Immediate and Long-Term Effects of Hyperbaric Oxygenation in Patients with Long COVID-19 Syndrome Using SF-36 Survey and VAS Score: A Clinical Pilot Study

(1) Background: Long COVID syndrome (LCS) is a heterogeneous long-standing condition following COVID-19 infection. Treatment options are limited to symptomatic measures, and no specific medication has been established. Hyperbaric oxygenation (HBO) has been found to have a positive impact on the treatment of COVID-19 infection. This study evaluates both the feasibility and outcome of supportive HBO in patients with LCS. (2) Methods: Within 17 months, 70 patients with proven LCS were prospectively included. Each patient underwent a cycle of 10 subsequent HBO treatment sessions administered for 75 min at 2.2 atmospheres. Evaluation of the patients was performed before the first and after the last HBO session and 3 months afterwards. Statistical evaluation was based on an intention-to-treat analysis using Fisher's exact test and Student's t-test for paired samples. (3) Results: In total, 59 patients (33 females, 26 males; mean age: 43.9 years; range: 23-74 years; median: 45.0) were evaluable. After HBO, a statistically significant improvement of physical functioning (p < 0.001), physical role (p = 0.01), energy (p < 0.001), emotional well-being (p < 0.001), social functioning (p < 0.001), pain (p = 0.01) and reduced limitation of activities (p < 0.001) was confirmed. (4) Conclusions: Physical functioning and both the physical and emotional role improved significantly and sustainably, suggesting HBO as a promising supportive therapeutic tool for the treatment of LCS.

Therapiebegrenzung in der Intensivmedizin

Eine der wesentlichen Aufgaben der Intensivmedizin ist die tägliche Überprüfung der getroffenen diagnostischen oder therapeutischen Maßnahmen nach Sinnhaftigkeit. Ist der Sinn nicht gegeben, so müssen nach unseren ethischen Grundsätzen diese unterlassen bzw. beendet und dem Menschen ein Sterben in Würde ermöglicht werden. Die Entscheidungen am Lebensende unterliegen diversen Einflussfaktoren, sodass die Therapiebegrenzung nationalen Richtlinien folgt. Das ethische Klima hat nicht nur Auswirkungen auf den Patienten und seine Familie, sondern auch Burnout-Rate, Personalzufriedenheit und Personalfluktuation stehen in einem direkten Zusammenhang mit den getroffenen Entscheidungen am Lebensende.

[Masterplan 2025 of the Austrian Society of Pneumology (ASP)-the expected burden and management of respiratory diseases in Austria]

Scientific Members of the Austrian Society of Pneumology describe the expected development in respiratory health and provide guidance towards patient-oriented and cost-efficient respiratory care in Austria.Methods: In November 2017, respiratory care providers (physicians, nurses, physiotherapists) together with patient's advocacy groups and experts in health development, collaborated in workshops on: respiratory health and the environment, bronchial asthma and allergy, COPD, pediatric respiratory disease, respiratory infections, sleep disorders, interventional pneumology, thoracic oncology and orphan diseases.Results: Respiratory disease is extremely prevalent and driven by ill-health behavior, i.e. cigarette smoking, over-eating and physical inactivity. For the majority of respiratory diseases increased prevalence, but decreased hospitalizations are expected.The following measures should be implemented to deal with future challenges:1. Screening and case-finding should be implemented for lung cancer and COPD.2. E-health solutions (telemedicine, personal apps) should be used to facilitate patient management.3. Regional differences in respiratory care should be reduced through E‑health and harmonization of health insurance benefits across Austria.4. Patient education and awareness, to reduce respiratory health illiteracy should be increased, which is essential for sleep disorders but relevant also for other respiratory diseases.5. Respiratory care should be inter-professional, provided via disease-specific boards beyond lung cancer (for ILDs, sleep, allergy)6. Programs for outpatient's pulmonary rehabilitation can have a major impact on respiratory health.7. Increased understanding of molecular pathways will drive personalized medicine, targeted therapy (for asthma, lung cancer) and subsequently health care costs.

Beatmung bei COPD: von der Präklinik bis zur außerklinischen Beatmung. Eine Übersicht des Arbeitskreises für Beatmung und Intensivmedizin der österreichischen Gesellschaft für Pneumologie

This paper was created by the Austrian Society of Pneumology (Working group Ventilation and Intensive Care) to summarize the specific characteristics of mechanical ventilation in patients presenting with chronic obstructive pulmonary disease (COPD). The main differences in pathophysiology and mechanical ventilation are shown, including acute respiratory failure and out-of-hospital mechanical ventilation.

[Non-invasive and invasive out of hospital ventilation in chronic respiratory failure : Consensus report of the working group on ventilation and intensive care medicine of the Austrian Society of Pneumology]

The current consensus report was compiled under the patronage of the Austrian Society of Pneumology (Österreichischen Gesellschaft für Pneumologie, ÖGP) with the intention of providing practical guidelines for out-of-hospital ventilation that are in accordance with specific Austrian framework parameters and legal foundations. The guidelines are oriented toward a 2004 consensus ÖGP recommendation concerning the setup of long-term ventilated patients and the 2010 German Respiratory Society S2 guidelines on noninvasive and invasive ventilation of chronic respiratory insufficiency, adapted to national experiences and updated according to recent literature. In 11 chapters, the initiation, adjustment, and monitoring of out-of-hospital ventilation is described, as is the technical equipment and airway access. Additionally, the different indications-such as chronic obstructive pulmonary diseases, thoracic restrictive and neuromuscular diseases, obesity hypoventilation syndrome, and pediatric diseases-are discussed. Furthermore, the respiratory physiotherapy of adults and children on invasive and noninvasive long-term ventilation is addressed in detail.

Evaluation of pituitary microadenomas with dynamic MR imaging

PURPOSE

To evaluate the use of keyhole dynamic magnetic resonance (MR) imaging in the evaluation of women with borderline hyperprolactinemia.

PATIENTS AND METHODS

We investigated 30 patients (mean age 31.6+/-4.3 years) with moderate hyperprolactinemia and clinically suspected microadenomas on T1-weighted spin echo (SE) sequences (repetition time (TR)/echo time (TE) 625/15 ms) with keyhole dynamic imaging and contrast enhancement of the pituitary gland. The probability of lesion presence according to MR criteria was ranked on a five-grade scale and compared with standard examinations of the hypophysis before and after intravenous administration of contrast media.

RESULTS

The probability for lesion presence showed a trend toward lower scores on standard SE sequences and higher scores with dynamic imaging (P=0.067).

CONCLUSION

Dynamic keyhole imaging of the pituitary gland could help establish a diagnosis of microadenomas with a higher probability.

[Hormonal etiology of secondary amenorrhea]

Over a 12-month period we evaluated 185 patients who consulted our outpatient department with symptoms of secondary amenorrhoea. Hormonal levels and body mass index were determined and an assessment made, on the basis of specific questioning. of the occurrence of possible mental alterations in the patients before they became amenorrhoic. Of our collective, 36 patients (19.5%) showed normal hormonal values, 50 patients (26%) were hypoestrogenemic, 46 women (25%) had elevated androgens, 15 patients (8%) had increased gonadotropins, 4 patients (2%) suffered from hyperprolactinemia, and 2 women (1%) had thyroid dysfunction. The remaining 32 amenorrhoic patients (17.2%) demonstrated different combinations of altered hormone values. The hypoestrogenemic patients showed a significant difference (p < 0.043) in body mass index in comparison with patients demonstrating normal hormone values. In contrast to reports in the literature hypoestrogenemia was the most frequent cause of secondary amenorrhoea in our study.

MRI of microadenomas in patients with hyperprolactinaemia

MRI is a sensitive tool for the investigation of pituitary microadenomas but cannot be used as a screening investigation. To establish a strategy for the use of MRI in patients with hyperprolactinaemia we investigated 74 women with serum prolactin levels above 52 ng/ml for the presence of microadenomas. We examined 55 premenopausal and 19 postmenopausal women, using a 1.5 T unit. We used T1-weighted spin-echo sequences, with coronal and sagittal images before and after intravenous gadolinium. We found microadenomas in 38 patients (51.3%), macroadenomas in 6 (8.1%) and an infundibular glioma in 1;29 patients had a normal pituitary gland (39.2%). The size of the adenomas was related to the prolactin level, and the mean level in patients with MRI evidence of adenomas was higher than in patients without microadenomas (155.72 +/- 131.01 ng/ml versus 110.14 +/- 80.86 ng/ml). The probability of the presence of an adenoma increased with rising serum prolactin levels. We suggest MRI in patients with prolactin levels more than 100 ng/ml. In patients on oestrogen therapy MRI should be performed with only slightly elevated prolactin levels. Evidence of a microadenoma should be considered in planning further therapy, especially concerning the use of hormone replacement therapy or of bromocriptine.

The lipid peroxidation product 4-hydroxynonenal is formed by--and is able to attract--rat neutrophils in vivo

4-Hydroxynonenal (HNE), a major aldehydic product of lipid peroxidation, is a chemoattractant for neutrophilic polymorphonuclear granulocytes in vitro. The question was studied, whether HNE is formed during the ingress of neutrophils in the Sephadex model of inflammation. The polydextrane Sephadex G-200, which causes an acute aseptic traumatic inflammation, was injected subcutaneously into rats. The implants were excised 6-36 hours later, and the neutrophils separated from the exsudate by centrifugation. After extraction with dichloromethane HNE was identified in the exsudate by non-derivative reversed phase HPLC in combination with on-line uv-spectroscopy. The concentration of HNE in the inflammatory focus did not correlate with the number of neutrophils present. While the peak of HNE coincided with the time point of the highest turnover rate of neutrophils (0.13 microM at 6 hrs after implantation), the highest number of neutrophils (about 100 million cells) occurred not earlier than 18 hrs later (24 hrs after onset of inflammation). When neutrophils were isolated from the inflammatory focus and stimulated with Zymosan, they were able to produce HNE in vitro depending on the time of isolation. The highest production of HNE (0.17 microM) by phagocyting neutrophils was observed at the shortest inflammation time studied (3 hrs). In order to compare these results with the oxidative burst of neutrophils the formation of superoxide was also measured by the cytochrome c reduction assay in vitro. The maximum of the production rate of superoxide anion was observed at the same inflammation time (6 hrs), when the HNE maximum occurred.(ABSTRACT TRUNCATED AT 250 WORDS)

Iron-induced lipid peroxidation and inhibition of proliferation in Ehrlich ascites tumor cells

The purpose of this study was to find further experimental evidence for the postulated negative association between the extent of lipid peroxidation in tumor cells and their proliferative behavior. After incubation of Ehrlich ascites tumor cells at 37 degrees C for 30 min with increasing concentrations of Fe(II) histidinate (Fe/His) the following parameters were determined: the formation of lipid hydroperoxides was measured fluorimetrically after reaction with dichlorofluorescein; 4-hydroxynonenal was determined by reversed-phase high-pressure chromatography after derivatization with dinitrophenylhydrazine; as a third parameter of lipid peroxidation the formation of 2-thiobarbituric-acid-reactive substances was determined. The proliferative activity was determined by measuring the growth rate in vivo after reimplantation i.p. of the tumor cells into mice. Trypan-blue exclusion tests for viability were performed before reimplantation. The reliability of the trypan-blue exclusion tests was checked by comparing the results with another parameter of viability, the release of the cytosolic enzyme lactate dehydrogenase. The concentration both of lipid hydroperoxides and of 2-thiobarbituric-acid-reactive substances showed a biphasic dependence on the concentration of Fe/His with maximal increase at iron concentrations of 0.25 mM and 0.1 mM respectively. 4-Hydroxynonenal, in contrast, showed a continuous increase up to 41.1 nM (corresponding to 0.58 pmol/10(9) cells) with increasing iron concentration in the range from 0.1 mM to 0.6 mM. The total number of tumor cells, when determined 5 days after reimplantation, continuously decreased with increasing iron concentration, showing half-maximal inhibition at about 0.22 mM Fe. The exclusion of the trypan-blue dye was unaffected by the presence of iron at any concentration used. Similarly, iron had no influence on the release of lactate dehydrogenase. The results support the hypothesis that 4-hydroxynonenal may act as an inhibiting messenger between endogenic lipid peroxidation and proliferation.

Functional and morphological changes in the rat kidney after long-term adrenaline application

A 24 h lasting long term adrenaline application in the form of subcutaneously implanted retard-tablets causes functional and morphological changes in the kidney, which are dose dependent and either reversible or irreversible. Animals in the V 15 group received one 15 mg and in the V 30 group two 15 mg adrenaline tablets resp. The tablets were removed after 24 h and a clearance depot capsule was implanted in the abdominal cavity. The test period extended from 22 h after removal of the retard tabl. to 21 d thereafter. Inulin (except the V 30 grp.), PAH and urea clearance are showing no significant differences. The data of urine gamma-GT activity, urea and urea-N in serum and urine, S-glucose, S-triglycerides, Combur-8-test, Na+ and K+ levels are in normal ranges. Morphological changes were found in the glomerula and tubular regions. Both the number of damaged nephrons and the extent of the damage depend upon the doses of adrenaline given. All glomerula with visible serious changes are irreversibly damaged; this was not true in case of the tubule. In the latter, after 7 d, the fatty deposits had diminished or disappeared.

Vasoconstriction of the vasa afferentia in the rat kidney after long-term adrenaline application

Adrenaline applied in the form of a retard tablet was implanted subcutaneously under short ether anesthesia under the neck skin of rats. Animals in the V 15 group received one 15 mg adrenaline tablet and those in the V 30 group two 15 mg tablets. The tablets were removed after 24 h. Twenty-two h later plasma catecholamines with the exception of dopamine are elevated in accordance with the amount of adrenaline applied. Histological examination reveals hyalinization of the vasa afferentia and glomerula which is more expressed in the inner part of the renal cortex. Hyalinization begins in the vas afferents and juxtaglomerular cells and extends to the glomerulus. Electron microscopic examination of the vas afferents shows vasoconstriction and beginning cellular degeneration of this vessel. Vasoconstriction is considered to be responsible for the decrease in kidney function.