Deutsche medizinische Wochenschrift
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Pharmacogenomics (PGx) is a key component of personalized medicine to improve clinical outcome of drug therapy and/or to avoid adverse drug reactions. Major efforts are currently spent internationally to implement PGx diagnostics into clinical practice. Evidence-based recommendations for dose-adjusted treatment which are established by international expert groups covering clinical and pharmacological expertise are publicly available. Clinical relevant examples for PGx diagnostics such as genetic testing for dihydropyrimidin-dehydrogenase and thiopurin-S-methyltransferase, as well as for various cytochrome P450 enzymes are summarized to promote the clinical implementation process of PGx in Germany.
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Polypharmacia is a frequent challenge in modern medicine due to increasing complexity of both patients' aspects in an ageing society - multimorbidity - and progress of therapeutic approaches. Although risks are clearly increasing with number of simultaneously prescribed drugs, neither analysis of the polypharmacia-problem solely by number nor focusing on deprescribing strategies by number alone is sufficient. ⋯ Pattern analysis may help this, by identifying both the most vulnerable patients and polypharmacia-pattern with pronounced risk burden. Patient vulnerability depends significantly on functional abilities and prioritizing therapeutic goals in a comprehensive deprescribing process needs to implement stage of life and disease.
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Dtsch. Med. Wochenschr. · Jan 2021
Review[Metformin Therapy During Surgical Interventions and Iodinated Contrast Agent Use].
Metformin as first-line treatment in type 2 diabetes mellitus (T2 D) shows benefits in terms of reducing cardiovascular events, but the risk of a lactic acidosis as a serious adverse event especially in patients with decreased renal function is still relevant. Since the perioperative management of Metformin or its use in diagnostic procedures with contrast agents is inconsistent in literature and different in practice, the results of various guidelines are reviewed below showing the current state of evidence. Despite many guidelines, the evidence on both issues is low, as they are mainly based on consensus recommendations. ⋯ At present, it is not possible to give reliable recommendations for practice with the aim of minimising the interruption of therapy. For this reason, only a strictly conservative approach with 48-hour breaks before and after both measures can be recommended at present. For the situations mentioned in this overview, the question of the right approach has not yet been conclusively and definitely answered, therefore further studies should be carried out.
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Oxygen treatment is being widely used in intensive care and emergency medicine and is required to maintain aerobic metabolism. It may be administered by nasal cannula, face mask, high-flow therapy, and by ventilation. Under clinical circumstances, blood oxygen concentration is not relevantly increased above a partial pressure of 80 mmHg. ⋯ For other conditions, no benefit has been shown for hyperoxia, but undoubtedly, hypoxemia must be avoided, as well. Therefore, a normoxic oxygenation strategy should be employed. The optimal oxygenation targets for distinct conditions need to be further defined.