Immunosuppression with tacrolimus in kidney transplant recipients aged 65+Review articles#E-publication

Silvie Rajnochová Bloudíčková, Roman Šafránek, Zdeněk Lys, Karel Krejčí, Milan Kuman, Vladimír Hanzal, Ondřej Viklický

Vnitr Lek 2026, 72(3):E5-E7 | DOI: 10.36290/vnl.2026.042  

Although the number of kidney transplant recipients aged 65+ is increasing, clear recommendations regarding immunosuppressive regimens have not yet been clearly defined. Immunosenescence increases the risk of post-transplant complications and adverse drug effects, contributing to a decline in quality of life, non-adherence, increased morbidity and mortality. The optimal strategy to minimize these complications is to take age and sensitization into account when accepting and allocating donors in order to limit the use of depletion induction therapy and utilize maintenance immunosuppression with lower toxicity.

Diabetic ketoacidosis and hypophosphatemiaReview articles#E-publication

Ondřej Lukáč, Ondřej Hloch, Nikola Stieranková, Juraj Michalec, Martin Wasserbauer, Jan Brož

Vnitr Lek 2026, 72(3):E1-E4 | DOI: 10.36290/vnl.2026.041  

Hypophosphatemia is a common but generally underestimated electrolyte abnormality associated with diabetic ketoacidosis (DKA) that can cause serious clinical complications. Monitoring and, if necessary, supplementation of phosphate levels should be an integral part of the care of patients with diabetic ketoacidosis, although routine supplementation is not currently recommended.

Hlavní téma – Novinky v léčbě alergie, astmatu a poruch imunityEditorial

doc. MUDr. Tomáš Milota, Ph.D.

Vnitr Lek 2026, 72(3):139  

Musculoskeletal pain - osteoporosis, or non-specific back pain?Good advice

Vlasta Tošnerová

Vnitr Lek 2026, 72(3):193-196 | DOI: 10.36290/vnl.2026.040  

Introduction: The question often arises as to how spinal pain is related to osteoporosis, or whether it is mainly non-specific back pain, vertebrogenic algic syndrome. Distinguishing the origin of pain is related to basic clinical specializatiin and the extension field of Rehabilitation and Physical Medicine. Interdisciplinary, it is appropriate, in addition to laboratory and imaging methods, which are related to basic fields, to supplement the examination with active range of motion, passive range of motion and range of motion to the segment in addition to a structured history. Palpation of muscles, fascia, skin, subcutaneous tissue and periosteal...

Pancreatic panniculitis - a cutaneous manifestation of pancreatic diseaseCase reports

David Solil, Petr Dítě, Radek Kroupa, Michal Šenkyřík, Martin Harazim, Petr Litzman, Klára Bochníčková, Jan Šlapák, Milan Dastych, Jiří Dolina

Vnitr Lek 2026, 72(3):189-192 | DOI: 10.36290/vnl.2026.039  

Pancreatic panniculitis is a rare cutaneous manifestation of pancreatic disease, characterized by painful erythematous nodules predominantly affecting the lower extremities, resulting from the release of pancreatic enzymes into subcutaneous tissue and subsequent fat necrosis. It is most commonly associated with acute pancreatitis but may also occur in the setting of pancreatic malignancy. In some cases, it represents the first clinical manifestation of previously asymptomatic pancreatic disease. This article provides an overview of pancreatic panniculitis, inspired by a case report from our institution.

The relationship between atrial fibrillation and dementiaReview articles

Petra Kratochvílová

Vnitr Lek 2026, 72(3):183-186 | DOI: 10.36290/vnl.2026.038  

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia worldwide and currently affecting approximately 2-4 % of the population. Its prevalence continues to rise, and by around 2050, the number of patients with AF is expected to approach 100 million (1). Dementia currently affects 5-7 % of individuals over the age of 60, and its prevalence is projected to triple by 2050 (2). This disease leads to loss of independence, increased need for long-term care, and higher overall mortality. In recent years, accumulating evidence has suggested an association between AF and an increased risk of cognitive decline and dementia. The aim of this...

Primary aldosteronism: diagnosis and treatment in clinical practiceReview articles

Ondřej Petrák

Vnitr Lek 2026, 72(3):176-182 | DOI: 10.36290/vnl.2026.037  

Primary aldosteronism is the most common cause of secondary endocrine hypertension, with a prevalence of 5-14% among hypertensive patients. It is caused by autonomous aldosterone overproduction from the adrenal cortex, leading to sodium retention and the development of hypertension, often accompanied by significant hypokalemia. Compared with essential hypertension, primary aldosteronism is associated with an increased cardiovascular and renal risk, independent of blood pressure levels. This article provides a concise overview of the pathophysiology, clinical manifestations, and complications of primary aldosteronism and focuses on a practical diagnostic...

Hypolipidemic therapy in pregnancyMain topic

Pavla Jadrníčková, Jan Václavík, Filip Dubský

Vnitr Lek 2026, 72(3):171-175 | DOI: 10.36290/vnl.2026.036  

Pregnancy is accompanied by significant metabolic adaptations, including a physiological increase in lipid levels, particularly low-density lipoprotein cholesterol (LDL-C), a causal risk factor for cardiovascular disease. Elevated LDL-C exposure during gestation, especially in women with familial hypercholesterolemia (FH), contributes to lifelong cardiovascular risk. Although atherosclerotic coronary artery disease is rare in women of reproductive age, pregnancy in the fourth and fifth decades of life is becoming increasingly common and is associated with a higher prevalence of acute myocardial infarction during pregnancy. This review summarizes current...

Advances in immuno-oncologyMain topic

Zuzana Ozaniak Střížová

Vnitr Lek 2026, 72(3):165-170 | DOI: 10.36290/vnl.2026.035  

Immunotherapy has emerged over the past decade as a central modality in the treatment of many malignancies, representing a fundamental shift from conventional therapeutic approaches toward strategies that harness the patient's immune system. It is no longer considered merely an adjunctive option used after the failure of other therapeutic modalities; rather, in selected indications, it constitutes a first-line treatment. A thorough understanding of the tumor microenvironment and tumor immunogenicity is a key factor influencing treatment efficacy. The following sections provide a detailed overview of the main types of immunotherapy, including nonspecific...

Secondary antibody deficiency - novel diagnostic and therapeutic approachesMain topic

Tomáš Milota

Vnitr Lek 2026, 72(3):158-164 | DOI: 10.36290/vnl.2026.034  

Secondary antibody immunodeficiencies (SAD) are a heterogeneous group of diseases of acquired immune disorders that arise under broad spectrum of internal and external factors. Unlike primary antibody immunodeficiencies, they are often accompanied by multiple components of the immune system being affected, either within the disease itself or as a result of its treatment. The picture is often accompanied by neutropenia, lymphopenia, hypocomplementemia, etc. According to etiology, SAD can be divided into loss hypogammaglobulinemia and SAD associated with impaired antibody production. We assess the total levels of immunoglobulins and specific antibodies...

Recent advances in primary immunodeficienciesMain topic

Ondřej Vladyka, Katarína Simonová, Martin Orlický, Adam Klocperk

Vnitr Lek 2026, 72(3):151-157 | DOI: 10.36290/vnl.2026.033  

The article summarises key recent developments in the field of primary immunodeficiencies, now preferentially referred to as inborn errors of immunity (IEI). It is based on the current International Union of Immunological Societies (IUIS) classification, which reflects the rapidly increasing number of described entities, and highlights the shift from an "infection-centred" perspective to a broad spectrum of manifestations including autoimmunity, allergy, autoinflammation, and malignancies. Using selected examples of newly described conditions, it illustrates phenotypic diversity and diagnostic challenges, including incomplete penetrance, mosaicism,...

Advances in asthma treatmentMain topic

Tomáš Slisz

Vnitr Lek 2026, 72(3):148-150 | DOI: 10.36290/vnl.2026.032  

This review summarizes the latest GINA 2025 recommendations, focusing on updated diagnostic criteria, particularly in pediatric patients, the role of biomarkers such as FeNO and blood eosinophils, and modern therapeutic strategies. Special emphasis is placed on the anti-inflammatory reliever concept, which promotes the use of low-dose ICS-formoterol as needed across all severity steps. The article also reviews recent developments in biologic therapy, including expanded indications for dupilumab, the use of tezepelumab across asthma phenotypes, and the emerging role of long-acting agents such as depemokimab. Environmental factors influencing disease...

Recent advances in biologic therapy of allergic diseasesMain topic

Mojmír Račanský

Vnitr Lek 2026, 72(3):144-147 | DOI: 10.36290/vnl.2026.031  

Allergic diseases are showing a continuously rising prevalence worldwide. It is estimated that 20-40 % of the global population suffer from some form of allergic condition. According to data from the World Allergy Organization affiliated with the World Health Organization, roughly one in five people are affected. The severity of allergic diseases varies. However, all forms impact the daily lives of those affected - from seasonal allergic rhinitis, through various manifestations of atopic dermatitis and food allergies, to severe bronchial asthma. Severe forms of allergic diseases considerably diminish patients' quality of life. Their management is challenging...

Valve-in-valve transcatheter implantation of a valve replacement in the mitral position using the LAMPOON techniqueCase reporty#E-publication

Beáta Šoltésová, Zuzana Hlubocká, Tomáš Bouček, Tomáš Kovárník, David Zemánek

Vnitr Lek 2026, 72(2):E7-E11 | DOI: 10.36290/vnl.2026.028  

Over the last ten years, there has been a significant progression in the possibilities of trascatheter intervention on the mitral valve, both on the native valve and on bioprostheses. Although surgical treatment of mitral defects currently prevails, transcatheter mitral valve replacement is mainly used in patients with a high surgical risk or in patients with valve replacement with a bioprosthesis in whom reoperation is no longer possible. Transcatheter implantation of a bioprosthesis into the mitral position has its specifics and complications. One of the possible complications is the formation of a significant obstruction in the outflow tract of...

Reassessing the SIBO-Hypertension Link in Symptomatic PatientsOriginal articles#E-publication

Pavol Fülöp, Lívia Szczygieľová, Štefan Tóth, Tibor Porubän, Mariana Dvorožňáková, Natália Vaňová

Vnitr Lek 2026, 72(2):E1-E6 | DOI: 10.36290/vnl.2026.027  

Background: Recent evidence suggests small intestinal bacterial overgrowth (SIBO) may serve as a diagnostic marker for hypertension through gut-cardiovascular axis mechanisms. However, this relationship has not been evaluated in symptomatic gastrointestinal patients. We aimed to assess the association between SIBO and arterial hypertension in patients undergoing clinical evaluation for gastrointestinal symptoms. Methods: Retrospective cross-sectional analysis of 331 consecutive symptomatic patients (263 controls, 68 with hypertension) who underwent hydrogen breath testing. SIBO was diagnosed using North American Consensus criteria (H₂ rise ≥20...

Hlavní téma – novinky v kardiologiiEditorial

MUDr. Michael Jenšovský

Vnitr Lek 2026, 72(2):71  

RECENZE KNIHY Etika a komunikace v medicíněReview

Prof. MUDr. Jan Škrha, DrSc.

Vnitr Lek 2026, 72(2):133  

Zmírnění příznaků i projevů chronického žilního onemocnění všech stadií při užívání mikronizované purifikované flavonoidní frakce - metaanalýza 56 studiíCommentaries

MUDr. Zuzana Zafarová

Vnitr Lek 2026, 72(2):127-132  

AI audio processing transforms healthcareAI in medicine and health care

Jan Rychtar

Vnitr Lek 2026, 72(2):123-126 | DOI: 10.36290/vnl.2026.026  

Artificial intelligence is revolutionizing audio processing in healthcare. The article presents key applications: ambient AI scribe systems automatically generate medical documentation from doctor-patient conversations, saving hours of work and reducing burnout. Intelligent voicebots streamline phone communication in clinics. In diagnostics, AI analyzes cough sounds to detect respiratory diseases, while digital stethoscopes recognize heart murmurs with accuracy exceeding that of typical physicians. Voice analysis reveals signs of Parkinson's disease, Alzheimer's dementia, and depression. Smartphone applications enable sleep apnea screening from nighttime...

Fixed combination of rosuvastatin and perindopril - the next step in cardiovascular disease preventionPharmacological profile

Jiří Vítovec

Vnitr Lek 2026, 72(2):120-122 | DOI: 10.36290/vnl.2026.025  

The combination of a statin and an ACE inhibitor represents a modern therapeutic approach to the simultaneous management of hypercholesterolemia and arterial hypertension - the two main risk factors for cardiovascular disease (CVD). The fixed-dose combination of rosuvastatin and perindopril provides comprehensive prevention of CVD in patients at high or very high risk. This combination offers synergistic effects on blood pressure and lipid levels, and its simplified regimen improves patient adherence. This article summarizes the pharmacological properties of both agents, the rationale and benefits of their fixed combination, clinical indications, and...

Hyperuricemia: Indications for treatment vs. non-treatment according to current guidelinesGood advice

Zdeněk Monhart

Vnitr Lek 2026, 72(2):118-119 | DOI: 10.36290/vnl.2026.024  

Pharmacological treatment of hyperuricemia is indicated in patients with clear clinical manifestations such as gout or nephrolithiasis. Current guidelines do not support pharmacotherapy for asymptomatic hyperuricemia, even in the presence of chronic kidney disease (CKD) or cardiovascular disease.

Spironolactone in the treatment of heart failure and resitant arterial hypertensionReview articles

Filip Málek

Vnitr Lek 2026, 72(2):113-116 | DOI: 10.36290/vnl.2026.023  

Chronic heart failure is clinical syndrome charatcterised by increasing prevalence and unfavorable prognosis. Resistent arterial hypertension increases the risk of cardiovascular events and the risk of death from cardiovascular causes. Both heart failure and resistant arterial hypertension are associated with secondary hyperaldosternism. Spironolactone blocks the adverse effects of aldosterone on the level of its receptors Its efficacy in the indications of heart failure and resistant arterial hypertension is supported by scientific findings, it is also supported by the guidelines from professional societies.Spironolactone reduces mortality and morbidity...

New generation anti-obesity drugs and bone health in postmenopausal womenReview articles

Jana Tomasová Studýnková

Vnitr Lek 2026, 72(2):104-112 | DOI: 10.36290/vnl.2026.022  

Obesity represents a major global medical and socioeconomic challenge. The prevalence of overweight and obesity has increased markedly over the past three decades and currently affects nearly one third of the world's population. Up to 70 % of women experience weight gain during the menopausal transition. Glucagon-like peptide-1 receptor agonists (GLP-1RA) represent an effective pharmacological treatment for overweight and obesity and have become an important therapeutic option across various populations, including peri- and postmenopausal women. Available data suggest that some of these agents may have a beneficial effect on bone mineral density and...

Hypertension in women and menReview articles

Barbora Nussbaumerová

Vnitr Lek 2026, 72(2):99-103 | DOI: 10.36290/vnl.2026.021  

This paper summarizes current knowledge on the epidemiology, diagnosis, treatment, and the potential development of target organ damage in hypertension in women and men, with an emphasis on sex-related differences, based on current clinical guidelines. Women have a lower prevalence of hypertension at a younger age; however, after menopause, prevalence may equal or even exceed that in men. Women with high-normal blood pressure may be more likely to develop hypertension than men. Compared with men, women may be more susceptible to hypertension-related target organ damage, and hypertension in women may be associated with a higher risk of ischemic heart...

What's new in the ESC guidelines for management of valvular heart disease?Main topic

Hana Línková

Vnitr Lek 2026, 72(2):92-96 | DOI: 10.36290/vnl.2026.020  

Valvular heart disease is a major cause of morbidity and mortality, especially in the elderly population. In 2025, updated recommendations from the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS) were published, reflecting the rapid development of transcatheter treatment methods, advances in imaging techniques, and new results from clinical studies. Compared to the recommendations issued in 2021, they mark a further step forward and change clinical practice. This mainly involves shifting interventions to earlier stages of disease development and expanding the role of transcatheter treatment of valve...

Recent advances in the pharmacotherapy of pulmonary arterial hypertensionMain topic

Lucie Miksová, Pavel Jansa

Vnitr Lek 2026, 72(2):86-91 | DOI: 10.36290/vnl.2026.019  

Pulmonary arterial hypertension (PAH) is a rare, progressive, and life-threatening disease characterized by pathological remodeling of the pulmonary vasculature, ultimately leading to right ventricular failure. Despite substantial advances in diagnostic strategies and therapeutic options over recent decades, the prognosis of patients with PAH remains unfavorable, and a sustained low-risk profile cannot be achieved in a considerable proportion of patients even when treated according to current guideline recommendations. Current PAH-specific pharmacotherapy primarily targets the endothelin, prostacyclin, and nitric oxide-cGMP signaling pathways, with...

Advances in the treatment of acute coronary syndromes - from standardized algorithms to individualized therapyMain topic

Karolína Bartošková, Zuzana Moťovská

Vnitr Lek 2026, 72(2):81-84 | DOI: 10.36290/vnl.2026.018  

Recent years have brought a shift in the management of acute coronary syndromes (ACS) from uniform treatment algorithms towards an individualized, risk-based approach. This strategy integrates ischaemic and bleeding risk assessment, clinical course and patient comorbidities. The most relevant changes concern antithrombotic therapy, including duration and composition of dual antiplatelet therapy, early P2Y12 inhibitor monotherapy and de-escalation strategies. Further developments involve the selective use of mechanical circulatory support in cardiogenic shock and an expanding role of adjunctive pharmacotherapy after myocardial infarction. This review...

Novel therapies for hypertrophic cardiomyopathyMain topic

Michael Jenšovský, Veronika Puchnerová, Jiří Bonaventura, Petr Ošťádal

Vnitr Lek 2026, 72(2):76-80 | DOI: 10.36290/vnl.2026.017  

Hypertrophic cardiomyopathy (HCM) is a genetic disease that requires complex diagnostics and evolving therapeutic options. We present advances in pharmacotherapy of HCM in the year 2025. We focus on the results of trials involving myosin inhibitors and the implications of these studies on daily practice. Additionally, we explore experimental therapies with novel mechanisms of action in different stages of development. Lastly, we describe the current structure of expert centers that care for HCM patients in the Czech Republic.

Zaznělo na XXXII. kongresu České internistické společnosti ČLS JEP, 19.–22. 11. 2025, Brno: 
Autonomní nervový systém a kardiovaskulární léčba: zaměřeno na β-blokátoryInsert

MUDr. Zuzana Zafarová

Vnitr Lek 2026, 72(1)  

Internista a kardiolog profesor Richard Češka se stal šéfem světové interní medicínyLatest from the society#E-publication

prof. MUDr. Michael Aschermann, DrSc.

Vnitr Lek 2026, 72(1):e22-e23