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Biomedical subjects

M Kvapil

Publications and source records attributed to M Kvapil.

At least 19 recordsLinked to original sources
PubMed2005

[Recommendations for the treatment of tobacco dependence].

This first Czech version of guidelines formulated by the working group of mentioned medical associations is based on current literature and international guidelines. They are aimed mainly on clinical medicine and on incorporation of this treatment into the health care system according to WHO recommendations. They should serve to the treatment of tobacco dependence at any level: during any contact with the smoking patient (short intervention), in specialised centres or for the health care providers or health system itself.

Humans↗
PubMed2005

Effect of rofecoxib on the glomerular filtration rate, proteinuria and the renin-angiotensin-aldosterone system in elderly subjects with chronic renal impairment.

UNLABELLED: Considering the increasing popularity and prescribing of specific COX-2 inhibitors, a new class of NSAIDs lacking gastrointestinal side effects, the evaluation of their effects on renal function has become very important. OBJECTIVE: The aim of the study was to evaluate the effect of rofecoxib on GFR, proteinuria and the renin-angiotensin-aldosterone system (RAAS) in elderly patients with chronic renal impairment under controlled conditions of water and salt intake. SUBJECTS: There were ten patients (average age 67 years, range 53 - 80 years) with analgesic or vascular nephropathy (average GFR 54 ml/min/1.73 m2, range 30 - 79 ml/min/ 1.73 m2) given 25 mg rofecoxib daily for seven days under balanced conditions of water and sodium metabolism (salt intake 6 - 8 g/24 hours). METHODS: The effect of rofecoxib on GFR measured using inulin clearance (C(in)), creatinine clearance (C(Cr)) serum cystatin C concentration (S(cystatin)), tubular creatinine secretion (using the ratio C(Cr)/C(in)), 24-hour urinary excretion of albumin (U(alb)V) and prostaglandins (U(PGE2)V and U(PGF2alpha)V), basal and stimulated plasma renin activity (PRA) and serum aldosterone concentration S(aldosterone) was evaluated before and on Day 7 during rofecoxib treatment. RESULTS: Rofecoxib did not significantly change C(in), C(Cr), S(cystatin), C(Cr)/C(in) and U(alb)V. However, U(PGE2)V and U(PGF2alpha)V were decreased during rofecoxib administration (p = 0.059 and p = 0.024, respectively). Rofecoxib attenuated the stimulated rise of PRA and S(aldosterone) (p = 0.019 and p = 0.008, respectively). CONCLUSIONS: Short-term rofecoxib administration was not associated with significant change in GFR in elderly patients with moderate chronic renal impairment under conditions of balanced salt and water metabolism despite significant attenuation of RAAS activity. Since the C(Cr)/C(in) ratio did not change in our study, we assume rofecoxib to have no influence on creatinine tubular secretion.

Aged↗
PubMed2004

GUIDE study: double-blind comparison of once-daily gliclazide MR and glimepiride in type 2 diabetic patients.

BACKGROUND: Progressive beta-cell failure is a characteristic feature of type 2 diabetes; consequently, beta-cell secretagogues are useful for achieving sufficient glycaemic control. The European GUIDE study is the first large-scale head-to-head comparison of two sulphonylureas designed for once-daily administration used under conditions of everyday clinical practice. DESIGN: Eight hundred and forty-five type 2 diabetic patients were randomized to either gliclazide modified release (MR) 30-120 mg daily or glimepiride 1-6 mg daily as monotherapy or in combination with their current treatment (metformin or an alpha-glucosidase inhibitor) according to a double-blind, 27-week, parallel-group design. Efficacy was evaluated by HbA1c and safety by hypoglycaemic episodes using the European Agency definition. RESULTS: HbA1c decreased similarly in both groups from 8.4% to 7.2% on gliclazide MR and from 8.2% to 7.2% on glimepiride. Approximately 50% of the patients achieved HbA1c levels less than 7%, and 25% less than 6.5%. The mean difference between groups of the final HbA1c was -0.06% (noninferiority test P < 0.0001). No hypoglycaemia requiring external assistance occurred. Hypoglycaemia with blood glucose level < 3 mmol L(-1) occurred significantly less frequently (P = 0.003) with gliclazide MR (3.7% of patients) compared with glimepiride (8.9% of patients). The distribution of the sulphonylurea doses was similar in both groups. CONCLUSIONS: This study provides new insights into therapeutic strategies using sulphonylureas. It shows that gliclazide MR is at least as effective as glimepiride, either as monotherapy or in combination. The safety of gliclazide MR was significantly better, demonstrating approximately 50% fewer confirmed hypoglycaemic episodes in comparison with glimepiride.

Diabetes Mellitus, Type 2↗
PubMed2004

Somatostatin: beneficial effects on remission in young adult patients with newly diagnosed diabetes mellitus type 1.

To assess a possible influence of short-term administration of somatostatin on remission development in adult patients with newly diagnosed diabetes mellitus type 1, the somatostatin analog octreotide was given for two weeks after the establishment of the diagnosis at the daily dose of 150 microg subcutaneously in addition to the regular insulin and metabolic therapy. When compared to the control group, the remission was achieved earlier in the octreotide group (6+/-4 weeks vs. 11+/-12 weeks in the control group, p 0.05) and its duration was longer (99+/-49 weeks vs. 49+/-31 weeks in the control group, p 0.05). Moreover, remission also appeared in patients from the octreotide group with lower endogenous residual secretion of insulin (basal C peptide at the time of diagnosis in patients who later entered remission was 0.23+/-0.16 nmol/l vs. 0.34+/-.18 nmol/l in the control group, p<0.05). The increase of 24-h urine excretion of C-peptide after the therapy with octreotide was predictive for remission development. It can thus be concluded that octreotide administration in adults with newly diagnosed diabetes mellitus type 1 positively influences both the onset and duration of remission.

Adult↗
PubMed2004

Comparison of the exercise ECG and stress myocardial SPECT in detection of the significant coronary artery disease in the asymptomatic patients with diabetes mellitus type 2.

BACKGROUND: Diabetes mellitus is known to be a risk factor of the coronary heart disease even in the asymptomatic patients. Only a limited number of reports comparing the significance of different noninvasive stress tests in establishing the diagnosis of the advanced coronary lesions exists. OBJECTIVES: The aim of the study was to compare the significance of 12-lead exercise ECG and the myocardial SPECT in order to detect the significant coronary heart disease in asymptomatic type 2 diabetics. METHODS: 126 type 2 diabetic patients with negative history and no clinical or electrocardiographic signs of coronary heart disease were examined with the exercise ECG and the stress myocardial SPECT. The selective coronary angiography (SCG) was recommended to all patients with an abnormal SPECT or (and) a positive exercise ECG. The SCG was recommended to patients with equivocal results of the stress myocardial SPECT as well. RESULTS: 33 out of 126 examined patients (26.2%) had an abnormal, 33 equivocal and 60 normal stress myocardial SPECT. The exercise test could be evaluated in 99 examined patients (78%). 25 diabetics had positive test (19.8%). The correlation between the results of 2 tests was very good (p=0.0001). 38 patients had SCG, 24 with the abnormal SPECT, 13 with equivocal and 1 with normal SPECT. Out of these 20 patients had positive, 10 negative and 8 non-assessable exercise ECG. The relation between the presence of significant coronary stenosis (stenosis >70%) and the presence of abnormal stress myocardial SPECT was stronger (p=0.006) when compared with the positive exercise test (p=0.037). For the significant coronary stenosis the positive predictive value was 90% with the stress myocardial SPECT and 68% with the exercise ECG. CONCLUSION: The significance of the exercise ECG is lower predominantly due to high proportion of patients with non-assessable results. For the presence of significant coronary stenosis the positive predictive value of the stress myocardial SPECT is better than that of the exercise ECG. (Tab. 2, Ref: 25.)

Coronary Angiography↗
PubMed2004

[Diabetes mellitus and liver diseases].

Diabetes mellitus is a independent risk factor for the hepatitis C and for the hepatocellular carcinoma. Fatty liver is a obviously finding in patients with type 2 diabetes. It can develop steatofibrosis, steatohepatitis or liver cirrhosis. Steatohepatitis may be affected with weight reduction, metformin, rosiglitazon, or orlistat.

Diabetes Complications↗
PubMed2004

[Relation between diabetes compensation, albuminuria and biochemical parameters and the results of stress myocardial SPECT in asymptomatic type 2 diabetics].

The patients with diabetes mellitus and another risk factors have significantly higher risk to suffer from ischemic heart disease. Myocardial stress SPECT represents the examination which correlates very well with the results of selective coronary angiography even in asymptomatic diabetic patients. The aim of our study was to evaluate the relation of SPECT result to diabetes compensation, presence of micro/macroalbuminuria, blood level of fibrinogen, CRP, homocysteine and uric acid. Out of 126 diabetic 2. type abnormal SPECT has been found in 33 (26%). Fasting blood sugar (9.3 +/- 1.4 mmol/l in patients with abnormal SPECT vs. 9.7 +/- 1.9 mmol/l in the other diabetics, n.s.) and HbA1c (7.5 +/- 1.3% vs. 7.5 +/- 1.3%, n.s.) are not significantly different in the patients with abnormal SPECT to the other diabetics without this finding. Micro/macroalbuminuria was significantly more frequently seen in patients with abnormal SPECT (60% of patients with abnormal SPECT and 29% in the rest of diabetics, p = 0.01). Fibrinogen was significantly more elevated in diabetics with abnormal SPECT (3.76 +/- 0.5 g/l in the group with abnormal SPECT vs. 3.23 +/- 0.43 g/l, p = 0.0003). In the diabetics with abnormal SPECT we have found significantly higher CRP (3.84 +/- 1.51 mg/l vs. 2.79 +/- 1.13 mg/l, p = 0.024) and homocysteine (13.78 +/- 3.26 micromol/l vs. 10.98 +/- 2.33 micromol/l, p = 0.006). Uric acid level was not significantly different in the group of diabetics with abnormal SPECT to the rest of the patients (361 +/- 64 micromol/l in abnormal SPECT vs. 353 +/- 51 micromol/l, n.s.). When we analyse our results we have found that abnormal SPECT is rarely discovered in the asymptomatic 2nd type diabetics with the combination of negative micro/macroalbuminuria and fibrinogen level below 3.5 g/l.

Albuminuria↗
PubMed2004

Life-threatening renal failure caused by vasomotor nephropathy associated with nonsteroidal anti-inflammatory drugs.

The purpose of this study was to evaluate the prevalence of life-threatening renal failure (RF) caused by vasomotor nephropathy associated with nonsteroidal anti-inflammatory drug (NSAID) treatment (NSAID-RF) and risk factors for this renal impairment in an inception cohort of patients with recently diagnosed uremia treated by emergency hemodialysis in a prospective regional study. There are few published data on this phenomenon. Two hundred fifty-six patients (137 men, 119 women, mean age 68 years [22-95 years]) with acute uremia were treated with emergency hemodialysis in the intensive care unit over a period of 70 months. The patients were from an area of 231,000 inhabitants. Of the 256 patients, clinical data from a group of 79 patients with medical-type renal failure were analyzed in detail. The prevalence of NSAID-RF was 8%. This prevalence decreased to 4% when patients without any other medication affecting compensatory renal hemodynamics were considered. Moreover when nonpharmacological insults were not taken into account the prevalence decreased to only 1.6%. In 80% of the patients with NSAID-RF, nonpharmacological insults contributed to renal impairment. Both hypotension of cardiac etiology and dehydration/hypovolemia were present in 25% of the patients with this type of RF while urinary tract obstruction was seen in 1%. In 75% patients with NSAID-RF the underlying nephropathies were identified. NSAID-RF was not frequent. The population at greatest risk for renal functional alteration associated with NSAID therapy included patients with dehydration/hypovolemia, hypotension of cardiac etiology and those with pre-existing renal impairment, especially with vascular and analgesic nephropathy.

Acute Disease↗
PubMed2003

[Nutritional intervention in patients with cerebrovascular stroke].

The patients with acute cerebral stroke suffer from stress situation which may induce the catabolic state. The aim of our study was to evaluate the influence of the nutrition intervention and follow-up of the nutrition parameters in the patients with acute ischemic cerebral stroke. We have examined 30 patients with acute ischemic cerebral stroke, the average age 71.4 +/- 8.6 years. In all the patients we have measured some antropometric, biochemic and immunologic parameters of the nutrition status on admission. At the same time we have evaluated the size of the neurological deficit with NIH stroke scale and Barthel index. Every day we have monitored in all the patients the nutrition intake. In case the food intake has not reached 30 kcal/kg/day we have started the nutrition intervention by giving polymer enteral nutrition: either like sipping or if necessary through nasogastric tube. The nutrition intervention has been necessary in 18 patients (60%). The measurement of antropometric, biochemical and immunologic parameters have been repeated after 14 days. The evaluation of nutrition parameters have shown no significant changes since admission. The changes of the nutrition parameters in this group of the patients we have compared with the earlier reported group of the patients where no nutrition monitoring and intervention were applied and the nutrition parameters have deteriorated significantly in 2 weeks. By comparing we have confirmed that the careful monitoring of nutrition intake and in the majority of patients also nutrition intervention are necessary, especially because the improvement of the neurological deficit have been noticed more in the group of the monitored and intervened patients. The nutrition intervention can stabilize the followed nutrition parameters which may play the significant role in the speed and efficacy of the rehabilitation.

Aged↗
PubMed2003

[Hypertension and diabetes--current views on specific questions].

Hypertension in patients with diabetes is proved to be connected with early development of macrovascular and atherosclerotic complications, increased incidence of heart failures, and development and progression of microangiopathic complications. We start interventions in diabetics when blood pressure values reach 140/90 mm Hg. Non-pharmacological treatment is often unsuccessful, so we apply pharmacological treatment. The target value of blood pressure does not exceed 130/80 mm Hg. Monotherapy is usually insufficient. Individual drugs we choose according to attendant complications, according to a potential benefit from affecting individual risks for a patient's prognosis.

Diabetes Mellitus, Type 2↗
PubMed2002

[Helicobacter pylori and diabetes mellitus].

BACKGROUND: Helicobacter (H.) pylori participates significantly on the pathogeny of chronic gastritis, duodenal a gastric ulcer, carcinoma and lymphoma of the stomach. Attention was attracted also by some extragastric diseases, including diabetes mellitus, where the elevated antibodies levels against H. pylori was found. The aim of the work was to determine the seroprevalence in relation to the sex and type of disease in a cohort of diabetics and in a control group of blood donors. METHODS AND RESULTS: In 195 diabetic patients (type I and II) and 216 blood donors levels of IgG antibodies were determined by ELISA method. Seroprevalence in the group of diabetic patients was 27%, in males 26% and in women 28% (n.s.). No differences related to sex or diabetes type were found. Significant differences in seroprevalence were found among the group of diabetic patients and blood donors (27% vs. 51%, p < 0.001), male diabetics of both types and blood donors (26% vs. 62%, p < 0.001). No differences were found between female diabetic patients and controls (28%, 27% vs. 40%, n.s.). CONCLUSIONS: Our study has shown a lower seroprevalence of H. pylori in diabetic patients of type I and II in comparison with the healthy population. Such finding differs from the generally accepted experience of the higher sensitivity of these patients to infection. The practical significance of the observation remains unsolved.

Antibodies, Bacterial↗
PubMed2002

[Diagnosis and therapy of gestational diabetes mellitus].

In 1999-2000 at the Medical Clinic Motol Faculty Hospital in collaboration with the Gynaecological Clinic of the Hospital a group of 55 pregnant women with the diagnosis of gestational diabetes (GDM) were followed up. The objective of the investigation was to find out how in the investigated area (detachment area of the Gynaecological and Obstetric Clinic Motol Faculty Hospital) GDM is diagnosed at present, how it is treated and what is the percentage of perinatal morbidity in the investigated group. The mean age of the investigated women was 32.3 +/- 4.5 years. The presence of risk factors for the development of GDM was found in 59.8% of the examined women. 65.7% women had a positive gynaecological case-history. GDM was detected most frequently during the 30th week of pregnancy, in 25% women in the 35th and later week of gestation. In 52% the diagnosis of GDM was established only on hospital admission on account of complications of pregnancy. The mean HbA1C level during detection of gestational diabetes was 6.81 +/- 0.41%. The majority of women -91.1%--were treated by diet, 8.9% women had insulin treatment. The prevalence of diabetic foctopathy was 48.3%. The mean weight of the offspring of diabetic mothers was 3350 g +/- 248 g, the mean length was 49.6 +/- 6.3 cm. No stillbirth was recorded. One infant suffered from an inborn developmental defect (morbus Down). The results provide evidence not only of late diagnosis of GDM (after the 28th week of gestation) but also of inadequate screening in the field, as GDM is frequently detected only during complications of pregnancy.

Adult↗
PubMed2002

[Comparison of short-term and long-term results after aortocoronary bypass in ischemic heart disease in diabetics and non-diabetics].

In the presented study we have evaluated short-term and long-term results of the multiple aortocoronary bypass surgery in the patients with ischemic heart disease. We have compared the incidence of the preoperative and postoperative complications, short-term and long-term mortality in the group of diabetics in comparison to nondiabetics as well as the entry characteristics of both groups. Among 2518 patients who were treated with aortocoronary bypass surgery there were 773 (30.6%) diabetics. The diabetic patients were significantly elder, we have found more women among them, more frequent presence of hypertension, chronic heart failure and peripheral vascular disease. Contrary in the incidence of the previous myocardial infarction we have not found any significant difference between both groups. The patients with diabetes mellitus had lower ejection fraction of the left ventricle and significantly more extensive coronary artery disease which explains that in this group of patients the number of coronary bypasses was significantly higher. Comparing the incidence of preoperative complications we have not seen any significant difference between the patients with and without diabetes mellitus. Out of the postoperative complications we have noticed significantly more renal failure, infectious complications, low cardiac output syndrome and bleeding disorders in the diabetic patients. The duration of hospitalisation in the intensive care unit was significantly longer in diabetics (55.11 +/- 89.09 hours to 47.84 +/- 65.18 hours in nondiabetics, p < 0.05). 30 days mortality in diabetics was 3.75% and 2.4% in nondiabetics (p < 0.05). This difference was mainly due to the significantly higher incidence of multiorgans failure as a cause of death among diabetics (1.3% in diabetics, 0.5% in nondiabetics, p < 0.05). 89.1% of nondiabetics and 86.9% of diabetics lived 2-6 years after aortocoronary bypass surgery (n.s.). We have found the significantly higher long-term cardiovascular mortality (2-6 years) in diabetics (10.3%) then in nondiabetics (7.6%, p < 0.05).

Coronary Artery Bypass↗
PubMed2002

[New oral antidiabetic agents and current strategies of peroral antidiabetic therapy (PAD)].

Optimal compensation in patients with type 2 diabetes is individualization of therapy according to the stage of the disease and ratio of the main pathophysiological disorders. Because of the hitherto inadequate effectiveness of known procedures attention is focused on seeking new more effective procedures either based on the use of known molecules of oral antidiabetics or introduction of new substances.

Administration, Oral↗
PubMed2002

[Gestational diabetes mellitus].

Any degree of carbohydrate intolerance which develops for the first time during pregnancy is defined as gestational diabetes mellitus (GDM). GDM is often discovered late, in more than half the cases only during complications associated with pregnancy. Early diagnosis of GDM and early correct therapy of GDM leads to reduction of complications associated with pregnancy, delivery and the perinatal period of the infant. As in our country unequivocal rules for detection of gestational diabetes are still lacking. We feel that introduction of correct routine screening will contribute to the earlier diagnosis of GDM in all women and thus also to appropriate therapy of gestational diabetes.

Diabetes, Gestational↗
PubMed2001

[Ethylene glycol poisoning].

Ethylene glycol is a common substance in various antifreeze preparations. Intoxication is caused by ingestion either as a suicide attempt or by an accident. The clinical course of intoxication is always severe, however, immediate launching of proper treatment can reverse the poor prognosis. Intoxication clinically proceeds in three stages: 1. Depressive CNS disturbances that can lead to coma. 2. Organ manifestations. 3. Acute renal failure. The case report of 46-year-old man admitted after ingestion of ethylene glycol in suicidal attempt summarises the essential principles of therapy--monitoring of vital functions, administration of ethanol solution as an antidote and hemodialysis to remove toxic components.

Ethylene Glycol↗
PubMed2001

[Diabetes mellitus in the elderly].

Diabetes mellitus is one of the most frequent chronic diseases of the elderly population with a high prevalence after the age of 65 years. In this group it is a serious cause of increased mortality and morbidity. More than 90% of patients suffer from type 2 diabetes mellitus. The disease takes frequently for a long time an asymptomatic course and if it persists for long it may lead to microvascular complications and is an important risk factor of cardiovascular and cerebrovascular diseases. The objective of treatment of diabetes in old age is in particular to restrict symptomatic hyperglycaemia, but at the same time we must not forget prevention of hypoglycaemia. It is also important to diagnose and treat diabetic complications. As elderly diabetic patients are usually polymorbid, diabetes mellitus in old age calls for a comprehensive approach not only to the treatment of hyperglycaemia but also of hypertension, dyslipidaemia and other associated diseases.

Age Factors↗