Deutsche medizinische Wochenschrift
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Dtsch. Med. Wochenschr. · Apr 2021
Review[Acute ischemic stroke and elevated troponin: Diagnostic work-up and therapeutic consequences].
Elevated troponin values are frequently detected in patients with acute ischemic stroke, requiring adequate diagnostic work-up due to the high cardiac mortality after stroke. Since dual platelet inhibition can cause secondary intracerebral hemorrhage careful consideration of invasive coronary intervention is mandatory. Based on three case reports, this review article presents a diagnostic algorithm taking into account latest findings from the literature.
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Dtsch. Med. Wochenschr. · Apr 2021
[Banks, archives or libraries? Models for the ethical foundation of biobanks].
At present, when it comes to research with biomedical data, research interests and data protection seem to be irreconcilable. Such differences are best mediated by an institution. The presuppositions of biobanking can be productively questioned with respect to public libraries. These represent a successful combination of knowledge and power, security and freedom.
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Understanding the (patho-)physiology of volume regulation and osmoregulation is fundamental to guide patient advice and therapy in chronic kidney disease (CKD). Volume regulation primarily impacts the amount of sodium in the body, and it mainly affects the extracellular space, while osmoregulation primarily impacts the amount of free water, and it affects both the intra- and extracellular space. The kidneys control water and sodium homeostasis both through their sensor (e. g. tubuloglomerular feedback) and regulator systems (e. g. sodium reabsorption). ⋯ Many CKD patients are hypervolemic, and sodium restriction is of key importance in patients' effort to utilize lifestyle changes as therapeutic means. Pharmacologically, (particularly loop) diuretics are the basis of therapy, increasing sodium excretion. Recent developments shift the focus towards classes of drugs ameliorating prognosis in CKD: sodium-glucose linked transporter 2 (SGLT2) inhibitors have proven beneficial in heart and renal failure - by sodium and fluid excretion, among others; additionally, a novel mineralocorticoid receptor antagonist (MRA), finerenone, was recently shown to improve prognosis in CKD.
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Dtsch. Med. Wochenschr. · Apr 2021
[Old and depressed and/or demented? - Pseudodepression vs. pseudodementia].
Many elderly patients suffer from both, depressive symptoms and cognitive deficits. Clinically, it oftentimes appears unclear whether the affective or the cognitive problems are primary or secondary. ⋯ A careful history and clinical investigations are necessary to identify the underlying diseases, but they do not always offer sufficient therapeutic guidance. If in doubt, the condition should always be considered as potentially reversible and treated emphatically (but with age-appropriate caution).
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Inhaled maintenance therapies in chronic obstructive pulmonary disease (COPD) are based on bronchodilators and inhaled corticosteroids (ICS). Inhaled bronchodilator therapies consist of long-acting beta-2 agonists (LABA) and long-acting muscarinic antagonists (LAMA). LABA or LAMA treatment is recommended in symptomatic COPD patients. ⋯ LABA LAMA combination therapies are used in patients who are highly symptomatic. Adding ICS to bronchodilator treatment is recommended in COPD patients with repeated exacerbations. Recently, fixed triple therapies consisting of LABA, LAMA and ICS in single inhalers became available.