Hlavní téma: Pneumologie up-to-date

Vladimír Koblížek

Vnitr Lek 2025, 71(4):207-212  

Up-to-date therapy of interstitial lung processes

Martina Šterclová

Vnitr Lek 2025, 71(4):213-217 | DOI: 10.36290/vnl.2025.039  

In recent years, attention has been paid to patients with connective tissue diseases and interstitial lung disease (ILD). This is reflected in the number of recently published guidelines dealing with this issue. Most of them evaluate the effect of already known molecules on the management of ILDs. During 2024, no clinical study was published that would enrich the portfolio of treatment options with a new molecule. Guidelines for the management and treatment of pulmonary alveolar proteinosis were recently published. It turns out that in patients with idiopathic pulmonary fibrosis who suffer acute exacerbation, treatment with high doses of corticosteroids...

Current biological therapies for bronchial asthma

Martina Kulířová, Vratislav Sedlák

Vnitr Lek 2025, 71(4):218-223 | DOI: 10.36290/vnl.2025.040  

The prevalence of bronchial asthma is increasing and severe asthma, which is not controlled even with optimal therapy with a high dose of inhaled corticosteroid in combination with a long-acting β2-mimetic, affects up to 10 % of asthmatics. Severe asthma is associated with a higher risk of fixed bronchial obstruction, acute exacerbations, impaired quality of life and financial burden on the healthcare system. Biological treatment of asthma should be considered in all patients who, despite optimal treatment of asthma and its comorbidities, experience acute exacerbations or use chronic systemic corticotherapy due to asthma. Currently, we have five...

Overview of lung cancer treatment according to ESMO recommendations

Martin Svatoň

Vnitr Lek 2025, 71(4):224-227 | DOI: 10.36290/vnl.2025.041  

Lung cancer continues to rank among the top malignant neoplasms in the Czech Republic in terms of incidence and mortality. The correct decision about treatment depends on high-quality staging, biopsy examination including predictive markers, the patient's overall condition and comorbidities, and last but not least, the patient's wishes. Given the evolving treatment options, decision-making is key in an experienced multidisciplinary team (MDT), where the treatment schemes listed in the guidelines are a valuable guide, but not always dogma. In small cell lung cancer (SCLC), surgical resection plus chemotherapy may be considered in early stages. In locally...

CFTR Modulator Therapy of cystic fibrosis

Libor Fila

Vnitr Lek 2025, 71(4):228-232 | DOI: 10.36290/vnl.2025.042  

Cystic fibrosis (CF) is a hereditary disease caused by pathogenic variants of the CFTR gene. It is mainly manifested by chronic sinopulmonary disease, digestive tract involvement with nutritional status disorders, high sweat chloride concentration and obstructive azoospermia. In addition to traditional symptomatic treatment, modulator therapy has become available in recent years, which targets the missing or dysfunctional CFTR protein. For carriers of at least one F508del mutation, treatment with a combination of elexacaftor, tezacaftor and ivacaftor is indicated; among other mutations, carriers of so-called gating mutations (e.g. G551D) are...

Alpha-1 Antitrypsin Deficiency - Characteristics, Diagnosis, Monitoring and Therapy of Patients in the Czech Republic

Libor Nevoránek, Marek Kvarda, Matyáš Wanke, Jiří Ruta, Vladimír Koblížek

Vnitr Lek 2025, 71(4):E1-E7 | DOI: 10.36290/vnl.2025.051  

Alpha-1 antitrypsin deficiency (AATD) is one of the most common inherited genetic disorders in adults worldwide, affecting not only lung function but also liver tissue and, rarely, the skin. It is still a significantly underdiagnosed diagnosis (1, 2). First described more than 60 years ago by scientists at Lund University in Sweden, it is caused by a defect in the serine protease inhibitor group A1 gene (SERPINA1, chromosome 14q32.13, wild-type M), which codes for the production of alpha-1 antitrypsin (AAT), the major antiprotease in the lungs (3). In AATD, less AAT is produced, insufficient AAT is produced, or no AAT is produced. Inadequate/faulty...

Gliflozins - the nephrologist's point of view

Petr Táborský

Vnitr Lek 2025, 71(4):235-240 | DOI: 10.36290/vnl.2025.043  

Gliflozins are a group of agents that were originally marketed as antidiabetic drugs, but later several studies demonstrated their beneficial effect in heart failure and chronic kidney disease. Their introduction into practice has allowed early treatment of these diseases and a reduction in their late complications. In nephrology they are applied as nephroprotective agents, diuretics and treatment of cardio-renal syndrome. Nephroprotection means not only delaying end-stage renal failure but also reducing the incidence of cardiovascular complications associated with renal dysfunction. The use of gliflozins as a diuretic allows for a reduction in the...

Finerenone in internal medicine and cardiology practice

Markéta Ječmenová

Vnitr Lek 2025, 71(4):241-248 | DOI: 10.36290/vnl.2025.044  

Finerenone is a highly selective, non-steroidal mineralocorticoid receptor antagonist with high binding affinity (higher than spironolactone and eplerenone). In contrast to the steroidal mineralocorticoid receptor antagonists, finerenone proved cardiovascular and renal benefit. Finerenone reduces albuminuria, which is a sensitive marker of chronic kidney disease and cardiovascular risk. It is an earlier marker than decreased glomerular filtration rate (GFR). Albuminuria is a marker of increased risk of progression of heart failure and cardiovascular death. Currently, finerenone is indicated to adult patients with type 2 diabetes mellitus with chronic...

Antibiograms in clinical practice

Milan Kolář, Miroslava Htoutou Sedláková, Kateřina Bogdanová

Vnitr Lek 2025, 71(4):E14-E21 | DOI: 10.36290/vnl.2025.049  

The antibiogram is a fundamental diagnostic instrument for the appropriate selection and optimization of antimicrobial therapy in clinical practice. It is an essential component of antibiotic stewardship, which, through collaboration between clinical microbiologists and treating physicians, enables optimal treatment outcomes in bacterial infections, minimization of adverse effects, prevention of antibiotic resistance development, and cost-effective treatment. This review article summarizes various antibiogram methodologies and their determination procedures, with particular emphasis on the interpretation and practical implementation of antibiograms...

Kidney transplantation outcomes of racial minority groups in a Central European setting: a retrospective cohort study

Zuzana Pichová, Ivan Zahrádka, István Módos, Filip Tichánek, Věra Kočová, Ondřej Viklický

Vnitr Lek 2025, 71(4):E8-E13 | DOI: 10.36290/vnl.2025.048  

Background and Aims: It has been previously reported that Caucasian population has different kidney transplantation outcomes compared to other racial groups. Data from the Czech Republic are lacking. Methods: In this retrospective cohort study, we analysed 2315 kidney transplant recipients between years 2014-2024 and identified 24 ethnic minority patients (Asians n=20, African Europeans n=4). A control group consisting of Caucasian population was established by propensity score matching in a 3:1 ratio. The primary endpoint was a composite of poor graft function, graft failure, rejection and all-cause mortality at 1- and 5-years post-transplant. Secondary...

Sweet desire for the white coat and the sweetness of the blood of medical students - case report

Natália Michalcová, Petra Toušková, Ema Povolná, Julie Suchá, Juraj Michalec, Jana Urbanová, Svatava Krejčová, Jan Brož

Vnitr Lek 2025, 71(4):256-259 | DOI: 10.36290/vnl.2025.046  

Stress is often described as a risk factor for developing various diseases. However, a relatively less explored area is the effect of stress on glucose levels, and thus potentially on the risk of developing type 2 diabetes mellitus, in generally healthy young individuals who are exposed to stress regularly. This case report describes the glycaemic trends over 14 days in a 23-year-old medical student while preparing for an exam and the dermatology exam itself. Values measured by the FreeStyle Libre 2 device were within the physiological range most of the time, with expected increases after meals and physical activity. Otherwise, glycaemia had a relatively...

Cholestasis and Carcinoma of the Ureter: Stauffer Syndrome?

Štefan Sotak

Vnitr Lek 2025, 71(4):E22-E27 | DOI: 10.36290/vnl.2025.050  

Stauffer syndrome is a rare paraneoplastic syndrome classically associated with clear cell renal carcinoma, rarely with other malignancies. It is a disease of unclear pathophysiology characterized by reversible anicteric, rarely icteric, elevation of liver enzymes, sedimentation, thrombocytosis, prolongation of activated partial thromboplastin time and hepatosplenomegaly in the absence of hepatobiliary obstruction. Therefore, it is important to consider Stauffer syndrome in the differential diagnosis for unexplained cholestasis in the absence of obstruction (e.g. metastatic) in the liver. This may allow early recognition and treatment of occult malignancy....

Advances in the treatment of heat failure

Filip Málek

Vnitr Lek 2025, 71(4):261-264 | DOI: 10.36290/vnl.2025.047  

Advances in pharmacotherapy have brought new possibilities in the treatment of heart failure. Therapy of heart failure with reduced ejection fraction has four basic pillars - fundamental drugs. Update of heart failure guidelines extended new options in the treatment of heart failure with preserved and mildly reduced ejection fraction. In additon to sodium glucose co-transporter 2 inhibitors, it is a hope for patients with heart failure and ejection fraction over 40 % selective non-steroideal mineralocorticoid receptro antagonist - finerenon.

Atherosclerosis progression under the influence of subclinical inflammation

Eva Tůmová

Vnitr Lek 2025, 71(4):249-254 | DOI: 10.36290/vnl.2025.045  

Long-term subclinical inflammation is one of the factors that influence the progression of atherosclerosis and lead to the destabilization of atherosclerotic plaques with increased risk of complications such as acute coronary syndrome. Control of the pro-inflammatory state brings similar benefits as pharmacological management of traditional risk factors of atherosclerosis resulting in lower risk of cardiovascular events. Decreased inflammatory state can be monitored, for example, by the concentration of highly sensitive C-reactive protein. The possibilities of targeted influence of subclinical inflammation are currently limited, but it is possible...

Zemřela prof. MUDr. Lenka Špinarová, Ph.D., FESC

prof. MUDr. Jiří Vítovec, CSc., prof. MUDr. Jan Krejčí, Ph.D.

Vnitr Lek 2025, 71(4):265-266