Classification of Aeromonas spp. isolated from water and clinical sources and distribution of virulence genes.

In this work, 84 isolates of aeromonads were isolated from water and clinical samples, identified, and characterized. Identification was based on routine phenotyping combined with multiplex PCR. In this study, multiplex PCR was retested and reevaluated and its identification key was enhanced by 17 newly described species and five subspecies. Identification score increased from 36 % (only phenotyping) to 90 % when supported with multiplex PCR. Further description of isolates included detection of eight virulence genes. These genes were overall present in 46 % (act), 2.4 % (ast), 80 % (alt), 40 % (ahh1), 20 % (asa1), 69 % (pla/lip/lipH3/alp-1), 69 % (ser), and 81 % (fla), and no significant differences between water and clinical isolates were found. Results of this work show that the proper combination of different approaches is necessary for final identification of Aeromonas spp. at the species level. Multiplex PCR was shown to have limits in final identification, specifically inability to distinguish four species pairs and one triplet as their gene profiles are identical. However, it seems to be rapid and easy to do method able to support routine biochemical identification in laboratories. Moreover, our results supported previous proposal of reclassification of "Aeromonas hydrophila subsp. dhakensis" and "Aeromonas aquariorum" as identical species.

[Preparation of patients with haemostatic disorder for invasive medical interventions]. / Príprava pacientu s poruchou hemostázy k invazivním lékarským zákrokum.

The current trend in medicine is to sustain the possibility for necessary procedures to be performed in patients who suffer from haemostatic disorders which complicate eventual surgery. Among such disorders are congenital blood coagulation disorders, haemostatic disorders concomitant with other diseases and also therapies which affect haemostasis either on purpose or as part of adverse effects. Among coagulation disorders are congenital haemorrhagic or thrombotic conditions, acquired blood coagulation disorders--combined in the vast majority of cases-- and associated with pregnancy, severe internal diseases and surgery related diseases, severe injuries, wounds, burns, malignancies, systemic connective tissue diseases, inflammatory bowel disease, and a number of other diseases. A separate issue is that ofanticoagulation therapy--both antiplatelet, used in the treatment or prevention of venous thrombosis, and anticoagulation, predominantly used to manage venous thromboembolism. Also considered should be any therapy which may have a negative impact on coagulation due to its adverse effects.

[Prevention of venous thromboembolism: generally accepted guidelines]. / Prevence zilní tromboembolické nemoci: obecne platná pravidla.

This article summarizes the published data on the prevention of venous thromboembolism. Routine thromboprophylaxis is the best way to lower the risk. It is recommended to sort patients according the thrombosis risk and to make use of the standard prophylactic modes. In low risk patients, no specific thromboprophylaxis is needed. Patients with moderate risk levels are candidates for administration of subcutaneous low molecular weight heparin (LMWH) at doses under 3 400 anti-Xa units a day and patients with increased risk at doses higher than 3400 anti-Xa units a day during the period of higher risk. In order to decrease the risk of bleeding, a half dose 2 hours prior or 4-6 hours after the operation can be administered. Under the highest risk conditions, there is a recommendation to combine LMWH over 3 400 anti-Xa units with elastic panty-hose or, alternatively, with intermittent pneumatic compression. At moderate risk levels, subcutaneous administration of unfractionated heparin at the doses of 5 000 units twice a day is also possible and at increased risk levels, a TID administration over the increased risk period. In patients with a significant bleeding risk, the physical method of thromboprophylaxis can be used and pharmacological prophylaxis can set in after the risk of bleeding has passed. Fondaparinux is the alternative to LMWH in people after major orthopaedic surgeries and with a history of heparin induced thrombocytopenia over the past three months. An alternative to the administration of LMWH even after the end of the hospitalization can be warfarin in certain situations. The sole use of acetylsalicylic acid or Rheodextran is not recommended. While undertaking epidural anaesthesia or analgesia, it is necessary to follow strictly the guidelines of the use of pharmacological thromboprophylaxis.

[Prevention of venous thromboembolism in surgery, in laparoscopic surgery, in venous surgery and in urology]. / Prevence zilní tromboembolické nemoci v chirurgii, v laparoskopické chirurgii, v cévní chirurgii a v urologii.

The article summarizes published data regarding the prophylaxis of venous thromboembolism in surgery, in laparoscopic surgery, in venous surgery and in urology. In surgical patients with low risk, no specific thromboprophylaxis is needed. Patients with moderate risk levels are the candidates for administration of subcutaneous low molecular weight heparin (LMWH) at doses under 3 400 anti-Xa units a day and patients with increased risk at doses higher than 3 400 anti-Xa units a day during the period of higher risk. In order to decrease the risk of bleeding, a half dose 2 hours prior or 4-6 hours after the operation can be administered. Under the highest risk conditions, there is a recommendation to combine LMWH over 3 400 anti-Xa units with elastic panty-hose or, alternatively, with intermittent pneumatic compression (IPC). At moderate risk levels, subcutaneous administration of unfractionated heparin at the doses of 5 000 units twice a day is also possible and at increased risk levels, a TID administration (LDUH) over the increased risk period. In patients with a significant bleeding risk, the physical method of thromboprophylaxis can be used and pharmacological prophylaxis can set in after the risk of bleeding has passed. Fondaparinux is the alternative to LMWH in people with a history of heparin induced thrombocytopenia over the past three months. The sole use of acetylsalycilic acid is not recommended. While undertaking epidural anaesthesia or analgesia, it is necessary to follow strictly the guidelines of the use of pharmacological thromboprophylaxis. Thromboprophylaxis with LMWH, LDUH, elastic panty-hose or IPC is indicated only in those patients who undergo laparoscopic surgeries and who moreover display the additional thrombosis factors. Patients with additional risk thrombosis factors undergoing major venous reconstructions require prophylaxis with LMWH (or LDUH). Uncomplicated patients undergoing transurethral or other low risk urologic surgery require no specific thromboprophylaxis. If they undergo a major intervention and/or they display additional risk thrombosis factors, they require the administration of LMWH or LDUH. Elastic panty-hose and/or intermittent pneumatic compression have the same indication as in abdominal surgeries.

[Hemorrhagic complications during warfarin treatment]. / Krvácivé komplikace pri lécbe warfarinem.

Bleeding is probably the major complication of anticoagulant treatment with vitamin K antagonists represented nowadays mostly by warfarin in the Czech Republic. The main risk factors in hemorrhagic complications of warfarinisation are the intensity and instability of the anticoagulant treatment, individual patient characteristics, warfarin interactions with other drugs and the length of the anticoagulant therapy. Severe bleeding in warfarin patients is most effectively brought about by a fast and complete undoing of the anticoagulation effect of the drug employing the prothrombin complex concentrate and slow i.v. vitamin K1 infusion regardless of the reason for the anticoagulation. This approach can secure the minimalisation of the bleeding's negative consequences. A less severe bleeding or asymptomatic increase in the international normalized ratio can be treated effectively by skipping or decreasing of the warfarin dosage and/or oral administration of vitamin K1 (i.v. administration only in selected higher risk cases) that does result only in a partial consolidation of coagulopathy but of such type that the risk of thrombotic event requires. The article's goal is to contribute to the treatment standardization in patients with warfarin overdose and/or with hemorrhagic complications due to warfarin treatment and it is available at www.thrombosis.cz. The guidelines include a ready-reference chart whose objective is immediate and quick crash course in the clinical practice.

[Heparin induced thrombocytopenia]. / Heparinem indukovaná trombocytopenie.

This article describes the pathogenesis, diagnostics, treatment and prevention of heparin induced thrombocytopenia (HIT). Although HIT is considered to be a hematological diagnosis, every physician who treats patients with heparin can encounter it in daily practice. It is even more probable that surgeons of any specialisation will meet with HIT patients. A section of them elude diagnostic detection. There are two forms of HIT - HIT I and HIT II. HIT I is caused by a direct pro-aggregation effect of heparin. It has no clinic significance. HIT II is an antidote mediated adverse reaction to heparin. Antidotes will generate only after the exposure to heparin. They are targeted against the platelet factor 4 and they act only at the presence of heparin. They may lead to the aggregation of thrombocytes in the vascular system (there is a decrease in thrombocyte count). This event can be accompanied by a development of venous or arterial thrombosis that can have a rapid and even fatal course. This fact clarifies the importance of HIT II diagnostics. Diagnosis of HIT II is based on recognizing of the typical decrease in thrombocyte count usually 1 day after heparin administration is initiated. Clinical manifestations are more likely in patients with already damaged endothelium. If thrombocyte count decrease is not connected with clinical manifestations, it is the so called isolated HIT II and in patients who display the signs of thrombosis, it is HIT II associated with thrombosis. The goal of this article is apart from implementing the recommendations of the 7th conference of the American Respiratory Society in real life also the exploration of the diagnostic and therapeutic limits (availability) in the Czech Republic.

[Plasma pH and anticoagulant solutions used in the plasmapheresis method of blood collection from donors]. / Závislost pH plazmy na pouzitém protisrázlivém roztoku pri odberu dárcovské krve technikou plazmaferézy.

The resulting pH of fresh frozen plasma for clinical use, collected by plasmapheresis from blood donors is influenced by the type of anticoagulant solution and its ratio with the donor's blood. The authors describe the use of three anticoagulant solutions with a different sodium citrate concentration and different ratios of donor blood. As compared with the physiological range of pH of the blood, the resulting pH value of the collected plasma, when using ACD-A and AB-16 solutions, varies within the range classified as acidosis, i.e. less than 7.36. When using a 4% sodium citrate solution the plasma pH value is in the area evaluated as alkalosis. The authors discuss indications for administration of fresh frozen plasma in clinically serious diseases and the influence of administration of this transfusion preparation on the acid-base balance as the transfusion recipients are threatened by the development of metabolic acidosis. Maintaining the pH value of fresh frozen plasma slightly above the physiological range of blood pH prevents in particular during massive plasma transfusions the possibility of deterioration of acidosis or its development.