Basal insulin analogues still play an irreplaceable role in the treatment of type 2 diabetes mellitus (T2DM) and are indicated when patients are poorly controlled with oral antidiabetic drugs. In the multicentre prospective observational BIGGER (Biosimilar Insulin GlarGin czEch Real-life non-interventional study) trial, the efficacy of biosimilar insulin glargine (Semglee) and its good safety profile were confirmed. Aim: To determine the efficacy and safety of biosimilar insulin glargine (Semglee) in adult patients with T2DM in real clinical practice and to evaluate the effect of previous therapy on the course of treatment. Patient population (material) and method: Results from 1 066 patients with T2DM who were referred for treatment with insulin glargine were processed. Treatment efficacy and safety indicators were assessed at the initial visit and after one, two and six months of treatment. Results: All study participants experienced significant reductions in HbA1c and weight over the six months. The mean HbA1c values decreased from 69.7 ± 13.16 to 59.9 ± 12.01 mmol/mol; p < 0.001 in the entire study population. The decrease was most significant in the insulin naive group, from 74.7 ± 12.12 to 59.9 ± 10.69 mmol/mol; < 0.001. In patients with previous insulin treatment there was a reduction - human insulin group (from 69.4 ± 13.53 to 58.8 ± 12.52 mmol/mol; < 0,001), 1st generation insulin analogues (from 67.1 ± 12.44 to 59.7 ± 12.10 mmol/mol; < 0.001), 2nd generation insulin analogues (from 70.7 ± 13.05 to 61.7 ± 13.51 mmol/mol; <0,001). In patients with previous treatment with 1st generation basal insulin analogues, mean baseline body weight values were significantly lower compared to patients with previous treatment with 2nd generation basal insulin analogues (90.0 ± 17.39 kg vs. 95.2 ± 19.54 kg; p = 0.016). The incidence of hypoglycaemia was comparable to that before treatment and the incidence of ketoacidosis during treatment was rare. Conclusion: Treatment with the biosimilar insulin glargine (Semglee) led to a mean decrease in HbA1c of 9.8 mmol/mol over 6 months in patients with T2DM. The greatest improvement was achieved in patients with no previous insulin therapy. Early initiation of basal insulin therapy and subsequent dose titration is crucial to ensure good treatment outcomes. Patient education and regular monitoring for ongoing assessment of status leads to improved patient adherence and increases treatment success.

Light Chain Deposition Disease (LCDD) is a very rarely diagnosed condition affecting the kidneys. We describe a case where this diagnosis was morphologically confirmed in a biopsy of a transplanted kidney, and retrospectively identified in a previous kidney biopsy where the changes were not correctly classified. The biopsy of the transplanted kidney was performed due to worsening graft function. Subsequent testing focused on monoclonal gammopathy, revealing elevated serum concentrations of free kappa light chains (FLC) with a maximum FLC kappa value of 226 mg/l and FLC lambda at only 6 mg/l. The FLC kappa / FLC lambda ratio was clearly pathological at 37 (normal range 0.26-1.65). Serum and urine immunofixation electrophoresis were repeatedly negative. Bone marrow cytology described 8% pathological plasma cells, and flow cytometry demonstrated 0.7% plasma cells among all nuclear bone marrow cells. These plasma cells were 100% clonal, of the abnormal kappa + phenotype. The diagnosis was thus concluded as a non-malignant gammopathy of the type „monoclonal gammopathy of clinical significance“ with renal damage in a morphological form corresponding to LCDD. A combination of daratumumab, bortezomib, cyclophosphamide and dexamethasone was chosen for treatment LCDD. Free light kappa chains decreased below the lower limit of the norm during the first two months of anti-CD38 therapy. LCDD is one of the many forms of kidney damage that can occur in non-malignant gammopathies. Therefore, FLC testing should always be performed as part of the differential diagnosis of renal failure. For kidney damage by monoclonal immunoglobulin, a classification created by The International Kidney and Monoclonal Gammopathy Research Group was accepted. It is advisable to inform the evaluating morphologists of the possible presence of pathological concentrations of FLC and/or M-Ig so that they can focus the diagnosis in this direction, otherwise these rare forms of kidney injury may remain unrecognized.

Low incidence of multiple myeloma (MM) in the general population is one of the reasons for absence of a screening program. Kidney dysfunction is one of the most common types of end-organ damage in MM patients. Some transplant centers, therefore, established a screening to detect monoclonal immunoglobulin, mostly employing serum protein electrophoresis (SPEP) with or without immunofixation of serum and urine. If only monoclonal free light chain is produced, however, the sensitivity of SPEP and immunofixation is low. Here, we describe a case report of patient with newly diagnosed MM only after kidney transplantation. This case report emphasis the need for screening of monoclonal gammopathy (MG) in patients whose cause of kidney failure is unknown.

Myocardial free wall rupture is a rare, but serious complication of acute myocardial infarction with high mortality. We present a case of a 64-year-old patient with this devastating complication of an anterior ST segment elevation myocardial infarction (STEMI) with a prolonged time delay. Cardiac surgery was not performed due to prohibitive surgical risk and predicted poor prognosis. We describe our successful therapeutic intervention consisting of immediate pericardial drainage, vasoactive and inotropic support, intraaortic balloon pump placement and continuous veno-venous hemodialysis. This combined therapy led to patient stabilization and after incremental clinical improvement the patient was able to return to a normal life. After several months a long-term mechanical circulatory support was implanted as a bridge to heart transplant.

Neoplasms of lymphoid tissues represent relatively great and heterogeneous group of human tumors. The expansion of data on lymphomagenesis could help us to understand similarities and also differences among various subgroups of malignant lymphomas. Hence there has been an increasing need to exactly define, differentiate and classify individual lymphoma entities. Previous classification systems were based on a neoplastic cell and tissue morphology, only a few information about physiology and pathophysiology of immune system were incorporated in them. These lymphoma classifications have been a source of confusion for many years for both clinicians and pathologists. The construction of a new lymphoma classification was started in early 90th years of 20th century. The classification was publicated in 1994 as "A Revisited European-American Classification of Lymphoid Neoplasms". For the first time in a history it has worked consistently with morphologic, immunophenotypic, genetic and clinical information together. The philosophy and form of REAL classification have been adopted by the new WHO Classification of Neoplastic Diseases of the Hematopoietic and Lymphoid Tissues. This scheme is now accepted as a modern and universal language of communication on the field of hemato-oncology.

Monoclonal gammopathy of clinical significance (MGCS) is an umbrella term to describe a broad spectrum of disorders with remarkable organ dysfunctions related to the underlying non-malignant B or plasma cell clone. Although the clone itself is typically very small, it is associated with diverse clinical manifestations through different mechanisms, such as monoclonal protein deposition, the biological activity of the monoclonal immunoglobulin, or angiogenic/inflammatory cytokine hyper-secretion, or the ethiopathogensis is still unknown. Some predominantly involve a single organ, commonly peripheral nerves, kidney, skin and eye, while others are systemic diseases with syndromic presentations. Recognizing the clinical features with appropriate workups, analysis of monoclonal immunoglobulin in serum and urine and free light chain analysis in serum with particular tissue biopsies, are the key to making a timely diagnosis, especially when the kidney or skin is affected. Treatment strategy is similar to multiple myeloma or Waldenström macroglobulinemia, complete remission of gammopathy is prerequisite of significant improvement of clinical symptoms and reversal of organ dysfunctions. Therapy is based on clone-directed therapy, application of high effective antiplasmocytic or antilymphocytic therapy with monoclonal antibody (anti-CD20 or anti-CD38) with high probability of total disappearing of monoclonal immunoglobulin. Other therapeutic possibility is immunomodulation with high-dose intravenous immunoglobulin 2g/kg administered in 28days interval as maintenance therapy.

Progress in multiple myeloma (MM) treatment is remarkable. Combined regimens for newly diagnosed MM patients achieve progression-free survival of more than seven years. In the Czech Republic, the approval of a four-drug combination of anti-CD38 monoclonal antibody (mAb) with a proteasome inhibitor (PI), immunomodulatory agent (IMiD) and dexamethasone is expecting in 2025. It is not yet clear whether consolidation with autologous transplantation will be beneficial in terms of extending the time to progression. The development of immunotherapy has literally exploded. Autologous chimeric antigen receptor T-cell therapy (CAR T-cells) targeting the BCMA antigen have already been approved for second-line therapy in the USA. The development of bispecific antibodies (bsAb) is even faster. Bispecific antibodies targeting BCMA and GPRC5D antigens are available in late relapse. Clinical trials are testing additional therapeutic targets (e.g., FcRH5) and combination regimens (e.g., bsAb, PI, IMiD). Response rates to these combinations in the first line treatment are 90-100 %, with a high percentage of patients achieving minimal residual disease (MRD) negativity. In 2024, assessment of MRD was approved as a primary outcome in clinical trials and it is likely that we are now moving to wals an era of MRD-driven therapy.

Introduction:
GLP1 receptor agonist lixisenatide has demonstrated its efficacy in numerous clinical trials, nevertheless its real-life effectiveness data is limited.
Aim:
To describe effectiveness and safety of lixisenatide in routine clinical practice in the Czech Republic and the Slovak Republic, as recorded by the Registry-Based Observational Study.
Methods:
Multinational, multicenter, observational, non-interventional, 6-month prospective product registry of patients with type 2 diabetes mellitus aged > 18 years who were initiating therapy with lixisenatide. Patients were enrolled into this registry, provided written informed consent, between 1 May 2013 and 31 December 2015. Evaluations were performed at baseline and after 3 and 6 months of lixisenatide treatment. The primary objective of the study was the absolute change in glycated hemoglobin (HbA_1c) from baseline to month 6 after lixisenatide initiation. The study was approved by responsible ethics committees and performed in accordance with the Helsinki Declaration. Informed consent was obtained from all patients before enrolment in the study.
Results:
Overall 772 eligible patients (51.4 % males), mean age 56.7 (± 9.3) years, with mean diabetes duration 7.7 (± 5.5) years, mean duration of treatment with oral antidiabetic drugs 6.8 (± 4.9) years, and body mass index 37.6 (± 5.9) kg/m² were enrolled in the study. Overall, 93.6 % were obese, 86.3 % subject were treated for hypertension, and 76.0 % for dyslipidemia. In total 96.1 % of patients completed the 6 months' therapy. Lixisenatide significantly reduced HbA_1c (decrease by 9.7 ± 14.4 mmol/mol [3.1 ± 0.2 % DCCT] after 6 months in per protocol population), and body weight (decrease by 3.5 ± 5.4 kg). The best responders to the treatment were younger patients with higher BMI, who had a shorter duration of diabetes. Overall safety profile of lixisenatide was satisfactory in the study. The most frequent adverse events were functional disorders affecting the gastrointestinal system. There was no episode of severe hypoglycemia reported throughout the study.
Conclusion:
In a real-life practice cohort of patients with type 2 diabetes mellitus 6 months treatment with once-daily GLP1 receptor agonist lixisenatide significantly improved glucose control and decreased body weight without increasing the risk of symptomatic and/or severe hypoglycemia risk.
Funding:
Sanofi Czech Republic.

Objective: LDL-cholesterol (LDL-C) is determined by methods whose accuracy is significantly affected in various clinical or analytical situations. Two computational methods have recently been described, the Martin equation and the Sampson equation, validity of which we compare with the Friedewald equation. Methods: LDL-C comparisons determined by the 3 equations were performed on 4 real sets of lipid data, generated in various previous studies, ranging from n = 140 to n = 7 393. We have created an artificial set of data on the extent of 900 members with equally distributed values of TC, HDL-C and TG troughout the commonly found range. Such a data set is independent of the phrase "we performed the calculations on our file". Comparisons were also made on this artificial file. Results: The difference between the LDL-C values determined by the different equations gradually increases with decreasing LDL-C levels, both in the subgroup of low TG values and in the subgroups of medium and higher TG values. This applies to all 4 real files as well as to the artificial file. These differences are more visible the larger the file size. For the artificial set, the overall agreement between the LDL-C categories was lowest when comparing the Friedewald and Martin equations (83.1%), higher between the Sampson and Martin equations (88.9%) and highest when comparing the Friedewald and Sampson equations (90.9%). In all 4 real sets, the trends of overestimation and underestimation between the equations were exactly the same as in the artificial set. Conclusion: The results of clinical and epidemiological studies are significantly influenced by the method used to determine LDL-C. When comparing the calculation methods for determining LDL-C, it is possible to preferably use the described artificial set.

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 work is devoted to the potential advantages of POCUS in internal medicine, data on the use of POCUS in an actual clinical practice relevant to the internist, and data on the use of the so-called pocket ultrasound devices.

The ultimate goal in the treatment of asthma is the achievement of disease control and minimization of the risk for future exacerbation. Despite using medium/high dose of inhaled corticosteroids (ICS) in fixed combination with long-acting beta-2 agonists (LABA), many patients still do not achieve an adequate level of disease control and remain at risk of exacerbations. Disease severity may be related to poor treatment adherence or improper inhaler technique. LAMA is suggested as the first add-on therapy to moderate dose ICS + LABA (GINA 2024), called as triple therapy. GINA recommends triple therapy (LAMA to ICS/LABA) as a further option at step 4 and as first choice at step 5. Therefore, it is useful to know strategy this treatment and adequate indicate free and fixed triple therapy in patients with bronchial asthma. It offers to achieve therapeutic control of asthma. Despite evidence of its efficacy and safety, inhaled triple therapy (ITT) is still not mostly used in patients with asthma.

In recent years, attention has been paid to patients with connective tissue diseases and interstitial lung disease (ILD). This is reflected in the number of recently published guidelines dealing with this issue. Most of them evaluate the effect of already known molecules on the management of ILDs. During 2024, no clinical study was published that would enrich the portfolio of treatment options with a new molecule. Guidelines for the management and treatment of pulmonary alveolar proteinosis were recently published. It turns out that in patients with idiopathic pulmonary fibrosis who suffer acute exacerbation, treatment with high doses of corticosteroids can be considered more harmful than beneficial to the patient. Home oxygen therapy should continue to be reserved only for patients with ILD who meet the indication criteria for this therapy. The effect on alleviating exertional dyspnea in the daily life of patients has not been proven. Similarly, the benefit of opioid treatment to alleviate symptoms has not been proven. National guidelines dedicated to this issue are gradually updated and are available on the website of Czech Pneumological and Phthiseological Society.

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 diseases, based on randomized studies and real-world data from recent years. This applies not only to the expansion of indications for transcatheter aortic valve implantation, but also to the strengthening of the role of transcatheter treatment of mitral regurgitation and the systematic integration of interventions on the tricuspid valve. The recommendations also emphasize the diagnosis and role of imaging methods, including coronary examinations, and the simplification of antithrombotic treatment regimens. The result is a more proactive and patient-centred approach led by a multidisciplinary team. The article focuses only on significant changes and revisions to previous recommendations, not on the recommended procedures as a whole.

We reported the first real data about efficacy of interferon-free therapy of chronic hepatitis C in the Czech Republic. Patients were treated with combined therapy of paritaprevir/ritonavir + ombitasvir + dasabuvir with or without ribavirin. There were 109 patients, predominantly men - 62 (57 %), most of them infected by genotype 1b - 101 patients (93 %), minority infected by genotypes 1a (6/109, 5 %) and 4 (2/109, 2 %). Both treatment-naive (43/109, 39 %), and treatment-experienced patients (66/109, 61 %) were treated. Sustained virological response 12 weeks after therapy termination (SVR12) was 100 %, with exclusion of patients with other reason than virological treatment failure.

Recent data suggest that we are on the verge of a dementia pandemic. Hypertension is a significant risk factor for this so far untreatable irreversible condition. The attention of researchers is now focused on identifying individuals at increased risk of cognitive decline or with early-stage cognitive deficit. Apart from cognitive function tests and imaging studies, no suitable biomarkers to identify these individuals have been available as yet. Haemodynamic parameters could be potentially useful biomarkers. At the ESH 2022 Congress, Professor Cunha presented the current knowledge suggesting that cognitive decline could be related to visit-to-visit blood pressure variability, carotid artery intima media thickness, and aortic stiffness as measured by pulse wave velocity (PWV). Currently, the CEREBRO study is being conducted to evaluate the prevalence of cognitive dysfunction in patients with hypertension and to search for early vascular biomarkers that correlate with cognitive decline. In addition to early and tight control of blood pressure, early detection of cognitive impairment could be a way to reduce the prevalence of advanced stages of dementia in the future.

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 practice showed that the risk of bleeding with direct oral anticoagulants as a whole is not too different from warfarin, but depends on the type and dose of the drug. It is relatively lowest at low doses of edoxaban. Concomitant use of proton pump inhibitors slightly reduced the risk of upper gastrointestinal bleeding, more significantly with warfarin, dabigatran, and in high­‑risk patients, by up to 24-44 %. To reduce the risk of bleeding, it is recommended to discontinue oral anticoagulants for high­‑risk endoscopic procedures. In era of increasing prescription of oral anticoagulants, it is essential to reduce the risk of bleeding by selection the appropriate medication on an individual basis and adjustment of dosage according to the patient's condition and specific clinical situation.

Introduction:
Assessment of serum levels of free light chains (FLC-κ and FLC-λ) and recently heavy/light chain pairs of immunoglobulin (HLC-κ and HLC-λ) and their ratio (FLC-r and HLC-r) has significantly enriched traditional algorithm of multiple myeloma (MM) evaluation. The aim of the presented study was to assess the relationship of classical prognostic parameters of MM, standard FLC-κ/λ and HLC-κ/λ ratio (^sFLC-r and ^sHLC-r), modified ratio of "involved/uninvolved" FLC and HLC (^mFLC-r and ^mHLC-r ), the difference between "involved - uninvolved" FLC and HLC (FLC-dif. and HLC-dif.) to current stratification models of MM based on the result of cytogenetic analysis.
Patients and methods:
In a group of 97 patients with MM we assessed serum levels of FLC by Freelite^TM method, and we calculated ^sFLC-r, ^mFLC-r and FLC-dif. indices by Hevylite^TM method. For cytogenetic analysis we used FICTION (fluorescence immunophenotyping and interphase cytogenetics as a tool for the investigation of neoplasms). For MM stratification we used standard staging systems according to Durie-Salmon (D-S) and International Staging System (ISS) as well as novel stratification systems based on the results of cytogenetic analysis, ie. "Mayo Stratification of Myeloma and Risk-Adapted Therapy" (mSMART) and "Revised International Staging System" (R-ISS).
Results:
Stratification mSMART and R-ISS has significantly different representation of "standard" or "low-risk" (71, 15.5, 11.3 a 29.9 %), "intermediate risk" (15.5, 53.6, 34 a 33 %) and "high risk" patients (13.4, 30.9, 54.7 a 37.1 %) compared to standard staging systems. mSMART stratification was compared to prognostic factors of MM (Hb, albumin, β₂-M, creatinine and LDH), and the only significant relationship was found in the case of β₂-M, R-ISS had relationship only to Hb and creatinine. In the case of D-S staging we found significant relationship of stages 1-3 and substages A and B to the levels of ^mFLC-r, FLC-dif. and ^mHLC-r, ISS had moreover relationship to k HLC-dif. and MIg concentration. Analysis of mSMART stratification showed primarily significant relationship of risk categories 1-3 to ^mFLC-r and ^sHLC-r indices, and R-ISS to ^mHLC-r index and MIg concentration. In both cytogenetics-based stratifications there was a lack of relationship to ^sFLC-r, FLC-dif. and HLC-dif. indices.
Conclusion:
Comparison of the results of standard staging systems according to D-S and ISS with cytogenetics based models mSMART and R-ISS showed different representation of risk groups, and significantly different relationship to classical prognostic factors together with original relationship of sMART stratification to ^mFLC-r and ^sHLC-r, and R-ISS to ^mHLC-r and MIg concentration.

Celiac disease is a lifelong autoimmune disorder that occurs in genetically predisposed people when consuming gluten. Its prevalence is around 1% of the population with about twice higher proportion of women. Celiac disease is one of the most common causes of malabsorption, however, its manifestations can be quite diverse - from completely asymptomatic to fully developed malabsorption syndrome. Extraintestinal manifestations are a common finding in adults. The gold standard of diagnosis is the serological detection of specific antibodies (the serum tissue transglutaminase IgA antibodies) in combination with a typical histological finding from a duodenal biopsy. Causal treatment is a lifelong gluten-free diet. Strict adherence to gluten-free diet will reduce the risk of serious complications (intestinal T-cell lymphoma). In the following case report we present a case of a 58-year-old patient, who have been diagnosed with celiac disease at this age based on non-classical symptoms. Specifically, these were multiple pathological fractures from metabolic bone disease due to malabsorption of calcium and vitamin D and subsequent secondary hyperparathyroidism.

Systemic mastocytosis (SM) is a disease characterized by the proliferation of clonal mast cells. SM biologically include a wide spectrum, ranging from relatively benign indolent forms to mast cell leukemia. The clinical presentation varies from nearly asymptomatic forms, through various degrees of mediator syndrome, to a neoplastic syndrome associated with hepatosplenomegaly, lymphadenopathy, and constitutional symptoms. Diagnosis relies on morphological and histological evaluation of the bone marrow. Patients are classified based on diagnostic findings and symptomatology according to the WHO and ICC classifications, which determine the type of disease and subsequent therapy, which is strictly individualized and includes symptomatic, targeted, and cytoreductive therapy. Given the wide spectrum of symptoms, patients with SM may visit specialists in most internal medicine departments in addition to hematologists and allergologists. Raising awareness of this diagnosis within the medical community is crucial. Low awareness leads to delayed diagnosis and undertreatment, posing risks of life-threatening situations in patients liable to severe allergic reactions.

Background: Thyrotoxic crisis is a medical emergency status needed rapid diagnostic and urgent treatment, presented by decompensation and multiorgan dysfunction. Amiodarone induced thyrotoxicosis (AIT) is one of the severe complications caused by amiodarone therapy. Aim: Analysis of patients suffered from thyrotoxic crisis induced by Amiodarone therapy, with focus on clinical picture, laboratory findings and therapeutic options. Methods and Results: A total of 39 consecutive patients were dispensed to the Endocrine outpatient clinic of the University Hospital Banská Bystrica, with AIT during the period of 2005-2021 year we performed retrospective analysis of 5 consecutive patients with thyrotoxic crisis, who have been hospitalized on department of Internal Medicine University Hospital Banska Bystrica. All of patients were men (mean age 56,0 ± 5,4 years), All of analysed patients (n = 5) have been treated for arterial hypertension, 20% (n = 1) ischemic heart disease, 60% (n = 3) had medical history of heart failure and 40% (n = 2) had implantable cardioverter defibrillator. Indication for Amiodarone therapy was atrial fibrillation (n = 2) and ventricular tachyarrhythmias (n = 3). The average time of use of amiodarone until development AIT was 1005 ± 199 days. Mean TSH in the time of diagnosis was 0,005 ± 0,008 mIU/L and mean free T4 was 52,1 ± 14,3 pmol/L. Mean volume of thyroid gland was 19,8 ± 5,8 ml and mean Burch-Wartofsky Score was 86 ± 18. Three patients have been diagnosed as mixed type AIT and the two as AIT type 2. Diagnosis was made on the basis of clinical, laboratory and imaging examinations. All of the patients (n=5) have been treated with antithyroid drugs and corticosteroids at the maximum recommended doses. 80% (n=4) underwent urgently thyroidectomy and one was threated conservatively. The thyroid papillary micro adenocarcinoma was histologically confirmed in 1 of the observed patients. Conclusion: Thyrotoxic crisis induced by Amiodarone is an endocrine emergency which is characterized by multiple organs failure due to sever thyrotoxicosis.

The use of glucose sensors first changed self-monitoring and also the treatment of patients with type 1 diabetes mellitus, as it enabled safer and more flexible reaching of physiological blood glucose values. Despite certain inconsistencies in subsequent studies, it is clear that this form of glycaemic self-monitoring has the potential to improve diabetes control in patients with type 2 diabetes as well (DM2; possibly also with other forms of diabetes). In addition, DM2 patients generally appreciate this type of glycaemic self-monitoring. The effect of using personal continuous monitoring of glucose concentration (either in real time or in the form of so-called intermittent scanning) in patients with DM2 requiring insulin therapy, especially in the form of an intensified insulin regimen, has been convincingly documented in randomized controlled trials. Moreover, in some studies, these patients were treated primarily by general practitioners. There are also positive reports on the benefit of continuous glucose monitoring in DM2 patients treated by other forms of therapy than with an intensified insulin regimen. Currently, in the Czech Republic, however, reimbursement of glucose sensors by the insurance company is restricted to a diagnosis of type 1 diabetes mellitus. Patients with DM2 can of course use them, but as self-payers.

Syncope is a sudden transient loss of consciousness caused by short-term hypoperfusion of the brain. It is a common reason for patients to visit acute admissions, where it is crucial to distinguish life-threatening causes from benign conditions. In this case report, we present the case of a 71-year-old patient whose syncope was caused by rupture of a right coronary artery aneurysm, resulting in the formation of a bulky hematoma in the right-sided cardiac compartments. This mechanism led to recurrent syncope, which at first glance could be mistakenly attributed to orthostatic hypotension caused by newly administered antihypertensive drugs. The case highlights the importance of a comprehensive approach to the diagnosis of syncope and emphasizes the need to exclude serious cardiovascular causes, especially in cases of recurrent and unexplained syncope. This rare but life-threatening condition was promptly diagnosed and treated by urgent cardiac surgery.

The concept of functional revascularization based on proving ischemia has been strongly recommended in the practical guidelines of both European and Czech Societies of Cardiology. In daily practice, application of this concept decreases the rate of coronary interventions. Though the best clinical evidence has been provided in patients with chronic coronary syndromes, recent data strongly advocate its usage also in patients with acute coronary syndromes. Invasive pressure-derived indices: hyperemic FFRmyo (fractional flow reserve of myocardium) and resting iFR (instantaneous wave-free ratio) require an interventional procedure by wiring the diseased vessel. FFRmyo ≤ 0.80 and iFR ≤ 0.89 mean functionally significant coronary disease mostly indicated for revascularization. Besides that, there are several non-invasive functional tests that may be used for detecting ischemia: perfusion scintigraphy, cardiovascular magnetic resonance, positron emission tomography and recently developed FFRCT or quantitative flow ratio (QFR). In routine practice, the concept of functional revascularization avoids unneccessary coronary interventions and, in case of functionally non-significant disease/stenoses, the patients may be treated conservatively with a very good prognosis. Currently, the "functionally complete revascularization", instead of the anatomic one, might become the goal of our treatment as the all-in-one concept in the cathetrization laboratory.

Background: Probe‑based confocal laser endomicroscopy (pCLE) is a novel diagnostic technique for endoscopy which enables a microscopic view at a cellular resolution in real‑time. Endoscopic detection of early neoplasia in the distal esophagus is difficult and often these lesions can be missed. The aim of the pilot study was to obtain characteristic pCLE figures in esophageal diseases for following studies, and to evaluate the possible future role of pCLE in the diagnostics of dysplastic Barrett's esophagus (BE) or early esophageal adenocarcinoma (EAC). Methods: A review of the current literature was performed and previously published pCLE images and classifications of esophageal diseases were searched and studied first. In phase two of the pilot study patients with esophageal diseases such as reflux esophagitis, BE and EAC were enrolled and scheduled for upper endoscopy with pCLE. A healthy cohort was also included. Results: From January 2019 to July 2019, a total of 14 patients were enrolled in this prospective pilot study: 3 patients with reflux esophagitis, 4 with BE, 3 with EAC and 4 persons were included in the healthy cohort. The endoscopy with pCLE was performed and characteristic pCLE figures were obtained. The correct diagnoses based on real‑time pCLE were evaluated by an endoscopist in 11 of the 14 cases (78.6 %). Conclusion: It was possible to obtain typical pCLE images of esophageal diseases during a standard cap‑assisted endoscopic procedure. pCLE seems to be a feasible new technique in BE surveillance and early neoplastic lesion detection. However, more studies and data on larger number of patients are needed.

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 persistent overproduction of cortisol, we must normalize its production, where pharmacological treatment has its place. The oral product Isturisa with the active substance osilodrostat (code LCI699) is indicated for the treatment of endogenous CS in adult patients. Its efficacy and safety have been and are being verified in the clinical trial program (LINC 1-7). Clinical studies phase III verified the efficacy and safety of osilodrostat. In vitro data indicate that neither osilodrostat nor its major metabolite inhibit enzymes and transporters at clinically relevant levels. Drug interactions do not appear likely. The most serious adverse event was adrenal insufficiency.

Chronic myeloid leukemia (CML) is a clonal myeloproliferative neoplasia that is characterised by Philadelphia chromosome (Ph1 chromosome) and/or fusion gene BCR-ABL1 in bone marrow. Interpheron α and bone marrow transplantation used to be the main treatment modalities for patients with CML 20 years ago. Due to the introduction of imatinib mesylate since the year 2000 the outcome of CML patients has dramatically improved. The survival of both younger and elderly patients in the case of an optimal response has been prolonged and currently is close to survival of healthy population. Although, one third of patients does not respond well to first line imatinib and needs to change the treatment to second line tyrosine kinase inhibitors (TKI: bosutinib, dasatinib and nilotinib). Younger patients without cardiologic and metabolic disorders and those with poor risk profile score may have benefit from TKI of 2nd generation as a 1^st line treatment option with the aim of reaching deeper molecular response and the chance of treatment free remission (TFR) in future. By older patients with severe comorbidities and in patients with good risk profile score imatinib as a 1^st line treatment option can be used. For patients who are resistant simultaneously to 2^nd generation TKI and for patients with mutation T315I ponatinib - TKI of 3^rd generation can be used effectively. Intolerance and toxicity of TKI´s are the main barriers of effective CML treatment. TKI selection for each patient should be individual. Patient´s cooperation with medical team is crucial and inevitable in long time treatment process. The chance for TFR has become feasible for approximately 40-60 % CML patients in deep and durable molecular remission and represents a further important milestone in the management of CML patients.

Point-of-Care ultrasound (POCUS) is bedside ultrasound examination performed by a clinician. POCUS is a suitable tool for rapid diagnosis and monitoring of the condition of many patients examined by internists in emergency departments and inpatient departments. POCUS allows the examining physician to supplement the physical examination with additional information obtained in real time, and is a useful tool for differential diagnosis of a number of acute conditions (shock, shortness of breath, etc.). Chest POCUS includes an indicative assessment of cardiac function and evaluation of the lung parenchyma, including exclusion of pericardial effusion, pneumothorax or fluidothorax. One of the most common applications of POCUS is to assess the state of the venous filling by examining the inferior vena cava. When examining the abdomen, the internist should at least be able to diagnose fluid in the abdominal cavity and exclude congestion in the hollow system of the kidney. POCUS for internists also includes examination of main venous trunks to rule out proximal venous thrombosis. Even when performing conventional invasive procedures, we cannot do without ultrasound at the bedside, whether it is a puncture of ascites or pleural effusion, or cannulation of the central vein. The advantage of POCUS is the immediate availability of the examination and the possibility to repeat scans when needed for monitoring the patient's condition.

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 up accordingly to their risk factors mainly the risk of progression to overt hypothyroidism. Aproach to each patient should be individulized and flexible.