Articles: treatment.
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Withdrawal of life-sustaining treatment (WLST) in severe traumatic brain injury (TBI) is complex, with a paucity of standardized guidelines. We aimed to assess the variability in WLST practices between trauma centers in North America. ⋯ We highlighted the presence of contextual phenomena associated with disparate WLST practice patterns between trauma centers after adjustment for case-mix and hospital attributes. These findings highlight a need for standardized WLST guidelines to improve equity of care provision for patients with severe TBI.
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Pol. Arch. Med. Wewn. · Jan 2024
Hydroxychloroquine as an important immunomodulator: a novel insight into an old drug.
Hydroxychloroquine (HCQ) is an increasingly popular drug owing to its efficacy, long‑term safety, and a wide range of therapeutic effects. Currently, due to the numerous benefits it provides, the use of the drug goes beyond the treatment of rheumatic and dermatologic diseases. As HCQ shows anti‑inflammatory, immunomodulatory, antiproliferative, and photoprotective action, it has a great potential to be applied also in the treatment of oncologic diseases, multiple sclerosis, diabetes, cardiovascular diseases, or recurrent miscarriages. ⋯ This paper presents the latest data on HCQ, its mechanisms of action, its therapeutic potential in current clinical practice as well as future perspectives. It also discusses the correct dosing regimen and long‑term monitoring, with consideration of possible rare complications. Finally, it focuses on the enormous benefits for patients with rheumatic diseases in terms of reducing the disease activity and organ damage, preventing flares and pregnancy‑related complications, and, most importantly, lowering mortality rates in SLE patients.
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Pol. Arch. Med. Wewn. · Jan 2024
Recent advances in the management of psoriatic arthritis: practical considerations.
Psoriatic arthritis (PsA) is an inflammatory arthritis characterized by inflammation of peripheral and / or axial joints, with or without other tissue manifestations, including skin psoriasis, dactylitis, enthesitis, uveitis, and inflammatory bowel disease. There has been an exponential increase in PsA treatment options over the last 2 decades, and while guidelines have attempted to keep up with the deluge of emerging data, there are several areas in which guidance remains sparse. This is, in part, due to a lack of robust strategy trials, head‑to‑head studies, and real‑world observational data. ⋯ This article provides a concise summary of the current state of guidelines for the management of PsA, and an in‑depth discussion of some of the areas where guidelines and evidence are still lacking. These areas of unmet clinical need in the treatment of PsA should be a priority for further PsA research in the coming years. Only by working with patients and addressing these gaps in our knowledge can we strive for a future where all PsA patients are able to receive treatment that is the best for them, and tailored to their specific needs at any particular time point in their disease trajectory.
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Pol. Arch. Med. Wewn. · Jan 2024
Hepatitis B virus coinfection in patients treated for chronic hepatitis C: Clinical characteristics, risk of reactivation with long-term follow-up and effectiveness of antiviral therapy.
Hepatitis B virus (HBV) and hepatitis C virus (HCV) share a similar transmission route, which increases coinfection odds and worsens clinical outcomes. ⋯ Neither the presence of HBV markers nor HBV reactivation during DAA treatment reduced effectiveness of the therapy. Our findings are important for future recommendations and guidelines on managing HBV/HCV coinfection.
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Pol. Arch. Med. Wewn. · Jan 2024
Hospitalizations of sarcoidosis patients before and during the COVID-19 pandemic in Poland.
Sarcoidosis is a multisystemic granulomatous disease that mostly affects the lungs and lymphatic system. Due to its rarity and variable clinical course, analyses of factors related to sarcoidosis should be based on large databases and long observation periods. ⋯ Health care changes related to the outbreak of the COVID‑19 pandemic may have increased the health debt for inpatient sarcoidosis treatment. The occurrence of sarcoidosis in Poland may be related to demographic and territorial factors.