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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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Autoimmune thyroid disorders in pregnancy and after delivery (Regional screening of thyroid disorders in pregnancy)
Špitálníková, Sylvie ; Horáček, Jiří (advisor) ; Límanová, Zdeňka (referee) ; Zamrazil, Václav (referee)
Our universal screening revealed a relatively high prevalence of autoimmune thyroid disorders (AITD), namely Hashimoto's thyroiditis (HT) and postpartum thyroiditis (PPT), and incipient hypothyroidism in an unselected population of pregnant women from a chosen district, roughly similar to that in foreign studies. Most of the disorders recognized in this way were asymptomatic, and if only high-risk women, defined according to the recommended guidelines, were examined, a large proportion of pregnant women with thyroid disorders would be neither followed by an endocrinologist, nor treated. The universal screening for thyroid autoimmunity and dysfunction appears to be more beneficial for improving the care of pregnant and postpartum women and their children than limiting the testing on women with risk factors only. For the evaluation of TSH levels in pregnant women in the first trimester of pregnancy, the range 0.15-3.5 mIU/l appeared to be the most appropriate one with respect to the method used. On the basis of the results obtained, we believe that the use of the screening target of 3.5 mIU/l and the treatment target of 2.5 mIU/l in women identified as having HT brings satisfactory outcomes. Pregnant women who were treated properly and in time showed a lower occurrence of complications in pregnancy....
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Molecular- genetic analysis of the Thyroid carcinomas
Sýkorová, Vlasta ; Bendlová, Běla (advisor) ; Zamrazil, Václav (referee) ; Peterka, Miroslav (referee)
Introduction: Thyroid cancer represents more than 90% of endocrine tumors and its incidence, predominantly of papillary thyroid carcinoma (PTC), is still increasing in the Czech Republic. Several genetic changes are known, but thein impact to phenotype is still controversial. Aims: To study of the genetic causes (RET/PTC, BRAF and RAS alterations) and the role of RET polymorphisms in thyroid cancer (predominantly PTC), and to correlate genotype with phenotype. Subjects and Methods: Overall 234 PTC tissues, 8 poorly differentiated carcinomas, 3 anaplastic carcinomas, 23 medullary carcinomas, 6 follicular carcinomas and one follicular adenoma were analyzed. Samples of fresh frozen thyroid tissues, fine-needle aspiration biopsies and paraffin-embedded formalin-fixed tissue sections of patients with thyroid cancer and blood samples of healthy controls were used for analysis. The expression of RET/PTC rearrangements was detected on agarose gel. Five RET polymorphisms were analyzed using specific TaqMan probes. Detection of mutations in the BRAF gene and three RAS genes was performed by direct sequencing. Presence of alteration was correlated with clinicopathological parameters. Results: We found out that some RET polymophisms are associated with development of RET/PTC rearrangements in PTC and proved,...
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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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Effect of carbamazepine on thyroid hormone homeostasis
Šimko, Julius ; Šonka, Karel (advisor) ; Mareš, Jan (referee) ; Zamrazil, Václav (referee)
8. Summary Introduction: While carbamazepine (CBZ) treatment may affect serum thyroid hormone concentrations it rarely leads to clinically important hypothyroidism. This study was aimed to evaluate an early effect of CBZ on thyroid status in hypothyroid patients with thyroid hormone replacement, as compared with patients without a thyroid disorder. Methods: Twenty-nine patients indicated for CBZ treatment were followed prospectively. Their thyrotropin (TSH), total thyroxine (TT4), free thyroxine (FT4) and antibodies against thyreoperoxidase (TPO- ab) and thyreoglobulin (TG-ab) serum levels were assayed before the start of CBZ medication (150 mg/d increasing to 450 mg/d), and then their TSH, TT4 and FT4 serum levels were assayed at week intervals for 7 weeks. Nineteen patients had no thyroid disorder before CBZ treatment (control group A), whereas 10 patients were treated with L-thyroxine (median 100μg/d ) for hypothyroidism and were stable before CBZ treatment (group B). The fluctuations of thyroid status after the start of CBZ treatment were compared between the groups. Results: In the control group, TT4 was significantly decreased by ca. 15 to 25 %, starting from the 1st week of treatment (Friedman, p<0.001), while FT4 was decreased by only ca. 10 to 15 %, and the significance (p<0.001) was delayed till...
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Changes of bone mass density in selected endocrine diseases
Vašátko, Tomáš ; Čáp, Jan (advisor) ; Zamrazil, Václav (referee) ; Hána, Václav (referee)
Osteoporosis is a serious social and medical problem. About 6% people suffer from osteoporosis in European countries. As for aetiology it is a multi-factorial disease. Endocrinopaties play an important role in it's development. We focused on three specific endocrinopaties with relation to bone metabolism in our study. Goal of the study: 1/ To evaluate the influence of long term thyroid hormone therapy (substitution and suppressive dose) on bone mass and bone metabolism. 2/ To evaluate the possibility of prediction of bone mass increase after the operation in patients with mild primary hyperparathyroidism. 3/ To evaluate changes of bone mass, bone metabolism and body composition in patients with growth hormone deficiency treated with growth hormone substitution. Patients and methods: 1/ a) First - cross sectional part of the study - 76 patients on suppressive dose of L-thyroxine therapy, 34 patients on substitution therapy. We examined bone markers and bone mass in each group. We evaluated how each of the two doses of therapy influences the bone metabolism and we compared the groups with each other. b) In second - prospective part of the study - we observed the changes of bone mass in the course of the time (5 years) in each group. 2/ Retrospective cross-sectional study - 54 patients with primary...
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