Deutsche medizinische Wochenschrift
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While effects of vitamin D on bone metabolism are widely acknowledged, many questions regarding extraskeletal actions of vitamin D have emerged. In-vitro data show the expression of the nuclear vitamin D receptor in a variety of different extraskeletal tissues. ⋯ Very recently, several randomized controlled trials assessing the effect of vitamin D supplementation on prevention of different diseases have been published with disappointing results. In this review we focus on assessment of vitamin D status, as well as results of currently published randomized controlled trials on vitamin D and disease prevention.
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The increasing aging demographics never seen before is associated with the enormous challenge of dementia epidemics which urgently needs a paradigm shift in the approach to cognitive functions in health and disease. If on one hand the achievement or maintenance of a healthy lifestyle should be a medical priority, the early recognition of cognitive disturbances is mandatory. Cognitive impairment is not only associated with disability and lack of compliance and adherence, but also with dangerous geriatric syndromes such as instability, falls, and delirium. ⋯ The best way to prevent cognitive impairment and its worsening include vascular risk control and a healthy diet including a balanced natural nutrition (without nutritional supplements for which scientific evidence is lacking), physical exercise (preferably aerobic), enough social participation, interaction and conviviality as well as cognitive exercise (focusing on general cognitive function, executive function and working memory) While the activation of all domains of lifestyle are critical for the achievement of the best preventive effects, these should be implemented 1) in a personalized, goal-oriented fashion (the so called tailored interventions) and 2) with the ultimate goal of maintaining the care of personal interests and functions along with quality of life and wellbeing. For an effective prevention of cognitive decline, resources from all domains of lifestyle (nutrition, exercise, rest, social participation, cognitive activity) should be used, however in a personalized way. The Comprehensive Geriatric Assessment (CGA), evaluating the physical, psychosocial and functional aspects of young-old, old-old and oldest-old persons, can be used to detect early cognitive impairment and factors associated with its course in order to modulate them.
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Dtsch. Med. Wochenschr. · Feb 2020
Case Reports[mTOR-induced pneumonitis in a 72-year-old patient after heart transplantation].
A 72-year-old heart transplant recipient presented to the hospital with progressive dyspnea. His immunosuppressive therapy was switched to the mTOR-inhibitor everolimus. A few months before, due to a progressive decline in renal function. Primarily, a community-acquired pneumonia was suspected and an empiric antibiotic therapy was initiated. Despite antimicrobial treatment, an acute respiratory distress syndrome developed and mechanical ventilation became necessary. ⋯ Everolimus-related interstitial pneumonitis represents a rare but important adverse effect of everolimus in immunosuppressed patients. Recognition of everolimus induced pneumonitis is of high clinical relevance and should be considered in all patients on everolimus presenting with respiratory symptoms of unknown origin.
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Infections of the central nervous system (CNS) are a diagnostic and therapeutic challenge in daily clinical practice. In most cases, an early and efficient empiric therapy is crucial for the prognosis. Here, an update on current developments concerning the following CNS infections is presented:- Herpes simplex virus (HSV) encephalitis,- bacterial meningitis,- tick borne encephalitis,- neuroborreliosis.
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Dtsch. Med. Wochenschr. · Feb 2020
[New aspects on autoantibodies for classification, diagnosis and therapy within rheumatology].
Recent advances in rheumatology indicate increased relevance of autoantibodies. In this regard, positive ANA are now required as entrance criterium for the first EULAR/ACR classification criteria of SLE. Importantly, ANA diagnostic with detection of isolated anti-dense fine speckled antibodies (DSF-70) need consideration since their unique detection has been identified to exclude largely an autoimmune disease. ⋯ Treatment of obstetric APS is mainly based on low dose aspirin and low molecular heparin. Notably, this treatment should be maintained for 6 weeks after delivery. Thus, serologic findings provide the basis for certain key clinical decisions and require their reliable detection.