Beta-lactam Antibiotics Level Monitoring in Febrile Neutropenia Patients and Patients with Sepsis

Tato práce byla zaměřena na monitoraci hladin antibiotik (ATB) u imunokompromitovaných, hematoonkologických nemocných. Byla prováděna monitorace beta laktamových ATB, používaných nejčastěji k léčbě gram-negativních patogenů nebo k léčbě febrilních imunokompromitovaných a často neutropenických nemocných (piperacillin, meropenem, ceftazidim). V průběhu podání prolongovaných infuzí byly provedeny odběry k vytvoření individuální farmakokinetiky. Ty byly dále použity k vytvoření populačního modelu. Monte Carlo simulace byla pak použita k vytvoření finálního modelu a demonstraci fakmakokinetického/farmakodynamického cíle. Cílem celé práce tak bylo prokázání farmakokinetických/farmakodynamických cílů pro daná ATB při jejich použití v léčbě stabilních, ale i kriticky nemocných pacientů. Pro ceftazidim byla doplněna klinická práce ukazující účinnost podání vysoké dávky ceftazidimu při infekcích u hematoonkologických nemocných způsobených extenzivně rezistentní Pseudomonas aeruginosa.Beta - lactam antibiotics level monitoring in febrile neutropenia patients and patients with sepsis. Monitoring of antibiotic blood concentration in hemato-oncological patients was primary objective of this work. Monitoring of antibiotics level were done mainly in antibiotics used for gram-negative infections treatment (piperacilline, meropenem, ceftazidime) or for the treatment of febrile immunocompromised patient, usually neutropenic. For individual pharmacokinetics evaluation blood concentration were taken during the administration of prolonged antibiotics infusion. It was further used to create population model. Monte Carlo simulation was then used for creation of final model and for demonstration of pharmacokinetics/pharmacodynamics goals. Pharmacokinetics/pharmacodynamics goals were primary aim of whole study for different antibiotics during the use in stable hemato-oncological patients but also critical patients. Clinical data were used for further study, where we proved high clinical efficacy of high dose ceftazidime in the treatment of extended drug resistant Pseudomonas aeruginosa infection in hemato-oncological patients.IV. interní hematologická klinika4th Department of Internal Medicine - HaematologyLékařská fakulta v Hradci KrálovéFaculty of Medicine in Hradec Králov

Beta-lactam Antibiotics Level Monitoring in Febrile Neutropenia Patients and Patients with Sepsis

Beta - lactam antibiotics level monitoring in febrile neutropenia patients and patients with sepsis. Monitoring of antibiotic blood concentration in hemato-oncological patients was primary objective of this work. Monitoring of antibiotics level were done mainly in antibiotics used for gram-negative infections treatment (piperacilline, meropenem, ceftazidime) or for the treatment of febrile immunocompromised patient, usually neutropenic. For individual pharmacokinetics evaluation blood concentration were taken during the administration of prolonged antibiotics infusion. It was further used to create population model. Monte Carlo simulation was then used for creation of final model and for demonstration of pharmacokinetics/pharmacodynamics goals. Pharmacokinetics/pharmacodynamics goals were primary aim of whole study for different antibiotics during the use in stable hemato-oncological patients but also critical patients. Clinical data were used for further study, where we proved high clinical efficacy of high dose ceftazidime in the treatment of extended drug resistant Pseudomonas aeruginosa infection in hemato-oncological patients

Metodika implementace IIIF v českých digitálních knihovnách:se zvláštním zřetelem na systém digitální knihovny Kramerius

Překládaná metodika si klade za cíl nabídnout knihovnám i dalším paměťovým institucím v České republice doporučený postup při implementaci mezinárodního standardu IIIF do digitální knihovny či repozitáře. V současné době je zdigitalizována významná část dokumentů v knihovních fondech a výsledky digitalizace jsou prezentovány v různých systémech digitálních knihoven. V rámci zachování interoperability je nutné dodržovat jak standardy digitalizace (což je díky projektu Národní digitální knihovny v knihovním prostředí na vysoké úrovní), tak i standardy pro zpřístupňování digitálních dokumentů. IIIF je široce uplatňovaný v mezinárodní komunitách digitálních knihoven a repozitářů, přináší řadu přínosů pro uživatele a nabízí i další výhody pro samotný repozitář, který může snadno pomocí IIIF prezentovat svoje dokumenty a sbírky nezávisle na použitých technologiích a nabízet k nim i další pokročilé funkce

Pneumocystis Pneumonia During Medicamentous Treatment of Cushing’s Syndrome – A Description of Two Cases

Only a few cases of pneumocystis pneumonia (PCP) in Cushing’s syndrome have been published in the literature so far. In the majority of these patients, the pneumonia occurred after reduction of the hypercortisolism with medicamentous treatment. We report two cases of PCP during conservative treatment of hypercortisolism. We describe clinical, imaging and laboratory findings in two patients and review published cases of pneumocystits pneumonia in Cushing’s syndrome. A 60-year-old woman and 20-year-old man with Cushing’s syndrome due to ectopic ACTH syndrome were treated at our department. Both developed pneumocystis pneumonia early after treatment with ketoconazole and ethomidate bromide had been introduced and the levels of cortisol rapidly decreased. PCP prophylaxis in patients with high cortisolemia should be started before treatment of hypercortisolism in current practice. Gradual lowering of plasma cortisol should also reduce the risk of infection by Pneumocystis jiroveci

CASE 2–2012: a 57-Year-Old Woman with Post-Transplant Lymphoproliferative Disorder after Allogeneic Stem Cell Transplantation for Primary Myelofibrosis

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FIFTEEN YEARS OF SINGLE CENTER EXPERIENCE WITH STEM CELL TRANSPLANTATION FOR MULTIPLE MYELOMA: A RETROSPECTIVE ANALYSIS

Introduction: Autologous stem cell transplantation (ASCT) became standard of care for patients with multiple myeloma (MM) under the age of 65 years. We routinely perform ASCT for newly diagnosed MM since 1996 in our department. Patients and methods: We retrospectively analyzed all 285 transplants in 185 patients done for MM from January 1996 till December 2010. We analyzed overall survival (OS) and progression-free survival (PFS) regarding conditioning, stage, complete or very good partial remission (CR, VGPR) achievement, renal impairment, single vs. double transplant. Results: Estimated 10-years survival of the whole set of patients is 39% (median survival 95 months). Patients with renal impairment show same OS as those without (p = 0.22). Patients show similar overall survival and event free survival regardless of type of transplant. We observed better outcome in terms of overall survival in patients treated with new drugs (p = 0.0014). Reaching CR or VGPR was not translated into better OS (p = 0.30) and EFS (p = 0.10). Also stage of the disease and whether single or double transplant was used did not make any significant difference in the outcome. Conclusion: Stem cell transplantation greatly improved outcome of patients with MM. Poor outcome of allogeneic transplantation in our group of patients is related to high transplant related mortality (20% vs. 0%) and unexpected high relapse rate. There is a trend towards better survival, when new drugs are incorporated at any time in the course of the disease. This fact supports hypothesis that use of these drugs with ASCT should translate into better long-term outcome

Treatment of Multifocal Multisystem BRAF positive Langerhans Cell Histiocytosis with Cladribine, surgery and Allogenic Stem Cell Transplantation

Langerhans cell histiocytosis (LCH) is a very rare disease in adults and as well a very rare cause of sellar expansion. The clinical presentation can be heterogeneous, from a single bone lesion to potentially fatal, widespread disease. We describe the difficulties with the diagnosis and treatment of LCH as well as successful treatment with cladribine chemotherapy and allogeneic stem cell transplantation