Deutsche medizinische Wochenschrift
-
Dtsch. Med. Wochenschr. · Jan 2020
[Mild Hypertension: What are the Limits, Who Should Be Treated How?]
For decades, it was not clear how to deal with mild hypertension in patients, especially with low cardiovascular risk. In particular, the findings of the therapy studies, which have rarely examined the uncomplicated mild case of hypertension due to the low expected event rate, certainly suggest that therapy of mild hypertension in a period of 10 years has little effect on the patients. With a longer observation period and also through insights from register analyzes, especially with systematic follow-up, it becomes clear that it makes sense to treat a mild hypertension even at low cardiovascular risk. ⋯ Patients well below the age of 65 years with mild hypertension and low overall cardiovascular risk should be offered the option to adjust blood pressure even with systolic targets below 130 mmHg. If the patient is older than 65, target blood pressure achievement should not be so ambitious anymore, but also dependent on the tolerance of the patient. Certainly, the practitioner must explain clearly to the younger patient that regular therapy will not necessarily bring him an advantage over the next 10 years, and that the effects may not really materialize until 20 years, and then reduce the risk of stroke or heart attack.
-
Dtsch. Med. Wochenschr. · Jan 2020
[The specialist examination in internal medicine: a qualitative and quantitative analysis of minutes from memory].
The specialist examination entitles to independent professional conduct and is therefore of great significance for the quality of medical care. It should cover the contents of the continuing education regulations. So far, little is known about the actual content of the exam. In this study, the question was, which content and which structural characteristics do specialist examinations in internal medicine in Germany contain. ⋯ In the oral specialist examination in internal medicine in Germany as many topics as in foreign specialist examinations are examined. However, the variance between the individual exams is relatively large. A standardization of the exam is important to create equal exam conditions for all candidates.
-
The prevalence of arterial hypertension with its cardiovascular diseases like myocardial infarction, stroke, chronic kidney disease and peripheral artery disease is increasing in our aging population. Despite numerous efficient and well-tolerated antihypertensive drugs more than eight million people die worldwide from the consequences of insufficiently controlled hypertension every year. One third of the german adult population suffers from high blood pressure. ⋯ It is certainly not decisive to request a broad screening for all hypertensive patients. A certain pre-selection of potential patients is mandatory. The most common types of secondary hypertension are discussed and the diagnostic and therapeutic pathways are specified.
-
Dtsch. Med. Wochenschr. · Jan 2020
[Lyme Borreliosis: Cutaneous and Neurologic Manifestations, Case Definitions and Therapy].
Lyme borreliosis is the most common zoonosis in Germany with an incidence of up to 138/100 000. More than 90 % of all cases show dermatological manifestations. Early manifestations are erythema migrans, multiple erythemata migrantia, and (less frequently) borrelial lymphocytoma. ⋯ Treatment duration for early manifestations is 10 to 14 days, in Lyme neuroborreliosis it should not exceed 21 days. All manifestations, also Lyme neuroborreliosis, usually show a favourable prognosis after antibiotic treatment. Antibiotic treatment does not show any efficacy in patients with unspecific symptoms and concurrent positive anti-borrelial serology.