Spánek jako klinická veličina: měřit, interpretovat, léčit

prof. MUDr. Milan Sova, Ph.D.

Vnitr Lek 2026, 72(5):280  

Device-based diagnostics in Czech sleep medicine

Tomáš Krejčí, Samuel Genzor, Jaromír Vachutka

Vnitr Lek 2026, 72(5):284-299 | DOI: 10.36290/vnl.2026.055  

This article reviews the historical development and current state of sleep medicine in the Czech Republic from the perspective of device-based diagnostics. It briefly introduces methods used across all six major groups of sleep disorders and focuses in detail on sleep-related breathing disorders, particularly obstructive sleep apnea (OSA). The historical four-level classification of diagnostic methods is discussed, ranging from laboratory polysomnography (PSG), which remains the reference method, through home sleep apnea testing (HSAT) to simple screening. The article also provides a detailed technical overview of diagnostic systems used in the Czech...

Insomnia in patients with chronic obstructive pulmonary disease: pathophysiology, diagnosis and treatment

Milan Sova, Jaroslav Vejrych, Vladimír Herout, Ondřej Venclíček

Vnitr Lek 2026, 72(5):300-305 | DOI: 10.36290/vnl.2026.056  

Insomnia is an independent sleep-wake disorder that is common in patients with chronic obstructive pulmonary disease (COPD) and may substantially impair daytime functioning, quality of life, and coping with the underlying respiratory disease. Its origin is usually multifactorial. Contributing factors include nocturnal dyspnoea, cough and sputum, sleep-related changes in ventilation, hypoxaemia or hypercapnia, COPD-obstructive sleep apnoea overlap, pain, gastro-oesophageal reflux, nocturia, heart failure, anxiety and depression, medication effects, and perpetuating behavioural patterns. Diagnosis is primarily clinical and should distinguish subjective...

Sleep and athletic performance

Markéta Sovová, Eliška Sovová

Vnitr Lek 2026, 72(5):306-310 | DOI: 10.36290/vnl.2026.057  

Sleep is a key biological process essential for optimal physical and mental functioning and plays a crucial role in recovery, adaptation to stress, and athletic performance. This review article focuses on the physiology of sleep in athletes, its impact on performance, the consequences of sleep deprivation, and the importance of circadian rhythms. Adequate sleep duration and quality support muscle recovery, hormonal balance, and cognitive function, while sleep deprivation leads to impaired physical and mental performance, increased fatigue, and a higher risk of injury.

Iron deficiency anemia: when to use oral versus intravenous iron, how much, and for how long

Veronika Cíglerová, Jan Válka

Vnitr Lek 2026, 72(5):312-319 | DOI: 10.36290/vnl.2026.059  

Iron deficiency anemia is the most common hematologic disorder and its management requires accurate diagnosis as well as a rational choice of iron replacement strategy. The decision between oral and intravenous therapy is based on the patient's clinical status, the etiology of iron deficiency, and the expected absorption of iron. Oral preparations at a dose of 100-200 mg of elemental iron daily represent first-line treatment in stable patients; with an adequate response, an increase in hemoglobin of ≥ 10 g/L can be expected within 2 weeks, and therapy should continue for at least 3 months after normalization to replenish iron stores. Intravenous...

Initiating antihypertensive treatment with combination therapy: why it should become standard practice in most patients

Eva Kociánová

Vnitr Lek 2026, 72(5):320-324 | DOI: 10.36290/vnl.2026.060  

Contemporary hypertension guidelines have shifted from stepwise escalation of monotherapy toward earlier use of combination treatment. The rationale is not limited to greater blood pressure-lowering efficacy; it also includes shortening exposure to uncontrolled blood pressure, reducing therapeutic inertia, and improving adherence. The 2024 ESC and 2023 ESH guidelines prefer an initial low-dose two-drug combination, ideally as a single-pill combination, in most patients with confirmed hypertension; the 2025 AHA/ACC guideline recommends two first-line agents for stage 2 hypertension. Monotherapy remains appropriate in selected situations, particularly...

Low-trauma fracture: a window of opportunity for secondary prevention without delay

Soňa Dubecká, Martin Kužma, Peter Jackuliak, Juraj Payer

Vnitr Lek 2026, 72(5):326-334 | DOI: 10.36290/vnl.2026.061  

The modern risk-oriented approach to the diagnosis and treatment of osteoporosis is no longer based solely on the assessment of bone mineral density by DXA, but on a comprehensive evaluation of fracture risk. An important role is played by clinical risk factors, a history of low-trauma fracture, FRAX, TBS, and other tools that allow more precise patient stratification and treatment individualization. A low-trauma fracture represents a window of opportunity for secondary prevention without delay, because after a recent fracture the risk of another fracture is highest in the short-term period. This article summarizes the current approach to the diagnosis...

Gouty arthritis: current insights into diagnosis and treatment

Stela Kašperová, Lenka Tarabčáková, Daniela Šutovská, Emőke Šteňová

Vnitr Lek 2026, 72(5):E11-E20 | DOI: 10.36290/vnl.2026.062  

Gout is a crystal-induced arthritis and represents the most common form of inflammatory arthritis in adulthood. The clinical course of the disease includes acute flares alternating with asymptomatic intercritical periods and, in the case of long-term untreated hyperuricaemia, it may progress to a chronic tophaceous form. A typical feature of an acute gout flare is the rapid onset of inflammatory activity within a few hours, which helps to distinguish gout from other forms of arthritis. Despite the fact that the "disease of kings" is well-known and a treatment is commonly available, it remains frequently underdiagnosed, and its management in clinical...

Diabetic foot: from antibiotics to offloading and revascularization

Jana Pecová

Vnitr Lek 2026, 72(5):E21-E26 | DOI: 10.36290/vnl.2026.063  

Diabetic foot syndrome (DFS, diabetic foot) is one of the late complications of diabetes mellitus. The WHO defines DFS as damage of the tissues of the foot distal to the ankle, most commonly associated with diabetic neuropathy and varying degrees of lower limb ischemia. (5) The clinical manifestations of DFS include ulcers, gangrene, and Charcot neuropathic osteoarthropathy (CNO). DFS is characterized by the heterogeneity of clinical findings. Patient care is multidisciplinary. It encompasses regular preventive education of patients on self-care of the feet, treatment of ulcers, administration of antibiotics in cases of foot infection, treatment of...

Erdheim-Chester disease diagnosed and treated at the Hematology and Oncology Clinic of the Brno University Hospital in the last 26 years. Description of 6 cases and an overview of the symptoms and treatment of this disease

Zdeněk Adam, Zdeněk Řehák, Karel Starý, Richard Chaloupka, Aleš Čermák, Sandra Soboličová, Ivanna Boichuk, Martin Štork, Viera Sandecká, Andrea Křivanová, Marta Krejčí, Luděk Pour

Vnitr Lek 2026, 72(5):E1-E10 | DOI: 10.36290/vnl.2026.058  

Erdheim-Chester disease (ECD) is a malignant histiocytic disease that is usually accompanied by a systemic inflammatory reaction (fever of uknown origin). Osteosclerotic bone changes are characteristic. A typical feature is increased accumulation of osteotropic radiopharmaceuticals around the knee joints (hot knees) and the formation of retroperitoneal infiltrates. ECD can affect virtually any organ. Its incidence in the adult population has been estimated in Europe and the USA at 3 cases/10 million adults. The number of diagnosed cases has been increasing in recent years due to better awareness among physicians. At the Hematology Clinic in Brno, we...

Acute coronary syndrome without atherosclerosis: paradoxical coronary embolism in a patient with venous thromboembolism and occult lung adenocarcinoma

Mária Ivančíková, Martin Hudec, Zuzana Celecová

Vnitr Lek 2026, 72(5):338-340 | DOI: 10.36290/vnl.2026.064  

The occurrence of acute coronary syndrome without angiographic evidence of atherosclerosis in combination with venous thromboembolism represents a diagnostically challenging situation with a potential systemic underlying cause. We present the case of 50-year-old man with a recent deep vein thrombosis who was admitted with acute pulmonary embolism and concomitant acute coronary syndrome. Coronary angiography revealed distal occlusion of the ramus intermedius, which was treated by aspiration thrombectomy. Transesophageal echocardiography (TEE) confirmed the presence of a patent foramen ovale (PFO). During the subsequent clinical course, the patient...

Giant cell arteritis with a mixed cranial and large-vessel phenotype presenting with atypical retroauricular headache and fever of unknown origin

Marcel Pavlík, Oliver Kuchař, Róbert Novotný

Vnitr Lek 2026, 72(5):E27-E33 | DOI: 10.36290/vnl.2026.065  

Giant cell arteritis is the most common primary large-vessel vasculitis affecting individuals older than 50 years. The classical cranial form is typically associated with temporal headache, jaw claudication, scalp tenderness, visual disturbances, and the risk of irreversible vision loss. However, the disease may also present as fever of unknown origin accompanied by a marked systemic inflammatory response without typical temporal artery involvement, leading to substantial diagnostic delay. We present the case of a 62-year-old woman with an approximately two-month history of right-sided retroauricular and occipital headache, daily febrile episodes,...

Flu vaccination - common myths and how to talk to patients

Šárka Rumlarová

Vnitr Lek 2026, 72(5):342-344 | DOI: 10.36290/vnl.2026.066  

Influenza is a highly contagious disease that can lead to serious complications. Vaccination against influenza clearly reduces the risk of infection or a severe course of the illness. Despite the fact that its effectiveness is reliably supported by extensive data, the Czech population has long shown distrust toward influenza vaccination. Vaccination coverage in the Czech Republic is lamentably low, even among high-risk patient groups. This article examines the most common objections cited as reasons for refusing the influenza vaccine and provides appropriate arguments to counter these concerns. These may help in discussions with patients and contribute...

Large language models in healthcare: benefits, risks and outlook

Ondřej Volný, Adam Gřunděl

Vnitr Lek 2026, 72(5):345-350 | DOI: 10.36290/vnl.2026.067  

Large language models (LLMs) such as ChatGPT, Gemini, or Claude have become widely accessible tools increasingly used by patients and clinicians for health-related purposes, regardless of whether these tools are certified as medical devices. A large-scale analysis of over 500,000 health-related conversations with Microsoft Copilot demonstrated that nearly one in five queries involves personal symptom assessment, and one in seven personal health queries concerns someone other than the user. Health-related queries markedly increase during nighttime hours, when traditional healthcare access is most limited. This trend creates both opportunities (information...