Deutsche medizinische Wochenschrift
-
Dtsch. Med. Wochenschr. · Mar 2022
[Novel European Heart Failure Guidelines - Change in Treatment Paradigms].
NEW DRUG THERAPY ALGORITHM FOR HEART FAILURE WITH LVEF ≤ 40 %: The new Heart Failure Guidelines 2021 recommend a fundamentally new treatment algorithm for heart failure (HF) with reduced ejection fraction ≤ 40 % (HFrEF). This involves, that all four mortality reducing substances (ARNI or ACE-Inhibitor, Betablocker, MRA und SGLT-2-Inhibitor) are given as fast as possible. The conventional sequence with stepwise uptitration is no longer recommended.
-
Dtsch. Med. Wochenschr. · Mar 2022
[Nephrotic syndrome: Current understanding and future therapies].
Advances in basic and clinical research have improved our understanding of the pathomechanisms underlying nephrotic syndrome caused by minimal change disease (MCD) and focal and segmental glomerulosclerosis (FSGS). These advances are reflected in the new 2021 KDIGO-Guidelines, which emphasize the clear distinction between primary, secondary and genetic causes. Proper classification is critical, as it directly affects the therapy of choice. ⋯ Finally, we recommend the inclusion of all MCD/FSGS patients in clinical registries (e. g. FOrMe Registry in Germany) to ensure adequate therapy and genetic testing if indicated. In addition, national registries are an invaluable source of clinical data that helps to refine our therapies towards individualized medicine.
-
Amelanotic melanoma (AM) is a subtype of melanoma characterized by a diminished or lacking melanin synthesis. AM, especially ulcerated variants of the plantar region (AMP), are often clinically misdiagnosed, leading to a delay in treatment initiation. ⋯ AMP shows a variety of clinical presentations and particularly elderly patients with many accompanying medical conditions are in danger of incorrect clinical diagnoses. Therefore, we recommend to biopsy any amelanotic plantar ulcer or tumor that does not respond to treatment within 6 weeks to rule out AM.
-
Dtsch. Med. Wochenschr. · Mar 2022
[Loss of information in cross-sectoral treatment: causes and solutions].
Missing information on patients and their medication is a leading cause of medication errors and preventable harm. The TOP Projects uses pharmacy claim data and electronic decision support to improve quality and safety of care on hospital admission. In a survey 100 % of responding hospitals in Germany consider this approach helpful and important to improve availability of necessary information and medication safety and to reduce workload.
-
In addition to the well-known clinical early symptoms of hantavirus disease (fever, flank and abdominal pain as well as arthralgia), unusual neurological changes in the context of infection come into focus. The spectrum of neurological symptoms ranges from transient myopia to severe pareses in the context of Guillain-Barré syndrome. In endemic areas, rapid IgM tests for initial assessment are of certain value for differential diagnosis. ⋯ A new systematic review could not confirm a human-to-human transmission previously postulated for South American hantaviruses. While all known human pathogenic hantaviruses are transmitted by rodents, other hantaviruses have been recently detected in shrews, moles, and bats. The clinical significance of these new viruses is quite unclear as yet.