Internal Medicine

Home mechanical ventilation in a patient with Duchenne muscular dystrophy

Author: Ivana Paraničová

annotation image

Duchenne muscular dystrophy (DMD) is a hereditary progressive neuromuscular disorder that is inherited in X-linked recessive pattern. Mutation of dystrophin gene results into a loss of integrity and function of muscular fibres and their replacement by adipose and connective tissue. Muscle degeneration leads to motoric impairment and loss of walk around 12th year of age. Myocardium is also frequently affected. Respiratory muscles impairment and other complications lead to respiratory failure. If left untreated, death occurs around 20th year of life, usually due to cardiac or respiratory causes. Respiratory insufficiency development is treated by mechanical ventilation support.

Are the case reports useful for you? Would you also require case reports from other clinical disciplines? Do you have any comments or suggestions for improvement? Please provide your feedback by filling out a short questionnaire.

Systemic lupus erythematosus with multiple organ complications

Author: Katarína Demková

annotation image

Systemic lupus erythematosus (SLE) is an autoimmune disease, mostly with a chronic course, that can affect almost all important organs, most commonly skin, joints, heart and vessels, kidneys, central nervous system and lungs. The disease is characterized by B-lymphocyte hyperactivity, which leads to the formation of autoantibodies predominantly directed against non-specific antigens. This case study describes a case of SLE with multiple organ complications in a 29-year-old female patient.

Are the case reports useful for you? Would you also require case reports from other clinical disciplines? Do you have any comments or suggestions for improvement? Please provide your feedback by filling out a short questionnaire.

Parainfectious myocarditis

Author: Katarína Demková

annotation image

Myocarditis is an acute inflammatory condition that can have an infectious, toxic or autoimmune aetiology. Myocarditis can complicate many infections in which inflammation may be due directly to infection of the myocardium or the effects of circulating toxins. The clinical picture ranges from a symptomless disorder, sometimes recognised by the presence of an inappropriate tachycardia or abnormal ECG, to fulminant heart failure. Myocarditis may be heralded by an influenza-like illness. In most patients, the disease is self-limiting and the immediate prognosis is excellent. However, death may occur due to a ventricular arrhythmia or rapidly progressive heart failure. Myocarditis has been reported as a cause of sudden and unexpected death in young athletes. Some forms of myocarditis may lead to chronic low-grade myocarditis or dilated cardiomyopathy. The case report describes a case of parainfectious myocarditis in a 20-year-old patient.

Are the case reports useful for you? Would you also require case reports from other clinical disciplines? Do you have any comments or suggestions for improvement? Please provide your feedback by filling out a short questionnaire.

Obstructive sleep apnoea in extremely obese patient

Author: Ivana Paraničová

annotation image

Obstructive sleep apnoea (OSA) is characterized by repetitive episodes of interruption of breathing during sleep due to partial or complete collapse of pharynx. Prevalence of mild OSA is about 9-24%, clinically significant disease is present in about 4% men and 2% women. Morphology of upper airways and body weight are important factors for development of OSA. Approximately 70% of OSA patients are overweight and 40% obese patients suffer from OSA.

Are the case reports useful for you? Would you also require case reports from other clinical disciplines? Do you have any comments or suggestions for improvement? Please provide your feedback by filling out a short questionnaire.

Chronic Respiratory Failure due to Kyphoscoliosis

Author: Ivana Trojová

annotation image

Kyphoscoliosis is a well-recognized cause of respiratory failure. Kyphoscoliosis is a chronic disease, occurring in 2-3% of the general population, which leads to a distorted spinal curvature and chest wall deformity. As a consequence, respiratory function is impaired due to reduced chest wall compliance and restrictive lung function pattern arises. The development of noninvasive ventilation (NIV) has made it an accepted standard modality of care at the present time for patients with chronic respiratory failure caused by kyphoscoliosis. The presented case report describes a 49-year-old female with idiopathic kyphoscoliosis who developed chronic hypercapnic respiratory failure with the need of noninvasive ventilatory support.

Are the case reports useful for you? Would you also require case reports from other clinical disciplines? Do you have any comments or suggestions for improvement? Please provide your feedback by filling out a short questionnaire.

Newly diagnosed COPD - obstructive ventilatory impairment

Author: Pavol Pobeha

annotation image

Presented case report documents an example of a patient with an accidentally diagnosed chronic obstructive pulmonary disease (COPD) based on clinical signs. Diagnosis was confirmed by a pneumologist using spirometry. A bronchodilation test was carried out to confirm the irreversibility of detected obstructive ventilatory impairment. The patient was given combined bronchodilator treatment with ß2-mimetics and anticholinergics to relieve symptoms, improve functional parameters and prevent subsequent exacerbations.

Are the case reports useful for you? Would you also require case reports from other clinical disciplines? Do you have any comments or suggestions for improvement? Please provide your feedback by filling out a short questionnaire.

Multiple lung abscesses

Author: Ivana Trojová

annotation image

Lung abscesses are caused due to microbial infection when an area of infected lung becomes necrotic, which results in the development of a cavity containing pus or necrotic debris within the lung itself (Figure 1). In contrast to pleural infection, the incidence and mortality rate of lung abscesses have steadily declined since antibiotic era. The case report presents a 43-year-old patient with multiple lung abscesses.

Are the case reports useful for you? Would you also require case reports from other clinical disciplines? Do you have any comments or suggestions for improvement? Please provide your feedback by filling out a short questionnaire.

Posterior wall myocardial infarction

Author: Marianna Vachalcová

annotation image

Isolated posterior myocardial infarction is occurring in 3-11% of all infarctions. ST - segment depression in leads V1-V3 suggests myocardial ischaemia, especially when the terminal T - wave is positive (ST - segment elevation equivalent), and confirmation by concomitant ST-segment elevation ≥ 0,5mm recorded in leads V7-V9 should be considered as a mean to identify posterior myocardial infarction. Emergent coronary angiography and percutaneous coronary intervention of the infarct - related artery is indicated.

Are the case reports useful for you? Would you also require case reports from other clinical disciplines? Do you have any comments or suggestions for improvement? Please provide your feedback by filling out a short questionnaire.

Obesity hypoventilation syndrome

Author: Ivana Paraničová

annotation image

Obesity hypoventilation syndrome (OHS) is defined as the combined presence of obesity (BMI > 30kg/m2) with awake arterial hypercapnia (pCO2 > 6.0 kPa / 45 mmHg) in the absence of other causes of hypoventilation. The exact prevalence of OHS in the general population remains unknown, and most prevalence data describe subjects with obstructive sleep apnoea, wherein its prevalence has been estimated to range from 10% to 38% in different groups. On the other hand, patients with OHS often suffer from sleep-related breathing disorders. Prevalence of obstructive sleep apnoea may reach up to 90-95% in OHS patients.

Are the case reports useful for you? Would you also require case reports from other clinical disciplines? Do you have any comments or suggestions for improvement? Please provide your feedback by filling out a short questionnaire.

Acid-based balance

Author: Ivana Valočiková

annotation image

Lecture for 5- year subject Internal Medicine 4. Basic knowledge of disorders of the internal environment, their cause, diagnosis and principles of treatment of metabolic and respiratory acidosis and alkalosis. Metabolic processes ► acid/base ACIDS from carbohydrates and fat metabolism (15-20 000 mmol of CO2 daily) CO2 + H2O ►H2CO3 ►(carbonic anhydrase) H + HCO3 H + Hb in RBC ►released with oxygenation in the alveoli ►reversed reaction – H2O + CO2 – exhaled in each breath.