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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Acute interstitial nephritis (AIN) is a cause of acute kidney injury and characterized by an inflammation of the tubulointerstitial space, leading to a decline in kidney function. Multiple etiologies can cause AIN including medications, autoimmune diseases and infections. A multiplicity of drugs is associated with AIN, while antibiotics (especially beta-lactams), proton-pump inhibitors (PPI) and non-steroidal anti-inflammatory agents (NSAIDs) are the most common. ⋯ Small rodents (mostly mice) are the host of the virus accountable for a rising number of infections during spring and summer. It is causing a syndrome consisting of AIN, fever and often thrombocytopenia. There is a good chance of complete recovery of kidney function following NE.
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Lung carcinoma is still one of the most common forms of cancer in both sexes in Germany and the most common cause of cancer-related death. However, we are in the midst of a revolution in the treatment of lung cancer. Above all, the new immune and target therapies as well as the possible combinations of the individual therapy components have expanded the spectrum of drug therapy for lung cancer in recent years. ⋯ The full guideline is available at https://www.leitlinienprogramm-onkologie.de/leitlinien/lungenkrebs/ or in the guideline program app. There are already new treatment options that have not yet been taken into account in the recommendations. In order to take account of the dynamics of medical progress, the S3 guideline is going to be continued as a living guideline with annually updates.
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Current publications on the topic of communication in intensive care units (ITS) are shaped by the experiences of the COVID19 pandemic and the restrictions on personal contact and communication experienced during this time. Virtual, computer-based and telemedical concepts have grown out of this situation with limited contact and communication possibilities with patients and their relatives, but also between the individual service providers in the health system. It can also be assumed that artificial intelligence will increasingly be an issue in communication in intensive care units in the coming years. However, the significance, consequences and risks of the use of these new possibilities remain to be seen.