Polskie Archiwum Medycyny Wewnętrznej
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Pol. Arch. Med. Wewn. · Apr 2023
ReviewReflections on internal medicine in Poland on the occasion of the 100th anniversary of Polish Archives of Internal Medicine.
Dynamic development of medicine in the 20th and 21st centuries has only been possible due to its split into narrow specialties. The increasingly complicated and costly technologies used in clinical practice can only be mastered by small groups of highly‑ qualified specialists; however, diagnosis and treatment are not about matching a patient with the latest and most sophisticated technologies but about finding an optimal patient‑ oriented solution, as it is the human being as a whole that needs help. To achieve this goal, a close collaboration of different specialists is required, but the key role rests with a physician with good general internal medicine skills and the right motivation to act. ⋯ The task is further complicated by chronic underfunding of these wards. The aim of the present review is to reflect on the current state and prospects of Polish internal medicine as well as to attempt a definition of an internist and their role in the integration of different medical specialties. It also stresses the importance of a master in the teaching and practice of medicine and presents profiles of 4 eminent Polish internists.
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Pol. Arch. Med. Wewn. · Apr 2023
ReviewExtracellular vesicles in vascular pathophysiology: beyond their molecular content.
Extracellular vesicles (EVs) are released by all cells, both in physiological and pathological conditions. Their molecular charge and composition emerge as possible biomarkers, but EVs may also be considered for other clinical applications. This review discusses the role of other features of EVs, such as their lipid components or composition of glycans that form the EV corona and regulate EV biodistribution and uptake by target cells. The importance of EV electric charge has been discussed as a new insight into EV fate and destination.
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Pol. Arch. Med. Wewn. · Mar 2023
ReviewPolypill in cardiovascular disease prevention: recent advances.
Triple therapy with lipid‑lowering, antihypertensive, and antiplatelet agents reduces the risk of recurrent cardiovascular fatal and nonfatal events, cardiovascular mortality, and total mortality in secondary prevention. In real life, however, effective implementation of these optimal treatments both in primary and secondary prevention is low, and thus their contribution to cardiovascular prevention is much lower than it could be, based on research data. One of the main barriers to the adequate implementation of these strategies is low adherence to the elevated number of pills, as adherence is adversely affected by the complexity of the prescribed treatment regimen, and can be considerably improved by treatment simplification. ⋯ The increased prevalence of patients with multiple cardiovascular risk factors and comorbidities provides the rationale for a therapeutic strategy based on a combination of drugs against different risk factors in a single pill. Pharmacologic studies have demonstrated that different cardiovascular drugs can be combined in a single pill with no loss of their individual efficacy, and this favors adherence to and persistence of treatment, as well as multiple risk factor control. Recently, a randomized clinical trial SECURE (Secondary Prevention of Cardiovascular Disease in the Elderly) has shown a significant, 30% reduction in cardiovascular events, and a 33% reduction in cardiovascular death in patients after myocardial infarction treated with a polypill, as compared with usual care, thus supporting the polypill use as an integral part of any cardiovascular prevention strategy.
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Pol. Arch. Med. Wewn. · Jan 2023
ReviewVariants of autoimmune liver diseases: how to diagnose? how to treat?
Autoimmune liver diseases (AILDs), such as autoimmune hepatitis (AIH), primary sclerosing cholangitis (PSC), and primary biliary cholangitis (PBC), are classified as rare diseases, but their incidence is increasing. In this review, we present the characteristics of AILDs in adults, and mainly focus on their variants in terms of diagnosis and management. The classic AILDs have been well defined in clinical guidelines, but a proportion of patients with a single AILD tend to show features of other AILDs. ⋯ However, treating these patients is challenging, even for experienced clinicians. Progression to end‑stage liver disease is, unfortunately, not a rare course, despite combined and second‑line therapies, particularly for AIH‑PSC variants. Thus, studies based on prospective registers are necessary to elaborate upon widely accepted guidelines, to offer better care to these patients, and to improve their prognosis.
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Pol. Arch. Med. Wewn. · Nov 2022
ReviewChallenges in pulmonary rehabilitation: COVID-19 and beyond.
Pulmonary rehabilitation is a comprehensive multidisciplinary intervention requiring a team involving an expert chest physician, an exercise training specialist, a nutritional expert, a psychologist, a social worker, and an occupational therapist, who together aim at improving respiratory functional capacity in patients with chronic obstructive pulmonary disease (COPD). We aimed at evaluating the effectiveness of pulmonary rehabilitation in a large number of trials, systematic reviews, and meta‑analyses in pre-COVID-19 conditions, and the impact of pulmonary rehabilitation during the COVID‑19 pandemic was estimated based on results of abundant available studies. ⋯ The response to rehabilitation in patients with COVID‑19 is also satisfactory. The effectiveness of pulmonary rehabilitation in COPD patients shows an evolving need for health care professionals to design an individually tailored pulmonary rehabilitation program for patients with COVID-19 to alleviate the chronic symptoms and reduce complications.