Polskie Archiwum Medycyny Wewnętrznej
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Pol. Arch. Med. Wewn. · Jan 2013
Meta Analysis Comparative StudyFluid resuscitation in severe sepsis and septic shock: systematic description of fluids used in randomized trials.
Fluid therapy is one of the cornerstones of initial management of sepsis, but the choice of fluids used for resuscitation is controversial. ⋯ The basic characteristics of fluids used in fluid therapy trials are often not easily available, yet of increasingly recognized clinical importance. We provide the information concerning composition of fluids used in RCTs, which will be useful not only to future investigators and systematic reviewers but also to clinicians using those fluids in regular clinical practice.
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Pol. Arch. Med. Wewn. · Jan 2013
Randomized Controlled Trial Comparative StudyMetformin added to intensive insulin therapy reduces plasma levels of glycated but not oxidized low‑density lipoprotein in young patients with type 1 diabetes and obesity in comparison with insulin alone: a pilot study.
There are scarce data about the effect of metformin on lipid profile in patients with type 1 diabetes. ⋯ Addition of metformin to intensive insulin therapy in young obese patients with type 1 diabetes results in a significant reduction of glycated LDL levels. This can be possibly explained by better glucose control, which improved insulin sensitivity of the peripheral tissues and reduced body mass in this patient group.
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Pol. Arch. Med. Wewn. · Jan 2013
Review2012 revision of the Atlanta classification of acute pancreatitis.
Recently, the original Atlanta classification of 1992 was revised and updated by the Working Group using a web-based consultative process involving multiple international pancreatic societies. The new understanding of the disease, its natural history, and objective description and classification of pancreatic and peripancreatic fluid collections make this new 2012 classification a potentially valuable means of international communication and interest. This revised classification identifies 2 phases of acute pancreatitis - early (first 1 or 2 weeks) and late (thereafter). ⋯ Severe acute pancreatitis is defined by the presence of persistent organ failure (organ failure that persists for ≥2 days). Local complications are defined by objective criteria based primarily on contrast-enhanced computed tomography; these local complications are classified as acute peripancreatic fluid collections, pseudocyst (which are very rare in acute pancreatitis), acute (pancreatic/peripancreatic) necrotic collection, and walled-off necrosis. This classification will help the clinician to predict the outcome of patients with acute pancreatitis and will allow comparison of patients and disease treatment/management across countries and practices.
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Pol. Arch. Med. Wewn. · Jan 2013
ReviewEmerging concepts and therapies for chronic obstructive pulmonary disease.
Chronic obstructive pulmonary disease (COPD) is one of the leading causes of morbidity and mortality worldwide. Although considerable advances have been made in the diagnosis and treatment of COPD, much remains to be done both to alleviate symptoms and reduce mortality associated with this condition. Previously, diagnosis, management, and research all centred on staging based on the forced expiratory flow in 1 second. ⋯ These allow for more options for individualized care of patients. In addition, new applications of old medications, such as long‑term antibiotics, also provide new options for patients struggling with recurrent symptoms. Finally, the growing awareness that this is a heterogeneous disease composed not only of differing phenotypes but also having significant extrapulmonary comorbidities have opened new avenues of research and interdisciplinary collaboration that will further enable us to offer personalized care to patients.