Deutsche medizinische Wochenschrift
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Important new developments in the understanding of CAP encompass new insights into pathogens, risk stratification and antibiotic treatment. Respiratory viruses are increasingly described as relevant pathogens in CAP, such as influenza and rhinoviruses. ⋯ Risk adapted antibiotic treatment is increasingly refined and the use of macrolides in patients with bacteremia or marked inflammation is advocated. Recently developed new antibiotics add to the therapeutic options in CAP.
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Dtsch. Med. Wochenschr. · Oct 2019
[Current standard in diagnostic and therapy of peripheral T-cell lymphoma].
NEW WHO CLASSIFICATION 2016 FOR LYMPHOMA AND MOLECULAR MARKER: The new WHO 2016 Classification for Lymphomas included more detailed definitions of individual entities, such as: the Anaplastic Large Cell Lymphoma, ALK; the terminus of enteropathy-associated T-cell lymphoma (EATCL, type 1) now is restricted to celiac-associated form. The integration of next Generation sequencing (NGS) enables better differential diagnostics, e. g. angioimmunoblastic lymphoma (AITL) can be characterized by the presence of TET2, RHOA, IDH2 or DNMT3A mutations. Furthermore, certain mutations also have prognostic impact. In ALCL/ALK-, evidence of a DUSP22 / IRF4 re-arrangement is associated with a better and detection of TP63 is associated with a worse prognosis. ⋯ At present demethylating agent 5-azacytidine is explored in AITL and PTCL with a T-follicle helper type (TFH).
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Pulmonary embolism (PE) is a life-threatening disease and the third most frequent cardiovascular cause of death after stroke and myocardial infarction. The annual incidence is increasing. The individual risk for PE-related complications and death increases with the number of comorbidities and severity of right ventricular dysfunction. ⋯ Being comparably efficient and due to a preferable safety profile compared to vitamin-K antagonists (VKAs), non-vitamin K-dependent oral anticoagulants (NOACs) are increasingly considered to be the treatment of choice for initial and prolonged anticoagulation of patients with pulmonary embolism. The use of low molecular weight heparins (LMWHs) is recommended for PE patients with cancer; however, recent studies indicate that treatment with factor Xa-inhibitors may be effective and safe (in patients without gastrointestinal cancer). Only prolonged anticoagulation (in reduced dosage) will ensure reduction of VTE recurrence and thus should be considered for all patients with unprovoked events.