Casopis lekaru ceskych最新文献

In connection with the increasing prevalence of overweight and obesity, the number of these patients in intensive care units is increasing - current statistics indicate 20-30% of patients admitted in the obesity zone and 25% in the overweight zone. Nutritional goals and strategies for patients with obesity are one of the biggest challenges of modern nutritional care. They include a comprehensive diagnosis of malnutrition and the correct determination of energy and protein intake, for which it is possible to use formulas recommended by the European Society for Parenteral and Enteral Nutrition (ESPEN) or the American Society for Parenteral and Enteral Nutrition (ASPEN). The research focuses on the possibilities of immunonutrition and influencing the microbiota.

Alcohol-related liver disease (ALD) represents a broad continuum of pathological conditions caused by excessive alcohol consumption - from simple steatosis through steatohepatitis and fibrosis to cirrhosis and its complications. The article summarizes the current view on this issue.

The current effective antibiotic therapy requires modern approaches focused on optimizing treatment and slowing the growth of antimicrobial resistance. A key tool in hospitals is the concept of antimicrobial stewardship, which relies on collaboration in multidisciplinary teams composed of infectious disease specialists, microbiologists, clinical pharmacists, and epidemiologists. These teams focus on the correct choice of antibiotic and its dosage, monitoring its effectiveness and minimising adverse effects. Expanding possibilities in the field of monitoring and interpretation of plasma concentrations of an increasing number of antibiotics enable effective and safe optimization of dosing and administration methods (prolonged and continuous infusions) adjusted for individual patients, thereby allowing a personalized approach to pharmacotherapy. The optimization of antibiotic dosing is further supported using modern administration tools. In the hospital setting, electronic parametric prescribing, centralized preparation and dispensing of anti-infectives by the hospital pharmacy also leads to improved safety. In outpatient care, possibilities are expanding with the concept of outpatient parenteral antimicrobial therapy, which reduces the risk of nosocomial infections and provides the comfort of a home environment for patients. However, its broader use is hindered mainly by the lack of official stability data for antibiotic preparations, as well as administrative and financial barriers associated with integrating this innovative concept into routine practice.

Artificial intelligence (AI) has been increasingly applied in radiology, where it offers the potential to improve the accuracy and efficiency of diagnosis, particularly in the evaluation of conventional imaging modalities such as chest X-rays. This study analyzes the performance of commercial software using machine learning and, respectively, artificial intelligence approaches (Carebot AI CXR; Carebot s.r.o.) in detecting abnormalities in chest radiographs compared with independent evaluations by 3 radiologists of different levels of experience. The study was conducted in collaboration with Hospital Tabor, which provided a dataset of 207 anonymised radiographs, out of which 196 were assessed as relevant. The sensitivity and specificity of AI were compared with human assessment in 5 categories of abnormalities: atelectasis (ATE), consolidation (CON), cardiac shadow enlargement (CMG), pleural effusion (EFF) and pulmonary lesions (LES). Carebot AI CXR software achieved high sensitivity in all evaluated categories (e.g., ATE: 0.909, CMG: 0.889, EFF: 0.951), and its performance was consistent across all findings. In contrast, AI specificity was lower in some categories (e.g., EFF: 0.792, CON: 0.895), while radiologists achieved performance values approaching 1.000 in most cases (e.g., RAD 1 and RAD 2 EFF: 1.000). AI demonstrated consistently higher sensitivity than less experienced radiologists (e.g., RAD 1 ATE: 0.087, CMG: 0.327) and in some cases than more experienced assessors, but at a modest decrease in specificity. The study also includes case reports, including false-positive and false-negative findings, which contribute to a deeper understanding of AI performance in clinical practice. The results suggest that AI can effectively complement the work of radiologists, especially for less experienced doctors, and improve the sensitivity of diagnosis on chest radiographs.

Peyronie's disease is an acquired fibrotic disorder of the tunica albuginea, leading to penile deformity, painful erections, and often erectile dysfunction; its prevalence in Europe reaches up to 9% in middle-aged men. This review summarizes the results of studies from 2019-2025 concerning diagnostic methods and therapeutic options. Based on the analysis of 142 original studies, 23 meta-analyses, and current European Association of Urology (EAU) a American Urological Association (AUA) recommendations, we confirm that intralesional verapamil reduces curvature in the active phase by an average of 9-17° and low-intensity shockwave therapy (LiSWT) improves pain and reduces curvature by approximately 10°, particularly for plaques larger than 2 cm. Surgical methods - plication, incision/grafting, and penile prosthesis implantation - achieve initial straightening in more than 90% of cases but differ in impact on penile length and the risk of de novo erectile dysfunction. Regenerative therapies like platelet-rich plasma (PRP) or mesenchymal stem cells (MSC) offer promising, yet currently experimental results. Optimal care is based on early diagnosis, individualization of conservative treatment, and precise surgical correction; in the Czech Republic, standard approaches include verapamil, LiSWT, and surgery, while biological approaches require further research.

Mlíková Seidlerová J. Alcohol and the cardiovascular system The consumption of alcohol leads to a variety of direct and indirect effects on the cardiovascular system, as evidenced by numerous epidemiological studies on this topic. The effect of alcohol on the development of cardiovascular complications is influenced not only by the amount of alcohol consumed but also by the drinking pattern (binge drinking vs. regular consumption of moderate amounts of alcohol). This applies to the relationship between alcohol consumption and the rise in blood pressure or the development of arterial hypertension as well.

Inosine pranobex (IP), also known as inosine pranobex dimepranol, is an immunomodulatory drug with a history spanning more than fifty years. It was first introduced in the 1970s and has since been licensed in more than 50 countries around the world. It was originally considered a potential drug for AIDS, which raised high hopes at the time of the discovery of the HIV virus. However, after initial interest, its use in this area declined, and for a long time, IP was no longer discussed significantly in professional literature or clinical practice. Renewed interest came only in the last decade, when IP began to reappear in connection with the treatment of acute respiratory infections, diseases caused by human papillomavirus (HPV), and other viral diseases, including COVID-19. It also began to be used as an adjuvant in the foot-and-mouth disease vaccine, and research began on an IP-based anti-tumor vaccine.