Deutsche medizinische Wochenschrift
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Dtsch. Med. Wochenschr. · Apr 2022
[Autoimmune Hepatitis - What is important for clinical practice?]
Autoimmune hepatitis is a rare but chronic autoimmune-mediated liver disease. Key features are elevated transaminases, hypergammaglobulinemia, presence of specific autoantibodies and typical histological features. Diagnostic scores are helpful in establishing the diagnosis. ⋯ First-line therapy includes steroids and azathioprine and results in biochemical and histological remission in the majority of patients. In most cases, lifelong therapy is required. Every patient should receive regular follow-up surveillance including biochemical parameters as well as sonography and elastography.
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Dtsch. Med. Wochenschr. · Apr 2022
[Safety and effectiveness of oral anticoagulation in patients with atrial fibrillation and renal insufficiency - a real-world perspective].
Non-vitamin-K dependent oral anti-coagulants (NOAC) are the current therapeutic standard for preventing strokes in patients with atrial fibrillation (AF) and should be preferred over vitamin K antagonists (VKA) in this indication. This recommendation applies also to patients with VHF and concomitant chronic kidney disease (CKD). ⋯ In addition, RWE in respect to the indication showed that the superiority of NOAC versus the VKA warfarin can also be extrapolated to phenprocoumon, the commonly used VKA in Germany. Furthermore, data include evidence that the typical progression of CKD appears to be less pronounced in individuals treated with NOAC compared to those treated with VKA.
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Celiac disease is a T-cell-mediated autoimmune disorder. It is relevant to us for two very different reasons. Firstly, it has a prevalence of 1 % in the European population. ⋯ This again contributes to new celiac treatment modalities that will presumably alleviate the future fate of celiac disease patients. In 2022, the German guidelines for celiac disease are published by the Deutsche Gesellschaft für Verdauungs- und Stoffwechselkrankheiten (DGVS). We have summarized some of the recommendations published therein.
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Dtsch. Med. Wochenschr. · Apr 2022
[New therapeutic developments in the treatment of type 2 diabetes mellitus].
Diabetes mellitus has become a widespread disease worldwide. In recent years, there has been a rapid development of therapeutic options in the field of diabetology. ⋯ The article focuses, among other things, on the new findings of SGLT-2-inhibitors in cardiac and chronic renal failure and the further development of incretin-based drugs toward dual GIP/GLP-1-receptor agonists. Once-weekly insulin and the selective mineralocorticoid receptor antagonist finerenone will also be presented.
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Dtsch. Med. Wochenschr. · Apr 2022
[Functional somatic symptoms: Clinical varieties, diagnostic challenges, therapeutic principles].
Functional somatic symptoms are common and multiform. They occur in all genders and age groups, with and without somatic or mental comorbidity. Dysfunctional illness behaviour on the patients' (e. g., excessive attention or anxiety) and also on the caregivers' side (e. g., nocebo messages, redundant investigations or risky treatments) can promote chronification. Empathy, well balanced diagnostics, comprehensible information within individual multifactorial explanatory models, refocussing, activation, and - in more severe forms - additional measures such as psychotherapy are recommended.