Hlavní téma - Multimorbidita ve vnitřním lékařství

prof. MUDr. Jan Václavík, Ph.D., FESC, FEFIM

Vnitr Lek 2023, 69(3):143  

Perioperative care about a patient with multimorbidity

Eduard Havel

Vnitr Lek 2023, 69(3):148-155 | DOI: 10.36290/vnl.2023.027  

The assumption of accelerated postoperative recovery according to the ERAS (Enhanced Recovery After Surgery) method is good condition of the patient prepared for surgery and gently operated on. Application of ERAS in postoperative care in the situation of patient with multimorbidity requires an individual approach and greater pre-operative preparation. During the healing process, the operation causes a systemic inflammatory reaction in the body, which is proportional to the size of the surgery trauma. There is fluid movement between the intravascular and interstitial spaces, increased protein catabolism, increased susceptibility to infectious complications...

Multimorbidity in nephrotic syndrome

Vladimír Teplan

Vnitr Lek 2023, 69(3):156-165 | DOI: 10.36290/vnl.2023.028  

Nephrotic syndrome (NS) is characterized by high proteinuria (over 3,5g/24 hrs), hypalbuminaemia, general edemas and hypercoagulation. Beside of primary glomerulonephritides this is found in secundary glomerulopaties eg. diabetes, systemic inflammatory diseases, oncology, damage by drugs and poisoning, by alergy, serious infections and in children from hereditary reasons. The most frequent reason for NS in adults patiens is diabetes and diabetes with nephropathy represents almost 40% of dialysed patiens. From this point of view, there is great interest focusing on gliflozins (SGLT2 inhibitors) with positive nephroprotecive effect. It leads do increasing...

Critical care for multimorbid patients

Marcela Královcová, Thomas Karvunidis, Martin Matějovič

Vnitr Lek 2023, 69(3):166-172 | DOI: 10.36290/vnl.2023.029  

Multimorbidity - the simultaneous presence of several chronic diseases - is very common in the critically ill patients. Its prevalence is roughly 40-85 % and continues to increase further. Certain chronic diseases such as diabetes, obesity, chronic heart, pulmonary, liver or kidney disease and malignancy are associated with higher risk of developing serious acute complications and therefore the possible need for intensive care. This review summarizes and discusses selected specifics of critical care for multimorbid patients.

Clinical assessment and management of patients with multimorbidity

Zdeněk Monhart

Vnitr Lek 2023, 69(3):173-180 | DOI: 10.36290/vnl.2023.030  

Internal medicine specialists, also known as general internal medicine specialists are specialist physicians trained to manage particularly complex or multisystem disease conditions that single-organ-disease specialists may not be trained to deal with. The management of multimorbidity, however, is often complex, and requires specific clinical skills and corresponding experience in appropriate diagnostic and therapeutic procedures. Multimorbidity is associated with a decline in many aspects of health and in consequence with an increase in hospital admissions, polypharmacy, and use of health care and social resouces. When prescribing medicine to patients...

JAK inhibition in the treatment of inflammatory rheumatic diseases

Ladislav Šenolt

Vnitr Lek 2023, 69(3):181-188 | DOI: 10.36290/vnl.2023.031  

The most common immune-mediated inflammatory rheumatic diseases, such as rheumatoid arthritis, psoriatic arthritis, and axial spondyloarthritis, have reached significant progress in recent years with the introduction of biological therapies targeting cytokines and immune cells, but also small molecules targeting intracellular enzymes, specifically Janus kinases (JAKs). Intracellular JAK signaling is activated by binding various cytokines or growth factors to their respective cellular receptors, leading to the activation of Signal Transducers and Activators of Transcription (STAT) and ultimately gene transcription with a pivotal role in innate and adaptive...

Effect of sodium-glucose co-transporter-2 inhibitor empagliflozin on disease progression in a patient with heart failure and preserved ejection fraction

Filip Málek

Vnitr Lek 2023, 69(3):189-192 | DOI: 10.36290/vnl.2023.032  

Sodiumglucose co-transporter 2 inhibitors - gliflozins - have a scientific evidence on efficacy in patients with heart failure regardless left ventricular ejection fraction. Gliflozins They reduced combined endpoint of cardiovascular mortality and heart failure hospitalization also in patients with heart failure and left ventricular ejection fraction above 40 %. We report a case study of a patient with new onset heart failure. Early initiation of therapy with empagliflozin was associated with an improvement of symptoms and laboratory parameters including NT-proBNP level.

Successful therapy of retroperitoneal fibrosis due to IgG4-related disease with rituximab, cyclophosphamide and glucocorticoids followed by maintenance therapy wit ritutixmab

Zdeněk Adam, Aleš Čermák, Hana Petrášová, Zdeněk Řehák, Renata Koukalová, Zdeněk Fojtík, Luděk Pour, Ivanna Boichuk, Marta Krejčí, Zdeněk Král, Petr Benda

Vnitr Lek 2023, 69(3):E4-E15 | DOI: 10.36290/vnl.2023.035  

Idiopathic retroperitoneal fibrosis (IRF) is a rare condition characterized by the development of a peri-aortic and peri-iliac tissue showing chronic inflammatory infiltrates and pronounced fibrosis. Ureteral entrapment with consequent obstructive uropathy is one of the most common complications, which can lead to acute renal failure and, in the long term, to varying degrees of chronic kidney disease. Common symptoms at onset include lower back, abdominal or flank pain, and constitutional symptoms such as malaise, fever, and anorexia and weight loss. Pain is frequently referred to the hip, to the groin and to the lateral regions of the leg, with nocturnal...

Barakat syndrome

Beáta Arciniegas Berkešová, Zoltán Borbély

Vnitr Lek 2023, 69(3):E16-E19 | DOI: 10.36290/vnl.2023.036  

Barakat syndrome, also known as HDR syndrome, is a clinically heterogenous, autosomal dominant rare genetic disease, which frequency is unknown. It is primarily caused by deletion of chromosome 10p14 or mutation of GATA3 gene, located on chromosome 10. Although this syndrome is phenotypically defined by its triad of HDR: hypoparathyroidism (H), deafness (D), renal disease (R), the literature identifies cases with different components, consisting of HD, DR, HR (1). The syndrome was first described by Amin J. Barakat et al. in 1977 in siblings with hypocalcemia and proteinuria (2). So far, about 180 cases have been reported in the worldwide medical literature...

Differential diagnostics of interstitial lung diseases

Martina Šterclová

Vnitr Lek 2023, 69(3):193-197 | DOI: 10.36290/vnl.2023.033  

Interstitial lung diseases very often do not only affect the lung tissue, but are part of multisystem diseases. Awareness of their classification and differential diagnosis therefore does not belong only to respiratory departments, but shall be acknowledged by all specialisations. It is obvious that the approach to a patient with life-threatening disease or acute onset of symptoms differently then patients with slow disease onset or "accidentally" detected lung abnormalities. The presented manuscript brings a differential diagnostic approach to facilitate orientation in the field of interstitial ling diseases.

Whats new in ESC Guidelines for the management of valvular heart disease?

Marian Branny

Vnitr Lek 2023, 69(3):E24-E27 | DOI: 10.36290/vnl.2023.038  

The article summarize the most important changes regarding the management of valvular heart disease, which have been made in the ESC Guidelines 2021. Based on the randomized clinical study data, which were recently published, the most frequent changes were done in terms of the choice of mode of intervention in the aortic and mitral valves as well as in the management of the antithrombotic therapy.

Finerenone

Jan Vachek, Vladimír Tesař

Vnitr Lek 2023, 69(3):E20-E23 | DOI: 10.36290/vnl.2023.037  

In developed countries, diabetes mellitus (DM) is one of the main causes of end stage renal disease (ESRD). In addition, the development of chronic kidney disease (CKD) further increases the already significantly increased cardiovascular (CV) risk in patients with diabetes. Both albuminuria and impaired renal function predict CV disease-related morbidity. The multifactorial pathogenesis of DM-related CKD involves structural, physiological, hemodynamic, and inflammatory processes. Instead of a so-called glucocentric approach, current evidence suggests that a multimodal, interdisciplinary treatment approach is needed to also prevent further progression...

Komentář k článku „Jak přesvědčit pacienta odmítajícího kolonoskopické vyšetření – kvalitativní studie“ z psychologického hlediska

Svatava Krejčová

Vnitr Lek 2023, 69(3):E28-E29  

News in gastroenterology, hepatology and digestive endoscopy

Přemysl Falt, Dana Ďuricová, Tomáš Fejfar, Štěpán Šembera, Ilja Tachecí

Vnitr Lek 2023, 69(3):198-206 | DOI: 10.36290/vnl.2023.034  

Gastroenterology, hepatology and digestive endoscopy are rapidly evolving disciplines with significant advances in the diagnostics and treatment in the entire gastrointestinal tract. The aim of our article was to summarize new perspectives on relevant situations in gastroenterology and hepatology like acute pancreatitis, functional dyspepsia, rational indication of proton pump inhibitors, inflammatory bowel diseases (IBD), cholestatic liver diseases, alcohol induced hepatitis, non-alcoholic fatty live disease (NAFLD) and patophysiology of bilirubin and bile acids. Digestive endoscopy represents an interventional part of gastroenterology and key recent...