When to use proton pump inhibitors

Štěpán Šembera, Jiří Cyrany, Ilja Tachecí

Vnitr Lek 2024, 70(3):158-165 | DOI: 10.36290/vnl.2024.033  

Proton pump inhibitors (PPIs) have been available in clinical practice for 35 years, and during the time of their use, they have become a very frequently used medication. In some countries, around 10% of the population uses them. This is due to their ability to most effectively suppress the production of hydrochloric acid by the gastric mucosa, thereby treating primarily peptic ulcer disease of the gastroduodenum and gastroesophageal reflux disease. Furthermore, these drugs are widely used in the prevention of these diseases and in the treatment of functional dyspepsia. The seemingly favorable safety profile of these drugs has acquired significant...

Biological and innovative therapies of inflammatory bowel disease

Petra Mináriková

Vnitr Lek 2024, 70(3):166-172 | DOI: 10.36290/vnl.2024.034  

Crohn's disease and ulcerative colitis are chronic, inflammatory bowel disease medically and surgically incurable. In the last 20 years, there has been a dramatic development, especially of medicamentous treatment. In biological therapy, new agents have been introduced with a mechanism of action targeted on molecules of key role in the pathogenesis of inflammatory bowel disease.

Recent developments in blood bacteriological testing

Miroslava Htoutou Sedláková, Kateřina Bogdanová, Milan Kolář

Vnitr Lek 2024, 70(3):174-179 | DOI: 10.36290/vnl.2024.035  

Identifying the etiological agent in blood is one of the most crucial yet time-consuming investigations in diagnosing bacterial infections. The conventional approach of blood culture utilizing automated systems, followed by identification from a 24-hour bacterial culture and determination of quantitative antibiotic susceptibility, typically takes about 3-5 days. However, in recent years, new methods have been implemented in practice, enabling the identification of bacterial pathogens and the determination of sensitivity/resistance to antibiotics, including the detection of resistance genes through amplification techniques directly from positive blood...

Treatment of asymptomatic hypertension during hospitalization - less is often much more

Tomáš Zelinka

Vnitr Lek 2024, 70(3):181-186 | DOI: 10.36290/vnl.2024.036  

Although they are no doubts that treatment of chronic hypertension reduces cardiovascular risk, little is known how to deal with acute elevations of blood pressure (BP) values among asymptomatic subjects during hospitalization. In-hospital BP pressure elevations are relatively frequent and may not correspond with poorly controlled chronic hypertension. Conditions for BP measurement during hospitalization significantly differ from those recommended for outpatient settings. Recent published observational studies showed that active approach for asymptomatic BP elevations was associated with worse outcome compared to the conservative approach. It increased...

Therapy of disorders with organ dysfunctions related to "Monoclonal Gammopathy of Clinical Significance" - MGCS

Zdeněk Adam, Luděk Pour

Vnitr Lek 2024, 70(3):188-194 | DOI: 10.36290/vnl.2024.037  

Monoclonal gammopathy of clinical significance (MGCS) is an umbrella term to describe a broad spectrum of disorders with remarkable organ dysfunctions related to the underlying non-malignant B or plasma cell clone. Although the clone itself is typically very small, it is associated with diverse clinical manifestations through different mechanisms, such as monoclonal protein deposition, the biological activity of the monoclonal immunoglobulin, or angiogenic/inflammatory cytokine hyper-secretion, or the ethiopathogensis is still unknown. Some predominantly involve a single organ, commonly peripheral nerves, kidney, skin and eye, while others are systemic...

Biological therapy of interstitial lung diseases

Martina Šterclová

Vnitr Lek 2024, 70(3):E10-E12 | DOI: 10.36290/vnl.2024.041  

Biological therapies, despite their widespread use in other areas of pneumology, are not typically the first-line treatment for patients with interstitial lung diseases. This is due to the relatively rare occurrence of these diseases and their incompletely understood etiopathogenesis. Biologics are most commonly used in patients with interstitial lung involvement in systemic connective tissue diseases; conversely, they do not have a routine place in the treatment of patients with idiopathic interstitial pneumonias. In patients with sarcoidosis, biological therapy constitutes third-line treatment. Before initiating biological treatment, it is necessary...

Is fibromyalgia a neurological disorder?

Štefan Alušík

Vnitr Lek 2024, 70(3):E13-E16 | DOI: 10.36290/vnl.2024.042  

The article discusses new developments in fibromyalgia disease in terms of diagnosis, evaluation of clinical manifestation and treatment. The most important change is the elucidation of the pathophysiological mechanisms in the brain (nociplastic pain) that underlie the clinical manifestation of the symptoms, especially the widespread muscle and ligament pain. In clinical diagnosis, the biggest change has been the abandonment of the investigation of the so-called tender points and the use of newer diagnostic criteria. In drug therapy, we are particularly concerned with the use of pregabalin, duloxetine and milnacipran, their optimal dosage and side...

Mortality associated with peripheral artery disease of the legs

Jiří Spáčil, Jaroslava Svobodová

Vnitr Lek 2024, 70(3):145-150 | DOI: 10.36290/vnl.2024.031  

Introduction: Data on mortality due to peripheral artery disease of the legs (PAD) in the Czech Republic is unknown. We used the set of patients with PAD of our outpatient facility to select those with known dates and causes of death based on data of the Institute of Health Information and Statistics of the Czech Republic. Results: Of the group comprising 390 patients with PAD caused by atherosclerosis, 145 patients died. The mean time from the first examination at our facility to death was 6.13 years. The mean follow-up time of surviving patients was 6.99 years. Mean annual mortality was 6.25% (95 CI 4.25-8.26%). Forty four percent of the patients...

Should we already deal with lipoprotein(a) in clinical practice?

Zuzana Vantová, Otto Mayer Jr.

Vnitr Lek 2024, 70(3):152-156 | DOI: 10.36290/vnl.2024.032  

Lipoprotein(a) represents a virtually overlooked risk factor. However, its pathophysiological mechanism leads to a non-negligible increase in the incidence of cardiovascular diseases, additively beyond the risk mediated by conventional factors. Currently, several promising drugs are in the final phase of clinical development to directly affect lipoprotein(a) concentrations. It is therefore necessary to improve awareness of this factor in clinical practice and, in particular, proceed to its systematic screening.

Adverse obstetric and neonatal outcomes of pregnancy in high-risk women with heart disease

Juraj Dubrava, Monika Kaldararova, Zuzana Niznanska, Miroslav Korbel

Vnitr Lek 2024, 70(3):E4-E9 | DOI: 10.36290/vnl.2024.040  

Background: The latest ESC guidelines on the management of cardiovascular diseases during pregnancy recommend estimating maternal cardiovascular risk according to the modified World Health Organization (mWHO) classification. In contrast, there are no validated models for predicting neonatal and obstetric risk in these women. Objectives: To compare the neonatal and obstetric outcomes of pregnancy between two groups of mothers with heart disease: women at high to extremely high maternal risk (mWHO III-IV; group 1) and women at low to intermediate maternal risk (mWHO < III; group 2). Methods: We included 48 consecutive women with clinically significant...

Echinococcosis - a disease imitating a generalized tumor process

Miroslav Hikaník

Vnitr Lek 2024, 70(3):195-197 | DOI: 10.36290/vnl.2024.038  

Echinococcosis is a rare parasitic disease that affects multiple organs. In some cases, it can imitate a generalized oncological disease, as in the case of our patient. In these article, we also point out to the necessity of correct diagnosis and immediate adequate treatment intervention.

Za profesorom MUDr. Zoltánom Mikešom, DrSc.

Prof. MUDr. Juraj Payer, PhD, MPH, Prof. MUDr. Andrej Dukát, CSc., Doc. MUDr. Martin Dúbrava, CSc.

Vnitr Lek 2024, 70(3):E17-E18  

Zemřel doc. MUDr. Tomáš Kára, Ph.D.

Mirek Souček, Jiří Vítovec

Vnitr Lek 2024, 70(3):E19  

News in cardiology 2023

Veronika Puchnerová, Michael Jenšovský, Petr Ošťádal, Jiří Bonaventura

Vnitr Lek 2024, 70(3):198-206 | DOI: 10.36290/vnl.2024.039  

This review summarizes the latest advances in cardiology published in 2023, which affect clinical practice. First, we discuss the European Society of Cardiology guidelines and clinical updates. Then, we present an overview of the most important clinical trials published within the last year.