Polskie Archiwum Medycyny Wewnętrznej
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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.
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Pol. Arch. Med. Wewn. · Jan 2012
ReviewTroponin T level and mortality risk after noncardiac surgery: practical implications of the VISION study.
This review article presents the current state of knowledge about major perioperative cardiovascular complications in noncardiac surgery patients and the role of the currently available stratification models and biomarkers in risk prediction. The authors discuss a recent paper presented by the VISION Investigators in the June edition of the Journal of the American Medical Association and its practical implications in day-to-day perioperative practice. ⋯ One in 25 patients with a peak fourth generation troponin T (TnT) measurement of 0.02 μg/l, 1 in 11 patients with a peak TnT measurement of 0.03 to 0.29 μg/l, and 1 in 6 patients with a peak TnT measurement of 0.30 μg/l or higher will die within 30 days of surgery. Postoperative monitoring of TnT measurements substantially improves risk stratification after noncardiac surgery and may help identify patients requiring further therapeutic interventions.
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Pol. Arch. Med. Wewn. · Jan 2012
ReviewAntiplatelet therapy beyond 2012: role of personalized medicine.
Since its first approval in 1997, clopidogrel has revolutionized interventional cardiology and transformed therapy for non‑ST‑segment elevation myocardial infarction (NSTEMI), STEMI, and percutaneous coronary intervention‑treated patients. It enjoyed a remarkable 15‑year "homerun" in the world market without any major competition. With the introduction of more potent P2Y12 receptor blockers, the current antiplatelet strategy is undergoing a transition period. ⋯ The unpredictable, slow onset, and overall modest pharmacodynamic effects are the major limitations of clopidogrel. The new, more potent P2Y12 receptor blockers overcome the limitations of clopidogrel therapy and are associated with better clinical efficacy, but are more costly and associated with more bleeding. In this scenario, personalization of antiplatelet therapy based on platelet function and genetic testings to strike a balance between cost, benefit, and safety is a potential option.
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Pol. Arch. Med. Wewn. · Jan 2012
Acute kidney injury after abdominal aortic aneurysm surgery: detailed assessment of early effects using novel markers.
One of the most severe complications of repair surgery for abdominal aortic aneurysms (AAA) is acute kidney injury (AKI). Even small rises in serum creatinine after surgery are associated with increased mortality. ⋯ Elective AAA surgery may induce AKI. Novel markers can facilitate early detection of AKI, thus allowing to start therapy at an appropriate time point.