Dr. Ernst Wodak (1891-1962) was one of the most important figures of early European vestibulology. Although he was born in Moravia and received his medical education in Prague, his name is now almost unknown in Czech medical literature. This article provides a comprehensive overview of his life and career - from his studies at the University of Vienna and the German University in Prague, his work at the Otiatric-Rhinological Clinic under professor Otto Piffl, and his scientific achievements and international recognition in interwar Europe, to his emigration from Nazi-occupied Czechoslovakia and his subsequent work in Palestine and later Israel. Wodak made a fundamental contribution to the development of diagnostic methods of the vestibular system, published more than 200 scientific papers, and became a respected member of CORLAS. Despite his worldwide professional reputation, he did not find adequate academic opportunities in Israel, and his later years were marked by severe illness and social isolation. The aim of this article is to highlight his remarkable contributions, place them within their historical and social context, and restore this important figure to his rightful place in the history of otorhinolaryngology in Bohemia.
The life story represents a useful tool that enables people living with dementia to better preserve their identity and sense of continuity, that is, the connection between who they were and who they still are. At the same time, they provide care providers with a deeper understanding of the needs and values of people with dementia and enable the provision of care that is truly individualized, sensitive, and respectful. In practice, information from life stories is used as a valuable source of knowledge for care planning. However, this approach raises several ethical questions. Who has the right to tell the story? Who decides on its form and content? The aim of this article is therefore to reflect on the aspects of working with life stories in relation to the dignity and autonomy of people with dementia.
The advance directives institute represents a legally established instrument that allows patients to define their wishes and preferences regarding the provision of health care in advance, for situations in which they lose decision-making capacity. Although advance directives have been part of the Czech legal framework since 2012, their practical use remains limited and systematic data on their implementation are lacking. The aim of this article is to summarize available knowledge regarding the awareness of the Czech public and healthcare professionals about advance directives, identify the main barriers to their use, and place these findings in the context of current debates about end-of-life decision-making.
A nuclear power plant accident or the use of a nuclear weapon represents a serious crisis situation requiring a rapid and coordinated response by all components of the Integrated Rescue System, public administration authorities, and other institutions involved in civil protection. The primary objective of the emergency response is to minimize the health effects of ionizing radiation and radionuclides on the population and to reduce the risks of long-term environmental contamination. An essential prerequisite for the effective management of such an event is adequate awareness and professional preparedness of all participating entities. This professional publication provides a comprehensive overview of the acute management of a radiological emergency of the nature of a radiation accident. The text is based on the principles of the crisis management system of the Czech Republic, national emergency response plans, and current knowledge in radiation medicine and radiation protection. It focuses on the role and activities of the Integrated Rescue System at the incident site, including coordination of response operations and implementation of protective measures for population protection. Furthermore, it addresses the prediction of the health effects of ionizing radiation and radioactive contamination, as well as the possibilities for minimizing their impact on the exposed population.
Therapeutic antibiotic monitoring allows for the assessment of whether the chosen dosage leads to the achievement of the desired pharmacokinetic-pharmacodynamic (PK/PD) indices in a specific patient. The modern concept of therapeutic drug monitoring (TDM) goes beyond merely comparing to the therapeutic range and emphasizes the determination of an individual therapeutic target. Knowledge of PK/PD indices: Cmax/MIC, AUC/MIC, and fT>MIC is crucial for optimizing treatment and minimizing the risk of toxicity. TDM is a tool of personalized pharmacotherapy. TDM represents a process and includes individual steps, the implementation of which into routine practice contributes to the rationalization and safety of antibiotic therapy.
The issue of the biological effects of ionizing radiation (IR) is returning to the forefront of scientific research for several reasons. One is the further development of cancer radiotherapy and radiation protection, now also in the context of planned pilot trips to Mars. A very strong negative motivation is probably the historically highest risk of misuse of radioactive materials by terrorists and nuclear weapons by terrorist states. Conventional attacks on nuclear facilities, accompanied by the dispersion of highly radioactive substances, cannot be ruled out either. Understanding the health risks of exposure and the possibilities of protection against IR depends on how different types of IR interact with living organisms. The different effects of photon and particle types of radiation, which can be encountered not only on planet Earth but especially in space, allow for an explanation of the differences between stochastic effects of IR, which can be caused by even low doses of radiation, and deterministic effects, which appear only in the case of exposure to higher doses.
The Artificial Intelligence Act (AI Act) establishes specific obligations for entities that use AI systems. In healthcare, these obligations primarily concern high-risk AI systems, which include a significant proportion of medical applications. The aim of this article is to provide a systematic analysis of the obligations of healthcare providers as deployers of high-risk AI systems, with particular emphasis on clinical practice. The text outlines the key obligations imposed on deployers and analyzes them in a structured manner. The article also highlights the relationship between these obligations and existing requirements of healthcare law, in particular the principles of lege artis practice and informed consent.
Anaphylaxis, if not promptly recognised and adequately treated, can rapidly lead to death even in previously healthy individuals. At the same time, a number of myths and misconceptions persist, complicating both its diagnosis and management. It is often assumed, for example, that cutaneous manifestations such as exanthema are a defining feature of anaphylaxis and that symptoms always occur immediately following exposure to an allergen. In clinical practice, treatment is not infrequently initiated with corticosteroids and antihistamines, while adrenaline is reserved for cases of clinical deterioration. There is also a widespread belief that all patients who experience anaphylaxis must invariably be hospitalised. In the following text, we address uncertainties in the diagnosis, treatment, and organisation of care for patients with anaphylaxis. We reflect on current guideline recommendations, with an emphasis on their practical application in everyday clinical practice.
New-onset sexual dysfunction in men, particularly erectile dysfunction, should not be regarded merely as an isolated sexual complaint. It may represent an early manifestation of endothelial dysfunction, atherosclerotic disease, diabetes mellitus type 2, obesity, arterial hypertension, dyslipidemia, hypogonadism, hyperprolactinemia, thyroid disorders, or adverse drug effects. The aim of this review is to summarize current evidence on the relationship between sexual dysfunction and cardiometabolic risk and to provide a practical outpatient approach for primary care, internal medicine, diabetology, urology, and sexual medicine. This narrative review is based mainly on the current European Association of Urology recommendations, the Princeton IV Consensus, and selected systematic reviews and meta-analyses. Particular attention is paid to focused history taking, physical examination, basic laboratory work-up, risk stratification, and the differential diagnosis of vasculogenic, endocrine, iatrogenic, and psychogenic causes. The review also incorporates the Czech clinical context and proposes a pragmatic referral framework for situations requiring further evaluation or specialist care.
Virtual reality has rapidly established itself in recent years as an innovative component of modern medicine. It is applied in rehabilitation, neurology, oncology, psychotherapy, geriatric care, and many other areas of clinical practice. Advanced systems make it possible to create individualized, controlled, and interactive environments for training motor, cognitive, and behavioral functions, while providing immediate feedback and objective measurement of patient performance. The technology is used not only in therapy, but also in healthcare education, surgical simulation, and crisis-scenario training. Clinical studies and meta-analyses demonstrate beneficial effects of virtual reality on anxiety, depression, motor rehabilitation after stroke, Parkinson's disease, and postural stability in older adults. Despite these promising results, significant limitations remain, including methodological shortcomings of existing studies, technical and organizational barriers, the risk of cybersickness, and the need for protocol standardization. Projects in the Czech Republic illustrate the practical application of virtual reality; however, fully unlocking its potential will require ongoing research and long-term monitoring to objectively evaluate its effectiveness, safety, and sustainability.
In 2024, the Chamber of Deputies of the Parliament of the Czech Republic approved a bill amending Act No. 372/2011, on health services and conditions for their provision (the Health Services Act). Its amendment (Act No. 240/2024) was, among other things, supposed to include provisions concerning spiritual care provided by hospital chaplains. However, this did not happen, and hospital chaplaincy received legal support only with the next comprehensive amendment to the Health Services Act in 2025. However, this did not happen, and hospital chaplaincy received legal support only with the next comprehensive amendment to the Health Services Act in 2025 (Act No. 290/2025).
The study focuses on the personality of Eduard Albert (1841-1900) in the full scope of his professional, cultural and social activities. Albert is presented not only as a founding figure of modern surgery in the Habsburg monarchy, but also as a writer, translator, patron and political mediator of Czech interests in Vienna. The text follows his life path from modest circumstances in East Bohemia through his peak career at the University of Vienna to the "second life" of his legacy, embodied in the name and symbolic meaning of the Prague university campus Albertov.
Although Vavřinec Pospíšil was not among the prominent protagonists of Czech otorhinolaryngology at the beginning of the 20th century, he still deserves not to be forgotten. The 42-year-old graduate of the medical faculty became one of the last assistants of the founder of the first Czech otological-pharyngological clinic in Prague, professor Emilian Kaufmann and then returned to his birthplace in Haná. For 16 years, he provided specialized care to the residents of Olomouc and the surrounding area, as he was the first Czech specialist doctor in this region.
Drug-induced sexual dysfunction (iatrogenic sexual dysfunction) ranks among the most common, least reported, and at the same time clinically most significant adverse effects of long-term pharmacotherapy in men. In clinical practice, it typically manifests as reduced libido, erectile dysfunction (ED), ejaculatory disorders, orgasmic dysfunction, or a combination of several phenotypes, while the temporal relationship to treatment initiation or dose titration may be subtle. The aim of this article is to provide a pragmatic, implementable algorithm for the outpatient physician, integrating sexuological assessment with a basic pharmacological analysis (likelihood of a drug-related cause, dose dependence, interactions, substitution options) and recommended interventions, including the safe use of phosphodiesterase type 5 (PDE5) inhibitors in ED.
Drug-related complications during acute intercurrent illnesses represent a significant clinical problem particularly in multimorbid patients. The Sick Day Rules concept provides a simple and effective framework for healthcare professionals to safely implement temporary witholding of medications that affect renal haemodynamics and glycaemic control. However, several commonly used high-risk drug classes, specifically statins, anticoagulants, and methotrexate, cannot be included in these simplified recommendations, as their management requires individualised clinical assessment. This article summarizes the pharmacological and clinical rationale for excluding these agents from this concept and proposes an argument-based framework to support clinical decision-making in routine practice, with the aim of minimising risks associatied with both inappropriate continuation and unjustified interruption of therapy.
Dysphoric milk ejection reflex (D-MER) is a syndrome characterized by a sudden onset of negative emotional experiences occurring a few seconds prior to each ejection of breast milk. These sensations arise and resolve abruptly, typically lasting only several minutes, and recur with every individual milk let-down. As a result, women affected by D-MER may experience dozens of such episodes throughout the day and night. According to available studies, D-MER affects approximately one in ten to one in five breastfeeding women. The specific emotional experiences vary among individuals in type, intensity, and duration. While some mothers experience symptoms throughout the entire breastfeeding period, in others the symptoms resolve spontaneously after several months, most commonly after approximately three months. Reported emotional states include insecurity, sadness, irritability, aggression, panic, shame, self-loathing, and depressive mood; in rare cases, suicidal ideation has also been described. Additional accompanying symptoms include loss of appetite and impaired concentration. D-MER has a neurobiological basis. The pathophysiology of this syndrome remains a subject of research. The most supported hypothesis is because prolactin, a hormone essential for milk ejection, is tonically inhibited by dopamine. For prolactin levels to rise sufficiently, a reduction in the level of its inhibitor must first occur. A transient decrease in dopamine is therefore considered a likely mechanism underlying the negative emotional changes characteristic of D-MER. There is no available causal therapy. Current evidence suggests that awareness of D-MER itself, together with practical measures such as drinking ice-cold water, getting adequate sleep, and ensuring privacy during breastfeeding, may help reduce the subjectively perceived intensity of symptoms. Education and basic awareness can therefore represent an important source of support for many women.
Doxycycline post-exposure prophylaxis (Doxy-PEP; a single 200 mg dose of doxycycline within 72 hours after sexual exposure, not exceeding 200 mg per 24 hours) has been shown in randomized trials among men who have sex with men (MSM) and transgender women (TGW) to reduce the incidence of syphilis and Chlamydia trachomatis infection; its effect on Neisseria gonorrhoeae transmission is smaller and varies by locale. In 2024, the U.S. Centers for Disease Control and Prevention (CDC) published the first clinical guidance recommending targeted use of Doxy-PEP for MSM/TGW with a bacterial sexually transmitted infection (STI) in the previous 12 months; European branch of International Union Against Sexually Transmitted Infectuions (IUSTI-Europe) in June 2024 acknowledged individual benefits while urging caution; and in 2025 the World Health Organization initiated development of global guidance. To provide a clinically oriented review of the effectiveness, safety, and risks of Doxy-PEP and to place these findings within the Czech context of epidemiology and antimicrobial resistance, including interpretation of the national position statement of the Society for Infectious Medicine (SIL ČLS JEP). Doxy-PEP is an effective tool for preventing syphilis and Chlamydia trachomatis infection in high-risk MSM/TGW. Given potential adverse effects, the risk of antimicrobial resistance (AMR) development, and the still limited data for other populations, cautious, data-driven use within comprehensive sexual health care is advisable. This approach is consistent with international recommendations and the current SIL ČLS JEP position statement.
Inosine pranobex (IP), also known as inosine pranobex dimepranol, is an immunomodulatory drug with a history spanning more than fifty years. It was first introduced in the 1970s and has since been licensed in more than 50 countries around the world. It was originally considered a potential drug for AIDS, which raised high hopes at the time of the discovery of the HIV virus. However, after initial interest, its use in this area declined, and for a long time, IP was no longer discussed significantly in professional literature or clinical practice. Renewed interest came only in the last decade, when IP began to reappear in connection with the treatment of acute respiratory infections, diseases caused by human papillomavirus (HPV), and other viral diseases, including COVID-19. It also began to be used as an adjuvant in the foot-and-mouth disease vaccine, and research began on an IP-based anti-tumor vaccine.
