Jak pečovat o pacienta, který nemá domov?

MUDr.Libor Kvapil

Interní Med. 2009; 11(11): 479  

Targeted screening of celiac disease

prof.MUDr.Přemysl Frič, DrSc., prof.MUDr.Jiří Nevoral, CSc.

Interní Med. 2009; 11(11): 484-487  

Celiac disease in Czech population remains diagnosed infrequently and at a late stage. The altered phenotype of the disease is the main cause. Intestinal symptoms dominate in small children only. Extraintestinal (atypical) symptoms are observed with increased frequency in older children, adolescents and particularly in adults. Targeted screening program aimed at risk groups and diseases, suspicious symptoms and associated autoimmune diseases represents the most important measure to improve the present situation. The two-step program is recommended in subjects of individual groups. The first step includes determination of IgA-serum antibodies...

Pain treatment in Czech republic - chronic pain and trends in invasive approaches

MUDr.Marek Hakl, Ph.D.

Interní Med. 2009; 11(11): 488-490  

Prevalence of chronic pain in Czech Republic and other European countries is about 20 % and this number slightly increases. Chronic pain is serious social problem. Correct pain treatment is multimodal, involves pharmacotherapy, physical treatment, psychotherapy and invasive and other treatment approaches. Invasive technics are used as accessory treatment method or as a last step in cases of pharmacotherapy failure. Recently we can see increasing interest in new modern and sophisticated methods like radiofrequency or neuromodulation and decreasing interest in anesthesiological type of blocks.

Occupational asthma and the challenge of its diagnostics

prof.MUDr.Daniela Pelclová, CSc., MUDr.Pavlína Klusáčková, Ph.D.

Interní Med. 2009; 11(11): 491-493  

In industrialized countries, occupational factors have been implicated in about 10 % of all cases of adult asthma. Occupational asthma includes immunologic asthma, characterized by a latency period before the onset of symptoms, and irritants-induced asthma after usually single exposure to high concentration of irritants. On the other hand, work-aggravated asthma, which is preexisting asthma exacerbated by workplace exposures is not acknowledged as occupational in the Czech Republic. Diagnosis of occupational asthma should be confirmed early after its onset by objective testing and the worker should be removed from the exposure to causal agent....

Why and how to check blood pressure at home

doc.MUDr.Eliška Sovová, Ph.D., MBA

Interní Med. 2009; 11(11): 494-497  

Cardiovascular mortality is the leading cause of death in the developed countries. High blood pressure is one of the essential risk factors. In 2002, the Prospective Studies Collaborators study was published which summarized the findings of 61 observational studies on the association of hypertension and mortality from cardiovascular diseases (CVD). Based on this metaanalysis, a correlation between blood pressure level and the risk of death from CVD was clearly confirmed. In 2007, the latest European guidelines for the diagnosis and treatment of hypertension were issued that place an emphasis on the assessment of cardiovascular risk. Regular...

New findings of the treatment of osteoporosis

MUDr.Dana Michalská, Ph.D.

Interní Med. 2009; 11(11): 498-502  

Osteoporotic fractures result from changes in bone mass, architecture and/or quality. In most instances these changes result from an imbalance between bone resorption and formation during the remodeling cycle. Therapeutic intervention can decrease bone resorption (anti-resorptives) and/or increase bone formation (anabolics). These interventions are however complicated by a coupling between resorption and formation in bone remodeling, leading to decreased bone formation in patiens treated with anti-resorptive. The understanding of the regulary mechanisms of the bone formation and the bone resorption brings new options of the treatment of osteoporosis....

Treatment of chronic viral hepatitides in 2009

prof.MUDr.Petr Husa, CSc.

Interní Med. 2009; 11(11): 504-506  

In April 2009, a new Czech guideline was issued on diagnosing and treatment of chronic hepatitis B. Therapeutically, the most significant change is the diversion from using drugs that have the lowest efficacy and are associated with a high risk of developing resistance to them during treatment (lamivudine, telbivudine, adefovir dipivoxil). Currently, pegylated interferon alpha-2a, tenofovir, and entecavir are clearly preferred in treatment-naive patients. The combination of pegylated interferon alpha and ribavirin remains the standard treatment of chronic infection with the hepatitis C virus. Monitoring of viral kinetics at the beginning of...

Diferencial diagnosis of hypocalcemia

prof.MUDr.Petr Broulík, DrSc.

Interní Med. 2009; 11(11): 507-510  

Ionized calcium plays a pivotal role in many physiological and biochemical procesesses including the contraction of muscles, the clotting of blood and impulse conduction in the heart and nervous system. Moreover it acts as secondary messenger within the cell to initiate other cascades important for cell signaling and both exocrine and endocrine secretion. In blood calcium is found in three forms ionized (50 %) protein bound (40 %) and soluble complexes (10 %). In normal individuals the range of serum calcium is 2,2–2,55 mmol/l. Hypocalcemia is characterized by decreased level of ionized calcium under the normal level which is usually...

Adrenal incidentalomas

doc.MUDr.Zdeněk Fryšák, CSc., MUDr.David Karásek, Ph.D., MUDr.Milan Halenka, Ph.D.

Interní Med. 2009; 11(11): 511-514  

Incidentaloma, an incidental finding of a pathological structure in the area of the adrenals detected by imaging methods, must elicit interest in the attending physician appropriate to the relevance of such a finding. Not all available imaging methods are capable of providing information of sufficient quality, and nor can they assure a reliable interpretation concerning the biological nature of the incidentaloma. An assessment of possible secretory activity is another, substantial, and no less significant aspect of the diagnostic process. The present review should help those who seek to find updated information on adrenal incidentalomas. The...

Dependence on zolpidem

MUDr.Josef Chval

Interní Med. 2009; 11(11): 518-519  

In this case report I am presenting a case of zolpidem dependent patient who was repeatedly hospitalised in psychiatric hospital. As such, there is an increase in number of zolpidem dependent patients. We have limited experience with the treatment of withdrawal syndrome and with the long term treatment of such patients. Therefore in my article I would like to draw attention towards the risk of zolpidem dependence and raise the interest upon this problem.

Medication of erectile dysfunction and its security

doc.MUDr.Michal Pohanka, Ph.D., prof.MUDr.RNDr.Luboslav Stárka, DrSc.

Interní Med. 2009; 11(11): 515-517  

Erectile dysfunction is a relatively frequent disorder substantially increasing with age. The high effective treatment of erectile dysfunction by drugs based on inhibition of phosphodiesterases type 5 (sildenafil, tadalafil, vardenafil) tempt to prescription of these drugs without careful examination. It is demanded to include besides personal history and physical examination also laboratory data for exclusion of diseases associated with erectile dysfunction as diabetes mellitus, hyperprolactinemia or hypogonadismus. Contraindicated for treatment by inhibitors of phophodiesterases are nitrates. For patients on intensive antihypertension therapy...

Education of the clients in question with testing for detection of ocult bleeding by fecal occult blood tests

Mgr.Jan Chrastina, doc.PhDr.Jana Marečková, Ph.D.

Interní Med. 2009; 11(11): 524-526  

This theoretical article is focused on the necessity of the correct educational process in question with testing of occult bleeding in stool by the patient (client). Article sumps up the recommendations for effective fulfilment and scoring of test and it is focused on understandable and high quality information, which can be used as so-called baterry of information for the educational process of patients (clients). Article can be used as instance of educational program for patients (clients) who will be able to do the testing for occult bleeding in stool at the convenience of their own homes. Article contains changes in colorectacal cancer...

Is there an effective influenza prevention?

MUDr.Jana Vojtíšková

Interní Med. 2009; 11(11): 520-521  

Prevention refers to a set of strategies and measures that can be taken to promote health. Is effective prevention from influenza possible and what are the possible measures?

The concept of nutritional pharmacotherapy in critically ill patients

MUDr.Jan Jahoda

Interní Med. 2009; 11(11): 522-523  

Nutritional support for critically ill patients is undergoing a significant worldwide progress. It is not a coincidence that in the last few years many societes created evidence based recommendations for enteral and parenteral nutrition. However, it takes a long way to implement most of these guidelines to daily clinical practice. The concept of nutritional pharmacotherapy is one of them.

Autodidaktický test 10/2009

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Interní Med. 2009; 11(11): 527