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Ivaškevičius V, Biswas A, Singh S, Stulpinaitė U, Reda S, Rühl H, Pezeshkpoor B, Pavlova A, Oldenburg J. Fibrinogen Bonn (p. Arg510Cys) in the Aα-Chain Is Associated with High Risk of Venous Thrombosis. Hamostaseologie 2023; 43:440-446. [PMID: 37442158 DOI: 10.1055/a-2094-7191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/15/2023] Open
Abstract
INTRODUCTION Inherited dysfibrinogenemia is a qualitative defect of fibrinogen caused by various mutations among three fibrinogen genes. Dysfibrinogenemia can be associated with an increased risk of thrombosis, bleeding, or both. Here, we report a 36-year-old female with dysfibrinogenemia who experienced two successful pregnancies under thromboprophylaxis after cerebral venous sinus thrombosis (CVST). PATIENTS AND METHODS In addition to plasmatic coagulation tests, fibrinogen genes FGA, FGB, and FGG were screened using direct genomic DNA sequencing. The structural-functional implications of the detected mutation were analyzed in silico. RESULTS Inherited dysfibrinogenemia was diagnosed in an index patient after CVST in a risk situation. Anticoagulation with warfarin was stopped after 12 months when the first pregnancy was planned. Pregnancy and spontaneous delivery (2020) was uncomplicated. A second pregnancy was interrupted because of acute cytomegalovirus infection and the third pregnancy was successful in 2022. Pregnancies were accompanied by thromboprophylaxis with enoxaparin 40 mg once daily until 6 weeks postpartum. Substitution of fibrinogen has not become necessary in the index patient so far. Genetic analysis revealed a novel missense mutation (p. Arg510Cys) in the FGA gene ("fibrinogen Bonn") in the index patient, as well as an asymptomatic sister, and their father who experienced recurrent pulmonary embolism. Surface exposure of wild-type Arg510 suggested the mutated Cys510 to form nonnative disulfide bonds with surface-exposed reactive cysteines from other plasma proteins like albumin leading to formation of aggregates and impaired fibrinolysis. CONCLUSIONS Fibrinogen Bonn might be associated with an increased risk of thrombosis, possibly due to impaired polymerization.
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Affiliation(s)
- V Ivaškevičius
- Institute for Experimental Hematology and Transfusion Medicine, University Hospital Bonn, Bonn, Germany
| | - A Biswas
- Institute for Experimental Hematology and Transfusion Medicine, University Hospital Bonn, Bonn, Germany
| | - S Singh
- Institute for Experimental Hematology and Transfusion Medicine, University Hospital Bonn, Bonn, Germany
| | - U Stulpinaitė
- Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - S Reda
- Institute for Experimental Hematology and Transfusion Medicine, University Hospital Bonn, Bonn, Germany
| | - H Rühl
- Institute for Experimental Hematology and Transfusion Medicine, University Hospital Bonn, Bonn, Germany
| | - B Pezeshkpoor
- Institute for Experimental Hematology and Transfusion Medicine, University Hospital Bonn, Bonn, Germany
| | - A Pavlova
- Institute for Experimental Hematology and Transfusion Medicine, University Hospital Bonn, Bonn, Germany
| | - J Oldenburg
- Institute for Experimental Hematology and Transfusion Medicine, University Hospital Bonn, Bonn, Germany
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Saxena A, Shovestul BJ, Dudek EM, Reda S, Venkataraman A, Lamberti JS, Dodell-Feder D. Training volitional control of the theory of mind network with real-time fMRI neurofeedback. Neuroimage 2023; 279:120334. [PMID: 37591479 DOI: 10.1016/j.neuroimage.2023.120334] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 07/12/2023] [Accepted: 08/14/2023] [Indexed: 08/19/2023] Open
Abstract
Is there a way improve our ability to understand the minds of others? Towards addressing this question, here, we conducted a single-arm, proof-of-concept study to evaluate whether real-time fMRI neurofeedback (rtfMRI-NF) from the temporo-parietal junction (TPJ) leads to volitional control of the neural network subserving theory of mind (ToM; the process by which we attribute and reason about the mental states of others). As additional aims, we evaluated the strategies used to self-regulate the network and whether volitional control of the ToM network was moderated by participant characteristics and associated with improved performance on behavioral measures. Sixteen participants underwent fMRI while completing a task designed to individually-localize the TPJ, and then three separate rtfMRI-NF scans during which they completed multiple runs of a training task while receiving intermittent, activation-based feedback from the TPJ, and one run of a transfer task in which no neurofeedback was provided. Region-of-interest analyses demonstrated volitional control in most regions during the training tasks and during the transfer task, although the effects were smaller in magnitude and not observed in one of the neurofeedback targets for the transfer task. Text analysis demonstrated that volitional control was most strongly associated with thinking about prior social experiences when up-regulating the neural signal. Analysis of behavioral performance and brain-behavior associations largely did not reveal behavior changes except for a positive association between volitional control in RTPJ and changes in performance on one ToM task. Exploratory analysis suggested neurofeedback-related learning occurred, although some degree of volitional control appeared to be conferred with the initial self-regulation strategy provided to participants (i.e., without the neurofeedback signal). Critical study limitations include the lack of a control group and pre-rtfMRI transfer scan, which prevents a more direct assessment of neurofeedback-induced volitional control, and a small sample size, which may have led to an overestimate and/or unreliable estimate of study effects. Nonetheless, together, this study demonstrates the feasibility of training volitional control of a social cognitive brain network, which may have important clinical applications. Given the study's limitations, findings from this study should be replicated with more robust experimental designs.
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Affiliation(s)
- Abhishek Saxena
- Department of Psychology, University of Rochester, 500 Wilson Blvd Rochester, NY 14627 USA
| | - Bridget J Shovestul
- Department of Psychology, University of Rochester, 500 Wilson Blvd Rochester, NY 14627 USA
| | - Emily M Dudek
- Department of Psychology, University of Houston, 3695 Cullen Boulevard Houston, TX 77204 USA
| | - Stephanie Reda
- Department of Psychology, University of Rochester, 500 Wilson Blvd Rochester, NY 14627 USA
| | - Arun Venkataraman
- School of Medicine and Dentistry, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY 14642 USA
| | - J Steven Lamberti
- Department of Psychiatry, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY 14642 USA
| | - David Dodell-Feder
- Department of Psychology, University of Rochester, 500 Wilson Blvd Rochester, NY 14627 USA; Department of Neuroscience, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY 14642 USA.
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Allen T, Reda S, Martin S, Long P, Franklin A, Bedoya SZ, Wiener L, Wolters PL. The Needs of Adolescents and Young Adults with Chronic Illness: Results of a Quality Improvement Survey. Children 2022; 9:children9040500. [PMID: 35455544 PMCID: PMC9025253 DOI: 10.3390/children9040500] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 03/25/2022] [Accepted: 03/29/2022] [Indexed: 11/16/2022]
Abstract
Adolescent and young adults (AYAs) with chronic illnesses cope with complex issues that require unique psychological support and healthcare services to reduce psychosocial difficulties, improve disease management, and facilitate positive transitions to adult care. Engaging patients and caregivers can help providers understand the specific needs of this population and identify the perceived areas of support. The purpose of this quality improvement initiative is to assess the needs of AYAs with chronic medical conditions at a large government research hospital. Eighty-nine AYA patients (age = 23.5 years; range 13–34) with neurofibromatosis type 1, cancer, primary immunodeficiencies, or sickle cell disease, and a sample of caregivers (n = 37, age = 52 years; range: 41–65), completed an anonymized survey that assessed their preferences for a wide range of informational and service-related needs. The results indicate an overwhelming desire for information about general health and wellbeing and disease-specific medical knowledge. The most endorsed item was the need for more information about an individual’s medical condition (72%), which was a primary concern across disease, racial, and gender groups. Demographic and disease-specific needs were also identified. Thus, providing information to AYA patients and caregivers is a critical and largely unmet component of care, which requires the development and implementation of targeted educational and psychosocial interventions.
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Yagan J, Mahmoud T, Geith O, El Serwey N, Mustafa M, Reda S, Nair P, AlOtaibi T. POS-822 SODIUM-GLUCOSE CO-TRANSPORTER 2 INHIBITORS (SGLT2i); SHORT-TERM OUTCOME IN DIABETIC KIDNEY TRANSPLANT RECIPIENTS. Kidney Int Rep 2022. [DOI: 10.1016/j.ekir.2022.01.858] [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] Open
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Martin S, Allen T, Toledo-Tamula MA, Struemph K, Reda S, Wolters PL, Baldwin A, Quinn M, Widemann BC. Acceptance and commitment therapy for adolescents and adults with neurofibromatosis type 1, plexiform neurofibromas, and chronic pain: Results of a randomized controlled trial. Journal of Contextual Behavioral Science 2021. [DOI: 10.1016/j.jcbs.2021.10.003] [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: 10/20/2022]
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Wolters PL, Reda S, Martin S, Al Ghriwati N, Baker M, Berg D, Erickson G, Franklin B, Merker VL, Oberlander B, Reeve S, Rohl C, Rosser T, Toledo-Tamula MA, Vranceanu AM. Impact of the coronavirus pandemic on mental health and health care in adults with neurofibromatosis: Patient perspectives from an online survey. Am J Med Genet A 2021; 188:71-82. [PMID: 34536052 PMCID: PMC8652613 DOI: 10.1002/ajmg.a.62490] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 07/19/2021] [Accepted: 08/10/2021] [Indexed: 01/25/2023]
Abstract
The coronavirus pandemic increased anxiety and stress and prevented access to health care worldwide; it is unclear how COVID-19 affected adults with a multisystem genetic disorder such as neurofibromatosis (NF). An anonymous online survey was distributed through an international registry and foundations to adults with NF (June-August 2020) to assess the impact of the pandemic on mental health and NF health care. Six hundred and thirteen adults (18-81 years; M = 45.7) with NF1 (77.8%), NF2 (14.2%), and schwannomatosis (7.8%) provided complete responses. Respondents rated moderate-to-high amounts of worry about the impact of COVID-19 on their emotional (46.3%) and physical health (46.7%), and 54.8% endorsed moderate-to-high pandemic-related stress. Adults with diagnosed/suspected mental health disorders or moderate-to-severe NF symptom impact as well as females endorsed higher COVID-19 stress (ps < 0.01). Less than half who missed a doctor's appointment for their NF care (43.4%) used telehealth. Of these, 33.3% and 46.2% reported that telehealth met their needs to a moderate or high degree, respectively. Results indicated that subgroups of adults with NF experience higher COVID-19-related worries and stress and may need additional support. Furthermore, telehealth is under-utilized and could help NF providers connect with patients, although improved delivery and patient training may facilitate expanded use of these services.
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Affiliation(s)
- Pamela L Wolters
- Pediatric Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Stephanie Reda
- Pediatric Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Staci Martin
- Pediatric Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Nour Al Ghriwati
- Pediatric Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Melissa Baker
- Pediatric Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Dale Berg
- Response Evaluation in Neurofibromatosis and Schwannomatosis (REiNS) International Collaboration
| | - Gregg Erickson
- Response Evaluation in Neurofibromatosis and Schwannomatosis (REiNS) International Collaboration.,NF Network, Wheaton, Illinois, USA
| | - Barbara Franklin
- Response Evaluation in Neurofibromatosis and Schwannomatosis (REiNS) International Collaboration
| | - Vanessa L Merker
- Department of Neurology and Cancer Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Beverly Oberlander
- Response Evaluation in Neurofibromatosis and Schwannomatosis (REiNS) International Collaboration.,NF Network, Wheaton, Illinois, USA
| | - Stephanie Reeve
- Response Evaluation in Neurofibromatosis and Schwannomatosis (REiNS) International Collaboration
| | - Claas Rohl
- Response Evaluation in Neurofibromatosis and Schwannomatosis (REiNS) International Collaboration.,NF Kinder, NF Patients United, Vienna, Austria
| | - Tena Rosser
- Division of Neurology, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Mary Anne Toledo-Tamula
- Clinical Research Directorate (CRD), Frederick National Laboratory for Cancer Research, Frederick, Maryland, USA
| | - Ana-Maria Vranceanu
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Hou Y, Allen T, Wolters PL, Toledo-Tamula MA, Martin S, Baldwin A, Reda S, Gillespie A, Goodwin A, Widemann BC. Predictors of cognitive development in children with neurofibromatosis type 1 and plexiform neurofibromas. Dev Med Child Neurol 2020; 62:977-984. [PMID: 32052421 PMCID: PMC7332409 DOI: 10.1111/dmcn.14489] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/06/2020] [Indexed: 11/29/2022]
Abstract
AIM To describe the cognitive development of children with neurofibromatosis type 1 (NF1) and plexiform neurofibromas, and identify predictors of cognitive development. METHOD Participants included 88 children with NF1 and plexiform neurofibromas (50 males, 38 females, aged 6-18y, mean=12y, SD=3y 7mo) on a natural history study at the National Cancer Institute. Neuropsychological assessments (e.g. IQ, academic achievement, attention, and executive functioning) were administered three times over 6 years. RESULTS Relative to normative peers, the total sample of children with NF1 and plexiform neurofibromas demonstrated significantly lower scores in most cognitive domains and decreasing z-scores over time in math, writing, inhibitory control, and working memory. Children who had parents with (vs without) NF1 were more likely to experience decreased z-scores in performance IQ, reading, writing, attention, and working memory. Higher (vs lower) parental education was related to higher levels of IQ, math, reading, and cognitive flexibility and a slower decrease in math z-scores. Children's sex and the number of NF1 disease-related complications were not related to most cognitive outcomes. INTERPRETATION Children with NF1 and plexiform neurofibromas are at high risk for cognitive difficulties and declining z-scores in various domains of cognitive functioning over time. The findings highlight the need for a better understanding of the within-group differences in these children and their need for individualized educational plans. WHAT THIS PAPER ADDS Math, writing, inhibitory control, and working memory scores decreased over time. The proportion of children with clinically significant cognitive deficits increased over time. Parental neurofibromatosis type 1 and low education were related to greater cognitive difficulties in children.
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Affiliation(s)
- Yang Hou
- Department of Family Sciences, University of Kentucky, Lexington, KY, USA
- NIH Pediatric Oncology Branch, National Cancer Institute, Bethesda, MD, USA
| | - Taryn Allen
- Clinical Research Directorate, Frederick National Laboratory for Cancer Research sponsored by the National Cancer Institute, Frederick, MD, USA
| | - Pamela L Wolters
- NIH Pediatric Oncology Branch, National Cancer Institute, Bethesda, MD, USA
| | - Mary Anne Toledo-Tamula
- Clinical Research Directorate, Frederick National Laboratory for Cancer Research sponsored by the National Cancer Institute, Frederick, MD, USA
| | - Staci Martin
- NIH Pediatric Oncology Branch, National Cancer Institute, Bethesda, MD, USA
| | - Andrea Baldwin
- Clinical Research Directorate, Frederick National Laboratory for Cancer Research sponsored by the National Cancer Institute, Frederick, MD, USA
| | - Stephanie Reda
- NIH Pediatric Oncology Branch, National Cancer Institute, Bethesda, MD, USA
| | - Andy Gillespie
- NIH Pediatric Oncology Branch, National Cancer Institute, Bethesda, MD, USA
| | - Anne Goodwin
- NIH Pediatric Oncology Branch, National Cancer Institute, Bethesda, MD, USA
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López F, García-Marín R, Suárez-Fernández L, Naves-Cabal V, Riobello C, Reda S, Hermsen M, Llórente J. PO-180 InfiltratingCD8 + T-cells and PD-L1 expression as indicators for immunotherapy in sinonasal cancer. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)30346-9] [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: 11/17/2022]
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Kolbitsch T, Larbig R, Reda S, Blasius A, Paar V, Wernly B, Ohnewein B, Dinges C, Lichtenauer M, Brandt M, Hoppe UC, Motloch LJ. P5136Coronary tortuosity is an indicator of poor controlled arterial hypertension and correlates with the severity of dyspnea in the absence of coronary artery disease. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p5136] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- T Kolbitsch
- University Clinics Salzburg, Internal Medicine II, Salzburg, Austria
| | - R Larbig
- Clinics Maria Hilf, Cardiology, Mönchengladbach, Germany
| | - S Reda
- University Clinics Salzburg, Internal Medicine II, Salzburg, Austria
| | - A Blasius
- Clinics Maria Hilf, Cardiology, Mönchengladbach, Germany
| | - V Paar
- University Clinics Salzburg, Internal Medicine II, Salzburg, Austria
| | - B Wernly
- University Clinics Salzburg, Internal Medicine II, Salzburg, Austria
| | - B Ohnewein
- University Clinics Salzburg, Internal Medicine II, Salzburg, Austria
| | - C Dinges
- University Clinics Salzburg, Cardiac Surgery, Salzburg, Austria
| | - M Lichtenauer
- University Clinics Salzburg, Internal Medicine II, Salzburg, Austria
| | - M Brandt
- University Clinics Salzburg, Internal Medicine II, Salzburg, Austria
| | - U C Hoppe
- University Clinics Salzburg, Internal Medicine II, Salzburg, Austria
| | - L J Motloch
- University Clinics Salzburg, Internal Medicine II, Salzburg, Austria
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Motloch LJ, Larbig R, Darabi T, Reda S, Motloch KA, Wernly B, Lichtenauer M, Gebing T, Schwaiger A, Zagidullin N, Wolny M, Hoppe UC. Long-QT syndrome-associated caveolin-3 mutations differentially regulate the hyperpolarization-activated cyclic nucleotide gated channel 4. Physiol Int 2017. [DOI: 10.1556/2060.104.2017.2.6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background
Caveolin-3 (cav-3) mutations are linked to the long-QT syndrome (LQTS) causing distinct clinical symptoms. Hyperpolarization-activated cyclic nucleotide channel 4 (HCN4) underlies the pacemaker current If. It associates with cav-3 and both form a macromolecular complex.
Methods
To examine the effects of human LQTS-associated cav-3 mutations on HCN4-channel function, HEK293-cells were cotransfected with HCN4 and wild-type (WT) cav-3 or a LQTS-associated cav-3 mutant (T78M, A85T, S141R, or F97C). HCN4 currents were recorded using the whole-cell patch-clamp technique.
Results
WT cav-3 significantly decreased HCN4 current density and shifted midpoint of activation into negative direction. HCN4 current properties were differentially modulated by LQTS-associated cav-3 mutations. When compared with WT cav-3, A85T, F97C, and T78M did not alter the specific effect of cav-3, but S141R significantly increased HCN4 current density. Compared with WT cav-3, no significant modifications of voltage dependence of steady-state activation curves were observed. However, while WT cav-3 alone had no significant effect on HCN4 current activation, all LQTS-associated cav-3 mutations significantly accelerated HCN4 activation kinetics.
Conclusions
Our results indicate that HCN4 channel function is modulated by cav-3. LQTS-associated mutations of cav-3 differentially influence pacemaker current properties indicating a pathophysiological role in clinical manifestations.
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Affiliation(s)
- LJ Motloch
- 1Department of Internal Medicine II, Paracelsus Medical University, Salzburg, Austria
| | - R Larbig
- 2Division of Electrophysiology, Department of Cardiovascular Medicine, University Hospital Muenster, Muenster, Germany
| | - T Darabi
- 1Department of Internal Medicine II, Paracelsus Medical University, Salzburg, Austria
| | - S Reda
- 1Department of Internal Medicine II, Paracelsus Medical University, Salzburg, Austria
| | - KA Motloch
- 3Research Program for Ophthalmology and Glaucoma Research, University Clinic of Ophthalmology and Optometry, Paracelsus Medical University/SALK, Salzburg, Austria
| | - B Wernly
- 1Department of Internal Medicine II, Paracelsus Medical University, Salzburg, Austria
| | - M Lichtenauer
- 1Department of Internal Medicine II, Paracelsus Medical University, Salzburg, Austria
| | - T Gebing
- 1Department of Internal Medicine II, Paracelsus Medical University, Salzburg, Austria
| | - A Schwaiger
- 1Department of Internal Medicine II, Paracelsus Medical University, Salzburg, Austria
| | - N Zagidullin
- 4Department of Internal Diseases, Bashkir State Medical University, Ufa, Russia
| | - M Wolny
- 1Department of Internal Medicine II, Paracelsus Medical University, Salzburg, Austria
| | - UC Hoppe
- 1Department of Internal Medicine II, Paracelsus Medical University, Salzburg, Austria
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El-Moghazy E, Abd-Elmageed AE, Reda S. Measurements of UV-A radiation and hazard limits from some types of outdoor lamps. Int J Metrol Qual Eng 2014; 5:407. [DOI: 10.1051/ijmqe/2014021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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Abstract
Chronic heart failure has an age-dependent prevalence of 2% and is therefore one of the most frequent diseases in western societies. A reduced hemoglobin concentration according to the definition of the World Health Organization is a common comorbidity affecting more than half of all heart failure patients. Elderly patients, patients suffering from renal impairment and women are more likely to develop anemia but a definitive etiology of anemia is only identified in the minority of cases. Anemia is associated with a poor clinical status and a greater risk of hospitalization and is a predictive factor for increased mortality. The incidence of anemia appears to increase with a poorer functional class. Intravenous iron therapy improves the exercise capacity in patients with systolic heart failure and iron deficiency and is currently being recommended for patients with persistent symptoms despite optimal medical and device therapy. However, erythropoietin-stimulating agents as a treatment for anemia in chronic heart failure have failed to improve clinical outcome in a large randomized trial. In patients with heart failure but with maintained ejection fraction, anemia is also associated with a poor prognosis. Specific therapeutic recommendations for these patients are still not available.
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Affiliation(s)
- S Reda
- Klinik II für Innere Medizin, Paracelsus Medizinische Privatuniversität, Müllner Hauptstr. 48, A-5020, Salzburg, Österreich,
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Rottlaender D, Motloch L, Reda S, Larbig R, Hoppe U. Cardiac arrest due to long QT syndrome associated with excessive consumption of energy drinks. Int J Cardiol 2012; 158:e51-2. [DOI: 10.1016/j.ijcard.2011.10.017] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2011] [Accepted: 10/18/2011] [Indexed: 10/15/2022]
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Rottlaender D, Reda S, Motloch LJ, Hoppe UC. [New tyrosine kinase and EGFR inhibitors in cancer therapy. Cardiac and skin toxicity as relevant side effects. Part A: heart]. Internist (Berl) 2011; 52:1245-55. [PMID: 21792599 DOI: 10.1007/s00108-011-2895-3] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Cardiotoxicity is a serious side effect of targeted molecular therapies in cancer treatment. Monoclonal antibodies and tyrosine kinase inhibitors are known to be potent therapies in various neoplastic diseases due to inhibition of specific signal transduction pathways. Although targeted therapies are considered to be less toxic and better tolerated than common chemotherapies certain cardiac side effects have been observed. Cardiac toxicity may range from asymptomatic reduction of left ventricular function to life-threatening events like heart failure and acute coronary syndrome. Further side effects are arterial hypertension, thrombosis and arrhythmias. Cardiovascular side effects are common for anti-HER2 therapy in combination with anthracyclines and for inhibitors of angiogenesis. In these patients careful cardiac monitoring is warranted. Because of missing randomized long-term follow-ups, information about cardiac side effects is limited in newly developed targeted molecular therapies. In case of cardiac side effects or preexisting cardiac disease before therapy initiation, assessments by a cardiologist throughout the course of treatment are important. For patients with severe cardiac side effects, discontinuation of treatment is warranted; in case of asymptomatic cardiac side effects symptom-specific therapy should be performed.
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Affiliation(s)
- D Rottlaender
- Klinik III für Innere Medizin, Universität zu Köln, Kerpener-Straße 62, 50937, Köln, Deutschland
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Abstract
BACKGROUND Prompts to encourage attendance at clinics are often used in day-to-day practice by diligent carers of people with mental health problems. These may take the form of telephone prompting, financial incentives or issuing a copy of the referral letter to the appointee. OBJECTIVES To estimate the effects of simple prompting by professional carers to encourage attendance at clinics for those with serious mental illness. SEARCH STRATEGY Methodical searches of Biological Abstracts (1985-2000), CINAHL (1982-2000), Cochrane Schizophrenia Group's Register (June 2000), Cochrane Library (Issue 2, 2000), EMBASE (1980-2000), MEDLINE (1966-2000) and PsycLIT (1887-2000) were undertaken. These were supplemented by searching of reference lists, personal contact and hand searching of high yield journals. SELECTION CRITERIA All relevant randomised (or quasi-randomised) studies comparing the addition of 'prompts' to standard care for those with serious mental illnesses such as schizophrenia. Prompts had the stated purpose of encouraging attendance or contact with mental health teams and could be text-based, electronic, by telephone call, by personal visit, or could employ financial or other rewards. DATA COLLECTION AND ANALYSIS Studies and data were independently selected and extracted. For homogeneous dichotomous data the random effects relative risk (RR), the 95% confidence intervals (CI) and, where appropriate, the number needed to treat (NNT) were calculated on an intention-to-treat basis. For continuous data the reviewers calculated weighted mean differences. MAIN RESULTS Only three relevant trials were identified (total n=597). It is not clear whether there is any real difference between attendance of those prompted by telephone one or two days before the appointment, and those given the standard appointment management system (2 trials, n=457, RR missed appointment 0.84 CI 0.7 to 1.1). Text-based prompts, a few days before the appointment day, did increase clinic attendance when compared with no prompt (2 trials, n=200, RR missed appointment 0.6 CI 0.4 to 0.9, NNT 6 CI 2 to 14). Only one small study (n=61) reported data on the combination of telephone and text-based prompts versus no prompt (RR missed appointments 0.7 CI 0.4 to 1.2). When telephone prompts were compared with text-based prompts (1 trial, n=75), the latter, in the form of an 'orientation statement' (a short paragraph, taking about 30 seconds to read, explaining the programme of care, the fee system, and providing gentle encouragement) may be somewhat more effective than the telephone prompt (RR missed appointments 1.9 CI 0.98 to 3.8). One last study (n=120) compared a standard letter prompt with a letter 'orientation statement'. Overall, results tended to favour the orientation statement approach rather than the simple letter prompting attendance but the results did not reach conventional levels of statistical significance (RR missed appointments 1.6 CI 0.9 to 2.9). REVIEWER'S CONCLUSIONS There is evidence that a simple prompt to attend clinic, very close to the time of the appointment may encourage attendance, and a simple orientation-type letter, 24 hours before the clinic appointment, may be more effective than a telephone prompt. This simple intervention could be a more cost effective means of encouraging compliance at first attendance, but supplementing these data with the results of large, well designed, conducted and reported randomised studies would be desirable.
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Affiliation(s)
- S Reda
- European Institute of Health and Mental Science, University of Surrey, Guildford, Surrey, UK, GU2 5XH.
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17
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Abstract
To determine whether casual contact with former psychiatric patients changes public perceptions of and attitudes toward persons with mental illness, 100 residents of urban North London, England, were interviewed before and six months after a residential facility for former patients was opened in their neighborhood. Their responses were compared with those of a control group of residents living elsewhere. The semistructured, door-to-door interviews revealed extremely negative attitudes toward persons with mental illness, largely formed by the media. No differences between the study and control groups were found. The negative attitudes in the study group had not changed at the six-month interview.
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Affiliation(s)
- S Reda
- University of Survey, Guildford, England
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18
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Abstract
The trend in psychiatric care in the National Health Service in Britain is to move patients into the community. However, few attempts have been made to identify public opinions about such moves. This paper describes public beliefs of mental illness and their attitudes towards patients moved from two large institutions into their neighbourhood. Residents local to a community mental health facility were interviewed before and six months after opening the facility. The results shows that public attitudes remain negative. It seems that deinstitutionalisation has little impact on public attitudes. No distinction could be drawn between the study and control groups.
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Affiliation(s)
- S Reda
- European Institute for Health and Medical Sciences, University of Surrey, Guildford, England
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19
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Abstract
The objective of this study was to investigate the staff's experiences involved in the processes of the transition of 20 non-demented long-stay psychiatric patients. Staff members expressed satisfaction from working outside the hospital. They believed that the patients' condition and their quality of life had improved and that they were likely to achieve successful resettlement after a lengthy process of rehabilitation. However, staff members considered that their roles were demanding and involved a lot of domestic activities. They recommended gradual and slow preparation for the patients, and an educational programme for the public as well as appropriate preparation and continuing professional support for staff.
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Thornicroft G, Gooch C, O'Driscoll C, Reda S. The TAPS Project. 9: The reliability of the Patient Attitude Questionnaire. Br J Psychiatry Suppl 1993:25-9. [PMID: 8484927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The development of the hospital and community versions of the Patient Attitude Questionnaire is described. The instrument rates the attitudes of psychiatric patients towards their treatment settings and staff, and is framed specifically to assess attitudinal change during the transfer of patients from hospital. For the items rated using the kappa coefficient of agreement, the mean test-retest reliability value was 0.51, and the average inter-rater value was 0.82. This study shows that long-term psychiatric patients are able to give clear and consistent views about their living arrangements--views that should be sought and respected by staff.
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