Deutsche medizinische Wochenschrift
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Patients with chronic renal insufficiency often show symptoms that are atypical for cardiovascular problems. The correct interpretation of the symptoms is crucial in order to correctly assess the risk of a heart-related emergency and to take preventive measures and initiate the right therapy. Biomarkers such as NT-proBNP, troponin T or hsCRP (highly sensitive CRP) are independent predictors of mortality, but do not replace instrument-based diagnostics. Patients with renal insufficiency often have stiff vessels which, due to the premature reflection of the pulse wave, can lead to left ventricular dysfunction and ultimately to heart failure.
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In many general medical practices, iron infusions are still regarded as the treatment of choice for iron deficiency. However, they are only very rarely indicated and are often prescribed without a medical basis. This article shows the correct procedure for intravenous iron administration if it is really indicated.
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Obesity is a highly prevalent, chronically progressing disease. Obesity represents a challenge for people living with obesity, health care professionals and the society, because it is also associated with several comorbid diseases. ⋯ The treatment access gap is mainly caused by a lack of legal frameworks for the guideline-driven obesity management. A currently developed disease management program for obesity has the potential to fill the gap in obesity management in the future.
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Diabetes is one of the most common chronical diseases in old age. More than 50 % of the patients are older than 65 years. Elderly with diabetes often suffer from functional or cognitive deficits that should be registered in therapy. ⋯ Simple therapy regimens should be preferred to avoid polypharmacia and to preserve patient's independence. Specific risks of old age under new antidiabetic drugs should be noted. Check-ups and treatment of diabetic complications, especially the diabetic foot should be consequently induced considerating age-specific features.
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Therapeutic fasting has found its way into modern medicine in the last decade through a multitude of experimental work and animal studies as well as increasing clinical research. It is a procedure with a tradition dating back thousands of years and thus comes with a variety of different practices. What they all have in common, is the reduction of daily food intake for a limited period of time. This has a variety of effects on metabolism, cells and organ systems, which can make it a potent tool in medical practice.