Successful long-term systemic sclerosis treatment by high-frequent low-dose B cell-depleting therapy.

OBJECTIVES: Systemic sclerosis (SSc) is a multiorgan disease with a 10-year mortality rate of up to 50 %. B cell-depleting therapy with rituximab (RTX) appears effective in SSc treatment, but data from randomized controlled trials (RCTs) are lacking, and the frequency and dosage of RTX in SSc have no consensus. We aimed to evaluate the long-term efficacy and safety of quarterly RTX administration in SSc. METHODS: This study retrospectively analyzed 40 patients with SSC treated with RTX twice within 14 days every 3 months from 2010 to 2020. The patients fulfilled the LeRoy and the American College of Rheumatology/European League Against Rheumatism Criteria for SSc. Modified Rodnan skin score (mRSS), lung function test results, and serum immunoglobulin (IgG, IgA, and IgM) concentrations were analyzed. RESULTS: A total of 40 patients with SSc received RTX over a median time of 3.9 years (range: 1-10 years). The median mRSS (baseline: 19, 24 months: 16, p < 0.001) demonstrated a significant improvement, and the predicted forced vital capacity was stable. No new or unexpected safety signals, especially regarding treatment-related infectious adverse events, were observed. Immunoglobulin concentrations were within normal range, and specific antibodies to pneumococcal polysaccharides were preserved despite long-term B cell-depleting therapy. None of the patients died during the observation period of up to 10 years. CONCLUSION: SSc was effectively and safely treated with low-dose RTX quarterly. RCTs are warranted to validate the advantage of continuous B cell depletion by quarterly low-dose RTX administration compared to other treatment intervals.

[Value of CT and transthoracic lung ultrasound in patients with systemic sclerosis : Joint statement of the ÖRG/ÖGP/ÖGR/ÖGUM]. / Wertigkeit der CT und des transthorakalen Lungenultraschalls bei PatientInnen mit systemischer Sklerose : Gemeinsame Stellungnahme der ÖRG/ÖGP/ÖGR/ÖGUM.

Lung involvement is the most frequent cause of death in patients with systemic sclerosis (SSc). As lung involvement is frequently asymptomatic, the current recommendation is to carry out thoracic computed tomography (CT) in all patients newly diagnosed with SSc. There is currently disagreement on how patients with SSc for whom no lung involvement was found at the time of diagnosis, should be followed up. Based on a consensus of Austrian rheumatologists, pneumologists and radiologists it is recommended that for asymptomatic patients with a negative CT at the time of initial diagnosis, a transthoracic ultrasound examination should be carried out annually and a lung function examination every 6-12 months. In the presence of a positive lung ultrasound finding a supplementary CT for further clarification is recommended. Based on the data situation, annual CT follow-up controls are recommended for patients with a high risk as defined by appropriate risk factors.

[Management of Adult Community-Acquired Pneumonia and Prevention - Update 2021 - Guideline of the German Respiratory Society (DGP), the Paul-Ehrlich-Society for Chemotherapy (PEG), the German Society for Infectious Diseases (DGI), the German Society of Medical Intensive Care and Emergency Medicine (DGIIN), the German Viological Society (DGV), the Competence Network CAPNETZ, the German College of General Practitioneers and Family Physicians (DEGAM), the German Society for Geriatric Medicine (DGG), the German Palliative Society (DGP), the Austrian Society of Pneumology Society (ÖGP), the Austrian Society for Infectious and Tropical Diseases (ÖGIT), the Swiss Respiratory Society (SGP) and the Swiss Society for Infectious Diseases Society (SSI)]. / Behandlung von erwachsenen Patienten mit ambulant erworbener Pneumonie ­ Update 2021.

The present guideline provides a new and updated concept of the management of adult patients with community-acquired pneumonia. It replaces the previous guideline dating from 2016.The guideline was worked out and agreed on following the standards of methodology of a S3-guideline. This includes a systematic literature search and grading, a structured discussion of recommendations supported by the literature as well as the declaration and assessment of potential conflicts of interests.The guideline has a focus on specific clinical circumstances, an update on severity assessment, and includes recommendations for an individualized selection of antimicrobial treatment.The recommendations aim at the same time at a structured assessment of risk for adverse outcome as well as an early determination of treatment goals in order to reduce mortality in patients with curative treatment goal and to provide palliation for patients with treatment restrictions.

[Management of Adult Community-acquired Pneumonia and Prevention - Update 2016]. / Behandlung von erwachsenen Patienten mit ambulant erworbener Pneumonie und Prävention - Update 2016.

The present guideline provides a new and updated concept of treatment and prevention of adult patients with community-acquired pneumonia. It replaces the previous guideline dating from 2009.The guideline was worked out and agreed on following the standards of methodology of a S3-guideline. This includes a systematic literature search and grading, a structured discussion of recommendations supported by the literature as well as the declaration and assessment of potential conflicts of interests.The guideline has a focus on specific clinical circumstances, an update on severity assessment, and includes recommendations for an individualized selection of antimicrobial treatment as well as primary and secondary prevention.

Comparison of clinical presentation and laboratory values at admission between PCR-confirmed influenza A H1N1 infection and influenza-like disease, South-East Austria.

PURPOSE: Reliable and rapid diagnosis of influenza A H1N1 is essential to initiate the appropriate antiviral therapy and preventive measures. As PCR assays are time-consuming and rapid antigen tests have a limited sensitivity, official influenza case definitions are used in many clinical settings. These, however, are based exclusively on clinical criteria and have only a moderate potential to differentiate between influenza and other febrile diseases. Only limited data on the differences in clinical and laboratory parameters between influenza and non-influenza febrile diseases are available to date. METHODS: This was a retrospective case-negative control series that was conducted in Styria, southeast Austria. We analyzed the differences in clinical presentation and laboratory admission parameters between patients with PCR-confirmed H1N1 influenza infection (n = 199) and those with influenza-like disease and negative influenza PCR results (ILD group; n = 252). RESULTS: In the multivariable analysis lower C-reactive protein (CRP) level, lower white blood cell (WBC) count, fever, wheezing, cough, and the absence of nausea or sudden onset remained significant predictors of H1N1 influenza in adult patients (n = 263). Lower CRP level, lower WBC count, and cough remained significant predictors in pediatric patients (<16 years; n = 188). CONCLUSION: Lower CRP level, lower WBC count, and cough were significant predictors of H1N1 in both the adult and pediatric patient group. These data may help to develop an improved case definition for suspected H1N1 infection which combines clinical findings and easily available laboratory parameters.

[Rare viral infections of the lungs]. / Seltene virale Infektionen der Lunge.

Due to the direct contact with the environment the lungs are exposed to a multitude of viruses. This article describes four viral pathogens, which can lead to pulmonary manifestations but are little known because they are rare in Germany. Avian influenza, Middle East respiratory syndrome (MERS), and Hantavirus infections are all zoonotic infections, whereas measles is a purely human disease. All four infections may lead to severe pulmonary complications with a high mortality. Measles, MERS and avian influenza can lead to far-reaching public health consequences due to transmission via individual patients within the human population. The article focusses on relevant aspects of epidemiology, clinical course, treatment, and prevention for each of the viruses. This knowledge seems to be important as cases of these diseases may occur at any time in Germany.

[Rare parasitic infections of the lung]. / Seltene parasitäre Infektionen der Lunge.

Pulmonary parasitic infections occur worldwide; however, in Germany, these infections are rarely considered as the primary diagnosis due to their infrequent incidence. Parasitic infections of the lungs can present with a variety of pulmonary manifestations. Therefore, these infections should be considered relevant in cases of unclear diagnostic findings or failure to respond to treatment in order to identify these potentially curable diseases as soon as possible.

[Statement of the Austrian Society of Pneumology (ASP)]. / Stellungnahme der Österreichischen Gesellschaft für Pneumologie (ÖGP): Management von Patienten mit SARS-CoV-2-Infektionen und von Patienten mit chronischen Lungenerkrankungen während der COVID-19-Pandemie (Stand 27.04.2020).

The COVID-19 pandemic is currently a challenge worldwide. In Austria, a crisis within the health care system has so far been avoided. The treatment of patients with community-acquired pneumonia (CAP), including SARS-CoV­2 infections, should continue to be based on evidence-based CAP guidelines during the pandemic. However, COVID-19-specific adjustments are useful. The treatment of patients with chronic lung diseases must be adapted during the pandemic, but must still be guaranteed.

Smoking artifacts: factors of source evaluation.

Responses from 323 students in communication indicated that credibility factors associated with nonverbal smoking artifacts are not the same as those associated with verbal stimuli; a character factor was absent for nonverbal stimuli. Verbosity, however, may permit inferences regarding potential verbal behavior.

Predictors of H1N1 influenza in the emergency department: proposition for a modified H1N1 case definition.

Reliable and rapid diagnosis of influenza A H1N1 is essential to initiate appropriate antiviral therapy and preventive measures. We analysed the differences in clinical presentation and laboratory parameters between emergency department patients with PCR-confirmed H1N1 influenza infection (n = 199) and those with PCR-negative influenza-like illness (ILI; n = 252). Cough, wheezing, leucopenia, eosinopenia and a lower C-reactive protein remained significant predictors of H1N1 influenza. Proposed combinations of clinical symptoms with simple laboratory parameters (e.g. reported or measured fever and either cough or leucocytes <8.5 × 10(9) /L) were clearly superior to currently used official ILI case definitions that use clinical criteria alone.

[Myopexia posterior with tissue adhesive (author's transl)]. / Myopexia posterior mit Gewebekleber; Fadenoperation nach Cüppers ohne Faden.

Myopexia posterior with tissue adhesive has many advantages over the classic procedure employed in the Cüppers "Fadenoperation". The technique presents few complications, is simple, time-saving and causes no trauma. After experiments on animals, we have now successfully employed this technique on human ocular muscles.

[Occlusion contact lenses (author's transl)]. / Okklusionskontaktlinsen.

A reliable inconspicuous occlusion therapy is achieved by fitting different, specially manufactured contact lenses. Based on a study of a number of cases, the author discusses the indications for a occlusion contact lens. These lenses provide a means for treating amblyopia in schoolchildren and adults, as well as for eliminating diplopia, photophobia and metamorphopsia.

[Unilateral myopia in children (author's transl)]. / Einseitige Myopie beim Kind.

In cases of high unilateral myopia good prognosis for monocular visual acuity as well as binocular vision is expected if timely and cosistent therapy is administered. Therapy comprises full optical correction, amblyopia therapy, mostly occlusion, squint therapy and possibly fitting of contact lenses. The author presents 31 cases of unilateral high myopic children up to age 12 with anisometropia between 4 and 19 dioptres. Although the aniseikonia in cases of high unilateral myopia increases with contact lenses as compared to spectacles for geometric optical reasons, we obtained good results with contact lens correction. Examination show that the child's brain adapts very well to the aniseikonia. Complicate correction with aniseikonic lenses is thus neither necessary nor advantageous.

[Unilateral aphakia in childhood (author's transl)]. / Die einseitige Aphakie im Kindesalter

The monocular and binocular vision will always be disturbed after unilateral cataract extraction in childhood. The treatment therefore not only means operation, but also correction of the optic error, pleoptics and orthoptics. In 40 cases of unilateral aphakia (12 congenital, 28 traumatical) the prognosis depends on the age of the individual and maintenance of treatment. The older the child and the sooner therapy is started the better are the functional results.

[Synthetic, absorbable suture in eye-muscle surgery (author's transl)]. / Synthetisches, resorbierbares Nahtmaterial in der Augenmuskelchirurgie.

A synthetic, absorbable suture (Vicryl), was investigated for its usability in eye-muscle surgery. In experimental investigations on animals and strabismus surgery in humans, properties of the suture were compared with those of plain catgut. Histological investigations after modified strabismus surgery on rabbits clearly showed a smaller degree of tissue reaction around the hydrolytically dissolvable synthetic suture than around plain catgut. After implantation of Vicryl or catgut into the anterior chamber of rabbit eyes, within the first eight days both cause infective reactions which were somewhat stronger with Vicryl, which caused more scarring over the iris, than with catgut. One-hundred and eighty strabismus operations on man showed that the synthetic suture handles better and rips less markedly than plain catgut, whereas duration and amount of postoperative irritations are similar. Overreactions and granuloma were rare.

[Infiltrating retinoblastoma - a difficult differential diagnosis (author's transl)]. / Das infiltrativ wachsende Retinoblastom - eine schwierige Differentialdiagnose.

The diffuse infiltrative retinoblastoma closely resembles uveitis, because of a pseudohypopyon and vitreous infiltration. Since late diagnosis endangers the lives of the children affected, the authors describe two cases of this rare and unusual clinical picture.