Reforma zdravotnictví a její dopad na internu

MUDr. Pavel Vepřek

Interní Med. 2011; 13(10): 371  

Current perspective on diagnosing and treating ankylosing spondylitis

doc.MUDr.Ladislav Šenolt, Ph.D.

Interní Med. 2011; 13(10): 374-377  

Ankylosing spondylitis is a chronic inflammatory rheumatic disease affecting the axial skeleton that causes inflammatory back pain and may lead to structural spinal damage, functional handicap and major reduction in the quality of life. The diagnosis of ankylosing spondylitis is based on the 1984 modified New York criteria that require radiographic evidence of damage to the sacroiliac joints. The use of magnetic resonance imaging and of modern therapeutic options has substantially improved the approach to this condition. The author provides an overview of the classification criteria for axial spondyloarthritis and a recently defined guideline...

Pharmacotherapy after myocardial infarction

prof.MUDr.Jindřich Špinar, CSc., prof.MUDr.Jiří Vítovec, CSc., prof.MUDr.Lenka Špinarová, CSc.

Interní Med. 2011; 13(10): 378-382  

Early reperfusion is currently the mainstay of treatment for acute coronary syndrome. Thanks to a network of 22 catheterization centres, the Czech Republic is among countries with a high availability of reperfusion therapy. Approximately 28,000 patients are thus treated annually. Successful reperfusion must be followed by lifestyle measures including not smoking, maintaining a healthy weight, etc. All this must be complemented with effective pharmacotherapy whose goal is to prevent left ventricular remodelling, coronary artery restenosis, rethrombosis and arrhythmias. Four drug groups are designed for this purpose: renin-angiotensin-aldosterone...

Vitamin D and its role (not only) in osteology

prof.MUDr.Vladimír Palička, CSc.

Interní Med. 2011; 13(10): 383-387  

Vitamin is a substance that has long been known and, in osteology, considered essential for a healthy development and subsequent metabolism of bone tissue. However, only recently have some details of its effect on bone tissue been elucidated. The active form of vitamin D (calcitriol) stimulates the production of RANKL, thus activating osteoclasts and simultaneously affecting the plasticity of pluripotent mesenchymal cells and the stimulation of genes involved in osteoblast transformation. However, vitamin D is also involved in a number of other processes in the organism. Of major importance is the interaction between vitamin D and the immune...

Thyroid disorders in pregnancy

prof.MUDr.Jiří Horáček, CSc.

Interní Med. 2011; 13(10): 388-390  

There is an increased need for thyroid hormones in pregnancy, and normal thyroid increases their synthesis in compensation. In the terrain of chronic autoimmune thyroiditis, such a compensation may be absent, and the resulting hypothyroidism (even subclinical), and even the autoimmune process itself, may adversely affect the pregnancy course and outcome, maternal quality of life, as well as neurological development of the offspring. At least some of these risks are reversible by levothyroxine treatment. Therefore, we recommend universal screening of thyroid disorders in early pregnancy using TSH and TPO-Ab assays.

Invasive meningococcal diseases

doc.MUDr.Stanislav Plíšek, Ph.D., doc.MUDr.Roman Chlíbek, Ph.D., MUDr.Pavel Kosina, MUDr.Vanda Boštíková, Ph.D., MUDr.Petr Prášil, Ph.D.

Interní Med. 2011; 13(10): 391-393  

The majority of meningococcal diseases are caused by serogroups A, B, C, W-135, X and Y of bacteria Neisseria meningitidis, geographical distribution of which varies substantially. Neisseria meningitidis is fairly sensitive to the broad spectrum of antibiotics, but in some cases, even after timely initiation of proper antibiotic therapy, systemic inflammatory response may develop, which can lead to a severe multiorgan failure. Neisseria meningitidis can cause both invasive and noninvasive form of the disease. Noninvasive meningoccocal diseases include for example pharyngitis, pneumonia, bronchitis and others. Invasive meningococcal disease...

The care for patients with pandemic influenza

MUDr.Lenka Petroušová, MUDr.Luděk Rožnovský, CSc., MUDr.Tomáš Daněk, MUDr.Roman Kula, CSc., Mgr.Jakub Mrázek

Interní Med. 2011; 13(10): 398-400  

The influenza A (H1N1) 2009 is a new subtype of a virus that emerged in a human population in April 2009. It was causing mild illnesses but also serious hemorrhagic pneumonia, it was attacking mainly younger and middle generation. More serious course of the disease was observed in patients with immunosuppression or with obesity, in pregnant women, but a third of patients were without any risk factors. In the following text we would like to present our own experience with this serious disease and would like to recommend larger use of the seasonal and pandemic influenza vaccination.

Vagaries of the thyroid gland

MUDr.Ľubica Cibičková, Ph.D., MUDr.Ľubica Víchová

Interní Med. 2011; 13(10): 401-402  

We present a case of a young woman with alternating hyper- and hypothyroidism. During the treatment of her infertility, the outpatient gynaecologist revealed subclinical hyperthyroidism (diagnosed as a hyperthyroid period of chronic lymphocytic thyroiditis) which subsequently switched to hypothyroidism. Following thyroxin supplementation the patient became pregnant and bore a full-term child. Four months after the delivery a post-partum thyroiditis sprang up and vanished spontaneously without treatment. This case-report demonstrates how thyroid gland function may alternate in an immunologically predisposed terrain (positive thyreoglobulin antibodies)...

Endometriosis: impact on quality of the life for women

MUDr.Hana Hrušková

Interní Med. 2011; 13(10): 394-396  

The article overviews of the etiopathogenesis, pathophysiology, diagnosis and treatment of endometriosis based on the conclusions of ESHRE (European Society of Human Reproduction), which regularly provides new data on the basis of EBM (Evidence Based Medicine) guidelines for diagnosis and treatment of endometriosis.

Nutrition in Crohn´s disease

MUDr.Milana Šachlová, CSc.et Ph.D.

Interní Med. 2011; 13(10): 403-405  

Crohn‘s disease is a chronic inflammatory bowel disease with relapse and remission. Nutrition plays an important role in the prevention and treatment of malnutrition. In active disease, the effective support of energy and nutrients is a very important part of the therapy. Natural and artificial nutrition or the combination of two can be chosen for supporting therapy of Crohn´s disease.

Upper dyspeptic syndrome - guidelines for practice

doc.MUDr.Bohumil Seifert, Ph.D.

Interní Med. 2011; 13(10): 406-408  

Dyspeptic complaints are among the most common reasons to see a physician and their diagnosis and treatment represents a major economic burden. Specialized care for patients with gastrointestinal complaints is not to be simplified in that there are gastroenterology specialists to treat dyspeptic complaints. Given the prevalence of these complaints and particularly the predominance of functional disorders, the role of general practitioners and their competency in this area is significant and urgent as is the need to optimize interdisciplinary cooperation. In the recent years, a lot of effort has been put into creating guidelines and algorithms...

Human insulin vs. insulin analogue: results of a prospective, multi-centre, open-labelled, non-interventional,

doc.MUDr.Martin Prázný, CSc., Ph.D.a spolupracovníci

Interní Med. 2011; 13(10): 409-412  

24-week observational study in type 2 diabetics taking NovoRapid®, NovoMix® or Levemir® A large observational study aimed at the treatment with modern insulins was carried out in the Czech Republic in the years 2008 and 2009. It included 266 centres in which a total of 4824 patients were enrolled. The primary outcome was observation of improvement in HbA1C (IFCC) levels after switching from treatment with human insulin to that with modern insulins (insulin analogues) in the treatment of type 2 diabetes. The secondary outcomes were observation of some other parameters of diabetes control and the safety of treatment with insulin...

Autodidaktický test 9/2011

Interní Med. 2011; 13(10): 415