Deutsche medizinische Wochenschrift (1946)最新文献

The gastrointestinal microbiome influences physiological functions and is altered in a variety of diseases. The causality of "dysbiosis" in the pathogenesis is not always proven; association studies are often involved. Patients with IBD, bacteria, fungi, bacteriophages, and archaea show disease-typical patterns associated with metabolome disturbances. Fecal microbiome transfer (FMT) for treating various diseases is the subject of numerous clinical studies. Currently, recurrent Clostridioides difficile infection (rCDI) is the only confirmed indication recommended in medical guidelines. In Germany, the FMT is subject to the Medicines Act and may only be carried out as part of individual healing attempts or clinical studies. For patient safety, repeated donor screening, ideally with the construction of a chair bench, is necessary. This significantly limits the nationwide availability of the FMT in Germany. Microbiota-based therapeutics prepared from the stool of tested donors have recently been approved by the US Food and Drug Administration (FDA) for the prevention of rCDI. More microbiome-based medicines can be expected in the future.

A 46-year-old male presented at the emergency department with a 2-day history of a fever up to 40°C, exertional dyspnea and a rash. The patient was on holiday in Greece up until a week prior to the development of symptoms.A chest CT scan showed an atypical pneumonia and marked lymphadenopathy. The detection of measles virus RNA led to the diagnosis of measles as a cause of the pneumonia.The patient was admitted to the hospital and received symptom-based treatment. He received temporary supplemental oxygen for mild hypoxemia.Any patients presenting with typical symptoms of measles (fever, rash, conjunctivitis) should be tested for it (serology, PCR), regardless of the patients' age.

Demographic trends mean that the proportion of older and very old patients in hospitals at all levels of care is increasing. This means that significantly more patients from these age groups can be expected in the future. These developments pose new challenges for both medical care and the management of geriatric intensive care patients, taking into account their multimorbidity and functional limitations due to acute illness. Although mortality increases with age, the outcome is highly dependent on the patient's functionality and comorbidity. The elderly patient also shows structural and functional organ changes, knowledge of which is important for the treatment of geriatric patients in intensive care medicine. This increasing need for geriatric treatment will have a decisive influence on the development of intensive care medicine in the coming years.

Pleural ultrasonography enables the rapid and reliable detection of pneumothoraces, pleural effusions, and other lung pathologies. Its advantages - such as high image resolution and ease of bedside use - make it particularly popular in acute and intensive care medicine. Despite its limitations in examining deeper structures, it offers many benefits compared to other imaging modalities.

A 54-year-old man presented with increasing arthralgia and swelling of the metacarpophalangeal (MCP) joints II and III for approximately 2 years. He also reported morning stiffness and joint pain in both knees and feet.Both MCP joints II and III and the proximal interphalangeal joints II and III were tender without visible swelling. X-rays of the hands showed symmetrical osteoarthritic changes of the MCP joints I-III on both sides. Joint ultrasound revealed symmetrical osteophyte formation without inflammatory signs. Laboratory tests showed elevated ferritin (1436µg/l), iron (252µg/dl), and transferrin saturation (79%). Genetic testing confirmed a homozygous C282Y mutation, and FibroScan elastography indicated advanced fibrosis.Hemochromatosis-associated arthropathy.A symptom-oriented analgesic treatment with Metamizole was initiated. During the hospital stay, the patient received physical and occupational therapy. Hepatology specialists will manage further treatment at a university center, and the outcome remains to be seen.Symmetrical involvement of the MCP joints II and III should raise suspicion of hemochromatosis.

As the survival prognosis of cancer patients continues to improve, the improvement in quality of life during and after cancer treatment is becoming increasingly important 1. Exercise therapy has a positive effect on so-called "patient-reported outcomes" 2. The combination of endurance training and individualized strength training plays a particularly important role here. There is therefore a need for consistent and comprehensive implementation of quality-assured exercise therapy in everyday clinical practice.