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)  

Aprocitentan - a dual endothelin receptor antagonist for the treatment of resistant arterial hypertensionPharmacological profile #E-publication

Jitka Mlíková Seidlerová

Vnitr Lek 2026, 72(6):E16-E20 | DOI: 10.36290/vnl.2026.079  

Aprocitentan is a dual endothelin receptor inhibitor and a new drug approved in both the U.S. and Europe for the treatment of resistant hypertension. It is distinctive in that it targets a pathophysiological mechanism that is not affected by any existing antihypertensive medications. Unlike first-generation endothelin receptor blockers, it is not metabolized by CYP450 or BcRP, which means a lower risk of drug interactions. Current evidence demonstrates a significant reduction in blood pressure, both clinical and 24-hour, including sustained reductions during the night. In the PRECISION study, the difference in blood pressure reduction in patients treated...

Hematoncology treatment toxicityReview articles#E-publication

Simona Pavúková, Roman Králik, Juraj Payer, Ľuboš Drgoňa

Vnitr Lek 2026, 72(6):E11-E15 | DOI: 10.36290/vnl.2026.078  

Modern anticancer therapy, including conventional chemotherapy, targeted biological treatment, and immunotherapy, has significantly improved survival rates for patients with hematological and oncological malignancies. However, despite their high therapeutic efficacy, these modalities impose a substantial burden on the organism and are associated with a wide spectrum of adverse effects. Among the most frequent and clinically significant complications are hematotoxicity, organ toxicities - particularly cardiotoxicity, pneumotoxicity, and nephrotoxicity - and specific immune-related adverse events. Understanding the underlying mechanisms of these complications,...

Carotid Plaque Score and the Risk of Coronary Artery Disease in Patients with Arterial HypertensionOriginal articles#E-publication

Danka Škultétyová, Slavomíra Filipová, Ján Postulka

Vnitr Lek 2026, 72(6):E6-E10 | DOI: 10.36290/vnl.2026.076  

Introduction: Cardiovascular diseases (CVD) are the most common cause of death in Europe. 2023 European Society of Hypertension Guidelines for the management of arterial hypertension (AH) recommend looking for hypertension-mediated organ damage. Aim: We investigated whether carotid plaque score (CPS) may be useful in diagnostics of coronary artery disease. We analyzed relationships between CPS and the coronary artery calcium score (CACS), as well as with coronary computed tomography angiography (CCTA). Patients and methods: We examined 50 high risk hypertensive patients with an average age of 67±8 years with suspected or confirmed coronary artery...

Changes in diabetes care assessed from the number of HbA1c assays performed during COVID pandemic in SlovakiaOriginal articles#E-publication

Martin Jankovsky, Jozef Lacka, Viktor Oliver Rácz, Petra Ištokovičová, Elena Tibenská, Peter Jackuliak

Vnitr Lek 2026, 72(6):E1-E5 | DOI: 10.36290/vnl.2026.077  

Introduction: In Slovakia during the first two years of COVID-19 pandemic a significant increase of mortality in diabetic patients occurred, which returned near to the initial values in its last stage (2022). Patients with diabetes mellitus need regular assessment of HbA1c. The aim of this study was evaluation of the effect of pandemic on the number of HbA1c measurements performed before (2019), during (2020; 2021), and in the last stage (2022) of pandemic. Methods: 382 803 HbA1c measurements from Medirex Inc. laboratory chain and 23 779 assays from a local laboratory (Cumulus Inc.) were evaluated. Results: The number of HbA1c measurements...

Kardio-reno-metabolické kontinuum: návrat k integrující roli vnitřního lékařstvíEditorial

prof. MUDr. Michal Vrablík, Ph.D.

Vnitr Lek 2026, 72(6):356  

Thiamine deficiency syndromes - case report and overviewCase reports

Jiří Müller, Jaroslav Raděj, Lenka Valešová, Miroslav Kříž, Roman Pavlík, Alena Vondráková, Martin Matějovič

Vnitr Lek 2026, 72(6):413-419 | DOI: 10.36290/vnl.2026.075  

Thiamine (vitamin B1) is a water-soluble vitamin that plays a pivotal role as a cofactor for enzymes involved in energy metabolism. Its deficiency can result in the development of heterogeneous and complex syndromes, primarily characterised by impaired nervous and cardiovascular system. Timely diagnosis and treatment of these potentially life-threatening conditions are often delayed due to the incomplete or atypical clinical presentation and the lack of accessible and reliable methods for determining vitamin B1 levels. The objective of this case report, which details a critically ill female patient with advanced central nervous system involvement,...

Cushing's syndrome: current viewReview articles

Michal Kršek

Vnitr Lek 2026, 72(6):402-411 | DOI: 10.36290/vnl.2026.074  

Cushing's syndrome is a rare endocrine disorder that significantly affects patients and is associated with significantly increased morbidity and mortality, mainly due to cardiovascular disorders and complications. Increased morbidity and mortality persist even many years after the successful cure. Therefore, early diagnosis and treatment are of eminent importance. It is necessary to state that diagnosis and differential diagnosis of Cushing's syndrome belong to the most difficult ones in clinical endocrinology mainly for variable aetiology and also not sufficiently good performance of diagnostic tests. That also pays for the treatment that often has...

Modern treatment of hereditary angioedema due to C1 inhibitor deficiency: from attack control to complete disease controlReview articles

Roman Hakl, Jan Baroš, Jiří Litzman

Vnitr Lek 2026, 72(6):396-400 | DOI: 10.36290/vnl.2026.073  

Hereditary angioedema due to C1 inhibitor deficiency (HAE-C1-INH) is a rare, potentially life-threatening disorder characterized by recurrent episodes of bradykinin-mediated angioedema. In recent years, major advances have been achieved in both the diagnosis and treatment of HAE-C1-INH, particularly due to the development of targeted biological and molecular therapies. The updated 2025 WAO guidelines emphasize an individualized approach, the availability of effective on-demand therapy for all patients, and a treatment strategy aimed at achieving complete disease control. This review article summarizes current therapeutic options for HAE-C1-INH, including...

Sequencing and combination of therapies in the cardiovascular-kidney-metabolic syndrome: GLP-1 RA, SGLT2 inhibitors, lipid-lowering drugs and mineralocorticoid receptor antagonistsMain topic

Michal Dubský

Vnitr Lek 2026, 72(6):388-394 | DOI: 10.36290/vnl.2026.072  

Cardiovascular-kidney-metabolic (CKM) syndrome is a concept introduced by the 2023 consensus statement of the American Heart Association (AHA). It describes an interconnected complex of obesity, type 2 diabetes mellitus (T2DM), dyslipidemia, chronic kidney disease (CKD), and cardiovascular (CV) disease, including heart failure (HF). Current evidence from large randomized trials supports early sequencing and, in appropriately selected patients, combination of several therapeutic classes: SGLT2 inhibitors, glucagon-like peptide-1 receptor agonists (GLP-1 RAs), lipid-lowering therapies (statins, ezetimibe, PCSK9 inhibitors, inclisiran, bempedoic acid),...

Dyslipidemia in cardio-reno-metabolic syndromeMain topic

David Karásek

Vnitr Lek 2026, 72(6):382-387 | DOI: 10.36290/vnl.2026.071  

Cardio-reno-metabolic (CRM) syndrome is a complex disease resulting from the interaction of metabolic disorders, cardiovascular impairment and chronic kidney disease. The basic pathogenetic mechanism is adipose tissue dysfunction leading to insulin resistance, chronic inflammation and vascular dysfunction. A typical laboratory manifestation is atherogenic dyslipidemia characterized by hypertriglyceridemia, reduced HDL-cholesterol and increased small dense LDL particles, often with only slightly increased LDL-cholesterol. Postprandial lipoproteins and residual cholesterol represent a significant cardiovascular risk. The basal therapy of dyslipidemia...

GLP-1 receptor agonists in obesity treatment: where we are today and what can we expect?Main topic

Dita Pichlerová

Vnitr Lek 2026, 72(6):374-381 | DOI: 10.36290/vnl.2026.070  

Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) represent a major breakthrough in the treatment of obesity and type 2 diabetes. Their ability to reduce body weight is well documented, and the outlook for new anti-obesity drugs in the near future is more than positive. Along with a reduction of up to 15-22% of baseline weight with semaglutide and tirzepatide, evidence is growing for a wide range of metabolic, cardiovascular, liver, kidney, and neurobiological effects that are independent of weight loss itself. This review article summarizes current clinical and preclinical knowledge about the pleiotropic effects of GLP-1 RAs, with a focus on the...

The role of SGLT2 inhibitors in outpatient cardiology practiceMain topic

Petra Buděšínská

Vnitr Lek 2026, 72(6):364-372 | DOI: 10.36290/vnl.2026.069  

The article discusses the beneficial effects of sodium-glucose cotransporter 2 (SGLT2) inhibitors (gliflozins) on the kidneys and the heart, thereby slowing the progression of pathophysiological processes underlying heart failure and chronic kidney disease, which may ultimately lead to cardiorenal syndrome. Early diagnosis of these processes through interdisciplinary cooperation among internal medicine specialties, with a focus on biomarkers of heart failure and renal impairment, including NT-proBNP, eGFR, and albuminuria, enables timely initiation of treatment with these drugs.

SGLT2 inhibitors in cardiology, nephrology, and diabetes care: who should take them, how to start treatment, and when to discontinueMain topic

Jan Škrha

Vnitr Lek 2026, 72(6):360-363 | DOI: 10.36290/vnl.2026.068  

SGLT2 inhibitors, also known as gliflozins, were originally developed as oral antidiabetic agents with mild diuretic and glycosuric effects; they have gradually become a cornerstone of treatment for heart failure and chronic kidney disease, regardless of the presence of diabetes. This article aims to summarize the current status of SGLT2i across internal medicine specialties, define the optimal patient for their use, and provide practical guidance for their safe management, with particular emphasis on perioperative care.

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...