Deutsche medizinische Wochenschrift
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Acute liver failure (ALF) refers to primary damage to a previously healthy liver. It is a rare disease with an incidence of about 200-500 cases/year in Germany. The liver can recover to restitutio ad integrum or lead to death in no time despite best medical treatment. ⋯ Among drugs paracetamol and phenprocoumone are the leading cause for ALF. However, there are a couple of dietary supplements, herbs and mushroom poisoning that cause ALF. Other reasons are ischemic hepatitis and autoimmune hepatitis.
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The Acute Respiratory Distress Syndrome is still a very severe condition in intensive care patients. Prone positioning is known to improve outcome in patients with moderate to severe ARDS. ⋯ The risks of proning are reasonably low - if proning is done correctly. Therefore a method of proning in a step-by-step-approach is shown in this article.
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In Germany, baricitinib and tofacitinib have been approved for the treatment of at least moderately active rheumatoid arthritis after the failure of conventional disease modifying anti-rheumatic drugs in 2017, and tofacitinib also for psoriatic arthritis and ulcerative colitis. Both baricitinib and tofacitinib can be taken orally and reversibly inhibit Janus kinases (JAK) and therefore the signaling of a large number of cytokines via the JAK/STAT pathway. JAK inhibitors have been shown to be at least as efficacious in rheumatoid arthritis as adalimumab and tofacitinib was also efficacious in psoriatic arthritis. ⋯ In the placebo-controlled trials, venous thromboembolic events (VTE) were more common in the baricitinib treated patients. The VTE rate does not appear to be elevated in baricitinib treated patients compared to RA cohorts however. In conclusion, JAK inhibitors are a powerful new treatment of RA and likely many other rheumatic diseases and fulfill an unmet need since they may be taken orally.
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Dtsch. Med. Wochenschr. · Jun 2019
Review[Clostridium Difficile: Monoclonal Antibody Therapy and Vaccines].
Hospital-acquired Clostridium difficile infections have become much more frequent in recent years. Besides treatment with antibiotics and fecal microbiota transplant, new preventive strategies are available now. Bezlotoxumab is an antibody against toxin B and may reduce the risk of relapse by roughly 10 %. Several vaccine candidates against toxins A and B and surface-associated antigens were immunogenic and are tested in clinical trials to investigate the efficacy and safety.
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Dtsch. Med. Wochenschr. · Apr 2019
[Step-by-Step tutorial of bedside percutaneous dilatational tracheostomy].
Bedside percutaneous dilatational tracheostomy has become one of the most commonly used interventions in ICU medicine. Different techniques have been developed, but guidance of percutaneous dilatational tracheostomy by video bronchoscope has been suggested to be clinically reasonable for direct visualization. The current Step-by-Step tutorial gives a detailed instruction of the procedure with visualization of every single step offering tips and pitfalls of the procedure.