Deutsche medizinische Wochenschrift
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Dtsch. Med. Wochenschr. · Sep 2022
Review[Pharmaceutical therapy of infarct-related cardiogenic shock].
Acute myocardial infarction complicated by cardiogenic shock (AMI-CS) is a comparably seldom but fatal entity. The definition of cardiogenic shock - unlike e. g. septic shock - is not uniform. Immediate revascularization is central to the patient's prognosis in AMI-CS. Patients who continue to meet the criteria of shock despite revascularization should be hemodynamically phenotyped to allow guidance of personalized subsequent therapy. ⋯ PDE-III (phosphodiesterase enzyme type III)-inhibitors should be used with restraint in myocardial infarction. Dopamine is no longer recommended in Europe. A sasodilator may be an option in highly selected patients with AMI-CS. This review will provide a detailed updated overview on pharmacological treatment modalities and indications in individual patients.
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Dtsch. Med. Wochenschr. · Sep 2022
[Acute respiratory tract infections and antibiotic prescriptions: What are patients' expectations?]
The use of antibiotics in human medicine is partly responsible for the global increase in antibiotic resistance. Significant reductions in antibiotic prescribing were realised through educational campaigns, communication training and prescribing feedback. Based on data from the cluster-randomised CHANGE-3 trial, the present analysis focuses on the question of patient expectations for an antibiotic in acute respiratory infections. ⋯ Patients still receive antibiotics more often than they actually hope for. On the part of GPs, prescriptions may still be written because of perceived pressure from patients, but this is not reflected in patient expectations. In addition to dealing openly with patients' expectations, strengthening patients' health literacy, mindful doctor-patient communication and offered opportunities for re-presentation in the case of specific diagnoses could further reduce the perceived pressure on GPs.
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Dtsch. Med. Wochenschr. · Sep 2022
[Congenital hemolytic anemias due to erythrocyte membrane and enzyme defects].
Erythrocyte membrane and enzyme defects are the most common cause of congenital hemolytic anemias in the Central European population. Diagnostics include erythrocyte morphology, special biochemical tests such as osmotic fragility (AGLT) and EMA. For enzymopenic hemolytic anemias, cost-effective biochemical analysis remains the gold standard, supplemented by molecular genetic diagnostics when appropriate. ⋯ Aplastic crises in the setting of parvovirus B19 infection occur in all congenital hemolytic anemias. Transfusion is not preventable in most cases. Iron-excreting treatment is required in the rare patients in need of chronic transfusion.
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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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A large proportion of patients with peripheral arterial disease (PAD) remain asymptomatic with respect to peripheral reduced perfusion. Most symptomatic patients present with walking distance limitation, intermittent claudication. In the advanced stage, critical limb ischemia, rest pain, gangrene, or ulceration occur. ⋯ In patients with critical limb ischemia, the focus is on leg preservation, improvement of quality of life, and amputation-free survival. Regardless of the stage of symptoms, cardiovascular risk factors should be optimally adjusted to reduce peripheral vascular, cardiovascular, and cerebrovascular events. In addition to conservative therapy with intensive gait training, endovascular and open vascular surgical revascularization are significant in the treatment of PAD.