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Conservative Treatment of Acute Pancreatitis and Use of Enteral Nutrition
Česák, Vojtěch ; Rušavý, Zdeněk (advisor) ; Kvapil, Milan (referee) ; Sobotka, Luboš (referee)
Acute pancreatitis is a disease which can present in a mild or severe form. In the last few years, the incidence of acute pancreatitis has been steadily rising. The treatment of severe cases is complex and nutrition is one of the key treatment factors. Enteral and parenteral nutrition are documented parts of acute phase treatment included in many guidelines. However, there is a controversy about the timing of initiation of peroral nutrition after the acute phase of severe pancreatitis has resolved. This dissertation shows the results of monocentric prospective randomized trial which compares the safety and effectivity of peroral nutrition compared to enteral nutrition in patients with severe acute pancreatitis during hospitalization as well as in long term after hospital discharge. Patients with severe acute pancreatitis were randomized into two groups - enteral nutrition versus peroral nutrition. The randomized nutrition strategy was initiated within the first 14 days of hospitalization. We monitored the length of hospital stay, tolerance of nutrition, complications, body weight and nutrition parameters. The two groups did not differ significantly in the length of hospital stay. The number of complications was similar between the groups, there was no significant difference in the rate of acute...
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Impact of stable ghrelin receptor agonists and antagonists on food intake regulation
Holubová, Martina ; Maletínská, Lenka (advisor) ; Kopecký, Jan (referee) ; Sobotka, Luboš (referee)
The thesis is focused on the effect of ghrelin receptor (GHS-R1a) agonists and antagonist on food intake regulation. Ghrelin is the only known periferally produced orexigenic hormone and the only known acylated hormone. GHS-R1a agonists and antagonists could be useful in the treatment of cachexia and obesity, respectively. In the first part of the thesis, newly designed peptidic GHS-R1a agonists were characterized. The agonists were stabilized by replacing octanoylated Ser3 with a fatty acid coupled to diaminopropionic acid by a stable amide bond. Other noncoded amino acids were also incorporated. Ghrelin analogs were modified by replacing the octanoyl group with another fatty acid, incorporation of the second fatty acid or shortening the peptide chain. Most of the tested GHS-R1a agonists were found to possess high affinities for GHS-R1a (Ki = 10-9 - 10-10 nM) and to activate signaling pathways of ghrelin. After subcutaneous (SC) administration to mice, agonists showed significant and prolonged orexigenic effect. In the second part of the thesis, acute and long-term effects of pseudopeptide GHS-R1a agonist JMV1843 were tested in lean C57BL/6 mice. Acute SC administration of JMV1843 to fed mice increased food intake in a dose-dependent manner (ED50 = 1.94 mg/kg). JMV1843 was stable in blood serum in...
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Conservative Treatment of Acute Pancreatitis and Use of Enteral Nutrition
Česák, Vojtěch ; Rušavý, Zdeněk (advisor) ; Kvapil, Milan (referee) ; Sobotka, Luboš (referee)
Acute pancreatitis is a disease which can present in a mild or severe form. In the last few years, the incidence of acute pancreatitis has been steadily rising. The treatment of severe cases is complex and nutrition is one of the key treatment factors. Enteral and parenteral nutrition are documented parts of acute phase treatment included in many guidelines. However, there is a controversy about the timing of initiation of peroral nutrition after the acute phase of severe pancreatitis has resolved. This dissertation shows the results of monocentric prospective randomized trial which compares the safety and effectivity of peroral nutrition compared to enteral nutrition in patients with severe acute pancreatitis during hospitalization as well as in long term after hospital discharge. Patients with severe acute pancreatitis were randomized into two groups - enteral nutrition versus peroral nutrition. The randomized nutrition strategy was initiated within the first 14 days of hospitalization. We monitored the length of hospital stay, tolerance of nutrition, complications, body weight and nutrition parameters. The two groups did not differ significantly in the length of hospital stay. The number of complications was similar between the groups, there was no significant difference in the rate of acute...
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Nutrition of seniors in selected facilities of the social services of the Hradec Kralove Region
Zindulková, Lucie ; Sobotka, Luboš (advisor) ; Psutka, Jan (referee)
The thesis deals with seniors' diet in selected social services facilities of the Kralovehradecky region. The main aim of this project is to establish what kind of diet from a quantitative and qualitative point of view is served to the clients of these social services facilities. This was accomplished by collecting and subsequently analyzing in the lab all meals served daily for the duration of 7 days. Furthermore, there was an evaluation of the variety of food conducted. This evaluation was accomplished by observing the menu for a period of one month. Points were awarded only for non-repetitive foods and meals. The evaluation was based on the dietary diversity coefficient. This Diploma project also deals with clients' actual consumption of the served food in social services facilities. There was a client survey conducted, namely, the Mini Nutritional Assessment short form. This was done along with recording the clients' physical activity. Key words: nutrition, senior, Kralovehradecky region
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Effect of Clinical Nutrition and Physiotherapy in Acutely ill Geriatric Patients on Morbidity, Mortality and Physical Condition - Prospective Longitudinal Study
Hegerová, Petra ; Sobotka, Luboš (advisor) ; Matějovská Kubešová, Hana (referee) ; Charvát, Jiří (referee)
2. Summary: Effect of clinical nutri on and physiotherapy in acutely ill geriatric pa ents on morbidity, mortality and physical condi on - prospec ve longitudinal study Background and aims: An acute disease with catabolic reac on, decreased food intake and low physical ac vity leads to the muscle mass loss. Deepening of sarcopenia then brings a higher morbidity and mortality in elderly people. The aim of our study was to determine whether an ac ve approach based on early nutri onal therapy and exercise during the acute illness may influence the development of sarcopenia and long-term prognosis of the illness. Methods: There were 200 seniors at the age of over 78 years included in the prospec ve study. They were hospitalized in geriatric department with an acute internal disease, randomized with an envelope method into an interven on group (IG, n=100) and a control group (CG, n=100). The interven on group had nutri on support (600 calories, 20 grams of protein per day) on top of a standard diet and started with an intensive physiotherapy (training with bicycle ergometr twice a day and 15 minutes of physiotherapy twice a day). The control group was treated the usual way. The total follow-up period was 2 years. The tolerance of nutri onal supplements and its effect on the spontaneous food intake were evaluated...
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Effect of Clinical Nutrition and Physiotherapy in Acutely ill Geriatric Patients on Self-sufficiency and Physical Condition - Prospective Longitudinal Study
Dědková, Zuzana ; Sobotka, Luboš (advisor) ; Charvát, Jiří (referee) ; Matějovská Kubešová, Hana (referee)
- Effect of clinical nutrition and physiotherapy in acutely ill geriatric patients on self-sufficiency and physical condition - prospective longitudinal study Background & aims: Acute internal disease of the elderly often leads to loss of muscle mass and self-sufficiency. Reversal of muscle tissue, especially in geriatric patients, is very difficult and thus can an acute illness leads to necessity a second person helping a form of subsequent social care at home or in institutions aftercare. The aim of our study was to determine whether an active approach based on early physiotherapy and nutritional supplementation legs to influence the development of sarcopenia and patient's self- sufficiency during the acute illness. Methods: Two hundred patients, older than 78 years, admitted to geriatric department with acute illness were enrolled in a prospective, randomized, controlled study. Patients were randomized to the control group (standard treatment, n = 100) and the intervention group (n = 100). The intervention consisted of the administration of nutritional supplements (600 kcal, 20 g protein daily) added to the standard diet and simultaneous intensive rehabilitation therapy. Patients were followed-up for 2 years after discharge. The tolerance of nutritional supplements and its effect on the...
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The influence of severe illnes on the thermic effect of parenteral nutrition and substrates oxidation
Bajnárek, Jiří ; Sobotka, Luboš (advisor) ; Kábrt, Jan (referee) ; Wilhelm, Zdeněk (referee)
Objective: The thermic effect (TE) of parenteral nutrition (PV) is not known in severely ill patients. The aim of our study was to measure TE and the dynamics of substrates oxidation during PV in this population. Type of the study: prospective Material and methods: After a fastening period of 12 hours (infusion of saline) we administered to ICU patients (N=21) total PV of the following composition: amino acids 1.2 mg, fat 0.5 mg, glucose 4.0 mg per minute per kilogram of ideal body weight. Prior to PV administration and subsequently 2, 5, 12, and 24 hour later energy expenditure (EV) and oxidation of energy substrates were measured by indirect calorimetry. The correlation between assessed parameters and APACHE II score was searched. Results: TE reached its maximum 5 hours after the onset of PV (6.6 ± 9.5 % (p=0.004)) and then it gradually declined. It was not influenced by disease severity. Lipid oxidation was suppressed from the fasting level of 0.88 ± 0.60 to the minimum of 0.02 ± 1.0 mg.kg-1 .min-1 (p<0.001), whereas glucose oxidation increased from 1.19 ± 1.67 to the maximum of 3.46 ± 2.14 mg.kg-1 .min-1 (p<0.001) in the 12th hour. The rate of suppression of lipid oxidation by PV was directly correlated with APACHE II score (R=0.56; p=0.018) Conclusions: The TE of PV administered to medical ICU...
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Impact of stable ghrelin receptor agonists and antagonists on food intake regulation
Holubová, Martina ; Maletínská, Lenka (advisor) ; Kopecký, Jan (referee) ; Sobotka, Luboš (referee)
The thesis is focused on the effect of ghrelin receptor (GHS-R1a) agonists and antagonist on food intake regulation. Ghrelin is the only known periferally produced orexigenic hormone and the only known acylated hormone. GHS-R1a agonists and antagonists could be useful in the treatment of cachexia and obesity, respectively. In the first part of the thesis, newly designed peptidic GHS-R1a agonists were characterized. The agonists were stabilized by replacing octanoylated Ser3 with a fatty acid coupled to diaminopropionic acid by a stable amide bond. Other noncoded amino acids were also incorporated. Ghrelin analogs were modified by replacing the octanoyl group with another fatty acid, incorporation of the second fatty acid or shortening the peptide chain. Most of the tested GHS-R1a agonists were found to possess high affinities for GHS-R1a (Ki = 10-9 - 10-10 nM) and to activate signaling pathways of ghrelin. After subcutaneous (SC) administration to mice, agonists showed significant and prolonged orexigenic effect. In the second part of the thesis, acute and long-term effects of pseudopeptide GHS-R1a agonist JMV1843 were tested in lean C57BL/6 mice. Acute SC administration of JMV1843 to fed mice increased food intake in a dose-dependent manner (ED50 = 1.94 mg/kg). JMV1843 was stable in blood serum in...
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Contentment patients with diet in hospital
Hornychová, Petra ; Vaňková, Dana (advisor) ; Sobotka, Luboš (referee) ; Ulrychová, Hana (referee)
This bachelor's thesis discuss a contentment patiens with diet in the fakulty hospital in Hradec Králové. The goal of the bachelor's thesis is to find out satisfaction patiens with hospital's diet in fakulty hospital in Hradec Králové. A theoretical part describe basicly element's of food (lipids, carbohydrates, proteins, vitamins and minerals) and some methods used for find out mutrition state od patiens.There is define dietary system, describe some diet and describe method of giving enteral and parenteral nutrition. A empirical part consist of research od satisfaction patients with diet by questionnaire. The questionnaire I did myself and distributed to patiens in the fakulty hospital in Hradec Králové.
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