Rheumatoid arthritis as an internal diseaseMain topic

Martina Skácelová, Pavel Horák

Vnitr Lek 2024, 70(6):358-365 | DOI: 10.36290/vnl.2024.072  

Rheumatoid arthritis (RA) is an autoimunne disease that, in addition to persistent synovial inflammation with bone destruction and cartilage loss, can manifest a variety of extra-articular symptoms and associated comorbidities that can significantly affect the quality of life of patients or limit the treatment options for RA. Extraarticular manifestations include skin, eye, mucous membrane, lung or pleural involvement, and less commonly heart a kidney involvement. The higher mortality and morbidity in RA patients is due to the high prevalence of comorbidities. These include cardiovascular diseases, infections, solid tumors and lymfomas, lung and gastrointestinal...

Early diagnosis of rheumatoid arthritis: The key to successful therapyMain topic

Adam Lukáč

Vnitr Lek 2024, 70(6):352-356 | DOI: 10.36290/vnl.2024.071  

Early diagnosis of rheumatoid arthritis (RA) is a key factor for successful treatment and improving patient prognosis. This article provides an overview of the diagnostic approach for RA. It also discusses the challenges associated with early diagnosis. Furthermore, it focuses on the benefits of early treatment initiation, including reducing disease progression and improving patients' quality of life. In conclusion, recommendations for clinical practice are provided, emphasizing the importance of timely recognition and intervention in patients with RA. This article highlights the necessity of a proactive approach by physicians to early RA diagnosis...

Autoantibodies in the diagnosis of autoimmune rheumatic diseases - practical useMain topic

Martin Žurek

Vnitr Lek 2024, 70(6):344-351 | DOI: 10.36290/vnl.2024.070  

Autoimmune rheumatic diseases represent a diverse group of conditions that may manifest with the production of autoantibodies, immune dysfunction, and systemic symptoms. Diagnosis can be challenging due to many nonspecific manifestations. A key test used in practice is the detection of organ-nonspecific autoantibodies. Autoantibodies present in individuals with systemic rheumatic diseases can serve not only as markers for classification, diagnosis, and prognosis but also in assessing disease activity and guiding treatment decisions. Autoantibodies often also play a direct role in the pathogenesis of individual diseases.

Profesor Kršek oslavil významné životní jubileumLatest from the society#E-publication

Prof. MUDr. Richard Češka, CSc., FACP, FEFIM

Vnitr Lek 2024, 70(5):E28-E29  

Výsledky léčby hypertenze v České republice v letech 1972-2022Commentaries#E-publication

Arian Taniwall, Jan Brož, Michala Lustigová, Lucia Fačkovcová, Jana Urbanová

Vnitr Lek 2024, 70(5):E27  

OPAT - ambulantní parenterální antimikrobiální terapieGuidelines#E-publication

Marek Štefan, Pavel Dlouhý

Vnitr Lek 2024, 70(5):E21-E26 | DOI: 10.36290/vnl.2024.068  

Growth hormone secretion disorders and their impact on bone qualityReview articles#E-publication

Juraj Payer, Peter Jackuliak, Peter Vaňuga, Martin Kužma

Vnitr Lek 2024, 70(5):E16-E20 | DOI: 10.36290/vnl.2024.067  

In this article, we address endocrine-mediated osteoporosis caused by disorders of growth hormone (GH) secretion; growth hormone deficiency in adults and acromegaly. GH and insulin-like growth factor-1 (IGF-1) stimulate linear bone growth through complex hormonal interactions and activate epiphyseal prechondrocytes. GH stimulates the production of osteoprotegerin and its accumulation in the bone matrix through the receptor activator of nuclear factor-kappaB (RANK), its ligand (RANK-L) and the osteoprotegerin system. Incorrect function of this mechanism can lead to specific bone damage. The primary problem of bone involvement in disorders of GH secretion...

Adrenal incidentalomasReview articles#E-publication

Ivana Ságová

Vnitr Lek 2024, 70(5):E9-E15 | DOI: 10.36290/vnl.2024.066  

Adrenal incidentalomas (AI) include all adrenal lesions ≥ 1 cm in diameter found incidentally during radiological examinations indicated for other than adrenal pathologies. Based on hormonal activity, AI are divided into hormonally non-functional and hormone active (functional). Nonfunctional AI and those with mild hormonal secretion can remain asymptomatic. However, AI that exhibit significant hormonal activity often present with characteristic symptoms of Cushing syndrome, primary hyperaldosteronism, or hyperandrogenism. Evaluation of AI requires a comprehensive approach involving hormonal examinations as well as imaging examinations to accurately...

Pilot analysis of insulin pump (CSII) utilization for the treatment of seniors with diabetes in the Czech RepublicOriginal articles#E-publication

Martina Nováková, Klára Benešová, Jiří Jarkovský, Ladislav Dušek, Iva Holmerová, Milan Kvapil

Vnitr Lek 2024, 70(5):E3-E8 | DOI: 10.36290/vnl.2024.065  

Introduction: Good glucose control is the optimal goal of antidiabetic therapy in most patients. CSII improves results and does not increase the risk of hypoglycemia in patients with type 1 and type 2 diabetes mellitus; it reduces cardiovascular mortality in type 1 diabetics. Objectives: evaluation of the use of CSII in the therapy of elderly treated with insulin in the Czech Republic. Methodology: An anonymized set of patients with DM from the data of the National Register of Paid Health Services (NRHZS) in the years 2010-2021 (patients for whom an insulin pump, accessories or consumables were reported in the given year) was used for the analysis....

Hlavní téma – Moderní trendy antibiotické léčbyEditorial

Pavel Dlouhý, Marek Štefan

Vnitr Lek 2024, 70(5):371  

Periprocedural care, bleeding control and rules for the use of antithrombotics in patients with haemostatic disorders in liver diseaseGuidelines

MUDr. Jaromír Gumulec

Vnitr Lek 2024, 70(5):326-334 | DOI: 10.36290/vnl.2024.064  

Prevention and treatment of bleeding or thrombosis in patients with liver cirrhosis is associated with a number of pitfalls, perceived ideas and established stereotypes. A false paradigm persists in the professional community that changes in haemostasis accompanying liver cirrhosis are a priori bleeding. In fact, a new haemostatic balance develops along with liver disease. The problem is that it is fragile and easily disrupted by internal drives or external interventions. The result can be bleeding as well as thrombosis. Inadequate medical interventions conducted in an attempt to correct pathological coagulation abnormalities or thrombocytopenia may...

News in gastroenterology, hepatology and digestive endoscopyNews in...

Dana Ďuricová, Ivana Mikoviny Kajzrlíková, Kateřina Košťálová, Lucie Zdrhová, Ondřej Urban, Václav Šmíd, Přemysl Falt, Ilja Tachecí

Vnitr Lek 2024, 70(5):318-325 | DOI: 10.36290/vnl.2024.063  

Gastroenterology, digestive endoscopy, and hepatology are dynamically developing fields that bring many interesting and clinically important innovations and findings every year. The aim of this article is to provide an overview of these developments. The discussed topics include oesophageal diseases (specifically the treatment of eosinophilic esophagitis and reflux oesophageal disease) and the surveillance of patients at high risk of pancreatic cancer. In hepatology, much attention has been paid in recent years to the metabolic dysfunction-associated steatotic liver disease (MASLD), which is one of the most common chronic liver diseases. The last part...

Arterial hypertension - chronic disease which needs an active and dynamic approachCase reports

Pavel Rutar

Vnitr Lek 2024, 70(5):314-317 | DOI: 10.36290/vnl.2024.062  

Cardiovascular diseases are 80 % preventable. One of the main risk factors of cardiovascular diseases which can be controlled easily is arterial hypertension. There are two main conditions which influences our chance to reach the therapeutic target - active role of a physician and a patient's adherence to the therapy. Early treatment, the proper choice of the drug, periodic check-up of results and fortification of the therapy if it's necessary, encouraging patient's adherence by a simple therapeutic schema with using a polypill and a control of other important cardiovascular risk factors as hypercholesterolaemia - these are characteristics which bring...

Percutaneous coronary angioplasty for chronic coronary syndrome: the antithrombotic therapyReview articles

Ivo Varvařovský, Roman Miklík

Vnitr Lek 2024, 70(5):308-313 | DOI: 10.36290/vnl.2024.061  

Percutaneous coronary angioplasty (PCI) is an established method of treating chronic coronary syndrome, the safety of which is fundamentally increased by properly administered antithrombotic treatment. The actual performance of PCI is ensured by a combination of anticoagulant treatment and acetylsalicylic acid. Platelet P2Y12 receptor inhibitors have been shown to be crucial for the safe use of coronary stents both in the perioperative period and in long-term treatment after PCI. The choice of a P2Y12 inhibitor and the duration of its administration are governed primarily by the risk of bleeding.

Specifics of antibiotic treatment in intensive careMain topic

Hynek Bartoš

Vnitr Lek 2024, 70(5):303-307 | DOI: 10.36290/vnl.2024.060  

Antibiotics are one of the most frequently administered groups of drugs in intensive care. The treatment of critically ill patients with community and nosocomial infections has some significant specifics compared to the treatment of outpatients or patients hospitalized in wards. Septic patients must be treated in a timely manner with an appropriately chosen empiric antibiotic treatment in a sufficient dose and at adequately selected dosing intervals. Compared to less serious conditions, these patients cannot wait to start antibiotic therapy. Pharmacokinetics is very often changed in critically ill patients, and it also changes dynamically during the...

Current recommendations for antibiotic dosing in obese patientsMain topic

Jan Strojil

Vnitr Lek 2024, 70(5):295-302 | DOI: 10.36290/vnl.2024.059  

Obesity is a growing societal and population health problem the prevalence of which has increased significantly in the recent decades. Pathophysiological changes associated with obesity can alter the pharmacokinetics (PK) of antiinfective drugs and result in subtherapeutic levels and treatment failure. Due to complex changes in distribution volume and elimination functions, a simple correction based on total body weight would often lead to overdosing and risk of toxicity. Thanks to a number of PK studies evaluating antibiotic doses in the critically ill and thanks to dedicated studies in the obese we have gained new insights into adequate dosing in...

Sequential antibiotic therapyMain topic

Pavel Dlouhý

Vnitr Lek 2024, 70(5):289-294 | DOI: 10.36290/vnl.2024.058  

The article summarizes information on sequential antibiotic therapy, i.e. the transition from parenteral to oral administration of antibiotics. The aim of this approach is to improve patient comfort, reduce the length of hospital stay, limit complications associated with intravenous access, and decrease costs, all while achieving the same treatment outcomes as in parenteral antibiotic therapy. The review also outlines the conditions on the patient's side, suitable clinical situations, and available oral antibiotics.

Duration of antibiotic therapy of the most common bacterial infectionsMain topic

Marek Štefan

Vnitr Lek 2024, 70(5):284-288 | DOI: 10.36290/vnl.2024.057  

The duration of antibiotic therapy is a controversial topic, as historically, recommendations for treatment duration were based on traditional concepts, empirical experience and concerns about the recurrence of inadequately treated infections. However, in the last few decades, a large amount of data has accumulated in the scientific literature, allowing for the safe shortening of antibiotic therapy duration for many bacterial infections. Compared to longer treatment regimens, shorter therapy duration has been shown in multiple randomized controlled trials to be equally effective, with the advantage of less antibiotic exposure, resulting in a lower...

Antibiotic therapy for the most common infections in outpatient practiceMain topic

Milan Trojánek, Marek Štefan, Ludmila Bezdíčková, Michal Prokeš, Helena Žemličková

Vnitr Lek 2024, 70(5):276-283 | DOI: 10.36290/vnl.2024.056  

The World Health Organization (WHO) has identified antimicrobial resistance as one of the leading risks to global health. In 2019, antibiotic resistance led to 4.95 million deaths worldwide. The primary cause is the exposure of bacteria to antibiotics, especially in human medicine. There is evidence that improving antibiotic prescriptions can reduce antimicrobial resistance. Most antibiotics are prescribed to outpatients, often for respiratory infections, where they are frequently overused. To improve clinical practice, it is necessary to influence not only the quantity of prescribed antibiotics but also to prefer antibiotics with a lower potential...

Profesorka Hana Rosolová slaví významné životní jubileumLaudatio#E-publication

prof. MUDr. Jan Filipovský, CSc.

Vnitr Lek 2024, 70(4):E34-E35  

Alpha-1 antitrypsin deficiencyReview articles#E-publication

Mikoláš Holinka, Jan Šperl, Soňa Fraňková

Vnitr Lek 2024, 70(4):E28-E33  

Alpha-1-antitrypsin (AAT) deficiency (AATD) is one of the most common genetic disorders. Most people carry two copies of the wild-type M allele of the SERPINA1 gene, which encodes AAT, and have normal blood concentrations of AAT. Ninety-five percent of cases of severe AAT deficiency result from the homozygous Glu342Lys substitution (Z allele), which is present in 1 in 25 persons of European descent. Mild AAT deficiency is usually due to the Glu264Val mutation (S allele). AAT is synthesized in the liver and secreted into the blood. Its primary role is to protect lung tissue from neutrophil elastase attack. Point mutations can lead to the retention...

Amiodarone-induced thyropathiesReview articles#E-publication

Marianna Bystrianska, Adrian Bystriansky, Iveta Wildová

Vnitr Lek 2024, 70(4):E21-E27  

Amiodaron is one of the most effective and widely used antiarrhythmics drug. It has an irreplaceable position in the treatment of ventricular tachycardia, the high content of iodine in its molecule predisposes it to the possible development of thyropathies. Amiodarone induced thyropathies, represent one of the serious complications of amiodarone treatment. The aim of the article is to provide a comprehensive review of the diagnosis, management and treatment of patients with amiodarone - induced thyropathies. The management of patient with amiodarone - induced thyrotoxicosis requires an interdisciplinary approach and a properly chosen treatment strategy....

Sarcopenia in chronic dialysis patientsReview articles#E-publication

Zdeněk Lys, Tomáš Balner, Jan Václavík

Vnitr Lek 2024, 70(4):E16-E20  

Sarcopenia is a generalized, progressive disease of muscle tissue conditioned not only by age but also by other factors such as physical inactivity, nutritional impairment, or several chronic diseases. The prevalence of sarcopenia in patients with advanced chronic kidney disease is high, and this number is further increased in patients on dialysis. The prognosis for this group of patients is severe and sarcopenia itself is associated with an increased risk of falls, fractures, disability, and further worsening mortality. Chronic kidney disease affects 10-12% of the population and the prevalence of renal failure increases with increasing age. In the...

Thyrotoxic crisis induced by amiodaroneOriginal articles#E-publication

Marianna Bystrianska, Adrian Bystriansky, Iveta Wildová, Lýdia Opravilová

Vnitr Lek 2024, 70(4):E8-E15  

Background: Thyrotoxic crisis is a medical emergency status needed rapid diagnostic and urgent treatment, presented by decompensation and multiorgan dysfunction. Amiodarone induced thyrotoxicosis (AIT) is one of the severe complications caused by amiodarone therapy. Aim: Analysis of patients suffered from thyrotoxic crisis induced by Amiodarone therapy, with focus on clinical picture, laboratory findings and therapeutic options. Methods and Results: A total of 39 consecutive patients were dispensed to the Endocrine outpatient clinic of the University Hospital Banská Bystrica, with AIT during the period of 2005-2021 year we performed retrospective analysis...

Posúdenie nutričného stavu u hospitalizovaných geriatrických pacientovOriginal articles#E-publication

Jaroslav Madleňák, Ivana Bóriková

Vnitr Lek 2024, 70(4):E3-E7  

Cieľ: Zistiť stav výživy u hospitalizovaných geriatrických pacientov na internom oddelení; zistiť, či existujú štatisticky významné korelácie medzi vybranými socio-demografickými údajmi, zdravotnými charakteristikami a meracím nástrojom. Súbor a metódy. Geriatrickí pacienti vo veku ≥ 65 rokov hospitalizovaní na internom oddelení. Dizajn štúdie kvantitatívny, deskriptívny, korelačný. Výskumný protokol obsahoval sledované premenné: demografické údaje, zdravotné charakteristiky, laboratórne parametre a merací nástroj na posúdenie stavu výživy MNA®. Empirické údaje boli spracované metódami deskriptívnej a induktívnej štatistiky. Výsledky: V...

News in geriatric medicine - what's new in dementia?News in...

Katarína Bielaková, Ondřej Ludka

Vnitr Lek 2024, 70(4):260-263  

Population aging is changing the world dramatically and fundamentally. Contemporary geriatrics has an interventional and preventive nature and strives to preserve physical and mental health for as long as possible, prevent loss of self-sufficiency and improve the prognosis of seniors with a focus on quality of life. Dementia is a serious problem that geriatrics deals with. The diagnosis of dementia not only affects the quality of life of individuals, but also represents a huge social and economic burden for the family, health systems and society. With the aging of the population, dementia has become an important problem in our health care and there...

Assessment of the fluid status and fluid therapy optimization in the emergency department: Is inferior vena cava a reliable marker?In brief

Jiří Müller, Martin Matějovič

Vnitr Lek 2024, 70(4):255-259  

Infusion therapy, in terms of fluid resuscitation, is without a doubt one of the most common therapeutic intervention in the management of an acutely ill patient. Despite the growing body of evidence showing potentially harmful effects of non-indicated fluid administration, this "fluid-reflex" remains a common practice in the Emergency department. One of the reasons for this is that fluid status assessment, based just on the clinical findings, is generally difficult if the patient does not have extreme fluid balance disturbances. Inferior Vena Cava ultrasound provides a relatively quick and simple answer to the basic clinical question: "Does my patient...

Deficiency of adenosine deaminase type 2 (DADA2) - first experiences in Slovakia: case reportsCase reports

Barbora Balažiová, Peter Čižnár, Miroslava Pozdechová, Dušana Genšor, Viktória Halušková, Ivana Hulínková, Peter Švec, Miloš Jeseňák, Hana Grombiříková, Tomáš Freiberger, Eva Froňková, Giorgia Bucciol, Isabelle Meyts, Tomáš Dallos

Vnitr Lek 2024, 70(4):246-254  

Deficiency of adenosine deaminase type 2 (DADA2) is an autoinflammatory disease identified in 2014 as a monogenic cause of systemic vasculitis resembling polyarteritis nodosa, with fever, livedo racemosa, peripheral necrosis, and early-onset stroke. Over the past 10 years, the knowledge of the phenotypic spectrum of DADA2 has expanded considerably. With 378 cases published so far in the world literature, DADA2 is considered a rare disease, but known cases represent only a fraction of the estimated 35,000 affected individuals worldwide (estimated prevalence ~ 1:222 000). We present the first 3 Slovak patients with genetically and biochemically confirmed...

Multiple myeloma as a cause of primary graft dysfunction after kidney transplantationCase reports

Katarína Jakubov, Martin Kment, Ondřej Viklický

Vnitr Lek 2024, 70(4):241-244  

Low incidence of multiple myeloma (MM) in the general population is one of the reasons for absence of a screening program. Kidney dysfunction is one of the most common types of end-organ damage in MM patients. Some transplant centers, therefore, established a screening to detect monoclonal immunoglobulin, mostly employing serum protein electrophoresis (SPEP) with or without immunofixation of serum and urine. If only monoclonal free light chain is produced, however, the sensitivity of SPEP and immunofixation is low. Here, we describe a case report of patient with newly diagnosed MM only after kidney transplantation. This case report emphasis the need...

Deficiency of adenosine deaminase type 2 (DADA2): clinical picture, diagnosis and treatmentReview articles

Barbora Balažiová, Gabriela Hrčková, Veronika Dobšinská, Tomáš Dallos

Vnitr Lek 2024, 70(4):233-240  

Deficiency of adenosine deaminase type 2 (DADA2) is a genetically determined multisystem autoinflammatory disease first described in 2014. It results from pathogenic variants in the ADA2 gene that lead to the reduction or complete loss of ADA2 enzyme activity. It presents with a highly variable phenotype as systemic or cerebral vasculitis, immunodeficiency and/or bone marrow failure, usually with early onset. More than 370 published cases of DADA2 can be found in international literature, however, statistical calculations estimate the prevalence to more than 35,000 individuals worldwide. The diversity of the phenotypic spectrum delays diagnosis and...