Context: Acidemia is a marker of prognosis in methanol poisoning, as well as compounding formateinduced cytotoxicity. Prompt correction of acidemia is a key treatment of methanol toxicity and methods to optimize this are poorly defined. Objective: We studied the efficiency of acidemia correction by intermittent hemodialysis (IHD) and continuous renal replacement therapy (CRRT) in a mass outbreak of methanol poisoning. Methods: The study was designed as observational cohort study. The mean time for an increase of 1 mmol/L HCO 3 -, 0.01 unit arterial blood pH, and the total time for correction of HCO 3 -were determined in IHD-and CRRT-treated patients. Results: Data were obtained from 18 patients treated with IHD and 13 patients treated with CRRT. At baseline, CRRT group was more acidemic than IHD group (mean arterial pH 6.79 ± 0.10 versus 7.05 ± 0.10; p ¼ 0.001). No association was found between the rate of acidemia correction and age, weight, serum methanol, lactate, formate, and glucose on admission. The time to HCO 3 -correction correlated with arterial blood pH (r¼ À0.511; p ¼ 0.003) and creatinine (r ¼ 0.415; p ¼ 0.020). There was association between the time to HCO 3 -correction and dialysate/effluent and blood flow rates (r¼ À0.738; p < 0.001 and r¼ À0.602; p < 0.001, correspondingly). The mean time for HCO 3 -to increase by 1 mmol/L was 12 ± 2 min for IHD versus 34 ± 8 min for CRRT (p < 0.001), and the mean time for arterial blood pH to increase 0.01 was 7 ± 1 mins for IHD versus 11 ± 4 min for CRRT (p ¼ 0.024). The mean increase in HCO 3 -was 5.67 ± 0.90 mmol/L/h for IHD versus 2.17 ± 0.74 mmol/L/h for CRRT (p < 0.001). Conclusions: Our study supports the superiority of IHD over CRRT in terms of the rate of acidemia correction. ARTICLE HISTORY

Key words: Obesity in children/Insulin resistance/Hypertension in children/HOMA/QUICKIBackground. Obesity and arterial hypertension are a serious risk factor for insulin resistance patients leading to diabetes and other disorders. Obesity is one of the most common nutritional problems in developed countries. Actually the incidence of obesity is increasing considerably, obesity is emerging in alarming rates between the last 10 years. Obesity and hypertension beginning in childhood often precedes the hyperinsulinemic state. The metabolic syndrome is rapidly increasing in prevalence with rising childhood obesity and sedentary lifestyles worldwide. The aim of this study was to compare average levels of the homeostatic indices HOMA and QUICKI in obese children compared to healthy and hypertonic children in order to find convenient markers for insulin sensitivity in clinical pediatric practice.Methods. 49 obese children (11 girls, 38 boys), 42 children healthy (33 boys and 9 girls) and 37 hypertensive children (4 girls, 33 boys) were selected.Results. The average level of HOMA in obese children was 4.58; in healthy children 1.8 and in the group of hypertonic children the level was 2.75. The average level of QUICKI in obese children was 0.22; in healthy children 0.29 and in hypertonic children 0.28.Conclusions. The results demonstrate the possibility of insulin sensitivity assessment using these indices in pediatric practice. QUICKI has a narrower confidence interval and thus a lower variability. QUICKI an HOMA indexes are useful predominantly for epidemiological purposes, mainly for maping the scope of insulinoresistance among children.gest that the prevalence of elevated blood pressure could have increased in children over the last few decades. Obesity itself needs not always mean overweight but an accumulation of fatty tissue. In childhood, it is obvious that the continuous increase in weight is not merely caused by the increase of fat tissue but also by the development of the body frame and the muscle mass. The share of this component differs according to the individual age group and gender.Obesity. One of the most common nutritional disorder worldwide, affecting virtually both developed and developing countries of all socio-economic groups, irrespective of age, sex or ethnicity, clearly associated with the metabolic syndrome, condition with implications for the development of many chronic diseases as obesity and hypertension, type 2 diabetes mellitus, dyslipidemia, obstructive sleep apnoe, and orthopedic problems. In the Czech Republic, childhood obesity is now a serious epidemiological problem: 20% of children aged 6-12 and 11% of children aged 13-17 years are already overweight or obese. These data were provided by the study of the Czech Obesity Association entitled "Life Style and INTRODUCTION

Předloženo v listopadu 2009Obezita je problém, který se netýká pouze dospělé populace, ale stá-le častěji dětské populace. Cílem této práce bylo porovnat u skupiny dětí s obezitou a skupiny atletů pohybovou aktivitu a porovnat délku kojení, BMI (body mass index) rodičů. Při porovnávání hodnot BMI rodičů se oba soubory statisticky významně lišily a to pouze ve skupině otců, ve skupině matek nebyl prokázán signifi kantní rozdíl. Obezita je tedy problémem celé rodiny a jejich životního stylu. Mezi atlety a obézními dětmi jsme nenašli signifi kantní rozdíly v porodní hmotnosti ani v délce kojení. Statisticky významné rozdíly nebyly nalezeny ani v účasti při tělesné výchově nebo v čase, který stráví u televize nebo počítače. Tyto údaje byly získány pomocí dotazníku a domníváme se, že bylo by vhodné tuto informaci objektivizovat např. pomocí CSA akcelerometru. Klíčová slova: obezita v dětském věku, pohybová aktivita, rizikové faktory. ÚVODPohyb patří k základním biologickým projevům lidského života. V dneš-ní době dochází k jeho úbytku, stále častěji se setkáváme s pojmy jako je hypokineze a sedavý životní styl (Stejskal, 2004).

V naší kazuistice poukazujeme na komplikaci léčby amiodaronem-indukovanou tyreotoxikózu 2. typu (AIT), která skončila fatálně. Konkrétně pojednáváme o 79letém pacientovi, který byl léčen amiodaronem pro paroxyzmální fibrilaci. AIT se u něho projevila velmi netypicky, a to změnou psychického stavu a kvalitativní poruchou vědomí s projevy srdečního selhání ústícího do zástavy oběhu. Byla provedena úspěšná kardiopulmonální resuscitace (KPCR) s napojením na umělou plicní ventilaci (UPV). Od začátku jsme podávali agresivní kombinovanou tyreostatickou terapii spolu s kortikoidy. I přes adekvátně vedenou terapii nedošlo ke klinické ani laboratorní remisi a nadále trvaly známky tyreotoxikózy. Proto byla z vitální indikace provedena totální tyreoidektomie (TTE) s tracheostomií (TS). Po dosažení eufunkce hormonální substituce. V dalším průběhu hospitalizace došlo k řadě komplikací. Dominují recidivující nozokomiální pneumonie v rámci UPV. Laboratorně bylo dosaženo eutyreózy, avšak po úspěšném odpojení od ventilátoru a odtlumení zůstává porucha vědomí na úrovni perzistentního vegetativního stavu (PVS). V průběhu dlouhodobé intenzivní péče dochází k postupnému vyčerpání biologických rezerv s rozvojem multiorgánového selhání, které končí po 72denní hospitalizaci smrtí pacienta. Klíčová slova: amiodaron, hypertyreóza, tyreotoxická krize, tyreostatika. Amiodaron: a good servant, but a bad master. Case report of amiodarone induced thyrotoxicosis with fatal outcome The case report showcases a complication of amiodarone treatment-type 2 amiodarone induced thyrotoxicosis (AIT) with a fatal outcome. A 79-year old patient was being treated with the culprit drug for paroxysmal atrial fibrillation. The treatment was complicated by an atypical clinical presentation of AIT with altered mental status, qualitative change of consciousness and heart failure resulting in cardiac arrest. A successful CPR was performed and the patient was put on mechanical ventilation. An aggressive course of thyrostatic treatment along with corticosteroids was started early on. Due to little to no clinical or laboratory response an urgent thyroidectomy with tracheostomy was performed as a last resort. Having at last reached euthyroid state, the thyroid hormone replacement therapy was started. A series of post-operative complications emerged including relapsing ventilator-associated pneumonia. The patient was ultimately weaned off the ventilator support and sedation but deep impairment of consciousness persisted (persistent vegetative state). Subsequent prolonged intensive care led to progressive deterioration of overall condition and multiple organ dysfunction syndrome developed. Death occured after a total of 72 days of hospital stay.