Deutsche medizinische Wochenschrift
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A majority of COVID patients suffers from hetereogenous symptoms after acute infection which are limiting patients participation in social life, activities of daily living and the return to work. In March 2021, the German Society of Pneumology initiated the AWMF S1 guideline Post-COVID/Long-COVID in order to show an individual practice-oriented, diagnostic and therapeutic clinical algorithm according to the individual symptoms. ⋯ The guideline and, accordingly, this article have an explicitly practical and clinical purpose. The guideline will be further developed by the author team based on the current increase in knowledge this is reflected in the clinical summary article.
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Older age, cardiovascular comorbidities, chronic lung diseases, and GC use were identified as independent risk factors for severe courses of COVID-19 resulting in the need of hospitalization. Glucocorticoid dosis of > 10 mg over a longer period of time should be very carefully used as there are various immunomodulatory alternatives. Of particular note, disease activity of inflammatory rheumatic diseases (IRD) was also identified as an independent predictor of COVID-19 related hospitalization. ⋯ Preliminary data indicate that all available COVID-19 vaccines in Europe are not associated with higher rates of disease flares or differences of side effect profiles compared to the general population. There is no recommendation to discontinue or reduce immunomodulatory treatment in general to achieve better immune response. In the case of Rituximab, consideration should be given to postponing or switching to alternative therapies, taking into account the risk of reactivation of the underlying disease on the one hand and the improvement of a potential vaccine response on the other.
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Dtsch. Med. Wochenschr. · Nov 2021
[Perspective of General Practitioners on Management of Non-dialysis Chronic Kidney Disease - a Qualitative Study].
Chronic Kidney Disease (CKD) is a common diagnosis in older age due to age dependent kidney function decline, as well as an increase in causative diseases like diabetes mellitus and arterial hypertension. The condition knows a long asymptomatic phase in the early stages, and only a small part of the patient will progress to end stage renal disease requiring renal replacement therapy. Patients with CKD are generally managed by General Practitioners (GPs). ⋯ GPs reported that their decisions about CKD management were based on Individual patient factors such as high age or multimorbidity.
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Dtsch. Med. Wochenschr. · Nov 2021
[Locally advanced rectal cancer - Standards and new multimodality treatment concepts].
Treatment strategies for locally advanced rectal cancer are changing dramatically. The treatment recommended in the guidelines for locally advanced tumors of neoadjuvant radio(chemo)therapy (RChT), followed by surgery and, if necessary, adjuvant therapy, are increasingly be abandoned in favor of the following concepts: (i) prolonged neoadjuvant (RChT (i. e. "more chemotherapy before resection", referred to as total neoadjuvant therapy, TNT); (ii) omission of radiotherapy in tumors with a low risk of local recurrence; (iii) organ preservation in patients with a complete clinical response after neoadjuvant radiochemotherapy. Herein, current strategies and study concepts are to be discussed based on the guideline-based status quo.
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Dtsch. Med. Wochenschr. · Nov 2021
[Colorectal carcinoma: from prevention to endoscopic diagnosis and therapy].
In recent decades, significant progress has been made in the diagnosis and treatment of colorectal carcinomas. Prevention and early detection with endoscopic therapy are of central importance. ⋯ Thus, primary and secondary prevention are of considerable importance, although the annual uptake in Germany for screening Kolonoscopy is still only between 1.9 and 4.4 % and for stool test use between 8.6 and 27.1 %. We present here the importance of primary and secondary prevention based on pathogenesis, risk factors and diagnostic and therapeutic endoscopic options.