Deutsche medizinische Wochenschrift
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Dtsch. Med. Wochenschr. · Sep 2022
[Update nephrotic syndrome - new pathophysiologic concepts 2022].
The identification of autoantibodies responsible for the development of membranous nephropathy (MN) in most patients, has led to the development of antigen-specific diagnosis and treatment options for this disease. Pathomechanisms leading to the initiation of the immune response against PLA2R1 are not clear, yet. Environmental and genetic factors may play a role in these processes. ⋯ For both MCD and FSGS steroids remain the first line treatment strategy. When a steroid treatment needs to be avoided, calcineurin inhibitors are often used as a second line therapy. Other treatment options include cyclophosphamide, MMF and rituximab.
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Autoimmune haemolytic anemia (AIHA) is defined as the immune-mediated destruction of red blood cells. In most cases, antibodies that target surface antigens on erythrocytes lead to their premature degradation in the spleen or, less commonly, in the liver. The term includes a heterogenous group of diseases, which differ largely in pathophysiology and treatment. ⋯ The IgM antibodies have their highest affinity below body temperature which is why patients experience symptoms mainly in cold-exposed body areas. Although the IgM antibodies dissolve at body temperature, the complement-loaded erythrocytes are destroyed in the liver. Therapeutic options include protection from cold and immunosuppressive agents or complement inhibition.
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Dtsch. Med. Wochenschr. · Sep 2022
[Mechanical Assist Devices in Cardiogenic Shock Complicating Myocardial Infarction].
In acute myocardial infarction cardiogenic shock is still one of the most feared complications. Although medical and interventional treatment of myocardial infarction improved significantly over the last decades mortality of cardiogenic shock patients remains on unacceptable high levels with 30-day mortality rates of 40-50 %. To date only an early revascularization of the culprit infarct lesion is the only intervention with proven survival benefit for patients. ⋯ This viewpoint gives an overview about the most used devices. The different mechanism of left ventricular support will be explained, and the current evidence discussed. Furthermore, ongoing randomized controlled trials are highlighted.
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Dtsch. Med. Wochenschr. · Sep 2022
[The broad spectrum of sickle cell disease: HbSC in everyday clinical practice].
Sickle cell disease has come to Germany from the Mediterranean region, Africa and the Middle East since the 1950 s and initially mainly concerned paediatricians. Since the 1970 s, the life expectancy of those affected has risen significantly, and about 95 % now live to adulthood. Therefore, general practitioners and internists should be familiar with the different forms of sickle cell disease, especially HbSC disease (approx. 20 %). ⋯ Annual retinoscopy is recommended for HbSC patients from the age of 7, and for all other sickle cell patients from the age of 10. If a hearing loss occurs in an HbSC patient, phlebotomy should be performed immediately. In all sickle cell patients with dizziness or pain and an Hb > 10 g/dl, phlebotomy is indicated.
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Serial murder in clinics and care homes have gained attention more than once in recent years. The strong yet quickly fading public outrage has not yet led to well-founded professional and health-political engagement with the topic. With few systematic studies conducted, knowledge about perpetrator-related and environment-related risk factors in the day-to-day context of healthcare is sparse. ⋯ More information about serial murder in clinics and care homes is necessary. Research efforts are needed to better assess the prevalence of such crimes and to develop appropriate preventive measures. Circumstances that enable such acts, risk factors, perpetrator profiles, and early-stage countermeasures must be comprehensively addressed in the context of education, training and further education.