Clinical and immunological effects of low-dose IFN-alpha treatment in patients with corticosteroid-resistant asthma.

BACKGROUND: Interferon (IFN)-alpha is a cytokine that possesses potent anti-viral and immunoregulatory activities. We aimed to assess clinical and immunological effects of low-dose IFN-alpha in patients with severe corticosteroid-resistant asthma with and without Churg-Strauss syndrome. There is currently no efficient pharmacological treatment available for this group of patients. METHODS: We studied 10 patients with corticosteroid-resistant asthma, in which 3x10(6) IU/day IFN-alpha were administrated in addition to the prednisone dose given already before introduction of the cytokine therapy. The prednisone dose was gradually reduced dependent on the clinical situation and used as a clinical readout to evaluate the efficacy of the cytokine therapy. To distinguish between IFN-alpha- and prednisone-mediated immunological changes, the corticosteroid dose was kept constant for at least 2 weeks upon introduction of the cytokine therapy in seven patients. The effects of treatment on clinical and immunological parameters were measured at 2-4 weeks and 5-10 months depending on the availability of the patient. RESULTS: Interferon-alpha treatment rapidly improved the clinical situation as assessed by lung function parameters and required prednisone dose. Important immunological changes included: decreased leukocyte numbers, increased relative numbers of CD4+ T cells, increased differentiation of T helper (Th)1 cells, and increased expression of interleukin (IL)-10 in peripheral blood mononuclear cells. CONCLUSION: Interferon-alpha treatment was associated with dramatic improvements in the condition of patients with corticosteroid-resistant asthma with and without Churg-Strauss syndrome. Potential mechanisms of action include the establishment of a correct Th1/Th2 balance and the induction of the anti-inflammatory IL-10 gene.

Poor assessment of HIV epidemiology and occupational HIV transmission risk by medical students.

Due to the increasing global number of HIV-positive patients, the potential risk of acquiring infection with HIV during routine clinical care is on the increase. Assessments of the knowledge of medical students about occupational HIV transmission are therefore important. This study analysed the knowledge of 397 first year and 75 fifth year medical students about the epidemiology of HIV in Germany and their assessment of the risk of acquiring HIV in different clinical situations. Medical students overestimated the incidence and mortality of HIV in Germany, with fewer than 30% knowing the correct numbers. They also overestimated the risk of occupational HIV infection in several clinical settings, such as changing dirty linen or wound dressings. Few differences were found between first and fifth year medical students. For their later work as physicians medical students still need more information and counselling about the epidemiology of HIV, prevention of occupational HIV infections and care for patients with HIV/AIDS.

[What do medical students know about the epidemiology of tetanus and tuberculosis in Germany?--A comparison of epidemiologic knowledge regarding a rare and a prevalent infectious disease]. / Was wissen Medizinstudierende über die Epidemiologie von Tetanus und Tuberkulose in Deutschland?--Ein Vergleich der epidemiologischen Kenntnisse über eine seltene und eine häufige Infektionskrankheit.

A Comparison of Epidemiological Knowledge About a Rare and a Common Infectious Disease: Tetanus and tuberculosis are still worldwide health problems. Due to an increasing number of insufficiently vaccinated persons, mainly in adults, tetanus in Germany requires more and more medical attention. At the same time, due to global migration and an increasing number of immunocompromised patients, the probability of getting infected with tuberculosis is on the increase. For preventing infectious diseases it is necessary to analyse to what extent medical students are informed about the epidemiology of tetanus and tuberculosis in Germany. This knowledge is a mainstay for later differential diagnosis. After completing medical training it is expected that they are capable of diagnosing both diseases properly and that they are trained to inform the population about necessary vaccinations. The following study analysed the incidence estimation of medical students (n = 472) on tetanus and tuberculosis morbidity in Germany. It is obvious that medical students still have gaps in their knowledge about the epidemiology of tetanus and tuberculosis. They overestimated the incidence of tetanus cases per year around 10-1,000 times. In comparison, they underestimated the incidence of tuberculosis. The study shows a distorted assessment of importance of medical problems by the students of medicine. Medical education should consider this and focus more on epidemiology of infectious diseases including tetanus and tuberculosis.

Humoral and cell-mediated autoimmune reactions to human acidic ribosomal P2 protein in individuals sensitized to Aspergillus fumigatus P2 protein.

A panel of cDNAs encoding allergenic proteins was isolated from an Aspergillus fumigatus cDNA library displayed on the surface of filamentous phage. Solid phase-immobilized serum immunoglobulin E (IgE) from A. fumigatus-allergic individuals was used to enrich phage displaying IgE-binding molecules. One of the cDNAs encoded a 11.1-kD protein that was identified as acidic ribosomal phosphoprotein type 2 (P2 protein). The allergen, formally termed rAsp f 8, shares >62% sequence identity and >84% sequence homology to corresponding eukaryotic P2 proteins, including human P2 protein. The sequences encoding human and fungal P2 protein were subcloned, expressed in Escherichia coli as His6-tagged fusion proteins, and purified by Ni2+-chelate affinity chromatography. Both recombinant P2 proteins were recognized by IgE antibodies from allergic individuals sensitized to the A. fumigatus P2 protein and elicited strong type 1-specific skin reactions in these individuals. Moreover, human and fungal P2 proteins induced proliferative responses in peripheral blood mononuclear cells of A. fumigatus- allergic subjects sensitized to the fungal P2 protein. These data provide strong evidence for in vitro and in vivo humoral and cell-mediated autoreactivity to human P2 protein in patients suffering from chronic A. fumigatus allergy.

[Psychological concepts in pain therapy practice. 2: Behavior therapy, self-management and overview of cognitive interventions]. / Psychologische Konzepte in der schmerztherapeutischen Praxis. Teil 2: Verhaltenstherapie, Selbstmanagement und Uberblick über kognitive Interventionen.

In this part, the contribution of cognitive behavior therapy and the self management approach in psychological pain therapy is presented. A five-step-model of cognitive behavior is explained. The different steps are diagnostics, development of a new cognitive model of the disorder, acquisition of coping strategies, applications, transfer and relapse prevention. Focus of this paper are the coping strategies, thus, the interventions in confrontation with a pain stimulus. The self management approach has the goal to enable the patient to use coping strategies as quickly as possible by himself and to support the self-regulation of the patient. At the end, a survey about cognitive self-control strategies is given.

[Neglect of tuberculosis in medical education. How medical students perceive the incidence of tuberculosis in Germany]. / Vernachlässigung der Tuberkulose im Medizinstudium. Wie Medizinstudierende die Tuberkulosehäufigkeit in Deutschland einschätzen.

BACKGROUND: Tuberculosis is still a health problem. Due to an increasing number of immunosuppressed patients the probability of getting infected with tuberculosis in the hospital rises up. SUBJECTS AND METHODS: For prevention of infections, medical students play a critical role: Firstly, because of bedside-teaching in the hospital, medical students are at risk of getting infected with tuberculosis. Secondly, immediately after university training, it is expected that they are capable to diagnose tuberculosis. The following study analysed the incidence-estimation of medical students (n = 278) of tuberculosis-morbidity and tuberculosis-mortality in Germany. RESULTS: It becomes obvious, that medical students still have gaps in their knowledge about tuberculosis. They underestimated the incidence of tuberculosis and they overestimated the mortality of tuberculosis. CONCLUSION: The study indicates a misperception of relevant health problems which may be due to the study situation at German Medical Schools. Medical students need more information and counselling about epidemiology of infectious diseases including tuberculosis.

Effects of pain-incompatible imagery on tolerance of pain, heart rate, and skin resistance.

Imagery is an important component in strategies for coping with pain. In this study, we examined, whether imagery influences tolerance for pain and whether subjects, trained in pain-incompatible imagery differ in heart rate and skin resistance from these in a control group during a pain-induction session. 39 subjects were randomly assigned to two groups: imagery and control. Both groups had two pain-induction sessions. At intake into the study (t1). Pain Tolerance and Psychophysiological Reaction to Pain were assessed using a pressure algometer. After the first session, the experimental group received 1 hr. of training in pain-incompatible imagery. Seven days later, the session was repeated (t2). The results showed that Pain Tolerance was significantly increased in the group who used pain-incompatible imagery. One might follow the notion that increased Pain Tolerance is associated with increased Psychophysiological Pain Reaction, but results suggest the contrary. Subjects trained in pain-incompatible imagery had lower heart rates during the second pain induction than the control group. Groups did not differ with regard to skin resistance. It can be stated that besides information, cues on coping with pain may be helpful in clinical practice.

Effects of nondirective suggestions on pain tolerance, pain threshold and pain intensity perception.

In this experiment, we followed the issue whether nondirective suggestions have an effect on pain threshold, pain tolerance, and perception of pain intensity. 48 healthy subjects consented to take part. At intake into the study (t1), pain threshold and pain tolerance were assessed in all subjects using a pressure algometer. Perception of maximum pain intensity perception was rated on a scale of 0 to 25. Seven days later, the session was repeated (t2). Subjects were randomly assigned to one of two groups. One group received nondirective suggestions as pretreatment. Subjects listened to a tape of 20 min. which consisted of general information about pain theory. In this context, suggestions for coping with pain were placed. The other group served as a control and received no pretreatment. Analysis showed that pain tolerance was significantly prolonged in the group who received nondirective suggestions, while pain threshold and perception of maximum pain intensity did not differ across groups. This study demonstrates that nondirective suggestions are effective in prolonging pain tolerance. It can be stated that, beside information, cues on coping with pain may be helpful in clinical practice.

[Psychological concept of pain therapy. 1. Relaxation therapy, imagery methods, hypnotherapy and psychoanalysis]. / Psychologische Konzepte in der schmerztherapeutischen Praxis. Teil 1: Entspannungsverfahren, imaginative Verfahren, Hypnotherapie und Psychoanalyse.

In this article, the contribution of the psychotherapy schools to psychological pain therapy shall be explained. In the first part, relaxation methods, imaginative techniques hypnotherapy, and psychoanalysis as well as their importance for psychological pain therapy are presented. Research findings for autogenic training, progressive muscle relaxation and meditative methods are shown as example for relaxation methods. Imagery is shortly explained and associated to hypnotherapeutic methods. In hypnotherapy, research results, the pattern of a session and hypnotherapeutic strategies for pain reduction are demonstrated. In the explanation of psychoanalysis, the aims and explanation principles of analytic methods for the psychogenic pain development are shown.

[Rational therapy of chronic pain conductions by the family physician]. / Rationale Therapie chronischer Schmerzzustände durch den Hausarzt.

Despite numerous efforts to establish an adequate pain treatment, many patients still do not receive a proper pain therapy. This is unfortunate as it is estimated that between 5 and 7.6 Mi. people are suffering from chronic pain in Germany. This paper is demonstrating an adequate pain management for different diseases including an interdisciplinary approach. Further, we hope to reduce the fear of many physicians for the administration of opioid analgetics to realize a proper pain treatment where indicated.

Effects of rehabilitation exercise programmes on anxiety and depression in coronary patients: a meta-analysis.

In coronary patients, emotional disturbances in the sense of increased anxiety and depression have often been documented. Over the last years, there has been a growing interest in the effects of exercise on emotion. This meta-analysis, based on 13 to 15 studies on psychological effects of exercise programmes in coronary patients, showed a positive effect size both for anxiety (dmean = .3137) and depression (dmean = .4569). Nevertheless, these effect sizes have to be evaluated as less than medium by convention and in comparison to the effect size of psychotherapeutic interventions. The effect sizes on anxiety or depression were not related to methodological characteristics of the included studies, like duration of the exercise programme, time chosen for follow-up, publication year or use of control groups. But there was a significantly negative correlation between sample size and effect size. This might indicate a potential publication bias in the sense that significant rather than non-significant results may be published on small subject samples. We concluded that exercise programmes should not be considered the only treatment for emotional disturbances in coronary patients, but that they can be psychologically beneficial as an additional treatment component.

Rise in systolic blood pressure during sphygmomanometry depends on the maximum inflation pressure of the arm cuff.

OBJECTIVE: Sphygmomanometric recordings of blood pressure are a standard technique in clinical practice. We investigated whether arm-cuff inflation can induce short-term blood pressure changes ('cuff-inflation hypertension'), limiting the generalizability of recordings. METHODS: Progress in biomedical methodology makes it feasible to monitor blood pressure continuously and non-invasively at the finger artery (the Peñaz method). Seventy-two normotensive subjects were randomly assigned either to a series of sphygmomanometric recordings in which a maximum cuff pressure of 300 mmHg was applied, to a series in which the maximum cuff pressure was 175 mmHg or to a control group in whom no sphygmomanometric recordings were made. RESULTS: The subjects exposed to arm-cuff inflations perceived the cuff inflation pressure, but their perception could not differentiate between the two maximum cuff pressures. Furthermore, increases in systolic blood pressure during the inflation period were recorded when a maximum cuff pressure of 300 mmHg was applied. The effects on diastolic blood pressure were not significant. CONCLUSIONS: The maximum arm-cuff pressure during sphygmomanometry should be not too far above the pressure needed to occlude the brachial artery. A high maximum arm-cuff pressure increases the chances of inducing 'cuff-inflation hypertension'.