Vnitr̆ní lékar̆ství
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Vnitr̆ní lékar̆ství · Feb 2015
Case Reports[Calcific uremic arteriolopathy - treatment with sodium thiosulfate].
Calcific uremic arteriolopathy or calciphylaxis is a rare disorder characterized by systemic medial calcification of arterioles that leads to ischemia and subcutaneous necrosis. It most commonly occurs in patients with end-stage renal disease who are on haemodialysis or who have received a renal transplant. Calciphylaxis is dangerous by its fast progression into tissue necrosis, difficult healing process and a great risk of secondary infection which is the most common cause of death in this condition. ⋯ The wound care played another major role with gentle debridement and intensive local care. After five to six months the skin defects resolved in the first patient, partially resolved in the second patient and deteriorated in the third patient. We have observed no side effects of sodium thiosulfate application.
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Vnitr̆ní lékar̆ství · Jan 2015
[Utility of Pneumonia Severity Index in hospitalized patients with pneumonia in intensive respiratory care units].
The aim of this study was to evaluate the prognostic value of Pneumonia Severity Index (PSI) for prediction of 30-day mortality in patients admitted to intensive care unit (ICU) for community-acquired pneumonia (CAP). In patients with CAP, comorbidities, complications, and physical, laboratory, radiological and microbiological findings were evaluated relative to their prognosis. ⋯ Our study showed that PSI represents an important predictor of 30-day mortality in patients with CAP at ICU, but does not correlate neither with the length of hospitalisation nor with particular pathogens. Independent negative prognostic factors in CAP were age, incidence of heart diseases (most importantly ischaemic heart disease), tachycardia, tachypnoe and acidosis. Staphylococcus sp. and Klebsiella pneumoniae infection led to longer hospitalisation period. All these factors point out the need for increased care in CAP patients.
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Vnitr̆ní lékar̆ství · Dec 2014
Review[Anaemia and iron deficiency in clinical practice:from cardiology to gastroenterology and beyond].
Anaemia is one of the most common diseases. Worldwide affects up to 25% of the population. Anaemia with iron deficiency (Fe) is the leading one. ⋯ It is shown that treatment of anaemia is important in chronic fatigue (especially women) and affects quality of life. Improvement in symptoms of fatigue has been demonstrated after administration of 1000 mg of ferric carboxymaltose. Fe treatment improves quality of life in anaemic oncology patients as well.
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All existing recommendations sign hormone replacement therapy (HRT) as first therapy for acute climacteric syndrome. The low dose vaginal therapy is the first choice for prevention and therapy of urogenital atrophy and its complications. ⋯ It is sure that HRT is effective in prevention and therapy of postmenopausal osteoporosis. Long term therapy must be individualized on base of benefits to risks ratio with differences by type of HRT.
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Vnitr̆ní lékar̆ství · Oct 2014
Review[Monoclonal gammopathy of undetermined significance and asymptomatic multiple myelom in the year 2014 ].
Presence of monoclonal immunoglobulin in serum or urine is a relatively common event affecting about 3.2 % of people over 50. Isolated increase of only one type of free light chain, either κ or λ, is detected in 0.7-0.8 % of people over 50. Most people with monoclonal immunoglobulin meet the criteria of the so-called "mono-clonal gammopathy of undetermined significance (MGUS)". ⋯ In 2014, discussion of subdivision of subgroups of patients with asymptomatic myeloma with high ( 80 %) probability of early (within 2 years) transformation in multiple myeloma which would be beneficial for early initiation of treatment is ongoing. According to first proposals, patients with asymptomatic myeloma that meet at least one of the three conditions: more than 60 % of plasma cells in the bone marrow, ratio of free light kappa and lambda chains is greater than 100 or less than 0.01, or multiple focal lesions on whole-body MRI of the skelet. The review contains current opinions on prognostic classification and appropriate intervals and extent of control examinations.