Deutsche medizinische Wochenschrift
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Recommendations for vaccination of patients with rheumatic Diseases. Patients with rheumatic diseases are particularly at risk from infections. ⋯ Important new developments, such as sequential vaccination against pneumococcus or the approval of a vaccine against Herpes Zoster, improve the possibilities of an effective infection protection. Special attention must be paid to the current recommendations for the use of live vaccines like MMR vaccination in patients under immunosuppressive therapy.
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Membranous nephropathy is an autoimmune disease caused in most cases by binding of circulating antibodies to antigens on podocytes. PLA2R1 and THSD7A have been identified as target antigens in 70-80 % and 2-3 % of patients, respectively. The detection of PLA2R1- and THSD7A-antibodies in the blood and staining of renal biopsies for the respective antigens allow the correct diagnosis of PLA2R1- and THSD7A-associated membranous nephropathy, respectively, in practically 100 % of cases. ⋯ Rituximab was shown to be non-inferior to ciclosporine A to induce remission of proteinuria after 12 months. After 24 months rituximab was superior to ciclosporine A for the same endpoint. Development of novel treatment strategies, focusing on disease pathogenesis, remains highly relevant for these patients.
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Dtsch. Med. Wochenschr. · Oct 2020
[Recommendations for Drug Treatment in Patients with Multimorbidity].
Applying guidelines in patients with multimorbidity can result in dangerous or contraindicated drug-drug and drug-disease-interactions. A representative working group of medical scientific associations identifies such therapeutic conflicts and develops management strategies that will be published as a formally consensus based (S2K) guideline. Rational, aims and methods used are described, as well as evaluation and updating of recommendations.
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Dtsch. Med. Wochenschr. · Oct 2020
[Abdominal Emergencies in The View of an Intensivist - Intra-abdominal Hypertension and Abdominal Compartment Syndrome].
In critically ill patients an intra-abdominal hypertension is a common phenomenon. An IAH is defined as an IAP persistent ≥ 12 mmHg, an abdominal compartment syndrome is defined as an IAP persistent ≥ 20 mmHg in combination with new organ failure. ⋯ The bladder pressure should be measured in a standardized manner. The therapy of IAH should be individualized.
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The 2019 guidelines of the European Society of Cardiology (ESC) rename stable coronary heart disease to chronic coronary syndrome (CCS). Under CCS, six different scenarios have been defined, which take its heterogeneity into account. An important part of the current guideline plays the diagnostic assessment of the pre-test probability in the event of the possible presence of stenosing coronary heart disease. ⋯ Imaging techniques such as CT angiography have been significantly upgraded as diagnostic procedures for the detection of CHD, while exercise ECG is no longer routinely recommended in this regard. Invasive coronary angiography with revascularization option remains a central diagnostic and therapeutic procedure. In addition to antianginal, lipid-lowering and antithrombotic therapy, the current CCS guideline places special emphasis on prevention by means of lifestyle modification.