Prof. Jiří Šonka a obezitologie

Štěpán Svačina

Vnitr Lek 2020, 66(8):459  

Obesity-associated changes in drug pharmacokinetics

Alena Pilková, Jan Miroslav Hartinger

Vnitr Lek 2020, 66(8):465-471 | DOI: 10.36290/vnl.2020.141  

Pharmacokinetics of drugs in obese patients can be affected by changes in drug distribution and/or changes in elimination functions. Drug dosing based on patient's weight or body surface area may not be satisfactory in terms of safety or efficacy, especially for patients with a higher degree of obesity. However, current knowledge about most drugs does not provide sufficient guidance for dose adjustment in this group of patients. This article provides an overview of factors influencing changes in pharmacokinetics of drugs in obese, including some examples (eg. analgesics, antibiotics, anticoagulants and others). Due to different changes in pharmacokinetics,...

Bariatry - surgical therapy of the severe obesity

Mojmír Kasalický

Vnitr Lek 2020, 66(8):472-477 | DOI: 10.36290/vnl.2020.142  

When conservative therapy of the morbid obesity repeatedly fails bariatric surgery begins. Adults patients from 18 to 60 age with obesity 3^rd grade (BMI > 40 kg/m²), respectively 2^nd grade (BMI > 35 kg/m²), with symptomatic diseases caused by obesity as type 2 diabetes, hypertension, dyslipidaemia or heavy failure of the joints, in which conservative therapy failed, are indicate for bariatric surgery. Nearly all of the bariatric procedures are providing by laparoscopy at present. Contemporary bariatric surgery is using restrictive or malabsorptive or combination of both operating methods. Adjustable...

Contemporary state and perspectives of obesity pharmacotherapy

Štěpán Svačina

Vnitr Lek 2020, 66(8):478-482 | DOI: 10.36290/vnl.2020.143  

The history of obesity pharmacotherapy is controversial. Many drugs are not used more due to severe side effects. Today we have four effective antiobesity drugs. The effect of some of them is comparable with bariatric sugary. Weight loss induced by bariatric surgery is culminating in the first year. The effect of incretine analogues is progressive in several years and culminating later. There are many antiobesity drugs in development. Both centrally or peripherally acting new drugs will be available soon. Even targeted therapy using antibodies will be used in obesitology soon.

Physical activity in the treatment of obesity in practice

Martin Matoulek, Natálie Cibulková, Ondřej Kádě, Marcela Hašpicová

Vnitr Lek 2020, 66(8):483-488 | DOI: 10.36290/vnl.2020.144  

Physical activity is an integral part of the obesity treatment. Curiously, even among health professionals, the evaluation of obesity treatment persists only based on weight loss. However, the treatment of obesity is not only a simple weight loss, but above all the treatment of associated diseases such as hypertension, diabetes, dyslipidemia, etc. Physical fitness is very rarely assessed, although it best predicts the future and reduces mortality from all causes. It is mainly a cardiovascular disease, where it is shown that the parameter VO2Max is the strongest predictor of not only cardiovascular mortality. The specifics of the prescription of physical...

K 100. výročí narození prof. MUDr. Jiřího Šonky, DrSc.

Štěpán Svačina, Martin Matoulek

Vnitr Lek 2020, 66(8):e3-e4 | DOI: 10.36290/vnl.2020.150  

How to treat arterial hypertension in obese patients?

Hana Rosolová

Vnitr Lek 2020, 66(8):490-493 | DOI: 10.36290/vnl.2020.145  

Obesity (the most common metabolic disease) and arterial hypertension (the most common cardiovascular disease) are often occurring together, which brings very high cardiometabolic risk, i.e. risk for atherosclerotic vascular diseases and type 2 diabetes. Hypertension in obese patients is often resistant to drug treatment, represents the salt sensitive hypertension and many organ damages and other diseases are present. The common pathophysiological mechanisms of the both diseases are mentioned. Those mechanisms stimulate the development of macro- and micro-vascular complications and from those mechanisms arise the management of hypertension in obese...

Vitamin D supplementation as an important factor in COVID-19 prevention and treatment: what evidence do we have?

Juraj Smaha, Martin Kužma, Peter Jackuliak, Juraj Payer

Vnitr Lek 2020, 66(8):494-500 | DOI: 10.36290/vnl.2020.146  

The immunomodulatory effect of vitamin D and its potential in prevention and treatment of acute respiratory infections have long been of interest to many scientific teams around the world. Several meta-analyses in the last 10 years have confirmed the protective (albeit of modest size) effect of vitamin D against respiratory infections. Because of many overlapping risk factors for vitamin D deficiency and severe COVID-19 infection, many experts believe that vitamin D supplementation could play an important role in prevention and treatment of the new coronavirus disease. Based on available data on the immunological action of vitamin D, it is possible...

Antiplatelet therapy in secondary prevention of non‑embolic ischaemic stroke

Štefan Alušík, Zoltán Paluch

Vnitr Lek 2020, 66(8):501-506 | DOI: 10.36290/vnl.2020.147  

The authors address the topic of antiplatelet therapy after a non-cardioembolic ischaemic stroke. They discuss some controversial issues in therapy such as monotherapy versus combination therapy, short-term versus long-term therapy and whether current therapy should be modified or continued in the event a patient has experienced a stroke. Other outstanding issues dealt with include e.g., the risk of such therapy in patients developing cerebral microbleeds. While consensus has been reached by experts regarding the utility of dual therapy in the initial period, divergent opinions exist as to the selection of drugs and therapy duration. Definition of...

Age‑related myocardial remodeling: myth or reality?

Radek Pudil

Vnitr Lek 2020, 66(8):507-511 | DOI: 10.36290/vnl.2020.148  

Age-related myocardial remodeling is a long-term process that involves a wide range of pathogenetic mechanisms. The result is structural and functional changes of the myocardium, which lead to a change in the functional myocardium itself (changes in the geometry of the heart compartments, myocardial contractility, myocardial reserves). These changes can lead to the development of heart failure, reduce the quality of life and thus increase the morbidity and mortality of patients. It is a process that can be negatively affected by risk factors for cardiovascular disease, many comorbidities, on the contrary, this process can be significantly positively...

Acute infections, venous thrombosis, and recommended thromboprophylaxis

Dalibor Musil

Vnitr Lek 2020, 66(8):e17-e23 | DOI: 10.36290/vnl.2020.153  

One of the most serious complications of acute infection is venous thromboembolism (VTE). The mechanism of host procoagulant responses in bacterial and viral infections is complex, and various factors are known to trigger the proinflammatory responses and activate systemic coagulation. Host defense mechanisms include proinflammatory cytokines such as interleukins, tumor necrosis factor-α, and complement system proteins, all of which can induce coagulopathy. Tissue factor (TF) expression on monocytes/macrophages, neutrophil and platelet activation, produce activation of thrombosis. This thromboinflammatory response, together with extracellular...

Male hypogonadism associated with obesity

Luboslav Stárka, Michaela Dušková, Martin Hill

Vnitr Lek 2020, 66(8):e24-e27 | DOI: 10.36290/vnl.2020.154  

Male hypogonadism associated with obesity by yet not fully understood mechanisms promote fat depositions and on contrary obesity induces decrease of androgen production. It is necessary to diagnose hypogonadism correctly and to treat it. The definition of hypogonadism is based on subnormal levels of circulating testosterone and on the occurrence of symptoms, which, however, are not much specific. As obesity decreases substantially the concentrations of sex hormone binding globulin SHBG it is recommended in these men to check not only the level of total testosterone but also the concentration of free testosterone or the value of the index of free androgens....

Dialysis patient in internal medicine inpatient ward

Petr Táborský

Vnitr Lek 2020, 66(8):e28-e33 | DOI: 10.36290/vnl.2020.155  

Chronic kidney disease has been recognized as a worldwide epidemic. Its prevalence in developed countries is about 10 %, the number of patients treated by dialysis is on average 1.000 person per 1 million of population. Kidney failure is associated with high mortality due to high prevalence of cardiovascular disease. Cardiovascular risk factors differ in renal patients and general population. Most important of them are chronic overhydratation, anemia, disturbed calcium-phosphate metabolism, uremic toxins and protein-calorie malnutrition. Hospitalization of dialysis patient in internal medicine ward has some specific problems including dialysis tactics,...

Infliximab pharmacokinetics monitoring in inflammatory bowel disease

Pavel Svoboda, Tomáš Kupka

Vnitr Lek 2020, 66(8):e34-e38 | DOI: 10.36290/vnl.2020.156  

Therapeutic drug monitoring is a strategy utilized to optimize biological therapy. It consists in the drug level measurement before the next dose is due, when the drug concentration reaches the trough level, and includes the detection of potential antidrug antibodies. The monitoring makes it possible to adjust the therapy accordingly - to intensify or change the biologics applied to secure safe and highly effective therapeutics. Therapeutic optimization is based on the nature of therapy failure, which can be caused by pharmacokinetic or pharmacodynamic factors. Pharmacokinetic monitoring can be currently classified as reactive, measuring the drug level...

Heparin induced thrombocytopenia and up to date options of treatment - review of literature

Juraj Sokol, František Nehaj, Juraj Chudej, Michal Mokáň, Marianna Kubašková, Martin Jozef Péč, Jana Žolková, Ľubica Vadelová, Peter Galajda, Ján Staško

Vnitr Lek 2020, 66(8):e39-e46 | DOI: 10.36290/vnl.2020.157  

Heparin-induced thrombocytopenia (HIT) is a profoundly dangerous, potentially lethal, immunologically mediated adverse drug reaction to unfractionated heparin or, less commonly, to low-molecular weight heparin. Some patients with HIT develop serious thrombotic complications like limb ischemia and gangrene, while others may not develop such complications. Current laboratory diagnostic tools incur significant time delays before confirming HIT, therefore upon clinical suspicion, treatment of HIT should start immediately. In this review, the authors highlight heparin-induced thrombocytopenia's risk factors, clinical presentation, pathophysiology, diagnostic...

Influence of ageism on guideline adeherence in seniors with atrial fibrillation in the local practise of private cardiology clinic among years 2012 a 2017

Peter Olexa, Martina Habiňáková, Štefan Koval

Vnitr Lek 2020, 66(8):e5-e11 | DOI: 10.36290/vnl.2020.151  

Background: Atrial fibrillation (AF) is a problem of growing prevalence as a consequence of the ageing population, is associated with high morbidity, mortality, and healthcare costs. The risk is significantly reduced by oral anticoagulation. Adherence to guidelines may lower the risks for both all cause and cardiovascular (CV) deaths. Methods: Our objective was to evaluate the type and adherence of prescribed antithrombotic treatment according to the 2012 and 2016 European Society of Cardiology (ESC) guidelines in studied group of consecutive patients managed in private cardiology office in years 2012 and 2017. Only patients with diagnosis of AF were...

The role of metabolic syndrome in the induction of chronic pancreatitis after a first attack of acute pancreatitis - multicenter trial

Martina Bojková, Petr Dítě, Lumír Kunovský, Martin Blaho, Bohuslav Kianička, Ivo Novotný, Magdalena Uvírová, Jana Dvořáčková, Jiří Dolina, Marie Přecechtělová, Hana Mašková, Vladimír Procházka, Pavel Janeček, Oldřich Motyka, Arnošt Martínek

Vnitr Lek 2020, 66(8):e12-e16 | DOI: 10.36290/vnl.2020.152  

Background: Metabolic syndrome is a serious societal problem worldwide. In the Czech Republic more than 30% of the adult population are sufferers. The role of recurrent acute pancreatitis in the induction of chronic pancreatitis, following the so­‑called „mechanistic definition“ of chronic pancreatitis, has been unequivocally confirmed. However, there are a number of factors that may contribute to the development of chronic pancreatitis. The first aim of the study was to determine whether the metabolic syndrome may affect the development of chronic pancreatitis. The second question we asked ourselves was whether even one acute attack...

Rare manifestation of CMV infection - circular stenosis of the stomach

Pavel Hrabák, Jaromír Petrtýl, Renata Šroubková, Aleš Novotný, Ivana Vítková, Josef Hořejš, Miloš Dvořák, Radan Brůha

Vnitr Lek 2020, 66(8):e47-e50 | DOI: 10.36290/vnl.2020.158  

This article reports a case of a female patient who presented with epigastric pain. Further investigations confirmed CMV infection as a cause of stenosing gastric ulcer. In this case treatment with a proton pump inhibitor and antivirotic treatment led to a full recovery. Orgain manifestation of CMV infection if often in immunocompromitant hosts and it is, on the contratry, relatively rare in immunocompetent adults.

Danger of the sea‑complications After Scorpion Fish Attack

Iva Tresnerová, Břetislav Lipový, Alexandra Mertová, Jana Bartošková, Yvona Kaloudová

Vnitr Lek 2020, 66(8):e51-e54 | DOI: 10.36290/vnl.2020.159  

Hundreds of people come back from exotic countries with bacterial or parasitic infection every year. Venomous animal attack is less common. One such animal is scorpion fish (Scorpaena scrofa). We present case report of a 57-year-old patient treated at the Clinic of Burns and Plastic Surgery with extensive necrotic skin defekt on the right lower leg (1,5 % total body surface area). Defect was caused by puncture injury by scorpion fish in the Red sea. The injury was complicated with comorbid diseases of the patient, especially diabetes mellitus type 2.

Dissection of ascending aorta, a diagnosis needs to remember about it

Veronika Jankovičová, Margita Belicová, Milan Ochodnický, Marián Mokáň

Vnitr Lek 2020, 66(8):e55-e60 | DOI: 10.36290/vnl.2020.160  

Acute type A aortic dissection is a life-threating condition, and is associated with significant morbidity and mortality. Patients typically present with the acute onset of chest pain, which occurs in up to 85% of cases. Acute chest pain may lead to the suspicion of acute coronary syndrome, and as the electrocardiogram may indicate ischaemia, patients are given anti-thrombotic treatment. Some patients can present without chest pain, but with focal neurological deficits, which can occur with involvement of the great vessel. The authors described three patients with acute type A aortic dissection. Two of them did not present with the acute onset of chest...

110. výročí narození primáře Kadeřábka

Martin Polák

Vnitr Lek 2020, 66(8):e64-e65  

Fixed-dose combination of rosuvastatin and ezetimibe

Martin Šatný

Vnitr Lek 2020, 66(8):513-517 | DOI: 10.36290/vnl.2020.149  

Atherosclerotic cardiovascular diseases (ASCVD) play a significant role in morbidity and mortality not only in developed but also increasingly in developing countries. The only causal risk factor (RF) of ASKVO is LDL-cholesterol. The basic pillar of pharmacotherapy of dyslipidaemias are statins, which should be titrated to the maximum (tolerated) dose and then combined with ezetimibe if the LDL-cholesterol targets for the specific categories of CV risk are not reached. Combination therapy is known to be far more effective than increasing the statin dose. Fixed combinations of statins with ezetimibe can be advantageously used to improve adherence.

Molekula erdostein společnosti Recipharm byla s pozitivním výsledkem testována jako součást léčby pacientů s COVID-19
Antioxidační a bronchoprotektivní účinek erdosteinu

Adriana Vavříková

Vnitr Lek 2020, 66(8):518-520  

2020: rok, kdy ambulantní internisté vzali budoucnost do svých rukou. Konečně!

Jaroslav Duba

Vnitr Lek 2020, 66(8):e61-e63