MMW Fortschritte der Medizin
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More than 80% of cases of mycotic nail diseases are caused by the dermatophyte T. rubrum, which is becoming ever more widespread. In the majority of cases, onychomycoses affect the nails of the feet, where they are particularly favored by primary mycoses close to the nail, as well as warm, moist environment and repeated minor traumatization. A differentiation is made between distolateral onychomycosis and proximal subungual, white superficial and dystrophic onychomycoses, the latter being the terminal stage of the other forms. ⋯ Depending on the nature and spread of the pathogen, management comprises systemic and/or topical antimycotic therapy followed by disinfection of shoes and socks. Furthermore, atraumatic removal of the diseased body of the nail is recommended. Surgical extraction of the nail, in contrast, is no longer indicated.
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The diagnosis and treatment of acute respiratory distress or dyspnea in children needs to consider the age-related major causes, but also the rare causes. In neonates, congenital abnormalities, immaturity of the lungs, perinatal complications and infections are major causes, in infants bronchiolitis/obstructive bronchitis and croup, while in older children and adolescents acute asthmatic attacks and pneumonia predominate. Of critical importance is a clear diagnostic classification, assessment of severity, securement of adequate oxygenation and a carefully taken decision for hospital or ambulatory treatment. Where indicated, less invasive therapeutic options (inhaled bronchodilators, rectal or oral steroids) are to be preferred over more invasive (i.m., i.v.) alternative measures.