Deutsche medizinische Wochenschrift
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Dtsch. Med. Wochenschr. · Jan 2025
Review[Acutely Altered Mental Status: When the Patient is Acting Odd].
An acutely altered mental status is a common presenting complaint. A wide variety of neurological, systemic or psychiatric conditions can be the cause. Sometimes there is even overlap of various diseases that contribute to the patient's confusion. ⋯ Nevertheless, even with just limited preclinical resources perceptive teams are able to gather and analyse enough information to diagnose and treat the patient. The result of this detective work can be quite rewarding, especially if the initial diagnosis is confirmed. Therapeutic measures preclinically focus on maintaining the cerebral equilibrium.
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Dtsch. Med. Wochenschr. · Jan 2025
Review[Renal replacement therapy in Germany: An overview with a clinical focus].
In Germany, around 80000 people are currently dependent on permanent renal replacement therapy (RRT). Due to demographic developments and improvements in life expectancy, the prevalence will continue to increase even if the effects of newer pharmacological substances such as SGLT2 inhibitors and GLP1 agonists are promising in inhibiting progression. There are basically three different methods of renal replacement therapy and their variants: Kidney transplantation (KTX), peritoneal dialysis (PD), hemodialysis (HD)/hemodiafiltration (HDF). ⋯ PD and HD are considered to be equivalent in terms of mortality. Currently, HDF is increasingly coming back into focus after the last randomized controlled trial (CONVINCE trial) proved its superiority over conventional HD. Kidney transplantation is clearly superior to dialysis therapy in terms of life expectancy; according to a meta-analysis, the risk of death is reduced by around 55% in comparison.
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Dtsch. Med. Wochenschr. · Jan 2025
[(Surviving) life with cancer: the importance of sport and physical activity].
As the survival prognosis of cancer patients continues to improve, the improvement in quality of life during and after cancer treatment is becoming increasingly important 1. Exercise therapy has a positive effect on so-called "patient-reported outcomes" 2. The combination of endurance training and individualized strength training plays a particularly important role here. There is therefore a need for consistent and comprehensive implementation of quality-assured exercise therapy in everyday clinical practice.
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Dtsch. Med. Wochenschr. · Jan 2025
Case Reports[Atypical spontaneous bacterial peritonitis linked to streptococcal toxic shock syndrome].
A 59-year-old female patient with an unremarkable medical history presented with watery diarrhea, severe lower abdominal pain, and fever for approximately 7 days. Physical examination revealed a distended abdomen, bowel sounds were absent, and there was an acute abdomen with generalized guarding and significantly elevated inflammatory markers. ⋯ Primary spontaneous bacterial peritonitis caused by Streptococcus pyogenes is a rare cause of acute abdomen. An early diagnosis and immediate antibiotic therapy are crucial for prognosis.
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Dtsch. Med. Wochenschr. · Jan 2025
[Antibiotic prescribing trends in German acute care hospitals from 2012/13 through 2021/22].
An important prerequisite for ascertaining rational antibiotic prescribing is the availability and evaluation of antibiotic use data. In this study we report evolving trends of antibiotic use in German hospitals during the last decade. Using drug dispensing data from acute care hospital pharmacies, we calculated yearly antibiotic use density values for the period from 2012/13 through to 2021/22. ⋯ During the last decade, there was no increasing use of antibiotics in German acute care hospitals. We observed shifts in selected drug classes, in particular an increasing use of penicillins. The estimated hospital antibiotic consumption per population was slightly above the European average.