Deutsche medizinische Wochenschrift
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Dtsch. Med. Wochenschr. · Sep 2022
Case Reports[Hypoglycemia in a patient treated with a SGLT2-inhibitor with HFrEF without diabetes mellitus].
HFrEF (heart failure with reduced ejection fraction) with a left ventricular ejection fraction of 25-30 % was detected in a 79-year-old man. For further treatment, inpatient cardiac rehabilitation war carried out. ⋯ The presented case raises awareness of the side effect of hypoglycaemia, which occurs very rarely with SGLT2 inhibitors in studies in patients with HFrEF without the presence of diabetes mellitus.
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Dtsch. Med. Wochenschr. · Sep 2022
[Pulmonary Disease caused by less common Nontuberculous Mycobacteria - New international guidelines].
The spectrum of pulmonary disease caused by nontuberculous mycobateria (NTM) is diverse, and each species requires species-specific therapy. With the new ATS/ERS/ESCMID/IDSA guideline on the management of pulmonary disease caused by NTMs covering only the most common pathogens, namely M. avium complex (MAC), M. kansasii, M. xenopi, and M. abscessus, it was necessary to write treatment recommendations for pulmonary disease caused by rarer NTM species that were still represented in the old 2007 guideline. The panel of guideline committee members from the ATS, ERS, ESCMID, and IDSA- therefore, independently of the professional societies, again conducted systematic literature reviews to develop evidence-based recommendations for the treatment of lung disease caused by seven additional organisms: M. chelonae, M. fortuitum, M. genavense, M. gordonae, M. malmoense, M. simiae, and M. szulgai. A German summary of these international recommendations is presented here.
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Urinary tract infections are among the most common bacterial infections. A significant proportion of urinary tract infections recur, which leads to impairments in patients' physical intimacy, social contacts and ability to work. The standardised ACSS questionnaire can provide help in establishing a diagnosis and assessing the course of the disease. ⋯ Non-antibiotic strategies most notably include personal counselling with communication of behavioural recommendations, immunoprophylaxis, phytotherapeutics and local oestrogen substitution. However, in cases of high patient suffering, antibiotic prophylaxis should also be considered after due deliberation. In summary, individual counselling should take place and treatment should be given in a multimodal therapeutic approach.
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Dtsch. Med. Wochenschr. · Sep 2022
[Short- and long-term follow-up care in patients with infarction-related cardiogenic shock].
Infarction-related cardiogenic shock is the most severe complication of an acute coronary syndrome, that still bears a high mortality up to 50 % and wastes a lot of resources of an intensive care unit, especially if extracorporeal assist devices are used. In contrast to the adverse short-term outcome, patients fare a surprisingly well in the long range, both for survival and quality of life. ⋯ Since there is good evidence for cardiologic therapies from randomized controlled trials, high quality data to treat long-term sequalae of the stay on intensive care unit, are sparse. Overall, follow-up care of survivors of infarction related cardiogenic shock includes the best available treatment of the coronary artery disease, intensified heart failure therapy of left and right heart dysfunction and evaluation for the risk of sudden cardiac death and treatment of sequelae of the intensive-care-unit stay.
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A 56-year-old male patient consulted our surgical department presenting repetitive pain in his right upper abdomen and already known cholecystolithiasis. There were no other findings in the clinical examination; fever or abnormalities concerning bowel movement or micturition were denied. Except from the extirpation of a melanoma and an appendectomy years ago there were no relevant previous illnesses. ⋯ Gallbladder metastasis of any cancer entities are a rare event, but some studies suggest that the number of events is underestimated concerning the malignant melanoma.If there is a corresponding medical history, symptoms should quickly lead to determined diagnosis and, if in doubt, to cholecystectomy.