Deutsche medizinische Wochenschrift
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Dtsch. Med. Wochenschr. · Jun 2022
[Current pathophysiological concepts of acute decompensation in patients with liver cirrhosis and prognostic scores in different stages of disease].
Acute decompensation and acute-on chronic liver failure (ACLF) are associated with a significant reduced prognosis. Previously, the pathophysiological concept of acute decompensation was mainly based on the peripheral vasodilatation hypothesis. However, during the last years, systemic inflammation was recognized as a major driver for decompensation of liver cirrhosis and ACLF. ⋯ Inflammation also affects the function of extrahepatic organs and therefore leads to the development of an inflammatory cirrhotic multi-organ syndrome. The importance of systemic inflammation in the context of decompensated liver cirrhosis is also transferred to new clinical scores such as the CLIF-C AD and CLIF-C ACLF score. In this article, we provide an overview of the new systemic inflammation hypothesis of decompensated cirrhosis and also discuss current clinical scores for prognostication in different stages of liver cirrhosis.
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Malaria remains one of the most important infectious diseases worldwide. The annual number of cases is currently estimated at around 240 million globally, of which more than 500,000 cases are fatal. The majority of malaria cases in Europe are imported from the African continent. ⋯ The treatment of choice for severe malaria is parenteral artesunate. For all patients presenting with febrile illness after a stay in a malaria-endemic area malaria must be ruled out immediately. Microscopy of the thick drop remains the gold standard for diagnosis in clinical routine.
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Dtsch. Med. Wochenschr. · Jun 2022
[Physicians with cancer: when doctors get a life-changing diagnosis].
We doctors often have a detached approach to our relationship to patients: we see ourselves as healthy helpers of the sick, needy patients. But some of us are, or have been, patients, and many of us have treated colleagues who were ill. What happens when a doctor becomes seriously ill? In this paper, we describe the change of perspective that resulted from our experience with cancer, and how it has shaped our attitude toward modern medicine.
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Dtsch. Med. Wochenschr. · Jun 2022
[Baby on board - recommendations for pediatric travel consultation].
Traveling with babies and children is challenging for parents and the doctor providing travel medicine advice. Especially pediatric VFR (visiting friends and relatives) travelers have a higher risk for infectious diseases due to lower risk perception and higher exposure. ⋯ Topics to be discussed in pediatric travel consultation are travel vaccinations, mosquito repellents, malaria prophylaxis, thorough sun protection, rehydration for gastroentritis, avoidance of rabies exposure, an agetailored travel pharmacy and more. We provide a guide to the most important topics for pediatric travel consultations.
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Dtsch. Med. Wochenschr. · Jun 2022
[Polycystic kidneys: Genetic testing and correct classification clinically and therapeutically of increasing significance].
Cystic kidney disease is a clinically and genetically diverse group of diseases, with more than 100 genes known to date. One in 500 is affected worldwide, mostly due to a malfunction of cilia. New genes have been identified recently for the most common form autosomal dominant polycystic kidney disease (ADPKD). ⋯ Due to the number and complexity of genes that need to be considered, a tailored NGS (Next Generation Sequencing) approach using a customized, well-balanced multi-gene panel is cost-effective and currently the method of choice. Differences in the quality of laboratories must be taken into account. With this, the genetic etiology and underlying mutation(s) can be found in most cases.