Deutsche medizinische Wochenschrift
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Dtsch. Med. Wochenschr. · Sep 2022
[Update on the diagnosis and management of SIADH and Diabetes insipidus].
Dysnatremia is a common occurrence in patients with COVID-19 and is associated with higher mortality and risk for septic conditions. The pathomechanisms are probably multifaceted, but severe hyponatremia may also occur as a result of underlying SIADH or hypocortisolism. Patients with preexisting AVP dysfunction, like SIADH or diabetes insipidus, are at high risk for severe electrolyte imbalances in the event of a COVID-19 infection. ⋯ Fluid restriction has long been considered as first-line treatment of chronic hyponatremia due to SIADH. Additional treatment with Furosemid and/or oral NaCl tablets does not improve efficacy but reduces tolerance to therapy. Copeptin-based dynamic tests show higher diagnostic accuracy in the differential diagnosis of patients with hypotonic polyuria polydipsia syndrome than the indirect water deprivation test.
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Dtsch. Med. Wochenschr. · Sep 2022
[Pulmonary Disease caused by less common Nontuberculous Mycobacteria - New international guidelines].
The spectrum of pulmonary disease caused by nontuberculous mycobateria (NTM) is diverse, and each species requires species-specific therapy. With the new ATS/ERS/ESCMID/IDSA guideline on the management of pulmonary disease caused by NTMs covering only the most common pathogens, namely M. avium complex (MAC), M. kansasii, M. xenopi, and M. abscessus, it was necessary to write treatment recommendations for pulmonary disease caused by rarer NTM species that were still represented in the old 2007 guideline. The panel of guideline committee members from the ATS, ERS, ESCMID, and IDSA- therefore, independently of the professional societies, again conducted systematic literature reviews to develop evidence-based recommendations for the treatment of lung disease caused by seven additional organisms: M. chelonae, M. fortuitum, M. genavense, M. gordonae, M. malmoense, M. simiae, and M. szulgai. A German summary of these international recommendations is presented here.
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Thalassemias are a heterogeneous group of genetic diseases based on a quantitative disorder of globin chain synthesis. They are among the most frequent monogenic hereditary diseases worldwide. ⋯ The complex treatment of the patients represents a medical and socioeconomic challenge with the need for structured interdisciplinary clinical care and close collaboration among healthcare providers, regulatory authorities, and health care insurance companies. The following article provides an overview of the causes, pathogenesis, clinical presentation, and treatment of alpha- and beta-thalassemias.