Tebentafusp in the treatment of metastatic uveal melanoma - the first patient treated in the Czech Republic

BACKGROUND

Uveal melanoma is a rare cancer, in which metastases occur in approximately one half of cases. In metastatic disease, the prognosis is unfavorable and the median of survival does not exceed 6 months. Effective treatment options were very limited up to date. Tebentafusp is a bispecific fusion protein, which as the first drug proved efficacy in uveal melanoma.

CASE

The patient was referred for suspected uveal melanoma of the left eye. She was treated for Hodgkin's disease in the past. Primarily, the tumor was treated by radiosurgery with radiotherapy of a small lesion of the vertebral body. However, later the patient had to undergo bulbus enucleation with confirmation of a large tumor category pT4b. PET/CT revealed metastases of the bones and the liver; simultaneously, haplotype A*02: 01 was confirmed. The patient underwent radiotherapy of the sternum and later, after confirmation of payment from the health insurance company, she started treatment with tebentafusp. The first three doses were administered during admission to the hospital, with a need to treat cytokine release syndrome by corticosteroids. Later, the administration was performed in an out-patient regimen, without complications, except for a transient elevation of transaminases. The first CT restaging confirmed stable disease; however, the second restaging confirmed a new osteolytic lesion in the processus of Th11. Because of progression, the treatment with tebentafusp was withdrawn after 6 months. Unfortunately, the lesion could not be treated by radiotherapy. Two months later, the patient was urgently admitted to the hospital because of right-sided hemiplegia; MRI revealed bleeding metastatic lesion in the brain stem.

CONCLUSION

In this case report, we present the case of the first patient treated with this drug in the Czech Republic.

Blast syndrome - pathophysiology, diagnosis and treatment of blast injuries

The incidence of explosions in large agglomerations is high even during peacetime and continues rising. Blast syndrome injuries are complex, with shock wave causing severe injuries of multiple organ systems. In situations with large numbers of injured persons, effective triage allows an early diagnosis and treatment of the highest number of victims. Treatment is challenging, and potentially conflicting therapeutic goals may alternate. This review provides an overview of the pathophysiology of blast injuries, current diagnostic algorithms and therapeutic procedures.

Human babesiosis

Babesiosis is a less common but important tick-borne infectious disease. Over the last 50 years, an increasing number of cases have been reported worldwide, especially in the USA. The northern part of the US is an endemic area where the incidence has risen to 2,000 cases per year in the last decade. Babesia microti, a parasite of small rodents, is the cause of most of these infections in that region. In Europe, 56 autochthonous cases of human babesiosis have been reported since 1957. Most of them were caused by the species Babesia divergens, a parasite of cattle. Since 1992, 13 cases of B. microti infection have been imported from North America into Europe. The disease is serious especially for splenectomised and immunocompromised patients. Although the most important vector of babesiosis in Europe is the tick Ixodes ricinus, infection was transmitted through blood transfusion in number of patients, which can be fatal for immunosuppressed patients. The diagnosis of babesiosis is based on the identification of intraerythrocytic parasites in a blood smear, PCR detection of Babesia DNA, and determination of antibodies by serology and immunofluorescence assays. The disease is treated with antibiotics (azithromycin or clindamycin in a severe course of the disease) and quinine. The increase in human babesiosis is not only due to climate change and tick activity, outdoor leisure activities, and increased human migration, but an important role is also played by improved molecular methods and growing awareness of the disease.

Retroperitoneal tumour resection in fifteen consecutive cases: Single centre experience

INTRODUCTION

Retroperitoneal tumours (RTs) in adults are a rare heterogeneous group of neoplasms arising from the retroperitoneal space. RTs'clinical manifestations are nonspecific and depend on their anatomical positioning and relation with bordering structures. Our study aimed to retrospectively evaluate our patients' diagnosis, length of hospital stay, disease-free period and postoperative metastasis occurrence.

METHODS

From 2011 to 2019, fifteen suspected RT resections were performed at our centre. Retrospective analysis of patients' hospital stays, follow-up, histological and immunological tumour profile, and metastasis occurrence/ re-occurrence was performed.

RESULT

All of the 15 (100%) patients were males. The average age of our patients was 44 years (SD ± 11.2 years), average hospital stay was 7.4 days (SD±3.4 days) (Tab.1). All resected tumours underwent histological and immunological evaluation. Based on histological examination of the resected tumours, nonseminomatous germ cell tumours were present in 12 (80%) patients - including teratoma in 4 (26.6%) patients, seminoma in 2 (13.3%) patients, and malignant B-cell lymphoma in 1 (6.6%) patient. The average patient follow-up was 42.7 months (SD±31.4.9 months). Complete remission after the surgery was achieved in 11 (76.9%) patients, and 2 (13.3%) patients were lost in follow-up.

CONCLUSION

RT is a rare heterogeneous group of neoplasm. The patient's prognosis dramatically depends on the type of tumour, metastasis occurrence and re-occurrence, and the surgeons' ability to resect the tumour completely.

Mycobacteriosis: the most common causative agents

The annual number of diagnosed diseases caused by non-tuberculous mycobacteria in predisposed individuals remains constant in the Czech Republic. Their clinical characteristics vary depending on the properties of the causative species and its presence and quantity in the immediate environment of the patient. The most common clinically relevant species are Mycobacterium avium, M. kansasii, and M. xenopi. The most important source of M. avium is peat and products derived from it. M. avium may colonise warm water systems, posing a high risk of exposure to users (jacuzzi users in particular). M. kansasii is still present in waters of areas affected by industrial and mining activities. Its recently isolated genetic variants are mostly of no clinical significance but may be present as contaminants in medical preparations. M. xenopi permanently colonises most warm water systems, and its practical ubiquity makes difficult the interpretation of ambiguous findings on imaging. The antibiotic treatment, which may not always be successful, should be initiated after a comprehensive assessment of the patient's condition, imaging data, and disease progression. Similarly, the results of laboratory tests may not always be authoritative in decision making.

Acute kidney injury in patients with cirrhosis - practical summary

Acute kidney injury (AKI) is a relatively common condition in patients with advanced liver disease and which is associated with increased mortality. It mainly affects patients with decompensated cirrhosis, particularly those with advanced portal hypertension and ascites. The dual organ involvement may have different forms. The contributing pathogenetic mechanisms are common and predict a dismal prognosis. Early diagnosis and interventions involving specialists (in particular, hepatologists and nephrologists) are essential to improve outcomes.

New ESMO guidelines for clinical practice in metastatic colorectal cancer - commentary on changes in systemic therapy

Commentary on the newly released European Society for Medical Oncology (ESMO) guidelines for the diagnosis and treatment of metastatic colorectal cancer (mCRC). After 6 years, individual chapters have been updated, from molecular tumor testing to diagnostic and treatment procedures to the implementation of newly registered medicinal products. The authors highlight the most important changes in the guidelines. Awareness of possible new treatments for mCRC is important to determine the treatment strategy for patients with mCRC. In this commentary, we focus primarily on the status of systemic treatment in unresectable disease.

Use of botulinum toxin in the management of radiotherapy side effects

BACKGROUND

Many experimental and clinical studies are conducted to investigate the effects of various applications of botulinum toxin (BTx) in the treatment of radiation related side effects. There are no studies that show clear results about the positive and negative effects of its active clinical use in the long run, and discussions are ongoing. In addition, there is a need for various researches about how BTx can be used and how long it can be used, and the side effects it may cause. BTx-A, which is one of the options in the treatment of side effects that will occur due to radiotherapy, is an effective and safe option. Applying BTx injection to the right place with specific injection methods increases the effectiveness and safety of the treatment.

PURPOSE

It has been investigated whether BTx will be a potential tool to perfect the esthetic and functional results in reducing the chronic side effects associated with radiotherapy.

Treatment of adult patients with acute lymphoblastic leukemia in the Czech Republic in the period 2007-2020

BACKGROUND

Pediatric-inspired protocols with prospective monitoring of minimal residual disease (MRD) are considered the standard of intensive treatment for adults with acute lymphoblastic leukemia (ALL). They have been used in the Czech Republic since 2007.

PATIENTS AND METHODS

Two hundred and ninety-seven patients aged 18-65 years were treated at five hematology centers between 2007-2020 according to the GMALL 07/2003 protocol. This is a retrospective analysis of their treatment outcomes.

RESULTS

In the Ph-negative cohort, 189 (93.1%) patients achieved complete remission, 5 (2.4%) patients were refractory, and early mortality was 3.0%. Seventy (34.5%) patients experienced relapse in a median of 10.6 months. Overall survival (OS) at 3 and 5 years was 63.5% and 55.9%, disease-free survival (DFS) at 3 and 5 years was 54.5% and 49.7%, respectively. Young adults under 35 years of age (P = 0.015), patients without initial CNS infiltration (P = 0.016), with MRD negativity before consolidation treatment (P < 0.001), transplanted in the 1st complete remission (P < 0.001), and subjects treated after 2012 (P = 0.05) had significantly better overall survival. In a multivariate analysis, MRD at week 11 was the only independent factor affecting OS (HR 3.06; P = 0.006). For DFS, baseline CNS infiltration (HR 2.08; P = 0.038) and MRD at week 11 (HR 2.15; P = 0.020) were significant. In the Ph-positive cohort, 84 (89.4%) patients achieved complete remission, 1 (1.0%) patient was refractory, early mortality was 4.3%. Twenty-six (27.7%) patients relapsed in a median of 8.6 months. Survival at 3 and 5 years was 57.2% and 52.4% for OS and 50.2% and 44.9% for DFS, respectively. Transplanted patients and patients diagnosed after 2012 had statistically better overall survival (P < 0.001).

CONCLUSION

The introduction of pediatric-inspired protocols with treatment intensification according to MRD levels resulted in a significant improvement in the survival outcomes of adult patients with ALL.

Venous thromboembolism in antiphosholipid syndrome

Antiphosholipid syndrome (APS) is defined by the presence of clinical and laboratory criteria, it means by presence of antiphospholipid antibodies. Venous thromboembolism belongs to the most frequent clinical manifestation of this syndrome. Here we summarised basic pathophysiological mechanisms of venous thrombosis and lung embolism development, epidemiology of APS, and also the situations when this syndrome should be considered. The possible difficulties of laboratory diagnosis and their therapy involvement are mentioned.

Extrahepatic bile duct malignancies

INTRODUCTION

Biliary tract malignancies belong to very aggressive malignancies of the gastrointestinal tract. The only radical treatment is surgical resection which is possible only in a limited number of cases due to late diagnosis. The aim of this report was to present the experience of our own department with the diagnosis and treatment of these tumours.

METHODS

In the years 2005-2021 radical (R0) resection was performed in 27 (28.4%) patients, the same number were managed only symptomatically and in 41 (43.2%) patients we used biliary stenting and external-internal drainage as the definitive procedure. Adjuvant oncological treatment was indicated in 16 (59.3%) of the radically operated and 49 (72.1%) of the non-operated patients.

RESULTS

Median overall survival and median progression-free survival in the operated patients were 19.9 months and 15.7 months, respectively. Overall survival in the operated patients was significantly better (p.

Anticoagulation in cancer patients; new recommendations based on randomized clinical trials

Venous thromboembolic disease (VTD) is currently the second leading cause of death in cancer patients with a prevalence of approximately 20% compared with that of 5% in the entire adult population. Cancer patients are a heterogeneous group with significant differences in the risk of VTD which is, in particular, determined by the type of tumour, its extent, location, and the presence of metastases. Some tumours represent a mean 3- to 5-fold increase in risk, while in others the risk of developing VTD is even several times higher. In comparison with non-cancer patients, those with a tumour are not only at an increased risk of an initial thromboembolic event, but also of its recurrence, regardless of ongoing anticoagulation which is associated with a higher risk of bleeding, particularly in mucosal involvement. Venous thrombosis and its treatment may interfere with the ongoing diagnosis and treatment. In cancer patients, VTD is a frequent incidental finding on imaging studies. Primary thromboprophylaxis (apixaban, rivaroxaban, LMWH) is currently recommended in selected groups of cancer patients who are either hospitalized for acute internal disease or immobilized and have an active malignancy, undergo outpatient systemic chemotherapy for a tumour with a high risk of VTD (a Khorana score of 2) or surgery and are not at high risk of bleeding. DOACs should be administered six months after the initiation of chemotherapy. If there is a risk of drug interactions or mucosal bleeding, LMWHs are recommended. At present, DOACs (apixaban, edoxaban, rivaroxaban) and LMWHs are the first-choice drugs in treating VTD. LMWHs are preferred in mucosal tumours, when there is a high risk of bleeding, in progressive malignancy, concomitant emetogenic therapy, and dyspeptic difficulties. In severe renal insufficiency (CrCl &lt; 15 ml/min), vitamin K antagonists may be of value. Individualized treatment should take into consideration the patients general condition, prognosis, and personal preferences.

Pituitary incidentaloma

Pituitary incidentaloma are being accidentally found during imaging procedures in approximately 10% of normal population. Facing pituitary incidentalomas endocrinologists have to decide about further management based on the assessment of hormonal activity, aetiology, size, and possible compressive symptoms. Treatment of choice for prolactinomas is medical therapy. Surgical treatment is a treatment of choice for other hormonally active tumours and in case of complications as defects of visual field, pituitary apoplexy with compressive symptoms, ophthalmoplegia respectively. Tumour not indicated for surgical treatment are followed-up by imaging techniques and in indicated cases also by endocrinological or visual field evaluation.

Therapy of hypertension in elderly population and its potential risks

Arerial hypertension is comon in subjects 65 years old and includes in majority of subjects systolic/diastolic form or isolated systolic hypertension. Basic therapeutic principles to the therapy of hypertension of elderly subjects are summarized. Slow and careful uptitration of antihypertensive therapy is recommended. Potential complications and caveats of therapy are also discussed, which are especially related to older frail subjects. Pharmacotherapy of hypertension in elderly is in vast majority of subjects highly beneficial with decrease of cardiovascular (CV) events and CV mortality.

The position of SGLT2 inhibitors in current medical practice - update 2022

Cardiovascular diseases are still the most common cause of mortality in patients with type 2 diabetes. Studies on the cardiovascular safety of new antidiabetic treatments, that have significantly expanded the treatment options for type 2 diabetes over the last 20 years, have provided evidence not only for the cardiovascular safety of SGLT-2 inhibitors (SGLT-2i, gliflozins), but also unexpectedly showed a significant effect on the reduction of cardiovascular risk, incidence and progress of heart failure and nephroprotectivity. For the first time, a reduction in cardiovascular and overall mortality was demonstrated for empagliflozin in 2015 in patients at very high cardiovascular risk. Further studies with gliflozins in patients with diabetes, but also in non-diabetic individuals, show that gliflozins have more pharmacological similarities than differences, especially in terms of protection against the development and progression of heart failure and maintenance of glomerular filtration rate. The revolutionary contribution of SGLT-2i is therefore perceived today not only by diabetologists, but also by cardiologists and nephrologists. In ESC guidelines, SGLT-2i are recommended as a first-line antidiabetic treatment for patients with diabetes at high cardiovascular risk, attacking the hitherto unshakable position of metformin at this pole position, and their indications should be considered in patients with type 2 diabetes with atherosclerosis, heart and renal failure regardless of the level of diabetes control (values of HbA1c). In the treatment of heart failure with reduced ejection fraction (with or without diabetes), dapagliflozin and empagliflozin have been recommended by cardiologists since 2021 to prevent hospitalizations for heart failure and to reduce mortality with the strongest class and level of evidence.

Potential use of mesenchymal stem cells in the treatment of inflammatory bowel disease - a systematic review of the literature

INTRODUCTION

The incidence of inflammatory bowel disease is increasing worldwide and, despite advances in conservative and surgical treatment, a significant proportion of patients do not achieve complete remission and have to undergo repeated surgical procedures. Stem cell therapy is a new alternative to immunomodulatory therapy.

METHODS

We performed a systematic review of the literature dealing with the use of mesenchymal stem cells for the treatment of IBD. The PubMed database was searched and original studies published between 2015 and 2021 were included.

RESULTS

A total of 80 citations were found, of which 21 clinical studies and 47 experimental studies were included in the review.

CONCLUSION

The efficacy of MSCs in the treatment of perianal Crohns disease is at least comparable to current therapies. A positive effect of MSC administration has also been demonstrated in animal models of luminal disease or enterocutaneous fistula. The results after systemic administration in IBD patients are still ambiguous.

KEY WORDS

inflammatory bowel disease.

Tobacco dependence treatment guidelines

These recommendations are relevant for all clinical fields and all medical professions, although for some more and for some less. Smoking is the cause of every sixth death in the Czech Republic and is related to diseases of all organ systems. Effective treatment for the diagnosis of F17 exists and should be offered and available to approximately 2 million smokers in the Czech Republic as a standard part of medical and preventive care according to time availability - from brief intervention in frame of each clinical contact with the patient to intensive care. It includes psycho-socio-behavioral support and pharmacotherapy. It should cover all professions in clinical medicine - according to WHO recommendations, especially doctors, nurses, pharmacists and dentists and should be reimbursed within health systems. It should also be offered in other services like e.g., social or addictology care. From an economic point of view, it is one of the most cost-effective interventions in medicine.

Oral semaglutide - Rybelsus®, the first GLP-1 receptor agonist for oral use in clinical practice

Glucagon like peptide-1 receptor agonists (GLP-1 RA) are potent antidiabetic drugs associated with significant weight loss and minimal risk of hypoglycemia. Semaglutide is a GLP-1 RA with a proven cardiovascular benefit. It is currently also available in oral form, which is especially suitable for the treatment of the initial phase of type 2 diabetes. However, it is also effective at later initiation of therapy, in different diabetic populations. The PIONEER 6 trial demonstrated cardiovascular safety of oral semaglutide, its administration was accompanied by a significant reduction in cardiovascular and overall mortality.

Colorectal cancer in patients with diabetes - epidemiology, pathophysiology and applications for clinical practice

Diabetes mellitus (type 2 diabetes in particular) and colorectal carcinoma are relatively frequent diseases in our population. At the same time, these units share some common risk factors, for example obesity, lack of physical activity and hyperinsulinemia. Available data show patients with diabetes have increased risk of colorectal adenoma and carcinoma, increased risk of colorectal carcinoma at a lower age, as well as increased risk of relapse and increased mortality with colorectal cancer. The aim of this article is to point out the relationship between diabetes and colorectal carcinoma, with emphasis on the information important for clinical practice, particularly the screening of colorectal carcinoma and lifestyle recommendations for patients with diabetes. Therefore, we offer an overview of the important available publications which consider this topic.

Bartter and Gitelman syndromes

Bartter and Gitelman syndromes belong to salt-losing tubulopathies. These rare diseases may be associated with severe electrolyte disorders. Early identification of tubulopathies is essential for appropriate management. Progress in molecular genetics enabled the identification of genes and pathophysiologic mechanisms associated with these diseases. Here, we review etiology and diagnostics of these disorders from the light of current knowledge. Additionally, we discuss contemporary therapeutic approaches.

Urapidil: an unknown / known antihypertensive

Essential arterial hypertension is not a disease that would significantly adversely affect patients in their daily activities. At least mostly. Nonetheless, it has a significant negative impact on cardiovascular morbidity and mortality. The tight correlation with the degree of hypertension, the patients age and, of course, commorbidities and cardiovascular risk factors is obvious. Therefore, the goal of hypertensive therapy is not only to try to achieve optimal reduction of blood pressure, but in a broader sense to reduce the risk of the just mentioned consequences, i.e. to reduce morbidity and reduce mortality. The antihypertensive drug urapidil can also be used in pharmacotherapy, the brief description of which is the subject of this article.

Diagnosis and treatment of surgical skin and soft tissue infections - current status

Surgical skin and soft tissue infections (SSTIs) result from microbial invasion of the skin and underlying soft tissues, often requiring surgical treatment. SSTIs encompass a variety of pathological conditions, ranging from frequent simple superficial skin infections with very good outcomes to rare, rapidly progressive necrotizing infections associated with long-lasting morbidity and high mortality. The document summarizes current knowledge of the diagnosis and therapy of these diseases and provides clinicians with current standards of care of these patients based on international guidelines. Additionally, regional specific aspects are also reflected, and thus in all cases, this paper on diagnostic-therapeutic management of individual clinical forms respects the actual clinical practice and epidemiology in the Czech Republic. The document has been prepared based on multidisciplinary consensus of experts from universities all over the Czech Republic.

What do the new ESC Guidelines for the treatment of heart failure bring to internists?

Chronic heart failure is in european countries in 0,4-2,0% population with an increase with age. The improved care of acute cases enables to decrease the number of patients with chronic heart failure.The disease has a bad prognosis, the diagnosis therapy are demanding. European guidelines for diagnosis and treatment heart failure stress, that patients should have all 4 drugs with class 1 reccomendation (ACE I/ARNI, betablockers, MRA and SGLT2) in reccomended doses. These drugs will be given step by step with dose titration.

A review on the most important management of keratocystic odontogenic tumor

BACKGROUND

Keratocystic odontogenic tumor (KCOT) is a recurrent benign tumor with a keratinized epithelial shape. The treatment methods in KCOT are still debated. The aim of all treatment methods is to eradicate the cyst and to reduce recurrence and surgical complications. This review article was conducted to assess the findings of studies on the dia-gnosis, management and recurrence of KCOT.

METHODS

Information were gathered by searching keywords such as management, treatment, pharmacology, surgery and keratocystic odontogenic tumor in international databases such as Web of Science, PubMed and Scopus. The search period was between 2010-2020.

RESULTS

Techniques used for the treatment include decompression, marsupialization, enucleation with or without adjunct, Caldwell-Luc surgery and resection. Of the 40 studies, recurrence was observed in 13 studies and the recurrence ranged from 0 to 48% in different treatment methods.

CONCLUSION

Due to the high recurrence of this disease, it is suggested that long term follow-up be considered after treatment to reduce recurrence. Decision on the treatment should be made considering age, tumor size, and the site of involvement in order to reduce the economic and psychological burden of the disease.

Reactive, infectious, or postinfectious arthritis?

The issue of reactive arthritis belongs to one of the most complex problems in rheumatology. Although the original concept of reactive arthritis as a &#8222;sterile arthritis&#8220; has already been overcome, much remains unclear. Non-uniform terminology, classification and diagnostic criteria as well as treatment guidelines leave room for different interpretations of this issue. Therefore it is difficult for non-rheumatologists (internal medicine physicians and general practitioners) to find their way around this topic. Our comprehensive report discusses the latest findings from etiology to treatment of reactive arthritis. It also addresses the aforementioned controversies from terminology to the latest list of causative pathogens, including viruses, parasites and vaccines.

New treatment modalities in the early stage and locally advanced non-small cell lung cancer

The lung cancer dia-gnosis is still connected with high mortality. Even the new anticancer drugs are not able to preserve long survival in the advanced lung cancer patients. Only a minority of patients is diagnosed with early or locally advanced stages. In the following review, we present interesting data regarding the treatment updates in these potentially curable patients.

Treatment strategies for myelodysplastic syndrome in 2021

The heterogeneous nature of myelodysplastic syndrome (MDS) brings a very variable prognosis of patients with the need for individualized treatment. The prognosis and treatment depend on the conventional determination of IPSS (International Prognostic Scoring System) and its revised form IPSS-R, which divides patients into lower and higher risk groups. Treatment of patients with lower risk of MDS include the improvement of cytopenia, especially anemia. The goal of treatment in patients with higher risk of MDS is delaying disease progression and improve patient survival. The only curative method for therapy of MDS is allogeneic hematopoietic stem cell transplantation (HSCT), howewer it is rarely applicable due to the age and comorbidities of patients.

Current view of diagnosis and treatment of latent autoimmune diabetes in adults

Latent Autoimmune Diabetes in Adults (LADA) is an autoimmune disease arising at adulthood. LADA is characterized by a less intensive autoimmune process, slower progression and a mild metabolic decompensation at onset compared with young-onset type 1 diabetes mellitus. The onset of LADA is usually in non-obese patients over 30, without prominent features of metabolic syndrome and insulin resistance. Nevertheless it may be falsely classified as type 2 diabetes, especially, when diagnosed in older age and for the possibility of non-insulin treatment for at least 6 months after diagnosis. LADA is treated early with insulin and combined with metformin in patients with a higher level of insulin resistance. Clinical studies suggested also effectivity of other oral antidiabetics enabling preservation of residual &#946;-cell function, such as particularly incretines.

Longterm mechanical circulatory support for chronic heart failure - real life practice

Thanks to developments in pharmacological and non-pharmacological treatment of heart failure over the last half century, there has been improved quality of life and reduced mortality and morbidity. Despite these advances, the prognosis of advanced heart failure remains poor and the number of patients with terminal heart failure is currently increasing. In the general medical community, knowledge of pharmacological and device therapy with implantable cardioverter-defibrillator or resynchronization therapy is prevalent. However, only a limited number of professionals, mostly in tertiary centres, have personal experience with the use of long-term mechanical circulatory support (MCS) in patients with advanced heart failure after the above conventional therapeutic options have been exhausted. The purpose of this communication is, therefore, to provide the general medical community with basic information about benefits, limitations and referral strategies for MCS.

Importance and efficiency of blood pressure control not only in type 2 diabetes patients

Arterial hypertension is one of the most frequent comorbidities of patients with type 2 diabetes, the rates are approximately three times higher among diabetics than in general population. The presence of both diseases increases the cardiovascular risk of the patients two to three times. Therefore, it is essential to control the blood pressure values vigorously down to 130/80 mmHg as recommended in guidelines of the Czech Hypertension Society. According to EHES Study data, the blood pressure control is not sufficient in Czech diabetic population. The target values are reached in only 29 % of diabetics. A well organized system of care, intensive antihypertensive treatment, self-monitoring of patients or appointment reminder system can be used to improve blood pressure control.

What we know and still do not know about tick-borne encephalitis?

Tick-borne encephalitis (TBE) is a febrile illness caused by tick-borne encephalitis virus (TBEV), frequently manifesting as inflammation of the central nervous system. TBEV is a typical arbovirus, i.e., belongs to a group of viruses transmitted by blood-sucking arthropods. Taxonomically, TBEV is a member of the genus Flavivirus, family Flaviviridae. The disease is endemic in North Eurasia, from western Europe to East Asia. The virus occurs in natural foci of the disease all over Czechia, where it is transmitted predominantly by the castor bean tick (Ixodes ricinus). This infection has a potential to cause significant long-term disability affecting the quality of the patients life. Vaccine is available; however, vaccination coverage in Czechia is still low (around 30% of the total population). Lately, attention has been focused on new possibilities for early diagnosis and specific treatment, which so far has only been symptomatic or empirical.

High-rank technology in the medicine - the impact of continuous glucose monitoring system alarm settings values on glycemic control in type 1 diabetes patients: a systematic review

Alarms in continuous glucose monitoring systems (CGM) represent a very important feature enabling to patients with diabetes who use these systems to keep their blood glucose level in the target range and to avoid excursion to hypoglycemia or hyperglycemia. The possibility to warn the patient that the target range has been crossed means one of the main advantages of CGM over the selfmonitoring of blood glucose with personal glucometers, but also (so far) flash glucose monitoring systems. However, there is surprisingly few studies concerning specifically the relationship between the alarms settings and glucose control. Therefore, there are currently no recommendations nor guidelines for optimal settings of alarms in CGM. Limited number of studies suggest that the setting of the hypoglycemia alarm to a level higher than 4 mmol/L is associated with lower frequency and shorter duration of hypoglycemia, and may be temporarily increased to 6 mmol/L in patients with impaired hypoglycemia awareness.

Glucagon in treatment of hypoglycemia - novelties

Glucagon is actually used in the treatment of severe hypoglycemia. Due to technological difficulties with stability in solution, glucagon in currently available preparations was contained in a form of powder, which needs to be first dissolved in the water before application. This particular administration of glucagon was associated with a certain delay and several mistakes that decreased real amount of glucagon injected in the body. Currently two new formulas of glucagon appeared on the market - first as a stable liquid solution, second as a powder for nasal administration. This article summarizes currently available information about these preparations.

Epithelioid hemangioendothelioma on PET/CT scan

BACKGROUND

At present, lung cancer ranks among the most frequent malignant diseases. However, according to literature data, mesenchymal lung tumors are very rare, representing less than 0.5% of all malignant lung tumours. Epithelioid hemangioendothelioma of the lungs belongs to this group of uncommon entities.

CASE REPORT

We present a case of a 45-year-old male with a history of increasing dyspnoea and abdominal and back pains, developing over the past several months. Vertebral lesions were found on imaging studies. PET/&#8202;CT following 18F-fluorodeoxyglucose administration (FDG) showed a large FDG-positive malignant infiltration affecting the thorax, abdominal cavity, and bones. The extension and other characteristics of the mass on PET/&#8202;CT did not correspond to any of the common oncologic diseases. With its spread in a plaque-like form predominantly in the right hemithorax and on the surface of the liver, the disease closely resembled malignant mesothelioma. The primary tumour origin could not be clearly identified on PET/&#8202;CT scans but they allowed us to choose a suitable site to obtain tissue for pathologic examination. Based on a CT-guided bone bio-psy of the 7th right rib, the dia-gnosis was concluded as epithelioid hemangioendothelioma. Despite an early initiation of systemic treatment, the patient succumbed to the disease only 15 days after the dia-gnosis, due to superior vena cava syndrome and progressive pleural effusion leading to respiratory insufficiency.

CONCLUSIONS

Given the extremely low prevalence of epithelioid hemangioendothelioma and its heterogeneous manifestation, it is impossible to base the dia-gnosis solely on disease symptoms, laboratory findings, and imaging modalities. In this respect, pathologic examination has a crucial role. For the same reason, there is a lack of recommendations for the standard-of-care systemic therapy of metastatic disease.

Hypoglycemia in non -diabetic patients

Hypoglycemia is a rather frequent complication of diabetes treatment, however it can occur also in non-diabetic patients. The article presents a brief differential diagnosis of hypoglycemia in non-diabetic patients.

Sulfonylurea derivatives and risk of hypoglycaemia in type 2 diabetic patients

Hypoglycemia related to treatment of type 2 diabetes mellitus patients constantly represents a substantial problem. It is connected with higher mortality and lower quality of life, mostly displayed with elder patients. Therefore it is vital to revise the antidiabetic therapy regularly and to inquire for the associated risks. Nevertheless, elder patiens are often following the inadvisable treatment by sulphonylureas derivates, which represent the second most risky medication causing hypoglycemia after insulin. In our retrospective study we analysed the occurence of serious hypoglycemia, caused by any factor, with severe diabetics urgently hospitalised at The Department of Internal Medicine of Masaryk Hospital in Ústí nad Labem, in relation to the applied antidiabetic therapy. We suspected a negative influence of hypoglycemizing therapy (above all sulphonylureas) with the elderly patiens. In sum, we hospitalised 32 patients with type 2 diabetes mellitus (average age 76,5 ± 8,2 years), 18 of these using sulphonylureas (average age 77,4, with a relatively wide range from 65 to alarming 93 years). The average figure of estimated glomerular filtration rate (eGFR) was 0,745 (±0,293) ml/s/1,73m2. Moreover, the patients manifested polmorbidity - the average of comorbidities was 3,125, and even 3,5 with patiens on sulphonylureas. Following the arguments summarised above, we believe that hypoglycemic episodes are extremely dangerous especially for elder patients with T2DM, and from this point of view, the medication using sulphonylureas derivates seems to be inappropriate.

A general view of epidemiology of hypoglycemia in type 1 and type 2 diabetes mellitus

Hypoglycemia particularly severe one is important side effect of diabetes therapy with impact on patient´s quality of life and mortality. The highest risk of hypoglycemia is connected with insulin therapy followed by derivates of sulfonylurea (SU) and glinides. The risk of hypoglycemia found in observational studies were 2-3 times higher in patients treated with SU and 3-4 higher when treated with insulin compared with other types of antidiabetics. The risk of hypoglycemia is increased in patients over 75 years of age, with longer period of treatment with insulin and in those treated with several types of antidiabetics.

Current view of treatment of hypoglycemia

Hypoglycemia is a side effect of the therapy primarily with insulin, sulphonylurea derivates and glinides. Its therapy is based on the immediate ingestion of sacharides, preferably glucose. Amount of 15-20 g is recommended as its optimal dose, although several recent studies are suggesting amount related to the patient´s weight. The therapy of severe hypoglycemia in the non-professional settings is based on glucagon injection, in the professional ones intravenous administration of glucose is preferable option.

How well we treat with insulin in the Czech Republic and in the Slovak Republic A summary of results and comments on the original Czech-Slovak DIAINFORM study

Despite the continuously improving treatment options, many patients with type 1 (T1DM) and type 2 diabetes (T2DM) still do not achieve the recommended treatment goals. The article provides summary and commentary of the results of DIAINFORM study focused on the level of metabolic control in T1DM and T2DM patients treated with insulin in the Czech and Slovak Republics. The overall percentage of patients with HbA1c 3 mmol/mol in the T1DM group was 29.9 % and in the T2DM group was 33.4 %.