Vnitřní lékařství, 2016 (vol. 62), issue 7-8

Original articles

Estimating the prevalence of potential drug interactions in patients treated with 5 and more drugs in the Czech Republic and Slovac Repuplic

Richard Češka, Ivan Tkáč

Vnitr Lek 2016, 62(7-8):514-520

Polypragmasy is currently a growing phenomenon, leading to an increased risk of drug interactions. Empirical data to document this trend can only be obtained through a field survey, which, however, is missing in both Czechia and Slovakia. Therefore an international, multicentre, observational, non-interventional study "Estimating the prevalence of potential drug interactions in patients treated with 5 and more drugs in the Czech Republic and Slovakia" was conducted, with the primary aim to identify the prevalence of potential drug-drug interactions in the conditions of routine clinical practice. The patients aged 18 years or more and treated with 5...

Autoimmune insulitis in patients with type 2 diabetes mellitus. A randomized clinical trial in hospitalized patients

Emil Martinka, Mariana Rončáková, Michaela Mišániková, Arash Davani

Vnitr Lek 2016, 62(7-8):521-533

Background:It is not always easy to classify diabetes (DM) diagnosed in adults, with a significant group of patients initially classified and treated for type 2 diabetes mellitus (DM2T) presenting signs indicating the presence of autoimmune insulitis (AI), which is characteristic of type 1 diabetes mellitus (DM1T), or latent autoimmune diabetes mellitus in adults (LADA). Goal:Identify the proportion of patients entered with DM2T who present AI signs, and the number of patients of that proportion, who at the same time present low insulin secretion, and what clinical and laboratory manifestations could be used to differentiate...

Reviews

Clinical contribution of new basal analogue insulin

Alena Adamíková

Vnitr Lek 2016, 62(7-8):534-538

Chronic long term hyperglycemia plays a key role in the pathogenesis of micro and macrovascular complications. The UKPDS study and its further analysis has proved that reduction of the value of glycated hemoglobin by 1 % leads to a 14 % reduction of the risk of myocardial infarction and a 37 % reduction of the risk of microvascular complications. Effective control of glycaemia, optimal value of pre-prandial, postprandial glycaemia, and low variability from the start of the disease has a long term beneficial impact. The therapy of basal insulin analogues ranks among the recommended procedures for achieving control. The new insulin analogues (insulin...

Changes in nutritional recommendations for a healthy population and their influence on a diabetic diet

Michal Anděl, Ludmila Brunerová, Pavel Dlouhý, Jan Polák, Jan Gojda, Pavel Kraml

Vnitr Lek 2016, 62(7-8):539-546

Recently, thousands of papers brought knowledge about effects of nutrients on cellular level, in experimental animals and in human experiments on one side, the results of epidemiological studies on the other side have suggested the nutrients and foods for healthy diet and nutrients and foods, which should be consumed only in limited amount. Among foods, which should be avoided, those with higher content of trans-fatty acids. Their daily intake should not exceed 1 % of total energy intake. Similar should be limited saturated fatty acid, added sugar and salt. On the contrary, the intake of monounsaturated and polyunsaturated fatty acids in foods should...

Impaired hypoglycemia awareness in diabetes mellitus

Jan Brož, Pavlína Piťhová, Denisa Janíčková Žďárská

Vnitr Lek 2016, 62(7-8):547-550

Impaired hypoglycemia awareness is defined at the onset of neuroglycopenia without the appearance of autonomic warning symptoms. Impaired hypoglycemia awareness is disorder which affects aprox. one third of patients with type 1 diabetes mellitus and 8-10 % of patients with type 2 diabetes mellitus who are treated with insulin. The most dangerous consequence is 6 times higher frequency of severe hypoglycemia in patients with Type 1 diabetes mellitus and 17 times higher in Type 2 diabetic patients treated with insulin. Treatment of impaired hypoglycemia awareness is complex, based on a multifactorial intervention of clinical care and structured patient...

Treatment of liver cirrhosis - actually possibility of ambulant internist

Jiří Ehrmann, Květa Aiglová, Michal Konečný, Vlastimil Procházka, Drahomíra Vrzalová

Vnitr Lek 2016, 62(7-8):553-563

There are 40 000-60 000 patients with cirrhosis in the Czech Republic. 2 000 die of this disease yearly. This group of patients needs a complex treatment and it is mostly an internist cooperating with other specialists. The most important for an ambulant internist is to diagnose the disease as soon as possible and start with treatment of chronic liver disease that could lead to a cirrhosis. It means especially chronic viral hepatitis, alcoholic or non-alcoholic steatosis/steatohepatitis, auto-immune liver damage and metabolic disease. The next step is to diagnose the cirrhosis in time when it is in no manifest stage. The third step is to diagnose and...

Hypoglycemia as a symptom of cancer in adults

Zdeněk Fryšák, David Karásek

Vnitr Lek 2016, 62(7-8):564-567

Decrease of blood glucose levels below 3 mmol/l is in fully developed cases accompanied by neuroglycopenic symptoms that may even lead to altered state of consciousness. The treating physician frequently faces a complicated situation. This may be due to inappropriately administered drugs including cases motivated by self-harm intentions (insulin, insulin secretagogues), or alcohol abuse. Undernourished people, or those afflicted with a serious systemic infection, end-stage liver or kidney diseases or with a failing heart, belong to a risk group. Hypoglycemia typically accompanies hypocorticism (Addison's disease) or lack of glucagon. Endogenous hyperinsulinism...

Sepsis - how to recognize and what to focus on - back to basics in the light of the new definition

Jan Horák, Martin Harazim, Thomas Karvunidis, Jaroslav Raděj, Ivan Novák, Martin Matějovič

Vnitr Lek 2016, 62(7-8):568-574

Sepsis is the primary cause of death from infection. However, its early recognition remains a fundamental challenge in clinical practice. In February 2016, a newly revised sepsis definition has been published (SEPSIS-3). Sepsis has been redefined as life-threatening organ dysfunction caused by a dysregulated host response to infection. In this article, we introduce the updated definition of sepsis, discuss its pros and cons and suggest practical implications. The emphasis is put on basic and comprehensive clinical assessment.

The skin - a mirror of internal diseases

Kateřina Jůzlová, Jana Hercogová

Vnitr Lek 2016, 62(7-8):575-581

The knowledge of the relationship between dermatologic manifestations and disorders and internal diseases may facilitate early identification of general disease. The report aims to provide an overview of dermatologic manifestations of gastrointestinal disorders, non-specific inflammatory bowel disease and gastrointestinal stromal tumours, and skin alterations related to diabetes mellitus. The role of a dermatologist is primarily to diagnose dermatoses.

The effect of antidiabetic treatment on the bone of patients with type 2 diabetes

David Karásek

Vnitr Lek 2016, 62(7-8):582-587

Despite a normal or higher bone mass, type 2 diabetes is associated with a higher risk of osteoporotic fractures. Besides a higher falls frequency the lower quality of diabetics bone plays the crucial role in this case. One of the factors affecting their fracture risk is a choice of antidiabetic treatment. So far, professional societies have warned before the thiazolidinediones use only, but gliflozines can be harmful for bone too. Metformin, sulfonylureas, GLP-1 agonists and DPP-4 inhibitors belong to the drugs without a negative effect on the fracture risk. The increased frequency of bone fractures in diabetics treated with insulin lies more in the...

The benefit of urgent endoscopic retrograde cholangiopancreatography for the therapy of acute pancreatitis

Radan Keil

Vnitr Lek 2016, 62(7-8):588-591

Pancreatitis of biliary etiology accounts for 30-60 % of all cases of acute pancreatitis. A number of randomized studies have been completed to assess the role of acute endoscopic retrograde cholangiopancreatography (ERCP) and papilosphincterotomy in the therapy of biliary pancreatitis. Analysis of the respective studies has shown that urgent endoscopy is clearly indicated for the patients with a severe form of acute biliary pancreatitis as well as for those with an ongoing acute cholangitis or obstructive icterus. The author believes that based on a detailed analysis of the results, urgent endoscopic retrograde cholangiopancreatography can also be...

Type 2 diabetes mellitus and heart failure

Aleš Linhart, Jan Bělohlávek

Vnitr Lek 2016, 62(7-8):592-597

Type 2 diabetes mellitus is associated with a substantial increase in the risk of development of heart failure. The mechanisms causing this complication are complex and include coronary heart disease, myocardial changes induced by hypertension, increased aortic stiffness, arrhythmias, renal failure and last but not least by direct metabolic alterations causing diabetic cardiomyopathy. The heart failure could be induced by several drugs used for diabetes therapy. This review debates the current evidence of harms and benefits of diabetes treatment related to heart failure in the light of results of recent randomized trials. An increased risk of heart...

The differential diagnosis of pleural effusions

Miloslav Marel, Libor Fila, Michaela Červená

Vnitr Lek 2016, 62(7-8):598-604

The problems of pleural effusions are connected with many areas of medicine. The problem affects approx. 0.5 % of the population every year. The paper summarizes pathophysiological data relating to the emergence of effusions, their epidemiology, description of particular types of effusions and possibilities of treatment. More attention is paid to the differential diagnosis and therapy for malign pleural effusions.

Adverse effects of biological therapy in rheumatology

Marta Olejárová

Vnitr Lek 2016, 62(7-8):605-612

The biological treatment which is the most effective type of therapy for inflammatory rheumatic diseases, has become part of a standard clinical rheumatology practice in recent years. Thousands of patients in the Czech Republic with rheumatoid arthritis, different forms of spondyloarthritides and with psoriatic arthritis are now successfully treated in this way. The following medications are registered in the Czech Republic for the treatment of rheumatic diseases: infliximab, adalimumab, golimumab, certolizumab pegol, etanercept, abatacept, rituximab, tocilizumab and belimumab, newly also secukinumab. This effective therapy also entails a new spectrum...

Possibilities of influencing cardiovascular risk in type 2 diabetes mellitus by antidiabetic treatment. Lowering of cardiovascular risk in treatment with liraglutide - Results of the LEADER

Jindřich Olšovský

Vnitr Lek 2016, 62(7-8):613-615

The article summarizes current knowledge about the possibilities for influencing the cardiovascular risk in treatment of type 2 diabetes, especially focusing on the results of a prospective morbidity-mortality LEADER trial, which demonstrated the superiority of liraglutide in patients with very high cardiovascular risk.

Methanol: the threat of intoxication is still there

Daniela Pelclová, Sergey Zakharov

Vnitr Lek 2016, 62(7-8):616-619

Methanol mass poisoning occurs across the world quite frequently, but the complete clinical and laboratory data of the patients are only rarely available. Approximately 138 cases of poisoning were documented in the Czech Republic, 107 patients were hospitalized. Another 31 persons died out of hospital. About 60 % of the hospitalized patients survived intoxication without consequences, one half of the remaining 40 % died and the other half survived with the CNS and/or sight impaired. The Czech study successfully used modern diagnostic methods. A positive effect of the prehospital first aid with an oral antidote has been proven and a comparable effect...

Diabetic retinopathy: pathogenesis and therapeutic implications

Terezie Pelikánová

Vnitr Lek 2016, 62(7-8):620-628

Diabetic retinopathy (DR) develops in patients with both type 1 and type 2 diabetes and is the major cause of vision loss and blindness in the working population. The main risk factor of DR is hyperglycemia accompanied by enhanced mitochondrial production of reactive oxygen species and oxidative stress, formation of advanced glycation end products (AGE) and hexosamines, increase in polyol metabolism of glucose. The severity of vascular injury depends on the individual genetic background and is modified by other epigenetic, metabolic and haemodynamic factors, including hypertension, dyslipidemia and oxidative stress. In diabetes, damage to the retina...

The difference and ratio between serum concentrations of natrium and chlorides in patients with hyponatremia

Otto Schück, Miroslava Horáčková

Vnitr Lek 2016, 62(7-8):629-634

The differential diagnosis of hyponatremia is often difficult. This most frequently occurring disorder of the water and electrolyte metabolism is frequently connected with deviations relating to the acid-base balance (ABB). This survey analyzes the relationship between the changes of the volume of body fluids and ABB and infers to what extent the analysis of combinations of the two disorders can support the differential diagnosis of different forms of hyponatremia (differentiation between the dilution vs. depletion forms). The changes of the total water volume (CTV) and ABB may be presented at the same time in the values of the difference and ratio...

Systolic blood pressure targets

Miroslav Souček

Vnitr Lek 2016, 62(7-8):635-639

When treating systolic hypertension we do not know the optimum blood pressure which leads to the reduction of cardiovascular events and cardiovascular and total mortality. The results of the ACCORD study, when comparing intensive treatment of systolic blood pressure (SBP) < 120 mm Hg and standard treatment < 140 mm Hg, did not lead to affecting the primary target for patients with diabetes mellitus. The SPRINT study (Systolic Blood Pressure Intervention Trial) has shown that more intensive treatment of hypertension (aimed at readings lower than the generally recommended target readings) significantly reduces incidence of cardiovascular diseases...

Clinical significance of natriuretic peptides in the differential diagnosis of dyspnea

Jiří Špác

Vnitr Lek 2016, 62(7-8):640-645

Acute dyspnea is one of the most common emergency department symptoms. But early diagnosis and treatment could be e challenging because of multiple potential causes. The gold standard biomarkers in cardiac dyspnea are B-type natriuretic peptide (BNP) and N-terminal pro-B-type (natriuretic peptide NT-pro BNP), which play an important role in the diagnosis, prognosis, and management of acute decompensated heart failure. The purpose of this review is to analyze diagnostic potential of BNP and NT-pro BNP biomarkers use in patients with acute dyspnea. BNP and NT-proBNP are markers of cardiac stress but are not cardiac-specific. They have comparable clinical...

Heart failure with preserved ejection fraction

Jindřich Špinar, Jiří Vítovec, Lenka Špinarová

Vnitr Lek 2016, 62(7-8):646-651

Heart failure with preserved ejection fraction occurs almost with the same frequency as heart failure with reduced ejection fraction. The diagnosis is based on echocardiography with evidence-based ejection fraction over 50 %, or with left atrial enlargement and left ventricular hypertrophy, and specification of natriuretic peptides. BNP 35 pg/ml and NT-proBNP 125 pg/ml are considered the limits of the norm for chronic heart failure. The treatment of heart failure with preserved ejection fraction lacks clear evidence of mortality reduction, diuretics are recommended to remove symptoms, ACE inhibitors or sartans and beta-blockers to improve the prognosis....

A near future of treatment of dyslipidemia in type 2 diabetics

Michal Vrablík

Vnitr Lek 2016, 62(7-8):652-660

Dyslipidemia in type 2 diabetics represents a complex change of lipoprotein metabolism that is highly proatherogenic. It originates on a genetic background in the context of insulin resistance and affects lipoprotein metabolism at multiple levels (e.g. hepatocyte, enterocyte, intravascular processing) mainly in the postprandial phase. The treatment of diabetic (atherogenic) dyslipidemia is an effective option to lower the risk of both macro- and microvascular complications of diabetes. Lifestyle changes effectively impact on dyslipidemia in diabetics, however, it is impossible to reach treatment goals and achieve necessary risk reduction without lipid...

Glucagon antagonists open a new way in treatment of type 2 diabetes Mellitus

Karel Vondra

Vnitr Lek 2016, 62(7-8):661-666

Excessive hepatic glucose production resulting from dysregulated glucagon secretion associated with inappropriate fasting and postprandial hyperglucagonemia is common feature in type 2 diabetes (DM2T). The effects of some currently widely used anti-diabetic agents, especially concerning metformin, GLP1 agonists and inhibitors of DPP4, comprise partial supression of glucagon secretion and/or action. Complete supression of glucagon action is recently widely investigated in experiments, and also results of phase 1 and 2 of the clinical trials are available. The experimental studies proved expected therapeutical potential of this approach. Blockade of...

Breviary of diabetes education for internist

Vladimír Uličiansky

Vnitr Lek 2016, 62(7-8):667-670

Diabetes education is an important cornerstone for diabetes care. Patients with diabetes should participate in education to facilitate the knowledge, skill sand ability necessary for diabetes both at diagnosis and there after. Effective self-management can improve clinical outcomes, health status, and quality of life.

Prevention and therapy of sarcopenia in the ageing

Zdeněk Zadák

Vnitr Lek 2016, 62(7-8):671-677

Sarcopenia is one of the severe disorders associated with nutritional imbalance. While sarcopenia is an inseparable part of the process of ageing as people get older, it plays a vital role in pathological situations such as protein-calorie and kwashiorkor malnutrition, it accompanies various diseases of rheumatic character and is an almost ever-present feature of the clinical picture of oncological patients. Sarcopenia in people under strain is fatally manifested mainly in the elderly, medically fragile patients. In view of the fact that sarcopenia is the decisive factor regarding the course of chronic as well as acute illnesses, it must be diagnosed,...

Case reports

Granulomatosis with polyangiitis manifested as diabetes insipidus

Ondřej Pátek, Miroslava Horáčková, Lenka Vítová, Rudolf Horváth, Jaromír Háček, Otto Schück

Vnitr Lek 2016, 62(7-8):679-683

The case report shows a surprising presentation of pulmonary granulomatosis with polyangiitis (GPA) through symptoms of diabetes insipidus (DI) with granulomatous infiltration of the pituitary gland. The pituitary hormonal dysfunction as a result of granulomatosis of the pituitary gland is rare. Several studies have demonstrated that the incidence of the pituitary dysfunction reaches approx. 1 % of the patients with GPA. However it is mostly presented in patients with the disease already diagnosed. The patient described by us had no clinical expressions of GPA in the respiratory tract. He presented with polyuria and polydipsia. It was not until a more...