Via Medica Journals
Not a member yet
55128 research outputs found
Sort by
Rola i zadania dietetyka w kompleksowej opiece nad pacjentem z przewlekłą chorobą nerek
No full textChronic kidney disease (CKD) represents a significant clinical challenge; wherein dietary modifica-tion constitutes an essential component of therapy. A clinical dietitian develops and modifies the nutritional plan according to the stage of the disease, comorbidities, and laboratory results, which allows for slowing the progression of CKD and improving patients’ quality of life. The primary objec-tives of dietary intervention include: controlling protein intake, managing electrolyte disturbances (phosphorus, potassium, sodium), and preventing protein-energy wasting. Currently, the impor-tance of a low-protein diet and a diet with a predominance of plant-based proteins is emphasized. The dietitian also plays a crucial role in the care of patients using keto-analogues of amino acids in conjunction with a very low-protein diet. Psychodietetic aspects — such as providing support, motivation, and identifying barriers — are very important in the context of treatment adherence. In summary, a renal dietitian is responsible for coordinating nutritional therapy, mitigating complica-tions, and collaborating within an interdisciplinary team, which contributes to improved treatment outcomes and enhances cost-effectiveness.Przewlekła choroba nerek (PChN) stanowi poważne wyzwanie kliniczne. Istotnym elementem terapii jest modyfikacja diety — dietetyk kliniczny opracowuje i modyfikuje plan żywieniowy zależnie od stadium choroby, schorzeń współwystępujących i wyników badań, co spowalnia progresję PChN oraz poprawia jakość życia pacjentów. Główne cele interwencji dietetycznej to: kontrola podaży białka, regulacja zaburzeń elektrolitowych (fosfor, potas, sód) oraz zapobieganie niedożywieniu białkowo-energetycznemu. Aktualnie podkreśla się znaczenie diety niskobiałkowej oraz diety z prze-wagą białek pochodzenia roślinnego. Dietetyk pełni także kluczową rolę w opiece nad pacjentami stosującymi ketoanalogi aminokwasów wraz z dietą niskobiałkową. Bardzo ważne w kontekście przestrzegania zaleceń są aspekty psychodietetyczne — wsparcie, motywowanie i identyfikacja barier. Dietetyk nefrologiczny odpowiada więc za koordynację terapii żywieniowej, ograniczanie powikłań oraz współpracę w ramach zespołu interdyscyplinarnego, co sprzyja poprawie wyników leczenia i zwiększa efektywność kosztową
Znaczenie i rola interwencji żywieniowej we wspomaganiu leczenia ran przewlekłych w onkologii
No full textChronic wounds present a therapeutic challenge, and their treatment is a long-term process that requires the involvement of both medical staff and the patient. Chronic wounds in oncology are par-ticularly difficult, including complications after radiotherapy, malignant wounds, and postoperative wounds in malnourished patients. Nutritional intervention is one of the key elements in supporting the treatment of chronic wounds, especially in oncology, where malnutrition is a significant issue that slows healing, weakens immunity, and increases the risk of infection. Adequate protein intake, supplementation with amino acids (arginine, glutamine), vitamins (A, C, D), trace elements (zinc, selenium), and omega-3 fatty acids is essential in the wound-healing process, as these components influence collagen synthesis, tissue regeneration, and immune response. Nutritional strategies include oral nutrition, and when oral intake is not possible — enteral nutrition (via a feeding tube or surgically created access to the gastrointestinal tract) or parenteral nutrition. Long-term protein malnutrition and the stress associated with chronic illness can lead to a catabolic state in which the body uses energy derived from muscle tissue, thereby impairing healing. The treatment of chronic wounds is a complex process that requires collaboration among specialists from various fields and a multidimensional approach, including appropriate nutritional intervention.Rany przewlekłe stanowią wyzwanie terapeutyczne, a ich leczenie jest procesem długotrwałym, wymagającym zaangażowania personelu medycznego i pacjenta. Szczególnie trudne są rany przewlekłe w onkologii, w tym powikłania po radioterapii, owrzodzenia nowotworowe czy rany pooperacyjne u pacjentów niedożywionych. Interwencja żywieniowa jest jednym z kluczowych elementów we wspomaganiu leczenia ran przewlekłych, szczególnie w onkologii, gdzie niedożywienie jest istotnym problemem, spowalniającym gojenie, osłabiającym odporność i zwiększającym ryzyko infekcji. Prawidłowa podaż białka oraz suplementacja aminokwasów (argininy, glutaminy), witamin (A, C, D), mikroelementów (cynku, selenu) i kwasów omega-3 są niezbędne w procesie gojenia ran — wpływają na syntezę kolagenu, regenerację tkanek i odpowiedź immunologiczną. Strategie żywieniowe obejmują żywienie doustne, a w przypadku braku możliwości jego przeprowadzenia — żywienie dojelitowe (przez zgłębnik lub wytworzony sztuczny dostęp do przewodu pokarmowego) lub pozajelitowe. Długotrwałe niedożywienie białkowe i stres związany z przewlekłą chorobą mogą prowadzić do stanu katabolicznego, w którym organizm zużywa energię z mięśni, utrudniając gojenie. Leczenie ran przewlekłych jest procesem złożonym, wymagającym współpracy specjalistów z różnych dziedzin oraz interwencji wielopłaszczyznowej, w tym odpowiedniej interwencji żywieniowej
Air embolism resulting from atrioesophageal fistula following thoracoscopic atrial fibrillation ablation
Get PDFIwosydenib w leczeniu chorych na raka dróg żółciowych z obecnością mutacji IDH1 – dane z rzeczywistej praktyki medycznej – badanie wieloośrodkowe.
No full textIntroduction. Cholangiocarcinoma, especially in the advanced stage, is a disease with poor prognosis despite significant progress in the treatment of cancer patients in recent years. Using new therapies, such as immunotherapy and molecular targeted therapy, may improve the prognosis in this group of patients. This publication presents a multicenter analysis of a Polish research group, including ivosidenib in the treatment of patients with cholangiocarcinoma with IDH1 mutation in the second-fourth lines in salvage access to drug therapy (RDTL, ratunkowy dostęp do technologii lekowych).
Material and methods. The study included patients with unresectable or metastatic CCA with an IDH1 mutation who started treatment with ivosidenib between 01/08/2023 and 31/07/2024 within the RDTL program at ten tertiary oncology centers in Poland.
Results. The study included 13 patients with unresectable or metastatic cholangiocarcinoma with IDH1 mutation, who were treated with ivosidenib, including second-line patients — 2 patients (15%), third-line patients — 10 patients (77%), and fourth-line patients — 1 patient (8%). The estimated median PFS and OS rates from the start of ivosidenib treatment were 2.5 and 6.3 months, respectively, while the median OS rate from the start of systemic therapy for the study group was 20 months. The median duration of treatment with ivosidenib was 2.6 months (range 1.0–13.9 months), and 4 (31%) patients continued therapy. Grade 3 adverse events during ivosidenib therapy were observed in 3 (23%) patients. There were no grade 4 adverse events or deaths related to ivosidenib.
Conclusions. The study confirmed the efficacy and safety of ivosidenib in patients with advanced cholangiocarcinoma with IDH1 mutation.Pomimo znacznego postępu, jaki nastąpił w ostatnich latach w leczeniu chorych na nowotwory, rak dróg żółciowych, szczególnie w stadium zaawansowanym, pozostaje w dalszym ciągu chorobą o złym rokowaniu. Wydaje się, że zastosowanie nowoczesnych terapii, jak immunoterapia oraz leczenie ukierunkowane molekularnie, może przynieś poprawę rokowania w tej grupie chorych. W prezentowanej pracy przedstawiono analizę wieloośrodkową polskiej grupy badawczej dotyczącej leczenia chorych na raka dróg żółciowych z mutacją IDH1 leczonych iwosydenibem w II-IV linii leczenia w ramach ratunkowego dostępu do terapii lekowej (RDTL). Do badania włączono 13 chorych na nieoperacyjnego lub przerzutowego CCA z mutacją IDH1, którzy otrzymali leczenie iwosydenibem, w tym w II linii - 2 chorych (15%), III linii - 10 chorych (77%) i IV linii - 1 chory (8%). Estymowane mediany PFS i OS od momentu rozpoczęcia leczenia iwosydenibem wyniosły odpowiednio 2,5 i 6,3 miesiąca, natomiast mediana OS od początku terapii systemowej dla całej badanej grupy wyniosła 20 miesięcy. Mediana czasu leczenia iwosydenibem wyniosła 2,6 miesiąca (zakres 1,0-13,9 miesiąca), 4 (31%) chorych kontynuuje terapię. Działania w stopniu 3 w trakcie terapii iwosydenibem zanotowano u 3 (23%) chorych. Nie zanotowano działań niepożądanych w stopniu G4 ani zgonów związanych ze stosowaniem iwosydenibu. W badaniu potwierdzono skuteczność i bezpieczeństwo iwosydenibu u chorych na zaawansowanego raka dróg żółciowych z mutacją IDH1
Koenzym Q10 w niewydolności serca – przegląd literatury i badań klinicznych
No full textCoenzyme Q10, or ubiquinone, is an over-the-counter dietary supplement. It is a fat-soluble molecule that acts as an electron carrier in mitochondria and as a coenzyme for mitochondrial enzymes. Coenzyme Q10 deficiency may be associated with a number of diseases, including heart failure. The severity of heart failure correlates with the severity of coenzyme Q10 deficiency. Emerging evidence suggests that the harmful effects of reactive oxygen species are increased in people with heart failure, and coenzyme Q10 may help reduce these toxic effects, partly because of its antioxidant activity. Available evidence suggests that coenzyme Q10 has the potential to be a clinically effective and cost-effective agent for heart failure and to play an important role in further optimizing therapyKoenzym Q10, czyli ubichinon, to suplement diety dostępny bez recepty. Jest rozpuszczalną w tłuszczach cząsteczką, która działa jako nośnik elektronów w mitochondriach i jako koenzym dla enzymów mitochondrialnych. Niedobór koenzymu Q10 może być związany z wieloma chorobami, w tym niewydolnością serca. Nasilenie niewydolności serca koreluje z nasileniem niedoboru koenzymu Q10. Nowe dane sugerują, że szkodliwe działanie reaktywnych form tlenu jest zwiększone u osób z niewydolnością serca, a koenzym Q10 może pomóc w zmniejszeniu tych toksycznych efektów m.in. ze względu na swoją aktywność antyoksydacyjną. Dostępne dowody sugerują, że koenzym Q10 ma potencjał, aby być środkiem klinicznie skutecznym i opłacalnym w przypadku niewydolności serca oraz odgrywającym istotną rolę w dalszej optymalizacji terapi
Premeal Load of Macronutrients as an Effective Nutritional Strategy to Control Postprandial Glycemia
Get PDFObjective: Effective glycemic management is of paramount importance for individuals with prediabetes and type 2 diabetes (T2D). Specifically, controlling postprandial hyperglycemia (PPHG) appears to be a significant factor in regulating blood glucose levels, especially in the early stages of T2D. Consequently, controlling PPHG becomes a crucial goal in managing diabetes to mitigate the development of diabetic macrovascular disease. In this review, we aim to examine the existing body of evidence regarding premeal load and its impact on glucose disturbances in humans. Materials and methods: We scrutinize the role of proteins, fats, dietary fiber, fructose, and edible nuts such as almonds, in their capacity to influence postprandial glucose excursions. To identify articles investigating the effects of premeal load on glycemia, we conducted a comprehensive literature search using the PubMed medical search database (National Library of Medicine, Bethesda, MD, USA) from 1966 to August 2023. Results: The incorporation of these nutrients as premeal load components in conventional dietary regimens stands as an effective strategy to decrease postmeal blood glucose levels and, in some cases, restore glycemic homeostasis to a normative state. These favorable outcomes can be attributed to alterations in gastric emptying kinetics, modulation of incretin hormones, and dynamic interactions with the gut microbiota. Conclusions: The customization of dietary patterns to encompass these components as premeal load holds the promise for glycemic regulation, particularly among high-riskpopulations, such as individuals of Asian Indian descent, who are disproportionatelysusceptible to prediabetes and T2D
Attitudes and experiences about medical cannabis in palliative care patients and caregivers in Thailand: a qualitative study
Get PDFBackground: Although cannabis has been introduced to alleviate symptoms in palliative care patients for decades, research on the attitudes and experiences of patients and their caregivers regarding its use remains limited. This qualitative study explores their perspectives on this newly legalized treatment option.
Methods: A purposive sample of 20 participants (12 patients, 8 caregivers) visiting cannabis or palliative clinics (May–November 2023) were interviewed face-to-face using semi-structured questions. Interviews were recorded, transcribed, and analyzed thematically until saturation was reached. Triangulation techniques ensured data credibility.
Results: Six major themes were identified: 1) attitudes toward medical cannabis, with some viewing it as medicine and others as an illegal drug; 2) reasons for medical cannabis use, mostly used for symptom relief, with some hoping to cure diseases; 3) sources of information, from cannabis users, healthcare providers, and the internet; 4) issues of support, family and physicians being a major role influencing patients’ decisions to use cannabis; 5) barriers, access being impeded by the perspectives of some physicians and social judgment; and 6) medical outcome perception, effects of medical cannabis varied considerably between individuals.
Conclusions: While some patients and their caregivers consider medical cannabis as an alternative drug, concerns about social judgment, attitudes about illegal drugs, safety concerns, and a reluctance among healthcare providers to discuss or recommend cannabis, remain barriers to access. Information from this study could in part be used for healthcare professionals to consider the use of cannabis in these patients
Anatomy of the lymphatics in normal stomach and gastric carcinomas
Get PDFThe lymphatic system is composed of lymphoid organs/tissues and a complex network of lymphatic vessels that transport interstitial fluid, antigens, lipids, immune cells, and other materials in the body. There is growing evidence that lymphatic vasculature is associated with many pathological conditions such as lymphoedema and cancer progression and metastasis. Thus, improved understanding of the anatomical features, the molecular profile, and the function of the lymphatic vasculature may provide innovative approaches for disease prevention and treatment. This article aims to present a comprehensive review of the gastric lymphatic anatomy and its importance in the pathology, treatment, and prognosis of gastric carcinomas
Unusual anatomical variants of infrahyoid muscles — a case report
Get PDFAnatomical anomalies of neck muscles are rarely observed, and usually comprise variations of digastric and omohyoid muscles. Neck muscle abnormalities are sometimes correlated with embryological development and are observed in individuals with aneuploidies such as Edwards’ syndrome (18-trisomy) or Down’s syndrome (21-trisomy). Some infrahyoid muscles are important landmarks during surgery, and therefore the anatomical variations of these muscles are related to a higher risk of surgical complications. Below, we present a rare case of infrahyoid muscle anomalies found during routine dissection of a male cadaver. Redundant muscle bellies of sternohyoid muscle (sternohyoid azygos muscle), the presence of levator glandulae thyroideae and also one hypoplastic superior belly of the omohyoid muscle were observed. The presence of muscle fibres within the found structures was confirmed using Masson’s trichrome staining method
Assessment of atrial and ventricular mitral annular disjunction using cardiac computed tomography
Get PDFBackground: Mitral annular disjunction (MAD) is a spatial displacement of the leaflet hinge line towards the left atrium (a-MAD) or the left ventricle (v-MAD).Aims: We sought to determine morphological characteristics of MAD types along the mural mitral leaflet and commissures using cardiac computed tomography (CT) imaging.Methods: CT images from 250 adult patients were analyzed. A three-dimensional reconstruction of the left atrial wall-mitral annulus-left ventricular wall junction was performed to detect MADs and their measurements.Results: a-MADs were identified in 25.6% of patients (12.8% of mural leaflets and 14.0% mitral commissures), while v-MAD in 27.6% of patients (23.6% of mural leaflets and 4.8% mitral commissures). Notably, the P2 scallop was the most common site for both a-MAD (10.8%) and v-MAD (22.4%). The median disjunction height and length were larger for MADs located in leaflets than for commissures (all P <0.001). No significant sex-based disparities in the presence of both a-MADs and v-MADs were found. Patients with a-MAD were younger (P = 0.006) in comparison to the v-MAD and no-MAD groups. There were no differences in the body mass index, body surface area, and comorbidities across the study groups (all P >0.05).Conclusions: Cardiac CT emerges as a reliable tool for the precise detection and assessment of MADs, which are relatively frequent variations in the structure of the mitral valve annulus. MADs are typically sectional and do not extend beyond one of the mural mitral leaflet scallops or commissures. Further investigations are warranted to establish the clinical implications of a-MADs and v-MADs