1
|
Bode SFN, Schwender A, Toth M, Kaeppler-Schorn C, Siebeneich U, Freihorst J, Janda A, Fabricius D. Characterization of adolescents with functional respiratory disorders and prior history of SARS-CoV-2. Mol Cell Pediatr 2023; 10:10. [PMID: 37698705 PMCID: PMC10497462 DOI: 10.1186/s40348-023-00165-3] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 08/15/2023] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND The SARS-CoV-2 pandemic has caused significant pulmonary morbidity and mortality in the adult population. Children and adolescents typically show milder symptoms; however, a relevant proportion of them report persistent pulmonary symptoms even after mild SARS-CoV-2 infection. Functional respiratory disorders may be relevant differential diagnoses of persistent dyspnea. This study aims at characterizing functional respiratory disorders that may arise after SARS-CoV-2 infection regarding their clinical presentation and pulmonary function tests as well as gaining insights into the clinical course after initiation of appropriate therapy. METHODS This study retrospectively identified all patients referred to an outpatient clinic for pediatric pulmonology with functional respiratory disorders manifesting after proven SARS-CoV-2 infection between January 1, 2022, and October 31, 2022. Clinical history, thorough clinical examination regarding breathing patterns, and pulmonary function tests (PFTs) were taken into consideration to diagnose functional respiratory disorders. RESULTS Twenty-five patients (44% female) with mean (m) age = 12.73 years (SD ± 1.86) who showed distinctive features of functional respiratory disorders after SARS-CoV-2 infection (onset at m = 4.15 (± 4.24) weeks after infection) were identified. Eleven patients showed thoracic dominant breathing with insufficient ventilation, and 4 patients mainly had symptoms of inducible laryngeal obstruction. The rest (n = 10) showed overlap of these two etiologies. Most patients had a flattened inspiratory curve on spirometry and slightly elevated residual volume on body plethysmography, but values of PFTs were normal before and after standardized treadmill exercise testing. Patients were educated about the benign nature of the condition and were offered rebreathing training. All patients with follow-up (n = 5) showed normalization of the breathing pattern within 3 months. CONCLUSIONS Functional respiratory disorders are important differential diagnoses in persisting post-SARS-CoV-2 dyspnea in adolescents. A combination of clinical history, detailed examination of breathing patterns, and pulmonary function tests are helpful to correctly diagnose these conditions. Reassurance and rebreathing training are the mainstay of the therapy. The clinical course is favorable.
Collapse
Affiliation(s)
- Sebastian Felix Nepomuk Bode
- Department of Pediatrics and Adolescent Medicine, Ulm University Medical Center, Ulm University, Eythstrasse 24, Ulm, 89075, Germany.
| | - Anja Schwender
- Department of Pediatrics and Adolescent Medicine, Ulm University Medical Center, Ulm University, Eythstrasse 24, Ulm, 89075, Germany
| | - Monika Toth
- Department of Pediatrics and Adolescent Medicine, Ulm University Medical Center, Ulm University, Eythstrasse 24, Ulm, 89075, Germany
| | - Christine Kaeppler-Schorn
- Department of Pediatrics and Adolescent Medicine, Ulm University Medical Center, Ulm University, Eythstrasse 24, Ulm, 89075, Germany
| | - Ute Siebeneich
- Department of Pediatrics and Adolescent Medicine, Ulm University Medical Center, Ulm University, Eythstrasse 24, Ulm, 89075, Germany
| | - Joachim Freihorst
- Department of Pediatrics and Adolescent Medicine, Ulm University Medical Center, Ulm University, Eythstrasse 24, Ulm, 89075, Germany
| | - Ales Janda
- Department of Pediatrics and Adolescent Medicine, Ulm University Medical Center, Ulm University, Eythstrasse 24, Ulm, 89075, Germany
| | - Dorit Fabricius
- Department of Pediatrics and Adolescent Medicine, Ulm University Medical Center, Ulm University, Eythstrasse 24, Ulm, 89075, Germany
| |
Collapse
|
2
|
Schmidt H, Höpfer LM, Wohlgemuth L, Knapp CL, Mohamed AOK, Stukan L, Münnich F, Hüsken D, Koller AS, Stratmann AEP, Müller P, Braun CK, Fabricius D, Bode SFN, Huber-Lang M, Messerer DAC. Multimodal analysis of granulocytes, monocytes, and platelets in patients with cystic fibrosis before and after Elexacaftor-Tezacaftor-Ivacaftor treatment. Front Immunol 2023; 14:1180282. [PMID: 37457734 PMCID: PMC10347380 DOI: 10.3389/fimmu.2023.1180282] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 05/15/2023] [Indexed: 07/18/2023] Open
Abstract
Cystic fibrosis (CF) is a monogenetic disease caused by an impairment of the cystic fibrosis transmembrane conductance regulator (CFTR). CF affects multiple organs and is associated with acute and chronic inflammation. In 2020, Elexacaftor-Tezacaftor-Ivacaftor (ETI) was approved to enhance and restore the remaining CFTR functionality. This study investigates cellular innate immunity, with a focus on neutrophil activation and phenotype, comparing healthy volunteers with patients with CF before (T1, n = 13) and after six months (T2, n = 11) of ETI treatment. ETI treatment reduced sweat chloride (T1: 95 mmol/l (83|108) vs. T2: 32 mmol/l (25|62), p < 0.01, median, first|third quartile) and significantly improved pulmonal function (FEV1 T1: 2.66 l (1.92|3.04) vs. T2: 3.69 l (3.00|4.03), p < 0.01). Moreover, there was a significant decrease in the biomarker human epididymis protein 4 (T1: 6.2 ng/ml (4.6|6.3) vs. T2: 3.0 ng/ml (2.2|3.7), p < 0.01) and a small but significant decrease in matrix metallopeptidase 9 (T1: 45.5 ng/ml (32.5|140.1) vs. T2: 28.2 ng/ml (18.2|33.6), p < 0.05). Neutrophil phenotype (CD10, CD11b, CD62L, and CD66b) and function (radical oxygen species generation, chemotactic and phagocytic activity) remained largely unaffected by ETI treatment. Likewise, monocyte phenotype and markers of platelet activation were similar at T1 and T2. In summary, the present study confirmed a positive impact on patients with CF after ETI treatment. However, neither beneficial nor harmful effects of ETI treatment on cellular innate immunity could be detected, possibly due to the study population consisting of patients with well-controlled CF.
Collapse
Affiliation(s)
- Hanna Schmidt
- Department of Pediatric and Adolescent Medicine, University Hospital Ulm, Ulm, Germany
| | - Larissa Melina Höpfer
- Institute of Clinical and Experimental Trauma Immunology, University Hospital Ulm, Ulm, Germany
| | - Lisa Wohlgemuth
- Institute of Clinical and Experimental Trauma Immunology, University Hospital Ulm, Ulm, Germany
| | - Christiane Leonie Knapp
- Institute of Clinical and Experimental Trauma Immunology, University Hospital Ulm, Ulm, Germany
| | | | - Laura Stukan
- Institute of Clinical and Experimental Trauma Immunology, University Hospital Ulm, Ulm, Germany
| | - Frederik Münnich
- Institute of Clinical and Experimental Trauma Immunology, University Hospital Ulm, Ulm, Germany
| | - Dominik Hüsken
- Institute of Clinical and Experimental Trauma Immunology, University Hospital Ulm, Ulm, Germany
| | | | | | - Paul Müller
- Institute of Clinical and Experimental Trauma Immunology, University Hospital Ulm, Ulm, Germany
| | - Christian Karl Braun
- Department of Pediatric and Adolescent Medicine, University Hospital Ulm, Ulm, Germany
- Institute of Transfusion Medicine, Ulm University, Ulm, Germany
- Institute of Clinical Transfusion Medicine and Immunogenetics Ulm, German Red Cross Blood Transfusion Service and University Hospital Ulm, Ulm, Germany
| | - Dorit Fabricius
- Department of Pediatric and Adolescent Medicine, University Hospital Ulm, Ulm, Germany
| | | | - Markus Huber-Lang
- Institute of Clinical and Experimental Trauma Immunology, University Hospital Ulm, Ulm, Germany
| | - David Alexander Christian Messerer
- Institute of Clinical and Experimental Trauma Immunology, University Hospital Ulm, Ulm, Germany
- Department of Transfusion Medicine and Hemostaseology, Friedrich-Alexander University Erlangen-Nuremberg, University Hospital Erlangen, Erlangen, Germany
| |
Collapse
|
3
|
Bode SFN, Uhl M, Heinzmann A. Persistent Pulmonary Hypertension as Clue for Swyer-James-MacLeod Syndrome. Klin Padiatr 2021; 234:113-115. [PMID: 34911133 DOI: 10.1055/a-1696-1807] [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)
- Sebastian Felix Nepomuk Bode
- Center for Pediatrics - Department of General Pediatrics, Adolescent Medicine and Neonatology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany, Freiburg, Germany
| | - Markus Uhl
- Department of Diagnostic and Therapeutic Radiology, St. Josefs Hospital Freiburg, Freiburg, Germany
| | - Andrea Heinzmann
- Center for Pediatrics - Department of General Pediatrics, Adolescent Medicine and Neonatology, Medical Center-University of Freiburg, Freiburg, Germany
| |
Collapse
|
4
|
Friedrich S, Straub C, Bode SFN, Heinzmann A. SIESTA: a quick interprofessional learning activity fostering collaboration and communication between paediatric nursing trainees and medical students. BMC Med Educ 2021; 21:475. [PMID: 34488723 PMCID: PMC8422752 DOI: 10.1186/s12909-021-02880-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 08/11/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Interprofessional education has emerged as a key concept in education of health professionals over the last 20 years. Positive effects of interprofessional education have been shown, but it has proved to be more time-consuming than traditional teaching methods. We therefore developed a 30-minute interprofessional learning activity, using peer-teaching methods. We were interested in effects on and ways of interprofessional learning, including conditions and resources that make it successful despite limited time. METHODS Speed InterprofESsional Peer Teaching PaediAtric (SIESTA) was developed in the context of an interprofessional training ward. 20 paediatric nursing trainees and 20 medical students were enrolled in the study. Two students from each profession participated in a total of four SIESTA sessions each, supervised by registered paediatric nurses and paediatricians. We used a mixed-methods approach of quantitative and qualitative data (questionnaires, semi-guided focus group interviews) to evaluate self-perceived interprofessional competencies, interprofessional learning gains and ways of interprofessional learning. RESULTS Questionnaires were obtained from all participants (n = 40) and n = 26 took part in the group interviews. Participants from both professions reported an increase in self-perceived understanding of interprofessional roles and tasks. Communication and cooperation emerged as important aspects. The workplace-based nature of SIESTA promoted interprofessional learning, while peer teaching fostered a safe learning environment. Regarding time constraints participants suggested thorough preparation and structuring by facilitators as a solution. CONCLUSIONS Our short interprofessional peer teaching activity showed promising results. Participants reported enhanced interprofessional competencies and provided suggestions for successful learning in limited time. Further studies should include an objective assessment of the interprofessional learning progress. The SIESTA concept can be easily adapted to other medical fields, providing interprofessional learning opportunities for many more health care professionals to come.
Collapse
Affiliation(s)
- Sebastian Friedrich
- Department of General Pediatrics, Adolescent Medicine and Neonatology, Medical Centre, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Christine Straub
- Department of General Pediatrics, Adolescent Medicine and Neonatology, Medical Centre, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Sebastian Felix Nepomuk Bode
- Department of General Pediatrics, Adolescent Medicine and Neonatology, Medical Centre, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Department of Pediatrics and Adolescent Medicine, Ulm University Medical Center, Ulm, Germany
| | - Andrea Heinzmann
- Department of General Pediatrics, Adolescent Medicine and Neonatology, Medical Centre, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| |
Collapse
|
5
|
Klemann C, Kellermann KB, Ehl S, Stenzel M, Mueller C, Heinzmann A, Bode SFN. Non-CF Bronchiectasis as a Possible Indicator of a Primary Immunodeficiency: Diagnosis, Clinical Course, and Quality of Life in a Pediatric Cohort. Klin Padiatr 2019; 231:240-247. [PMID: 31340404 DOI: 10.1055/a-0963-0293] [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] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Non cystic fibrosis bronchiectasis (NCBE) is an increasingly recognized chronic, progressive respiratory disorder with significant morbidity also in children and adolescents. METHODS We longitudinally assessed a cohort of 35 pediatric patients with NCBE and investigated underlying diagnosis, symptoms, clinical course, treatment, and quality of life. RESULTS NCBE were diagnosed at a mean age of 9.5 (±5.3) years. In half of the children NCBE were found prior to identification of the causative diagnosis. Primary immunodeficiency (PID) was identified as the underlying diagnosis in 24/35 (68%) cases, of which two-thirds showed antibody deficiency. In the 11 non-PID cases ciliopathies were most common (n=7). Clinical aspects such as manifestation age, cough or dyspnea symptoms, and exacerbation frequency did not differ significantly between PID and non-PID patients. Likewise, quality of life (QoL) was equally reduced in both groups. Lung function test parameters were stable under appropriate therapy in all children. The majority in both groups was insufficiently vaccinated against influenza and pneumococci. CONCLUSION Our data indicates that NCBE need to be especially appreciated as a presenting sign of PID in pediatric patients. Thus, occurrence of NCBE should warrant rigorous diagnostics to identify the underlying condition. In our cohort NCBE themselves rather than the causative diagnoses seem to dictate the clinical course of disease and reduce QoL in children. More intensive efforts have to be undertaken to vaccinate patients according to recommendations.
Collapse
Affiliation(s)
- Christian Klemann
- Department of Pediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Hannover
| | - Kinga Beata Kellermann
- Center for Pediatrics - Department of general pediatrics, adolescent medicine and neonatology, University Medical Center Freiburg, Freiburg
| | - Stephan Ehl
- Center for Chronic Immunodeficiency, University Medical Center Freiburg, Freiburg
| | - Martin Stenzel
- Pediatric radiology department, Children's Hospital Amsterdamer Strasse, Köln
| | - Christoph Mueller
- Center for Pediatrics - Department of general pediatrics, adolescent medicine and neonatology, University Medical Center Freiburg, Freiburg
| | - Andrea Heinzmann
- Center for Pediatrics - Department of general pediatrics, adolescent medicine and neonatology, University Medical Center Freiburg, Freiburg
| | - Sebastian Felix Nepomuk Bode
- Center for Pediatrics - Department of general pediatrics, adolescent medicine and neonatology, University Medical Center Freiburg, Freiburg
| |
Collapse
|
6
|
Bode SFN, Straub C, Giesler M, Biller S, Forster J, Krüger M. Audience-response systems for evaluation of pediatric lectures--comparison with a classic end-of-term online-based evaluation. GMS Z Med Ausbild 2016; 32:Doc18. [PMID: 26038683 PMCID: PMC4446649 DOI: 10.3205/zma000960] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Revised: 02/03/2015] [Accepted: 03/20/2015] [Indexed: 11/30/2022]
Abstract
AIM Course evaluations are often conducted and analyzed well after the course has taken place. By using a digital audience response system (ARS), it is possible to collect, view and discuss feedback during or directly following a course or lecture session. This paper analyzes a student evaluation of a lecture course with ARS to determine if significant differences exist between the results of the ARS lecture evaluation and those of the online evaluation at the end of the semester. In terms of the overall evaluation, consideration is given to the level of students' prior knowledge, the presentation of the lecture material by the lecturers and the relevance of the lecture topic for students. METHOD During the 2011-12 winter semester, the lecture on Pediatrics at the Freiburg Center for Pediatric and Adolescent Medicine (Zentrum für Kinder- und Jugendmedizin (ZKJ) Freiburg) was evaluated using ARS. Thirty-four lectures were evaluated by an average of 22 (range 8-44) students, who responded to four questions each time an evaluation took place. RESULTS On a 6-point Likert scale (1=very good to 6=deficient), the students rated their level of preparedness with a mean of 3.18, the presentation of the lecture with 2.44, and the relevance of the lecture topic with 2.19. The overall evaluation of the lecture course by means of ARS resulted in 2.31. The online evaluation conducted at the end of the semester yielded a score of 2.45. Highly significant correlations were seen between the results of the ARS for the overall evaluation, assessment of prior knowledge, lecture presentation, and the estimated relevance of the lecture topic. CONCLUSION The use of ARS is suitable for immediate evaluation of lectures, in particular regarding timely feedback for the individual lecturer/lecturers. In comparison with an end-of-term evaluation, ARS yielded a better assessment.
Collapse
Affiliation(s)
| | - Christine Straub
- Universitätsklinikum Freiburg, Zentrum für Kinder- und Jugendmedizin, Freiburg, Germany
| | - Marianne Giesler
- Universität Freiburg, Kompetenzzentrum Evaluation Baden-Württemberg, Freiburg, Germany
| | - Silke Biller
- Universität Basel, Medizinische Fakultät, Studiendekanat, Basel, Switzerland
| | | | - Marcus Krüger
- Universitätsklinikum Freiburg, Zentrum für Kinder- und Jugendmedizin, Freiburg, Germany
| |
Collapse
|
7
|
Bode SFN, Giesler M, Heinzmann A, Krüger M, Straub C. Self-perceived attitudes toward interprofessional collaboration and interprofessional education among different health care professionals in pediatrics. GMS J Med Educ 2016; 33:Doc17. [PMID: 27280128 PMCID: PMC4895846 DOI: 10.3205/zma001016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Revised: 02/22/2016] [Accepted: 03/10/2016] [Indexed: 05/25/2023]
Abstract
Interprofessional education (IPE) is the basis for interprofessional collaboration (IPC) in health care systems. It has beneficial effects for both patients and health care professionals. IPC is paramount for adequate care of patients and their families, especially in pediatrics. To determine the attitudes of medical doctors (n=121), nurses (n=15), psychologists (n=14), and social workers (n=19) toward IPE and IPC in a tertiary pediatric university teaching hospital, as well as the inpatient and outpatient settings in pediatrics, we developed a questionnaire with 21 items in four categories based on established questionnaires. All participants worked as part of interprofessional teams, and the overwhelming majority valued IPC highly. Most competencies important for IPC were acquired on the job. There was a substantial lack of interprofessional education, especially for medical doctors and psychologists. IPE still needs to be established as part of the undergraduate curriculum at German universities.
Collapse
Affiliation(s)
| | - Marianne Giesler
- University Hospital Freiburg, Competency Centre for Evaluation in Medicine, Baden-Württemberg, Freiburg, Germany
| | - Andrea Heinzmann
- University Hospital Freiburg, Center for Pediatrics and Adolescent Medicine, Freiburg, Germany
| | - Marcus Krüger
- University Hospital Freiburg, Center for Pediatrics and Adolescent Medicine, Freiburg, Germany
| | - Christine Straub
- University Hospital Freiburg, Center for Pediatrics and Adolescent Medicine, Freiburg, Germany
| |
Collapse
|
8
|
Bode SFN, Egg M, Wallesch C, Hermanns-Clausen M. 10-fold liraglutide overdose over 7 months resulted only in minor side-effects. J Clin Pharmacol 2013; 53:785-6. [PMID: 23733710 DOI: 10.1002/jcph.94] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Accepted: 04/08/2013] [Indexed: 11/07/2022]
|