2024: ROK INTERNY

Prof. MUDr. Richard Češka, CSc., FEFIM, FACP

Vnitr Lek 2023, 69(8):479  

Hlavní téma – práce oceněné na 40. dnech mladých internistů

prof. MUDr. Pavel Horák, CSc.

Vnitr Lek 2023, 69(8):484  

Haemoglobin glycation index (HGI) as a marker of individual glycation in diabetes

Martin Pehr, Jan Škrha jr.

Vnitr Lek 2023, 69(8):485-487 | DOI: 10.36290/vnl.2023.097  

Glycated haemoglobin (HbA1c) is the golden standard in the assessment of long-term diabetes control. It has certain flaws and can be misleading especially in chronic kidney disease, anaemia and other RBC disturbances. The growing use of continuous glucose sensors has enabled the assessment of diabetes control by the glucose management indicator (GMI) based on average glycemia and thus glycation only. In certain patients, GMI differs significantly from HbA1c, which reflects both glycation and deglycation processes together. This difference is characterised by the haemoglobin glycation index (HGI). HGI = HbA1c - GMI. The higher HGI observed in patients...

Unusual presentation of rhabdomyolysis

Kristína Liachovická, Věra Sztuchlíková, Lucie Lysková, Jiří Orság, Zdenka Kosatíková, Miroslav Hrubý, Jiří Vymětal, Karel Krejčí

Vnitr Lek 2023, 69(8):488-493 | DOI: 10.36290/vnl.2023.098  

Rhabdomyolysis is a potentially life-threatening syndrome characterized by necrosis of muscle cells and release of intracellular contents into the circulation. Acute kidney injury represents one of its most serious complications. The detection of the causative factor requires considerable diagnostic effort in some cases, as documented in the case report. The basis of therapy, in addition to affecting the cause itself, is early and relatively aggressive rehydration therapy. In the most severe cases, replacement of renal function is necessary, guided by renal indications. However, elimination of myoglobin itself is insufficient in conventional dialysis...

Deformation parameters of left heart and serum levels of markers of endothelial dysfunction in patients with acute decompensation of chronic heart failure

Jakub Jurica, Ján Staško, Martin Jozef Péč, Ingrid Škorňová, Peter Galajda, Tomáš Bolek, Marek Cingel, Matej Samoš, Marián Mokáň

Vnitr Lek 2023, 69(8):494-498 | DOI: 10.36290/vnl.2023.099  

Aims: Two-dimensional speckle tracking (2D ST) analysis provides assessment of myocardial deformation and can be used as a diagnostic tool to determine the function of the left ventricle (LV) and the left atrium (LA). This study aimed to compare global longitudinal strain of LV (LV-GLS) and reservoir strain of LA (R-LAS) results between patients hospitalised for acute decompensation of heart failure (HF) and individuals with no known cardiovascular disease (CVD); and to observe the plasma concentration of vascular endothelial growth factor (VEGF) with treatment of acute decompensation of HF. Methods: We performed a pilot, prospective and observational...

Rate of repeated hospitalization of patients with cirrhosis and its risk factors

Petra Vrbová, Tomáš Koller

Vnitr Lek 2023, 69(8):500-505 | DOI: 10.36290/vnl.2023.100  

Background: Patients with cirrhosis make up a non-negligible part of hospitalized patients and are often hospitalized repeatedly. The aim of our work was to find out what happens to patients after being discharged from the hospital to outpatient care, how often they are re-hospitalized, what their prognosis is, and what are the risk factors for these events. Methods: Data on consecutive patients hospitalized with complications of cirrhosis at the V. internal clinic were recorded in the database. We monitored demographic, social and basic laboratory parameters along with prognostic indices. We recorded the rate of the first event after discharge within...

Depression and cardiovascular disorders

Dana Končelíková Kamarádová

Vnitr Lek 2023, 69(8):506-508 | DOI: 10.36290/vnl.2023.101  

Depression and cardiovascular disorders are more connected groups of diseases than it might seem at first glance. It is connected not only with a large incidence in the population and an overall negative effect on a person's life, but also with risk factors, the course of treatment and the response to it. Therefore, doctors of individual specialties should be especially careful with these groups of patients and perceive the patient as a whole more than usual, because as it turns out, influencing mental problems can have a positive effect on the physical health of the patient and vice versa.

Heart failure with mildly reduced ejection fraction - updates in pharmacotherapy

Alzběta Trčková, Lenka Špinarová

Vnitr Lek 2023, 69(8):510-515 | DOI: 10.36290/vnl.2023.102  

This review targets at patients suffering from heart failure with mildly reduced ejection fraction (HFmrEF). Diagnostic is briefly mentioned whereas pharmacotherapy is discused more due to significant changes in guidelines. New to therapy are gliflosins with AI recommendation. Also other therapy, such as angiotensin receptor blockers, beta blockers, mineralocorticoid blockers and diuretics are discussed below. Vericiguat and iron supplement therapy is described to complete the pharmacotherapeutic portfolio.

New version of STOPP­‑START criteria 2023. A suitable tool for drug prescribing optimization in older patients

Eva Topinková, Daniela Fialová

Vnitr Lek 2023, 69(8):516-524 | DOI: 10.36290/vnl.2023.103  

New revised and updated STOPP-START criteria, version 3 are explicit criteria for sceening and identification of potentially inappropriate medications and treatments in patients 65 years and older, and medications and treatments omittted despite their potential benefit in older persons. Part STOPP (Screening Tool of Older People's Potentially inappropriate Prescriptions) includes 133 drugs/drug classes that are inappropriate or risky in older patients. Part START (Screening Tool to Alert doctors to the Right Treatment) includes 57 potentially beneficial treatments which are frequently underprescribed despite their evidence-based benefit also in older...

Sepsis - associated disseminated intravascular coagulation - a constant problem of the present

Jaromír Tupý

Vnitr Lek 2023, 69(8):E10-E18 | DOI: 10.36290/vnl.2023.107  

Disseminated intravascular coagulation (DIC) is a common and life-threatening complication in sepsis. Sepsis-associated DIC is recognized as the systemic activation in coagulation with suppressed fibrinolysis that leads to organ dysfunction in combination with systemic intravascular inflammation. In this proces, thrombin, neutrophils, platelets, endothelium and damage-associated molecular patterns play a key role as part of immunothrombosis. Recent advances in the understanding of pathophysiology have made it possible to diagnose sepsis-associated DIC at earlier timing and with better accuracy. However, progress in the treatment is still limited, and...

Overlooked upper gastrointestinal tract carcinoma (PEUGIC) - from epidemiology to root cause analysis

Michal Štěpán, Barbora Pipek, Patrik Tokoš, Petr Fojtík, Přemysl Falt

Vnitr Lek 2023, 69(8):E19-E25 | DOI: 10.36290/vnl.2023.108  

PEUGIC (Post Esophagogastroduodenoscopy Upper Gastrointestinal Cancer) is cancer in the upper gastrointestinal tract, which at the time of diagnosis was preceded by gastroscopy in the last 3 years, which did not show this cancer. Its incidence is directly related to the quality of performing upper endoscopy and is therefore a parameter that can be monitored to assess the quality of upper endoscopy at individual endoscopy units. According to available data, PEUGIC accounts for approximately 10 % of all diagnosed cancers of the upper GIT (gastrointestinal tract). It occurs more often in women, at a younger age than common cancers and in patients with...

Rationale and benefits of value history in clinical practice: attitudes of internal medicine teachers and physicians

Kateřina Rusinová, Tereza Sládková, Michal Vrablík, Alexandra Židková, Tereza Petrů, Pavel Dušek, Martin Matějovič

Vnitr Lek 2023, 69(8):E4-E9 | DOI: 10.36290/vnl.2023.106  

Aim: In patients with severe illnesses, particularly in situations of unfavorable prognosis, it is essential to consider and decide on the appropriateness of further treatment. The ability to conduct a values-oriented conversation is crucial for providing care that aligns with the patient's values and preferences. Values History Taking (VHT) should be included in the curriculum of medical schools. Method: A questionnaire survey mapping the attitudes of internal medicine educators at the 1st Faculty of Medicine, Charles University, and the Faculty of Medicine in Plzeň, Charles University, regarding the significance, experiences, potential benefits,...

Diagnosis and therapy of chronic hepatitis D: Czech national guidelines. The date of release: 2023

Petr Husa, Jan Šperl, Petr Urbánek, Soňa Fraňková, Pavel Dlouhý

Vnitr Lek 2023, 69(8):525-532 | DOI: 10.36290/vnl.2023.104  

For the first time, this is a separate Czech recommended practice that focuses only on HDV infection. Until now, HDV infection has been mentioned only in the guidelines on hepatitis B virus (HBV) infection, in the HBV/HDV co-infection chapters. The European Association for the Study of the Liver (EASL) clinical practice guidelines from July 2023 were the basis for writing this guideline. HDV can co-infect a susceptible host with HBV (co-infection) or superinfect a person chronically infected with HBV. HBV/HDV coinfection usually leads to acute hepatitis with a wide clinical spectrum ranging from an asymptomatic course, to mild hepatitis, to acute liver...

Vascular changes that may affect the prognosis of patients and that could also be looked for by an internist, diabetologist, lipidologist or general practitioner

Jiří Matuška

Vnitr Lek 2023, 69(8):E26-E29 | DOI: 10.36290/vnl.2023.109  

Early diagnosis of preclinical atherosclerosis should lead to intervention of lifestyle and eating habits and, in most cases, to the initiation of hypolipidemic therapy. Current ambulatory diagnostic options are greatly expanded by the use of cheap and simple handheld ultrasounds/smaller ultrasound devices. The detection of atherosclerotic plaque on peripheral arteries is a clear factor emphasizing the need for adequate therapy of dyslipidemia. The general availability and reasonable imaging quality of simple pocket ultrasounds will probably lead to their expansion to a level corresponding to the current use of the phonedoscope.

What's new in nephrology?

Ivan Zahrádka, Ondřej Viklický

Vnitr Lek 2023, 69(8):534-541 | DOI: 10.36290/vnl.2023.105  

This article summarizes the latest developments in the field of nephrology over the past year. The EMPA-KIDNEY study confirmed a significant renoprotective effect of SGLT-2 inhibitors in patients without diabetes, while a renoprotective effect in patients with diabetes was confirmed for finerenone. The STOP-ACEi study showed that discontinuation of renin-angiotensin-aldosterone system inhibitors does not confer benefit in patients with advanced chronic kidney disease. The CHAP study showed a significant beneficial effect of early treatment of hypertension above 140/90mmHg in pregnant women. It has also been confirmed that both systemic and topical...