Ve spojení a jednotě je síla

prof. MUDr. Richard Češka, CSc.

Vnitr Lek 2020, 66(1)  

Editorial – Hlavní téma: Metabolický syndrom

Hana Rosolová

Vnitr Lek 2020, 66(1):9  

Treatment of arterial hypertension in metabolic syndrome

Barbora Nussbaumerová

Vnitr Lek 2020, 66(1):10-14 | DOI: 10.36290/vnl.2020.002  

High-normal blood pressure/arterial hypertension is one of the diagnostic criteria of metabolic syndrome. Metabolic syndrome is connected with an increased cardiometabolic risk. The cornerstone of treatment is lifestyle intervention. Pharmacotherapy is iniciated with ACE inhibitors/angiotensin receptor blockers and calcium chanel blockers or diuretic according to current guidelines.

Atherogenic dyslipidemia typical for metabolic syndrome

Vladimír Blaha, Jakub Víšek, Martina Lášticová

Vnitr Lek 2020, 66(1):15-20 | DOI: 10.36290/vnl.2020.003  

Atherogenic dyslipidemias plays an important role in determining the cardiovascular risk. In these patients, insulin resistance is responsible for overproduction and secretion of atherogenic very low density lipoprotein. In addition, insulin resistance promotes the production of small dense low-density lipoprotein (LDL) and reduces high-density lipoprotein (HDL) production. Cardiovascular disease remains a leading cause of morbidity and mortality in these patients. The most European guidelines for the management of dyslipidemias recommend the goal values of LDL-c for moderate cardiovascular risk < 2.6 mmol/l (patients < 50 years with diabetes...

Type 2 diabetes in praxis - balancing between resistance and secretion

Barbora Pavlíková, Martina Vodičková, Vojtěch Česák, Michal Krčma, Zdeněk Rušavý

Vnitr Lek 2020, 66(1):21-27 | DOI: 10.36290/vnl.2020.004  

Type 2 diabetes mellitus is a disease characterized by a progressive failure of β cells on a background of significant insulin resistance. An individualized approach has its meaning especially in long-term decompensated patients, where the knowledge of the predominant patophysiologic mechanism can help to better conduct the therapy. A patient with near none secretion surely won´t benefit from secretagogues or incretin therapy, on the other hand a patient with high resistance on insulin therapy is in risk of developing a circulus vitiosus: higher doses - weight gain caused by anabolic effect of insulin with contribution of over-eating due to hypoglycemias...

Hepatotoxicity induced by bodybuilding supplements

Martina Jakabovičová, Zuzana Ďurkovičová, Tereza Hlavatá, Mária Szántová

Vnitr Lek 2020, 66(1):28-33 | DOI: 10.36290/vnl.2020.005  

Bodybuilding supplements are known as anabolic-androgenic steroids (AAS), as well as dietary supplements with their addition. Without medical indications, they are illegal but easily accessible and harmful, capable of causing various forms of liver damage from the transient increase in serum enzymes through acute cholestatic syndrome to the development of hepatic tumours in long-term use. The strongest hepatotoxic effects are associated with alkylated forms, although tumours have also been associated with unmodified or esterified testosterone. Since the 1980s, they have been widespread not only in top-level sport but also in the general population...

Chronic stress, mental discomfort, and depression increase the rates of infectious, autoimmune as well as malignant diseases

Zdeněk Adam, Zdeněk Král, Jeroným Klimeš, Zdeněk Boleloucký, Luděk Pour

Vnitr Lek 2020, 66(1):34-38 | DOI: 10.36290/vnl.2020.006  

Chronic stress and/or depression affect human health in all aspects of functioning. Chronic stress and/or depression reduce the functionality of immune defence. This review presents an overview of laboratory and clinical studies the aim of which was to evaluate the effect of stress on the development of malignant diseases as well as on that of infectious and autoimmune diseases. Numerous laboratory experiments have shown that chronic mental stress contributes to the development of tumours and has the potential to accelerate tumour growth. Many clinical studies have demonstrated that chronic mental stress increases the rates of cancer diseases (morbidity)...

Sarcopenic obesity - current view

Matej Pekař, Anna Pekařová, Tereza Chovancová, Pavol Holéczy

Vnitr Lek 2020, 66(1):39-43 | DOI: 10.36290/vnl.2020.007  

Obesity is a serious disease with interdisciplinary medical overlap and important socio-economic implications for patients and society. Therefore, a great deal of attention is paid to the clarification of the exact pathophysiological mechanisms involved in the disease, the possibility of their influence and, consequently, the treatment of the already existing conditions and related complications. Sarcopenic obesity is a type of obesity that is caused by fat infiltration of muscle tissue, that replaces its volume and causes its strength loss. A key pathophysiological mechanism in the aetiology of this problem is the inflammatory activity of the excessive...

Autoimmune hepatitis

Petr Urbánek

Vnitr Lek 2020, 66(1):e11-e18 | DOI: 10.36290/vnl.2020.027  

Autoimmune hepatitis is a chronic inflammatory disease of hepatic tissue of unknown aetiology characterized by serological reactivity of various types of autoantibodies and hypergammaglobulinaemia. It predominantly affects younger or middle-aged women. If untreated, in the majority of cases there occurs gradual disease progression and development of liver cirrhosis with all its consequences. Clinical manifestations are not uniform, with several manifestation phenotypes having been identified: acute hepatocellular injury resembling acute viral hepatitis; more rarely, a manifestation in the form of fulminant hepatitis; most commonly, however, the disease...

20 years of nephrologist's journey into the depths of phosphorus toxicity

Sylvie Dusilová Sulková

Vnitr Lek 2020, 66(1):e19-e25 | DOI: 10.36290/vnl.2020.028  

This article focuses on phosphate toxicity in kidney disease and namely in kidney failure. Twenty years ago, the first article documenting the link between hyperphosphatemia and mortality, was published. Shortly after, the association between phosphate and cardiovascular complications in kidney failure was demonstrated. Phosphate itself plays an active role in vascular calcifications. It induces phenotypic changes in vascular smooth muscle cells giving rise a matrix with consequent phosphate and calcium accumulation. The body is fighting again phosphate load. Initially, these mechanisms are adaptive (PTH and FGF-23 elevation). In kidney failure, they...

Monitoring and tailoring the P2Y12 ADP receptor blocker therapy

Tomáš Bolek, Barbora Korpallová, Lukáš Urban, Jakub Marko, Jakub Benko, Dana Prídavková

Vnitr Lek 2020, 66(1):e26-e33 | DOI: 10.36290/vnl.2020.029  

P2Y12 ADP receptor blocker (ADPRB) treatment forms currently the basis of pharmacotherapy in acute coronary syndrome (ACS) patients, and in patients after percutaneous coronary interventions (PCI). However, nowadays, there are lots of data demonstrating an association between insufficient ADPRB on-treatment response and the risk of ischemic events, including stent trombosis, which is an uncommon but life-threatening complication in patients after PCI. High on-treatment platelet reactivity may be detected with several laboratory tests. Light transsmition aggregometry with ADP induction is so far considered to be a "golden standard", and VASP (vasodilator...

Prevalence and risk factors of T-cell mediated rejection in patients after liver transplantation from deceased donors: a retrospective study over 10 years

Svetlana Adamcová-Selčanová, Ľubomír Skladaný, Tomáš Koller

Vnitr Lek 2020, 66(1):e4-e10 | DOI: 10.36290/vnl.2020.026  

Introduction: T-cell mediated rejection (TCMR) is still one of the most common non-surgical complications following liver transplantation (LTx). Aims: To determine the prevalence, risk factors and outcome of TCMR after LTx from deceased donors (DDLT) in a single center. Methods: Retrospective analysis; Study interval: May 2008-December 2017. Inclusion criteria: DDLT at this TC; exclusion criteria: patients treated with CyA or basiliximab. Recorded variables: demographics, MELD score, Child-Pugh, etiology, CIT (Cold Ischemia Time), BG (blood groups), tacrolimus (TAC) on 5^th day post LTx and at discharge, length of hospital stay (LOS), survival....

Acute myocardial infarction in a male patient with metabolic syndrome and obstructive sleep apnea syndrome

Jan Peterka, Hana Rosolová

Vnitr Lek 2020, 66(1):44-48 | DOI: 10.36290/vnl.2020.008  

A casuistic of a male, obese smoker, to whom the syndrom of obstructive sleep apnea (OSA) was diagnosed at his age of 32 years, was suffering from acute myocardial infarction at his 50 years. The patient had fulfilled all criteria of metabolic syndrome during time of acute heart attack: visceral obesity, arterial hypertension, mixed dyslipidemia, and type 2 diabetes mellitus. He was never examined by routine screening and then not treated. This patient ranked to the very high total cardiovascular risk subjects before the acute event occured. The growing evidence suggests that OSA may contribute to the metabolic derangements that characterized the metabolic...

Difficulties in the Diagnosis of Cardiac Amyloidosis and Treatment Options: Case Report

Renáta Závodná, Kamil Zeman, Martin Pleva, Milan Kamínek

Vnitr Lek 2020, 66(1):e34-e40 | DOI: 10.36290/vnl.2020.030  

Amyloidosis is a disease characterized by extracellular deposition of amyloid, an insoluble pathological protein. Clinical manifestation is based on the type of amyloid, and to define the specific type of amyloid is crucial to determining prognosis and optimal therapy. Echocardiography may be the first method to highlight the diagnosis of cardiac amyloidosis, but this is not a specific method. Typical echocardiographic findings in cardiac amyloidosis are myocardial enlargement, atrial dilatation, decreased longitudinal contraction with relatively long preserved systolic function of the left ventricle and left ventricular diastolic dysfunction with...

Mandibular pain and deformation as a presentation of fibrous dysplasia of the mandible

Tomáš Křiva, Zdeněk Adam, Marek Brumla, Ctirad Macháček, Tomáš Nebeský, Zdeněk Řehák, Luděk Pour, Renata Koukalová, Marta Krejčí, Zdeněk Král

Vnitr Lek 2020, 66(1):e41-e49 | DOI: 10.36290/vnl.2020.031  

A case of fibrous dysplasia of the mandible is reported. The condition started with toothache and swelling of the jaw and adjacent portion of the neck. A panoramic jaw radiograph and a CT scan of the jaw revealed mandibular deformation that may have been associated with both osteomyelitis and a tumorous process. Histological examination of the material taken from the mandible and histological study of regional lymph nodes showed fibrous dysplasia of the mandible and inflammatory changes in the regional nodes. An FDG-PET/CT scan showed a single-site form of the disease. After having considered all the information published on the benefit of the bisphosphonate...

What is the clinical use of total cholesterol results measurement?

Vladimír Soška

Vnitr Lek 2020, 66(1):49-51  

Assessment of total cholesterol concentration is one of the basic and relatively frequently determined blood analytes. However, significance of this parameter is limited to only a few areas: the main one is the estimation of the 10-year cumulative risk of the first fatal atherosclerotic event (myocardial infarction, stroke or other occlusive vascular disease including sudden cardiac death) according to the SCORE tables (Systematic Coronary Risk Estimation), where the knowledge of total cholesterol concentration cannot be dispensed with. This risk value can be also used to estimate the vascular age of the patient. Other main areas of application are:...

A few notes from reading of the 2019 dyslipidemia guidelines

Michal Vrablík

Vnitr Lek 2020, 66(1):52-59  

In September 2019, European companies presented new recommendations for dyslipidemia management. In October they were followed by a brief Statement of the Committee of the Czech Society for Atherosclerosis, which adheres to the principles of the new guidelines and brings comments to these. The recommended procedures summarized the rapidly accumulating knowledge of the importance of dyslipidemia in the field of atherosclerotic cardiovascular disease (ASCVO). It summarized recommendations for the diagnosis of disorders of plasma lipid metabolism. The stratification of risk categories was added and refined, to which the extreme risk category was added....

How to motivate patient to lifestyle change?

Vladimír Tuka, jr., Vladimír Tuka

Vnitr Lek 2020, 66(1):60-61  

A healthy lifestyle forms the basis for the treatment of most civilization diseases. However, changing our lifestyle, i.e. daily habits, is difficult for most of us. If we want to motivate patients to change their lifestyle, then the relationship is trust. If we want to gain the patient's trust, the critical assumption is that we trust him. To honestly believe we need to listen to the patient's world, be interested in seeing the problem - the situation on the part of the patient. The text briefly outlines strategies on how to motivate a patient to change their lifestyle.

Založení profesního spolku SAI – sdružení ambulantních internistů, z. s.

Jakub Weber, Miroslava Aszalayová

Vnitr Lek 2020, 66(1):e51  

Odešel velký člověk a lékař prof. MUDr. Vítězslav Kolek, DrSc., FCCP

Petr Jakubec

Vnitr Lek 2020, 66(1):e52