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Evaluation of nutritional status and cardiac risk in patients with anorexia nervosa.
Pálová, Sabina ; Charvát, Jiří (advisor) ; Ošťádal, Petr (referee) ; Zamrazil, Václav (referee)
Anorexia nervosa (MA) is serious psychiatric disease associated with significant mortality. One of the main causes of mortality in these patients is cardiac complications. In 2003 - 2010 we examined 30 patients with established diagnosis of MA. Routinely used nutritional parameters are normal even in severe malnutrition in MA patients and we can ́t use them to diagnose or monitor nutritional status. Therefore we evaluated plasma aminoacids levels to detect minor changes of protein metabolism. According to our results we found mild hyperaminoacidemia and significant elevation of Gly/Val and Phe/Tyr ratio. In the second part of our research we performed non invasive examination s in risky patients with AN to consider possible cardiac complications. Results of ECG and echocardiography confirm results of the previous published studies. Original finding is significant decrease in flow mediated dilatation of brachial artery and its normalization after realimentation. We found also in ambulatory blood pressure monitoring significant decrease in blood pressure during the active period which was the consequence of changes in the heart rate variability. Decrease of the blood pressure in patients with AN in standing position was associated with increase of HF power in supine position and particularly with the lack of...
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Investigation of thyroid disorder in pregnancy and reference intervals in evaluation of maternal thyroid function
Springer, Drahomíra ; Zima, Tomáš (advisor) ; Průša, Richard (referee) ; Zamrazil, Václav (referee)
The importance of maternal thyroxine for the development of the fetus brain early in pregnancy has received increasing acceptance. It has more recently become evident that maternal hypothyroxinemia results in the birth of children with decreased mental and psychomotor development. In our group of 7,530 women in 9-11 week of pregnancy were determined TSH, anti TPOAb and FT4. For evaluation of results was necessary to set reference intervals for pregnant women. The TSH reference interval was determined to be 0.06 - 3.67 mU/l and for FT4 9.8 - 23.43 pmol/l was used. The limit for anti-TPO positivity was determined to be 143 kU/l. A raised concentration of TSH was found in 5.14% of women; and a suppression of TSH was found in 2.90% of women and 11.5% of pregnant women were found positive. Serum concentrations of FT4 were lower in TPOAb positive as compared to TPOAb negative women and differences of FT4 in euthyroid women with suppressed, normal and elevated TSH were found. (...) In Czech Republic, case finding screening is able to disclose only about 20% of asymptomatic mild or deep hypothyroidism or women with positive anti TPO in pregnancy. Foreign study report 70% of these high-risk pregnant women, consequently is evident need of general screening of pregnancy thyroid failure in Czech Republic. Moreover the...
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The incidence of thyroid in selected regions of the Czech Republic in terms of saturation with iodine
Dvořáková, Marcela ; Zamrazil, Václav (advisor) ; Topolčan, Ondřej (referee) ; Stárka, Luboslav (referee) ; Čáp, Jan (referee)
24 9. SUMMARY 1. Natural sources such as water or soil contain iodine in low amounts in the Czech Republic. 2. Clinical manifestations of iodopenia were severe and occured in certain geographical areas in the past. 3. Iodization of table salt started in the fifties of the last century as a result of extensive epidemiological research and since then it has significantly improved iodine saturation in general. 4. Further steps in iodine prophylaxis in the mid-nineties of the 20th century have improved iodine saturation according to ICCIDD/WHO criteria. 5. Resolution of iodine deficiency does not represent, however, a closed chapter. 6. Individuals at risk, such as pregnant or breastfeeding women and patients on a salt- restricted diet, are worthy of public health concern. 7. There needs to be increased awareness of chronic excess of iodine with respect to an increasing prevalence of autoimmune thyroid disorders. 8. There is a need to continue education of the general population focused on adequate iodine intake from various foods (see products, milk) and to maintain a daily iodine intake in the "optimal ranges". Based on the international criteria, the Czech Republic is iodine sufficient country. This happened due to a multidisciplinary collaboration coordinated by the Regional Iodine Deficiency Council...
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Economic aspects of screening for thyroid disease in pregnancy and in women with fertility disorders
Bartáková, Jana ; Jiskra, Jan (advisor) ; Zamrazil, Václav (referee) ; Smutek, Daniel (referee)
The incidence of thyroid diseases in pregnancy in the Czech Republic reaches 10- 15%. Emphasis on early diagnosis and treatment is laid not only during pregnancy but also in the time preceding conception due to the impact of thyroid diseases on fertility, the course of pregnancy, birth and fetal development. The aim of the dissertation was to assess the effectiveness and economical aspects of screening for thyroid disease in pregnancy and in women with fertility disorders in the conditions of the Czech Republic. The dissertation consists of four published studies. The first study is a prospective cross-sectional study of 200 positively screened pregnant women. In the study we come to conclusion that pregnant women who are at high- and low-risk for thyroid disease have similar clinical and laboratory characteristics and screening, currently focused only on risk groups, is ineffective. The second study of 5 223 pregnant women is a case-control study. We find that the age of women over 30 cannot be regarded as a risk factor for thyroid disease in pregnancy, although addition this age criterion to the case-finding screening strategy improve its efficiency and ATA (American Thyroid Association) include it in their guideline 2011. The third publication is a retrospective cross-sectional study of 188...
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Assumptions development and success of selected carsharing company
Zamrazil, Václav ; Plášková, Alena (advisor) ; Martínez, Felipe (referee)
The thesis is focused on carsharing. Firstly, the concept of carsharing is defined , followed by specifications of different types of this business, as well as its developments and both customer and social advantages . The thesis also evaluates the developments of Czech carsharing market with main focus on the leading company on the Czech carsharing market. Regarding the history of carsharing in the developed market economies, the thesis has been evaluating strengths and weaknesses of the respective company. The thesis also tries to make the comparison of the price competitiveness of the leading Czech company compared to its direct and indirect competitors. Recommendations of the steps how to develop this particular company and how to strengthen its market position are subject to the final part of the thesis.
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Economic aspects of screening for thyroid disease in pregnancy and in women with fertility disorders
Bartáková, Jana ; Jiskra, Jan (advisor) ; Zamrazil, Václav (referee) ; Smutek, Daniel (referee)
The incidence of thyroid diseases in pregnancy in the Czech Republic reaches 10- 15%. Emphasis on early diagnosis and treatment is laid not only during pregnancy but also in the time preceding conception due to the impact of thyroid diseases on fertility, the course of pregnancy, birth and fetal development. The aim of the dissertation was to assess the effectiveness and economical aspects of screening for thyroid disease in pregnancy and in women with fertility disorders in the conditions of the Czech Republic. The dissertation consists of four published studies. The first study is a prospective cross-sectional study of 200 positively screened pregnant women. In the study we come to conclusion that pregnant women who are at high- and low-risk for thyroid disease have similar clinical and laboratory characteristics and screening, currently focused only on risk groups, is ineffective. The second study of 5 223 pregnant women is a case-control study. We find that the age of women over 30 cannot be regarded as a risk factor for thyroid disease in pregnancy, although addition this age criterion to the case-finding screening strategy improve its efficiency and ATA (American Thyroid Association) include it in their guideline 2011. The third publication is a retrospective cross-sectional study of 188...
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Haemorheopheresis in treatment of severe thyroid associated orbitopathy, the role of changes in selected pathogenetic indicators
Ceeová, Věra ; Čáp, Jan (advisor) ; Zamrazil, Václav (referee) ; Fryšák, Zdeněk (referee)
Haemorheopheresis in treatment of severe thyroid associated orbitopathy, the role of changes in selected pathogenetic indicators Introduction: Thyroid associated orbitopathy (TAO) is an autoimmune disease characterized by inflammatory swelling and cellular infiltration of orbital tissues. In severe cases causes disablement and disfigurement of patients. The treatment of choice has been for many years corticosteroid treatment. Its benefit was clearly demonstrated in spite of many important adverse events. The effect of other immunosuppressive treatment has not been clearly demonstrated. Objective: The aim of our study was to determine the effect of haemorheopheresis on the course of TAO in patients with very severe form of disease in a randomized study (10 patients treated with high doses of glucocorticosteroids and 10 patients on combination of glucocorticosteroids and haemorheopheresis). Secondary aim is to follow selected pathogenetically important immunological and biochemical parameters during haemorheopheretic treatment and to evaluate safety and tolerability of our method modification. Patients and methods: 20 patients with very severe form of disease, without improvement on standard glucocorticoid treatment were enrolled into the study. They were randomized into two groups. Ten patients were treated...
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Radioactive iodine for Graves-Basedow thyreotoxicosis (optimization of dosage regimen)
Čepková, Jitka ; Horáček, Jiří (advisor) ; Zamrazil, Václav (referee) ; Límanová, Zdeňka (referee)
2 Summary Introduction: Despite more than 60 years' experience with radioactive iodine 131 I (RAI) treatment of Graves' disease (GD) the most appropriate dosing regimen is still controversial. Namely, there has been a lot of discussion comparing the individualized dose to the fixed dose (activity). Objective: The main objective of our research was to analyze the outcome of RAI therapy depending on the initial status of patients and to relate the success rate of RAI therapy to the fixed activity and to the adjusted dose. Our practical objective was to suggest the arrangement of dosing regimen in clinical use on the basis of researched data. Patients and methods: Retrospectively, we analyzed 603 patients with GD (500 women and 103 men, mean age 51.5 ± 12.7 years) treated with RAI in our thyroid unit between the years 1998-2012. According to recommended practice in the Czech Republic, most patients came with at least 1-year history of the disease, in the first or next relapse. Their antithyroid medication was withdrawn 4 days before RAI administration. Initially, RAI activity corresponding to dose ca. 3.2-6.2 MBq/g (adjusted to thyroid volume and 24-hour RAI accumulation) was used. Since 2001, we administered at least 6.5 MBq/g, median 8.5 MBq/g. The treatment was considered successful if patients were...
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Evaluation of nutritional status and cardiac risk in patients with anorexia nervosa.
Pálová, Sabina ; Charvát, Jiří (advisor) ; Ošťádal, Petr (referee) ; Zamrazil, Václav (referee)
Anorexia nervosa (MA) is serious psychiatric disease associated with significant mortality. One of the main causes of mortality in these patients is cardiac complications. In 2003 - 2010 we examined 30 patients with established diagnosis of MA. Routinely used nutritional parameters are normal even in severe malnutrition in MA patients and we can ́t use them to diagnose or monitor nutritional status. Therefore we evaluated plasma aminoacids levels to detect minor changes of protein metabolism. According to our results we found mild hyperaminoacidemia and significant elevation of Gly/Val and Phe/Tyr ratio. In the second part of our research we performed non invasive examination s in risky patients with AN to consider possible cardiac complications. Results of ECG and echocardiography confirm results of the previous published studies. Original finding is significant decrease in flow mediated dilatation of brachial artery and its normalization after realimentation. We found also in ambulatory blood pressure monitoring significant decrease in blood pressure during the active period which was the consequence of changes in the heart rate variability. Decrease of the blood pressure in patients with AN in standing position was associated with increase of HF power in supine position and particularly with the lack of...
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