Ultrazvuk ve vnitřním lékařství – zaostřeno na Point­‑of­‑Care ultrasonografii

MUDr. Zdeněk Monhart, Ph.D., FEFIM

Vnitr Lek 2023, 69(4):211  

Point‑of‑Care Ultrasound in internal medicine

Zdeněk Monhart

Vnitr Lek 2023, 69(4):214-221 | DOI: 10.36290/vnl.2023.041  

Point-of-Care ultrasound (POCUS) is bedside ultrasound examination performed by a clinician. POCUS is a suitable tool for rapid diagnosis and monitoring of the condition of many patients examined by internists in emergency departments and inpatient departments. POCUS allows the examining physician to supplement the physical examination with additional information obtained in real time, and is a useful tool for differential diagnosis of a number of acute conditions (shock, shortness of breath, etc.). Chest POCUS includes an indicative assessment of cardiac function and evaluation of the lung parenchyma, including exclusion of pericardial effusion, pneumothorax...

Point­‑of­‑Care Ultrasound - accuracy, education

Roman Škulec

Vnitr Lek 2023, 69(4):223-228 | DOI: 10.36290/vnl.2023.042  

A review article discussing the reliability of Point-of-Care ultrasound and education in this method in various fields of medicine.

How much POCUS for Czech internists?

Zdeněk Monhart

Vnitr Lek 2023, 69(4):230-232 | DOI: 10.36290/vnl.2023.043  

The introduction of point-of-care ultrasonography into practice in internal medicine and subsequently into the educational program for our specialty brought the need to define a curriculum for training in this method. We solve the question of "what to teach" - i.e. what core ultrasound competencies internists should learn for their practice. It is also necessary to define the procedure "how to teach" - the form and content of the education program, what the basic course should contain, and above all how the subsequent training should take place in practice. The third major problem to be solved is "who should teach", i.e. the definition of the requirements...

The current training for non­‑echocardiographers in University Hospital Hradec Králové

Petr Grenar, Jiří Nový, Karel Mědílek, Martin Jakl

Vnitr Lek 2023, 69(4):233-236 | DOI: 10.36290/vnl.2023.044  

Emergency echocardiography is a reproducible method providing clinically significant information during the process of primary assessment of the acute cardiovascular diseases. The main aim of the course is implementation of the emergency echocardiography by non-cardiologist is the standardization of the procedure, structured training system and agreement on the competences. The article summaries the current training for non-echocardiographers in University Hospital Hradec Králové.

Implementation of Point­‑of­‑Care ultrasound examination in general practice

David Halata, Dušan Zhoř, Roman Škulec

Vnitr Lek 2023, 69(4):237-241 | DOI: 10.36290/vnl.2023.045  

Point-of-Care ultrasonography (POCUS) is a method defined as a targeted ultrasound examination of patients with acute symptoms or syndromes that can be diagnosed by a healthcare worker at a site. The aim is to answer a specific diagnostic or therapeutic question or to ease the therapeutic procedure. Recently in Europe, there has been an increase in implementing POCUS in many medical fields including primary health care. The Czech Society of General Practice (SVL ČLS JEP) has for several years been watching the use of POCUS in primary care in many European countries. In August 2020, the committee of the Czech Society of General Practice charged the...

Statement of the Expert Discussion Panel of the 1st Expert Conference on Point­‑of­‑Care ultrasound

Roman Škulec, Martin Balík, Vladimír Černý, David Doležal, David Halata, Zdeněk Monhart, Martin Štěpán

Vnitr Lek 2023, 69(4):242-243  

The document summarizes the statement of the expert discussion panel of the 1st Point- of-Care Ultrasonography, which took place on 14 November 2022 in Prague and which led to the foundation of the Czech Multidisciplinary Task Force Group for standards,education and research in Point-of-Care ultrasound (Czech POCUS group).

Deep vein thrombosis - the role of ultrasound in the diagnosis and follow-up of patients

Tomáš Hauer

Vnitr Lek 2023, 69(4):244-248 | DOI: 10.36290/vnl.2023.046  

Deep vein thrombosis still represents a challenge regarding the diagnostics, treatment and follow-up. All this steps are often performed in the internal medicine ambulatory centers and such clinics therefore need to be aable to manage the whole process. Its key part is vascular sonography, which is needed to establish the diagnosis, the form of thrombosis and proper treatment course. There are two types of vascular sonography - Point of Care a expert sonography, being performed in two different regimes (diagnostic and follow up sonography). There are different demands for each of these two types, and each type is performed by physicians with different...

In the prevention of dementia, the focus should be on early and consistent treatment of hypertension

Miroslav Souček

Vnitr Lek 2023, 69(4):249-253 | DOI: 10.36290/vnl.2023.047  

The brain is among the target organs of hypertension. Patients with hypertension have a higher risk of developing stroke as well as experiencing a decline in cognitive functions and dementia. Changes in the white matter and atrophy of the grey matter of the brain induced by high blood pressure develop insidiously since the onset of hypertension, even in young individuals. The effect of high blood pressure on the vessel wall cumulates in time; therefore, hypertension in younger people implies an increased risk of dementia in older age. Hypertension in young age cannot be considered a benign condition. Hypertension in middle age increases the risk of...

Osteomalacia

Jan Rosa

Vnitr Lek 2023, 69(4):254-260 | DOI: 10.36290/vnl.2023.048  

Osteomalacia with characteristic histomorphometric, radiographic, laboratory and clinical features is a prominent syndrome of disturbed bone mineralisation in adulthood. From an etiological point of view, osteomalacia is usually caused by substrate (calcium, phosphate) deficiency, presence of excess mineralization inhibitors or deficiency or ineffectivness of mineralization facilitator (vitamin D). In proportion to the high number of congenital and acquired causes of osteomalacia, its clinical and laboratory picture is heterogeneous and rarely fully expressed. The treatment of a particular case is determined by the cause of osteomalacia and may (but...

Osteoporosis in adults in clinical practice (1): diagnosis and differential diagnosis

Vít Zikán

Vnitr Lek 2023, 69(4):E4-E15 | DOI: 10.36290/vnl.2023.052  

Osteoporosis is a systemic metabolic disease of the skeleton characterized by low bone strength that results in an increased risk of fracture. Fractures are associated with serious clinical consequences, including pain, disability, loss of independence, and death, as well as high healthcare costs. Early identification and intervention with patients at high risk for fracture is needed to reduce the burden of osteoporotic fractures. The identification of a patient at high risk of fracture should be followed by evaluation for factors contributing to low bone mineral density (BMD) and/or low bone quality, falls, and fractures. Components of the osteological...

Dapagliflozin in the treatment of heart failure with preserved ejection fraction

Terézia Švarcová

Vnitr Lek 2023, 69(4):261-264 | DOI: 10.36290/vnl.2023.049  

We present obese patient with numerous comorbidities in this case report, who's treatment of heart failure with preserved ejection fraction (HF PEF) has been managed in our office for several years. The treatment was limited by the patient's comorbidities (renal failure, obesity, atrial fibrillation, anemia) and by the patient's preferences. The patient's trust and cooperation is essential, as this case report confirms. The patient paid for empagliflozin which he did not tolerate. The patient however was willing to try dapagliflozin at his own expense. Dapaglifllozin was well tolerated by the patient and improved his quality of life significantly....

Initial use of subcutaneous plasma-derived C1 inhibitor in prophylaxis of acute attacks of hereditary angioedema in pregnant patients in Slovakia

Katarína Hrubišková, Miloš Jeseňák, Juraj Payer

Vnitr Lek 2023, 69(4):265-268 | DOI: 10.36290/vnl.2023.050  

Hereditary angioedema (HAE) is a rare, inborn disease manifested with recurrent attacks of angioedema. They can affect the skin and subcutaneous tissue, mucous membranes (gastrointestinal, respiratory, and uropoietic tracts), and submucous tissue. Women in reproductive age require specific management of the disease regarding both the course of the disease and treatment options. It is not only the treatment in female patients that is specific, but also the situations (pregnancy, breastfeeding). We present a case report of the initial use of a subcutaneous C1 inhibitor in the long-term prophylaxis of HAE attacks in two pregnant patients.

Transient hemodynamic instability caused by TIPS

David Schneider, Vladimír Kojecký

Vnitr Lek 2023, 69(4):E16-E19 | DOI: 10.36290/vnl.2023.053  

Variceal bleeding belongs to the one of the complications of portal hypertension and is a life-threatening condition. A transjugular intrahepatic portosystemic shunt (TIPS) is indicated in case of failure of the pharmacological and endoscopic therapy, even if it is associated with complications. Stent migration to the heart, is a rare event which may cause perforation of the right cardiac chambers or damage to the tricuspid valve. However, it may not be a problem in some cases. There are two approaches to extraction - percutaneous or surgical. Leaving the stent in situ is possible, especially in polymorbid patients. Choosing an optimal approach often...

Complications after administration of mRNA vaccine against COVID-19 - case report and short review

Ivan Varga, Peter Michalka, Jana Poláková Mištinová

Vnitr Lek 2023, 69(4):E20-E27 | DOI: 10.36290/vnl.2023.054  

The pandemic of the disease COVID-19 (COronaVIrus Disease 2019) caused by the SARS-CoV-2 coronavirus (severe acute respiratory syndrome coronavirus 2) resulted in millions of deaths and many patients have chronic consequences after overcoming the acute condition. Several vaccines have been developed in an effort to stop the spread of the virus, but they have potentially serious adverse effects. We present a case report of a patient with acute (myocarditis, exacerbation of bronchial asthma) and long-term (postural orthostatic tachycardia syndrome - POTS) complications after vaccination with the second dose of mRNA vaccine BNT162b2 (Comirnaty®)....

News in diabetology 2022

Milan Flekač

Vnitr Lek 2023, 69(4):270-273 | DOI: 10.36290/vnl.2023.051  

The use of new antidiabetic drugs in clinical practice in the last two decades has completely changed the Type 2 diabetes management. Following the results of new clinical trials, international recommendations for the treatment of diabetes were regularly modified. In the field of Type 1 diabetes, new technologies have appeared, such as smart insulin pens. We can await once weekly insulins and dual GLP-1 and GIP analogues in the near future.