Polskie Archiwum Medycyny Wewnętrznej
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This paper provides an overview of the efficacy of vitamin C for preventing and treating respiratory infections. Studies in a wide variety of animals have shown vitamin C to be protective against infections. In controlled trials in the general human population, vitamin C at a dose greater than 1 g/day did not prevent common colds. ⋯ It is unlikely that vitamin C would reduce the risk of pneumonia in the general population; however, 4 trials reported a treatment benefit for pneumonia patients, although the findings encourage further research rather than providing firm evidence of efficacy. Vitamin C has been tested for efficacy in COVID‑19 and sepsis with conflicting results. Given the evidence that vitamin C reduces the severity and duration of the common cold, paired with its good safety profile and low cost, it is not unreasonable for patients to test whether therapeutic vitamin C supplementation at a dose of 6-8 g/day is beneficial at the individual level.
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Pol. Arch. Med. Wewn. · Jan 2025
ReviewAnticoagulation in patients with a history of heparin-induced thrombocytopenia who require cardiovascular surgery: is it okay to use heparin?
Heparin‑induced thrombocytopenia (HIT) is an adverse drug reaction with significant thromboembolic risk. Though there are models for use of nonheparin anticoagulants, heparin remains the preferred anticoagulant in many operative settings, especially cardiovascular surgery and percutaneous cardiac intervention. ⋯ If procedures cannot be delayed, approaches include intraoperative bivalirudin or intraoperative heparin with pre- or intraoperative plasma exchange or a potent antiplatelet agent, sometimes in combination with intravenous immunoglobulin. In subacute HIT B (immunoassay positive, functional assay negative) and remote HIT (immunoassay negative, functional assay negative), brief exposure to heparin in the intraoperative setting with close monitoring postoperatively is suggested due to the low risk of recurrent HIT.
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Pol. Arch. Med. Wewn. · Dec 2024
ReviewDiagnosis of sepsis: which clinical and laboratory biomarkers are useful?
The quest for a definitive diagnostic tool for sepsis has spanned decades, yet it remains elusive. The diagnostic workup of sepsis is inherently complex, involving dozens of biochemical, hematologic, and immunologic parameters, alongside complex microbiological diagnostics. Over the past decade, the integration of omics technologies has further complicated this diagnostic landscape. ⋯ This work provides an overview of selected diagnostic biomarkers that are deemed readily applicable in routine clinical practice, extending applicability beyond highly specialized university hospitals. Verifying the reliability and clinical utility of diagnostic parameters generally takes several years, and often is more challenging in patients with sepsis, as compared with other cohorts, because of the complexity of this condition. Nevertheless, the integration of new technologies, the expanded use of bedside diagnostics, and advancements in omics technologies are propelling us toward the realization of personalized medicine and theranostics.
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Pol. Arch. Med. Wewn. · Dec 2024
ReviewNovel factors affecting fibrin clot formation and their clinical implications.
Fibrin formation is pivotal in hemostasis, serving as a temporary barrier to blood loss following vascular injury, while in thrombosis this process is involved in thrombus progression, stability, and recurrence. Growing evidence shows exceptional complexity of processes that determine fibrin clot structure and function, especially lysability, both in health and disease, which might be relevant in the pathogenesis of arterial and venous thromboembolic diseases. ⋯ These factors have been shown to be not only associated with ischemic stroke, myocardial infarction, pulmonary embolism, and cardiovascular death, but also with unfavorably altered fibrin clot characteristics, which underscores clinical relevance of fibrin clot properties. Given preclinical or ongoing studies aimed at modifying some of these factors, in particular FXI/FXIa inhibitors, recent findings might expand our knowledge on fibrin‑related mechanisms of emerging therapeutic agents tested and stimulate further research into new targets for future therapeutic interventions to prevent thromboembolic events.
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Pol. Arch. Med. Wewn. · Nov 2024
Meta AnalysisNeuropsychiatric adverse events in tenofovir disoproxil fumarate- and tenofovir alafenamide-based HIV therapy and prophylaxis: a systematic review and meta-analysis.
Tenofovir is integral to antiretroviral therapy (ART) and pre‑exposure prophylaxis (PrEP) for HIV; however, neuropsychiatric adverse events (NPAEs) associated with its use have not been systematically investigated. ⋯ Common occurrence of NPAEs in tenofovir‑based HIV multidrug regimens highlights the need to screen HIV patients for neuropsychiatric complications. The lack of effect of tenofovir, as compared with placebo, for most analyzable NPAEs suggests its favorable safety profile. However, a possible increase in the dizziness risk on tenofovir, and a potentially elevated risk of headache on tenofovir alafenamide- as compared with tenofovir disoproxil fumarate-based regimens in HIV therapy merit further investigation.