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The toxicology of combustion products
SIKORA, Henryk
Fire presents a significant risk of the formation of toxic combustion gases. These substances further endanger fire squad units and nearby residents. Toxic gases are responsible for almost 50% of all fire casualties and cause one third of fatal casualties. The amount and composition of gases depend to a great extent on the conditions of thermal degradation especially temperature and the amount of oxygen in the surrounding atmosphere. Prevention or minimisation of consequences of formation of toxic gases involves a rapid and a quality analysis. For this purpose, the methods that proved to be the best suited are gas chromatography and mass spectrometry combined with micro-extraction to solid phase. This work involves analysis of combustion products of selected materials and study of their toxic characteristics. These are especially wood, oil products, various types of rubber and plastic materials. Using analysis of these combustion gases more than 300 hundred substances have been identified. These are especially carbon oxides, nitrogen oxides, sulphur oxides, volatile organic substances, polycyclic aromatic hydrocarbons, etc. Monitoring of combustion gases was performed even in the vicinity of large fires. The findings were complemented by information from expert studies and events of past years. In case of identified substances which present the greatest health risk, the most significant toxic characteristics were described with emphasis on acute exposition, symptoms of intoxication and possible consequences. Following all these facts protection measures are suggested in relation to the formation of toxic combustion gases.
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Nursing care of child patient with acute pancreatitis.
ŽENÍŠKOVÁ, Pavla
Abstract Child patient acute pancreatitis nursing care Current status: Acute pancreatitis is an inflammatory disease of the pancreas. This disease can be classified as an acute abdominal event. The essence of the disease is the autodigestion of pancreas maternal tissues. The most common cause of pancreatitis in childhood is an infection. This infection may have viral, bacterial or parasitary origin. The main clinical symptom is abdominal pain, connected with vomiting. The diagnosis can be confirmed by a laboratory blood test, where increased values of amylase and lipase are found in the serum. For acute pancreatitis diagnosis in pediatric patients, a non invasive displaying method has remained unsurpassed up to now - ultrasonographic abdominal examination. The method is non-invasive, Quit and available examination. Based on the progression and form of the disease, the child patient is admitted to an intensive care unit, or to a standard ward. The onset of treatment requires the absolute prohibition of any intake of nutrition per os. The application of analgetics and antibiotics is also very important. Regarding the application of analgetics there are different opinions regarding opiate or non-opiate types., Some complications can occur in more serious forms of the disease, like biliar ways compression followed by icter, duodena stenosis and following ileus. There are also connected complications regarding the cardio vascular system and the gastroinstestinal tract. The prognosis is very good in milder forms of the disease. Acute pancreatitis can turn into the chronic disease in 15-35% of cases. Targets: The first target was to evaluate the acute pancreatitis growth rate in childhood in the Czech republic from 2004 up to 2014. The second target was to describe specific aspects of nursing care for the pediatric patient with acute pancreatitis during hospitalization, during follow up care and after being released home. Methodology and research group: The Institute of sanitary information and statistics was appproached regarding the achievment of the first tagret as were all seven health insurance companies operating in the Czech republic. The method of documents analysis and data collection was used to achieve the second target. The information was gathered from primary documentation and professional studies on the topic. Results: From 2010 there has been a constant and gradual growth of acute pancreatitis in pediatric patients in the Czech republic. While in 2010 there were 221 patients, in 2014 there were already 318 pediatric patients with this disease. The specific aspects of nursing care for a pediatric patient with acute pancreatitis are in early diagnostics, analgetics and antibiotics therapy, and mainly, in dietary measures. During hospitalization in an intensive care unit, or in a standard ward, the specific aspects of nursing care are the following: Physiological functions monitoring, pain monitoring, monitoring the intravenous catheter, or urine catheter if applicable, and nazogastric probe, observing the emptying and nutrition of a pediatric patient, and also in meeting the child´s needs. The most important aim after acute pancreatitis, is maintaining the correct diet. The gradual return of the child back to normal life is also very important. Conclusion: This disease can be classified as an acute abdominal event. The clinical image is accompanied by strong abdominal pain and vomiting. Ultrasonogprahic abdominal examination is the first option of displaying diagnostic methods. The treatment takes place during hospitalization in an intensive care unit or in a standard ward. Strict diet maintaining is the most important specific aspect. Practical recommendations: The outcome of the thesis is a brief summary of nursing care for a child with a past of acute pancreatitis when is discharged home.
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Development of prostate cancer radiotherapy from the 80s to the present day
SUCHANOVÁ, Markéta
Prostate cancer (CaP) remains the most common cancer diagnosed in men. This desease has worldwide increasing incidence. In the Czech Republic incidence has tripled during the last 20 years. The increase of the mortality is much more slower, but CaP is still the third leading cause of cancer-related death in men. CaP treatment management options may include active surveillance, radical prostatectomy, brachytherapy and external beam radiation therapy. The radiotherapy occupies an irreplaceable position. It is used as a curative therapy for clinically localized CaP with a low and intermediate risk. In the case of high risk CaP and locally advanced tumors are often treated with the addition of the hormonal therapy, which enhances tumor control and overall patient's survival. The radiotherapy is also used in some cases as an adjuvant treatment following a radical prostatectomy, as well as a salvage therapy in a biochemical relapse or as a palliative treatment if the cancer progresses. The aim of this study is to provide an overview of the development of CaP radiotherapy from the 80s till the present day. The specific objective of the study is to assess the incidence of the radiation-related complications (RRC) in patients with CaP treated with IMRT and PT. Among the methods of processing this thesis was using secondary data analysis. Practical information were obtained during the visits to the Department of the Radiation Oncology at the Hospital Ceske Budejovice a.s. (NCB) and the Proton Therapy Center Czech s.r.o. (PTC). During these visits was observed the radiotherapeutic treatment of the patients with CaP and valuable information were obtained through interviews with Mrs.Vančurová, MD and Mr. Vítek, MD., Ph.D., MBA This study analysed the incidence of the acute and late RRC in patients with CaP treated in these facilities. The acute and late side effects was assessed for GU and GI toxicity using RTOG / EORTC score. The specific problems were measured with the CTCAE v.4.0 scale. The overall incidence of the RRC was subjected to the statistical hypothesis testing using a two-sample unpaired t-test. The examined sample consisted of the 30 patients with CaP irradiated at NCB and the 30 patients from PTC with low, intermediate and high risk CaP. It was found that for the patients from NCB the rectum mean dose was 40,7 Gy and the mean dose of bladder was 39,4 Gy. For the patients treated at PTC the mean dose to the rectum was 13,2 Gy and to the bladder 11.1 Gy. This is related to the incidence of the RRC. Acute GU and GI toxicities Grade 2+ occurred in 33 % and 23,3 % of the patients treated in NCB. With a median follow-up of 22 months there was late GU toxicity Grade 2+ in 13,3 %. Late GI toxicity Grade 2+ occurred in 26,7 %, which exceeds incidence of the RRC described in the literature. Incidence of late GI toxicity Grade 3 and 4 was also increased, it appeared in 10 % (3 patients). Furthermore in one case cancer reoccurred and metastasized one and half year after the radiotherapy. In PTC no acute or late Grade 3+ toxicities were observed. Acute GU and GI toxicities Grade 2 occurred in 13,3 % and 6,7 %. After median follow-up of 21,5 months there was incidence of late GI toxicity Grade 2 3,3 %, late GU toxicity appeared only Grade 1 in 13,3 %. There was found statistically significant difference in occurrence of RRC in patients treated in NCB and PTC. The hypothesis that PT reduces the incidence of the radiation side-effects compared to the IMRT technique in the patients with the prostate cancer was confirmed. The prostate can move greatly during the day. It is recommended using CBCT, which is part of new linear accelerators at NCB, to check the position of the prostate before each irradiation. This study provides an overview of the treatment of CaP and may serve to increase of awareness of the RRC. The main contribution can be seen in the comparison of a standard approach with a promising alternative.
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Periradicular therapy in the Hospital Český Krumlov a.s.
KUTIŠOVÁ, Magdalena
This bachelor thesis focuses on the issue of backache and its treatment. Backache is one of the most common diagnosis. The most affected are usually people in their productive age and therefore the economic and social consequences are very significant. There are many techniques used in diagnosis of backache, easier and cheaper techniques are used in the first place. The diagnosis consists of examination of the patient, medical history and clinical examination. The treatment depends on type and progress of the illness. The basic division is acute (4 to 6 weeks) and chronic case (more than 3 months). Another division is common backache, nervous radicular pain and serious illness of spine. I will mainly focus on nervous radicular pain. The basis of the therapy should be active treatment accompanied by physiotherapy. In addition to this therapy, pharmacological treatment is also used. The pharmacological treatment consists of application of nonsteroidal anti-inflammatory drugs, analgesic and also antidepressants. If the conservative therapy is not effective, it is possible to use the least invasive techniques. The most popular one is the periradicular therapy under CT guidance, which is also the subject of this thesis. During the periradicular therapy under CT guidance the needle is being inserted to intervertebral foramen in the area of radicular affected nerve where lytic mixture is then being applied. The lytic mixture is sometimes replaced by ozone with the same effect. When the PRT was first used, it was mainly applied in the area of lumbar spine. Nowadays, it is usually used in treatment of lesion in the area of cervical spine. The objective of this thesis is to describe anatomy of the examined area, physiological and pathological state, the main indications for the periradicular therapy and methods of implementation including the used tools and pharmaceutical. Following part is focused on development of application of this method in the Hospital of Český Krumlov, a.s. the radiodiagnostics department, and to analyse the effectiveness of the treatment. I have conducted analysis and processed data of performed periradicular therapies in the Hospital of Český Krumlov, a.s. from 2010, when the method was introduced, up to 2015. I have made a questionnaire survey of 40 people selected by chance and then I processed the data in order to create a general overview of obtained results. The result of the thesis is that the number of performed periradicular therapies is steadily increasing. One-third increase was recorded from 2010 to 2015. The number of women patients prevails, 53% of patients in the given period were women. The most common age category is 50 to 59 years, this category constitutes 37% of all patients. It was found out that most of the patients were treated just for one or two times. Only 7% of the patients were treated for more than two times. When processing the data from my survey, I have found out that most of the patients are satisfied with the effectiveness of the therapy, which corresponds with the results quoted in the bibliography.
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Biomarkers in Myocardial Damage Diagnostics
KOPŘIVOVÁ, Olga
Anotace (abstract) Biomarkers diagnosing myocardial damages have recently been a very dynamically developing part of clinical biochemistry. Implementing of new biomarkers is very prompt; they are mostly implemented into practice without wider clinical and analytical experience. During a few years these are new methods to determine myoglobin, troponins (cTnI, cTnT), CK-MB mass, BNP etc. The effort of clinical biochemists and cardiologists is to cover all phases and levels of myocardial damage in acute coronary syndromes by means of cardio markers. These investigations are dramatically changing the view of diagnosis, determination of prognosis and therapy in acute coronary syndromes. In my thesis I covered retrospective data analysis in patients with the pain in the chest, presented at an inpatient clinic. The value of myocardial damage indicators and their dynamism was analysed from the definitive diagnosis point of view. I performed my own analysis at OKB Nemocnice Písek, a.s. (Hospital Písek, Inc.). The aim of my thesis was to cover the significance of particular myocardial damage markers and find out if investigated set of markers is sufficient for correct and prompt diagnosis of acute myocardial infarction. In terms of this thesis I tried to find out if the panel of cardiac markers contains excess values. In OKB Písek, a.s. the panel of myocardial damage markers includes: myoglobin, troponin I, CK-MB mass and the marker of heart failure BNP. In the samples of fifty-six patients I analysed the presence of the above mentioned markers of myocardial damage and heart failure. I examined only the markers which were determined by a physician. In the group of investigated patients with chest pain, measured values of troponins proved myocardial infarction in sixteen patients, values of CK-MB mass in sixteen patients and values of myoglobin in twelve patients. In the control group of twenty patients with chest pain the boundary values of troponin I were measured in two patients, without the increase of other myocardial damage markers. High value of troponin I was measured in two patients in non-ischemic myocardial damage (acute pericarditis), which agrees with data in scientific literature. The thesis shows that the level of troponin I reflects myocardial damage relatively accurately; troponin I is sufficiently cardio specific but is not a sufficiently early marker. For early management of acute myocardial infection it is important to determine myoglobin, which is detectable within two hours since the beginning of troubles but is not sufficiently cardio specific. The course of CK-MB mass elevation wave copies the course of troponin I elevation wave. That is why the investigation of this marker appears to be excessivet at current investigation of troponin I and myoglobin to prove myocardial damage, which is in agreement with scientific association recommendations.
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The analysis of influence of reimbursement regulatory fee in regional hospitals on the length of stay.
Junga, Přemysl ; Bolcha, Peter (advisor) ; Bartoň, Petr (referee)
The thesis analyses the influence of reimbursement regulatory fee for hospitalization which was introduced in regional hospitals in 2009 in Czech Republic. The difference in difference analysis was used to research the possible relationship between reimbursement of the fee and length of hospitalization in acute care hospitals and in after-care facilities. In acute care the influence was 0,5-1 % of the length and in after-care facilities between 8-12 %. This relationship may be biased because of introduction of DRG system which may decrease the length of stay and may be differently distributed between treatment and control group.
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Synthesis of colloidal gold nanorods for biomedical applications
Valkovičová, Jiřina ; Bernard, Vladan (referee) ; Drbohlavová, Jana (advisor)
Diplomová práce se zabývá výrobou a využitím zlatých koloidních nanotyčinek v biomedicínských aplikacích. Konkrétně se zaměřuje na tři základní funkce nanočástic v analýze - transportní, separační a především zobrazovací. V části o využití nanočástic pro zobrazování je hlavní zájem věnován zejména povrchové plazmonové rezonanci zlatých nantyčinek. Dále je práce zaměřena na využití nanotyčinek pro termální terapii. Následující část je věnována vhodným modifikacím povrchu, hlavně za účelem zmírnění toxicity částic. Závěrem teoretické části jsou způsoby přípravy zlatých koloidních nanotyčinek a techniky jejich následné analýzy. V navazující experimetální části jsou uvedeny postupy, podmínky a výsledky provedených pokusů.
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The Care of Patients with Acute Myocardial Infarction after the Implantation of the Coronary Stent with Regard to Presence or Absence of the Artificial Pulmonary Ventilation
Burošová, Ivana ; Bartůněk, Petr (advisor) ; Bělohlávek, Jan (referee)
Main subject of this theses is acute myocardial infarction treated by percutaneous transluminal coronary intervention with implantation of stent. The diploma paper is divided into two parts. First part, theoretical, describes present knowledge of the disease, anatomy and physiology of cardiovascular system, definition of myocardial infarction and risk factor of atherosclerosis. The atherosclerosis is the main cause of myocardial infarction. The theses is about the etiology and pathophysiology, clinical manifestation, diagnostic, possibilities of treatment and complications of myocardial infarction. It also presents invasive cardiology which is important and irreplaceable method of treating the acute myocardial infarction. In empiric part were used six cases of patients from intensive coronary care unit Královské Vinohrady Hospital in Prague. The theses has to compare the basic advance of nursing care of patients after the coronary intervention with or without the arteficial pulmonary ventilation. I focused on the first, most critical 24 hours. A feed-back data analysis was used in this theses.
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Physiotherapy for patients with acute disseminated encephalomyelitis
JINDROVÁ, Kateřina
ADEM is the inflammatory demyelinating disease of central nervous system which affects mainly white matter cerebrospinal. This bachelor thesis deal with problems of the acute disseminated encephalomyelitis and appropriate approaches of the physiotherapy approaches. For the purpose of this diagnosis is to give a comprehensive view about the disease. Question of acute disseminated encephalomyelitis is nowadays increasingly topical because the incidence of this disease increases every year not only in the world, but also in the Czech Republic. The issue of children is described in detail and subsequently divided. The main stated aim of my thesis is to explore the issue of acute disseminated encephalomyelitis, physiotherapy and process approaches at selected patients with this diagnosis realize defined physiotherapy processes. The theoretical part focuses on the incidence of acute disseminated encephalomyelitis in the Czech Republic and in the world, disease characteristics, causes of its formation, progression, diagnosis and prognosis, and not least the many options in the treatment of diseases such as neurorehabilitation, pharmacological, spa treatment etc. Methodological part is processed using qualitative research. Data collection is carried out observation, interview, analysis of medical records, kinesiology and as neurological examinations is used video and photographic documentation of individual respondents. The research sample includes 2 respondents from Arpida Centers in Ceske Budejovice. Examination and treatment was carried out for 5 months in Arpida areas. To evaluate changes in the patient after treatment is performed input and output kinesiology and neurological examination. One kinesiology examination is completed by testing for posturograf from Copany Neurocom that the patient has received at the beginning of therapy and after its completion. The main research question was determinated in accordance with the objective and qualitative research. The research question was: What are the changes in kinesiological examination occurs after physical therapy in patients with acute disseminated encephalomyelitis? Physiotherapy primarily affected the stereotype of breathing, better stability of scapulas, improved walking stereotypes and generally improved postural stability in stance. Physiotherapy as itself may well affect some degrees of clinical symptoms of acute disseminated encephalomyelitis. It helps improve the quality of life, physical or mental state of a person, helping to improve self-care and improve its team-integration.
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