Co přinášejí pro klinickou praxi mezinárodní aktivity Less is more a Choosing wisely?

MUDr. Luboš Kotík, CSc.

Vnitr Lek 2021, 67(7):383-384 | DOI: 10.36290/vnl.2021.104  

Ways to make the right decisions in internal medicine and some specialized fields

Pavel Havránek

Vnitr Lek 2021, 67(7):390-393 | DOI: 10.36290/vnl.2021.105  

The article presents the Choosing wisely (CHW) approach to selected problems of internal medicine, as developed by professional societies in the USA, Great Britain, Canada, Australia and the Federal Republic of Germany. It deals in more detail with issues and procedures in specialized fields of nephrology and rheumatology. There are negative, but also some positive recommendations on how the CHW approach views them.

In general medicine surplus of care can harm the patients

Luboš Kotík

Vnitr Lek 2021, 67(7):394-398 | DOI: 10.36290/vnl.2021.106  

Article brings several chosen topics, where in therapy and diagnostic would less be more, that are very often dealt by so called generalists, experts with broad knowledge in medicine. Those are first of all internists and general practitioners.

Metabolic and endocrine diseases - is our approach always rational?

Ludmila Brunerová, Jana Urbanová, Jan Brož

Vnitr Lek 2021, 67(7):399-403 | DOI: 10.36290/vnl.2021.107  

Choosing wisely in metabolic and endocrine diseases shows the inutility of some, in clinical practice often used, ways of management. In diabetology, the routine recommendation for selfmonitoring of type 2 diabetic patients not treated with insulin represents a contraversial issue. On the contrary, there is a consensus on rational targets of glycemic control in elderly frailty patients with limited life expectancy. In endocrinology (thyroid diseases), the iniciative fights against the overuse of some laboratory examinations and ultrasonography. The recommendations on the rational indications of densitometry are discussed. In conclusion, these recommendations...

Expert consensus on the practical aspects of the cooperation of cardiologist and diabetologist in the management of the patients with chronic heart failure and reduced ejection fraction

Martin Haluzík, Markéta Kubíčková, Jiří Veselý, Aleš Linhart, Martin Prázný, Jan Škrha, Miloš Táborský, Filip Málek

Vnitr Lek 2021, 67(7):404-410 | DOI: 10.36290/vnl.2021.108  

Diabetes mellitus is an important risk factor for the development of heart failure and presence of diabetes significantly worsens heart failure outcome. Introduction of gliflozins to the therapy of heart failure is one of the most important novelty. Gliflozins reduce glucose level by the sodium-glucose contransporter 2 inhibition in proximal tubulus in the kidney. Gliflozins are used as effective antidiabetic drugs with improvement of glycemic control without risk of hypoglycemia, gliflozins decrease blood pressure and patients weight. Recent studies have shown that gliflozins significantly reduce risk of cardiovascular complications and heart failure...

Cardiovascular prevention: early and consistent prevention versus late intervention, complex approach to the treatment of modifiable risk factors: hypertension and dyslipidemia

Lukáš Zlatohlávek

Vnitr Lek 2021, 67(7):412-418 | DOI: 10.36290/vnl.2021.109  

Cardiovascular diseases (not including COVID-19 infection) are still one of the most common causes of mortality and morbidity in our country and in developed countries. Today no one questions the intervention of all risk factors for atherosclerosis after a cardiovascular event, although unfortunately even in this case the recommended target values are often not achieved. However, the intervention of risk factors in primary prevention is often neglected. Atherosclerosis is a long-term process, developing since the childhood. It is a continuous process and the event itself is only the culmination of this process. Therefore, it is necessary to intervene...

Hereditary hemorrhagic telangiectasia (Osler‑Weber‑Rendu syndrome) - Part II. Pharmacological therapy and international guidelines for the therapy 2020

Zdeněk Adam, Dagmar Brančíková, Gabriela Romanová, Luděk Pour, Marta Krejčí, Jiří König, Tomáš Nebeský, Zuzana Adamová, Martin Štork, Martin Krejčí, Sabina Ševčíková, Michal Eid, Viera Sandecká, Zdeněk Král

Vnitr Lek 2021, 67(7):419-424 | DOI: 10.36290/vnl.2021.110  

Hereditary hemorrhagic telangiectasia also known as Osler-Weber-Rendu syndrome, is an disorder that causes abnormal blood vessel formation with bleeding. Inhibition of angiogenesis amelioretes bleeding complication. Anti-angiogenic agents such as bevacizumab, aflibercept, thalidomid, lenadomid and other new anti-angiogenic thyrosinkinase inhibitors, as well as sirolimus and takrolimus have emerged as a promising systemic or local therapy in reducing bleeding complications but are not curative. Other pharmacological agents include iron supplementation, antifibrinolytics and hormonal treatment. This review concentrates on new anti-agioproliferative drugs...

Appropriate and inappropriate therapies of implantable cardioverter‑defibrillators

David Kiss, Milan Kozák, Milan Sepši, Petr Kala

Vnitr Lek 2021, 67(7):426-432 | DOI: 10.36290/vnl.2021.111  

Implantable cardioverter-defibrillators (ICD) reduce mortality of patients with risk of sudden cardiac death in primary and secondary prevention. Patients with implanted ICD can receive appropriate and inappropriate therapies with different incidence in both indication groups. There are some factors which can predict the incidence of ICD therapies. In some cases higher incidence of ICD therapies could negatively impact quality of patients lives. As predictive factors for higher incidence of appropriate therapies are discussed: reduced left venctricular ejection fraction, body mass index, chronic renal failure and frequent hospitalization for acute...

Recommendations for safe collection of venous blood by a closed collection system

Beáta Bolerázska, Anna Birková, Beáta Čižmárová, Beáta Hubková

Vnitr Lek 2021, 67(7):E8-E12 | DOI: 10.36290/vnl.2021.114  

In recent years, data have been repeatedly published stating that most errors in the process of obtaining a laboratory result occur in the pre-analytical phase (46 % to 68.2 %). This is an area that is usually out of direct control of the laboratory, involving venous blood collection (phlebotomy). The detection of these errors is considered to be quite difficult and can therefore easily lead to a misinterpretation of laboratory results with a consequent adverse effect for the patient and even in unintended injury. The most effective way to prevent them is to have a good knowledge of the current blood collection recommendations, which were recently...

Amanita phalloides intoxication: mechanism of toxicity, clinical manifestations and therapeutic approaches

Eva Kieslichová

Vnitr Lek 2021, 67(7):E13-E17 | DOI: 10.36290/vnl.2021.115  

Ingestion of Amanita phalloides is the most common cause of fatal mushroom poisoning. The clinical picture of intoxication varies from mild subclinical manifestation to lethal fulminant course with the development of acute liver failure. Early diagnosis of Amanita phalloides poisoning is crucial for the outcome but i tis difficult because it is often mistaken as gastroenteritis or due to other mushroom poisoning. The diagnosis is based on the history of recent mushroom ingestion followed by gastrointestinal symptoms, typical time course and laboratory markers and is proven with mycological examination or toxicological examination. Specific treatment...

Monitoring and analysis of fall risk factors in hospitalized patients

Iva Brabcová, Hana Hajduchová, Valérie Tóthová, Sylva Bártlová, Jiří Holý, Martin Doseděl, Josef Malý, Jiří Vlček

Vnitr Lek 2021, 67(7):E3-E7 | DOI: 10.36290/vnl.2021.113  

Goal: The goal of the study was to identify pharmacological and non-pharmacological fall risk factors in hospitalized patients. Methodology: A multicenter observational case study and monitoring was chosen for this purpose. The study involved patients hospitalized at 20 hospital units of the South Bohemian Region between 2017 and 2019. The total number included 378 patients with falls (case group) and 1,821 patients without falls (control group). Results: Dementia OR 2.47 [95%; CI 2.01-3.76] and stroke OR 6.83 [95%; CI: 3.47-13.45] were the most probable diagnoses to increase the fall risk. The medication groups that significantly increased the fall...

First zero contrast PCI guided by intracoronary ultrasound in the Czech Republic

Marek Sůva, Roman Štípal, Martin Poloczek, Jan Kaňovský, Otakar Boček, Petr Jeřábek, Martin Hudec, Vojtěch Brázdil, Petr Kala

Vnitr Lek 2021, 67(7):433-437 | DOI: 10.36290/vnl.2021.112  

Contrast induced nephropathy is associated with worse clinical outcome in patients undergoing coronary intervention. The most profound risk factor is advanced chronic renal insufficiency. Due to the increasing number of coronary interventions on severally ill patients, there is a need of modern therapeutic approach that could reduce the volume of contrast media to minimum or even zero. Herein, the authors present a case report of a 68-year-old patient with chronic kidney disease, who required elective coronary intervention (PCI) due to a significant lesion of the left anterior descending coronary artery. During this intervention, maximum emphasis was...

Amiodarone induced pulmonary toxicity

Martin Hudec, Petra Vysočanová, Vojtěch Brázdil, Martin Poloczek, Martin Hetmer, Jiřina Little, Martina Doubková, Petr Kala

Vnitr Lek 2021, 67(7):E18-E23 | DOI: 10.36290/vnl.2021.116  

Amiodarone is one of the more frequently used drugs in the treatment of supraventricular and ventricular arrhythmias. Many adverse effects, more or less serious, are associated with its administration. Amiodaron-induced pulmonary toxicity (AIPT) is quite rare but represents one of the most severe adverse effects with high mortality. We present an 80 years old patient, who used amidorane due to paroxysmal atrial fibrillation for several years. Within 3 months, he was repeatedly hospitalized for a bilateral pneumonia. Eventually, AIPT was diagnosed. Early diagnosis, proper therapy of AIPT and changed antiarrhythmic therapy has significantly improved...

Pitfalls of diagnosing autoimmune pancreatitis

Denisa Frajerová

Vnitr Lek 2021, 67(7):E24-E27 | DOI: 10.36290/vnl.2021.117  

The diagnosis of the rare disease autoimmune pancreatitis (AIP) is demonstrated in the case of a patient who underwent a series of examinations that were unable to unequivocally prove the diagnosis of benignity. The disease as a form of chronic pancreatitis, and the most important and first objective of the examination is to exclude malignant disease of the pancreas and biliary tract. While imaging led to suspicion of malignancy, repeated histological examinations did not confirm it. After we were able to exclude suspected carcinoma according to the available diagnostic criteria, AIP was confirmed, and a diagnosis of type I was made, which belongs...