Praxis最新文献

Introduction: In Switzerland, patients are referred to their GP for preoperative examinations before cataract surgery. However, according to the ESC Guideline 2022, this is unnecessary. The aim of this study was to assess guideline adherence for preoperative assessment prior to cataract surgery in Northwestern and Central Switzerland. All licensed ophthalmic surgeons were identified via public registers. They were contacted and asked for the preoperative GP form. These forms were then compared to recommendations. Only two of five categories showed a majority of adherence to the guideline. There was no significant difference between regions. Preoperative examinations lead to avoidable workload, additional costs and unnecessary patient examinations.

Introduction: Palliative care provides care for seriously ill and dying people, often suffering from pain. Adequate pain treatment is therefore a main focus of the treatment team. Attempts are made to objectify the occurrence of pain using scoring systems such as ESAS or MIDOS. However, the difficulty of objectifying subjective conditions, such as the phenomenon of pain, is problematic and renders the scoring systems poor in content. Only through the complementary efforts of the treatment team, which can be found in the basic attitude of an open-minded recognition of states of suffering, can the best possible approximation to what can be understood as an intersubjective objectification of the pain event be achieved and ultimately the symptom burden be better reduced. However, without negating the difficulties that arise with the objectification of pain.

Introduction: We present the case of a 53-year-old patient who developed DRESS syndrome with hepatopathy and sepsis-like symptoms, including the need for vasoactive agents, while receiving antibiotic therapy. In this report, we show the diagnostic process from the initially suspected and frequent abdominal sepsis to the rare DRESS syndrome. Only after discontinuation of the antibiotic therapy and initiation of steroids did the condition gradually improve.

Introduction: Ageing of the general population is a major forthcoming challenge for all healthcare systems. Co-morbidities in geriatrics lead to the prescription of complex polymedications. Deprescribing is a decision-making process that limits the number of inappropriate drugs. Nevertheless, the patient's perspective remains insufficiently studied. An extensive literature search of several databases identified nine studies up to May 2024 that met the criteria for inclusion. Four main themes have been identified around patients' perception of deprescription: 1) the relationship with the general practitioner, 2) the clinical aspects, 3) the psychosocial dimension and 4) the practical aspects. Several factors facilitating deprescribing from the patient's perspective have been identified and can be exploited clinically.

Introduction: Ciprofloxacin is among the most commonly prescribed Fluoroquinolones. Side effects of Fluoroquinolones include tendinopathies, ar-rhythmias, gastrointestinal discomfort, and neurological symptoms. The definition of a "Fluoroquinolone-associated disability" includes dis-ability, symptoms in several body systems and duration of symptoms after discontinuation of the antibiotic. The pathophysiology of this disease is probably due to a damage to the redox system. We report on a 41-year-old patient who felt pain in his Achilles tendons three days after starting to take ciprofloxacin (of a total of 3 g) and presented as an emergency. In the course of the disease, the pain became chronically disabling and the patient developed paresthesia of both extremities and intermittent heart palpitations. The only tolerated pain medication was Pregabalin. Several MRI examinations showed minimal peritendinitis and irritation of the Achilles tendons. Blood samples indicated probable intracellular damage at low intracellular ATP and coenzyme Q10 values.

Introduction: In addition to the treatment recommendations published by the Special Interest Group (SIG) "Mental Health" (formerly "Sleep Psychiatry") of the Swiss Society for Sleep Research, Sleep Medicine and Chronobiology (SGSSC), the following article focusses on cognitive behavioural therapy for insomnia (CBT-I), its evidence, implementation and application, including in shift work, patients on medication, older people, various formats and non-pharmacological alternatives. Chronic insomnia is a disorder characterised by hyperarousal rather than sleep deprivation. The most effective treatment is bedtime restriction. This can be accompanied by increased daytime sleepiness and concentration deficits, which can be challenging. Furthermore, it is a challenge to find activities for the time that becomes available. The number of therapy places is still insufficient. However, it has been shown that CBT-I is also effective in shortened formats, digitally or when carried out by other professional groups.

Introduction: This case report describes a phototoxic drug reaction in an 81-year-old patient taking the antifibrotic drug pirfenidone for the treatment of idiopathic pulmonary fibrosis. After two hours of sun exposure with sunscreen (SPF 50), the patient developed pruritic, erythematous and scaly lesions on the sun-exposed areas (face, neck, hands and forearms). Physical examination revealed an erythematous exanthema with coarse lamellar scale. A phototoxic reaction to pirfenidone was suspected based on the clinical presentation and distribution pattern. Treatment with topical corticosteroids and discontinuation of pirfenidone led to a marked improvement in symptoms. This case highlights the potential phototoxic risks of pirfenidone, which should be considered especially in dermatological practice where the drug is less known. In addition, important differential diagnoses are outlined and discussed.

Introduction: Bronchial asthma is a well-known and common disease. However, there is less knowledge about the fact that asthma can also have an association with the profession. However, this is very relevant because young patients who are in the middle of their working lives are often affected and suffer far-reaching consequences if a diagnosis of occupational asthma is made. The consequences are of a health as well as of a socio-economic nature. Since the asthma symptoms are present inconsistently and corresponding questions about the job may not be asked in the anamnesis, the workplace association is sometimes misunderstood and the diagnosis is therefore delayed. In this article we would like to raise medical awareness of work-related asthma, focus on occupational asthma and the steps to clarify it and finally explain the further procedure regarding suitability for work.

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Introduction: A patient presented with fever and upper abdominal pain after returning from Australia and Vanuatu. Pronounced eosinophilia served as a diagnostic clue, leading to a successful treatment of acute fascioliasis with Triclabendazole. Following the therapy, the patient experienced complete symptom relief.