Deutsche medizinische Wochenschrift
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Parasites are a diverse group of pathogens; they range from unicellular protozoa (e. g. Giardia lamblia) to tapeworms that can grow several meters long. Parasites have adapted to humans over millions of years and cause a wide, colorful variety of diseases. ⋯ Nonetheless, the diagnosis is often delayed due to lack of experience of attending clinicians with parasitic infections. In this review article we give an overview of the epidemiology, transmission, diagnosis and treatment of some of the most common parasitic infections that are endemic, or regularly imported to Germany. We also discuss current and future challenges in the diagnosis, treatment and control of these pathogens.
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Dtsch. Med. Wochenschr. · Jun 2022
Review[Gastrointestinal motility disorders in critically ill patients].
The gastrointestinal tract is one of the most complex organ systems of the human body. On the one hand, it forms the absorption surface for nutrients, but on the other hand it is also a barrier for toxins, food components and against up to 1014 commensal microorganisms. ⋯ In this article, we review the latest updates on pathogenic relationships of motility disorders and diagnostic algorithms in intensive care patients. In addition to established therapies, new developments in the treatment of hypomotility are outlined.
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Dtsch. Med. Wochenschr. · Jun 2022
Review[Long known and mostly unused: lifestyle measures to support lipid-lowering therapy].
Dyslipidemias are common metabolic disorders in Western industrialized countries. Lifestyle measures such as increasing physical activity and improving diet were for many years the only measure for their treatment. ⋯ Due to the numerous efficient options for intensive lipid-lowering medication, lifestyle measures are recommended by responsible physicians, but their implementation is usually not intensively pursued due to the large time commitment; in contrast to sustained recommendations for increasing physical activity and normalizing body weight, nutritional therapists are too rarely consulted as specialists despite the significant effects our diet has on cardiovascular risk factors such as LDL-cholesterol, triglycerides and blood pressure. In this review, the principles of nutritional therapy of dyslipidemias are described, and it is outlined how recent studies support the plausibility and evidence of the individual measures.
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The use of red blood cell concentrates must follow the dictates of a rational indication. To further ensure this, the "Cross-Sectional Guidelines for Therapy with Blood Components and Plasma Derivatives" 1 of the German Medical Association, published in 2009 and last revised in part in 2014, were systematically revised in 2020. This article presents them.
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Dtsch. Med. Wochenschr. · Jun 2022
[Current pathophysiological concepts of acute decompensation in patients with liver cirrhosis and prognostic scores in different stages of disease].
Acute decompensation and acute-on chronic liver failure (ACLF) are associated with a significant reduced prognosis. Previously, the pathophysiological concept of acute decompensation was mainly based on the peripheral vasodilatation hypothesis. However, during the last years, systemic inflammation was recognized as a major driver for decompensation of liver cirrhosis and ACLF. ⋯ Inflammation also affects the function of extrahepatic organs and therefore leads to the development of an inflammatory cirrhotic multi-organ syndrome. The importance of systemic inflammation in the context of decompensated liver cirrhosis is also transferred to new clinical scores such as the CLIF-C AD and CLIF-C ACLF score. In this article, we provide an overview of the new systemic inflammation hypothesis of decompensated cirrhosis and also discuss current clinical scores for prognostication in different stages of liver cirrhosis.