very high physical and thermal loads. If not timely interrupted, any extreme labour-thermal load may lead to a failure of the body and fatal collapse. This risk may be significantly reduced by devices that monitor the response of the body during the intervention and inform rescuers about the need to interrupt the exposure when the critical value of the reference indicator is achieved. The aim of the study was to test the correlation between the data of the newly developed device for signaling the strain of rescuers and the indicators of physiological response of the body. MATERIAL AND METHODS: The tests were performed on 2 physically fit fire fighters dressed in a protective rescue suit and using insulating breathing apparatus, over a wide range of heat load under a model load on a bicycle ergometer in a climatic chamber. RESULTS: The study provided a significant correlation between the body temperature measured in the ear canal and the temperature under the suit sensed by the tested device - the Safety Ambient Monitor (SAM) (R = 0.9007). The temperature under the suit also correlated with the temperature of the chest skin (R = 0.8928) and heart rate (R = 0.8613). CONCLUSIONS: A statistically significant correlation was proven between the temperature sensed by the SAM and the body temperature. The technical solution of sensing the temperature under the suit using the verified SAM technology does not affect or limit fire fighters in their work and minimizes the possibility of damage to the sensor and signaling failures. Med Pr 2018;69(1):1-11.

Environmental and Socioeconomic Health Inequalities: a Review and an Example of the Industrial Ostrava Region.

BACKGROUND AND AIM: According to the World Health Organization (WHO) more than 2 million premature deaths and 7 million of total deaths each year can be attributed to the effects of air pollution. The contribution of air pollution to the health status of population is estimated to be about 20%. Health is largely determined by factors outside the reach of healthcare sector, including low income, unemployment, poor environment, poor education, and substandard housing. The aim of the paper was to review a current knowledge of relationships among air pollution, socioeconomic health inequalities, socio-spatial differentiation, and environmental inequity. The relationships were demonstrated on an example of the Ostrava region. Also basic approaches to health valuation were reviewed. RESULTS: Social differences are reasons both for health inequalities and spatial patterns of unprivileged area housing. In urban environments with poor air quality there is also a large concentration of low income residents. Less affluent population groups are more often affected by inadequate housing conditions including second-hand smoking and higher environmental burden in their residential neighbourhoods. Environmental injustice is highly correlated with other factors that link poverty with poor health, including inadequate access to medical and preventive care, lack of availability of healthful food, lack of safe play spaces for children, absence of good jobs, crime, and violence. CONCLUSIONS: The theoretical background and also results of the studies brought evidence that population health is affected by both socioeconomic and environmental inequalities. Air pollution is unevenly distributed in Ostrava and is related to distribution of socially disadvantaged environment and social exclusion as well.

PM10 Air Pollution and Acute Hospital Admissions for Cardiovascular and Respiratory Causes in Ostrava.

BACKGROUND AND AIM: The city of Ostrava and its surroundings belong to the most long-therm polluted areas in the Czech Republic and Europe. For identification of health risk, the World Health Organization recommends a theoretical estimation of increased short-term PM10 concentrations effect on hospital admissions for cardiac complaints based on a 0.6% increase per 10 µg.m-3 PM10 and 1.14% increase for respiratory causes. The goal of the present study is to verify the percentage increase of morbidity due to cardiovascular and respiratory causes, as per WHO recommendations for health risk assessment, in the population of Ostrava. METHOD: The input data include data on PM10 air pollution, meteorological data, the absolute number of hospital admissions for acute cardiovascular and respiratory diseases in the period 2010-2012. To examine the association between air pollution and health outcomes the time series Poisson regression adjusted for covariates was used. RESULTS: A significant relationship was found between the cardiovascular hospital admissions (percentage increase of 1.24% per 10 µg.m-3) and values of PM10 less than 150 µg.m-3 in the basic model, although after adjustment for other factors, this relationship was no longer significant. A significant relationship was also observed for respiratory causes of hospital admissions in the basic model. Contrary to cardiovascular hospitalization, the relationship between respiratory hospital admissions and PM10 values below 150 µg.m-3 (percentage increase of 1.52%) remained statistically significant after adjustment for other factors. CONCLUSIONS: The observed significant relationship between hospital admissions for respiratory causes was consistent with the results of large European and American studies.

A Summary of Environmental Health Studies in the City of Ostrava and the Surrounding Region in the Czech Republic.

AIM: This study is concerned with environmental health studies conducted in Ostrava (Czech Republic) and the surrounding region since the early nineties. METHODS: Various databases, journals and reports, including internal or unpublished reports, were reviewed to assess the individual publications. A brief description of the studies and main results were collated. RESULTS: The city of Ostrava and the surrounding region is an important industrial centre in the Czech Republic with a long-term heavy environmental and occupational disease burden. In spite of the theoretically assessed decline of health risks related to decreasing concentrations of compounds in the environment in recent years, it still poses a disproportionally high risk for the city residents. There are a number of studies suggesting supportive evidence, but they are highly variable in their approach to this topic resulting in a high uncertainty of observed associations and consistency of results. Most of the studies were focused on specific contexts, without any relation to environmental factors. CONCLUSIONS: A more systematic approach is needed to assess environmental health burden of diseases especially in relation to air pollution, based on the prospective cohort study, that would lead to sufficient new evidence for accurate and updated description of the environmental health burden in Ostrava.

[Ageing and Alzheimer disease - system dynamics model prediction]. / Alzheimerova choroba a stárnutí populace - predikce s pomocí systémového modelování.

The aim of the paper is to describe asystem dynamics model applied on aprediction of the number of patients with Alzheimers disease in the EU in the future and related financial impacts. Dementia resulting from Alzheimers disease is the most widely spread type of dementia and is highly connected with the age of the person - the patient. Most people are diagnosed with Alzheimers disease when they are older than 64. The ageing of population will be an ongoing problem in the next few decades due to alow birth rate and increasing life expectancy. This is areason to focus on prediction models of Alzheimers disease and its impact on economy. The paper presents adynamic modelling approach of system dynamics. The created model of the EU population and patients with AD is expanded by afinancial submodel at the end. This submodel estimates the cost on patients from three available cost studies.Key words: systém dynamic Alzhimers disease population ageing.

Inter-rater reliability of carotid atherosclerotic plaque quantification by 3-dimensional sonography.

OBJECTIVES: Embolization from atherosclerotic carotid plaques is the most common cause of ischemic stroke; therefore, identification of high-risk plaques by sonography is important. The aim of this study was to investigate the agreement between 2 investigators in the evaluation of sonographic parameters relating to plaque stability. METHODS: The following plaque parameters were assessed: echogenicity, homogeneity, surface, maximum content, and total volume. Serial 2-dimensional (2D) image sequences were obtained. Linear motion of the probe was automatically synchronized with the electrocardiogram. The edges of the plaque in each image were manually identified by the investigators. The total plaque volume was calculated after computer transformation of 2D images into a 3-dimensinoal (3D) format. Inter-rater reliability for echogenicity, homogeneity, and the surface was assessed by the weighted κ coefficient. Parametric values were tested by a paired t test. RESULTS: We enrolled 30 patients (22 male; mean age ± SD, 72 ± 13 years) in the study and evaluated 28 atherosclerotic plaques. Inter-rater agreement values were as follows: homogeneity, 96% (κ = 0.84; P < .001); surface, 90% (κ = 0.77; P < .001); and echogenicity, 86% (κ = 0.60; P < .001). The significance values for plaque content and volume measurement agreement were P = .311 and .312, respectively, and the correlation coefficient was 0.808. CONCLUSIONS: In our study, the agreement between 2 examiners in the evaluation of 2D and 3D sonographic parameters related to plaque stability was good to excellent. The sonographic measurement of plaque volume growth was the most accurate parameter; therefore, 3D sonography may be used for risk assessment of plaques in the future.

Lacrimal sac dacryolith (76 cases): a predictive factor for successful endonasal dacryocystorhinostomy?

To evaluate whether the presence of dacryolith is a predictive factor for successful dacryocystorhinostomy. The success rate of endonasal dacryocystorhinostomy (EDCR) performed to relieve obstruction of the nasolacrimal duct was evaluated according to the presence of dacryolithiasis. The surgical results of patients with (group I) and without dacryoliths (group II) were analysed and compared 1-year post surgery. A total of 771 EDCRs performed from 1994 to 2010 were evaluated. Dacryolith was found in 76/771 procedures (9.9%). Complete improvement was achieved significantly more frequently in group I (76/76; 100.0%) than in group II (633/695; 91.1%; p < 0.001). EDCRs were performed significantly more frequently in people aged 31-50-years, the average age of the group I was 41.1 years (range 18-72 years), of the group II 53.3 years (range 3 months-86 years; p < 0.001). There was no significant difference in the female-to-male ratio in the two groups. The presence of dacryoliths is a predictive factor for successful endonasal dacryocystorhinostomy.

Development and implementation of fidelity assessment in first episode psychosis services in Czechia: A pilot study.

AIM: The aim of the study was to evaluate fidelity in first episode psychosis (FEP) teams in Czechia and to gage the feasibility and utility of the process in a mental health system that is undergoing a transformation. METHODS: Fidelity assessment was conducted using The First Episode Psychosis Services Fidelity Scale (FEPS-FS). Fidelity assessment was based on a review of data abstracted from the health records of active clients, program documents, administrative data, and interviews with members of staff. The mean scores were compared across the teams. Feasibility and utility were assessed by program response to their fidelity results. RESULTS: Three FEP teams were involved in the fidelity assessment. Across the 35 items, the mean fidelity score ranged from 2.5 to 3.1. Across the FEP teams, the percentage of the 35 items rated as 4 or 5 (satisfactory or exemplary) ranged from 34.3% to 51.4%. CONCLUSIONS: This study provided an opportunity to implement FEPS-FS and assess fidelity in FEP teams in Czechia. The fidelity assessment also provided a baseline for measuring change.

Automatic seizure detection by convolutional neural networks with computational complexity analysis.

BACKGROUND AND OBJECTIVES: Nowadays, an automated computer-aided diagnosis (CAD) is an approach that plays an important role in the detection of health issues. The main advantages should be in early diagnosis, including high accuracy and low computational complexity without loss of the model performance. One of these systems type is concerned with Electroencephalogram (EEG) signals and seizure detection. We designed a CAD system approach for seizure detection that optimizes the complexity of the required solution while also being reusable on different problems. METHODS: The methodology is built-in deep data analysis for normalization. In comparison to previous research, the system does not necessitate a feature extraction process that optimizes and reduces system complexity. The data classification is provided by a designed 8-layer deep convolutional neural network. RESULTS: Depending on used data, we have achieved the accuracy, specificity, and sensitivity of 98%, 98%, and 98.5% on the short-term Bonn EEG dataset, and 96.99%, 96.89%, and 97.06% on the long-term CHB-MIT EEG dataset. CONCLUSIONS: Through the approach to detection, the system offers an optimized solution for seizure diagnosis health problems. The proposed solution should be implemented in all clinical or home environments for decision support.

The Role of Acute Rehabilitation during the COVID-19 Pandemic: A Retrospective Study in the Czech Republic.

In this retrospective study, we used data from the hospital information system (HIS) to evaluate the influence of the COVID-19 pandemic on rehabilitation care at the University Hospital of Ostrava (UHO). From March 2020 to December 2021, 5173 COVID-19 cases were hospitalized at UHO. Cases within individual groups and categories are shown in a flowchart. The average patient age was 64.9 ± 16.9 years. The mean BMI value was 30.6 ± 6.8 in the rehabilitated group, which was significantly higher compared to that among the non-rehabilitated cases 29.1 ± 6.9 (p < 0.001). Among the admitted patients, 16.6% required artificial pulmonary ventilation (APV), 1.8% extracorporeal membrane oxygenation (ECMO), and 11.9% high-flow oxygenation (HF). The days of rehabilitation ranged from 1-102 days. Among all rehabilitated patients, 92.0% (n = 1302) had a hospitalization duration ranging from 1-15 days and 8.0% (n = 114) longer than 15 days. Overall, rehabilitation care plays an important role in providing exercise, mobilization, and rehabilitation interventions to survivors of critical illness associated with COVID-19, enabling the early and functional return to home, and it must, therefore, be integrated into the clinical care of patients with COVID-19.

Associations between migraine and possible risk factors in the Czech Republic.

Introduction: Migraine is a widespread neurological disorder, growing increasingly common. However, the pathogenesis of the disease is often unclear and the evidence for the role of various risk factors is limited. This study aimed to identify risk factors associated with migraine and to contribute towards a better understanding of this disease. Methods: Data from 3,247 questionnaires were analyzed for associations between migraine and sex, age, BMI, degree of education, and air pollution, along with other factors such as contact with friends, physical condition, health, anxiety, and depression. A cross-sectional study was conducted with an approximately equal distribution of the sample by age, gender and two analysed regions. Data were presented using basic descriptive statistics using the chi-square test. The model output was presented using a crude odds ratio (OR) and a fully adjusted OR. Three hundred and eight-six individuals (12%) suffered from migraine. Results: In an adjusted model, the presented study found associations between the prevalence of migraine and sex, age, and level of education. Individuals with migraine statistically significantly more often suffered from depression, anxiety and other selected factors. However, the assumed significant association between the occurrence of migraine and pollution in the region has not been found.

The effects of COVID-19 on sleep and general health of Czech patients with epilepsy.

Objectives: To assess the impact of COVID-19 illness and pandemic era on sleep, general health, health care, and social status in patients with epilepsy in the Czech Republic. Methods: Our designed and approved questionnaire consisted of 23 questions. We focused on (1) patients' demographic and epidemiological data regarding COVID-19, (2) subjective assessment of sleep; (3) epilepsy, and (4) perception of general health during the first year of the COVID-19 pandemic in the Czech Republic from March 2020 to May 2021. We administered the questionnaires during outpatient visits or by phone calls in three major university Czech epilepsy centers (Ostrava, Brno, Pilsen). Results: We enrolled 227 (100%) patients. The mean age (±SD) was 41.2 ± 14.82 years (min 18, max 86 years), and 138 (61%) were women. COVID-19 was confirmed using the PCR test method in 57 (25.1%) patients. In the pre-pandemic era, 62 (27.3%) patients reported sleep disturbances. Insomnia in 46 (74.2%) and excessive daytime sleepiness in 6 (9.7%) were the most mentioned sleep abnormalities. Nocturnal seizures predispose to sleep impairment (p = 0.014) and vivid dreams and nightmares (p = 0.033). COVID-19 infection significantly increased the risk of vivid dreams and nightmares in patients with diurnal seizures (p = 0.006). Sleep quality impairment and seizure frequency worsening [(p < 0.001) and (p = 0.001), respectively] were the most significant risk factors to perform general health deterioration regardless of having COVID-19 (p = 0.559). The most affected age group was 51+ years (p = 0.033). The three centers provided adequate outpatient care during the first year of the pandemic. The employment and social status of the patients remained unchanged (p = 0.074). Conclusions: COVID- 19 infection significantly increased the occurrence of vivid dreams and nightmares in patients with diurnal seizures. Sleep quality deterioration and seizure frequency worsening significantly negatively impacted general health performance.