Praxis最新文献

Introduction: In rare cases, dilatation of the remaining cystic duct remnant after cholecystectomy can lead to a neogallbladder, in which gallstones can recur and cause further biliary problems (such as choledocholithiasis). The differential diagnosis of a "neogallbladder" should therefore be considered in cases of biliary colic even after cholecystectomy.

Introduction: Physician Associates (PAs) and Nurse Practitioners (NPs) are healthcare professionals with advanced clinical skills who play a key role in strengthening integrated care and mitigating physician shortages. PAs hold a CAS or MAS (15-60 ECTS) and support physicians by taking on specific responsibilities (task shifting) to improve efficiency and ensure high-quality care. NPs have a Master of Science in Nursing (90-180 ECTS), and work with physicians (task-sharing) to care for a defined population, establishing diagnoses, managing treatment, and providing self-management support. PAs and NPs work in both inpatient and outpatient settings. Their training, competencies and scopes of practice differ; allowing them to complement each other. National regulation and tariff structures are necessary for both professions to reach their full potential.

Introduction: A 35-year-old woman presented with delayed bone healing after periacetabular osteotomy, despite appropriate postoperative unloading and vitamin D supplementation. Laboratory evaluation revealed persistently low serum alkaline phosphatase (ALP) activity with otherwise normal bone metabolism markers. The patient's family history, which included a known ALPL gene mutation, ultimately led to the diagnosis of a rare metabolic bone disorder. Genetic testing confirmed the adult form of hypophosphatasia. This case highlights the importance of subtle biochemical findings and thorough family history in the diagnosis of rare conditions.

Introduction: In this case study, we present an unusual course of a 40-year-old patient with clinical signs of a viral infection with leading gastrointestinal symptoms. In the short term, he developed a progressive ascending sensorimotor tetraparesis with autonomic symptoms as well as qualitative disturbance of consciousness and the need for intensive medical care. Imaging revealed transverse myelitis and a diffusion disorder of the splenium (so-called CLOCC lesion). A diagnosis of "mild encephalopathy with reversible splenial lesion (MERS)" and "longitudinally extensive transverse myelitis (LETM)" was made. An influenza B infection was diagnosed as the causative disease. This is an immunologically triggered pathogenesis. Immunosuppressive therapy indicated.

Introduction: A 60-year-old patient suffered from non-specific complaints (recurrent abdominal pain). Targeted diagnostics were only carried out after hemoptysis, anemia and an inflammatory condition occurred. Due to lesions suspected to be malignant in imaging (pulmonary nodules, osteolytic changes) the diagnosis of angiosarcoma was finally confirmed by biopsy. In summary, angiosarcomas are aggressive subtypes of soft tissue sarcomas with poor prognosis an limited treatment options. On the basis of the following case report the difficulties of making a diagnosis as well as the limited treatment options will be discussed.

Introduction:

Introduction: Heat stroke is a serious and underdiagnosed condition, which is subdivided into exercise and classic subtypes. Climate change and increasing temperatures are making this pathology more and more common. Its pathophysiology is closely linked to the ability of the cardiovascular system to adapt. Multi-organ damage can complicate this disease, through a systemic inflammatory response. Acute neurological symptoms and signs are the typical clinical presentation of heatstroke. Management is based on early and active cooling, as well as support for vital functions. Preventing this problem requires a community and public health response.

Introduction: For the past 15 years, the WHM FMF Foundation has actively promoted postgraduate training in primary care and played a pioneering role in developing structured postgraduate training, also known as "practice assistance". Practice assistance and the so-called curricular rotation programs (rotations in disciplines relevant to primary care) are now integral components of primary care postgraduate training and contribute signifcantly to securing primary healthcare provision in Switzerland. Today, all cantons provide financial support for practice assistance and have implemented their programs. For the sustainable development of postgraduate primary care training, increased intercantonal collaboration and coordinated program structures will be key in the future.

Introduction: We report the diagnosis and clinical course of a 62-year-old patient with non-specific symptoms, such as dry cough, weight loss, increased fatigue, and a long-standing previously operated aortic graft prosthesis. Extensive investigations led to the diagnosis of a chronic infection of the aortic graft caused by Coxiella burnetii (Q-fever), following which an antibiotic therapy with Doxycycline and Hydroxychloroquine was established.

Introduction: Acne is one of the most common skin diseases. It has a high impact on the quality of life of the affected patients. It is now recognized that in some patients, acne shows characteristics of a chronic disease. Because of a lack of current recommendations/guidelines in Switzerland, a group of hospital and private practice based dermatologists, specialized in acne, as well as an experienced general practitioner revised the available literature on acne and its treatment. The group subsequently developed several consensus statements regarding grading, treatment and monitoring of acne. The first version of the recommendations was published in 2020 and is now being updated. The experts agreed that acne severity should be determined by a subjective method and that, for short-term therapy, treatment success is defined as an approximately 50 % reduction of inflammatory lesions within 3 months. The choice of induction treatment is based on the severity of the disease. Its main component is a topical retinoid alone or - in more severe case - in combination with benzoyl peroxide (BPO). Only in moderate to severe forms of acne or if a more rapid resolution of inflammatory lesions is desired, a systemic antibiotic should be added to induction treatment. For severe acne with a tendency to scarring, systemic retinoids are the induction treatment of choice in the absence of contra-indications. Maintenance therapy is indicated in all patients with acne, independent of disease severity. The choice of maintenance therapy should always be based on acne severity, duration of disease, current treatment and history of relapse. The preferred options for maintenance therapy are topical retinoids with/without BPO. While treating acne, a special focus should lie on the prevention of scars. For this reason, patients should be evaluated 3 months after treatment initiation to determine whether they have responded or whether further therapeutic options should be considered. The expert group also recommends counselling patients on nutrition, psychological aspects, stress, use of contraceptives, skin care, use of cosmetics and use of other drugs (like steroids). Monitoring of patients with acne should particularly focus on adherence to treatment and quality of life. Patients with severe forms of acne (acne with a tendency of scarring, patients with acne conglobata or acne fulminans), patients with insufficient treatment response after 3 months and patients with frequent relapses should be referred to a dermatologist.