Aktive Online-Nachsorge für Patienten mit Schizophrenie-Diagnose? Bedarf und Risiken aus Sicht der Behandler

Kognitive Interventionen haben sich bei der Behandlung von Schizophrenie als wirksam erwiesen und werden mittlerweile in nationalen Richtlinien empfohlen. Viele Patienten mit Schizophrenie-Diagnose haben jedoch keinen Zugang zu post-stationären, ambulanten Psychotherapie-Plätzen nach stationären Klinikaufenthalten. Eine Möglichkeit, Patienten den Zugang zu kognitiven Interventionen zu ermöglichen, sind Online-Nachsorge-Programme. Die vorliegende Befragung hatte zum Ziel, den Bedarf sowie mögliche Risiken und Nachteile von Online-Nachsorge für Schizophrenie aus Sicht der Behandler zu erfassen. Dreißig psychologische und ärztliche BehandlerInnen von Patienten mit Schizophrenie-Diagnose nahmen an einer Online-Befragung teil (Alter: M=34.5 Jahre, SD=9.8; 24 bis 60 Jahre; 63% weiblich; 70% PsychologInnen; 73% in Weiterbildung Psychotherapie, 20% approbiert). Die Stichprobe hatte im Mittel M=6.2 Jahre Berufserfahrung (SD=7.5) und war zum Großteil bei 26 bis 100 Behandlungen von Patienten mit Schizophrenie-Diagnose involviert. Im Mittel erhält die Hälfte der Patienten nach Einschätzung der Behandler keine post-stationäre psychotherapeutische Nachsorge mit nachgewiesen wirksamen und hilfreichen psychotherapeutischen Verfahren (M=50.2%, SD=38.2%). Die Behandler befürworteten die Online-Nachsorge bei Patienten, die keinen ambulanten Therapieplatz zur Verfügung haben, ohne weiteres (53.3%) oder zumindest nach wissenschaftlicher Überprüfung auf Unbedenklichkeit und Wirksamkeit (46.7%). Die nicht-repräsentative Online-Erhebung mit vor allem jungen, in Ausbildung befindlichen BehandlerInnen legt den Schluss nahe, dass Online-Nachsorge mit aktiven Interventionen für Patienten mit Schizophrenie-Diagnose aus Sicht der Behandler prinzipiell vertretbar und erwünscht ist. Mögliche Voraussetzungen (wie z.B. Medikation) für die Teilnahme an Online-Nachsorge-Programmen sowie mögliche Risiken aus Sicht von BehandlerInnen werden diskutiert.

Milk fatty acids as possible biomarkers to early diagnose elevated concentrations of blood plasma nonesterified fatty acids in dairy cows

Most cows encounter a state of negative energy balance during the periparturient period, which may lead to metabolic disorders and impaired fertility. The aim of this study was to assess the potential of milk fatty acids as diagnostic tools of detrimental levels of blood plasma nonesterified fatty acids (NEFA), defined as NEFA concentrations beyond 0.6 mmol/L, in a data set of 92 early lactating cows fed a glucogenic or lipogenic diet and subjected to 0-, 30-, or 60-d dry period before parturition. Milk was collected in wk 2, 3, 4, and 8 (n = 368) and blood was sampled weekly from wk 2 to 8 after parturition. Milk was analyzed for milk fatty acids and blood plasma for NEFA. Data were classified as "at risk of detrimental blood plasma NEFA" (NEFA ≥ 0.6 mmol/L) and "not at risk of detrimental blood plasma NEFA" (NEFA <0.6 mmol/L). Concentrations of 45 milk fatty acids and milk fat C18:1 cis-9-to-C15:0 ratio were subjected to a discriminant analysis. Milk fat C18:1 cis-9 revealed the most discriminating variable to identify detrimental blood plasma NEFA. A false positive rate of 10% allowed us to diagnose 46% of the detrimental blood plasma NEFA cases based on a milk fat C18:1 cis-9 concentration of at least 230 g/kg of milk fatty acids. Additionally, it was assessed whether the milk fat C18:1 cis-9 concentrations of wk 2 could be used as an early warning for detrimental blood plasma NEFA risk during the first 8 wk in lactation. Cows with at least 240 g/kg of C18:1 cis-9 in milk fat had about 50% chance to encounter blood plasma NEFA values of 0.6 mmol/L or more during the first 8 wk of lactation, with a false positive rate of 11.4%. Profit simulations were based on costs for cows suffering from detrimental blood plasma NEFA, and costs for preventive treatment based on daily dosing of propylene glycol for 3 wk. Given the relatively low incidence rate (8% of all observations), continuous monitoring of milk fatty acids during the first 8 wk of lactation to diagnose detrimental blood plasma NEFA does not seem cost effective. On the contrary, milk fat C18:1 cis-9 of the second lactation week could be an early warning of cows at risk of detrimental blood NEFA. In this case, selective treatment may be cost effective.

[Klinik und Diagnose von Hypogonadismus und Andropause]

Diagnosis and therapy of male hypogonadism is still a challenge because of the unspecific clinical signs and symptoms. The clinical presentation of a androgen deficiency is age-related. In the adult men, one can often observe fatigue, decrease in physical capacity, loss of libido and erectile dysfunction. At the physical examination, genitalia have always to be assessed in search of a testes/penis atrophy. Two fasting measurements of total testosterone concentrations by a reliable assay are needed to confirm the diagnosis. By assessing gonadotropines the origin of hypogonadism can be determined (central/secondary or peripheral/primary). Exogenous administration of androgens should be considered in young, sportive, healthy and muscular males. Patients with metabolic syndrome should only be screened for hypogonadism in the presence of suggestive symptoms. Prostate disease, hematocrit higher than 50 %, uncontrolled heart failure and severe obstructive sleep apnea are contraindications of a testosterone replacement therapy. Patients with metabolic-syndrome-associated low testosterone levels should firstly benefit from a lifestyle intervention that can normalize clinical and biochemical hypogonadism. So far, there is no clear evidence for a possible benefit of testosterone therapy in patients with the metabolic syndrome. Similarly, in patients with PADAM (partial androgen deficiency of the aging male) testosterone therapy is not established or recommended.

Marfan-Syndrom: Wissenswertes zu Diagnose und Therapie für die Praxis

• Das M arfan-Syndrom ist die häufigste h ereditäre Bindegewebskrankheit mit einer Häufigkeit (Prävalenz) von etwa 1:5000. • Die Ursache ist eine Mutation im FBN1-Gen. Die Vererbung erfolgt autosomal- dominant, bei etwa 30% der Fälle handelt es sich um de novo FBN1-Mutationen. • Die Hauptmanifestationen des Marfan-Syndroms sind: Aortendilatation, Mitralklappenprolaps, Augenveränderungen (Linsensubluxation) und Skelettveränderungen ( Skoliose, Thoraxasymmetrie, Platt- u nd/oder Senkfüsse, Arachnodaktylie). • Ziel einer frühzeitigen Diagnose ist die Verminderung des Risikos katastrophaler Aortendissektionen. Dies wird erreicht durch eine frühzeitige korrekte Diagnose sowie darauf basierend durch einen entsprechenden Lebensstil zur Vermeidung von hohen Blutdruckbelastungen, eine prophylaktische Behandlung mit Betablockern/Angiotensin-II-Antagonisten und den frühzeitigen prothetischen Ersatz dilatierter Aortenabschnitte.

Eine (nicht ganz) unerwartete Diagnose

Die Zuweisung eines 50-jährigen Patienten mit seronegativer Spondarthritis auf die pneumologische Abteilung erfolgte durch den be­han­delnden Rheumatologen bei linksseitigem Pleuraerguss und Konversion im interferon-gamma release assay (IGRA).

An analysis of IN.PACT DEEP randomized trial on the limitations of the societal guidelines-recommended hemodynamic parameters to diagnose critical limb ischemia.

OBJECTIVE Recent small single-center data indicate that the current hemodynamic parameters used to diagnose critical limb ischemia are insensitive. We investigated the validity of the societal guidelines-recommended hemodynamic parameters against core laboratory-adjudicated angiographic data from the multicenter IN.PACT DEEP (RandomIzed AmPhirion DEEP DEB vs StAndard PTA for the treatment of below the knee Critical limb ischemia) Trial. METHODS Of the 358 patients in the IN.PACT DEEP Trial to assess drug-eluting balloon vs standard balloon angioplasty for infrapopliteal disease, 237 had isolated infrapopliteal disease with an available ankle-brachial index (ABI), and only 40 of the latter had available toe pressure measurements. The associations between ABI, ankle pressure, and toe pressure with tibial runoff, Rutherford category, and plantar arch were examined according to the cutoff points recommended by the societal guidelines. Abnormal tibial runoff was defined as severely stenotic (≥70%) or occluded and scored as one-, two-, or three-vessel disease. A stenotic or occluded plantar arch was considered abnormal. RESULTS Only 14 of 237 patients (6%) had an ABI <0.4. Abnormal ankle pressure, defined as <50 mm Hg if Rutherford category 4 and <70 mm Hg if Rutherford category 5 or 6, was found only in 37 patients (16%). Abnormal toe pressure, defined as <30 mm Hg if Rutherford category 4 and <50 mm Hg if Rutherford category 5 or 6, was found in 24 of 40 patients (60%) with available measurements. Importantly, 29% of these 24 patients had an ABI within normal reference ranges. A univariate multinomial logistic regression found no association between the above hemodynamic parameters and the number of diseased infrapopliteal vessels. However, there was a significant paradoxic association where patients with Rutherford category 6 had higher ABI and ankle pressure than those with Rutherford category 5. Similarly, there was no association between ABI and pedal arch patency. CONCLUSIONS The current recommended hemodynamic parameters fail to identify a significant portion of patients with lower extremity ulcers and angiographically proven severe disease. Toe pressure has better sensitivity and should be considered in all patients with critical limb ischemia.

Is Microarray Analysis Really Useful and Sufficient to Diagnose Nut Allergy in the Mediterranean Area?

Background: Component-based diagnosis on multiplex platforms is widely used in food allergy but its clinical performance has not been evaluated in nut allergy. Objective: To assess the diagnostic performance of a commercial protein microarray in the determination of specific IgE (sIgE) in peanut, hazelnut, and walnut allergy. Methods: sIgE was measured in 36 peanut-allergic, 36 hazelnut-allergic, and 44 walnut-allergic patients by ISAC 112, and subsequently, sIgE against available components was determined by ImmunoCAP in patients with negative ISAC results. ImmunoCAP was also used to measure sIgE to Ara h 9, Cor a 8, and Jug r 3 in a subgroup of lipid transfer protein (LTP)-sensitized nut-allergic patients (positive skin prick test to LTP-enriched extract). sIgE levels by ImmunoCAP were compared with ISAC ranges. Results: Most peanut-, hazelnut-, and walnut-allergic patients were sensitized to the corresponding nut LTP (Ara h 9, 66.7%; Cor a 8, 80.5%; Jug r 3, 84% respectively). However, ISAC did not detect sIgE in 33.3% of peanut-allergic patients, 13.9% of hazelnut-allergic patients, or 13.6% of walnut-allergic patients. sIgE determination by ImmunoCAP detected sensitization to Ara h 9, Cor a 8, and Jug r 3 in, respectively, 61.5% of peanut-allergic patients, 60% of hazelnut-allergic patients, and 88.3% of walnut-allergic patients with negative ISAC results. In the subgroup of peach LTP?sensitized patients, Ara h 9 sIgE was detected in more cases by ImmunoCAP than by ISAC (94.4% vs 72.2%, P<.05). Similar rates of Cor a 8 and Jug r 3 sensitization were detected by both techniques. Conclusions: The diagnostic performance of ISAC was adequate for hazelnut and walnut allergy but not for peanut allergy. sIgE sensitivity against Ara h 9 in ISAC needs to be improved.

Is the performance of ImmunoCAP ISAC 112 sufficient to diagnose peach and apple allergies?

Food allergies constitute a public health issue, with a reported overall estimated prevalence of 6% in Europe1 and Rosacea as the main allergenic fruits among adults.2 The commercial microarray ImmunoCAP ISAC 112 (Thermofisher, Uppsala, Sweden) is a semiquantitative and reproducible in vitro diagnostic tool used for the determination of specific IgE (sIgE).3 However, its panel of allergens does not have the best accuracy when it comes to determining fruit allergies in the Mediterranean area: the inclusion of the thaumatinlike protein (TLP) Pru p 2 or the apple lipid transfer protein (LTP) Mal d 3 has been proposed to improve the diagnosis of peach4 and apple5 allergies, respectively, in the Mediterranean basin. We sought to determine the usefulness of a component-resolved microarray for the diagnosis of peach and apple allergies in the Mediterranean area.

Desenvolvimento de um método para diagnose de falhas na operação de navios transportadores de gás natural liquefeito através de redes bayesianas.

O Gás Natural Liquefeito (GNL) tem, aos poucos, se tornado uma importante opção para a diversificação da matriz energética brasileira. Os navios metaneiros são os responsáveis pelo transporte do GNL desde as plantas de liquefação até as de regaseificação. Dada a importância, bem como a periculosidade, das operações de transporte e de carga e descarga de navios metaneiros, torna-se necessário não só um bom plano de manutenção como também um sistema de detecção de falhas que podem ocorrer durante estes processos. Este trabalho apresenta um método de diagnose de falhas para a operação de carga e descarga de navios transportadores de GNL através da utilização de Redes Bayesianas em conjunto com técnicas de análise de confiabilidade, como a Análise de Modos e Efeitos de Falhas (FMEA) e a Análise de Árvores de Falhas (FTA). O método proposto indica, através da leitura de sensores presentes no sistema de carga e descarga, quais os componentes que mais provavelmente estão em falha. O método fornece uma abordagem bem estruturada para a construção das Redes Bayesianas utilizadas na diagnose de falhas do sistema.

Using percentiles to diagnose familial hypercholesterolemia in Portugal

Aims: Familial hypercholesterolemia (FH) is a genetic disorder of lipid metabolism, clinically characterised by high levels of low-density lipoprotein cholesterol (LDL-C) that leads to cholesterol accumulation in tendons and arteries, premature atherosclerosis and increased risk of premature coronary heart disease. In 1999, the Portuguese FH Study was established at the National Institute of Health to identify the genetic cause of hypercholesterolemia in individuals with a clinical diagnosis of FH and to perform an epidemiologic study to determine the prevalence and distribution of FH in Portugal. In the last 16 years, a genetic defect was identified in 749 patients, representing 3. 7 % of the cases estimated to exist in Portugal. Index patients were included in this study using the Simon Broome (SB) criteria. However, there are different FH clinical criteria to diagnose index cases. Since there are no clinical criteria to identify relatives with FH, the aim of this work was to investigate if a diagnostic tool based on population specific 95 th percentile improves the clinical identification of Portuguese FH patients comparing with SB criteria.

Selective survey of the capability of representative automobile repair facilities to diagnose and repair automobiles. Final report.

Transportation Department, Office of the Secretary of Transportation, Washington, D.C.