Klinika Gerontologicka A Metabolicka

Hradec Králové, Czech Republic

Klinika Gerontologicka A Metabolicka

Hradec Králové, Czech Republic
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Dusek J.,I. Interni Kardioangiologicka Klinika | Stasek J.,I. Interni Kardioangiologicka Klinika | Bis J.,I. Interni Kardioangiologicka Klinika | Brtko M.,Kardiochirurgicka Klinika | And 4 more authors.
Intervencni a Akutni Kardiologie | Year: 2012

New biomarkers of myocardial ischemia have the potential to improve diagnostic accuracy of acute coronary syndrome (ACS) within a shorter time interval after symptom onset. This paper reviews the avaiable information and evaluates the evidence for use of new biomarkers in diagnosing ACS in patients presenting with chest pain or symptoms suggestive of cardiac ischemia to the emergency department or chest pain unit. Ischemia modified albumin, measured using the albumin cobalt binding test, is currently the most promising biomarker for early detection of ischemia before the onset of irreversible cardiac injury. Fatty acid bindig protein, B-type natriuretic peptide, copeptin, and matrix metalloproteinase-9 are other promising biomarkers. According this progress, we have to conclude, that there is anadequate evidence suggesting the routine testing of these markers in isolation, however these biomarkers have the potintial to improve the sensitivity of diagnosing ACS when combined with cardiac-specific troponin.

Zadak Z.,Centrum Pro Vyzkum A Vyvoj | Ticha A.,Centrum Pro Vyzkum A Vyvoj | Hronek M.,Centrum Pro Vyzkum A Vyvoj | Hyspler R.,Klinika Gerontologicka A Metabolicka
Vnitrni Lekarstvi | Year: 2011

Summary: Current model of metabolic and nutritional disorders management utilizes modern techniques that promote some of the nutritional techniques to pharmacoteherapy. This approach is demonstrated on an example of multiple organ failure and systemic inflammatory reaction managed with pharmacologically active nutritional substrates, such as arginine, glutamine, taurine, threonine and cysteine. Treatment of sarcopenia in older age is also discussed. Personalized nourishment as a component part of a wider term personalized medicine represents a new approach that requires recognition of individual differences in human genome and its expression. However, this approach also requires a change of attitude towards laboratory diagnostics and clinical practice, with patients and clinical prediction as the focal point. From this perspective, there is a need to replace current traditional laboratory tests with a new system that utilizes molecular biology and bioinformatics.

Juraskova B.,Klinika gerontologicka a metabolicka | Juraskova B.,Charles University | Hegerova P.,Klinika gerontologicka a metabolicka | Holmerova I.,Gerontocentrum Prague
Interni Medicina pro Praxi | Year: 2011

The authors try to describe the role of microelements in senior citizens, causes and consequences of thein deficiency. Trace elements play an important role in the body in a series of biochemical, immunological processes. Thein deficienty cause damane leading to deterioration not only the existing pathological processes in old age, but the cause of other, equally important for the aging organism.

Stilec R.,Klinika Gerontologicka a Metabolicka | Chovanec V.,Radiologicka Klinika | Safranek R.,Klinika Gerontologicka a Metabolicka
Aktuality v Nefrologii | Year: 2010

Femoral veins are not frequently used site for insertion of tunneled cuffed central venous catheters for hemodialysis. Similarly to catheters in thoracic veins, catheter tip may be incorrectly located. This may result in malfunction of the catheter. We describe catheter insertion to femoral vein that resulted in unusual location of the catheter tip. Because of insufficient function of the inserted catheter, skiascopy was performed. That revealed dislocation to left ascending lumbar vein. Using guidewire the catheter was positioned to common iliac vein. Flebography confirmed right position of the catheter and also showed pathologically dilated collateral lumbar veins that may predispose to described wrong position of the catheter tip.

Hrabovsky V.,Interni Klinika LF OU | Mendlova A.,Metabolicka JIP | Zadak Z.,Centrum Pro Vidu A Vyzkum | Blaha V.,Klinika Gerontologicka A Metabolicka | And 3 more authors.
Gastroenterologie a Hepatologie | Year: 2013

Purpose of the study: The aim of this pilot study was to describe changes in lipid metabolism in patients with acute gastrointestinal (GI) bleeding and to assess possible influence of hemodilution and changes in the cholesterol synthesis/absorption process. Material and methods: In 12 patients with gastrointestinal bleeding, the levels of lipid metabolism (total, LDL and HDL cholesterol and triglycerides) were determined on days 0, 3 and 6. On the same days, levels of the cholesterol synthesis indexes (lathosterol, squalene) and absorption (campesterol, sitosterol) were determined. The results were evaluated in comparison with the control set, and cirrhotic and non-cirrhotic patients were compared. At the same time, correlations of lipids and haemoglobin, hematocrit levels anduse of transfusions were evaluated. Results: The patients had significantly lower levels of total cholesterol (p 0.001). Decrease of LDL and HDL cholesterol was not significant. Concentrations of triglycerides were normal. Decrease of lathosterol was significant (p 0.05), but decrease in squalene, campesterol and sitosterol levels was insignificant. Comparing patients with cirrhosis and without cirrhosis showed statistically significant difference in levels of cholesterol and lathosterol (p 0.05). Correlations did not show any statistically significant findings. Conclusion: In patients with acute GI bleeding, changes is lipid metabolism including alteration of the process of synthesis and absorption were proved. Therefore, hypocholesterolemia cannot be explained by blood loss only. However, more detailed studies need to be carried out.

Hendrychova T.,Katedra Socialni A Klinicke Farmacie | Matoulkova P.,Katedra Socialni A Klinicke Farmacie | Vlcek J.,Katedra Socialni A Klinicke Farmacie | Smahelova A.,Klinika Gerontologicka A Metabolicka
Vnitrni Lekarstvi | Year: 2012

The paper brings an overview of published systematic reviews and meta-analyses concerning the evaluation of the effectiveness of the treatment with insulin pump (CSII) in comparison with multiple daily injections (MDI) in type 1 diabetes mellitus. According to found works CSII leads to slightly lower levels of glycosylated hemoglobin (HbA1c) in patients with type 1 diabetes mellitus against MDI. The levels of HbA1c and the variability of glycaemia during the day on MDI before an initiation of CSII should serve for the prediction of an effect of CSII in particular patient. Type 1 diabetics on CSII have less often hypoglycaemia, higher flexibility of their daily regime and thus higher satisfaction with their treatment against MDI. The daily doses of insulin decrease. The weight of patients is the same or slightly higher after the initiation of CSII. There were not enough information for the assesment of the frequency of adverse reactions. It is necessary to educate each patient not only how to manipulate the particular insulin pump, but also about general recommendations for the treatment of diabetes and the application of insulin.

Sobotka L.,Klinika Gerontologicka a Metabolicka
Vnitrni Lekarstvi | Year: 2010

Skin defects and wounds are rather frequent in diabetic population. They most frequently occur on lower limbs and their origins are often multifaceted. If vascular perfusion is not damaged, it is important to secure perfect drainage with sufficient incision and to use local treatment modalities such as hyaluronan-iodine complex, now well-established at our clinic. It is always essential to save the vascular system if this is damaged. Careful examination by an angiologist is normally followed by angioplasty or vascular bypass. Amputation is an extreme solution that, nevertheless, may save the limb functionality if done in a patient with ischemic damage that cannot be resolved.

Blaha V.,Klinika gerontologicka a metabolicka | Visek J.,Klinika gerontologicka a metabolicka
Interni Medicina pro Praxi | Year: 2011

The consumption of saturated fatty acids (SFAs) elevates the concentration of low-density lipoprotein (LDL) cholesterol in plasma and contributes to an increased risk of ischemic heart disease (IHD). Reducing the occurrence of atherogenic dyslipidemia (includes a higher content of small LDL particles, reduced HDL-C and increased triglycerides) can be achieved by lowering the consumption of carbohydrates in the diet or by weight loss while altering the content of total or saturated fat has only minimal effect. A low-fat and high-carbohydrate diet results in reduced concentrations of LDL-C compared to a high-fat and low-carbohydrate diet, particularly in individuals with lipoprotein phenotype B. From what is mentioned above, it is not entirely clear which type of diet (whether one with low or with high content of carbohydrates) is of greater benefit in terms of cardiovascular risk. Observational epidemiological and randomized controlled studies evaluating the incidence of IHD have contributed to the establishment of dietary guidelines focused on a controlled and restricted intake of SFAs in order to prevent IHD. Critically, it can be stated that evidence from cohort and randomized controlled studies has its limitations.

Zajic J.,Klinika gerontologicka a metabolicka
Interni Medicina pro Praxi | Year: 2012

Arterial hypertension is the most common cardiovascular disease. Its high prevalence in the adult population of industrialized countries in particular, represents a serious health problem. The incidence of hypertension increases with increasing age. Population aged over 80 years represents the fastest growing population subgroup. For healthcare worldwide will be necessary to reduce the morbidity associated with older age and the associated dependence of these persons. Arterial hypertension is a risk factor not only for the "classical" cardiovascular disease but also associated with higher risk of dementia.

Blaha V.,Klinika gerontologicka a metabolicka
Kardiologicka Revue | Year: 2012

Residual cardiovascular risk can be defined as the residual risk of incident vascular events or progression of established vascular damage persisting in patients treated with current evidence-based recommended care including the risk that established from risk factors, such as dyslipidemia, characterized by low HDL-cholesterol, elevated triglycerides and apolipoprotein B, small dense LDL and sometimes also high lipoprotein(a), high blood pressure, and the risk related to emerging or newer risk factors. High residual risk is common in patients with metabolic syndrome, type 2 diabetes mellitus, insulinoresistance and abdominal obesity. Current evidence supports a causal association between elevated triglyceride-rich lipoproteins and their remnants, low HDL-C, and cardiovascular risk. This interpretation is based on mechanistic and genetic studies for triglyceride-rich lipoproteins and remnants, together with the epidemiological data suggestive of the association for circulating triglycerides and cardiovascular disease. For HDL, epidemiological, mechanistic, and clinical intervention data are consistent with the view that low HDL-C contributes to elevated cardiovascular risk; genetic evidence is unclear however, potentially reflecting the complexity of HDL metabolism. The concept clearly derives from intervention trials, mainly the statin trials, and there is a lot of debate about the residual risk conferred by other lipid components, in particular low levels of HDL cholesterol and high levels of triglycerides. A meta-analysis of 53 fibrates (16,802 subjects) and 30 niacin trials (4,749 subjects) revealed an average HDL-C increase of 10% with fibrates and 16% with niacin, a triglyceride decrease of 36% with fibrates and 20% with niacin, and a LDL-C decrease of 8% with fibrates and 14% with niacin. These lipid changes resulted in similar overall reductions in major coronary events evidenced by a 25% decrease with fibrates and 27% with niacin. The experts believe that therapeutic targeting of elevated triglycerides (≥ 1.7 mmol/L), a marker of triglyceride-rich lipoproteins and their remnants, and/or low HDL-C (< 1.0 mmol/L) may provide further benefit. The first step should be lifestyle interventions together with consideration of compliance with pharmacotherapy and secondary causes of dyslipidaemia. If inadequately corrected, adding niacin or a fibrate, or intensifying LDL-C lowering therapy may be considered. Treatment decisions regarding statin combination therapy should take into account relevant safety concerns, i.e. the risk of elevation of blood glucose, uric acid or liver enzymes with niacin, and myopathy, increased serum creatinine and cholelithiasis with fibrates. These recommendations will facilitate reduction in the substantial cardiovascular risk that persists in patients with cardiometabolic abnormalities at LDL-C goal.

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