Polskie Archiwum Medycyny Wewnętrznej
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Pol. Arch. Med. Wewn. · Feb 2020
ReviewHypertensive kidney disease: a true epidemic or rare disease?
In the industrialized world, hypertension affects approximately 30% of the general population. Hypertensive kidney disease is considered one of the consequences of long-term and poorly controlled hypertension. According to renal databases, it is a leading cause of end‑stage renal failure, second only to diabetic kidney disease. ⋯ Studies of the morphology of kidney biopsies have indicated that arterionephrosclerosis, classically considered a morphological equivalent of the clinical term "hypertensive kidney disease"(previously referred to as "hypertensive nephropathy"), most commonly superimposes upon variable chronic renal diseases, even in the absence of elevated blood pressure. To date, no prospective controlled clinical trials have been conducted in primary hypertension patients with renal events as primary endpoints. Data from available clinical trials with renal events that serve as secondary endpoints suggest that lowering blood pressure below current targets may provide additional cardiovascular benefits but may be harmful to the kidneys.
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Pol. Arch. Med. Wewn. · Feb 2020
ReviewAspirin for primary cardiovascular prevention: why the wonder drug should not be precipitously dismissed.
Primary cardiovascular prevention is the combined set of actions aimed at reducing the likelihood of symptomatic atherosclerotic disease or major adverse cardiovascular events (MACEs) in currently asymptomatic individuals. Older studies on aspirin for primary prevention were positive or neutral as to the primary ischemic endpoint (often represented by MACE), but the reduction in nonfatal ischemic events seemed largely counterbalanced by an increase in bleeding events. The 3 latest large randomized controlled trials on aspirin in primary prevention, all published in 2018, reached basically similar conclusions, leading to an intense debate on whether aspirin therapy is warranted in asymptomatic patients and whether there are subgroups that may benefit. ⋯ Based on a meta‑regression of the benefits and harm of aspirin therapy in primary prevention as a function of the 10‑year risk of MACE, which is an alternative type of pooled analysis of available evidence, we propose a treatment algorithm acknowledging differences among patients and emphasizing the need for an individualized assessment of benefits and risks. Following general preventive measures (physical exercise, smoking cessation, treatment of hypertension and hypercholesterolemia, etc), a tailored approach to aspirin prescription is warranted. When patients are younger than 70 years of age, clinicians should assess the 10‑year cardiovascular risk: when such risk is high and bleeding risk is low, aspirin treatment should still be considered, also taking patients' preferences into account.
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Pol. Arch. Med. Wewn. · Feb 2020
Comparative StudyComparison of clinicopathological features in patients with noninvasive follicular thyroid neoplasm with papillary-like nuclear features and follicular variant papillary thyroid cancer.
Noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) is a newly defined entity accepted as a tumor precursor. ⋯ We suggest that patients diagnosed with NIFTP according to the new classification are considered lowrisk, and margin characteristics of the nodule detected on preoperative ultrasonography may be helpful in the differential diagnosis.
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Pol. Arch. Med. Wewn. · Feb 2020
Comparative StudyAutologous stem cell transplantation in the treatment of multiple myeloma with 17p deletion.
Deletion of chromosome 17p [del(17p)] in patients with multiple myeloma is associated with a poor prognosis. High‑dose chemotherapy followed by autologous stem cell transplantation (ASCT) remains the standard of treatment in this population. ⋯ Patients with multiple myeloma with del(17p) do not benefit from high‑dose chemotherapy followed by ACST.