Deutsche medizinische Wochenschrift
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Dtsch. Med. Wochenschr. · May 2020
Review[Reclassification of diabetes mellitus based on pathophysiologic and genetic features].
Diabetes mellitus has been defined by hyperglycemia, but in addition to hyperglycemia, there are several other factors determining the clinical course and complications. We review the current classification of diabetes and recent attempts to identify new subphenotypes. Notably, there are anthropometry-pathophysiology based and genome-based subphenotyping approaches. They aim to improve the prediction of disease course and complications and could pave the way for precision medicine in the therapy of diabetes.
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The Coronavirus Disease Pandemic 2019 (COVID-19), caused by the Severe Acute Respiratory Syndrome-related Coronavirus 2 (SARS-CoV-2), started in December 2019 in China. SARS-CoV-2 is easily transmitted by droplet infection. After an incubation period of 1-14 days, COVID-19 shows a mild course in 80 % of observed cases and a severe course in 20 %, with a lethality rate of 0.3-5.8 %. ⋯ So far there are neither effective drugs nor vaccinations available, so only public health interventions such as physical distancing and hygiene measures on the one hand and targeted testing followed by isolation and quarantine measures on the other hand are available. China has shown that maximum use of these measures can control the epidemic. The further course and also the consequences for the global economy cannot be clearly predicted at present.
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Gestational diabetes is asymptomatic. Screening in Germany has been part of the maternity guidelines since 2012. Uncovering the glucose tolerance disorder and intensive treatment reduce maternal and child risks. ⋯ In 70-90 % of GDM cases, non-pharmacological basic therapy is sufficient; the gold standard in pharmacotherapy is insulin. Maternity clinics with a spatially connected children's clinic offer the best security for mother and child at birth. Breastfeeding should be recommended and encouraged because of its long-term protective effects.
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Dtsch. Med. Wochenschr. · May 2020
Case Reports[Position dependent dyspnea and cyanosis of the lips at the daily round - A case of Platypnea-Orthodeoxia Syndrome].
We elaborate a case of a 79-year-old patient who presented with position dependent shortness of breath and cyanosis of the lips at the daily round. ⋯ The combination of position dependent shortness of breath and decreased oxygen saturation should lead to the diagnosis of Platypnea-Orthodeoxia Syndrome. The underlying reasons are diverse and not only of cardiologic origin.
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Dtsch. Med. Wochenschr. · May 2020
[Nighttime restlessness in elderly patients: differential diagnosis and treatment - Differential diagnosis and therapy].
Elderly individuals, particularly those with cognitive impairment, are oftentimes restless during the night, and this increases the distress of relatives, professional carers and themselves. A number of conditions other than dementia need to be considered from nyctophobia and insomnophobia, to pain, specific motor disorders during sleep, parasomnias as REM-sleep behaviour disorder, dipping, hypoglycemia, withdrawal or excessive tea, coffee and alcohol consumption. A clear-cut differential diagnosis between dementia and delirium is not always possible, as dementia is the major risk factor for confusional states decreasing the vulnerability by anticholinergic medication and any other disruptive factor, biological or psychological. ⋯ Quetiapine or mirtazapine at low dosages can be employed in patients with psychotic or depressive symptoms. Melatonin and its derivatives hold promise for chronic circadian rhythm disorders. There is no "one fits all" recipe for this notorious problem and each case needs to be examined individually.