Der Internist
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Recurrent stroke is a frequent event and clinical trials that addressed the best secondary prevention are sparse. If patients take a thrombocyte aggregation inhibitor (TAI) before the recurrent stroke, clopidogrel can be chosen instead of aspirin or vice versa but evidence is lacking. A 3-week period of dual antiplatelet treatment might be a good alternative after acute reinfarction. ⋯ Patients with ICH associated with oral anticoagulation (OAC) and atrial fibrillation should be restarted on novel OACs, if there are no relevant contraindications and the risk of ischemia is high. The anticoagulation treatment of patients with cerebral amyloid angiopathy is still a clinical dilemma as there is a high risk of recurrent ICH. These patients might be candidates for left appendage closure.
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Patients with chronic kidney disease (CKD) exhibit an increased risk to develop heart failure and the presence of heart failure in CKD patients is associated with a poorer prognosis. The following overview article summarizes the current standard of drug treatment of heart failure and discusses special aspects in the treatment of patients with CKD.
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Against the background of increasing antimicrobial resistance, antibiotic stewardship (ABS) is an important measure to counteract the spread of resistant pathogens and multidrug resistance. For Germany and Austria, a comprehensive S3 guideline is available, which was last updated in 2018. The control of antibiotic or anti-infective use in hospitals should be guided by specialized ABS teams. ⋯ ABS consists of regular ward rounds ("ABS visits"), during which members of the ABS team review the indication, dosage, route of administration and duration of antimicrobial therapy at the bedside. Here, the key challenge is to save antibiotics without compromising the individual patient. Digitalization and artificial intelligence offer new options for ABS, while the adaption of inpatient concepts to outpatient care is also important.
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Case Reports
[Severe pneumonia and delirium in a 90-year-old male patient with postdeglutition regurgitation].
Pneumonia and in particular aspiration pneumonia, is a common disease in geriatrics. These aspirations are often due to dysphagia, which is frequently first noticed in the context of a geriatric assessment. The reasons for dysphagia are manifold. ⋯ The case highlights the importance of logopedic diagnostics and treatment in geriatric patients with recurrent pneumonia. With the aid of early diagnostics it was possible to quickly recognize the finding of a PSHR that is typical for a Zenker diverticulum. The findings in this case could be clearly demonstrated based on the images of the FEES and contrast esophagography.
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This article presents a case of recurrent anti-GBM disease (with antibodies against the glomerular basement membrane [GBM]) in a 17-year-old patient successfully treated with rituximab. Kidney biopsy with detection of linear deposition of immunoglobulin G (IgG) along the basement membrane is the diagnostic gold standard, which should be accompanied by serological testing. ⋯ In this particular case, an increase in proteinuria despite standard therapy (plasmapheresis, steroids, cyclophosphamide) was the clinical correlate of relapsing disease. The use of rituximab completely resolved the recurrent anti-GBM disease.