Deutsche medizinische Wochenschrift
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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.
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Dtsch. Med. Wochenschr. · Sep 2022
Case Reports[Hypoglycemia in a patient treated with a SGLT2-inhibitor with HFrEF without diabetes mellitus].
HFrEF (heart failure with reduced ejection fraction) with a left ventricular ejection fraction of 25-30 % was detected in a 79-year-old man. For further treatment, inpatient cardiac rehabilitation war carried out. ⋯ The presented case raises awareness of the side effect of hypoglycaemia, which occurs very rarely with SGLT2 inhibitors in studies in patients with HFrEF without the presence of diabetes mellitus.
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Dtsch. Med. Wochenschr. · Sep 2022
[Pulmonary Disease caused by less common Nontuberculous Mycobacteria - New international guidelines].
The spectrum of pulmonary disease caused by nontuberculous mycobateria (NTM) is diverse, and each species requires species-specific therapy. With the new ATS/ERS/ESCMID/IDSA guideline on the management of pulmonary disease caused by NTMs covering only the most common pathogens, namely M. avium complex (MAC), M. kansasii, M. xenopi, and M. abscessus, it was necessary to write treatment recommendations for pulmonary disease caused by rarer NTM species that were still represented in the old 2007 guideline. The panel of guideline committee members from the ATS, ERS, ESCMID, and IDSA- therefore, independently of the professional societies, again conducted systematic literature reviews to develop evidence-based recommendations for the treatment of lung disease caused by seven additional organisms: M. chelonae, M. fortuitum, M. genavense, M. gordonae, M. malmoense, M. simiae, and M. szulgai. A German summary of these international recommendations is presented here.
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Immunosuppression is an essential prerequisite for successful transplantation. In order to reduce the sometimes-considerable side effects, combination therapies with different agents are used. This article aims to provide an up-to-date overview of immunosuppression after liver and kidney transplantation.
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Urinary tract infections are among the most common bacterial infections. A significant proportion of urinary tract infections recur, which leads to impairments in patients' physical intimacy, social contacts and ability to work. The standardised ACSS questionnaire can provide help in establishing a diagnosis and assessing the course of the disease. ⋯ Non-antibiotic strategies most notably include personal counselling with communication of behavioural recommendations, immunoprophylaxis, phytotherapeutics and local oestrogen substitution. However, in cases of high patient suffering, antibiotic prophylaxis should also be considered after due deliberation. In summary, individual counselling should take place and treatment should be given in a multimodal therapeutic approach.