Introduction: In addition to preventive measures (wearing masks, hand hygiene, isolation), mass vaccination of the population remains the most effective means of combatting the COVID -19 pandemic. ...One of the serious hypersensitivity reactions to the vaccine is anaphylaxis. The aim of this study was to present the experience of the Clinical Hospital Center (CHC) Rijeka with screening and vaccination of patients at increased risk for anaphylaxis or similar severe allergic reaction to the SARS-CoV-2 vaccine. Participants and Methods: The study included data from all patients registered in the electronic consultation system of CHC Rijeka in 2021, in whom vaccination in hospital setting was indicated and who had received at least one dose of the vaccine against COVID -19 in the same year. The inquiry about the need for vaccination at the day hospital was made by a general practitioner, and the indication was made by a team of hospital allergologists. Only Pfizer’s vaccine (Comirnaty®) was used for vaccination. Results: In 2021, a total of 451 patients were vaccinated based on the prior e-consultation. Of these, 138 received only the first dose of the vaccine, 308 received both doses, and five patients received three doses. The most common indication for in-hospital vaccination was a history of anaphylaxis or anaphylactoid reaction, in 330 (73.2%) patients. A total of 97 patients (21.5%) were referred for a history of non-anaphylactic allergic reaction, 17 (3.8%) for angioedema, and seven patients (1.6%) for other reasons. None of the patients vaccinated at the day hospital developed an anaphylactic reaction to the SARS-CoV-2 vaccine. A total of six patients reported mild reactions after vaccine administration. Conclusion: In the context of COVID -19 morbidity and mortality, the benefit of vaccination far outweighs the risk of anaphylaxis, which is readily treatable in the hospital setting. However, caution and prolonged monitoring is still warranted when vaccinating individuals with a history of anaphylaxis or allergy to any of the components of the administered vaccine.
SAŽETAK
UvodUz korištenje preventivnih mjera (nošenje maski, higijena ruku, izolacija), masovno cijepljenje pučanstva ostaje najučinkovitiji način u borbi protiv pandemije COVID-19. Jedna od ...ozbiljnih reakcija preosjetljivosti na cjepivo jest anafilaksija. Cilj ovoga rada bio je prikazati iskustva Kliničkoga bolničkog centra (KBC) Rijeka u probiru i cijepljenju bolesnika u kojih postoji povećan rizik za razvoj anafilaksije ili srodne teške alergijske reakcije na cjepivo protiv SARS-CoV-2.
Ispitanici i metodeU istraživanje su uključeni podatci o svim bolesnicima koji su registrirani u ambulanti za e-savjetovanje KBC-a Rijeka tijekom 2021. godine, kojima je postavljena indikacija za cijepljenje u bolničkim uvjetima te koji su tijekom iste godine primili barem jednu dozu cjepiva protiv COVID-19. Upit o potrebi cijepljenja u bolničkim uvjetima postavljao je liječnik obiteljske medicine, a indikaciju je postavljao tim bolničkih liječnika alergologa. Pri cijepljenju je isključivo primjenjivano Pfizer (Comirnaty®) cjepivo.
RezultatiOd bolesnika kojima je kroz e-savjetovanje postavljena indikacija za cijepljenje u bolničkim uvjetima, tijekom 2021. godine cijepljeno je ukupno 451. Pritom je samo prvu dozu cjepiva primilo 138, obje doze 308, a docjepnu dozu pet bolesnika. Najčešća indikacija za cijepljenje putem dnevne bolnice bila je anamneza anafilaksije ili anafilaktoidne reakcije i to u 330 bolesnika (73,2%). Ukupno 97 bolesnika (21,5%) upućeno je zbog anamneze neanafilaktičke alergijske reakcije, njih 17 (3,8%) zbog anamneze angioedema, a sedam bolesnika (1,6%) zbog ostalih razloga. Među bolesnicima cijepljenim putem dnevne bolnice niti jedan nije razvio anafilaktičku reakciju na cjepivo protiv SARS-CoV-2. Zabilježeno je ukupno šest blažih reakcija prilikom aplikacije cjepiva.
ZaključakU kontekstu morbiditeta i mortaliteta od COVID-19, korist cijepljenja daleko nadmašuje rizik od pojave anafilaksije, koja je liječiva. Ipak, potreban je nadzor pri cijepljenju osoba koje u anamnezi imaju anafilaksiju ili alergiju na neku od komponenti primjenjivanog cjepiva.
Hypertriglyceridemia is the third most common cause of acute pancreatitis (AP). It has been shown that hypertriglyceridemia aggravates the severity and related complications of AP; however, detailed ...analyses of large cohorts are contradictory. Our aim was to investigate the dose-dependent effect of hypertriglyceridemia on AP.
AP patients over 18 years old who underwent triglyceride measurement within the initial three days were included into our cohort analysis from a prospective international, multicenter AP registry operated by the Hungarian Pancreatic Study Group. Data on 716 AP cases were analyzed. Six groups were created based on the highest triglyceride level (<1.7 mmol/l, 1.7–2.19 mmol/l, 2.2–5.59 mmol/l, 5.6–11.29 mmol/l, 11.3–22.59 mmol/l, ≥22.6 mmol/l).
Hypertriglyceridemia (≥1.7 mmol/l) presented in 30.6% of the patients and was significantly and dose-dependently associated with younger age and male gender. In 7.7% of AP cases, hypertriglyceridemia was considered as a causative etiological factor (≥11.3 mmol/l); however, 43.6% of these cases were associated with other etiologies (alcohol and biliary). Hypertriglyceridemia was significantly and dose-dependently related to obesity and diabetes. The rates of local complications and organ failure and maximum CRP level were significantly and dose-dependently raised by hypertriglyceridemia. Triglyceride above 11.3 mmol/l was linked to a significantly higher incidence of moderately severe AP and longer hospital stay, whereas triglyceride over 22.6 mmol/l was significantly associated with severe AP as well.
Hypertriglyceridemia dose-dependently aggravates the severity and related complications of AP. Diagnostic workup for hypertriglyceridemia requires better awareness regardless of the etiology of AP.
Ancient DNA research in the past decade has revealed that European population structure changed dramatically in the prehistoric period (14,000-3000 years before present, YBP), reflecting the ...widespread introduction of Neolithic farmer and Bronze Age Steppe ancestries. However, little is known about how population structure changed from the historical period onward (3000 YBP - present). To address this, we collected whole genomes from 204 individuals from Europe and the Mediterranean, many of which are the first historical period genomes from their region (e.g. Armenia and France). We found that most regions show remarkable inter-individual heterogeneity. At least 7% of historical individuals carry ancestry uncommon in the region where they were sampled, some indicating cross-Mediterranean contacts. Despite this high level of mobility, overall population structure across western Eurasia is relatively stable through the historical period up to the present, mirroring geography. We show that, under standard population genetics models with local panmixia, the observed level of dispersal would lead to a collapse of population structure. Persistent population structure thus suggests a lower effective migration rate than indicated by the observed dispersal. We hypothesize that this phenomenon can be explained by extensive transient dispersal arising from drastically improved transportation networks and the Roman Empire's mobilization of people for trade, labor, and military. This work highlights the utility of ancient DNA in elucidating finer scale human population dynamics in recent history.
Fertility-sparing surgery (FSS) aims to achieve oncological outcomes that are non-inferior to radical treatment while preserving fertility and optimizing reproductive results. This study assesses in ...vitro fertilization (IVF) outcomes in early-stage cervical cancer survivors following FSS, comparing radical and non-radical approaches.
This retrospective analysis used data from Hungary's National Health Insurance Fund (2004–2022) on patients who underwent IVF treatment following FSS for early-stage cervical cancer at ten Hungarian fertility clinics. Patients were classified into radical and non-radical surgical groups, with the uterine arteries being spared in the non-radical procedures. RStudio (R software version: 4.2.2) was used for statistical analysis. Student's t-test was used to compare group means, and Fisher's exact test was applied to assess independence and distributions between categorical variables, and to estimate odds.
The study analyzed data from 122 IVF treatment cycles involving 36 patients. The non-radical group had a significantly higher live birth rate (83%, 5/6 compared to the radical group (17%, 5/30). Additionally, the non-radical group had a significantly higher implantation rate and cumulative live birth rate per oocyte retrieval (37%, 7/19 and 55%, 6/11 respectively) compared to the radical group (8%, 12/148 and 6%, 5/80 respectively).
This is the largest study to evaluate IVF outcomes in young cervical cancer survivors who have undergone FSS. The findings suggest that less radical procedures are associated with significantly better IVF outcomes. These results emphasize the importance of considering oncological safety and reproductive outcomes together when choosing FSS for early-stage cervical cancer patients. It also highlights the reproductive benefits of performing less radical surgery.
•IVF outcomes were analyzed in cervical cancer survivors treated by fertility-sparing surgery.•Radical fertility sparing procedures were associated with lower cumulative live birth rates.•Reduced implantation rate may be the key factor explaining worse IVF outcome in patients with uterine artery ligation.•Decreased radicality and uterine artery sparing is advocated to optimize reproductive outcomes.
The aim of this study was to draw attention to the challenges of solubility measurement and to present new techniques and detection methods that provide more accurate results. We investigated the ...effect of crystal structure, pH and buffer composition on thermodynamic equilibrium solubility using two polymorphs of carvedilol (Form I and Form II) as model compounds. Measuring the solubility of carvedilol is challenging, as the literature data show extremely high standard deviation. Therefore standardized measurements were performed in the pH range 3-10, in two solutions at 25 °C: Britton-Robinson (BR) and BR with added KCl. Solid phase analysis was performed by X-ray powder diffraction and Raman spectroscopy. The measured
S
pH
data were compared to the theoretical Henderson-Hasselbalch (HH) curve and a perfect fit was found in the pH range 7-10. The salt formation could be observed in the acidic pH range. The counter-ion and solubility of the salt were found to be different in various buffer solutions.
In situ
fiber optic UV probes were used to monitor the dissolution of carvedilol polymorphs in real-time. The results showed significantly different dissolution kinetics for the polymorphs depending on the pH and the buffer solution. From the dissolution profile, the time required to reach the equilibrium was determined. In most cases, it was more than 24 hours, therefore using the standard protocol (6 hours agitation, 18 hours sedimentation) would have caused significant inaccuracy in results. In extreme cases the measured concentration after 24 hours was found to be 5 or 6 times higher than the real equilibrium solubility.
Study of factors like type of polymorphs, pH and buffer composition influencing the equilibrium time of carvedilol using
in situ
UV-probes.
The incidence of acute pancreatitis (AP) and the prevalence of metabolic syndrome (MetS) are growing worldwide. Several studies have confirmed that obesity (OB), hyperlipidemia (HL), or diabetes ...mellitus (DM) can increase severity, mortality, and complications in AP. However, there is no comprehensive information on the independent or joint effect of MetS components on the outcome of AP. Our aims were (1) to understand whether the components of MetS have an independent effect on the outcome of AP and (2) to examine the joint effect of their combinations.
From 2012 to 2017, 1435 AP cases from 28 centers were included in the prospective AP Registry. Patient groups were formed retrospectively based on the presence of OB, HL, DM, and hypertension (HT). The primary endpoints were mortality, severity, complications of AP, and length of hospital stay. Odds ratio (OR) with 95% confidence intervals (CIs) were calculated.
1257 patients (55.7 ± 17.0 years) were included in the analysis. The presence of OB was an independent predictive factor for renal failure OR: 2.98 (CI: 1.33-6.66) and obese patients spent a longer time in hospital compared to non-obese patients (12.1 vs. 10.4 days,
= 0.008). HT increased the risk of severe AP OR: 3.41 (CI: 1.39-8.37), renal failure OR: 7.46 (CI: 1.61-34.49), and the length of hospitalization (11.8 vs. 10.5 days,
= 0.020). HL increased the risk of local complications OR: 1.51 (CI: 1.10-2.07), renal failure OR: 6.4 (CI: 1.93-21.17), and the incidence of newly diagnosed DM OR: 2.55 (CI: 1.26-5.19). No relation was found between the presence of DM and the outcome of AP. 906 cases (mean age ±
: 56.9 ± 16.7 years) had data on all four components of MetS available. The presence of two, three, or four MetS factors increased the incidence of an unfavorable outcome compared to patients with no MetS factors.
OB, HT, and HL are independent risk factors for a number of complications. HT is an independent risk factor for severity as well. Components of MetS strongly synergize each other's detrimental effect. It is important to search for and follow up on the components of MetS in AP.
Fertility preservation in cancer patients Vesztergom, Dóra; Téglás, Gyöngyvér; Nánássy, László ...
Orvosi hetilap,
02/2022, Letnik:
163, Številka:
6
Journal Article
Recenzirano
Odprti dostop
Introduction: Fertility preservation or oncofertility is a relatively new interdisciplinary field dealing with the preservation of female and male reproductive functions before the administration of ...gonadotoxic therapy. Despite recommendations from different international scientific bodies, Hungary still does not have a national fertility preservation network, patient referral is unorganised. Objective: As the first step towards establishing a national fertility preservation program, a study was designed to evaluate the Hungarian oncologists' knowledge, attitudes and practice in the field of oncofertility. Method: A national online survey was sent to the physician members of the Hungarian Society of Clinical Oncology between November 2020 and February 2021. The survey was completed by 94 physicians and the results were analysed statistically. Results: The majority of the oncologists (77%) discusses reproductive health issues before starting gonadotoxic therapy. However, almost half of these physicians do not refer patients for fertility preservation consultation or treatment. Physicians report lack of organised fertility preservation network, lack of knowledge and clinical practice guidelines as major barriers in referring their patients for fertility preservation. The majority (86%) proposes that a better col-laboration between cancer and fertility centers needs to be organized in Hungary. Conclusion: This study is the first nationwide survey to assess oncologists' attitude, knowledge and practice in the field of oncofertility in Hungary. It highlights the need for more education and increased collaboration between oncologists and reproductive specialists. This is an important step towards the establishment of a national fertility preservation network which is our ultimate goal.
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