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

{"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":"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}

{"title":"The impact of angiotensin receptor-neprilysin inhibitor on clinical status and hemodynamic parameters in patients with pulmonary hypertension due to heart failure with preserved left ventricular ejection fraction: a case series analysis.","authors":"Małgorzata Niemiec, Marek Grabka, Rafał Niemiec, Artur Filipecki, Mateusz Polak, Katarzyna Mizia-Stec","doi":"10.20452/pamw.17120","DOIUrl":"https://doi.org/10.20452/pamw.17120","url":null,"abstract":"","PeriodicalId":49680,"journal":{"name":"Polskie Archiwum Medycyny Wewnetrznej-Polish Archives of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145066196","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":"The prevalence of metabolic syndrome in a Polish population-based study: a comparison of previous and updated diagnostic criteria.","authors":"Natalia Zieleniewska, Jacek Jamiołkowski, Paweł Sowa, Małgorzata Kazberuk, Urszula Roszkowska, Małgorzata Chlabicz, Irina Kowalska, Karol Kamiński","doi":"10.20452/pamw.17118","DOIUrl":"https://doi.org/10.20452/pamw.17118","url":null,"abstract":"<p><strong>Introduction: </strong> Metabolic syndrome (MetS) is a growing global health concern characterized by adiposity, elevated blood pressure, and lipid and glucose metabolism abnormalities-that synergistically increase cardiovascular (CV) risk. The newly introduced concept of cardio-kidney-metabolic (CKM) syndrome aims to capture the continuum of metabolic dysfunction and its direct link to CV risk.</p><p><strong>Objectives: </strong> To assess the prevalence of MetS and CKM, compare traditional and updated MetS definitions, examine their diagnostic concordance, and explore associations with CV risk.</p><p><strong>Patients and methods: </strong> We analyzed 2110 adults (mean age (SD) 49.3 (15.3); 44.4% male) from the population-based Białystok PLUS cohort. MetS was defined using the 2009 and updated 2022 criteria. CKM staging was applied, and CV risk was estimated using SCORE2 and SCORE2-OP. Anthropometric, biochemical, and imaging data were assessed. Receiver operating characteristics analyses were performed to evaluate diagnostic utility.</p><p><strong>Results: </strong> MetS was diagnosed in 22.1% using both definitions; 5.1% met only the 2022 and 13.1% only the 2009 criteria. Individuals fulfilling both definitions had higher age, body mass index (BMI), and adiposity. BMI (AUC = 0.941, 95% CI 0.931-0.951) and waist circumference (AUC = 0.912, 95% CI 0.900-0.924) showed the highest diagnostic accuracy under the 2022 criteria. CV risk and subclinical atherosclerosis were most prevalent in those meeting both definitions. CKM stage ≥2 was present in 55.3%, with increasing prevalence of higher CV risk observed across stages.</p><p><strong>Conclusions: </strong> MetS and CKM are highly prevalent, yet their diagnostic overlap is limited. CKM staging captures high-risk individuals beyond MetS criteria, underscoring its broader utility for integrated cardiometabolic risk assessment.</p>","PeriodicalId":49680,"journal":{"name":"Polskie Archiwum Medycyny Wewnetrznej-Polish Archives of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145066261","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":"Changes in the prevalence of heart failure phenotypes over time and their association with patients' prognosis.","authors":"Agnieszka Doryńska, Anna Drohomirecka, Roman Topór-Mądry, Hubert Łazarczyk, Tomasz Zieliński, Tomasz M Rywik","doi":"10.20452/pamw.17119","DOIUrl":"https://doi.org/10.20452/pamw.17119","url":null,"abstract":"<p><strong>Introduction: </strong>The prevalence and phenotypic frequency of heart failure (HF) vary across populations, yet little is known about how these phenotypes change over time and how such changes affect patient outcomes.</p><p><strong>Objectives: </strong>To evaluate temporal trends in HF phenotype prevalence and their associations with patients' characteristics and prognosis.</p><p><strong>Patients and methods: </strong> We retrospectively analyzed data from 2597 patients hospitalized with HF between January 2014 and May 2019. Patients were categorized into tertiles according to their time of hospital admission and stratified by HF phenotype: HFrEF, HFmrEF, and HFpEF. We assessed changes in phenotype prevalence, clinical characteristics, and survival. Data were obtained from hospital records and the National Health Fund. The endpoint was all-cause mortality or censoring on May 25, 2023.</p><p><strong>Results: </strong>  A 27% decrease in the prevalence of HFrEF and an increase in HFmrEF and HFpEF (53% and 92%, respectively) were observed between the first and third tertile. There was a progressive increase in the proportion of older patients, women, and comorbidities, particularly hypertension, atrial fibrillation, diabetes, and cancer. 5-year survival improved across tertiles for all HF patients (48.4% to 60.2%, P <0.001), with significant gains observed in HFrEF (45.7% to 57.0%, P <0.001). After adjusting for confounders, the later tertiles remained independent predictors of better survival compared to the first tertile.</p><p><strong>Conclusions: </strong> The proportion of HFpEF and HFmrEF patients has increased recently and this shift was paralleled by a growing proportion of elderly and female patients and a rising burden of comorbidities. However overall survival has improved, particularly among HFrEF patients.</p>","PeriodicalId":49680,"journal":{"name":"Polskie Archiwum Medycyny Wewnetrznej-Polish Archives of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145041927","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":"Therapeutic use of cannabis and cannabinoids: benefits and risks.","authors":"Xiadi Zhai, Pooja R Sarkar, Kevin P Hill","doi":"10.20452/pamw.17117","DOIUrl":"https://doi.org/10.20452/pamw.17117","url":null,"abstract":"<p><p>The international popularity of cannabis and the shifting legal landscape have propelled conversations around medical and recreational use to the forefront of public discussion. Clinicians face increased questions from patients, though there is a lack of clear medical consensus on several conditions for which cannabis is commonly used. As of 2025, key indications for cannabis and cannabinoid use are nausea and vomiting induced by chemotherapy, loss of appetite induced by HIV / AIDS, Dravet syndrome, Lenox Gastaut syndrome, seizures associated with tuberous sclerosis, and multiple sclerosis spasticity. However, cannabis and cannabinoids are used to treat additional conditions, which we discuss in this update of Hill and Palastro's 2017 review of medical cannabis. We review current evidence for cannabis and cannabinoid treatment of chronic non-cancer pain, insomnia, psychiatric and neurologic disorders. We also consider current inconclusive evidence for cannabis to treat opioid use disorder and neurological disorders. Risks associated with cannabis and cannabinoid use include addiction, decreased neurocognitive function, particularly in adolescents, cannabinoid hyperemesis syndrome, psychosis, perinatal complications, cardiovascular, pulmonary and physical injury risks such as falls and motor vehicle accidents. As public and clinical interest in cannabis grows, clinicians must evaluate potential harms alongside benefits relevant to the medical condition for which cannabis is being considered. Anecdotal experiences and commercial claims, whether positive or negative, and however compelling, must be eschewed in favor of research findings and fact to guide clinical decision-making.</p>","PeriodicalId":49680,"journal":{"name":"Polskie Archiwum Medycyny Wewnetrznej-Polish Archives of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145042105","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":"Oxidative stress markers associate with hypofibrinolysis in atrial fibrillation.","authors":"Patrycja Mołek-Dziadosz, Joanna Natorska, Paweł T Matusik, Michał Ząbczyk, Aleksander Siniarski","doi":"10.20452/pamw.17116","DOIUrl":"https://doi.org/10.20452/pamw.17116","url":null,"abstract":"","PeriodicalId":49680,"journal":{"name":"Polskie Archiwum Medycyny Wewnetrznej-Polish Archives of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145042084","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":"18F-prostate-specific membrane antigen-1007 positron emission tomography / computed tomography detects occult leptomeningeal metastases in poorly differentiated thyroid carcinoma misdiagnosed as vascular mimicry on magnetic resonance imaging.","authors":"Min Liu, Yan Sun, Li Cai, Zhiying Xu, Weilong Li","doi":"10.20452/pamw.17112","DOIUrl":"https://doi.org/10.20452/pamw.17112","url":null,"abstract":"","PeriodicalId":49680,"journal":{"name":"Polskie Archiwum Medycyny Wewnetrznej-Polish Archives of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145041950","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}