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

{"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":"https://doi.org/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 intervention.</p><p><strong>Objectives: </strong>This study aims to assess the clinical utility of commonly used questionnaires for diagnosing IAH, providing practical insight for medical professionals. Additionally, we seek to identify clinical factors associated with IAH in adults with type 1 diabetes (T1D), enhancing 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) aged 41 years (IQR: 30-52). Awareness of hypoglycemia using the validated questionnaires [Clarke scale, Gold scale, and Hypoglycemia Awareness Questionnaire (HypoA-Q)], anthropometric data, and metabolic control were evaluated. To estimate the optimal cut-off point for the diagnosis of IAH using HypoA-Q, the Receiver Operating Characteristic (ROC) curve analysis was used. IAH was diagnosed by at least one abnormal questionnaire score.</p><p><strong>Results: </strong>We found a cut-off point of 9 points for diagnosing IAH on HypoA-Q (sensitivity of 79%, specificity of 82%, AUC = 0.898). IAH in any abnormal 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 (A1c) value, mean glycemia, standard deviation (SD), total, LDL and non-HDL cholesterol levels, and daily dose of insulin.</p><p><strong>Conclusions: </strong>The HypoA-Q, with a 9-point cut-off, demonstrated the highest sensitivity for 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":"2025-02-06","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}

{"title":"Steatotic liver disease in patients treated for chronic hepatitis B.","authors":"Jakub Janczura, Michał Brzdęk, Krystyna Dobrowolska, Robert Flisiak, Diana Martonik, Kinga Brzdęk, Robert Pleśniak, Dominika Kukla-Woźnica, Małgorzata Wajdowicz, Dorota Zarębska-Michaluk","doi":"10.20452/pamw.16942","DOIUrl":"https://doi.org/10.20452/pamw.16942","url":null,"abstract":"<p><strong>Introduction: </strong>Steatotic liver disease (SLD) can worsen the prognosis of other chronic liver diseases, including viral hepatitis.</p><p><strong>Objectives: </strong>To compare SLD and non-SLD patients with chronic hepatitis B virus (HBV) infection.</p><p><strong>Patients and methods: </strong>The study included consecutive Caucasian patients with chronic hepatitis B treated with nucleos(t)ide analogs (NA), entecavir or tenofovir, for a median (quartile 1-3) of 6 (2-11) years and evaluated between January 2023 and June 2024.</p><p><strong>Results: </strong>Of the 273 patients included in the analysis, 86 were diagnosed with SLD. Men dominated the overall population, but their percentage was higher in the SLD group (77.9% vs. 63.6%, P = 0.02). The burden of comorbidities was higher in the SLD population compared to non-SLD (P <0.001), including obesity (P <0.001), diabetes (P = 0.004), and gout (P = 0.03). Cirrhosis was diagnosed in 16.3% of SLD and 11.8% of non-SLD patients (P = 0.31). Aminotransferases activity was higher in the SLD group (P <0.001), while positive HBe antigen was significantly less frequent in this population, and HBV DNA viral load was comparable in both groups. More than 97% of patients in both groups achieved HBV DNA clearance during therapy, with a negative rate of 69.5% in the SLD and 66.7% in the non-SLD group after 1 year of treatment.</p><p><strong>Conclusion: </strong>Liver steatosis was diagnosed in nearly one-third of HBV-infected patients treated with NA. They were significantly more likely to have obesity, diabetes, and gout compared to the non-SLD population. Despite higher baseline aminotransferases activity in the SLD group, the virological HBV activity and response to therapy were comparable.</p>","PeriodicalId":49680,"journal":{"name":"Polskie Archiwum Medycyny Wewnetrznej-Polish Archives of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143081869","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":"Association between standardized management algorithm and outcomes of patients undergoing high-risk percutaneous coronary interventions included in the IMPELLA-PL registry.","authors":"Aleksandra Gąsecka, Arkadiusz Pietrasik, Tomasz Pawłowski, Jerzy Sacha, Marek Grygier, Michał Łomiak, Hubert Bochenek, Janusz Kochman","doi":"10.20452/pamw.16905","DOIUrl":"10.20452/pamw.16905","url":null,"abstract":"<p><strong>Introduction: </strong>Impella CP is a percutaneous left ventricular assist device used in selected patients undergoing high‑risk percutaneous coronary interventions (HR‑PCIs). To improve outcomes of Impella‑supported HR‑PCI, institutional Impella programs have been developed.</p><p><strong>Objectives: </strong>We evaluated the association between the use of a standardized periprocedural management algorithm and outcomes of patients undergoing HR‑PCI included in the national IMPELLA‑PL registry.</p><p><strong>Patients and methods: </strong>Consecutive patients undergoing HR‑PCI supported with Impella CP (n = 253), enrolled in the IMPELLA‑PL registry between January 2014 and December 2021, were retrospectively divided into those fulfilling (n = 77) and not fulfilling (n = 176) the criteria of a standardized management algorithm, as proposed in the Roadmap Towards an Institutional Impella Program for HR‑PCI (ROAD TIP).</p><p><strong>Results: </strong>Implementation of the standardized management algorithm allowed for selection of patients at a higher baseline risk, manifested by higher prevalence of acute coronary syndrome (P = 0.001), higher EuroScore (P = 0.02), and greater coronary artery disease complexity (P = 0.003). It also allowed for performing more complex PCI procedures, including a higher proportion of left main PCIs (P = 0.005), bifurcation PCIs (P <0.001), and use of calcium modification techniques (P = 0.02), more frequent Impella implantation before PCI (P = 0.002), and a higher proportion of ultrasound‑guided punctures (P <0.001). Despite higher baseline risk and greater procedural complexity, 12‑month outcomes of the patients treated according to the ROAD TIP algorithm were comparable to those of the individuals not fulfilling the algorithm criteria, who had a more favorable risk profile and underwent less complex procedures. In low‑volume centers, 12‑month mortality was lower in the standardized management group (P = 0.047), whereas in high‑volume centers, it was comparable between the groups.</p><p><strong>Conclusions: </strong>Implementation of a dedicated management algorithm might improve outcomes of Impella‑assisted HR‑PCI, especially in low‑volume centers.</p>","PeriodicalId":49680,"journal":{"name":"Polskie Archiwum Medycyny Wewnetrznej-Polish Archives of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142916084","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":"Immunoglobulin A antibodies: prognostic tools with unknown mechanism in primary sclerosing cholangitis.","authors":"Maria Papp, David Tornai","doi":"10.20452/pamw.16938","DOIUrl":"10.20452/pamw.16938","url":null,"abstract":"","PeriodicalId":49680,"journal":{"name":"Polskie Archiwum Medycyny Wewnetrznej-Polish Archives of Internal Medicine","volume":"135 1","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143068879","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 diagnostic challenge: unraveling a parotid gland tumor in a patient with medullary thyroid carcinoma.","authors":"Adam Gałązka, Katarzyna Stawarz, Wojciech Kłos, Monika Durzyńska, Anna Gorzelnik, Jakub Zwoliński","doi":"10.20452/pamw.16864","DOIUrl":"10.20452/pamw.16864","url":null,"abstract":"","PeriodicalId":49680,"journal":{"name":"Polskie Archiwum Medycyny Wewnetrznej-Polish Archives of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142511741","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 huge right ventricular metastasis of lung cancer.","authors":"Hiroaki Matsumoto, Toshiyuki Irie, Hiroaki Satoh","doi":"10.20452/pamw.16868","DOIUrl":"10.20452/pamw.16868","url":null,"abstract":"","PeriodicalId":49680,"journal":{"name":"Polskie Archiwum Medycyny Wewnetrznej-Polish Archives of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142577122","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":"Anticoagulation in patients with a history of heparin-induced thrombocytopenia who require cardiovascular surgery: is it okay to use heparin?","authors":"Saarang R Deshpande, Adam Cuker","doi":"10.20452/pamw.16908","DOIUrl":"10.20452/pamw.16908","url":null,"abstract":"<p><p>Heparin‑induced thrombocytopenia (HIT) is an adverse drug reaction with significant thromboembolic risk. Though there are models for use of nonheparin anticoagulants, heparin remains the preferred anticoagulant in many operative settings, especially cardiovascular surgery and percutaneous cardiac intervention. The natural history of HIT can be stereotyped into phases using HIT laboratory testing to guide clinical management and determine whether heparin re‑exposure can be considered. In acute HIT and subacute HIT A (immunoassay positive, functional assay positive) when thromboembolic risk is high, nonurgent procedures should be delayed, if feasible. If procedures cannot be delayed, approaches include intraoperative bivalirudin or intraoperative heparin with pre- or intraoperative plasma exchange or a potent antiplatelet agent, sometimes in combination with intravenous immunoglobulin. In subacute HIT B (immunoassay positive, functional assay negative) and remote HIT (immunoassay negative, functional assay negative), brief exposure to heparin in the intraoperative setting with close monitoring postoperatively is suggested due to the low risk of recurrent HIT.</p>","PeriodicalId":49680,"journal":{"name":"Polskie Archiwum Medycyny Wewnetrznej-Polish Archives of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142916138","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":"Finding logic in biologics: different outcomes in inflammatory bowel disease-associated pyoderma gangrenosum.","authors":"Paweł Głuszak, Kamila Stawczyk-Eder, Piotr Sobolewski, Piotr Eder, Agnieszka Dobrowolska, Dagmara S Mahadea","doi":"10.20452/pamw.16855","DOIUrl":"10.20452/pamw.16855","url":null,"abstract":"","PeriodicalId":49680,"journal":{"name":"Polskie Archiwum Medycyny Wewnetrznej-Polish Archives of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142330987","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":"Herpetic esophagitis in a patient with focal segmental glomerulosclerosis.","authors":"Iwona Filipska, Katarzyna Kozielec, Tomasz Arłukowicz, Tomasz Stompór","doi":"10.20452/pamw.16885","DOIUrl":"10.20452/pamw.16885","url":null,"abstract":"","PeriodicalId":49680,"journal":{"name":"Polskie Archiwum Medycyny Wewnetrznej-Polish Archives of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142689506","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":"Vitamin C for the common cold and pneumonia.","authors":"Harri Hemilä, Elizabeth Chalker","doi":"10.20452/pamw.16926","DOIUrl":"10.20452/pamw.16926","url":null,"abstract":"<p><p>This paper provides an overview of the efficacy of vitamin C for preventing and treating respiratory infections. Studies in a wide variety of animals have shown vitamin C to be protective against infections. In controlled trials in the general human population, vitamin C at a dose greater than 1 g/day did not prevent common colds. However, in 5 trials with participants undertaking heavy physical activity, vitamin C halved the incidence of colds. In 15 trials (n = 6244), regular supplementation of 1 g or more of vitamin C per day decreased the severity of colds by 15%. Results of therapeutic trials in which vitamin C was initiated after the onset of common cold symptoms have been inconsistent. However, 2 therapeutic trials found that 6-8 g/day of vitamin C was twice as effective at reducing the duration of colds as 3-4 g/day. In 3 controlled trials, vitamin C was shown to prevent pneumonia, but the contexts were atypical: the participants were schoolboys attending a boarding school in the United Kingdom before World War II, soldiers hospitalized for influenza A, and United States Marine recruits. It is unlikely that vitamin C would reduce the risk of pneumonia in the general population; however, 4 trials reported a treatment benefit for pneumonia patients, although the findings encourage further research rather than providing firm evidence of efficacy. Vitamin C has been tested for efficacy in COVID‑19 and sepsis with conflicting results. Given the evidence that vitamin C reduces the severity and duration of the common cold, paired with its good safety profile and low cost, it is not unreasonable for patients to test whether therapeutic vitamin C supplementation at a dose of 6-8 g/day is beneficial at the individual level.</p>","PeriodicalId":49680,"journal":{"name":"Polskie Archiwum Medycyny Wewnetrznej-Polish Archives of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142972921","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}