Deutsche medizinische Wochenschrift
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Dtsch. Med. Wochenschr. · Apr 2020
Practice Guideline[German S3 guideline sepsis: selected recommendations].
The German Sepsis guideline is an interdisciplinary guideline (S3 classification). It is an evidence- and consensus-based instrument for the improvement and quality assurance of prevention, diagnosis, therapy and aftercare of sepsis. It summarizes appropriate, scientifically based and up-to-date procedures for diagnosis, therapy and follow-up. The recommendations of the guideline are intended to serve as a supportive information and decision basis for the clinician in the treatment of adult patients with sepsis or septic shock.
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Dtsch. Med. Wochenschr. · Apr 2020
[Lipid management 2020 - medical therapy and lipid apheresis in context].
The recently updated 2019 European Society of Cardiology/European Atherosclerosis Society Guidelines for the management of dyslipidaemias set new, ambitious goals for lipid lowering based on recently generated evidence from large outcome trials. Noninvasive imaging as well as measurement of lipoprotein(a) as a non-traditional risk factor is advocated for the refinement of risk stratification. ⋯ If needed, lipid apheresis can complement the medical armamentarium. Moreover, lipid apheresis remains the only approved treatment modality for lowering lipoprotein(a), however medical treatments are under current investigation.
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Dtsch. Med. Wochenschr. · Apr 2020
[Abdominal Sonography in Medical Emergencies: do Complete Abdominal Scans offer Advantages over a Focused Strategy?]
To determine, whether in case of abdominal emergencies, complete abdominal ultrasound scans offer advantages over a goal-directed strategy in regard to problem-solving and detection of relevant pathologies. ⋯ In medical abdominal emergencies, ultrasound scans of the complete abdomen detect more relevant pathologies and solve more problems than focused sonography does.
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Dtsch. Med. Wochenschr. · Apr 2020
[Cardiovascular infections - recent progress and future challenges].
Patients with previous endocarditis are at highest risk of infective endocarditis (266-fold compared to the general population) - preventive strategies are of particular importance in this patient subgroup. Patients with community-acquired E. faecalis bacteremia should undergo transesophageal echocardiography - according to a recent study the prevalence of endocarditis may be ≥ 20 % in this setting. Several smaller observational studies suggest an association between E. faecalis endocarditis and colorectal neoplasias - colonoscopy should therefore be offered to patients with newly diagnosed E. faecalis endocarditis (particularly in patients with unknown portal of entry). ⋯ Approximately one out three patients with a left ventricular assist device (LVAD) will suffer from LVAD-related infections during the first year after implantation. Appropriate antibiotic treatment and adequate surgical debridement are essential management strategies.
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A 33-year old Romanian chef presented with sudden onset of chest pain and chills as well as a significant elevation of myocardial markers and CRP. ⋯ Myocarditis is a rare manifestation of Q fever, which should not be missed. The diagnostic evaluation with antibody titers is easy. The antibiotic therapy is well tolerated and is a causal treatment that helps to prevent long-term damage.