Deutsche medizinische Wochenschrift
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Recommendations for vaccination of patients with rheumatic Diseases. Patients with rheumatic diseases are particularly at risk from infections. ⋯ Important new developments, such as sequential vaccination against pneumococcus or the approval of a vaccine against Herpes Zoster, improve the possibilities of an effective infection protection. Special attention must be paid to the current recommendations for the use of live vaccines like MMR vaccination in patients under immunosuppressive therapy.
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Dtsch. Med. Wochenschr. · Oct 2020
[Breast cancer - state of the art - Short overview of the current standard of treatment].
Breast cancer is the most frequently diagnosed type of cancer in women and there are continuously new findings in research for further treatment approaches. ⋯ The detection of an ESR1 mutation could possibly be used as a predictive marker regarding endocrine therapy in the future. Furthermore, there are promising results for blocking the PD-1 axis in primary systemic chemotherapy for triple-negative breast cancer.
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Hyponatremia is a common condition affecting hospitalized and ambulatory patients as well. The clinical spectrum of hyponatremia can range from asymptomatic laboratory findings to severely symptomatic conditions such as acute epileptic seizures. ⋯ As hyponatremia can be a potentially life-threatening condition, it requires an efficient management with the goal of identifying the etiology and to subsequently provide adequate treatment, while avoiding treatment-related adverse effects such as overcorrection and pontine myelinolysis. This article summarizes the pathophysiology and differential diagnosis, as well as useful diagnostic tests and therapy of hyponatremia in a practice-oriented manner.
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Dtsch. Med. Wochenschr. · Oct 2020
[Intestinal motility disorders in multimorbidity: between constipation and diarrhea].
The Rome IV criteria for primary chronic obstipation help to distinguish between short-term ailments and a chronic pattern of complaints 1. In general, there are several causes of defecation disorder in the age group of the elderly. Anamnesis and observance of red flags in addition to a geriatric basic assessment make it possible to narrow down the causes. The distinction between low-transit constipation and normal intestinal function can decisively influence the therapeutic consequence. ⋯ In the drug intervention, osmotic laxatives, stimulating laxatives, suppositories and enemas with different additives are still used very frequently. In the second place, the prokinetic prucaloride and for some years methylnaltrexonium bromide can be used as a representative of the peripheral-acting opioid receptor antagonists 2 3. Fibre-rich diet produces more bowel movement and prebiotic additives can influence the microbiome favorably. Additional fibre is not likely to show benefit in case of severe constipation, in particular to patients with low-transit constipation or defecation disorders. When preparing for colonoscopies, it appears that additional movement activation has positive effects on the quality of intestinal cleansing 4.