Polskie Archiwum Medycyny Wewnętrznej
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Pol. Arch. Med. Wewn. · Nov 2023
ReviewConsistency assessment and visualization on recommendations for gastroesophageal reflux disease: a scoping review of clinical practice guidelines.
Gastroesophageal reflux disease (GERD) is a highly prevalent gastrointestinal disorder that causes diverse esophageal and extraesophageal symptoms. Many clinical practice guidelines (CPGs) have been issued around the world to provide practical evidence regarding GERD management. However, some of the recommendations discussed in various CPGs are inconsistent across individual documents. ⋯ Most CPG recommendations regarding GERD were consistent in direction, except for 5 discrepancies, for which further well‑designed, large‑scale research is required to explain the inconsistency.
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Pol. Arch. Med. Wewn. · Nov 2023
Determinants of body weight changes during COVID-19 pandemic in older urban residents.
COVID‑19 pandemic is associated with unfavorable body weight changes. However, little is known about these changes in older individuals, a particularly vulnerable group with limited representation in both direct and online research. ⋯ Most people with a change in their body weight gained weight due to unfavorable lifestyle modifications, but the history of COVID‑19, especially hospitalization, was a strong determinant of body weight loss.
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Pol. Arch. Med. Wewn. · Nov 2023
Influence of diabetes mellitus on the invasive assessment of myocardial ischemia in patients with coronary artery disease.
Current guidelines recommend physiological evaluation of borderline coronary artery stenoses using hyperemic (fractional flow reserve [FFR]) and nonhyperemic (instantaneous wave‑free ratio [iFR] and resting full‑cycle ratio [RFR]) methods. However, comorbidities, such as diabetes mellitus (DM), may influence the results of the assessment. ⋯ The rate of FFR and iFR/FFR discordance was similar regardless of the diabetes status, and insulin‑treated DM was associated with an increased risk of negative FFR and positive iFR/RFR discordance.
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Pol. Arch. Med. Wewn. · Nov 2023
D-dimer in diagnosis and prevention of venous thrombosis: recent advances and their practical implications.
D‑Dimers derive from degradation of cross‑linked fibrin by plasmin, and thus their level is a marker of coagulation and fibrinolytic system activation. Guidelines recommend that D‑dimers are determined if the pretest probability (PTP) is low or intermediate, to exclude venous thromboembolism (VTE), either deep vein thrombosis or pulmonary embolism, and to avoid imaging tests. If the PTP is high or D‑dimer level is above the suggested thresholds, imaging is recommended. ⋯ As a result, there have been several proposals to improve the diagnostic accuracy of D‑dimer levels by adjusting the cutoffs according to patient characteristics, such as age, PTP, pregnancy, renal function, or cancer. D‑Dimer levels can also predict clinical severity of COVID‑19, and escalated anticoagulation based on D‑dimer levels can be associated with a lower risk of mortality in patients with severe COVID‑19. Finally, D‑dimer levels have been incorporated in prediction models for recurrent VTE to help identify patients who may benefit from prolonged anticoagulation.