140. internistický den - XXVII. Vanýskův den - program

Vnitr Lek 2017, 63(7-8):462  

Viral hepatitis C and organ transplantation

Libuše Husová, Vladimír Mejzlík

Vnitr Lek 2017, 63(7-8):531-534 | DOI: 10.36290/vnl.2017.108  

At the Centre for Cardiovascular and Transplantation Surgery, Brno (CKTCH), a total of 638 liver transplantations were performed from the beginning of the transplantation programme on 2/2 1983 to 1/1 2017. Of the overall number of 638 transplantations indicated based on cirrhosis with chronic hepatitis C (HCV), 68 patients (11 %) underwent liver transplantation. Patients with HCV diagnosis were treated both while on the waiting list and after liver transplantation (LT). There was interferon as well as interferon-free therapy used during the treatment. 15 patients received interferon therapy after LT with only 2 of them achieving a sustained virological...

History and presence of hepatitis B and C therapy

Petr Husa sr

Vnitr Lek 2017, 63(7-8):465-470 | DOI: 10.36290/vnl.2017.097  

Infection with hepatitis B virus (HBV) and hepatitis C virus (HCV) are the world's major causes of chronic liver disease. Care of patients infected with HBV and HCV and/or over the last 20 years has significantly improved thanks to the better understanding of the pathophysiology of disease, improvement of diagnostic, therapeutic and preventive options. The goal of treatment of chronic hepatitis B is to extend the length of life and improve its quality through the barriers of the progression of chronic hepatitis to cirrhosis, decompensation cirrhosis and hepatocellular carcinoma (HCC). Chronic HBV infection can by currently treated either with tenofovir...

PCR diagnosis of infectious diseases

Tomáš Freiberger

Vnitr Lek 2017, 63(7-8):472-474 | DOI: 10.36290/vnl.2017.098  

The practices based on microbe cultivation are the corner stone of laboratory diagnostics of infectious diseases etiology. However, cultivation-independent molecular methods for microorganism detection are increasingly being used in a routine clinical setting as an important complement to the conventional procedures and, in some cases, they have already become the golden diagnostic standard. The PCR-based methods are used the most frequently.

The current problems related to nosocomial infections and antibiotic resistance today

Renata Tejkalová

Vnitr Lek 2017, 63(7-8):476-480 | DOI: 10.36290/vnl.2017.099  

Nosocomial, also known as hospital acquired infections, are today considered to be an important indicator of the quality of health care in all health establishments. They involve an undesirable complication of the provided health care with a number of negative consequences, such as increased morbidity and mortality, longer time of hospitalization and higher costs. Their incidence at present is also related, among other things, to the broadening, sometimes invasive technical possibilities of diagnosing and therapy. Another issue in Czech hospitals consists in the growing resistance of some bacteria to antibiotics. In practice this means considerably...

Development of views on pathophysiology of sepsis

Jiří Beneš

Vnitr Lek 2017, 63(7-8):481-487 | DOI: 10.36290/vnl.2017.100  

Sepsis was understood as a disease caused by an invasive bacterial infection associated with deluging of organism with bacterial toxins (blood poisoning). Schottmüller's definition emphasized the existence of a focus as the source of invading bacteria. Further research led to the discovery of the cytokine cascade and to the recognition that sepsis is induced by our own endogenous mediators. The dysfunction or failure of various organs in sepsis can be explained both by hemodynamic disorders which originate in the altered microcapillars but also by a complex transformation of metabolism. To explain metabolic changes, the theory of tissue hibernation...

Cytomegalovirus and polyomavirus infection after renal transplantation

Jana Machová, Tomáš Reischig

Vnitr Lek 2017, 63(7-8):488-497 | DOI: 10.36290/vnl.2017.101  

Viral infections are among the most common infectious complications affecting transplant recipients. Due to immunosuppressive therapy predominantly affecting cellular immunity and thus successfully reducing the incidence of acute rejection, there is a higher incidence of viral infections. Herpesviruses and polyomaviruses are ubiquitous pathogens which have the ability to persist in a state of latent infection. In addition to post-transplant reactivation, donor-induced primoinfection can also occur, leading to increased morbidity and contributing to decreased survival of patients. Moreover, there are long-term indirect effects, resulting in an impaired...

Viral hepatitis A - possible diagnostic and therapeutic problems

Petr Husa jr, Petr Husa sr

Vnitr Lek 2017, 63(7-8):498-501 | DOI: 10.36290/vnl.2017.102  

Viral hepatitis A (VHA) is the disease which has an ancient history. Reports of epidemic jaundice were described by Hippocrates in Greece during the 5th century B.C. Incidence of VHA in developed countries is dropping in last decades. What was once common disease is now very rare, usually emerging in local epidemies. With decreasing incidence of hepatitis A clinicians losing practical experiences with disease. Authors present possible diagnostic and therapeutic problems based on their experience with large epidemic of hepatitis A, which occurred in 2016-2017 in Brno area.

HIV infection - a new disease of internal medicine

Svatava Snopková

Vnitr Lek 2017, 63(7-8):502-506 | DOI: 10.36290/vnl.2017.103  

Modern antiretroviral treatment belongs to the greatest success of current medicine. HIV infection has gone from a death sentence to a manageable chronic disease which develops several decades. Thanks to treatment advances, people with HIV can and do live long and full lives. In the last two decades, the incidence AIDS defining illnesses have been dramatically reduced especially opportunistic infections and malignancies, whereas the role of non-infection comorbidities has risen than age-matched HIV uninfected adults. These comorbidities include cardiovascular diseases, venous and arterial thrombosis, metabolic disorders, chronic liver and renal diseases,...

Myocarditis and inflammatory cardiomyopathy

Dalibor Mlejnek, Jan Krejčí

Vnitr Lek 2017, 63(7-8):507-512 | DOI: 10.36290/vnl.2017.104  

Myocarditis is an inflammation of the heart muscle. The most common cause of myocarditis is viral infection in industrialized countries. Myocarditis with left ventricular dysfunction is called inflammatory cardiomyopathy and is the major cause of dilated cardiomyopathy. The clinical picture is very diverse, most often the patient present with signs of heart failure, arrhythmic symptoms and chest pains. Despite significant advances in non-invasive diagnostics, particularly magnetic resonance imaging, endomyocardial biopsy remains the gold standard of myocarditis diagnosis. Myocarditis and inflammatory cardiomyopathy therapy is primarily based on the...

Community pneumonia - fundamentals of diagnosing and treatment

Vítězslav Kolek

Vnitr Lek 2017, 63(7-8):514-517 | DOI: 10.36290/vnl.2017.105  

Pneumonia is the most serious respiratory disease which causes more than 3 000 deaths per year in the Czech Republic. Community-acquired pneumonia is contracted in the ordinary life environment outside of hospitals, its development is caused by known infectious agents which mostly exhibit satisfactory sensitivity to antibiotics. Diagnosing, prevention and treatment of the disease are described including considerations of individual evaluation of the risk of complications and possible death. The strategy of administering antibiotics is discussed.

Nosocomial pneumonia

Jana Skřičková

Vnitr Lek 2017, 63(7-8):518-526 | DOI: 10.36290/vnl.2017.106  

Nosocomial pneumonia (hospital-acquired pneumonia - HAP) is the form of pneumonia the symptoms of which present after more than 2 days (> 48 hours) of admission to hospital or as late as 14 days of discharge from hospital. The HAP pneumonias represent 13-18 % of all nosocomial infections. Incidence of HAP is the most frequent in mechanically ventilated patients. The type and representation of HAP agents primarily depends on the length of a patient's stay in hospital and on their condition and character of treatment. Diagnosing of pneumonia is based on anamnesis, physical and X-ray findings, results of examination of microbiological samples from...

Infectious complications related to liver transplants

Vladimír Mejzlík, Libuše Husová, Milan Kuman, Soňa Štěpánková, Jiří Ondrášek, Petr Němec

Vnitr Lek 2017, 63(7-8):527-530 | DOI: 10.36290/vnl.2017.107  

Infection is a feared complication in the process of transplantation. The study discusses sources of infection, screening of infection and risk factors for infection, time occurrence of individual infections during the peritransplantation and posttransplantation course. It describes the most frequent forms of bacterial, viral and mycotic infections. It specifies efficient prophylactic measures that considerably reduce the risk of infection following liver transplantation.

Heart transplantation and infection

Eva Ozábalová, Jan Krejčí, Petr Hude, Julius Godava, Tomáš Honek, Lenka Špinarová, Petr Pavlík, Helena Bedáňová, Petr Němec

Vnitr Lek 2017, 63(7-8):535-539 | DOI: 10.36290/vnl.2017.109  

Heart transplantation (HTx) is a method of treatment for patients with end-stage heart failure with severe symptoms despite complex therapy. Post-transplant difficulties include acute rejection and infectious complications, which are the most common reason of morbidity and mortality in the first year after heart transplant. It requires the patient to remain on immunosuppressive medication to avoid the possibility of graft rejection. Therefore the range of infection is much larger. The diagnosis and treatment of viral, bacterial and fungal infections is often difficult.