Dtsch Med Wochenschr
· 2025 Dec · PMID 41290034
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The fate of dementia patients often causes deep emotional crises for those living with the disease as well as their relatives. The inevitable loss of personal memories, identity and ultimately of basic bodily functions i...The fate of dementia patients often causes deep emotional crises for those living with the disease as well as their relatives. The inevitable loss of personal memories, identity and ultimately of basic bodily functions is deeply frightening and thus makes the neurodegenerative condition a predestined pathology for dramatic roles in film tragedies. Since the 1980s, the subject of dementia - in correlation with its increasing prevalence - has frequently been incorporated into feature films, however initially in minor productions and TV movies. This began to change in the 1990s and the new millennium was the beginning of a genuine boom for this subgenre, leading to overwhelming public, box office and critical success. Dementia has arrived in the repertoire of filmmakers and recent productions such as Robert and Frank (2012), Falling (2020) or The Father (2020) have reached millions of viewers and shaped their perception of the disease. Therefore the taboo surrounding dementia is gradually broken, reducing fears, misconceptions and prejudices in the population. While this trend should be viewed positively, it nevertheless has its downsides: dementia films tend to equate the progress of the disease with a regression into the infantile, to portray love as a potent antagonist of the condition and to glorify the (vegetative) final stage as a mystical-pantheistic state. Such trivialization by mass media may lead to an underestimation of both the patients' suffering as well as the Herculean task of caring for dementia patients. This can create new challenges in the healthcare of patients, issues that physicians should be aware of in the future whenever advising patients affected or their relatives.
Joisten C, Büssenschütt A, Gellhaus I
… +9 more, Jaeschke R, Kapellen TM, Kauth T, Knab K, Röbl M, Torbahn G, Wabitsch M, Weihrauch-Blüher S, Wiegand S
Dtsch Med Wochenschr
· 2026 Jan · PMID 41218622
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The prevalence of overweight and obesity in children and adolescents constitutes a significant health issue associated with a range of comorbidities. In Germany, the care provided to these young patients is often insuffi...The prevalence of overweight and obesity in children and adolescents constitutes a significant health issue associated with a range of comorbidities. In Germany, the care provided to these young patients is often insufficient. The introduction of a disease management programme (DMP) for obesity in children and adolescents aims to improve interdisciplinary and guideline-based care. This study examines the perceptions and evaluations of paediatricians regarding the current state of obesity care.An online survey was conducted among 9662 paediatricians in Germany. 802 participants delivered complete responses which were included in the study. They provided information on the frequency of obesity-related consultations, their decisions on addressing the issue, and the availability of treatment options.The majority of respondents (82,0%) rated the quality of care as poor or very poor. Time constraints and limited infrastructure were cited as the main barriers to effective obesity management. Only a small proportion of respondents reported access to a sufficient network of nutritional, exercise, and psychotherapeutic services.The findings highlight the urgent need for structured and comprehensive care options for children and adolescents with obesity, including improved infrastructure and the development of interdisciplinary services. The recent implementation of the DMP could play a pivotal role in sustainably improving the care landscape.
Dtsch Med Wochenschr
· 2025 Nov · PMID 41213536
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Thromboangiitis obliterans (TAO) is a rare cause of peripheral circulatory disorders and is fundamentally linked to nicotine consumption. Presumably due to the global decline in tobacco consumption, TAO is now rarely enc...Thromboangiitis obliterans (TAO) is a rare cause of peripheral circulatory disorders and is fundamentally linked to nicotine consumption. Presumably due to the global decline in tobacco consumption, TAO is now rarely encountered even in vascular medicine practice. TAO has a fluctuating course and can present initially with acral necrosis. The application of clinical criteria according to Shionoya and the adequate interpretation of imaging with segmental occlusions and periarterial collaterals are essential for the diagnosis of TAO. Vasculitis, which occurs predominantly in younger men under the age of 45, is undergoing a clinical change and now more frequently affects women, more frequently occurs in patients over the age of 45, less frequently affects multiple extremities, and less frequently presents with thrombophlebitis. Early-onset peripheral artery disease (PAD) should be ruled out in the differential diagnosis. It can be difficult to distinguish cannabis arteritis in cases of simultaneous consumption. The therapeutic pillar of TAO, the etiology of which remains unclear to this day, is the immediate and complete cessation of tobacco use. To avoid amputations, escalating strategies involving systemic administration of prostaglandins, sympathectomy, and endovascular recanalization are often necessary. The prognosis for amputation-free survival is good under these circumstances.
Rieg S, Kern WV, Draenert R
… +4 more, Friedrichs A, Jung N, Joost I, Hennigs A
Dtsch Med Wochenschr
· 2025 Nov · PMID 41213535
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New guidelines and position papers on the management of infective endocarditis have led to discussions on specific statements. In the current position paper, the main controversies will be summarized and commented on fro...New guidelines and position papers on the management of infective endocarditis have led to discussions on specific statements. In the current position paper, the main controversies will be summarized and commented on from an infectious diseases perspective. Background information and an adaptation of the recommendations for the German setting will be provided. Important adjustments and changes appear to be necessary with regard to the diagnostic work-up, the indication for endocarditis prophylaxis and certain treatment recommendations. A major challenge concerning many recommendations is the very limited evidence from prospective clinical studies in the context of a complex clinical picture with diverse pathogens, varying severity, complication risks and both surgical and conservative treatment options. More clinical research and treatment studies are necessary, and interdisciplinary management is mandatory.
Dtsch Med Wochenschr
· 2025 Nov · PMID 41213534
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Human genetics is increasingly becoming an important tool to supplement conventional clinical and laboratory diagnostics and is playing an increasingly important role in clinical medicine. Genetics can help to avoid furt...Human genetics is increasingly becoming an important tool to supplement conventional clinical and laboratory diagnostics and is playing an increasingly important role in clinical medicine. Genetics can help to avoid further, sometimes invasive, examinations and provide important information to confirm, specify, or correct a suspected clinical diagnosis.
Dtsch Med Wochenschr
· 2025 Nov · PMID 41213533
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Nephropathology is a subdiscipline of pathology requiring specialized knowledge and technical equipment, and is therefore not offered by all pathology institutes. Specialized histopathological examinations of kidney biop...Nephropathology is a subdiscipline of pathology requiring specialized knowledge and technical equipment, and is therefore not offered by all pathology institutes. Specialized histopathological examinations of kidney biopsies began with the first percutaneous kidney biopsy in 1958, replacing urine analysis as the main diagnostic tool for kidney disease, which had been common since the Middle Ages. Nowadays, radiologists can also perform a transvenous biopsy when contraindications for a percutaneous biopsy are present. Special techniques are required to assess kidney biopsies, such as special staining, immunofluorescence, immunohistology and, in particular, electron microscopy. The ultrastructural examination of kidney biopsies is one of the few remaining routine applications of electron microscopy in pathology today.The following section will present and discuss the essential technical and methodological requirements for the detailed processing and diagnosis of kidney biopsies, as well as current developments in the field.
Dtsch Med Wochenschr
· 2025 Nov · PMID 41213532
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Artificial intelligence (AI) is rapidly reshaping medical diagnostics, and nephrology - characterized by multifactorial disease patterns - stands to benefit markedly. Machine‑learning and deep‑learning algorithms, especi...Artificial intelligence (AI) is rapidly reshaping medical diagnostics, and nephrology - characterized by multifactorial disease patterns - stands to benefit markedly. Machine‑learning and deep‑learning algorithms, especially convolutional neural networks (CNNs) and large language models (LLMs), can analyze heterogeneous data streams from electronic health records, imaging, histopathology and genomics to support diagnosis, prognosis and therapeutic planning. AI‑driven automation of routine workflows (e.g., appointment scheduling, NLP‑based documentation, chatbot‑guided anamneses) enables clinicians to focus on complex decision‑making, while real‑time decision‑support tools can integrate laboratory, imaging and guideline data. Recent advances include CNN‑based detection of renal lesions, deep‑learning prognostic scores for IgA nephropathy, and AI‑enhanced variant calling (e.g., DeepVariant). Nevertheless, challenges persist: data bias, limited external validation, "hallucinations" of LLMs, regulatory compliance (MDR, GDPR), and the need for transparent, locally hosted models. Successful implementation requires interoperable, FHIR‑compatible data, robust training of staff, and integration of AI education into medical education. With this, AI promises substantial efficiency gains, improved diagnostic precision, and sustained care quality in nephrology.
Dtsch Med Wochenschr
· 2025 Nov · PMID 41213531
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A decline in glomerular filtration rate (GFR) is considered a physiological change in older age. Accurate estimation of the eGFR is essential not only for establishing a diagnosis but also for selecting appropriate medic...A decline in glomerular filtration rate (GFR) is considered a physiological change in older age. Accurate estimation of the eGFR is essential not only for establishing a diagnosis but also for selecting appropriate medications and determining correct dosages, in order to avoid both under- and overdosing, as well as associated adverse drug reactions. In patients with signs of sarcopenia, relying solely on serum creatinine or creatinine-based eGFR may lead to an overestimation of kidney function. In older adults, the most accurate estimation of eGFR is achieved by using equations that combine creatinine and cystatin C. The currently recommended EKFC equation has been well validated in a large cohort of older European individuals. In cases of suspected kidney disease, a spot urine test for albumin and creatinine - with calculation of the albumin-to-creatinine ratio (UACR) - should also be performed in older adults.
Dtsch Med Wochenschr
· 2025 Nov · PMID 41151617
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For the first time, German recommendations for diagnosis and treatment of gout on an interdisciplinary S3 guideline level are available. For the diagnosis of a typical gout attack in a primary care setting, the typical c...For the first time, German recommendations for diagnosis and treatment of gout on an interdisciplinary S3 guideline level are available. For the diagnosis of a typical gout attack in a primary care setting, the typical clinical picture, medical history, and an elevated serum uric acid level are usually sufficient; gout might be diagnosed with the aid of the so-called gout calculator. For acute joint inflammations not typical of gout, specialist medical professionals may utilize additional diagnostic procedures such as joint sonography, joint aspiration with microscopic crystal detection, and dual-energy computed tomography. Once the diagnosis is confirmed, there are 2 pillars of gout treatment: short-term acute treatment of the attack; and target-oriented, causal uric acid-lowering therapy. Since patients with gout usually suffer from other cardio-metabolic-renal diseases, treatment of these conditions should also be optimized. In addition to recurrent gout inflammation, these diseases ultimately cause a higher rate of cardiovascular events and mortality. Although not primarily approved for gout, the group of SGLT2 inhibitors, due to their uricosuric side effect, represents a possible treatment option for patients with gout and corresponding comorbidities.
Dtsch Med Wochenschr
· 2025 Nov · PMID 41151616
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Non-tuberculous mycobacteria (NTM) are increasingly recognized as clinically relevant pathogens, particularly in countries with a low tuberculosis incidence. Recent data from Denmark demonstrate a continuous annual rise...Non-tuberculous mycobacteria (NTM) are increasingly recognized as clinically relevant pathogens, particularly in countries with a low tuberculosis incidence. Recent data from Denmark demonstrate a continuous annual rise in NTM-related pulmonary disease (NTM-PD) of 4.6% over 3 decades, with more than half of the isolates associated with true disease. Structural lung diseases such as bronchiectasis, prior tuberculosis, and chronic pulmonary conditions are major risk factors, alongside immunodeficiencies and immunosuppressive therapies. The diagnosis of NTM-PD requires a combination of clinical symptoms, radiological findings, and the microbiological confirmation. Novel diagnostic tools, such as anti-GPL IgA serology and a CRISPR-Cas-based cfDNA assay, show promise for differentiating colonization from disease and monitoring treatment response, but the sputum culture remains essential for species identification and drug susceptibility testing. Treatment is complex and species-specific, with macrolides forming the backbone of most regimens. Refractory cases, particularly those involving Mycobacterium abscessus, pose therapeutic challenges and often require multidisciplinary management. Inhaled liposomal amikacin (ALIS) has shown benefit in refractory MAC disease. Clinical decision-making must balance efficacy, tolerability, and long-term adherence, highlighting the need for individualized treatment strategies and regular monitoring. This review outlines current evidence and practical recommendations for clinicians managing NTM-PD.
Dtsch Med Wochenschr
· 2025 Nov · PMID 41151615
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Antineutrophil Cytoplasmic Antibody (ANCA)-associated Vasculitis (AAV) is a life-threatening systemic autoimmune disease. Break of tolerance against either proteinase 3 or myeloperoxidase is key to the disease etiology....Antineutrophil Cytoplasmic Antibody (ANCA)-associated Vasculitis (AAV) is a life-threatening systemic autoimmune disease. Break of tolerance against either proteinase 3 or myeloperoxidase is key to the disease etiology. Innate and adaptive immune cells cooperate and contribute to the inflammatory necrotizing small-vessel vasculitis. AAV can affect every organ and frequently affects the kidneys. Necrotizing crescentic glomerulonephritis is associated with worse patient outcome. Anti-inflammatory and immunosuppressive treatments are effective in inducing acute vasculitis remission but are associated with treatment-related morbidity and mortality. In 2024, Kidney Disease: Improving Global Outcomes (KDIGO) provided an update of the Clinical Practice Guideline for the Management of AAV patients with kidney manifestation. A major aspect of the update is the consequent reduction of glucocorticoid exposure to diminish glucocorticoid toxicity. The C5a receptor blocker avacopan allows significant reduction of the cumulative glucocorticoids during AAV induction treatment, while increasing sustained remission and improving the glomerular filtration rate. Therefore, avacopan is now considered in the guideline as an alternative to glucocorticoids. Other topics covered by the KDIGO experts are the use of cyclophosphamide and rituximab or combinations thereof in patients with severe kidney involvement for inducing AAV remission. Moreover, considerations for the use of plasma exchange are provided.
Dtsch Med Wochenschr
· 2025 Nov · PMID 41151614
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PD, often underestimated, is more than a dialysis method - it is a promise of autonomy and quality of life. Especially in times of demographic shifts, rising chronic conditions, and healthcare staff shortages, PD is gain...PD, often underestimated, is more than a dialysis method - it is a promise of autonomy and quality of life. Especially in times of demographic shifts, rising chronic conditions, and healthcare staff shortages, PD is gaining relevance as an equal alternative to hemodialysis (HD). While HD dominates dialysis care in Germany (94%), international comparisons show a far more balanced use of modalities.PD utilizes the peritoneum as a natural dialysis membrane and can be performed manually (CAPD) or automatically at night (APD). With proper training, even elderly or dependent patients can safely manage PD at home or with support, enabling greater flexibility and reducing strain on healthcare infrastructure.General practitioners play a key role in early identification and education of chronic kidney disease (CKD) patients, offering PD as an empowering treatment path. Structured training and close monitoring help prevent complications such as peritonitis or peritoneal sclerosis.Remarkably, 55% of nephrologists would choose PD for themselves, compared to only 9% who would opt for the most commonly used method - center-based HD.PD is not a second-choice option. It is a viable, gentle, and forward-looking renal replacement therapy - an answer to the demographic and resource challenges ahead. Sometimes, modern nephrology begins not in a clinic, but quietly at the kitchen table.
Dtsch Med Wochenschr
· 2025 Nov · PMID 41151613
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Heart failure is the leading single cause of hospitalisation in Germany and places a heavy clinical and psychosocial burden on patients, families, and caregivers. Since 2021, evidence‑based management of heart failure wi...Heart failure is the leading single cause of hospitalisation in Germany and places a heavy clinical and psychosocial burden on patients, families, and caregivers. Since 2021, evidence‑based management of heart failure with reduced ejection fraction (HFrEF) has centred on four pharmacological "pillars": β‑blockers, sacubitril/valsartan (or an ACE inhibitor), mineralocorticoid‑receptor antagonists, and sodium-glucose co‑transporter‑2 (SGLT‑2) inhibitors. While these agents improve survival and quality of life, they also predispose to adverse effects - most notably electrolyte disturbances. Hypo‑ or hyperkalaemia can precipitate malignant arrhythmias and therefore demands vigilant monitoring. Iron deficiency is equally prevalent in the heart‑failure population; randomised trials have primarily tested intravenous iron(III)‑carboxymaltose and iron(III)‑derisomaltose to correct this deficit. This review summarises the most recent epidemiological data for heart failure in Germany and Europe, outlines current guideline‑directed therapies, and highlights key treatment‑related complications clinicians must anticipate and manage.
Dtsch Med Wochenschr
· 2025 Nov · PMID 41151612
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Recently approved immunotherapeutic agents in Europe mostly consist of monoclonal antibody-based products. For solid cancers, these comprise the antibody-drug-conjugate Mirvetuximab Soravtansine for platinum-resistant ov...Recently approved immunotherapeutic agents in Europe mostly consist of monoclonal antibody-based products. For solid cancers, these comprise the antibody-drug-conjugate Mirvetuximab Soravtansine for platinum-resistant ovarian cancer, the monoclonal antibody Zolbetuximab for Claudin-18.2 positive gastric adenocarcinoma and the checkpoint inhibitor Tislelizumab for esophageal squamous cell carcinoma. For the treatment of relapsed or refractory hematologic B cell malignancies, the use of bispecific T cell engaging antibodies like the BCMA-CD3 targeting Teclistamab and CD20-CD3 targeting Glofitamab were approved by the EMA recently.Combinatorial approaches of conventional chemotherapy and checkpoint inhibitors for the treatment of cholangiocarcinoma, urothelial carcinoma and endometrial carcinoma received recent approval.A CD38 antibody-based bridging therapy for the treatment of newly diagnosed multiple myeloma and the Glofitamab-based approach in combination with Gemcitabine and Oxaliplatin for relapsed DLBCL are the latest additions for hematologic malignancies after promising clinical trials.The first T cell products for the treatment of solid cancers using either tumor-infiltrating lymphocytes or TCR-engineered peripheral blood T cells were approved by the FDA in 2024, for the treatment of advanced melanoma (Lifileucel) and synovial sarcoma (Afamitresgene autoleucel). To further expand the success of T cell products to solid tumors, promising preclinical studies suggest solutions to main obstacles, such as modular CAR T cells, targeting of two antigens simultaneously or generation of cytokine-secreting 4th generation CAR T cells.
Dtsch Med Wochenschr
· 2025 Nov · PMID 41151611
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The recently updated guidelines on medical and surgical therapeutics of Crohn's disease issued by the European Crohn's and Colitis Organization (ECCO) critically review the various drug and surgical treatment approaches....The recently updated guidelines on medical and surgical therapeutics of Crohn's disease issued by the European Crohn's and Colitis Organization (ECCO) critically review the various drug and surgical treatment approaches. To optimize the delivery of care and therapeutic endpoints, involvement of multidisciplinary teams and treat-to-target approaches are recommended. Conventional medical therapies have only limited relevance. 5-aminosalicylates should not be used and corticosteroids are at best suitable for short-term control of acute flares. The therapeutic benefit of thiopurines is viewed with caution due to potential side effects and their inferior efficacy compared to infliximab. Advanced therapies (antibodies and small molecules) should be selected with regard to individual patient factors. TNF antibodies continue to be a mainstay of Crohn's therapy. IL-23 antibodies appear to be effective alternatives following loss of response to TNF antibodies. Nutritional therapies have so far been given too little consideration in clinical practice. Exclusive enteral nutrition can be used in children or compliant adults. Other diets including Mediterranean diet can be applied to maintain remission. Surgical treatment of Crohn's disease may be increasingly used in early stages of the disease, as it can avoid long-term complications and medical therapies. Whenever possible, operations are performed laparoscopically, with preoperative conditioning (avoidance of corticosteroids, correction of malnutrition) playing a particularly important role.
Dtsch Med Wochenschr
· 2025 Nov · PMID 41101347
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Overweight and obesity pose significant challenges for the healthcare system. General practitioners in particular are in a good position to make important contributions to the prevention and management of obesity. The ai...Overweight and obesity pose significant challenges for the healthcare system. General practitioners in particular are in a good position to make important contributions to the prevention and management of obesity. The aim of the study was to determine the positions, attitudes and experiences, as well as the wishes for improvement of GPs with regard to obesity care.In the course of an online survey, a total of 4,038 GPs were surveyed between January and April 2024. In addition to the descriptive analysis, a t-test for independent samples was conducted to determine significant differences between 2 groups.GPs experience obesity as a significant challenge. When providing weight advice, they place particular importance on assessing the individual's life situation in order to better determine the causes and consequences of excess weight. While nutritional advice is provided by every second respondent, exercise advice is less common. Some make use of the opportunity to recommend specific health services to patients. In terms of therapeutic measures, the respondents place great emphasis on changing the diet, followed by questions of psychosocial support and physical activation. GPs are often not satisfied with the outcome of disease management. The respondents would like to see more sustainable interprofessional structures.The potential of primary care for obesity management is currently not being fully exploited. It seems sensible to raise awareness among GPs of the causes of obesity and to anchor a motivating, behavior-oriented conversation in a more efficient way. A diagnosis of obesity should be linked to concrete recommendations for action. GPs should be strengthened in their mediator role by integrating patients into a network of other support services as needed. The development of GP-compliant care programs for obesity management should be further promoted.
Dtsch Med Wochenschr
· 2025 Oct · PMID 41072429
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Nowadays, a wide range of targeted therapies are available for the treatment of chronic lymphocytic leukemia, offering superior efficacy and a longer-lasting responses compared to chemoimmunotherapy in both first- and se...Nowadays, a wide range of targeted therapies are available for the treatment of chronic lymphocytic leukemia, offering superior efficacy and a longer-lasting responses compared to chemoimmunotherapy in both first- and second-line settings. Owing to the favorable tolerability of novel targeted agents, genetic factors have superseded age and fitness as key determinants in the selection of first-line therapy. Currently, high-risk genetic features include del(17p13) or TP53 mutations, complex karyotype (≥3 chromosomal aberrations), and unmutated IGHV status. Initial risk stratification focuses on detecting del(17p13)/TP53 mutations and assessing karyotype. This new strategy, along with the improved tolerability of these agents, offers particular benefit to older and frail patients, with dosing tailored to comorbidities and concomitant therapies.Given the heterogeneity in older patients' health status, geriatric assessments (e.g., CIRS, FRAIL score) are additional key for individualized therapy decisions and adverse events influence therapy choice (e.g. cardiovascular risk with BTK inhibitors. Beyond clinical factors, patient preferences-such as opting for continuous (e.g., BTK inhibitor monotherapy) versus time-limited therapy (e.g., venetoclax plus obinutuzumab or ibrutinib plus venetoclax)-and treatment tolerability are decisive.