Deutsche medizinische Wochenschrift
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Dtsch. Med. Wochenschr. · Feb 2025
[Unstable heart failure: practical guidelines for avoiding frequent hospital admissions].
Heart failure is the leading cause of hospital admissions in Germany. The prevention of hospitalizations due to heart failure has recently improved, encompassing guideline-based basic therapy, targeted medication escalation options, and structured outpatient care incorporating telemedicine. An early identification of parameters that precede or indicate acute heart failure is crucial. ⋯ It is recommended to start or up-titrate guideline-recommended medical therapy and additionally initiate treatment with the soluble guanylate cyclase stimulator Vericiguat in patients with heart failure with a reduced ejection fraction. Initiation and up-titration should begin during hospitalization and should be completed during careful follow-up within the first 6 weeks after discharge. This guide provides recommendations for the comprehensive and coordinated treatment of worsening heart failure, considering all these aspects which are crucial for improving patient outcomes.
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Traveler's diarrhea is a common and, in most cases, self-limiting illness among long-distance travelers. Pathogen diagnostics are indicated for severe or dysenteric courses as well as for increased risk of severe courses. A central component of pathogen diagnostics is stool culture. ⋯ Empirical anti-infective therapy is only indicated for febrile or bloody diarrhea or if there is a high risk of a severe course. To further guide therapy, pathogen detection should be sought. Qualified travel advice should always be provided before traveling.
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Gastrointestinal infections are widespread and a major cause of global mortality, mainly affecting young children and the elderly. In Germany, each resident typically experiences one episode yearly. After COVID-19 pandemic, gastrointestinal infection rates have significantly increased again. ⋯ The diagnosis of acute gastroenteritis should be based on clinical presentation and a thorough medical history, with stool testing reserved for severe cases or suspected outbreaks. Symptomatic treatment and rehydration of the patient are usually sufficient. Antibiotic treatment is generally not recommended except in severe cases, risk situations or the detection of specific pathogens.