Deutsche medizinische Wochenschrift (1946)最新文献

The transition from compensated to decompensated advanced chronic liver disease (ACLD) is associated with increased mortality. Clinically significant portal hypertension (CSPH), defined by a hepatic venous pressure gradient (HVPG) ≥10 mmHg, is the main precondition of decompensation. Non-invasive tools like transient elastography help identifying patients at risk. Preventing the first decompensation, especially ascites, is a key therapeutic goal. Non-selective beta-blockers (NSBBs), particularly carvedilol, reduce portal pressure and have shown efficacy in preventing decompensation, independent of variceal status. Lifestyle modification and treating underlying liver disease (e.g., alcohol abstinence, viral eradication) remain essential. Early identification and initiation of therapy in CSPH can change the natural history of cirrhosis and improve patient outcomes.

Since 2022, an estimated 150000 to 200000 patients with heart failure (HF) in Germany have met the inclusion criteria for HF telemonitoring in accordance with the Federal Joint Committee's (G-BA) decision. Currently, only a few artificial intelligence (AI) applications are used in standard cardiovascular telemedicine care. However, AI applications could improve the predictive accuracy of existing telemedical sensor technology by recognising patterns across multiple data sources. AI-based biomarkers are also being developed for use in telemedical sensor technology. Voice analysis to recognise pulmonary congestion appears to be a promising approach. In the future, AI-based decision support systems could help optimise the diagnostic process in telemedicine centres. Large language models offer the potential to support the diagnostic process. The European Union's AI regulation has established the first framework for testing new AI-based technologies in healthcare. Real-world laboratories provide an opportunity to research innovative technologies in a protected environment.

The COVID-19 pandemic led to a sharp increase in the recognitions of COVID-19 as an occupational disease in Germany. The patients often report diverse symptoms, whereas causality and objectification remain difficult.A selective literature research in PubMed was carried out, assessment recommendations and guidelines were included, too.Long-term consequences of COVID-19 belong to various medical fields. Direct and indirect objectification are necessary. The latter requires concrete indications for the connection between COVID-19 and symptoms. An individual case assessment is also required regarding the reduction in earning capacity. Official recommendations for assessment were published shortly before this review in June 2025.Objectification is a crucial factor, whereas its implementation is complex. Effects on the degree of damage and the degree of disability should be taken into account.

The patient (male, two expert reports: 61 and 63 years old) experienced symptoms of a flu-like infection with rapid deterioration and cognitive complaints. He has been an employee of the municipal building yard with a sewage treatment plant for approximately 24 years.Acute renal insufficiency (creatinine 9.7 mg/dl), increased anti-Leptospira IgM antibodies and Leptospira DNA using PCR were detected. The CT neurocranium without contrast medium did not reveal any relevant abnormalities.Sepsis with multiorgan failure including a type 2 myocardial infarction and acute renal failure in the context of leptospirosis was diagnosed.Antibiotic therapies with piperacillin/tazobactam, clarithromycin and meropenem were given. Regarding acute renal failure, renal function was significantly improved by using temporary hemodialysis. After an assessment, leptospirosis was recognized as occupational disease No. 3102 in accordance with Appendix 1 of the Occupational Diseases Ordinance.Physicians should take a work history and, if there is reasonable suspicion, are legally obliged to report suspected occupational diseases. The primary infection and such a complex course (including costs) can be prevented by adequate occupational safety.

Systemic amyloidoses present with non-specific symptoms which lead to a wide spectrum of possible differential diagnoses. In this retrospective study we analyzed a patient cohort that was referred to the amyloidosis center Heidelberg under the suspicion of amyloidosis but ultimately did not receive the diagnosis of amyloidosis after diagnostic work-up. The usefulness of differential diagnosis (DDX) generators in the diagnostic process of amyloidosis is unclear.Included in this retrospective analysis were the data of patients who were referred to the amyloidosis center between 2014 and 2020 and who did not receive the diagnosis of amyloidosis.In order to test the usefulness of the DDX-Generator, 90 patients without amyloidosis were selected from this cohort and compared to another cohort of 30 random patients with confirmed amyloidosis.The diagnosis of amyloidosis was ruled out in 351/2829 (12,4%) patients. The most frequent diagnoses were polyneuropathies (n=129/351, 36,7%) and cardiomyopathies (n=76/351, 21,7%). Plasma cell dyscrasia associated diseases were only present in 17/351 (4,8%) of patients. The cause of the disease remained unknown in 160/186 (86,0%) patients with a mean follow-up time of 34,5 months.In the non-amyloidosis cohort, the DDX generator listed amyloidosis as a possible differential diagnosis in the top 10 differential diagnoses in 25/90 (27,8%) cases.In the amyloidosis-cohort, amyloidosis was significantly more often present in the top 10 differential diagnoses (n=28/30, 93,3%,).Point of contact for patients with unknown or rare diseases are the centers for rare diseases. DDX-Generators could aid physicians to consider amyloidosis as a possible differential diagnosis.

Digital devices can be used for arrhythmia detection and cardiac rhythm monitoring. Various technologies, such as electrocardiography, photoplethysmography and phonocardiogram are available for this approach. Current recommendations emphasize the need for appropriate recording, evaluation and assessment of data. Benefits and risks of digital devices need to be weighed for the individual patient. Moreover, reimbursement varies between different countries. In the future, wearables are expected to have a rising impact on the establishment of diagnosis as well as monitoring of heart rhythm disorders.