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Bohórquez JA, Adduri S, Ansari D, John S, Florence J, Adejare O, Singh G, Konduru N, Jagannath C, Yi G. A Novel Humanized Mouse Model for HIV and Tuberculosis Co-infection Studies. bioRxiv 2024:2024.03.05.583545. [PMID: 38496484 PMCID: PMC10942347 DOI: 10.1101/2024.03.05.583545] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
Tuberculosis (TB), caused by Mycobacterium tuberculosis (Mtb), continues to be a major public health problem worldwide. The human immunodeficiency virus (HIV) is another equally important life-threatening pathogen. Further, co-infections with HIV and Mtb have severe effects in the host, with people infected with HIV being fifteen to twenty-one times more likely to develop active TB. The use of an appropriate animal model for HIV/Mtb co-infection that can recapitulate the diversity of the immune response in humans would be a useful tool for conducting basic and translational research in HIV/Mtb infections. The present study was focused on developing a humanized mouse model for investigations on HIV-Mtb co-infection. Using NSG-SGM3 mice that can engraft human stem cells, our studies showed that they were able to engraft human CD34+ stem cells which then differentiate into a full-lineage of human immune cell subsets. After co-infection with HIV and Mtb, these mice showed decrease in CD4+ T cell counts overtime and elevated HIV load in the sera, similar to the infection pattern of humans. Additionally, Mtb caused infections in both lungs and spleen, and induced the development of granulomatous lesions in the lungs, detected by CT scan and histopathology. Distinct metabolomic profiles were also observed in the tissues from different mouse groups after co-infections. Our results suggest that the humanized NSG-SGM3 mice are able to recapitulate the effects of HIV and Mtb infections and co-infection in the human host at pathological, immunological and metabolism levels, providing a dependable small animal model for studying HIV/Mtb co-infection.
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Affiliation(s)
- José Alejandro Bohórquez
- Department of Cellular and Molecular Biology, The University of Texas Health Science Center at Tyler, Tyler, TX 75708, USA
- Center for Biomedical Research, The University of Texas Health Science Center at Tyler, Tyler, TX 75708, USA
- Department of Medicine, The University of Texas at Tyler School of Medicine, Tyler, TX 75708, USA
| | - Sitaramaraju Adduri
- Department of Cellular and Molecular Biology, The University of Texas Health Science Center at Tyler, Tyler, TX 75708, USA
- Center for Biomedical Research, The University of Texas Health Science Center at Tyler, Tyler, TX 75708, USA
| | - Danish Ansari
- Department of Cellular and Molecular Biology, The University of Texas Health Science Center at Tyler, Tyler, TX 75708, USA
- Center for Biomedical Research, The University of Texas Health Science Center at Tyler, Tyler, TX 75708, USA
- Department of Medicine, The University of Texas at Tyler School of Medicine, Tyler, TX 75708, USA
| | - Sahana John
- Department of Cellular and Molecular Biology, The University of Texas Health Science Center at Tyler, Tyler, TX 75708, USA
- Center for Biomedical Research, The University of Texas Health Science Center at Tyler, Tyler, TX 75708, USA
- Department of Medicine, The University of Texas at Tyler School of Medicine, Tyler, TX 75708, USA
| | - Jon Florence
- Department of Cellular and Molecular Biology, The University of Texas Health Science Center at Tyler, Tyler, TX 75708, USA
- Center for Biomedical Research, The University of Texas Health Science Center at Tyler, Tyler, TX 75708, USA
| | - Omoyeni Adejare
- Department of Cellular and Molecular Biology, The University of Texas Health Science Center at Tyler, Tyler, TX 75708, USA
- Center for Biomedical Research, The University of Texas Health Science Center at Tyler, Tyler, TX 75708, USA
| | - Gaurav Singh
- Department of Medicine, The University of Texas at Tyler School of Medicine, Tyler, TX 75708, USA
| | - Nagarjun Konduru
- Department of Cellular and Molecular Biology, The University of Texas Health Science Center at Tyler, Tyler, TX 75708, USA
- Center for Biomedical Research, The University of Texas Health Science Center at Tyler, Tyler, TX 75708, USA
| | - Chinnaswamy Jagannath
- Department of Pathology and Genomic Medicine, Center for Infectious Diseases and Translational Medicine, Houston Methodist Research Institute, Houston, TX, USA
| | - Guohua Yi
- Department of Cellular and Molecular Biology, The University of Texas Health Science Center at Tyler, Tyler, TX 75708, USA
- Center for Biomedical Research, The University of Texas Health Science Center at Tyler, Tyler, TX 75708, USA
- Department of Medicine, The University of Texas at Tyler School of Medicine, Tyler, TX 75708, USA
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John S, Barnett W, Abdala A, Zoccal D, Rubin J, Molkov Y. The role of Kölliker-Fuse nucleus in breathing variability. bioRxiv 2023:2023.06.15.545086. [PMID: 37398197 PMCID: PMC10312726 DOI: 10.1101/2023.06.15.545086] [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] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Abstract
The Kölliker-Fuse nucleus (KF), which is part of the parabrachial complex, participates in the generation of eupnea under resting conditions and the control of active abdominal expiration when increased ventilation is required. Moreover, dysfunctions in KF neuronal activity are believed to play a role in the emergence of respiratory abnormalities seen in Rett syndrome (RTT), a progressive neurodevelopmental disorder associated with an irregular breathing pattern and frequent apneas. Relatively little is known, however, about the intrinsic dynamics of neurons within the KF and how their synaptic connections affect breathing pattern control and contribute to breathing irregularities. In this study, we use a reduced computational model to consider several dynamical regimes of KF activity paired with different input sources to determine which combinations are compatible with known experimental observations. We further build on these findings to identify possible interactions between the KF and other components of the respiratory neural circuitry. Specifically, we present two models that both simulate eupneic as well as RTT-like breathing phenotypes. Using nullcline analysis, we identify the types of inhibitory inputs to the KF leading to RTT-like respiratory patterns and suggest possible KF local circuit organizations. When the identified properties are present, the two models also exhibit quantal acceleration of late-expiratory activity, a hallmark of active expiration featuring forced exhalation, with increasing inhibition to KF, as reported experimentally. Hence, these models instantiate plausible hypotheses about possible KF dynamics and forms of local network interactions, thus providing a general framework as well as specific predictions for future experimental testing. Key points The Kölliker-Fuse nucleus (KF), a part of the parabrachial complex, is involved in regulating normal breathing and controlling active abdominal expiration during increased ventilation. Dysfunction in KF neuronal activity is thought to contribute to respiratory abnormalities seen in Rett syndrome (RTT). This study utilizes computational modeling to explore different dynamical regimes of KF activity and their compatibility with experimental observations. By analyzing different model configurations, the study identifies inhibitory inputs to the KF that lead to RTT-like respiratory patterns and proposes potential KF local circuit organizations. Two models are presented that simulate both normal breathing and RTT-like breathing patterns. These models provide plausible hypotheses and specific predictions for future experimental investigations, offering a general framework for understanding KF dynamics and potential network interactions.
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John S, Hermes C. [We are THE team]. Med Klin Intensivmed Notfmed 2023; 118:331-332. [PMID: 37261478 DOI: 10.1007/s00063-023-01015-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2023] [Indexed: 06/02/2023]
Affiliation(s)
- S John
- Abteilung Internistische Intensivmedizin, Medizinische Klinik 8, Paracelsus Medizinische Privatuniversität Nürnberg (PMU Nürnberg) & Universität Erlangen-Nürnberg, Klinikum Nürnberg-Süd, 90473, Nürnberg, Deutschland.
| | - C Hermes
- Akkon Hochschule für Humanwissenschaften, Berlin, Deutschland
- Hochschule für Angewandte Wissenschaften Hamburg (HAW Hamburg), Hamburg, Deutschland
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Yang B, Mukherjee T, Radhakrishnan R, Paidipally P, Ansari D, John S, Vankayalapati R, Tripathi D, Yi G. HIV-Differentiated Metabolite N-Acetyl-L-Alanine Dysregulates Human Natural Killer Cell Responses to Mycobacterium tuberculosis Infection. Int J Mol Sci 2023; 24:ijms24087267. [PMID: 37108430 PMCID: PMC10138430 DOI: 10.3390/ijms24087267] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 04/09/2023] [Accepted: 04/12/2023] [Indexed: 04/29/2023] Open
Abstract
Mycobacterium tuberculosis (Mtb) has latently infected over two billion people worldwide (LTBI) and caused ~1.6 million deaths in 2021. Human immunodeficiency virus (HIV) co-infection with Mtb will affect the Mtb progression and increase the risk of developing active tuberculosis by 10-20 times compared with HIV- LTBI+ patients. It is crucial to understand how HIV can dysregulate immune responses in LTBI+ individuals. Plasma samples collected from healthy and HIV-infected individuals were investigated using liquid chromatography-mass spectrometry (LC-MS), and the metabolic data were analyzed using the online platform Metabo-Analyst. ELISA, surface and intracellular staining, flow cytometry, and quantitative reverse-transcription PCR (qRT-PCR) were performed using standard procedures to determine the surface markers, cytokines, and other signaling molecule expressions. Seahorse extra-cellular flux assays were used to measure mitochondrial oxidative phosphorylation and glycolysis. Six metabolites were significantly less abundant, and two were significantly higher in abundance in HIV+ individuals compared with healthy donors. One of the HIV-upregulated metabolites, N-acetyl-L-alanine (ALA), inhibits pro-inflammatory cytokine IFN-γ production by the NK cells of LTBI+ individuals. ALA inhibits the glycolysis of LTBI+ individuals' NK cells in response to Mtb. Our findings demonstrate that HIV infection enhances plasma ALA levels to inhibit NK-cell-mediated immune responses to Mtb infection, offering a new understanding of the HIV-Mtb interaction and providing insights into the implication of nutrition intervention and therapy for HIV-Mtb co-infected patients.
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Affiliation(s)
- Baojun Yang
- Department of Medicine, The University of Texas at Tyler School of Medicine, Tyler, TX 75708, USA
- Center for Biomedical Research, The University of Texas at Tyler School of Medicine, Tyler, TX 75708, USA
- Department of Cellular and Molecular Biology, The University of Texas Health Science Center at Tyler, Tyler, TX 75708, USA
| | - Tanmoy Mukherjee
- Center for Biomedical Research, The University of Texas at Tyler School of Medicine, Tyler, TX 75708, USA
- Department of Cellular and Molecular Biology, The University of Texas Health Science Center at Tyler, Tyler, TX 75708, USA
| | - Rajesh Radhakrishnan
- Center for Biomedical Research, The University of Texas at Tyler School of Medicine, Tyler, TX 75708, USA
- Department of Cellular and Molecular Biology, The University of Texas Health Science Center at Tyler, Tyler, TX 75708, USA
| | - Padmaja Paidipally
- Center for Biomedical Research, The University of Texas at Tyler School of Medicine, Tyler, TX 75708, USA
- Department of Cellular and Molecular Biology, The University of Texas Health Science Center at Tyler, Tyler, TX 75708, USA
| | - Danish Ansari
- Department of Medicine, The University of Texas at Tyler School of Medicine, Tyler, TX 75708, USA
- Center for Biomedical Research, The University of Texas at Tyler School of Medicine, Tyler, TX 75708, USA
- Department of Cellular and Molecular Biology, The University of Texas Health Science Center at Tyler, Tyler, TX 75708, USA
| | - Sahana John
- Department of Medicine, The University of Texas at Tyler School of Medicine, Tyler, TX 75708, USA
- Center for Biomedical Research, The University of Texas at Tyler School of Medicine, Tyler, TX 75708, USA
- Department of Cellular and Molecular Biology, The University of Texas Health Science Center at Tyler, Tyler, TX 75708, USA
| | - Ramakrishna Vankayalapati
- Center for Biomedical Research, The University of Texas at Tyler School of Medicine, Tyler, TX 75708, USA
- Department of Cellular and Molecular Biology, The University of Texas Health Science Center at Tyler, Tyler, TX 75708, USA
| | - Deepak Tripathi
- Center for Biomedical Research, The University of Texas at Tyler School of Medicine, Tyler, TX 75708, USA
- Department of Cellular and Molecular Biology, The University of Texas Health Science Center at Tyler, Tyler, TX 75708, USA
| | - Guohua Yi
- Department of Medicine, The University of Texas at Tyler School of Medicine, Tyler, TX 75708, USA
- Center for Biomedical Research, The University of Texas at Tyler School of Medicine, Tyler, TX 75708, USA
- Department of Cellular and Molecular Biology, The University of Texas Health Science Center at Tyler, Tyler, TX 75708, USA
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Mohan C, Entezami P, John S, Hewitt J, Sylevych V, Psirides A. Comparison of the Aotearoa New Zealand Early Warning Score and National Early Warning Score to predict adverse inpatient events in a vital sign dataset. Anaesthesia 2023. [PMID: 36991498 DOI: 10.1111/anae.16007] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2023] [Indexed: 03/31/2023]
Abstract
Aotearoa New Zealand uses a single early warning score (EWS) across all public and private hospitals to detect adult inpatient physiological deterioration. This combines the aggregate weighted scoring of the UK National Early Warning Score with single parameter activation from Australian medical emergency team systems. We conducted a retrospective analysis of a large vital sign dataset to validate the predictive performance of the New Zealand EWS in discriminating between patients at risk of serious adverse events and compared this with the UK EWS. We also compared predictive performance for patients admitted under medical vs. surgical specialties. A total of 1,738,787 aggregate scores (13,910,296 individual vital signs) were obtained from 102,394 hospital admissions to six hospitals within the Canterbury District Health Board of New Zealand's South Island. Predictive performance of each scoring system was determined using area under the receiver operating characteristic curve. Analysis showed that the New Zealand EWS is equivalent to the UK EWS in predicting patients at risk of serious adverse events (cardiac arrest, death and/or unanticipated ICU admission). Area under the receiver operating characteristic curve for both EWSs for any adverse outcome was 0.874 (95%CI 0.871-0.878) and 0.874 (95%CI 0.870-0.877), respectively. Both EWSs showed superior predictive value for cardiac arrest and/or death in patients admitted under surgical rather than medical specialties. Our study is the first validation of the New Zealand EWS in predicting serious adverse events in a broad dataset and supports previous work showing the UK EWS has superior predictive performance in surgical rather than medical patients.
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Affiliation(s)
- C Mohan
- Department of Neurosurgery, Christchurch Hospital, Christchurch, New Zealand
| | - P Entezami
- Department of Neurosurgery, Albany Medical Center, Albany, NY, USA
| | - S John
- Department of Neurosurgery, Christchurch Hospital, Christchurch, New Zealand
| | - J Hewitt
- Quality and Patient Safety, Christchurch Hospital, Christchurch, New Zealand
| | - V Sylevych
- Decision Support Unit, Christchurch Hospital, Christchurch, New Zealand
| | - A Psirides
- Department of Intensive Care, Wellington Regional Hospital, Wellington, New Zealand
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Yang B, Mukherjee T, Radhakrishnan R, Paidipally P, Ansari D, John S, Vankayalapati R, Tripathi D, Yi G. HIV-differentiated metabolite N-Acetyl-L-Alanine dysregulates human natural killer cell responses to Mycobacterium tuberculosis infection. bioRxiv 2023:2023.02.28.530445. [PMID: 36909560 PMCID: PMC10002710 DOI: 10.1101/2023.02.28.530445] [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] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
Background Mycobacterium tuberculosis ( Mtb ) has latently infected over two billion people worldwide (LTBI) and causes 1.8 million deaths each year. Human immunodeficiency virus (HIV) co-infection with Mtb will affect the Mtb progression and increase the risk of developing active tuberculosis by 10-20 times compared to the HIV-LTBI+ patients. It is crucial to understand how HIV can dysregulate immune responses in LTBI+ individuals. Methods Plasma samples collected from healthy and HIV-infected individuals were investigated by liquid chromatography-mass spectrometry (LC-MS), and the metabolic data were analyzed using an online platform Metabo-Analyst. ELISA, surface and intracellular staining, flow cytometry, quantitative reverse transcription PCR (qRT-PCR) were performed by standard procedure to determine the surface markers, cytokines and other signaling molecule expression. Seahorse extra cellular flux assays were used to measure the mitochondrial oxidative phosphorylation and glycolysis. Results Six metabolites were significantly less abundant, and two were significantly higher in abundance in HIV+ individuals compared to healthy donors. One of the HIV-upregulated metabolites, N-Acetyl-L-Alanine (ALA), inhibits pro-inflammatory cytokine IFN-□ production by NK cells of LTBI+ individuals. ALA inhibits glycolysis of LTBI+ individuals' NK cells in response to Mtb . Conclusions Our findings demonstrate that HIV infection enhances plasma ALA levels to inhibit NK cell-mediated immune responses to Mtb infection, offering a new understanding of the HIV- Mtb interaction and providing the implication of nutrition intervention and therapy for HIV- Mtb co-infected patients.
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Sy K, Briottet M, John S, Wade Z, Valsecchi I, Botterel F, Urbach V. Specialized pro-resolving lipid mediators protect epithelial barrier integrity of airway epithelial cells subject to a mechanical or fungal lesion. Rev Mal Respir 2023. [DOI: 10.1016/j.rmr.2022.11.061] [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: 02/18/2023]
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John S, Nelson D, Ponnambalam AM. A diagnostic conundrum: case of acute appendiceal abscess mimicking multisystem inflammatory syndrome in children in a toddler. Am J Med Sci 2023. [DOI: 10.1016/s0002-9629(23)00052-6] [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: 01/28/2023]
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Jose N, Varghese A, Thomas H, Irodi A, Paul J, Mathew M, Isiah R, John S, Godson H, Peace T, Pavamani S, Devadhas D, Sasidharan B. Can CBCT-Based Delta Radiomics Predict Normal Lung Toxicity during Thoracic Radiation? Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.934] [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]
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John S, Ewing R, Baud M, Divecha N, Skipp P. 74P Characterizing the beta-catenin interactome using inhibitor screens and novel interaction proteomics techniques. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.09.075] [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: 11/01/2022] Open
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Khetan M, Kalhan S, John S, Sethi D, Kannaujiya P, Ramana B. MIS retromuscular repair of lateral incisional hernia: technological deliberations and short-term outcome. Hernia 2022; 26:1325-1336. [DOI: 10.1007/s10029-022-02671-1] [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] [Received: 04/16/2022] [Accepted: 08/30/2022] [Indexed: 11/29/2022]
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Robinson E, John S, Singh P. P.115 Optimising obstetric care in high BMI patients: should we offer elective caesarean sections based on BMI? Int J Obstet Anesth 2022. [DOI: 10.1016/j.ijoa.2022.103411] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Saxena SN, Swarup Meena R, Vishal MK, John S, Kumar Sharma L, Mishra BK, Agarwal D. Variation in essential oil constituents of coriander (Coriandrum sativum L.) germplasm across coriander growing regions in India. Journal of Essential Oil Research 2022. [DOI: 10.1080/10412905.2022.2036644] [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] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- S. N. Saxena
- ICAR-National Research Centre on Seed Spices, Tabiji, Ajmer, India
| | - R. Swarup Meena
- ICAR-National Research Centre on Seed Spices, Tabiji, Ajmer, India
| | - M. K. Vishal
- ICAR-National Research Centre on Seed Spices, Tabiji, Ajmer, India
| | - S. John
- ICAR-National Research Centre on Seed Spices, Tabiji, Ajmer, India
| | - L. Kumar Sharma
- ICAR-National Research Centre on Seed Spices, Tabiji, Ajmer, India
| | - B. K. Mishra
- ICAR-National Research Centre on Seed Spices, Tabiji, Ajmer, India
| | - D. Agarwal
- ICAR-National Research Centre on Seed Spices, Tabiji, Ajmer, India
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John S, Orlowski K, Mrkor K, Edelmann-Nusser J, Witte K. Differences in Hip Muscle Strength and Static Balance in Patients with Transfemoral Amputations Classified at Different K-Levels: A Preliminary Cross-Sectional Study. Can Prosthet Orthot J 2022; 5:37456. [PMID: 37614483 PMCID: PMC10443478 DOI: 10.33137/cpoj.v5i1.37456] [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] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 01/05/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Following amputation, patients with lower limb amputations (LLA) are classified into different functional mobility levels (K-levels) ranging from K0 (lowest) to K4 (highest). However, K-level classification is often based on subjective criteria. Objective measures that are able to differentiate between K-levels can help to enhance the objectivity of K-level classification. OBJECTIVES The goal of this preliminary cross-sectional study was to investigate whether differences in hip muscle strength and balance parameters exist among patients with transfemoral amputations (TFA) assigned to different K-levels. METHODOLOGY Twenty-two participants with unilateral TFA were recruited for this study, with four participants assigned to K1 or K2, six assigned to K3 and twelve assigned to K4. Maximum isometric hip strength of the residual limb was assessed in hip flexion, abduction, extension, and adduction using a custom-made diagnostic device. Static balance was investigated in the bipedal stance on a force plate in eyes open (EO) and eyes closed (EC) conditions. Kruskal-Wallis tests were used to evaluate differences between K-level groups. FINDINGS Statistical analyses revealed no significant differences in the parameters between the three K-level groups (p>0.05). Descriptive analysis showed that all hip strength parameters differed among K-level groups showing an increase in maximum hip torque from K1/2-classified participants to those classified as K4. Group differences were also present in all balance parameters. Increased sway was observed in the K1/2 group compared to the K4 group, especially for the EC condition. CONCLUSION Although not statistically significant, the magnitude of the differences indicates a distinction between K-level groups. These results suggest that residual limb strength and balance parameters may have the potential to be used as objective measures to assist K-level assignment for patients with TFA. This potential needs to be confirmed in future studies with a larger number of participants.
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Affiliation(s)
- S John
- Department of Sports Science, Faculty of Humanities, Otto von Guericke University, Magdeburg, Germany
| | - K Orlowski
- Department of Computer Science and Media, Brandenburg University of Applied Sciences, Brandenburg an der Havel, Germany
| | - K.U. Mrkor
- Department of Computer Science and Media, Brandenburg University of Applied Sciences, Brandenburg an der Havel, Germany
| | - J Edelmann-Nusser
- Department of Sports Science, Faculty of Humanities, Otto von Guericke University, Magdeburg, Germany
| | - K Witte
- Department of Sports Science, Faculty of Humanities, Otto von Guericke University, Magdeburg, Germany
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Affiliation(s)
- S John
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada
| | - K S Joseph
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
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Render L, Truss A, Waddington H, John S, Henderson C, Aldaraggi A, Page O. 91 An audit of COVID-19 Awareness and Public Health Message Effectiveness in the Hospital Setting Over the Course of the Pandemic. Br J Surg 2021. [PMCID: PMC8135649 DOI: 10.1093/bjs/znab134.035] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Introduction An audit of healthcare workers investigated the effectiveness of Public Health England’s (PHE) information campaign across COVID’s timeline and assess knowledge between job roles. Method Data was collected across 3 cycles in 3 hospitals. A questionnaire assessed four domains: symptoms; spread; risk factors and the means to reduce transmission. PHE materials were shown before cycle 2 and respondents then subjected to the general campaign. Results 253 responses were collected. Symptom recognition was 84%, increasing to 88% post-intervention, longer-term recognition remained high at 81% - including the new symptom of anosmia. Identification of COVID’s means of transmission increased from 76% to 95% post intervention, risk factor recognition increased from 85% to 93% post-intervention. This fell to 74% later in the pandemic when recognised risk factors increased. Recognition of the new risk factors BAME status and BMI was 73% and 79% respectively in the final cycle. Doctors had the highest number of pre-intervention correct answers for 3 domains and nurses gave the most incorrect answers for 3 domains pre-intervention. Conclusions We have shown the PHE message is being transmitted effectively. We have also shown an increase in hospital workers recognition of aspects of COVIDs characteristics that have since been verified in the literature.
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Affiliation(s)
- L Render
- St Helens and Knowsley Teaching Hospitals NHS Trust, Liverpool, United Kingdom
| | - A Truss
- St Helens and Knowsley Teaching Hospitals NHS Trust, Liverpool, United Kingdom
| | - H Waddington
- St Helens and Knowsley Teaching Hospitals NHS Trust, Liverpool, United Kingdom
| | - S John
- St Helens and Knowsley Teaching Hospitals NHS Trust, Liverpool, United Kingdom
| | - C Henderson
- St Helens and Knowsley Teaching Hospitals NHS Trust, Liverpool, United Kingdom
| | - A Aldaraggi
- St Helens and Knowsley Teaching Hospitals NHS Trust, Liverpool, United Kingdom
| | - O Page
- St Helens and Knowsley Teaching Hospitals NHS Trust, Liverpool, United Kingdom
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John S, Ignatyeva Y, Greenberg B, Lin A, Wettersten N, Urey M, Kim P, Hong K, Tran H, Encisco JS, Pretorius V, Yagil A, Adler E. Machine Learning for Prognostication in Patients Undergoing LVAD Implantation. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.1220] [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: 10/21/2022] Open
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Hong K, Battikha C, Lin A, John S, Brambatti M, Garcia-Alvarez A, Garcia-Guereta L, Diez C, Perez-Gomez L, Garcia-Pavia P, Taylor M, Adler E. Cardiac Transplantation in Danon Disease. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.781] [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: 10/21/2022] Open
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John S, Kochanek M. [Immunocompromised patients in the intensive care unit]. Med Klin Intensivmed Notfmed 2021; 116:102-103. [PMID: 33666704 PMCID: PMC7934350 DOI: 10.1007/s00063-021-00787-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2021] [Indexed: 11/26/2022]
Affiliation(s)
- S John
- Abteilung Internistische Intensivmedizin, Medizinische Klinik 8, Paracelsus Medizinische Privatuniversität Nürnberg und Universität Erlangen-Nürnberg, Klinikum Nürnberg-Süd, Breslauer Str. 20, 90471, Nürnberg, Deutschland.
| | - M Kochanek
- Klinik I für Innere Medizin, Universitätsklinikum Köln, Kerpener Str. 62, 50937, Köln, Deutschland.
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20
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John S, Riessen R, Karagiannidis C, Janssens U, Busch HJ, Kochanek M, Michels G, Hermes C, Buerke M, Kluge S, Baumgärtel M, Braune S, Erbguth F, Fuhrmann V, Lebiedz P, Mayer K, Müller-Werdan U, Oppert M, Sayk F, Sedding D, Willam C, Werdan K. [Core curriculum Medical intensive care medicine of the German Society of Medical Intensive Care and Emergency Medicine (DGIIN)]. Med Klin Intensivmed Notfmed 2021; 116:1-45. [PMID: 33427907 PMCID: PMC7799161 DOI: 10.1007/s00063-020-00765-1] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2020] [Indexed: 11/25/2022]
Abstract
Medical intensive care medicine treats patients with severe, potentially life-threatening diseases covering the complete spectrum of internal medicine. The qualification in medical intensive care medicine requires a broad spectrum of knowledge and skills in medical intensive care medicine, but also in the general field of internal medicine. Both sides of the coin must be taken into account, the treatment with life-sustaining strategies of the acute illness of the patient and also the treatment of patient's underlying chronic diseases. The indispensable foundation of medical intensive care medicine as described in this curriculum includes basic knowledge and skills (level of competence I-III) as well as of behavior and attitudes. This curriculum is primarily dedicated to the internist in advanced training in medical intensive care medicine. However, this curriculum also intends to reach trainers in intensive care medicine and also the German physician chambers with their examiners, showing them which knowledge, skills as well as behavior and attitudes should be taught to trainees according to the education criteria of the German Society of Medical Intensive Care and Emergency Medicine (DGIIN).
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Affiliation(s)
- S John
- Klinikum Nürnberg-Süd, Medizinische Klinik 8, Abteilung für Internistische Intensivmedizin, Paracelsus Medizinische Privatuniversität, Nürnberg, Deutschland
| | - R Riessen
- Dept. für Innere Medizin, Internistische Intensivstation, Universitätsklinikum Tübingen, Tübingen, Deutschland
| | - C Karagiannidis
- ARDS und ECMO Zentrum Köln-Merheim, Professur für extrakorporale Lungenersatzverfahren der Universität Witten-Herdecke, Abteilung Pneumologie, Intensiv- und Beatmungsmedizin, Kliniken der Stadt Köln gGmbH, Köln, Deutschland
| | - U Janssens
- Klinik für Innere Medizin und Internistische Intensivmedizin, St.-Antonius-Hospital gGmbH, Akademisches Lehrkrankenhaus der RWTH Aachen, Eschweiler, Deutschland
| | - H-J Busch
- Universitäts-Notfallzentrum Freiburg, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - M Kochanek
- Klinik I für Innere Medizin (Hämatologie und Onkologie), Schwerpunkt Internistische Intensivmedizin, Universitätsklinikum Köln, Köln, Deutschland
| | - G Michels
- Klinik für Akut- und Notfallmedizin, St.-Antonius-Hospital gGmbH, Akademisches Lehrkrankenhaus der RWTH Aachen, Eschweiler, Deutschland
| | | | - M Buerke
- Medizinische Klinik II, St. Marien-Krankenhaus Siegen, Siegen, Deutschland
| | - S Kluge
- Klinik für Intensivmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - M Baumgärtel
- Klinikum Nürnberg-Nord, Intensivstation 10/II, Klinik für Innere Medizin 3, Schwerpunkt Pneumologie, Paracelsus Medizinische Privatuniversität, Nürnberg, Deutschland
| | - S Braune
- IV. Med. Klinik - Internistische Intensivmedizin und Notaufnahme, Franziskus-Hospital Münster, Münster, Deutschland
| | - F Erbguth
- Klinikum Nürnberg, Universitätsklinik für Neurologie, Paracelsus Medizinische Privatuniversität, Nürnberg, Deutschland
| | - V Fuhrmann
- Klinik für Innere Medizin I, Evangelisches Klinikum Niederrhein, Duisburg, Deutschland
| | - P Lebiedz
- Klinik für Innere Medizin und Internistische Intensivmedizin, Ev. Krankenhaus Oldenburg, Steinweg 13-17, Oldenburg, Deutschland
| | - K Mayer
- Medizinische Klinik 4, Pneumologie und Schlafmedizin, ViDia Kliniken, Karlsruhe, Deutschland
| | - U Müller-Werdan
- Klinik für Geriatrie und Altersmedizin, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
- Evangelisches Geriatriezentrum Berlin (EGZB), Berlin, Deutschland
| | - M Oppert
- Klinik für Notfall- und Intensivmedizin, Klinikum Ernst von Bergmann, Potsdam, Deutschland
| | - F Sayk
- Campus Lübeck, Medizinische Klinik I, Universitätsklinikum Schleswig-Holstein, Lübeck, Deutschland
| | - D Sedding
- Universitätsklinikum Halle (Saale), Klinik und Poliklinik für Innere Medizin III, Martin-Luther-Universität Halle-Wittenberg, Ernst-Grube-Straße 40, 06120, Halle (Saale), Deutschland
| | - C Willam
- Universitätsklinikum Erlangen, Medizinische Klinik 4, Nephrologie und Hypertensiologie, Friedrich-Alexander-Universität Erlangen, Erlangen, Deutschland
| | - K Werdan
- Universitätsklinikum Halle (Saale), Klinik und Poliklinik für Innere Medizin III, Martin-Luther-Universität Halle-Wittenberg, Ernst-Grube-Straße 40, 06120, Halle (Saale), Deutschland.
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21
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Brunkhorst FM, Weigand MA, Pletz M, Gastmeier P, Lemmen SW, Meier-Hellmann A, Ragaller M, Weyland A, Marx G, Bucher M, Gerlach H, Salzberger B, Grabein B, Welte T, Werdan K, Kluge S, Bone HG, Putensen C, Rossaint R, Quintel M, Spies C, Weiß B, John S, Oppert M, Jörres A, Brenner T, Elke G, Gründling M, Mayer K, Weimann A, Felbinger TW, Axer H, Heller T, Gagelmann N. [S3 guideline sepsis-prevention, diagnosis, treatment, and aftercare : Summary of the strong recommendations]. Med Klin Intensivmed Notfmed 2020; 115:178-188. [PMID: 32185422 DOI: 10.1007/s00063-020-00671-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- F M Brunkhorst
- Zentrum für Klinische Studien, Integriertes Forschungs- und Behandlungszentrum (IFB) Sepsis und Sepsisfolgen, Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinikum Jena, Salvador-Allende-Platz 27, 07747, Jena, Deutschland.
| | - M A Weigand
- Klinik für Anästhesiologie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - M Pletz
- Institut für Infektionsmedizin und Krankenhaushygiene, Universitätsklinikum Jena, Jena, Deutschland
| | - P Gastmeier
- Institut für Hygiene und Umweltmedizin, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - S W Lemmen
- Zentralbereich für Krankenhaushygiene und Infektiologie, Universitätsklinikum Aachen, Aachen, Deutschland
| | - A Meier-Hellmann
- Klinik für Anästhesie, Intensivmedizin und Schmerztherapie, Helios-Klinikum Erfurt GmbH, Erfurt, Deutschland
| | - M Ragaller
- Klinik und Poliklinik für Anästhesiologie und Intensivtherapie, Universitätsklinikum Dresden, Dresden, Deutschland
| | - A Weyland
- Klinik für Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie, Klinikum Oldenburg gGmbH, Oldenburg, Deutschland
| | - G Marx
- Klinik für Operative Intensivmedizin und Intermediate Care, Universitätsklinikum Aachen, Aachen, Deutschland
| | - M Bucher
- Klinik für Anästhesiologie und Operative Intensivmedizin, Universitätsklinikum Halle, Halle, Deutschland
| | - H Gerlach
- Klinik für Anästhesie, operative Intensivmedizin und Schmerztherapie, Vivantes Klinikum Neukölln, Berlin, Deutschland
| | - B Salzberger
- Abteilung für Krankenhaushygiene und Infektiologie, Universitätsklinikum Regensburg, Regensburg, Deutschland
| | - B Grabein
- Stabsstelle Klinische Mikrobiologie und Krankenhaushygiene, Klinikum der Universität München, München, Deutschland
| | - T Welte
- Klinik für Pneumologie, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - K Werdan
- Universitätsklinik und Poliklinik für Innere Medizin III, Klinikum der MLU Halle-Wittenberg, Halle, Deutschland
| | - S Kluge
- Klinik für Intensivmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - H G Bone
- Zentrum für Anästhesiologie, Intensivmedizin und Schmerztherapie, Knappschaftskrankenhaus Recklinghausen, Recklinghausen, Deutschland
| | - C Putensen
- Klinik für Anästhesiologie und Operative Intensivmedizin, Universitätsklinikum Bonn, Bonn, Deutschland
| | - R Rossaint
- Klinik für Anästhesiologie, Universitätsklinikum Aachen, Aachen, Deutschland
| | - M Quintel
- Klinik für Anästhesiologie, Universitätsmedizin Göttingen, Göttingen, Deutschland
| | - C Spies
- Klinik für Anästhesiologie mit Schwerpunkt operative Intensivmedizin, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - B Weiß
- Klinik für Anästhesiologie mit Schwerpunkt operative Intensivmedizin, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - S John
- Klinik für Innere Medizin 8, Schwerpunkt Kardiologie, Klinikum Nürnberg, Nürnberg, Deutschland
| | - M Oppert
- Klinik für Notfall- und Internistische Intensivmedizin, Klinikum Ernst von Bergmann Potsdam, Potsdam, Deutschland
| | - A Jörres
- Medizinische Klinik I, Klinik für Nephrologie, Transplantationsmedizin und internistische Intensivmedizin, Krankenhaus Merheim, Klinikum der Universität Witten/Herdecke, Köln, Deutschland
| | - T Brenner
- Klinik für Anästhesiologie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - G Elke
- Klinik für Anästhesiologie und Operative Intensivmedizin, Universitätsklinikum Kiel, Kiel, Deutschland
| | - M Gründling
- Klinik für Anästhesiologie - Anästhesie, Intensiv‑, Notfall- und Schmerzmedizin, Universitätsklinikum Greifswald, Greifswald, Deutschland
| | - K Mayer
- Medizinische Klinik und Poliklinik II, Klinikum der Justus-Liebig-Universität Gießen, Gießen, Deutschland
| | - A Weimann
- Klinik für Allgemein‑, Viszeral- und Onkologische Chirurgie, Klinikum "St. Georg" Leipzig gGmbH, Leipzig, Deutschland
| | - T W Felbinger
- Klinik für Anästhesiologie, operative Intensivmedizin und Schmerztherapie, Städtisches Klinikum München, München, Deutschland
| | - H Axer
- Klinik für Neurologie, Universitätsklinikum Jena, Jena, Deutschland
| | - T Heller
- Universitätsklinikum Jena, Jena, Deutschland
| | - N Gagelmann
- Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
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22
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Trifan G, Goldenberg FD, Caprio FZ, Biller J, Schneck M, Khaja A, Terna T, Brorson J, Lazaridis C, Bulwa Z, Alvarado Dyer R, Saleh Velez FG, Prabhakaran S, Liotta EM, Batra A, Reish NJ, Ruland S, Teitcher M, Taylor W, De la Pena P, Conners JJ, Grewal PK, Pinna P, Dafer RM, Osteraas ND, DaSilva I, Hall JP, John S, Shafi N, Miller K, Moustafa B, Vargas A, Gorelick PB, Testai FD. Characteristics of a Diverse Cohort of Stroke Patients with SARS-CoV-2 and Outcome by Sex. J Stroke Cerebrovasc Dis 2020; 29:105314. [PMID: 32951959 PMCID: PMC7486061 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105314] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 09/03/2020] [Accepted: 09/07/2020] [Indexed: 12/14/2022] Open
Abstract
COVID-19 disease is associated with stroke All strokes subtypes are seen in association with COVID-19, with ischemic stroke being most prevalent The most common etiology for ischemic stroke in SARS-CoV2 infection is cryptogenic Sex plays an important role in stroke outcomes in patients with COVID-19 disease Males have higher rates of ICU admission, in-hospital complications and more likely to have worse outcome at hospital discharge compare with females
Background and Purpose Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection is associated with stroke. The role of sex on stroke outcome has not been investigated. To objective of this paper is to describe the characteristics of a diverse cohort of acute stroke patients with COVID-19 disease and determine the role of sex on outcome. Methods This is a retrospective study of patients with acute stroke and SARS-CoV-2 infection admitted between March 15 to May 15, 2020 to one of the six participating comprehensive stroke centers. Baseline characteristics, stroke subtype, workup, treatment and outcome are presented as total number and percentage or median and interquartile range. Outcome at discharge was determined by the modified Rankin Scale Score (mRS). Variables and outcomes were compared for males and females using univariate and multivariate analysis. Results The study included 83 patients, 47% of which were Black, 28% Hispanics/Latinos, and 16% whites. Median age was 64 years. Approximately 89% had at least one preexisting vascular risk factor (VRF). The most common complications were respiratory failure (59%) and septic shock (34%). Compared with females, a higher proportion of males experienced severe SARS-CoV-2 symptoms requiring ICU hospitalization (73% vs. 49%; p = 0.04). When divided by stroke subtype, there were 77% ischemic, 19% intracerebral hemorrhage and 3% subarachnoid hemorrhage. The most common ischemic stroke etiologies were cryptogenic (39%) and cardioembolic (27%). Compared with females, males had higher mortality (38% vs. 13%; p = 0.02) and were less likely to be discharged home (12% vs. 33%; p = 0.04). After adjustment for age, race/ethnicity, and number of VRFs, mRS was higher in males than in females (OR = 1.47, 95% CI = 1.03–2.09). Conclusion In this cohort of SARS-CoV-2 stroke patients, most had clinical evidence of coronavirus infection on admission and preexisting VRFs. Severe in-hospital complications and worse outcomes after ischemic strokes were higher in males, than females.
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Affiliation(s)
- G Trifan
- Department of Neurology and Rehabilitation, University of Illinois at Chicago, Chicago, IL 60612, U.S.A..
| | - F D Goldenberg
- Department of Neurology, University of Chicago Hospital, Chicago, IL 60612, U.S.A..
| | - F Z Caprio
- Department of Neurology, Northwestern University, 633 Clark St, Evanston, IL 60208, U.S.A..
| | - J Biller
- Department of Neurology, Loyola University Health System, 2160 S 1st Ave, Maywood, IL 60153, U.S.A..
| | - M Schneck
- Department of Neurology, Loyola University Health System, 2160 S 1st Ave, Maywood, IL 60153, U.S.A..
| | - A Khaja
- AMITA Health - Alexian Brothers Hospital, 800 Biesterfield Rd, IL 60007, U.S.A..
| | - T Terna
- AMITA Health - Alexian Brothers Hospital, 800 Biesterfield Rd, IL 60007, U.S.A..
| | - J Brorson
- Department of Neurology, University of Chicago Hospital, Chicago, IL 60612, U.S.A
| | - C Lazaridis
- Department of Neurology, University of Chicago Hospital, Chicago, IL 60612, U.S.A..
| | - Z Bulwa
- Department of Neurology, University of Chicago Hospital, Chicago, IL 60612, U.S.A..
| | - R Alvarado Dyer
- Department of Neurology, University of Chicago Hospital, Chicago, IL 60612, U.S.A..
| | - F G Saleh Velez
- Department of Neurology, University of Chicago Hospital, Chicago, IL 60612, U.S.A..
| | - S Prabhakaran
- Department of Neurology, University of Chicago Hospital, Chicago, IL 60612, U.S.A..
| | - E M Liotta
- Department of Neurology, Northwestern University, 633 Clark St, Evanston, IL 60208, U.S.A..
| | - A Batra
- Department of Neurology, Northwestern University, 633 Clark St, Evanston, IL 60208, U.S.A..
| | - N J Reish
- Department of Neurology, Northwestern University, 633 Clark St, Evanston, IL 60208, U.S.A..
| | - S Ruland
- Department of Neurology, Loyola University Health System, 2160 S 1st Ave, Maywood, IL 60153, U.S.A..
| | - M Teitcher
- Department of Neurology, Loyola University Health System, 2160 S 1st Ave, Maywood, IL 60153, U.S.A..
| | - W Taylor
- Department of Neurology, Loyola University Health System, 2160 S 1st Ave, Maywood, IL 60153, U.S.A..
| | - P De la Pena
- Department of Neurology, Loyola University Health System, 2160 S 1st Ave, Maywood, IL 60153, U.S.A..
| | - J J Conners
- Department of Neurological Sciences, Rush University Medical Center, 1620 W Harrison St, Chicago, IL 60612, U.S.A..
| | - P K Grewal
- Department of Neurological Sciences, Rush University Medical Center, 1620 W Harrison St, Chicago, IL 60612, U.S.A..
| | - P Pinna
- Department of Neurological Sciences, Rush University Medical Center, 1620 W Harrison St, Chicago, IL 60612, U.S.A..
| | - R M Dafer
- Department of Neurological Sciences, Rush University Medical Center, 1620 W Harrison St, Chicago, IL 60612, U.S.A..
| | - N D Osteraas
- Department of Neurological Sciences, Rush University Medical Center, 1620 W Harrison St, Chicago, IL 60612, U.S.A..
| | - I DaSilva
- Department of Neurological Sciences, Rush University Medical Center, 1620 W Harrison St, Chicago, IL 60612, U.S.A..
| | - J P Hall
- Department of Neurological Sciences, Rush University Medical Center, 1620 W Harrison St, Chicago, IL 60612, U.S.A..
| | - S John
- Department of Neurological Sciences, Rush University Medical Center, 1620 W Harrison St, Chicago, IL 60612, U.S.A..
| | - N Shafi
- Department of Neurology and Rehabilitation, University of Illinois at Chicago, Chicago, IL 60612, U.S.A..
| | - K Miller
- Department of Neurology and Rehabilitation, University of Illinois at Chicago, Chicago, IL 60612, U.S.A..
| | - B Moustafa
- Department of Neurology and Rehabilitation, University of Illinois at Chicago, Chicago, IL 60612, U.S.A..
| | - A Vargas
- Department of Neurological Sciences, Rush University Medical Center, 1620 W Harrison St, Chicago, IL 60612, U.S.A..
| | - P B Gorelick
- Department of Neurology, Northwestern University, 633 Clark St, Evanston, IL 60208, U.S.A..
| | - F D Testai
- Department of Neurology and Rehabilitation, University of Illinois at Chicago, Chicago, IL 60612, U.S.A..
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Battisti N, Lee K, Nash T, Mappouridou S, Senthivel N, Asavisanu K, Obeid M, Tripodaki ES, Angelis V, Fleming E, Goode E, John S, Andres M, Allen M, Lyon A, Ring A. 222P Rates of cardiac adverse events in older versus younger adults receiving trastuzumab for HER2-positive early breast cancer: Results from 931 patients treated at The Royal Marsden. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.344] [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: 10/23/2022] Open
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24
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Gupte AN, Selvaraju S, Paradkar M, Danasekaran K, Shivakumar SVBY, Thiruvengadam K, Dolla C, Shivaramakrishnan G, Pradhan N, Kohli R, John S, Raskar S, Jain D, Momin A, Subramanian B, Gaikwad A, Lokhande R, Suryavanshi N, Gupte N, Salvi S, Murali L, Checkley W, Golub JE, Bollinger R, Chandrasekaran P, Mave V, Gupta A. Respiratory health status is associated with treatment outcomes in pulmonary tuberculosis. Int J Tuberc Lung Dis 2020; 23:450-457. [PMID: 31064624 DOI: 10.5588/ijtld.18.0551] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
<sec id="st1"> <title>BACKGROUND</title> The association between respiratory impairment and tuberculosis (TB) treatment outcomes is not clear. </sec> <sec id="st2"> <title>METHODS</title> We prospectively evaluated respiratory health status, measured using the Saint George's Respiratory Questionnaire (SGRQ), in a cohort of new adult pulmonary TB cases during and up to 18 months following treatment in India. Associations between total SGRQ scores and poor treatment outcomes of failure, recurrence and all-cause death were measured using multivariable Poisson regression. </sec> <sec id="st3"> <title>RESULTS</title> We enrolled 455 participants contributing 619 person-years at risk; 39 failed treatment, 23 had recurrence and 16 died. The median age was 38 years (interquartile range 26-49); 147 (32%) ever smoked. SGRQ scores at treatment initiation were predictive of death during treatment (14% higher risk per 4-point increase in baseline SGRQ scores, 95%CI 2-28, P = 0.01). Improvement in SGRQ scores during treatment was associated with a lower risk of failure (1% lower risk for every per cent improvement during treatment, 95%CI 1-2, P = 0.05). Clinically relevant worsening in SGRQ scores following successful treatment was associated with a higher risk of recurrence (15% higher risk per 4-point increase scores, 95%CI 4-27, P = 0.004). </sec> <sec id="st4"> <title>CONCLUSION</title> Impaired respiratory health status was associated with poor TB treatment outcomes. The SGRQ may be used to monitor treatment response and predict the risk of death in pulmonary TB. </sec>.
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Affiliation(s)
- A N Gupte
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - S Selvaraju
- National Institute for Research in Tuberculosis, Chennai
| | - M Paradkar
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune
| | - K Danasekaran
- National Institute for Research in Tuberculosis, Chennai
| | | | | | - C Dolla
- National Institute for Research in Tuberculosis, Chennai
| | | | - N Pradhan
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune
| | - R Kohli
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune
| | - S John
- National Institute for Research in Tuberculosis, Chennai
| | - S Raskar
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune
| | - D Jain
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune
| | - A Momin
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune
| | - B Subramanian
- National Institute for Research in Tuberculosis, Chennai
| | - A Gaikwad
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune
| | - R Lokhande
- Byramjee Jeejeebhoy Government Medical College and Sassoon General Hospitals, Pune
| | - N Suryavanshi
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune
| | - N Gupte
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - S Salvi
- Chest Research Foundation, Pune, India
| | - L Murali
- National Institute for Research in Tuberculosis, Chennai
| | - W Checkley
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - J E Golub
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - R Bollinger
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | - V Mave
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - A Gupta
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Gkekas I, Novotny J, Fabian P, Nemecek R, Palmqvist R, Strigård K, John S, Pecen L, Reginacova K, Gunnarsson U. Mismatch repair status predicts survival after adjuvant treatment in stage II colon cancer patients. J Surg Oncol 2020; 121:392-401. [PMID: 31828810 DOI: 10.1002/jso.25798] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 10/15/2019] [Accepted: 11/25/2019] [Indexed: 01/24/2023]
Abstract
BACKGROUND AND OBJECTIVES Stage II colon cancer is primarily a surgical disease. Only a still not well-defined subset of patients may benefit from postoperative adjuvant chemotherapy. The relationship between adjuvant chemotherapy and survival after relapse is furthermore still not definitely explored in this group of patients. A number of reports suggest some association between defective mismatch repair (dMMR) and colorectal cancer stage II prognosis, but due to contradictory results from existing studies, the exact predictive role is still not fully understood. METHODS Retrospective multicenter study including 451 stage II colon cancer patients. The proficiency or deficiency of mismatch repair was tested using immunohistochemistry and analyzed in relationship to two survival outcomes: overall survival (OS) and postrelapse survival. RESULTS Patients with dMMR (20.4%) derived no OS benefit from adjuvant chemotherapy (hazard ratio [HR], 1.05; 95% confidence interval [CI], 0.47-2.38; P = .897). Patients with proficient mismatch repair (pMMR) tumors receiving adjuvant chemotherapy had the significantly better OS in comparison to those not receiving chemotherapy (HR, 0.54; 95% CI, 0.35-0.82; P = .004). This relationship remained significant in multivariable analysis (HR, 0.42; 95% CI, 0.22-0.78; P = .007). Patients with pMMR relapsing after adjuvant treatment lived significantly longer than those relapsing without previous adjuvant treatment (HR, 0.55; 95% CI, 0.32-0.96; P = .033) and this result remained significant in the multivariable model (HR, 0.49; 95% CI, 0.26-0.93; P = .030). CONCLUSION In stage II CC patients, adjuvant chemotherapy improves therapeutic outcomes only in patients with pMMR tumors. Survival after relapse in patients having received adjuvant chemotherapy is significantly longer for patients with pMMR. No survival benefit from adjuvant chemotherapy was seen among patients with dMMR tumors.
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Affiliation(s)
- I Gkekas
- Department of Surgical and Perioperative Sciences, Umea University, Umea, Sweden
| | - J Novotny
- Department of Surgical and Perioperative Sciences, Umea University, Umea, Sweden
| | - P Fabian
- Department of Oncological Pathology, Masaryk Memorial Cancer Institute, Brno, Czech Republic
| | - R Nemecek
- Department of Comprehensive Cancer Care, Masaryk Memorial Cancer Institute, Brno, Czech Republic
| | - R Palmqvist
- Department of Medical Biosciences/Pathology, Umea University, Umea, Sweden
| | - K Strigård
- Department of Surgical and Perioperative Sciences, Umea University, Umea, Sweden
| | - S John
- Department of Medical Biology and Genetics, Faculty of Medicine Hradec Kralove, Charles University, Prague, Czech Republic
| | - L Pecen
- Faculty Hospital Pilsen, Charles University, Prague, Czech Republic
| | - K Reginacova
- Department of Radiotherapy and Oncology, University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - U Gunnarsson
- Department of Surgical and Perioperative Sciences, Umea University, Umea, Sweden
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Pareek V, Chandra M, Bhalavat R, Ambekar U, John S, Jain D, Iyer L. OC-085: Role of intervention-Patient reported sexual adjustment following brachytherapy for cervical cancer. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(20)30454-0] [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: 11/28/2022]
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Jozwiak BP, O'Sullivan A, Hussain S, John S, Navarro R, Zahra K, Kumar V, Samples S, Mifsud V. Cleveland clinic Abu Dhabi stroke registry (CCADSR) methodology. J Neurol Sci 2019. [DOI: 10.1016/j.jns.2019.10.604] [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: 10/25/2022]
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Jozwiak BP, Kumar V, Hussain S, John S, Navarro R, Zahra K, O'Sullivan A, Samples S, Mifsud V. Cleveland clinic Abu Dhabi stroke registry (CCADSR) young hemorrhagic strokes - Initial results. J Neurol Sci 2019. [DOI: 10.1016/j.jns.2019.10.600] [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: 12/01/2022]
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Jozwiak BP, Kumar V, Hussain S, John S, Navarro R, Zahra K, O'Sullivan A, Samples S, Mifsud V. Cleveland clinic Abu Dhabi stroke registry (CCADSR) young ischemic strokes - Initial results. J Neurol Sci 2019. [DOI: 10.1016/j.jns.2019.10.586] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Evans S, John S, Willis-Parker M, Loring D, Goldstein F. A-04 Evaluating Race-Related Differences in Performance of Two App-based Cognitive Tasks. Arch Clin Neuropsychol 2019. [DOI: 10.1093/arclin/acz034.04] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Objective
Increased participation of African Americans (AA) in Alzheimer’s disease (AD) clinical research is a national priority given their increased risk for developing AD. Removal of logistical barriers, such as time and travel costs, may increase AA participation. We developed two racially unbiased smartphone applications to assess cognition adapted from traditional tasks, the computerized Flanker test and paper-based Symbol Digit Modalities Test (SDMT). This study evaluated baseline performance and construct validity of the tasks in Non-Hispanic White (NHW) and AA participants.
Method
A sample of AA (n = 47) and NHW (n = 50) cognitively normal, middle-age and older adults (Mage = 60.73, SDage = 7.65) completed an in-clinic visit that included traditional assessments, as well as two app-based measures, Arrows and Number Match. Racial differences in group performance were evaluated with independent samples t-tests. Construct validity was assessed through inter-version correlations between traditional and app-based measures.
Results
There were no statistically significant differences between races on any metric of overall performance: Number Match (t(84) = 1.912, p = .06, 95% CI [-.130, 6.672]), Arrows average reaction time (RT) for incongruent trials (t(93) = -1.496, p = .14, 95% CI [-278.94, 39.27]), average RT for congruent trials (t(93) = -1.751, p = .083, 95% CI [-356.64, 22.44]), or average RT across all trials (t(93) = -1.691, p = .09, 95% CI [-298.21, 23.89]). The overall sample demonstrated small to moderate statistically significant inter-version correlations, from r = 0.39 to r = 0.55, ps < .01, with Number Match and SDMT showing a stronger association than Arrows and Flanker.
Conclusions
Preliminary data suggest no performance differences between races. Future research will evaluate the tasks’ ability to discriminate between clinical populations.
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John S, Silva M, Newman N, Loring D. AGR - 2 Diagnosis of Posterior Cortical Atrophy Through Inter-Departmental Collaboration. Arch Clin Neuropsychol 2019. [DOI: 10.1093/arclin/acz037.02] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Objective
We present a patient with rapidly progressive visual decline of 2-year duration that interfered with daily functioning. She was evaluated by neuro-ophthalmology and neurology prior to neuropsychological referral. A series of evaluations led to diagnosis of posterior cortical atrophy, demonstrating the importance of inter-departmental collaboration.
Method
A 66-year old white female presented with a 2-year history of progressive changes to vision and memory. Medical history included hypertension, dyslipidemia, and a strong family history of optic neuropathy causing blindness. She was diagnosed with a left homonymous hemianopia. MRI revealed "significant cortical atrophy more remarkable on the right temporal, parietal, and occipital regions." She reported dressing apraxia, unsteady gait, declines in reading and writing, and difficulty recalling well-learned information.
Results
She was a good historian, had fluent speech and no apparent comprehension difficulty. Neuropsychological evaluation revealed relatively preserved language and verbal abilities, including confrontation naming, in the presence of otherwise impaired performances across all domains of functioning. She demonstrated agraphia, acalculia, left-right confusion, and difficulties with motor programming. Perceptual and constructional tasks revealed prominent deficits in visual integration, map orientation, form discrimination, and construction of simple geometric designs. She was perseverative and susceptible to verbal and visual stimulus pull.
Conclusions
The pattern on neuropsychological testing, with prominent visual spatial and perceptual difficulties, was consistent with posterior cortical atrophy. The decline in visual ability is likely exacerbated but not entirely explained by left hemianopia. Neuropsychological, neuroimaging, and visual field evidence demonstrated posterior cortical atrophy in the absence of positive biomarker evidence, leading to initiation of anti-cholinesterase therapy.
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Petros S, John S. [Ten key messages of the guidelines for family-centered care in intensive care medicine]. Med Klin Intensivmed Notfmed 2019; 114:56-58. [PMID: 30203212 DOI: 10.1007/s00063-018-0481-3] [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] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
The family plays an important role in the care of the critically ill patient. There is a substantial psychological burden to family members during the intensive care management of the patient. The family has to bear the pitiable state of the patient with the feeling of helplessness. The critically ill patient is frequently unable to actively decide on the processes of intensive care. Therefore, the family has to take over the responsibility of representing the values and wishes of the patient and become involved in decision making, for which most family members are not prepared. A considerable proportion of family members suffers from stress, anxiety and depression. This psychological burden also continues after the conclusion of the intensive care management. Therefore, structured approaches are needed to support family members of critically ill patients during the intensive care management. In this short review, we present the ten key messages of the recent guidelines for family-centered care in the intensive care unit by the Society of Critical Care Medicine.
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Affiliation(s)
- S Petros
- Interdisziplinäre Internistische Intensivmedizin, Zentrum für Hämostaseologie, Universitätsklinikum Leipzig AöR, Liebigstr. 20, 04103, Leipzig, Deutschland.
| | - S John
- Medizinische Klinik 4, Intensivmedizin, Universität Erlangen-Nürnberg, Klinikum Nürnberg-Süd, Breslauer Str.201, 90471, Nürnberg, Deutschland
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Kumari D, John S. Health risk assessment of pesticide residues in fruits and vegetables from farms and markets of Western Indian Himalayan region. Chemosphere 2019; 224:162-167. [PMID: 30822723 DOI: 10.1016/j.chemosphere.2019.02.091] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 01/11/2019] [Accepted: 02/14/2019] [Indexed: 05/19/2023]
Abstract
The extensive use of pesticides in agriculture has become a very common practice in developing countries like India. Consequently, the increased concentration of residues of these hazardous pesticides in fruits and vegetables is manifested. The study aimed to assess the health hazards associated with the presence of pesticide residues in fruits and vegetables sampled from farms and markets of Kinnaur district of Himachal Pradesh (India). Residues of predominant pesticides used in the region, belonging to the group of organophosphates, pyrethroid and phthalimide, were analysed using gas chromatograph quadrupole mass spectrometer (GC-MS/MS). The pesticide extraction from the matrix was done following the modified QuEChERS method. Results indicated varying concentrations of pesticide residue in market and farm samples with farm samples more contaminated than market samples. Chronic health hazards prediction indicated that organophosphorus groups (methyl parathion and triazophos) posed health risk to children in the study area.
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Affiliation(s)
- D Kumari
- Civil Engineering Department, Punjab Engineering College, Chandigarh, India
| | - S John
- Civil Engineering Department, Punjab Engineering College, Chandigarh, India.
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Abstract
Sepsis is still associated with very high morbidity and mortality. Continuous improvements in the early recognition and management of this syndrome are thus necessary. The 2016 Surviving Sepsis Campaign sepsis guideline presents current evidence and consequences in the management of sepsis. This new guideline came at the beginning of the paradigm shift in sepsis definition, whereby the influence of the current sepsis definition on the management of sepsis is yet to be seen. Despite tremendous research efforts, several recommendations in the new sepsis guideline have a weak to moderate evidence grade. Several issues, such as the effect of the Sepsis-3 definition on the early recognition of sepsis, the selection of appropriate fluid and antibiotic therapy, as well as individualizing sepsis management are yet to be addressed. Therefore, the current guideline is also a call for the intensive care community for more and better research on sepsis treatment.
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Affiliation(s)
- S Petros
- Interdisziplinäre Internistische Intensivmedizin, Zentrum für Hämostaseologie, Universitätsklinikum Leipzig, Liebigstr. 20, 04103, Leipzig, Deutschland.
| | - S John
- Medizinische Klinik 4, Intensivmedizin, Universität Erlangen-Nürnberg, Klinikum Nürnberg-Süd, Nürnberg, Deutschland
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Janssens U, Michels G, Karagiannidis C, Riessen R, Busch HJ, Welte T, Werdan K, Buerke M, John S, Kluge S. [Presumed consent for organ donation? : A survey among members of the German Society of Medical Intensive Care and Emergency Medicine]. Med Klin Intensivmed Notfmed 2019; 115:239-244. [PMID: 30969352 DOI: 10.1007/s00063-019-0579-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 02/26/2019] [Accepted: 03/01/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND Since 2010, the number of organ donations has decreased by 30% in Germany; however, stricter organizational structures in clinics and improved payment for hospital services associated with organ removal should increase the current decline in the number of organ donations in Germany. In addition, the Federal Minister of Health proposed introduction of the double presumed consent solution for organ donation. This proposal is currently being discussed very controversially. Against this background, we conducted an online survey of all members of the German Society of Medical Intensive Care and Emergency Medicine (DGIIN) in order to evaluate the attitude towards organ donation. METHOD The present work is an anonymous online survey among the members of DGIIN, which took place from 10-23 September 2018. In addition to a few demographic queries, the personal opinion on the regulation of organ donation was collected. RESULTS A total of 1019 (51.9%) of 1964 invited DGIIN members took part at the survey: 79.3% of the participants were male; average age 47.5 ± 11.2 years; 97.7% were physicians, of whom 89.2% were specialists and 62.7% had the additional degree in critical care; 20.6% voted for the current decision-making solution, 43.1% for the presumed consent, 33.1% for the double presumed consent, whereas 3.2% of the respondents were uncertain in their decision. CONCLUSION A clear majority of the surveyed members of DGIIN support the concept of presumed consent.
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Affiliation(s)
- U Janssens
- Klinik für Innere Medizin, St.-Antonius Hospital, Dechant-Deckers-Str. 8, 52249, Eschweiler, Deutschland.
| | - G Michels
- Klinik III für Innere Medizin, Universitätsklinikum Köln, Köln, Deutschland
| | - C Karagiannidis
- Lungenklinik Köln-Merheim, Kliniken der Stadt Köln, Klinikum der Universität Witten/Herdecke, Köln, Deutschland
| | - R Riessen
- Internistische Intensivstation, Universitätsklinikum Tübingen, Tübingen, Deutschland
| | - H-J Busch
- Universitäts-Notfallzentrum, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - T Welte
- Klinik für Pneumologie, Medizinische Hochschule Hannover, Hannover, Deutschland
- Deutsches Zentrum für Lungenforschung (DZL), Gießen, Deutschland
| | - K Werdan
- Klinik und Poliklinik für Innere Medizin III, Universitätsklinikum Halle (Saale), Martin-Luther-Universität Halle-Wittenberg, Halle, Deutschland
| | - M Buerke
- Klinik für Kardiologie, Angiologie und internistische Intensivmedizin, Marien Kliniken, Siegen, Deutschland
| | - S John
- Klinik für Innere Medizin, Universitätsklinik, Paracelsus Medizinische Privatuniversität Nürnberg, Nürnberg, Deutschland
| | - S Kluge
- Klinik für Intensivmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
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Das A, Sharmeen F, John S. Comparison of cardiotoxicity among left sided breast cancer patient treated with either hypofractionated or conventional fractionated radiotherapy: a single center experience. Breast 2019. [DOI: 10.1016/s0960-9776(19)30304-2] [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] Open
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Kluge S, John S. [Organ donation-a German "emergency"]. Med Klin Intensivmed Notfmed 2019; 114:98-99. [PMID: 30635684 DOI: 10.1007/s00063-018-0526-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- S Kluge
- Klinik für Intensivmedizin, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland.
| | - S John
- Abteilung Internistische Intensivmedizin, Medizinische Klinik 8, Paracelsus Medizinische Privatuniversität Nürnberg & Universität Erlangen-Nürnberg, Klinikum Nürnberg-Süd, 90473, Nürnberg, Deutschland.
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John S, Bhat A, Gan G, Tan T. Prospective Comparison of Semi-Automated 2-Dimensional Global Longitudinal Strain Measurements using three Different Software Programs in a Busy Clinical Setting. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.308] [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: 10/26/2022]
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John S, Jose R, Dhanuja V, Haran J, Augustine P. Prevalence of Known Risk Factors of Breast Cancer and Breast Cancer Screening Practices Among Women in Thiruvananthapuram, Kerala, India. J Glob Oncol 2018. [DOI: 10.1200/jgo.18.48200] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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
Background: Breast cancer rates are rising both in the developed and the developing world, probably due to increase in life expectancy, increasing urbanization and adoption of western lifestyles. Incidence of breast cancer is reported to be increasing in India and it has become the most common cancer among women. Kerala and its capital city Thiruvananthapuram are also following the same pattern. Early detection and treatment of breast cancer is highly beneficial as it leads to increased survival rates and better quality of life to the patient. By identifying the risk factors and through regular and proper screening practices, we can detect the high risk population for this disease and contribute to its prevention and early treatment. Aim: 1. To study the prevalence of known risk factors of breast cancer among women aged 20 years and above in Thiruvananthapuram, Kerala, India. 2. To describe the breast cancer screening practices prevalent in the study population and to find out the proportion of high risk individuals using breast cancer risk calculator. Methods: A community based cross sectional survey was conducted among 2000 women hailing from Thiruvananthapuram. General population was invited through mass media to attend breast cancer screening camps. 2000 women aged more than 20 years who attended the camps and gave informed consent were included in the study. Data were collected from 40 participants each from 50 camps out of a total of 150 screening camps. A semi structured pro forma was used to collect the data regarding the sociodemographic profile, the various known risk factors of breast cancer according to research literature and breast cancer screening methods undergone. Descriptive statistics was done using SPSS version 16. Results are expressed in proportions with 95% confidence interval, wherever appropriate. Results: The mean age of the study population was 45.67 years. Majority of the women 82.5% had never undergone any sort of breast cancer screening. Clinical breast examination alone was undergone by 9.8%. Breast cancer risk calculator showed that 65% of the women screened had normal risk, 22.2% had moderate risk and 12.9% had high risk. Conclusion: Increased prevalence of major known risk factors of breast cancer like positive family history, low breast feeding duration, late age at menopause, are found. Also the prevalence of modifiable risk factors like obesity and low physical activity are high. Majority of the study participants have never undergone any breast cancer screening. Breast cancer risk calculator showed a fairly high prevalence of study participants in high risk and moderate risk category and therefore women need to be motivated to undergo regular screening.
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Affiliation(s)
- S. John
- Sree Gokulam Medical College and Research Foundation, Community Medicine, Thiruvananthapuram, India
| | - R. Jose
- Sree Gokulam Medical College and Research Foundation, Community Medicine, Thiruvananthapuram, India
| | - V.A. Dhanuja
- Sree Gokulam Medical College and Research Foundation, Community Medicine, Thiruvananthapuram, India
| | - J.C. Haran
- Sree Gokulam Medical College and Research Foundation, Community Medicine, Thiruvananthapuram, India
| | - P. Augustine
- Regional Cancer Centre, Surgical Oncology, Thiruvananthapuram, India
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Jose R, Augustine P, . Bindhu S A, Sebasitan SR, VA D, John S, Haran J. Clinical Breast Examination Campaign: Experience From Thiruvananthapuram, South India. J Glob Oncol 2018. [DOI: 10.1200/jgo.18.47900] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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
Background and context: Thiruvananthapuram has the highest breast cancer incidence in India and majority of cases are detected late pointing to the inefficiency of early detection programs. Primary health care providers do not advise regarding regular screening and most women never resort to any screening practices. Mammogram is not cost-effective and clinical breast examination (CBE) is not popular as a screening modality in our population. Aim: To describe the conduct, utilization and outcome of mass screening program conducted in Thiruvananthapuram. Strategy: A mass screening program with media publicity to motivate organizations and residential associations was planned. CBE was conducted by one of the five lady doctors who were trained by an expert breast surgeon at a tertiary care center to detect suspicious lumps. All suspicious cases referred to experts who would further evaluate the cases at a clinic outside the tertiary care center. Advocacy and expert service at accessible sites and availability of expert service outside the tertiary care center at convenient timings improved the acceptance of screening. Intersectoral coordination, community participation, accessible expert services and appropriate technology were followed. Program/Policy process: 9942 women had CBE along with breast awareness in 101 camps over 66 days and it was probably “the first ever marathon breast cancer screening campaign” in the world. Sociodemographic variables, details regarding previous screening, breast symptoms and known risk factors were collected. Anyone with suspicious findings was referred to experts. Outcomes: 868 (8.73%) women with suspicious findings were referred to experts who advised 258 mammograms and confirmed breast cancer in 16 women (1.61 per 1000 women). Mean age was 45.46 years. 82.5% had screening for the first time. Uniformity in examination, three levels of screening and minimum utilization of diagnostic procedures makes this campaign distinct from others. All participants are kept on follow-up through a free clinic maintained by a nonprofit NGO in Thiruvananthapuram. Effective planning and selfless service along with coordinated effort of an apex institution (Regional Cancer Centre, Thiruvananthapuram), a private medical college (Sree Gokulam Medical College, Thiruvananthapuram) and media partners were the key to success. What was learned: Early detection of breast cancer is possible by CBE, provided women can be motivated for regular screening and adequate expertise is available. CBE campaigns can improve screening behavior and breast awareness among women. Primary health care providers and mass media could educate women regarding the benefits of breast awareness and motivate them for regular screening. Proper referral system including certified intermediate referral centers should be in place to ensure the success of early detection by CBE.
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Affiliation(s)
- R. Jose
- Snehita Women's Health Foundation, Thiruvananthapuram, India
- Sree Gokulam Medical College and Research Foundation, Community Medicine, Thiruvananthapuram, India
| | - P. Augustine
- Regional Cancer Centre, Surgical Oncology, Thiruvananthapuram, India
| | - A . Bindhu S
- Sree Gokulam Medical College and Research Foundation, Community Medicine, Thiruvananthapuram, India
| | - S. Rose Sebasitan
- Sree Gokulam Medical College and Research Foundation, Community Medicine, Thiruvananthapuram, India
| | - D. VA
- Sree Gokulam Medical College and Research Foundation, Community Medicine, Thiruvananthapuram, India
| | - S. John
- Sree Gokulam Medical College and Research Foundation, Community Medicine, Thiruvananthapuram, India
| | - J.C. Haran
- Sree Gokulam Medical College and Research Foundation, Community Medicine, Thiruvananthapuram, India
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Román LS, Menon BK, Blasco J, Hernández-Pérez M, Dávalos A, Majoie CBLM, Campbell BCV, Guillemin F, Lingsma H, Anxionnat R, Epstein J, Saver JL, Marquering H, Wong JH, Lopes D, Reimann G, Desal H, Dippel DWJ, Coutts S, du Mesnil de Rochemont R, Yavagal D, Ferre JC, Roos YBWEM, Liebeskind DS, Lenthall R, Molina C, Al Ajlan FS, Reddy V, Dowlatshahi D, Sourour NA, Oppenheim C, Mitha AP, Davis SM, Weimar C, van Oostenbrugge RJ, Cobo E, Kleinig TJ, Donnan GA, van der Lugt A, Demchuk AM, Berkhemer OA, Boers AMM, Ford GA, Muir KW, Brown BS, Jovin T, van Zwam WH, Mitchell PJ, Hill MD, White P, Bracard S, Goyal M, Berkhemer OA, Fransen PSS, Beumer D, van den Berg LA, Lingsma HF, Yoo AJ, Schonewille WJ, Vos JA, Nederkoorn PJ, Wermer MJH, van Walderveen MAA, Staals J, Hofmeijer J, van Oostayen JA, Lycklama à Nijeholt GJ, Boiten J, Brouwer PA, Emmer BJ, de Bruijn SF, van Dijk LC, Kappelle J, Lo RH, van Dijk EJ, de Vries J, de Kort PL, van Rooij WJJ, van den Berg JS, van Hasselt BA, Aerden LA, 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VA, Lanthier S, Odier C, Durocher A, Raymond J, Weill A, Daneault N, Deschaintre Y, Jankowitz B, Baxendell L, Massaro L, Jackson-Graves C, Decesare S, Porter P, Armbruster K, Adams A, Billigan J, Oakley J, Ducruet A, Jadhav A, Giurgiutiu DV, Aghaebrahim A, Reddy V, Hammer M, Starr M, Totoraitis V, Wechsler L, Streib S, Rangaraju S, Campbell D, Rocha M, Gulati D, Silver FL, Krings T, Kalman L, Cayley A, Williams J, Stewart T, Wiegner R, Casaubon LK, Jaigobin C, del Campo JM, Elamin E, Schaafsma JD, Willinsky RA, Agid R, Farb R, ter Brugge K, Sapkoda BL, Baxter BW, Barton K, Knox A, Porter A, Sirelkhatim A, Devlin T, Dellinger C, Pitiyanuvath N, Patterson J, Nichols J, Quarfordt S, Calvert J, Hawk H, Fanale C, Frei DF, Bitner A, Novak A, Huddle D, Bellon R, Loy D, Wagner J, Chang I, Lampe E, Spencer B, Pratt R, Bartt R, Shine S, Dooley G, Nguyen T, Whaley M, McCarthy K, Teitelbaum J, Tampieri D, Poon W, Campbell N, Cortes M, Dowlatshahi D, Lum C, Shamloul R, Robert S, Stotts G, Shamy M, Steffenhagen N, Blacquiere D, Hogan M, AlHazzaa M, Basir G, Lesiuk H, Iancu D, Santos M, Choe H, Weisman DC, Jonczak K, Blue-Schaller A, Shah Q, MacKenzie L, Klein B, Kulandaivel K, Kozak O, Gzesh DJ, Harris LJ, Khoury JS, Mandzia J, Pelz D, Crann S, Fleming L, Hesser K, Beauchamp B, Amato-Marzialli B, Boulton M, Lopez-Ojeda P, Sharma M, Lownie S, Chan R, Swartz R, Howard P, Golob D, Gladstone D, Boyle K, Boulos M, Hopyan J, Yang V, Da Costa L, Holmstedt CA, Turk AS, Navarro R, Jauch E, Ozark S, Turner R, Phillips S, Shankar J, Jarrett J, Gubitz G, Maloney W, Vandorpe R, Schmidt M, Heidenreich J, Hunter G, Kelly M, Whelan R, Peeling L, Burns PA, Hunter A, Wiggam I, Kerr E, Watt M, Fulton A, Gordon P, Rennie I, Flynn P, Smyth G, O'Leary S, Gentile N, Linares G, McNelis P, Erkmen K, Katz P, Azizi A, Weaver M, Jungreis C, Faro S, Shah P, Reimer H, Kalugdan V, Saposnik G, Bharatha A, Li Y, Kostyrko P, Santos M, Marotta T, Montanera W, Sarma D, Selchen D, Spears J, Heo JH, Jeong K, Kim DJ, Kim BM, Kim YD, Song D, Lee KJ, Yoo J, Bang OY, Rho S, Lee J, Jeon P, Kim KH, Cha J, Kim SJ, Ryoo S, Lee MJ, Sohn SI, Kim CH, Ryu HG, Hong JH, Chang HW, Lee CY, Rha J, Davis SM, Donnan GA, Campbell BCV, Mitchell PJ, Churilov L, Yan B, Dowling R, Yassi N, Oxley TJ, Wu TY, Silver G, McDonald A, McCoy R, Kleinig TJ, Scroop R, Dewey HM, Simpson M, Brooks M, Coulton B, Krause M, Harrington TJ, Steinfort B, Faulder K, Priglinger M, Day S, Phan T, Chong W, Holt M, Chandra RV, Ma H, Young D, Wong K, Wijeratne T, Tu H, Mackay E, Celestino S, Bladin CF, Loh PS, Gilligan A, Ross Z, Coote S, Frost T, Parsons MW, Miteff F, Levi CR, Ang T, Spratt N, Kaauwai L, Badve M, Rice H, de Villiers L, Barber PA, McGuinness B, Hope A, Moriarty M, Bennett P, Wong A, Coulthard A, Lee A, Jannes J, Field D, Sharma G, Salinas S, Cowley E, Snow B, Kolbe J, Stark R, King J, Macdonnell R, Attia J, D'Este C, Saver JL, Goyal M, Diener HC, Levy EI, Bonafé A, Mendes Pereira V, Jahan R, Albers GW, Cognard C, Cohen DJ, Hacke W, Jansen O, Jovin TG, Mattle HP, Nogueira RG, Siddiqui AH, Yavagal DR, von Kummer R, Smith W, Turjman F, Hamilton S, Chiacchierini R, Amar A, Sanossian N, Loh Y, Devlin T, Baxter B, Hawk H, Sapkota B, Quarfordt S, Sirelkhatim A, Dellinger C, Barton K, Reddy VK, Ducruet A, Jadhav A, Horev A, Giurgiutiu DV, Totoraitis V, Hammer M, Jankowitz B, Wechsler L, Rocha M, Gulati D, Campbell D, Star M, Baxendell L, Oakley J, Siddiqui A, Hopkins LN, Snyder K, Sawyer R, Hall S, Costalat V, Riquelme C, Machi P, Omer E, Arquizan C, Mourand I, Charif M, Ayrignac X, Menjot de Champfleur N, Leboucq N, Gascou G, Moynier M, du Mesnil de Rochemont R, Singer O, Berkefeld J, Foerch C, Lorenz M, Pfeilschifer W, Hattingen E, Wagner M, You SJ, Lescher S, Braun H, Dehkharghani S, Belagaje SR, Anderson A, Lima A, Obideen M, Haussen D, Dharia R, Frankel M, Patel V, Owada K, Saad A, Amerson L, Horn C, Doppelheuer S, Schindler K, Lopes DK, Chen M, Moftakhar R, Anton C, Smreczak M, Carpenter JS, Boo S, Rai A, Roberts T, Tarabishy A, Gutmann L, Brooks C, Brick J, Domico J, Reimann G, Hinrichs K, Becker M, Heiss E, Selle C, Witteler A, Al-Boutros S, Danch MJ, Ranft A, Rohde S, Burg K, Weimar C, Zegarac V, Hartmann C, Schlamann M, Göricke S, Ringlestein A, Wanke I, Mönninghoff C, Dietzold M, Budzik R, Davis T, Eubank G, Hicks WJ, Pema P, Vora N, Mejilla J, Taylor M, Clark W, Rontal A, Fields J, Peterson B, Nesbit G, Lutsep H, Bozorgchami H, Priest R, Ologuntoye O, Barnwell S, Dogan A, Herrick K, Takahasi C, Beadell N, Brown B, Jamieson S, Hussain MS, Russman A, Hui F, Wisco D, Uchino K, Khawaja Z, Katzan I, Toth G, Cheng-Ching E, Bain M, Man S, Farrag A, George P, John S, Shankar L, Drofa A, Dahlgren R, Bauer A, Itreat A, Taqui A, Cerejo R, Richmond A, Ringleb P, Bendszus M, Möhlenbruch M, Reiff T, Amiri H, Purrucker J, Herweh C, Pham M, Menn O, Ludwig I, Acosta I, Villar C, Morgan W, Sombutmai C, Hellinger F, Allen E, Bellew M, Gandhi R, Bonwit E, Aly J, Ecker RD, Seder D, Morris J, Skaletsky M, Belden J, Baker C, Connolly LS, Papanagiotou P, Roth C, Kastrup A, Politi M, Brunner F, Alexandrou M, Merdivan H, Ramsey C, Given II C, Renfrow S, Deshmukh V, Sasadeusz K, Vincent F, Thiesing JT, Putnam J, Bhatt A, Kansara A, Caceves D, Lowenkopf T, Yanase L, Zurasky J, Dancer S, Freeman B, Scheibe-Mirek T, Robison J, Rontal A, Roll J, Clark D, Rodriguez M, Fitzsimmons BFM, Zaidat O, Lynch JR, Lazzaro M, Larson T, Padmore L, Das E, Farrow-Schmidt A, Hassan A, Tekle W, Cate C, Jansen O, Cnyrim C, Wodarg F, Wiese C, Binder A, Riedel C, Rohr A, Lang N, Laufs H, Krieter S, Remonda L, Diepers M, Añon J, Nedeltchev K, Kahles T, Biethahn S, Lindner M, Chang V, Gächter C, Esperon C, Guglielmetti M, Arenillas Lara JF, Martínez Galdámez M, Calleja Sanz AI, Cortijo Garcia E, Garcia Bermejo P, Perez S, Mulero Carrillo P, Crespo Vallejo E, Ruiz Piñero M, Lopez Mesonero L, Reyes Muñoz FJ, Brekenfeld C, Buhk JH, Krützelmann A, Thomalla G, Cheng B, Beck C, Hoppe J, Goebell E, Holst B, Grzyska U, Wortmann G, Starkman S, Duckwiler G, Jahan R, Rao N, Sheth S, Ng K, Noorian A, Szeder V, Nour M, McManus M, Huang J, Tarpley J, Tateshima S, Gonzalez N, Ali L, Liebeskind D, Hinman J, Calderon-Arnulphi M, Liang C, Guzy J, Koch S, DeSousa K, Gordon-Perue G, Haussen D, Elhammady M, Peterson E, Pandey V, Dharmadhikari S, Khandelwal P, Malik A, Pafford R, Gonzalez P, Ramdas K, Andersen G, Damgaard D, Von Weitzel-Mudersbach P, Simonsen C, Ruiz de Morales Ayudarte N, Poulsen M, Sørensen L, Karabegovich S, Hjørringgaard M, Hjort N, Harbo T, Sørensen K, Deshaies E, Padalino D, Swarnkar A, Latorre JG, Elnour E, El-Zammar Z, Villwock M, Farid H, Balgude A, Cross L, Hansen K, Holtmannspötter M, Kondziella D, Hoejgaard J, Taudorf S, Soendergaard H, Wagner A, Cronquist M, Stavngaard T, Cortsen M, Krarup LH, Hyldal T, Haring HP, Guggenberger S, Hamberger M, Trenkler J, Sonnberger M, Nussbaumer K, Dominger C, Bach E, Jagadeesan BD, Taylor R, Kim J, Shea K, Tummala R, Zacharatos H, Sandhu D, Ezzeddine M, Grande A, Hildebrandt D, Miller K, Scherber J, Hendrickson A, Jumaa M, Zaidi S, Hendrickson T, Snyder V, Killer-Oberpfalzer M, Mutzenbach J, Weymayr F, Broussalis E, Stadler K, Jedlitschka A, Malek A, Mueller-Kronast N, Beck P, Martin C, Summers D, Day J, Bettinger I, Holloway W, Olds K, Arkin S, Akhtar N, Boutwell C, Crandall S, Schwartzman M, Weinstein C, Brion B, Prothmann S, Kleine J, Kreiser K, Boeckh-Behrens T, Poppert H, Wunderlich S, Koch ML, Biberacher V, Huberle A, Gora-Stahlberg G, Knier B, Meindl T, Utpadel-Fischler D. Imaging features and safety and efficacy of endovascular stroke treatment: a meta-analysis of individual patient-level data. Lancet Neurol 2018; 17:895-904. [DOI: 10.1016/s1474-4422(18)30242-4] [Citation(s) in RCA: 213] [Impact Index Per Article: 35.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 06/11/2018] [Accepted: 06/12/2018] [Indexed: 11/29/2022]
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Wehrmann W, John S, Skudlik C. Management und Abrechnung der BK 5103 − Tipps und Tricks. Akt Dermatol 2018. [DOI: 10.1055/a-0597-7053] [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: 10/28/2022]
Abstract
ZusammenfassungAufgrund des sich aus der Aufnahme der Berufskrankheit Nr. 5103 „Plattenepithelkarzinome oder multiple aktinische Keratosen der Haut durch natürliche UV-Strahlung“ in die Berufskrankheitenliste ergebenden Bedarfs der Versorgung von Patienten mit beruflich verursachtem Hautkrebs in der hautärztlichen Praxis, wurden seitens der ständigen Gebührenkommission neue Gebührennummern für die UV-GOÄ beschlossen. Diese neuen Gebührennummern bieten nunmehr den behandelnden Dermatologen von Patienten mit berufsbedingtem Hautkrebs einschließlich von aktinischen Keratosen bzw. Feldkanzerisierung Sicherheit in der Abrechnung und eine leistungsbezogene Vergütung.
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Affiliation(s)
- W. Wehrmann
- Hautärztliche BAG, Münster, Universität Osnabrück
| | - S. John
- Institut für interdisziplinäre Dermatologische Prävention und Rehabilitation (iDerm) an der Universität Osnabrück und BG Klinikum Hamburg, Dermatologie
| | - C. Skudlik
- Institut für interdisziplinäre Dermatologische Prävention und Rehabilitation (iDerm) an der Universität Osnabrück und BG Klinikum Hamburg, Dermatologie
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Lovesley D, John S, Khakhar A, Ramamurthy A. Nutritional prehab to rehab of liver transplant patients: An indian perspective. Clin Nutr 2018. [DOI: 10.1016/j.clnu.2018.06.1274] [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: 11/30/2022]
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Schmitz M, Joannidis M, Czock D, John S, Jörres A, Klein SJ, Oppert M, Schwenger V, Kielstein J, Zarbock A, Kindgen-Milles D, Willam C. [Regional citrate anticoagulation in renal replacement therapy in the intensive care station : Recommendations from the renal section of the DGIIN, ÖGIAIN and DIVI]. Med Klin Intensivmed Notfmed 2018; 113:377-383. [PMID: 29737362 DOI: 10.1007/s00063-018-0445-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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: 04/03/2018] [Accepted: 04/03/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND Regional citrate anticoagulation (RCA) in continuous renal replacement therapy can effectively anticoagulate dialysis circuits without having adverse effects on systemic heparin application. In particular, in continuous renal replacement therapy RCA is well established and represents a safe procedure with longer filter lifetimes and fewer bleeding complications. OBJECTIVES To provide guidance on the indications, advantages and disadvantages, and use of RCA, current recommendations from the renal section of the DGIIN (Deutschen Gesellschaft für Internistische Intensivmedizin und Notfallmedizin), ÖGIAIN (Österreichischen Gesellschaft für Internistische und Allgemeine Intensivmedizin und Notfallmedizin) and DIVI (Deutschen Interdisziplinären Vereinigung für Intensiv- und Notfallmedizin) are stated. MATERIALS AND METHODS The recommendations in this paper are based on the current KDIGO (Kidney Disease: Improving Global Outcomes) guidelines, other published guidelines and protocols as well as the expert knowledge and clinical experience of the authors. RESULTS The use of commercially available machines with coupled pumps and integrated safety features, effective personal training and standardized protocols for clinical usage (SOP) is particularly important for the safe clinical use of RCA in renal replacement therapy. Contrary to previous recommendations, even liver failure or shock with lactic acidosis may no longer be an absolute contra-indication for RCA. However, these particular patients have to be carefully monitored for signs of citrate accumulation.
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Affiliation(s)
- M Schmitz
- Klinik für Nephrologie und Allgemeine Innere Medizin, Städtisches Klinikum Solingen, Gotenstraße 1, 42653, Solingen, Deutschland.
| | - M Joannidis
- Gemeinsame Einrichtung internistische Intensiv- und Notfallmedizin, Department für Innere Medizin, Medizinische Universität Innsbruck, Innsbruck, Österreich
| | - D Czock
- Medizinische Klinik, Abteilung Klinische Pharmakologie und Pharmakoepidemiologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Deutschland
| | - S John
- Abteilung Internistische Intensivmedizin, Medizinische Klinik 8, Paracelsus Medizinische Privatuniversität (PMU) Nürnberg, Universität Erlangen-Nürnberg, Klinikum Nürnberg-Süd, Nürnberg, Deutschland
| | - A Jörres
- Medizinische Klinik I für Nephrologie, Transplantationsmedizin und internistische Intensivmedizin, Klinikum der Universität Witten/Herdecke, Köln-Merheim, Deutschland
| | - S J Klein
- Gemeinsame Einrichtung internistische Intensiv- und Notfallmedizin, Department für Innere Medizin, Medizinische Universität Innsbruck, Innsbruck, Österreich
| | - M Oppert
- Klinik für Notfall- und internistische Intensivmedizin, Klinikum Ernst von Bergmann, Potsdam, Deutschland
| | - V Schwenger
- Klinik für Nieren‑, Hochdruck- und Autoimmunerkrankungen, Klinikum Stuttgart, Kriegsbergstr. 60, 70174, Stuttgart, Deutschland
| | - J Kielstein
- Medizinische Klinik V, Nephrologie, Rheumatologie, Blutreinigungsverfahren, Städtisches Klinikum Braunschweig, Braunschweig, Deutschland
| | - A Zarbock
- Klinik für Anästhesiologie, operative Intensivmedizin und Schmerztherapie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Münster, Deutschland
| | - D Kindgen-Milles
- Klinik für Anästhesiologie, Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität, Moorenstr. 5, 40225, Düsseldorf, Deutschland
| | - C Willam
- Medizinische Klinik 4, Nephrologie und Hypertensiologie, Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Deutschland
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Druml W, Joannidis M, John S, Jörres A, Schmitz M, Kielstein J, Kindgen-Milles D, Oppert M, Schwenger V, Willam C, Zarbock A. [Metabolic management and nutrition in critically ill patients with renal dysfunction : Recommendations from the renal section of the DGIIN, ÖGIAIN, and DIVI]. Med Klin Intensivmed Notfmed 2018; 113:393-400. [PMID: 29725741 DOI: 10.1007/s00063-018-0427-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 03/19/2018] [Indexed: 01/22/2023]
Abstract
BACKGROUND Intensive care patients with renal failure or insufficiency comprise a heterogeneous group of subjects with widely differing metabolic patterns and nutritional requirements. They include subjects with various stages of acute kidney injury (AKI), acute-on-chronic renal failure (A-CKD), without/with renal replacement therapy (RRT), chronic kidney disease (CKD), and subjects on regular hemodialysis or peritoneal dialysis therapy (HD/PD). GOALS Development of recommendations by the renal section of DGIIN (Deutsche Gesellschaft für Internistische Intensivmedizin und Notfallmedizin), ÖGIAIN (Österreichische Gesellschaft für Internistische und Allgemeine Intensivmedizin und Notfallmedizin) and DIVI (Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin) for the metabolic management and the planning, indication, implementation, and monitoring of nutrition therapy in this heterogeneous group of patients. MATERIALS AND METHODS The recommendations are based on recent evidence and current recommendations of DGEM (Deutsche Gesellschaft für Ernährungsmedizin), ASPEN (American Society for Parenteral and Enteral Nutrition) and ESPEN (European Society for Clinical Nutrition and Metabolism) and also the KDGIO (Kidney Disease: Improving Global Outcomes) clinical practice guidelines for AKI and the expert knowledge and clinical experience of the authors. RESULTS Nutrition support in these patient groups is not fundamentally different from that in other disease states but must consider the multiple variations in metabolism and nutrient requirements. Nutrition therapy must be adapted to the stage of disease and especially, in those patients on RRT. Nutritional needs can differ widely between patients but also in the same patient during the course of the disease. CONCLUSIONS Thus, the patient with renal failure requires an individualized approach in nutrition support and because of the altered metabolism of many nutrients and intolerances for electrolytes and fluids, the nutrition support in patients with renal insufficiency requires close clinical and laboratory monitoring.
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Affiliation(s)
- W Druml
- Klinik für Innere Medizin III, Abteilung für Nephrologie, Allgemeines Krankenhaus Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich.
| | - M Joannidis
- Gemeinsame Einrichtung Internistische Intensiv- und Notfallmedizin, Department für Innere Medizin, Medizinische Universität Innsbruck, Innsbruck, Österreich
| | - S John
- Abteilung Internistische Intensivmedizin, Medizinische Klinik 8, Paracelsus Medizinische Privatuniverstität Nürnberg, Universität Erlangen-Nürnberg, Klinikum Nürnberg-Süd, Nürnberg, Deutschland
| | - A Jörres
- Medizinische Klinik I für Nephrologie, Transplantationsmedizin und internistische Intensivmedizin, Klinikum der Universität Witten/Herdecke, Köln-Merheim, Deutschland
| | - M Schmitz
- Klinik für Nephrologie, Städtisches Klinikum Solingen, Solingen, Deutschland
| | - J Kielstein
- Medizinische Klinik V, Nephrologie | Rheumatologie | Blutreinigungsverfahren, Städtisches Klinikum Braunschweig, Braunschweig, Deutschland
| | - D Kindgen-Milles
- Klinik für Anästhesiologie Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität, Düsseldorf, Deutschland
- Medizinische Klinik, Abteilung Klinische Pharmakologie und Pharmakoepidemiologie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - M Oppert
- Klinik für Notfall- und internistische Intensivmedizin, Klinikum Ernst von Bergmann, Potsdam, Deutschland
| | - V Schwenger
- Klinik für Nieren‑, Hochdruck- und Autoimmunerkrankungen, Klinikum Stuttgart, Stuttgart, Deutschland
| | - C Willam
- Medizinische Klinik 4, Nephrologie und Hypertensiologie, Erlangen, Deutschland
| | - A Zarbock
- Klinik für Anästhesiologie, operative Intensivmedizin und Schmerztherapie, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Münster, Deutschland
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Riessen R, Janssens U, John S, Karagiannidis C, Kluge S. [Organ assist devices in the future : Limits and perspectives]. Med Klin Intensivmed Notfmed 2018; 113:277-283. [PMID: 29632968 DOI: 10.1007/s00063-018-0420-3] [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] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 03/07/2018] [Indexed: 11/30/2022]
Abstract
In the last decade, extracorporeal organ assist devices (extracorporeal membrane oxygenation [ECMO]) have been increasingly applied to treat the most severe forms of respiratory failure and cardiogenic shock, although the underlying scientific evidence is still limited and the methods carry a high risk of complications despite all technical improvements. The selection of those patients who most benefit from these devices is still a great challenge for intensivists and all other involved disciplines. Besides the severity of the acute organ failure, it is important to thoroughly evaluate etiology and treatment options of the underlying disease, comorbidities, and the functional status of the patients in an interdisciplinary team. This also includes ethical challenges. Because of the complexity of the treatment and the high organizational demands it is reasonable to concentrate ECMO treatments in specifically qualified centers and to promote a comprehensive scientific analysis of the treatment data.
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Affiliation(s)
- R Riessen
- Internistische Intensivstation, Department für Innere Medizin, Universitätsklinikum Tübingen, Otfried-Müller-Str. 10, 72076, Tübingen, Deutschland.
| | - U Janssens
- Klinik für Innere Medizin und Internistische Intensivmedizin, St.-Antonius-Hospital, Dechant-Deckers-Str. 8, 52249, Eschweiler, Deutschland
| | - S John
- Abteilung Internistische Intensivmedizin, Medizinische Klinik 8, Paracelsus Medizinische Privatuniversität Nürnberg, Klinikum Nürnberg-Süd, Universität Erlangen-Nürnberg, Breslauer Str. 201, 90471, Nürnberg, Deutschland
| | - C Karagiannidis
- ARDS- und ECMO-Zentrum Köln-Merheim, Kliniken der Stadt Köln, Krankenhaus Merheim, Universität Witten/Herdecke, Ostmerheimer Str. 200, 51109, Köln, Deutschland
| | - S Kluge
- Klinik für Intensivmedizin, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland
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Joannidis M, Klein SJ, John S, Schmitz M, Czock D, Druml W, Jörres A, Kindgen-Milles D, Kielstein JT, Oppert M, Schwenger V, Willam C, Zarbock A. [Prevention of acute kidney injury in critically ill patients : Recommendations from the renal section of the DGIIN, ÖGIAIN and DIVI]. Med Klin Intensivmed Notfmed 2018; 113:358-369. [PMID: 29594317 DOI: 10.1007/s00063-018-0413-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 02/26/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND Acute kidney injury (AKI) has both high mortality and morbidity. OBJECTIVES To prevent the occurrence of AKI, current recommendations from the renal section of the DGIIN (Deutschen Gesellschaft für Internistische Intensivmedizin und Notfallmedizin), ÖGIAIN (Österreichischen Gesellschaft für Internistische und Allgemeine Intensivmedizin und Notfallmedizin) and DIVI (Deutschen Interdisziplinären Vereinigung für Intensiv- und Notfallmedizin) are stated. MATERIALS AND METHODS The recommendations stated in this paper are based on the current Kidney Disease Improving Global Outcomes (KDIGO) guidelines, the published statements of the "Working Group on Prevention, AKI section of the European Society of Intensive Care Medicine" and the expert knowledge and clinical experience of the authors. RESULTS Currently there are no approved clinically effective drugs for the prevention of AKI. Therefore the mainstay of prevention is the optimization of renal perfusion by improving the mean arterial pressure (>65 mm Hg, higher target may be considered in hypertensive patients). This can be done by vasopressors, preferably norepinephrine and achieving or maintaining euvolemia. Hyperhydration that can lead to AKI itself should be avoided. In patients with maintained diuresis this can be done by diuretics that are per se no preventive drug for AKI. Radiocontrast enhanced imaging should not be withheld from patients at risk for AKI; if indicated, however, the contrast media should be limited to the smallest possible volume.
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Affiliation(s)
- M Joannidis
- Gemeinsame Einrichtung Internistische Intensiv- und Notfallmedizin, Department für Innere Medizin, Medizinische Universität Innsbruck, Anichstraße 35, 6020, Innsbruck, Österreich.
| | - S J Klein
- Gemeinsame Einrichtung Internistische Intensiv- und Notfallmedizin, Department für Innere Medizin, Medizinische Universität Innsbruck, Anichstraße 35, 6020, Innsbruck, Österreich
| | - S John
- Abteilung Internistische Intensivmedizin, Medizinische Klinik 8, Paracelsus Medizinische Privatuniversität Nürnberg, Klinikum Nürnberg-Süd, Universität Erlangen-Nürnberg, Nürnberg, Deutschland
| | - M Schmitz
- Klinik für Nephrologie, Städtisches Klinikum Solingen, Solingen, Deutschland
| | - D Czock
- Medizinische Klinik, Abteilung Klinische Pharmakologie und Pharmakoepidemiologie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - W Druml
- Department für Innere Medizin III, Allgemeines Krankenhaus Wien, Wien, Österreich
| | - A Jörres
- Medizinische Klinik I für Nephrologie, Transplantationsmedizin und internistische Intensivmedizin, Klinikum der Universität Witten/Herdecke, Köln-Merheim, Deutschland
| | - D Kindgen-Milles
- Klinik für Anästhesiologie, Heinrich-Heine-Universität, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland
| | - J T Kielstein
- Medizinische Klinik V, Nephrologie
- Rheumatologie
- Blutreinigungsverfahren, Städtisches Klinikum Braunschweig, Braunschweig, Deutschland
| | - M Oppert
- Klinik für Notfall- und internistische Intensivmedizin, Klinikum Ernst von Bergmann, Potsdam, Deutschland
| | - V Schwenger
- Klinik für Nieren‑, Hochdruck- und Autoimmunerkrankungen, Klinikum Stuttgart, Stuttgart, Deutschland
| | - C Willam
- Nephrologie und Hypertensiologie, Medizinische Klinik 4, Erlangen, Deutschland
| | - A Zarbock
- Klinik für Anästhesiologie, operative Intensivmedizin und Schmerztherapie, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Münster, Deutschland
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Riessen R, Kluge S, Janssens U, Kierdorf H, Bodmann KF, Busch HJ, John S, Möckel M. [Choosing wisely recommendations in intensive care medicine]. Internist (Berl) 2018; 58:550-555. [PMID: 28488056 DOI: 10.1007/s00108-017-0250-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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: 01/28/2023]
Abstract
Intensive care medicine is an important and integral part of internal medicine. Modern intensive care medicine permits survival of many patients with severe and life-threatening internal diseases in acute situations. Decisive for therapeutic success is often not the application of complicated and expensive medical technologies, but rather the rapid diagnosis and identification of core issues, with immediate and competent initiation of standard treatment regimens. An adequately staffed, well-organized interprofessional team is of central importance. With the application of standard therapies, it has been increasingly demonstrated that "less is more", and that personalized treatment concepts are better than aggressive strategies with higher therapeutic goals. In accordance with the Choosing wisely recommendations of the American societies for intensive care medicine, the extended board of the Deutsche Gesellschaft für Internistische Intensivmedizin und Notfallmedizin (DGIIN) has formulated five positive and five negative recommendations reflecting these principles. The current paper is an updated version of the manuscript originally published in the Deutsches Ärzteblatt. When applying these recommendations, it is important to consider that intensive care patients are very complex; therefore, the applicability of these principles must be assessed on an individual basis and, where necessary, modified appropriately.
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Affiliation(s)
- R Riessen
- Internistische Intensivstation, Department für Innere Medizin, Universitätsklinikum Tübingen, Tübingen, Deutschland
| | - S Kluge
- Klinik für Intensivmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - U Janssens
- Innere Medizin, St.-Antonius-Hospital, Eschweiler, Deutschland
| | - H Kierdorf
- Kliniken der Stadt Köln gGmbH, Köln, Deutschland
| | - K F Bodmann
- Klinik für Internistische Intensiv- und Notfallmedizin und Klinische Infektiologie, Klinikum Barnim GmbH, Werner-Forßmann-Krankenhaus, Eberswalde, Deutschland
| | - H-J Busch
- Universitäts-Notfallzentrum, Universitätsklinikum, Albert-Ludwigs-Universität Freiburg, Freiburg, Deutschland
| | - S John
- Nephrologie und Hypertensiologie, Klinikum Nürnberg Süd, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nürnberg, Deutschland
| | - M Möckel
- Arbeitsbereich Notfallmedizin/Rettungsstellen/CPU, Campus Virchow-Klinikum und Charité Mitte, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13363, Berlin, Deutschland.
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Campbell BCV, van Zwam WH, Goyal M, Menon BK, Dippel DWJ, Demchuk AM, Bracard S, White P, Dávalos A, Majoie CBLM, van der Lugt A, Ford GA, de la Ossa NP, Kelly M, Bourcier R, Donnan GA, Roos YBWEM, Bang OY, Nogueira RG, Devlin TG, van den Berg LA, Clarençon F, Burns P, Carpenter J, Berkhemer OA, Yavagal DR, Pereira VM, Ducrocq X, Dixit A, Quesada H, Epstein J, Davis SM, Jansen O, Rubiera M, Urra X, Micard E, Lingsma HF, Naggara O, Brown S, Guillemin F, Muir KW, van Oostenbrugge RJ, Saver JL, Jovin TG, Hill MD, Mitchell PJ, Berkhemer OA, Fransen PSS, Beumer D, van den Berg LA, Lingsma HF, Yoo AJ, Schonewille WJ, Vos JA, Nederkoorn PJ, Wermer MJH, van Walderveen MAA, Staals J, Hofmeijer J, van Oostayen JA, Lycklama à Nijeholt GJ, Boiten J, Brouwer PA, Emmer BJ, de Bruijn SF, van Dijk LC, Kappelle J, Lo RH, van Dijk EJ, de Vries J, de Kort PL, van Rooij WJJ, van den Berg JS, van Hasselt BA, Aerden LA, Dallinga RJ, Visser MC, Bot JC, Vroomen PC, Eshghi O, Schreuder TH, Heijboer RJ, Keizer K, Tielbeek AV, den Hertog HM, Gerrits DG, van den Berg-Vos RM, Karas GB, Steyerberg EW, Flach Z, Marquering HA, Sprengers ME, Jenniskens SF, Beenen LF, van den Berg R, Koudstaal PJ, van Zwam WH, Roos YB, van der Lugt A, van Oostenbrugge RJ, Wakhloo A, Moonis M, Henninger N, Goddeau R, Massari F, Minaeian A, Lozano JD, Ramzan M, Stout C, Patel A, Majoie CB, Tunguturi A, Onteddu S, Carandang R, Howk M, Ribó M, Sanjuan E, Rubiera M, Pagola J, Flores A, Muchada M, Dippel DW, Meler P, Huerga E, Gelabert S, Coscojuela P, Tomasello A, Rodriguez D, Santamarina E, Maisterra O, Boned S, Seró L, Brown MM, Rovira A, Molina CA, Millán M, Muñoz L, Pérez de la Ossa N, Gomis M, Dorado L, López-Cancio E, Palomeras E, Munuera J, Liebig T, García Bermejo P, Remollo S, Castaño C, García-Sort R, Cuadras P, Puyalto P, Hernández-Pérez M, Jiménez M, Martínez-Piñeiro A, Lucente G, Stijnen T, Dávalos A, Chamorro A, Urra X, Obach V, Cervera A, Amaro S, Llull L, Codas J, Balasa M, Navarro J, Andersson T, Ariño H, Aceituno A, Rudilosso S, Renu A, Macho JM, San Roman L, Blasco J, López A, Macías N, Cardona P, Mattle H, Quesada H, Rubio F, Cano L, Lara B, de Miquel MA, Aja L, Serena J, Cobo E, Albers GW, Lees KR, Wahlgren N, Arenillas J, Roberts R, Minhas P, Al-Ajlan F, Salluzzi M, Zimmel L, Patel S, Eesa M, Martí-Fàbregas J, Jankowitz B, van der Heijden E, Serena J, Salvat-Plana M, López-Cancio E, Bracard S, Ducrocq X, Anxionnat R, Baillot PA, Barbier C, Derelle AL, Lacour JC, Ghannouti N, Richard S, Samson Y, Sourour N, Baronnet-Chauvet F, Clarencon F, Crozier S, Deltour S, Di Maria F, Le Bouc R, Leger A, Fleitour N, Mutlu G, Rosso C, Szatmary Z, Yger M, Zavanone C, Bakchine S, Pierot L, Caucheteux N, Estrade L, Kadziolka K, Hooijenga I, Leautaud A, Renkes C, Serre I, Desal H, Guillon B, Boutoleau-Bretonniere C, Daumas-Duport B, De Gaalon S, Derkinderen P, Evain S, Puppels C, Herisson F, Laplaud DA, Lebouvier T, Lintia-Gaultier A, Pouclet-Courtemanche H, Rouaud T, Rouaud Jaffrenou V, Schunck A, Sevin-Allouet M, Toulgoat F, Pellikaan W, Wiertlewski S, Gauvrit JY, Ronziere T, Cahagne V, Ferre JC, Pinel JF, Raoult H, Mas JL, Meder JF, Al Najjar-Carpentier AA, Geerling A, Birchenall J, Bodiguel E, Calvet D, Domigo V, Godon-Hardy S, Guiraud V, Lamy C, Majhadi L, Morin L, Naggara O, Lindl-Velema A, Trystram D, Turc G, Berge J, Sibon I, Menegon P, Barreau X, Rouanet F, Debruxelles S, Kazadi A, Renou P, van Vemde G, Fleury O, Pasco-Papon A, Dubas F, Caroff J, Godard Ducceschi S, Hamon MA, Lecluse A, Marc G, Giroud M, Ricolfi F, de Ridder A, Bejot Y, Chavent A, Gentil A, Kazemi A, Osseby GV, Voguet C, Mahagne MH, Sedat J, Chau Y, Suissa L, Greebe P, Lachaud S, Houdart E, Stapf C, Buffon Porcher F, Chabriat H, Guedin P, Herve D, Jouvent E, Mawet J, Saint-Maurice JP, de Bont-Stikkelbroeck J, Schneble HM, Turjman F, Nighoghossian N, Berhoune NN, Bouhour F, Cho TH, Derex L, Felix S, Gervais-Bernard H, Gory B, de Meris J, Manera L, Mechtouff L, Ritzenthaler T, Riva R, Salaris Silvio F, Tilikete C, Blanc R, Obadia M, Bartolini MB, Gueguen A, Janssen K, Piotin M, Pistocchi S, Redjem H, Drouineau J, Neau JP, Godeneche G, Lamy M, Marsac E, Velasco S, Clavelou P, Struijk W, Chabert E, Bourgois N, Cornut-Chauvinc C, Ferrier A, Gabrillargues J, Jean B, Marques AR, Vitello N, Detante O, Barbieux M, Licher S, Boubagra K, Favre Wiki I, Garambois K, Tahon F, Ashok V, Voguet C, Coskun O, Guedin P, Rodesch G, Lapergue B, Boodt N, Bourdain F, Evrard S, Graveleau P, Decroix JP, Wang A, Sellal F, Ahle G, Carelli G, Dugay MH, Gaultier C, Ros A, Lebedinsky AP, Lita L, Musacchio RM, Renglewicz-Destuynder C, Tournade A, Vuillemet F, Montoro FM, Mounayer C, Faugeras F, Gimenez L, Venema E, Labach C, Lautrette G, Denier C, Saliou G, Chassin O, Dussaule C, Melki E, Ozanne A, Puccinelli F, Sachet M, Slokkers I, Sarov M, Bonneville JF, Moulin T, Biondi A, De Bustos Medeiros E, Vuillier F, Courtheoux P, Viader F, Apoil-Brissard M, Bataille M, Ganpat RJ, Bonnet AL, Cogez J, Kazemi A, Touze E, 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Effect of general anaesthesia on functional outcome in patients with anterior circulation ischaemic stroke having endovascular thrombectomy versus standard care: a meta-analysis of individual patient data. Lancet Neurol 2018; 17:47-53. [DOI: 10.1016/s1474-4422(17)30407-6] [Citation(s) in RCA: 129] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 10/05/2017] [Accepted: 10/11/2017] [Indexed: 10/18/2022]
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