Der Internist
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Cancer-related fatigue (CRF) is a highly prevalent and the most distressing symptom during and after treatment for cancer. It is characterized by feelings of physical and mental tiredness, weakness, and lack of energy and is not influenced by rest or sleep. Approximately 40% of patients suffer from CRF at diagnosis and nearly all patients experience fatigue during the course of cancer therapy. ⋯ The fatigue is also associated with significant levels of distress and it imposes a financial burden by limiting the ability to work. The underlying causes of CRF are poorly understood as are the relationship between fatigue and psychosocial distress, depression or anxiety. This paper seeks to give an overview of cancer-related fatigue and its psychosocial burden.
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Pregnancy causes a number of physiological alterations in thyroid hormone metabolism that need to be distinguished from the pathophysiological states of thyroid dysfunction. Both hypothyroidism and thyrotoxicosis may impair the course of pregnancy and may negatively affect the fetus. In particular, maternal hypothyroidism may lead to irreparable and detrimental deficits in the neurocognitive development of the fetus. ⋯ Hashimoto's thyroiditis is associated with impaired fertility and miscarriage, and may first manifest in pregnancy due to the increased thyroid hormone requirement. Graves' disease often shows a characteristic course in pregnancy with amelioration of thyrotoxicosis in the second half of pregnancy and exacerbation after delivery. In addition transplacental passage of maternal TSH receptor antibodies may lead to thyrotoxicosis in the fetus and/or newborn.
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Invasive fungal infections have gained importance in many areas of clinical medicine and represent a growing diagnostic and therapeutic challenge for clinicians. During the last decade, several new antifungals were introduced into routine therapy: two second-generation triazoles and the new class of echinocandins. ⋯ Consequently, they were integrated in recent therapeutic guidelines, often replacing former standard drugs as first-line options. The echinocandins (anidulafungin, caspofungin, micafungin) primarily have gained a central role in the treatment of invasive Candida infections, while the novel triazoles voriconazole and posaconazole established themselves as the current mainstays in therapy and prophylaxis of invasive fungal infections, particularly aspergillosis, in hemato-oncologic high-risk patients.
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Influenza infections have important socio-economic consequences. Risk groups identified so far include small children and elderly adults with comorbidities. ⋯ For the latter other at risk groups were affected and a different clinical course has been documented. The focus of this article is to give an overview on the epidemiology, clinical characteristics, diagnosis and therapy of influenza infections.