Deutsche medizinische Wochenschrift
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Gestational diabetes is asymptomatic. Screening in Germany has been part of the maternity guidelines since 2012. Uncovering the glucose tolerance disorder and intensive treatment reduce maternal and child risks. ⋯ In 70-90 % of GDM cases, non-pharmacological basic therapy is sufficient; the gold standard in pharmacotherapy is insulin. Maternity clinics with a spatially connected children's clinic offer the best security for mother and child at birth. Breastfeeding should be recommended and encouraged because of its long-term protective effects.
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Dtsch. Med. Wochenschr. · May 2020
Case Reports[Position dependent dyspnea and cyanosis of the lips at the daily round - A case of Platypnea-Orthodeoxia Syndrome].
We elaborate a case of a 79-year-old patient who presented with position dependent shortness of breath and cyanosis of the lips at the daily round. ⋯ The combination of position dependent shortness of breath and decreased oxygen saturation should lead to the diagnosis of Platypnea-Orthodeoxia Syndrome. The underlying reasons are diverse and not only of cardiologic origin.
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Dtsch. Med. Wochenschr. · May 2020
[Nighttime restlessness in elderly patients: differential diagnosis and treatment - Differential diagnosis and therapy].
Elderly individuals, particularly those with cognitive impairment, are oftentimes restless during the night, and this increases the distress of relatives, professional carers and themselves. A number of conditions other than dementia need to be considered from nyctophobia and insomnophobia, to pain, specific motor disorders during sleep, parasomnias as REM-sleep behaviour disorder, dipping, hypoglycemia, withdrawal or excessive tea, coffee and alcohol consumption. A clear-cut differential diagnosis between dementia and delirium is not always possible, as dementia is the major risk factor for confusional states decreasing the vulnerability by anticholinergic medication and any other disruptive factor, biological or psychological. ⋯ Quetiapine or mirtazapine at low dosages can be employed in patients with psychotic or depressive symptoms. Melatonin and its derivatives hold promise for chronic circadian rhythm disorders. There is no "one fits all" recipe for this notorious problem and each case needs to be examined individually.
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In recent years, high-flow oxygen therapy (HFNC) has become established and proven as an oxygenation method for patients with severe respiratory restrictions in most intensive care units. Advantages of this method, which is used especially for patients with hypoxaemia, are the easy application and the compliance by the patient. Devices are used which enable individual oxygen therapy by means of humidification, warming up and gas flow regulation options.
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Dtsch. Med. Wochenschr. · May 2020
[Therapy of type 2 diabetes - Recommendations of the European Association for the Study of Diabetes (EASD)].
New joint clinical recommendations for the treatment of patients with type 2 diabetes of the european (EASD) and american (ADA) diabetes associations and the european society for cardiology (ESC) implement the evidence from clinical cardiovascular endpoint studies into daily clinical practice. The individual patient profile and it´s cardiovascular risk rather than HbA1c levels alone dominate treatment strategies. In case of high oder very high cardiovascular risk GLP-1-receptor agonists or SGLT-2-inhibitors are the preferred choice, the latter especially in patients with chronic heart failure or increased risk, respectively.