[Spectrum of diseases occurring in refugees and asylum seekers: data from three different medical institutions in the Munich area from 2014 and 2015]. / Erkrankungen bei Flüchtlingen und Asylbewerbern: Daten von drei verschiedenen medizinischen Einrichtungen im Raum München aus den Jahren 2014 und 2015.

BACKGROUND: In 2014 the number of refugees and asylum seekers in Germany rose steeply. Therefore, the provision of sufficient medical care for this special group of people became a major topic. Up to now, data on the spectrum of illnesses in this group in Germany is scarce. PATIENTS AND METHODS: Anonymized data of 548 ill refugees and asylum seekers were retrospectively evaluated. Cases from three different institutions and time periods were collected and summarized: 329 outpatients from the general medical clinic of REFUDOCS (RD, January to beginning of March 2015), 175 inpatients from the 1. medical department of the municipal hospital Schwabing (KS, June 2014 to February 2015) and 44 outpatients from the department of infectious diseases and tropical medicine of the Ludwig-Maximilians-University, Munich (AITM, 2014). RESULTS: Health problems seen at the RD general medical clinic mostly matched the usual spectrum seen by general practitioners. Respiratory illnesses especially by unspecific viral infections (152 visits), followed by neuropsychiatric (68), and gastrointestinal illnesses (56), as well as musculoskeletal (52) and skin problems (45), were common. Infectious diseases or diseases typical or specific for the tropics were mostly treated in the specialized centers. Cases of pulmonary and extrapulmonary tuberculosis (53), malaria (53), scabies, pneumonia, and schistosomiasis were prevalent. CONCLUSION: The results of this exemplary study mostly show the occurrence of illnesses in refugees and asylum seekers that are well known to German general practitioners and pediatricians. However, depending on the country of origin infectious / tropical diseases like tuberculosis, malaria, or relapsing fever have to be considered. Rapid diagnosis of these illnesses is warranted to prevent severe cases or further spreading of contagious diseases.

[Vaccinations for international travelers]. / Reiseimpfungen.

Vaccinations are a prominent part of health preparations before international travel. They can avoid or significantly reduce the risk of numerous infectious diseases. Until recently, vaccination against yellow fever was the only obligatory vaccination. However, according to updated international health regulations, other vaccinations and prophylactic measures may be required at entry from certain countries. For all routine vaccinations as recommended in Germany, necessary revaccination and catch-up of missed vaccinations should be administered before travel. At most destinations the risk of infection is higher than in Germany. Hepatitis A vaccine is generally recommended for travelers to areas of increased risk, polio vaccine for all destinations where eradication is not yet confirmed (Asia and Africa). The indications for other travel vaccines must take into consideration travel destination and itinerary, type and duration of travel, individual risk of exposure as well as the epidemiology of the disease to be prevented. Several vaccines of potential interest for travel medicine, e.g., new vaccines against malaria and dengue fever, are under development.

Pharmacokinetics and pharmacodynamic action of budesonide in children with Crohn's disease.

BACKGROUND: Budesonide is effective as initial therapy of mild to moderate Crohn's disease in adults. Superior tolerability to conventional corticosteroids might be attributed to extensive first-pass metabolism of budesonide by cytochrome P450 3A. AIM: To evaluate biotransformation and pharmacodynamic action of budesonide in children. METHODS: Drug disposition and effects on endogenous cortisol were evaluated in 12 children with Crohn's disease (5-15 years) after first intake of 3 mg budesonide (single dose), and again after 1 week of thrice daily dosing (steady-state). The parent drug and cytochrome P450 3A-dependent metabolites were analysed in blood and urine. RESULTS: Pharmacokinetic parameters of budesonide following single-dose administration (e.g. AUC(0-infinity) 7.7+/-5.1 h ng/mL, C(max) 1.8+/-1.2 ng/mL) did not change upon multiple dosing. Overall systemic elimination of budesonide reflected by clearance and half-life was not different between children and adults. After 1 week of treatment reversible adrenal suppression was observed - most pronounced in children aged below 12 years. CONCLUSIONS: Disposition of oral budesonide appears to be similar between children and adults, but the doctor has to be aware of an increased risk for adrenal suppression in paediatric patients.