Immune response to vaccination in the elderly

Ivan Šterzl, Karolína Absolonová, Anna Fišerová

Vnitr Lek 2021, 67(8):E14-E18 | DOI: 10.36290/vnl.2021.129  

The immune system develops from childhood until the late age. Each of these periods has its own specialities. Aging is typical for immunity, depending on the conversion of hematogenous bone marrow to adipose, involution of the thymus and persistent viral infections (e.g. CMV). In the elderly, whose numbers have been increasing in recent decades, there is a need to understand the changes in the immune system also called as immunosenescence. The substantial remodeling of the immune system during aging leads to a decline in its functional activity in both innate (complement, cytokines, granulocytes, NK cells, macrophages) and adaptive immunity (B lymphocytes...

Antibiotic treatment issues in patients with COVID-19

Milan Kolář, Lenka Doubravská, Petr Jakubec, Miroslava Htoutou Sedláková, Kateřina Fišerová

Vnitr Lek 2021, 67(8):448-454 | DOI: 10.36290/vnl.2021.118  

The COVID-19 pandemic may increase the current threat of antimicrobial resistance and exacerbate another, rather silent, pandemic posed by the increasing frequency of multidrug-resistant bacterial pathogens and the associated potential for loss of effective antibiotics. Antibiotic treatment has often been used in patients hospitalized for COVID-19 due to concerns about possible bacterial co-infection, as confirmed by previous experience with viral respiratory infections such as H1N1 influenza, SARS and MERS. Concerns or unknowns related to the COVID-19 pandemic have also affected physicians' behavior, including the use of antibiotics. However, the...

Acute searching and early diagnosis of HCV infected persons

Petr Husa ml., Petr Husa

Vnitr Lek 2021, 67(8):455-458 | DOI: 10.36290/vnl.2021.119  

Hepatitis C virus (HCV) infection is still a major cause of chronic liver diseases, with approximately 71 million chronically infected persons worldwide. People who inject drugs currently or in the past (PWID), mostly intravenously, are the main risk group among HCV chronically infected persons. The efficacy of therapy with direct-acting antivirals (DAA) is almost 100 %. Currently, the main mission is to diagnose HCV infection in the most possible number of infected persons; it is in collision with poor adherence of PWID in particular. Changing the spectrum of chronic hepatitis C patients forces medical professionals to change their approach to diagnosis...

Optimal potassium levels in patients with heart failure

Radek Pudil

Vnitr Lek 2021, 67(8):459-464 | DOI: 10.36290/vnl.2021.120  

Heart failure therapy involves the use of a number drugs that significantly affect potassium levels. While diuretics decrease potassium levels, others (angiotensin converting enzyme inhibitors, AT2 receptor blockers, sacubitril/valsartan, spironolactone) increase. Patients also have several comorbidities that can significantly reduce renal function and thus affect the resulting potassium level. Decreased or elevated potassium levels can be very dangerous for the patient and therefore need to be monitored. In recent years, the results of several studies have been published that have focused on potassium levels and mortality and have shown that the optimal...

Unicentric Castleman's disease. Symptoms, diagnostics and therapy

Zdeněk Adam, Zdeněk Řehák, Zuzana Adamová, Renata Koukalová, Luděk Pour, Marta Krejčí, Ivanna Boichuk, Martin Krejčí, Martin Štork, Sabina Ševčíková, Zdeněk Král

Vnitr Lek 2021, 67(8):465-473 | DOI: 10.36290/vnl.2021.121  

Castleman disease (CD) includes a group of rare and heterogeneous disorders with characteristic lymph node histopathological abnormalities. CD can occur in a single lymph node station, which is referred to as unicentric CD (UCD). CD can also involve multicentric lymphadenopathy and inflammatory symptoms - multicentric Castleman disease. The first-ever diagnostic and treatment guidelines were recently developed for UCD and published 2020. Complete surgical resection is often curative and is therefore the preferred first-line therapy, if possible. The management of unresectable UCD is more challenging. Existing evidence supports that asymptomatic unresectable...

SGLT2 inhibitors - a new pillar for the treatment of heart failure

Dominika Tavačová, Jan Václavík

Vnitr Lek 2021, 67(8):475-478 | DOI: 10.36290/vnl.2021.122  

DAPA-HF and EMPEROR-REDUCED clinical trials have shown significant benefits of dapagliflozin and empagliflozin in the treatment of heart failure with reduced ejection fraction regardless of the presence or absence of diabetes mellitus. Their results support the implementation of SGLT2 inhibitors into clinical practice in patients with heart failure, due to their efficacy, safety, and minimal side effects. Their mechanism of action does not depend on the state of neurohumoral activation and SGLT2 inhibitors have a simple dosing regimen, without the need for dose titration. In addition to cardioprotective properties, SGLT2 inhibitors also have a very...

Renal parenchymal hypertension: relevant new aspects

Jan Vachek, Oskar Zakiyanov, Kateřina Oulehle, Hana Ciferská, Vladimír Tesař

Vnitr Lek 2021, 67(8):479-484 | DOI: 10.36290/vnl.2021.123  

Renal parenchymal disease is the most common cause of secondary hypertension, accounting for up to 5% cases of all cases of systemic hypertension. Renal parenchymal hypertension occurs as a complication of a wide variety of glomerular and tubulointerstitial diseases and may aggravate the decline of kidney function. The pathophysiology of renal parenchymal hypertension represents a combined interaction of the impaired sodium handling leading to volume expansion, alteration of the renin-angiotensin system, abnormalities in endogenous vasodepressor compounds and possibly enhanced activity of vasoactive substances. Renal parenchymal hypertension can occur...

Long‑term mechanical circulatory support for chronic heart failure - real life practice

Luděk Pavlů, Marek Vícha, Libor Jelínek, Miloš Táborský, Jana Petřková

Vnitr Lek 2021, 67(8):E3-E6 | DOI: 10.36290/vnl.2021.127  

Thanks to developments in pharmacological and non-pharmacological treatment of heart failure over the last half century, there has been improved quality of life and reduced mortality and morbidity. Despite these advances, the prognosis of advanced heart failure remains poor and the number of patients with terminal heart failure is currently increasing. In the general medical community, knowledge of pharmacological and device therapy with implantable cardioverter-defibrillator or resynchronization therapy is prevalent. However, only a limited number of professionals, mostly in tertiary centres, have personal experience with the use of long-term mechanical...

Review of Czech literature focused on terminology of medication adherence

Eliška Voříšková, Barbora Košťálová, Josef Malý, Kateřina Malá‑Ládová

Vnitr Lek 2021, 67(8):E7-E13 | DOI: 10.36290/vnl.2021.128  

Background: Medication taking terminology is often used incorrectly or inconsistently in the world literature and the meaning of the terms is interchanged. The aim of the work was to map the Czech literature and find out whether Czech authors use terminology related to medication adherence and whether they are consistent in defining it. Methods: Based on the methodological instructions for the translation of the so-called ABC Taxonomy introduced by International Society for Medication Adherence (ESPACOMP), a search of Czech literature published until September 22nd, 2021 in the databases ProLékaře.cz, BMČ, PubMed, and Solen was prepared. Morphological...

Tumor induced osteomalacia

Lenka Filipová, Ivica Lazúrová

Vnitr Lek 2021, 67(8):E19-E22 | DOI: 10.36290/vnl.2021.130  

Tumor induced osteomalacia (TIO) is a rare paraneoplastic syndrome typically caused by small endocrine tumors that secrete fibroblast growth factor 23(FGF23). TIO is clinically characterized by progressive muskuloskeletal pain, fatigue, proximal muscle weakness, and multiple fractures that lead to long-term disability. Due to the non-specific symptoms of the disease, it may take several years for them to be properly diagnosed and treated, so it is important to better inform about this rare paraneoplastic syndrome. Key word: FGF23, hypophosphataemia, tumor induced osteomalacia.

Th1, Th2 and Th17 lymphocytes in autoimmune thyreopathies

Karolína Absolonová, Petr Matucha, Ivan Šterzl

Vnitr Lek 2021, 67(8):E23-E28 | DOI: 10.36290/vnl.2021.131  

Among the most common organ-specific autoimmune diseases are autoimmune thyreopathies. We have focused on the importance of Th1, Th2 and Th17 lymphocytes in autoimmune thyroiditis (AT). The cohort consisted of 136 treated patients in the full clinical course of AT (24 men, mean age 41.0±16.8 years and 112 women, mean age 44.6±17.6 years). The control group consisted of 17 healthy men (mean age 44.0±5.0 years). Box-Cox transformation of the data, t-tests and Pearson correlation analysis were used for statistical calculations. Lymphocyte subpopulations were determined by flow cytometry. We found statistically significant correlations between...

Bilateral multiple pneumatocele as a rare late complication of COVID-19 pneumonia

Samuel Genzor, Jan Mizera, Milan Sova, Shayan Nadjarpour, Petr Jakubec

Vnitr Lek 2021, 67(8):485-488 | DOI: 10.36290/vnl.2021.124  

Pneumatocele is a cavity, which may develop rarely as a complication of pneumonia. It is more common in patients requiring ventilation support. After COVID-19 pneumonia, there are only several case reports described. Our case report is about a male patient without any serious commorbities. The patient had bilateral multiple pneumatocele which have formed in postacute phase of moderate course of COVID-19. Other possible causes have been exluded by a complex examination. During the follow-up there was a clear gradual spontaneous resorption of the finding. The patient is still in very good clinical condition.

Lethal alcohol intoxications cases: thinking about the causes

Peter Makovický, Radek Matlach, Pavol Makovický

Vnitr Lek 2021, 67(8):E29-E36 | DOI: 10.36290/vnl.2021.132  

Alcohol is a well-known, socially tolerated drug. Its harmfulness to human health, including its associated negative impact on the family of alcoholics, is well known. It is an interdisciplinary problem, whose solution requires financial contributions, society support, the involvement of a wider group of experts and finally also an active approach on young people and adults to this problem. The work is based on six lethal alcohol intoxication cases. The first case is devoted to a woman who dies in alcohol intoxication in the casino. The second case involves a man who died near the pond in alcohol intoxication. The third describes the course of the...

What are the specifics of diabetic foot syndrome and why we need interdisciplinary recommendations for its diagnosis and treatment?

Alexandra Jirkovská, Vladimíra Fejfarová, Michal Dubský, Veronika Wosková, Jiří Jarkovský, Klára Benešová, Tomáš Pavlík

Vnitr Lek 2021, 67(8):489-494 | DOI: 10.36290/vnl.2021.125  

The care of patients with diabetic foot syndrome (DFS) requires interdisciplinary cooperation, and therefore interdisciplinary recommendations focused on the diagnosis and treatment and prevention of DFS are in place. We also need these recommendations because DFS has its own specifics that affect its diagnosis, therapy, but also the prognosis of patients. These include, for example, the different course of infection and PAD in patients with diabetes, the diagnosis of neuropathic Charcot osteoarthropathy, and the frequent association with end stage kidney disease, which worsens the course of SDN and increases its risk. Last but not least, the specifics...

Expert consensus on the importance of iron deficiency and the possibility of its correction in patients with heart failure

Vojtěch Melenovský, Miloš Táborský, Aleš Linhart, Jan Malík, Filip Málek, Radek Pudil, Jan Krejčí, Milan Šíranec

Vnitr Lek 2021, 67(8):495-497 | DOI: 10.36290/vnl.2021.126  

Anemia and iron deficiency are common non-cardiovascular comorbidities of heart failure. The prevalence of iron deficiency is up to 55 % of patients with chronic heart failure and up to 80 % subjects with acute heart failure including acute decompensated heart failure, independently on anemia. The European Society of Cardiology Heart Failure Guidelines 2021 recommend intravenous iron replacement in patients with heart failure and iron deficiency to improve symptoms, stress tolerance and quality of life in chronic heart failure and to reduce risk of subsequent hospitalization after acute decompenstation.

Memorandum z jednání zástupců ČIS a ČPFS dne 6. 5. 2021 v Lékařském domě ČLS JEP v Praze

Richard Češka, v. r., Martina Vašáková, v. r.

Vnitr Lek 2021, 67(8):498  

24hodinová mortalita seniorů akutně hospitalizovaných pro interní onemocnění - může být ovlivněna přítomností diabetu jako komorbidity?

Jan Brož, Martina Nováková, Milan Kvapil

Vnitr Lek 2021, 67(8):E37-E38 | DOI: 10.36290/vnl.2021.133