Der Internist
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Gliflozine (inhibitors of sodium-dependent glucose cotransporters, SGLT) are medications which were originally used in the treatment of diabetes mellitus and are assigned to the group of antidiabetics. Since November 2020 the SGLT2 inhibitor dapagliflozin has been approved for the treatment of heart failure (with reduced left ventricular function) for the first time, independent of the diabetes status. ⋯ Therefore, different gliflozins are now available not only for the treatment of diabetes mellitus but also for the treatment of cardiac insufficiency. This article mediates fundamental knowledge on the gliflozins and provides an overview of the importance in the treatment of type 2 diabetes mellitus as well as cardioprotective and nephroprotective functions.
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Resources for the rapid and comprehensive availability of reliable diagnostic tests were an important prerequisite for the detection and management of the pandemic triggered by the coronavirus disease 2019 (COVID-19). The capacity for the diagnostic tests had to be rapidly planned and established in early 2020 and had to be constantly expanded. The German healthcare system with dedicated and experienced specialists for laboratory medicine, clinical microbiology, virology and infection epidemiology was well prepared to meet these challenges, both professionally and organizationally. The experiences with the challenges in the first year of the pandemic are presented in this article.
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Myocardial ischemia is triggered by a mismatch between the oxygen supply and demand of the myocardial tissue. The most common cause is coronary artery disease; however, not every coronary stenosis is hemodynamically relevant and leads to myocardial ischemia. ⋯ Cardiac computed tomography, stress echocardiography, nuclear cardiological procedures (positron emission tomography and single photon emission computed tomography) and cardiac magnetic resonance imaging are the main diagnostic tools for this purpose and are incorporated into the clinical routine. This article provides a review of the indications, the relative advantages and disadvantages of the respective methods and their utilization in routine clinical practice.
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Review Case Reports
[Multicentric Castleman's disease combined with polyserositis and POEMS syndrome: case report and review article].
Castleman disease (CD) is a very rare disorder characterised by hyperplasia of the lymphoid tissue. The aetiology varies considerably and includes autoimmunological, infectious, autoinflammatory and paraneoplastic diseases (e.g. MGUS with POEMS syndrome). ⋯ The sum of these changes sometimes causes very heterogeneous symptoms and thus often makes early diagnosis difficult. The prognosis of unrecognised and untreated disease is very serious and has an average 5‑year survival rate of 55-77%. The present paper describes the case of a 79-year-old patient with refractory polyserositis who was correctly diagnosed after > 8 years.
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Case Reports
[Treatment-refractory anaemia in a 35-year-old heart transplant recipient on chronic hemodialysis].
This article presents a case of pure red cell aplasia in a 35-year-old heart transplant recipient on chronic hemodialysis. Elevated parvovirus B19 immunoglobulin M blood levels were detected along with a high viral load of 80 billion IU/ml quantified by polymerase chain reaction. ⋯ Anaemia had significantly improved 4 weeks later. Parvovirus B19 infection should be excluded in organ transplant recipients with anaemia due to ineffective erythropoiesis.