Deutsche medizinische Wochenschrift
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Dtsch. Med. Wochenschr. · Feb 2020
[Glomerulonephritis, diseases not only important for nephrologists].
Chronic kidney disease (CKD) is an increasing health problem in all societies. The role of diabetes mellitus and hypertension in CKD is well established in the medical community. This is not necessarily the case for the various forms of glomerulonephitis (GN). ⋯ Since many forms of GN have only sparse clinical symptoms at the beginning of the disease and the treatment is only effective in early stages, it is important for patients' outcome to make an early diagnosis. In case of any - even small - changes in the urine of patients the diagnoses of GN should be considered. It is the purpose of this article to describe the clinical significance and the road to the diagnosis of the most frequent forms of GN to allow an early start of therapy in order to prevent the development of ESRD.
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Myocarditis is a heterogenous disease regarding aetiology, clinical presentation and course. A defined diagnostic procedure is needed to reliably detect myocarditis. While findings from medical laboratory parameters, electrocardiography and echocardiography are rather unspecific, endomyocardial biopsies supply dependable data regarding inflammatory and viral status. ⋯ Currently, treatment of myocarditis symptoms and heart failure is in the focus of clinical care. In addition, cardiac involvement in systemic inflammatory diseases should be stringently treated via immunosuppression. Avoidance of physical exercise has to be observed in order to reduce cardiac strain and consequently the number of adverse events.
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While monitoring and symptomatic care is sufficient for most intoxicated patients, some develop life threatening symptoms. We present recent changes in the recommendations of the treatment in patients with calcium channel blocker, beta blocker and high dose paracetamol intoxications. Additionally, new insights in the efficacy and safety of the use of physostigmine in anticholinergic patients and beta blockers in cocaine intoxication are discussed as well as the specific considerations in the resuscitation of intoxicated patients.
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Dtsch. Med. Wochenschr. · Feb 2020
[Sepsis: Sequelae for Affected Patients and The Health Care System].
The number of patients who survive sepsis is growing. However, two of three sepsis survivors suffer from new physical or mental sequelae. Cognitive deficits, depression or limitations of the activities of daily living can seriously impair quality of life and working ability. ⋯ An interdisciplinary approach is necessary to evaluate and treat sepsis sequelae. Survivors and their relatives should be informed about sepsis and possible sequelae as early as possible. Further studies are needed to improve the understanding of pathomechanisms and effectivity of treatment interventions for sepsis sequelae.
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Dtsch. Med. Wochenschr. · Feb 2020
[Reimbursement for tobacco cessation: legislator must give up blockade].
A constitutional expert opinion, which reviews the social and constitutional foundations of tobacco cessation within the framework of statutory health insurance in Germany, comes to the conclusion that the legislator must release the reimbursement of professional tobacco cessation as a curative service by the statutory health insurance - and not only as a subsidy for a psychotherapeutically oriented measure within the framework of prevention.