Deutsche medizinische Wochenschrift
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While genetic kidney diseases were long regarded as a rare cause of kidney failure, it has been shown in recent years that they account for a relevant proportion of cases. In cohorts of kidney transplant recipients, a monogenic cause is found in up to 30% of cases. Identifying the genetic cause of kidney disease has become much easier thanks to technological advances in DNA sequencing. ⋯ Centers of excellence with extensive experience in this area therefore play an important role in improving care. This also applies to the further training of colleagues in the field. In Germany, the National Action Alliance for People with Rare Diseases (NAMSE) and the nationwide establishment of - to date - 36 centers for rare diseases play an important role in this regard.
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Dtsch. Med. Wochenschr. · Nov 2024
[Differential diagnosis of dizziness: what's the contribution of Artificial Intelligence?].
Dizziness is one of the most common reasons for medical consultations. The interdisciplinary range of differential diagnoses often leads to difficulties in proper classification. Artificial Intelligence and machine learning can assist through data-driven algorithms and facilitate the collection of important clinical signs as digital biomarkers. The article will present and critically discuss the current evidence on the topic.
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Dtsch. Med. Wochenschr. · Nov 2024
[Outpatient exercise training for chronic lung disease - for whom, how and why?].
There is a legal entitlement to participate in outpatient exercise groups in accordance with the German Social Code (Book IX) which regulates and facilitates prescriptions for patients with chronic respiratory diseases. A medical examination with specific inclusion and exclusion criteria prior to admission to an exercise group ensures safe participation. Traditional outpatient exercise groups are conducted in face-to-face groups for 60 to 90 minutes, once a week, with structured warm-up, main and cool-down phases. ⋯ Scientific evidence confirms the significant benefits of regular exercise, such as improved physical performance and reduced breathlessness. The psychosocial benefits and the promotion of self-efficacy are additionally supported by the supervision of a specialized trainer. Regular exercise (e.g. in outpatient exercise groups) is an inexpensive and very effective form of therapy to improve the quality of life of people with chronic respiratory diseases.
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Dietary recommendations for patients on dialysis are changing as our understanding of enteral microbiotal metabolism and bioavailability of nutrients from food improves. A diet low in phosphate and potassium is recommended for patients on hemodialysis. However, the absolute content does not reflect bioavailability: How much phosphate or potassium is taken up depends on food source (plant vs. animal) and to which grade it is processed. ⋯ The energy and protein requirements on dialysis are high: 25-35 kcal and 1-1,2 g protein per kg body weight per day (in relation to "ideal" body weight, if patient is overweight). Protein energy wasting is associated with higher stages of kidney disease, and malnutrition is associated with worse survival on dialysis. Nutritional status should be assessed on a regular basis using validated scores, and malnutrition should be addressed and treated.
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Dtsch. Med. Wochenschr. · Nov 2024
[Vaccinations in pulmonary diseases - part 2: herpes zoste, RSV, pneumococcal infection and pertussis].
RSV is a common cause of respiratory tract infections, posing a risk of severe disease, particularly for newborns and infants, as well as in older individuals with pre-existing conditions. Two safe and effective RSV vaccines were approved in 2023. These vaccines elicit protective antibodies and offer robust protection with no additional benefit from annual boosters. Both vaccines have been approved for individuals aged 60 years and older, while one of the vaccines has also been approved in pregnant women to elicit maternal immunity for passive protection of the unborn child. In Germany, RSV vaccination is currently recommended for all individuals aged 75 years and older, as well as people aged 60-74 years of age with severe underlying conditions. PNEUMOCOCCAL INFECTION: Streptococcus pneumoniae is a primary cause of community-acquired pneumonia (CAP). Since early 2022, a 20-valent conjugate vaccine (PCV20) is approved and recommended for people over 60 years of age and individuals over 18 years of age with risk factors. PCV20 replaces the 23-valent polysaccharide vaccine (PPV23) previously recommended for those over 60 years of age. ⋯ Herpes Zoster (shingles) is caused by the varicella-zoster virus, and reactivations can lead to painful skin lesions and potential complications such as herpes zoster oticus, meningitis, or postherpetic neuralgia. People with chronic lung diseases such as COPD or asthma are at increased risk of herpes zoster-related complications. A recombinant adjuvanted inactivated vaccine was approved in 2018 and offers robust protection against herpes zoster and its complications. The vaccine is recommended for all people over 60 years of age and for certain risk groups over 50 years of age.