Casopis Lekaru Ceskych[JOURNAL]
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200 papers
My patient is taking a statin and is scheduled for surgery.
Piťha J
Cas Lek Cesk · 2024 · PMID 40816907
Statins rank among the most useful drug groups with convincing data from clinical trials, especially in patients at very high risk of developing or recurring cardiovascular events of atherosclerotic origin. As with all e...
Statins rank among the most useful drug groups with convincing data from clinical trials, especially in patients at very high risk of developing or recurring cardiovascular events of atherosclerotic origin. As with all effective drugs, side effects are described also for statins, but these effects are rare. Nevertheless, because statins are used by many individuals for a long time periods, these effects could be observed. The main discussed ones include myopathy, hepatopathy, decreased renal function and higher incidence of diabetes mellitus. Another area of recent discussions is the possibility of untoward effects of statins during extensive surgical procedures, when it is considered their discontinuation. However, the vast majority of available data demonstrated that statins are safe or even beneficial in terms of surgical procedures complications. Therefore, discontinuation of these drugs before surgery is not recommended in majority of individuals. Nevertheless, in certain risk groups statins could cause complications; these include patients with impaired renal function exposed to loading dose of statins before surgery. However, the presumption that the most serious complication of surgery might be unnecessary discontinuation of statins is still valid.
Young adult cancer patients in the Czech Republic: Is there a need for national guidelines?
Sokop T, Dufek D, Polášková K … +4 more , Nováková K, Lakomý R, Petráková K, Obermannová RL
Cas Lek Cesk · 2024 · PMID 40816906
Adolescents and young adults (AYAs) are a group of patients characterized by specific needs in cancer care. Although only 5 % of cancers are diagnosed in this age group, malignancies represent a significant burden in ter...
Adolescents and young adults (AYAs) are a group of patients characterized by specific needs in cancer care. Although only 5 % of cancers are diagnosed in this age group, malignancies represent a significant burden in terms of years of healthy life lost and the consequences of cancer treatment. Important issues for young patients include diagnostic delay, promotion of primary prevention, biologically distinct tumor types, oncogenetic evaluation, unique psychosocial challenges, fertility issues, monitoring of adverse effects of treatment including the development of secondary malignancies, or the absence of age-specific clinical trials. The centralization of care and the formation of multidisciplinary teams dedicated to young patients will allow for a more comprehensive approach with a focus on these issues. One means of improving care for young cancer patients is the development of national guidelines and the organisation of international and national clinical trials.
Smoking in cars - unhealthy and hazardous.
Králíková E
Cas Lek Cesk · 2024 · PMID 40816905
Why not smoke in the car? Smoking harms the smoker in the first place, but passive smoking also harms others in the car. Unfortunately, even with the windows open or the air conditioning on, the air pollution levels in t...
Why not smoke in the car? Smoking harms the smoker in the first place, but passive smoking also harms others in the car. Unfortunately, even with the windows open or the air conditioning on, the air pollution levels in the car cabin still exceed the given limits. Smoking in car contributes to the normalisation of smoking as a standard activity, which is particularly important for children. It distracts the driver's attention and the substances in the smoke reduce his or her attention and reactivity. Lighting a cigarette can be blinding. Driver's smoking significantly increases the risk of an accident, both for mechanical reasons and because of the dampening effect of tobacco smoke, especially carbon monoxide, and the high dose of nicotine. Dozens of countries ban smoking in cars, usually if a child, adolescent, or pregnant woman are present in the car, the Czech Republic is not yet one of these countries.
Harm reduction and tobacco smoking.
Mravčík V
Cas Lek Cesk · 2024 · PMID 40816904
The article provides a narrative review of the rationale, arguments and evidence for the effectiveness of harm reduction strategies in reducing tobacco smoking and its consequences and offers a summary for health policy...
The article provides a narrative review of the rationale, arguments and evidence for the effectiveness of harm reduction strategies in reducing tobacco smoking and its consequences and offers a summary for health policy and clinical practice. Tobacco smoking is a critical health determinant in developed countries, including the Czech Republic, reducing adult life expectancy by 1-2 years and draining about 10% of health spending. Alternative products, i.e. products delivering nicotine other than in tobacco smoke, represent an opportunity to complement already implemented tobacco control measures. Their main benefit is the diversion of smokers away from conventional cigarettes towards less harmful forms of nicotine use. E-cigarettes, heated tobacco products or low-nitrosamine oral tobacco are approximately twenty times less harmful than conventional cigarettes and the risk of nicotine pouches is two to three orders of magnitude lower and reach the risk of nicotine replacement therapy or non-smokers. Nicotine contributes to the risks of alternative products, but its harmfulness is much lower compared to the other constituents of tobacco smoke. Nicotine dependence remains its major risk, and the increasing use of alternative products is of particular concern in adolescent non-smokers. However, the best available evidence suggests that alternative products do not represent a gateway to smoking and that they are replacing smoking even in the part of the adolescent population that is vulnerable to experiments with nicotine. Alternative products are also proving effective in smoking cessation and can be offered during counselling in clinical practice as an alternative to smoking for those who are not ready to quit completely. A balanced harm reduction strategy, including the supply and use of alternative products, represents an opportunity that can be a critical factor in curbing the tobacco epidemic.
The decision-making on cost-inefficient care.
Černý D, Doležal T, Doležal A
Cas Lek Cesk · 2024 · PMID 40816903
Cost-inefficient care in health care is an extremely urgent problem. In a context of limited resources and rising healthcare costs, it is essential to allocate resources efficiently and fairly. Cost-effectiveness assessm...
Cost-inefficient care in health care is an extremely urgent problem. In a context of limited resources and rising healthcare costs, it is essential to allocate resources efficiently and fairly. Cost-effectiveness assessment methods have ethical implications, in particular raising issues of fairness and discrimination. The issue of cost-effective care requires a broader social discussion on the rules of allocation and prioritization, which should respect the values of fairness and efficiency, and on transparency in decision-making processes.
Strategy for prevention of thromboembolic disease in urology.
Medková T, Jurok M, Revészová K … +3 more , Kičerka Z, Záleský M, Murínová I
Cas Lek Cesk · 2024 · PMID 40816902
Venous thromboembolism, which includes deep vein thrombosis and pulmonary embolism, is associated with high morbidity and mortality rates. Surgical procedures are a significant risk factor for the development of venous t...
Venous thromboembolism, which includes deep vein thrombosis and pulmonary embolism, is associated with high morbidity and mortality rates. Surgical procedures are a significant risk factor for the development of venous thromboembolism. Preventing venous thromboembolism must be personalized for each patient, based on their individual risk factors and the specific nature of the surgical procedure, considering the types of surgeries performed. In urology, elderly patients are the most frequent recipients of pharmacological venous thromboembolism prevention. With the growing challenge of an aging population, it is increasingly important to customize drug regimens in older adults to ensure safe pharmacotherapy. This article outlines the venous thromboembolism prevention system at the Urology Clinic of the First Faculty of Medicine, Charles University, and the Military University Hospital Prague. The strategy has been integrated into application software for ease of use in daily practice. The implementation of this system has led to more rational anticoagulant pharmacotherapy. It serves as an example of interdisciplinary collaboration between physicians and clinical pharmacists, which is key to improving patient care.
Efficiency of health care in the Czech Republic in international comparison 2010-2021.
Dlouhý M, Pavlík F
Cas Lek Cesk · 2024 · PMID 40816901
The efficiency of the Czech health care system was evaluated by the efficiency index, which contains 4 inputs and 3 outputs of the health care system. The weights of medical inputs and outputs were obtained on the basis...
The efficiency of the Czech health care system was evaluated by the efficiency index, which contains 4 inputs and 3 outputs of the health care system. The weights of medical inputs and outputs were obtained on the basis of a questionnaire survey among experts. International comparisons show that the efficiency of the Czech healthcare system has been declining in the long term in the period 2010-2021. However, the same trend can be observed in other European countries.
Opinion of an international panel of experts on the clinical use of microbiome testing.
Cahová M, Najmanová L
Cas Lek Cesk · 2025 · PMID 40816900
The international panel of experts has issued a joint consensus opinion on the possibilities of clinical use of gut microbiome analysis with an unequivocal conclusion: The microbiome is an important component of the huma...
The international panel of experts has issued a joint consensus opinion on the possibilities of clinical use of gut microbiome analysis with an unequivocal conclusion: The microbiome is an important component of the human body, and its condition is indisputably related to human health. However, the methodology of microbiome composition analysis has not yet been standardized and the interpretation of the results regarding the health of the individual is not yet sufficiently conclusive. Therapeutic counseling based on the results of microbiome testing is strongly discouraged. Further research is required for widespread use in clinical practice.
Utilization of telemedicine in the care of children with obesity.
Veselá L, Hainerová IA
Cas Lek Cesk · 2025 · PMID 40816899
Obesity is a chronic, relapsing, and progressive disease with increasing prevalence, that significantly impacts health and quality of life, even in children. It is associated with an increased risk of metabolic and cardi...
Obesity is a chronic, relapsing, and progressive disease with increasing prevalence, that significantly impacts health and quality of life, even in children. It is associated with an increased risk of metabolic and cardiovascular diseases such as insulin resistance, type 2 diabetes mellitus, hypertension, dyslipidemia, and metabolic dysfunction-associated steatotic liver disease. Additionally, obesity can lead to the development of sleep apnea syndrome, orthopedic issues, and psychological complications. The cornerstone of the care is educating the whole family about a healthy lifestyle; however, this may often be challenging due to obstacles such as time constraints, limited access to specialists, and low long-term adherence of families. Telemedicine offers an innovative approach to improving obesity treatment in children through digital tools, online consultations, smart applications, and wearable technologies. It enables more effective monitoring of dietary and physical activity habits, supports mental health, and reduces time and financial burdens for families. Studies indicate that combining in-person and remote support, along with active involvement of family members, leads to higher success rates in weight reduction and a healthy lifestyle maintenance. This article focuses on the use of telemedicine in the treatment of obesity in children, providing an overview of the methods applied in this field and their effectiveness in the context of current scientific knowledge.
Basic legal prerequisites for secondary use of genomic data for scientific purposes.
Jirsa J, Franková V
Cas Lek Cesk · 2025 · PMID 40816898
The aim of genomic data sharing is to enable secure access to this data, primarily for research, personalized healthcare and health policy-making. Data sharing has the potential to accelerate research and bring about sig...
The aim of genomic data sharing is to enable secure access to this data, primarily for research, personalized healthcare and health policy-making. Data sharing has the potential to accelerate research and bring about significant advances in the understanding of health and disease, but it faces legal and ethical issues related to the protection of privacy and confidentiality of information. In addition to the often counterintuitive European legislation leading to different legal interpretations, there are other national rules in individual European Union countries that can further specify the handling of genomic data. This diversity complicates international cooperation and data sharing, not only in genetics but also in other areas of biomedical research. This thesis analyzes the basic legal framework and its application enabling the sharing of genomic data and clarifies the concepts of further processing, secondary use and purpose of data processing. Furthermore, it stresses the importance of data subjects' consent and specific exceptions to the general ban on processing sensitive data. For effective sharing of genomic data, it is essential to comply with European and national legislation, including a clear definition of the purpose and legal basis of processing. International cooperation requires regulatory harmonization and robust data management. This paper analyzes the fundamental dynamics and legality of data sharing in the field of genomic research.
The importance of the regulation of surrogacy from the point of view of civil, medical and criminal law.
Arnoštová LT, Navrátilová JT, Galovcová I
Cas Lek Cesk · 2025 · PMID 40816897
Surrogate motherhood is one of the possible procedures to become a parent, However, it is not legally regulated. Practice shows that there are several problematic or controversial aspects that should be regulated in the...
Surrogate motherhood is one of the possible procedures to become a parent, However, it is not legally regulated. Practice shows that there are several problematic or controversial aspects that should be regulated in the interest of all participants, but especially the well-being of the child. The legislation should mainly concern the altruistic principle, the medical indications of the intended and surrogate mother, their medical examinations and approval by the court.
Advances in the diagnosis and treatment of male infertility - an overview of current methods.
Broul M, Hujová A, Liegertová M
Cas Lek Cesk · 2025 · PMID 40816896
Male infertility is a multifactorial condition influenced by hormonal, anatomical, genetic, and lifestyle factors. Although the male factor contributes to up to 40% of infertility cases, the exact etiology often remains...
Male infertility is a multifactorial condition influenced by hormonal, anatomical, genetic, and lifestyle factors. Although the male factor contributes to up to 40% of infertility cases, the exact etiology often remains unknown (so-called idiopathic infertility). Current diagnostic approaches include detailed clinical evaluation, semen analysis, hormonal assessment, genetic testing, and imaging techniques. Significant progress has been achieved in sperm DNA fragmentation testing and oxidative stress evaluation, offering a broader insight into sperm quality. Treatment strategies vary depending on the underlying cause, ranging from pharmacological therapy and surgical interventions to assisted reproductive technologies. Rapid advances in regenerative medicine and gene therapy show promise for novel therapeutic options. A healthy lifestyle and risk factor management are integral to both prevention and treatment.
Shooting at the Faculty of Arts of Charles University and activation of the trauma plan at the First Surgical Clinic of the General Teaching Hospital.
Kraus J, Burget F
Cas Lek Cesk · 2025 · PMID 40816895
The Trauma Plan is a set of measures to mitigate the consequences of injury in emergencies and crisis situations. It was activated at the First Surgical Clinic of the General University Hospital in December 2023, on the...
The Trauma Plan is a set of measures to mitigate the consequences of injury in emergencies and crisis situations. It was activated at the First Surgical Clinic of the General University Hospital in December 2023, on the day of the tragic shooting in the building of the Faculty of Arts of Charles University in Prague. Thanks to the practice activations, teams, premises and beds were prepared within 20 minutes without complications. An exceptional case was a gunshot wound that occurred at 350 meters (on the other bank of the Vltava River), the origin of which, however, the patient-foreigner was not aware of and was reported as a fracture of the femur after a fall while fleeing.
Czech doctors in Ukraine - MEDEVAC mission.
Streck M, Burget F, Holoubek J
Cas Lek Cesk · 2025 · PMID 40816894
A multidisciplinary medical team from several Czech hospitals participated in a mission to a hospital in the Ukrainian town of Vynnyky as part of the MEDEVAC project. Civilian patients were provided with specialized surg...
A multidisciplinary medical team from several Czech hospitals participated in a mission to a hospital in the Ukrainian town of Vynnyky as part of the MEDEVAC project. Civilian patients were provided with specialized surgical care in cooperation with plastic surgeons for injuries related to combat operations and without it. A case of a complex open fracture of the forearm bones with extensive defect of soft tissues and skeleton in a 32-year-old civilian patient is briefly described.
How to feed patients with obesity in intensive care?
Křížová J, Kršáková Z
Cas Lek Cesk · 2025 · PMID 40816893
In connection with the increasing prevalence of overweight and obesity, the number of these patients in intensive care units is increasing - current statistics indicate 20-30% of patients admitted in the obesity zone and...
In connection with the increasing prevalence of overweight and obesity, the number of these patients in intensive care units is increasing - current statistics indicate 20-30% of patients admitted in the obesity zone and 25% in the overweight zone. Nutritional goals and strategies for patients with obesity are one of the biggest challenges of modern nutritional care. They include a comprehensive diagnosis of malnutrition and the correct determination of energy and protein intake, for which it is possible to use formulas recommended by the European Society for Parenteral and Enteral Nutrition (ESPEN) or the American Society for Parenteral and Enteral Nutrition (ASPEN). The research focuses on the possibilities of immunonutrition and influencing the microbiota.
Clinical obesity - finally a change of paradigm? From BMI to chronic disease.
Sucharda P
Cas Lek Cesk · 2025 · PMID 40816892
The still valid method of defining obesity by the current body mass index (BMI) value does not adequately reflect the severity or health risks of individuals and does not meet the requirements of evidence-based medicine....
The still valid method of defining obesity by the current body mass index (BMI) value does not adequately reflect the severity or health risks of individuals and does not meet the requirements of evidence-based medicine. This definition of obesity has, among other things, led in the past to proposals for such problematic categories as metabolically healthy obesity or obesity with normal weight, and it also contributes to the so-called obesity paradox. The definition of clinical obesity according to The Lancet Diabetes & Endocrinology Commission addresses these shortcomings and characterizes obesity as a chronic, systemic disease characterized by changes in the function of tissues, organs, the whole individual, or their combinations due to excessive fat accumulation. Conditions with increased amounts of fat tissue without such changes are referred to as preclinical obesity; the recommendations for the care of individuals with preclinical obesity are somewhat problematic.
Dyslipidemias as rare diseases.
Tesařová Š, Češka R
Cas Lek Cesk · 2025 · PMID 40816891
Dyslipidemias are mostly considered to be diseases with mass incidence. However, there are also several dyslipidemias that occur within the framework of rare diseases. Most of them are genetically determined. In this rev...
Dyslipidemias are mostly considered to be diseases with mass incidence. However, there are also several dyslipidemias that occur within the framework of rare diseases. Most of them are genetically determined. In this review, we have focused on three selected diseases for which new therapy is available and significantly change prognosis of the patients. Homozygous familial hypercholesterolaemia is associated with extreme elevation of LDL cholesterol, leading to premature manifestation of atherosclerotic cardiovascular disease in the first decade of life. Thanks to new hypolipidemic drugs such as evinacumab and lomitapide, patients today have a much better prognosis than in the past. Lipodystrophies are a heterogeneous group of diseases characterized by progressive loss of adipose tissue leading to metabolic abnormalities. Due to new causal metreleptine therapy, we can help patients with managing these metabolic complications significantly. Familial chylomicronemia is not associated with an increased risk of atherosclerotic cardiovascular disease, but it is accompanied by extremely high levels of triglycerides, leading to frequent attacks of acute pancreatitis, which can be potentially fatal. Therapy with volanesorsen leads to a reduction of hypertriglyceridemia, thereby reducing the risk of developing acute pancreatitis. Although these diseases are rare, it is necessary to think about them and diagnose them early. Interdisciplinary cooperation is essential during search and treatment of these patients.
The benefits of the MEDEVAC project for the Czech healthcare system.
Bříza J
Cas Lek Cesk · 2025 · PMID 40816890
The MEDEVAC Permanent Medical Humanitarian Program of the Czech Republic focuses on providing medical care to vulnerable groups of the population in regions affected by migration, burdened by many refugees or in places w...
The MEDEVAC Permanent Medical Humanitarian Program of the Czech Republic focuses on providing medical care to vulnerable groups of the population in regions affected by migration, burdened by many refugees or in places where specialized medical care is not available. Treatment is provided free of charge and exclusively to civilians who are in a serious health condition or whose health condition does not allow them to lead a dignified life. The program started in 1993 in Bosnia and Herzegovina, continued in Kosovo and has gradually been extended to several other countries. At present, MEDEVAC is a program of the Government of the Czech Republic coordinated by the Department of Asylum and Migration Policy of the Ministry of the Interior of the Czech Republic in cooperation with the Ministry of Foreign Affairs, the Ministry of Health, the Ministry of Defense and the Army of the Czech Republic. The MEDEVAC program is of fundamental educational importance. Participants expand their practical experience with situations typical of conflict and natural disaster areas and become acquainted with the organizational specifics of care in crisis areas. The experience gained in crisis areas is a significant contribution to the preparedness of our health care system, especially traumatology and related fields. The General University Hospital in Prague has been involved in several of its departments since 2011, in addition to the First Surgical Clinic, the Department of Ophthalmology, the Department of Rehabilitation Medicine and the Department of Gynaecology, Obstetrics and Neonatology.
Comparison of performance between artificial intelligence and radiologists in detecting abnormalities on chest X-rays.
Dandár J, Jindra T, Kvak D
Cas Lek Cesk · 2025 · PMID 40816889
Artificial intelligence (AI) has been increasingly applied in radiology, where it offers the potential to improve the accuracy and efficiency of diagnosis, particularly in the evaluation of conventional imaging modalitie...
Artificial intelligence (AI) has been increasingly applied in radiology, where it offers the potential to improve the accuracy and efficiency of diagnosis, particularly in the evaluation of conventional imaging modalities such as chest X-rays. This study analyzes the performance of commercial software using machine learning and, respectively, artificial intelligence approaches (Carebot AI CXR; Carebot s.r.o.) in detecting abnormalities in chest radiographs compared with independent evaluations by 3 radiologists of different levels of experience. The study was conducted in collaboration with Hospital Tabor, which provided a dataset of 207 anonymised radiographs, out of which 196 were assessed as relevant. The sensitivity and specificity of AI were compared with human assessment in 5 categories of abnormalities: atelectasis (ATE), consolidation (CON), cardiac shadow enlargement (CMG), pleural effusion (EFF) and pulmonary lesions (LES). Carebot AI CXR software achieved high sensitivity in all evaluated categories (e.g., ATE: 0.909, CMG: 0.889, EFF: 0.951), and its performance was consistent across all findings. In contrast, AI specificity was lower in some categories (e.g., EFF: 0.792, CON: 0.895), while radiologists achieved performance values approaching 1.000 in most cases (e.g., RAD 1 and RAD 2 EFF: 1.000). AI demonstrated consistently higher sensitivity than less experienced radiologists (e.g., RAD 1 ATE: 0.087, CMG: 0.327) and in some cases than more experienced assessors, but at a modest decrease in specificity. The study also includes case reports, including false-positive and false-negative findings, which contribute to a deeper understanding of AI performance in clinical practice. The results suggest that AI can effectively complement the work of radiologists, especially for less experienced doctors, and improve the sensitivity of diagnosis on chest radiographs.
Operability of lung cancer at the Department of Pulmonology, 2nd Faculty of Medicine, Charles University and Motol University Hospital in Prague in 2024 and its development in the Czech Republic in the last 45 years.
Marel M, Fila L, Rakita D … +7 more , Mendéz LFC, Koubková L, Bejčková A, Chládková Z, Lischke R, Šimonek J, Švorcová M
Cas Lek Cesk · 2025 · PMID 40816888
In 2024, the multidisciplinary team of the Department of Pulmonology, 2nd Faculty of Medicine, Charles University and Motol University Hospital discussed 454 cases of patients with lung cancer; There were 70 (16%) operat...
In 2024, the multidisciplinary team of the Department of Pulmonology, 2nd Faculty of Medicine, Charles University and Motol University Hospital discussed 454 cases of patients with lung cancer; There were 70 (16%) operated on that year. Patients with adenocarcinoma (52%) in TNM stages I to IIIB prevailed among the operated patients. We administered immunochemotherapy as neoadjuvant treatment to 18 of the operated patients, and 61% of them experienced complete pathological regression. Lobectomies (86%) were significantly more prevalent among surgical procedures, only once the procedure ended with exploratory thoracotomy. We have achieved a 55% agreement between cTNM and pTNM. No one died within 30 days after the operation. We compared the current results of lung cancer surgery with similar groups of patients from outpatient and clinical departments from the last 45 years. During this time, the number of indications for resection treatment did not increase. The proportion of morphological types of lung carcinoma has changed (increase in adenocarcinomas), procedures performed in patients (lobectomies clearly predominate today) and the number of patients operated on in stages IIIA and IIIB has increased slightly. The agreement between the clinically evaluated extent of the tumor and its actual size determined by the pathologist remains at a very good level, as in the past, and is comparable to the results of the most advanced centers in the world. The number of indications for resection depends on the timeliness of diagnosis. At present, less than 20% of patients with lung cancer are diagnosed in TNM stages I and II. We see a possible improvement in the increase in the number of participants in lung cancer screening using low-dose CT, which is well organized and available to all interested parties from 2022. The results of this screening known so far confirm a 57% representation of stages I and II of TNM in patients detected in this way.
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