Search

Introduction: Chronic kidney failure (CKD) is as common as diabetes or coronary heart disease in a population aged 40 years and older. Although CKD increases the risk of secondary diseases or premature death, patients with CKD are often unaware of their disease. In a recent analysis of German data, unawareness CKD was higher in women than in men., Methods: Baseline data from 2010 of 3,305 CKD patients from German cohort studies and registries were analyzed. Stage 1-4 CKD was defined by eGFR (estimated glomerular filtration rate) and albumin-creatinine ratio according to the KDIGO-guideline. Patient knowledge of CKD was coded according to self-report. The proportion of patients without knowledge of CKD and the sex-specific proportion difference (each with 95 % confidence interval) were calculated according to CKD stages and additional comorbidities (diabetes, hypertension, anemia, and cardiovascular disease). In addition, the prevalence ratio (PR) for not knowing about CKD was estimated for women compared to men crude and adjusted for age and other risk factors., Results: Women were less likely than men to know about their CKD in all subgroups studied by age, CKD stage, and comorbidities. The proportion difference for CKD awareness increased with higher CKD stage and was 21 percentage points (7.6; 34.6) at the expense of women in CKD stage 4. Among patients with CKD stage 3b and concomitant grade 2 hypertension, 61 % of women versus 45 % of men were unaware of their disease. The PR for CKD unawareness in women compared with men in the fully adjusted model increased from 1.08 (1.00; 1.16) in CKD stage 3a to 1.75 (1.14; 2.68) in CKD stage 4., Conclusion: Despite the presence risk factors that necessitate monitoring of renal function, less than half of patients know they have CKD stage 3b or 4. Women are less likely to be aware of their CKD in all subgroups. Possible causes are gender-related differences in primary health care (gender bias) or in patient-doctor communication., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).)

This article presents a case of recurrent anti-GBM disease (with antibodies against the glomerular basement membrane [GBM]) in a 17-year-old patient successfully treated with rituximab. Kidney biopsy with detection of linear deposition of immunoglobulin G (IgG) along the basement membrane is the diagnostic gold standard, which should be accompanied by serological testing. However, standard assays for the detection of anti-GBM antibodies have a high rate of false-negative results. In this particular case, an increase in proteinuria despite standard therapy (plasmapheresis, steroids, cyclophosphamide) was the clinical correlate of relapsing disease. The use of rituximab completely resolved the recurrent anti-GBM disease.

Long-term prophylaxis achievements, demographic changes, scientific progress, patient requirements, and political regulations through social legislation will fundamentally change the future of orthodontics, i.e., a reduction in children and adolescent therapy as well as an increase in interdisciplinary complex treatments for adult patients mostly outside the social security system. Health care research at a high evidence level needs to be intensified due to social-political reasons. In addition to well-proven appliances, modern sometimes even invisible appliances (CAD-CAM) will be used in future orthodontic therapy. Three-dimensional diagnostics could improve treatment planning. Whether improved prenatal diagnosis will alter the number of newborns with dentofacial malformations (cleft lip and palate) or syndromes (e.g., Down syndrome), thus, changing treatment needs in the future, cannot be predicted today, due to the multiple influencing factors. A well-structured 4-year specialist training according to European guidelines will also be necessary in the future to comply with complex treatment needs be it within or outside the social security system (quality assurance).

Case Report: A 71-year-old woman, suffering from spinal stenosis presented interstitial lung disease, albinism, and severe loss of visual acuity. On physical examination she showed tic-like automatism predominantly periorbital in the face and in the fingers. A computed tomography of the chest revealed typical findings of interstitial lung disease and additional mediastinal lymphomas and ground-glass attenuation in the lower regions of the lung. The findings of a transbronchial lung biopsy, presenting alveolar macrophages with ceroid-like material and platelet function studies proving slightly impaired platelet aggregation confirmed the clinical diagnosis of Hermansky-Pudlak syndrome. Sufficient pain control could be achieved without surgery and the patient was discharged home. 11 months after discharge, severe dyspnea and fever developed and finally the patient died of respiratory failure., Conclusion: The Hermansky-Pudlak syndrome is a rare cause of interstitial lung disease. In general, the lung disease presents in younger patients, but it may emerge in the elderly as well. Alveolar macrophages containing ceroid-like material are typical findings in BAL or lung biopsy. Furthermore impaired platelet aggregation and bleeding diathesis may be present. Both findings are useful to identify this rare disorder.

The syntheses of two chiral fomocaines namely rac ((4-[2-methyl-3-(morpholin-4-yl)propyl]-benzyl)-phenyl-ether (O/G 3) and rac (4-[1-methyl-3-(morpholin-4-yl)propyl]benzyl)-phenyl-ether) (O/G 5) are reported. These compounds are part of a new research program concerning the relation between chirality and local anaesthetic activity in the group of fomocaines. The yield over five steps is in the range of 9% (O/G 3) up to 19.2% (O/G 5). The racemates were resoluted via the diastereomeric salts formed with (+)- or (-)-camphersulfonic acid. The chromatographic resolution in analytical scale is successful using a Daicel OD-column. The enantiomers are stable. The surface anaesthesia of the racemates as well as of the enantiomeres is weaker in comparison with fomocaine. The rate of tissue irritation is higher. The LD50 (mouse i.v.) is in the range between 290-390 mg/kg, while fomocaine shows a LD50 value of 175 mg/kg.

KEY POSITION: Pediatric nursing owns a key position in pain therapy, due to its patient centered tasks and special kind of labor repartition between medicine and nursing. However, it is to admit that this key position obtains various forms of appearance in the different settings of pediatric nurses's practice. PAIN QUESTIONNAIRES: The difficulties within the correct assessment of children's pain by nurses refer to the application of valide pain questionnaires and continuous documentation. A prototype of pain prevention in nursing is the 'minimal handling' concept. Effective psychologic measures of pain prevention and relief are not only intrinsic and extrinsic focussing of awareness but also just holding the patient's hand. 'Cutaneous stimulation' and 'counterirritation' should be mentioned as physical techniques. COPING ABILITY: Close contact with friends or parents is one of the most important factors enhancing the patient's coping ability. If confronted with their own child in pain, parents often feel helpless which may result in anxiousness, overprotection, and inadequate support. Thus both parents and children need professional training to face painful procedures and behave in a supportive manner. There are numerous non-medical techniques which either by themselves, or in combination with analgetics, have the potential to substantially add to quality of life of the paediatric patient in pain.

Nursing homes are important, but often neglected, facilities for the care of frail older people. The demand for nursing home capacity in Germany will continue to increase over the next decade despite improvements in infrastructure of home care and day care centers. The leading medical reason for this is the growing number of elderly persons suffering from neurodegenerative diseases, depression, and stroke. Currently, more than 650,000 residents are in various forms of institutionalized care in Germany. To date, the medical profession has shown little interest in establishing an efficient medical care system for such patients, nor are care-providing physicians required to undergo special training in Germany. The article describes current practice and future principles of geriatric treatment.

The article presents the design of an open controlled, non-randomized population based intervention trial in institutionalized elderly that will be performed in Ulm/Germany starting in 1998. The multimodal intervention includes education, counseling, training, and hip protectors as well as information on potential environmental modifications in nursing homes. Two historical and one geographical control group will be formed. All institutionalized elderly will be assessed by means of the Minimum Data Set of the Resident Assessment Instrument. The intervention will last 12 months. The main objective is to test a model for cost-effective reduction of proximal femoral fractures in institutionalized elderly and to demonstrate its effectiveness.

We briefly review the possibilities of side effects caused by therapy with drugs other than psychotropic agents. These complications are mainly depressive/manic, paranoid-hallucinatoric/deliriant or anxiety/panic syndromes. Especially elderly patients and patients with multiple diseases are the preferred group with these side effects, because they are most likely to show a disturbance of blood-brain barrier and renal clearance. We will discuss the psychiatrically meaningful side effects of frequently used drugs, and we will present a concept of how to reduce such unwanted side effects.

The mucociliary transport of the human nasal mucosa was studied by using very small resin beads tagged with 51Cr. Several modifications of previous methods were introduced, e.g. kind of nuclide, particle size, pH, mode of application, measuring technique and reduction of local irradiation. Finally arrangements implying exact measurements of transport not only horizontally but also vertically or obliquely were obtained. No mucociliary transport was demonstrated in five of nine subjects with a common cold 10 days before or one week after the investigation. Xylometazolin as a nasal spray diminished the mucociliary transport significantly. In addition, the effects on mucociliary transport caused by homolateral or contralateral experimental nasal obstruction as well as by tobacco smoking were studied in healthy subjects. Finally, patients with various diseases: pollen allergy in free intervals, chronic rhinitis, septal deviation or perforation, and condition after laryngectomy were also investigated.