Polskie Archiwum Medycyny Wewnętrznej
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Pol. Arch. Med. Wewn. · Jan 2012
ReviewDosing of antibiotics in critically ill patients: are we left to wander in the dark?
Critically ill patients are frequently affected by acute kidney injury accompanied by dysfunction of other systems and organs. Sepsis is common in this population and remains a major cause of multiorgan dysfunction syndrome, indicating a crucial role in efficient antibiotic treatment. ⋯ Current guidelines concerning the dosing of antibiotics in this patient population are not particularly reliable because they are based on studies involving small and heterogeneous groups of patients, often treated with different RRT modalities. Our paper reviews the basic pharmacokinetic and pharmacodynamic parameters as well as other factors that should be considered while devising a proper therapeutic approach for this patient population.
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Microparticles (MPs) are phenotypically and functionally heterogeneous population of microvesicles. Although MP formation represents a physiological phenomenon. ⋯ Elevated levels of platelet‑, endothelial cell‑, and monocyte‑derived MPs have been documented in a number of clinical conditions in which vascular dysfunction and inflammation are important pathophysiological mechanisms (e.g., coronary artery disease or thrombotic microangiopathies). Knowledge of the functional properties of MPs will contribute to a better understanding of the pathological mechanisms of communication between cells and of the causes of various diseases.
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Pol. Arch. Med. Wewn. · Jan 2012
ReviewMacrolide therapy for the prevention of acute exacerbations in chronic obstructive pulmonary disease.
Acute exacerbations are a major contributor to health care costs and a leading cause of death in patients with chronic obstructive pulmonary disease (COPD). A reduction in acute exacerbations of COPD (AECOPD) would lead to significant improvements in patient well-being and survival. Bacterial and viral infections cause a majority of AECOPD episodes; however, with the exception of influenza and pneumococcal vaccines, preventative therapies for exacerbations do not directly address these infectious causes of AECOPD. ⋯ Macrolides could also suppress bacterial colonization and thus decrease airway inflammation, thereby interrupting the vicious cycle of inflammation and infection in COPD. COPD patients with two or more exacerbations a year in spite of appropriate standard therapy are potential candidates for this therapeutic approach. However, optimal duration and dosing of macrolide prophylaxis for AECOPD remains uncertain.
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Pol. Arch. Med. Wewn. · Jan 2012
ReviewA new era for anticoagulation in atrial fibrillation. Which anticoagulant should we choose for long‑term prevention of thromboembolic complications in patients with atrial fibrillation?
For more than 60 years, vitamin K antagonists have been the only available oral anticoagulants for the prevention of stroke and systemic embolism in atrial fibrillation (AF). Several new molecules, with a favorable pharmacokinetic profile and avoiding routine monitoring, have been recently developed, opening a new era in anticoagulation. The oral direct thrombin inhibitor, dabigatran, and the oral activated factor X inhibitors, rivaroxaban and apixaban, are the novel oral anticoagulants with data from large randomized clinical trials showing that these drugs are noninferior to warfarin in the prevention of stroke and thromboembolic complications of AF, with the advantage of less hemorrhagic stroke and intracranial bleeding. While these trial data are extremely encouraging, several practical issues (e.g., lack of specific antidote, safety of long-term treatment or cost-effectiveness in "real-life" clinical practice) still need to be elucidated.
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Pol. Arch. Med. Wewn. · Jan 2012
Practice Guideline[Polish guidelines for the prevention and treatment of venous thromboembolism. 2012 update].
The overall objective of the Polish guidelines for the prevention and treatment of venous thromboembolism is to increase patient benefit and safety by appropriate prevention and treatment of deep vein thrombosis and pulmonary embolism as well as proper management of the complications associated with antithrombotic and thrombolytic therapy. These guidelines apply to adult trauma, cancer, surgical, and medical patients as well as those at increased risk of venous thromboembolism. Specific recommendations have been formulated for pregnant women, patients requiring surgery while receiving long-term oral anticoagulant treatment, and patients undergoing regional anesthesia and/or analgesia. ⋯ When necessary, we explicitly stated the rationale for modification of the previously published recommendations and judgements about the values and preferences we assumed. The information regarding reimbursement of drugs mentioned in the recommendations was added in chapters 6-9 and 13 and approved by the National Health Fund. The final version of the practice guidelines was officially approved by the scientific societies and institutions listed at the beginning of the document.