Deutsche medizinische Wochenschrift
-
Dtsch. Med. Wochenschr. · Dec 2020
Review[Therapeutic drug monitoring of antiinfectives in intensive care unit patients - what's new?]
Pharmacokinetic and pharmacodynamic changes in intensive care unit patients can increase the risk for therapeutic failure or adverse effects of anti-infective therapy. Therapeutic drug monitoring (TDM) can inform required dose adaptions. The present article reviews the current practice and outlines modern approaches for decision making such as model-informed precision dosing software using the area-under-the-concentration-time-curve as target in favor of simplistic decision making based on trough concentrations. Moreover, the current recommendations for performing TDM of beta-lactams, aminoglycosides, linezolid, glycopeptides and voriconazole are concisely summarized.
-
Dtsch. Med. Wochenschr. · Dec 2020
Review Historical Article[Franciscus Sylvius: A Life for Clinic, Research, Teaching And a Little Gin].
Franciscus Sylvius, latinized from Franz de le Boë (*15 March 1614 in Hanau; † 14 November 1672 in Leiden), was a Hessian-Dutch physician, anatomist, and natural scientist of Flemish descent. He was an important clinician and iatrochemist, and is considered the founder of scientifically oriented medicine and clinical chemistry. Sylvius introduced the concept of affinity and dealt with digestive processes and body fluids. ⋯ For heartburn and digestive disorders, Sylvius mixed juniper berries, herbs and alcohol to create a medicine. According to legend, Sylvius marketed this medicine as Genever, for which the name Gin was later adopted in the British Isles, but not only used for medical purposes. Accordingly, the city of birth of Sylvius today calls itself a "birthplace of gin".
-
Dtsch. Med. Wochenschr. · Dec 2020
Review[Supraventricular tachycardia - ECG interpretation and clinical management].
Supraventricular tachycardia (SVT) is a very common cause of hospital admission and its diagnostic and treatment may be difficult sometimes. While vagal maneuvers or intravenous adenosis administration during 12-lead ECG recording should be performed in hemodynamically stable patients for diagnosis and treatment, hemodynamically unstable patients should be carioverted immediately. The new ESC guideline (2019) on diagnosis and clinical management of SVT significantly upgrades catheter ablation and gives it a new preferential status. ⋯ The therapy of supraventricular tachycardia during pregnancy should be free of antiarrhythmic medication, especially in the first trimester. If ablation is necessary during pregnancy, only fluoroscopy-free mapping systems should be used. This review covers aspects of ECG diagnosis and guideline-based treatment of SVT.
-
Dtsch. Med. Wochenschr. · Dec 2020
Review[Behavioural Changes Caused by Parasites: The Parasite Manipulation Hypothesis].
Bacteria, archaeae, fungi and viruses of the intestinal microbiome play an important role as symbionts in the complex human ecosystem. Parasites, which account for about 40 % of the earth's biodiversity, depend on hosts to complete their life cycle. This article explains how they use them and which signalling pathways play a role in this, using toxoplasmosis and malaria as examples. ⋯ The assumption of an adaptive manipulation of humans by T. gondii in the sense of a cause-effect relationship is not proven. Alternative explanations include the inflammatory and immunological processes on the host side, which change the neuronal signal transduction as concomitant symptoms of an infection. Even without confirmation of parasitic manipulation in humans, it could be worthwhile to further investigate the observed associations in order to develop new possibilities for diagnosis and therapy, e. g. for schizophrenia.
-
Dtsch. Med. Wochenschr. · Dec 2020
Review[Placebo Effect - The Benefit of "Nothingness" in Pain Therapy].
For a long time considered ineffective, placebos nowadays have an accepted role in studies as well as clinical practice. The identification of psychological as well as neurophysiological mechanisms helped to conceptualize and legitimize the placebo effect. ⋯ Consequently, the benefits of a thoughtfully applied placebo effect are increasingly being exploited. This article reviews the concept and current understanding of the placebo effect and depicts its use in the field of pain management.