ZAZNĚLO NA 21. interní medicíně pro praxi - Clarion Congress Hotel Olomouc, 12.–13. 3. 2026Supplement

MUDr. Zuzana Zafarová

Vnitr Lek 2026, 72(Suppl.C)  

Praktická doporučení - Expertní konsenzus pro diagnostiku a léčbu pacientů s hyperurikemií a vysokým kardiovaskulárním rizikem: aktualizace 2025Supplement

MUDr. Zuzana Zafarová, prof. MUDr. Michal Vrablík, Ph.D.

Vnitr Lek 2026, 72(Suppl.B)  

XXXII. KONGRES ČESKÉ INTERNISTICKÉ SPOLEČNOSTI ČLS J. E. PURKYNĚ: 19.–21. 11. 2025, BrnoAbstracts

Redakce

Vnitr Lek 2026, 72(Suppl.A)  

Giant cell arteritis with a mixed cranial and large-vessel phenotype presenting with atypical retroauricular headache and fever of unknown originCase reporty#E-publication

Marcel Pavlík, Oliver Kuchař, Róbert Novotný

Vnitr Lek 2026, 72(5):E27-E33 | DOI: 10.36290/vnl.2026.065  

Giant cell arteritis is the most common primary large-vessel vasculitis affecting individuals older than 50 years. The classical cranial form is typically associated with temporal headache, jaw claudication, scalp tenderness, visual disturbances, and the risk of irreversible vision loss. However, the disease may also present as fever of unknown origin accompanied by a marked systemic inflammatory response without typical temporal artery involvement, leading to substantial diagnostic delay. We present the case of a 62-year-old woman with an approximately two-month history of right-sided retroauricular and occipital headache, daily febrile episodes,...

Diabetic foot: from antibiotics to offloading and revascularizationReview articles#E-publication

Jana Pecová

Vnitr Lek 2026, 72(5):E21-E26 | DOI: 10.36290/vnl.2026.063  

Diabetic foot syndrome (DFS, diabetic foot) is one of the late complications of diabetes mellitus. The WHO defines DFS as damage of the tissues of the foot distal to the ankle, most commonly associated with diabetic neuropathy and varying degrees of lower limb ischemia. (5) The clinical manifestations of DFS include ulcers, gangrene, and Charcot neuropathic osteoarthropathy (CNO). DFS is characterized by the heterogeneity of clinical findings. Patient care is multidisciplinary. It encompasses regular preventive education of patients on self-care of the feet, treatment of ulcers, administration of antibiotics in cases of foot infection, treatment of...

Gouty arthritis: current insights into diagnosis and treatmentReview articles#E-publication

Stela Kašperová, Lenka Tarabčáková, Daniela Šutovská, Emőke Šteňová

Vnitr Lek 2026, 72(5):E11-E20 | DOI: 10.36290/vnl.2026.062  

Gout is a crystal-induced arthritis and represents the most common form of inflammatory arthritis in adulthood. The clinical course of the disease includes acute flares alternating with asymptomatic intercritical periods and, in the case of long-term untreated hyperuricaemia, it may progress to a chronic tophaceous form. A typical feature of an acute gout flare is the rapid onset of inflammatory activity within a few hours, which helps to distinguish gout from other forms of arthritis. Despite the fact that the "disease of kings" is well-known and a treatment is commonly available, it remains frequently underdiagnosed, and its management in clinical...

Erdheim-Chester disease diagnosed and treated at the Hematology and Oncology Clinic of the Brno University Hospital in the last 26 years. Description of 6 cases and an overview of the symptoms and treatment of this diseaseOriginal articles#E-publication

Zdeněk Adam, Zdeněk Řehák, Karel Starý, Richard Chaloupka, Aleš Čermák, Sandra Soboličová, Ivanna Boichuk, Martin Štork, Viera Sandecká, Andrea Křivanová, Marta Krejčí, Luděk Pour

Vnitr Lek 2026, 72(5):E1-E10 | DOI: 10.36290/vnl.2026.058  

Erdheim-Chester disease (ECD) is a malignant histiocytic disease that is usually accompanied by a systemic inflammatory reaction (fever of uknown origin). Osteosclerotic bone changes are characteristic. A typical feature is increased accumulation of osteotropic radiopharmaceuticals around the knee joints (hot knees) and the formation of retroperitoneal infiltrates. ECD can affect virtually any organ. Its incidence in the adult population has been estimated in Europe and the USA at 3 cases/10 million adults. The number of diagnosed cases has been increasing in recent years due to better awareness among physicians. At the Hematology Clinic in Brno, we...

Spánek jako klinická veličina: měřit, interpretovat, léčitEditorial

prof. MUDr. Milan Sova, Ph.D.

Vnitr Lek 2026, 72(5):280  

Large language models in healthcare: benefits, risks and outlookAI in medicine and health care

Ondřej Volný, Adam Gřunděl

Vnitr Lek 2026, 72(5):345-350 | DOI: 10.36290/vnl.2026.067  

Large language models (LLMs) such as ChatGPT, Gemini, or Claude have become widely accessible tools increasingly used by patients and clinicians for health-related purposes, regardless of whether these tools are certified as medical devices. A large-scale analysis of over 500,000 health-related conversations with Microsoft Copilot demonstrated that nearly one in five queries involves personal symptom assessment, and one in seven personal health queries concerns someone other than the user. Health-related queries markedly increase during nighttime hours, when traditional healthcare access is most limited. This trend creates both opportunities (information...

Flu vaccination - common myths and how to talk to patientsGood advice

Šárka Rumlarová

Vnitr Lek 2026, 72(5):342-344 | DOI: 10.36290/vnl.2026.066  

Influenza is a highly contagious disease that can lead to serious complications. Vaccination against influenza clearly reduces the risk of infection or a severe course of the illness. Despite the fact that its effectiveness is reliably supported by extensive data, the Czech population has long shown distrust toward influenza vaccination. Vaccination coverage in the Czech Republic is lamentably low, even among high-risk patient groups. This article examines the most common objections cited as reasons for refusing the influenza vaccine and provides appropriate arguments to counter these concerns. These may help in discussions with patients and contribute...

Acute coronary syndrome without atherosclerosis: paradoxical coronary embolism in a patient with venous thromboembolism and occult lung adenocarcinomaCase reports

Mária Ivančíková, Martin Hudec, Zuzana Celecová

Vnitr Lek 2026, 72(5):338-340 | DOI: 10.36290/vnl.2026.064  

The occurrence of acute coronary syndrome without angiographic evidence of atherosclerosis in combination with venous thromboembolism represents a diagnostically challenging situation with a potential systemic underlying cause. We present the case of 50-year-old man with a recent deep vein thrombosis who was admitted with acute pulmonary embolism and concomitant acute coronary syndrome. Coronary angiography revealed distal occlusion of the ramus intermedius, which was treated by aspiration thrombectomy. Transesophageal echocardiography (TEE) confirmed the presence of a patent foramen ovale (PFO). During the subsequent clinical course, the patient...

Low-trauma fracture: a window of opportunity for secondary prevention without delayReview articles

Soňa Dubecká, Martin Kužma, Peter Jackuliak, Juraj Payer

Vnitr Lek 2026, 72(5):326-334 | DOI: 10.36290/vnl.2026.061  

The modern risk-oriented approach to the diagnosis and treatment of osteoporosis is no longer based solely on the assessment of bone mineral density by DXA, but on a comprehensive evaluation of fracture risk. An important role is played by clinical risk factors, a history of low-trauma fracture, FRAX, TBS, and other tools that allow more precise patient stratification and treatment individualization. A low-trauma fracture represents a window of opportunity for secondary prevention without delay, because after a recent fracture the risk of another fracture is highest in the short-term period. This article summarizes the current approach to the diagnosis...

Initiating antihypertensive treatment with combination therapy: why it should become standard practice in most patientsReview articles

Eva Kociánová

Vnitr Lek 2026, 72(5):320-324 | DOI: 10.36290/vnl.2026.060  

Contemporary hypertension guidelines have shifted from stepwise escalation of monotherapy toward earlier use of combination treatment. The rationale is not limited to greater blood pressure-lowering efficacy; it also includes shortening exposure to uncontrolled blood pressure, reducing therapeutic inertia, and improving adherence. The 2024 ESC and 2023 ESH guidelines prefer an initial low-dose two-drug combination, ideally as a single-pill combination, in most patients with confirmed hypertension; the 2025 AHA/ACC guideline recommends two first-line agents for stage 2 hypertension. Monotherapy remains appropriate in selected situations, particularly...

Iron deficiency anemia: when to use oral versus intravenous iron, how much, and for how longReview articles

Veronika Cíglerová, Jan Válka

Vnitr Lek 2026, 72(5):312-319 | DOI: 10.36290/vnl.2026.059  

Iron deficiency anemia is the most common hematologic disorder and its management requires accurate diagnosis as well as a rational choice of iron replacement strategy. The decision between oral and intravenous therapy is based on the patient's clinical status, the etiology of iron deficiency, and the expected absorption of iron. Oral preparations at a dose of 100-200 mg of elemental iron daily represent first-line treatment in stable patients; with an adequate response, an increase in hemoglobin of ≥ 10 g/L can be expected within 2 weeks, and therapy should continue for at least 3 months after normalization to replenish iron stores. Intravenous...

Sleep and athletic performanceMain topic

Markéta Sovová, Eliška Sovová

Vnitr Lek 2026, 72(5):306-310 | DOI: 10.36290/vnl.2026.057  

Sleep is a key biological process essential for optimal physical and mental functioning and plays a crucial role in recovery, adaptation to stress, and athletic performance. This review article focuses on the physiology of sleep in athletes, its impact on performance, the consequences of sleep deprivation, and the importance of circadian rhythms. Adequate sleep duration and quality support muscle recovery, hormonal balance, and cognitive function, while sleep deprivation leads to impaired physical and mental performance, increased fatigue, and a higher risk of injury.

Insomnia in patients with chronic obstructive pulmonary disease: pathophysiology, diagnosis and treatmentMain topic

Milan Sova, Jaroslav Vejrych, Vladimír Herout, Ondřej Venclíček

Vnitr Lek 2026, 72(5):300-305 | DOI: 10.36290/vnl.2026.056  

Insomnia is an independent sleep-wake disorder that is common in patients with chronic obstructive pulmonary disease (COPD) and may substantially impair daytime functioning, quality of life, and coping with the underlying respiratory disease. Its origin is usually multifactorial. Contributing factors include nocturnal dyspnoea, cough and sputum, sleep-related changes in ventilation, hypoxaemia or hypercapnia, COPD-obstructive sleep apnoea overlap, pain, gastro-oesophageal reflux, nocturia, heart failure, anxiety and depression, medication effects, and perpetuating behavioural patterns. Diagnosis is primarily clinical and should distinguish subjective...

Device-based diagnostics in Czech sleep medicineMain topic

Tomáš Krejčí, Samuel Genzor, Jaromír Vachutka

Vnitr Lek 2026, 72(5):284-299 | DOI: 10.36290/vnl.2026.055  

This article reviews the historical development and current state of sleep medicine in the Czech Republic from the perspective of device-based diagnostics. It briefly introduces methods used across all six major groups of sleep disorders and focuses in detail on sleep-related breathing disorders, particularly obstructive sleep apnea (OSA). The historical four-level classification of diagnostic methods is discussed, ranging from laboratory polysomnography (PSG), which remains the reference method, through home sleep apnea testing (HSAT) to simple screening. The article also provides a detailed technical overview of diagnostic systems used in the Czech...

Do you want to be healthier? Try cutting back on highly processed foodsGood advice#E-publication

Markéta Sovová, Eliška Sovová

Vnitr Lek 2026, 72(4):E4-E6 | DOI: 10.36290/vnl.2026.054  

In recent decades, there has been a significant increase in the consumption of ultra-processed foods (UPF) worldwide, which in some countries account for almost half of total energy intake. The aim of this review article is to summarize current knowledge on the definition and classification of UPF, the extent of their consumption in Europe and the Czech Republic, possible mechanisms of their effects on human health, and their relationship to health risks. Special attention is paid to the NOVA classification, which is currently the most widely used tool for identifying UPF. Available epidemiological studies and meta-analyses consistently show that higher...

Type 2 diabetes mellitus + glaucoma = type 4 diabetes mellitusReview articles#E-publication

Štefan Sotak

Vnitr Lek 2026, 72(4):E1-E3 | DOI: 10.36290/vnl.2026.053  

The term "type 4 diabetes mellitus (DM)" is not generally recognized. It occurs more in popular science than in professional science literature. However, it is interesting that this term has two meanings, two different definitions. The first definition of this type of diabetes is that it is a type 2 DM that occurs in patients with glaucoma. Although the relationship between any type of glaucoma and any type of DM has been debated in the past, cumulative epidemiological evidence confirms that the risk of developing glaucoma, specifically primary open-angle glaucoma, is increased in the diabetic population. Other types of glaucoma in diabetes have not...

Hlavní téma – současné trendy v gastroenterologiiEditorial

MUDr. Denisa Kyselová, Ph.D.

Vnitr Lek 2026, 72(4):203  

Vasculitides - a fast diagnostic-therapeutic guide for internistsIn brief

Jakub Videman, Martina Skácelová, Pavel Horák

Vnitr Lek 2026, 72(4):268-274 | DOI: 10.36290/vnl.2026.052  

Vasculitides represent a broad group of diseases characterized by inflammatory involvement of the vessel wall. Primary vasculitides are categorized according to the caliber of the affected vessels. Symptoms of primary vasculitides are significantly heterogeneous and vasculitides should be included in a broader differential diagnostic consideration of many clinical scenarios. The diagnosis of vasculitides is usually challenging, based on the synthesis of clinical, laboratory, and radiographic findings, evidence of organ damage, and often requiring biopsy verification. A wide range of immunosuppressive agents is used in therapy. Oftentimes, the possibility...

OsilodrostatPharmacological profile

Michal Kršek, Marta Šimůnková

Vnitr Lek 2026, 72(4):262-266 | DOI: 10.36290/vnl.2026.051  

Cushing's syndrome (CS) is a disease caused by excessive autonomous production of cortisol and its effects on cells, tissues and organs of the human body. The clinical feature of CS is very complex and directly threatens the lives of its carriers. Morbidity and mortality of patients with active CS is up to four times higher than in the reference population, mainly due to cardiovascular causes, but patients are at risk of a number of other complications. In addition, there is evidence that increased morbidity and mortality persist for many years even after successful treatment. Treatment of CS must be early and comprehensive. In all situations with...

Combined heme and nonheme iron: a detailed perspective on their synergy, biology, and significance based on new in vitro evidenceGood advice

Jiří Slíva

Vnitr Lek 2026, 72(4):256-260 | DOI: 10.36290/vnl.2026.050  

Combining heme and nonheme iron represents a promising strategy capable of overcoming the limitations of conventional nonheme iron supplements. New in vitro evidence demonstrates that such formulations not only enhance iron absorption but also preserve and stabilise intestinal barrier integrity, supporting improved safety and tolerability. They concomitantly activate both major iron transport pathways, DMT1 and HCP1, while promoting intracellular metabolic handling through ferritin and ferroportin. These synergistic mechanisms explain the significantly higher bioavailability observed with combined formulations compared with traditional soluble iron...

Primary aldosteronism: A review of the 2025 American-European Endocrine Society Clinical Practice GuidelinesReview articles

Zdeněk Ramík, Libor Jelínek, Monika Beliančinová, Martin Ráchela, Jiří Vrtal, Josef Dodulík, Tomáš Kvapil, Jan Václavík

Vnitr Lek 2026, 72(4):247-254 | DOI: 10.36290/vnl.2026.049  

Primary aldosteronism represents a common and clinically important cause of secondary hypertension, the diagnosis and management of which have undergone substantial advances in recent years. The updated 2025 Endocrine Society clinical practice guidelines provide a structured framework for screening, laboratory diagnostics, disease confirmation, subtyping, and the selection of targeted therapy. Particular emphasis is placed on the expansion of screening indications, standardization of aldosterone-to-renin ratio interpretation with regard to the analytical method used, clinical stratification of patients according to the probability of lateralized aldosterone...

Mineral and bone disorder in chronic kidney disease (CKD-MBD): a practical perspective for the internistReview articles

Kateřina Oulehle, Jan Vachek, Oskar Zakiyanov, Martin Jedlička, Richard Pikner, Vladimír Tesař

Vnitr Lek 2026, 72(4):240-246 | DOI: 10.36290/vnl.2026.048  

disorders of mineral and bone metabolism in chronic kidney disease (CKD-MBD) represent a complex systemic syndrome involving dysregulation of calcium, phosphorus, parathyroid hormone (PTH), vitamin D, and fibroblast growth factor 23 (FGF23) metabolism, disturbances of bone remodeling and mineralization, and extraskeletal-particularly vascular and valvular-calcifications. Understanding of this issue has undergone a fundamental transformation: from an isolated perception of secondary hyperparathyroidism, through the concept of renal osteodystrophy, to the current integrated view that also includes osteoporosis, cardiovascular risk, and the overall clinical...

MASLD and its lean phenotypeMain topic

Kateřina Janstová, Denisa Kyselová, Pavel Trunečka

Vnitr Lek 2026, 72(4):232-239 | DOI: 10.36290/vnl.2026.047  

Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most common chronic liver disease, with a global prevalence of 30-40%. Although it is typically associated with obesity and metabolic syndrome, a significant and often overlooked group of patients consists of individuals with normal body weight, referred to as the lean phenotype of MASLD. These individuals account for approximately 5-20% of MASLD patients, and their disease is often diagnosed only at advanced stages. The pathogenesis is complex and involves combination of genetic predisposition, visceral adiposity, insulin resistance, and sarcopenia. Despite having a normal body...

Acute pancreatitis: a practical update through the eyes of young gastroenterologistsMain topic

Martin Kyselý, Štěpán Šembera

Vnitr Lek 2026, 72(4):224-230 | DOI: 10.36290/vnl.2026.046  

Background: Acute pancreatitis (AP) is one of the most frequent gastrointestinal diseases with a steadily increasing incidence. Despite declining mortality, clinical practice remains burdened by outdated management strategies not aligned with current evidence. Aim: To provide a practical and up-to-date overview of the diagnosis, classification and management of acute pancreatitis for internal medicine physicians, highlighting recent paradigm shifts in clinical practice. Methods: This narrative review is based on current international guidelines (2025) and recommendations of professional societies. It summarizes contemporary evidence on etiology, diagnostic...

Inflammatory bowel diseases - current situation in the Czech Republic and future perspectivesMain topic

Václav Štěpánek, Martin Bortlík

Vnitr Lek 2026, 72(4):215-223 | DOI: 10.36290/vnl.2026.045  

Crohn's disease and ulcerative colitis belong to chronic inflammatory conditions (IBD) with increasing prevalence. In the Czech Republic, the current prevalence reaches 1%. Both conditions require long-term medical therapy that consists of conventional and advanced drugs (biologics and small molecules). Advanced therapy is more effective and safer compared to conventional drugs and should be preferred in patients with moderate to severe disease. In the Czech Republic, IBD patients with advanced drugs are enrolled into the registry called CREdIT. The proportion of such patients is, however, low compared to most developerd countries in the Europe. On...

Oncological screening in gastroenterology and hepatologyMain topic

Jan Křivinka, Přemysl Falt, Barbora Pipek, Ondřej Urban

Vnitr Lek 2026, 72(4):208-214 | DOI: 10.36290/vnl.2026.044  

Gastrointestinal cancers are among the leading causes of death in the Czech Republic. Screening programs focused on the detection of precancerous lesions and early-stage disease play a crucial role in secondary prevention, as they have been proven to reduce mortality and improve overall survival rates. In this review article, we summarize current epidemiological data, etiopathogenesis and screening diagnostic methods for patients with Barrett's esophagus, colorectal cancer (including patients with inflammatory bowel disease), hepatocellular carcinoma in patients with liver cirrhosis and individuals at risk of developing pancreatic cancer.

Při jaké klidové srdeční frekvenci se zvyšuje riziko kardiovaskulárních příhod u pacientů s diabetem 2. typu? Komentář ke studii Sobieraj et al.: Heart rate and cardiovascular risk in diabetesCommentaries#E-publication

Sabina Kvasnicová, Jan Brož

Vnitr Lek 2026, 72(3):E8-E9 | DOI: 10.36290/vnl.2026.043