Polskie Archiwum Medycyny Wewnętrznej
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Pol. Arch. Med. Wewn. · Mar 2022
Multicenter StudyAssociation of antineutrophil cytoplasmic antibody (ANCA) specificity with the demographic and clinical characteristics of patients with ANCA-associated vasculitides.
Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is characterized by the presence of proteinase‑3 (PR3) or myeloperoxidase (MPO) ANCA. In over 90% of cases, PR3‑ANCA is associated with granulomatosis with polyangiitis (GPA). However, it is also rarely found in microscopic polyangiitis (MPA) and eosinophilic granulomatosis with polyangiitis (EGPA). On the other hand, MPO‑ANCA being characteristic of MPA (>90% of cases), is also found in about 40% of EGPA and 5% of GPA patients. On the ground of this overlap, clinical importance of ANCA specificity identification has been questioned. ⋯ The presence and specificity of ANCA in AAV patients are related to sex and age, determine their organ involvement and influence mortality as previously shown. Patients with MPO‑ANCA-positive AAV constitute a clinically homogeneous group, whereas PR3‑ANCA-positive patients are much more clinically heterogeneous. ANCA-negative AAV patients are characterized by better prognosis. Thus, ANCA identification is an indispensable element and should not be omitted in establishing AAV diagnosis.
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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.