Internal Medicine for Practice, 2017, issue 3

Editorial

Pohled na současnou postgraduální přípravu lékařů

JUDr. Pavel Janda

Interní Med. 2017; 19(3): 103

Review articles

What has changed in treatment of patients with dyslipidemia?

MUDr. Ondřej Kyselák, prof. MUDr. Vladimír Soška, CSc.

Interní Med. 2017; 19(3): 106-108 | DOI: 10.36290/int.2017.020

Summary: Dyslipidemia is very frequent metabolic disease in general population of developed countries. Last year, the European Society of Cardiology (ESC) and European Society of Atherosclerosis (EAS) released new guidelines for management of dyslipidaemias. In some groups of patients, the criteria for estimation of individual cardiovascular risk were changed. Recommendations for target LDL cholesterol values were also modified and this is why reaching the target level of LDL cholesterol should be now more difficult. Therefore, combination of hypolipidemic drugs and using new drugs (as PCSK9 inhibitors) will be needed. Patient’s compliance...

Innovations in treatment of IBD

MUDr. Tomáš Douda, Ph.D.

Interní Med. 2017; 19(3): 110-115 | DOI: 10.36290/int.2017.021

The steady advances in the treatment of IBD for the past decade have been quite significant. The changes concern all of the steps in the treatment pyramid. The changes involve the surgical approach to treatment, method of aminosalicylate administration in ulcerative colitis, the use of new slow release tablets by means of MMX, optimization of azathioprine treatment a resumption methotrexate treatment comes into play. New biologics have been established in the past decade, particularly biosimilar anti-TNF. New possibilities of IBD treatment with different mechanism of action apart from the anti-TNF are discovered nowadays.

Atypical hemolytic uremic syndrome and current view on the treatment

prof. MUDr. Romana Ryšavá, CSc.

Interní Med. 2017; 19(3): 116-124 | DOI: 10.36290/int.2017.022

Atypical hemolytic uremic syndrome (aHUS) is one of many causes of thrombotic microangiopathies (TMA) and represents about 5–10% of all HUS. aHUS is a very rare life-threatening disease with can impair many body systems and untreated disease can have a very poor prognosis with high morbidity and also mortality. More than 40% of patients are older than 18 years of age. Permanent activation of alternative complement pathway due to the defective function of some complement factors is a leading cause of the disease. Alteration in some complement factors function is caused by loss of function mutations in responsible genes or in formation of...

Different aspects of treatment of stable COPD according to GOLD 2017 strategy

MUDr. Ondřej Kudela, MUDr. Vratislav Sedlák, Ph.D., MUDr. Vladimír Koblížek, Ph.D.

Interní Med. 2017; 19(3): 126-130 | DOI: 10.36290/int.2017.023

This article examines changes in therapeutic strategies in stable COPD, as presented in The Global Initiative For Chronic Obstructive Pulmonary Disease(GOLD) 2017 revised document.

Hereditary angioedema – therapeutic trends

MUDr. Irena Krčmová, CSc.

Interní Med. 2017; 19(3): 131-137 | DOI: 10.36290/int.2017.024

Hereditary angioedema is a serious and rare autosomal dominant hereditary disease manifested by the formation of painless, nonpruritic subcutaneous and/or submucosal swelling. It is caused by a gene mutation resulting in an absolute or relative lack of C1 inhibitor (nonfunctional protein). It occurs with a frequency of 1 : 50 000 to 1 : 10 000 in the population. The treatment of hereditary angioedema involves the use of three therapeutic strategies comprising long-term prophylaxis, short-term prophylaxis, and acute state treatment. Long-term prophylaxis involves the use of oral esterase inhibitors (tranexamic acid) or anabolic steroids (attenuated...

Modern antihistamines in treating allergies: current trends in symptomatic therapy of allergic conditions

MUDr. Jaroslava Braunová, Ph.D., MUDr. Mojmír Račanský

Interní Med. 2017; 19(3): 138-141

Allergic diseases are a challenge for contemporary medicine. They involve not only the mere manifestations of seasonal rhinitis, encountered to a certain degree by nearly everyone, but also serious conditions, such as anaphylactic shock and bronchial asthma exacerbation. A non-negligible aspect is the issue of various skin manifestations of hypersensitivity. They are invariably associated with a great deal of discomfort for the sufferer. With a rising incidence of these allergic conditions, the demand for effective treatment naturally rises. An example of causal therapy is allergen immunotherapy (AIT). Unfortunately, it is not indicated in all patients...

News and trends in antibiotic therapy

MUDr. Otakar Nyč, Ph.D.

Interní Med. 2017; 19(3): 142-144 | DOI: 10.36290/int.2017.050

Current antibiotic treatment is marked by a rapidly increasing resistance of microorganisms to antibiotics. Some educated estimates suggest that over several years can occur a real crisis of antimicrobial therapy, or even the beginning of the postantibiotic era. Developing new products is not enough to adequately respond to the changing epidemiological situation, therefore, it is an attempt to realize the full potential and older products.It is essential to reduce excessive consumption of antibiotics and in indicated cases administered them in such a way as to minimize the risk of a further spread of resistance. The basic condition for preserving...

Pharmacotherapy of irritable bowel syndrome

doc. PharmDr. Jan Juřica, Ph.D., MUDr. Radek Kroupa, Ph.D.

Interní Med. 2017; 19(3): 146-153

Irritable bowel syndrome is one of the most frequent functional diseases of gastrointestinal tract. Among typical symptoms there are GIT dyscomfort, abdominal pain, bloating, and change in stool consistency and/or stool frequency. Pharmacotherapy is supplementary to dietary and regime approaches and is truly symptomatic, but it often brings patients significant relief from symptoms. This article is pharmacological review of groups of drugs used in the treatment of irritable bowel syndrome. It introduces mechanisms of action, particularities of pharmacokinetics of spasmolytics, laxatives, antidiarhoics, prokinetics, antibiotics and psychotropic drugs...

Comments

Vaskulárne choroby sú najčastejšou príčinou chronickej panvovej bolesti

doc. MUDr. Peter Gavorník, PhD., mim. prof., prof. MUDr. Andrej Dukát, CSc., FRCP, doc. MUDr. Ľudovít Gašpar, CSc.

Interní Med. 2017; 19(3): 170

Case report

Fixed dose combination of two antihypertensive drugs and statin in hypertensive patients in clinical practice

doc. MUDr. Jitka Mlíková Seidlerová, Ph.D.

Interní Med. 2017; 19(3): 160-161 | DOI: 10.36290/int.2017.027

Medical care of hypertensive patients involves besides efforts to lower blood pressure also efforts to reduce other cardiovascular risk factors. One of the most common risk factors is dyslipidemia. This paper describes two case histories of patients in whom we used fixed dose combination of perindopril arginine + amlodipine + atorvastatin. Fixed dose combinations improves adherence to treatment. The two case histories mentioned in a present paper shows that this fixed dose combination might be used in treatment naïve patients as well as method how to increase efficiency or how to simplify existing therapy.

A single-centre experience of antifibrotic treatment in idiopathic pulmonary fibrosis

MUDr. Monika Žurková, Ph.D., MUDr. Filip Čtvrtlík, Ph.D., MUDr. Vladimíra Loštáková, Ph.D., MUDr. Tomáš Tichý, Ph.D., Dr. Eva Kriegová

Interní Med. 2017; 19(3): 162-166 | DOI: 10.36290/int.2017.051

Idiopathic pulmonary fibrosis (IPF) is one of the most difficult to treat diseases with usually progressive course and unfavourable prognosis. Together with development of new therapeutic approaches there is a need to early diagnose this disease. With early diagnosis more patients are able to receive new types of antifibrotic drugs. In our current clinical practice, we may choose two different treatments – pirfenidone (2 403 mg/day, i. e. 3 × 3 cps) or nintedanib (300 mg/day, i. e. 2 × 1 tbl.). Here we present a case report of 69 years old patient with diagnosis of IPF who was treated with antifibrotic therapy (pirfenidone) which led to complete...

A long-term use of ivabradine in a middle-aged woman with chronic heart failure

MUDr. Jiří Leso

Interní Med. 2017; 19(3): 214-216 | DOI: 10.36290/int.2017.029

Longterm application ivabradine in middle-aged woman with chronic heart failure. Case report of a female patient who was monitoredfor a period of 18 eyars from the „innoncent“ beginnings until the clear morphological manifestation of a left ventricular non-compactcardiomyopathy with systolic dysfcuntion, which as preceded by a working diagnosis of idiopathic dilated cardiomyopathy. Theunfavourable development of chronic heart failure was reversed by decreasing the heart rate using ivabradine for 9 years.

Paget Schroetter syndrome – clinical case of effort thrombosis

MUDr. Petr Grenar, MUDr. Dan Rakušan, MUDr. Tomáš Adámek, Ph.D., doc. MUDr. Pavel Kohout, Ph.D.

Interní Med. 2017; 19(3): 217-219 | DOI: 10.36290/int.2017.053

Paget Schroetter syndrome (idiopatic thrombosis of upper extremity, exertional thrombosis) is generally rare clinical conditionwith progressively worsening symptoms, which affects mainly young patients. In cases with delayed diagnostic processand inappropriate treatment, it tends to have long term impact on patients health status. This article is mainly concerned withrecomended diagnostic and treatment approaches to Paget Schroertter syndrome. There is a case report included in order toprove a manifestation of the syndrome in clinical practice.

Pharmacological profile

Migalastat in the treatment of Fabry disease

MUDr. Lubor Goláň

Interní Med. 2017; 19(3): 167-170 | DOI: 10.36290/int.2017.028

Fabry disease is an inherited disease with multiorgan involvement. Until now the only specific therapy was intravenous enzyme replacement. In a short time a new oral therapy with migalastat is expected on our market. The medication is indicated only for treatment of certain mutations with residual enzyme activity. It binds to the enzyme, stabilizes it and enhances its transportation to lysosomes. Results of clinical studies are favourable and indicate that the new medication migalastat could significantly increase the quality of care of selected patients.

Interdisciplinary overviews

Alemtuzumab in the treatment of multiple sclerosis: a haematologist perspective

prof. MUDr. Tomáš Kozák, Ph.D.

Interní Med. 2017; 19(3): 154-159

Alemtuzumab is one of the first monoclonal antibodies used in cancer therapy. From the beginning of this millenium alemtuzumab was studied in the therapy of multiple sclerosis (MS), it became also part of the conditioning regimen in a study with autologous haematopoietic cell transplantation for MS. In the same time the positive effect of alemtuzumab monotherapy has been shown in both first line therapy of RRMS and MS resistant to previous therapy in well designed clinical studies. Adverse events analysis revealed the alemtuzumab therapy in MS could be associated with development of a secondary autoimmune disease. Except of relatively frequent autoimmune...