1
|
Katschnig H, Straßmayr C, Endel F, Posch M, Steiner I. Are early post-discharge physician contacts associated with 30-day psychiatric re-hospitalisation? A nationwide claims data based retrospective cohort study in Austria free of immortal time bias. Int J Methods Psychiatr Res 2023; 33:e1983. [PMID: 37608583 PMCID: PMC10804335 DOI: 10.1002/mpr.1983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 06/28/2023] [Accepted: 07/27/2023] [Indexed: 08/24/2023] Open
Abstract
OBJECTIVES Cost containment and quality of care considerations have increased research interest in the potential preventability of early re-hospitalisations. Various registry-based retrospective cohort studies on psychiatric re-hospitalisation have focused on the role of early post-discharge service contacts, but either did not consider their time-dependent nature ('immortal time bias') or evaded the issue by analysing late re-hospitalisations. The present study takes care of the immortal time bias in studying early psychiatric re-hospitalisations. METHODS In a retrospective cohort study using nationwide electronic claims data in Austria, 10,689 adults discharged from acute psychiatric inpatient wards were followed up for 30 days. Cox regression analyses were performed with post-discharge psychiatric and general practitioner contacts as time-dependent covariates and time to first psychiatric re-hospitalisation as outcome. RESULTS Post-discharge ambulatory physician contacts were significantly associated with a decreased psychiatric re-hospitalisation rate (hazard ratio 0.77 [95% CI 0.69; 0.87], p < 0.0001), with similarly strong contributions to this association by general practitioners and psychiatrists. CONCLUSIONS Despite avoiding the immortal time bias and controlling for several confounders, we suggest to be cautious with a causal interpretation of the identified association, since potentially relevant confounders, such as disease severity, were unavailable in our claims data base.
Collapse
Affiliation(s)
- H. Katschnig
- Department of PsychiatryMedical University of ViennaViennaAustria
- IMEHPS.researchViennaAustria
| | | | | | - M. Posch
- Medical University of ViennaCenter for Medical Data ScienceInstitute of Medical StatisticsViennaAustria
| | - I. Steiner
- Medical University of ViennaCenter for Medical Data ScienceInstitute of Medical StatisticsViennaAustria
| |
Collapse
|
2
|
Brandt JB, Golej J, Irschik S, Steiner A, Voitl P, Steiner I, Höflich A. Effects of pediatric intensive care due to congenital heart defects on maternal mental health. Acta Paediatr 2023. [PMID: 37166454 DOI: 10.1111/apa.16843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 03/06/2023] [Accepted: 05/10/2023] [Indexed: 05/12/2023]
Abstract
AIM Successful mother-child-bonding is a fundamental step for a healthy development of the child. Different factors like postpartum depression can hinder the bonding process. This study aimed to investigate how intensive care treatment due to congenital heart diseases of the infant alters bonding and how mothers cope with the situation. METHODS Validated questionnaires were used to analyze postpartum depression, mother-child bonding, stress factors and coping strategies for mothers at a pediatric intensive care unit (PICU; n=38) and a group of mothers without known psychiatric disorders attending a babywell visit with their child (n=91). Descriptive statistics and interaction models were calculated. RESULTS The PICU group showed on average higher total scores on the postpartum bonding questionnaire indicating mother-child bonding impairment and a higher proportion of mothers with severe depression was observed (76% versus 11%). The model showed a significant interaction between effective coping strategies and mother infant bonding (p = 0.04). Ineffective coping had no effect on bonding or depression in the PICU group. CONCLUSION Mothers of children treated at an ICU due a congenital heart disease are at increased risk for the development of depression and difficulties in different aspects of postpartum bonding. Our results show that coping mechanisms might significantly influence postpartum bonding. Implementation of tailored support is needed to optimize maternal outcomes.
Collapse
Affiliation(s)
- J B Brandt
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Medical University of Vienna, Austria
| | - J Golej
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Medical University of Vienna, Austria
| | - S Irschik
- Out of hospital pediatrician, Vienna
| | - A Steiner
- Department of Internal Medicine, Hospital Lilienfeld, Austria
| | - P Voitl
- First Vienna Pediatric Medical Center, Vienna, Austria
| | - I Steiner
- Center for Medical Data Science, Institute of Medical Statistics, Medical University of Vienna, Austria
| | - A Höflich
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Austria
- Department of Psychiatry and Psychotherapeutic Medicine, Karl Landsteiner University for Health and Science, Tulln, Austria
| |
Collapse
|
3
|
Starvaggi CA, Travaglini N, Aebi C, Romano F, Steiner I, Sauter TC, Keitel K. www.coronabambini.ch: Development and usage of an online decision support tool for paediatric COVID-19-testing in Switzerland: a cross-sectional analysis. BMJ Open 2023; 13:e063820. [PMID: 36927586 PMCID: PMC10030280 DOI: 10.1136/bmjopen-2022-063820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
Abstract
OBJECTIVES To describe the development and usage of www.coronabambini.ch as an example of a paediatric electronic public health application and to explore its potential and limitations in providing information on disease epidemiology and public health policy implementation. DESIGN We developed and maintained a non-commercial online decision support tool, www.coronabambini.ch, to translate the Swiss Federal Office of Public Health (FOPH) paediatric (age 0-18 years) COVID-19 guidelines around testing and school/daycare attendance for caregivers, teachers and healthcare personnel. We analysed the online decision tool as well as a voluntary follow-up survey from October 2020 to September 2021 to explore its potential as a surveillance tool for public health policy and epidemiology. PARTICIPANTS 68 269 users accessed and 52 726 filled out the complete online decision tool. 3% (1399/52 726) filled out a voluntary follow-up. 92% (18 797/20 330) of users were parents. RESULTS Certain dynamics of the pandemic and changes in testing strategies were reflected in the data captured by www.coronabambini.ch, for example, in terms of disease epidemiology, gastrointestinal symptoms were reported more frequently in younger age groups (13% (3308/26 180) in children 0-5 years vs 9% (3934/42 089) in children ≥6 years, χ2=184, p≤0.001). As a reflection of public health policy, the proportion of users consulting the tool for a positive contact without symptoms in children 6-12 years increased from 4% (1415/32 215) to 6% (636/9872) after the FOPH loosened testing criteria in this age group, χ2=69, p≤0.001. Adherence to the recommendation was generally high (84% (1131/1352)) but differed by the type of recommendation: 89% (344/385) for 'stay at home and observe', 75% (232/310) for 'school attendance'. CONCLUSIONS Usage of www.coronabambini.ch was generally high in areas where it was developed and promoted. Certain patterns in epidemiology and adherence to public health policy could be depicted but selection bias was difficult to measure showing the potential and challenges of digital decision support as public health tools.
Collapse
Affiliation(s)
- Carl Alessandro Starvaggi
- Department of Pediatrics, Division of Pediatric Emergency Medicine, Inselspital University Hospital, Bern, Switzerland
| | | | - Christoph Aebi
- Department of Pediatrics, Inselspital University Hospital, Bern, Switzerland
| | - Fabrizio Romano
- Department of Pediatrics, Division of Pediatric Emergency Medicine, Inselspital University Hospital, Bern, Switzerland
| | - Isabelle Steiner
- Department of Pediatrics, Division of Pediatric Emergency Medicine, Inselspital University Hospital, Bern, Switzerland
| | | | - Kristina Keitel
- Department of Pediatrics, Division of Pediatric Emergency Medicine, Inselspital University Hospital, Bern, Switzerland
| |
Collapse
|
4
|
Romano F, Wendelspiess M, Mansour R, Abplanalp-Marti O, Starvaggi C, Holzner F, Steiner I, Keitel K. Safety of nurse-directed triage intranasal fentanyl protocol for acute pain management in a European pediatric emergency department: A retrospective observational analysis. Front Pediatr 2023; 11:1070685. [PMID: 36861074 PMCID: PMC9969078 DOI: 10.3389/fped.2023.1070685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 01/18/2023] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND Nurse-directed pain protocols for intranasal fentanyl administration are not widely implemented in European (EU) pediatric emergency departments (PED). Barriers include perceived safety concerns for intranasal (IN) fentanyl. The aim of this study is to describe our experience with a nurse-directed triage IN fentanyl protocol with a focus on safety in a tertiary EU PED. METHODS We conducted a retrospective analysis of patient records of children aged 0-16 years who received nurse-directed IN fentanyl between January 2019 and December 2021 at the PED of the University Children's Hospital of Bern, Switzerland. Extracted data points included demographics, presenting complaint, pain score, IN fentanyl dosage, concomitant pain medication use, and adverse events. RESULTS A total of 314 patients were identified with ages ranging from 9 months to 15 years. The main indication for nurse-directed fentanyl administration was musculoskeletal pain due to trauma (n = 284, 90%). Mild adverse events (vertigo) were reported in two patients (0.6%), without a correlation to concomitant pain medication or protocol violation. The only reported severe adverse event of syncope and hypoxia in a 14-year-old adolescent occurred in a setting where the institutional nurse-directed protocol was violated. CONCLUSION In accordance with previous studies outside of Europe, our data support the case that when appropriately used, nurse-directed IN fentanyl is a safe potent opioid analgesic for pediatric acute pain management. We strongly encourage the introduction of nurse-directed triage fentanyl protocols Europe-wide in order to provide effective and adequate acute pain management in children.
Collapse
Affiliation(s)
- F Romano
- Department of Paediatrics, Division of Paediatric Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - M Wendelspiess
- Department of Paediatrics, Division of Paediatric Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - R Mansour
- Faculty of Medicine and Medical Sciences, University of Balamand, Beirut, Lebanon
| | - O Abplanalp-Marti
- Department of Paediatrics, Division of Paediatric Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - C Starvaggi
- Department of Paediatrics, Division of Paediatric Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - F Holzner
- Department of Paediatrics, Division of Paediatric Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - I Steiner
- Department of Paediatrics, Division of Paediatric Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - K Keitel
- Department of Paediatrics, Division of Paediatric Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland
| |
Collapse
|
5
|
Franke I, Streb J, Dudeck M, Mayer J, Steiner I, Wolf V. Alcohol use disorder as a risk factor for violent offending in a sample of female forensic-psychiatric inpatients. Eur Psychiatry 2022. [PMCID: PMC9564744 DOI: 10.1192/j.eurpsy.2022.883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Female gender is associated with a lower risk for aggressive behaviour and violent offending. Well established risk factors for aggressive behaviour are alcohol and other substance use, but previous studies focused mainly on male offenders and the general population. However, for therapeutic and prognostic reasons it is important to understand pathways to female offending. Objectives To examine a sample of female forensic-psychiatric inpatients regarding the association of alcohol (AUD) and other substance use disorders (SUD) with violent offending (homicide, assault, robbery). Methods We conducted a retrospective cohort study of 334 female patients discharged before 01.01.2019 from a secure psychiatric hospital in Germany. Results In total, 72% of the patients with AUD committed a violent crime, leading to admission to secure psychiatric treatment. In comparison a statistically significant lower rate (19%) of the SUD group was convicted of violent offending. Over 70% of the participants with AUD had a family history of AUD, and over 83% experienced physical violence in adulthood. We found no group differences (AUD vs. SUD) regarding aggressive behaviour during inpatient treatment. Conclusions According to our results, AUD compared to other SUD, is a significant risk factor for violent offending in women. A family background with AUD and a history of physical abuse might function as a risk factor for both: developing an AUD and violent offending. The comparable rates of aggression in both groups during inpatient treatment suggest that abstinence is a protective factor. Disclosure No significant relationships.
Collapse
|
6
|
Steiner I, Brandenberger J, Wagner F, Huwendiek S. [Blended Learning With Virtual Pediatric Emergency Patients for Medical Students]. Praxis (Bern 1994) 2021; 110:961-966. [PMID: 34875867 DOI: 10.1024/1661-8157/a003749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Blended Learning With Virtual Pediatric Emergency Patients for Medical Students Abstract. Treating critically ill children is a major challenge for learners. Medical Students often feel inadequately prepared for their later role as physicians. This article describes the implementation and evaluation of blended learning using virtual patients (VP) during the student rotation at the pediatric emergency department Inselspital Bern. Students rated the project as highly beneficial and recommended its integration into the entire clinical curriculum.
Collapse
Affiliation(s)
- Isabelle Steiner
- Notfallzentrum für Kinder und Jugendliche, Universitäre Kinderkliniken, Inselspital, Bern
| | - Julia Brandenberger
- Notfallzentrum für Kinder und Jugendliche, Universitäre Kinderkliniken, Inselspital, Bern
| | - Felicitas Wagner
- Institut für Medizinische Lehre, Abteilung für Assessment und Evaluation, Medizinische Fakultät, Bern
| | - Sören Huwendiek
- Institut für Medizinische Lehre, Abteilung für Assessment und Evaluation, Medizinische Fakultät, Bern
| |
Collapse
|
7
|
Akhvlediani T, Jelcic I, Taba P, Pfausler B, Steiner I, Sellner J. What did we learn from the previous coronavirus epidemics and what can we do better: a neuroinfectiological point of view. Eur J Neurol 2020; 27:e69-e72. [PMID: 32526060 PMCID: PMC7307067 DOI: 10.1111/ene.14395] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 06/05/2020] [Indexed: 12/18/2022]
Affiliation(s)
- T Akhvlediani
- American MD Program, Faculty of Medicine, Tbilisi State Medical University, Tblisi, Georgia
| | - I Jelcic
- Department of Neurology, University Hospital Zürich, Zürich, Switzerland
| | - P Taba
- Department of Neurology and Neurosurgery, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia.,Neurology Clinic, Tartu University Hospital, Tartu, Estonia
| | - B Pfausler
- Department of Neurology, Neurological Intensive Care Unit, Medical University of Innsbruck, Innsbruck, Austria
| | - I Steiner
- Department of Neurology, Rabin Medical Center, Petach Tikva, Israel
| | - J Sellner
- Department of Neurology, Landesklinikum Mistelbach-Gänserndorf, Mistelbach, Austria.,Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria.,Department of Neurology, Klinikum rechts der Isar, Technische Universität München, München, Germany
| |
Collapse
|
8
|
Eckl-Dorna J, Fröschl R, Lupinek C, Kiss R, Gattinger P, Marth K, Campana R, Mittermann I, Blatt K, Valent P, Selb R, Mayer A, Gangl K, Steiner I, Gamper J, Perkmann T, Zieglmayer P, Gevaert P, Valenta R, Niederberger V. Intranasal administration of allergen increases specific IgE whereas intranasal omalizumab does not increase serum IgE levels-A pilot study. Allergy 2018; 73:1003-1012. [PMID: 29083477 PMCID: PMC5969304 DOI: 10.1111/all.13343] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2017] [Indexed: 02/06/2023]
Abstract
Background Administration of the therapeutic anti‐IgE antibody omalizumab to patients induces strong increases in IgE antibody levels. Objective To investigate the effect of intranasal administration of major birch pollen allergen Bet v 1, omalizumab or placebo on the levels of total and allergen‐specific IgE in patients with birch pollen allergy. Methods Based on the fact that intranasal allergen application induces rises of systemic allergen‐specific IgE, we performed a double‐blind placebo‐controlled pilot trial in which birch pollen allergic subjects were challenged intranasally with omalizumab, placebo or birch pollen allergen Bet v 1. Total and allergen‐specific IgE, IgG and basophil sensitivity were measured before and 8 weeks after challenge. For control purposes, total, allergen‐specific IgE levels and omalizumab‐IgE complexes as well as specific IgG levels were studied in subjects treated subcutaneously with either omalizumab or placebo. Effects of omalizumab on IgE production by IL‐4/anti‐CD40‐treated PBMCs from allergic patients were studied in vitro. Results Intranasal challenge with Bet v 1 induced increases in Bet v 1‐specific IgE levels by a median of 59.2%, and this change differed significantly from the other treatment groups (P = .016). No relevant change in allergen‐specific and total IgE levels was observed in subjects challenged with omalizumab. Addition of omalizumab did not enhance IL‐4/anti‐CD40‐induced IgE production in vitro. Significant rises in total IgE (mean IgE before: 131.83 kU/L to mean IgE after: 505.23 kU/L) and the presence of IgE‐omalizumab complexes were observed after subcutaneous administration of omalizumab. Conclusion Intranasal administration of allergen induced rises of allergen‐specific IgE levels, whereas intranasal administration of omalizumab did not enhance systemic total or allergen‐specific IgE levels.
Collapse
Affiliation(s)
- J. Eckl-Dorna
- Department of Otorhinolaryngology; Medical University of Vienna; Vienna Austria
| | - R. Fröschl
- Clinical Institute for Laboratory Medicine; Medical University of Vienna; Vienna Austria
| | - C. Lupinek
- Division of Immunopathology; Department of Pathophysiology and Allergy Research; Center for Pathophysiology, Infectiology and Immunology; Medical University of Vienna; Vienna Austria
| | - R. Kiss
- Division of Immunopathology; Department of Pathophysiology and Allergy Research; Center for Pathophysiology, Infectiology and Immunology; Medical University of Vienna; Vienna Austria
| | - P. Gattinger
- Division of Immunopathology; Department of Pathophysiology and Allergy Research; Center for Pathophysiology, Infectiology and Immunology; Medical University of Vienna; Vienna Austria
| | - K. Marth
- Division of Immunopathology; Department of Pathophysiology and Allergy Research; Center for Pathophysiology, Infectiology and Immunology; Medical University of Vienna; Vienna Austria
| | - R. Campana
- Division of Immunopathology; Department of Pathophysiology and Allergy Research; Center for Pathophysiology, Infectiology and Immunology; Medical University of Vienna; Vienna Austria
| | - I. Mittermann
- Division of Immunopathology; Department of Pathophysiology and Allergy Research; Center for Pathophysiology, Infectiology and Immunology; Medical University of Vienna; Vienna Austria
| | - K. Blatt
- Division of Hematology and Hemostaseology; Department of Internal Medicine I; Medical University of Vienna; Vienna Austria
| | - P. Valent
- Division of Hematology and Hemostaseology; Department of Internal Medicine I; Medical University of Vienna; Vienna Austria
| | - R. Selb
- Department of Otorhinolaryngology; Medical University of Vienna; Vienna Austria
| | - A. Mayer
- Department of Otorhinolaryngology; Medical University of Vienna; Vienna Austria
| | - K. Gangl
- Department of Otorhinolaryngology; Medical University of Vienna; Vienna Austria
| | - I. Steiner
- Center for Medical Statistics, Informatics, and Intelligent Systems; Section for Medical Statistics; Medical University of Vienna; Vienna Austria
| | - J. Gamper
- Center for Medical Statistics, Informatics, and Intelligent Systems; Section for Medical Statistics; Medical University of Vienna; Vienna Austria
| | - T. Perkmann
- Clinical Institute for Laboratory Medicine; Medical University of Vienna; Vienna Austria
| | | | - P. Gevaert
- Upper Airway Research Laboratory (URL); Ghent University Hospital; Ghent Belgium
| | - R. Valenta
- Division of Immunopathology; Department of Pathophysiology and Allergy Research; Center for Pathophysiology, Infectiology and Immunology; Medical University of Vienna; Vienna Austria
| | - V. Niederberger
- Department of Otorhinolaryngology; Medical University of Vienna; Vienna Austria
| |
Collapse
|
9
|
Bertl K, Steiner I, Pandis N, Buhlin K, Klinge B, Stavropoulos A. Statins in nonsurgical and surgical periodontal therapy. A systematic review and meta-analysis of preclinical in vivo trials. J Periodontal Res 2017; 53:267-287. [PMID: 29211309 DOI: 10.1111/jre.12514] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2017] [Indexed: 12/13/2022]
Abstract
The cholesterol-lowering drugs, statins, possess anti-inflammatory, antimicrobial and pro-osteogenic properties, and thus have been tested as an adjunct to periodontal treatment. The present systematic review aimed to answer the following focused research question: What is the effect of local and/or systemic statin use on periodontal tissues in preclinical in vivo studies of experimentally induced periodontitis (EIP) and/or acute/chronified periodontal defect (ACP) models? A literature search (of Medline/PubMed, Embase/Ovid, CENTRAL/Ovid) using the following main eligibility criteria was performed: (i) English or German language; (ii) controlled preclinical in vivo trials; (iii) local and/or systemic statin use in EIP and/or ACP models; and (iv) quantitative evaluation of periodontal tissues (i.e., alveolar bone level/amount, attachment level, cementum formation, periodontal ligament formation). Sixteen studies in EIP models and 7 studies in ACP models evaluated simvastatin, atorvastatin or rosuvastatin. Thirteen of the EIP (81%) and 2 of the ACP (29%) studies presented significantly better results in terms of alveolar bone level/amount in favor of statins. Meta-analysis based on 14 EIP trials confirmed a significant benefit of local and systemic statin use (P < .001) in terms of alveolar bone level/amount; meta-regression revealed that statin type exhibited a significant effect (P = .014) in favor of atorvastatin. Three studies reported a significantly higher periodontal attachment level in favor of statin use (P < .001). Complete periodontal regeneration was never observed; furthermore, statins did not exert any apparent effect on cementum formation. Neither local nor systemic use of statins resulted in severe adverse effects. Statin use in periodontal indications has a positive effect on periodontal tissue parameters, supporting the positive results already observed in clinical trials. Nevertheless, not all statins available have been tested so far, and further research is needed to identify the maximum effective concentration/dose and optimal carrier.
Collapse
Affiliation(s)
- K Bertl
- Department of Periodontology, Faculty of Odontology, University of Malmö, Malmö, Sweden.,Division of Oral Surgery, School of Dentistry, Medical University of Vienna, Vienna, Austria
| | - I Steiner
- Private Practice, Taiskirchen, Austria.,Postgraduate Course Periodontology, Medical University of Vienna, Vienna, Austria
| | - N Pandis
- Department of Orthodontics and Dentofacial Orthopedics, Dental School/Medical Faculty, University of Bern, Bern, Switzerland
| | - K Buhlin
- Division of Periodontology, Department of Dental Medicine, Karolinska Institute, Huddinge, Sweden
| | - B Klinge
- Department of Periodontology, Faculty of Odontology, University of Malmö, Malmö, Sweden
| | - A Stavropoulos
- Department of Periodontology, Faculty of Odontology, University of Malmö, Malmö, Sweden
| |
Collapse
|
10
|
Taba P, Schmutzhard E, Forsberg P, Lutsar I, Ljøstad U, Mygland Å, Levchenko I, Strle F, Steiner I. EAN consensus review on prevention, diagnosis and management of tick‐borne encephalitis. Eur J Neurol 2017; 24:1214-e61. [DOI: 10.1111/ene.13356] [Citation(s) in RCA: 99] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 06/01/2017] [Indexed: 12/30/2022]
Affiliation(s)
- P. Taba
- Department of Neurology and Neurosurgery University of Tartu Tartu Estonia
| | - E. Schmutzhard
- Department of Neurology Medical University Innsbruck Innsbruck Austria
| | - P. Forsberg
- Department of Clinical and Experimental Medicine and Department of Infectious Diseases Linköping University Linköping Sweden
| | - I. Lutsar
- Department of Microbiology University of Tartu Tartu Estonia
| | - U. Ljøstad
- Department of Neurology Sørlandet Hospital Kristiansand Norway
- Department of Clinical Medicine University of Bergen Bergen Norway
| | - Å. Mygland
- Department of Neurology Sørlandet Hospital Kristiansand Norway
- Department of Clinical Medicine University of Bergen Bergen Norway
| | - I. Levchenko
- Institute of Neurology Psychiatry and Narcology of the National Academy of Medical Sciences of Ukraine Kharkiv Ukraine
| | - F. Strle
- Department of Infectious Diseases University Medical Centre Ljubljana Ljubljana Slovenia
| | - I. Steiner
- Department of Neurology Rabin Medical Center Petach Tikva Israel
| |
Collapse
|
11
|
Palm J, Steiner I, Abramov-Sommariva D, Ammendola A, Mitzenheim S, Steindl H, Wonnemann M, Bachert C. Assessment of efficacy and safety of the herbal medicinal product BNO 1016 in chronic rhinosinusitis. Rhinology 2017; 55:142-151. [PMID: 28214913 DOI: 10.4193/rhin16.103] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The objective of this clinical trial (CRS-02) was to assess the efficacy, safety and tolerability of two dosages of the herbal medicinal product BNO 1016 (Sinupret extract) in patients with chronic rhinosinusitis (CRS). METHODOLOGY 929 patients suffering from CRS were enrolled in this randomised placebo-controlled trial with a treatment period of 12 weeks. The primary endpoint was the mean Major Symptom Score (MSS) in week 8 and week 12 compared to placebo. Secondary endpoints included further MSS related parameters and responder rates over time. Pharmacoeconomic endpoints were also analysed. Finally, safety and tolerability were evaluated. RESULTS Sinupret extract was not superior over placebo regarding the primary endpoint. However, the results of the secondary endpoints showed a clear trend towards superior efficacy. Therefore, additional post-hoc sensitivity analyses were performed in patients with a baseline MSS over 9 and persistence of disease more than 1 year diagnosed by specialists in otorhinolaryngology. Those patients significantly benefited from Sinupret extract. Therapy was superior for the primary endpoint analysis. Patients were less impaired with respect to work and daily activities. A good safety and tolerability of Sinupret extract was assured in all patients. CONCLUSIONS Sinupret extract can safely be administered in patients with CRS. Although the primary endpoint of the study was not significant, a post-hoc subgroup analysis in patients whose disease was diagnosed by a specialist revealed a pronounced treatment effect. Effects in that subgroup were even stronger with longer disease persistence and stronger severity.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - C Bachert
- Ghent University Hospital, Ghent, Belgium
| |
Collapse
|
12
|
Trattner H, Blüml S, Steiner I, Plut U, Radakovic S, Tanew A. Quality of life and comorbidities in palmoplantar pustulosis - a cross-sectional study on 102 patients. J Eur Acad Dermatol Venereol 2017; 31:1681-1685. [DOI: 10.1111/jdv.14187] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 02/06/2017] [Indexed: 01/08/2023]
Affiliation(s)
- H. Trattner
- Department of Dermatology; Medical University of Vienna; Vienna Austria
| | - S. Blüml
- Department of Rheumatology; Medical University of Vienna; Vienna Austria
| | - I. Steiner
- Center for Medical Statistics, Informatics and Intelligent Systems; Section for Medical Statistics; Medical University of Vienna; Vienna Austria
| | - U. Plut
- Department of Dermatology; Medical University of Vienna; Vienna Austria
| | - S. Radakovic
- Department of Dermatology; Medical University of Vienna; Vienna Austria
| | - A. Tanew
- Department of Dermatology; Medical University of Vienna; Vienna Austria
| |
Collapse
|
13
|
Szepanowski F, Steiner I, Derksen A, zu Hörste GM, Daldrup T, Hartung HP, Kieseier B. EP 12. Fingolimod promotes nerve regeneration by modulating Lysophospholipid signaling. Clin Neurophysiol 2016. [DOI: 10.1016/j.clinph.2016.05.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
14
|
Amor M, Moreno Viedma V, Sarabi A, Grün NG, Itariu B, Leitner L, Steiner I, Bilban M, Kodama K, Butte AJ, Staffler G, Zeyda M, Stulnig TM. Identification of matrix metalloproteinase-12 as a candidate molecule for prevention and treatment of cardiometabolic disease. Mol Med 2016; 22:487-496. [PMID: 27385318 DOI: 10.2119/molmed.2016.00068] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 06/22/2016] [Indexed: 01/01/2023] Open
Abstract
Obesity is strongly associated with metabolic syndrome, a combination of risk factors that predispose to the development of the cardiometabolic diseases: atherosclerotic cardiovascular disease and type 2 diabetes mellitus. Prevention of metabolic syndrome requires novel interventions to address this health challenge. The objective of this study was the identification of candidate molecules for the prevention and treatment of insulin resistance and atherosclerosis, conditions that underlie type 2 diabetes mellitus and cardiovascular disease, respectively. We used an unbiased bioinformatics approach to identify molecules that are upregulated in both conditions by combining murine and human data from a microarray experiment and meta-analyses. We obtained a pool of eight genes that were upregulated in all the databases analysed. This included well known and novel molecules involved in the pathophysiology of type 2 diabetes mellitus and cardiovascular disease. Notably, matrix metalloproteinase 12 (MMP12) was highly ranked in all analyses and was therefore chosen for further investigation. Analyses of visceral and subcutaneous white adipose tissue from obese compared to lean mice and humans convincingly confirmed the up-regulation of MMP12 in obesity at mRNA, protein and activity levels. In conclusion, using this unbiased approach an interesting pool of candidate molecules was identified, all of which have potential as targets in the treatment and prevention of cardiometabolic diseases.
Collapse
Affiliation(s)
- M Amor
- Christian Doppler Laboratory for Cardio-Metabolic Immunotherapy and Clinical Division of Endocrinology and Metabolism, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - V Moreno Viedma
- Christian Doppler Laboratory for Cardio-Metabolic Immunotherapy and Clinical Division of Endocrinology and Metabolism, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - A Sarabi
- Christian Doppler Laboratory for Cardio-Metabolic Immunotherapy and Clinical Division of Endocrinology and Metabolism, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - N G Grün
- Christian Doppler Laboratory for Cardio-Metabolic Immunotherapy and Clinical Division of Endocrinology and Metabolism, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - B Itariu
- Christian Doppler Laboratory for Cardio-Metabolic Immunotherapy and Clinical Division of Endocrinology and Metabolism, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - L Leitner
- Christian Doppler Laboratory for Cardio-Metabolic Immunotherapy and Clinical Division of Endocrinology and Metabolism, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - I Steiner
- Center for Medical Statistics, Informatics, and Intelligent Systems, Section for Medical Statistics, Medical University of Vienna, Austria
| | - M Bilban
- Core Facility Genomics, Core Facilities, Medical University of Vienna, Vienna, Austria
| | - K Kodama
- Institute for Computational Health Sciences. University of California, San Francisco, EEUU
| | - A J Butte
- Institute for Computational Health Sciences. University of California, San Francisco, EEUU
| | | | - M Zeyda
- Department of Pediatrics and Adolescent Medicine, Clinical Division of Pediatric Pulmonology, Allergology and Endocrinology, Medical University of Vienna
| | - T M Stulnig
- Christian Doppler Laboratory for Cardio-Metabolic Immunotherapy and Clinical Division of Endocrinology and Metabolism, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| |
Collapse
|
15
|
Lotan I, Hellman MA, Steiner I. Diagnostic criteria of chronic inflammatory demyelinating polyneuropathy in diabetes mellitus. Acta Neurol Scand 2015; 132:278-83. [PMID: 25819084 DOI: 10.1111/ane.12394] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2015] [Indexed: 01/22/2023]
Abstract
OBJECTIVE The possibility of co-association between diabetes mellitus (DM) and chronic inflammatory demyelinating polyneuropathy (CIDP) has long been a focus of interest as well as of clinical significance. As CIDP is a potentially treatable condition, it is diagnosis in the context of DM is of great importance. However, diagnostic criteria to identify CIDP in patients with diabetes are not available. We propose a diagnostic tool that should help clinicians to decide what is the probability that a patient with diabetes might have CIDP. METHODS We list several clinical, electrophysiological, and laboratory parameters that, when combined, have the power of discriminating an immune-mediated neuropathy in patients with DM. By summing the points assigned to each of these parameters, we define four levels of probability for a patient with diabetes to have CIDP. To analyze the validity of the diagnostic toll, we applied it in three different patient populations: (i) Patients with diabetes with peripheral neuropathy, (ii) Patients with CIDP without DM, and (iii) Patients with diabetes with CIDP. RESULTS The scores of patients with diabetes without CIDP ranged from -7 to 2, while those of patients with DM-CIDP ranged from 2 to 20. The scores of non-diabetic patients with CIDP were similar to those of patients with DM-CIDP and ranged from 6 to 16. The mean score of patients with DM-CIDP was 9.083, while the score of patients with CIDP was 11.16 and that of patients with diabetic polyneuropathy was -3.59. CONCLUSIONS These results show that this diagnostic tool is able to identify patients with diabetes with overlapping CIDP.
Collapse
Affiliation(s)
- I. Lotan
- Department of Neurology; Rabin Medical Center; Beilinson Campus; PetachTikva; Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| | - M. A. Hellman
- Department of Neurology; Rabin Medical Center; Beilinson Campus; PetachTikva; Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| | - I. Steiner
- Department of Neurology; Rabin Medical Center; Beilinson Campus; PetachTikva; Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| |
Collapse
|
16
|
|
17
|
Hellmann M, Mosberg-Galili R, Lotan I, Steiner I. Maintenance IVIg therapy in myasthenia gravis does not affect disease activity. J Neurol Sci 2014; 338:39-42. [DOI: 10.1016/j.jns.2013.10.043] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2013] [Revised: 10/26/2013] [Accepted: 10/29/2013] [Indexed: 10/26/2022]
|
18
|
Lemke JR, Hendrickx R, Geider K, Laube B, Schwake M, Harvey RJ, James VM, Pepler A, Steiner I, Hörtnagel K, Neidhardt J, Ruf S, Wolff M, Bartholdi D, Caraballo R, Platzer K, Suls A, De Jonghe P, Biskup S, Weckhuysen S. GRIN2B mutations in West syndrome and intellectual disability with focal epilepsy. Ann Neurol 2014; 75:147-54. [PMID: 24272827 PMCID: PMC4223934 DOI: 10.1002/ana.24073] [Citation(s) in RCA: 157] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Revised: 11/10/2013] [Accepted: 11/18/2013] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To identify novel epilepsy genes using a panel approach and describe the functional consequences of mutations. METHODS Using a panel approach, we screened 357 patients comprising a vast spectrum of epileptic disorders for defects in genes known to contribute to epilepsy and/or intellectual disability (ID). After detection of mutations in a novel epilepsy gene, we investigated functional effects in Xenopus laevis oocytes and screened a follow-up cohort. RESULTS We revealed de novo mutations in GRIN2B encoding the NR2B subunit of the N-methyl-D-aspartate (NMDA) receptor in 2 individuals with West syndrome and severe developmental delay as well as 1 individual with ID and focal epilepsy. The patient with ID and focal epilepsy had a missense mutation in the extracellular glutamate-binding domain (p.Arg540His), whereas both West syndrome patients carried missense mutations within the NR2B ion channel-forming re-entrant loop (p.Asn615Ile, p.Val618Gly). Subsequent screening of 47 patients with unexplained infantile spasms did not reveal additional de novo mutations, but detected a carrier of a novel inherited GRIN2B splice site variant in close proximity (c.2011-5_2011-4delTC). Mutations p.Asn615Ile and p.Val618Gly cause a significantly reduced Mg(2+) block and higher Ca(2+) permeability, leading to a dramatically increased Ca(2+) influx, whereas p.Arg540His caused less severe disturbance of channel function, corresponding to the milder patient phenotype. INTERPRETATION We identified GRIN2B gain-of-function mutations as a cause of West syndrome with severe developmental delay as well as of ID with childhood onset focal epilepsy. Severely disturbed channel function corresponded to severe clinical phenotypes, underlining the important role of facilitated NMDA receptor signaling in epileptogenesis.
Collapse
MESH Headings
- Animals
- Child
- Child, Preschool
- Crystallography, X-Ray
- Epilepsies, Partial/complications
- Epilepsies, Partial/diagnosis
- Epilepsies, Partial/genetics
- Female
- Humans
- Infant, Newborn
- Intellectual Disability/complications
- Intellectual Disability/diagnosis
- Intellectual Disability/genetics
- Mutation/genetics
- Rats
- Receptors, N-Methyl-D-Aspartate/chemistry
- Receptors, N-Methyl-D-Aspartate/genetics
- Spasms, Infantile/complications
- Spasms, Infantile/diagnosis
- Spasms, Infantile/genetics
- Xenopus laevis
Collapse
Affiliation(s)
- Johannes R Lemke
- Division of Human Genetics, University Children’s
Hospital InselspitalBern, Switzerland
- Partners of EuroEPINOMICS, RES
consortium
| | - Rik Hendrickx
- Neurogenetics Group, Department of Molecular Genetics,
Vlaams Institute of BiotechnologyAntwerp, Belgium
- Laboratory of Neurogenetics, Institute Born-Bunge,
University of AntwerpAntwerp, Belgium
| | - Kirsten Geider
- Department of Neurophysiology and Neurosensory Systems,
Technical University DarmstadtDarmstadt, Germany
| | - Bodo Laube
- Department of Neurophysiology and Neurosensory Systems,
Technical University DarmstadtDarmstadt, Germany
| | - Michael Schwake
- Biochemistry III, Faculty of Chemistry, University of
BielefeldBielefeld, Germany
| | - Robert J Harvey
- Department of Pharmacology, University College London
School of PharmacyLondon, United Kingdom
| | - Victoria M James
- Department of Pharmacology, University College London
School of PharmacyLondon, United Kingdom
| | - Alex Pepler
- Department of Pharmacology, University College London
School of PharmacyLondon, United Kingdom
- CeGaT GmbHTübingen, Germany
| | | | | | - John Neidhardt
- Institute of Medical Molecular Genetics, University of
ZurichSwitzerland
| | - Susanne Ruf
- Department of Neuropediatrics, University of
TübingenTübingen, Germany
| | - Markus Wolff
- Department of Neuropediatrics, University of
TübingenTübingen, Germany
| | - Deborah Bartholdi
- Institute of Clinical GeneticsKlinikum Stuttgart, Stuttgart, Germany
| | - Roberto Caraballo
- Department of Neurology, Juan P. Garrahan Pediatric
HospitalBuenos Aires, Argentina
| | - Konrad Platzer
- Department of Human Genetics, University of
LübeckLübeck, Germany
| | - Arvid Suls
- Partners of EuroEPINOMICS, RES
consortium
- Neurogenetics Group, Department of Molecular Genetics,
Vlaams Institute of BiotechnologyAntwerp, Belgium
| | - Peter De Jonghe
- Partners of EuroEPINOMICS, RES
consortium
- Neurogenetics Group, Department of Molecular Genetics,
Vlaams Institute of BiotechnologyAntwerp, Belgium
- Laboratory of Neurogenetics, Institute Born-Bunge,
University of AntwerpAntwerp, Belgium
- Department of Neurology, Antwerp University
HospitalAntwerp, Belgium
| | - Saskia Biskup
- CeGaT GmbHTübingen, Germany
- Institute of Clinical GeneticsKlinikum Stuttgart, Stuttgart, Germany
- Hertie Institute of Clinical Brain Research and German
Center for Neurodegenerative Diseases, University of TübingenTübingen, Germany
| | - Sarah Weckhuysen
- Partners of EuroEPINOMICS, RES
consortium
- Neurogenetics Group, Department of Molecular Genetics,
Vlaams Institute of BiotechnologyAntwerp, Belgium
- Laboratory of Neurogenetics, Institute Born-Bunge,
University of AntwerpAntwerp, Belgium
| |
Collapse
|
19
|
Stiebel-Kalish H, Eyal S, Steiner I. The role of aquaporin-1 in idiopathic and drug-induced intracranial hypertension. Med Hypotheses 2013; 81:1059-62. [PMID: 24169407 DOI: 10.1016/j.mehy.2013.10.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Revised: 09/27/2013] [Accepted: 10/04/2013] [Indexed: 10/26/2022]
Abstract
Idiopathic intracranial hypertension is a common disorder affecting mainly healthy, young, overweight women. The pathogenesis of this condition is unknown, but it has been shown to follow treatment with several compounds including corticosteroids and vitamin A derivatives. This paper will offer a novel hypothesis and insight on the pathogenesis of drug induced intracranial hypertension following a review and analysis of the literature. Both corticosteroids and vitamin A derivatives have been shown to upregulate the expression of aquaporin 1, a water channel protein. Aquaporin 1 is widely distributed in the human brain and is associated with water secretion into the subarachnoid space. Aquaporin 1 was also shown to participate in the regulation of weight. Agents used for treating idiopathic intracranial hypertension reduce aquaporin 1 expression. Based on these observations, we propose that aquaporin 1 has a pathogenetic role in drug induced idiopathic intracranial hypertension. Over expression of this gene causes increased intracranial pressure, and downregulation reduces pressure and alleviates the symptomatology and complications of idiopathic intracranial hypertension.
Collapse
Affiliation(s)
- H Stiebel-Kalish
- Department of Ophthalmology, Neuro-Ophthalmology Unit, Rabin Medical Center, Petach Tikva 49100, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel.
| | | | | |
Collapse
|
20
|
Syrbe S, Bertsche A, Bernhard MK, Steiner I, Biskup S, Merkenschlager A. Benigne familiäre Neugeborenenkrämpfe bei einer Familie mit neuer Missense-Mutation im KCNQ3-Gen. KLIN NEUROPHYSIOL 2013. [DOI: 10.1055/s-0033-1337317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
21
|
Steiner I, Schmutzhard E, Sellner J, Chaudhuri A, Kennedy PGE. EFNS-ENS guidelines for the use of PCR technology for the diagnosis of infections of the nervous system. Eur J Neurol 2012; 19:1278-91. [DOI: 10.1111/j.1468-1331.2012.03808.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2012] [Accepted: 06/12/2012] [Indexed: 11/30/2022]
Affiliation(s)
- I. Steiner
- Department of Neurology; Rabin Medical Center; Petach Tikva Israel
| | - E. Schmutzhard
- Department of Neurology; Medical University Innsbruck; Innsbruck Austria
| | - J. Sellner
- Department of Neurology; Klinikum rechts der Isar; Technische Universität München; München Germany
- Neurologische Abteilung; Krankenhaus Hietzing mit Neurologischem Zentrum Rosenhügel; Vienna Austria
| | - A. Chaudhuri
- Clinical Neurosciences; Queen's Hospital; Romford UK
| | - P. G. E. Kennedy
- Department of Neurology; Southern General Hospital; Institute of Neurological Sciences; Glasgow University; Glasgow UK
| |
Collapse
|
22
|
Abstract
Anthrax is a serious disease caused by Bacillus anthracis. Humans can become infected by handling products from infected animals, by breathing spores and rarely by eating undercooked meat from infected animals. The genome of B. anthracis is highly monomorphic and thus shows very low DNA sequence variation. We analysed the molecular characteristics of 12 B. anthracis isolates from outbreaks in Croatia and Bosnia and Herzegovina, which have occurred during the past 10 years along with two vaccine strains. Genotyping system based on variable-number tandem repeat analysis at six loci revealed that six isolates belong to genotype from the A1.a cluster whilst six isolates relate to the B2 cluster, compared to 89 previously described genotypes. The distribution of two evolutionarily distant clusters suggests an introduction of B. anthracis to this area in at least two separate events.
Collapse
Affiliation(s)
- I Steiner
- Faculty of Food Technology and Biotechnology, University of Zagreb, Zagreb, Croatia
| | | | | | | |
Collapse
|
23
|
Lemke JR, Riesch E, Scheurenbrand T, Schubach M, Wilhelm C, Steiner I, Hansen J, Courage C, Gallati S, Bürki S, Strozzi S, Simonetti BG, Grunt S, Steinlin M, Alber M, Wolff M, Klopstock T, Prott EC, Lorenz R, Spaich C, Rona S, Lakshminarasimhan M, Kröll J, Dorn T, Krämer G, Synofzik M, Becker F, Weber YG, Lerche H, Böhm D, Biskup S. Targeted next generation sequencing as a diagnostic tool in epileptic disorders. Epilepsia 2012; 53:1387-98. [PMID: 22612257 DOI: 10.1111/j.1528-1167.2012.03516.x] [Citation(s) in RCA: 242] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE Epilepsies have a highly heterogeneous background with a strong genetic contribution. The variety of unspecific and overlapping syndromic and nonsyndromic phenotypes often hampers a clear clinical diagnosis and prevents straightforward genetic testing. Knowing the genetic basis of a patient's epilepsy can be valuable not only for diagnosis but also for guiding treatment and estimating recurrence risks. METHODS To overcome these diagnostic restrictions, we composed a panel of genes for Next Generation Sequencing containing the most relevant epilepsy genes and covering the most relevant epilepsy phenotypes known so far. With this method, 265 genes were analyzed per patient in a single step. We evaluated this panel on a pilot cohort of 33 index patients with concise epilepsy phenotypes or with a severe but unspecific seizure disorder covering both sporadic and familial cases. KEY FINDINGS We identified presumed disease-causing mutations in 16 of 33 patients comprising sequence alterations in frequently as well as in less commonly affected genes. The detected aberrations encompassed known and unknown point mutations (SCN1A p.R222X, p. E289V, p.379R, p.R393H; SCN2A p.V208E; STXBP1 p.R122X; KCNJ10 p.L68P, p.I129V; KCTD7 p.L108M; KCNQ3 p.P574S; ARHGEF9 p.R290H; SMS p.F58L; TPP1 p.Q278R, p.Q422H; MFSD8 p.T294K), a putative splice site mutation (SCN1A c.693A> p.T/P231P) and small deletions (SCN1A p.F1330Lfs3X [1 bp]; MFSD8 p.A138Dfs10X [7 bp]). All mutations have been confirmed by conventional Sanger sequencing and, where possible, validated by parental testing and segregation analysis. In three patients with either Dravet syndrome or myoclonic epilepsy, we detected SCN1A mutations (p.R222X, p.P231P, p.R393H), even though other laboratories had previously excluded aberrations of this gene by Sanger sequencing or high-resolution melting analysis. SIGNIFICANCE We have developed a fast and cost-efficient diagnostic screening method to analyze the genetic basis of epilepsies. We were able to detect mutations in patients with clear and with unspecific epilepsy phenotypes, to uncover the genetic basis of many so far unresolved cases with epilepsy including mutation detection in cases in which previous conventional methods yielded falsely negative results. Our approach thus proved to be a powerful diagnostic tool that may contribute to collecting information on both common and unknown epileptic disorders and in delineating associated phenotypes of less frequently mutated genes.
Collapse
Affiliation(s)
- Johannes R Lemke
- Division of Human Genetics, University Children's Hospital Inselspital, Bern, Switzerland.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
24
|
Eckl-Dorna J, Ellinger A, Blatt K, Ghanim V, Steiner I, Pavelka M, Valent P, Valenta R, Niederberger V. Basophils are not the key antigen-presenting cells in allergic patients. Allergy 2012; 67:601-8. [PMID: 22335568 DOI: 10.1111/j.1398-9995.2012.02792.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2012] [Indexed: 12/01/2022]
Abstract
BACKGROUND Recent data obtained in mouse models have initiated a controversy whether basophils are the key antigen-presenting cells (APCs) in allergy. Here, we investigate whether basophils are of importance for the presentation of allergen and the induction of T cell proliferation in allergic patients. METHODS T cells, basophils, and APCs depleted of basophils were purified from allergic patients. Co-culture systems based on purified major allergens were established to study allergen-specific T cell responses using proliferation assays. RESULTS Only co-cultures of T cells with APCs depleted of basophils but not with basophils proliferated in response to allergen. Even addition of IL-3 to T cell-basophil co-cultures failed to induce allergen-specific T cell proliferation. CONCLUSIONS Our data demonstrate by classical in vitro proliferation assays that basophils are not key antigen-presenting cells that promote T cell proliferation in secondary immune responses to allergen in allergic patients.
Collapse
Affiliation(s)
- J. Eckl-Dorna
- Department of Otorhinolaryngology; Medical University of Vienna, AKH; Vienna; Austria
| | - A. Ellinger
- Department of Cell Biology and Ultrastructure Research; Center for Anatomy and Cell Biology; Medical University of Vienna; Vienna; Austria
| | - K. Blatt
- Division of Hematology and Hemostaseology; Department of Internal Medicine I; Medical University of Vienna, AKH; Vienna; Austria
| | - V. Ghanim
- Division of Hematology and Hemostaseology; Department of Internal Medicine I; Medical University of Vienna, AKH; Vienna; Austria
| | - I. Steiner
- Center for Medical Statistics, Informatics, and Intelligent Systems; Medical University of Vienna; Vienna; Austria
| | - M. Pavelka
- Department of Cell Biology and Ultrastructure Research; Center for Anatomy and Cell Biology; Medical University of Vienna; Vienna; Austria
| | - P. Valent
- Division of Hematology and Hemostaseology; Department of Internal Medicine I; Medical University of Vienna, AKH; Vienna; Austria
| | - R. Valenta
- Division of Immunopathology; Department of Pathophysiology and Allergy Research; Center for Pathophysiology, Infectiology and Immunology; Medical University of Vienna, AKH; Vienna; Austria
| | - V. Niederberger
- Department of Otorhinolaryngology; Medical University of Vienna, AKH; Vienna; Austria
| |
Collapse
|
25
|
Ortner C, Steiner I, Margeta K, Schulz M, Gustorff B. Dose response of tramadol and its combination with paracetamol in
UVB
induced hyperalgesia. Eur J Pain 2012; 16:562-73. [DOI: 10.1016/j.ejpain.2011.08.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- C.M. Ortner
- Department of AnesthesiologyGeneral Intensive Care and Pain ControlVienna Human Pain Research GroupMedical University Vienna Vienna Austria
- Department of Anesthesiology and Pain MedicineUniversity of Washington Seattle WA USA
| | - I. Steiner
- Institute for Medical StatisticsMedical University Vienna Vienna Austria
| | - K. Margeta
- Department of AnesthesiologyGeneral Intensive Care and Pain ControlVienna Human Pain Research GroupMedical University Vienna Vienna Austria
| | - M. Schulz
- Department of AnesthesiologyGeneral Intensive Care and Pain ControlVienna Human Pain Research GroupMedical University Vienna Vienna Austria
| | - B. Gustorff
- Department of AnesthesiologyGeneral Intensive Care and Pain ControlVienna Human Pain Research GroupMedical University Vienna Vienna Austria
| |
Collapse
|
26
|
Abstract
OBJECTIVE - To assess the symptom of sudden hearing loss in multiple sclerosis (MS). METHOD - We reviewed patient files in our MS clinic between January 2004 and November 2009 for symptoms of sudden hearing loss. RESULTS - We were able to identify 11 of 253 patients (4.35%) with sudden hearing loss. In seven patients, the hearing decline was the presenting symptom of MS and in all 11 patients, it appeared early in the course of the disease. There was no residual hearing deficit in 9/11 patients. In no patient was the condition bilateral and in none did it recur. CONCLUSION - Episodes of hearing loss are not uncommon in MS and have a good chance of complete recovery.
Collapse
Affiliation(s)
- M A Hellmann
- Department of Neurology, Rabin Medical Center, Petah Tikva, Tel Aviv University, Israel.
| | | | | |
Collapse
|
27
|
Steiner I, Rosenberg G, Wirguin I. Transient immunosuppression: a bridge between infection and the atypical autoimmunity of Guillain-Barré syndrome? Clin Exp Immunol 2010; 162:32-40. [PMID: 20735441 DOI: 10.1111/j.1365-2249.2010.04223.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Guillain-Barré syndrome (GBS) is an acute, usually monophasic, disorder of the peripheral nervous system that is assumed to be of immune-mediated pathogenesis. However, several clinical features and experimental findings of GBS are uncharacteristic for an immune-mediated disorder and set this condition apart from other disorders with a putative immune-mediated pathogenesis. These features include, among others, the monophasic nature of GBS, the lack of response to immunosuppressive (unlike immunomodulatory) therapy, the absence of a typical association with immunogenetic background and the inability to establish a valid and relevant animal model. We suggest a comprehensive hypothesis for the pathogenesis of GBS that is based on the assumption that the condition is due to a transient (or occasionally chronic) immune deficiency, as in most cases GBS follows an infection with pathogens known to induce immunosuppression. Such infections may be followed by breakdown of immune tolerance and induction of an immune attack on peripheral nerves. Mounting of the immune-mediated assault might be triggered either by the same infective pathogen or by secondary infection. Clearance of the infection and resumption of a normal immune response and tolerance eventually terminate the immune-mediated damage to the peripheral nerves and enable recovery. This hypothesis assumes that the entire sequence of events that culminates in GBS is due to transient exogenous factors and excludes a significant role for inherent host susceptibility, which explains the monophasic nature of the disorder.
Collapse
Affiliation(s)
- I Steiner
- Department of Neurology, Rabin Medical Center, Petah Tiqva, D-Pharm Ltd, Kiryat Weizmann Science Park, Rehovot, Israel.
| | | | | |
Collapse
|
28
|
Steiner I, Krbal L, Dominik J. Blood vessels and lymphatics in calcific aortic stenosis--in support of its inflammatory pathogenesis. Cesk Patol 2010; 46:33-36. [PMID: 21275223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
In developed countries, calcific aortic stenosis (CAS) has become the most common acquired valvular disease. It is considered a for of atherosclerosis and, like the latter, of inflammatory origin. Majority of cases of CAS are classified etiologically as either senile ("degenerative")--developing on previously normal aortic valve with three cusps, or based on congenitally malformed--bicuspid aortic valve. Twenty-eight cases of CAS (18 of the senile type, 7 of the bicuspid valve type, and 3 of indeterminable type) were examined by means of histology and immunohistochemistry (CD31 for blood vessels; D2-40 for lymphatics). In the calcified cusps, blood vessels were present in all 28 cases, and lymphatics in 14 of them. Vascularization was associated with lymphocytic infiltrates in 24 cases. There was no difference in the pattern between the two types of CAS. The origin of the cusp vessels is discussed. Our finding in the calcified cusps of both blood and lymphatic vessels together with lymphocytic infiltrates supports the inflammatory theory of the CAS pathogenesis.
Collapse
Affiliation(s)
- I Steiner
- The Fingerland Department of Pathology, Charles University Faculty of Medicine and Faculty Hospital Hradec Králové, Czech Republic.
| | | | | |
Collapse
|
29
|
Steiner I, Budka H, Chaudhuri A, Koskiniemi M, Sainio K, Salonen O, Kennedy PGE. Viral meningoencephalitis: a review of diagnostic methods and guidelines for management. Eur J Neurol 2010; 17:999-e57. [PMID: 20236175 DOI: 10.1111/j.1468-1331.2010.02970.x] [Citation(s) in RCA: 132] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Viral encephalitis is a medical emergency. The prognosis depends mainly on the pathogen and host immunologic state. Correct immediate diagnosis and introduction of symptomatic and specific therapy has a dramatic influence upon survival and reduces the extent of permanent brain injury. METHODS We searched the literature from 1966 to 2009. Recommendations were reached by consensus. Where there was lack of evidence but consensus was clear, we have stated our opinion as good practice points. RECOMMENDATIONS Diagnosis should be based on medical history and examination followed by CSF analysis for protein and glucose levels, cellular analysis, and identification of the pathogen by polymerase chain reaction amplification (recommendation level A) and serology (level B). Neuroimaging, preferably by MRI, is essential (level B). Lumbar puncture can follow neuroimaging when immediately available, but if this cannot be performed immediately, LP should be delayed only under unusual circumstances. Brain biopsy should be reserved only for unusual and diagnostically difficult cases. Patients must be hospitalized with easy access to intensive care units. Specific, evidence-based, antiviral therapy, acyclovir, is available for herpes encephalitis (level A) and may also be effective for varicella-zoster virus encephalitis. Ganciclovir and foscarnet can be given to treat cytomegalovirus encephalitis, and pleconaril for enterovirus encephalitis (IV class evidence). Corticosteroids as an adjunct treatment for acute viral encephalitis are not generally considered to be effective, and their use is controversial, but this important issue is currently being evaluated in a large clinical trial. Surgical decompression is indicated for impending uncal herniation or increased intracranial pressure refractory to medical management.
Collapse
Affiliation(s)
- I Steiner
- Department of Neurology, Rabin Medical Center, Beilinson Campus, Petach Tiqva, Israel.
| | | | | | | | | | | | | |
Collapse
|
30
|
Mygland A, Ljøstad U, Fingerle V, Rupprecht T, Schmutzhard E, Steiner I. EFNS guidelines on the diagnosis and management of European Lyme neuroborreliosis. Eur J Neurol 2009; 17:8-16, e1-4. [PMID: 19930447 DOI: 10.1111/j.1468-1331.2009.02862.x] [Citation(s) in RCA: 418] [Impact Index Per Article: 27.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- A Mygland
- Department of Neurology, Sorlandet Sykehus, Kristiansand, Norway.
| | | | | | | | | | | |
Collapse
|
31
|
|
32
|
Zacharovský R, Vojácek J, Dominik J, Steiner I, Hrncír Z. [Replacement of aortic valva and ascending aorta in patient with Takayasu's arteritis]. Rozhl Chir 2009; 88:493-496. [PMID: 20052925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Takayasu's arteritis (TA) is a rare vascular disorder, which predominantlly affects aorta and its primary branches. TA has a worldwide distribution and it is most frequent in young women. We report the case report of 36-year-old women, who underwent replacement of aortic valve and ascending aorta due to signifiant aortic regurgitation and dilatation of ascending aorta as a consequence of TA.
Collapse
Affiliation(s)
- R Zacharovský
- Kardiochirurgická klinika LF UK a FN Hradec Králové.
| | | | | | | | | |
Collapse
|
33
|
Brodowicz T, Steiner I, Beslija S, Ciuleanu TE, Inbar M, Krzakowski M, Kahan Z, Tzekova V, Vrbanec D, Zielinski CC. Time interval between final protocol approval (FPA) and inclusion of the first patient into randomized clinical trials (RCTs) performed by the Central European Cooperative Oncology Group (CECOG): A 10-year experience. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.6546] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
6546 Background: CECOG has been formed in 1999 to unite centers of clinical oncology from Central and Southeastern Europe and Israel in order to conduct and coordinate multicenter oncology RCTs. Based on the European legislation passed in 2001 (Directive 2001/20/EC), clinical trials must get ethical approval and approval from the competent authorities (CA). However, the duration of these regulatory procedures to initiate a clinical trial is a factor determining the competitive position in clinical research. Methods: Within the last 10 years, CECOG conducted trials in breast, colorectal, esophago-gastric, NSCLC, pancreatic, prostate cancer and GIST. We analyzed the dates of FPA, the approvals by Ethics Review Boards (ERB) and CAs, the letters of agreement between sponsor and site (LoA), the site initiation and the inclusion of the first patient in a total of 6 multicenter trials in 25 CECOG study centers in Austria, Bosnia, Bulgaria, Croatia, the Czech Republic, Hungary, Israel, Poland, Romania, Serbia, and Slovakia. Results: The average time interval from FPA to the inclusion of the first patient was 18.4 ± 9.4 months. Most of this time has been spent for regulatory procedures, i.e. the approval by ERBs (9.6 ± 7.2 months) and CAs (10.0 ± 6.6 months). The LoA were signed 11.5 ± 9.4 months after FPA. The time interval from approval by the CAs to site initiation was 3.3 ± 3.7 months and the interval between site initiation and the inclusion of the first patient was 4.2 ± 4.5 months. Conclusions: The ‘paper to patient process‘ - the time interval between the approval of the final study protocol and the inclusion of the first patient - required 18.4 months on average in 6 multicenter trials conducted by CECOG. As the regulatory procedures used up more than 50% of duration of the whole process, optimization is necessary and realistic in order to make novel therapies available to patients more quickly. No significant financial relationships to disclose.
Collapse
Affiliation(s)
- T. Brodowicz
- Medical University of Vienna, Vienna, Austria; Clinical Center of Sarajevo University, Sarajevo, Bosnia and Herzegovina; Universitatea de Medicina, Cluj-Napoca, Romania; Tel Aviv Medical Center, Tel Aviv, Israel; Maria Skolodowska-Curie Memorial Cancer Center, Warsaw, Poland; Onkotherapias Klinika, Szeged, Hungary; University Hospital Queen Joanna, Sofia, Bulgaria; University Hospital Rebro, Zagreb, Croatia
| | - I. Steiner
- Medical University of Vienna, Vienna, Austria; Clinical Center of Sarajevo University, Sarajevo, Bosnia and Herzegovina; Universitatea de Medicina, Cluj-Napoca, Romania; Tel Aviv Medical Center, Tel Aviv, Israel; Maria Skolodowska-Curie Memorial Cancer Center, Warsaw, Poland; Onkotherapias Klinika, Szeged, Hungary; University Hospital Queen Joanna, Sofia, Bulgaria; University Hospital Rebro, Zagreb, Croatia
| | - S. Beslija
- Medical University of Vienna, Vienna, Austria; Clinical Center of Sarajevo University, Sarajevo, Bosnia and Herzegovina; Universitatea de Medicina, Cluj-Napoca, Romania; Tel Aviv Medical Center, Tel Aviv, Israel; Maria Skolodowska-Curie Memorial Cancer Center, Warsaw, Poland; Onkotherapias Klinika, Szeged, Hungary; University Hospital Queen Joanna, Sofia, Bulgaria; University Hospital Rebro, Zagreb, Croatia
| | - T. E. Ciuleanu
- Medical University of Vienna, Vienna, Austria; Clinical Center of Sarajevo University, Sarajevo, Bosnia and Herzegovina; Universitatea de Medicina, Cluj-Napoca, Romania; Tel Aviv Medical Center, Tel Aviv, Israel; Maria Skolodowska-Curie Memorial Cancer Center, Warsaw, Poland; Onkotherapias Klinika, Szeged, Hungary; University Hospital Queen Joanna, Sofia, Bulgaria; University Hospital Rebro, Zagreb, Croatia
| | - M. Inbar
- Medical University of Vienna, Vienna, Austria; Clinical Center of Sarajevo University, Sarajevo, Bosnia and Herzegovina; Universitatea de Medicina, Cluj-Napoca, Romania; Tel Aviv Medical Center, Tel Aviv, Israel; Maria Skolodowska-Curie Memorial Cancer Center, Warsaw, Poland; Onkotherapias Klinika, Szeged, Hungary; University Hospital Queen Joanna, Sofia, Bulgaria; University Hospital Rebro, Zagreb, Croatia
| | - M. Krzakowski
- Medical University of Vienna, Vienna, Austria; Clinical Center of Sarajevo University, Sarajevo, Bosnia and Herzegovina; Universitatea de Medicina, Cluj-Napoca, Romania; Tel Aviv Medical Center, Tel Aviv, Israel; Maria Skolodowska-Curie Memorial Cancer Center, Warsaw, Poland; Onkotherapias Klinika, Szeged, Hungary; University Hospital Queen Joanna, Sofia, Bulgaria; University Hospital Rebro, Zagreb, Croatia
| | - Z. Kahan
- Medical University of Vienna, Vienna, Austria; Clinical Center of Sarajevo University, Sarajevo, Bosnia and Herzegovina; Universitatea de Medicina, Cluj-Napoca, Romania; Tel Aviv Medical Center, Tel Aviv, Israel; Maria Skolodowska-Curie Memorial Cancer Center, Warsaw, Poland; Onkotherapias Klinika, Szeged, Hungary; University Hospital Queen Joanna, Sofia, Bulgaria; University Hospital Rebro, Zagreb, Croatia
| | - V. Tzekova
- Medical University of Vienna, Vienna, Austria; Clinical Center of Sarajevo University, Sarajevo, Bosnia and Herzegovina; Universitatea de Medicina, Cluj-Napoca, Romania; Tel Aviv Medical Center, Tel Aviv, Israel; Maria Skolodowska-Curie Memorial Cancer Center, Warsaw, Poland; Onkotherapias Klinika, Szeged, Hungary; University Hospital Queen Joanna, Sofia, Bulgaria; University Hospital Rebro, Zagreb, Croatia
| | - D. Vrbanec
- Medical University of Vienna, Vienna, Austria; Clinical Center of Sarajevo University, Sarajevo, Bosnia and Herzegovina; Universitatea de Medicina, Cluj-Napoca, Romania; Tel Aviv Medical Center, Tel Aviv, Israel; Maria Skolodowska-Curie Memorial Cancer Center, Warsaw, Poland; Onkotherapias Klinika, Szeged, Hungary; University Hospital Queen Joanna, Sofia, Bulgaria; University Hospital Rebro, Zagreb, Croatia
| | - C. C. Zielinski
- Medical University of Vienna, Vienna, Austria; Clinical Center of Sarajevo University, Sarajevo, Bosnia and Herzegovina; Universitatea de Medicina, Cluj-Napoca, Romania; Tel Aviv Medical Center, Tel Aviv, Israel; Maria Skolodowska-Curie Memorial Cancer Center, Warsaw, Poland; Onkotherapias Klinika, Szeged, Hungary; University Hospital Queen Joanna, Sofia, Bulgaria; University Hospital Rebro, Zagreb, Croatia
| |
Collapse
|
34
|
Steiner I, Holloway R, Thompson J, Noyes K, Dorsey E, Schwid S. QUANTITATIVE RISK-BENEFIT ANALYSIS OF NATALIZUMAB. Neurology 2009; 72:1791-2; author reply 1791-2. [DOI: 10.1212/01.wnl.0000347020.85704.36] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|
35
|
Wagner CC, Steiner I, Zeitlinger M. Daptomycin elimination by CVVH in vitro: evaluation of factors influencing sieving and membrane adsorption. Int J Clin Pharmacol Ther 2009; 47:178-86. [PMID: 19281727 DOI: 10.5414/cpp47178] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2023] Open
Abstract
OBJECTIVE Knowledge on the elimination of antibiotics by extracorporeal hemofiltration is a prerequisite for appropriate antimicrobial dosing in patients with renal failure. The present study set out to determine the clearance of the novel lipopetide antibiotic daptomycin from human whole blood by continuous venovenous hemofiltration (CVVH) in vitro. In addition, factors influencing daptomycin sieving and membrane adsorption were investigated. METHODS A recirculation model using different solvent media was established and daptomycin was added to the simulated blood circuit at varying concentrations. The concentration of daptomycin over time in the modelled blood compartment and the ultrafiltrate was measured by high performance liquid chromatography (HPLC). RESULTS Mean Sieving coefficients (SCs) of daptomycin over time were calculated to 0.98 +/- 0.05, 0.33 +/- 0.02 and 0.40 +/- 0.03 at a baseline concentration of 60 microg/ml in Ringer lactate, Ringer lactate containing human albumin and in human whole blood, respectively. SCs of daptomycin in protein-containing media were higher than the free fraction in plasma of approximately 10%. Neither concentration of daptomycin nor addition of a second antibiotic showed significant impact on the SC. Adsorption of daptomycin to synthetic surfaces proved moderate and saturable, resulting in loss of around 20% of the amount initially added to the artificial blood circuit. CONCLUSION In our in vitro setting the calculated clearance of daptomycin from whole blood exceeded the physiological clearance described for individuals with normal renal function. Investigation of clearance by CVVH in vivo seems necessary. Until sufficient clinical data are available for patients undergoing CVVH, monitoring of daptomycin concentrations in this population might be recommended in order to avoid sub-therapeutic exposure to daptomycin.
Collapse
Affiliation(s)
- C C Wagner
- Department of Clinical Pharmacology, Medical University of Vienna, Austria
| | | | | |
Collapse
|
36
|
Chaudhuri A, Martinez-Martin P, Martin PM, Kennedy PGE, Andrew Seaton R, Portegies P, Bojar M, Steiner I. EFNS guideline on the management of community-acquired bacterial meningitis: report of an EFNS Task Force on acute bacterial meningitis in older children and adults. Eur J Neurol 2008; 15:649-59. [PMID: 18582342 DOI: 10.1111/j.1468-1331.2008.02193.x] [Citation(s) in RCA: 139] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Acute bacterial meningitis (ABM) is a potentially life-threatening neurological emergency. An agreed protocol for early, evidence-based and effective management of community-acquired ABM is essential for best possible outcome. A literature search of peer-reviewed articles on ABM was used to collect data on the management of ABM in older children and adults. Based on the strength of published evidence, a consensus guideline was developed for initial management, investigations, antibiotics and supportive therapy of community-acquired ABM. Patients with ABM should be rapidly hospitalized and assessed for consideration of lumbar puncture (LP) if clinically safe. Ideally, patients should have fast-track brain imaging before LP, but initiation of antibiotic therapy should not be delayed beyond 3 h after first contact of patient with health service. In every case, blood sample must be sent for culture before initiating antibiotic therapy. Laboratory examination of cerebrospinal fluid is the most definitive investigation for ABM and whenever possible, the choice of antibiotics, and the duration of therapy, should be guided by the microbiological diagnosis. Parenteral therapy with a third-generation cephalosporin is the initial antibiotics of choice in the absence of penicillin allergy and bacterial resistance; amoxicillin should be used in addition if meningitis because of Listeria monocytogenes is suspected. Vancomycin is the preferred antibiotic for penicillin-resistant pneumococcal meningitis. Dexamethasone should be administered both in adults and in children with or shortly before the first dose of antibiotic in suspected cases of Streptococcus pneumoniae and H. Influenzae meningitis. In patients presenting with rapidly evolving petechial skin rash, antibiotic therapy must be initiated immediately on suspicion of Neisseria meningitidis infection with parenteral benzyl penicillin in the absence of known history of penicillin allergy.
Collapse
Affiliation(s)
- A Chaudhuri
- Department of Neurology, Essex Centre for Neurological Sciences, Queen' Hospital, Romford, UK.
| | | | | | | | | | | | | | | | | |
Collapse
|
37
|
Steiner I, Gotkine M, Steiner-Birmanns B, Biran I, Silverstein S, Abeliovich D, Argov Z, Wirguin I. Increased severity over generations of Charcot-Marie-Tooth disease type 1A. J Neurol 2008; 255:813-9. [DOI: 10.1007/s00415-008-0693-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2007] [Revised: 05/31/2007] [Accepted: 07/06/2007] [Indexed: 10/22/2022]
|
38
|
Steiner I. [What is your diagnosis? Answer: lepromatous leprosy (miliary)]. Cesk Patol 2008; 44:40-49. [PMID: 18853524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
|
39
|
Steiner I, Aebi C, Ridolfi Lüthy A, Wagner B, Leibundgut K. Fatal adenovirus hepatitis during maintenance therapy for childhood acute lymphoblastic leukemia. Pediatr Blood Cancer 2008; 50:647-9. [PMID: 17278117 DOI: 10.1002/pbc.21120] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Disseminated adenoviral infection with hepatitis is rare in children undergoing standard chemotherapy. We report on a 3(1/2)-year-old male with fatal adenovirus hepatitis receiving maintenance chemotherapy for acute lymphoblastic leukemia (ALL). Adenoviral hepatitis was proven by histology, viral culture, and PCR in a liver biopsy. Quantitative real-time PCR in the peripheral blood showed adenoviral DNA copy number >10(9)/ml. Despite aggressive supportive care and antiviral treatment with cidofovir, the patient died rapidly due to fulminant liver failure. Diagnostic and treatment options for adenovirus infection remain unsatisfactory for these patients. We propose suggestions for diagnosis and therapy.
Collapse
Affiliation(s)
- Isabelle Steiner
- Division of Pediatric Hematology/Oncology, University Children's Hospital, Inselspital, Bern, Switzerland
| | | | | | | | | |
Collapse
|
40
|
Gotkine M, Rosenberg G, Steiner I, Stolz E, Wunderlich M. RECANALIZATION AFTER INTRAVENOUS THROMBOLYSIS: DOES A RECANALIZATION TIME WINDOW EXIST? Neurology 2008; 70:406; author reply 406-7. [DOI: 10.1212/01.wnl.0000304032.77813.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|
41
|
Steiner I, Laco J. [Rokitansky on atherosclerosis]. Cesk Patol 2008; 44:23-24. [PMID: 18333331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Karl Rokitansky (1804-1878) was the first to put forward a theory on pathogenesis of atherosclerosis. His "thrombogenic" theory is included in his famous three-volume Manual of Pathological Anatomy. In its first edition issued in 1844 he describes the disease under the heading Excessive formation of plaques on the interior of vessels. He does not use the term "atherosclerosis", speaking simply about a process. The description is merely macroscopic, based predominantly on lesions of the aorta. The process starts as thickening--hypertrophy and plaque formation of the vascular inner layer. The apposed pseudomembrane is composed of foreign substance of blood origin--fibrin. The pseudomembrane eventually develops into either an atheromatous process or ossification. Rokitansky accurately describes an atheromatous plaque with its lipid-rich interior, including its complications, however, he misregards plaque calcification for ossification. Although Rokitansky is aware that the disease may cause both narrowing and dilatation of a vessel, he claims that outcomes of the disease are unknown. In the third edition of Rokitansky's textbook issued 12 years later there are already included histological drawings of the aortic intimal and medial lesions.
Collapse
Affiliation(s)
- I Steiner
- Fingerlandův ústav patologie, Lékarské fakulty UK a Fakultní nemocnice, Hradec Králové.
| | | |
Collapse
|
42
|
Dominik J, Tuna M, Steiner I, Zacek P, Pojar M. Papillary fibroelastoma--an unusual cause of angina pectoris. Thorac Cardiovasc Surg 2007; 55:515-6. [PMID: 18027340 DOI: 10.1055/s-2007-965481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- J Dominik
- Department of Cardiac Surgery, Charles University in Prague, Faculty of Medicine in Hradec Králové, University Hospital Hradec Králové, Hradec Králové, Czech Republic
| | | | | | | | | |
Collapse
|
43
|
Steiner I, Wirguin I, Blumen SC, Dano M, Raphaeli G, Schwartz I, Korn-Lubetzki I. 'Hyperacute' Guillain-Barré syndrome. Eur Neurol 2007; 59:88-90. [PMID: 17934279 DOI: 10.1159/000109575] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2006] [Accepted: 03/31/2007] [Indexed: 11/19/2022]
|
44
|
|
45
|
Steiner I. [The autopsy of Reinhard Heydrich]. Cesk Patol 2007; 43:114-6. [PMID: 17821840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Reinhard Heydrich died on 4 June, 1942, eight days after assassination attempted on him in Prague by two members of the Czechoslovak army in Great Britain. The text of his autopsy report became available only in 2004. From the pathologist's view, the autopsy and the report show several unusual features: - The autopsy was performed early, only some 4 hours after death. - It was performed not in an autopsy room, but in the hospital director's office. - There was only a partial autopsy; the head and the neck organs were not examined. - The report lacks description of external examination; only the operation wounds are described. - The weights of the organs are not given. - And particularly: The autopsy did not reveal the cause of death.
Collapse
Affiliation(s)
- I Steiner
- Fingerlandův ústav patologie Lékarské fakulty UK a Fakultní nemocnice, Hradec Králové.
| |
Collapse
|
46
|
Steiner I. [Pathology of the cardiovascular system--new findings]. Cesk Patol 2007; 43:5-11. [PMID: 17370469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Presented is a review of important new informations in the field of cardiovascular pathology. The particular items discussed are hypertension (new definition and classification), etiopathogenesis of atherosclerosis, ischemic heart disease (unstable plaque; acute coronary syndrome; advances in therapy), valvular diseases (changing spectrum; calcific aortic stenosis; mitral valve prolapse), cardiomyopathies (new definition; etiology), infective endocarditis (changing pattern), senile heart diseases, and endomyocardial biopsy.
Collapse
Affiliation(s)
- I Steiner
- Fingerlandův ústav patologie Lékarské fakulty UK a Fakultní nemocnice, Hradec Králové.
| |
Collapse
|
47
|
Abstract
Music creation requires a highly orchestrated temporal pattern. The study of a patient with repetitive musical hallucinations enabled us to examine temporal pacemakers in music production. Here, we show that the pattern of faster silent production of a chosen tune compared with its production aloud was reversed when the patient produced the hallucinatory tune. This observation might suggest the utilization of a pacemaker(s), which functions differentially during the disease.
Collapse
Affiliation(s)
- I Biran
- Department of Neurology, Hadassah University Medical Center, Jerusalem, Israel.
| | | |
Collapse
|
48
|
|
49
|
Steiner I, Hájková P, Kvasnicka J, Kholová I. [Pulmonary veins and atrial fibrillation: a pathological study of 100 hearts]. Cesk Patol 2005; 41:124-31. [PMID: 16382985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Pathogenesis of atrial fibrillation (AF), the most common sustained heart arrhythmia, is not yet fully elucidated. Recent electrophysiological studies have shown that in most patients with AF the arrhythmia is triggered by ectopic beats originating from extensions of left atrial myocardium over the pulmonary veins (PVs), so called myocardial sleeves (MSPV). A total of 100 hearts (393 PVs) obtained at autopsy were prospectively studied - 50 from patients with chronic AF (average age 76.9 +/- 7.3 yrs.) and a control group of 50 with a sinus rhythm (aver. age 71.7 +/- 9.5 yrs.). This is a largest study published on this topic so far. It appeared that MSPV frequently harbour pathological lesions, particularly senile atrial amyloid, and scarring. These two pathological changes were evaluated semiquantitatively on a grade 0-3 basis in individual PVs, comparing the results in the AF vs. the control group. Amyloidosis of MSPV was found in 68 % of all hearts and in 55 % of all sleeves. The deposits were most marked in the right superior PV. Amyloidosis was more frequent and more severe in MSPV of patients with AF (58.5 %; average grade 0.89) than of those without AF (51.7 %; aver. grade 0.76); the differences, however, lack statistical significance. Scarring of MSPV was present in all 349 sleeves, more markedly in the left inferior, left superior, and right superior PVs. It was significantly more severe in patients with AF compared to those without the arrhythmia. By an injection metod, we have shown that MSPV are supplied by coronary arteries. However, the degree of scarring of the sleeves did not correlate with the degree of coronary atherosclerosis. We suggest that genesis of the scarring is not postnecrotic but degenerative, due to diffuse hypoxia of the sleeve myocardium. To conclude, amyloidosis and particularly scarring of MSPV appear generally in the elderly population as an arrhythmogenic substrate for AF.
Collapse
Affiliation(s)
- I Steiner
- Fingerlandův ústav patologie LF UK a FN, Hradec Králové.
| | | | | | | |
Collapse
|
50
|
Korn-Lubetzki I, Steiner I. Correspondance. Rev Neurol (Paris) 2005; 161:848; author reply 848-9. [PMID: 16244570 DOI: 10.1016/s0035-3787(05)85147-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|