Dtsch Med Wochenschr
· 2025 Oct · PMID 41072428
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Chronic viral hepatitis, particularly chronic hepatitis B and C, is among the leading global causes of liver cirrhosis and hepatocellular carcinoma (HCC). Despite effective treatment options such as virus suppressive nuc...Chronic viral hepatitis, particularly chronic hepatitis B and C, is among the leading global causes of liver cirrhosis and hepatocellular carcinoma (HCC). Despite effective treatment options such as virus suppressive nucleos(t)ide analogues for HBV and curative direct acting antiviral therapies for HCV, many infections remain undetected. The WHO aims to eliminate hepatitis B and C as public health threats by 2030, targeting a 90% reduction in new infections and a 65% reduction in deaths. Germany supports these objectives through its BIS 2030 strategy, which emphasizes prevention, identification of at-risk groups, education, and treatment. A central component is screening to diagnose chronic infections early and initiate therapy promptly. This article summarizes practical current recommendations for the prevention and early detection of chronic viral hepatitis, with a particular focus on hepatitis B and hepatitis C, including complementary aspects regarding hepatitis D and hepatitis E in immunocompromised individuals.
Dtsch Med Wochenschr
· 2025 Oct · PMID 41072427
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Hepatocellular carcinoma (HCC) is the most common primary liver malignancy and a leading cause of cancer-related death worldwide. The incidence is increasing globally, primarily due to the rising prevalence of chronic li...Hepatocellular carcinoma (HCC) is the most common primary liver malignancy and a leading cause of cancer-related death worldwide. The incidence is increasing globally, primarily due to the rising prevalence of chronic liver diseases. While chronic viral hepatitis (HBV, HCV) and alcohol abuse have traditionally been considered the main risk factors, metabolic dysfunction-associated steatohepatitis (MASH) is increasingly gaining importance, especially in Western industrialized nations. In the vast majority of cases, HCC develops on the basis of liver cirrhosis. When cirrhosis is present, diagnosis can usually be reliably made through dynamic imaging techniques. However, despite established surveillance programs, most cases of HCC are often diagnosed only at advanced stages, which significantly limits therapeutic options. The treatment of HCC depends on tumor stage, overall health, and liver function of the affected patients. Selecting the appropriate therapy requires a multidisciplinary decision-making process. While curative options include resection, transplantation, and local ablation, advanced stages are managed with loco-regional therapies or systemic treatments. In recent years, the therapeutic spectrum has been significantly expanded by the introduction of immune checkpoint inhibitors. Particularly, immunotherapeutic combination therapies approved for first-line treatment have significantly improved the overall survival of patients with advanced HCC. Nevertheless, the prognosis remains unfavorable in many cases, highlighting the need for further research to identify predictive biomarkers and develop innovative therapies.
Reincke M, Sturm L, Thimme R
… +1 more, Bettinger D
Dtsch Med Wochenschr
· 2025 Oct · PMID 41072426
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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 gradi...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.
Röhlen N, Laubner K, Seufert J
… +1 more, Thimme R
Dtsch Med Wochenschr
· 2025 Oct · PMID 41072425
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Metabolic dysfunction-associated steatotic liver disease (MASLD) is one of the most common causes of liver cirrhosis and hepatocellular carcinoma. The severity of the metabolic syndrome and in particular type 2 diabetes...Metabolic dysfunction-associated steatotic liver disease (MASLD) is one of the most common causes of liver cirrhosis and hepatocellular carcinoma. The severity of the metabolic syndrome and in particular type 2 diabetes are major risk factors for the progression of liver disease, but also for the frequent occurrence of cardiovascular complications. Patients therefore benefit in particular from an interdisciplinary treatment. This article provides an overview of recommended strategies for the prevention and treatment of MASLD.
Dtsch Med Wochenschr
· 2025 Oct · PMID 41072422
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The process of becoming a medical specialist is a transformative phase with professional competence as well as personal development. This study examines the role of crisis in the moral development of physicians during th...The process of becoming a medical specialist is a transformative phase with professional competence as well as personal development. This study examines the role of crisis in the moral development of physicians during their postgraduate training.Based on Carol Gilligan's ethics of care and interviews with 45 physicians in Germany, the study demonstrates that crises can be an opportunity for the reflection on ethical problems and of moral maturity.The results show that more than half of the participants experienced at least one crisis during their training that significantly impacted their emotional and professional balance. Main triggers were workload, challenging patient situations, and conflicts with supervisors. Women were more frequently affected. These crises not only led to professional changes such as job change or temporary career breaks but also influenced the physicians' self-conception and moral values. Profound ethical reflections and changes such as an increased awareness of compassion, and moral integrity were observed. Peer exchange proved to be an important resource in coping with these situations. Many respondents expressed a desire for more structural and institutional support.The study highlights the importance of ethical competencies and interpersonal care in medical training. By integrating ethics of care, physicians can grow not only professionally but also morally, thereby contributing to holistic patient care.
Dtsch Med Wochenschr
· 2025 Oct · PMID 41022086
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When we think of addiction, we don't automatically think of elderly people. Rather, we see young to middle-aged alcohol or drug addicts in our mind's eye. The following article shows that this is a misconception and also...When we think of addiction, we don't automatically think of elderly people. Rather, we see young to middle-aged alcohol or drug addicts in our mind's eye. The following article shows that this is a misconception and also how important the topic of addiction is in old age - even if it is different for senior citizens.
Barnbrock A, Porto L, Schmoll J
… +2 more, Lehrnbecher T, Girschikofsky M
Dtsch Med Wochenschr
· 2025 Oct · PMID 41022085
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Langerhanscell histiocytosis (LCH) is a rare malignant disease, which commonly occurs during childhood and adolescence, but may also be seen in adult patients. Although LCH lesions are mostly found in bones, skin and the...Langerhanscell histiocytosis (LCH) is a rare malignant disease, which commonly occurs during childhood and adolescence, but may also be seen in adult patients. Although LCH lesions are mostly found in bones, skin and the pituitary gland, the disease may affect almost each organ and cause a variety of symptoms. There are differences between pediatric and adult patients regarding diagnostics and therapy. Better insights in the pathophysiology of the disease resulted in the development of new therapeutic approaches such as the use of RAF or MAP-Kinase inhibitors and may help to guide therapy. Although each patient with LCH should be referred to a pediatric or internal oncologist, long-term interdisciplinary care is needed for many patients.
Köhler N, Otto-Knapp R, Heinrich N
… +2 more, Lange C, Brehm TT
Dtsch Med Wochenschr
· 2025 Oct · PMID 41022084
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Tuberculosis remains the leading cause of death from a single infectious pathogen. Despite global health initiatives and the WHO's "End TB" Strategy, progress toward TB elimination has been slow, particularly in low- and...Tuberculosis remains the leading cause of death from a single infectious pathogen. Despite global health initiatives and the WHO's "End TB" Strategy, progress toward TB elimination has been slow, particularly in low- and middle-income countries.The standard treatment for drug-susceptible tuberculosis involves a 6-month combination of rifampicin, isoniazid, pyrazinamide, and ethambutol. However, results from recent clinical trials suggest that with novel treatment regimens standard tuberculosis treatment can be shortened substantially in the majority of affected patients. In the field of drug-resistant tuberculosis, innovations include 6-9-month all-oral regimens with improved efficacy and tolerability.An integrated management approach includes patient support, culturally sensitive education, management of adverse drug reactions, and close clinical monitoring. Novel diagnostic tools and biomarkers may enhance treatment monitoring in the future. Additionally, 20 new drug candidates are currently in clinical development and may offer shorter, safer, and more effective therapies.
Mischnik A, Kuhns M, Meiwes L
… +4 more, Pichlo S, Gaudlitz J, Zielinski N, Brehm TT
Dtsch Med Wochenschr
· 2025 Oct · PMID 41022083
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Tuberculosis remains the leading cause of death by a single infectious agent worldwide, with over 10 million cases annually. Despite global efforts, delayed or missed diagnoses continue to fuel transmission and mortality...Tuberculosis remains the leading cause of death by a single infectious agent worldwide, with over 10 million cases annually. Despite global efforts, delayed or missed diagnoses continue to fuel transmission and mortality, particularly in resource-limited settings. This review outlines both the current diagnostic standards - microscopy, culture, and nucleic acid amplification tests - and highlights promising innovations aimed at improving diagnosis of tuberculosis disease. Novel approaches include stool polymerase chain reaction (PCR), CRISPR (clustered regularly interspaced short palindromic repeats)-based detection of circulating cell-free DNA (cfDNA), transcriptomic signatures, molecular bacterial load assay (MBLA), lipoarabinomannan (LAM) detection in urine or sputum, and non-invasive sampling techniques using exhaled breath condensate, face masks or oral swabs. Furthermore, advancements in imaging technologies and AI (artificial intelligence)-based tools may enhance diagnostic accuracy. Together, these developments have the potential to accelerate and simplify tuberculosis diagnostics in the future.
Klingmüller A, Steinke J, Rybniker J
… +1 more, Suárez I
Dtsch Med Wochenschr
· 2025 Oct · PMID 41022082
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In 2023, tuberculosis (TB) caused 1.25 million deaths among 10.8 million cases, remaining the deadliest infectious disease worldwide. In Germany, incidence declined for decades but rose slightly in 2022-2023, driven main...In 2023, tuberculosis (TB) caused 1.25 million deaths among 10.8 million cases, remaining the deadliest infectious disease worldwide. In Germany, incidence declined for decades but rose slightly in 2022-2023, driven mainly by migration from high-prevalence countries (e.g., Syria, Afghanistan, Ukraine). While most cases are pulmonary TB (PTB), 22.8% are extrapulmonary TB (EPTB), which can affect any organ and is often hard to diagnose due to nonspecific symptoms. Diagnosis uses microscopy, PCR, and culture; treatment typically lasts at least 6 months, extended for CNS, bone, or miliary TB. Treatment response is assessed clinically and radiologically; reliable blood-based markers are urgently needed.
WHO WE CAN TRULY BE AS DOCTORS. WHY PROFESSIONAL IDENTITY FORMATION IS MORE THAN KNOWLEDGE AND SKILLS:WHO WE CAN TRULY BE AS DOCTORS. WHY PROFESSIONAL IDENTITY FORMATION IS MORE THAN KNOWLEDGE AND SKILLS:
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 se...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.
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 rec...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.
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, onl...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.
Rapid advancements in Artificial Intelligence (AI) have significantly impacted multiple sectors of our society, including healthcare. While conventional AI has been instrumental in solving mainly image recognition tasks...Rapid advancements in Artificial Intelligence (AI) have significantly impacted multiple sectors of our society, including healthcare. While conventional AI has been instrumental in solving mainly image recognition tasks and thereby adding in well-defined situations such as supporting diagnostic imaging, the emergence of generative AI is impacting on one of the main professional competences: doctor-patient interaction.A convergence of natural language processing (NLP) and generative AI is exemplified by intelligent chatbots like ChatGPT. A first study that has compared the empathy and quality of responses between ChatGPT and human physicians in a healthcare setting has shown that ChatGPT can outperform human physicians in both quality and empathy of answers to medical questions. The results suggest that generative AI models like ChatGPT could serve as valuable adjuncts in medical consultations, potentially improving patient engagement and reducing clinician workload.