Vnitřní lékařství v době koronavirové

Mirek Souček

Vnitr Lek 2020, 66(3):139  

Vážení a milí čtenáři Vnitřního lékařství

redakce

Vnitr Lek 2020, 66(3):e2  

"All‑in‑one" concept of functional myocardial revascularization in the cathlab

Tomáš Kovárník, Petr Kala

Vnitr Lek 2020, 66(3):152-159 | DOI: 10.36290/vnl.2020.044  

The concept of functional revascularization based on proving ischemia has been strongly recommended in the practical guidelines of both European and Czech Societies of Cardiology. In daily practice, application of this concept decreases the rate of coronary interventions. Though the best clinical evidence has been provided in patients with chronic coronary syndromes, recent data strongly advocate its usage also in patients with acute coronary syndromes. Invasive pressure-derived indices: hyperemic FFRmyo (fractional flow reserve of myocardium) and resting iFR (instantaneous wave-free ratio) require an interventional procedure by wiring the diseased...

Long term antithrombotic threapy after myocardial infarction: why, to whom and which one?

Ivo Varvařovský

Vnitr Lek 2020, 66(3):160-168 | DOI: 10.36290/vnl.2020.045  

Despite the progress in secondary prevention, life expectancy after myocardial infarction is poor for some specific groups of patients. High ischemic risk patients could benefit from some strategies of long-term and aggressive antithrombotic therapy provided that their bleeding risk is acceptably low.

Are proton pump inhibitors an effective and safe drug not only in the prophylaxis of gastrointestinal bleeding in antithrombotic treatment?

Jan Bultas

Vnitr Lek 2020, 66(3):169-179 | DOI: 10.36290/vnl.2020.046  

Proton pump inhibitors (PPIs) are popular and widely used "gastroprotectives". More than 10% of our population is treated. In addition to classical indications such as gastroduodenal peptic disease or gastroesophageal reflux disease, they are indicated for the reduction of hemorrhagic complications in the digestive tract during antithrombotic treatment. The effect of PPIs on reducing upper gastrointestinal bleeding in antithrombotic treatment (rivaroxaban, acetylsalicylic acid or a combination) was called into question by a recently published randomised mega-study - COMPASS pantoprazole. Treatment of PPIs is accompanied by a number of significant drug...

Psychical reaction of patients to the negative information on cancer diagnosis

Zdeněk Adam, Jeroným Klimeš, Zdeněk Boleloucký

Vnitr Lek 2020, 66(3):182-185 | DOI: 10.36290/vnl.2020.047  

Strong negative message of the type "You have been diagnosed with cancer" produces blustering reaction with specific phases in any individual. Elizabeth Kűbler-Ross was the first who described this reaction to cancer findings. However, her description hit the most distinctive marks only, while less noticeable signs did not occur in the original specification. The goal of this text is to familiarize a reader with complex spectrum of all possible patient reactions to the announcement of cancer as met in real life.

What is hiden behind autoinflammation?

Katarína Hrubišková, Miloš Jeseňák, Juraj Payer

Vnitr Lek 2020, 66(3):e13-e21 | DOI: 10.36290/vnl.2020.054  

Autoinflammatory diseases represent a group of disorders that are distinct from autoimmune diseases, infections and malignancies. They are characterised by attacks of unprovoked noninfectious inflammation. A key feature of autoinflammatory diseases is dysregulation of innate immune system and overproduction of pro-inflammatory cytokines. The best-characterized group of autoinflammatory diseases arises from mutations in single genes. They are typically manifested by recurrent attacks of fever and serositis as well as arthralgia, myalgia and skin exanthema.

Cardiac involvement in hypereosinophilia

Lenka Roblová, Petr Kuchynka, Jan Kuchař, Tomáš Paleček

Vnitr Lek 2020, 66(3):e22-e27 | DOI: 10.36290/vnl.2020.055  

Cardiac abnormalities associated with hypereosinophilia represent rare diseases and occurs most commonly due to hypersensitivity or allergic reactions, other possible etiologies cover infections, malignancy, vasculitis or hypereosinophilic syndromes. Three stages of cardiac involvement are usually described. Initially, myocardial inflammation occurs, that can continue with a thrombotic stage and eventually progress to the last irreversible stage called endomyocardial fibrosis, which represents one of the acquired forms of restrictive cardiomyopathy. In most patients, increased levels of eosinophils in the blood differential test; however, it may not...

Overview of psychological problems accompanying cancer

Jeroným Klimeš, Zdeněk Adam, Zdeněk Boleloucký, Luděk Pour

Vnitr Lek 2020, 66(3):e28-e37 | DOI: 10.36290/vnl.2020.056  

In recent years, dramatic advances in early detection and treatment options have increased the overall survival rates in patients of all ages with cancer and malignant hematologic diseases. At the same time, these improved treatment options are also associated with substantial long-term side effects, such as fatigue, pain, anxiety, and depression and posttraumatic stress disorder, that interfere with patients' ability to perform daily activities. Furthermore, patients with cancer may have preexisting psychologic or psychiatric conditions that affect their ability to cope with cancer. Survivors of cancer are about twice as likely to report medication...

Importance of breath tests for the evaluation liver function in patients with chronic kidney disease

Nikola Mejzlíková, Karolína Krátká, Miluše Vejvodová, Pavla Libicherová, Nikola Uzlová, Jana Vránová, Ivan Rychlík

Vnitr Lek 2020, 66(3):e38-e40 | DOI: 10.36290/vnl.2020.057  

Breath tests for the evaluation liver metabolic function are a non-invasive diagnostic method with high sensitivity and specificity. Up today, the issue of liver damage in patients with chronic kidney disease has not been investigated sufficiently, although it might have significant clinical consequences. The following article describes the principles of breath tests, experiences with breath tests in patients with chronic kidney disease (CKD) and the results of our pilot study with methacetin breath tests in patients with CKD and in regular peritoneal dialysis treatment.

Adherence to cardiovascular prevention principles in subjects at high risk

Otto Mayer Jr., Jan Bruthans, Julius Gelžinský, Markéta Mateřánková, Štěpán Mareš, Veronika Svobodová, Jitka Seidlerová, Renata Cífková, Jan Filipovský

Vnitr Lek 2020, 66(3):e5-e12 | DOI: 10.36290/vnl.2020.053  

Background: Asymptomatic high-risk individuals represent one of the highest priorities of cardiovascular prevention, in clinical practice frequently overlooked. We analyzed the real adherence to recommended principles of cardiovascular prevention in primary care subjects. Methods: Our analysis is based on random general population sample, examined in the frame of post-MONICA survey in 2016/17. Each subject was categorized with regard to its individual cardiovascular risk (based on Sixth Joint European Guidelines) and the real adherence to recommended targets was ascertained. Results: In total 898 subjects aged 25-75 years (47 % males) were analyzed....

The first cases of genetically confirmed congenital diarrhea with chloride loss in Slovakia

Ľudmila Podracká, Mária Chocholová

Vnitr Lek 2020, 66(3):186-189 | DOI: 10.36290/vnl.2020.048  

Chloride ions are involved in regulating cell volume, secreting body fluids and maintaining acid-base balance. Hypo/hyperchloraemia in neonates and infants is an emergent situation requiring careful differential diagnosis to detect a cause of the condition. The rare causes of severe hypochloremia include congenital chloridorhea (CLD), characterized by profound bulky diarrhea, high chloride concentration in stool, and severe metabolic alkalosis. CLD is a rare autosomal recessive disease caused by the mutation of the SLC26A3 gene located on chromosome 7q31, which encodes the transmembrane protein in intestinal cells. Genetic defect causes a disorder...

Stress kardiomyopathy triggered by unusual situation

Katarína Bobocká, Oľga Jurkovičová, Branislav Líška, Slavomíra Filipová

Vnitr Lek 2020, 66(3):e49-e54 | DOI: 10.36290/vnl.2020.060  

Stress - "takotsubo" cardiomyopathy - is a reversible mimicking acute myocardial infarction. The trigger is extreme mental or physical stress. The main diagnostic examination is ventriculography with typical left ventricle apical ballooning wall motion abnormality. We present a case report of 63 years old woman, hospitalized at the Department of IV. internal Clinic Medical Faculty and University Hospital Bratislava due to angina. The main trigger was atypical stress situation - urgent need to urinate. On admission, the patient's condition was dominated by the hypertension emergency, tachycardia and psychic tension. The ECG on admission revealed the...

Hepatorenal syndrome - update 2020

Karolína Krátká, Pavla Libicherová, Nikola Mejzlíková, Ivan Rychlík

Vnitr Lek 2020, 66(3):e58-e62 | DOI: 10.36290/vnl.2020.062  

Hepatorenal syndrome (HRS) is a serious complication in patients with advanced liver cirrhosis and ascites occurring simultaneously. According to current diagnostic criteria it is considered as one of the less common forms of acute kidney injury (AKI), referred to as HRS-AKI. As a result of the revision of the diagnostic criteria, there was a significant shift in the diagnosis of AKI in patients with liver cirrhosis, allowing early initiation of adequate measures and appropriate treatment. The following article describes the issue of AKI in liver cirrhosis in a wider context, the diagnostic criteria and algorithm of HRS-AKI treatment.

Local thrombolysis for deep vein thrombosis: why, for whom and how?

Martin Radvan, Jakub Hustý, Alena Floriánová, Kateřina Hořáková, Petr Kala

Vnitr Lek 2020, 66(3):146-151 | DOI: 10.36290/vnl.2020.043  

Despite the progress achieved in prevention and therapy in recent decades, venous thromboembolic disorder still presents medical burden. Incidence is estimated about 100-200/100 000 per year. Patients, who underwent deep vein thrombosis are at risk of recurrence and/or development of post-thrombotic syndrome. Both can affect the quality of life. In acute phase of the disease anticoagulation and compression are effective therapy in most cases. But in severe clinical manifestations escalation of the therapy should be considered. Surgical embolectomy is possible, but complication rate is high. Endovascular approaches are viable option. Catheter directed...

What are the blood pressure targets for patients with chronic kidney disease?

Ivan Rychlík, Petra Bachroňová, Anna Maršáková, Lidmila Francová, Karolína Krátká

Vnitr Lek 2020, 66(3):200-204 | DOI: 10.36290/vnl.2020.051  

Cardiovascular (CV) diseases remain the main reason for mortality and morbidity among patients with or without chronic kidney disease (CKD) and hypertension represents one of their risk factor. Despite the lack of definitive evidence that intensive blood pressure (BP) lowering improves kidney function outcomes, we agree with the recommendation of target BP < 130/80 mm Hg in most adults with CKD for the purpose of CV disease prevention. SPRINT trial showed that more intensive systolic BP control decreased the incidence of CV events and death, including in patients with CKD. On the other hand, intensive BP control may lead to a slightly faster decline...

Proteinuria from an internist's point of view

Jan Vachek, Adéla Maříková, Kateřina Oulehle, Oskar Zakiyanov, Vladimír Tesař

Vnitr Lek 2020, 66(3):e55-e57  

A basal level of proteinuria is about 30-100 mg/day, the upper limit of basal proteinuria does not exceed 150 mg/day which is considered non-pathology. Albumin accounts approximately 15 % of basal protein in the urine, other plasma proteins (immunoglobulins, β-2 microglobulin, Tamm-Horsfall mucoprotein) comprise the remaining 85 % of total quantity non-pathology proteinuria. Persistent proteinuria present for more than three months already meets the definition of chronic kidney disease independently of the stage of the estimated glomerular filtration rate. Patients are classified as A1-A3 based on the level of albuminuria. Examination of the albumin...

Proteinuria from an internist's point of view

Jan Vachek, Adéla Maříková, Kateřina Oulehle, Oskar Zakiyanov, Vladimír Tesař

Vnitr Lek 2020, 66(3):e55-e57  

A basal level of proteinuria is about 30-100 mg/day, the upper limit of basal proteinuria does not exceed 150 mg/day which is considered non-pathology. Albumin accounts approximately 15 % of basal protein in the urine, other plasma proteins (immunoglobulins, β-2 microglobulin, Tamm-Horsfall mucoprotein) comprise the remaining 85 % of total quantity non-pathology proteinuria. Persistent proteinuria present for more than three months already meets the definition of chronic kidney disease independently of the stage of the estimated glomerular filtration rate. Patients are classified as A1-A3 based on the level of albuminuria. Examination of the albumin...

Miroslav Souček, Petr Svačina a kolektiv. Vnitřní lékařství v kostce. Grada; Praha 2019; 462 stran; ISBN 978-80-271-2289-9 (print)

prof. MUDr. Jiří Ehrmann, CSc.

Vnitr Lek 2020, 66(3):e63  

Profesorka MUDr. Sylvie Opatrná, PhD. - in memoriam (1959-2020)

Ing. Katarína Derzsiová

Vnitr Lek 2020, 66(3):e64-e65  

Euvascor - early intervention of hypertension and dyslipidaemia (dual combination of atorvastatin and perindopril)

Lukáš Zlatohlávek

Vnitr Lek 2020, 66(3):190-195 | DOI: 10.36290/vnl.2020.049  

Over the last 30 years, the number of cardiovascular causes of death has decreased, but Cardi-ovascular Disease has been the leading cause of mortality and morbidity in the Czech Republic. In spite of a clear decline, this still persisting primacy is due to the failure to achieve the target recommended values and the late initiation of pharmacotherapy. We know that lifetime LDL cholesterol exposure reduced by 1 mmol/l is associated with a 54% reduction in the incidence of coronary events. A lifetime lower systolic BP of 10 mmHg is associated with a 45% reduction in the incidence of coronary events. Lifetime exposure to a combination of LDL cholesterol...

Rivaroxaban in COMPASS trial

Filip Šustr, Miroslav Souček

Vnitr Lek 2020, 66(3):197-198 | DOI: 10.36290/vnl.2020.050  

Cardiovascular diseases (CVD) are still at the first place in the case of mortality in European countries. Consistent secondary prevention for CVD is very important aspect in the fight with this negative statistics. We consider antithrombotic treatment as a gold standard in secondary prevention for CVD . There are a lot of latest trials about this problematics. COMPASS trial targets the effectiveness of rivaroxaban in patients with CVD as a secondary prevention. The results of this trial are very positive about using rivaroxaban and acetylsalicylic acid together in effort to avoid progression or relapse of CVD.

Arterial hypertension and COVID-19 infections: A brief commentary

Jiří Widimský

Vnitr Lek 2020, 66(3):e41-e43 | DOI: 10.36290/vnl.2020.058  

The issue of hypertension/antihypertensive treatment in patients with COVID-19 infection is discussed in the commentary.

Distant diabetes care: what can the patient, nurse and patient do

František Saudek, Klára Picková

Vnitr Lek 2020, 66(3):e44-e48 | DOI: 10.36290/vnl.2020.059  

Due to the spread of new coronavirus disease, COVID-19, social interactions between people have been significantly reduced. In healthcare, outpatient care is a high-risk frontline of infection transmission in both patients and healthcare professionals. The presence of routine digital communication, remote data management and the availability of glucose monitoring and insulin delivery devices have given diabetology a certain advantage in this situation. However, the potential of these modalities has not been fully utilized so far. We provide an overview of practical methods of distance patient management, which can be used in most diabetes outpatient...