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

{"title":"Cyclic Cushing syndrome associated with cadherin-23 and multiple endocrine neoplasia type 1 gene mutations accompanied by bilateral primary papillary thyroid carcinoma.","authors":"Lin Lin, Wenjing Ma, Dongsheng Zhou, Guoxia Zhang, Jianguo Xu, Dan Wei","doi":"10.20452/pamw.17057","DOIUrl":"10.20452/pamw.17057","url":null,"abstract":"","PeriodicalId":49680,"journal":{"name":"Polskie Archiwum Medycyny Wewnetrznej-Polish Archives of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144561763","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":"Cutaneous vasculitis manifestations in patients with systemic lupus erythematosus: a comprehensive retrospective analysis with clinical implications.","authors":"Joanna Kosałka-Węgiel, Radosław Dziedzic, Andżelika Siwiec-Koźlik, Magdalena Spałkowska, Lech Zaręba, Mariusz Korkosz","doi":"10.20452/pamw.17077","DOIUrl":"10.20452/pamw.17077","url":null,"abstract":"<p><strong>Introduction: </strong> Systemic lupus erythematosus (SLE) is an autoimmune disease with clinical and laboratory heterogeneity. Data on cutaneous vasculitis (CV) in SLE are limited, especially in the context of its clinical value.</p><p><strong>Objectives: </strong>This study aimed to compare the clinical characteristics, laboratory findings, and treatment patterns of SLE individuals with and without CV to determine if skin vasculitis identified a distinct subset of patients with unique outcomes.</p><p><strong>Patients and methods: </strong> We conducted a retrospective analysis based on medical records of 1021 SLE patients (64 with CV and 957 without CV) treated at the University Hospital in Kraków, Poland, between 2012 and 2022. All patients met the 2019 European Alliance of Associations for Rheumatology / American College of Rheumatology classification criteria for SLE.</p><p><strong>Results: </strong>Overall, CV was observed in 6.27% of the study cohort (n = 64). The patients with CV more often exhibited constitutional symptoms (87.5% vs 76.2%; P = 0.04), joint manifestations (96.9% vs 87.3%; P = 0.02), central nervous system (CNS) involvement (15.6% vs 6.6%; P = 0.007), and heart failure (14.1% vs 4.4%; P <0.001), as compared with the individuals without CV. Higher prevalence of anti-Sjögren syndrome type A (75% vs 59.2%; P = 0.02) and antiribonucleoprotein antibodies (35% vs 20.3%; P = 0.007) was observed in the CV group. Treatment involved more frequent use of azathioprine (51.6% vs 37.5%; P = 0.03), belimumab (9.4% vs 3.7%; P = 0.03), and cyclophosphamide (40.6% vs 27.5%; P = 0.02) in the individuals with CV, as compared with those without CV.</p><p><strong>Conclusions: </strong>SLE patients with CV present with more severe disease, including heart failure and CNS involvement, and a specific autoantibody profile. These individuals may require more aggressive immunosuppressive treatment. Our findings suggest that CV in SLE may serve as a marker of more severe disease, necessitating careful monitoring and more intensive treatment.</p>","PeriodicalId":49680,"journal":{"name":"Polskie Archiwum Medycyny Wewnetrznej-Polish Archives of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144745826","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":"Genetic architecture of dilated cardiomyopathy in Poland: variant distribution, clinical characteristics, and prognosis.","authors":"Przemysław Chmielewski, Grażyna Truszkowska, Grażyna Kostrzewa, Ewa Michalak, Piotr Stawiński, Ilona Kowalik, Ilona Minota, Przemysław Leszek, Łukasz Mazurkiewicz, Jolanta Krzysztoń-Russjan, Rafał Płoski, Zofia T Bilińska","doi":"10.20452/pamw.17083","DOIUrl":"10.20452/pamw.17083","url":null,"abstract":"<p><strong>Introduction: </strong> Genetic variants are the leading cause of dilated cardiomyopathy (DCM). Data on genetic testing in DCM from Central European populations are scarce.</p><p><strong>Objectives: </strong> We sought to determine the genetic architecture of DCM in Poland and to assess its influence on patient clinical characteristics and prognosis.</p><p><strong>Patients and methods: </strong> The study included 280 DCM patients (mean [SD] age, 39 [13] y; 68% men) who underwent next‑generation sequencing or in whom disease‑causing variants were identified using single‑gene testing.</p><p><strong>Results: </strong> DCM‑related variants were identified in 46% of the patients. Variants in titin (TTN) and lamin A/C (LMNA) genes were the most frequent (18% and 8% of the study cohort, respectively). Other genes with variant frequency equal to or above 2% included desmoplakin (DSP), myosin heavy chain 7 (MYH7), sodium voltage‑gated channel α subunit 5 (SCN5A), filamin C (FLNC), BCL2‑associated athanogene 3 (BAG3), and dystrophin (DMD). Positive family history, atrioventricular block, or atrial arrhythmias were found more often in the causative variant carriers, whereas the frequency of left bundle branch block or hypertension was lower. Severe DCM and a composite end point (cardiovascular death, heart transplantation, left ventricular assist device implantation) occurred with similar frequency in gene‑negative DCM and TTN‑related DCM, whereas the prognosis was worse in the remaining variant carriers. The risks of severe DCM and the composite end point were 2.4- and 3‑fold higher, respectively, for LMNA‑related DCM and 2.3- and 2‑fold higher for variants in the other genes.</p><p><strong>Conclusions: </strong> The distribution of causative genetic variants in Polish DCM patients is similar to that in Western European cohorts. The presence of the causative variants in the genes other than TTN is associated with a poorer prognosis.</p>","PeriodicalId":49680,"journal":{"name":"Polskie Archiwum Medycyny Wewnetrznej-Polish Archives of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144823058","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":"Clinically relevant pituitary adenomas: a single-center epidemiological study.","authors":"Aleksandra Derwich-Rudowicz, Katarzyna B Kubiak, Kacper Wojciechowski, Katarzyna Kobusińska, Norbert Wąsik, Włodzimierz Liebert, Marek Ruchała, Nadia Sawicka-Gutaj","doi":"10.20452/pamw.17082","DOIUrl":"10.20452/pamw.17082","url":null,"abstract":"<p><strong>Introduction: </strong>Pituitary adenomas (PAs) are a heterogeneous group of central nervous system lesions that are mostly benign. They account for 13.5%-20% of all primary brain tumors, and their incidence is rising.</p><p><strong>Objectives: </strong>We retrospectively analyzed patients with PA to determine their specific epidemiological characteristics, focusing specifically on a series of surgically resected PAs.</p><p><strong>Patients and methods: </strong>We analyzed all patients diagnosed with PA (n = 1111) and hospitalized in the Department of Endocrinology, Poznań, Poland, between 2018 and 2023, with a special focus on clinically relevant PAs qualified for transsphenoidal surgery (n = 194). Medical history, demographic characteristics, tumor features, and diagnostic results were reviewed. The incidence of PAs was defined as a new diagnosis of PA.</p><p><strong>Results: </strong>We identified 1111 patients with newly diagnosed PA, including 403 men (36.3%), with an annual incidence rate of 4.11/100 000 population. Women were diagnosed at a younger age than men (P <0.001). In the group qualified for surgery (n = 194), the most common diagnosis was nonfunctioning PA (NFPA; 76%). Men were diagnosed with NFPA more often (P = 0.02) and presented with larger tumors (P = 0.005). The patients with NFPA were older at diagnosis (P <0.001). Larger tumors were associated with an increased risk of complications, such as visual field defects, headaches, and hypopituitarism. Although 90% of the patients were diagnosed with multimorbidity and over half with polypharmacy, we did not find any association between comorbidities and the tumor type.</p><p><strong>Conclusions: </strong>Although most PAs were diagnosed in women, clinically relevant tumors were more frequent in men. Male patients were diagnosed with NFPA significantly more often than women, and their tumors were larger at presentation.</p>","PeriodicalId":49680,"journal":{"name":"Polskie Archiwum Medycyny Wewnetrznej-Polish Archives of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144817965","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":"When the adrenal cortex acts as the hypothalamus: a rare case of ectopic corticotropin-releasing hormone production.","authors":"Nadia Sawicka-Gutaj, Barbara Bromińska, Ewelina Szczepanek-Parulska, Tomasz Wierzbicki, Małgorzata Janicka-Jedyńska, Marek Ruchała","doi":"10.20452/pamw.17041","DOIUrl":"10.20452/pamw.17041","url":null,"abstract":"","PeriodicalId":49680,"journal":{"name":"Polskie Archiwum Medycyny Wewnetrznej-Polish Archives of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144327529","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":"Reasons for inertia of treatment with flozins across the whole spectrum of heart failure in Poland based on the Heart Failure Observational Study of the Polish Cardiac Society (HEROES).","authors":"Robert Morawiec, Paweł Maeser, Maciej Nadel, Agata Galas, Agata Tymińska, Jarosław Drożdż","doi":"10.20452/pamw.17063","DOIUrl":"10.20452/pamw.17063","url":null,"abstract":"","PeriodicalId":49680,"journal":{"name":"Polskie Archiwum Medycyny Wewnetrznej-Polish Archives of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144561768","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":"Real-life application of the European Society for Medical Oncology guidelines for the prevention and treatment of cancer-associated thrombosis: challenges and perspectives.","authors":"Grigoris Gerotziafas, Elmina Lefkou, Peter Marschang, Matija Kozak, Benilde Cosmi, Agata Stanek","doi":"10.20452/pamw.17090","DOIUrl":"10.20452/pamw.17090","url":null,"abstract":"<p><p>Cancer‑associated thrombosis (CAT) is the second leading cause of death in cancer patients, significantly affecting their quality of life, survival, and health care costs. This review summarizes key recommendations from the 2023 European Society for Medical Oncology guidelines on CAT prevention and treatment, illustrated by a real‑world case, and examines barriers to their implementation. CAT risk is multifactorial, shaped by tumor‑related factors (type, stage, time since diagnosis), treatment exposures (anticancer agents, surgery, central venous catheters), and comorbidities, captured by the \"4TS\" rule. Emerging biomarkers (eg, D‑dimer, thrombin generation, coagulome genes) and oncogenic mutations may refine risk stratification. The guidelines recommend routine assessment using models such as the Khorana score, COMPASS‑CAT, or Vienna‑CATS, with COMPASS‑CAT demonstrating superior predictive accuracy for patients with breast, lung, ovarian, or colon cancer. For high‑risk ambulatory patients, thromboprophylaxis is recommended for up to 6 months, with regular reassessment of risk thereafter. Treatment of CAT favors low‑molecular‑weight heparin or oral direct FXa inhibitors (apixaban, edoxaban, rivaroxaban), with incidental venous thromboembolism managed similarly to symptomatic events. The API‑CAT study supports low‑dose apixaban (2.5 mg twice a day) as a safer long‑term treatment. Screening for antiphospholipid antibodies guides therapeutic strategies. Major challenges for optimization of the antithrombotic treatment include renal impairment, thrombocytopenia, and treatment adherence. Oral direct FXa inhibitors may improve quality of life. Effective CAT management requires individualized care, strong clinician-patient communication, and education. The guideline implementation remains suboptimal. Closing the gap demands national strategies promoting health‑provider training, patient empowerment, e‑health applications, equitable access, and dedicated CAT outpatient clinics for sustained, personalized care.</p>","PeriodicalId":49680,"journal":{"name":"Polskie Archiwum Medycyny Wewnetrznej-Polish Archives of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144976382","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":"Joint association of body mass index and lipoprotein(a) with atrial fibrillation prevalence: an observational and mendelian randomization study.","authors":"Wenxing Guo, Huan Shi, Xinpeng You, Jiahe Hu, Jiawei Lu, Kang Zhang, Ling Yang, Qi Jiang","doi":"10.20452/pamw.17123","DOIUrl":"https://doi.org/10.20452/pamw.17123","url":null,"abstract":"<p><strong>Introduction: </strong>Although previous studies have demonstrated that lipoprotein(a) [Lp(a)] and body mass index (BMI) are associated with atrial fibrillation (AF), their joint effect on atrial fibrillation remains poorly understood.</p><p><strong>Objectives: </strong>Our primary objective was to examine the combined influence of body mass index and lipoprotein(a) on atrial fibrillation.</p><p><strong>Patients and methods: </strong>The study included 8886 patients, among whom 205 were diagnosed with persistent AF. The joint association between BMI and Lp(a) with AF was evaluated. A mediation Mendelian randomization analysis was also performed.</p><p><strong>Results: </strong>Compared with people with a higher Lp(a) level (≥30 mg/dL) and a BMI ≥24 kg/m2, those with a lower Lp(a) level and BMI had the lowest prevalence of AF (OR 0.96 [0.95-0.97], P <0.001), which was predominant between 50-69 years, and the lowest risk of stroke (HR 0.28 [0.12-0.68], P = 0.004), heart failure (HR 0.24 [0.08-0.66], P = 0.006) and major adverse cardiovascular events (MACE) (HR 0.35 [0.18-0.66], P = 0.001). Mediation Mendelian randomization analysis highlight the coexposure effects of Lp(a) levels and BMI on AF and that both act independently of AF.</p><p><strong>Conclusions: </strong>Lower BMI and Lp(a) levels were associated with a reduced prevalence of AF. Mediation analysis showed that neither BMI nor Lp(a) mediates the effect of the other, suggesting that their contributions to AF risk operate through independent pathways.</p>","PeriodicalId":49680,"journal":{"name":"Polskie Archiwum Medycyny Wewnetrznej-Polish Archives of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145087972","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":"Early use of SGLT2 inhibitors after acute myocardial infarction: a systematic review and meta-analysis of randomized controlled trials.","authors":"Krzysztof Kurek, Michał Pruc, Ewa Sajnaga, Cezary Grochowski, Zbigniew Siudak, Jacek Kubica, Julia Uminska, Karol Momot, Kamil Krauz, Artur Mamcarz, Lukasz Szarpak","doi":"10.20452/pamw.17122","DOIUrl":"10.20452/pamw.17122","url":null,"abstract":"<p><strong>Introduction: </strong>Acute myocardial infarction (AMI) continues to be a primary cause of post-hospitalization heart failure (HF), severely impacting morbidity, healthcare resource consumption, and mortality rates.</p><p><strong>Objectives: </strong>This meta-analysis sought to assess the efficacy and safety of the early introduction of SGLT2 inhibitors in patients hospitalized for AMI, irrespective of previous HF or diabetes history.</p><p><strong>Patient and methods: </strong>Up until June 10, 2025, a comprehensive search was carried out in six major databases, including randomized controlled trials (RCTs) assessing SGLT2i that were started within 14 days of hospitalization for AMI.</p><p><strong>Results: </strong>Seven randomized controlled trials (n = 11,405) comparing SGLT2i with placebo or standard medical therapy without SGLT2i, with follow-up ranging from 6 to 18 months, were included. The commencement of SGLT2 inhibitors markedly diminished the likelihood of HF hospitalization (OR = 0.71; 95%CI: 0.58-0.86; P = 0.004). No notable changes were detected in all-cause mortality (OR = 1.05; 95%CI: 0.77-1.43), cardiovascular mortality (OR = 1.04; 95%CI: 0.83-1.30), major adverse cardiovascular events (MACE) (OR = 0.94; 95%CI: 0.85-1.05), recurrent myocardial infarction (OR = 1.12; 95%CI: 0.73-1.72), or stroke (OR = 0.58; 95%CI: 0.26-1.27).</p><p><strong>Conclusions: </strong>Early initiation of SGLT2i post-AMI significantly reduces the risk of subsequent HF hospitalization without increasing adverse events. However, no mortality benefit was observed. These findings support the selective use of SGLT2i in post-AMI patients at high risk of HF, while highlighting the need for further large-scale trials to assess long-term outcomes and refine patient selection.</p>","PeriodicalId":49680,"journal":{"name":"Polskie Archiwum Medycyny Wewnetrznej-Polish Archives of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145076393","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":"New fever in adults in the intensive care unit: current insights from the 2024 Society of Critical Care Medicine and Infectious Diseases Society of America guidelines.","authors":"Waleed Alhazzani, Haifa F Alotaibi, Zainab Alduhailib, Morten Hylander Møller, Andre C Kalil","doi":"10.20452/pamw.17121","DOIUrl":"https://doi.org/10.20452/pamw.17121","url":null,"abstract":"<p><p>Fever is among the most frequent clinical signs encountered in the intensive care unit. It often triggers broad diagnostic evaluation and empiric treatment, with implications for patient outcomes and resource use. The 2024 joint guidelines from the Society of Critical Care Medicine and the Infectious Diseases Society of America offer updated, evidence-based recommendations for the evaluation of new-onset fever in adults in the intensive care unit. Replacing the 2008 guideline, this iteration integrates advances in diagnostic methods, a structured guideline development process, and renewed emphasis on antimicrobial stewardship. The panel issued one strong recommendation, 12 weak recommendations, nine best practice statements, and identified four areas where no recommendation was feasible. This review distills the guideline's most relevant insights, clarifies points of uncertainty, and presents a practical framework for applying its recommendations at the bedside.</p>","PeriodicalId":49680,"journal":{"name":"Polskie Archiwum Medycyny Wewnetrznej-Polish Archives of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145070927","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}