Changes in the level of health literacy in Czechia between 2015 and 2020.

During the five years from 2015 to 2020, the proportion of people with limited health literacy decreased by 12%. This finding results from international research on the level of health literacy, which took place since 2019 till 2021 in 17 countries of the European region of the World Health Organization. In total, more than 42,000 respondents were interviewed, in Czechia there were 1,650 respondents. In 2020, however, we recorded a limited level of health literacy in 47% of the population over the age of 18. Respondents have the greatest problems with understanding health information from the media and with assessing different treatment options. Czechs (like Slovaks) have the biggest problem with following the instructions of a doctor or pharmacist. Health literacy is influenced by gender, age and education: women, older people and less educated people show higher levels of health literacy. The respondent's social gradient, primarily subjective social status has positive influence to health literacy while financial deprivation has negative influence. On the other hand, health literacy positively affects the physical activity of the respondent; subjectively perceived health and consumption of medical services are influenced as well. The Czech Health Literacy Institute is currently preparing monitoring in 2024-2025.

Novel biochemical markers for non-invasive detection of pancreatic cancer.

To identify non-invasive biomarkers of non-metastatic pancreatic cancer (PC), the blood from 186 patients (PC n=28; DM-diabetes mellitus n=60; ChP-chronic pancreatitis n=47; healthy controls n=51) was analyzed for 58 candidate biomarkers. Their effectiveness to identify PC was compared with CA19-9. Panel defined by Random-forest (RF) analysis (CA19-9, AAT, IGFBP2, albumin, ALP, Reg3A, HSP27) outperforms CA19-9 in discrimination of PC from DM (AUC 0.92 vs. 0.82). Panel (S100A11, CA72-4, AAT, CA19-9, CB, MMP-7, S100P-s, Reg3A) is better in discrimination PC from ChP than CA19-9 (AUC 0.90 vs. 0.75). Panel (MMP-7, Reg3A, sICAM1, OPG, CB, ferritin) is better in discrimination PC from healthy controls than CA19-9 (AUC 0.89 vs. 0.78). Panel (CA19-9, S100P-pl, AAT, albumin, adiponectin, IGF-1, MMP7, S100A11) identifies PC among other groups better than CA19-9 (AUC 0.91 vs. 0.80). Panel defined by logistic regression analysis (prealbumin, IGFBP-2, DJ-1, MIC-1, CA72-4) discriminates PC from DM worse than CA19-9 (AUC 0.80 vs. 0.82). Panel (IGF-1, S100A11, Reg1alfa) outperforms CA19-9 in discrimination PC from ChP (AUC 0.76 vs. 0.75). Panel (IGF-2, S100A11, Reg3A) outperforms CA19-9 in discrimination PC from healthy controls (AUC 0.95 vs. 0.78). Panel (albumin, AAT, S100P-serum, CRP, CA19-9, TFF1, MMP-7) outperforms CA19-9 in identification PC among other groups (AUC 0.89 vs. 0.8). The combination of biomarkers identifies PC better than CA19-9 in most cases. S100A11, Reg3A, DJ-1 were to our knowledge identified for the first time as possible serum biomarkers of PC.

Professor Josef Charvát and Informatics.

Professor Josef Charvát, a prominent internist and endocrinologist, has been following the issues of cybernetics and computers from the very beginning. In the difficult times of the 1950s, he was heavily involved in the organization of seminars and meetings of workers in technical and medical fields interested in cybernetics. Later, in his books for the general public, he foresaw a significant application of computers in medicine. His predictions are quite accurate even 50 years after the publication of these ideas.

Optimizing clinical approaches to COVID-19 patients in primary care.

There is insufficient evidence from medical studies for clinical approaches to patients with COVID-19 in primary care. Patients often urge the therapeutic use and preventive administration of various medicines, often controlled by studies insufficiently or completely unverified. The aim of the project, commissioned by the Committee of the Society of General Practice of the Czech Medical Association JEP, was to compensate for this deficiency by interdisciplinary consensus and thus provide general practitioners (GPs) with a basic support in accessing patients with COVID-19. Representatives of GPs identified the most common questionable diagnostic or therapeutic approaches and formulated 17 theses, taking into account their own experience, existing Czech and foreign professional recommendations. The RAND/UCLA Appropriateness Method, modified for the needs of pandemic situation, was chosen to seek consensus. Representatives of 7 medical specialties accepted the participation in the 20-member panel. The panel evaluated in 2 rounds, with the comments and opinions of others available to all panelists before the second round. The outcome of the evaluation was agreement on 10 theses addressing the administration of vitamin D, inhaled corticosteroids in patients with COPD and bronchial asthma, acetylsalicylic acid, indications for D-dimer levels examination, preventive administration of LMWH, importance of pulse oximetry, indication for emergency services, indication for antibiotics and rules for distant contact. The panel disagreed on 6 theses recommending the administration of ivermectin, isoprinosine, colchicine and corticosteroids in patients with COVID-19 in primary care. One thesis, taking into account the use of D-dimers in primary care was evaluated as uncertain. The most discussed theses, on which there was also no agreement, were outpatient administration of corticosteroids and the importance of elevation of D-dimers levels or their dynamic increase in a symptomatic patient with COVID-19 as an indication for referral to hospital. The results of the consensus identified topics that need to be further discussed and on which it is appropriate to focus further research.

Obesity and cardiovascular disease.

Obesity with no comorbidities probably carries no cardiovascular risk, and the so-called obesity paradox even comes into play, wherein obesity may improve the prognosis of cardiovascular disease. Cardiovascular complications primarily occur indirectly due to metabolic comorbidities of obesity. However, a thrombogenic potential of obesity has also been established. A very important question in contemporary obesitology is whether antidiabetics currently administered in obese non-diabetic individuals will have a positive cardiovascular effect similar to that in diabetics. Myokines, muscle tissue hormones, certainly have a protective effect on the cardiovascular system. Also of importance is the research into epicardial and pericardial fat. Its investigation and management will aid in finding additional options of diagnosing and treating cardiovascular disease.

Contemporary state and perspectives of obesity pharmacotherapy.

The history of obesity pharmacotherapy is controversial. Many drugs are not used more due to severe side effects. Today we have four effective antiobesity drugs. The effect of some of them is comparable with bariatric sugary. Weight loss induced by bariatric surgery is culminating in the first year. The effect of incretine analogues is progressive in several years and culminating later. There are many antiobesity drugs in development. Both centrally or peripherally acting new drugs will be available soon. Even targeted therapy using antibodies will be used in obesitology soon.

Current views on metabolic syndrome.

The theory of metabolic syndrome originated 30 years ago. Several definitions try to explain the frequent common incidence of the risk factors for atherosclerosis. At first the syndrome of insulin resistance was involved. It was only later that the relation of the metabolic syndrome was described to what is known as systemic inflammation arising in adipose tissue and inflammatory diseases such as chronic bronchitis or psoriasis, or to degenerative diseases such as Alzheimers disease. The views on the metabolic syndrome are thus constantly changing. Key words: adipose tissue inflammation - definition of metabolic syndrome - insulin resistance - myokines - systemic inflammation.

[Treatment strategy of type 2 diabetes used in Czech Republic after metformin therapy failure]. / Strategie lécby diabetu 2. typu pri selhání lécby metforminem pouzívané ceskými lékari nebo v Ceské republice.

INTRODUCTION: Type 2 diabetes is an enormous medical problem caused by increasing prevalence of the disease and increasing prevalence of severe chronic complications of diabetes. New ADA/EASD guidelines and also Czech diabetes society guidelines enable effective individual approach to the patient. Goal of the therapy is optimal compensation of diabetes and prevention of acute and chronic complications of diabetes and decrease of mortality. Diabetes therapy is started by education in diet a regime combined with metformin. According to the progressive character of the disease it is usually necessary to intensify the therapy by adding antidiabetics from other groups. AIM: This study was proposed to analyse the use of therapy algorithm in Czech Republic in patients with insufficient metformin therapy. Secondary objectives were to describe level of compensation of diabetes in time and level of components of the metabolic syndrome in different treatment combinations.Methodic and results: In the sample of 1 516 patients, frequency of use of antidiabetic medication after metformin it was gliflozins 33% and gliptins 28% in the first phase of the study and the number increased later during the study. Median of HbA1c in the beginning of the study was 65 mmol/mol, greatest decrease was found in patents using combination of incretine analogs with metformin - 89 % of them had the HbA1c level < 60 mmol/mol. CONCLUSION: The study showed also that antidiabetic drugs used after metformin in Czech Republic are very effective in reducing weight, and improving blood pressure and lipid profile. Therapy using combination of metformin with gliflozins, gliptins or incretin analogs is most effective when metformin is not effective enough.Key words: diabetes type 2 - gliflozins - gliptins - incretine analogs - metformin therapy failure.

Urine Levels of Phthalate Metabolites and Bisphenol A in Relation to Main Metabolic Syndrome Components: Dyslipidemia, Hypertension and Type 2 Diabetes. A Pilot Study.

AIM: Human exposure to organic pollutants (some of them also called endocrine disruptors) can be associated with adverse metabolic health outcomes including type 2 diabetes. The goal of this study was to compare the urine levels of bisphenol A and phthalate metabolites in subgroups of patients with metabolic syndrome composed of patients with and without three important components of metabolic syndrome (hypertension, dyslipidemia and diabetes). METHODS: We have investigated 24 hr urine samples of 168 patients with metabolic syndrome from the Metabolic Outpatient Department of General University Hospital in Prague. Using standard metabolic syndrome criteria, we classified patients as dyslipidemic (n=87), hypertensive (n=96), and type 2 diabetic (n=58). Bisphenol A and 15 metabolites of phthalates were evaluated in relation to creatinine excretion. Samples were analysed with enzymatic cleavage of glucuronide using ultra-high-performance liquid chromatography-electrospray ionization tandem mass spectrometry in one laboratory with external quality control. RESULTS: Four metabolites, mono-n-butyl phthalate, mono-(2-ethyl-5-hydroxyhexyl) phthalate, mono-(2-ethyl-5-oxohexyl) phthalate, and mono-(2-ethyl-5-carboxypentyl) phthalate showed significantly higher levels in diabetic compared to non-diabetic patients (p<0.001, p=0.002, p=0.002, and p=0.005, respectively). The differences remained significant after adjustment to hypertension, dyslipidemia, age, and BMI. No difference was found between either the hypertensive and non-hypertensive or dyslipidemic and non-dyslipidemic patients. There was no significant relation of bisphenol A level to diabetes, hypertension, dyslipidemia, age, and BMI. CONCLUSIONS: Urine levels of four phthalate metabolites were significantly higher in type 2 diabetics independently on specified predictors. Phthalate levels can be in relation to beta cell dysfunction in type 2 diabetic patients but this study is not able to show if the relation is causal.

[Alternative healing methods around us]. / Alternativní lécebné metody kolem nás.

This article gives information on selected alternative medicine methods (AMM) under conditions of the Czech health care system. They can be defined as contemporaneous diagnostic and therapeutic methods which differ in their theoretical fundaments as well as practices from the evidence based medicine. This definition is controversial because these methods are an intrinsically incompatible aggregate of modalities acting as a placebo above all. We can encounter many "therapeutic" and "examination" methods which are practiced namely by healers without formal medical education, and connected closely with esotericism. A general feature of the alternative methods is a void usage of scientific concepts and theories, e.g. the concept of energy.Motivations of patients and doctors are briefly introduced here. However, AMM is also an ethical problem because the doctor should help the patient with maximum efficiency hence excluding the methods with a questionable, small or negligible efficiency. The opinions how to find the way out from this situation are divergent. It could be a refusal or a very reserved attitude to AMM plus maximisation of the placebo effect enhancing the efficiency of a rational therapy. Furthermore, the methods most spread in the Czech Republic are subjected to elementary critics - the homoeopathy, acupuncture, the so-called "bioresonance" instrumental methods, psychic healing, and also some refused methods in cancer treatment. In our opinion medicine disposes of sufficient knowledge and experience to assess the efficiency of AMM and refuse them in causal therapy, eventually. Their use as a placebo should be carefully considered.Key words: alternative medicine, placebo, homeopathy, acupuncture.

[Potential sources of phthalates and bisphenol A and their significance in the development of metabolic diseases]. / Potenciální zdroje ftalátu a bisfenolu A a jejich význam u metabolických onemocnení.

Nowadays, there is increasing evidence showing that the development of the metabolic syndrome combining obesity, type 2 diabetes mellitus, arterial hypertension and dyslipidemia involves except of traditional risk factors (overnutrition, lack of physical activity, genetic predisposition) also the effect of environmental organic substances called organic pollutants or endocrine disruptors. These chemicals can be found in plastic covers, paints, flame retardants, exhaust gases, fertilizers as well as diverse daily utensils. Phthalates, used primarily as plasticizers, and bisphenol A, are among the most wide-spread members of this group.The aim of this article is to provide a basic overview of the relationship between phthalates and bisphenol A and the etiopathogenesis of the metabolic syndrome and to highlight their potential sources. According to the analysis of materials used for parenteral nutrition and urinary excretion of phthalate metabolites and bisphenol A in subjects on long-term parenteral nutrition we suppose that currently used medical materials are safe with respect to the exposure to both phthalates and bisphenol A and that home environment, especially cosmetic products, might constitute a more probable source of these substances.

[A diet suitable for patients with dyslipidemia and metabolic syndrome]. / Dieta pri dyslipidemii a metabolickém syndromu.

Atherosclerosis or cardiovascular disease is the leading cause of mortality and morbidity in developed countries. Intervention of its risk factors is pharmacological but non-pharmacological intervention must be its integral part. Dietary recommendations for dyslipidemia are long known however it is necessary to emphasize the importance of their compliance. Presently, these recommendations for adult population to prevent from atherosclerosis are based on healthy nourishment, especially to have sufficient consumption of fish, fresh vegetable and fruit and to avoid consumption of secondary processed meat especially, i.e. smoked meat. Nowadays, there is a diverting trend from recommendation to strictly avoid cholesterol in the diet.Key works: atherosclerosis - cholesterol - diet intervention - dyslipidemia - fatty acids.

[The microbial flora in the digestive tract and diabetes]. / Mikrobiální flóra trávicího traktu a diabetes.

The microbial flora in the digestive tract has been recently studied in relation to metabolic diseases. There are relations to both type 1 diabetes and type 2 diabetes. The intestinal flora is affected by diet, physical exercise and it significantly changes after bariatric surgeries. Giving birth by caesarean section affects the gut flora development and increases the risk of type 1 diabetes in further life of the child. Obese patients with type 2 diabetes may lack protective microbes which improve glucoregulation in the experiment or on the contrary their patogenous microbes may grow which have been proven to even be able to penetrate into abdominal adipose tissue and play a role, inter alia, in the hepatic impairment and systemic inflammation. Also vaccination against these microbes is under consideration. Microbiome can be also positively affected by metformin treatment. The transfer of intestinal flora by means of fecal transplantation can improve glucoregulation. The influencing of intestinal flora is likely to become a new mechanism of diabetes treatment.

[Obesity and orthopedic surgery, or else do mechanical complications of obesity exist?]. / Obezita a ortopedické operace aneb existují mechanické komplikace obezity?

Arthroses of weight-bearing joints and vertebrogenic problems are characteristic diseases of the obese. However the extreme risk is associated in particular with the combination with metabolic syndrome. Arthroses of bearing joints thus do not only present a mechanical complication of obesity, but also a metabolic complication. Similarly, the risk of venous thromboembolism which involves all orthopedic surgeries, is associated with both a rising BMI and hormonal condition (use of hormones and the like.). A joint replacement surgery can be typically performed on patients with a weight of up to 90 kg or BMI below 30. A preparation aimed at decreasing BMI to reach these values significantly reduces the risk of postoperative complications. However it is also necessary for the patient to maintain the reduced weight.Key words: diabetes mellitus - knee joint replacement - hip joint replacement - mechanical complications of obesity - metabolic complications of obesity - metabolic syndrome - obesity - surgery related risk - venous tromboembolizmus.

[Myokines - muscle tissue hormones]. / Myokiny - hormony svalové tkáne.

Physical inactivity is demonstrably related to the manifestation of chronic diseases which significantly modify the quality and prognosis of life in a negative way. The benefits of exercise are surely mediated by many pathophysiological mechanisms interrelated in varying degrees, which have not yet been fully examined in their complexity. In the late 20th century it was positively proven that a working striated muscle really regulates the metabolic and physiological response in the other organs. These involve several hundred substances with autocrine, paracrine and endocrine effects. These proteins and peptides, if released into the blood stream, substantially affect the metabolism of distant organs. They were classified as "myokines" (cytokines produced by myocytes). The identified myokines include e.g. IL4, IL6, IL7, IL15, myostatin, LIF (leukemia inhibitory factor), BDNF (brain-derived neurotrophic factor), IGF1 (insulin-like growth factor), FGF2 (fibroblast growth factor 2), FGF21, FSTL1 (follistatin-related protein 1), irisin, EPO (erythropoetin) and BAIBA (ß-aminoisobutyric acid). Myokines have first of all an immunoregulatory role in the human body. Another important effect of myokines is, coincidentally also in the interaction with adipose tissue, the regulation of energy homeostasis. They also affect the growth of muscle fibres and their regeneration, stimulate angiogenesis, they are involved in the regulation of glucose metabolism and have a proven effect on lipids. Considering their diverse function, myokines present a prospective therapeutic goal in the treatment of disorders of muscle growth and regeneration as well as obesity. Another recent research moves toward uncovering of the "myokine resistance" as a result of long-term muscle inactivity and its association with chronic subclinical inflammation.

[Perspective of obesity pharmacotherapy]. / Perspektivy farmakoterapie obezity.

Obesity is a very common disease with very difficult treatment. Most patients are not able to change their behaviour. Most hopeful for the future is a safe pharmacotherapy which could be widely used. In this review, old and potentially new drugs decreasing weight are mentioned (centrally acting anorectics, orlistat, incretine analogues and gliphlozines). Review of newly in U.S.A used antiobesitics is also mentioned. Finally potentially new principles of obesity pharmacotherapy are enumerated.

[How are changing the therapy options in obese diabetic type 2 patients]. / Jak se mení moznosti lécby obézních diabetiku 2. typu.

Classical consequence of treatment with anti-diabetic agents, including insulin, is weight gain which enhances insulin resistance and leads to a further increase in drug dose. This creates an unwanted cycle. Administration of weight neutral anti-diabetic drugs has broken this scenario. Another option is to use anti-obesity agents, but actually many of them are not available. However, in the United States, two new drugs have been used in past two years. The most important change in the treatment of obese type 2 diabetes patients is administration of anti-diabetic agents that reduce weight. These agents are well-known incretin analogs characterized by their unpleasant injecting administration. However, application becomes easier and the drugs are administered for the866 longer time period. Even greater change in treatment is administration of gliflozins. Dapagliflozin and empagliflozin enter almost simultaneously to the Czech Republic. The new class of drugs has very complex metabolic effect and in particular significantly reduces the weight even in patients treated with insulin. The treatment options have significantly expanded for obese type 2 diabetes patient in course of this year.

[How we indicate oral antidiabetics today (from metformin to gliptins and gliflozins)]. / Jak dnes indikujeme perorální antidiabetika (od metforminu ke gliptinum a gliflozinum).

Today we treat Type 2 diabetes mellitus by gradually adding antidiabetics from monotherapy to double, triple and multi combinations of medicines. Metformin still remains the first-line medicine, if well tolerated and not contraindicated. In the next step, we have a wide choice of 5 groups of medicines at least. The new algorithms used in the U.S.A. introduce some degree of preference for the incretin therapy (gliptins and incretin analogues) and the new groups of gliflozins over the standard treatments. In the near future, the indication of antidiabetics is therefore about to undergo big changes or at least a discussion about the preferences of the individual groups of medicines including those new to diabetology.Key words: gliflozins - gliptins - incretin therapy - metformin - oral antidiabetics - type 2 diabetes mellitus.

[Why and how do insulin agents act on weight]. / Proc a jak pusobí inzulinové prípravky na hmotnost.

The weight gain in insulin therapy is known phenomenon for decades. Different types of insulin and insulin analogues differ in many clinical effects, e.g. duration of action, risk of hypoglycaemia and effect on the weight as well. These effects vary with change of insulin for insulin analogues and vice versa. It has been unclear for a long time why some insulin analogues have positive effect on weight gain. Currently, it is obvious that several factors are crucial: binding to albumin, reduction of hypoglycaemia events, dissociation between hepatic and peripheral effects, influence on renal function and differences in action of insulin in brain. Therefore, we know how to use beneficial effect of particular agent in daily practice. In addition, we know pathogenetic mechanisms that influence the weight - in other words, we can answer the question why and how does particular agent change the weight.

[Obesity and heart]. / Obezita a srdce.

Cardiovascular complications of obesity are traditionally considered an important complication of obesity. Obesity itself is probably not direct cause of atherosclerosis or coronary heart disease. This may occur indirectly in metabolic complications of obesity, especially diabetes and metabolic syndrome. However, thrombogenicity potential of obesity contributes to embolism and atherosclerosis development. In cardiology is well-known a phenomenon of obesity paradox when obese patients have better prognosis than thin. This is the case of heart failure and some other cardiovascular diseases. Recently, a new concept has emerged of myokines - hormones from muscle tissue that have extensive protective effects on organism and probably on heart. Whether heart is a source of myokines is uncertain. However, undoubted importance has epicardial and pericardial fatty tissue. The epicardial fatty tissue has mainly protective effects on myocardium. This fatty tissue may produce factors of inflammation affecting the myocardium. Relationship between amount of epicardial fatty tissue and coronary heart disease is rather pathogenic. Currently, it is certain that obesity brings more metabolic and cancer complications than cardiovascular and accurate contribution to pathogenic or protective character of fatty tissue in cardiology requires further research. Nevertheless, the conclusion is that adipose tissue of organism and around the heart may be in some circumstances beneficial.