Deutsche medizinische Wochenschrift
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Hemochromatosis is a disorder of genetic origin which affects iron hemostasis, resulting in an increased transferrin saturation, hyperferritinemia and parenchymal iron overload. Recently, a new system for the classification of hemochromatosis has been proposed, wherein patients are separated into 4 groups, based on the disease affected iron regulatory genes. Excess iron and increased transferrin saturation results in the formation of non-transferrin bound iron which leads to tissue damage. ⋯ In order to provide ideal care for hemochromatosis patients, it is crucial to delineate hemochromatosis from other causes of hyperferritinemia, which is a common finding in patients with metabolic disorders. This article summarizes the diagnostic algorithm for hemochromatosis. Furthermore, recommendations for optimal care - including targets for phlebotomy - are discussed.
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Women have a higher lifetime risk of venous thromboembolism (VTE) than men. Hormone-associated risk factors such as pregnancy, contraception and hormone replacement therapy contribute significantly to this. ⋯ Affected women should be informed that the risk of VTE recurrence is increased in a subsequent pregnancy and usually requires VTE prophylaxis with low molecular weight heparin during pregnancy. If the suspicion of recurrent VTE arises during pregnancy, diagnostics must be carried out promptly so that deep vein thrombosis and/or pulmonary embolism can be reliably confirmed or ruled out.
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Dtsch. Med. Wochenschr. · Oct 2024
Case Reports[Emergence of a multidrug-resistant tuberculosis through inadequate treatment of isoniazid monoresistance].
We admitted a 65-year-old patient with suspected reactivation of a pulmonary tuberculosis for further diagnosis. ⋯ Treating tuberculosis, considering drug resistances is crucial. To avoid ineffective therapy, molecular diagnostic methods are recommended, however, cultural testing remains essential. Diagnostic latency, rising rates of drug resistances and lengthy treatment courses contribute to the complexity of treatment. In Germany, specialized outpatient clinics are available since 2014 for diagnosis and treatment of patients with tuberculosis or non-tuberculous mycobacterial diseases, even in the event of mere suspicion.
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Dtsch. Med. Wochenschr. · Oct 2024
[Assisted suicide in Switzerland, a model in the international discussion about medical aid in dying: framework conditions and long-term development of a new societal and medical-ethical phenomenon].
In the observation period between 1999 and 2022, the Swiss Federal Statistical Office recorded 14 170 assisted suicide (AS) cases. During this 24-year period, the annual number of cases increased significantly: While only 63 cases were observed in 1999, the number of cases in 2022 amounted to almost 1600, corresponding to 2.1 % of all deaths in Switzerland. The most common underlying disease group for AS was cancer, accounting for 40 % of cases. AS is mainly chosen by women (unchanged over time at 58 % of cases) and is primarily a geriatric phenomenon: In 2022, the median age of those who opted for assisted dying was 81 years; the median age of those who chose AS due to cancer was 77 years, while the median age of those who died with non-cancer-related AS was 84 years.