Co dnes trápí ambulantní specialisty?

Zorjan Jojko

Interní Med. 2016; 18(2)  

Idiopathic pulmonary fibrosis - or what new in idiopathic interstitial pneumonia

MUDr.Martina Doubková

Interní Med. 2016; 18(2): 61-65 | DOI: 10.36290/int.2016.015  

Interstitial lung diseases, also called difuse parenchymal lung disorders, are characterized by a variable degree of inflammatory and fibrotic changes affecting interstitial spaces, air spaces and alveolar walls. New knowledge about these diseases led in 2013 to create a new classification of one of the subgroups of interstitial lung diseases called idiopathic interstitial pneumonias (IIPs). IIPs are divided into major, rare and unclassifiable. Major IIPs are subdivided into chronic IIPs, smoking-related IIPs and acute/ subacute IIPs. Idiopathic pulmonary fibrosis (IPF), the most common and severe form IIP, with a poor prognosis. IPF is characterised...

Combination therapy of arterial hypertension - a review of actual guidelines

MUDr.Barbora Nussbaumerová, Ph.D.

Interní Med. 2016; 18(2): 66-70 | DOI: 10.36290/int.2016.016  

The article summarizes the present oppinion on the combination treatment of arterial hypertension. The most recommended and evidence based combinations are 1/angiotensin converting enzyme inhibitor/angiotensin receptor blocker + calcium channel blocker, 2/ angiotensin converting enzyme inhibitor/angiotensin receptor blocker + diuretic and 3/ calcium channel blocker + diuretic. Fixed combination of 2 or 3 drugs are available and recommended.

Do we use statins enough? News in the combination treatment by statins ánd ezetimibe

MUDr.Barbora Nussbaumerová, Ph.D.

Interní Med. 2016; 18(2): 71-73 | DOI: 10.36290/int.2016.017  

Many patients do not reach target cholesterol levels because of the underdosed statin treatment. The IMPROVE-IT study shows that a further lowering of the LDL cholesterol in patients on statins after an acute coronary syndrome by ezetimibe leads to a further cardiovascular risk reduction.

Statin associated muscle symptoms - literature review and our experience

MUDr.Ľubica Cibičková, Ph.D., doc.MUDr.David Karásek, Ph.D.

Interní Med. 2016; 18(2): 74-76 | DOI: 10.36290/int.2016.018  

Muscle symptoms associated with statin therapy (statin associated muscle symptoms, SAMS) decreases patients’ adherence to this effective therapy. SAMS are not specific muscle aches, which can but needen’t to be accompanied by elevation of creatinkinase. Their occurrence differs depending on the type of performed study with statins. Older patients, females, patients with concomitant medication, comorbidities, higher physical activity, alcohol intake and genetically predisposed patients are in higher risk in developing SAMS. Although concrete mechanism leading to development of SAMS is not clear, consequences of SAMS are clearly...

New peroral antidiabetic drugs and heart failure

MUDr.Jana Jiráčková, doc.MUDr.Alena Šmahelová, Ph.D.

Interní Med. 2016; 18(2): 78-82 | DOI: 10.36290/int.2016.019  

Important risk factors of chronic heart failure (CHF) i diabetics represent ischaemic heart disease and arterial hypertension as well as diabetic cardiomyopathy (specific heart tissue impairment of diabetes mellitus). Optimal diabetic compensation is essential for prevention and treatment of CHF. A wide range of antidiabetic drugs can lower effectively blood glucose as well as improve cardiovascular parameters. Metformin – traditional antidiabetic drug is a very effective insulin sensitizer with positive cardiovascular effect; metformin can be used in patients with compensated CHF. Gliptins, modern peroral antidiabetic drugs, are used...

Cor pulmonale chronicum

MUDr.Martina Tuháčková, doc.MUDr.Jaromír Chlumský, Ph.D.

Interní Med. 2016; 18(2): 83-86 | DOI: 10.36290/int.2016.020  

Cor pulmonale is a clinical term defined as an alteration in the structure and /or function of the right ventricle caused by a precapillary pulmonary hypertension. Worldwide, the most common cause of chronic cor pulmonale is chronic obstructive pulmonary disease (COPD). Diseases complicated by cor pulmonale have a worse survival rate than the same disease without malfunction of the right ventricule. Symptoms of cor pulmonale include dyspnea, lethargy, exertional syncope, and exertional chest pain. Echocardiography is the most used diagnostic method. Major goals of this treatment include reduction of the right ventricular afterload, a decrease...

Komentář k článku „Co je C-reaktivní protein a jak správně interpretovat jeho zvýšené hodnoty?“ - Interní Med. 2016; 18(1): 49-51

prof. MUDr. Vladimír Soška, CSc.

Interní Med. 2016; 18(2): 106  

Treating a type 2 diabetic patient with renal insufficiency

MUDr.Eva Račická

Interní Med. 2016; 18(2): 91-94 | DOI: 10.36290/int.2016.022  

The treatment of type 2 diabetes mellitus is comprehensive where, in addition to recommendations on lifestyle modifications, pharmacological treatment is initiated the range of which has expanded significantly in recent years. Metformin remains the firstchoice drug and, according to disease progress, it is possible to choose combinations with other drugs. The present case report describes the treatment in an obese type 2 diabetic patient who, at the time of diagnosis of his disease, was found to have stage 3 chronic kidney disease that is a contraindication to administering metformin. Following the compensation with insulin treatment, the...

Linagliptin - diabetes safely controlled from the very start

MUDr.Barbora Doležalová, MUDr.Milan Flekač, Ph.D.

Interní Med. 2016; 18(2): 97-99 | DOI: 10.36290/int.2016.023  

This article presents case reports of two patients with type 2 diabetes in whom the use of linagliptin led to long-term excellent glycemic control, and offered the patients to maintain an active lifestyle without the risk of hypoglycaemia or drug interactions.

Campylobacter myocarditis with septic shock and STEMI equivalent in a young patient

MUDr.Jakub Rychlík, MUDr.Martin Zeman, MUDr.Jiří Hlas, MUDr.Petr Šimek, MUDr.Milan Sepši, Ph.D., MUDr.Zdeněk Klimsa

Interní Med. 2016; 18(2): 100-102 | DOI: 10.36290/int.2016.024  

In this paper we present a case report of a young patient that was hospitalized in Jihlava hospital for gastroenteritis with fulminant progress resulting in septic shock. Stool cultivation was positive for Campylobacter jejuni. Bacterial infection caused perimyocarditis with transient ST elevation in unipolar leads V1-V3. Patient recovered completely after ampicilin and ciprofloxacin therapy including 6 months of follow up. To our best knowledge this is the first documented case of periomyocarditis associated with C. jejuni infection in the Czech Republic.

Canagliflozin-inhibitor SGLT2 in diabetes mellitus therapy

MUDr.Alena Adamíková, Ph.D.

Interní Med. 2016; 18(2): 103-106 | DOI: 10.36290/int.2016.025  

Canagliflozin-inhibitor SGLT2 ranks among the selectively acting inhibitors of the sodium-glucose co-transporter SGLT2. It reduces glycaemia by blocking reabsorption of glucose in the kidneys and by lowering the renal threshold. Increased glycosuria is linked to reduction of weight during energy losses and lowering of blood pressure at osmotic diuresis. Transient inhibition of SGLT1 with impact on enteric absorption of glucose is assumed. During inhibition of SGLT2 there exists a lower risk of hypoglycaemia as the extent of excretion of glucose in the urine diminishes on decrease of glycaemia. Reduction of glycaemia at SGLT2 inhibition is independent...

Optimising treatment in Alzheimer’s disease

MUDr.Vanda Franková

Interní Med. 2016; 18(2): 87-90  

The first step in Alzheimer’s disease treatment is an accurate diagnosis and recognition of all symptoms of the disorder. Management should start as soon as possible, optimally in the initial stage of the disease. The approach has to be complex, person-centred and conclude not only the patient but also his family/caregivers. Careful assessment for any comorbidities, their treatment and programming meaningful activities is necessary. Management of problem behaviors begins with a careful search for triggers and causative factors, where possible should be non-pharmacological. Cholinesterase inhibitors and memantine are recommended for Alzheimer’s...