Polskie Archiwum Medycyny Wewnętrznej
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Pol. Arch. Med. Wewn. · Apr 2019
ReviewRole of gestational weight gain, gestational diabetes, breastfeeding, and hypertension in mother-to-child obesity transmission.
Given the reported 30% prevalence of early-life obesity in the Western world, the nongenetic, maternally derived risk factors for excess body mass in offspring have been widely investigated recently. This review article aimed to analyze the results of 67 articles published from 2014 onwards that investigated causative non-genetic-based associations between maternal and infantile excess body mass. Excessive gestational weight gain was found to increase the incidence of excess body mass in offspring, reaching nearly 20% at 2 years of age. ⋯ Their occurrence should be monitored and prevention of these factors should become the principal aim of obesity prevention programs for children. Occurrence of these factors may justify intense screening to diagnose early stages of metabolic disorders in offspring, even in adulthood. Further large-scale studies are warranted to draw a firm conclusion.
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Pol. Arch. Med. Wewn. · Apr 2019
ReviewA review of menopausal hormone therapy: recalibrating the balance of benefit and risk.
While menopausal hormone therapy (MHT) was initially marketed to women of menopausal age to prolong youth, it has endured a tumultuous history evaluating the risk-to-benefit ratio. In response to evidence that MHT may confer cardioprotective effects, 2 landmark randomized controlled trials tested this hypothesis, and both were stopped prematurely due to increased incident cancers and cardiovascular events, creating much controversy and confusion. As women and physicians grew reticent to use MHT, most symptomatic menopausal women remained untreated. ⋯ Most recently, the 18-year follow-up data of postmenopausal women in the Women's Health Institute trial did not show any change in long-term survival associated with the use of MHT at any age. More recent studies have evaluated alternative treatments for high-risk women, including lower doses and newer formulations of MHT, along with combined new therapies such as selective estrogen receptor modulators, antidepressants, and exercise therapies, which are effective in reducing vasomotor symptoms and improving menopause-specific quality of life. These alternatives provide new options to symptomatic women who are unable or unwilling to take conventional MHT and allow for more person-centered decision making strategies to support women through the menopause.
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Pol. Arch. Med. Wewn. · Apr 2019
Multicenter StudyAssociation of intrarenal blood flow with renal function and target organ damage in hypertensive patients with fibromuscular dysplasia: the ARCADIA-POL study.
INTRODUCTION Data on the assessment of intrarenal blood flow parameters in patients with renal fibromuscular dysplasia (FMD) are scarce. OBJECTIVES The aim of the study was to evaluate intrarenal blood flow parameters in patients with FMD and significant or nonsignificant renal artery stenosis (RAS). PATIENTS AND METHODS We evaluated intrarenal blood flow parameters by Doppler ultrasonography in 153 patients with renal FMD enrolled in the ARCADIA‑POL study: 32 and 121 patients with and without significant RAS, respectively, compared with 60 matched patients with essential hypertension and 60 healthy controls. ⋯ In patients with significant RAS, there was a significant correlation between RRI and known duration time of hypertension, left ventricular diastolic function, and age. In a separate, "per‑kidney" analysis, renal arteries with FMD and significant RAS were characterized by lower RRI values, higher maximal blood flow velocity, higher renal aortic ratio, and longer acceleration time compared with renal arteries with FMD and nonsignificant RAS as well as renal arteries without FMD. CONCLUSIONS In contrast to atherosclerotic RAS, intrarenal blood flow in patients with FMD and RAS is preserved, confirming that renal vasculature is relatively intact in these patients.
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Pol. Arch. Med. Wewn. · Apr 2019
Early chemotherapy de-escalation strategy in patients with advanced-stage Hodgkin lymphoma with negative positron emission tomography scan after 2 escalated BEACOPP cycles.
INTRODUCTION Escalated BEACOPP (escBEACOPP: bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, prednisone) significantly improves overall response rates (ORRs) and prolongs progression‑free survival (PFS) in patients with advanced‑stage Hodgkin lymphoma (HL). However, 6 to 8 cycles of escBEACOPP are associated with increased acute toxicity and late complications. OBJECTIVES We aimed to determine the role of early positron emission tomography-computed tomography (PET‑CT) response assessment in a de‑escalation strategy. ⋯ In the whole cohort, ORR was 87.8% (CR, 85.6%), while the 10‑year PFS and OS were 79.3% and 89.4%, respectively. Hematological and thromboembolic complications were significantly more frequent in patients treated with 6 escBEACOPP cycles, including febrile neutropenia (25 patients, [53.2%] vs 7 [5%]), serious anemia (35 [74.5%] vs 11 [7.8%]), or thrombocytopenia (16 [34%] vs 7 [5%]) (P <0.001 for all comparisons with de‑escalation strategy) as well as pulmonary embolism (3 [6.4%] vs 0) (P = 0.02). CONCLUSIONS The early de‑escalation strategy allows for effective treatment of advanced HL, with a comparable efficacy to that of 6 to 8 cycles of escBEACOPP, but with significantly reduced toxicity.
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Pol. Arch. Med. Wewn. · Apr 2019
End-of-life care for patients with advanced lung cancer and chronic obstructive pulmonary disease: survey among Polish pulmonologists.
INTRODUCTION There is evidence that people with nonmalignant disease receive poorer end‑of‑life (EOL) care compared with people with cancer. OBJECTIVES The aim of the study was to assess the selected aspects of symptomatic treatment and communication between physicians and patients diagnosed with either advanced chronic obstructive pulmonary disease (COPD) or lung cancer. METHODS A questionnaire survey was conducted online among members of the Polish Respiratory Society. ⋯ CONCLUSIONS Patients with COPD, as compared with patients with lung cancer, were less frequently treated with opioids to relieve chronic breathlessness or referred for a PC consultation. Discussing the EOL issues with a patient was generally found challenging by physicians, and most often pursued with caregivers instead. The COPD recommendations on PC may prove helpful in providing better EOL care by pulmonologists.