Torque Teno Virus plasma level as novel biomarker of retained immunocompetence in HIV-infected patients.

PURPOSE: To predict the course of immune recovery (IR) in HIV-1-infected patients after initiation of combined antiretroviral therapy (cART) by determination of the plasma concentration of Torque Teno Virus (TTV). TTV has been identified as marker for risk assessment in immunosuppressed patients after transplantation procedures. Here, TTV was analyzed in HIV-1-infected therapy-naïve patients to evaluate its use as predictor of the course of IR for guidance of individualized treatment. METHODS: TTV DNA was quantified in plasma samples of 301 therapy-naïve HIV-1-infected patients and correlated to CD4+ cell count, HIV viral load, presence of the herpes viruses CMV, EBV and HHV-8, age and sex. Patients were classified according to their initial CD4+ cell count and to the extent of CD4+ T-cell increase within the first year of cART. RESULTS: TTV DNA was detectable in 96% of the patients' plasma samples with a median TTV plasma concentration of 5.37 log10 cop/ml. The baseline CD4+ cell count was negatively correlated with TTV plasma concentration (p = 0.003). In patients with a CD4+ cell recovery < 50 cells/µl, the median TTV plasma concentration was significantly higher compared to patients with a CD4+ cell recovery of > 200 CD4+ cells/µl (5.68 log10 cop/ml versus 4.99 log10 cop/ml; p = 0.011). TTV plasma concentration in combination with baseline CD4+ cell count were significantly correlated to CD4+ cell recovery (p = 0.004). For all other parameters considered, no significant correlation for CD4+ cell recovery was found. CONCLUSION: Within the cohort, the significantly elevated TTV plasma concentration in patients with diminished CD4+ cell recovery indicates a more profound immune defect. Baseline TTV plasma concentrations and CD4+ cell count are predictive for the course of immune recovery in HIV-1-infected patients with severe immunodeficiency.

[Oro- and Nasopharyngeal Swab for Detection of SARS-CoV-2 - Step-by-step Approach]. / Oro- und nasopharyngealer Abstrich ­ Schritt für Schritt.

Oro- and nasopharyngeal swab specimens by quantitative reverse-transcriptase polymerase chain reaction (RT-PCR) to detect SARS-CoV-2 is currently the main diagnostic tool during the ongoing COVID-19 pandemia. Accurate performance of the procedure to avoid false negative results, adequate personal protective equipment and material sparing algorithms are mandatory while obtaining swab specimens. In the current stey-by-step review a feasible approach will be presented.

[The clinical spectrum of urea cycle defects in adult patients]. / Das klinische Spektrum von Harnstoffzyklusdefekten im Erwachsenenalter.

Urea cycle defects belong to the most common metabolic disorders with a cumulative incidence of 1:8000. A common trait of urea cycle defects is a disturbed detoxification of ammonia leading to hyperammonemia in the event of a high nitrogen load. Most patients develop symptoms in the neonatal period or in infancy, e. g. vomiting, seizures and disturbed consciousness. Depending on the affected enzyme and its residual activity, patients differ in the age at first presentation, the character and severity of symptoms and in the susceptibility to metabolic derangement. The presence of hyperammonemia and an altered plasma amino acid profile give the essential diagnostic clues. Since modern therapeutic measures have prolonged the life expectancy of these patients and provided the possibility of a first presentation in adulthood, patients with urea cycle defects have become an increasing challenge in internal medicine. The reported case series illustrates the heterogeneous clinical course of these disorders from childhood to adulthood.

[Optimization of microbial diagnostics by introduction of a blood culture standard operating procedure in the emergency department]. / Optimierung der mikrobiellen Diagnostik durch Einführung einer Standard Operating Procedure "Blutkulturen" in der zentralen Notaufnahme.

INTRODUCTION: The emergency department (ED) is the main port of entry for patients with infectious diseases, the place where a number of diagnostic procedures are performed and treatment is often initiated. The aim of this retrospective study was to estimate the influence of the establishment and introduction of a blood culture standard operating procedure (BC-SOP) and of the subsequent training of microbial diagnostics in an ED. METHODS: In a before and after study over a study period of 3 months each (November 2017-January 2018 and November 2018-January 2019), the number of blood cultures taken, the rate of blood cultures per 1000 patients, the number of positive blood cultures and the frequency of typical skin pathogens were evaluated. In the interim time between the two study periods, a BC-SOP was developed in collaboration with the hospital's antibiotic stewardship team and subsequently introduced with staff training in the ED. The study was approved by the local ethics committee of the medical faculty of the Heinrich Heine University (2019-392-RetroDEuA). RESULTS: In total 92% of the nursing personnel and 93% of the medical personnel received training. The total number of blood cultures increased from 1757 to 2872 (64% increase) and the rate of blood cultures per 1000 patients from 287 to 481 (68% increase). The number of positive blood cultures decreased from 18.6% to 13.7% (p < 0.05). Typical skin pathogens were found in 34.4% and 26.4% of the cases, respectively (p < 0.05). CONCLUSION: The development, introduction and training of a BC-SOP in the ED can make a relevant contribution to the microbial diagnostics and increase the quantity as well as the quality.

Exercise testing and training in physically disabled men with clinical evidence of coronary artery disease.

A prospective, randomized, controlled clinical trial in patients with coronary artery disease (CAD) and a concurrent physical disability evaluated the effects of a home exercise training program on cardiovascular function and blood lipids. Eighty-eight men between the ages of 42 and 72 years (mean 62) with documented CAD and a physical disability with functional use of > or = 2 extremities including 1 arm were randomized to either a 6-month home exercise training program using wheelchair ergometry or to a control group that received usual and customary care. Both groups received dietary instructions and were requested to follow a fat-controlled diet. Exercise test variables with echocardiography and blood lipids were measured at baseline and at 6 months. The home exercise training group significantly improved both peak exercise left ventricular ejection fraction (p = 0.007) and fractional shortening (p = 0.01) between baseline to 6 months, whereas the control group showed no significant changes. Exercise training effects of decreased resting heart rate (p = 0.03) and decreased peak rate pressure product (p = 0.03) were also found in the treatment group. No exercise-related cardiac complications occurred. Both groups significantly (p < or = 0.01) increased high-density lipoprotein cholesterol levels. These results indicate that physically disabled men with CAD can safely participate in a home exercise training program which may result in intrinsic cardiac benefits. The metabolic cost of activities of daily living imposed on this disabled population may also have a positive effect on high-density lipoprotein cholesterol levels.

Adherence in the training levels comparison trial.

In the Training Levels Comparison Trial, 197 male coronary heart disease patients were randomized to low or high intensity training with target heart rates, which corresponded to 50% and 85% of the VO2max achieved on the previous exercise test, respectively. Patients were to exercise at their assigned intensity level at three 1-h long supervised sessions per week for 2 yr. This paper reports on two components of adherence: attendance at exercise sessions and achievement of heart rates in the target range. During the first year of training, the average percent of exercise sessions attended (mean +/- SE) for the low intensity group (64.0 +/- 2.5%) was significantly higher than for the high intensity group (55.5% +/- 2.7%). At the end of 1 yr of training, 54% and 37% of the low and high intensity patients, respectively, achieved heart rates within 5 beats.min-1 of their target heart rates. Although the low intensity program was preferable to achieve maximum attendance, attenders on the high intensity program achieved higher heart rates. These results suggest that to maximize the achieved heart rate, it would be optimal to motivate a cardiac rehabilitation patient to train at the high intensity level for a prolonged period of time.

High-dose intravenous acyclovir in the treatment of zoster: a double-blind, placebo-controlled trial.

In a randomised, double-blind, controlled trial, 40 patients with zoster of short duration (rash present for less than three days) were given either 10 mg/kg acyclovir (20) or placebo (20) intravenously three times daily for five days. Pain was reduced in the treatment group both in the acute phase and at follow-up, when compared with the placebo group, but this difference did not reach statistically significant levels. Healing of the lesions was also better, but not significantly so, in the acyclovir group. No complications of the disease were seen in the six cases of ophthalmic zoster given acyclovir whereas, of the four cases in the placebo group, two developed seventh cranial nerve palsies and one secondary glaucoma. No evidence of renal or other major toxicity was detected in the acyclovir group, although three patients developed mild thrombophlebitis. We conclude that acyclovir, given by the route and in the dose and frequency as used in this study, is free from major side effects, but is only of marginal benefit in the treatment of zoster.

Effects of precision of knowledge of results on performance of a gross motor coincidence-anticipation task.

The purpose of the investigation was to determine the effects from three knowledge of results (KR) precision levels (qualitative; 0.10 sec, 0.001 sec) on the performance of a gross motor coincidence-anticipation task where subjects performed with visual and other sense modality input. Other variables included in the analysis were sex, movement distance, and practice over three blocks of trials. Absolute error (AE), constant error (CE), variable error (VE), and E scores (E) of the subjects from two experiments (N = 90; N = 54) were analyzed with 3 x 2 x 2 x 3 ANOVAs with repeated measures on the last two factors (feedback, sex, movement distance, blocks). Consistent finding from both experiments indicated that, for this gross motor coincidence-anticipation task, the subjects performed as accurately and as consistently when they received qualitative KR as when, in addition, they received more precise KR. Subjects performed with less error on the short as opposed to the long term distance pattern. Males performed with less error on the long movement pattern than females in Experiment 1; however, the only sex difference noted in Experiment 2, when the movement distances were shortened, was that males had a more on-time CE mean score.

Training level comparison study. Effect of high and low intensity exercise on ventilatory threshold in men with coronary artery disease.

PURPOSE: To determine whether exercise at low intensity (LO; 50% of peak VO2) or high intensity (HI; 85% of peak VO2) results in improvement of the ventilatory threshold (VT), 186 men with coronary artery disease (CAD) were enrolled in an exercise study for 1 year. METHODS: A symptom-limited exercise test was performed at baseline and the heart rate corresponding to 50% and 85% of peak VO2 was determined. Subjects were randomized to LO or HI intensity exercise. Exercise sessions included 45 minutes of walking/jogging and/or stationary cycling at the appropriate target heart rate and were conducted 3 days per week. The exercise test was repeated at 3 and 6 months. Target heart rates were revised to adjust for training. RESULTS: Both LO and HI resulted in improved VO2 at VT and peak. However, HI resulted in greater improvement than LO. CONCLUSION: Among this population, both HI and LO improve the VO2 at VT and peak, but the improvement is greater with HI. The VT can be a useful adjunct to heart rate and peak oxygen uptake when prescribing exercise.

Design of the training levels comparison trial.

The Training Levels Comparison (TLC) trial was a grant-supported, multicenter, randomized, controlled clinical trial designed to determine whether cardiac rehabilitation patients would benefit from supervised exercise for a prolonged period (2 years) and whether subjecting patients to a more vigorous exercise program than currently recommended would provide additional cardiac benefit. If high-intensity exercise does not enhance the cardiac benefit, then physical activity should be limited to low-intensity levels that are safer, easier to implement and more adaptable to a greater number of patients. Patients were randomly assigned to either a low-intensity or high-intensity training program. All patients were to attend three 1-hour supervised exercise sessions per week for a period of 2 years. Attendance at exercise sessions and adherence to assigned treatments were monitored throughout the study. Patients were evaluated for outcome measures at 3, 6, 12, and 24 months. This paper reports the study design and methodology for the TLC trial, and should be useful in providing methodologies to facilitate comparison of data from other studies with different levels of exercise as an intervention.

Antibodies to pigeon antigens in pigeon breeders. Detection of antibodies by an enzyme-linked immunosorbent assay.

Antibodies to whole pigeon serum (PS) and pigeon dropping extract (PDE) were investigated in pigeon breeders and controls by an enzyme-linked immunosorbent assay (ELISA). The optimal antigen concentration was in the range of 3-30 microgram protein/ml for both PS and PDE. PDE antibody titres greater than or equal to 10240 were found in three (75%) of four patients with pigeon breeders' disease (PBD) and in 19 (13.6%) of 140 other pigeon breeders (P = 0.011). PS antibody titres greater than or equal to 10240 occurred in all four (100%) PBD patients and in only seven (5.0%) of 140 other breeders (P = 0.0002). In 85 blood donors antibodies in low titres against PS and PDE occurred in 4.7% and 7.1%, respectively. By immunodiffusion three or more precipitin lines were found more often in PBD patients than in other breeders (P = 0.0006), and the highest ELISA antibody titres occurred in patients with precipitating antibodies. No correlation between P blood group phenotypes or anti-P1 antibodies and respiratory symptoms or antibodies to pigeon antigens could be demonstrated.

Treatment of zoster with idoxuridine in dimethyl sulphoxide. Results of two double-blind controlled trials.

The antiviral effect of 5% idoxuridine in dimethyl sulphoxide intermittently applied and of 40% idoxuridine in dimethyl sulphoxide continuously applied for four days to the lesions in patients with zoster of recent onset was studied in two double-blind controlled trials. Most, but not all, of the patients receiving intermittent active treatment had pain for a short period only. The effect of continuous treatment was striking: pain had disappeared within nine days in all the patients and healing was accelerated. The results were statistically significant.

Do patients with cerebral malaria have cerebral oedema? A computed tomography study.

Computed tomography of the brain in 10 patients with severe cerebral malaria, 5 of whom died, showed evidence of cerebral oedema in only 2 fatal cases. Small areas of altered density were seen in 4 cases; these were not associated with focal neurological signs and were still visible in convalescent scans in 2 survivors. 4 patients, including 1 of the fatalities, had completely normal scans. Cerebral oedema may occur in severe cerebral malaria but is not a consistent feature of living patients and cannot, therefore, always be the cause of their coma.