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1.
Clin Immunol ; 221: 108614, 2020 12.
Article in English | MEDLINE | ID: mdl-33153974

ABSTRACT

The heterogeneous disease course of COVID-19 is unpredictable, ranging from mild self-limiting symptoms to cytokine storms, acute respiratory distress syndrome (ARDS), multi-organ failure and death. Identification of high-risk cases will enable appropriate intervention and escalation. This study investigates the routine laboratory tests and cytokines implicated in COVID-19 for their potential application as biomarkers of disease severity, respiratory failure and need of higher-level care. From analysis of 203 samples, CRP, IL-6, IL-10 and LDH were most strongly correlated with the WHO ordinal scale of illness severity, the fraction of inspired oxygen delivery, radiological evidence of ARDS and level of respiratory support (p ≤ 0.001). IL-6 levels of ≥3.27 pg/ml provide a sensitivity of 0.87 and specificity of 0.64 for a requirement of ventilation, and a CRP of ≥37 mg/l of 0.91 and 0.66. Reliable stratification of high-risk cases has significant implications on patient triage, resource management and potentially the initiation of novel therapies in severe patients.


Subject(s)
C-Reactive Protein/metabolism , COVID-19/diagnosis , Cytokine Release Syndrome/diagnosis , Interleukin-6/blood , Respiratory Distress Syndrome/diagnosis , SARS-CoV-2/pathogenicity , Adult , Aged , Aged, 80 and over , Biomarkers/blood , COVID-19/blood , COVID-19/therapy , COVID-19/virology , Cytokine Release Syndrome/blood , Cytokine Release Syndrome/therapy , Cytokine Release Syndrome/virology , Female , Hospitalization , Humans , Interleukin-10/blood , L-Lactate Dehydrogenase/blood , Male , Middle Aged , Respiration, Artificial , Respiratory Distress Syndrome/blood , Respiratory Distress Syndrome/therapy , Respiratory Distress Syndrome/virology , Risk Factors , Severity of Illness Index
2.
J Neurol ; 263(10): 2105-13, 2016 Oct.
Article in English | MEDLINE | ID: mdl-27485170

ABSTRACT

Few regional and seasonal Guillain-Barré syndrome (GBS) clusters have been reported so far. It is unknown whether patients suffering from sporadic GBS differ from GBS clusters with respect to clinical and paraclinical parameters, HLA association and antibody response to glycosphingolipids and Campylobacter jejuni (Cj). We examined 40 consecutive patients with GBS from the greater Munich area in Germany with 14 of those admitted within a period of 3 months in fall 2010 defining a cluster of GBS. Sequencing-based HLA typing of the HLA genes DRB1, DQB1, and DPB1 was performed, and ELISA for anti-glycosphingolipid antibodies was carried out. Clinical and paraclinical findings (Cj seroreactivity, cerebrospinal fluid parameters, and electrophysiology) were obtained and analyzed. GBS cluster patients were characterized by a more severe clinical phenotype with more patients requiring mechanical ventilation and higher frequencies of autoantibodies against sulfatide, GalC and certain ganglioside epitopes (54 %) as compared to sporadic GBS cases (13 %, p = 0.017). Cj seropositivity tended to be higher within GBS cluster patients (69 %) as compared to sporadic cases (46 %, p = 0.155). We noted higher frequencies of HLA class II allele DQB1*05:01 in the cluster cohort (23 %) as compared to sporadic GBS patients (3 %, p = 0.019). Cluster of severe GBS was defined by higher frequencies of autoantibodies against glycosphingolipids. HLA class II allele DQB1*05:01 might contribute to clinical worsening in the cluster patients.


Subject(s)
Autoantibodies/cerebrospinal fluid , Glycosphingolipids/immunology , Guillain-Barre Syndrome/cerebrospinal fluid , Guillain-Barre Syndrome/genetics , HLA-DQ beta-Chains/genetics , Adolescent , Adult , Aged , Aged, 80 and over , Alleles , Campylobacter Infections/immunology , Enzyme-Linked Immunosorbent Assay , Female , Follow-Up Studies , Gene Frequency , Genetic Predisposition to Disease/genetics , Germany , Guillain-Barre Syndrome/physiopathology , Humans , Male , Middle Aged , Neural Conduction/genetics , Severity of Illness Index , Young Adult
3.
Infect Control Hosp Epidemiol ; 32(11): 1103-8, 2011 Nov.
Article in English | MEDLINE | ID: mdl-22011538

ABSTRACT

OBJECTIVE: Most professionals in the healthcare environment wear uniforms. For the purpose of this study, we concentrated on nurses' uniforms. In the United Kingdom, many nurses are expected to launder their uniforms at home by using a domestic washing machine that frequently has low-temperature wash cycles. We have investigated whether the use of low-temperature wash cycles results in a microbiologically acceptable product to wear on the wards. METHODS: We have assessed the bioburden on uniforms before and after laundry and the effectiveness of low-temperature wash cycles and ironing on removal of methicillin-resistant Staphylococcus aureus (MRSA) and Acinetobacter baumannii. We did not assess the role of tumble drying. RESULTS: We demonstrate contamination of uniforms by gram-negative bacteria after wash, the removal of MRSA at low-temperature wash cycles in the presence of detergent, and the eradication of gram-negative bacteria after ironing. CONCLUSIONS: Our conclusions are that laundry in a domestic situation at 60°C (140°F) for 10 minutes is sufficient to decontaminate hospital uniforms and reduces the bacterial load by more than 7-log reduction, that items left in the pockets are decontaminated to the same extent, that the addition of either a biological detergent or a nonbiological detergent is beneficial in removing MRSA from experimentally contaminated swatches, and that uniforms become recontaminated with low numbers of principally gram-negative bacteria after laundry but that these are effectively removed by ironing.


Subject(s)
Clothing , Decontamination , Laundering/methods , Methicillin-Resistant Staphylococcus aureus/growth & development , Temperature , Textiles/microbiology , Acinetobacter baumannii/isolation & purification , Colony Count, Microbial , Cross Infection/etiology , Cross Infection/prevention & control , Detergents , Humans , Nursing Staff, Hospital , United Kingdom
4.
Mult Scler ; 17(11): 1333-40, 2011 Nov.
Article in English | MEDLINE | ID: mdl-21685230

ABSTRACT

BACKGROUND: Incorporation of routine clinical testing for neutralizing antibodies (NAbs) to interferon (IFN)-ß has remained problematic. With increasing treatment choice for patients, routine NAb testing should be incorporated to aid therapeutic decisions. OBJECTIVE: We sought to improve interpretation of NAb results by combining the luciferase NAb assay (luciferase gene expression assay under control of interferon-stimulated response element) and in-vivo biomarker (myxovirus A protein, MxA) induction in patients with MS. METHODS: Blood samples (serum and PAXGene(®) for RNA) were obtained pre-injection and 12 hours post-injection of IFN-ß from 144 subjects. Sera were tested for NAbs using the luciferase assay. MxA expression was quantified by real-time polymerase chain reaction (PCR). RESULTS: 26% of samples were NAb positive (titre > 20 NU). There was no difference in NAb titres in the pre- or post-dose sera (p = 0.643). MxA expression was inhibited in a dose-dependent fashion in NAb positive samples. Mean MxA level post-IFN-ß: NAb negative 2330 (95% CI 1940-2719), NAb 20-99 NU 1533 (95% CI 741-2324), NAb 100-600 NU 832 (186-1478) and NAb > 600 NU 101 (95% CI 0-224). NAb titre and MxA level correlated strongly: MxA pre- (Spearman r = -0.72, p < 0.0001), MxA post- (Spearman r = -0.79, p < 0.0001) and MxA induction (Spearman r = -0.67, p = 0.0004). CONCLUSION: A single, 12-hour post-injection sample should be used to test for NAbs using the luciferase assay and IFN-ß bioactivity (MxA) in the clinical setting.


Subject(s)
Antibodies, Neutralizing/blood , Biological Assay/methods , Drug Monitoring/methods , Immunologic Factors/therapeutic use , Interferon-beta/therapeutic use , Multiple Sclerosis/drug therapy , Adult , Aged , Analysis of Variance , Biomarkers/blood , Case-Control Studies , Cell Line, Tumor , Female , GTP-Binding Proteins/blood , GTP-Binding Proteins/genetics , Genes, Reporter , Humans , Immunologic Factors/immunology , Interferon beta-1a , Interferon-beta/immunology , London , Luciferases/biosynthesis , Luciferases/genetics , Male , Middle Aged , Multiple Sclerosis/immunology , Myxovirus Resistance Proteins , Predictive Value of Tests , Real-Time Polymerase Chain Reaction , Response Elements , Time Factors , Transfection , Treatment Outcome , Young Adult
5.
Pediatr Cardiol ; 28(5): 400-2, 2007.
Article in English | MEDLINE | ID: mdl-17687589

ABSTRACT

Anomalous aortic origin of one of the coronary arteries is uncommon. There have been few reports of the left coronary artery arising from the noncoronary sinus. The occurrence of Prinzmetal's angina in association with anomalous aortic origin is extremely rare. We report a case of such a combination and discuss the diagnostic options and therapeutic decision making.


Subject(s)
Angina Pectoris, Variant/epidemiology , Coronary Vessel Anomalies/epidemiology , Coronary Vessel Anomalies/surgery , Adult , Aorta/abnormalities , Comorbidity , Coronary Angiography , Coronary Vasospasm/therapy , Coronary Vessel Anomalies/diagnostic imaging , Extracorporeal Membrane Oxygenation , Female , Humans , Postoperative Complications/therapy
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