Polskie Archiwum Medycyny Wewnętrznej
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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.
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Coronavirus disease 2019 (COVID‑19) is an infectious disease that became a global health emergency. This review focuses on the aspects of COVID‑19 pertaining to rheumatology, including signs and symptoms akin to those observed in rheumatic disorders, risk of infection or severe course of the disease in patients with a pre‑ existing rheumatic disease and those receiving antirheumatic or immunosuppressive medication, as well as potential use of antirheumatic or anticytokine therapeutic strategies that are already applied in rheumatology (among others, chloroquine, hydroxychloroquine, tocilizumab, and baricitinib) in patients with COVID‑19.
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Pol. Arch. Med. Wewn. · Aug 2020
ReviewE-cigarettes and their impact on health: from pharmacology to clinical implications.
Worldwide, cigarette smoking is the major cause of premature mortality and diseases that can be prevented. Given that people continue smoking despite associated health risks, delivering nicotine without combustion should be considered a valuable and much less harmful way to reduce the public health burden caused by smoking. E‑cigarettes could play such a role if they were proven to be less harmful than combustible cigarettes. ⋯ Most studies have indicated so far that e‑cigarettes are less harmful, but this applies only to smokers who completely switched to e‑cigarettes. In the opinion of the authors, good-quality research is crucial to establish the tolerance, safety, efficacy, and harm reduction potential of new technologies. Considering a significant role that physicians and other health providers play in helping smokers, there is an urgent need for evidence‑based guidelines and recommendations for clinical practitioners on potential benefits and risks of e‑cigarette use.