Deutsche medizinische Wochenschrift
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Dtsch. Med. Wochenschr. · Feb 2025
Practice Guideline[Atypical hemolytic uremic syndrome: differential diagnosis and therapy - A clinical practice guideline for diagnosis and therapy].
Atypical hemolytic uremic syndrome (aHUS) is an important differential diagnosis in thrombotic microangiopathy (TMA). The absence of definitive biomarkers usually allows for aHUS to be diagnosed only through a process of exclusion. Due to the unfavorable prognosis if adequate therapy is delayed or not provided, differential diagnostic considerations and initiation of treatment must occur promptly. The presented guideline is intended to serve as an aid in this process.
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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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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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The gastrointestinal microbiome influences physiological functions and is altered in a variety of diseases. The causality of "dysbiosis" in the pathogenesis is not always proven; association studies are often involved. Patients with IBD, bacteria, fungi, bacteriophages, and archaea show disease-typical patterns associated with metabolome disturbances. ⋯ This significantly limits the nationwide availability of the FMT in Germany. Microbiota-based therapeutics prepared from the stool of tested donors have recently been approved by the US Food and Drug Administration (FDA) for the prevention of rCDI. More microbiome-based medicines can be expected in the future.
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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.