Deutsche medizinische Wochenschrift
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Hypertension is defined as resistant to treatment when treatment fails to lower office systolic and diastolic blood pressure values to < 140/90 mmHg. The treatment strategy should include lifestyle measures and appropriate doses of three or more drugs acting by different mechanisms including a diuretic. An updated definition of treatment resistance includes all patients with ≥ 4 antihypertensive agents of different classes irrespective of their on-treatment blood pressure. ⋯ While the prevalence of apparent resistance may be in the range of 10-15 % of treated patients, the exact prevalence of true resistance remains unknown due to the lack of appropriate studies but is likely to be rather small including a high proportion of patients with secondary forms of hypertension. Once identified most patients with true treatment resistance should receive intensified drug treatment primarily by expanded diuretic usage. Thus, resistant hypertension is primarily a diagnostic challenge: identifying patients with true resistance and those with secondary hypertension.
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Hematuria is a common clinical finding and has a wide spectrum of possible causes. Erythrocytes can originate from any part of the genitourinary tract. An urine dipstick test is the first step in diagnostic approach. ⋯ If an urological pathology is suspected, sonography should be complemented by a multi-phasic computed tomography. Based on the imaging results, a retrograde ureteroscopy should be considered. Repeated urinalysis on an annual basis for two consecutive years is recommended, if no diagnosis can be established.
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Dtsch. Med. Wochenschr. · Jan 2020
Review[Anti B-cell-antibody treatment for maintenance of remission in granulomatosis with polyangiitis and microscopic polyangiitis].
Granulomatosis with polyangiitis (GPA) and microscopic polyangiitis (MPA) are the most frequent primary necrotizing small vessel vasculitides. In these formerly fatal diseases remission can be induced by stage- and activity-adapted immunosuppressive regimens in the majority of patients. This does not lead to drug-free long-term remission or even cure. ⋯ Recent randomized controlled trials demonstrated that maintenance treatment with the anti-B-cell antibody Rituximab, administered 6-monthly as opposed to azathioprine leads to a significantly lower relapse rate but a similar profile of adverse events. These data enabled the extension of the approval of Rituximab for maintenance of remission treatment of GPA and MPA in Germany in 2018. Guidelines and expert recommendations concerning measures of infection prevention and vaccination of immunosuppressed patients as well as the management of hypogammaglobulinemia and cytopenia on Rituximab are presented in this review.
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Dtsch. Med. Wochenschr. · Jan 2020
[Lyme Borreliosis: Serological and Microbiological Diagnostics and Differential Diagnosis].
Lyme borreliosis caused by at least six Borrelia burgdorferi species, is the most important tick-borne disease in the northern hemisphere. With a wide spectrum of possible symptoms, the microbiological diagnosis of this disease is associated with a wide variety of ideas, divergent approaches and much uncertainty. ⋯ Most important messages include that (I) the suspected diagnosis of Lyme borreliosis is first based on anamnestic data and clinical symptoms (compare "case definitions") which is substantiated by microbiological examinations; (II) microbiological diagnostics - primarily antibody detection, downstream PCR and culture - are only indicated if there are indicative symptoms, with typical erythema migrans not requiring microbiological diagnostics; (III) keep in mind: The more unspecific the symptoms are the lower the positive and the higher the negative predictive value of microbiological testing; (IV) serological diagnosis should follow a two-step procedure: a sensitive ELISA as first step, if reactive followed by immunoblot (IgM and IgG). Detection rates are ca. 50 % in localized, 70- > 90 % in disseminated early and nearly 100 % (only IgG relevant) in late disease; (V) in the immunoblot early forms of disease show a narrow band spectrum, late forms show a broad spectrum; (VI) methods that are not recommended for diagnostic purposes include lymphocyte activation or transformation tests (LTT, MELISA, ELISPOT), PCR or antigen detection from urine or blood, lymphocyte subpopulations, or direct detection of borreliae from patient material using dark field- or focus floating microscopy.
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Education of medical students requires teaching students how to navigate in the broad field of medical research. The objective of this article is to provide an overview about medical research and to show how to denote a medical study in a concise fashion. Medical research can be classified into categories according to the object of investigation. ⋯ Each research category uses a specific set of study types with names such as cross-sectional study, case-control study etc. The article describes the principles of the study types. Together, research category and study type briefly describe the design of a medical study.