Department of Family Medicine and Internal Diseases is one of the clinics at the Medical Center of Postgraduate Education (CMKP) which is providing education courses in internal medicine for specializing doctor as specialists of family medicine. Three years ago, specialists working in this Department began to organize continuous education programs in the field of internal diseases for family physicians and other physicians who work in grand outpatient clinics. They are the authors of the articles presented in „Postępy Nauk Medycznych” (journal under the patronage of CMKP).

In the current issue of the journal you will find nine articles on various topics related to general practice – there are some articles that provide you with basic information, some which are more advances as well as some commentaries.

The article by Orzechowski and Wąsowski deals with the issue of heart failure treatment. The overall prevalence of heart failure (HF) is increasing because of the ageing of the population, the success of prolonging survival in patient with coronary events and the effectiveness of the primary and secondary prevention. Family physicians play a substantial role in medical care of patients with HF. The aim of this article is to provide guidelines for the non- pharmacological and pharmacological management as well as recommendations for use of devices such as cardiac resynchronization therapy (CRT) and implantable cardioverter – defibrillator (ICD) based on European Society of Cardiology guidelines and current references.

The article by Puchalska-Krotki and Marcinowska-Suchowierska deals with pharmacotherapy of stable angina pectoris which has a fundamental significance in modification of atherosclerosis and atherosclerotic plaques development. Under the influence of the medical treatment atherosclerosis does not develop or it even recedes. As myocardial infractions and deaths are prevented, the prognoses for patients improve. The pharmacotherapy improves the patients´ quality of life by eliminating anginal pains, reducing their frequency and the severity of the symptoms. Changing of the lifestyle matters here greatly.

The article by Jasik and Marcinowska-Suchowierska presents provides up-to-date information on the etiology, diagnosis and methods for treatment of chronic obturative pulmonary disease (COPD). The basic method of treatment of COPD exacerbations is the use of inhaled bronchodilators and corticoids. The antibiotics should be used in some cases of exacerbations, but not routinely. One of the important points in acute exacerbation of COPD is treatment of co- morbidities especially cardiovascular disease.

The article by Kapitan-Malinowska and Bogołowska-Stieblich concerning deep vein thrombosis (DVT) and its most severe complication, pulmonary embolism presents one of the most serious problems of modern medicine. The evaluation of probability of pulmonary embolism is a very serious problem. A very important thing is to perform fast diagnosis using lab tests and imaging exams and start immediate treatment. Most of the patients must be treated in hospital, conservatively same times invasive techniques such as embolectomy or percutaneous thrombus removal. In early stages of treatment the thrombolysis or heparins (UFH or LMWH) are used. In treatment continuation or prophylaxis oral anticoagulants or LMWH are applied. The lasting of secondary prophylaxis depends on the presence of reversal factors of DVT. Removal of these factors allows prophylaxis to be shortened to three months.

The article by Walicka, Czerwińska and Marcinowska-Suchowierska deals with Type 2 diabetes (excepted insulin). Type 2 diabetes mellitus is one of the biggest health problems worldwide nowadays. The treatment of type 2 diabetes should include: education, diet, exercise and pharmacotherapy. The development of new classes of hypoglycemic drugs has extended type 2 diabetes treatment possibilities but also has raised new doubts about the best method of treatment. The drugs used in diabetes treatment are different with regard to power and mechanism of action, therefore principal factors that determine the choice of the drug should be the present glycemia, type of disorder that was found in the patient and influence of the drug on diabetes complications. The paper describes the principal information on type 2 diabetes treatment with lifestyle modification as well as with drugs, which are registered in Poland excluding insulin.

The article by Czerwińska, Walicka and Marcinowska-Suchowierska treatment of thyroid diseases most common in general practice: hyperthyroidism, hypothyroidism, thyroiditis is discussed. Antithyroid drug therapy in Graves disease gives a chance for a sustained remission, while in toxic nodular goiter surgical treatment or radioactive iodine therapy is necessary. Making a decision when to start a pharmacological treatment in occult hypothyroidism is often difficult. In subacute thyroiditis, in spite of hyperthyroidism symptoms, antithyroid drug therapy is not indicated.

The article by Sikorski and Marcinowska-Suchowierska on peptic ulcer disease provides up-to-date information on the etiology, diagnosis and possibilities of treatment. Because an epigastric pain, a complaint frequently reported by patients, is a cardinal symptom of peptic ulcer, a general practitioner must be excellently familiar with diagnosis, therapy and prevention of peptic ulcer disease. In the past 40 years, there has been an unexampled advancement in peptic ulcer diagnosis and antisecretory therapy, that changed a course of the disease and its prognosis allowing prompt ulcer healing in most patients, and even, after an efficient eradication, a cure of H. pylori -related disease, and confining indications for surgery to peptic ulcer complications. An H. pylori infection, and especially in case of gastric ulcer, nonsteroidal anti-inflammatory drugs (NSAIDs) continue to be the most frequent causes of peptic ulcer. In this article, up-to-date guidelines concerning diagnosis, therapy, and prevention of peptic ulcer are presented, while putting a special emphasis on an eradication therapy and an antiulcer prophylactics in long-term NSAIDs users.

The articles by Marcinowska-Suchowierska and Tałałaj deal with the issues of osteoporosis-pharmacological therapy and prevention and pharmacological treatment of urolithiasi.

The aim of osteoporosis treatment is to decrease fracture risk. It combines minimizing fracture risk factors effects including fall prevention and improvement of bone quality with applying pharmacotherapy. It is required for persons with fracture risk greater than average population risk. The knowledge of population risk is necessary to evaluate the intervention threshold in each country separately, because it is a result of agreement and guidelines developed by expert groups, administrators, and insurance companies representatives. This study presents current possibilities of pharmacological treatment of osteoporosis. Guidelines for antiresorptive and anabolic treatment in fracture prevention are described.

In the article on urolithiasis, the authors provide information on the effective prevention and treatment of this disease. They stress the role of maintaining large diuresis, modification of diet and proper use of pharmacological therapy depending on the kind of stone disease and on metabolic disturbances found.

I hope you will enjoy reading the current issue of „Postępy Nauk Medycznych” and that the information presented in the articles will aid you in your daily practice.

Prof. Dr hab. med. Ewa Marcinowska-Suchowierska The Head of the Department of Family Medicine and Internal Diseases of the Medical Center of Postgraduate Education