Polskie Archiwum Medycyny Wewnętrznej
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Pol. Arch. Med. Wewn. · Apr 2019
ReviewRole of gestational weight gain, gestational diabetes, breastfeeding, and hypertension in mother-to-child obesity transmission.
Given the reported 30% prevalence of early-life obesity in the Western world, the nongenetic, maternally derived risk factors for excess body mass in offspring have been widely investigated recently. This review article aimed to analyze the results of 67 articles published from 2014 onwards that investigated causative non-genetic-based associations between maternal and infantile excess body mass. Excessive gestational weight gain was found to increase the incidence of excess body mass in offspring, reaching nearly 20% at 2 years of age. ⋯ Their occurrence should be monitored and prevention of these factors should become the principal aim of obesity prevention programs for children. Occurrence of these factors may justify intense screening to diagnose early stages of metabolic disorders in offspring, even in adulthood. Further large-scale studies are warranted to draw a firm conclusion.
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Pol. Arch. Med. Wewn. · Apr 2019
ReviewA review of menopausal hormone therapy: recalibrating the balance of benefit and risk.
While menopausal hormone therapy (MHT) was initially marketed to women of menopausal age to prolong youth, it has endured a tumultuous history evaluating the risk-to-benefit ratio. In response to evidence that MHT may confer cardioprotective effects, 2 landmark randomized controlled trials tested this hypothesis, and both were stopped prematurely due to increased incident cancers and cardiovascular events, creating much controversy and confusion. As women and physicians grew reticent to use MHT, most symptomatic menopausal women remained untreated. ⋯ Most recently, the 18-year follow-up data of postmenopausal women in the Women's Health Institute trial did not show any change in long-term survival associated with the use of MHT at any age. More recent studies have evaluated alternative treatments for high-risk women, including lower doses and newer formulations of MHT, along with combined new therapies such as selective estrogen receptor modulators, antidepressants, and exercise therapies, which are effective in reducing vasomotor symptoms and improving menopause-specific quality of life. These alternatives provide new options to symptomatic women who are unable or unwilling to take conventional MHT and allow for more person-centered decision making strategies to support women through the menopause.
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Pol. Arch. Med. Wewn. · Apr 2019
Early chemotherapy de-escalation strategy in patients with advanced-stage Hodgkin lymphoma with negative positron emission tomography scan after 2 escalated BEACOPP cycles.
INTRODUCTION Escalated BEACOPP (escBEACOPP: bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, prednisone) significantly improves overall response rates (ORRs) and prolongs progression‑free survival (PFS) in patients with advanced‑stage Hodgkin lymphoma (HL). However, 6 to 8 cycles of escBEACOPP are associated with increased acute toxicity and late complications. OBJECTIVES We aimed to determine the role of early positron emission tomography-computed tomography (PET‑CT) response assessment in a de‑escalation strategy. ⋯ In the whole cohort, ORR was 87.8% (CR, 85.6%), while the 10‑year PFS and OS were 79.3% and 89.4%, respectively. Hematological and thromboembolic complications were significantly more frequent in patients treated with 6 escBEACOPP cycles, including febrile neutropenia (25 patients, [53.2%] vs 7 [5%]), serious anemia (35 [74.5%] vs 11 [7.8%]), or thrombocytopenia (16 [34%] vs 7 [5%]) (P <0.001 for all comparisons with de‑escalation strategy) as well as pulmonary embolism (3 [6.4%] vs 0) (P = 0.02). CONCLUSIONS The early de‑escalation strategy allows for effective treatment of advanced HL, with a comparable efficacy to that of 6 to 8 cycles of escBEACOPP, but with significantly reduced toxicity.
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Pol. Arch. Med. Wewn. · Apr 2019
Levels of tissue factor pathway inhibitor in patients with inflammatory bowel disease.
INTRODUCTION Endothelial dysfunction has been reported to be involved in the pathogenesis of inflammatory bowel disease (IBD) and concomitant thromboembolic complications. Inflammation stimulates the expression of tissue factor and tissue factor pathway inhibitor (TFPI) by endothelial cells. OBJECTIVES This study assessed the relationship between TFPI levels and disease activity in patients with IBD. ⋯ The von Willebrand factor level was higher in patients with UC (median, 143.4 IU/dl [IQR, 115.5-170.4]) and those with CD (median, 151.8 IU/dl [IQR, 112.8-189.4]) than in controls (85.1 IU/dl [IQR, 77.1-101.5]; P <0.001 for both comparisons). CONCLUSIONS The anticoagulant TFPI pathway is activated during remissions and flares in patients with IBD. The free TFPI level correlates with biochemical markers of inflammation and disease activity.