Vnitrni lekarstvi最新文献

Gastroenterology, hepatology and digestive endoscopy are rapidly evolving disciplines with significant advances in the diagnostics and treatment in the entire gastrointestinal tract. The aim of our article was to summarize new perspectives on relevant situations in gastroenterology and hepatology like acute pancreatitis, functional dyspepsia, rational indication of proton pump inhibitors, inflammatory bowel diseases (IBD), cholestatic liver diseases, alcohol induced hepatitis, non-alcoholic fatty live disease (NAFLD) and patophysiology of bilirubin and bile acids. Digestive endoscopy represents an interventional part of gastroenterology and key recent topics are mentioned like pancreatic cancer screening, arteficial intelligence, resection of low-risk neoplastic lesions, enteroscopy techniques, cholangio- and pancreatiscopy and extraluminal expansion of endoscopy techniques by means of endoscopic submucosal and transmural dissection, endoscopic myotomy and lumen apposing stents.

SAPHO is an acronym derived from capital letters of Synovitis, Acne, Pustulosis, Hyperostosis, and Osteitis (SAPHO). SAPHO syndrome is an umbrella term covering a constellation of bone lesions and skin manifestations. A 40-year-old male complained about his jaw and back pain, swelling of multiple joints and weight loss accompanied by physical deterioration and acne type skin lesions. Laboratory tests revealed abnormal elevation of inflammatory markers. Imaging studies illustrated multiple osteolytic bone lesions and paraosseal infiltrates. According to the set of criteria diagnosis of SAPHO syndrome was stated. The patient was treated with glucocorticoids and non-steroidal anti-inflammatory drugs (NSAIDs), but only high dose dexamethasone and prednisone were effective. Daily subcutaneous administration of anakinra at the dose of 100 mg was initiated due to limited response to more classical therapies. Because of planned mandibular osteosynthesis initiation of denosumab was preferred before bisphosphonates. Therapeutic response was confirmed by FDG-PET/MR after 5 months of anakinra and denosumab therapy, showing decreased accumulation of FDG in periosteal and paraosseal infiltrates. Inflammatory markers significantly decreased, bone pain deferred but skin manifestation receded only partially. Therefore the response was evaluated as partial remission.

An elevated number of eosinophils have been implicated in several type 2 inflammatory chronic diseases that occur at various sites in the body. Over the past 20 years, our knowledge of diseases associated with increased numbers of eosinophils has advanced thanks to the development of drugs that can reduce or even eliminate eosinophils. One such agent is mepolizumab, a humanized monoclonal antibody that binds to interleukin -5 (IL-5). This article briefly and clearly summarizes the pharmacological profile of mepolizumab and its current indications for a number of chronic eosinophilic diseases.

Hyperthyreoidism is a clinical manifestation of excessive production of thyroid hormones. In most cases pacient ´s condition allows ambulant treatment. Rarely, it can develop into an acute, life- threatening thyrotoxic crisis which has to be treated in the intensive care unit. Main therapy includes antithyroid medication, corticosteroids, beta- blockers and rehydratation, mostly parenteral. If initial treatment fails, plasmapheresis provides effective strategy. Antithyroid medication may come with side effects as rash, digestive issues, joint pain.Agranulocystosis or acute liver lesion which leads to liver failure belong among the most severe ones. In this case we report a pacient with thyrotoxic crisis, atrial fibrilation which led to ventricular fibrilation, cor thyreotoxicum. The treatment was complicated by febrile neutropenia.

The most recent guidelines on heart failure of the European Society of Cardiology were published in 2021. These guidelines devide patients according to the ejection fraction of the left ventricle into the group with reduced, mildly reduced and preserved ejection fraction. The guidelines follow the recent evidence based medicine and clinical studies in their recommendations. A novel group of drugs aiming to reduce morbidity and mortality and to improve the quality of life in patients with reduced ejection frations are SGLT2 inhibitors - gliflozins. The guidelines of the American Society of Cardiology set the treatment by gliflozins regardless of ejection fracion. The guidelines point out the treatment of comorbidities like diabetes, iron deficiency or tumors. A complex approach of patients with heart failure including heart failure clinics is presented.

Cardiomyopathies are defined as myocardial disorders in which the heart muscle is structurally and functionaly abnormal in the absence of a disease sufficient to cause this abnormality such as coronary artery disease, hypertension, valvular or congenital heart disease. According to the phenotype expresion cardiomyopathies are divided into dilated, hypertrophic, restrictive, arrhytmogenic and unclassified cardiomyopathies (noncompaction and tako-tsubo cardiomyopathy). The same phenotypic expression may include etiologically different forms of the disease, and at the same time phenotypic expression may change in many cardiomyopathies in the course of illness. For each type of cardiomyopathy, we further distinguish the familial (genetic) form and the acquired form. The clinical manifestation of the disease includes symptoms of heart failure, with reduced, mildly reduced or preserved ejection fraction, symptoms resulting from a number of arrhythmias and extracardiac symptoms, but in some cases symptoms may not be presented for a relatively long time. The disease can lead to significant morbidity and mortality if not detected and treated early, especially in young people who are frequently affected. Significant developments in diagnostic and treatment methods have led to an improvement in the prognosis of patients with cardiomyopathies in recent years.

Reflections of preventive cardiology history, it´s development and look to the future are mentioned. The main problems of primary and secondary prevention for atherosclerotic cardiovascular diseases are presented. New ways to the prevention improvement are sketched in the field of physician care, inside the whole society and throught the new technologies.

Introduction: Polypharmacy (polypharmacotherapy) is a serious problem among seniors. The aim of the work was to compare pharmacotherapy and polypharmacy among seniors in social facilities in 2001 and 2019.

Methodology: As of December 31, 2001, we collected data on the pharmacotherapy of 151 residents of two retirement homes (average age 75.1 years, 68.9% women). We compared the results with the pharmacotherapy of residents of two facilities for seniors as of October 31, 2019 (237 seniors, average age 80.5 years, 73.4% women). According to the medical records, we determined and compared the regularly used medicines of all residents, the use of medicines by age and sex, the use of 0-4 medicines, 5-9 medicines, 5 or more medicines, 10 or more medicines and the groups of medicines according to the ATC classification. For statistical processing, we used the t-test and chi-square test.

Results: In 2001, residents regularly used a total of 891 medicines, 18 years later, they used a total of 2099 medicines. We observed a significant increase in the average number of regularly used medications per resident by more than a half (from 5.90 medications to 8.86 medications), in women from 6.11 drugs to 9.24 drugs and in men from 5.45 drugs to 7.81 drugs. The number of residents with polypharmacy (regular use of ≥ 5 drugs) increased by almost a quarter (from 70.2% to 87.3%), and the number of seniors with excessive polypharmacy (regular use of ≥ 10 drugs) increased 4.6 times (from 9, 3% to 43.5%).

Conclusion: Our work confirmed that over the course of 18 years, the number of medications used by seniors in social-type institutions has increased. It also points to the trend of increasing polypharmacy and excessive polypharmacy among seniors, especially at the age of 75+ and among women.

Histamine intolerance (HIT) is a non-immunological disorder associated with an impaired ability to metabolize ingested histamine. Manifestation of HIT includes gastrointestinal and non-gastrointestinal symptoms. Clinical symptoms of HIT are non-specific and can imitate different diseases such as allergies, food intolerance, mastocytosis and other. The diagnosis of HIT is difficult. There are several candidate tests to detect DAO insufficiency, but their informative value is questionable. Currently, a positive clinical effect of a low-histamine diet is the most important for establishing the diagnosis. Equally in the treatment, a low-histamine diet is the most crucial approach. Other therapeutic options such as DAO supplementation treatment with antihistamines or probiotics are considered as complementary treatments. Our article provides a review on histamine intolerance, focusing on etiology and the diagnostic and treatment possibilities.

Deep vein thrombosis still represents a challenge regarding the diagnostics, treatment and follow-up. All this steps are often performed in the internal medicine ambulatory centers and such clinics therefore need to be aable to manage the whole process. Its key part is vascular sonography, which is needed to establish the diagnosis, the form of thrombosis and proper treatment course. There are two types of vascular sonography - Point of Care a expert sonography, being performed in two different regimes (diagnostic and follow up sonography). There are different demands for each of these two types, and each type is performed by physicians with different level of expertise. There are well defined criteria for performance a conclusions made for each type, and their precise fulfillment leads to establishment of diagnosis of DVT, early treatment initiation and setting of optimal strategy following the baseline treatment period.