Národní program komplexní interní péčeSupplement

Redakce

Vnitr Lek 2025, 71(Suppl.A)  

Suspected pellagra in a patient treated with azathioprine for Crohn's diseaseCase reporty#E-publication

Pavel Polák, Michal Řiháček, Andrea Wagnerová, Alexandr Trunečka, Petra Adamczyk, Dalibor Váhala

Vnitr Lek 2025, 71(8):E22-E27 | DOI: 10.36290/vnl.2025.100  

Pellagra is a disease due to nutritional deficiency of niacin (vitamin B3). The main causes include nutritionally poor diet or impaired intestinal absorbtion. Other risk factors represent alcohol abuse, idiopathic bowel disease and immunosuppressive and antituberculotic treatment. Dermatitis, diarrhoea and dementia (3D) are characteristical clinical signs, untreated disease may lead to the death. The diagnosis is based on typical clinical signs which subside quickly after niacin supplementation. The authors present a clinical case of a patient with Crohn´s disease treated with azathioprine, who was acutely hospitalized for community-onset pneumonia,...

Current trends in pharmacotherapy of overweight and obesityReview articles#E-publication

Anna Ürgeová, Miriam Kozárová

Vnitr Lek 2025, 71(8):E14-E21 | DOI: 10.36290/vnl.2025.099  

Obesity is a chronic, progressive, often relapsing disease with numerous metabolic, physical, and psychological complications. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have emerged as a pivotal therapeutic class in the management of type 2 diabetes mellitus (T2DM), demonstrating remarkable efficacy not only in glycemic control, but also in weight reduction. GLP-1RAs act as incretin mimetics, i.e. enhancers of the incretin effect. GLP-1, an incretin hormone secreted from the gut after food intake, stimulates insulin release from pancreatic islet β-cells in a glucose-dependent manner. The incretin effect is often impaired in patients...

Potential of Glucagon-like peptide-1 receptor agonists (GLP1a) and Sodium-Glucose Co-transporter-2 inhibitors (SGLT2i) in the treatment of MASLDOriginal articles#E-publication

Anna Török Zapletalová, Boris Focko, Martin Jozef Péč, Daniel Ján Havaj, Ľubomír Skladaný, Emil Martinka, Peter Galajda

Vnitr Lek 2025, 71(8):E7-E13 | DOI: 10.36290/vnl.2025.098  

Objectives: In type 2 diabetics, MASLD has a prevalence of 65.33%. DM2 itself is a risk factor for disease progression. GLP-1 receptor agonists (GLP1a) and SGLT2 inhibitors (SGLT2i) have shown significant cardioprotective and hypoglycemic effects. Their potential in the treatment of MASLD is currently being investigated. The aim of our pilot prospective observational study was to determine the prevalence of MASLD in a sample of hospitalized patients with DM2 and to evaluate the impact of GLP1a and SGLT2i on hepatic steatosis and fibrosis. Material and method: 112 hospitalized patients with DM2 and MASLD were included in the study. The presence of steatosis...

Atrial Fibrillation at the Internal Medicine Department of the Regional Hospital in Frýdek-Místek in 2023Original articles#E-publication

Iveta Ožanová, Tomáš Svoboda, Kamil Zeman

Vnitr Lek 2025, 71(8):E1-E6 | DOI: 10.36290/vnl.2025.097  

Introduction: Atrial fibrillation (AF) is the most common supraventricular arrhythmia, with a prevalence that increases significantly with age and is associated with reduced quality of life, higher morbidity, and mortality. On internal medicine wards, patients with AF represent a substantial proportion of hospitalizations, and it is essential not only to manage the acute condition but also to establish an optimal long-term treatment strategy. Aim: To evaluate the demographic characteristics of the patient cohort, the chosen treatment strategy, and its outcomes. Methods and patient cohort: A retrospective analysis of patients with AF hospitalized at...

Hlavní téma – diabetologieEditorial

prof. MUDr. David Karásek, Ph.D.

Vnitr Lek 2025, 71(8):479  

Why might it be appropriate to replace rosuvastatin with atorvastatin in patients with chronic kidney disease?Good advice

Kryštof Rückl

Vnitr Lek 2025, 71(8):535-541 | DOI: 10.36290/vnl.2025.096  

Despite excellent mortality data, rosuvastatin does not appear to be a suitable hypolipidemic agent in patients with chronic kidney disease due to the risk of rhabdomyolysis and direct tubulotoxicity. As part of nephroprotection, it seems appropriate to replace rosuvastatin with atorvastatin in patients at risk because atorvastatin has a similar hypolipidemic action and it has been documented as nephroprotective agent. When using rosuvastatin, the need for dose reduction adjusted to glomerular filtration rate is often not respected, which is documented in a small review of cases of acute kidney injury in rhabdomyolysis recorded from a district hospital...

Mirikizumab in the therapeutic portfolio for inflammatory bowel diseasesPharmacological profile

Jan Šťovíček

Vnitr Lek 2025, 71(8):530-534 | DOI: 10.36290/vnl.2025.095  

Mirikizumab is a newly available biologic that expands the range of targeted therapies for inflammatory bowel disease. As a selective inhibitor of interleukin 23, it demonstrates beneficial effects in patients with ulcerative colitis and Crohn's disease, particularly in those who have not responded to previous treatment. Clinical studies indicate a favorable efficacy and safety profile, supporting its inclusion in current therapeutic strategies. This review summarizes existing knowledge on the mechanism of action, key clinical trial findings, and practical considerations related to the use of mirikizumab in the management of intestinal inflammation.

Acute liver failure after unprofessional indication for albendazoleCase reports

Helena Laurinová

Vnitr Lek 2025, 71(8):525-527 | DOI: 10.36290/vnl.2025.094  

Albendazole is a used medication for parasitic diseases and is generally accepted as a safe drug. It may cause asymptomatic transient liver enzyme abnormalities but manifestation of toxic damage is very rare. This case study presents the case of a middle-aged female patient evaluated for suddenly developed acute liver failure caused by several days of administration of higher doses of albendazole. The aim of the case report is to highlight that even potentially safe drugs can lead to serious adverse effects such as drug-induced liver injury (Drug induced liver injury, DILI).

Angioedema as an adverse effect of treatment with various drugsReview articles

Jan Baroš, Roman Hakl, Sáva Pešák, Zita Chovancová

Vnitr Lek 2025, 71(8):517-523 | DOI: 10.36290/vnl.2025.093  

Angioedema is an intermittent and localized swelling of the deeper layers of the skin or mucous membranes. The most important mediators involved in its development are bradykinin and histamine. The latest classification (known as DANCE) distinguishes five types of angioedema. Drug-induced angioedema forms a separate group. The most significant drug classes causing angioedema include angiotensin-converting enzyme inhibitors (ACEIs), angiotensin receptor-neprilysin inhibitors (ARNIs), nonsteroidal anti-inflammatory drugs (NSAIDs), and tissue plasminogen activators (tPAs). Although the exact mechanism responsible for the development of angioedema in these...

Unrealized potential of innovative therapies for type 2 diabetes - the economic burden of preventable cardiorenal complicationsMain topic

Tomáš Doležal, Klára Lamblová, Kateřina Chadimová, Barbora Decker, Bohdana Kubešová, Iva Piljarová, Klára Koubková, Michal Kostern, Anastasie Halas

Vnitr Lek 2025, 71(8):509-515 | DOI: 10.36290/vnl.2025.092  

In the Czech Republic, the prevalence of type 2 diabetes is significantly increasing. For the future sustainability of treatment costs related to complications, timely treatment based on evidence-based medicine and in accordance with clinical guidelines is essential. The current consensus on type 2 diabetes treatment focuses not only on glycemic and weight control but primarily on reducing cardiorenal risk using modern drug classes with sufficient evidence - GLP-1 receptor agonists and SGLT2 inhibitors. An analysis of administrative patient data from 81,204 insured individuals of the health insurance companies OZP, RBP, and ZPS, who had the E11 (type...

Cardio-renal-metabolic syndrome and its management in clinical practiceMain topic

Martin Šatný

Vnitr Lek 2025, 71(8):502-507 | DOI: 10.36290/vnl.2025.091  

Cardio-reno-metabolic syndrome (CRM syndrome) is an umbrella term linking metabolic, kidney, and cardiovascular diseases, resulting from the complex interaction of insulin resistance, chronic inflammation, activation of neurohumoral systems, and maladaptive organ responses. Epidemiological data clearly show its high prevalence and significant contribution to global morbidity and mortality. The following text summarizes the current evidence on CRM syndrome, with an emphasis on pharmacotherapy with simultaneous cardiovascular and kidney benefits, particularly SGLT2 inhibitors, GLP-1 receptor agonists, renin-angiotensin-aldosterone inhibitors, mineralocorticoid...

Immune-mediated diabetes mellitus induced by checkpoint inhibitors: case reports and clinical overview for internistsMain topic

Martina Tuháčková, Jan Brož

Vnitr Lek 2025, 71(8):498-501 | DOI: 10.36290/vnl.2025.090  

Immune checkpoint inhibitors (ICIs) represent a major advancement in the treatment of solid tumors, but their use carries the risk of immune-related adverse events (irAEs). Among the rare but clinically significant irAEs is insulin-dependent diabetes mellitus (ICI-DM), which shares features with type 1 diabetes. This article presents two case reports of patients who developed ICI-DM during anti-PD-1 therapy (nivolumab, pembrolizumab). The first case involved acute onset of ICI-DM with diabetic ketoacidosis, positive autoantibodies, and concurrent autoimmune hepatitis. The second patient, with pre-existing type 2 diabetes, initially presented with hyperglycemia;...

Pancreatic cancer and diabetes mellitusMain topic

Jan Křivinka, Petr Dítě, Beatrice Mohelníková Duchoňová, Ondřej Urban, Lumír Kunovský

Vnitr Lek 2025, 71(8):490-496 | DOI: 10.36290/vnl.2025.089  

Pancreatic cancer (PC) is one of the most lethal malignancies with increasing incidence. Diabetes mellitus (DM) is a common condition that shares multiple pathophysiological links with pancreatic cancer. New-onset diabetes may represent an early manifestation of pancreatic cancer, whereas long-standing diabetes slightly increases its risk. Recognizing features of paraneoplastic diabetes is essential in clinical practice. This article reviews current knowledge on the PC-DM relationship, emphasizing diagnostic and therapeutic implications.

Endocrine disruptors and diabetes mellitusMain topic

Michaela Svojtková, Lucie Kolátorová, Jana Vítků

Vnitr Lek 2025, 71(8):484-488 | DOI: 10.36290/vnl.2025.088  

The incidence of diabetes mellitus of all types has been increasing in recent years. At the same time, the number of anthropogenic chemicals in the environment that can influence the endocrine system is increasing. These substances are called endocrine disruptors (EDs) and their effects on endocrine-active organs are intensively studied. The relationship between ED and diabetes mellitus is a current topic of research. This review presents the current state of knowledge about the role of ED in all types of diabetes and the possible late consequences of their exposure during development. It also briefly discusses a basic overview of endocrine disruptors,...

Diagnosis and therapy of hepatitis B virus infection: Czech national guidelinesGuidelines#E-publication

Petr Husa, Jan Šperl, Petr Urbánek, Soňa Fraňková

Vnitr Lek 2025, 71(7):E13-E29 | DOI: 10.36290/vnl.2025.086  

The new recommendations reflect the increase in knowledge that has been reported since the release of previous Czech guidelines in September 2017. The base for these guidelines were European Association for the Study of the Liver (EASL) guidelines from May 2025. According to qualified estimates, there are 254 million people with chronic hepatitis B (HBV) infection worldwide. The Czech Republic is among the countries with a low prevalence of HBV infection. HBV infection can cause serious, life-threatening liver damage - fulminant hepatitis, liver cirrhosis, and hepatocellular carcinoma (HCC). The main goal of treatment is to prolong life and improve...

Endovascular method of arteriovenous fistula creationReview articles#E-publication

Katarína Tokarčíková, Ján Tokarčík, Tibor Varga ml., Ondrej Zahornacký

Vnitr Lek 2025, 71(7):E7-E12 | DOI: 10.36290/vnl.2025.085  

Arteriovenous fistulas are considered the preferred vascular access for patients requiring long-term hemodialysis. Their excellent patency, combined with low rates of infection and reintervention compared to central venous catheters and arteriovenous grafts, makes them the ideal access option for many patients with end-stage renal failure. The traditional method of creating arteriovenous fistulas is surgical. The development of two systems - WavelinQ™ (Becton, Dickinson and Company; Franklin Lakes, NJ) and Ellipsys® (Medtronic, Minneapolis, MN) - has led to a minimally invasive endovascular method of creating arteriovenous fistulas. Given...

Drug-Drug interaction between rivaroxaban and amiodarone: A systematic reviewOriginal articles#E-publication

Pavol Fülöp, Štefan Tóth2, Tibor Porubän3, Zuzana Fülöpová4, Mariana Dvorožňáková

Vnitr Lek 2025, 71(7):E1-E6 | DOI: 10.36290/vnl.2025.087  

Background: The concurrent use of rivaroxaban and amiodarone in cardiovascular patients raises concerns about potential drug-drug interactions and increased bleeding risk. Objective: This systematic review aimed to evaluate the impact of combining amiodarone with rivaroxaban on bleeding events compared to rivaroxaban monotherapy in cardiovascular patients. Methods: We systematically reviewed observational studies and clinical trials examining bleeding outcomes in patients receiving rivaroxaban with or without concurrent amiodarone therapy. Studies were included if they reported clinical bleeding outcomes, included both combination therapy and monotherapy...

Hlavní téma – klinická nefrologieEditorial

prof. MUDr. Josef Zadražil, CSc.

Vnitr Lek 2025, 71(7):403  

Evaluation of the effect of allergen immunotherapy for practiceGood advice

Jiří Nevrlka

Vnitr Lek 2025, 71(7):468-472 | DOI: 10.36290/vnl.2025.084  

Specific allergen immunotherapy represents an effective treatment modality for respiratory allergies with the potential for sustained effects persisting many years after cessation of therapy. To achieve this long-term benefit, it is administered continuously for a minimum of 3 years or repeatedly in pre/co-seasonal regimens. Proper and early evaluation of its efficacy after the first year or season of treatment is crucial for the identification of non-responders, optimization of care, and minimization of unnecessary costs. The assessment of allergen immunotherapy efficacy and its standardization are addressed in the European Academy of Allergy and...

Our first experience with caplacizumab in TTPCase reports

Eva Drbohlavová, Kristýna Datinská

Vnitr Lek 2025, 71(7):462-467 | DOI: 10.36290/vnl.2025.083  

Thrombotic thrombocytopenic purpura (TTP) is a rare disease with high mortality. Its prognosis depends on early diagnosis and timely initiation of treatment when there is reasonable suspicion of this disease. Until 2021, the gold standard was a combination of immunosuppression and therapeutic plasma exchange (TPE) (1,2). Caplacizumab is now available as a first-line treatment, significantly changing the rate of therapeutic response in patients with acquired TTP (3-5). The case of our patient demonstrates how early initiation of treatment with caplacizumab, together with immunosuppression and TPE, brought her back to life.

Barriers to smoking cessation in patients with diabetes mellitusReview articles

Marika Koželuhová, Jana Malinovská, Natália Michalcová, Sofia Talalaievska, Jan Brož

Vnitr Lek 2025, 71(7):456-460 | DOI: 10.36290/vnl.2025.082  

Although the prevalence of smoking is lower among people with diabetes mellitus (DM) than in the general population, it remains an important issue that requires targeted smoking-cessation interventions. Smoking worsens metabolic control, increases insulin resistance, and accelerates the progression of both macrovascular and microvascular complications. The treatment of tobacco dependence in patients with DM is complicated by specific barriers, including lack of knowledge about the effects of smoking on DM, concerns about weight gain, psychological burden associated with the disease, and the risk of glycemic variability. Effective treatment combines...

Hypersensitivity pneumonitis: a comprehensive overview of pathogenesis, diagnostics and therapeutic optionsReview articles

Martina Doubková

Vnitr Lek 2025, 71(7):451-455 | DOI: 10.36290/vnl.2025.081  

Hypersensitivity pneumonitis, formerly known as extrinsic allergic alveolitis, is an immune-mediated interstitial lung disease triggered by repeated inhalation of organic or inorganic antigens. Current classification distinguishes between non-fibrotic and fibrotic forms, with the fibrotic phenotype associated with worse outcomes. Diagnosis requires a multidisciplinary approach. Management is based on antigen avoidance, with glucocorticoid therapy cosiderec in symptomatic patients; antifibrotic treatment may be appropriate for progressive fibrotic diseasse. Early diagnosis and identification of the causative antigen remain crucial for optimizing patient...

Risk of gastrointestinal bleeding with oral anticoagulants: actual review and influencing factorsReview articles

Antonín Bartusek, Radek Kroupa

Vnitr Lek 2025, 71(7):443-450 | DOI: 10.36290/vnl.2025.080  

Gastrointestinal bleeding is the most common bleeding complication in users of oral anticoagulants and is associated with significant morbidity and mortality. Warfarin is gradually being replaced by direct thrombin inhibitors (dabigatran etexilate) and factor Xa inhibitors (rivaroxaban, apixaban, and edoxaban). Total number of users of all oral anticoagulants increased by 60% during last 10 years. Conclusions from early randomized controlled trials showed a 23-60 % higher risk of gastrointestinal bleeding in users of direct oral anticoagulants compared to warfarin. Recent meta­‑analyses and observational studies from real­‑world clinical...

Dual effect of keto amino acids and SGLT2 receptor inhibitors in seniors with chronic kidney disease: three years clinical monitoringReview articles

Vladimír Teplan, Naděžda Petejová, Ivo Valkovský

Vnitr Lek 2025, 71(7):432-440 | DOI: 10.36290/vnl.2025.079  

In last decades, there is growing number of seniors over 65 years with chronic kidney disease (CKD). Beside of development in technology of dialysis and kidney transplantation there is a lot of patients who are not indicated for succefull management in dialysis - transplantation programme due to serious other organ damages. In our previous studies we have confirmed long-term effectivity of conservative management of CKD 3b-4 on modified low-protein diet (LPD) supplemented with keto amino acids (KA) in old patients over 80 years. In last decade, there were published very important studies supporting protective effect of SGLT2 receptor inhibitors (dapagliflozin...

Indications, efficacy, and safety of NOACs in patients with CKDMain topic

Marie Vanková, Kateřina Oulehle, Oskar Zakiyanov, Jan Vachek, Vladimír Tesař

Vnitr Lek 2025, 71(7):425-430 | DOI: 10.36290/vnl.2025.078  

Chronic kidney disease (CKD) represents a significant and independent risk factor for cardiovascular morbidity and mortality. Patients with CKD frequently present with atrial fibrillation and venous thromboembolism, creating a clinical need for optimal anticoagulation strategies that balance efficacy and safety. However, the selection of an appropriate anticoagulant in this population is challenging, owing both to the increased risk of bleeding complications and to the altered pharmacokinetics of renally excreted agents. Over the past decade, non-vitamin K antagonist oral anticoagulants (NOACs) have emerged as a widely adopted alternative to warfarin...

What should an internist understand about acute kidney injuryMain topic

Nadežda Petejová, Josef Zadražil, Vladimír Teplan, Arnošt Martínek

Vnitr Lek 2025, 71(7):415-423 | DOI: 10.36290/vnl.2025.077  

Acute kidney injury (AKI) is a significant concern in routine clinical practice, as it requires prompt and thorough differential diagnosis to identify its causes and initiate appropriate treatment. Patients with AKI are often heterogeneous, and their clinical presentation can be greatly affected by underlying conditions such as infections, heart failure, endocrine disorders, or diseases of the liver or lungs. This article aims to provide a rapid assessment for differential diagnosis across various internal medicine specialties, with the goal of enhancing the care of critically ill patients with AKI and achieving optimal recovery of renal function,...

ANCA-associated vasculitides - diagnostic and therapeutic optionsMain topic

Zdenka Hrušková, Vladimír Tesař

Vnitr Lek 2025, 71(7):408-413 | DOI: 10.36290/vnl.2025.076  

Granulomatosis with polyangiitis, microscopic polyangiitis and eosinophilic granulomatosis with polyangiitis are three rare diseases ranked among ANCA-associated vasculitides. The most commonly affected organs include the ENT area, lungs and kidneys. The diagnosis is based on the clinical picture, positivity of ANCA antibodies (directed against proteinase 3, PR3-ANCA, or myeloperoxidase, MPO-ANCA) and/or biopsy verification. Early recognition of the disease and prompt initiation of therapy are crucial for the patients´ prognosis. Nowadays, treatment usually consists of corticosteroids and either cyclophosphamide or rituximab, or both. In severe forms...

Cardiovascular diseases in pregnancy - a current overviewReview articles#E-publication

Jana Čepelová

Vnitr Lek 2025, 71(6):E1-E12 | DOI: 10.36290/vnl.2025.075  

Even though, there have been many advances in maternal medical care and fertility treatments, the presence of cardiovascular disease has a significant impact on pregnancy. Congenital heart diseases, valvular heart diseases, chronic hypertension and cardiomyopathies are linked to increased risk of maternal as well as fetal morbidity and mortality. The management of the pre-existing heart diseases in pregnancy has been challenging for cooperation of cardiologists and gynecologists, in order to improve maternal and fetal morbidity and mortality. This overview offers a summary of the recent knowledge of pregnancy-related cardiovascular diseases in women.

Hlavní téma – AlergologieEditorial

prof. MUDr. Petr Panzner, CSc.

Vnitr Lek 2025, 71(6):339