Polskie Archiwum Medycyny Wewnetrznej-Polish Archives of Internal Medicine最新文献

{"title":"Antithrombotic therapy in patients with inherited bleeding disorders: practical considerations.","authors":"Jerzy Windyga, Riitta Lassila","doi":"10.20452/pamw.16993","DOIUrl":"https://doi.org/10.20452/pamw.16993","url":null,"abstract":"<p><p>For decades hemophilia and allied bleeding disorders caused by inherited deficiency of clotting factors were considered conditions protecting against thromboembolism (TE). This opinion was coined over 60 years ago, when average life expectancy of people with hemophilia (PWH) was below 30 years, long-term anti-hemorrhagic prophylaxis of bleeding episodes was unattainable, and the main cause of premature death of hemophilia patients were life-threatening bleeds. At that time, arterial or venous thromboembolism were simply not observed among people with inherited bleeding disorders. With the progress of hemophilia management leading to improved hemostasis, resulting in reduction of severity and frequency of bleeding episodes and longer life expectancy it became obvious that hemophilia patients may and do develop TE episodes. This review is focused on how to manage arterial and venous thromboembolism in people with inherited bleeding disorders. Anticoagulant therapy should be avoided in severe or moderate hemophilia without anti-hemorrhagic prophylaxis. Use of anticoagulants in therapeutic doses is safer when FVIII or FIX plasma activity is permanently ≥20 IU/dl rather than <20 IU/dl. Taking into account their efficacy, safety profile and convenience, direct oral anticoagulants are the first choice as oral anticoagulation therapy for stroke prevention in non-valvular atrial fibrillation as well as in venous TE treatment in PWH. People with hemophilia may be offered many treatment options which allow to minimize exposure to antithrombotic agents, e.g. cardioversion, catheter ablation, left atrial appendage occlusion, newer generation drug-eluting stents, bioprosthetic heart valves, mechanical thromboprophylaxis methods.</p>","PeriodicalId":49680,"journal":{"name":"Polskie Archiwum Medycyny Wewnetrznej-Polish Archives of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143803253","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vision impairment following glucagon-like peptide-1 receptor agonist use: is it harmful?","authors":"Maria Cecilia Bahit, Michael Gibson, Martyna Kuleta, Łukasz Szarpak, Krzysztof P Malinowski, Iwona Kowalska-Bobko, Zbigniew Siudak","doi":"10.20452/pamw.16987","DOIUrl":"https://doi.org/10.20452/pamw.16987","url":null,"abstract":"","PeriodicalId":49680,"journal":{"name":"Polskie Archiwum Medycyny Wewnetrznej-Polish Archives of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143803944","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness of coronary sinus reducer implantation in routine clinical practice. 12-month outcomes.","authors":"Szymon Włodarczak, Piotr Rola, Artur Jastrzębski, Mateusz Barycki, Łukasz Furtan, Piotr Włodarczak, Jan J Kulczycki, Andrzej Korda, Karol Turkiewicz, Adrian Włodarczak, Maciej Lesiak","doi":"10.20452/pamw.16986","DOIUrl":"https://doi.org/10.20452/pamw.16986","url":null,"abstract":"<p><strong>Introduction: </strong>Refractory angina (RA) due to the lack of therapeutic options still remains a significant challenge. Coronary Sinus Reducer (CSR) has been recently introduced in the field of therapy of this advance form of Coronary Artery disease (CAD). However, despite growing evidence data from routine clinical practice are scar.</p><p><strong>Objectives: </strong>12-month observation of the efficacy and safety of the Coronary Sinus Reducer (CSR) (ShockWave Medical, Santa Clara, USA), based on the results from the Lower Silesia Sinus Reducer Registry (NCT06288165).</p><p><strong>Patients and methods: </strong>The study includes data from 67 consecutive patients diagnosed with chronic refractory angina (CCS classes 2-4), despite optimal medical therapy, who underwent CSR implantation. The study endpoints were defined as changes in angina severity (CCS class, SAQ-7), safety outcomes, exercise tolerance (6-MWT), and quality of life assessments (SF-36; EQ-5D-5L, EQ-VAS).</p><p><strong>Results: </strong>A total of 86.6% of patients showed improvement by at least one CCS class (P <0.001) over the 12 months compared to baseline.  Significant improvement in 12-month angina control was demonstrated, as measured by the SAQ-7 total score (39.9 [15.2] vs. 54.6 [19.7], P <0.001). A similar improvement in the 12-month quality of life assessment measured by the SF-36 total score (112.7 [23.2] vs. 98.4 [31.9]; P <0.001) was noticed. 1-year after CSR implantation, significant improvement in exercise tolerance was observed (mean 6-MWT distance: 265.9 [136.9] vs. 234.9 [109.1], P = 0.03).</p><p><strong>Conclusions: </strong>1-year data from our registry indicate that CSR implantation is an effective therapeutic option for patients with refractory angina. Additionally, the present study does not indicate any long-term adverse effects associated with reducer implantation.</p>","PeriodicalId":49680,"journal":{"name":"Polskie Archiwum Medycyny Wewnetrznej-Polish Archives of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143796911","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A placebo-adjusted effect of the initial eGFR decline following SGLT-2 inhibitor initia-tion: a systematic review and meta-analysis.","authors":"Szymon Urban, Jan Biegus, Mikołaj Błaziak, Gracjan Iwanek, Michał Fułek, Katarzyna Fułek, Oskar Szymański, Magdalena Grzesiak, Wojciech Tokarczyk, Jakub Ptak, Piotr Ponikowski, Robert Zymliński","doi":"10.20452/pamw.16981","DOIUrl":"https://doi.org/10.20452/pamw.16981","url":null,"abstract":"<p><strong>Introduction: </strong>Sodium-glucose cotransporter-2 inhibitors (SGLT-2i) are pivotal in managing heart failure (HF), chronic kidney disease (CKD), and type 2 diabetes mellitus. While their beneficial impact is well-established, the initial decline in estimated glomerular filtration rate (eGFR) at the start of SGLT-2i therapy is poorly understood.</p><p><strong>Objectives: </strong>The study aimed to assess the initial eGFR dip's impact on prognosis in mentioned populations.</p><p><strong>Patients and methods: </strong>We systematically reviewed several databases to identify studies analyzing the effect of the initial eGFR dip following the initiation of SGLT-2i on selected outcomes. Randomized controlled trials were included, and a backward snowballing method was applied. The analysis was conducted according to the PRISMA guidelines and registered in PROSPERO (CRD42024527609).</p><p><strong>Results: </strong>Out of 2.422 papers screened, 14 passed the initial screening, and 5 papers were included in the quantitative analysis. The dip status was reported for all 23890 encompassed patients, with the dip occurring in 13575 of them, representing 56.82% of the analyzed patients (8245(34.51%) in the intervention arm and 5330 (22.31%) in the placebo arm). The initial eGFR dip, regardless of its magnitude, was not linked to an increased risk of adverse kidney outcomes,cardiovascular (CV) composite endpoint, CV mortality (HR 0.85 [95% CI 0.65;1.11], P=0.24) and all-cause mortality (HR 0.90 [95% CI 0.70;1.15], P=0.40).</p><p><strong>Conclusions: </strong>Unlike in the placebo arms of RCTs, where an eGFR dip was associated with unfavorable outcomes, the early eGFR dip in patients receiving SGLT-2i was either neutral or beneficial. The dip appears to confer a particularly favorable effect in the HFrEF population.</p>","PeriodicalId":49680,"journal":{"name":"Polskie Archiwum Medycyny Wewnetrznej-Polish Archives of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143784629","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An unusual etiology of a well-known disease: the first case of infective endocarditis caused by Lactococcus garvieae bacterium reported in Poland.","authors":"Dominika Wójcicka, Krzysztof Kłos, Beata Uziębło-Życzkowska, Magdalena Potapowicz-Krysztofiak, Andrzej Chciałowski","doi":"10.20452/pamw.16922","DOIUrl":"10.20452/pamw.16922","url":null,"abstract":"","PeriodicalId":49680,"journal":{"name":"Polskie Archiwum Medycyny Wewnetrznej-Polish Archives of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142980469","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Takotsubo syndrome induced by catheter ablation-related tamponade.","authors":"Bartosz Krzowski, Katarzyna Madyniak, Michał Peller, Monika Budnik, Piotr Lodziński, Paweł Balsam","doi":"10.20452/pamw.16923","DOIUrl":"10.20452/pamw.16923","url":null,"abstract":"","PeriodicalId":49680,"journal":{"name":"Polskie Archiwum Medycyny Wewnetrznej-Polish Archives of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142980472","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Corrections: Prognostic value of preoperative echocardiography in predicting myocardial injury after open abdominal aortic surgery.","authors":"","doi":"10.20452/pamw.16984","DOIUrl":"https://doi.org/10.20452/pamw.16984","url":null,"abstract":"","PeriodicalId":49680,"journal":{"name":"Polskie Archiwum Medycyny Wewnetrznej-Polish Archives of Internal Medicine","volume":"135 3","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143694045","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cerebral oximetry and cardiac arrest: a window still open.","authors":"Giovanni Landoni, Antonio Pisano","doi":"10.20452/pamw.16982","DOIUrl":"https://doi.org/10.20452/pamw.16982","url":null,"abstract":"","PeriodicalId":49680,"journal":{"name":"Polskie Archiwum Medycyny Wewnetrznej-Polish Archives of Internal Medicine","volume":"135 3","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143694043","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessment of regional cerebral oxygen saturation and end-tidal carbon dioxide in prediction of a return of spontaneous circulation and patient outcome after in-hospital cardiac arrest.","authors":"Mateusz Putowski, Magdalena Dudzikowska, Zbigniew Siudak","doi":"10.20452/pamw.16914","DOIUrl":"10.20452/pamw.16914","url":null,"abstract":"<p><strong>Introduction: </strong>Cerebral oximetry measurement using near‑infrared spectroscopy (NIRS) has been highlighted as a technology that can provide noninvasive information on regional cerebral oxygen saturation (rSO2) during cardiopulmonary resuscitation (CPR), even though its effectiveness has not been fully confirmed. The research focused on the use of NIRS to predict the return of spontaneous circulation (ROSC) and neurological outcomes.</p><p><strong>Objectives: </strong>The purpose of the study was to evaluate the validity of rSO2 vs end‑tidal carbon dioxide (ETCO2) measurement during CPR and its association with ROSC, as well as to assess the neuroprognostic value of NIRS.</p><p><strong>Patients and methods: </strong>The study was carried out from January 11, 2023 to January 31, 2024, at the University Hospital, Kraków, Poland. The study group included 104 patients who experienced in‑hospital cardiac arrest. The values of rSO2 and ETCO2 were monitored during CPR and for 24 hours after ROSC.</p><p><strong>Results: </strong>The group of patients who achieved spontaneous circulation during CPR (ROSC group) had higher rSO2 values than the non‑ROSC group throughout the resuscitation period (63.8% vs 35.6%; P <0.001). Cerebral oximetry demonstrated higher predictive efficacy of rSO2 than ETCO2 as an indicator of ROSC (area under the curve [AUC], 0.978 vs 0.815; P <0.001). The mean rSO2 value equal to or above 66% during CPR was associated with a higher chance of survival within 30 days (AUC, 0.992; 95% CI, 0.98-1).</p><p><strong>Conclusions: </strong>The rSO2 value is a more sensitive indicator of ROSC than ETCO2. Higher rSO2 values are associated with a higher probability of achieving ROSC. The monitoring of rSO2 during CPR provides prognostic information.</p>","PeriodicalId":49680,"journal":{"name":"Polskie Archiwum Medycyny Wewnetrznej-Polish Archives of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142916146","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy of selected scales in the assessment of impaired awareness of hypoglycemia in adults with type 1 diabetes.","authors":"Magdalena Michalak, Dorota Zozulińska-Ziółkiewicz, Michał Michalak, Aleksandra Cieluch, Mateusz Michalski, Aleksandra Araszkiewicz","doi":"10.20452/pamw.16945","DOIUrl":"10.20452/pamw.16945","url":null,"abstract":"<p><strong>Introduction: </strong>Impaired awareness of hypoglycemia (IAH) increases the risk of severe hypoglycemia. Questionnaires may allow for easy identification of patients with IAH and facilitate appropriate interventions.</p><p><strong>Objectives: </strong>This study aims to assess the clinical utility of the questionnaires commonly used for diagnosing IAH, providing practical insight for medical professionals. Additionally, we sought to identify clinical factors associated with IAH in adults with type 1 diabetes (T1D), enhancing the understanding of this condition in a real‑world context.</p><p><strong>Patients and methods: </strong>The study included 252 adults with T1D (135 men), at a median (interquartile range) age of 41 (30-52) years. We evaluated their awareness of hypoglycemia using the validated questionnaires (Clarke scale, Gold scale, and Hypoglycemia Awareness Questionnaire [HypoA‑Q]), anthropometric data, and metabolic control data. To estimate the optimal cutoff point for the diagnosis of IAH using HypoA‑Q, we used the receiver operating characteristic (ROC) curve analysis. IAH was diagnosed based on at least 1 abnormal questionnaire score.</p><p><strong>Results: </strong>We found a cutoff of 9 points for diagnosing IAH with HypoA‑Q (sensitivity, 79%; specificity, 82%; area under the ROC curve, 0.898). IAH in any test was found in 98 patients (39%). In the univariable logistic regression models, the diagnosis of IAH was associated with lifetime episodes of severe hypoglycemia, hypertension, glycated hemoglobin level, mean glycemia, standard deviation, total cholesterol, low‑density lipoprotein cholesterol, non-high‑density lipoprotein cholesterol, and daily dose of insulin.</p><p><strong>Conclusions: </strong>HypoA‑Q, with a 9‑point cutoff, demonstrated the highest sensitivity in diagnosing IAH, and may be considered the most valuable screening tool for IAH detection.</p>","PeriodicalId":49680,"journal":{"name":"Polskie Archiwum Medycyny Wewnetrznej-Polish Archives of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143257141","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}