4区医学

Internist Pub Date : 2024-03-01 Epub Date: 2023-06-26 DOI: 10.1177/10600280231181135

Kimberly N Day, Julie A Vircks, Christine E Henricks, Kaci M Reaves, Ashley K Holmes, Karen L Florio

{"title":"Latency Antibiotics in Preterm Prelabor Rupture of Membranes: A Comparison of Azithromycin Regimens.","authors":"Kimberly N Day, Julie A Vircks, Christine E Henricks, Kaci M Reaves, Ashley K Holmes, Karen L Florio","doi":"10.1177/10600280231181135","DOIUrl":"10.1177/10600280231181135","url":null,"abstract":"Background: Treatment with antibiotics at the time of preterm prelabor rupture of membranes (PPROM) has been shown to prolong pregnancy. Due to the recurrent shortage of erythromycin, azithromycin has been substituted in the traditional regimen; however, there are little data on optimal dosing.Objective: The objective of this study was to determine whether there is a difference in latency from onset of PPROM to delivery in patients who received a single dose of azithromycin compared with a 5-day course.Methods: This was a single-center, multisite, retrospective, IRB approved analysis of patients admitted with a diagnosis of PPROM. Patients were included if rupture occurred between 22 0/7 and 33 6/7 weeks of gestation and received either a single dose or a 5-day course of azithromycin along with a beta lactam.Results: A total of 376 patients were reviewed with 296 patients included in the final analysis. There was no statistical difference in the primary outcome of latency days in patients who received the 5-day versus the single-dose course (4 vs 5 days, P = 0.641). There was a significantly higher rate of histologic chorioamnionitis in the single-dose course of azithromycin (46.4% vs 62.6%, P = 0.006).Conclusions and relevance: There was no difference in latency for patients who received a 5-day course of azithromycin versus a single dose for the treatment of PPROM. A higher rate of histologic chorioamnionitis was observed in those who received the single-day course. Prospective follow-up studies are needed to confirm these findings.","PeriodicalId":54924,"journal":{"name":"Internist","volume":"46 1","pages":"234-240"},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73518732","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

[Causal treatment of Alzheimer's disease: amyloid antibodies]. 【阿尔茨海默病的病因治疗：淀粉样抗体】。

4区医学

Internist Pub Date : 2022-09-01 Epub Date: 2022-03-15 DOI: 10.1007/s00108-022-01291-2

Matthias Pawlowski, Tobias Warnecke

{"title":"[Causal treatment of Alzheimer's disease: amyloid antibodies].","authors":"Matthias Pawlowski, Tobias Warnecke","doi":"10.1007/s00108-022-01291-2","DOIUrl":"10.1007/s00108-022-01291-2","url":null,"abstract":"Background: Alzheimer's disease (AD) is the most common cause of dementia. The number of people affected will increase dramatically in the coming decades due to the demographic change. Causal pharmacological approaches have not been available to date. The monoclonal anti-amyloid beta antibody aducanumab was recently approved for the treatment of AD in the USA but was rejected in Europe in December 2021 by the European Medicines Agency (EMA).Objective: This review presents the background and rationale for amyloid beta-directed treatment approaches in AD. The focus is on passive immunization with monoclonal anti-amyloid beta antibodies.Data situation: There are four monoclonal anti-amyloid beta antibodies in an advanced stage of clinical development. Evidence of a clear and significant reduction of the cerebral amyloid load was found for all of them. In the case of aducanumab this has already led to approval by the U.S. Food and Drug Administration (FDA). In the USA donanemab, gantenerumab and lecanemab have received the status of a so-called breakthrough therapy and are expected to go through an accelerated approval process by the FDA in the next 1-2 years.Conclusion: Anti-amyloid antibodies represent the first cause-based, disease-modifying therapy for AD approved in the USA. Compared to the near-complete removal of cerebral amyloid plaques, the magnitude of the clinical effect is smaller and the benefit for patients is currently subject to controversial discussions. Nonetheless, the new treatment option represents an important step in the development of effective treatment. Future strategies for the treatment of AD will likely aim at a multimodal concept with different molecular targets. A prerequisite for all effective disease-modifying therapies will be an early biomarker-based diagnosis prior to the onset of a dementia-type syndrome.","PeriodicalId":54924,"journal":{"name":"Internist","volume":"63 1","pages":"1000-1008"},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"51945552","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Mitteilungen des BDI BDI通信

4区医学

Internist Pub Date : 2022-08-23 DOI: 10.1007/s00108-022-01393-x

Berlin

引用次数: 0

[Superficial venous thrombosis, varicose veins, and chronic venous insufficiency: an update for clinical practice]. [浅静脉血栓、静脉曲张和慢性静脉功能不全：临床实践的最新进展]。

4区医学

Internist Pub Date : 2022-06-01 Epub Date: 2022-05-03 DOI: 10.1007/s00108-022-01341-9

Markus Stücker

{"title":"[Superficial venous thrombosis, varicose veins, and chronic venous insufficiency: an update for clinical practice].","authors":"Markus Stücker","doi":"10.1007/s00108-022-01341-9","DOIUrl":"10.1007/s00108-022-01341-9","url":null,"abstract":"Background: Venous disorders affect a large proportion of the German population (varicose veins 13.3%, chronic venous insufficiency 40.8%).Objectives: Based on current literature, a practically oriented update on superficial venous thrombosis, varicosis, and chronic venous insufficiency is provided.Results and conclusion: Superficial vein thrombosis of the legs requires comprehensive duplex ultrasonography of the superficial and deep leg veins. Only superficial vein thrombosis less than 5 cm in length and more than 3 cm from the saphenofemoral or saphenopopliteal junction can be treated conservatively with compression, cooling, and relative immobilization. Superficial vein thrombosis greater than 5 cm in length with more than 3 cm distance to the deep venous system is treated pharmacologically with fondaparinux for 45 days (approved for 30-45 days). If the surface thrombus reaches the saphenofemoral or saphenopopliteal junction at a distance of less than 3 cm, therapy analogous to deep vein thrombosis is required for 3 months. The most effective therapy for varicose veins is invasive removal. In this regard, endovenous thermal ablation has become particularly important in recent years, given that its effectiveness is of a similar order of magnitude to that of crossectomy and stripping surgery, but the complication rates are significantly lower. Invasive removal of varicose veins not only improves patients' quality of life, but also significantly reduces the risk of deep vein thrombosis. Recent epidemiological data demonstrate an increased risk of cardiovascular disease in patients with chronic venous insufficiency. There is preliminary evidence that this risk of cardiovascular disease in varicose vein patients can be lowered by varicose vein therapy.","PeriodicalId":54924,"journal":{"name":"Internist","volume":"20 1","pages":"612-618"},"PeriodicalIF":0.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"51946594","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

[Sarcoidosis and berylliosis]. 石棺和绿柱石

4区医学

Internist Pub Date : 2022-05-01 Epub Date: 2022-04-09 DOI: 10.1007/s00108-022-01323-x

Daniel Soriano, Caroline Quartucci, Prerana Agarwal, Joachim Müller-Quernheim, Björn Christian Frye

{"title":"[Sarcoidosis and berylliosis].","authors":"Daniel Soriano, Caroline Quartucci, Prerana Agarwal, Joachim Müller-Quernheim, Björn Christian Frye","doi":"10.1007/s00108-022-01323-x","DOIUrl":"10.1007/s00108-022-01323-x","url":null,"abstract":"Sarcoidosis and berylliosis (chronic beryllium disease, CBD) are granulomatous diseases and are phenocopies which cannot be differentiated based on the clinical presentation. Whereas for sarcoidosis the eliciting agent is unknown, for berylliosis an exposure to beryllium (mostly as occupational exposure) can be confirmed that therefore induces a sensitization against beryllium. The diagnosis is generally made in patients with a typical clinical presentation, the histological proof of a non-necrotizing granuloma and the exclusion of other diseases causing granulomas. In most cases, granulomas can be detected in the lungs and/or (intrathoracic) lymph nodes. The proof of sensitization to beryllium for the differential diagnosis can be performed with a so-called beryllium lymphocyte proliferation test in peripheral mononuclear blood cells or cells from a bronchoalveolar lavage. The objectives of treatment are avoidance of functional organ impairment and symptom control. Immunosuppressive therapy (initially mostly with corticosteroids) and supportive measures can prove beneficial; however, in many cases clinical observation can be sufficient because of stable disease or spontaneous resolution. In addition, further beryllium exposure must be avoided, which mostly necessitates a change of the workplace.","PeriodicalId":54924,"journal":{"name":"Internist","volume":"63 1","pages":"557-565"},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48104953","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

[Antibody therapy in patients with COVID-19]. [新冠肺炎患者的抗体治疗]。

4区医学

Internist Pub Date : 2022-05-01 Epub Date: 2022-04-04 DOI: 10.1007/s00108-022-01321-z

M Augustin, M Hallek, S Nitschmann

引用次数: 0

[Immune system and allergies-An unholy alliance]. 这是不神圣的联盟

4区医学

Internist Pub Date : 2022-05-01 Epub Date: 2022-04-07 DOI: 10.1007/s00108-022-01327-7

Ludger Klimek

{"title":"[Immune system and allergies-An unholy alliance].","authors":"Ludger Klimek","doi":"10.1007/s00108-022-01327-7","DOIUrl":"10.1007/s00108-022-01327-7","url":null,"abstract":"Various factors affect the maturation of the infantile immune system both prenatally and postnatally, including risk and protective factors from the environment, nutrition, genetics and epigenetics. The microbiome seems to play a substantial role. The complex interaction and regulation of all these factors is ultimately decisive for whether a child develops an allergy during the course of development of the immune system. The genetic components play a decisive role in the development of allergic diseases. The epigenetic regulation could represent a mechanism where environmental influences act upon the immune regulation in the emergence of allergic diseases. The main factors in the pathophysiology of allergic reactions are a dysregulation of various cells of the innate and acquired immune systems as well as their interaction. This review describes the role of various T helper cell types in allergic diseases. The incidence and duration of airway infections are clearly increased in allergic patients compared to nonallergic controls. In addition to functional aspects, the reason for the more frequent infections is an impairment of the immune defence by the allergy-related persisting inflammation of the mucous membranes. These mechanisms must be differentiated from a true immunodeficiency. Allergic rhinitis (AR) and bronchial asthma are nowadays no longer defined as separate diseases but as two forms of expression of an atopic entity with a similar pathology. Both diseases can be mediated by immunoglobulin E and be elicited by identical triggers. A bronchial hyperreactivity is detectable in the majority of patients with AR but without clinical asthma.","PeriodicalId":54924,"journal":{"name":"Internist","volume":"63 1","pages":"467-475"},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44469445","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

[Innovations in the pharmaceutical treatment of systemic lupus erythematosus]. 系统性红斑狼疮药物治疗的创新

4区医学

Internist Pub Date : 2022-05-01 Epub Date: 2022-01-20 DOI: 10.1007/s00108-021-01250-3

Johanna Mucke, Matthias Schneider

{"title":"[Innovations in the pharmaceutical treatment of systemic lupus erythematosus].","authors":"Johanna Mucke, Matthias Schneider","doi":"10.1007/s00108-021-01250-3","DOIUrl":"10.1007/s00108-021-01250-3","url":null,"abstract":"Background: Systemic lupus erythematosus (SLE) is a heterogeneous disease with a complex pathogenesis. Until now, the choice of therapeutic agents has been limited.Objective: This review revisits known forms of treatment for SLE and introduces new recently approved agents and agents currently under investigation in clinical trials. The aim of this article is to map the current data from phase 2 and phase 3 studies and European recommendations for the management of SLE and to provide an outlook on the future of lupus treatment.Data situation: As the focus of SLE treatment is on the achievement of remission with low steroid dosages, early and effective immunosuppressive therapy is essential. With the interferon type I receptor antagonist anifroluma, a treatment for extrarenal lupus has been approved for the first time since 2011. For lupus nephritis, the well-known belimumab (approval by the U.S. Food and Drug Administration, FDA and the European Medicines Agency, EMA) and the calcineurin inhibitor voclosporin (FDA) are newly available. In addition, a large number of substances are currently undergoing clinical trials, e.g. the CD-20 inhibitor obinutuzumab, Janus kinase inhibitors and low-dose interleukin‑2.Conclusion: New and innovative treatment concepts are finding their way into lupus treatment and other promising substances are in the pipeline; however, only long-term data will show to what extent these improve the long-term outcome of patients. Nevertheless, these are important and much needed advances in the treatment of SLE.","PeriodicalId":54924,"journal":{"name":"Internist","volume":" ","pages":"566-572"},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39845519","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

[Spontaneous expulsion of a mesenchymal colonic tumor via the rectum]. [结肠间充质肿瘤经直肠自发排出]。

4区医学

Internist Pub Date : 2022-05-01 Epub Date: 2022-02-16 DOI: 10.1007/s00108-022-01278-z

Wolfgang Scheppach, Ulrich Steger, Wolfgang Küsters, Vanessa Wild

引用次数: 0

[Uncommon tumor-associated deep vein thrombosis]. [罕见的肿瘤相关深静脉血栓]。

4区医学

Internist Pub Date : 2022-05-01 Epub Date: 2022-02-23 DOI: 10.1007/s00108-022-01272-5

Rosemary Poulose, Anselm A Derda, Mohamed Omar, Christian von Falck, Florian Länger, Jochen Tillmanns, Adrian Groh, Johann Bauersachs, L Christian Napp

引用次数: 1

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