Dysnatremias are among the most common mineral imbalances encountered in clinical practice. Both hyponatremia and hypernatremia are associated with increased morbiditidy and mortality and represent negative prognostic factors regardless of their cause. Serum osmolality, extracellular fluid volume and sodium urine concentration are important parameters for evaluation the cause and differential diagnosis. The rate of onset of ionic disorder and severity of clinical symptoms are essential. While acute disorders with symptoms are treated immediately, in chronic disorders, thorough diagnostic evaluation and a careful approach to their correction are necessary. Especially with rapid substitution of chronic hyponatremia, there is a risk of osmotic demyelination syndrome. Therefore, a slow correction of the serum sodium level with frequent mineralogram checks is required.
{"title":"Differential diagnosis of hyponatremia and hypernatremia.","authors":"Otakar Pšenička, Jarmila Křížová","doi":"10.36290/vnl.2022.118","DOIUrl":"https://doi.org/10.36290/vnl.2022.118","url":null,"abstract":"Dysnatremias are among the most common mineral imbalances encountered in clinical practice. Both hyponatremia and hypernatremia are associated with increased morbiditidy and mortality and represent negative prognostic factors regardless of their cause. Serum osmolality, extracellular fluid volume and sodium urine concentration are important parameters for evaluation the cause and differential diagnosis. The rate of onset of ionic disorder and severity of clinical symptoms are essential. While acute disorders with symptoms are treated immediately, in chronic disorders, thorough diagnostic evaluation and a careful approach to their correction are necessary. Especially with rapid substitution of chronic hyponatremia, there is a risk of osmotic demyelination syndrome. Therefore, a slow correction of the serum sodium level with frequent mineralogram checks is required.","PeriodicalId":23501,"journal":{"name":"Vnitrni lekarstvi","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41344137","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
I. Vacula, Z. Rusiňáková, D. Čelovská, P. Jackuliak, J. Slopovský, P. Palacka, M. Moščovič, S. Špánik, J. Staško, Alexander Wild, A. Bátorová, Juraj Ma Arič
The increasing volume of the data and experience with direct oral anticoagulants (DOACS) in the primary and secondary prevention of venous thromboembolism in oncologic patients (CAVTE) has recently lead to changes in several international guidelines. We reflect these changes within the conditions in Slovak republic. In the primary prevention of CAVTE we recognise oncosurgical patients and nonsurgical patients: hospitalised and out patients. Low molecular weight heparins are still dominant in the primary prevention of CAVTE. Regarding the treatment and the secondary prevention of CAVTE, we recommend always to consider the possibility to use DOACs as they proved to be non inferior to LMWH. However, LMWH should be prefered over DOACs as well as over warfarin (VKA) in all patients who are in a clinically unstable condition with the high risk of bleeding and/or interaction with the systemic treatment. Primarily in the patients with intraluminal tumours of the upper part of the gastrointestinal tract and genitourinary tumours with the high risk of bleeding. As for the lack of data, LMWH are still preferd also in patients with primary tumours and metastatic disease of the central nervous system and in hemato oncology.
{"title":"Prevention and treatment of cancer associated venous thromboembolism - interdisciplinary consensus.","authors":"I. Vacula, Z. Rusiňáková, D. Čelovská, P. Jackuliak, J. Slopovský, P. Palacka, M. Moščovič, S. Špánik, J. Staško, Alexander Wild, A. Bátorová, Juraj Ma Arič","doi":"10.36290/vnl.2022.047","DOIUrl":"https://doi.org/10.36290/vnl.2022.047","url":null,"abstract":"The increasing volume of the data and experience with direct oral anticoagulants (DOACS) in the primary and secondary prevention of venous thromboembolism in oncologic patients (CAVTE) has recently lead to changes in several international guidelines. We reflect these changes within the conditions in Slovak republic. In the primary prevention of CAVTE we recognise oncosurgical patients and nonsurgical patients: hospitalised and out patients. Low molecular weight heparins are still dominant in the primary prevention of CAVTE. Regarding the treatment and the secondary prevention of CAVTE, we recommend always to consider the possibility to use DOACs as they proved to be non inferior to LMWH. However, LMWH should be prefered over DOACs as well as over warfarin (VKA) in all patients who are in a clinically unstable condition with the high risk of bleeding and/or interaction with the systemic treatment. Primarily in the patients with intraluminal tumours of the upper part of the gastrointestinal tract and genitourinary tumours with the high risk of bleeding. As for the lack of data, LMWH are still preferd also in patients with primary tumours and metastatic disease of the central nervous system and in hemato oncology.","PeriodicalId":23501,"journal":{"name":"Vnitrni lekarstvi","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46896979","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Idiopathic pulmonary fibrosis and chronic fibrotic interstitial lung disease with progressive phenotype are characterized by fibrotic lung parenchyma. Current antifibrotic treatment does not affect pre-existing lung parenchyma fibrosis, but prevents fibrosis progression and reduces mortality by reducing fibrotization. This work summarizes fibrotic lung processes and their treatment options.
{"title":"Antifibrotic therapy and its indications for interstitial pulmonary fibrosis.","authors":"M. Doubková","doi":"10.36290/vnl.2022.045","DOIUrl":"https://doi.org/10.36290/vnl.2022.045","url":null,"abstract":"Idiopathic pulmonary fibrosis and chronic fibrotic interstitial lung disease with progressive phenotype are characterized by fibrotic lung parenchyma. Current antifibrotic treatment does not affect pre-existing lung parenchyma fibrosis, but prevents fibrosis progression and reduces mortality by reducing fibrotization. This work summarizes fibrotic lung processes and their treatment options.","PeriodicalId":23501,"journal":{"name":"Vnitrni lekarstvi","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44166737","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Essential arterial hypertension is not a disease that would significantly adversely affect patients in their daily activities. At least mostly. Nonetheless, it has a significant negative impact on cardiovascular morbidity and mortality. The tight correlation with the degree of hypertension, the patients age and, of course, commorbidities and cardiovascular risk factors is obvious. Therefore, the goal of hypertensive therapy is not only to try to achieve optimal reduction of blood pressure, but in a broader sense to reduce the risk of the just mentioned consequences, i.e. to reduce morbidity and reduce mortality. The antihypertensive drug urapidil can also be used in pharmacotherapy, the brief description of which is the subject of this article.
{"title":"Urapidil: an unknown / known antihypertensive.","authors":"J. Slíva","doi":"10.36290/vnl.2022.052","DOIUrl":"https://doi.org/10.36290/vnl.2022.052","url":null,"abstract":"Essential arterial hypertension is not a disease that would significantly adversely affect patients in their daily activities. At least mostly. Nonetheless, it has a significant negative impact on cardiovascular morbidity and mortality. The tight correlation with the degree of hypertension, the patients age and, of course, commorbidities and cardiovascular risk factors is obvious. Therefore, the goal of hypertensive therapy is not only to try to achieve optimal reduction of blood pressure, but in a broader sense to reduce the risk of the just mentioned consequences, i.e. to reduce morbidity and reduce mortality. The antihypertensive drug urapidil can also be used in pharmacotherapy, the brief description of which is the subject of this article.","PeriodicalId":23501,"journal":{"name":"Vnitrni lekarstvi","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46120802","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
E. Sovová, S. Genzor, M. Sova, M. Sovova, K. Moravcova, M. Simek, Lenka Obare Pyzsková
COVID-19 pandemic has massive impact on the whole world, lead to the death of milions of people and required excessive restrictions with large economical, psychological and other impacts. Post-COVID syndrome is defined according to the Czech pneumological and phtizeological society as a complex of symptoms persisting for more than 12 weeks from the acute stage of COVID-19 and which is not possible to explain by other causes. Exact pathopysiological mechanisms and its frequency are still not known, and the data from the literature are not consisent. We present case reports of 2 patients with very different disease and convalescence course. COVID-19 and post-COVID syndrome represent large space for the further research. The prediction of the persisting limitations and other consequencies of the diseases is still not possible. Even though there is usualy higher incidence of post-COVID symptoms in patients surviving severe COVID-19 course, the presented case reports show paradoxically exactly the oposite situation.
{"title":"COVID-19 and post-COVID - Jekyll and Hyde of modern medicine.","authors":"E. Sovová, S. Genzor, M. Sova, M. Sovova, K. Moravcova, M. Simek, Lenka Obare Pyzsková","doi":"10.36290/vnl.2022.044","DOIUrl":"https://doi.org/10.36290/vnl.2022.044","url":null,"abstract":"COVID-19 pandemic has massive impact on the whole world, lead to the death of milions of people and required excessive restrictions with large economical, psychological and other impacts. Post-COVID syndrome is defined according to the Czech pneumological and phtizeological society as a complex of symptoms persisting for more than 12 weeks from the acute stage of COVID-19 and which is not possible to explain by other causes. Exact pathopysiological mechanisms and its frequency are still not known, and the data from the literature are not consisent. We present case reports of 2 patients with very different disease and convalescence course. COVID-19 and post-COVID syndrome represent large space for the further research. The prediction of the persisting limitations and other consequencies of the diseases is still not possible. Even though there is usualy higher incidence of post-COVID symptoms in patients surviving severe COVID-19 course, the presented case reports show paradoxically exactly the oposite situation.","PeriodicalId":23501,"journal":{"name":"Vnitrni lekarstvi","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44607492","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pharmacovigilance is an integral part of medicine. There is always a risk of side effects when using medication; these can be completely trivial, but there are side effects that can be life-threatening or fatal. Pharmacovigilance practices should prevent such side effects, or at least reduce their incidence, especially by developing preventive measures that are based on adverse drug reaction (ADR) data and the evaluations of these. This article discusses the general concept of pharmacovigilance and compares individual pharmacovigilance systems of several countries and regions.
{"title":"The position and importance of pharmacovigilance in the Czech Republic and in the world.","authors":"Petra Zatovkaňuková, J. Slíva","doi":"10.36290/vnl.2022.054","DOIUrl":"https://doi.org/10.36290/vnl.2022.054","url":null,"abstract":"Pharmacovigilance is an integral part of medicine. There is always a risk of side effects when using medication; these can be completely trivial, but there are side effects that can be life-threatening or fatal. Pharmacovigilance practices should prevent such side effects, or at least reduce their incidence, especially by developing preventive measures that are based on adverse drug reaction (ADR) data and the evaluations of these. This article discusses the general concept of pharmacovigilance and compares individual pharmacovigilance systems of several countries and regions.","PeriodicalId":23501,"journal":{"name":"Vnitrni lekarstvi","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44543556","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Čellár, Martina Konko Ová, E. Lacková, Terézia Hrubá, P. Galajda, I. Dedinská
INTRODUCTION Kidney transplantation is now a routine method used to treat end-stage renal disease. About 10 % of kidney transplant patients are patients with autosomal dominant polycystic kidney disease (ADPKD). After successful kidney transplantation, recurrent urinary tract infections also occur in initially asymptomatic patients. MATERIAL AND METHODS The group included 320 patients after kidney transplantation. We compared patients with ADPKD versus patients without ADPKD in terms of the presence of recurrent urinary tract infections. THE RESULTS The incidence of recurrent urinary tract infections (rIMCs) was 18% in patients without ADPKD and 48% in patients without ADPKD. Nephrectomy after kidney transplantation due to recurrent urinary tract infections eliminated this infectious complication (in 86% of patients). CONCLUSION Kidney transplant patients with ADPKD have a significantly higher incidence of recurrent urinary tract infections. Removal of polycystic kidneys is a suitable solution if the infection persists.
{"title":"Recurrent urinary tract infections in kidney transplant patients with polycystic kidneys.","authors":"M. Čellár, Martina Konko Ová, E. Lacková, Terézia Hrubá, P. Galajda, I. Dedinská","doi":"10.36290/vnl.2022.053","DOIUrl":"https://doi.org/10.36290/vnl.2022.053","url":null,"abstract":"INTRODUCTION\u0000Kidney transplantation is now a routine method used to treat end-stage renal disease. About 10 % of kidney transplant patients are patients with autosomal dominant polycystic kidney disease (ADPKD). After successful kidney transplantation, recurrent urinary tract infections also occur in initially asymptomatic patients.\u0000\u0000\u0000MATERIAL AND METHODS\u0000The group included 320 patients after kidney transplantation. We compared patients with ADPKD versus patients without ADPKD in terms of the presence of recurrent urinary tract infections.\u0000\u0000\u0000THE RESULTS\u0000The incidence of recurrent urinary tract infections (rIMCs) was 18% in patients without ADPKD and 48% in patients without ADPKD. Nephrectomy after kidney transplantation due to recurrent urinary tract infections eliminated this infectious complication (in 86% of patients).\u0000\u0000\u0000CONCLUSION\u0000Kidney transplant patients with ADPKD have a significantly higher incidence of recurrent urinary tract infections. Removal of polycystic kidneys is a suitable solution if the infection persists.","PeriodicalId":23501,"journal":{"name":"Vnitrni lekarstvi","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43108816","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Arterial hypertension (AH) is a very common disease with increasing incidence and prevalence. AH becomes worldwide the main preventable cause of the preventable deaths. Therefore, it is very important to obtain early diagnose and convenient treatment. Still high cardiovascular mortality in Slovakia, where we have a position at the tail compared to other European countries, very closely related to the failure to obtain treatment blood pressure (BP) target ranges. AH rarely occurs in isolation, and often clusters with other CV risk factors such as dyslipidemia and obesity. 2018 ESC/ESH Guidelines for the management of arterial hypertension has brought several new concepts how to manage arterial hypertension. However, it is important to implement the recommendations of the European Society of Cardiology to everyday clinical practice in each country.
{"title":"Had care of arterial hypertension patients been advanced in 2021?","authors":"A. Vachulová, Adriana Šimková, S. Filipová","doi":"10.36290/vnl.2022.051","DOIUrl":"https://doi.org/10.36290/vnl.2022.051","url":null,"abstract":"Arterial hypertension (AH) is a very common disease with increasing incidence and prevalence. AH becomes worldwide the main preventable cause of the preventable deaths. Therefore, it is very important to obtain early diagnose and convenient treatment. Still high cardiovascular mortality in Slovakia, where we have a position at the tail compared to other European countries, very closely related to the failure to obtain treatment blood pressure (BP) target ranges. AH rarely occurs in isolation, and often clusters with other CV risk factors such as dyslipidemia and obesity. 2018 ESC/ESH Guidelines for the management of arterial hypertension has brought several new concepts how to manage arterial hypertension. However, it is important to implement the recommendations of the European Society of Cardiology to everyday clinical practice in each country.","PeriodicalId":23501,"journal":{"name":"Vnitrni lekarstvi","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48128062","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The article provides an overview of the development of recommendations for indications of venoactive drugs for treating symptoms and signs associated with chronic venous disease (CVD). Venoactive drugs may be beneficial in patients with subjective problems and/or swelling of the lower limbs, after surgery for varicose veins, in chronic venous insufficiency or in microcirculatory disorders. They are not indicated in asymptomatic patients with CVD, in the prevention of varicose veins or to prevent their progression. Drugs with proven efficacy in clinical trials should be preferred.
{"title":"Development of recommendations for the use of venoactive drugs in the treatment of chronic venous disease - where they are effective and where they are not.","authors":"D. Musil","doi":"10.36290/vnl.2022.049","DOIUrl":"https://doi.org/10.36290/vnl.2022.049","url":null,"abstract":"The article provides an overview of the development of recommendations for indications of venoactive drugs for treating symptoms and signs associated with chronic venous disease (CVD). Venoactive drugs may be beneficial in patients with subjective problems and/or swelling of the lower limbs, after surgery for varicose veins, in chronic venous insufficiency or in microcirculatory disorders. They are not indicated in asymptomatic patients with CVD, in the prevention of varicose veins or to prevent their progression. Drugs with proven efficacy in clinical trials should be preferred.","PeriodicalId":23501,"journal":{"name":"Vnitrni lekarstvi","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43634349","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Acquired von Willebrand syndrome (AvWS) is a rare bleeding disorder caused by von Willebrand factor (vWF) dysfunction of various types and severities. Clinical manifestations and differences in the intensity of bleeding are then given by the diversity of vWF disorders. AvWS usually occurs in adult patients with a negative personal or family history of bleeding symptoms and is associated with underlying disease. In recent years, vWF dysfunction has been most commonly attributed to cardiovascular, autoimmune, lymphoproliferative or myeloproliferative comorbidities. The true prevalence of AvWS is unknown, since many cases may be clinically or laboratory silent and remain undiagnosed. Thus, a higher incidence can be expected in the above-mentioned specific patient population. We present a case report of a 90year-old patient with the very first episode of bleeding manifestation and newly diagnosed vWF dysfunction. By describing the case, we will try to present the diagnostic and treatment options of AvWS, including their pitfalls, and draw attention to situations in which to think about AvWS.
{"title":"Acquired von Willebrand syndrome (AvWS).","authors":"Petr Drenko, Petra Přenosilová, Alena Lavičková","doi":"10.36290/vnl.2022.055","DOIUrl":"https://doi.org/10.36290/vnl.2022.055","url":null,"abstract":"Acquired von Willebrand syndrome (AvWS) is a rare bleeding disorder caused by von Willebrand factor (vWF) dysfunction of various types and severities. Clinical manifestations and differences in the intensity of bleeding are then given by the diversity of vWF disorders. AvWS usually occurs in adult patients with a negative personal or family history of bleeding symptoms and is associated with underlying disease. In recent years, vWF dysfunction has been most commonly attributed to cardiovascular, autoimmune, lymphoproliferative or myeloproliferative comorbidities. The true prevalence of AvWS is unknown, since many cases may be clinically or laboratory silent and remain undiagnosed. Thus, a higher incidence can be expected in the above-mentioned specific patient population. We present a case report of a 90year-old patient with the very first episode of bleeding manifestation and newly diagnosed vWF dysfunction. By describing the case, we will try to present the diagnostic and treatment options of AvWS, including their pitfalls, and draw attention to situations in which to think about AvWS.","PeriodicalId":23501,"journal":{"name":"Vnitrni lekarstvi","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45677639","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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