Ohlédnutí za XXVIII. kongresem ČIS ČLS JEP

MUDr. Zdeněk Monhart, Ph.D.

Vnitr Lek 2022, 68(1):3  

How to run an internal medicine department: head physician - trainer

Zdeněk Monhart

Vnitr Lek 2022, 68(1):8-13 | DOI: 10.36290/vnl.2022.001  

Internal medicine is the core medical discipline that is responsible for the care of adults with complex illness. Therefore, the preparation for the internal medicine specialty is demanding and requires close cooperation of trainees with the educational supervisor, who is usually the head of the internal medicine department. In addition to his medical work, the head of the department is also director of the training programme. Educational activities should have their allocated time, and all doctors who act as trainers should recognise their responsibility to participate in the postgraduate training of future physicians. Comprehensive assessment of...

Operating a modern performance-oriented internal medicine outpatient unit

Tomáš Hauer

Vnitr Lek 2022, 68(1):15-18 | DOI: 10.36290/vnl.2022.002  

Outpatient internal medicine clinics as a key providers of health care are not in their best shape and are facing up to range of economical as well as staffing issues. If current status does not change, outpatient internal medicine can become marginal field of medicine. Article offers analysis of current situation and possible means of change.

Recommendations of the European Society of Hypertension for measuring blood pressure in the medical office and outside the medical facility

Jan Filipovský

Vnitr Lek 2022, 68(1):34-40 | DOI: 10.36290/vnl.2022.005  

The document was prepared by the Working Group on Blood Pressure Monitoring and Cardiovascular Variability of the European Society of Hypertension (1). It presents practical and simple recommendations which are, however, important for accurate blood pressure measurement. Contrary to the majority of other guidelines, it does not assess level of evidence and classes of recommendations because many aspects of blood pressure measurement are based on usual clinical practice rather than on data from high-quality studies.

Multicentric Castleman's disease. Symptoms, diagnostics and therapy

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

Vnitr Lek 2022, 68(1):41-53 | DOI: 10.36290/vnl.2022.006  

Castleman disease (CD) describes a group of heterogeneous hematologic disorders with characteristic histopathological features. CD can present with unicentric (UCD) or multicentric (MCD) regions of lymph node enlargement. Some cases of MCD are caused by human herpesvirus-8 (HHV-8), whereas others are HHV-8-negative/idiopathic (iMCD). Treatment of iMCD is challenging, and outcomes can be poor. In this paper, we briefly report about symptoms of iMCD and about the International, evidence‑based consensus diagnostic criteria for HHV-8-negative/idiopathic multicentric Castleman disease and International evidence based consensus treatment guidelines...

Cholesterol measurement and current guidelines

Vladimír Soška

Vnitr Lek 2022, 68(1):54-57 | DOI: 10.36290/vnl.2022.007  

The concentration of total cholesterol has so far been part of the SCORE tables for estimating the risk of cardiovascular events; in the new SCORE2 tables, it has already been replaced by non-HDL-cholesterol. Total cholesterol continues to serve as a guide for the presence of dyslipoproteinemia and is necessary for the calculation of LDL-cholesterol and non-HDL-cholesterol. The importance of HDL-cholesterol as a separate risk factor is already limited, but it is necessary for the calculation of non-HDL-cholesterol and LDL-cholesterol. LDL-cholesterol remains an essential indicator of risk, it is needed for decision making and control of hypolipidemic...

Smoking cessation and risk of type 2 diabetes

Jana Malinovská, Jana Urbanová, Veronika Vejtasová, Alexandra Romanová, Sabina Pálová, Syed Taha Naeem, Jan Brož

Vnitr Lek 2022, 68(1):E04-E08 | DOI: 10.36290/vnl.2022.011  

Risk of type 2 diabetes mellitus (T2DM) is higher in tobacco smokers compared to non-smokers. The risk declines after smoking cessation. However, ex-smokers are also more prone to the metabolic syndrome. The question thus is, whether ex-smokers could temporarily have a higher risk of T2DM than current smokers. The available studies on this topic are not in agreement in their conclusions, as most of them also primarily do not compare ex-smokers to current smokers, but to non-smokers. However, based on the available studies, it rather seems the risk of T2DM is temporarily higher after smoking cessation. The higher risk of T2DM seems to be enhanced by...

Ethical connotations of conducting clinical trials during the COVID-19 pandemic

Anetta Jedličková

Vnitr Lek 2022, 68(1):E09-E15 | DOI: 10.36290/vnl.2022.012  

The paper focuses on conducting clinical trials on medicinal products for human use during the COVID-19 pandemic, which has brought entirely new ethical dilemmas to clinical research professionals, as well as to the general public. Growing ethical concerns emphasized the need for partially modified or completely new procedures in order to ensure the safety of clinical trial participants, compliance with good clinical practice, and minimizing risks to the clinical trial integrity and validity of data obtained from clinical trials conducted during the pandemic. The paper acquaints with emergency measures issued by the State Institute for Drug Control...

Exercise in the treatment of ankylosing spondylitis

Dávid Líška

Vnitr Lek 2022, 68(1):E16-E21 | DOI: 10.36290/vnl.2022.013  

Seronegative spondyloarthritis is a progressive inflammatory disease with a wide and varied range of symptoms. Ankylosing spondylitis (AS) is a chronic inflammatory rheumatic disease characterized by pain and structural changes. Ankylosing spondylitis is characterized by functional disorders such as reduced mobility and axial deformity, leading to a decrease in patient quality of life. The purpose of this article is to provide basic information on therapeutic options for exercise in the treatment of ankylosing spondylitis. Therapeutic exercise is the most important non-pharmacological intervention in patients. In addition to positive metabolic effects,...

Direct costs in patients with nonvalvular atrial fibrillation newly indicated to apixaban: a retrospective‑prospective single‑arm cohort study

Daniela Štrosová, Jan Tužil, Barbora Pilnáčková, Lada Lžičařová, Veronika Typovská, Helena Doležalová, Martin Herold, Tomáš Doležal

Vnitr Lek 2022, 68(1):26-33 | DOI: 10.36290/vnl.2022.004  

Background: Atrial fibrillation (AF) affects 46.3 million people; its prevalence has tripled over the last 50 years. AF leads to formation of blood clots increasing four-fold the risk of a stroke. Preventive anticoagulant therapy with warfarin has been well established for over 50 years but has efficacy and safety limitations. New anticoagulants do not require laboratory monitoring of prothrombin time, have low risk of adverse events, yet are more costly. Methods: This non-interventional (Act 378/2007 Coll.) retrospective-prospective single-arm cohort study consisted of 3 visits. The primary objective was to compare the total direct cost of treatment...

Pacient s jaterní cirhózou na interním oddělení, intervence případného abúzu alkoholu

Jana Malinovská, Roman Pavlof, Ondřej Hloch, Veronika Vejtasová, Jana Urbanová, Jan Brož

Vnitr Lek 2022, 68(1):19-25 | DOI: 10.36290/vnl.2022.003  

Závažné zlyhávanie srdca a arytmia po protinádorovej liečbe podávanej v detstve

Xénia Faktorová, Milan Luknár, Zuzana Zelinková, Lucia Horniaková, Eva Mikušková, Michal Šašov, Mária Szántová, Viliam Mojto, Beata Mladosievičová

Vnitr Lek 2022, 68(1):E22-E26 | DOI: 10.36290/vnl.2022.014  

Cieľom kazuistiky je popísať prípad mladého pacienta, v detstve úspešne liečeného pre non-Hodgkinov lymfóm chemoterapiou s obsahom anthracyklínu doxorubicínu s neskorším rozvojom príznakov závažného kardiovaskulárneho poškodenia 27 rokov od diagnostiky lymfómu. Pacient je dlhodobo v kompletnej remisii onkologického ochorenia. U pacienta bola započatá liečba chronického srdcového zlyhávania v súlade s najnovšími odporúčaniami vrátane implantácie kardioverter-defibrilátora, ako primárnej prevencie náhlej kardiálnej smrti. Momentálne je pacient čakateľom na transplantáciu srdca.

Differential diagnosis of pituitary enlargement

Katarína Štěchovská, Tomáš Tůma, Václav Masopust, Mikuláš Kosák

Vnitr Lek 2022, 68(1):58-63 | DOI: 10.36290/vnl.2022.008  

Enlargement of the pituitary gland is heterogenous in the etiology. Common causes of pituitary enlargement are physiological hypertrophy during pregnancy, primary and secondary tumors, autoimmune hypophysitis including side effects of anticancer therapy with check-point inhibitors. Terms like hypertrophy, hyperplasia, sellar expansion and hypophysitis are commonly used to describe enlargement of the pituitary gland on MR scan regardless its etiology. The most common pathology causing pituitary gland enlargement is pituitary adenoma. Magnetic resonance imaging can differentiate pituitary tumors from diffuse enlargement due to hypophysitis in most but...

Testing renal function in practice

Vladimíra Bednářová, Hana Šafránková

Vnitr Lek 2022, 68(1):E27-E32 | DOI: 10.36290/vnl.2022.015  

Chronic kidney disease patients often present late for dialysis due to minimal clinical symptoms, which are frequently undiscovered by both general practitioners and specialists. They have no information about renal replacement therapy, including preemptive kidney transplantation and do not have a permanent dialysis access. This fact increases the morbidity and mortality of those patients. Common preventive examinations such as blood pressure measurement, serum biochemistry, urinalysis, and glomerular filtration tests, might help with earlier diagnosis of these patients by others specialities and timely referral to nephrologist.

Advances of the contemporary treatment of hypertension and hypercholesterolemia by a new fixed combination

Hana Rosolová

Vnitr Lek 2022, 68(1):64-67 | DOI: 10.36290/vnl.2022.009  

Parallel occurrence of high blood pressure and high plasma cholesterol level is very frequent, in our population in 30 %, and brings multiplicative higher risk for atherosclerotic cardiovascular diseases. On the other hand the contemporary treatment of them reduces that risk synergically. New fixed combination pill of rosuvastatin and ramipril (Kastel) is very felicitous choice for patients with hypercholesterolemia and mild hypertension, in which two antihypertensive drugs are not required immediatelly.

Levothyroxine

Jan Krátký

Vnitr Lek 2022, 68(1):68-73 | DOI: 10.36290/vnl.2022.010  

Levothyroxine is a synthetic levoisomer of thyroxine. Currently, it is one of the most commonly prescribed drugs worldwide. The main indication for levothyroxine treatment is hypothyroidism of any type. It is also used for suppression therapy in patients with thyroid cancer. The therapeutic dose depends on the residual thyroid secretion, the weight of the patient, and the purpose of the treatment. The initial dose typically ranges from 25 to 50 μg daily, with further adjustment according to the level of thyroid-stimulating hormone (TSH). Initial dose titration is not recommended during postoperative replacement therapy and in pregnant women with...

Muž s dýmkou, prof. MUDr. Pavel Klener, DrSc., se v dubnu 2022 dožívá 85 let

Jan Haber, Marek Trněný

Vnitr Lek 2022, 68(1):E33-E34