Systemic mastocytosis - a common diagnosis for allergists and hematologistsReview articles

Marie Žemličková, Tomáš Kozák

Vnitr Lek 2024, 70(4):224-232  

Systemic mastocytosis (SM) is a disease characterized by the proliferation of clonal mast cells. SM biologically include a wide spectrum, ranging from relatively benign indolent forms to mast cell leukemia. The clinical presentation varies from nearly asymptomatic forms, through various degrees of mediator syndrome, to a neoplastic syndrome associated with hepatosplenomegaly, lymphadenopathy, and constitutional symptoms. Diagnosis relies on morphological and histological evaluation of the bone marrow. Patients are classified based on diagnostic findings and symptomatology according to the WHO and ICC classifications, which determine the type of disease...

Cystic fibrosis related diabetes - current situation and perspectiveReview articles

Kateřina Štechová, Libor Fila

Vnitr Lek 2024, 70(4):219-223  

Cystic fibrosis (CF) is an autosomal recessive inherited disease caused by mutations in the CFTR gene (the Cystic Fibrosis Transmembrane Conductance Regulator). In most patients, the disease manifests itself in the form of chronic sinobronchial disease, pancreatic insufficiency, and increased concentration of chlorides in sweat. With increasing age, other complications appear, one of which is a specific form of diabetes CFRD (Cystic Fibrosis Related Diabetes), which affects up to 50 % of adult CF patients. The introduction of treatment with so-called CFTR modulators has led to a significant extension of the lifespan of patients with CF, and...

Inhibition of coagulation factor XI/XIa - the next step in increasing the safety of anticoagulant therapy?Review articles

Jan Bultas

Vnitr Lek 2024, 70(4):213-218  

Modern medicine places great emphasis not only on the efficacy but especially on the safety of the treatment. A common deficiency of anticoagulants inhibitingg the common pathway of the coagulation cascade (thrombin inhibitors, factor Xa inhibitors or antivitamins K) is an increased risk of clinically significant bleeding. A new strategy is being developed to inhibit the intrinsic pathway of the coagulation cascade, specifically to inhibit the synthesis or block the function of factor XI/XIa. This route is promising, as the most common indications of anticoagulants include activation of haemostasis by contact (induced e.g. by polyphosphates on the...

Zemřel doc. MUDr. Tomáš Kára, Ph.D.Necrolog#E-publication

Mirek Souček, Jiří Vítovec

Vnitr Lek 2024, 70(3):E19  

Za profesorom MUDr. Zoltánom Mikešom, DrSc.Necrolog#E-publication

Prof. MUDr. Juraj Payer, PhD, MPH, Prof. MUDr. Andrej Dukát, CSc., Doc. MUDr. Martin Dúbrava, CSc.

Vnitr Lek 2024, 70(3):E17-E18  

Is fibromyalgia a neurological disorder?Review articles#E-publication

Štefan Alušík

Vnitr Lek 2024, 70(3):E13-E16 | DOI: 10.36290/vnl.2024.042  

The article discusses new developments in fibromyalgia disease in terms of diagnosis, evaluation of clinical manifestation and treatment. The most important change is the elucidation of the pathophysiological mechanisms in the brain (nociplastic pain) that underlie the clinical manifestation of the symptoms, especially the widespread muscle and ligament pain. In clinical diagnosis, the biggest change has been the abandonment of the investigation of the so-called tender points and the use of newer diagnostic criteria. In drug therapy, we are particularly concerned with the use of pregabalin, duloxetine and milnacipran, their optimal dosage and side...

Biological therapy of interstitial lung diseasesReview articles#E-publication

Martina Šterclová

Vnitr Lek 2024, 70(3):E10-E12 | DOI: 10.36290/vnl.2024.041  

Biological therapies, despite their widespread use in other areas of pneumology, are not typically the first-line treatment for patients with interstitial lung diseases. This is due to the relatively rare occurrence of these diseases and their incompletely understood etiopathogenesis. Biologics are most commonly used in patients with interstitial lung involvement in systemic connective tissue diseases; conversely, they do not have a routine place in the treatment of patients with idiopathic interstitial pneumonias. In patients with sarcoidosis, biological therapy constitutes third-line treatment. Before initiating biological treatment, it is necessary...

Adverse obstetric and neonatal outcomes of pregnancy in high-risk women with heart diseaseOriginal articles#E-publication

Juraj Dubrava, Monika Kaldararova, Zuzana Niznanska, Miroslav Korbel

Vnitr Lek 2024, 70(3):E4-E9 | DOI: 10.36290/vnl.2024.040  

Background: The latest ESC guidelines on the management of cardiovascular diseases during pregnancy recommend estimating maternal cardiovascular risk according to the modified World Health Organization (mWHO) classification. In contrast, there are no validated models for predicting neonatal and obstetric risk in these women. Objectives: To compare the neonatal and obstetric outcomes of pregnancy between two groups of mothers with heart disease: women at high to extremely high maternal risk (mWHO III-IV; group 1) and women at low to intermediate maternal risk (mWHO < III; group 2). Methods: We included 48 consecutive women with clinically significant...

News in cardiology 2023News in...

Veronika Puchnerová, Michael Jenšovský, Petr Ošťádal, Jiří Bonaventura

Vnitr Lek 2024, 70(3):198-206 | DOI: 10.36290/vnl.2024.039  

This review summarizes the latest advances in cardiology published in 2023, which affect clinical practice. First, we discuss the European Society of Cardiology guidelines and clinical updates. Then, we present an overview of the most important clinical trials published within the last year.

Echinococcosis - a disease imitating a generalized tumor processCase reports

Miroslav Hikaník

Vnitr Lek 2024, 70(3):195-197 | DOI: 10.36290/vnl.2024.038  

Echinococcosis is a rare parasitic disease that affects multiple organs. In some cases, it can imitate a generalized oncological disease, as in the case of our patient. In these article, we also point out to the necessity of correct diagnosis and immediate adequate treatment intervention.

Therapy of disorders with organ dysfunctions related to "Monoclonal Gammopathy of Clinical Significance" - MGCSReview articles

Zdeněk Adam, Luděk Pour

Vnitr Lek 2024, 70(3):188-194 | DOI: 10.36290/vnl.2024.037  

Monoclonal gammopathy of clinical significance (MGCS) is an umbrella term to describe a broad spectrum of disorders with remarkable organ dysfunctions related to the underlying non-malignant B or plasma cell clone. Although the clone itself is typically very small, it is associated with diverse clinical manifestations through different mechanisms, such as monoclonal protein deposition, the biological activity of the monoclonal immunoglobulin, or angiogenic/inflammatory cytokine hyper-secretion, or the ethiopathogensis is still unknown. Some predominantly involve a single organ, commonly peripheral nerves, kidney, skin and eye, while others are systemic...

Treatment of asymptomatic hypertension during hospitalization - less is often much moreReview articles

Tomáš Zelinka

Vnitr Lek 2024, 70(3):181-186 | DOI: 10.36290/vnl.2024.036  

Although they are no doubts that treatment of chronic hypertension reduces cardiovascular risk, little is known how to deal with acute elevations of blood pressure (BP) values among asymptomatic subjects during hospitalization. In-hospital BP pressure elevations are relatively frequent and may not correspond with poorly controlled chronic hypertension. Conditions for BP measurement during hospitalization significantly differ from those recommended for outpatient settings. Recent published observational studies showed that active approach for asymptomatic BP elevations was associated with worse outcome compared to the conservative approach. It increased...

Recent developments in blood bacteriological testingReview articles

Miroslava Htoutou Sedláková, Kateřina Bogdanová, Milan Kolář

Vnitr Lek 2024, 70(3):174-179 | DOI: 10.36290/vnl.2024.035  

Identifying the etiological agent in blood is one of the most crucial yet time-consuming investigations in diagnosing bacterial infections. The conventional approach of blood culture utilizing automated systems, followed by identification from a 24-hour bacterial culture and determination of quantitative antibiotic susceptibility, typically takes about 3-5 days. However, in recent years, new methods have been implemented in practice, enabling the identification of bacterial pathogens and the determination of sensitivity/resistance to antibiotics, including the detection of resistance genes through amplification techniques directly from positive blood...

Biological and innovative therapies of inflammatory bowel diseaseReview articles

Petra Mináriková

Vnitr Lek 2024, 70(3):166-172 | DOI: 10.36290/vnl.2024.034  

Crohn's disease and ulcerative colitis are chronic, inflammatory bowel disease medically and surgically incurable. In the last 20 years, there has been a dramatic development, especially of medicamentous treatment. In biological therapy, new agents have been introduced with a mechanism of action targeted on molecules of key role in the pathogenesis of inflammatory bowel disease.

When to use proton pump inhibitorsReview articles

Štěpán Šembera, Jiří Cyrany, Ilja Tachecí

Vnitr Lek 2024, 70(3):158-165 | DOI: 10.36290/vnl.2024.033  

Proton pump inhibitors (PPIs) have been available in clinical practice for 35 years, and during the time of their use, they have become a very frequently used medication. In some countries, around 10% of the population uses them. This is due to their ability to most effectively suppress the production of hydrochloric acid by the gastric mucosa, thereby treating primarily peptic ulcer disease of the gastroduodenum and gastroesophageal reflux disease. Furthermore, these drugs are widely used in the prevention of these diseases and in the treatment of functional dyspepsia. The seemingly favorable safety profile of these drugs has acquired significant...

Should we already deal with lipoprotein(a) in clinical practice?Original articles

Zuzana Vantová, Otto Mayer Jr.

Vnitr Lek 2024, 70(3):152-156 | DOI: 10.36290/vnl.2024.032  

Lipoprotein(a) represents a virtually overlooked risk factor. However, its pathophysiological mechanism leads to a non-negligible increase in the incidence of cardiovascular diseases, additively beyond the risk mediated by conventional factors. Currently, several promising drugs are in the final phase of clinical development to directly affect lipoprotein(a) concentrations. It is therefore necessary to improve awareness of this factor in clinical practice and, in particular, proceed to its systematic screening.

Mortality associated with peripheral artery disease of the legsOriginal articles

Jiří Spáčil, Jaroslava Svobodová

Vnitr Lek 2024, 70(3):145-150 | DOI: 10.36290/vnl.2024.031  

Introduction: Data on mortality due to peripheral artery disease of the legs (PAD) in the Czech Republic is unknown. We used the set of patients with PAD of our outpatient facility to select those with known dates and causes of death based on data of the Institute of Health Information and Statistics of the Czech Republic. Results: Of the group comprising 390 patients with PAD caused by atherosclerosis, 145 patients died. The mean time from the first examination at our facility to death was 6.13 years. The mean follow-up time of surviving patients was 6.99 years. Mean annual mortality was 6.25% (95 CI 4.25-8.26%). Forty four percent of the patients...

Focal segmental glomerulosclerosisReview articles#E-publication

Silvie Rajnochová Bloudíčková, Dana Thomasová

Vnitr Lek 2024, 70(2):E32-E36 | DOI: 10.36290/vnl.2024.030  

Focal segmental glomerulosclerosis, FSGS, is a progressive glomerular disease of different ethiology that leads in almost 50 % of patients to end stage renal failure. FSGS is caused by damage of podocytes, histologically characterized by partial scarring of glomeruli, clinically by nephrotic-range proteinuria or nephrotic syndrome and unsatisfactory therapeutic response. Kidney transplantation in FSGS patients is associated with high risk of disease recurrence and worse long-term outcomes. Early treatment is essential for the patient's prognosis, which varies between different forms of FSGS (primary, secondary, genetic).

Antibiotic treatment of patients hypersensitive to penicillin and β-lactam antibioticsReview articles#E-publication

Martin Sučík, Róbert Rosoľanka, Dušan Krkoška, Katarína Šimeková

Vnitr Lek 2024, 70(2):E24-E31 | DOI: 10.36290/vnl.2024.029  

Presumed or confirmed hypersensitivity to penicillins is a common problem in clinical practice. Knowledge about the nature of cross-reactivity of the immune system to various β-lactam antibiotics has increased considerably over the years. The original notion of a high degree of cross-reactivity between the major groups of β-lactam antibiotics was based on the presence of a common β-lactam ring in their molecule. However, the conclusions of recent clinical observations and studies suggest that the match or similarity of the side chains bound to the β-lactam ring plays a dominant role in the development of cross-reactivity between...

Pharmacological treatment of osteoporosis and prevention of fractures: recommendations for clinical practiceReview articles#E-publication

Vít Zikán

Vnitr Lek 2024, 70(2):E7-E23 | DOI: 10.36290/vnl.2024.028  

The clinical significance of osteoporosis lies in the low-trauma fractures that arise. Fractures lead to increased morbidity, excess mortality, decreased quality of life and loss of autonomy. Management of osteoporosis involves assessing risk factors for fracture, reducing modifiable risk factors through dietary and lifestyle changes, and the use of pharmacologic therapy for patients at significant risk of fractures. Osteoporosis is a chronic condition and therefore needs a long-term management plan with a personalized approach to treatment. Current medications build bone and/or decrease bone breakdown and reduce incident fractures. In individuals...

Cutting-edge technology in medicine: the use of continuous glucose monitoring in reimbursed carein the Czech Republic in 2014-2021: data from the National Registry of Covered Health ServicesOriginal articles#E-publication

Jan Brož, Jana Urbanová, Martina Nováková, Klára Benešová, Jiří Jarkovský, Ladislav Dušek, Dominik Foltán, Matúš Marec, Lukáš Rozsíval, Denisa Janíčková Žďárská, Milan Kvapil

Vnitr Lek 2024, 70(2):E3-E6 | DOI: 10.36290/vnl.2024.027  

Continuous glucose monitoring (CGM) is currently the most effective way to control glucose excursions in patients with diabetes mellitus (DM). In the Czech Republic, health insurance companies have covered enough CGM for patients with type 1 diabetes cover the entire year from December 2019. Based on data obtained from the National Registry of Covered Health Services - NRHZS), an estimated 38% of patients used one of the CGM systems in 2021, with approximately 2/3 of patients using intermittent scan monitoring (isCGM). The analysis showed differences in CGM use between different age groups of diabetic patients and also large differences between regions,...

Hlavní téma – metabolický syndromEditorial

prof. MUDr. David Karásek, Ph.D.

Vnitr Lek 2024, 70(2):71  

What´s new in Infectology?News in...

Petr Husa, Svatava Snopková, Petr Husa ml.

Vnitr Lek 2024, 70(2):131-137 | DOI: 10.36290/vnl.2024.026  

Infectious diseases are still a major health, social and economic problem in the 21st century. New treatment options for HIV and viral hepatitis D, the increasing incidence of viral hepatitis E and alveococcosis in the Czech Republic are discussed. In all cases, these are highly topical issues that are important in the Czech Republic and internationally. Long-acting slow effective release antiretroviral therapy (LASER ART) represents the most advanced form of modification of antiretroviral therapy (ART). It has been available in the Czech Republic since February 2023. According to clinical trials, 90-98 % of patients prefer a long-term regimen. Bulevirtide...

How to approach arterial hypertension in adolescents and young adults?Main topic

Jitka Mlíková Seidlerová

Vnitr Lek 2024, 70(2):126-130 | DOI: 10.36290/vnl.2024.025  

Arterial hypertension is observed less frequently in adolescents and young adults than in older persons. Although the absolute cardiovascular risk in this age group is low, untreated hypertension is a source of organ damage development and health complications later in life. Therefore, diagnosis and early initiation of treatment is an important part of the management of this population. The cornerstone of diagnosis is the measurement of blood pressure in a healthcare facility and using out-of-office methods of blood pressure measurement. In indicated cases, secondary hypertension must be excluded. We always search for and intervene other cardiovascular...

Suspicion of a hypervitaminosis A during acitretin therapyCase reports

Markéta Kobzová, Pavel Polák

Vnitr Lek 2024, 70(2):120-125 | DOI: 10.36290/vnl.2024.024  

The authors present a clinical case of a 90 years old woman treated with acitretin for psoriasis during past two years, in whom develloped spontaneously haemorrhagic blisters on extremities, on oral mucosal surfaces and large subcutaneous hematomas. In the differential diagnostic work-up an allergy to co-trimoxazole, plazmocellular neoplasia, amyloidosis and bacterial endocarditis were suspected. Both microscopic evaluation as microbial cultivation of the aspirated hemorrhagic fluid were concluded as contamination. There were no signs of paraproteinemia in serum immunoelektrophoresis study. Extended medical history revealed till months persisting xerophthlamia,...

Novel insights into pathophysiology and management of hypertrophic cardiomyopathyReview articles

Miloš Kubánek

Vnitr Lek 2024, 70(2):113-119 | DOI: 10.36290/vnl.2024.023  

We aimed to summarize the current knowledge regarding the pathophysiology and management of hypertrophic cardiomyopathy (HCM). Genetic aetiology of HCM can be traced in approximately 30-50% of probands. The predominant pathogenetic mechanisms of genetic HCM seem to be hypercontractility of sarcomere and its impaired relaxation due to depletion of super-relaxed isoform of cardiac myosin heavy chain. These processes may lead to an increased energetic consumption and possibly to progression of left ventricular (LV) hypertrophy. Inhibition of cardiac myosin ATPase corrects hypercontractility of sarcomere and its impaired relaxation both in tissue and animal...

Resistant hypertensionReview articles

Jan Filipovský

Vnitr Lek 2024, 70(2):108-112 | DOI: 10.36290/vnl.2024.022  

Resistant hypertension is defined as blood pressure (BP) ≥ 140/90 mmHg despite administration of at least three antihypertensive drugs including diuretics in maximum tolerated doses. Pseudoresistance due to bad adherence to treatment is very common. Ambulatory BP monitoring should be done should be performed as up to one third of patients has ambulatory BP within normal limits. Secondary causes of hypertension should be excluded. Resistance on treatment is common in patients with renal parenchymatous hypertension. The diagnosis of primary aldosteronism may be more difficult and may occur also in young patients with hypertension. Other causes...

Prevention of the development of advanced chronic heart failure - pharmacotherapy optionsReview articles

Monika Špinarová, Jiří Vítovec, Lenka Špinarová

Vnitr Lek 2024, 70(2):102-106 | DOI: 10.36290/vnl.2024.021  

The treatment of chronic heart failure is always complex and includes both pharmacological and non-pharmacological procedures. However, the disease progresses to the end-stage of advanced heart failure in many patients, which is characterized by the persistence of symptoms despite maximal therapy. The basis of the treatment of patients with heart failure with reduced ejection fraction (HFrEF) are 4 pillars of drug groups: Angiotensin Receptor-Neprilysin Inhibitor (ARNI)/ Angiotensin-Converting Enzyme Inhibitors (ACEi), Beta blockers (BB), Mineralocorticoid receptor antagonist (MRA) and Sodium-glucose cotransporter-2 inhibitors (SGLT2i), which have...

Incretins and the metabolic syndromeMain topic

David Karásek

Vnitr Lek 2024, 70(2):97-101 | DOI: 10.36290/vnl.2024.020  

Metabolic syndrome is characterized by the accumulation of adverse cardio-metabolic risk factors. Non-pharmacological measures are an important part of its treatment, but many patients cannot follow them, or the measures are insufficiently effective. Pharmacological treatment usually consists in the intervention of individual components of the metabolic syndrome. There is increasing evidence that incretin mimetics, which were originally developed for the treatment of type 2 diabetes, have the potential to beneficially affect not only hyperglycemia or obesity, but also dyslipidemia and elevated blood pressure. There is also evidence that some agonists...

Metabolic effects of glyphlozinesMain topic

Michal Krčma

Vnitr Lek 2024, 70(2):91-96 | DOI: 10.36290/vnl.2024.019  

Gliflozins, or SGLT-2 inhibitors, are a relatively new class of drugs, first introduced as antidiabetic agents. The observed positive effects on the cardiovascular system and renal function later led to a widening of the spectrum of indications. The article describes the different metabolic pathways of action, discusses the side effects of treatment as well as the management of specific medical situations. It provides an overview of health insurance reimbursements at the end of the text.