{"title":"Reflections on the current situation and the future of internal medicine in Poland.","authors":"F. Kokot","doi":"10.20452/pamw.3620","DOIUrl":"https://doi.org/10.20452/pamw.3620","url":null,"abstract":"","PeriodicalId":20343,"journal":{"name":"Polskie Archiwum Medycyny Wewnetrznej","volume":"1 1","pages":"812-813"},"PeriodicalIF":0.0,"publicationDate":"2016-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89187620","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The European League against Rheumatism (EULAR) with the European Renal Association - European Dialysis and Transplant Association recently published an update of 2009 EULAR recommendations with a focus on the management of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitides (AAV). In this article, we discuss the following key messages for clinical practice derived from these recommendations: 1) biopsy should be performed if possible to confirm new diagnosis or relapse; 2) glucocorticoid therapy is an extremely important adjunct to the management of AAV, but it is also responsible for the majority of adverse effects; the dose should be tapered to 7.5 to 10 mg/d at 3 to 5 months; 3) cyclophosphamide or rituximab are the mainstay of remission induction; 4) patients with major relapse should be treated like those with new disease, but rituximab is the preferred option in those patients who relapse after prior cyclophosphamide; 5) minor relapse should not be treated with glucocorticoid alone, and a change in immunosuppressive regimen should be considered; 6) rituximab can be used not only for remission induction but also for maintenance; 7) maintenance therapy should continue for at least 2 years, after which gradual taper could be considered; 8) while ANCA are extremely useful for diagnosis and rising ANCA levels seem to be associated with relapse, serial monitoring should not guide treatment decisions; 9) monitoring of AAV patients should be holistic with a structured assessment tool and monitoring for effects related to the vasculitis as well as treatment; 10) management should be either at or in conjunction with an expert center; and 11) patients should be involved in decision making and have access to educational resources.
{"title":"How to treat ANCA‑associated vasculitis: practical messages from 2016 EULAR/ERA‑EDTA recommendations.","authors":"J. Sznajd, C. Mukhtyar","doi":"10.20452/pamw.3598","DOIUrl":"https://doi.org/10.20452/pamw.3598","url":null,"abstract":"The European League against Rheumatism (EULAR) with the European Renal Association - European Dialysis and Transplant Association recently published an update of 2009 EULAR recommendations with a focus on the management of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitides (AAV). In this article, we discuss the following key messages for clinical practice derived from these recommendations: 1) biopsy should be performed if possible to confirm new diagnosis or relapse; 2) glucocorticoid therapy is an extremely important adjunct to the management of AAV, but it is also responsible for the majority of adverse effects; the dose should be tapered to 7.5 to 10 mg/d at 3 to 5 months; 3) cyclophosphamide or rituximab are the mainstay of remission induction; 4) patients with major relapse should be treated like those with new disease, but rituximab is the preferred option in those patients who relapse after prior cyclophosphamide; 5) minor relapse should not be treated with glucocorticoid alone, and a change in immunosuppressive regimen should be considered; 6) rituximab can be used not only for remission induction but also for maintenance; 7) maintenance therapy should continue for at least 2 years, after which gradual taper could be considered; 8) while ANCA are extremely useful for diagnosis and rising ANCA levels seem to be associated with relapse, serial monitoring should not guide treatment decisions; 9) monitoring of AAV patients should be holistic with a structured assessment tool and monitoring for effects related to the vasculitis as well as treatment; 10) management should be either at or in conjunction with an expert center; and 11) patients should be involved in decision making and have access to educational resources.","PeriodicalId":20343,"journal":{"name":"Polskie Archiwum Medycyny Wewnetrznej","volume":"51 1","pages":"781-788"},"PeriodicalIF":0.0,"publicationDate":"2016-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79079939","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"BRIDGE trial. Dr. James Douketis in an interview with Dr. Roman Jaeschke: part 1.","authors":"J. Douketis, R. Jaeschke","doi":"10.20452/pamw.3608","DOIUrl":"https://doi.org/10.20452/pamw.3608","url":null,"abstract":"","PeriodicalId":20343,"journal":{"name":"Polskie Archiwum Medycyny Wewnetrznej","volume":"28 1","pages":"798-800"},"PeriodicalIF":0.0,"publicationDate":"2016-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73335364","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Abandonment of internal medicine as a specialty: the point of no return?","authors":"T. Stompór","doi":"10.20452/pamw.3632","DOIUrl":"https://doi.org/10.20452/pamw.3632","url":null,"abstract":"","PeriodicalId":20343,"journal":{"name":"Polskie Archiwum Medycyny Wewnetrznej","volume":"15 1","pages":"824-826"},"PeriodicalIF":0.0,"publicationDate":"2016-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81786737","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Gone with the age(DL): high‑density lipoprotein in senescence.","authors":"K. Distelmaier, G. Goliasch","doi":"10.20452/pamw.3594","DOIUrl":"https://doi.org/10.20452/pamw.3594","url":null,"abstract":"","PeriodicalId":20343,"journal":{"name":"Polskie Archiwum Medycyny Wewnetrznej","volume":"2 1","pages":"727-728"},"PeriodicalIF":0.0,"publicationDate":"2016-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88804715","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Stress ulcer prophylaxis in critical care: a 2016 perspective Dr. Waleed Alhazzani in an interview with Dr. Roman Jaeschke: part 2.","authors":"W. Alhazzani, R. Jaeschke","doi":"10.20452/pamw.3606","DOIUrl":"https://doi.org/10.20452/pamw.3606","url":null,"abstract":"","PeriodicalId":20343,"journal":{"name":"Polskie Archiwum Medycyny Wewnetrznej","volume":"82 1","pages":"796-797"},"PeriodicalIF":0.0,"publicationDate":"2016-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76046610","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
821 As a medical doctor, I had started my carrier in the field of internal medicine, but subsequently I spent most of my professional life working as a biomedical researcher. Moreover, a huge majority of my scientific activities have taken place abroad. Still, I have always been closely collaborating with renowned Polish researchers. In addition, my scientific work involved not only pure laboratory investigations but was often connected to clinical studies of different types. Finally, as part of my quite recent work, I have been involved in establishing some genetic assays for single-gene disorders as well as for analysis and interpretation of genetic testing results. Thus, although my perspective is rather subjective and has mostly foreign and not strictly clinical character, I am still providing some of my thoughts on internal medicine, as shortly outlined below.
{"title":"Internal medicine and biomedicine in Poland: views from the inside and outside.","authors":"D. P. Potaczek","doi":"10.20452/pamw.3630","DOIUrl":"https://doi.org/10.20452/pamw.3630","url":null,"abstract":"821 As a medical doctor, I had started my carrier in the field of internal medicine, but subsequently I spent most of my professional life working as a biomedical researcher. Moreover, a huge majority of my scientific activities have taken place abroad. Still, I have always been closely collaborating with renowned Polish researchers. In addition, my scientific work involved not only pure laboratory investigations but was often connected to clinical studies of different types. Finally, as part of my quite recent work, I have been involved in establishing some genetic assays for single-gene disorders as well as for analysis and interpretation of genetic testing results. Thus, although my perspective is rather subjective and has mostly foreign and not strictly clinical character, I am still providing some of my thoughts on internal medicine, as shortly outlined below.","PeriodicalId":20343,"journal":{"name":"Polskie Archiwum Medycyny Wewnetrznej","volume":"30 5 1","pages":"821-823"},"PeriodicalIF":0.0,"publicationDate":"2016-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76035020","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Łukaszewicz-Zając, A. Kulczyńska-Przybik, P. Muszyński, M. Kozłowski, M. Szmitkowski, B. Mroczko
INTRODUCTION A specific receptor for interleukin 8, known as C-X-C chemokine type‑2 receptor (CXCR‑2), is one of the 7‑transmembrane G‑protein‑coupled receptors. Its involvement in the development of numerous malignancies, including esophageal cancer (EC), has been suggested. OBJECTIVES The aim of this study was to assess the diagnostic and prognostic usefulness of serum CXCR‑2 level measurement in patients with EC, in comparison with C‑reactive protein (CRP) levels and classic tumor markers such as carcinoembryonic antigen (CEA) and squamous cell carcinoma antigen (SCC‑Ag). PATIENTS AND METHODS The study included 72 individuals: 42 patients with EC and 30 healthy volunteers. Serum CXCR‑2 concentrations were measured by an immunoenzymatic assay. The levels of classic tumor markers were measured using the chemiluminescent method, and CRP levels were measured using the immunoturbidimetric method. RESULTS Serum CXCR‑2 concentrations were significantly higher in patients with EC than in the control group, similarly to CEA and CRP levels. Moreover, CXCR‑2 concentrations were significantly higher in patients with poorly differentiated EC (G3) compared with those with G2 tumors. The diagnostic sensitivity and accuracy, as well as the negative predictive value of the serum CXCR‑2 assay were higher than those observed for classic tumor markers and slightly lower than those observed for CRP levels. The highest diagnostic sensitivity was found for the combined analysis of CXCR‑2 and CRP. CONCLUSIONS Our results suggest the role of CXCR‑2 in the development of EC. Thus, further research is needed to clarify the significance of chemokines and their receptors as potential tumor markers of EC.
{"title":"Serum concentrations of receptor for interleukin 8 in patients with esophageal cancer.","authors":"M. Łukaszewicz-Zając, A. Kulczyńska-Przybik, P. Muszyński, M. Kozłowski, M. Szmitkowski, B. Mroczko","doi":"10.20452/pamw.3589","DOIUrl":"https://doi.org/10.20452/pamw.3589","url":null,"abstract":"INTRODUCTION A specific receptor for interleukin 8, known as C-X-C chemokine type‑2 receptor (CXCR‑2), is one of the 7‑transmembrane G‑protein‑coupled receptors. Its involvement in the development of numerous malignancies, including esophageal cancer (EC), has been suggested. OBJECTIVES The aim of this study was to assess the diagnostic and prognostic usefulness of serum CXCR‑2 level measurement in patients with EC, in comparison with C‑reactive protein (CRP) levels and classic tumor markers such as carcinoembryonic antigen (CEA) and squamous cell carcinoma antigen (SCC‑Ag). PATIENTS AND METHODS The study included 72 individuals: 42 patients with EC and 30 healthy volunteers. Serum CXCR‑2 concentrations were measured by an immunoenzymatic assay. The levels of classic tumor markers were measured using the chemiluminescent method, and CRP levels were measured using the immunoturbidimetric method. RESULTS Serum CXCR‑2 concentrations were significantly higher in patients with EC than in the control group, similarly to CEA and CRP levels. Moreover, CXCR‑2 concentrations were significantly higher in patients with poorly differentiated EC (G3) compared with those with G2 tumors. The diagnostic sensitivity and accuracy, as well as the negative predictive value of the serum CXCR‑2 assay were higher than those observed for classic tumor markers and slightly lower than those observed for CRP levels. The highest diagnostic sensitivity was found for the combined analysis of CXCR‑2 and CRP. CONCLUSIONS Our results suggest the role of CXCR‑2 in the development of EC. Thus, further research is needed to clarify the significance of chemokines and their receptors as potential tumor markers of EC.","PeriodicalId":20343,"journal":{"name":"Polskie Archiwum Medycyny Wewnetrznej","volume":"249 4-6","pages":"854-861"},"PeriodicalIF":0.0,"publicationDate":"2016-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91509551","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hypoglycemia is the major barrier for optimal glycemic control in patients on maintenance insulin therapy. It is widely known that good glycemic control leads to prevention of or delay in the development of microvascular complications, and can reduce macrovascular events. It is thought that hypoglycemia may predispose patients to cognitive deterioration and may negatively affect the cardiovascular system. Hypoglycemia per se can contribute to a blunted counterregulatory response and disabling hypoglycemia, while hypoglycemia avoidance restores normal response to low blood glucose levels. There are some new approaches to reducing the incidence of hypoglycemia occurrence, including education programs, insulin regimens, the type of insulin used, as well as new technologies for insulin delivery and blood glucose measurement. However, none of these approaches have been able to eliminate the incidence of hypoglycemia completely. The current paper summarizes the physiology and major aspects of hypoglycemia‑related health consequences and possible ways to avoid hypoglycemia.
{"title":"Hypoglycemia in patients with insulin‑treated diabetes.","authors":"J. Gumprecht, K. Nabrdalik","doi":"10.20452/pamw.3586","DOIUrl":"https://doi.org/10.20452/pamw.3586","url":null,"abstract":"Hypoglycemia is the major barrier for optimal glycemic control in patients on maintenance insulin therapy. It is widely known that good glycemic control leads to prevention of or delay in the development of microvascular complications, and can reduce macrovascular events. It is thought that hypoglycemia may predispose patients to cognitive deterioration and may negatively affect the cardiovascular system. Hypoglycemia per se can contribute to a blunted counterregulatory response and disabling hypoglycemia, while hypoglycemia avoidance restores normal response to low blood glucose levels. There are some new approaches to reducing the incidence of hypoglycemia occurrence, including education programs, insulin regimens, the type of insulin used, as well as new technologies for insulin delivery and blood glucose measurement. However, none of these approaches have been able to eliminate the incidence of hypoglycemia completely. The current paper summarizes the physiology and major aspects of hypoglycemia‑related health consequences and possible ways to avoid hypoglycemia.","PeriodicalId":20343,"journal":{"name":"Polskie Archiwum Medycyny Wewnetrznej","volume":"45 1","pages":"870-878"},"PeriodicalIF":0.0,"publicationDate":"2016-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90816738","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
E. Wielosz, M. Majdan, Arkadiusz Koszarny, M. Dryglewska, J. Tabarkiewicz
INTRODUCTION According to literature, some organ-specific antibodies may be present in systemic sclerosis (SSc). OBJECTIVES The objective of this study was to assess the prevalence of antithyroid antibodies (aTPO and/or aTG) and antimitochondrial antibodies (AMAs) in SSc patients (pts) moreover, to evaluate their clinical consequences. PATIENTS AND METHODS Analysis involved 86 consecutive patients with SSc hospitalized in the Department of Rheumatology; 32 patients had diffuse cutaneous (dcSSc) and 54 had limited cutaneous (lcSSc). Patients were observed for autoimmune thyroid diseases (ATDs) and primary biliary cirrhosis (PBC). Serum samples were obtained from each patient. RESULTS 27/86 pts (31%) had positive antithyroid antibodies and 11/86 pts (13%) had positive AMAs. ATD was diagnosed in 26/86 pts (30%) and PBC in 10/86 pts (12%) with SSc. No significant intergroup differences in the prevalence of antithyroid antibodies were found between dcSSc vs. lcSSc patients, but the prevalence of AMAs was significantly higher in lcSSc compared to dcSSc. The prevalence of anti-Ro-52 antibodies was significantly higher in the SSc group with positive aTPO antibodies compared to the SSc group with negative aTPO antibodies. The prevalence of anticentromere antibodies (ACAs) was significantly higher in the SSc group with positive AMAs compared to the SSc group with negative AMAs. CONCLUSIONS The prevalence of organ-specific antibodies in SSc patients is relatively high. The prevalence of AMAs is higher in the lcSSc than in the dcSSc group and is strongly associated with ACAs. Therefore patients with systemic sclerosis should be evaluated for coexisting ATD and PBC.
{"title":"Systemic sclerosis and organ - specific antibodies.","authors":"E. Wielosz, M. Majdan, Arkadiusz Koszarny, M. Dryglewska, J. Tabarkiewicz","doi":"10.20452/pamw.3583","DOIUrl":"https://doi.org/10.20452/pamw.3583","url":null,"abstract":"INTRODUCTION According to literature, some organ-specific antibodies may be present in systemic sclerosis (SSc). OBJECTIVES The objective of this study was to assess the prevalence of antithyroid antibodies (aTPO and/or aTG) and antimitochondrial antibodies (AMAs) in SSc patients (pts) moreover, to evaluate their clinical consequences. PATIENTS AND METHODS Analysis involved 86 consecutive patients with SSc hospitalized in the Department of Rheumatology; 32 patients had diffuse cutaneous (dcSSc) and 54 had limited cutaneous (lcSSc). Patients were observed for autoimmune thyroid diseases (ATDs) and primary biliary cirrhosis (PBC). Serum samples were obtained from each patient. RESULTS 27/86 pts (31%) had positive antithyroid antibodies and 11/86 pts (13%) had positive AMAs. ATD was diagnosed in 26/86 pts (30%) and PBC in 10/86 pts (12%) with SSc. No significant intergroup differences in the prevalence of antithyroid antibodies were found between dcSSc vs. lcSSc patients, but the prevalence of AMAs was significantly higher in lcSSc compared to dcSSc. The prevalence of anti-Ro-52 antibodies was significantly higher in the SSc group with positive aTPO antibodies compared to the SSc group with negative aTPO antibodies. The prevalence of anticentromere antibodies (ACAs) was significantly higher in the SSc group with positive AMAs compared to the SSc group with negative AMAs. CONCLUSIONS The prevalence of organ-specific antibodies in SSc patients is relatively high. The prevalence of AMAs is higher in the lcSSc than in the dcSSc group and is strongly associated with ACAs. Therefore patients with systemic sclerosis should be evaluated for coexisting ATD and PBC.","PeriodicalId":20343,"journal":{"name":"Polskie Archiwum Medycyny Wewnetrznej","volume":"175 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2016-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76873747","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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