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Factors affecting glucose metabolism and inflammatory response in critically ill patients
Kotulák, Tomáš ; Haluzík, Martin (advisor) ; Maruna, Pavel (referee) ; Šenolt, Ladislav (referee)
Hyperglycemia in critically ill patients was considered for many years an adaptive response to stress conditions being present in both patients with and without previous history of diabetes. Hyperglycemia is caused mainly by peripheral insulin resistance induced by the factors acting counteracting insulin signalling at the postreceptor level. Furthermore, hyperglycemia itself can then increase serum levels of pro-inflammatory cytokines such as tumor necrosis factor alpha (TNF-α), interleukin-6 (Il-6) and interleukin-8 (Il- 8) and others. On the contrary, peripheral insulin resistance induced by pro- inflammatory cytokines may further potentiate hyperglycemia. White adipose tissue represents in addition to its energy storage function also a very active endocrine active organ. In addition to regulation of a number of metabolic processes it also significantly modulates the inflammatory response. In critically ill patients, adipose tissue changes its morphology, i.e. the adipocytes are shrinking and adipose tissue is abundantly infiltrated by macrophages. Paradoxically, overweight and obese critically ill patients have lower mortality than underweight, lean and morbidly obese subjects. In our studies, we selected population of the patients undergoing elective major cardiac surgery with extracorporeal...
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Thrombophilia and thrombotic complications in severe septic patients
Zenáhlíková, Zuzana ; Kvasnička, Jan (advisor) ; Maruna, Pavel (referee) ; Malý, Jaroslav (referee)
Introduction: Thrombotic events are among the most serious complications of sepsis and also the most frequent causes of morbidity and mortality in patients with sepsis. Currently, the administration of low molecular weight heparins (LMWH) is recommended in patients with severe sepsis for prophylaxis of these complications. However, this prophylaxis often fails. Objectives of the study: One of the objectives of our study was to examine changes in haemostasis in relation to the inflammatory response during 15 days of severe sepsis. The next objective was to determine whether a prophylactic inhibition of F Xa in the range from 0.2 to 0.4 IU/mL is achieved in these patients, if they receive the recommended prophylaxis with LMWH. We also recorded the dynamics of changes in the F Xa inhibition during the entire study period. Moreover, we tried to identify the factors that may affect the antithrombotic efficacy of the subcutaneously administered enoxaparin. Patient population and methods: A total of 35 ICU patients meeting the criteria of severe sepsis were enrolled in the study. Only 16 of these patients could be followed throughout the entire 15-day period. Patients were treated according to the current guidelines, including LMWH prophylaxis; enoxaparin (40 mg sc per day) was used in this study....
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The importance of the expression of leukocyte and thrombogenic markers in the atherogenesis
Svobodová, Helena ; Štulc, Tomáš (advisor) ; Maruna, Pavel (referee) ; Poledne, Rudolf (referee)
Inflammatory and prothrombotic factors play a crucial role in the atherogenesis. Dyslipidemia and diabetes mellitus as well are associated with the endothelial and leukocyte activation, which facilitate the inflammatory infiltration of the subendothelial space and deteriorate endothelial dysfunction, and thus contribute to the development of premature atherosclerosis. Furthermore, diabetes is associated with a number of platelets and coagulation factors abnormalities that participate in atherogenesis by other mechanisms and may be involved in the acute atherothrombotic events progression. Therefore, the factors that could favourably influence these actions become the subject of interest. In this work, we examined leukocyte expression of cell adhesion molecules in patients with hypercholesterolemia and type 2 diabetes, and thrombogenic molecules on leukocytes in type 2 diabetes, and also soluble endothelial and thrombogenic markers. In these patient groups, we investigated the effect of lipid lowering and antidiabetic treatment on these markers. (...) In contrast, there was nearly no effect of the hypolipidemic and antidiabetic treatment on the serum/plasma endothelial and thrombogenic molecules. Leukocyte molecules may therefore be a more sensitive marker of atherogenesis than circulating endothelial...
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