Deutsche medizinische Wochenschrift
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Procalcitonin (PCT) is an established marker for bacterial infection. Elevation of PCT can occur due to various reasons and is not specific, as we outline in the following case report. ⋯ This case illustrates that PCT-elevation is not specific for a bacterial infection and must be seen in correlation to patient's history and clinical findings.
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In hospital, effective smoking cessation can be organized through counselling, pharmacological aids and, above all, continuous care in outpatient structures following discharge. Pharmacological treatment has proven to be effective and safe with nicotine replacement therapy as well as varenicline. Counselling plus pharmacotherapy is more effective in combination than either therapy is on its own. ⋯ The long-term effectiveness of e-cigarettes in tobacco cessation is still uncertain and epidemiologic data clearly point toward ineffectiveness. Furthermore, dual use with potentiation of the toxic effects is common. Therefore, e-cigarettes cannot be recommended for tobacco cessation.
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Dtsch. Med. Wochenschr. · Jun 2021
[Diagnosis and treatment of HIV-associated lymphoma: Update 202].
The risk of malignant lymphomas is markedly increased in HIV-infected persons even in the era of effective combination antiretroviral therapy. Major risk factors are the depth of CD4-cell nadir and HIV viremia. R-CHOP remains treatment of choice for diffuse large B-cell lymphoma. ⋯ Favourable results have been reported with a stage adapted treatment for HIV-Hodgkin lymphoma. Patients with relapsed/refractory HIV-lymphoma should undergo autologous stem cell transplantation if indicated. Successful anti-CD19 CAR T-cell therapy was also reported in HIV-infected patients with refractory B-cell lymphoma.
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Deep vein thrombosis usually manifests as leg or pelvic vein thrombosis (DVT). The causes are either acquired or inherited and can also occur in combination. Early diagnosis and treatment of DVT can reduce the risk of pulmonary embolism and postthrombotic syndrome. ⋯ After diagnosis, risk factors that led to the occurrence of thrombosis can be identified in many cases. In more than half of the cases, genetic causes play a role. If the cause is not clear, tumor screening should be performed, since up to 20 % of thromboses are due to tumor disease.
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Psychocardiological research has contributed a better understanding of mental health, psychosocial factors and quality of life of in patients with cardiovascular diseases. In this update of psychocardiology in 2021, stressful experiences in childhood and adolescence are found to increase the risk of type II diabetes mellitus, coronary heart disease and stroke along the life course. ⋯ Summarizing the update of psychocardiological interventions, the effectiveness of team-based treatment ("blended collaborative care") in secondary prevention is currently being tested in Germany in the randomized, controlled TEACH multicenter trial of patients with coronary heart disease and distress. Interventions such as positive psychology and mindfulness training can lead to a significant reduction in anxiety, stress and depression in heart patients.