Praxis最新文献

Introduction: Cirrhosis is a common disease with high morbidity and mortality. In industrialised countries, the most common causes of cirrhosis are the alcoholic liver disease, non-alcoholic fatty liver disease and chronic viral hepatitis. Cirrhosis is often diagnosed late, as it can be asymptomatic for a long time. Therefore, hepatopathy screening in high-risk patients and fibrosis surveillance using the ultrasound, in the presence of a chronic hepatopathy are essential. A liver biopsy is necessary to confirm the diagnosis. With optimal therapy, in some cases, cirrhosis is preventable and potentially reversible in others. In the stage of decompensation, typically characterised by ascites, patients often die from recurrent infections or hepatocellular carcinoma unless cured by liver transplantation. The prevention and treatment of complications as well as the evaluation of a transplant require cooperation with a centre hospital.

Introduction: COVID-19 is a multi-organ disease with a broad spectrum of manifestations. Many affected individuals have major difficulties in resuming their previous daily routine or occupation as a result of the disease. Currently, no causal therapeutic approaches are available for the treatment of post-COVID disease. Due to the wide range of possible symptoms, an interprofessional and integrated treatment should be used, while rehabilitation and interventions should be based on the objective findings as well as on the patient's goals. Fatigue and cognitive impairment are among the most common symptoms, which can limit both occupational participation and coping with everyday life. Fatigue management is a central component of rehabilitation. The workload should be increased very slowly; indications of post-exertional malaise must be given special consideration. Due to the fluctuating course of the disease, a periodic reevaluation and adjustment of the workload may be necessary.

Introduction: Recommendations for surgical versus conservative treatment of asymptomatic carotid stenosis (ACS) are based on prospective randomized trials, some of which were performed several decades ago. However, during this time, "best medical treatment" (BMT) for conservative therapy of arteriosclerotic patients has evolved significantly. Because of the associated risk reduction of ACS, surgical therapy is increasingly being questioned. By identifying clinical and morphological risk parameters, subgroups could be identified that might, however, benefit from invasive therapy. Consequently, multidisciplinary therapy decision-making requires an increasingly patient-individualized approach.

Introduction: The 90-year-old female patient with underlying rheumatoid arthritis and spinal canal stenosis was admitted to hospital for pain control. The clinical exam of the lower abdomen was impressively painful and the inflammatory parameters were significantly increased. For further diagnosis a computer tomography was performed, showing a covered perforated appendicitis with a perityphlitic abscess. The conservative therapy with abscess drainage and antibiotics was successful.

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Introduction: With its sensitivity, taste buds and complex anatomical structure of various muscles, the tongue is a central organ for speaking, tasting and food intake, especially oral food transport, chewing and swallowing. Changes in the tongue 's condition are frequent and often lead to uncertainty among patients and eventually to a visit to the family doctor, to the ear, nose and throat specialist, dentist or maxillofacial surgeon. The question whether the condition of the tongue is a lesion requiring treatment or just a variant can quite often prove a major challenge. The differential diagnoses are wide-ranging from harmless changes to alarming signs of disease. The time and duration of occurrence, the accompanying symptoms such as a burning sensation or taste disorders as well as risk factors such as nicotine and alcohol consumption are important anamnestic elements. Possible causes can be malnutrition, systemic diseases, inflammatory processes or malignancies. Accordingly, a blood test and a smear or a biopsy may be necessary as the first diagnostic step. The aim of this review is to explain the different types and causes of tongue problems and to explain in which cases further clarifications are necessary.

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Introduction: No other class of drugs has caused as much of a stir in the last decade as sodium-glucose linked transporter 2 inhibitors (SGLT-2i) or gliflozines. At the latest since the SGLT-2i originally developed as a diabetes mellitus drug unexpectedly also showed protective effects for heart and kidney in pivotal studies, they are now the talk of the town. Although the cellular and molecular mechanisms have not yet been clarified in all details, they have revolutionized therapeutic approaches for diabetes mellitus, heart failure independent of left ventricular ejection fraction, and nephropathies based on positive data available. The purpose of this article is to review the effects and postulated mechanisms of action of SGLT-2 inhibitors, particularly in heart failure and renal failure, and to outline their potential risks and side effects.

Introduction: Medical guidelines summarize evidence based knowledge and give helpful recommendations for diagnostics and therapy in daily practice. Most Swiss medical societies therefore adapt international guidelines for the Swiss setting. In primary care this adaption must not only take into account the specific Swiss healthcare system, but also the specific setting of primary care, which is characterized by a low prevalence of most diseases as well as by chronic conditions and multimorbidity. Exactly these multimorbid patients are underrepresented in the studies, which underline the current guidelines of medical societies. The institute of primary care at the university of Zurich, IHAMZ, therefore creates evidence based guidelines according to international established quality criteria for the Swiss primary care setting.

Introduction: Nephrology may have quite a lot in common with with palliative care. Examples of this are the conservative therapy of a terminal chronic kidney disease or dialysis termination. Nevertheless, palliative co-care of patients with chronic kidney disease still happens rather rarely. On the one hand, this might be due to lacking experience regarding the benefits and opportunities of incorporating palliative care in nephrology care, on the other hand, palliative care is often misunderstood as pure "end-of-life" care. By highlighting the whole spectrum of palliative care, we aim to promote these two disciplines in order to integrate palliative care services into the nephrological treatment concept at an early stage.