Biomedical subjects
Publications and source records attributed to J Janota.
A series of 2,3-dihydroindole-2-thiones was evaluated for in vitro antimycobacterial activity against Mycobacterium tuberculosis, M. kansasii, M. fortuitum, two strains of M. intracellulare and three strains of M. avium. 2,3-Dihydro-1-methyl-2-thioxoindole-3-one and 2,3-dihydro-1-butyl-2-thioxoindole-3-one were the most active substances against potentially pathogenic strains, being more active than isoniazide.
The occurrence of coexisting congenital diaphragmatic hernia (CDH) and esophageal atresia (EA) with distal tracheoesophageal fistula (TEF) is extremely rare and is considered highly lethal. The combination of CDH with EA/TEF and truncus arteriosus communis (TAC) has not been reported in the literature to date. The authors describe a premature neonate with this association.
In connection with a systematic study of antimycobacterial agents against potentially pathogenic strains the series of 12 S-alkylisothiosemicarbazones was evaluated for in vitro antimycobacterial activity against Mycobacterium tuberculosis, M. kansasii, M. fortuitum, two strains of M. intracellulare and three strains of M. avium. Quinoline-4-carbaldehyde-S-hexyl-isothiohydrazone was found to be more active against potentially pathogenic strains than isoniazide.
OBJECTIVE: To compare the predictive accuracy of the NEOMOD score and the Apgar score as concerns prediction of mortality and affection of the central nervous system (CNS) in neonates. DESIGN: Prospective multi-centre clinical study. SETTING: Mother and Child Care Institute, Prague; Thomayer's Faculty Hospital with a Policlinic, Prague. METHODS: All neonates with a gestation age > or =35 weeks of pregnancy, hospitalised in the intensive care units of the cooperating hospitals in the period 1998-2002, were included in the study. For all the neonates, the NEOMOD score was established in the first 24 hours and the Apgar score was established in the 1st, 5th and 10th minutes of their lives. The aim was to establish the predictive accuracy of the scoring systems for mortality and affection of CNS in the first 28 days of life. RESULTS: 620 patients participated in the study; 16 patients (1.90%) died by the 28h day. The predictive accuracy for mortality expressed as AUS - the area under receiver operating characteristic (ROC) curve reached the highest level for NEOMOD AUC = 0.96. AUC for the Apgar score was 0.84 in the 1st minute; it was 0.84 in the 5th minute and it was 0.88 in the 10th minute. The predictive accuracy for affection of CNS was AUC = 0.76 in the case of NEOMOD; in the case of Apgar, AUC was 0.71, 0.74 and 0.77 in the 1st, 5th and 10th minute, respectively. CONCLUSION: The NEOMOD system proved a high accuracy in the prediction of neonatal mortality in a group of patients with a gestation age > or =35 weeks of pregnancy. The predictive accuracy of NEOMOD was higher than that of the Apgar score. The predictive accuracy of both the NEOMOD and Apgar scores for affection of CNS in the neonatal period was low.
OBJECTIVE: Nosocomial infections caused by the coagulase-negative staphylococci are among the most frequent complications in an intensive care unit for neonates. The authors describe three cases of successful treatment of this complication in which the new antibiotic Linezolide was used. DESIGN: Analysis of three clinical cases. SETTING: Mother and Child Care Institute, Prague. METHODS: Description of cases of nosocomial sepsis in 3 immature neonates where the usual treatment of multiresistant strains of coagulase-negative staphylococci, based on the use of Vankomycin, was not successful. CONCLUSION: Administration of Linezolide proved to be very effective in all of the described cases. In spite of the high effectiveness and relative safety of this preparation, its precise role in the treatment of infection-related complications caused by coagulase-negative staphylococci has not yet been established. For the time being, we recommend administering this preparation only in strictly indicated cases after the usual therapy fails.
BACKGROUND: Multidrug-resistant (MDR) tuberculosis, defined as a disease caused by Mycobacterium tuberculosis strains, which are resistant to more antituberculous drugs (at least to isoniazid and rifampicin), is a problem frequently discussed in the Czech Republic. Cases of specific disease refractive to causal antituberculous therapy are associated with the risk of the spread of the causative agent among the population. METHODS AND RESULTS: The National Reference Laboratory for Mycobacteria collected 2813 Mycobacterium tuberculosis strains isolated by Czech mycobacteriological laboratories in 1999 to 2001. All strains were tested for susceptibility to basic antituberculous drugs and then the MDR strains were further tested for susceptibility/resistance to other antituberculous and antibacterial drugs. The MDR strains were studied by DNA analysis (DNA fingerprinting restriction analysis, RFLP-Restriction Fragment Length Polymorphism) as well. Thirty-nine patients who had MDR tuberculosis were excretors of 56 Mycobacterium tuberculosis strains. In average, MDR tuberculosis accounted for 1.96% (1.7-2.4) of all cases of bacillary tuberculosis. The most frequent type of the multidrug resistance was that resistant to four basic antituberculous drugs (isoniazid, rifampicin, ethambutol and streptomycin). It was confirmed in 48.2% multidrug resistant strains. CONCLUSIONS: Isepamicin, clofazimin, capreomycin and amikacin are considered to be the most promising antituberculosis drugs. Based on RFLP profiles, 61.5% of strains were placed into 8 clusters while the other strains remained unclustered. No significant differences in geographical distribution and population structure were found between the excretors of clustered strains and those of unclustered strains. Preliminary comparison with restriction profiles of the MDR Mycobacterium tuberculosis strains in the international database suggests the uniqueness of Czech strains showing the profiles not found elsewhere to date.
The authors describe very rare complication (pseudopleural effusion) after peripheral venous cannulation (Introcan-W 24G3/4 through v. axilaris) in extremely premature newborn with birth weight 600 grams, which lead to worsening of patient's respiratory insufficiency. Ultrasonographic examination confirmed extrapleural process without necessity of surgical intervention. Cannula extraction and infusion interruption were followed by spontaneous regression of the complication, thereafter artificial ventilation was discontinued and baby was discharged.
BACKGROUND: To determine the influence of chorioamnionitis and neonatal sepsis on procalcitonin (PCT) levels in very-low-birth-weight (VLBW) infants within the first week of life. DESIGN: PCT serum levels were measured in cord blood 1 h after delivery and on day 3 and day 7 of life. Chorioamnionitis and neonatal sepsis within the first week were monitored. RESULTS: Chorioamnionitis was present in eight of 37 patients (21.6%). PCT on day 3 was increased in both the "No chorioamnionitis" (2.54 ng mL(-1), SEM 0.51) and "Chorioamnionitis" (6.96 ng mL(-1), SEM 2.93) groups of VLBW infants compared with the 1st hour values (0.45 and 0.58 ng mL(-1) SEM 0.07 and 0.11, respectively, P < 0.001) of the same patients. The postnatal gain was higher in the "Chorioamnionitis" group (P < 0.01). Neonatal sepsis was diagnosed (after exclusion) in 12 of 32 patients (37.5%). Mean values of maximum PCT in patients with and without sepsis were 8.41 ng mL(-1) (SEM 1.87) and 3.02 ng mL(-1) (SEM 1.38), respectively (P < 0.05). Sensitivity to sepsis of PCT, ratio of immature to total neutrophils (I : T), and C-reactive protein (CRP) were 75%, 50% and 25%, respectively. CONCLUSIONS: In the group of VLBW infants the PCT level within 72 h of delivery was markedly increased in patients with chorioamnionitis. Compared with I : T and CRP, PCT appears to be a more sensitive marker of neonatal sepsis.
To define multiple organ dysfunction in newborns, we established a sequential scoring system NEOMOD (Neonatal Multiple Organ Dysfunction Score). It was developed to describe the process of increasing physiologic derangement in critically ill newborns. It provides, during the first 28 days of life, information concerning function of organ systems having a primary influence on mortality in very low birth weight (VLBW) infants. Our scoring system has been used in 142 VLBW infants. It evaluates moderate (1 point) or severe dysfunction (2 points) in 7 organ systems (central nervous system, cardiovascular, renal, respiratory, and gastrointestinal systems, and hemocoagulation and acid-base balance) in 24-h intervals from day 1 to 28 of life. Maximum possible value of NEOMOD was 14 points. Receiver operating characteristic curve was used for assessing predictive accuracy of maximum NEOMOD score obtained by daily scoring for mortality rate. AUC (area under curve) attained by NEOMOD was 0.95 for mortality within the first 28 days and 0.91 for hospital mortality, respectively. In the study group, NEOMOD score of > or = 9 was associated with 100% mortality. An analysis of specific organ dysfunctions in the non-survivors group (n = 16) disclosed, in all patients, dysfunction of more than two organ systems 24 h before death. Similar to critically ill adults, secondary multiple organ dysfunction can be described also in a majority of critically ill VLBW infants. NEOMOD scores may help to evaluate daily the severity of the syndrome and risk of death.
Procalcitonin (PCT) is a protein consisting of 116 aminoacids with molecular weight 13 kDa. It is encoded by CALC-1 gene. According to the basic and clinical research results PCT appears to be a highly sensitive and specific marker reflecting severity of the systemic inflammatory response to infectious stimuli. Despite the investigation focused on CALC-1 gene, little is known about the biology of PCT and cellular sources of PCT during inflammation. One of the possible sources may be human peripheral blood mononuclear cells. PCT is an indicator of bacterial infections minimally stimulated by viral infections, autoimmune diseases and tumors.
The authors present their experience with the reconstruction of the diaphragm with a synthetic polytetrafluoroethylene patch in a group of 66 neonates with a congenital diaphragmatic hernia. After preoperative stabilization 53 neonates (80%) were operated, simple reconstruction of the diaphragm was made in 39 neonates (74%), reconstruction of the diaphragm with a polytetrafluoroethylene patch was indicated in 14 patients (26%). Nine patients recovered after reconstruction of the diaphragm by a synthetic patch without complications. The only relapse of diaphragmatic hernia when using a patch was recorded in a neonate with a bilateral diaphragmatic hernia, sternal cleft and omphalocele. After simple reconstruction of the diaphragm there was no relapse of hernia. The total mortality in the group was 27% (18 neonates). After surgery five neonates died. Two of them died of serious haemorrhagic complications during extracorporeal membrane oxygenation and three died after operations performed at borderline oxygenation and ventilation values and subsequent deterioration of the general condition. In four of them a polytetrafluoroethylene patch (GORE-TEX) was used. Reconstruction of the diaphragm by a polytetrafluoroethylene patch is a suitable surgical method in the treatment of neonates with a congenital diaphragmatic hernia. Indication for the use of a patch is agenesis of the diaphragm and major diaphragmatic defects with hypoplastic borders. The use of a non-absorbable synthetic patch is from the aspect of the long-term effect on growth and the development of skeletal deformities equivocal and will call for further detailed studies.
OBJECTIVE: To determine the influence of maternal chorioamnionitis and neonatal sepsis on interleukin-6 (IL-6) levels in cord blood and in blood obtained from very low birth weight (VLBW) infants within the first two hours of life. DESIGN: Prospective clinical study. SETTING: Institute for the Care of Mother and Child, Prague. METHODS: We measured the serum levels of IL-6 in 30 consecutive VLBW infants born in our institute. IL-6 levels were evaluated in cord blood and in neonatal blood within 2 hours after delivery. Maternal chorioamnionitis and neonatal sepsis within the first 72 hours of life were monitored. RESULTS: Maternal chorioamnionitis was detected in 7 of 30 patients (23.3%). There was no significant increase in IL-6 level in cord blood of newborns with maternal chorioamnionitis (p = 0.42). Serum level of IL-6 in this group did not differ from the level in newborns of mothers without signs of intraamniotic infection (p = 0.39). Neonatal early-onset sepsis was diagnosed in 7 of 30 patients (23.3%). There was no influence of neonatal sepsis on IL-6 level in cord blood (p = 0.98) and IL-6 level in neonatal blood (p = 0.19). We did not find any correlation between the group "chorioamnionitis positive" and "sepsis positive" (p = 0.31). CONCLUSION: IL-6 in cord blood or in neonatal blood within 2 hours of life was not enough sensitive and specific marker of maternal chorioamnionitis as well as for early-onset neonatal sepsis in the group of very low birth weight infants.
Criteria for the AT III substitution were fulfilled by 33 infants. Mean birth weight was 1321 g (480 g up to 2860 g), and mean gestational age was 29 weeks (23-39 weeks). AT III substitution in dosing of 5 u/kg/hr was administered to all patients as well as standard heparin 10 u/kg/hr. Initial plasma level of AT III in the study group prior to start of the substitution was 45 +/- 17% activity of normal plasma of adult donor. The value increased up to 90 +/- 32% after 24 hours and up to 113 +/- 38% at the end of the therapy. Eight patients died (24%). Considerable decrease of the Neonatal Therapeutic Intervention Scoring System (NTISS), indicating a level of multiple organ dysfunction, was observed as early as after the first 48 hours of AT III therapy in the entire group (p < 0.01). Extensive increase of platelet count (p < 0.05) occurred after 48 hours of AT III therapy in survivors. Except for a severe sepsis in one case, no clinical signs of increased bleeding occurred during the AT III therapy, and the clinical signs of pre-existing bleeding even disappeared in 5 cases. Analysis of the group of 8 deceased patients revealed irreversible organ dysfunction in 7 cases present prior to the start of AT III substitution. In conclusion, during the AT III substitution, no bleeding, no clinical side effects but improvement in multiple organ dysfunction including increase in platelet count was recorded.
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The authors describe the case of newborn with laparoschisis in whom severe idiopathic pulmonary hypertension during postoperative period developed and initiation of extracorporeal membrane oxygenation (ECMO) to maintain circulatory stability and adequate oxygenation was necessary. ECMO was performed for 75 hours with maximum extracorporeal support up to 50% of cardiac output (Biomedicus pump BP 50, Jostra oxygenator M8). Patient was successfully weaned and switched to conventional ventilation and nitric oxide inhalation with consequent extubation. No bleeding complications were observed during ECMO in connection with surgical repair of laparoschisis.
OBJECTIVE: To determine the influence of early-onset neonatal sepsis on interleukin-6 (IL-6) and procalcitonin (PCT) levels in cord blood. To evaluate the significance of usually used infection markers--C-reactive protein (CRP) and immature to total neutrophil ratio (I/T)--and new markers (PCT, IL-6) for the diagnosis of early-onset neonatal sepsis. DESIGN: Prospective clinical study. SETTING: Institute for the Care of Mother and Child, Prague. METHODS: The serum levels of IL-6 and PCT were measured in cord blood in 37 low birht weight infants less than 35 week of gestation born in our institute. IL-6 and PCT levels were further evaluated together with CRP and I/T in neonatal blood within 2 hours after delivery. Neonatal sepsis within the first 72 hours of life was monitored. RESULTS: Differences in mean values of CRP, I/T, IL-6, and PCT between "sepsis proven" and "sepsis not proven" groups were not statistically significant. Only the difference between groups in cord blood PCT was of borderline significance (p = 0.06, higher in "sepsis proven" group). Fisher test showed significant dependence on sepsis in cord blood PCT only (cut-off point 0.4 ng/ml, p < or = 0.05). Other parameters did not show significant dependence on sepsis. Sensitivity for early onset sepsis above 50% was found in cord blood PCT only (sensitivity 60%, specificity 85.2%). PCT predictive accuracy for sepsis expressed as AUC value was 0.74 +/- 0.06. CONCLUSION: The only relatively sensitive marker and moderate predictor of early-onset sepsis in premature low birthweight infant was in our study cord blood PCT.
OBJECTIVE OF STUDY: Evaluation of the natural surfactant in treatment of the respiratory distress syndrome (RDS) on the mortality and morbidity of neonates with a birth weight lower than 1500 g. TYPE OF STUDY: Retrospective analysis of data. SETTING: Department:perinatological centre, Institute for Mother and Child, Prague. METHOD: A total of 442 neonates with birth weights under 1500 g were evaluated. During period I/1994-XII/1998 271 neonates were analyzed (Group A). The results of the total neonatal mortality and morbidity were compared with results of care provided to 171 patients during I/1989-XII/1993 before introduction of the surfactant. Surfactant therapy was used in 134 patients of group A (9%) with RDS who met the standard indication criteria. The initial surfactant dose (Alveofact R Boehringer Ingelheim, GFR) depended on the ventilation parameters and was 50 mg/kg and in severe forms of RDS 100 mg/kg. The total cumulative dose did not exceed 200 mg/kg. The data were assembled in a database used in the Institute for the Care of Mother and Child and evaluated using the statistical programme EpiInfo (CDC, USA). RESULTS: In the group of neonates with a birth weight lower than 1000 g 110 neonates in group A were evaluated and 61 in group B. Surfactant was administered to 77 infants of the treated group (70%). Statistically significant differences were recorded: in the total mortality (A: 29 vs. B: 79%, p < 0.0001, the number of neonates who died during UPV (A: 32% vs. B: 80%, p < 0.0001), incidence of PVH-IVH grade I-IV (A: 29% vs. B: 67%, p < 0.0001). In the group of neonates with a birth weight of 1000 to 1499 g 161 children were evaluated in group A and 110 in group B. Alveofact was administered to 57 neonates of the treated group (35%). Statistically significant differences were recorded: in the total mortality (A: 4%, vs. B: 31%, p < 0.0001), the number of neonates who died during UBPV (A: 7% vs. B: 45%, p < 0.0001), incidence of perintraventricular grade I-IV (A: 11% vs. B: 35%, p < 0.0001), incidence of patent ductus arteriosus (A: 6% vs. B: 15%, p < 0.02), incidence of pneumothorax (A: 7% vs. B: 18%, p < 0.01) and in the incidence of posthaemorrhagic hydrocephalus (A: 2% vs. B: 11%, p < 0.01). There was a statistically significant difference in the incidence of BPD to the disadvantage of group A (A: 16% vs. B: 8%, p < 0.01). CONCLUSION: The study confirmed the favourable effect of the introduction of surfactant in the treatment of RDS and on the general mortality and morbidity of neonates with a birth weight below 1500 g.
OBJECTIVE OF STUDY: Evaluation of success of extracorporeal membrane oxygenation, EMCO) in the treatment of acute respiratory failure in mature neonates. TYPE OF STUDY: Clinical pilot study of the EMCO centre. SETTING: Institute for the Care of Mother and Child, Prague. MATERIAL AND METHOD: In 12 consecutive patients with severe acute respiratory distress syndrome and/or circulatory failure of different etiology who met the indication criteria the method of venoarterial EMCO was used. RESULTS: Venoarterial extracorporeal membrane oxygenation was successful in 75% patients who survived. Four patients died (1x syndrome of cerebral death associated with severe hypoxic-ischaemic encephalopathy, 2x severe irreversible haemorrhage, into the abdominal and thoracic cavity, 1x periventricular intraventricular haemorrhage grade III.). The mean period of EMCO was 71.4 +/- 31.7 hours (range 25-130 hours). On comparison of the surviving group (S) and the non-surviving group (NS) there was a significant difference in the necessity of continuous inotropic adrenaline support during EMCO. In patients who died necropsy confirmed irreversible multiorgan failure. CONCLUSION: In indicated cases extracorporeal membrane oxygenation remains the method of choice in critically ill mature neonates. A prognostically adverse factor is the necessity of inotropic support and haemodialysis during EMCO.