Diabetes a kardiovaskulární onemocnění

doc. MUDr. David Karásek, Ph.D.

Vnitr Lek 2020, 66(2):71 | DOI: 10.36290/vnl.2020.023  

Epidemiologie infekcí vyvolaných Clostridium difficile (CDI) v České republice

Marcela Krůtová

Vnitr Lek 2020, 66(2):e4-e5 | DOI: 10.36290/vnl.2020.032  

Extraintestinální projevy celiakie

MUDr. Iva Hoffmanová, Ph.D.

Vnitr Lek 2020, 66(2):e6-e7 | DOI: 10.36290/vnl.2020.033  

Incretin-based treatment of diabetes and cardiovascular complications

Martin Haluzík

Vnitr Lek 2020, 66(2):74-80 | DOI: 10.36290/vnl.2020.012  

Cardiovascular complications are main cause of increased mortality in patients with type 2 diabetes. Decrease of overall cardiovascular risk and subsequently cardiovascular morbidity and mortality in type 2 diabetes patients is therefore an important treatment aim. To this end, intensive intervention of classical risk factors such as dyslipidemia, arterial hypertension, smoking along with lifestyle intervention is necessary. Good diabetes control optimally with the use of antidiabetic medication and smoking with positive effect on cardiovascular complication is of high importance as well. Incretin-based therapy includes an approach based on an increase...

The position of SGLT2 inhibitors in current medicine

Martin Prázný

Vnitr Lek 2020, 66(2):82-88 | DOI: 10.36290/vnl.2020.013  

Cardiovascular disease is still the most common cause of mortality in patients with type 2 diabetes. Some prospective studies have produced unexpected results in connection with the requirements for the demonstration of cardiovascular safety of new antidiabetics, which have significantly expanded the treatment options for diabetes over the past 20 years. Although these studies were statistically designed to exclude excessive cardiovascular risk in patients with type 2 diabetes, some drugs have shown not only cardiovascular safety but also significant cardioprotective and nephroprotective effects in these studies. For the first time, a reduction in...

Obesity and cardiovascular disease

Štěpán Svačina

Vnitr Lek 2020, 66(2):89-91 | DOI: 10.36290/vnl.2020.014  

Obesity with no comorbidities probably carries no cardiovascular risk, and the so-called obesity paradox even comes into play, wherein obesity may improve the prognosis of cardiovascular disease. Cardiovascular complications primarily occur indirectly due to metabolic comorbidities of obesity. However, a thrombogenic potential of obesity has also been established. A very important question in contemporary obesitology is whether antidiabetics currently administered in obese non-diabetic individuals will have a positive cardiovascular effect similar to that in diabetics. Myokines, muscle tissue hormones, certainly have a protective effect on the cardiovascular...

Diabetic foot

Robert Bém, Michal Dubský, Vladimíra Fejfarová, Jitka Husáková, Veronika Wosková

Vnitr Lek 2020, 66(2):92-96 | DOI: 10.36290/vnl.2020.015  

Diabetic foot (DF) is a serious late complication of diabetes associated with high morbidity and mortality, often leading to lower limb amputation. Risk factors for DF include neuropathy, infection, and ischemia. The prevention of ulceration is essential for reducing amputation rate. Effective follow-up of patients and application of preventive approaches such as using of appropriate shoes and foot care can reduce the incidence of ulcerations by up to 50 %. DF treatment is very expensive and includes offloading of the affected foot, treatment of infection and revascularization. Local treatment and satisfactory diabetes control are also very important....

Diosmin/hesperidin: a cooperating tandem, or is diosmin crucial and hesperidin an inactive ingredient only?

Debora Karetová, Josef Suchopár, Jan Bultas

Vnitr Lek 2020, 66(2):97-103 | DOI: 10.36290/vnl.2020.016  

With the advent of novel monocomponent venoactive drugs containing the flavonoid diosmin, the need has arisen to answer the question of therapeutic equivalence of the widely used micronized purified flavonoid fraction (MPFF) contained in Detralex and of the currently introduced monocomponent venoactive drugs. Experimental work provides evidence that each of the two dominant components, i.e. diosmin and hesperidin, has its specific and distinctive pharmacodynamic effect. There is also evidence of a mutual synergistic effect, e.g. in antiexudative action. Clinical studies have been carried out with MPFF for the most part, and effect has clearly been...

Blood vessel ageing and vascular memory

Jan Václavík

Vnitr Lek 2020, 66(2):104-110 | DOI: 10.36290/vnl.2020.017  

As blood vessels age, their structure and function gradually change. This process is influenced by diet and the presence of modifiable risk factors. Blood vessel status can be clinically evaluated by measuring arterial stiffness or ankle-brachial index. The patient's vascular age can be calculated using the SCORE project and indicates what age would have a person with the same calculated cardiovascular risk, whose risk factors were all within the normal range. The vascular age can be positively influenced by nonpharmacological measures, hypolipidemic statin therapy and also by hypertension pharmacotherapy, especially renin-angiotensin-aldosterone system...

Clinical aspects of epicardial fat deposition

Markéta Sovová

Vnitr Lek 2020, 66(2):e8-e12 | DOI: 10.36290/vnl.2020.034  

Obesity is a chronic metabolic disease which is characterized by an increased body fat. Obesity increases cardiovascular morbidity and mortality and presents an important socioeconomic burden for the health system. So-called "central-android-abdominal-visceral" obesity plays an important role in the development of cardiovascular diseases. Adipose tissue is nowadays considered to be metabolically active tissue which is involved in many metabolic processes, managing food intake, lipid metabolism regulation, and also inflammatory diseases. Many cytokines, such as those regulating body temperature, are produced by the adipose tissue. In the last few years,...

Adipocytokines and thyreopathies

Štefan Sotak

Vnitr Lek 2020, 66(2):e13-e18 | DOI: 10.36290/vnl.2020.035  

Adipocytokines are numerous proteins secreted by adipose tissue predominantly. They regulate many key physiological processes in human body. High or low levels of thyroid hormones in various thyropathies may have influence on levels of various adipocytokines, especially adiponectin, resistin and visfatin. However, results of studies are controversial or miss. Perplexing influence could have associate diseases of metabolic character (e. g. insulin resistance and type 2 diabetes mellitus or developing atherosclerosis).

Thymoma - diagnostics options

Petr Konvička, Dan Marek, Jiří Habermann, Peter Jevík, Josef Chudáček, Filip Čtvrtlík, Jaroslav Michálek

Vnitr Lek 2020, 66(2):e19-e23 | DOI: 10.36290/vnl.2020.036  

Various types of tumors (either benign or malignant) can be found in mediastinum. Early diagnosis and treatment may help to improve survival and quality if life in these patients. Compared to direct mediastinoscopy, used for obtaining a specimen for histological analysis in previous decades, modern imaging methods, specifically the CT navigated biopsy, represent an effective and less invasive approach to the diagnosis. In our publication, we present a patient with thymoma, rather rare type of anterior mediastinum tumor.

Clostridium difficile Infection: an update on treatment and prevention

Roman Stebel, Lenka Vojtilová, Petr Husa

Vnitr Lek 2020, 66(2):e24-e28 | DOI: 10.36290/vnl.2020.037  

Disruption of the colonic microflora is one of the most significant adverse effects of antibiotic (ATB) therapy. Excessive multiplication of toxigenic Clostridioides difficile strains is responsible for about 20 % of cases of post-antibiotic diarrhoea. The global trend of Clostridium colitis incidence, severity, mortality and in particular therapeutic failure keeps rising. At the Department of Infectious Diseases we work on long-term monitoring of the most important colitis-associated risk factors and evaluation of individual therapeutic and preventive procedures (selective ATB therapy, faecal bacteriotherapy). A diligent analysis of risk factors...

Hypoxemia/hypoxia and new concepts of oxygen therapy in intensive care

Jan Máca, Marcela Káňová, Roman Kula, Pavel Ševčík

Vnitr Lek 2020, 66(2):e29-e36 | DOI: 10.36290/vnl.2020.038  

Oxygen is biologically vital element sustaining life. The tissue oxygen delivery is therefore precisely regulated. The degree of tissue oxygenation is estimated by measurement of oxygen blood level. The lack of oxygen on cellular and tissue level can lead to organ failure and life-threatening condition. Important adaptive processes are activated during the sublethal hypoxia with goal to preserve cellular and tissue functions. Inadequate effort to correct hypoxia can cause either disturbance of the adaptation or undesirable tissue hyperoxia. This fact is taken into account in two currently proposed concepts: (1) precise control of arterial oxemia and...

Relation between testosterone levels and body composition, physical functioning and selected biochemical parameters in adult males

Milan Sedliak, Michal Kralik, Jan Cvecka, Gabriel Buzgo, Matus Putala, Barbara Ukropcova, Jozef Ukropec, Zdenko Kilinger, Juraj Payer, Boris Kollarik, Peter Bujdak, Truls Raastad

Vnitr Lek 2020, 66(2):e37-e42 | DOI: 10.36290/vnl.2020.039  

Introduction: The objective of the study was to examine the relationship between the values of selected parameters of physical function, body composition, body mass index (BMI) and biochemical markers of metabolic health with the total testosterone (TT) levels in adult males. We aimed to analyse the correlation between these values and variations in the TT levels. Methods: A total of 17 subjects (age = 50.2 ± 8.1 years, TT = 11.4 ± 3.8 nmol/l) were included in the study. Subjects were tested on physical function (1RM on leg press, bench-press, handgrip, VO_2max), body composition (DXA), biochemical parameters (morning fasting blood...

Celiac disease in adults

Zuzana Vacková

Vnitr Lek 2020, 66(2):116-120 | DOI: 10.36290/vnl.2020.019  

Celiac disease is a lifelong autoimmune disorder that occurs in genetically predisposed people when consuming gluten. Its prevalence is around 1% of the population with about twice higher proportion of women. Celiac disease is one of the most common causes of malabsorption, however, its manifestations can be quite diverse - from completely asymptomatic to fully developed malabsorption syndrome. Extraintestinal manifestations are a common finding in adults. The gold standard of diagnosis is the serological detection of specific antibodies (the serum tissue transglutaminase IgA antibodies) in combination with a typical histological finding from a duodenal...

Cushing's syndrome and acromegaly based on picoadenoma of the pituitary gland

Ivana Ságová, Daniela Kantárová, Dušan Pavai, Milan Dragula, Anton Vaňuga, Peter Vaňuga

Vnitr Lek 2020, 66(2):e43-e47 | DOI: 10.36290/vnl.2020.040  

Cushing's syndrome (CS) is a relatively rare disease characterized by autonomous hypersecretion of cortisol. The incidence of CS is estimated to be equal to 2-3 cases per million inhabitants per year. The incidence of acromegaly is 3-4 patients per 1 000 000 per year. The disease is caused by hypersecretion of growth hormone which is mainly caused by benign tumour of the pituitary gland. In our case report we present a 41- year old woman suffering from both Cushing's syndrome and acromegaly. The patient was examined in National Institute of Endocrinology and Diabetology Ľubochňa for a centripetal type of obesity and hirsutism. Laboratory tests revealed...

Inherited C2-complement deficiency: variable clinical manifestation (case reports and review)

Pavlína Králíčková, Ctirad Andrýs, Tomáš Freiberger, Jan Krejsek

Vnitr Lek 2020, 66(2):e48-e52 | DOI: 10.36290/vnl.2020.041  

C2 deficiency represents the most frequent type of a complement deficiency. Clinical manifestation includes infections caused by encapsulated bacteria (Steptococcus pneumoniae, Neisseria meningitidis) such as meningitis, gonitis, pneumonia or septicaemia. A causative treatment has not been available yet. A prophylactic vaccination and/or a long-term antibiotics prophylaxis are recommended. Here we report 2 patients from 2 unrelated families. The first patient suffered from recurrent otitis in his childhood. He underwent osteomyelitis, meningitis complicates with hear-loss, and one episode of pneumonia during adulthood. The second index...

Differential diagnosis of hypoglycemia

Jan Schovánek, Ľubica Cibičková, Filip Čtvrtlík, Zdeněk Fryšák, David Karásek

Vnitr Lek 2020, 66(2):129-133 | DOI: 10.36290/vnl.2020.022  

Our review summarizes the possible differential diagnoses of hypoglycemia. It confirms the absolute necessity of fulfilling all the three Whipple hypoglycemia criteria. Briefly is mentioned Clinical symptoms of hypoglycemia are briefly mentioned and several ways to classify the hypoglycemic events are offered. Highlighted is the recommended approach to distinguish patients as seemingly ill and healthy and also as hypoglycemia occurring in diabetic and non-diabetic. All the classifications and recommendations are summarized in attached tables and schemes.

What is new for internists in ESC guidelines on diabetes?

MUDr. Jan Škrha jr., Ph.D.

Vnitr Lek 2020, 66(2):111-115 | DOI: 10.36290/vnl.2020.018  

A brief summarization of European Society of Cardiology 2019 Guidelines on diabete{s, pre-diabetes, and cardiovascular diseases.

Diabetes management in hospital

Jan Škrha jr., Eva Horová, Tomáš Štulc

Vnitr Lek 2020, 66(2):126-128 | DOI: 10.36290/vnl.2020.021  

Patients with diabetes represent around 25 % of hospitalized persons. Treatment of diabetes patient is more complicated. Modification or initiation of antidiabetic treatment is often a significant problem during hospitalization on standard medical ward. The aim of this article is to present basic recommendations for in-patient diabetes treatment.

Pioglitazone

David Karásek

Vnitr Lek 2020, 66(2):121-125 | DOI: 10.36290/vnl.2020.020  

Pioglitazone belongs to the drugs primarily reducing insulin resistance. Currently, it is the only insulin sensitizer available. In addition to hypoglycaemic action, it has a number of other metabolically beneficial effects that are responsible for its positive effect on the vascular wall. The paper provides an overview of cardiovascular clinical trials with pioglitazone, its safety profile and practical recommendations for its administration.