Deutsche medizinische Wochenschrift
-
The present article addresses clinical challenges associated with the choice of the anticoagulant agent, the definition of the duration of anticoagulant treatment and the assessment of the risk-to-benefit ratio of prolonged anticoagulation for patients with pulmonary embolism (PE). Anticoagulation is performed with unfractionated heparin (UFH) in hemodynamically unstable patients and with low molecular weight heparins (LWMH) or fondaparinux in normotensive patients. In patients with high or intermediate clinical probability of pulmonary embolism, anticoagulation should be initiated without delay while awaiting the results of diagnostic tests. ⋯ The risk for recurrent PE after discontinuation of treatment is related to the features of the index PE event. While patients with a strong transient risk factor have a low risk of recurrence and anticoagulation can be discontinued after three months, patients with strong persistent risk factor (such as active cancer) have a high risk of recurrence and thus should receive anticoagulant treatment of indefinite duration. Given the favourable safety profile of NOACs (especially if a reduced dosage of Apixaban or Rivaroxaban is initiated after at least six months of therapeutic anticoagulation), extended oral anticoagulation of indefinite duration should be considered for all patients with intermediate risk of recurrence.
-
COVID 19, caused by SARS-CoV2, a new variant of coronaviruses, typically presents with respiratory symptoms. However, in a significat number of patients different organs are involved in the disease, often including gastrointestinal symptoms. ⋯ Because viral RNA can be detected in fecal samples, some implications for clinical routine in diagnostic and therapeutic procedures are grown. Until yet, no clear evidence is given regarding fecal-oral transmission of SARS-CoV2.
-
Excess body weight (EBW) is the second most important and potentially modifiable risk factor of cancer in Germany. The longer and the more excess body weight a person has, the higher the cancer risk. About 60 % of adult Germans have EBW (BMI ≥ 25.0 kg/m²) and more than 23 % are obese (BMI ≥ 30.0 kg/m²). ⋯ In recent years, more and more young adults (20-40 years) were diagnosed with EBW-associated tumors. People with EBW should be encouraged to join programs of cancer screening. Keeping a healthy weight is a major public health concern in Germany.
-
Dtsch. Med. Wochenschr. · Jul 2020
[Pulmonary Sonography in Patients With Suspected COVID-19 - Step-by-Step].
Pulmonary sonography can be a valuable aid in the differential diagnosis of a variety of cardiopulmonary diseases, including patients with COVID-19. Pulmonary sonography is an examination method that is also quickly available at the bedside without additional risks for the patient. ⋯ However, the findings of pulmonary sonography must be placed in the clinical context; sonography does not replace the gold standard of PCR diagnosis. The article shows how this sonography is performed and which findings in COVID-19 are relevant.