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- Bennet, Louise, et al.
(author)
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Clinical appearance of erythema migrans caused by Borrelia afzelii and Borrelia garinii : effect of the patient´s sex
- 2006
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In: Wiener Klinische Wochenschrift. - : SPRINGER WIEN. - 0043-5325 .- 1613-7671. ; 118:17-18, s. 531-537
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Journal article (peer-reviewed)abstract
- Aim: The aim in this survey was to study the clinical characteristics of infections caused by Borrelia genospecies in patients with erythema migrans where Borrelial origin was confirmed by polymerase chain reaction. The aim was also to study factors influencing the clinical appearance of erythema migrans. Methods: The study was conducted in southern Sweden from May 2001 to December 2003 on patients 18 years and older attending with erythema migrans at outpatient clinics. All erythema migrans were verified by polymerase chain reaction, photographed and categorized into “annular” or “non-annular” lesions. A logistic regression model was used to analyze relations between the appearance of the erythema migrans (i.e., annular or non-annular) and factors that influenced its clinical appearances. Results: A total of 118 patients, 54 women (45.8%) and 64 men (54.2%), fulfilled the inclusion criteria. Of these patients, 74% were infected by B. afzelii, 26% by B. garinii ( p < 0.001). A total of 45% (38/85) of the erythema migrans were annular, 46% (39/85) were non-annular and 9.4% (8/85) were atypical. For men infected by B. afzelii the odds ratio of developing non-annular erythema migrans was 0.09 (95% CI: 0.03 - 0.33) in comparison with women with the same infection. Conclusions: In this prospective study of a large series of erythema migrans, where infecting genospecies were confirmed by polymerase chain reaction, the sex of patients infected with B. afzelii had a strong influence on the appearance of the rash. Patients infected by B. garinii more often had non-annular erythema migrans and a more virulent infection with more individuals presenting with fever, raised levels of C-reactive protein and seroreactivity in the convalescence sera.
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- Bergström, Sven, et al.
(author)
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Microbiological features distinguishing Lyme disease and relapsing fever spirochetes
- 2018
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In: Wiener Klinische Wochenschrift. - : Springer. - 0043-5325 .- 1613-7671. ; 130:15-16, s. 484-490
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Journal article (peer-reviewed)abstract
- The recent proposal of splitting the genus Borrelia into two genera in the newly formed family of Borreliaceae, i.aEuroe. Borrelia and Borreliella has motivated us to reflect upon how these organisms has been characterized and differentiated. This article therefore aims to take a closer look on the biology and virulence attributes of the two suggested genera, i.aEuroe. those causing Lyme borreliosis and relapsing fever borreliosis. Both genera have much in common with similar infection biological features. They are both characterized as bacterial zoonoses, transmitted by hematophagous arthropods with almost identical microbiological appearance. Nevertheless, a closer look at the genotypic and phenotypic characteristics clearly reveals several differences that might motivate the suggested split. On the other hand, a change of this well-established classification within the genus Borrelia might impose an economical burden as well as a great confusion in society, including medical and scientific societies as well as the general population.
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- Borena, Wegene, et al.
(author)
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Long-term temporal trends in cardiovascular and metabolic risk factors
- 2009
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In: Wiener Klinische Wochenschrift. - : Springer Science and Business Media LLC. - 0043-5325 .- 1613-7671. ; 121:19-20, s. 623-630
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Journal article (peer-reviewed)abstract
- OBJECTIVES: Metabolic factors such as obesity, hypertension, dyslipidemia and hyperglycemia have consistently been associated with increased risk of cardiovascular disease. There is also growing evidence that these factors are linked to cancer incidence and mortality. The aim of this study was to investigate long-term trends in major metabolic risk factors in three large cohorts. MATERIALS AND METHODS: Data from 239,602 individuals aged 25-64 years participating in health examinations between 1976 and 2005 were used to estimate prevalence and trends in five risk factors. RESULTS: Irrespective of geographic location, individual metabolic risk factors showed divergent trends across the observation period. Whereas obesity and hyperglycemia in men increased by a per decade ratio of 1.54 (95% CI: 1.42-1.66) and 1.62 (95% CI: 1.49-1.76), respectively, and in women by 1.48 (95% CI: 1.41-1.56) and 1.66 (95% CI: 1.57-1.75), hypertension decreased by 0.71 (95% CI: 0.68-0.74) in men and 0.83 (95% CI: 0.79-0.86) in women. Dyslipidemia increased from the 1970s to the 1980s but declined in the succeeding decade. A combination of three or more of these risk factors increased significantly in men by a ratio of 1.15 (95% CI: 1.08-1.22) per decade and in women by 1.20 (95% CI: 1.15-1.27). CONCLUSION: The study shows that individual metabolic risk factors followed divergent trends over the period of three decades even though the combination of three or more risk factors used as a proxy for the metabolic syndrome appeared to be stable over the last two of the decades. The two key components of the syndrome, namely BMI and glucose levels, increased significantly and deserve professional attention.
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- Harreiter, Jürgen, et al.
(author)
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Behandlung von früh diagnostiziertem Gestationsdiabetes mellitus vor der 20. Schwangerschaftswoche : [Treatment of early diagnosed Gestational Diabetes mellitus before the 20th Week of Pregnancy]
- 2023
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In: Wiener Klinische Wochenschrift. - : Springer. - 0043-5325 .- 1613-7671. ; 135:Suppl. 7, s. S762-S762
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Journal article (other academic/artistic)abstract
- Einleitung: Bei Diagnose eines Gestationsdiabetes (GDM) vor der 20.Schwangerschaftswoche (SSW) wird leitliniengemäß eine Therapie begonnen. Für diese Praxis liegt keine Evidenz vor, die eine Verbesserung der Gesundheit von Mutter oder Nachkommen bei GDM-Behandlung in der frühen Schwangerschaft belegt.Methoden: Frauen mit einem Risikofaktor für GDM wurden zwischen 4.−20.SSW bei Vorliegen einer GDM Diagnose nach WHO 2013 Kriterien randomisiert einer Behandlungsgruppe oder einer Kontrollgruppe zugeordnet. Die Behandlungs-gruppe erhielt sofortige GDM Behandlung, während die Kontrollgruppe je nach Ergebnissen eines erneuten oralen Glukosetoleranztests (OGTT) in der 24.−28.SSW eine verschobene oder keine Behandlung erhielt. Die Studie hatte drei primäre Endpunkte: eine Kombination ungünstiger neonataler Ereignisse (Geburt <37.SSW, Geburtstrauma, Geburtsgewicht ≥4500 g, RDS, Phototherapie, Totgeburt/neonataler Tod oder Schulterdystokie), schwangerschaftsbedingte Hypertonieerkrankungen (Präeklampsie, Eklampsie, gestationsbedingter Bluthochdruck) und neonatale fettfreie Körpermasse.Ergebnisse: Insgesamt wurden 802 Frauen randomisiert (406 Sofortbehandlung, 396 Kontrollgruppe). Die Erstvisite fand durchschnittlich in der 15,6 ± 2,5 SSW statt. Der neonatale Kombinationsendpunkt trat bei 94/378 Frauen (24,9 %) bei sofortiger Behandlung und bei 113/370 Frauen (30,5 %) in der Kontrollgruppe auf (adj. Risikounterschied −5,6 %;95 % KI,–10,1;−1,2, RR 0,82;0,68-0,98). Schwangerschaftsbedingter Bluthochdruck trat bei 40/378 Frauen (10,6 %) bei sofortiger Behandlung und bei 37/372 Frauen (9,9 %) in der Kontrollgruppe auf (0,7 %,95 % KI,–1,6;2,9, RR 1.08;0.85–1.38). Die fettfreie Körpermasse der Neugeborenen betrug 2,86 kg bei sofortiger Behandlung und 2,91 kg in der Kontrollgruppe (−0,04 kg; 95 % KI,–0,09;0,02). Untergruppenanalysen zeigten eine stärkere Wirkung der Intervention auf neonatale Ergebnisse bei Frauen mit höheren Blutzuckerwerten und bei OGTT Durchführung vor der 14.SSW.Schlussfolgerung: Die sofortige Behandlung von Gestationsdiabetes vor der 20.SSW führte zu einer geringeren Häufigkeit ungünstiger neonataler Ergebnisse im Vergleich zu späterem Behandlungsbeginn.
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- Naidoo, Poobalan, et al.
(author)
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Real-world evidence and product development : Opportunities, challenges and risk mitigation
- 2021
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In: Wiener Klinische Wochenschrift. - : Springer. - 0043-5325 .- 1613-7671. ; 133:15-16, s. 840-846
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Research review (peer-reviewed)abstract
- Real-world evidence (RWE) is derived from real-world data (RWD) sources including electronic health records, claims data, registries (disease, product) and pragmatic clinical trials. The importance of RWE derived from RWD has been once again demonstrated during the coronavirus disease 2019 (COVID-19) pandemic, as it can improve patient care by complementing information obtained from traditional clinical trial programs. Additionally, RWE can generate insights into disease mechanisms, epidemiology, patient flows in and out of healthcare systems, and drivers and barriers to optimal clinical care in real-world settings. Identifying unmet medical needs is crucial as it often can inform which investigational new drugs enter clinical trial testing, and RWE studies from hospital settings have contributed substantial progress here. RWE can also optimize the design of clinical studies, inform benefit risk assessments and use networks of pragmatic studies to help with clinical trial feasibilities and eventual trial initiation. The challenges of RWD include data quality, reproducibility and accuracy which may affect validity. RWD and RWE must be fit for purpose and one must be cognizant of inherent biases.
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- Protic, Alen, et al.
(author)
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Effect of preoperative feeding on gastric emptying following spinal anesthesia: a randomized controlled trial
- 2010
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In: WIENER KLINISCHE WOCHENSCHRIFT. - : Springer Science and Business Media LLC. - 0043-5325 .- 1613-7671. ; 122:1-2, s. 50-53
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Journal article (peer-reviewed)abstract
- BACKGROUND: Preoperative fasting is associated with various untoward postoperative health problems. Previous studies have stressed the advantages of preoperative feeding with a carbohydrate-rich drink 2 hours before surgery; this protocol does not increase the risk of gastric-content aspiration but reduces the level of anxiety and thirstiness during the perioperative period. Spinal anesthesia with the local anesthetic bupivacaine can decrease gastric emptying in the early postoperative period. However, the effect of spinal anesthesia on the gastric emptying rate following preoperative feeding is unknown. The aim of this study was to determine the impact of preoperative feeding with a clear carbohydrate-rich drink on gastric emptying early after orthopedic surgery under spinal anesthesia. METHODS: A total of 110 patients scheduled for semi-elective orthopedic surgery under spinal anesthesia were included in a randomized controlled trial. Patients were randomly assigned to two groups: group 1 (56 patients) received a standardized 200 ml of clear carbohydrate-enriched drink orally 2 hours before surgery; group 2 (54 patients) acted as a control group with no preoperative feeding. Gastric emptying was evaluated with a paracetamol test at five time points: 15 min, 30 min, 60 min, 90 min and 120 min after administration of paracetamol. RESULTS: No significant differences were observed between the two groups in paracetamol plasma concentrations or area under the curve during the early postoperative period. CONCLUSION: In patients undergoing spinal anesthesia, preoperative feeding 2 hours before surgery had no influence on the gastric emptying rate, indicating that preoperative feeding does not increase the risk of gastric-content aspiration and can be given safely.
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