Deutsche medizinische Wochenschrift
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Pain in the musculoskeletal system and therefore joint pain is one of the most common reasons for consulting a general practitioner (GP). Inflammatory rheumatic diseases are among the important differential diagnoses. ⋯ This article presents the first differential diagnostic steps that make it easier for the GP to make further treatment decisions. Physical examination, laboratory diagnostics and imaging are discussed, and the concept of "clinically suspect arthralgia" as well as the possible effects of treatment trials with glucocorticoids are presented.
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Food allergies are divided into 2 main categories: IgE-mediated and non-IgE-mediated food allergies. Both forms can have significant health effects but differ in mechanism, symptoms, and management. The manifestation of the 2 forms differs between children and adults. ⋯ This article provides an in-depth review of both types of food allergy, discussing their potential causes, diagnostic possibilities, and available therapeutic strategies. Some diseases represent a mixed form of IgE and non-IgE-mediated immunological adverse reactions. Eosinophilic oesophagitis is the most common eosinophilic disease, and the diagnosis and treatment options are explained in more detail below.
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Dtsch. Med. Wochenschr. · Sep 2024
Review[Multi-resistant pathogens - are they also resistant to disinfectants?].
Epidemiological studies show that the care of patients in rooms with a previous stay by a person with evidence of multi-resistant pathogens (MRP) is associated with an increased risk of these pathogens occurring. The question therefore regularly arises as to whether MRP also exhibit resistance to the disinfectants used. To date, there are no standardised definitions for "resistance" to disinfectants. ⋯ A reduced sensitivity to disinfectants can occur in individual isolates due to selection under sub-inhibitory concentrations of disinfectants. Resistance mechanisms to antibiotics do not mediate cross-resistance to disinfectants, but a change in the permeability of bacterial cells can influence sensitivity to disinfectants and antibiotics. In general, the success of routine disinfection can be improved by suitable process controls and contribute to reducing the transmission of MRP.
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Dtsch. Med. Wochenschr. · Sep 2024
Review[Small intestinal bacterial overgrowth (SIBO) - Therapy, nutrition, microbiome].
SIBO (small intestinal bacterial overgrowth) is defined by bacterial overgrowth or colonization of the small intestine in combination with gastrointestinal symptoms such as bloating, nausea, pain, diarrhoea, malabsorption and food intolerance. SIBO can be caused by various mechanisms such as reduced intestinal motility, altered gastrointestinal anatomy, reduced gastric acid or pancreatic enzyme production, altered bile acid metabolism, or immune defects. Accordingly, SIBO often develops secondary to different underlying diseases. ⋯ However, both aspects have so far been insufficiently investigated. Nevertheless, elemental diets, carbohydrate-reduced diets, as well as pre- and probiotics are potential therapy options. This article provides a summary of current knowledge on the pathophysiology, diagnosis and treatment of SIBO, with particular emphasis on the role of nutrition and the microbiome.
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Dtsch. Med. Wochenschr. · Sep 2024
Case Reports[Severe complicated malaria caused by Plasmodium falciparum in a female traveler returning from Zanzibar].
A 25-year-old female outpatient presenting with fever and micro-hematuria was treated for urinary tract infection. Her condition worsened over 3 days at home. After experiencing multiple falls caused by leg weakness and mental confusion, she was admitted to a hospital with high fever. ⋯ The evaluation of fever is often challenging, but most often a detailed patient history is key to early diagnosis and treatment preventing deathly outcomes in severe cases.