Deutsche medizinische Wochenschrift
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Dtsch. Med. Wochenschr. · Nov 2022
[Multimorbidity in patient's care - definitions, strategies and limitations].
The challenge of multimorbidity, the occurrence of multiple medical conditions, lies in its complexity, considering their type and severity, their interactions, and the patient's social status and characteristics. Although the number of combinations appears unlimited, there emerge so-called multimorbidity patterns, that group diseases, that often coincide. The prevalence of multimorbidity will increase dramatically because of the demographic change and the medical progress, leading to exploding costs in healthcare. ⋯ Action strategies and the integration of guidelines are needed and will support the clinician during the decision-making processes. Furthermore, clinical studies should include older adults with multimorbidity and should particularly consider their relevant outcomes. Geroscience is a new research area that addresses the hallmarks of aging with therapeutic approaches to delay or even avoid the onset of multimorbidity.
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After several years of declining tobacco consumption, the number of smokers in Germany is currently stagnating or rising again. The reasons seem to be manifold, e. g. stress caused by the pandemic with social isolation, rising cost of living and war in Europe. With tobacco use still widespread in the German population, evidence-based tobacco cessation is rarely implemented. ⋯ However, they are usually consumed continuously and thus perpetuate nicotine dependence. Their use increases the risk of relapse to tobacco smoking. Despite the various new approaches, such as Internet-based offerings, app, etc., talks and pharmacotherapy are the gold standard and more effective than any therapy on its own.
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Dtsch. Med. Wochenschr. · Nov 2022
[CAR-T cell therapy - personalized cellular immunotherapy in 2022].
Chimeric antigen receptor T cells (CAR T cells) are genetically modified autologous or allogeneic T lymphocytes that target specific antigens and can be used to combat tumor cells. The approval studies show a high response and remission rate in heavily pretreated patients with aggressive B-cell lymphoma, acute lymphoblastic leukemia or multiple myeloma. The article presents the indications for approval, the clinical implementation and the management of side effects of CAR cell therapy.
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Dtsch. Med. Wochenschr. · Nov 2022
[Cardiac amyloidosis - important differential diagnosis in heart failure].
The systemic disease amyloidosis is caused by deposits of misfolded proteins and can cause very different symptoms depending on the organ involvement. The two most common forms are AL amyloidosis and ATTR amyloidosis. The determination of light chains and bone scintigraphy have a high priority in the diagnostic algorithm. ⋯ The classic heart failure medication is often not well tolerated by patients with cardiac amyloidosis and must be adjusted in the presence of symptoms. This article shows which findings and symptom complexes should make you think of amyloidosis and how to arrive at the correct diagnosis in a targeted manner. Causal therapy options as well as special features of heart failure therapy in this patient collective are explained.
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Patients with peripheral artery disease and diabetes mellitus are vulnerable with an increased risk for morbidity, amputation and mortality compared to non-diabetic patients with peripheral artery disease. Despite huge efforts of the health care system diabetes mellitus still represents an important risk factor, also in people with peripheral artery disease. ⋯ Further, only few people with peripheral artery disease consult an angiologist or vascular surgeon. Aiming to reduce morbidity and mortality prevention, early detection and optimal therapy of peripheral artery disease and diabetes mellitus are crucial factors in adequate health-care management.