Acute non-invasive ventilation (NIV) is a lifesaving treatment for acute hypercapnic respiratory failure, particularly during exacerbations of chronic obstructive pulmonary disease (COPD), and is also an established therapy that improves outcomes in acute cardiogenic pulmonary oedema. Decisions regarding NIV initiation are complex and require careful consideration of patient-specific factors. With an aging population, with increasing multimorbidity, understanding the evolving acute NIV patient characteristics is critical to optimize NIV delivery. We audited all adult acute NIV patients at a tertiary centre, pre-COVID (April 2019-March 2020) and post-COVID (April 2023-March 2024) and performed a retrospective observational cohort analysis. We compared the Charlson Comorbidity Index (CCI) scores and outcomes using Chi-squared or Mann-Whitney U. Three hundred and twelve patients received acute NIV, 171 pre-COVID and 141 post-COVID. Post-COVID patients had higher comorbidity burden vs pre-COVID (median CCI 5 vs 4, p=0.002), and ward-based NIV ceiling of care frequency (83% vs 66%, p=0.009). Across the entire cohort, higher CCI score associated with increased NIV failure (p=0.007) and in-hospital mortality (p<0.001). Our demonstration of increasing multimorbidity in a real-world cohort, and the association of multimorbidity with NIV failure, provides insights to guide optimization strategies for acute NIV services. Further understanding the evolving patient characteristics and their impact on outcome is essential to determine how best to incorporate comorbidity assessment into clinical decision making for improved NIV delivery.
Last autumn we commemorated the 80th anniversary of the founding of the Faculty of Medicine of Charles University in Hradec Králové. A number of events were held and several publications were released, including a special issue of the Časopis lékařů českých entirely dedicated to this anniversary and to the faculty. At the ceremonial assembly of the academic community on 8 October 2025, the dean of the faculty, Professor Manďák, delivered an extensive speech in which he clearly described the historical circumstances of the faculty's foundation, its beginnings, development, and growth through various stages up to the present day.Despite the many difficulties and changes related to both international and domestic political developments and the broader social climate over the past eight decades, the faculty has consistently fulfilled its main missions in student education, research, and scientific work. Outstanding physicians, teachers, and researchers have worked and continue to work here. Over the course of a demanding 80-year journey, the faculty has evolved into a modern educational and scientific research institution respected both nationally and internationally.Throughout this development - one that was not always without challenges - an important role was played by the exceptionally supportive environment and conditions created by the authorities of the city of Hradec Králové and the entire East Bohemian region. Even before the faculty itself was established after the end of the Second World War, efforts had been made to build a regional university. The critical shortage of physicians after the war, together with the possibility of utilizing a well-functioning modern hospital staffed by many top specialists in Hradec Králové, were among the main reasons for choosing this city.The excellent cooperation between the district hospital (later the University Hospital), the faculty, and the municipal and regional authorities has historically been one of the valuable attributes of mutual collaboration - something not entirely common elsewhere in the country. The spirit of interdisciplinary cooperation in Hradec Králové was further strengthened in 1969 with the establishment of the Faculty of Pharmacy of the university.In this article we would also like to recall another unique and very important characteristic of the Hradec Králové Faculty of Medicine. Within the framework of interministerial cooperation, it prepares - as the only institution in former Czechoslovakia and now in the Czech Republic - prepares physicians for the needs of the Czech Armed Forces, within a joint study programme with the Military Medical Faculty of the University of Defence. This extremely significant and today highly relevant role represents a unique chapter and a distinctive feature in the faculty's history.At the turn of the 1940s and 1950s, the international situation deteriorated with the emergence of two political-military blocs and the threat of a new conflict, potentially involving nuclear weapons. In order to ensure the country's defence capability, the armed forces expanded, but they faced a post-war shortage of professional military physicians. This situation created an objective need to establish an independent military medical university.By Order of the President of the Republic No. 247, the Military Medical Academy (VLA) was established on 15 August 1951, and from 1955 it bore the name of Jan Evangelista Purkyně. After analysing several possibilities, Hradec Králové was selected - specifically its young medical faculty with its progressive orientation. The rapid establishment of the academy was possible only because it was built on the basis of the Faculty of Medicine of Charles University, including both its theoretical and clinical departments, which enjoyed an excellent reputation thanks to their staff. Most of these staff members became members of the academy. Among them were professors Baštecký, Hybášek, Janoušek, Krákora, Santholzer, Vanýsek, Vávra, Vavrda, and Vrtiš serving as officers in high ranks, as well as Bedrna, Blecha, Dvořák, Fingerland, and Lukl as civilian employees. These outstanding personalities became renowned representatives of their disciplines and contributed to the high quality of Hradec Králové and Czechoslovak medicine in education, clinical practice, and research. The Military Medical Academy, with its 40 departments and its own clinical hospital, became an educational and scientific centre and gained a strong reputation both domestically and internationally.With the easing of international tensions and changes in domestic political conditions, further transformations in the status, organisation, and structure of this military medical institution followed. On 30 June 1958, the academy was dissolved and replaced by the Military Medical Research and Postgraduate Training Institute of J. E. Purkyně (VLVDÚ JEP). The Faculty of Medicine returned to civilian administration under the Ministry of Education as part of Charles University, and the clinical hospital was reintegrated into the civilian structure of the Ministry of Health. The main tasks of the VLVDÚ focused on research and postgraduate training and specialization of military physicians and pharmacists.Under interministerial agreements, the undergraduate education of future military physicians continued at the restored civilian Faculty of Medicine of Charles University. Military students therefore complete the full curriculum of general medicine or dentistry, while additionally undergoing training in military-professional subjects, practical training in a vivarium or on simulators, and field exercises. In 1988, the institute was renamed again as the Military Medical Academy of J. E. Purkyně (VLA JEP).Like the civilian Faculty of Medicine, the institution entered a completely new stage of development after November 1989. It underwent a transformation that significantly changed its military educational programmes, organisational structure, and staffing. With the establishment of the University of Defence of the Czech Republic, the school continued its activities from 1 September 2004 under the name Faculty of Military Health Sciences of the University of Defence (FVZ UO). On 1 January 2025, it was renamed once again to its current title: Military Medical Faculty of the University of Defence (VLF UO).Today the Military Medical Faculty enters the third decade of its modern existence as a unique educational and scientific institution linking medicine, defence, and the state's security community. Its main mission is to pre- pare military and civilian healthcare professionals - physicians, dentists, pharmacists, and paramedics - capable of operating in a rapidly changing security environment, ranging from crisis situations and mass-casualty events to foreign missions, telemedicine, and modern threats associated with infectious diseases or hybrid conflicts. The faculty fulfils its mission through high-quality education, research, and professional expertise. Modern study programmes combine classical medicine with fields essential for military healthcare, including emergency medicine, epidemiology, toxicology, preventive medicine, radiation protection, and the specifics of field medical support. This enables the preparation of professionals capable of providing care not only in standard conditions but also in resource-limited, high-risk environments requiring rapid decision-making.At the same time, the faculty plays a significant role in scientific research. Its departments focus systematically on infectious diseases, vaccinology, crisis management, military surgery, internal medicine, hygiene, toxicology, and radiobiology. The results of this work have practical impacts on both military and civilian healthcare systems, improving preparedness and contributing to innovations in prevention and health protection.Today the significance of the faculty extends beyond the defence sector. Through its activities, it contributes to societal resilience, the development of professional knowledge, and the training of a new generation of physicians and healthcare professionals who combine professionalism, responsibility, and public service. Another future goal is to initiate the education and training of military nurses (general nursing). At a time when healthcare and security systems face growing challenges, the role of the Military Medical Faculty is clear: to be a stable pillar of expertise, a source of highly qualified professionals, and a guarantor that healthcare and health protection in both the armed forces and civilian sector will meet the needs of the present and the future.Looking back at the 80-year history of the Faculty of Medicine of Charles University in Hradec Králové and the 75-year history of the Military Medical Faculty in Hradec Králové, it is evident how many things have changed and evolved in response to international political developments and the circumstances of the time. What can be stated with pride, however, is that the coexistence and close, mutually supportive cooperation between these two "sister" faculties has become beneficial and unique example of mutually collaboration in medical education, science, and research.The close integration of working teams, shared clinical workplaces, and joint activities in research and science - together with collegial and personal friendships often extending beyond formal interministerial agreements - runs like a red thread throughout the entire history of both institutions. This project linking a civilian and a military faculty is regarded as an exemplary model in military higher education, not only in the Czech Republic but also abroad.Through the cooperation of both institutions, nearly three thousand military physicians and other military healthcare professionals have already been trained for the Czech Armed Forces. This long-standing collaboration between the ministries of education, health, and defence therefore contributes significantly to meeting the health-care and defence needs of our country.
Cytotoxic chemotherapy remains integral to contemporary uro-oncology despite the rapid expansion of targeted therapy, antibody-drug conjugates, and immunotherapy. Its role is especially critical where therapeutic success depends on maintaining adequate dose intensity, most notably in metastatic testicular germ cell tumours and in cisplatin-based perioperative treatment for muscle-invasive bladder cancer. In metastatic prostate cancer and selected penile squamous cell carcinoma, taxane- and platinum-based regimens also retain clinical value but are constrained by hematologic, neurologic, renal, pulmonary, and gastrointestinal toxicities. This narrative review summarises current evidence and guideline recommendations for Common Terminology Criteria for Adverse Events (CTCAE)-guided management of chemotherapy toxicity across major uro-oncologic disease settings. A practical emphasis is placed on pretreatment risk stratification, cycle-by-cycle surveillance, supportive care, and intent-adapted treatment modification. Across tumour types, early recognition of grade 2 toxicity, urgent management of febrile neutropenia and organ toxicity, and thoughtful preservation of dose intensity when cure is realistic are the central management principles. In older, frail, immunosuppressed, heavily pretreated, or organ-limited patients, CTCAE grades must be interpreted against baseline reserve and cumulative toxicity.
The basic characteristic of chronic idiopathic demyelinating polyneuropathy (CIDP) is demyelination of peripheral nerves of autoimmune origin. Antibodies against various myelin sheath proteins play an important role in the pathogenesis of the disease. Cell-mediated immunity, characterised by T-cell and macrophage infiltration in peripheral nerves and spinal roots, is also significantly involved (1). Treatment of CIDP is aimed at suppressing inflammation, but also at removing autoantibodies, cytokines and other pro-inflammatory molecules from the blood. Treatment options include corticosteroids, (intravenous or subcutaneous) immunoglobulins, and plasma exchange (plasmapheresis). If a patient with CIDP does not show an adequate clinical response to these three treatment modalities, it is then refractory CIDP. Based on various studies, this affects up to 10% of patients. We present here a patient with CIDP whose condition gradually stopped improving after all three commonly used treatment modalities (corticosteroids, immunoglobulins, and plasmapheresis). His neurological findings were very severe. The case was ultimately diagnosed as a refractory form of CIDP, which is discussed here in the light of current knowledge of this issue.
Background: Recurrent and refractory chronic subdural hematoma (cSDH) remains a significant neurosurgical challenge due to high recurrence rates and morbidity associated with repeated surgical interventions. Middle meningeal artery embolization (MMAE) has recently emerged as a minimally invasive alternative, but its efficacy compared to surgical evacuation in this specific subgroup has not been systematically evaluated. Methodology: A systematic search of Pubmed was conducted to identify studies reporting outcomes of MMAE and surgical evacuation in recurrent or refractory cSDH cases. Pooled efficacy rates and complication rates were extracted and analyzed using fixed-effects meta-analysis. Statistical significance was assessed with a p-value threshold of 0.05. Results: Sixteen studies were included in the meta-analysis. 181 patients underwent surgical evacuation while 97 patients underwent MMAE for recurrent and refractory cSDH. MMAE demonstrated significantly higher efficacy with a pooled success rate of 95% versus 84% for surgery (p=0.002, I2=0). Complication rates were lower in the MMAE group (6%) versus the surgical group (10%), though the difference was not statistically significant (p=0.06, I2=0). Conclusions: MMAE shows promise as a highly effective and safe treatment modality for recurrent and refractory cSDH, potentially surpassing surgical evacuation in both efficacy and safety. Given these findings, MMAE should be strongly considered not only as a salvage therapy but also as a frontline treatment option in this challenging patient population. Further high-quality randomized controlled trials are warranted to confirm these results and refine patient selection criteria.
The European Resuscitation Council Guidelines 2025, officially launched as the Guidelines on Cardiopulmonary Resuscitation 2025 on 22 October 2025 in Rotterdam and published in Resuscitation (1) as a thematic collection of guideline papers, represent far more than a scheduled update of resuscitation algorithms. That reading would be too narrow. The ERC Guidelines 2025 are better understood as a portrait of a discipline that has entered a new phase in its understanding of the continuum of resuscitation care. In these guidelines, resuscitation medicine is not reduced to the dramatic moment of cardiac arrest. It is presented as a continuum of knowledge, decision-making, technical skill, system organization, ethical responsibility, and longterm outcome. The algorithm retains its grammar, but not the whole language of care. This is what makes the 2025 guidelines important. They document the transformation of resuscitation from an acute technical intervention into a mature clinical discipline situated at the intersection of time, pathophysiology, teamwork, system design, and value-based decision-making. Resuscitation remains inseparable from urgency, but contemporary resuscitation medicine shows that speed without structure, technical correctness without a functioning system, and intensity of treatment without an ethical frame are not enough. Saving life in a critical moment requires not only hands capable of performing the correct intervention, but also an environment in which that intervention can be delivered early, reliably, in the appropriate clinical context, and with a clear pathway to subsequent care. This shift from algorithm to system is visible throughout the guidelines. Resuscitation is no longer merely a question of what happens in the minutes after collapse. It is shaped by how the system works before cardiac arrest, during cardiac arrest, and after return of spontaneous circulation. Recognition of deterioration, activation of help, first aid, basic life support, automated external defibrillation, dispatcher assistance, emergency medical service organization, in-hospital rapid response systems, advanced life support, post-resuscitation care, registries, and audit all form a single clinical and organizational continuum. The chain of survival is therefore not only an educational metaphor. It is an operational responsibility. Survival after cardiac arrest is not the property of an isolated intervention; it is a property of the system. The concept of systems saving lives is consequently one of the central messages of the ERC Guidelines 2025. There is no isolated hero in resuscitation detached from the system. Citizens, dispatchers, first responders, ambulance crews, emergency departments, catheterization laboratories, intensive care units, rehabilitation professionals, and registries are all part of the same trajectory of care. Each enters at a different point, with different competencies, but in relation to the same outcome. Where one link is absent or weak, even an otherwise excellent intervention loses part of its effect. In resuscitation, a system weakness rapidly becomes a biological loss. The technical core of resuscitation has not lost its importance. Quite the opposite. High-quality chest compressions, early defibrillation, adequate ventilation, treatment of reversible causes, and well-conducted advanced life support remain decisive interventions. Their strength lies in simplicity, reproducibility, and clarity. This is precisely why algorithms are indispensable: under cognitive overload, time pressure, and complex team dynamics, they reduce chaos, create a common language, and give rhythm to decision-making. Yet the ERC Guidelines 2025 also remind us that a correct algorithm does not absolve clinicians from thinking. Special circumstances of cardiac arrest demonstrate that standardization and individualization are not opposites. Cardiac arrest is not a diagnosis, but the final common pathway of many pathophysiological processes. Successful resuscitation must therefore be more than a response to the rhythm on the monitor; it must be a response to the cause, the context, and the possibility of meaningful causal intervention. The integration of ethics into the core of resuscitation medicine is another sign of maturity. Decisions to start, continue, or terminate resuscitation are not merely technical judgments about the probability of return of spontaneous circulation. They are clinical decisions framed by patient values, goals of care, proportionality, and previously expressed preferences. Advance care planning, DNACPR decisions, family presence, termination of futile resuscitation, and organ donation are not peripheral subjects that appear after medicine has done its work. They are part of medicine itself. A discipline capable of rapid and aggressive action must be equally capable of determining when such action is meaningful, proportionate, and aligned with what good care would mean for this particular patient. The significance of the ERC Guidelines 2025 also depends on epidemiology, registries, and outcome measurement. Resuscitation medicine must know itself. It must know how many cardiac arrests occur out of hospital and in hospital, who initiates resuscitation, how often an AED is used, how rapidly the system responds, how many patients survive, and in what neurological condition. Without data, quality becomes impression. Registries, audit, and standardized reporting are not administrative ornaments attached to clinical work; they are prerequisites for responsible improvement. Only a measured system can identify its weaknesses, compare itself with others, and move from conviction to quality. Between scientific recommendation and patient survival lies another decisive space: education and implementation. Guidelines do not become a clinical reality because they are published. They become clinical reality when they are translated into teaching, simulation, team training, feedback, debriefing, local protocols, and the everyday culture of practice. In resuscitation, knowledge without rehearsal quickly becomes uncertainty, and rehearsal without measurement becomes ritual. Simulation is not merely an imitation of reality for educational purposes; it is a safe space in which clinical reality can be processed before it occurs in a real patient. Team culture does not arise at the moment of cardiac arrest. It must be built before it. The breadth of the ERC Guidelines 2025 further reminds us that resuscitation medicine is not one physiological world. Newborns at the threshold between intrauterine and extrauterine life, children threatened by hypoxia or shock, adults with cardiac arrest in the community, frail in-hospital patients with previously expressed treatment limitations, and survivors after return of spontaneous circulation all require different forms of reasoning. A unifying principle exists, but its clinical expression changes with age, cause, setting, prognosis, and available resources. One of the key shifts reinforced by the ERC Guidelines 2025 is that return of spontaneous circulation is not the end of resuscitation. It is a threshold event after which another, often more complex, phase of care begins. Diagnosis of the cause of arrest, oxygenation, ventilation, haemodynamic stability, coronary reperfusion, seizure control, temperature management, neurological prognostication, rehabilitation, psychological consequences, and quality of life determine whether biological survival becomes a return to life. Survival to intensive care admission, survival to hospital discharge, and long-term neurological outcome are not interchangeable endpoints. Post-resuscitation care is therefore not an epilogue. It is an integral part of resuscitation, where the true value of acute success is determined. The ERC Guidelines 2025 are therefore not simply a document on how to resuscitate. They are a document on how resuscitation care should be conceived, organized, taught, measured, and ethically grounded. Their greatest challenge begins not at publication, but at implementation. Their significance will be defined by what hospitals, emergency medical services, educators, professional societies, registries, and clinical teams are able to make of them. The value of guidelines is ultimately measured not by their publication but by the people, teams, and systems that transform them into timely, competent, ethical, and measurable care.
Introduction: Breast cancer is the most common cancer in women and is often diagnosed at an advanced stage. Chemotherapy plays a crucial role in disease control but is limited by toxicity and response variability. Vitamin D, with its biological functions and the high prevalence of deficiency in patients, has potential as an adjuvant therapy to improve treatment response and clinical outcomes. Objective: To integrate existing evidence on the role of vitamin D supplementation in breast cancer patients undergoing chemotherapy, focusing on its impact on treatment response and clinical outcomes. Methods: This systematic review followed PRISMA guidelines and included RCTs, cohort, and case-control studies evaluating vitamin D supplementation in adult women with breast cancer undergoing chemotherapy. A comprehensive search across five databases up to June 2025 was conducted, applying the pre-established PICOS criteria, with filtering, data extraction, and quality assessment performed. This systematic review has been prospectively registered in the PROSPERO database (CRD420251142938). Results: This systematic review identified six eligible studies involving breast cancer patients undergoing chemotherapy, with interventions ranging from low- to high-dose vitamin D, either alone or in combination with synbiotics. Vitamin D supplementation in breast cancer patients undergoing chemotherapy has been associated with improved clinical outcomes, including enhanced nutritional status, reduced inflammatory and cardiotoxic biomarkers, and increased pathological complete response (pCR) and disease-free survival (DFS). Conclusion: Vitamin D supplementation during chemotherapy shows potential benefits in breast cancer patients, but large-scale standardized trials with long-term follow-up are needed to confirm its impact on survival outcomes.
Acromegaly is a chronic disorder caused by pathological hypersecretion of growth hormone (GH), most commonly due to pituitary somatotroph adenomas. Excess GH leads to elevated insulin-like growth factor 1 (IGF-1) levels, which together mediate progressive physical changes and a wide range of systemic complications. A key metabolic abnormality in acromegaly is impaired glucose metabolism, which may result in diabetes through mechanisms of insulin resistance. This report describes a case of diabetic ketoacidosis (DKA), a severe complication of relative insulin deficiency, presenting as a rare initial manifestation of acromegaly. Following surgical intervention and remission of acromegaly, the glycemic control of the patient significantly improved, underscoring the importance of addressing the underlying endocrinopathy. This report highlights the critical need for comprehensive clinical evaluations in patients with common metabolic disorders, such as diabetes mellitus, to identify rare underlying causes and ensure timely diagnosis. Furthermore, it examines potential mechanisms of ketosis in acromegaly and reviews current approaches to glycemic management in this population, where evidence-based guidelines remain limited.
The management of impacted mandibular third molars can be a difficult clinical issue due to the proximity of the tooth to critical neurovascular structures. Surgical removal is routinely performed, but the technique carries a known risk of injury to the inferior alveolar and lingual nerves. The complication may induce temporary or permanent sensory impairment. Orthodontic traction can be an alternative to reposition the tooth in a more desirable location before surgical removal. The selection of the appropriate treatment is important to avoid a mechanical injury and to allow the adjacent bone and soft tissue to adapt, which may reduce the risk of nerve injury from compression or transection. This review discusses the anatomy of the inferior alveolar canal and the lingual nerve route, describes the known mechanisms and classifications of nerve injury, and outlines how orthodontic traction may diminish these risks. Technical aspects of traction, including the surgical exposure with coronectomy or not, force application, anchorage methods, and radiographic observation, are reviewed. Potential complications, including root resorption and unwanted tooth movement, were also explained. Criteria for patient selection are discussed, with emphasis on age, root morphology, eruption space, and imaging findings that indicate proximity to neurovascular structures. The purpose of this scoping review was to compare orthodontic traction and complete surgical extraction of mandibular impacted third molars with respect to injury of the inferior alveolar nerve (IAN) and lingual nerve (LN). The limited but growing evidence allows us to identify gaps in long-term outcome data and calls for further prospective studies. Orthodontic traction cannot replace extraction in every case, but for carefully chosen patients, it may offer a practical treatment option for preserving neurosensory function. The approach requires interdisciplinary collaboration, precise biomechanical planning, and a clear explanation of treatment goals to support informed decision-making.
The purpose of this report is to document the occurrence of transient central retinal artery occlusion (CRAO) as a rare and serious ocular complication in a patient with granulomatosis with polyangiitis (GPA), emphasizing the potential vision-threatening nature of this condition. A 49-year-old male with a known diagnosis of GPA presented with transient CRAO. The case was analyzed to understand the ocular manifestations associated with GPA and the challenges in its management. The patient exhibited a transient CRAO, highlighting the potential for severe ocular complications in the context of GPA. Transient CRAO is a rare but serious vision-threatening complication of GPA. This case underscores the importance of early diagnosis and timely management in patients with ocular manifestations of GPA. Financial disclosure: No financial support was received for this case report. None of the authors has any proprietary interests or conflicts of interest related to this submission. It is not simultaneously being considered for publication at any other journal.
Cardiac hemodynamics during exercise depend on both structural and functional adaptations of the oxygen transport system. This narrative review summarizes the knowledge on total hemoglobin mass (tHbmass) as a structural determinant of convective oxygen transport, and cardiac output and hemodynamic responses as key functional determinants, with attention to sex-related differences and clinical translation. We describe carbon monoxide rebreathing as the preferred method for quantifying tHbmass, outline typical values in untrained and endurance-trained men and women, and discuss the contributions of genetics, training, altitude exposure, and blood manipulation to inter-individual variation. The association between tHbmass and maximal oxygen uptake, its sport-specific distribution, and emerging clinical applications in the differential diagnosis of anemia and risk stratification are highlighted. We then review the regulation of cardiac output and arteriovenous oxygen difference during dynamic exercise, compare invasive and noninvasive techniques for their assessment, and summarize consistent sex differences in stroke volume, cardiac output, blood volume, and oxygencarrying capacity. Across both domains, major gaps remain, particularly in the paucity of data in women and elite athletes studied at or near their physiological limits. Integrative assessments combining tHbmass, blood volume, and exercise hemodynamics may improve the understanding of both normal performance and cardiovascular pathology.
BACKGROUND:Otologic symptoms are commonly reported by patients with temporomandibular disorders. OBJECTIVE:This study aims to investigate the likely outcome or progression of temporomandibular disorders with and without accompanying otologic symptoms when treated in the dental clinic. METHODS:The study is registered under the International Standard Randomised Controlled Trial Number: ISRCTN49976724, DOI: 10.1186/ISRCTN49976724. Forty patients with temporomandibular disorders were included and allocated into two groups: Control group (n=20): isolated temporomandibular disorders symptoms, and Experimental group (n=20): temporomandibular disorders symptoms with otologic symptoms (confirmed by otorhinolaryngological evaluation to exclude primary ear pathology). All participants underwent non-invasive, non-pharmacological treatment. The treatment contained physiotherapy and custom-made occlusal splints. Outcomes (full/partial/no recovery) were assessed at 3 months by a single maxillofacial surgeon, with follow-up every 3 weeks. Statistical analysis included Fisher's exact test and odds ratios. RESULTS:Fisher's exact test revealed a statistically significant association between group allocation and recovery outcomes (χ2=5.979, p=0.041). The odds ratio was 5.33. CONCLUSION:The presence of otological symptoms accompanying temporomandibular disorders might predict a better prognosis after non-invasive, non-pharmacological treatment, perhaps not as a direct predictor per se but as a confounding factor.
This review evaluates existing methods for the measurement of osseointegration, which is the biological mechanism that assures longterm stability of dental implants. Invasive techniques, such as histology and pull-out torque measures, provide direct objective evaluation; however, they cannot be employed clinically due to their invasive nature. Non-invasive methods such as radiographic imaging, resonance frequency analysis, Periotest, and newer methods utilizing ultrasound have been used clinically. These are mainly based on indirect measurements or incomplete measures regarding bone-to-implant contact. Clinical measures of implant osseointegration are often subjective and vary significantly. Research into biochemical blood markers, biochemical markers in peri-implant fluids, and the use of digital technologies associated with decision-making shows promise for generating more personalized assessment outcomes and possibly predictive capacity. Many factors, including implant design, bone density, surgical technique, systemic disease, and others, influence the accuracy of measurement. Future research assessment will likely be based upon the usage of a multimodal protocol (involving mechanical, radiographic, biological, and computational data) so that the oral surgeon will consider all available data to assist decision-making, evaluation, and enhance long-term assessment of implants.
Introduction: Health literacy is a fundamental tool for improving patients self-care, so this study evaluated the association between health literacy and self-care in patients with hypertension and type 2 diabetes mellitus. Method: Cross-sectional observational study of 200 patients at Hospital Florencia de Mora (June–November 2024), using the Health Literacy Survey Questionnaire (HLS-Q12), Diabetes Self-Management Questionnaire, and Self-Care of Hypertension Inventory. Parametric tests (t-test, ANOVA) and multivariate analyses were applied. Results: The sample included 47.5% patients with hypertension, 39.5% with diabetes, and 13% with both conditions, mean age 67.54 years (±8.82), female predominance (58.5%). Health literacy demonstrated a moderate correlation with self-care in patients with hypertension (r = 0.648; p < 0.001) and weak but significant correlation in patients with diabetes (r = 0.274; p < 0.001). Multivariate analyses revealed that health literacy was associated with 42% of self-care variance in patients with hypertension (β = 0.927; 95% CI: 0.729–1.125; p < 0.001), while in patients with diabetes, together with sex factor, it was associated with 10.6% of variance (β = 0.117; 95% CI: 0.027–0.207; p = 0.011). Conclusion: Health literacy shows a stronger association with self-care hypertension’s patients than in patients with diabetes, suggesting the need for differentiated strategies to improve self-care in both populations.
Last year marked 80 years since Edvard Beneš, President of the Czechoslovak Republic, signed a decree establishing the medical faculty in Hradec Králové as a branch of the Faculty of Medicine at Charles University in Prague. This was the beginning of medical education in the city and the wider East Bohemian region.The decision to establish the faculty here was no coincidence.For centuries, Hradec Králové was an important fortified town in the Austrian Empire, and all aspects of life in the town and its surroundings were subordinated to this fact. This situation lasted until the end of the 19th century, when the fortress was dismantled. It was only after this that the town and region underwent rapid development, a process that continued during the First Republic.The region's development led to a sharp increase in population, creating a need for better, more accessible healthcare. Thanks to the significant support and efforts of city officials, one of the largest and most modern hospitals in what was then Czechoslovakia was built. This hospital employed a number of leading experts who, in addition to their high level of professional expertise and medical experience, were also actively involved in lecturing, publishing and social activities.The region therefore possessed a high level of personnel, professional and material readiness to support a medical faculty. Its possible establishment was therefore discussed throughout the interwar period as part of the efforts to establish a university in Hradec Králové - or rather, a regional university in East Bohemia. However, this process was halted for six long years by a significant historical event: the occupation of the republic and its subjugation as the Protectorate as part of the German Reich.The desperate shortage of doctors after the liberation in 1945 increased the urgency to open a medical faculty as soon as possible. The closure of universities during the occupation, violent deaths on the battlefield, in concentration and labour camps, the post-war displacement of the German population and waves of emigration all contributed to the critical shortage of physicians. Given these circumstances, it was only logical that the city of Hradec Králové was chosen to establish a medical faculty shortly after the war ended. Thanks to the extraordinary efforts of the government, the Ministry, the district and municipal authorities, representatives of higher education and leading physicians at the Hradec Králové hospital, the city became a university town 80 years ago when a branch of the Medical Faculty of Charles University was established there.However, the beginnings were not easy. Besides having access to the state-of-the-art hospital, the school also needed adequate facilities for teaching basic theoretical subjects and high-quality teaching materials. The need for teaching facilities was resolved thanks to the opportunity to use a modern building on Šimkova Street. Built just before the war for the command corps of the Czechoslovak army, the building was seized and used by the Germans for other, more sinister purposes during the occupation. Adapting it for medical teaching was challenging, but hard work and enthusiasm resolved this issue relatively quickly. Leading physicians, scientists and respected experts became involved in managing individual departments and organising teaching. The level of interest in studying medicine was huge, and the teaching was of a very high standard, at the cutting edge. The faculty soon became a respected and recognised institution.The escalation of the international political situation in the 1950s, coupled with the world's division into irreconcilable camps, led to a rapid increase in armaments, expansion of individual armies, and a simultaneous need to bolster the ranks of military doctors. In response to political demands, the Faculty of Medicine in Hradec Králové was transformed into the Military Medical Academy in 1951. Alongside a partial change in the content of teaching and research, this resulted in significant personnel changes within various departments. Unfortunately, as a result of this transformation, a number of doctors who did not wish to become professional soldiers left the faculty. However, it should be noted that despite all the political and personnel complications, the academy's professional level remained high.Another significant milestone in the history of the Hradec Králové faculty was its return to the civilian sector in 1958, which led to the establishment of an independent Faculty of Medicine at Charles University. Basic theoretical, preclinical and clinical disciplines developed dynamically in line with the needs of modern times, and this was later supported by the opportunity to cooperate with foreign countries thanks to the partial easing of the political situation at that time. Unfortunately, the so-called 'normalisation' of the 1970s hit our entire society hard, including our faculty. Political purges led to severe staff shortages at virtually all workplaces, paralysing the development of the faculty for a long time. Recovery was slow, and the negative impact was evident for a long time.Fundamental changes occurred following the revolutionary societal changes of 1989. Academic values were reinstated, and democratic traditions in higher education were revived. Management of the faculty and university was based on new principles, and development of individual fields, departments, institutes and clinics was no longer politically restricted. Since then, there has been noticeable and sustained positive development.Teaching has also changed significantly thanks to modern teaching methods and programmes, sophisticated aids, computer technology and the internet. However, the most important thing that has remained unchanged since the beginnings of our faculty is the role of the teacher. Their experience, knowledge of the subject and personal approach, enabling the traditional transfer of acquired knowledge from generation to generation, remains as important as ever.The Faculty of Medicine currently offers degree programmes in General Medicine, Dentistry, General Nursing and Midwifery. These programmes are taught in Czech and, for hundreds of foreign students, in English. The faculty also offers doctoral programmes. A total of almost 2,000 students are currently enrolled at the faculty.However, teaching is not the only role of a modern medical faculty. Science and research are also integral to the faculty's activities as world-class research into a wide range of biomedical issues is carried out.Adequate conditions are also necessary to support all faculty activities. This is why the faculty now offers modern facilities that are ideal for teaching medicine and conducting research. These facilities are located in a carefully renovated building on Šimkova Street and in the historic Na Hradě building, as well as in study areas at individual university hospital departments. In addition, new complexes have been gradually constructed. These include a teaching centre on the grounds of the Faculty Hospital and a joint campus for the medical and pharmaceutical faculties nearby. Completing these is now one of our most important tasks. The planned opening this year will create new opportunities for our students and staff. If all goes according to plan, the 2026/27 academic year will begin in the new premises.Throughout its existence, the Faculty of Medicine has worked closely with the University Hospital in Hradec Králové. Cooperation between the two institutions is essential and is conducted on a consistently high professional level, with mutual respect. After all, the Faculty of Medicine cannot exist without its hospital, just as the University Hospital cannot exist without its faculty. Without a balanced and functional connection between the two, it would not be possible to fulfill their missions. And the University Hospital in Hradec Králové, which is now one of the largest and most modern hospitals in the country, is the main base for the practical training of our students.We also successfully cooperate with other contracted hospitals in our country when it comes to providing practical training. Our students have the opportunity to work at these facilities during their vacation and pre-exam internships.However, the Faculty of Medicine is more than just buildings. First of all, it is the people who work there and the students who study there that make it what it is, today as in previous years. It is the people who founded it and built it together over the decades. Leading experts, doctors, scientists and teachers. Outstanding students and graduates.The Faculty of Medicine in Hradec Králové has undergone a long and complex journey. During that time, it has become one of the most modern educational and scientific institutions, enjoying high prestige. An integral, solid and indispensable part of Charles University, it has its own specific character and independence, and cooperates with other medical faculties.Our history binds us together, and we are facing one of the most challenging tasks ahead. We must maintain the current high level of our faculty, whose foundations were laid 80 years ago, and continue to develop its mission, and all its responsibilities in the coming decades.
INTRODUCTION:Health literacy is a fundamental tool for improving patients self-care, so this study evaluated the association between health literacy and self-care in patients with hypertension and type 2 diabetes mellitus. METHOD:Cross-sectional observational study of 200 patients at Hospital Florencia de Mora (June-November 2024), using the Health Literacy Survey Questionnaire (HLS-Q12), Diabetes Self-Management Questionnaire, and Self-Care of Hypertension Inventory. Parametric tests (t-test, ANOVA) and multivariate analyses were applied. RESULTS:The sample included 47.5% patients with hypertension, 39.5% with diabetes, and 13% with both conditions, mean age 67.54 years (±8.82), female predominance (58.5%). Health literacy demonstrated a moderate correlation with self-care in patients with hypertension (r = 0.648; p < 0.001) and weak but significant correlation in patients with diabetes (r = 0.274; p < 0.001). Multivariate analyses revealed that health literacy was associated with 42% of self-care variance in patients with hypertension (β = 0.927; 95% CI: 0.729-1.125; p < 0.001), while in patients with diabetes, together with sex factor, it was associated with 10.6% of variance (β = 0.117; 95% CI: 0.027-0.207; p = 0.011). CONCLUSION:Health literacy shows a stronger association with self-care hypertension's patients than in patients with diabetes, suggesting the need for differentiated strategies to improve self-care in both populations.
BACKGROUND:Constipation and other lower intestinal disorders are more common in the middle-aged population. According to recent research, enteric glial cells (EGCs) may have an impact on colonic motility. Little is known about how ageing impacts EGCs in the human colon. This study aims to compare the morphology of EGCs in the colons of young and middle-aged individuals. OBJECTIVE:To study the age-related morphological variations in the EGCs of the myenteric plexus in human transverse colon. MATERIALS AND METHODS:Colon specimens from 11 deceased individuals were obtained from a mortuary and categorized into two age groups: Group 1 (Young, n = 6) and Group 2 (Middle-Aged, n = 5). Immunohistochemistry for Glial Fibrillary Acidic Protein (GFAP) and routine staining were performed. Both qualitative and quantitative evaluations were conducted. RESULTS:In the middle-aged group 2, vacuolization was observed between Myenteric Ganglia (MG), and myenteric neurons appeared more scattered compared to the young group 1. The number of myenteric neurons and EGCs decreased with increasing age. The mean count of EGCs per MG and per mm2 of ganglionic area was significantly higher in group 1 (young) as compared to group 2 (middle-aged). The MG density, expressed relative to the thickness of the inner circular muscle, was significantly greater in group 1 (young). CONCLUSION:There is a significant decrease in the number of EGCs with advancing age, along with notable morphological changes. These changes may contribute to various gut motility disorders observed in the middle-aged, impacting their quality of life.
Hyperlipidemia is recently recognised as a factor that could impair bone regeneration and dental implant osseointegration. High fat diets raise oxidised lipid levels in blood, which accumulate in bone and suppress osteoblast function, tipping the balance toward bone resorption. Excess lipids also induce oxidative stress and inflammatory cytokine production in bone, further inhibiting bone formation. These changes may affect implant osseointegration. At the cellular level, high lipid levels cause overproduction of reactive oxygen species and inhibit Wnt/β-catenin signalling in osteoblasts. Health promotion strategies should address these mechanisms. Lipid lowering drugs such as statins may improve bone healing ability both by reducing blood lipids and by directly stimulating bone formation. Antioxidant nutrients or drugs may counteract lipid driven ROS and inflammation. Emerging approaches include epigenetic interventions to boost osteoblast gene expression and dampen inflammatory pathways. Improving lipid control alongside these future targeted therapies may help preserve bone health and implant success in patients with hyperlipidemia associated oxidative stress. While very exploratory, incorporating molecular level approaches into continuing clinical protocols could represent a path towards future therapies. Maximizing postoperative management is essential in order to limit the effects of hyperlipidemia induced negative microenvironment at implant sites. This could include controlling laboratory levels of lipids prior to surgery.
Statins, widely prescribed for dyslipidemia, may exert bone modifying effects through coordinated stimulation of osteoblast activity and suppression of osteoclastogenesis. Lipophilic statins, including simvastatin, lovastatin, and atorvastatin, have been shown in preclinical models to enhance osteoblast differentiation and matrix synthesis via BMP-2/Smad and Ras-PI3K-Akt-Erk signaling, while attenuating osteoclast development through modulation of the OPG/RANKL axis, NF-kB inhibition, and blockade of p38 MAPK pathways. Despite mechanistic consistency in experimental systems, human data remain inconclusive, with modest increases in bone mineral density and no confirmed reduction in fracture risk. In implant dentistry, hyperlipidemia has been linked to impaired osseointegration, likely via reduced osteoblastic function, increased osteoclast activity, and compromised collagen turnover. The interplay between obesity, lipid metabolism, and skeletal biology introduces additional confounding variables, emphasizing the need for patient stratification in clinical research. Current evidence supports the biological plausibility of statin mediated enhancement of peri-implant bone formation, but definitive clinical translation requires large-scale, stratified trials with controlled delivery approaches and extended follow-up.
Purpose: To analyze the clinical characteristics and outcomes of patients with acute heart failure (AHF) admitted to an internal medicine department (IMD), with a focus on their trajectories, risk factors, and rehospitalisation/mortality rate. Methods: This retrospective cohort study included 410 hospitalisations (280 patients; 28% readmissions) for AHF during 2023. Diagnosis was validated using the European Society of Cardiology age-specific NT-proBNP thresholds and echocardiographic criteria. Baseline clinical and laboratory data were analyzed, prognostic markers were identified, and a risk algorithm was developed. Results: Mean patient age was 82 years (54% women). Most cases involved nonischemic etiology (80%) and HF with preserved ejection fraction (HFpEF, 69%). Frequent comorbidities included hypertension (85%), diabetes (45%), atrial fibrillation (44%), and multiple noncardiac conditions. In-hospital mortality was 19.6%; 30-day readmission was 9.9%. Three clinical trajectories (index/first hospitalisation) were identified: single admission (n: 169), rehospitalisation (with/without death) (n: 73), and in-hospital death (n: 38). Prognostic markers included advanced age, elevated NT-proBNP, renal dysfunction, anemia, and non-cardiac cause of HF decompensation. Conclusions: This elderly IMD-HF cohort, mainly female and multimorbid, showed high HFpEF prevalence and adverse outcomes. NT-proBNP, renal function, haemoglobin, and non-cardiac causes of HF decompensation were key prognostic indicators.
