Polskie Archiwum Medycyny Wewnętrznej
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Pol. Arch. Med. Wewn. · Dec 2020
Periprocedural management of patients on oral anticoagulation: focus on regional anesthesia.
The management of anticoagulant medications in patients undergoing regional anesthesia procedures remains an evolving topic. As with all procedures, the goal is to maintain balance between bleeding and thrombotic risks when interrupting oral anticoagulants. ⋯ For neuraxial anesthesia and deep plexus and peripheral nerve blocks, a lower volume bleed in an enclosed deep noncompressible area can result in transient or permanent neuronal damage. Differences exist between current guidelines for the management of oral anticoagulants, likely due to patient anatomy, practitioner experience, and standardized use of imaging modalities for different procedures.
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Pol. Arch. Med. Wewn. · Dec 2020
ReviewAcute kidney injury, its definition, and treatment in adults: guidelines and reality.
In the last decades, a lot of research has been done to improve our understanding of acute kidney injury (AKI) as well to standardize its diagnostic criteria. As a result of many years of work of intensivists and nephrologists, consensus definitions were established, finally unified in 2012 by the Kidney Disease: Improving Global Outcomes (KDIGO) group. ⋯ The present review covers issues discussed during the KDIGO controversy conference, devoted to AKI. Here, we attempted to answer 3 main questions: Is the KDIGO definition of AKI valuable in clinical research and global epidemiology? Is it helpful in everyday clinical practice? Is it useful in the treatment of critically ill patients with AKI?
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Pol. Arch. Med. Wewn. · Dec 2020
Long-term results of 11,021 patients with chronic coronary syndrome and after coronarography (from the PRESAGE Registry).
There is a paucity of real‑world registries concerning patients with chronic coronary syndromes (CCS). ⋯ The PRESAGE registry provides valuable information about the clinical characteristics and long‑term outcomes of patients with CCS. The population of CCS patients is heterogeneous, and long‑term prognosis is also varied. The poorest characteristics and outcomes were reported in patients with significant lesions and ineligible for revascularization procedures.
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Pol. Arch. Med. Wewn. · Dec 2020
Atrial fibrillation is more frequently associated with non-obstructive coronary lesions: The Bialystok Coronary Project.
Atrial fibrillation (AF) and chronic coronary syndrome (CCS) share common risk factors and frequently coexist. Additionally, AF symptoms may mimic CCS. ⋯ In our study, AF was associated with the absence of significant coronary lesions on angiography, reflecting difficulties with qualifying patients with AF for invasive CCS diagnostic workup. Our findings suggest the need for more efficacious noninvasive diagnostic approach for patients with AF and suspected CCS.
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Pol. Arch. Med. Wewn. · Dec 2020
Observational StudyAn elevated liver fibrosis index FIB 4 score is associated with poor clinical outcomes in patients with sepsis: an observational cohort study.
So far, no study has investigated the association between subclinical hepatic fibrosis and sepsis, especially in terms of prognosis. ⋯ The FIB‑4 index is associated with 28‑day, 90‑day, and in‑hospital mortality as well as with renal replacement therapy in septic patients without overt chronic liver disease. In other words, an advanced stage of subclinical hepatic fibrosis as represented by the FIB‑4 score indicates poor outcomes in patients with sepsis.