Don't we forget about biological therapy of hypercholesterolemia with PCSK9-inhibitors?

Vladimír Soška, Ondřej Kyselák

Vnitr Lek 2021, 67(3):138-142 | DOI: 10.36290/vnl.2021.034  

In many patients it is difficult to achieve the current very low target LDL-cholesterol levels, recommended for the prevention of atherosclerotic cardiovascular events. If statin therapy or statins in combination with ezetimibe are not sufficient, addition of PCSK9 inhibitors should be considered. PCSK9 inhibitors reduce LDL-CH by an average of 50-60 % and reduce the risk of atherosclerotic cardiovascular events. They are currently reserved for patients with atherosclerotic cardiovascular disease and for patients with familial hypercholesterolaemia, in whom despite intensive hypolipidemic therapy statins with ezetimibe the target LDL-cholesterol value...

What's new in the 2020 update of the CEAP classification system of chronic venous disease?

Dalibor Musil

Vnitr Lek 2021, 67(3):143-148 | DOI: 10.36290/vnl.2021.035  

The aim of the 2020 update of the CEAP (Clinical-Etiology-Anatomy-Pathophysiology) classification is provide the reproducibility of clinical findings between physicians, enable comparison of old and new versions of the CEAP classification, incorporate new evidence-based knowledge into the classification, and provide a balance between simple practical use and highly specific and detailed description of patient with chronic venous disease (CVD) in clinical and other studies. Clinical (C) classification remained unchanged and clinical definitions of all seven classes C₀-C₆ have been preserved. Class C₄ is newly divided...

Treatment strategies for myelodysplastic syndrome in 2021

Petra Bělohlávková

Vnitr Lek 2021, 67(3):150-155 | DOI: 10.36290/vnl.2021.036  

The heterogeneous nature of myelodysplastic syndrome (MDS) brings a very variable prognosis of patients with the need for individualized treatment. The prognosis and treatment depend on the conventional determination of IPSS (International Prognostic Scoring System) and its revised form IPSS-R, which divides patients into lower and higher risk groups. Treatment of patients with lower risk of MDS include the improvement of cytopenia, especially anemia. The goal of treatment in patients with higher risk of MDS is delaying disease progression and improve patient survival. The only curative method for therapy of MDS is allogeneic hematopoietic stem cell...

Therapy of 3 patients with Erdhiem-Chester disease with cladribin or cladribin in combination with cyclophosphamide. Case report and review of the therapy

Zdeněk Král, Zdeněk Řehák, Marta Krejčí, Renata Koukalová, Sabina Ševčíková, Luděk Pour, Martin Krejčí, Martin Štork, Viera Sandecká, Zdeněk Adam

Vnitr Lek 2021, 67(3):157-164 | DOI: 10.36290/vnl.2021.037  

Three adult patients with confirmed Erdheim-Chester disease (ECD) are followed at our department. Cladribine in monotherapy or in combination with cyclophosphamide were used for first line therapy. The median number of cycles of cladribine or cladribine and cyclophosphamide was 7 (range 6-8). In two cases complete response was achieved, in one case this therapy achieved no response. The duration of response is in one case 11 years, in second case the follow up is too short for evaluation of response duration. In case of no-response to cladribine and cyclophosphamide stabilisation of disease was achieved with anakinra. The tolerance was good without...

Rivaroxaban for the treatment and prevention of reccurence of venous thromboembolism in children

Eliška Boženková, Miroslav Souček

Vnitr Lek 2021, 67(3):165-168 | DOI: 10.36290/vnl.2021.038  

Venous thromboembolism in children is rare, but the incidence has increased sharply during the last years. The standard of care for treating this disease consists of warfarin, unfractionated heparin, low-molecular-weight heparins and fondaparinux. Lately, the usage of rivaroxaban (direct oral anticoagulant) was officially approved. According to a recent study, treatment with rivaroxaban resulted in a similarly low recurrence risk and reduced thrombotic burden without increased risk of bleeding. The usage of direct oral anticoagulants could overcome the limitation of currently used care (mainly the necessity of regular laboratory monitoring and parenteral...

The use of moxonidine in the treatment of arterial hypertension

Jan Vachek

Vnitr Lek 2021, 67(3):170-172 | DOI: 10.36290/vnl.2021.039  

Moxonidine is an oral antihypertensive drug from the group of 2nd generation sympatholytics. In patients with mild to moderate hypertension, moxonidine lowers blood pressure (BP) as effectively as most first-line antihypertensives when used as monotherapy - if appropriate, and is also an effective adjunctive therapy in combination with other antihypertensives. It improves metabolic profile in patients with hypertension and diabetes mellitus or impaired glucose tolerance, is very well tolerated, has a low potential for drug interactions and is administered in a single daily dose. Thus, moxonidine is a good choice especially in the treatment of patients...

Differential dignosis: "primary" or secondary diabetes - should Cushing´s syndrome be routinely screened in the patients with type 2 diabetes mellitus?

Karolína Melicharová, Ludmila Brunerová, Jana Urbanová, Jan Brož

Vnitr Lek 2021, 67(3):e08-e10 | DOI: 10.36290/vnl.2021.044  

Cushing´s syndrome is a rare disease with the population prevalence about 40 patients per 1 million inhabitants, the number among patients with diabetes mellitus (DM) is probably higher. The screening of CS among the DM patients showed the prevalence between 0-2.9% in the groups of outpatients and 2-2.9% among the patients admitted to the hospital at the time of randomization. The routine screening of CS among patients with type 2 DM is not recommended at the moment. Nevertheless, the possibility of CS should be taken into the account mainly in patients with hypertension, obesity, microvascular complications, bad level of metabolic control or high...

Biomarker GDF-15 in cardiology

Štěpán Havránek, Josef Marek

Vnitr Lek 2021, 67(3):e11-e14 | DOI: 10.36290/vnl.2021.045  

GDF-15 (Growth differentiation factor 15) is a protein synthesised in some tissues including liver, kidney, heart, or lung. GDF-15 a stress-responsive cytokine. GDF-15 is emerging as a biomarker of cardiometabolic risk and disease burden. GDF-15 is linked to the incidence and prognosis of heart failure. In acute coronary syndromes GDF-15 identifies risk of complications including bleeding, reinfarction, development of heart failure or mortality. In patients with atrial fibrillation, GDF-15 is a potent marker of bleeding adverse events in anticoagulated patients and a predictor of overall mortality. Role of GDF-15 in cardiology is not definitively constituted...

Transformation of IgM-MGUS into Waldenström´s macroglobulinemia in two of six patients treated for Schnitzler´s syndrome

Zdeněk Adam, Miroslav Tomíška, Zdeněk Řehák, Renata Koukalová, Marta Krejčí, Zdeněk Král, Zuzana Adamová, Sabina Ševčíková, Luděk Pour, Martin Štork, Martin Krejčí, Viera Sandecká

Vnitr Lek 2021, 67(3):e15-e23 | DOI: 10.36290/vnl.2021.046  

Transformation of IgM-MGUS into Waldenström´s macroglobulinemia in two of six patients treated for Schnitzler´s syndrome Schnitzler´s syndrome is a very rare, adult-onset, apparently acquired autoinflammatory disease. Chronic urticarial rash and symptoms of systemic inflammation including fever, arthralgia and bone pain with the presence of monoclonal immunoglobulin M (IgM), rarely IgG, are among hallmarks of the disease. We performed a retrospective study of 6 patients (5 men, 1 woman) diagnosed with Schnitzler´s syndrome fulfilling the Strasbourg criteria who had been treated at our centre in the University Hospital Brno from 2007 to 2021. Median...

Rituximab in the treatment of primary glomerulopathies - our experience

Karol Graňák, Matej Vnučák, Margaréta Pytliaková, Ľudovít Laca, Marián Mokáň, Ivana Dedinská

Vnitr Lek 2021, 67(3):e03-e07 | DOI: 10.36290/vnl.2021.043  

Pembrolizumab-induced hypothyreosis and subcutaneous bleeding

Pavel Polák, Jana Špeldová, Monika Bratová, Jiřina Zavřelová, Miroslav Penka

Vnitr Lek 2021, 67(3):175-179 | DOI: 10.36290/vnl.2021.040  

Pembrolizumab belongs to so called immune checkpoint inhibitors. Frequent adverse event of this therapy is hypothyroidism. The authors present a case report of patient treated with pembrolizumab for non-small cell lung carcinoma, in whom severe hypothyroidism followed quite rapidly after transient phase of subclinical hyperthyroidism - at this time point new and spontaneous onset of large subcutaneous hematomas was observed. Acquired von Willebrand syndrome, acquired hemophilia A, dysfibrinogenemia, activation of fibrinolysis and thrombocytopathy were all actively ruled out in hematological differential diagnosis. Concomittantly, laboratory markers...

Recurrent respiratory arrests - an unusual manifestion of SLE

Adam Lukáč, Hana Matějovská Kubešová

Vnitr Lek 2021, 67(3):e24-e27 | DOI: 10.36290/vnl.2021.047  

We report on a case of a 40-year-old female who presented with two respiratory arrests occurring a few months apart. The investigations performed in our hospital during admission showed diffuse alveolar haemorrhage of unknown aetiology. Once the correct diagnosis of systemic lupus erythematosus was made, adequate treatment was initiated. This induced remission of the disease and allowed the patient to return to her normal life.

Liver cirrhosis and pregnancy: a case report and review of literature

Veronika Zvárová, Jiří Dolina, Michal Šenkyřík, Radek Kroupa, Lubomíra Horňáková, Petr Jabandžiev, Štěpán Hrabovský, Marta Číhalová, Jakub Hustý, Kornelia Mytsak, Lumír Kunovský

Vnitr Lek 2021, 67(3):e28-e32 | DOI: 10.36290/vnl.2021.048  

Liver cirrhosis is a chronic liver disease in which the liver tissue and the vascular beds are remodeled leading to impaired hepatic function. Portal hypertension and subsequent esophageal varices are a frequent complication of liver cirrhosis and are a cause of mortality in patients with liver cirrhosis. Pregnancy in women with liver cirrhosis is uncommon, the incidence being about 1 in 5 950 pregnancies. Hepatocellular damage and the associated alteration in the metabolism of the sex hormones is thought to be responsible and leads to anovulation. In spite of all these factors, women with cirrhosis can and do become pregnant. Pregnancy is successful...

COVID-19 patient care experience in the United Kingdom

Bashar Aldhoon

Vnitr Lek 2021, 67(3):e35-e40 | DOI: 10.36290/vnl.2021.050  

In response to the COVID-19 pandemic many health care systems have attempted to reorganize healthcare workforce. Many doctors and nurses have been redeployed to acute care wards. In order to ensure the best quality of care it is essential for health professionals to stay updated on clinical studies and novel therapeutical approaches. Most patients with COVID-19 who become seriously unwell have an acute respiratory illness and about 14 % will require non-invasive respiratory support. This article aims at presenting some of the approaches in respiratory support and drug therapy. The overview of management is based on current guidelines and conclusions...

Vericiguat in patients with heart failure and reduced ejection fraction

Jindřich Špinar, Lenka Špinarová, Jiří Vítovec

Vnitr Lek 2021, 67(3):180-182 | DOI: 10.36290/vnl.2021.041  

Komentář k článku: Co může internista udělat pro svého pacienta po ischemické cévní mozkové příhodě Vnitř Lek 2021; 67(1): 7-14
Co může diabetolog udělat pro svého pacienta po iCMP?

Jan Brož, Jana Malinovská, Barbora Pelechová, Jana Urbanová, Ludmila Brunerová

Vnitr Lek 2021, 67(3):e33-e34 | DOI: 10.36290/vnl.2021.049  

Komentáře k analýze složení směsi flavonoidů v tabletách Diozen 500 mg metodou UHPLC

František Kováčik, Anna Šantorová

Vnitr Lek 2021, 67(3):184-186 | DOI: 10.36290/vnl.2021.042  

The ESH-ISH ON-AIR Joint Meeting 2021

Michal Fejfuša

Vnitr Lek 2021, 67(3):e47-e48  

Legal aspects of intestinal microbiome application

Šárka Špeciánová

Vnitr Lek 2021, 67(3):e41-e46 | DOI: 10.36290/vnl.2021.051  

Application of intestinal microbiome (Fecal Microbiota Transplantation) is currently discussed treatment procedure which is the subject of professional interest not only when it comes to its medical aspects, but also its legal regulation. The aim of this article is to introduce a legal perspective on this subject matter and outline possible newly regulated areas. The subject matter is linked not only with the legislation contained in the Czech Civil Code in the section devoted to products having its origin in the human body, but also with other laws in the area of medical law. The position of regulatory authorities in the EU is also mentioned. It is...