Použití léků vyvinutých pro jiné indikace v léčbě infekce covid-19

Vladimír Tesař, Jan Hartinger

Vnitr Lek 2021, 67(4):191-192  

Targeted and biological drugs in the treatment of inflammatory rheumatic diseases

Karel Pavelka

Vnitr Lek 2021, 67(4):195-200 | DOI: 10.36290/vnl.2021.052  

Treating inflammatory bowel diseases in the 21^st century: individualized therapy and telemedicine

Milan Lukáš

Vnitr Lek 2021, 67(4):201-205 | DOI: 10.36290/vnl.2021.053  

Monitoring and therapy in patients with inflammatory bowel disease have been completely changed with regards of monitoring tolls, therapeutic aims and pursuance of therapeutic responses since of beginning this century. Uncomparable higher access to the modern and innovative conservative treatment requires precise consideration how to choice optimal drug at the therapy beginning. Crohn´s disease and ulcerative colitis prevalence is stable increasing and within next ten years has been expanded more than 20-30%. Higher IBD prevalence will dictate implementation of new tools for long-term follow up. Telemedicine seems to be the most important project implemented...

Biologic therapy for dyslipidemia

David Karásek

Vnitr Lek 2021, 67(4):206-211 | DOI: 10.36290/vnl.2021.054  

Dyslipidemia treatment represents a very dynamically growing segment of pharmacotherapy, including a production of biological agents. Nowadays, they are targeting at various proteins that are involved in the synthesis, transport, or metabolism of lipoproteins. This review provides a statement of current options for the biological treatment of dyslipidemias and for other products that have the potential to broaden its spectrum in the near future.

Importance and efficiency of blood pressure control not only in type 2 diabetes patients

Veronika Vejtasová, Jana Urbanová, Ludmila Brunerová, Michala Lustigová, Michael Jenšovský, Barbora Prýmková, Sabina Pálová, Jan Brož

Vnitr Lek 2021, 67(4):218-222 | DOI: 10.36290/vnl.2021.056  

Arterial hypertension is one of the most frequent comorbidities of patients with type 2 diabetes, the rates are approximately three times higher among diabetics than in general population. The presence of both diseases increases the cardiovascular risk of the patients two to three times. Therefore, it is essential to control the blood pressure values vigorously down to 130/80 mmHg as recommended in guidelines of the Czech Hypertension Society. According to EHES Study data, the blood pressure control is not sufficient in Czech diabetic population. The target values are reached in only 29 % of diabetics. A well organized system of care, intensive antihypertensive...

Giant cell arteritis: controversial issues

Štefan Alušík

Vnitr Lek 2021, 67(4):224-229 | DOI: 10.36290/vnl.2021.057  

Giant cell arteritis is the most common vasculitis in adults. The author presents the latest findings in diagnostics and treatment emphasising the growing importance of non-invasive examination methods where a biopsy of the temporal artery is no longer considered the only possible examination that confirms the diagnosis. He emphasises the importance of early diagnosis and initiation of treatment and also points out difficulties in treatment, especially frequent relapses. In addition to glucocorticoids, modern drugs influencing the decisive factors in the pathogenesis of inflammation are beginning to gain ground in treatment. Despite of new findings,...

Chronic obstructive pulmonary disease: diagnosis and treatment of stable phase of disease; personalized treatment approach using phenotype features of the disease

Kristián Brat, Jaromír Zatloukal, Kateřina Neumannová, Eva Voláková, Ondřej Kudela, Michal Kopecký, Marek Plutinský, Vladimír Koblížek

Vnitr Lek 2021, 67(4):230-239 | DOI: 10.36290/vnl.2021.058  

Chronic obstructive pulmonary disease (COPD) is a heterogenous condition affecting hundreds of millions of people worldwide. COPD is a major health problem associated with significant morbidity and mortality. In this review, the authors present the current concept of care for patients with COPD in the Czech Republic, along with a summary of treatment recommendations formulated by the expert group of the Czech Pneumological and Phthisiological Society. A more detailed version of the position paper was published in 2020. The aim of this work was to transform the most recent scientific knowledge into the context of daily practice in the Czech Republic....

Lymphangiomatosis - very rare disease of the lymphatic vessels

Zdeněk Král, Marta Krejčí, Ivana Červinková, Luděk Pour, Martin Štork, Martin Krejčí, Viera Sandecká, Zdeněk Adam

Vnitr Lek 2021, 67(4):E09-E12 | DOI: 10.36290/vnl.2021.062  

Lymphangiomatosis is rare disease, we can find this entity in differential diagnosis of osteolytic leasions of bones of unknown origin. Typical sign for lymphangiomatosis is proliferation of lymphatic tissue with production of lymphangiomas in various organs and systems. Clinical manifestation of disease is variable, involvement of lungs and bone is typical. In our article we present recent classification of lymphatic tissue neoplasias, their clinical symptoms and treatment possibilities.

Aortic stenosis and right ventricular dysfunction

Pavol Fülöp, Marianna Dvorožňáková, Gabriel Valočik

Vnitr Lek 2021, 67(4):E13-E16 | DOI: 10.36290/vnl.2021.063  

Cardiac damage in severe aortic stenosis (AS) is not limited to the aortic valve and left ventricle, but is a systemic disease characterized by a significant alteration in cardiac structure and function. Therefore, a new classification of AS based on the degree of myocardial damage was proposed. A significant number of patients with AS have right ventricular dysfunction likely due to ventricular interdependence. Relationship between right ventricular dysfunction and increased mortality in both symptomatic and asymptomatic patients with severe AS was demonstrated. These patients could benefit more from intervention. Therefore, a standardized echocardiographic...

Percutaneous coronary intervention of chronic total occlusion - to whom, when and why

Roman Štípal, Martin Poloczek, Marek Sůva, Petr Kala

Vnitr Lek 2021, 67(4):E17-E25 | DOI: 10.36290/vnl.2021.064  

Chronic total occlusion is characterised by total discontinuation of a blood flow in coronary vessel present for at least three months. Typical finding involves filling of the distal arterial segments by collateral flow. Well developed collaterals usually provide sufficient supply to preserve myocardial viability, but frequently are not capable of preventing excercise ischemia in the occluded territory. Percutaneous intervention of a CTO is focused on ischemia reduction, improvement of excercise capacity and quality of life. A succesful recanalization of a CTO leads to an improvement of left ventricular systolic function. Patients presenting with acute...

Monitoring the dynamics of clinical and laboratory markers of chronic heart failure during 12 months of sacubitril/valsartan treatment

Jana Čepelová, Marek Malý, Josef Daněk, Martin Malý

Vnitr Lek 2021, 67(4):212-117 | DOI: 10.36290/vnl.2021.055  

Aim: Treatment with sacubitril/valsartan (S/V) significantly improves cardiovascular morbidity, mortality, quality of life and prolongs the survival of chronic heart failure patients with reduced ejection fraction. The aim of the study was to evaluate changes in ejection fraction, NT-proBNP and glomerular filtration after 12 months of sacubitril/valsartan treatment. Methods: 30 patients (28 men) with chronic heart failure with reduced ejection fraction, functional classes NYHA II-III, EF LK < 40%, NT-proBNP (> 450 ng/l), with glomerular filtration > 0.5 ml/s/1.73 m², with a potassium < 5.4 mmol/l were classified in the study....

Assessment of toe brachial index validity in diabetic patients - interim results

Ondřej Machaczka, Miroslav Homza, Petra Macounová, Martina Kovalová, Jana Janoutová, Vladimír Janout

Vnitr Lek 2021, 67(4):E03-E08 | DOI: 10.36290/vnl.2021.061  

Introduction: The toe brachial index (TBI) is recommended for the detection of lower extremity arterial disease (LEAD) in case of reduced efficacy of the ankle brachial index (ABI), which most often occurs in diabetics. In this case, TBI is expected to give more accurate results. There are not many studies dealing with the use of TBI specifically in diabetics and the results are different. Objective: The purpose of this work is to present the interim results of the study, whose main objective is to assess the validity of TBI in diabetics and to determine whether this method provides improvements over the ABI. Methods: In the first phase of the study,...

Thymoma - disease of many faces

Kateřina Pokorná, Vladimír Kojecký

Vnitr Lek 2021, 67(4):240-243 | DOI: 10.36290/vnl.2021.059  

A thymoma belongs to rather rare tumors, although it holds the first place among primary mediastinal tumors in adults. The biological characteristics of thymomas are considerably divergent. The tumors are usually asymptomatic at the begining, later due to a local spread, symptoms from the infiltration or compression of adjacent structures arise, they metastasize rarely. Thymomas are often associated with various autoimmune or endocrinologic diseases. The authors present case of the patient with less common paraneoplasia - autoimmune hemolytic anemia (AIHA). Main strategy of treatment thymom with AIHA isn´t clear. The most important seems to...

Pancytopenia as the main manifestation of human immunodeficiency virus infection in the AIDS stage

Pavel Polák, Leoš Křen, Jana Lindušková, Andrea Pavlíková, Michael Doubek, Markéta Šejnohová, Miroslav Penka

Vnitr Lek 2021, 67(4):E26-E28 | DOI: 10.36290/vnl.2021.065  

The authors present a case report of 59-years-old woman examined for pancytopenia recently diagnosed during hospitalization for bilateral interstitial pneumonia without any confirmed etiological agents. Concomitantly, some systemic symptoms like lack of appetite and weight loss were present. Primary hematological disease was ruled out. Positivity of serological screening for HIV-1,2 was rather surprising. Absolute count of CD4+ lymphocytes was 8/µl. Thus, HIV infection was already in stage of AIDS and retrospectively, the interstitial pneumonia has to be judged as AIDS-indicative illness.

An effective communication between the physician and the patient in an early intervention of hypertension and dyslipidemia

Barbora Nussbaumerová

Vnitr Lek 2021, 67(4):244-248 | DOI: 10.36290/vnl.2021.060  

The article summarizes the cornestones of inicitating the pharmacotherapy of hypertension and dyslipidemia. The intervention of dyslipidemia should not be delayed after the intervention of hypertension. The compliance and the adhrence are far from ideal. The physicians should support their patients with an appropriate approach. Vascular age should be used for the explanation of the cardiovascular risk.