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.

Sweet desire for the white coat and the sweetness of the blood of medical students - case reportCase reports

Natália Michalcová, Petra Toušková, Ema Povolná, Julie Suchá, Juraj Michalec, Jana Urbanová, Svatava Krejčová, Jan Brož

Vnitr Lek 2025, 71(4):256-259 | DOI: 10.36290/vnl.2025.046  

Stress is often described as a risk factor for developing various diseases. However, a relatively less explored area is the effect of stress on glucose levels, and thus potentially on the risk of developing type 2 diabetes mellitus, in generally healthy young individuals who are exposed to stress regularly. This case report describes the glycaemic trends over 14 days in a 23-year-old medical student while preparing for an exam and the dermatology exam itself. Values measured by the FreeStyle Libre 2 device were within the physiological range most of the time, with expected increases after meals and physical activity. Otherwise, glycaemia had a relatively...

Atherosclerosis progression under the influence of subclinical inflammationGood advice

Eva Tůmová

Vnitr Lek 2025, 71(4):249-254 | DOI: 10.36290/vnl.2025.045  

Long-term subclinical inflammation is one of the factors that influence the progression of atherosclerosis and lead to the destabilization of atherosclerotic plaques with increased risk of complications such as acute coronary syndrome. Control of the pro-inflammatory state brings similar benefits as pharmacological management of traditional risk factors of atherosclerosis resulting in lower risk of cardiovascular events. Decreased inflammatory state can be monitored, for example, by the concentration of highly sensitive C-reactive protein. The possibilities of targeted influence of subclinical inflammation are currently limited, but it is possible...

Finerenone in internal medicine and cardiology practiceReview articles

Markéta Ječmenová

Vnitr Lek 2025, 71(4):241-248 | DOI: 10.36290/vnl.2025.044  

Finerenone is a highly selective, non-steroidal mineralocorticoid receptor antagonist with high binding affinity (higher than spironolactone and eplerenone). In contrast to the steroidal mineralocorticoid receptor antagonists, finerenone proved cardiovascular and renal benefit. Finerenone reduces albuminuria, which is a sensitive marker of chronic kidney disease and cardiovascular risk. It is an earlier marker than decreased glomerular filtration rate (GFR). Albuminuria is a marker of increased risk of progression of heart failure and cardiovascular death. Currently, finerenone is indicated to adult patients with type 2 diabetes mellitus with chronic...

Gliflozins - the nephrologist's point of viewReview articles

Petr Táborský

Vnitr Lek 2025, 71(4):235-240 | DOI: 10.36290/vnl.2025.043  

Gliflozins are a group of agents that were originally marketed as antidiabetic drugs, but later several studies demonstrated their beneficial effect in heart failure and chronic kidney disease. Their introduction into practice has allowed early treatment of these diseases and a reduction in their late complications. In nephrology they are applied as nephroprotective agents, diuretics and treatment of cardio-renal syndrome. Nephroprotection means not only delaying end-stage renal failure but also reducing the incidence of cardiovascular complications associated with renal dysfunction. The use of gliflozins as a diuretic allows for a reduction in the...

CFTR Modulator Therapy of cystic fibrosisMain topic

Libor Fila

Vnitr Lek 2025, 71(4):228-232 | DOI: 10.36290/vnl.2025.042  

Cystic fibrosis (CF) is a hereditary disease caused by pathogenic variants of the CFTR gene. It is mainly manifested by chronic sinopulmonary disease, digestive tract involvement with nutritional status disorders, high sweat chloride concentration and obstructive azoospermia. In addition to traditional symptomatic treatment, modulator therapy has become available in recent years, which targets the missing or dysfunctional CFTR protein. For carriers of at least one F508del mutation, treatment with a combination of elexacaftor, tezacaftor and ivacaftor is indicated; among other mutations, carriers of so-called gating mutations (e.g. G551D) are...

Overview of lung cancer treatment according to ESMO recommendationsMain topic

Martin Svatoň

Vnitr Lek 2025, 71(4):224-227 | DOI: 10.36290/vnl.2025.041  

Lung cancer continues to rank among the top malignant neoplasms in the Czech Republic in terms of incidence and mortality. The correct decision about treatment depends on high-quality staging, biopsy examination including predictive markers, the patient's overall condition and comorbidities, and last but not least, the patient's wishes. Given the evolving treatment options, decision-making is key in an experienced multidisciplinary team (MDT), where the treatment schemes listed in the guidelines are a valuable guide, but not always dogma. In small cell lung cancer (SCLC), surgical resection plus chemotherapy may be considered in early stages. In locally...

Current biological therapies for bronchial asthmaMain topic

Martina Kulířová, Vratislav Sedlák

Vnitr Lek 2025, 71(4):218-223 | DOI: 10.36290/vnl.2025.040  

The prevalence of bronchial asthma is increasing and severe asthma, which is not controlled even with optimal therapy with a high dose of inhaled corticosteroid in combination with a long-acting β2-mimetic, affects up to 10 % of asthmatics. Severe asthma is associated with a higher risk of fixed bronchial obstruction, acute exacerbations, impaired quality of life and financial burden on the healthcare system. Biological treatment of asthma should be considered in all patients who, despite optimal treatment of asthma and its comorbidities, experience acute exacerbations or use chronic systemic corticotherapy due to asthma. Currently, we have five...

Up-to-date therapy of interstitial lung processesMain topic

Martina Šterclová

Vnitr Lek 2025, 71(4):213-217 | DOI: 10.36290/vnl.2025.039  

In recent years, attention has been paid to patients with connective tissue diseases and interstitial lung disease (ILD). This is reflected in the number of recently published guidelines dealing with this issue. Most of them evaluate the effect of already known molecules on the management of ILDs. During 2024, no clinical study was published that would enrich the portfolio of treatment options with a new molecule. Guidelines for the management and treatment of pulmonary alveolar proteinosis were recently published. It turns out that in patients with idiopathic pulmonary fibrosis who suffer acute exacerbation, treatment with high doses of corticosteroids...

Hlavní téma: Pneumologie up-to-dateEditorial

Vladimír Koblížek

Vnitr Lek 2025, 71(4):207-212  

Health aspect of airplane travelReview articles#E-publication

Dana Lauková

Vnitr Lek 2025, 71(3):E17-E25 | DOI: 10.36290/vnl.2025.038  

Almost 2 billion people travel aboard commercial airlines every year. Health-care providers and travellers need to be aware of the potential health risks associated with air travel. Changes resulting from three physical laws about gas occur during routine commercial flights. They lead most often to mild hypoxia and gas expansion (risk od hypoxemia, barotrauma and decompression), which can exacerbate chronic medical conditions or incite acute in-flight medical events. The association between venous thromboembolism and long-haul flights, trapping gas, jet lag, and cabin-air quality are growing health-care issues associated with air travel. In-flight...

Acute alcoholis hepatitisReview articles#E-publication

Markéta Štajnerová, Stanislav Ševela, Karolína Hronová, Marek Šatný

Vnitr Lek 2025, 71(3):E11-E16 | DOI: 10.36290/vnl.2025.037  

Acute alcoholic hepatitis is a life-threatening condition with an unfavorable prognosis, characterized by jaundice and acute deterioration of liver function in the context of proven alcohol abuse. Prior to initiating therapy, it is essential to exclude other potential etiologies and assess disease severity using validated scoring systems. To date, systemic corticosteroid therapy remains the only specific treatment recommended for severe hepatitis. Supportive care is indispensable and should be provided to all patients. Numerous other pharmacological agents and interventions are under investigation, some of which show promising potential.

Tyrosine kinase inhibitors and cardiovascular and metabolic risks in patients with chronic myeloid leukemiaReview articles#E-publication

Pavel Kraml

Vnitr Lek 2025, 71(3):E7-E10 | DOI: 10.36290/vnl.2025.036  

The oncology therapy represents an independent cardiovascular risk factor. For chronic myeloid leukemia (CML), the BCR:ABL1 tyrosine kinase inhibitors (TKI) have become the frontline therapy. While the first generation inhibitor (imatinib) revealed a relatively safe cardiovascular profile, the introduction of the second and third generation TKIs was associated with an in -crease of cardiovascular events as well as worsening of their risk factors, esp. hypertension, hyperglycemia, dyslipidemia and renal failure. Other observed side effects include pulmonary hypertension, pericardial and pleural effusions, arrhythmias and to lesser extent venous thrombosis....

Treatment of paroxysmal nocturnal hemoglobinuria patients with complement inhibitorsOriginal articles#E-publication

Jaroslav Čermák, Marie Lauermannová, Jacqueline Maaloufová Soukupová

Vnitr Lek 2025, 71(3):E1-E6 | DOI: 10.36290/vnl.2025.035  

Introduction: Paroxysmal nocturnal hemoglobinuria represents a rare but serious disorder of hematopoiesis. A deficiency in natural complement inhibitors results in intravascular hemolysis, hemoglobinuria, thrombotic complications and bone marrow failure. Introduction of complement inhibitors in the treatment of PNH completely changed the prognosis of the patients. Our study summarizes experience with the treatment of PNH patients using complement inhibitors in Institute of Hematology in Prague. Patients and treatment: Twenty-one patients with hemolytic PNH were treated with C5 complement inhibitors eculizumab or ravulizumab. Indication criteria were...

Updated procedures in the diagnosis and treatment of dyslipidemiaIn brief

Jan Piťha, Ondřej Kyselák

Vnitr Lek 2025, 71(3):198-202 | DOI: 10.36290/vnl.2025.034  

The aim of dyslipidemia treatment is to reduce cardiovascular (CV) risk as much as possible by lowering LDL-cholesterol (LDL-C) concentrations; in persons with higher triglyceride concentration (>1.7 mmol/l), especially non-HDL cholesterol (non-HDL-C). For each CV risk category there are recommended target values for LDL-C, apolipoprotein B and non-HDL-C. In recent years, there have been significant developments in the diagnosis and treatment of dyslipidemias. After almost 40 years since the introduction of statin therapy, new effective treatments are available, such as propotein convertase subtilisin kexin type 9 inhibitors (iPCSK9), bempedoic...

DanicopanPharmacological profile

Libor Červinek

Vnitr Lek 2025, 71(3):190-196 | DOI: 10.36290/vnl.2025.033  

Danicopan is a selective inhibitor of complement factor D that acts through the alternative pathway of complement activation. By blocking the alternative pathway of complement, danikopan inhibits extravascular hemolysis (EVH). The efficacy and safety of danikopan in adult PNH patients with clinically significant EVH were evaluated in a multicenter, randomized, double-blind, placebo-controlled, phase 3 study ALXN2040-PNH-301. Danicopan added to ravulizumab or eculizumab demonstrated superiority over placebo in the primary endpoint of increase in hemoglobin levels. Danicopan also achieved statistically significant improvements compared to placebo in...

Leishmaniasis as a rare case of bone marrow suppressionCase reports

Aleš Tenk

Vnitr Lek 2025, 71(3):185-189 | DOI: 10.36290/vnl.2025.032  

Bone marrow decline hides a plethora of etiopathogenetic causes, which the physician tries to understand. Our patient's case was all the more tricky because she was an immunocompromised person whose clinical picture and laboratory results were distorted by immunosuppressive therapy. In the following article, we try to highlight the importance of taking basic anamnestic data that should not be neglected and thorough physical and laboratory investigations. The highly erudite haematology department played a major, if not the most important role and is greatly helped with the diagnosis and subsequent treatment and is to be thanked. I believe that the following...

New therapeutic options and trends in the treatment of multiple myelomReview articles

Roman Hájek, Ludmila Muroňová, Jana Mihályová, Michaela Horňáková, Tereza Popková, Hana Plonková, Tomáš Jelínek

Vnitr Lek 2025, 71(3):176-182 | DOI: 10.36290/vnl.2025.031  

Progress in multiple myeloma (MM) treatment is remarkable. Combined regimens for newly diagnosed MM patients achieve progression-free survival of more than seven years. In the Czech Republic, the approval of a four-drug combination of anti-CD38 monoclonal antibody (mAb) with a proteasome inhibitor (PI), immunomodulatory agent (IMiD) and dexamethasone is expecting in 2025. It is not yet clear whether consolidation with autologous transplantation will be beneficial in terms of extending the time to progression. The development of immunotherapy has literally exploded. Autologous chimeric antigen receptor T-cell therapy (CAR T-cells) targeting the BCMA...

Liver steatosis and Type 2 diabetes mellitusReview articles

Jan Škrha

Vnitr Lek 2025, 71(3):170-175 | DOI: 10.36290/vnl.2025.030  

Development of liver steatosis and Type 2 diabetes mellitus is caused by identical pathogenic mechanisms. Actual discoveries bring narrower information on the relationship of both diseases. New nomenclature of the metabolic liver disease and recently defined subtypes of Type 2 diabetes bring new insight on both diseases and their relationship. Increasing prevalence generates the needs not only for early diagnosis but for targeted treatment as well. The way to prevention based on healthy lifestyle has been opened to be realized from the early childhood.

Triple therapy in treatment of bronchial asthmaReview articles

Dana Lauková

Vnitr Lek 2025, 71(3):162-169 | DOI: 10.36290/vnl.2025.029  

The ultimate goal in the treatment of asthma is the achievement of disease control and minimization of the risk for future exacerbation. Despite using medium/high dose of inhaled corticosteroids (ICS) in fixed combination with long-acting beta-2 agonists (LABA), many patients still do not achieve an adequate level of disease control and remain at risk of exacerbations. Disease severity may be related to poor treatment adherence or improper inhaler technique. LAMA is suggested as the first add-on therapy to moderate dose ICS + LABA (GINA 2024), called as triple therapy. GINA recommends triple therapy (LAMA to ICS/LABA) as a further option at step 4...

The effect of long‑term beta‑blocker therapy in patients after myocardial infarction with preserved left ventricular ejection fractionReview articles

Robert Holaj

Vnitr Lek 2025, 71(3):156-161 | DOI: 10.36290/vnl.2025.028  

The long-term use of beta-blockers in patients after myocardial infarction (MI) with preserved left ventricular ejection fraction (LVEF) remains controversial. While benefits of beta-blockers are well established in patients with reduced LVEF, there is a lack of randomized clinical trial data for patients with LVEF > 40 %. Two recent studies (REDUCE-AMI and ABYSS) yielded conflicting results regarding the safety of beta-blocker discontinuation. REDUCE-AMI showed no mortality or reinfarction benefit from long-term beta-blocker therapy, while ABYSS indicated increased cardiovascular hospitalizations, especially in hypertensive patients. Results of...

Tree pollen allergy, pollen food syndrome and allergen immunotherapyReview articles

Magdalena Herknerová

Vnitr Lek 2025, 71(3):152-155 | DOI: 10.36290/vnl.2025.027  

Tree pollen allergy presents an increasing problem in industrialized countries. This disease develops in sensitised people after inhalation of pollen grains of birch and other related trees. Clinical symptoms of tree pollen allergy (seasonal allergic rhinoconjunctivitis, seasonal asthma bronchiale and secondary pollen food syndrome) have significant negative impact on the quality of life in these patients. The purpose of this review is to touch the taxonomy of the trees, describe cross-reactivity of relevant allergens, prevalence, the influence of climatic changes and to stress the importance of allergen immunotherapy as a disease modifying treatment.

Treatment of type 2 diabetes mellitus - a current view of the different drug classes and strategies for their useReview articles

Jan Brož

Vnitr Lek 2025, 71(3):144-151 | DOI: 10.36290/vnl.2025.026  

New drug classes targeting type 2 diabetes mellitus and their individual representatives entering clinical use in the last 10 years in particular have gradually changed the paradigm of the treatment strategy. The former central role of HbA_1c with respect to combination therapy and the central role of metformin, especially in the initial treatment of a newly diagnosed patient, is modified by his cardiovascular and renal profile. The latter then, if positive or at high risk of cardiovascular disease, should be treated with SGLT2 inhibitors and/or GLP-1 receptor agonists. Initiation of treatment with these agents is not dependent on HbA1C levels...

Malnutrition in Whipple’s Disease: A Case ReportCase reporty#E-publication

Veronika Janošcová

Vnitr Lek 2025, 71(2):E19-E24 | DOI: 10.36290/vnl.2025.025  

Whipple‘s Disease (WD) is a rare multisystem disorder caused by the actinomycete Tropheryma whipplei, characterized by a diverse clinical presentation. The prodromal stage is often characterized by arthralgia, while the symptomatic stage predominantly manifests with gastrointestinal symptoms such as chronic diarrhea, abdominal pain, and weight loss. Duodenal biopsy remains the cornerstone of diagnosis, with PCR analysis providing a definitive confirmation. Treatment involves long-term antibiotic therapy. This case report describes a 65-year-old woman newly diagnosed with WD, presenting with severe malnutrition and notable rheumatological and...

The rate of progression of diabetic kidney disease in patients with type 1 diabetes mellitusReview articles#E-publication

Lucia Bučková, Miroslava Horáčková, Petr Hoffmann, Michala Lustigová, Monika Tothová, Marika Koželuhová, Ondřej Pátek, Jan Brož

Vnitr Lek 2025, 71(2):E13-E18 | DOI: 10.36290/vnl.2025.024  

The risk of developing diabetic nephropathy is directly proportional to the duration of type 1 diabetes, with metabolic control of the disease playing a crucial role. The peak incidence of diabetic nephropathy occurs between 10 and 20 years after the diagnosis of the underlying disease. The annual incidence of albuminuria development in patients with type 1 diabetes mellitus is 2-3%. The annual incidence of a decline in estimated glomerular filtration rate below 60 ml/min/1.73 m² is 2-4 %, regardless of the type of diabetes. According to older studies from the late 1980s, an individual with type 1 diabetes mellitus (DMT1) has a 40% chance...

Secondary diabetes mellitus in acromegalyReview articles#E-publication

Ivana Ságová, Tomáš Bolek, Matej Samoš, Daniela Kantárová, Jakub Benko, Martin Jozef Péč, Jakub Jurica, Ingrid Tonhajzerová, Marián Mokáň

Vnitr Lek 2025, 71(2):E6-E12 | DOI: 10.36290/vnl.2025.023  

Acromegaly is a rare endocrine disorder characterized by the overproduction of growth hormone (GH), most commonly due to a pituitary adenoma, leading to increased production of insulin-like growth factor 1 (IGF-1) in the liver. The effects of GH and IGF-1 on glucose metabolism are antagonistic; GH induces insulin resistance, while IGF-1 enhances insulin sensitivity. However, the insulin-antagonizing effect of GH outweighs the insulin-sensitizing effect of IGF-1 in target tissues, leading to the development of diabetes mellitus (DM) in acromegaly.Secondary DM is a frequent complication in patients with acromegaly. In fact, DM may be the first manifestation...