Deutsche medizinische Wochenschrift
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Inhaled maintenance therapies in chronic obstructive pulmonary disease (COPD) are based on bronchodilators and inhaled corticosteroids (ICS). Inhaled bronchodilator therapies consist of long-acting beta-2 agonists (LABA) and long-acting muscarinic antagonists (LAMA). LABA or LAMA treatment is recommended in symptomatic COPD patients. ⋯ LABA LAMA combination therapies are used in patients who are highly symptomatic. Adding ICS to bronchodilator treatment is recommended in COPD patients with repeated exacerbations. Recently, fixed triple therapies consisting of LABA, LAMA and ICS in single inhalers became available.
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Nausea (like vomiting) is a symptom and not an independent disease pattern. This makes it difficult to give an accurate number of the incidences in the elderly population. Approximately every 2nd to 3rd elderly person is affected. ⋯ Initially the therapy aims to treat the cause (underlying disease or polypharmacy). Symptom-oriented medication should only be considered as secondary meassure. However, numerous possible drugs are inadequate for elderly people.
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CARDIOVASCULAR RISK PROFILE OF PATIENTS WITH INFLAMMATORY ARTHRITIS: Patients with inflammatory arthritis have an increased risk of cardiovascular disease compared to the general population. The discovery of this fact dates back to over a decade ago, but cardiovascular morbidity and mortality in these patients have not yet significantly improved. In 2021, the management of cardiovascular risk in patients with inflammatory arthritis remains an important aspect for general practitioners, rheumatologists and researchers. ⋯ Tumor necrosis factor α inhibitors, for instance, reduce cardiovascular event rate by 15 %. Data on methotrexate is less robust but also suggests a protective effect in patients with inflammatory arthritis. Studies on the relatively new janus kinase inhibitors are expected to provide new data in the coming years.
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Dtsch. Med. Wochenschr. · Apr 2021
Review[SARS-CoV-2 vaccines - what the nephrologist should know].
Only fifteen months after the beginning of the COVID-19 pandemic, several vaccines are already available for clinical use. While the spike protein of SARS-CoV-2 constitutes the main target of all predominant SARS-CoV-2 vaccines, they work by different mechanisms (mRNA-based vaccines vs. vector-based vaccines vs. protein-based vaccines). Though there are slight differences regarding the level of protection against mild COVID-19, all five vaccines that have been through phase 3 trials were nearly 100 % effective in preventing severe or fatal cases of COVID-19. ⋯ Patients with chronic kidney disease (or other significant comorbidities) were largely excluded from Phase 3 trials, which makes definite recommendations concerning their vaccination difficult. The vaccine's effectiveness may be reduced in that population due to a uremic immune defect and/or immunosuppressive medication. However, these patients have an increased risk for severe or fatal COVID-19, so that they may particularly benefit from the vaccine.
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Dtsch. Med. Wochenschr. · Apr 2021
[Functional Exams in the gastroenterology - new developments and tips for the common practice].
The functional gastrointestinal disorders (FGIDs) have a high prevalence and are associated with high healthcare costs. The diagnosis of these diseases could be difficult and require func-tional tests such as high-resolution manometry (HRM) of the esophagus, anorectal manometry and H2-Breathtests. ⋯ The HRM of the esophagus is the diagnostic standard for Achalasia, a rare clinical condi-tion associated to dysphagia - new European guidelines suggests a safe strategy in perform-ing the pneumatic dilatation. The intestinal methanogen overgrowth (IMO) is a clinical condition caused by a high production of methane in the small intestine due to overgrowth of Methanobrevibacter smithii, this condition could be in some patients associated with irritable bowel syndrome.