[Efficacy and safety of symphytum herb extract cream in the treatment of pressure ulcers]. / Therapieergebnisse und Anwendungssicherheit von Symphytum-Herba-Extrakt-Creme in der Behandlung von Dekubitus.

In an open, prospective use study, 161 patients with 198 decubitus ulcers (pressure ulcers, ITT population) in stages II and III were treated with the topical preparation symphytum herb extract cream. The bandages with the cream were changed every 2-3 days. The primary parameters evaluated were the area of the sore and the depth of the wound (planimetrically in mm). In all, 151 patients with a total of 184 pressure sores (PP population) were included and received treatment over a period of 4 weeks in order to evaluate the treatment results. Complete healing of the pressure sores within 4 weeks was observed in 85.9 % (PP population)/79.8 % (ITT population) of the treated ulcers. Over a treatment duration of 25-30 days, a 89.2 % reduction of the total decubitus area was observed. The same result was found for the depth of the pressure ulcer with a reduction of 88 %. The overall treatment success was from both the perspective of the physician and the patient considered successful in 90.4 % (5-point scale) of cases and 87.9% (100 mm VAS, PP population). Two cases of local irritation were observed after 25/30 days (1.2 % of the patients with exposure), thus showing very good skin compatibility. The efficacy of symphytum herb extract cream is surprisingly good in the treatment of pressure ulcers.

Randomized double-blind study: wound-healing effects of a Symphytum herb extract cream (Symphytum×uplandicum Nyman) in children.

The wound healing effects of the topically applied preparation Traumaplant® containing a concentrate (10% active ingredient) from the aerial parts of medicinal comfrey (Symphytum × uplandicum Nyman) were examined in a randomized, controlled, clinical double-blind study. An otherwise identical low-dose preparation (1% active ingredient) was used as a control. The study population consisted of 108 children aged 3-12 years (n=54/group) with fresh abrasions. A 50% healing rate was reached 0.9 days earlier with the higher than with the lower concentration cream. The difference in the healing rate (0.38±0.18/day [95% CI 0.33-0.4] vs. 0.26±0.14/day [95% CI 0.222-0.297]) was statistically significant (p=0.0002). Physicians and children/parents both rated the efficacy of the 10% cream as significantly better than that of the control preparation (physicians' assessment after 2-3 and 7-9 days for verum vs. control: 90.7 and 92.6% vs. 55.6 and 74.0% of the healing rates were rated as "good" or "very good", respectively; p=0.0004 and 0.01). In subgroup analyses, there was no significant influence on the healing rate of the time elapsed between the accident and the first consultation, the wound surface, the affected body part, the origin of the injury and gender. There were no reported adverse effects or problems with tolerability such as local skin irritations. The results justify application of the Symphytum herb extract cream in children with blunt traumata with or without abrasions.

Effect of topical heparin and levomenol on atopic dermatitis: a randomized four-arm, placebo-controlled, double-blind clinical study.

BACKGROUND: The aim of the controlled double-blind trial was to demonstrate the superiority of a topical combination product over its single constituents. PATIENTS AND METHODS: A total of 278 patients with atopic dermatitis were randomized into four groups: 79 patients were treated with a topical combination of levomenol and heparin (A), 80 patients with levomenol alone (B), 78 patients with heparin alone (C) and 41 patients with the cream base with no active substances (D). The medication was applied twice daily for 8weeks. Efficacy criteria included the severity of pruritus (visual analogue scale, VAS) and the SCORing Atopic Dermatitis (SCORAD) index as well as the overall assessment of efficacy and tolerance by both physician and patient. RESULTS: The improvement of pruritus and SCORAD values in Group A was significantly higher compared with Groups B-D (ancova, P<7×10(-8) ). The improvement of pruritus in Group A approximately corresponded to the cumulative effect of the two single active substances, with mean improvements of itching of -41.3, -13.3, -21.3 and +0.6mm VAS in Groups A-D, respectively (95% CI 7.1-13.5, 2.9-9.2 and 10.4-18.3mm for the comparisons A vs. B, A vs. C and A vs. D). CONCLUSION: The combination of levomenol and heparin proved to be significantly more efficacious in the treatment of pruritus and inflamed skin than the preparations of the single components.

Pregnancy-associated plasma protein A and proform eosinophilic major basic protein in the detection of different types of coronary artery disease.

Kryptor system was proven to be a rapid, standard method for pregnancy-associated plasma protein A and proform eosinophilic major basic protein (PAPP-A/proMBP) complex detection in coronary artery disease (CAD). No age and/or gender differences in 51 controls and 110 stable coronary artery disease (SCAD) patients were found. SCAD patients did not differ from controls and no difference in PAPP-A/proMBP levels with regards to the number of affected vessels was found. In 21 unstable angina pectoris (UAP), in 35 without and 66 with ST elevation acute myocardial infarctions (NSTEMI, STEMI respectively) patients PAPP-A/proMBP levels were increased (P=0.004 and P<0.0005, respectively). PAPP-A/proMBP levels did not correlate with cardiac troponin I (cTnI) in STEMI and NSTEMI patients. PAPP-A/ proMBP increase was more frequent than cTnI (P=0.036) within the early phase of STEMI. In NSTEMI patients PAPP-A/proMBP positivity was present in 50% of cTnI negative cases. Receiver operating characteristic (ROC) analysis revealed the highest diagnostic accuracy of PAPP-A/proMBP (0.919) in STEMI cTnI positive cases. The highest specificity/sensitivity PAPP-A/proMBP levels for particular acute coronary syndrome (ACS) types were 10.65-14.75 mIU/l. Combination of PAPP-A/proMBP with cTnI increases their diagnostic efficacy within the early phase of ACS. Our results suggest that PAPP-A/proMBP complex is involved in processes preceding vulnerable plaque development in ACS.

Exposure to silica and risk of ANCA-associated vasculitis.

BACKGROUND: Exposure to silica dust is considered to be one of etiological factors of antineutrophil cytoplasmic antibodies (ANCA) -associated vasculitis (AAV). METHODS: Subjects exposed to silica dust in Central Bohemia and followed in the Department of Occupational Medicine, Charles University, were selected for study. A group of 86 men exposed to SiO2 for at least 5 years were examined. The association between occupational exposure to silica dust and ANCA positivity is analyzed. RESULTS: The subjects had a mean age of 66.7 years, and mean exposure to silica of 22.3 years. ANCA were detected significantly more frequently in patients group (17.1%; P-ANCA 18x, C-ANCA 3x) than in controls (n = 28, mean age 64.2 years, P-ANCA 1x, i.e., 3.6%). ANCA positivity was found less frequently (7.1%) in the group with history of SiO2 exposure without signs of pronounced silicosis, than in the group with simple (30.3%) or complicated silicosis (36.0%). Odds ratio for ANCA positivity and relative risk estimate in patients with silicosis were highly significant. Among possible predictor factors for ANCA positivity, silicosis and tuberculosis were relevant. No typical AAV was present among the patients. CONCLUSION: Long-term silica exposure may be one of the exogenous factors contributing to ANCA production, however, silica exposure alone, without typical silicosis, was not associated with ANCA positivity.

Evaluation of health care related web resources based on web citation analysis and other quality criteria.

Automatic system for ranking of educational health care related web resources based on quality criteria was developed. Automatic retrieval of new web resources from well-known directories followed by their automatic evaluation is a keystone of the system. The system provides this information: a) location of the resource and its author, b) number of back links to the resource, c) checks presence of electronic labels of quality. Currently the system encompasses more than 500 links to educational web resources divided into 47 medical specialities. The resources in all categories are ranked according to their link popularity, the electronic labels of quality are presented. History of link popularity is recorded and might be displayed at every resource. There are 2 language editions. The system operates automatically, the editors check and correct the retrieved values. The described system adds to webcite indexing criteria for objective evaluation of quality of webpages. It is useful for the selection of optimum education resources in health care.

Long-term retention of knowledge after a distance course in medical informatics at Charles University Prague.

BACKGROUND: Distance education is instructional delivery that does not constrain the student to be physically present in the same location as the instructor. The electronic distance learning called e-learning has evolved with the development of computer technologies and electronic communication. PURPOSE: Before setting the distance way of teaching as a standard part of medical schools' curricula, the impact of number of factors on the effectiveness of this way of teaching should be considered. METHODS: A group of 38 students went through a distance course of medical informatics. The course consisted of 10 lessons. At the end of the course the students sat for a final test that contained 60 multiple-choice test questions. There was always one correct answer. Time limit for test completion was 60 minutes. After 12 months, 31 students from the original group sat for the same test. The topics of the course were not repeated in the meantime. The students were not aware that their knowledge would be tested after 1 year. RESULTS: The average retention of knowledge expressed as a percentage of the students' performance in the first test was 66.8%. The knowledge retention correlated significantly with the statement "I liked the online course more than the classroom course" and positively with the number of hours spent with the computer weekly. CONCLUSIONS: Retention of knowledge after the electronic distance course after 12 months is close to 67%. Other results indicate that we can expect better retention of knowledge from independent, responsible, and positively motivated students who can easily operate information technologies.

Lymphocyte subpopulations and immunoglobulin levels in Hodgkin's disease survivors.

We investigated the frequency of lymphocyte populations (CD3+ /T lymphocytes/, CD4+ /helpers/, CD8+ /suppressor and cytotoxic/, CD3- CD16+ /NK cells/, CD3+ HLA-DR+ /activated T lymphocytes/, and CD20+ /B lymphocytes/) and immunoglobulin G, A, M, and E levels in a group of two hundred twenty nine Hodgkins disease long term survivors. The most frequent pathological findings were increased IgE levels, decreased CD3+ and CD4+ proportions, an increased CD20+ proportion and especially a low CD4/CD8 proportion. Decreased CD3+ and CD4+ and increased CD20+ proportions were more frequently found in the group with recurrent infections. IgM and IgA levels were positively correlated with plasmatic cholesterol and triacylglycerols levels. We suppose that immunological defects (increase of IgE levels, decreased T and helper lymphocytes) in Hodgkins disease survivors are inherent and are not related to atopy. Examination of lymphocyte subpopulations may be helpful in the prediction of an increased risk of recurrent infections.

[Nitric oxide in the treatment of acute respiratory distress syndrome]. / Uzití oxidu dusnatého ke zvládání syndromu akutní dechové tísne.

BACKGROUND: Nitric oxide (NO) is a selective pulmonary vasodilator effective in the treatment of pulmonary hypertension and hypoxemic respiratory failure. Reports in the Czech literature on the results of its therapeutic use are still scarce. METHODS AND RESULTS: Effects of inhaled NO on the changes of PaO2/FiO2 were assessed in the retrospective study. Records of artificially ventilated patients suffering from acute respiratory distress syndrome (ARDS) were reviewed. Daily highest NO dose, the highest PaO2/FiO2 ratio, duration of NO administration and death or survival of the patient was noted. Survivors and nonsurvivors, as well as responders (rise of PaO2/FiO2 by at least 20%) and non-responders were compared using Mann-Whitney and ANOVA test, alpha = 0.05. 16 patients were entered into the study, 13 (81%) responded positively to NO administration, the mortality was 56%. Comparing the age, NO dose, duration of its administration and APACHE II score in survivors and non-survivors, in respondents and non-respondents no differences were found. After NO administration the PaO2/FiO2 rose both in survivors and non-survivors (p < 0.0005). In survivors the response of oxygenation was more pronounced, although the difference did not reach the statistical significance (p = 0.07). On the days 1-3 the PaO2/FiO2 ratio was higher in survivors (p < 0.05). CONCLUSIONS: Despite the transient increase in oxygenation after NO administration, mortality of patients with ARDS remained high. NO administration could not be considered the standard method of treatment of patients with ARDS in intensive care.

[Aprotinin (Antilysin Spofa)--its effect on decreasing hemorrhage in the postoperative period in hip arthroplasty]. / Aprotinin (Antilysin Spofa)--jeho úcinek pri snizování krvácení v pooperacním období u pacientu s náhradou kycelního kloubu.

PURPOSE OF THE STUDY: Aprotinin is a non-specific inhibitor of serine proteases with hemostyptic and hemostatic properties. The effect covers suppression of fibrinolysis and support of the role of thrombocytes in coagulation. In a prospective randomized study we verified whether the application of aprotinin (Antilysin Spofa, Czech Republic) in the dosage effective in cardiosurgical patients reduces blood loss and the need for blood transfusion for orthopaedic patients. MATERIAL: 42 patients indicated to the primary THA were randomly selected into the study and control groups. Excluded were allergic patients and those who used aprotinin before. METHODS: Administration of 2.10(6) KIU of aprotinin was started preoperatively and is continued in the course of the first hour of surgery. In the operated on patients we recorded prior to operation and in the first post-operative morning the level of hemoglobin in blood and hematocrit, the number of infusions and blood transfusion units administered in the course of the surgery and in the post-operative period until the first post-operative morning. We recorded blood loss in the period between the surgery and the first post-operative morning. Data acquired in the patients of the studied and control groups were compared by means of ANOVA test for repeated measuring and with the use of Mann-Whitney and chi 2-test, the level of significance p < or = 0.05. During the hospitalization we the patients were checked for symptoms of deep venous trombosis and tromboembolic or other adverse events. RESULTS: Hemoglobinemia and hematocrit in both groups significantly decreased after the operation (p < 0.0005), the differences between the studied and control groups were not significant. The number of administered blood units did not differ in the examined and control groups. The frequency of blood transfusions was postoperatively higher in the control group (59.1% as compared to 30%), however, the difference was not statistically significant (p = 0.059). Blood loss in the post-operative period was higher in the control group (p = 0.048). Patients from the control group got in total blood transfusion more frequently (p = 0.032). Differences in the total frequency of blood transfusion and in the amount of post-operative blood loss were statistically significant. In the course of hospitalisation no signs of deep phlebothrombosis or thromboembolic condition were encountered in either group of patients. Complications were not recorded. DISCUSSION: Our results correspond with most of the published data. Blood loss of the operated on patients who were administered prior to and at the beginning of the operation in total 2.10(6) KIU of aprotinin (Antilysin Spofa) in infusion was on average by 33% less in the post-operative period and in the whole peropetive period they required less frequently blood transfusion (40% vs 73%). CONCLUSION: Infusion of aprotinin (Antilysin Spofa) in the dosage of the order of 106 KIU significantly reduces post-operative blood loss and frequency of transfusion in the peroperative period in patients undergoing THA.

[Present status and perspectives in international cooperation in the Cochrane Collaboration]. / Soucasný stav a perspektivy mezinárodní spolupráce "Cochrane Collaboration".

The Cochrane Collaboration is an international organization that aims to help people make well-informed decisions about healthcare by preparing, maintaining and promoting the accessibility of systematic reviews of the effects of healthcare interventions. It is a non-profit organization. The main work of the Collaboration is done by about fifty Collaborative Review Groups, within which Cochrane Reviews are prepared and maintained. The members of these groups share an interest in generating reliable, up-to-date evidence relevant to the prevention, treatment and rehabilitation of particular health problems or groups of problems.

[Statistical software--review of current products]. / Statistický software--prehled aktuálních produktu.

The paper gives an objective sight on extent variety of submitted statistical packages. It's especially evaluated range and quality of statistical methods, user environment and graphical facility of software. The paper brings information which is dispersed in many sources and therefore is hardly accessible.

Metabolic bone status in young women with JCA.

The study was based on clinical, densitometric and biochemical evaluations and on a life-style questionnaire, applied in a cohort of 41 individuals. The mean age of the young women was 24.2 (18-36) years. The main point was to compare subgroups with (CS) an without (NCS) corticosteroid treatment (19 and 22 patients, respectively). There was no significant difference in age, weight and duration of JCA. Of the densitometric examinations, spine DXA (DPX-L LUNAR apparatus) yielded values significantly lower in CS than in NCS individuals (p = 0.05). Much more apparent was the difference in stiffness measurements in the calcanei performed by Achilles-LUNAR ultrasound instrument, again with lower values in CS women (p = 0.001) (Fig. 1, 2, 3). No significant differences were found between the two subgroups as regards blood levels of bone alkaline phosphatase, osteocalcin and tartrate-resistant acidic phosphatase, and urine hydroxyproline output. Menarche occurred at a mean age of 14.37 years in the CS subgroup (p = 0.01, against healthy population) and of 13.32 years in the NCS subgroup (not significant). The prevalence of fractures was enconsiderable in both subgroups. These findings are to be understood from the viewpoint of combined influences of both disease activity and corticotherapy in the CS patients with JCA.

[The physician and the computer. 30. Evaluation of time, different aspects of the same problem]. / Lékar a pocítac. 30. Posuzování casu, ruzné pohledy na týz problém.

The authors mention different ways in which a give problem can be described within the framework of the theory of sets, logic, mathematical analysis, statistic and cybernetics. As an example of the confrontation of the mentioned aspects they discuss different approaches to the evaluation of time as a variable--temporal logic, Markov chains, theory of catastrophes which play a part in medicine, in particular in prognostic considerations. These different aspects make possible solutions which may differ and their application depends in particular on the purpose for which they are intended.

[The physician and the computer. 29. Learning systems and neuron networks]. / Lékar a pocítac. 29. Ucící se systémy a neuronové síte.

The authors discuss basic properties of the process of learning as a form of artificial intelligence. They deal with the application of adaptive and learning systems in the area of identification, regulation, manipulation and recognition. A very important perspective trend is learning in a medium of neuron networks which are actually software or hardware simulation of the functional architecture of the CNS. The authors discuss peculiar features of representation of knowledge, structure and mode of function of this neuron network. Finally the authors give examples of the solution of optimalization and classification tasks within the framework of neurocomputers.

[The physician and the computer. 28. Expert systems]. / Lékar a pocítac. 28. Expertní systémy.

The authors review problems of expert systems and their application in medicine. They discuss their application, structure and function. Special attention is devoted to questions which concern the users, in particular the selection of the decision making method with regard to the character of the problem and then the structure of the knowledge base. The structure of the medical knowledge base has some specific features which are formulated as the classification of rules of medical knowledge.

[The physician and the computer. 26. Commercial software]. / Lékar a pocítac. 26. Komercni software.

The authors give an account of different types of commercially supplied programmes which can be used also in the health services. They discuss the properties and types of different software - data base programmes, text processors, graphic and statistical programmes and finally so-called integrated software along with data on possible mutual combinations. At the same time also general conditions for the application of these programmes within the framework of clinical informations systems are discussed incl. their advantages and short-comings.