Vnitr̆ní lékar̆ství
-
Obesity (esp. abdominal type) was still considered as a risk factor for cardiovascular disease. During the last decade has a new phenomenon appeared: "obesity paradox", i.e. patients with high BMI die less frequently than patients with low BMI. ⋯ In comparison with population studies, BMI associated with low cardiovascular mortality in patients with Type 2 diabetes is shifted to the higher level than in subjects from general population. Mechanisms of obesity paradox is not yet clarified.
-
Obstructive sleep apnoea syndrome (OSA) is a disease very frequently occurring in people with type 2 diabetes, that significantly increases cardiovascular morbidity and mortality. In a number of studies, OSA has been identified as an independent risk factor for the development of insulin resistance, glucose intolerance and type 2 diabetes mellitus. Disorders of glucose homeostasis in patients with OSA are probably mediated by chronic intermittent hypoxia and/or sleep fragmentation through activation of the sympathetic nervous system, the hypothalamic-pituitary-adrenal stress axis, pro-inflammatory paths or oxidative stress. ⋯ Active OSA screening should therefore be performed in all patients with type 2 diabetes, ideally through home monitoring of oxygen saturation and breathing during sleep. Although the effect of CPAP therapy on the improvement in diabetes control (decrease in glycated hemoglobin) has not been clearly proven in patients with type 2 diabetes so far, promising outcomes have been observed during the treatment of patients with prediabetes. Key words: CPAP - diabetes mellitus - glycemic control - intermittent hypoxia - obstructive sleep apnoea - screening - sleep fragmentation.
-
Vnitr̆ní lékar̆ství · Jan 2016
Randomized Controlled Trial[The SPRINT Research. A Randomized Trial of Intensive versus Standard Blood-Pressure Control].
The most appropriate targets for systolic blood pressure to reduce cardiovascular morbidity and mortality among persons without diabetes remain uncertain. ⋯ Among patients at high risk for cardiovascular events but without diabetes, targeting a systolic blood pressure of less than 120 mm Hg as compared with less than 140 mm Hg, resulted in lower rates of fatal and nonfatal major cardiovascular events and death from any cause, although significantly higher rates of some adverse events were observed in the intensive-treatment group. Funded by the National Institutes of Health.
-
The paper describes specific aspects of work of a scientific expedition doctor and the stay and life at a polar research station in Antarctica. Apart from the outline of everyday problems, the first named author also learns about the history of medical practitioners working in Antarctica, writes about the results of the biomedical research activities conducted in the period of 2011-2014 and briefly describes the daily routine at a scientific polar station in Antarctica.
-
Vnitr̆ní lékar̆ství · Dec 2015
Randomized Controlled Trial[PATHWAY-2 Study: spironolactone vs placebo, bisoprolol and doxazosin to determine optimal treatment of resistant hypertension. Spironolactone high effective in lowering blood pressure in drug resistant hypertension].
The PATHWAY-2 study, funded by the British Heart Foundation, randomised 335 patients with resistant hypertension (already treated according to guidelines) to sequentially receive 12 weeks of spironolactone (25-50 mg), bisoprolol (5-10 mg), doxazosin (4-8 mg modified release) and placebo. The study design allowed drug comparisons in each patient, with 230 patients completing all cycles. ⋯ By the end of the trial, there would only be 15 patients considered eligible for renal denervation trials in uncontrolled hypertension. PATHWAY-2 will have significant implications for patient recruitment in to other trials.