Deutsche medizinische Wochenschrift
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Dtsch. Med. Wochenschr. · Nov 2021
[Clinical benefit of Tocilizumab and other immunomodulating agents for treatment of COVID-19].
The pathophysiological course of COVID-19 can be distinguished in a phase of viral replication and an inflammatory phase. Hyperinflammatory processes promote the development of severe COVID-19. Therefore, immunomodulating agents came into focus. ⋯ Treatment with JAK inhibitors is an option for hospitalized patients with moderate COVID-19. It should be emphasized that comedication of JAK inhibitors and Tocilizumab is not recommended. Further high quality research is required for the widespread use of immunomodulating agents in COVID-19.
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First goal in an emergency department must be the immediate recognition of patients at risk. The primary success of therapy depends mainly on whether a critical risk is identified immediately upon arrival at the central emergency department and appropriate therapy is initiated. In order to identify critical patients among the many patients with a wide range of diseases and, nurse-assisted initial assessment systems can help. The assessment thus represents a complex decision-making process to identify critically ill patients in times of high patient volume and limited resources.
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Dtsch. Med. Wochenschr. · Nov 2021
[KDIGO 2021 guideline glomerulonephritis - focus on ANCA-associated vasculitides and anti-glomerular basement membrane glomerulonephritis].
In 2021 new KDIGO (Kidney Disease: Improving Global Outcomes) guidelines for the management of glomerular diseases were published. For ANCA-associated glomerulonephritis the new recommendations comprise a more rapid steroid taper during induction treatment with cyclophosphamide or rituximab, the advice against routine use of plasma exchange, the choice of drug for and duration of maintenance treatment in accordance with predictors of relapse. A kidney transplant should be performed after at least 6 months of remission irrespective of the ANCA titer in ANCA-associated disease, and 6 months after absence of anti-GBM-antibodies in anti-GBM-disease.
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Dtsch. Med. Wochenschr. · Nov 2021
Review[Neoadjuvant and adjuvant therapy of resectable colon cancer - Current standards and developments].
The present review focusses on perioperative diagnosis and treatment of resectable colon cancer. In UICC stages associated with a higher risk of recurrence, adjuvant chemotherapy after resection of the primary tumor is an established standard. While initial data also indicate the benefit of Neoadjuvant, pre-operative chemotherapy, a final evaluation is still pending. ⋯ However, it cannot be considered a predictive factor for the efficacy of adjuvant chemotherapy. Specifically, recent data of the IDEA study have opened the arena for shared decision making between physicians and patients allowing to define individual treatment approaches based on common assessment of risks and benefits. After completion of perioperative treatment, structured follow-up is of great importance and should be carried out according to the recommendations of the S3 guideline.