Mianowska B, Seget S, xGawrecki A
… +8 more, Cyganek K, Jarosz-Chobot P, Juza A, Klupa T, Myśliwiec M, Porada D, Szymańska-Garbacz E, Szadkowska A
Pol Arch Intern Med
· 2026 Jun · PMID 42376900
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INTRODUCTION: Automated insulin delivery (AID) systems have become a standard of care in type 1 diabetes and are increasingly used across all age groups, including during pregnancy. As their use expands, clinicians are...INTRODUCTION: Automated insulin delivery (AID) systems have become a standard of care in type 1 diabetes and are increasingly used across all age groups, including during pregnancy. As their use expands, clinicians are increasingly encountering patients using AID systems in perioperative and peripartum settings. However, guidance regarding continuation of AID therapy during procedures under anesthesia, sedation, or during labor remains limited. OBJECTIVES: This document provides practical, consensus-based recommendations for the use of AID systems during minor procedures, selected major surgeries, and throughout labor and delivery, aiming to support anesthesiologists, surgeons, and other procedural specialists, obstetric teams, and diabetes specialists in clinical decision-making. METHODS: Eleven experts in pediatric and adult diabetology, each with extensive clinical experience in managing AID users in outpatient and inpatient settings, conducted a comprehensive literature review and synthesized available evidence with collective clinical experience. RESULTS: The authors outline criteria for continuation of AID therapy during procedures, including requirements related to the patient, procedural team, and type of procedure. Detailed perioperative algorithms are provided. Recommendations for labor emphasize adjustments of AID parameters, glucose targets, and postpartum modifications. While AID continuation may be appropriate for many minor procedures and selected major surgeries, intravenous insulin therapy remains preferable in situations associated with hemodynamic instability or high metabolic risk. CONCLUSIONS: With appropriate preparation and interdisciplinary coordination, continuation of AID therapy during selected procedures and childbirth can be safe and effective, reducing glycemic variability and treatment burden. As evidence remains limited, further clinical studies are urgently needed to validate and refine these recommendations.
Pol Arch Intern Med
· 2026 Jun · PMID 42376745
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Pericarditis is the most frequent pericardial syndrome and a common cause of chest pain in emergency and cardiology practice. During the past two decades, management has moved from largely empirical anti-inflammatory tre...Pericarditis is the most frequent pericardial syndrome and a common cause of chest pain in emergency and cardiology practice. During the past two decades, management has moved from largely empirical anti-inflammatory treatment towards a mechanism-based, risk-stratified, and imaging-supported approach. Diagnosis remains clinical, based on typical chest pain, pericardial rub, electrocardiographic changes and pericardial effusion, but inflammatory biomarkers and multimodality imaging, especially cardiac magnetic resonance, increasingly support diagnostic confidence, differential diagnosis, and therapeutic decisions. For most patients with acute idiopathic or presumed viral pericarditis, aspirin or a non-steroidal anti-inflammatory drug combined with colchicine is first-line therapy, with exercise restriction and follow-up guided by symptoms and C-reactive protein. Corticosteroids should be avoided when possible or used at low-to-moderate doses only for selected indications, because they promote chronicity and recurrence in unselected cases. The major recent advance is the recognition of recurrent pericarditis as an autoinflammatory, interleukin (IL)-1-mediated disease in a substantial proportion of patients with an inflammatory phenotype. Randomized and registry data now support IL-1 inhibition (eg, anakinra or rilonacept) for corticosteroid-dependent and colchicine-resistant recurrent pericarditis, allowing rapid symptom control, withdrawal of corticosteroids, and marked reduction in recurrences. Remaining challenges include optimal treatment duration, cost and access to biologics, management of patients without overt systemic inflammation, and personalized strategies for tapering and return to activity.
Zieliński K, Kaczmarek K, Grygier M
… +9 more, Kralisz P, Strzelecki A, Grygier J, Struniawski K, Mielczarek M, Pręgowski J, Witkowski A, Demkow M, Pracoń R
Pol Arch Intern Med
· 2026 Jun · PMID 42366832
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INTRODUCTION: The hybrid strategy, defined as left atrial appendage closure (LAAC) followed by long-term anticoagulation, may be considered in patients with thromboembolic events or left atrial appendage thrombus despite...INTRODUCTION: The hybrid strategy, defined as left atrial appendage closure (LAAC) followed by long-term anticoagulation, may be considered in patients with thromboembolic events or left atrial appendage thrombus despite anticoagulation (anticoagulation failure). OBJECTIVES: To report the adoption and outcomes of the hybrid strategy. PATIENTS AND METHODS: High-volume Polish centers reported outcomes of LAAC after anticoagulation failure between 2014 and 2024. The hybrid strategy was compared with other pharmacotherapy regimens (non-hybrid) with respect to thromboembolic events, device-related thrombus (DRT), and major bleeding. RESULTS: Out of 1,625 LAAC procedures across 5 centers, 141 patients (8.7%) had a history of anticoagulation failure. The hybrid strategy was applied in n=64 (45%) and increased from none in 2014 to 80% of patients in 2024. Compared with the non-hybrid group, hybrid strategy patients received newer-generation occluders (98.4% vs 68.8%, P<0.001), had less prior bleeding (12.5% vs 35.1%, P=0.003), lower HAS-BLED scores [3 (2-3) vs 3 (2-4), P=0.008], more often had prior appendage thrombus (23.4% vs 10.4%, P=0.042) and LVEF<40% (18.8% vs 6.5%, P=0.037). During a median 1.3-year follow-up, the hybrid strategy showed greater thromboembolic risk reduction relative to CHA2DS2-VASc-predicted (91% vs 60%; annualized event rates of 1.1% vs 5.5%), and greater major bleeding risk reduction relative to HAS-BLED-predicted (100% vs 73%; annualized rates of 0.0% vs 1.7%), with similar DRT rates (6.9% vs 6.8%, P=1.000). CONCLUSIONS: The hybrid strategy after LAAC for anticoagulation failure is increasingly adopted and was associated with greater thromboembolic risk reduction compared with the standard non-hybrid strategy, without compromising the bleeding profile.
Nowacka-Ejsmont J, Bączek K, Bestry I
… +9 more, Błasinska K, Skronska P, Rozy A, Langfort R, Sobiecka M, Pujana MA, Chorostowska-Wynimko J, Miłkowska-Dymanowska J, Radzikowska E
Pol Arch Intern Med
· 2026 Jun · PMID 42284501
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INTRODUCTION: Sirolimus is the standard disease-modifying therapy for lymphangioleiomyomatosis (LAM), but long-term routine-care data integrating pulmonary, lymphatic, extrapulmonary, and biomarker outcomes remain limit...INTRODUCTION: Sirolimus is the standard disease-modifying therapy for lymphangioleiomyomatosis (LAM), but long-term routine-care data integrating pulmonary, lymphatic, extrapulmonary, and biomarker outcomes remain limited. OBJECTIVES: To assess long-term effectiveness and safety of sirolimus in routine clinical practice. PATIENTS AND METHODS: We retrospectively analyzed consecutive adults with definite LAM treated with sirolimus at a national tertiary referral center in Poland between 2010 and 2020. RESULTS: Seventy-one patients were included (70 women; 57/71 [80%] with sporadic LAM and 14/71 [20%] with TSC-associated disease). The median duration of available functional follow-up was 5.0 years [IQR, 2.0-5.0], and mean trough sirolimus concentration was 7.85 (2.36) ng/mL. Baseline chylous pleural and/or peritoneal effusions were present in 15/71 (21%), renal angiomyolipomas in 33/71 (46%), and lymphangioleiomyomas in 28/71 (39%) patients. FEV1 increased at 12 months by a median Δ of 0.03 L [IQR, -0.10 to 0.30] from baseline (n=66; P=0.03). FVC and 6-minute walk distance also improved during early follow-up, while TLCO remained generally stable. Chylous effusions resolved in all affected patients by 12 months without recurrence, and renal angiomyolipoma and lymphangioleiomyoma volumes decreased significantly in patients with paired MRI measurements. Higher baseline VEGF-D was associated with lymphatic involvement, and VEGF-D decreased during treatment. Adverse events were mostly mild; permanent discontinuation occurred in approximately 6%. CONCLUSIONS: In routine practice, sirolimus was associated with long-term stabilization of lung function, marked improvement of lymphatic disease, reduction of angiomyolipoma burden, and acceptable tolerability. VEGF-D aligned with lymphatic phenotype and declined with treatment, supporting its role as a monitoring biomarker.
Andreotti F, Balaji AN, Cappannoli L
… +3 more, Megaro L, Landi F, Burzotta F
Pol Arch Intern Med
· 2026 Jun · PMID 42274170
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Direct oral anticoagulants (DOACs) have been available since 2008, boosting appropriate anticoagulation and reducing intracranial hemorrhages compared to warfarin therapy. For older patients with atrial fibrillation (AF)...Direct oral anticoagulants (DOACs) have been available since 2008, boosting appropriate anticoagulation and reducing intracranial hemorrhages compared to warfarin therapy. For older patients with atrial fibrillation (AF) and comorbidities, however, decisions on DOAC therapy may be challenging. In frail, stable-on-warfarin patients, the FRAIL-AF trial reported increased relevant bleeding with DOAC switching. However, subsequent individual patient-data analyses of the four pivotal DOAC-versus-warfarin AF trials confirmed overall advantages of DOACs over warfarin even among older, frail, warfarin-experienced individuals. Advanced age should not exclude the use of any DOAC for AF, but care is needed to adjust the doses, when indicated, particularly by renal function. All DOACs undergo variable renal clearance and, in Europe, a creatinine clearance <30mL/min contraindicates dabigatran and <15mL/min the factor-Xa inhibitors. AF patients on DOACs presenting with an acute coronary syndrome and/or requiring percutaneous coronary interventions are generally managed by additional dual antiplatelet therapy for 1-4 weeks, followed by clopidogrel plus DOAC for up to 1 year. AF patients with chronic coronary syndromes should generally receive a DOAC without additional antiplatelet therapy, as this abates major bleeding and improves cardiovascular survival without evidence of increased ischemic risk. For AF patients who develop an acute ischemic stroke, recent exposure to a DOAC is a relative contraindication to intravenous thrombolysis, but the latter may be considered when clinically-relevant anticoagulation can be excluded. Finally, for AF patients who develop a non-severe hemorrhagic stroke during DOAC therapy, resuming a DOAC to prevent ischemic strokes is counterbalanced by considerably enhanced major bleeding, including intracranial.