The selection of the suitable long peripheral catheter in DIVA patients: The significance of ultrasonography.

BACKGROUND: There are several types of LPC (long peripheral catheters) that vary in length, size, insertion method, and cost. The aim of the study was to evaluate whether ultrasonography can be useful for the selection of the suitable LPC in DIVA (difficult intravenous access) patients. METHODS: Based on the ultrasonographic examination, a long peripheral catheter was selected. A 6.4 cm LPC into a vein at a depth of up to 0.5 cm, a 8.5 cm LPC into a vein at a depth up to 1.5 cm, and a 9.8 cm catheter at a depth up to 2 cm using the cannula over needle method. A 12 cm catheter was inserted into the deeper veins using the direct Seldinger method. The catheter diameter was no more than 33% vein diameter. Dwell time and the number of complications of four vascular devices were recorded and compared. RESULTS: One thousand one hundred fifty-six patients, average age 76 years (19-102), 501 men and 655 women, were included in the study. Average dwelling time was 10 days (1-30), there were 136 complications (11.7%). A catheter 6.4 cm long was inserted in 346 (29.8%), 8.5 cm in 140 (12.1%), 9.8 cm in 320 (27, 5%), and 12 cm in 356 (30.6%) patients. There were no significant differences in dwelling time, rate, and type of complications among the four catheters used. CONCLUSION: Our results confirm that ultrasound examination can be useful for the selection of the suitable long peripheral catheter in DIVA patients.

Optimal vascular access to hemodialysis, or what modern medicine offers us.

Hemodialysis is a life-saving method for patients with acute and chronic kidney failure. This treatment requires sufficiently large and safe vascular access. Ensuring optimal vascular access is therefore a prerequisite and an integral part of the care of these patients. In addition to commonly known vascular approaches such as non-tunnelized or tunneled hemodialysis catheters and AV fistulas, less well-known methods are also available, such as a translumbar or directly surgically inserted hemodialysis catheter into the right atrium. However, these alternative approaches are the only, life-saving alternative for some patients. The ambition of this review article is to offer a comprehensive view of the available options for vascular access, the algorithm for its selection and solutions to the most common complications in clinical practice.

Smoking cessation and risk of type 2 diabetes.

Risk of type 2 diabetes mellitus (T2DM) is higher in tobacco smokers compared to non-smokers. The risk declines after smoking cessation. However, ex-smokers are also more prone to the metabolic syndrome. The question thus is, whether ex-smokers could temporarily have a higher risk of T2DM than current smokers. The available studies on this topic are not in agreement in their conclusions, as most of them also primarily do not compare ex-smokers to current smokers, but to non-smokers. However, based on the available studies, it rather seems the risk of T2DM is temporarily higher after smoking cessation. The higher risk of T2DM seems to be enhanced by weight gain that typically occurs first years after smoking cessation without intervention. Therefore, smoking cessation in patients who are in an increased risk of T2DM should be accompanied by T2DM preventative measures (lifestyle modification, weight monitoring and recommendation of pharmacotherapy of tobacco addiction to lower the risk of weight gain) and more frequent checks of blood glucose level to ensure early T2DM detection.

Significance of plasma fibrinogen and malondialdehyde in the post-inflammatory period in patients with cystic fibrosis.

OBJECTIVES: Evaluation of selected inflammatory parameters and serum malondialdehyde (MDA) significance in the post-inflammatory period in adult patients with cystic fibrosis. BACKGROUND: Laboratory biomarkers can be integrated into clinical practice as part of monitoring the effectiveness of treatment. METHODS: After recovery from an acute exacerbation of lung infection, selected inflammatory parameters (fibrinogen, IL-1, IL-6, SAA, hs-CRP) and serum MDA were examined in 30 adult patients with cystic fibrosis. Their correlation with FEV1, frequency and duration of subsequent hospitalizations and 6-year prognosis in terms of mortality or need for lung transplantation was evaluated. RESULTS: FEV1 negatively correlated with fibrinogen, but positively with MDA. No significant correlation with hs-CRP, IL-1, IL-6 and SAA was recorded. Plasma fibrinogen predicted the frequency and duration of subsequent hospitalizations. The 6-year prognosis was negatively associated with plasma fibrinogen whereas its association with MDA was positive. However, the prognosis of patients in the multivariate analysis was significantly associated only with FEV1. CONCLUSION: Plasma fibrinogen examined in the post-inflammatory period is a marker of lung damage in patients with cystic fibrosis and can be used to predict the prognosis. The positive correlation of serum MDA with FEV1 in the post-inflammatory period may be important to the interpretation of treatment interventions (Tab. 3, Fig. 2, Ref. 17).

Importance and efficiency of blood pressure control not only in type 2 diabetes patients.

Arterial hypertension is one of the most frequent comorbidities of patients with type 2 diabetes, the rates are approximately three times higher among diabetics than in general population. The presence of both diseases increases the cardiovascular risk of the patients two to three times. Therefore, it is essential to control the blood pressure values vigorously down to 130/80 mmHg as recommended in guidelines of the Czech Hypertension Society. According to EHES Study data, the blood pressure control is not sufficient in Czech diabetic population. The target values are reached in only 29 % of diabetics. A well organized system of care, intensive antihypertensive treatment, self-monitoring of patients or appointment reminder system can be used to improve blood pressure control.

Insulin Management of Patients with Inadequately Controlled Type 2 Diabetes Admitted to Hospital: Titration Patterns and Frequency of Hypoglycemia as Results of a Prospective Observational Study (Hospital Study).

INTRODUCTION: Despite the continuously growing number of therapeutic options for type 2 diabetes mellitus (T2DM) including insulins, a large percentage of patients fail to achieve HbA1c targets. Several real-world studies focused on patients with T2DM receiving insulin treatment in outpatient settings were conducted, but information about real-world in-hospital insulin management is lacking. The aim of this study was to describe the management of insulin therapy with a focus on basal-bolus and premixed insulin regimens in patients with T2DM under routine in-hospital medical practice in the Czech Republic. METHODS: This non-interventional prospective study was conducted from June 2014 to December 2017 in 22 centers in the Czech Republic under routine clinical practice conditions. Adult patients admitted to hospital with metabolically uncontrolled T2DM [HbA1c ≥ 60 mmol/mol; > 7.6% Diabetes Control and Complications Trial (DCCT)] and there treated with basal-bolus and premixed insulin regimens were documented during hospitalization. RESULTS: Overall, 369 patients with T2DM (54.7% male, mean age 64.44 ± 13.84 years, BMI 31.10 ± 6.00 kg/m2, duration of diabetes 8.11 ± 9.93 years, HbA1c 95.90 ± 24.38 mmol/mol, length of stay was 7.94 ± 4.53 days) were included. The percentage of glucose values under 10 mmol/l at time of randomization (the group with basal-bolus insulin regimen vs. the premix insulin regimen group) was 24.2% vs. 33.5% (p = 0.053), at time of first insulin dose adjustment it was 43.1% vs. 50.0% (p = 0.330), and 1 day before hospital discharge it was 61.7% vs. 61.4% (p = 0.107). A hypoglycemic event occurred in a total of 15 patients in the basal-bolus regimen group, and no hypoglycemic event occurred in the premixed insulin regimen group. CONCLUSION: In-hospital insulin management regarding basal-bolus and premixed insulin regimens is safe and in concordance with current international recommendations.

Screening and brief intervention in illicit drug users.

Illicit drug use is quite prevalent in the Czech population with a lifetime prevalence of illicit drug use being 29.7 % in 2018. People who use illicit drugs can use health care services more often and they are thus relevant in early identification of illicit substance use disorders and in providing brief intervention. Primary evaluation of presence of illicit substance use disorders can be done using simple and fast screening questionnaires, such as DAST-10. Screening is followed with time effective brief intervention that includes education, advice and motivation for ceasing drug use. Brief intervention should always precede potential referral to specialised addiction services. Implementation of the evidence-based guidelines into daily practise can have a positive effect on early problem resolution, lead to reduction or termination of substance use and decrease harms on patients health and other areas of his life. Screening of illicit drug use, brief intervention in case of positive screening and eventual referral to a specialist should be implemented into routine medical care.

The association of heart rate variability examined in supine and standing position with ambulatory blood pressure monitoring in anorexia nervosa.

OBJECTIVE: To evaluate the association of heart rate variability (HRV) examined in supine and standing position with ambulatory blood pressure monitoring (ABPM) in patients with anorexia nervosa (AN). METHODS: HRV in supine and standing position and ABPM were examined in 30 AN patients and 30 control subjects. The correlations between HRV and ABPM were evaluated. RESULTS: The average age was 25±5 in AN patients and 25±4 years in controls (NS). LF (low frequency) power in AN patients and controls was comparable in supine position. LF power significantly increased during standing in controls, but no increment was detected in AN patients. The HF (high frequency) power was significantly increased in AN patients in supine position, but after standing was comparable with controls. The ratio LF/HF was lower both in supine and standing position in AN patients but the differences did not reach statistical significance. Blood pressure values in AN patients were comparable with controls in supine position but were significantly lower in standing position. Ambulatory blood pressure values were significantly lower in AN patients during active but not sleeping period. In standing position HF and LF powers positively and LF/HF negatively correlated with ABPM blood pressure values during active period in controls while in AN patients only LF power correlated with diastolic and mean blood pressures. CONCLUSION: The lower ABPM values in AN patients during active period in comparison with control subjects may be explained by HRV changes, mainly by its impaired relations with blood pressure in standing position.