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Diese umfassende Übersichtsarbeit gibt einen Überblick über verschiedene immuntherapeutische Ansätze zur Behandlung von aktinischen Keratosen (AKs), präkanzerösen Hautläsionen, die durch UV-Exposition verursacht werden. Neben Behandlungen, deren Hauptwirkmechanismus die Immunmodulation ist, wie Imiquimod oder Diclofenac, haben auch andere Behandlungen, die hauptsächlich auf dysplastische Zellen abzielen, eine gewisse immunologische Wirkung, die zu ihrer Wirksamkeit beiträgt. Während Behandlungen wie 5-Fluorouracil, Imiquimod, photodynamische Therapie und Nicotinamid bei der Behandlung von AKs vielversprechend sind, vor allem bei immunkompetenten Personen, ist ihre Wirksamkeit bei Empfängern solider Organtransplantate aufgrund der Immunsuppression eingeschränkt. Die Übersicht umfasst die optimale Kombination und fokussiert sich auf die Kryoimmuntherapie als relevanteste. Neue Immuntherapien sind Resimiquimod, Ingenoldisoxat, N-Phosphonacetyl-L-Aspartat (PALA) oder Anti-PD-1, die vielversprechende Ergebnisse erzielt haben, aber weitere Studien erfordern, um ihre Verwendung zu standardisieren. [ABSTRACT FROM AUTHOR]

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The article provides an overview of osteoporosis, including definition, epidemiology, and risk factors. The fracture risk in osteoporosis depends on various factors such as age, body mass index, previous fractures, and medication intake. The FRAX fracture risk assessment tool can be used to calculate individual risk. The diagnosis of osteoporosis requires a comprehensive evaluation, including medical history, imaging, and bone density measurement. Treatment includes fall prevention, adequate calcium and vitamin D intake, as well as medication therapy. Various medications such as bisphosphonates, denosumab, and teriparatide are recommended, with individual adjustment of therapy being important. Fall prevention is also of great importance. Vitamin D supplementation is controversial, and high-dose therapies may increase fracture risk. [Extracted from the article]

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Two new studies from the UK and Norway have examined the effects of additional vitamin D supplementation on respiratory infections and COVID-19. The British study CORONAVIT found that vitamin D supplementation does not significantly reduce the risk of acute respiratory infections and COVID-19. The Norwegian study, called "Cod Liver Oil for Covid-19 (CLOC)", also showed no significant protective effect of cod liver oil and low-dose vitamin D supplementation against COVID-19 and other respiratory infections. In summary, both studies suggest that additional vitamin D supplementation alone does not significantly reduce the risk of respiratory infections and COVID-19. [Extracted from the article]

We report on a 57-year-old female patient with a distal extra-articular radius fracture. The family doctor's suspicion was an osteoporosis-associated fracture, and an interdisciplinary investigation was initiated. In addition to DXA measurement differential diagnoses for secondary osteoporosis were considered. In our case, secondary osteoporosis was diagnosed as part of Graves' disease and insufficiency of vitamin D leading to a radius fracture. [ABSTRACT FROM AUTHOR]

Copyright of Gynäkologische Endokrinologie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Journal fuer Verbraucherschutz und Lebensmittelsicherheit is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

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Copyright of Der Internist is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

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Copyright of Der Gynäkologe is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The article "Which thiazide diuretic should we prescribe?" discusses a study on the effectiveness of chlorthalidone (CTD) compared to hydrochlorothiazide (Hct) in the treatment of hypertension. The study found that there was no significant difference in terms of cardiovascular events between the two medications. However, hypokalemia and allergic reactions occurred more frequently under CTD. Another study examined the relationship between correcting suboptimal vitamin D levels and the risk of acute respiratory infections and COVID-19. The results of this randomized controlled phase III study were heterogeneous, therefore further investigations are necessary to clarify the relationship between vitamin D levels and infection risk. [Extracted from the article]

Vitamin D plays an important role in the body as part of bone metabolism. Blood serum concentrations demonstrate that 30.2% of adults (29.7% of women and 30.8% of men) have a deficient vitamin D status. In total, 38.4% of adults (38.6% of women, 38.3% of men) have an adequate status. Although there is little variation among men between the various age groups, the proportion of women with deficient vitamin D status increases with age, while the proportion of women with an adequate status decreases. Furthermore, adults with a low socio-economic status are significantly more likely to have a deficient vitamin D status than adults with a higher socio-economic status. Vitamin D status is subject to strong seasonal fluctuations. In order to ensure adequate concentrations of serum vitamin D, it is recommended to expose the face, hands and arms to the sun two to three times a week between March and October without using sun protection; however, sunburn should be strictly avoided.

An undersupply of 25-(OH) vitamin D3 (calcifediol) exists in many countries with moderate sunlight, long winters and only moderate fish consumption. Risk groups for vitamin D3 deficiency are older persons over 65 years, geriatric persons in nursing homes, infants and children/adolescents. Therefore, there are also many situations in Germany which justify vitamin D substitution; however, vitamin D3 is currently praised as a "magic bullet" against everything. But what do the data look like? Where can it help and where can it not help?, (© 2023. The Author(s).)

Physical training is an important component in the prophylaxis of osteoporosis and the prevention of fractures. Physical training not only has a direct effect on muscle strength and muscular performance, but also on the risk of falling and the fear of falling. Therefore, physical training is also an integral part of the basic treatment for osteoporosis. The recommendations for basic treatment are an adequate intake of nutrients, including protein in particular. The intake of calcium and vitamin D in sufficient quantities is also important and, in the case of specific drug therapy, also to avoid side effects and to ensure the therapeutic effect. This article summarizes the recommendations of the updated S3 guideline on the diagnosis and treatment of osteoporosis and explains the background for the recommendations included., (© 2023. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Definition and Epidemiology: Chronic kidney disease (CKD): abnormalities of kidney structure or function, present for over 3 months. Staging of CKD is based on GFR and albuminuria (not graded). Osteoporosis: compromised bone strength (low bone mass, disturbance of microarchitecture) predisposing to fracture. By definition, osteoporosis is diagnosed if the bone mineral density T‑score is ≤ -2.5. Furthermore, osteoporosis is diagnosed if a low-trauma (inadequate trauma) fracture occurs, irrespective of the measured T‑score (not graded). The prevalence of osteoporosis, osteoporotic fractures and CKD is increasing worldwide (not graded). PATHOPHYSIOLOGY, DIAGNOSIS AND TREATMENT OF CHRONIC KIDNEY DISEASE-MINERAL AND BONE DISORDER (CKD-MBD): Definition of CKD-MBD: a systemic disorder of mineral and bone metabolism due to CKD manifested by either one or a combination of the following: abnormalities of calcium, phosphorus, PTH, or vitamin D metabolism; renal osteodystrophy; vascular calcification (not graded). Increased, normal or decreased bone turnover can be found in renal osteodystrophy (not graded). Depending on CKD stage, routine monitoring of calcium, phosphorus, alkaline phosphatase, PTH and 25-OH-vitamin D is recommended (2C). Recommendations for treatment of CKD-MBD: Avoid hypercalcemia (1C). In cases of hyperphosphatemia, lower phosphorus towards normal range (2C). Keep PTH within or slightly above normal range (2D). Vitamin D deficiency should be avoided and treated when diagnosed (1C)., Diagnosis and Risk Stratification of Osteoporosis in Ckd: Densitometry (using dual X‑ray absorptiometry, DXA): low T‑score correlates with increased fracture risk across all stages of CKD (not graded). A decrease of the T‑score by 1 unit approximately doubles the risk for osteoporotic fracture (not graded). A T-score ≥ -2.5 does not exclude osteoporosis (not graded). Bone mineral density of the lumbar spine measured by DXA can be increased and therefore should not be used for the diagnosis or monitoring of osteoporosis in the presence of aortic calcification, osteophytes or vertebral fracture (not graded). FRAX can be used to aid fracture risk estimation in all stages of CKD (1C). Bone turnover markers can be measured in individual cases to monitor treatment (2D). Bone biopsy may be considered in individual cases, especially in patients with CKD G5 (eGFR < 15 ml/min/1.73 m 2 ) or CKD 5D (dialysis)., Specific Treatment of Osteoporosis in Patients With Ckd: Hypocalcemia should be treated and serum calcium normalized before initiating osteoporosis therapy (1C). CKD G1-G2 (eGFR ≥ 60 ml/min/1.73 m 2 ): treat osteoporosis as recommended for the general population (1A). CKD G3-G5D (eGFR < 60 ml/min/1.73 m 2 to dialysis): treat CKD-MBD first before initiating osteoporosis treatment (2C). CKD G3 (eGFR 30-59 ml/min/1.73 m 2 ) with PTH within normal limits and osteoporotic fracture and/or high fracture risk according to FRAX: treat osteoporosis as recommended for the general population (2B). CKD G4-5 (eGFR < 30 ml/min/1.73 m 2 ) with osteoporotic fracture (secondary prevention): Individualized treatment of osteoporosis is recommended (2C). CKD G4-5 (eGFR < 30 ml/min/1.73 m 2 ) and high fracture risk (e.g. FRAX score > 20% for a major osteoporotic fracture or > 5% for hip fracture) but without prevalent osteoporotic fracture (primary prevention): treatment of osteoporosis may be considered and initiated individually (2D). CKD G4-5D (eGFR < 30 ml/min/1.73 m 2 to dialysis): Calcium should be measured 1-2 weeks after initiation of antiresorptive therapy (1C)., Physical Medicine and Rehabilitation: Resistance training prioritizing major muscle groups thrice weekly (1B). Aerobic exercise training for 40 min four times per week (1B). Coordination and balance exercises thrice weekly (1B). Flexibility exercise 3-7 times per week (1B)., (© 2022. The Author(s).)