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Deutsche medizinische Wochenschrift (1946)最新文献

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[Pacing in a 59-year-old female patient with post-Covid syndrome - a model for self-directed rehabilitation]. [科维德综合征后 59 岁女性患者的起搏--自我指导康复的典范]。
Pub Date : 2024-09-01 Epub Date: 2024-09-09 DOI: 10.1055/a-2373-5038
Lienhard Dieterle, Hans Richter
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引用次数: 0
[Joint pain - a rheumatic disease?] [关节疼痛--风湿病?]
Pub Date : 2024-09-01 Epub Date: 2024-09-09 DOI: 10.1055/a-2329-6673
Frank Moosig, Julia U Holle

Pain in the musculoskeletal system and therefore joint pain is one of the most common reasons for consulting a general practitioner (GP). Inflammatory rheumatic diseases are among the important differential diagnoses. However, the prevalence of rheumatological diseases is significantly lower than that of degenerative causes of pain. Incorrect referrals can be avoided if the causes of pain are better differentiated in GP practices. This article presents the first differential diagnostic steps that make it easier for the GP to make further treatment decisions. Physical examination, laboratory diagnostics and imaging are discussed, and the concept of "clinically suspect arthralgia" as well as the possible effects of treatment trials with glucocorticoids are presented.

肌肉骨骼系统疼痛,因此关节疼痛是向全科医生(GP)咨询的最常见原因之一。炎症性风湿病是重要的鉴别诊断之一。然而,风湿病的发病率明显低于退化性疼痛。如果全科医生能更好地区分疼痛的原因,就能避免错误的转诊。本文介绍了第一个鉴别诊断步骤,使全科医生更容易做出进一步的治疗决定。文章讨论了体格检查、实验室诊断和影像学检查,并介绍了 "临床可疑关节痛 "的概念以及糖皮质激素治疗试验的可能效果。
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引用次数: 0
[Multi-resistant pathogens - are they also resistant to disinfectants?] [多重抗药性病原体--它们对消毒剂也有抗药性吗?]
Pub Date : 2024-09-01 Epub Date: 2024-09-09 DOI: 10.1055/a-2250-0901
Johannes Knobloch, Birte Knobling

Epidemiological studies show that the care of patients in rooms with a previous stay by a person with evidence of multi-resistant pathogens (MRP) is associated with an increased risk of these pathogens occurring. The question therefore regularly arises as to whether MRP also exhibit resistance to the disinfectants used. To date, there are no standardised definitions for "resistance" to disinfectants. However, disinfectants authorised on the market are also effective against multi-resistant pathogens and the failure of efficient disinfection is mainly caused by application errors (insufficient cleaning, incomplete wetting, incorrect application concentration or exposure time etc.). The effectiveness of disinfectants depends on a variety of environmental factors (especially accompanying contamination). A reduced sensitivity to disinfectants can occur in individual isolates due to selection under sub-inhibitory concentrations of disinfectants. Resistance mechanisms to antibiotics do not mediate cross-resistance to disinfectants, but a change in the permeability of bacterial cells can influence sensitivity to disinfectants and antibiotics. In general, the success of routine disinfection can be improved by suitable process controls and contribute to reducing the transmission of MRP.

流行病学研究表明,在曾有多重耐药病原体(MRP)感染者入住过的病房护理病人,会增加这些病原体感染的风险。因此,人们经常会问,多重耐药病原体是否也会对所使用的消毒剂产生耐药性。迄今为止,对消毒剂的 "抗药性 "还没有统一的定义。然而,市场上批准使用的消毒剂对多重抗性病原体也有效,而消毒效果不佳的主要原因是使用不当(清洁不充分、未完全润湿、使用浓度或接触时间不正确等)。消毒剂的效果取决于各种环境因素(尤其是伴随的污染)。在亚抑制浓度的消毒剂作用下,个别分离物对消毒剂的敏感性可能会降低。抗生素的抗药性机制并不介导对消毒剂的交叉抗药性,但细菌细胞渗透性的变化会影响对消毒剂和抗生素的敏感性。一般来说,通过适当的过程控制可以提高常规消毒的成功率,并有助于减少 MRP 的传播。
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引用次数: 0
[Small intestinal bacterial overgrowth (SIBO) - Therapy, nutrition, microbiome]. [小肠细菌过度生长 (SIBO) - 治疗、营养、微生物组]。
Pub Date : 2024-09-01 Epub Date: 2024-08-29 DOI: 10.1055/a-2205-5794
Gernot Sellge, Johann Ockenga

SIBO (small intestinal bacterial overgrowth) is defined by bacterial overgrowth or colonization of the small intestine in combination with gastrointestinal symptoms such as bloating, nausea, pain, diarrhoea, malabsorption and food intolerance. SIBO can be caused by various mechanisms such as reduced intestinal motility, altered gastrointestinal anatomy, reduced gastric acid or pancreatic enzyme production, altered bile acid metabolism, or immune defects. Accordingly, SIBO often develops secondary to different underlying diseases.Diet has a fundamental influence on the composition of the intestinal microbiome and is therefore also a potential pathomechanism in SIBO. Furthermore, food intolerances are common in SIBO patients. However, both aspects have so far been insufficiently investigated. Nevertheless, elemental diets, carbohydrate-reduced diets, as well as pre- and probiotics are potential therapy options.This article provides a summary of current knowledge on the pathophysiology, diagnosis and treatment of SIBO, with particular emphasis on the role of nutrition and the microbiome.

SIBO(小肠细菌过度生长)是指细菌在小肠内过度生长或定植,并伴有胃肠道症状,如腹胀、恶心、疼痛、腹泻、吸收不良和食物不耐受。SIBO 可由多种机制引起,如肠蠕动减弱、胃肠道解剖结构改变、胃酸或胰酶分泌减少、胆汁酸代谢改变或免疫缺陷。因此,SIBO 常继发于不同的潜在疾病。饮食对肠道微生物群的组成有着根本性的影响,因此也是 SIBO 的潜在病理机制之一。此外,食物不耐受在 SIBO 患者中也很常见。然而,迄今为止对这两方面的研究还不够。本文概述了目前有关 SIBO 的病理生理学、诊断和治疗的知识,特别强调了营养和微生物组的作用。
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引用次数: 0
[69-year old patient with chronic polyarthralgia]. [69岁慢性多关节痛患者]。
Pub Date : 2024-09-01 Epub Date: 2024-09-09 DOI: 10.1055/a-2333-1837
Nils Schulz, Philipp Klemm
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引用次数: 0
[Food allergies: A diagnostic challenge of increasing importance]. [食物过敏:日益重要的诊断挑战]。
Pub Date : 2024-09-01 Epub Date: 2024-08-29 DOI: 10.1055/a-2180-0138
Raja Atreya
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引用次数: 0
Erratum: Differenzialdiagnose und Therapie der Immunthrombozytopenie. 勘误:免疫性血小板减少症的鉴别诊断和治疗。
Pub Date : 2024-08-08 DOI: 10.1055/a-2381-4927
Aristoteles Giagounidis
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引用次数: 0
[Fiber endoscopic evaluation of swallowing (FEES) - an important tool for diagnosing myasthenia gravis]. [纤维内窥镜吞咽评估(FEES)--诊断重症肌无力的重要工具]。
Pub Date : 2024-08-01 Epub Date: 2024-08-15 DOI: 10.1055/a-2352-5193
Michael Kowar, Monika Frackowiak, Christiane Kaufhold, Andreas H Jacobs

History and admission findings:  A 76-year old man was admitted with a globus sensation and weight loss for further investigations to our geriatric ward. A gastroscopic evaluation executed before had been unremarkable.

Investigations:  Physical examination was unremarkable, including a neurological examination.

Treatment and course:  All radiological findings (computer tomography of chest, abdomen and neck) were unremarkable. In a FEES investigation we found retentions and a reduction of frequency of swallowing after a while. During the investigation the patient complained about a muscular weakness in his neck. The assumed diagnosis of a myasthenia gravis was confirmed by antibodies against acetylcholine receptors and a decrement in repetitive irritation of the orbicularis and trapezius muscle.

Conclusion:  FEES can be a valid diagnosis tool for a pharyngeal type of a myasthenia gravis.

病史和入院检查结果:一名 76 岁的老人因腹部不适和体重减轻被送入本院老年病房接受进一步检查。之前进行的胃镜检查没有发现异常:体格检查无异常,包括神经系统检查:所有放射检查结果(胸部、腹部和颈部计算机断层扫描)均无异常。在 FEES 检查中,我们发现患者有吞咽困难,吞咽频率在一段时间后有所下降。调查期间,患者抱怨颈部肌肉无力。针对乙酰胆碱受体的抗体以及眼轮匝肌和斜方肌重复刺激的减少证实了重症肌无力的假定诊断:结论:FEES 是诊断咽部型重症肌无力的有效工具。
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引用次数: 0
[Polymyalgia rheumatica: What's new?] [多发性风湿病:有什么新进展?]
Pub Date : 2024-08-01 Epub Date: 2024-08-15 DOI: 10.1055/a-2144-8222
Wolfgang A Schmidt

Currently, only 25% of all polymyalgia rheumatica (PMR) patients are referred to specialists. An expert committee has recently recommended confirmation of diagnosis by specialist care. This can help to avoid misdiagnoses and hospital stays and can result in lower glucocorticoid doses.Using ultrasound, magnetic resonance imagining (MRI), or positron emission tomography-computed tomography (PET-CT), typical periarticular inflammatory changes are observed, especially in the shoulder and pelvic girdle area. However, for clinical use, ultrasound is usually sufficient.In 20-25% of newly diagnosed PMR patients without symptoms of giant cell arteritis (GCA), GCA can be detected through vascular ultrasound. These patients require higher glucocorticoid doses in analogy to GCA therapy. There is growing awareness of a joint GCA-PMR spectrum disease.Glucocorticoids remain the primary treatment. The interleukin-6 inhibitor Sarilumab has recently been approved in the USA for patients with recurrent PMR. Studies have also demonstrated the effectiveness of Tocilizumab in PMR.

目前,只有 25% 的多发性风湿痛(PMR)患者被转诊至专科医生。最近,一个专家委员会建议由专科医生进行确诊。通过超声波、磁共振成像(MRI)或正电子发射计算机断层扫描(PET-CT),可以观察到典型的关节周围炎症变化,尤其是在肩部和骨盆部位。然而,就临床应用而言,超声检查通常就足够了。在20%-25%没有巨细胞动脉炎(GCA)症状的新诊断PMR患者中,可通过血管超声检查发现GCA。这些患者需要更高的糖皮质激素剂量,以类比GCA治疗。糖皮质激素仍是主要的治疗手段。白细胞介素-6抑制剂沙利鲁单抗(Sarilumab)最近在美国获准用于复发性 PMR 患者的治疗。研究还证明了托珠单抗对 PMR 的疗效。
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引用次数: 0
[Community-Acquired Bacterial Meningoencephalitis: The New Guideline]. [社区获得性细菌性脑膜脑炎:新指南]。
Pub Date : 2024-08-01 Epub Date: 2024-08-15 DOI: 10.1055/a-2204-5167
Alexandros Hadjilaou, Manuel Alexander Friese

Updating the vaccination recommendations against meningococci and pneumococci, in particular the introduction of the B vaccine as the standard vaccination for infants from January 2024 and the adaptation of the pneumococcal vaccination strategy for infants and adults aged 60 and over with the latest conjugate vaccines (PCV13, PCV15, PCV20).Emphasis on the need for rapid diagnostic lumbar puncture and simultaneous serum and cerebrospinal fluid analysis to increase diagnostic precision. The introduction of procalcitonin (PCT) in serum as an additional biomarker to differentiate between bacterial and viral meningitis.The use of multiplex PCR as a supplement, not a replacement, for standard diagnostics to speed up pathogen identification.Adaptation of antibiotic recommendations based on the current resistance situation, in particular for meningococcal meningitis, consideration of penicillin G only after resistance testing.Clarification of the areas and duration of use of dexamethasone in bacterial meningitis, particularly in pneumococcal meningitis and the controversial data situation in Listeria meningitis.New findings on the safe use of heparin in septic sinus thrombosis without increased risk of hemorrhage.

更新针对脑膜炎球菌和肺炎球菌的疫苗接种建议,特别是自 2024 年 1 月起将 B 型疫苗作为婴儿的标准接种疫苗,并调整婴儿和 60 岁及以上成人的肺炎球菌疫苗接种策略,接种最新的结合疫苗(PCV13、PCV15 和 PCV20)。强调需要进行快速诊断性腰椎穿刺并同时进行血清和脑脊液分析,以提高诊断精确度。引入血清中的降钙素原(PCT)作为区分细菌性和病毒性脑膜炎的额外生物标志物。使用多重 PCR 作为标准诊断的补充,而不是替代,以加快病原体的鉴定。根据当前的耐药性情况调整抗生素建议,特别是对于脑膜炎球菌性脑膜炎,只有在耐药性检测后才考虑使用青霉素 G。澄清地塞米松在细菌性脑膜炎中的使用范围和持续时间,尤其是在肺炎球菌脑膜炎中的使用范围和持续时间,以及李斯特菌脑膜炎中存在争议的数据情况。
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Deutsche medizinische Wochenschrift (1946)
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