Aim of the study: To evaluate the real-life experience of microelimination of chronic hepatitis C in Slovak prisons. We assessed the impact of removing treatment restrictions on the number of treated patients and the time from diagnosis to treatment initiation. Material and methods: A retrospective analysis was conducted on 205 incarcerated patients diagnosed with chronic hepatitis C between 2018 and 2024 in five prisons in Eastern Slovakia. We compared patient data before and after the removal of treatment indication restrictions. Results: Of the total of 205 patients, 94.1% (n = 193) were men. A history of intravenous drug use was reported by 93.7% of patients. Liver fibrosis stage F0-F1 had been confirmed in 74.9% and liver cirrhosis in 5.8% of patients. Additionally, liver cirrhosis was significantly associated with older age (p < 0.0005). The most common HCV genotypes were 3a (30.7%), 1a (23.4%) and 1b (21.5%). Following the complete removal of treatment restrictions in March 2024, the number of treated patients in 2024 increased more than threefold compared to 2023 and fourfold compared to the previous annual average. The time from diagnosis to treatment initiation was significantly reduced from 325 days to 91 days (p < 0.0005). Among treated patients, 98.2% achieved an end-of-treatment response (ETR), and 98.4% achieved a sustained virological response (SVR). Conclusions: The removal of treatment restrictions significantly improved access to therapy for incarcerated patients with HCV. Prisons provide a controlled setting for microelimination efforts, and expanding treatment in this population could contribute to broader national HCV elimination goals.
BACKGROUND:Patients with diabetes mellitus (DM) or aspirin resistance are exposed to recurrent atherothrombotic events after acute coronary syndrome (ACS). Aspirin once-daily can allow the recovery of platelet cyclooxygenase activity before the next intake in these patients. Twice-daily administration provides more stable inhibition of platelet aggregation and may improve prognosis in these patients. AIM:To demonstrate the superiority of twice-daily aspirin compared to once daily in reducing major adverse cardiovascular events (MACE) in patients with DM or aspirin resistance after ACS. METHODS:The ANDAMAN trial is a randomized, multicenter study including patients (aged ≥18 years) with DM or with aspirin resistance defined as: (1) index event occurring under aspirin; (2) body mass index ≥27 kg/m2); (3) increased waist circumference (≥88 cm for women or ≥ 102 cm for men). The patients will be recruited in 39 centers after an ACS (with or without ST elevation) with at least one significant coronary stenosis and will be randomized before hospital discharge between twice-daily vs once daily low-dose aspirin (100 mg bid vs od). The primary composite endpoint will be the occurrence of MACE including all-cause death, myocardial infarction, stroke, urgent coronary revascularization or acute arterial thrombotic event during a follow-up of 18 months. To achieve a 20% reduction in the relative risk of MACE in the twice-daily aspirin group, a total of 2,574 patients will be included in the trial. The main secondary endpoint will be major bleeding (type 3-5 following BARC classification). CONCLUSIONS:The trial will evaluate the prognostic impact of twice-daily aspirin for ACS patients with DM or aspirin resistance and may change the way aspirin is administered to these patients. TRIAL REGISTRATION:ClinicalTrials.gov Identifier: NCT02520921.
Narcolepsy impacts quality of life (QoL) with its symptomatology in hobbies and everyday activities, work and productivity and has social and economic consequences. The aim of this review is to map and synthesize evidence about QoL in narcolepsy patients and to focus on research strategies and publications in the matter. A scoping review of articles published between 2014–2025. The initial search of WoS resulted in 7748 articles and 2583 in PubMed being screened for eligibility. Intervention, comorbidity, non-narcolepsy, prevalence and medical trials studies were excluded. We extracted data on bibliometric characteristics, research questions, sample and recruitment method, design, concepts and measures, and the main findings. Two independent reviewers did the screening and analyses. The analyzed data were consulted on with stakeholders to settle gaps, possibilities and directions for future research. This study followed the PRISMA-ScR guidelines. Twenty papers were included in this study. There is an increasing trend in publishing studies focused on QoL in narcolepsy patients, but its spread is very limited across various audiences. Most of the studies assess the association of narcolepsy symptoms, treatment, mental health or nutritional status and QoL in narcolepsy patients. Most used was a questionnaire-based cross-sectional design comparing a control group vs narcolepsy patients recruited through regular follow up at a sleep clinic or national reference centers or patients’ organization. There is a need to spread knowledge beyond the neurology audience, to widen the scope of research beyond the burden of the symptoms and to employ explorative qualitative designs.
Extracellular vesicles (EVs) are the foundation of modern regenerative medicine using a cell-free approach. While current research mainly explores EVs from biological fluids and cell culture supernatants, tissue-derived EVs hold great promise, but remain largely underexplored. Since healthy placental tissues such as the chorion are widely available after full-term delivery, ethically unobjectionable, and possess exceptional regenerative potential, we sought to compare the biological effects of EVs derived directly from chorion tissue with those from chorion-derived mesenchymal stromal cell EVs and plasma EVs. We compared the biological impact of EVs from various sources (chorion tissue CHO-Ti, MSCs from chorion CHO-MSC and platelet-poor plasma PPP) and isolated by various techniques on the gene expression of osteoarthritic chondrocytes. Additionally, we assessed the effect of enriched soluble proteins of CHO-MSC and CHO-Ti secretome vs. their EVs. EVs were characterized by particle number and size (NTA), protein content (BCA assay) and immunophenotype (flow cytometry). Changes in gene expression of chondrocytes were quantified by RT-qPCR. CHO-Ti-EVs and PPP-EVs showed particularly beneficial effect on the inflammatory process, with their biological impact surpassing that of CHO-MSC-EVs. Chondroprotective markers COL2A and ACAN were robustly upregulated by CHO-Ti-EVs and PPP-EVs but showed only modest or variable increases with CHO-MSC-EVs. COMP expression, however, was specifically enhanced by CHO-MSC-derived components. Furthermore, our results also indicate that the therapeutic properties of the CHO-Ti secretome are exclusively linked to EVs. Among CHO-MSC-EVs, purification combined with UC resulted in the highest purity, however EVs purified by SEC presented a more favourable surface marker profile and better biological effects. The observed variability suggests that different EV preparations harbour distinct subpopulations that influence regulatory pathways differently and highlight the importance of EV source and isolation methodology in determining biological activity. CHO-Ti-EVs showed promising effects on cartilage regeneration and inflammation modulation, suggesting they may represent a viable alternative to plasma- and CHO-MSC-EVs. Moreover, the chorion represents a readily accessible and abundant source of perinatal tissue obtainable non-invasively after full-term delivery, further supporting the translational potential of CHO-Ti-EVs.
Primary cardiac lymphoma (PCL), defined as extranodal non-Hodgkin's lymphoma involving exclusively the heart and∕or pericardium, is a neoplasm with an extremely low incidence, a high degree of malignancy, and a poor prognosis. It comprises 0.5% of all extranodal lymphomas and 1-2% of all primary cardiac tumors, while the most commonly reported subtype is diffuse large B-cell lymphoma (DLBCL). The tumor is more common in immunocompromised patients compared with those who are immunocompetent. Modern imaging methods now allow for earlier detection of these tumors, despite their variable clinical manifestation, which is often a cause of misdiagnosis. We present an autopsy case of undiagnosed PCL in an immunocompetent 72-year-old man, where postmortem examination revealed massive tumor infiltration of the right-sided heart chambers extending to the left ventricle. Histological analysis showed microscopic tumor infiltration within the left atrium as well. A diagnosis of DLBCL of non-germinal subtype was made based on immunohistochemistry.
