Vnitrni lekarstvi最新文献

The field of immunology has undergone a very significant development in recent decades, which has been reflected especially in the beginning of this millennium in significant advances in the understanding of the immune system and in the application of this knowledge in practice. The progress and acceleration of research and advances in the field of immunology was further prompt by the unexpected onset of the COVID-19 pandemic in 2020. The intense scientific work has not only led to the development of our understanding of the immune response to viruses, but also to the rapid conversion of this knowledge into practical pandemic management on a global scale, as exemplified by the development of vaccines against SARS-Cov-2 virus. The pandemic era has further contributed to the acceleration of the application of not only biological discoveries but also technological approaches into practical applications, such as use of advanced mathematics, computer science and, more recently, artificial intelligence which are all are adding to the advances that are significantly moving the field of immunology forward. In this communication, we present specific advances in particular areas of immunopathology, which are mainly allergy, immunodeficiency, immunity and infection, vaccination, autoimmune diseases and cancer immunology.

The document summarizes the statement of the expert discussion panel of the 1st Point- of-Care Ultrasonography, which took place on 14 November 2022 in Prague and which led to the foundation of the Czech Multidisciplinary Task Force Group for standards,education and research in Point-of-Care ultrasound (Czech POCUS group).

Eplerenone is a selective mineralocorticoid receptor antagonist. Its approved for the therapy of patients with chronic heart failure with left ventricular systolic dysfunction and for the patients after myocardial infarction complicated by heart failure and left ventricular dysfunction. It´s also recommended for the therapy of primary hyperaldosteronism and the treatment of drug resistant hypertension.

The assumption of accelerated postoperative recovery according to the ERAS (Enhanced Recovery After Surgery) method is good condition of the patient prepared for surgery and gently operated on. Application of ERAS in postoperative care in the situation of patient with multimorbidity requires an individual approach and greater pre-operative preparation. During the healing process, the operation causes a systemic inflammatory reaction in the body, which is proportional to the size of the surgery trauma. There is fluid movement between the intravascular and interstitial spaces, increased protein catabolism, increased susceptibility to infectious complications and increased risk of decompensation of chronic diseases. The mandatory content of the pre-operative examination is a functional cardiopulmonary reserves assessment, nutritional risk screening, update of diagnostic summary and optimization of chronic medication before surgery. Prehabilitation and nutritional preparation before the planned operation is influenced by the time urgency of the operation, but even in the case of cancer, short-term nutritional preparation is indicated., Medical workplaces are the most suitable for parenteral and enteral pre-operative nutrition however some surgical departments perform the preparation themselves if necessary. The GDT (Goal Directed Therapy) regimen with a higher degree of hemodynamic monitoring and intervention is applied in the postoperative care of hemodynamic unstable risk patients. Next to decompensation of a chronic disease is mainly heart rhythm disorders (most often atrial fibrillation), cardiac complications including coronary event, stroke, acute delirium.

Thyroid carcinoma (TC) is rare and represents 1-2 % of all human tumors. The incidence of TC has been increasing worldwide. TC comprises of a heterogeneous group of tumours with variable biological activity. Women are mostly affected. TC can be divided in differentiated TC/DTCs (papillary - PTC, follicular - FTC, from Hürthle cells - HCC), medullary carcinoma - MTC and anaplastic thyroid cancer - ATC. In this article, we focus on possible pitfalls of suppression therapy (cardiovascular, bone and mental), particularly in low-risk patients, and we discuss the data on the adherence to guidelines for suppression therapy in DTC.

Anemia, which is a manifestation of the deterioration of patients' health and performance, is a common concomitant condition in diseases with signs of inflammation activation. This anemia - anemia of inflammation, is caused by disturbances of iron metabolism that lead to iron retention within macrophages, cytokine mediated inhibition of erythropoietin function and erythroid progenitor cell differentiation, and a reduced erytrocyte half-life. Anemia is usually mild to moderate, normocytic and normochromic. It is characterized by low iron circulation, but normal to increased levels of stored ferritin and the hormone hepcidin. The primary therapeutic approach is the treatment of the underlying inflammatory disease. In case of failure, iron supplementation and / or treatment with erythropoietin stimulating agents may be used. Blood transfusions are just an emergency treatment for life-threatening anemia. A new treatment modalities with hepcidin-modifying strategies and stabilizers of hypoxia inducible factors is emerging. However, their therapeutic efficacy needs to be verified and evaluated in clinical trials.

Introduction: Chronic venous disease is known to gradually worsen in the course of years. However, little clinical data is available. The patient group and methods: We used the set of our patients with completed clinical examination, duplex sonography and photoplethysmography and selected 160 patients examined at our office after 10 and more years. Females represented 79% in the group. The mean age was 54 years (range 18-82 years). Venous varices in lower limbs in the family were reported by 49% patients. Venous sclerotization had been undergone by 6.3% and venous surgery by 10.6% patients. The mean body mass index was 27. We used CEAP classification. The clinical class C1 included 50 patients, C2 included 81, C3 included 15 and C4 included 14 patients. Regurgitation in superficial veins was found in 43%. The mean venous return time after physical activity was 24.5 s.

Results: The last examination was performed after 13 years on average (range 10-28 years). Deterioration of the clinical condition and progression to a higher class were observed in 36% patients in class C1, in 23.5% patients in C2, in 13% patients in C3 and in 7% patients in C4. We did not demonstrate any statistically significant effect of the followed parameters on the progression of the disease.

Conclusion: The progression rate of the disease in our patient group followed at the vascular office for 10 and more years is lower compared to population studies.

Sodiumglucose co-transporter 2 inhibitors - gliflozins - have a scientific evidence on efficacy in patients with heart failure regardless left ventricular ejection fraction. Gliflozins They reduced combined endpoint of cardiovascular mortality and heart failure hospitalization also in patients with heart failure and left ventricular ejection fraction above 40 %. We report a case study of a patient with new onset heart failure. Early initiation of therapy with empagliflozin was associated with an improvement of symptoms and laboratory parameters including NT-proBNP level.

Osteomalacia with characteristic histomorphometric, radiographic, laboratory and clinical features is a prominent syndrome of disturbed bone mineralisation in adulthood. From an etiological point of view, osteomalacia is usually caused by substrate (calcium, phosphate) deficiency, presence of excess mineralization inhibitors or deficiency or ineffectivness of mineralization facilitator (vitamin D). In proportion to the high number of congenital and acquired causes of osteomalacia, its clinical and laboratory picture is heterogeneous and rarely fully expressed. The treatment of a particular case is determined by the cause of osteomalacia and may (but does not necessarily) include correction of the underlying disease, administration of calcium and various forms of vitamin D, as well as orthopaedic interventions. For some of the hereditary forms, biological or replacement therapy is prospectively available. The article attempts to cover the whole range of osteomalacia variants, mentioning a fact discussed only in recent years - the occurrence of oligosymptomatic, incompletely expressed forms.

Compared to general population, patients with chronic kidney disease (CKD) exhibit high prevalence of cardiovascular disease (CVD) that increases with a stage of CKD. Traditional and non-traditional risk factors associated with CKD contribute to accelerated atherosclerosis leading to CVD. CVD represents the main cause of morbidity and mortality in CKD population. Pretransplant examination is essential to evaluate and optimize the state of cardiovascular system prior transplantation, thus   to minimize risks that could have a negative impact on transplant outcome.