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Marosevic D, Belting A, Schönberger K, Carl A, Wenzel JJ, Brey R. Hepatitis A Outbreak in the General Population due to a MSM-Associated HAV Genotype Linked to a Food Handler, November 2017-February 2018, Germany. Food Environ Virol 2019; 11:149-156. [PMID: 30868371 DOI: 10.1007/s12560-019-09375-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 02/27/2019] [Indexed: 06/09/2023]
Abstract
Hepatitis A (HAV) is a viral infection causing a range of symptoms, sudden onset of fever, malaise, diarrhea, and jaundice. It is mostly transmitted fecal-oral through contaminated food, with immediate household and sexual contacts having a higher risk of infection. Since 2016 an increased number of HAV infections, mostly affecting men who have sex with men (MSM) have been noticed worldwide, with three main genotypes circulating. We report here on the first spillover outbreak of the MSM-associated HAV genotype RIVM-HAV16-090 in the German general population in November 2017-February 2018. In total, twelve cases could be attributed to the outbreak with the index case and a coworker in a butchers shop being the most probable source of the outbreak. The identical HAV genotype was detected in two environmental samples in the premises of the butchers shop and in nine cases. Outbreak control measures included detailed contact tracing and stool examinations, several environmental investigations, thorough cleaning, and disinfection of the premises of the butchers shop. Post-exposure vaccination was recommended to all unprotected contacts during the investigation. Furthermore, although hand-washing facilities were in accordance with the required law, additional installment of soap and disinfectant dispensers and contactless faucets has been recommended.
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Affiliation(s)
- Durdica Marosevic
- Bavarian Health and Food Safety Authority, Oberschleißheim, Germany.
| | - Anne Belting
- Bavarian Health and Food Safety Authority, Oberschleißheim, Germany
| | | | - Anja Carl
- Bavarian Health and Food Safety Authority, Oberschleißheim, Germany
| | - Jürgen J Wenzel
- Consultant laboratory for HAV and HEV, Institute of Clinical Microbiology and Hygiene, University Medical Centre Regensburg, Regensburg, Germany
| | - Roland Brey
- Health Authority Amberg-Sulzbach, Amberg, Germany
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Orbai AM, Truedsson L, Sturfelt G, Nived O, Fang H, Alarcón GS, Gordon C, Merrill J, Fortin PR, Bruce IN, Isenberg DA, Wallace DJ, Ramsey-Goldman R, Bae SC, Hanly JG, Sanchez-Guerrero J, Clarke AE, Aranow CB, Manzi S, Urowitz MB, Gladman DD, Kalunian KC, Costner MI, Werth VP, Zoma A, Bernatsky S, Ruiz-Irastorza G, Khamashta MA, Jacobsen S, Buyon JP, Maddison P, Dooley MA, Van Vollenhoven RF, Ginzler E, Stoll T, Peschken C, Jorizzo JL, Callen JP, Lim SS, Fessler BJ, Inanc M, Kamen DL, Rahman A, Steinsson K, Franks AG, Sigler L, Hameed S, Pham N, Brey R, Weisman MH, McGwin G, Magder LS, Petri M. Anti-C1q antibodies in systemic lupus erythematosus. Lupus 2014; 24:42-9. [PMID: 25124676 DOI: 10.1177/0961203314547791] [Citation(s) in RCA: 85] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVE Anti-C1q has been associated with systemic lupus erythematosus (SLE) and lupus nephritis in previous studies. We studied anti-C1q specificity for SLE (vs rheumatic disease controls) and the association with SLE manifestations in an international multicenter study. METHODS Information and blood samples were obtained in a cross-sectional study from patients with SLE (n = 308) and other rheumatologic diseases (n = 389) from 25 clinical sites (84% female, 68% Caucasian, 17% African descent, 8% Asian, 7% other). IgG anti-C1q against the collagen-like region was measured by ELISA. RESULTS Prevalence of anti-C1q was 28% (86/308) in patients with SLE and 13% (49/389) in controls (OR = 2.7, 95% CI: 1.8-4, p < 0.001). Anti-C1q was associated with proteinuria (OR = 3.0, 95% CI: 1.7-5.1, p < 0.001), red cell casts (OR = 2.6, 95% CI: 1.2-5.4, p = 0.015), anti-dsDNA (OR = 3.4, 95% CI: 1.9-6.1, p < 0.001) and anti-Smith (OR = 2.8, 95% CI: 1.5-5.0, p = 0.01). Anti-C1q was independently associated with renal involvement after adjustment for demographics, ANA, anti-dsDNA and low complement (OR = 2.3, 95% CI: 1.3-4.2, p < 0.01). Simultaneously positive anti-C1q, anti-dsDNA and low complement was strongly associated with renal involvement (OR = 14.9, 95% CI: 5.8-38.4, p < 0.01). CONCLUSIONS Anti-C1q was more common in patients with SLE and those of Asian race/ethnicity. We confirmed a significant association of anti-C1q with renal involvement, independent of demographics and other serologies. Anti-C1q in combination with anti-dsDNA and low complement was the strongest serological association with renal involvement. These data support the usefulness of anti-C1q in SLE, especially in lupus nephritis.
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Affiliation(s)
- A-M Orbai
- Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - L Truedsson
- Department of Laboratory Medicine, Section of Microbiology, Immunology and Glycobiology, Lund University, Lund, Sweden
| | - G Sturfelt
- Department of Rheumatology, Skåne University Hospital, Lund, Sweden
| | - O Nived
- Department of Rheumatology, Skåne University Hospital, Lund, Sweden
| | - H Fang
- Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - G S Alarcón
- Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - C Gordon
- Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences University of Birmingham, Birmingham, UK
| | - Jt Merrill
- Department of Clinical Pharmacology, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA
| | - P R Fortin
- Division of Rheumatology, Department of Medicine, Centre Hospitalier Universitaire (CHU) de Québec Axe Maladies Infectieuses et Immunitaires, CRCHU de Québec, Université Laval, Quebec City, Quebec, Canada
| | - I N Bruce
- Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Institute of Inflammation and Repair, Manchester Academic Health Sciences Centre, The University of Manchester, Manchester, UK NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, UK
| | - D A Isenberg
- Centre for Rheumatology, Research Division of Medicine, London, UK
| | - D J Wallace
- Cedars-Sinai Medical Center, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - R Ramsey-Goldman
- Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - S-C Bae
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
| | - J G Hanly
- Division of Rheumatology, Departments of Medicine and Pathology Capital Health and Dalhousie University, Halifax, Nova Scotia, Canada
| | - J Sanchez-Guerrero
- Mount Sinai Hospital and University Health Network, Toronto, Ontario, Canada
| | - A E Clarke
- Divisions of Clinical Epidemiology and Rheumatology, McGill University Health Centre, Montreal, Quebec, Canada
| | - C B Aranow
- Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - S Manzi
- Department of Medicine, Division of Rheumatology, Allegheny Singer Research Institute, Allegheny General Hospital, Pittsburgh, PA, USA
| | - M B Urowitz
- Toronto Western Hospital Toronto, Ontario, Canada
| | - D D Gladman
- Toronto Western Hospital Toronto, Ontario, Canada
| | - K C Kalunian
- Division of Rheumatology, Allergy and Immunology, UCSD School of Medicine, La Jolla, CA, USA
| | - M I Costner
- North Dallas Dermatology Associates, Dallas, TX, USA
| | - V P Werth
- Philadelphia VA Medical Center and University of Pennsylvania, Philadelphia, PA, USA
| | - A Zoma
- Lanarkshire Centre for Rheumatology and Hairmyres Hospital, East Kilbride, UK
| | - S Bernatsky
- Divisions of Clinical Epidemiology and Rheumatology, McGill University Health Centre, Montreal, Quebec, Canada
| | - G Ruiz-Irastorza
- Autoimmune Diseases Research Unit, Hospital Universitario Cruces Universidad del Pais Vasco, Barakaldo, Spain
| | | | - S Jacobsen
- Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - J P Buyon
- New York University, New York, NY, USA
| | | | - M A Dooley
- University of North Carolina, Chapel Hill, NC, USA
| | | | - E Ginzler
- State University of New York, Downstate Medical Center, Brooklyn, NY, USA
| | - T Stoll
- Kantonsspital Schaffhausen, Schaffhausen, Switzerland
| | - C Peschken
- University of Manitoba Winnipeg, Manitoba, Canada
| | - J L Jorizzo
- Wake Forest University, Winston-Salem, NC, USA
| | - J P Callen
- University of Louisville, Louisville, KY, USA
| | - S S Lim
- Emory University, Atlanta, GA, USA
| | - B J Fessler
- Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - M Inanc
- Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - D L Kamen
- Medical University of South Carolina, Charleston, SC, USA
| | - A Rahman
- NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, UK
| | - K Steinsson
- Landspitali University Hospital, Reykjavik, Iceland
| | | | - L Sigler
- Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - S Hameed
- Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - N Pham
- Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - R Brey
- University of Texas Health Science Center, San Antonio, TX, USA
| | - M H Weisman
- Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - G McGwin
- Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - L S Magder
- Department of Epidemiology and Public Health, University of Maryland, Baltimore, MD, USA
| | - M Petri
- Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Ruiz-Irastorza G, Cuadrado MJ, Ruiz-Arruza I, Brey R, Crowther M, Derksen R, Erkan D, Krilis S, Machin S, Pengo V, Pierangeli S, Tektonidou M, Khamashta M. Evidence-based recommendations for the prevention and long-term management of thrombosis in antiphospholipid antibody-positive patients: report of a task force at the 13th International Congress on antiphospholipid antibodies. Lupus 2011; 20:206-18. [PMID: 21303837 DOI: 10.1177/0961203310395803] [Citation(s) in RCA: 322] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The antiphospholipid syndrome (APS) is defined by the presence of thrombosis and/or pregnancy morbidity in combination with the persistent presence of circulating antiphospholipid antibodies: lupus anticoagulant, anticardiolipin antibodies and/or anti-β2-glycoprotein I antibodies in medium to high titers. The management of thrombosis in patients with APS is a subject of controversy. This set of recommendations is the result of an effort to produce guidelines for therapy within a group of specialist physicians in Cardiology, Neurology, Hematology, Rheumatology and Internal Medicine, with a clinical and research focus on APS.
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Affiliation(s)
- G Ruiz-Irastorza
- Autoimmune Disease Research Unit, Department of Internal Medicine, Hospital de Cruces, University of the Basque Country, Barakaldo, Spain.
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4
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Kupča AM, Essbauer S, Zoeller G, de Mendonça PG, Brey R, Rinder M, Pfister K, Spiegel M, Doerrbecker B, Pfeffer M, Dobler G. Isolation and molecular characterization of a tick-borne encephalitis virus strain from a new tick-borne encephalitis focus with severe cases in Bavaria, Germany. Ticks Tick Borne Dis 2010; 1:44-51. [DOI: 10.1016/j.ttbdis.2009.11.002] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2009] [Revised: 11/18/2009] [Accepted: 11/19/2009] [Indexed: 12/31/2022]
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Mosca M, Tani C, Aringer M, Bombardieri S, Boumpas D, Brey R, Cervera R, Doria A, Jayne D, Khamashta MA, Kuhn A, Gordon C, Petri M, Rekvig OP, Schneider M, Sherer Y, Shoenfeld Y, Smolen JS, Talarico R, Tincani A, van Vollenhoven RF, Ward MM, Werth VP, Carmona L. European League Against Rheumatism recommendations for monitoring patients with systemic lupus erythematosus in clinical practice and in observational studies. Ann Rheum Dis 2009; 69:1269-74. [PMID: 19892750 DOI: 10.1136/ard.2009.117200] [Citation(s) in RCA: 271] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVES To develop recommendations for monitoring patients with systemic lupus erythematosus (SLE) in clinical practice and observational studies and to develop a standardised core set of variables to monitor SLE. METHODS We followed the European League Against Rheumatism (EULAR) standardised procedures for guideline development. The following techniques were applied: nominal groups, Delphi surveys for prioritisation, small group discussion, systematic literature review and two Delphi rounds to obtain agreement. The panel included rheumatologists, internists, dermatologists, a nephrologist and an expert related to national research agencies. The level of evidence and grading of recommendations were determined according to the Levels of Evidence and Grades of Recommendations of the Oxford Centre for Evidence-Based Medicine. RESULTS A total of 10 recommendations have been developed, covering the following aspects: patient assessment, cardiovascular risk factors, other risk factors (osteoporosis, cancer), infection risk (screening, vaccination, monitoring), frequency of assessments, laboratory tests, mucocutaneous involvement, kidney monitoring, neuropsychological manifestations and ophthalmology assessment. A 'core set' of minimal variables for the assessment and monitoring of patients with SLE in clinical practice was developed that included some of the recommendations. In addition to the recommendations, indications for specific organ assessments that were viewed as part of good clinical practice were discussed and included in the flow chart. CONCLUSIONS A set of recommendations for monitoring patients with SLE in routine clinical practice has been developed. The use of a standardised core set to monitor patients with SLE should facilitate clinical practice, as well as the quality control of care for patients with SLE, and the collection and comparison of data in observational studies.
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Affiliation(s)
- M Mosca
- Correspondence to Dr Marta Mosca, University of Pisa, via Roma 67, Ospedale S. Chiara, Pisa, 56126, Italy.
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6
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Mamtani M, Rovin B, Brey R, Camargo JF, Kulkarni H, Herrera M, Correa P, Holliday S, Anaya JM, Ahuja SK. CCL3L1 gene-containing segmental duplications and polymorphisms in CCR5 affect risk of systemic lupus erythaematosus. Ann Rheum Dis 2007; 67:1076-83. [PMID: 17971457 DOI: 10.1136/ard.2007.078048] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVES There is an enrichment of immune response genes that are subject to copy number variations (CNVs). However, there is limited understanding of their impact on susceptibility to human diseases. CC chemokine ligand 3 like-1 (CCL3L1) is a potent ligand for the HIV coreceptor, CC chemokine receptor 5 (CCR5), and we have demonstrated previously an association between CCL3L1-gene containing segmental duplications and polymorphisms in CCR5 and HIV/AIDS susceptibility. Here, we determined the association between these genetic variations and risk of developing systemic lupus erythaematosus (SLE), differential recruitment of CD3+ and CD68+ leukocytes to the kidney, clinical severity of SLE reflected by autoantibody titres and the risk of renal complications in SLE. METHODS We genotyped 1084 subjects (469 cases of SLE and 615 matched controls with no autoimmune disease) from three geographically distinct cohorts for variations in CCL3L1 and CCR5. RESULTS Deviation from the average copy number of CCL3L1 found in European populations increased the risk of SLE and modified the SLE-influencing effects of CCR5 haplotypes. The CCR5 human haplogroup (HH)E and CCR5-Delta32-bearing HHG*2 haplotypes were associated with an increased risk of developing SLE. An individual's CCL3L1-CCR5 genotype strongly predicted the overall risk of SLE, high autoantibody titres, and lupus nephritis as well as the differential recruitment of leukocytes in subjects with lupus nephritis. The CCR5 HHE/HHG*2 genotype was associated with the maximal risk of developing SLE. CONCLUSION CCR5 haplotypes HHE and HHG*2 strongly influence the risk of SLE. The copy number of CCL3L1 influences risk of SLE and modifies the SLE-influencing effects associated with CCR5 genotypes. These findings implicate a key role of the CCL3L1-CCR5 axis in the pathogenesis of SLE.
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Affiliation(s)
- M Mamtani
- The Veterans Administration Center for AIDS and HIV-1 Infection, South Texas Veterans Health Care System and Department of Medicine, University of Texas Health Science Center at San Antonio, Texas 78229-7870, USA
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Shanahan J, Eckerman K, Arndt A, Gold C, Patton P, Rudin M, Brey R, Gesell T, Rusetski V, Pagava S. Calculation of dose coefficients for radionuclides produced in a spallation neutron source utilizing NUBASE and the evaluated nuclear structure data file databases. Health Phys 2006; 90:56-65. [PMID: 16340608 DOI: 10.1097/01.hp.0000175837.08948.74] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Based on a mercury spallation neutron source target, the UNLV Transmutation Research Program has identified 72 radionuclides with a half-life greater than or equal to a minute as lacking an appropriate reference for a published dose coefficient according to existing radiation safety dose coefficient databases. A method was developed to compare the nuclear data presented in the ENSDF and NUBASE databases for these 72 radionuclides. Due to conflicting or lacking nuclear data in one or more of the databases, internal and external dose coefficient values have been calculated for only 14 radionuclides, which are not currently presented in Federal Guidance Reports Nos. 11, 12, and 13 or Publications 68 and 72 of the International Commission on Radiological Protection. Internal dose coefficient values are reported for inhalation and ingestion of 1 microm and 5 microm AMAD particulates along with the f1 values and absorption types for the adult worker. Internal dose coefficient values are also reported for inhalation and ingestion of 1 microm AMAD particulates as well as the f1 values and absorption types for members of the public. Additionally, external dose coefficient values for air submersion, exposure to contaminated ground surface, and exposure to soil contaminated to an infinite depth are also presented.
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Affiliation(s)
- J Shanahan
- University of Nevada-Las Vegas, Las Vegas, NV 89154-3037, USA
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Arndt A, Shanahan J, Gold C, Brey R, Gesell T, Patton P, Rudin M, Eckerman K, Rusetski V, Pagava S. Quality assurance methods and procedures used to verify consistency in calculating dose coefficients. Health Phys 2006; 90:74-80. [PMID: 16340610 DOI: 10.1097/01.hp.0000176545.97510.66] [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] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
The development of a spallation neutron source with a mercury target will lead to the production of rare radionuclides. The dose coefficients for many of these radionuclides have not yet been published. A collaboration of universities and national labs has taken on the task of calculating dose coefficients for the rare radionuclides using the software package DCAL. The working group developed a procedure for calculating dose coefficients and a quality assurance (QA) program to verify the calculations completed. The first portion of this QA program was to verify that each participating group could independently reproduce the dose coefficients for a known set of radionuclides. The second effort was to divide the group of rare radionuclides among the independent participants in a manner that assured that each radionuclide would be redundantly and independently calculated, and the results subsequently be submitted for publication in a separate manuscript. The final aspect of this program was to resolve any discrepancies arising among the participants as a group. The output of the various software programs for six QA radionuclides, 144Nd, 201Au, 50V, 61Co, 41Ar, and 38S were compared among all members of the working group. Initially, a few differences in outputs were identified. This exercise identified weaknesses in the procedure, which has since been revised. After the revisions, dose coefficients were calculated and compared to published dose coefficients with good agreement. The present efforts involve generating dose coefficients for the rare radionuclides anticipated to be produced from the spallation neutron source should a mercury target be employed.
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Affiliation(s)
- A Arndt
- Idaho State University, Pocatello, ID 83209, USA
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Brey R, Jankowiak J. Neurology for the patient. Neurology 2002. [DOI: 10.1212/wnl.59.1.5] [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
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Navarrete M, Holliday S, Stallworth C, Brey R. A case of klinefelter's syndrome with lupus: coincidence or causality? Arch Clin Neuropsychol 2000. [DOI: 10.1093/arclin/15.8.727a] [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: 11/14/2022] Open
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Navarrete M, Holliday S, Clauser G, Brey R. A case of Creutzfeldt--Jakob disease presenting with bilingual Gerstmann syndrome. Arch Clin Neuropsychol 2000. [DOI: 10.1093/arclin/15.8.707] [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: 11/13/2022] Open
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Wilson WA, Gharavi AE, Koike T, Lockshin MD, Branch DW, Piette JC, Brey R, Derksen R, Harris EN, Hughes GR, Triplett DA, Khamashta MA. International consensus statement on preliminary classification criteria for definite antiphospholipid syndrome: report of an international workshop. Arthritis Rheum 1999. [PMID: 10403256 DOI: 10.1002/1529-0131(199907)42:7<1309::aid-anr1>3.0.co;2-f] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- W A Wilson
- Louisiana State University Medical Center, New Orleans 70112-2822, USA
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Wilson WA, Gharavi AE, Koike T, Lockshin MD, Branch DW, Piette JC, Brey R, Derksen R, Harris EN, Hughes GR, Triplett DA, Khamashta MA. International consensus statement on preliminary classification criteria for definite antiphospholipid syndrome: report of an international workshop. Arthritis Rheum 1999. [PMID: 10403256 DOI: 10.1002/1529-0131(199907)42] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- W A Wilson
- Louisiana State University Medical Center, New Orleans 70112-2822, USA
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Wilson WA, Gharavi AE, Koike T, Lockshin MD, Branch DW, Piette JC, Brey R, Derksen R, Harris EN, Hughes GR, Triplett DA, Khamashta MA. International consensus statement on preliminary classification criteria for definite antiphospholipid syndrome: report of an international workshop. Arthritis Rheum 1999; 42:1309-11. [PMID: 10403256 DOI: 10.1002/1529-0131(199907)42:7<1309::aid-anr1>3.0.co;2-f] [Citation(s) in RCA: 1628] [Impact Index Per Article: 65.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- W A Wilson
- Louisiana State University Medical Center, New Orleans 70112-2822, USA
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Tincani A, Brey R, Balestrieri G, Vitali C, Doria A, Galeazzi M, Meroni PL, Migliorini P, Neri R, Tavoni A, Bombardieri S. International survey on the management of patients with SLE. II. The results of a questionnaire regarding neuropsychiatric manifestations. Clin Exp Rheumatol 1996; 14 Suppl 16:S23-9. [PMID: 9049450] [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: 02/03/2023]
Abstract
OBJECTIVE To determine the diagnostic and therapeutic approach used in clinical practice for the management of systemic lupus erythematosus (SLE) patients with primary SLE-mediated neuropsychiatric (NP) manifestations. METHODS A questionnaire was drawn up to assess how clinicians manage various clinical manifestations of SLE. A portion of this questionnaire was designed to assess how clinicians diagnose and treat primary NP-SLE. Most of the questions in the NP-SLE section consisted of lists of different clinical manifestations and laboratory or radiological studies that participants were asked to rate on a scale of importance [from 1 (extremely important) to 5 (not important)] to the diagnosis of primary NP-SLE. The questionnaire also assessed how different NP manifestations are treated in clinical practice. The relative importance of each clinical manifestation was determined through its mean score, and the agreement among participants on each issue was determined using the coefficient of variation (CV). Fifty-nine lupus centers participated in the NP-SLE portion of the survey. RESULTS The clinical manifestations which were considered to be of extreme or major importance for the diagnosis of primary NP-SLE were seizures, psychosis, transverse myelitis, stroke, transient ischemic attack (TIA) and aseptic meningitis. Among the radiological and laboratory studies, only brain magnetic resonance imaging (MRI) and antiphospholipid antibodies (aPL) achieved "extremely important" mean scores (between 1 and 2). aPL testing was used routinely in the majority of patients (mean 96.8%; CV = 0.1), while brain MRI was used less frequently (mean 56.5%; CV = 0.61). Only brain MRI and cerebral angiography were considered to be helpful in differentiating cerebral vasculopathy from multi-infarct (mean score = 1.6 and 1.9, respectively), whereas a prompt response to treatment with increased doses of steroids was considered helpful in differentiating SLE-related psychosis from steroid-induced psychosis (mean score = 1.58). The results of aPL testing, coagulation tests for the lupus anticoagulant, an brain MRI were considered to be of extreme or major importance in decisions involving treatment with anticoagulant or anti-platelet therapy. Symptomatic therapies, such as heparin, or anti-convulsant, anti-platelet, oral anticoagulant, and antipsychotic therapy were the most widely used. Corticosteroids were the most frequently used immunosuppressive therapy. The administration of other immunosuppressive agents as specific treatment for NP-SLE was uncommon. CONCLUSIONS Our survey found that in clinical practice, the NP manifestations currently considered to be diagnostic of primary SLE-mediated CNS involvement are not limited to those included in the American Rheumatism Association (ARA) criteria, e.g. seizures and psychosis. Antiphospholipid antibodies appeared to be the laboratory parameter most frequently relied upon in the diagnosis of NP-SLE, and in decisions regarding treatment. Apart from that, only brain MRI and, in selected cases, cerebral angiography seemed to be of real help in diagnosis. The lack of consensus regarding the treatment of primary NP-SLE manifestations most probably reflects both the complex nature of neurological illness in SLE patients and the lack of clear diagnostic criteria.
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MESH Headings
- Adrenal Cortex Hormones/therapeutic use
- Antibodies, Antiphospholipid/analysis
- Anticoagulants/therapeutic use
- Anticonvulsants/therapeutic use
- Brain/blood supply
- Brain/pathology
- Central Nervous System/pathology
- Central Nervous System/physiopathology
- Cerebral Angiography
- Cerebrovascular Disorders/epidemiology
- Cerebrovascular Disorders/pathology
- Cerebrovascular Disorders/physiopathology
- Europe/epidemiology
- Heparin/therapeutic use
- Humans
- Immunosuppressive Agents/therapeutic use
- International Cooperation
- Lupus Erythematosus, Systemic/diagnosis
- Lupus Erythematosus, Systemic/drug therapy
- Lupus Erythematosus, Systemic/psychology
- Magnetic Resonance Imaging
- Meningitis, Aseptic/epidemiology
- Meningitis, Aseptic/pathology
- Meningitis, Aseptic/physiopathology
- Myelitis, Transverse/epidemiology
- Myelitis, Transverse/pathology
- Myelitis, Transverse/physiopathology
- Nervous System Diseases/epidemiology
- Nervous System Diseases/pathology
- Nervous System Diseases/physiopathology
- Prevalence
- Seizures/epidemiology
- Seizures/pathology
- Seizures/physiopathology
- Surveys and Questionnaires
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Affiliation(s)
- A Tincani
- Clinical Immunology Unit, Ospedale Civile di Brescia, Italy
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Abstract
A joint committee comprised of representatives from the American School Health Association and the Association for the Advancement of Health Education delineated five areas of instructional responsibility and 31 competencies needed for elementary health educators. Practicing elementary educators in southeastern Pennsylvania were surveyed as to their usage and perceived importance of these health instruction responsibilities and competencies. Competency usage varied from a high of 98.6% to a low of 33.5%. The second area of instructional responsibility -- Assessing the Health Instruction Needs and Interests of Elementary Students -- had the highest mean usage per competency. Chi-square tests indicated a statistically significant relationship for competency usage and highest academic degree earned for two competencies, while competency usage and total number of years experience as an elementary educator indicated a statistically significant relationship for three competencies. The authors conclude with suggested strategies to improve the health education preparation of elementary educators.
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Affiliation(s)
- S Patterson
- Dept. of Health, West Chester University, PA 19383, USA
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17
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Abstract
Thirty-six subjects with confirmed, unilateral benign paroxysmal positioning vertigo of at least 2 months' duration were randomly assigned to one of two treatment groups. After complete informational counseling and explanation of the posttreatment instructions, subjects were randomly assigned to receive either Epley's canalith repositioning procedure or a placebo maneuver. All subjects completed a daily diary for 1 month to document any dizzy spells and their adherence to the posttreatment instructions. Follow-up Dix-Hallpike testing was performed after 1 month by an audiologist who was blinded to the patient's treatment group status. Analysis of Dix-Hallpike results confirmed that those who received the canalith repositioning procedure had significantly more negative responses (88.9%) than did those in the placebo group (26.7%).
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Affiliation(s)
- S Lynn
- Department of Otorhinolaryngolgy, Mayo Clinic, Rochester, MN 55905, USA
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18
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Abstract
Thirty-six subjects with confirmed, unilateral benign paroxysmal positioning vertigo of at least 2 months' duration were randomly assigned to one of two treatment groups. After complete informational counseling and explanation of the posttreatment instructions, subjects were randomly assigned to receive either Epley's canalith repositioning procedure or a placebo maneuver. All subjects completed a daily diary for 1 month to document any dizzy spells and their adherence to the posttreatment instructions. Follow-up Dix-Hallpike testing was performed after 1 month by an audiologist who was blinded to the patient's treatment group status. Analysis of Dix-Hallpike results confirmed that those who received the canalith repositioning procedure had significantly more negative responses (88.9%) than did those in the placebo group (26.7%).
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Affiliation(s)
- S Lynn
- Department of Otorhinolaryngolgy, Mayo Clinic, Rochester, MN 55905, USA
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19
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Lynn S, Brey R. Benign paroxysmal positioning vertigo with indeterminate cerebellar lesion: case report. J Am Acad Audiol 1993; 4:384-91. [PMID: 8298174] [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: 01/29/2023]
Abstract
Of the numerous causes of dizziness, those that represent a life-threatening condition are rare. Physicians must guard against missing these rare but serious conditions while controlling the cost of the evaluation of patients who present with dizziness. This case study involving a 41-year-old female was written to illustrate the importance of systematic case history taking and of obtaining an ENG. The patient presented with classic symptoms of benign paroxysmal positioning vertigo (BPPV). The managing physician performed an MRI, which showed a cerebellar lesion. Results of a biopsy were negative. The patient's symptoms persisted, and she travelled to our clinic for further assessment. An ENG demonstrated a classic response to the Dix-Hallpike maneuvers, and a canalith repositioning maneuver was performed. The positioning dizziness resolved, and when contacted several months later, the patient stated she had remained asymptomatic.
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Affiliation(s)
- S Lynn
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota 55905
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Foote R, Coffey R, Earle J, Schomberg P, Shaw E, Swanson J, Davis D, Kelly P, Horner S, Beatty C, Brey R, Robinette M, Bourland D, Kline R, McCullough E, Stevens L, O'Fallon J. Stereotactic radiosurgery using the gamma knife for acoustic neuromas. Int J Radiat Oncol Biol Phys 1993. [DOI: 10.1016/0360-3016(93)90668-l] [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: 11/27/2022]
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Abstract
Three complex partial seizure (CPS) types have been described based upon the behaviors seen at the onset of the ictal event. Type I CPSs are preceded by a motionless stare and have been correlated with a temporal focus, whereas Type II CPSs are not preceded by a motionless stare and have been correlated with an extratemporal focus. A third type of CPS, temporal lobe syncope, has been correlated with bilateral mesial temporal foci. We examined the utility of this CPS classification system in predicting surgical outcomes by reviewing our patients who had undergone surgical excision of their epileptogenic foci for the treatment of medically refractory CPSs. Forty-six consecutive patients were evaluated, with the seizure focus ultimately found to be temporal in 41 and frontal in 5. All 5 patients with frontal foci had Type II CPSs; of the 41 patients with temporal foci, 20 had Type I and 21 had the Type II CPSs. Twenty of 26 patients with Type II CPSs and 18 of 20 patients with Type I CPSs had a good or excellent outcome. Although our data suggest that patients with frontal foci have Type II CPSs, the reverse is not true. Furthermore, CPS type is not correlated with the surgical outcome, since there was no significant difference between the CPS type and the category of surgical outcome.
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