Vnitřní lékařství, 2021 (vol. 67), issue 5

Editorial

Endocrinology – focused on osteoporosis

Juraj Payer

Vnitr Lek 2021, 67(5):255

Main topic

Bone disesase in end-stage kidney disease - renal and non-renal components

Sylvie Dusilová Sulková, Anita Pokorná, Roman Šafránek, Ladislava Pavlíková, Vladimír Palička

Vnitr Lek 2021, 67(5):258-263 | DOI: 10.36290/vnl.2021.072

Metabolic bone disease in chronic kidney disease and end-stage renal failure represents one of the most severe clinical complication in kidney patients, namely those on maintenance dialysis. Traditionally, bone changes are induced by secondary hyperparathyroidism. The CKD-MBD concept reflects the link between bone and cardiovascular disease in these patients. Studies documented also other bone pathological pathways in renal patients, such as osteoporosis, as in kidney and dialysis patients its risk factors are present as well as in general population. Resulting bone disease in renal disease and failure is far more complex than previously seen. However,...

Introduction: Patients with primary adrenal insufficiency receive long - term glucocorticoid replacement therapy, which may cause osteoporosis

Peter Vaňuga, Ivana Ságová

Vnitr Lek 2021, 67(5):264-269 | DOI: 10.36290/vnl.2021.073

Aim of the study: The aim of the study was to assess the effect of glucocorticoid replacement therapy in patients with Addison´s disease on bone mineral density (BMD), parameters of calcium - phosphate (Ca-P) metabolism as well as on bone turneover markers. Patients and methods: The study group consisted of 46 patients with Addison´s disease (12men, 17 pre- and 17 postmenopausal women, the control group consisted of 44 healthy individuals (8 men, 16 prepre- and 16 postmenopausal women). Ca-P metabolism parameters, bone turnover markers and adrenal hormones were examined in all groups. BMD was measured by dual-energy X-ray absorptiometry in the lumbar...

Osteoporosis in men: underappreciated and undertreated

Vít Zikán

Vnitr Lek 2021, 67(5):271-283 | DOI: 10.36290/vnl.2021.074

Osteoporotic fractures of the vertebrae and the proximal end of the femur dramatically impair quality of life and increase morbidity and mortality. Although up to 40% of all osteoporotic fractures occur in men, physicians tend to underestimate the osteoporosis in men, and it remains underdiagnosed and undertreated. Though, there is no evidence that current approved osteoporosis medications work any less well in men than in women, insufficient awareness of the risk of fractures, fear of side effects of drugs and other barriers have made management challenging in men at risk for fracture. Our review provides updates on pathophysiology and current options...

Osteoporosis in premenopausal women

Juraj Payer, Juraj Smaha, Martin Kužma, Zdenko Killinger, Peter Jackuliak

Vnitr Lek 2021, 67(5):284-290 | DOI: 10.36290/vnl.2021.075

In contrast to postmenopausal women diagnostic process and treatment of premenopausal osteoporosis in young women reamin poorly defined. A low bone mineral density in premenopausal women is not associated with the same risk of fractures as in postmenopausal women, therefore diagnosis requires not only densitometric examination but depends on the consideration of other risk factors. Most cases of premenopausal osteoporosis are associated with chronic diseases affecting bone metabolism. Treatment of the underlying disease may improve bone density as well as bone quality. Rarely, a bone-specific antiporotic therapy may be used, although quality evidence...

Osteoporosis in diabetes mellitus patients

Peter Jackuliak, Magdaléna Kovářová, Martin Kužma, Juraj Payer

Vnitr Lek 2021, 67(5):291-295 | DOI: 10.36290/vnl.2021.076

Diabetes mellitus (DM) is currently a pandemic problem, and the number of diabetic patients is constantly increasing. There are known and established diabetic complication but it is also comorbidities associated with DM cannot be forgotten. One of these is osteoporosis and osteoporotic fractures. In diabetic patients, the fractures are usually 2 to 6 times higher. In management of diabetes we should screen also the risk of osteoporosis and fractures. From a diabetic point of view, optimum glycaemic control should be achieved, however, we should take into account the effect of antidiabetic agents on bone. In this summary data on the diagnosis and treatment...

Review articles

Uncommon thrombotic complications after SARS-CoV-2 vaccination

Dalibor Musil

Vnitr Lek 2021, 67(5):297-302 | DOI: 10.36290/vnl.2021.077

Shortly after the worldwide initiation of vaccination against SARS-CoV-2, concerns emerged about a possible link between vaccination, severe thrombocytopenia, and the development of atypical venous thrombosis. Concerns were primarily about AstraZeneca (ChAdOx1 nCov-19), later Johnson & Johnson (Ad26.COV2.S), but cases of acute immune thrombocytopenic purpura (ITP) and bleeding without thrombosis and also atypical venous thrombosis after exposure to the messenger RNA-based vaccines produced by Pfizer-BioNTech and Moderna have been reported. Examination of the circumstances of these complications revealed that this is a similar mechanism to heparin-induced...

Role of inflammation and imunity in atherosclerosis and possible ways of their control

Jan Bruthans

Vnitr Lek 2021, 67(5):304-308 | DOI: 10.36290/vnl.2021.078

Atherosclerosis and its clinical manifestations are characterised by ongoing arterial wall inflammation. Innate and adaptive imunity patterns are involved in all stages of atherosclerosis. Intensity of inflammation, more advanced proatherogenic imunity activity enhance development of cardiovascular (CV) disease. Efforts to control inflammation and imune proatherogenic patterns face considerable problems, but recent clinical studies offer promissing results. Statins have antiinflammatory effect, but PCSK9 monoclonal antibodies not. SGLT2 inhibitors (gliflozins) have a proven antiinflammatory effect and this might partly explain their protective CV effect....

Carcinoid syndroma - diagnosis and management

Soňa Kiňová, Michal Koreň

Vnitr Lek 2021, 67(5):310-314 | DOI: 10.36290/vnl.2021.079

Neuroendocrine tumors (NETs, originally termed "carcinoids") create a relatively rare group of neoplasms with an approximate incidence rate of 5 to 8 cases per 10 000 persons. NETs predominantly demonstrate indolent disease biology for many years. They become symptomatic when they are large enough or when they metastasize to the liver or the lungs, bones, or other sites. Roughly 30% to 40% of subjects with NETs develop carcinoid syndrome. Signs and symptoms of carcinoid syndrome are bronchospasm, flushing, diarrhea and cramping, cyanosis and pellagra. White plaque-like deposits on the endocardial surface of heart structures are characteristic for carcinoid...

E-publication

Whipple disease - systemic disease with gastrointestinal manifestations

Leoš Chrudimský

Vnitr Lek 2021, 67(5):e03-e08 | DOI: 10.36290/vnl.2021.080

Whipple disease is rare, potentionally life-threatening disease with broad scale of possible symptoms and therefore wide differential diagnosis. Localized forms as well as systemic manifestations are possible. Etiological agent is bacteria Tropheryma whipplei. The most common manifestations include arthralgias, fever, diarrhea, abdominal pain, malabsorption syndrome and weight loss. In my article I present literature review and a case report of the pacient with relatively typical course of the disease.

Preleukemic fusion genes typical for acute myeloid leukemia

Daniela Klimová, Jakub Styk, Michal Svoboda, Simona Humplíková, Vanda Repiská

Vnitr Lek 2021, 67(5):e09-e12 | DOI: 10.36290/vnl.2021.081

Acute myeloid leukemia (AML) is a highly heterogeneous subtype of leukemia, accounting for 25 % of childhood leukemias. By the presence of genetic mutations in hematopoietic/ progenitor stem cells, the bone marrow produces a large number of abnormal undifferentiated leukocytes (blasts), which significantly impairs the proper differentiation of cells. AML is induced by two interventions. Chromosomal translocation during hematopoiesis of intrauterine development is the first intervention. This creates preleukemic fusion genes (PFG), which can later be transformed by a second intervention (point genetic mutation - deletion, insertion …) into a functional...

Original articles

Retrospective analysis of the incidence of pulmonary embolism in CT images in patients with a positive value of D-dimers

Vlastimil Válek jr., Vlastimil Válek, Michal Uher

Vnitr Lek 2021, 67(5):e13-e16 | DOI: 10.36290/vnl.2021.082

Aim: The analysis of the correlation between D-dimer and positive finding of pulmonary embolism on CT-angiography. Determination of the cut-off value of D-dimers, which would lead to a reduction in the number of examinations on CT-angiography. Materials and methods: Patients who had positive D-dimer values in their blood tests and were examined using CT-angiography were included in the analysis. The relationship between the D-dimer value and the finding of pulmonary embolism on CT-angiography was analyzed. The analysis included 91 consecutive patients (46 women, 64,5 ± 18,8 years) examined from December 2019 to January 2020. Results: The...

Do we care enough about the medication in the elderly? (Case of the geriatric care facility at Military University Hospital Prague)

Veronika Krejčí, Irena Murínová, Jana Mohoutová, Petra Staňková

Vnitr Lek 2021, 67(5):e17-e22 | DOI: 10.36290/vnl.2021.083

Objective: The aim of this paper is a complex evaluation of client’s medication in the geriatric care facility Domov Vlčí mák (DVM) with regard to the most common drug related risk factors in elderly. The paper shows ways of identification, resolution and prevention of drug related problems from the perspective of a clinical pharmacist. Methods: The medication was evaluated in 74 DVM clients. The sample consisted of 45 women (61 %) and 29 men (39 %) with an average age of 90 years. The project took place in the period from April to June 2020. Patient’s pharmacotherapy was graded as low, medium or high...

ICU mortality of covid-19 patients - our experience

Radka Čapková, Stanislav Ševela, Hana Petrášková, Marie Ryšánková, Radan Brůha

Vnitr Lek 2021, 67(5):e23-e27 | DOI: 10.36290/vnl.2021.084

Objectives: To determinate characteristics of covid-19 patients in our ICU, to determinate mortality and presence of comorbidities considered as risk factor for severe course of disease. Methods: Retrospective observation study in ICU with 5–8 beds. Population of 91 adults with covid-19 admitted to ICU. Results: Median age was 67 years (38–88). Hypertension (56 patients, 61 %) and diabetes (35 patients, 38 %) were the most common comorbidities. 24 patients (26 %) were obese with BMI 30–40, 10 patients (11 %) with BMI > 40. Average SOFA score on admission was 3,5 (1–10). HFNO (high flow nasal...

Case reporty

D-lactic acidosis - a rare complication of short bowel syndrome

Vladimír Podušel, Simona Morgošová, Pavol Majdák, Jurina Sadloňová

Vnitr Lek 2021, 67(5):e28-e33 | DOI: 10.36290/vnl.2021.085

D-lactic acidosis represents a rare form of metabolic acidosis that occurs most commonly in patients with short bowel syndrome. This is a serious, sometimes life-threatening complication. The cause is the accumulation of D-lactate in the body, which is formed in excessive amounts by fermentation of unabsorbed carbohydrates by the intestinal microbiota. The nervous system is predominantly affected, which also results in clinical manifestations. The clinical picture is dominated by a wide range of non-specific neurological symptoms. The disease can sometimes manifest as somnolence to coma. From the aspect of laboratory diagnostics, the disease is characterized...