Deutsche medizinische Wochenschrift
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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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Dtsch. Med. Wochenschr. · Sep 2022
[Mechanical Assist Devices in Cardiogenic Shock Complicating Myocardial Infarction].
In acute myocardial infarction cardiogenic shock is still one of the most feared complications. Although medical and interventional treatment of myocardial infarction improved significantly over the last decades mortality of cardiogenic shock patients remains on unacceptable high levels with 30-day mortality rates of 40-50 %. To date only an early revascularization of the culprit infarct lesion is the only intervention with proven survival benefit for patients. ⋯ This viewpoint gives an overview about the most used devices. The different mechanism of left ventricular support will be explained, and the current evidence discussed. Furthermore, ongoing randomized controlled trials are highlighted.
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Dtsch. Med. Wochenschr. · Sep 2022
[Triglycerides - assessment as risk factor and therapeutic goals].
Elevated triglycerides and their lipidological consequences (small, dense LDL, residual particles (remnants), reduced HDL cholesterol) are an important and independent cardiovascular risk factor. Particularly in diabetes mellitus, hypertriglyceridemia is regarded as the main cause of high cardiovascular morbidity and mortality; very high triglyceride levels can cause acute pancreatitis. This article provides an overview of the current scientific status of the pathogenesis and clinical significance of hypertriglyceridemia.
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Dtsch. Med. Wochenschr. · Sep 2022
[Peptic ulcer disease and H. pylori gastritis: key advances in clinical management].
Helicobacter pylori (H. pylori) gastritis and non-steroidal anti-inflammatory drug (NSAID) intake are the most important risk factors for peptic ulcer disease (PUD) and ulcer bleeding. H. pylori infection was shown to increase the risk of ulcer bleeding in patients with PUD who are taking NSAID, aspirin, or another antiplatelet drug. H. pylori-positive patients on combined platelet aggregation inhibition are at the highest risk of bleeding. ⋯ In patients with successful endoscopic treatment of early GC, H. pylori testing with subsequent eradication also halves the rate of metachronous GC. Clarithromycin-based triple therapy for H. pylori eradication shows a decreasing effectiveness due to increasing antibiotic resistance, especially against macrolides. Accordingly, bismuth-containing quadruple therapy is widely recommended as the standard empiric first-line therapy.
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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.