Hlavní téma – biomarkery astmatu 

doc. MUDr. Petr Čáp, Ph.D.

Vnitr Lek 2023, 69(6):347  

Alarmins - novel targets for biological therapy

Irena Krčmová, Jakub Novosad

Vnitr Lek 2023, 69(6):352-358 | DOI: 10.36290/vnl.2023.070  

Biological therapy shows promise for patients with severe asthma, and more biological drugs in clinical trial phases targeted at types of airway inflammation are expected. The choice of biologicals in patients with severe asthma is based on a diagnostic assessment of whether the inflammatory asthma endotype/phenotype is T2-high (i.e., eosinophilic, allergic, or non-allergic) or T2-low (i.e., non-eosinophilic). In clinical practice, three molecules with an anti-eosinophilic access to the cytokine 5 pathway (mepolizumab, benralizumab, reslizumab), a molecule targeted at the IL4/13 receptor (dupilumab), and a molecule binding to immunoglobulin E (omalizumab)...

The role of allergen immunotherapy in the internist's consulting room

Petr Čáp

Vnitr Lek 2023, 69(6):359-364  

The text offers an up‑to‑date view of allergen immunotherapy (AIT) as a method of very effective induction of tolerance to aeroallergens of mites, pollens and venom of white‑winged insects. It has an effect not only on the alleviation or disappearance of rhinoconjunctivitis symptoms, but it pervasively reduces the risk of asthma development or alleviates its manifestations. In the case of allergy to the venom of white‑winged animals (wasp and bee), it can very effectively prevent anaphylaxis, which is a life‑threatening allergy. Awareness of internists about the current options of modern galenic forms of AIT is important...

The role of eosinophils in the pathogenesis, diagnosis and treatment of asthma

Jakub Novosad, Irena Krčmová

Vnitr Lek 2023, 69(6):365-372  

Cells corresponding to eosinophils were already histopathologically documented in the first half of the 19th century. However, the term "eosinophils" was first used by Paul Ehrlich in 1878. Since the discovery of eosinophils, their existence has been associated with bronchial asthma, allergies and the pathogenesis of helminthic disorders. Since the beginning of the 21st century, understanding this cell population's nature has undergone a fundamental reassessment. In 2010, J. J. Lee proposed the concept of "LIAR" (Local Immunity And/or Remodeling /Repair), underscoring the extensive immunoregulatory functions of eosinophils in the context of health...

FENO potential in asthma

Petr Čáp

Vnitr Lek 2023, 69(6):373-379 | DOI: 10.36290/vnl.2023.073  

Mechanisms of FENO production in epithelial cells in the area lower airways is being resumed. The author focuses on usage of this biomarker in clinical practice and with respect to new established upcoming biological treatment just in severe variants of the disease. Recent publications of FENO are analysed in omalizumab and other types of biological treatment such as mepolizumab and reslizumab, concentrated on IL-5 or receptor for IL-5 benralizumab. They have been approved as an additional treatment of severe refractory eosinophilic adult asthma. FENO as a marker of asthma influenceable by biological treatment can be used to evaluate the efficiency...

Multimorbidity in acute kidney injury

Vladimír Teplan

Vnitr Lek 2023, 69(6):380-386 | DOI: 10.36290/vnl.2023.074  

Acute kidney injury (AKI) is often associated with other organ damage. The most frequent are cardiac , lung,liver,gastrointestinal, vascular and skin disturbances.Serious illness is acute kidney injury due to circulation break down and toxicity, and disorders of water and mineral metabolism (hypotension,bleeding,diarrhoea,vomiting).AKI can be connected with haevy hypertension, and also with oedemas (high proteinuria) of different etiology (cardiac failure,vessel inflammation, liver and gastrointestinal lesion, oncologic illness etc.).Frequently,there is acute kidney damage in poisonig and infectious damage together with liver,lung,vessel,muscle,bone...

Endoscopic and surgical therapy for obesity

Jan Král, Filip Doleček, Kateřina Waloszková, Jana Selucká, Evžen Machytka, Julius Špičák, Marek Bužga

Vnitr Lek 2023, 69(6):E4-E11 | DOI: 10.36290/vnl.2023.079  

Obesity is a serious disease whose incidence continues to rise worldwide. Obesity-associated diseases lead to reduced quality of life and increased mortality (high blood pressure, dyslipidemia, type 2 diabetes mellitus, etc.). The treatment of obesity is a multidisciplinary and complex process that requires consistent patient cooperation. Lifestyle change is the cornerstone of successful obesity treatment. Pharmacological therapy has experienced a renaissance in recent years and its role, both in monotherapy and in combination with other methods, will gradually become more important. Endoscopic therapy is a rapidly evolving subfield of digestive endoscopy...

Stem cells therapy in patients with chronic limb-threating ischemia

Dominika Sojáková, Jitka Husáková, Vladimíra Fejfarová, Veronika Wosková, Andrea Němcová, Radka Jarošíková, Michal Dubský

Vnitr Lek 2023, 69(6):E12-E18 | DOI: 10.36290/vnl.2023.080  

Autologous cell therapy has been used in patients with chronic limb-threatening ischemia for many years. Numerous studies and meta-analyses assessed benefits of cell therapy and also presented its new possibilities. In addition to the standard sources of stem cells, like bone marrow and peripheral blood, new possibilities of using various types of tissues were considered. There is still question about a comparison of the effect among different types of cells and their administration. The possibility of combined therapy consisting of hyperbaric oxygen therapy and stem cell therapy is also an interesting approach. According to the experience from our...

Point-of-care ultrasonography: a revolution in a daily routine of an internist?

Juraj Smaha, Jakub Falat, Anzhelika Shevchuk, Martin Kužma, Peter Jackuliak, Juraj Payer

Vnitr Lek 2023, 69(6):E19-E28 | DOI: 10.36290/vnl.2023.081  

Point-of-care ultrasonography (POCUS) is a form of ultrasonography where the attending physician performs an ultrasonographic examination at the patient's bedside in real-time, which allows him to evaluate dynamic changes in the sonographic image and directly correlate the findings with the patient's symptoms. The doctor performing POCUS has a specific clinical question in mind that he wants to answer with the sonographic examination. POCUS has the potential to streamline the diagnosis, treatment, monitoring, and screening of many diseases in internally ill patients, but its position within internal medicine is not yet clearly defined. The present...

Heart failure as the first clinical symptom of amyloidosis

František Novák, Jan Václavík

Vnitr Lek 2023, 69(6):387-390 | DOI: 10.36290/vnl.2023.075  

The term amyloidosis includes a group of disorders in which proteins, both native and mutated, are deposited in the tissues. These proteins form an ordered fibrous, poorly soluble matrix called amyloid. Its deposition impairs the function of the affected organs (1, 2). Diagnosis is difficult and often late (3). Heart involvement is very common and limits the prognosis of the patient (4). We describe the case of a patient in which even the relatively early diagnosis did not prevent her sudden death.

Intrathoracic bacterial infection caused by Delftia acidovorans

Martin Sučík, Róbert Rosoľanka, Peter Bánovčin, Peter Lipták, Diana Važanová, Lenka Nosáková

Vnitr Lek 2023, 69(6):391-393 | DOI: 10.36290/vnl.2023.076  

Delftia acidovorans is a Gram-negative, aerobic, rod-shaped bacterium which causes infections in humans only rarely. It causes mostly nosocomial infections, described more frequently in immunocompromised patients across all age groups. In recent years, several cases involving this bacterium in infections affecting various organ systems have been published in the literature. With regard to its common resistance to aminoglycosides and polymyxins, which oftentimes serve as salvage therapy for complicated Gram-negative bacterial infections, there is inevitably a need for its quick identification followed by a correctly chosen treatment. This article describes...

Rosacea: skin disease or a systemic disorder?

Štefan Alušík

Vnitr Lek 2023, 69(6):E29-E31 | DOI: 10.36290/vnl.2023.082  

Rosacea is a disease that has a multifactorial cause and a complex pathophysiology that is not limited to the skin. In clinical practice, rosacea is associated with a variety of comorbidities and there is currently a debate as to whether rosacea is a systemic sickness. The author briefly reviews those diseases that are more common in rosacea than in the general population. In particular, he mentions cardiovascular, gastrointestinal, neuropsychiatric and autoimmune diseases, as well as some types of tumours. Internists should be sufficiently familiar with these issues. When examining a patient with rosacea, they must take a broader approach and in a...

Subclinical hypothyroidism

Jan Drugda, Jan Čáp, Filip Gabalec

Vnitr Lek 2023, 69(6):394-396 | DOI: 10.36290/vnl.2023.077  

Subclinical hypothyroidism is a relatively common condition characterized by elevated serum TSH levels, but normal free thyroxine levels. The risks associated with subclinical hypothyroidism are less severe compared to those with overt hypothyroidism, making it essential to carefully select patients who would benefit from the treatment. Factors such as the patient´s age, comorbidities, symptoms, and TSH concentration need to be considered in this selections proces. The therapy, if required, consists of levothyroxine substitution with carefull dose titration to avoid overtreatment. The goal is to normalize TSH levels. Untreated patients should be folowed...

What's new in rheumatology

Ladislav Šenolt, Mária Filková, Kristýna Bubová, Jakub Závada, Michal Tomčík, Jiří Vencovský, Šimon Tichý, Karel Pavelka

Vnitr Lek 2023, 69(6):397-405 | DOI: 10.36290/vnl.2023.078  

Rheumatology has experienced significant advances in recent years as a result of the emphasis on early diagnosis and the application of treat-to-target principles, as well as new immunopathogenetic findings and the availability of a wide range of biologic and targeted synthetic drugs. In this communication, we present new findings in the diagnosis and treatment of selected rheumatic diseases, specifically rheumatoid arthritis, spondyloarthritis, systemic lupus erythematosus, systemic scleroderma, idiopathic inflammatory myopathies, systemic vasculitis, rheumatic polymyalgia and giant cell arteritis, and osteoarthritis. This communication aims to provide...