III. interni gerontometabolicka klinika

Hradec Králové, Czech Republic

III. interni gerontometabolicka klinika

Hradec Králové, Czech Republic
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Proprotein convertase subtilisin/kexin type 9 (PCSK9) is a newly discovered member of the proprotein convertase family. Expression studies and human genetics have revealed an important role for PCSK9 in cholesterol metabolism. PCSK9 is regulated by dietary cholesterol and cellular cholesterol levels putatively via the SREBP (sterol-responsive element-binding protein) transcription factors. Mutations in PCSK9 are associated with the third locus implicated in ADH (autosomal dominant hypercholesterolemia). PCSK9 clearly plays an important role in controlling LDLR levels. If the true function of PCSK9 is to degrade the LDLR, inhibitors of PCSK9 may act to increase LDLR levels, enhance LDL uptake by the liver, and decrease plasma LDL cholesterol levels. Furthermore, such inhibitors would be synergistic with statin drugs in raising hepatic LDLR levels. PCSK9 inhibition is undoubtedly the most attractive new approach to decrease levels of atherogenic lipoproteins and to enhance the LDL-C-lowering efficacy of statins. Published phase II data have shown that monoclonal antibodies are effective and well tolerated at 3 months. The most advanced monoclonal antibodies are currently in phase III to determine the long-term safety, tolerability and efficacy profile, including the effect on cardiovascular disease.

Jirackova J.,III. interni gerontometabolicka klinika | Jirackova J.,Charles University | Smahelova A.,III. interni gerontometabolicka klinika | Smahelova A.,Charles University
Interni Medicina pro Praxi | Year: 2016

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 in patients with cardiovascular complications however results of recent cardiovascular studies (SAVOR, TECOS, EXAMINE) were a bit confusing. Gliflozines on the other hand have become very promising for patients with CHF, based on results of EMPA-REG presenting statistically significant reduction in cardiovascular mortality and complications of chronic heart failure.

Mala E.,Ustav klinicke imunologie a alergologie | Vejrazkova E.,IV. interni klinika | Bielmeierova J.,Rehabilitacni klinika | Jindra M.,Rehabilitacni klinika | And 3 more authors.
Clinical Oncology | Year: 2015

Background: Malnutrition in head and neck cancer (HNC) patients decreases survival, quality of life (QOL) and oncological outcomes. The aim of the prospective three-year study was to compare QOL, clinical symp toms and variables (complications, survival and mortality rates in HNC patients). Patients and Methods: A total of 726 patients aged 55 to 72 years with treatable HNC were included from January 2004 to December 2009; these patients were randomized to either group with PEG and enteral nutrition and nonPEG group with nutritional counselling accord ing to nutritional care. We used EORTC questionnaires QOL C-30 and Head and neck module (HN-35) for measuring of QOL. The following variables due to expectable influence on QOL (demographic data, oncological data, nutritional screening, Clinical symp tom score, Karnofsky performance status score, Charlson comorbidity index) were included. Monitoring was done five times in three years. Results: In the first six months, we found decrease of weight and body mass index (BMI). After this critical time point and finish of oncological treatment, a marked difference in the development of patients treated with PEG. Negative factors influencing patients survival, QOL, clinical status were males aged > 63 years, hypopharyngeal cancer (stage III-IV), smoking, weight loss > 10%, BMI < 21 and disallowance of PEG. Conclusions: QOL is an essential factor for cancer patients. Our study showed that nutritional intervention with early enteral nutrition may improve QOL and survival in HNC patients. The PEG group better tolerated oncological treatment, had lower incidence of complications, shorter time to re-entry of permanent increase in weight, lower rate of rehospitalization and its shorter length. We found QOL questionnaires to be very important for better understanding and communication and a key instrument for improving solution of patient's difficulties during their therapy in multidisciplinary approach.

Blaha V.,III. interni gerontometabolicka klinika
Interni Medicina pro Praxi | Year: 2014

Proprotein convertase subtilisin/kexin type (PCSK9) is a crucial protein in LDL cholesterol (LDL-C) metabolism because of its pivotal role in the degradation of the LDL receptor. In recent years, both in vitro and in vivo studies have greatly supplemented our understanding of the role of PCSK9 in human biology. As PCSK9 has emerged as a novel target for LDL-C lowering therapy, being discovered in 2003, recent developments in inhibition of PCSK9 are reviewed. Initial data from investigations of PCSK9 inhibition in humans are promising and indicate that PCSK9 inhibition may be a viable new therapeutic option for the treatment of dyslipidemia and associated cardiovascular diseases.

Visek J.,III. Interni Gerontometabolicka Klinika | Manak J.,III. Interni Gerontometabolicka Klinika | Safranek R.,III. Interni Gerontometabolicka Klinika | Kubisova M.,III. Interni Gerontometabolicka Klinika | And 3 more authors.
Vnitrni Lekarstvi | Year: 2012

Home parenteral nutrition is the only option to provide nutrition in a number of patients. Care of venous entry, its management and treatment of complications resulting from its use importantly affect patient survival. Appropriate care of the catheter and the use of current knowledge may prolong the lifespan of the catheter, reduce patient morbidity and mortality and thus increase quality of life of patients who are dependent on home parenteral nutrition. The present paper summarizes recommendations for the care of long-term venous catheters.

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