Therapeutische Umschau. Revue thérapeutique
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Autoimmune bullous skin disorders are rare, potentially fatal disorders of skin and mucous membranes which are associated with IgG or IgA autoantibodies against distinct adhesion molecules of the epidermis and dermal epidermal basement membrane zone, respectively. These autoantibodies lead to a loss of skin adhesion which shows up clinically as the formation of blisters or erosions. In pemphigus, loss of adhesion occurs within the epidermis while in the pemphigoids, linear IgA dermatosis, epidermolysis bullosa acquisita and dermatitis herpetiformis, loss of adhesion takes place within or underneath the basement membrane zone. ⋯ In bullous pemphigoid, topical treatment with clobetasol led to complete clinical remissions without major side effects seen when glucocorticoids were applied systemically. Therapeutic depletion of B cells by rituximab as a second line therapy has significantly improved the overall prognosis of pemphigus. Comparable controlled therapeutic trials have not yet been performed in dermatitis herpetiformis and epidermolysis bullosa acquisita.
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Review
[Recommendations for sexual activity after total hip arthroplasty - review of the literature].
Population is getting older and arthroplasty is getting more common. And the evolution of implants and their better longevity enables arthroplasty to be done for younger patients too. Therefore sexual activity with hip prosthesis is more common. ⋯ This also makes sexual activity - not only in this time period, a potential risk for hip dislocation. We do recommend written guidelines for patients to be given to them preoperatively. This will allow some privacy.
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Drugs have been strongly associated with the development of delirium, and they are one of the most easily reversible triggers. In addition to polypharmacy, physiological changes with aging including pharmacokinetic and pharmacodynamic changes as well as medical co-morbidities can increase the susceptibility to a drug induced delirium. Since it is widely accepted that delirium represents reversible impairment of cerebral oxidative metabolism and neurotransmission [37], it is not surprising that any drug interfering with the function, the supply or the use of substrates for neurotransmitter metabolism can cause delirium. ⋯ Misinterpretation of an adverse drug reaction as another medical condition may lead to the prescription of additional medications with their own potential to cause side effects. To reduce the morbidity and mortality associated with drug induced delirium and also to prevent it, patients' medications should be closely monitored. Wherever possible, drugs with anticholinergic effects should be avoided in elderly patients, particularly in those suffering from dementia.
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Deliria are a common phenomenon in clinical practise. Predisposing factors are age > 70 yr, dementia, substance abuse, and polypharmacy. ⋯ Anticholinergic and/or dopaminergic substances may also trigger deliria. This review presents medical treatment options for delirium from current literature and points out substances, which may potentially cause deliria.
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Based on actual evidence, about one third of deliria can be prevented. Hereby, preventive measures can address both delirium predisposing as well as delirium precipitating factors. ⋯ An interprofessional and interdisciplinary approach for the prevention of delirium has multiple winners: the patient, nurses and doctors.