Deutsche medizinische Wochenschrift
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Dtsch. Med. Wochenschr. · Feb 2025
Case Reports[83-year-old with angina pectoris, hemoglobinuria and icterus].
An 83-year-old female patient presented with angina pectoris, hemoglobinuria and jaundice. Laboratory diagnostics proved difficult due to hemolysis in all blood tubes, following re-evaluation after warming the blood sample. With low haptoglobin, elevated lactate dehydrogenase and elevated indirect bilirubin, we made a suspected diagnosis of autoimmune hemolytic anemia with cold antibodies, which was confirmed through a positive Coombs test and detection of C3d-loaded erythrocytes. ⋯ After treatment of the underlying infection and high-dose prednisolone therapy, the hemolysis parameters regressed and the patient could be discharged to outpatient hematologic follow-up. Interdisciplinary and multi-professional collaboration with laboratory staff and transfusion medicine is crucial for both rapid diagnosis and further treatment. Blood transfusions in AIHA should only be carried out according to strict indications.
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Dtsch. Med. Wochenschr. · Feb 2025
Review Comparative Study[Phlebological or lymphological compression bandage: What are the differences?].
Compression therapy is a recognized method for reducing oedema and should be used for venous and lymphatic disorders. It is important to differentiate between phleboedema and lymphoedema, as different bandaging techniques and materials are used in each case. This article provides an insight into this.
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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.
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Dtsch. Med. Wochenschr. · Feb 2025
[Nosocomial gastrointestinal infections and Clostridioides difficile].
German surveillance data from 2022 reported a prevalence of nosocomial infections among hospitalized patients of 5,2%. Clostridioides-difficile-infections (CDI) are the most frequent cause of nosocomial diarrhea. They are usually caused by antibiotic exposure and the subsequent changes in the gut microbiota. ⋯ According to the current German Gastrointestinal Infection Guidelines, fidaxomicin is the preferred treatment option for CDI, especially in patients at high risk of recurrence or those already suffering from recurrence. Vancomycin can also be used as an alternative for initial CDI treatment. Fecal microbiota transplantation is considered a treatment approach for patients with multiple recurrences.