Deutsche medizinische Wochenschrift
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Dtsch. Med. Wochenschr. · Jul 2020
Comparative Study[Antithrombotic Therapy in Patients with Acute Coronary Syndrome and Atrial Fibrillation].
The number of patients with atrial fibrillation (AF) is increasing due to the aging of the population. In addition, the number of patients with AF and an indication for oral anticoagulation (OAC) for the prevention of strokes increases, who are in need for a dual antiplatelet therapy (DAPT) with acetyl salicylic acid (ASA) plus a P2Y12-Inhibitor because of an acute coronary syndrome and/or coronary stent implantation. These patients did receive a triple therapy (TT) for 3-12 months in the past. ⋯ The current status is that a NOAC plus a single antiplatelet agent, mostly clopidogrel, is superior to TT with respect to the bleeding complications, without any obvious and statistically significant disadvantage for stroke rates or cardiac ischemic events. The international guidelines already recommend to treat with a NOAC and one antiplatelet agent instead of TT in case the patients bleeding risk is prevailing. Thus, TT seems not to be indicated anymore for most patients with AF and ACS or PCI.
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Myositis is a rare and an extremely heterogeneous autoimmune disease, that causes muscle weakness. Currently, "idiopathic inflammatory myopathies (IIM)" is the preferred umbrella-term used to describe the disease complexity within individuals. ⋯ Correct classification is the key for successful management. One single treatment regime for every possible organ involvement in all different forms of IIM is still not existing.
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Muscle pain as a common symptom in daily practice frequently occurs as a non-specific accompanying symptom in multiple internal and neurological diseases. Primarily inflammatory or autoimmune muscular diseases are causing muscle pain. However, a number of non-inflammatory causes of pain can also be considered for differential diagnosis. ⋯ The cause of metabolic myopathies can be disorders of the carbohydrate, fat or purine metabolism. Fibromyalgia syndrome (FMS) is a non-inflammatory disease and, according to the current knowledge, recognized as the result of an exposure to physical, biological and psychosocial factors (biopsychological disease model). To help diagnosing FMS, pain regions and core symptoms (fatigue, sleep disturbances) can be detected using questionnaires (Widespread Pain Index [WPI] and Symptom Severity Scale [SSS]).
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The pandemic due to the SARS-CoV-2 virus challenges all of us in the many areas of life. Our health systems are tested for their sustainability and load capacity. SARS-CoV-2 virus-infections will become part of our lives, but they mainly threaten vulnerable and multimorbid older adults. ⋯ Adapted caring structures are required and the pandemic will introduce important ethical discussions. As examples, distribution of limited resources, requests for more Advance Care Planning as well as balancing between infection protection versus the drawbacks of long-lasting social isolation should be named. This article therefore focuses on ethical questions for older adults in times of the SARS-CoV-2 virus pandemic.
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The SARS-CoV-2 pandemic has rapidly spread around the world and has led to a substantial morbidity and mortality in many countries. Although Corona Virus Disease 19 (COVID-19) is primarily a respiratory tract infection, there is growing evidence that other organs including the cardiovascular system are affected by COVID-19. ⋯ Furthermore, we discuss potential mechanisms of myocardial injury including myocarditis and vascular thrombosis. Last, we review the current evidence on drugs which have been evaluated or are currently tested for the treatment of COVID-19 patients.