Value of electrocardiogram and chest X-ray examinations in preoperative managementOriginal articles#E-publication

Bronislav Čapek, Jan Václavík, Klára Benešová, Jiří Jarkovský

Vnitr Lek 2024, 70(8):E3-E10 | DOI: 10.36290/vnl.2024.103  

Aims: An electrocardiogram (ECG) and chest X-ray (CXR) are widely used in the preoperative period for patients undergoing non-cardiac surgery (NCS). We aimed to assess whether preoperative ECG and CXR had any impact on changes in preoperative management for an unselected population undergoing non-elective NCS. Methods: We retrospectively reviewed records of hospitalized patients undergoing an internal preoperative examination in 2015-2021. The primary endpoint was a change in preoperative management that caused postponement or complete cancelation of a surgery (PCCS), due to an abnormal ECG or CXR. Results: We enrolled 2362 patients. 72% had an abnormal...

New trends in the field of inborn errors of immunityNews in...

Zita Chovancová

Vnitr Lek 2024, 70(8):533-538 | DOI: 10.36290/vnl.2024.101  

Congenital disorders of the immune system PIDs/IEIs) represent a dynamically developing group of diseases characterized not only by an increased susceptibility to infections but also by the occurrence of autoimmune, autoinflammatory, allergic, and malignant complications. Around 500 of these diseases have been described to date, and their number continues to grow. The result of dynamic progress in the diagnosis and therapy of these diseases is the progress of genetic diagnostics, the introduction of screening for PID/IEIs in newborns, as well as the use of new therapeutic approaches including gene therapy. Since the beginning of 2024, nationwide screening...

Syncope caused by rupture of a right coronary artery aneurysmCase reports

Jakub Šyler, Jiří Plášek, Jiří Vrtal, Jan Václavík, Jozef Dodulík

Vnitr Lek 2024, 70(8):528-532 | DOI: 10.36290/vnl.2024.100  

Syncope is a sudden transient loss of consciousness caused by short-term hypoperfusion of the brain. It is a common reason for patients to visit acute admissions, where it is crucial to distinguish life-threatening causes from benign conditions. In this case report, we present the case of a 71-year-old patient whose syncope was caused by rupture of a right coronary artery aneurysm, resulting in the formation of a bulky hematoma in the right-sided cardiac compartments. This mechanism led to recurrent syncope, which at first glance could be mistakenly attributed to orthostatic hypotension caused by newly administered antihypertensive drugs. The case...

DRESS syndrome as a probable cause of acute kidney injury and skin involvement in a polymorbid patientCase reports

František Novák, Jiří Vymětal, Petr Konvička

Vnitr Lek 2024, 70(8):522-527 | DOI: 10.36290/vnl.2024.099  

DRESS syndrome (Drug Reaction with Eosinophilia and Systemic Symptoms) is a severe late drug reaction, which can be potentially life threatening. It usually manifests itself as a whole-body exanthema, changes in blood count and organ involvement, especially the liver and kidneys. Here, we describe a case of a polymorbid elderly patient with skin involvement and renal failure related to the use of allopurinol. Early diagnosis and adequate treatment led to restoration of renal function. Eosinophilia was a crucial diagnostic indicator.

Kidney transplantation in patients with multiple myeloma: current optionsReview articles

Silvie Rajnochová Bloudíčková, Anna Novotná

Vnitr Lek 2024, 70(8):517-521 | DOI: 10.36290/vnl.2024.102  

Kidney disease is common in patients with multiple myeloma. Due to an unfavourable prognosis, patients with end-stage kidney disease in multiple myeloma were not accepted for kidney transplantation. Current therapeutic options for multiple myeloma have significantly improved the survival of these patients, thus more individuals are being referred for kidney transplantation. Recently published data support that a certain cohort of patients may benefit from transplantation. These are mainly patients with stable remission of multiple myeloma, whose treatment included stem cell transplantation. A multidisciplinary approach with an individualised assessment...

Modern trends in asthma treatmentReview articles

Samuel Genzor

Vnitr Lek 2024, 70(8):513-516 | DOI: 10.36290/vnl.2024.098  

Asthma bronchiale is a highly prevalent respiratory disease that reduces the quality of life of patients if the treatment is insufficient or ineffective. The mainstays of therapy are inhaled glucocorticoids, optimally in a fixed combination with long-acting beta-2-agonists. In case of insufficient effect, it is possible to consider increasing the dose of inhaled glucocorticoid, adding an antileukotriene, or adding long-acting anticholinergics. A patient with insufficiently controlled asthma on maximized treatment should be referred for precise diagnosis and medication adjustment to a specialized center for the treatment of difficult-to-treat asthma....

Febrility in malignant diseaseReview articles

Štefan Sotak

Vnitr Lek 2024, 70(8):508-512 | DOI: 10.36290/vnl.2024.097  

Fevers have many causes. The most common is infection. They can also occur in oncological diseases. Fevers caused directly by malignancy are called paraneoplastic. Their diagnosis can sometimes be very complex and lengthy and represents a therapeutic challenge even for an experienced physician; therefore they represent a non-negligible percentage of fevers of unknown origin. The so-called can be helpful naproxen test. Levels of inflammatory parameters can sometimes be misleading - they can be significantly elevated in active malignancy. In addition, febrility in an oncology patient can also occur due to infection, which arises as a result of malignant...

How microorganisms evade the immune systemReview articles

Karolína Absolonová, Petr Matucha, Ivan Šterzl

Vnitr Lek 2024, 70(8):502-506 | DOI: 10.36290/vnl.2024.096  

Microorganisms have evolved a wide variety of strategies to evade both the innate and adaptive immune systems during evolution, and some of these strategies are addressed in our review. Microorganisms can use the similarity of their proteins to host proteins, produce anti-inflammatory factors, disrupt the complement system, affect the function and block the synthesis of cytokines, inhibit the recognition of immunoglobulins, reduce the expression and modify antigens on their surface, disrupt the processing and presentation of antigen by immune cells, enter immune cells , influence cell apoptosis, modulate immune cell functions or influence hormone production....

Diagnosis and treatment of hyperuricemia in cardiovascular prevention based on its pathophysiological mechanism: An Expert Consensus of Czech and Slovak Specialists, 2024Review articles

Michal Vrablîk, Claudio Borghi, Hana Rosolová, Blanka Stibůrková, Ivana Šoóšová, Martin Čaprnda, Ján Števlîk, Adriana Ilavská, Peter Jackuliak, Zuzana Zafarová

Vnitr Lek 2024, 70(8):491-500  

A panel of experts from the Czech and Slovak Republics, with the contribution of Professor C. Borghi from the University of Bologna, discussed the clinical approach for the investigation and treatment of hyperuricemia (HU) in patients with increased cardiovascular (CV) risk. Since elevated uric acid (UA) modifies CV risk, it should be considered as an important modifier of CV risk and patients in whom its therapeutic reduction may improve CV parameters should be identified. The lack of selection of suitable patients is probably the reason for the inconsistent results of studies evaluating the clinical outcomes of antihyperuricemic therapy to date....

Results and recommendations for colorectal cancer screeningReview articles

Tomáš Grega, Miroslav Zavoral, Štěpán Suchánek

Vnitr Lek 2024, 70(8):484-489 | DOI: 10.36290/vnl.2024.095  

Colorectal cancer is the second most common cancer worldwide and represents a significant health burden, particularly in economically developed countries. The Czech Republic has one of the highest incidences of colorectal cancer in Europe. However, a long-standing screening program has led to a substantial reduction in both the incidence and mortality rates of this disease. The article emphasizes the importance of achieving sufficient population coverage in screening to effectively reduce the public health burden of colorectal cancer. It provides an overview of the global incidence of colorectal cancer and the current epidemiology of the disease in...

N-acetylcysteine for prevention of contrast-induced nephropathyReview articles#E-publication

Štefan Sotak

Vnitr Lek 2024, 70(7):E11-E13 | DOI: 10.36290/vnl.2024.094  

N-acetylcysteine (ACC) is an acetylated variant of the amino acid L-cysteine and is primarily used as a specific antidote for paracetamol overdose. Other indications for its application include prevention of exacerbation of chronic obstructive pulmonary disease, relief of flu symptoms, treatment of pulmonary fibrosis, treatment of infertility in patients with polycystic ovary syndrome resistant to clomiphene, moreover, in the treatment of autism, Alzheimer's disease, bipolar affective disorder, schizophrenia, obsessive-compulsive disorder and drug addiction. In addition, ACC may also play a role as a chemoprevention of malignancies, an adjunct in the...

Diagnosis and treatment of electric shockReview articles#E-publication

Jozef Dodulík, Jiří Plášek, Jiří Vrtal, Lukáš Evin, Marie Lazárová, Jan Václavík

Vnitr Lek 2024, 70(7):E8-E10 | DOI: 10.36290/vnl.2024.093  

Electrocution poses a serious health risk with a wide range of consequences, from mild to life-threatening complications. These effects depend on factors like voltage, current, tissue resistance, and duration of exposure. Electrocution injuries require a multidisciplinary approach involving emergency medicine, internal medicine, and, in some cases, burn and trauma care. This review summarizes current recommendations for diagnosing and treating patients after electrocution, with an emphasis on the role of the internist and the management of patients not directed to burn centers.

In-hospital management of non-surgical patients treated with gliflozinsReview articles#E-publication

Michal Šitina

Vnitr Lek 2024, 70(7):E3-E7 | DOI: 10.36290/vnl.2024.092  

A rare but serious complication of the treatment with gliflozins is euglycemic ketoacidosis. It predominantly affects individuals with type 1 or type 2 diabetes. In non-diabetic patients taking gliflozin, the risk of ketoacidosis is minimal. The risk is more pronounced in the perioperative period. Therefore, gliflozin should be discontinued 3-4 days prior to the scheduled major surgery. In case of minor surgery without prolonged fasting, gliflozins can be discontinued only one day before and on the day of surgery. In non-surgical patients, the initiation and continuation of gliflozins during hospitalization appears to be safe, unless risk factors,...

Hlavní téma – GeriatrieEditorial

prof. MUDr. Eva Topinková, CSc.

Vnitr Lek 2024, 70(7):407  

Cutting-edge technology in medicine: preparation for colonoscopy in a patient with type 1 diabetes mellitus treated with a hybrid closed-loop insulin pump-continuous glucose monitor - case report and framework recommendationsCase reports

Adina Večeřová, Monika Neščáková, Martin Wasserbauer, Jana Urbanová, Jan Král, Lucie Šestáková, František Škopek, Juraj Michalec, Jan Brož

Vnitr Lek 2024, 70(7):469-473 | DOI: 10.36290/vnl.2024.091  

Colonoscopy is a key method for preventing, diagnosing, and treating colon diseases. The colonoscopic examination includes preparing the colon before the procedure, which involves emptying the bowel with orally administered lavage agents and the associated temporary change in diet. This preparation can lead to glycemic fluctuations and the risk of hypoglycemia in patients with diabetes mellitus. This case report describes the case of a patient with type 1 diabetes mellitus treated with a hybrid closed-loop system who used 5 grams of sucrose sachets during colonoscopic preparation to replenish energy and stabilize glucose based on continuous glucose...

Large vessel vasculitis - new classification criteria and new treatment optionsReview articles

Debora Karetová, Agáta Jeníšová

Vnitr Lek 2024, 70(7):462-467 | DOI: 10.36290/vnl.2024.090  

Large vessel vasculitis (LVV) affects the aorta and the large arteries branching from it. There are 2 diseases in particular, namely Giant cell arteritis (GCA) and Takayasu arteritis (TAK). Both diseases are rare, which is why early diagnosis often fails. GCA (formerly called Horton's temporal arteritis) is an idiopathic inflammatory disease taking place mainly in the wall of the media and adventitia. It is often associated with extravascular inflammation, most commonly in the form of polymyalgia rheumatica. It is now clear that this arteritis includes a wide range of phenotypic expression: a distinction is made between large vessel GCA (LV-GCA) and...

Current treatment options for ventricular arrhythmias in heart failureReview articles

Renáta Aiglová

Vnitr Lek 2024, 70(7):457-461 | DOI: 10.36290/vnl.2024.089  

Despite advances in care, heart failure is still associated with a poor prognosis. Arrhythmic complications also contribute to the poor prognosis of patients with heart failure. Ventricular arrhythmias occur very frequently in patients with heart failure. They can be the result of structural myocardial damage, but less often they can also cause de novo heart failure or worsen pre-existing heart failure. Treatment of ventricular arrhythmias in heart failure requires a comprehensive approach. The basis is the optimized therapy of heart failure. Non-pharmacological treatment is also an integral part - ICD implantation, catheter ablation. Catheter ablation...

Thromboprophylaxis of venous thromboembolism in internal medicineReview articles

Petr Dulíček

Vnitr Lek 2024, 70(7):452-456 | DOI: 10.36290/vnl.2024.088  

Venous thromboembolism is still serious not only medical, but also social economic problem. For many decades we know about the risk of surgery for venous thromboembolism, but in hospitalized medical patients the awareness was underestimated. In the last 25 years the situation has been changed with the advance of scoring models, which can help us the identify individuals who need pharmacologic prophylaxis. The Padua prediction score is one of the most used. However, due to the amounts of risk factors, individual variability, it is not always easy to find correct recommendation not only from medical, but also economic point of view.

Atrial fibrillation in patients with arterial hypertension and novel European GuidelinesReview articles

Štěpán Havránek

Vnitr Lek 2024, 70(7):446-451 | DOI: 10.36290/vnl.2024.087  

Atrial fibrillation and arterial hypertension are frequent diagnoses in internal medicine and are often combined. The presence of arterial hypertension, especially insufficiently corrected, is a risk factor for the occurrence of atrial fibrillation itself, but also a factor in the progression of the disease and a risk factor for the failure of atrial fibrillation rhythm control treatment. Arterial hypertension also increases the risk of complications of atrial fibrillation, especially thromboembolic events, and increases the risk of bleeding during anticoagulant treatment. The therapy of atrial fibrillation and arterial hypertension overlaps at certain...

Intermittently scanned continuous glucose monitoring (isCGM) in hospitalized elderly patientsMain topic

Darina Matvějeva, Martina Nováková, Pavlína Piťhová, Lucie Tománková, Vladimíra Kotvová, Daniela Polanecká, Milan Kvapil

Vnitr Lek 2024, 70(7):438-444 | DOI: 10.36290/vnl.2024.086  

The prevalence of internal diseases increasing with age is the reason for the increased number of seniors among those hospitalized in non-surgical beds. The disease that is the reason for hospitalization in a patient with diabetes usually fluctuates blood sugar. A number of examination methods require preparation with a change in intake and diet composition, a certain period of fasting before or after the procedure. All this increases the risk of hypo/hyperglycemia. It threatens the health and life of the patient. Prevention is especially frequent monitoring of blood glucose. Despite the advanced development of collection and measurement of glucose...

The benefits and risks of new antidiabetic drugs for the treatment of geriatric patients with diabetesMain topic

Darina Matvejeva, Martina Nováková, Pavlína Piťhová, Milan Kvapil

Vnitr Lek 2024, 70(7):430-437 | DOI: 10.36290/vnl.2024.085  

Life expectancy is increasing in patients with diabetes. The prevalence of diabetes increases with age. New classes of antidiabetics (gliflozins, incretin therapy, new insulin analogues) are safer, have at least comparable efficacy to conventional treatment, and also bring a positive impact on the risk of late complications of diabetes. The use of their potential for the treatment of elderly people with diabetes is particularly beneficial in terms of safety and prevention of complications.

Pharmacological treatment of arterial hypertensin in old and very old patient in current evidence-based guidelinesMain topic

Eva Topinková, Jan Filipovský

Vnitr Lek 2024, 70(7):419-429 | DOI: 10.36290/vnl.2024.084  

Arterial hypertension is one of the most common disorders in older people and there is undoubtedly professional agreement that antihypertensive treatment is beneficial in the wide range of older age for preventing cardiovascular events and reducing overall mortality. However, treatment in old age confers several pharmacological risks. The 2023 Guidelines on hypertension management of the European Society of Hypertension distinguish two age groups (65-79 and 80+years) for which separate criteria for treatment initiation and target blood pressure values are recommended. Unfortunately, there is a gap of evidence on effectiveness and safety of antihypertensives...

News in the diagnosis of sarcopenic obesity in older adultsMain topic

Katarína Bielaková, Ondřej Ludka

Vnitr Lek 2024, 70(7):412-417 | DOI: 10.36290/vnl.2024.083  

Sarcopenic obesity is characterized by the combination of obesity and sarcopenia, Sarcopenic obesity needs to be considered as a unique clinical condition, different from obesity or sarcopenia alone. These two problems significantly potentiate each other, thereby maximizing their impact on morbidity and disability. Until now, sarcopenic obesity has been identified using different definitions and diagnostic criteria, and this fragmentation has had a negative impact on the development of prevention and treatment strategies for sarcopenic obesity in the elderly. In 2022, the European Society for Parenteral and Enteral Nutrition (ESPEN) and the European...

Dopis redakciLetters to the editor#E-publication

prof. MUDr. Milan Kvapil, CSc., MBA

Vnitr Lek 2024, 70(6):E27-E28  

Z čeho jsme se učili internu?Latest from the society#E-publication

Jan Petrášek

Vnitr Lek 2024, 70(6):E18-E26  

Národní program snížení příjmu soli v ČR v letech 2023-2030 - "30 % do roku 2030"INFORMATION#E-publication

Jan Václavík, Richard Češka, Michal Vrablík, Jan Piťha, Petr Ošťádal

Vnitr Lek 2024, 70(6):E13-E17  

Primary and secondary prevention of stroke and arterial hypertensionReview articles#E-publication

Jiří Widimský

Vnitr Lek 2024, 70(6):E10-E12 | DOI: 10.36290/vnl.2024.080  

Strokes are among the most common cardiovascular complications, with arterial hypertension being considered the most significant risk factor. It is estimated that more than 50% of strokes are caused by hypertension, and high blood pressure alone increases the risk of stroke by 3-4 times! Furthermore, hypertension is an independent risk factor for the development of atrial fibrillation. The following brief summary addresses approaches to antihypertensive treatment in the primary and secondary prevention of strokes. Adequate control of hypertension through pharmacological treatment leads (among other benefits) to a significant reduction in the risk of...

Microvascular complications of diabetes - their prevention and treatmentReview articles#E-publication

Martina Lášticová

Vnitr Lek 2024, 70(6):E3-E9 | DOI: 10.36290/vnl.2024.079  

Microvascular complications of diabetes are a cause of significant morbidity and cardiovascular mortality of patients with diabetes. Their development and progression is associated with chronic hyperglycemia, and other risk factors are hypertension, dyslipidemia, smoking and genetic factors. Preventative startegies should focus on optimal individualized glycemic control, and also treatment of other modifiable factors. Early detection of complications using screening procedures and early and appropriate treatment lower the risk of advanced complications and of their subsequent physical, social and economic impact.

Hlavní téma – revmatologieMain topic

prof. MUDr. Pavel Horák, CSc.

Vnitr Lek 2024, 70(6):339  

Semaglutide in different indicationsReview articles

Ľubica Cibičková

Vnitr Lek 2024, 70(6):399-402 | DOI: 10.36290/vnl.2024.078  

Semaglutide belongs to the group of GLP-1 receptor agonists, which have a significant effect on the adjustment of blood sugar and body weight. The development of semaglutide administration led to subcutaneous administration once a week and orally once a day. This article provides information on current indications for semaglutide treatment, as well as contraindications and side effects. Finally, the use of semaglutide as an antiobesity drug is mentioned.