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News After 20 years, a new treatment option for primary biliary cholangitis arrives
Primary biliary cholangitis (PBC), formerly known as cirrhosis, is a rare disease with a negative impact on prognosis and quality of life. While ursodeoxycholic acid (UDCA) has been essentially the only treatment option for PBC so far, in 2016, the European Medicines Agency (EMA) approved obeticholic acid as a second-line option. Since 2019, this medication has been available and fully covered by health insurance in 11 selected centers in the Czech Republic.
News Alarming Data on Prevalence and Insufficient Treatment of Hypertension in Working Age − Another Underestimated 'Civilization Epidemic'?
The National Cardiology Information System (NKIS), developed by the Czech Society of Cardiology in collaboration with the Institute of Health Information and Statistics (ÚZIS), has provided the first data on the prevalence of hypertension in the Czech population. It revealed that even the treatment of a significant risk factor for cardiovascular diseases – hypertension – is not well managed in the Czech Republic. About 40% of patients with hypertension do not have regular preventive check-ups with their general practitioner, while 40% of hypertensive patients are simultaneously of working age.
News Subcutaneous vs. Intravenous Immunoglobulins in Patients with CLL
Secondary antibody immunodeficiency is a common complication in patients with chronic lymphocytic leukemia (CLL), and infections, along with secondary malignancies, are the leading cause of death in these patients. Hypogammaglobulinemia can be managed with immunoglobulin replacement therapy (IGRT). Besides the classic intravenous form (IVIG), a subcutaneous form (SCIG) is also available. An Italian retrospective study published in the journal Current Oncology compared their efficacy in secondary immunodeficiency in CLL patients.
News Multiparametric Magnetic Resonance in Predicting Progression of Low-Risk Prostate Cancer
A newly published study has demonstrated the utility of imaging using multiparametric magnetic resonance imaging (mpMRI) and its interpretation using PI-RADS version 2 (Prostate Imaging Reporting and Data System) in predicting unfavorable disease outcomes in patients with prostate cancer suitable for active surveillance.
News Spectrum of Mechanisms of Action of Fenfluramine in the Treatment of Rare Epilepsies
Fenfluramine (FFA) is an anticonvulsant used in the treatment of rare epilepsies such as Dravet syndrome and Lennox-Gastaut syndrome. In addition to effectively reducing seizure frequency, it also mitigates non-seizure comorbidities in patients with these conditions. Last year, Belgian authors published a detailed review of all its described mechanisms of action. They also explain how these mechanisms might contribute to the clinical benefits of FFA beyond seizure suppression, such as reducing the risk of sudden unexpected death in epilepsy (SUDEP) or improving executive functions.
News Cenobamate in the Therapy of Pharmacoresistant Epilepsy in a Warfarinized Patient – A Case Study
A case study from Czech practice presents a patient with pharmacoresistant epilepsy and concurrent warfarin medication for heart valve replacement, where the INR value remained within the cardiologist’s recommended range without further adjustments to anticoagulant therapy during combined antiepileptic therapy with cenobamate (CNB) under the recommended dose titration.
News MDT Board: a unique project for doctors caring for patients with lung diseases and other thoracic pathologies
A unique concept of a cooperative thoracic group has been created in the Czech Republic, involving specialists from several leading Prague clinics. The primary purpose of the so-called board is to provide the best diagnostic and treatment plan for a patient with lung disease and other pathologies in the thoracic area, shared by all members of the multidisciplinary team and based on current knowledge. The MDT Board project, which operates on the principle of online indication seminars, is intended for doctors of patients with common and rare lung diseases.
News Biosimilar Bevacizumab in Patients with Non-Small Cell Lung Cancer
Biosimilar drugs are essentially analogous to generics for biological medicines. The patent protection for the original bevacizumab product will expire in the European Union in 2022. Consequently, several companies have already embarked on developing a biosimilar molecule.
News Most Common Dermatoses Around the Stoma
The incidence of stomal complications ranges between 20 and 70%. One type of complication is dermatoses affecting the peristomal skin. These issues can occur in the early postoperative period, but also several years later.
News Doc. Miloslav Salavec: We Still Encounter Delayed Initiation of Biological Treatment in AD and Many Other Diagnoses
Not all patients with atopic dermatitis (AD) who are indicated for biological treatment with dupilumab manage to reach centers where the treatment is provided. It's even more unfortunate when there's ample evidence that the effects of this therapy on disease manifestations and overall quality of life extend beyond just the patients. It also impacts the lives of their close ones who care for those with atopic dermatitis. Head of the Clinic of Venereal and Skin Diseases at Charles University and the University Hospital Hradec Králové Doc. MUDr. Miloslav Salavec, CSc., evaluates how dupilumab has performed over several years of real clinical practice and the specific benefits it has brought to patients.
News Less is Sometimes More – How Generic Substitution Can Affect Patient Adherence
It is undisputed that the use of generic drugs saves the healthcare system significant costs. Although doctors should certainly care about the health of the system, they primarily care for the health of individual patients – and for them, generic substitution may not always be the best choice. For instance, it is now known that it is not ideal for drugs with a narrow therapeutic range, such as antiepileptics, antidepressants, or antiparkinsonian drugs. But does this mean that generic substitution is always a welcome choice for other drugs?
News Does olaparib improve overall survival in patients with recurrent ovarian cancer and BRCA mutation?
Olaparib, a poly(ADP-ribose) polymerase (PARP) enzyme inhibitor, in tablet form is indicated, among other things, for the maintenance treatment of adult patients with platinum-sensitive recurrent high-grade epithelial ovarian, fallopian tube, or primary peritoneal cancer who respond (complete or partial response) to platinum-based chemotherapy. Its efficacy in this indication in terms of prolonging progression-free survival and overall survival was addressed by the phase III study presented below.
News The Role of Inflammation in the Cardiovascular Continuum and the Aging Process
Inflammation plays a role at various stages of the cardiovascular (CV) continuum, in both atherosclerotic and non-atherosclerotic CV diseases. Where to look for inflammation in the pathophysiology of CV diseases, why inflammation is related to aging, and how to utilize these findings in clinical practice was explained in a lecture by MUDr. Peter Wohlfahrt, Ph.D., from the Center of Preventive Cardiology IKEM in Prague, at the XXXII Annual Meeting of the Czech Cardiology Society.
News Different doses of LMWH in hospitalized patients with COVID-19 – interim experience
Many experts recommend administering heparin to patients with COVID-19 as part of anticoagulant prophylaxis, especially in severe forms of this infection. However, data on dosage, administration duration, and the effectiveness of this approach are limited. Therefore, authors from Bologna, Italy, investigated the relationship between various doses of low-molecular-weight heparin (LMWH) and mortality in patients hospitalized with COVID-19.
News Fixed Combination of Tramadol/Paracetamol in the Treatment of Chronic Lower Back Pain and Its Effect on Apathy in Chronically Algic Patients
Long-term chronic pain is associated with apathy, loss of motivation, and depression in patients. However, these comorbidities of chronic pain and their interconnections are still insufficiently explored. The aim of the Japanese study was to evaluate the prevalence of apathy in patients with chronic low back pain (LBP) and the therapeutic efficacy of the fixed combination of tramadol/paracetamol in treating this pain and its effect on apathy in LBP patients.
News Rapid Strengthening and Long-term Stabilization – New Strategy for Sequential Treatment of Severe Osteoporosis
Osteoanabolics have long been considered a treatment modality for osteoporosis that is only considered when antiresorptive medication lacks the desired efficacy. However, their role has been shifting in recent years based on new findings from clinical research, as evidenced by the conclusions of the expert working group of the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis, and Musculoskeletal Diseases (ESCEO), whose brief summary we bring.
News Sotorasib in the Treatment of a Patient with NSCLC and DIC – A Case Report
Sotorasib is the first clinically used inhibitor of the KRAS oncogene with the G12C mutation. Its efficacy in the targeted treatment of non-small cell lung cancer (NSCLC) is still under research, but it is expected to bring significant benefits. The effect of sotorasib in a patient with a low baseline performance status (PS) and active brain metastases is presented in the following case report.
News Nutritional Care as Part of Prehabilitation in Surgical Patients
Nutritional preparation of patients before surgery as part of prehabilitation can significantly affect the quality of recovery and physical condition of patients after surgery. This topic is highlighted, among other sources, by a team of Canadian doctors in their work published in the journal Anesthesiology, an interesting meta-analysis of 15 RCTs, and last but not least, it is covered in a webinar titled 'Surgical Patient and Nutrition'.
News Non-Invasive Diagnosis of Cardiac Amyloidosis
Cardiac amyloidosis has always been considered a rare pathology. However, thanks to advancements in imaging methods and laboratory tests, it is now evident that it might be responsible for a larger amount of cardiac diseases than previously thought. Which non-invasive diagnostic methods are useful in identifying cardiac amyloidosis?
News Diagnosis and Management of Therapy for a Breastfeeding Patient with Significant Elevation of Liver Enzymes Postpartum – Interactive Case Study
In the following case study, we present a specific approach to a patient who developed a significant elevation of liver enzymes after childbirth. Through interactive elements, you can try out how you would proceed in diagnosing and treating this case.
News Effect of PCSK9 Inhibitors on Clinical Outcomes in Patients with Hypercholesterolemia – Meta-Analysis of 35 Randomized Controlled Trials
The authors from several American institutions examined the efficacy and safety of two proprotein convertase subtilisin/kexin type 9 (PCSK9i) inhibitors, alirocumab and evolocumab, in their work. They conducted a systematic meta-analysis of randomized controlled clinical trials comparing the administration of these two PCSK9i with standard treatment.
News The Position of Lurasidone in Schizophrenia Therapy − Current Conclusions and Consensus of the Expert Panel
Lurasidone is an antipsychotic belonging to the group of serotonin and dopamine antagonists (SDA) indicated for the treatment of schizophrenia in adults and adolescents aged 13 years and older. The efficacy of lurasidone has been confirmed by a number of clinical studies, compared to placebo and using active control with known antipsychotics (e.g., olanzapine or quetiapine). The aim of the recently published study was to define current possibilities of using lurasidone in the treatment of schizophrenia and to identify patient groups that would benefit the most from this therapy.