Deutsche medizinische Wochenschrift
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Pharmacogenomics (PGx) is a key component of personalized medicine to improve clinical outcome of drug therapy and/or to avoid adverse drug reactions. Major efforts are currently spent internationally to implement PGx diagnostics into clinical practice. Evidence-based recommendations for dose-adjusted treatment which are established by international expert groups covering clinical and pharmacological expertise are publicly available. Clinical relevant examples for PGx diagnostics such as genetic testing for dihydropyrimidin-dehydrogenase and thiopurin-S-methyltransferase, as well as for various cytochrome P450 enzymes are summarized to promote the clinical implementation process of PGx in Germany.
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The elderly patient with acute coronary syndrome (ACS) is often not treated on an evidence based basis due to age, previous illnesses and also an increased risk of bleeding. This applies to both drug and interventional therapy. However, valid data clearly show that elderly patients in particular benefit from guideline-adherent therapy, especially interventional revascularisation.
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Dtsch. Med. Wochenschr. · Jan 2021
Case Reports[Celebrations with consequences: fever, dyspnea and chest pain].
We report on a 35-year-old male patient who presented to the emergency department a day after celebrations. The night before, the alcoholized patient tried to spit fire with an oily fuel paste. A fever, dyspnea and chest pain were present. ⋯ Aspiration of oily fuel paste led to lipoid pneumonia. Few such cases have been described so far, but the medical history, symptoms and radiological imaging are very characteristic. Antibiotic therapy is not primarily necessary, however, depending on the clinical condition may help to prevent bacterial superinfection. The administration of systemic steroids is controversial in this situation.
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Polypharmacia is a frequent challenge in modern medicine due to increasing complexity of both patients' aspects in an ageing society - multimorbidity - and progress of therapeutic approaches. Although risks are clearly increasing with number of simultaneously prescribed drugs, neither analysis of the polypharmacia-problem solely by number nor focusing on deprescribing strategies by number alone is sufficient. ⋯ Pattern analysis may help this, by identifying both the most vulnerable patients and polypharmacia-pattern with pronounced risk burden. Patient vulnerability depends significantly on functional abilities and prioritizing therapeutic goals in a comprehensive deprescribing process needs to implement stage of life and disease.