Vnitřní lékařství, 2020 (vol. 66), issue 7

Review articles

Coagulopathy associated with COVID-19

Simona Bílková, Jana Hirmerová

Vnitr Lek 2020, 66(7):402-408 | DOI: 10.36290/vnl.2020.118

Infection with a new type of coronavirus surprised with the diversity of its clinical symptoms. The disease may be asymptomatic, with only mild symptoms in the form of olfactory loss, general weakness or flu-like symptoms. However, in some patients, COVID-19 infection can be severe, with hypercoagulation being a common finding, with vascular endothelial damage and the consequent risk of venous and arterial thrombotic complications. Coa-gulopathy subsequently significantly worsens the prognosis of patients and increases overall mortality. Recently, a new term has been introduced to indicate the presence of activated hemostasis in SARS-CoV-2 infection...

Current diagnosis and therapy in sarcoidosis

Martina Šterclová

Vnitr Lek 2020, 66(7):409-413 | DOI: 10.36290/vnl.2020.119

Sarcoidosis is a disorder of unknown etiology, that may affect any organ in human body, most often lungs and lymph nodes. New diagnostic guidelines and new treatment recommendations were recently published. Since differential diagnosis of sarcoidosis is broad, diagnostic algorithm has to be complex. Diagnosis needs to be confirmed before initiation of any any treatment regimen - it is a severe mistake to start treatment before confirmation of diagnosis (histologic pattern of epitheloid non necrotising granuloma, exclusion of other possible causes of granulomatous diseases, exclusive situations mentioned in the article body). Not every patient with...

Obstructive sleep apnea and hypertension: the role of gut microbiome

Pavel Šiarnik, Katarína Klobučníková, Imrich Mucska, Alžbeta Hlucháňová, Oto Hanus, Peter Turčáni, Branislav Kollár

Vnitr Lek 2020, 66(7):415-419 | DOI: 10.36290/vnl.2020.120

Obstructive sleep apnea is common disorder affecting approximately one quarter of the common population. Prevalence is even higher in a population with increased vascular risk. Obstructive sleep apnea is a significant risk factor for hypertension, with approximately 50% of obstructive sleep apnea patients suffering hypertension. While the relationship between sleep apnea and hypertension has been firmly established, mechanisms linking these disorders are still poorly understood. Importance of sympathetic nervous system and renin-angiotensin-aldosterone system hyperactivity as well as endothelial dysfunction is suspected. There is increasing evidence...

CAR T-cells: hot news in cancer therapy

Štěpán Hrabovský

Vnitr Lek 2020, 66(7):420-424 | DOI: 10.36290/vnl.2020.121

Cancer immunotherapy has become a standard therapeutic option in oncology over the past few decades. From the early anti-tumor vaccine experiments in the late nineteenth and early twentieth centuries, its journey led through the discovery of the allogeneic hematopoietic stem cell transplantation principles in the nineteen-seventies, introduction of monoclonal antibodies in the nineteen-nineties, their enhancing in the form of immunoconjugates and bispecific antibody constructs, up to today's checkpoint inhibitors and chimeric antigen receptor T-cells (CAR T-cells). Not so long ago, a treatment with genetically modified lymphocytes may have seemed quite...

Renal failure in multiple myeloma and its treatment

Romana Ryšavá

Vnitr Lek 2020, 66(7):425-431 | DOI: 10.36290/vnl.2020.122

Renal failure is a serious complication of multiple myeloma, and up to 50% of patients with this most frequent haematological malignancy may develop some form of renal impairment. The aetiology of renal damage is multifactorial, but increased production of free light chains that are filtered into the urine is crucial for the development of renal failure and could be associated with distal tubule involvement (myeloma kidney, light chain cast nephropathy) or with fully developed Fanconi syndrome in proximal tubule damage (proximal tubulopathy, light chain proximal tubulopathy). Glomerular damage most often manifests as AL amyloidosis or light chain deposition...

Bone Metabolism in Inflammatory Bowel Diseases 2

Tomáš Kupka, Pavel Svoboda, Martina Bojková, Martin Blaho, Adam Vašura, Vladimír Hrabovský, Petr Dítě

Vnitr Lek 2020, 66(7):432-436 | DOI: 10.36290/vnl.2020.123

Inflammatory Bowel Disease encompasses Crohn's Disease, which is capable of affecting the entire GI tract, although usually favors the ileocolonic and perianal areas, and Ulcerative Colitis, which is limited to the colon. The pathophysiology is not fully understood but is thought to be caused by a complex interplay among gut microbiota, dysregulation of the host's immune system, genetic susceptibility and environmental factors. Osteopenia and osteoporosis are considered to be extraintestinal manifestations of inflammatory bowel disease. Osteoporosis is usually diagnosed by dual-energy X-ray absortiometry. Early interventions to treat active CD and...

E-publication

Bone metabolism in inflammatory bowel diseases 1

Tomáš Kupka, Pavel Svoboda, Martina Bojková, Martin Blaho, Adam Vašura, Vladimír Hrabovský, Petr Dítě

Vnitr Lek 2020, 66(7):e3-e7 | DOI: 10.36290/vnl.2020.131

Ethical connotations of the treatment of COVID-19 disease

Anetta Jedličková

Vnitr Lek 2020, 66(7):e8-e12 | DOI: 10.36290/vnl.2020.132

The current situation of the COVID-19 pandemic has brought entirely new challenges to the health care professionals as well as to the general public, and together with them a number of new problems that the society needs to deal with. One of the groups of new challenges are undoubtedly ethical issues. For physicians in their daily practice, it is important to realize the significant role of ethical aspects during an epidemic or pandemic. The article aims to acquaint health care professionals with ethical principles in general, with their distinctiveness and application in the course of infectious diseases, and with the main ethical aspects of the COVID-19...

Biomarkers for non-endoscopic examination of esophageal mucosa

Tereza Deissová, Zdeněk Kala, Ondřej Slabý, Jiří Dolina, Radek Kroupa, Lumír Kunovský, Lydie Izakovičová Hollá, Petra Bořilová Linhartová

Vnitr Lek 2020, 66(7):e13-e19 | DOI: 10.36290/vnl.2020.133

Gastroesophageal reflux disease (GERD) is a multifactorial disease; an individual´s genetic predisposition may contribute to the development of this disorder. Endoscopic methods and histological examination are commonly used to diagnose GERD and its complications such as Barrett's esophagus (BE) and esophageal adenocarcinoma (EAC). For BE screening in high-risk individuals as well as monitoring the development of BE dysplasia, esophageal mucosa samples could be taken using modern non-endoscopic procedures to minimize invasiveness of the procedure and improve patient adherence and compliance with a treatment. Esophageal mucosa samples taken by non-endoscopic...

Risk of cardiovascular complications related to blood glucose concentration: from diabetes to prediabetes

Michael Jenšovský, Jana Malinovská, Ludmila Brunerová, Veronika Vejtasová, Rhea Saldanha, Kristýna Kučera, Jan Brož

Vnitr Lek 2020, 66(7):e20-e25 | DOI: 10.36290/vnl.2020.134

Diabetes is an established risk factor of cardiovascular disease including the coronary heart disease (CHD) and elevates the risk of cardiovascular death 2 times. Based on current evidence the risk of acquiring the CHD increases accordingly to the level of fasting blood glucose even in the prediabetic range. In the range of 5.6-6.0 mmol/l the risk is 1.11, in the range of 6.1-6.9 mmol/l the risk is 1.17. In the range of HbA_1c of 42-47 mmol/l the risk of the CHD is 1.28. The probability of the CHD occurrence therefore does indeed increase in conjunction with the fasting blood glucose levels but the dependence is not linear.

Original articles

ERCP in patients after choledochodenoanastomosis

Bohuslav Kianička, Martin Blaho, Lumír Kunovský, Miroslav Souček, Petr Piskač, Petr Vlček

Vnitr Lek 2020, 66(7):e26-e30 | DOI: 10.36290/vnl.2020.135

The aim of this retrospective study is to evaluate our experience with diagnostic and therapeutic endoscopic retrograde cholangiopancreaticography (ERCP) in patients after choledochoduodenoanastomosis. Methods: The study took 20 years (November 1994 - December 2014). Three patients after choledochoduodenoanastomosis who had symptoms of biliary obstruction were retrospectively evaluated. In all cases, a standard therapeutic videolateroscope was used to perform ERCP. Patients and results: We achieved ERCP in these 3 patients with choledochoduodenoanastomosis 100% cannulation success rate - 3 out of 3 patients. This was 100% success rate of diagnostic...

Rationed nursing care as one of the indicators of the occurrence of medication errors

Ilona Plevová, Darja Jarošová, Eva Janíková, Renáta Zeleníková, Eva Mynaříková, Andrea Polanská

Vnitr Lek 2020, 66(7):e31-e38 | DOI: 10.36290/vnl.2020.137

Aim: The aim was to analyze selected studies on rationed nursing care as one of the indicators that influence the occurrence of medication errors. Methods: A descriptive review study. Articles and studies were searched in the following selected electronic databases: EBSCO (Academic Search Ultimate, Academic Search Complete), CINAHL Plus with Full Text, MEDLINE Complete, ScienceDirect and Central & Eastern European Academic Source. The search for relevant sources was based on the following English keywords: unfinished care, omitted care, rationing care, missed care, nursing care, medication errors. Results: Total of 86 contributions...

Case reports

Metformin‑associated lactic acidosis

Martina Lášticová, Jakub Víšek, Ondřej Zima, Alena Šmahelová, Vladimír Blaha

Vnitr Lek 2020, 66(7):438-442 | DOI: 10.36290/vnl.2020.124

Lactic acidosis is a feared complication of metformin therapy. In our article we describe 2 case reports of patients treated with metformin, who developed this complication. In the first case, which was fatal, cummulation of lactate was a result of acute kidney failure caused by diarrhea. In the second patient, lactic acidosis developed in the terrain of preexisting chronic kidney disease, when dyspepsia and decreased fluid intake caused progression into acute kidney failure. In this case, treatment of lactic acidosis was successful. Death of the first patient was probably caused by the presence of serious comorbidities and other complications which...

Tangier disease in family with the phenotype of familial hypercholesterolemia

Robin Urbánek, Lukáš Tichý, Tomáš Freiberger

Vnitr Lek 2020, 66(7):443-446 | DOI: 10.36290/vnl.2020.125

Within the project MedPed (Make Early Diagnosis to Prevent Deaths) we have examined patient with familial hypercholesterolemia in our lipid ambulance. During the following investigation of the patient's family we found out that her sister has on the contrary very low levels of total and LDL-cholesterol. Concentration of HDL-cholesterol was extreamly low (almost immeasurable). Differential diagnosis uttered a suspicion of rare form of familial hypoalfalipoproteinemia so-called Tangier disease. This suspicion was then confirmed by molecular genetic examination. Tangier disease is a rare lipoprotein metabolism disorder characterized biochemically by almost...

Case reporty

E-publication

Adenokarcinom tenkého střeva diagnostikovaný pomocí video kapslové endoskopie u pacientky s celiakií: kazuistika a přehled literatury

Barbora Packová, Lumír Kunovský, Michal Eid, Radek Kroupa, Milan Dastych, Michal Šenkyřík, Tomáš Grolich, Jakub Hustý, Petr Jabandžiev, Václav Kubeš, Vladimír Procházka, Jiří Dolina

Vnitr Lek 2020, 66(7):e39-e42 | DOI: 10.36290/vnl.2020.138

Celiakie je imunitně zprostředkovaná enteropatie, rozvíjející se při požití lepku u geneticky predisponovaných osob. Je spojena se zvýšeným rizikem rozvoje malignit trávicího traktu. Tyto komplikace jsou většinou diagnostikovány v pozdním stádiu, což je jedním z faktorů jejich nepříznivé prognózy. Naše kazuistika se týká ženy, jíž byla celiakie diagnostikována v 53 letech. Po 2 letech se u ní náhle rozvinula sideropenická anémie. Esofagogastroduodenoskopie ani kolonoskopie neprokázala krvácení do gastrointestinálnho traktu. Video kapslová endoskopie odhalila exulcerovanou stenózu v jejunu se známkami krvácení, před kterou kapsle retinovala. Na simultánně...

A rare coincidence of a chylothorax and a hydrothorax caused by gastric adenocarcinoma - a case report

Nela Šťastná, Kristián Brat

Vnitr Lek 2020, 66(7):e43-e45 | DOI: 10.36290/vnl.2020.139

We present a case report of a 74-years old patient with a finding of bilateral pleural effusion due to a different fluid composition caused by gastric adenocarcinoma. The finding of a bilateral effusion, where the exudate fluid is of a different chemical composition, is a rare phenomenon. While the right-sided exudate had the characteristics of hydrothorax, the left-sided exudate had those of chylothorax. The initial suspicion of a lung tumor was not confirmed, and further examination surprisingly revealed gastric adenocarcinoma. The patient did not benefit from targeted oncological treatment for a long time and the chemotherapy was terminated after...

A man with dysthymia (with negative evaluation of allmost all through his live) induced depression in his sensitive spouse

Jeroným Klimeš, Zdeněk Adam

Vnitr Lek 2020, 66(7):e46-e54 | DOI: 10.36290/vnl.2020.140

Long lasting, low intensity depressive episodes have been diversely integrated according to the classifications types or the psychodynamic points of view. The concept of anxious persistent lasting depression, neurotic depressive states, neurotic depression have been unified into the dysthymic disorder category of the DSM classification. This concept unification have been a topic of dispute considering that dysthymic disorder was a restrictive, heterogeneous an extensively comorbid diagnosis. Nevertheless the definition of this category offers the opportunity to place the notions of temperament, personality, adjustment disorder. Including dysthymic...

In brief

Hypoglycemia in non‑diabetic patients

Jan Škrha jr.

Vnitr Lek 2020, 66(7):447-448 | DOI: 10.36290/vnl.2020.126

Hypoglycemia is a rather frequent complication of diabetes treatment, however it can occur also in non-diabetic patients. The article presents a brief differential diagnosis of hypoglycemia in non-diabetic patients.

Good advice

Screening and brief intervention in illicit drug users

Jana Malinovská, Barbora Švarcová, Ludmila Brunerová, Sabina Pálová, Jan Brož

Vnitr Lek 2020, 66(7):450-454 | DOI: 10.36290/vnl.2020.127

Illicit drug use is quite prevalent in the Czech population with a lifetime prevalence of illicit drug use being 29.7 % in 2018. People who use illicit drugs can use health care services more often and they are thus relevant in early identification of illicit substance use disorders and in providing brief intervention. Primary evaluation of presence of illicit substance use disorders can be done using simple and fast screening questionnaires, such as DAST-10. Screening is followed with time effective brief intervention that includes education, advice and motivation for ceasing drug use. Brief intervention should always precede potential referral to...

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