RESUMEN
Coronavirus disease 2019 (COVID-19) has had a substantial impact on the incidence of cardiac arrest and survival. The challenge is to find the correct balance between the risk to the rescuer when undertaking cardiopulmonary resuscitation (CPR) on a person with possible COVID-19 and the risk to that person if CPR is delayed. These guidelines focus specifically on patients with suspected or confirmed COVID-19. The guidelines include the delivery of basic and advanced life support in adults and children and recommendations for delivering training during the pandemic. Where uncertainty exists treatment should be informed by a dynamic risk assessment which may consider current COVID-19 prevalence, the person's presentation (e.g. history of COVID-19 contact, COVID-19 symptoms), likelihood that treatment will be effective, availability of personal protective equipment (PPE) and personal risks for those providing treatment. These guidelines will be subject to evolving knowledge and experience of COVID-19. As countries are at different stages of the pandemic, there may some international variation in practice.
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Infecciones por Coronavirus/complicaciones , Paro Cardíaco/etiología , Paro Cardíaco/terapia , Neumonía Viral/complicaciones , Betacoronavirus , COVID-19 , Reanimación Cardiopulmonar/normas , Europa (Continente) , Humanos , Pandemias , Equipo de Protección Personal/provisión & distribución , Medición de Riesgo , SARS-CoV-2 , Sociedades MédicasRESUMEN
A basic precondition for the development of preeclampsia is the presence of placental trophoblast cells in the maternal blood circulation. On the other hand, while trophoblast cells are present in the blood of all pregnant women, preeclampsia occurs in only 2-5% of them. Evidently, other factors play a crucial role. The aim of this study was to compare a set of selected immunological factors (anti-cardiolipin autoantibodies, trophoblast-induced cell-mediated immunity, C3 and C4 complement components) and biochemical factors (serum immunoglobulins IgA, IgG, IgM) among three groups of women with uncomplicated pregnancy, gestational hypertension, or preeclampsia. Blood samples were taken 2-12h before delivery. In the preeclampsia group, there was a significantly higher number of women positive for anti-cardiolipin autoantibodies, trophoblast-induced cell-mediated immunity was elevated, serum IgG was elevated and C4 complement component was reduced. We conclude that both elevated autoimmune reactivity and the higher immune reactivity to trophoblast may contribute to the onset of preeclampsia.
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Autoanticuerpos/inmunología , Complemento C4/metabolismo , Preeclampsia/inmunología , Trofoblastos/inmunología , Adulto , Biomarcadores/metabolismo , Cardiolipinas/inmunología , Complemento C3/metabolismo , Femenino , Humanos , Inmunidad Celular , Inmunoglobulinas/sangre , Preeclampsia/diagnóstico , Embarazo , Adulto JovenRESUMEN
OBJECTIVE: To assess the results of intracorneal ring segment implantation assisted by the Tecnolas Perfect Vision(®) femtosecond laser (Heidelberg, Germany). SETTINGS: Retrospective observational study. METHODS: The patients were operated on with the Tecnolas Perfect Vision(®) femtosecond laser. The following parameters were evaluated before and after surgery: uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), corneal topography, wavefront analysis, and central corneal thickness. The Wilcoxon test was used for statistical analysis. RESULTS: Seventeen eyes of 15 patients were included. The mean follow-up was 6.9±0.71 months. Significant improvement of UCVA and BCVA was observed in 82.35% (P=0.027) and 94.12% (P=0.003) of the eyes, respectively. The subjective refraction showed a significant decrease of the sphere from -10.29±5.54 to -6.5±5.03D (P=0.002). The subjective cylinder significantly decreased from 5.43±3.20 to 3.69±2.30D (P=0.026). The SAI also decreased significantly (P=0.011). CONCLUSION: Femtosecond-assisted intracorneal ring segment implantation is an effective treatment for corneal ectasia. Further studies are needed to improve surgical parameters and outcomes.
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Queratocono/cirugía , Terapia por Láser , Adolescente , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Procedimientos Quirúrgicos Oftalmológicos/métodos , Estudios Retrospectivos , Adulto JovenRESUMEN
PURPOSE: Anterior segment imaging using optical coherence tomography (OCT) time domain technology has been used for many years. When it appeared, it was a promising technique in the analysis of the anterior segment, making it possible to reach a definition of the ocular structures comparable with histology. Now with new-generation OCT, it is possible to perform high-definition and three-dimensional imaging. MATERIAL AND METHOD: A 3D OCT-1000 (Topcon, Tokyo, Japan) parameterized to obtain high-definition and 3D imaging of the iridocorneal structures. RESULTS: We present a collection of images obtained using this technique. DISCUSSION: Based on a very sophisticated tool for retinal and glaucoma imagery, it is now possible to obtain very-high-quality imaging of the anterior segment, which, with its great versatility, increases the value of acquiring this type of device. CONCLUSIONS: The potential of 3D OCT-1000, already a very good exam for the posterior segment, and the only one to perform anterior segment three-dimensional imaging in a single acquisition, should not be neglected.
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Segmento Anterior del Ojo/anatomía & histología , Tomografía de Coherencia Óptica , Diseño de Equipo , Humanos , Imagenología Tridimensional , Tomografía de Coherencia Óptica/instrumentaciónRESUMEN
The aim of this study was to investigate differences in the relative distributions of subsets of natural killer (NK) cells, including immunoregulatory NK cells (CD56(+)CD16(-)), cytotoxic NK cells (CD56(+)CD16(+)), as well as total NK cells (CD56(+)CD3(-)), and NKT cells (CD56(+)CD3(+)) in peripheral blood and follicular fluid in subjects with successful or unsuccessful IVF treatment. The immunoregulatory NK cell population in follicular fluid of women who failed to achieve pregnancy after IVF treatment was significantly decreased compared to women who became pregnant after IVF. Conversely, the NKT cell population in the follicular fluid of women with unsuccessful treatment was significantly elevated compared with those with successful IVF. Understanding the changes in the distribution of NK and NKT cell populations in follicular fluid might serve as the basis for a more detailed study to determine whether NK cell parameters have prognostic value in guiding the selection of individual ova for use in IVF procedures.
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Fertilización In Vitro , Líquido Folicular/inmunología , Infertilidad Femenina/patología , Células Asesinas Naturales/metabolismo , Células T Asesinas Naturales/metabolismo , Adulto , Antígenos CD/biosíntesis , Biomarcadores/metabolismo , Recuento de Células , Separación Celular , Femenino , Citometría de Flujo , Líquido Folicular/citología , Líquido Folicular/metabolismo , Humanos , Infertilidad Femenina/sangre , Infertilidad Femenina/diagnóstico , Infertilidad Femenina/fisiopatología , Infertilidad Femenina/terapia , Células Asesinas Naturales/inmunología , Células Asesinas Naturales/patología , Células T Asesinas Naturales/inmunología , Células T Asesinas Naturales/patología , Embarazo , Pronóstico , Resultado del TratamientoRESUMEN
OBJECTIVE: To summarize recent knowledge concerning mechanisms which influence the implantation of embryo. DESIGN: Literature-based overview. SETTING: Institute for the Care of Mother and Child, Prague. SUBJECT OF THE STUDY: Factors influencing implantation of embryo in the uterus elicit increased interest due to study of unexplained failures of embryotransfer following the successful in vitro fertilization. Our article points to recent information about physiology and pathology of mechanisms controlling implantation, namely the factors of immunity (antibodies, cells, cytokines and other mediators) whose exact regulation on the feto-maternal interface is a crucial precondition of successful implantation. Also the genetics of early embryo, as well as the possibilities of modern endoscopic techniques offer new insight onto mechanisms of implantation. Recommendations for diagnostics and treatment of implantation failure are given in the end of the article.
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Implantación del Embrión , Infertilidad Femenina/fisiopatología , Transferencia de Embrión , Femenino , Humanos , Infertilidad Femenina/etiología , EmbarazoRESUMEN
Advanced oxidation protein products (AOPP) represent terminal products of proteins exposure to free radicals. The aim of this study was to estimate the serum AOPP levels in preeclamptic patients together with ultrasensitive C-reactive protein and anticardiolipin antibodies (ACA) IgG and IgM. 21 women in the third trimester of pregnancy were included in the study--10 women with preeclampsia and 11 women with normal outcome of pregnancy. AOPP levels in preeclampsia were higher than those in normal pregnant women in the third trimester, but not statistically significantly. The comparison with AOPP levels in non-pregnant women has shown a significant increase (P<0.0001). CRP in preeclampsia was significantly increased in comparison with third trimester levels in normal pregnancy (P<0.001) as well as with non-pregnant women (P<0.0001). In preeclampsia, the ACA IgG levels were even significantly lower than in normal pregnant women in the same gestation age, but significantly higher than in non-pregnant women (P<0.001). No difference was found in ACA IgM in preeclampsia and normal third trimester pregnancy and non-pregnant women. A statistically significant negative correlation was found between AOPP and ACA IgG (r= - 0.708, P<0.05). The results indicate enhanced oxidative and inflammatory reaction of maternal organism to pregnancy, which is more pronounced in preeclampsia than in uncomplicated pregnancy.
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Proteínas Sanguíneas/metabolismo , Mediadores de Inflamación/sangre , Preeclampsia/sangre , Adulto , Anticuerpos Anticardiolipina/sangre , Biomarcadores/sangre , Proteína C-Reactiva/análisis , Femenino , Radicales Libres/metabolismo , Humanos , Inmunoglobulina G/sangre , Inmunoglobulina M/sangre , Inflamación , Estrés Oxidativo , EmbarazoRESUMEN
OBJECTIVE: To evaluate leucocytic infiltration of fetomaternal interface in ectopic pregnancy and to evaluate the changes in cell immunity against trophoblast (AT-CMI) in women with extrauterine pregnancy (GEU) in their medical history. To assess the effect of these factors on possible fertility disorders in a woman. DESIGN: A retrospective study. SETTING: Mother and Child Care Institute, Prague. METHODS: In most of the patients, we addressed GEU through laparoscopy. The tube was extirpated in toto and immediately fixed in Baker's solution. Thereafter, it was prepared in a dissection microscope and then processed in a standard way. In order to identify the intensity of AT-CMI, we used the leucocyte migration inhibition test. The cytotrophoblastic cell line JAR was used as an antigen. The degree of inhibition of the migration was monitored by means of a computer image analyser. Inhibition of migration below 75% was rated as favourable. RESULTS: We monitored the presence of inflammatory infiltrate in the place of implantation and correlated the findings with the hCG levels and the presence of the foetal ovum or its part in the tube. In 28 patients (23.5%) of the total number of 119 patients in the group, we observed an inflammatory infiltrate in the place of implantation. In these patients, the hCG levels were lower and in 17 of them (60.7%) we did not prove the presence of a foetal ovum or its parts. In women with GEU in their medical history, the AT-CMI positivity was established in 61.1% of the women 1 year after surgery, in 56.8% of the women 1-3 years after surgery and in 41.2% of the women 3 years after surgery. CONCLUSION: Ectopic pregnancy involves a pathological fetomaternal interface. The leucocytic infiltrate in the area of implantation may be of secondary character and may cause gradual destruction of the ectopically positioned product of conception. The results of our study indicate a possible participation of the increased AT-CMI in the destruction of the ectopically located trophoblast. Persisting anti-trophoblast immunity may influence the occurrence and course of further gravidities.
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Trompas Uterinas/patología , Infertilidad Femenina/etiología , Leucocitos/patología , Embarazo Tubario/inmunología , Embarazo Tubario/patología , Trofoblastos/inmunología , Inhibición de Migración Celular , Gonadotropina Coriónica/sangre , Implantación del Embrión , Femenino , Humanos , Inflamación , Embarazo , Embarazo Tubario/complicacionesRESUMEN
OBJECTIVE: To provide an overview of the results obtained from the more than ten-year systematic monitoring of the contribution of immunopathological mechanisms to the ethiopathogenesis of fertility disorders in men. DESIGN: A summarising retrospective study. SETTING: Mother and Child Care Institute, Prague. METHODS: The data source is a selected group of a total of 3,800 couples, who were examined in the Immunobiological Department (ID) of the Mother and Child Care Institute (MCCI) in Prague- -Podolí for fertility disorders in the past. From among the laboratory quantities, the following ones were systematically monitored: a) sperm parameters; b) cell-mediated immunity against spermatozoa; c) the presence of anti-spermatozoa auto-antibodies attached to spermatozoa; d) in a part of the clinical group, the serum concentrations of FSH, testosterone, SHBG and the free androgen index (FAI) were monitored. RESULTS: After selection was made according to defined criteria, the group comprised of a total of 1,680 men, of whom 49.4% were normozoospermic and 50.6% suffered from some form of seminal pathology. Increased cell-mediated immunity against spermatozoa was identified in 10.2% of fertile men, in 18.5% of normozoospermic men and in 66.3% of azoospermic men. In asthenozoospermic and teratozoospermic men, the increased cell-mediated immunity against spermatozoa was identified in 48.3% and 53.1% of them, respectively. The auto-antibodies attached to spermatozoa were identified in 3 out of every 42 fertile men (7%), while in asthenozoospermic men, it was a total of 21% (IgA antibodies) and 22% (IgG antibodies). As concerns the concentration of free androgens (FAI) in the serum, there was no difference among the individual subgroups of men. In oligoasthenozoospermic men, FSH was significantly higher on the average in comparison with normospermic men. CONCLUSION: The significantly higher incidence of increased cell-mediated immunity against spermatozoa in men with a pathological spermiogram in comparison with the control group (fertile men and normozoospermic men) indicates that cell-mediated immunity participates in the pathogenesis of seminal pathologies.
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Infertilidad Masculina/inmunología , Andrógenos/sangre , Autoanticuerpos/análisis , Inhibición de Migración Celular , Hormona Folículo Estimulante/sangre , Humanos , Inmunidad Celular , Infertilidad Masculina/sangre , Masculino , Recuento de Espermatozoides , Espermatozoides/inmunologíaRESUMEN
OBJECTIVE: To test the hypothesis of relationship between sperm pathology and elevated humoral and/or cell-mediated antisperm autoimmunity in male partners from infertile couples. DESIGN: Analytic study. SETTING: Department of Immunobiology, Institute for the Care of Mother and Child, Prague. METHODS: Sperm samples were evaluated according to WHO rules. Sperm-bound antisperm autoantibodies (ASA) were determined by SpermMar Test (FertiPro N. V., Sint-Martens-Latem, Belgium). For evaluation of cell-mediated antisperm autoimmunity (CMAA) the authors used their own modification of migration-inhibition test (Dimitrov et al., J. Immunol. Methods 154: 147, 1992). RESULTS: The pool of men was divided into groups according to the result of sperm examination: normozoospermia (740 men), asthenozoospermia (244), teratozoospermia (191), oligoasthenozoospermia levis (61), oligoasthenozoospermia gravis (29), oligoteratozoospermia (82), and azoospermia (54). Subgroup of fertile men (32) consisted of normozoospermic men--fathers of child younger than 3 years. Percentage of sperm-bound ASA-positive samples was significantly higher in asthenozoospermia in comparison with normozoospermia in both IgA (20.8% versus 10.6%) and IgG classes (13.8% vs 6.8%). Positivity of CMAA was significantly more frequent in group of asthenozoospermic (52%) than in normozoospermic (28.5%) and fertile (12.5%) men. CONCLUSION: Antisperm autoimmunity, namely its cell-mediated form, appears to play a significant role in impairment of spermiogenesis. Sperm-bound autoantibodies were found more frequently in asthenozoospermia, but also in some men with normozoospermia they may impair fertility.
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Autoanticuerpos/análisis , Inhibición de Migración Celular , Infertilidad Masculina/inmunología , Espermatozoides/inmunología , Humanos , MasculinoAsunto(s)
Surfactantes Pulmonares/uso terapéutico , Proyectos de Investigación/normas , Síndrome de Dificultad Respiratoria del Recién Nacido/tratamiento farmacológico , Edad Gestacional , Humanos , Recién Nacido , Tiempo de Internación/estadística & datos numéricos , Surfactantes Pulmonares/clasificación , Surfactantes Pulmonares/economía , Respiración Artificial , Síndrome de Dificultad Respiratoria del Recién Nacido/mortalidad , Análisis de SupervivenciaRESUMEN
In previous papers, we referred to studies of the influence of antiovarian autoantibodies on menstrual cycle disorders in adolescent girls. We examined autoantibodies against ooplasma, zona pellucida, membrana granulosa, theca folliculi interna, and lutein cells. In infertile women in the IVF/ET program, we studied the positivity of antiovarian antibodies and cytokines, namely, TNF-alpha and IL-1 beta, in follicular fluid correlated with the following subgroups, characterized by the outcome of in vitro fertilization, as follows: G, pregnant; F, fertilized; N, nonfertilized; and O, no oocyte gained. The presence of autoantibodies corresponds to the success or failure of the IVF/ET program. Our results support the hypothesis that antiovarian autoantibodies play an important role in both the endocrine and the reproductive function of the human ovary and that it can influence them negatively.
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Autoanticuerpos/análisis , Transferencia de Embrión , Fertilización In Vitro , Infertilidad Femenina/inmunología , Ovario/inmunología , Adulto , Femenino , Líquido Folicular/química , Líquido Folicular/inmunología , Humanos , Infertilidad Femenina/terapia , Interferón gamma/análisis , Interleucina-1/análisis , Linfotoxina-alfa/análisis , EmbarazoRESUMEN
OBJECTIVE: Use of monoclonal antibodies against sperm proteins in human medicine. DESIGN: Experimental and clinical studies. SETTING: Dep. Biology and Biochemistry of Fertilization, Institute of Molecular Genetics, Prague, Laboratory IVF, Iscare IVF, Prague, Dep. of Immunobiology, Institute for the Care of Mother and Child, Prague. METHODS: Monoclonal antibodies against human sperm intra-acrosomal and cell surface proteins were used for quantitative analysis of these proteins by the immunofluorescence test in samples of human sperm of good and poor qualities. RESULTS: The detection of intra-acrosomal proteins was decreased and, on the other hand, detection of surface proteins was the same or higher in pathological spermatozoa. CONCLUSIONS: Monoclonal antibodies can be used for diagnostics of sperm pathology (quantitative detection of proteins) and for evaluation of the physiological state of sperm cells (state of acrosome before or after acrosome reaction). Finally, monoclonal antibodies could be useful for selection of a suitable method of fertilization (IUI, standard IVF, ICSI) in the laboratories of assisted reproduction.
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Anticuerpos Monoclonales , Infertilidad Masculina/terapia , Técnicas Reproductivas , Espermatozoides/inmunología , Acrosoma/inmunología , Femenino , Técnica del Anticuerpo Fluorescente , Humanos , Infertilidad Masculina/diagnóstico , Infertilidad Masculina/inmunología , Masculino , EmbarazoRESUMEN
Babies of 37-41 wk gestation are, by international convention, said to be born at 'term', but some still develop respiratory distress. It is not clear how mature a baby has to be to be free of risk of primary surfactant deficiency. An area-based retrospective study of all the 179,701 babies of 34 or more weeks' gestation born alive in a defined area of the north of England in 1988-92 identified 149 babies with features of respiratory distress typical of surfactant deficiency severe enough to be managed with ventilatory support and with no evidence of aspiration or intrapartum infection. Gestation was carefully cross-validated against antenatal information, including at least one ultrasound assessment in the first half of pregnancy. Thirty-six of these babies were born at or after 37 wk gestation. Only 4 of the 35 delivered at 37-38 wk went into spontaneous labour. Seven became ill enough to be candidates for ECMO and two died. A review of all neonatal deaths in the study area between 1981 and 1995 identified four similar deaths in 1981-87 and two in 1993-95. Babies who are not premature, using the internationally agreed definition, can show signs of potentially lethal pulmonary immaturity at birth, especially if subjected to pre-labour Caesarean delivery. Those born at 37-38 wk are 120 times more likely to receive ventilatory support for surfactant deficiency than those born at 39-41 wk. Elective delivery should only be undertaken before 39 wk gestation for good medical reasons.
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Cesárea/estadística & datos numéricos , Edad Gestacional , Mortalidad Infantil , Embarazo/fisiología , Surfactantes Pulmonares/deficiencia , Síndrome de Dificultad Respiratoria del Recién Nacido/epidemiología , Femenino , Humanos , Recién Nacido , Inicio del Trabajo de Parto , Masculino , Respiración Artificial/métodos , Síndrome de Dificultad Respiratoria del Recién Nacido/diagnóstico , Síndrome de Dificultad Respiratoria del Recién Nacido/terapia , Estudios Retrospectivos , Medición de Riesgo , Índice de Severidad de la Enfermedad , Tasa de Supervivencia , Reino Unido/epidemiologíaRESUMEN
BACKGROUND: The authors dealt with the urgent problem under what conditions it is possible to achieve in a woman with systemic lupus erythematosus (SLE) or another collagenosis, or secondary antiphospholipid syndrome (APS) a favourable outcome of pregnancy and the delivery of a healthy infant. METHODS AND RESULTS: The investigation comprised 23 women incl. 20 with SLE, two with the mixed form of a diffuse connective tissue disease (MCTD) and one with Sjögren's syndrome of the primary type. From the total number of 20 pregnancies six were consulted in advance with a doctor (group I-s-called planned pregnancies) and all terminated by a successful delivery. Of 11 pregnancies which were not consulted with a doctor in advance (group II-so-called unplanned pregnancies) 9 were terminated in term, however, only 5 with a successful delivery (55.5%), two women are still pregnant. Exacerbation of the basic disease during pregnancy was recorded only once and did not lead to discontinuation of the pregnancy. CONCLUSIONS: The authors provide evidence that desired pregnancy of informed women suffering from SLE or another collagenosis when assisted by a specialized medical team can lead to a successful delivery of an infant.