Vnitr̆ní lékar̆ství
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Vnitr̆ní lékar̆ství · Oct 2009
[Relationship between quality of life and BODE index of stable ex-smokers with chronic obstructive pulmonary disease].
This study was carried out to assess relationship between quality of life (QoL) and disease severity expressed by multifactorial prognostic index (BODE) in ex-smokers suffering from chronic obstructive pulmonary disease (COPD), minimally 8 weeks free of exacerbation. ⋯ Our results proved close correlation ofquality of life (SGRQ) and multidimensional prognostic score (BODE) in stable COPD exsmokers' population. Both these scoring systems are useful tools for the assessment of clinical course and stratification of severity of COPD. However at present both scales are minimally used in the Czech Republic.
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Vnitr̆ní lékar̆ství · Sep 2009
Review[Target values in hypertension treatment. Will they apply in older patients with hypertension, diabetics and in patients with IHD?].
The incidence of isolated systolic hypertension increases with age since 50 years. Systolic pressure appears to have higher prognostic importance than diastolic pressure in patients older than 50 years. Treatment of isolated systolic hypertension importantly decreases cerebrovascular events, coronary events as well as overall mortality. ⋯ We believe that this should apply to older patients with ischemic heart disease in particular. In summary, it is possible to conclude that hypertension treatment target blood pressure values of less than 140/90 mmHg are justified. However, target values of less than 130/80 mmHg in diabetics, in patients with a cardiovascular disease and in other patient groups (metabolic syndrome, overall cardiovascular risk of 5% or higher) are challenged by the results of a range of large studies, and verification in prospective studies is of utmost importance.
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Hyperglycaemia is a typical feature of metabolic syndrome (MeTS) and one of its independent diagnostic criteria. The term includes impaired glucose homeostasis (impaired fasting glucose and impaired glucose tolerance) and type 2 diabetes mellitus. Although glycaemic control has been shown to lower the risk of microvascular events, the effect of intensive glycaemic control on macrovascular outcomes is less clear. ⋯ It is possible to use a range of different combinations, metformin is administered with a glitazone (zero risk of hypoglycaemias is the advantage) with sulphonylurea derivatives (low price is the advantage) with glinides, with incretins, acarbose, antiobesity agents or insulin. The next step is a triple combination of hypoglycaemic agents with different mechanisms of action. Therapy also includes education focusing on changes to dietary and lifestyle habits, including smoking cessation, and education related to the prevention of complications, with particular regard to prevention of diabetic foot and atherosclerosis.
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Vnitr̆ní lékar̆ství · Mar 2009
Review[Inferior vena cava filters in pulmonary embolism prevention].
Pulmonary embolism (PE) is the most serious sign of venous thromboembolism and the 3rd most frequent cause of cardiovascular death. Therapy with anticoagulants represents, among other measures, the mainstay of PE treatment. However, anticoagulant therapy does not prevent recurrence of pulmonary embolism in 3-20% of patients. ⋯ This was one of the causes of relatively high incidence of complications related to the use of these filters, particularly venous thromboses, as confirmed by so far the only randomised study PREPIC. Consequently, retrievable filters that are currently preferred have been developed. The authors also provide an overview of studies in progress, describe the process of implantation and describe own patient group.