Hlavní téma – Geriatrie

prof. MUDr. Eva Topinková, CSc.

Vnitr Lek 2024, 70(7):407  

News in the diagnosis of sarcopenic obesity in older adults

Katarína Bielaková, Ondřej Ludka

Vnitr Lek 2024, 70(7):412-417 | DOI: 10.36290/vnl.2024.083  

Sarcopenic obesity is characterized by the combination of obesity and sarcopenia, Sarcopenic obesity needs to be considered as a unique clinical condition, different from obesity or sarcopenia alone. These two problems significantly potentiate each other, thereby maximizing their impact on morbidity and disability. Until now, sarcopenic obesity has been identified using different definitions and diagnostic criteria, and this fragmentation has had a negative impact on the development of prevention and treatment strategies for sarcopenic obesity in the elderly. In 2022, the European Society for Parenteral and Enteral Nutrition (ESPEN) and the European...

Pharmacological treatment of arterial hypertensin in old and very old patient in current evidence-based guidelines

Eva Topinková, Jan Filipovský

Vnitr Lek 2024, 70(7):419-429 | DOI: 10.36290/vnl.2024.084  

Arterial hypertension is one of the most common disorders in older people and there is undoubtedly professional agreement that antihypertensive treatment is beneficial in the wide range of older age for preventing cardiovascular events and reducing overall mortality. However, treatment in old age confers several pharmacological risks. The 2023 Guidelines on hypertension management of the European Society of Hypertension distinguish two age groups (65-79 and 80+years) for which separate criteria for treatment initiation and target blood pressure values are recommended. Unfortunately, there is a gap of evidence on effectiveness and safety of antihypertensives...

The benefits and risks of new antidiabetic drugs for the treatment of geriatric patients with diabetes

Darina Matvejeva, Martina Nováková, Pavlína Piťhová, Milan Kvapil

Vnitr Lek 2024, 70(7):430-437 | DOI: 10.36290/vnl.2024.085  

Life expectancy is increasing in patients with diabetes. The prevalence of diabetes increases with age. New classes of antidiabetics (gliflozins, incretin therapy, new insulin analogues) are safer, have at least comparable efficacy to conventional treatment, and also bring a positive impact on the risk of late complications of diabetes. The use of their potential for the treatment of elderly people with diabetes is particularly beneficial in terms of safety and prevention of complications.

Intermittently scanned continuous glucose monitoring (isCGM) in hospitalized elderly patients

Darina Matvějeva, Martina Nováková, Pavlína Piťhová, Lucie Tománková, Vladimíra Kotvová, Daniela Polanecká, Milan Kvapil

Vnitr Lek 2024, 70(7):438-444 | DOI: 10.36290/vnl.2024.086  

The prevalence of internal diseases increasing with age is the reason for the increased number of seniors among those hospitalized in non-surgical beds. The disease that is the reason for hospitalization in a patient with diabetes usually fluctuates blood sugar. A number of examination methods require preparation with a change in intake and diet composition, a certain period of fasting before or after the procedure. All this increases the risk of hypo/hyperglycemia. It threatens the health and life of the patient. Prevention is especially frequent monitoring of blood glucose. Despite the advanced development of collection and measurement of glucose...

Atrial fibrillation in patients with arterial hypertension and novel European Guidelines

Štěpán Havránek

Vnitr Lek 2024, 70(7):446-451 | DOI: 10.36290/vnl.2024.087  

Atrial fibrillation and arterial hypertension are frequent diagnoses in internal medicine and are often combined. The presence of arterial hypertension, especially insufficiently corrected, is a risk factor for the occurrence of atrial fibrillation itself, but also a factor in the progression of the disease and a risk factor for the failure of atrial fibrillation rhythm control treatment. Arterial hypertension also increases the risk of complications of atrial fibrillation, especially thromboembolic events, and increases the risk of bleeding during anticoagulant treatment. The therapy of atrial fibrillation and arterial hypertension overlaps at certain...

Thromboprophylaxis of venous thromboembolism in internal medicine

Petr Dulíček

Vnitr Lek 2024, 70(7):452-456 | DOI: 10.36290/vnl.2024.088  

Venous thromboembolism is still serious not only medical, but also social economic problem. For many decades we know about the risk of surgery for venous thromboembolism, but in hospitalized medical patients the awareness was underestimated. In the last 25 years the situation has been changed with the advance of scoring models, which can help us the identify individuals who need pharmacologic prophylaxis. The Padua prediction score is one of the most used. However, due to the amounts of risk factors, individual variability, it is not always easy to find correct recommendation not only from medical, but also economic point of view.

Current treatment options for ventricular arrhythmias in heart failure

Renáta Aiglová

Vnitr Lek 2024, 70(7):457-461 | DOI: 10.36290/vnl.2024.089  

Despite advances in care, heart failure is still associated with a poor prognosis. Arrhythmic complications also contribute to the poor prognosis of patients with heart failure. Ventricular arrhythmias occur very frequently in patients with heart failure. They can be the result of structural myocardial damage, but less often they can also cause de novo heart failure or worsen pre-existing heart failure. Treatment of ventricular arrhythmias in heart failure requires a comprehensive approach. The basis is the optimized therapy of heart failure. Non-pharmacological treatment is also an integral part - ICD implantation, catheter ablation. Catheter ablation...

Large vessel vasculitis - new classification criteria and new treatment options

Debora Karetová, Agáta Jeníšová

Vnitr Lek 2024, 70(7):462-467 | DOI: 10.36290/vnl.2024.090  

Large vessel vasculitis (LVV) affects the aorta and the large arteries branching from it. There are 2 diseases in particular, namely Giant cell arteritis (GCA) and Takayasu arteritis (TAK). Both diseases are rare, which is why early diagnosis often fails. GCA (formerly called Horton's temporal arteritis) is an idiopathic inflammatory disease taking place mainly in the wall of the media and adventitia. It is often associated with extravascular inflammation, most commonly in the form of polymyalgia rheumatica. It is now clear that this arteritis includes a wide range of phenotypic expression: a distinction is made between large vessel GCA (LV-GCA) and...

In-hospital management of non-surgical patients treated with gliflozins

Michal Šitina

Vnitr Lek 2024, 70(7):E3-E7 | DOI: 10.36290/vnl.2024.092  

A rare but serious complication of the treatment with gliflozins is euglycemic ketoacidosis. It predominantly affects individuals with type 1 or type 2 diabetes. In non-diabetic patients taking gliflozin, the risk of ketoacidosis is minimal. The risk is more pronounced in the perioperative period. Therefore, gliflozin should be discontinued 3-4 days prior to the scheduled major surgery. In case of minor surgery without prolonged fasting, gliflozins can be discontinued only one day before and on the day of surgery. In non-surgical patients, the initiation and continuation of gliflozins during hospitalization appears to be safe, unless risk factors,...

Diagnosis and treatment of electric shock

Jozef Dodulík, Jiří Plášek, Jiří Vrtal, Lukáš Evin, Marie Lazárová, Jan Václavík

Vnitr Lek 2024, 70(7):E8-E10 | DOI: 10.36290/vnl.2024.093  

Electrocution poses a serious health risk with a wide range of consequences, from mild to life-threatening complications. These effects depend on factors like voltage, current, tissue resistance, and duration of exposure. Electrocution injuries require a multidisciplinary approach involving emergency medicine, internal medicine, and, in some cases, burn and trauma care. This review summarizes current recommendations for diagnosing and treating patients after electrocution, with an emphasis on the role of the internist and the management of patients not directed to burn centers.

N-acetylcysteine for prevention of contrast-induced nephropathy

Štefan Sotak

Vnitr Lek 2024, 70(7):E11-E13 | DOI: 10.36290/vnl.2024.094  

N-acetylcysteine (ACC) is an acetylated variant of the amino acid L-cysteine and is primarily used as a specific antidote for paracetamol overdose. Other indications for its application include prevention of exacerbation of chronic obstructive pulmonary disease, relief of flu symptoms, treatment of pulmonary fibrosis, treatment of infertility in patients with polycystic ovary syndrome resistant to clomiphene, moreover, in the treatment of autism, Alzheimer's disease, bipolar affective disorder, schizophrenia, obsessive-compulsive disorder and drug addiction. In addition, ACC may also play a role as a chemoprevention of malignancies, an adjunct in the...

Cutting-edge technology in medicine: preparation for colonoscopy in a patient with type 1 diabetes mellitus treated with a hybrid closed-loop insulin pump-continuous glucose monitor - case report and framework recommendations

Adina Večeřová, Monika Neščáková, Martin Wasserbauer, Jana Urbanová, Jan Král, Lucie Šestáková, František Škopek, Juraj Michalec, Jan Brož

Vnitr Lek 2024, 70(7):469-473 | DOI: 10.36290/vnl.2024.091  

Colonoscopy is a key method for preventing, diagnosing, and treating colon diseases. The colonoscopic examination includes preparing the colon before the procedure, which involves emptying the bowel with orally administered lavage agents and the associated temporary change in diet. This preparation can lead to glycemic fluctuations and the risk of hypoglycemia in patients with diabetes mellitus. This case report describes the case of a patient with type 1 diabetes mellitus treated with a hybrid closed-loop system who used 5 grams of sucrose sachets during colonoscopic preparation to replenish energy and stabilize glucose based on continuous glucose...