Deutsche medizinische Wochenschrift
-
Dtsch. Med. Wochenschr. · Sep 2022
[High patient unawareness for chronic kidney disease even in later stages - but why is it more frequent in women than in men?]
Chronic kidney failure (CKD) is as common as diabetes or coronary heart disease in a population aged 40 years and older. Although CKD increases the risk of secondary diseases or premature death, patients with CKD are often unaware of their disease. In a recent analysis of German data, unawareness CKD was higher in women than in men. ⋯ Despite the presence risk factors that necessitate monitoring of renal function, less than half of patients know they have CKD stage 3b or 4. Women are less likely to be aware of their CKD in all subgroups. Possible causes are gender-related differences in primary health care (gender bias) or in patient-doctor communication.
-
Dtsch. Med. Wochenschr. · Sep 2022
[Triglycerides - assessment as risk factor and therapeutic goals].
Elevated triglycerides and their lipidological consequences (small, dense LDL, residual particles (remnants), reduced HDL cholesterol) are an important and independent cardiovascular risk factor. Particularly in diabetes mellitus, hypertriglyceridemia is regarded as the main cause of high cardiovascular morbidity and mortality; very high triglyceride levels can cause acute pancreatitis. This article provides an overview of the current scientific status of the pathogenesis and clinical significance of hypertriglyceridemia.
-
Dtsch. Med. Wochenschr. · Sep 2022
[Acute respiratory tract infections and antibiotic prescriptions: What are patients' expectations?]
The use of antibiotics in human medicine is partly responsible for the global increase in antibiotic resistance. Significant reductions in antibiotic prescribing were realised through educational campaigns, communication training and prescribing feedback. Based on data from the cluster-randomised CHANGE-3 trial, the present analysis focuses on the question of patient expectations for an antibiotic in acute respiratory infections. ⋯ Patients still receive antibiotics more often than they actually hope for. On the part of GPs, prescriptions may still be written because of perceived pressure from patients, but this is not reflected in patient expectations. In addition to dealing openly with patients' expectations, strengthening patients' health literacy, mindful doctor-patient communication and offered opportunities for re-presentation in the case of specific diagnoses could further reduce the perceived pressure on GPs.
-
Dtsch. Med. Wochenschr. · Sep 2022
[Update on the diagnosis and management of SIADH and Diabetes insipidus].
Dysnatremia is a common occurrence in patients with COVID-19 and is associated with higher mortality and risk for septic conditions. The pathomechanisms are probably multifaceted, but severe hyponatremia may also occur as a result of underlying SIADH or hypocortisolism. Patients with preexisting AVP dysfunction, like SIADH or diabetes insipidus, are at high risk for severe electrolyte imbalances in the event of a COVID-19 infection. ⋯ Fluid restriction has long been considered as first-line treatment of chronic hyponatremia due to SIADH. Additional treatment with Furosemid and/or oral NaCl tablets does not improve efficacy but reduces tolerance to therapy. Copeptin-based dynamic tests show higher diagnostic accuracy in the differential diagnosis of patients with hypotonic polyuria polydipsia syndrome than the indirect water deprivation test.
-
A large proportion of patients with peripheral arterial disease (PAD) remain asymptomatic with respect to peripheral reduced perfusion. Most symptomatic patients present with walking distance limitation, intermittent claudication. In the advanced stage, critical limb ischemia, rest pain, gangrene, or ulceration occur. ⋯ In patients with critical limb ischemia, the focus is on leg preservation, improvement of quality of life, and amputation-free survival. Regardless of the stage of symptoms, cardiovascular risk factors should be optimally adjusted to reduce peripheral vascular, cardiovascular, and cerebrovascular events. In addition to conservative therapy with intensive gait training, endovascular and open vascular surgical revascularization are significant in the treatment of PAD.