Deutsche medizinische Wochenschrift
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Dtsch. Med. Wochenschr. · Jan 2025
Review[Acutely Altered Mental Status: When the Patient is Acting Odd].
An acutely altered mental status is a common presenting complaint. A wide variety of neurological, systemic or psychiatric conditions can be the cause. Sometimes there is even overlap of various diseases that contribute to the patient's confusion. ⋯ Nevertheless, even with just limited preclinical resources perceptive teams are able to gather and analyse enough information to diagnose and treat the patient. The result of this detective work can be quite rewarding, especially if the initial diagnosis is confirmed. Therapeutic measures preclinically focus on maintaining the cerebral equilibrium.
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Dtsch. Med. Wochenschr. · Jan 2025
Review[Renal replacement therapy in Germany: An overview with a clinical focus].
In Germany, around 80000 people are currently dependent on permanent renal replacement therapy (RRT). Due to demographic developments and improvements in life expectancy, the prevalence will continue to increase even if the effects of newer pharmacological substances such as SGLT2 inhibitors and GLP1 agonists are promising in inhibiting progression. There are basically three different methods of renal replacement therapy and their variants: Kidney transplantation (KTX), peritoneal dialysis (PD), hemodialysis (HD)/hemodiafiltration (HDF). ⋯ PD and HD are considered to be equivalent in terms of mortality. Currently, HDF is increasingly coming back into focus after the last randomized controlled trial (CONVINCE trial) proved its superiority over conventional HD. Kidney transplantation is clearly superior to dialysis therapy in terms of life expectancy; according to a meta-analysis, the risk of death is reduced by around 55% in comparison.
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Dtsch. Med. Wochenschr. · Dec 2024
Review Historical Article[Haematology and Oncology - A look back at 150 years].
The success story of haematology and oncology extends from Virchow's concept of "cellular pathology" to the possibilities of personalized cancer therapy, which molecular oncology offers today. This article highlights the beginnings and developments of chemotherapy, immunotherapy, as well as molecular oncology and psycho-oncology over the past 150 years.
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Dtsch. Med. Wochenschr. · Nov 2024
Review[Vaccination against RSV infections - update and perspective].
Almost 60 years after a disastrous clinical vaccine trial in children, which resulted in enhanced disease and even deaths, the world of RSV vaccination is currently undergoing a dramatic positive change and development, closely linked to advances in new vaccine technologies. Three licensed safe and highly efficacious vaccines, Abrysvo, Arexvy and mRESVIA, reduce the incidence of RSV lower respiratory disease by 80% in people older than 60 years of age. ⋯ In the coming years, results of numerous pediatric candidate RSV vaccine studies are expected, although particular caution seems advisable for historical reasons. In summary, the field of RSV vaccination has been revolutionized in the last 2 years and we will see further significant progress soon.
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Chronic constipation is one of the most common health disorders in all of medicine. Its extent ranges from mild discomfort, which is usually easy to improve, to severe functional limitations that may significantly reduce quality of life and may be refractory to various treatment approaches. Our understanding of the pathomechanism has grown considerably in recent years and has also led to important new therapeutic developments. ⋯ The respective significance of traditional and recent drug developments is classified and categorized in modern "step-up" treatment strategies. In particular, numerous important aspects of everyday practice are addressed, such as questions on long-term treatment and therapeutic options in specific constellations (adequate treatment of constipation in older people, constipation during pregnancy, and drug-induced [especially opioid-induced]constipation). The most important new developments (i.e. new therapeutic approaches, but also re-evaluations of "traditional" laxatives and the importance of careful diagnostics in therapy-refractory patients) are summarized in this article.