Deutsche medizinische Wochenschrift
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Dtsch. Med. Wochenschr. · Sep 2022
Case Reports[Hypoglycemia in a patient treated with a SGLT2-inhibitor with HFrEF without diabetes mellitus].
HFrEF (heart failure with reduced ejection fraction) with a left ventricular ejection fraction of 25-30 % was detected in a 79-year-old man. For further treatment, inpatient cardiac rehabilitation war carried out. ⋯ The presented case raises awareness of the side effect of hypoglycaemia, which occurs very rarely with SGLT2 inhibitors in studies in patients with HFrEF without the presence of diabetes mellitus.
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Dtsch. Med. Wochenschr. · Sep 2022
[Short- and long-term follow-up care in patients with infarction-related cardiogenic shock].
Infarction-related cardiogenic shock is the most severe complication of an acute coronary syndrome, that still bears a high mortality up to 50 % and wastes a lot of resources of an intensive care unit, especially if extracorporeal assist devices are used. In contrast to the adverse short-term outcome, patients fare a surprisingly well in the long range, both for survival and quality of life. ⋯ Since there is good evidence for cardiologic therapies from randomized controlled trials, high quality data to treat long-term sequalae of the stay on intensive care unit, are sparse. Overall, follow-up care of survivors of infarction related cardiogenic shock includes the best available treatment of the coronary artery disease, intensified heart failure therapy of left and right heart dysfunction and evaluation for the risk of sudden cardiac death and treatment of sequelae of the intensive-care-unit stay.
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Immunosuppression is an essential prerequisite for successful transplantation. In order to reduce the sometimes-considerable side effects, combination therapies with different agents are used. This article aims to provide an up-to-date overview of immunosuppression after liver and kidney transplantation.
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The suspicion of acute myeloid leukemia (AML) is a haematological emergency that requires a rapid diagnostic workup. Symptoms are usually caused by cytopenias of all blood cell lines. The differentiation of acute promyelocytic leukemia (APL) is important because of the early death rate caused by thrombembolic and bleeding events. Rapid immunophenotypic and genetic characterization is necessary for risk stratification and therapy selection. ⋯ In addition, oral azacitidine is available for non-allogeneic transplant eligible patients in first complete remission. These new drugs have improved prognosis and resulted in a more individualized therapy mostly driven by genetic aberrations. This development will continue in the next years and will significantly improve treatment options, especially for older patients.
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Urinary tract infections are among the most common bacterial infections. A significant proportion of urinary tract infections recur, which leads to impairments in patients' physical intimacy, social contacts and ability to work. The standardised ACSS questionnaire can provide help in establishing a diagnosis and assessing the course of the disease. ⋯ Non-antibiotic strategies most notably include personal counselling with communication of behavioural recommendations, immunoprophylaxis, phytotherapeutics and local oestrogen substitution. However, in cases of high patient suffering, antibiotic prophylaxis should also be considered after due deliberation. In summary, individual counselling should take place and treatment should be given in a multimodal therapeutic approach.