Polskie Archiwum Medycyny Wewnętrznej
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Pol. Arch. Med. Wewn. · Nov 2021
Multicenter StudyBurden of multimorbidity in a Polish cohort of ambulatory and hospitalized heart failure patients from two large European registry programs: prognostic implications.
Introduction: Individual comorbidities have been shown to adversely affect prognosis in heart failure (HF). However, our knowledge of multimorbidity in HF and understanding of its prognostic implications still remain incomplete. Objectives: We aimed to analyze the prevalence of multimorbidity in Polish HF patients and to investigate the quantitative and qualitative impact of comorbidity burden on 12-month outcomes in that population. Patients and methods: We retrospectively analyzed data of 1765 Polish patients with ambulatory or acute (requiring hospitalization) HF from 2 multicenter observational European Society of Cardiology registries: the ESC-HF Pilot Survey (2009–2010) and ESC-HF-LT Registry (2011–2013). Results: Arterial hypertension and coronary artery disease were the most prevalent comorbidities, similarly to the entire European cohort. The great majority of HF patients had more than 1 predefined comorbidity and the most frequent number of comorbidities was 3. ⋯ The best accuracy for predicting the adjusted 12-month rate of all-cause death was ensured by the model including only anemia and kidney dysfunction. The model including 4 comorbidities—anemia, kidney dysfunction, diabetes, and coronary artery disease—provided best accuracy for predicting 12-month rate of composite all-cause death or HF hospitalization. Conclusions: Multimorbidity is highly prevalent in a real-world cohort of Polish HF patients and the quantitative burden of comorbidities is related to increased mortality. In such patients, the clinical profile characterized by pathophysiological continuum of diabetes, kidney dysfunction, and anemia is particularly associated with unfavorable outcomes.
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Pol. Arch. Med. Wewn. · Nov 2021
ReviewManagement of cancer pain: challenging the evidence of the recent palliative care opioid guidelines.
Opioid therapy is indisputably the mainstay of cancer pain management. However, important issues such as the worldwide variability in the availability and accessibility of opioids, myths and misconceptions about opioid use, and lack of knowledge about prescribing opioids among health care professionals have been pointed out by researchers, clinicians, and several health organizations. In an attempt to improve cancer pain management, guidelines for opioid use were elaborated to assist practitioners in prescribing opioids for the management of cancer-related pain. ⋯ Moreover, the increased frequency of prescribing opioids for chronic noncancer pain has raised other issues, such as iatrogenic adverse effects, which may also occur in patients with cancer pain on long-term opioid therapy (L-TOT). In this narrative review, we discussed the role of opioid guidelines and recent knowledge regarding the consequences of L-TOT, in particular opioid addiction and deficiencies of the immune and endocrine systems. Finally, we addressed new strategies to strengthen the L-TOT in the management of cancer-related pain among patients in palliative care.
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Pol. Arch. Med. Wewn. · Nov 2021
Randomized Controlled TrialOptimal medical therapy in patients with stable coronary artery disease in Poland. The ISCHEMIA Trial experience.
Introduction: Optimal medical therapy (OMT) is the cornerstone of treatment for stable coronary disease with the ISCHEMIA trial showing similar outcomes using OMT with or without an initial invasive approach. Objectives: To describe OMT goal attainment in Polish ISCHEMIA participants compared with other countries. Patients and methods: Among 5179 trial participants, 333 were randomized in Poland. The median follow-up was 3.2 years. ⋯ In Poland, significant improvements were achieved regarding high-intensity statin therapy (27% vs 50%), LDL-C <70 mg/dl (29% vs 65%), and systolic blood pressure of less than 140 mm Hg (63% vs 81%) (P <0.001 for all), whereas not-smoking (89% vs 89%), aspirin (90% vs 88%), ACEI / ARB (93% vs 95%), and β-blocker therapy (94% vs 90%) remained high. Conclusions: With regular surveillance and contemporary medical therapy, high OMT goal attainment was achievable among the participants of the ISCHEMIA trial in Poland relative to other countries. There is still room for improvement in LDL-C and blood pressure management.
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Pol. Arch. Med. Wewn. · Nov 2021
ReviewFibrin clot properties in coronary artery disease: new determinants and prognostic markers.
Despite improved diagnosis and treatment options, coronary artery disease (CAD) is still the leading cause of mortality and morbidity worldwide. Established risk factors such as smoking, hypercholesterolemia, and hypertension only partly explain the pathophysiology of CAD. Besides the well-known role of platelets in atherosclerosis and arterial thrombus formation, reduced endogenous fibrinolytic activity may play a key role in CAD formation and progression. ⋯ We present today’s evidence on fibrin clot properties in patients with stable CAD or acute coronary syndrome compared with healthy individuals and the significance of altered fibrinolysis as a risk for coronary thrombotic disease. In conclusion, we found evidence that altered fibrin clot properties and impaired fibrinolysis appear to contribute significantly to the thromboembolic risk in CAD patients. Therefore, more research is crucial in order to clarify whether modulation of the fibrinolytic system may pave the way for improved treatment of CAD.
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Pol. Arch. Med. Wewn. · Nov 2021
Outcomes of COVID-19 in hospitalized kidney and liver transplant recipients- a single-center experience.
Introduction: Solid organ transplant recipients seem to be more susceptible to severe COVID-19. Objectives: Our study aimed to assess the clinical outcomes of COVID-19 in kidney (KTRs) and liver transplant recipients (LTRs). Patients and methods: In this single-center study, the medical records of KTRs and LTRs with PCR-confirmed COVID-19 admitted between November 9, 2020 and February 26, 2021 were retrospectively reviewed. Results: Overall, 41 patients, including 32 KTRs (78%), one kidney-pancreas transplant recipient (2.4%), and 8 LTRs (19.5%) were included. Seven patients (17%) experienced COVID-19 in the first month after transplantation. ⋯ Baseline estimated glomerular filtration rate, respiratory rate on admission, and diabetes mellitus constituted independent risk factors for in-hospital mortality in the KTRs. The LTRs experienced relatively mild COVID-19: only 2 patients (25%) required oxygen supplementation and a single patient (12.5%) died of severe ARDS. Conclusion: In summary, hospitalized KTRs with COVID-19 are at a high risk of acute kidney injury, ARDS, and death.