Praxis最新文献

Introduction: After a young female patient received an intravenous iron infusion for severe symptomatic iron-deficiency-anemia, a severe hypophosphatemia was diagnosed with associated mild muscle weakness. With renal phosphate loss and elevated serum FGF23 (Fibroblast Growth Factor 23), the diagnosis of a hypophosphatemia caused by ferric carboxymaltose was made. Upregulation of FGF23 inhibits renal phosphate reabsorption and also the activation of vitamin D, which additionally reduces intestinal phosphate absorption. The symptoms of hypophosphatemia may be masked after iron replacement.

Introduction: Colorectal cancer (CRC) is the third most common type of cancer in Switzerland in terms of annual new cases and cancer deaths. Since most cantons have an organized screening program, more people are recorded with a positive family history of CRC. In the majority, the familial form of CRC is present, a hereditary form is much less common. Relatives of patients with CRC are a heterogeneous group whose CRC risk varies. A good assessment of disease risk can optimize the benefit-risk ratio for more intensive prevention. These recommendations («expert opinion statement») are intended to serve as a basis in clinical practice for planning preventative care, monitoring and human genetic counseling in the presence of a family history positive for CRC.

Introduction: Based on the cases in which assisted suicide (AS) has taken place in Switzerland in the context of a mental disorder or dementia, we discuss whether the slippery slope argument often brought up by opponents of assisted dying is justified. Long-term data from the Swiss Federal Statistical Office shows that while the number of cases with these «indications» is increasing (1999-2017: on average 21 cases/year vs. 2018-2022: n = 73 cases/year), the percentage share of these diseases in the total number of all AS cases has remained unchanged at around 5 %. Opponents of assisted dying believe that the slippery slope argument is already fulfilled by the fact that these cases occur at all. However, the still limited prevalence of these specific indications which still represent only a minority of assisted suicide cases over time, may be used by advocates of assisted dying to weaken the opposing viewpoint.

Introduction: Thrombotic microangiopathy (TMA) is defined by the typical triad of severe thrombocytopenia, hemolytic anemia and endorgan dysfunction and can be characterized by the pathophysiology of ischemia-inducing microthrombi in arterioles and capillaries possibly leading to severe organ dysfunction up to acutely life-threatening endorgan damage. In terms of etiology, management, therapy and prognosis, the following manifestations are distinguished: thrombotic thrombocytopenic purpura (TTP), shigatoxin-induced hemolytic-uremic syndrome (STEC-HUS), secondary comorbidity-related TMA and atypical hemolytic-uremic syndrome (aHUS). We present the case of a 49 year old lung transplant recipient developing aHUS. The complexity of the underlying pathomechanisms of TMA, the complicated differentiation of each TMA manifestation and the complex management of aHUS in the post-transplant setting illustrate the uniqueness of this patient case.

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Introduction: We describe the case of an immunocompromised patient in whom a severe infection with meningoencephalitis was detected. Listeria monocytogenes was the pathogen. Invasive listeriosis is a rare infectious disease that is notifiable in Switzerland and can be lethal. The most common route of contamination for the ubiquitous bacteria is the consumption of foods such as dairy products, raw vegetables or meat. Antibiotic treatment can lead to a complete cure.

Introduction: Background The Swiss Society of General Internal Medicine (SGAIM) has chosen the topic "Recognising drug interactions and preventing side effects" as a quality indicator in the primary care setting. Methodology Retrospectively, in a group practice of 6 general practitioners (GPs), all patients aged 65 and over who were prescribed ≥ 5 long-term medications were identified in the year 2022. These medications were systematically checked for interaction reports using the Compendium® software. Results The 226 patients were on average 77 years old and took an average of 7 different medications. In 188 (83.2 %) individuals with drug interaction signals, the severity of the drug interaction was classified as mild in 164 (87.3 %), moderate in 21 (11.1 %) and severe in 3 (1.6 %). Diuretics, antidiabetics and ACE-inhibitors/sartans were most frequently involved. In case of severe drug interaction reports, antidepressant agents and amiodarone were most frequently involved. In the multivariate analysis, no statistically significant associations were identified between the number of drug interaction reports and age, gender or type of residence. Conclusion In over 65-year-olds with polypharmacy (≥ 5 medications) in a GP setting, a software-supported systematic drug interaction check identified drug interactions of the prescribed medication in nine out of ten patients. The vast majority of drug interaction reports were minor and not clinically relevant. The number of drug interactions as an indicator of quality of care is limited, as patient-specific information other than their medication regimens is not taken into account. GPs' classification in the clinical context and the context and the assessment of the benefits and risks of (poly-)medication is indispensable.

Introduction: The subject of this guideline from the Institute of Family Medicine at the University of Zurich (IHAMZ) is the management of venous thrombosis. The review summarizes the current evidence and recommendations from international guidelines (1-6). The IHAMZ-guidelines focus on primary care, they also provide guidance on the coordination of general and specialist medical care as well as on the transition between outpatient and hospital care taking into account the special features of the Swiss healthcare system. The guideline is devided in two parts. Part 1 discusses the diagnosis and treatment of deep vein thrombosis (DVT). A validated algorithm is recommended for the diagnostic process, which begins with the assessment of the clinical probability. With the inclusion of the D-dimer test, the need for subsequent imaging diagnostics can be reduced. The differences between the evaluation of an initial and recurrent DVT are shown and the indications and scope of evidence-based environmental diagnostics (thrombophilia and tumor search) are presented. All patients with DVT should receive anticoagulation (AC) for 3-6 months, as there is a high risk of recurrence with AC 3 months. The duration of the subsequent secondary prophylaxis depends on the presumed risk of recurrence on the one hand and the risk of bleeding on the other. Part 2 is dedicated to special thrombosis situations such as isolated distal thrombosis of the deep and muscle veins (idDVT, iMVT), shoulder-arm vein thrombosis (SAVT), cancer-associated thrombosis (CAT) and superficial vein thrombosis (SVT). The article on hormone- and pregnancy-associated DVT, developed together with the Department of Gynecology at the University Hospital of Zurich, discusses the importance of hormonal contraception and menopausal hormone replacement therapy (HRT) as thrombogenic risk factor as well as special features in the diagnosis and treatment of thrombosis in pregnancy.

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