Deutsche medizinische Wochenschrift
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The current guidelines on the diagnosis and treatment of pulmonary hypertension (PH) contain several important new aspects. The definition of PH is changed to a mean pulmonary arterial pressure (mPAP) of >20mmHg in combination with PVR threshold value of >2 Wood units to a define a precapillary component. The clinical classification of PH still distinguishes 5 main groups. ⋯ In high-risk patients, initial triple combination therapy with additional prostacyclin analogues should be considered. Diagnosis and treatment of CTEPH including pulmonary endarterectomy, medical therapy and pulmonary balloon angioplasty should be carried out in CTEPH centers. Patients with severe PH (PVR >5WE) due to PH group II, III or V should be referred to the PH center for study inclusion or individual therapy.
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Despite clear guideline recommendations, only about every second PAD patient is prescribed statins, women less often than men. There is an international consensus that every PAD patient should be treated with statins, as these not only lower lipids but also stabilize plaque, resulting in a prognostic benefit. Limb-related endpoints (MALE) can be reduced by 24% compared to placebo by lowering lipids. ⋯ About 20% of the population have severely elevated Lp(a) levels that require risk factor management beyond lipid management. A high Lp(a) concentration is associated with PAD progression as an independent risk factor for all atherosclerosis manifestations. Every adult should have an Lp(a) assessment once in their lifetime.
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Myelodysplastic syndromes (MDS) represent a heterogeneous group of myeloid disorders characterized by peripheral blood cytopenias and increased risk of transformation to acute myeloid leukemia (AML). Recent developments include the classification and the estimation of prognosis. In 2022 the former 2016 WHO classification was replaced by the ICC and WHO 2022 classification. ⋯ The COMMANDS trial has just reported an interim analysis, where the superiority of luspatercept in the 1st line compared to erythropoietin could be demonstrated. In addition, data from the phase III trial with Imeltelstat give reason to hope that we will be able to offer a new second-line therapy to LR-MDS patients. For higher risk MDS patients azacitidine therapy remains the standard of care, results of phase III trials of combination therapies must be awaited.
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Frailty affects approximately one in two patients over 70 years of age in the emergency department. These are inadequately identified as high-risk patients using conventional triage tools. Frailty screening improves the identification of high-risk patients with increased hospitalisation and readmission rates, 30-day and one-year mortality. ⋯ Inpatient admission is partly avoidable, even if this is associated with health risks. This should be discussed with the patient within the framework of participatory decision-making. In advanced frailty, the needs correspond to those of palliative patients.
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Viral hemorrhagic fevers (VHF) are serious, often fatal diseases that affect humans and non-human primates. The nomenclature of these diseases has changed in that they are now referred to as viral diseases because the previously named symptoms of fever or hemorrhages are not obligatory. In this article, the focus will be on the VHFs Ebola and Marburg viral disease with the potential for human-to-human transmission; these diseases are so-called high-consequence infectious diseases (HCID), some with considerable potential for epidemic spread and the risk of nosocomial transmission.