Deutsches Arzteblatt international最新文献

Background: Approximately 280 000 people in Germany suffer from multiple sclerosis (MS), an autoimmune disease of the central nervous system. Of these, approximately 5% have a comorbid chronic inflammatory disease: the more common ones are psoriasis, rheumatoid arthritis (RA), and chronic inflammatory bowel diseases (IBDs, of which the main types are ulcerative colitis and Crohn's disease).

Methods: This narrative review is based on pertinent publications retrieved by a literature search in PubMed, as well as relevant guidelines. All statements in this article reflect a consensus among the authors, who represent different medical disciplines.

Results: As the data from clinical trials to date are limited, judgments about the proposed treatments are a matter of expert opinion. In general, TNFα blockers should not be used in patients with MS, as they can worsen the disease. In patients with MS and psoriasis, dimethyl fumarate is a useful option for mild disease activity. In MS with comorbid RA, azathioprine and leflunomide/teriflunomide are suitable for mild disease activity. For more severe disease activity, anti-CD20 antibodies have been approved for both diseases and should be used. In MS with comorbid IBD, azathioprine is suitable for mild disease activity. Ozanimod has been approved for patients who have MS and comorbid ulcerative colitis with more severe disease activity, especially those who are JCnegative; it shares its mechanism of action (VLA-4 blockade) with natalizumab.

Conclusion: The treatment of patients who have both MS and another chronic inflammatory disease should be interdisciplinary and personalized, and treatments must be planned with due attention to potential adverse effects. Further studies of treatment for this group of patients are needed.

Background: Autism spectrum disorder (ASD) is a persistent neu - rodevelopmental condition characterized by impaired social communication and the presence of restricted, repetitive patterns of behavior, typically manifesting in early childhood. The rising prevalence of ASD has been discussed in relation to increased media consumption.

Methods: A selective literature search was conducted in the Medline database on the topics of media consumption and mental disorders, particularly autism, in preschool children. Seven systematic reviews and meta-analyses and 36 original studies were included in the analysis.

Results: The findings across studies consistently demonstrated that media consumption in preschool children was associated with deficits in language and cognitive development (adjusted odds ratio [aOR] 1.67-2.28) and was a risk factor for the development of emotional, behavioral, and developmental disorders (aOR: 1.34-3.06). Symptoms consistent with ASD were also found to be associated with increased media consumption (OR 1.97, 95% confidence interval [1.30; 3.00]). However, these observed effects were consistently identified in the context of multiple other risk factors for mental health problems-such as low socioeconomic status, a family history of mental disorders, or parental stress-which mediated these effects, either directly or indirectly. Intervention studies showed that reducing media consumption, combined with an increase in constructive parent-child interactions, led to a reduction in symptom severity.

Conclusion: In the context of additional risk factors, increased media consumption in young children is associated with atypical or delayed development. The extent of developmental disorders can be reduced through targeted support for parents. When risk factors are present, it is therefore essential to educate parents and implement preventive measures to promote the long-term healthy development of children.

Background: Gynecomastia (GM) is the most common abnormality of the male breast; it is benign and usually bilateral. GM is a manifestation of disease and not a diagnosis in itself. An important differential diagnosis of unilateral GM is breast cancer.

Methods: This narrative review is based on pertinent publications from 2010 onward that were retrieved by a PubMed search, with special attention to the guidelines of the AWMF and the European Academy of Andrology (EAA) and the recommendations of the German Society for Gynecology and Obstetrics.

Results: GM can occur physiologically in newborns, during puberty, and in men over age 65. The basic diagnostic evaluation of GM consists of a thorough history and physical examination (especially of the breast area and genitals), breast and testicular sonography, and laboratory testing for total testosterone (tT), estradiol (E2), luteinizing hormone (LH), human chorionic gonadotropin (hCG), and prolactin (PRL) levels. Further tests to be carried out as indicated according to the clinical findings include the determination of follicle-stimulating hormone (FSH), thyroid-stimulating hormone (TSH), fT4, alpha-1-fetoprotein (AFP), dehydroepiandrosterone (DHEA), and free testosterone (fT) levels, liver and kidney function tests, chromosomal analysis, and supplementary imaging procedures. The treatment depends on the underlying disease and the severity of symptoms, ranging from further observation alone to pharmacotherapy and surgery. Approximately 700 men receive a diagnosis of breast cancer each year in Germany. Because breast cancer in men is rare, there are no pertinent studies, and its treatment is analogous to the treatment of breast cancer in women as recommended in the guidelines.

Conclusion: Men should be included in clinical trials of treatment for breast cancer whenever this is fea - sible, so that the evidence base can be enlarged and men can be given access to innovative treatment methods.

Background: The Global Polio Eradication Initiative (GPEI), founded in 1988, has contributed to a drastic reduction in the number of cases of wild poliovirus (WPV) infection. Progress has stalled for years, however, even though the GPEI has become a very costly global health program. Poliomyelitis is caused by WPV types 1, 2, and 3, as well as by mutated vaccine viruses.

Methods: This review is based on publications retrieved by a selective literature search relating to challenges that currently face the GPEI, with an emphasis on the situation in Germany, e.g., the problem of maintaining the high rate of vaccination coverage.

Results: WPV1 remains endemic in Pakistan and Afghanistan. In addition, outbreaks caused by viral mutants of oral live polio vaccines (OPV) have become a problem in countries with low vac cination coverage, with several thousand cases since 2000. Industrialized countries have also had rare cases of poliomyelitis in recent years, caused by mutated vaccine viruses, which often circulate undetected. Aside from the dysfunctionality of the health care systems of many countries, geopolitical tensions, international and civil wars, mass human migration, hesitancy and skepticism of the population about vaccination, and funding fatigue on the part of donor countries, there are a variety of technical problems confronting the GPEI in its quest for success.

Conclusion: Maintaining high polio vaccination rates may be a more realistic solution to the problem of polio than continuing to pursue the GPEI's objective of putting all polioviruses out of existence. Doctors in Germany can actively contribute to the achievement of both these goals by checking the polio vaccination status of their patients, as recommended by the German Standing Committee on Vaccination (STIKO). This is especially important when doctors care for refugees and asylum-seekers who have arrived in Germany from abroad.