Factors influencing overall survival and GvHD development after allogeneic hematopoietic stem cell transplantation - single centre experience.

BACKGROUNDS: Allogeneic hematopoietic stem cell transplantation (alloHSCT) is a substantial therapeutic procedure for the treatment of a wide spectrum of severe diseases. Despite advancements in treatment and supportive care, alloHSCT still carries a considerable mortality risk, primarily caused by graft-versus-host disease (GvHD). Our retrospective analysis aimed to identify the factors influencing overall survival and GvHD development in HLA-identical sibling alloHSCT. We have analyzed patients' and donors' age, AB0 compatibility, recipient-donor gender match, stem cell source, time from the diagnosis to alloHSCT, conditioning regimen type, GvHD prophylaxis, and relapse. PATIENTS AND METHODS: Our study included 96 patients (54 male, 42 female) who underwent HLA-identical sibling alloHSCT. The median follow-up was 64.5 months (range 1-218 months), and the median age of both recipients and donors was 34 years. Malignant hematological diseases were the most common indications for alloHSCT. RESULTS: GvHD and its complications accounted for the highest number of deaths (N = 24; 46.2%), followed by relapse (N = 18; 34.6%). Acute GvHD developed in 30 patients (31.3%), while chronic GvHD occurred in 25 patients (26.0%), resulting in a total of 45 patients (46.9%) experiencing GvHD. Male recipients with female donors had significantly worse overall survival compared to other patients (P = 0.01; HR = 2.33). Overall survival was better in patients transplanted within 1 year from the diagnosis compared to those transplanted after 1 year (P = 0.03; HR = 1.93). No factor reached statistical significance regarding the impact on acute GvHD, chronic GvHD, or overall GvHD. CONCLUSION: We confirmed that sex mismatch, specifically in the case of a female donor and a male recipient, significantly negatively affects overall survival after alloHSCT. Additionally, overall survival is significantly shorter when the interval between the diagnosis and alloHSCT exceeds one year.

Antimicrobial resistance of bacterial isolates from sheep and goat cheeses in eastern Slovakia.

The aim of this study was to determine prevalence of undesirable bacteria and their antimicrobial profile in samples obtained from a productive farm situated in border region Slanské vrchy (Slovakia), involved in keeping sheep and goats for the purpose of processing raw milk to special products (cheeses). Genus and species identification was carried out by PCR method and MALDI -TOF MS. Isolates thus identified were detected for antimicrobial resistance using the Agar Dilution Method. Bacteria of Staphylococcus spp. exhibited the highest resistance to penicillin (98% isolates). Isolates from the family Enterobacteriacae showed the highest resistance to azithromycin (90%). At the same time, in isolates of Enterococcus spp. we detected high resistance to linezolid (100%). Our investigation showed that all tested strains were resistant to more than one antibiotic used in this study.

TREATMENT OPTIONS FOR PREMACULAR AND SUB-INTERNAL LIMITING MEMBRANE HEMORRHAGE.

INTRODUCTION: Premacular hemorrhage (PH) and sub-internal limiting membrane hemorrhage (sub-ILM-H) are among the causes of sudden deterioration of central visual acuity. Anatomical and functional outcomes of different therapeutic options were evaluated retrospectively. METHODS: The study included three eyes of three patients (2 females and 1 male). Location of the hemorrhage was determined by spectral domain optical coherence tomography. Subhyaloid premacular location of the hemorrhage was proven in one eye of each woman and sub-ILM location of the hemorrhage in one eye of the male. The baseline best corrected visual acuity (BCVA) was 0.63 in the eyes of the females and 0.16 in the eye of the male. Conservative treatment option was chosen in case of juxtafoveolar PH in the eye of the female patient on anticoagulant warfarin therapy. The female patient with PH secondary to proliferative diabetic retinopathy (PDR) underwent Nd: YAG laser hyaloidotomy. The male patient with unexplained cause of the sub- ILM-H underwent 25-Gauge vitrectomy with ILM peeling and subsequent ultrastructural morphometric and histopathological examination of the ILM. RESULTS: Both BCVA and retinal finding improvement were achieved in all patients. Final BCVA was 0.8 in the eye of the female patient with PDR and 1.0 in rest of the eyes of the other patients. No complications were recorded at follow-up visits. Histopathological and morphometric examination demonstrated variable ILM thickness (2.70 ±1.58 μm) and proved presence of fibroblasts and macrophages with hemosiderin deposits on the retinal side of ILM. CONCLUSION: The choice of the treatment option of PH and sub-ILM-H depends on input parameters such as the initial BCVA, the extent and the location of the hemorrhage, as well as the overall health of the patient. Nd: YAG laser hyaloidotomy is an effective method for rapid recovery of visual functions. Surgical ILM peeling and aspiration of the underlying hemorrhage result in the removal of breakdown products of hemoglobin and minimization of the risk of secondary epiretinal membranes development.

OCT Findings and Long-term Follow-up Results of Vitrectomy in Patients with Optic Disc Pit and Associated Maculopathy.

PURPOSE: To evaluate OCT findings and long-term follow-up results in patient with optic disc pit (ODP) and associated maculopathy treated with pars plana vitrectomy (PPV). METHODS: Six eyes of 6 patients (3 females, 3 males) were included in a retrospective study. We excluded patients with ODP without maculopathy. Patients were followed in years 2008-2017. Mean age at the first examination was 40,3 years (15-70 years). Duration of worsening of the best corrected visual acuity (BCVA) ranged from 2 days to few years. In all patients we performed BCVA test at Early Treatment of Diabetic Retinopathy Study (ETDRS) optotype, examination of anterior and posterior segment and photo documentation of fundus. Optic disc, parapapillary region and macula were examined by optic coherence tomography (OCT). Four patients underwent 23-Ga PPV with active detachment of posterior hyaloid membrane and tamponade with perfluoropropan (16% C3F8). In 2 patients a sample of tissue from ODP was taken during PPV to histological examination. RESULTS: Mean BCVA at the first examination was 0,10 (ranging from 0,05 to 0,16). OCT findings proved macular schisis in outer retinal layers (RSE) in 2 eyes, in 1 of these eyes with additional presence of subretinal fluid. In 4 patients macular schisis in outer as well as inner retinal layers (RSI) was present, in 2 of them with additional subretinal fluid. In 5 eyes glial tissue and/or vitreous condensation was present in ODP. Four eyes with RSE and RSI improved both anatomically as well as functionally after vitrectomy. In 1 patient with previous communication between ODP and RSE this was closed after vitrectomy. Mean pre-operative BCVA was 0,11 (ranging from 0,05 to 0,16), mean final BVCA was 0,5 (ranging from 0,25 to 0,63), mean visual gain was +30 letters (ranging from +10 to +45). Mean follow-up after PPV was 59 months (36-96). CONCLUSION: Spectral OCT shows variability of morphological findings in patient with ODP associated with maculopathy. Traction of glial tissue and/or condensed vitreous in ODP together with adherent posterior vitreous membrane could be one of the factors causing macular retinoschisis and/or secondary serous macular detachment. Complete separation of vitreous from optic nerve head during the vitrectomy is an efficient treatment resulting in macular reattachment and improvement in visual functions. Key words: optic disc pit, intrapapillary proliferation, macular retinoschisis, optical coherence tomography, pars plana vitrectomy, posterior vitreous detachment.

Heart failure affects liver morphology and function. What are the clinical implications?

Liver dysfunction in heart failure is common and usually clinically significant, especially in patients with advanced or severe acute heart failure. Lesions are caused by an impaired hepatic circulation due to congestion and hypoperfusion. Congestive lesions are more common and typically manifested by painful hepatomegaly and increased direct bilirubin and alkaline phosphatase. The inferior vena cava and hepatic veins are usually dilated. Congestive lesions are characterized by dilatation of the central vein with fibrotic changes in the surrounding areas on histological examination. Isolated ischaemic lesions are rare and occur due to severe and prolonged ineffective perfusion, often accompanied by hypoxemia. Ineffective perfusion is reflected by an increase in total bilirubin and significantly increased transaminase levels. The prognosis of ischaemic lesions without an adequate treatment of the cause of hypoperfusion is poor. Increased levels of bilirubin and liver function tests, as well as signs of impaired liver proteosynthetic function, are associated with a poor prognosis. Knowledge of the phenotypes of hepatic lesions in heart failure is important to select the appropriate treatment for an acute decompensation. Changes in biochemical markers, hepatic perfusion or stiffness of the liver can be used to evaluate the effectiveness of diuretic treatment and achieve euvolemic status in the patients with heart failure (Tab. 1, Fig. 3, Ref. 28).

[Arterial hypertension in gravidity - a risk factor for cardiovascular diseases]. / Artériová hypertenzia v gravidite - rizikový faktor kardiovaskulárnych ochorení

Gravidity is a dynamic process and complications may occur at any stage and anytime during a thus far physiological gravidity. Such gravidity puts the mother, the foetus and, later, the newborn at a greater risk. The incidence of arterial hypertension is between 7 and 15% and is one of the 4 main causes of maternal and perinatal mortality. Cardiovascular stress test, such as gravidity, might help to identify women at a greater risk of cardiovascular diseases or with a subclinical vascular disease. Women with a history of preeclampsia are more likely to develop chronic arterial hypertension in the future either alone or associated with a cardiovascular disease. Arterial hypertension during gravidity should be considered as a risk factor for cardiovascular diseases during later stages of maternal life. Prevention of cardiovascular diseases should be a life-long aspiration.

[Prevention and treatment of extremity vascular ischemic disease]. / Preventia a liecba koncatinovocievnej ischemickei choroby.

Extremitovascular ischemic disease (peripheral arterial disease of extremities - PAD) is an important manifestation of systemic atherosclerosis and other arterial diseases of vascular system. The lower the anklebrachial pressure index, the greater the risk of serious cardiovascular events (e.g., acute myocardial infarction, stroke). Prevention and treatment ofextremitovascular disease is discussed in this article.

[The contribution of the hematological examination in patients with retinal vein occlusion]. / Prínos hematologického vysetrení u pacientu s venózní retinální okluzí.

OBJECTIVE: The aim of this study is to evaluate outcomes of hematological examinations in patients under 60 years of age affected by central (CRVO) or branch (BRVO) retinal vein occlusion. Furthermore, it also proves possible existence of risk factors resulting in early atherosclerosis and hematological disease. PATIENTS AND METHODS: Eleven patients (5 women and 6 men) of 38 years of age in average (15-56 years) were examined. Eight patients suffered from CRVO, 3 patients from BRVO. All patients were tested for hematological diseases. We focused on the following hematological parameters: presence of paraprotein, homocysteine blood level, lipoprotein A, presence of antiphospholipid antibody, level of activated protein C resistance, protein S, protein C, antithrombin III. The average follow up period was 19 months. RESULTS: hematological screening was positive in 5 patients, 4 patients out of them suffered from CRVO. High homocysteine blood level was detected in 2 patients and more over, an increased level of antiphospholipid antibodies was diagnosed in 1 patient. An increased level of lipoprotein A was determined in 2 remaining patients. BRVO was diagnosed in one case. Outcome of the hematological examination proved the pathological level of activated protein C resistance and lower level of protein S. CONCLUSION: according to these results we assume, the co-existence of more risk factors for hematological disease increase the probability of CRVO.