Jubilant prof. Miroslav Penka, CSc.

Jan Kvasnička

Vnitr Lek 2012, 58(7-8):103-104  

Profesor Miroslav Penka - jeden z běžců Maratónu pro hemofilii

J. Blatný

Vnitr Lek 2012, 58(7-8):105-107  

CZEMP - děcko prof. Penky

J. Schwarz

Vnitr Lek 2012, 58(7-8):108-109  

The prophylaxis and treatment of antiphospholipid syndrome - current options, difficulties and future perspectives

A. Buliková, P. Smejkal, J. Kissová, G. Chlupová, M. Matýšková, M. Šlechtová

Vnitr Lek 2012, 58(7-8):110-122  

The antiphospholipid syndrome is the most frequent acquired thrombophilia. However, not only thromboembolic events belong to possible clinical manifestations which are caused by antiphospholid antibodies presence. Patients could also suffer from pregnancy loss and/or wide spectrum of non-thromboembolic complications. The paper summarizes current treatment options and recommendations, their difficulties and brings new visions for the future.

Therapeutic approach to the bleeding in association with "old" and "new" anticoagulants

P. Dulíček

Vnitr Lek 2012, 58(7-8):123-127  

There are a several new anticoagulants emerging in the clinical medicine in the last a few years. Rivaroxaban, an oral direct F Xa inhibitor has been already approved in more than 100 countries worldwide, and Dabigatran etexilate, an oral direct thrombin inhibitor is also routinely used in thromboprophylaxis of venous thromboembolism. These agents possess many of the characteristic of the "ideal" anticoagulant but a lack of specific antidotes may be a potentional disadvantage in the therapy of bleeding complications. We assume, this lack of antidote does not represent a significant problem. In comparison with established anticoagulants (unfractionated...

Diagnosis of heparin-induced thrombocytopenia in the Czech Republic

J. Gumulec

Vnitr Lek 2012, 58(7-8):128-134  

Heparin-induced thrombocytopenia is a prothrombotic adverse effect induced by platelet-activating antibodies against complexes of platelet factor 4 and heparin. Diagnosis rests on a clinical assesment of disease probability and laboratory testing. In this review, I describe some approaches to the evaluation of patients with suspected heparin-induced thrombocytopenia. In conclusion I draw attention to some of the reserves in the diagnostic approaches to this potentially fatal disorder in the Czech Republic.

Advancement in the area of multiple myeloma and development of connected laboratory background

R. Hájek, M. Almáši, L. Říhová, J. Smejkalová, L. Pour, L. Zahradová, Z. Adam

Vnitr Lek 2012, 58(7-8):135-140  

Development in research, diagnostics and treatment of multiple myeloma has been unprecedented in the past 10 years. One of the basic conditions of research is entry processing and sorting of biological material as well as creation of a biobank with archiving of a critical amount of samples for research. This work described the development and functioning of a research laboratory of experimental hematology that needs to answer high demands of quickly developing research of multiple myeloma and other monoclonal gammopathies for entry processing and sorting of material and its archiving for research as well as diagnostics needs.

How to avoid the mistake in diagnosing incipient critical disorder of haemostasis in an out-patient clinic

P. Kessler

Vnitr Lek 2012, 58(7-8):141-145  

Critical disorders of haemostasis occur mostly in hospitalized patients; they are usually associated with a serious illness. However, a patient with an early phase of such disorder can visit the office of the general practitioner, hematologist or internist. Every patient with newly emerging bleeding symptoms should be thoroughly investigated with the aim of early detecting of developing critical disorder of haemostasis. The disseminated intravascular coagulation, microangiopathic hemolytic anemia (thrombotic thrombocytopenic purpura, hemolytic-uremic syndrome, pre-eclampsia, HELLP syndrome and catastrophic antiphospholipid syndrome), acute leukemia...

Frequencies of the new thrombophilic mutations of antithrombin (SERPINC1) (IVS +141G>A), glycoprotein GPVI (Ser219Pro) and cytochrome CYP4V2 (Lys259Gln) in healthy middle-aged people in Central Bohemia

J. Kvasnička, J. Hájková, P. Bobčíková, T. Kvasnička, D. Dušková, Š. Poletínová, V. Kieferová

Vnitr Lek 2012, 58(7-8):146-151  

Objective:The aim of study was to determine frequencies of alleles and genotypes of new thrombophilia polymorhisms associated according to GWAS studies with venous thrombosis in Caucasian healthy people in Central Bohemia. Methods:Genotyping of thrombophilic mutations SERPINC1 IVS +141G>A, GP6 13254T>C and CYP4V2 (Lys259Gln) was performed in 1,527 healthy subjects using a robotic DNA isolation and subsequent PCR amplification with melting curve analysis (LightCycler480 System, Roche). Results:For the reference group was the frequency of risk allele A of SERPINC1 (IVS +141G>A) polymorphism 11.3% and...

Megakaryopoesis and platelet genesis

M. Pecka

Vnitr Lek 2012, 58(7-8):152-154  

Similar to other haematopoietic cells, megakaryocytes originate from haematopoietic stem cells. Proliferation and maturation of the megacaryotic cell line is stimulated by a number of factors. This process is different in progenitor and precursor cells. Towards the end of their development, mature megakaryocytes are transferred and are localized near the bone marrow sinus wall. "Proplatelets" are formed in cytoplasmic extensions of megakaryocytes and are subsequently separated from parental megacaryocyte and transformed into platelets in the circulation.

Acquired haemophilia A

P. Smejkal, A. Buliková, G. Chlupová, J. Zavřelová

Vnitr Lek 2012, 58(7-8):155-162  

Acquired haemophilia A is a rare auto-immune disease caused by an inhibitory antibody to factor VIII. Patients with this disorder are at high risk of severe bleeding until the inhibitor has been eradicated. Management of this disorder consists in rapid accurate diagnosis, control of bleeding and eradication of the inhibitor by immunosuppression. The cessation of bleeding is based mainly on recombinant factor VIIa and activated prothrombin complex concentrate which are approximately equally efficacious. Immunosuppression is still based on steroids alone or with combination with cyclopfosphamide which may result in a higher rate of remission. New drugs...

Temporary diagnostics and treatment of myeloma bone disease in clinical practice

V. Ščudla, Z. Adam

Vnitr Lek 2012, 58(7-8):164-174  

The presented paper demonstrates clinical manifestations of myeloma bone disease and its position within diagnostics, differential diagnostics and stratification of multiple myeloma. Attention is drawn to the role of conventional and modern imaging techniques, especially to whole body magnetic resonance (WB-MR), positron emission tomography/computed tomography, and other radionuclide imaging methods (MIBI scintigraphy of the skeleton). We touch also the role of dual energy X-ray absorptiometry, and the evaluation of biomarkers of bone metabolism in the assessment of the state and evolution of myeloma bone disease. We aim at present therapeutic modalities...

High dose treatments and preparatory regimens prior to haematopoietic stem cell transplantation

M. Tomíška

Vnitr Lek 2012, 58(7-8):175-180  

High-dose chemotherapy can be defined as utilization of cytotoxic drug doses that produce bone marrow ablation. Transfusion of autologous graft serves as rescue from otherwise fatal myelotoxicity. Immune reaction of graft versus tumor that lowers relaps rates of malignant disease becomes an important contribution of allogeneic hematopoietic stem cell transplantation. New reduced intensity conditioning regimens with lower initial cytotoxicity rely on this immune effect with the potencial of additional elimination of remaining cancer cells. Decreased toxicity of these regimens enables treatment of patients with comorbidity and/or in higher age.

Refeeding syndrome in a young patient with the anxiety-depressive disorder

J. Vejmelka, P. Kohout, Z. Beneš, J. Dolina, A. Hep

Vnitr Lek 2012, 58(7-8):181-183  

The aim of this paper is to emphasise the clinical relevance of refeeding syndrome. Consequent to family intervention, a patient (28 years) with prolonged history of reduced food intake and on vegetarian diet suddenly rapidly increased food intake, including animal protein. This combination of hypermetabolic strain, chronic work overload with periods of acute work and physical (sports) overloading of this anxious-depressive patient have led to severe hypophosphataemia with severe adynamia.

K životnímu jubileu prof. MUDr. Miroslava Součka, CSc.

Petr Svačina

Vnitr Lek 2012, 58(7-8):185  

Detecting KRAS and its mutations in biopsy of advanced colorectal carcinoma during colonoscopy

Z. Beneš, J. Abrahámová, M. Matějčková, Z. Antoš, G. Puškárová, P. Kohout, M. Rozmahel, A. Hep, J. Dolina, F. Koukolík

Vnitr Lek 2012, 58(7-8):186-189  

Colorectal carcinoma (CRC) is a very frequent malignant cancer in the Czech Republic. In recent years, significant advances have occurred in its detection and treatment. New medication has been developed that acts upon the EGRF domain expressed on the surface of cancer cells. The most important agents of this targeted treatment are cetuximab and panitumumab. Nevertheless, a known aspect of this treatment is that their efficacy is significantly reduced upon the detection of a KRAS mutation in the cancerous tissue. Usually, the evaluation of KRAS is performed on malignant tissue within the resected material. There are, nevertheless, situations where...

Aortic stiffness increases central aortic pressure in patients with hypertension

J. Bulas, M. Potočárová, J. Murín, A. Šimková, I. Janiga

Vnitr Lek 2012, 58(7-8):190-194  

Introduction:Increased aortic stiffness belongs into the category of preclinical cardiovascular diseases. It is defined by pathologically increased velocity of carotido-femoral pulse wave velocity (PWV_Ao). In the group of treated hypertensive patients we measured the aortic pulse wave velocity and augmentation indices with the aim to define some parameters of central hemodynamics and to search for a relationship among them and the central aortic blood pressure. Patient and methods:We examined a group of 68 nonselected patient with arterial hypertension treated by combination therapy (mean of 3.4 drugs per patient)....

How to define people at a high risk of pancreatic cancer

P. Dítě, E. Geryk, M. Jelšíková, I. Novotný, J. Trna, A. Martínek, H. Nechutová

Vnitr Lek 2012, 58(7-8):195-198  

Pancreatic cancer is a disease with exceptionally poor prognosis. This is mainly due to late diagnosis; surgical resection, as the only currently available curative method, cannot be performed if diagnosed late. It is known that 5-year survival does not exceed 5.0% and, similarly, the number of new diagnoses worldwide per calendar year equals the number of deaths per calendar year, i.e. 300,000 people. So far, no effective screening for pancreatic cancer is available in asymptomatic people. Therefore, identification of risk factors with respect to possible induction of cancerous growth, and their bearers, provides some hope. These factors include hereditary...

The size of LDL-lipoprotein particles among patient after acute stroke

A. Dukát, S. Oravec, P. Gavorník, M. Wawruch, P. Sabaka, D. Baláž, L. Mistríková

Vnitr Lek 2012, 58(7-8):199-201  

Introduction:Acute stroke represents the severe state both for the patient as well as for the physician. Poor outcome with residual handicap brings the problems both for the family and for the society and the therapy and follow-up is cost expensive. Patients and methods:50 consecutive patients with acute stroke were admitted to the acute care unit at the internal medicine department. During acute care blood sample was examined with Lipoprint method to evaluate their lipid parameters. Size of LDL particles spectrum (LDL 1-7), before starting the drug treatment were measured. Results:Atherogenic profile was detected...

Triple combination treatment of chronic hepatitis C

P. Husa

Vnitr Lek 2012, 58(7-8):202-204  

The 2011 has brought about a significant change in the treatment of chronic hepatitis C virus (HCV) infection. This change has been enabled by commercial availability of new antiviral agents for treatment of chronic HCV infection - telaprevir and boceprevir - in combination with pegylated interferon (PEG-IFN) α and ribavirin (RBV). The triple combination is significantly more effective than the PEG-IFN and RBV combination alone in antiviral treatment-naive patients as well as in patients in whom the traditional PEG-IFN and RBV combination did not provide permanent HCV infection elimination. In treatment-naive patients, the triple combination...

Chronic inflammation and the metabolic syndrome

Š. Svačina

Vnitr Lek 2012, 58(7-8):205-207  

Metabolic syndrome is a disease associated with systemic inflammation. At present, metabolic syndrome is understood chiefly as an abdominal obesity with complications. Inflammatory signs then have the strongest association with the wasteline. Nevertheless, metabolic syndrome is most certainly also induced by an inflammation of a different origin. Metabolic syndrome is linked to typically inflammatory diseases such as paradontosis, rheumatoid diseases, chronic obstructive pulmonary disease and, to a large extent, psoriasis. The association is thus certainly reciprocal; metabolic syndrome causes inflammation and inflammatory diseases cause metabolic...

An anaesthesiologist's perspective on requirements for pre-surgery examinations

M. Svítek, J. Bruthans, R. Češka

Vnitr Lek 2012, 58(7-8):208-213  

A preoperative check-up remains still an issue. The preoperative check-up should thoroughly evaluate an actual state of patient's health, an anticipated perioperative course should be taken into account. An internist should closely collaborate not only with a surgeon, but with an anaesthesiologist as well. As guidelines cover this topic only sparsely, different approach might result either in excess or in insufficient examinations. Therefore an anaesthesia department should have its own guidelines available that would cover required preoperative check-ups considering expected operation. These guidelines should be then sent to the internist. Preoperative...

Fixed combinations in the treatment of hypertension

J. Špinar, J. Vítovec, L. Špinarová, M. Bendová

Vnitr Lek 2012, 58(7-8):215-222  

We present an overview of current opinions on combination therapy and the role of fixed combinations in the treatment of hypertension as per the ESH/ESC and CSH guidelines of 2007 and the revised European guidelines of 2009. A renin-angiotensin system blocker (ACE-I or sartan) combined with a calcium channel blocker is the most frequently recommended combination, followed by renin-angiotensin system blocker and a diuretic and a calcium channel blocker and a diuretic. A fixed combination of a calcium channel blocker and a beta-blocker has now been also recommended. Higher patient compliance and thus better control of hypertension is the main advantage...

Farmacotherapy of hypertension after heart transplantation

L. Špinarová, P. Hude, J. Krejčí, H. Poloczková, J. Godava, J. Vítovec

Vnitr Lek 2012, 58(7-8):224-227  

Heart transplantation is now used for the treatment of severe heart failure. In a long-term patient follow-up, hypertension has been identified as a complication. Incidence of hypertension in patients treated with cyclosporine and prednisone is between 70-90%. Besides the traditional mechanisms (renin-angiotensin system, fluid volume and peripheral resistance), aetiology of hypertension includes negative effect of cardiac denervation, cyclosporine immunosuppression, administration of corticosteroids and nephropathy. There is no night drop in the blood pressure and heart rate. Treatment aims to maintain cyclosporine level as low as possible and, if...

Effects of selective heart rate reduction with ivabradine on left ventricular remodelling and health related quality of life: results from the SHIFT substudies

J. Vítovec, L. Špinarová, J. Špinar

Vnitr Lek 2012, 58(7-8):228-233  

The SHIFT study showed a positive effect of ivabradine in patients with chronic heart failure, sinus rhythm and heart rate at rest above 70 beats per minute. The aim of the first sub-study was to ascertain the effect of ivabradine on changes to the left ventricle function using echocardiography; ivabradine significantly increased ejection fraction of the left ventricle and reduced terminal left ventricular end-systolic and end-diastolic volumes. The second sub-study explored changes to the quality of life in patients treated with ivabradine or placebo. This study also showed statistically significantly improved quality of life after treatment with...

Významné životné jubileum profesora MUDr. Miroslava Mydlíka, DrSc.

Katarína Derzsiová, Viera Spustová

Vnitr Lek 2012, 58(7-8):8-11  

Changes to calcium-phosphate metabolism associated with chronic nephropathies

J. Blahoš, I. Sotorník

Vnitr Lek 2012, 58(7-8):12-18  

The paper discusses bone mineral and bone disorders associated with chronic nephropathies that are a logical consequence of reduced renal function. These are principally driven by changes in parathormone production and vitamin D synthesis. Bones are usually affected by renal osteopathy - osteodystrophy with abnormities of bone turnover, mineralization and volume, and with growth retardation in children. Extra-skeletal calcifications may occur, of which vascular wall localization is the most serious. A collection of pathologies develops, now termed chronic kidney disease - mineral and bone disorder (CKD-MBD).

The Restless Legs Syndrome in patients receiving hemodialysis treatment

J. Boldizsár, A. Gyuríková, M. Drančíková, J. Jantošík, J. Rosenberger

Vnitr Lek 2012, 58(7-8):19-22  

The authors of this work were concerned about the occurrence of the Restless Legs Syndrome in patients receiving hemodialysis treatment. The study was conducted based on a questionnaire. In accordance with data from literary sources, a three times higher occurrence of the Restless Legs Syndrome was found compared to the normal population (not receiving hemodialysis treatment). On the other hand, the four times higher presence of the Restless Legs Syndrome among men does not match data from literary sources. Average age was found to be higher among women. In the sample of 60 patients under hemodialysis treatment no statistically significant difference...

Aldosterone antagonists in chronic heart failure treatment

P. Gavorník, Ľ. Gašpar, A. Kunová, I. Gašparová, J. Hodulíková

Vnitr Lek 2012, 58(7-8):23-28  

The article provides a review of actual information about the place of aldosterone antagonists in the treatment of chronic heart failure. Arterial hypertension and coronary artery disease are among risk factors/diseases of heart failure. Aldosterone antagonists play an important role in the treatment of NYHA class III and IV chronic heart failure, as shown by the RALES (Randomized Aldactone Evaluation Study) trial in the case of spironolactone. Recent trials have shown spironolactone to significantly improve left ventricular remodeling and left ventricular diastolic function in NYHA class I and II chronic heart failure. Aldosterone antagonists are...

Management of stable angina pectoris and of other chronic cardiovascular arterial diseases

P. Gavorník, A. Dukát, Ľ. Gašpar

Vnitr Lek 2012, 58(7-8):29-36  

The aim of this document of the Angiologists' Section of the Slovak Medical Chamber (AS SMC) is to address a member studies on stable angina pectoris published in the last 5 years in order to assess their contribution to our expanding knowledge of chronic cardiovascular arterial diseases. The prevalence of angina pectoris, according to the European Society of Cardiology (ESC), is from 2-5% (men, 45-54 years-old) to 10-20% (men, 65-74 years-old) and from 0,1-1% (women, 45-54 years-old) to 10-15% (women, 65-74 years-old). During the last decade there has been a shift of these patients to a higher age group. As a result of the increased age of Europeans...

Antiatherogenic effect of HDL subpopulations in patients with newly diagnosed peripheral artery disease

M. Kaško, P. Gavorník, K. Gruber, S. Oravec, A. Dukát

Vnitr Lek 2012, 58(7-8):37-41  

Objective:To assess the relationship of high-density lipoprotein subfractions to newly diagnosed lower extremity artery disease (LEAD) in individuals without diabetes mellitus (DM). Background:The high-density lipoprotein (HDL) family forms a protective part of plasma lipoproteins. It consists of large HDL, intermediate HDL, and small HDL subclasses. The large HDL and intermediate HDL subclasses are widely considered as anti-atherogenic parts of the HDL family. The atherogenicity of the small HDL subclass is currently the subject of wide interest. The association of HDL cholesterol (HDL-C) spectrum abnormality with lower extremity...

End stage of chronic kidney disease and metabolic acidosis

J. Klaboch, S. Opatrná, K. Matoušovic, O. Schück

Vnitr Lek 2012, 58(7-8):42-47  

Renal function disorder is inevitably associated with metabolic acidosis. An adult produces approximately 1 mmol of acids/kg of body weight every day (3 mmol/kg in children), derived from metabolization of proteins from food. Development of metabolic acidosis in patients with kidney disease is based on accumulation of acids and insufficient production of bicarbonates; alkaline loss represents a marginal issue here limited to patients with type II renal tubular acidosis only. The prevalence of this disorder increases with declining glomerular filtration (GFR) from 2% in patients with GFR 1.0-1.5 ml/s/1.73 m² to 39% in patients with GFR <...

Chronic kidney disease and cellular calcium homeostasis

I. Lajdová, A. Okša, A. Spustová, R. Dzúrik

Vnitr Lek 2012, 58(7-8):48-53  

Free intracellular calcium represents a critical signaling mediator in a number of biological systems. Calcium cations (Ca²⁺) are an important ubiquitous messenger, controlling a broad range of cellular processes. Free cytosolic calcium concentration ([Ca²⁺]_i) is controlled by mechanisms that regulate Ca²⁺ entry from the extracellular space and Ca²⁺ release from intracellular stores, and by the activity of ATP-dependent Ca²⁺ pumps and antiporters that move Ca²⁺ back into stores or out of cells. Chronic kidney disease is associated with a significant elevation in [Ca²⁺]_i...

Ischemic and non-ischemic causes of ST-segment elevation in patients with chest pain: a systematic review of the literature

M. Levine, Y. Kanei, M. Rachko, P. Schweitzer

Vnitr Lek 2012, 58(7-8):54-59  

The electrocardiogram remains the most crucial tool in the diagnosis on ST-segment elevation myocardial infarction. It is rapidly available, easily reproducible, and highly cost effective. To the trained interpreter it is also highly sensitive and specific. Early diagnosis and subsequent treatment of ST-segment myocardial infarction relies on rapid performance and correct interpretation of the electrocardiogram. In addition to acute myocardial infarction, there are multiple other causes of ST-segment elevation in the patient with active chest pain. The clinician must be aware of these differential diagnoses, and be able to quickly confirm or exclude...

Sodium concentration in dialysate - an important but neglected parameter in haemodialysis of patients with chronic renal failure

F. Lopot, F. Švára, V. Polakovič

Vnitr Lek 2012, 58(7-8):60-65  

Sodium ion with its accompanying anions plays the major role in osmolality of body fluids changes of which determine overall fluid balance in health given on one side by water intake and on the other side by its excretion via kidneys. In renal failure, control of the excess fluid removal is taken over by dialysis but control of water intake via thirst induced by changes in osmolality remains functional. Sodium balance is thus of utmost importance. It consists of two components - dietary salt intake and sodium balance during haemodialysis (HD). Choice of sodium concentration in dialysis solution (CD_Na) and its difference from plasma sodium...

To salt or not to salt in kidney diseases? Not more than quantum satis!

K. Matoušovic, Ľ. Podracká

Vnitr Lek 2012, 58(7-8):66-70  

The salt intake in former Czechoslovakia is twice as high as recommended 5 g/24 hours, which corresponds to 85 mmol//24 hours of sodium in the urine. In the population, the systemic blood pressure level correlates with a urinary excretion of sodium/24 hours. On the other hand, limited salt intake decreases blood pressure in salt-sensitive hypertensive patients. Albuminuria also positively correlates with a salt intake in the population. In patients with renal disease, a diet with low salt content suppresses proteinuria, and, in contrast, proteinuria is elevated with increased salt intake. The positive influence of the decreased salt intake on the progression...

Oxidative stress and antioxidation systems in haemodialyzed patients

O. Rácz, M. Mydlík, A. Chmelárová, K. Derzsiová, D. Maceková, F. Ništiar, E. Lovásová, B. Fodor

Vnitr Lek 2012, 58(7-8):71-74  

The authors present a critical analysis of current knowledge on oxidative stress and on the activity of antioxidative systems in patients with chronic kidney disease with a focus on haemodialysed patients. Even though oxidative stress in these patients is well documented, a number of questions remain unanswered. The overview describes pathobiochemistry of oxidative stress during haemodialysis, analysis of current knowledge on lipid peroxidation and antioxidant enzyme activity in the red blood cells in patients with this disease. Finally, the authors evaluate opinions on justifiability of exogenous supplementation of vitamins with antioxidant properties...

Myocardial infarction the young - our results and experience

I. Riečanský, J. Pacák, J. Péč, J. Melicherčík

Vnitr Lek 2012, 58(7-8):75-82  

Aims:Coronary artery disease in young adults is important task of contemporary cardiology. Presented our results experience and opinion were obtained by our long term investigation of myocardial infarction in young patients under 40 years. Methods:Two sets of patients were examined - 78 patients (74 men, 4 women) hospitalised in pretrombolytic era in prospective 8 years follow up (1984-1992) and 39 patients (35 men, 4 women) admitted during period 2000-2010 analysed retrospective. Results:Myocardial infarction in young age belongs roughly to two different groups with considerable overlap in pathogenetic mechanisms:...

An association between microalbuminuria and obesity in healthy adolescents - preliminary results from the "Respect for Health" study

K. Šebeková, R. Kollárová, A. Stecová, V. Potičný, Z. Gerová

Vnitr Lek 2012, 58(7-8):83-91  

Background:Microalbuminuria is a marker of present/future cardiovascular and/or renal disease. The roots of these diseases extend back into childhood. Data on renal excretion of albumin (albumin/creatinine ratio - ACR) and the prevalence of microalbuminuria in apparently healthy adolescents are scares. Methods and results:We determined ACR and the prevalence of microalbuminuria in 15-to-19-years-old adolescents (n = 846, 482 boys), in association with markers of obesity. ACR (0.43; 0.29-0.67 mg albumin/mmol creatinine vs 0.35; 0.25-0.51 mg albumin/mmol creatinine, p < 0.001), and the prevalence of microalbuminuria (3.6...

Contrast nephropathy and prevention

V. Teplan

Vnitr Lek 2012, 58(7-8):93-96  

Contrast-induced nephropathy (CIN) is a serious complication of radio-contrast vascular examination, mainly in high-risk patients with decreased renal function. In prevention, we have to know risk factors strongly influencing follow-up. All potential nephrotoxic drugs should be excluded. We recommend adequate intravenous hydration, supplemented individually with bicarbonate and N-acetylcystein. Studies designed to explore options in CIN prevention included trimetazidine (TMZ) belonging to cytoprotective antiischemic agents used in the treatment of angina pectoris. Trimetazidine affects reperfusion at the cellular and mitochondrial levels, and has antioxidant...

Pharmacogenetic aspects of treatment with oral antidiabetics

I. Tkáč

Vnitr Lek 2012, 58(7-8):97-100  

Patients with type 2 diabetes present with high variability of therapeutic responses to treatment with oral antidiabetics. This variability stems from psychological and social factors, such as treatment adherence, access to health care and prescribing habits of the physicians, as well as from biological factors. Biological factors are non-genetic and genetic. Non-genetic factors include disease duration (reflects residual function of β cells), body weight, kidney function, liver function etc. Among genetic factors, genes associated with pharmacokinetics as well as pharmacodynamics of oral antidiabetic agents have been studied. Cytochrom P450 2C9...