Polskie Archiwum Medycyny Wewnętrznej
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Pol. Arch. Med. Wewn. · Sep 2020
ReviewInvestigations and management of chronic cough: update from the European Respiratory Society Chronic Cough Taskforce 2020.
Chronic cough affects approximately 10% of the general population, is highest amongst people aged 50 to 60 years, and is twice as common in women than men. It is described to last 8 weeks or longer in adults and does not respond well to treatment with over-the-counter medications and those targeting potential associated conditions. This is a debilitating condition with physical, social, and psychological consequences. ⋯ In some cases, no cause can be found and the cough is classified as unexplained chronic cough. If treatment of any underlying disease is unsuccessful at controlling cough, then neuromodulatory treatment such as a low‑dose opioid, gabapentin, pregabalin or speech and language therapy may be considered. There is no licensed treatment for chronic cough, but a new class of treatment targeting the purinergic P2X3 receptor is currently in phase 2 and 3 of development.
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Pol. Arch. Med. Wewn. · Sep 2020
Meta AnalysisAntiviral agents, glucocorticoids, antibiotics, and intravenous immunoglobulin usage in 1142 patients with coronavirus disease 2019: a systematic review and meta-analysis.
The treatment effects of antiviral agents, glucocorticoids, antibiotics, and intravenous immunoglobulin are controversial in patients with coronavirus disease 2019 (COVID‑19). ⋯ With the varied heterogeneities across interventions, the current evidence indicated a probable survival benefit from antiviral agent use and a harmful effect of glucocorticoids in patients with COVID‑19. Neither any of antibiotics nor intravenous immunoglobulin were associated with survival benefit in this population.
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Pol. Arch. Med. Wewn. · Sep 2020
ReviewDysregulation of the immune system as a driver of the critical course of the novel coronavirus disease 2019.
Novel coronavirus disease 2019 (COVID‑19) is a highly contagious, respiratory disease caused by the newly emerged severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2). Given that inflammatory immune cells may induce severe lung injury, the involvement of immunological factors in the pathogenesis of the disease cannot be overestimated. It has been demonstrated that coronaviruses have developed mechanisms of immune evasion, making themselves invisible to the immune system at an early stage of infection. ⋯ The occurrence of virus transmission even in asymptomatic individuals infected with SARS‑CoV‑2 clearly strengthens the evidence for the key role played by the sufficient immune control of viral replication in a subset of cases (eg, in children, a population with a highly effective innate immune response). Although administration of immunomodulatory drugs is recommended under certain conditions by the guidelines for COVID‑19 management, controversies regarding treatment protocols in immunocompromised patients infected with SARS‑CoV‑2 still exist. Extending clinicians' knowledge on the dysregulated immune response, which is a driver of the COVID‑19 outcome, may improve both therapeutic strategies and the prognosis of patients infected with SARS‑CoV‑2.
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Pol. Arch. Med. Wewn. · Sep 2020
ReviewImmunotherapy of solid tumors: how safely treat the patients.
Immunotherapy with immune checkpoint inhibitors (ICIs) was shown to improve survival of patients with solid tumors such as: melanoma, renal carcinoma, non-small cell lung cancer, cutaneous carcinomas, or head and neck carcinoma. However, a special type of ICIs toxicity is observed, namely noninfectious inflammation of different organs associated with autoimmunity known as immune‑related adverse events (irAEs). This noninfectious inflammation may affect the endocrine system, gastrointestinal tract, heart, skin, and nervous system. ⋯ Knowledge of irAEs should be promoted among clinicians of all specialties, nurses, patients and their families. The aim of this review is to present the wide spectrum of irAEs: clinical signs and symptoms, differential diagnosis, diagnostic procedures, and treatment. Data are supported by our own clinical observations.