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Camp I, Füszl A, Selitsch B, Kröckel I, Kovac K, Wahrmann M, Steinlechner B, Weber J, Schellongowski P, Zauner C, Sengölge G, Seitz T, Zoufaly A, Ströbele B, Fuchs S, Lass-Flörl C, Burgmann H, Kundi M, Willinger B. Is the T2 magnetic resonance imaging Candida panel a suitable alternative to the SeptiFast for the rapid diagnosis of candidemia in routine clinical practice? Clin Microbiol Infect 2024:S1198-743X(24)00099-5. [PMID: 38432432 DOI: 10.1016/j.cmi.2024.02.024] [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: 04/06/2023] [Revised: 02/11/2024] [Accepted: 02/27/2024] [Indexed: 03/05/2024]
Abstract
OBJECTIVES The diagnosis of invasive Candida infection remains challenging because of tests with slow turnaround times or mediocre performance. T2magnetic resonance imaging is a new diagnostic tool. We investigated the diagnostic accuracy of the T2Candida panel (T2) in comparison with blood culture (BC) and the SeptiFast (SF) for the detection of five different Candida species among high-risk intensive care unit patients with suspected candidemia. METHODS We analysed blood samples collected from patients with suspected candidemia (177 samples from 138 patients) from August 2018 to April 2020. Blood samples were collected and analysed concurrently by BC, SF, and T2Candida. Subsequently, based on clinical and microbiological findings, patient samples were assigned to specific risk categories (proven, probable, and no candidemia). RESULTS Twenty-two samples from 17 patients were classified as proven candidemia, and 15 samples from 14 patients were classified as probable candidemia. A sensitivity of 68.2% (95% CI, 45-86%) was observed for the BC and the SF, and a sensitivity of 63.6% (95% CI, 41-83%) was observed for the T2 when only cases with proven candidemia were evaluated. For proven and probable candidemia, the sensitivity was 40.5% (95% CI, 23-58%) for BC, 81.1% (95% CI, 65-92%) for SF, and 73.0% (95% CI, 56-86%) for T2. DISCUSSION The diagnostic performance of SF and T2 was similar. For samples with proven/probable candidemia, SF and T2 had a higher sensitivity compared to BC. Used in conjunction with other diagnostic methods, T2 can replace the no longer available SF for the diagnosis of candidemia, enabling the timely initiation of targeted antifungal therapy.
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Affiliation(s)
- Iris Camp
- Division of Clinical Microbiology, Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Astrid Füszl
- Institute for Medical Microbiology and Hygiene, Österreichische Agentur für Gesundheit und Ernährungssicherheit (AGES), Vienna, Austria
| | - Brigitte Selitsch
- Division of Clinical Microbiology, Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Ivonne Kröckel
- Division of Cardiothoracic and Vascular Anesthesia and Intensive Care, Medical University of Vienna, Vienna, Austria
| | - Katharina Kovac
- Division of Cardiothoracic and Vascular Anesthesia and Intensive Care, Medical University of Vienna, Vienna, Austria
| | - Martin Wahrmann
- Division of Cardiothoracic and Vascular Anesthesia and Intensive Care, Medical University of Vienna, Vienna, Austria
| | - Barbara Steinlechner
- Division of Cardiothoracic and Vascular Anesthesia and Intensive Care, Medical University of Vienna, Vienna, Austria
| | - Johannes Weber
- University Department of Anesthesia, Intensive Care Medicine and Pain Medicine, Intensive Care Unit 9D, Medical University of Vienna, Vienna, Austria
| | - Peter Schellongowski
- Department of Medicine I, Intensive Care Unit 13i2, Comprehensive Cancer Center, Center of Excellence in Medical Intensive Care, Medical University of Vienna, Vienna, Austria
| | - Christian Zauner
- Department of Medicine III, Intensive Care Unit 13H1, Medical University of Vienna, Vienna, Austria
| | - Guerkan Sengölge
- Department of Internal Medicine III, Division of Nephrology and Dialysis, Medical University of Vienna, Vienna, Austria
| | - Tamara Seitz
- 4th Medical Department with Infectious Diseases and Tropical Medicine, Klinik Favoriten, Austria and Sigmund Freud University Vienna, Vienna, Austria
| | - Alexander Zoufaly
- 4th Medical Department with Infectious Diseases and Tropical Medicine, Klinik Favoriten, Austria and Sigmund Freud University Vienna, Vienna, Austria
| | - Barbara Ströbele
- University Hospital of St. Pölten, Institute for Hygiene and Microbiology, St Pölten, Austria
| | - Stefan Fuchs
- Institute of Hygiene and Medical Microbiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Cornelia Lass-Flörl
- Institute of Hygiene and Medical Microbiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Heinz Burgmann
- Department of Internal Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Vienna, Austria
| | - Michael Kundi
- Department of Environmental Health, Medical University Vienna, Vienna, Austria
| | - Birgit Willinger
- Division of Clinical Microbiology, Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria.
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2
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Seitz T, Bergmayr F, Kitzberger R, Holbik J, Grieb A, Hind J, Lucny F, Tyercha A, Neuhold S, Krenn C, Wenisch C, Zoufaly A, Kaniusas E, Széles JC. Randomized controlled study to evaluate the safety and clinical impact of percutaneous auricular vagus nerve stimulation in patients with severe COVID-19. Front Physiol 2023; 14:1223347. [PMID: 37614753 PMCID: PMC10442574 DOI: 10.3389/fphys.2023.1223347] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 07/20/2023] [Indexed: 08/25/2023] Open
Abstract
Introduction: A severe course of COVID-19 is characterized by a hyperinflammatory state resulting in acute respiratory distress syndrome or even multi-organ failure along a derailed sympatho-vagal balance. Methods: In this prospective, randomized study, we evaluate the hypothesis that percutaneous minimally invasive auricular vagus nerve stimulation (aVNS) is a safe procedure and might reduce the rate of clinical complications in patients with severe course of COVID-19. In our study, patients with SARS-CoV-2 infection admitted to the intensive care unit with moderate-to-severe acute respiratory distress syndrome, however without invasive ventilation yet, were included and following randomization assigned to a group receiving aVNS four times per 24 h for 3 h and a group receiving standard of care (SOC). Results: A total of 12 patients were included (six in the aVNS and six in the SOC group). No side effects in aVNS were reported, especially no significant pain at device placement or during stimulation at the stimulation site or significant headache or bleeding after or during device placement or lasting skin irritation. There was no significant difference in the aVNS and SOC groups between the length of stay in the intensive care unit and at the hospital, bradycardia, delirium, or 90-day mortality. In the SOC group, five of six patients required invasive mechanical ventilation during their stay at hospital and 60% of them venovenous extracorporeal membrane oxygenation, compared to three of six patients and 0% in the aVNS group (p = 0.545 and p = 0.061). Discussion: Vagus nerve stimulation in patients with severe COVID-19 is a safe and feasible method. Our data showed a trend to a reduction of progression to the need of invasive ventilation and venovenous extracorporeal membrane oxygenation which encourages further research with larger patient samples.
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Affiliation(s)
- Tamara Seitz
- Department of Infectious Diseases and Tropical Medicine, Clinic Favoriten, Vienna, Austria
| | - Franziska Bergmayr
- Faculty of Medicine, Sigmund Freud University, Vienna, Austria
- Department of General Surgery, Division of Vascular Surgery, Center for Wound Surgery and Special Pain Therapy, Health Service Center of Vienna Privat Clinics, Medical University of Vienna, Vienna, Austria
- Department of Anesthesiology and General Intensive Care Medicine, Medical University of Vienna, Vienna, Austria
| | - Reinhard Kitzberger
- Department of Infectious Diseases and Tropical Medicine, Clinic Favoriten, Vienna, Austria
| | - Johannes Holbik
- Department of Infectious Diseases and Tropical Medicine, Clinic Favoriten, Vienna, Austria
| | - Alexander Grieb
- Department of Infectious Diseases and Tropical Medicine, Clinic Favoriten, Vienna, Austria
| | - Julian Hind
- Department of Infectious Diseases and Tropical Medicine, Clinic Favoriten, Vienna, Austria
| | - Felix Lucny
- Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria
| | - Alexander Tyercha
- Department of General Surgery, Division of Vascular Surgery, Center for Wound Surgery and Special Pain Therapy, Health Service Center of Vienna Privat Clinics, Medical University of Vienna, Vienna, Austria
| | - Stephanie Neuhold
- Department of Infectious Diseases and Tropical Medicine, Clinic Favoriten, Vienna, Austria
| | - Claus Krenn
- Department of Anesthesiology and General Intensive Care Medicine, Medical University of Vienna, Vienna, Austria
| | - Christoph Wenisch
- Department of Infectious Diseases and Tropical Medicine, Clinic Favoriten, Vienna, Austria
| | - Alexander Zoufaly
- Department of Infectious Diseases and Tropical Medicine, Clinic Favoriten, Vienna, Austria
- Faculty of Medicine, Sigmund Freud University, Vienna, Austria
| | - Eugenijus Kaniusas
- Faculty of Electrical Engineering and Information Technology, Institute of Biomedical Electronics, Vienna University of Technology (TU Wien), Vienna, Austria
| | - József Constantin Széles
- Department of General Surgery, Division of Vascular Surgery, Center for Wound Surgery and Special Pain Therapy, Health Service Center of Vienna Privat Clinics, Medical University of Vienna, Vienna, Austria
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3
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Pirabe A, Schrottmaier WC, Heber S, Schmuckenschlager A, Treiber S, Pereyra D, Santol J, Pawelka E, Traugott M, Schörgenhofer C, Seitz T, Karolyi M, Jilma B, Resch U, Zoufaly A, Assinger A. Immunoglobulin G production in COVID-19 - associations with age, outcome, viral persistence, inflammation and pro-thrombotic markers. J Infect Public Health 2023; 16:384-392. [PMID: 36702013 PMCID: PMC9862708 DOI: 10.1016/j.jiph.2023.01.016] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 01/16/2023] [Accepted: 01/19/2023] [Indexed: 01/22/2023] Open
Abstract
Age represents the major risk factor for fatal disease outcome in coronavirus disease (COVID-19) due to age-related changes in immune responses. On the one hand lymphocyte counts continuously decline with advancing age, on the other hand somatic hyper-mutations of B-lymphocytes and levels of class-switched antibodies diminish, resulting in lower neutralizing antibody titers. To date the impact of age on immunoglobulin G (IgG) production in response to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is unknown. Therefore, we investigated the impact of age on the onset of IgG production and its association with outcome, viral persistence, inflammatory and thrombotic markers in consecutive, hospitalized COVID-19 patients admitted to the Clinic Favoriten (Vienna, Austria) between April and October 2020 that fulfilled predefined inclusion criteria. Three different IgGs against SARS-CoV-2 (spike protein S1, nucleocapsid (NC), and the spike protein receptor binding domain (RBD)) were monitored in plasma of 97 patients upon admission and three times within the first week followed by weekly assessment during their entire hospital stay. We analyzed the association of clinical parameters including C-reactive protein (CRP), D-dimer levels and platelet count as well as viral persistence with the onset and concentration of different anti-SARS-CoV-2 specific IgGs. Our data demonstrate that in older individuals anti-SARS-CoV-2 IgG production increases earlier after symptom onset and that deceased patients have the highest amount of antibodies against SARS-CoV-2 whereas intensive care unit (ICU) survivors have the lowest titers. In addition, anti-SARS-CoV-2 IgG concentrations are not associated with curtailed viral infectivity, inflammatory or thrombotic markers, suggesting that not only serological memory but also other adaptive immune responses are involved in successful viral killing and protection against a severe COVID-19 infection.
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Affiliation(s)
- Anita Pirabe
- Institute of Vascular Biology and Thrombosis Research, Center of Physiology and Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Waltraud C. Schrottmaier
- Institute of Vascular Biology and Thrombosis Research, Center of Physiology and Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Stefan Heber
- Institute of Physiology, Center of Physiology and Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Anna Schmuckenschlager
- Institute of Vascular Biology and Thrombosis Research, Center of Physiology and Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Sonja Treiber
- Institute of Vascular Biology and Thrombosis Research, Center of Physiology and Pharmacology, Medical University of Vienna, Vienna, Austria
| | - David Pereyra
- Institute of Vascular Biology and Thrombosis Research, Center of Physiology and Pharmacology, Medical University of Vienna, Vienna, Austria,Department of Surgery, Division of Visceral Surgery, Medical University of Vienna, General Hospital Vienna, Vienna, Austria
| | - Jonas Santol
- Institute of Vascular Biology and Thrombosis Research, Center of Physiology and Pharmacology, Medical University of Vienna, Vienna, Austria,Department of Surgery, Division of Visceral Surgery, Medical University of Vienna, General Hospital Vienna, Vienna, Austria
| | - Erich Pawelka
- Department of Medicine IV, Clinic Favoriten, Vienna, Austria
| | | | - Christian Schörgenhofer
- Department of Clinical Pharmacology, Medical University of Vienna, General Hospital Vienna, Vienna, Austria
| | - Tamara Seitz
- Department of Medicine IV, Clinic Favoriten, Vienna, Austria
| | - Mario Karolyi
- Department of Medicine IV, Clinic Favoriten, Vienna, Austria
| | - Bernd Jilma
- Department of Clinical Pharmacology, Medical University of Vienna, General Hospital Vienna, Vienna, Austria
| | - Ulrike Resch
- Institute of Vascular Biology and Thrombosis Research, Center of Physiology and Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Alexander Zoufaly
- Department of Medicine IV, Clinic Favoriten, Vienna, Austria,Faculty of Medicine, Sigmund Freud University, Vienna, Austria
| | - Alice Assinger
- Institute of Vascular Biology and Thrombosis Research, Center of Physiology and Pharmacology, Medical University of Vienna, Vienna, Austria.
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Traugott MT, Pleininger S, Inschlag-Tisch S, Eder B, Seitz T, Merrelaar A, Reiß-Kornfehl J, Fussi J, Schindler S, Blaschitz M, Heger F, Indra A, Karolyi M, Staudacher M, Oelschlaegel T, Hoepler W, Neuhold S, Wenisch C. Correction: A case of fulminant respiratory diphtheria in a 24-year-old Afghan refugee in Austria in May 2022: a case report. Infection 2023; 51:497-498. [PMID: 36639594 PMCID: PMC10042953 DOI: 10.1007/s15010-022-01964-y] [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] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Affiliation(s)
- M T Traugott
- IV Medical Department with Infectious Diseases and Tropical Medicine, Clinic Favoriten, Kundratstraße 3, 1100, Vienna, Austria.
| | - S Pleininger
- Austrian Reference Centre for Diphtheria, Austrian Agency for Health and Food Safety, Vienna, Austria
| | - S Inschlag-Tisch
- Department of Internal Medicine, Cardiology and Nephrology, Hospital of Wiener Neustadt, Wiener Neustadt, Austria
| | - B Eder
- IV Medical Department with Infectious Diseases and Tropical Medicine, Clinic Favoriten, Kundratstraße 3, 1100, Vienna, Austria
| | - T Seitz
- IV Medical Department with Infectious Diseases and Tropical Medicine, Clinic Favoriten, Kundratstraße 3, 1100, Vienna, Austria
| | - A Merrelaar
- IV Medical Department with Infectious Diseases and Tropical Medicine, Clinic Favoriten, Kundratstraße 3, 1100, Vienna, Austria
| | - J Reiß-Kornfehl
- Department of Otorhinolaryngology, Hospital of Wiener Neustadt, Wiener Neustadt, Austria
| | - J Fussi
- Department of Internal Medicine, Cardiology and Nephrology, Hospital of Wiener Neustadt, Wiener Neustadt, Austria
| | - S Schindler
- Austrian Reference Centre for Diphtheria, Austrian Agency for Health and Food Safety, Vienna, Austria
| | - M Blaschitz
- Austrian Reference Centre for Diphtheria, Austrian Agency for Health and Food Safety, Vienna, Austria
| | - F Heger
- Austrian Reference Centre for Diphtheria, Austrian Agency for Health and Food Safety, Vienna, Austria
| | - A Indra
- Austrian Reference Centre for Diphtheria, Austrian Agency for Health and Food Safety, Vienna, Austria
| | - M Karolyi
- IV Medical Department with Infectious Diseases and Tropical Medicine, Clinic Favoriten, Kundratstraße 3, 1100, Vienna, Austria
| | - M Staudacher
- IV Medical Department with Infectious Diseases and Tropical Medicine, Clinic Favoriten, Kundratstraße 3, 1100, Vienna, Austria
| | - T Oelschlaegel
- IV Medical Department with Infectious Diseases and Tropical Medicine, Clinic Favoriten, Kundratstraße 3, 1100, Vienna, Austria
| | - W Hoepler
- IV Medical Department with Infectious Diseases and Tropical Medicine, Clinic Favoriten, Kundratstraße 3, 1100, Vienna, Austria
| | - S Neuhold
- IV Medical Department with Infectious Diseases and Tropical Medicine, Clinic Favoriten, Kundratstraße 3, 1100, Vienna, Austria
| | - C Wenisch
- IV Medical Department with Infectious Diseases and Tropical Medicine, Clinic Favoriten, Kundratstraße 3, 1100, Vienna, Austria
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5
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Seitz T, Holbik J, Grieb A, Karolyi M, Hind J, Gibas G, Neuhold S, Zoufaly A, Wenisch C. The Role of Bacterial and Fungal Superinfection in Critical COVID-19. Viruses 2022; 14:v14122785. [PMID: 36560789 PMCID: PMC9783059 DOI: 10.3390/v14122785] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 12/11/2022] [Accepted: 12/13/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The range of reported rates of bacterial and fungal superinfections in patients with a severe course of COVID-19 is wide, suggesting a lack of standardised reporting. METHODS The rates of bacterial and fungal superinfection were assessed using predefined criteria to differentiate between infection and contamination. RESULTS Overall, 117 patients admitted to the Intensive Care Unit due to severe COVID-19 were included. Overall, 55% of patients developed a superinfection and 13.6% developed a fungal superinfection (5.9% candidemia and 7.7% CAPA). The rate of ventilator-associated pneumonia was 65.2%. If superinfection was detected, the length of hospital stay was significantly longer and the mortality was especially increased if candidemia was detected. An increased risk of superinfection was observed in patients with pre-existing diabetes mellitus or chronic heart failure. The presence of immunomodulating therapy did not seem to have an impact on the frequency of superinfections. CONCLUSION Increased awareness of high superinfection rates, fungal infections in particular, in patients suffering from severe COVID-19 is necessary.
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Affiliation(s)
- Tamara Seitz
- Department of Infectious Diseases and Tropical Medicine, Klinik Favoriten, 1100 Vienna, Austria
- Correspondence: ; Tel.: +43-6019172412; Fax: +43-1601912419
| | - Johannes Holbik
- Department of Infectious Diseases and Tropical Medicine, Klinik Favoriten, 1100 Vienna, Austria
| | - Alexander Grieb
- Department of Infectious Diseases and Tropical Medicine, Klinik Favoriten, 1100 Vienna, Austria
| | - Mario Karolyi
- Department of Infectious Diseases and Tropical Medicine, Klinik Favoriten, 1100 Vienna, Austria
| | - Julian Hind
- Department of Infectious Diseases and Tropical Medicine, Klinik Favoriten, 1100 Vienna, Austria
| | - Georg Gibas
- Department of Infectious Diseases and Tropical Medicine, Klinik Favoriten, 1100 Vienna, Austria
| | - Stephanie Neuhold
- Department of Infectious Diseases and Tropical Medicine, Klinik Favoriten, 1100 Vienna, Austria
| | - Alexander Zoufaly
- Department of Infectious Diseases and Tropical Medicine, Klinik Favoriten, 1100 Vienna, Austria
- Faculty of Medicine, Sigmund Freud University, 1020 Vienna, Austria
| | - Christoph Wenisch
- Department of Infectious Diseases and Tropical Medicine, Klinik Favoriten, 1100 Vienna, Austria
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6
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Traugott MT, Pleininger S, Inschlag-Tisch S, Eder B, Seitz T, Merrelaar A, Reiß-Kornfehl J, Fussi J, Schindler S, Blaschitz M, Heger F, Indra A, Karolyi M, Staudacher M, Oelschlaegel T, Hoepler W, Neuhold S, Wenisch C. A case of fulminant respiratory diphtheria in a 24-year-old Afghan refugee in Austria in May 2022: a case report. Infection 2022; 51:489-495. [PMID: 36178603 PMCID: PMC10042955 DOI: 10.1007/s15010-022-01926-4] [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: 08/10/2022] [Accepted: 09/15/2022] [Indexed: 01/15/2023]
Abstract
PURPOSE Raising awareness of respiratory diphtheria and for the importance of early antitoxin administration. METHODS Report of a case of fulminant, imported respiratory diphtheria in an otherwise healthy 24-year-old Afghan refugee in Austria in May 2022. RESULT This was the first case of respiratory diphtheria in Austria since 1993. Diphtheria antitoxin was administered at an already progressed disease stage. This delay contributed to a fulminant disease course with multiorgan failure and death. CONCLUSION In high-income countries with low case numbers, awareness of respiratory diphtheria and for the importance of early antitoxin administration must be raised.
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Affiliation(s)
- M T Traugott
- IV Medical Department with Infectious Diseases and Tropical Medicine, Clinic Favoriten, Kundratstraße 3, 1100, Vienna, Austria.
| | - S Pleininger
- Austrian Reference Centre for Diphtheria, Austrian Agency for Health and Food Safety, Vienna, Austria
| | - S Inschlag-Tisch
- Department of Internal Medicine, Cardiology and Nephrology, Hospital of Wiener Neustadt, Wiener Neustadt, Austria
| | - B Eder
- IV Medical Department with Infectious Diseases and Tropical Medicine, Clinic Favoriten, Kundratstraße 3, 1100, Vienna, Austria
| | - T Seitz
- IV Medical Department with Infectious Diseases and Tropical Medicine, Clinic Favoriten, Kundratstraße 3, 1100, Vienna, Austria
| | - A Merrelaar
- IV Medical Department with Infectious Diseases and Tropical Medicine, Clinic Favoriten, Kundratstraße 3, 1100, Vienna, Austria
| | - J Reiß-Kornfehl
- Department of Otorhinolaryngology, Hospital of Wiener Neustadt, Wiener Neustadt, Austria
| | - J Fussi
- Department of Internal Medicine, Cardiology and Nephrology, Hospital of Wiener Neustadt, Wiener Neustadt, Austria
| | - S Schindler
- Austrian Reference Centre for Diphtheria, Austrian Agency for Health and Food Safety, Vienna, Austria
| | - M Blaschitz
- Austrian Reference Centre for Diphtheria, Austrian Agency for Health and Food Safety, Vienna, Austria
| | - F Heger
- Austrian Reference Centre for Diphtheria, Austrian Agency for Health and Food Safety, Vienna, Austria
| | - A Indra
- Austrian Reference Centre for Diphtheria, Austrian Agency for Health and Food Safety, Vienna, Austria
| | - M Karolyi
- IV Medical Department with Infectious Diseases and Tropical Medicine, Clinic Favoriten, Kundratstraße 3, 1100, Vienna, Austria
| | - M Staudacher
- IV Medical Department with Infectious Diseases and Tropical Medicine, Clinic Favoriten, Kundratstraße 3, 1100, Vienna, Austria
| | - T Oelschlaegel
- IV Medical Department with Infectious Diseases and Tropical Medicine, Clinic Favoriten, Kundratstraße 3, 1100, Vienna, Austria
| | - W Hoepler
- IV Medical Department with Infectious Diseases and Tropical Medicine, Clinic Favoriten, Kundratstraße 3, 1100, Vienna, Austria
| | - S Neuhold
- IV Medical Department with Infectious Diseases and Tropical Medicine, Clinic Favoriten, Kundratstraße 3, 1100, Vienna, Austria
| | - C Wenisch
- IV Medical Department with Infectious Diseases and Tropical Medicine, Clinic Favoriten, Kundratstraße 3, 1100, Vienna, Austria
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7
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Karolyi M, Pawelka E, Omid S, Koenig F, Kauer V, Rumpf B, Hoepler W, Kuran A, Laferl H, Seitz T, Traugott M, Rathkolb V, Mueller M, Abrahamowicz A, Schoergenhofer C, Hecking M, Assinger A, Wenisch C, Zeitlinger M, Jilma B, Zoufaly A. Camostat Mesylate Versus Lopinavir/Ritonavir in Hospitalized Patients With COVID-19—Results From a Randomized, Controlled, Open Label, Platform Trial (ACOVACT). Front Pharmacol 2022; 13:870493. [PMID: 35935856 PMCID: PMC9354138 DOI: 10.3389/fphar.2022.870493] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 06/14/2022] [Indexed: 01/08/2023] Open
Abstract
Background: To date, no oral antiviral drug has proven to be beneficial in hospitalized patients with COVID-19.Methods: In this randomized, controlled, open-label, platform trial, we randomly assigned patients ≥18 years hospitalized with COVID-19 pneumonia to receive either camostat mesylate (CM) (considered standard-of-care) or lopinavir/ritonavir (LPV/RTV). The primary endpoint was time to sustained clinical improvement (≥48 h) of at least one point on the 7-category WHO scale. Secondary endpoints included length of stay (LOS), need for mechanical ventilation (MV) or death, and 29-day mortality.Results: 201 patients were included in the study (101 CM and 100 LPV/RTV) between 20 April 2020 and 14 May 2021. Mean age was 58.7 years, and 67% were male. The median time from symptom onset to randomization was 7 days (IQR 5–9). Patients in the CM group had a significantly shorter time to sustained clinical improvement (HR = 0.67, 95%-CI 0.49–0.90; 9 vs. 11 days, p = 0.008) and demonstrated less progression to MV or death [6/101 (5.9%) vs. 15/100 (15%), p = 0.036] and a shorter LOS (12 vs. 14 days, p = 0.023). A statistically nonsignificant trend toward a lower 29-day mortality in the CM group than the LPV/RTV group [2/101 (2%) vs. 7/100 (7%), p = 0.089] was observed.Conclusion: In patients hospitalized for COVID-19, the use of CM was associated with shorter time to clinical improvement, reduced need for MV or death, and shorter LOS than the use of LPV/RTV. Furthermore, research is needed to confirm the efficacy of CM in larger placebo-controlled trials.Systematic Review Registration: [https://clinicaltrials.gov/ct2/show/NCT04351724, https://www.clinicaltrialsregister.eu/ctr-search/trial/2020-001302-30/AT], identifier [NCT04351724, EUDRACT-NR: 2020–001302-30].
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Affiliation(s)
- M. Karolyi
- Department for Infectious Diseases and Tropical Medicine, Klinik Favoriten, Vienna, Austria
- *Correspondence: M. Karolyi,
| | - E. Pawelka
- Department for Infectious Diseases and Tropical Medicine, Klinik Favoriten, Vienna, Austria
| | - S. Omid
- Department for Infectious Diseases and Tropical Medicine, Klinik Favoriten, Vienna, Austria
| | - F. Koenig
- Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - V. Kauer
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - B. Rumpf
- Department of Internal Medicine III, Clinical Division of Nephrology and Dialysis, Medical University of Vienna, Vienna, Austria
| | - W. Hoepler
- Department for Infectious Diseases and Tropical Medicine, Klinik Favoriten, Vienna, Austria
| | - A. Kuran
- Department for Infectious Diseases and Tropical Medicine, Klinik Favoriten, Vienna, Austria
| | - H. Laferl
- Department for Infectious Diseases and Tropical Medicine, Klinik Favoriten, Vienna, Austria
| | - T. Seitz
- Department for Infectious Diseases and Tropical Medicine, Klinik Favoriten, Vienna, Austria
| | - M. Traugott
- Department for Infectious Diseases and Tropical Medicine, Klinik Favoriten, Vienna, Austria
| | - V. Rathkolb
- Department of Internal Medicine III, Clinical Division of Nephrology and Dialysis, Medical University of Vienna, Vienna, Austria
| | - M. Mueller
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - A. Abrahamowicz
- Faculty of Medicine, Sigmund Freud University, Vienna, Austria
| | - C. Schoergenhofer
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - M. Hecking
- Department of Internal Medicine III, Clinical Division of Nephrology and Dialysis, Medical University of Vienna, Vienna, Austria
| | - A. Assinger
- Department of Vascular Biology and Thrombosis Research, Center of Physiology and Pharmacology, Medical University of Vienna, Vienna, Austria
| | - C. Wenisch
- Department for Infectious Diseases and Tropical Medicine, Klinik Favoriten, Vienna, Austria
| | - M. Zeitlinger
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - B. Jilma
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - A. Zoufaly
- Department for Infectious Diseases and Tropical Medicine, Klinik Favoriten, Vienna, Austria
- Faculty of Medicine, Sigmund Freud University, Vienna, Austria
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8
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Seitz T, Szeles JC, Kitzberger R, Holbik J, Grieb A, Wolf H, Akyaman H, Lucny F, Tychera A, Neuhold S, Zoufaly A, Wenisch C, Kaniusas E. Percutaneous Auricular Vagus Nerve Stimulation Reduces Inflammation in Critical Covid-19 Patients. Front Physiol 2022; 13:897257. [PMID: 35860660 PMCID: PMC9289290 DOI: 10.3389/fphys.2022.897257] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 06/14/2022] [Indexed: 12/11/2022] Open
Abstract
Covid-19 is an infectious disease associated with cytokine storms and derailed sympatho-vagal balance leading to respiratory distress, hypoxemia and cardiovascular damage. We applied the auricular vagus nerve stimulation to modulate the parasympathetic nervous system, activate the associated anti-inflammatory pathways, and reestablish the abnormal sympatho-vagal balance. aVNS is performed percutaneously using miniature needle electrodes in ear regions innervated by the auricular vagus nerve. In terms of a randomized prospective study, chronic aVNS is started in critical, but not yet ventilated Covid-19 patients during their stay at the intensive care unit. The results show decreased pro-inflammatory parameters, e.g. a reduction of CRP levels by 32% after 1 day of aVNS and 80% over 7 days (from the mean 151.9 mg/dl to 31.5 mg/dl) or similarly a reduction of TNFalpha levels by 58.1% over 7 days (from a mean 19.3 pg/ml to 8.1 pg/ml) and coagulation parameters, e.g. reduction of DDIMER levels by 66% over 7 days (from a mean 4.5 μg/ml to 1.5 μg/ml) and increased anti-inflammatory parameters, e.g. an increase of IL-10 levels by 66% over 7 days (from the mean 2.7 pg/ml to 7 pg/ml) over the aVNS duration without collateral effects. aVNS proved to be a safe clinical procedure and could effectively supplement treatment of critical Covid-19 patients while preventing devastating over-inflammation.
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Affiliation(s)
- Tamara Seitz
- Department of Infectious Diseases and Tropical Medicine, Klinik Favoriten, Vienna, Austria
- *Correspondence: Tamara Seitz,
| | - József Constantin Szeles
- Department of General Surgery, Division of Vascular Surgery, Medical University of Vienna Center for Wound Surgery, Health Service Center of Vienna Privat Clinics, Vienna, Austria
| | - Reinhard Kitzberger
- Department of Infectious Diseases and Tropical Medicine, Klinik Favoriten, Vienna, Austria
| | - Johannes Holbik
- Department of Infectious Diseases and Tropical Medicine, Klinik Favoriten, Vienna, Austria
| | - Alexander Grieb
- Department of Infectious Diseases and Tropical Medicine, Klinik Favoriten, Vienna, Austria
| | - Hermann Wolf
- Immunology Outpatient Clinic, Vienna, Austria
- Medical School, Sigmund Freud Private University, Vienna, Austria
| | | | - Felix Lucny
- Department of General Surgery, Division of Vascular Surgery, Medical University of Vienna Center for Wound Surgery, Health Service Center of Vienna Privat Clinics, Vienna, Austria
| | - Alexander Tychera
- Department of General Surgery, Division of Vascular Surgery, Medical University of Vienna Center for Wound Surgery, Health Service Center of Vienna Privat Clinics, Vienna, Austria
| | - Stephanie Neuhold
- Department of Infectious Diseases and Tropical Medicine, Klinik Favoriten, Vienna, Austria
| | - Alexander Zoufaly
- Department of Infectious Diseases and Tropical Medicine, Klinik Favoriten, Vienna, Austria
- Medical School, Sigmund Freud Private University, Vienna, Austria
| | - Christoph Wenisch
- Department of Infectious Diseases and Tropical Medicine, Klinik Favoriten, Vienna, Austria
| | - Eugenijus Kaniusas
- Faculty of Electrical Engineering and Information Technology, Institute of Biomedical Electronics, Vienna University of Technology (TU Wien), Vienna, Austria
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Seitz T, Holbik J, Hind J, Gibas G, Karolyi M, Pawelka E, Traugott M, Wenisch C, Zoufaly A. Rapid Detection of Bacterial and Fungal Pathogens Using the T2MR versus Blood Culture in Patients with Severe COVID-19. Microbiol Spectr 2022; 10:e0014022. [PMID: 35695564 PMCID: PMC9241933 DOI: 10.1128/spectrum.00140-22] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 05/09/2022] [Indexed: 11/20/2022] Open
Abstract
A high rate of bacterial and fungal superinfections was reported in critically ill patients with COVID-19. However, diagnosis can be challenging. The aim of this study is to evaluate the sensitivity and the clinical utility of the point-of-care method T2 magnetic resonance (T2MR) with the gold standard: the blood culture. T2MR can potentially detect five different Candida species and six common bacteria (so-called "ESKAPE" pathogens including Escherichia coli, Staphylococcus aureus, Klebsiella pneumoniae, Acinet`obacter baumanii, Pseudomonas aeruginosa, and Enterococcus faecium). If superinfection was suspected in patients with COVID-19 admitted to the intensive care unit, blood culture and two panels of T2MR were performed. Eighty-five diagnostic bundles were performed in 60 patients in total. T2MR detected an ESKAPE pathogen in 9 out of 85 (10.6%) samples, compared to BC in 3 out of 85 (3.5%). A Candida species was detected in 7 of 85 (8.2%) samples of T2MR compared to 1 out of 85(1.2%) in blood culture. The mean time to positive test result in samples with concordant positive results was 4.5 h with T2MR and 52.5 h with blood culture. The additional use of T2MR enables a highly sensitive and rapid detection of ESKAPE and Candida pathogens. IMPORTANCE Coronavirus disease 2019 (COVID-19) has led to a high number of deaths since the beginning of the pandemic worldwide. One of the reasons is the high number of bacterial and fungal superinfections in patients suffering from critical disease. However, diagnosis is often challenging. In this study we could show that the additional use of the culture-independent method T2MR did not only show a much higher detection rate of bacterial and fungal pathogens but also a significantly shorter time until detection and therapy change compared to the gold standard: the blood culture. The implementation of T2MRin the care of patients with severe course of COVID-19 might lead to an earlier sufficient antimicrobial therapy and as a result lower mortality and less use of broad-spectrum unnecessary therapy reducing the risk of resistance development.
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Affiliation(s)
- Tamara Seitz
- Department of Infectious Diseases and Tropical Medicine, Klinik Favoriten, Vienna, Austria
| | - Johannes Holbik
- Department of Infectious Diseases and Tropical Medicine, Klinik Favoriten, Vienna, Austria
| | - Julian Hind
- Department of Infectious Diseases and Tropical Medicine, Klinik Favoriten, Vienna, Austria
| | - Georg Gibas
- Department of Infectious Diseases and Tropical Medicine, Klinik Favoriten, Vienna, Austria
| | - Mario Karolyi
- Department of Infectious Diseases and Tropical Medicine, Klinik Favoriten, Vienna, Austria
| | - Erich Pawelka
- Department of Infectious Diseases and Tropical Medicine, Klinik Favoriten, Vienna, Austria
| | - Marianna Traugott
- Department of Infectious Diseases and Tropical Medicine, Klinik Favoriten, Vienna, Austria
| | - Christoph Wenisch
- Department of Infectious Diseases and Tropical Medicine, Klinik Favoriten, Vienna, Austria
| | - Alexander Zoufaly
- Department of Infectious Diseases and Tropical Medicine, Klinik Favoriten, Vienna, Austria
- Faculty of Medicine, Sigmund Freud University, Vienna, Austria
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10
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Seitz T, Lickefett B, Traugott M, Pawelka E, Karolyi M, Baumgartner S, Jansen-Skoupy S, Atamaniuk J, Fritsche-Polanz R, Asenbaum J, Wenisch C, Födinger M, Zoufaly A. Evaluation of Five Commercial SARS-CoV-2 Antigen Tests in a Clinical Setting. J Gen Intern Med 2022; 37:1494-1500. [PMID: 35301660 PMCID: PMC8929460 DOI: 10.1007/s11606-022-07448-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 02/02/2022] [Indexed: 01/08/2023]
Abstract
BACKGROUND Point-of-care antigen tests (AgTs) for the detection of severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) enable the rapid testing of infected individuals and are easy-to-use. However, there are few studies evaluating their clinical use. OBJECTIVE The present study aimed to evaluate and compare the clinical performance characteristics of various commercial SARS-CoV-2 AgTs. DESIGN The sensitivity of five AgTs, comprising four rapid antigen tests (RAT; AMP Rapid Test SARS-CoV-2 Ag, NADAL COVID-19 Antigen Rapid Test, CLINITEST Rapid COVID-19 Antigen Test, and Roche SARS-CoV-2 Rapid Antigen Test) and one sandwich chemiluminescence immunoassay (CLIA; LIAISON SARS-CoV-2 Assay), were evaluated in 300 nasopharyngeal (NP) swabs. Reverse transcriptase (RT) polymerase chain reaction (PCR) was used as a reference method. PARTICIPANTS NP swabs were collected from patients admitted to hospital due to COVID-19. KEY RESULTS Sensitivities of the AgTs ranged from 64.9 to 91.7% for samples with RT-PCR cycle threshold (Ct) values lower than 30 and were 100% for cycle threshold (Ct) values lower than 20. The highest sensitivity was observed for CLINITEST Rapid COVID-19 Antigen Test, and Roche SARS-CoV-2 rapid antigen test. Multivariate analysis using time from symptom onset and the Ct value for AgT sensitivity showed an inverse correlation. Further, the female sex was an independent factor of lower RAT sensitivity. CONCLUSIONS Antigen tests from NP swab samples show high sensitivity in patients with a Ct value < 20. The best clinical sensitivity can be obtained using AgTs within the first 6 days after symptom onset.
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Affiliation(s)
- Tamara Seitz
- Department of Infectious Diseases and Tropical Medicine, Clinic Favoriten, Vienna, Austria.
| | - Benno Lickefett
- Department of Infectious Diseases and Tropical Medicine, Clinic Favoriten, Vienna, Austria
| | - Marianna Traugott
- Department of Infectious Diseases and Tropical Medicine, Clinic Favoriten, Vienna, Austria
| | - Erich Pawelka
- Department of Infectious Diseases and Tropical Medicine, Clinic Favoriten, Vienna, Austria
| | - Mario Karolyi
- Department of Infectious Diseases and Tropical Medicine, Clinic Favoriten, Vienna, Austria
| | - Sebastian Baumgartner
- Department of Infectious Diseases and Tropical Medicine, Clinic Favoriten, Vienna, Austria
| | - Sonja Jansen-Skoupy
- Institute of Laboratory Diagnostics, Clinic Favoriten, Vienna, Austria
- Medical Faculty, Sigmund Freud Private University, Vienna, Austria
| | - Johanna Atamaniuk
- Institute of Laboratory Diagnostics, Clinic Favoriten, Vienna, Austria
- Medical Faculty, Sigmund Freud Private University, Vienna, Austria
| | - Robert Fritsche-Polanz
- Institute of Laboratory Diagnostics, Clinic Favoriten, Vienna, Austria
- Medical Faculty, Sigmund Freud Private University, Vienna, Austria
| | - Johannes Asenbaum
- Institute of Laboratory Diagnostics, Clinic Favoriten, Vienna, Austria
- Medical Faculty, Sigmund Freud Private University, Vienna, Austria
| | - Christoph Wenisch
- Department of Infectious Diseases and Tropical Medicine, Clinic Favoriten, Vienna, Austria
| | - Manuela Födinger
- Institute of Laboratory Diagnostics, Clinic Favoriten, Vienna, Austria
- Medical Faculty, Sigmund Freud Private University, Vienna, Austria
| | - Alexander Zoufaly
- Department of Infectious Diseases and Tropical Medicine, Clinic Favoriten, Vienna, Austria
- Medical Faculty, Sigmund Freud Private University, Vienna, Austria
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11
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Kellner MJ, Ross JJ, Schnabl J, Dekens MPS, Matl M, Heinen R, Grishkovskaya I, Bauer B, Stadlmann J, Menéndez-Arias L, Straw AD, Fritsche-Polanz R, Traugott M, Seitz T, Zoufaly A, Födinger M, Wenisch C, Zuber J, Pauli A, Brennecke J. A Rapid, Highly Sensitive and Open-Access SARS-CoV-2 Detection Assay for Laboratory and Home Testing. Front Mol Biosci 2022; 9:801309. [PMID: 35433827 PMCID: PMC9011764 DOI: 10.3389/fmolb.2022.801309] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 03/01/2022] [Indexed: 11/20/2022] Open
Abstract
RT-qPCR-based diagnostic tests play important roles in combating virus-caused pandemics such as Covid-19. However, their dependence on sophisticated equipment and the associated costs often limits their widespread use. Loop-mediated isothermal amplification after reverse transcription (RT-LAMP) is an alternative nucleic acid detection method that overcomes these limitations. Here, we present a rapid, robust, and sensitive RT-LAMP-based SARS-CoV-2 detection assay. Our 40-min procedure bypasses the RNA isolation step, is insensitive to carryover contamination, and uses a colorimetric readout that enables robust SARS-CoV-2 detection from various sample types. Based on this assay, we have increased sensitivity and scalability by adding a nucleic acid enrichment step (Bead-LAMP), developed a version for home testing (HomeDip-LAMP), and identified open-source RT-LAMP enzymes that can be produced in any molecular biology laboratory. On a dedicated website, rtlamp.org (DOI: 10.5281/zenodo.6033689), we provide detailed protocols and videos. Our optimized, general-purpose RT-LAMP assay is an important step toward population-scale SARS-CoV-2 testing.
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Affiliation(s)
- Max J. Kellner
- Research Institute of Molecular Pathology (IMP), Vienna BioCenter (VBC), Vienna, Austria
- Institute of Molecular Biotechnology of the Austrian Academy of Sciences (IMBA), Vienna BioCenter (VBC), Vienna, Austria
- Vienna BioCenter PhD Program, Doctoral School of the University of Vienna and Medical University of Vienna, Vienna, Austria
- MRC Laboratory of Molecular Biology, Cambridge, United Kingdom
- *Correspondence: Max J. Kellner, ; Andrea Pauli, ; Julius Brennecke,
| | - James J. Ross
- Institute of Molecular Biotechnology of the Austrian Academy of Sciences (IMBA), Vienna BioCenter (VBC), Vienna, Austria
- Vienna BioCenter PhD Program, Doctoral School of the University of Vienna and Medical University of Vienna, Vienna, Austria
| | - Jakob Schnabl
- Institute of Molecular Biotechnology of the Austrian Academy of Sciences (IMBA), Vienna BioCenter (VBC), Vienna, Austria
- Vienna BioCenter PhD Program, Doctoral School of the University of Vienna and Medical University of Vienna, Vienna, Austria
| | - Marcus P. S. Dekens
- Research Institute of Molecular Pathology (IMP), Vienna BioCenter (VBC), Vienna, Austria
| | - Martin Matl
- Research Institute of Molecular Pathology (IMP), Vienna BioCenter (VBC), Vienna, Austria
- Institute of Molecular Biotechnology of the Austrian Academy of Sciences (IMBA), Vienna BioCenter (VBC), Vienna, Austria
| | - Robert Heinen
- Research Institute of Molecular Pathology (IMP), Vienna BioCenter (VBC), Vienna, Austria
- Institute of Molecular Biotechnology of the Austrian Academy of Sciences (IMBA), Vienna BioCenter (VBC), Vienna, Austria
| | - Irina Grishkovskaya
- Research Institute of Molecular Pathology (IMP), Vienna BioCenter (VBC), Vienna, Austria
| | - Benedikt Bauer
- Research Institute of Molecular Pathology (IMP), Vienna BioCenter (VBC), Vienna, Austria
| | - Johannes Stadlmann
- Research Institute of Molecular Pathology (IMP), Vienna BioCenter (VBC), Vienna, Austria
- Institute of Molecular Biotechnology of the Austrian Academy of Sciences (IMBA), Vienna BioCenter (VBC), Vienna, Austria
- Department of Chemistry, University of Natural Resources and Life Sciences, Vienna, Austria
| | - Luis Menéndez-Arias
- Centro de Biología Molecular “Severo Ochoa” (Consejo Superior de Investigaciones Científicas and Universidad Autónoma de Madrid), Madrid, Spain
| | - Andrew D. Straw
- Institute of Biology I and Bernstein Center Freiburg, Faculty of Biology, Albert-Ludwigs-University Freiburg, Freiburg, Germany
| | | | - Marianna Traugott
- 4th Medical Department with Infectious Diseases and Tropical Medicine, Vienna, Austria
| | - Tamara Seitz
- 4th Medical Department with Infectious Diseases and Tropical Medicine, Vienna, Austria
| | - Alexander Zoufaly
- 4th Medical Department with Infectious Diseases and Tropical Medicine, Vienna, Austria
| | - Manuela Födinger
- Institute of Laboratory Diagnostics, Vienna, Austria
- Sigmund Freud Private University, Vienna, Austria
| | - Christoph Wenisch
- 4th Medical Department with Infectious Diseases and Tropical Medicine, Vienna, Austria
| | - Johannes Zuber
- Research Institute of Molecular Pathology (IMP), Vienna BioCenter (VBC), Vienna, Austria
- Medical University of Vienna, Vienna BioCenter (VBC), Vienna, Austria
| | - Andrea Pauli
- Research Institute of Molecular Pathology (IMP), Vienna BioCenter (VBC), Vienna, Austria
- *Correspondence: Max J. Kellner, ; Andrea Pauli, ; Julius Brennecke,
| | - Julius Brennecke
- Institute of Molecular Biotechnology of the Austrian Academy of Sciences (IMBA), Vienna BioCenter (VBC), Vienna, Austria
- *Correspondence: Max J. Kellner, ; Andrea Pauli, ; Julius Brennecke,
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12
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Wölfl-Duchek M, Bergmann F, Jorda A, Weber M, Müller M, Seitz T, Zoufaly A, Strassl R, Zeitlinger M, Herkner H, Schnidar H, Anderle K, Derhaschnig U. Sensitivity and Specificity of SARS-CoV-2 Rapid Antigen Detection Tests Using Oral, Anterior Nasal, and Nasopharyngeal Swabs: a Diagnostic Accuracy Study. Microbiol Spectr 2022; 10:e0202921. [PMID: 35107327 PMCID: PMC8809344 DOI: 10.1128/spectrum.02029-21] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 01/06/2022] [Indexed: 12/23/2022] Open
Abstract
The objective of our study was to evaluate the sensitivity and specificity of rapid antigen detection tests versus those of reverse transcriptase PCR (RT-PCR) using oral, anterior nasal, and nasopharyngeal swabs. The underlying prospective, diagnostic case-control-type accuracy study included 87 hospitalized and nonhospitalized participants in a positive and a negative sample cohort between 16 March and 14 May 2021 in two hospitals in Vienna. SARS-CoV-2 infection status was confirmed by RT-PCR. Participants self-performed one oral and one anterior nasal swab for the rapid antigen test, immediately followed by two nasopharyngeal swabs for the rapid antigen test and RT-PCR by the investigator. Test results were read after 15 min, and participants completed a questionnaire in the meantime. Test parameters were calculated based on the evaluation of 87 participants. The overall sensitivity of rapid antigen detection tests versus that of RT-PCR with oral, anterior nasal, and nasopharyngeal samples was 18.18% (95% confidence interval [CI] 8.19% to 32.71%), 63.04% (95% CI 47.55% to 76.79%), and 73.33% (95% CI 58.06% to 85.4%), respectively. All sampling methods had a test specificity of 100% regardless of the cycle threshold (CT) value. Rapid antigen detection tests using self-collected anterior nasal swabs proved to be as sensitive as and more tolerable than professionally collected nasopharyngeal swabs for CT values up to 30 determined by RT-PCR. This finding illustrates the reliability of tests obtained by adequate self-collected anterior nasal specimen. Sensitivity was dependent upon the CT value for each sampling method. While the main advantage of rapid antigen detection tests is the immediate availability of results, PCR should be preferred in crucial settings wherever possible. IMPORTANCE Rapid antigen detection devices for SARS-CoV-2 represent a valuable tool for monitoring the spread of infection. However, the reliability of the tests depends largely on the test performance and the respective sampling method. Nasopharyngeal swabs mark the gold standard for sample collection in suspected respiratory tract infections but are unsuitable for widespread application, as they must be performed by medically trained personnel. With the underlying study, the head-to-head test performance and the usability of self-collected samples for SARS-CoV-2 detection using rapid antigen detection devices were evaluated. The results confirm similar sensitivity of self-collected anterior nasal swabs to that of professionally collected nasopharyngeal swabs for patients with a CT of < 30 determined by RT-PCR.
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Affiliation(s)
- Michael Wölfl-Duchek
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Felix Bergmann
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Vienna, Austria
| | - Anselm Jorda
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Maria Weber
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Matthias Müller
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Tamara Seitz
- Fourth Medical Department for Infectious Diseases and Tropical Medicine, Clinic Favoriten, Vienna, Austria
| | - Alexander Zoufaly
- Fourth Medical Department for Infectious Diseases and Tropical Medicine, Clinic Favoriten, Vienna, Austria
- Faculty of Medicine, Sigmund Freud University, Vienna, Austria
| | - Robert Strassl
- Department of Laboratory Medicine, Division of Clinical Virology, Medical University of Vienna, Vienna, Austria
| | - Markus Zeitlinger
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Harald Herkner
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | | | - Karolina Anderle
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Ulla Derhaschnig
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
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13
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Elbayomi M, Weyand M, Seitz T. Wearable Cardioverter Defibrillator (WCD) after Cardiac Surgery. Thorac Cardiovasc Surg 2022. [DOI: 10.1055/s-0042-1742807] [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] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- M. Elbayomi
- University Hospital Erlangen, Erlangen, Deutschland
| | - M. Weyand
- Department of Cardiac Surgery, University Clinic Erlangen, Erlangen, Deutschland
| | - T. Seitz
- Herzchirurgie des Uni-Klinikums Erlangen, Krankenhausstraße, Erlangen, Germany, Erlangen, Deutschland
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14
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Laferl H, Seitz T, Baier-Grabner S, Kelani H, Scholz E, Heger F, Götzinger F, Frischer PT, Wenisch C, Allerberger PF. Evaluation of RT-qPCR of mouthwash and buccal swabs for detection of SARS-CoV-2 in children and adults. Am J Infect Control 2022; 50:176-181. [PMID: 34718065 PMCID: PMC8552590 DOI: 10.1016/j.ajic.2021.10.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 10/07/2021] [Accepted: 10/08/2021] [Indexed: 12/19/2022]
Abstract
Background The use of nasopharyngeal (NP) swabs as a specimen collection method to diagnose SARS-CoV-2 infection is frequently perceived as uncomfortable by patients and requires trained personnel. In this study, detection rate of SARS-CoV-2 in mouthwash samples and buccal swabs were compared in both children and adults. Material and methods In patients admitted to hospital with confirmed COVID-19 within the previous 72 hours, NP and buccal swabs as well as mouthwash samples were collected. RT-qPCR was performed on all samples. Results In total, 170 samples were collected from 155 patients (137 adults and 18 children). Approximately 91.7% of the collected NP swabs were positive in RT-PCR compared to 63.1% of mouthwash samples and 42.4% of buccal swabs. Compared to NP swabs, the sensitivity of using mouthwash was 96.3% and 65.4% for buccal swabs in NP swab samples with a CT value <25. With increasing CT values, sensitivity decreased in both mouthwash and buccal swabs. The virus load was highest during the first week of infection, with a continuous decline observed in all three collection methods over time. Discussion Mouthwash presents an alternative collection method for detecting SARS-CoV-2 in the case of unfeasible NP swab sampling. Buccal swabs should not be used due to their low sensitivity.
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15
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Heber S, Pereyra D, Schrottmaier WC, Kammerer K, Santol J, Rumpf B, Pawelka E, Hanna M, Scholz A, Liu M, Hell A, Heiplik K, Lickefett B, Havervall S, Traugott MT, Neuböck MJ, Schörgenhofer C, Seitz T, Firbas C, Karolyi M, Weiss G, Jilma B, Thålin C, Bellmann-Weiler R, Salzer HJF, Szepannek G, Fischer MJM, Zoufaly A, Gleiss A, Assinger A. A Model Predicting Mortality of Hospitalized Covid-19 Patients Four Days After Admission: Development, Internal and Temporal-External Validation. Front Cell Infect Microbiol 2022; 11:795026. [PMID: 35141170 PMCID: PMC8819729 DOI: 10.3389/fcimb.2021.795026] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 12/13/2021] [Indexed: 12/24/2022] Open
Abstract
Objective To develop and validate a prognostic model for in-hospital mortality after four days based on age, fever at admission and five haematological parameters routinely measured in hospitalized Covid-19 patients during the first four days after admission. Methods Haematological parameters measured during the first 4 days after admission were subjected to a linear mixed model to obtain patient-specific intercepts and slopes for each parameter. A prediction model was built using logistic regression with variable selection and shrinkage factor estimation supported by bootstrapping. Model development was based on 481 survivors and 97 non-survivors, hospitalized before the occurrence of mutations. Internal validation was done by 10-fold cross-validation. The model was temporally-externally validated in 299 survivors and 42 non-survivors hospitalized when the Alpha variant (B.1.1.7) was prevalent. Results The final model included age, fever on admission as well as the slope or intercept of lactate dehydrogenase, platelet count, C-reactive protein, and creatinine. Tenfold cross validation resulted in a mean area under the receiver operating characteristic curve (AUROC) of 0.92, a mean calibration slope of 1.0023 and a Brier score of 0.076. At temporal-external validation, application of the previously developed model showed an AUROC of 0.88, a calibration slope of 0.95 and a Brier score of 0.073. Regarding the relative importance of the variables, the (apparent) variation in mortality explained by the six variables deduced from the haematological parameters measured during the first four days is higher (explained variation 0.295) than that of age (0.210). Conclusions The presented model requires only variables routinely acquired in hospitals, which allows immediate and wide-spread use as a decision support for earlier discharge of low-risk patients to reduce the burden on the health care system. Clinical Trial Registration Austrian Coronavirus Adaptive Clinical Trial (ACOVACT); ClinicalTrials.gov, identifier NCT04351724.
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Affiliation(s)
- Stefan Heber
- Institute of Physiology, Centre of Physiology and Pharmacology, Medical University of Vienna, Vienna, Austria
| | - David Pereyra
- Department of Vascular Biology and Thrombosis Research, Centre of Physiology and Pharmacology, Medical University of Vienna, Vienna, Austria
- Department of General Surgery, Division of Visceral Surgery, Medical University of Vienna, General Hospital Vienna, Vienna, Austria
| | - Waltraud C. Schrottmaier
- Department of Vascular Biology and Thrombosis Research, Centre of Physiology and Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Kerstin Kammerer
- Department of Vascular Biology and Thrombosis Research, Centre of Physiology and Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Jonas Santol
- Department of Vascular Biology and Thrombosis Research, Centre of Physiology and Pharmacology, Medical University of Vienna, Vienna, Austria
- Department of General Surgery, Division of Visceral Surgery, Medical University of Vienna, General Hospital Vienna, Vienna, Austria
| | - Benedikt Rumpf
- Department of Medicine IV, Kaiser Franz Josef Hospital, Vienna, Austria
| | - Erich Pawelka
- Department of Medicine IV, Kaiser Franz Josef Hospital, Vienna, Austria
| | - Markus Hanna
- Department of Vascular Biology and Thrombosis Research, Centre of Physiology and Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Alexander Scholz
- Department of Vascular Biology and Thrombosis Research, Centre of Physiology and Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Markus Liu
- Department of Vascular Biology and Thrombosis Research, Centre of Physiology and Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Agnes Hell
- Department of Vascular Biology and Thrombosis Research, Centre of Physiology and Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Klara Heiplik
- Department of Vascular Biology and Thrombosis Research, Centre of Physiology and Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Benno Lickefett
- Department of Vascular Biology and Thrombosis Research, Centre of Physiology and Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Sebastian Havervall
- Division of Internal Medicine, Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden
| | | | - Matthias J. Neuböck
- Department of Pulmonology, Kepler University Hospital and Johannes Kepler University, Linz, Austria
| | - Christian Schörgenhofer
- Department of Clinical Pharmacology, Medical University of Vienna, General Hospital Vienna, Vienna, Austria
| | - Tamara Seitz
- Department of Medicine IV, Kaiser Franz Josef Hospital, Vienna, Austria
| | - Christa Firbas
- Department of Clinical Pharmacology, Medical University of Vienna, General Hospital Vienna, Vienna, Austria
| | - Mario Karolyi
- Department of Medicine IV, Kaiser Franz Josef Hospital, Vienna, Austria
| | - Günter Weiss
- Department of Internal Medicine II, Medical University of Innsbruck, Innsbruck, Austria
| | - Bernd Jilma
- Department of Clinical Pharmacology, Medical University of Vienna, General Hospital Vienna, Vienna, Austria
| | - Charlotte Thålin
- Division of Internal Medicine, Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden
| | - Rosa Bellmann-Weiler
- Department of Internal Medicine II, Medical University of Innsbruck, Innsbruck, Austria
| | - Helmut J. F. Salzer
- Department of Pulmonology, Kepler University Hospital and Johannes Kepler University, Linz, Austria
| | - Gero Szepannek
- Institute of Applied Computer Science, Stralsund University of Applied Sciences, Stralsund, Germany
| | - Michael J. M. Fischer
- Institute of Physiology, Centre of Physiology and Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Alexander Zoufaly
- Department of Medicine IV, Kaiser Franz Josef Hospital, Vienna, Austria
| | - Andreas Gleiss
- Section for Clinical Biometrics, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Alice Assinger
- Department of Vascular Biology and Thrombosis Research, Centre of Physiology and Pharmacology, Medical University of Vienna, Vienna, Austria
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16
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Schrottmaier WC, Pirabe A, Pereyra D, Heber S, Hackl H, Schmuckenschlager A, Brunnthaler L, Santol J, Kammerer K, Oosterlee J, Pawelka E, Treiber SM, Khan AO, Pugh M, Traugott MT, Schörgenhofer C, Seitz T, Karolyi M, Jilma B, Rayes J, Zoufaly A, Assinger A. Platelets and Antiplatelet Medication in COVID-19-Related Thrombotic Complications. Front Cardiovasc Med 2022; 8:802566. [PMID: 35141292 PMCID: PMC8818754 DOI: 10.3389/fcvm.2021.802566] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 12/24/2021] [Indexed: 12/22/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) induces a hypercoagulatory state that frequently leads to thromboembolic complications. Whereas anticoagulation is associated with reduced mortality, the role of antiplatelet therapy in COVID-19 is less clear. We retrospectively analyzed the effect of anticoagulation and antiplatelet therapy in 578 hospitalized patients with COVID-19 and prospectively monitored 110 patients for circulating microthrombi and plasma markers of coagulation in the first week of admission. Moreover, we determined platelet shape change and also thrombi in postmortem lung biopsies in a subset of patients with COVID-19. We observed no association of antiplatelet therapy with COVID-19 survival. Adverse outcome in COVID-19 was associated with increased activation of the coagulation cascade, whereas circulating microthrombi did not increase in aggravated disease. This was in line with analysis of postmortem lung biopsies of patients with COVID-19, which revealed generally fibrin(ogen)-rich and platelet-low thrombi. Platelet spreading was normal in severe COVID-19 cases; however, plasma from patients with COVID-19 mediated an outcome-dependent inhibitory effect on naïve platelets. Antiplatelet medication disproportionally exacerbated this platelet impairment in plasma of patients with fatal outcome. Taken together, this study shows that unfavorable outcome in COVID-19 is associated with a profound dysregulation of the coagulation system, whereas the contribution of platelets to thrombotic complications is less clear. Adverse outcome may be associated with impaired platelet function or platelet exhaustion. In line, antiplatelet therapy was not associated with beneficial outcome.
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Affiliation(s)
- Waltraud C. Schrottmaier
- Department of Vascular Biology and Thrombosis Research, Centre of Physiology and Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Anita Pirabe
- Department of Vascular Biology and Thrombosis Research, Centre of Physiology and Pharmacology, Medical University of Vienna, Vienna, Austria
| | - David Pereyra
- Department of Vascular Biology and Thrombosis Research, Centre of Physiology and Pharmacology, Medical University of Vienna, Vienna, Austria
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, General Hospital Vienna, Vienna, Austria
| | - Stefan Heber
- Institute of Physiology, Centre of Physiology and Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Hubert Hackl
- Institute of Bioinformatics, Biocenter, Medical University of Innsbruck, Innsbruck, Austria
| | - Anna Schmuckenschlager
- Department of Vascular Biology and Thrombosis Research, Centre of Physiology and Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Laura Brunnthaler
- Department of Vascular Biology and Thrombosis Research, Centre of Physiology and Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Jonas Santol
- Department of Vascular Biology and Thrombosis Research, Centre of Physiology and Pharmacology, Medical University of Vienna, Vienna, Austria
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, General Hospital Vienna, Vienna, Austria
| | - Kerstin Kammerer
- Department of Vascular Biology and Thrombosis Research, Centre of Physiology and Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Justin Oosterlee
- Department of Vascular Biology and Thrombosis Research, Centre of Physiology and Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Erich Pawelka
- Department of Medicine IV, Clinic Favoriten, Vienna, Austria
| | - Sonja M. Treiber
- Department of Vascular Biology and Thrombosis Research, Centre of Physiology and Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Abdullah O. Khan
- Institute of Cardiovascular Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Matthew Pugh
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom
| | | | - Christian Schörgenhofer
- Department of Clinical Pharmacology, Medical University of Vienna, General Hospital Vienna, Vienna, Austria
| | - Tamara Seitz
- Department of Medicine IV, Clinic Favoriten, Vienna, Austria
| | - Mario Karolyi
- Department of Medicine IV, Clinic Favoriten, Vienna, Austria
| | - Bernd Jilma
- Department of Clinical Pharmacology, Medical University of Vienna, General Hospital Vienna, Vienna, Austria
| | - Julie Rayes
- Institute of Cardiovascular Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | | | - Alice Assinger
- Department of Vascular Biology and Thrombosis Research, Centre of Physiology and Pharmacology, Medical University of Vienna, Vienna, Austria
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17
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Karolyi M, Kaltenegger L, Pawelka E, Kuran A, Platzer M, Totschnig D, Koenig F, Hoepler W, Laferl H, Omid S, Seitz T, Traugott M, Arthofer S, Erlbeck L, Jaeger S, Kettenbach A, Assinger A, Wenisch C, Zoufaly A. Early administration of remdesivir may reduce mortality in hospitalized COVID-19 patients : A propensity score matched analysis. Wien Klin Wochenschr 2022; 134:883-891. [PMID: 36301355 PMCID: PMC9610353 DOI: 10.1007/s00508-022-02098-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 07/04/2022] [Accepted: 09/15/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Remdesivir is the only antiviral agent approved for the treatment of hospitalized coronavirus disease 2019 (COVID-19) patients requiring supplemental oxygen. Studies show conflicting results regarding its effect on mortality. METHODS In this single center observational study, we included adult hospitalized COVID-19 patients. Patients who were treated with remdesivir were compared to controls. Remdesivir was administered for 5 days. To adjust for any imbalances in our cohort, a propensity score matched analysis was performed. The aim of our study was to analyze the effect of remdesivir on in-hospital mortality and length of stay (LOS). RESULTS After propensity score matching, 350 patients (175 remdesivir, 175 controls) were included in our analysis. Overall, in-hospital mortality was not significantly different between groups remdesivir 5.7% [10/175] vs. control 8.6% [15/175], hazard ratio 0.50, 95% confidence interval (CI) 0.22-1.12, p = 0.091. Subgroup analysis showed a significant reduction of in-hospital mortality in patients who were treated with remdesivir ≤ 7 days of symptom onset remdesivir 4.2% [5/121] vs. control 10.4% [13/125], hazard ratio 0.26, 95% CI 0.09 to 0.75, p = 0.012 and in female patients remdesivir 2.9% [2/69] vs. control 12.2% [9/74], hazard ratio 0.18 95%CI 0.04 to 0.85, p = 0.03. Patients in the remdesivir group had a significantly longer LOS (11 days vs. 9 days, p = 0.046). CONCLUSION Remdesivir did not reduce in-hospital mortality in our whole propensity score matched cohort, but subgroup analysis showed a significant mortality reduction in female patients and in patients treated within ≤ 7 days of symptom onset. Remdesivir may reduce mortality in patients who are treated in the early stages of illness.
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Affiliation(s)
- Mario Karolyi
- Department for Infectious Diseases and Tropical Medicine, Klinik Favoriten, Kundratstraße 3, 1100 Vienna, Austria
| | - Lukas Kaltenegger
- Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Erich Pawelka
- Department for Infectious Diseases and Tropical Medicine, Klinik Favoriten, Kundratstraße 3, 1100 Vienna, Austria
| | - Avelino Kuran
- Department for Infectious Diseases and Tropical Medicine, Klinik Favoriten, Kundratstraße 3, 1100 Vienna, Austria
| | - Moritz Platzer
- Department for Infectious Diseases and Tropical Medicine, Klinik Favoriten, Kundratstraße 3, 1100 Vienna, Austria
| | - David Totschnig
- Department for Infectious Diseases and Tropical Medicine, Klinik Favoriten, Kundratstraße 3, 1100 Vienna, Austria
| | - Franz Koenig
- Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Wolfgang Hoepler
- Department for Infectious Diseases and Tropical Medicine, Klinik Favoriten, Kundratstraße 3, 1100 Vienna, Austria
| | - Hermann Laferl
- Department for Infectious Diseases and Tropical Medicine, Klinik Favoriten, Kundratstraße 3, 1100 Vienna, Austria
| | - Sara Omid
- Department for Infectious Diseases and Tropical Medicine, Klinik Favoriten, Kundratstraße 3, 1100 Vienna, Austria
| | - Tamara Seitz
- Department for Infectious Diseases and Tropical Medicine, Klinik Favoriten, Kundratstraße 3, 1100 Vienna, Austria
| | - Marianna Traugott
- Department for Infectious Diseases and Tropical Medicine, Klinik Favoriten, Kundratstraße 3, 1100 Vienna, Austria
| | | | | | | | | | - Alice Assinger
- Department of Vascular Biology and Thrombosis Research, Center of Physiology and Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Christoph Wenisch
- Department for Infectious Diseases and Tropical Medicine, Klinik Favoriten, Kundratstraße 3, 1100 Vienna, Austria
| | - Alexander Zoufaly
- Department for Infectious Diseases and Tropical Medicine, Klinik Favoriten, Kundratstraße 3, 1100 Vienna, Austria ,Sigmund Freud University, Vienna, Austria
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18
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Schrottmaier WC, Pirabe A, Pereyra D, Heber S, Hackl H, Schmuckenschlager A, Brunnthaler L, Santol J, Kammerer K, Oosterlee J, Pawelka E, Treiber SM, Khan AO, Pugh M, Traugott MT, Schörgenhofer C, Seitz T, Karolyi M, Jilma B, Rayes J, Zoufaly A, Assinger A. Adverse Outcome in COVID-19 Is Associated With an Aggravating Hypo-Responsive Platelet Phenotype. Front Cardiovasc Med 2021; 8:795624. [PMID: 34957266 PMCID: PMC8702807 DOI: 10.3389/fcvm.2021.795624] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 11/22/2021] [Indexed: 12/13/2022] Open
Abstract
Thromboembolic complications are frequently observed in Coronavirus disease 2019 (COVID-19). While COVID-19 is linked to platelet dysregulation, the association between disease outcome and platelet function is less clear. We prospectively monitored platelet activation and reactivity in 97 patients during the first week of hospitalization and determined plasma markers of platelet degranulation and inflammation. Adverse outcome in COVID-19 was associated with increased basal platelet activation and diminished platelet responses, which aggravated over time. Especially GPIIb/IIIa responses were abrogated, pointing toward impeded platelet aggregation. Moreover, platelet-leukocyte aggregate formation was diminished, pointing toward abrogated platelet-mediated immune responses in COVID-19. No general increase in plasma levels of platelet-derived granule components could be detected, arguing against platelet exhaustion. However, studies on platelets from healthy donors showed that plasma components in COVID-19 patients with unfavorable outcome were at least partly responsible for diminished platelet responses. Taken together this study shows that unfavorable outcome in COVID-19 is associated with a hypo-responsive platelet phenotype that aggravates with disease progression and may impact platelet-mediated immunoregulation.
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Affiliation(s)
- Waltraud C. Schrottmaier
- Department of Vascular Biology and Thrombosis Research, Centre of Physiology and Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Anita Pirabe
- Department of Vascular Biology and Thrombosis Research, Centre of Physiology and Pharmacology, Medical University of Vienna, Vienna, Austria
| | - David Pereyra
- Department of Vascular Biology and Thrombosis Research, Centre of Physiology and Pharmacology, Medical University of Vienna, Vienna, Austria
- Department of General Surgery, Division of Visceral Surgery, Medical University of Vienna, General Hospital Vienna, Vienna, Austria
| | - Stefan Heber
- Institute of Physiology, Centre of Physiology and Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Hubert Hackl
- Institute of Bioinformatics, Biocenter, Medical University of Innsbruck, Innsbruck, Austria
| | - Anna Schmuckenschlager
- Department of Vascular Biology and Thrombosis Research, Centre of Physiology and Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Laura Brunnthaler
- Department of Vascular Biology and Thrombosis Research, Centre of Physiology and Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Jonas Santol
- Department of Vascular Biology and Thrombosis Research, Centre of Physiology and Pharmacology, Medical University of Vienna, Vienna, Austria
- Department of General Surgery, Division of Visceral Surgery, Medical University of Vienna, General Hospital Vienna, Vienna, Austria
| | - Kerstin Kammerer
- Department of Vascular Biology and Thrombosis Research, Centre of Physiology and Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Justin Oosterlee
- Department of Vascular Biology and Thrombosis Research, Centre of Physiology and Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Erich Pawelka
- Department of Medicine IV, Clinic Favoriten, Vienna, Austria
| | - Sonja M. Treiber
- Department of Vascular Biology and Thrombosis Research, Centre of Physiology and Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Abdullah O. Khan
- Institute of Cardiovascular Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Matthew Pugh
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom
| | | | - Christian Schörgenhofer
- Department of Clinical Pharmacology, Medical University of Vienna, General Hospital Vienna, Vienna, Austria
| | - Tamara Seitz
- Department of Medicine IV, Clinic Favoriten, Vienna, Austria
| | - Mario Karolyi
- Department of Medicine IV, Clinic Favoriten, Vienna, Austria
| | - Bernd Jilma
- Department of Clinical Pharmacology, Medical University of Vienna, General Hospital Vienna, Vienna, Austria
| | - Julie Rayes
- Institute of Cardiovascular Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | | | - Alice Assinger
- Department of Vascular Biology and Thrombosis Research, Centre of Physiology and Pharmacology, Medical University of Vienna, Vienna, Austria
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19
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Abbas A, Abdukahil SA, Abdulkadir NN, Abe R, Abel L, Absil L, Acharya S, Acker A, Adachi S, Adam E, Adrião D, Ageel SA, Ahmed S, Ain Q, Ainscough K, Aisa T, Ait Hssain A, Ait Tamlihat Y, Akimoto T, Akmal E, Al Qasim E, Alalqam R, Alam T, Al-dabbous T, Alegesan S, Alegre C, Alessi M, Alex B, Alexandre K, Al-Fares A, Alfoudri H, Ali I, Ali Shah N, Alidjnou KE, Aliudin J, Alkhafajee Q, Allavena C, Allou N, Altaf A, Alves J, Alves JM, Alves R, Amaral M, Amira N, Ammerlaan H, Ampaw P, Andini R, Andrejak C, Angheben A, Angoulvant F, Ansart S, Anthonidass S, Antonelli M, Antunes de Brito CA, Anwar KR, Apriyana A, Arabi Y, Aragao I, Arali R, Arancibia F, Araujo C, Arcadipane A, Archambault P, Arenz L, Arlet JB, Arnold-Day C, Aroca A, Arora L, Arora R, Artaud-Macari E, Aryal D, Asaki M, Asensio A, Ashley E, Ashraf M, Ashraf S, Asim M, Assie JB, Asyraf A, Atique A, Attanyake AMUL, Auchabie J, Aumaitre H, Auvet A, Azemar L, Azoulay C, Bach B, Bachelet D, Badr C, Baig N, Baillie JK, Baird JK, Bak E, Bakakos A, Bakar NA, Bal A, Balakrishnan M, Balan V, Bani-Sadr F, Barbalho R, Barbosa NY, Barclay WS, Barnett SU, Barnikel M, Barrasa H, Barrelet A, Barrigoto C, Bartoli M, Bartone C, Baruch J, Bashir M, Basmaci R, Basri MFH, Bastos D, Battaglini D, Bauer J, Bautista Rincon DF, Bazan Dow D, Bedossa A, Bee KH, Behilill S, Beishuizen A, Beljantsev A, Bellemare D, Beltrame A, Beltrão BA, Beluze M, Benech N, Benjiman LE, Benkerrou D, Bennett S, Bento L, Berdal JE, Bergeaud D, Bergin H, Bernal Sobrino JL, Bertoli G, Bertolino L, Bessis S, Betz A, Bevilcaqua S, Bezulier K, Bhatt A, Bhavsar K, Bianchi I, Bianco C, Bidin FN, Bikram Singh M, Bin Humaid F, Bin Kamarudin MN, Bissuel F, Biston P, Bitker L, Blanco-Schweizer P, Blier C, Bloos F, Blot M, Blumberg L, Boccia F, Bodenes L, Bogaarts A, Bogaert D, Boivin AH, Bolze PA, Bompart F, Bonfasius A, Borges D, Borie R, Bosse HM, Botelho-Nevers E, Bouadma L, Bouchaud O, Bouchez S, Bouhmani D, Bouhour D, Bouiller K, Bouillet L, Bouisse C, Boureau AS, Bourke J, Bouscambert M, Bousquet A, Bouziotis J, Boxma B, Boyer-Besseyre M, Boylan M, Bozza FA, Brack M, Braconnier A, Braga C, Brandenburger T, Brás Monteiro F, Brazzi L, Breen D, Breen P, Breen P, Brett S, Brickell K, Broadley T, Browne A, Browne S, Brozzi N, Brusse-Keizer M, Buchtele N, Buesaquillo C, Bugaeva P, Buisson M, Burhan E, Burrell A, Bustos IG, Butnaru D, Cabie A, Cabral S, Caceres E, Cadoz C, Callahan M, Calligy K, Calvache JA, Cam J, Campana V, Campbell P, Campisi J, Canepa C, Cantero M, Caraux-Paz P, Cárcel S, Cardellino CS, Cardoso F, Cardoso F, Cardoso N, Cardoso S, Carelli S, Carlier N, Carmoi T, Carney G, Carpenter C, Carqueja I, Carret MC, Carrier FM, Carroll I, Carson G, Carton E, Casanova ML, Cascão M, Casey S, Casimiro J, Cassandra B, Castañeda S, Castanheira N, Castor-Alexandre G, Castrillón H, Castro I, Catarino A, Catherine FX, Cattaneo P, Cavalin R, Cavalli GG, Cavayas A, Ceccato A, Cervantes-Gonzalez M, Chair A, Chakveatze C, Chan A, Chand M, Chantalat Auger C, Chapplain JM, Chas J, Chaudary M, Chávez Iñiguez JS, Chen A, Chen YS, Cheng MP, Cheret A, Chiarabini T, Chica J, Chidambaram SK, Chin-Tho L, Chirouze C, Chiumello D, Cho HJ, Cho SM, Cholley B, Chopin MC, Chow TS, Chow YP, Chua HJ, Chua J, Cidade JP, Cisneros Herreros JM, Citarella BW, Ciullo A, Clarke E, Clarke J, Claure Del Granado R, Clohisey S, Cobb JP, Coca N, Codan C, Cody C, Coelho A, Coles M, Colin G, Collins M, Colombo SM, Combs P, Connolly J, Connor M, Conrad A, Contreras S, Conway E, Cooke GS, Copland M, Cordel H, Corley A, Cormican S, Cornelis S, Cornet AD, Corpuz AJ, Cortegiani A, Corvaisier G, Costigan E, Couffignal C, Couffin-Cadiergues S, Courtois R, Cousse S, Cregan R, Crepy D'Orleans C, Croonen S, Crowl G, Crump J, Cruz C, Cruz Berm JL, Cruz Rojo J, Csete M, Cucino A, Cullen A, Cullen C, Cummings M, Curley G, Curlier E, Curran C, Custodio P, da Silva Filipe A, Da Silveira C, Dabaliz AA, Dagens A, Dahly D, Dalton H, Dalton J, Daly S, D'Amico F, Daneman N, Daniel C, Dankwa EA, Dantas J, D’Aragon F, de Boer M, de Loughry G, de Mendoza D, De Montmollin E, de Oliveira França RF, de Pinho Oliveira AI, De Rosa R, de Silva T, de Vries P, Deacon J, Dean D, Debard A, DeBenedictis B, Debray MP, DeCastro N, Dechert W, Deconninck L, Decours R, Defous E, Delacroix I, Delaveuve E, Delavigne K, Delfos NM, Deligiannis I, Dell'Amore A, Delmas C, Delobel P, Delsing C, Demonchy E, Denis E, Deplanque D, Depuydt P, Desai M, Descamps D, Desvallée M, Dewayanti S, Diallo A, Diamantis S, Dias A, Diaz P, Diaz R, Diaz Diaz JJ, Didier K, Diehl JL, Dieperink W, Dimet J, Dinot V, Diop F, Diouf A, Dishon Y, Dixit D, Djossou F, Docherty AB, Doherty H, Dondorp AM, Dong A, Donnelly CA, Donnelly M, Donohue C, Donohue S, Donohue Y, Doran C, Doran P, Dorival C, D'Ortenzio E, Douglas JJ, Douma R, Dournon N, Downer T, Downey J, Downing M, Drake T, Driscoll A, Dryden M, Duarte Fonseca C, Dubee V, Dubos F, Ducancelle A, Duculan T, Dudman S, Duggal A, Dunand P, Dunning J, Duplaix M, Durante-Mangoni E, Durham III L, Dussol B, Duthoit J, Duval X, Dyrhol-Riise AM, Ean SC, Echeverria-Villalobos M, Egan S, Eira C, El Sanharawi M, Elapavaluru S, Elharrar B, Ellerbroek J, Eloy P, Elshazly T, Elyazar I, Enderle I, Endo T, Eng CC, Engelmann I, Enouf V, Epaulard O, Escher M, Esperatti M, Esperou H, Esposito-Farese M, Estevão J, Etienne M, Ettalhaoui N, Everding AG, Evers M, Fabre I, Fabre M, Faheem A, Fahy A, Fairfield CJ, Fakar Z, Faria P, Farooq A, Farrar JJ, Farshait N, Fateena H, Fatoni AZ, Faure K, Favory R, Fayed M, Feely N, Feeney L, Fernandes J, Fernandes M, Fernandes S, Ferrand FX, Ferrand Devouge E, Ferrão J, Ferraz M, Ferreira B, Ferreira S, Ferrer-Roca R, Ferriere N, Ficko C, Figueiredo-Mello C, Fiorda J, Flament T, Flateau C, Fletcher T, Florio LL, Flynn B, Flynn D, Foley C, Foley J, Fomin V, Fonseca T, Fontela P, Forsyth S, Foster D, Foti G, Fourn E, Fowler RA, Fraher DM, Franch-Llasat D, Fraser C, Fraser JF, Freire MV, Freitas Ribeiro A, Friedrich C, Fritz R, Fry S, Fuentes N, Fukuda M, Gaborieau V, Gaci R, Gagliardi M, Gagnard JC, Gagné N, Gagneux-Brunon A, Gaião S, Gail Skeie L, Gallagher P, Gallego Curto E, Gamble C, Gani Y, Garan A, Garcia R, García Barrio N, Garcia-Diaz J, Garcia-Gallo E, Garimella N, Garot D, Garrait V, Gauli B, Gault N, Gavin A, Gavrylov A, Gaymard A, Gebauer J, Geraud E, Gerbaud Morlaes L, Germano N, ghisulal PK, Ghosn J, Giani M, Giaquinto C, Gibson J, Gigante T, Gilg M, Gilroy E, Giordano G, Girvan M, Gissot V, Gitahi J, Giwangkancana G, Glikman D, Glybochko P, Gnall E, Goco G, Goehringer F, Goepel S, Goffard JC, Goh JY, Golob J, Gomes R, Gomez K, Gómez-Junyent J, Gominet M, Gonzalez A, Gordon P, Gordon A, Gorenne I, Goubert L, Goujard C, Goulenok T, Grable M, Graf J, Grandin EW, Granier P, Grasselli G, Grazioli L, Green CA, Greene C, Greenhalf W, Greffe S, Grieco DL, Griffee M, Griffiths F, Grigoras I, Groenendijk A, Grosse Lordemann A, Gruner H, Gu Y, Guarracino F, Guedj J, Guego M, Guellec D, Guerguerian AM, Guerreiro D, Guery R, Guillaumot A, Guilleminault L, Guimarães de Castro M, Guimard T, Haalboom M, Haber D, Habraken H, Hachemi A, Hadri N, Haidash O, Haider S, Haidri F, Hakak S, Hall A, Hall M, Halpin S, Hamer A, Hamers R, Hamidfar R, Hammond T, Han LY, Haniffa R, Hao KW, Hardwick H, Harrison EM, Harrison J, Harrison SBE, Hartman A, Hashmi J, Hashmi M, Hayat M, Hayes A, Hays L, Heerman J, Heggelund L, Hendry R, Hennessy M, Henriquez A, Hentzien M, Herekar F, Hernandez-Montfort J, Herr D, Hershey A, Hesstvedt L, Hidayah A, Higgins D, Higgins E, HigginsOKeeffe G, Hinchion R, Hinton S, Hiraiwa H, Hitoto H, Ho A, Ho YB, Hoctin A, Hoffmann I, Hoh WH, Hoiting O, Holt R, Holter JC, Horby P, Horcajada JP, Hoshino K, Hoshino K, Houas I, Hough CL, Houltham S, Hsu JMY, Hulot JS, Hussain I, Ijaz S, Illes HG, Imbert P, Imran M, Imran Sikander R, Inácio H, Infante Dominguez C, Ing YS, Iosifidis E, Ippolito M, Isgett S, Ishani PGPI, Isidoro T, Ismail N, Isnard M, Itai J, Ito A, 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Klenerman P, Klont R, Kloumann Bekken G, Knight S, Kobbe R, Kodippily C, Kohns Vasconcelos M, Koirala S, Komatsu M, Korten V, Kosgei C, Kpangon A, Krawczyk K, Krishnan S, Krishnan V, Kruglova O, Kumar A, Kumar D, Kumar G, Kumar M, Kumar Vecham P, Kuriakose D, Kurtzman E, Kusumastuti NP, Kutsogiannis D, Kutsyna G, Kyriakoulis K, Lachatre M, Lacoste M, Laffey JG, Lagrange M, Laine F, Lairez O, Lakhey S, Lalueza A, Lambert M, Lamontagne F, Langelot-Richard M, Langlois V, Lantang EY, Lanza M, Laouénan C, Laribi S, Lariviere D, Lasry S, Latif N, Launay O, Laureillard D, Lavie-Badie Y, Law A, Lawrence C, Lawrence T, Le M, Le Bihan C, Le Bris C, Le Falher G, Le Fevre L, Le Hingrat Q, Le Maréchal M, Le Mestre S, Le Moal G, Le Moing V, Le Nagard H, Le Turnier P, Leal E, Leal Santos M, Lee BH, Lee HG, Lee J, Lee SH, Lee TC, Lee YL, Leeming G, Lefebvre B, Lefebvre L, Lefevre B, LeGac S, Lelievre JD, Lellouche F, Lemaignen A, Lemee V, Lemeur A, Lemmink G, Lene HS, Lennon J, León R, Leone M, Leone M, Lepiller Q, Lescure FX, Lesens O, Lesouhaitier M, Lester-Grant A, Levy B, Levy Y, Levy-Marchal C, Lewandowska K, L'Her E, Li Bassi G, Liang J, Liaquat A, Liegeon G, Lim KC, Lim WS, Lima C, Lina B, Lina L, Lind A, Lingas G, Lion-Daolio S, Lissauer S, Liu K, Livrozet M, Lizotte P, Loforte A, Lolong N, Loon LC, Lopes D, Lopez-Colon D, Loschner AL, Loubet P, Loufti B, Louis G, Lourenco S, Lovelace-Macon L, Low LL, Lowik M, Loy JS, Lucet JC, Lumbreras Bermejo C, Luna CM, Lungu O, Luong L, Luque N, Luton D, Lwin N, Lyons R, Maasikas O, Mabiala O, MacDonald S, MacDonald S, Machado M, Macheda G, Macias Sanchez J, Madhok J, Maestro de la Calle G, Mahieu R, Mahy S, Maia AR, Maier LS, Maillet M, Maitre T, Malfertheiner M, Malik N, Mallon P, Maltez F, Malvy D, Manda V, Mandei JM, Mandelbrot L, Manetta F, Mangal K, Mankikian J, Manning E, Manuel A, Maria Sant`Ana Malaque C, Marino D, Marino F, Markowicz S, Maroun Eid C, Marques A, Marquis C, Marsh B, Marsh L, Marshal M, Marshall J, Martelli CT, Martin DA, Martin E, Martin-Blondel G, Martinelli A, Martin-Loeches I, Martinot M, Martin-Quiros A, Martins A, Martins J, Martins N, Martins Rego C, Martucci G, Martynenko O, Marwali EM, Marzukie M, Masa Jimenez JF, Maslove D, Maslove D, Mason P, Mason S, Masood S, Masood S, Mat Nor B, Matan M, Mateus Fernandes H, Mathew M, Mathieu D, Mattei M, Matulevics R, Maulin L, Maxwell M, Maynar J, Mazzoni T, Mc Sweeney L, McAndrew L, McArthur C, McCarthy A, McCarthy A, McCloskey C, McConnochie R, McDermott S, McDonald SE, McElroy A, McElwee S, McEneany V, McEvoy N, McGeer A, McKay C, McKeown J, McLean KA, McNally P, McNicholas B, McPartlan E, Meaney E, Mear-Passard C, Mechlin M, Meher M, Mehkri O, Mele F, Melo L, Memon K, Mendes JJ, Menkiti O, Menon K, Mentré F, Mentzer AJ, Mercier E, Mercier N, Merckx A, Mergeay-Fabre M, Mergler B, Merson L, Mesquita A, Metwally O, Meybeck A, Meyer D, Meynert AM, Meysonnier V, Meziane A, Mezidi M, Michelagnoli G, Michelanglei C, Michelet I, Mihelis E, Mihnovit V, Miranda-Maldonado H, Misnan NA, Mohamed NNE, Mohamed TJ, Moin A, Molina D, Molinos E, Molloy B, Mone M, Monteiro A, Montes C, Montrucchio G, Moore S, Moore SC, Morales Cely L, Moro L, Morocho Tutillo DR, Morton B, Motherway C, Motos A, Mouquet H, Mouton Perrot C, Moyet J, Mudara C, Mufti AK, Muh NY, Muhamad D, Mullaert J, Muller F, Müller KE, Munblit D, Muneeb S, Munir N, Munshi L, Murphy A, Murphy A, Murphy L, Murris M, Murthy S, Musaab H, Muyandy G, Myrodia DM, N N, Nagpal D, Nagrebetsky A, Narasimhan M, Narayanan N, Nasim Khan R, Nazerali-Maitland A, Neant N, Neb H, Nekliudov NA, Nelwan E, Neto R, Neumann E, Neves B, Ng PY, Nghi A, Nguyen D, Ni Choileain O, Ni Leathlobhair N, Nichol A, Nitayavardhana P, Nonas S, Noordin NAM, Noret M, Norharizam NFI, Norman L, Notari A, Noursadeghi M, Nowicka K, Nowinski A, Nseir S, Nunez JI, Nurnaningsih N, Nyamankolly E, O Brien F, O'Callaghan A, Occhipinti G, OConnor D, O'Donnell M, Ogston T, Ogura T, Oh TH, O'Halloran S, O'Hearn K, Ohshimo S, Oldakowska A, Oliveira J, Oliveira L, Olliaro PL, O'Neil C, Ong DS, Ong JY, Oosthuyzen W, Opavsky A, Openshaw P, Orakzai S, Orozco-Chamorro CM, Orquera A, Ortoleva J, Osatnik J, O'Shea L, O'Sullivan M, Othman SZ, Ouamara N, Ouissa R, Owyang C, Oziol E, Pabasara HMU, Pagadoy M, Pages J, Palacios A, Palacios M, Palmarini M, Panarello G, Panda PK, Paneru H, Pang LH, Panigada M, Pansu N, Papadopoulos A, Parke R, Parker M, Parra B, Parrini V, Pasha T, Pasquier J, Pastene B, Patauner F, Patel J, Pathmanathan MD, Patrão L, Patricio P, Patrier J, Patterson L, Pattnaik R, Paul C, Paul M, Paulos J, Paxton WA, Payen JF, Peariasamy K, Pedrera Jiménez M, Peek GJ, Peelman F, Peiffer-Smadja N, Peigne V, Pejkovska M, Pelosi P, Peltan ID, Pereira R, Perez D, Periel L, Perpoint T, Pesenti A, Pestre V, Petrou L, Petrov-Sanchez V, Pettersen FO, Peytavin G, Pharand S, Piagnerelli M, Picard W, Picone O, Piero MD, Pierobon C, Piersma D, Pimentel C, Pinto R, Pires C, Pironneau I, Piroth L, Pius R, Piva S, Plantier L, Plotkin D, Png HS, Poissy J, Pokeerbux R, Pokorska-Spiewak M, Poli S, Pollakis G, Ponscarme D, Popielska J, Post AM, Postma DF, Povoa P, Póvoas D, Powis J, Prapa S, Preau S, Prebensen C, Preiser JC, Prinssen A, Pritchard MG, Priyadarshani GDD, Proença L, Pudota S, Puéchal O, Pujo Semedi B, Pulicken M, Puntoni M, Purcell G, Quesada L, Quinones-Cardona V, Quirós González V, Quist-Paulsen E, Quraishi M, Rabaa M, Rabaud C, Rabindrarajan E, Rafael A, Rafiq M, Ragazzo G, Rahman AKHA, Rahman RA, Rahutullah A, Rainieri F, Rajahram GS, Rajapakse N, Ralib A, Ramakrishnan N, Ramanathan K, Ramli AA, Rammaert B, Ramos GV, Rana A, Rangappa R, Ranjan R, Rapp C, Rashan A, Rashan T, Rasheed G, Rasmin M, Rätsep I, Rau C, Ravi T, Raza A, Real A, Rebaudet S, Redl S, Reeve B, Rehan A, Rehman A, Reid L, Reid L, Reikvam DH, Reis R, Rello J, Remppis J, Remy M, Ren H, Renk H, Resende L, Resseguier AS, Revest M, Rewa O, Reyes LF, Reyes T, Ribeiro MI, Richardson D, Richardson D, Richier L, Ridzuan SNAA, Riera J, Rios AL, Rishu A, Rispal P, Risso K, Rivera Nuñez MA, Rizer N, Robb D, Robba C, Roberto A, Roberts S, Robertson DL, Robineau O, Roche-Campo F, Rodari P, Rodeia S, Rodriguez Abreu J, Roessler B, Roger C, Roger PM, Roilides E, Rojek A, Romaru J, Roncon-Albuquerque Jr R, Roriz M, Rosa-Calatrava M, Rose M, Rosenberger D, Rossanese A, Rossetti M, Rossignol B, Rossignol P, Rousset S, Roy C, Roze B, Rusmawatiningtyas D, Russell CD, Ryan M, Ryan M, Ryckaert S, Rygh Holten A, Saba I, Sadaf S, Sadat M, Sahraei V, Saint-Gilles M, Sakiyalak P, Salahuddin N, Salazar L, Saleem J, Saleem J, Sales G, Sallaberry S, Salmon Gandonniere C, Salvator H, Sanchez O, Sánchez Choez X, Sanchez de Oliveira K, Sanchez-Miralles A, Sancho-Shimizu V, Sandhu G, Sandhu Z, Sandrine PF, Sandulescu O, Santos M, Sarfo-Mensah S, Sarmento Banheiro B, Sarmiento ICE, Sarton B, Satyapriya S, Satyawati R, Saviciute E, Savio R, Savvidou P, Saw YT, Schaffer J, Schermer T, Scherpereel A, Schneider M, Schroll S, Schwameis M, Schwartz G, Scott JT, Scott-Brown J, Sedillot N, Seitz T, Selvanayagam J, Selvarajoo M, Semaille C, Semple MG, Senian RB, Senneville E, Sepulveda C, Sequeira F, Sequeira T, Serpa Neto A, Serrano Balazote P, Shadowitz E, Shahidan SA, Shahnaz Hasan M, Shamsah M, Shankar A, Sharjeel S, Sharma P, Shaw CA, Shaw V, Shi H, Shiban N, Shiekh M, Shiga T, Shime N, Shimizu H, Shimizu K, Shimizu N, Shindo N, Shrapnel S, Shum HP, Si Mohammed N, Siang NY, Sibiude J, Siddiqui A, Sigfrid L, Sillaots P, Silva C, Silva MJ, Silva R, Sim Lim Heng B, Sin WC, Singh BC, Singh P, Sitompul PA, Sivam K, Skogen V, Smith S, Smood B, Smyth C, Smyth M, Smyth M, Snacken M, So D, Soh TV, Solis M, Solomon J, Solomon T, Somers E, Sommet A, Song MJ, Song R, Song T, Song Chia J, Sonntagbauer M, Soom AM, Sotto A, Soum E, Sousa AC, Sousa M, Sousa Uva M, Souza-Dantas V, Sperry A, Spinuzza E, Sri Darshana BPSR, Sriskandan S, Stabler S, Staudinger T, Stecher SS, Steinsvik T, Stienstra Y, Stiksrud B, Stolz E, Stone A, Streinu-Cercel A, Streinu-Cercel A, Strudwick S, Stuart A, Stuart D, Subekti D, Suen G, Suen JY, Sukumar P, Sultana A, Summers C, Supic D, Suppiah D, Surovcová M, Suwarti S, Svistunov AA, Syahrin S, Syrigos K, Sztajnbok J, Szuldrzynski K, Tabrizi S, Taccone FS, Tagherset L, Taib SM, Talarek E, Taleb S, Talsma J, Tampubolon ML, Tan KK, Tan LV, Tan YC, Tanaka C, Tanaka H, Tanaka T, Taniguchi H, Tanveer H, Taqdees H, Taqi A, Tardivon C, Tattevin P, Taufik MA, Tawfik H, Tedder RS, Tee TY, Teixeira J, Tejada S, Tellier MC, Teoh SK, Teotonio V, Téoulé F, Terpstra P, Terrier O, Terzi N, Tessier-Grenier H, Tey A, Thabit AAM, Tham ZD, Thangavelu S, Thibault V, Thiberville SD, Thill B, Thirumanickam J, Thompson S, Thomson D, Thomson EC, Thurai SRT, Thuy DB, Thwaites RS, Tierney P, Tieroshyn V, Timashev PS, Timsit JF, Tirupakuzhi Vijayaraghavan BK, Tissot N, Toh JZY, Toki M, Tolppa T, Tonby K, Tonnii SL, Torres A, Torres M, Torres Santos-Olmo RM, Torres-Zevallos H, Towers M, Trapani T, Traynor D, Treoux T, Trieu HT, Tripathy S, Tromeur C, Trontzas I, Trouillon T, Truong J, Tual C, Tubiana S, Tuite H, Turmel JM, Turtle LC, Tveita A, Twardowski P, Uchiyama M, Udayanga PGI, Udy A, Ullrich R, Umer Z, Uribe A, Usman A, Vajdovics C, Val-Flores L, Valle AL, Valran A, Van de Velde S, van den Berge M, van der Feltz M, van der Valk P, Van Der Vekens N, Van der Voort P, Van Der Werf S, van Dyk M, van Gulik L, Van Hattem J, van Lelyveld S, van Netten C, Van Twillert G, van Veen I, Vanel N, Vanoverschelde H, Varghese P, Varrone M, Vasudayan SR, Vauchy C, Vaughan H, Veeran S, Veislinger A, Vencken S, Ventura S, Verbon A, Vidal JE, Vieira C, Vijayan D, Villanueva JA, Villar J, Villeneuve PM, Villoldo A, Vinh Chau NV, Visseaux B, Visser H, Vitiello C, Vonkeman H, Vuotto F, Wahab NH, Wahab SA, Wahid NA, Wainstein M, Wan Muhd Shukeri WF, Wang CH, Webb SA, Wei J, Weil K, Wen TP, Wesselius S, West TE, Wham M, Whelan B, White N, Wicky PH, Wiedemann A, Wijaya SO, Wille K, Willems S, Williams V, Wils EJ, Wing Yiu N, Wong C, Wong TF, Wong XC, Wong YS, Xian GE, Xian LS, Xuan KP, Xynogalas I, Yacoub S, Yakop SRBM, Yamazaki M, Yazdanpanah Y, Yee Liang Hing N, Yelnik C, Yeoh CH, Yerkovich S, Yokoyama T, Yonis H, Yousif O, Yuliarto S, Zaaqoq A, Zabbe M, Zacharowski K, Zahid M, Zahran M, Zaidan NZB, Zambon M, Zambrano M, Zanella A, Zawadka K, Zaynah N, Zayyad H, Zoufaly A, Zucman D. The value of open-source clinical science in pandemic response: lessons from ISARIC. Lancet Infect Dis 2021; 21:1623-1624. [PMID: 34619109 PMCID: PMC8489876 DOI: 10.1016/s1473-3099(21)00565-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 08/16/2021] [Indexed: 12/31/2022]
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Ercan H, Schrottmaier WC, Pirabe A, Schmuckenschlager A, Pereyra D, Santol J, Pawelka E, Traugott MT, Schörgenhofer C, Seitz T, Karolyi M, Yang JW, Jilma B, Zoufaly A, Assinger A, Zellner M. Platelet Phenotype Analysis of COVID-19 Patients Reveals Progressive Changes in the Activation of Integrin αIIbβ3, F13A1, the SARS-CoV-2 Target EIF4A1 and Annexin A5. Front Cardiovasc Med 2021; 8:779073. [PMID: 34859078 PMCID: PMC8632253 DOI: 10.3389/fcvm.2021.779073] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 10/22/2021] [Indexed: 01/08/2023] Open
Abstract
Background: The fatal consequences of an infection with severe acute respiratory syndrome coronavirus 2 are not only caused by severe pneumonia, but also by thrombosis. Platelets are important regulators of thrombosis, but their involvement in the pathogenesis of COVID-19 is largely unknown. The aim of this study was to determine their functional and biochemical profile in patients with COVID-19 in dependence of mortality within 5-days after hospitalization. Methods: The COVID-19-related platelet phenotype was examined by analyzing their basal activation state via integrin αIIbβ3 activation using flow cytometry and the proteome by unbiased two-dimensional differential in-gel fluorescence electrophoresis. In total we monitored 98 surviving and 12 non-surviving COVID-19 patients over 5 days of hospital stay and compared them to healthy controls (n = 12). Results: Over the observation period the level of basal αIIbβ3 activation on platelets from non-surviving COVID-19 patients decreased compared to survivors. In line with this finding, proteomic analysis revealed a decrease in the total amount of integrin αIIb (ITGA2B), a subunit of αIIbβ3, in COVID-19 patients compared to healthy controls; the decline was even more pronounced for the non-survivors. Consumption of the fibrin-stabilizing factor coagulation factor XIIIA (F13A1) was higher in platelets from COVID-19 patients and tended to be higher in non-survivors; plasma concentrations of the latter also differed significantly. Depending on COVID-19 disease status and mortality, increased amounts of annexin A5 (ANXA5), eukaryotic initiation factor 4A-I (EIF4A1), and transaldolase (TALDO1) were found in the platelet proteome and also correlated with the nasopharyngeal viral load. Dysregulation of these proteins may play a role for virus replication. ANXA5 has also been identified as an autoantigen of the antiphospholipid syndrome, which is common in COVID-19 patients. Finally, the levels of two different protein disulfide isomerases, P4HB and PDIA6, which support thrombosis, were increased in the platelets of COVID-19 patients. Conclusion: Platelets from COVID-19 patients showed significant changes in the activation phenotype, in the processing of the final coagulation factor F13A1 and the phospholipid-binding protein ANXA5 compared to healthy subjects. Additionally, these results demonstrate specific alterations in platelets during COVID-19, which are significantly linked to fatal outcome.
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Affiliation(s)
- Huriye Ercan
- Center for Physiology and Pharmacology, Institute of Vascular Biology and Thrombosis Research, Medical University of Vienna, Vienna, Austria
| | - Waltraud Cornelia Schrottmaier
- Center for Physiology and Pharmacology, Institute of Vascular Biology and Thrombosis Research, Medical University of Vienna, Vienna, Austria
| | - Anita Pirabe
- Center for Physiology and Pharmacology, Institute of Vascular Biology and Thrombosis Research, Medical University of Vienna, Vienna, Austria
| | - Anna Schmuckenschlager
- Center for Physiology and Pharmacology, Institute of Vascular Biology and Thrombosis Research, Medical University of Vienna, Vienna, Austria
| | - David Pereyra
- Center for Physiology and Pharmacology, Institute of Vascular Biology and Thrombosis Research, Medical University of Vienna, Vienna, Austria
- Division of Visceral Surgery, Department of General Surgery, General Hospital Vienna, Medical University of Vienna, Vienna, Austria
| | - Jonas Santol
- Center for Physiology and Pharmacology, Institute of Vascular Biology and Thrombosis Research, Medical University of Vienna, Vienna, Austria
- Division of Visceral Surgery, Department of General Surgery, General Hospital Vienna, Medical University of Vienna, Vienna, Austria
| | - Erich Pawelka
- Department of Medicine IV, Clinic Favoriten, Vienna, Austria
| | | | - Christian Schörgenhofer
- Department of Clinical Pharmacology, Medical University of Vienna, General Hospital Vienna, Vienna, Austria
| | - Tamara Seitz
- Department of Medicine IV, Clinic Favoriten, Vienna, Austria
| | - Mario Karolyi
- Department of Medicine IV, Clinic Favoriten, Vienna, Austria
| | - Jae-Won Yang
- Center for Physiology and Pharmacology, Institute of Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Bernd Jilma
- Department of Clinical Pharmacology, Medical University of Vienna, General Hospital Vienna, Vienna, Austria
| | | | - Alice Assinger
- Center for Physiology and Pharmacology, Institute of Vascular Biology and Thrombosis Research, Medical University of Vienna, Vienna, Austria
| | - Maria Zellner
- Center for Physiology and Pharmacology, Institute of Vascular Biology and Thrombosis Research, Medical University of Vienna, Vienna, Austria
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Pereyra D, Heber S, Schrottmaier WC, Santol J, Pirabe A, Schmuckenschlager A, Kammerer K, Ammon D, Sorz T, Fritsch F, Hayden H, Pawelka E, Krüger P, Rumpf B, Traugott MT, Glaser P, Firbas C, Schörgenhofer C, Seitz T, Karolyi M, Pabinger I, Brostjan C, Starlinger P, Weiss G, Bellmann-Weiler R, Salzer HJF, Jilma B, Zoufaly A, Assinger A. Low molecular weight heparin use in COVID-19 is associated with curtailed viral persistence-a retrospective multicenter observational study. Cardiovasc Res 2021; 117:2807-2820. [PMID: 34609480 PMCID: PMC8500043 DOI: 10.1093/cvr/cvab308] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 05/04/2021] [Indexed: 12/22/2022] Open
Abstract
Aims Anticoagulation was associated with improved survival of hospitalized coronavirus disease 2019 (COVID-19) patients in large-scale studies. Yet, the development of COVID-19-associated coagulopathy (CAC) and the mechanism responsible for improved survival of anticoagulated patients with COVID-19 remain largely elusive. This investigation aimed to explore the effects of anticoagulation and low-molecular-weight heparin (LMWH) in particular on patient outcome, CAC development, thromboinflammation, cell death, and viral persistence. Methods and results Data of 586 hospitalized COVID-19 patients from three different regions of Austria were evaluated retrospectively. Of these, 419 (71.5%) patients received LMWH and 62 (10.5%) received non-vitamin-K oral anticoagulants (NOACs) during hospitalization. Plasma was collected at different time points in a subset of 106 patients in order to evaluate markers of thromboinflammation (H3Cit-DNA) and the cell death marker cell-free DNA (cfDNA). Use of LMWH was associated with improved survival upon multivariable Cox regression (hazard ratio = 0.561, 95% confidence interval: 0.348–0.906). Interestingly, neither LMWH nor NOAC was associated with attenuation of D-dimer increase over time, or thromboinflammation. In contrast, anticoagulation was associated with a decrease in cfDNA during hospitalization, and curtailed viral persistence was observed in patients using LMWH leading to a 4-day reduction of virus positivity upon quantitative polymerase chain reaction [13 (interquartile range: 6–24) vs. 9 (interquartile range: 5–16) days, P = 0.009]. Conclusion Time courses of haemostatic and thromboinflammatory biomarkers were similar in patients with and without LMWH, indicating either no effects of LMWH on haemostasis or that LMWH reduced hypercoagulability to levels of patients without LMWH. Nonetheless, anticoagulation with LMWH was associated with reduced mortality, improved markers of cell death, and curtailed viral persistence, indicating potential beneficial effects of LMWH beyond haemostasis, which encourages use of LMWH in COVID-19 patients without contraindications.
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Affiliation(s)
- David Pereyra
- Department of Vascular Biology and Thrombosis Research, Center of Physiology and Pharmacology, Medical University of Vienna, Vienna, Austria.,Department of Surgery, Division of Visceral Surgery, Medical University of Vienna, General Hospital Vienna, Vienna, Austria
| | - Stefan Heber
- Institute of Physiology, Centre of Physiology and Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Waltraud C Schrottmaier
- Department of Vascular Biology and Thrombosis Research, Center of Physiology and Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Jonas Santol
- Department of Surgery, Division of Visceral Surgery, Medical University of Vienna, General Hospital Vienna, Vienna, Austria
| | - Anita Pirabe
- Department of Vascular Biology and Thrombosis Research, Center of Physiology and Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Anna Schmuckenschlager
- Department of Vascular Biology and Thrombosis Research, Center of Physiology and Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Kerstin Kammerer
- Department of Vascular Biology and Thrombosis Research, Center of Physiology and Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Daphni Ammon
- Department of Surgery, Division of Visceral Surgery, Medical University of Vienna, General Hospital Vienna, Vienna, Austria
| | - Thomas Sorz
- Department of Surgery, Division of Visceral Surgery, Medical University of Vienna, General Hospital Vienna, Vienna, Austria
| | - Fabian Fritsch
- Department of Surgery, Division of Visceral Surgery, Medical University of Vienna, General Hospital Vienna, Vienna, Austria
| | - Hubert Hayden
- Department of Surgery, Division of Vascular Surgery, Medical University of Vienna, General Hospital Vienna, Vienna, Austria
| | - Erich Pawelka
- Department of Medicine IV, Kaiser Franz Josef Hospital, Vienna, Austria
| | - Philipp Krüger
- Department of Vascular Biology and Thrombosis Research, Center of Physiology and Pharmacology, Medical University of Vienna, Vienna, Austria.,Department of Surgery, Division of Visceral Surgery, Medical University of Vienna, General Hospital Vienna, Vienna, Austria
| | - Benedikt Rumpf
- Department of Surgery, Division of Visceral Surgery, Medical University of Vienna, General Hospital Vienna, Vienna, Austria.,Department of Medicine IV, Kaiser Franz Josef Hospital, Vienna, Austria
| | | | - Pia Glaser
- Department of Medicine I, Medical University of Vienna, General Hospital Vienna, Vienna, Austria
| | - Christa Firbas
- Department of Clinical Pharmacology, Medical University of Vienna, General Hospital Vienna, Vienna, Austria
| | - Christian Schörgenhofer
- Department of Clinical Pharmacology, Medical University of Vienna, General Hospital Vienna, Vienna, Austria
| | - Tamara Seitz
- Department of Medicine IV, Kaiser Franz Josef Hospital, Vienna, Austria
| | - Mario Karolyi
- Department of Medicine IV, Kaiser Franz Josef Hospital, Vienna, Austria
| | - Ingrid Pabinger
- Department of Medicine I, Medical University of Vienna, General Hospital Vienna, Vienna, Austria
| | - Christine Brostjan
- Department of Surgery, Division of Vascular Surgery, Medical University of Vienna, General Hospital Vienna, Vienna, Austria
| | - Patrick Starlinger
- Department of Surgery, Division of Visceral Surgery, Medical University of Vienna, General Hospital Vienna, Vienna, Austria
| | - Günter Weiss
- Department of Internal Medicine II, Medical University of Innsbruck, Innsbruck, Austria
| | - Rosa Bellmann-Weiler
- Department of Internal Medicine II, Medical University of Innsbruck, Innsbruck, Austria
| | - Helmut J F Salzer
- Department of Pulmonology, Kepler University Hospital, and Johannes Kepler University, Linz, Austria
| | - Bernd Jilma
- Department of Clinical Pharmacology, Medical University of Vienna, General Hospital Vienna, Vienna, Austria
| | - Alexander Zoufaly
- Department of Medicine IV, Kaiser Franz Josef Hospital, Vienna, Austria
| | - Alice Assinger
- Department of Vascular Biology and Thrombosis Research, Center of Physiology and Pharmacology, Medical University of Vienna, Vienna, Austria
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22
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Pawelka E, Karolyi M, Mader T, Omid S, Kelani H, Baumgartner S, Ely S, Hoepler W, Jilma B, Koenig F, Laferl H, Traugott M, Turner M, Seitz T, Wenisch C, Zoufaly A. Correction to: COVID-19 is not "just another flu": a real-life comparison of severe COVID-19 and influenza in hospitalized patients in Vienna, Austria. Infection 2021; 49:917. [PMID: 34287791 PMCID: PMC8294295 DOI: 10.1007/s15010-021-01654-1] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Erich Pawelka
- Department for Infectious Diseases and Tropical Medicine, Kaiser-Franz-Josef Hospital, Kundratstraße 3, 1100 Vienna, Austria
| | - Mario Karolyi
- Department for Infectious Diseases and Tropical Medicine, Kaiser-Franz-Josef Hospital, Kundratstraße 3, 1100 Vienna, Austria
| | - Theresa Mader
- Department for Infectious Diseases and Tropical Medicine, Kaiser-Franz-Josef Hospital, Kundratstraße 3, 1100 Vienna, Austria
| | - Sara Omid
- Department for Infectious Diseases and Tropical Medicine, Kaiser-Franz-Josef Hospital, Kundratstraße 3, 1100 Vienna, Austria
| | - Hasan Kelani
- Department for Infectious Diseases and Tropical Medicine, Kaiser-Franz-Josef Hospital, Kundratstraße 3, 1100 Vienna, Austria
| | - Sebastian Baumgartner
- Department for Infectious Diseases and Tropical Medicine, Kaiser-Franz-Josef Hospital, Kundratstraße 3, 1100 Vienna, Austria
| | - Sarah Ely
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Wolfgang Hoepler
- Department for Infectious Diseases and Tropical Medicine, Kaiser-Franz-Josef Hospital, Kundratstraße 3, 1100 Vienna, Austria
| | - Bernd Jilma
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Franz Koenig
- Section for Medical Statistics, Medical University of Vienna, Vienna, Austria
| | - Hermann Laferl
- Department for Infectious Diseases and Tropical Medicine, Kaiser-Franz-Josef Hospital, Kundratstraße 3, 1100 Vienna, Austria
| | - Marianna Traugott
- Department for Infectious Diseases and Tropical Medicine, Kaiser-Franz-Josef Hospital, Kundratstraße 3, 1100 Vienna, Austria
| | - Michael Turner
- Department for Infectious Diseases and Tropical Medicine, Kaiser-Franz-Josef Hospital, Kundratstraße 3, 1100 Vienna, Austria
| | - Tamara Seitz
- Department for Infectious Diseases and Tropical Medicine, Kaiser-Franz-Josef Hospital, Kundratstraße 3, 1100 Vienna, Austria
| | - Christoph Wenisch
- Department for Infectious Diseases and Tropical Medicine, Kaiser-Franz-Josef Hospital, Kundratstraße 3, 1100 Vienna, Austria
| | - Alexander Zoufaly
- Department for Infectious Diseases and Tropical Medicine, Kaiser-Franz-Josef Hospital, Kundratstraße 3, 1100 Vienna, Austria
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23
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Pawelka E, Seitz T, Hoepler W, Karolyi M, Laferl H, Neuhold S, Petschnak S, Brandl I, Zoufaly A, Wenisch C. Intestinal necrosis as an uncommon complication of Plasmodium falciparum malaria with a parasite count of 50. J Travel Med 2021; 28:5940799. [PMID: 33107572 DOI: 10.1093/jtm/taaa203] [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] [Received: 09/16/2020] [Revised: 09/27/2020] [Accepted: 09/28/2020] [Indexed: 11/14/2022]
Affiliation(s)
- Erich Pawelka
- Department of Infectious Diseases and Tropical Medicine, Klinik Favoriten, 1100 Vienna, Austria
| | - Tamara Seitz
- Department of Infectious Diseases and Tropical Medicine, Klinik Favoriten, 1100 Vienna, Austria
| | - Wolfgang Hoepler
- Department of Infectious Diseases and Tropical Medicine, Klinik Favoriten, 1100 Vienna, Austria
| | - Mario Karolyi
- Department of Infectious Diseases and Tropical Medicine, Klinik Favoriten, 1100 Vienna, Austria
| | - Hermann Laferl
- Department of Infectious Diseases and Tropical Medicine, Klinik Favoriten, 1100 Vienna, Austria
| | - Stephanie Neuhold
- Department of Infectious Diseases and Tropical Medicine, Klinik Favoriten, 1100 Vienna, Austria
| | - Sophia Petschnak
- Department of Infectious Diseases and Tropical Medicine, Klinik Favoriten, 1100 Vienna, Austria
| | - Irmgard Brandl
- Department of Infectious Diseases and Tropical Medicine, Klinik Favoriten, 1100 Vienna, Austria
| | - Alexander Zoufaly
- Department of Infectious Diseases and Tropical Medicine, Klinik Favoriten, 1100 Vienna, Austria
| | - Christoph Wenisch
- Department of Infectious Diseases and Tropical Medicine, Klinik Favoriten, 1100 Vienna, Austria
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24
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Karolyi M, Omid S, Pawelka E, Jilma B, Stimpfl T, Schoergenhofer C, Laferl H, Seitz T, Traugott M, Wenisch C, Zoufaly A. High Dose Lopinavir/Ritonavir Does Not Lead to Sufficient Plasma Levels to Inhibit SARS-CoV-2 in Hospitalized Patients With COVID-19. Front Pharmacol 2021; 12:704767. [PMID: 34276386 PMCID: PMC8282360 DOI: 10.3389/fphar.2021.704767] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 05/03/2021] [Accepted: 06/16/2021] [Indexed: 12/15/2022] Open
Abstract
Background: Despite lopinavir/ritonavir (LPV/RTV) demonstrating in-vitro activity against SARS-CoV-2, large trials failed to show any net clinical benefit. Since SARS-CoV-2 has an EC50 of 16.4 μg/ml for LPV this could be due to inadequate dosing. Methods: COVID-19 positive patients admitted to the hospital who received high dose LPV/RTV were included. High dose (HD) LPV/RTV 200/50 mg was defined as four tablets bid as loading dose, then three tablets bid for up to 10 days. Trough plasma concentrations were measured after the loading dose and on day 5–7 in steady state (SS). Post loading dose (PLD) and SS plasma trough levels were compared with SS trough levels from COVID-19 patients who received normal dose (ND) LPV/RTV (2 tablets bid) at the beginning of the pandemic. Results: Fifty patients (30% female) with a median age of 59 years (interquartile range 49–70.25) received HD LPV/RTV. Median HD-PLD concentration was 24.9 μg/ml (IQR 15.8–30.3) and significantly higher than HD-SS (12.9 μg/ml, IQR 7.2–19.5, p < 0.001) and ND-SS (13.6 μg/ml, IQR 10.1–22.2, p = 0.013). HD-SS and ND-SS plasma levels did not differ significantly (p = 0.507). C-reactive-protein showed a positive correlation with HD-SS (Spearman correlation-coefficient rS = 0.42, p = 0.014) and ND-SS (rS = 0.81, p = 0.015) but not with HD-PLD (rS = 0.123, p = 0.43). Conclusion: HD-PLD plasma trough concentration was significantly higher than HD-SS and ND-SS concentration, but no difference was detected between HD-SS and ND-SS trough levels. Due to the high EC50 of SARS-CoV-2 and the fact that LPV/RTV is highly protein bound, it seems unlikely that LPV/RTV exhibits a relevant antiviral effect against SARS-CoV-2 in vivo.
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Affiliation(s)
- Mario Karolyi
- Department for Infectious Diseases and Tropical Medicine, Klinik Favoriten, Vienna, Austria
| | - Sara Omid
- Department for Infectious Diseases and Tropical Medicine, Klinik Favoriten, Vienna, Austria
| | - Erich Pawelka
- Department for Infectious Diseases and Tropical Medicine, Klinik Favoriten, Vienna, Austria
| | - Bernd Jilma
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Thomas Stimpfl
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | | | - Hermann Laferl
- Department for Infectious Diseases and Tropical Medicine, Klinik Favoriten, Vienna, Austria
| | - Tamara Seitz
- Department for Infectious Diseases and Tropical Medicine, Klinik Favoriten, Vienna, Austria
| | - Marianna Traugott
- Department for Infectious Diseases and Tropical Medicine, Klinik Favoriten, Vienna, Austria
| | - Christoph Wenisch
- Department for Infectious Diseases and Tropical Medicine, Klinik Favoriten, Vienna, Austria
| | - Alexander Zoufaly
- Department for Infectious Diseases and Tropical Medicine, Klinik Favoriten, Vienna, Austria
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25
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Hoepler WP, Weidner L, Traugott MT, Neuhold S, Meyer EL, Zoufaly A, Seitz T, Kitzberger R, Baumgartner S, Pawelka E, Karolyi M, Grieb A, Hind J, Laferl H, Friese E, Wenisch C, Aberle SW, Aberle JH, Weseslindtner L, Jungbauer C. Adjunctive treatment with high-titre convalescent plasma in severely and critically ill COVID-19 patients - a safe but futile intervention. A comparative cohort study. Infect Dis (Lond) 2021; 53:820-829. [PMID: 34128763 PMCID: PMC8220442 DOI: 10.1080/23744235.2021.1940271] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Background Convalescent plasma (CP) containing antibodies derived from coronavirus disease 2019 (COVID-19) survivors has been proposed as a promising therapeutic option for severe COVID-19. Methods In our intensive care unit (ICU), 55 patients (46 male, median age 61 years) with PCR-confirmed COVID-19 (35 = 63.6% on mechanical ventilation, 7 = 14.5% on high-flow nasal oxygen, 12 = 20% on non-invasive ventilation, 1 = 1.8% without respiratory support) were treated with high-titre CP (200 mL per dose, range 1–6 doses, median 3 doses per patient, minimum titre > 1:100, Wantai test). 139 COVID-19 patients treated in the same ICU who did not receive CP served as control group. In 27 patients, the effect of CP on the individual levels of SARS-CoV-2 IgG antibodies was assessed by ELISA in serum sample pairs collected before and after CP transfusion. Results The first CP dose was administered at a median of 8 days after symptom onset. 13 patients in the plasma cohort died (28-day mortality 24.1%), compared to 42 (30.2%) in the cohort who did not receive CP (p = 0.5, Pearson Chi-squared test). Out of the 27 individuals investigated for the presence of IgG antibodies, 8 did not have detectable IgG levels before the first CP transfusion. In this subpopulation, 3 patients (37.5%) died. Not a single confirmed adverse reaction to CP was noted. Conclusions While adjunctive treatment with CP for severe and life-threatening COVID-19 was a very safe intervention, we did not observe any effect on mortality.
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Affiliation(s)
- Wolfgang Paul Hoepler
- Department of Infectious Diseases and Tropical Medicine, Klinik Favoriten, Vienna, Austria
| | - Lisa Weidner
- Austrian Red Cross, Blood Service for Vienna, Lower Austria and Burgenland, Vienna, Austria
| | | | - Stephanie Neuhold
- Department of Infectious Diseases and Tropical Medicine, Klinik Favoriten, Vienna, Austria
| | - Elias Laurin Meyer
- Section for Medical Statistics, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University Vienna, Vienna, Austria
| | - Alexander Zoufaly
- Department of Infectious Diseases and Tropical Medicine, Klinik Favoriten, Vienna, Austria.,Department of Infectious Diseases, Sigmund Freud Privatuniversität Wien, Vienna, Austria
| | - Tamara Seitz
- Department of Infectious Diseases and Tropical Medicine, Klinik Favoriten, Vienna, Austria
| | - Reinhard Kitzberger
- Department of Infectious Diseases and Tropical Medicine, Klinik Favoriten, Vienna, Austria
| | - Sebastian Baumgartner
- Department of Infectious Diseases and Tropical Medicine, Klinik Favoriten, Vienna, Austria
| | - Erich Pawelka
- Department of Infectious Diseases and Tropical Medicine, Klinik Favoriten, Vienna, Austria
| | - Mario Karolyi
- Department of Infectious Diseases and Tropical Medicine, Klinik Favoriten, Vienna, Austria
| | - Alexander Grieb
- Department of Infectious Diseases, Sigmund Freud Privatuniversität Wien, Vienna, Austria
| | - Julian Hind
- Department of Infectious Diseases and Tropical Medicine, Klinik Favoriten, Vienna, Austria
| | - Hermann Laferl
- Department of Infectious Diseases and Tropical Medicine, Klinik Favoriten, Vienna, Austria
| | - Emanuela Friese
- Department of Infectious Diseases and Tropical Medicine, Klinik Favoriten, Vienna, Austria
| | - Christoph Wenisch
- Department of Infectious Diseases and Tropical Medicine, Klinik Favoriten, Vienna, Austria
| | | | | | | | - Christoph Jungbauer
- Austrian Red Cross, Blood Service for Vienna, Lower Austria and Burgenland, Vienna, Austria
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26
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Giannella M, Pankey GA, Pascale R, Miller VM, Miller LE, Seitz T. Antimicrobial and resource utilization with T2 magnetic resonance for rapid diagnosis of bloodstream infections: systematic review with meta-analysis of controlled studies. Expert Rev Med Devices 2021; 18:473-482. [PMID: 33863237 DOI: 10.1080/17434440.2021.1919508] [Citation(s) in RCA: 3] [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] [Indexed: 12/13/2022]
Abstract
Objectives: To compare antimicrobial and resource utilization with T2 Magnetic Resonance (T2MR) versus blood culture (BC) in patients with suspected bloodstream infection.Methods: We systematically searched MEDLINE, EMBASE, and CENTRAL for randomized trials or observational controlled studies of patients with suspected bloodstream infection receiving a diagnosis with T2MR or BC. Using an inverse variance meta-analysis model, we reported mortality using the risk ratio (RR) and the remaining outcomes as the mean difference (MD).Results: Fourteen studies were included in the meta-analysis. Time to detection (MD = -81 hours; p < 0.001) and time to species identification (MD = -77 hours; p < 0.001) were faster with T2MR. Patients testing positive on T2MR received targeted antimicrobial therapy faster (-42 hours; p < 0.001) and patients testing negative on T2MR were de-escalated from empirical therapy faster (-7 hours; p = 0.02) vs. BC. Length of intensive care unit stay (MD = -5.0 days; p = 0.03) and hospital stay (MD = -4.8 days; p = 0.03) were shorter with T2MR. Mortality rates were comparable between T2MR and BC (28.9% vs. 29.9%, RR = 1.02, p = 0.86).Conclusion: Utilization of T2MR for identification of bloodstream pathogens provides faster time to detection, faster transition to targeted microbial therapy, faster de-escalation of empirical therapy, shorter ICU and hospital stay, and with comparable mortality rate versus BC.
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Affiliation(s)
- Maddalena Giannella
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, Sant'Orsola-Malpighi Polyclinic, University of Bologna, Bologna, Italy
| | - George A Pankey
- Infectious Disease Translational Research, Ochsner Clinic Foundation, New Orleans, LA, United States
| | - Renato Pascale
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, Sant'Orsola-Malpighi Polyclinic, University of Bologna, Bologna, Italy
| | - Valerie M Miller
- Department of Biostatistics, Miller Scientific, Johnson City, TN, United States
| | - Larry E Miller
- Department of Biostatistics, Miller Scientific, Johnson City, TN, United States
| | - Tamara Seitz
- Department of Medicine IV, Clinic Favoriten, Vienna Healthcare Group, Vienna, Austria
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27
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Yelagandula R, Bykov A, Vogt A, Heinen R, Özkan E, Strobl MM, Baar JC, Uzunova K, Hajdusits B, Kordic D, Suljic E, Kurtovic-Kozaric A, Izetbegovic S, Schaeffer J, Hufnagl P, Zoufaly A, Seitz T, Födinger M, Allerberger F, Stark A, Cochella L, Elling U. Multiplexed detection of SARS-CoV-2 and other respiratory infections in high throughput by SARSeq. Nat Commun 2021; 12:3132. [PMID: 34035246 PMCID: PMC8149640 DOI: 10.1038/s41467-021-22664-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 03/23/2021] [Indexed: 12/14/2022] Open
Abstract
The COVID-19 pandemic has demonstrated the need for massively-parallel, cost-effective tests monitoring viral spread. Here we present SARSeq, saliva analysis by RNA sequencing, a method to detect SARS-CoV-2 and other respiratory viruses on tens of thousands of samples in parallel. SARSeq relies on next generation sequencing of multiple amplicons generated in a multiplexed RT-PCR reaction. Two-dimensional, unique dual indexing, using four indices per sample, enables unambiguous and scalable assignment of reads to individual samples. We calibrate SARSeq on SARS-CoV-2 synthetic RNA, virions, and hundreds of human samples of various types. Robustness and sensitivity were virtually identical to quantitative RT-PCR. Double-blinded benchmarking to gold standard quantitative-RT-PCR performed by human diagnostics laboratories confirms this high sensitivity. SARSeq can be used to detect Influenza A and B viruses and human rhinovirus in parallel, and can be expanded for detection of other pathogens. Thus, SARSeq is ideally suited for differential diagnostic of infections during a pandemic. Massively parallel but cost-effective testing is essential to monitor the spread of pathogenic agents. Here the authors present SARSseq, which uses a dual indexing strategy in a multiplexed RT-PCR reaction to diagnose SARS-CoV-2 at scale.
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Affiliation(s)
- Ramesh Yelagandula
- Institute of Molecular Biotechnology of the Austrian Academy of Science (IMBA), Vienna BioCenter (VBC), Vienna, Austria
| | - Aleksandr Bykov
- Research Institute of Molecular Pathology (IMP), Vienna BioCenter (VBC), Vienna, Austria
| | - Alexander Vogt
- Vienna Biocenter Core Facilities GmbH (VBCF), Vienna, Austria
| | - Robert Heinen
- Institute of Molecular Biotechnology of the Austrian Academy of Science (IMBA), Vienna BioCenter (VBC), Vienna, Austria.,Research Institute of Molecular Pathology (IMP), Vienna BioCenter (VBC), Vienna, Austria.,Gregor Mendel Institute (GMI), Vienna BioCenter (VBC), Vienna, Austria
| | - Ezgi Özkan
- Research Institute of Molecular Pathology (IMP), Vienna BioCenter (VBC), Vienna, Austria
| | - Marcus Martin Strobl
- Institute of Molecular Biotechnology of the Austrian Academy of Science (IMBA), Vienna BioCenter (VBC), Vienna, Austria
| | - Juliane Christina Baar
- Institute of Molecular Biotechnology of the Austrian Academy of Science (IMBA), Vienna BioCenter (VBC), Vienna, Austria
| | - Kristina Uzunova
- Institute of Molecular Biotechnology of the Austrian Academy of Science (IMBA), Vienna BioCenter (VBC), Vienna, Austria.,Research Institute of Molecular Pathology (IMP), Vienna BioCenter (VBC), Vienna, Austria.,Gregor Mendel Institute (GMI), Vienna BioCenter (VBC), Vienna, Austria
| | - Bence Hajdusits
- Research Institute of Molecular Pathology (IMP), Vienna BioCenter (VBC), Vienna, Austria
| | - Darja Kordic
- Research Institute of Molecular Pathology (IMP), Vienna BioCenter (VBC), Vienna, Austria
| | - Erna Suljic
- Clinical Center of the University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | | | - Sebija Izetbegovic
- Clinical Center of the University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Justine Schaeffer
- Österreichische Agentur für Gesundheit und Ernährungssicherheit (AGES), Vienna, Austria.,EUPHEM Fellowship, European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Peter Hufnagl
- Österreichische Agentur für Gesundheit und Ernährungssicherheit (AGES), Vienna, Austria
| | - Alexander Zoufaly
- Department for Infectious Diseases, Clinic Favoriten, Vienna, Austria.,Faculty of Medicine, Sigmund Freud Private University, Vienna, Austria
| | - Tamara Seitz
- Department for Infectious Diseases, Clinic Favoriten, Vienna, Austria
| | | | - Manuela Födinger
- Faculty of Medicine, Sigmund Freud Private University, Vienna, Austria.,Institute of Laboratory Diagnostics, Clinic Favoriten, Vienna, Austria
| | - Franz Allerberger
- Österreichische Agentur für Gesundheit und Ernährungssicherheit (AGES), Vienna, Austria
| | - Alexander Stark
- Research Institute of Molecular Pathology (IMP), Vienna BioCenter (VBC), Vienna, Austria.,Medical University of Vienna, Vienna BioCenter (VBC), Vienna, Austria
| | - Luisa Cochella
- Research Institute of Molecular Pathology (IMP), Vienna BioCenter (VBC), Vienna, Austria.
| | - Ulrich Elling
- Institute of Molecular Biotechnology of the Austrian Academy of Science (IMBA), Vienna BioCenter (VBC), Vienna, Austria.
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28
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Pawelka E, Karolyi M, Mader T, Omid S, Kelani H, Baumgartner S, Ely S, Hoepler W, Jilma B, Koenig F, Laferl H, Traugott M, Turner M, Seitz T, Wenisch C, Zoufaly A. COVID-19 is not "just another flu": a real-life comparison of severe COVID-19 and influenza in hospitalized patients in Vienna, Austria. Infection 2021; 49:907-916. [PMID: 33983624 PMCID: PMC8117126 DOI: 10.1007/s15010-021-01610-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 12/09/2020] [Accepted: 03/26/2021] [Indexed: 01/08/2023]
Abstract
Background COVID-19 is regularly compared to influenza. Mortality and case-fatality rates vary widely depending on incidence of COVID-19 and the testing policy in affected countries. To date, data comparing hospitalized patients with COVID-19 and influenza is scarce. Methods Data from patients with COVID-19 were compared to patients infected with influenza A (InfA) and B (InfB) virus during the 2017/18 and 2018/19 seasons. All patients were ≥ 18 years old, had PCR-confirmed infection and needed hospital treatment. Demographic data, medical history, length-of-stay (LOS), complications including in-hospital mortality were analyzed. Results In total, 142 patients with COVID-19 were compared to 266 patients with InfA and 300 with InfB. Differences in median age (COVID-19 70.5 years vs InfA 70 years and InfB 77 years, p < 0.001) and laboratory results were observed. COVID-19 patients had fewer comorbidities, but complications (respiratory insufficiency, pneumonia, acute kidney injury, acute heart failure and death) occurred more frequently. Median length-of-stay (LOS) was longer in COVID-19 patients (12 days vs InfA 7 days vs. InfB 7 days, p < 0.001). There was a fourfold higher in-hospital mortality in COVID-19 patients (23.2%) when compared with InfA (5.6%) or InfB (4.7%; p < 0.001). Conclusion In hospitalized patients, COVID-19 is associated with longer LOS, a higher number of complications and higher in-hospital mortality compared to influenza, even in a population with fewer co-morbidities. This data, a high reproduction number and limited treatment options, alongside excess mortality during the SARS-CoV-2 pandemic, support the containment strategies implemented by most authorities.
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Affiliation(s)
- Erich Pawelka
- Department for Infectious Diseases and Tropical Medicine, Kaiser-Franz-Josef Hospital, Kundratstraße 3, 1100, Vienna, Austria.
| | - Mario Karolyi
- Department for Infectious Diseases and Tropical Medicine, Kaiser-Franz-Josef Hospital, Kundratstraße 3, 1100, Vienna, Austria
| | - Theresa Mader
- Department for Infectious Diseases and Tropical Medicine, Kaiser-Franz-Josef Hospital, Kundratstraße 3, 1100, Vienna, Austria
| | - Sara Omid
- Department for Infectious Diseases and Tropical Medicine, Kaiser-Franz-Josef Hospital, Kundratstraße 3, 1100, Vienna, Austria
| | - Hasan Kelani
- Department for Infectious Diseases and Tropical Medicine, Kaiser-Franz-Josef Hospital, Kundratstraße 3, 1100, Vienna, Austria
| | - Sebastian Baumgartner
- Department for Infectious Diseases and Tropical Medicine, Kaiser-Franz-Josef Hospital, Kundratstraße 3, 1100, Vienna, Austria
| | - Sarah Ely
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Wolfgang Hoepler
- Department for Infectious Diseases and Tropical Medicine, Kaiser-Franz-Josef Hospital, Kundratstraße 3, 1100, Vienna, Austria
| | - Bernd Jilma
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Franz Koenig
- Section for Medical Statistics, Medical University of Vienna, Vienna, Austria
| | - Hermann Laferl
- Department for Infectious Diseases and Tropical Medicine, Kaiser-Franz-Josef Hospital, Kundratstraße 3, 1100, Vienna, Austria
| | - Marianna Traugott
- Department for Infectious Diseases and Tropical Medicine, Kaiser-Franz-Josef Hospital, Kundratstraße 3, 1100, Vienna, Austria
| | - Michael Turner
- Department for Infectious Diseases and Tropical Medicine, Kaiser-Franz-Josef Hospital, Kundratstraße 3, 1100, Vienna, Austria
| | - Tamara Seitz
- Department for Infectious Diseases and Tropical Medicine, Kaiser-Franz-Josef Hospital, Kundratstraße 3, 1100, Vienna, Austria
| | - Christoph Wenisch
- Department for Infectious Diseases and Tropical Medicine, Kaiser-Franz-Josef Hospital, Kundratstraße 3, 1100, Vienna, Austria
| | - Alexander Zoufaly
- Department for Infectious Diseases and Tropical Medicine, Kaiser-Franz-Josef Hospital, Kundratstraße 3, 1100, Vienna, Austria
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Seitz T, Schindler S, Winkelmeyer P, Zach B, Wenisch C, Zoufaly A, Allerberger F. Evaluation of rapid antigen tests based on saliva for the detection of SARS-CoV-2. J Med Virol 2021; 93:4161-4162. [PMID: 33788280 PMCID: PMC8251355 DOI: 10.1002/jmv.26983] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 03/03/2021] [Accepted: 03/29/2021] [Indexed: 11/10/2022]
Affiliation(s)
- Tamara Seitz
- Department of Infectious Diseases and Tropical Medicine, Clinic Favoriten, Vienna, Austria
| | | | | | - Bernhard Zach
- Austrian Agency for Health and Food Safety (AGES), Vienna, Austria
| | - Christoph Wenisch
- Department of Infectious Diseases and Tropical Medicine, Clinic Favoriten, Vienna, Austria
| | - Alexander Zoufaly
- Department of Infectious Diseases and Tropical Medicine, Clinic Favoriten, Vienna, Austria
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Karolyi M, Pawelka E, Mader T, Omid S, Kelani H, Ely S, Jilma B, Baumgartner S, Laferl H, Ott C, Traugott M, Turner M, Seitz T, Wenisch C, Zoufaly A. Hydroxychloroquine versus lopinavir/ritonavir in severe COVID-19 patients : Results from a real-life patient cohort. Wien Klin Wochenschr 2021; 133:284-291. [PMID: 32776298 PMCID: PMC7416584 DOI: 10.1007/s00508-020-01720-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [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] [Received: 06/30/2020] [Accepted: 07/18/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is associated with a high mortality. To date no trial comparing hydroxychloroquine (HCQ) and lopinavir/ritonavir (LPV/RTV) has been performed. METHODS Hospitalized patients ≥18 years old with severe coronavirus disease 2019 (COVID-19) were treated with either HCQ or LPV/RTV if they had either respiratory insufficiency (SpO2 ≤ 93% on room air or the need for oxygen insufflation) or bilateral consolidations on chest X‑ray and at least 2 comorbidities associated with poor COVID-19 prognosis. Outcomes investigated included in-hospital mortality, intensive care unit (ICU) admission, length of stay, PCR (polymerase chain reaction) negativity and side effects of treatment. RESULTS Of 156 patients (41% female) with a median age of 72 years (IQR 55.25-81) admitted to our department, 67 patients fulfilled the inclusion criteria (20 received HCQ, 47 LPV/RTV). Groups were comparable regarding most baseline characteristics. Median time from symptom onset to treatment initiation was 8 days and was similar between the groups (p = 0.727). There was no significant difference (HCQ vs. LPV/RTV) in hospital mortality (15% vs. 8.5%, p = 0.418), ICU admission rate (20% vs. 12.8%, p = 0.470) and length of stay (9 days vs. 11 days, p = 0.340). A PCR negativity from nasopharyngeal swabs was observed in approximately two thirds of patients in both groups. Side effects led to treatment discontinuation in 15% of patients in the LPV/RTV group. CONCLUSION No statistically significant differences were observed in outcome parameters in patients treated with HCQ or LPV/RTV but patients in the LPV/RTV group showed a numerically lower hospital mortality rate. Additionally, in comparison to other studies we demonstrated a lower mortality in patients treated with LPV/RTV despite having similar patient groups, perhaps due to early initiation of treatment.
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Affiliation(s)
- Mario Karolyi
- Department for Infectious Diseases and Tropical Medicine, Kaiser-Franz-Josef Hospital, Kundratstraße 3, 1100, Vienna, Austria.
| | - Erich Pawelka
- Department for Infectious Diseases and Tropical Medicine, Kaiser-Franz-Josef Hospital, Kundratstraße 3, 1100, Vienna, Austria
| | - Theresa Mader
- Department for Infectious Diseases and Tropical Medicine, Kaiser-Franz-Josef Hospital, Kundratstraße 3, 1100, Vienna, Austria
| | - Sara Omid
- Department for Infectious Diseases and Tropical Medicine, Kaiser-Franz-Josef Hospital, Kundratstraße 3, 1100, Vienna, Austria
| | - Hasan Kelani
- Department for Infectious Diseases and Tropical Medicine, Kaiser-Franz-Josef Hospital, Kundratstraße 3, 1100, Vienna, Austria
| | - Sarah Ely
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Bernd Jilma
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Sebastian Baumgartner
- Department for Infectious Diseases and Tropical Medicine, Kaiser-Franz-Josef Hospital, Kundratstraße 3, 1100, Vienna, Austria
| | - Hermann Laferl
- Department for Infectious Diseases and Tropical Medicine, Kaiser-Franz-Josef Hospital, Kundratstraße 3, 1100, Vienna, Austria
| | - Clemens Ott
- Department for Infectious Diseases and Tropical Medicine, Kaiser-Franz-Josef Hospital, Kundratstraße 3, 1100, Vienna, Austria
| | - Marianna Traugott
- Department for Infectious Diseases and Tropical Medicine, Kaiser-Franz-Josef Hospital, Kundratstraße 3, 1100, Vienna, Austria
| | - Michael Turner
- Department for Infectious Diseases and Tropical Medicine, Kaiser-Franz-Josef Hospital, Kundratstraße 3, 1100, Vienna, Austria
| | - Tamara Seitz
- Department for Infectious Diseases and Tropical Medicine, Kaiser-Franz-Josef Hospital, Kundratstraße 3, 1100, Vienna, Austria
| | - Christoph Wenisch
- Department for Infectious Diseases and Tropical Medicine, Kaiser-Franz-Josef Hospital, Kundratstraße 3, 1100, Vienna, Austria
| | - Alexander Zoufaly
- Department for Infectious Diseases and Tropical Medicine, Kaiser-Franz-Josef Hospital, Kundratstraße 3, 1100, Vienna, Austria
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Totschnig D, Seitz T, Zoufaly A, Hagenauer-Drektraan S, Wenisch C. Whipple's disease diagnosed in a patient with suspected sarcoidosis. Int J Infect Dis 2021; 106:41-42. [PMID: 33766689 DOI: 10.1016/j.ijid.2021.03.053] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 03/17/2021] [Accepted: 03/18/2021] [Indexed: 11/29/2022] Open
Abstract
This paper presents a case of a 51-year-old patient with chronic diarrhea, weight loss, polyarthralgia, and diffuse lymphadenopathy. Laboratory work-up showed anemia, leukocytosis and thrombocytosis, and increased C-reactive protein (CRP). Due to an inconspicuous differential leukocyte count and lymph node biopsy findings showing granulomatous lymphadenopathy, sarcoidosis was initially suspected. Colonoscopy found no abnormalities and duodenal biopsies showed negative Periodic acid-Schiff stains. However, PCR testing on these biopsies revealed Tropheryma whipplei DNA. Further PCR testing of urine and cerebrospinal fluid also revealed T. whipplei DNA. The patient was treated with ceftriaxone for 2 weeks followed by trimethoprim for a year. A rapid improvement of his symptoms was seen.
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Affiliation(s)
- David Totschnig
- Department of Medicine IV, Kaiser Franz Josef Hospital, Vienna, Austria.
| | - Tamara Seitz
- Department of Medicine IV, Kaiser Franz Josef Hospital, Vienna, Austria
| | - Alexander Zoufaly
- Department of Medicine IV, Kaiser Franz Josef Hospital, Vienna, Austria
| | | | - Christoph Wenisch
- Department of Medicine IV, Kaiser Franz Josef Hospital, Vienna, Austria
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Traugott M, Hoepler W, Kitzberger R, Pavlata S, Seitz T, Baumgartner S, Placher-Sorko G, Pirker-Krassnig D, Ehehalt U, Grasnek A, Beham-Kacerovsky M, Friese E, Wenisch C, Neuhold S. Successful treatment of intubation-induced severe neurogenic post-extubation dysphagia using pharyngeal electrical stimulation in a COVID-19 survivor: a case report. J Med Case Rep 2021; 15:148. [PMID: 33752743 PMCID: PMC7983095 DOI: 10.1186/s13256-021-02763-z] [Citation(s) in RCA: 3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 03/01/2021] [Indexed: 02/08/2023] Open
Abstract
Background A significant portion of critically ill patients with coronavirus disease 2019 (COVID-19) are at high risk of developing intensive care unit (ICU)-acquired swallowing dysfunction (neurogenic dysphagia) as a consequence of requiring prolonged mechanical ventilation. Pharyngeal electrical stimulation (PES) is a simple and safe treatment for neurogenic dysphagia. It has been shown that PES can restore safe swallowing in orally intubated or tracheotomized ICU patients with neurogenic dysphagia following severe stroke. We report the case of a patient with severe neurogenic post-extubation dysphagia (PED) due to prolonged intubation and severe general muscle weakness related to COVID-19, which was successfully treated using PES. Case presentation A 71-year-old Caucasian female patient with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection developed neurogenic dysphagia following prolonged intubation in the ICU. To avoid aerosol-generating procedures, her swallowing function was evaluated non-instrumentally as recommended by recently published international guidelines in response to the COVID-19 pandemic. Her swallowing function was markedly impaired and PES therapy was recommended. PES led to a rapid improvement of the PED, as evaluated by bedside swallowing assessments using the Gugging Swallowing Screen (GUSS) and Dysphagia Severity Rating Scale (DSRS), and diet screening using the Functional Oral Intake Scale (FOIS). The improved swallowing, as reflected by these measures, allowed this patient to transfer from the ICU to a non-intensive medical department 5 days after completing PES treatment. Conclusions PES treatment contributed to the restoration of a safe swallowing function in this critically ill patient with COVID-19 and ICU-acquired swallowing dysfunction. Early clinical bedside swallowing assessment and dysphagia intervention in COVID-19 patients is crucial to optimize their full recovery. PES may contribute to a safe and earlier ICU discharge of patients with ICU-acquired swallowing dysfunction. Earlier ICU discharge and reduced rates of re-intubation following PES can help alleviate some of the pressure on ICU bed capacity, which is critical in times of a health emergency such as the ongoing COVID-19 pandemic.
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Affiliation(s)
- Marianna Traugott
- Fourth Medical Department with Infectious Diseases and Tropical Medicine, Klinik Favoriten - Kaiser Franz Josef Hospital, Kundratstraße 3, 1100, Vienna, Austria.
| | - Wolfgang Hoepler
- Fourth Medical Department with Infectious Diseases and Tropical Medicine, Klinik Favoriten - Kaiser Franz Josef Hospital, Kundratstraße 3, 1100, Vienna, Austria
| | - Reinhard Kitzberger
- Fourth Medical Department with Infectious Diseases and Tropical Medicine, Klinik Favoriten - Kaiser Franz Josef Hospital, Kundratstraße 3, 1100, Vienna, Austria
| | - Sophie Pavlata
- Otorhinolaryngeology Department, Klinik Favoriten - Kaiser Franz Josef Hospital, Kundratstraße 3, 1100, Vienna, Austria
| | - Tamara Seitz
- Fourth Medical Department with Infectious Diseases and Tropical Medicine, Klinik Favoriten - Kaiser Franz Josef Hospital, Kundratstraße 3, 1100, Vienna, Austria
| | - Sebastian Baumgartner
- Fourth Medical Department with Infectious Diseases and Tropical Medicine, Klinik Favoriten - Kaiser Franz Josef Hospital, Kundratstraße 3, 1100, Vienna, Austria
| | - Gudrun Placher-Sorko
- Fourth Medical Department with Infectious Diseases and Tropical Medicine, Klinik Favoriten - Kaiser Franz Josef Hospital, Kundratstraße 3, 1100, Vienna, Austria
| | - Daniela Pirker-Krassnig
- Fourth Medical Department with Infectious Diseases and Tropical Medicine, Klinik Favoriten - Kaiser Franz Josef Hospital, Kundratstraße 3, 1100, Vienna, Austria
| | - Urs Ehehalt
- Fourth Medical Department with Infectious Diseases and Tropical Medicine, Klinik Favoriten - Kaiser Franz Josef Hospital, Kundratstraße 3, 1100, Vienna, Austria
| | - Andreas Grasnek
- Fourth Medical Department with Infectious Diseases and Tropical Medicine, Klinik Favoriten - Kaiser Franz Josef Hospital, Kundratstraße 3, 1100, Vienna, Austria
| | - Michaela Beham-Kacerovsky
- Fourth Medical Department with Infectious Diseases and Tropical Medicine, Klinik Favoriten - Kaiser Franz Josef Hospital, Kundratstraße 3, 1100, Vienna, Austria
| | - Emanuela Friese
- Fourth Medical Department with Infectious Diseases and Tropical Medicine, Klinik Favoriten - Kaiser Franz Josef Hospital, Kundratstraße 3, 1100, Vienna, Austria
| | - Christoph Wenisch
- Fourth Medical Department with Infectious Diseases and Tropical Medicine, Klinik Favoriten - Kaiser Franz Josef Hospital, Kundratstraße 3, 1100, Vienna, Austria
| | - Stephanie Neuhold
- Fourth Medical Department with Infectious Diseases and Tropical Medicine, Klinik Favoriten - Kaiser Franz Josef Hospital, Kundratstraße 3, 1100, Vienna, Austria
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Laferl H, Kelani H, Seitz T, Holzer B, Zimpernik I, Steinrigl A, Schmoll F, Wenisch C, Allerberger F. An approach to lifting self-isolation for health care workers with prolonged shedding of SARS-CoV-2 RNA. Infection 2021; 49:95-101. [PMID: 33025521 PMCID: PMC7538033 DOI: 10.1007/s15010-020-01530-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [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] [Received: 07/11/2020] [Accepted: 09/16/2020] [Indexed: 12/23/2022]
Abstract
PURPOSE According to the European Public Health Authority guidance for ending isolation in the context of COVID-19, a convalescent healthcare worker (HCW) can end their isolation at home and resume work upon clinical improvement and two negative RT-PCR tests from respiratory specimens obtained at 24-h intervals at least 8 days after the onset of symptoms. However, convalescent HCWs may shed SARS-CoV-2 viral RNA for prolonged periods. METHODS 40 healthy HCWs off work because of ongoing positive RT-PCR results in combined nasopharyngeal (NP) and oropharyngeal (OP) swabs following SARS-CoV-2 infection were invited to participate in this study. These HCWs had been in self-isolation because of a PCR-confirmed SARS-CoV-2 infection. NP and OP swabs as well as a blood sample were collected from each participant. RT-PCR and virus isolation was performed with each swab sample and serum neutralization test as well as two different ELISA tests were performed on all serum samples. RESULTS No viable virions could be detected in any of 29 nasopharyngeal and 29 oropharyngeal swabs taken from 15 long-time carriers. We found SARSCoV- 2 RNA in 14/29 nasopharyngeal and 10/29 oropharyngeal swabs obtained from screening 15 HCWs with previous COVID-19 up to 55 days after symptom onset. Six (40%) of the 15 initially positive HCWs converted to negative and later reverted to positive again according to their medical records. All but one HCW, a healthy volunteer banned from work, showed the presence of neutralizing antibodies in concomitantly taken blood samples. Late threshold cycle (Ct) values in RT-PCR [mean 37.4; median 37.3; range 30.8-41.7] and the lack of virus growth in cell culture indicate that despite the positive PCR results no infectivity remained. CONCLUSION We recommend lifting isolation if the RT-PCR Ct-value of a naso- or oropharyngeal swab sample is over 30. Positive results obtained from genes targeted with Ct-values > 30 correspond to non-viable/noninfectious particles that are still detected by RT-PCR. In case of Ct-values lower than 30, a blood sample from the patient should be tested for the presence of neutralizing antibodies. If positive, non-infectiousness can also be assumed.
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Affiliation(s)
- H Laferl
- 4th Medical Department with Infectious Diseases and Tropical Medicine, Kaiser Franz Josef Hospital, 1100, Vienna, Austria.
| | - H Kelani
- 4th Medical Department with Infectious Diseases and Tropical Medicine, Kaiser Franz Josef Hospital, 1100, Vienna, Austria
| | - T Seitz
- 4th Medical Department with Infectious Diseases and Tropical Medicine, Kaiser Franz Josef Hospital, 1100, Vienna, Austria
| | - B Holzer
- Austrian Agency for Health and Food Safety (AGES), Institute for Veterinary Disease Control Mödling, 2340, Mödling, Austria
| | - I Zimpernik
- Austrian Agency for Health and Food Safety (AGES), Institute for Veterinary Disease Control Mödling, 2340, Mödling, Austria
| | - A Steinrigl
- Austrian Agency for Health and Food Safety (AGES), Institute for Veterinary Disease Control Mödling, 2340, Mödling, Austria
| | - F Schmoll
- Austrian Agency for Health and Food Safety (AGES), Institute for Veterinary Disease Control Mödling, 2340, Mödling, Austria
| | - C Wenisch
- 4th Medical Department with Infectious Diseases and Tropical Medicine, Kaiser Franz Josef Hospital, 1100, Vienna, Austria
| | - F Allerberger
- Austrian Agency for Health and Food Safety (AGES), Institute for Veterinary Disease Control Mödling, 2340, Mödling, Austria
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Hoepler W, Traugott MT, Christ G, Kitzberger R, Pawelka E, Karolyi M, Seitz T, Baumgartner S, Kelani H, Wenisch C, Laferl H, Zoufaly A, Weseslindtner L, Neuhold S. Clinical and Angiographic Features in Three COVID-19 Patients with Takotsubo Cardiomyopathy. Case Report. ACTA ACUST UNITED AC 2021; 3:263-268. [PMID: 33426474 PMCID: PMC7786154 DOI: 10.1007/s42399-020-00683-5] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2020] [Indexed: 10/31/2022]
Abstract
While coronavirus disease 2019 (COVID-19), caused by severe acute respiratory coronavirus 2 (SARS-CoV-2), has often been perceived as a predominantly respiratory condition, it is characterized by complications in multiple organ systems. Especially the involvement of the cardiovascular system, along with the possibly severe pulmonary injury, is crucial for prognosis. We identified three COVID-19 patients with takotsubo (TT) cardiomyopathy at our infectious diseases treatment center and present their clinical, laboratory, echocardiographic, electrocardiographic, and angiographic features. All patients were female (median age, 67 years); disease severity regarding COVID-19 ranged from asymptomatic to ARDS (adult respiratory syndrome) necessitating mechanical ventilation for 22 days. Angiography revealed normal coronary arteries in patient 1, severe three-vessel coronary artery disease (CAD) in patient 2, and insignificant bystander CAD in patient 3. All patients showed classic apical hypokinesia with basal hyperkinesia. In patient 3, TT cardiomyopathy resulted in transient cardiogenic shock. Twenty-eight-day mortality was 0% in this case series. In conclusion, takotsubo cardiomyopathy may be yet another clinical entity associated with SARS-CoV-2 infection.
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Affiliation(s)
- Wolfgang Hoepler
- Fourth Medical Department with Infectious Diseases and Tropical Medicine, Klinik Favoriten/Kaiser-Franz-Josef Hospital, 1100 Vienna, Austria
| | - Marianna Theresia Traugott
- Fourth Medical Department with Infectious Diseases and Tropical Medicine, Klinik Favoriten/Kaiser-Franz-Josef Hospital, 1100 Vienna, Austria
| | - Guenter Christ
- Fifth Medical Department with Cardiology, Kaiser-Franz-Josef Hospital, 1100 Vienna, Austria
| | - Reinhard Kitzberger
- Fourth Medical Department with Infectious Diseases and Tropical Medicine, Klinik Favoriten/Kaiser-Franz-Josef Hospital, 1100 Vienna, Austria
| | - Erich Pawelka
- Fourth Medical Department with Infectious Diseases and Tropical Medicine, Klinik Favoriten/Kaiser-Franz-Josef Hospital, 1100 Vienna, Austria
| | - Mario Karolyi
- Fourth Medical Department with Infectious Diseases and Tropical Medicine, Klinik Favoriten/Kaiser-Franz-Josef Hospital, 1100 Vienna, Austria
| | - Tamara Seitz
- Fourth Medical Department with Infectious Diseases and Tropical Medicine, Klinik Favoriten/Kaiser-Franz-Josef Hospital, 1100 Vienna, Austria
| | - Sebastian Baumgartner
- Fourth Medical Department with Infectious Diseases and Tropical Medicine, Klinik Favoriten/Kaiser-Franz-Josef Hospital, 1100 Vienna, Austria
| | - Hasan Kelani
- Fourth Medical Department with Infectious Diseases and Tropical Medicine, Klinik Favoriten/Kaiser-Franz-Josef Hospital, 1100 Vienna, Austria
| | - Christoph Wenisch
- Fourth Medical Department with Infectious Diseases and Tropical Medicine, Klinik Favoriten/Kaiser-Franz-Josef Hospital, 1100 Vienna, Austria
| | - Hermann Laferl
- Fourth Medical Department with Infectious Diseases and Tropical Medicine, Klinik Favoriten/Kaiser-Franz-Josef Hospital, 1100 Vienna, Austria
| | - Alexander Zoufaly
- Fourth Medical Department with Infectious Diseases and Tropical Medicine, Klinik Favoriten/Kaiser-Franz-Josef Hospital, 1100 Vienna, Austria
| | | | - Stephanie Neuhold
- Fourth Medical Department with Infectious Diseases and Tropical Medicine, Klinik Favoriten/Kaiser-Franz-Josef Hospital, 1100 Vienna, Austria
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Koblischke M, Traugott MT, Medits I, Spitzer FS, Zoufaly A, Weseslindtner L, Simonitsch C, Seitz T, Hoepler W, Puchhammer-Stöckl E, Aberle SW, Födinger M, Bergthaler A, Kundi M, Heinz FX, Stiasny K, Aberle JH. Dynamics of CD4 T Cell and Antibody Responses in COVID-19 Patients With Different Disease Severity. Front Med (Lausanne) 2020; 7:592629. [PMID: 33262993 PMCID: PMC7686651 DOI: 10.3389/fmed.2020.592629] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [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: 08/07/2020] [Accepted: 10/12/2020] [Indexed: 12/11/2022] Open
Abstract
Disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ranges from mild illness to severe respiratory disease and death. In this study, we determined the kinetics of viral loads, antibody responses (IgM, IgG, neutralization) and SARS-CoV-2-specific CD4 T cells by quantifying these parameters in 435 serial respiratory and blood samples collected from a cohort of 29 COVID-19 patients with either moderate or severe disease during the whole period of hospitalization or until death. Remarkably, there was no significant difference in the kinetics and plateau levels of neutralizing antibodies among the groups with different disease severity. In contrast, the dynamics of specific CD4 T cell responses differed considerably, but all patients with moderate or severe disease developed robust SARS-CoV-2-specific responses. Of note, none of the patients had detectable cross-reactive CD4 T cells in the first week after symptom onset, which have been described in 20–50% of unexposed individuals. Our data thus provide novel insights into the kinetics of antibody and CD4 T cell responses as well as viral loads that are key to understanding the role of adaptive immunity in combating the virus during acute infection and provide leads for the timing of immune therapies for COVID-19.
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Affiliation(s)
| | - Marianna T Traugott
- Department of Medicine IV, Clinic Favoriten, Vienna Healthcare Group, Vienna, Austria
| | - Iris Medits
- Center for Virology, Medical University of Vienna, Vienna, Austria
| | | | - Alexander Zoufaly
- Department of Medicine IV, Clinic Favoriten, Vienna Healthcare Group, Vienna, Austria
| | | | - Cara Simonitsch
- Center for Virology, Medical University of Vienna, Vienna, Austria
| | - Tamara Seitz
- Department of Medicine IV, Clinic Favoriten, Vienna Healthcare Group, Vienna, Austria
| | - Wolfgang Hoepler
- Department of Medicine IV, Clinic Favoriten, Vienna Healthcare Group, Vienna, Austria
| | | | - Stephan W Aberle
- Center for Virology, Medical University of Vienna, Vienna, Austria
| | - Manuela Födinger
- Institute of Laboratory Diagnostics, Clinic Favoriten, Vienna Healthcare Group, Vienna, Austria.,Medical Faculty, Sigmund Freud Private University, Vienna, Austria
| | - Andreas Bergthaler
- Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria
| | - Michael Kundi
- Center for Public Health, Medical University of Vienna, Vienna, Austria
| | - Franz X Heinz
- Center for Virology, Medical University of Vienna, Vienna, Austria
| | - Karin Stiasny
- Center for Virology, Medical University of Vienna, Vienna, Austria
| | - Judith H Aberle
- Center for Virology, Medical University of Vienna, Vienna, Austria
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Karolyi M, Pawelka E, Kelani H, Funk GC, Lindner B, Porpaczy C, Publig S, Seitz T, Traugott M, Unterweger M, Zoufaly A, Wenisch C. Gender differences and influenza-associated mortality in hospitalized influenza A patients during the 2018/19 season. Infection 2020; 49:103-110. [PMID: 33090329 DOI: 10.1007/s15010-020-01537-x] [Citation(s) in RCA: 3] [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] [Received: 05/08/2020] [Accepted: 10/05/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND In this study we analyzed gender differences in the clinical presentation of patients with molecular confirmed influenza A. Additionally, we tried to identify predictors of influenza-associated mortality. MATERIALS/METHODS In this prospective observational multi-center-study we included all influenza-positive patients ≥ 18 years who were hospitalized and treated on flu-isolation-wards in three hospitals in Vienna during the 2018/19 influenza season. Diagnoses were made via Cobas® Liat® POCT. RESULTS 490 Patients (48.8% female) tested positive for influenza A. Female patients were older (median age 76 years vs. 70 years, p < 0.001). Male patients had a higher rate of chronic liver disease in history (8.8% vs. 2.9%, p = 0.006), myositis (11.7% vs. 3.1%, p < 0.001) and ICU admissions (9.6% vs. 4.6%, p = 0.03). The in-hospital mortality rate was 4.3% and increased to 9.5% during the 90-day follow-up period. Female patients > 75 years had a significantly higher in-hospital mortality rate than ≤ 75-year-old females (9.2% vs. 1.7%, p = 0.019). This effect was not observed in male patients (5.4% vs. 1.9%, p = ns). Age > 75 years (OR 5.49, 95% CI 1.10-27.43), acute heart failure (OR 3.56, 95% CI 1.03-12.05) and ICU admission (OR 6.1, 95% CI 0.98-37.91) were predictors for in-hospital mortality for female patients, while any malignancy (OR 9.4, 95% CI 1.90-46.54) and ICU admission (OR 7.05, 95% CI 1.44-34.55) were predictors in male patients. CONCLUSIONS Gender is associated with differences in clinical presentation and complications of influenza A virus infection. Women with acute heart failure or aged > 75 years have an increased risk of influenza associated in-hospital mortality, while ICU admission and any malignancy are predictors for male patients. Mortality rates in patients > 75 years are 5-10 times higher compared to their non-hospitalized influenza-negative Austrian counterparts.
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Affiliation(s)
- Mario Karolyi
- Department for Infectious Diseases, Kaiser-Franz-Josef-Hospital (KFJ), Kundratstraße 3, 1100, Vienna, Austria.
| | - E Pawelka
- Department for Infectious Diseases, Kaiser-Franz-Josef-Hospital (KFJ), Kundratstraße 3, 1100, Vienna, Austria
| | - H Kelani
- Medical University of Vienna (MUW), Vienna, Austria
| | - G C Funk
- Medical Department II and Karl-Landsteiner Institute for Lung Research and Pulmonological Oncology, Wilheminen-Hospital (WSP), Vienna, Austria
| | - B Lindner
- Medical Department II, Center for Diagnosis and Treatment of Rheumatic Diseases, Hospital Hietzing, Vienna, Austria
| | - C Porpaczy
- Medical Department II, Center for Diagnosis and Treatment of Rheumatic Diseases, Hospital Hietzing, Vienna, Austria
| | - S Publig
- Medical Department II and Karl-Landsteiner Institute for Lung Research and Pulmonological Oncology, Wilheminen-Hospital (WSP), Vienna, Austria
| | - T Seitz
- Department for Infectious Diseases, Kaiser-Franz-Josef-Hospital (KFJ), Kundratstraße 3, 1100, Vienna, Austria
| | - M Traugott
- Department for Infectious Diseases, Kaiser-Franz-Josef-Hospital (KFJ), Kundratstraße 3, 1100, Vienna, Austria
| | - M Unterweger
- Department for Anesthesia and Surgical Intensive Care, Kaiser-Franz-Josef-Hospital (KFJ), Vienna, Austria
| | - A Zoufaly
- Department for Infectious Diseases, Kaiser-Franz-Josef-Hospital (KFJ), Kundratstraße 3, 1100, Vienna, Austria
| | - C Wenisch
- Department for Infectious Diseases, Kaiser-Franz-Josef-Hospital (KFJ), Kundratstraße 3, 1100, Vienna, Austria
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Pitscheider L, Karolyi M, Burkert FR, Helbok R, Wanschitz JV, Horlings C, Pawelka E, Omid S, Traugott M, Seitz T, Zoufaly A, Lindeck-Pozza E, Wöll E, Beer R, Seiwald S, Bellmann-Weiler R, Hegen H, Löscher WN. Muscle involvement in SARS-CoV-2 infection. Eur J Neurol 2020; 28:3411-3417. [PMID: 32997370 PMCID: PMC7537196 DOI: 10.1111/ene.14564] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [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: 07/30/2020] [Revised: 09/09/2020] [Accepted: 09/23/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND PURPOSE Since the outbreak of the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) pandemic, several reports indicated neurological involvement in COVID-19 disease. Muscle involvement has also been reported as evidenced by creatine kinase (CK) elevations and reports of myalgia. METHODS Creatine kinase, markers of inflammation, pre-existing diseases and statin use were extracted from records of Austrian hospitalised COVID-19 patients. Disease severity was classified as severe in case of intensive care unit (ICU) admission or mortality. COVID-19 patients were additionally compared to an historical group of hospitalised influenza patients. RESULTS Three hundred fifty-one patients with SARS-CoV-2 and 258 with influenza were included in the final analysis. CK was elevated in 27% of COVID-19 and in 28% of influenza patients. CK was higher in severe COVID-19 as were markers of inflammation. CK correlated significantly with inflammation markers, which had an independent impact on CK when adjusted for demographic variables and disease severity. Compared to influenza patients, COVID-19 patients were older, more frequently male, had more comorbidities, and more frequently had a severe disease course. Nevertheless, influenza patients had higher baseline CK than COVID-19, and 35.7% of intensive care unit (ICU)-admitted patients had CK levels >1,000 U/L compared to only 4.7% of ICU-admitted COVID-19 patients. CONCLUSIONS HyperCKemia occurs in a similar frequency in COVID-19 and influenza infection. CK levels were lower in COVID-19 than in influenza in mild and severe disease. CK levels strongly correlate with disease severity and markers of inflammation. To date, it remains unclear whether hyperCKemia is due to a virus-triggered inflammatory response or direct muscle toxicity.
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Affiliation(s)
- Lea Pitscheider
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Mario Karolyi
- 4th Medical Department with Infectious Diseases and Tropical Medicine, Kaiser Franz Josef Hospital, Vienna, Austria
| | - Francesco R Burkert
- Department of Internal Medicine II, Infectious Diseases, Pneumology, Rheumatology, Medical University of Innsbruck, Innsbruck, Austria
| | - Raimund Helbok
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Julia V Wanschitz
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Corinne Horlings
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Erich Pawelka
- 4th Medical Department with Infectious Diseases and Tropical Medicine, Kaiser Franz Josef Hospital, Vienna, Austria
| | - Sara Omid
- 4th Medical Department with Infectious Diseases and Tropical Medicine, Kaiser Franz Josef Hospital, Vienna, Austria
| | - Marianna Traugott
- 4th Medical Department with Infectious Diseases and Tropical Medicine, Kaiser Franz Josef Hospital, Vienna, Austria
| | - Tamara Seitz
- 4th Medical Department with Infectious Diseases and Tropical Medicine, Kaiser Franz Josef Hospital, Vienna, Austria
| | - Alexander Zoufaly
- 4th Medical Department with Infectious Diseases and Tropical Medicine, Kaiser Franz Josef Hospital, Vienna, Austria
| | | | - Ewald Wöll
- Department of Internal Medicine, St. Vinzenz Hospital, Zams, Austria
| | - Ronny Beer
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Stefanie Seiwald
- Department of Internal Medicine II, Infectious Diseases, Pneumology, Rheumatology, Medical University of Innsbruck, Innsbruck, Austria
| | - Rosa Bellmann-Weiler
- Department of Internal Medicine II, Infectious Diseases, Pneumology, Rheumatology, Medical University of Innsbruck, Innsbruck, Austria
| | - Harald Hegen
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Wolfgang N Löscher
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
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Karolyi M, Pawelka E, Omid S, Kelani H, Mader T, Baumgartner S, Laferl H, Traugott M, Seitz T, Zoufaly A, Wenisch C. Late onset pulmonary embolism in young male otherwise healthy COVID-19 patients. Eur J Clin Microbiol Infect Dis 2020; 40:633-635. [PMID: 32965656 PMCID: PMC7509817 DOI: 10.1007/s10096-020-04044-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 05/15/2020] [Accepted: 09/18/2020] [Indexed: 11/29/2022]
Abstract
SARS-CoV-2 infection is associated with increased risk of thrombosis in severely ill patients but little is known about the risk in outpatients with mild to moderate disease. Our case series consists of four male otherwise healthy patients between 32 and 50 years of age. Initial symptoms completely resolved but they developed new onset of dyspnea and thoracic pain at days 14 to 26. CT scan revealed pulmonary embolism in all patients which led to hospitalization. Standard anticoagulation practice needs to be re-evaluated and may be considered for certain outpatients with COVID-19.
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Affiliation(s)
- M Karolyi
- Department for Infectious Diseases and Tropical Medicine, Kaiser-Franz-Josef Hospital, Kundratstraße 3, 1100, Vienna, Austria.
| | - E Pawelka
- Department for Infectious Diseases and Tropical Medicine, Kaiser-Franz-Josef Hospital, Kundratstraße 3, 1100, Vienna, Austria
| | - S Omid
- Department for Infectious Diseases and Tropical Medicine, Kaiser-Franz-Josef Hospital, Kundratstraße 3, 1100, Vienna, Austria
| | - H Kelani
- Department for Infectious Diseases and Tropical Medicine, Kaiser-Franz-Josef Hospital, Kundratstraße 3, 1100, Vienna, Austria
| | - T Mader
- Department for Infectious Diseases and Tropical Medicine, Kaiser-Franz-Josef Hospital, Kundratstraße 3, 1100, Vienna, Austria
| | - S Baumgartner
- Department for Infectious Diseases and Tropical Medicine, Kaiser-Franz-Josef Hospital, Kundratstraße 3, 1100, Vienna, Austria
| | - H Laferl
- Department for Infectious Diseases and Tropical Medicine, Kaiser-Franz-Josef Hospital, Kundratstraße 3, 1100, Vienna, Austria
| | - M Traugott
- Department for Infectious Diseases and Tropical Medicine, Kaiser-Franz-Josef Hospital, Kundratstraße 3, 1100, Vienna, Austria
| | - T Seitz
- Department for Infectious Diseases and Tropical Medicine, Kaiser-Franz-Josef Hospital, Kundratstraße 3, 1100, Vienna, Austria
| | - A Zoufaly
- Department for Infectious Diseases and Tropical Medicine, Kaiser-Franz-Josef Hospital, Kundratstraße 3, 1100, Vienna, Austria
| | - C Wenisch
- Department for Infectious Diseases and Tropical Medicine, Kaiser-Franz-Josef Hospital, Kundratstraße 3, 1100, Vienna, Austria
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Traugott MT, Hoepler W, Seitz T, Baumgartner S, Karolyi M, Pawelka E, Friese E, Neuhold S, Kelani H, Thalhammer F, Zoufaly A, Laferl H, Aberle JH, Wenisch C, Puchhammer-Stöckl E, Stiasny K, Aberle SW, Weseslindtner L. Diagnosis of COVID-19 using multiple antibody assays in two cases with negative PCR results from nasopharyngeal swabs. Infection 2020; 49:171-175. [PMID: 32785885 PMCID: PMC7851003 DOI: 10.1007/s15010-020-01497-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 07/30/2020] [Indexed: 01/11/2023]
Abstract
We report of two cases of progressed COVID-19 with negative PCR tests from nasopharyngeal swabs, in whom diagnosis was made by different antibody assays, including a lateral flow rapid test and multiple commercial ELISAs, finally confirmed by comprehensive serological assays. These cases highlight that commercial ELISAs and even rapid tests might significantly aid the diagnosis of COVID-19, particularly, if a combination of serological assays is used with a specific clinical question, in severely ill patients after seroconversion and when comprehensive serological methods are used for confirmation.
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Affiliation(s)
- Marianna Theresia Traugott
- 4th Medical Department, Department of Infectious Diseases and Tropical Medicine, Kaiser-Franz-Josef Hospital, Vienna, Austria
| | - Wolfgang Hoepler
- 4th Medical Department, Department of Infectious Diseases and Tropical Medicine, Kaiser-Franz-Josef Hospital, Vienna, Austria
| | - Tamara Seitz
- 4th Medical Department, Department of Infectious Diseases and Tropical Medicine, Kaiser-Franz-Josef Hospital, Vienna, Austria
| | - Sebastian Baumgartner
- 4th Medical Department, Department of Infectious Diseases and Tropical Medicine, Kaiser-Franz-Josef Hospital, Vienna, Austria
| | - Mario Karolyi
- 4th Medical Department, Department of Infectious Diseases and Tropical Medicine, Kaiser-Franz-Josef Hospital, Vienna, Austria
| | - Erich Pawelka
- 4th Medical Department, Department of Infectious Diseases and Tropical Medicine, Kaiser-Franz-Josef Hospital, Vienna, Austria
| | - Emanuela Friese
- 4th Medical Department, Department of Infectious Diseases and Tropical Medicine, Kaiser-Franz-Josef Hospital, Vienna, Austria
| | - Stephanie Neuhold
- 4th Medical Department, Department of Infectious Diseases and Tropical Medicine, Kaiser-Franz-Josef Hospital, Vienna, Austria
| | - Hasan Kelani
- 4th Medical Department, Department of Infectious Diseases and Tropical Medicine, Kaiser-Franz-Josef Hospital, Vienna, Austria
| | - Florian Thalhammer
- Division of Infectious Diseases and Tropical Medicine, Department of Medicine I, Medical University Vienna, Vienna, Austria
| | - Alexander Zoufaly
- 4th Medical Department, Department of Infectious Diseases and Tropical Medicine, Kaiser-Franz-Josef Hospital, Vienna, Austria
| | - Hermann Laferl
- 4th Medical Department, Department of Infectious Diseases and Tropical Medicine, Kaiser-Franz-Josef Hospital, Vienna, Austria
| | - Judith Helene Aberle
- Center for Virology, Medical University of Vienna, Kinderspitalgasse 15, 1090, Vienna, Austria
| | - Christoph Wenisch
- 4th Medical Department, Department of Infectious Diseases and Tropical Medicine, Kaiser-Franz-Josef Hospital, Vienna, Austria
| | | | - Karin Stiasny
- Center for Virology, Medical University of Vienna, Kinderspitalgasse 15, 1090, Vienna, Austria
| | - Stephan Walter Aberle
- Center for Virology, Medical University of Vienna, Kinderspitalgasse 15, 1090, Vienna, Austria
| | - Lukas Weseslindtner
- Center for Virology, Medical University of Vienna, Kinderspitalgasse 15, 1090, Vienna, Austria.
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Seitz T, Ucsnik L, Kottmel A, Bitzer J, Teleky B, Löffler-Stastka H. Let us integrate sexual health-do psychiatrists integrate sexual health in patient management? Arch Womens Ment Health 2020; 23:527-534. [PMID: 31897606 PMCID: PMC7368870 DOI: 10.1007/s00737-019-01016-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Accepted: 12/18/2019] [Indexed: 02/07/2023]
Abstract
The high prevalence of sexual dysfunction and the importance of sexual health issues in general stress the need for a physician to integrate sexual health issues in patient management. In this study, we evaluate the frequency of psychiatrists addressing sexual health issues as well as their attitude towards sexual health. Plus, we want to evaluate the multi-professional network for patient treatment that is needed by physicians for collaboration with other medical specialists and health care professionals. At total 100 psychiatrists (age range 30-60 years), participating at the annual meeting of the Austrian Society of Psychiatry, Psychotherapy, and Psychosomatics, were invited to self-assess their caring for patients' sexual health issues and answer a self-report questionnaire. The return rate was 74%. A third of the participating psychiatrists and psychotherapists stated to address sexual health in patients in daily routine. Twenty-five percent of the physicians suspected sexual health problems in 60-100% of their patients but did not ask the patients about this topic. Mentioned reasons why patients would not actively address sexual problems were rated by the survey participants "a different problem was more important", "lack of time", and "embarrassment". Only few of the participating psychiatrists stated to offer a consultation in sexual health to the patients, none to offer sexual therapy. A mentioned reason was "lack of competence regarding sexual health". Twelve percent referred the patients with sexual issues to a physician with another medical specialization, especially to experts in gynaecology and obstetrics, to experts in urology, or to andrologists. However, a need for a network in the field of sexual medicine was stated and an unawareness of a sexual health care network: where to refer the patients in need. Our data showed an increased need in the routine treatment and management of sexual health care in psychiatrists and psychotherapists. Plus, the data stresses the need for professional sexual medicine qualification and for extended cooperation between different medical fields and health care professionals in order to integrate sexual health topics professionally in daily routine.
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Affiliation(s)
- Tamara Seitz
- Department of Infectious Diseases and Tropical Medicine, SMZ SÜD, Vienna, Austria
| | - Lucia Ucsnik
- Department of Visceral Surgery, University Clinic of Surgery, Medical University Vienna, Vienna, Austria
| | - Andrea Kottmel
- Private Practice for Gynecology and Sexual Medicine, Vienna, Austria
| | | | - Bela Teleky
- Department of Visceral Surgery, University Clinic of Surgery, Medical University Vienna, Vienna, Austria
| | - Henriette Löffler-Stastka
- University Clinic of Psychoanalysis and Psychotherapy, Medical University Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
- Austrian Society of Psychiatry, Psychotherapy and Psychosomatics, Section Psychotherapy, Vienna, Austria.
- Postgraduate Unit, Teaching Center, Medical University Vienna, Vienna, Austria.
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Wadowski PP, Litschauer B, Seitz T, Ertl S, Löffler-Stastka H. Case-based blended eLearning scenarios-adequate for competence development or more? Neuropsychiatr 2019; 33:207-211. [PMID: 31696411 PMCID: PMC6901430 DOI: 10.1007/s40211-019-00322-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 10/03/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Learning, competence development and scientific thinking in medicine need several strategies to facilitate new diagnostic and therapeutic ways. The optimal collaboration between creative thinking and biomedical informatics provides innovation for the individual patient and for a medical school or society. Utilizing the flexibilities of an e‑learning platform, a case based blended learning (CBBL) framework consisting of A) case based textbook material, B) online e‑CBL with question driven learning scenarios and C) simulated patient (SP) contact seminars was developed and implemented in multiple medical fields. Real-life clinical cases were anonymized and transferred into an interactive and an interdisciplinary eLearning platform. METHODS As an example of the offered clinical teaching-case collection, an example of a psychiatric case for the disease "posttraumatic stress disorder (PTSD)" is presented: a 30-year-old man with a history of insomnia with difficulties in falling asleep and sleeping through, nightmares, nervousness and psychomotor restlessness. The students are challenged to identify possible differential diagnoses and further get to know the patient's personal history (loss of relatives due to war, torture and flight from home country). Further, the students are guided through the principles of fear conditioning including translational aspects like neurotransmitter signaling of PTSD pathomechanism (translational and research aspects like dopamine transporter gene polymorphism, long term potentiation and synaptic signaling). RESULTS/CONCLUSION The case presentation comprises different learning aspects: First, declarative knowledge has to be acquired and collected in basic medical sciences, knowledge that is in fact available and can be accessed on the conscious and preconscious level in long-term memory. Second, associative learning leads to the formation of neuronal connections and is an important way of learning and discovering, founded in neural associations. Third, polythematic-crosslinking thinking is needed as ability to link information in a meaningful way. These steps are a typical intellectual ability of gifted learners and researchers that combine previously seemingly unrelated areas to each other and drive innovation.
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Affiliation(s)
- Patricia Pia Wadowski
- Department of Internal Medicine II, Division of Angiology, Medical University of Vienna, Vienna, Austria
| | - Brigitte Litschauer
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Tamara Seitz
- Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Sebastian Ertl
- Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Henriette Löffler-Stastka
- Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
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Abstract
Abstract
Background
The EK-189 study evaluates the clinical impact of T2 magnetic resonance (T2MR) for rapid detection of bloodstream infections (BSI) caused by ESKAPE-pathogens (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumanii, Pseudomonas aeruginosa, and Escherichia coli) compared with blood culture (BC). Here we present preliminary results from this ongoing study.
Methods
Patients newly admitted to an infectious diseases department with suspected blood stream infection with ESKAPE pathogens (based on predefined criteria) are included and randomized into BSI diagnosis with (a) T2MR and blood culture or (b) blood culture alone. Routine diagnostic workup including chest X-ray, complete laboratory workup (including blood count, C-reactive protein, interleukin-6) is performed in all patients. Antibiotic regimens are selected empirically based on suspected pathogens and are switched to targeted therapy at the discretion of the treating physician once a pathogen is detected. Outcome parameters include time to targeted (predefined) antibiotic therapy and time to discharge. Test characteristics of the T2MR compared with BC are also assessed.
Results
So far 44 patients were included (22 in each group). In 9/22 patients (41%) in the T2MR-group a pathogen was detected (4 Escherichia coli, 2 Klebsiella pneumoniae, 1 Staphylococcus aureus, 1 Pseudomonas aeruginosa and 1 Acinetobacter baumanii) and in 3/22 (14%) patients in the BC-group (all E. coli). The comparison of T2MR vs. BC is depicted in Table 1. Sensitivity and specificity of T2MR in comparison to BC were 100% and 64.7%. All positive results in T2MR were considered true positive results. The days until clinical improvement, the need for admission at ICU and the in-hospital mortality were similar in both groups.
Conclusion
The results from this preliminary analysis show that in patients with suspected BSI with ESKAPE pathogens, T2MR detects more pathogens than BC and potentially provides a quicker detection and shorter time to targeted therapy. Further analyses of this ongoing study with a larger sample size are needed to evaluate the impact of the use of T2MR on patient’s outcome
Disclosures
All authors: No reported disclosures.
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Affiliation(s)
- Tamara Seitz
- SMZ SÜD Vienna, Department of Infectious Diseases and Tropical Medicine, Vienna, Wien, Austria
| | - Sebastian Baumgartner
- SMZ SÜD Vienna, Department of Infectious Diseases and Tropical Medicine, Vienna, Wien, Austria
| | - Christoph Wenisch
- SMZ SÜD Vienna, Department of Infectious Diseases and Tropical Medicine, Vienna, Wien, Austria
| | - Alexander Zoufaly
- SMZ SÜD Vienna, Department of Infectious Diseases and Tropical Medicine, Vienna, Wien, Austria
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Seitz T, Stastka K, Schiffinger M, Rui Turk B, Löffler-Stastka H. Interprofessional care improves health-related well-being and reduces medical costs for chronic pain patients. Bull Menninger Clin 2019; 83:105-127. [PMID: 30840490 DOI: 10.1521/bumc_2019_83_01] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
This study evaluated whether patients with somatic symptom disorder, expressing chronic pain that could not be attributed to a medical condition, would benefit from an 8-week inpatient residence at a psychiatric ward. In the 1-year follow-up after termination the authors examined the extent to which the integrated treatment decreased patient costs. A total of 106 patients participated in the follow-up and reported a significant improvement in their general health (Cohen's d = 1.5-2.21), a decrease in impairment due to pain (d = 2.24), and a decrease in symptom severity (d = 1.29). They took fewer medications and sick days, reported fewer hospital stays and medical examinations, and consulted and changed physicians and outpatient clinics less often (d = 0.55-1.1). The average cost per patient was cut in half, down to € 80,000/$96,000 per year. From a clinical standpoint, group analysis that focused on aggression was the most effective intervention.
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Affiliation(s)
- Tamara Seitz
- Medical University of Vienna, Department of Psychoanalysis and Psychotherapy, and Teaching Center/Postgraduate Unit/Health Care Management and Psychotherapy Research, Vienna, Austria
- SMZ Süd Hospital of Vienna, Department of Infectious Diseases and Tropical Medicine, Vienna, Austria
| | - Kurt Stastka
- SMZ Süd Hospital of Vienna, Department of Psychiatry, Vienna, Austria
| | | | - Bela Rui Turk
- Kennedy Krieger Institute, Johns Hopkins Medical Institutions, Baltimore, MD
| | - Henriette Löffler-Stastka
- Medical University of Vienna, Department of Psychoanalysis and Psychotherapy, and Teaching Center/Postgraduate Unit/Health Care Management and Psychotherapy Research, Vienna, Austria
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Seitz T, Raschauer B, Längle AS, Löffler-Stastka H. Competency in medical history taking-the training physicians' view. Wien Klin Wochenschr 2019; 131:17-22. [PMID: 30569233 PMCID: PMC6342885 DOI: 10.1007/s00508-018-1431-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 12/06/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Because effective communication skills are crucial for every physician, this study evaluated students' competence to take a sufficient medical history. This ability was measured via reports from the students' supervising and training physicians. METHODS A total of 24 physicians from several different departments were interviewed' and a stratification of medical specialties was performed due to the current supply-relevant number of medical doctors in the country. A qualitative content analysis was then performed. RESULTS The analysis revealed the students' lack of expertise and ability to take a structured and complete medical history. Additionally, the lack of students' engagement was criticized by the training physicians. An insufficiency of student supervision was also shown as only half of the departments have a fixed supervisor for the students during the internship. CONCLUSION The data showed the need for a refinement of the training of communicative skills at university and the practical training at hospitals.
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Affiliation(s)
- Tamara Seitz
- Social-Medical Center South, Vienna, Austria
- Dept. of Psychoanalysis and Psychotherapy, Medical University Vienna, Währingerstraße 18-20, 1090, Vienna, Austria
| | | | - Angelika S Längle
- Dept. of Psychoanalysis and Psychotherapy, Medical University Vienna, Währingerstraße 18-20, 1090, Vienna, Austria
- Postgraduate Unit/Teaching Center, Medical University Vienna, Vienna, Austria
| | - Henriette Löffler-Stastka
- Dept. of Psychoanalysis and Psychotherapy, Medical University Vienna, Währingerstraße 18-20, 1090, Vienna, Austria.
- Postgraduate Unit/Teaching Center, Medical University Vienna, Vienna, Austria.
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Seitz T, Längle AS, Seidman C, Löffler-Stastka H. Does medical students' personality have an impact on their intention to show empathic behavior? Arch Womens Ment Health 2018; 21:611-618. [PMID: 29623465 PMCID: PMC6245122 DOI: 10.1007/s00737-018-0837-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 03/21/2018] [Indexed: 02/07/2023]
Abstract
Several studies have demonstrated a correlation between specific personal traits and empathy. However, it is not clear if persons with certain personality traits lack the intent to show empathic behavior or if other factors independent of their intent are affecting their empathic behavior. To answer this question, we asked 132 medical students to fill out questionnaires evaluating the General Intention to Show Empathic Behavior (GISEB) and the five personality traits measured by NEO Five-Factor Inventory (NEO-FFI). Additionally, we evaluated the influence of other factors, such as age, gender, curricular progress (second versus fourth year), and preferred specialization after graduation. We performed a Pearson's correlation and a regression analysis. Results indicate that the five personality traits and gender have little influence on the General Intention (GISEB), only extraversion (r = .221, 95% CI [.013-.394], p = .027), and agreeableness (r = .229, 95% CI [.021-.428], p = .022) correlated with the intention. The only predictor for General Intention (GISEB) was curricular progress (β = - .27, p < .05), showing a decrease of General Intention to Show Empathic Behavior from second to fourth year of university (U = 1203.5, p = .002). A further finding indicates that gender and personality influence the students' wish of specialization after graduation: Agreeableness (F(12, 53) = 2.376, p = .016) impacted the preferred specialization. Our study demonstrated that medical students' personality might not notably impact the intention to show empathic behavior. Further research is needed to investigate moderating effects.
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Affiliation(s)
- Tamara Seitz
- Department of Infectious Diseases and Tropical Medicine, SMZ Süd Wien, Vienna, Austria
| | - Angelika S Längle
- Department of Psychoanalysis und Psychotherapy, and Teaching Center/Postgraduate Unit, Medical University of Vienna, Währingerstraße 18-20, 1090, Vienna, Austria
| | | | - Henriette Löffler-Stastka
- Department of Psychoanalysis und Psychotherapy, and Teaching Center/Postgraduate Unit, Medical University of Vienna, Währingerstraße 18-20, 1090, Vienna, Austria.
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Paasch U, Bäumler W, Seitz T, Grunewald S. Facharztgrundseminare „Laser in der Dermatologie“. Akt Dermatol 2018. [DOI: 10.1055/a-0644-9408] [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: 10/27/2022]
Abstract
ZusammenfassungLaser erfreuen sich umfänglicher Anwendung in der täglichen dermatologischen Routine, obwohl nahezu jede dermatologische Laserintervention durch andere Methoden ersetzt werden kann. Zudem sind Laser gefährlich, teuer, schwierig zu bedienen und erfordern ein hohes Maß an handwerklicher Geschicklichkeit. Nicht zuletzt bedarf es noch einiger Aufwände, die geforderten Zusatzqualifikationen zu erlangen, um dann allein Stück für Stück möglichst fehlerfrei praktische Erfahrung zu sammeln. Gut ausgebildet bietet die Laserintervention im Vergleich zu alternativen Optionen häufig den präziseren, schnelleren, ästhetischeren und eleganteren Therapieweg. Ziel der 2004 ins Leben gerufenen strukturierten Facharztgrundseminare war es, eine qualifizierte Ausbildungsplattform für diesen Spezialbereich der Dermatologie zu etablieren. Ausgewiesen wird dies durch das Zertifikat „Laser in der Dermatologie“.Es wird zu den Standards der Ausbildungsinhalte, der nunmehr 14-jährigen Praxiserfahrung und zu den mit neuen gesetzlichen Vorschriften notwendig werdenden Änderungen Stellung genommen.
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Affiliation(s)
- U. Paasch
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Leipzig AöR und Medizinische Fakultät der Universität Leipzig
| | - W. Bäumler
- Klinik und Poliklinik für Dermatologie, Universität Regensburg
| | - T. Seitz
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Leipzig AöR und Medizinische Fakultät der Universität Leipzig
| | - S. Grunewald
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Leipzig AöR und Medizinische Fakultät der Universität Leipzig
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47
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Himmelbauer M, Seitz T, Seidman C, Löffler-Stastka H. Standardized patients in psychiatry - the best way to learn clinical skills? BMC Med Educ 2018; 18:72. [PMID: 29625572 PMCID: PMC5889557 DOI: 10.1186/s12909-018-1184-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 03/27/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Standardized patients (SP) have been successfully utilized in medical education to train students' communication skills. At the Medical University of Vienna communication training with SPs in psychiatry is a mandatory part of the curriculum. In the training, the SP plays the role of four different patients suffering from depression/suicidal tendencies, somatoform disorder, anxiety disorder, or borderline disorder while the student attempts to gather the patient's medical history. Both the instructor and SP then give the student constructive feedback afterwards. METHOD The aim of the study was to evaluate the quality of the SP's roleplay and feedback, using a self-created questionnaire. Additionally, we wanted to gauge the differences between the students' and teachers' evaluations of the SP's role playing performance and feedback. RESULTS The questionnaire was completed by 529 students and 29 teachers who attended the training. Overall, both students and teachers evaluated the SPs' performance and feedback very well. In comparison to the responses given by the teachers, more students reported that the "SP overacted" while fewer students believed that the "SP could be a real patient". The feedback given by the SP was evaluated similarly by students and teachers, suggesting that students are able to recognize the quality of constructive feedback. Furthermore, the SP's quality of roleplaying was evaluated as the poorest while playing the psychiatric disorder "depression/suicidal tendencies." CONCLUSIONS Our study showed that students and teachers appreciate SPs' competence of role play and of giving feedback. However, further studies should be performed to figure out why both students and teachers alike evaluated the played psychiatric disorder "depression/suicidal tendencies" to be the worst.
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Affiliation(s)
- Monika Himmelbauer
- 0000 0000 9259 8492grid.22937.3dTeaching Center, Medical University of Vienna, Vienna, Austria
| | - Tamara Seitz
- Department of Infectious Diseases and Tropical Medicine, SMZ Süd, Kundratstraße 10, 1100 Wien, Austria
| | - Charles Seidman
- 0000000419368729grid.21729.3fColumbia University, New York, USA
| | - Henriette Löffler-Stastka
- 0000 0000 9259 8492grid.22937.3dDepartment of Psychoanalysis and Psychotherapy, and Teaching Center/Postgraduate Unit, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
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48
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Ludwig B, Turk B, Seitz T, Klaus I, Löffler-Stastka H. The search for attitude-a hidden curriculum assessment from a central European perspective. Wien Klin Wochenschr 2018; 130:134-140. [PMID: 29356896 PMCID: PMC5816099 DOI: 10.1007/s00508-018-1312-5] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 01/03/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Little is known about the development of the hidden curriculum in the medical education system. It refers to a conglomeration of implicit beliefs, attitudes and forms of conduct that are unwittingly transmitted from one generation of teaching physicians to the next. How can we describe this process, what are the potential positive or negative impacts, and last but not least, how can we measure it? METHODS Students of the Medical University of Vienna complete their clinical rotations in Vienna and in other accredited, mostly central European hospitals. They were subsequently invited to evaluate their rotations in an online questionnaire regarding dimensions, such as professionalism, teaching, integration and appreciation. RESULTS In total, 133 students participated in this pilot study and the average response rate was 10.1%, similar to evaluations conducted prior to that. Although the evaluation results on average were positive, several experiences of deprecation and less professional conduct were present in each evaluated rotation. Giving the students the opportunity to reflect upon their experiences could be seen as an intervention and investigation at the same time. CONCLUSIONS This survey serves as a precursor to a qualitative interview-based study, accompanying the implementation of case-based learning designed by collaborating residents and medical students. The findings of this pilot-study support the necessity of fostering a reflective capacity in the education of medical students, enabling them to speak up and live up to the expected professionalism despite shortcomings within the hidden curriculum.
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Affiliation(s)
- Birgit Ludwig
- Dept. for Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Bela Turk
- Kennedy Krieger Institute, Johns Hopkins Medical Institutions, Baltimore, USA
| | | | | | - Henriette Löffler-Stastka
- Dept. for Psychoanalysis and Psychotherapy, and Teaching Center, Postgraduate Unit, Medical University Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
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49
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Niemeyer P, Seitz T, Plaumann U, Wallner F, Wanke E, Ohlendorf D. Einfluss von „foam rolling“ des M. rectus femoris auf die Oberkörperstatik. Manuelle Medizin 2017. [DOI: 10.1007/s00337-017-0284-2] [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: 10/19/2022]
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50
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André M, Caballé A, van der Schaar M, Solsona A, Houégnigan L, Zaugg S, Sánchez AM, Castell JV, Solé M, Vila F, Djokic D, Adrián-Martínez S, Albert A, Anghinolfi M, Anton G, Ardid M, Aubert JJ, Avgitas T, Baret B, Barrios-Martí J, Basa S, Bertin V, Biagi S, Bormuth R, Bouwhuis MC, Bruijn R, Brunner J, Busto J, Capone A, Caramete L, Carr J, Celli S, Chiarusi T, Circella M, Coleiro A, Coniglione R, Costantini H, Coyle P, Creusot A, Deschamps A, De Bonis G, Distefano C, Di Palma I, Donzaud C, Dornic D, Drouhin D, Eberl T, El Bojaddaini I, Elsässer D, Enzenhöfer A, Fehn K, Felis I, Fusco LA, Galatà S, Gay P, Geißelsöder S, Geyer K, Giordano V, Gleixner A, Glotin H, Gracia-Ruiz R, Graf K, Hallmann S, van Haren H, Heijboer AJ, Hello Y, Hernandez-Rey JJ, Hößl J, Hofestädt J, Hugon C, Illuminati G, James CW, de Jong M, Jongen M, Kadler M, Kalekin O, Katz U, Kießling D, Kouchner A, Kreter M, Kreykenbohm I, Kulikovskiy V, Lachaud C, Lahmann R, Lefèvre D, Leonora E, Loucatos S, Marcelin M, Margiotta A, Marinelli A, Martínez-Mora JA, Mathieu A, Melis K, Michael T, Migliozzi P, Moussa A, Mueller C, Nezri E, Păvălaş GE, Pellegrino C, Perrina C, Piattelli P, Popa V, Pradier T, Racca C, Riccobene G, Roensch K, Saldaña M, Samtleben DFE, Sanguineti M, Sapienza P, Schnabel J, Schüssler F, Seitz T, Sieger C, Spurio M, Stolarczyk T, Sánchez-Losa A, Taiuti M, Trovato A, Tselengidou M, Turpin D, Tönnis C, Vallage B, Vallée C, Van Elewyck V, Vivolo D, Wagner S, Wilms J, Zornoza JD, Zuñiga J. Sperm whale long-range echolocation sounds revealed by ANTARES, a deep-sea neutrino telescope. Sci Rep 2017; 7:45517. [PMID: 28401960 PMCID: PMC5388847 DOI: 10.1038/srep45517] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 02/14/2017] [Indexed: 11/09/2022] Open
Abstract
Despite dedicated research has been carried out to adequately map the distribution of the sperm whale in the Mediterranean Sea, unlike other regions of the world, the species population status is still presently uncertain. The analysis of two years of continuous acoustic data provided by the ANTARES neutrino telescope revealed the year-round presence of sperm whales in the Ligurian Sea, probably associated with the availability of cephalopods in the region. The presence of the Ligurian Sea sperm whales was demonstrated through the real-time analysis of audio data streamed from a cabled-to-shore deep-sea observatory that allowed the hourly tracking of their long-range echolocation behaviour on the Internet. Interestingly, the same acoustic analysis indicated that the occurrence of surface shipping noise would apparently not condition the foraging behaviour of the sperm whale in the area, since shipping noise was almost always present when sperm whales were acoustically detected. The continuous presence of the sperm whale in the region confirms the ecological value of the Ligurian sea and the importance of ANTARES to help monitoring its ecosystems.
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Affiliation(s)
- M André
- Technical University of Catalonia, BarcelonaTech (UPC), Laboratory of Applied Bioacoustics (LAB), Rambla Exposició, 24, 08800 Vilanova i la Geltru, Barcelona, Spain
| | - A Caballé
- Technical University of Catalonia, BarcelonaTech (UPC), Laboratory of Applied Bioacoustics (LAB), Rambla Exposició, 24, 08800 Vilanova i la Geltru, Barcelona, Spain
| | - M van der Schaar
- Technical University of Catalonia, BarcelonaTech (UPC), Laboratory of Applied Bioacoustics (LAB), Rambla Exposició, 24, 08800 Vilanova i la Geltru, Barcelona, Spain
| | - A Solsona
- Technical University of Catalonia, BarcelonaTech (UPC), Laboratory of Applied Bioacoustics (LAB), Rambla Exposició, 24, 08800 Vilanova i la Geltru, Barcelona, Spain
| | - L Houégnigan
- Technical University of Catalonia, BarcelonaTech (UPC), Laboratory of Applied Bioacoustics (LAB), Rambla Exposició, 24, 08800 Vilanova i la Geltru, Barcelona, Spain
| | - S Zaugg
- Technical University of Catalonia, BarcelonaTech (UPC), Laboratory of Applied Bioacoustics (LAB), Rambla Exposició, 24, 08800 Vilanova i la Geltru, Barcelona, Spain
| | - A M Sánchez
- Technical University of Catalonia, BarcelonaTech (UPC), Laboratory of Applied Bioacoustics (LAB), Rambla Exposició, 24, 08800 Vilanova i la Geltru, Barcelona, Spain
| | - J V Castell
- Technical University of Catalonia, BarcelonaTech (UPC), Laboratory of Applied Bioacoustics (LAB), Rambla Exposició, 24, 08800 Vilanova i la Geltru, Barcelona, Spain
| | - M Solé
- Technical University of Catalonia, BarcelonaTech (UPC), Laboratory of Applied Bioacoustics (LAB), Rambla Exposició, 24, 08800 Vilanova i la Geltru, Barcelona, Spain
| | - F Vila
- Technical University of Catalonia, BarcelonaTech (UPC), Laboratory of Applied Bioacoustics (LAB), Rambla Exposició, 24, 08800 Vilanova i la Geltru, Barcelona, Spain
| | - D Djokic
- Technical University of Catalonia, BarcelonaTech (UPC), Laboratory of Applied Bioacoustics (LAB), Rambla Exposició, 24, 08800 Vilanova i la Geltru, Barcelona, Spain
| | - S Adrián-Martínez
- Institut d'Investigació per a la Gestió Integrada de les Zones Costaneres (IGIC) - Universitat Politècnica de Valencia, C/Paranimf 1, 46730 Gandia, Spain
| | - A Albert
- GRPHE - Université de Haute Alsace - Institut universitaire de technologie de Colmar, 34 rue du Grillenbreit BP 50568 - 68008, Colmar, France
| | - M Anghinolfi
- INFN - Sezione di Genova, Via Dodecaneso 33, 16146 Genova, Italy
| | - G Anton
- Friedrich-Alexander-Universitat Erlangen-Nurnberg, Erlangen Centre for Astroparticle Physics, Erwin-Rommel-Str. 1, 91058 Erlangen, Germany
| | - M Ardid
- Institut d'Investigació per a la Gestió Integrada de les Zones Costaneres (IGIC) - Universitat Politècnica de Valencia, C/Paranimf 1, 46730 Gandia, Spain
| | - J-J Aubert
- Aix-Marseille Université, CNRS/IN2P3, CPPM UMR 7346, 13288 Marseille, France
| | - T Avgitas
- APC, Université Paris Diderot, CNRS/IN2P3, CEA/IRFU, Observatoire de Paris, Sorbonne Paris Cité, 75205 Paris, France
| | - B Baret
- APC, Université Paris Diderot, CNRS/IN2P3, CEA/IRFU, Observatoire de Paris, Sorbonne Paris Cité, 75205 Paris, France
| | - J Barrios-Martí
- IFIC - Institut de Física Corpuscular (CSIC - Universitat de València) c/Catedrático José Beltran, 2 E-46980 Paterna, Valencia, Spain
| | - S Basa
- LAM - Laboratoire d'Astrophysique de Marseille, Pôle de l'Etoile Site de Château-Gombert, rue Frédéric Joliot-Curie 38, 13388 Marseille Cédex 13, France
| | - V Bertin
- Aix-Marseille Université, CNRS/IN2P3, CPPM UMR 7346, 13288 Marseille, France
| | - S Biagi
- INFN - Laboratori Nazionali del Sud (LNS), Via S. So a 62, 95123 Catania, Italy
| | - R Bormuth
- Nikhef, Science Park, Amsterdam, The Netherlands.,Huygens-Kamerlingh Onnes Laboratorium, Universiteit Leiden, The Netherlands
| | - M C Bouwhuis
- Nikhef, Science Park, Amsterdam, The Netherlands
| | - R Bruijn
- Nikhef, Science Park, Amsterdam, The Netherlands.,Universiteit van Amsterdam, Instituut voor Hoge-Energie Fysica, Science Park 105, 1098 XG Amsterdam, The Netherlands
| | - J Brunner
- Aix-Marseille Université, CNRS/IN2P3, CPPM UMR 7346, 13288 Marseille, France
| | - J Busto
- Aix-Marseille Université, CNRS/IN2P3, CPPM UMR 7346, 13288 Marseille, France
| | - A Capone
- INFN -Sezione di Roma, P.le Aldo Moro 2, 00185 Roma, Italy.,Dipartimento di Fisica dell'Universita La Sapienza, P.le Aldo Moro 2, 00185 Roma, Italy
| | - L Caramete
- Institute for Space Science, RO-077125 Bucharest, Magurele, Romania
| | - J Carr
- Aix-Marseille Université, CNRS/IN2P3, CPPM UMR 7346, 13288 Marseille, France
| | - S Celli
- INFN -Sezione di Roma, P.le Aldo Moro 2, 00185 Roma, Italy.,Dipartimento di Fisica dell'Universita La Sapienza, P.le Aldo Moro 2, 00185 Roma, Italy
| | - T Chiarusi
- INFN - Sezione di Bologna, Viale Berti-Pichat 6/2, 40127 Bologna, Italy
| | - M Circella
- INFN - Sezione di Bari, Via E. Orabona 4, 70126 Bari, Italy
| | - A Coleiro
- APC, Université Paris Diderot, CNRS/IN2P3, CEA/IRFU, Observatoire de Paris, Sorbonne Paris Cité, 75205 Paris, France
| | - R Coniglione
- INFN - Laboratori Nazionali del Sud (LNS), Via S. So a 62, 95123 Catania, Italy
| | - H Costantini
- Aix-Marseille Université, CNRS/IN2P3, CPPM UMR 7346, 13288 Marseille, France
| | - P Coyle
- Aix-Marseille Université, CNRS/IN2P3, CPPM UMR 7346, 13288 Marseille, France
| | - A Creusot
- APC, Université Paris Diderot, CNRS/IN2P3, CEA/IRFU, Observatoire de Paris, Sorbonne Paris Cité, 75205 Paris, France
| | - A Deschamps
- Geoazur, UCA, CNRS, IRD, Observatoire de la Côte d'Azur, Sophia Antipolis, France
| | - G De Bonis
- INFN -Sezione di Roma, P.le Aldo Moro 2, 00185 Roma, Italy.,Dipartimento di Fisica dell'Universita La Sapienza, P.le Aldo Moro 2, 00185 Roma, Italy
| | - C Distefano
- INFN - Laboratori Nazionali del Sud (LNS), Via S. So a 62, 95123 Catania, Italy
| | - I Di Palma
- INFN -Sezione di Roma, P.le Aldo Moro 2, 00185 Roma, Italy.,Dipartimento di Fisica dell'Universita La Sapienza, P.le Aldo Moro 2, 00185 Roma, Italy
| | - C Donzaud
- APC, Université Paris Diderot, CNRS/IN2P3, CEA/IRFU, Observatoire de Paris, Sorbonne Paris Cité, 75205 Paris, France.,Univ. Paris-Sud, 91405 Orsay Cedex, France
| | - D Dornic
- Aix-Marseille Université, CNRS/IN2P3, CPPM UMR 7346, 13288 Marseille, France
| | - D Drouhin
- GRPHE - Université de Haute Alsace - Institut universitaire de technologie de Colmar, 34 rue du Grillenbreit BP 50568 - 68008, Colmar, France
| | - T Eberl
- Friedrich-Alexander-Universitat Erlangen-Nurnberg, Erlangen Centre for Astroparticle Physics, Erwin-Rommel-Str. 1, 91058 Erlangen, Germany
| | - I El Bojaddaini
- University Mohammed I, Laboratory of Physics of Matter and Radiations, B.P.717, Oujda 6000, Morocco
| | - D Elsässer
- Institut für Theoretische Physik und Astrophysik, Universität Wärzburg, Emil-Fischer Str. 31, 97074 Würzburg, Germany
| | - A Enzenhöfer
- Aix-Marseille Université, CNRS/IN2P3, CPPM UMR 7346, 13288 Marseille, France
| | - K Fehn
- Friedrich-Alexander-Universitat Erlangen-Nurnberg, Erlangen Centre for Astroparticle Physics, Erwin-Rommel-Str. 1, 91058 Erlangen, Germany
| | - I Felis
- Institut d'Investigació per a la Gestió Integrada de les Zones Costaneres (IGIC) - Universitat Politècnica de Valencia, C/Paranimf 1, 46730 Gandia, Spain
| | - L A Fusco
- INFN - Sezione di Bologna, Viale Berti-Pichat 6/2, 40127 Bologna, Italy.,Dipartimento di Fisica e Astronomia dell'Universita, Viale Berti Pichat 6/2, 40127 Bologna, Italy
| | - S Galatà
- APC, Université Paris Diderot, CNRS/IN2P3, CEA/IRFU, Observatoire de Paris, Sorbonne Paris Cité, 75205 Paris, France
| | - P Gay
- APC, Université Paris Diderot, CNRS/IN2P3, CEA/IRFU, Observatoire de Paris, Sorbonne Paris Cité, 75205 Paris, France.,Laboratoire de Physique Corpusculaire, Clermont Université, Université Blaise Pascal, CNRS/IN2P3, BP 10448, F-63000 Clermont-Ferrand, France
| | - S Geißelsöder
- Friedrich-Alexander-Universitat Erlangen-Nurnberg, Erlangen Centre for Astroparticle Physics, Erwin-Rommel-Str. 1, 91058 Erlangen, Germany
| | - K Geyer
- Friedrich-Alexander-Universitat Erlangen-Nurnberg, Erlangen Centre for Astroparticle Physics, Erwin-Rommel-Str. 1, 91058 Erlangen, Germany
| | - V Giordano
- INFN - Sezione di Catania, Viale Andrea Doria 6, 95125 Catania, Italy
| | - A Gleixner
- Friedrich-Alexander-Universitat Erlangen-Nurnberg, Erlangen Centre for Astroparticle Physics, Erwin-Rommel-Str. 1, 91058 Erlangen, Germany
| | - H Glotin
- LSIS, Aix Marseille Université CNRS ENSAM LSIS UMR 7296 13397 Marseille, France.,Université de Toulon CNRS LSIS UMR 7296 83957 La Garde, France.,Institut universitaire de France, 75005 Paris, France
| | - R Gracia-Ruiz
- APC, Université Paris Diderot, CNRS/IN2P3, CEA/IRFU, Observatoire de Paris, Sorbonne Paris Cité, 75205 Paris, France
| | - K Graf
- Friedrich-Alexander-Universitat Erlangen-Nurnberg, Erlangen Centre for Astroparticle Physics, Erwin-Rommel-Str. 1, 91058 Erlangen, Germany
| | - S Hallmann
- Friedrich-Alexander-Universitat Erlangen-Nurnberg, Erlangen Centre for Astroparticle Physics, Erwin-Rommel-Str. 1, 91058 Erlangen, Germany
| | - H van Haren
- Royal Netherlands Institute for Sea Research (NIOZ), Landsdiep 4, 1797 SZ 't Horntje (Texel), The Netherlands
| | - A J Heijboer
- Nikhef, Science Park, Amsterdam, The Netherlands
| | - Y Hello
- Geoazur, UCA, CNRS, IRD, Observatoire de la Côte d'Azur, Sophia Antipolis, France
| | - J J Hernandez-Rey
- IFIC - Institut de Física Corpuscular (CSIC - Universitat de València) c/Catedrático José Beltran, 2 E-46980 Paterna, Valencia, Spain
| | - J Hößl
- Friedrich-Alexander-Universitat Erlangen-Nurnberg, Erlangen Centre for Astroparticle Physics, Erwin-Rommel-Str. 1, 91058 Erlangen, Germany
| | - J Hofestädt
- Friedrich-Alexander-Universitat Erlangen-Nurnberg, Erlangen Centre for Astroparticle Physics, Erwin-Rommel-Str. 1, 91058 Erlangen, Germany
| | - C Hugon
- INFN - Sezione di Genova, Via Dodecaneso 33, 16146 Genova, Italy.,Dipartimento di Fisica dell'Universita, Via Dodecaneso 33, 16146 Genova, Italy
| | - G Illuminati
- IFIC - Institut de Física Corpuscular (CSIC - Universitat de València) c/Catedrático José Beltran, 2 E-46980 Paterna, Valencia, Spain.,INFN -Sezione di Roma, P.le Aldo Moro 2, 00185 Roma, Italy.,Dipartimento di Fisica dell'Universita La Sapienza, P.le Aldo Moro 2, 00185 Roma, Italy
| | - C W James
- Friedrich-Alexander-Universitat Erlangen-Nurnberg, Erlangen Centre for Astroparticle Physics, Erwin-Rommel-Str. 1, 91058 Erlangen, Germany
| | - M de Jong
- Nikhef, Science Park, Amsterdam, The Netherlands.,Huygens-Kamerlingh Onnes Laboratorium, Universiteit Leiden, The Netherlands
| | - M Jongen
- Nikhef, Science Park, Amsterdam, The Netherlands
| | - M Kadler
- Institut für Theoretische Physik und Astrophysik, Universität Wärzburg, Emil-Fischer Str. 31, 97074 Würzburg, Germany
| | - O Kalekin
- Friedrich-Alexander-Universitat Erlangen-Nurnberg, Erlangen Centre for Astroparticle Physics, Erwin-Rommel-Str. 1, 91058 Erlangen, Germany
| | - U Katz
- Friedrich-Alexander-Universitat Erlangen-Nurnberg, Erlangen Centre for Astroparticle Physics, Erwin-Rommel-Str. 1, 91058 Erlangen, Germany
| | - D Kießling
- Friedrich-Alexander-Universitat Erlangen-Nurnberg, Erlangen Centre for Astroparticle Physics, Erwin-Rommel-Str. 1, 91058 Erlangen, Germany
| | - A Kouchner
- APC, Université Paris Diderot, CNRS/IN2P3, CEA/IRFU, Observatoire de Paris, Sorbonne Paris Cité, 75205 Paris, France.,LSIS, Aix Marseille Université CNRS ENSAM LSIS UMR 7296 13397 Marseille, France.,Université de Toulon CNRS LSIS UMR 7296 83957 La Garde, France.,Institut universitaire de France, 75005 Paris, France
| | - M Kreter
- Institut für Theoretische Physik und Astrophysik, Universität Wärzburg, Emil-Fischer Str. 31, 97074 Würzburg, Germany
| | - I Kreykenbohm
- Dr. Remeis-Sternwarte and ECAP, Universitat Erlangen-Nurnberg, Sternwartstr. 7, 96049 Bamberg, Germany
| | - V Kulikovskiy
- INFN - Laboratori Nazionali del Sud (LNS), Via S. So a 62, 95123 Catania, Italy.,Moscow State University, Skobeltsyn Institute of Nuclear Physics, Leninskie gory, 119991 Moscow, Russia
| | - C Lachaud
- APC, Université Paris Diderot, CNRS/IN2P3, CEA/IRFU, Observatoire de Paris, Sorbonne Paris Cité, 75205 Paris, France
| | - R Lahmann
- Friedrich-Alexander-Universitat Erlangen-Nurnberg, Erlangen Centre for Astroparticle Physics, Erwin-Rommel-Str. 1, 91058 Erlangen, Germany
| | - D Lefèvre
- Mediterranean Institute of Oceanography (MIO), Aix-Marseille University, 13288, Marseille, Cédex 9, France.,Université du Sud Toulon-Var, 83957 CNRS-INSU/IRD UM 110, La Garde Cédex, France
| | - E Leonora
- INFN - Sezione di Catania, Viale Andrea Doria 6, 95125 Catania, Italy.,Dipartimento di Fisica ed Astronomia dell'Universita, Viale Andrea Doria 6, 95125 Catania, Italy
| | - S Loucatos
- APC, Université Paris Diderot, CNRS/IN2P3, CEA/IRFU, Observatoire de Paris, Sorbonne Paris Cité, 75205 Paris, France.,Direction des Sciences de la Matière - Institut de recherche sur les lois fondamentales de l'Univers - Service de Physique des Particules, CEA Saclay, 91191 Gif-sur-Yvette Cédex, France
| | - M Marcelin
- LAM - Laboratoire d'Astrophysique de Marseille, Pôle de l'Etoile Site de Château-Gombert, rue Frédéric Joliot-Curie 38, 13388 Marseille Cédex 13, France
| | - A Margiotta
- INFN - Sezione di Bologna, Viale Berti-Pichat 6/2, 40127 Bologna, Italy.,Dipartimento di Fisica e Astronomia dell'Universita, Viale Berti Pichat 6/2, 40127 Bologna, Italy
| | - A Marinelli
- INFN - Sezione di Pisa, Largo B. Pontecorvo 3, 56127 Pisa, Italy.,Dipartimento di Fisica dell'Universita, Largo B. Pontecorvo 3, 56127 Pisa, Italy
| | - J A Martínez-Mora
- Institut d'Investigació per a la Gestió Integrada de les Zones Costaneres (IGIC) - Universitat Politècnica de Valencia, C/Paranimf 1, 46730 Gandia, Spain
| | - A Mathieu
- Aix-Marseille Université, CNRS/IN2P3, CPPM UMR 7346, 13288 Marseille, France
| | - K Melis
- Nikhef, Science Park, Amsterdam, The Netherlands.,Universiteit van Amsterdam, Instituut voor Hoge-Energie Fysica, Science Park 105, 1098 XG Amsterdam, The Netherlands
| | - T Michael
- Nikhef, Science Park, Amsterdam, The Netherlands
| | - P Migliozzi
- INFN -Sezione di Napoli, Via Cintia 80126 Napoli, Italy
| | - A Moussa
- University Mohammed I, Laboratory of Physics of Matter and Radiations, B.P.717, Oujda 6000, Morocco
| | - C Mueller
- Institut für Theoretische Physik und Astrophysik, Universität Wärzburg, Emil-Fischer Str. 31, 97074 Würzburg, Germany
| | - E Nezri
- LAM - Laboratoire d'Astrophysique de Marseille, Pôle de l'Etoile Site de Château-Gombert, rue Frédéric Joliot-Curie 38, 13388 Marseille Cédex 13, France
| | - G E Păvălaş
- Institute for Space Science, RO-077125 Bucharest, Magurele, Romania
| | - C Pellegrino
- INFN - Sezione di Bologna, Viale Berti-Pichat 6/2, 40127 Bologna, Italy.,Dipartimento di Fisica e Astronomia dell'Universita, Viale Berti Pichat 6/2, 40127 Bologna, Italy
| | - C Perrina
- INFN -Sezione di Roma, P.le Aldo Moro 2, 00185 Roma, Italy.,Dipartimento di Fisica dell'Universita La Sapienza, P.le Aldo Moro 2, 00185 Roma, Italy
| | - P Piattelli
- INFN - Laboratori Nazionali del Sud (LNS), Via S. So a 62, 95123 Catania, Italy
| | - V Popa
- Institute for Space Science, RO-077125 Bucharest, Magurele, Romania
| | - T Pradier
- Université de Strasbourg, IPHC, 23 rue du Loess 67037 Strasbourg, France.,CNRS, UMR7178, 67037 Strasbourg, France
| | - C Racca
- GRPHE - Université de Haute Alsace - Institut universitaire de technologie de Colmar, 34 rue du Grillenbreit BP 50568 - 68008, Colmar, France
| | - G Riccobene
- INFN - Laboratori Nazionali del Sud (LNS), Via S. So a 62, 95123 Catania, Italy
| | - K Roensch
- Friedrich-Alexander-Universitat Erlangen-Nurnberg, Erlangen Centre for Astroparticle Physics, Erwin-Rommel-Str. 1, 91058 Erlangen, Germany
| | - M Saldaña
- Institut d'Investigació per a la Gestió Integrada de les Zones Costaneres (IGIC) - Universitat Politècnica de Valencia, C/Paranimf 1, 46730 Gandia, Spain
| | - D F E Samtleben
- Nikhef, Science Park, Amsterdam, The Netherlands.,Huygens-Kamerlingh Onnes Laboratorium, Universiteit Leiden, The Netherlands
| | - M Sanguineti
- INFN - Sezione di Genova, Via Dodecaneso 33, 16146 Genova, Italy.,Dipartimento di Fisica dell'Universita, Via Dodecaneso 33, 16146 Genova, Italy
| | - P Sapienza
- INFN - Laboratori Nazionali del Sud (LNS), Via S. So a 62, 95123 Catania, Italy
| | - J Schnabel
- Friedrich-Alexander-Universitat Erlangen-Nurnberg, Erlangen Centre for Astroparticle Physics, Erwin-Rommel-Str. 1, 91058 Erlangen, Germany
| | - F Schüssler
- Direction des Sciences de la Matière - Institut de recherche sur les lois fondamentales de l'Univers - Service de Physique des Particules, CEA Saclay, 91191 Gif-sur-Yvette Cédex, France
| | - T Seitz
- Friedrich-Alexander-Universitat Erlangen-Nurnberg, Erlangen Centre for Astroparticle Physics, Erwin-Rommel-Str. 1, 91058 Erlangen, Germany
| | - C Sieger
- Friedrich-Alexander-Universitat Erlangen-Nurnberg, Erlangen Centre for Astroparticle Physics, Erwin-Rommel-Str. 1, 91058 Erlangen, Germany
| | - M Spurio
- INFN - Sezione di Bologna, Viale Berti-Pichat 6/2, 40127 Bologna, Italy.,Dipartimento di Fisica e Astronomia dell'Universita, Viale Berti Pichat 6/2, 40127 Bologna, Italy
| | - Th Stolarczyk
- Direction des Sciences de la Matière - Institut de recherche sur les lois fondamentales de l'Univers - Service de Physique des Particules, CEA Saclay, 91191 Gif-sur-Yvette Cédex, France
| | - A Sánchez-Losa
- INFN - Laboratori Nazionali del Sud (LNS), Via S. So a 62, 95123 Catania, Italy.,INFN - Sezione di Bari, Via E. Orabona 4, 70126 Bari, Italy
| | - M Taiuti
- INFN - Sezione di Genova, Via Dodecaneso 33, 16146 Genova, Italy.,Dipartimento di Fisica dell'Universita, Via Dodecaneso 33, 16146 Genova, Italy
| | - A Trovato
- INFN - Laboratori Nazionali del Sud (LNS), Via S. So a 62, 95123 Catania, Italy
| | - M Tselengidou
- Friedrich-Alexander-Universitat Erlangen-Nurnberg, Erlangen Centre for Astroparticle Physics, Erwin-Rommel-Str. 1, 91058 Erlangen, Germany
| | - D Turpin
- Aix-Marseille Université, CNRS/IN2P3, CPPM UMR 7346, 13288 Marseille, France
| | - C Tönnis
- IFIC - Institut de Física Corpuscular (CSIC - Universitat de València) c/Catedrático José Beltran, 2 E-46980 Paterna, Valencia, Spain
| | - B Vallage
- Technical University of Catalonia, BarcelonaTech (UPC), Laboratory of Applied Bioacoustics (LAB), Rambla Exposició, 24, 08800 Vilanova i la Geltru, Barcelona, Spain.,Direction des Sciences de la Matière - Institut de recherche sur les lois fondamentales de l'Univers - Service de Physique des Particules, CEA Saclay, 91191 Gif-sur-Yvette Cédex, France
| | - C Vallée
- Aix-Marseille Université, CNRS/IN2P3, CPPM UMR 7346, 13288 Marseille, France
| | - V Van Elewyck
- APC, Université Paris Diderot, CNRS/IN2P3, CEA/IRFU, Observatoire de Paris, Sorbonne Paris Cité, 75205 Paris, France
| | - D Vivolo
- INFN -Sezione di Napoli, Via Cintia 80126 Napoli, Italy.,Dipartimento di Fisica dell'Universita Federico II di Napoli, Via Cintia 80126, Napoli, Italy
| | - S Wagner
- Friedrich-Alexander-Universitat Erlangen-Nurnberg, Erlangen Centre for Astroparticle Physics, Erwin-Rommel-Str. 1, 91058 Erlangen, Germany
| | - J Wilms
- Dr. Remeis-Sternwarte and ECAP, Universitat Erlangen-Nurnberg, Sternwartstr. 7, 96049 Bamberg, Germany
| | - J D Zornoza
- IFIC - Institut de Física Corpuscular (CSIC - Universitat de València) c/Catedrático José Beltran, 2 E-46980 Paterna, Valencia, Spain
| | - J Zuñiga
- IFIC - Institut de Física Corpuscular (CSIC - Universitat de València) c/Catedrático José Beltran, 2 E-46980 Paterna, Valencia, Spain
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