The role of motivation in obesity treatmentGood advice

Šárka Slabá

Vnitr Lek 2025, 71(6):394-397 | DOI: 10.36290/vnl.2025.074  

Patient motivation plays a key role in obesity treatment, not only at the initiation of lifestyle changes but particularly in their long-term maintenance. This article summarizes current knowledge about motivational processes in individuals with obesity, outlining common barriers and influencing factors through the lens of self-determination theory and behavioral science. It focuses on practical strategies for effective patient communication, enhancing intrinsic motivation, and managing relapse as a normal part of treatment. Emphasis is placed on interdisciplinary collaboration and the need for ongoing motivational support throughout the therapeutic...

Evinacumab: a therapeutic agent for homozygous familial hypercholesterolemiaPharmacological profile

Vladimír Blaha

Vnitr Lek 2025, 71(6):389-393 | DOI: 10.36290/vnl.2025.073  

Homozygous familial hypercholesterolemia (HoFH) is a severe genetic disorder characterized by extremely high levels of LDL cholesterol and early development of atherosclerosis. Despite combined lipid-lowering therapy, the vast majority of patients fail to achieve target LDL-C levels. Evinacumab, a fully human monoclonal antibody against angiopoietin-like protein 3 (ANGPTL3), represents a novel therapeutic option. This article summarizes the mechanism of action, clinical evidence, and practical aspects of evinacumab administration in patients with HoFH.

Parainfectious exudative pericarditis in bilateral pneumonia as the primary manifestation of systemic lupus erythematosusCase reports

Jakub Tatarka

Vnitr Lek 2025, 71(6):385-388 | DOI: 10.36290/vnl.2025.072  

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease with a diverse clinical presentation that can affect almost all organ systems. Cardiopulmonary manifestations are no exception, with pericarditis being the most common cardiac involvement in patients with SLE. It is usually an aseptic serous pericarditis, while the parainfectious exudative form with complicated pleural effusion is rare and represents a diagnostic and therapeutic challenge. In this article, we present the case of a 53-year-old female patient hospitalized for parainfectious exudative pericarditis and bilateral pneumonia, in whom the diagnosis of SLE was established during...

Advances in the diagnosis and treatment of systemic lupus erythematosusReview articles

Martina Skácelová

Vnitr Lek 2025, 71(6):377-383 | DOI: 10.36290/vnl.2025.071  

Advances in the research of targeted therapy have greatly expanded the treatment options for patients with systemic lupus erythematosus (SLE). Biological therapies have become an integral part of the new 2023 EULAR recommendations for the treatment of SLE and lupus nephritis. Biologic drugs (belimumab, anifrolumab) are indicated in the treatment of patients with severe forms of non-renal SLE without life-threatening organ involvement and severe neuropsychiatric manifestations, i.e. especially when extensive skin and joint involvement predominates; belimumab also has a role in the treatment of lupus nephritis. Rituximab is particularly indicated in...

Viral hepatitis: News in diagnosis and therapyReview articles

Petr Husa, Petr Husa ml.

Vnitr Lek 2025, 71(6):372-376 | DOI: 10.36290/vnl.2025.070  

Viral hepatitis remains a serious health problem in the 21st century. In the Czech Republic, the biggest problems currently are repeated local epidemics of viral hepatitis A, an increasing number of cases of acute hepatitis E, and the treatment of viral hepatitis C in drug users. Since May 2025, new recommended procedures from the European Association for the Study of the Liver (EASL) have been available, which in some respects change the approach to the diagnosis and treatment of viral hepatitis B. Viral hepatitis D is still very rare in the Czech Republic, occurring mainly in foreigners. In the case of superinfection with hepatitis D virus (HDV)...

Current options for pharmacotherapy of obesityReview articles

Ľubica Cibičková

Vnitr Lek 2025, 71(6):365-371 | DOI: 10.36290/vnl.2025.069  

Antiobesity medication are one of the options to promote weight loss, especially when dietary measures and physical activity do not bring the expected results. However, their use should always be part of a comprehensive approach to obesity treatment that includes a healthy diet, exercise and psychological support. In recent years, we have seen an increase in the availability of pharmacotherapy for obesity, so that we can individualise treatment and try to 'tailor it to the patient'. The popular drug phentermine (Adipex), which acts on the central nervous system and helps to suppress appetite, has been withdrawn from the market relatively recently....

Penicillin allergy delabeling - the path to effective antibiotic therapyMain topic

Lenka Sedláčková, Tereza Rudová

Vnitr Lek 2025, 71(6):359-363 | DOI: 10.36290/vnl.2025.068  

Betalactam allergy, especially the most common allergy to penicillin, is one of the most common drug allergies. Ten percent of patients claim to have it, although in 90% of them it is ruled out after a thorough allergy testing and they tolerate penicillin. The use of alternative antibiotics in these patients may be associated with lower efficacy, more side effects, higher risk of multidrug-resistant bacterial infections and longer hospital stays. Comprehensive allergy testing to rule out allergy may not always be available. However, strategies are emerging in antimicrobial stewardship programs to quickly and safely screen for penicillin tolerance without...

Allergy to insect stings - clear rules, but also new questionsMain topic

Martina Vachová

Vnitr Lek 2025, 71(6):353-358 | DOI: 10.36290/vnl.2025.067  

The most serious clinical manifestation of insect venom allergy is life-threatening anaphylaxis. European epidemiological data clearly confirm that insect stings are the most common trigger of this severe systemic allergic reaction in adults, surpassing even medications and foods in this regard. Another manifestation of insect venom allergy is large local reaction around the site of the insect sting. From a clinical point of view, these reactions are significantly less serious than systemic reactions, but even extensive local swelling can bother the patient for several days. The aim of this article is to present current diagnostic and treatment procedures...

Angioedema - differential diagnosis and new therapeutic optionsMain topic

Irena Krčmová

Vnitr Lek 2025, 71(6):343-352 | DOI: 10.36290/vnl.2025.066  

Angioedema is defined as transient, recurrent swelling of the subcutaneous and/or submucosal tissues. Angioedema may affect the face, lips, neck and extremities, oral cavity, larynx and/or intestinal mucosa. Local swelling results from regionally increased permeability in subcutaneous or submucosal capillaries and postcapillary venules. Plasma extravasation occurs in response to vasoactive mediators released by activation of mast cells and/or basophils or the contact (kinin-kallikrein), complement and fibrinolytic enzyme systems of plasma, although biologically the situation is not clearly black and white. From a pathophysiological perspective, angioedema...

42. dny mladých internistů v OlomouciLatest from the society#E-publication

MUDr. Jiří Vymětal, Ph.D.

Vnitr Lek 2025, 71(5):E29-E30  

Upadacitinib: JAK inhibitor for the treatment of rheumatoid arthritisPharmacological profile #E-publication

Daniel Zuzčák, Petra Matalová

Vnitr Lek 2025, 71(5):E19-E28 | DOI: 10.36290/vnl.2025.064  

Upadacitinib (UPA), a JAK inhibitor, is classified as a tsDMARD, a targeted synthetic disease-modifying antirheumatic drug. It was first approved by the FDA in August 2019 and by the European Commission in December of the same year. Unlike monoclonal antibodies, UPA is a very small molecule with a molecular weight of 380 Da (daltons), which makes it preferable for oral administration. It is currently one of the leading drugs in the treatment of rheumatoid arthritis.

Options for artificial nutrition in a home settingReview articles#E-publication

Michal Šenkyřík, Petr Wohl, Pracovní skupina pro domácí parenterální výživu při Společnosti klinické výživy metabolické péče

Vnitr Lek 2025, 71(5):E13-E18 | DOI: 10.36290/vnl.2025.062  

Home artificial nutrition allows the administration of specialized nutritional products for the purpose of treatment and/or nutrition in the home environment. Home enteral nutrition is a widely available modality, involving sipping and administration of enteral formulas into a tube or through a specially acesses into the gastrointestinal tract. Home parenteral nutrition is a method performed in specialized centers, mainly in patients with chronic intestinal failure. It allows the administration of parenteral nutrition or hydromineral substitution through long-term vascular access. The administration of nutritional support in the home environment reduces...

The role of bronchoscopy in the diagnosis of solitary pulmonary nodules in 2025Review articles#E-publication

Jiří Votruba

Vnitr Lek 2025, 71(5):E6-E12 | DOI: 10.36290/vnl.2025.061  

Solitary pulmonary nodules (SPN) are an increasingly common clinical challenge and will continue to place a huge burden on healthcare systems for at least another 30 years. They are problematic due to their variable malignant potential and diverse etiology. The number of detected nodules is rapidly increasing and will certainly continue to do so in the future (1). This is due to the widespread use of computed tomography and the introduction of early detection programs for high-risk patients. The shift in the primary detection of bronchogenic carcinoma from the central to the peripheral airways is another reason for the increase in their incidence....

Myostatin and irisin in predicting the outcomes of patients with systemic inflammationOriginal articles#E-publication

Otakar Pšenička, Zuzana Kršáková, Jarmila Křížová

Vnitr Lek 2025, 71(5):E1-E5 | DOI: 10.36290/vnl.2025.063  

Background: Systemic inflammatory response syndrome (SIRS) is associated with rapid development of myopathy. Skeletal muscles produce myokines, which may contribute to muscle weakness. The aim of this study is to determine the potential effect of selected myokines in SIRS on the length of the hospitalization of probands. Methodology: Levels of myostatin and irisin, selected, laboratory and muscle parameters were recorded upon admission and at the day 10 of hospital stay. Control group consists of healthy individuals with BMI 18,5-29,9. Results: Myostatin levels were higher in probands than in controls and there was a significant correlation between...

Umělá inteligence v interní medicíně – nová éra klinické praxeEditorial

doc. MUDr. Ondřej Volný, Ph.D., FESO

Vnitr Lek 2025, 71(5):271-272  

Hypomagnezemie jako nejčastější nediagnostikovaná iontová nerovnováha v klinické praxi a jak ji řešitAdvertorial

MUDr. Jiří Havel, MSc.

Vnitr Lek 2025, 71(5):330-334  

How to properly interpret lipid profile resultsGood advice

Vladimír Soška

Vnitr Lek 2025, 71(5):326-328 | DOI: 10.36290/vnl.2025.060  

The lipid profile usually includes total cholesterol, triglycerides, LDL-cholesterol, HDL-cholesterol and calculation of non-HDL-cholesterol. It is optimal to evaluate the results in their mutual context, not in isolation as a single parameter. The concentration of triglycerides and total cholesterol is important for assessing whether atherogenic dyslipidemia is present, whether the LDL-cholesterol result can be relied on, and whether non-HDL-cholesterol can be used to estimate risk according to the SCORE2 tables. Lipoprotein(a) and apolipoprotein B can be used to specify the risk. It is also appropriate to take into account the reliability of blood...

Complete atrioventricular block as a manifestation of Lyme carditisCase reports

Ivana Čapková

Vnitr Lek 2025, 71(5):321-325 | DOI: 10.36290/vnl.2025.059  

Lyme disease is a common infection with multi-systemic manifestations. In some patients, it may be asymptomatic, but in symptomatic cases, the most frequent manifestation is a skin lesion known as erythema migrans. In a small percentage of cases, the infection presents as Lyme carditis. The symptoms of Lyme carditis include fatigue, syncope, palpitations, and dyspnea. These symptoms are most often caused by cardiac conduction system disorders. The main risk of Lyme carditis is rapid progression of conduction abnormalities, the development of malignant arrhythmias, and sudden cardiac death. Suspicion of Lyme-associated carditis should prompt immediate...

Monitoring oxygen concentration using the internet of things during the COVID-19 pandemicReview articles

Jan Velička, Martin Pieš, Ján Hrubovčák, Petr Jelínek, Tomáš Mimra, Radovan Hájovský

Vnitr Lek 2025, 71(5):312-319 | DOI: 10.36290/vnl.2025.058  

During the COVID-19 pandemic, up to twice as many fires and explosions related to the occurrence of dangerous oxygen concentrations in hospitals were recorded compared to non-pandemic times. This was probably due to the lack of preparedness of hospitals for the sharp increase in the use of ventilators during oxygen therapy in seriously ill patients with COVID-19. The pandemic thus showed that it is necessary to consider departments working with medical oxygen as potentially dangerous and to introduce systemic measures that can eliminate these risks threatening human lives. A possible solution to prevent fires related to the occurrence of dangerous...

Venous excess ultrasound - what we (don't) know so farReview articles

Adam Koudelka, Michaela Habánová, Ondřej Ludka

Vnitr Lek 2025, 71(5):306-311 | DOI: 10.36290/vnl.2025.057  

Venous excess ultrasound (VExUS) is a novel, non-invasive method for the semiquantitative assessment of venous congestion, using doppler examination of the hepatic, portal and renal veins. It expands the capabilities of bedside ultrasound in evaluating a patient's hemodynamic status. Disorders of fluid balance are a common clinical issue in internal medicine, particularly in patients with cardiac or renal disease, including acute conditions. In such cases, VExUS provides a non-invasive assessment of the venous part of the circulation and enables treatment adjustments based on the findings. This review article outlines the fundamentals of VExUS, its...

Osteoporosis - prevention, diagnosis and treatmentReview articles

Jana Tomasová Studýnková

Vnitr Lek 2025, 71(5):295-304 | DOI: 10.36290/vnl.2025.056  

Osteoporosis (OP) is the most common systemic skeletal disease with multifactorial etiology, affecting approximately 5-10 % of the population, mainly older people. Osteoporosis is characterized by decreased bone mineral density (BMD) and deterioration of bone tissue with disruption of bone microarchitecture, which leads to enhanced fragility and higher risk of osteoporotic fractures. Osteoporosis is influenced by demographic factors such as age and hormonal changes. The essential tools for asseing osteoporosis are dual energy X-ray absorptiometry (DXA). The intent of this paper is to provide evidence-based information about the evaluation, screening,...

Transthyretin cardiac amyloidosis - overview of the issue in 2025Review articles

Miloš Kubánek

Vnitr Lek 2025, 71(5):289-294 | DOI: 10.36290/vnl.2025.055  

Transthyretin cardiomyopathy is associated with a significant mortality and morbidity, which are caused by congestive heart failure, atrial fibrillation and atrioventricular block. In the Czech Republic, we can diagnose mainly wild-type form of the disease. Rarely, a hereditary form may be detected associated with a variable occurrence of sensorimotor polyneuropathy with a significant vegetative component. This review should provide an update of current knowledge regarding aetiology, pathophysiology, clinical presentation, diagnostics, epidemiology and treatment of transthyretin cardiomyopathy.

Artificial intelligence in primary care: From dimensionality reduction to clinical decision­‑making and time efficiencyMain topic

Michal Mačák

Vnitr Lek 2025, 71(5):284-288 | DOI: 10.36290/vnl.2025.054  

This review summarizes the principles of applying artificial intelligence (in primary care, focusing on dimensionality reduction and the integration of large language models in clinical decision-making. The article demonstrates how modern algorithms based on latent representations and deep learning contribute to more efficient diagnostics, refined diagnosis, and streamlined administrative processes, all while complementing the clinical expertise of practicing physicians.

The role of insuline glargine in the context of current pharmacotherapy of type 2 diabetes - real life dataOriginal articles

Denisa Janíčková Žďárská, Praveen Raj, Rahul Kapur, Zbynek Schroner, Robert Bém

Vnitr Lek 2025, 71(5):275-282 | DOI: 10.36290/vnl.2025.053  

Basal insulin analogues still play an irreplaceable role in the treatment of type 2 diabetes mellitus (T2DM) and are indicated when patients are poorly controlled with oral antidiabetic drugs. In the multicentre prospective observational BIGGER (Biosimilar Insulin GlarGin czEch Real-life non-interventional study) trial, the efficacy of biosimilar insulin glargine (Semglee) and its good safety profile were confirmed. Aim: To determine the efficacy and safety of biosimilar insulin glargine (Semglee) in adult patients with T2DM in real clinical practice and to evaluate the effect of previous therapy on the course of treatment. Patient population (material)...

Cholestasis and Carcinoma of the Ureter: Stauffer Syndrome?Case reporty#E-publication

Štefan Sotak

Vnitr Lek 2025, 71(4):E22-E27 | DOI: 10.36290/vnl.2025.050  

Stauffer syndrome is a rare paraneoplastic syndrome classically associated with clear cell renal carcinoma, rarely with other malignancies. It is a disease of unclear pathophysiology characterized by reversible anicteric, rarely icteric, elevation of liver enzymes, sedimentation, thrombocytosis, prolongation of activated partial thromboplastin time and hepatosplenomegaly in the absence of hepatobiliary obstruction. Therefore, it is important to consider Stauffer syndrome in the differential diagnosis for unexplained cholestasis in the absence of obstruction (e.g. metastatic) in the liver. This may allow early recognition and treatment of occult malignancy....

Antibiograms in clinical practiceReview articles#E-publication

Milan Kolář, Miroslava Htoutou Sedláková, Kateřina Bogdanová

Vnitr Lek 2025, 71(4):E14-E21 | DOI: 10.36290/vnl.2025.049  

The antibiogram is a fundamental diagnostic instrument for the appropriate selection and optimization of antimicrobial therapy in clinical practice. It is an essential component of antibiotic stewardship, which, through collaboration between clinical microbiologists and treating physicians, enables optimal treatment outcomes in bacterial infections, minimization of adverse effects, prevention of antibiotic resistance development, and cost-effective treatment. This review article summarizes various antibiogram methodologies and their determination procedures, with particular emphasis on the interpretation and practical implementation of antibiograms...

Kidney transplantation outcomes of racial minority groups in a Central European setting: a retrospective cohort studyOriginal articles#E-publication

Zuzana Pichová, Ivan Zahrádka, István Módos, Filip Tichánek, Věra Kočová, Ondřej Viklický

Vnitr Lek 2025, 71(4):E8-E13 | DOI: 10.36290/vnl.2025.048  

Background and Aims: It has been previously reported that Caucasian population has different kidney transplantation outcomes compared to other racial groups. Data from the Czech Republic are lacking. Methods: In this retrospective cohort study, we analysed 2315 kidney transplant recipients between years 2014-2024 and identified 24 ethnic minority patients (Asians n=20, African Europeans n=4). A control group consisting of Caucasian population was established by propensity score matching in a 3:1 ratio. The primary endpoint was a composite of poor graft function, graft failure, rejection and all-cause mortality at 1- and 5-years post-transplant. Secondary...

Alpha-1 Antitrypsin Deficiency - Characteristics, Diagnosis, Monitoring and Therapy of Patients in the Czech RepublicMain topic#E-publication

Libor Nevoránek, Marek Kvarda, Matyáš Wanke, Jiří Ruta, Vladimír Koblížek

Vnitr Lek 2025, 71(4):E1-E7 | DOI: 10.36290/vnl.2025.051  

Alpha-1 antitrypsin deficiency (AATD) is one of the most common inherited genetic disorders in adults worldwide, affecting not only lung function but also liver tissue and, rarely, the skin. It is still a significantly underdiagnosed diagnosis (1, 2). First described more than 60 years ago by scientists at Lund University in Sweden, it is caused by a defect in the serine protease inhibitor group A1 gene (SERPINA1, chromosome 14q32.13, wild-type M), which codes for the production of alpha-1 antitrypsin (AAT), the major antiprotease in the lungs (3). In AATD, less AAT is produced, insufficient AAT is produced, or no AAT is produced. Inadequate/faulty...

Zemřela prof. MUDr. Lenka Špinarová, Ph.D., FESCNecrolog

prof. MUDr. Jiří Vítovec, CSc., prof. MUDr. Jan Krejčí, Ph.D.

Vnitr Lek 2025, 71(4):265-266  

Advances in the treatment of heat failureIn brief

Filip Málek

Vnitr Lek 2025, 71(4):261-264 | DOI: 10.36290/vnl.2025.047  

Advances in pharmacotherapy have brought new possibilities in the treatment of heart failure. Therapy of heart failure with reduced ejection fraction has four basic pillars - fundamental drugs. Update of heart failure guidelines extended new options in the treatment of heart failure with preserved and mildly reduced ejection fraction. In additon to sodium glucose co-transporter 2 inhibitors, it is a hope for patients with heart failure and ejection fraction over 40 % selective non-steroideal mineralocorticoid receptro antagonist - finerenon.