ABSTRACT
The German Society of Pneumology initiated 2021 the AWMF S1 guideline Long COVID/Post-COVID. In a broad interdisciplinary approach, this S1 guideline was designed based on the current state of knowledge.The clinical recommendations describe current Long COVID/Post-COVID symptoms, diagnostic approaches, and therapies.In addition to the general and consensus introduction, a subject-specific approach was taken to summarize the current state of knowledge.The guideline has an explicit practical claim and will be developed and adapted by the author team based on the current increase in knowledge.
Subject(s)
COVID-19 , Post-Acute COVID-19 Syndrome , HumansABSTRACT
This evidence- and consensus-based practical guideline for the diagnosis and treatment of Guillain-Barré Syndrome (GBS) in childhood and adolescence has been developed by a group of delegates from relevant specialist societies and organisations; it is the result of an initiative by the German-Speaking Society of Neuropediatrics (GNP), and is supported by the Association of Scientific Medical Societies (AWMF, Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften). A systematic analysis of the literature revealed that only a few adequately-controlled studies exist for this particular age group, while none carries a low risk of bias. For this reason, the diagnostic and therapeutic recommendations largely rely on findings in adult patients with GBS, for which there are a higher number of suitable studies available. Consensus was established using a written, multi-step Delphi process. A high level of consensus could be reached for the crucial steps in diagnosis and treatment. We recommend basing the diagnostic approach on the clinical criteria of GBS and deriving support from CSF and electrophysiological findings. Repetition of invasive procedures that yield ambiguous results is only recommended if the diagnosis cannot be ascertained from the other criteria. For severe or persistently-progressive GBS treatment with intravenous immunoglobulin (IVIG) is recommended, whereas in cases of IVIG intolerance or inefficacy we recommended treatment with plasmapheresis. Corticosteroids are ineffective for GBS but can be considered when acute onset chronic inflammatory demyelinating polyneuropathy (A-CIDP) is suspected due to a prolonged disease course. The full German version of the Guideline is available on the AWMF website (https://www.awmf.org/leitlinien/detail/ll/022-008.html).
Subject(s)
Guillain-Barre Syndrome/diagnosis , Guillain-Barre Syndrome/therapy , Adolescent , Child , Delphi Technique , Disease Progression , Female , Humans , Immunoglobulins, Intravenous/therapeutic use , Plasma ExchangeABSTRACT
Dysphagia is a risk factor for pneumonia in patients with neuromuscular disease (NMD). The management of dysphagia influences respiratory complications and prognosis in NMD. Early symptoms of dysphagia are often discrete. There may be symptoms like change of voice ("wet voice") or dyspnea following a meal, or weight loss. Fiberoptic flexible endoscopic evaluation of swallowing (FEES) and videofluoroscopy are important diagnostic tools in the work-up of dysphagia. FEES should be performed with different nourishments like fluid (water), pulp, normal meal and dry cookies. The therapy for swallowing dysfunction in patients with NMD should be performed by experienced speech therapists in an interdisciplinary setting with regard to the fatiguability of the orophyryngeal muscles. Therapy should focus on adaptive procedures and safe, adapted nourishment.
