THERAPEUTISCHE UMSCHAU最新文献

Introduction: Adverse drug reactions (ADRs) are a major global health problem with high morbidity and mortality rates. They are divided into two main types: the more common type A reactions, which are dose-dependent and usually predictable, and the rarer type B reactions, which occur independently of the dose and require an individual predisposition on the part of the patient and often pose a particular challenge in everyday clinical practice. The majority of cutaneous adverse drug reactions (ADRs) are uncomplicated. The most common are maculopapular exanthema, which typically represent a type IV hypersensitivity reaction. Serious cutaneous ADRs, on the other hand, are rare but can be potentially life-threatening. Skin changes associated with immune checkpoint inhibitors and other immunotherapies represent a separate entity within cutaneous drug reactions. Immune-related adverse events (irAE) are common in immunotherapy and are considered in many cases to be a correlate of a positive therapeutic response.

Introduction: The growing popularity of tattoos highlights the importance of careful regulation of tattoo inks to minimise health risks. In Switzerland, tattoo inks are subject to strict legal requirements based on food legislation, which are designed to ensure that they are sterile and harmless. The European Union has significantly tightened restrictions on substances in tattoo inks through Regulation (EU) 2020/2081 in order to increase safety. In contrast, the USA regulate tattoo inks under the supervision of the Food and Drug Administration (FDA), but do not have specific pre-market controls for tattoo ink products. This comparison highlights different regulatory approaches in Switzerland, the EU and the USA and underlines the need for more harmonised global regulation to protect consumer health.

Introduction: In clinical practice, correctly diagnosing headaches can be challenging due to the many differential diagnoses. It is particularly important to differentiate between the more common primary headache types, where the headache itself is the main condition, and secondary headaches, which may have potentially lifethreatening causes. The diagnostic approach initially focuses on identifying secondary headaches.

Introduction: Polyneuropathies are common, can have very different clinical presentations and numerous causes. This article is intended to provide a practice-oriented overview of possible symptoms, the most important causes and a targeted, step-by-step diagnostic approach. Based on red flags, patients should be identified who urgently require a timely specialist assessment. The most important treatment approaches should be briefly explained.

Introduction: Stroke is a common, potentially life-threatening event that presents both acute and long-term challenges for patients and the healthcare system. The importance of educating patients about key symptoms, rapid diagnosis, and timely therapy is often underestimated. In addition to prevention through the optimal management of risk factors such as high blood pressure and diabetes, early detection of stroke symptoms is crucial. Modern and effective therapies such as thrombolysis and endovascular procedures can significantly improve outcomes if initiated promptly. Familiarity with stroke symptoms is essential for recognizing and differentiating so-called stroke mimics and stroke chameleons. In patients showing corresponding symptoms, immediate referral to a hospital is imperative. The 4-S acronym (Sehstörung, Sprachstörung, Schwäche, schnell handeln - visual disturbance, speech disturbance, weakness, act fast) serves as an easily understandable mnemonic for patients. If stroke is suspected, the emergency services (144) should be contacted immediately, as every minute counts ("Time is Brain"). Given that strokes can also present with atypical symptoms, rapid imaging is indispensable in uncertain cases to rule out misdiagnosis. In this context, general practitioners play a crucial role in early detection and timely referral, which again significantly improves the quality of care.

Introduction: Dizziness is one of the most common, yet diagnostically challenging cardinal symptoms with a wide range of causes. It accounts for 2-8 % of all consultations in both the emergency room and in general practice. The extremely broad differential diagnosis, which covers numerous medical specialties, the often transient nature of the symptoms, and the difficulty for patients to put the experienced symptoms into words, often make the evaluation of dizziness challenging. A structured history and targeted clinical examination - particularly with a focus on duration, triggers and oculomotor signs (HINTS-plus) - are crucial. The priority is to quickly identify dangerous causes such as stroke or cardiac arrhythmias. Diagnostic tests should be targeted to avoid overdiagnosis. The treatment depends on the cause and should be based on guidelines.

Introduction: Epileptic seizures rank among the most striking neurological key symptoms and pose a particular diagnostic challenge, especially when occurring for the first time. Differentiating between provoked, unprovoked seizures and epilepsy is essential for making appropriate therapeutic decisions. A thorough medical history, supported by EEG, MRI, and laboratory tests, usually allows for a well-founded classification and helps exclude important differential diagnoses such as syncope or psychogenic non-epileptic seizures. The International League Against Epilepsy (ILAE) classifies seizures based on their origin into focal, generalized, and seizures of unknown onset, which facilitates therapeutic categorization. Acute management is particularly indicated in cases of seizure clusters or status epilepticus. The decision to initiate long-term antiseizure therapy should be made on an individual basis and depends on seizure type, etiology, risk of recurrence, comorbidities, and the patient's individual life circumstances. Patient education is a central aspect of management and should cover trigger factors, therapy adherence, everyday safety risks, and driving eligibility. Early and differentiated diagnostics combined with an individually tailored treatment approach can significantly improve the prognosis - around two-thirds of affected individuals achieve seizure freedom with antiseizure therapy.

Introduction: Visual disturbances are a common presenting symptom of multiple sclerosis (MS), often caused by optic neuritis. This acute inflammation of the optic nerve leads to pain during eye movements, visual impairment and colour vision defects. Optic neuritis can be idiopathic, MS-associated or occur in the context of other diseases such as NMOSD or MOGAD. Diagnosis is based on clinical findings, imaging and visual evoked potentials. Early high-dose corticosteroid treatment can support recovery and improve long-term prognosis.

Introduction:

Introduction: The diagnosis and treatment of alcohol use disorders often pose complex questions and challenges for healthcare professionals. In addition to the established indirect biomarkers (e. g. carbohydrate-deficient transferrin [CDT]), clinical research in recent years has produced increasingly valuable findings on the use of direct biomarkers. In this regard, the marker phosphatidyltethanol (PEth), a lipid metabolite that is formed during the breakdown of ethanol, is stored in the erythrocytes, should be emphasized in particular. The advantage of targeted use of PEth in general medical and psychiatric practice to improve diagnostics and therapy has been demonstrated in clinical studies in recent years. Together with the established screening instruments (e. g. AUDIT), PEth can lead to greater validity in the diagnosis of alcohol use disorders. Targeted use of PEth can be used to control treatment goals (e. g. abstinence vs. controlled drinking) and monitor them longitudinally. The determination of PEth generally facilitates and improves communication with patients and can contribute to a destigmatization of the clinical picture, as certain feelings of shame and inhibitions in doctor-patient contact could be diminished.