Vnitřní lékařství, 2024 (vol. 70), issue 8
Review articles
Results and recommendations for colorectal cancer screening
Tomáš Grega, Miroslav Zavoral, Štěpán Suchánek
Vnitr Lek 2024, 70(8):484-489 | DOI: 10.36290/vnl.2024.095 
Colorectal cancer is the second most common cancer worldwide and represents a significant health burden, particularly in economically developed countries. The Czech Republic has one of the highest incidences of colorectal cancer in Europe. However, a long-standing screening program has led to a substantial reduction in both the incidence and mortality rates of this disease. The article emphasizes the importance of achieving sufficient population coverage in screening to effectively reduce the public health burden of colorectal cancer. It provides an overview of the global incidence of colorectal cancer and the current epidemiology of the disease in...
Diagnosis and treatment of hyperuricemia in cardiovascular prevention based on its pathophysiological mechanism: An Expert Consensus of Czech and Slovak Specialists, 2024
Michal Vrablîk, Claudio Borghi, Hana Rosolová, Blanka Stibůrková, Ivana Šoóšová, Martin Čaprnda, Ján Števlîk, Adriana Ilavská, Peter Jackuliak, Zuzana Zafarová
Vnitr Lek 2024, 70(8):491-500
A panel of experts from the Czech and Slovak Republics, with the contribution of Professor C. Borghi from the University of Bologna, discussed the clinical approach for the investigation and treatment of hyperuricemia (HU) in patients with increased cardiovascular (CV) risk. Since elevated uric acid (UA) modifies CV risk, it should be considered as an important modifier of CV risk and patients in whom its therapeutic reduction may improve CV parameters should be identified. The lack of selection of suitable patients is probably the reason for the inconsistent results of studies evaluating the clinical outcomes of antihyperuricemic therapy to date....
How microorganisms evade the immune system
Karolína Absolonová, Petr Matucha, Ivan Šterzl
Vnitr Lek 2024, 70(8):502-506 | DOI: 10.36290/vnl.2024.096
Microorganisms have evolved a wide variety of strategies to evade both the innate and adaptive immune systems during evolution, and some of these strategies are addressed in our review. Microorganisms can use the similarity of their proteins to host proteins, produce anti-inflammatory factors, disrupt the complement system, affect the function and block the synthesis of cytokines, inhibit the recognition of immunoglobulins, reduce the expression and modify antigens on their surface, disrupt the processing and presentation of antigen by immune cells, enter immune cells , influence cell apoptosis, modulate immune cell functions or influence hormone production....
Febrility in malignant disease
Štefan Sotak
Vnitr Lek 2024, 70(8):508-512 | DOI: 10.36290/vnl.2024.097
Fevers have many causes. The most common is infection. They can also occur in oncological diseases. Fevers caused directly by malignancy are called paraneoplastic. Their diagnosis can sometimes be very complex and lengthy and represents a therapeutic challenge even for an experienced physician; therefore they represent a non-negligible percentage of fevers of unknown origin. The so-called can be helpful naproxen test. Levels of inflammatory parameters can sometimes be misleading - they can be significantly elevated in active malignancy. In addition, febrility in an oncology patient can also occur due to infection, which arises as a result of malignant...
Modern trends in asthma treatment
Samuel Genzor
Vnitr Lek 2024, 70(8):513-516 | DOI: 10.36290/vnl.2024.098
Asthma bronchiale is a highly prevalent respiratory disease that reduces the quality of life of patients if the treatment is insufficient or ineffective. The mainstays of therapy are inhaled glucocorticoids, optimally in a fixed combination with long-acting beta-2-agonists. In case of insufficient effect, it is possible to consider increasing the dose of inhaled glucocorticoid, adding an antileukotriene, or adding long-acting anticholinergics. A patient with insufficiently controlled asthma on maximized treatment should be referred for precise diagnosis and medication adjustment to a specialized center for the treatment of difficult-to-treat asthma....
Kidney transplantation in patients with multiple myeloma: current options
Silvie Rajnochová Bloudíčková, Anna Novotná
Vnitr Lek 2024, 70(8):517-521 | DOI: 10.36290/vnl.2024.102
Kidney disease is common in patients with multiple myeloma. Due to an unfavourable prognosis, patients with end-stage kidney disease in multiple myeloma were not accepted for kidney transplantation. Current therapeutic options for multiple myeloma have significantly improved the survival of these patients, thus more individuals are being referred for kidney transplantation. Recently published data support that a certain cohort of patients may benefit from transplantation. These are mainly patients with stable remission of multiple myeloma, whose treatment included stem cell transplantation. A multidisciplinary approach with an individualised assessment...
E-publication
Album-in & Album-out - a look behind the curtain of new recommendations
Jiří Müller, Martin Matějovič
Vnitr Lek 2024, 70(8):E11-E14 | DOI: 10.36290/vnl.2024.104
Although synthetic colloids have fallen out of favour in the current evidence-based medicine, the use of albumin remains a common clinical practice. The rationale behind the utilisation of this colloid solution is to increase intravascular volume, facilitate fluid removal, and to treat complications of liver cirrhosis. Nevertheless, the apparently uncontroversial clinical use based on physiological principles is in fact not supported by any robust evidence. Consequently, the 2024 ICTM (International Collaboration for Transfusion Medicine) guidelines recommends albumin administration solely in a very specific subset of patients and notably, even in...
Microbiome and atherosclerosis
Pavol Fülöp, Marianna Vachalcová, Barbora Sepešiová, Denisa Harvanová, Katarîna Šoltys, Gabriel Valočik
Vnitr Lek 2024, 70(8):E15-E18 | DOI: 10.36290/vnl.2024.105
Atherosclerosis is a major cause of cardiovascular diseases and significantly contributes to global mortality. An increasing body of evidence suggests that the gut microbiome may play a key role in the pathogenesis of this disease. The gut microbiome consists of trillions of microorganisms that not only support digestion and metabolism but also influence the host's immune response. Alterations in the composition of the gut microbiome have been associated with various chronic diseases, including obesity, diabetes, and atherosclerosis. This article provides a brief overview of the gut microbiome composition in patients with coronary artery disease and...
Original articles
Value of electrocardiogram and chest X-ray examinations in preoperative management
Bronislav Čapek, Jan Václavík, Klára Benešová, Jiří Jarkovský
Vnitr Lek 2024, 70(8):E3-E10 | DOI: 10.36290/vnl.2024.103
Aims: An electrocardiogram (ECG) and chest X-ray (CXR) are widely used in the preoperative period for patients undergoing non-cardiac surgery (NCS). We aimed to assess whether preoperative ECG and CXR had any impact on changes in preoperative management for an unselected population undergoing non-elective NCS. Methods: We retrospectively reviewed records of hospitalized patients undergoing an internal preoperative examination in 2015-2021. The primary endpoint was a change in preoperative management that caused postponement or complete cancelation of a surgery (PCCS), due to an abnormal ECG or CXR. Results: We enrolled 2362 patients. 72% had an abnormal...
Case reports
DRESS syndrome as a probable cause of acute kidney injury and skin involvement in a polymorbid patient
František Novák, Jiří Vymětal, Petr Konvička
Vnitr Lek 2024, 70(8):522-527 | DOI: 10.36290/vnl.2024.099
DRESS syndrome (Drug Reaction with Eosinophilia and Systemic Symptoms) is a severe late drug reaction, which can be potentially life threatening. It usually manifests itself as a whole-body exanthema, changes in blood count and organ involvement, especially the liver and kidneys. Here, we describe a case of a polymorbid elderly patient with skin involvement and renal failure related to the use of allopurinol. Early diagnosis and adequate treatment led to restoration of renal function. Eosinophilia was a crucial diagnostic indicator.
Syncope caused by rupture of a right coronary artery aneurysm
Jakub Šyler, Jiří Plášek, Jiří Vrtal, Jan Václavík, Jozef Dodulík
Vnitr Lek 2024, 70(8):528-532 | DOI: 10.36290/vnl.2024.100
Syncope is a sudden transient loss of consciousness caused by short-term hypoperfusion of the brain. It is a common reason for patients to visit acute admissions, where it is crucial to distinguish life-threatening causes from benign conditions. In this case report, we present the case of a 71-year-old patient whose syncope was caused by rupture of a right coronary artery aneurysm, resulting in the formation of a bulky hematoma in the right-sided cardiac compartments. This mechanism led to recurrent syncope, which at first glance could be mistakenly attributed to orthostatic hypotension caused by newly administered antihypertensive drugs. The case...
Case reporty
E-publication
Unintended Intravenous Administration of P-PNC and the Infusion Set as a Safety Brake
Vojtěch Fišera, Kateřina Langmaierová, Michaela Rothová, Petr Vojtíšek, Andrea Vlčková
Vnitr Lek 2024, 70(8):E19-E24 | DOI: 10.36290/vnl.2024.106
The article describes a case of unintended intravenous administration of procaine penicillin (P-PNC) instead of the prescribed crystalline penicillin (G-PNC). This unique incident is analyzed from the perspectives of human factors and quality management, using the Root Cause Analysis (RCA) method. A key element was the protective role of the infusion set with a filter, which prevented larger suspension particles from entering the patient's bloodstream, thereby averting more serious consequences. This case also serves as an important example for nursing practice, emphasizing the necessity of adhering to safety and Standard Operating Procedures (SOP)...
News in...
New trends in the field of inborn errors of immunity
Zita Chovancová
Vnitr Lek 2024, 70(8):533-538 | DOI: 10.36290/vnl.2024.101
Congenital disorders of the immune system PIDs/IEIs) represent a dynamically developing group of diseases characterized not only by an increased susceptibility to infections but also by the occurrence of autoimmune, autoinflammatory, allergic, and malignant complications. Around 500 of these diseases have been described to date, and their number continues to grow. The result of dynamic progress in the diagnosis and therapy of these diseases is the progress of genetic diagnostics, the introduction of screening for PID/IEIs in newborns, as well as the use of new therapeutic approaches including gene therapy. Since the beginning of 2024, nationwide screening...