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Schindler M, Schuster-Winkelmann P, Weß V, Czell S, Rueff F, Wollenberg A, Siebeck M, Gropp R. NOD/Scid IL2Rγ null Mice Reconstituted with PBMCs from Patients with Atopic Dermatitis or Psoriasis Vulgaris Reflect the Respective Phenotype. JID Innov 2024; 4:100268. [PMID: 38736522 PMCID: PMC11087984 DOI: 10.1016/j.xjidi.2024.100268] [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: 08/04/2023] [Revised: 01/18/2024] [Accepted: 01/19/2024] [Indexed: 05/14/2024] Open
Abstract
NSG (NOD/Scid IL2Rγnull) mice reconstituted with PBMCs donated by patients with ulcerative colitis or Crohn's disease highly reflect the respective pathological phenotype. To determine whether these findings could be applicable to atopic dermatitis (AD) and psoriasis vulgaris (PV), PBMCs isolated from patients with AD and PV were first subjected to immunological profiling. Subsequently, NSG mice were reconstituted with these PBMCs. Hierarchical clustering and network analysis revealed a distinct profile of patients with AD and PV with activated CD4+ T cells (CD69, CD25) occupying a central position in the AD network and CD4+ CD134+ cells acting as the main hub in the PV network. After dermal application of DMSO, both NSG mice reconstituted with PBMCs from donors with AD (ie, NSG-AD mice) and NSG mice reconstituted with PBMCs from donors with PV (ie, NSG-PV mice) exhibited increased clinical, skin, and histological scores. Immunohistochemical analysis, frequencies of splenic human leukocytes, and cytokine expression levels indicated that CD4+ CD69+ cells, M1 and TSLP receptor-expressing monocytes, switched B cells, and monocyte chemoattractant protein 3 were the driving factors of inflammation in NSG-AD mice. In contrast, inflammation in NSG-PV mice was characterized by an increase in fibroblasts in the epidermis, frequencies of CD1a-expressing monocytes, and IL-17 levels. Therefore, the pathological phenotypes of NSG-AD mice and NSG-PV mice differ and partially reflect the respective human diseases.
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Affiliation(s)
- Marietta Schindler
- Department of General, Visceral, and Transplantation Surgery, LMU University Hospital, LMU Munich, Munich, Germany
| | - Paula Schuster-Winkelmann
- Department of General, Visceral, and Transplantation Surgery, LMU University Hospital, LMU Munich, Munich, Germany
| | - Veronika Weß
- Department of General, Visceral, and Transplantation Surgery, LMU University Hospital, LMU Munich, Munich, Germany
| | - Sophia Czell
- Department of Dermatology and Allergology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Franziska Rueff
- Department of Dermatology and Allergology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Andreas Wollenberg
- Department of Dermatology and Allergology, LMU University Hospital, LMU Munich, Munich, Germany
- Department of Dermatology and Allergology, University Hospital Augsburg, Augsburg, Germany
| | - Matthias Siebeck
- Department of General, Visceral, and Transplantation Surgery, LMU University Hospital, LMU Munich, Munich, Germany
| | - Roswitha Gropp
- Department of General, Visceral, and Transplantation Surgery, LMU University Hospital, LMU Munich, Munich, Germany
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Tuladhar S, Delius M, Siebeck M, Oberhauser C, Paudel D, Rehfuess E. Standards of care and determinants of women's satisfaction with delivery services in Nepal: a multi-perspective analysis using data from a health facility-based survey. BMC Pregnancy Childbirth 2024; 24:132. [PMID: 38350883 PMCID: PMC10863287 DOI: 10.1186/s12884-024-06301-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 01/29/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND Compliance with standards of care is required for sustained improvement in the quality of delivery services. It thus represents a key challenge to improving maternal survival and meeting the Sustainable Development Goal (SDG) target of reducing the maternal mortality ratio to 70 deaths per 100,000 live births. This study examines the extent to which normal low-risk health facility deliveries in Nepal meet the standards of quality of care and assesses the effect of the standards of quality of care and various contextual factors on women's satisfaction with the services they receive. METHODS Drawing on the 2021 Nepal Health Facility Survey, the sample comprised 320 women who used health facilities for normal, low-risk delivery services. A weighted one-sample t-test was applied to examine the proportion of deliveries meeting the eight standards of care. Women's overall satisfaction level was computed from seven satisfaction variables measured on a Likert scale, using principal component analysis. The composite measure was then dichotomized. Binary logistic regression was used to analyze the determinants of women's satisfaction with delivery care services. RESULTS Deliveries complying with the eight standards of care and its 53 indicators varied widely; output indicators were more frequently met than input indicators. Of the eight standards of care, the "functional referral system" performed highest (92.0%), while "competent, motivated human resources" performed the least (52.4%). Women who were attended by a provider when they called for support (AOR: 5.29; CI: 1.18, 23.64), who delivered in health facilities that displayed health statistics (AOR 3.16; CI: 1.87, 5.33), who experienced caring behaviors from providers (AOR: 2.59; CI: 1.06, 6.30) and who enjoyed audio-visual privacy (AOR 2.13; CI: 1.04, 4.38) had higher satisfaction levels compared to their counterparts. The implementation of the Maternity Incentive Scheme and presence of a maternal waiting room in health facilities, however, were associated with lower satisfaction levels. CONCLUSIONS Nepal performed moderately well in meeting the standards of care for normal, low-risk deliveries. To meet the SDG target Nepal must accelerate progress. It needs to focus on people-centered quality improvement to routinely assess the standards of care, mobilize available resources, improve coordination among the three tiers of government, and implement high-impact programs.
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Affiliation(s)
- Sabita Tuladhar
- Teaching & Training Unit, Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU, Munich, Germany.
- Center for International Health, LMU, Munich, Germany.
| | - Maria Delius
- Department of Obstetrics and Gynecology, University Hospital, LMU, Munich, Germany
| | - Matthias Siebeck
- Institute of Medical Education, LMU University Hospital, LMU, Munich, Germany
| | - Cornelia Oberhauser
- Institute for Medical Information Processing, Biometry, and Epidemiology, LMU, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | | | - Eva Rehfuess
- Institute for Medical Information Processing, Biometry, and Epidemiology, LMU, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
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Tuladhar S, Paudel D, Rehfuess E, Siebeck M, Oberhauser C, Delius M. Changes in health facility readiness for obstetric and neonatal care services in Nepal: an analysis of cross-sectional health facility survey data in 2015 and 2021. BMC Pregnancy Childbirth 2024; 24:79. [PMID: 38267966 PMCID: PMC10807104 DOI: 10.1186/s12884-023-06138-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 11/18/2023] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND Nepal is committed to achieving the Sustainable Development Goal (SDG) 2030 target 3.1 of reducing the maternal mortality ratio to 70 deaths per 100,000 live births. Along with increasing access to health facility (HF)-based delivery services, improving HF readiness is critically important. The majority of births in Nepal are normal low-risk births and most of them take place in public HFs, as does the majority of maternal deaths. This study aims to assess changes in HF readiness in Nepal between 2015 and 2021, notably, if HF readiness for providing high-quality services for normal low-risk deliveries improved; if the functionality of basic emergency obstetric and neonatal care (BEmONC) services increased; and if infection prevention and control improved. METHODS Cross-sectional data from two nationally representative HF-based surveys in 2015 and 2021 were analyzed. This included 457 HFs in 2015 and 804 HFs in 2021, providing normal low-risk delivery services. Indices for HF readiness for normal low-risk delivery services, BEmONC service functionality, and infection prevention and control were computed. Independent sample T-test was used to measure changes over time. The results were stratified by public versus private HFs. RESULTS Despite a statistically significant increase in the overall HF readiness index for normal low-risk delivery services, from 37.9% in 2015 to 43.7%, in 2021, HF readiness in 2021 remained inadequate. The availability of trained providers, essential medicines for mothers, and basic equipment and supplies was high, while that of essential medicines for newborns was moderate; availability of delivery care guidelines was low. BEmONC service functionality did not improve and remained below five percent facility coverage at both time points. In private HFs, readiness for good quality obstetrical care was higher than in public HFs at both time points. The infection prevention and control index improved over time; however, facility coverage in 2021 remained below ten percent. CONCLUSIONS The slow progress and sub-optimal readiness for normal, low-risk deliveries and infection prevention and control, along with declining and low BEmONC service functionality in 2021 is reflective of poor quality of care and provides some proximate explanation for the moderately high maternal mortality and the stagnation of neonatal mortality in Nepal. To reach the SDG 2030 target of reducing maternal deaths, Nepal must hasten its efforts to strengthen supply chain systems to enhance the availability and utilization of essential medicines, equipment, and supplies, along with guidelines, to bolster the human resource capacity, and to implement mechanisms to monitor quality of care. In general, the capacity of local governments to deliver basic healthcare services needs to be increased.
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Affiliation(s)
- Sabita Tuladhar
- Teaching & Training Unit, Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU, Munich, Germany.
- Center for International Health, LMU, Munich, Germany.
| | | | - Eva Rehfuess
- Institute for Medical Information Processing, Biometry and Epidemiology, LMU, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Matthias Siebeck
- Institute of Medical Education, LMU, University Hospital, LMU, Munich, Germany
| | - Cornelia Oberhauser
- Institute for Medical Information Processing, Biometry and Epidemiology, LMU, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Maria Delius
- Department of Obstetrics and Gynecology, University Hospital, LMU, Munich, Germany
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Hanago GA, Siebeck M, Dira SJ, Tadesse T, Irnich D. Perception of Pain Expression Among Surgical Patients and Families from Three Ethnic Groups of a Nation: A Multicenter Qualitative Study. J Pain Res 2024; 17:241-251. [PMID: 38249567 PMCID: PMC10799569 DOI: 10.2147/jpr.s447676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 01/09/2024] [Indexed: 01/23/2024] Open
Abstract
Background Despite its universal nature; perception, coping, responses, treatment options, and overall experiences of pain are influenced by biopsychosocial factors to various extents. Pain perception, expression, and control are progressively learned behaviors among members of a society and are culture-specific. Effects of ethnicity-related culture (ethnoculture) on pain experience in a broader context have increasingly been reported. However, evidence from ethnoculturally diverse groups of a nation, particularly based on surgical patients, is limited. Therefore, as a qualitative research effort of a broader project aimed at assessing ethnocultural determinants of surgical pain management, this study explored the perception of ethnoculturally diverse patients and families about expressing surgical disease-related pain. Methods This study follows subjectivist-interpretivist philosophical assumptions as an underpinning research paradigm. We purposively selected 11 patients for in-depth interviews and 12 patients' family members for focus group discussions in three hospitals of ethnic-based regions of Ethiopia. In the phenomenological frame, thematic analysis was employed. Finding Ethnocultural background influences how individuals express and respond to pain according to emergent themes of finding- Pain and overlooked cultural influence, Pain expressiveness in cultural context, Stereotypes of pain expressiveness, and Bravehood through stoic response. Pain feelings are commonly hidden where the domestic culture values stoic response to pain compared to ethnoculture where pain expressiveness is encouraged. Conclusion Individuals can express and respond to pain differently due to ethnocultural diversity within a nation. Researchers and clinicians should consider cultural context while applying the prevailing one-size-fits-all pain assessment tools among surgical patients of a nation with ethnocultural diversity.
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Affiliation(s)
| | - Matthias Siebeck
- Institute of Medical Education, LMU University Hospital, LMU Munich, Munich, Germany
| | - Samuel Jilo Dira
- Department of Anthropology, Hawassa University, Hawassa, Ethiopia
| | - Tefera Tadesse
- Institute of Educational Research, Addis Ababa University, Addis Ababa, Ethiopia
| | - Dominik Irnich
- Multidiciplinary Pain Center, Department of Anesthesiology, LMU University Hospital LMU Munich, Munich, Germany
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Rueb M, Rehfuess EA, Siebeck M, Pfadenhauer LM. Cinemeducation: A mixed methods study on learning through reflective thinking, perspective taking and emotional narratives. Med Educ 2024; 58:63-92. [PMID: 37525520 DOI: 10.1111/medu.15166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 05/29/2023] [Accepted: 06/27/2023] [Indexed: 08/02/2023]
Abstract
INTRODUCTION Cinemeducation describes the use of film in medical education. The M23 Cinema (M23C) comprises a film screening and subsequent discussion with experts, affected persons and the audience. Previous research suggests that participating in cinemeducation may affect emotions and attitudes. This study aimed to establish a conceptual framework and explore when learning takes place, how learning occurs and what participants learn during the M23C. METHODS Informed by focused literature searches, discussions of the authors and the research results, a conceptual framework of the M23C was developed, comprising three dimensions (five distinct phases, learning methodology and potential impact). A mixed method study was undertaken, employing an exploratory sequential design. Initially, the qualitative component was conducted by interviewing everyone involved, comprising focus groups, expert interviews, a group interview and one narrative interview. All qualitative data were analysed using qualitative content analysis. The qualitative findings were used to inform the development of a survey among the participants of M23C evenings. The survey results were analysed descriptively. The findings generated by both data sets were integrated using the "following a thread" protocol and visualised by joint displays. RESULTS In total, 15 participants in M23C courses, six members of the current and two of the former organising committee, two experts, two affected persons and the initiator of the M23C were included in the qualitative component (n = 28). A total of 503 participants responded to the survey. The qualitative data confirmed the relevance of the five phases and participants described reflective thinking, perspective taking and emotional narratives as the three dimensions of how they learned during the M23C. Participants reported a change in attitudes, enriching their knowledge, experiencing empathy and learning about other health professions. DISCUSSION Our findings suggest that the M23C as a cinemeducation course provides a unique learning environment in the training of health professionals.
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Affiliation(s)
- Mike Rueb
- Institute of Medical Information Processing, Biometry and Epidemiology (IBE), Faculty of Medicine, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
- Institute of Medical Education, LMU University Hospital, LMU Munich, Munich, Germany
| | - Eva A Rehfuess
- Institute of Medical Information Processing, Biometry and Epidemiology (IBE), Faculty of Medicine, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Matthias Siebeck
- Institute of Medical Education, LMU University Hospital, LMU Munich, Munich, Germany
| | - Lisa M Pfadenhauer
- Institute of Medical Information Processing, Biometry and Epidemiology (IBE), Faculty of Medicine, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
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Fink MC, Heitzmann N, Reitmeier V, Siebeck M, Fischer F, Fischer MR. Diagnosing virtual patients: the interplay between knowledge and diagnostic activities. Adv Health Sci Educ Theory Pract 2023; 28:1245-1264. [PMID: 37052740 PMCID: PMC10099021 DOI: 10.1007/s10459-023-10211-4] [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] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 01/22/2023] [Indexed: 06/19/2023]
Abstract
Clinical reasoning theories agree that knowledge and the diagnostic process are associated with diagnostic success. However, the exact contributions of these components of clinical reasoning to diagnostic success remain unclear. This is particularly the case when operationalizing the diagnostic process with diagnostic activities (i.e., teachable practices that generate knowledge). Therefore, we conducted a study investigating to what extent knowledge and diagnostic activities uniquely explain variance in diagnostic success with virtual patients among medical students. The sample consisted of N = 106 medical students in their third to fifth year of university studies in Germany (6-years curriculum). Participants completed professional knowledge tests before diagnosing virtual patients. Diagnostic success with the virtual patients was assessed with diagnostic accuracy as well as a comprehensive diagnostic score to answer the call for more extensive measurement of clinical reasoning outcomes. The three diagnostic activities hypothesis generation, evidence generation, and evidence evaluation were tracked. Professional knowledge predicted performance in terms of the comprehensive diagnostic score and displayed a small association with diagnostic accuracy. Diagnostic activities predicted comprehensive diagnostic score and diagnostic accuracy. Hierarchical regressions showed that the diagnostic activities made a unique contribution to diagnostic success, even when knowledge was taken into account. Our results support the argument that the diagnostic process is more than an embodiment of knowledge and explains variance in diagnostic success over and above knowledge. We discuss possible mechanisms explaining this finding.
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Affiliation(s)
- Maximilian C Fink
- Institute of Medical Education, University Hospital, LMU Munich, Munich, Germany
- Department for Education, University of the Bundeswehr Munich, Institute of Education, Learning and Teaching with Media, Werner-Heisenberg-Weg 39, 85577, Neubiberg, Germany
| | - Nicole Heitzmann
- Department of Psychology, LMU Munich, Munich, Germany
- Munich Center of the Learning Sciences (MCLS), LMU Munich, Munich, Germany
| | - Victoria Reitmeier
- Institute of Medical Education, University Hospital, LMU Munich, Munich, Germany
| | - Matthias Siebeck
- Institute of Medical Education, University Hospital, LMU Munich, Munich, Germany
- Munich Center of the Learning Sciences (MCLS), LMU Munich, Munich, Germany
| | - Frank Fischer
- Department of Psychology, LMU Munich, Munich, Germany
- Munich Center of the Learning Sciences (MCLS), LMU Munich, Munich, Germany
| | - Martin R Fischer
- Institute of Medical Education, University Hospital, LMU Munich, Munich, Germany.
- Munich Center of the Learning Sciences (MCLS), LMU Munich, Munich, Germany.
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Amare EM, Siebeck M, Yigzaw T, Fischer MR, Tadesse M, Berndt M. Differences in perceptions of capability, autonomy, and expectations between residents and surgical team members in executing EPAs in Ethiopian medical education. Heliyon 2023; 9:e14316. [PMID: 36942250 PMCID: PMC10023974 DOI: 10.1016/j.heliyon.2023.e14316] [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: 07/26/2022] [Revised: 02/24/2023] [Accepted: 03/01/2023] [Indexed: 03/11/2023] Open
Abstract
Background Entrustable Professional Activities (EPAs) are units of professional practice that are defined as tasks or responsibilities that are entrusted to an unsupervised execution by a trainee. In 2021, a framework of 29 EPAs was developed for surgical residency training programs in Ethiopia, with the goal of residents being able to perform independently by the time they graduate. However, studies show that surgical residents lack confidence and are unable to execute EPAs autonomously upon graduation, and concerns have been raised about graduate competencies in EPA execution. The goal of this research is to assess how surgical team members judge/perceive residents' performance in executing these EPAs autonomously at the time of graduation and how residents rate their own capability and autonomy in executing EPAs in order to systematically introduce and implement EPAs in Ethiopian medical education. Methods A survey was conducted in the Departments of Surgery at four residency training institutions in Ethiopia. All eligible surgical team members and final-year general surgery residents were invited to participate. Surgical team members were asked to rate the observed performance of a group of graduating surgical residents in each of the 29 EPAs, and residents were asked to rate their own capability in executing EPAs. The analysis focused on variations in performance ratings between surgical team members and residents, as well as across surgical team members. Results A total of 125 surgical team members and 49 residents participated in this study. Residents rate their competence in performing these EPAs higher than surgical team members, mean 4.2 (SD = 0.63) vs. 3.7 (SD = 0.9). A statistically significant difference in perceptions of capability, autonomy, and expectations in executing EPAs was observed between the two groups of study (p = 0.03, CI: 0.51-0.95), as well as within surgical team members (p < 0.001). Conclusions Differences in perceptions of capability, autonomy, and expectations between residents and surgical team members, as well as within faculty members, were seen in executing EPAs. There were concerns about graduate surgical residents' competence to execute EPAs autonomously at the time of graduation. Surgical team members perceived that a set of graduating surgical residents are not yet safe to perform these EPAs independently (without supervision) and still requires distant supervision.
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Affiliation(s)
- Equlinet Misganaw Amare
- CIH LMU, Center for International Health, University Hospital, LMU Munich, Germany
- Corresponding author. Wollo Sefer (near Mina Building), P. O. Box 2881, Code, 1250, Addis Ababa, Ethiopia.
| | - Matthias Siebeck
- Institute of Medical Education, University Hospital, LMU Munich, Munich, Germany
| | - Tegbar Yigzaw
- Jhpiego – Ethiopia (an Affiliate of Johns Hopkins University), Addis Ababa, Ethiopia
| | - Martin R. Fischer
- Institute of Medical Education, University Hospital, LMU Munich, Munich, Germany
| | - Mekdim Tadesse
- St. Paul Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Markus Berndt
- Institute of Medical Education, University Hospital, LMU Munich, Munich, Germany
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Rueb M, Siebeck M, Rehfuess EA, Pfadenhauer LM. Cinemeducation in medicine: a mixed methods study on students' motivations and benefits. BMC Med Educ 2022; 22:172. [PMID: 35279156 PMCID: PMC8918310 DOI: 10.1186/s12909-022-03240-x] [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] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 03/07/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Cinemeducation courses are used to supplement more standard teaching formats at medical schools and tend to emphasise biopsychosocial aspects of health. The purpose of this paper is to explore why medical students attend the cinemeducation course M23 Cinema (M23C) at LMU Munich and whether a film screening with a subsequent expert and peer discussion benefits their studies and their future careers as medical doctors. METHODS An exploratory sequential mixed methods study design was used. Qualitative research, i.e. three focus groups, four expert interviews, one group interview and one narrative interview, was conducted to inform a subsequent quantitative survey. Qualitative data was analysed using qualitative content analysis and quantitative data was analysed descriptively. The findings were integrated using the "following a thread" protocol. RESULTS In total, 28 people were interviewed and 503 participants responded to the survey distributed at seven M23C screenings. Participants perceive the M23C as informal teaching where they learn about perspectives on certain health topics through the combination of film and discussion while spending time with peers. The reasons for and reported benefits of participation varied with educational background, participation frequency and gender. On average, participants gave 5.7 reasons for attending the M23C. The main reasons for participating were the film, the topic and the ability to discuss these afterwards as well as to spend an evening with peers. Attending the M23C was reported to support the students' memory with regards to certain topics addressed in the M23C when the issues resurface at a later stage, such as during university courses, in the hospital, or in their private life. CONCLUSIONS The M23C is characterised by its unique combination of film and discussion that encourages participants to reflect upon their opinions, perspectives and experiences. Participating in the M23C amplified the understanding of biopsychosocial aspects of health and illness in students. Thus, cinemeducative approaches such as the M23C may contribute to enabling health professionals to develop and apply humane, empathetic and relational skills.
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Affiliation(s)
- Mike Rueb
- Pettenkofer School of Public Health, Elisabeth-Winterhalter-Weg 6, 81377, Munich, Germany.
- Institute for Medical Information Processing, Biometry and Epidemiology, LMU Munich, Elisabeth-Winterhalter-Weg 6, 81377, Munich, Germany.
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nussbaumstrasse 7, 80336, Munich, Germany.
| | - Matthias Siebeck
- Institute of Medical Education, University Hospital, LMU Munich, Pettenkoferstrasse 8a, 80336, Munich, Germany
| | - Eva A Rehfuess
- Pettenkofer School of Public Health, Elisabeth-Winterhalter-Weg 6, 81377, Munich, Germany
- Institute for Medical Information Processing, Biometry and Epidemiology, LMU Munich, Elisabeth-Winterhalter-Weg 6, 81377, Munich, Germany
| | - Lisa M Pfadenhauer
- Pettenkofer School of Public Health, Elisabeth-Winterhalter-Weg 6, 81377, Munich, Germany
- Institute for Medical Information Processing, Biometry and Epidemiology, LMU Munich, Elisabeth-Winterhalter-Weg 6, 81377, Munich, Germany
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Amare EM, Siebeck M, Sendekie TY, Fischer MR, Berndt M. Development of an Entrustable Professional Activities (EPA) Framework to Inform Surgical Residency Training Programs in Ethiopia: A Three-round National Delphi Method Study. J Surg Educ 2022; 79:56-68. [PMID: 34294572 DOI: 10.1016/j.jsurg.2021.06.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 06/15/2021] [Accepted: 06/27/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Entrustable Professional Activities (EPAs) have been proposed as a means to translate competencies into clinical practice. Although EPAs for residency training have become available, 1 set of core EPAs cannot automatically be transferred from one context to another due to cultural variability. Further, there is a lack of African- and Asian-based EPA development and implementation studies. We developed an end-of-training EPAs framework to inform surgical residency training programs in the local context of Ethiopian medical education. METHODS A three-round Delphi method was used to establish consensus about important surgical EPAs among experts. A total of 136 experts representing all surgical residency training institutions in Ethiopia were invited to participate. Round 1 & 2 consisted of senior expert panelists (n = 8) to identify potential EPAs and determine the content validity. Round 3 consisted of a survey (n = 128) to further validate the identified EPAs by attending surgeons who work with them. Each EPA had to achieve at least 80% or higher agreement among experts to be considered having acceptable content validity. RESULTS In round 1, a total of 272 EPAs were proposed, reduced, and grouped to 39 consented EPAs. In round 2, the same experts rated each EPA's relevance, resulting in 32 EPAs with a satisfactory item-level content validity index (I-CVI > 0.83). Overall, in the survey in round 3, 29 EPAs met the standard criterion for acceptability (S-CVI/Ave = 0.90) and achieved a high degree of final consensus (ICC = 0.998, 95% CI [0.996, 0.999]; (F = 439.2, p < 0.0001). CONCLUSIONS The framework of 29 validated and accepted EPAs can guide future surgical residency training programs in the Ethiopian medical education context. The framework allows programs to move from a time-dependent to an outcome-based model and transforms traditional assessment into entrustment decisions. Thus, the use of the framework can improve the quality of training and patient care in Ehtiopia.
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Affiliation(s)
| | - Matthias Siebeck
- Institute of Medical Education, University Hospital, LMU Munich, Munich, Germany
| | | | - Martin R Fischer
- Institute of Medical Education, University Hospital, LMU Munich, Munich, Germany
| | - Markus Berndt
- Institute of Medical Education, University Hospital, LMU Munich, Munich, Germany
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Gudina EK, Siebeck M, Eshete MT. Evidence Gaps and Challenges in the Fight Against COVID-19 in Africa: Scoping Review of the Ethiopian Experience. Risk Manag Healthc Policy 2021; 14:4511-4521. [PMID: 34764709 PMCID: PMC8575488 DOI: 10.2147/rmhp.s333545] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 10/14/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Ethiopia, like many African countries, took immediate actions to contain the coronavirus disease (COVID-19) outbreak and its impacts. However, the pandemic control measures were not guided by robust local evidence and not tailored to national contexts. In this review, we aimed to evaluate the evidence gaps and challenges of COVID-19 control measures in Ethiopia during the early months of the pandemic. DESIGN Scoping Review. DATA SOURCE Searches were conducted in PubMed, LitCovid, Web of Sciences, Embase, MedRx, ChemRxiv, BioRx, and Google Scholar. ELIGIBILITY CRITERIA Peer-reviewed or pre-print original research articles on COVID-19 from Ethiopia during a period of January 1, 2020 and October 10, 2020 were included in this review. RESULTS Of 573 articles found, 64 were eligible for inclusion. However, only 25 of them were peer-reviewed; 78% (50/64) were based on cross-sectional descriptive studies. Most of the studies focused on human behavior and healthcare system; only 13 articles addressed epidemiology and clinical spectrum of COVID-19. The studies have revealed a good level of awareness and a favorable attitude by community and healthcare workers (HCWs) towards COVID-19 and its control. However, the practices of infection prevention were found to be low among HCWs and the community. The outbreak unfolded at a slower rate than initially feared but the impact of the counter measures against COVID-19 on the delivery of essential healthcare services was felt more than the direct impact of the pandemic. Moreover, the actions taken by the country did not appear to be tailored to the pattern of the outbreak and existing local evidence. The overall number of published COVID-19-related scientific articles from Ethiopia during the review period was found to be limited. CONCLUSION COVID-19 control in Ethiopia was challenged by lack of robust local scientific evidence, and the pandemic control measures were not adapted to local context and the outbreak patterns. Thus, Ethiopia and other African countries should design culturally sensitive and locally acceptable public health interventions for COVID-19 and potential future outbreaks based on locally generated scientific evidence.
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Affiliation(s)
- Esayas Kebede Gudina
- Department of Internal Medicine, Institute of Health, Jimma University, Jimma, Ethiopia
- Center for International Health at LMU, University Hospital, LMU, Munich, Germany
| | - Matthias Siebeck
- Center for International Health at LMU, University Hospital, LMU, Munich, Germany
- Institute of Medical Education, University Hospital, LMU, Munich, Germany
| | - Million Tesfaye Eshete
- Center for International Health at LMU, University Hospital, LMU, Munich, Germany
- Department of Anesthesiology, Institute of Health, Jimma University, Jimma, Ethiopia
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11
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Fink MC, Heitzmann N, Siebeck M, Fischer F, Fischer MR. Learning to diagnose accurately through virtual patients: do reflection phases have an added benefit? BMC Med Educ 2021; 21:523. [PMID: 34620156 PMCID: PMC8497044 DOI: 10.1186/s12909-021-02937-9] [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] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 09/04/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Simulation-based learning with virtual patients is a highly effective method that could potentially be further enhanced by including reflection phases. The effectiveness of reflection phases for learning to diagnose has mainly been demonstrated for problem-centered instruction with text-based cases, not for simulation-based learning. To close this research gap, we conducted a study on learning history-taking using virtual patients. In this study, we examined the added benefit of including reflection phases on learning to diagnose accurately, the associations between knowledge and learning, and the diagnostic process. METHODS A sample of N = 121 medical students completed a three-group experiment with a control group and pre- and posttests. The pretest consisted of a conceptual and strategic knowledge test and virtual patients to be diagnosed. In the learning phase, two intervention groups worked with virtual patients and completed different types of reflection phases, while the control group learned with virtual patients but without reflection phases. The posttest again involved virtual patients. For all virtual patients, diagnostic accuracy was assessed as the primary outcome. Current hypotheses were tracked during reflection phases and in simulation-based learning to measure diagnostic process. RESULTS Regarding the added benefit of reflection phases, an ANCOVA controlling for pretest performance found no difference in diagnostic accuracy at posttest between the three conditions, F(2, 114) = 0.93, p = .398. Concerning knowledge and learning, both pretest conceptual knowledge and strategic knowledge were not associated with learning to diagnose accurately through reflection phases. Learners' diagnostic process improved during simulation-based learning and the reflection phases. CONCLUSIONS Reflection phases did not have an added benefit for learning to diagnose accurately in virtual patients. This finding indicates that reflection phases may not be as effective in simulation-based learning as in problem-centered instruction with text-based cases and can be explained with two contextual differences. First, information processing in simulation-based learning uses the verbal channel and the visual channel, while text-based learning only draws on the verbal channel. Second, in simulation-based learning, serial cue cases are used to gather information step-wise, whereas, in text-based learning, whole cases are used that present all data at once.
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Affiliation(s)
- Maximilian C Fink
- Institute of Medical Education, University Hospital, LMU Munich, Pettenkoferstr. 8a, 80336, Munich, Germany.
- Institute of Education, Universität der Bundeswehr München, Neubiberg, Germany.
| | - Nicole Heitzmann
- Department of Psychology, LMU Munich, Munich, Germany
- Munich Center of the Learning Sciences, LMU Munich, Munich, Germany
| | - Matthias Siebeck
- Institute of Medical Education, University Hospital, LMU Munich, Pettenkoferstr. 8a, 80336, Munich, Germany
- Munich Center of the Learning Sciences, LMU Munich, Munich, Germany
| | - Frank Fischer
- Department of Psychology, LMU Munich, Munich, Germany
- Munich Center of the Learning Sciences, LMU Munich, Munich, Germany
| | - Martin R Fischer
- Institute of Medical Education, University Hospital, LMU Munich, Pettenkoferstr. 8a, 80336, Munich, Germany
- Munich Center of the Learning Sciences, LMU Munich, Munich, Germany
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12
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Unterweger AL, Rüscher A, Seuß M, Winkelmann P, Beigel F, Koletzko L, Breiteneicher S, Siebeck M, Gropp R, Aszodi A. NOD/scid IL-2Rγ null mice reconstituted with peripheral blood mononuclear cells from patients with Crohn's disease reflect the human pathological phenotype. Immun Inflamm Dis 2021; 9:1631-1647. [PMID: 34499803 PMCID: PMC8589348 DOI: 10.1002/iid3.516] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 08/10/2021] [Accepted: 08/11/2021] [Indexed: 12/13/2022]
Abstract
Introduction Crohn's disease (CD) is characterized by pronounced intestinal fibrosis and severe mucosal damage and conventional animal models are limited to reflect these pathological manifestations. The aim of this study was to examine whether the combination of patient immune‐profiling and preclinical studies in a mouse model based on NOD/scid IL‐2Rγnull (NSG) reconstituted with peripheral blood mononuclear cells (PBMC) from CD patients has the capacity to harmonize ex vivo human and in vivo animal studies. Methods Immunological profiles of CD (n = 24) and ulcerative colitis (UC) patients (n = 47) were established by flow cytometry of subgroups of immune cells and subjected to hierarchical cluster and estimation graphics analyses. Pathological phenotypes of NSG mice, which were reconstituted with PBMC from CD, UC, and non‐IBD donors (NSG‐CD, NSG‐UC, and NSG‐non‐IBD) were compared. Readouts were the clinical, colon, and histological scores; subtypes of immune cells from spleen and colon; and levels of inflammatory markers, such as c‐reactive protein (CRP), monocyte chemotactic protein (MCP)‐3, transforming growth factor‐beta (TGFß), and hepatocyte growth factor (HGF). Fibrocytes were identified by immunohistochemistry in colonic sections. Results CD patients were significantly clustered in a group characterized by increased levels of TH1, TH2 cells, and decreased levels of CD14+ CD163+ monocytes (p = .003). In contrast to NSG‐UC mice, NSG‐CD mice exhibited an immune‐remodeling phenotype characterized by enhanced collagen deposition, elevated levels of CD14+ CD163+ monocytes, HGF, and TGFß. This phenotype was further corroborated by the presence of human fibrocytes as components of fibrotic areas. Conclusion The NSG‐CD model partially reflects the human disease and allows for studying the development of fibrosis.
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Affiliation(s)
- Anna-Lena Unterweger
- Department of General, Visceral and Transplantation Surgery, Hospital of the LMU, Munich, Germany
| | - Alena Rüscher
- Department of General, Visceral and Transplantation Surgery, Hospital of the LMU, Munich, Germany
| | - Marietta Seuß
- Department of General, Visceral and Transplantation Surgery, Hospital of the LMU, Munich, Germany
| | - Paula Winkelmann
- Department of General, Visceral and Transplantation Surgery, Hospital of the LMU, Munich, Germany
| | - Florian Beigel
- Department of Medicine II, Hospital of the LMU, Munich, München, Germany
| | - Leandra Koletzko
- Department of Medicine II, Hospital of the LMU, Munich, München, Germany
| | | | - Matthias Siebeck
- Department of General, Visceral and Transplantation Surgery, Hospital of the LMU, Munich, Germany
| | - Roswitha Gropp
- Department of General, Visceral and Transplantation Surgery, Hospital of the LMU, Munich, Germany
| | - Attila Aszodi
- Department of Experimental Surgery and Regenerative Medicine, Hospital of the LMU, Planegg, Germany
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13
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Gidi NW, Siebeck M. Neonatal Hyperbilirubinemia treatment by Locally Made Low-Cost Phototherapy Units. Ethiop J Health Sci 2021; 31:55-62. [PMID: 34158752 PMCID: PMC8188098 DOI: 10.4314/ejhs.v31i1.7] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Hyperbilirubinemia is a very common finding in neonates and may occasionally cause severe morbidity and even mortality. Severe hyperbilirubinemia is typically treated, either with phototherapy or exchange transfusions. This study assessed the effectiveness of a locally manufactured phototherapy device for reducing serum bilirubin in neonates with severe hyperbilirubinemia. Methods Retrospective chart review was carried out to assess the outcome of 32 infants who were treated for neonatal hyperbilirubinemia at Jimma Medical Center (JMC) from May, 2017 to April, 2018. RESULTS: Out of 75 charts reviewed, only 32 had subsequent bilirubin level determination, 18(56.3%) of them were males. The age at which jaundice was noticed and confirmed with plasma bilirubin level was 4 ± 2.7 days (mean±SD). Sepsis was thought to be the cause of hyperbilirubinemia in 13(40.5%) of the cases, while hemolysis from ABO incompatibility or RH incompatibility contributed in 5(15.6%) and 3(9.4) of the infants respectively. The mean (minimum, maximum) level of baseline TSB was 21.4(14, 55) mg/dL. Five infants (15.6%) had exchange transfusions because of extreme hyperbilirubinemia. The duration of phototherapy and decline in TSB were 5.34 ±2.8 days and 2.2±1.5mg/dl/day (mean±SD) respectively. The levels of TSB before and at the end of phototherapy were significantly different (p<0.001). Conclusion Acceptable reduction of TSB was achieved by using locally manufactured PT devices. Benefits included better accessibility and lower price and maintenance costs. High mean baseline TSB was observed, and duration of phototherapy is prolonged which could indicate late diagnosis compared to similar studies.
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Affiliation(s)
- Netsanet Workneh Gidi
- Jimma University, Jimma, Ethiopia.,CIHLMU Center for International Health, Medical Center of the University of Munich (LMU), Germany
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14
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Winkelmann P, Unterweger AL, Khullar D, Beigel F, Koletzko L, Siebeck M, Gropp R. The PI3K pathway as a therapeutic intervention point in inflammatory bowel disease. Immun Inflamm Dis 2021; 9:804-818. [PMID: 33942546 PMCID: PMC8342202 DOI: 10.1002/iid3.435] [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] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 03/26/2021] [Accepted: 03/29/2021] [Indexed: 12/31/2022]
Abstract
With glucose being the preferred source of energy in activated T cells, targeting glycolysis has become an attractive therapeutic intervention point for chronic inflammatory bowel diseases (IBD). The switch to glycolysis is mediated by phosphoinositide‐3‐kinases (PI3K) which relay signals from surface receptors to the AKT pathway. We first confirmed by analysis of the oxygen consumption rate (OCR) and extracellular acidification rate (ECAR) that metabolism is shifted towards glycolysis in IBD patients as compared to non‐IBD donors. In contrast to non‐IBD donors, OCR correlated with ECAR (IBD: cor = 0.79, p = 2E‐10; non‐IBD: cor = 0.37, p = n.s.), in IBD patients. Second, we tested the PI3K inhibitor copanlisib as a potential therapeutic. Ex vivo, copanlisib suppressed the ECAR significantly in T cells activated by anti‐CD3 antibodies and significantly decreased ECAR rates in the presence of copanlisib (anti‐CD3: 58.24 ± 29.06; copanlisib: 43.16 ± 20.23, p < .000. In addition, copanlisib impaired the activation of CD4+ CD25+ T cells (anti‐CD3: 42.15 ± 21.46; anti‐CD3 + copanlisib: 26.06 ± 21.82 p = .013) and the secretion of cytokines (IFNγ: anti‐CD3: 6332.0 ± 5707.61 pmol/ml; anti‐CD3 + copanlisib: 6332.0 ± 5707.61, p = .018). In vivo, copanlisib significantly improved the histological scores (ethanol: 8.5 ± 3.81; copanlisib: 4.57 ± 2.82, p = .006) in the NSG‐UC mouse model. Orthogonal partial least square analysis confirmed the efficacy of copanlisib. These data suggest that the PI3K pathway provides an attractive therapeutic intervention point in IBD for patients in relapse. Targeting metabolic pathways have the potential to develop phase dependent therapies.
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Affiliation(s)
- Paula Winkelmann
- Department of General, Visceral, and Transplantation Surgery, University Hospital, LMU, Munich, Germany
| | - Anna-Lena Unterweger
- Department of General, Visceral, and Transplantation Surgery, University Hospital, LMU, Munich, Germany
| | - Diya Khullar
- Department of General, Visceral, and Transplantation Surgery, University Hospital, LMU, Munich, Germany
| | - Florian Beigel
- Department of Medicine II, University Hospital, LMU, München, Germany
| | - Leandra Koletzko
- Department of Medicine II, University Hospital, LMU, München, Germany
| | - Matthias Siebeck
- Department of General, Visceral, and Transplantation Surgery, University Hospital, LMU, Munich, Germany
| | - Roswitha Gropp
- Department of General, Visceral, and Transplantation Surgery, University Hospital, LMU, Munich, Germany
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15
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Unterweger AL, Jensen MØ, Giordanetto F, Jogini V, Rüschher A, Seuß M, Winkelmann P, Koletzko L, Shaw DE, Siebeck M, Gropp R, Beigel F, Aszodi A. Suppressing Kv1.3 Ion Channel Activity with a Novel Small Molecule Inhibitor Ameliorates Inflammation in a Humanised Mouse Model of Ulcerative Colitis. J Crohns Colitis 2021; 15:1943-1958. [PMID: 33891001 PMCID: PMC8575044 DOI: 10.1093/ecco-jcc/jjab078] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND AND AIMS The potassium channel Kv1.3 is a potentially attractive therapeutic target in T cell-mediated inflammatory diseases, as the activity of antigen-activated T cells is selectively impeded by Kv1.3 inhibition. In this study, we examined Kv1.3 as a potential therapeutic intervention point for ulcerative colitis [UC], and studied the efficacy of DES1, a small-molecule inhibitor of Kv1.3, in vitro and in vivo. METHODS Kv1.3 expression on T cells in peripheral blood mononuclear cells [PBMCs] isolated from donors with and without UC was examined by flow cytometry. In biopsies from UC patients, Kv1.3-expressing CD4+ T cells were detected by flow cytometry and immunohistochemistry. In vitro, we determined the ability of DES1 to inhibit anti-CD3-driven activation of T cells. In vivo, the efficacy of DES1 was determined in a humanised mouse model of UC and compared with infliximab and tofacitinib in head-to-head studies. RESULTS Kv1.3 expression was elevated in PBMCs from UC patients and correlated with the prevalence of TH1 and TH2 T cells. Kv1.3 expression was also detected on T cells from biopsies of UC patients. In vitro, DES1 suppressed anti-CD3-driven activation of T cells in a concentration-dependent manner. In vivo, DES1 significantly ameliorated inflammation in the UC model and most effectively so when PBMCs from donors with higher levels of activated T cells were selected for reconstitution. The efficacy of DES1 was comparable to that of either infliximab or tofacitinib. CONCLUSION Inhibition of Kv1.3 [by DES1, for instance] appears to be a potential therapeutic intervention strategy for UC patients.
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Affiliation(s)
- Anna-Lena Unterweger
- Department of General, Visceral und Transplantation Surgery, University Hospital, LMU, Munich, Germany
| | | | | | | | - Alena Rüschher
- Department of General, Visceral und Transplantation Surgery, University Hospital, LMU, Munich, Germany
| | - Marietta Seuß
- Department of General, Visceral und Transplantation Surgery, University Hospital, LMU, Munich, Germany
| | - Paula Winkelmann
- Department of General, Visceral und Transplantation Surgery, University Hospital, LMU, Munich, Germany
| | - Leandra Koletzko
- Department of Medicine II, University Hospital, LMUMunich, Germany
| | - David E Shaw
- D. E. Shaw Research, New York, NY, USA,Department of Biochemistry and Molecular Biophysics, Columbia University, New York, NY, USA
| | - Matthias Siebeck
- Department of General, Visceral und Transplantation Surgery, University Hospital, LMU, Munich, Germany
| | - Roswitha Gropp
- Department of General, Visceral und Transplantation Surgery, University Hospital, LMU, Munich, Germany,Corresponding author: Roswitha Gropp, Department of General, Visceral and Transplantation Surgery, Hospital of the Ludwig-Maximilian University Munich, Nussbaumstr. 20, 80336 Munich, Germany.
| | - Florian Beigel
- Department of Medicine II, University Hospital, LMUMunich, Germany
| | - Attila Aszodi
- Department of General, Trauma and Reconstructive Surgery, University Hospital, LMU Munich, Germany’
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16
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Fink MC, Reitmeier V, Stadler M, Siebeck M, Fischer F, Fischer MR. Assessment of Diagnostic Competences With Standardized Patients Versus Virtual Patients: Experimental Study in the Context of History Taking. J Med Internet Res 2021; 23:e21196. [PMID: 33661122 PMCID: PMC7974754 DOI: 10.2196/21196] [Citation(s) in RCA: 8] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 10/01/2020] [Accepted: 12/27/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Standardized patients (SPs) have been one of the popular assessment methods in clinical teaching for decades, although they are resource intensive. Nowadays, simulated virtual patients (VPs) are increasingly used because they are permanently available and fully scalable to a large audience. However, empirical studies comparing the differential effects of these assessment methods are lacking. Similarly, the relationships between key variables associated with diagnostic competences (ie, diagnostic accuracy and evidence generation) in these assessment methods still require further research. OBJECTIVE The aim of this study is to compare perceived authenticity, cognitive load, and diagnostic competences in performance-based assessment using SPs and VPs. This study also aims to examine the relationships of perceived authenticity, cognitive load, and quality of evidence generation with diagnostic accuracy. METHODS We conducted an experimental study with 86 medical students (mean 26.03 years, SD 4.71) focusing on history taking in dyspnea cases. Participants solved three cases with SPs and three cases with VPs in this repeated measures study. After each case, students provided a diagnosis and rated perceived authenticity and cognitive load. The provided diagnosis was scored in terms of diagnostic accuracy; the questions asked by the medical students were rated with respect to their quality of evidence generation. In addition to regular null hypothesis testing, this study used equivalence testing to investigate the absence of meaningful effects. RESULTS Perceived authenticity (1-tailed t81=11.12; P<.001) was higher for SPs than for VPs. The correlation between diagnostic accuracy and perceived authenticity was very small (r=0.05) and neither equivalent (P=.09) nor statistically significant (P=.32). Cognitive load was equivalent in both assessment methods (t82=2.81; P=.003). Intrinsic cognitive load (1-tailed r=-0.30; P=.003) and extraneous load (1-tailed r=-0.29; P=.003) correlated negatively with the combined score for diagnostic accuracy. The quality of evidence generation was positively related to diagnostic accuracy for VPs (1-tailed r=0.38; P<.001); this finding did not hold for SPs (1-tailed r=0.05; P=.32). Comparing both assessment methods with each other, diagnostic accuracy was higher for SPs than for VPs (2-tailed t85=2.49; P=.01). CONCLUSIONS The results on perceived authenticity demonstrate that learners experience SPs as more authentic than VPs. As higher amounts of intrinsic and extraneous cognitive loads are detrimental to performance, both types of cognitive load must be monitored and manipulated systematically in the assessment. Diagnostic accuracy was higher for SPs than for VPs, which could potentially negatively affect students' grades with VPs. We identify and discuss possible reasons for this performance difference between both assessment methods.
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Affiliation(s)
- Maximilian C Fink
- Institute for Medical Education, University Hospital, LMU Munich, Munich, Germany
| | - Victoria Reitmeier
- Institute for Medical Education, University Hospital, LMU Munich, Munich, Germany
| | - Matthias Stadler
- Department of Psychology, Ludwig-Maximilians-Universität München, Munich, Germany
- Munich Center of the Learning Sciences, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Matthias Siebeck
- Institute for Medical Education, University Hospital, LMU Munich, Munich, Germany
- Munich Center of the Learning Sciences, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Frank Fischer
- Department of Psychology, Ludwig-Maximilians-Universität München, Munich, Germany
- Munich Center of the Learning Sciences, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Martin R Fischer
- Institute for Medical Education, University Hospital, LMU Munich, Munich, Germany
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17
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Jodeleit H, Winkelmann P, Caesar J, Sterz S, Holdt LM, Beigel F, Stallhofer J, Breiteneicher S, Bartnik E, Leeuw T, Siebeck M, Gropp R. Head-to-head study of oxelumab and adalimumab in a mouse model of ulcerative colitis based on NOD/Scid IL2Rγnull mice reconstituted with human peripheral blood mononuclear cells. Dis Model Mech 2021; 14:dmm.046995. [PMID: 33293281 PMCID: PMC7847261 DOI: 10.1242/dmm.046995] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 12/01/2020] [Indexed: 12/13/2022] Open
Abstract
This study's aim was to demonstrate that the combination of patient immune profiling and testing in a humanized mouse model of ulcerative colitis (UC) might lead to patient stratification for treatment with oxelumab. First, immunological profiles of UC patients and non-UC donors were analyzed for CD4+ T cells expressing OX40 (CD134; also known as TNFRSF4) and CD14+ monocytes expressing OX40L (CD252; also known as TNFSF4) by flow cytometric analysis. A significant difference was observed between the groups for CD14+ OX40L+ (UC: n=11, 85.44±21.17, mean±s.d.; non-UC: n=5, 30.7±34.92; P=0.02), whereas no significant difference was detected for CD4+ OX40+. CD14+ OX40L+ monocytes were correlated significantly with T helper 1 and 2 cells. Second, NOD/Scid IL2Rγ null mice were reconstituted with peripheral blood mononuclear cells from UC donors exhibiting elevated levels of OX40L, and the efficacy of oxelumab was compared with that of adalimumab. The clinical, colon and histological scores and the serum concentrations of IL-6, IL-1β and glutamic acid were assessed. Treatment with oxelumab or adalimumab resulted in significantly reduced clinical, colon and histological scores, reduced serum concentrations of IL-6 and reduced frequencies of splenic human effector memory T cells and switched B cells. Comparison of the efficacy of adalimumab and oxelumab by orthogonal partial least squares discrimination analysis revealed that oxelumab was slightly superior to adalimumab; however, elevated serum concentrations of glutamic acid suggested ongoing inflammation. These results suggest that oxelumab addresses the pro-inflammatory arm of inflammation while promoting the remodeling arm and that patients exhibiting elevated levels of OX40L might benefit from treatment with oxelumab. Summary: The combination of patient profiling and testing in a NOD/Scid IL2Rγnull mouse model of ulcerative colitis (UC) validates oxelumab as a potential therapeutic in UC.
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Affiliation(s)
- Henrika Jodeleit
- Department of General, Visceral and Transplantation Surgery, Hospital of the Ludwig-Maximilian-University Munich, Nussbaumstraße 20, 80336 Munich, Germany
| | - Paula Winkelmann
- Department of General, Visceral and Transplantation Surgery, Hospital of the Ludwig-Maximilian-University Munich, Nussbaumstraße 20, 80336 Munich, Germany
| | - Janina Caesar
- Department of General, Visceral and Transplantation Surgery, Hospital of the Ludwig-Maximilian-University Munich, Nussbaumstraße 20, 80336 Munich, Germany
| | - Sebastian Sterz
- Institute of Laboratory Medicine, Hospital of the Ludwig-Maximilian-University Munich, 81377 Munich, Germany
| | - Lesca M Holdt
- Institute of Laboratory Medicine, Hospital of the Ludwig-Maximilian-University Munich, 81377 Munich, Germany
| | - Florian Beigel
- Department of Medicine II, Hospital of the Ludwig-Maximilian-University Munich, Marchioninistraße 15, 81377 Munich, Germany
| | - Johannes Stallhofer
- Department of Medicine II, Hospital of the Ludwig-Maximilian-University Munich, Marchioninistraße 15, 81377 Munich, Germany
| | - Simone Breiteneicher
- Department of Medicine II, Hospital of the Ludwig-Maximilian-University Munich, Marchioninistraße 15, 81377 Munich, Germany
| | - Eckart Bartnik
- Immunology and Inflammation Research TA, Sanofi-Aventis Deutschland GmbH, 65926 Frankfurt am Main, Germany
| | - Thomas Leeuw
- Immunology and Inflammation Research TA, Sanofi-Aventis Deutschland GmbH, 65926 Frankfurt am Main, Germany
| | - Matthias Siebeck
- Department of General, Visceral and Transplantation Surgery, Hospital of the Ludwig-Maximilian-University Munich, Nussbaumstraße 20, 80336 Munich, Germany
| | - Roswitha Gropp
- Department of General, Visceral and Transplantation Surgery, Hospital of the Ludwig-Maximilian-University Munich, Nussbaumstraße 20, 80336 Munich, Germany
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Gidi NW, Goldenberg RL, Nigussie AK, Tazu Bonger Z, McClure EM, Abayneh M, Siebeck M, Genzel-Boroviczény O, Muhe LM. Disparity in Birth Size of Ethiopian Preterm Infants in Comparison to International INTERGROWTH-21st Data. Glob Pediatr Health 2020; 7:2333794X20973484. [PMID: 33283026 PMCID: PMC7684671 DOI: 10.1177/2333794x20973484] [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] [Received: 04/14/2020] [Revised: 10/09/2020] [Accepted: 10/16/2020] [Indexed: 11/23/2022] Open
Abstract
Background. Patterns of fetal growth are largely influenced by
environmental, nutritional, and socioeconomic factors more than differences in
populations. The aim of this study was to assess anthropometric measurements of
Ethiopian preterm infants at birth and compare the results with the
international INTERGROWTH-21st data. Patients and methods. We
analyzed anthropometric data on live-born singleton preterm infants enrolled in
a hospital-based multicenter study of illness in preterm infants (SIP). Eligible
newborns with gestational age of 28-36 weeks were included. Gestational age (GA)
and sex-specific mean and standard deviations (SD), 10th, 50th, 90th, centile
values for birth weight, length and head circumference (HC) were calculated and
compared with INTERGROWTH-21st data. Result. A total of 2763
preterm infants were included in the study, 54% were male. The prevalence of
small for GA (SGA) (<10th percentile) and large for GA (LGA) (>90th
percentile) were 10.8% and 9.9%, respectively. In all 3 parameters, the mean
values of boys were higher than of girls. Birth weight centiles were comparable
to international averages at lower GA, then after GA of 32 weeks the 10th, 50th,
and 90th centile values were 100-500 g less than the international averages. The
head circumference centiles were mostly comparable, and the 90th centile values
were greater than the international averages across the GA and in both sexes.
Conclusion. The infants’ birth weights were smaller at
higher GA, which may indicate maternal undernutrition in the third trimester of
pregnancy. Strengthening antenatal nutrition counseling and providing nutrition
supplementation might improve the birth weight.
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Affiliation(s)
- Netsanet Workneh Gidi
- Jimma University, Jimma, Ethiopia.,CIHLMU, Center for International Health, University Hospital, LMU Munich, Germany
| | | | | | | | | | - Mahlet Abayneh
- St Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | | | | | - Lulu M Muhe
- Addis Ababa University, Addis Ababa, Ethiopia
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19
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Gidi NW, Mekasha A, Nigussie AK, Goldenberg RL, McClure EM, Worku B, Amaru GM, Tazu Bonger Z, Demtse AG, Kebede ZT, Siebeck M, Genzel-Boroviczény O, Muhe LM. Preterm Nutrition and Clinical Outcomes. Glob Pediatr Health 2020; 7:2333794X20937851. [PMID: 32782918 PMCID: PMC7383644 DOI: 10.1177/2333794x20937851] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 05/19/2020] [Accepted: 05/29/2020] [Indexed: 11/18/2022] Open
Abstract
Background. In low-income countries, preterm nutrition is often inadequately addressed. The aim of the study was to assess the patterns of feeding and associated clinical outcomes of preterm neonates admitted to neonatal intensive care units in Ethiopia. Method. This was a multicenter, prospective study. Infants' clinical characteristics at birth, daily monitoring of feeding history, and weight measurements were collected. An outcome assessment was completed at 28 days. Result. For this analysis, 2560 infants (53% male) were eligible. The mean (SD) gestational age was 33.1 (2.2) weeks. During the hospital stay the proportion of infants on breast milk only, preterm formula, term formula, and mixed feeding was 58%, 27.4%, 1.6%, and 34.1%, respectively. Delay in enteral feeding was associated with increased risk of death (odds ratio [OR] = 1.92, 95% confidence interval [CI] = 1.33-2.78; P < .001) and (OR = 5.06, 95% CI = 3.23-7.87; P < .001) for 1 to 3 and 4 to 6 days of delay in enteral feeding, respectively, after adjusting for possible confounders. The length of delay in enteral feeding was associated with increased risk of hypoglycemia (OR = 1.2, 95% CI = 1.1-1.2; P = .005). The mortality rate was lower in hospitals providing preterm formula more often (P = .04). Half of the infants continued losing weight at the time of discharge. Conclusion. Delayed enteral feeding significantly increases the risk of mortality before discharge and hypoglycemia in preterm infants in resource-limited settings. Ensuring adequate nutritional support of preterm infants is highly needed.
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Affiliation(s)
| | | | | | | | | | - Bogale Worku
- Ethiopian Pediatric Society, Addis Ababa, Ethiopia
| | - Gesit M. Amaru
- St Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | | | | | | | - Matthias Siebeck
- Medical Center of the University of Munich (LMU), Munich, Germany
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20
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Jodeleit H, Caesar J, Villarroel Aguilera C, Sterz S, Holdt L, Beigel F, Stallhofer J, Breiteneicher S, Bartnik E, Siebeck M, Gropp R. The Combination of Patient Profiling and Preclinical Studies in a Mouse Model Based on NOD/Scid IL2Rγ null Mice Reconstituted With Peripheral Blood Mononuclear Cells From Patients With Ulcerative Colitis May Lead to Stratification of Patients for Treatment With Adalimumab. Inflamm Bowel Dis 2020; 26:557-569. [PMID: 31782956 PMCID: PMC7054775 DOI: 10.1093/ibd/izz284] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 08/06/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND To date, responsiveness to tumor necrosis factor alpha inhibitors in ulcerative colitis (UC) patients is not predictable. This is partially due to a lack of understanding of the underlying inflammatory processes. The aim of this study was to identify immunological subgroups of patients with UC and to test responsiveness to adalimumab in these subgroups in the mouse model of ulcerative colitis (UC), which is based on NOD/scid IL-2Rγ null (NSG) mice reconstituted with peripheral blood mononuclear cells (PBMCs; NSG-UC). METHODS The immunological profiles of 40 UC patients and 16 non-UC donors were determined by flow cytometric analysis of PBMCs in a snapshot and longitudinal study and analyzed by principal component, orthogonal partial least square discrimination (oPLS-DA), and hierarchical clustering analysis. NSG mice were reconstituted 5 times at consecutive time points with PBMCs from a single donor and were analyzed for frequencies of human leukocytes and histological phenotype. The response to adalimumab of 2 identified subgroups was tested in the NSG-UC model. We used the clinical, colon, and histological score, serum levels of glutamic and aspartic acid, and IL-6 and IL-1ß. Response was analyzed by oPLS-DA. RESULTS Analysis revealed a distinction between UC and non-UC donors. Hierarchical clustering identified 2 major subgroups in UC patients. Group I was characterized by TH17 and M1 monocytes, group II by TH2/TH1, and switched B cells. These subgroups reflect the dynamics of inflammation as patients. NSG-UC mice achieved an immunological phenotype reflecting the patient's immunological phenotype. oPLS-DA revealed that NSG-UC mice reconstituted with PBMCs from group II responded better to adalimumab. CONCLUSIONS The combination of profiling and testing of therapeutics in the NSG-UC model may lead to individualized and phase-dependent therapies.
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Affiliation(s)
- Henrika Jodeleit
- Department of General, Visceral und Transplantation Surgery, Hospital of the Ludwig Maximilian University of Munich, München, Germany,Present affiliation: IPEC, Hospital of the Ludwig Maximilian University of Munich, Munich, Germany
| | - Janina Caesar
- Department of General, Visceral und Transplantation Surgery, Hospital of the Ludwig Maximilian University of Munich, München, Germany
| | - Christina Villarroel Aguilera
- Department of General, Visceral und Transplantation Surgery, Hospital of the Ludwig Maximilian University of Munich, München, Germany
| | - Sebastian Sterz
- Institute of Laboratory Medicine, Hospital of the Ludwig Maximilian University of Munich, München, Germany
| | - Lesca Holdt
- Institute of Laboratory Medicine, Hospital of the Ludwig Maximilian University of Munich, München, Germany
| | - Florian Beigel
- Department of Medicine II, Hospital of the Ludwig Maximilian University of Munich, München, Germany
| | - Johannes Stallhofer
- Department of Medicine II, Hospital of the Ludwig Maximilian University of Munich, München, Germany
| | - Simone Breiteneicher
- Department of Medicine II, Hospital of the Ludwig Maximilian University of Munich, München, Germany
| | - Eckart Bartnik
- Immunology and Inflammation Research TA, Sanofi-Aventis Deutschland GmbH, Frankfurt am Main, Germany
| | - Matthias Siebeck
- Department of General, Visceral und Transplantation Surgery, Hospital of the Ludwig Maximilian University of Munich, München, Germany
| | - Roswitha Gropp
- Department of General, Visceral und Transplantation Surgery, Hospital of the Ludwig Maximilian University of Munich, München, Germany,Address correspondence to: Roswitha Gropp, PhD, Department of General, Visceral und Transplantation Surgery, Hospital of the Ludwig Maximilian University of Munich, Nussbaumstr. 20, 80336 Munich, Germany ()
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21
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Jodeleit H, Milchram L, Soldo R, Beikircher G, Schönthaler S, Al-amodi O, Wolf E, Beigel F, Weinhäusel A, Siebeck M, Gropp R. Autoantibodies as diagnostic markers and potential drivers of inflammation in ulcerative colitis. PLoS One 2020; 15:e0228615. [PMID: 32050001 PMCID: PMC7015398 DOI: 10.1371/journal.pone.0228615] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 01/21/2020] [Indexed: 12/18/2022] Open
Abstract
To date, no comprehensive analysis of autoantibodies in sera of patients with ulcerative colitis has been conducted. To analyze the spectrum of autoantibodies and to elucidate their role serum-IgG from UC patients (n = 49) and non-UC donors (n = 23) were screened by using a human protein microarray. Screening yielded a remarkable number of 697 differentially-reactive at the nominal 0·01 significance level (FDR<0·1) of the univariate test between the UC and the non-UC group. CD99 emerged as a biomarker to discriminate between both groups (p = 1e-04, AUC = 0·8). In addition, cytokines, chemokines and growth factors were analyzed by Olink's Proseek® Multiplex Inflammation-I 96×96 immuno-qPCR assay and 31 genes were significant at the nominal 0.05 level of the univariate test to discriminate between UC and non-UC donors. MCP-3, HGF and CXCL-9 were identified as the most significant markers to discriminate between UC patients with clinically active and inactive disease. Levels of CXCL10 (cor = 0.3; p = 0.02), CCL25 (cor = 0.25; p = 0.04) and CCL28 (cor = 0.3; p = 0.02) correlated positively with levels of anti CD99. To assess whether autoantibodies are detectable prior to diagnosis with UC, sera from nine donors at two different time points (T-early, median 21 months and T-late, median 6 months) were analyzed. 1201 features were identified with higher reactivity in samples at time points closer to clinical UC presentation. In vitro, additional challenge of peripheral mononuclear cells with CD99 did not activate CD4+ T cells but induced the secretion of IL-10 (-CD99: 20.21±20.25; +CD99: 130.20±89.55; mean ±sd; p = 0.015). To examine the effect of CD99 in vivo, inflammation and autoantibody levels were examined in NOD/ScidIL2Rγnull mice reconstituted with PBMC from UC donors (NSG-UC). Additional challenge with CD99 aggravated disease symptoms and pathological phenotype as indicated by the elevated clinical score (-CD99: 1·85 ± 1·94; +CD99: 4·25 ± 1·48) and histological score (-CD99: 2·16 ± 0·83; +CD99: 3·15 ± 1·16, p = 0·01). Furthermore, levels of anti-CD99 antibodies increased (Control: 398 ± 323; mean MFI ± sd; Ethanol + PBS: 358 ±316; Ethanol + CD99: 1363 ± 1336; Control versus Ethanol + CD99: p = 0.03). In a highly inflammatory environment, frequencies of pro-inflammatory M1 monocytes (CD14+ CD64+: unchallenged 8.09±4.72; challenged 14.2±8.62; p = 0.07; CD14+ CD1a+: unchallenged 16.29 ±6.97; challenged 43.81±14.4, p = 0.0003) increased and levels of autoantibodies in serum decreased in the NSG-UC mouse model. These results suggest that autoantibodies are potent biomarkers to discriminate between UC and non-UC and indicate risk to develop UC. In an inflammatory environment, auto-antibodies may promote the pathological phenotype by activating M1 monocytes in the NSG-UC animal model and also in patients with UC.
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Affiliation(s)
- Henrika Jodeleit
- Department of General, Visceral und Transplantation Surgery, Hospital of the Ludwig-Maximilian-University Munich, Munich, Germany
| | - Lisa Milchram
- Austrian Institute of Technology GmbH (AIT), Giefinggasse, Wien, Austria
| | - Regina Soldo
- Austrian Institute of Technology GmbH (AIT), Giefinggasse, Wien, Austria
| | - Gabriel Beikircher
- Austrian Institute of Technology GmbH (AIT), Giefinggasse, Wien, Austria
| | - Silvia Schönthaler
- Austrian Institute of Technology GmbH (AIT), Giefinggasse, Wien, Austria
| | - Omar Al-amodi
- Department of General, Visceral und Transplantation Surgery, Hospital of the Ludwig-Maximilian-University Munich, Munich, Germany
| | - Eckhard Wolf
- Institute of Molecular Animal Breeding and Biotechnology, Laboratory for Functional Genome Analysis (LAFUGA), Gene Center, LMU Munich, Munich, Germany
| | - Florian Beigel
- Department of Medicine II, Hospital of the Ludwig-Maximilian University Munich, München, Germany
| | - Andreas Weinhäusel
- Austrian Institute of Technology GmbH (AIT), Giefinggasse, Wien, Austria
| | - Matthias Siebeck
- Department of General, Visceral und Transplantation Surgery, Hospital of the Ludwig-Maximilian-University Munich, Munich, Germany
| | - Roswitha Gropp
- Department of General, Visceral und Transplantation Surgery, Hospital of the Ludwig-Maximilian-University Munich, Munich, Germany
- * E-mail:
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22
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Gidi NW, Goldenberg RL, Nigussie AK, McClure E, Mekasha A, Worku B, Siebeck M, Genzel-Boroviczeny O, Muhe LM. Incidence and associated factors of extrauterine growth restriction (EUGR) in preterm infants, a cross-sectional study in selected NICUs in Ethiopia. BMJ Paediatr Open 2020; 4:e000765. [PMID: 33094173 PMCID: PMC7552851 DOI: 10.1136/bmjpo-2020-000765] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 06/14/2020] [Revised: 07/25/2020] [Accepted: 08/06/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Preterm infants have high risk of developing growth restriction and long-term complications. Enteral feeding is often delayed in neonatal intensive care units (NICUs) for the fear of feeding intolerance and the associated necrotising enterocolitis, and recent advances in nutritional support are unavailable in low-income countries. OBJECTIVE The aim of this study was to assess the incidence and associated factors of extrauterine growth restriction (EUGR) among preterm infants in selected NICUs in Ethiopia. METHOD This was a cross-sectional study involving a subgroup analysis of preterm infants admitted to hospitals, from a multicentre descriptive study of cause of illness and death in preterm infants in Ethiopia, conducted from 2016 to 2018. EUGR was defined as weight at discharge Z-scores <-1.29 for corrected age. Clinical profiles of the infants were analysed for associated factors. SPSS V.23 software was used for analysis with a significance level of 5% and 95% CI. RESULT From 436 preterm infants included in the analysis, 223 (51%) were male, 224 (51.4%) very low birth weight (VLBW) and 185 (42.4%) small for gestational age (SGA). The mean (SD) of weight for corrected age Z-score at the time of discharge was -2.5 (1.1). The incidence of EUGR was 86.2%. Infants who were SGA, VLBW and longer hospital stay over 21 days had increased risk of growth restriction (p-value<0.01). SGA infants had a 15-fold higher risk of developing EUGR at the time of discharge from hospital than those who were appropriate or large for gestational age (OR (95% CI)=15.2 (4.6 to 50.1). CONCLUSION The majority of the infants had EUGR at the time of discharge from the hospital, which indicates suboptimal nutrition. Revision of national guidelines for preterm infants feeding and improvement in clinical practice is highly required.
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Affiliation(s)
- Netsanet Workneh Gidi
- CIHLMU Center for International Health, Ludwig-Maximilians-Universität, Munich, Germany.,Department of Pediatrics and Child Health, Jimma University, Jimma, Ethiopia
| | - Robert L Goldenberg
- Department of Obstetrics and Gynecology, Columbia University, New York, New York, USA
| | - Assaye K Nigussie
- Newborn & Child Health, Bill and Melinda Gates Foundation, Seattle, Washington, USA
| | - Elizabeth McClure
- Center for Clinical Research Network Coordination, RTI International, Research Triangle Park, North Carolina, USA
| | - Amha Mekasha
- Department of Pediatrics and Child Health, Addis Ababa University College of Health Sciences, Addis Ababa, Oromia, Ethiopia
| | - Bogale Worku
- Department of Pediatrics and Child Health, Addis Ababa University College of Health Sciences, Addis Ababa, Oromia, Ethiopia.,Ethiopian Pediatric Society, Addis Ababa, Ethiopia
| | - Matthias Siebeck
- Institute for Medical Education, University Hospital, LMU Munich, Germany, Munich, Germany
| | | | - Lulu M Muhe
- Department of Pediatrics and Child Health, Addis Ababa University College of Health Sciences, Addis Ababa, Oromia, Ethiopia
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23
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Gidi NW, Goldenberg RL, Nigussie AK, McClure E, Mekasha A, Worku B, Siebeck M, Genzel-Boroviczeny O, Muhe LM. Comparison of neonatal outcomes of small for gestational age and appropriate for gestational age preterm infants born at 28-36 weeks of gestation: a multicentre study in Ethiopia. BMJ Paediatr Open 2020; 4:e000740. [PMID: 32984553 PMCID: PMC7493091 DOI: 10.1136/bmjpo-2020-000740] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 05/21/2020] [Revised: 08/08/2020] [Accepted: 08/11/2020] [Indexed: 12/15/2022] Open
Abstract
PURPOSE The aim of this study was to assess morbidity and mortality pattern of small for gestational age (SGA) preterm infants in comparison to appropriate for gestational age (AGA) preterm infants of similar gestational age. METHOD We compared neonatal outcomes of 1336, 1:1 matched, singleton SGA and AGA preterm infants based on their gestational age using data from the study 'Causes of Illness and Death of Preterm Infants in Ethiopia (SIP)'. Data were analysed using SPSS V.23. ORs and 95% CIs and χ2 tests were done, p value of <0.05 was considered statistically significant. RESULT The majority of the infants (1194, 89%) were moderate to late preterm (32-36 weeks of gestation), 763 (57%) were females. Male preterm infants had higher risk of being SGA than female infants (p<0.001). SGA infants had increased risk of hypoglycaemic (OR and 95% CI 1.6 (1.2 to 2.0), necrotising enterocolitis (NEC) 2.3 (1.2 to 4.1), polycythaemia 3.0 (1.6 to 5.4), late-onset neonatal sepsis (LOS) 3.6 (1.1 to 10.9)) and prolonged hospitalisation 2.9 (2.0 to 4.2). The rates of respiratory distress syndrome (RDS), apnoea and mortality were similar in the SGA and AGA groups. CONCLUSION Neonatal complications such as hypoglycaemic, NEC, LOS, polycythaemia and prolonged hospitalisation are more common in SGA infants, while rates of RDS and mortality are similar in SGA and AGA groups. Early recognition of SGA status, high index of suspicion and screening for complications associated and timely intervention to prevent complications need due consideration.
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Affiliation(s)
- Netsanet Workneh Gidi
- Pediatric and Child Health, Jimma University, Jimma, Oromia, Ethiopia.,Center for International Health, University Hospital, LMU, Munich, Germany
| | - Robert L Goldenberg
- Department of Obstetrics and Gynecology, Columbia University, New York, New York, USA
| | - Assaye K Nigussie
- Newborn & Child Health, Bill and Melinda Gates Foundation, Seattle, Washington, USA
| | - Elizabeth McClure
- Center for Clinical Research Network Coordination, RTI International, Durham, North Carolina, USA
| | - Amha Mekasha
- Pediatrics and Child Heath, Addis Ababa University College of Health Sciences, Addis Ababa, Oromia, Ethiopia
| | - Bogale Worku
- Pediatrics and Child Heath, Addis Ababa University College of Health Sciences, Addis Ababa, Oromia, Ethiopia.,Ethiopian Pediatric Society, Addis Ababa, Ethiopia
| | - Matthias Siebeck
- Institute for Medical Education, University Hospital, LMU, Munich, Germany
| | | | - Lulu M Muhe
- Pediatrics and Child Heath, Addis Ababa University College of Health Sciences, Addis Ababa, Oromia, Ethiopia
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24
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Eshete MT, Baeumler PI, Siebeck M, Tesfaye M, Haileamlak A, Michael GG, Ayele Y, Irnich D. Quality of postoperative pain management in Ethiopia: A prospective longitudinal study. PLoS One 2019; 14:e0215563. [PMID: 31042777 PMCID: PMC6494043 DOI: 10.1371/journal.pone.0215563] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 04/04/2019] [Indexed: 02/06/2023] Open
Abstract
Background The annual number of surgical operations performed is increasing throughout the world. With this rise in the number of surgeries performed, so too, the challenge of effectively managing postoperative pain. In Africa, there are scanty data available that make use of multi-center data to characterize the quality of postoperative pain management. In this study using a longitudinal data, we have attempted to characterize the quality of postoperative pain management; among patients scheduled for major elective orthopedic, gynecologic and general surgery. Methods This prospective longitudinal study evaluated the quality of postoperative pain management in patients undergoing elective general, gynecologic, and orthopedic surgery. We quantified the prevalence of moderate to severe postoperative pain with the International Pain Outcome Questionnaire and the corresponding adequacy of treatment with the pain management index. At four time points after surgery, we estimated pain severity, its physical and emotional interference, and patient satisfaction. Results Moderate to severe postoperative pain was present in 88.2% of patients, and pain was inadequately treated in 58.4% of these patients. Chronic pain (β = 0.346, 95% CI: 0.212, 0.480) predicted patients’ worst pain intensity. Gender was not associated with the worst pain intensity or percentage of time spent in severe pain. Patient’s pain intensity did not predicted the level of satisfaction. Conclusions The prevalence of moderate to severe postoperative pain and its functional interference is high in Ethiopian patients. The treatment provided to patients is inadequate and not in line with international recommendations and standards.
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Affiliation(s)
- Million Tesfaye Eshete
- Department of Anesthesiology, Institute of Health, Faculty of Medicine, Jimma University, Jimma, Ethiopia
- CIHLMU Center for International Health, Medical Center of the University of Munich (LMU), Munich, Germany
- * E-mail:
| | - Petra I. Baeumler
- Multidisciplinary Pain Center, Department of Anesthesiology, University Hospital, Ludwig Maximilians University (LMU), Munich, Germany
| | - Matthias Siebeck
- CIHLMU Center for International Health, Medical Center of the University of Munich (LMU), Munich, Germany
- Department of General, Visceral und Transplantation Surgery, Medical Center of the University of Munich (LMU), Munich, Germany
| | - Markos Tesfaye
- Department of Psychiatry, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Abraham Haileamlak
- Department of Pediatrics and Child Health, Institute Of Health, Faculty of Medicine, Jimma University, Jimma, Ethiopia
| | - Girma G. Michael
- Department of Anesthesiology, Institute of Health, Faculty of Medicine, Jimma University, Jimma, Ethiopia
| | - Yemane Ayele
- Department of Anesthesiology, Institute of Health, Faculty of Medicine, Jimma University, Jimma, Ethiopia
| | - Dominik Irnich
- Multidisciplinary Pain Center, Department of Anesthesiology, University Hospital, Ludwig Maximilians University (LMU), Munich, Germany
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25
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Eshete MT, Baeumler PI, Siebeck M, Tesfaye M, Wonde D, Haileamlak A, Michael GG, Ayele Y, Irnich D. The views of patients, healthcare professionals and hospital officials on barriers to and facilitators of quality pain management in Ethiopian hospitals: A qualitative study. PLoS One 2019; 14:e0213644. [PMID: 30870467 PMCID: PMC6417681 DOI: 10.1371/journal.pone.0213644] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 02/26/2019] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Postoperative pain remains a challenge in the developed world, but the consequences of inadequately treated postoperative pain are particularly severe in low- and middle-income countries. Since 2011, reports have drawn attention to the poor quality of postoperative pain management in Ethiopia; however, our multicenter qualitative study was the first to attempt to understand the factors that are barriers to and facilitators of quality pain managment in the country. To this aim, the study explored the perspectives of patients, healthcare professionals, and hospital officials. We expected that the results of this study would inform strategies to improve the provision of quality pain management in Ethiopia and perhaps even in other low- and middle-income countries. METHODS This study used a qualitative, descriptive approach in which nine healthcare professionals, nine patients, and six hospital officials (i.e. executives in a managerial or leadership position in administration, nursing, or education) participated in face-to-face, semi-structured interviews. Thematic data analysis was conducted, and patterns were explained with the help of a theoretical framework. FINDINGS The barriers identified ranged from healthcare professionals' lack of empathy to a positive social appraisal of patients' ability to cope with pain. They also included a lack of emphasis on pain and its management during early medical education, together with the absence of available resources. Enhancing the ability of healthcare professionals to create favorable rapport with patients and increasing the cultural competence of professionals are essential ingredients of future pain education interventions. CONCLUSIONS Barriers to and facilitators of postoperative pain management do not exist independently but are reciprocally linked. This finding calls for holistic and inclusive interventions targeting healthcare professionals, patients, and hospital officials. The current situation is unlikely to improve if only healthcare professionals are educated about pain physiology, pharmacology, and management. Patients should also be educated, and the hospital environment should be modified to provide high-quality postoperative pain management.
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Affiliation(s)
- Million Tesfaye Eshete
- Department of Anesthesiology, Institute of Health, Faculty of Medicine, Jimma University, Jimma, Ethiopia
- Centre for International Health, Ludwig-Maximilians-Universität Munich, Munich, Germany
| | - Petra I. Baeumler
- Multidisciplinary Pain Center, Department of Anaesthesiology, University Hospital Ludwig Maximilians University Munich, Munich, Germany
| | - Matthias Siebeck
- Centre for International Health, Ludwig-Maximilians-Universität Munich, Munich, Germany
- Department of General, Visceral, Vascular and Transplantation Surgery, Hospital of the University of Munich (LMU), Munich, Germany
| | - Markos Tesfaye
- Department of Psychiatry, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Dereje Wonde
- Department of Sociology, College of Social Sciences and Humanity, Jimma, University, Ethiopia
| | - Abraham Haileamlak
- Department of Pediatrics and Child Health, Institute of Health, Faculty of Medicine, Jimma University, Jimma, Ethiopia
| | - Girma G. Michael
- Department of Anesthesiology, Institute of Health, Faculty of Medicine, Jimma University, Jimma, Ethiopia
| | - Yemane Ayele
- Department of Anesthesiology, Institute of Health, Faculty of Medicine, Jimma University, Jimma, Ethiopia
| | - Dominik Irnich
- Multidisciplinary Pain Center, Department of Anaesthesiology, University Hospital Ludwig Maximilians University Munich, Munich, Germany
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Soboka M, Adorjan K, Dehning S, Asaminew T, Abera M, Siebeck M, Tesfaye M, Jobst A. Evaluation of a Master of Science in Integrated Clinical and Community Mental Health (MSc ICCMH) program in Ethiopia. Ger Med Sci 2018; 16:Doc04. [PMID: 30627083 PMCID: PMC6317302 DOI: 10.3205/000266] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 12/13/2018] [Indexed: 11/30/2022]
Abstract
Introduction: The shortage of trained manpower in the field of mental health remains a significant obstacle to the treatment of people with mental illnesses in low and middle-income countries. In 2010, a new Master of Science in Integrated Clinical and Community Mental Health (MSc ICCMH) program for non-physician clinicians was established at Jimma University to address this shortage in Ethiopia. This study aimed to assess the competency, satisfaction, and involvement level of graduates of the program. Methods: A cross-sectional study was conducted among the graduates of the program. Data were collected with a semi-structured, self-administered questionnaire that was developed for the study. Responses were recorded on a Likert scale to assess graduates' competency and satisfaction level. The quantitative data were summarized by descriptive statistics, including means, standard deviations, and frequencies. Qualitative data were transcribed and analyzed thematically. Result: Until June 2015, 32 trainees had graduated from the MSc ICCMH program; 87.5% (n=28) of these graduates participated in the study. Almost all (96.4%, n=27) graduates were working in public institutions. The majority (75%, n=21) were directly engaged in the clinical care of patients. Also, two-thirds of the graduates (67.9%, n=19) were involved in mental health research. All of the graduates felt confident in conducting psychiatric assessments of adults and identifying and managing common mental disorders (100%, n=28). Similarly, 100% (n=28) of the graduates reported that they felt confident in identifying and managing severe mental illnesses. Conclusions: The outcome of the program is a considerable workforce of skilled mental health professionals. The majority of graduates were retained within the public mental health service. Brain drain does not appear to be a challenge among non-physician mental health specialists. The findings on the self-perceived competencies mirror the amount of clinical exposure during the training. With a minimal revision of the curriculum, the level of satisfaction and competencies can be enhanced.
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Affiliation(s)
- Matiwos Soboka
- Department of Psychiatry, College of Health Sciences, Jimma University, Jimma, Ethiopia
| | - Kristina Adorjan
- Center for International Health, LMU, Munich, Germany.,Department of Psychiatry and Psychotherapy, LMU, Munich, Germany.,Institute of Psychiatric Phenomics and Genomics (IPPG), University Hospital, LMU, Munich, Germany
| | - Sandra Dehning
- Center for International Health, LMU, Munich, Germany.,Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, LMU, Munich, Germany
| | - Tsedeke Asaminew
- Department of Ophthalmology, College of Health Sciences, Jimma University, Jimma, Ethiopia
| | - Mubarek Abera
- Department of Psychiatry, College of Health Sciences, Jimma University, Jimma, Ethiopia
| | - Matthias Siebeck
- Center for International Health, LMU, Munich, Germany.,Department of General, Visceral, Vascular and Transplantation Surgery, LMU, Munich, Germany
| | - Markos Tesfaye
- Department of Psychiatry, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Andrea Jobst
- Center for International Health, LMU, Munich, Germany.,Department of Psychiatry and Psychotherapy, LMU, Munich, Germany
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Jodeleit H, Al-Amodi O, Caesar J, Villarroel Aguilera C, Holdt L, Gropp R, Beigel F, Siebeck M. Targeting ulcerative colitis by suppressing glucose uptake with ritonavir. Dis Model Mech 2018; 11:dmm.036210. [PMID: 30322872 PMCID: PMC6262818 DOI: 10.1242/dmm.036210] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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: 06/22/2018] [Accepted: 10/02/2018] [Indexed: 01/06/2023] Open
Abstract
Glucose is the preferred source of energy in activated inflammatory cells. Glucose uptake into the cell is ensured by a family of glucose uptake transporters (GLUTs), which have been identified as off-target molecules of the HIV protease inhibitor ritonavir. In this study, we examined the effect of ritonavir on inflammation in vitro and in vivo. Peripheral blood mononuclear cells (PBMCs) were activated with anti-CD3 in the presence or absence of ritonavir and analyzed by flow cytometric analysis. Frequencies of CD4+ cells were significantly affected by ritonavir (CD69+ P=3E-05; CD134 P=4E-06; CD25+ P=E-07; central memory P=0.02; effector P=6E-03; effector memory P=6E-05). To corroborate that inflammation has a metabolic effect in vivo, a mouse model was used that is based on immunocompromised NOD-scid IL-2Rγ null mice reconstituted with PBMCs from patients with ulcerative colitis (UC). Inflammation had a significant effect on amino acid (AA) levels (Glu P=1E-07, Asp P=1E-04). Principal component analysis (PCA) discriminated between unchallenged and challenged groups. Finally, the efficacy of ritonavir was tested in the same mouse model. Dependent variables were clinical and histological scores, frequencies of human leukocytes isolated from spleen and colon, and levels of AA in sera of mice. Mice benefited from treatment with ritonavir as indicated by significantly decreased colon (P=7E-04) and histological (P=1E-04) scores, frequencies of M2 monocytes (CD14+ CD163; P=0.02), and Glu levels (P=2E-05). PCA discriminated between control and challenged groups (P=0.026). Thus, inhibition of glucose uptake might be a promising therapeutic intervention point for active UC. Summary: Insights into immuno-metabolism open up new avenues for therapeutic intervention. The study presented here suggests that inhibition of glucose suppresses inflammation in a mouse model of ulcerative colitis.
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Affiliation(s)
- Henrika Jodeleit
- Department of General-, Visceral-, Transplantation- and Vascular Surgery, University Hospital, LMU Munich, Nussbaumstr. 20, 80336 Munich, Germany
| | - Omar Al-Amodi
- Department of General-, Visceral-, Transplantation- and Vascular Surgery, University Hospital, LMU Munich, Nussbaumstr. 20, 80336 Munich, Germany
| | - Janina Caesar
- Department of General-, Visceral-, Transplantation- and Vascular Surgery, University Hospital, LMU Munich, Nussbaumstr. 20, 80336 Munich, Germany
| | - Christina Villarroel Aguilera
- Department of General-, Visceral-, Transplantation- and Vascular Surgery, University Hospital, LMU Munich, Nussbaumstr. 20, 80336 Munich, Germany
| | - Lesca Holdt
- Department of Laboratory Medicine, Institute of Laboratory Medicine, University Hospital, LMU Munich, 81377 Munich, Germany
| | - Roswitha Gropp
- Department of General-, Visceral-, Transplantation- and Vascular Surgery, University Hospital, LMU Munich, Nussbaumstr. 20, 80336 Munich, Germany
| | - Florian Beigel
- Department of Medicine II, University Hospital, LMU Munich, Marchioninistr. 15, 81377 München, Germany
| | - Matthias Siebeck
- Department of General-, Visceral-, Transplantation- and Vascular Surgery, University Hospital, LMU Munich, Nussbaumstr. 20, 80336 Munich, Germany
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Tesfaye M, Bäumler P, Siebeck M, Tesfaye M, Irnich D. Acupuncture versus Patient Education: A Non-randomized, Open-Label, Controlled, Longitudinal Observational Study. J Acupunct Meridian Stud 2018. [DOI: 10.1016/j.jams.2018.08.114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Al-amodi O, Jodeleit H, Beigel F, Wolf E, Siebeck M, Gropp R. CD1a-Expressing Monocytes as Mediators of Inflammation in Ulcerative Colitis. Inflamm Bowel Dis 2018; 24:1225-1236. [PMID: 29788291 PMCID: PMC6176881 DOI: 10.1093/ibd/izy073] [Citation(s) in RCA: 12] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND CD1a-expressing CD14+ monocytes have been identified as inducers of autoreactive T cells. In this study, the link between inflammatory and metabolic signals and CD1a-expressing monocytes in vitro and in vivo was examined, and CD1a was evaluated as a potential therapeutic target for treatment of ulcerative colitis (UC). METHODS Peripheral blood mononuclear cells (PBMCs) from UC patients and non-UC donors were incubated with phosphatidylcholine (PC) for 2 and 7 days and subjected to flow cytometric analysis. Triacylglycerol (TAG) and cholesterol levels and frequencies of CD14+ CD1a+ monocytes were determined in a mouse model of UC that is based on NOD/scid IL2Rγnull mice reconstituted with PBMCs from UC patients (NSG-UC). NSG-UC mice were treated with anti-CD1a antibodies. Response to treatment was determined by clinical and histological scores, flow cytometric analysis of human leucocytes from the spleen and colon, and expression levels of TGFß1, HGF, IFNγ, and TARC. RESULTS Incubation of PBMCs with PC resulted in an increase of the frequency of CD1a+ CD14+ monocytes at the expense of CCR2-, CD86-, and TSLPR-expressing CD14+ monocytes. CD1a+ CD14+ monocytes induced the activation of CD4+ T cells and differentiation of Th cells. In vivo, TAG and cholesterol levels increased upon inflammation and correlated positively with CD14+ CD1a+ monocytes. NSG-UC mice benefitted from treatment with anti-CD1a antibodies, as indicated by a reduced histological score and reduced frequencies of CD1a+ CD14+ monocytes in the colon and spleen of mice. CONCLUSION CD1a-expressing monocytes might act as sensors and mediators of inflammation in UC. Mice benefitted from treatment with anti-CD1a antibodies.
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Affiliation(s)
- Omar Al-amodi
- Department of General- Visceral-, Vascular- and Transplantation Surgery, Hospital of the LMU, Munich, Germany
| | - Henrika Jodeleit
- Institute of Molecular Animal Breeding and Biotechnology, and Laboratory for Functional Genome Analysis (LAFUGA), Gene Center, LMU Munich, Munich, Germany
| | - Florian Beigel
- Department of Medicine II-Grosshadern, Hospital of the LMU Munich, München, Germany
| | - Eckhard Wolf
- Institute of Molecular Animal Breeding and Biotechnology, and Laboratory for Functional Genome Analysis (LAFUGA), Gene Center, LMU Munich, Munich, Germany
| | - Matthias Siebeck
- Department of General- Visceral-, Vascular- and Transplantation Surgery, Hospital of the LMU, Munich, Germany
| | - Roswitha Gropp
- Department of General- Visceral-, Vascular- and Transplantation Surgery, Hospital of the LMU, Munich, Germany,Address correspondence to: Roswitha Gropp, PhD, Department of General-, Visceral-, and Transplantation Surgery, Hospital of the LMU, Nussbaumstraße 20, 80336 Munich, Germany ()
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Jodeleit H, Palamides P, Beigel F, Mueller T, Wolf E, Siebeck M, Gropp R. Design and validation of a disease network of inflammatory processes in the NSG-UC mouse model. J Transl Med 2017; 15:265. [PMID: 29282132 PMCID: PMC5745765 DOI: 10.1186/s12967-017-1368-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [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: 07/07/2017] [Accepted: 12/15/2017] [Indexed: 11/16/2022] Open
Abstract
Background Ulcerative colitis (UC) is a highly progressive inflammatory disease that requires the interaction of epithelial, immune, endothelial and muscle cells and fibroblasts. Previous studies suggested two inflammatory conditions in UC-patients: ‘acute’ and ‘remodeling’ and that the design of a disease network might improve the understanding of the inflammatory processes. The objective of the study was to design and validate a disease network in the NOD-SCID IL2rγnull (NSG)-UC mouse model to get a better understanding of the inflammatory processes. Methods Leukocytes were isolated from the spleen of NSG-UC mice and subjected to flow cytometric analysis. RT-PCR and RNAseq analysis were performed from distal parts of the colon. Based on these analyses and the effects of interleukins, chemokines and growth factors described in the literature, a disease network was designed. To validate the disease network the effect of infliximab and pitrakinra was tested in the NSG-UC model. A clinical- and histological score, frequencies of human leukocytes isolated from spleen and mRNA expression levels from distal parts of the colon were determined. Results Analysis of leukocytes isolated from the spleen of challenged NSG-UC mice corroborated CD64, CD163 and CD1a expressing CD14+ monocytes, CD1a expressing CD11b+ macrophages and HGF, TARC, IFNγ and TGFß1 mRNA as inflammatory markers. The disease network suggested that a proinflammatory condition elicited by IL-17c and lipids and relayed by cytotoxic T-cells, Th17 cells and CD1a expressing macrophages and monocytes. Conversely, the remodeling condition was evoked by IL-34 and TARC and promoted by Th2 cells and M2 monocytes. Mice benefitted from treatment with infliximab as indicated by the histological- and clinical score. As predicted by the disease network infliximab reduced the proinflammatory response by suppressing M1 monocytes and CD1a expressing monocytes and macrophages and decreased levels of IFNγ, TARC and HGF mRNA. As predicted by the disease network inflammation aggravated in the presence of pitrakinra as indicated by the clinical and histological score, elevated frequencies of CD1a expressing macrophages and TNFα and IFNγ mRNA levels. Conclusions The combination of the disease network and the NSG-UC animal model might be developed into a powerful tool to predict efficacy or in-efficacy and potential mechanistic side effects. Electronic supplementary material The online version of this article (10.1186/s12967-017-1368-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Henrika Jodeleit
- Institute of Molecular Animal Breeding and Biotechnology and Laboratory for Functional Genome Analysis (LAFUGA), Gene Center, LMU Munich, 81377, Munich, Germany
| | - Pia Palamides
- Department of Medicinal Microbiology, Max von Pettenkofer Institute, 80336, Munich, Germany
| | - Florian Beigel
- Department of Medicine II-Grosshadern, Ludwig-Maximilians-University (LMU), Marchioninistr. 15, 81377, Munich, Germany
| | - Thomas Mueller
- Julius von Sachs Institute, University of Würzburg, 97082, Würzburg, Germany
| | - Eckhard Wolf
- Institute of Molecular Animal Breeding and Biotechnology and Laboratory for Functional Genome Analysis (LAFUGA), Gene Center, LMU Munich, 81377, Munich, Germany
| | - Matthias Siebeck
- Department of General- Visceral-, and Transplantation Surgery, Hospital of the University of Munich, Nussbaumstr. 20, 80336, Munich, Germany
| | - Roswitha Gropp
- Department of General- Visceral-, and Transplantation Surgery, Hospital of the University of Munich, Nussbaumstr. 20, 80336, Munich, Germany.
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Mihailov D, Savescu D, Bordos D, Niculescu S, Jinca C, Lacatusu A, Siebeck M, Schramm W, Serban M. Long-term outcome of an unusual haemophilic pseudotumour. Hamostaseologie 2017. [DOI: 10.1055/s-0037-1619774] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
SummaryHaemophilia, a lifelong congenital bleeding disease, is a highly demanding disorder, due to the costs of its replacement therapy. In the absence of this pivotal treatment, life expectancy and quality of life are deleteriously affected.As illustration, we present a 14 years long follow- up of a patient with severe haemophilia A, treated sporadically with fresh plasma, cryoprecipitate and factor concentrates, who developed a giant iliopsoas pseudotumor. Since he was an infant, under on demand therapy with fresh frozen plasma, cryoprecipitate and low doses of factor concentrates he presented many spontaneous bleedings, developing multiple disabling arthropathies. At the age of 14 years, an iliopsoas hematoma occurred, which relapsed several times, developing an iliopsoas pseudotumour. After 5 years, sepsis with Klebsiella was diagnosed. A CT scan revealed fistula between the pseudotumor and the gut. Under antibiotics, the evolution of sepsis improved, but over a period of 10 months 5 episodes of haematemesis and melena, followed by one episode of macroscopic haematuria occurred; two months later he developed an inguino-crural mass, which fistulized through the abdominal wall. A mixt german-romanian team solved the clinical concern. After 108 hospitalization days and consumption of 104 840 IU factor VIII he left the clinic in good condition. One year later, the temporary colostomy with anus praeter was closed. The follow-up reveals now, after almost 10 years with favourable outcome, that the patient is well, active within his family and profession.
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Abstract
OBJECTIVE To evaluate the impact of the community-based newborn care package (CBNCP) on six essential practices to improve neonatal health. METHODS CBNCP pilot districts were matched to comparison districts using propensity scores. Impact on birth preparedness, antenatal care seeking, antenatal care quality, delivery by skilled birth attendant, immediate newborn care and postnatal care within 48 hours were assessed using Demographic and Health Survey (DHS) and Health Management Information System (HMIS) data through difference-in-differences and multivariate logistic regression analyses. FINDINGS Changes over time in intervention and comparison areas were similar in difference-in-differences analysis of DHS and HMIS data. Logistic regression of DHS data also did not reveal any significant improvement in combined outcomes: birth preparedness, adjusted OR (aOR)=0.8 (95% CI 0.4 to 1.7); antenatal care seeking, aOR=1.0 (0.6 to 1.5); antenatal care quality, aOR=1.4 (0.9 to 2.1); delivery by skilled birth attendant, aOR=1.5 (1.0 to 2.3); immediate newborn care, aOR=1.1 (0.7 to 1.9); postnatal care, aOR=1.3 (0.9 to 1.9). Health providers' knowledge and skills in intervention districts were fair but showed much variation between different providers and districts. CONCLUSIONS This study, while representing an early assessment of impact, did not identify significant improvements in newborn care practices and raises concerns regarding CBNCP implementation. It has contributed to revisions of the package and it being merged with the Integrated Management of Neonatal and Childhood Illness programme. This is now being implemented in 35 districts and carefully monitored for quality and impact. The study also highlights general challenges in evaluating the impacts of a complex health intervention under 'real life' conditions.
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Affiliation(s)
- Deepak Paudel
- Center for International Health, Ludwig Maximilians University, Munich, Germany
- Office of Health and Family Planning, United States Agency for International Development, Kathmandu, Nepal
| | - Ishwar B Shrestha
- Department of Community Medicine and Family Health, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Matthias Siebeck
- Center for International Health, Ludwig Maximilians University, Munich, Germany
| | - Eva Rehfuess
- Institute for Medical Information Processing, Biometry and Epidemiology, Pettenkofer School of Public Health and Center for International Health, Ludwig Maximilians University, Munich, Germany
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Török HP, Bellon V, Konrad A, Lacher M, Tonenchi L, Siebeck M, Brand S, De Toni EN. Functional Toll-Like Receptor (TLR)2 polymorphisms in the susceptibility to inflammatory bowel disease. PLoS One 2017; 12:e0175180. [PMID: 28388655 PMCID: PMC5384663 DOI: 10.1371/journal.pone.0175180] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Accepted: 03/21/2017] [Indexed: 01/17/2023] Open
Abstract
Background The recent genome-wide association studies (GWAS) in inflammatory bowel disease (IBD) suggest significant genetic overlap with complex mycobacterial diseases like tuberculosis or leprosy. TLR variants have previously been linked to susceptibility for mycobacterial diseases. Here we investigated the contribution to IBD risk of two TLR2 polymorphisms, the low-prevalence variant Arg753Gln and the GTn microsatellite repeat polymorphism in intron 2. We studied association with disease, possible correlations with phenotype and gene-gene interactions. Methodology/Principal findings We conducted a large study in 843 patients with Crohn’s disease, 426 patients with ulcerative colitis and 805 healthy, unrelated controls, all of European origin. Overall, the frequency for carriers of shorter GTn repeats in intron 2 of the TLR2 gene, which have previously been associated with low TLR2 expression and high IL-10 production, was slightly elevated in Crohn’s disease and ulcerative colitis compared to healthy controls (16.0% resp. 16.7% vs. 12.8%). The highest frequency of short GTn carriers was noted among IBD patients on anti TNF-alpha therapy. However, none of these differences was significant in the multivariate analysis. The Arg753Gln polymorphism showed no association with any clinical subtype of IBD, including extensive colitis, for which such an association was previously described. We found no association with specific phenotypic disease subgroups. Also, epistasis analysis revealed no significant interactions between the two TLR2 variants and confirmed IBD susceptibility genes. Conclusions The two functional relevant polymorphisms in TLR2, the GTn microsatellite repeat polymorphism in intron 2 and the Arg753Gln variant do not seem to play a role in the susceptibility to Crohn’s disease or ulcerative colitis.
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Affiliation(s)
- Helga Paula Török
- Department of Medicine II, Ludwig-Maximilians-University, Munich, Germany
- * E-mail:
| | - Victor Bellon
- MINES ParisTech, PSL-Research University, CBIO-Centre for Computational Biology, Fontainebleau, France
- Institut Curie, Paris,France
- INSERM U900, Paris, France
| | - Astrid Konrad
- Department of Medicine II, Ludwig-Maximilians-University, Munich, Germany
| | - Martin Lacher
- Department of Pediatric Surgery, University of Leipzig, Leipzig, Germany
| | - Laurian Tonenchi
- Department of General, Visceral, Vascular and Transplantation Surgery, Ludwig-Maximilians-University, Munich, Germany
| | - Matthias Siebeck
- Department of General, Visceral, Vascular and Transplantation Surgery, Ludwig-Maximilians-University, Munich, Germany
| | - Stephan Brand
- Department of Medicine II, Ludwig-Maximilians-University, Munich, Germany
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Chiapponi C, Witt M, Dlugosch GE, Gülberg V, Siebeck M. The Perception of Physician Empathy by Patients with Inflammatory Bowel Disease. PLoS One 2016; 11:e0167113. [PMID: 27875561 PMCID: PMC5119824 DOI: 10.1371/journal.pone.0167113] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2016] [Accepted: 11/08/2016] [Indexed: 12/30/2022] Open
Abstract
Background and Aims This study focused on the difference between perceived and desired physician empathy (pPE and dPE) in the eye of patients with inflammatory bowel disease (IBD). It was investigated if a discrepancy (ΔPE) correlates with trust and satisfaction of patients. At the same time the aim was to gain detailed information about the subjective burden of disease and the resources of IBD patients, in order to better understand them. Methods A modified version of the German Version of the Consultation and Relational Empathy (CARE) measure was completed as a paper-and-pencil questionnaire by IBD patients attending our facility (n = 32) and as an online survey by IBD patients at other locations throughout Germany (n = 89). Patients were in average 36.3±12 years old. Results The mean (SD) rating of pPE was 3.93 (0.96) on a scale of 1 to 5 (“poor” to “excellent”); however, the mean (SD) dPE was 4.38 (0.48) on the same scale. ΔPE correlated with perceived empathy and with patients’ satisfaction with treatment and trust in their health care providers. Patients reported quite a high subjective burden (mean [SD]: 2.93 [.63]) and named family, friends, and support groups as resources. Conclusions Rather than assessing patient satisfaction with treatment and trust in their physician only with perceived PE, we suggest ΔPE as a useful additional parameter.
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Affiliation(s)
- Costanza Chiapponi
- Department of General, Visceral, Vascular and Transplantation Surgery, Hospital of the University of Munich (LMU), Munich, Germany
- * E-mail:
| | - Maxie Witt
- Center of Empirical Educational Research (zepf), University of Koblenz-Landau, Campus Landau, Landau in der Pfalz, Germany
| | - Gabriele E. Dlugosch
- Center of Empirical Educational Research (zepf), University of Koblenz-Landau, Campus Landau, Landau in der Pfalz, Germany
| | - Veit Gülberg
- Medizinische Klinik IV, Division of Gastroenterology, Hospital of the University of Munich (LMU), Munich, Germany
| | - Matthias Siebeck
- Department of General, Visceral, Vascular and Transplantation Surgery, Hospital of the University of Munich (LMU), Munich, Germany
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35
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Föhlinger M, Palamides P, Mansmann U, Beigel F, Siebeck M, Gropp R. Immunological profiling of patients with ulcerative colitis leads to identification of two inflammatory conditions and CD1a as a disease marker. J Transl Med 2016; 14:310. [PMID: 27809916 PMCID: PMC5094062 DOI: 10.1186/s12967-016-1048-9] [Citation(s) in RCA: 10] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Accepted: 10/03/2016] [Indexed: 01/09/2023] Open
Abstract
Background Conventional approaches to understand mechanisms underlying the development of pathological manifestations in ulcerative colitis (UC) mostly rely on identification of certain cell types and cytokines followed by verification of their roles in vitro and in vivo. In light of the highly dynamic processes in UC, requiring the cross talk of immune cells, epithelial-, endothelial-, muscle cells and fibrocytes, this approach might neglect temporal and spatial connectivity of individually differing inflammatory responses. Methods We undertook a more holistic approach whereby we designed a flow cytometric analysis- and ELISA panel and determined the immunological profiles of UC patients in comparison to Non UC donors. This panel consisted of B-cells, T-cells, macrophages, monocytes, NK- and NK T-cells and subtypes thereof, the cytokines TGFß1 and HGF, the chemokine TARC and periostin. Blood was collected from 41 UC patients and 30 non-UC donors. Isolated PBMC were subjected to flow cytometric analysis and sera were analyzed by ELISA. Data were analysed by cluster- and correlation analysis. To corroborate that the identified cells reflected the inflammatory condition in the colon of UC patients, leucocytes were isolated from colons of UC patients and subjected to the same flow cytometric analysis. Results Immunological profiling followed by cluster- and correlation analysis led to the identification of two inflammatory conditions: An ‘acute’ condition characterized by adaptive immune cells as plasma cells, TSLPR expressing CD11b+ macrophages, CD64 and CCR2 expressing CD14+ monocytes, HGF and TARC and a ‘remodeling’ condition signified by NK T-cells and TLSPR expressing CD14+ monocytes, TGFß1 and periostin. ROC analysis identified TARC and TGFß1 as biological markers with high potential to discriminate between these two conditions (Δ = −6687.72 ng/ml; p = 1E−04; AUC = 0.87). In addition, CD1a+ CD11b+ macrophages (Δ = 17.73% CD1a+ CD11b+; p = 5E−04; AUC = 0.86) and CD1a+ CD14+ monocytes (Δ = 20.35; p = 0.02, AUC = 0.75) were identified as markers with high potential to discriminate between UC and Non UC donors. CD1a+ CD11b+ macrophages and NK T-cells were found to be significantly increased in inflamed colons of UC patients as compared to non-UC control samples (p = 0.02). Conclusions Immunological profiling of UC patients might improve our understanding of the pathology underlying individual manifestations and phases of the disease. This might lead to the development of novel diagnostics and therapeutic interventions adapted to individual needs and different phases of the disease. In addition, it might result in stratification of patients for clinical trials. Electronic supplementary material The online version of this article (doi:10.1186/s12967-016-1048-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- M Föhlinger
- Department of General Visceral, and Transplantation Surgery, Hospital of the LMU Munich, Nussbaumstr. 20, 80336, Munich, Germany
| | - P Palamides
- Institute of Molecular Animal Breeding and Biotechnology, and Laboratory for Functional Genome Analysis (LAFUGA), Gene Center, LMU Munich, 81377, Munich, Germany
| | - U Mansmann
- Institute for Medical Informatics, Biometry and Epidemiology, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - F Beigel
- Department of Medicine II-Grosshadern, Ludwig-Maximilians-University (LMU), Marchioninistr. 15, 81377, Munich, Germany
| | - M Siebeck
- Department of General Visceral, and Transplantation Surgery, Hospital of the LMU Munich, Nussbaumstr. 20, 80336, Munich, Germany
| | - R Gropp
- Department of General Visceral, and Transplantation Surgery, Hospital of the LMU Munich, Nussbaumstr. 20, 80336, Munich, Germany.
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Palamides P, Jodeleit H, Föhlinger M, Beigel F, Herbach N, Mueller T, Wolf E, Siebeck M, Gropp R. A mouse model for ulcerative colitis based on NOD-scid IL2R γnull mice reconstituted with peripheral blood mononuclear cells from affected individuals. Dis Model Mech 2016; 9:985-97. [PMID: 27491073 PMCID: PMC5047691 DOI: 10.1242/dmm.025452] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [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: 03/17/2016] [Accepted: 07/19/2016] [Indexed: 11/22/2022] Open
Abstract
Animal models reflective of ulcerative colitis (UC) remain a major challenge, and yet are crucial to understand mechanisms underlying the onset of disease and inflammatory characteristics of relapses and remission. Mouse models in which colitis-like symptoms are induced through challenge with toxins such as oxazolone, dextran sodium sulfate (DSS) or 2,4,6-trinitrobenzenesulfonic acid (TNBS) have been instrumental in understanding the inflammatory processes of UC. However, these neither reflect the heterogeneous symptoms observed in the UC-affected population nor can they be used to test the efficacy of inhibitors developed against human targets where high sequence and structural similarity of the respective ligands is lacking. In an attempt to overcome these problems, we have developed a mouse model that relies on NOD-scid IL2R γnull mice reconstituted with peripheral blood mononuclear cells derived from UC-affected individuals. Upon challenge with ethanol, mice developed colitis-like symptoms and changes in the colon architecture, characterized by influx of inflammatory cells, edema, crypt loss, crypt abscesses and epithelial hyperplasia, as previously observed in immune-competent mice. TARC, TGFβ1 and HGF expression increased in distal parts of the colon. Analysis of human leucocytes isolated from mouse spleen revealed an increase in frequencies of CD1a+, CD64+, CD163+ and TSLPR+ CD14+ monocytes, and antigen-experienced CD44+ CD4+ and CD8+ T-cells in response to ethanol. Analysis of human leucocytes from the colon of challenged mice identified CD14+ monocytes and CD11b+ monocytes as the predominant populations. Quantitative real-time PCR (RT-PCR) analysis from distal parts of the colon indicated that IFNγ might be one of the cytokines driving inflammation. Treatment with infliximab ameliorated symptoms and pathological manifestations, whereas pitrakinra had no therapeutic benefit. Thus, this model is partially reflective of the human disease and might help to increase the translation of animal and clinical studies. Summary: The phenotype and colitis-like symptoms induced in NSG mice reconstituted with PBMCs derived from ulcerative-colitis-affected donors reflect the human disease.
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Affiliation(s)
- Pia Palamides
- Institute of Molecular Animal Breeding and Biotechnology, Gene Center, LMU Munich, Munich 81377, Germany Laboratory for Functional Genome Analysis (LAFUGA), Gene Center, LMU Munich, Munich 81377, Germany
| | - Henrika Jodeleit
- Institute of Molecular Animal Breeding and Biotechnology, Gene Center, LMU Munich, Munich 81377, Germany Laboratory for Functional Genome Analysis (LAFUGA), Gene Center, LMU Munich, Munich 81377, Germany
| | - Michael Föhlinger
- Department of General- Visceral-, and Transplantation Surgery, Hospital of the University of Munich, Nussbaumstr. 20, Munich 80336, Germany
| | - Florian Beigel
- Department of Medicine II-Grosshadern, Ludwig Maximilians University, Munich, Germany
| | - Nadja Herbach
- Institute of Veterinary Pathology, Ludwig Maximilians University, Munich, Germany
| | - Thomas Mueller
- Julius von Sachs Institute, University of Würzburg, Würzburg 97082, Germany
| | - Eckhard Wolf
- Institute of Molecular Animal Breeding and Biotechnology, Gene Center, LMU Munich, Munich 81377, Germany Laboratory for Functional Genome Analysis (LAFUGA), Gene Center, LMU Munich, Munich 81377, Germany
| | - Matthias Siebeck
- Department of General- Visceral-, and Transplantation Surgery, Hospital of the University of Munich, Nussbaumstr. 20, Munich 80336, Germany
| | - Roswitha Gropp
- Department of General- Visceral-, and Transplantation Surgery, Hospital of the University of Munich, Nussbaumstr. 20, Munich 80336, Germany
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Chiapponi C, Dimitriadis K, Özgül G, Siebeck RG, Siebeck M. Awareness of ethical issues in medical education: an interactive teach-the-teacher course. GMS J Med Educ 2016; 33:Doc45. [PMID: 27275510 PMCID: PMC4894361 DOI: 10.3205/zma001044] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Revised: 11/30/2015] [Accepted: 12/21/2015] [Indexed: 05/28/2023]
Abstract
PURPOSE We conducted an international, interdisciplinary teach-the-teacher course to sensitize physicians from different countries to ethical issues in medical education. The purpose of this study was to assess the effects of this course. METHOD Before and after participating in a short session on ethical issues in medical education, 97 physicians from different countries in Africa, Asia, and Europe completed a self-assessment questionnaire on their competence and interest in this field. The short session consisted of working in small groups to identify, analyze and discuss ethical dilemmas described in case vignettes adapted from published examples or written by medical students. In addition to the questionnaire, we conducted a large-group experience to explore four basic orientations of participants in ethical thinking: relativism, intentionalism, consequentialism, and absolutism. RESULTS We found a significant self-perceived increase in the participants' ability to identify and describe ethical issues and students' dilemmas, in their knowledge about these issues and teaching professionalism, and in their ability to describe both students' perspectives and teachers' and students' behaviors. In addition, participants' feeling of understanding their own culturally learned patterns of determining what is right and wrong increased after taking part in the course. The four contrasting basic ethical orientations showed no significant differences between participants regarding nationality, age, or gender. CONCLUSION Ethics of education is an important issue for medical teachers. Teachers' self-perceived competence can be increased by working on case vignettes in small groups.
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Affiliation(s)
- Costanza Chiapponi
- Hospital of the University of Magdeburg (OvGU), Department of General, Visceral and Vascular Surgery, Magdeburg, Germany
| | | | - Gülümser Özgül
- Hospital of Aalen, Department of Gynaecology, Aalen, Germany
| | | | - Matthias Siebeck
- Hospital of the University of Munich (LMU), Department of General, Visceral, Vascular and Transplantation Surgery, Munich, Germany
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Fleckenstein J, Kohls N, Evtouchenko E, Lehmeyer L, Kramer S, Lang P, Siebeck M, Mussack T, Hatz R, Heindl B, Conzen P, Rehm M, Czerner S, Zwißler B, Irnich D. No effect of the cyclooxygenase-2 inhibitor etoricoxib on pre-emptive and post-operative analgesia in visceral surgery: results of a randomized controlled trial. Eur J Pain 2015; 20:186-95. [DOI: 10.1002/ejp.699] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/11/2015] [Indexed: 11/06/2022]
Affiliation(s)
- J. Fleckenstein
- Department of Anaesthesiology; University of Munich; Germany
| | - N. Kohls
- Division Integrative Health Promotion; University of Applied Sciences and Arts Coburg; Germany
- Brain, Mind & Healing Program; Samueli Institute; Alexandria USA
| | - E. Evtouchenko
- Department of Anaesthesiology; University of Munich; Germany
| | - L. Lehmeyer
- Department of Anaesthesiology; University of Munich; Germany
| | - S. Kramer
- Department of Anaesthesiology; University of Munich; Germany
| | - P.M. Lang
- Department of Anaesthesiology; University of Munich; Germany
| | - M. Siebeck
- Department of General, Visceral, Transplantation, Vascular and Thoracic Surgery; Ludwig Maximilians University; Munich Germany
| | - T. Mussack
- Department of General, Visceral, Transplantation, Vascular and Thoracic Surgery; Ludwig Maximilians University; Munich Germany
| | - R. Hatz
- Department of General, Visceral, Transplantation, Vascular and Thoracic Surgery; Ludwig Maximilians University; Munich Germany
| | - B. Heindl
- Department of Anaesthesiology; University of Munich; Germany
| | - P. Conzen
- Department of Anaesthesiology; University of Munich; Germany
| | - M. Rehm
- Department of Anaesthesiology; University of Munich; Germany
| | - S. Czerner
- Department of Anaesthesiology; University of Munich; Germany
| | - B. Zwißler
- Department of Anaesthesiology; University of Munich; Germany
| | - D. Irnich
- Department of Anaesthesiology; University of Munich; Germany
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Siebeck M, Kindgen-Milles D. Super high-flux CVVHD using regional citrate anticoagulation: long-term stability of middle molecule clearance. Crit Care 2015. [PMCID: PMC4471236 DOI: 10.1186/cc14381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Jovanovic K, Siebeck M, Gropp R. The route to pathologies in chronic inflammatory diseases characterized by T helper type 2 immune cells. Clin Exp Immunol 2014; 178:201-11. [PMID: 24981014 DOI: 10.1111/cei.12409] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2014] [Indexed: 12/23/2022] Open
Abstract
T helper type 2 (Th2)-characterized inflammatory responses are highly dynamic processes initiated by epithelial cell damage resulting in remodelling of the tissue architecture to prevent further harm caused by a dysfunctional epithelial barrier or migrating parasites. This process is a temporal and spatial response which requires communication between immobile cells such as epithelial, endothelial, fibroblast and muscle cells and the highly mobile cells of the innate and adaptive immunity. It is further characterized by a high cellular plasticity that enables the cells to adapt to a specific inflammatory milieu. Incipiently, this milieu is shaped by cytokines released from epithelial cells, which stimulate Th2, innate lymphoid and invariant natural killer (NK) T cells to secrete Th2 cytokines and to activate dendritic cells which results in the further differentiation of Th2 cells. This milieu promotes wound-healing processes which are beneficial in parasitic infections or toxin exposure but account for increasingly dysfunctional vital organs, such as the lung in the case of asthma and the colon in ulcerative colitis. A better understanding of the dynamics underlying relapses and remissions might lead ultimately to improved therapeutics for chronic inflammatory diseases adapted to individual needs and to different phases of the inflammation.
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Affiliation(s)
- K Jovanovic
- Department of General-, Visceral-, Transplantation- and Thoracic Surgery, University Clinics of Munich, Munich, Germany
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Aenderl I, Gashaw T, Siebeck M, Mutschler W. Head injury--a neglected public health problem: a four-month prospective study at Jimma University Specialized Hospital, Ethiopia. Ethiop J Health Sci 2014; 24:27-34. [PMID: 24591796 PMCID: PMC3929925 DOI: 10.4314/ejhs.v24i1.4] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [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] [Indexed: 11/21/2022] Open
Abstract
Background Trauma, especially head trauma, is an expanding major public health problem and the leading cause of death of the young and productive part of the world's population. Research is mainly done in high-income countries where only a small proportion of the worldwide fatalities occur. The intention of this study was to analyze head injury in a setting where most patients in low- and middle-income countries receive treatment, a referral hospital with general but no neurosurgical service like Jimma University Specialized Hospital. The study aims to provide surgeons, hospital managers and health planners working in similar set-ups with baseline information for further investigation and prevention programs intending to reduce the burden of head injury. Methods All head injury patients presented to Jimma University Specialized Hospital between March and June 2010 were included in this prospective research. Epidemiological, clinical and management data were collected for the study. Results Out of 52 patients, 47 were males. The median age was 20.0 years (SD=13.3). Fights (n=20, 38.5%) and road traffic accidents (n=19, 36.5%) were the most common causes of head injury. Half of the patients sustained mild and 36.5% sustained severe head injury. The initial GCS had a significant correlation with the outcome. The mortality rate was 21.2%. Of all patients 76.9% were managed conservatively. Conclusion Prevention of road traffic accidents and improvement of conservative care were identified as major methods to reduce the burden of head injury in a set-up similar to Jimma. Further studies on head injury patients in low-income countries should be done.
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Affiliation(s)
- Isabel Aenderl
- Department of Surgery, Ludwig Maximilian University, Munich, Germany
| | - Teshager Gashaw
- Department of Surgery, College of Public Health and Medical Science, Jimma University, Ethiopia
| | - Matthias Siebeck
- Department of Surgery, Ludwig Maximilian University, Munich, Germany ; Center for International Health, Ludwig Maximilian University, Munich, Germany
| | - Wolf Mutschler
- Department of Surgery, Ludwig Maximilian University, Munich, Germany
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Mannert K, Dehning S, Krause D, Leitner B, Rieder G, Siebeck M, Tesfaye M, Abera M, Hailesilassie H, Tesfay K, Jobst A. Quality of life in Ethiopia's street youth at a rehabilitation center and the association with trauma. J Trauma Stress 2014; 27:593-601. [PMID: 25322888 DOI: 10.1002/jts.21953] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Quality of life (QOL) tends to be lower among the homeless than the general population, and traumatic events experienced on the streets have a negative impact on QOL. Low-income countries face a high number of street youth, yet little research has been performed so far on QOL, trauma, and posttraumatic stress disorder (PTSD) among this group. This study aimed at examining the QOL of a sample of Ethiopian street youth within a rehabilitation program and at exploring whether the street youth have experienced traumatic events and show posttraumatic stress symptoms. We interviewed 84 street youths with the World Health Organization Quality of Life Questionnaire (WHOQOL-BREF) and the Diagnostic Interview for Children and Adolescents (DICA). Mean QOL scores differed significantly between the groups assessed at the beginning and at the end of the program (Cohen's d = 0.48). Eighty-three percent of the Ethiopian street youths had experienced traumatic events, and 25.0% met criteria for PTSD according to the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders. QOL did not differ between those with and without PTSD symptoms. These findings show the high rate of traumatic events among Ethiopian street youth and the importance for rehabilitation programs that focus on improving QOL. The results of the study may have cultural limitations.
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Affiliation(s)
- Kerstin Mannert
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University, Munich, Germany
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Dehning S, Reiß E, Krause D, Gasperi S, Meyer S, Dargel S, Müller N, Siebeck M. Empathy in high-tech and high-touch medicine. Patient Educ Couns 2014; 95:259-264. [PMID: 24589130 DOI: 10.1016/j.pec.2014.01.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Revised: 01/08/2014] [Accepted: 01/18/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVE Surgeons and psychiatrists have been described as two contrary groups, the one healing by hands and the other by words. Empathy is needed in every physician-patient relationship. We tested whether (1) surgeons and psychiatrists show different levels of cognitive and emotional empathy; (2) measurements of cognitive and emotional empathy correlate with physician-specific empathy; and (3) gender, experience, and career choices are influencing factors. METHODS 56 surgeons and 50 psychiatrists participated. We measured empathy with the Jefferson Scale of Physician Empathy (JSPE), cognitive empathy with the Reading the Mind in the Eyes Test Revised (RME-R6), and emotional empathy with the Balanced Emotional Empathy Scale (BEES). RESULTS Male psychiatrists scored significantly higher than that of male surgeons (118.0±9.86 vs. 107.5±13.84; p=0.0006) in the JSPE. Analytically trained psychiatrists scored significantly higher in the JSPE than that of behaviorally trained psychiatrists (p=0.024, F test, adjusted for gender). Both the RME and the BEES correlated positively with the JSPE. CONCLUSION Higher scores for empathy were found in male psychiatrists than in male surgeons. PRACTICE IMPLICATIONS Further research is needed to learn about the effects of general medical training on empathy.
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Affiliation(s)
- Sandra Dehning
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University, Munich, Germany
| | - Eva Reiß
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University, Munich, Germany
| | - Daniela Krause
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University, Munich, Germany.
| | - Sarah Gasperi
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University, Munich, Germany
| | - Sebastian Meyer
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University, Munich, Germany
| | - Sascha Dargel
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University, Munich, Germany
| | - Norbert Müller
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University, Munich, Germany
| | - Matthias Siebeck
- Department of Surgery, Ludwig Maximilian University, Munich, Germany
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Jacobs F, Stegmann K, Siebeck M. Promoting medical competencies through international exchange programs: benefits on communication and effective doctor-patient relationships. BMC Med Educ 2014; 14:43. [PMID: 24589133 PMCID: PMC3945959 DOI: 10.1186/1472-6920-14-43] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Accepted: 02/25/2014] [Indexed: 06/03/2023]
Abstract
BACKGROUND Universities are increasingly organizing international exchange programs to meet the requirements of growing globalisation in the field of health care. Analyses based on the programs' fundamental theoretical background are needed to confirm the learning value for participants. This study investigated the extent of sociocultural learning in an exchange program and how sociocultural learning affects the acquisition of domain-specific competencies. METHODS Sociocultural learning theories were applied to study the learning effect for German medical students from the LMU Munich, Munich, Germany, of participation in the medical exchange program with Jimma University, Jimma, Ethiopia. First, we performed a qualitative study consisting of interviews with five of the first program participants. The results were used to develop a questionnaire for the subsequent, quantitative study, in which 29 program participants and 23 matched controls performed self-assessments of competencies as defined in the Tuning Project for Health Professionals. The two interrelated studies were combined to answer three different research questions. RESULTS The participants rated their competence significantly higher than the control group in the fields of doctor-patient relationships and communication in a medical context. Participant responses in the two interrelated studies supported the link between the findings and the suggested theoretical background. CONCLUSION Overall, we found that the exchange program affected the areas of doctor-patient relationships and effective communication in a medical context. Vygotsky's sociocultural learning theory contributed to explaining the learning mechanisms of the exchange program.
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Affiliation(s)
- Fabian Jacobs
- Center for International Health CIH, Department of Surgery, Faculty of Medicine, LMU Munich, Nussbaumstr. 20, 80336 Munich, Germany
| | - Karsten Stegmann
- Department of Psychology, LMU Munich, Leopoldstrasse 13, 80802 Munich, Germany
| | - Matthias Siebeck
- Center for International Health CIH, Department of Surgery, Faculty of Medicine, LMU Munich, Nussbaumstr. 20, 80336 Munich, Germany
- Department of Surgery, Faculty of Medicine, LMU Munich, Munich, Germany
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Aenderl I, Gashaw T, Siebeck M, Mutschler W. Head injury--a neglected public health problem: a four-month prospective study at Jimma University Specialized Hospital, Ethiopia. Ethiop J Health Sci 2014. [PMID: 24591796 DOI: 10.4314/ejhs.v24i1.4.pmid:24591796;pmcid:pmc3929925] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023] Open
Abstract
BACKGROUND Trauma, especially head trauma, is an expanding major public health problem and the leading cause of death of the young and productive part of the world's population. Research is mainly done in high-income countries where only a small proportion of the worldwide fatalities occur. The intention of this study was to analyze head injury in a setting where most patients in low- and middle-income countries receive treatment, a referral hospital with general but no neurosurgical service like Jimma University Specialized Hospital. The study aims to provide surgeons, hospital managers and health planners working in similar set-ups with baseline information for further investigation and prevention programs intending to reduce the burden of head injury. METHODS All head injury patients presented to Jimma University Specialized Hospital between March and June 2010 were included in this prospective research. Epidemiological, clinical and management data were collected for the study. RESULTS Out of 52 patients, 47 were males. The median age was 20.0 years (SD=13.3). Fights (n=20, 38.5%) and road traffic accidents (n=19, 36.5%) were the most common causes of head injury. Half of the patients sustained mild and 36.5% sustained severe head injury. The initial GCS had a significant correlation with the outcome. The mortality rate was 21.2%. Of all patients 76.9% were managed conservatively. CONCLUSION Prevention of road traffic accidents and improvement of conservative care were identified as major methods to reduce the burden of head injury in a set-up similar to Jimma. Further studies on head injury patients in low-income countries should be done.
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Affiliation(s)
- Isabel Aenderl
- Department of Surgery, Ludwig Maximilian University, Munich, Germany
| | - Teshager Gashaw
- Department of Surgery, College of Public Health and Medical Science, Jimma University, Ethiopia
| | - Matthias Siebeck
- Department of Surgery, Ludwig Maximilian University, Munich, Germany ; Center for International Health, Ludwig Maximilian University, Munich, Germany
| | - Wolf Mutschler
- Department of Surgery, Ludwig Maximilian University, Munich, Germany
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Paudel D, Shrestha IB, Siebeck M, Rehfuess EA. Neonatal health in Nepal: analysis of absolute and relative inequalities and impact of current efforts to reduce neonatal mortality. BMC Public Health 2013; 13:1239. [PMID: 24373558 PMCID: PMC3890515 DOI: 10.1186/1471-2458-13-1239] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [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: 03/21/2013] [Accepted: 12/26/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Nepal has made substantial progress in reducing under-five mortality and is on track to achieve Millennium Development Goal 4, but advances in neonatal health are less encouraging. The objectives of this study were to assess relative and absolute inequalities in neonatal mortality over time, and to review experience with major programs to promote neonatal health. METHODS Using four nationally representative surveys conducted in 1996, 2001, 2006 and 2011, we calculated neonatal mortality rates for Nepal and for population groups based on child sex, geographical and socio-economic variables using a true cohort log probability approach. Inequalities based on different variables and years were assessed using rate differences (rd) and rate ratios (rr); time trends in neonatal mortality were measured using the annual rate of reduction. Through literature searches and expert consultation, information on Nepalese policies and programs implemented since 1990 and directly or indirectly attempting to reduce neonatal mortality was compiled. Data on timeline, coverage and effectiveness were extracted for major programs. RESULTS The annual rate of reduction for neonatal mortality between 1996 and 2011 (2.8 percent per annum) greatly lags behind the achievements in under-five and infant mortality, and varies across population groups. For the year 2011, stark absolute and relative inequalities in neonatal mortality exist in relation to wealth status (rd = 21.4, rr = 2.2); these are less pronounced for other measures of socio-economic status, child sex and urban-rural residence, ecological and development region. Among many efforts to promote child and maternal health, three established programs and two pilot programs emerged as particularly relevant to reducing neonatal mortality. While these were designed based on national and international evidence, information about coverage of different population groups and effectiveness is limited. CONCLUSION Neonatal mortality varies greatly by socio-demographic variables. This study clearly shows that much remains to be achieved in terms of reducing neonatal mortality across different socio-economic, ethnic and geographical population groups in Nepal. In moving forward it will be important to scale up programs of proven effectiveness, conduct in-depth evaluation of promising new approaches, target unreached and hard-to-reach populations, and maximize use of financial and personnel resources through integration across programs.
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Affiliation(s)
- Deepak Paudel
- Center for International Health, Ludwig Maximilians University, Munich, Germany.
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Abstract
The medical curriculum (MeCuM) of the Ludwig Maximilian University (LMU) in Munich is a dynamic curriculum aimed to support the learning process of all students with their different learning styles. It is based on interactive, activating teaching methods in order to increase students' interest, and on repetitive evaluation of teaching units to modify the teaching in order to meet students' needs and wishes. In this context the teaching of surgery at our faculty takes place. Besides interdisciplinary lessons where diseases are taught in cooperation with our colleagues from internal medicine, indications for surgery, complications and consequences of surgery for the patients are analysed in PBL tutorials, online cases, bedside teachings and practical teaching on the ward. Surgical skills like suturing are demonstrated in videos, practiced on models or during practical teaching on the ward and they are tested in OSCEs. During the "praktisches Jahr", the students in the last year of their medical studies are supposed to apply their practical skills besides repeating theoretical knowledge in order to pass the final examination. For this purpose they are taught in a revision course called "LMU-StaR" (revision course for the Staatsexamen). In this paper we describe in detail the teaching of surgery at our faculty.
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Affiliation(s)
- C Chiapponi
- Klinik für Allgemeine, Viszeral-, Transplantations-, Gefäß- und Thoraxchirurgie, Ludwig-Maximilians-Universität, München, Deutschland
| | - C J Bruns
- Klinik für Allgemeine, Viszeral-, Transplantations-, Gefäß- und Thoraxchirurgie, Ludwig-Maximilians-Universität, München, Deutschland
| | - F Pilz
- Klinik für Allgemeine, Viszeral-, Transplantations-, Gefäß- und Thoraxchirurgie, Ludwig-Maximilians-Universität, München, Deutschland
| | - K-G Kanz
- Klinik für Allgemeine, Viszeral-, Transplantations-, Gefäß- und Thoraxchirurgie, Ludwig-Maximilians-Universität, München, Deutschland
| | - W Mutschler
- Klinik für Allgemeine, Viszeral-, Transplantations-, Gefäß- und Thoraxchirurgie, Ludwig-Maximilians-Universität, München, Deutschland
| | - K-W Jauch
- Klinik für Allgemeine, Viszeral-, Transplantations-, Gefäß- und Thoraxchirurgie, Ludwig-Maximilians-Universität, München, Deutschland
| | - M Siebeck
- Klinik für Allgemeine, Viszeral-, Transplantations-, Gefäß- und Thoraxchirurgie, Ludwig-Maximilians-Universität, München, Deutschland
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Dehning S, Gasperi S, Tesfaye M, Girma E, Meyer S, Krahl W, Riedel M, Möller HJ, Müller N, Siebeck M. Empathy without borders? Cross-cultural heart and mind-reading in first-year medical students. Ethiop J Health Sci 2013; 23:113-22. [PMID: 23950627 PMCID: PMC3742888] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND This cross-cultural study was designed to examine cultural differences in empathy levels of first-year medical students. METHODS A total of 257 students from the academic year 2010/11, 131 at Jimma University, Ethiopia, and 126 at the Ludwig Maximilian University, Munich, Germany, completed the Balanced Emotional Empathy Scale (BEES), the Reading the Mind in the Eyes (RME-R) test, and a questionnaire on sociodemographic and cultural characteristics. Furthermore, we conducted a qualitative analysis of the students' personal views on the definition of empathy and possible influencing factors. Group comparisons and correlation analyses of empathy scores were performed for the entire cohort and for the Jimma and Munich students separately. We used a regression tree analysis to identify factors influencing the BEES. RESULTS The male students in Jimma (39.1 ± 22.3) scored significantly higher in the BEES than those male students from Munich (27.2 ± 22.6; p = 0.0002). There was no significant difference between the female groups. We found a moderate, positive correlation between the BEES and RME-R test, i.e. between emotional and cognitive empathy, within each university. Nevertheless, the RME-R test, which shows only Caucasian eyes, appears not to be suitable for use in other cultures. CONCLUSIONS The main findings of our study were the influence of culture, religion, specialization choice, and gender on emotional empathy (assessed with the BEES) and cognitive empathy (assessed with the RME-R test) in first-year medical students. Further research is required into the nature of empathy in worldwide medical curricula.
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Affiliation(s)
- Sandra Dehning
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University, Munich, Germany
| | - Sarah Gasperi
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University, Munich, Germany
| | - Markos Tesfaye
- Department of Health Education and Behavioural Sciences, Jimma University, Ethiopia
| | - Eshetu Girma
- Department of Surgery, Hospital of Ludwig Maximilian University, Munich, Germany
| | - Sebastian Meyer
- Department of Forensic Psychiatry, Isar Amber Hospital, Munich, Germany
| | - Wolfgang Krahl
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University, Munich, Germany
| | - Michael Riedel
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University, Munich, Germany
| | - Hans-Jürgen Möller
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University, Munich, Germany
| | - Norbert Müller
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University, Munich, Germany
| | - Matthias Siebeck
- Department of Forensic Psychiatry, Isar Amber Hospital, Munich, Germany
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Nolte T, Zadeh-Khorasani M, Safarov O, Rueff F, Gülberg V, Herbach N, Wollenberg A, Mueller T, Siebeck M, Wolf E, Gropp R. Oxazolone and ethanol induce colitis in non-obese diabetic-severe combined immunodeficiency interleukin-2Rγ(null) mice engrafted with human peripheral blood mononuclear cells. Clin Exp Immunol 2013; 172:349-62. [PMID: 23574330 DOI: 10.1111/cei.12057] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2012] [Indexed: 12/14/2022] Open
Abstract
Oxazolone-induced colitis in mice has become a recognized model to study the efficacy of therapeutics targeting the immunological response underlying the development of inflammatory bowel disease. However, this model cannot be used when therapeutics designed to address human targets do not interact with the respective murine counterpart. In this study, we examined the induction of oxazolone mediated colitis in non-obese diabetic-severe combined immunodeficiency interleukin-2Rγ(null) (NOD-SCID IL2Rγ(null)) mice engrafted with human peripheral blood mononuclear cells (hPBMC) derived from patients suffering from ulcerative colitis (UC), atopic dermatitis (AD) and healthy volunteers. NOD-SCID IL2Rγ (null) mice were engrafted with hPBMC followed by challenge with oxazolone or ethanol vehicle. Mice developed the same symptoms as observed previously in immunocompetent mice. The clinical activity score increased and the colon architecture was characterized by the development of oedema, fibrosis, crypt loss and dense infiltration of predominantly T cells into the lamina propria. Fluorescence activated cell sorter (FACS) analysis of lymphocytes in the colon identified natural killer (NK) T cells as a major constituent. In contrast to studies with immunocompetent mice, we observed the same phenotype in the group challenged with ethanol vehicle. The phenotype was most pronounced in mice engrafted with PBMC derived from a patient suffering from UC, suggesting that the immunological history of the donors predisposes the engrafted mice to react to ethanol. The model described here has the potential to study the efficacy of therapeutics targeting human lymphocytes in a model which is more reflective of the human disease. In addition, it might be developed to elucidate molecular mechanisms underlying the disease.
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Affiliation(s)
- T Nolte
- Institute of Molecular Animal Breeding and Biotechnology, Laboratory for Functional Genome Analysis, Gene Center, LMU Munich, Germany
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Zadeh-Khorasani M, Nolte T, Mueller TD, Pechlivanis M, Rueff F, Wollenberg A, Fricker G, Wolf E, Siebeck M, Gropp R. NOD-scid IL2R γnull mice engrafted with human peripheral blood mononuclear cells as a model to test therapeutics targeting human signaling pathways. J Transl Med 2013; 11:4. [PMID: 23294516 PMCID: PMC3558457 DOI: 10.1186/1479-5876-11-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [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: 10/19/2012] [Accepted: 12/25/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Animal models of human inflammatory diseases have limited predictive quality for human clinical trials for various reasons including species specific activation mechanisms and the immunological background of the animals which markedly differs from the genetically heterogeneous and often aged patient population. OBJECTIVE Development of an animal model allowing for testing therapeutics targeting pathways involved in the development of Atopic Dermatitis (AD) with better translatability to the patient. METHODS NOD-scid IL2R γnull mice engrafted with human peripheral blood mononuclear cells (hPBMC) derived from patients suffering from AD and healthy volunteers were treated with IL-4 and the antagonistic IL-4 variant R121/Y124D (Pitrakinra). Levels of human (h)IgE, amount of B-, T- and plasma- cells and ratio of CD4 : CD8 positive cells served as read out for induction and inhibition of cell proliferation and hIgE secretion. Results were compared to in vitro analysis. RESULTS hIgE secretion was induced by IL-4 and inhibited by the IL-4 antagonist Pitrakinra in vivo when formulated with methylcellulose. B-cells proliferated in response to IL-4 in vivo; the effect was abrogated by Pitrakinra. IL-4 shifted CD4 : CD8 ratios in vitro and in vivo when hPBMC derived from healthy volunteers were used. Pitrakinra reversed the effect. Human PBMC derived from patients with AD remained inert and engrafted mice reflected the individual responses observed in vitro. CONCLUSION NOD-scid IL2R γnull mice engrafted with human PBMC reflect the immunological history of the donors and provide a complementary tool to in vitro studies. Thus, studies in this model might provide data with better translatability from bench to bedside.
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Affiliation(s)
- Maryam Zadeh-Khorasani
- Department of Surgery, Klinikum der Ludwig-Maximilians Universität München, Munich, Germany
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