Deutsche medizinische Wochenschrift
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Dtsch. Med. Wochenschr. · Mar 2022
[Hyponatraemia in elderly patient - significance, clarification and therapy].
In the general population, the prevalence of mild, usually asymptomatic hyponatremia ranges from 1,7-7,7 %. With increasing age, it rises to 11,6 % in > 75-year-olds. The prevalence is much higher in nursing home residents and hospital patients. ⋯ This is the only way to improve the prognosis and functionality of elderly patients. For SIADH, we have a potent substance available in tolvaptan. In order to be able to recognize the danger of overcorrection in time, the adjustment should take place in the inpatient setting.
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Subclinical hypothyroidism is usually a laboratory diagnosis without significant symptoms and is defined by an elevated thyroid-stimulating hormone (thyrotropin, TSH) with normal thyroid hormone levels. On laboratory checks after two to three months, spontaneous normalization is found in 50 % of all cases in the sense of a transient elevation. With persistently elevated TSH levels, subclinical hypothyroidism is associated with evidence of thyroid-specific antibodies in the sense of autoimmune thyroiditis. ⋯ One group in which diagnosis and therapy require special sensitivity is pregnant women. Here, two individuals, mother and child, must be treated. Varying target values and dosages in relation to the gestational age must be taken into account.
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Treatment of myeloproliferative neoplasia (MPN) is based on patients' individual risk-stratification and includes cytoreductive agents for high-risk essential thrombocythemia (ET), polycythemia vera (PV) and Myelofibrosis (MF). Classical cytoreductive drugs largely fail to modify the basic clonal composition of the disease. In contrast, in PV for example treatment with Ropeg-Interferon not only results in higher hematological response rates compared to hydroxyurea but in addition significantly reduces JAK2 allele-burden in high-risk PV patients as well as it depletes concurrent cytogenetic and molecular abnormalities. ⋯ Both, mutated as well as non-clonal inflammatory and other stromal cells produce significant amounts of local cytokines. Also the initiation of the neoplastic process itself seems to depend on inflammatory cytokines. Recent scRNASeq data revealed components of the alarmin complex (S100A8 und S100A9) drive this local sterile inflammation process, which also represents a potential therapeutic target, as the S100A8 and A9 inhibitor Tasquinimod reduced fibrosis in a pre-clinical animal model.