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Kunkel J, Schott E. Rheumatologie und Hepatologie
interdisziplinär. AKTUEL RHEUMATOL 2021. [DOI: 10.1055/a-1626-8710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
ZusammenfassungRheumatologische und hepatologische Erkrankungen haben einige
Überschneidungen, die für Behandler aus beiden Disziplinen
relevant sind. In dieser Übersicht wird ein Schlaglicht auf 2
Erkrankungen geworfen, die sich an der Schnittstelle befinden: Arthropathie bei
Hämochromatose und Systemische Sklerose bei Primär
Biliärer Cholangitis. Daneben werden hepatologische Fragestellungen bei
rheumatologischer Therapie beleuchtet.
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Affiliation(s)
- Jan Kunkel
- Klinik für Innere Medizin II, HELIOS Klinikum Emil von Behring
Berlin-Zehlendorf, Berlin, Deutschland
| | - Eckart Schott
- Klinik für Innere Medizin II, HELIOS Klinikum Emil von Behring
Berlin-Zehlendorf, Berlin, Deutschland
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2
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Flanagan S, Kunkel J, Appleby V, Eldridge SE, Ismail S, Moreea S, Griffiths C, Walton R, Pitt M, Salmon A, Madurasinghe V, Barnes E, Simms E, Agarwal K, Foster GR. Case finding and therapy for chronic viral hepatitis in primary care (HepFREE): a cluster-randomised controlled trial. Lancet Gastroenterol Hepatol 2018; 4:32-44. [PMID: 30477810 DOI: 10.1016/s2468-1253(18)30318-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 09/24/2018] [Accepted: 09/24/2018] [Indexed: 01/08/2023]
Abstract
BACKGROUND The prevalence of viral hepatitis (hepatitis B virus and hepatitis C virus) in migrants is higher than among the general population in many high-income countries. We aimed to determine whether incentivising and supporting primary-care physicians in areas with a high density of migrants increases the numbers of adult migrants screened for viral hepatitis. METHODS HepFREE was a multicentre, open, cluster-randomised controlled trial in general practices in areas of the UK with a high density of migrants (Bradford, Yorkshire, and northeast and southeast London). Participants were adult patients (aged 18 years or older) in primary care, who had been identified as a first or second generation migrant from a high-risk country. General practices were randomly assigned (1:2:2:2:2) to an opportunistic screening (control) group or to one of four targeted screening (interventional) groups: standard (ie, hospital-based) care and a standard invitation letter; standard care and an enhanced invitation letter; community care and a standard invitation letter; or community care and an enhanced invitation letter. In control screening, general practitioners (GPs) were given a teaching session on viral hepatitis and were asked to test all registered migrants. In the intervention, GPs were paid a nominal sum for setting up searches of records, reimbursed for signed consent forms, and supported by a dedicated clinician. Patients who were eligible for testing and tested positive for viral hepatitis in the intervention groups were eligible to enrol in a second embedded trial of community versus hospital based care. The primary outcomes were the proportion of patients eligible for screening, the proportion of those eligible who were sent an invitation letter in the intervention groups, the uptake of viral hepatitis screening (in the intention-to-treat population), the proportion of patients who tested positive for viral hepatitis, the proportion who complied with treatment, and the cost-effectiveness of the intervention. This trial is registered with ISRCTN, number ISRCTN54828633. FINDINGS Recruitment and testing ran from Oct 31, 2013, to Feb 4, 2017, and each practice recruited for 18 consecutive calendar months. We approached 70 general practices in three areas with a high density of migrants, of which 63 general practices agreed to participate. Five practices withdrew and 58 practices were randomly assigned: eight to control and 50 to an intervention. In control practices, 26 046 (38·4%) of 67 820 patients who were initially registered were eligible for testing, as were 152 321 (43·3%) of 351 710 patients in the interventional groups in London and Bradford. Of 51 773 randomly selected eligible patients in the intervention groups in London and Bradford, letters were sent to 43 585 (84·2%) patients. In the eight control general practices, screening was taken up by 543 (1·7%) of 31 738 eligible participants, which included 5692 newly registered patients. However, in the 50 general practices that used the intervention, screening was taken up by 11 386 (19·5%) of 58 512 eligible participants (including 6739 newly registered patients; incidence rate ratio 3·70, 95% CI 1·30-10·51; p=0·014) and this intervention was cost-effective. 720 (4·5%) of 15 844 patients who received a standard letter versus 1032 (3·7%) of 28 095 patients who received the enhanced letter were tested (0·70, 0·38-1·31; p=0·26). In the control group, 17 patients tested positive for viral hepatitis, as did 220 patients (one with a co-infection) in the intervention groups. In the embedded study, 220 patients were randomly assigned to either hospital-based care or community care; 80 (87·9%) of 91 patients in the hospital setting complied with treatment versus 105 (81·4%) of 129 patients in the community setting. The intervention was cost-effective at willingness to pay thresholds in excess of £8540. One serious adverse event (thyroiditis) was noted. INTERPRETATION Screening migrants for viral hepatitis in primary care is effective if doctors are incentivised and supported. Community care is expensive and there is no evidence that this offers benefits in this setting or that bespoke invitation letters add value. We suggest that bespoke invitation letters should not be used, and we suggest that outreach, community-based services for migrants should not be developed. FUNDING National Institute for Health Research.
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Affiliation(s)
- Stuart Flanagan
- Barts Liver Centre, Queen Mary University of London, London, UK
| | - Jan Kunkel
- Barts Liver Centre, Queen Mary University of London, London, UK
| | - Victoria Appleby
- Department of Gastroenterology, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | | | - Sharif Ismail
- Barts Liver Centre, Queen Mary University of London, London, UK
| | - Sulleman Moreea
- Department of Gastroenterology, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | | | - Robert Walton
- Blizard Institute, Queen Mary University of London, London, UK
| | - Martin Pitt
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Andrew Salmon
- College of Medicine and Health, University of Exeter, Exeter, UK
| | | | - Eleanor Barnes
- Nuffield Department of Medicine and Oxford University Hospitals NHS Trust, University of Oxford, Oxford, UK
| | - Elizabeth Simms
- Nuffield Department of Medicine and Oxford University Hospitals NHS Trust, University of Oxford, Oxford, UK
| | | | - Graham R Foster
- Barts Liver Centre, Queen Mary University of London, London, UK.
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Cook J, Helphrey M, Crouch D, Fox D, Schultz L, Cook C, Kunkel J, Headrick J. A novel radiographic method to facilitate measurement of the tibial plateau angle in dogs. Vet Comp Orthop Traumatol 2017. [DOI: 10.1055/s-0037-1616583] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
SummaryThe tibial plateau levelling osteotomy (TPLO) is commonly performed for treatment of cranial cruciate ligament deficiency in dogs. In order to be performed as described, this procedure relies on consistent measurement of the tibial plateau angle (TPA) on radiographs. This prospective study compared two radiographic methods for subsequent TPA measurement with respect to measured angle and ease of determining landmarks for measurement as determined by four observers. One method was the accepted standard radiographic protocol outlined in the TPLO training seminars. The other method involved a novel split image radiographic protocol not yet described in the literature. Participants' subjective scores as to ease of identifying landmarks and determining TPA on radiographs for each method were evaluated. Inter-observer TPA measurement variability was also assessed for each method. The novel radiographic method was judged to be significantly better in terms of ease of measuring TPA. Inter-observer measurement variability was considered appropriate for recommending use of this novel method for radiographing patients for TPA measurements.
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Lewis H, Kunkel J, Axten D, Dalton J, Gardner H, Tippett A, Wynne S, Wilkinson M, Foster GR. Community nurse-led initiation of antiviral therapy for chronic hepatitis C in people who inject drugs does not increase uptake of or adherence to treatment. Eur J Gastroenterol Hepatol 2016; 28:1258-63. [PMID: 27487966 DOI: 10.1097/meg.0000000000000711] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Chronic hepatitis C is common in people who inject drugs (PWID) and this population serves as a reservoir for infection. Treatment levels are low among this group, ranging from 1 to 19%. We explored whether a nurse-initiated community treatment model increased uptake of and adherence to interferon-based therapies. METHODS This was a cluster randomized trial of nurse-initiated versus physician-initiated antiviral therapy with pegylated interferon and ribavirin for hepatitis C virus in community clinics (trial registration: ISRCTN07774040). RESULTS The proportion of participants initiating treatment during follow-up was 10% with nurse-initiated (6/62) and 9% with physician-initiated (6/76) therapy. Adherence was similar in both groups, with only one patient in each arm not adhering to therapy. There were no serious adverse events, but interferon-related side effects were common. Drug and alcohol use did not change during therapy. CONCLUSION Despite easy access to antiviral therapy, uptake of treatment was poor, with no significant difference between the groups. Nurse-led initiation of interferon-based antiviral therapy in PWID did not lead to increased uptake of, response to or adherence with treatment. Further service improvement is unlikely to increase the proportion of PWID undergoing antiviral therapy for hepatitis C virus and early adoption of interferon-free regimens may increase the proportion initiating and completing treatment.
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Affiliation(s)
- Heather Lewis
- aDepartment of Gastroenterology, Frimley Health Foundation Trust, Surrey bHepatology Unit, Barts and the London School of Medicine and Dentistry, Blizard Institute, Queen Mary University of London cBlood Borne Virus Team, Tower Hamlets Specialist Addiction Unit, East London NHS Foundation Trust, Beaumont House, Mile End Hospital, London, UK
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Zant R, Melter M, Knoppke B, Ameres M, Kunkel J. Kinetics of interleukin-6, procalcitonin, and C-reactive protein after pediatric liver transplantation. Transplant Proc 2015; 46:3507-10. [PMID: 25498081 DOI: 10.1016/j.transproceed.2014.08.048] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Accepted: 08/19/2014] [Indexed: 11/18/2022]
Abstract
In the early phase after pediatric liver transplantation (pLT) several concomitant factors may reduce the performance of established sepsis markers. To date, their clinical interpretation is hindered by a lack of information on their postoperative kinetics. To gather more information on the postoperative course and their changes in bacterial sepsis, we prospectively studied C-reactive protein (CRP), interleukin-6 (IL-6), and procalcitonin (PCT) on 9 perioperative days in 25 consecutive pLTs. After an initial postoperative peak, IL-6 and CRP levels significantly re-increased in patients with bacterial sepsis (P < .001). In contrast, PCT had very high postoperative levels; therefore severe infection was a comparatively inferior trigger for PCT elevation compared with the initial operation. The area under the receiver operating characteristic curve to diagnose postoperative sepsis for PCT was only 0.52, compared with 0.95 for IL-6 and 0.89 for CRP. None of the studied biomarkers were depressed by poor graft function. In conclusion, PCT performs poorly as a biomarker for sepsis in the early phase after pLT. With a rapid decline of initially elevated levels, IL-6 provides the best kinetics for detection of postoperative bacterial sepsis.
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Affiliation(s)
- R Zant
- KUNO Children's University Hospital, Regensburg, Germany.
| | - M Melter
- KUNO Children's University Hospital, Regensburg, Germany
| | - B Knoppke
- KUNO Children's University Hospital, Regensburg, Germany
| | - M Ameres
- KUNO Children's University Hospital, Regensburg, Germany
| | - J Kunkel
- KUNO Children's University Hospital, Regensburg, Germany
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6
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Duncan S, Kunkel J, White K, McPhee J, Schofield G, Meredith-Jones K, Johnston M, Taylor R. Is physical activity and body composition associated with neurocognitive function in children? J Sci Med Sport 2012. [DOI: 10.1016/j.jsams.2012.11.835] [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]
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Tucker JD, Li JZ, Robbins GK, Davis BT, Lobo AM, Kunkel J, Papaliodis GN, Durand ML, Felsenstein D. Ocular syphilis among HIV-infected patients: a systematic analysis of the literature. Sex Transm Infect 2011; 87:4-8. [PMID: 20798396 PMCID: PMC3103105 DOI: 10.1136/sti.2010.043042] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Ocular syphilis among HIV-infected patients continues to be a problem in the highly active antiretroviral therapy (HAART) era. However, outside of case reports or small case series, little is known about the clinical, laboratory, and treatment outcomes of these patients. Objective To examine the literature on HIV-infected patients and determine the results of treatment. METHODS Systematic review of cases series and case reports among HIV-infected individuals with ocular syphilis. Reviews, languages other than English and pre-1980 reports were excluded. The effect of CD4 count and virological suppression on clinical manifestations and diagnostic laboratory values was evaluated. RESULTS A total of 101 HIV-infected individuals in case series and case reports were identified. Ocular syphilis led to the HIV diagnosis in 52% of cases, including patients with CD4 count >200 cells/mm(3). Posterior uveitis was significantly more common in individuals with CD4 count <200 cells/mm(3) (p = 0.002). Three patients with confirmed ocular syphilis had negative non-treponemal tests. Ninety-seven per cent of patients with visual impairment improved following intravenous penicillin or ceftriaxone. CONCLUSIONS Non-treponemal tests may be negative in HIV-infected patients with ocular syphilis. Ocular syphilis remains an important clinical manifestation that can lead to initial HIV diagnosis.
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Affiliation(s)
- Joseph D Tucker
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, GRJ-504, Boston 02114, USA.
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Kunkel J, Schmidt S, Loddenkemper C, Zeitz M, Schulzke JD. Chronic diarrhea and melanosis coli caused by wellness drink. Int J Colorectal Dis 2009; 24:595-6. [PMID: 19066917 DOI: 10.1007/s00384-008-0625-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/27/2008] [Indexed: 02/04/2023]
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Kunkel J, Schürmann D, Pleyer U, Rüther K, Kneifel C, Krause L, Reichert M, Ignatius R, Schneider T. Ocular syphilis – indicator of previously unknown HIV-infection. J Infect 2009; 58:32-6. [DOI: 10.1016/j.jinf.2008.11.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2008] [Revised: 11/05/2008] [Accepted: 11/08/2008] [Indexed: 10/21/2022]
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Jansen A, Stark K, Kunkel J, Schreier E, Ignatius R, Liesenfeld O, Werber D, Göbel UB, Zeitz M, Schneider T. Aetiology of community-acquired, acute gastroenteritis in hospitalised adults: a prospective cohort study. BMC Infect Dis 2008; 8:143. [PMID: 18940017 PMCID: PMC2596151 DOI: 10.1186/1471-2334-8-143] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2008] [Accepted: 10/22/2008] [Indexed: 11/11/2022] Open
Abstract
Background The aetiology of severe gastroenteritis leading to hospitalisation in adults frequently remains unclear. Our objective was to study the causes and characteristics of community-acquired, acute gastroenteritis in adult hospitalized patients to support the clinical management of these patients. Methods From August 2005 to August 2007, we conducted a prospective cohort study among patients ≥18 y hospitalized with community-acquired gastroenteritis in a university hospital in Berlin, Germany. Stool specimens were examined for 26 gastrointestinal pathogens, supplemented by serologic tests for antibodies to Campylobacter spp., Yersinia spp., and Entamoeba histolytica. Patient data on demographics and clinical presentation were recorded and analyzed. Coexisting medical conditions were assessed using the Charlson Comorbidity Index score. Results Of 132 patients presenting with acute community-acquired gastroenteritis, 104 were included in the study. A non-infectious aetiology was diagnosed in 8 patients (8%). In 79 (82%) of the remaining 96 patients at least one microorganism was identified. Campylobacter spp. (35%) was detected most frequently, followed by norovirus (23%), Salmonella spp. (20%), and rotavirus (15%). In 46% of the patients with Campylobacter spp. infection, the diagnosis was made solely by serology. More than one pathogen was found in seventeen (22%) patients. Simultaneous infection was significantly more likely in patients with rotavirus and salmonella infections (RR 3.6; 95% CI: 1.8–7.4; RR 2.5; 95%CI: 1.2–5.5). Length of hospital stay (median: 5.5 days) was independent of the pathogen, but was associated with coexisting medical conditions (OR 4,8; 95%CI:2,0–11,6). Conclusion Known enteric pathogens were detected in 82% of adult patients who were hospitalized with acute gastroenteritis. We found that currently used culture-based methods may miss a substantial proportion of Campylobacter infections, and additional serological testing for Campylobacter should be considered. Viral infections emerged as an important cause of severe gastroenteritis in adults, and viral-bacterial co-infections in adults are probably underrecognized so far. The presence of coexisting medical conditions – but not the etiological agent – was a predictor for the duration of the hospital stay.
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Affiliation(s)
- Andreas Jansen
- Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany.
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Headrick J, Cook J, Helphrey M, Crouch D, Fox D, Schultz L, Cook C, Kunkel J. A novel radiographic method to facilitate measurement of the tibial plateau angle in dogs. A prospective clinical study. Vet Comp Orthop Traumatol 2007; 20:24-8. [PMID: 17364092] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
The tibial plateau levelling osteotomy (TPLO) is commonly performed for treatment of cranial cruciate ligament deficiency in dogs. In order to be performed as described, this procedure relies on consistent measurement of the tibial plateau angle (TPA) on radiographs. This prospective study compared two radiographic methods for subsequent TPA measurement with respect to measured angle and ease of determining landmarks for measurement as determined by four observers. One method was the accepted standard radiographic protocol outlined in the TPLO training seminars. The other method involved a novel split image radiographic protocol not yet described in the literature. Participants' subjective scores as to ease of identifying landmarks and determining TPA on radiographs for each method were evaluated. Inter-observer TPA measurement variability was also assessed for each method. The novel radiographic method was judged to be significantly better in terms of ease of measuring TPA. Inter-observer measurement variability was considered appropriate for recommending use of this novel method for radiographing patients for TPA measurements.
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Affiliation(s)
- J Headrick
- University of Tennessee, College of Veterinary Medicine, Department of Small Animal Clinical Sciences, Knoxville, Tennessee, USA.
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Kunkel J, Ignatius R, Jansen A, Zeitz M, Schneider T. 27-jähriger Reiserückkehrer mit hohem Fieber und septischem Schock im Verlauf. Internist (Berl) 2006. [DOI: 10.1007/s00108-006-1748-y] [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: 11/29/2022]
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Kunkel J, Ignatius R, Jansen A, Zeitz M, Schneider T. 27-jähriger Reiserückkehrer mit hohem Fieber und septischem Schock im Verlauf. Internist (Berl) 2006; 47 Suppl 1:S49-53. [PMID: 16485096 DOI: 10.1007/s00108-006-1590-2] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
A 27-year-old man was admitted with high fever and shivers eleven days after returning from vacation in Indonesia. Physical examination, laboratory values, abdominal ultrasound, and chest x-ray were not conclusive. All blood cultures yielded growth of Salmonella enterica serovar Typhi, and typhoid fever was diagnosed. Subsequently, the patient developed septic shock and pulmonary edema. In this case report epidemiological, clinical, and therapeutic aspects of typhoid fever are discussed with special emphasis on criteria for severe typhoid fever, which is treated with additional glucocorticoids.
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Affiliation(s)
- J Kunkel
- Medizinische Klinik I, Charité Campus Benjamin Franklin, Berlin
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Baumeister FAM, Oberhoffer R, Liebhaber GM, Kunkel J, Eberhardt J, Holthausen H, Peters J. Fatal propofol infusion syndrome in association with ketogenic diet. Neuropediatrics 2004; 35:250-2. [PMID: 15328567 DOI: 10.1055/s-2004-820992] [Citation(s) in RCA: 85] [Impact Index Per Article: 4.3] [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: 10/26/2022]
Abstract
Propofol is used for the treatment of refractory status epilepticus. When given as a long-term infusion propofol may cause a rare but frequently fatal complication, the propofol infusion syndrome. The hallmarks are metabolic acidosis, lipemia, rhabdomyolysis and myocardial failure. Propofol infusion syndrome is caused by impaired fatty acid oxidation. Beside anticonvulsants the ketogenic diet, a high-fat, low-carbohydrate, adequate-protein diet, is an effective treatment for difficult-to-control seizures. We report a 10-year-old boy with catastrophic epilepsy, who developed fatal propofol infusion syndrome when a ketogenic diet was initiated. Substances like propofol which impair fatty acid oxidation may pose an increased risk if combined with ketogenic diet.
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Affiliation(s)
- F A M Baumeister
- Children's Hospital of the Technical University Munich, Munich, Germany.
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Kunkel J. The future of computers in nursing. Semin Perioper Nurs 2000; 9:57-60. [PMID: 12029760] [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: 02/25/2023]
Abstract
Nursing and computers will enter the new millennium in synergy. As a science, nursing is using computers to organize and communicate information to expedite the nursing process and provide safe patient care. In 1992, the American Nursing Association recognized a new specialty in nursing: Nursing Informatics, a specialty that will provide the ability to adapt to the ever-changing future technology.
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Affiliation(s)
- J Kunkel
- Froedtert Memorial Lutheran Hospital, Milwaukee, WI, USA
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Rothe M, Pragst F, Spiegel K, Harrach T, Fischer K, Kunkel J. Hair concentrations and self-reported abuse history of 20 amphetamine and ecstasy users. Forensic Sci Int 1997; 89:111-28. [PMID: 9306670 DOI: 10.1016/s0379-0738(97)00123-0] [Citation(s) in RCA: 68] [Impact Index Per Article: 2.5] [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: 02/05/2023]
Abstract
Hair samples of 20 volunteers of the techno-music scene, who more or less regularly consumed ecstasy tablets and speed and anonymously reported their abuse history, were analyzed in one to seven 3 cm segments for amphetamine (A), methamphetamine (MA), methylenedioxyamphetamine (MDA), methylenedioxymethamphetamine (MDMA), methylenedioxyethamphetamine (MDE) and N-methyl-1-(1,3-benzodioxol-5-yl)-2-butylamine (MBDB) by digestion in 1 M NaOH, subsequent extraction with C18 Bond Elut columns, derivatization with pentafluoropropionyl anhydride and GC/MS-SIM measurements using deuterated standards of A, MA, MDA and MDMA. The concentrations were in the regions 0.1 to 4.8 ng/mg for A (17 samples), 0.05 to 0.89 ng/mg for MDA (16 samples), 0.1 to 8.3 ng/mg for MDMA (16 samples), 0.12 to 15 ng/mg for MDE (13 samples) and 0.21 to 1.3 ng/mg for MBDB (2 samples). MA was not detected. For comparison the frequency and the concentration of these drugs in 124 different ecstasy tablets were determined by HPLC. The drug concentration in the hair segments were compared with the volunteers' reports. Despite the enormous interindividual differences qualitatively an increase of the total concentration of MDA, MDMA and MDE in the proximate 3 cm segments with increasing ecstasy abuse frequency during the last three month before sampling is recognized. In the individual comparison with the chronological consumer reports in most cases a longer interruption or a change of the abuse intensity is not clearly seen at the segment concentrations. As a reason the incorporation of the drugs from sweat into elder hair regions and the slow removal by washing are discussed.
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Affiliation(s)
- M Rothe
- Institute of Forensic Medicine, Humboldt-University, Berlin, Germany
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Podlech J, Hengerer F, Fleck M, Kunkel J, Falke D. Localization of latency-associated transcripts in the uterovaginal plexus of herpes simplex virus type 1 and 2 latently infected mice. J Gen Virol 1997; 78 ( Pt 5):1103-8. [PMID: 9152429 DOI: 10.1099/0022-1317-78-5-1103] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [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: 02/04/2023] Open
Abstract
The vagina and medulla of the adrenal gland of mice vaginally infected with herpes simplex virus (HSV) types 1 and 2 were examined in the latent stage of infection (5 to 51 weeks post-infection). RNA in situ hybridization with HSV-1 and -2 latency-associated transcript (LAT) RNA probes resulted in positively stained neuronal cell nuclei in the uterovaginal plexus, but not in the medulla of the adrenal gland. These organs were chosen because HSV antigens can be detected not only in the vaginal epithelium, but also in neurons of the uterovaginal plexus and in the medulla of the adrenal gland at the acute stage of genital infection. To our knowledge, this is the first report describing LATs in neurons of the uterovaginal plexus in the genital tract of latently HSV-infected mice.
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MESH Headings
- Animals
- DNA, Viral/analysis
- Disease Models, Animal
- Female
- Herpes Genitalis/pathology
- Herpes Genitalis/virology
- Herpes Simplex/pathology
- Herpes Simplex/virology
- Herpesvirus 1, Human/genetics
- Herpesvirus 1, Human/isolation & purification
- Herpesvirus 1, Human/physiology
- Herpesvirus 2, Human/genetics
- Herpesvirus 2, Human/isolation & purification
- Herpesvirus 2, Human/physiology
- Humans
- Mice
- Mice, Inbred BALB C
- Neurons/virology
- RNA, Messenger/analysis
- Uterus/virology
- Vagina/pathology
- Vagina/virology
- Vaginitis/pathology
- Vaginitis/virology
- Virus Latency
- Vulvitis/pathology
- Vulvitis/virology
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Affiliation(s)
- J Podlech
- Institute of Virology, Johannes Gutenberg-University, Mainz, Germany.
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Saweljew P, Kunkel J, Feddersen A, Baumert M, Baehr J, Ludwig W, Bhakdi S, Husmann M. Case of fatal systemic infection with an Aureobacterium sp.: identification of isolate by 16S rRNA gene analysis. J Clin Microbiol 1996; 34:1540-1. [PMID: 8735113 PMCID: PMC229057 DOI: 10.1128/jcm.34.6.1540-1541.1996] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [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: 02/01/2023] Open
Abstract
The case of a 75-year-old man who succumbed to a disseminated infection most likely caused by a species of the genus Aureobacterium is reported. Identification of the isolate was achieved by comparative 16S rRNA gene analysis. Aureobacteria are commonly found in the environment. However, only recently have they been recognized as a cause of infections including septicemia and soft tissue infections. To our knowledge, this is the first documentation of a fatal infection caused by an Aureobacterium sp.
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Affiliation(s)
- P Saweljew
- Institute of Medical Microbiology and Hygiene, University of Mainz, Germany
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19
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Feddersen A, Kunkel J, Jonas D, Engel V, Bhakdi S, Husmann M. Infection of the upper extremity by Mycobacterium marinum in a 3-year-old boy--diagnosis by 16S-rDNA analysis. Infection 1996; 24:47-8. [PMID: 8852464 DOI: 10.1007/bf01780651] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [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: 02/02/2023]
Abstract
A 3-year-old boy developed several subcutaneous nodular lesions on his right arm. Based on the histological examination of one of these nodules furunculosis was suspected and cefuroxime was tentatively given. However, acid-fast bacilli were then detected in the tissue specimen and a few colonies of acid fast, gram-positive rods grew on blood agar. Definitive species diagnosis (Mycobacterium marinum) was rapidly achieved by automated sequencing of amplified 16S-rDNA and antimicrobial therapy was adjusted according to the available literature. After 3 weeks of treatment with clarithromycin, rifampicin and protionamid regression of the nodular lesions was evident.
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Affiliation(s)
- A Feddersen
- Institut für Medizinische Mikrobiologie und Hygiene, Hochhaus am Augustusplatz, Mainz, Germany
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Keefe D, Pepperell J, Rinaudo P, Kunkel J, Smith P. Identification of calcium flux in single preimplantation mouse embryos with the calcium-sensitive vibrating probe. Biol Bull 1995; 189:200. [PMID: 8541398 DOI: 10.1086/bblv189n2p200] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Affiliation(s)
- D Keefe
- Yale University School of Medicine, Department of Obstetrics and Gynecology, USA
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21
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Walev I, Kunkel J, Schwaeble W, Weise K, Falke D. Relationship between HLA I surface expression and different cytopathic effects produced after herpes simplex virus infection in vitro. Arch Virol 1992; 126:303-11. [PMID: 1326264 DOI: 10.1007/bf01309703] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [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: 12/26/2022]
Abstract
In the present study, we investigated the effects of herpes simplex virus (HSV) infection on the expression of HLA class I antigens and beta 2-microglobulin in human fibroblasts. The mRNA abundance for HLA class I was shown to be strongly reduced after infection with HSV strains either producing cell rounding or fusion from within (FFWI), however, HLA class I expression on the surface of cells is strongly reduced only after appearance of FFWI. Using a ts mutant (ts 78R) or CyA in combination with a fusion from without (FFWO) inducing strain of HSV, this loss of HLA class I antigens is assumed to be correlated to the rearrangement of the cell membrane during the fusion process itself as a late event of cytopathogenicity.
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Affiliation(s)
- I Walev
- Division of Experimental Virology, Johannes Gutenberg University, Mainz, Federal Republic of Germany
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22
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Klammt J, Gänsicke A, Gänsicke W, Kunkel J, Müller U, Pingel G, Scheibner B, Scheibner F, Schubert F. [Risk of alveolitis after dental extraction]. Stomatol DDR 1985; 35:586-93. [PMID: 3868844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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23
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Kunkel J. Intestinal flu or something more serious? Nurs Life 1984; 4:45. [PMID: 6564438] [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: 04/05/2023]
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24
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Kunkel J. Is this a case of anemia? Nurs Life 1984; 4:36. [PMID: 6561454] [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: 04/05/2023]
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25
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Kunkel J. Respiratory problems in a previously healthy patient. What's wrong here? Nurs Life 1983; 3:41. [PMID: 6554546] [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: 05/21/2023]
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Kunkel J. Seizures, tachycardia, and abnormal electrolytes: what's wrong with this patient? Nurs Life 1983; 3:32. [PMID: 6554535] [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: 04/05/2023]
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Kunkel J. Patient teaching: getting your message through. Nurs Life 1981; 1:36-40. [PMID: 6975905] [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: 01/22/2023]
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29
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Kunkel J. Nursing management of the head injured patient. Crit Care Update 1981; 8:22-33. [PMID: 6907074] [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: 01/22/2023]
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30
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Kunkel J, Wiley JK. Acute head injury: what to do when--an why. Nursing 1979; 9:22-33. [PMID: 253200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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