Deutsche medizinische Wochenschrift
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Sodium-glucose co-transporter 2 (SGLT2) inhibitors can block glucose reabsorption in the proximal tubule and thus play an important role in glycemic control in diabetes mellitus. In addition to glucosuric effects, surprisingly very extensive other positive effects were observed in chronic renal dysfunction and strong cardioprotective effects in heart failure. In the meantime, numerous mechanisms have been identified apart from the pure sugar-influencing effect of the SGLT2 inhibitors, which can have a direct positive influence heart and kidneys. ⋯ In a short period of 10 years, the use of SGLT2 inhibitors was established as an essential therapy for cardio-renal indications to inhibit the progression of renal failure as well as to protect against heart failure apart from pure diabetes therapy. In numerous guidelines (ESC heart failure, KDGIO diabetes, ESH hypertension), the early use of SGLT2 inhibitors is now recommended for protection against cardio-renal events and is an important first-line addition to the previously established therapies. Apart from diabetes therapy, it offers patients completely new options in cardio-renal protection.
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Dtsch. Med. Wochenschr. · Nov 2023
Review[Microbiome: from pathophysiology to clinical application?].
The "microbiome" or the intestinal microbiota is currently in the focus of scientific interest. The number of publications on the topic of the microbiome is increasing every year. In particular, the role of the microbiome in the pathophysiology of various diseases has been studied. ⋯ However, some key news stand out from this large number of publications. The first microbiota compounds for the therapy of Clostridioides difficile colitis were approved by the FDA last year or are about to be approved. This means that, for the first time, standardized microbiome products are available in addition to fecal microbiota transplantation (FMT) and are finding their way into everyday clinical practice.
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The current guidelines on the diagnosis and treatment of pulmonary hypertension (PH) contain several important new aspects. The definition of PH is changed to a mean pulmonary arterial pressure (mPAP) of >20mmHg in combination with PVR threshold value of >2 Wood units to a define a precapillary component. The clinical classification of PH still distinguishes 5 main groups. ⋯ In high-risk patients, initial triple combination therapy with additional prostacyclin analogues should be considered. Diagnosis and treatment of CTEPH including pulmonary endarterectomy, medical therapy and pulmonary balloon angioplasty should be carried out in CTEPH centers. Patients with severe PH (PVR >5WE) due to PH group II, III or V should be referred to the PH center for study inclusion or individual therapy.
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Frailty affects approximately one in two patients over 70 years of age in the emergency department. These are inadequately identified as high-risk patients using conventional triage tools. Frailty screening improves the identification of high-risk patients with increased hospitalisation and readmission rates, 30-day and one-year mortality. ⋯ Inpatient admission is partly avoidable, even if this is associated with health risks. This should be discussed with the patient within the framework of participatory decision-making. In advanced frailty, the needs correspond to those of palliative patients.
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Viral hemorrhagic fevers (VHF) are serious, often fatal diseases that affect humans and non-human primates. The nomenclature of these diseases has changed in that they are now referred to as viral diseases because the previously named symptoms of fever or hemorrhages are not obligatory. In this article, the focus will be on the VHFs Ebola and Marburg viral disease with the potential for human-to-human transmission; these diseases are so-called high-consequence infectious diseases (HCID), some with considerable potential for epidemic spread and the risk of nosocomial transmission.