Praxis最新文献

Introduction: A 60-year-old polymorbid patient developed severe metabolic acidosis during weeks of treatment with flucloxacillin and paracetamol. The acidosis was triggered by an accumulation of 5-oxoproline due to pre-existing risk factors for glutathione deficiency as well as a ketoacidosis due to starvation. After treatment with N-acetylcysteine and hemofiltration, the acidosis completely resolved.

Introduction: In Switzerland, additional vaccinations against influenza, COVID-19, Streptococcus pneumoniae and varicella zoster virus (VZV), are recommended for patients with chronic lung diseases such as COPD, asthma or interstitial lung disease, since infectious diseases often lead to exacerbation of lung diseases resulting in increased disease burden and mortality. In this review we give an overview on recommended vaccinations for patients with chronic lung diseases, also including vaccinations against pertussis and RSV, which are recommended in international guidelines. While continuous development of vaccines against S. pneumoniae has given rise to high-valency vaccines covering up to 68% of S. pneumoniae variants in individuals aged ≥65 years, vaccination rates in this age group remain low in Switzerland (10% in 2020). Vaccination rates are higher for influenza, and particularly high-dose vaccines account for high vaccination efficacy in years of low strain matching in individuals at risk. Although mortality of COVID-19 decreased since the emergence of the first SARS-CoV-2 variant, patients with chronic lung disease are still at increased risk for exacerbation, unless vaccinated with variant-adjusted vaccines. VZV and Bordetella pertussis vaccination has also significantly countered reactivation and infection rates, respectively, and subunit vaccines against VZV show long duration. However, pertussis vaccination is still limited by its fast waning. A glimpse into the future presumes the introduction of new higher-valence vaccinations against S. pneumoniae, and several types of RSV vaccines are expected to enter the Swiss market soon.

Introduction: Switzerland has been considered free of terrestrial rabies for more than 20 years. Nevertheless, the topics of rabies and rabies vaccination are more relevant than ever. On the one hand, this is because the demand for vaccines is increasing due to the increasing mobility of humans and animals, and on the other hand, there are frequent vaccine supply shortages. Our article highlights the key points in the face of growing challenges.

Introduction: A 47-year-old female presented with arthritis in the left hand's PIP III. Her symptoms were negative for connective tissue disease or spondyloarthritis, but she had HIV and hepatitis B. Initial tests showed no systemic inflammation or abnormal antibodies, and radiology revealed no bony changes. Despite a successful initial treatment with a Kenacort injection, arthritis recurred in both hands. A synovial biopsy via ultrasound revealed gout tophi, confirmed by dual-energy CT showing urate crystals in the soft tissue. Synovial biopsy is an effective, minimally invasive diagnostic tool for undifferentiated arthritis when other tests are inconclusive. Though puncture analysis remains the gold standard, it was not possible in this case due to lack of joint effusion.

Introduction: A young patient from Georgia presented with pulmonary XDR-tuberculosis after months of failed treatment in his home country. Based on genotypic examinations of the sputum samples and a Georgian antibiogram the diagnosis was confirmed and an empirical treatment was started. Despite many initial uncertainties and severe side effects over the course of the treatment, for which treatment adjustments were necessary, the therapy was succesfull with clear clinical and radiological response.

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Introduction: The possible authorisation of new monoclonal antibody therapies for Alzheimer's disease poses challenges for healthcare systems worldwide. In this paper, the Swiss Memory Clinics association (SMC) analyses the available resources and identifies potential health care shortages. Overcoming potential bottlenecks is a challenge that requires action at various levels. However, our analysis also shows that we are well positioned in Switzerland to integrate new developments into existing care structures.

Introduction: Cerebral cavernous malformations are benign vascular anomalies of the central nervous system (CNS). The clinical presentation of a cavernoma depends on its location. The majority of patients with cavernomas are asymptomatic. The most common symptoms include epileptic seizures, focal neurological deficits and/or headaches. The clinical management of cavernomas is challenging because numerous factors influence decision-making. These factors include the risk stratification of cavernoma-related hemorrhage, weighing the risks of surgical intervention against the natural course of the cavernoma and the clinical presentation. This article presents current guidelines and recommendations for clinical practice, based on the latest research findings and expert opinions. The article focuses on diagnostic approaches, risk stratification, therapeutic management and follow-up strategies.

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Introduction: On the palliative care ward, we treated a man with a small cell lung cancer who was suffering from vertigo for six years, however the vertigo got stronger the last six months with pronounced coordination disorders. After several examinations, the cause was a paraneoplastic neurologic syndrome (PNS) with Hu-antibodies. PNS are various neurological malfunctions, which occur mostly in certain patterns. The pathogenesis is immune-mediated through a tumor. This is the reason why the treatment of the PNS is within the treatment of the tumor.