Vnitřní lékařství, 2025 (vol. 71), issue 3
Review articles
Treatment of type 2 diabetes mellitus - a current view of the different drug classes and strategies for their use
Jan Brož
Vnitr Lek 2025, 71(3):144-151 | DOI: 10.36290/vnl.2025.026 
New drug classes targeting type 2 diabetes mellitus and their individual representatives entering clinical use in the last 10 years in particular have gradually changed the paradigm of the treatment strategy. The former central role of HbA1c with respect to combination therapy and the central role of metformin, especially in the initial treatment of a newly diagnosed patient, is modified by his cardiovascular and renal profile. The latter then, if positive or at high risk of cardiovascular disease, should be treated with SGLT2 inhibitors and/or GLP-1 receptor agonists. Initiation of treatment with these agents is not dependent on HbA1C levels...
Tree pollen allergy, pollen food syndrome and allergen immunotherapy
Magdalena Herknerová
Vnitr Lek 2025, 71(3):152-155 | DOI: 10.36290/vnl.2025.027
Tree pollen allergy presents an increasing problem in industrialized countries. This disease develops in sensitised people after inhalation of pollen grains of birch and other related trees. Clinical symptoms of tree pollen allergy (seasonal allergic rhinoconjunctivitis, seasonal asthma bronchiale and secondary pollen food syndrome) have significant negative impact on the quality of life in these patients. The purpose of this review is to touch the taxonomy of the trees, describe cross-reactivity of relevant allergens, prevalence, the influence of climatic changes and to stress the importance of allergen immunotherapy as a disease modifying treatment.
The effect of long‑term beta‑blocker therapy in patients after myocardial infarction with preserved left ventricular ejection fraction
Robert Holaj
Vnitr Lek 2025, 71(3):156-161 | DOI: 10.36290/vnl.2025.028
The long-term use of beta-blockers in patients after myocardial infarction (MI) with preserved left ventricular ejection fraction (LVEF) remains controversial. While benefits of beta-blockers are well established in patients with reduced LVEF, there is a lack of randomized clinical trial data for patients with LVEF > 40 %. Two recent studies (REDUCE-AMI and ABYSS) yielded conflicting results regarding the safety of beta-blocker discontinuation. REDUCE-AMI showed no mortality or reinfarction benefit from long-term beta-blocker therapy, while ABYSS indicated increased cardiovascular hospitalizations, especially in hypertensive patients. Results of...
Triple therapy in treatment of bronchial asthma
Dana Lauková
Vnitr Lek 2025, 71(3):162-169 | DOI: 10.36290/vnl.2025.029
The ultimate goal in the treatment of asthma is the achievement of disease control and minimization of the risk for future exacerbation. Despite using medium/high dose of inhaled corticosteroids (ICS) in fixed combination with long-acting beta-2 agonists (LABA), many patients still do not achieve an adequate level of disease control and remain at risk of exacerbations. Disease severity may be related to poor treatment adherence or improper inhaler technique. LAMA is suggested as the first add-on therapy to moderate dose ICS + LABA (GINA 2024), called as triple therapy. GINA recommends triple therapy (LAMA to ICS/LABA) as a further option at step 4...
Liver steatosis and Type 2 diabetes mellitus
Jan Škrha
Vnitr Lek 2025, 71(3):170-175 | DOI: 10.36290/vnl.2025.030
Development of liver steatosis and Type 2 diabetes mellitus is caused by identical pathogenic mechanisms. Actual discoveries bring narrower information on the relationship of both diseases. New nomenclature of the metabolic liver disease and recently defined subtypes of Type 2 diabetes bring new insight on both diseases and their relationship. Increasing prevalence generates the needs not only for early diagnosis but for targeted treatment as well. The way to prevention based on healthy lifestyle has been opened to be realized from the early childhood.
New therapeutic options and trends in the treatment of multiple myelom
Roman Hájek, Ludmila Muroňová, Jana Mihályová, Michaela Horňáková, Tereza Popková, Hana Plonková, Tomáš Jelínek
Vnitr Lek 2025, 71(3):176-182 | DOI: 10.36290/vnl.2025.031
Progress in multiple myeloma (MM) treatment is remarkable. Combined regimens for newly diagnosed MM patients achieve progression-free survival of more than seven years. In the Czech Republic, the approval of a four-drug combination of anti-CD38 monoclonal antibody (mAb) with a proteasome inhibitor (PI), immunomodulatory agent (IMiD) and dexamethasone is expecting in 2025. It is not yet clear whether consolidation with autologous transplantation will be beneficial in terms of extending the time to progression. The development of immunotherapy has literally exploded. Autologous chimeric antigen receptor T-cell therapy (CAR T-cells) targeting the BCMA...
E-publication
Tyrosine kinase inhibitors and cardiovascular and metabolic risks in patients with chronic myeloid leukemia
Pavel Kraml
Vnitr Lek 2025, 71(3):E7-E10 | DOI: 10.36290/vnl.2025.036
The oncology therapy represents an independent cardiovascular risk factor. For chronic myeloid leukemia (CML), the BCR:ABL1 tyrosine kinase inhibitors (TKI) have become the frontline therapy. While the first generation inhibitor (imatinib) revealed a relatively safe cardiovascular profile, the introduction of the second and third generation TKIs was associated with an in -crease of cardiovascular events as well as worsening of their risk factors, esp. hypertension, hyperglycemia, dyslipidemia and renal failure. Other observed side effects include pulmonary hypertension, pericardial and pleural effusions, arrhythmias and to lesser extent venous thrombosis....
Acute alcoholis hepatitis
Markéta Štajnerová, Stanislav Ševela, Karolína Hronová, Marek Šatný
Vnitr Lek 2025, 71(3):E11-E16 | DOI: 10.36290/vnl.2025.037
Acute alcoholic hepatitis is a life-threatening condition with an unfavorable prognosis, characterized by jaundice and acute deterioration of liver function in the context of proven alcohol abuse. Prior to initiating therapy, it is essential to exclude other potential etiologies and assess disease severity using validated scoring systems. To date, systemic corticosteroid therapy remains the only specific treatment recommended for severe hepatitis. Supportive care is indispensable and should be provided to all patients. Numerous other pharmacological agents and interventions are under investigation, some of which show promising potential.
Health aspect of airplane travel
Dana Lauková
Vnitr Lek 2025, 71(3):E17-E25 | DOI: 10.36290/vnl.2025.038
Almost 2 billion people travel aboard commercial airlines every year. Health-care providers and travellers need to be aware of the potential health risks associated with air travel. Changes resulting from three physical laws about gas occur during routine commercial flights. They lead most often to mild hypoxia and gas expansion (risk od hypoxemia, barotrauma and decompression), which can exacerbate chronic medical conditions or incite acute in-flight medical events. The association between venous thromboembolism and long-haul flights, trapping gas, jet lag, and cabin-air quality are growing health-care issues associated with air travel. In-flight...
Original articles
Treatment of paroxysmal nocturnal hemoglobinuria patients with complement inhibitors
Jaroslav Čermák, Marie Lauermannová, Jacqueline Maaloufová Soukupová
Vnitr Lek 2025, 71(3):E1-E6 | DOI: 10.36290/vnl.2025.035
Introduction: Paroxysmal nocturnal hemoglobinuria represents a rare but serious disorder of hematopoiesis. A deficiency in natural complement inhibitors results in intravascular hemolysis, hemoglobinuria, thrombotic complications and bone marrow failure. Introduction of complement inhibitors in the treatment of PNH completely changed the prognosis of the patients. Our study summarizes experience with the treatment of PNH patients using complement inhibitors in Institute of Hematology in Prague. Patients and treatment: Twenty-one patients with hemolytic PNH were treated with C5 complement inhibitors eculizumab or ravulizumab. Indication criteria were...
Case reports
Leishmaniasis as a rare case of bone marrow suppression
Aleš Tenk
Vnitr Lek 2025, 71(3):185-189 | DOI: 10.36290/vnl.2025.032
Bone marrow decline hides a plethora of etiopathogenetic causes, which the physician tries to understand. Our patient's case was all the more tricky because she was an immunocompromised person whose clinical picture and laboratory results were distorted by immunosuppressive therapy. In the following article, we try to highlight the importance of taking basic anamnestic data that should not be neglected and thorough physical and laboratory investigations. The highly erudite haematology department played a major, if not the most important role and is greatly helped with the diagnosis and subsequent treatment and is to be thanked. I believe that the following...
In brief
Updated procedures in the diagnosis and treatment of dyslipidemia
Jan Piťha, Ondřej Kyselák
Vnitr Lek 2025, 71(3):198-202 | DOI: 10.36290/vnl.2025.034
The aim of dyslipidemia treatment is to reduce cardiovascular (CV) risk as much as possible by lowering LDL-cholesterol (LDL-C) concentrations; in persons with higher triglyceride concentration (>1.7 mmol/l), especially non-HDL cholesterol (non-HDL-C). For each CV risk category there are recommended target values for LDL-C, apolipoprotein B and non-HDL-C. In recent years, there have been significant developments in the diagnosis and treatment of dyslipidemias. After almost 40 years since the introduction of statin therapy, new effective treatments are available, such as propotein convertase subtilisin kexin type 9 inhibitors (iPCSK9), bempedoic...
Pharmacological profile
Danicopan
Libor Červinek
Vnitr Lek 2025, 71(3):190-196 | DOI: 10.36290/vnl.2025.033
Danicopan is a selective inhibitor of complement factor D that acts through the alternative pathway of complement activation. By blocking the alternative pathway of complement, danikopan inhibits extravascular hemolysis (EVH). The efficacy and safety of danikopan in adult PNH patients with clinically significant EVH were evaluated in a multicenter, randomized, double-blind, placebo-controlled, phase 3 study ALXN2040-PNH-301. Danicopan added to ravulizumab or eculizumab demonstrated superiority over placebo in the primary endpoint of increase in hemoglobin levels. Danicopan also achieved statistically significant improvements compared to placebo in...