Polskie Archiwum Medycyny Wewnętrznej
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Pol. Arch. Med. Wewn. · May 2022
Meta AnalysisMortality in critically ill COVID-19 patients with fungal infections: a comprehensive systematic review and meta-analysis.
Patients with COVID‑19 may develop concomitant viral, bacterial, or fungal infections. Such patients are at a higher risk of death, especially from a critical illness. Although much attention has been recently given to fungal infections that may have devastating consequences, data on this issue are scarce. ⋯ In critically ill patients with COVID‑ 19, CAPA is rather common and significantly increases mortality. The evidence regarding other fungal infections is weaker, with CAC occurring less frequently but also impacting mortality. Therefore, clinical awareness and screening are needed, followed by personalized antifungal therapy stewardship, which is strongly recommended in order to improve the patients' prognosis.
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Obscure gastrointestinal (GI) bleeding (OGIB) is defined as small bowel bleeding of unknown etiology after negative endoscopic evaluation including esophagogastroduodenoscopy and colonoscopy with endoscopic evaluation of the terminal ileum. The presentation of OGIB may be either overt or occult. The former refers to persistent or recurrent visible GI bleeding (eg, melena and / or hematochezia, and rarely hematemesis), while the latter indicates the presence of persistently positive results of fecal oc-cult blood testing, iron deficiency anemia, or both, without evidence of visible GI bleeding. This review focuses exclusively on obscure‑overt GI bleeding and presents entities that should be considered as part of the differential diagnosis in patients with this type of bleeding, as well as details the role of endoscopic and radiographic techniques in the evaluation and treatment.
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Pol. Arch. Med. Wewn. · May 2022
ReviewBenefits and limitations of statin use in primary cardiovascular prevention: recent advances.
The status of low‑density lipoprotein (LDL) cholesterol is strong as an essential cause of atherosclerotic vascular disease (ASCVD) and primary target of lipid lowering. Drugs affecting primarily LDL choles-terol through an increase of LDL receptor expression are the backbone of current therapy, and generic statins are generally safe, effective, and inexpensive drugs serving this purpose. Statins are indicated for practically all patients in secondary prevention, whereas treatment in primary prevention (healthy individuals) is based on a calculated 10‑year risk of ASCVD. ⋯ More information about the benefits and risks of statins in primary prevention in older people (>70 years of age) will be provided by ongoing randomized and controlled trials (STAREE and PREVENTABLE). In this narrative review, I shall present recent advances in the use of statins in younger and older healthy people, and discuss their benefits and potential risks. I also raise a question whether with the current evidence base, most people in affluent societies would benefit from taking statins.
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Asthma is usually associated with pulmonary and extrapulmonary comorbidities that are more common in patients with severe asthma than in those with mild‑to‑moderate illness or in the general population. These comorbidities may affect the clinical intensity and severity of asthma and, as a result, increase health care costs related to its therapy. On the other hand, their recognition and appropriate treatment appear to improve asthma outcomes while optimizing therapy by preventing overtreatment. ⋯ The role of systemic inflammation in asthma, on the other hand, remains unknown. Understanding the mechanism(s) that link(s) asthma and its concomitant disorders is critical for developing an effective treatment strategy. This review examines the epidemiology, pathophysiology, treatment suggestions, and significant knowledge gaps of these comorbidities.
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Pol. Arch. Med. Wewn. · Mar 2022
ReviewMedical referral criteria for palliative care in adults: a scoping review.
Palliative care (PC) is focused on the relief of serious suffering due to severe illness. The Polish health care reimbursement system limits the access to PC to a so-called "basket" of recipients with life‑limiting incurable diseases (mainly cancer), not responding to disease‑modifying therapy. This scoping literature review was aimed to define the criteria of medical referral for PC in the context of the interpretation of the terms life‑limiting illness and disease‑modifying therapy, which may aid in increasing the number of appropriate referrals and patients receiving optimal treatment. ⋯ Equally important as limited survival prognosis is the presence of severe, complex, and persistent symptoms or problems occurring despite optimal treatment and general care. Based on the reviewed literature, the national reimbursement program should be urgently extended to cover more patients who are eligible and could benefit from specialist PC. Additionally, the importance of general PC should be universally acknowledged.