Vitamin D and its clinical applicationsReview articles

Michal Kršek

Vnitr Lek 2025, 71(2):108-114 | DOI: 10.36290/vnl.2025.019  

The article reviews current knowledge about vitamin D from the clinical point of view. The basic facts about its forms, physiological effects and metabolism are summarized. From clinical point of view the article deals with the state of supply of vitamin D, vitamin D deficiency and its clinical signs, symptoms and therapy. In paragraphs devoted to the treatment the current knowledge about forms of vitamin D, their indication, doses and dosage regimens are summarized.

Diabetes mellitus and chronic renal insufficiencyReview articles

Peter Girman

Vnitr Lek 2025, 71(2):103-106 | DOI: 10.36290/vnl.2025.018  

With the increasing number of diabetics in the population, there is also a rise in both microvascular and macrovascular complications. Kidney damage represents one of the leading causes of mortality in patients with diabetes. The classification of diabetic nephropathy is based on the glomerular filtration rate and the degree of albuminuria, categorizing patients into risk groups according to their mortality risk. The treatment of these patients is based on data from large multicenter studies, which have demonstrated cardiovascular benefits, particularly with the use of gliflozins. Therefore, gliflozins and statins, together with metformin, are among...

New trends in the diagnosis and treatment of hypertrophic cardiomyopathyMain topic

Mária Bakošová, Hana Poloczková, Tomáš Honek, Anna Chaloupka, Jan Krejčí

Vnitr Lek 2025, 71(2):93-102 | DOI: 10.36290/vnl.2025.017  

Hypertrophic cardiomyopathy (HCMP) is an inherited heart disease characterized by thickening of the left ventricular musculature that cannot be explained by hemodynamic load. The prevalence of HCMP is estimated to be 1:500, the disease has a good prognosis in general, but can lead to serious complications from dyspnea, arrhythmias, syncope to heart failure and sudden cardiac death. Today's progress in imaging techniques allows the identification of individual phenocopies of HCMP to target therapy properly. This paper mainly focuses on sarcomeric HCMP, where a recent breakthrough in treatment is the inclusion of the cardiac myosin inhibitor mavacamten...

What do the new ESC 2024 guidelines for the treatment of hypertension offer and how do they differ from ESH 2023?Main topic

Libor Jelínek, Zdeněk Ramík, Radek Adámek, Jan Václavík

Vnitr Lek 2025, 71(2):86-92 | DOI: 10.36290/vnl.2025.016  

Although the prevalence of arterial hypertension is increasing worldwide, the percentage of patients with controlled hypertension is also increasing. In diagnosing and treating arterial hypertension, doctors can rely on the European Society of Cardiology (ESC) 2024 and European Society of Hypertension (ESH) 2023 guidelines. Both sets of guidelines emphasize existing and add new recommendations. Values in the range of 120-139/70-89 mm Hg are now considered elevated blood pressure by ESC. In the diagnosis of hypertension, there is consensus on the emphasis on out-of-hospital blood pressure measurement. Initiation of pharmacotherapy is indicated in all...

Diagnosis and treatment of infective endocarditisMain topic

Ondřej Ludka, Miroslava Bendová

Vnitr Lek 2025, 71(2):72-85 | DOI: 10.36290/vnl.2025.015  

The European Society of Cardiology published an updated guideline for the diagnosis and treatment of infective endocarditis in 2023 (1), which was subsequently adopted by the Czech Society of Cardiology (2). Unfortunately, the recommendations in the areas of antibiotic prophylaxis and treatment contain many shortcomings and errors (3), which is why three Czech professional societies have developed their own recommendations (4). The following text is a compilation of these documents, primarily intended for internists.

Treatment of monoclonal gammopathy of renal significance with manifestations of Light Chain Deposition Disease (LCDD) in the transplanted kidneyCase reporty#E-publication

Tomáš Roháľ, Martin Kment, Luděk Voska, Zdeněk Adam, Marek Borský, Lenka Zdražilová-Dubská, Marta Krejčí, Zdeněk Král, Luděk Pour

Vnitr Lek 2025, 71(1):E14-E24 | DOI: 10.36290/vnl.2025.011  

Light Chain Deposition Disease (LCDD) is a very rarely diagnosed condition affecting the kidneys. We describe a case where this diagnosis was morphologically confirmed in a biopsy of a transplanted kidney, and retrospectively identified in a previous kidney biopsy where the changes were not correctly classified. The biopsy of the transplanted kidney was performed due to worsening graft function. Subsequent testing focused on monoclonal gammopathy, revealing elevated serum concentrations of free kappa light chains (FLC) with a maximum FLC kappa value of 226 mg/l and FLC lambda at only 6 mg/l. The FLC kappa / FLC lambda ratio was clearly pathological...

Nutrition and its role in the primary prevention of osteoporosisReview articles#E-publication

Matej Kohutiar, Monika Bartolomějová, Magdaléna Fořtová, Eva Klapková, Jana Čepová

Vnitr Lek 2025, 71(1):E8-E13 | DOI: 10.36290/vnl.2025.012  

Osteoporosis is a chronic metabolic bone disease that results from an imbalance between bone formation and resorption. Bone remodeling is a dynamic process influenced by genetic factors, nutrition and physical activity. Calcium, phosphorus, and vitamin D are key nutritional factors in the prevention and treatment of osteoporosis, but due to the complexity of bone tissue, other nutrients must also be considered. This article summarizes the importance of each nutrient, discusses the risks associated with inappropriate dietary habits, increasing consumption of ultra-processed foods and emphasizes the importance of overall lifestyle in the prevention of...

Analysis of indications for blood components in the Regional Hospital Liberec, asOriginal articles#E-publication

Petr Papoušek, Renata Procházková

Vnitr Lek 2025, 71(1):E1-E7 | DOI: 10.36290/vnl.2025.013  

Aim: Correct indications of blood components (BC) are the key to effective and safe haemotherapy. The aim of this study was to evaluate the indication criteria of BC, to compare the changes in BC indications between two periods and to improve the quality of haemotherapy at the Regional Hospital Liberec, as (KNL). Materials and methods: The study population consisted of all BCs (erythrocytes, platelets, plasma) administered in the KNL in the period from 1 October 2020 to 30 September 2021 and from 1 August 2022 to 31 July 2023. From the database of the laboratory information system, the laboratory results of BC recipients were matched to each BC: haemoglobin...

New recommendations on hyperglycemic crises treatment in patients with diabetesIn brief

Jan Škrha jr.

Vnitr Lek 2025, 71(1):58-61 | DOI: 10.36290/vnl.2025.010  

Diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar state (HHS) are the most severe hyperglycemic situations in patients with diabetes. In 2024, a new consensual recommendation on epidemiology, pathophysiology, manifestation, and therapy of these acute situations was published after 15 years. The most important information from this document is presented in the manuscript.

Tirzepatide - a promising medication for cardiovascular protection and treatment of Type 2 diabetes and obesityPharmacological profile

Pavlína Piťhová

Vnitr Lek 2025, 71(1):51-57 | DOI: 10.36290/vnl.2025.009  

Tirzepatide is a dual GLP-1/GIP receptor agonist. It is very promising substance in treatment of Type 2 diabetes mellitus, obesity treatment, improvement of metabolic profile and cardiovascular protectivity. This article summarizes mechanisms of effect and results of finished clinical trials.

Angioedema caused by of C1 esterase inhibitor deficiencyCase reports

Ondrej Šantavý, Jaroslav Žák

Vnitr Lek 2025, 71(1):47-49 | DOI: 10.36290/vnl.2025.008  

Our case study presents patient with C1 esterase inhibitor deficiency, whose first manifestation was due to abdominal colic. Our diagnosis was confirmed by assessing the C1INH levels and C1INH functional deficit. Therapy was started with B2 receptor antagonist Icatibant with promising result.

Humoral biomarkers and atrial fibrillationReview articles

Martin Ihnatko, Ivica Lazúrová

Vnitr Lek 2025, 71(1):40-44 | DOI: 10.36290/vnl.2025.007  

Atrial fibrillation (AF) is the most common arrhythmia in clinical practice, contributing to increased morbidity and mortality. Humoral biomarkers, such as natriuretic peptides, troponin, aldosterone, cortisol, copeptin, and apelin, are gaining importance in the diagnosis, prognosis, and management of AF. Elevated levels of these biomarkers indicate not only myocardial dysfunction and atrial remodeling but also inflammatory and procoagulant states that influence the progression and complications of AF. Monitoring biomarker levels provides deeper insight into the pathophysiological mechanisms of AF and can aid in identifying patients at higher risk...

Estrogenic treatment and liver functionsReview articles

Jiří Slíva

Vnitr Lek 2025, 71(1):37-39 | DOI: 10.36290/vnl.2025.006  

Estrogens are key hormones that play a vital role in the physiology of the reproductive system in women. However, their therapeutic use in hormonal treatment, contraception and the treatment of hormone-dependent diseases may be associated with a number of side effects, especially on the liver. This article focuses on the mechanisms of action of estrogens and their potential hepatotoxic effects, as well as risk factors and possible differences between representatives.

The significance of metabolism-associated steatotic liver disease and its treatmentReview articles

Adam Vašura, Evžen Machytka, Marek Bužga, Jitka Macháčková, Jan Král

Vnitr Lek 2025, 71(1):29-36 | DOI: 10.36290/vnl.2025.005  

Non-alcoholic fatty liver disease (NAFLD) is one of the most important chronic liver diseases, which is closely related to metabolic syndrome. It was renamed to metabolic-dysfunction-associated steatotic liver disease (MASLD) in May 2023. In recent decades, this disease has experienced a global prevalence increase, which is currently 32 %, mainly in connection with the increase of obese patients in all regions. MASLD prevalence copies the increase of metabolic syndrome. It is necessary to actively search for this disease and use available diagnostic tools, which will detect this disease and also will help with selection of high-risk patients who are...

Allopurinol and uricosuricsMain topic

Jiří Slíva

Vnitr Lek 2025, 71(1):24-26 | DOI: 10.36290/vnl.2025.004  

The presented text briefly characterizes the basic possibilities of pharmacotherapeutic treatment of hyperuricemia. Allopurinol acting as a competitive xanthine oxidase inhibitor with a potential for use beyond the mere influence of uricemia is still the most commonly used active substance in this indication. Other substances are also briefly mentioned, although many of them are not currently available in the Czech Republic.

Hyperuricaemia and metabolic syndromeMain topic

Lukáš Rozsíval, Michael Jenšovský, Jana Urbanová, Natálie Michalcová, Ludmila Brunerová, Jana Malinovská, Juraj Michalec, Jan Brož

Vnitr Lek 2025, 71(1):18-23 | DOI: 10.36290/vnl.2025.003  

Uric acid (UA) is predominantly formed in the liver, intestine and vascular endothelium as an end product of the metabolism of purines derived from food and endogenously from damaged or dead cells. The kidneys play a major role in the excretion of UA, eliminating about 70 % of the daily production. The remainder (approximately 30 %) is excreted by the intestine. If the production of UA exceeds the capacity of its excretion, hyperuricaemia results. Overexpression of urate transporter 1 (URAT1), glucose transporter 9 (GLUT9) and impaired glycolysis due to insulin resistance may be related to the development of hyperuricaemia in metabolic syndrome. Hyperuricemia...

Hyperuricaemia and kidneysMain topic

Brenda Mercy Musungu, Marie Vaňková, Kateřina Oulehle, Oskar Zakiyanov, Jan Vachek, Vladimír Tesař

Vnitr Lek 2025, 71(1):14-17 | DOI: 10.36290/vnl.2025.002  

Hyperuricaemia occurs in 60% of patients with chronic kidney disease (CKD) and gout in about 25% of these patients. Despite the frequent co-occurrence, the influence of uric acid on the progression of kidney disease is not clearly understood. There is controversy over the indications for treatment of asymptomatic uricemia in patients with CKD. The preponderance of evidence suggests that asymptomatic hyperuricaemia is likely to be harmful, but may be particularly relevant to certain subgroups of patients, namely those with systemic crystal deposits, urate crystalluria or urolithiasis, and those with high intracellular uric acid levels. Current evidence...

Hyperuricemia and gouty arthritisMain topic

Jan Voříšek, David Suchý

Vnitr Lek 2025, 71(1):8-13 | DOI: 10.36290/vnl.2025.001  

Crystal-induced arthropathy is caused by the deposition of crystal deposits in joint structures. Most often in clinical practice we encounter the deposition of sodium urate crystals, which is the cause of gouty arthritis. Gouty arthritis in adulthood is one of the most common inflammatory joint disorders. Especially in the developed part of the world, where in recent years we have seen a trend towards an increase in this disease. The main risk factor for the development of gouty arthritis is hyperuricemia, i.e. a pathological increase in the level of uric acid in the blood. Gouty arthritis affects the quality of life of patients not only by significant...

Kyselina močová a hyperurikemieEditorial

Hana Rosolová

Vnitr Lek 2025, 71(1):3  

Gastroenterologie - Výběr článkůSupplement

Kolektiv

Vnitr Lek 2024, 70(Suppl.C)  

Zaznělo na XXXII. výročním sjezdu České kardiologické společnosti v květnu 2024Presented at ...

redakce

Vnitr Lek 2024, 70(Suppl.B)  

Zaznělo na XXX. kongresu České internistické společnosti ČLS JEPPresented at ...

MUDr. Eva Gavendová, MUDr. Jan Škrha, Ph.D., MUDr. Zuzana Zafarová

Vnitr Lek 2024, 70(Suppl.A)  

Unintended Intravenous Administration of P-PNC and the Infusion Set as a Safety BrakeCase reporty#E-publication

Vojtěch Fišera, Kateřina Langmaierová, Michaela Rothová, Petr Vojtíšek, Andrea Vlčková

Vnitr Lek 2024, 70(8):E19-E24 | DOI: 10.36290/vnl.2024.106  

The article describes a case of unintended intravenous administration of procaine penicillin (P-PNC) instead of the prescribed crystalline penicillin (G-PNC). This unique incident is analyzed from the perspectives of human factors and quality management, using the Root Cause Analysis (RCA) method. A key element was the protective role of the infusion set with a filter, which prevented larger suspension particles from entering the patient's bloodstream, thereby averting more serious consequences. This case also serves as an important example for nursing practice, emphasizing the necessity of adhering to safety and Standard Operating Procedures (SOP)...

Microbiome and atherosclerosisReview articles#E-publication

Pavol Fülöp, Marianna Vachalcová, Barbora Sepešiová, Denisa Harvanová, Katarîna Šoltys, Gabriel Valočik

Vnitr Lek 2024, 70(8):E15-E18 | DOI: 10.36290/vnl.2024.105  

Atherosclerosis is a major cause of cardiovascular diseases and significantly contributes to global mortality. An increasing body of evidence suggests that the gut microbiome may play a key role in the pathogenesis of this disease. The gut microbiome consists of trillions of microorganisms that not only support digestion and metabolism but also influence the host's immune response. Alterations in the composition of the gut microbiome have been associated with various chronic diseases, including obesity, diabetes, and atherosclerosis. This article provides a brief overview of the gut microbiome composition in patients with coronary artery disease and...

Album-in & Album-out - a look behind the curtain of new recommendationsReview articles#E-publication

Jiří Müller, Martin Matějovič

Vnitr Lek 2024, 70(8):E11-E14 | DOI: 10.36290/vnl.2024.104  

Although synthetic colloids have fallen out of favour in the current evidence-based medicine, the use of albumin remains a common clinical practice. The rationale behind the utilisation of this colloid solution is to increase intravascular volume, facilitate fluid removal, and to treat complications of liver cirrhosis. Nevertheless, the apparently uncontroversial clinical use based on physiological principles is in fact not supported by any robust evidence. Consequently, the 2024 ICTM (International Collaboration for Transfusion Medicine) guidelines recommends albumin administration solely in a very specific subset of patients and notably, even in...

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...