Internista a pacient po ischemické CMP

Zdeněk Monhart

Vnitr Lek 2021, 67(1):3  

What internist can do for the patient after the ischemic stroke

Miroslav Škorňa

Vnitr Lek 2021, 67(1):7-14 | DOI: 10.36290/vnl.2021.001  

Stroke is frequent disease especially in older age. It is complex multidisciplinary issue and the internist plays very important role in the care of the stroke patients. Recurrent stroke is often disabling. Therefor the early and proper implementation of the effective secondary prevention is essential. This review presents basic information about the aetiology, diagnostic assessment and the secondary prevention of the ischemic stroke.

Long-term ECG monitoring

Veronika Bulková

Vnitr Lek 2021, 67(1):16-21 | DOI: 10.36290/vnl.2021.002  

ECG recording represents an essential method for the diagnosis of heart rhythm disturbances. Long-term monitoring helps to identify arrhythmias that have not been detected by means of standard 12-lead ECG or 24-48 hour ECG Holter. With time, ECG monitoring facilities improve, the ECG recorders are becoming smaller, and the recording time is prolonging. At present, continuous ECG recording is generally available. Smart watches and fitness bracelets further expand monitoring options in patients with known or suspected arrhythmia. Individual type and frequency of symptoms remain the most significant criterion for the selection of suitable ECG recorder...

Patent foramen ovale from the point of view of interventional cardiology

Martin Poloczek, Petr Kala, Tomáš Ondrúš

Vnitr Lek 2021, 67(1):22-28 | DOI: 10.36290/vnl.2021.003  

The link between patent foramen ovale (PFO) and paradoxical embolization, which may be cause of so-called "cryptogenic" ischemic stroke, has been known for more than 100 years. The catheteriziation closure of PFO as a secondary preventive treatment is performed in a greater extent since the end of the last century. The results of the first epidemiological and randomised clinical trials comparing antiagregation or anticoagulant therapy with the PFO closure did not show a clear benefit of any of these approaches. In 2017, major randomized clinical trials were published that demonstrated the benefit of PFO catheter closure compared to drug therapy alone....

Follow‑up care after COVID-19 and its related concerns

Martin Radvan, Elis Bartečků, Ľubica Sýkorová, Radana Pařízková, Svatopluk Richter, Martin Kameník, Lumír Koc, Petr Kala

Vnitr Lek 2021, 67(1):30-35 | DOI: 10.36290/vnl.2021.004  

Coronavirus disease 2019 (COVID-19) is an infectious disease caused by a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (1). Overall COVID-19-related rates of mortality are low; deaths usually occur in patients older than 60 and those suffering from serious chronic diseases. Most of the patients recover within one or two weeks. However, in approximately 5-10 % of the patients some of the symptoms persist for weeks and months. Post-COVID-19 syndrome is a multisystem disease with overlapping symptoms and may occur even in patients who were relatively mildly affected during the acute phase of the disease. Evaluating the number of patients...

Early and concurrent therapy of dyslipidemia and hypertension: when to start it and how to maintain patient´s good and long-term adherence?

Vladimír Soška

Vnitr Lek 2021, 67(1):37-40 | DOI: 10.36290/vnl.2021.005  

Treatment of dyslipidemia and hypertension is a key step for reducing the risk of atherosclerotic cardiovascular disease. Dyslipidemia and hypertension often occur in one patient at the same time, so both of these risk factors need to be addressed at the same time. It is better to start therapy before the patient is at high risk of a fatal cardiovascular event. To improve the patient's prognosis, it is important not only to achieve the target LDL-cholesterol value and the optimal blood pressure value, but it is also very important (and often more difficult) to maintain the patient's good and long-term adherence to established combination pharmacotherapy....

EMPEROR reduced - empagliflozin in patients with heart failure and reduced ejection fraction

Jindřich Špinar, Lenka Špinarová, Jiří Vítovec

Vnitr Lek 2021, 67(1):43-47 | DOI: 10.36290/vnl.2021.006  

Type 2 diabetes mellitus (T2DM) is common in patients with chronic heart failure and is associated with high morbidity and mortality. Significant advances have recently occured in the treatment of diabetes mellitus type 2 (T2DM) and cardiovascular diseases. Several new glucose lowering drugs have shown either neutral or positive cardiovascular effect especially on hospitalisations, but also on mortality. Some of these drugs have safety characteristics with strong practical implication in heart failure, for example sodium-glucose co-transporters type 2 inhibitors (SGLT-2). Position paper of the European Society of Cardiology/Heart Failure Association...

Current view on hepatitis B diagnosis and therapy

Petr Husa

Vnitr Lek 2021, 67(1):48-50 | DOI: 10.36290/vnl.2021.007  

Hepatitis B virus (HBV) infection remains a global public health problem with changing epidemiology due to several factors predominantly vaccination policy and migration. Chronic hepatitis B is a dynamic process reflecting the interaction between HBV replication and the host immune response and not all patients with chronic HBV infection have chronic hepatitis B. Stopping of nucleotide or nucleoside analogues (NA) therapy is a serious resolution due the danger of reactivation of viral replication associated with increasing HBV DNA level, ALT activity and inflammatory activity in the liver histology. The safest stopping rule for NA therapy is HBsAg...

Is autoimmune pancreatitis a risk factor for pancreatic adenocarcinoma?

Lumír Kunovský, Petr Dítě, Martin Blaho, Jana Dvořáčková, Magdalena Uvírová, Marie Přecechtělová, Petr Jabandžiev, Hana Mašková, Bohuslav Kianička, Pavel Janeček, Michal Eid, Arnošt Martínek

Vnitr Lek 2021, 67(1):e09-e13 | DOI: 10.36290/vnl.2021.011  

Immunoglobulin G4-related diseases (IgG4-RD) are a group of diseases characterized by high serum levels of immunoglobulin G4 (IgG4), increased lymphocyte and plasma cell with IgG4 positivity in the parenchyma of some organs, and storiform fibrosis. The most frequently affected organ is the pancreas. This is an autoimmune form of pancreatitis, which can be divided into two types: Type 1, which is significantly more common than Type 2, is high in IgG4 in the pancreatic parenchyma and shows a fundamental difference in the noted presence of extra­‑pancreatic disorders. In general, chronic inflammation is a risk factor in the development of carcinomas....

A comprehensive interdisciplinary view at the Return to Sport after COVID-19 infection

Filip Hrdlička, Jaroslav Větvička, Vendula Bendová, Jiří Beran, Bohuslav Bunganič, Petr Krejčí st., Lumír Kroček, Václav Monhart, Jan Mühlfeit, Přemysl Rákosník, Pavel Stejskal, Michal Šafář, Josef Veselka, Libor Vítek

Vnitr Lek 2021, 67(1):e14-e21 | DOI: 10.36290/vnl.2021.012  

The covid-19 pandemic has affected the whole world. It applies to all age and social groups. It is no different with athletes. So far, we cannot say for sure what the long-term consequences of SARS-CoV-2 infection are. Recent evidence, however, suggests that we should be very careful when returning to sports. After self-isolation, the athlete should undergo a Preparticipation Physical Examination and then pay attention to the gradual dosing of the load to prevent complications. Lifestyle changes and care for the mental health of athletes are also necessary during the illness. In this work, we present a comprehensive methodology for returning to sports...

Pitfalls of solving polypharmacy problems

Štefan Alušík, Zoltán Paluch

Vnitr Lek 2021, 67(1):e22-e25 | DOI: 10.36290/vnl.2021.013  

Polymedication is associated with a higher incidence of negative health indicators including falls, morbidity and mortality. Despite efforts, the solution to this problem is still unsatisfactory. The two main causes of polymedication are population aging and polymorbidity and, on the other hand, the development of the pharmaceutical industry and the availability of a wide range of medicines. The authors discuss the main shortcomings in the investigation of this issue, such as inconsistent terminology used, methodological shortcomings in data acquisition, lack of recommended guidelines for the polymorbid patients treatment, etc. They discuss whether...

Taxane‑induced polyneuropathy - current possibilities of prediction and management

Magdaléna Jablonická, Lucia Žideková, Beáta Mladosievičová

Vnitr Lek 2021, 67(1):e26-e31 | DOI: 10.36290/vnl.2021.014  

Peripheral neurotoxicity is the most typical non-haematological adverse effect of taxanes. Symptoms are dominated by sensory peripheral neuropathy, the incidence and degree of which depend on the cumulative dose level. The impact of neurotoxicity on the patient´s quality of life is significant, therefore it is necessary to consider the selection of therapy and the patient´s pre-existing risk factors for developing neuropathy and to get acquainted with current management options, including genetic prediction of polyneuropathy. This review article reports on a very common complication of cancer therapy that can be encountered at each internist´s outpatient...

Diagnostic hospitalizations before patient inclusion on the waiting list for kidney transplantation

Monika Beliančinová, Karol Graňák, Matej Vnučák, Petra Skálová, Ľudovít Laca, Marián Mokáň, Ivana Dedinská

Vnitr Lek 2021, 67(1):e04-e08 | DOI: 10.36290/vnl.2021.010  

Introduction: For kidney transplantation is indicated any patient with chronic kidney disease in the terminal stage, unless it has a contraindication for this operation. The aim of this work is to evaluate the benefit of diagnostic hospitalizations of the patients before inclusion on the waiting list for kidney transplantation and to identify the most common differential diagnostic problems for the indication / contraindication for kidney transplantation. Material and methods: This is a retrospective analysis, which included all potential recipients who underwent the examination process before inclusion on the waiting list and living donors in the...

Fatal coincidence of inapparent SARS‑CoV-2 infection and drug toxicity in the field of immunosuppression in a 33-year old woman

Xénia Faktorová, Lucia Horniaková, Jozef Sedlačko, Alena Havranová, Peter Martanovič, Petra Malíková, Martina Jakabovičová, Zuzana Ďurkovičová, Mária Szántová

Vnitr Lek 2021, 67(1):51-56 | DOI: 10.36290/vnl.2021.008  

The Covid-19 pandemic represents a wide-ranging form of involvement from asymptomatic through mild respiratory form to bilateral bronchopneumonia with acute respiratory and multiorgan fatal failure. Patients with comorbidities (obesity, cardiovascular diseases, diabetes mellitus) are particularly at risk of a more severe course of infection. We present a 33-year old lean patient with a medical history of ulcerative colitis on immunosuppressive treatment with Azathioprine, after unsuccessful in vitro fertilization one week before the onset of symptoms, admitted to hospital for two-week-long cough with sore throat with fever ap to 40°C. CT confirmed...

Overlap syndrome SLE - ANCA associated vasculitis

Martina Skácelová, Pavel Horák, Jana Janková

Vnitr Lek 2021, 67(1):58-61 | DOI: 10.36290/vnl.2021.009  

Incidence of ANCA antibodies in patients with systemic lupus erythematosus (SLE) is described in 24-31 %, but they are not related to the distribution and severity of organ involvement in SLE; the routine monitoring is not recommended. Overlap syndrome of systemic lupus erythematosus and ANCA associated vasculitis (AAV) is rare. The difficult diagnosis and treatment of this syndrome is described in this case report of the patient with SLE and severe kidney involvement resulting from AAV.

Fever of unknown origin

Vyacheslav Grebenyuk, Olga Kryštůfková, Monika Gregová, Magdalena Sokalská‑Jurkiewicz, Renata Steinbauerová, Marie Sukovská, Lubica Gahérová, Ivana Zubatá, Jana Gregorová, Lucia Kaliská, Hana Roháčová, Milan Trojánek

Vnitr Lek 2021, 67(1):e32-e42 | DOI: 10.36290/vnl.2021.015  

Fever of unknown origin is a rare clinical syndrome, that represents a significant diagnostic challenge. There have been described more than 200 potential diseases, that can manifest as a fever of unknown origin. These are classically divided into following categories: infections, non-infectious inflammatory diseases, malignancies, and other miscellaneous disorders. Each of the disease type is associated with rather characteristic symptoms, clinical signs and laboratory findings, which are individually non-specific, but may provide helpful clues for a further focused diagnostic work-up. The clinician's task is to be able to identify these hallmark...

Nutritional support in the early stage of critical illness - focused on energy and protein intake

Roman Kula, Roman Kula jr, Daniela Charwátová, Tatiana Sušková

Vnitr Lek 2021, 67(1):e43-e48 | DOI: 10.36290/vnl.2021.016  

The aim of this article is to emphasize the importance of taking into account the mechanism of host's response to insult when choosing a nutritional strategy in the early phase of a critical illness. At the same time, the article discusses the risks associated with early aggressive nutritional intervention for both energy and protein intake. Today, it seems that the most optimal choice of nutritional support during the first week of stay in the ICU is a gradual increase in both energy and protein intake. In numerical terms, this means a daily increase in energy dose of approximately 5 kcal/kg/day and a daily increase in protein dose of 0.2 g /kg/day....

Prof. MUDr. Jiří Vítovec, CSc., fesc, má jubileum

Jindřich Špinar

Vnitr Lek 2021, 67(1):E56-E57  

Jubileum prof. MUDr. Vlastimila Ščudly, CSc.

Pavel Horák, Josef Zadražil, Edgar Faber

Vnitr Lek 2021, 67(1):E58-E59  

Komentáře k analýze složení směsi flavonoidů v tabletách Diozen 500 mg metodou UHPLC

Jiří Slíva, Debora Karetová

Vnitr Lek 2021, 67(1):63-66  

Competence and informed consent

Adam Doležal, Tomáš Doležal

Vnitr Lek 2021, 67(1):e49-e55 | DOI: 10.36290/vnl.2021.017  

The issue of a patient´s competence is often solved in practice without a major theoretical concept. Such an approach, focused only on the basis of intuitions and experiences of physicians, however, may lead in some cases to an inadequate assessment of competence of a particular patient. Ultimately, it can happen that the decision of an incompetent person will be respected or that the decision of the competent person will be disrespected. Both possibilities can have ethical as well as legal consequences. This article addresses both theoretical and practical issues of competence in adult patients.