Polskie Archiwum Medycyny Wewnętrznej
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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. · Oct 2021
ReviewHow can exercise reduce cardiovascular disease risk? A primer for the clinician.
Despite advances in drug development and medical treatments, cardiovascular diseases (CVDs) remain a leading cause of mortality across the globe. Fortunately, CVD can be delayed by engaging in appropriate lifestyle behaviors. An abundance of epidemiological evidence supports a direct association between increased levels of physical activity or cardiovascular fitness and reduced premature CVD morbidity and mortality. ⋯ Thus, the purpose of this review is to highlight the cardioprotective effects of exercise training and to explore the underlying mechanistic pathways that might explain these benefits. The review will focus on those physiological pathways that are directly involved in atherosclerotic disease development. They include hypercholesterolemia, hypertension, chronic inflammation, and insulin resistance.
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Plant‑based diets are considered to improve cardiometabolic health and to protect against cardiovascular disease. Although they center around plant‑based foods, they do not necessarily exclude all animal products and comprise of a range of intakes that vary according to the type and the proportion of animal products included. Numerous metabolic pathways have been identified through which plant‑based diets can exert beneficial effects including improved body composition, lipid profile, and glucose metabolism and decreased inflammation and blood pressure. ⋯ Ample evidence for the effects of individual dietary components of plant‑based diets on thrombotic risk factors exists, but the effect of whole diets and / or dietary patterns remains less‑well explored with the existing literature reporting inconsistent and inconclusive findings. Here we aim to review the literature describing the effect of different plant‑based diets (vegan, lacto‑vegetarian, lacto‑ovo‑vegetarian, pescatarian, and flexitarian) and dietary patterns (Mediterranean, Nordic, Portfolio, and DASH) on specific thrombotic risk factors (fibrinogen, platelets, factor VII, fibrinolysis) in order to better clarify these relationships and to try to explain the apparent discrepant findings. We demonstrate that a one‑size‑fits-all conclusion cannot be drawn and that the potential antithrombotic effect of different plant‑based diets depends on the nutrient composition, the content of active antithrombotic dietary components, the relative absence of prothrombotic dietary factors as well as the degree of total caloric restriction.
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Pol. Arch. Med. Wewn. · Sep 2021
Meta AnalysisImpact of continuous glucose monitoring on improving emotional well-being among adult people with type 1 diabetes mellitus: a systematic review and meta-analysis.
Real-time continuous glucose monitoring (CGM) has changed the way people with type 1 diabetes mellitus (T1DM) and health care providers perceive diabetes management and glucose control. ⋯ This is the first quantitative meta-analysis of studies involving adult patients exclusively with T1DM, providing further evidence for the ability of CGM systems to reduce fear of hypoglycemia and improve quality of life. Continuous glucose monitoring systems have advantage over SMBG in adults with T1DM and improve HbA1c levels.
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Infection with SARS-CoV-2, responsible for COVID-19, has spread all over the world since the beginning of 2020. Healthcare providers and researchers have been overwhelmed not only by the rapid diffusion of the disease resulting in a pandemic with more than 4 million cases of death, but also by the lack of therapeutic options. After more than 1 year, the knowledge on COVID-19 has increased thanks to the enormous effort of the scientific community. ⋯ When low-flow oxygen fails to significantly improve oxygen saturation, oxygen therapy using a high-flow nasal cannula is recommended. The current challenges in the treatment of COVID-19 include the need to define the role of convalescent plasma and monoclonal antibodies as well as to identify the optimal target and time for anticoagulation. In this review, we highlight the main aspects of these challenges in light of recent updates.