Deutsche medizinische Wochenschrift
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In an unprecedented collaborative effort, basic and clinical scientists have provided us with an effective COVID-19 vaccine within less than one year after SARS CoV-2 emergence. Virus or vaccine induced immunity may offer different degrees of protection against infection, transmission and pathology (disease). Immunity decides on the outcome of COVID-19, both at an individual as well as a population level. ⋯ Based largely on clinical data, this literature analysis suggests that antiviral immunity against Coronaviruses including SARS CoV-2 is waning significantly over time regarding infection and transmission protection. However, in individuals who have recovered from infections with human Coronaviruses (including SARS CoV-2) or been vaccinated against SARS CoV-2, immunity is robust in its most critical quality: protection against pathology/severe disease. Thus, immunologists see the glass half-full and envisage the transition of COVID-19 from an epidemic to an endemic state with semiannual peaks of incidence but, most importantly, protection from severe COVID-19 or death in the vast majority of individuals (as observed in other human Coronavirus infections).
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The effective reduction of atherogenic lipoproteins has contributed to the rate of atherosclerosis-related cardiovascular complications being approximately halved over the last 50 years. Nevertheless, cardiovascular disease will be the leading cause of death worldwide in the coming years. The focus of this review is on the clinical significance of the pathophysiology of changes in lipid and lipoprotein metabolism. ⋯ Primary forms of hypercholesterolaemia have a significantly higher ASCVD risk because of the already lifelong LDL elevation (higher cumulative LDL exposure for the vessel wall). Secondary changes in lipid and lipoprotein metabolism (e. g. in diabetes or hypothyroidism) must be excluded or treated. Regulatory key steps in the pathophysiology of lipid metabolism and atherosclerotic plaque are "drug targets" for existing and new lipid and lipoprotein modifying therapies.
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In recent years, clinically significant advances have been made in the management of giant cell arteritis and Takayasu arteritis. This concise review article highlights important aspects of the diagnostic workup and imaging-based treatment surveillance of the large vessel vasculitides.
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Dtsch. Med. Wochenschr. · Nov 2021
[Non-invasive Home-Ventilation: Pathophysiology, Initiation and Follow up].
COPD is the most common reason for hypercapnia. However, it is -by far- not the only reason. In fact, numerous neuromuscular disorders (not only ALS) as well as restrictive thoracic disorders do also lead to clinically highly relevant hypercapnia. ⋯ Firstline settings for a NIV therapy to treat "stable hypercapnia" are as follows: Pressure Support Ventilation Modus, EPAP 5 cmH2O, IPAP 15 cmH2O, Back Up rate 15/Minute. The overall goal of NIV treatment is a successful reduction in CO2. This can be achieved by changing the following variables of the ventilator settings: increase in IPAP ± increase in back up respiratory rate ± use of assisted pressure controlled ventilation mode (APCV).