Der Internist
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The influenza virus (IV)-associated mortality and morbidity remains high in Europe. ⋯ Although the incidence of IV infections remains underrecognized, it is the leading infectious disease-associated cause of mortality and morbidity in Europe. Viruses are mainly transmitted by aerosol inhalation and can cause a wide spectrum of symptoms, ranging from mild signs of a cold to severe respiratory failure requiring mechanical ventilation. The clinical diagnosis should be verified through a PCR-based test in patients with indications for treatment. Neuraminidase inhibitors are currently the treatment of choice for IV infections. Seasonal influenza vaccination is an efficient preventive method. It is therefore imperative to improve vaccination rates in Germany, which have been continuously declining since the pandemic of 2009/2010.
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Inhibitors of sodium-glucose cotransporters type 2 (SGLT-2) are a class of oral antidiabetic drugs with a novel specific mode of action in the kidneys. ⋯ Outcome trials with SGLT-2 inhibitors have collectively demonstrated cardioprotective and nephroprotective effects in patients with type 2 diabetes and high CV risk. The use of SGLT-2 inhibitors is recommended in current guidelines and consensus statements as primary combination partners for metformin in patients with type 2 diabetes and established CV disease, high CV risk, heart failure or kidney disease.
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Iodinated contrast is essential for diagnosis and treatment in contemporary interventional cardiology. An important complication of percutaneous intervention is contrast-induced nephropathy, which is associated with increased morbidity and mortality, while prolonged hospitalization is responsible for economic consequences. ⋯ Interventions to improve outcomes of established acute kidney injury have not been developed as yet. Prevention and early diagnosis are relevant factors in clinical management. It is important to identify patients at risk and to treat them preemptively.
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Chronic neuropathic pain has a prevalence of 6.9-10% in the general population. The current recommendations for treatment are presented based on a literature search. Neuropathic pain requires the use of co-analgesic, antidepressant, anticonvulsant drugs and topical agents because non-opioid analgesic drugs are usually ineffective. ⋯ Topical therapeutics are only used to treat peripheral neuropathic pain. At present the use of drugs is independent of the etiology of the pain. Comorbidities, concomitant medication, potential side effects and patients' age have to be considered in treatment planning.
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In emergency situations, patients present with symptoms rather than diagnoses. Due to its high prevalence, the acute coronary syndrome (ACS) dominates acute diagnostics as a consequence of its chief complaint chest pain. The challenge for the attending physicians is that only a minor part of patients with chest pain are finally diagnosed with an acute myocardial infarction (AMI) and that other rare but dangerous differential diagnoses have to be kept in mind and-vice versa-severely ill patients with AMI may present with symptoms other than chest pain. ⋯ Further relevant biomarkers are copeptin in combination with cardiac troponin or natriuetic peptides, which help to diagnose relevant cardiac dysfunction in (acute) heart failure. In addition, patients who present with the symptom of a suspected cardiac syncope need the differential diagnosis of an underlying arrhythmia, which may be due to an ACS or reduced left ventricular (LV) function and other causes like pulmonary embolism or structural heart disease (e. g. aortic valve stenosis). This highlights that biomarker-based diagnostics are often crucial to decide after the initial clinical evaluation whether early imaging is needed or early discharge is possible.