Polskie Archiwum Medycyny Wewnętrznej
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Pol. Arch. Med. Wewn. · Sep 2022
Multicenter Study Observational StudyDeep dive into achieving the therapeutic target: results from a prospective, 6-month, observational study nested in routine rheumatoid arthritis care.
Achieving remission or lowdisease activity (LDA) is an integral principle of treat‑to‑target (T2T) strategy in rheumatoid arthritis (RA). Prior studies have reported that achieving T2T therapeutic goals may be realistic only for a fraction of patients. Prospective, real‑world data on achieving target disease control in ambulatory care populations are limited for Central and Eastern European countries. ⋯ A combination of clinical characteristics and provider treatment decisions shapes the "profile" of a patient failing to achieve T2T goals. Low‑dose steroid equivalent, never smoking, and lower body mass index appear as individual characteristics independently associated with achieving LDA / remission at 3 and 6 months.
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Pol. Arch. Med. Wewn. · Sep 2022
Elevated urinary Kidney Injury Molecule 1 (KIM-1) at discharge strongly predicts early mortality following an episode of acute decompensated heart failure.
Hospitalization for acute decompensation of heart failure (ADHF) is a frequent event associated with long‑term adverse effects. Prognosis is even worse if acute kidney injury (AKI) occurs during hospitalization. ⋯ Discharge urinary KIM‑1 was a strong and independent predictor of mortality, particularly during the most vulnerable period shortly after hospitalization. Admission serum NGAL was inferior to conventional renal function parameters in predicting AKI during ADHF.
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Pol. Arch. Med. Wewn. · Sep 2022
ReviewCOVID-19 in renal replacement therapy patients: an overview of current data and future challenges.
Patients with chronic kidney disease, especially those on renal replacement therapy, demonstrate increased incidence and mortality from COVID‑ 19, as compared with the general population. One of the main reasons for this phenomenon is a dysfunction of the immune system associated with its accelerated aging, weakened immune functions, impaired regulation of proinflammatory reactions, chronic inflammation, and immunosuppressive therapy. Most of these patients have a high rate of comorbidities, which may also have a negative impact on the severity of COVID‑ 19 and prognosis. ⋯ Moreover, response to vaccination varied over time depending on the geographic region and variant of the virus causing the infection. The epidemiology was significantly influenced by the improved prevention methods and treatment of infections as well as the growing percentage of vaccinated and convalescent people. We present the most important differences in the epidemiology of COVID‑ 19, the course of the disease, prognosis, and prevention, as well as the challenges associated with improving the prognosis in patients receiving renal replacement therapy.
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Pol. Arch. Med. Wewn. · Sep 2022
ReviewRecent advances in the diagnosis and management of autoimmune hepatitis.
Autoimmune hepatitis (AIH) is an acute or chronic inflammatory disease of the liver caused by an immune response of unknown origin. It affects people from all ethnic groups irrespective of age or sex. AIH is characterized by hyperglobulinemia, presence of circulating autoantibodies, and liver inflammation. ⋯ Most patients initially respond to first‑ line treatment, which consists of corticosteroids combined with azathioprine or mycophenolate mofetil. However, insufficient response to the treatment and intolerance due to side effects are common, so a significant proportion of patients require second- and / or third‑ line therapies. Herein, we review the challenges and recent advances in AIH diagnosis and management.