THERAPEUTISCHE UMSCHAU最新文献

Introduction:

Introduction: Fears and anxieties are a common cause of suffering for patients at the end of life. These are often either fears about dying - for example, fear of unbearable pain or fear of suffocation - or fear of death itself. If unrecognized and untreated, fears and anxieties can contribute to a considerable reduction in the quality of life in the last phase of life. Careful diagnosis of anxiety and fear is therefore crucial. Multimodal treatment, which includes psychotherapy and other non-pharmacological and - if necessary - pharmacological treatments, can provide significant relief.

Introduction: Individuals with obesity who undergo surgical or pharmacological therapies achieve good results in terms of weight and cardiometabolic risk reduction. It is not uncommon for those affected to equate the extent of weight loss achieved, with long-term treatment success. What is overlooked is that, in addition to obesity, significant weight loss also carries a risk of sarcopenia. Sarcopenic obesity and sarcopenia, in turn, increase the risk of cardiometabolic diseases. Physical activity has the potential to counteract cardiometabolic disease risk caused by obesity and sarcopenia. The underlying mechanism is contained in the endocrine organ skeletal muscle. The production and release of myokines in particular counteracts sarcopenic obesity and its complications. Physical activity is required to initiate myokine production. Endurance and strength training proves to be an effective training combination. In order to achieve a sustainable cardiometabolic risk reduction, the objectives and timing of physical activity should therefore be divided into two phases, a preparatory phase and an actual weight loss phase.

Introduction: Formula diets, through the use of industrially manufactured meal replacement products, lead to effective and rapid weight reduction and improvement in obesity-associated comorbidities. The specific composition of these meal replacement products simplifies the adherence to calorie goals and ensures the supply of essential nutrients during significant energy restriction. Despite numerous potential applications, evidence from randomized controlled studies, and simplicity in practical implementation, challenges persist. Monotony and social restrictions complicate adherence and acceptance. The use of formula diets for sustainable weight loss requires integration into a multimodal treatment approach with the goal of long-term changes in eating and activity behaviour. This includes accompanying nutritional counselling, promotion of physical activity, evaluation of adjuvant pharmacological or interventional therapies, as well as psychological support. The development of new incretin-based anti-obesity medications has opened another application field for formula products. There is optimization potential in expanding the product range and combining it with digital applications to enhance acceptance and reach a larger patient group.

Introduction: The obesity epidemic has led to an increased prevalence of obesity-related glomerulopathy (ORG). This disease is characte-rized by proteinuria, glomerulomegaly, progressive glomerulosclerosis and a decline in renal function. Individuals with obesity frequently display arterial hypertension and diabetes mellitus, exacerbating renal damage. The pathogenesis involves overactivation of the RAAS (Renin-Angiotensin-Aldosterone System), glomerular hyperfiltration, an inflammatory state with oxidative stress, hyperinsulinemia-induced hemodynamic alterations and lipotoxicity. Additionally, obesity represents a significant risk factor for kidney stone formation, further contributing to renal damage. The management of obesity-induced nephropathy primarily involves weight reduction strategies and optimized control of blood pressure and metabolic factors. Early detection is crucial to counteract the progression of kidney disease. Noteworthy, obesity significantly complicates the implementation of renal replacement procedures, including kidney transplantation, and increases the rate of complications. In summary, there are many reasons why obesity should gain attention in the field of nephrology.

Introduction: The prevalence of overweight and obesity has increased dramatically. At the same time, lack of sleep has become a part of the modern lifestyle, as well as shift and night work. As a result, chronodisruption, i. e. a change in physiological processes that are controlled by the internal clock, becomes commonplace. Epidemiological data show that too short but also too long sleep are associated with an increased risk of obesity, also seen for night shift work. Overweight and obesity are associated with metabolic syndrome and data likewise report an increased risk by both short and long sleep. It has not yet been conclusively clarified how chronodisruption influences the metabolic risks. Clinical experimental studies report on neuroendocrine and circadian mechanisms and it has been shown that lack of sleep increases the hunger-promoting hormone ghrelin as well as subjective feelings of hunger and increases leptin levels. Lack of sleep also increases hedonic hunger and food-related reward signals. Through preventive measures, chronodisruption and thus, the risk of obesity can be counteracted. The extent to which smartwatches and fitness trackers, which according to the manufacturer can measure and analyze sleep, provide an objective picture of sleep has not been sufficiently investigated. However, smartwatches and fitness trackers can - probably - increase awareness of sleep in the modern society.

Introduction: This contribution highlights novel developments and innovations in psychological psychotherapy for patients with obesity. It underscores the importance of an interdisciplinary approach to treatment, which incorporates not only traditional methods but also contemporary psychotherapeutic modalities such as Acceptance and Commitment Therapy (ACT). Current research suggests that assessing the effectiveness of psychotherapy should not solely rely on changes in weight, but should also consider other outcomes such as subjective quality of life and mental health. Furthermore, the role of telemedicine and blended psychotherapy is emphasized as promising approaches to enhance accessibility and effectiveness of treatment. Through a case study of a 55-year-old woman with obesity and psychiatric comorbidities, the effectiveness of a multimodal psychotherapeutic approach is demonstrated.

Introduction: Obesity is a chronic disease characterized by increased body fat mass and adipose tissue dysfunction, the pathogenesis of which is based on a neurobiological regulatory disorder of energy homeostasis. The primary aim of medical obesity therapy is to reduce the pathologically increased body fat mass and thus prevent secondary diseases and improve comorbidities. In this sense, bariatric-metabolic surgery is currently the most effective obesity therapy. In addition, new agents, which are essentially based on GLP-1 receptor agonism, are making pharmacological therapy increasingly effective. It is important to note that both bariatric-metabolic surgery as well as the pharmacological obesity therapy have direct effects on the central nervous regulation of energy homeostasis and, in particular, hunger and appetite, and therefore represent pathogenetically causal therapies. In this overview, we aim to shed light on the aforementioned medical interventions for obesity therapy and place them in the context of a pathogenetic disease concept.

Introduction:

Introduction: Heart failure with preserved left ventricular ejection fraction (HFpEF) is a common and very important disease entity because of its association with frequent repeat hospitalization and high mortality. Hallmarks of the underlying pathophysiology include a small left ventricular cavity due to concentric remodeling, impaired left ventricular compliance and left atrial dysfunction. This leads to an increase in left atrial and pulmonary pressure on exertion and in advanced stages of the disease already at rest with consecutive exertional dyspnea and exercise intolerance. Additional cardiovascular mechanisms including atrial fibrillation, chronotropic incompetence and coronary artery disease as well as non-cardiac co-morbidities contribute to a variable extent to the clinical picture. The diagnostic work-up is demanding and complex but the concepts have significantly improved during the last years. The study results of the Sodium Glucose cotransporter-2 inhibitors (SGLT-2-inhibitors) have revolutionized the treatment of HFpEF. In the present article, we provide an overview about the current understanding of the pathophysiology of HFpEF, the principles of the diagnostic pathways and a summary of the intervention studies in the field, and we propose an approach for the treatment in clinical practice.