Deutsche medizinische Wochenschrift
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Dtsch. Med. Wochenschr. · Oct 2022
[When COVID does not heal: post-COVID courses with fatigue and exercise intolerance].
Post-COVID-Syndrome consists of several pathobiologically different entities, ranging from damage to specific organs to new onset autoimmune diseases. This article focuses on post-COVID courses with the leading symptoms of fatigue and exercise intolerance. This category is also known from other infectious diseases and includes myalgic encephalomyelitis/chronic fatigue syndrome.
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Dtsch. Med. Wochenschr. · Oct 2022
[The Impact of Next-Generation Sequencing on Medical Genetic Diagnostics and Counseling].
Next-generation sequencing is a modern diagnostic high-throughput method (multi-gene analysis) that can be used to better diagnose both hereditary cancers (tumor disposition syndromes, germline diagnostics) and somatic mutations in tumors. The broad usage of this technology in daily clinical practice demonstrates the real interindividual genetic variability. This method has great importance for the investigation of heterogeneous genetic diseases (e. g. tumors, neurodegenerative and neuromuscular diseases). ⋯ It can be expected that this diagnostic tool will find wide clinical application. With the rapid increase and complexity of genetic data information, the correct interpretation and transmission of the results in the human genetic counseling (germline diagnostics) is of great importance. The genetic counseling must be realigned and adapted accordingly in daily clinical practice.
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Dtsch. Med. Wochenschr. · Oct 2022
[Generalist palliative care in hospitals during the first wave of the COVID-19 pandemic].
In the research network of German university palliative care centers (PallPan), as part of Network University Medicine (NUM), recommendations for action were developed in regard to the care provided for seriously ill and dying patients during a pandemic. For this purpose, the experiences and needs of hospital staff working closely with patients outside of specialized palliative care units during the first wave of the COVID-19 pandemic were also examined. ⋯ Experiences and suggestions for improving palliative care in pandemic times are integrated into the PallPan recommendations for action. Family visits should be allowed and supplemented by digital offers. Palliative Care should also be integrated into both pandemic and contingency plans.
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The application of chemotherapy against malignant tumors might control the malignant disease but harbours many pitfalls. The chemotherapy type is chosen depending on the entity and stage of the tumor as well as on the patient's characteristics and fitness. Patients under therapy should be informed on the potential side effects and should be closely monitored by physicians, familiar with the common as well as the substance specific side effects of the drugs used. ⋯ The use of new medical drug classes, targeted molecular and immune therapies has changed and improved disease control in many tumor entities in a revolutionary manner. Overall, combination treatments including targeted drugs, immunotherapy and/or classical chemotherapy show improved efficacy in tumor control. These novel (combination) therapies may provoke different side effects that physicians need to be familiar with and take into account.
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The interstitial lung diseases ILDs are a heterogeneous group of diseases that often lead to progressive fibrosis of the lungs with corresponding functional impairment. With nintedanib, a tyrosinkinase inhibitor and angiokinase inhibitor, as well as pirfenidone, which unfolds its effect among other things by inhibiting the transforming growth factor β, there are currently 2 approved antifibrotic drugs. In the rapidly progressing idiopathic pulmonary fibrosis IPF, the antifibrotic drugs nintedanib and pirfenidone have been established and approved in therapy for several years. ⋯ This describes the course of various disease entities such as connective tissue disease associated ILDs (CTD-ILDs), fibrosing hypersensitivity pneumonitis or fibrosing courses of non-IPF idiopathic interstitial pneumonitis (non-IPF IIPs) that have a corresponding fibrose-related worsening of respiratory symptoms, a deterioration of lung-functioning parameters or a disease progression in CT. Although pirfenidone also shows positive signals for this group of patients in some selected studies, its use in PF-ILD is not yet recommended. In particular, gastrointestinal side effects can occur under therapy with antifibrotic drugs and require a long-term close interdisciplinary connection of patients.